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Gao X, Mujahid MS, Nuru-Jeter AM, Morello-Frosch R. The Influence of Gentrification on Adverse Birth Outcomes in California. J Urban Health 2024:10.1007/s11524-024-00902-7. [PMID: 39333453 DOI: 10.1007/s11524-024-00902-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 09/29/2024]
Abstract
Evidence has documented the effects of place on perinatal outcomes, but less is known about the sociopolitical mechanisms, such as gentrification, that shape neighborhood context and produce spatialized inequities in adverse birth outcomes. Leveraging a diverse sample in California, we assessed the associations between gentrification and birth outcomes: preterm birth, small-for-gestational-age, and low birth weight. Gentrification was measured using the Freeman method and the Displacement and Gentrification Typology. Descriptive analysis assessed outcome prevalence and race and ethnicity distribution by exposure and participant characteristics. Overall and race and ethnicity-stratified mixed effects logistic models examined associations between gentrification and birth outcomes, sequentially adjusting for sociodemographic status and pregnancy factors, with a random intercept to account for clustering by census tract. In a sample of 5,116,131 births, outcome prevalence ranged from 1.0% for very preterm birth, 5.0% for low birth weight, 7.9% for preterm birth, and 9.4% for small-for-gestational-age. Adjusting for individual-level factors, gentrification was associated with increased odds of preterm birth (Freeman OR = 1.09, 95% CI 1.07-1.10; Displacement and Gentrification Typology OR = 1.11, 95% CI 1.09-1.13). While Displacement and Gentrification Typology-measured gentrification was consistently associated with greater odds of adverse outcomes, Freeman-measured gentrification was associated with slightly lower odds of small-for-gestational-age and low birth weight. Furthermore, gentrification was associated with birth outcome odds across multiple racial and ethnic groups, but the directions and magnitudes of the associations varied depending on the gentrification assessment methodology and the outcome assessed. Results demonstrate that gentrification plays a role in shaping adverse birth outcomes in California.
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Affiliation(s)
- Xing Gao
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Amani M Nuru-Jeter
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA, USA
- Division of Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Rachel Morello-Frosch
- Division of Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, CA, USA.
- Division of Environmental Health Sciences, School of Public Health, University of California Berkeley, Berkeley, CA, USA.
- Department of Environmental Science, Policy and Management, University of California Berkeley, 130 Mulford Hall, Berkeley, CA, 94720, USA.
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Edwards SR, Elver AA, Frederick KB, Humphries LS, Hoppe IC. Impact of Social Vulnerability, Race, and Urbanicity on Early Nutritional Outcomes in Patients With Cleft Palate. J Craniofac Surg 2024:00001665-990000000-01970. [PMID: 39325060 DOI: 10.1097/scs.0000000000010685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 08/24/2024] [Indexed: 09/27/2024] Open
Abstract
Patients with cleft palate experience early feeding difficulties, resulting in increased hospital utilization due to poor nutritional status. Sociodemographic factors may impact access and outcomes for cleft patients. This study investigates the association of social vulnerability, race, and urbanicity on birth encounter metrics and failure to thrive (FTT) rates for patients with cleft palate. Retrospective data from 2013 to 2023 was queried from Cosmos, a national deidentified database from Epic electronic health record. Birth metrics, the prevalence of FTT, and MyChart activation rates were compared across sociodemographic cohorts based on (1) social vulnerability index (SVI) quartiles, (2) patient race, and (3) USDA Rural-Urban Commuting Area (RUCA) codes using χ2 or Fisher exact tests. There were 92,437 patients diagnosed with cleft palate. Birth weight was lower in socially vulnerable and Black patients (SVI 75%: 101.50±1.57 oz; SVI 25%: 106.40±1.85 oz; Black: 95.3±2.63 oz; White: 104.90±1.02 oz; Other: 104.80±2.09 oz), and length of stay was longer (SVI 75%: 21±2.39 d; SVI 25%: 15±2.18 d; Black: 22±4 d). FTT related admissions increased with SVI quartile (Q25: 0.19%; Q25-50; 0.29%, Q50-75: 0.34%; Q75: 0.47%; P<0.001). An opposite trend was observed for MyChart activation rates (P<0.001). High SVI and Black patients are susceptible to unfavorable nutritional outcomes. Access disparities, such as direct-to-provider communication systems (ie, MyChart), may contribute. Awareness of social identities, geography, and community may assist in providing individualized care in early life.
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Affiliation(s)
- Shelley R Edwards
- School of Medicine, University of Mississippi Medical Center
- Graduate Program in Neuroscience, School of Graduate Studies in Health Sciences, University of Mississippi Medical Center
| | - Ashlie A Elver
- Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center
| | - Keeley B Frederick
- Center for Informatics and Analytics, University of Mississippi Medical Center
| | - Laura S Humphries
- Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center
- Stephanie and Mitchell Morris Center for Cleft and Craniofacial Research and Innovation, Children's of Mississippi, Jackson, MS
| | - Ian C Hoppe
- Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center
- Stephanie and Mitchell Morris Center for Cleft and Craniofacial Research and Innovation, Children's of Mississippi, Jackson, MS
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Hoffman C, Harris M, Acharya K, Malnory M, Cohen S, Lagatta J. Impact of systematic screening for social determinants of health in a level IV neonatal intensive care unit. J Perinatol 2024:10.1038/s41372-024-02096-x. [PMID: 39244612 DOI: 10.1038/s41372-024-02096-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE To determine whether screening for social determinants of health (SDoH) in a level IV neonatal intensive care unit (NICU) could uncover additional family needs. METHODS Secondary analysis of a prospective study in a level IV NICU. Participants filled out the Protocol for Responding to and Assessing Patients' Assets, Risks and Experiences (PRAPARE) tool, which includes economic, housing, transportation, and safety questions. Questionnaires were completed via secure tablet; the research team notified social workers of reported needs. Illness and demographic characteristics were compared between families who did and did not report resource needs. Manual chart review assessed subsequent response to reported SDoH needs. RESULTS Of 319 respondents, 61(19%) reported resource needs. Of 61 families, 88% received repeat social work encounters to re-assess for resources; 59% received new resource referrals. CONCLUSIONS Systematic SDoH screening can identify needs throughout the NICU stay, even among families already connected to social work support.
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Affiliation(s)
- Caitlin Hoffman
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Melissa Harris
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Krishna Acharya
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Margaret Malnory
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Susan Cohen
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joanne Lagatta
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
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Bishop B, Hockenberry H, Sperber J, Owolo E, Baeta C, Price M, Neff C, Kruchko C, Barnholtz-Sloan JS, Charles AJ, Sciubba C, Ostrom QT, Johnson E, Goodwin CR. The intersection of race, ethnicity, and urbanicity on treatment paradigms and clinical outcomes for non-malignant primary tumors of the spine. Cancer Epidemiol 2024; 93:102657. [PMID: 39243579 DOI: 10.1016/j.canep.2024.102657] [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: 03/28/2024] [Revised: 07/26/2024] [Accepted: 08/26/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Non-malignant primary tumors of the spine (NMPTS) patients in rural areas face unique barriers that may limit their capacity to receive optimal care. With a lower geographical distribution of neurosurgical specialists and limited healthcare infrastructure, rural NMPTS patients may receive certain treatments at a lower frequency than metropolitan patients. NMPTS We sought to examine the association between residential urbanicity, race-ethnicity, treatment patterns, and survival outcomes for cases diagnosed with NMPTS. METHODS Cases of NMPTS diagnosed between 2004 and 2019 were identified from the Central Brain Tumor Registry of the United States (CBTRUS), a combined dataset of CDC's National Program of Cancer Registries (NPCR) and NCI's Surveillance, Epidemiology and End Results (SEER) data. Using multivariable logistic regression, we evaluated the association between urbanicity and treatment (including surgery and radiation), adjusted for age at diagnosis, sex, and race-ethnicity. Patient-level all-cause survival data were obtained from the NPCR Survival Analytical Database (2004-2018). RESULTS A total of 38,414 cases were identified, 33,097 of whom lived in metropolitan and 5317 of whom lived in non-metropolitan regions. Nerve sheath tumors and meningiomas were the most common tumor histopathologies across both regions, with no clinically significant difference in other histopathologies (p<0.001). There were statistically significant differences between the frequency and type of surgery received by urbanicity (p<0.001). Overall all-cause survival was significantly lower for NH Blacks residing in non-metropolitan areas when compared to NH Blacks residing in metropolitan areas (p<0.0001). CONCLUSION Our data demonstrates significant differences in the incidence of NMPTS across both race-ethnicity and urbanicity. However, a wider analysis of all-cause mortality reveals disparities in health outcomes across both race-ethnicity and urbanicity for Black and Hispanic populations. To address the disparity in health outcomes, policymakers and health providers need to work with local communities in rural areas to improve access to equitable and quality healthcare.
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Affiliation(s)
- Brandon Bishop
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA; Kansas City University School of Osteopathic Medicine, Kansas City, MO, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
| | - Harrison Hockenberry
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
| | - Jacob Sperber
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
| | - Edwin Owolo
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
| | - Cesar Baeta
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
| | - Mackenzie Price
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA; Central Brain Tumor Registry of the United States, Hinsdale, IL, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
| | - Corey Neff
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA; Central Brain Tumor Registry of the United States, Hinsdale, IL, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA; Trans-Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, MD, USA; Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute, Bethesda, MD, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
| | - Antionette J Charles
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
| | - Camryn Sciubba
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
| | - Quinn T Ostrom
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA; Central Brain Tumor Registry of the United States, Hinsdale, IL, USA; Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
| | - Eli Johnson
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA; Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA; Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA.
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Belanoff C, Black A, Ncube CN, Acevedo-Garcia D, Almeida J. Neighborhood Child Opportunity and Preterm Birth Rates by Race and Ethnicity. JAMA Netw Open 2024; 7:e2432766. [PMID: 39259538 PMCID: PMC11391324 DOI: 10.1001/jamanetworkopen.2024.32766] [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] [Indexed: 09/13/2024] Open
Abstract
Importance In the US, infants born to non-Hispanic Black birthing parents are 50% more likely to be born preterm than those born to non-Hispanic White birthing parents, and individual-level factors do not fully account for this inequity. Neighborhood context, rooted in historic patterns of structural racism, may facilitate understanding patterns of inequity in preterm birth. Objective To estimate the association between neighborhood opportunity level, measured by the Child Opportunity Index (COI), and preterm birth among infants in Massachusetts. Design, Setting, and Participants In this cross-sectional, population-based study, Massachusetts birth certificates from 3 large metropolitan areas (Boston, Springfield, and Worcester) were linked to US Census tract-level data from the COI, and log binomial regression models and generalized estimating equations were fit to examine associations of different levels of opportunity with preterm birth. Singleton infants born in Massachusetts between February 1, 2011, and December 31, 2015, were included. Analyses were originally conducted in 2019 and updated in 2024. Exposure Level of child opportunity (measured by the COI) at the US Census tract level. Race and ethnicity were ascertained from the birth certificate, as reported by the birthing parent. Main Outcomes and Measures Live birth before 37 completed weeks' gestation. Results The analytic dataset included 267 553 infants, of whom 18.9% were born to Hispanic, 10.1% to non-Hispanic Asian or Pacific Islander, 10.1% to non-Hispanic Black, and 61.0% to non-Hispanic White birthing parents. More than half of infants born to non-Hispanic Black and Hispanic birthing parents were born into very low opportunity neighborhoods, and in crude models, this was associated with greater prevalence of preterm birth relative to very high opportunity neighborhoods (prevalence ratio, 1.44; 95% CI, 1.37-1.52). After adjustment for covariates, infants born into very low opportunity neighborhoods still had a greater prevalence of preterm birth (prevalence ratio, 1.16; 95% CI, 1.10-1.23). Conclusions and Relevance In this cross-sectional study of neighborhood opportunity and preterm birth, elevated risk associated with exposure to a very low opportunity neighborhood, coupled with the disproportionate exposure by race and ethnicity, points to a modifiable factor that may contribute to racial and ethnic inequities in preterm birth. Future research should investigate interventions that seek to address neighborhood opportunity.
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Affiliation(s)
- Candice Belanoff
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Adriana Black
- Office of the Vice Chancellor for Health Affairs, University of Illinois, Chicago
| | - Collette N Ncube
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | | | - Joanna Almeida
- Simmons University School of Social Work, Boston, Massachusetts
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Gao X, Morello-Frosch R, Nuru-Jeter AM, Snowden JM, Carmichael SL, Mujahid MS. Historical Redlining, Contemporary Gentrification, and Severe Maternal Morbidity in California, 2005-2018. JAMA Netw Open 2024; 7:e2429428. [PMID: 39312242 PMCID: PMC11420692 DOI: 10.1001/jamanetworkopen.2024.29428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/11/2024] [Indexed: 09/26/2024] Open
Abstract
Importance Historically redlined neighborhoods may experience disinvestment, influencing their likelihood of gentrification, a process of neighborhood (re-)development that unequally distributes harms and benefits by race and class. Understanding the combined outcomes of redlining and gentrification informs how the mutually constitutive systems of structural racism and racial capitalism affect pregnancy outcomes. Objective To examine if historical redlining and contemporary gentrification is associated with increased severe maternal morbidity (SMM) odds. Design, Setting, and Participants This cross-sectional study used data from a statewide population-based sample of all live hospital births at 20 weeks' gestation or more between 2005 and 2018 in California. Analysis was conducted from March 2023 to January 2024. Exposure Redlining (as characterized by the federal Home Owners' Loan Corporation mortgage security maps) and displacement (using present-day sociodemographic and housing market information). Main Outcomes and Measures Mixed-effects logistic regression models were used to assess the association of census tract-level exposure to historical redlining and contemporary gentrification with increased SMM odds, adjusting for sociodemographic and pregnancy related factors. Outcome classification was based on the Centers for Disease Control and Prevention SMM index, which defines SMM as having any of the 21 procedures and diagnoses based on the International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Results The study sample included 1 554 837 births (median [SD] maternal age, 29.0 [6.4] years; 3464 American Indian or Alaskan Native [0.2%], 224 774 Asian [14.5%], 132 240 Black [8.5%], 880 104 Hispanic [56.6%], 312 490 White [20.1%]), with 22 993 cases of SMM (1.4%). Residents in historically redlined neighborhoods that were undergoing gentrification or displacement were more likely to be Black, Hispanic, and American Indian or Alaskan Native. Independent of individual-level characteristics, SMM odds were greater for individuals living in redlined neighborhoods that experienced displacement (OR, 1.21; 95% CI, 1.14-1.28) and in redlined neighborhoods undergoing gentrification (OR, 1.21; 95% CI, 1.13-1.29) compared with those in continuously advantaged neighborhoods. Conclusions and Relevance Findings from this cross-sectional study demonstrate that the legacies of redlining, intertwined with current dynamics of displacement and gentrification, affect SMM. Place-based sociopolitical mechanisms that inequitably distribute resources may be important intervention points to address structural drivers of adverse pregnancy outcomes and their racial inequities.
