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Becene I, Rinne GR, Schetter CD, Hollenbach JP. Prenatal stress and hair cortisol in a sample of Latina women. Psychoneuroendocrinology 2024; 164:107017. [PMID: 38503196 DOI: 10.1016/j.psyneuen.2024.107017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 03/01/2024] [Accepted: 03/03/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Stress during pregnancy adversely impacts maternal and infant health. Dysregulation of the hypothalamic pituitary axis is a mediator of the relationship between stress and health. Evidence supporting an association between prenatal chronic stress and cortisol is limited, and the majority of research published has been conducted amongst White participants, who experience less chronic stress than people of color. AIM This study investigated associations between various measures of prenatal stress and hair cortisol concentrations which is a biomarker of the integrated stress response in a sample of Latina participants during the third trimester of pregnancy. METHOD Pregnant women (n=45) were surveyed with scales measuring chronic stress, perceived stress, pregnancy-related and pregnancy-specific anxiety. Hair samples were collected as an objective neuroendocrine measure of chronic stress. Linear regression analyses were performed to assess associations between stress measures and hair cortisol. Pre-pregnancy BMI, smoking during pregnancy, and steroid use during pregnancy were used as covariates in adjusted models. RESULTS Chronic stress, operationalized as maternal reports of neighborhood/housing strain, daily activities and relationship strain, discrimination, and financial strain, was significantly associated with higher hair cortisol concentrations. No significant associations were found between hair cortisol and perceived stress, pregnancy-related anxiety, nor pregnancy-specific anxiety in adjusted models. CONCLUSION Chronic stress may be a more robust correlate of physiological stress, as measured by hair cortisol in pregnancy, than other common measures of prenatal stress and anxiety.
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Affiliation(s)
- Iris Becene
- Yale University School of Medicine, New Haven CT 06510, United States
| | - Gabrielle R Rinne
- UCLA Department of Psychology, Los Angeles CA 90095-1563, United States
| | | | - Jessica P Hollenbach
- CT Children's Medical Center, Hartford, CT 06016; Department of Pediatrics, University of Connecticut Health Center, School of Medicine, Farmington CT 06030, United States.
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Wizentier MM, Stephenson BJK, Goodman MS. The measurement of racism in health inequities research. Epidemiol Rev 2023; 45:32-43. [PMID: 37147182 DOI: 10.1093/epirev/mxad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/07/2023] Open
Abstract
There is limited literature on the measures and metrics used to examine racism in the health inequities literature. Health inequities research is continuously evolving, with the number of publications increasing over time. However, there is limited knowledge on the best measures and methods to examine the impact of different levels of racism (institutionalized, personally mediated, and internalized) on health inequities. Advanced statistical methods have the potential to be used in new ways to examine the relationship between racism and health inequities. In this review, we conduct a descriptive examination of the measurement of racism in the health inequities epidemiologic literature. We examine the study design, methods used for analysis, types of measures used (e.g., composite, absolute, relative), number of measures used, phase of research (detect, understand, solutions), viewpoint (oppressor, oppressed), and components of structural racism measures (historical context, geographical context, multifaceted nature). We discuss methods (e.g., Peters-Belson, latent class analysis, difference in differences) that have demonstrated potential for future work. The articles reviewed were limited to the detect (25%) and understand (75%) phases, with no studies in the solutions phase. Although the majority (56%) of studies had cross-sectional designs, many authors pointed to the need for longitudinal and multilevel data for further exploration. We examined study design features as mutually exclusive elements. However, racism is a multifaceted system and the measurement of racism in many studies does not fit into a single category. As the literature grows, the significance of methodological and measurement triangulation to assess racism should be investigated.
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Affiliation(s)
- Marina Mautner Wizentier
- Department of Biostatistics, School of Global Public Health, New York University, New York, New York 10003, United States
| | - Briana Joy K Stephenson
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Melody S Goodman
- Department of Biostatistics, School of Global Public Health, New York University, New York, New York 10003, United States
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Vaughan SE, Misra DP, Gohar J, Hyer S, Price M, Giurgescu C. The associations of objective and perceived neighborhood disadvantage with stress among pregnant black women. Public Health Nurs 2023; 40:372-381. [PMID: 36740747 PMCID: PMC10164036 DOI: 10.1111/phn.13177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/15/2022] [Accepted: 01/13/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neighborhood disadvantage may impact risk of preterm birth through stress. Few studies have examined how neighborhood disadvantage relates to stress during pregnancy, especially for Black women. METHODS Secondary data analysis of 572 women in a prospective cohort in Detroit, MI and Columbus, OH. Participants completed questionnaires including the ROSS Neighborhood Disorder Scale, the crime subscale of the Perceived Neighborhood Scale (PNS), and the Perceived Stress Scale. An objective neighborhood disadvantage index (NDI) was created using principal components analysis after geocoding residential addresses and linking to Census data. RESULTS All models used logistic regression. Adjusted for maternal age and annual household income, perceived stress was positively associated with perceived neighborhood disorder (p < .01). In a separate model, perceived neighborhood crime was positively associated with perceived neighborhood disorder (p = .005). In a joint model adjusted for age and income, the association of disorder with stress was similar in magnitude (p < .01) but the association between crime and stress weakened. The NDI was not associated with perceived stress before or after adjustment for confounders. CONCLUSIONS Perceived neighborhood disadvantage may capture a different dimension than objective neighborhood disadvantage. Future studies should test stress as a pathway by which neighborhood environment increases risk of preterm birth.
