The Relation of Neighborhood Income to the Age-Related Patterns of Preterm Birth Among White and African-American Women: The Effect of Cigarette Smoking

Parental Education and Adolescents' Asthma: The Role of Ethnicity

While high parental education is associated with better health, this association may be weaker for ethnic minority than for ethnic majority families. It is unknown whether the association between parental education and adolescents' asthma also varies by ethnicity.

AIM

To study the association between parental education and adolescents' asthma overall and by ethnicity.

METHODS

The current study used data from the Population Assessment of Tobacco and Health (PATH)-Adolescents study. All participants were 12 to 17-year-old non-smokers (n = 8652). The outcome of interest was adolescents' asthma. The predictor of interest was baseline parental education, the covariates were age, sex, and number of parents present at baseline, and the moderator was ethnicity.

RESULTS

According to logistic regression analyses, higher parental education was predictive of adolescents' asthma; however, this association was weaker for Latino than non-Latino adolescents (OR 1.771; CI 1.282-2.446). We did not find a significant difference in the effect of parental education on asthma of White and African American adolescents. Our stratified models also showed that higher parental education was associated with lower asthma for non-Latino but not for Latino adolescents.

CONCLUSION

The effect of high parental education on adolescents' asthma prevalence differs between Latino and non-Latino families, with Latino families showing weaker protective effects of parental education on adolescents' asthma. Future research should test the role of exposure to environmental pollutants, neighborhood quality, and prevalence of smoking in social network members as well as other contextual factors at home, in school, and in the neighborhood that may increase prevalence of asthma in Latino adolescents regardless of their parental education. Given that these potential causes are multi-level, potential causes of such disparities should be tested in future multi-level research.

Race and Ethnic Differences in the Protective Effect of Parental Educational Attainment on Subsequent Perceived Tobacco Norms among US Youth

BACKGROUND

Although parental educational attainment is known to be associated with a lower prevalence of behaviors such as tobacco use, these effects are shown to be weaker for Black than White youth. It is important to study whether this difference is due to higher perceived tobacco use norms for Black youth.

AIM

To study the association between parental educational attainment and perceived tobacco use norms overall and by race/ethnicity among youth in the US.

METHODS

The current study used four years of follow-up data from the Population Assessment of Tobacco and Health (PATH-Youth) study conducted between 2013 and 2017. All participants were 12- to 17-year-old non-smokers at baseline and were successfully followed for four years (n = 4329). The outcome of interest was perceived tobacco use norms risk at year four. The predictor of interest was baseline parental educational attainment, the moderator was race/ethnicity, and the covariates were age, sex, and parental marital status at baseline.

RESULTS

Our linear regressions in the pooled sample showed that higher parental educational attainment at baseline was predictive of perceived disapproval of tobacco use at year four; however, this association was weaker for Latino than non-Latino youth. Our stratified models also showed that higher parental educational attainment was associated with perceived tobacco use norms for non-Latino but not for Latino youth.

CONCLUSION

The effect of high parental educational attainment on anti-tobacco norms differs between Latino and non-Latino youth. Latino youth with highly educated parents remain at risk of tobacco use, while non-Latino youth with highly educated parents show low susceptibility to tobacco use.

Stress during pregnancy: An ecological momentary assessment of stressors among Black and White women with implications for maternal health

BACKGROUND

Stress can lead to adverse physiological and psychological outcomes. Therefore, understanding stress during pregnancy provides insight into racial disparities in maternal health, particularly Black maternal health.

OBJECTIVES

This study aimed to describe (1) daily exposure to self-reported stress levels during pregnancy, and (2) sources of stress among participants that identified as Black or White using data collected via ecological momentary assessment.

METHODS

We leveraged survey data from the Postpartum Mothers Mobile Study, a prospective longitudinal study using ecological momentary assessment data collection methods to describe patterns of stress during pregnancy. This article is descriptive and documents patterns of self-reported stress levels and sources of stress. Frequencies and percentages of stress responses were computed to describe these patterns.

