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Holliday CN, Bevilacqua K, Grace KT, Denhard L, Kaur A, Miller J, Decker MR. Examining the Neighborhood Attributes of Recently Housed Partner Violence Survivors in Rapid Rehousing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084177. [PMID: 33920892 PMCID: PMC8071223 DOI: 10.3390/ijerph18084177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 11/25/2022]
Abstract
Survivors’ considerations for re-housing following intimate partner violence (IPV) are understudied despite likely neighborhood-level influences on women’s safety. We assess housing priorities and predictors of re-housing location among recent IPV survivors (n = 54) in Rapid Re-housing (RRH) in the Baltimore-Washington Metropolitan Area. Choropleth maps depict residential location relative to census tract characteristics (neighborhood deprivation index (NDI) and residential segregation) derived from American Community Survey data (2013–2017). Linear regression measured associations between women’s individual, economic, and social factors and NDI and segregation. In-depth interviews (n = 16) contextualize quantitative findings. Overall, survivors re-housed in significantly more deprived and racially segregated census tracts within their respective regions. In adjusted models, trouble securing housing (B = 0.74, 95% CI: 0.13, 1.34), comfortability with proximity to loved ones (B = 0.75, 95% CI: 0.02, 1.48), and being unsure (vs unlikely) about IPV risk (B = −0.76, 95% CI: −1.39, −0.14) were significantly associated with NDI. Economic dependence on an abusive partner (B = −0.31, 95% CI: −0.56, −0.06) predicted re-housing in segregated census tracts; occasional stress about housing affordability (B = 0.39, 95% CI: 0.04, 0.75) predicted re-housing in less segregated census tracts. Qualitative results contextualize economic (affordability), safety, and social (familiarity) re-housing considerations and process impacts (inspection delays). Structural racism, including discriminatory housing practices, intersect with gender, exacerbating challenges among survivors of severe IPV. This mixed-methods study further highlights the significant economic tradeoffs for safety and stability, where the prioritization of safety may exacerbate economic devastation for IPV survivors. Findings will inform programmatic policies for RRH practices among survivors.
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Affiliation(s)
- Charvonne N. Holliday
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (K.B.); (K.T.G.); (A.K.); (M.R.D.)
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Correspondence:
| | - Kristin Bevilacqua
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (K.B.); (K.T.G.); (A.K.); (M.R.D.)
| | - Karen Trister Grace
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (K.B.); (K.T.G.); (A.K.); (M.R.D.)
- Department of Advanced Nursing Practice, School of Nursing & Health Studies, Georgetown University, Washington, DC 20057, USA
| | - Langan Denhard
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Arshdeep Kaur
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (K.B.); (K.T.G.); (A.K.); (M.R.D.)
| | | | - Michele R. Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (K.B.); (K.T.G.); (A.K.); (M.R.D.)
- Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
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Masa R, Shangani S, Operario D. Socioeconomic Status and Psychosocial Resources Mediate Racial/Ethnic Differences in Psychological Health Among Gay and Bisexual Men: A Longitudinal Analysis Using Structural Equation Modeling. Am J Mens Health 2021; 15:15579883211001197. [PMID: 33724073 PMCID: PMC7970305 DOI: 10.1177/15579883211001197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A large body of research demonstrates disparities in psychological health attributed to sexual minority identity, racial/ethnic minority identity, and socioeconomic status (SES). Fewer studies have explicated the role of these multiple attributes on psychological health and explored the role of SES and psychosocial resources in determining outcomes. We analyzed data from Project STRIDE, a longitudinal survey involving a diverse sample of gay and bisexual adult men (n = 198). Using structural equation modeling, we tested hypothesized direct and indirect effects of race/ethnicity, SES, and three psychosocial mediational variables (collective self-efficacy, everyday discrimination, internalized homophobia) on two outcome variables-psychological and social well-being-assessed at 1-year follow-up. Our model indicated that: (1) race/ethnicity and SES were significantly associated with each other and with each psychosocial mediator; (2) higher SES was directly and indirectly associated with both measures of well-being; and (3) collective self-esteem and everyday discrimination mediated the association between SES and both measures of well-being. The model also indicated that racial/ethnic associations with psychological mediators and outcomes are evident in the context of SES, but these effects might be suppressed when the model does not consider SES. Findings highlight the critical role of SES and race/ethnicity in determining the psychological and social well-being of sexual minority men. Specification of mediating variables-collective self-efficacy, everyday discrimination, internalized homophobia-indicates potential intervention targets to improve psychological and social health in sexual minority men. Associations between race/ethnicity and SES support the need for intersectional frameworks in addressing the health of sexual minority men.
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Affiliation(s)
- Rainier Masa
- School of Social Work, University of North Carolina, Chapel Hill, NC, USA
| | - Sylvia Shangani
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA
| | - Don Operario
- School of Public Health, Brown University, Providence, RI, USA
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103
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Padula AM, Shariff-Marco S, Yang J, Jain J, Liu J, Conroy SM, Carmichael SL, Gomez SL, Phibbs C, Oehlert J, Gould JB, Profit J. Multilevel social factors and NICU quality of care in California. J Perinatol 2021; 41:404-412. [PMID: 32157221 PMCID: PMC7483231 DOI: 10.1038/s41372-020-0647-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 02/21/2020] [Accepted: 02/27/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Our objective was to incorporate social and built environment factors into a compendium of multilevel factors among a cohort of very low birth weight infants to understand their contributions to inequities in NICU quality of care and support providers and NICUs in addressing these inequities via development of a health equity dashboard. STUDY DESIGN We examined bivariate associations between NICU patient pool and NICU catchment area characteristics and NICU quality of care with data from a cohort of 15,901 infants from 119 NICUs in California, born 2008-2011. RESULT NICUs with higher proportion of minority racial/ethnic patients and lower SES patients had lower quality scores. NICUs with catchment areas of lower SES, higher composition of minority residents, and more household crowding had lower quality scores. CONCLUSION Multilevel social factors impact quality of care in the NICU. Their incorporation into a health equity dashboard can inform providers of their patients' potential resource needs.
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Affiliation(s)
- Amy M Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | - Juan Yang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer Jain
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Jessica Liu
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Shannon M Conroy
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | - Suzan L Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, USA
| | - Ciaran Phibbs
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - John Oehlert
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jeffrey B Gould
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jochen Profit
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
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104
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Shenassa ED, Widemann LG, Hunt CD. Antepartum Depression and Preterm Birth: Pathophysiology, Epidemiology, and Disparities due to structural racism. Curr Psychiatry Rep 2021; 23:14. [PMID: 33630175 DOI: 10.1007/s11920-021-01223-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Informed by the evidence of links between physiology of stress and parturition, we review recent epidemiologic evidence (2015-2020) of antenatal depression as a risk factor for preterm birth (PTB). We also explain racial/ethnic disparities in depression and preterm birth as a consequence of structural racism. RECENT FINDINGS Epidemiologic evidence is consistent in linking antepartum depression with an elevated risk of PTB. Antidepressant usage has been linked with an elevated risk of PTB. However, recent evidence suggests that severity of depression is the underlying driver of the elevated risk attributed to antidepressant usage. The number of depressive symptoms, as a proxy for severity of maternal stress, may be a more informative predictor of PTB than criterion based predictors. Across various study designs, measurement modalities, and populations, antenatal depression predicts an elevated risk of delivering preterm. The physiology of stress provides a plausible explanation for this observation. Excessive stress-induced elevations in maternal and then fetal HPA hormones can alter maternal and fetal homeostasis and hasten the timing of parturition. Antenatal depression and exposure to structural racism are two stressors that can trigger the maternal stress response. Chronically elevated levels of stress hormones among women of color in the USA provide a likely physiologic explanation for Black-White disparities in the risk of PTB. Focusing on the number of depressive symptoms as the more informative predictor of PTB raises several questions. We consider these questions as well as directions for future research in the context of recent advances in the field.
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Affiliation(s)
- Edmond D Shenassa
- Maternal & Child Health Program, Department of Family Science; and Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA. .,Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA. .,Department of Epidemiology & Biostatistics, School of Medicine, University of Maryland, Baltimore, MD, USA.
| | - Lea G Widemann
- Maternal & Child Health Program, Department of Family Science; and Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
| | - Cole D Hunt
- Maternal & Child Health Program, Department of Family Science; and Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
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105
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Wakeel F, Njoku A. Application of the Weathering Framework: Intersection of Racism, Stigma, and COVID-19 as a Stressful Life Event among African Americans. Healthcare (Basel) 2021; 9:145. [PMID: 33540498 PMCID: PMC7912903 DOI: 10.3390/healthcare9020145] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/16/2021] [Accepted: 01/27/2021] [Indexed: 11/16/2022] Open
Abstract
The disproportionate impact of coronavirus disease 2019 (COVID-19) on African American communities necessitates an increased focus on the intersectional roles of racism, stigma, and other social determinants of health in influencing disease and mortality risk. The Weathering Framework is applied to demonstrate the dynamic interrelationships between these factors and to conceptualize COVID-19 as a stressful life event that will have profound health implications over the life course for African Americans. Recommendations for population health research, interventions and policies aimed at reducing COVID-19 incidence and mortality, and mitigation of the long-term impacts of the pandemic on communities of color are discussed.
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Affiliation(s)
- Fathima Wakeel
- College of Health, Lehigh University, 1 W. Packer Ave., STEPS Building, Room 366, Bethlehem, PA 18015, USA
| | - Anuli Njoku
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, 144 Farnham Avenue, New Haven, CT 06515, USA;
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106
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Riggan KA, Gilbert A, Allyse MA. Acknowledging and Addressing Allostatic Load in Pregnancy Care. J Racial Ethn Health Disparities 2021; 8:69-79. [PMID: 32383045 PMCID: PMC7647942 DOI: 10.1007/s40615-020-00757-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/18/2020] [Accepted: 04/06/2020] [Indexed: 12/11/2022]
Abstract
The USA is one of the few countries in the world in which maternal and infant morbidity and mortality continue to increase, with the greatest disparities observed among non-Hispanic Black women and their infants. Traditional explanations for disparate outcomes, such as personal health behaviors, socioeconomic status, health literacy, and access to healthcare, do not sufficiently explain why non-Hispanic Black women continue to die at three to four times the rate of White women during pregnancy, childbirth, or postpartum. One theory gaining prominence to explain the magnitude of this disparity is allostatic load or the cumulative physiological effects of stress over the life course. People of color disproportionally experience social, structural, and environmental stressors that are frequently the product of historic and present-day racism. In this essay, we present the growing body of evidence implicating the role of elevated allostatic load in adverse pregnancy outcomes among women of color. We argue that there is a moral imperative to assign additional resources to reduce the effects of elevated allostatic load before, during, and after pregnancy to improve the health of women and their children.
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Affiliation(s)
- Kirsten A Riggan
- Biomedical Ethics Research Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Anna Gilbert
- Biomedical Ethics Research Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Megan A Allyse
- Biomedical Ethics Research Program, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
- Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA.
