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Weight Gain During Pregnancy and Violent Neighborhoods

Jessica Galin PHN Capstone Presentation

May 3, 2016

Neighborhood Violence

Inadequate or Excessive

Gestational Weight Gain

Poor Birth Outcomes

Pregnancy Complications

?

Background

• Hypothesis 1. Neighborhood violence will be associated with both inadequate and excessive gestational weight gain

• Hypothesis 2. The strength of the associations will differ

by race/ethnicity

• Hypothesis 3. The strength of the associations will differ by pre-pregnancy weight

What is the association between living in violent neighborhoods and GWG?

Methods • Comprehensive look at GWG in the state of California

• 2.5 million pregnancies (2007-2012)

• Exposure: Neighborhood Rates of Interpersonal Violence

• Outcomes: Inadequate GWG, Excessive GWG

• Multi-level Logistic Regressions Models • Marginal Additive Effects • Sensitivity Analyses

• Multinomial Logistic Regressions • GWG z-scores, IOM categories

Methods

Key Results

0.90

0.95

1.00

1.05

1.10

1.15

1.20

Low Violence Low-Medium Violence Medium-High Violence High Violence

Adjusted Odds Ratios for Associations Between Neighborhood Violence Exposure and Inadequate or Excessive Gestational Weight Gain

Inadequate GWG Excessive GWG

1.18

-1.0%

-0.5%

0.0%

0.5%

1.0%

Low Violence Low-Medium Violence Medium-High Violence High Violence

Additive Scale for Associations Between Neighborhood Violence Exposure and Inadequate or Excessive Gestational Weight Gain

Inadequate GWG Excessive GWG

-2.0%

-1.5%

-1.0%

-0.5%

0.0%

0.5%

1.0%

Low Violence Low-Medium Violence Medium-High Violence High Violence

Additive Scale Associations Between Neighborhood Violence Exposure and Inadequate or Excessive Gestational Weight Gain Among

non-Hispanic (NH) Asian/Pacific Islander (API) Women

Inadequate (API) Excessive (API)

1.7%

0.6%

0.00%

0.25%

0.50%

0.75%

1.00%

Low Violence Low-Medium Violence Medium-High Violence High Violence

Additive Scale Associations Between Neighborhood Violence Exposure and Inadequate or Excessive Gestational Weight Gain Among NH White (W)

Women

Inadequate (W) Excessive (W)

Summary of Findings

• Association with excessive GWG but not inadequate GWG overall

• Some subgroups show shift in weight gain

• NH-White women: increase in inadequate and excessive GWG

Discussion

Neighborhood Socio-economic Disadvantage (NSED)

• Mendez et al, 2014 • NSED inadequate GWG • NSED excessive GWG

• Current Project:

• Included zip-code level percent poverty

• Poverty as driver for inadequate GWG • Neighborhood violence accounting weight gain

Conclusions

Living in violent neighborhoods is associated with INCREASED gestational weight gain for pregnant women, particularly for some race and pre-pregnancy BMI subgroups.

Neighborhood violence is a public health issue, not just a social justice issue.

Thank you!

And a special thank you to… • Dr. Jen Ahern • Dr. Barbara Abrams • Ellie Colson • Stephanie Leonard • Dr. Lia Fernald • Maggie Rasnake • PHN 2016 Cohort