Neighborhood-level variability in asthma-related emergency department visits in Central Texas.

BACKGROUND: The extent to which incidence rates of asthma-related emergency department (ED) visits vary from neighborhood to neighborhood and predictors of neighborhood-level asthma ED visit burden are not well understood. OBJECTIVE: We aimed to describe the census tract-level spatial distribution of asthma-related ED visits in Central Texas and identify neighborhood-level characteristics that explain variability in neighborhood-level asthma ED visit rates. METHODS: Conditional autoregressive models were used to examine the spatial distribution of asthma-related ED visit incidence rates across census tracts in Travis County, Texas, and assess the contribution of census tract characteristics to their distribution. RESULTS: There were distinct patterns in ED visit incidence rates at the census tract scale. These patterns were largely unexplained by socioeconomic or selected built environment neighborhood characteristics. However, racial and ethnic composition explained 33% of the variability of ED visit incidence rates across census tracts. The census tract predictors of ED visit incidence rates differed by racial and ethnic group. CONCLUSIONS: Variability in asthma ED visit incidence rates are apparent at smaller spatial scales. Most of the variability in census tract-level asthma ED visit rates in Central Texas is not explained by racial and ethnic composition or other neighborhood characteristics.

Racial and ethnic disparities in cervical and breast cancer screenings by nativity and length of U.S. residence.

OBJECTIVE: Previous studies of disparities in breast and cervical cancer screenings have focused on broad racial/ethnic groups or nativity status without accounting for immigration histories. Recent theoretical work argues for using intersectional approaches and examining within-group inequalities. Utilizing multiple years of National Health Interview Survey (NHIS) data, we examined between- and within-group Papanicolaou (Pap) test and mammogram screening based on nativity and length of U.S. residence for Asian and Hispanic women, along with non-Hispanic Black and White women. DESIGN: The study samples consist of 54,900 women ages 21-64 without a hysterectomy who responded to questions about Pap test screening and 36,300 women ages 40-64 who responded to questions about mammogram screening. Asian and Hispanic women were further stratified by nativity and, for immigrants, length of time in the United States. Logistic regression analysis was used to identify significant associations with Pap test and mammogram screenings. RESULTS: Recent Asian and Hispanic immigrants had the lowest Pap test and mammogram rates among all other groups, while Black (and White women for mammograms) women had the highest rates. After accounting for age, marital status, health insurance, education, employment status, and income, both Asian groups had lower odds, and Black and all Hispanic groups had higher odds of Pap test screening compared with White women. Similar results were observed for mammogram screening, except that long-term immigrant/U.S.-born Asian and U.S.-born Hispanic women did not have significantly different odds compared with White women. In general, the strength and direction of most sociodemographic variables were similar across groups for Pap test screening but differed for mammogram screening. CONCLUSIONS: The between-group differences identified emphasize the disparities in screening between racial/ethnic groups while the within-group differences suggest the need to examine whether more targeted outreach efforts and prevention messages can increase screening for specific groups.

An Intersectional Approach to Understanding Barriers to Healthcare for Women.

Access to health care depends on multiple sociodemographic factors such as race/ethnicity, marital status, education, income, and insurance status. However, a paucity of research has examined access to healthcare disparities as they uniquely affect women, specifically women of color. National data were analyzed from the Medical Expenditure Panel Survey (MEPS) utilizing an 11-year sample (2005-2015) of women ages 18-74 (N = 128,355). More recent data were not included due to changes in how sampling was conducted after 2015. Predictor variables included race/ethnicity cross-classified with marital status, education, income, or insurance status, controlling for age. A dichotomous outcome variable called "any barriers to healthcare" was created based on usual source of care, delayed medical care, delayed dental care and delayed prescription care. Multivariate logistic regression models were used to identify associations with barriers to care. The foundation of this methodology is intersectionality and how it impacts access to care for women across social identities. Hispanic women (OR 1.08, 95% CI 1.02-1.14) had higher odds of having a barrier to care compared to White women. However, Black women (OR 0.92, 95% CI 0.87-0.97) had lower odds of having a barrier to care compared to White women. Race/ethnicity also significantly moderated the relationship between socioeconomic variables (marital status, income, education and insurance status) and having a barrier to care. To achieve a healthy community, addressing these racial/ethnic and socioeconomic inequalities helps to support the people who live and work within these communities.

