Person, place and context: the interaction between the social and physical environment on adverse pregnancy outcomes in British Columbia

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dc.contributor.authorErickson, Anders Carl
dc.contributor.supervisorArbour, Laura
dc.contributor.supervisorOstry, Aleck S.
dc.date.accessioned2016-09-22T19:44:12Z
dc.date.available2016-09-22T19:44:12Z
dc.date.copyright2016en_US
dc.date.issued2016-09-22
dc.degree.departmentInterdisciplinary Graduate Program
dc.degree.departmentDivision of Medical Sciences
dc.degree.departmentSchool of Medical Sciences
dc.degree.departmentDepartment of Geography
dc.degree.levelDoctor of Philosophy Ph.D.en_US
dc.description.abstractThis study was a population-based retrospective cohort of all singleton births in British Columbia for the years 2001 to 2006. The purpose of this dissertation is to examine how social and physical environment factors influence the risk of adverse pregnancy outcomes and whether they interact with each other or with maternal characteristics to modify disease risk. The main environmental factors examined include ambient particulate air pollution (PM2.5), neighbourhood socioeconomic status (SES), neighbourhood immigrant density, neighbourhood level of post-secondary education level and the urban-rural context. Census dissemination areas (DAs) were used as the neighbourhood spatial unit. The data (N=242,472) was extracted from the BC Perinatal Data Registry (BCPDR) from Perinatal Services BC (PSBC). The main perinatal outcomes investigated include birth weight and indicators of fetal growth restriction such as small-for-gestational age (SGA), term low birth weight (tLBW), and intrauterine growth restriction (IUGR), preterm birth (PTB) and gestational age, gestational diabetes mellitus (GDM) and gestational hypertension (GH). Collectively, this dissertation contributes to the perinatal epidemiological literature linking particulate air pollution and neighbourhood SES context to adverse pregnancy outcomes. Assumptions about the linear effect of PM2.5 and smoking on birth weight are challenged showing that the effects are most pronounced between low and average exposures and that the magnitude of their effect is modified by neighbourhood and individual-level characteristics. These results suggest that focusing exclusively on individual risk factors may have limited success in improving outcomes without addressing the contextual influences at the neighbourhood-level. This dissertation therefore also contributes to the public health, sociological and community-urban development literature demonstrating that context and place matters.en_US
dc.description.proquestcode0766en_US
dc.description.proquestcode0573en_US
dc.description.proquestcode0768en_US
dc.description.proquestemailanderse@uvic.caen_US
dc.description.scholarlevelGraduateen_US
dc.identifier.bibliographicCitationErickson AC, Arbour LT. Heavy smoking during pregnancy as a marker for other risk factors of adverse birth outcomes: a population-based study in British Columbia, Canada. BMC Public Health. 2012;12(1):102.en_US
dc.identifier.bibliographicCitationErickson A.C., Arbour L. The shared pathoetiological effects of particulate air pollution and the social environment on fetal-placental development. Journal of Environmental and Public Health. 2014en_US
dc.identifier.bibliographicCitationErickson A.C., Ostry A, Chan L.H.M., Arbour L. The reduction of birth weight by fine particulate matter and its modification by maternal and neighbourhood-level factors: a multilevel analysis in British Columbia, Canada. Environmental Health; 2016 Apr 14; 15(1).en_US
dc.identifier.bibliographicCitationErickson A.C., Ostry A., Chan L.H.M., Arbour L. Air pollution, neighbourhood and maternal-level factors modify the effect of smoking on birth weight: a multilevel analysis in British Columbia, Canada. BMC Public Health. Accepted, in press.en_US
dc.identifier.urihttp://hdl.handle.net/1828/7557
dc.languageEnglisheng
dc.language.isoenen_US
dc.rightsAvailable to the World Wide Weben_US
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/2.5/ca/*
dc.subjectperinatal epidemiologyen_US
dc.subjectenvironmental epidemiologyen_US
dc.subjectair pollutionen_US
dc.subjectparticulate matteren_US
dc.subjectlow birth weighten_US
dc.subjectgestational diabetesen_US
dc.subjectpreterm birthen_US
dc.subjectsocial determinants of healthen_US
dc.subjectsmokingen_US
dc.subjectmultilevel modelsen_US
dc.subjectdisease mappingen_US
dc.subjectsocial environmenten_US
dc.titlePerson, place and context: the interaction between the social and physical environment on adverse pregnancy outcomes in British Columbiaen_US
dc.typeThesisen_US

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