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Beltran-Silva F, McInnis N. Relationship Between Sex-Specific Labor Market Performance and Breastfeeding Prevalence. J Hum Lact 2024; 40:318-327. [PMID: 38454611 DOI: 10.1177/08903344241230547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Prior research has explored the association between women's employment status and breastfeeding at the individual level, however; a notable gap in scholarly inquiry exists regarding the relationship between labor market performance and breastfeeding at the population level. RESEARCH AIM The aim of this paper is to investigate the association between labor market performance and breastfeeding prevalence in the United States. METHODS This study is a cross-sectional analysis of the association between labor market performance and the prevalence of breastfeeding. Our analysis is conducted at the state level using data published up to late 2021 from the Current Population Survey and the National Immunization Survey. The first dataset was used to construct aggregate and sex-specific state level indicators of labor market performance for both males and females. The second dataset supplied the proportion of mothers breastfeeding for the corresponding birth cohort from each state. RESULTS Higher average weekly hours worked by females in the year before giving birth was associated with a lower prevalence of breastfeeding, but employment rates among females did not significantly affect breastfeeding prevalence. Among males, current employment rates were positively associated with breastfeeding prevalence; however, no significant relationship was observed between breastfeeding prevalence and average weekly work hours worked. CONCLUSION Sex-specific labor market performance may play a role in breastfeeding decisions and the timing of labor market performance relative to childbirth is important. Furthermore, these results highlight that employment rates and hours worked might be associated with child health through breastfeeding prevalence.
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Affiliation(s)
- Francisco Beltran-Silva
- Bookstein Hall David Nazarian College of Business and Economics, California State University Northridge, Northridge, CA, USA
| | - Nicardo McInnis
- Bookstein Hall David Nazarian College of Business and Economics, California State University Northridge, Northridge, CA, USA
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Xiao X, Liu R, Zhang Z, Jalaludin B, Heinrich J, Lao X, Morawska L, Dharmage SC, Knibbs LD, Dong GH, Gao M, Yin C. Using individual approach to examine the association between urban heat island and preterm birth: A nationwide cohort study in China. ENVIRONMENT INTERNATIONAL 2024; 183:108356. [PMID: 38043323 DOI: 10.1016/j.envint.2023.108356] [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: 07/05/2023] [Revised: 10/22/2023] [Accepted: 11/26/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Evidence suggests that maternal exposure to heat might increase the risk of preterm birth (PTB), but no study has investigated the effect from urban heat island (UHI) at individual level. AIMS Our study aimed to investigate the association between individual UHI exposure and PTB. METHODS We utilized data from the ongoing China Birth Cohort Study (CBCS), encompassing 103,040 birth records up to December 2020. UHI exposure was estimated for each participant using a novel individual assessment method based on temperature data and satellite-derived land cover data. We used generalized linear mixed-effects models to estimate the association between UHI exposure and PTB, adjusting for potential confounders including maternal characteristics and environmental factors. RESULTS Consistent and statistically significant associations between UHI exposure and PTB were observed up to 21 days before birth. A 5 °C increment in UHI exposure was associated with 27 % higher risk (OR = 1.27, 95 % confident interval: 1.20, 1.34) of preterm birth in lagged day 1. Stratified analysis indicated that the associations were more pronounced in participants who were older, had higher pre-pregnancy body mass index level, of higher socioeconomic status and living in greener areas. CONCLUSION Maternal exposure to UHI was associated with increased risk of PTB. These findings have implications for developing targeted interventions for susceptible subgroups of pregnant women. More research is needed to validate our findings of increased risk of preterm birth due to UHI exposure among pregnant women.
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Affiliation(s)
- Xiang Xiao
- Department of Geography, Hong Kong Baptist University, Hong Kong, China
| | - Ruixia Liu
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
| | - Zheng Zhang
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
| | - Bin Jalaludin
- School of Public Health and Community Medicine, The University of New South Wales, Kensington 2052, Australia
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich 80336, Germany
| | - Xiangqian Lao
- Department of Biomedical Sciences, the City University of Hong Kong, Hong Kong, China
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane 4059, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Luke D Knibbs
- School of Public Health, The University of Sydney, NSW 2006, Australia; Public Health Research Analytics and Methods for Evidence, Public Health Unit, Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
| | - Meng Gao
- Department of Geography, Hong Kong Baptist University, Hong Kong, China; Center for Ocean Research in Hong Kong and Macau (CORE), Hong Kong, China.
| | - Chenghong Yin
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.