Impact of Geography and Rurality on Preconception Health Status in the United States.

Introduction: Maternal illness and death are largely preventable; however, the field of preconception health needs further study. Geographic region and rurality play a large role in maternal health, and an understanding of the effect of these 2 factors at the individual level could prevent future adverse maternal health outcomes. Methods: We developed an abbreviated index of preconception health risk (diabetes, hypertension, body weight, mental health, unintended pregnancy, HIV, alcohol and nicotine use, nutrition, physical activity, receipt of the influenza vaccine) by using data from the 2019 Behavioral Risk Factor Surveillance System (BRFSS). A score of 1 was assigned for each behavior factor classified as unhealthy and a score of 0 for each factor classified as healthy, for a total potential score of 11. Respondent women from the 37 states that included the BRFSS family planning supplemental module who were aged 18 to 44 years who could become pregnant (N = 25,999) were included. We used univariate and multivariate regression models to assess the relationship between sociodemographic factors (age, race or ethnicity, relationship status, insurance status, education, income, and rurality and region) and preconception health, with a primary focus on rurality and region. Results: The average preconception health risk index score among participants was 3.5, with higher average scores in rural areas than in urban areas. All factors were independently associated with preconception health. Compared with women living in the urban Northeast, women living in all rural and region groups, except the rural West, had increased preconception health risk. Conclusion: Preconception health scores from our study showed that, on average, a person had more than 3 risk factors or behaviors. Given the current state of reproductive health policy in the United States, increased efforts are needed to address preconception health.

Nativity moderates the relationship between nationality and healthcare access for some Latinx women in the United States.

OBJECTIVES: Gender has been identified as a social determinant of health, particularly as it relates to healthcare access for women of color. Yet, few analyses focus on the unique barriers that impact Latinx women's access to healthcare, which demonstrates a significant gap in the literature given the heterogeneity of the Latinx population. The purpose of this study is to (1) describe how sociodemographic characteristics impact access to healthcare for Latinx women and (2) examine whether intersecting factors, particularly nativity and nationality, influence barriers to healthcare for Latinx women in the United States (US). DESIGN: An outcome variable called 'any barriers to care' was created based on four healthcare access variables: lacking a usual source of care and delayed care (medical, dental and prescription). Data were from the Medical Expenditure Panel Survey (2005-2015). The sample included Latinx women between ages 18 and 74 (N = 27,162), cross-classified by nationality and nativity. Control variables included language, age, marital status, education, income, and insurance status. Multivariate logistic regression models were used to assess nativity and nationality as a predictor of any barriers to care. RESULTS: 37% of the sample experienced at least one barrier to care. Initially, nativity status was not a predictor of having a barrier to care. However, in adjusted models with cross-classified nativity and nationality variables, Mexican (US- and foreign-born), Cuban (US- and foreign-born) and Central/South American women (foreign-born only) had higher odds of having any barriers to care compared to continental US-born Puerto Rican women. CONCLUSIONS: Latinx women experience barriers to healthcare, yet the prevalence rates vary widely depending on nationality and nativity. It is important to recognize the heterogeneity that exists within the Latinx community and address the underlying causes for limited healthcare access such as immigration policy.

County-Level Poverty and Barriers to Breast and Cervical Cancer Screening in a Health Education and Patient Navigation Program for Rural and Border Texas Residents.

The study examined the impact of (1) county-level poverty rates and (2) patient navigation on breast and cervical cancer screening outcomes for women in rural and border counties in Texas reporting barriers to screening.Univariate analyses described the distribution and screening prevalence rates in the sample, while a series of random intercept logistic regression models analyzed mammogram (N = 2326 women aged 40+) and Papanicolaou (Pap; N = 2959 women aged 21-64) screening separately.Mammogram and Pap screening prevalence rates were highest among women who were aged 40-64, Spanish-speaking Latinas, lower educated, attending cancer education events because of the cost of the screenings, patient navigation recipients, living in the south region of Texas, and in counties with high poverty. Although models indicated significant variability in screening rates by county, county-level poverty was only significantly associated with odds of getting Pap screening in adjusted models. Not receiving patient navigation vs. receiving it was associated with lower odds for both mammogram (OR: 0.51, CI: 0.38-0.70) and Pap (OR: 0.69, CI: 0.50-0.94) screenings.County-level variation in screening rates exists for both mammogram and Pap tests and should be considered in the development and implementation of screening interventions in rural and border areas. However, other factors beyond poverty levels may explain the variation.