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107
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Dunlop AL, Essalmi AG, Alvalos L, Breton C, Camargo CA, Cowell WJ, Dabelea D, Dager SR, Duarte C, Elliott A, Fichorova R, Gern J, Hedderson MM, Thepaksorn EH, Huddleston K, Karagas MR, Kleinman K, Leve L, Li X, Li Y, Litonjua A, Ludena-Rodriguez Y, Madan JC, Nino JM, McEvoy C, O’Connor TG, Padula AM, Paneth N, Perera F, Sathyanarayana S, Schmidt RJ, Schultz RT, Snowden J, Stanford JB, Trasande L, Volk HE, Wheaton W, Wright RJ, McGrath M. Racial and geographic variation in effects of maternal education and neighborhood-level measures of socioeconomic status on gestational age at birth: Findings from the ECHO cohorts. PLoS One 2021; 16:e0245064. [PMID: 33418560 PMCID: PMC7794036 DOI: 10.1371/journal.pone.0245064] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022] Open
Abstract
Preterm birth occurs at excessively high and disparate rates in the United States. In 2016, the National Institutes of Health (NIH) launched the Environmental influences on Child Health Outcomes (ECHO) program to investigate the influence of early life exposures on child health. Extant data from the ECHO cohorts provides the opportunity to examine racial and geographic variation in effects of individual- and neighborhood-level markers of socioeconomic status (SES) on gestational age at birth. The objective of this study was to examine the association between individual-level (maternal education) and neighborhood-level markers of SES and gestational age at birth, stratifying by maternal race/ethnicity, and whether any such associations are modified by US geographic region. Twenty-six ECHO cohorts representing 25,526 mother-infant pairs contributed to this disseminated meta-analysis that investigated the effect of maternal prenatal level of education (high school diploma, GED, or less; some college, associate's degree, vocational or technical training [reference category]; bachelor's degree, graduate school, or professional degree) and neighborhood-level markers of SES (census tract [CT] urbanicity, percentage of black population in CT, percentage of population below the federal poverty level in CT) on gestational age at birth (categorized as preterm, early term, full term [the reference category], late, and post term) according to maternal race/ethnicity and US region. Multinomial logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CIs). Cohort-specific results were meta-analyzed using a random effects model. For women overall, a bachelor's degree or above, compared with some college, was associated with a significantly decreased odds of preterm birth (aOR 0.72; 95% CI: 0.61-0.86), whereas a high school education or less was associated with an increased odds of early term birth (aOR 1.10, 95% CI: 1.00-1.21). When stratifying by maternal race/ethnicity, there were no significant associations between maternal education and gestational age at birth among women of racial/ethnic groups other than non-Hispanic white. Among non-Hispanic white women, a bachelor's degree or above was likewise associated with a significantly decreased odds of preterm birth (aOR 0.74 (95% CI: 0.58, 0.94) as well as a decreased odds of early term birth (aOR 0.84 (95% CI: 0.74, 0.95). The association between maternal education and gestational age at birth varied according to US region, with higher levels of maternal education associated with a significantly decreased odds of preterm birth in the Midwest and South but not in the Northeast and West. Non-Hispanic white women residing in rural compared to urban CTs had an increased odds of preterm birth; the ability to detect associations between neighborhood-level measures of SES and gestational age for other race/ethnic groups was limited due to small sample sizes within select strata. Interventions that promote higher educational attainment among women of reproductive age could contribute to a reduction in preterm birth, particularly in the US South and Midwest. Further individual-level analyses engaging a diverse set of cohorts are needed to disentangle the complex interrelationships among maternal education, neighborhood-level factors, exposures across the life course, and gestational age at birth outcomes by maternal race/ethnicity and US geography.
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Affiliation(s)
- Anne L. Dunlop
- Woodruff Health Sciences Center, School of Medicine and Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, United States of America
| | - Alicynne Glazier Essalmi
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - Lyndsay Alvalos
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Carrie Breton
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Carlos A. Camargo
- Department of Epidemiology Harvard University, Cambridge, Massachusetts, United States of America
| | - Whitney J. Cowell
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Dana Dabelea
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Stephen R. Dager
- Department of Radiology and Bioengineering, University of Washington, Seattle, Washington, United States of America
| | - Cristiane Duarte
- Department of Psychiatry, Columbia University, New York, New York, United States of America
| | - Amy Elliott
- Avera Research Institute Center for Pediatric & Community Research, Sioux Falls, South Dakota, United States of America
| | - Raina Fichorova
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - James Gern
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, United States of America
| | - Monique M. Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States of America
| | - Elizabeth Hom Thepaksorn
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Kathi Huddleston
- College of Health and Human Services, George Mason University, Fairfax, Virginia, United States of America
| | - Margaret R. Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Ken Kleinman
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Leslie Leve
- Prevention Science Institute, University of Oregon, Eugene, Oregon, United States of America
| | - Ximin Li
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland United States of America
| | - Yijun Li
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland United States of America
| | - Augusto Litonjua
- Division of Pediatric Pulmonary Medicine, Golisano Children’s Hospital at Strong, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Yunin Ludena-Rodriguez
- Division of Environmental and Occupational Health, Public Health Sciences, School of Medicine, University of California, Davis, California, United States of America
| | - Juliette C. Madan
- Department of Epidemiology Geisel School of Medicine at Dartmouth Hitchcock Medical Center, Hanover, New Hampshire, United States of America
| | - Julio Mateus Nino
- Obstetrics and Gynecology, Maternal and Fetal Medicine, Atrium Health, Charlotte, North Carolina, United States of America
| | - Cynthia McEvoy
- Division of Neonatal, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Thomas G. O’Connor
- Department of Psychiatry, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Amy M. Padula
- Program on Reproductive Health and the Environment, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Nigel Paneth
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - Frederica Perera
- Department of Psychiatry, Columbia University, New York, New York, United States of America
| | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington & Seattle Children’s Research Institute, Seattle, Washington, United States of America
| | - Rebecca J. Schmidt
- Division of Environmental and Occupational Health, Public Health Sciences, School of Medicine, University of California, Davis, California, United States of America
| | - Robert T. Schultz
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Jessica Snowden
- Department of Pediatrics, University of Arkansas Medical Sciences, Little Rock, Arkansas, United States of America
| | - Joseph B. Stanford
- Department of Family Preventative Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Leonardo Trasande
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York, United States of America
| | - Heather E. Volk
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland United States of America
| | - William Wheaton
- Science and Technology Program, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Rosalind J. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Monica McGrath
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland United States of America
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Black Women's Perspectives on Structural Racism across the Reproductive Lifespan: A Conceptual Framework for Measurement Development. Matern Child Health J 2021; 25:402-413. [PMID: 33398713 DOI: 10.1007/s10995-020-03074-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Exposures to structural racism has been identified as one of the leading risk factors for adverse maternal and infant health outcomes among Black women; yet current measures of structural racism do not fully account for inequities seen in adverse maternal and infant health outcomes between Black and white women and infants. In response, the purpose of this study was to conceptualize structural racism from the perspectives of Black women across the reproductive lifespan and its potential impact on adverse maternal and infant health outcomes. METHODS We conducted a series of focus groups with 32 Black women across the reproductive lifespan (5 preconception, 13 pregnant, and 14 postpartum). Study criteria including self-identifying as Black, residing in Oakland or Fresno, California and representing one of three reproductive life tracks (preconception, pregnant, postpartum). We consulted with study participants and an expert advisory board to validate emergent domains of structural racism. RESULTS Nine domains of structural racism emerged from a ground theory constant comparative analysis: Negative Societal Views; Housing; Medical Care; Law Enforcement; Hidden Resources; Employment; Education, Community Infrastructure; and Policing Black Families. CONCLUSIONS FOR PRACTICE Findings from this study suggest that there is an interplay among structural racism, and social and structural determinants of health which has negative impacts on Black women's sexual and reproductive health. Furthermore, findings from this study can be used to develop more comprehensive medical assessments and policies to address structural racism experienced by Black women across the reproductive lifespan.
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109
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Gaining a deeper understanding of social determinants of preterm birth by integrating multi-omics data. Pediatr Res 2021; 89:336-343. [PMID: 33188285 PMCID: PMC7898277 DOI: 10.1038/s41390-020-01266-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/13/2020] [Accepted: 10/20/2020] [Indexed: 12/14/2022]
Abstract
In the US, high rates of preterm birth (PTB) and profound Black-White disparities in PTB have persisted for decades. This review focuses on the role of social determinants of health (SDH), with an emphasis on maternal stress, in PTB disparity and biological embedding. It covers: (1) PTB disparity in US Black women and possible contributors; (2) the role of SDH, highlighting maternal stress, in the persistent racial disparity of PTB; (3) epigenetics at the interface between genes and environment; (4) the role of the genome in modifying maternal stress-PTB associations; (5) recent advances in multi-omics studies of PTB; and (6) future perspectives on integrating multi-omics with SDH to elucidate the Black-White disparity in PTB. Available studies have indicated that neither environmental exposures nor genetics alone can adequately explain the Black-White PTB disparity. Preliminary yet promising findings of epigenetic and gene-environment interaction studies underscore the value of integrating SDH with multi-omics in prospective birth cohort studies, especially among high-risk Black women. In an era of rapid advancements in biomedical sciences and technologies and a growing number of prospective birth cohort studies, we have unprecedented opportunities to advance this field and finally address the long history of health disparities in PTB. IMPACT: This review provides an overview of social determinants of health (SDH) with a focus on maternal stress and its role on Black-White disparity in preterm birth (PTB). It summarizes the available literature on the interplay of maternal stress with key biological layers (e.g., individual genome and epigenome in response to environmental stressors) and significant knowledge gaps. It offers perspectives that such knowledge may provide deeper insight into how SDH affects PTB and why some women are more vulnerable than others and underscores the critical need for integrating SDH with multi-omics in prospective birth cohort studies, especially among high-risk Black women.
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110
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Partnering with Churches to Conduct a Wide-Scale Health Screening of an Urban, Segregated Community. J Community Health 2020; 45:98-110. [PMID: 31399892 DOI: 10.1007/s10900-019-00715-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
West Side Alive (WSA) is a partnership among pastors, church members and health researchers with the goal of improving health in the churches and surrounding community in the West Side of Chicago, a highly segregated African American area of Chicago with high rates of premature mortality and social disadvantage. To inform health intervention development, WSA conducted a series of health screenings that took place in seven partner churches. Key measures included social determinants of health and healthcare access, depression and PTSD screeners, and measurement of cardiometabolic risk factors, including blood pressure, weight, cholesterol and hemoglobin A1C (A1C). A total of 1106 adults were screened, consisting of WSA church members (n = 687), members of the local community served by the church (n = 339) and 80 individuals with unknown church status. Mean age was 52.8 years, 57% were female, and 67% reported at least one social risk factor (e.g. food insecurity). Almost all participants had at least one cardiovascular risk factor (92%), including 50% with obesity, 79% with elevated blood pressure and 65% with elevated A1C. A third of participants experienced ≥ 4 potentially traumatic events and 26% screened positive for depression and/or post-traumatic stress disorder. Participants were given personalized health reports and referred to services as needed. Information from the screenings will be used to inform the design of interventions targeting the West Side community and delivered in partnership with the churches. Sharing these results helped mobilize community members to improve their own health and the health of their community.
