Alan Booth Jennifer Buher Kane Pennsylvania State University, University Park
Providing insights into how to improve infant health outcomes is an important goal of health disparities research given that conditions such as preterm birth and low birth weight often contribute to poorer physical and cognitive outcomes later. Prior research has shown that poor infant health outcomes are not randomly distributed in the population; thus, social stratification processes likely play a central role in explaining differential incidence and risk factors. This dissertation studies how such inequalities are produced and reproduced through interactions between individuals and social structures such as families and neighborhoods. More specifically, this study investigates (1) the social processes that underlie the marital disparity in infant health outcomes, (2) the role of social resources (at the individual- and neighborhood-level) in attenuating the risk of poor infant health outcomes, and (3) the intergenerational processes that explain mother-daughter similarities in infant health outcomes. To address these goals, this study will employ advanced quantitative analytic techniques using multiple secondary data sources including the newly released National Survey of Family Growth (NSFG Cycle 7), (restricted-access) spatially located data from the NSFG (which will be performed onsite at the National Center for Health Statistics in Hyattsville, Maryland), the National Longitudinal Survey of Youth (NLSY) 1979 cohort, and the Children of the NLSY79.
Broader Impacts: This project, using theoretically-motivated empirical research, presents a unique opportunity to expand the health disparities and family sociology literatures by providing insights into how persistent infant health disparities in the U.S. are produced and reproduced. Research findings will be made available through publishing in peer-reviewed journals, and sharing with policymakers and practitioners via conference presentations (particularly within interdisciplinary venues).
Public and scholarly interest in changing family trends has increased over the past several years. We know for example that men and women are now much more likely to live with a cohabiting partner before marriage than in the past, and that more children are now born within nonmarital unions. We also know that, on average, these children face several disadvantages compared with children born within marital unions but as cohabitation, divorce, and remarriage become a larger part of the "typical" experience for families in the U.S., these patterns may change. This project focuses on one type of disadvantage that has been consistently documented among children born to unmarried women: they are at a higher risk of being born low birth weight (or, less than 5 ½ pounds at birth) and preterm (or, less than 37 weeks of gestational age). Both outcomes are consequential for infant’s long-term development. For example, low birth weight and preterm infants are more likely to experience several physical problems as they age including a higher risk of Type-2 diabetes, obesity, heart disease, poor bone density, cerebral palsy, deafness, impaired cognitive ability, and poorer neuromotor functioning. Thus, identifying the causes of low birth weight and preterm birth may also help us better understand a variety of other health problems as well. Previous studies have shown that poor infant health outcomes are not randomly distributed across the population, but are rather more common among women who are poor, unmarried, non-Hispanic Black (vs. non-Hispanic White or Hispanic), live in impoverished neighborhoods, and report poor health status. This project focuses on one of these disparities—differences between married, cohabiting, and single women—which is an area that is particularly understudied, yet increasingly important. This project began by simultaneously investigating two possible explanations of the "marriage advantage" in a way that has not yet been accomplished in past research: a life course or selection model (suggesting that advantages are grounded in women’s experiences—either observed or unobserved—in prior life stages such as childhood and adolescence) and a mediation model (suggesting that marriage leads to positive prenatal health characteristics, which in turn lead to better infant health outcomes). Using data from the National Survey of Family Growth (NSFG, 2006-8), results document greater support for a life course/selection model in that there was no disparity between cohabiting and married women once (observed) childhood environment characteristics and (unobserved) selection factors were taken into account. There was a disparity between married and single women that was partially explained by increased rates of prenatal smoking among single women. This project then explored a second dimension of the marriage advantage: how neighborhood environments affect disparities between married and unmarried women. Much research has focused on how social conditions within local neighborhood environments impact one’s health outcomes. But when it comes to infant health disparities, we don’t yet know how social environments may differentially impact outcomes for infants born to married, cohabiting, and single women. Using data that identifies where women lived while they were pregnant (NSFG Cycles 6 and 7), this portion of the study examined if mother-father relationship status was one type of interpersonal resource that differentially buffered women from the effects of living within stressful social environments. We found that in neighborhoods characterized by high levels of violent and serious property crimes, infants born to cohabiting mothers were more at risk of poor infant health than their counterparts born to cohabiting mothers who lived in neighborhoods with relatively low levels of crime. This disadvantage existed above and beyond measures of a host of human capital, sociodemographic, family background, and pregnancy characteristics. Finally, this project tackled the marriage advantage from yet another perspective: an intergenerational approach. Here we addressed a pertinent question raised—but not answered—by previous biological and social research: why do mothers and daughters exhibit similar infant health outcomes? We used intergenerational data spanning more than 65 years of historical time (from grandparents, mothers, daughters, and infants) from the National Longitudinal Study of Youth (NLSY79) and the Children of the NSLY79. Findings demonstrated that previously-documented mother-daughter similarities in birth weight may be at least partly spurious in that intergenerational transmissions of educational attainment and sociobehavioral modeling were consequential. In sum, findings suggest that infant health outcomes among recent cohorts of cohabiting and married women are convergent (not divergent), which is a trend that stands in contrast to much historical research on marriage and infant health. This research also identifies various subgroups of women at higher risk of poor infant health (i.e., single smokers, cohabiting women living in high crime neighborhoods) who may be targeted for future prevention efforts aimed at improving infant health outcomes in the U.S. Results may be used to inform future health and social policies related to reducing infant health disparities that affect long-term human development and social investment among children in the U.S.
