PSYCHOSOCIAL STRESS AND PERSISTENT RACIAL DISPARITIES IN

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PSYCHOSOCIAL STRESS AND PERSISTENT RACIAL
DISPARITIES IN ADVERSE BIRTH OUTCOMES

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

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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

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Infant Mortalitydeaths before age 1 per 1000
live births
Mathews, Menacker, MacDorman, 2003
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Preterm Birthlt 37 weeks gestation
Martin, Hamilton, Sutton, Ventura, Menacker,
Munson, 2003
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Low Birthweightlt 2500 grams
Martin, Hamilton, Sutton, Ventura, Menacker,
Munson, 2003
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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
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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

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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
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A Biopsychosocial Model
Neuroendocrine system
Birth outcomes
Immune system
STRESS
Cardiovascular system
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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
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RACISM LINKED TO

Decreased life satisfaction
Psychological distress
Depression
High blood pressure
Lower self-esteem
Cardiovascular disease
Stroke
INFANT MORTALITY
PRETERM DELIVERY
LOW BIRTHWEIGHT
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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
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RACISM AND ADVERSE PREGNANCY OUTCOMES A Program
of Research
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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

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STUDY 1 Does stress mediate racial differences
in birth outcomes?
Parker Dominguez, Dunkel Schetter, Glynn, Hobel,
Sandman, 2005
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STUDY SAMPLE

• N 124
• African-American (n51) Nonhispanic White (n73)
• Born and raised in U.S.
• Live-born infant
• T1, T2, birth outcome data

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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?
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Mediation Models
Sobel test of mediation -1.64, p lt .10
(one-tailed)
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Mediation Models
Sobel test of mediation -1.97, p lt .05
(one-tailed)
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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
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STUDY 2 Are there physiological factors that
link racism to birth outcomes?
Parker Dominguez, Hilmert, Dunkel Schetter,
Glynn, Sandman, Hobel, 2005
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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

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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
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Racism, NE Function and BW

Vicarious Childhood Exposure
CRH 34-36 weeks
Birthweight
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Mediation Models
Sobel_ChV -1.91, p lt .05 Sobel_NE -1.71, p
lt .05
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• 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

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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
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MS-BIPS SAMPLE consisted of

• 70 Latinas
• 177 Nonhispanic Whites
• 25 Asian/Pacific Islanders
• African-Americans
• with racism data

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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
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DISTRESS

AfrAms and Latinas were significantly less
distressed than APIs and Whites
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RESPONSE

• AfrAms significantly more likely to keep racism
  experiences to themselves
• AfrAms significantly more likely to accept unfair
  treatment as a fact of life

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Associations with Racism
plt0.05, plt0.01
Parker Dominguez, Dunkel Schetter, Glynn, Hobel,
Sandman, 2004
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Associations with Racism
plt0.05
Parker Dominguez, Dunkel Schetter, Glynn, Hobel,
Sandman, 2004
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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
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• 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

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Looking ahead..

• Improved racism measures
• Multi-level studies
• Lifespan Approach
• CBPR
• Interdisciplinary teams

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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