Tyan Parker Dominguez

Racial Differences in Birth Outcomes : The Role of General, Pregnancy, and Racism Stress

OBJECTIVE This study examined the role of psychosocial stress in racial differences in birth outcomes. DESIGN Maternal health, sociodemographic factors, and 3 forms of stress (general stress, pregnancy stress, and perceived racism) were assessed prospectively in a sample of 51 African American and 73 non-Hispanic White pregnant women. MAIN OUTCOME MEASURES The outcomes of interest were birth weight and gestational age at delivery. Only predictive models of birth weight were tested as the groups did not differ significantly in gestational age. RESULTS Perceived racism and indicators of general stress were correlated with birth weight and tested in regression analyses. In the sample as a whole, lifetime and childhood indicators of perceived racism predicted birth weight and attenuated racial differences, independent of medical and sociodemographic control variables. Models within each race group showed that perceived racism was a significant predictor of birth weight in African Americans, but not in non-Hispanic Whites. CONCLUSIONS These findings provide further evidence that racism may play an important role in birth outcome disparities, and they are among the first to indicate the significance of psychosocial factors that occur early in the life course for these specific health outcomes.

‘‘It’s The Skin You’re In’’: African-American Women Talk About Their Experiences of Racism. An Exploratory Study to Develop Measures of Racism for Birth Outcome Studies

Objectives Stress due to experiences of racism could contribute to African-American women’s adverse birth outcomes, but systematic efforts to measure relevant experiences among childbearing women have been limited. We explored the racism experiences of childbearing African-American women to inform subsequent development of improved measures for birth outcomes research. Methods Six focus groups were conducted with a total of 40 socioeconomically diverse African-American women of childbearing age in four northern California cities. Results Women reported experiencing racism (1) throughout the lifecourse, with childhood experiences seeming particularly salient and to have especially enduring effects (2) directly and vicariously, particularly in relation to their children; (3) in interpersonal, institutional, and internalized forms; (4) across different life domains; (5) with active and passive responses; and (6) with pervasive vigilance, anticipating threats to themselves and their children. Conclusions This exploratory study’s findings support the need for measures reflecting the complexity of childbearing African-American women’s racism experiences. In addition to discrete, interpersonal experiences across multiple domains and active/passive responses, which have been measured, birth outcomes research should also measure women’s childhood experiences and their potentially enduring impact, perceptions of institutionalized racism and internalized negative stereotypes, vicarious experiences related to their children, vigilance in anticipating future racism events, as well as the pervasiveness and chronicity of racism exposure, all of which could be sources of ongoing stress with potentially serious implications for birth outcomes. Measures of racism addressing these issues should be developed and formally tested.

The Role of Socioeconomic Factors in Black–White Disparities in Preterm Birth

OBJECTIVES We investigated the role of socioeconomic factors in Black-White disparities in preterm birth (PTB). METHODS We used the population-based California Maternal and Infant Health Assessment survey and birth certificate data on 10 400 US-born Black and White California residents who gave birth during 2003 to 2010 to examine rates and relative likelihoods of PTB among Black versus White women, with adjustment for multiple socioeconomic factors and covariables. RESULTS Greater socioeconomic advantage was generally associated with lower PTB rates among White but not Black women. There were no significant Black-White disparities within the most socioeconomically disadvantaged subgroups; Black-White disparities were seen only within more advantaged subgroups. CONCLUSIONS Socioeconomic factors play an important but complex role in PTB disparities. The absence of Black-White disparities in PTB within certain socioeconomic subgroups, alongside substantial disparities within others, suggests that social factors moderate the disparity. Further research should explore social factors suggested by the literature-including life course socioeconomic experiences and racism-related stress, and the biological pathways through which they operate-as potential contributors to PTB among Black and White women with different levels of social advantage.

Differences in the self-reported racism experiences of US-born and foreign-born Black pregnant women.

Differential exposure to minority status stressors may help explain differences in United States (US)-born and foreign-born Black womens birth outcomes. We explored self-reports of racism recorded in a survey of 185 US-born and 114 foreign-born Black pregnant women enrolled in Project Viva, a prospective cohort study of pregnant women in Boston, Massachusetts, USA. Self-reported prevalence of personal racism and group racism was significantly higher among US-born than foreign-born Black pregnant women, with US-born women having 4.1 and 7.8 times the odds, respectively, of childhood exposure. In multivariate analyses, US-born womens personal and group racism exposure also was more pervasive across the eight life domains we queried. Examined by immigrant subgroups, US-born women were more similar in their self-reports of racism to foreign-born women who moved to the US before age 18 than to women who immigrated after age 18. Moreover, US-born women more closely resembled foreign-born women from the Caribbean than those from Africa. Differential exposure to self-reported racism over the life course may be a critically important factor that distinguishes US-born Black women from their foreign-born counterparts.