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Perry MF, Trasatti E, Yee LM, Feinglass J. The association of state percent uninsured and the likelihood of low birth weight: evidence from the 2016-2019 Pregnancy Risk Assessment Monitoring System. Public Health 2023; 225:182-190. [PMID: 37939459 DOI: 10.1016/j.puhe.2023.10.005] [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: 06/22/2023] [Revised: 09/08/2023] [Accepted: 10/02/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE To evaluate the association of state-level lack of health insurance among women of reproductive age with variation in state low birth weight (LBW) rates. STUDY DESIGN This cross-section study analyzes data from the 2016-2019 Pregnancy Risk Assessment Monitoring Survey for respondents with singleton, live births. METHODS Respondents were divided into groups by state-level percent of uninsured women aged 19-44 years. Poisson regression was used to model the association between state percent uninsured and likelihood of LBW, controlling for individual sociodemographic and clinical risk factors. Sensitivity analyses were done for Medicaid and non-Hispanic Black subpopulations and alternative state characteristics, including Gini coefficients, total and public welfare expenditures, and state reproductive rights rankings. RESULTS In adjusted multiple regression analyses, compared to respondents from states with <7% uninsured, respondents from states with 7% or more uninsured had an increased risk of LBW status (7-8.99% uninsured: adjusted incidence rate ratio [aIRR] 1.11, 95% confidence interval [CI] 1.04-1.18; 9-11.99% uninsured: aIRR 1.09, 95% CI 1.02-1.17; >11.99% uninsured: aIRR 1.15, 95% CI 1.08-1.22). However, there was no evident dose-response gradient. Sensitivity analyses produced virtually identical findings for subpopulations, and no other state characteristics were significant. CONCLUSION States with the highest level of insurance coverage had a significantly lower LBW rate than other states. However, there was little evidence for greater odds of LBW with the highest levels of uninsured. Individual risk factors dominated LBW models, while state differences in income inequality, reproductive health policy, and per capita spending explained little of the variance in LBW.
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Affiliation(s)
- M F Perry
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - E Trasatti
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - L M Yee
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J Feinglass
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Abstract
The COVID-19 pandemic has taken a large toll on population health and well-being. We examine the consequences of prenatal exposure for infant health, through which the pandemic may have lasting intergenerational effects. We examine multiple pathways by which the pandemic shaped birth outcomes and socioeconomic disparities in these consequences. Analysis of more than 3.5 million birth records in California with universal information on COVID infection among persons giving birth at the time of delivery reveals deep inequalities in infection by education, race/ethnicity, and place-based socioeconomic disadvantage. COVID infection during pregnancy, in turn, predicts a large increase in the probability of preterm birth, by approximately one third. At the population level, a surprising reduction in preterm births during the first months of the pandemic was followed by an increase in preterm births during the surge in COVID infections in the winter of 2021. Whereas the early-pandemic reduction in preterm births benefited primarily highly educated mothers, the increase in preterm births during the winter infection surge was entirely concentrated among mothers with low levels of schooling. The COVID-19 pandemic is expected to exacerbate U.S. inequality in multiple ways. Our findings highlight a particularly enduring pathway: the long-term legacy of prenatal exposure to an unequal pandemic environment.
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Affiliation(s)
| | - Jenna Nobles
- Department of Sociology, University of Wisconsin-Madison, Madison, WI, USA
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Gailey S, Mortensen LH, Bruckner TA. Job loss and fetal growth restriction: identification of critical trimesters of exposure. Ann Epidemiol 2022; 76:174-180. [PMID: 35605768 PMCID: PMC10194830 DOI: 10.1016/j.annepidem.2022.05.003] [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: 12/02/2021] [Revised: 04/29/2022] [Accepted: 05/12/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Previous research suggests that job loss in a household during pregnancy may perturb fetal growth. However, this work often cannot rule out unmeasured confounding due to selection into job loss. Recent work using data on exogenous job loss (due to a plant closure) finds that a father's unexpected job loss during his spouse's pregnancy increases the risk of a low weight birth. Using a unique set of linked registries in Denmark, we build on this work and examine whether associations between a father's unexpected job loss and low birthweight differ by trimester of in utero exposure. We additionally examine trimester-specific associations of job loss with small-for-gestational-age, a proxy for restricted fetal growth, which may cause low birthweight. METHODS We apply a sibling control design to over 1.4 million live births in Denmark, 1980 to 2017, to examine whether this plausibly exogenous form of job loss corresponds with increased risk of low weight or small-for-gestational-age births, depending on the timing of displacement in the first, second, or third trimester. RESULTS Results indicate an elevated risk of low birthweight (OR = 1.80, 95% CI: 1.24, 2.62) and small-for-gestational-age (OR = 1.40, 95% CI: 1.02, 1.93) among gestations exposed to job loss in the second trimester of pregnancy. Sensitivity analyses using continuous outcome measures (e.g., birthweight in grams, birthweight for gestational age percentile) and maternal fixed effects analyses produce substantively similar inference. CONCLUSIONS Findings support the notion that unexpected job loss may affect fetal growth and that the second trimester in particular appears sensitive to this external stressor.
