Sealy-Jefferson Shawnita, Slaughter-Acey Jaime, Caldwell Cleopatra H, Kwarteng Jamila, Misra Dawn P
Virginia Commonwealth University, Department of Family Medicine and Population Health, Division of Epidemiology.
Drexel University, College of Nursing and Health Professions.
SSM Popul Health. 2016 Dec;2:656-661. doi: 10.1016/j.ssmph.2016.09.001.
Evidence suggests that neighborhood disadvantage predicts preterm delivery (PTD). However, the design of most existing studies precludes within-group analyses, which would allow the identification segments of the population at highest risk, as well as preventive factors. African Americans (AA) are disproportionately affected by PTD, are disproportionately concentrated in disadvantaged neighborhoods, and frequently use religious coping in response to chronic stressors. Our objective was to examine the association between neighborhood disadvantage and PTD, and whether religious coping moderated the associations, among postpartum AA women. Addresses from participants of the Life Influences on Fetal Environments Study (n=1387) were geocoded and linked to data from the American Community Survey. An index of neighborhood disadvantage was derived from a principal components analysis of the following variables: % below poverty, % unemployed, % receiving public assistance income, % college educated, % AA, % female-headed households, % owner occupied homes, median income, and median home value. Three domains of religious coping were assessed: organizational (church attendance), non-organizational (praying for self and asking others for prayer), and personal or subjective (experiences, perceptions, and sentiments about religion), and all were dichotomized as frequent/infrequent or satisfied/not satisfied. Preterm delivery was defined as birth before 37 completed weeks of gestation. Prevalence ratios and 95% confidence intervals were estimated with log binomial regression models. Neighborhood disadvantage did not predict PTD rates in the overall sample. However, there was evidence of moderation by asking others for prayer ( for asking for prayer X disadvantage index interaction term: 0.01). Among women who infrequently asked others for prayer, neighborhood disadvantage was positively associated with PTD rates (adjusted Prevalence ratio: 1.28, 95% Confidence Interval: 1.01, 1.63), and a null association was found for those who frequently asked others for prayer. No evidence of moderation by the other religious coping variables was present. Non-organizational religious coping may buffer against the adverse effects of neighborhood disadvantage on PTD rates, among urban AA women. Future research should examine the mechanisms of the reported relationships.
有证据表明，社区劣势可预测早产（PTD）。然而，大多数现有研究的设计排除了组内分析，而组内分析能够识别出风险最高的人群细分以及预防因素。非裔美国人（AA）受早产的影响尤为严重，在弱势社区中的集中程度也过高，并且经常采用宗教应对方式来应对慢性压力源。我们的目标是研究产后非裔美国女性中社区劣势与早产之间的关联，以及宗教应对方式是否会调节这种关联。对“生活对胎儿环境的影响研究”（n = 1387）参与者的住址进行了地理编码，并与美国社区调查的数据相链接。社区劣势指数源自对以下变量的主成分分析：贫困率、失业率、接受公共援助收入的比例、受过大学教育的比例、非裔美国人的比例、女性户主家庭的比例、自有住房的比例、收入中位数和房屋价值中位数。评估了宗教应对的三个领域：组织性（参加教堂活动）、非组织性（为自己祈祷并请求他人祈祷）和个人或主观（对宗教的体验、认知和情感），所有这些都被二分法分为频繁/不频繁或满意/不满意。早产定义为妊娠满37周前分娩。采用对数二项回归模型估计患病率比值和95%置信区间。在总体样本中，社区劣势并不能预测早产率。然而，有证据表明请求他人祈祷具有调节作用（请求祈祷×劣势指数交互项：0.01）。在不经常请求他人祈祷的女性中，社区劣势与早产率呈正相关（调整后的患病率比值：1.28，95%置信区间：1.01，1.63），而在经常请求他人祈祷的女性中则未发现关联。没有证据表明其他宗教应对变量具有调节作用。在城市非裔美国女性中，非组织性宗教应对可能会缓冲社区劣势对早产率的不利影响。未来的研究应探讨所报告关系的机制。
