Jessica Galin - · PDF file03.05.2016 · Weight Gain During Pregnancy and Violent...
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Transcript of Jessica Galin - · PDF file03.05.2016 · Weight Gain During Pregnancy and Violent...
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