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Webb EK, Carter SE, Ressler KJ, Fani N, Harnett NG. The neurophysiological consequences of racism-related stressors in Black Americans. Neurosci Biobehav Rev 2024; 161:105638. [PMID: 38522814 PMCID: PMC11081835 DOI: 10.1016/j.neubiorev.2024.105638] [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: 01/03/2024] [Revised: 03/01/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Abstract
Racism-related stressors, from experiences of both implicit and explicit racial discrimination to systemic socioeconomic disadvantage, have a cumulative impact on Black Americans' health. The present narrative review synthesizes peripheral (neuroendocrine and inflammation markers), psychophysiological (heart-rate variability, skin conductance), and neuroimaging (structural and functional) findings that demonstrate unique associations with racism-related stress. Emerging evidence reveals how racism-related stressors contribute to differential physiological and neural responses and may have distinct impacts on regions involved with threat and social processing. Ultimately, the neurophysiological effects of racism-related stress may confer biological susceptibility to stress and trauma-related disorders. We note critical gaps in the literature on the neurophysiological impact of racism-related stress and outline additional research that is needed on the multifactorial interactions between racism and mental health. A clearer understanding of the interactions between racism-related stress, neurophysiology, and stress- and trauma-related disorders is critical for preventative efforts, biomarker discovery, and selection of effective clinical treatments for Black Americans.
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Affiliation(s)
- E Kate Webb
- McLean Hospital, Division of Depression and Anxiety, Belmont, MA, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, USA
| | - Sierra E Carter
- Georgia State University, Department of Psychology, Athens, GA, USA
| | - Kerry J Ressler
- McLean Hospital, Division of Depression and Anxiety, Belmont, MA, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, USA
| | - Negar Fani
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA
| | - Nathaniel G Harnett
- McLean Hospital, Division of Depression and Anxiety, Belmont, MA, USA; Harvard Medical School, Department of Psychiatry, Boston, MA, USA.
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Daniels KP, D Thomas M, Chae DH, Allen AM. Black Mothers' Concern for Their Children as a Measure of Vicarious Racism-Related Vigilance and Allostatic Load. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:520-536. [PMID: 37332176 DOI: 10.1177/00221465231175942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
This study investigates the relationship between allostatic load and a novel form of altruistic racism-related fear, or concern for how racism might harm another, which we term vicarious racism-related vigilance. Using a subsample of Black mothers from the African American Women's Heart & Health Study (N = 140), which includes detailed health and survey data on a community sample of Black women in the San Francisco Bay Area, this study investigates the relationship between Black mothers' experiences with racism-related vigilance as it relates to their children and allostatic load-a multisystem metric of underlying health across multiple biological systems. Findings indicate that vicarious racism-related vigilance was positively associated with allostatic load (i.e., worse health). Findings highlight the salience of vicarious racism-related vigilance for the health of Black mothers, underscoring how intersections between race, gender, and parenthood result in susceptibility to unique forms of health-harming stress.
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Lucente M, Guidi J. Allostatic Load in Children and Adolescents: A Systematic Review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:295-303. [PMID: 37666236 PMCID: PMC10716875 DOI: 10.1159/000533424] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION The concept of allostatic load encompasses the cumulative effects of both ordinary daily life events as well as major challenges, and also includes related health-damaging behavior. Allostatic overload ensues when environmental challenges exceed the individual's ability to cope. Identification of allostatic load is carried out through the use of biomarkers and clinimetric criteria. Studies are increasingly reported on allostatic load in younger populations, yet a systematic review is missing. OBJECTIVE The aim of the present systematic review was to summarize the current knowledge on allostatic load/overload among children and adolescents. METHODS PubMed, PsycINFO, Web of Science, and the Cochrane Library were searched from inception to April 2023. A manual search of the literature was also performed. We considered only studies in which allostatic load or overload were adequately described and assessed in either clinical or non-clinical populations younger than 18 years. RESULTS A total of 38 original investigations were included in this systematic review. Studies reported an association between allostatic load and sociodemographic characteristics (e.g., poverty, ethnicity, perceived discrimination, adverse childhood experiences) and environmental factors, as well as consequences of allostatic load on both physical and mental health among children and adolescents. CONCLUSIONS The findings indicate that greater allostatic load is associated with poorer health outcomes in both clinical and non-clinical pediatric populations, with possible enduring effects. The results support the clinical utility of the transdiagnostic identification of allostatic load and overload in children and adolescents across a variety of settings, with a number of potential clinical implications.
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Affiliation(s)
- Marcella Lucente
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
| | - Jenny Guidi
- Department of Psychology "Renzo Canestrari", University of Bologna, Bologna, Italy
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Anda-Duran ID, Hwang PH, Popp ZT, Low S, Ding H, Rahman S, Igwe A, Kolachalama VB, Lin H, Au R. Matching science to reality: how to deploy a participant-driven digital brain health platform. FRONTIERS IN DEMENTIA 2023; 2:1135451. [PMID: 38706716 PMCID: PMC11067045 DOI: 10.3389/frdem.2023.1135451] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Introduction Advances in digital technologies for health research enable opportunities for digital phenotyping of individuals in research and clinical settings. Beyond providing opportunities for advanced data analytics with data science and machine learning approaches, digital technologies offer solutions to several of the existing barriers in research practice that have resulted in biased samples. Methods A participant-driven, precision brain health monitoring digital platform has been introduced to two longitudinal cohort studies, the Boston University Alzheimer's Disease Research Center (BU ADRC) and the Bogalusa Heart Study (BHS). The platform was developed with prioritization of digital data in native format, multiple OS, validity of derived metrics, feasibility and usability. A platform including nine remote technologies and three staff-guided digital assessments has been introduced in the BU ADRC population, including a multimodal smartphone application also introduced to the BHS population. Participants select which technologies they would like to use and can manipulate their personal platform and schedule over time. Results Participants from the BU ADRC are using an average of 5.9 technologies to date, providing strong evidence for the usability of numerous digital technologies in older adult populations. Broad phenotyping of both cohorts is ongoing, with the collection of data spanning cognitive testing, sleep, physical activity, speech, motor activity, cardiovascular health, mood, gait, balance, and more. Several challenges in digital phenotyping implementation in the BU ADRC and the BHS have arisen, and the protocol has been revised and optimized to minimize participant burden while sustaining participant contact and support. Discussion The importance of digital data in its native format, near real-time data access, passive participant engagement, and availability of technologies across OS has been supported by the pattern of participant technology use and adherence across cohorts. The precision brain health monitoring platform will be iteratively adjusted and improved over time. The pragmatic study design enables multimodal digital phenotyping of distinct clinically characterized cohorts in both rural and urban U.S. settings.
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Affiliation(s)
- Ileana De Anda-Duran
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Phillip H. Hwang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Zachary Thomas Popp
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Spencer Low
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Huitong Ding
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Salman Rahman
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Akwaugo Igwe
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Vijaya B. Kolachalama
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, MA, United States
| | - Honghuang Lin
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Rhoda Au
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
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Simoncic V, Deguen S, Enaux C, Vandentorren S, Kihal-Talantikite W. A Comprehensive Review on Social Inequalities and Pregnancy Outcome-Identification of Relevant Pathways and Mechanisms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416592. [PMID: 36554473 PMCID: PMC9779203 DOI: 10.3390/ijerph192416592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 05/12/2023]
Abstract
Scientific literature tends to support the idea that the pregnancy and health status of fetuses and newborns can be affected by maternal, parental, and contextual characteristics. In addition, a growing body of evidence reports that social determinants, measured at individual and/or aggregated level(s), play a crucial role in fetal and newborn health. Numerous studies have found social factors (including maternal age and education, marital status, pregnancy intention, and socioeconomic status) to be linked to poor birth outcomes. Several have also suggested that beyond individual and contextual social characteristics, living environment and conditions (or "neighborhood") emerge as important determinants in health inequalities, particularly for pregnant women. Using a comprehensive review, we present a conceptual framework based on the work of both the Commission on Social Determinants of Health and the World Health Organization (WHO), aimed at describing the various pathways through which social characteristics can affect both pregnancy and fetal health, with a focus on the structural social determinants (such as socioeconomic and political context) that influence social position, as well as on intermediary determinants. We also suggest that social position may influence more specific intermediary health determinants; individuals may, on the basis of their social position, experience differences in environmental exposure and vulnerability to health-compromising living conditions. Our model highlights the fact that adverse birth outcomes, which inevitably lead to health inequity, may, in turn, affect the individual social position. In order to address both the inequalities that begin in utero and the disparities observed at birth, it is important for interventions to target various unhealthy behaviors and psychosocial conditions in early pregnancy. Health policy must, then, support: (i) midwifery availability and accessibility and (ii) enhanced multidisciplinary support for deprived pregnant women.
