Psychosocial Stress and Persistent Racial Disparities in Adverse Birth Outcomes

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Tyan Parker Dominguez, PhD, MPH, MSW
School of Social Work, University of Southern California

Published in: Health & Medicine, Spiritual
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  • Psychosocial Stress and Persistent Racial Disparities in Adverse Birth Outcomes

    1. 1. Tyan Parker Dominguez, PhD, MPH, MSWTyan Parker Dominguez, PhD, MPH, MSW School of Social WorkSchool of Social Work University of Southern CaliforniaUniversity of Southern California PSYCHOSOCIAL STRESS ANDPSYCHOSOCIAL STRESS AND PERSISTENT RACIALPERSISTENT RACIAL DISPARITIES IN ADVERSEDISPARITIES IN ADVERSE BIRTH OUTCOMESBIRTH OUTCOMES
    2. 2. 1)1) Review the nature of persistent racialReview the nature of persistent racial disparities in adverse birth outcomesdisparities in adverse birth outcomes 2)2) Discuss the stress and pregnancyDiscuss the stress and pregnancy paradigm, highlighting physiologicalparadigm, highlighting physiological mechanismsmechanisms 3)3) Present research findings from work onPresent research findings from work on stress and birth outcomesstress and birth outcomes OBJECTIVESOBJECTIVES
    3. 3. Infant MortalityInfant Mortality deaths before age 1 per 1000 live birthsdeaths before age 1 per 1000 live births OVERALL 6.8 NONHISPANIC WHITE 5.7 HISPANIC 5.4 ASIAN/PACIFIC ISLANDER 4.7 NONHISPANIC BLACK 13.5 Mathews, Menacker, & MacDorman, 2003Mathews, Menacker, & MacDorman, 2003
    4. 4. Preterm BirthPreterm Birth < 37 weeks gestation< 37 weeks gestation Martin, Hamilton, Sutton, Ventura, Menacker, & Munson, 2003Martin, Hamilton, Sutton, Ventura, Menacker, & Munson, 2003 OVERALL 12.1% NONHISPANIC WHITE 11.0% HISPANIC 11.6% ASIAN/PACIFIC ISLANDER 10.4% NONHISPANIC BLACK 17.7%
    5. 5. OVERALL 7.8% NONHISPANIC WHITE 6.9% HISPANIC 6.5% ASIAN/PACIFIC ISLANDER 7.8% NONHISPANIC BLACK 13.4% Martin, Hamilton, Sutton, Ventura, Menacker, & Munson, 2003Martin, Hamilton, Sutton, Ventura, Menacker, & Munson, 2003 Low BirthweightLow Birthweight < 2500 grams< 2500 grams
    6. 6. Disparity not explained by establishedDisparity not explained by established SociodemographicSociodemographic BehavioralBehavioral MedicalMedical risk factorsrisk factors Berkowitz & Papiernik, 1993; Collins & David, 1990; David & Collins, 1991; Frisbie, Biegler, de Turk, Forbes, & Pullum, 1997;Berkowitz & Papiernik, 1993; Collins & David, 1990; David & Collins, 1991; Frisbie, Biegler, de Turk, Forbes, & Pullum, 1997; Kleinman & Kessel, 1987; Shiono, Klebanoff, Graubard, Berendes, & Rhoads, 1986; Wise, 1993Kleinman & Kessel, 1987; Shiono, Klebanoff, Graubard, Berendes, & Rhoads, 1986; Wise, 1993
    7. 7. P s y c h o s o c i a l S t r e s sP s y c h o s o c i a l S t r e s s Environmental demands that tax orEnvironmental demands that tax or exceed the adaptive capacity of anexceed the adaptive capacity of an organism, resulting in physiologicalorganism, resulting in physiological and psychological changes that mayand psychological changes that may place the organism at risk forplace the organism at risk for diseasedisease Cohen, Kessler, & Gordon, 1995Cohen, Kessler, & Gordon, 1995