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Affiliation(s)
- Samantha Gailey
- Minnesota Population Center, University of Minnesota, Twin Cities, Minnesota, USA.
| | - Laust H Mortensen
- Statistics Denmark, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tim A Bruckner
- University of California Irvine, Center for Population, Inequality and Policy and Program in Public Health, Irvine, California, USA
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Boslett A, Hill E. Mortality during Resource Booms and Busts. JOURNAL OF ENVIRONMENTAL ECONOMICS AND MANAGEMENT 2022; 115:102696. [PMID: 36643912 PMCID: PMC9835077 DOI: 10.1016/j.jeem.2022.102696] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Using national data on county-level mortality, coal mining, and shale development, we examine the effects of resource booms and busts on mortality in the United States. We find evidence that decreases in operating coal mines increased total all-cause mortality, non-drug mortality, and opioid overdose mortality, especially for counties with greater than 10 operating coal mines in 2000. Our model results for drug overdose mortality and opioid overdose mortality are sensitive to the panel's start year. For shale development, the shale boom is associated with increases in non-drug suicides but otherwise had little impact on mortality. Our findings suggest a potential role for job-training programs and the cultivation of local healthcare resources in regions suffering coal busts and suicide prevention in areas with shale development.
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Affiliation(s)
- Andrew Boslett
- Dept. of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14620
- Rochester Data Science Consortium, Rochester, NY 14604
| | - Elaine Hill
- Dept. of Public Health Sciences, University of Rochester Medical Center, Rochester, NY 14620
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Davis KM, Jones KA, Yee LM, Feinglass J. Modeling the Likelihood of Low Birth Weight: Findings from a Chicago-Area Health System. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01360-0. [PMID: 35799041 PMCID: PMC9823150 DOI: 10.1007/s40615-022-01360-0] [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: 03/28/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study presents a statistical model of the incidence of low birth weight (LBW) births in a large, Chicago-area hospital system. The study was undertaken to provide a strategic framework for future health system interventions. METHODS Administrative and electronic health records were matched to census Zip Code Tabulation Area (ZCTA) household poverty data for 42,681 births in 2016-2019 at seven system hospitals, serving a diverse patient population. A logistic regression model of LBW incidence was estimated to test the independent significance of maternal sociodemographic characteristics after controlling for clinical risk factors. RESULTS The incidence of LBW was 6.3% overall but 11.3% among non-Hispanic Black patients as compared to 5.1% among non-Hispanic White patients. LBW incidence ranged from 9.2% for patients from the poorest ZCTA (20% + poor households) compared to 5.6% of patients from the most affluent (< 5% poor) ZCTA. Nulliparous patients, patients with pre-existing chronic conditions, and patients with hypertensive disorders of pregnancy were significantly more likely to have LBW births. After controlling for clinical risk factors and poverty level, non-Hispanic Black patients were still over 80% more likely and to have a LBW birth. DISCUSSION Study findings reveal the joint effects of social and clinical risk factors. Findings profile our highest-risk populations for targeted interventions. Promising prenatal care redesign programs include pregnancy patient navigators, home and group visits, eHealth telemonitoring, improved mental health screening, and diversification of the maternity care workforce. Decreasing LBW births should be a national public health policy priority and will require major investments in the most impacted communities.