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Affiliation(s)
- Valentin Simoncic
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
- Correspondence:
| | - Séverine Deguen
- Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population Health Research Center, University of Bordeaux, 33076 Boedeaux, France
| | - Christophe Enaux
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
| | - Stéphanie Vandentorren
- Equipe PHARes Population Health Translational Research, Inserm CIC 1401, Bordeaux Population Health Research Center, University of Bordeaux, 33076 Boedeaux, France
- Santé Publique France, French National Public Health Agency, 94410 Saint-Maurice, France
| | - Wahida Kihal-Talantikite
- LIVE UMR 7362 CNRS (Laboratoire Image Ville Environnement), University of Strasbourg, 67100 Strasbourg, France
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Lueth AJ, Allshouse AA, Blue NM, Grobman WA, Levine LD, Simhan HN, Kim JK, Johnson J, Wilson FA, Murtaugh M, Silver RM. Allostatic Load and Adverse Pregnancy Outcomes. Obstet Gynecol 2022; 140:974-982. [PMID: 36357956 PMCID: PMC9712159 DOI: 10.1097/aog.0000000000004971] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the association between allostatic load, as an estimate of chronic stress, and adverse pregnancy outcomes. METHODS This was a secondary analysis of nuMoM2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be), a prospective observational cohort study. Our primary exposure was dichotomous high allostatic load in the first trimester, defined as 4 or more of 12 biomarkers in the "worst" quartile. The primary outcome was a composite adverse pregnancy outcome: hypertensive disorders of pregnancy (HDP), preterm birth, small for gestational age (SGA), and stillbirth. Secondary outcomes included components of the composite. Multivariable logistic regression was used to test the association between high allostatic load and adverse pregnancy outcomes, adjusted for potential confounders. Mediation and moderation analyses were conducted to assess the role of allostatic load along the causal pathway between racial disparities and adverse pregnancy outcomes. RESULTS Among 4,266 individuals, 34.7% had a high allostatic load. Composite adverse pregnancy outcome occurred in 1,171 (27.5%): 14.0% HDP, 8.6% preterm birth (48.0% spontaneous and 52.2% indicated), 11.0% SGA, and 0.3% stillbirth. After adjustment for maternal age, gravidity, smoking, bleeding in the first trimester, and health insurance, high allostatic load was significantly associated with a composite adverse pregnancy outcome (adjusted odds ratio [aOR] 1.5, 95% CI 1.3, 1.7) and HDP (aOR 2.5, 95% CI 2.0-2.9), but not preterm birth or SGA. High allostatic load partially mediated the association between self-reported race and adverse pregnancy outcomes. The association between allostatic load and HDP differed by self-reported race, but not for a composite adverse pregnancy outcome, preterm birth, or SGA. CONCLUSION High allostatic load in the first trimester is associated with adverse pregnancy outcomes, particularly HDP. Allostatic load was a partial mediator between race and adverse pregnancy outcomes. The association between allostatic load and HDP differed by self-reported race.
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Affiliation(s)
- Amir J. Lueth
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Amanda A. Allshouse
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Nathan M. Blue
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - William A. Grobman
- Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio
| | - Lisa D. Levine
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hyagriv N. Simhan
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jin Kyung Kim
- Department of Obstetrics and Gynecology, University of California Irvine, Irvine, California
| | - Jasmine Johnson
- Department of Obstetrics and Gynecology, School of Medicine, Indiana University
| | - Fernando A. Wilson
- Department of Population Health Sciences, University of Utah Health, Salt Lake City, Utah
| | - Maureen Murtaugh
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
| | - Robert M. Silver
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
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Barry MC, Halpern CT, Zimmer C. Biomarkers of pre-pregnancy allostatic load and subsequent adverse birth outcomes. SSM Popul Health 2022; 18:101099. [PMID: 35698482 PMCID: PMC9187525 DOI: 10.1016/j.ssmph.2022.101099] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 11/12/2022] Open
Abstract
Racial disparities in birth outcomes are seemingly intractable. Using person-centered methods and drawing from the life course and Weathering Hypothesis literatures, we used data from the National Longitudinal Study of Adolescent to Adult Health to group non-Hispanic White and non-Hispanic Black women ages 24–34 into latent classes based on pre-pregnancy biomarkers of allostatic load. Stratified analyses yielded four latent classes among non-Hispanic White women, characterized by: 1) high blood pressure, 2) high body mass index and waist circumference, 3) high total cholesterol and triglycerides, and low high-density lipoprotein, and 4) low-risk, and two latent classes among non-Hispanic Black women, characterized by: 1) high body mass index and waist circumference, and moderate-risk blood pressure, hbA1c, and c-reactive protein, and 2) low-risk. Allostatic load class membership and other maternal- and infant-level covariates were then included simultaneously as predictors of three separate dichotomous outcomes: preterm birth, macrosomia, and low birth weight in multilevel logistic regression models. In a separate multilevel linear regression model, the same variables were simultaneously entered to predict continuously measured birthweight. In multilevel, multivariate models, White women in the high-risk body mass index and waist circumference class, as compared to the high-risk blood pressure class, had infants with higher birthweights. Other comparisons were not significant or not of meaningful magnitude. Prioritizing temporality so that allostatic load measurement preceded first birth likely biased the composition of the analytical sample. Additional research is needed to help medical providers and public health practitioners understand the complex biological and social mechanisms underlying inequities in birth outcomes and identify prevention strategies. White women were characterized by 4 classes of biomarkers of pre-pregnancy health. Black women were characterized by 2 classes of biomarkers of pre-pregnancy health. Black (v White) women were 2x as likely to have a preterm or low birthweight birth. White women in the high-risk BMI and WC class, as compared to the high-risk BP class, had infants with higher birthweights. Other allostatic load class comparisons were not significant or not of meaningful magnitude. Overall, the allostatic load classes were not associated with birth outcomes.
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Hill CN, Schmitt D, Reed W, Arent SM, Sands LP, Queen RM. Racial differences in running and landing measures associated with injury risk vary by sex. Sports Biomech 2022:1-19. [PMID: 35352977 DOI: 10.1080/14763141.2022.2056075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
Abstract
It is unknown whether running and landing mechanics differ between racial groups despite injury disparities between African Americans (AA) and white Americans (WA). This study aimed to identify potential racial differences in running and landing mechanics and understand whether anthropometric, strength, and health status factors contribute to these differences. Venous blood samples, anthropometry, lower-extremity strength, and health status assessments were collected (n = 84, 18-30y). Three-dimensional motion capture and force plate data were recorded during 7 running and 7 drop vertical jump trials. Racial effects were determined, and regression models evaluated explanatory factors. AA females ran with longer stance times (p = 0.003) than WA females, while AA males ran with smaller loading rates (p = 0.046) and larger peak vertical ground reaction forces (p = 0.036) than WA males. Frontal plane knee range of motion during landing was greater in AA females (p = 0.033) than WA females; larger waist circumference and weaker knee extension strength accounted for this significance. Although outcome measures were associated with physiologic, anthropometric, and activity measures, their explanatory power for race was ambiguous, except for knee range of motion in females. Modifiable factors explaining racial effects during landing in females are potential intervention targets to reduce racial health disparities in running and landing injuries.
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Affiliation(s)
- Cherice N Hill
- Department of Biomedical Engineering and Mechanics, College of Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Daniel Schmitt
- Department of Evolutionary Anthropology, College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Wornie Reed
- Department of Sociology, College of Liberal Arts and Human Sciences, Virginia Tech, Blacksburg, VA, USA
| | - Shawn M Arent
- Department of Exercise Science, School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Laura P Sands
- Center for Gerontology, College of Liberal Arts and Human Sciences, Virginia Tech, Blacksburg, VA, USA
| | - Robin M Queen
- Department of Biomedical Engineering and Mechanics, College of Engineering, Virginia Tech, Blacksburg, VA, USA
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Hardeman RR, Chantarat T, Smith ML, Karbeah J, Van Riper DC, Mendez DD. Association of Residence in High-Police Contact Neighborhoods With Preterm Birth Among Black and White Individuals in Minneapolis. JAMA Netw Open 2021; 4:e2130290. [PMID: 34878551 PMCID: PMC8655601 DOI: 10.1001/jamanetworkopen.2021.30290] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/17/2021] [Indexed: 12/17/2022] Open
Abstract
Importance Police contact may have negative psychological effects on pregnant people, and psychological stress has been linked to preterm birth (ie, birth at <37 weeks' gestation). Existing knowledge of racial disparities in policing patterns and their associations with health suggest redesigning public safety policies could contribute to racial health equity. Objective To examine the association between community-level police contact and the risk of preterm birth among White pregnant people, US-born Black pregnant people, and Black pregnant people who were born outside the US. Design, Setting, and Participants This cross-sectional study used medical record data of 745 White individuals, 121 US-born Black individuals, and 193 Black individuals born outside the US who were Minneapolis residents and gave birth to a live singleton at a large health system between January 1 and December 31, 2016. Data were analyzed from March 2019 to October 2020. Exposures Police contact was measured at the level of the census tract where the pregnant people lived. Police incidents per capita (ie, the number of police incidents divided by the census tract population estimate) were dichotomized into high if the value was in the fourth quartile and low for the remaining three quartiles. Main Outcomes and Measures Preterm birth status was based on the International Statistical Classification of Diseases and Related Health Problems, 10th revision, Clinical Modification (ICD-10-CM) code. Preterm infants were those with ICD-10-CM codes P07.2 and P07.3 documented in their charts. Results Of 1059 pregnant people (745 [70.3%] White, 121 [11.4%] US-born Black, 193 [18.2%] Black born outside the US) in the sample, 336 White individuals (45.1%) and 62 Black individuals who were born outside the US (32.1%) gave birth between the ages of 30 and 34 years, while US-born Black individuals gave birth at younger ages, with 49 (40.5%) aged 25 years or younger. The incidence of preterm birth was 6.7% for White individuals (50 pregnant people), 14.0% for US-born Black individuals (17 pregnant people), and 5.7% for Black individuals born outside the US (11 pregnant people). In areas with high police contact vs low police contact, the odds of preterm birth were 90% higher for White individuals (odds ratio [OR], 1.9; 95% CI, 1.9-2.0), 100% higher for US-born Black individuals (OR, 2.0; 95% CI, 1.8-2.2), and 10% higher for Black individuals born outside the US (OR, 1.1; 95% CI, 1.0-1.2). Secondary geospatial analysis further revealed that the proportion of Black residents in Minneapolis census tracts was correlated with the number of police incidents reported between 2012 and 2016 (P = .001). Conclusions and Relevance In this study, police contact was associated with preterm birth for both Black and White pregnant people. Predominantly Black neighborhoods had greater police contact than predominantly White neighborhoods, indicating that Black pregnant people were more likely to be exposed to police than White pregnant people. These findings suggest that racialized police patterns borne from a history of racism in the United States may contribute to racial disparity in preterm birth.