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Affiliation(s)
- Xing Gao
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Rachel Morello-Frosch
- Department of Environmental Science, Policy and Management, University of California, Berkeley
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley
| | - Amani M. Nuru-Jeter
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley
- Division of Epidemiology, School of Public Health, University of California, Berkeley
| | - Jonathan M. Snowden
- School of Public Health, Oregon Health & Science University-Portland State University
| | - Suzan L. Carmichael
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford University, Stanford, California
- Department of Pediatrics, Division of Neonatal & Developmental Medicine, Stanford University, Stanford, California
| | - Mahasin S. Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley
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Hailu EM, Gao X, Needham BL, Seeman T, Lewis TT, Mujahid MS. Associations between historical and contemporary measures of structural racism and leukocyte telomere length: The Multi-Ethnic Study of Atherosclerosis (MESA). Soc Sci Med 2024; 360:117229. [PMID: 39303531 DOI: 10.1016/j.socscimed.2024.117229] [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: 02/02/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND We assessed the link between two manifestations of structural racism-historical redlining and contemporary racial residential segregation-and baseline and 10-year changes in leukocyte telomere length (LTL). METHODS We used data on Black and Hispanic/Latinx participants from Exams I and V of the Multi-Ethnic Study of Atherosclerosis Stress Ancillary Study (N = 741, age range = 45-84 years). LTL was defined as the ratio of telomeric DNA to a single copy gene (T/S), and 10-year changes were adjusted for regression to the mean. We used 1930s Home Owners' Loan Corporation maps to assign three historical redlining grades (A&B: best/still desirable, C: declining, D: hazardous/redlined) to participants' neighborhoods (census-tracts) at baseline. The Getis-Ord Gi∗ statistic was used to evaluate census-tract level baseline residential segregation (low/moderate/high). RESULTS In mixed-effects regression models accounting for neighborhood clustering, individual characteristics, and current neighborhood environments, those living in highly segregated Black neighborhoods had 0.08 shorter baseline LTL (95% CI: -0.13, -0.04), than those residing in the least segregated neighborhoods. We did not find a relationship between residing in segregated neighborhoods and 10-year LTL changes, and associations between residing in historically redlined neighborhoods and both baseline LTL and 10-year changes in LTL were null. Across discriminatory disinvestment trajectories examined, individuals residing in highly segregated but non-redlined neighborhoods had 0.6 shorter baseline LTL than individuals residing in non-redlined neighborhoods with low/moderate segregation (95% CI: -0.12, -0.01). CONCLUSIONS Our results highlight the impact of racial segregation on cellular aging and underscore the need to ameliorate structural inequities within segregated neighborhoods.
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Affiliation(s)
- Elleni M Hailu
- Division of Epidemiology, School of Public Health, University of California, Berkeley, 2121 Berkeley Way #5302, Berkeley, CA, 94720, USA.
| | - Xing Gao
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, USA
| | - Belinda L Needham
- Department of Epidemiology, School of Public Health, University of Michigan, USA
| | - Teresa Seeman
- Department of Geriatrics, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, 2121 Berkeley Way #5302, Berkeley, CA, 94720, USA
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Das A, Casey JA, Gemmill A, Catalano R, Lee H, Stolte A, Bustos B, Bruckner TA. Dynamic changes in place-based measures of structural racism and preterm birth in the USA. J Epidemiol Community Health 2024; 78:550-555. [PMID: 38886026 DOI: 10.1136/jech-2023-221750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/18/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Structurally racist systems, ideologies and processes generate and reinforce inequities among minoritised racial/ethnic groups. Prior cross-sectional literature finds that place-based structural racism, such as the Index of Concentration at the Extremes (ICE), correlates with higher infant morbidity and mortality. We move beyond cross-sectional approaches and examine whether a decline in place-based structural racism over time coincides with a reduced risk of preterm birth across the USA. METHODS We used as the outcome count of preterm births overall and among non-Hispanic (NH) black and NH white populations across three epochs (1998-2002, 2006-2010, 2014-2018) in 1160 US counties. For our measure of structural racism, we used ICE race/income county measures from the US Census Bureau. County-level fixed effects Poisson models include a population offset (number of live births) and adjust for epoch indicators, per cent poverty and mean maternal age within counties. RESULTS An SD increase in ICE (0.11) over time corresponds with a 0.6% reduced risk of preterm birth overall (incidence rate ratio (IRR): 0.994, 95% CI 0.990, 0.998), a 0.6% decrease in preterm risk among NH black births (IRR: 0.994, 95% CI 0.989, 0.999) and a 0.4% decrease among NH white births (IRR: 0.996, 95% CI 0.992, 0.999). CONCLUSIONS Movement away from county-level concentrated NH black poverty preceded reductions in preterm risk, especially among NH black populations. Our longitudinal design strengthens inference that place-based reductions in structural racism may improve perinatal health. These improvements, however, do not appear sufficient to redress large disparities.
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Affiliation(s)
- Abhery Das
- Health Policy and Administration, University of Illinois Chicago, Chicago, Illinois, USA
| | - Joan A Casey
- Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Alison Gemmill
- Department of Family, Population and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ralph Catalano
- Public Health, University of California Berkeley, Berkeley, California, USA
| | - Hedwig Lee
- Department of Sociology, Duke University, Durham, North Carolina, USA
| | - Allison Stolte
- Health, Society and Behavior, University of California Irvine, Irvine, California, USA
- Center for Population, Inequality, and Policy, University of California Irvine, Irvine, California, USA
| | - Brenda Bustos
- Health, Society and Behavior, University of California Irvine, Irvine, California, USA
- Center for Population, Inequality, and Policy, University of California Irvine, Irvine, California, USA
| | - Tim A Bruckner
- Health, Society and Behavior, University of California Irvine, Irvine, California, USA
- Center for Population, Inequality, and Policy, University of California Irvine, Irvine, California, USA
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Warren KF, Dail RB, Dawson RM, Boghossian NS, Felder TM. When a baby is born, so is a parent: Understanding the effects of preterm birth on Black parents through the lens of the NIMHD framework. Nurs Outlook 2024; 72:102246. [PMID: 39116649 DOI: 10.1016/j.outlook.2024.102246] [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: 01/29/2024] [Revised: 06/29/2024] [Accepted: 07/06/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND The rate of preterm birth (PTB) is high in the United States and Black infants remain disproportionately affected, with the disparity between Black and White infant deaths greater today than it was under antebellum slavery. PURPOSE The National Institute on Minority Health and Disparities Research Framework reflects a unique set of determinants relevant to the understanding and promotion of minority health. METHODS We have applied this framework to better understand the effects of PTB on Black parents and the distribution of the social determinants of health, including structural determinants and root causes of inequities. DISCUSSION This adaptation shows the intersection in maternal and infant health that shapes individuals' experiences, drives disparities and impacts perinatal outcomes in critical periods over the lifecourse. CONCLUSION In our efforts to achieve health equity, it is imperative that we study the underlying mechanisms and recognize that policies, institutional structures, and social factors are drivers of racism.
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Affiliation(s)
- Karen F Warren
- University of South Carolina, College of Nursing, Columbia, SC.
| | - Robin B Dail
- University of South Carolina, College of Nursing, Columbia, SC
| | - Robin M Dawson
- University of South Carolina, College of Nursing, Columbia, SC
| | - Nansi S Boghossian
- University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Tisha M Felder
- University of South Carolina, College of Nursing, Columbia, SC
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10
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Sooy-Mossey M, Matsuura M, Ezekian JE, Williams JL, Lee GS, Wood K, Dizon S, Kaplan SJ, Li JS, Parente V. The Association of Race and Ethnicity with Mortality in Pediatric Patients with Congenital Heart Disease: a Systematic Review. J Racial Ethn Health Disparities 2024; 11:2182-2196. [PMID: 37436684 DOI: 10.1007/s40615-023-01687-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/09/2023] [Accepted: 06/18/2023] [Indexed: 07/13/2023]
Abstract
CONTEXT Congenital heart disease (CHD) is a common condition with high morbidity and mortality and is subject to racial and ethnic health disparities. OBJECTIVE To conduct a systematic review of the literature to identify differences in mortality in pediatric patients with CHD based on race and ethnicity. DATA SOURCES Legacy PubMed (MEDLINE), Embase (Elsevier), and Scopus (Elsevier) STUDY SELECTION: English language articles conducted in the USA focused on mortality based on race and ethnicity in pediatric patients with CHD. DATA EXTRACTION Two independent reviewers assessed studies for inclusion and performed data extraction and quality assessment. Data extraction included mortality based on patient race and ethnicity. RESULTS There were 5094 articles identified. After de-duplication, 2971 were screened for title and abstract content, and 45 were selected for full-text assessment. Thirty studies were included for data extraction. An additional 8 articles were identified on reference review and included in data extraction for a total of 38 included studies. Eighteen of 26 studies showed increased risk of mortality in non-Hispanic Black patients. Results were heterogenous in Hispanic patients with eleven studies of 24 showing an increased risk of mortality. Results for other races demonstrated mixed outcomes. LIMITATIONS Study cohorts and definitions of race and ethnicity were heterogenous, and there was some overlap in national datasets used. CONCLUSION Overall, racial and ethnic disparities existed in the mortality of pediatric patients with CHD across a variety of mortality types, CHD lesions, and pediatric age ranges. Children of races and ethnicities other than non-Hispanic White generally had increased risk of mortality, with non-Hispanic Black children most consistently having the highest risk of mortality. Further investigation is needed into the underlying mechanisms of these disparities so interventions to reduce inequities in CHD outcomes can be implemented.
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Affiliation(s)
- Meredith Sooy-Mossey
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University School of Medicine, 2301 Erwin Road, DUMC Box 3127, Durham, NC, 27710, USA.
| | - Mirai Matsuura
- Deparment of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Jordan E Ezekian
- Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jason L Williams
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University School of Medicine, 2301 Erwin Road, DUMC Box 3127, Durham, NC, 27710, USA
| | - Grace S Lee
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Kathleen Wood
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University School of Medicine, 2301 Erwin Road, DUMC Box 3127, Durham, NC, 27710, USA
| | - Samantha Dizon
- Division of Cardiology, Columbia University Department of Medicine, New York, NY, USA
| | - Samantha J Kaplan
- Medical Center Library and Archives, Duke University, Durham, NC, USA
| | - Jennifer S Li
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University School of Medicine, 2301 Erwin Road, DUMC Box 3127, Durham, NC, 27710, USA
| | - Victoria Parente
- Pediatric Hospital Medicine, Duke University School of Medicine, Durham, NC, USA
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Barcelona V, Chen L, Zhao Y, Samari G, Monk C, McNeil R, Baccarelli A, Wapner R. Associations between Individual- and Structural-Level Racism and Gestational Age at Birth in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be. J Urban Health 2024; 101:682-691. [PMID: 38992222 PMCID: PMC11329443 DOI: 10.1007/s11524-024-00889-1] [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] [Accepted: 06/03/2024] [Indexed: 07/13/2024]
Abstract
The purpose of this study was to investigate the associations between multilevel racism and gestational age at birth among nulliparous women. We conducted a secondary analysis of data of the nuMoM2b Study (2010-2013) to examine the associations between individual- and structural-level experiences of racism and discrimination and gestational age at birth among nulliparous women (n = 9148) at eight sites across the U.S. Measures included the individual Experiences of Discrimination (EOD) scale and the Index of Concentration at the Extremes (ICE) to measure structural racism. After adjustment, we observed a significant individual and structural racism interaction on gestational length (p = 0.012). In subgroup analyses, we found that among those with high EOD scores, women who were from households concentrated in the more privileged group had significantly longer gestations (β = 1.27, 95% CI: 0.48, 2.06). Women who reported higher EOD scores and more economic privilege had longer gestations, demonstrating the moderating effect of ICE as a measure of structural racism. In conclusion, ICE may represent a modifiable factor in the prevention of adverse birth outcomes in nulliparas.