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Borrell LN, Kodali H, Rodriguez-Alvarez E. Interracial/ethnic marriage and adverse birth outcomes: The effect of neighborhood racial/ethnic composition. Soc Sci Med 2020; 270:113560. [PMID: 33385623 DOI: 10.1016/j.socscimed.2020.113560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/27/2020] [Accepted: 11/26/2020] [Indexed: 01/03/2023]
Abstract
Race/ethnicity is associated with adverse birth outcomes in the United States. However, mostly mother's race/ethnicity has been considered. We examined the associations of mother's and parents' race/ethnicity with low birth weight, small for gestational age, preterm birth and infant mortality among New York City women between 2012 and 2017. We also examined the independent and joint effects of neighborhood racial/ethnic composition. We found that mother's and parents' race/ethnicity are associated with adverse birth outcomes; these associations are outcome-specific; and neighborhood racial/ethnic composition is not only associated with such outcomes but also modifies the association of mother's and parents' race/ethnicity with these outcomes. Our findings underscore the need to consider the race/ethnicity of women's partners and their neighborhoods calling attention to the role of context where individuals reside, and their daily interactions take place. These findings may have implications beyond New York City as our society becomes more racial/ethnic diverse and interracial/ethnic marriage becomes more common in the United States.
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Affiliation(s)
- Luisa N Borrell
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA; OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU), Bizkaia, Spain; Department of Surgery, Medical and Social Science, University of Alcalá, Madrid, Spain.
| | - Hanish Kodali
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA.
| | - Elena Rodriguez-Alvarez
- OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU), Bizkaia, Spain; Department of Nursing I, University of the Basque Country (UPV/EHU), Bizkaia, Spain.
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Maternal Socioeconomic Factors and Racial/Ethnic Differences in Neonatal Anthropometry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197323. [PMID: 33036433 PMCID: PMC7579630 DOI: 10.3390/ijerph17197323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/25/2020] [Accepted: 09/30/2020] [Indexed: 12/29/2022]
Abstract
Disparities in birthweight by maternal race/ethnicity are commonly observed. It is unclear to what extent these disparities are correlates of individual socioeconomic factors. In a prospective cohort of 1645 low-risk singleton pregnancies included in the NICHD Fetal Growth Study (2009-2013), neonatal anthropometry was measured by trained personnel using a standard protocol. Socioeconomic characteristics included employment status, marital status, health insurance, annual income, and education. Separate adjusted generalized linear models were fit to both test the effect of race/ethnicity and the interaction of race/ethnicity and socioeconomic characteristics on neonatal anthropometry. Mean infant birthweight, length, head circumference, and abdominal circumference all differed by race/ethnicity (p < 0.001). We observed no statistically significant interactions between race/ethnicity and full-time employment/student status, marital status, insurance, or education in association with birthweight, neonatal exam weight, length, or head or abdominal circumference at examination. The interaction between income and race/ethnicity was significant only for abdominal circumference (p = 0.027), with no other significant interactions for other growth parameters, suggesting that racial/ethnic differences in neonatal anthropometry did not vary by individual socioeconomic factors in low-risk women. Our results do not preclude structural factors, such as lifetime exposure to poverty, as an explanation for racial/ethnic disparities.
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113
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Scott KA, Chambers BD, Baer RJ, Ryckman KK, McLemore MR, Jelliffe-Pawlowski LL. Preterm birth and nativity among Black women with gestational diabetes in California, 2013-2017: a population-based retrospective cohort study. BMC Pregnancy Childbirth 2020; 20:593. [PMID: 33023524 PMCID: PMC7541301 DOI: 10.1186/s12884-020-03290-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/27/2020] [Indexed: 02/08/2023] Open
Abstract
Background Despite the disproportionate prevalence of gestational diabetes (GDM) and preterm birth (PTB) and their associated adverse perinatal outcomes among Black women, little is known about PTB among Black women with GDM. Specifically, the relationship between PTB by subtype (defined as indicated PTB and spontaneous PT labor) and severity, GDM, and nativity has not been well characterized. Here we examine the risk of PTB by severity (early < 34 weeks, late 34 to 36 weeks) and early term birth (37 to 38 weeks) by nativity among Black women with GDM in California. Methods This retrospective cohort study used linked birth certificate and hospital discharge data for 8609 of the 100,691 self-identifying non-Hispanic Black women with GDM who had a singleton live birth between 20 and 44 weeks gestation in California in 2013–2017. Adjusted odds ratios (aOR) and 95% confidence intervals (CIs) were examine risks for PTB, by severity and subtype, and early term birth using multivariate regression modeling. Results Approximately, 83.9% of Black women with GDM were US-born and 16.1% were foreign-born. The overall prevalence of early PTB, late PTB, and early term birth was 3.8, 9.5, and 29.9%, respectively. Excluding history of prior PTB, preeclampsia was the greatest overall risk factor for early PTB (cOR = 6.7, 95%, CI 5.3 to 8.3), late PTB (cOR = 4.3, 95%, CI 3.8 to 5.0), and early term birth (cOR = 1.8, 95%, CI 1.6 to 2.0). There was no significant difference in the prevalence of PTB by subtypes and nativity (p = 0.5963). Overall, 14.2% of US- compared to 8.9% of foreign-born women had a PTB (early PTB: aOR = 0.56, 95%, CI 0.38 to 0.82; late PTB: aOR = 0.57, 95%, CI 0.45 to 0.73; early term birth: aOR = 0.67, 95%, CI 0.58 to 0.77). Conclusions Foreign-born status remained protective of PTB, irrespective of severity and subtype. Preeclampsia, PTB, and GDM share pathophysiologic mechanisms suggesting a need to better understand differences in perinatal stress, chronic disease, and vascular dysfunction based on nativity in future epidemiologic studies and health services research.
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Affiliation(s)
- Karen A Scott
- Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California San Francisco, 2356 Sutter Street, J-140, San Francisco, CA, 94143, USA.
| | - Brittany D Chambers
- California Preterm Birth Initiative, University of California San Francisco, 3333 California Street, Suite 285, San Francisco, CA, 94118, USA.,Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, 560 16th Street, Second Floor, San Francisco, CA, 94158, USA
| | - Rebecca J Baer
- Department of Obstetrics, Gynecology & Reproductive Sciences, School of Medicine, University of California San Francisco, 2356 Sutter Street, J-140, San Francisco, CA, 94143, USA.,California Preterm Birth Initiative, University of California San Francisco, 3333 California Street, Suite 285, San Francisco, CA, 94118, USA.,Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, Building 3, La Jolla, CA, 92161, USA
| | - Kelli K Ryckman
- Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, Office S435 CPHB, Iowa City, IA, 52242, USA
| | - Monica R McLemore
- Family Health Care Nursing Department, School of Nursing, University of California, 2 Koret Way, N431H, San Francisco, San Francisco, CA, 94143, USA
| | - Laura L Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California San Francisco, 3333 California Street, Suite 285, San Francisco, CA, 94118, USA.,Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, 560 16th Street, Second Floor, San Francisco, CA, 94158, USA
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Kandasamy V, Hirai AH, Kaufman JS, James AR, Kotelchuck M. Regional variation in Black infant mortality: The contribution of contextual factors. PLoS One 2020; 15:e0237314. [PMID: 32780762 PMCID: PMC7418975 DOI: 10.1371/journal.pone.0237314] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 07/15/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Compared to other racial/ethnic groups, infant mortality rates (IMR) are persistently highestamong Black infants in the United States, yet there is considerable regional variation. We examined state and county-level contextual factors that may explain regional differences in Black IMR and identified potential strategies for improvement. METHODS AND FINDINGS Black infant mortality data are from the Linked Birth/Infant Death files for 2009-2011. State and county contextual factors within social, economic, environmental, and health domains were compiled from various Census databases, the Food Environment Atlas, and the Area Health Resource File. Region was defined by the nine Census Divisions. We examined contextual associations with Black IMR using aggregated county-level Poisson regression with standard errors adjusted for clustering by state. Overall, Black IMR varied 1.5-fold across regions, ranging from 8.78 per 1,000 in New England to 13.77 per 1,000 in the Midwest. In adjusted models, the following factors were protective for Black IMR: higher state-level Black-White marriage rate (rate ratio (RR) per standard deviation (SD) increase = 0.81, 95% confidence interval (CI):0.70-0.95), higher state maternal and child health budget per capita (RR per SD = 0.96, 95% CI:0.92-0.99), and higher county-level Black index of concentration at the extremes (RR per SD = 0.85, 95% CI:0.81-0.90). Modeled variables accounted for 35% of the regional variation in Black IMR. CONCLUSIONS These findings are broadly supportive of ongoing public policy efforts to enhance social integration across races, support health and social welfare program spending, and improve economic prosperity. Although contextual factors accounted for about a third of regional variation, further research is needed to more fully understand regional variation in Black IMR disparities.
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Affiliation(s)
- Veni Kandasamy
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ashley H. Hirai
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Jay S. Kaufman
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Arthur R. James
- Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio, United States of America
- The Kirwan Institute for the Study of Race and Ethnicity, Ohio State University, Columbus, Ohio, United States of America
| | - Milton Kotelchuck
- Department of Pediatrics, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Nardone AL, Casey JA, Rudolph KE, Karasek D, Mujahid M, Morello-Frosch R. Associations between historical redlining and birth outcomes from 2006 through 2015 in California. PLoS One 2020; 15:e0237241. [PMID: 32764800 PMCID: PMC7413562 DOI: 10.1371/journal.pone.0237241] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/22/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Despite being one of the wealthiest nations, disparities in adverse birth outcomes persist across racial and ethnic lines in the United States. We studied the association between historical redlining and preterm birth, low birth weight (LBW), small-for-gestational age (SGA), and perinatal mortality over a ten-year period (2006-2015) in Los Angeles, Oakland, and San Francisco, California. METHODS We used birth outcomes data from the California Office of Statewide Health Planning and Development between January 1, 2006 and December 31, 2015. Home Owners' Loan Corporation (HOLC) Security Maps developed in the 1930s assigned neighborhoods one of four grades that pertained to perceived investment risk of borrowers from that neighborhood: green (grade A) were considered "Best", blue (grade B) "Still Desirable", yellow (grade C) "Definitely Declining", and red (grade D, hence the term "redlining") "Hazardous". Geocoded residential addresses at the time of birth were superimposed on HOLC Security Maps to assign each birth a HOLC grade. We adjusted for potential confounders present at the time of Security Map creation by assigning HOLC polygons areal-weighted 1940s Census measures. We then employed propensity score matching methods to estimate the association of historical HOLC grades on current birth outcomes. Because tracts graded A had almost no propensity of receiving grade C or D and because grade B tracts had low propensity of receiving grade D, we examined birth outcomes in the three following comparisons: B vs. A, C vs. B, and D vs. C. RESULTS The prevalence of preterm birth, SGA and mortality tended to be higher in worse HOLC grades, while the prevalence of LBW varied across grades. Overall odds of mortality and preterm birth increased as HOLC grade worsened. Propensity score matching balanced 1940s census measures across contrasting groups. Logistic regression models revealed significantly elevated odds of preterm birth (odds ratio (OR): 1.02, 95% confidence interval (CI): 1.00-1.05), and SGA (OR: 1.03, 95% CI: 1.00-1.05) in the C vs. B comparison and significantly reduced odds of preterm birth (OR: 0.93, 95% CI: 0.91-0.95), LBW (OR: 0.94-95% CI: 0.92-0.97), and SGA (OR: 0.94, 95% CI: 0.92-0.96) in the D vs. C comparison. Results differed by metropolitan area and maternal race. CONCLUSION Similar to prior studies on redlining, we found that worsening HOLC grade was associated with adverse birth outcomes, although this relationship was less clear after propensity score matching and stratifying by metropolitan area. Higher odds of preterm birth and SGA in grade C versus grade B neighborhoods may be caused by higher-stress environments, racial segregation, and lack of access to resources, while lower odds of preterm birth, SGA, and LBW in grade D versus grade C neighborhoods may due to population shifts in those neighborhoods related to gentrification.