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Affiliation(s)
- Rachel R. Hardeman
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
- Minnesota Population Center, Institute for Social Research & Data Innovation, Minneapolis
- Center for Antiracism Research for Health Equity, University of Minnesota School of Public Health, Minneapolis
| | - Tongtan Chantarat
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
- Minnesota Population Center, Institute for Social Research & Data Innovation, Minneapolis
- Center for Antiracism Research for Health Equity, University of Minnesota School of Public Health, Minneapolis
| | - Morrison Luke Smith
- Minnesota Population Center, Institute for Social Research & Data Innovation, Minneapolis
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis
| | - J’Mag Karbeah
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
- Minnesota Population Center, Institute for Social Research & Data Innovation, Minneapolis
- Center for Antiracism Research for Health Equity, University of Minnesota School of Public Health, Minneapolis
| | - David C. Van Riper
- Minnesota Population Center, Institute for Social Research & Data Innovation, Minneapolis
| | - Dara D. Mendez
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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Guidi J, Lucente M, Sonino N, Fava GA. Allostatic Load and Its Impact on Health: A Systematic Review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:11-27. [PMID: 32799204 DOI: 10.1159/000510696] [Citation(s) in RCA: 397] [Impact Index Per Article: 132.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Allostatic load refers to the cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity. When environmental challenges exceed the individual ability to cope, then allostatic overload ensues. Allostatic load is identified by the use of biomarkers and clinical criteria. OBJECTIVE To summarize the current knowledge on allostatic load and overload and its clinical implications based on a systematic review of the literature. METHODS PubMed, PsycINFO, Web of Science, and the Cochrane Library were searched from inception to December 2019. A manual search of the literature was also performed, and reference lists of the retrieved articles were examined.We considered only studies in which allostatic load or overload were adequately described and assessed in either clinical or non-clinical adult populations. RESULTS A total of 267 original investigations were included. They encompassed general population studies, as well as clinical studies on consequences of allostatic load/overload on both physical and mental health across a variety of settings. CONCLUSIONS The findings indicate that allostatic load and overload are associated with poorer health outcomes. Assessment of allostatic load provides support to the understanding of psychosocial determinants of health and lifestyle medicine. An integrated approach that includes both biological markers and clinimetric criteria is recommended.
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Affiliation(s)
- Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy,
| | | | - Nicoletta Sonino
- Department of Statistical Sciences, University of Padova, Padova, Italy.,Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York, USA
| | - Giovanni A Fava
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York, USA
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11
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Basile Ibrahim B, Barcelona V, Condon EM, Crusto CA, Taylor JY. The Association Between Neighborhood Social Vulnerability and Cardiovascular Health Risk Among Black/African American Women in the InterGEN Study. Nurs Res 2021; 70:S3-S12. [PMID: 34074961 PMCID: PMC8405545 DOI: 10.1097/nnr.0000000000000523] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Black/African American women in the United States are more likely to live in neighborhoods with higher social vulnerability than other racial/ethnic groups, even when adjusting for personal income. Social vulnerability, defined as the degree to which the social conditions of a community affect its ability to prevent loss and suffering in the event of disaster, has been used in research as an objective measure of neighborhood social vulnerability. Black/African American women also have the highest rates of hypertension and obesity in the United States. OBJECTIVES The purpose of this study was to examine the relationship between neighborhood social vulnerability and cardiovascular risk (hypertension and obesity) among Black/African American women. METHODS We conducted a secondary analysis of data from the InterGEN Study that enrolled Black/African American women in the Northeast United States. Participants' addresses were geocoded to ascertain neighborhood vulnerability using the Centers for Disease Control and Prevention's Social Vulnerability Index at the census tract level. We used multivariable regression models to examine associations between objective measures of neighborhood quality and indicators of structural racism and systolic and diastolic blood pressure and obesity (body mass index > 24.9) and to test psychological stress, coping, and depression as potential moderators of these relationships. RESULTS Seventy-four percent of participating Black/African American women lived in neighborhoods in the top quartile for social vulnerability nationally. Women living in the top 10% of most socially vulnerable neighborhoods in our sample had more than a threefold greater likelihood of hypertension when compared to those living in less vulnerable neighborhoods. Objective neighborhood measures of structural racism (percentage of poverty, percentage of unemployment, percentage of residents >25 years old without a high school diploma, and percentage of residents without access to a vehicle) were significantly associated with elevated diastolic blood pressure and obesity in adjusted models. Psychological stress had a significant moderating effect on the associations between neighborhood vulnerability and cardiovascular risk. DISCUSSION We identified important associations between structural racism, the neighborhood environment, and cardiovascular health among Black/African American women. These findings add to a critical body of evidence documenting the role of structural racism in perpetuating health inequities and highlight the need for a multifaceted approach to policy, research, and interventions to address racial health inequities.
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Dormire SL, Gary JC, Norman JM, Harvey IS. Insights into fear: A phenomenological study of Black mothers. J Adv Nurs 2021; 77:4490-4499. [PMID: 34245167 DOI: 10.1111/jan.14963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/29/2021] [Accepted: 06/10/2021] [Indexed: 12/01/2022]
Abstract
AIM The aim of the study was to explore the lived experience of stress as described by Black childbearing women. DESIGN A phenomenological approach was used. METHODS Seven mothers who met inclusion criteria participated in both individual and group interviews between August 2018 and August 2019. Each session was audio recorded and professionally transcribed. Consistent with van Manen's phenomenological approach, three rounds of reflective transcript analysis were conducted over several months. RESULTS Several stress themes were identified from the data. However, the most pervasive theme was the fear of having a son and keeping him safe. In this paper, the themes of Living in Fear and Living with Fear are detailed. CONCLUSION Previous research has found that Black populations in America fear for their safety. This study identified a pervasive and profound fear for their children, specifically sons who are at a higher risk of being killed in normal daily activities. Mothers also expressed fears about their responsibility to keep them safe by providing the right tools. IMPACT Although scientists have long studied poor pregnancy outcomes for Black American women, the disparity persists. This study sought to identify stressors acknowledged by Black mothers themselves. For the first time, Black mothers stated that their primary stress is fear for their children's lives. The role this fear has in adverse pregnancy outcomes, if any, is yet to be determined.
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Affiliation(s)
| | - Jodie C Gary
- College of Nursing, Texas A&M University, Bryan, TX, USA
| | - Jamil M Norman
- College of Nursing, Walden University, Minneapolis, MN, USA
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Racial and Ethnic Diversity of Family Physicians Delivering Maternity Care. J Racial Ethn Health Disparities 2021; 9:1145-1151. [PMID: 34036540 DOI: 10.1007/s40615-021-01055-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/02/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Maternal and birth outcomes represent some of the most profound racial and ethnic disparities in health in the USA, and are, in part, attributed to a lack of diversity in the maternity care workforce. Family physicians are an often-overlooked part of the maternity care workforce, yet frequently provide care to underserved populations. This study aims to characterize the family physician workforce providing obstetric care in terms of race/ethnicity. METHODS In this cross-sectional study, we used data collected via the American Board of Family Medicine Exam Registration Questionnaire from 2017 to 2019. Respondents included family physicians seeking to continue their certification in those years. We conducted bivariate tests and an adjusted analysis using logistic regression to examine associations with providing obstetric deliveries. Variables included race, ethnicity, age, gender, degree type, international medical graduate status, practice site, and rurality. RESULTS Of 20,820 family physicians in our sample, those identifying as Black/African American (OR 0.55, CI 0.41 to 0.74) and Asian (OR 0.40, CI 0.31 to 0.51) had significantly lower odds of including obstetrics in their practice than those identifying as White. We found no significant difference in practicing obstetrics between Hispanic and non-Hispanic family physicians (OR 0.94, CI 0.73 to 1.20). Asian (OR 0.40, CI 0.31 to 0.51) and Black/African American (OR 0.55, CI 0.41 to 0.74) physicians still have significantly lower odds of providing obstetric care than White physicians after controlling for rurality. CONCLUSIONS Family physicians who identified as Black/African American or Asian are less likely to include obstetrics in their practice. A diverse and racially/ethnically representative maternity care workforce, including family physicians, may help to ameliorate disparities in maternal and birth outcomes. Enhanced efforts to diversify the family physician maternity care workforce should be implemented.
