The Intersection of Social Determinants and Health Behaviors: Effect on Preterm Birth

The objective of this work to provide evidence that the engagement in healthy behaviors has a protective relationship between preterm birth (PTB). We also want to examine participation in healthy behaviors from a social context by examining the effects of social determinants. This study is a retrospective cohort study that used data from US counties. The data was sourced from the county health rankings website (https://www.countyhealthrankings.org) and March of Dimes Peristats. Healthy behaviors were defined as percent of county population abstinence from smoking, alcohol and drug use. We also included the percent sufficient consumption of fruits and vegetables, engagement in physical activities and sufficient sleep. Social determinants observed were race, immigration status, neighborhood deprivation, income, education, access to healthcare. We also included physical and mental health variables as well. Data were analyzed using principle components analysis (PCA) and ordinary least squares (OLS) regression. The results of the PTB model showed that behavior had a significant and inverse relationship with PTB (β = -0.276, p < 0.001). Other components that had significant relationships with PTB were household demographics (β=0.270, p < 0.001), community deprivation (β=0.166, p < 0.001), healthcare access (β=-0.108, p < 0.001), and chronic disease (β=0.110, p < 0.001). We also found that household economics (β=0.311, p < 0.001), healthcare access (β=0.290, p < 0.001), household demographics (β=-0.273, p < 0.001) and neighborhood deprivation (β=- 0.145, p < 0.001) are social determinants that have a significant relationship with engagement with healthy behaviors. This study reaffirmed the importance of healthy behaviors in the prevention of PTB and how engagement may offset the effect of social disadvantage. This work adds to the literature in that it does not look at behaviors in a vacuum, but sought to look at the behavior within social context by examining the social determinants which may promote or present barriers to the engagement of health promoting behaviors.