Maternal upward socioeconomic mobility and black-white disparities in infant birthweight

A Systematic Review of DNA Methylation and Preterm Birth in African American Women

BACKGROUND

The causes of many cases of preterm birth (PTB) remain enigmatic. Increased understanding of how epigenetic factors are associated with health outcomes has resulted in studies examining DNA methylation (DNAm) as a contributing factor to PTB. However, few studies on PTB and DNAm have included African American women, the group with the highest rate of PTB.

METHODS

The objective of this review was to systematically analyze the existing studies on DNAm and PTB among African American women.

RESULTS

Studies ( N = 10) were limited by small sample size, cross-sectional study designs, inconsistent methodologies for epigenomic analysis, and evaluation of different tissue types across studies. African Americans comprised less than half of the sample in 50% of the studies reviewed. Despite these limitations, there is evidence for an association between DNAm patterns and PTB.

CONCLUSIONS

Future research on DNAm patterns and PTB should use longitudinal study designs, repeated DNAm testing, and a clinically relevant definition of PTB and should include large samples of high-risk African American women to better understand the mechanisms for PTB in this population.

Hair cortisol and lifetime discrimination: Moderation by subjective social status

Discrimination has been associated with elevated cortisol as measured in saliva, blood, and urine. This study investigated the association between lifetime discrimination and hair cortisol concentrations, considered a measure of chronic stress. We recruited 180 young adults from diverse backgrounds. Participant responses to lifetime discrimination, home stress, and subjective status measures were recorded. Lifetime discrimination significantly predicted hair cortisol concentrations, supporting past research that discrimination experiences impact neuroendocrine systems. To our knowledge, these are the first findings associating hair cortisol concentrations with discrimination and supports prior evidence positing discrimination as a chronic stressor that serves as a risk factor for chronic disease.

Life-course Social Mobility and Reduced Risk of Adverse Birth Outcomes

INTRODUCTION

Higher adult socioeconomic position (SEP) is associated with better birth outcomes. However, few studies incorporate life-course or intergenerational SEP, which may inform etiology and targeted prevention efforts. This study tested whether life-course social mobility from childhood was associated with lower risk of adverse birth outcomes.

METHODS

Data were from the Life-course Influences of Fetal Environments (LIFE) retrospective cohort study among black women, 2009-2011, in metropolitan Detroit, MI. This study (analyzed in 2014-2016) examined whether social mobility was associated with two primary birth outcomes: small for gestational age (SGA) and preterm birth (PTB). Childhood and adulthood SEP were measured by survey in adulthood, for two constructs, measured ordinally: educational attainment and perceived financial sufficiency (subjective income/wealth). Social mobility was calculated as the difference of adulthood minus childhood SEP.

RESULTS

In covariate-adjusted Poisson regression models, 1-SD improved educational social mobility from childhood to adulthood was protective for SGA (adjusted risk ratio=0.76; 95% CI=0.64, 0.91); this association remained after adjusting for financial mobility. Upward financial social mobility from early childhood was marginally protective for SGA (adjusted risk ratio=0.85; 95% CI=0.72, 1.02), but became nonsignificant after controlling educational mobility. There were no overall associations of social mobility with PTB or low birth weight, although sensitivity analyses identified that improved financial mobility was associated with 16% marginally lower risk of spontaneous PTB and 28% marginally lower risk of low birth weight among upwardly mobile/stable women only.

CONCLUSIONS

Improved life-course social mobility is associated with reduced risk for SGA and spontaneous PTB among black women.

Jedi Public Health: Co-creating an Identity-Safe Culture to Promote Health Equity

The extent to which socially-assigned and culturally mediated social identity affects health depends on contingencies of social identity that vary across and within populations in day-to-day life. These contingencies are structurally rooted and health damaging inasmuch as they activate physiological stress responses. They also have adverse effects on cognition and emotion, undermining self-confidence and diminishing academic performance. This impact reduces opportunities for social mobility, while ensuring those who "beat the odds" pay a physical price for their positive efforts. Recent applications of social identity theory toward closing racial, ethnic, and gender academic achievement gaps through changing features of educational settings, rather than individual students, have proved fruitful. We sought to integrate this evidence with growing social epidemiological evidence that structurally-rooted biopsychosocial processes have population health effects. We explicate an emergent framework, Jedi Public Health (JPH). JPH focuses on changing features of settings in everyday life, rather than individuals, to promote population health equity, a high priority, yet, elusive national public health objective. We call for an expansion and, in some ways, a re-orienting of efforts to eliminate population health inequity. Policies and interventions to remove and replace discrediting cues in everyday settings hold promise for disrupting the repeated physiological stress process activation that fuels population health inequities with potentially wide application.

Movin' on Up: Socioeconomic Mobility and the Risk of Delivering a Small-for-Gestational Age Infant

OBJECTIVE

Poor fetal growth is associated with increased rates of adverse health outcomes in children and adults. The social determinants of poor fetal growth are not well understood. Using multiple socioeconomic indicators measured at the individual level, this study examined changes in maternal socioeconomic position (SEP) from childhood to adulthood (socioeconomic mobility) in relation to poor fetal growth in offspring.

METHODS

Data were from the Pregnancy Outcomes and Community Health Study (September 1998-June 2004) that enrolled women in mid-pregnancy from 52 clinics in five Michigan communities (2463 women: 1824 non-Hispanic White, 639 non-Hispanic Black). Fetal growth was defined by birthweight-for-gestational age percentiles; infants with birthweight-for-gestational age <10th percentile were referred to as small-for-gestational age (SGA). In logistic regression models, mothers whose SEP changed from childhood to adulthood were compared to two reference groups, the socioeconomic group they left and the group they joined.