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A biopsychosocial perspective on maternal parenting in the first two years of infant life. Behav Brain Res 2021; 411:113375. [PMID: 34023309 DOI: 10.1016/j.bbr.2021.113375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 11/21/2022]
Abstract
Guided by a biopsychosocial perspective of mothering, this study investigated the interplay among biological (maternal cortisol reactivity), psychological (maternal depressive symptoms), and social (infant emotion and regulation) factors in contributing to early changes in maternal parenting. Participants were 1292 low-income, mother-infant pairs, assessed when the infants were 6-months (T1), 15-months (T2), and 24-months old (T3). Maternal parenting was observed at all assessment points. At T1, infant emotion expression and orienting towards mothers were observed, when maternal cortisol reactivity was assessed. Mothers reported their depressive symptoms at T1. Exploratory factor analysis revealed two parenting factors across time points: positive engagement and negative intrusiveness. Second-order latent growth curve models revealed interactions among maternal cortisol reactivity, depressive symptoms, and child negative emotion/orienting at T1 in predicting intercepts and slopes of two parenting factors. T1 maternal cortisol reactivity was associated with a higher positive engagement intercept for infants having high negative emotion at T1, but a lower positive engagement intercept for infants with low negative emotion at T1, under low T1 maternal depressive symptoms. T1 maternal cortisol reactivity was also related to a lower negative intrusiveness intercept for infants showing high orienting at T1. Longitudinally, maternal cortisol reactivity at T1 predicted a faster decline in positive engagement when infants showed high negative emotion at T1, but a slower decline when infants were less negative at T1. This study reveals a bivalent adaptation process in maternal sensitivity and enhances the current understanding of how biopsychosocial factors contribute to maternal parenting in low-income families.
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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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Racial Differences in the Biochemical Effects of Stress in Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17196941. [PMID: 32977397 PMCID: PMC7579659 DOI: 10.3390/ijerph17196941] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022]
Abstract
Prenatal stress has been linked to preterm birth via inflammatory dysregulation. We conducted a cross-sectional study on female participants who delivered live, singleton infants at University of Pittsburgh Medical Center Magee Women’s Hospital. Participants (n = 200) were stratified by cumulative risk scores using a combination of individual factors (maternal education, diabetes, hypertension, smoking, relationship status, obesity, depression) and neighborhood deprivation scores. We hypothesized that inflammatory cytokines levels differ by risk group and race. Multiplex analyses of IL-6, IL-8, IL-10, IL-13 and TNF-alpha were run. We found that Black birthing people had more risk factors for chronic stress and had lower levels of IL-6 compared to White birthing people. When stratified by risk group and race, low-risk Black birthing people had lower levels of IL-6 compared to low-risk White birthing people, and high-risk Black birthing people had lower levels of IL-8 compared to high-risk White birthing people. Higher area deprivation scores were associated with lower IL-6 levels. Our results suggest that the relationship between chronic stress and inflammatory cytokines is modified by race. We theorize that Black birthing people encounter repetitive stress due to racism and social disadvantage which may result in stress pathway desensitization and a blunted cytokine response to future stressors.
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Racial disparities in pregnancy outcomes: genetics, epigenetics, and allostatic load. CURRENT OPINION IN PHYSIOLOGY 2020. [DOI: 10.1016/j.cophys.2019.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Forrester SN, Gallo JJ, Whitfield KE, Thorpe RJ. A Framework of Minority Stress: From Physiological Manifestations to Cognitive Outcomes. THE GERONTOLOGIST 2019; 59:1017-1023. [PMID: 30169640 PMCID: PMC6858824 DOI: 10.1093/geront/gny104] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Indexed: 12/31/2022] Open
Abstract
Cognitive impairment and dementia continue to threaten the aging population. Although no one is immune, certain groups, namely black older persons, are more likely to have a diagnosis of certain dementias. Because researchers have not found a purely biological reason for this disparity, they have turned to a biopsychosocial model. Specifically, black persons in the United States are more likely to live with social conditions that affect their stress levels which in turn affect physiological regulation leading to conditions that result in higher levels of cognitive impairment or dementia. Here we discuss some of these social conditions such as discrimination, education, and socioeconomic status, and how physiological dysregulation, namely allostatic load that can lead to cognitive impairment and dementia in black persons especially.
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Affiliation(s)
- Sarah N Forrester
- Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Joseph J Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Roland J Thorpe
- Departmnet of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Barrett ES, Vitek W, Mbowe O, Thurston SW, Legro RS, Alvero R, Baker V, Bates GW, Casson P, Coutifaris C, Eisenberg E, Hansen K, Krawetz S, Robinson R, Rosen M, Usadi R, Zhang H, Santoro N, Diamond M. Allostatic load, a measure of chronic physiological stress, is associated with pregnancy outcomes, but not fertility, among women with unexplained infertility. Hum Reprod 2019; 33:1757-1766. [PMID: 30085177 DOI: 10.1093/humrep/dey261] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 07/11/2018] [Indexed: 12/27/2022] Open
Abstract
STUDY QUESTION Among infertile women undergoing ovarian stimulation, is allostatic load (AL), a measure of chronic physiological stress, associated with subsequent fertility and pregnancy outcomes? SUMMARY ANSWER AL at baseline was not associated with conception, spontaneous abortion or live birth, however, it was significantly associated with increased odds of pre-eclampsia and preterm birth among women who had a live birth in the study. WHAT IS KNOWN ALREADY Several studies have linked AL during pregnancy to adverse outcomes including preterm birth and pre-eclampsia, hypothesizing that it may contribute to well-documented disparities in pregnancy and birth outcomes. However, AL biomarkers change over the course of pregnancy, raising questions as to whether gestational AL assessment is a valid measure of cumulative physiologic stress starting long before pregnancy. To better understand how AL may impact reproductive outcomes, AL measurement in the non-pregnant state (i.e. prior to conception) is needed. STUDY DESIGN, SIZE, DURATION A secondary data analysis based on data from 836 women who participated in Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS), a multi-center, randomized clinical trial of ovarian stimulation conducted from 2011 to 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS Ovulatory women with unexplained infertility (ages 18-40) were enrolled and at baseline, biological and anthropometric measures were collected. AL scores were calculated as a composite of the following baseline variables determined a priori: BMI, waist-to-hip ratio, systolic blood pressure, diastolic blood pressure, dehydroepiandrosterone sulfate, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, C-reactive protein and HOMA score. Participants received ovarian stimulation for up to four cycles and if they conceived, were followed throughout pregnancy. We fit multi-variable logistic regression models examining AL (one-tailed and two-tailed) in relation to the following reproductive outcomes: conception, spontaneous abortion, live birth, pre-eclampsia, preterm birth and low birthweight. MAIN RESULTS AND THE ROLE OF CHANCE Adjusting for covariates, a unit increase in two-tailed AL score was associated with 62% increased odds of pre-eclampsia (OR: 1.62, 95% CI: 1.14, 2.38) 44% increased odds of preterm birth (OR: 1.44, 95% CI: 1.02, 2.08), and 39% increased odds of low birthweight (OR: 1.39, 95% CI: 0.99, 1.97). The relationship between AL and preterm birth was mediated by pre-eclampsia (P = 0.0003). In one-tailed AL analyses, associations were similar, but slightly attenuated. AL was not associated with fertility outcomes (conception, spontaneous abortion, live birth). LIMITATIONS, REASONS FOR CAUTION Results may not be generalizable to fertile women who conceive naturally or women with other types of infertility. Comparisons to previous, related work are difficult because variables included in AL composite measures vary across studies. AL may be indicative of overall poor health, rather than being specific to chronic physiological stress. WIDER IMPLICATIONS OF THE FINDINGS Our results suggest that chronic physiological stress may not impact success of ovarian stimulation, however, they confirm and extend previous work suggesting that AL is associated with adverse pregnancy outcomes. Physiological dysregulation due to chronic stress has been proposed as a possible mechanism underlying disparities in birth outcomes, which are currently poorly understood. Assessing biomarkers of physiological dysregulation pre-conception or in early pregnancy, may help to identify women at risk of adverse pregnancy outcomes, particularly pre-eclampsia. STUDY FUNDING/COMPETING INTEREST(S) Support for AMIGOS was provided by: U10 HD39005, U10 HD38992, U10 HD27049, U10 HD38998, U10 HD055942, HD055944, U10 HD055936 and U10HD055925. Support for the current analysis was provided by T32ES007271, R25HD075737, P30ES001247 and P30ES005022. This research was made possible by funding by American Recovery and Reinvestment Act. The content is solely the responsibility of the authors and does not necessarily represent the official views of NICHD, NIEHS or NIH. E.B., W.V., O.M., R.A., M.R., V.B., G.W.B., C.C., E.E., S.K., R.U., P.C, H.Z., N.S. and S.T. have nothing to disclose. R.L. reported serving as a consultant to Abbvie, Bayer, Kindex, Odega, Millendo and Fractyl and serving as a site investigator and receiving grants from Ferring. K.H. reported receiving grants from Roche Diagnostics and Ferring. R.R. reported a grant from AbbVie. M.D. reported being on the Board of Directors of and a stockholder in Advanced Reproductive Care. TRIAL REGISTRATION NUMBER Clinical Trials.gov number: NCT01044862.
