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Page A, McCann R, Maness S, Merriweather M, Dobbs PD. Beyond the First Trimester: Social Determinants of Delayed Prenatal Care at a Community Health Center Using the PRAPARE Tool. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02052-7. [PMID: 38935333 DOI: 10.1007/s40615-024-02052-7] [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: 04/23/2024] [Revised: 05/29/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
Social determinants of health have been used to explore associations with pregnancy outcomes and the birth weight of infants; however, research employing individually based social risk measures has not examined associations among underserved populations, including pregnant persons at community health centers. Data were collected from a sample (n = 345) of pregnant persons who sought care at a community health center between January 2019 and December 2020. Social risks of pregnant patients were measured using the PRAPARE tool. First, associations between patients' social risks and trimester in which they initiated care were assessed using ANOVAs, grouping social risk by PRAPARE social determinant domains (persona characteristics, family and home, money and resources, and social and emotional health). ANOVAs were stratified by ethnicity. Next, a multivariate logistic regression examined associations between social measures and seeking care after the first trimester. Patients who sought care in the first trimester reported more financial needs than those who sought care in the second (p = .02) or the third (p = .049). Hispanic patients who sought care in the first trimester reported more monetary needs than those who sought care in the second trimester (p = .048), and non-Hispanic patients who sought care in the first trimester reported greater family and home needs than those who sought care in the second trimester (p = .47). Those who experienced stress were 3.07 times as likely to seek care after the first trimester as those who reported no stress. CHC may reduce social risk among poor and underserved communities by reducing barriers to access to care.
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Affiliation(s)
- Abbie Page
- Department of Health, Human Performance and Recreation, University of Arkansas, 346 West Ave. Suite 317, Fayetteville, AR, 72701, USA
- St. Francis House NWA Inc. dba. Community Clinic, Springdale, AR, 72764, USA
- Center for Public Health and Technology, University of Arkansas, 346 West Ave. Suite 317, Fayetteville, AR, 72701, USA
| | - Rebecca McCann
- Department of Health, Human Performance and Recreation, University of Arkansas, 346 West Ave. Suite 317, Fayetteville, AR, 72701, USA
- Center for Public Health and Technology, University of Arkansas, 346 West Ave. Suite 317, Fayetteville, AR, 72701, USA
- Eleanor Mann School of Nursing, University of Arkansas, Fayetteville, 72701, AR, USA
| | - Sarah Maness
- Department of Health Education and Promotion, East Carolina University, Greensville, NC, 27858-4353, USA
| | - Maya Merriweather
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Science, Little Rock, AR, 72205, USA
- Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Page D Dobbs
- Department of Health, Human Performance and Recreation, University of Arkansas, 346 West Ave. Suite 317, Fayetteville, AR, 72701, USA.
- Center for Public Health and Technology, University of Arkansas, 346 West Ave. Suite 317, Fayetteville, AR, 72701, USA.
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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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Axelsson Fisk S, Alex-Petersen J, Rostila M, Liu C, Juárez SP. Social inequalities in the risk of giving birth to a small for gestational age child in Sweden 2010-16: a cross-sectional study adopting an intersectional approach. Eur J Public Health 2024; 34:22-28. [PMID: 37878824 PMCID: PMC10843954 DOI: 10.1093/eurpub/ckad184] [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: 10/27/2023] Open
Abstract
BACKGROUND Well-established associations exist between the risk of small for gestational age (SGA) and unidimensional sociodemographic factors. We investigated social inequalities in SGA risk and adopted an intersectional approach that simultaneously considers different social categories. By doing so, we could assess heterogeneities in SGA risk within unidimensional sociodemographic categories. METHODS We included all live 679 694 singleton births in Sweden between 2010 and 2016. The outcome was SGA, and the exposures were age, maternal educational level, dichotomous migration status and civil status. Thirty-six possible combinations of these factors constituted the exposure in an intersectional model. We present odds ratios (ORs) with 95% confidence intervals (95% CIs) and the area under the receiver operating characteristic curve (AUC)-a measurement of discriminatory accuracy (i.e. the ability to discriminate the babies born SGA from those who are not). RESULTS Women with low education and women born outside Sweden had ORs of 1.46 (95% CI 1.38-1.54) and 1.50 (95% CI 1.43-1.56) in unidimensional analyses, respectively. Among women aged under 25 with low education who were born outside Sweden and unmarried, the highest OR was 3.06 (2.59-3.63). The discriminatory accuracy was low for both the unidimensional model that included all sociodemographic factors (AUC 0. 563) and the intersectional model (AUC 0.571). CONCLUSIONS The intersectional approach revealed a complex sociodemographic pattern of SGA risk. Sociodemographic factors have a low accuracy in identifying SGA at the individual level, even when quantifying their multi-dimensional intersections. This cautions against interventions targeted to individuals belonging to socially defined groups to reduce social inequalities in SGA risk.
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Affiliation(s)
- Sten Axelsson Fisk
- Department of Clinical Sciences Lund, Obstetrics and Gynaecology, Lund University, Lund, BMC C14. Lund, 22185, Sweden
- Department of Obstetrics and Gynaecology, Ystad Hospital, Ystad, Sweden
| | | | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society (NVS), Aging Research Center (ARC), Karolinska Institutet/Stockholm University, Stockholm, Sweden
| | - Can Liu
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sol Pia Juárez
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
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Deichen Hansen ME, Goldfarb SS, Mercouffer A, Dark T, Lateef H, Harman JS. Racial inequities in emergency department wait times for pregnancy-related concerns. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221129388. [PMID: 36300291 PMCID: PMC9623347 DOI: 10.1177/17455057221129388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: Emergency department care is common among US pregnant women. Given the
increased likelihood of serious and life-threatening pregnancy-related
health conditions among Black mothers, timeliness of emergency department
care is vital. The objective of this study was to evaluate racial/ethnic
variations in emergency department wait times for receiving obstetrical care
among a nationally representative population. Methods: The study used pooled 2016–2018 data from the National Hospital Ambulatory
Medical Care Survey, a nationally representative sample of emergency
department visits. Regression models were estimated to determine whether
emergency department wait time was associated with the race/ethnicity of the
perinatal patient. Adjusted models controlled for age, obesity status,
insurance type, whether the patient arrived by ambulance, triage status,
presence of a patient dashboard, and region. Results: There were a total of 821 reported pregnancy-related visits in the National
Hospital Ambulatory Medical Care Survey sample of emergency department
visits. Of those 821 visits, 40.6% were among White women, 27.7% among Black
women, and 27.5% among Hispanic women. Mean wait times differed
substantially by race/ethnicity. After adjusting for potential confounders,
Black women waited 46% longer than White women with emergency department
visits for pregnancy problems (p < .05). Those reporting another race
waited 95% longer for pregnancy problems in the emergency department than
White women (p < .05). Conclusion: Findings from this study document significant racial/ethnic differences in
wait times for perinatal emergency department care. Although inequities in
wait times may emerge across the spectrum of care, documenting the factors
influencing racial disparities in wait times are critical to promoting
equitable perinatal health outcomes.
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Affiliation(s)
- Megan E Deichen Hansen
- Megan E Deichen Hansen, Department of
Behavioral Sciences and Social Medicine, College of Medicine, Florida State
University, 1115 W Call St, Tallahassee, FL 32304, USA.
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