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Affiliation(s)
- Ka’Derricka M. Davis
- Division of Maternal and Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Lynn M. Yee
- Division of Maternal and Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joe Feinglass
- Division of General Internal Medicine and Geriatrics, Northwestern Feinberg School of Medicine, Chicago, IL
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Ren M, Wang Q, Zhao W, Ren Z, Zhang H, Jalaludin B, Benmarhnia T, Di J, Hu H, Wang Y, Ji JS, Liang W, Huang C. Effects of extreme temperature on the risk of preterm birth in China: A population-based multi-center cohort study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 24:100496. [PMID: 35899090 PMCID: PMC9310344 DOI: 10.1016/j.lanwpc.2022.100496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Extreme temperatures are associated with the risk of preterm birth (PTB), but evidence on the effects of different clinical subtypes and across different regions is limited. We aimed to evaluate the effects of maternal exposure to extreme temperature on PTB and its clinical subtypes in China, and to identify effect modification of regional factors in dimensions of population, economy, medical resources and environmental factors. METHODS This was a prospective population-based cohort of 210,798 singleton live births from 16 counties in eight provinces across China during 2014-2018. We used an extended Cox regression with time-varying variables to evaluate the effects of extreme heat and cold on PTB and its subtypes in the entire pregnancy, each trimester, the last gestational month and week. Meta-analysis and meta-regression were conducted to estimate the pooled effects of each city and effect modification by regional characteristics. FINDINGS Exposure to heat and cold during the entire pregnancy significantly increased the risk of PTB. The effects varied with subtypes, for medically indicated and spontaneous PTB, hazard ratios were 1·84 (95% CI: 1·29, 2·61) and 1·50 (95% CI: 1·11, 2·02) for heat, 2·18 (95% CI: 1·83, 2·60) and 2·15 (95% CI: 1·92, 2·41) for cold. The associations were stronger for PTB less than 35 weeks than those during weeks 35-36. The effects varied across locations, and GDP per capita (β=-0·16) and hospital beds per 1000 persons (β=-0·25) were protective factors for the effects. INTERPRETATION Extreme temperature can increase the risk of medically indicated and spontaneous PTB, and higher regional socio-economic status may moderate such effects. In the context of climate change, such findings may have important implications for protecting the health of vulnerable groups, especially newborns. FUNDING National Key R&D Program of China (2018YFA0606200), National Natural Science Foundation of China (42175183), Strategic Priority Research Program of the Chinese Academy of Sciences (XDA20030302), National Natural Science Foundation of China (42071377).
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Affiliation(s)
- Meng Ren
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China
- Shanghai Typhoon Institute, China Meteorological Administration, Shanghai, China
| | - Qiong Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wei Zhao
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhoupeng Ren
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Huanhuan Zhang
- School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Bin Jalaludin
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health & Scripps Institution of Oceanography, University of California San Diego, La Jolla, California, USA
| | - Jiangli Di
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huanqing Hu
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ying Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - John S. Ji
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute of Healthy China, Tsinghua University, Beijing, China
| | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute of Healthy China, Tsinghua University, Beijing, China
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Curtis DS, Smith KR, Chae DH, Washburn T, Lee H, Kim J, Kramer MR. Highly public anti-Black violence and preterm birth odds for Black and White mothers. SSM Popul Health 2022; 18:101112. [PMID: 35535210 PMCID: PMC9077530 DOI: 10.1016/j.ssmph.2022.101112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/22/2022] [Accepted: 04/27/2022] [Indexed: 12/02/2022] Open
Abstract
Highly public anti-Black violence may increase preterm birth in the general population of pregnant women via stress-mediated paths, particularly Black women exposed in early gestation. To examine spillover from racial violence in the US, we included a total of 49 high publicity incidents of the following types: police lethal force toward Black persons, legal decisions not to indict/convict officers involved, and hate crime murders of Black victims. National search interest in these incidents was measured via Google Trends to proxy for public awareness of racial violence. Timing of racial violence was coded in relation to a three-month preconception period and subsequent pregnancy trimesters, with the primary hypothesis being that first trimester exposure is associated with higher preterm birth odds. The national sample included 1.6 million singleton live births to US-born Black mothers and 6.6 million births to US-born White mothers from 2014 to 2017. Using a preregistered analysis plan, findings show that Black mothers had 5% higher preterm birth odds when exposed to any high publicity racial incidents relative to none in their first trimester, and 2-3% higher preterm birth odds with each log10 increase in national interest. However, post hoc sensitivity tests that included month fixed effects attenuated these associations to null. For White mothers, associations were smaller but of a similar pattern, and were attenuated when including month fixed effects. Highly public anti-Black violence may act as a national stressor, yet whether racial violence is associated with reproductive outcomes in the population is unknown and merits further research.
