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Primary Submission Category: Mediation

Mediating pathways of neighborhood violence on adverse pregnancy outcomes in California

Authors: Caitlin Chan, Shelley Jung, Dana Goin, Kara Rudolph, Kristen Marchi, William Dow, Paula Braveman, Mahasin Mujahid, Mark van der Laan, Jennifer Ahern,

Presenting Author: Caitlin Chan*

Community violence may contribute to adverse perinatal health outcomes through exposure to violence, buffering resources, and mediating mechanisms. In particular, the contribution of mediators such as unhealthy coping behaviors and medical conditions on perinatal outcomes is not well understood, and may be an important source of disparate impacts on historically minoritized populations.
We examined mediating pathways from acute changes in neighborhood violence to adverse perinatal outcomes, restricting analyses to within-neighborhood comparisons to control for time-constant neighborhood factors.
We combined California neighborhood violence data with hospital records of singleton live births from 2007-2011. We estimated the excess risk of infant mortality, neonatal mortality, preterm birth, gestational diabetes, and preeclampsia among birthing individuals exposed to acute neighborhood violence spikes. We employed targeted maximum likelihood estimation, adjusted for individual- (age, race, parity, education, insurance, conception year and season) and neighborhood- (temperature, precipitation, unemployment) level confounders. Substance use and maternal infection during pregnancy were analyzed as mediators.
Community violence was associated with elevated risk of gestational diabetes, preeclampsia, and preterm birth, with both substance use and maternal infection mediating these effects. Further analyses will estimate the magnitude of mediation effects by racial/ethnic group.