When do we know enough to recommend action on the social determinants of health?

The Robert Wood Johnson Foundation Commission to Build a Healthier America was charged to identify strategies beyond medical care to address health disparities in the U.S. related to social and economic disadvantage.

Father's education: an independent marker of risk for preterm birth.

To explore the association between paternal education and preterm birth, taking into account maternal social and economic factors. We analyzed data from a population-based cross-sectional postpartum survey, linked with birth certificates, of women who gave birth in California from 1999 through 2005 (n = 21,712). Women whose infants' fathers had not completed college had significantly higher odds of preterm birth than women whose infants' fathers were college graduates, even after adjusting for maternal education and family income [OR (95% CI) = 1.

Early postnatal care among healthy newborns in 19 States: pregnancy risk assessment monitoring system, 2000.

Objective: To examine early postnatal care among healthy newborns during 2000 in 19 states.

Methods: Using data from the Pregnancy Risk Assessment Monitoring System, a multistate population-based postpartum survey of women, we calculated prevalences of early discharge (ED; stays of < or =2 days after vaginal delivery and < or =4 days after Cesarean delivery) and early follow-up (within 1 week) after ED. We used logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) describing how ED and lack of early follow-up were associated with state legislation and maternal characteristics.

An approach to studying social disparities in health and health care.

Objective: We explored methods and potential applications of a systematic approach to studying and monitoring social disparities in health and health care.

Methods: Using delayed or no prenatal care as an example indicator, we (1) categorized women into groups with different levels of underlying social advantage; (2) described and graphically displayed rates of the indicator and relative group size for each social group; (3) identified and measured disparities, calculating relative risks and rate differences to compare each group with its a priori most-advantaged counterpart; (4) examined changes in rates and disparities over time; and (5) conducted multivariate analyses for the overall sample and "at-risk" groups to identify particular factors warranting attention.

Results: We identified at-risk groups and relevant factors and suggest ways to direct efforts for reducing prenatal care disparities.

Newborn early discharge revisited: are California newborns receiving recommended postnatal services?

Context: Responding to safety concerns, federal and state legislation mandated coverage of minimum postnatal stays and state legislation in California mandated coverage of follow-up after early discharge. Little is known about the postnatal services newborns are receiving.

Objective: To describe rates of early discharge and of timely follow-up for early-discharged newborns.