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Affiliation(s)
- Sarah E. Vaughan
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Dawn P. Misra
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Jazib Gohar
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Suzanne Hyer
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Mercedes Price
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Carmen Giurgescu
- College of Nursing, University of Central Florida, Orlando, FL, USA
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Johnson AJ, Urizar GG, Nwabuzor J, Dinh P. Racism, shame, and stress reactivity among young black women. Stress Health 2022; 38:1001-1013. [PMID: 35468656 PMCID: PMC10911821 DOI: 10.1002/smi.3152] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/28/2022] [Accepted: 04/12/2022] [Indexed: 01/01/2023]
Abstract
Black women experience disproportional rates of cardiovascular disease (CVD) warranting further exploration of CVD risk factors. Growing evidence suggests acute stress reactivity studies may elucidate the mechanisms driving psychosocial correlates of CVD risks. Race-related stress has been identified as a CVD risk factor among Black women though recent evidence suggests emotions may facilitate these risks. Black women may be vulnerable to shame related to frequent racist experiences. Yet, no study to date has examined racism, shame, and stress reactivity in this population. The current study utilized mixed linear models to test for time and group effects of racism and shame on stress reactivity (e.g., cortisol and C-reactive protein [CRP]) among 34 Black women who completed the Trier Social Stress Test. Tests for two-way interactions (i.e., shame by racism) were also performed. Significant time and group effects were observed for shame and racism on stress reactivity. Black women who experienced greater lifetime racism, stress appraised, but lower racism during the past year, exhibited greater CRP responses. Black women who experienced high levels of shame and racism during the past year and their lifetime demonstrated greater cortisol reactivity. These results prompt further research on racism and shame as CVD risk factors among Black women.
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Affiliation(s)
- Amber J. Johnson
- Department of Health Science, California State University, Long Beach, California, USA
| | - Guido G. Urizar
- Department of Psychology, California State University, Long Beach, California, USA
| | - Jessica Nwabuzor
- Department of Urban Public Health, Charles Drew University of Medicine and Science, Los Angeles, California, USA
| | - Peter Dinh
- Department of Psychology, California State University, Long Beach, California, USA
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White VanGompel E, Lai J, Davis D, Carlock F, Camara TL, Taylor B, Clary C, McCorkle‐Jamieson AM, McKenzie‐Sampson S, Gay C, Armijo A, Lapeyrolerie L, Singh L, Scott KA. Psychometric validation of a patient-reported experience measure of obstetric racism© (The PREM-OB Scale™ suite). Birth 2022; 49:514-525. [PMID: 35301757 PMCID: PMC9544169 DOI: 10.1111/birt.12622] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Perinatal quality improvement lacks valid tools to measure adverse hospital experiences disproportionately impacting Black mothers and birthing people. Measuring and mitigating harm requires using a framework that centers the lived experiences of Black birthing people in evaluating inequitable care, namely, obstetric racism. We sought to develop a valid patient-reported experience measure (PREM) of Obstetric Racism© in hospital-based intrapartum care designed for, by, and with Black women as patient, community, and content experts. METHODS PROMIS© instrument development standards adapted with cultural rigor methodology. Phase 1 included item pool generation, modified Delphi method, and cognitive interviews. Phase 2 evaluated the item pool using factor analysis and item response theory. RESULTS Items were identified or written to cover 7 previously identified theoretical domains. 806 Black mothers and birthing people completed the pilot test. Factor analysis concluded a 3 factor structure with good fit indices (CFI = 0.931-0.977, RMSEA = 0.087-0.10, R2 > .3, residual correlation < 0.15). All items in each factor fit the IRT model and were able to be calibrated. Factor 1, "Humanity," had 31 items measuring experiences of safety and accountability, autonomy, communication, and empathy. A 12-item short form was created to ease respondent burden. Factor 2, "Racism," had 12 items measuring experiences of neglect and mistreatment. Factor 3, "Kinship," had 7 items measuring hospital denial and disruption of relationships between Black mothers and their child or support system. CONCLUSIONS The PREM-OB Scale™ suite is a valid tool to characterize and quantify obstetric racism for use in perinatal improvement initiatives.