RESULTS

Approximately, 8.2 % of women (non-Hispanic White: 6.3 %, non-Hispanic Black: 13.9 %) delivered an SGA infant. Upward mobility was associated with decreased risk of delivering an SGA infant. Overall, the SGA adjusted-odds ratio was 0.34 [95 % confidence interval (CI) 0.17-0.69] for women who moved from lower to middle/upper versus static lower class, and 0.44 (CI 0.28-1.04) for women who moved from middle to upper versus static middle class. There were no significant differences in SGA risk when women were compared to the SEP group they joined.

CONCLUSIONS

Our findings support a link between mother's socioeconomic mobility and SGA offspring. Policies that allow for the redistribution or reinvestment of resources may reduce disparities in rates of SGA births.

Examining Life-Course Socioeconomic Position, Contextualized Stress, and Depression among Well-Educated African-American Pregnant Women

PURPOSE

This article explores how childhood and adulthood socioeconomic position (SEP) and socioeconomic mobility, as indicators of life-course experiences, impact the relationship between contextualized stress and depression among well-educated, pregnant African-American women.

METHODS

The Jackson, Hogue, Phillips Contextualized Stress Measure and the Beck Depression Inventory were administered to 101 well-educated, pregnant African-American women during their first and second trimesters. Bivariate associations and regression analysis were conducted to assess life-course SEP, mobility, and contextualized stress as predictors of depression. Based on the demographic data for childhood and adult SES, the SEP and mobility variables were created.

RESULTS

Results from χ2 analysis revealed that high contextual stress was significantly associated with no change in mobility, that is, staying the same. Results from regression models found that contextualized stress was the only predictor for depression. Additionally, life-course SEP and mobility did not moderate the relationship between contextualized stress and depression.

CONCLUSIONS

Our findings illuminated the persistence of racial and gendered stress as risk factors for depression among well-educated, pregnant African-American women, regardless of life-course SEP. We offer an explanation as to why African-American women who possess the material and social resources thought to mediate psychosocial and pregnancy risks remain in jeopardy.

Maternal and pediatric health and disease: integrating biopsychosocial models and epigenetics

The concepts of allostasis (stability through adaptation) and accumulated life stress (McEwen's allostatic load) aim to understand childhood and adult outcomes. Chronic malnutrition, changes in social condition, and adverse early-life experiences may program phenotypes and contribute to long-lasting disease risk. However, integration of life course approaches, social and economic contexts, and comparison among different biopsychosocial models has not generally been explored. This review critically examines the literature and evaluates recent insights into how environmental stress can alter lifelong hypothalamic-pituitary-adrenal axis and immune system responsiveness and induce metabolic and neurodevelopmental maladaptation. Models of biopsychosocial stress overlap but may consider different conditions. Concepts include allostasis, which incorporates hormonal responses to predictable environmental changes, and Geronimus's "weathering," which aims to explain how socially structured, repeated stress can accumulate and increase disease vulnerability. Weathering emphasizes roles of internalized/interpersonal racism in outcomes disparities. For Mexican immigrants and Mexican Americans, the "acculturation" framework has proven especially useful to explore disparities, including preterm birth and neuropsychiatric risks in childhood. Complexities of stress assessments and recent research into epigenetic mechanisms mediating effects of physical, nutritional, psychological, and social stress are reviewed.

Explaining racial disparities in infant health in Brazil

OBJECTIVES

We sought to quantify how socioeconomic, health care, demographic, and geographic effects explain racial disparities in low birth weight (LBW) and preterm birth (PTB) rates in Brazil.

METHODS

We employed a sample of 8949 infants born between 1995 and 2009 in 15 cities and 7 provinces in Brazil. We focused on disparities in LBW (< 2500 g) and PTB (< 37 gestational weeks) prevalence between infants of African ancestry alone or African mixed with other ancestries, and European ancestry alone. We used a decomposition model to quantify the contributions of conceptually relevant factors to these disparities.

RESULTS

The model explained 45% to 94% of LBW and 64% to 94% of PTB disparities between the African ancestry groups and European ancestry. Differences in prenatal care use and geographic location were the most important contributors, followed by socioeconomic differences. The model explained the majority of the disparities for mixed African ancestry and part of the disparity for African ancestry alone.

CONCLUSIONS

Public policies to improve children's health should target prenatal care and geographic location differences to reduce health disparities between infants of African and European ancestries in Brazil.

Allostatic load in women with a history of low birth weight infants: the national health and nutrition examination survey

BACKGROUND

The purpose of our study was to determine whether women of reproductive age with history of low birth weight (LBW) deliveries have higher allostatic load (AL), a measure of the cumulative toll of chronic stress, than those with normal-weight deliveries.

METHODS

We used data from women ages 17-35 who responded to the National Health and Nutrition Examination Survey (NHANES) reproductive-health questionnaire, 1999-2006. Women reported history of LBW infants and those who were preterm. We classified preterm-LBW and term-LBW as surrogates for preterm birth (PTB) and small for gestational age (SGA), respectively. Normal weight included those without LBW infant history. We utilized nine biomarkers measured in NHANES to determine AL and used linear regression to compare unadjusted and adjusted means.

RESULTS

We identified 877 women divided among SGA (2%), PTB (10%), and normal groups (88%). The SGA group had higher unadjusted and adjusted AL scores than did the normal group (2.82 ± 0.35 vs. 1.92 ± 0.07, p=0.011); women in the PTB group had higher AL scores than did the referent in adjusted analyses (2.58 ± 0.21 vs. 1.92 ± 0.07, p=0.001).

CONCLUSIONS

Women with history of SGA or PTB had higher AL than did those with normal birth weight outcomes. This suggests a link between adverse pregnancy outcomes, chronic stress, and subclinical disease.

