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Montoya-Williams D, Barreto A, Laguna-Torres A, Worsley D, Wallis K, Peña MM, Palladino L, Salva N, Levine L, Rivera A, Hernandez R, Fuentes-Afflick E, Yun K, Lorch S, Virudachalam S. Philadelphia Latine Immigrant Birthing People's Perspectives on Mitigating the Chilling Effect on Prenatal Care Utilization. Med Care 2024; 62:404-415. [PMID: 38728679 PMCID: PMC11090453 DOI: 10.1097/mlr.0000000000002002] [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] [Indexed: 05/12/2024]
Abstract
RESEARCH DESIGN Community-engaged qualitative study using inductive thematic analysis of semistructured interviews. OBJECTIVE To understand Latine immigrants' recent prenatal care experiences and develop community-informed strategies to mitigate policy-related chilling effects on prenatal care utilization. BACKGROUND Decreased health care utilization among immigrants due to punitive immigration policies (ie, the "chilling effect") has been well-documented among Latine birthing people both pre and postnatally. PATIENTS AND METHODS Currently or recently pregnant immigrant Latine people in greater Philadelphia were recruited from an obstetric clinic, 2 pediatric primary care clinics, and 2 community-based organization client pools. Thematic saturation was achieved with 24 people. Participants' pregnancy narratives and their perspectives on how health care providers and systems could make prenatal care feel safer and more comfortable for immigrants. RESULTS Participants' recommendations for mitigating the chilling effect during the prenatal period included training prenatal health care providers to sensitively initiate discussions about immigrants' rights and reaffirm confidentiality around immigration status. Participants suggested that health care systems should expand sources of information for pregnant immigrants, either by partnering with community organizations to disseminate information or by increasing access to trusted individuals knowledgeable about immigrants' rights to health care. Participants also suggested training non-medical office staff in the use of interpreters. CONCLUSION Immigrant Latine pregnant and birthing people in greater Philadelphia described ongoing fear and confusion regarding the utilization of prenatal care, as well as experiences of discrimination. Participants' suggestions for mitigating immigration-related chilling effects can be translated into potential policy and programmatic interventions which could be implemented locally and evaluated for broader applicability.
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Affiliation(s)
- Diana Montoya-Williams
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- CHOP PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Alejandra Barreto
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alicia Laguna-Torres
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Diana Worsley
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- CHOP PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kate Wallis
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Developmental-Behavioral Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michelle-Marie Peña
- Department of Pediatrics, Division of Neonatology, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Lauren Palladino
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nicole Salva
- Department of Obstetrics and Gynecology, Penn Medicine, Philadelphia, PA, USA
| | - Lisa Levine
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Obstetrics and Gynecology, Penn Medicine, Philadelphia, PA, USA
| | | | | | - Elena Fuentes-Afflick
- Division of General Pediatrics University of California, San Francisco, San Francisco, CA
| | - Katherine Yun
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott Lorch
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- CHOP PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Senbagam Virudachalam
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Barreto A, Formanowski B, Peña MM, Salazar EG, Handley SC, Burris HH, Ortiz R, Lorch SA, Montoya-Williams D. Preterm Birth Risk and Maternal Nativity, Ethnicity, and Race. JAMA Netw Open 2024; 7:e243194. [PMID: 38512251 PMCID: PMC10958237 DOI: 10.1001/jamanetworkopen.2024.3194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/28/2024] [Indexed: 03/22/2024] Open
Abstract
Importance Immigrant birthing people have lower rates of preterm birth compared with their US-born counterparts. This advantage and associated racial and ethnic disparities across the gestational age spectrum have not been examined nationally. Objective To examine associations of maternal nativity, ethnicity, and race with preterm birth. Design, Setting, and Participants This cohort study used birth certificates from the National Vital Statistics System to analyze in-hospital liveborn singleton births in the US between January 1, 2009, and December 31, 2018. Data were analyzed from January to June 2023. Exposure Mutually exclusive nativity, ethnicity, and race subgroups were constructed using nativity (defined as US-born or non-US-born), ethnicity (defined as Hispanic or non-Hispanic), and race (defined as American Indian or Alaska Native, Asian, Black, Native Hawaiian or Other Pacific Islander, White, or other [individuals who selected other race or more than 1 race]). Main Outcomes and Measures The primary outcome of interest was preterm birth. Modified Poisson and multinomial logistic regression models quantified relative risk (RR) of preterm birth overall (<37 weeks' gestation) and by gestational category (late preterm: 34-36 weeks' gestation; moderately preterm: 29-33 weeks' gestation; and extremely preterm: <29 weeks' gestation) for each maternal nativity, ethnicity, and race subgroup compared with the largest group, US-born non-Hispanic White (hereafter, White) birthing people. The RR of preterm birth overall and by category was also measured within each racial and ethnic group by nativity. Models were adjusted for maternal demographic and medical covariates, birth year, and birth state. Results A total of 34 468 901 singleton live births of birthing people were analyzed, with a mean (SD) age at delivery of 28 (6) years. All nativity, ethnicity, and race subgroups had an increased adjusted risk of preterm birth compared with US-born White birthing people except for non-US-born White (adjusted RR, 0.85; 95% CI, 0.84-0.86) and Hispanic (adjusted RR, 0.98; 95% CI, 0.97-0.98) birthing people. All racially and ethnically minoritized groups had increased adjusted risks of extremely preterm birth compared with US-born White birthing people. Non-US-born individuals had a decreased risk of preterm birth within each subgroup except non-Hispanic Native Hawaiian or Other Pacific Islander individuals, in which immigrants had significantly increased risk of overall (adjusted RR, 1.07; 95% CI, 1.01-1.14), moderately (adjusted RR, 1.10; 95% CI, 0.92-1.30), and late (adjusted RR, 1.11; 95% CI, 1.02-1.22) preterm birth than their US-born counterparts. Conclusions and Relevance Results of this cohort study suggest heterogeneity of preterm birth across maternal nativity, ethnicity, and race and gestational age categories. Understanding these patterns could aid the design of targeted preterm birth interventions and policies, especially for birthing people typically underrepresented in research.