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Affiliation(s)
- Emily White VanGompel
- Departments of Family Medicine and Obstetrics and GynecologyPritzker School of MedicineThe University of ChicagoChicagoIllinoisUSA,NorthShore University HealthSystem (NSUHS) Research InstituteEvanstonIllinoisUSA
| | - Jin‐Shei Lai
- Departments of Medical Social Sciences and PediatricsNorthwestern University Feinberg School of MedicineEvanstonIllinoisUSA
| | - Dána‐Ain Davis
- Queens CollegeCity University of New YorkNew YorkNew YorkUSA
| | - Francesca Carlock
- NorthShore University HealthSystem (NSUHS) Research InstituteEvanstonIllinoisUSA
| | | | - Brianne Taylor
- California Preterm Birth InitiativeUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Chakiya Clary
- California Preterm Birth InitiativeUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Ashlee M. McCorkle‐Jamieson
- Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA,Department of Obstetrics and GynecologyHighland General HospitalAlameda Health SystemOaklandCaliforniaUSA
| | - Safyer McKenzie‐Sampson
- California Preterm Birth InitiativeUniversity of CaliforniaSan FranciscoCaliforniaUSA,Department of Epidemiology & BiostatisticsUniversity of California San Francisco School of MedicineSan FranciscoCaliforniaUSA
| | - Caryl Gay
- Department of Family Health Care NursingUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Amanda Armijo
- Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lillie Lapeyrolerie
- Department of Obstetrics, Gynecology, and Reproductive SciencesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lavisha Singh
- Queens CollegeCity University of New YorkNew YorkNew YorkUSA
| | - Karen A. Scott
- Birthing Cultural Rigor, LLCOaklandCaliforniaUSA,Departments of Obstetrics, Gynecology, and Reproductive Sciences, and Humanities and Social SciencesUniversity of California San Francisco School of MedicineSan FranciscoCaliforniaUSA
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Needham BL, Ali T, Allgood KL, Ro A, Hirschtick JL, Fleischer NL. Institutional Racism and Health: a Framework for Conceptualization, Measurement, and Analysis. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01381-9. [PMID: 35994173 PMCID: PMC9395863 DOI: 10.1007/s40615-022-01381-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/28/2022]
Abstract
Despite growing interest in the health-related consequences of racially discriminatory institutional policies and practices, public health scholars have yet to reach a consensus on how to measure and analyze exposure to institutional racism. The purpose of this paper is to provide an overview of the conceptualization, measurement, and analysis of institutional racism in the context of quantitative research on minority health and health disparities in the United States. We begin by providing definitions of key concepts (e.g., racialization, racism, racial inequity) and describing linkages between these ideas. Next, we discuss the hypothesized mechanisms that link exposure to institutional racism with health. We then provide a framework to advance empirical research on institutional racism and health, informed by a literature review that summarizes measures and analytic approaches used in previous studies. The framework addresses six considerations: (1) policy identification, (2) population of interest, (3) exposure measurement, (4) outcome measurement, (5) study design, and (6) analytic approach. Research utilizing the proposed framework will help inform structural interventions to promote minority health and reduce racial and ethnic health disparities.
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Affiliation(s)
- Belinda L Needham
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Talha Ali
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Kristi L Allgood
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Annie Ro
- Department of Health, Society, and Behavior, University of California-Irvine Program in Public Health, Irvine, CA, USA
| | - Jana L Hirschtick
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Nancy L Fleischer
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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7
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Dyer L, Chambers BD, Crear-Perry J, Theall KP, Wallace M. The Index of Concentration at the Extremes (ICE) and Pregnancy-Associated Mortality in Louisiana, 2016-2017. Matern Child Health J 2022; 26:814-822. [PMID: 34148221 PMCID: PMC8684557 DOI: 10.1007/s10995-021-03189-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Social and contextual factors underlying the continually disproportionate and burdensome risk of adverse health outcomes experienced by Black women in the US are underexplored in the literature. The aim of this study was to use an index based on area-level population distributions of race and income to predict risk of death during pregnancy and up to 1 year postpartum among women in Louisiana. METHODS Using vital records data provided by the Louisiana Department of Health 2016-2017 (n = 125,537), a modified Poisson model was fit with generalized estimating equations to examine the risk of pregnancy-associated death associated with census tract-level values of the Index of Concentration at the Extremes (ICE)-grouped by tertile-while adjusting for both individual and tract-level confounders. RESULTS Analyses resulted in an estimated 1.73 (95% CI 1.02-2.93) times increased risk for pregnancy-associated death for those in areas which were characterized by concentrated deprivation (high proportions of Black and low-income residents) relative to those in areas of concentrated privilege (high proportions of white and high-income residents), independent of other factors. CONCLUSIONS FOR PRACTICE In addition to continuing to consider the deeply entrenched racism and economic inequality that shape the experience of pregnancy-associated death, we must also consider their synergistic effect on access to resources, maternal population health, and health inequities.
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Affiliation(s)
- Lauren Dyer
- Department of Social, Behavioral, and Population Sciences, Mary Amelia Women's Center, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA, 70112, USA.