    8. 8. African-American pregnant women reportAfrican-American pregnant women report more stress exposure and greater emotionalmore stress exposure and greater emotional distress from that exposure than otherdistress from that exposure than other groupsgroups Feldman, Dunkel-Schetter, Woo & Hobel, 1997; Zambrana et al., 1999Feldman, Dunkel-Schetter, Woo & Hobel, 1997; Zambrana et al., 1999
    9. 9. A Biopsychosocial ModelA Biopsychosocial Model NeuroendocrineNeuroendocrine systemsystem ImmuneImmune systemsystem CardiovascularCardiovascular systemsystem STRESSSTRESS BirthBirth outcomesoutcomes
    10. 10. The health of minority groups is intimatelyThe health of minority groups is intimately connected to theconnected to the HIGH STRESS STATESHIGH STRESS STATES created by a social system that condones,created by a social system that condones, reinforces, and perpetuates racialreinforces, and perpetuates racial discrimination.discrimination. Myers, 1982 Negative Self-Society DialecticNegative Self-Society Dialectic
    11. 11. RACISM LINKED TORACISM LINKED TO Decreased life satisfactionDecreased life satisfaction PRETERM DELIVERYPRETERM DELIVERY LOW BIRTHWEIGHTLOW BIRTHWEIGHT INFANT MORTALITYINFANT MORTALITY Cardiovascular diseaseCardiovascular diseaseStrokeStroke High blood pressureHigh blood pressure Psychological distressPsychological distress DepressionDepression Lower self-esteemLower self-esteem
    12. 12. ALLOSTATIC LOADALLOSTATIC LOAD Physiologic toll of repeated and/or chronicPhysiologic toll of repeated and/or chronic stress system activationstress system activation StressStress BaselineBaseline RecoveryRecovery AllostasisAllostasis Allostatic LoadAllostatic Load BaselineBaseline McEwen & Stellar, 1993; Sterling & Eyer, 1988McEwen & Stellar, 1993; Sterling & Eyer, 1988
    13. 13. RACISM AND ADVERSERACISM AND ADVERSE PREGNANCY OUTCOMESPREGNANCY OUTCOMES A Program of ResearchA Program of Research
    14. 14. • Prospective, repeated measures surveyProspective, repeated measures survey • Psychosocial, medical, physiological variablesPsychosocial, medical, physiological variables • 480 ethnically/SES diverse pregnant women480 ethnically/SES diverse pregnant women • Recruited in clinics or referred by MDsRecruited in clinics or referred by MDs • Fluent EnglishFluent English • >> 18 yrs18 yrs • << 18 wks gestation, non substance using18 wks gestation, non substance using Multi-Site Behavior in Pregnancy StudyMulti-Site Behavior in Pregnancy Study 1997-20021997-2002
    15. 15. STUDY 1 Does stress mediate racial differences in birth outcomes? Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2005
    16. 16. N = 124N = 124  African-American (n=51)African-American (n=51) Nonhispanic White (n=73)Nonhispanic White (n=73)  Born and raised in U.S.Born and raised in U.S.  Live-born infantLive-born infant  T1, T2, birth outcome dataT1, T2, birth outcome data STUDY SAMPLESTUDY SAMPLE
    17. 17. RACISM EXPOSURERACISM EXPOSURE • personal/vicarious experiencespersonal/vicarious experiences • childhood/adulthoodchildhood/adulthood • across different life domainsacross different life domains Have you ever felt that you (or someone close toHave you ever felt that you (or someone close to you) were (was) discriminated against or the targetyou) were (was) discriminated against or the target of prejudice because of race in interpersonal,of prejudice because of race in interpersonal, housing, employment, educational, other situations?housing, employment, educational, other situations?