Gestational age and newborn size according to parental social mobility: an intergenerational cohort study

Background

We examined the associations between socioeconomic trajectories from birth to adulthood and gestational age and birth size in the next generation, using linked data from two population-based birth cohorts carried out in a Brazilian city. By comparing socioeconomic trajectories of mothers and fathers, we attempted to identify-specific effects of maternal and paternal socioeconomic trajectory on offspring birth weight, birth length, head circumference and gestational age at birth.

Methods

2 population-based birth cohort studies were carried out in 1982 and 2004 in Pelotas (Brazil); 156 mothers and 110 fathers from the earlier cohort had children in 2004. Gestational age and birth length, weight and head circumference were measured. Analyses were carried out separately for mothers and fathers. Mediation analyses assessed the role of birth weight and adult body mass index (BMI).

Results

Among mothers, but not for fathers, childhood poverty was strongly associated with smaller size in the next generation (about 400 g in weight and 1.5 cm in height) and shorter gestations (about 2 weeks). Adult poverty did not play a role. For mothers, the associations with gestational age, birth length and weight—but not with head circumference—persisted after adjusting for maternal birth weight and for the height and weight of the grandmother. Maternal birth weight did not mediate the observed associations, but high maternal BMI in adulthood was partly responsible for the association with gestational age.

Conclusions

Strong effects of early poverty on gestational age and birth size in the next generation were observed among mothers, but not among fathers. These findings suggest a specific maternal effect of socioeconomic trajectory, and in particular of early poverty on offspring size and duration of pregnancy.

Race-Ethnicity, Poverty, Urban Stressors, and Telomere Length in a Detroit Community-based Sample

Residents of distressed urban areas suffer early aging-related disease and excess mortality. Using a community-based participatory research approach in a collaboration between social researchers and cellular biologists, we collected a unique data set of 239 black, white, or Mexican adults from a stratified, multistage probability sample of three Detroit neighborhoods. We drew venous blood and measured telomere length (TL), an indicator of stress-mediated biological aging, linking respondents' TL to their community survey responses. We regressed TL on socioeconomic, psychosocial, neighborhood, and behavioral stressors, hypothesizing and finding an interaction between poverty and racial-ethnic group. Poor whites had shorter TL than nonpoor whites; poor and nonpoor blacks had equivalent TL; and poor Mexicans had longer TL than nonpoor Mexicans. Findings suggest unobserved heterogeneity bias is an important threat to the validity of estimates of TL differences by race-ethnicity. They point to health impacts of social identity as contingent, the products of structurally rooted biopsychosocial processes.

Using a life course model to examine racial disparities in low birth weight during adolescence and young adulthood

INTRODUCTION

This study examined relationships between health, social, environmental, and economic factors during adolescence and the subsequent risk of giving birth to a low-birth-weight (LBW) infant, to inform strategies for reducing racial disparities in LBW.

METHODS

Data were derived from the National Longitudinal Study of Adolescent Health. A sample of 1213 adolescents, reporting on first pregnancies, was created with 35% black, non-Hispanic (black) and 65% white, non-Hispanic (white) participants. Independent variables were from the domains of individual characteristics, health status, access to care, and social environment. The dependent variable was low birth weight. Overall and race-specific logistic regression models were estimated.

RESULTS

Black women had 1.9 times the odds of giving birth to an LBW infant as white women. Factors associated with LBW differed between black women and white women. Black women with a history of hypertension were 6 times more likely to have an LBW infant. Intimate partner support during prenatal care was protective for black women. Factors associated with an increased risk of giving birth to an LBW infant for white women included an intergenerational pattern of LBW, low body mass index during adolescence, and smoking during pregnancy. Socioeconomic factors during adolescence did not predict the odds of having an LBW infant for either group, except for white women whose parents had less than a high school education and black women living in medium-poverty neighborhoods.

DISCUSSION

Findings suggest that strategies to reduce racial disparities should address the specific needs of the population being served over the life course.

Race/ethnicity and the socioeconomic status gradient in women's cancer screening utilization: a case of diminishing returns?

Using three years (2006, 2008, 2010) of nationally representative data from the Behavioral Risk Factor Surveillance System, I assessed the socioeconomic status (SES) gradient for odds of receiving a mammogram in the past two years and a Pap test in the past three years among White, Black, Hispanic, and Asian women living in the U.S. Mammogram and Pap test utilization were less likely among low-SES women. However, women of color experience less benefit than Whites from increasing SES for both screenings; as income and education increased, White women experienced more pronounced increases in the likelihood of being screened than did women of color. In what might be referred to as paradoxical returns, Asian women actually experienced a decline in the likelihood of obtaining a recent Pap test at higher levels of education. My findings suggest that women of color differ from Whites in the extent to which increasing socioeconomic resources is associated with increasing cancer screening utilization.

The role of socioeconomic factors in Black-White disparities in preterm birth

OBJECTIVES

We investigated the role of socioeconomic factors in Black-White disparities in preterm birth (PTB).

METHODS

We used the population-based California Maternal and Infant Health Assessment survey and birth certificate data on 10 400 US-born Black and White California residents who gave birth during 2003 to 2010 to examine rates and relative likelihoods of PTB among Black versus White women, with adjustment for multiple socioeconomic factors and covariables.

RESULTS

Greater socioeconomic advantage was generally associated with lower PTB rates among White but not Black women. There were no significant Black-White disparities within the most socioeconomically disadvantaged subgroups; Black-White disparities were seen only within more advantaged subgroups.

CONCLUSIONS

Socioeconomic factors play an important but complex role in PTB disparities. The absence of Black-White disparities in PTB within certain socioeconomic subgroups, alongside substantial disparities within others, suggests that social factors moderate the disparity. Further research should explore social factors suggested by the literature-including life course socioeconomic experiences and racism-related stress, and the biological pathways through which they operate-as potential contributors to PTB among Black and White women with different levels of social advantage.