An Evaluation of Breast and Cervical Cancer Screening Outcomes in an Education and Patient Navigation Program in Rural and Border Texas.

This study examines breast and cervical cancer screening uptake in a cancer education and patient navigation (PN) program for residents of rural and border counties in Texas by level of participation (education only, PN only, or education and PN). Data collected from March 1, 2012, to November 5, 2016, included 6663 follow-up surveys from participants aged 21-74. Logistic regression models assessed program participation on the odds of completing breast or cervical cancer screening. For women aged 40-74 years (N = 4942; mean age = 52 years), 58.4% reported a mammogram within 6 months on average from initial contact. In the breast cancer screening model, women who only received PN (OR: 6.06, CI: 4.87-7.53) or who participated in both the education plus PN program (OR: 3.33, CI: 2.77-4.02) had higher odds of mammogram screening compared to women who only received education. For women aged 21-64 years (N = 6169; mean age = 46 years), 37.7% received a Papanicolaou (Pap) test within 6 months on average from initial contact. In the Pap screening model, both education and PN (OR: 3.23, CI: 2.66-3.91) and PN only (OR: 2.35, CI: 1.88-2.93) groups had higher odds of screening for cervical cancer compared to those only receiving education. Graphed predicted probabilities examined significant interactions between race/ethnicity/language and program participation (P < 0.0001) for both screenings. PN, solely or in combination with education, is an effective strategy to increase screening for breast and cervical cancer, beyond educational outreach efforts alone, among un-/underserved, racially/ethnically diverse women in rural and border Texas counties.

Neighborhood Racial/Ethnic Composition Trajectories and Black-White Differences in Preterm Birth among Women in Texas.

The black-white disparity in preterm birth has been well documented in the USA. The racial/ethnic composition of a neighborhood, as a marker of segregation, has been considered as an underlying cause of the racial difference in preterm birth. However, past literature using cross-sectional measures of neighborhood racial/ethnic composition has shown mixed results. Neighborhoods with static racial/ethnic compositions over time may have different social, political, economic, and service environments compared to neighborhoods undergoing changing racial/ethnic compositions, which may affect maternal health. We extend the past work by examining the contribution of neighborhood racial/ethnic composition trajectories over 20 years to the black-white difference in preterm birth. We used natality files (N = 477,652) from birth certificates for all live singleton births to non-Hispanic black and non-Hispanic white women in Texas from 2009 to 2011 linked to the Neighborhood Change Database. We measured neighborhood racial/ethnic trajectories over 20 years. Hierarchical generalized linear models examined relationships between neighborhood racial/ethnic trajectories and preterm birth, overall and by mother's race. Findings showed that overall, living in neighborhoods with a steady high proportion non-Hispanic black was associated with higher odds of preterm birth, compared with neighborhoods with a steady low proportion non-Hispanic black. Furthermore, while black women's odds of preterm birth was relatively unaffected by neighborhood proportions of the Latinx or non-Hispanic white population, white women had the highest odds of preterm birth in neighborhoods characterized by a steady high proportion Latinx or a steady low proportion non-Hispanic white. Black-white differences were the highest in neighborhoods characterized by a steady high proportion white. Findings suggest that white women are most protected from preterm birth when living in neighborhoods with a steady high concentration of whites or in neighborhoods with a steady low concentration of Latinxs, whereas black women experience high rates of preterm birth regardless of proportion white or Latinx.

Downward Neighborhood Poverty Mobility during Childhood Is Associated with Child Asthma: Evidence from the Geographic Research on Wellbeing (GROW) Survey.

Causal evidence regarding neighborhood effects on health remains tenuous. Given that children have little agency in deciding where they live and spend proportionally more of their lives in neighborhoods than adults, their exposure to neighborhood conditions could make their health particularly sensitive to neighborhood effects. In this paper, we examine the relationship between exposure to poor neighborhoods from birth to ages 4-10 and childhood asthma. We used data from the 2003-2007 California Maternal Infant and Health Assessment (MIHA) and the 2012-2013 Geographic Research on Wellbeing (GROW) survey (N = 2619 mother/child dyads) to fit relative risks of asthma for children who experience different types of neighborhood poverty mobility using Poisson regression controlling for individual-level demographic and socioeconomic characteristics, and neighborhood satisfaction. Our results demonstrate that [1] living in a poor neighborhood at baseline and follow-up and [2] moving into a poor neighborhood were each associated with higher risk of asthma, compared with children not living in a poor neighborhood at either time. Exposure to impoverished neighborhoods and downward neighborhood poverty mobility matters for children's health, particularly for asthma. Public health practitioners and policymakers need to address downward neighborhood economic mobility, in addition to downward family economic mobility, in order to improve children's health.

