Maternal and Child Health Journal

, Volume 14, Issue 5, pp 774–785 | Cite as

Maternal Social Support and Neighborhood Income Inequality as Predictors of Low Birth Weight and Preterm Birth Outcome Disparities: Analysis of South Carolina Pregnancy Risk Assessment and Monitoring System Survey, 2000–2003

  • Stephen Nkansah-Amankra
  • Ashish Dhawain
  • James Robert Hussey
  • Kathryn J. Luchok


Effects of income inequality on health and other social systems have been a subject of considerable debate, but only a few studies have used multilevel models to evaluate these relationships. The main objectives of the study were to (1) Evaluate the relationships among neighborhood income inequality, social support and birth outcomes (low birth weight, and preterm delivery) and (2) Assess variations in racial disparities in birth outcomes across neighborhood contexts of income distribution and maternal social support. We evaluated these relationships by using South Carolina Pregnancy Risk Assessment and Monitoring System (PRAMS) survey for 2000–2003 geocoded to 2000 US Census data for South Carolina. Multilevel analysis was used to simultaneously evaluate the association between income inequality (measured as Gini), maternal social relationships and birth outcomes (low birth weight and preterm delivery). The results showed residence in neighborhoods with medium levels of income inequality was independently associated with low birth weight (OR: 2.00; 95% CI 1.14–3.26), but not preterm birth; low social support was an independent risk for low birth weight or preterm births. The evidence suggests that non-Hispanic black mothers were at increased risks of low birth weight or preterm birth primarily due to greater exposures of neighborhood deprivations associated with low income and reduced social support and modified by unequal income distribution.


Income inequality Gini coefficient Social support Low birth weight Preterm birth Neighborhood contexts Poverty 



The authors would like to express their deep appreciation to the South Carolina Department of Health and Environmental Control for their generous efforts in providing the geocoded data for the study. We are also grateful for the comments from anonymous reviewers and Editor-in-Chief of Maternal and Child Health Journal.


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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Stephen Nkansah-Amankra
    • 1
  • Ashish Dhawain
    • 2
  • James Robert Hussey
    • 3
  • Kathryn J. Luchok
    • 4
  1. 1.College of Health and Human SciencesUniversity of Northern Colorado/Colorado School of Public HealthGreeleyUSA
  2. 2.Monmouth Medical CenterLong BranchUSA
  3. 3.Department of Epidemiology & Biostatistics, Arnold School of Public HealthUniversity of South CarolinaColumbiaUSA
  4. 4.South Carolina Access Initiative and Adjunct Faculty, Department of Health Promotion, Education & Behavior, Arnold School of Public HealthUniversity of South CarolinaColumbiaUSA

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