The social structural context of pregnancy and adverse birth outcomes: the role of race, place, and time Public Deposited

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  • March 22, 2019
Creator
  • Richardson, Liana Janine.
    • Affiliation: Gillings School of Global Public Health, Department of Health Behavior
Abstract
  • The persistence of racial disparities in low birth weight (LBW) and preterm birth (PTB) is one of the most widely documented problems in public health. Most studies of these birth outcomes have focused primarily on maternal exposure to individual-level risk factors during the prenatal period. That research has resulted in only a partial explanation for the observed disparities. My research, therefore, had two primary aims: (1) to examine the relationship between adverse birth outcomes and maternal exposure to family and neighborhood disadvantage during childhood; and (2) to determine the behavioral, psychosocial, and health pathways through which these exposures affect birth outcomes and translate into racial disparities. Data for this research came from Waves I and III of the National Longitudinal Study of Adolescent Health (Add Health). The sample consisted of 500 Black and 1,077 White females who gave birth in late adolescence or young adulthood. I used structural equation modeling to test hypotheses associated with the study aims. Latent variables representing four domains of childhood disadvantage (i.e., family disadvantage and neighborhood structural, social, and physical disadvantage) were used in the analysis, along with measures of childhood health, depression, and substance use. When the latter measures were not included in the model, the effects of childhood family disadvantage and neighborhood structural disadvantage on infant birth weight were fully mediated by the other neighborhood variables and gestational age. When childhood substance use, depression, and health were entered into the model as mediators, a direct effect of childhood neighborhood physical disadvantage on infant gestational age remained. All relationships between birth weight and other aspects of childhood disadvantage were fully mediated. When the analysis was stratified by race, clear racial differences in overall and component model fit were apparent. The fit for Whites more closely matched the fit of the full sample model than did the fit for Blacks; indeed, no variables were associated with birth outcomes among Blacks. These findings suggest that disadvantage experienced at multiple levels and in multiple domains during childhood may play a role in subsequent birth outcomes. They also suggest that the role may differ between racial groups.
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  • In Copyright
Advisor
  • Earp, Jo Anne L.
Degree granting institution
  • University of North Carolina at Chapel Hill
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  • Open access
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