| | - Brittany D Chambers
- School of Medicine, Epidemiology and Biostatistics, University of San Francisco, 550 16th St., San Francisco, CA, 94158, USA
| | - Joia Crear-Perry
- National Birth Equity Collaborative, 4747 Earhart Blvd, New Orleans, LA, USA
| | - Katherine P Theall
- Department of Social, Behavioral, and Population Sciences, Mary Amelia Women's Center, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA, 70112, USA
| | - Maeve Wallace
- Department of Social, Behavioral, and Population Sciences, Mary Amelia Women's Center, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA, 70112, USA
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8
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Omowale SS, Casas A, Lai YH, Sanders SA, Hill AV, Wallace ML, Rathbun SL, Gary-Webb TL, Burke LE, Davis EM, Mendez DD. Trends in Stress Throughout Pregnancy and Postpartum Period During the COVID-19 Pandemic: Longitudinal Study Using Ecological Momentary Assessment and Data From the Postpartum Mothers Mobile Study. JMIR Ment Health 2021; 8:e30422. [PMID: 34328420 PMCID: PMC8457341 DOI: 10.2196/30422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Stress is associated with adverse birth and postpartum health outcomes. Few studies have longitudinally explored racial differences in maternal stress in a birthing population in the United States during the ongoing COVID-19 pandemic. OBJECTIVE This study aimed to do the following: (1) assess changes in reported stress before, during, and after initial emergency declarations (eg, stay-at-home orders) were in place due to the COVID-19 pandemic, and (2) assess Black-White differences in reported stress in a pregnant and postpartum population from Southwestern Pennsylvania. METHODS We leveraged data from the ongoing Postpartum Mothers Mobile Study (PMOMS), which surveys participants in real time throughout the pregnancy and postpartum periods via ecological momentary assessment (EMA) and smartphone technology. We analyzed data from a subset of PMOMS participants (n=85) who were either Black or White, and who submitted EMA responses regarding stress between November 1, 2019, and August 31, 2020, the time frame of this study. We divided data into four phases based on significant events during the COVID-19 pandemic: "pre" phase (baseline), "early" phase (first case of COVID-19 reported in United States), "during" phase (stay-at-home orders), and "post" phase (stay-at-home orders eased). We assessed mean stress levels at each phase using linear mixed-effects models and post hoc contrasts based on the models. RESULTS Overall mean stress (0=not at all to 4=a lot) during the pre phase was 0.8 for Black and White participants (range for Black participants: 0-3.9; range for White participants: 0-2.8). There was an increase of 0.3 points (t5649=5.2, P<.001) in the during phase as compared with the pre phase, and an increase of 0.2 points (t5649=3.1, P=.002) in the post phase compared with the pre phase (n=85). No difference was found between Black and White participants in the change in mean stress from the pre phase to the during phase (overall change predicted for the regression coefficient=-0.02, P=.87). There was a significant difference between Black and White participants in the change in mean stress from the during phase to the post phase (overall change predicted for the regression coefficient=0.4, P<.001). CONCLUSIONS There was an overall increase in mean stress levels in this subset of pregnant and postpartum participants during the same time as the emergency declarations/stay-at-home orders in the United States. Compared to baseline, mean stress levels remained elevated when stay-at-home orders eased. We found no significant difference in the mean stress levels by race. Given that stress is associated with adverse birth outcomes and postpartum health, stress induced by the ongoing COVID-19 pandemic may have adverse implications for birthing populations in the United States. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/13569.
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Affiliation(s)
- Serwaa S Omowale
- School of Social Work, University of Pittsburgh, Pittsburgh, PA, United States
- Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrea Casas
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yu-Hsuan Lai
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sarah A Sanders
- Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ashley V Hill
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Meredith L Wallace
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Stephen L Rathbun
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Tiffany L Gary-Webb
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lora E Burke
- Department of Health and Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Esa M Davis
- Division of Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Dara D Mendez
- Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Division of Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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Sewell AA. Political Economies of Acute Childhood Illnesses: Measuring Structural Racism as Mesolevel Mortgage Market Risks. Ethn Dis 2021; 31:319-332. [PMID: 34045834 PMCID: PMC8143851 DOI: 10.18865/ed.31.s1.319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives Health studies of structural racism/discrimination have been animated through the deployment of neighborhood effects frameworks that engage institutionalist concerns about sociopolitical resources and mobility structures. This study highlights the acute illness risks of place-based inequalities and neighborhood-varying race-based inequalities by focusing on access to and the regulation of mortgage markets. Design By merging neighborhood data on lending processes from the Home Mortgage Disclosure Act with individual health from the Project on Human Development in Chicago Neighborhoods, this article evaluates the acute childhood illness risks of four mutually inclusive, political economies using multilevel generalized linear models. Setting Chicago, IL, USA. Participants Youth aged 0 to 17 years. Main Outcome Measures The prevalence of 11 acute illnesses (cold/flu, sinus trouble, sore throat/tonsils, headache, upset stomach, bronchitis, skin infection, pneumonia, urinary tract infections, fungal disease, mononucleosis) and the past-year frequencies of 6 acute illnesses (cold/flu, sinus trouble, sore throat/tonsils, headache, upset stomach, bronchitis) are evaluated. Methods Multilevel logistic regression. Results The most theoretically consistent predictor of illness is a measure identifying neighborhoods with above-city-median levels of racial disparities in the regulation of loans - a mesolevel measure of structural racism. In areas with high levels of minority-White differences in less-regulated credit, youth are more likely to have a range of acute illnesses and experience them at more frequent intervals in the past year. Conclusions This article highlights the substantive and methodological importance of focusing on multidimensional representations of institutionalized political economic inequalities circumscribed and traversed by the power relations established by institutions and the state.
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10
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Pabayo R, Ehntholt A, Davis K, Liu SY, Muennig P, Cook DM. Structural Racism and Odds for Infant Mortality Among Infants Born in the United States 2010. J Racial Ethn Health Disparities 2019; 6:1095-1106. [PMID: 31309525 PMCID: PMC6832817 DOI: 10.1007/s40615-019-00612-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES While ecological studies indicate that high levels of structural racism within US states are associated with elevated infant mortality rates, studies using individual-level data are needed. To determine whether indicators of structural racism are associated with the individual odds for infant mortality among white and black infants in the US. METHODS We used data on 2,163,096 white and 590,081 black infants from the 2010 US Cohort Linked Birth/Infant Death Data Files. Structural racism indicators were ratios of relative proportions of blacks to whites for these domains: electoral (registered to vote and voted; state legislature representation), employment (civilian labor force; employed; in management; with a bachelor's degree), and justice system (sentenced to death; incarcerated). Multilevel logistic regression was used to determine whether structural racism indicators were risk factors of infant mortality. RESULTS Compared to the lowest tertile ratio of relative proportions of blacks to whites with a bachelor's degree or higher-indicative of low structural racism-black infants, but not whites, in states with moderate (OR = 1.12, 95% CI = 0.94, 1.32) and high tertiles (OR = 1.25, 95% CI = 1.03, 1.51) had higher odds of infant mortality. CONCLUSIONS Educational and judicial indicators of structural racism were associated with infant mortality among blacks. Decreasing structural racism could prevent black infant deaths.
