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C Ch ha ap pt te er r 1 18 8 Using Geo-Data Techniques to Analyze Environmental Health Inequities in Minority Neighborhoods: The Case of Toxic Exposures and Low Birth Weights FLORENCE M. MARGAI INTRODUCTION The move toward the construction of an inclusive multicultural society in America demands the elimination of race and place-based inequalities. This, in turn, requires the use of effective tools and analytical approaches that are capable of pinpointing these inequities among the population subgroups for remediation and redress. One such area of concern has been the disproportionate burden of disease and disabilities among American minorities. Specifically, persistent gaps in morbidity and mortality rates have been identified among blacks, Hispanics, Native Americans and the rest of the U.S. population (Hummer, 1993, 1996; Kallan, 1993; David and Collins, 1991; Geronimus et al., 1996). Of even greater concern is the fact that these gaps are expected to grow considerably wider as the projected “browning” of America continues through the next several decades (Frazier, Margai and Tettey-Fio, 2003). The U.S. Department of Health (2000) recently acknowledged this problem, noting disparities for at least six major health indicators: infant mortality rates, immunizations, diabetes, cardiovascular disease, HIV infection/AIDS, cancer screening and management. The gravity of this problem is apparent across all life stages of American minorities, literally from cradle to grave, forcing government officials to mandate the elimination of these health disparities, as the principal goal of the National Health Objectives of the 21st century. Of the six health indicators, the differential in infant mortality rate (IMR) is perhaps the most significant . The IMR has been consistently higher among minorities, particularly among African Americans, and most of this excess mortality has been attributed to low birth weight outcomes (NIH, 1999; Kleinman and Kessel, 1987). In this chapter, we explore the use of geographical information systems (GIS) and statistics in evaluating the spatial pattern of Low Birth Weights (LBW) as the principal and leading indicator of disparate patterns in IMR among racial and ethnic groups. The rate of LBW in the United States is approximately 7.6% (NIH, 1999). Yet, a breakdown by race and ethnic composition reveals significantly higher prevalence rates among minorities , especially blacks. Most experts now believe that controlling low birth weight incidences would narrow the infant mortality gap between racial and ethnic populations, as well as minimize other major group disparities in child health and developmental outcomes. Previous studies attempting to explain the prevalence rates of LBW however have focused on the differences in socio-economic status, access to quality health care and maternal risk factors such as smoking, substance abuse, low pre-pregnancy weight and low weight gain. Yet, the NIH (1999) contends that knowledge of these risk factors and the interventions directed toward them have not been very effective in reducing low birth weight rates. In the quest for answers, the agency now calls for new analytical frameworks and perspectives that call into question other modifiable causes such as neighborhood indicators, poverty, housing and environmental factors. For example, is the spatial distribution of LBW cases in urban neighborhoods consistent with those 264 Florence M. Margai found in other areas? Do the prevalence rates vary by race and ethnicity in these communities? Are neighborhoods with poor housing conditions (overcrowding, housing age and quality) associated with high rates of LBW? What are the environmental risk factors that might contribute to high rates of LBW? Do neighborhoods within a proximal distance to landfills, toxic release facilities, and other hazardous waste sites have elevated risks for low birth weight outcomes? The present study is couched within these contexts. The primary objective is to use geographically referenced data and information tools to characterize the spatial pattern of low birth weight outcomes and assess the role of environmental health hazards around the maternal residences in explaining the prevalence of these health outcomes in minority communities. This rest of the chapter is divided into four sections. The next section summarizes the pertinent findings from previous studies, documenting the trends in LBW, the disparities across racial/ethnic subgroups and the developmental outcomes among children in the United States. This is followed by a presentation of the research framework, emphasizing the relevance of environmental and contextual factors in addressing LBW among racial and ethnic neighborhoods. The third section describes the study area, data collection, integration and analysis. This is followed by a presentation and discussion of the research findings. LOW BIRTH WEIGHT: TRENDS, GROUP DISPARITIES, AND HEALTH CONSEQUENCES IN THE...

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