RESULTS

The sample (n = 296) was 27% Black (n = 78) and 63% White (n = 184). Results were based on at least one measurement of that stress level during pregnancy. A similar number of Black and White participants reported no stress during pregnancy. White (85%-95%) and Black (60%-70%) participants reported low to moderate levels of stress. Black participants (38%) and White participants (35%) reported experiencing high stress. Black and White participants reported similar sources of stress: stress from a partner, too many things to do, a baby or other children, and financial concerns. White participants reported work as a top stressor, and Black participants reported financial issues as a top source of stress.

CONCLUSION

This study provides insight into daily exposure to stress that has implications for maternal health. We described patterns of self-reported stress and sources of stress among Black and White participants. The daily exposures to stress reported by this sample exist within a context of root causes of structural inequities in education, health care, income, wealth, and housing that must be addressed to achieve maternal health equity.

Different maternal age patterns of preterm birth: Interplay of race/ethnicity, chronic stress, and marital status

The aim of this study was to examine whether the preterm birth (PTB) risks according to maternal age is altered by a woman's marital status and chronic stress among non-Hispanic (N-H) White, N-H Black, Hispanic, and Asian women. This researcher analyzed the Pregnancy Risk Assessment Monitoring System data for New York City and Washington State linked with the birth certificates for 2004-2007. The sample included 6344 singleton live births without birth defects to women aged 18 years or older identified as N-H White, N-H Black, Hispanic, or Asian. The outcome was PTB. Maternal age-specific PTB rates were calculated according to race/ethnicity, marital status, and chronic stress. Linear trends of PTB rates with maternal age were evaluated by the Mantel-Haenszel χ² test. Marriage had a protective effect against PTB at advancing maternal age across racial/ethnic groups. The health benefit of marriage was strong, particularly among the married N-H Black and Asian women, manifested as a maternal age-related decrease in the PTB rate (reverse-weathering). In contrast, women not married showed a maternal age-related increase in the PTB rate (weathering) across the racial/ethnic groups. Under higher chronic stress, married women generally experienced less weathering about PTB. These patterns were observed with noticeable racial/ethnic variations. Acknowledging the different dynamics among maternal age, marital status, and chronic stress by race/ethnicity could help shed light on the psychosocial mechanisms underlying the racial/ethnic inequalities in PTB in the United States. To that end, future studies should use more nuanced measurements of paternal support and chronic stress.

Whither weathering? The variable significance of age in Black-White low birth weight disparities

This paper uses birth certificate data to provide novel estimates of the age-specific risk of a low birth weight birth (LBW, an infant born weighting <2500 g) for U.S.-born non-Hispanic Black and White mothers, and finds that patterns vary markedly over space and time. Notably, risk of an LBW birth for Black mothers increased much more steeply with age in 1991-94 than in 2014-17. This decline in LBW risks among older Black mothers led to a decline in the Black-White LBW gap of more than half a percentage point. Both patterns and changes were regional; while age gradients on the Black-White LBW gap were lowest in the South in 1991-94, by 2014-17 they had increased in the South and declined in the rest of the country. These descriptive data allow a new examination of hypotheses regarding the causes of age-specific racial LBW gaps. Research has found that racial disparities in a number of health outcomes, including LBW, increase with age, leading some to speculate that this increase is due to the cumulative effects of exposure to disadvantage. The large degree of variability in Black-White LBW disparities suggests that age-specific causes may also play a role. A series of counterfactual trend analyses explore the roles of two specific mechanisms, smoking and hypertension, and compares these to a more fundamental indicator of socioeconomic status: education.

Risk and Protective Factors for Preterm Birth Among Black Women in Oakland, California

This project examines risk and protective factors for preterm birth (PTB) among Black women in Oakland, California. Women with singleton births in 2011-2017 (n = 6199) were included. Risk and protective factors for PTB and independent risk groups were identified using logistic regression and recursive partitioning. Having less than 3 prenatal care visits was associated with highest PTB risk. Hypertension (preexisting, gestational), previous PTB, and unknown Women, Infant, Children (WIC) program participation were associated with a two-fold increased risk for PTB. Maternal birth outside of the USA and participation in WIC were protective. Broad differences in rates, risks, and protective factors for PTB were observed.