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Affiliation(s)
- Emily S Barrett
- Department of Epidemiology, Environmental and Occupational Health Sciences Institute, Rutgers School of Public Health, 170 Frelinghuysen Road, Piscataway, NJ, USA.,Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY, USA
| | - Wendy Vitek
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY, USA
| | - Omar Mbowe
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, 265 Crittenden Avenue, Rochester, NY, USA
| | - Sally W Thurston
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, 265 Crittenden Avenue, Rochester, NY, USA
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State University College of Medicine, 500 University Drive, Hershey, PA, USA
| | - Ruben Alvero
- Department of Obstetrics and Gynecology, Warren Alpert School of Medicine, Brown University, 90 Plain Street, Providence, RI, USA
| | - Valerie Baker
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 1195 West Fremont Avenue, Sunnyvale, CA, USA
| | - G Wright Bates
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL, USA
| | - Peter Casson
- Department of Obstetrics and Gynecology, University of Vermont, 111 Colchester Avenue, Burlington, VT, USA
| | - Christos Coutifaris
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, 3701 Market Street, Philadelphia, PA, USA
| | - Esther Eisenberg
- Fertility and Infertility Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, 6710B Rockledge Drive, Bethesda, MD, USA
| | - Karl Hansen
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, 825 NE 10th Street, Oklahoma City, OK, USA
| | - Stephen Krawetz
- Department of Obstetrics and Gynecology, Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, 275 E. Hancock, Detroit, MI, USA
| | - Randal Robinson
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, 8300 Floyd Curl Drive, San Antonio, TX, USA
| | - Mitchell Rosen
- Department of Reproductive Endocrinology and Infertility, University of California, 550 16th Street, San Francisco, CA, USA
| | - Rebecca Usadi
- Carolinas Health Care System, 1025 Morehead Medical Drive, Charlotte, NC, USA
| | - Heping Zhang
- Yale School of Public Health, 300 George Street, New Haven, CT, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado, 12631 E 17th Avenue, Aurora, CO, USA
| | - Michael Diamond
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, 1120 15th Street, Augusta, GA, USA
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Russell JA, Brunton PJ. Giving a good start to a new life via maternal brain allostatic adaptations in pregnancy. Front Neuroendocrinol 2019; 53:100739. [PMID: 30802468 DOI: 10.1016/j.yfrne.2019.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/29/2019] [Accepted: 02/21/2019] [Indexed: 12/23/2022]
Abstract
Successful pregnancy requires adjustments to multiple maternal homeostatic mechanisms, governed by the maternal brain to support and enable survival of the growing fetus and placenta. Such adjustments fit the concept of allostasis (stability through change) and have a cost: allostatic load. Allostasis is driven by ovarian, anterior pituitary, placental and feto-placental hormones acting on the maternal brain to promote adaptations that support the pregnancy and protect the fetus. Many women carry an existing allostatic load into pregnancy, from socio-economic circumstances, poor mental health and in 'developed' countries, also from obesity. These pregnancies have poorer outcomes indicating negative interactions (failing allostasis) between pre-pregnancy and pregnancy allostatic loads. Use of animal models, such as adult prenatally stressed female offspring with abnormal neuroendocrine, metabolic and behavioural phenotypes, to probe gene expression changes, and epigenetic mechanisms in the maternal brain in adverse pregnancies are discussed, with the prospect of ameliorating poor pregnancy outcomes.
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Affiliation(s)
- John A Russell
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK
| | - Paula J Brunton
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK; Zhejiang University-University of Edinburgh Institute, Haining, Zhejiang, PR China.
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Giurgescu C, Misra DP. Psychosocial Factors and Preterm Birth Among Black Mothers and Fathers. MCN Am J Matern Child Nurs 2019; 43:245-251. [PMID: 29944478 DOI: 10.1097/nmc.0000000000000458] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Black women are more likely to live in disadvantaged neighborhoods and experience racial discrimination and psychological stress compared with White women. These factors have been related to preterm birth (PTB). However, research is limited on the associations of disadvantaged neighborhoods, racial discrimination, and psychological stress among expectant Black fathers and PTB. This review focuses on what is known about psychosocial factors in relation to PTB among Black parents. METHODS The Scopus database was used to search for studies using keywords of adverse childhood experiences, neighborhood environment, racial discrimination, psychological stress, depressive symptoms/depression, coping, locus of control, social support, and mother-father relationship. Each of these keywords was combined with the term preterm birth. This review focused on the associations of these psychosocial factors collected during the prenatal period and risk for PTB. However, due to lack of data for some of these factors during the prenatal period, studies conducted in the immediate period after birth were included. The focus of this review was on research conducted with Black expectant fathers given the limited data on the association between paternal psychosocial factors and PTB. This review only highlights studies that examined the associations of maternal psychosocial factors and PTB. It does not present a comprehensive review of studies on maternal factors given the extent of the studies that examined these associations. RESULTS Pregnant Black women are more likely to report living in disadvantaged neighborhoods; experiencing racial discrimination, psychological stress, and depressive symptoms; using avoidance coping; and reporting lower levels of social support compared with White women. Limited data suggest that Black expectant fathers experience higher rates of everyday unfair treatment because of race/ethnicity compared with White fathers. Research suggests that these psychosocial factors have been related to PTB among pregnant Black women; however, research is limited on examining these associations among expectant Black fathers. CLINICAL IMPLICATIONS Maternal-child nurses are in the position to assess these psychosocial factors among expectant parents. Nurses should also assess risk factors for PTB for both expectant parents and provide support to couples who are at risk for PTB.
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Affiliation(s)
- Carmen Giurgescu
- Carmen Giurgescu is an Associate Professor, College of Nursing, The Ohio State University, Columbus, OH. The author can be reached via e-mail at Dawn P. Misra is a Professor, Department of Family Medicine & Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI
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Edwards KL, Edes AN, Brown JL. Stress, Well-Being and Reproductive Success. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1200:91-162. [DOI: 10.1007/978-3-030-23633-5_5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Buschmann RN, Prochaska JD, Cutchin MP, Peek MK. Stress and health behaviors as potential mediators of the relationship between neighborhood quality and allostatic load. Ann Epidemiol 2018; 28:356-361. [DOI: 10.1016/j.annepidem.2018.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/24/2017] [Accepted: 03/24/2018] [Indexed: 01/24/2023]
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Ribeiro AI, Amaro J, Lisi C, Fraga S. Neighborhood Socioeconomic Deprivation and Allostatic Load: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1092. [PMID: 29843403 PMCID: PMC6024893 DOI: 10.3390/ijerph15061092] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 05/21/2018] [Accepted: 05/24/2018] [Indexed: 12/02/2022]
Abstract
Residing in socioeconomically deprived neighborhoods may pose substantial physiological stress, which can then lead to higher allostatic load (AL), a marker of biological wear and tear that precedes disease. The aim of the present study was to map the current evidence about the relationship between neighborhood socioeconomic deprivation and AL. A scoping review approach was chosen to provide an overview of the type, quantity, and extent of research available. The review was conducted using three bibliographic databases (PubMed, SCOPUS, and Web of Science) and a standardized protocol. Fourteen studies were identified. Studies were predominantly from the USA, cross-sectional, focused on adults, and involved different races and ethnic groups. A wide range of measures of AL were identified: the mode of the number of biomarkers per study was eight but with large variability (range: 6⁻24). Most studies (n = 12) reported a significant association between neighborhood deprivation and AL. Behaviors and environmental stressors seem to mediate this relationship and associations appear more pronounced among Blacks, men, and individuals with poor social support. Such conclusions have important public health implications as they enforce the idea that neighborhood environment should be improved to prevent physiological dysregulation and consequent chronic diseases.
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Affiliation(s)
- Ana Isabel Ribeiro
- EPIUnit⁻Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal.
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal.
| | - Joana Amaro
- EPIUnit⁻Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal.
| | - Cosima Lisi
- EPIUnit⁻Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal.
| | - Silvia Fraga
- EPIUnit⁻Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal.
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal.
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Li Y, Rosemberg MAS, Seng JS. Allostatic load: A theoretical model for understanding the relationship between maternal posttraumatic stress disorder and adverse birth outcomes. Midwifery 2018; 62:205-213. [PMID: 29709774 DOI: 10.1016/j.midw.2018.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 03/23/2018] [Accepted: 04/03/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adverse birth outcomes such as preterm birth and low birth weight are significant public health concerns and contribute to neonatal morbidity and mortality. Studies have increasingly been exploring the predictive effects of maternal posttraumatic stress disorder (PTSD) on adverse birth outcomes. However, the biological mechanisms by which maternal PTSD affects birth outcomes are not well understood. Allostatic load refers to the cumulative dysregulations of the multiple physiological systems as a response to multiple social-ecological levels of chronic stress. Allostatic load has been well documented in relation to both chronic stress and adverse health outcomes in non-pregnant populations. However, the mediating role of allostatic load is less understood when it comes to maternal PTSD and adverse birth outcomes. OBJECTIVE To propose a theoretical model that depicts how allostatic load could mediate the impact of maternal PTSD on birth outcomes. METHOD We followed the procedures for theory synthesis approach described by Walker and Avant (2011), including specifying focal concepts, identifying related factors and relationships, and constructing an integrated representation. We first present a theoretical overview of the allostatic load theory and the other 4 relevant theoretical models. Then we provide a brief narrative review of literature that empirically supports the propositions of the integrated model. Finally, we describe our theoretical model. FINDINGS/CONCLUSIONS The theoretical model synthesized has the potential to advance perinatal research by delineating multiple biomarkers to be used in future. After it is well validated, it could be utilized as the theoretical basis for health care professionals to identify high-risk women by evaluating their experiences of psychosocial and traumatic stress and to develop and evaluate service delivery and clinical interventions that might modify maternal perceptions or experiences of stress and eliminate their impacts on adverse birth outcomes.
