Developing measures of racism relevant to childbearing women

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Developing measures of racism relevant to
childbearing women

• Amani Nuru-Jeter, PhD
• Aimee Afable-Munsuz, PhD
• Susan Egerter, PhD
• Marilyn Skaff, PhD
• Paula Braveman, MD,
• and the
• Measures of Racism and Social Position
• Working Group
• December 9, 2005

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Outline

• Background
• Research objectives
• Conceptual framework
• Research methods
• Results
• Next steps
• Remaining questions

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US Preterm Birth Rate
Source National Center for Health Statistics,
final natality data. Prepared by the March of
Dimes Perinatal Data Center, 2000
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Racial disparities in reproductive health outcomes

• Disparity not fully explained
• Known risk factors explain 50 of the risk
  differential
• Disparity is greater at higher SES
• Role of social context
• Eco-social perspective (Krieger)
• Contextual factors ? pregnancy outcomes (e.g.,
  area poverty/SES, unemployment, income
  incongruity, racial density)
• Perceived racism potential race-related
  stressor

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Perceived racism and pregnancy outcomes

• 9 studies examining relationship between
  perceived racism and pregnancy outcomes
• 3X higher odds of VLBW (Collins et al 2000
  Collins et al 2004)
• Increased risk of preterm birth (Rosenberg et al
  2000 Dole et al 2003)
• Feeling a need to protect children from racism
  and racism in the workplace ? distress (Jackson
  et al 2001)
• Hypothesized perceived racism prior to and
  during pregnancy ? adverse pregnancy outcomes
• Other studies
• Psychosocial stress ? LBW among blacks (Orr et al
  1996)
• Hypothesized racism and psychosocial factors
  (e.g., coping style) ? adverse pregnancy outcomes
  (David and Collins 1991)

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Research objectives

• To better understand the range of life-course
  experiences of perceived racism among
  African-American women of childbearing age.
• To systematically develop a reliable and
  validated measure of perceived racism as a tool
  for pregnancy outcome studies.

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Conceptual framework

• Levels of Racism (Jones 2000)
• Internalized acceptance of negative
  stereotypes/images
• Personally-mediated acute and chronic/ episodic
  interpersonal experiences
• Institutional differential access to goods,
  services, and opportunities
• Stress and coping
• Exposure and emotional/behavioral response
  (McNeilly et al 1996 Krieger 1990 Harrell 2000)
• Exposure, appraisal, response framework (Selye
  1956)
• Stress-response process (e.g., CRH and HPA axis)
• Life-course (cumulative) approach

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Methods

• Measures of Racism and Social Position Working
  Group
• UCSF Center on Social Disparities in Health
• CDC partners
• Berkeley and Sacramento Divisions of Public
  Health and the San Francisco Department of
  Public Health
• Organized community groups (BIH, WIC, Youth
  Alive, etc.)
• 5 phases
• 1. Literature review
• 2. Focus groups for initial constructs/domains
  and questions
• 3. Analysis to develop measures for testing
• 4. Psychometric testing (reliability and
  validity)
• 5. Recommend measures

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Phase 1 Literature review

• How well do existing measures capture
• Levels of racism
• Stress coping response
• Lifecourse exposure
• Validity and reliability
• 21 measures
• 2 captured 3 levels of racism
• 4 capture stress and coping response
• 2 capture lifecourse experience/exposure
• 13 have been psychometrically tested
• No overlaps!

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Phase 2 Participants

• 8 focus groups of 5 to 10 African American
  participants each (N43)
• 2 teen groups (Oak, Sac)
• 6 adult groups (2 Berk, 2 Sac, 1 SF, 1 Oak)
• Low and moderate/high-SES black women with
  children lt 15 years old
• Low and moderate/high-SES black teens (13-18 yrs)
  
• Northern California region Berkeley, Sacramento,
  Oakland, San Francisco
• SES markers participation in programs for
  low-income (e.g., WIC, BIH), professional
  groups/networks, private school

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Focus group guide

• Semi-structured focus group guide
• Levels of racism
• Stress and coping
• Life-course
• Probes
• Setting (e.g., work, school, public, home,
  neighborhood)
• Frequency, chronicity, intensity
• Personal vs. vicarious (individual and/or group
  PGDD)

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Analysis

• 6 coders independently analyzed 8 transcripts for
  thematic content
• Coding manually and software
• Unit of analysis words and phrases
• Coding layers edge coding, thematic coding,
  pattern coding
• Codebook development consensus building
• Frequencies of agreement
• Re-analyze data using software and codebook
• pull out language describing themes
• Use language for item development

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Phase 3 Preliminary Results

• Anticipatory racism
• Racial identity
• Direct/vicarious
• Concern for children
• Coping response (emotional, cognitive,
  behavioral)
• Physical response
• Lifestage of experience
• Chronicity
• Pervasiveness
• Contextualized experience