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Affiliation(s)
- Alejandra Barreto
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brielle Formanowski
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michelle-Marie Peña
- Division of Neonatology, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Elizabeth G. Salazar
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute, University of Pennsylvania, Philadelphia
| | - Sara C. Handley
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute, University of Pennsylvania, Philadelphia
| | - Heather H. Burris
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute, University of Pennsylvania, Philadelphia
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Robin Ortiz
- Leonard Davis Institute, University of Pennsylvania, Philadelphia
- Department of Pediatrics, New York University Langone Health, New York
- Department of Population Health, New York University Langone Health, New York
- Institute for Excellence in Health Equity, New York University Langone Health, New York
| | - Scott A. Lorch
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute, University of Pennsylvania, Philadelphia
| | - Diana Montoya-Williams
- Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute, University of Pennsylvania, Philadelphia
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Debbink MP, Stanhope KK, Hogue CJR. Racial and ethnic inequities in stillbirth in the US: Looking upstream to close the gap: Seminars in Perinatology. Semin Perinatol 2024; 48:151865. [PMID: 38220545 DOI: 10.1016/j.semperi.2023.151865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Though stillbirth rates in the United States improved over the previous decades, inequities in stillbirth by race and ethnicity have persisted nearly unchanged since data collection began. Black and Indigenous pregnant people face a two-fold greater risk of experiencing the devastating consequences of stillbirth compared to their White counterparts. Because race is a social rather than biological construct, inequities in stillbirth rates are a downstream consequence of structural, institutional, and interpersonal racism which shape a landscape of differential access to opportunities for health. These downstream consequences can include differences in the prevalence of chronic health conditions as well as structural differences in the quality of health care or healthy neighborhood conditions, each of which likely plays a role in racial and ethnic inequities in stillbirth. Research and intervention approaches that utilize an equity lens may identify ways to close gaps in stillbirth incidence or in responding to the health and socioemotional consequences of stillbirth. A community-engaged approach that incorporates experiential wisdom will be necessary to create a full picture of the causes and consequences of inequity in stillbirth outcomes. Investigators working in tandem with community partners, utilizing a combination of qualitative, quantitative, and implementation science approaches, may more fully elucidate the underpinnings of racial and ethnic inequities in stillbirth outcomes.
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Affiliation(s)
- Michelle P Debbink
- University of Utah Spencer Fox Eccles, School of Medicine Department of Obstetrics and Gynecology, Salt Lake City, UT.
