Overview and Context for Contextual Analysis Webcasts Mary Kay Kenney, Ph.D. Health Resources and Services Administration Maternal and Child Health Bureau Office of Data and Program Development

U.S. Ranking Among the World’s Richest Countries Source: Innocenti Report Card 7, UNICEF, 2007

Trends in Preterm Birth: Deliveries to U.S. Resident Mothers Source: National Vital Statistics, Natality Data, Unpublished data from the National Center for Health Statistics

Trends in Preterm Births: Deliveries among Blacks and Whites Source: National Vital Statistics, Natality Data, Unpublished data from the National Center for Health Statistics

Individual Level Risk Factors for Preterm Birth Infection –Genital tract infection –Intrauterine infection –Any systemic maternal infection Substance misuse Age, parity, and past reproductive history Multiple pregnancies Body mass index Smoking Depression

Taking a Look at the Broader Context “Causal Factors in Infant Mortality” Woodbury, 1925 KEY FINDINGS * Paternal Earnings * Housing Congestion (Yankauer, 1994)

Social Context and Health 1950:“The Relationship of Fetal and Infant Mortality to Residential Segregation: an Inquiry into Social Epidemiology” (Alfred Yankauer) 1969: Social epidemiology defined as the study of the role of social factors in the etiology of disease. ( Lee G. Reeder addressing the American Sociological Association) 1970s: Interest in spatial location, social position and health waned and the “status attainment” model came into favor 1987: “The Truly Disadvantaged”, William Julius Wilson 1990s: Re-emergence of interest in “neighborhood” effects on health

Ghetto Miasma: Enough To Make You Sick - Helen Epstein, New York Times, October 12, 2003 “Living in such neighborhoods as southwest Yonkers, central and East Harlem, central Brooklyn and the South Bronx is assumed to predispose the poor to a number of social ills, including drug abuse, truancy and the persistent joblessness that draws young people into a long cycle of crime and incarceration. Now it turns out these neighborhoods could be destroying people's health as well.”

How to Study Neighborhood Factors Improved statistical modeling techniques e.g., multi-level modeling Account for Hierarchical Structure: –Group level factors (neighborhoods) –Individual level factors (people)

Multi-site Research Team Drexel University College of Medicine and University of Pennsylvania –Jennifer Culhane, Ph.D. –Irma Elo, Ph.D. –Iliana Kohler, Ph.D. University of North Carolina –Barbara Laraia, Ph.D. –Jay Kaufmann, Ph.D. –Lynne Messer, Ph.D. Michigan State University –Claudia Holzman, Ph.D. –Janet Eyster, PhD. –Veronika Skorokhod, M.S. –Mary Kleyn, B.A. St Michael’s Hospital and University of Pittsburgh –Pat O,Campo, Ph.D. –Jessica Burke, Ph.D.

Webcast Series on Contextual Analysis Webcast #1May 16 –general concepts underlying contextual analysis Webcast #2June 6 –multilevel analysis technique and interpretation using hypothetical data Webcast #3July 11 –real-world preterm birth examples of the analyses from the researchers sites and the resources to implement this type of analysis