Small-for-gestational age Portuguese babies: the effect of childhood social environment, growth and adult socioeconomic conditions

OBJECTIVE

We aimed to estimate the extent to which differences in small-for-gestational age (SGA) according to maternal socioeconomic position (SEP) and anthropometrics are accounted for childhood background.

METHODS

Adult mothers of singletons (n=6893) recruited in 2005/2006 in Porto, Portugal self-reported data on socio-demographics. Grandparents' education and social class were used to characterise childhood social environment. Maternal education and marital status were used as adult SEP indicators. Height was categorised according to the 10th and 90th percentiles. The odds of SGA according to adult SEP and height were stratified by childhood conditions.

RESULTS

SGA (14.5%) was less likely in taller [vs. 10th-90th percentiles: 0.62 (95% confidence interval (CI): 0.46-0.83)], more educated [vs. low: 0.77 (0.65-0.90)] and in married women [vs. single: 0.64 (0.47-0.86)]. No association was found between childhood social conditions and SGA. The protection provided by maternal education was found in women from deprived childhood backgrounds but not in those with more advantage conditions. Shorter women were more likely to deliver SGA babies but the effect was stronger (pinteraction<0.001) in those from least deprived childhood conditions.

CONCLUSIONS

Sufficient increase in education seems to overcome disadvantage earlier in life. Other pathological processes might impact physical development beyond social influence, having long lasting effects on SGA.

Conquering racial disparities in perinatal outcomes

Infant mortality rate (IMR) is a reference indicator for societal health status. Trend analysis of IMR highlights 2 challenges to overcome in the United States: (1) US IMR is higher than most industrialized countries and (2) there are persistent racial/ethnic disparities in birth outcomes, especially for blacks. Racial/ethnic infant mortality disparities result from the complex interplay of adverse social, economic, and environmental exposures. In this article, racial/ethnic disparities are discussed, highlighting trends, the role of epigenetics in understanding mechanisms, key domains of community action planning, and programs and policies addressing the racial gaps in adverse birth outcomes.

Exploration of preterm birth rates using the public health exposome database and computational analysis methods

Recent advances in informatics technology has made it possible to integrate, manipulate, and analyze variables from a wide range of scientific disciplines allowing for the examination of complex social problems such as health disparities. This study used 589 county-level variables to identify and compare geographical variation of high and low preterm birth rates. Data were collected from a number of publically available sources, bringing together natality outcomes with attributes of the natural, built, social, and policy environments. Singleton early premature county birth rate, in counties with population size over 100,000 persons provided the dependent variable. Graph theoretical techniques were used to identify a wide range of predictor variables from various domains, including black proportion, obesity and diabetes, sexually transmitted infection rates, mother’s age, income, marriage rates, pollution and temperature among others. Dense subgraphs (paracliques) representing groups of highly correlated variables were resolved into latent factors, which were then used to build a regression model explaining prematurity (R-squared = 76.7%). Two lists of counties with large positive and large negative residuals, indicating unusual prematurity rates given their circumstances, may serve as a starting point for ways to intervene and reduce health disparities for preterm births.

Childbearing postponement and child well-being: a complex and varied relationship?

Over the past several decades, U.S. fertility has followed a trend toward the postponement of motherhood. The socioeconomic causes and consequences of this trend have been the focus of attention in the demographic literature. Given the socioeconomic advantages of those who postpone having children, some authors have argued that the disadvantage experienced by certain groups would be reduced if they postponed their births. The weathering hypothesis literature, by integrating a biosocial perspective, complicates this argument and posits that the costs and benefits of postponement may vary systematically across population subgroups. In particular, the literature on the weathering hypothesis argues that, as a consequence of their unique experiences of racism and disadvantage, African American women may experience a more rapid deterioration of their health which could offset or eventually reverse any socioeconomic benefit of postponement. But because very few African American women postpone motherhood, efforts to find compelling evidence to support the arguments of this perspective rely on a strategy of comparison that is problematic because a potentially selected group of older black mothers are used to represent the costs of postponement. This might explain why the weathering hypothesis has played a rather limited role in the way demographers conceptualize postponement and its consequences for well-being. In order to explore the potential utility of this perspective, we turn our attention to the UK context. Because first-birth fertility schedules are similar for black and white women, we can observe (rather than assume) whether the meaning and consequences of postponement vary across these population subgroups. The results, obtained using linked UK census and birth record data, reveal evidence consistent with the weathering hypothesis in the United Kingdom and lend support to the arguments that the demographic literature would benefit from integrating insights from this biosocial perspective.

Residential mobility across local areas in the United States and the geographic distribution of the healthy population

Determining whether population dynamics provide competing explanations to place effects for observed geographic patterns of population health is critical for understanding health inequality. We focus on the working-age population-the period of adulthood when health disparities are greatest-and analyze detailed data on residential mobility collected for the first time in the 2000 U.S. census. Residential mobility over a five-year period is frequent and selective, with some variation by race and gender. Even so, we found little evidence that mobility biases cross-sectional snapshots of local population health. Areas undergoing large or rapid population growth or decline may be exceptions. Overall, place of residence is an important health indicator; yet, the frequency of residential mobility raises questions of interpretation from etiological or policy perspectives, complicating simple understandings that residential exposures alone explain the association between place and health. Psychosocial stressors related to contingencies of social identity associated with being black, urban, or poor in the United States may also have adverse health impacts that track with structural location even with movement across residential areas.