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Anticipatory Racism

• Necessity to be prepared for possibility of being
  treated differently because of race. (e.g., how
  often do you think about your race?)
• I expect it racism to happen everyday. (low
  SES, Sacramento)
• Its a constant thing that we Blacks have to
  deal with (low SES, Berkeley)
• Its everyday life, its going to be there. If
  you try to ignore it, its going to be there.
  (low SES, Sacramento)

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Racial identity/GroupConnectedness

• How connected one feels to other AAs.
• Because it was a black mother because they
  already look down on us and we dont need to give
  them more reason to do so.
• (mod SES, Berkeley)
• We already have this reputation, dont give them
  a reason to treat me different when I get up to
  them, or to look down on us. (mod SES, Berkeley)

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Direct personal experiences

• Direct/personal experiences with perceived racism
  (covered by existing measures but not across
  lifecourse)
• I was walking down the street and a white woman
  grabbed her purse.thats something you always
  feelbecause no matter what you have, youre
  black first.they will kiss your behind as long
  as you have money but they still see a nigger
• (low SES, Berkeley)

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Vicarious experiences

• Indirect experience with perceived racism
  (individual or group).
• My brother, he stays in trouble. But in our
  neighborhood, he was about 14 and were not even
  a year apart, but they arrested him at AM/PM and
  they had the description when they arrested him
  of a black man in a black coat with braids. Do
  you know how many people that is in our
  neighborhood?
• (mod SES, Sacramento)

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Concern for children

• I remember looking at my baby, he had to be
  about 2, I remember looking at him and saying oh
  my God, what have I done? And thats a sad, sad,
  sad feeling when you bring...because your child
  is supposed to be the happiest thing that you
  have on this earth and Im looking at him going
  what have I done? My child is going to have to
  go through this life being black.
• (mod SES Sacramento)
• I think about it everyday. More than myself, I
  think about the fact that my daughter is black.
• (mod SES, Sacramento)

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Concern for children

• Racism has affected me differently at different
  stages. As a child having best friends that did
  not look like me affected me. I wanted to have
  blonde hair and blue eyes like my friend. In
  high school going from the white school to the
  black school and feeling fearbecause having all
  that social stigma, stereotyped stuff inside
  saying that theres something wrong with us but
  trust me, the pressure of racism is a tripI
  instill this to my childrenIve heard my son say
  to me, why dont I have blue eyes? And I look at
  him because I have brown eyes and your daddy has
  brown eyes, thats why you brown eyes. And be
  proud that you have beautiful brown eyes and
  nappy hair. So constantly having to fight
  against that and educating.
• (high SES, Sacramento)

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Emotional coping response

• When youre working your hardest to get to a
  place in life where you want to be, and you see
  white people or people other than blacks getting
  ahead so quickly, it starts to wear on you where
  you get depressed and you start thinking bad
  thoughts, and wondering if youre really a valued
  part of society. (mod SES Sac)
• Realistically, its going to affect youit does
  bother you, you just put it in a different place.
  (low SES Berkeley)

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Cognitive coping response

• So everyday I have to deal with that racism so
  its stressful. I take that in internally. Its
  subtleits like hidden, but you feel it still.
  So I feel like I feel it everyday. And its more
  so because Ive got kids I think.
• (low SES teens, Oakland)
• I think that when it happens to you so much that
  you not necessarily learn to accept it, but you
  learn to not trip off of it no more.
• (low SES teens, Oakland)
• Youve just got to work harder I guess. (low SES
  teens, Oakland)

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Behavioral coping response

• I will take forever to find something to wear
  because I feel Im not going to be treated right
  when I go shopping. It makes me feel bad and sad
• (impression management)

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Physical (bodily) response

• My heart starts beating fast (low SES, SF)
• My stomach. My, like my baby. I know my baby is
  stressed out. My stomach is in a knot when I come
  over here. (low SES, SF)
• I get a stomach ache, Ive broken out
• (low SES, SF)

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Overarching themes

• Impact (invasive)
• Multiplicity of emotions
• Response
• Chronic/pervasive nature
• Cumulative
• Subtle and implicit
• The I in we
• Discrimination shifts across domains of
  interaction across the lifecourse (contextualized
  experience)

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Where we go from here?

• Literature review manuscript
• Finalize codebook
• Re-analyze data using software coding
• Draft measures of racism
• Validation
• Recommend measures

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Acknowledgements

• Measures of Racism and Social Position Working
  Group
• Wizdom Powell, PhD (UCSF/UCB)
• Tyan Parker Dominguez, PhD (USC)
• JanXin Leu, PhD (UCSF/UCB)
• Cassius Lockett, PhD (Sacramento DPH)
• Barbara Curry (Sacramento DPH)
• Vicky Alexander, MD (Berkeley DPH)
• Tiffany Simpson (Berkeley DPH)
• Lynda Dailey, NP (Berkeley DPH)
• Twila Brown,(San Francisco DPH)
• Camara Jones, MD, PhD, (CDC)
• Funding Support
• California Endowment
• CDC
• RWJ Health Disparities Working Group (UCSF)