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Affiliation(s)
- Veronica Barcelona
- Columbia University School of Nursing, 560 West 168th St, New York, NY, 10032, USA.
| | - LinQin Chen
- Mental Health Data Science Division, New York State Psychiatric Institute and Columbia University, 722 West 168Th Street, Room 210, New York, NY, 10032, USA
| | - Yihong Zhao
- Columbia University School of Nursing, 560 West 168th St, New York, NY, 10032, USA
| | - Goleen Samari
- Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Catherine Monk
- Mental Health Data Science Division, New York State Psychiatric Institute and Columbia University, 722 West 168Th Street, Room 210, New York, NY, 10032, USA
- Department of Obstetrics & Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, 10032, USA
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, 10032, USA
| | - Rebecca McNeil
- RTI International, Research Triangle Park, NC, 27709, USA
| | | | - Ronald Wapner
- Department of Obstetrics & Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, 10032, USA
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12
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Lagatta J, Hoffman C, Harris M, Acharya K, Malnory M, Cohen S. Impact of systematic screening for social determinants of health in a level IV neonatal intensive care unit. RESEARCH SQUARE 2024:rs.3.rs-4656439. [PMID: 39108473 PMCID: PMC11302683 DOI: 10.21203/rs.3.rs-4656439/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Objective To determine whether screening for social determinants of health (SDoH) in a level IV neonatal intensive care unit (NICU) could uncover additional family needs. Methods Secondary analysis of a prospective study in a level IV NICU. Participants filled out the Protocol for Responding to and Assessing Patients' Assets, Risks and Experiences (PRAPARE) tool, which includes economic, housing, transportation, and safety questions. Questionnaires were completed via secure tablet; the research team notified social workers of reported needs. Illness and demographic characteristics were compared between families who did and did not report resource needs. Manual chart review assessed subsequent response to reported SDoH needs. Results Of 319 respondents, 61(19%) reported resource needs. Of 61 families, 88% received repeat social work encounter to re-assess for resources; 59% received new resource referrals. Conclusions Systematic SDoH screening can identify needs throughout the NICU stay, even among families already connected to social work support.
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Ramos SZ, Rose B, Werner EF, Amutah-Onukagha N, Siegel M. Systemic racism and Non-Hispanic Black to Non-Hispanic White disparities in infant mortality at the county level. J Perinatol 2024:10.1038/s41372-024-02048-5. [PMID: 39014009 DOI: 10.1038/s41372-024-02048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/17/2024] [Accepted: 07/03/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVE To use a novel measure of systemic racism to examine its relationship with Non-Hispanic Black (NHB) to Non-Hispanic White (NHW) racial disparities in infant mortality across U.S. counties. STUDY DESIGN In this cross-sectional study, a composite, multi-dimensional measure of systemic racism at the county level was developed using confirmatory factor analysis based on indicators across five dimensions of systemic racism. Using linear regression analysis, we examined the relationship between the systemic racism factor scores and the NHB to NHW racial disparities in county-level infant mortality rates. Additionally, we performed a multi-level analysis of infant mortality, with births nested within counties by running a random intercept model that controlled for factors at both the individual and county levels to take into account the clustered nature of the data. RESULTS There were 325 counties that met inclusion criteria for the county level analysis and 1181 counties for the individual level analysis. Each one standard deviation increase in the Systemic Racism Index was associated with an increase of 10.4% in the Non-Hispanic Black to Non-Hispanic White infant mortality rate ratio at the county level (aOR 1.104, 95% CI [1.061-1.148]). After controlling for individual level clinical factors and county level factors, each one standard deviation increase in the systemic racism index score was associated with a decrease of 3.5% in the NHW infant mortality rate (aOR 0.965, 95% CI [0.943-0.988]). CONCLUSION Systemic racism is significantly associated with differences between counties in the magnitude of their Non-Hispanic Black to Non-Hispanic White racial disparities in infant mortality rates.
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Affiliation(s)
- Sebastian Z Ramos
- Department of Obstetrics and Gynecology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Bliss Rose
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Erika F Werner
- Department of Obstetrics and Gynecology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ndidiamaka Amutah-Onukagha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Michael Siegel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
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14
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Barcelona V, Condon EM, Jacoby SF. Leveraging biosocial methods to examine and address structural determinants of health and promote health equity. Nurs Outlook 2024; 72:102195. [PMID: 38810533 PMCID: PMC11330731 DOI: 10.1016/j.outlook.2024.102195] [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: 01/14/2024] [Revised: 03/26/2024] [Accepted: 04/28/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Biosocial approaches in nursing research have largely focused on the ways that social determinants of health influence individual-level outcomes, including symptom management, family and social support, and educational interventions. PURPOSE Theoretical, methodological, and practical strategies are needed to expand current biosocial methods for nursing science and focus on upstream, structural determinants of health and the policies that underlie health inequities. METHODS This paper summarizes presentations given at the 2023 Council for the Advancement of Nursing Science Advanced Methods Conference, Biosocial Methods to Advance Health Equity, in a panel titled "Individual, community, systems and policy related to biosocial methods." DISCUSSION Nurses are uniquely positioned to examine upstream, structural determinants of health by leveraging expertise in biosocial methods, collaborating with interdisciplinary researchers and community members, and advocating for policy change. By conducting theory-grounded biosocial research, nurse researchers can significantly advance scientific knowledge and promote health equity for individuals and communities. CONCLUSION Nurse scientists are conducting research using biosocial methods and provide recommendations for expansion of this approach in the field.
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Affiliation(s)
| | - Eileen M Condon
- University of Connecticut School of Nursing, Storrs, CT; Department of Pediatrics, University of Connecticut School of Medicine, Storrs, CT
| | - Sara F Jacoby
- Department of Family and Community, University of Pennsylvania School of Nursing, Philadelphia, PA
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15
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Yu X, Roman LA, Raffo JE, Meng R, Vander Meulen P, Lloyd CS, Meghea CI. Neighborhood Racialized Economic Polarization, Home Visiting Coverage, and Adverse Birth Outcomes in a Medicaid-eligible Population. Womens Health Issues 2024; 34:340-349. [PMID: 38845232 DOI: 10.1016/j.whi.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 04/19/2024] [Accepted: 05/02/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Residential polarization shaped by racial segregation and concentrations of wealth (hereafter neighborhood racialized economic polarization) results in both highly deprived and highly privileged neighborhoods. Numerous studies have found a negative relationship between neighborhood racialized economic polarization and birth outcomes. We investigated whether community-informed home visiting programs achieve high rates of service coverage in highly deprived neighborhoods and can attenuate the deleterious effect of neighborhood polarization on birth outcomes. METHODS We used 2016-2019 data from Michigan's statewide database that links birth records, Medicaid claims, and program participation (N = 211,412). We evaluated whether 1) home visiting programs achieved high rates of service coverage in highly deprived neighborhoods, 2) participation in home visiting may help to mitigate the negative relationship between neighborhood polarization and birth outcomes, and 3) the reductions in preterm birth and low birthweight were larger among Black birthing individuals. Data were examined using multilevel generalized linear models and mediation analysis. RESULTS The statewide home visiting program achieved higher rates of coverage in the most deprived neighborhoods (21.0% statewide, 28.3% in the most deprived vs. 10.4% in the most privileged neighborhoods). For all, home visiting participation was associated with a decrease in the relationship between neighborhood polarization and preterm birth by 6.8% (mean indirect effect, -0.008; 95% confidence interval, -0.011 to -0.005), and by 5.2% (mean indirect effect, -0.013; 95% confidence interval, -0.017 to -0.009) for low birthweight, adjusting for individual-level risk factors. The decrease was larger among Black individuals. CONCLUSIONS A statewide Medicaid-sponsored home visiting program achieved high rates of service coverage in highly deprived neighborhoods. Program participation may help to mitigate the negative relationship between neighborhood polarization and birth outcomes, and more so among Black individuals. Continued support for home visiting services is required to better engage birthing individuals in neighborhoods with concentrated deprivation and to decrease disparities.
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Affiliation(s)
- Xiao Yu
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids and East Lansing, Michigan.
| | - Lee Anne Roman
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids and East Lansing, Michigan
| | - Jennifer E Raffo
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids and East Lansing, Michigan
| | - Ran Meng
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids and East Lansing, Michigan
| | - Peggy Vander Meulen
- Corewell Health, Healthier Communities Department, Strong Beginnings, Grand Rapids, Michigan
| | - Celeste Sanchez Lloyd
- Corewell Health, Healthier Communities Department, Strong Beginnings, Grand Rapids, Michigan
| | - Cristian I Meghea
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids and East Lansing, Michigan
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Reed T, Patil C, Kershaw KN, Crooks N, Jeremiah R, Park C. Prevalence of Hypertensive Disorders of Pregnancy and Gestational Diabetes Mellitus by Race and Ethnicity in Illinois, 2018 to 2020. MCN Am J Matern Child Nurs 2024:00005721-990000000-00057. [PMID: 38865102 DOI: 10.1097/nmc.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
PURPOSE Use administrative discharge data from 2018 to 2020 to determine if there are differences in the prevalence of hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) by race and ethnicity in Illinois. STUDY DESIGN AND METHODS This retrospective cross-sectional study used administrative discharge records from all patients who had live births in Illinois over a 3-year period; 2018, 2019, 2020. Multivariate analyses were performed to control for covariates and determine if associations vary by race and ethnicity for HDP and GDM. RESULTS A total of 287,250 discharge records were included. Multivariate analyses showed that after adjusting for covariates, non-Hispanic Black women had 1.60 increased odds of HDP compared to non-Hispanic White women (OR, 1.60; 95% CI, 1.55-1.65). Hispanic women (OR, 1.45; 95% CI, 1.40-1.50), Asian/Pacific Islander women (OR, 2.07; 95% CI, 1.97-2.17), and American Indian/Alaska Native women (OR, 1.43; 95% CI, 1.17-1.74) had an increased odds of GDM compared to non-Hispanic White women. CLINICAL IMPLICATIONS Women of color were at increased odds for HDP and GDM in Illinois. To eliminate poor maternal outcomes in women of color at risk for HDP and GDM, more culturally congruent health equity practices, policies, and comprehensive care interventions must be adopted.
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Hicks PM, Lin G, Newman-Casey PA, Niziol LM, Lu MC, Woodward MA, Elam AR, Musch DC, Mehdipanah R, Ehrlich JR, Rein DB. Place-Based Measures of Inequity and Vision Difficulty and Blindness. JAMA Ophthalmol 2024; 142:540-546. [PMID: 38722650 PMCID: PMC11082749 DOI: 10.1001/jamaophthalmol.2024.1207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/26/2024] [Indexed: 05/12/2024]
Abstract
Importance Known social risk factors associated with poor visual and systemic health in the US include segregation, income inequality, and persistent poverty. Objective To investigate the association of vision difficulty, including blindness, in neighborhoods with measures of inequity (Theil H index, Gini index, and persistent poverty). Design, Setting, and Participants This cross-sectional study used data from the 2012-2016 American Community Survey and 2010 US census tracts as well as Theil H index, Gini index, and persistent poverty measures from PolicyMap. Data analysis was completed in July 2023. Main Outcomes and Measures The main outcome was the number of census tract residents reporting vision difficulty and blindness (VDB) and the association with the Theil H index, Gini index, or persistent poverty, assessed using logistic regression. Results In total, 73 198 census tracts were analyzed. For every 0.1-unit increase in Theil H index and Gini index, there was an increased odds of VDB after controlling for census tract-level median age, the percentage of the population that identified as female sex, the percentage of the population that identified as a member of a racial or ethnic minority group, state, and population size (Theil H index: odds ratio [OR], 1.14 [95% CI, 1.14-1.14; P < .001]; Gini index: OR, 1.15 [95% CI, 1.15-1.15; P < .001]). Persistent poverty was associated with an increased odds of VDB after controlling for census tract-level median age, the percentage of the population that identified as female sex, the percentage of the population that identified as a member of a racial or ethnic minority group, state, and population size compared with nonpersistent poverty (OR, 1.36; 95% CI, 1.35-1.36; P < .001). Conclusions and Relevance In this cross-sectional study, residential measures of inequity through segregation, income inequality, or persistent poverty were associated with a greater number of residents living with VDB. It is essential to understand and address how neighborhood characteristics can impact rates of VDB.
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Affiliation(s)
- Patrice M. Hicks
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
- Housing Solutions for Health Equity, University of Michigan, Ann Arbor
| | - George Lin
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
| | - Paula Anne Newman-Casey
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
| | - Leslie M. Niziol
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
| | - Ming-Chen Lu
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
| | - Maria A. Woodward
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
| | - Angela R. Elam
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
| | - David C. Musch
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - Roshanak Mehdipanah
- Housing Solutions for Health Equity, University of Michigan, Ann Arbor
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor
| | - Joshua R. Ehrlich
- Department of Ophthalmology & Visual Sciences, Medical School, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
- Institute for Social Research, University of Michigan, Ann Arbor
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Mersky JP, Jeffers NK, Lee CP, Shlafer RJ, Jackson DB, Gómez A. Linking Adverse Experiences to Pregnancy and Birth Outcomes: A Life Course Analysis of Racial and Ethnic Disparities Among Low-Income Women. J Racial Ethn Health Disparities 2024; 11:1741-1753. [PMID: 37289344 DOI: 10.1007/s40615-023-01647-w] [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: 03/06/2023] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 06/09/2023]
Abstract
Racial and ethnic disparities in birth outcomes have persisted in the United States for decades, though the causes remain poorly understood. The life course perspective posits that poorer outcomes of Black birthing people stem from heightened exposure to stressors early in life and cumulative exposure to stressors over time. Despite its prominence, this perspective has seldom been investigated empirically. We analyzed longitudinal data gathered from 1319 women in low-income households in Wisconsin who received perinatal home visiting services. Variable- and person-centered analyses were performed to assess whether 15 adverse childhood experiences (ACEs) and 10 adverse adult experiences (AAEs) were associated, alone and in combination, with pregnancy loss, preterm birth, and low birth weight among Hispanic (i.e., Latinx) and non-Hispanic Black and White participants. As expected, there were disparities in preterm birth and low birth weight, and both ACEs and AAEs were linked to poorer pregnancy and birth outcomes. Unexpectedly, bivariate and multivariate analyses showed that the associated effects of ACEs and AAEs were most robust for non-Hispanic White women. A latent class analysis produced four patterns of life course adversity, and multigroup latent class analyses confirmed that, compared to White women, higher-adversity class assignments were associated with less robust effects for Hispanic women, and even less robust effects for Black women. We discuss interpretations of the paradoxical findings, including the possibility that alternative sources of stress such as interpersonal and structural racism may better account for the reproductive disparities that disproportionately affect Black birthing people.
