The long-term goal of my research is to develop an evidence-based, culturally appropriate intervention that decreases health disparities associated with preterm births among African American (AA) women. In 2005 in the United States, more than half a million (12.7%) infants were born prematurely and AA women had almost twice the rates of preterm birth. Preterm birth is a major factor associated with neonatal mortality and long-term health problems, including motor and mental developmental delays, school failure, and chronic illness and costs $26 billion annually. The causes of preterm birth disparity are poorly understood. Attempts to explain the high rates of preterm birth in AA women have focused on race-related stressors of neighborhood environment and racial discrimination. These stressors increase stress and are related to higher rates of preterm birth. Stress and negative emotional and physiological stress responses are associated with preterm birth. In contrast, personal resources ameliorate stress responses and have protective effects on preterm birth. Race-related stressors, personal resources and stress responses have individually been related to preterm birth. No investigation has examined the relationships among these factors in a single model. The proposed theoretical model examines the relationships among objective and perceived neighborhood environment, perceived racial discrimination, personal resources, stress responses and preterm birth.
The specific aims of this pilot study are 1) to determine the feasibility of conducting a larger prospective study of pregnant urban AA women, and 2) to discern if our theoretical model has the potential to explain preterm birth in this population. Specific issues are: (1) feasibility, the ability to recruit the sample;(2) acceptability, validity, and reliability of measures for use in low-income urban pregnant AA women;(3) utility of geocoding based on precise address rather than census tract data to measure neighborhood environments, and the relation between the objective and perceived neighborhood environment;(4) variability of the predictors for use in power analyses for sample size in a larger study;(5) exploring differences in race-related stressors, personal resources, and stress responses between women with preterm birth and women with full term birth when controlling for gestational age at data collection and circadian rhythm;and (6) preliminary evidence of the promise of our theoretical model with this sample. In this innovative longitudinal exploratory descriptive study, we will enroll 137 pregnant AA women who live in predominantly low-income Chicago neighborhoods. We will collect data three times: T1 between 16-22 weeks, T2 between 26-32 weeks, and T3 after birth. Geocoded addresses will be used to derive objective measures of the neighborhood environment. Each woman's perceived neighborhood environment, perceived racial discrimination, personal resources, and emotional stress responses will be assessed though questionnaires. Physiological stress responses will be assessed by biological markers. Data obtained from this pilot will be instrumental in the submission of an NIH R01 application that will further test the model. Understanding the relationships among neighborhood environment, racial discrimination, personal resources, stress responses, and preterm birth, will allow researchers to develop an evidence-based intervention that decreases preterm birth in AA women. In 2005 in the United States, more than half a million (12.7 percent) infants were born prematurely and African- American women had almost twice the rate of preterm birth as non-Hispanic white women. Preterm birth is a major risk for neonatal mortality and long-term health problems, including motor and mental developmental delays and chronic illness. The causes of the disproportionately higher rates of preterm birth in African- American women are not well understood. Cumulative exposures to adverse neighborhood conditions such as poverty, housing vacancy, crime, and racial discrimination may increase stress of African-American women and their risk for preterm birth. In this study, we propose to examine influences of the neighborhood environment and racial discrimination on women's emotions and their pregnancies. By understanding how neighborhood conditions and experiences of discrimination contribute to preterm birth, we can target programs and interventions that reduce the risk for preterm birth in African-American women.