Adverse Birth Outcomes in African American Women: The Social Context of Persistent Reproductive Disadvantage

African Americans have the highest rates of infant mortality and adverse birth outcomes of all major racial/ethnic groups in the United States. The long-standing nature of this disparity suggests the need to shift epidemiologic focus from individual-level risk factors to the larger social forces that shape disease risk in populations. In this article, the African American reproductive disadvantage is discussed within the context of American race relations. The review of the literature focuses on racism as a social determinant of race-based disparities in adverse birth outcomes with specific attention to the viability of genetic explanations, the role of socioeconomic factors, the multidimensional nature of racism, and the stress-induced physiologic pathways by which racism may negatively affect pregnancy. Implications for social work research and practice also are discussed.

Stress and Blood Pressure During Pregnancy : Racial Differences and Associations With Birthweight

Objective: To extend findings that African American women report greater stress during pregnancy, have higher blood pressure (BP), and are twice as likely to have low birthweight infants relative to white women. This study examines a) racial differences in associations between stress and BP during pregnancy, and b) the combined effects of stress and BP on infant birthweight in a sample of 170 African American and white women. Methods: A prospective, longitudinal study of pregnant women was conducted in which measures of BP, stress, and other relevant variables were collected. Multiple measures of systolic and diastolic BP were taken at each of three points during pregnancy (18–20, 24–26, and 30–32 weeks gestation). Results: Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were positively associated with stress in pregnant African American women and not in pregnant white women. In analyses of birthweight, there were no main effects of BP or stress. However, a significant interaction demonstrated that, when stress was high, DBP was negatively associated with birthweight and a combination of high stress and high DBP predicted the lowest birthweight in the sample. Furthermore, African American women were twice as likely as white women to have a combination of high stress and high DBP. Conclusions: Racial differences in relationships between stress and BP, and the interactive effect of stress and DBP on birthweight together suggest that a high stress-high BP profile may pose a risk for lower birthweight among African American women, in particular, and possibly for all pregnant women. BP = blood pressure; DBP = diastolic blood pressure; SBP = systolic blood pressure; BMI = body mass index; Ms = means.

Communalism Predicts Prenatal Affect, Stress, and Physiology Better than Ethnicity and Socioeconomic Status

The authors examined the relevance of communalism, operationalized as a cultural orientation emphasizing interdependence, to maternal prenatal emotional health and physiology and distinguished its effects from those of ethnicity and childhood and adult socioeconomic status (SES). African American and European American women (N = 297) were recruited early in pregnancy and followed through 32 weeks gestation using interviews and medical chart review. Overall, African American women and women of lower socioeconomic backgrounds had higher levels of negative affect, stress, and blood pressure, but these ethnic and socioeconomic disparities were not observed among women higher in communalism. Hierarchical multivariate regression analyses showed that communalism was a more robust predictor of prenatal emotional health than ethnicity, childhood SES, and adult SES. Communalism also interacted with ethnicity and SES, resulting in lower blood pressure during pregnancy for African American women and women who experienced socioeconomic disadvantage over the life course. The effects of communalism on prenatal affect, stress, and physiology were not explained by depressive symptoms at study entry, perceived availability of social support, self-esteem, optimism, mastery, nor pregnancy-specific factors, including whether the pregnancy was planned, whether the pregnancy was desired after conception, or how frequently the woman felt happy to be pregnant. This suggests that a communal cultural orientation benefits maternal prenatal emotional health and physiology over and above its links to better understood personal and social resources in addition to economic resources. Implications of culture as a determinant of maternal prenatal health and well-being and an important lens for examining ethnic and socioeconomic inequalities in health are discussed.