Psychometrics: Trust, but Verify.

There is a continued mandate for practicing evidence-based medicine and the prerequisite rigorous analysis of the comparative effectiveness of alternative treatments. There is also an increasing emphasis on delivering value-based health care. Both these high priorities and their related endeavors require correct information about the outcomes of care. Accurately measuring and confirming health care outcomes are thus likely now of even greater importance. The present basic statistical tutorial focuses on the germane topic of psychometrics. In its narrower sense, psychometrics is the science of evaluating the attributes of such psychological tests. However, in its broader sense, psychometrics is concerned with the objective measurement of the skills, knowledge, and abilities, as well as the subjective measurement of the interests, values, and attitudes of individuals-both patients and their clinicians. While psychometrics is principally the domain and content expertise of psychiatry, psychology, and social work, it is also very pertinent to patient care, education, and research in anesthesiology, perioperative medicine, critical care, and pain medicine. A key step in selecting an existing or creating a new health-related assessment tool, scale, or survey is confirming or establishing the usefulness of the existing or new measure; this process conventionally involves assessing its reliability and its validity. Assessing reliability involves demonstrating that the measurement instrument generates consistent and hence reproducible results-in other words, whether the instrument produces the same results each time it is used in the same setting, with the same type of subjects. This includes interrater reliability, intrarater reliability, test-retest reliability, and internal reliability. Assessing validity is answering whether the instrument is actually measuring what it is intended to measure. This includes content validity, criterion validity, and construct validity. In evaluating a reported set of research data and its analyses, in a similar manner, it is important to assess the overall internal validity of the attendant study design and the external validity (generalizability) of its findings.

Familial Childhood Adversity is Associated with Chronic Disease Among Women: Data from the Geographic Research on Wellbeing (GROW) Study.

Objectives Few population-based studies on the relationship between childhood adversity and health in adulthood for women exist. Little is known about whether some social groups are more vulnerable to childhood adversity than other groups. Methods Using data from the Geographic Research on Wellbeing survey (GROW) conducted in California during 2012-2013, we examine associations between familial childhood adversities (FCAs) and a set of important chronic diseases and related conditions among women with young children, employing logistic regression models (N = 2409). Specifically, we test two measures of FCAs on the odds of reporting one or more chronic diseases or related-conditions (diabetes, hypertension, high cholesterol, heart disease). We also examine whether the associations between the two measures and the dependent variables vary by social factors (race/ethnicity, marital status, education, income). Results Both FCA measures were associated with reporting one or more chronic diseases after controlling for a set of important sociodemographic factors. Each unit increase in the number of FCAs corresponded to about a 10% increase in the odds of reporting one or more chronic disease(s). Moderating effects were also observed, with greater impacts among more socially vulnerable groups. Furthermore, ancillary analyses demonstrated that diabetes and high cholesterol were the drivers of the relationship between FCAs and chronic disease. Conclusions for Practice The social ecological model framework suggests that childhood adversity can be considered at multiple levels; that is, a sustainable reduction in the adverse health impacts of childhood adversity requires a concerted effort among policymakers and practitioners that includes both "upstream" and "downstream" approaches.

Is neighborhood poverty harmful to every child? Neighborhood poverty, family poverty, and behavioral problems among young children.

This longitudinal study investigates the association between neighborhood poverty and behavioral problems among young children. This study also examines whether social environments mediate the relationship between neighborhood poverty and behavioral problems. We used data from the third and fourth waves of the Fragile Families and Child Wellbeing study to assess behavioral problems separately for children who experienced no family poverty, moved out of family poverty, moved into family poverty, and experienced long-term family poverty. Regression models assessed the effect of neighborhood poverty on behavioral problem outcomes among children aged 5 years, after controlling for sociodemographic characteristics and earlier behavioral problems. Results showed an association between neighborhood poverty and lower social cohesion and safety, which lead to greater externalizing problems among children with long-term family poverty living in high-poverty neighborhoods compared with those in low-poverty neighborhoods. Policies and community resources need to be allocated to improve neighborhood social environments, particularly for poor children in high-poverty neighborhoods.