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Affiliation(s)
- Joshua P Mersky
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
- Institute for Child & Family Well-Being, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
| | | | - ChienTi Plummer Lee
- Institute for Child & Family Well-Being, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Rebecca J Shlafer
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Anthony Gómez
- Institute for Child & Family Well-Being, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
- School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
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Vu H, Green TL, Swan LET. Born on the wrong side of the tracks: Exploring the causal effects of segregation on infant health. JOURNAL OF HEALTH ECONOMICS 2024; 95:102876. [PMID: 38763530 DOI: 10.1016/j.jhealeco.2024.102876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 01/24/2024] [Accepted: 03/15/2024] [Indexed: 05/21/2024]
Abstract
Prior research has found that a high level of residential racial segregation, or the degree to which racial/ethnic groups are isolated from one another, is associated with worsened infant health outcomes, particularly among non-Hispanic (NH) Black infant populations. However, because exposure to segregation is non-random, it is unclear whether and to what extent segregation is causally linked to infant health. To overcome this empirical limitation, we leverage exogenous variation in the placement of railroad tracks in the 19th century to predict contemporary segregation, an approach first introduced by Ananat (2011). In alignment with prior literature, we find that residential segregation has statistically significant associations with negative birth outcomes among Black infant populations in the area. Using OLS methods underestimates the negative impacts of segregation on infant health. We fail to detect comparable effects on health outcomes among NH White infant populations. Further, we identify several key mechanisms by which residential segregation could influence health outcomes among Black infant populations, including lower access to prenatal care during the first trimester, higher levels of anti-Black prejudice, greater transportation barriers, and increased food insecurity. Given that poor birth outcomes have adverse effects on adults' health and well-being, the findings suggest that in-utero exposure to residential segregation could have important implications for Black-White inequality over the life course.
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Affiliation(s)
- Hoa Vu
- School of Education and Social Policy, Northwestern University, United States of America.
| | - Tiffany L Green
- Department of Population Health Sciences, University of Wisconsin-Madison, United States of America.
| | - Laura E T Swan
- Department of Population Health Sciences, University of Wisconsin-Madison, United States of America.
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Stanhope KK, Kapila P, Hossain A, Abu-Salah M, Singisetti V, Umerani A, Carter S, Boulet S. Understanding the Relationship Between Gender Representation in County Government and Perinatal Outcomes to Black, White, and Hispanic Birthing People in Georgia. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:201-210. [PMID: 38516654 PMCID: PMC10956532 DOI: 10.1089/whr.2023.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/23/2024]
Abstract
Objective To characterize the association between percent of county-level elected officials who were female-presenting and perinatal outcomes in Georgia and variation by individual race, 2020-2021. Materials and Methods We gathered data on the gender composition of county-level elected officials for all Georgia counties (n = 159) in 2022 and calculated the percent of female elected officials (percent female, 0-100). We linked this to data from 2020 to 2021 birth certificates (n = 238,795) to identify preterm birth (PTB, <37 weeks), low birthweight (LBW, <2500 grams), hypertensive disorders of pregnancy, and cesarean delivery. We fit multilevel log binomial models with generalized estimating equations, with percent female as the primary independent variable. We adjusted for individual and county-level potential confounders and individual race/ethnicity as an effect modifier. Results County median percent female elected officials was 22.2% (interquartile range: 15.5). Overall, 14.6% of births were PTB and 10.1% LBW. A 15 percentage point increase in percent female elected officials was associated with lower risk of hypertensive disorders of pregnancy for white (adjusted risk ratio [RR]: 0.94, 95% confidence interval [CI]: 0.88-0.99), and possibly Hispanic (adjusted RR: 0.95, 95% CI: 0.89-1.0) and non-Hispanic other (adjusted RR: 0.94 (0.87-1.01), but not black birthing people (adjusted RR: 1.0, 95% CI: 0.95-1.05). There was not a clear pattern for PTB, birthweight, or cesarean delivery. Conclusion Greater female representation in county government was associated with improved maternal health for some racial/ethnic groups in Georgia.
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Affiliation(s)
- Kaitlyn K. Stanhope
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Pragati Kapila
- Emory College of Arts and Sciences, Atlanta, Georgia, USA
| | - Afsha Hossain
- Emory College of Arts and Sciences, Atlanta, Georgia, USA
| | - Maha Abu-Salah
- Emory College of Arts and Sciences, Atlanta, Georgia, USA
| | | | - Amal Umerani
- Emory College of Arts and Sciences, Atlanta, Georgia, USA
| | - Sierra Carter
- Department of Psychology, Georgia State Uniersity, Atlanta, Georgia, USA
| | - Sheree Boulet
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, USA
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Phillips-Bell GS, Mohamoud YA, Kirby RS, Parks SE, Cozier YC, Shapiro-Mendoza CK. Neighborhood Deprivation and Privilege: an Examination of Racialized-Economic Segregation and Preterm Birth, Florida 2019. J Racial Ethn Health Disparities 2024; 11:72-80. [PMID: 36652162 PMCID: PMC10352457 DOI: 10.1007/s40615-022-01498-x] [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: 10/03/2022] [Revised: 12/08/2022] [Accepted: 12/15/2022] [Indexed: 01/19/2023]
Abstract
The Black-White disparity in preterm birth persists and is not fully explained by individual-level social, behavioral, or clinical risk factors. Consequently, there is increasing emphasis on understanding the role of structural and area-level factors. Racialized-economic segregation measured as the index of concentration at the extremes (ICE) simultaneously captures extremes of deprivation and privilege. Our objective was to examine associations between preterm birth (PTB) and the index of concentration at the extremes (ICE). In this cross-sectional study, we analyzed 193,957 Florida birth records from 2019 linked to 2015-2019 census tract data from the American Community Survey. We assessed PTB (< 37 weeks gestation) by subtypes: (1) early (< 34 weeks) and late (34-36 weeks) and (2) spontaneous and indicated (i.e., provider-initiated) deliveries. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for three ICE measures: (1) ICE_INC: income, (2) INC_INC + WB: income + race/ethnicity (non-Hispanic White vs. Black), and (3) INC_INC + WH: income + race/ethnicity (non-Hispanic White vs. Hispanic). Results. For ICE_INC and INC_INC + WB, aORs for residing in the worst-off vs. best-off areas were 1.25 (95% CI: 1.12, 1.46) and 1.21 (95% CI: 1.07, 1.37) for early PTB, respectively, and 1.16 (95% CI: 1.05, 1.28) to 1.22 (95% CI: 1.12, 1.34) for indicated PTB. In conclusion, deprivation captured by ICE was associated with increased odds of early or indicated PTB. Eliminating PTB disparities may require a multifaceted approach that includes addressing the interplay between income and race/ethnicity in residential areas.
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Affiliation(s)
- Ghasi S Phillips-Bell
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S-1072, Atlanta, GA, 30341, USA.
| | - Yousra A Mohamoud
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S-1072, Atlanta, GA, 30341, USA
| | - Russell S Kirby
- University of South Florida College of Public Health, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Sharyn E Parks
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S-1072, Atlanta, GA, 30341, USA
| | - Yvette C Cozier
- Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Carrie K Shapiro-Mendoza
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S-1072, Atlanta, GA, 30341, USA
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22
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Wright MA, Giurgescu C, Misra DP, Slaughter-Acey JC, Engeland CG. Neighborhood racial composition and experiences of racial discrimination: Associations with cytokines during pregnancy among African American women. Brain Behav Immun Health 2024; 35:100715. [PMID: 38193096 PMCID: PMC10771980 DOI: 10.1016/j.bbih.2023.100715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 01/10/2024] Open
Abstract
Background Preterm birth rates are consistently higher in African American (AA) pregnancies compared to White pregnancies in the United States. Neighborhood racial composition, experiences of racial discrimination, and systemic inflammation are factors that have been associated with preterm birth and other adverse pregnancy outcomes that may account for these disparities. Here, we investigated whether perceived neighborhood racial composition and experiences of discrimination were predictive of cytokine levels during pregnancy among AA individuals. Methods 545 AA individuals completed surveys and had blood samples collected at prenatal clinics in the Midwest at three timepoints (8-18,19-29, and 30-36 weeks gestation) throughout pregnancy. Pro-inflammatory [interferon (IFN)-γ, interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-α, macrophage migration inhibitory factor (MIF)] and anti-inflammatory cytokines (IL-10) were quantified. Multivariate and multilevel models were used to examine associations of perceived neighborhood racial composition and experiences of racial discrimination with cytokine levels, controlling for relevant covariates. Results Perceived neighborhood racial composition was significantly associated with MIF at 30-36 weeks gestation in multivariate regression (p < 0.001). Living in neighborhoods with more compared to fewer White people was predictive of higher levels of MIF (b = 0.599, SE = 0.12, p < 0.001). Experiences of discrimination were also associated with higher levels of MIF (β = 0.141, SE = 0.07, p = 0.036). Neither predictor was associated with other cytokines. Follow-up analyses revealed that neighborhood racial composition was also predictive of higher MIF levels at 8-18 weeks gestation (p = 0.02) and at 19-29 weeks gestation (p = 0.04). Conclusions Living in neighborhoods with more White individuals and having more lifetime experiences of racial discrimination were positively related to levels of the pro-inflammatory cytokine, MIF, among pregnant AA individuals. MIF's known positive relationships with chronic stress and preterm birth suggest that these elevations in MIF may have negative health consequences. Future studies should explore whether MIF serves as a pathway between neighborhood racial composition or experiences of racial discrimination and preterm birth risk among AA individuals.
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Affiliation(s)
- Molly A. Wright
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Carmen Giurgescu
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Dawn P. Misra
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Jaime C. Slaughter-Acey
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Christopher G. Engeland
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA
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23
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Higgins BV, Baer RJ, Steurer MA, Karvonen KL, Oltman SP, Jelliffe-Pawlowski LL, Rogers EE. Resuscitation, survival and morbidity of extremely preterm infants in California 2011-2019. J Perinatol 2024; 44:209-216. [PMID: 37689808 PMCID: PMC10844092 DOI: 10.1038/s41372-023-01774-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/21/2023] [Accepted: 08/31/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE To describe changes over time in resuscitation, survival, and morbidity of extremely preterm infants in California. STUDY DESIGN This population-based, retrospective cohort study includes infants born ≤28 weeks. Linked birth certificates and hospital discharge records were used to evaluate active resuscitation, survival, and morbidity across two epochs (2011-2014, 2015-2019). RESULTS Of liveborn infants, 0.6% were born ≤28 weeks. Active resuscitation increased from 16.9% of 22-week infants to 98.1% of 25-week infants and increased over time in 22-, 23-, and 25-week infants (p-value ≤ 0.01). Among resuscitated infants, survival to discharge increased from 33.2% at 22 weeks to 96.1% at 28 weeks. Survival without major morbidity improved over time for 28-week infants (p-value < 0.01). CONCLUSION Among infants ≤28 weeks, resuscitation and survival increased with gestational age and morbidity decreased. Over time, active resuscitation of periviable infants and morbidity-free survival of 28-week infants increased. These trends may inform counseling around extremely preterm birth.
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Affiliation(s)
- Brennan V Higgins
- Division of Neonatology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
| | - Rebecca J Baer
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, USA
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Martina A Steurer
- Division of Neonatology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kayla L Karvonen
- Division of Neonatology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Scott P Oltman
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Laura L Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Elizabeth E Rogers
- Division of Neonatology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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24
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Barnett KS, Reece J, Mosley BM, Baek M, Hyder A, Kelleher K, Sealy-Jefferson S, Chisolm DJ. A History Of The Impacts Of Discriminatory Policies On Housing And Maternal And Infant Health In An Ohio Neighborhood. Health Aff (Millwood) 2024; 43:181-189. [PMID: 38315922 PMCID: PMC11328579 DOI: 10.1377/hlthaff.2023.01045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Community-level disinvestment and de facto segregation rooted in decades of discriminatory race-based policies and racism have resulted in unacceptably large infant mortality rates in racial minority neighborhoods across the US. Most community development and housing work, implemented with the goal of addressing health and social inequities, is designed to tackle current challenges in the condition of neighborhoods without a race-conscious lens assessing structural racism and discrimination. Using one historically segregated neighborhood-Linden, in Columbus, Ohio-we detail how state and local policies have affected the neighborhood and shaped neighborhood-level demographics and resources during the past 100 years. We explore how structural racism- and discrimination-informed strategic community reinvestment could provide a solution and yield lasting change.
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Affiliation(s)
- Kierra S Barnett
- Kierra S. Barnett , Nationwide Children's Hospital, Columbus, Ohio
| | - Jason Reece
- Jason Reece, Ohio State University, Columbus, Ohio
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25
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Hicks PM, Simmons K, Newman-Casey PA, Woodward MA, Elam AR. Spatial Vision Inequalities: A Literature Review of the Impact of Place on Vision and Eye Health Outcomes. Transl Vis Sci Technol 2024; 13:22. [PMID: 38285463 PMCID: PMC10829826 DOI: 10.1167/tvst.13.1.22] [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: 06/30/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
"Neighborhood and built environment" is one of the five domains of social determinants of health that has been outlined by Healthy People 2030, and this domain impacts an individual's well-being, health, and quality of life. Social risk factors (SRFs) in the neighborhood and built environment domain include unstable or unsafe housing, poor access to transportation, lack of green spaces, pollution, safety concerns, and neighborhood measures of inequity. In this narrative literature review, we assess the relationship between neighborhood and built environment SRFs and eye health and vision outcomes. We explain how mapping neighborhood-level SRFs may be used to advance health equity in the field of eye health and vision care.