Maternal Age Patterns of Preterm Birth: Exploring the Moderating Roles of Chronic Stress and Race/Ethnicity

BACKGROUND

Despite the suggested contribution of cumulative chronic stress to the racial/ethnic disparities in preterm birth (PTB), it is unclear how chronic stress, maternal age, and race/ethnicity are linked underlying PTB.

PURPOSE

We investigated the moderating effect of chronic stress on the maternal age-PTB association among non-Hispanic (N-H) White, N-H Black, Hispanic, and Asian women.

METHODS

We analyzed the Washington State's Pregnancy Risk Assessment Monitoring System data linked with birth certificates. The sample included women aged 18 years or older who birthed the first, singleton baby without birth defects. Chronic stress was measured by race/ethnicity-specific chronic stress indices. A maternal age-chronic stress interaction was modeled to predict PTB by logistic regression stratified by race/ethnicity. In subanalysis, the moderating role of racism was investigated in the maternal age-chronic stress interaction among three minority groups combined.

RESULTS

Women's maternal age trajectory of PTB varied by their race/ethnicity and chronic stress level. N-H White and N-H Black women showed a steeper maternal age-related increase in PTB (weathering) under higher chronic stress, indicating a chronic stress' cumulative effect with maternal age. Besides, the extent of weathering was amplified by racism on top of chronic stress, particularly among N-H Black women.

CONCLUSIONS

These results show that both chronic stress and racism may develop accelerated PTB risk among minority women. Future research should use more objective and accurate chronic stress measures to ascertain the complex relationships among chronic stress, racial discrimination, and maternal age underlying the racial/ethnic differentials in PTB.

The weathering hypothesis as an explanation for racial disparities in health: a systematic review

PURPOSE

The weathering hypothesis states that chronic exposure to social and economic disadvantage leads to accelerated decline in physical health outcomes and could partially explain racial disparities in a wide array of health conditions. This systematic review summarizes the literature empirically testing the weathering hypothesis and assesses the quality of the evidence regarding weathering as a determinant of racial disparities in health.

METHODS

Databases (Web of Science, Ovid MEDLINE, PubMed, and Embase) were searched for studies published in English up to July 1, 2017. Studies that tested the weathering hypothesis for any physical health outcome and included at least one socially or economically disadvantaged group (e.g., Blacks) for whom the weathering hypothesis applies were assessed for eligibility. Threats to validity were assessed using the Quality in Prognostic Studies tool.

RESULTS

The 41 included studies were rated as having overall good methodological quality. Most studies found evidence in support of the weathering hypothesis, although the magnitude of support varied by the health outcome and population studied.

CONCLUSIONS

Future evaluations of the weathering hypothesis should include an examination of additional health outcomes and interrogate mechanisms that could link weathering to poor health.

The age-related patterns of preterm birth among urban African-American and non-Latina White mothers: The effect of paternal involvement

Few studies have examined contributions of paternal factors to birth outcomes. Weathering is a pattern of increasing rates of adverse birth outcome with increasing maternal age. This study evaluates for an association between paternal involvement and weathering in the context of preterm birth (PTB, <37 weeks) among non-Hispanic African-American and non-Hispanic White women with and without lifelong exposure to neighborhood poverty. Using the Illinois transgenerational dataset with appended US census income information of infants (1989-1991) and their mothers (1956-1976), we compared infants of women by degree of paternal involvement: married, unmarried with father named on birth certificate, and unnamed father. Data were stratified by maternal residence in higher or lower income neighborhoods at both the time of mothers' birth and infants' birth, estimating maternal lifelong economic context. We computed race-specific PTB rates according to maternal age, lifelong neighborhood income, and paternal involvement. We calculated Mantel-Haenszel chi-square tests of linear trend from contingency tables to evaluate weathering. Among African-Americans (n = 39,991) with unnamed fathers and lifelong residence in lower income neighborhoods, PTB rate was lowest among teens at 18.8%, compared to 21.5% for 30-35 year-old mothers (p for linear trend <0.05). Among African-Americans with unnamed fathers and lifelong residence in higher income neighborhoods, PTB rate among teens was 16%, compared to 25% for 30-35 year-old mothers (p = 0.21). Among married African-Americans with lifelong residence in lower income neighborhoods, PTB rate among teens was 16.4%, compared to 12.5% for 30-35 year-old mothers (p = 0.79). Among married African-Americans with lifelong residence in higher income neighborhoods, PTB rate among teens was 20%, compared to 11.4% for 30-35 year-old mothers (p = 0.40). White mothers (n = 31,981) did not demonstrate weathering, regardless of paternal involvement and neighborhood poverty. We conclude that weathering was not seen among married African-Americans, independent of neighborhood income, suggesting a potentially protective mechanism associated with paternal involvement.