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Affiliation(s)
- Yang Li
- University of Missouri Sinclair School of Nursing, USA
| | - Marie-Anne Sanon Rosemberg
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, 400 North Ingalls Building, Ann Arbor, MI 48109 USA
| | - Julia S Seng
- Department of Systems, Populations and Leadership, School of Nursing, University of Michigan, 400 North Ingalls Building, Ann Arbor, MI 48109 USA.
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Stevenson EL, Silva S. Multidimensional Psychological Stress During Pregnancies in Women Who Conceived via In Vitro Fertilization. Res Theory Nurs Pract 2018; 31:295-312. [PMID: 28793950 DOI: 10.1891/1541-6577.31.3.295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore relationships among the 3 psychological dimensions of stress, stimulus/environmental, perceptual, and emotional response, and then to develop a multidimensional composite measure of overall stress, and to determine demographic and clinical characteristics associated with stress in women who became pregnant via in vitro fertilization (IVF). METHODS Cross-sectional design using self-report questionnaires during the second trimester. Multidimensional stress was assessed with the Prenatal Life Events Scale, Life Event Distress Scale, Perceived Stress Scale, State-Trait Anxiety Index-State, and the Pregnancy-Related Anxiety Measure. RESULTS Participants (n = 144), aged 25-40 years, were enrolled June 2010-August 2011 from a private fertility clinic. Exploratory principal factor analysis was used to develop an overall stress score from the stress measures. Multiple stepwise regression analyses were conducted to determine characteristics related to the stress measures. White race tended to be associated with lower stress scores (p = .079). White participants also had lower perceived stress (p = .007), and those with a history of miscarriage had higher pregnancy-related anxiety (p = .035). CONCLUSIONS White women had lower perceived stress. History of one or more miscarriage was associated with higher pregnancy-related anxiety. Additional research examining multidimensional stress is needed across the pregnancy trimesters as well as comparisons to women who conceived without IVF both in United States and internationally.
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McKee KS, Seplaki C, Fisher S, Groth SW, Fernandez ID. Cumulative Physiologic Dysfunction and Pregnancy: Characterization and Association with Birth Outcomes. Matern Child Health J 2018; 21:147-155. [PMID: 27439420 DOI: 10.1007/s10995-016-2103-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective To characterize cumulative physiologic dysfunction (CPD) in pregnancy as a measure of the biological effects of chronic stress and to examine its associations with gestational age and birth weight. Methods Women ≤28 weeks gestation were enrolled from obstetric clinics in Rochester, NY and followed through their delivery. CPD parameters included total cholesterol, Interleukin 6 (IL-6), high sensitivity-C-reactive protein (hs-CRP), systolic and diastolic blood pressure, body mass index at <14 weeks gestation, glucose tolerance, and urinary albumin collected in the third trimester. Linear regression was used to estimate the association between physiologic dysfunction and birth weight and gestational age, respectively (N = 111). Results CPD scores ranged from 0 to 6, out of a total of 8 parameters (Mean 2.09; SD = 1.42). Three-fourths of the participants had a CPD score of 3.0 or lower. The mean birth weight was 3397 g (SD = 522.89), and the mean gestational age was 39.64 weeks (SD = 1.08). CPD was not significantly associated with either birth weight or gestational age (p = 0.42 and p = 0.44, respectively). Conclusion CPD measured at >28 weeks was not associated with birth weight or gestational age. Refinement of a CPD score for pregnancy is needed, taking into consideration both the component parameters and clinical and pre-clinical cut-points for risk scoring.
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Affiliation(s)
- Kimberly Schmitt McKee
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA. .,Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104, USA.
| | - Christopher Seplaki
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA
| | - Susan Fisher
- Temple Clinical Research Institute, Department of Clinical Sciences, Temple University School of Medicine, Kresge Science Hall, Second Floor, 3440 N. Broad Street, Philadelphia, PA, 19140, USA.,Population Research, Fox Chase Cancer Center, Kresge Science Hall, Second Floor, 3440 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Susan W Groth
- School of Nursing, University of Rochester Medical Center, 255 Crittenden Blvd. Box SON, Rochester, NY, 14642, USA
| | - I Diana Fernandez
- Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA
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Chambers BD, Erausquin JT, Tanner AE, Nichols TR, Brown-Jeffy S. Testing the Association Between Traditional and Novel Indicators of County-Level Structural Racism and Birth Outcomes among Black and White Women. J Racial Ethn Health Disparities 2017; 5:966-977. [PMID: 29218496 DOI: 10.1007/s40615-017-0444-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/21/2017] [Accepted: 10/30/2017] [Indexed: 11/26/2022]
Abstract
Despite decreases in infants born premature and at low birth weight in the United States (U.S.), racial disparities between Black and White women continue. In response, the purpose of this analysis was to examine associations between both traditional and novel indicators of county-level structural racism and birth outcomes among Black and White women. We merged individual-level data from the California Birth Statistical Master Files 2009-2013 with county-level data from the United States (U.S.) Census American Community Survey. We used hierarchical linear modeling to examine Black-White differences among 531,170 primiparous women across 33 California counties. Traditional (e.g., dissimilarity index) and novel indicators (e.g., Black to White ratio in elected office) were associated with earlier gestational age and lower birth weight among Black and White women. A traditional indicator was more strongly associated with earlier gestational age for Black women than for White women. This was the first study to empirically demonstrate that structural racism, measured by both traditional and novel indicators, is associated with poor health and wellbeing of infants born to Black and White women. However, findings indicate traditional indicators of structural racism, rather than novel indicators, better explain racial disparities in birth outcomes. Results also suggest the need to develop more innovative approaches to: (1) measure structural racism at the county-level and (2) reform public policies to increase integration and access to resources.
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Affiliation(s)
- Brittany D Chambers
- UCSF Preterm Birth Initiative- California, University of California, San Francisco, San Francisco, CA, USA.
| | - Jennifer Toller Erausquin
- Department of Public Health Education, University of North Carolina, Greensboro, Greensboro, NC, USA
| | - Amanda E Tanner
- Department of Public Health Education, University of North Carolina, Greensboro, Greensboro, NC, USA
| | - Tracy R Nichols
- Department of Public Health Education, University of North Carolina, Greensboro, Greensboro, NC, USA
| | - Shelly Brown-Jeffy
- Department of Sociology, University of North Carolina, Greensboro, Greensboro, NC, USA
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Hux VJ, Roberts JM, Okun ML. Allostatic load in early pregnancy is associated with poor sleep quality. Sleep Med 2017; 33:85-90. [PMID: 28449913 PMCID: PMC5501183 DOI: 10.1016/j.sleep.2016.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/13/2016] [Accepted: 09/13/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Allostatic load (AL) measures the cumulative impact of chronic stress and is associated with adverse health outcomes. A novel scoring system has previously been developed for AL in early pregnancy that is associated with pre-eclampsia. It was hypothesized that AL, as identified by the present model, is associated with psychosocial stressors and, specifically, poor sleep quality. METHODS Women were selected from a low-risk, community-dwelling study population who enrolled at <15 weeks gestation. Nine physiologic components were divided among the domains of cardiovascular, metabolic, and inflammatory function. Spearman's rank correlations were used to examine the association of AL with age, income, the Revised Prenatal Distress Questionnaire (NuPDQ), Inventory of Depressive Symptoms (IDS), and Pittsburgh Sleep Quality Index (PSQI). The Wilcoxon rank-sum test was used to compare AL by race and educational attainment. RESULTS A total of 103 women were identified, with: a mean age of 29.8 ± 5.0 years, 17.5% black, and mean gestational age 12.2 ± 1.1 weeks. Allostatic load was positively correlated with the PSQI (ρ = 0.23, p = 0.018). There were no associations with age, income, prenatal distress, race, or depression scores. College-educated women had lower AL compared with those with less education (0.57 ± 0.43 vs 0.81 ± 0.55, p = 0.045). CONCLUSION Higher AL, measured by the pregnancy-specific model, was associated with poorer sleep quality and lower educational attainment, both of which were considered to be chronic stressors. These relationships were consistent with previous findings in non-pregnant populations, and suggest that AL may be useful for capturing the physiologic impact of chronic stress in early pregnancy.
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Affiliation(s)
- Vanessa J Hux
- Magee-Womens Research Institute, USA; Department of Obstetrics and Gynecology, The Ohio State University, USA
| | - James M Roberts
- Magee-Womens Research Institute, USA; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, USA; Department of Epidemiology, University of Pittsburgh, USA; Clinical and Translational Science Institute, University of Pittsburgh, USA
| | - Michele L Okun
- Magee-Womens Research Institute, USA; Department of Psychiatry, University of Pittsburgh, USA; University of Colorado, Colorado Springs, USA.
