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Omowale SS, Gary-Webb TL, Wallace ML, Wallace JM, Rauktis ME, Eack SM, Mendez DD. Stress during pregnancy: An ecological momentary assessment of stressors among Black and White women with implications for maternal health. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221126808. [PMID: 36148967 PMCID: PMC9510975 DOI: 10.1177/17455057221126808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Stress can lead to adverse physiological and psychological outcomes. Therefore, understanding stress during pregnancy provides insight into racial disparities in maternal health, particularly Black maternal health. OBJECTIVES This study aimed to describe (1) daily exposure to self-reported stress levels during pregnancy, and (2) sources of stress among participants that identified as Black or White using data collected via ecological momentary assessment. METHODS We leveraged survey data from the Postpartum Mothers Mobile Study, a prospective longitudinal study using ecological momentary assessment data collection methods to describe patterns of stress during pregnancy. This article is descriptive and documents patterns of self-reported stress levels and sources of stress. Frequencies and percentages of stress responses were computed to describe these patterns. RESULTS The sample (n = 296) was 27% Black (n = 78) and 63% White (n = 184). Results were based on at least one measurement of that stress level during pregnancy. A similar number of Black and White participants reported no stress during pregnancy. White (85%-95%) and Black (60%-70%) participants reported low to moderate levels of stress. Black participants (38%) and White participants (35%) reported experiencing high stress. Black and White participants reported similar sources of stress: stress from a partner, too many things to do, a baby or other children, and financial concerns. White participants reported work as a top stressor, and Black participants reported financial issues as a top source of stress. CONCLUSION This study provides insight into daily exposure to stress that has implications for maternal health. We described patterns of self-reported stress and sources of stress among Black and White participants. The daily exposures to stress reported by this sample exist within a context of root causes of structural inequities in education, health care, income, wealth, and housing that must be addressed to achieve maternal health equity.
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Affiliation(s)
- Serwaa S Omowale
- California Preterm Birth Initiative,
University of California San Francisco, San Francisco, CA, USA,Department of Obstetrics, Gynecology
& Reproductive Sciences, School of Medicine, University of California San
Francisco, San Francisco, CA, USA,School of Social Work, University of
Pittsburgh, Pittsburgh, PA, USA
| | - Tiffany L Gary-Webb
- Department of Epidemiology, School of
Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - John M Wallace
- School of Social Work, University of
Pittsburgh, Pittsburgh, PA, USA
| | - Mary E Rauktis
- School of Social Work, University of
Pittsburgh, Pittsburgh, PA, USA
| | - Shaun M Eack
- School of Social Work, University of
Pittsburgh, Pittsburgh, PA, USA
| | - Dara D Mendez
- Department of Epidemiology, School of
Public Health, University of Pittsburgh, Pittsburgh, PA, USA,Department of Behavioral and Community
Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA,
USA,Division of General Internal Medicine,
School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA,Dara D Mendez, Department of Epidemiology,
School of Public Health, University of Pittsburgh, 5130 Public Health, 130 De
Soto Street, Pittsburgh, PA 15261, USA.
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Goldfarb SS, Houser K, Wells BA, Brown Speights JS, Beitsch L, Rust G. Pockets of progress amidst persistent racial disparities in low birthweight rates. PLoS One 2018; 13:e0201658. [PMID: 30063767 PMCID: PMC6067759 DOI: 10.1371/journal.pone.0201658] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 07/19/2018] [Indexed: 01/10/2023] Open
Abstract
Racial disparities persist in adverse perinatal outcomes such as preterm birth, low birthweight (LBW), and infant mortality across the U.S. Although pervasive, these disparities are not universal. Some communities have experienced significant improvements in black (or African American) birth outcomes, both in absolute rates and in rate ratios relative to whites. This study assessed county-level progress on trends in black and white LBW rates as an indicator of progress toward more equal birth outcomes for black infants. County-level LBW data were obtained from the 2003 to 2013 U.S. Natality files. Black LBW rates, black-white rate ratios and percent differences over time were calculated. Trend lines were first assessed for significant differences in slope (i.e., converging, diverging, or parallel trend lines). For counties with parallel trend lines, intercepts were tested for statistically significant differences (sustained equality vs. persistent disparities). To assess progress, black LBW rates were compared to white LBW rates, and the trend lines were tested for significant decline. Each county's progress toward black-white equality was ultimately categorized into five possible trend patterns (n = 408): (1) converging LBW rates with reductions in the black LBW rate (decreasing disparities, n = 4, 1%); (2) converging LBW rates due to worsening white LBW rates (n = 5, 1%); (3) diverging LBW rates (increasing disparities, n = 9, 2%); (4) parallel LBW rates (persistent disparities, n = 373, 91%); and (5) overlapping trend lines (sustained equality, n = 18, 4%). Only four counties demonstrated improvement toward equality with decreasing black LBW rates. There is significant county-level variation in progress toward racial equality in adverse birth outcomes such as low birthweight. Still, some communities are demonstrating that more equitable outcomes are possible. Further research is needed in these positive exemplar communities to identify what works in accelerating progress toward more equal birth outcomes.