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Affiliation(s)
- Anthony L. Nardone
- University of California, Berkeley-University of California San Francisco Joint Medical Program, Berkeley, California, United States of America
| | - Joan A. Casey
- Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Kara E. Rudolph
- Department of Epidemiology, Columbia University, New York, New York, United States of America
| | - Deborah Karasek
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Mahasin Mujahid
- School of Public Health, University of California, Berkeley, California, United States of America
| | - Rachel Morello-Frosch
- School of Public Health, University of California, Berkeley, California, United States of America
- Department of Environmental Science, Policy and Management, University of California, Berkeley, California, United States of America
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Julian Z, Robles D, Whetstone S, Perritt JB, Jackson AV, Hardeman RR, Scott KA. Community-informed models of perinatal and reproductive health services provision: A justice-centered paradigm toward equity among Black birthing communities. Semin Perinatol 2020; 44:151267. [PMID: 32684310 DOI: 10.1016/j.semperi.2020.151267] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Perinatal health outcomes in the United States continue to worsen, with the greatest burden of inequity falling on Black birthing communities. Despite transdisciplinary literature citing structural racism as a root cause of inequity, interventions continue to be mostly physician-centered models of perinatal and reproductive healthcare (PRH). These models prioritize individual, biomedical risk identification and stratification as solutions to achieving equity, without adequately addressing the social and structural determinants of health. The objective of this review is to: (1) examine the association between the impact of structural and obstetric racism and patient-centered access to PRH, (2) define and apply reproductive justice (RJ) as a framework to combat structural and obstetric racism in PRH, and (3) describe and demonstrate how to use an RJ lens to critically analyze physician-led and community-informed PRH models. We conclude with recommendations for building a PRH workforce whose capacity is aligned with racial equity. Institutional alignment with a RJ praxis creates opportunities for advancing PRH workforce diversification and development and improving PRH experiences and outcomes for our patients, communities, and workforce.
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Affiliation(s)
- Zoë Julian
- Department of Obstetrics and Gynecology and Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
| | - Diana Robles
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, San Francisco, CA
| | - Sara Whetstone
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, San Francisco, CA
| | - Jamila B Perritt
- Independent Reproductive Health and Family Planning Specialist, Washington, DC, United States
| | - Andrea V Jackson
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, San Francisco, CA
| | - Rachel R Hardeman
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
| | - Karen A Scott
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco School of Medicine, San Francisco, CA
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Marshall MF, Taylor J, DeBruin D. Ferguson v. City of Charleston Redux: Motivated Reasoning and Coercive Interventions in Pregnancy. Pediatrics 2020; 146:S86-S92. [PMID: 32737239 DOI: 10.1542/peds.2020-0818q] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Criminalization of perinatal substance use disorder and other coercive interventions in pregnancy (such as forced cesarean delivery or involuntary hospitalization for bed rest) directly affect the well-being of children and their families and, potentially, of all women of reproductive capacity. Untenable legal and policy approaches that occasion such incursions not only persist but affect a growing number of women. They are antithetical to healthy pregnancies, healthy children, and healthy families; they have the potential to reduce prenatal care seeking, divert attention and resources away from critical mental health and maternal and child support services, and epigenetically affect maternal and infant bonding. Punitive and coercive interventions contravene long-established guidance by professional associations that advocate for public health approaches and ethical frameworks to guide practice. Harmful policies persist because of motivated reasoning by clinicians, members of the judiciary, and ill-informed legislators who rely on personal experience and anecdote rather than evidence to fashion policy. Compounding the problem are inadequate substance use treatment resources and professional associations that choose not to hold their members accountable for violating their ethical obligations to their patients. Pediatricians must advocate for the cessation of coercive interventions within their institutions and their larger communities. All health care professionals should collaborate at the local, state, and national level to provide policymakers and legislators with data emphasizing the negative effects of punitive and coercive policies aimed at pregnant women and their children.
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Affiliation(s)
- Mary Faith Marshall
- Center for Health Humanities and Ethics, University of Virginia, Charlottesville, Virginia; and
| | - Julia Taylor
- Center for Health Humanities and Ethics, University of Virginia, Charlottesville, Virginia; and
| | - Debra DeBruin
- Center for Bioethics, University of Minnesota, Minneapolis, Minnesota
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Krieger N, Van Wye G, Huynh M, Waterman PD, Maduro G, Li W, Gwynn RC, Barbot O, Bassett MT. Structural Racism, Historical Redlining, and Risk of Preterm Birth in New York City, 2013-2017. Am J Public Health 2020; 110:1046-1053. [PMID: 32437270 PMCID: PMC7287548 DOI: 10.2105/ajph.2020.305656] [Citation(s) in RCA: 228] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2020] [Indexed: 11/04/2022]
Abstract
Objectives. To assess if historical redlining, the US government's 1930s racially discriminatory grading of neighborhoods' mortgage credit-worthiness, implemented via the federally sponsored Home Owners' Loan Corporation (HOLC) color-coded maps, is associated with contemporary risk of preterm birth (< 37 weeks gestation).Methods. We analyzed 2013-2017 birth certificate data for all singleton births in New York City (n = 528 096) linked by maternal residence at time of birth to (1) HOLC grade and (2) current census tract social characteristics.Results. The proportion of preterm births ranged from 5.0% in grade A ("best"-green) to 7.3% in grade D ("hazardous"-red). The odds ratio for HOLC grade D versus A equaled 1.6 and remained significant (1.2; P < .05) in multilevel models adjusted for maternal sociodemographic characteristics and current census tract poverty, but was 1.07 (95% confidence interval = 0.92, 1.20) after adjustment for current census tract racialized economic segregation.Conclusions. Historical redlining may be a structural determinant of present-day risk of preterm birth.Public Health Implications. Policies for fair housing, economic development, and health equity should consider historical redlining's impacts on present-day residential segregation and health outcomes.
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Affiliation(s)
- Nancy Krieger
- Nancy Krieger and Pamela D. Waterman are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health (HSPH), Boston, MA. Gretchen Van Wye is with the Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene (NYC DOHMH), New York, NY. Mary Huynh is with the Office of Vital Statistics, NYC DOHMH. Gil Maduro is with the commissioner's office, NYC DOHMH. Wenhui Li is with the Statistical Analysis and Reporting Unit, NYC DOHMH. R. Charon Gwynn is with the Division of Epidemiology, NYC DOHMH. Oxiris Barbot is the commissioner of NYC DOHMH. At the time of the initial conceptualization of this work, Mary T. Bassett was the commissioner of the NYC DOHMH, and now is with the François-Xavier Bagnoud Center for Health and Human Rights and Department of Social and Behavioral Science, HSPH
| | - Gretchen Van Wye
- Nancy Krieger and Pamela D. Waterman are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health (HSPH), Boston, MA. Gretchen Van Wye is with the Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene (NYC DOHMH), New York, NY. Mary Huynh is with the Office of Vital Statistics, NYC DOHMH. Gil Maduro is with the commissioner's office, NYC DOHMH. Wenhui Li is with the Statistical Analysis and Reporting Unit, NYC DOHMH. R. Charon Gwynn is with the Division of Epidemiology, NYC DOHMH. Oxiris Barbot is the commissioner of NYC DOHMH. At the time of the initial conceptualization of this work, Mary T. Bassett was the commissioner of the NYC DOHMH, and now is with the François-Xavier Bagnoud Center for Health and Human Rights and Department of Social and Behavioral Science, HSPH
| | - Mary Huynh
- Nancy Krieger and Pamela D. Waterman are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health (HSPH), Boston, MA. Gretchen Van Wye is with the Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene (NYC DOHMH), New York, NY. Mary Huynh is with the Office of Vital Statistics, NYC DOHMH. Gil Maduro is with the commissioner's office, NYC DOHMH. Wenhui Li is with the Statistical Analysis and Reporting Unit, NYC DOHMH. R. Charon Gwynn is with the Division of Epidemiology, NYC DOHMH. Oxiris Barbot is the commissioner of NYC DOHMH. At the time of the initial conceptualization of this work, Mary T. Bassett was the commissioner of the NYC DOHMH, and now is with the François-Xavier Bagnoud Center for Health and Human Rights and Department of Social and Behavioral Science, HSPH
| | - Pamela D Waterman
- Nancy Krieger and Pamela D. Waterman are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health (HSPH), Boston, MA. Gretchen Van Wye is with the Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene (NYC DOHMH), New York, NY. Mary Huynh is with the Office of Vital Statistics, NYC DOHMH. Gil Maduro is with the commissioner's office, NYC DOHMH. Wenhui Li is with the Statistical Analysis and Reporting Unit, NYC DOHMH. R. Charon Gwynn is with the Division of Epidemiology, NYC DOHMH. Oxiris Barbot is the commissioner of NYC DOHMH. At the time of the initial conceptualization of this work, Mary T. Bassett was the commissioner of the NYC DOHMH, and now is with the François-Xavier Bagnoud Center for Health and Human Rights and Department of Social and Behavioral Science, HSPH
| | - Gil Maduro
- Nancy Krieger and Pamela D. Waterman are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health (HSPH), Boston, MA. Gretchen Van Wye is with the Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene (NYC DOHMH), New York, NY. Mary Huynh is with the Office of Vital Statistics, NYC DOHMH. Gil Maduro is with the commissioner's office, NYC DOHMH. Wenhui Li is with the Statistical Analysis and Reporting Unit, NYC DOHMH. R. Charon Gwynn is with the Division of Epidemiology, NYC DOHMH. Oxiris Barbot is the commissioner of NYC DOHMH. At the time of the initial conceptualization of this work, Mary T. Bassett was the commissioner of the NYC DOHMH, and now is with the François-Xavier Bagnoud Center for Health and Human Rights and Department of Social and Behavioral Science, HSPH
| | - Wenhui Li
- Nancy Krieger and Pamela D. Waterman are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health (HSPH), Boston, MA. Gretchen Van Wye is with the Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene (NYC DOHMH), New York, NY. Mary Huynh is with the Office of Vital Statistics, NYC DOHMH. Gil Maduro is with the commissioner's office, NYC DOHMH. Wenhui Li is with the Statistical Analysis and Reporting Unit, NYC DOHMH. R. Charon Gwynn is with the Division of Epidemiology, NYC DOHMH. Oxiris Barbot is the commissioner of NYC DOHMH. At the time of the initial conceptualization of this work, Mary T. Bassett was the commissioner of the NYC DOHMH, and now is with the François-Xavier Bagnoud Center for Health and Human Rights and Department of Social and Behavioral Science, HSPH
| | - R Charon Gwynn
- Nancy Krieger and Pamela D. Waterman are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health (HSPH), Boston, MA. Gretchen Van Wye is with the Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene (NYC DOHMH), New York, NY. Mary Huynh is with the Office of Vital Statistics, NYC DOHMH. Gil Maduro is with the commissioner's office, NYC DOHMH. Wenhui Li is with the Statistical Analysis and Reporting Unit, NYC DOHMH. R. Charon Gwynn is with the Division of Epidemiology, NYC DOHMH. Oxiris Barbot is the commissioner of NYC DOHMH. At the time of the initial conceptualization of this work, Mary T. Bassett was the commissioner of the NYC DOHMH, and now is with the François-Xavier Bagnoud Center for Health and Human Rights and Department of Social and Behavioral Science, HSPH
| | - Oxiris Barbot
- Nancy Krieger and Pamela D. Waterman are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health (HSPH), Boston, MA. Gretchen Van Wye is with the Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene (NYC DOHMH), New York, NY. Mary Huynh is with the Office of Vital Statistics, NYC DOHMH. Gil Maduro is with the commissioner's office, NYC DOHMH. Wenhui Li is with the Statistical Analysis and Reporting Unit, NYC DOHMH. R. Charon Gwynn is with the Division of Epidemiology, NYC DOHMH. Oxiris Barbot is the commissioner of NYC DOHMH. At the time of the initial conceptualization of this work, Mary T. Bassett was the commissioner of the NYC DOHMH, and now is with the François-Xavier Bagnoud Center for Health and Human Rights and Department of Social and Behavioral Science, HSPH
| | - Mary T Bassett
- Nancy Krieger and Pamela D. Waterman are with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health (HSPH), Boston, MA. Gretchen Van Wye is with the Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene (NYC DOHMH), New York, NY. Mary Huynh is with the Office of Vital Statistics, NYC DOHMH. Gil Maduro is with the commissioner's office, NYC DOHMH. Wenhui Li is with the Statistical Analysis and Reporting Unit, NYC DOHMH. R. Charon Gwynn is with the Division of Epidemiology, NYC DOHMH. Oxiris Barbot is the commissioner of NYC DOHMH. At the time of the initial conceptualization of this work, Mary T. Bassett was the commissioner of the NYC DOHMH, and now is with the François-Xavier Bagnoud Center for Health and Human Rights and Department of Social and Behavioral Science, HSPH
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Janevic T, Zeitlin J, Egorova N, Hebert PL, Balbierz A, Howell EA. Neighborhood Racial And Economic Polarization, Hospital Of Delivery, And Severe Maternal Morbidity. Health Aff (Millwood) 2020; 39:768-776. [PMID: 32364858 PMCID: PMC9808814 DOI: 10.1377/hlthaff.2019.00735] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Recent national and state legislation has called attention to stark racial/ethnic disparities in maternal mortality and severe maternal morbidity (SMM), the latter of which is defined as having a life-threatening condition or life-saving procedure during childbirth. Using linked New York City birth and hospitalization data for 2012-14, we examined whether racial and economic spatial polarization is associated with SMM rates, and whether the delivery hospital partially explains the association. Women in ZIP codes with the highest concentration of poor blacks relative to wealthy whites experienced 4.0 cases of SMM per 100 deliveries, compared with 1.7 cases per 100 deliveries among women in the neighborhoods with the lowest concentration (risk difference = 2.4 cases per 100). Thirty-five percent of this difference was attributable to the delivery hospital. Women in highly polarized neighborhoods were most likely to deliver in hospitals located in similarly polarized neighborhoods. Housing policy that targets racial and economic spatial polarization may address a root cause of SMM, while hospital quality improvement may mitigate the impact of such polarization.