| | - Kaitlyn K Stanhope
- Emory University School of Medicine, Department of Gynecology and Obstetrics, Atlanta, GA
| | - Carol J R Hogue
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA
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McKenzie-Sampson S, Baer RJ, Jelliffe-Pawlowski LL, Karasek D, Riddell CA, Torres JM, Blebu BE. Structural racism, nativity and risk of adverse perinatal outcomes among Black women. Paediatr Perinat Epidemiol 2024; 38:89-97. [PMID: 38116814 DOI: 10.1111/ppe.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Black women in the United States (US) have the highest risk of preterm birth (PTB) and small for gestational age (SGA) births, compared to women of other racial groups. Among Black women, there are disparities by nativity whereby foreign-born women have a lower risk of PTB and SGA compared to US-born women. Differential exposure to racism may confer nativity-based differences in adverse perinatal outcomes between US- and foreign-born Black women. This remains unexplored among US- and African-born women in California. OBJECTIVES Evaluate the relationship between structural racism, nativity, PTB and SGA among US- and African-born Black women in California. METHODS We conducted a population-based study of singleton births to US- and African-born Black women in California from 2011 to 2017 (n = 131,424). We examined the risk of PTB and SGA by nativity and neighbourhoods with differing levels of structural racism, as measured by the Index of Concentration at the Extremes. We fit crude and age-adjusted Poisson regression models, estimated using generalized estimating equations, with risk ratios (RR) and 95% confidence intervals (CI) as the effect measure. RESULTS The proportions of PTB and SGA were 9.7% and 14.5%, respectively, for US-born women, while 5.6% and 8.3% for African-born women. US-born women (n = 24,782; 20.8%) were more likely to live in neighbourhoods with high structural racism compared to African-born women (n = 1474; 11.6%). Structural racism was associated with an elevated risk of PTB (RR 1.19, 95% CI 1.12, 1.26) and SGA (RR 1.19, 95% CI 1.13, 1.25) for all Black women, however, there was heterogeneity by nativity, with US-born women experiencing a higher magnitude of effect than African-born women. CONCLUSIONS Among Black women in California, exposure to structural racism and the impacts of structural racism on the risk of PTB and SGA varied by nativity.
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Affiliation(s)
- Safyer McKenzie-Sampson
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Rebecca J Baer
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Pediatrics, University of California San Diego School of Medicine, San Francisco, California, USA
| | - Laura L Jelliffe-Pawlowski
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Deborah Karasek
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, California, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, California, USA
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, USA
| | - Corinne A Riddell
- Divisions of Biostatistics and Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Jacqueline M Torres
- Department of Epidemiology & Biostatistics, University of California San Francisco School of Medicine, San Francisco, California, USA
- UCSF California Preterm Birth Initiative, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Bridgette E Blebu
- Department of Obstetrics and Gynecology, Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, University of California, Los Angeles, Los Angeles, California, USA
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Whitworth KW, Moussa I, Salihu HM, Chardon Fabien A, Suter M, Aagaard KM, Symanski E. Environmental justice burden and Black-White disparities in spontaneous preterm birth in Harris County, Texas. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1296590. [PMID: 38179111 PMCID: PMC10766384 DOI: 10.3389/frph.2023.1296590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction Given limited evidence of previous studies, we evaluated the role of environmental justice (EJ) burden (i.e., a neighborhood characterized by both increased environmental burden and socioeconomic deprivation) in Black-White disparities in spontaneous preterm birth (sPTB) in Harris County, Texas and compared results that evaluated neighborhood-level socioeconomic deprivation alone. Methods We conducted a retrospective analysis using PeriBank, a database and biospecimen repository of gravidae giving birth at two hospitals in the Texas Medical Center. We included 3,703 non-Hispanic Black and 5,475 non-Hispanic white gravidae who were U.S.-born, delivered from August 2011-December 2020, and resided in Harris County, TX. We used data from the U.S. EPA EJScreen to characterize the EJ burden of participant's zip code of residence from fine particulate matter (PM2.5), ozone, and proximity to National Priorities List (NPL) sites and calculated zip-code level Area Deprivation Index (ADI). We assessed the contribution of neighborhood-level variables to the Black-White disparity in sPTB by evaluating attenuation of the odds ratio (OR) representing the effect of race in multivariable logistic regression models, controlling for individual-level characteristics. We also conducted race-stratified analyses between each neighborhood variable and sPTB. Exposure indices were treated as continuous variables; in stratified models, ORs and 95% Confidence Intervals (CIs) are presented per 10-unit increase in the neighborhood variable. Results Accounting for individual-level variables, Black gravidae had 79% higher odds of sPTB than white gravidae (OR = 1.79, 95%CI = 1.32, 2.44); the disparity was moderately attenuated when accounting for EJ burden or ADI (ORs ranged from 1.58 to 1.69). Though we observed no association between any of the EJ burden indices and sPTB among white gravidae, we found increased risks among Black gravidae, with ORs of similar magnitude for each EJ variable. For example, Black gravidae experienced 17% increased odds of sPTB associated with a 10-unit increase in the EJ burden index for PM2.5 (OR = 1.17, 95%CI = 0.97, 1.40). No racial differences were observed in the association of ADI with sPTB. Discussion Though we observed limited evidence of the contribution of living in EJ neighborhoods to the Black-White disparity in sPTB, our study suggests living in an EJ neighborhood may differentially impact Black and white gravidae.
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Affiliation(s)
- K. W. Whitworth
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - I. Moussa
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - H. M. Salihu
- Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - A. Chardon Fabien
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
| | - M. Suter
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children’s Hospital, Houston, TX, United States
| | - K. M. Aagaard
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine & Texas Children’s Hospital, Houston, TX, United States
| | - E. Symanski
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Center for Precision Environmental Health, Baylor College of Medicine, Houston, TX, United States
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