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Affiliation(s)
- David S. Curtis
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, 84112, USA
| | - Ken R. Smith
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, 84112, USA
| | - David H. Chae
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA, 70112, USA
| | - Tessa Washburn
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, 84112, USA
| | - Hedwig Lee
- Department of Sociology, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Jaewhan Kim
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, 84112, USA
| | - Michael R. Kramer
- Department of Epidemiology, Emory University, Atlanta, GA, 30322, USA
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Marti-Castaner M, Pavlenko T, Engel R, Sanchez K, Crawford AE, Brooks-Gunn J, Wimer C. Poverty after Birth: How Mothers Experience and Navigate U.S. Safety Net Programs to Address Family Needs. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 31:2248-2265. [PMID: 35539282 PMCID: PMC9073812 DOI: 10.1007/s10826-022-02322-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
Although pregnancy and the first year of life are sensitive windows for child development, we know very little about the lived experiences of mothers living in poverty or near poverty during the perinatal period; specifically, how they perceive and use public resources to support themselves and their newborn. In this qualitative study, we explore how predominantly Black and Latinx mothers with infants living in or near poverty and engaged in public assistance manage to meet their family's needs with available resources from safety net programs and social supports. We conducted 20 qualitative interviews with mothers living in (85%) or near poverty in New York City (NYC). All participants (mean age = 24) had an 11-month-old infant at the time of the interview. Using thematic analysis, we identified five main themes reflecting how mothers experience and navigate living with very low incomes while engaging in public assistance programs: (1) experiencing cascading effects of hardships during pregnancy, (2) relying on food assistance and informal supports amid scarcity, (3) waiting for limited affordable housing: 'life on hold', (4) finding pathways towards stability after the baby's birth, (5) making it work: efforts to look forward. Results describe how the current focus on "work first" of existing federal and state policies adds a layer of stress and burden on the lives of single mothers experiencing low incomes and entangled hardships during pregnancy and after birth. We document how mothers experience coverage gaps and implementation challenges navigating the patchwork of public assistance programs, yet how the support of flexible caseworkers accessing, using, and coordinating assistance has the potential to help mothers plan for longer-term goals.
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Affiliation(s)
- Maria Marti-Castaner
- Copenhagen University, Department of Public Health, Section of Health Services Research, Copenhagen, Denmark
| | | | - Ruby Engel
- Columbia University, Center on Poverty and Social Policy, New York, NY USA
| | - Karen Sanchez
- Columbia University, Center on Poverty and Social Policy, New York, NY USA
| | | | | | - Christopher Wimer
- Columbia University, Center on Poverty and Social Policy, New York, NY USA
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11
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CURTIS DAVIDS, FULLER‐ROWELL THOMASE, CARLSON DANIELL, WEN MING, KRAMER MICHAELR. Does a Rising Median Income Lift All Birth Weights? County Median Income Changes and Low Birth Weight Rates Among Births to Black and White Mothers. Milbank Q 2022; 100:38-77. [PMID: 34609027 PMCID: PMC8932634 DOI: 10.1111/1468-0009.12532] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Policy Points Policies that increase county income levels, particularly for middle-income households, may reduce low birth weight rates and shrink disparities between Black and White infants. Given the role of aggregate maternal characteristics in predicting low birth weight rates, policies that increase human capital investments (e.g., funding for higher education, job training) could lead to higher income levels while improving population birth outcomes. The association between county income levels and racial disparities in low birth weight is independent of disparities in maternal risks, and thus a broad set of policies aimed at increasing income levels (e.g., income supplements, labor protections) may be warranted. CONTEXT Low birth weight (LBW; <2,500 grams) and infant mortality rates vary among place and racial group in the United States, with economic resources being a likely fundamental contributor to these disparities. The goals of this study were to examine time-varying county median income as a predictor of LBW rates and Black-White LBW disparities and to test county prevalence and racial disparities in maternal sociodemographic and health risk factors as mediators. METHODS Using national birth records for 1992-2014 from the National Center for Health Statistics, a total of approximately 27.4 million singleton births to non-Hispanic Black and White mothers were included. Data were aggregated in three-year county-period observations for 868 US counties meeting eligibility requirements (n = 3,723 observations). Sociodemographic factors included rates of low maternal education, nonmarital childbearing, teenage pregnancy, and advanced-age pregnancy; and health factors included rates of smoking during pregnancy and inadequate prenatal care. Among other covariates, linear models included county and period fixed effects and unemployment, poverty, and income inequality. FINDINGS An increase of $10,000 in county median income was associated with 0.34 fewer LBW cases per 100 live births and smaller Black-White LBW disparities of 0.58 per 100 births. Time-varying county rates of maternal sociodemographic and health risks mediated the association between median income and LBW, accounting for 65% and 25% of this estimate, respectively, but racial disparities in risk factors did not mediate the income association with Black-White LBW disparities. Similarly, county median income was associated with very low birth weight rates and related Black-White disparities. CONCLUSIONS Efforts to increase income levels-for example, through investing in human capital, enacting labor union protections, or attracting well-paying employment-have broad potential to influence population reproductive health. Higher income levels may reduce LBW rates and lead to more equitable outcomes between Black and White mothers.
