tible to intentional and unintentional injuries; by limiting access to quality health care, healthy foods, and recreational opportunities; and by increasing crime rates (Holzman et al., 1998; James, 1993; Kleinman and Kessel, 1987; Konte et al., 1988; Mercer et al., 1996). One study of the distribution of food stores found significantly fewer (three to four times) supermarkets in poor and African American communities than in more affluent white communities (Kramer, 1987a).
Finally, the quality of the physical environment and the quality of the housing stock and public space could also have direct effects on health (Main et al., 1987; Olson et al., 1995). Factors that affect the quality of the physical environment include toxicants, noise, and air pollution to which a pregnant woman may be exposed
The concentration of adverse neighborhood conditions along all three dimensions discussed above is often closely tied to the clustering of socioeconomic disadvantage. A number of studies have documented a significant association between neighborhood-level socioeconomic disadvantage and birth outcomes (Cramer, 1995; Kaufman et al., 1997; Krieger et al., 1993). Collins and David (1990) documented variations in the rates of low birth weight in Chicago, Illinois, in 1982 and 1983 among neighborhoods classified by the census-tract median family income. Their results show that in univariate comparisons, the risks of low birth weight for the infants of high-risk African American and white women (whose risk was assessed by measurement of age, level of educational attainment, and marital status) were more similar in poor neighborhoods than in more affluent areas. Lowrisk white women had much lower rates of low birth weight than low-risk African American women, no matter where they lived. In a related study of an association between violent crime and low birth weight in Chicago’s low-income neighborhoods, defined as census tracts with a median family income of less than $10,000, the same authors found a significant association between the risk of intrauterine growth retardation and the level of violent crime (Collins and David, 1997).
Using 1990 birth record data for Chicago linked to 1990 census data on community-level measures of socioeconomic condition, residential stability, the racial compositions of neighborhoods, and selected housing characteristics, Roberts (1997) modeled the incidence of low birth weight by including individual-level and community-level characteristics in a multivariate logistic regression analysis. The findings indicated that women living in economically disadvantaged communities were more likely to have a low birth weight baby than women living in better off neighborhoods, when individual characteristics available on the birth certificate were controlled for. Several counterintuitive findings were also noted. For example, the percentage of community residents who were African American was inversely associated with low birth weight, as was the rate of crowded housing units,