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Misra DP, Slaughter-Acey J, Giurgescu C, Sealy-Jefferson S, Nowak A. Why Do Black Women Experience Higher Rates of Preterm Birth? CURR EPIDEMIOL REP 2017. [DOI: 10.1007/s40471-017-0102-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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O'Campo P, Schetter CD, Guardino CM, Vance MR, Hobel CJ, Ramey SL, Shalowitz MU. Explaining racial and ethnic inequalities in postpartum allostatic load: Results from a multisite study of low to middle income woment. SSM Popul Health 2016; 2:850-858. [PMID: 29082305 PMCID: PMC5659269 DOI: 10.1016/j.ssmph.2016.10.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Racial and ethnic inequalities in women's health are widely documented, but not for the postpartum period, and few studies examine whether neighborhood, psychosocial, and biological factors explain these gaps in women's health. METHODS Using prospective longitudinal data collected from 1766 low to middle income women between 2008 and 2012 by the Community Child Health Network (CCHN), we tested the extent to which adjustment for neighborhood, economic, psychological, and medical conditions following a birth explained differences between African American, Latina, and White women in an indicator of physiological dysregulation allostatic load (AL), at one year postpartum as measured by 10 biomarkers: Body Mass Index, Waist Hip Ratio, systolic and diastolic blood pressure, high sensitivity C-reactive protein, Hemoglobin A1c, high-density lipoprotein and cholesterol ratio, and diurnal cortisol. RESULTS Mean postpartum AL scores were 4.65 for African American, 4.57 for Latina and 3.86 for White women. Unadjusted regression estimates for high AL for African American women (with White as the reference) were 0.80 (SD = 0.11) and 0.53 (SD = 0.15) for Latina women. Adjustment for household poverty, neighborhood, stress, and resilience variables resulted in a reduction of 36% of the excess risk in high AL for African Americans versus Whites and 42% of the excess risk for Latinas compared to Whites. CONCLUSIONS Racial and ethnic inequalities in AL were accounted for largely by household poverty with additional contributions by psychological, economic, neighbourhood and medical variables. There remained a significant inequality between African American, and Latina women as compared to Whites even after adjustment for this set of variables. Future research into health inequalities among women should include a fuller consideration of the social determinants of health including employment, housing and prepregnancy medical conditions.
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Affiliation(s)
- Patricia O'Campo
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Christine M Guardino
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Calvin J Hobel
- UCLA and Cedar Sinai Health System, Los Angeles, CA, USA
| | - Sharon Landesman Ramey
- Virginia Tech Carilion Research Institute, Virginia Tech, 2 Riverside Circle, Roanoke, VA 24016, USA
| | - Madeleine U Shalowitz
- NorthShore University Health System and University of Chicago Pritzker School of Medicine, Evanston, IL, USA
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Sealy-Jefferson S, Slaughter-Acey J, Caldwell CH, Kwarteng J, Misra DP. Neighborhood Disadvantage and Preterm Delivery in Urban African Americans: The Moderating Role of Religious Coping. SSM Popul Health 2016; 2:656-661. [PMID: 28367490 PMCID: PMC5371396 DOI: 10.1016/j.ssmph.2016.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Evidence suggests that neighborhood disadvantage predicts preterm delivery (PTD). However, the design of most existing studies precludes within-group analyses, which would allow the identification segments of the population at highest risk, as well as preventive factors. African Americans (AA) are disproportionately affected by PTD, are disproportionately concentrated in disadvantaged neighborhoods, and frequently use religious coping in response to chronic stressors. Our objective was to examine the association between neighborhood disadvantage and PTD, and whether religious coping moderated the associations, among postpartum AA women. Addresses from participants of the Life Influences on Fetal Environments Study (n=1387) were geocoded and linked to data from the American Community Survey. An index of neighborhood disadvantage was derived from a principal components analysis of the following variables: % below poverty, % unemployed, % receiving public assistance income, % college educated, % AA, % female-headed households, % owner occupied homes, median income, and median home value. Three domains of religious coping were assessed: organizational (church attendance), non-organizational (praying for self and asking others for prayer), and personal or subjective (experiences, perceptions, and sentiments about religion), and all were dichotomized as frequent/infrequent or satisfied/not satisfied. Preterm delivery was defined as birth before 37 completed weeks of gestation. Prevalence ratios and 95% confidence intervals were estimated with log binomial regression models. Neighborhood disadvantage did not predict PTD rates in the overall sample. However, there was evidence of moderation by asking others for prayer (P for asking for prayer X disadvantage index interaction term: 0.01). Among women who infrequently asked others for prayer, neighborhood disadvantage was positively associated with PTD rates (adjusted Prevalence ratio: 1.28, 95% Confidence Interval: 1.01, 1.63), and a null association was found for those who frequently asked others for prayer. No evidence of moderation by the other religious coping variables was present. Non-organizational religious coping may buffer against the adverse effects of neighborhood disadvantage on PTD rates, among urban AA women. Future research should examine the mechanisms of the reported relationships.
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Affiliation(s)
- Shawnita Sealy-Jefferson
- Virginia Commonwealth University, Department of Family Medicine and Population Health, Division of Epidemiology
| | | | - Cleopatra H Caldwell
- University of Michigan, School of Public Health, Department of Health Behavior and Health Education
| | | | - Dawn P Misra
- Wayne State University, School of Medicine, Department of Family Medicine and Public Health Sciences
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Brown KK, Lewis RK, Baumgartner E, Schunn C, Maryman J, LoCurto J. Exploring the Experience of Life Stress Among Black Women with a History of Fetal or Infant Death: a Phenomenological Study. J Racial Ethn Health Disparities 2016; 4:484-496. [PMID: 27406594 DOI: 10.1007/s40615-016-0250-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/28/2016] [Accepted: 05/31/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Disparate birth outcomes among Black women continue to be a major public health problem. Whereas prior research has investigated the influence of stress on Black women's birth outcomes, few studies have explored how stress is experienced among Black women across the life course. The objectives of this study were to describe the experience of stress across the life course among Black women who reported a history of fetal or infant death and to identify stressful life events (SLE) that may not be represented in the widely used SLE inventory. METHODS Using phenomenological, qualitative research design, in-depth interviews were conducted with six Black women in Kansas who experienced a fetal or infant death. RESULTS Analyses revealed that participants experienced multiple, co-occurring stressors over the course of their lives and experienced a proliferation of stress emerging in early life and persisting into adulthood. Among the types of stressors cited by participants, history of sexual assault (trauma-related stressor) was a key stressful life event that is not currently reflected in the SLE inventory. CONCLUSION Our findings highlight the importance of using a life-course perspective to gain a contextual understanding of the experiences of stress among Black women, particularly those with a history of adverse birth outcomes. Further research investigating Black women's experiences of stress and the mechanisms by which stress impacts their health could inform efforts to reduce disparities in birth outcomes. An additional focus on the experience and impact of trauma-related stress on Black women's birth outcomes may also be warranted.
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Affiliation(s)
- Kyrah K Brown
- Public Health Performance Division, Sedgwick County Health Department, 1900 E. 9th Street, Wichita, KS, 67208, USA.
| | - Rhonda K Lewis
- Department of Psychology, Wichita State University, 1845 Fairmount St, Wichita, KS, 67260-0034, USA
| | - Elizabeth Baumgartner
- Kansas Infant Death and SIDS Network, Inc., 1148 S. Hillside Street, Suite 10, Wichita, KS, 67211, USA
| | - Christy Schunn
- Kansas Infant Death and SIDS Network, Inc., 1148 S. Hillside Street, Suite 10, Wichita, KS, 67211, USA
| | - J'Vonnah Maryman
- Department of Psychology, Wichita State University, 1845 Fairmount St, Wichita, KS, 67260-0034, USA
| | - Jamie LoCurto
- Department of Psychology, Wichita State University, 1845 Fairmount St, Wichita, KS, 67260-0034, USA
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Ncube CN, Enquobahrie DA, Albert SM, Herrick AL, Burke JG. Association of neighborhood context with offspring risk of preterm birth and low birthweight: A systematic review and meta-analysis of population-based studies. Soc Sci Med 2016; 153:156-64. [PMID: 26900890 PMCID: PMC7302006 DOI: 10.1016/j.socscimed.2016.02.014] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/05/2016] [Accepted: 02/08/2016] [Indexed: 11/28/2022]
Abstract
Findings from studies investigating associations of residential environment with poor birth outcomes have been inconsistent. In a systematic review and meta-analysis, we examined associations of neighborhood disadvantage with preterm birth (PTB) and low birthweight (LBW), and explored differences in relationships among racial groups. Two reviewers searched English language articles in electronic databases of published literature. We used random effects logistic regression to calculate odds ratios (and 95% confidence intervals) relating neighborhood disadvantage with PTB and LBW. Neighborhood disadvantage, most disadvantaged versus least disadvantaged neighborhoods, was defined by researchers of included studies, and comprised of poverty, deprivation, racial residential segregation or racial composition, and crime. We identified 1314 citations in the systematic review. The meta-analyses included 7 PTB and 14 LBW cross-sectional studies conducted in the United States (U.S.). Overall, we found 27% [95%CI: 1.16, 1.39] and 11% [95%CI: 1.07, 1.14] higher risk for PTB and LBW among the most disadvantaged compared with least disadvantaged neighborhoods. No statistically significant association was found in meta-analyses of studies that adjusted for race. In race-stratified meta-analyses models, we found 48% [95%CI: 1.25, 1.75] and 61% [95%CI: 1.30, 2.00] higher odds of PTB and LBW among non-Hispanic white mothers living in most disadvantaged neighborhoods compared with those living in least disadvantaged neighborhoods. Similar, but less strong, associations were observed for PTB (15% [95%CI: 1.09, 1.21]) and LBW (17% [95%CI: 1.10, 1.25]) among non-Hispanic black mothers. Neighborhood disadvantage is associated with PTB and LBW, however, associations may differ by race. Future studies evaluating causal mechanisms underlying the associations, and racial/ethnic differences in associations, are warranted.