Contextualizing racial disparities in preterm delivery: a rhetorical analysis of U.S. epidemiological research at the turn of the 21st century

Preterm delivery (PTD), defined as delivery prior to 37 weeks gestation, is a key contributor to persistent racial disparities in infant mortality in the United States. Five major funding initiatives were devoted to advancing PTD epidemiology during the 1990s and 2000s. By examining content and rhetorical features of 94 studies conducted under these initiatives, and published between 1993 and 2011, this paper considers how calls for more "contextual" approaches (focusing on social and environmental contexts) interacted with more "conventional" approaches (focusing on individual-level risk factors) to PTD epidemiology during this period. Contextual advocates initially emphasized complex biosocial reasoning to better connect social adversity with embodied outcomes. Yet responses by researchers invested in conventional approaches, as well as in studies published under new initiatives that explicitly claimed to incorporate contextual insights, often reframed this complex reasoning in biologically reductionist terms. Subsequent contextual advocates then focused on developing statistical methods to support research about social and environmental causes of PTD, and this strategy appears to have gained some traction with conventional researchers. These findings call for closer attention to language and power in both social scientific studies of epidemiological knowledge production, as well as among epidemiologists themselves.

Do post-migration perceptions of social mobility matter for Latino immigrant health?

Latino immigrants exhibit health declines with increasing duration in the United States, which some attribute to a loss in social status after migration or downward social mobility. Yet, research into the distribution of perceived social mobility and patterned associations to Latino health is sparse, despite extensive research to show that economic and social advancement is a key driver of voluntary migration. We investigated Latino immigrant sub-ethnic group variation in the distribution of perceived social mobility, defined as the difference between respondents' perceived social status of origin had they remained in their country of origin and their current social status in the U.S. We also examined the association between perceived social mobility and past-year major depressive episode (MDE) and self-rated fair/poor physical health, and whether Latino sub-ethnicity moderated these associations. We computed weighted logistic regression analyses using the Latino immigrant subsample (N=1561) of the National Latino and Asian American Study. Puerto Rican migrants were more likely to perceive downward social mobility relative to Mexican and Cuban immigrants who were more likely to perceive upward social mobility. Perceived downward social mobility was associated with increased odds of fair/poor physical health and MDE. Latino sub-ethnicity was a statistically significant moderator, such that perceived downward social mobility was associated with higher odds of MDE only among Puerto Rican and Other Latino immigrants. In contrast, perceived upward social mobility was not associated with self-rated fair/poor physical health. Our findings suggest that perceived downward social mobility might be an independent correlate of health among Latino immigrants, and might help explain Latino sub-ethnic group differences in mental health status. Future studies on Latino immigrant health should use prospective designs to examine the physiological and psychological costs associated with perceived changes in social status with integration into the U.S. mainland.

Construction of early and midlife work trajectories in women and their association with birth weight

OBJECTIVES

We derived trajectories of the substantive complexity (SC) of work across mid-adult life in women and determined their association with term birth weight. SC is a concept that encompasses decision latitude, active learning, and ability to use and expand one's abilities at work.

METHODS

Using occupational data from the National Longitudinal Survey of Youth 1979 and O*NET work variables, we used growth mixture modeling (GMM) to construct longitudinal trajectories of work SC from the ages of 18 to 34 years. The association between work trajectories and birth weight of infants born to study participants was modeled using generalized estimating equations, adjusting for education, income, and relevant covariates.

RESULTS

GMM yielded a 5-class solution for work trajectories in women. Higher work trajectories were associated with higher term birth weight and were robust to the inclusion of both education and income. A work trajectory that showed a sharp rise after age 24 years was associated with marked improvement in birth weight.

CONCLUSIONS

Longitudinal modeling of work characteristics might improve capacity to integrate occupation into a life-course model that examines antecedents and consequences for maternal and child health.

Influence of maternal height and weight on low birth weight: a cross-sectional study in poor communities of northeastern Brazil

Background

Low birth weight (LBW) is associated with an increased risk of mortality, adverse metabolic conditions, and long-term chronic morbidities. The relationship between LWB and short maternal stature coupled with nutritional status was investigated in poor communities.

Methods/Principal Findings

A cross-sectional population-based study involving 2226 mother-child pairs was conducted during the period 2009-2010 in shantytowns of Maceió, Alagoas, Brazil. Associations between LBW and maternal sociodemographics, stature and nutritional status were investigated. The outcome variable was birth weight (< 2500g and ≥ 2500g). The independent variables were the age, income, educational background, stature and nutritional status (eutrophic, underweight, overweight and obese) of the mother. The frequency of LBW was 10%. Short-statured mothers (1^st quartile of stature ≤ 152cm) showed a tendency of increased risk of LBW children compared to mothers in the 4^th quartile of stature (>160.4cm) (OR: 1.42, 95% CI: 0.96 - 1.09, p = 0.078). Children from short-statured mothers weighed an average of 125g less than those from taller mothers (3.18±0.56kg vs. 3.30±0.58kg, respectively p = 0.002). Multivariate analyses showed that short stature, age < 20y (OR: 3.05, 95% CI:1.44 - 6.47) or were underweight (OR: 2.26, 95% CI:0.92 - 5.95) increased the risk of LBW, while overweight (OR: 0.38, 95% CI:0.16 - 0.95) and obesity (OR: 0.39, 95% CI:0.11 - 1.31) had lower risk for LBW. In taller mothers, lower income and underweight were associated with LBW (OR: 1.88, 95% CI: 1.07 - 3.29 and 2.85, 95% CI:1.09 - 7.47, respectively), and obese mothers showed a trend of increased risk of LBW (OR: 1.66, 95% CI:0.84 - 3.25).

Conclusions/Significance

Overweight was found to have a protective effect in short-statured mothers, indicating that a surplus of energy may diminish the risk of LBW. Short-statured younger mothers, but not taller ones, showed higher risk of LBW. The mother being underweight, regardless of stature, was associated with LBW.