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Affiliation(s)
- Roman Pabayo
- University of Alberta School of Public Health, Edmonton, Canada.
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA.
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Amy Ehntholt
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Kia Davis
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Sze Y Liu
- Weill Cornell Medical College, New York City, NY, USA
| | - Peter Muennig
- Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Daniel M Cook
- School of Community Health Sciences, University of Nevada, Reno, Nevada, USA
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11
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Thomas MD, Michaels EK, Reeves AN, Okoye U, Price MM, Hasson RE, Chae DH, Allen AM. Differential associations between everyday versus institution-specific racial discrimination, self-reported health, and allostatic load among black women: implications for clinical assessment and epidemiologic studies. Ann Epidemiol 2019; 35:20-28.e3. [PMID: 31235363 PMCID: PMC7179332 DOI: 10.1016/j.annepidem.2019.05.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 04/06/2019] [Accepted: 05/08/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE Black women have the highest estimated allostatic load (AL). AL and self-perceived health are strong health predictors and have been linked to racial discrimination. Research suggests that everyday and institution-specific racial discrimination may predict different AL and self-reported health (SRH) outcomes. Furthermore, discrepancies between AL and self-perceived health could widen disparities. We estimated associations between everyday versus institution-specific racial discrimination with AL and SRH. METHODS Data are from a San Francisco Bay Area community sample of 208 black women aged 30-50 years. Participation involved a questionnaire, self-interview, blood draw, and anthropometric measurements. Adjusted generalized linear regression models estimated associations of racial discrimination with AL and SRH. RESULTS After adjusting for age, socioeconomic position, and medication use, institution-specific discrimination was negatively associated with AL (i.e., better health), whereas everyday experiences showed no association. Those reporting very-high (vs. moderate) institution-specific discrimination had lower AL (β = -1.31 [95% CI: -2.41, -0.20]; AL range: 0-15). No racial discrimination-SRH association was found. CONCLUSIONS For black women, (1) institution-specific racial discrimination may be differentially embodied compared with everyday experiences and (2) institutional racism may contribute to physiologic stress-regulation regardless of self-perceived health status. Potential factors that may contribute to an inverse racial discrimination-AL association, and future research, are discussed.
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Affiliation(s)
- Marilyn D Thomas
- Division of Epidemiology, School of Public Health, University of California, Berkeley.
| | - Elizabeth K Michaels
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Alexis N Reeves
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Uche Okoye
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Melisa M Price
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Rebecca E Hasson
- Schools of Kinesiology and Public Health, University of Michigan, Ann Arbor
| | - David H Chae
- Department of Human Development and Family Studies, College of Human Sciences, Auburn University, Auburn, AL
| | - Amani M Allen
- Division of Epidemiology, School of Public Health, University of California, Berkeley
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12
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A Bayesian spatio-temporal analysis on racial disparities in hypertensive disorders of pregnancy in Florida, 2005-2014. Spat Spatiotemporal Epidemiol 2019; 29:43-50. [PMID: 31128630 PMCID: PMC6631343 DOI: 10.1016/j.sste.2019.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/21/2019] [Accepted: 03/12/2019] [Indexed: 11/21/2022]
Abstract
Disparities in hypertensive disorders of pregnancy (HDP) exist among racial and ethnic groups in the US. However, little is known about spatio-temporal variations in HDP disparities. We used a Bayesian hierarchical regression approach to investigate spatio-temporal variations in HDP disparities from 2005 to 2014. County-level variation was firstly examined, followed by census tract-level variation assessment in counties where high HDP disparities were observed. A significant disadvantage in HDP was revealed for African Americans in Florida overall (Odds Ratio: 1.27, 95% Confidence Interval: 1.25, 1.29), with significant spatial variations. The greatest HDP disparities between African Americans and non-African Americans occurred in North Central Florida counties (the Big Bend region of Florida), with consistent patterns from 2005 to 2014. Analyses at census tract-level further revealed significant neighborhood disparities within these counties. Findings from this study provide important information for public health agencies and policymakers to reduce HDP disparities at the population level.