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Affiliation(s)
- Patrice M. Hicks
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Kirsten Simmons
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Maria A. Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Angela R. Elam
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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26
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Hatzenbuehler ML, McLaughlin KA, Weissman DG, Cikara M. A research agenda for understanding how social inequality is linked to brain structure and function. Nat Hum Behav 2024; 8:20-31. [PMID: 38172629 PMCID: PMC11112523 DOI: 10.1038/s41562-023-01774-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/01/2023] [Indexed: 01/05/2024]
Abstract
Consistent evidence documents powerful effects of social inequality on health, well-being and academic achievement. Yet research on whether social inequality may also be linked to brain structure and function has, until recently, been rare. Here we describe three methodological approaches that can be used to study this question-single site, single study; multi-site, single study; and spatial meta-analysis. We review empirical work that, using these approaches, has observed associations between neural outcomes and structural measures of social inequality-including structural stigma, community-level prejudice, gender inequality, neighbourhood disadvantage and the generosity of the social safety net for low-income families. We evaluate the relative strengths and limitations of these approaches, discuss ethical considerations and outline directions for future research. In doing so, we advocate for a paradigm shift in cognitive neuroscience that explicitly incorporates upstream structural and contextual factors, which we argue holds promise for uncovering the neural correlates of social inequality.
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Affiliation(s)
| | | | - David G Weissman
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Mina Cikara
- Department of Psychology, Harvard University, Cambridge, MA, USA
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27
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Bather JR, Furr-Holden D, Ramirez-Valles J, Goodman MS. Unpacking Public Health Implications of the 2023 Supreme Court Ruling on Race-Conscious Admissions. HEALTH EDUCATION & BEHAVIOR 2023; 50:713-717. [PMID: 37667626 DOI: 10.1177/10901981231198785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
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28
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Welch BM, Keil AP, Buckley JP, Engel SM, James-Todd T, Zota AR, Alshawabkeh AN, Barrett ES, Bloom MS, Bush NR, Cordero JF, Dabelea D, Eskenazi B, Lanphear BP, Padmanabhan V, Sathyanarayana S, Swan SH, Aalborg J, Baird DD, Binder AM, Bradman A, Braun JM, Calafat AM, Cantonwine DE, Christenbury KE, Factor-Litvak P, Harley KG, Hauser R, Herbstman JB, Hertz-Picciotto I, Holland N, Jukic AMZ, McElrath TF, Meeker JD, Messerlian C, Michels KB, Newman RB, Nguyen RH, O’Brien KM, Rauh VA, Redmon B, Rich DQ, Rosen EM, Schmidt RJ, Sparks AE, Starling AP, Wang C, Watkins DJ, Weinberg CR, Weinberger B, Wenzel AG, Wilcox AJ, Yolton K, Zhang Y, Ferguson KK. Racial and Ethnic Disparities in Phthalate Exposure and Preterm Birth: A Pooled Study of Sixteen U.S. Cohorts. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:127015. [PMID: 38117586 PMCID: PMC10732302 DOI: 10.1289/ehp12831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 11/17/2023] [Accepted: 11/27/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Phthalate exposures are ubiquitous during pregnancy and may contribute to racial and ethnic disparities in preterm birth. OBJECTIVES We investigated race and ethnicity in the relationship between biomarkers of phthalate exposure and preterm birth by examining: a) how hypothetical reductions in racial and ethnic disparities in phthalate metabolites might reduce the probability of preterm birth; and b) exposure-response models stratified by race and ethnicity. METHODS We pooled individual-level data on 6,045 pregnancies from 16 U.S. cohorts. We investigated covariate-adjusted differences in nine urinary phthalate metabolite concentrations by race and ethnicity [non-Hispanic White (White, 43%), non-Hispanic Black (Black, 13%), Hispanic/Latina (38%), and Asian/Pacific Islander (3%)]. Using g-computation, we estimated changes in the probability of preterm birth under hypothetical interventions to eliminate disparities in levels of urinary phthalate metabolites by proportionally lowering average concentrations in Black and Hispanic/Latina participants to be approximately equal to the averages in White participants. We also used race and ethnicity-stratified logistic regression to characterize associations between phthalate metabolites and preterm birth. RESULTS In comparison with concentrations among White participants, adjusted mean phthalate metabolite concentrations were consistently higher among Black and Hispanic/Latina participants by 23%-148% and 4%-94%, respectively. Asian/Pacific Islander participants had metabolite levels that were similar to those of White participants. Hypothetical interventions to reduce disparities in metabolite mixtures were associated with lower probabilities of preterm birth for Black [13% relative reduction; 95% confidence interval (CI): - 34 % , 8.6%] and Hispanic/Latina (9% relative reduction; 95% CI: - 19 % , 0.8%) participants. Odds ratios for preterm birth in association with phthalate metabolites demonstrated heterogeneity by race and ethnicity for two individual metabolites (mono-n-butyl and monoisobutyl phthalate), with positive associations that were larger in magnitude observed among Black or Hispanic/Latina participants. CONCLUSIONS Phthalate metabolite concentrations differed substantially by race and ethnicity. Our results show hypothetical interventions to reduce population-level racial and ethnic disparities in biomarkers of phthalate exposure could potentially reduce the probability of preterm birth. https://doi.org/10.1289/EHP12831.
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Affiliation(s)
- Barrett M. Welch
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
- University of Nevada, Reno, Reno, Nevada, USA
| | | | - Jessie P. Buckley
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stephanie M. Engel
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tamarra James-Todd
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Ami R. Zota
- Columbia University Mailman School of Public Health, Columbia University, New York, New York, USA
| | | | - Emily S. Barrett
- Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | | | - Nicole R. Bush
- University of California, San Francisco, San Francisco, California, USA
| | | | - Dana Dabelea
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Brenda Eskenazi
- Center for Environmental Research and Community Health (CERCH), University of California, Berkeley, Berkeley, California, USA
| | | | | | - Sheela Sathyanarayana
- Seattle Children’s Research Institute, University of Washington, Seattle, Washington, USA
| | - Shanna H. Swan
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jenny Aalborg
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Donna D. Baird
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | | | - Asa Bradman
- University of California, Merced, Merced, California, USA
| | | | - Antonia M. Calafat
- National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Kate E. Christenbury
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, North Carolina, USA
| | - Pam Factor-Litvak
- Columbia University Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Kim G. Harley
- Center for Environmental Research and Community Health (CERCH), University of California, Berkeley, Berkeley, California, USA
| | - Russ Hauser
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Julie B. Herbstman
- Columbia University Mailman School of Public Health, Columbia University, New York, New York, USA
| | | | - Nina Holland
- Center for Environmental Research and Community Health (CERCH), University of California, Berkeley, Berkeley, California, USA
| | - Anne Marie Z. Jukic
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | | | - John D. Meeker
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Carmen Messerlian
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Karin B. Michels
- University of California, Los Angeles, Los Angeles, California, USA
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Roger B. Newman
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ruby H.N. Nguyen
- University of Minnesota, School of Public Health, Minneapolis, Minnesota, USA
| | - Katie M. O’Brien
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Virginia A. Rauh
- Columbia University Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Bruce Redmon
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - David Q. Rich
- University of Rochester Medical Center, Rochester, New York, USA
| | - Emma M. Rosen
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Anne P. Starling
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christina Wang
- The Lundquist Institute at Harbor, UCLA Medical Center, West Carson, California, USA
| | - Deborah J. Watkins
- School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Clarice R. Weinberg
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Barry Weinberger
- Cohen Children’s Medical Center of New York, Northwell Health, Queens, New York, USA
| | - Abby G. Wenzel
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Allen J. Wilcox
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| | - Kimberly Yolton
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Yu Zhang
- Harvard TH Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Kelly K. Ferguson
- National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
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29
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Kong AY, Herbert L, Feldman JM, Trangenstein PJ, Fakunle DO, Lee JGL. Tobacco and Alcohol Retailer Availability and Neighborhood Racialized, Economic, and Racialized Economic Segregation in North Carolina. J Racial Ethn Health Disparities 2023; 10:2861-2871. [PMID: 36469288 DOI: 10.1007/s40615-022-01463-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite evidence of racialized and socioeconomic inequities in tobacco and alcohol outlet availability, few studies have investigated spatial inequities in areas experiencing both concentrated residential racialized segregation and socioeconomic disadvantage. This study examined whether segregation-racialized, economic or both-was associated with alcohol and tobacco retailer counts in North Carolina (NC). METHODS The NC Alcoholic Beverage Control Commission provided lists of 2021 off-premise alcohol retailers. We created a list of 2018 probable tobacco retailers using ReferenceUSA. We calculated three census tract-level measures of the Index of Concentrations at the Extremes (ICE), indicating racialized segregation between non-Hispanic White and Black residents and economic segregation based on household income. We used negative binomial regression to test associations between quintiles of each ICE measure and tobacco and, separately, alcohol retailer counts. RESULTS Tracts with the greatest racialized disadvantage had 38% (IRR, 1.38; 95% CI, 1.15-1.66) and 65% (IRR, 1.65; 95% CI, 1.34-2.04) more tobacco and alcohol outlets, respectively, as tracts with the lowest. Tracts with the highest racialized economic disadvantage had a predicted count of 1.51 tobacco outlets per 1000 people while those in the lowest had nearly one fewer predicted outlet. Similar inequities existed in the predicted count of alcohol outlets. DISCUSSION Tobacco and alcohol outlet availability are higher in NC places experiencing concentrated racialized and economic segregation. A centralized agency overseeing tobacco and alcohol outlet permits and strategies to reduce the retail availability of these harmful products (e.g., capping the number of permits) are needed to intervene upon these inequities.
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Affiliation(s)
- Amanda Y Kong
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Lily Herbert
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - David O Fakunle
- Public Health Program, Morgan State University School of Community Health & Policy, Baltimore, MD, USA
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30
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Dunlop AL, Burjak M, Dean LT, Alshawabkeh AN, Avalos LA, Aschner JL, Breton CV, Charifson MA, Cordero J, Dabelea D, D’Sa V, Duarte CS, Elliott AJ, Eick SM, Ferrara A, Fichorova RN, Ganiban JM, Gern JE, Hedderson MM, Herbstman JB, Hipwell AE, Huddleston KC, Karagas M, Karr C, Kerver JM, Koinis-Mitchell D, Lyall K, Madan J, Marsit C, McEvoy CT, Meeker JD, Oken E, O’Shea TM, Padula AM, Sathyanarayana S, Schantz S, Schmidt RJ, Snowden J, Stanford JB, Weiss S, Wright RO, Wright RJ, Zhang X, McGrath M. Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts. Front Public Health 2023; 11:1165089. [PMID: 38098826 PMCID: PMC10719953 DOI: 10.3389/fpubh.2023.1165089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/13/2023] [Indexed: 12/17/2023] Open
Abstract
Background In the United States, disparities in gestational age at birth by maternal race, ethnicity, and geography are theorized to be related, in part, to differences in individual- and neighborhood-level socioeconomic status (SES). Yet, few studies have examined their combined effects or whether associations vary by maternal race and ethnicity and United States Census region. Methods We assembled data from 34 cohorts in the Environmental influences on Child Health Outcomes (ECHO) program representing 10,304 participants who delivered a liveborn, singleton infant from 2000 through 2019. We investigated the combined associations of maternal education level, neighborhood deprivation index (NDI), and Index of Concentration at the Extremes for racial residential segregation (ICERace) on gestational weeks at birth using linear regression and on gestational age at birth categories (preterm, early term, post-late term relative to full term) using multinomial logistic regression. Results After adjustment for NDI and ICERace, gestational weeks at birth was significantly lower among those with a high school diploma or less (-0.31 weeks, 95% CI: -0.44, -0.18), and some college (-0.30 weeks, 95% CI: -0.42, -0.18) relative to a master's degree or higher. Those with a high school diploma or less also had an increased odds of preterm (aOR 1.59, 95% CI: 1.20, 2.10) and early term birth (aOR 1.26, 95% CI: 1.05, 1.51). In adjusted models, NDI quartile and ICERace quartile were not associated with gestational weeks at birth. However, higher NDI quartile (most deprived) associated with an increased odds of early term and late term birth, and lower ICERace quartile (least racially privileged) associated with a decreased odds of late or post-term birth. When stratifying by region, gestational weeks at birth was lower among those with a high school education or less and some college only among those living in the Northeast or Midwest. When stratifying by race and ethnicity, gestational weeks at birth was lower among those with a high school education or less only for the non-Hispanic White category. Conclusion In this study, maternal education was consistently associated with shorter duration of pregnancy and increased odds of preterm birth, including in models adjusted for NDI and ICERace.