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Affiliation(s)
- Samantha S. Goldfarb
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, United States of America
| | - Kelsey Houser
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, United States of America
| | - Brittny A. Wells
- Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, United States of America
| | - Joedrecka S. Brown Speights
- Department of Family Medicine and Rural Health, College of Medicine, Florida State University, Tallahassee, FL, United States of America
| | - Les Beitsch
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, United States of America
- Center for Medicine and Public Health, College of Medicine, Florida State University, Tallahassee, FL, United States of America
| | - George Rust
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, United States of America
- Center for Medicine and Public Health, College of Medicine, Florida State University, Tallahassee, FL, United States of America
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González-Jiménez J, Rocha-Buelvas A. Risk factors associated with low birth weight in the Americas: literature review. REVISTA DE LA FACULTAD DE MEDICINA 2018. [DOI: 10.15446/revfacmed.v66n2.61577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. El bajo peso al nacer (BPN) es uno de los principales factores de riesgo que afecta la morbimortalidad infantil en todo el mundo; cerca de 1/3 de las muertes neonatales son atribuibles a este.Objetivo. Revisar los artículos más relevantes sobre BPN en las Américas en el periodo de 2010-2016.Materiales y métodos. Revisión narrativa de literatura. La información se obtuvo de las bases de datos PubMed, SciELO, LILACS, Portal Regional da BVS, con el uso de los descriptores DeCS y MeSH.Resultados. La mayoría de los estudios fueron publicados entre el 2012 y el 2015. De los 27 artículos publicados, 11 (40.7%) fueron atribuidos a factores sociodemográficos, 9 (33.3%) a riesgos ambientales, 3 (11.1%) a factores conductuales, 2 (7.4%) a controles prenatales o por cobertura y 2 (7.4%) se interrelacionaban con otros factores de riesgo.Conclusión. La mayoría de los estudios coinciden en la asociación de factores sociodemográficos, biológicos y conductuales. Los estudios que refieren la asociación de BPN con factores de riesgo ambientales están tomando fuerza.
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Loggins Clay S, Griffin M, Averhart W. Black/White disparities in pregnant women in the United States: An examination of risk factors associated with Black/White racial identity. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:654-663. [PMID: 29488271 DOI: 10.1111/hsc.12565] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/24/2018] [Indexed: 06/08/2023]
Abstract
This paper explores racial disparities and risk factors of adverse pregnancy outcomes in Black and White pregnant women in the US. The study uses a cross-sectional approach to explore Black and White disparities using data from the 2012 National Survey on Drug Use and Health (NSDUH), which collects interview data from approximately 70,000 randomly selected participants. We included several self-reported conditions that we categorised as individual and social stressors (e.g. measures of institutionalised racism, individual health behaviours, access to quality care and social context factors). We used descriptive statistics, univariate and multivariate analyses in risk factors of adverse pregnancy outcomes between Black and White women. Black women who were pregnant had a lower socioeconomic status and experienced more measures of institutionalised racism compared to White women who were pregnant. More white women who were pregnant were married, had higher levels of educational attainment, higher income levels, and greater employment opportunities. White pregnant women also had higher levels of private health insurance and less dependency on government programmes for access to healthcare. Results from the regressions indicated that Black pregnant women were less likely to be married (OR = 0.01), less likely to have higher income levels (OR = 0.31) and less likely to be employed (OR = 0.52). However, Black pregnant women were more likely to be younger (OR = 1.82). For the health-eroding behaviours, Black pregnant women were less likely to smoke (OR = 0.53) and use alcohol (0.52). After assessing the SES Household-level stressors (access to healthcare), Black pregnant women were more likely to have Medicaid/CHIP (OR = 3.21) and health coverage through government assistant programmes (OR = 3.80); however, less likely to have private health insurance (OR = 0.38). There are differences in risk factors of adverse pregnancy outcomes between White and Black pregnant women based on measures of individual level/social stressors, institutionalised racism, health behaviours and access to care.
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Affiliation(s)
- Shondra Loggins Clay
- Counseling Center, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Marquianna Griffin
- Chapin Hall Center for Children, Data and Research Technology Liason, Oak Park, IL, USA
| | - Wanda Averhart
- Department of Pediatrics' General Pediatrics Division, University of Florida, Gainesville, FL, USA
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