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Affiliation(s)
- Teresa Janevic
- Blavatnik Family Women’s Health Research Institute, Departments of Population Health Science and Policy and Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, in New York City
| | - Jennifer Zeitlin
- Center for Epidemiology and Biostatistics, Inserm UMR 1153, Obstetrical, Perinatal, and Pediatric Epidemiology Research Team (Epopé), Paris Descartes University, in France
| | - Natalia Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai
| | - Paul L. Hebert
- Veterans Affairs (VA) Health Services Research and Development Center for Veteran-Centered, Value-Driven Health, VA Puget Sound Health Care System, and a research associate professor in the Department of Health Services, School of Public Health, University of Washington, both in Seattle
| | - Amy Balbierz
- Blavatnik Family Women’s Health Research Institute, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai
| | - Elizabeth A. Howell
- Blavatnik Family Women’s Health Research Institute, Departments of Population Health Science and Policy and Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai
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Fong KC, Yitshak-Sade M, Lane KJ, Fabian MP, Kloog I, Schwartz JD, Coull BA, Koutrakis P, Hart JE, Laden F, Zanobetti A. Racial Disparities in Associations between Neighborhood Demographic Polarization and Birth Weight. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3076. [PMID: 32354151 PMCID: PMC7246784 DOI: 10.3390/ijerph17093076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/13/2020] [Accepted: 04/25/2020] [Indexed: 12/02/2022]
Abstract
Neighborhood demographic polarization, or the extent to which a privileged population group outnumbers a deprived group, can affect health by influencing social dynamics. While using birth records from 2001 to 2013 in Massachusetts (n = 629,675), we estimated the effect of two demographic indices, racial residential polarization (RRP) and economic residential polarization (ERP), on birth weight outcomes, which are established predictors of the newborn's future morbidity and mortality risk. Higher RRP and ERP was each associated with higher continuous birth weight and lower odds for low birth weight and small for gestational age, with evidence for effect modification by maternal race. On average, per interquartile range increase in RRP, the birth weight was 10.0 g (95% confidence interval: 8.0, 12.0) higher among babies born to white mothers versus 6.9 g (95% CI: 4.8, 9.0) higher among those born to black mothers. For ERP, it was 18.6 g (95% CI: 15.7, 21.5) higher among those that were born to white mothers versus 1.8 g (95% CI: -4.2, 7.8) higher among those born to black mothers. Racial and economic polarization towards more privileged groups was associated with healthier birth weight outcomes, with greater estimated effects in babies that were born to white mothers than those born to black mothers.
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Affiliation(s)
- Kelvin C. Fong
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
- School of Forestry and Environmental Studies, Yale University, New Haven, CT 06511, USA
| | - Maayan Yitshak-Sade
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
| | - Kevin J. Lane
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA 02218, USA; (K.J.L.); (M.P.F.)
| | - M. Patricia Fabian
- Department of Environmental Health, School of Public Health, Boston University, Boston, MA 02218, USA; (K.J.L.); (M.P.F.)
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, 8410501 Beer Sheva, Israel;
| | - Joel D. Schwartz
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02215, USA
| | - Brent A. Coull
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA 02215, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
| | - Jaime E. Hart
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02215, USA
| | - Francine Laden
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA 02215, USA
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02215, USA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA 02215, USA; (M.Y.-S.); (J.D.S.); (B.A.C.); (P.K.); (J.E.H.); (F.L.); (A.Z.)
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Chambers BD, Arabia SE, Arega HA, Altman MR, Berkowitz R, Feuer SK, Franck LS, Gomez AM, Kober K, Pacheco-Werner T, Paynter RA, Prather AA, Spellen SA, Stanley D, Jelliffe-Pawlowski LL, McLemore MR. Exposures to structural racism and racial discrimination among pregnant and early post-partum Black women living in Oakland, California. Stress Health 2020; 36:213-219. [PMID: 31919987 PMCID: PMC7269549 DOI: 10.1002/smi.2922] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/13/2019] [Accepted: 12/17/2019] [Indexed: 11/12/2022]
Abstract
Research supports that exposure to stressors (e.g., perceived stress and racism) during pregnancy can negatively impact the immune system, which may lead to infection and ultimately increases the risk for having a preterm or low-birthweight infant. It is well known that Black women report higher levels of stressors at multiple timepoints across pregnancy compared with women of all other racial and ethnic groups. This study addresses gaps in the literature by describing pregnant and early post-partum Black women's exposures to structural racism and self-reported experiences of racial discrimination, and the extent to which these factors are related. We used a cross-sectional study design to collect data related to exposures to racism from pregnant and early post-partum Black women residing in Oakland, California, from January 2016 to December 2017. Comparative analysis revealed that living in highly deprived race + income neighborhoods was associated with experiencing racial discrimination in three or more situational domains (p = .01). Findings show that Black women are exposed to high levels of racism that may have negative impacts on maternal health outcomes.
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Affiliation(s)
- Brittany D Chambers
- Epidemiology and Biostatistics Department, School of Medicine, University of California, San Francisco, San Francisco, California
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California
| | - Silvia E Arabia
- Family Health Care Nursing Department, University of California, San Francisco, San Francisco, California
| | - Helen A Arega
- Family Health Care Nursing Department, University of California, San Francisco, San Francisco, California
| | - Molly R Altman
- Family and Child Nursing Department, School of Nursing, University of Washington, Seattle, Washington
| | - Rachel Berkowitz
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Sky K Feuer
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California
- Obstetrics, Gynecology, and Reproductive Sciences Department, University of California, San Francisco, San Francisco, California
| | - Linda S Franck
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California
- Family Health Care Nursing Department, University of California, San Francisco, San Francisco, California
| | - Anu M Gomez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, California
| | - Kord Kober
- Physiological Nursing Department, University of California, San Francisco, San Francisco, California
| | - Tania Pacheco-Werner
- Central Valley Health Policy Institute, California State University, Fresno, California
| | - Randi A Paynter
- Epidemiology and Biostatistics Department, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Aric A Prather
- Center for Health and Community, Psychiatry Department, University of California, San Francisco, San Francisco, California
| | - Solaire A Spellen
- Expecting Justice, San Francisco Department of Public Health, San Francisco, California
| | - Darcy Stanley
- LifeLong Medical Care Brookside, San Pablo, California
| | - Laura L Jelliffe-Pawlowski
- Epidemiology and Biostatistics Department, School of Medicine, University of California, San Francisco, San Francisco, California
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, California
| | - Monica R McLemore
- Family Health Care Nursing Department, University of California, San Francisco, San Francisco, California
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Johnson JD, Green CA, Vladutiu CJ, Manuck TA. Racial Disparities in Prematurity Persist among Women of High Socioeconomic Status. Am J Obstet Gynecol MFM 2020; 2:100104. [PMID: 33179010 DOI: 10.1016/j.ajogmf.2020.100104] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Despite persistent racial disparities in preterm birth (PTB) in the US among non-Hispanic (NH) black women compared to NH white women, it remains controversial whether sociodemographic factors can explain these differences. We sought to evaluate whether disparities in PTB persist among NH black women with high socioeconomic status (SES). Study Design We conducted a population-based cohort study of all live births in the US from 2015-2017 using birth certificate data from the National Vital Statistics System. We included singleton, non-anomalous live births among women who were of high SES (defined as having ≥ 16 years of education, private insurance, and not receiving Women, Infants and Children [WIC] benefits) and who identified as NH white, NH black, or 'mixed' NH black and white race. The primary outcome was PTB <37 weeks; secondary outcomes included PTB <34 and <28 weeks. In addition, analyses were repeated considering birthweight <2500g as a surrogate for preterm birth <37 weeks, birthweight <1500g as a surrogate for preterm birth <34 weeks, and birthweight <750g as a surrogate for preterm birth <28 weeks' gestation. Data were analyzed with chi-square, t-test, and logistic regression. Results 2,170,686 live births met inclusion criteria, with 92.9% NH white, 6.7% NH black, and 0.4% both NH white and black race. Overall, 5.9% delivered <37, 1.3% <34, and 0.3 % <28 weeks. In unadjusted analyses of women with high SES, the PTB rate at each gestational age cutoff was higher for women of 'mixed' NH white and black race, and highest for women who were NH black only compared to women who were NH white only. In regression models we further adjusted for women with insurance and prenatal care their entire pregnancy, maternal race was associated with higher odds of PTB at each GA cutoff, with the highest odds observed at <28 weeks. Finally, in further adjustement analysis including only the 1,934,912 women who received prenatal care in the first trimester, findings were similar. Rates of preterm birth at each gestational age cutoff remained highest for women who identified as non-Hispanic black, intermediate for women identifying as both non-Hispanic black and white race, and lowest for non-Hispanic white women at <37 weeks (9.9% vs. 6.1% vs. 5.5%, respectively; p<0.001), <34 weeks (3.5% vs. 1.5% vs. 1.1%, respectively; p<0.001), and <28 weeks' gestation (1.2% vs. 0.4% vs. 0.2%, respectively, p<0.001). Conclusions Even among college-educated women with private insurance who are not receiving WIC, racial disparities in prematurity persist. These national findings are consistent with prior studies that suggest factors other than socio-demographics are important in the underlying pathogenesis of PTB.