Relationship between hair cortisol and perceived chronic stress in a diverse sample

Hair cortisol (CORT) is a biomarker of chronic stress via long-term alterations in hypothalamus-pituitary-adrenal axis activity. Relationships to perceived stress measures, however, have rarely been specifically investigated. A diverse sample of 135 adults participated in a study assessing relationships between chronic stress indicator CORT to perceived stress and health indicators. CORT was not correlated to single perceived domain indices but with a global stress composite. Differences in objective and subjective measures were found for sociodemographics: racial/ethnic identity, sex and socioeconomic status (SES). Race by SES interactions predicted both CORT and perceived stress, but produced a complex and partially unanticipated pattern of results. For minorities, low and high SES showed the highest CORT, with mid-SES showing the lowest CORT; there was little change in perceived stress at all levels of SES. For non-minorities, mid-SES showed the highest CORT, with decreases in both CORT and perceived stress in high SES. The unanticipated findings of deleterious outcomes for high SES minorities highlight the importance of investigating potential stressors and moderators, including perceived discrimination and social identity. Moreover, these results suggest that CORT may not always correlate with single stress indices but may provide a global assessment of chronic stress, with implications for the allostatic load literature.

Transgenerational Consequences of Racial Discrimination for African American Health

Disparities in African American health remain pervasive and persist transgenerationally. There is a growing consensus that both structural and interpersonal racial discrimination are key mechanisms affecting African American health. The Biopsychosocial Model of Racism as a Stressor posits that the persistent stress of experiencing discrimination take a physical toll on the health of African Americans and is ultimately manifested in the onset of illness. However, the degree to which the health consequences of racism and discrimination can be passed down from one generation to the next is an important avenue of exploration. In this review, we discuss and link literature across disciplines demonstrating the harmful impact of racism on African American physical health and the health of their offspring.

The social determinants of infant mortality and birth outcomes in Western developed nations: a cross-country systematic review

Infant mortality (IM) and birth outcomes, key population health indicators, have lifelong implications for individuals, and are unequally distributed globally. Even among western industrialized nations, striking cross-country and within-country patterns are evident. We sought to better understand these variations across and within the United States of America (USA) and Western Europe (WE), by conceptualizing a social determinants of IM/birth outcomes framework, and systematically reviewing the empirical literature on hypothesized social determinants (e.g., social policies, neighbourhood deprivation, individual socioeconomic status (SES)) and intermediary determinants (e.g., health behaviours). To date, the evidence suggests that income inequality and social policies (e.g., maternal leave policies) may help to explain cross-country variations in IM/birth outcomes. Within countries, the evidence also supports neighbourhood SES (USA, WE) and income inequality (USA) as social determinants. By contrast, within-country social cohesion/social capital has been underexplored. At the individual level, mixed associations have been found between individual SES, race/ethnicity, and selected intermediary factors (e.g., psychosocial factors) with IM/birth outcomes. Meanwhile, this review identifies several methodological gaps, including the underuse of prospective designs and the presence of residual confounding in a number of studies. Ultimately, addressing such gaps including through novel approaches to strengthen causal inference and implementing both health and non-health policies may reduce inequities in IM/birth outcomes across the western developed world.

Explaining racial disparities in infant health in Brazil

OBJECTIVES

We sought to quantify how socioeconomic, health care, demographic, and geographic effects explain racial disparities in low birth weight (LBW) and preterm birth (PTB) rates in Brazil.

METHODS

We employed a sample of 8949 infants born between 1995 and 2009 in 15 cities and 7 provinces in Brazil. We focused on disparities in LBW (< 2500 g) and PTB (< 37 gestational weeks) prevalence between infants of African ancestry alone or African mixed with other ancestries, and European ancestry alone. We used a decomposition model to quantify the contributions of conceptually relevant factors to these disparities.

RESULTS

The model explained 45% to 94% of LBW and 64% to 94% of PTB disparities between the African ancestry groups and European ancestry. Differences in prenatal care use and geographic location were the most important contributors, followed by socioeconomic differences. The model explained the majority of the disparities for mixed African ancestry and part of the disparity for African ancestry alone.

CONCLUSIONS

Public policies to improve children's health should target prenatal care and geographic location differences to reduce health disparities between infants of African and European ancestries in Brazil.

Residential segregation and the health of African-American infants: does the effect vary by prevalence?

Segregation effects may vary between areas (e.g., counties) of low and high low birth weight (LBW; <2,500 g) and preterm birth (PTB; <37 weeks of gestation) rates due to interactions with area differences in risks and resources. We assess whether the effects of residential segregation on county-level LBW and PTB rates for African-American infants vary by the prevalence of these conditions. The study sample includes 368 counties of 100,000 or more residents and at least 50 African-American live births in 2000. Residentially segregated counties are identified alternatively by county-level dissimilarity and isolation indices. Quantile regression is used to assess how residential segregation affects the entire distributions of county-level LBW and PTB rates (i.e. by prevalence). Residential segregation increases LBW and PTB rates significantly in areas of low prevalence, but has no such effects for areas of high prevalence. As a sensitivity analysis, we use metropolitan statistical area level data and obtain similar results. Our findings suggest that residential segregation has adverse effects mainly in areas of low prevalence of LBW and preterm birth, which are expected overall to have fewer risk factors and more resources for infant health, but not in high prevalence areas, which are expected to have more risk factors and fewer resources. Residential policies aimed at area resource improvements may be more effective.

Mediators of adverse birth outcomes among socially disadvantaged women

BACKGROUND

Numerous studies find that socially disadvantaged women are more likely than socially advantaged women to deliver infants that weigh less than normal and/or are born weeks prior to their due date. However, little is known about the pathways that link maternal social disadvantage to birth outcomes. Using data from a prospective cohort study, we examined whether antenatal psychosocial stress, substance use, and maternal health conditions in pregnancy mediated the pathway between maternal social disadvantage and birth outcomes.

