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Objectives: In the United States, Hispanic mothers have birth outcomes comparable to those of White mothers despite lower socioeconomic status. The contextual effects of Hispanic neighborhoods may partially explain this "Hispanic paradox." We investigated whether this benefit extends to other ethnic groups., Methods: We used multilevel logistic regression to investigate whether the county-level percentage of Hispanic residents is associated with infant mortality, low birth weight, preterm delivery, and smoking during pregnancy in 581,151 Black and 2,274,247 White non-Hispanic mothers from the US Linked Birth and Infant Death Data Set, 2000., Results: For White and Black mothers, relative to living in counties with 0.00%-0.99% of Hispanic residents, living in counties with 50.00% or more of Hispanic residents was associated with an 80.00% reduction in the odds of smoking, an infant mortality reduction of approximately one third, and a modest reduction in the risks of preterm delivery and low birth weight., Conclusions: The health benefits of living in Hispanic areas appear to bridge ethnic divides, resulting in better birth outcomes even for those of non-Hispanic origin.

Objectives: We investigated whether mothers from ethnic minority groups have better pregnancy outcomes when they live in counties with higher densities of people from the same ethnic group-despite such areas tending to be more socioeconomically deprived., Methods: In a population-based US study, we used multilevel logistic regression analysis to test whether same-ethnic density was associated with maternal smoking in pregnancy, low birthweight, preterm delivery, and infant mortality among 581 151 Black and 763 201 Hispanic mothers and their infants, with adjustment for maternal and area-level characteristics., Results: Higher levels of same-ethnic density were associated with reduced odds of infant mortality among Hispanic mothers, and reduced odds of smoking during pregnancy for US-born Hispanic and Black mothers. For Black mothers, moderate levels of same-ethnic density were associated with increased risk of low birthweight and preterm delivery; high levels of same ethnic density had no additional effect., Conclusions: Our results suggest that for Hispanic mothers, in contrast to Black mothers, the advantages of shared culture, social networks, and social capital protect maternal and infant health.

Objectives: We investigated whether the processes underlying the association between income inequality and population health are related to those responsible for the socioeconomic gradient in health and whether health disparities are smaller when income differences are narrower., Methods: We used multilevel models in a regression analysis of 10 age- and cause-specific US county mortality rates on county median household incomes and on state income inequality. We assessed whether mortality rates more closely related to county income were also more closely related to state income inequality. We also compared mortality gradients in more- and less-equal states., Results: Mortality rates more strongly associated with county income were more strongly associated with state income inequality: across all mortality rates, r= -0.81; P=.004. The effect of state income inequality on the socioeconomic gradient in health varied by cause of death, but greater equality usually benefited both wealthier and poorer counties., Conclusions: Although mortality rates with steep socioeconomic gradients were more sensitive to income distribution than were rates with flatter gradients, narrower income differences benefit people in both wealthy and poor areas and may, paradoxically, do little to reduce health disparities.

Objectives: In 1994, the US Public Health Service launched the "Back to Sleep" campaign, promoting the supine sleep position to prevent sudden infant death syndrome (SIDS). Studies of SIDS in the United States have generally found socioeconomic and race disparities. Our objective was to see whether the "Back to Sleep" campaign, which involves an effective, easy, and free intervention, has reduced social class inequalities in SIDS., Methods: We conducted a population-based case-cohort study during 2 periods, 1989 to 1991 and 1996 to 1998, using the US Linked Birth/Infant Death Data Sets. Case group was infants who died of SIDS in infancy (N = 21 126); control group was a 10% random sample of infants who lived through the first year and all infants who died of other causes (N=2241218). Social class was measured by mother's education level., Results: There was no evidence that inequalities in SIDS were reduced after the Back to Sleep campaign. In fact, odds ratios for SIDS associated with lower social class increased between 1989-1991 and 1996-1998. The race disparity in SIDS increased after the Back to Sleep campaign., Conclusions: The introduction of an inexpensive, easy, public health intervention has not reduced social inequalities in SIDS; in fact, the gap has widened. Although the risk of SIDS has been reduced for all social class groups, women who are more educated have experienced the greatest decline.

Income inequality has been associated with both homicides and births to adolescents in the United States and with homicides internationally. We found that adolescent birth rates and general homicide rates were closely correlated with each other internationally (r= 0.95) and within the United States (r = 0.74) and with inequality internationally and within the United States. These results, coupled with no association with absolute income, suggested that violence and births to adolescents may reflect gender-differentiated responses to low social status and could be reduced by reducing income inequality.

Objectives: Recent research suggests that in utero exposure to maternal smoking is a risk factor for conduct disorder and delinquency. We review evidence of causality, a controversial but important public health question., Methods: We analyzed studies of maternal prenatal smoking and offspring antisocial behavior within a causal framework., Results: The association is (1) independent of confounders, (2) present across diverse contexts, and (3) consistent with basic science. Methodological limitations of existing studies preclude causal conclusions., Conclusions: Existing evidence provides consistent support for, but not proof of, an etiologic role for prenatal smoking in the onset of antisocial behavior. The possibility of identifying a preventable prenatal risk factor for a serious mental disorder makes further research on this topic important for public health.