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Affiliation(s)
- Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Mohamad Burjak
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lorraine T. Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Akram N. Alshawabkeh
- Department of Civil and Environmental Engineering, College of Engineering, Northeastern University, Boston, MA, United States
| | - Lyndsay A. Avalos
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Judy L. Aschner
- Albert Einstein College of Medicine, Bronx, NY, United States
- Hackensack Meridian School of Medicine, Nutley, NJ, United States
| | - Carrie V. Breton
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States
| | - Mia A. Charifson
- Division of Epidemiology, New York University Langone Health Grossman School of Medicine, New York, NY, United States
| | - Jose Cordero
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, GA, United States
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Viren D’Sa
- Department of Pediatrics, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Cristiane S. Duarte
- Division of Child and Adolescent Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY, United States
| | - Amy J. Elliott
- Avera Research Institute, Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Stephanie M. Eick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Raina N. Fichorova
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Jody M. Ganiban
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, United States
| | - James E. Gern
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Monique M. Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Julie B. Herbstman
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kathi C. Huddleston
- College of Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Margaret Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Catherine Karr
- Departments of Pediatrics and Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Jean M. Kerver
- Departments of Epidemiology and Biostatistics and Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Daphne Koinis-Mitchell
- Department of Pediatrics, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Kristen Lyall
- AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, United States
| | - Juliette Madan
- Department of Epidemiology, Pediatrics and Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Carmen Marsit
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Cindy T. McEvoy
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, United States
| | - John D. Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Amy M. Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Sheela Sathyanarayana
- Departments of Pediatrics and Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Susan Schantz
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Rebecca J. Schmidt
- Department of Public Health Sciences, MIND Institute, University of California, Davis, Davis, CA, United States
| | - Jessica Snowden
- Departments of Pediatrics and Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Joseph B. Stanford
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Scott Weiss
- Department of Medicine, Harvard School of Medicine, Boston, MA, United States
| | - Robert O. Wright
- Department of Pediatrics, The Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Rosalind J. Wright
- Department of Pediatrics, The Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Xueying Zhang
- Department of Pediatrics, The Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Monica McGrath
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Sofaer S, Glazer KB, Balbierz A, Kheyfets A, Zeitlin J, Howell EA. Characteristics of High Versus Low-Performing Hospitals for Very Preterm Infant Morbidity and Mortality. THE JOURNAL OF PEDIATRICS: X 2023; 10:100094. [PMID: 38186750 PMCID: PMC10769867 DOI: 10.1016/j.ympdx.2023.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/13/2023] [Accepted: 11/26/2023] [Indexed: 01/09/2024] Open
Abstract
Objective To ascertain organizational attributes, policies, and practices that differentiate hospitals with high versus low risk-adjusted rates of very preterm neonatal morbidity and mortality (NMM). Methods Using a positive deviance research framework, we conducted qualitative interviews of hospital leadership and frontline clinicians from September-October 2018 in 4 high-performing and 4 low-performing hospitals in New York City, based on NMM measured in previous research. Key interview topics included NICU physician and nurse staffing, professional development, standardization of care, quality measurement and improvement, and efforts to measure and report on racial/ethnic disparities in care and outcomes for very preterm infants. Interviews were audiotaped, professionally transcribed, and coded using NVivo software. In qualitative content analysis, researchers blinded to hospital performance identified emergent themes, highlighted illustrative quotes, and drew qualitative comparisons between hospital clusters. Results The following features distinguished high-performing facilities: 1) stronger commitment from hospital leadership to diversity, quality, and equity; 2) better access to specialist physicians and experienced nursing staff; 3) inclusion of nurses in developing clinical policies and protocols, and 4) acknowledgement of the influence of racism and bias in healthcare on racial-ethnic disparities. In both clusters, areas for improvement included comprehensive family engagement strategies, care standardization, and reporting of quality data by patient sociodemographic characteristics. Conclusions and relevance Our findings suggest specific organizational and cultural characteristics, from hospital leadership and clinician perspectives, that may yield better patient outcomes, and demonstrate the utility of a positive deviance framework to center equity in quality initiatives for high-risk infant care.
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Affiliation(s)
| | - Kimberly B. Glazer
- Department of Population Health Science and Policy, Blavatnik Family Women's Health Research Institute, The Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amy Balbierz
- New York University Grossman School of Medicine, New York, NY
| | - Anna Kheyfets
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, Inrae, Paris, France
| | - Elizabeth A. Howell
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Valentino K, Zhen-Duan J, Padilla J, Bernard D. Intergenerational Continuity of Child Maltreatment, Parenting, and Racism: Commentary on Valentino et al., (2012). CHILD MALTREATMENT 2023; 28:556-562. [PMID: 37491779 PMCID: PMC10543487 DOI: 10.1177/10775595231191395] [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: 07/27/2023]
Abstract
Recent editorials published in Child Maltreatment bring much needed attention to racism in child maltreatment reporting and investigation. In this commentary, we extend these efforts by responding to Valentino et al., (2012) and addressing prior omissions in our race-related work by explicitly discussing the role of racism in our explanation of key study findings. Together with scholars with expertise in the impact of racism on children and families, this commentary (a) discusses theoretical models of child maltreatment and of the influence of racism on parenting and child development; (b) discusses parental responses to racism in relation to the Valentino et al., (2012) findings; and (c) highlights future research directions.
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Affiliation(s)
- Kristin Valentino
- Department of Psychology, University of Notre Dame, Notre
Dame, IN, USA
| | - Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital,
Boston, MA, USA
| | - Jenny Padilla
- Department of Psychology, University of Notre Dame, Notre
Dame, IN, USA
| | - Donte Bernard
- Department of Psychological Sciences, University of
Missouri, Columbia, MO, USA
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33
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Gao X, Berkowitz RL, Michaels EK, Mujahid MS. Traveling Together: A Road Map for Researching Neighborhood Effects on Population Health and Health Inequities. Am J Epidemiol 2023; 192:1731-1742. [PMID: 37246316 DOI: 10.1093/aje/kwad129] [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: 10/01/2022] [Revised: 04/12/2023] [Accepted: 05/24/2023] [Indexed: 05/30/2023] Open
Abstract
As evidence of the relationship between place and health mounts, more epidemiologists and clinical science researchers are becoming interested in incorporating place-based measures and analyses into their examination of population health and health inequities. Given the extensive literature on place and health, it can be challenging for researchers new to this area to develop neighborhood-effects research questions and apply the appropriate measures and methods. This paper provides a road map for guiding health researchers through the conceptual and methodological stages of incorporating various dimensions of place into their quantitative health research. Synthesizing across reviews, commentaries, and empirical investigations, the road map consists of 4 broad stages for considering place and health: 1) why?: articulating the motivation for assessing place and health and grounding the motivation in theory; 2) what?: identifying the relevant place-based characteristics and specifying their link to health to build a conceptual framework; 3) how?: determining how to operationalize the conceptual framework by defining, measuring, and assessing place-based characteristics and quantifying their effect on health; and 4) now what?: discussing the implications of neighborhood research findings for future research, policy, and practice. This road map supports efforts to develop conceptually and analytically rigorous neighborhood research projects.
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Oka M. Neighborhood-level Residential Isolation and Neighborhood Composition: Similar but Different. J Urban Health 2023; 100:987-1006. [PMID: 37581710 PMCID: PMC10618146 DOI: 10.1007/s11524-023-00750-x] [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] [Accepted: 06/06/2023] [Indexed: 08/16/2023]
Abstract
Residential segregation has been considered as a potential cause of racial and/or ethnic disparities in health. Among the five dimensions of residential segregation, the isolation dimension has been conceived to play an essential role in disproportionately shaping the health of racial and ethnic minorities, particularly in urban or metropolitan areas. However, a noticeable amount of research studies has been using informal measures of neighborhood composition (i.e., proportions or percentages), which do not capture any of the five dimensions of residential segregation. Since the inappropriateness of measurement may obstruct a meaningful interpretation and an effective dissemination of research findings, a combination of graphical and non-graphical techniques was used to demonstrate the similarities and differences between formal measures of neighborhood-level residential isolation and informal measures of neighborhood composition. These were intended to provide intuitive and mutual understandings across academic disciples (e.g., city or urban planning, geography, public health, and sociology) and practitioners or professionals in multiple fields (e.g., community development workers, health service providers, policymakers, and social workers). Conceptual and methodological explanations with analytical discussions are also provided to differentiate and/or distinguish the two types of measures. While the concepts, methodologies, and research implications discussed herein are most relevant for research studies in urban or metropolitan areas of the United States, the general framework is also applicable to those of other industrialized counties.
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Affiliation(s)
- Masayoshi Oka
- Department of Management, Faculty of Management, Josai University, 1-1 Keyakidai, Sakado City, Saitama Prefecture, 350-0295, Japan.
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Karvonen KL, Anunwah E, Chambers Butcher BD, Kwarteng L, Mathis-Perry T, McLemore MR, Oh S, Pantell MS, Smith O, Rogers E. Structural Racism Operationalized via Adverse Social Events in a Single-Center Neonatal Intensive Care Unit. J Pediatr 2023; 260:113499. [PMID: 37211208 DOI: 10.1016/j.jpeds.2023.113499] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To evaluate structural racism in the neonatal intensive care unit (NICU) by determining if differences in adverse social events occur by racialized groups. STUDY DESIGN Retrospective cohort study of 3290 infants hospitalized in a single center NICU between 2017 and 2019 in the Racial and Ethnic Justice in Outcomes in Neonatal Intensive Care (REJOICE) study. Demographics and adverse social events including infant urine toxicology screening, child protective services (CPS) referrals, behavioral contracts, and security emergency response calls were collected from electronic medical records. Logistic regression models were fit to test the association of race/ethnicity and adverse social events, adjusting for length of stay. Racial/ethnic groups were compared with a White referent group. RESULTS There were 205 families (6.2%) that experienced an adverse social event. Black families were more likely to have experienced a CPS referral and a urine toxicology screen (OR, 3.6; 95% CI, 2.2-6.1 and OR, 2.2; 95% CI, 1.4-3.5). American Indian and Alaskan Native families were also more likely to experience CPS referrals and urine toxicology screens (OR, 15.8; 95% CI, 6.9-36.0 an OR, 7.6; 95% CI, 3.4-17.2). Black families were more likely to experience behavioral contracts and security emergency response calls. Latinx families had a similar risk of adverse events, and Asian families were less likely to experience adverse events. CONCLUSIONS We found racial inequities in adverse social events in a single-center NICU. Investigation of generalizability is necessary to develop widespread strategies to address institutional and societal structural racism and to prevent adverse social events.
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Affiliation(s)
- Kayla L Karvonen
- Department of Pediatrics, University of California San Francisco, San Francisco, CA; California Preterm Birth Initiative, San Francisco, CA.
| | - Erica Anunwah
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Brittany D Chambers Butcher
- California Preterm Birth Initiative, San Francisco, CA; Department of Human Ecology, University of California Davis, Sacramento, CA
| | - Lydia Kwarteng
- University of California San Francisco School of Medicine, San Francisco, CA
| | | | - Monica R McLemore
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA
| | - Sally Oh
- University of California San Francisco School of Medicine, San Francisco, CA
| | - Matthew S Pantell
- Department of Pediatrics, University of California San Francisco, San Francisco, CA; California Preterm Birth Initiative, San Francisco, CA
| | - Olga Smith
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA
| | - Elizabeth Rogers
- Department of Pediatrics, University of California San Francisco, San Francisco, CA; California Preterm Birth Initiative, San Francisco, CA
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MacKinnon NJ, Emery V, Waller J, Ange B, Ambade P, Gunja M, Watson E. Mapping Health Disparities in 11 High-Income Nations. JAMA Netw Open 2023; 6:e2322310. [PMID: 37418259 PMCID: PMC10329207 DOI: 10.1001/jamanetworkopen.2023.22310] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/21/2023] [Indexed: 07/08/2023] Open
Abstract
Importance Health care delivery faces a myriad of challenges globally with well-documented health inequities based on geographic location. Yet, researchers and policy makers have a limited understanding of the frequency of geographic health disparities. Objective To describe geographic health disparities in 11 high-income countries. Design, Setting, and Participants In this survey study, we analyzed results from the 2020 Commonwealth Fund International Health Policy (IHP) Survey-a nationally representative, self-reported, and cross-sectional survey of adults from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK, and the US. Eligible adults older than age 18 years were included by random sampling. Survey data were compared for the association of area type (rural or urban) with 10 health indicators across 3 domains: health status and socioeconomic risk factors, affordability of care, and access to care. Logistic regression was used to determine the associations between countries with area type for each factor, controlling for individuals' age and sex. Main Outcomes and Measures The main outcomes were geographic health disparities as measured by differences in respondents living in urban and rural settings in 10 health indicators across 3 domains. Results There were 22 402 survey respondents (12 804 female [57.2%]), with a 14% to 49% response rate depending on the country. Across the 11 countries and 10 health indicators and 3 domains (health status and socioeconomic risk factors, affordability of care, access to care), there were 21 occurrences of geographic health disparities; 13 of those in which rural residence was a protective factor and 8 of those where rural residence was a risk factor. The mean (SD) number of geographic health disparities in the countries was 1.9 (1.7). The US had statistically significant geographic health disparities in 5 of 10 indicators, the most of any country, while Canada, Norway, and the Netherlands had no statistically significant geographic health disparities. The indicators with the most occurrences of geographic health disparities were in the access to care domain. Conclusions and Relevance In this survey study of 11 high-income nations, health disparities across 10 indicators were identified. Differences in number of disparities reported by country suggest that health policy and decision makers in the US should look to Canada, Norway, and the Netherlands to improve geographic-based health equity.
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Affiliation(s)
- Neil J. MacKinnon
- Department of Population Health Sciences, Augusta University, Augusta, Georgia
| | - Vanessa Emery
- Office of the Provost and Institute of Public and Preventive Health, Augusta University, Augusta, Georgia
| | - Jennifer Waller
- Department of Population Health Sciences, Augusta University, Augusta, Georgia
| | - Brittany Ange
- Department of Population Health Sciences, Augusta University, Augusta, Georgia
| | - Preshit Ambade
- Department of Population Health Sciences, Augusta University, Augusta, Georgia
| | - Munira Gunja
- International Program in Health Policy and Practice Innovations, Commonwealth Fund, New York, New York
| | - Emma Watson
- National Health Service Education for Scotland, Edinburgh, Scotland
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Ogunwole SM, Oguntade HA, Bower KM, Cooper LA, Bennett WL. Health Experiences of African American Mothers, Wellness in the Postpartum Period and Beyond (HEAL): A Qualitative Study Applying a Critical Race Feminist Theoretical Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6283. [PMID: 37444130 PMCID: PMC10341853 DOI: 10.3390/ijerph20136283] [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: 04/01/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023]
Abstract
The objective of this study is to explore the cultural, social, and historical factors that affect postpartum primary care utilization among Black women with cardiometabolic risk factors and to identify the needs, barriers, and facilitators that are associated with it. We conducted in-depth interviews of 18 Black women with one or more cardiometabolic complications (pre-pregnancy chronic hypertension, diabetes, obesity, preeclampsia, or gestational diabetes) within one year of delivery. We recruited women from three early home-visiting programs in Baltimore, Maryland, between May 2020 and June 2021. We used Critical Race Feminism theory and a behavioral model for healthcare utilization as an analytical lens to develop a codebook and code interview transcripts. We identified and summarized emergent patterns and themes using textual and thematic analysis. We categorized our findings into six main themes: (1) The enduring influence of structural racism, (2) personally mediated racism in healthcare and beyond, (3) sociocultural beliefs about preventative healthcare, (4) barriers to postpartum care transitions, such as education and multidisciplinary communication, (5) facilitators of postpartum care transitions, such as patient-provider relationships and continuity of care, and (6) postpartum health and healthcare needs, such as mental health and social support. Critical race feminism provides a valuable lens for exploring drivers of postpartum primary care utilization while considering the intersectional experiences of Black women.
