els and across the life course to produce disparities in the rates of preterm birth. A more integrative approach to understanding racial-ethnic and socioeconomic disparities in the rates of preterm birth is needed (Lu and Halfon, 2003; Misra et al., 2003). Future research on disparities should aim for longitudinal integration linking a woman’s life history to her vulnerability for preterm delivery, as well as contextual integration linking individual biology and behaviors to the multilevel, multiple determinants of preterm birth.
Although some individual-level risk factors hold modest associations with a risk of preterm birth, individual-level characteristics do not adequately explain the high rate of preterm birth in the United States or the racial-ethnic differences in the rates of preterm birth. The notion that community-level conditions can produce profound effects on disease susceptibility is long-standing (Cassel, 1976). The questions, however, of whether community-level adversity has a deleterious impact on fetal outcomes, independent of individual-level risk factors, and whether the predictive power of these individual-level factors depends on community-level conditions have only recently been subjected to empirical testing. Numerous reports now show, however, that after adjustment for individual-level attributes, neighborhood conditions are in fact independently and significantly associated with a risk of delivering an infant with a low birth weight. Thus, because exposures to adverse neighborhood conditions are much more common for African American women than for their white counterparts, entire groups of women experience distress. There is also a need to examine the relationship between gestational age and adverse neighborhood conditions.
Exploring the social contribution to this important health outcome may contribute to an understanding of the racial-ethnic differential and provide new avenues for remedial strategies to decreasing the rates of preterm birth that move past the narrow biomedical approach. In addition, it is important to give equal consideration to the concept that social conditions are in fact fundamental causes of diseases and syndromes like preterm birth (Link and Phelen, 1995).
Finding 4-2: Independent of the individual-level attributes that are risk factors for preterm birth, adverse neighborhood conditions such as poverty and crime are risk factors for preterm birth. These data suggest that intervention strategies may need to expand from focusing exclusively on the individual to including the contributions of social structural factors to the risk of preterm birth.