Increasing Breast and Cervical Cancer Screening in Rural and Border Texas with Friend to Friend Plus Patient Navigation.

The Friend to Friend plus Patient Navigation Program (FTF+PN) aims to build an effective, sustainable infrastructure to increase breast and cervical screening rates for underserved women in rural Texas. The objective of this paper is to identify factors that (1) distinguish participants who chose patient navigation (PN) services from those who did not (non-PN) and (2) were associated with receiving a mammogram or Papanicolaou (Pap) test. This prospective study analyzed data collected from 2689 FTF+PN participants aged 18-99 years from March 1, 2012 to February 28, 2015 who self-identified as African American (AA), Latina, and non-Hispanic white (NHW). Women who were younger, AA or Latina, had less than some college education, attended a FTF+PN event because of the cost of screening or were told they needed a screening, and who reported a barrier to screening had higher odds of being a PN participant. Women who were PN participants and had more contacts with program staff had greater odds of receiving a mammogram and a Pap compared with their reference groups. Latina English-speaking women had lower odds of receiving a mammogram and a Pap compared with NHW women and Latina Spanish-speaking women had higher odds of receiving a Pap test compared with NHW women. Women with greater need chose PN services, and PN participants had higher odds of getting a screening compared with women who did not choose PN services. These results demonstrate the success of PN in screening women in rural Texas but also that racial/ethnic disparities in screening remain.

The role of neighborhood economic context on physical activity among children: Evidence from the Geographic Research on Wellbeing (GROW) study.

Less than half of young children in the U.S. meet physical activity recommendations. While neighborhood economic context has been shown to be associated with physical activity, it is unknown whether this association varies according to family economic context. This study thus investigates whether neighborhood economic context, measured by poverty concentration and income inequality, are associated with physical activity among poor and non-poor children using data from the Geographic Research on Wellbeing study, California, 2012-2013 (N=2670). Poor children who resided in (a) poor and equal neighborhoods or (b) non-poor and equal neighborhoods were more likely to engage in sufficient physical activity than were children residing in non-poor and unequal neighborhoods. Poor children in (a) non-poor and equal neighborhoods, (b) poor and equal neighborhoods, or (c) poor and unequal neighborhoods were less likely to report insufficient physical activity than those in non-poor and unequal neighborhoods. Neighborhood economic context was not associated with physical activity among non-poor children. Findings suggest that neighborhood economic context presents a social barrier to physical activity among poor children. Increasing physical activity among poor children in non-poor and unequal neighborhoods should be a high policy priority. Perceived social cohesion, perceived neighborhood safety, and park and walkability indicators did not mediate the associations between neighborhood economic context and physical activity. Further research needs to explore the mechanisms by which neighborhood economic context affects physical activity among children.

Social Cohesion and Food Insecurity: Insights from the Geographic Research on Wellbeing (GROW) Study.

Objectives Food insecurity in the United States is a stubborn public health issue, affecting more than one in five households with children and disproportionately impacting racial and ethnic minority women and their children. Past research and policy has focused on household predictors of food insecurity, but neglected broader factors, such as perceived neighborhood social cohesion, that might protect those most vulnerable to food insecurity. Methods We use a racially and ethnically diverse data set from the Geographic Research on Wellbeing study (N = 2847) of women and their young children in California to investigate whether social cohesion influences food insecurity and whether it moderates the relationship between race/ethnicity and food insecurity. Results We find that lower levels of perceived residential neighborhood social cohesion associate with higher odds of food insecurity even after considering important household socioeconomic factors. In addition, our results suggest that social cohesion is most relevant for reducing the risk of food insecurity among racial and ethnic minority mothers. For example, the probability of food insecurity for immigrant Latina mothers is nearly 0.40 in neighborhoods where mothers perceive little to no cohesion and less than 0.10 in neighborhoods where mothers perceive high cohesion. Conclusions for Practice Higher levels of neighborhood perceived social cohesion are protective against food insecurity in households with children and especially so for racial and ethnic minority households who are at a heightened risk of food insecurity. Supporting programs that focus on building closer knit communities may be a key to reducing food insecurity overall and for reducing disparities in food insecurity by race and ethnicity.

Social disparities in dietary habits among women: Geographic Research on Wellbeing (GROW) Study.

