Among the most challenging perinatal health problems in public health is the prediction and prevention of preterm birth (PTB). PTB is a major contributor to infant mortality, particularly among African Americans who have historically experienced higher rates of PTB than other racial/ethnic groups. During the past several decades, efforts to predict and prevent PTB-which mostly focused on behavioral, psychological, and medical risk factors-have had little impact on this racial disparity. The proposed study instead focuses on the role of social ecological factors in PTB, and the mechanisms by which these factors are related to more proximal causes of PTB. The study has four specific aims. First, it will determine whether the experience of structural disadvantage during childhood is associated with increased risk of PTB in adulthood, independent of adulthood socioeconomic status. Second, it will assess whether the effects of experiencing disadvantage in childhood and adulthood on PTB are multiplicative or cumulative. Third, it will explore potential behavioral, psychosocial, and biological mediators of these relationships. Finally, the study will examine whether differential experiences of structural disadvantage during childhood explain racial differences in rates of PTB in adulthood. To accomplish these aims, the study will use data from the public use dataset of the National Longitudinal Study of Adolescent Health-a study that collected data from a nationally representative sample of adolescents between 1994 and 1995 (Wave I), one year later (Wave II), and six years later (Wave III), when they were adults, as well as contextual information about their childhood neighborhoods. The proposed study will entail secondary analyses of data from a sample of females who reported at least one live birth at Wave III (n = 1,357 live births, 947 women). This study is consistent with the mission of NICHD, where the underlying causes of infant mortality, and where structural factors related to the health of women, their families, and their communities during their adolescent and childbearing years, are clear research priorities. Relevance: The proposed study responds to the Healthy People 2010 objective to eliminate racial disparities in pregnancy outcomes, and to the lOM's 2004 report on racial and ethnic differences in health over the lifecourse, which called for identifying mediating variables between childhood deprivation and adult health, including environmental conditions. Moreover, the study will attempt to identify the actions that public health professionals must take, and the appropriate targets and timing for those actions, in order to prevent PTB.