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Affiliation(s)
- Collette N Ncube
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
| | - Daniel A Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, 1959 NE Pacific Street, Health Sciences Building, Seattle, WA 98195-7236, USA.
| | - Steven M Albert
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
| | - Amy L Herrick
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
| | - Jessica G Burke
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA 15261, USA.
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Coley SL, Nichols TR. Race, Age, and Neighborhood Socioeconomic Status in Low Birth Weight Disparities Among Adolescent Mothers: An Intersectional Inquiry. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2016; 9:1-16. [PMID: 28824829 PMCID: PMC5560161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Few studies examined socioeconomic contributors to racial disparities in low birth weight outcomes between African-American and Caucasian adolescent mothers. This cross-sectional study examined the intersections of maternal racial status, age, and neighborhood socioeconomic status in explaining these disparities in low birth weight outcomes across a statewide sample of adolescent mothers. METHODS Using data from the North Carolina State Center of Health Statistics for 2010-2011, birth cases for 16,472 adolescents were geocoded by street address and linked to census-tract information from the 2010 United States Census. Multilevel models with interaction terms were used to identify significant associations between maternal racial status, age, and neighborhood socioeconomic status (as defined by census-tract median household income) and low birth weight outcomes across census tracts. RESULTS Significant racial differences were identified in which African-American adolescents had greater odds of low birth weight outcomes than Caucasian adolescents (OR=1.88, 95% CI 1.64, 2.15). Although racial disparities in low birth weight outcomes remained significant in context of maternal age and neighborhood socioeconomic status, the greatest disparities were found between African-American and Caucasian adolescents that lived in areas of higher socioeconomic status (p<.001). Maternal age was not significantly associated with racial differences in low birth weight outcomes. CONCLUSION These findings indicate that racial disparities in low birth weight outcomes among adolescent mothers can vary by neighborhood socioeconomic status. Further investigations using intersectional frameworks are needed for examining the relationships between neighborhood socioeconomic status and birth outcome disparities among infants born to adolescent mothers.
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Allostatic Load and Preterm Birth. Int J Mol Sci 2015; 16:29856-74. [PMID: 26694355 PMCID: PMC4691152 DOI: 10.3390/ijms161226209] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 12/03/2015] [Accepted: 12/04/2015] [Indexed: 12/28/2022] Open
Abstract
Preterm birth is a universal health problem that is one of the largest unmet medical needs contributing to the global burden of disease. Adding to its complexity is that there are no means to predict who is at risk when pregnancy begins or when women will actually deliver. Until these problems are addressed, there will be no interventions to reduce the risk because those who should be treated will not be known. Considerable evidence now exists that chronic life, generational or accumulated stress is a risk factor for preterm delivery in animal models and in women. This wear and tear on the body and mind is called allostatic load. This review explores the evidence that chronic stress contributes to preterm birth and other adverse pregnancy outcomes in animal and human studies. It explores how allostatic load can be used to, firstly, model stress and preterm birth in animal models and, secondly, how it can be used to develop a predictive model to assess relative risk among women in early pregnancy. Once care providers know who is in the highest risk group, interventions can be developed and applied to mitigate their risk.
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Addressing reproductive health disparities as a healthcare management priority: pursuing equity in the era of the Affordable Care Act. Curr Opin Obstet Gynecol 2015; 26:531-8. [PMID: 25379769 DOI: 10.1097/gco.0000000000000119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To summarize the newest available evidence on maternal and reproductive health disparities, and to describe elements of the Affordable Care Act most likely to impact these disparities. RECENT FINDINGS Significant racial and ethnic disparities in maternal and reproductive health outcomes have persisted in recent years, contributing to poor outcomes and increasing costs. Pregnancy-related mortality ratios are up to three times higher in Black women compared with non-Hispanic White women, with the risk of severe maternal morbidity also significantly higher in Black and Hispanic women. Unintended pregnancy is twice as likely in minority women. Insurance status, socioeconomic status, and broader social determinants of health are implicated in these disparities. Coverage changes associated with the Affordable Care Act may provide some opportunities to reach communities most at risk. Delivery innovation, payment reform, and further public financing of key services are examples of further management approaches that can be used to address reproductive health disparities. SUMMARY The Affordable Care Act offers important opportunities to address persistent reproductive health disparities, but significant gaps remain. Efforts must be made to reduce the negative outcomes and high financial and human costs associated with disparities in reproductive health.
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Jutte DP, Miller JL, Erickson DJ. Neighborhood adversity, child health, and the role for community development. Pediatrics 2015; 135 Suppl 2:S48-57. [PMID: 25733725 DOI: 10.1542/peds.2014-3549f] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Despite medical advances, childhood health and well-being have not been broadly achieved due to rising chronic diseases and conditions related to child poverty. Family and neighborhood living conditions can have lasting consequences for health, with community adversity affecting health outcomes in significant part through stress response and increased allostatic load. Exposure to this "toxic stress" influences gene expression and brain development with direct and indirect negative consequences for health. Ensuring healthy child development requires improving conditions in distressed, high-poverty neighborhoods by reducing children's exposure to neighborhood stressors and supporting good family and caregiver functioning. The community development industry invests more than $200 billion annually in low-income neighborhoods, with the goal of improving living conditions for residents. The most impactful investments have transformed neighborhoods by integrating across sectors to address both the built environment and the social and service environment. By addressing many facets of the social determinants of health at once, these efforts suggest substantial results for children, but health outcomes generally have not been considered or evaluated. Increased partnership between the health sector and community development can bring health outcomes explicitly into focus for community development investments, help optimize intervention strategies for health, and provide natural experiments to build the evidence base for holistic interventions for disadvantaged children. The problems and potential solutions are beyond the scope of practicing pediatricians, but the community development sector stands ready to engage in shared efforts to improve the health and development of our most at-risk children.
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Affiliation(s)
- Douglas P Jutte
- UC Berkeley-UCSF Joint Medical Program, University of California, Berkeley, School of Public Health, Berkeley, California; Build Healthy Places Network, San Francisco, California; Public Health Institute, Oakland, California; and
| | - Jennifer L Miller
- Build Healthy Places Network, San Francisco, California; Public Health Institute, Oakland, California; and
| | - David J Erickson
- Federal Reserve Bank of San Francisco, San Francisco, California
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Jiménez MP, Osypuk TL, Arevalo S, Tucker KL, Falcon LM. Neighborhood socioeconomic context and change in allostatic load among older Puerto Ricans: The Boston Puerto Rican health study. Health Place 2015; 33:1-8. [PMID: 25706323 DOI: 10.1016/j.healthplace.2015.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 01/27/2015] [Accepted: 02/01/2015] [Indexed: 10/24/2022]
Abstract
Neighborhood context may influence health and health disparities. However, most studies have been constrained by cross-sectional designs that limit causal inference due to failing to establish temporal order of exposure and disease. We tested the impact of baseline neighborhood context (neighborhood socioeconomic status factor at the block-group level, and relative income of individuals compared to their neighbors) on allostatic load two years later. We leveraged data from the Boston Puerto Rican Health Study, a prospective cohort of aging Puerto Rican adults (aged 45-75 at baseline), with change in AL modeled between baseline and the 2nd wave of follow-up using two-level hierarchical linear regression models. Puerto Rican adults with higher income, relative to their neighbors, exhibited lower AL after two years, after adjusting for NSES, age, gender, individual-level SES, length of residence, and city. After additional control for baseline AL, this association was attenuated to marginal significance. We found no significant association of NSES with AL. Longitudinal designs are an important tool to understand how neighborhood contexts influence health and health disparities.
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Affiliation(s)
- Marcia P Jiménez
- Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA 02138, USA
| | - Theresa L Osypuk
- Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, West Bank Office Building, Suite 435, 1300 S. Second Street, Minneapolis, MN 55454, USA
| | - Sandra Arevalo
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts at Lowell, 3 Solomont Way, Suite 4, Lowell, MA 01854, USA; Center for Population Health and Health Disparities, University of Massachusetts at Lowell, Weed Hall 3 Solomont Way, Suite 4, Lowell, MA 01854, USA
| | - Katherine L Tucker
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts at Lowell, 3 Solomont Way, Suite 4, Lowell, MA 01854, USA; Center for Population Health and Health Disparities, University of Massachusetts at Lowell, Weed Hall 3 Solomont Way, Suite 4, Lowell, MA 01854, USA
| | - Luis M Falcon
- College of Fine Arts, Humanities, & Social Sciences, University of Massachusetts at Lowell, 150 Wilder St., Lowell, MA 01854, USA; Center for Population Health and Health Disparities, University of Massachusetts at Lowell, Weed Hall 3 Solomont Way, Suite 4, Lowell, MA 01854, USA
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