    18. 18. Sobel test of mediation = -1.64, p < .10 (one-tailed) Mediation Models DV = BW Step 1 Step 2 Step 3 GA .65*** .67*** .65** Medrisk .05 .03 .04 Spont. Labor -.01 -.00 .01 Parents’ Educ .06 .03 .05 Race -.18* -.13+ Racism-Life -.13+
    19. 19. Sobel test of mediation = -1.97, p < .05 (one-tailed) Mediation Models DV = BW Step 1 Step 2 Step 3 GA .65*** .67*** .64** Medrisk .05 .03 .03 Spont. Labor -.01 -.00 .02 Parents’ Educ .06 .03 .05 Race -.18* -.13+ Racism-ChV -.16*
    20. 20. K E Y F I N D I N G Racism exposure, particularly vicarious childhood experiences, predicts BW and attenuates race effects on BW, controlling for confounders
    21. 21. STUDY 2 Are there physiological factors that link racism to birth outcomes? Parker Dominguez, Hilmert, Dunkel Schetter, Glynn, Sandman, & Hobel, 2005
    22. 22. C R H A C T H C O R T I S O L Assayed from blood at 10-12 weeks, 18-20 weeks, 24-26 weeks, 30-32 weeks, and 34-36 weeks gestation Neuroendocrine VariablesNeuroendocrine Variables ++ -- mothermother ++ ++ placentaplacenta
    23. 23. NE levels rise across pregnancy course in both ethnic groups ETHNIC COMPARISON Evidence of possible NE dysregulation in African Americans: - high ACTH, low CRH and Cortisol - smaller level of change in CRH and Cortisol HOWEVERHOWEVER
    24. 24. Racism, NE Function and BW Vicarious Childhood Exposure + CRH 34-36 weeks Birthweight
    25. 25. Sobel_ChV = -1.91, p < .05; Sobel_NE = -1.71, p < .05 Mediation Models DV = BW Step 1 Step 2 Step 3 GA .53*** .50*** .51** Medrisk .17 .15 .10 Spont. Labor .00 .02 .02 Parents’ Educ .06 .10 .08 Race -.30** -.22* -.22+ Racism-ChV -.22* -.16+ CRH 32-36wks .20*
    26. 26. K E Y F I N D I N G S 1. Evidence of NE dysregulation in AfrAms 2. Racism associated with AfrAm NE pattern 3. Late term CRH predicts BW and mediates ChV racism effects on BW
    27. 27. STUDY 3 Are there differences across multiple racial/ethnic groups in exposure to and impact of racism? Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2004
    28. 28. 7070 LatinasLatinas 177177 Nonhispanic WhitesNonhispanic Whites 2525 Asian/Pacific IslandersAsian/Pacific Islanders 5151 African-AmericansAfrican-Americans with racism datawith racism data MS-BIPS SAMPLE consisted ofMS-BIPS SAMPLE consisted of
    29. 29. Variable AfrAm API Latina White p-value DSCR_C 3.2(3.2) 3.1(2.4) 1.4(1.9) 1.0(1.7) 0.000 DSCR_D 72.5% 88.0% 54.3% 40.7% 0.000 RACISM EXPERIENCESRACISM EXPERIENCES LIFETIMELIFETIME Unadj: APIs & AfrAms / Latinas & Whites Adj: Latinas / Whites Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2004Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2004
    30. 30. DISTRESSDISTRESS AfrAms and Latinas were significantly less distressed than APIs and Whites
    31. 31. RESPONSERESPONSE •AfrAms significantly more likely to keep racism experiences to themselves •AfrAms significantly more likely to accept unfair treatment as a fact of life
    32. 32. Associations with RacismAssociations with Racism VariableVariable rr bb PSSPSS 0.270.27**** 0.230.23**** STAISTAI 0.300.30**** 0.300.30**** Preg AnxPreg Anx 0.240.24**** 0.220.22**** CES-DCES-D 0.180.18**** 0.150.15** ResourcesResources -0.14-0.14** -0.14-0.14** * p<0.05, ** p<0.01* p<0.05, ** p<0.01 Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2004Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2004
    33. 33. Associations with RacismAssociations with Racism VariableVariable rr bb BWBW -0.13-0.13** -0.08-0.08 GAGA -0.12-0.12** -0.10-0.10 *p<0.05*p<0.05 Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2004Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2004
    34. 34. Interaction EffectsInteraction Effects β = .22, p < .05 APIs: β = .07, p > .10 AfrAms: β = -.36, p < .05 Racism and BW African Americans X APIs
    35. 35. K E Y F I N D I N G S • Ethnic differences in racism exposure,Ethnic differences in racism exposure, distress, and copingdistress, and coping • Racism impacts psychosocial fx of allRacism impacts psychosocial fx of all groupsgroups • Evidence race may moderate racismEvidence race may moderate racism effects on birth outcomeseffects on birth outcomes
    36. 36. Improved racism measuresImproved racism measures Multi-level studiesMulti-level studies Lifespan ApproachLifespan Approach CBPRCBPR Interdisciplinary teamsInterdisciplinary teams Looking ahead…..
    37. 37. Christine Dunkel SchetterChristine Dunkel Schetter Department of Psychology, UCLADepartment of Psychology, UCLA Laura GlynnLaura Glynn Department of Psychiatry, UC-IrvineDepartment of Psychiatry, UC-Irvine Calvin J. HobelCalvin J. Hobel Department of Maternal/Fetal Med, Cedars-SinaiDepartment of Maternal/Fetal Med, Cedars-Sinai Curt SandmanCurt Sandman Department of Psychiatry, UC-IrvineDepartment of Psychiatry, UC-Irvine AcknowledgementsAcknowledgements

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