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Affiliation(s)
| | | | | | - MING WEN
- University of UtahSalt Lake City
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12
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Gailey S, Knudsen ES, Mortensen LH, Bruckner TA. Birth outcomes following unexpected job loss: a matched-sibling design. Int J Epidemiol 2021; 51:858-869. [PMID: 34508593 DOI: 10.1093/ije/dyab180] [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: 10/06/2020] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Research documents social and economic antecedents of adverse birth outcomes, which may include involuntary job loss. Previous work on job loss and adverse birth outcomes, however, lacks high-quality individual data on, and variation in, plausibly exogenous job loss during pregnancy and therefore cannot rule out strong confounding. METHODS We analysed unique linked registries in Denmark, from 1980 to 2017, to examine whether a father's involuntary job loss during his spouse's pregnancy increases the risk of a low-weight (i.e. <2500 grams) and/or preterm (i.e. <37 weeks of gestational age) birth. We applied a matched-sibling design to 743 574 sibling pairs. RESULTS Results indicate an increased risk of a low-weight birth among infants exposed in utero to fathers' unexpected job loss [odds ratio (OR) = 1.37, 95% confidence interval (CI): 1.07, 1.75]. Sex-specific analyses show that this result holds for males (OR = 1.70, 95% CI: 1.14, 2.53) but not females (OR = 1.24, 95% CI: 0.80, 1.91). We find no relation with preterm birth. CONCLUSIONS Findings support the inference that a father's unexpected job loss adversely affects the course of pregnancy, especially among males exposed in utero.
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Affiliation(s)
- Samantha Gailey
- Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA
| | - Elias Stapput Knudsen
- Department of Technology, Management, and Economics, Technical University of Denmark, Copenhagen, Denmark
| | - Laust H Mortensen
- Denmark Statistics, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tim A Bruckner
- Program in Public Health, University of California Irvine, Irvine, CA, USA.,Center for Population, Inequality, and Policy, University of California Irvine, Irvine, CA, USA
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Palatnik A, Walker RJ, Thakkar MY, Egede LE. Social Adaptability Index and Pregnancy Outcomes in Women With Diabetes During Pregnancy. Diabetes Spectr 2021; 34:268-274. [PMID: 34511853 PMCID: PMC8387617 DOI: 10.2337/ds20-0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The social adaptability index (SAI) is a composite indicator capturing an individual's social adaptability within society and socioeconomic status to predict overall health outcomes. The objective of this analysis was to examine whether the SAI is an independent risk factor for adverse pregnancy outcomes in women with and without diabetes during pregnancy. METHODS Data from the 2011-2017 National Survey of Family Growth were analyzed using a cross-sectional methodology. Women aged 18-44 years with a singleton gestation were included in the analysis. Maternal diabetes was defined as either presence of pregestational diabetes or diagnosis of gestational diabetes. The SAI was developed from the following maternal variables: educational level, employment status, income, marital status, and substance abuse. A higher score indicated lower risk. A series of multivariable logistic regression models were run stratified by maternal diabetes status to assess the association between SAI and pregnancy outcomes, including cesarean delivery, macrosomia (birth weight ≥4,000 g) and preterm birth (<37 weeks). All analyses were weighted and P <0.05 was considered significant. RESULTS A total of 17,772 women were included in the analysis, with 1,965 (10.7%) having maternal diabetes during pregnancy. The SAI was lower in women with diabetes during pregnancy compared with control subjects (6.7 ± 0.2 vs. 7.2 ± 0.1, P <0.001). After adjusting for maternal race and ethnicity, insurance status, BMI, age, and partner support of the index pregnancy, SAI was associated with preterm birth among women with diabetes during pregnancy (adjusted odds ratio 0.83, 95% CI 0.72-0.94). The SAI was not significantly associated with cesarean delivery or macrosomia in women with diabetes during pregnancy and was not associated with these outcomes in women without diabetes during pregnancy. CONCLUSION Among women with diabetes during pregnancy, a higher SAI is independently associated with a lower risk of preterm birth. The SAI could be a useful index to identify women at high risk of preterm birth in addition to traditionally defined demographic risk groups among women with diabetes during pregnancy.