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Affiliation(s)
- S. Michelle Ogunwole
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Johns Hopkins Center for Health Equity, Baltimore, MD 21287, USA
| | - Habibat A. Oguntade
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA
| | - Kelly M. Bower
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Lisa A. Cooper
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Johns Hopkins Center for Health Equity, Baltimore, MD 21287, USA
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Wendy L. Bennett
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Gao X, Snowden JM, Tucker CM, Allen A, Morello-Frosch R, Abrams B, Carmichael SL, Mujahid MS. Remapping racial and ethnic inequities in severe maternal morbidity: The legacy of redlining in California. Paediatr Perinat Epidemiol 2023; 37:379-389. [PMID: 36420897 PMCID: PMC10373920 DOI: 10.1111/ppe.12935] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/20/2022] [Accepted: 10/22/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Historical mortgage redlining, a racially discriminatory policy designed to uphold structural racism, may have played a role in producing the persistently elevated rate of severe maternal morbidity (SMM) among racialised birthing people. OBJECTIVE This study examined associations between Home-Owner Loan Corporation (HOLC) redlining grades and SMM in a racially and ethnically diverse birth cohort in California. METHODS We leveraged a population-based cohort of all live hospital births at ≥20 weeks of gestation between 1997 and 2017 in California. SMM was defined as having one of 21 procedures and diagnoses, per an index developed by Centers for Disease Control and Prevention. We characterised census tract-level redlining using HOLC's security maps for eight California cities. We assessed bivariate associations between HOLC grades and participant characteristics. Race and ethnicity-stratified mixed effects logistic regression models assessed the risk of SMM associated with HOLC grades within non-Hispanic Black, Asian/Pacific Islander, American Indian/Alaskan Native and Hispanic groups, adjusting for sociodemographic information, pregnancy-related factors, co-morbidities and neighbourhood deprivation index. RESULTS The study sample included 2,020,194 births, with 24,579 cases of SMM (1.2%). Living in a census tract that was graded as "Hazardous," compared to census tracts graded "Best" and "Still Desirable," was associated with 1.15 (95% confidence interval [CI] 1.03, 1.29) and 1.17 (95% CI 1.09, 1.25) times the risk of SMM among Black and Hispanic birthing people, respectively, independent of sociodemographic factors. These associations persisted after adjusting for pregnancy-related factors and neighbourhood deprivation index. CONCLUSIONS Historical redlining, a tool of structural racism that influenced the trajectory of neighbourhood social and material conditions, is associated with increased risk of experiencing SMM among Black and Hispanic birthing people in California. These findings demonstrate that addressing the enduring impact of macro-level and systemic mechanisms that uphold structural racism is a vital step in achieving racial and ethnic equity in birthing people's health.
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Affiliation(s)
- Xing Gao
- Division of Epidemiology, School of Public Health, University of California Berkeley, California, Berkeley, USA
| | - Jonathan M. Snowden
- Division of Epidemiology, School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon, USA
| | - Curisa M. Tucker
- Division of Neonatal & Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Amani Allen
- Division of Epidemiology, School of Public Health, University of California Berkeley, California, Berkeley, USA
- Division of Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Rachel Morello-Frosch
- Division of Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, California, USA
- Division of Environmental Health Sciences, University of California Berkeley, Berkeley, California, USA
- Department of Environmental Science, Policy and Management, University of California Berkeley, Berkeley, California, USA
| | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California Berkeley, California, Berkeley, USA
- Division of Maternal Child and Adolescent Health, School of Public Health, University of California Berkeley, Berkeley, California, USA
- Division of Public Health Nutrition, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Suzan L. Carmichael
- Division of Neonatal & Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California, USA
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford University, Stanford, California, USA
| | - Mahasin S. Mujahid
- Division of Epidemiology, School of Public Health, University of California Berkeley, California, Berkeley, USA
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Ivey Henry P, Spence Beaulieu MR, Bradford A, Graves JL. Embedded racism: Inequitable niche construction as a neglected evolutionary process affecting health. Evol Med Public Health 2023; 11:112-125. [PMID: 37197590 PMCID: PMC10184440 DOI: 10.1093/emph/eoad007] [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: 10/10/2022] [Revised: 04/11/2023] [Indexed: 05/19/2023] Open
Abstract
Racial health disparities are a pervasive feature of modern experience and structural racism is increasingly recognized as a public health crisis. Yet evolutionary medicine has not adequately addressed the racialization of health and disease, particularly the systematic embedding of social biases in biological processes leading to disparate health outcomes delineated by socially defined race. In contrast to the sheer dominance of medical publications which still assume genetic 'race' and omit mention of its social construction, we present an alternative biological framework of racialized health. We explore the unifying evolutionary-ecological principle of niche construction as it offers critical insights on internal and external biological and behavioral feedback processes environments at every level of the organization. We Integrate insights of niche construction theory in the context of human evolutionary and social history and phenotype-genotype modification, exposing the extent to which racism is an evolutionary mismatch underlying inequitable disparities in disease. We then apply ecological models of niche exclusion and exploitation to institutional and interpersonal racial constructions of population and individual health and demonstrate how discriminatory processes of health and harm apply to evolutionarily relevant disease classes and life-history processes in which socially defined race is poorly understood and evaluated. Ultimately, we call for evolutionary and biomedical scholars to recognize the salience of racism as a pathogenic process biasing health outcomes studied across disciplines and to redress the neglect of focus on research and application related to this crucial issue.
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Affiliation(s)
- Paula Ivey Henry
- Department of Social and Behavioral Sciences, T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Angelle Bradford
- Department of Physiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Joseph L Graves
- Department of Biology, North Carolina A&T State University, Greensboro, NC, USA
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Vilda D, Walker BC, Hardeman RR, Wallace ME. Associations Between State and Local Government Spending and Pregnancy-Related Mortality in the U.S. Am J Prev Med 2023; 64:459-467. [PMID: 36658021 PMCID: PMC10033388 DOI: 10.1016/j.amepre.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/20/2022] [Accepted: 10/27/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION There is limited evidence on how government spending is associated with maternal death. This study investigates the associations between state and local government spending on social and healthcare services and pregnancy-related mortality among the total, non-Hispanic Black, Hispanic, and non-Hispanic White populations. METHODS State-specific total population and race/ethnicity-specific 5-year (2015-2019) pregnancy-related mortality ratios were estimated from annual natality and mortality files provided by the National Center for Health Statistics. Data on state and local government spending and population-level characteristics were obtained from U.S. Census Bureau surveys. Generalized linear Poisson regression models with robust SEs were fitted to estimate adjusted rate ratios and 95% CIs associated with proportions of total spending allocated to social services and healthcare domains, adjusting for state-level covariates. All analyses were completed in 2021-2022. RESULTS State and local government spending on transportation was associated with 11% lower overall pregnancy-related mortality (adjusted rate ratio=0.89, 95% CI=0.83, 0.96) and 9%-12% lower pregnancy-related mortality among the racial/ethnic groups. Among spending subdomains, expenditures on higher education, highways and roads, and parks and recreation were associated with lower pregnancy-related mortality rates in the total population (adjusted rate ratio=0.90, 95% CI=0.86, 0.94; adjusted rate ratio=0.87, 95% CI=0.81, 0.94; and adjusted rate ratio=0.68, 95% CI=0.49, 0.95, respectively). These results were consistent among the racial/ethnic groups, but patterns of associations with pregnancy-related mortality and other spending subdomains differed notably between racial/ethnic groups. CONCLUSIONS Investing more in local- and state-targeted spending in social services may decrease the risk for pregnancy-related mortality, particularly among Black women.
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Affiliation(s)
- Dovile Vilda
- Mary Amelia Center for Women's Health Equity Research, Tulane University, New Orleans, Louisiana; Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health & Tropical Medicine, New Orleans, Louisiana.
| | - Brigham C Walker
- Department of Health Policy and Management, Tulane University School of Public Health & Tropical Medicine, New Orleans, Louisiana
| | - Rachel R Hardeman
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Maeve E Wallace
- Mary Amelia Center for Women's Health Equity Research, Tulane University, New Orleans, Louisiana; Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health & Tropical Medicine, New Orleans, Louisiana
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Smith MA, Steurer MA, Mahendra M, Zinter MS, Keller RL. Sociodemographic factors associated with tracheostomy and mortality in bronchopulmonary dysplasia. Pediatr Pulmonol 2023; 58:1237-1246. [PMID: 36700394 PMCID: PMC10122507 DOI: 10.1002/ppul.26328] [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: 11/30/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVES We sought to investigate how race, ethnicity, and socioeconomic status relate to tracheostomy insertion and post-tracheostomy mortality among infants with bronchopulmonary dysplasia (BPD). METHODS The Vizient Clinical Database/Resource Manager was queried to identify infants born ≤32 weeks with BPD admitted to US hospitals from January 2012 to December 2020. Markers of socioeconomic status were linked to patient records from the Agency for Healthcare Research and Quality's Social Determinants of Health Database. Regression models were used to assess trends in annual tracheostomy insertion rate and odds of tracheostomy insertion and post-tracheostomy mortality, adjusting for sociodemographic and clinical factors. RESULTS There were 40,021 ex-premature infants included in the study, 1614 (4.0%) of whom received a tracheostomy. Tracheostomy insertion increased from 2012 to 2017 (3.1%-4.1%), but decreased from 2018 to 2020 (3.3%-1.6%). Non-Hispanic Black infants demonstrated a 25% higher odds (aOR 1.25, 1.09-1.43) and Hispanic infants demonstrated a 20% lower odds (aOR 0.80, 0.65-0.96) of tracheostomy insertion compared with non-Hispanic White infants. Patients receiving public insurance had increased odds of tracheostomy insertion (aOR 1.15, 1.03-1.30), but there was no relation between other metrics of socioeconomic status and tracheostomy insertion within our cohort. In-hospital mortality among the tracheostomy-dependent was 14.1% and was not associated with sociodemographic factors. CONCLUSIONS Disparities in tracheostomy insertion are not accounted for by differences in socioeconomic status or the presence of additional neonatal morbidities. Post-tracheostomy mortality does not demonstrate the same relationships. Further investigation is needed to explore the source and potential mitigators of the identified disparities.
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Affiliation(s)
- Michael A Smith
- Department of Pediatrics, Division of Critical Care Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Martina A Steurer
- Department of Pediatrics, Division of Critical Care Medicine, School of Medicine, University of California, San Francisco, California, USA
- Department of Pediatrics, Division of Neonatology, School of Medicine, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California, USA
| | - Malini Mahendra
- Department of Pediatrics, Division of Critical Care Medicine, School of Medicine, University of California, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Matt S Zinter
- Department of Pediatrics, Division of Critical Care Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Roberta L Keller
- Department of Pediatrics, Division of Neonatology, School of Medicine, University of California, San Francisco, California, USA
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Davis BA, Arcaya MC, Williams DR, Krieger N. The impact of county-level fees & fines as exploitative revenue generation on US birth outcomes 2011-2015. Health Place 2023; 80:102990. [PMID: 36842240 DOI: 10.1016/j.healthplace.2023.102990] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/30/2022] [Accepted: 02/08/2023] [Indexed: 02/28/2023]
Abstract
Fees and fines collected through courts and law enforcement can comprise a considerable proportion of revenue for local governments. Law enforcement, as agents of revenue generation, change policing behavior to increase revenue, at times targeting Black and brown neighborhoods to bolster municipal budgets. This structural racism in revenue generation has not yet been assessed as an exposure for adverse health. Using the 2012 Census of Governments, and 2011-2015 vital statistics from the National Center of Health Statistics, we examine the relationship between countyaverage fees and fines as a percent of total own-source revenue and county-level characteristics, and risk of preterm birth and low birthweight across the United States. Mothers residing in counties with the greatest reliance on fees and fines had 1.08 (95% CI: 1.03-1.12) times the odds of preterm birth and 1.07 (95% CI: 1.02-1.11) times the odds of low birthweight than mothers residing in counties with the least reliance on fees and fines, controlling for individual- and county-level covariates. The addition of countylevel racial composition, and the Index of Concentration at the Extremes (ICE), reduced these associations yet remained statistically significant. Future studies should continue to examine how racist, exploitative revenue generation through police and court activities influences the health of residents.
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Affiliation(s)
- Brigette A Davis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; FXB Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Mariana C Arcaya
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of African and African American Studies, Harvard University, Cambridge, MA, USA.
| | - Nancy Krieger
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Listen to the Whispers before They Become Screams: Addressing Black Maternal Morbidity and Mortality in the United States. Healthcare (Basel) 2023; 11:healthcare11030438. [PMID: 36767014 PMCID: PMC9914526 DOI: 10.3390/healthcare11030438] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/09/2023] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
Black women in the United States (U.S.) disproportionately experience adverse pregnancy outcomes, including maternal mortality, compared to women of other racial and ethnic groups. Historical legacies of institutionalized racism and bias in medicine compound this problem. The disproportionate impact of COVID-19 on communities of color may further worsen existing racial disparities in maternal morbidity and mortality. This paper discusses structural and social determinants of racial disparities with a focus on the Black maternal mortality crisis in the United States. We explore how structural racism contributes to a greater risk of adverse obstetric outcomes among Black women in the U.S. We also propose public health, healthcare systems, and community-engaged approaches to decrease racial disparities in maternal morbidity and mortality.