Racial disparity in infant mortality

In the United States, African-American infants have significantly higher mortality than white infants. Previous work has identified associations between individual socioeconomic factors and select community-level factors. In this review, the authors look beyond traditional risk factors for infant mortality and examine the social context of race in this country, in an effort to understand African-American women's long-standing birth outcome disadvantage. In the process, recent insights are highlighted concerning neighborhood-level factors such as crime, segregation, built environment, and institutional racism, other likely causes for the poor outcomes of African-American infants in this country compared with infants in most other industrialized nations.

Applying Precision Public Health to Prevent Preterm Birth

Preterm birth (PTB) is one of the major health-care challenges of our time. Being born too early is associated with major risks to the child with potential for serious consequences in terms of life-long disability and health-care costs. Discovering how to prevent PTB needs to be one of our greatest priorities. Recent advances have provided hope that a percentage of cases known to be related to risk factors may be amenable to prevention; but the majority of cases remain of unknown cause, and there is little chance of prevention. Applying the principle of precision public health may offer opportunities previously unavailable. Presented in this article are ideas that may improve our abilities in the fields of studying the effects of migration and of populations in transition, public health programs, tobacco control, routine measurement of length of the cervix in mid-pregnancy by ultrasound imaging, prevention of non-medically indicated late PTB, identification of pregnant women for whom treatment of vaginal infection may be of benefit, and screening by genetics and other “omics.” Opening new research in these fields, and viewing these clinical problems through a prism of precision public health, may produce benefits that will affect the lives of large numbers of people.

Depression among current, former, and never smokers from 2005 to 2013: The hidden role of disparities in depression in the ongoing tobacco epidemic

BACKGROUND

After declining sharply for many years, the prevalence of smoking has remained fairly stable over the past decade. One possible explanation is that there has been an increase in the prevalence of barriers to cessation, like depression, among remaining smokers.

OBJECTIVES

To estimate changes in the prevalence of depression among current, former and never smokers in the United States (U.S.) population from 2005 to 2013 overall and by age, gender, and income.

METHODS

Data were drawn from the National Household Survey on Drug Use (NSDUH), an annual cross-sectional study of persons ages 12 and over (N=496,805). The prevalence of past 12-month depression was examined annually among current (past 12-month), former (not past 12-month), and lifetime non-smokers from 2005 to 2013. Data were re-analyzed stratified by age, gender, and household income, and adjusted for demographics.

RESULTS

Depression appears to have significantly increased in the United States from 2005 to 2013 among current, former, and never smokers. Depression prevalence increased among current smokers overall, but the increase among former and never smokers was even more prominent. Striking temporal changes emerged by age, gender and income. Specifically, (1) depression increased significantly among current smokers aged 12-17 (from 16% to 22%, p-value=0.0002) and the prevalence was consistently more than twice as high as that of never smokers; (2) depression increased among male smokers (6.19%-7.82%, p-value=0.0099); (3) depression increased significantly among smokers in the highest income group (6.36% to 8.91%, p-value=0.0400). Throughout this period, the prevalence of depression among current smokers was consistently twice as high as among former and never smokers.

DISCUSSION

Public health efforts aimed at decreasing the prevalence of smoking should take depression into account, a common and modifiable barrier whose treatment may help to increase successful smoking cessation. Future work is needed to disentangle the role of smoking and other factors that lead to increases in depression in the US population.