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Affiliation(s)
- Jasmine D Johnson
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC
| | - Celeste A Green
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC
| | - Catherine J Vladutiu
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC
| | - Tracy A Manuck
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, University of North Carolina, Chapel Hill, NC
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123
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Sumbul T, Spellen S, McLemore MR. A Transdisciplinary Conceptual Framework of Contextualized Resilience for Reducing Adverse Birth Outcomes. QUALITATIVE HEALTH RESEARCH 2020; 30:105-118. [PMID: 31752598 DOI: 10.1177/1049732319885369] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Research in preterm birth has focused on the disparate outcomes for Black, Hispanic, and Latina women as compared with White women. However, research studies have not focused on centering these women in frameworks that discuss how resilience is embodied. This article is a presentation of our transdisciplinary contextual framework of resilience, building on work that centers Black, Hispanic, and Latina women, as well as historical oppression and trauma resilience frameworks developed by transcultural psychiatry, psychology, public health, anthropology, medicine, nursing, sociology, and social work. To develop the model, we reviewed 115 articles and books (1977-2019), which were then evaluated and synthesized to develop a transdisciplinary framework of contextualized resilience to enable a better understanding of the complex interplay of medical and social conditions influencing preterm birth. The framework includes multiple ecological layers that cross the individual, familial and intimate, community, structural, policy and law, and hegemonic domains.
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Affiliation(s)
- Tijen Sumbul
- University of California, San Francisco, San Francisco, California, USA
| | - Solaire Spellen
- University of California, Berkeley, Berkeley, California, USA
| | - Monica R McLemore
- University of California, San Francisco, San Francisco, California, USA
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Beck AF, Edwards EM, Horbar JD, Howell EA, McCormick MC, Pursley DM. The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families. Pediatr Res 2020; 87:227-234. [PMID: 31357209 PMCID: PMC6960093 DOI: 10.1038/s41390-019-0513-6] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/04/2019] [Indexed: 02/06/2023]
Abstract
Racism, segregation, and inequality contribute to health outcomes and drive health disparities across the life course, including for newborn infants and their families. In this review, we address their effects on the health and well-being of newborn infants and their families with a focus on preterm birth. We discuss three causal pathways: increased risk; lower-quality care; and socioeconomic disadvantages that persist into infancy, childhood, and beyond. For each pathway, we propose specific interventions and research priorities that may remedy the adverse effects of racism, segregation, and inequality. Infants and their families will not realize the full benefit of advances in perinatal and neonatal care until we, collectively, accept our responsibility for addressing the range of determinants that shape long-term outcomes.
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Affiliation(s)
- Andrew F Beck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of General & Community Pediatrics and Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Erika M Edwards
- Vermont Oxford Network, Burlington, VT, USA.
- Department of Pediatrics, Robert Larner, MD, College of Medicine, University of Vermont, Burlington, VT, USA.
- Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, VT, USA.
| | - Jeffrey D Horbar
- Vermont Oxford Network, Burlington, VT, USA
- Department of Pediatrics, Robert Larner, MD, College of Medicine, University of Vermont, Burlington, VT, USA
| | - Elizabeth A Howell
- Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marie C McCormick
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - DeWayne M Pursley
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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125
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Padula AM, Monk C, Brennan PA, Borders A, Barrett ES, McEvoy C, Foss S, Desai P, Alshawabkeh A, Wurth R, Salafia C, Fichorova R, Varshavsky J, Kress A, Woodruff TJ, Morello-Frosch R. A review of maternal prenatal exposures to environmental chemicals and psychosocial stressors-implications for research on perinatal outcomes in the ECHO program. J Perinatol 2020; 40:10-24. [PMID: 31616048 PMCID: PMC6957228 DOI: 10.1038/s41372-019-0510-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/08/2019] [Accepted: 08/15/2019] [Indexed: 01/18/2023]
Abstract
Exposures to environmental chemicals and psychosocial stressors during pregnancy have been individually associated with adverse perinatal outcomes related to birthweight and gestational age, but are not often considered in combination. We review types of psychosocial stressors and instruments used to assess them and classes of environmental chemical exposures that are known to adversely impact perinatal outcomes, and identify studies relevant studies. We discuss the National Institutes of Health's Environmental influences on Child Health Outcomes (ECHO) program that has combined existing longitudinal cohorts that include more than 50,000 children across the U.S. We describe future opportunities for investigators to use this important new resource for addressing relevant and critical research questions to maternal health. Of the 84 cohorts in ECHO, 38 collected data on environmental chemicals and psychosocial stressors and perinatal outcomes. The diverse ECHO pregnancy cohorts provide capacity to compare regions with distinct place-based environmental and social stressors.
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Affiliation(s)
- Amy M. Padula
- University of California San Francisco, San Francisco, CA
USA
| | | | | | - Ann Borders
- North Shore University Health System, Evanston, IL,
USA
| | | | | | - Sophie Foss
- Columbia University Medical Center, New York, NY, USA
| | - Preeya Desai
- Columbia University Medical Center, New York, NY, USA
| | | | | | | | - Raina Fichorova
- Brigham and Women’s Hospital and Harvard Medical
School, Boston, MA, USA
| | | | - Amii Kress
- Johns Hopkins University, Baltimore, MD, USA
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Kim D. Social determinants of health in relation to firearm-related homicides in the United States: A nationwide multilevel cross-sectional study. PLoS Med 2019; 16:e1002978. [PMID: 31846474 PMCID: PMC6917210 DOI: 10.1371/journal.pmed.1002978] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/11/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Gun violence has shortened the average life expectancy of Americans, and better knowledge about the root causes of gun violence is crucial to its prevention. While some empirical evidence exists regarding the impacts of social and economic factors on violence and firearm homicide rates, to the author's knowledge, there has yet to be a comprehensive and comparative lagged, multilevel investigation of major social determinants of health in relation to firearm homicides and mass shootings. METHODS AND FINDINGS This study used negative binomial regression models and geolocated gun homicide incident data from January 1, 2015, to December 31, 2015, to explore and compare the independent associations of key state-, county-, and neighborhood-level social determinants of health-social mobility, social capital, income inequality, racial and economic segregation, and social spending-with neighborhood firearm-related homicides and mass shootings in the United States, accounting for relevant state firearm laws and a variety of state, county, and neighborhood (census tract [CT]) characteristics. Latitude and longitude coordinates on firearm-related deaths were previously collected by the Gun Violence Archive, and then linked by the British newspaper The Guardian to CTs according to 2010 Census geographies. The study population consisted of all 74,134 CTs as defined for the 2010 Census in the 48 states of the contiguous US. The final sample spanned 70,579 CTs, containing an estimated 314,247,908 individuals, or 98% of the total US population in 2015. The analyses were based on 13,060 firearm-related deaths in 2015, with 11,244 non-mass shootings taking place in 8,673 CTs and 141 mass shootings occurring in 138 CTs. For area-level social determinants, lag periods of 3 to 17 years were examined based on existing theory, empirical evidence, and data availability. County-level institutional social capital (levels of trust in institutions), social mobility, income inequality, and public welfare spending exhibited robust relationships with CT-level gun homicide rates and the total numbers of combined non-mass and mass shooting homicide incidents and non-mass shooting homicide incidents alone. A 1-standard deviation (SD) increase in institutional social capital was linked to a 19% reduction in the homicide rate (incidence rate ratio [IRR] = 0.81, 95% CI 0.73-0.91, p < 0.001) and a 17% decrease in the number of firearm homicide incidents (IRR = 0.83, 95% CI 0.73-0.95, p = 0.01). Upward social mobility was related to a 25% reduction in the gun homicide rate (IRR = 0.75, 95% CI 0.66-0.86, p < 0.001) and a 24% decrease in the number of homicide incidents (IRR = 0.76, 95% CI 0.67-0.87, p < 0.001). Meanwhile, 1-SD increases in the neighborhood percentages of residents in poverty and males living alone were associated with 26%-27% and 12% higher homicide rates, respectively. Study limitations include possible residual confounding by factors at the individual/household level, and lack of disaggregation of gun homicide data by gender and race/ethnicity. CONCLUSIONS This study finds that the rich-poor gap, level of citizens' trust in institutions, economic opportunity, and public welfare spending are all related to firearm homicide rates in the US. Further establishing the causal nature of these associations and modifying these social determinants may help to address the growing gun violence epidemic and reverse recent life expectancy declines among Americans.
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Affiliation(s)
- Daniel Kim
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, United States of America
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Letter to the Editor: Editorial: Beware of Studies Claiming that Social Factors are "Independently Associated" with Biological Complications of Surgery. Clin Orthop Relat Res 2019; 477:2807-2809. [PMID: 31764356 PMCID: PMC6907321 DOI: 10.1097/corr.0000000000001029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Burris H, Lorch S, Kirpalani H, Pursley DM, Elovitz MA, Clougherty JE. Racial disparities in preterm birth in USA: a biosensor of physical and social environmental exposures. Arch Dis Child 2019; 104:931-935. [PMID: 30850379 PMCID: PMC6732250 DOI: 10.1136/archdischild-2018-316486] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/15/2019] [Accepted: 02/19/2019] [Indexed: 01/16/2023]
Abstract
Race is a social construct that involves a person’s self-assigned, and externally-perceived, group membership. Group membership can determine much about Americans’ lives and health. Complex health disorders such as cardiovascular disease, asthma, and obesity disproportionately affect Non-Hispanic black Americans. An individual’s risk of any of these disorders encompasses both genetic predisposition and environmental stimuli. We propose that environmental stressors may be large contributors to differences in preterm birth rates in the United States between racial groups. Environmental exposures differ by race due to ongoing residential, educational and economic racial segregation as well as discrimination. Characterizing and mitigating environmental factors that contribute to differential preterm risk could identify women at risk, prevent some preterm births, and reduce perinatal health disparities.