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Hipwell AE, Fu H, Tung I, Stiller A, Keenan K. Preconception stress exposure from childhood to adolescence and birth outcomes: The impact of stress type, severity and consistency. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 4:1007788. [PMID: 36713849 PMCID: PMC9876597 DOI: 10.3389/frph.2022.1007788] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
The negative effects of prenatal stress on offspring health are well established, but there remains little understanding of the influence of stress prior to conception despite known effects on biological systems that are important for a healthy pregnancy. Furthermore, operational definitions of stress vary considerably, and exposure is often characterized via summed, ordinal scales of events. We hypothesized that type, severity, and consistency of preconception stress would be associated with birthweight and gestational age (GA) at birth. Data were drawn from a subsample of participants in the 21-year longitudinal Pittsburgh Girls Study (PGS, N = 2,450) that has followed women annually since childhood. Prior work in the PGS derived three domains of stress exposure between ages 7-17 years related to subsistence (e.g., resource strain, overcrowding), safety (e.g., community violence, inter-adult aggression), and caregiving (e.g., separation, maternal depression). We tested the effects of dimensions of preconception stress on birthweight and GA among offspring of 490 PGS participants who delivered at age 18 or older (n = 490; 76% Black, 20% White, 4% Multiracial). Our hypotheses were partially supported with results varying by stress type and severity and by infant sex. Severity of preconception exposure to subsistence stress was prospectively associated with lower offspring birthweight (B = -146.94, SE = 69.07, 95% CI = -282.66, -11.22). The association between severity of caregiving stress in childhood and adolescence and GA at birth was moderated by infant sex (B = 0.85, SE = .41, 95% CI = 0.04, 1.66), suggesting greater vulnerability to this type of stress for male compared to female infants. Exposure to safety stressors did not predict birth outcomes. Infants of Black compared with White mothers had lower birthweight in all models regardless of preconception stress type, severity or consistency. However, we observed no moderating effects of race on preconception stress-birth outcome associations. Demonstrating specificity of associations between preconception stress exposure and prenatal health has the potential to inform preventive interventions targeting profiles of exposure to optimize birth outcomes.
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Affiliation(s)
- Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Haoyi Fu
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Irene Tung
- Department of Psychology, California State University Dominguez Hills, Carson, CA, United States
| | - Ashley Stiller
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, United States
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Gregory EF, Cronholm PF, Johnson GT, Maddox AI, Kellom K, Levine LD, Lorch SA, Fiks AG, Resnicow K. A Qualitative Study of Perspectives of Black Women on Autonomy and Motivational Interviewing. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:94-102. [PMID: 36874236 PMCID: PMC9983129 DOI: 10.1089/whr.2022.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/24/2023]
Abstract
Purpose Motivational interviewing (MI) is an evidence-based strategy to modify health behaviors, including some risk factors for adverse birth outcomes. Black women, who have disproportionately high rates of adverse birth outcomes, have reported mixed preferences on MI. This study explored the acceptability of MI among Black women who are at high risk for adverse birth outcomes. Methods We conducted qualitative interviews with women with a history of preterm birth. Participants were English-language proficient and had Medicaid-insured infants. We purposively oversampled women whose infants had medical complexity. Interviews explored experiences with health care and health behaviors after birth. The interview guide was iteratively developed to obtain specific reactions to MI by including videos demonstrating MI-consistent and MI-inconsistent counseling. Interviews were audio recorded, transcribed, and coded following an integrated approach in which we applied a priori codes related to MI and allowed themes to emerge from the data. Results We interviewed 30 non-Hispanic Black women from October 2018 to July 2021. Eleven viewed the videos. Participants emphasized the importance of autonomy in decision-making and health behavior. Participants expressed a preference for MI-consistent clinical approaches, including autonomy support and building rapport, considering them respectful, nonjudgmental, and likely to support change. Conclusions In this sample of Black women with a history of preterm birth, participants valued an MI-consistent clinical approach. Incorporating MI into clinical care may improve the experience of health care among Black women, thus serving as one strategy to promote equity in birth outcomes.
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Affiliation(s)
- Emily F Gregory
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Peter F Cronholm
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Geminesse T Johnson
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adya I Maddox
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Katherine Kellom
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lisa D Levine
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Maternal Fetal Medicine Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Scott A Lorch
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Alexander G Fiks
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kenneth Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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OjiNjideka Hemphill N, Crooks N, Zhang W, Fitter F, Erbe K, Rutherford JN, Liese KL, Pearson P, Stewart K, Kessee N, Reed L, Tussing-Humphreys L, Koenig MD. Obstetric experiences of young black mothers: An intersectional perspective. Soc Sci Med 2023; 317:115604. [PMID: 36549014 PMCID: PMC9854070 DOI: 10.1016/j.socscimed.2022.115604] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND In Chicago, maternal morbidity and mortality is six times more likely among Black birthing people than white, despite policy initiatives to promote maternal health equity. Disparities in maternal morbidity and mortality reflect experiences of structural inequities - including limited quality obstetric care, implicit bias, and racism resulting patient mistrust in the health care system, inadequate social support, and financial insecurity. Although there is published literature on Black women's experiences with obstetric care, including experiences with individual and structural racism, little is known about the intersection of age and race and experiences with health care. The purpose of this study was to explore the maternal health and pregnancy experiences of young Black women utilizing an intersectional theoretical lens. METHODS In this study, we conducted two focus groups in a sample of 11 young Black pregnant people. We conducted a thematic analysis to identify codes, themes, and subthemes of the data. RESULTS We developed two overarching themes: obstetric racism and obstetric resistance. To elucidate how obstetric racism framed our participants' healthcare experiences, we identified sub-themes: intersectional identities as young Black women, medical mistrust, and pregnancy trauma. The second major theme describes ways in which participants protected themselves against obstetric racism to engender positive health experiences. These methods of resistance included identifying advocates and relying on trusted providers. CONCLUSIONS The current standard of obstetric care in the US is suboptimal due to individual and structural racism. This study provides unique data on the experiences with health care for young, Black pregnant individuals and delivers valuable insight into how individual and structural racism impacts obstetric care for young Black women.
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Affiliation(s)
- Nefertiti OjiNjideka Hemphill
- Department of Kinesiology and Nutrition, University of Illinois Chicago 1747 W Roosevelt Road, Chicago, IL, 60608, USA.
| | - Natasha Crooks
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Wenqiong Zhang
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Fareeha Fitter
- College of Liberal Arts and Sciences, University of Illinois Chicago 601 S. Morgan St., 4th Floor UH, Chicago, IL, 60607, USA.
| | - Katherine Erbe
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Julienne N Rutherford
- Biobehavioral Health Science Division at the University of Arizona, PO Box 210203, Tucson, AZ, 85721, USA.
| | - Kylea L Liese
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Pamela Pearson
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Karie Stewart
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
| | - Nicollette Kessee
- Department of Kinesiology and Nutrition, University of Illinois Chicago 1747 W Roosevelt Road, Chicago, IL, 60608, USA.
| | | | - Lisa Tussing-Humphreys
- Department of Kinesiology and Nutrition, University of Illinois Chicago 1747 W Roosevelt Road, Chicago, IL, 60608, USA.
| | - Mary Dawn Koenig
- Department of Human Development Nursing Science, University of Illinois Chicago, 845 S. Damen Ave. MC 802, Chicago, IL, 60612, USA.
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Balascio P, Moore M, Gongalla M, Regan A, Ha S, Taylor BD, Hill AV. Measures of Racism and Discrimination in Preterm Birth Studies. Obstet Gynecol 2023; 141:69-83. [PMID: 36701611 PMCID: PMC9886318 DOI: 10.1097/aog.0000000000005023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/29/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Preterm birth (any birth at less than 37 weeks of gestation) disproportionally affects Black birthing people and is associated with adverse perinatal and fetal health outcomes. Racism increases the risk of preterm birth, but standardized measurement metrics are elusive. This narrative synthesis examines literature on measures of racial discrimination used in preterm birth research. DATA SOURCES Six databases (CINAHL, Cochrane, EMBASE, PubMed [MEDLINE], Scopus, Web of Science) and ClinicalTrials.gov were searched. Search terms were categorized into three groups (racism terms, measurement terms, preterm birth terms) to identify original research articles that explored associations between racism and preterm birth. English-language, original research articles with U.S. populations were included. METHODS OF STUDY SELECTION Studies were excluded if conducted in only White populations, if only paternal factors were included, or if only racial differences in preterm birth were described. Articles were independently reviewed by two blinded researchers for inclusion at every stage of screening and data extraction; a third reviewer resolved discrepancies. TABULATION, INTEGRATION, AND RESULTS Sixty studies were included in the final analysis. Articles primarily included measures examining interpersonal forms of racism (n=17) through the Experiences of Discrimination and Everyday Discrimination scales, neighborhood composition (n=22) with the Neighborhood Deprivation Index and the Index of Concentration at the Extremes, policy-level racism (n=12) through institutions such as residential racial segregation or policy inequities, or multiple forms (n=9). CONCLUSION Among studies, assessment methods and application of constructs varied. This heterogeneity poses significant challenges to understanding associations between racial discrimination and preterm birth and to describing potential etiologic pathways of preterm birth, which ultimately hinders development of effective intervention. Strategies to capture multilevel exposures to racism require the development and expansion of metrics that are culturally inclusive, empirically valid, and reliable among Black pregnant populations. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022327484.
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Affiliation(s)
- Phoebe Balascio
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, and the Department of Sociology, College of Liberal Arts, Temple University, Philadelphia, Pennsylvania; the Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, Texas; and the School of Nursing and Health Professions, University of San Francisco, San Francisco, and the Department of Public Health, Health Science Research Institute, University of California, Merced, Merced, California
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Structural racism is associated with adverse postnatal outcomes among Black preterm infants. Pediatr Res 2022:10.1038/s41390-022-02445-6. [PMID: 36577795 PMCID: PMC9795138 DOI: 10.1038/s41390-022-02445-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/03/2022] [Accepted: 11/28/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Structural racism contributes to racial disparities in adverse perinatal outcomes. We sought to determine if structural racism is associated with adverse outcomes among Black preterm infants postnatally. METHODS Observational cohort study of 13,321 Black birthing people who delivered preterm (gestational age 22-36 weeks) in California in 2011-2017 using a statewide birth cohort database and the American Community Survey. Racial and income segregation was quantified by the Index of Concentration at the Extremes (ICE) scores. Multivariable generalized estimating equations regression models were fit to test the association between ICE scores and adverse postnatal outcomes: frequent acute care visits, readmissions, and pre- and post-discharge death, adjusting for infant and birthing person characteristics and social factors. RESULTS Black birthing people who delivered preterm in the least privileged ICE tertiles were more likely to have infants who experienced frequent acute care visits (crude risk ratio [cRR] 1.3 95% CI 1.2-1.4), readmissions (cRR 1.1 95% CI 1.0-1.2), and post-discharge death (cRR 1.9 95% CI 1.2-3.1) in their first year compared to those in the privileged tertile. Results did not differ significantly after adjusting for infant or birthing person characteristics. CONCLUSION Structural racism contributes to adverse outcomes for Black preterm infants after hospital discharge. IMPACT STATEMENT Structural racism, measured by racial and income segregation, was associated with adverse postnatal outcomes among Black preterm infants including frequent acute care visits, rehospitalizations, and death after hospital discharge. This study extends our understanding of the impact of structural racism on the health of Black preterm infants beyond the perinatal period and provides reinforcement to the concept of structural racism contributing to racial disparities in poor postnatal outcomes for preterm infants. Identifying structural racism as a primary cause of racial disparities in the postnatal period is necessary to prioritize and implement appropriate structural interventions to improve outcomes.
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Barber S, Ferreira A, Gripper AB, Jahn JL. Healthy and thriving: advancing anti-racism evidence and solutions to transform the health of Black communities. Lancet 2022; 400:2016-2018. [PMID: 36502828 DOI: 10.1016/s0140-6736(22)02402-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Sharrelle Barber
- The Ubuntu Center on Racism, Global Movements & Population Health Equity, Drexel University Dornsife School of Public Health, Philadelphia, PA 19104, USA; Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA 19104, USA.
| | - Andrêa Ferreira
- The Ubuntu Center on Racism, Global Movements & Population Health Equity, Drexel University Dornsife School of Public Health, Philadelphia, PA 19104, USA; Iyaleta-Research, Sciences and Humanities, Salvador, BA, Brazil
| | - Ashley B Gripper
- The Ubuntu Center on Racism, Global Movements & Population Health Equity, Drexel University Dornsife School of Public Health, Philadelphia, PA 19104, USA; Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA 19104, USA
| | - Jaquelyn L Jahn
- The Ubuntu Center on Racism, Global Movements & Population Health Equity, Drexel University Dornsife School of Public Health, Philadelphia, PA 19104, USA; Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA 19104, USA
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50
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Karvonen KL, Goronga F, McKenzie-Sampson S, Rogers EE. Racial disparities in the development of comorbid conditions after preterm birth: A narrative review. Semin Perinatol 2022; 46:151657. [PMID: 36153273 DOI: 10.1016/j.semperi.2022.151657] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite recognition and attempts to reduce racial disparities in perinatal outcomes, Black infants are still disproportionately represented among those who are born preterm. Postnatal investigations of racial disparities in comorbidities and outcomes after preterm birth are increasing, although their results and interpretations are conflicting. In the present review, we 1.) identify important methodological limitations of that literature 2.) summarize the conflicting literature investigating racial disparities, specifically Black-white differences, in postnatal comorbidities and outcomes after preterm birth 3.) describe mechanisms by which racism operates to contextualize our understanding to inform future work to actively reduce disparities in preterm birth and subsequently, its complications.
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Affiliation(s)
- Kayla L Karvonen
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States.
| | - Faith Goronga
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States
| | - Safyer McKenzie-Sampson
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | - Elizabeth E Rogers
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA, United States
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