METHODS

Analyses used structural equation modeling to examine data from a community clinic-based sample (n=2168) of pregnant women who completed questionnaires assessing psychosocial functioning and health behaviors as well as sociodemographic characteristics, which were matched with subsequent birth outcome data.

RESULTS

Analyses revealed maternal social disadvantage predicted poorer birth outcomes through a mediated pathway including maternal health conditions in pregnancy.

CONCLUSIONS

The findings demonstrate that maternal social disadvantage is associated with poor health status in pregnancy, which in turn adversely affects birth outcomes. Results argue for more systematic attention to the roles of social disadvantage, including life course perspectives that trace social disadvantage prior to and through pregnancy.

Are benefits conferred with greater socioeconomic position undermined by racial discrimination among African American men?

BACKGROUND: conventional wisdom suggests that increased socioeconomic resources should be related to better health. Considering the body of evidence demonstrating the significant association between racial discrimination and depression, we examined whether exposure to racial discrimination could attenuate the positive effects of increased levels of socioeconomic position (SEP) among African Americans. Specifically, this paper investigated the joint interactive effects of SEP and racial discrimination on the odds of depression among African Americans. METHODS: racial discrimination was measured using two measures, major and everyday discrimination. Study objectives were achieved using data from the National Survey of American Life, which included a nationally representative sample of African Americans (n =3570). Logistic regression models were used to estimate the effects of SEP and racial discrimination on the odds of depression. RESULTS: reports of racial discrimination were associated with increased risk of depression among American African men who possessed greater levels of education and income. Among African American men, significant, positive interactions were observed between education and experiences of major discrimination, which were associated with greater odds of depression (P = 0.02). Additionally, there were positive interactions between income and both measures of racial discrimination (income x everyday discrimination, P = 0.013; income x major discrimination, P = 0.02), which were associated with increased odds of depression (P = 0.02). CONCLUSIONS: it is possible that experiences of racial discrimination could, in part, diminish the effects of increased SEP among African American men.

Individual and community predictors of maternal smoking in the city of Baltimore: what can be learned from a predominantly minority case controlled study?

This case control study of 1,000 birth certificates examined what individual and community factors predicted maternal smoking in Baltimore, Maryland. Conditional multinomial logistic regression results indicated women who were White were more likely to start smoking at a young age, but as they got older, they were less likely to smoke. Minority women were more likely to start smoking at a later age. Also, White women were more likely to smoke as the rate of poverty increased, while for minority women, smoking was unrelated to whether they lived in higher or lower poverty areas. Medical assistance status, community education level, and crime rate were not found to be related to smoking status.

The role of maternal early-life and later-life risk factors on offspring low birth weight: findings from a three-generational study

PURPOSE

This study examined three research questions: (1) Is there an association between maternal early-life economic disadvantage and the birth weight of later-born offspring? (2) Is there an association between maternal abuse in childhood and the birth weight of later-born offspring? (3) To what extent are these early-life risks mediated through adolescent and adult substance use, mental and physical health status, and adult socioeconomic status (SES)?

METHODS

Analyses used structural equation modeling to examine data from two longitudinal studies, which included three generations. The first generation (G1) and the second generation (G2) were enrolled in the Seattle Social Development Project (SSDP), and the third generation (G3) was enrolled in the SSDP Intergenerational Project. Data for the study (N = 136) focused on (G2) mothers enrolled in the SSDP and their children (G3).

RESULTS

Analyses revealed that G2 low childhood SES predicted G3 offspring birth weight. Early childhood abuse among G2 respondents predicted G3 offspring birth weight through a mediated pathway including G2 adolescent substance use and G2 prenatal substance use. Birth weight was unrelated to maternal adult SES, depression, or obesity.

CONCLUSIONS

To our knowledge, this is the first study to identify the effect of maternal early-life risks of low childhood SES and child maltreatment on later-born offspring birth weight. These findings have far-reaching effects on the cumulative risk associated with early-life economic disadvantage and childhood maltreatment. Such findings encourage policies and interventions that enhance child health at birth by taking the mother's own early-life and development into account.

African American women's lifetime upward economic mobility and preterm birth: the effect of fetal programming

OBJECTIVES

We investigated whether African American mothers' upward economic mobility across the life course and having been of low birth weight are associated with the preterm birth of their children.

METHODS

We performed stratified and multilevel logistic regression analyses on an Illinois transgenerational data set of African American infants (born 1989-1991) and their mothers (n = 11 265; born 1956-1976) with appended US Census income information.

RESULTS

African American mothers with a lifelong residence in impoverished neighborhoods had a preterm birthrate of 18.7%. African American mothers with early life impoverishment who experienced low, modest, or high upward economic mobility by adulthood had lower preterm birthrates of 16.0% (rate ratio [RR] = 0.9; 95% confidence interval [CI] = 0.8, 0.9), 15.2% (RR = 0.8; 95% CI = 0.7, 0.9), and 12.4% (RR = 0.7; 95% CI = 0.6, 0.8), respectively. In multilevel logistic regression models of former low birth weight and non-low birth weight mothers aged 20 to 35 years, the adjusted odds ratio (95% confidence interval) of preterm birth for those who experienced high upward economic mobility (vs those with lifelong impoverishment) was 0.9 (0.5-1.6) and 0.7 (0.5-0.9), respectively.

CONCLUSIONS

African American mother's upward economic mobility from early life impoverishment is associated with a decreased risk of preterm birth. However, consistent with fetal programming, this phenomenon fails to occur among mothers born at low birth weight.

Race/ethnicity, socioeconomic characteristics, coethnic social ties, and health: evidence from the national Jewish population survey

OBJECTIVES

We explored whether a White ethnic group with a history of structural disadvantage, Jewish Americans, shows evidence of continuing health impact independent of socioeconomic position (SEP), whether coethnic social ties appear health protective, and whether the strength of any protection varies by SEP.