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13
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McClure E, Feinstein L, Cordoba E, Douglas C, Emch M, Robinson W, Galea S, Aiello AE. The legacy of redlining in the effect of foreclosures on Detroit residents' self-rated health. Health Place 2018; 55:9-19. [PMID: 30448354 DOI: 10.1016/j.healthplace.2018.10.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/05/2018] [Accepted: 10/15/2018] [Indexed: 10/27/2022]
Abstract
Historical practices, such as housing discrimination in Detroit, have been shown to have lasting impacts on communities. Perhaps the most explicit example is the practice of redlining in the 1930s, whereby lenders outlined financially undesirable neighborhoods, populated by minority families, on maps and prevented residents from moving to better resourced neighborhoods. Awareness of historical housing discrimination may improve research assessing the impacts of current neighborhood characteristics on health. Using the Detroit Neighborhood Health Study (DNHS), we assessed the association between two-year changes in home foreclosure rates following the 2007-2008 Great Recession, and residents' five-year self-rated health trajectories (2008-2013); and estimated the confounding bias introduced by ignoring historical redlining practices in the city. We used both ecological and multilevel models to make inference about person- and community-level processes. In a neighborhood-level linear regression adjusted for confounders (including percent redlined); a 10%-point slower foreclosure rate recovery was associated with an increase in prevalence of poor self-rated health of 0.31 (95% CI:-0.02 to 0.64). At the individual level, it was associated with a within-person increase in probability of poor health of 0.45 (95% CI:0.15-0.72). Removing redlining from the model biased the estimated effect upward to 0.38 (95% CI:0.07-0.69) and 0.56 (95% CI:0.21-0.84) in the neighborhood and individual-level models, respectively. Stratum-specific foreclosure recovery effects indicate stronger influence in neighborhoods with a greater proportion of residents identifying as white and a greater degree of historic redlining. These findings support earlier theory suggesting a historical influence of structural discrimination on the association between current neighborhood characteristics and health, and suggests that historical redlining specifically may increase vulnerability to contemporary neighborhood foreclosures. Community interventions should consider historical discrimination in conjunction with current place-based indicators to more equitably improve population health.
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Affiliation(s)
- Elizabeth McClure
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lydia Feinstein
- Social & Scientific Systems, Research Triangle Park, NC, United States
| | - Evette Cordoba
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Michael Emch
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Whitney Robinson
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sandro Galea
- Boston University School of Public Health, Boston, MA, United States
| | - Allison E Aiello
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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14
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Vines AI, Ward JB, Cordoba E, Black KZ. Perceived Racial/Ethnic Discrimination and Mental Health: a Review and Future Directions for Social Epidemiology. CURR EPIDEMIOL REP 2017; 4:156-165. [PMID: 28920011 PMCID: PMC5596659 DOI: 10.1007/s40471-017-0106-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Recent literature on racial or ethnic discrimination and mental health was reviewed to assess the current science and identify key areas of emphasis for social epidemiology. Objectives of this review were to: 1) Determine whether there have been advancements in the measurement and analysis of perceived discrimination; 2) Identify the use of theories and/or frameworks in perceived discrimination and mental health research; and 3) Assess the extent to which stress buffers are being considered and evaluated in the existing literature. RECENT FINDINGS Metrics and analytic approaches used to assess discrimination remain largely unchanged. Theory and/or frameworks such as the stress and coping framework continue to be underused in majority of the studies. Adolescents and young adults experiencing racial/ethnic discrimination were at greater risk of adverse mental health outcomes, and the accumulation of stressors over the life course may have an aggregate impact on mental health. Some growth seems evident in studies examining the mediation and moderation of stress buffers and other key factors with the findings suggesting a reduction in the effects of discrimination on mental health. SUMMARY Discrimination scales should consider the multiple social identities of a person, the context where the exposure occurs, how the stressor manifests specifically in adolescents, the historical traumas, and cumulative exposure. Life course theory and intersectionality may help guide future work. Despite existing research, gaps remain in in elucidating the effects of racial and ethnic discrimination on mental health, signaling an opportunity and a call to social epidemiologists to engage in interdisciplinary research to speed research progress.
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Affiliation(s)
- Anissa I Vines
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 266 Rosenau Hall, CB #7435, 135 Dauer Drive, Chapel Hill, NC 27599-7435
| | - Julia B Ward
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7435, Chapel Hill, NC 27599-7435
| | - Evette Cordoba
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7435, Chapel Hill, NC 27599-7435
| | - Kristin Z Black
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB #7440, Chapel Hill, NC 27599-7440
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15
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Mouzon DM, McLean JS. Internalized racism and mental health among African-Americans, US-born Caribbean Blacks, and foreign-born Caribbean Blacks. ETHNICITY & HEALTH 2017; 22:36-48. [PMID: 27354264 DOI: 10.1080/13557858.2016.1196652] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVES The tripartite model of racism includes personally mediated racism, institutionalized racism, and the less-oft studied internalized racism. Internalized racism - or negative beliefs about one's racial group - results from cultural racism that is endemic in American society. In this project, we studied whether these negative stereotypes are associated with mental health among African-Americans and Caribbean Blacks. DESIGN Using secondary data from the National Survey of American Life, we investigated the association between internalized racism and mental health (measured by depressive symptoms and serious psychological distress (SPD)) among these two groups. We also explored whether ethnicity/nativity and mastery moderate the association between internalized racism and mental health among African-Americans and Caribbean Blacks. RESULTS Internalized racism was positively associated with depressive symptoms and SPD among all Black subgroups. However, internalized racism was a weaker predictor of SPD among foreign-born Caribbean Blacks than US-born Caribbean Blacks and US-born African-Americans. Additionally, higher mastery was protective against distress associated with internalized racism. CONCLUSION Internalized racism is an important yet understudied determinant of mental health among Blacks. Future studies should take into account additional heterogeneity within the Black population (e.g. African-born individuals) and other potential protective mechanisms in addition to mastery (e.g. self-esteem and racial identity).