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Affiliation(s)
- Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Rebekah J. Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Madhuli Y. Thakkar
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
| | - Leonard E. Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
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Pollock EA, Gennuso KP, Givens ML, Kindig D. Trends in infants born at low birthweight and disparities by maternal race and education from 2003 to 2018 in the United States. BMC Public Health 2021; 21:1117. [PMID: 34112114 PMCID: PMC8193881 DOI: 10.1186/s12889-021-11185-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding current levels, as well as past and future trends, of the percentage of infants born at low birthweight (LBW) in the United States is imperative to improving the health of our nation. The purpose of this study, therefore, was to examine recent trends in percentage of LBW, both overall and by maternal race and education subgroups. Studying disparities in percentage of LBW by these subgroups can help to further understand the health needs of the population and can inform policies that can close race and class disparities in poor birth outcomes. METHODS Trends of percentage of LBW in the U.S. from 2003 to 2018, both overall and by race/ethnicity, and from 2007 to 2018 by education and race by education subgroups were analyzed using CDC WONDER Natality data. Disparities were analyzed using between group variance methods. RESULTS Percentage of LBW experienced a significant worsening in the most recent 5 years of data, negating nearly a decade of prior improvement. Stark differences were observed by race/ethnicity and by education, with all subgroups experiencing increasing rates in recent years. Disparities also worsened over the course of study. Most notably, all disparities increased significantly from 2014 to 2018, with annual changes near 2-5%. CONCLUSIONS Recent reversals in progress in percentage of LBW, as well as increasing disparities particularly by race, are troubling. Future study is needed to continue monitoring these trends and analyzing these issues at additional levels. Targets must be set and solutions must be tailored to population subgroups to effectively make progress towards equitable birth outcomes and maternal health.
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Affiliation(s)
- Elizabeth A Pollock
- University of Wisconsin Population Health Institute, University of Wisconsin Madison School of Medicine and Public Health, 610 N Walnut Street, Madison, WI, 53726, USA.
| | - Keith P Gennuso
- University of Wisconsin Population Health Institute, University of Wisconsin Madison School of Medicine and Public Health, 610 N Walnut Street, Madison, WI, 53726, USA
| | - Marjory L Givens
- University of Wisconsin Population Health Institute, University of Wisconsin Madison School of Medicine and Public Health, 610 N Walnut Street, Madison, WI, 53726, USA
| | - David Kindig
- University of Wisconsin Population Health Institute, University of Wisconsin Madison School of Medicine and Public Health, 610 N Walnut Street, Madison, WI, 53726, USA
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15
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African American Unemployment and the Disparity in Periviable Births. J Racial Ethn Health Disparities 2021; 9:840-848. [PMID: 33783756 PMCID: PMC9061667 DOI: 10.1007/s40615-021-01022-7] [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: 10/13/2020] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 11/16/2022]
Abstract
Periviable infants (i.e., born before 26 complete weeks of gestation) represent fewer than .5% of births in the US but account for 40% of infant mortality and 20% of billed hospital obstetric costs. African American women contribute about 14% of live births in the US, but these include nearly a third of the country’s periviable births. Consistent with theory and with periviable births among other race/ethnicity groups, males predominate among African American periviable births in stressed populations. We test the hypothesis that the disparity in periviable male births among African American and non-Hispanic white populations responds to the African American unemployment rate because that indicator not only traces, but also contributes to, the prevalence of stress in the population. We use time-series methods that control for autocorrelation including secular trends, seasonality, and the tendency to remain elevated or depressed after high or low values. The racial disparity in male periviable birth increases by 4.45% for each percentage point increase in the unemployment rate of African Americans above its expected value. We infer that unemployment—a population stressor over which our institutions exercise considerable control—affects the disparity between African American and non-Hispanic white periviable births in the US.
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Reynolds CME, McMahon LE, O'Malley EG, O'Brien O, Sheehan SR, Turner MJ. Maternal employment and pregnancy outcomes in a large European maternity hospital. Eur J Obstet Gynecol Reprod Biol 2020; 250:86-92. [PMID: 32413667 DOI: 10.1016/j.ejogrb.2020.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Epidemiological studies have previously reported that maternal socioeconomic disadvantage is associated with adverse feto-maternal outcomes. However, little attention has been paid to the question of the woman's employment status. The aim of this observational study was to examine the relationship between maternal employment status at the first antenatal visit and pregnancy outcomes. STUDY DESIGN The study was confined to women with a singleton pregnancy who attended for maternity care between the years 2010 and 2017 and delivered a baby weighing ≥500 g. Self-reported sociodemographic and clinical details were recorded at the first antenatal visit by a trained midwife and updated before hospital discharge. The hospital is one of the largest in Europe and accepts women from all socioeconomic groups, including women in the public system and those with private health insurance, across the rural-urban spectrum. RESULTS Of the 62,395 women, the mean age was 31.5 years (SD 5.4), 39.3% were nulliparas and 70.7% were Irish born. Compared with the 45,028 (72.2%) women who reported as being in paid employment, the 4984 (8.0%) women who were unemployed had a higher rate of stillbirth (8/4984 vs. 27/45,028, p = 0.005) and homemakers had a higher incidence of neonatal death (31/12,383 vs. 73/45,028, p = 0.02). On multivariable analysis, women who were unemployed or homemakers had increased adjusted odds ratios for neonatal unit (NNU) admissions, preterm birth, low birth weight, and small-for-gestational-age. Compared to women in paid employment, women who were unemployed or homemakers were associated with younger age (<30 years) in pregnancy, multiparity, unplanned pregnancy, no or postconceptional only folic acid supplementation, anxiolytic/antidepressant use, as well as persistent smoking and illicit drug use during pregnancy. CONCLUSIONS In a high-income European country, women who reported as unemployed or homemakers were associated with higher rates of adverse pregnancy outcomes. Furthermore, these women were associated with suboptimal lifestyle behaviours such as smoking and illicit drug use in early pregnancy. This highlights the need for long term public policies on female unemployment and retaining women with children in employment.