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Affiliation(s)
- Heather Burris
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania;,Corresponding Author: Heather H. Burris, Center for Research on Reproduction and Women’s Health, Biomedical Research Building II/III, Room 1352, 421 Curie Blvd., Philadelphia, PA, 19104-6160, (215) 573-4916 (phone), (215) 573-5408 (fax),
| | - Scott Lorch
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | - Haresh Kirpalani
- Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | - DeWayne M. Pursley
- Department of Neonatology, Beth Israel Deaconess Medical Center, Department of Pediatrics at Harvard Medical School
| | - Michal A. Elovitz
- Department of Obstetrics and Gynecology, Maternal Child Health Research Center, Perelman School of Medicine, University of Pennsylvania
| | - Jane E. Clougherty
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University
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129
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Altman MR, Oseguera T, McLemore MR, Kantrowitz-Gordon I, Franck LS, Lyndon A. Information and power: Women of color's experiences interacting with health care providers in pregnancy and birth. Soc Sci Med 2019; 238:112491. [DOI: 10.1016/j.socscimed.2019.112491] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 06/25/2019] [Accepted: 08/11/2019] [Indexed: 02/02/2023]
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130
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Starting Health Disparities Education During Resident Orientation: Our Patients, Our Community. Obstet Gynecol 2019; 132:1153-1157. [PMID: 30303918 DOI: 10.1097/aog.0000000000002911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Disparities in women's reproductive health outcomes are persistent and prevalent. Cultural competency education of trainees is central to reducing patient-, system-, and practitioner-level factors that promote disparate health outcomes. Such issues include health literacy, access to health care, and unconscious bias. We suggest that recognizing and reducing health disparities should be a longitudinal theme in resident education, first introduced during intern orientation and continued with dedicated didactics, experiential learning opportunities, grand rounds, and journal clubs built into the residency curricula. In this commentary, we present various methods of introducing health disparities education and commencing a larger conversation about inequity and race in medicine. We hope to encourage other training programs to incorporate this important topic earlier into their educational curriculum.
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131
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Curtis DS, Fuller-Rowell TE, Vilches S, Vonasek J, Wells NM. Associations between local government expenditures and low birth weight incidence: Evidence from national birth records. Prev Med Rep 2019; 16:100985. [PMID: 31516818 PMCID: PMC6734050 DOI: 10.1016/j.pmedr.2019.100985] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/05/2019] [Accepted: 08/29/2019] [Indexed: 12/26/2022] Open
Abstract
Local governments play an integral role in providing public services to their residents, yet the population health benefits are frequently overlooked, especially when services are outside the traditional health domain. With data from the U.S. Census of Governments and national birth records (spanning from 1992 to 2014), we examined whether local government expenditures on parks and recreation services (PRS) and housing and community development (HCD) predicted county low birth weight outcomes (population incidence and black-white disparities). Hypotheses were tested using bias-corrected county-by-period fixed effects models in a sample of 956 U.S. counties with a total of 3619 observations (observations were defined as three-year pooled estimates), representing 24 million births. Adjusting for prior county low birth weight incidence, levels of total operational, health, and hospital expenditures, and time-varying county sociodemographics, an increase in per capita county PRS expenditures of $50 was associated with 1.25 fewer low birth weight cases per 1000. Change in county HCD expenditures was not associated with low birth weight incidence, and, contrary to hypotheses, neither expenditure type was linked to county black-white disparities. Further examination of the benefits to birth outcomes from increasing parks and recreation services is warranted. Rising parks and recreation expenditures are linked to declining low birth weight. Housing and community expenditures are not associated with low birth weight. ‘Health’ was the only expenditure type linked to black-white perinatal disparities. Benefits of parks and recreation services may include healthier birth outcomes.
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Affiliation(s)
- David S Curtis
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT 84112, United States of America
| | - Thomas E Fuller-Rowell
- Department of Human Development and Family Studies, Auburn University, Auburn, AL 36849, United States of America
| | - Silvia Vilches
- Department of Human Development and Family Studies, Auburn University, Auburn, AL 36849, United States of America
| | - Joseph Vonasek
- Department of Political Science, Auburn University, Auburn, AL 36849, United States of America
| | - Nancy M Wells
- Design + Environmental Analysis Department, Cornell University, Ithaca, NY 14853, United States of America
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132
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Mehra R, Keene DE, Kershaw TS, Ickovics JR, Warren JL. Racial and ethnic disparities in adverse birth outcomes: Differences by racial residential segregation. SSM Popul Health 2019; 8:100417. [PMID: 31193960 PMCID: PMC6545386 DOI: 10.1016/j.ssmph.2019.100417] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 11/26/2022] Open
Abstract
Racial and ethnic disparities in adverse birth outcomes have persistently been wide and may be explained by individual and area-level factors. Our primary objective was to determine if county-level black-white segregation modified the association between maternal race/ethnicity and adverse birth outcomes using birth records from the National Center for Health Statistics (2012). Based on maternal residence at birth, county-level black-white racial residential segregation was calculated along five dimensions of segregation: evenness, exposure, concentration, centralization, and clustering. We conducted a two-stage analysis: (1) county-specific logistic regression to determine whether maternal race and ethnicity were associated with preterm birth and term low birth weight; and (2) Bayesian meta-analyses to determine if segregation moderated these associations. We found greater black-white and Hispanic-white disparities in preterm birth in racially isolated counties (exposure) relative to non-isolated counties. We found reduced Hispanic-white disparities in term low birth weight in racially concentrated and centralized counties relative to non-segregated counties. Area-level poverty explained most of the moderating effect of segregation on disparities in adverse birth outcomes, suggesting that area-level poverty is a mediator of these associations. Segregation appears to modify racial/ethnic disparities in adverse birth outcomes. Therefore, policy interventions that reduce black-white racial isolation, or buffer the poor social and economic correlates of segregation, may help to reduce disparities in preterm birth and term low birth weight.
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Affiliation(s)
- Renee Mehra
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Danya E. Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Trace S. Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Jeannette R. Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College St, New Haven, CT 06510, United States
| | - Joshua L. Warren
- Department of Biostatistics, Yale School of Public Health, 60 College St, New Haven, CT, 06510, United States
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Horbar JD, Edwards EM, Greenberg LT, Profit J, Draper D, Helkey D, Lorch SA, Lee HC, Phibbs CS, Rogowski J, Gould JB, Firebaugh G. Racial Segregation and Inequality in the Neonatal Intensive Care Unit for Very Low-Birth-Weight and Very Preterm Infants. JAMA Pediatr 2019; 173:455-461. [PMID: 30907924 PMCID: PMC6503514 DOI: 10.1001/jamapediatrics.2019.0241] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Racial and ethnic minorities receive lower-quality health care than white non-Hispanic individuals in the United States. Where minority infants receive care and the role that may play in the quality of care received is unclear. OBJECTIVE To determine the extent of segregation and inequality of care of very low-birth-weight and very preterm infants across neonatal intensive care units (NICUs) in the United States. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 743 NICUs in the Vermont Oxford Network included 117 982 black, Hispanic, Asian, and white infants born at 401 g to 1500 g or 22 to 29 weeks' gestation from January 2014 to December 2016. Analysis began January 2018. MAIN OUTCOMES AND MEASURES The NICU segregation index and NICU inequality index were calculated at the hospital level as the Gini coefficients associated with the Lorenz curves for black, Hispanic, and Asian infants compared with white infants, with NICUs ranked by proportion of white infants for the NICU segregation index and by composite Baby-MONITOR (Measure of Neonatal Intensive Care Outcomes Research) score for the NICU inequality index. RESULTS Infants (36 359 black [31%], 21 808 Hispanic [18%], 5920 Asian [5%], and 53 895 white [46%]) were segregated among the 743 NICUs by race and ethnicity (NICU segregation index: black: 0.50 [95% CI, 0.46-0.53], Hispanic: 0.58 [95% CI, 0.54-0.61], and Asian: 0.45 [95% CI, 0.40-0.50]). Compared with white infants, black infants were concentrated at NICUs with lower-quality scores, and Hispanic and Asian infants were concentrated at NICUs with higher-quality scores (NICU inequality index: black: 0.07 [95% CI, 0.02-0.13], Hispanic: -0.10 [95% CI, -0.17 to -0.04], and Asian: -0.26 [95% CI, -0.32 to -0.19]). There was marked variation among the census regions in weighted mean NICU quality scores (range: -0.69 to 0.85). Region of residence explained the observed inequality for Hispanic infants but not for black or Asian infants. CONCLUSIONS AND RELEVANCE Black, Hispanic, and Asian infants were segregated across NICUs, reflecting the racial segregation of minority populations in the United States. There were large differences between geographic regions in NICU quality. After accounting for these differences, compared with white infants, Asian infants received care at higher-quality NICUs and black infants, at lower-quality NICUs. Explaining these patterns will require understanding the effects of sociodemographic factors and public policies on hospital quality, access, and choice for minority women and their infants.
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Affiliation(s)
- Jeffrey D. Horbar
- Vermont Oxford Network, Burlington,Department of Pediatrics, Robert Larner MD College of Medicine, University of Vermont, Burlington
| | - Erika M. Edwards
- Vermont Oxford Network, Burlington,Department of Pediatrics, Robert Larner MD College of Medicine, University of Vermont, Burlington,Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, University of Vermont, Burlington
| | | | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, School of Medicine, Division of Neonatology, Department of Pediatrics, Stanford University, Lucile Packard Children’s Hospital, Palo Alto, California,California Perinatal Quality Care Collaborative, Palo Alto
| | - David Draper
- Department of Statistics, Baskin School of Engineering, University of California, Santa Cruz, Santa Cruz
| | - Daniel Helkey
- Department of Statistics, Baskin School of Engineering, University of California, Santa Cruz, Santa Cruz
| | - Scott A. Lorch
- Division of Neonatology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania, Philadelphia
| | - Henry C. Lee
- Perinatal Epidemiology and Health Outcomes Research Unit, School of Medicine, Division of Neonatology, Department of Pediatrics, Stanford University, Lucile Packard Children’s Hospital, Palo Alto, California,California Perinatal Quality Care Collaborative, Palo Alto
| | - Ciaran S. Phibbs
- Perinatal Epidemiology and Health Outcomes Research Unit, School of Medicine, Division of Neonatology, Department of Pediatrics, Stanford University, Lucile Packard Children’s Hospital, Palo Alto, California,Health Economics Resource Center and Center for Implementation to Innovation, Veterans Affairs Palo Alto Healthcare System, Menlo Park, California
| | - Jeannette Rogowski
- Department of Health Policy and Administration, Pennsylvania State University, State College
| | - Jeffrey B. Gould
- Perinatal Epidemiology and Health Outcomes Research Unit, School of Medicine, Division of Neonatology, Department of Pediatrics, Stanford University, Lucile Packard Children’s Hospital, Palo Alto, California,California Perinatal Quality Care Collaborative, Palo Alto
| | - Glenn Firebaugh
- Department of Sociology and Criminology, Pennsylvania State University, State College
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134
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Abstract
In recent decades, there has been remarkable growth in scientific research examining the multiple ways in which racism can adversely affect health. This interest has been driven in part by the striking persistence of racial/ethnic inequities in health and the empirical evidence that indicates that socioeconomic factors alone do not account for racial/ethnic inequities in health. Racism is considered a fundamental cause of adverse health outcomes for racial/ethnic minorities and racial/ethnic inequities in health. This article provides an overview of the evidence linking the primary domains of racism-structural racism, cultural racism, and individual-level discrimination-to mental and physical health outcomes. For each mechanism, we describe key findings and identify priorities for future research. We also discuss evidence for interventions to reduce racism and describe research needed to advance knowledge in this area.