Lifetime Racism and Blood Pressure Changes During Pregnancy: Implications for Fetal Growth

OBJECTIVE Research suggests that exposure to racism partially explains why African American women are 2 to 3 times more likely to deliver low birth weight and preterm infants. However, the physiological pathways by which racism exerts these effects are unclear. This study examined how lifetime exposure to racism, in combination with maternal blood pressure changes during pregnancy, was associated with fetal growth. METHODS African American pregnant women (n = 39) reported exposure to childhood and adulthood racism in several life domains (e.g., at school, at work), which were experienced directly or indirectly, meaning vicariously experienced when someone close to them was treated unfairly. A research nurse measured maternal blood pressure at 18 to 20 and 30 to 32 weeks gestation. Standardized questionnaires and trained interviewers assessed maternal demographics. Neonatal length of gestation and birth weight data were collected from medical charts. RESULTS Childhood racism interacted with diastolic blood pressure to predict birth weight. Specifically, women with two or more domains of indirect exposure to racism in childhood and increases in diastolic blood pressure between 18 and 32 weeks had lower gestational age adjusted birth weight than the other women. A similar pattern was found for direct exposure to racism in childhood. CONCLUSIONS Increases in diastolic blood pressure between the second and third trimesters predicted lower birth weight, but only when racism exposure in childhood (direct or indirect) was relatively high. Understanding pregnant African American womens lifetime direct and indirect experiences with racism in combination with prenatal blood pressure may improve identification of highest risk subgroups within this population.

Maternal familism predicts birthweight and asthma symptoms three years later

There are marked ethnic and socioeconomic differences in birthweight and childhood asthma, conditions which may be linked causally or via a third variable. Cultural resources are often credited with diminished health disparities in infancy and childhood among subsets of poor and minority populations; yet direct empirical tests of this hypothesis are needed. In this study, ethnicity, lifespan family socioeconomic position (FSEP), and the cultural resource of familism were compared as predictors of birthweight and expression of asthma symptoms (AE) by age three. Familism and lifespan FSEP were assessed in 4633 socioeconomically disadvantaged African Americans, White Americans, and Latinas upon giving birth, as was offspring birthweight. AE was assessed in offspring through age three. Asthma diagnosis by age three was likelier in very low (≤ 1500 g) and low (≤ 2500 g) birthweight infants compared to infants born at average (2501-3999 g) or larger (≥ 4000 g) birthweights. Asthma risk associated with lower birthweight was higher for Latinos (17-35%) and African Americans (19-23%) than for White Americans (13-14%). As predicted, maternal familism was higher among White Americans than among African Americans and Latinas, an effect that was largely driven by ethnic disparities in lifespan FSEP. Familism predicted continuous birthweight (p = .003) and AE (p = .001) by age three independently of ethnicity and lifespan FSEP accounting for appropriate control variables, including maternal biomedical risk, maternal acculturation, parental marital status, and infant sex. There was a 71-g gain in birthweight for every one-unit increase in familism. The protective effect of familism on AE by age three was strongest for participants of lower lifespan FSEP. Maternal familism is one cultural resource that may reduce reproductive and intergenerational health disparities in both U.S.- and foreign-born Americans. Consistent with our previous work, familism and other nonmaterial resources covary with material resources. Nevertheless, culture is distinguishable from lifespan FSEP and ethnicity, and has health implications beyond associations to ethnicity, lifespan FSEP, and related biomedical and sociodemographic factors.

Transmitting Trauma: A systematic review of vicarious racism and child health

Racism is a pervasive stressor. Although most research focuses on direct targets, racism can also have unintended victims. Because childrens lives are inevitably linked to the experiences of other individuals, and they are in critical phases of development, they are especially vulnerable to such stressors. Despite the growing body of literature on childrens direct exposure to racism, little is known about the relationship between vicarious racism (i.e. secondhand exposure to racism) and child health. To examine the state of this literature, we performed a systematic review and screened 1371 articles drawn from 7 databases, with 30 studies meeting inclusion criteria. For these 30, we reviewed research methodology, including conceptualization and measurement of vicarious exposure, sample characteristics, significant associations with child health outcomes, and mediators and/or moderators of those associations. Most studies were published after 2011 in urban areas in the U.S., employed longitudinal designs, and focused on African American populations. Socioemotional and mental health outcomes were most commonly reported with statistically significant associations with vicarious racism. While all studies examined racism indirectly experienced by children, there was no standard definition of vicarious racism used. We organize the findings in a schematic diagram illustrating indirectly-experienced racism and child health outcomes to identify current gaps in the literature and ways in which to bridge those gaps. To further the field, vicarious racism should be uniformly defined and directly measured using psychometrically validated tools. Future studies should consider using children as the informants and follow children into early adulthood to better understand causal mechanisms. Given the recent national exposure to racially-charged events, a deeper understanding of the association between vicarious racism and child health is crucial in fueling research-informed social action to help children, families, and communities exposed to racism. PROSPERO registration number: CRD42016039608.