METHODS

In a series of ordered logistic regressions, we analyzed data from the National Jewish Population Survey, 2000-2001, regressing self-rated health on race/ethnicity, education, and income for US Blacks, Jews, and other Whites and, for Jews alone, indicators of coethnic social ties.

RESULTS

controlling for SEP indicators, the self-rated health of Jews converged with that of Blacks and was significantly worse than that of other Whites. Access to coethnic social ties was associated with better self-rated health among Jews, with the strongest estimated association among those of lower SEP.

CONCLUSIONS

The finding that a White ethnic group with a favorable socioeconomic profile reported significantly worse health than did other Whites, after controlling for SEP, calls for better understanding of the complex interplay of cultural, psychosocial, and socioeconomic resources in shaping population health.

Examining alternative measures of social disadvantage among Asian Americans: the relevance of economic opportunity, subjective social status, and financial strain for health

Socioeconomic position is often operationalized as education, occupation, and income. However, these measures may not fully capture the process of socioeconomic disadvantage that may be related to morbidity. Economic opportunity, subjective social status, and financial strain may also place individuals at risk for poor health outcomes. Data come from the Asian subsample of the 2003 National Latino and Asian American Study (n = 2095). Regression models were used to examine the associations between economic opportunity, subjective social status, and financial strain and the outcomes of self-rated health, body mass index, and smoking status. Education, occupation, and income were also investigated as correlates of these outcomes. Low correlations were observed between all measures of socioeconomic status. Economic opportunity was robustly negatively associated with poor self-rated health, higher body mass index, and smoking, followed by financial strain, then subjective social status. Findings show that markers of socioeconomic position beyond education, occupation, and income are related to morbidity among Asian Americans. This suggests that potential contributions of social disadvantage to poor health may be understated if only conventional measures are considered among immigrant and minority populations.

The myth of meritocracy and African American health

Recent theoretical and empirical studies of the social determinants of health inequities have shown that economic deprivation, multiple levels of racism, and neighborhood context limit African American health chances and that African Americans' poor health status is predicated on unequal opportunity to achieve the American Dream. President Obama's election has been touted as a demonstration of American meritocracy-the belief that all may obtain the American Dream-and has instilled hope in African Americans. However, we argue that in the context of racism and other barriers to success, meritocratic ideology may act as a negative health determinant for African Americans.

Exploring weathering: effects of lifelong economic environment and maternal age on low birth weight, small for gestational age, and preterm birth in African-American and white women

White women experience their lowest rate of low birth weight (LBW) in their late 20s; the nadir LBW for African-American women is under 20 years with rates rising monotonically thereafter, hypothesized as due to "weathering" or deteriorating health with cumulative disadvantage. Current residential environment affects birth outcomes for all women, but little is known about the impact of early life environment. The authors linked neighborhood income to a transgenerational birth file containing infant and maternal birth data, allowing assessment of economic effects over a woman's life course. African-American women who were born in poorer neighborhoods and were still poor as mothers showed significant weathering with regard to LBW and small for gestational age (SGA) but not preterm birth (PTB). However, African-American women in upper-income areas at both time points had a steady fall in LBW and SGA rate with age, similar to the pattern seen in white women. No group of white women, even those always living in poorer neighborhoods, exhibited weathering with regard to LBW, SGA, or PTB. In contrast, the degree of weathering among African-American women is related to duration of exposure to low-income areas and disappears for those with a life residence in non-poor neighborhoods.

Invited commentary: the socioeconomic causes of adverse birth outcomes

Weathering-the cumulative burden of adverse psychosocial and economic circumstances on the bodies of minority women-has been repeatedly described in epidemiologic studies. The most common application has been the documentation of rapidly increasing risks of adverse birth outcomes as African-American women age. Previous work has been based largely on cross-sectional data that aggregate women across a variety of socioeconomic circumstances. When more specific information about women's life-course socioeconomic status is taken into account, however, heterogeneity in the weathering experience of African-American women becomes more readily apparent. Adverse birth outcome risk trajectories with advancing age for African-American women who reside in wealthier neighborhoods look much more similar to those of white women. The accompanying article by Love et al. (Am J Epidemiol. 2010;172(2):127-134) provides a more nuanced investigation of the social conditions that contribute to the weathering of African-American women and points to the critical role played by social and economic conditions over the life course in producing adverse birth outcome disparities.

Fetal origins of renal disparities

Epidemiologic studies of populations continue to emerge showing that early-life factors influence the risk of developing several chronic diseases of adulthood. Susceptibility to environmental factors is particularly problematic during renal development, which is not complete until 36 weeks of gestation. Environmental deprivation may lead to adaptations including early growth restriction, whereas late insults may alter the kidney during the final stages of development. Because disparities among those who are more likely to have low birth weight mirrors the disparities observed among those more likely to develop kidney-related disorders, fetal origins have been presumed to explain some of the observed disparities. Although current empiric evidence supports a link between fetal programming and childhood/adult kidney disease, affected pathways may vary by race.

Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities

This paper provides an overview of racial variations in health and shows that differences in socioeconomic status (SES) across racial groups are a major contributor to racial disparities in health. However, race reflects multiple dimensions of social inequality and individual and household indicators of SES capture relevant but limited aspects of this phenomenon. Research is needed that will comprehensively characterize the critical pathogenic features of social environments and identify how they combine with each other to affect health over the life course. Migration history and status are also important predictors of health and research is needed that will enhance understanding of the complex ways in which race, SES, and immigrant status combine to affect health. Fully capturing the role of race in health also requires rigorous examination of the conditions under which medical care and genetic factors can contribute to racial and SES differences in health. The paper identifies research priorities in all of these areas.