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Structural and Interpersonal Stigma and Racial Disparities in Adverse Birth Outcomes /

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	Structural and Interpersonal Stigma and Racial Disparities in Adverse Birth Outcomes // Renee Mehra.
作者:	Mehra, Renee,
面頁冊數:	1 electronic resource (226 pages)
附註:	Source: Dissertations Abstracts International, Volume: 82-12, Section: B.
Contained By:	Dissertations Abstracts International82-12B.
標題:	Epidemiology. -
電子資源:	https://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=27743553
ISBN:	9798516920714

Structural and Interpersonal Stigma and Racial Disparities in Adverse Birth Outcomes /
Mehra, Renee,

Structural and Interpersonal Stigma and Racial Disparities in Adverse Birth Outcomes /Renee Mehra. - 1 electronic resource (226 pages)

Source: Dissertations Abstracts International, Volume: 82-12, Section: B.

Background: The risks of adverse birth outcomes are higher in the United States (US) compared to other high-income countries. Annually in the US, approximately 380,000 infants are born preterm, 315,000 infants are born low birthweight, and 22,000 infants die in their first year of life. Furthermore, preterm birth and low birthweight are important contributors to infant mortality and morbidity throughout the life course. Substantial and persistent racial disparities in adverse birth outcomes are not fully explained by individual- or area-level risk factors. Stigma may be a fundamental cause of health disparities, since stigmatized groups are socioeconomically, socially, and psychologically disadvantaged. The objectives of this dissertation were to: determine the extent to which structural stigma is associated with racial disparities in adverse birth outcomes; examine the complex processes between structural stigma and adverse birth outcomes, and simulate interventions to address structural stigma and its mediating pathways; and deeply explore the experiences of stigma during pregnancy.Methods: We used a mixed-methods research approach for an in-depth exploration of structural stigma (operationalized as residential segregation) and interpersonal stigma as fundamental causes of racial disparities in adverse birth outcomes. We performed a systematic review and meta-analysis to assess the association between formal and proxy measures of residential segregation and race-specific adverse birth outcomes (Chapter 2). We conducted Bayesian meta-analyses with national vital statistics data to examine whether residential segregation moderated racial disparities in preterm birth and term low birth weight (Chapter 3). We built a discrete-event simulation model to better understand the complex interactions between residential segregation, area-level factors and preterm birth, and evaluate social policy interventions aimed at reducing racial disparities in preterm birth (Chapter 4). We conducted qualitative research among black pregnant women in New Haven to explore experiences of stigma that may contribute to the considerable racial disparities in adverse birth outcomes (Chapter 5).Results: We found that different measures of residential segregation were differentially associated with race-specific adverse birth outcomes (Chapter 2). Among Black mothers, exposure and hypersegregation were associated with increased risk of multiple adverse birth outcomes, evenness and black racial composition were not consistently associated with adverse birth outcomes, and clustering had differential associations with adverse birth outcomes. Among white mothers, neither formal nor proxy measures of residential segregation were consistently associated with adverse birth outcomes. We found greater black-white and Hispanic-white disparities in preterm birth in racially isolated (a measure of the exposure dimension of residential segregation) compared to non-isolated counties (Chapter 3). There were reduced Hispanic-white disparities in term low birth weight in racially concentrated and centralized counties relative to non-segregated counties. Area-level poverty was a mediator of these associations. In the discrete-event simulation model, when 10% of women changed neighborhoods each year with the housing supplement or universal basic income intervention, there were modest but significant reductions in black-white disparities in preterm birth compared to the baseline model (Chapter 4). The greater the percentage of housing supplement recipients that changed neighborhoods each year, the greater the reduction in black-white disparities in preterm birth for both interventions. We found that women encountered interpersonal stigma in the form of gendered pregnancy racism in a multitude of contexts, which may contribute to poorer maternal and infant outcomes through increased stress and reduced access to quality healthcare, services, resources, and social support (Chapter 5).Conclusions: This dissertation addressed current gaps in the literature by using innovative mixed-methods research to better understand the impact of stigma on racial disparities in adverse birth outcomes. Both structural and interpersonal stigma influence adverse birth outcomes, particularly among black women. Future research should continue to examine mechanistic pathways between structural and interpersonal stigma and adverse birth outcomes to guide future practice and policy to promote health equity. Ultimately, if stigma is a fundamental cause of health disparities, then interventions must address stigma itself, otherwise racial disparities in adverse birth outcomes will persist in the US.

English

ISBN: 9798516920714Subjects--Topical Terms:

568544
Epidemiology.
Subjects--Index Terms:

Health disparities

Structural and Interpersonal Stigma and Racial Disparities in Adverse Birth Outcomes /
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