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Affiliation(s)
- Dawne M Mouzon
- a Edward J. Bloustein School of Planning and Public Policy , Rutgers, The State University of New Jersey , New Brunswick , NJ , USA
- b Institute for Health, Health Care Policy, and Aging Research , Rutgers, The State University of New Jersey , New Brunswick , NJ , USA
| | - Jamila S McLean
- a Edward J. Bloustein School of Planning and Public Policy , Rutgers, The State University of New Jersey , New Brunswick , NJ , USA
- b Institute for Health, Health Care Policy, and Aging Research , Rutgers, The State University of New Jersey , New Brunswick , NJ , USA
- c Rutgers School of Public Health , Piscataway Township , NJ , USA
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16
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Mendez DD, Thorpe RJ, Amutah N, Davis EM, Walker RE, Chapple-McGruder T, Bodnar L. Neighborhood racial composition and poverty in association with pre-pregnancy weight and gestational weight gain. SSM Popul Health 2016; 2:692-699. [PMID: 29349180 PMCID: PMC5757954 DOI: 10.1016/j.ssmph.2016.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/25/2016] [Accepted: 09/27/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Studies of neighborhood racial composition or neighborhood poverty in association with pregnancy-related weight are limited. Prior studies of neighborhood racial density and poverty has been in association with adverse birth outcomes and suggest that neighborhoods with high rates of poverty and racial composition of black residents are typically segregated and systematically isolated from opportunities and resources. These neighborhood factors may help explain the racial disparities in pre-pregnancy weight and inadequate weight gain. This study examined whether neighborhood racial composition and neighborhood poverty was associated with weight before pregnancy and weight gain during pregnancy and if this association differed by race. METHODS We used vital birth records of singleton births of 73,061 non-Hispanic black and white women in Allegheny County, PA (2003-2010). Maternal race and ethnicity, pre-pregnancy body-mass-index (BMI), gestational weight gain and other individual-level characteristics were derived from vital birth record data, and measures of neighborhood racial composition (percentage of black residents in the neighborhood) and poverty (percentage of households in the neighborhood below the federal poverty) were derived using US Census data. Multilevel log binomial regression models were performed to estimate neighborhood racial composition and poverty in association with pre-pregnancy weight (i.e., overweight/obese) and gestational weight gain (i.e., inadequate and excessive). RESULTS Black women as compared to white women were more likely to be overweight/obese before pregnancy and to have inadequate gestational weight gain (53.6% vs. 38.8%; 22.5% vs. 14.75 respectively). Black women living in predominately black neighborhoods were slightly more likely to be obese prior to pregnancy compared to black women living in predominately white neighborhoods (PR 1.10; 95% CI: 1.03, 1.16). Black and white women living in high poverty areas compared with women living in lower poverty areas were more likely to be obese prior to pregnancy; while only white women living in high poverty areas compared to low poverty areas were more likely gain an inadequate amount of weight during pregnancy. CONCLUSIONS Neighborhood racial composition and poverty may be important in understanding racial differences in weight among childbearing women.
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Affiliation(s)
- Dara D. Mendez
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, 130 DeSoto Street, Pittsburgh, PA 15261, USA
| | - Roland J. Thorpe
- Johns Hopkins University Bloomberg School of Public Health Department of Health, Behavior, and Society, 624 N. Broadway, Suite 708, Baltimore, MD 21205, USA
| | - Ndidi Amutah
- Montclair State University, Department of Health and Nutrition Sciences, 1 Normal Avenue UN-4192 Upper, Montclair, NJ 07042, USA
| | - Esa M. Davis
- University of Pittsburgh, Medical Center Center for Research on Healthcare, 230 McKee Pl, Suite 600, Pittsburgh, PA 15213, USA
| | - Renee E. Walker
- University of Wisconsin-Milwaukee, Joseph J. Zilber School of Public Health, Building 415, Milwaukee, WI 53201, USA
| | | | - Lisa Bodnar
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, 130 DeSoto Street, Pittsburgh, PA 15261, USA
- University of Pittsburgh, School of Medicine Department of Obstetrics, Gynecology, and Reproductive Sciences, USA
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17
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Bediako PT, BeLue R, Hillemeier MM. A Comparison of Birth Outcomes Among Black, Hispanic, and Black Hispanic Women. J Racial Ethn Health Disparities 2015; 2:573-82. [PMID: 26561541 PMCID: PMC4637167 DOI: 10.1007/s40615-015-0110-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND While non-Hispanic Black populations tend to be disproportionately affected by adverse reproductive outcomes, Hispanic populations tend to demonstrate healthier birth outcomes, regardless of socioeconomic background. Little is known about birth outcomes for women who are both Black and Hispanic. We examined whether birth outcomes and risk factors for women who are both Black and Hispanic most closely resemble those of women who are only Black or Hispanic and also compared these outcomes to those for Whites. METHODS Using the 2013 US natality files, we examined 2,970,315 singleton births to Black Hispanic, Hispanic, Black, and White mothers. We used logistic regression to calculate predicted probabilities of low birth weight (LBW), preterm birth (PTB), or small for gestational age (SGA). Race-stratified regression analysis was used to identify the factors that significantly predicted risk for each outcome for each racial/ethnic group. RESULTS Black mothers had the highest prevalence and predicted probabilities of experiencing all three outcomes. Black Hispanic mothers were less likely than Black mothers and more likely than Hispanic mothers to experience each of the adverse outcomes. We also found support for racial variation in risk and protective factors for mothers in the different groups. Factors like age and education inconsistently predicted risk of experiencing the birth outcomes for all groups. Overall, Black Hispanic mothers had birth outcomes and risk factor profiles like Hispanic mothers, although they had sociodemographic characteristics and health behaviors like Black mothers. CONCLUSIONS Patterning of birth outcomes among Black Hispanic women suggest an intersection of risk and protective factors associated with their respective racial and ethnic identities. Additional information about sociodemographic context is needed to develop a more complete picture of how factors related to race and ethnic group membership influence Black Hispanic women's birth outcomes.
