birth. Against this backdrop, some researchers have redirected attention to consideration of the social determinants of reproductive health, calling for new approaches that go far beyond traditional medical risk assessment models and individual-level poverty-driven paradigms to include contextualized research (Holzman et al., 1998; Krieger et al., 1993; Link and Phelan, 1995; Rowley et al., 1993; Susser and Susser, 1996).
The notion that adverse neighborhood conditions influence health outcomes through direct and indirect pathways has recently received increased attention (Robert, 1999). Evidence supporting the contributing role of neighborhood conditions is presented in this section. An important note is that the studies conducted thus far use birth weight as an outcome. A major need in future work is to examine gestational age as well. Neighborhood context may be a fruitful and salient avenue of exploration for explaining differences in preterm birth rates between African American and white women because of clear patterns of residential segregation that result in unequal exposures to adverse neighborhood conditions across racial-ethnic groups. Concentrated poverty and associated neighborhood disadvantages (including a lack of goods and services, health care facilities, and recreational opportunities; poor housing quality; and high crime rates) are more common features of African American neighborhoods than of white neighborhoods (Massey and Denton, 1993; Wilson, 1987). Residents of disadvantaged areas, in turn, not only are at a greater risk of physical injury but also are exposed to higher levels of everyday life stressors.
The social environment, service environment, and physical characteristics of a neighborhood have been hypothesized to affect the health of its residents (Konte et al., 1988). Social environment refers to the level of neighborhood cohesion or disorganization, norms of reciprocity, civic participation, crime, socioeconomic compositions, residential stability, and related attributes. These characteristics are thought to influence health outcomes through pathways such as the availability of social support, the adaptation of coping strategies, and exposure to chronic stress (Casey et al., 1988; Challis, 1994; Geronimus, 1996; Olson et al., 1995; Petraglia et al., 1996; Romero et al., 1994).
The service environment reflects the availability of goods and services, such as access to quality health care, grocery stores, recreational facilities, and police and fire protection. The availability of such services is likely to be affected by the degree of political organization influencing residents’ ability to demand public services and recruit private service providers to their neighborhoods. Poor public and private services may have direct and indirect impacts on an individual’s health by making residents more suscep-