Direct and Vicarious Racial Discrimination at Three Life Stages and Preterm Labor: Results from the African American Women’s Heart & Health Study

Abstract

Introduction

Health disparities research has demonstrated a negative relationship between racial discrimination and African American women’s maternal health outcomes. Yet, the relationship between racial discrimination and preterm labor, a key measure of maternal health, remains understudied. This study sought to examine the associations between preterm labor and direct and vicarious racial discrimination among African American women at three life stages: childhood, adolescence, and adulthood.

Methods

Logistic regression methods were used to analyze cross-sectional data from the African American Women’s Heart & Health Study (AAWHHS; N = 173). The AAWHHS includes detailed maternal health information on a community sample of African American women residing in the San Francisco Bay Area.

Results

Findings indicated each unit increase in adolescent direct racial discrimination was associated with a 48% increase in the odds of preterm labor (OR: 1.480, 95% CI 1.002–2.187, p < 0.05) and each unit increase in childhood vicarious racial discrimination was associated with a 45% increase in the odds of preterm labor (OR: 1.453, 95% CI 1.010–2.092, p < 0.05) after adjusting for number of pregnancies and socioeconomic variables.

Discussion

This study provides evidence of an association between life-stage racial discrimination and preterm labor risk among African American women, underscoring a need to consider how both directly and vicariously experienced racial discrimination at different developmental periods impact racial disparities in birth outcomes.

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Acknowledgements

This work was supported by research grants from: University of California, Berkeley (UCB) Hellman Fund, USA; UCB Population Center, USA; UCB Research Bridging Grant, USA; UCB Experimental Social Science Laboratory, USA; Robert Wood Johnson Health and Society Scholars Program (UCB site), USA; UC Center for New Racial Studies, USA; and the UCB Institute for the Study of Societal Issues, USA. AM Allen was also partially supported by NIMHD Grant P60MD006902, USA; DH Chae was supported by the National Institute on Aging (NIA) of the National Institutes of Health (NIH) [K01AG041787]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIA. Study sponsors did not participate in study design, data collection, data analysis, interpretation of study results, or drafting of the manuscript. We wish to thank Holly Berryman Stern from the UCB Tang Center for laboratory support, Roger Hoffman of Westportal for in-kind support in building the CASIC platform, Miguel Dorta from StataCorp, Maureen Lahiff for comments on statistical analysis, Whitney Pirtle for advice on study conceptualization, and the many undergraduate, graduate, and postdoctoral students working as volunteer research assistants. KP Daniels conceptualized the study, designed and performed all statistical analyses (and takes responsibility for the integrity of the data analyzed), and took primary responsibility for drafting the manuscript; Z Valdez helped conceptualize the study, assisted with the design of the analysis, operationalizing study variables, as well as, data interpretation, and drafting the manuscript. DH Chae helped conceptualize the study and aided with data interpretation and drafting the manuscript. AM Allen conceptualized the study, coordinated all logistics related to recruitment and data collection, assisted with the design of the analysis, operationalizing study variables, as well as, data interpretation, and drafting the manuscript.

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Daniels, K.P., Valdez, Z., Chae, D.H. et al. Direct and Vicarious Racial Discrimination at Three Life Stages and Preterm Labor: Results from the African American Women’s Heart & Health Study. Matern Child Health J 24, 1387–1395 (2020). https://doi.org/10.1007/s10995-020-03003-4

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Keywords

  • Preterm labor
  • Racial discrimination
  • Pregnancy
  • Health disparities