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Affiliation(s)
| | - Rhonda BeLue
- Pennsylvania State University, University Park, PA, USA
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18
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Wentz AE, Messer LC, Nguyen T, Boone-Heinonen J. Small and large size for gestational age and neighborhood deprivation measured within increasing proximity to homes. Health Place 2014; 30:98-106. [PMID: 25240489 DOI: 10.1016/j.healthplace.2014.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 08/04/2014] [Accepted: 08/21/2014] [Indexed: 11/28/2022]
Abstract
Neighborhood deprivation is consistently associated with greater risk of low birthweight. However, large birth size is increasingly relevant but overlooked in neighborhood health research, and proximity within which neighborhood deprivation may affect birth outcomes is unknown. We estimated race/ethnic-specific effects of neighborhood deprivation index (NDI) within 1, 3, 5, and 8km buffers around Oregon Pregnancy Risk Assessment Monitoring System (n=3716; 2004-2007) respondents׳ homes on small and large for gestational age (SGA, LGA). NDI was positively associated with LGA and SGA in most race/ethnic groups. The results varied little across the four buffer sizes.
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Affiliation(s)
- Anna E Wentz
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098, USA; Population Studies Center, University of Michigan Institute for Social Research, 426 Thompson Street, Ann Arbor, MI, 48104, USA.
| | - Lynne C Messer
- Portland State University, Community Health - Urban & Public Affairs (SCH), PO Box 751, Portland, OR 97207, USA.
| | - Thuan Nguyen
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098, USA.
| | - Janne Boone-Heinonen
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098, USA.
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Wallace M, Harville E, Theall K, Webber L, Chen W, Berenson G. Neighborhood poverty, allostatic load, and birth outcomes in African American and white women: findings from the Bogalusa Heart Study. Health Place 2013; 24:260-6. [PMID: 24184350 PMCID: PMC3921680 DOI: 10.1016/j.healthplace.2013.10.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 08/08/2013] [Accepted: 10/03/2013] [Indexed: 01/09/2023]
Abstract
As a biologically-mediated pathway between adversity and declines in physical health, allostatic load has been frequently hypothesized as a potential contributor to racial disparities in birth outcomes, but an empirical evidence is lacking. The purpose of this study was to examine the relationships between maternal preconception allostatic load, race, and adverse birth outcomes within the context of neighborhood-level poverty using data from the Bogalusa Heart Study. Allostatic load was quantified as a count of regulatory biomarkers falling in the highest risk quartile of the sample distribution as measured from a physical examination that took place prior to conception. Consistent with previous findings, African American women resided in more impoverished neighborhoods and had higher allostatic load scores compared to whites; however, allostatic load was not associated with preterm birth or low birth weight in fully adjusted models. These results underscore a need for further refinement of both biologic and contextual measures that capture holistically the way in which stressful conditions and experiences encountered across the life-course influence health potentials and engender inequities in reproductive health outcomes.
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Affiliation(s)
- Maeve Wallace
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine 1440 Canal St. Suite 2000 New Orleans, LA70112
| | - Emily Harville
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine 1440 Canal St. Suite 2000 New Orleans, LA70112
| | - Katherine Theall
- Department of Global Community Health and Behavioral Sciences Tulane University School of Public Health and Tropical Medicine 1440 Canal St. Suite 2301 New Orleans, LA 70112
| | - Larry Webber
- Department of Biostatistics and Bioinformatics Tulane University School of Public Health and Tropical Medicine 1440 Canal St. Suite 2000 New Orleans, LA70112
| | - Wei Chen
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine 1440 Canal St. Suite 2000 New Orleans, LA70112
| | - Gerald Berenson
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine 1440 Canal St. Suite 2000 New Orleans, LA70112
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Williams DR, Mohammed SA. Racism and Health I: Pathways and Scientific Evidence. THE AMERICAN BEHAVIORAL SCIENTIST 2013; 57:10.1177/0002764213487340. [PMID: 24347666 PMCID: PMC3863357 DOI: 10.1177/0002764213487340] [Citation(s) in RCA: 680] [Impact Index Per Article: 61.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This article reviews the scientific research that indicates that despite marked declines in public support for negative racial attitudes in the United States, racism, in its multiple forms, remains embedded in American society. The focus of the article is on the review of empirical research that suggests that racism adversely affects the health of non-dominant racial populations in multiple ways. First, institutional racism developed policies and procedures that have reduced access to housing, neighborhood and educational quality, employment opportunities and other desirable resources in society. Second, cultural racism, at the societal and individual level, negatively affects economic status and health by creating a policy environment hostile to egalitarian policies, triggering negative stereotypes and discrimination that are pathogenic and fostering health damaging psychological responses such as stereotype threat and internalized racism. Finally, a large and growing body of evidence indicates that experiences of racial discrimination are an important type of psychosocial stressor that can lead to adverse changes in health status and altered behavioural patterns that increase health risks.
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Affiliation(s)
- David R Williams
- Department of Social and Behavioral Sciences, Harvard School of Public Health ; Department of African and African American Studies and of Sociology, Harvard University ; Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Selina A Mohammed
- Nursing and Health Studies Program, University of Washington Bothell, Bothell, WA
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