# Presentation: 314939

## 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 

- 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 1980-2000

- Source: National Vital Statistics, Natality Data, 1980-2000.  Unpublished data from the National Center for Health Statistics

## Trends in Preterm Births:  Deliveries among Blacks and Whites 1980-2000

- Source: National Vital Statistics, Natality Data, 1980-2000.  Unpublished data from the National Center for Health Statistics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 #1**_				*May 16*
- general concepts underlying contextual analysis
_**Webcast #2**_				*June 6*
- multilevel analysis technique and interpretation using hypothetical data
_**Webcast #3**_				*July 11*
- real-world preterm birth examples of the analyses from the researchers sites and the resources to implement this type of analysis