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Affiliation(s)
- David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA;
- Department of African and African American Studies and Department of Sociology, Harvard University, Cambridge, Massachusetts 02138-3654, USA
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jourdyn A Lawrence
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA;
| | - Brigette A Davis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts 02115, USA;
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135
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Chambers BD, Baer RJ, McLemore MR, Jelliffe-Pawlowski LL. Using Index of Concentration at the Extremes as Indicators of Structural Racism to Evaluate the Association with Preterm Birth and Infant Mortality-California, 2011-2012. J Urban Health 2019; 96:159-170. [PMID: 29869317 PMCID: PMC6458187 DOI: 10.1007/s11524-018-0272-4] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Disparities in adverse birth outcomes for Black women continue. Research suggests that societal factors such as structural racism explain more variation in adverse birth outcomes than individual-level factors and societal poverty alone. The Index of Concentration at the Extremes (ICE) measures spatial social polarization by quantifying extremes of deprived and privileged social groups using a single metric and has been shown to partially explain racial disparities in black carbon exposures, mortality, fatal and non-fatal assaults, and adverse birth outcomes such as preterm birth and infant mortality. The objective of this analysis was to assess if local measures of racial and economic segregation as proxies for structural racism are associated and preterm birth and infant mortality experienced by Black women residing in California. California birth cohort files were merged with the American Community Survey by zip code (2011-2012). The ICE was used to quantify privileged and deprived groups (i.e., Black vs. White; high income vs. low income; Black low income vs. White high income) by zip code. ICE scores range from - 1 (deprived) to 1 (privileged). ICE scores were categorized into five quintiles based on sample distributions of these measures: quintile 1 (least privileged)-quintile 5 (most privileged). Generalized linear mixed models were used to test the likelihood that ICE measures were associated with preterm birth or with infant mortality experienced by Black women residing in California. Black women were most likely to reside in zip codes with greater extreme income concentrations, and moderate extreme race and race + income concentrations. Bivariate analysis revealed that greater extreme income, race, and race + income concentrations increased the odds of preterm birth and infant mortality. For example, women residing in least privileged zip codes (quintile 1) were significantly more likely to experience preterm birth (race + income ICE OR = 1.31, 95% CI = 1.72-1.46) and infant mortality (race + income ICE OR = 1.70, 95% CI = 1.17-2.47) compared to women living in the most privileged zip codes (quintile 5). Adjusting for maternal characteristics, income, race, and race + income concentrations remained negatively associated with preterm birth. However, only race and race + income concentrations remained associated with infant mortality. Findings support that ICE is a promising measure of structural racism that can be used to address racial disparities in preterm birth and infant mortality experienced by Black women in California.
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Affiliation(s)
- Brittany D Chambers
- Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA.
| | - Rebecca J Baer
- Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Monica R McLemore
- Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
- Family Health Care Nursing Department, University of California San Francisco, San Francisco, CA, USA
| | - Laura L Jelliffe-Pawlowski
- Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, USA
- Epidemiology and Biostatistics Department, University of California San Francisco, San Francisco, CA, USA
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136
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Thorsen ML, Thorsen A, McGarvey R. Operational efficiency, patient composition and regional context of U.S. health centers: Associations with access to early prenatal care and low birth weight. Soc Sci Med 2019; 226:143-152. [PMID: 30852394 PMCID: PMC6474796 DOI: 10.1016/j.socscimed.2019.02.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/02/2019] [Accepted: 02/24/2019] [Indexed: 11/20/2022]
Abstract
Community health centers (CHCs) provide comprehensive medical services to medically under-served Americans, helping to reduce health disparities. This study aimed to identify the unique compositions and contexts of CHCs to better understand variation in access to early prenatal care and rates of low birth weights (LBW). Data include CHC-level data from the Uniform Data System, and regional-level data from the US Census American Community Survey and Behavioral Risk Factor Surveillance System. First, latent class analysis was conducted to identify unobserved subgroups of CHCs. Second, data envelopment analysis was performed to evaluate the operational efficiency of CHCs. Third, we used generalized linear models to examine the associations between the CHC subgroups, efficiency, and perinatal outcomes. Seven classes of CHCs were identified, including two rural classes, one suburban, one with large centers serving poor minorities in low poverty areas, and three urban classes. Many of these classes were characterized by the racial compositions of their patients. Findings indicate that CHCs serving white patients in rural areas have greater access to early prenatal care. Health centers with greater efficiency have lower rates of LBW, as do those who serve largely white patient populations in rural areas. CHCs serving poor racial minorities living in low-poverty areas had particularly low levels of access to early prenatal care and high rates of LBW. Findings highlight that significant diversity exists in the sociodemographic composition and regional context of US health centers, in ways that are associated with their operations, delivery of care, and health outcomes. Results from this study highlight that while the provision of early prenatal care and the efficiency with which a health center operates may improve the health of the women served by CHCs and their babies, the underlying social and economic conditions facing patients ultimately have a larger association with their health.
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Affiliation(s)
- Maggie L Thorsen
- Department of Sociology & Anthropology, Montana State University, P.O. Box 172380, Bozeman, MT, 59717-2380, USA.
| | - Andreas Thorsen
- Jake Jabs College of Business and Entrepreneurship, Montana State University, P.O. Box 173040, Bozeman, MT, 59717-3040, USA.
| | - Ronald McGarvey
- Department of Industrial and Manufacturing Systems Engineering, E3437 Thomas and Nell Lafferre Hall, University of Missouri, Columbia, MO, 65211, USA; Truman School of Public Affairs, University of Missouri, USA.
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137
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Pollack Porter KM, Rutkow L, McGinty EE. The Importance of Policy Change for Addressing Public Health Problems. Public Health Rep 2019; 133:9S-14S. [PMID: 30426876 PMCID: PMC6243447 DOI: 10.1177/0033354918788880] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Keshia M Pollack Porter
- 1 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 2 Institute for Health and Social Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 3 Policy Change Workgroup, Bloomberg American Health Initiative, Baltimore, MD, USA
| | - Lainie Rutkow
- 1 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 3 Policy Change Workgroup, Bloomberg American Health Initiative, Baltimore, MD, USA
| | - Emma E McGinty
- 1 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 2 Institute for Health and Social Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 3 Policy Change Workgroup, Bloomberg American Health Initiative, Baltimore, MD, USA
- 4 Johns Hopkins Center for Mental Health and Addiction Policy Research, Baltimore, MD, USA
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138
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Mayne SL, Yellayi D, Pool LR, Grobman WA, Kershaw KN. Racial Residential Segregation and Hypertensive Disorder of Pregnancy Among Women in Chicago: Analysis of Electronic Health Record Data. Am J Hypertens 2018; 31:1221-1227. [PMID: 30010764 DOI: 10.1093/ajh/hpy112] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/11/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Racial residential segregation is associated with higher rates of chronic hypertension, as well as greater risk of preterm birth and low birthweight. However, few studies have examined associations between segregation and hypertensive disorder of pregnancy (HDP). METHODS Electronic health records from 4,748 singleton births among non-Hispanic black women at Prentice Women's Hospital in Chicago, IL (2009-2013) were geocoded to the census tract level. Residential segregation was measured using the Gi* statistic, a z-score measuring the extent to which each individual's neighborhood composition deviates from the composition of the larger surrounding area. Segregation was categorized as low (z < 0), medium (z = 0-1.96) or high (z > 1.96). We estimated cross-sectional associations of segregation with HDP using multilevel logistic regression models with census tract random intercepts. Models adjusted for neighborhood poverty and maternal characteristics. We also examined effect modification by neighborhood poverty. RESULTS Overall, 27.2% of women lived in high segregation, high-poverty neighborhoods. Racial residential segregation was not associated as a main effect with HDP in models adjusting for neighborhood poverty and maternal characteristics. However, at higher levels of neighborhood poverty (>20%), women living in high- and medium-segregated neighborhoods had greater odds of HDP relative to those in low-segregation neighborhoods (P interaction: 0.002). CONCLUSIONS In this sample of non-Hispanic black women in Chicago, racial residential segregation was associated with greater prevalence of HDP among those living in higher poverty neighborhoods. Understanding sources of heterogeneity in the relationship between segregation and health will help refine targeted intervention efforts to reduce disparities.
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Affiliation(s)
- Stephanie L Mayne
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Disha Yellayi
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lindsay R Pool
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - William A Grobman
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kiarri N Kershaw
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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139
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SmithBattle L. The past is prologue? The long arc of childhood trauma in a multigenerational study of teen mothering. Soc Sci Med 2018; 216:1-9. [PMID: 30245301 DOI: 10.1016/j.socscimed.2018.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 01/17/2023]
Abstract
The purpose of this interpretive phenomenological study was to describe intergenerational patterns in adverse childhood experiences (ACE) and protective childhood experiences among teen mothers, their parents and children, and to include social disadvantage as a source of ACE. At the seventh wave of a study that has followed teen mothers and families beginning in 1988 for 28 years, 42 family members were reinterviewed in 2016. Adult participants also completed two tools that identify ACE and childhood family strengths. After narrative data were coded inductively, Interpretive Family Profiles were created to facilitate case and cross-case analysis. Of the 9 participating teen mothers at Time 7, 4 reported few ACE and many family strengths; their parents and children reported similar scores. Of the 5 mothers reporting high ACE, children's scores improved with one exception. Findings suggest that mothers' aspirations to shield their children from trauma was a fragile endeavor for mothers who faced ongoing trauma and economic hardships. Clinicians may facilitate intergenerational repair by capitalizing on mothers' aspirations with trauma-informed care and referrals to community resources. Trauma assessment should also include poverty-related ACE and experiences related to stigma and discrimination.
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Affiliation(s)
- Lee SmithBattle
- School of Nursing, Saint Louis University, 3525 Caroline Ave, Saint Louis, Missouri, 63104, USA.
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140
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Knopov A, Rothman EF, Cronin SW, Franklin L, Cansever A, Potter F, Mesic A, Sharma A, Xuan Z, Siegel M, Hemenway D. The Role of Racial Residential Segregation in Black-White Disparities in Firearm Homicide at the State Level in the United States, 1991-2015. J Natl Med Assoc 2018; 111:62-75. [PMID: 30129481 DOI: 10.1016/j.jnma.2018.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 05/09/2018] [Accepted: 06/11/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the relationship between racial residential segregation and differences in Black-White disparities in overall firearm homicides across U.S states. METHODS Using a linear regression, we evaluated the relationship between racial residential segregation, as measured by the index of dissimilarity, and the Black-White firearm homicide disparity ratio in 32 states over the period 1991-2015. To account for clustering of observations within states, we used a generalized estimating equations approach. RESULTS After controlling for measures of White and Black deprivation, multivariate analysis showed that racial segregation was positively associated with the Black-White firearm homicide disparity. For each 10-point increase in the index of dissimilarity, the ratio of Black to White firearm homicide rates in a state increased by 39%. After controlling for levels of White and Black deprivation, racial segregation remained negatively associated with White firearm homicide rates and positively associated with Black firearm homicide rates. CONCLUSIONS These findings suggest that racial segregation may increase the disparity in firearm homicide between the Black and White population.
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Affiliation(s)
- Anita Knopov
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, USA.
| | - Emily F Rothman
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, USA
| | - Shea W Cronin
- Metropolitan College, Boston University, Boston, MA, USA
| | - Lydia Franklin
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, USA
| | - Alev Cansever
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, USA
| | - Fiona Potter
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, USA
| | - Aldina Mesic
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, USA
| | - Anika Sharma
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, USA
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, USA
| | - Michael Siegel
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, USA
| | - David Hemenway
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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