Emory University doctoral student, Tyralynn Frazier, supervised by Dr. Carol Worthman, will undertake research on the relative influence of race, culture, economic status, and place of residence on reproductive health outcomes. The researcher will simultaneously focus on both race and place by investigating if similarities and differences in localized pregnancy ideas are shaped by racial and socioeconomic belonging.
The research will be carried out among a population-based sample of women living in a county in the state of Georgia. The researcher will employ cultural consensus modeling first, to see if cultural models of pregnancy behaviors differ by race, and second to determine if relative consonance with locally accepted pregnancy models predicts stress levels and pre-term births. Race is a frequently used, but often under-theorized category. Using domain analysis methods and cultural consensus modeling, this study aims to put race as an assumed cultural grouping into question in the context of pregnancy behaviors.
This research is important because by emphasizing culturally defined influences on reproductive health behaviors it may contribute to understanding negative birth outcome patterns that are not fully explained by demographic factors or socioeconomic status. If the hypotheses presented hold true then a broader implication of this work would be to understand how the emergence of new pregnancy beliefs and behaviors may produce generational differences in reproductive health disparities in immigrant populations in the United States and other industrialized countries.
Part 1: We hypothesized that, in the domain of healthy pregnancy behaviors and beliefs, women in different race/class categories have distinct consensus patterns of subjective ideals on what is important for a good and healthy pregnancy. We also hypothesized that variations in patterns of sharing healthy pregnancy behaviors and beliefs are associated with environmental factors that constrain access to information. We found that beliefs and behaviors around what constitutes a good and healthy pregnancy do not differ by race or class, but behaviors and beliefs are associated with a woman’s relationship with her father even when controlling for race and class. In this study we attempt to demonstrate how "root cause" variables can be assessed and evaluated in order to inform implementation initiatives. Instead of looking at birth outcomes, we looked at how women think about being healthy within the context of birth, or the cultural model of a healthy birth. Culture drives shard understandings within environments, so when social epidemiologists focus on population-based demographic factors - including empirically grounded explanations of culture within the demographic contexts - they can more accurately help health professionals find more targeted solutions. This is particularly salient in the field of racial health disparities because race is so poorly understood. Part 2: We hypothesized that agreement between what a women believes is important for a good and healthy pregnancy and what they actually do during pregnancy differs by race and class. We use the cultural consensus modeling results from publication 1 and compare them to what individual women say they are doing based on Dressler’s work on consensus, consonance and congruency. We then test if other environmental factors besides race and class influence agreement between what she believes and what she can actually do. We found that average agreement was not associated with race/class category, but the ability for a woman to do what she believes is important for her pregnancy is associated with having a good relationship with her mother, having a good relationship with her partner, and having her father present within her pregnancy network. We also go through individual factors associated with a good and healthy pregnancy to show that a woman’s ability to do what she thinks she should do is primarily associated with quality of the relationships around her regardless of race/class status. Part 3: We hypothesize that environmental stressors women encounter during pregnancy make up the contexts of a women’s constrains, and can impact her ability to engage in behaviors she deems most important during pregnancy. We found that stress exposure is associated with a woman’s ability to do what she thinks is important to do during pregnancy irrespective of race/class category. The type of stressors to which women are exposed during pregnancy do differ by race and class, and many of these are a result of structural factors within the context of her life over which she does not have control.
