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70 Latinas. 177 Nonhispanic Whites. 25 Asian/Pacifi

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70 Latinas. 177 Nonhispanic Whites. 25 Asian/Pacific Islanders ... AfrAms and Latinas were significantly less distressed than APIs and Whites. RESPONSE ... – PowerPoint PPT presentation

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Title: 70 Latinas. 177 Nonhispanic Whites. 25 Asian/Pacifi


1
PSYCHOSOCIAL STRESS AND PERSISTENT RACIAL
DISPARITIES IN ADVERSE BIRTH OUTCOMES
  • Tyan Parker Dominguez, PhD, MPH, MSW
  • School of Social Work
  • University of Southern California

2
OBJECTIVES
  • Review the nature of persistent racial
    disparities in adverse birth outcomes
  • Discuss the stress and pregnancy paradigm,
    highlighting physiological mechanisms
  • Present research findings from work on stress and
    birth outcomes

3
Infant Mortalitydeaths before age 1 per 1000
live births
Mathews, Menacker, MacDorman, 2003
4
Preterm Birthlt 37 weeks gestation
Martin, Hamilton, Sutton, Ventura, Menacker,
Munson, 2003
5
Low Birthweightlt 2500 grams
Martin, Hamilton, Sutton, Ventura, Menacker,
Munson, 2003
6
Disparity not explained by established
Sociodemographic Behavioral Medic
al risk factors
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, 1993
7
P s y c h o s o c i a l S t r e s s
Environmental demands that tax or exceed the
adaptive capacity of an organism, resulting in
physiological and psychological changes that may
place the organism at risk for disease Cohen,
Kessler, Gordon, 1995

8

African-American pregnant women report more
stress exposure and greater emotional distress
from that exposure than other groups
Feldman, Dunkel-Schetter, Woo Hobel, 1997
Zambrana et al., 1999
9
A Biopsychosocial Model
Neuroendocrine system
Birth outcomes
Immune system
STRESS
Cardiovascular system
10
Negative Self-Society Dialectic
The health of minority groups is intimately
connected to the HIGH STRESS STATES created by
a social system that condones, reinforces, and
perpetuates racial discrimination.
Myers, 1982
11
RACISM LINKED TO

Decreased life satisfaction
Psychological distress
Depression
High blood pressure
Lower self-esteem
Cardiovascular disease
Stroke
INFANT MORTALITY
PRETERM DELIVERY
LOW BIRTHWEIGHT
12
ALLOSTATIC LOAD
Physiologic toll of repeated and/or chronic
stress system activation
Allostasis
Allostatic Load
Stress
Recovery
Baseline
Baseline
McEwen Stellar, 1993 Sterling Eyer, 1988
13
RACISM AND ADVERSE PREGNANCY OUTCOMES A Program
of Research
14
Multi-Site Behavior in Pregnancy Study
1997-2002
  • Prospective, repeated measures survey
  • Psychosocial, medical, physiological variables
  • 480 ethnically/SES diverse pregnant women
  • Recruited in clinics or referred by MDs
  • Fluent English
  • gt 18 yrs
  • lt 18 wks gestation, non substance using

15
STUDY 1 Does stress mediate racial differences
in birth outcomes?
Parker Dominguez, Dunkel Schetter, Glynn, Hobel,
Sandman, 2005
16
STUDY SAMPLE
  • N 124
  • African-American (n51) Nonhispanic White (n73)
  • Born and raised in U.S.
  • Live-born infant
  • T1, T2, birth outcome data

17
RACISM EXPOSURE
  • personal/vicarious experiences
  • childhood/adulthood
  • across different life domains

Have you ever felt that you (or someone close to
you) were (was) discriminated against or the
target of prejudice because of race in
interpersonal, housing, employment, educational,
other situations?
18
Mediation Models
Sobel test of mediation -1.64, p lt .10
(one-tailed)
19
Mediation Models
Sobel test of mediation -1.97, p lt .05
(one-tailed)
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
STUDY 2 Are there physiological factors that
link racism to birth outcomes?
Parker Dominguez, Hilmert, Dunkel Schetter,
Glynn, Sandman, Hobel, 2005
22
Neuroendocrine Variables
  • 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

- mother

placenta

23
ETHNIC COMPARISON
NE levels rise across pregnancy course in both
ethnic groups

HOWEVER
Evidence of possible NE dysregulation in African
Americans - high ACTH, low CRH and Cortisol -
smaller level of change in CRH and Cortisol
24
Racism, NE Function and BW

Vicarious Childhood Exposure
CRH 34-36 weeks
Birthweight
25
Mediation Models
Sobel_ChV -1.91, p lt .05 Sobel_NE -1.71, p
lt .05
26
  • K E Y F I N D I N G S
  • Evidence of NE dysregulation in AfrAms
  • Racism associated with AfrAm NE pattern
  • Late term CRH predicts BW and mediates ChV racism
    effects on BW

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
MS-BIPS SAMPLE consisted of
  • 70 Latinas
  • 177 Nonhispanic Whites
  • 25 Asian/Pacific Islanders
  • African-Americans
  • with racism data

29
RACISM EXPERIENCES
LIFETIME
Variable AfrAm API
Latina White p-value
Unadj APIs AfrAms / Latinas Whites Adj
Latinas / Whites
Parker Dominguez, Dunkel Schetter, Glynn, Hobel,
Sandman, 2004
30
DISTRESS

AfrAms and Latinas were significantly less
distressed than APIs and Whites
31
RESPONSE
  • AfrAms significantly more likely to keep racism
    experiences to themselves
  • AfrAms significantly more likely to accept unfair
    treatment as a fact of life

32
Associations with Racism
plt0.05, plt0.01
Parker Dominguez, Dunkel Schetter, Glynn, Hobel,
Sandman, 2004
33
Associations with Racism
plt0.05
Parker Dominguez, Dunkel Schetter, Glynn, Hobel,
Sandman, 2004
34
Interaction Effects

African Americans X APIs
b .22, p lt .05 APIs b .07, p gt .10 AfrAms
b -.36, p lt .05
Racism and BW
35
  • K E Y F I N D I N G S
  • Ethnic differences in racism exposure,
  • distress, and coping
  • Racism impacts psychosocial fx of all groups
  • Evidence race may moderate racism effects on
    birth outcomes

36
Looking ahead..
  • Improved racism measures
  • Multi-level studies
  • Lifespan Approach
  • CBPR
  • Interdisciplinary teams

37
Acknowledgements
  • Christine Dunkel Schetter
  • Department of Psychology, UCLA
  • Laura Glynn
  • Department of Psychiatry, UC-Irvine
  • Calvin J. Hobel
  • Department of Maternal/Fetal Med, Cedars-Sinai
  • Curt Sandman
  • Department of Psychiatry, UC-Irvine
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