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health are really only realizable through the design, implementation, and rigorous evaluation of randomized clinical trials where a “community-level” treatment is delivered to a randomly selected set of communities. As examples, Oakes suggests community interventions that alter norms with mass media public health messages, change local policies, add green space or clean existing parks, repair sidewalks, or institute community policing strategies. However, Oakes cautions that these types of interventions are very expensive, are hard to evaluate given the long latency between exposure and disease and, most significantly, are hard to design given our limitations in theories linking neighborhoods to health. Given the complex relationships between health and social conditions, this type of methodology might be very productively applied in the field of perinatal epidemiology.

Interaction Between Neighborhood- and Individual-Level Characteristics

Neighborhood-level characteristics may indirectly exert their influence on reproductive outcomes by patterning individual-level economic opportunities and health behaviors. For example, the neighborhood-level opportunity structure may restrict or facilitate access to schooling, training programs, and employment opportunities and thus influence reproductive outcomes through the socioeconomic condition that a woman has attained (Anderson et al., 1996; Konte et al., 1988). Thus, disparities in birth outcomes according to a woman’s socioeconomic condition may originate in part from the neighborhood context that shape an individual’s life chances.

Furthermore, the social characteristics of neighborhoods, perhaps through shared cultural norms and values, may well influence health behaviors that are linked to reproductive outcomes. For example, individual-level smoking patterns (Cubbin et al., 2000; Diez-Roux et al., 1997), alcohol consumption, and dietary practices (Macintyre et al., 2002; Shepard, 1994; Taylor and Repetti, 1997; Yen and Kaplan, 1999; Yen and Syme, 1999), which seem particularly relevant to this discussion, have been significantly associated with area-level deprivation when individual attributes are controlled for. In addition to health behaviors, adverse conditions such as high crime rates, housing abandonment, and even noise pollution may act as either acute or chronic stressors that exert their influences through stress physiology and are thus potential intervening mechanisms between neighborhood context and reproductive health. Geronimus (1996), for example, has argued that long-term exposure to socioeconomic disadvantage, including residence in socioeconomically disadvantaged neighborhoods, is detrimental to maternal reproductive health and is one of the factors that contributes to more adverse birth outcomes among African American women (O’Campo et al., 1997).

Finally, neighborhood context and individual-level characteristics may



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