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Affiliation(s)
- Ciara M E Reynolds
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland.
| | - Léan E McMahon
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Eimer G O'Malley
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Oliver O'Brien
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Sharon R Sheehan
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
| | - Michael J Turner
- UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin, Ireland
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Mrejen M, Machado DC. In utero exposure to economic fluctuations and birth outcomes: An analysis of the relevance of the local unemployment rate in Brazilian state capitals. PLoS One 2019; 14:e0223673. [PMID: 31600322 PMCID: PMC6786569 DOI: 10.1371/journal.pone.0223673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/25/2019] [Indexed: 11/30/2022] Open
Abstract
Objective Analyze if in utero exposure to economic downturns is associated with worsened birth outcomes. Methods We used birth records from all live singleton births in the 27 Brazilian state capitals between October 2012 and December 2016 (n = 2,952,430) and linked them to local unemployment rates according to the mother’s residence. We estimated the association between different birth outcomes and the local unemployment rate in the three trimesters before birth. We included maternal characteristics and month, year and municipality fixed effects as covariates. We also estimated the association for different groups of mothers, based on marital status, educational level, age and race. Results A 1 p.p. increase in the local unemployment rate in the trimester before birth is associated with 2.68% higher odds of being born with very low birthweight (< 1500 grams) (OR: 1.0268, 95% CI: 1.0006–1.0536). That result is pushed by the effect among newborns from mothers younger than 24 (OR: 1.0684, 95%CI: 1.0353–1.1024), from mothers with 11 years of schooling or less (OR: 1.0477, 95% CI: 1.0245–1.0714), and from brown or black mothers (OR: 1.0387, 95%CI: 1.0156–1.0624). The associations among children born from younger, less educated and black or brown mothers are robust to the application of a procedure to control for multiple testing, albeit the results considering the whole sample are not. Conclusions Our study shows that there is an association between in utero exposure to higher unemployment rates during the last gestational trimester and the odds of being born with VLBW among children born from mothers younger than 24 years old, with less of 11 years of education and black or brown. These results suggest that children born from women of low socioeconomic status are more vulnerable to in utero exposure to economic downturns.
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Affiliation(s)
- Matias Mrejen
- Department of Economics, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
- * E-mail:
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The Great Recession and adverse birth outcomes: Evidence from California, USA. SSM Popul Health 2019; 9:100470. [PMID: 31649996 PMCID: PMC6804518 DOI: 10.1016/j.ssmph.2019.100470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/14/2019] [Accepted: 08/16/2019] [Indexed: 01/29/2023] Open
Abstract
Objectives Prior studies of the health effects of recessions have shown mixed results. Ecological studies often report a positive relationship between economic downturns and population health while individual-level studies often show that conditions related to recessions are deleterious. Our study examines the spatially and temporally heterogenous effects of the Great Recession (TGR) on adverse birth outcomes, a contemporaneous measure of population health that is highly responsive to changing social conditions. Methods We use restricted birth cohort data from California (2004–2012) merged with both county- and tract-level socio-demographic data, to explore birth selectivity and temporal and unemployment effects during TGR on adverse birth outcomes. Results We find that gestational exposure – more specifically, second trimester exposure – during or adjacent to the months of TGR was generally deleterious for birth outcomes, more so, in some cases, for mothers with lower levels of education, and that increases in county-level unemployment were generally deleterious for birth outcomes. Conclusions Although recessionary effects on population health are problematic and may have far-reaching effects, it appears that these effects may be largely universal, even given potential selective fertility favoring advantaged groups. We use restricted data from California to determine the effects of The Great Recession on adverse birth outcomes. We find that increases in unemployment are generally harmful to birth outcomes. We also find these effects to be largely universal and not differential in disparity populations.
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