OBJECTIVE: Relationships among race/ethnicity, individual socio-economic status (SES), neighbourhood SES and acculturation are complex. We sought to answer whether: (i) race/ethnicity, individual SES and neighbourhood SES have independent effects on women's fruit and vegetable consumption (FVC); (ii) SES modifies the effects of race/ethnicity on FVC; and (iii) nativity modifies the effect of Latina ethnicity on FVC. DESIGN: Cross-sectional surveys from the population-based Geographic Research on Wellbeing (GROW) Study were linked with census-tract level data. FVC was indicated by (i) consuming fruits and vegetables less often than daily (LOWFV) and (ii) not having fruits and vegetables in the home very often. Other variables included age, marital status, race/ethnicity, country of birth, educational attainment, family income and longitudinal neighbourhood poverty (based on latent class growth models). Weighted logistic regression models accounting for the complex sample design were constructed. SETTING: California, USA, 2012-2013. SUBJECTS: Women (n 2669). RESULTS: In adjusted models, race/ethnicity, education and income were independently associated with FVC, but not neighbourhood poverty. Women of colour, high-school graduates and women with incomes at 301-400 % of the federal poverty level were at higher odds of LOWFV compared with non-Hispanic Whites, college graduates and those with incomes >400 % of the federal poverty level. Little evidence for interactions between race/ethnicity and individual or neighbourhood SES was found; similar patterns were observed for immigrant and US-born Latinas. CONCLUSIONS: Addressing the dietary needs of lower-SES communities requires multilevel interventions that simultaneously provide culturally tailored nutrition education and address the physical and economic accessibility of culturally acceptable fruits and vegetables.

Post-partum Residential Mobility Among a Statewide Representative Sample of California Women, 2003-2007.

OBJECTIVES: Researchers often examine neighborhood socioeconomic environment and health during the perinatal period using geocoded addresses recorded on birth certificates at the time of delivery. Our objective was to assess the potential for post-partum neighborhood misclassification by examining whether women move neighborhoods during the immediate post-partum period, whether they move to neighborhoods of different socioeconomic status (SES), and whether mobility differs by maternal characteristics. METHODS: We used data from the 2003-2007 California Maternal and Infant Health Assessment (MIHA), an annual, statewide-representative survey of post-partum women, to examine women's neighborhood mobility patterns between giving birth and completing a survey 2-7 months post-partum. We examined whether women changed neighborhoods, whether moves were to neighborhoods of higher, lower, or similar socioeconomic status (SES), and whether these patterns differed by maternal race/ethnicity, maternal SES, or other demographic characteristics. RESULTS: Overall, 93% of women either did not move neighborhoods or moved to a neighborhood of similar SES post-partum. Only 4% of women moved to a neighborhood of lower SES and 3% to an area of higher SES. Mothers who were non-Hispanic black or US-born Hispanic, young, unmarried, primiparous, or lower SES were slightly more likely to move overall and more likely to move to neighborhoods with different SES, compared to other women. CONCLUSIONS: These findings suggest that geocoded addresses from birth certificates can be used to estimate women's neighborhood SES during the early post-partum period with little misclassification, an especially relevant finding for researchers using post-partum surveys.

Beyond the cross-sectional: neighborhood poverty histories and preterm birth.

OBJECTIVES: We examined associations between longitudinal neighborhood poverty trajectories and preterm birth (PTB). METHODS: Using data from the Neighborhood Change Database (1970-2000) and the American Community Survey (2005-2009), we categorized longitudinal trajectories of poverty for California neighborhoods (i.e., census tracts). Birth data included 23 291 singleton California births from the Maternal and Infant Health Assessment (2003-2009). We estimated associations (adjusted for individual-level covariates) between PTB and longitudinal poverty trajectories and compared these to associations using traditional, cross-sectional measures of poverty. RESULTS: Compared to neighborhoods with long-term low poverty, those with long-term high poverty and those that experienced increasing poverty early in the study period had 41% and 37% increased odds of PTB (95% confidence interval [CI] = 1.18, 1.69 and 1.09, 1.72, respectively). High (compared with low) cross-sectional neighborhood poverty was not associated with PTB (odds ratio = 1.08; 95% CI = 0.91, 1.28). CONCLUSIONS: Neighborhood poverty histories may contribute to an understanding of perinatal health and should be considered in future research.