Contact Us


Frequently Asked Questions

ETD Help

Policies and Procedures

Copyright and Patents

Access Restrictions

Search ETDs:
Advanced Search
Browse by:
Browse ProQuest
Search ProQuest

Laney Graduate School

Rollins School of Public Health

Candler School of Theology

Emory College

Emory Libraries

New ETD website is now LIVE and located here:

Low Birth Weight, Maternal Age, and County Economic Status in the Appalachian Region

Harlan, Elizabeth (2014)
Master's Thesis (60 pages)
Committee Chair / Thesis Adviser: Kramer, Michael R
Committee Members:
Research Fields: Health Sciences, Epidemiology; Health Sciences, Public Health
Partnering Agencies: Does not apply (no collaborating organization)
Keywords: Low birth weight; Appalachia; Accelerated aging; Weathering hypothesis
Program: Rollins School of Public Health, Epidemiology (Global Epidemiology)
Permanent url:


Introduction: The effects of area deprivation on perinatal outcomes in the Appalachian region have not been well studied. This analysis assessed the relationship between county economic status and low birth weight (LBW), hypothesizing that there would be a pattern of accelerated aging contrasting low economic status and high economic status counties, which would be supportive of the weathering hypothesis. Methods: Appalachian Regional Commission county economic status labels were applied to the National Vital Statistics System natality file for births in the Appalachian region between 2006 and 2011. The outcome of interest was births weighing <2,500 grams, and predictors included maternal age, race, parity, adequacy of prenatal care use, education, and smoking. General estimating equations models were used to account for repeated county measures. The estimated age-specific risks of LBW were depicted graphically to better understand the relationship with county status. Results: Women in low income counties were younger, had lower educational attainment, and a greater proportion smoked than women in high income counties. The relationship between county economic status and low birth weight varied by race and ethnicity. When controlling for smoking, women in low income counties had decreased odds of low birth weight compared to women in high income counties, OR 0.71 (95% CI 0.53-0.94). Among women living in low economic status counties had the lowest risk of LBW at age 28, while women living in high income counties had the lowest risk of LBW at age 32. Discussion & Conclusions: Smoking is an important predictor of low birth weight among Appalachian women in low economic status counties, where smoking was more common than in high economic status counties. The age-specific risks of LBW are suggestive of a pattern of accelerated aging in women from low economic status counties as compared to women in high economic status counties. Accelerated aging leads to an increased risk of low birth weight as women age, and may be associated with limited educational or career opportunities. The results of this analysis support the weathering hypothesis as a function of county economic status in the Appalachian region.

Table of Contents

Introduction -- -- Review of the Literature. 4 -- Accelerated Aging. 4 -- The Weathering Hypothesis. 5 -- Health in Appalachia. 6 -- Relevance of Births to Adolescents. 9 -- Low Birth Weight as an Indicator of Maternal Health. 10 -- Gaps in the Literature. 12 -- Methods. 13 -- Study Population. 13 -- Data Sources and Predictors of Interest 13 -- Data Preparation. 14 -- Data Analysis. 16 -- Results. 18 -- Descriptive Statistics. 18 -- Models. 19 -- Age-specific Risk of Low Birth Weight 21 -- Discussion. 24 -- Demographics. 24 -- Models. 26 -- Age-Specific Risk of Low Birth Weight 28 -- Strengths and Weaknesses. 32 -- Conclusions. 34 -- Tables. 35 -- References. 45 --


application/pdf Master's Thesis 60 pages (971.7 KB) [Access copy of Master's Thesis]
Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.