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Tyan Parker Dominguez, PhD, MPH, MSW School of Social Work University of Southern California PSYCHOSOCIAL STRESS AND PERSISTENT RACIAL DISPARITIES IN ADVERSE.

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Presentation on theme: "Tyan Parker Dominguez, PhD, MPH, MSW School of Social Work University of Southern California PSYCHOSOCIAL STRESS AND PERSISTENT RACIAL DISPARITIES IN ADVERSE."— Presentation transcript:

1 Tyan Parker Dominguez, PhD, MPH, MSW School of Social Work University of Southern California PSYCHOSOCIAL STRESS AND PERSISTENT RACIAL DISPARITIES IN ADVERSE BIRTH OUTCOMES

2 1)Review the nature of persistent racial disparities in adverse birth outcomes 2)Discuss the stress and pregnancy paradigm, highlighting physiological mechanisms 3)Present research findings from work on stress and birth outcomes OBJECTIVES

3 Infant Mortality deaths before age 1 per 1000 live births OVERALL6.8 NONHISPANIC WHITE5.7 HISPANIC5.4 ASIAN/PACIFIC ISLANDER 4.7 NONHISPANIC BLACK13.5 Mathews, Menacker, & MacDorman, 2003

4 Preterm Birth < 37 weeks gestation Martin, Hamilton, Sutton, Ventura, Menacker, & Munson, 2003 OVERALL12.1% NONHISPANIC WHITE11.0% HISPANIC11.6% ASIAN/PACIFIC ISLANDER 10.4% NONHISPANIC BLACK17.7%

5 OVERALL7.8% NONHISPANIC WHITE6.9% HISPANIC6.5% ASIAN/PACIFIC ISLANDER 7.8% NONHISPANIC BLACK13.4% Martin, Hamilton, Sutton, Ventura, Menacker, & Munson, 2003 Low Birthweight < 2500 grams

6 Disparity not explained by established Disparity not explained by established Sociodemographic Behavioral BehavioralMedical risk factors Berkowitz & Papiernik, 1993; Collins & David, 1990; David & Collins, 1991; Frisbie, Biegler, de Turk, Forbes, & Pullum, 1997; Kleinman & Kessel, 1987; Shiono, Klebanoff, Graubard, Berendes, & Rhoads, 1986; Wise, 1993

7 P s y c h o s o c i a l S t r e s s Environmental demands that tax or exceed the adaptive capacity of an organism, resulting in physiological and psychological changes that may place the organism at risk for disease Cohen, Kessler, & Gordon, 1995

8 African-American pregnant women report more stress exposure and greater emotional distress from that exposure than other groups Feldman, Dunkel-Schetter, Woo & Hobel, 1997; Zambrana et al., 1999

9 A Biopsychosocial Model Neuroendocrine system Immune system Cardiovascular system STRESS Birth outcomes

10 The health of minority groups is intimately connected to the HIGH STRESS STATES created by a social system that condones, reinforces, and perpetuates racial discrimination. Myers, 1982 Negative Self-Society Dialectic

11 RACISM LINKED TO Decreased life satisfaction PRETERM DELIVERY LOW BIRTHWEIGHT INFANT MORTALITY Cardiovascular disease Stroke High blood pressure Psychological distress Depression Lower self-esteem

12 ALLOSTATIC LOAD Physiologic toll of repeated and/or chronic stress system activation Stress Baseline Recovery Allostasis Allostatic Load Baseline McEwen & Stellar, 1993; Sterling & Eyer, 1988

13 RACISM AND ADVERSE PREGNANCY OUTCOMES A Program of Research

14 Prospective, repeated measures surveyProspective, repeated measures survey Psychosocial, medical, physiological variablesPsychosocial, medical, physiological variables 480 ethnically/SES diverse pregnant women480 ethnically/SES diverse pregnant women Recruited in clinics or referred by MDsRecruited in clinics or referred by MDs Fluent EnglishFluent English > 18 yrs> 18 yrs < 18 wks gestation, non substance using< 18 wks gestation, non substance using Multi-Site Behavior in Pregnancy Study

15 STUDY 1 Does stress mediate racial differences in birth outcomes? Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2005

16 N = 124 African-American (n=51) Nonhispanic White (n=73) African-American (n=51) Nonhispanic White (n=73) Born and raised in U.S. Born and raised in U.S. Live-born infant Live-born infant T1, T2, birth outcome data T1, T2, birth outcome data STUDY SAMPLE

17 RACISM EXPOSURE personal/vicarious experiencespersonal/vicarious experiences childhood/adulthoodchildhood/adulthood across different life domainsacross different life domains Have you ever felt that you (or someone close to you) were (was) discriminated against or the target of prejudice because of race in interpersonal, housing, employment, educational, other situations?

18 Sobel test of mediation = -1.64, p <.10 (one-tailed) Mediation Models DV = BWStep 1Step 2Step 3 GA.65***.67***.65** Medrisk Spont. Labor Parents’ Educ Race-.18*-.13+ Racism-Life-.13+

19 Sobel test of mediation = -1.97, p <.05 (one-tailed) Mediation Models DV = BWStep 1Step 2Step 3 GA.65***.67***.64** Medrisk Spont. Labor Parents’ Educ Race-.18*-.13+ Racism-ChV-.16*

20 K E Y F I N D I N G Racism exposure, particularly vicarious childhood experiences, predicts BW and attenuates race effects on BW, controlling for confounders

21 STUDY 2 Are there physiological factors that link racism to birth outcomes? Parker Dominguez, Hilmert, Dunkel Schetter, Glynn, Sandman, & Hobel, 2005

22 C R H A C T H C O R T I S O L Assayed from blood at weeks, weeks, weeks, weeks, and weeks gestation Neuroendocrine Variables + -mother + +placenta

23 NE levels rise across pregnancy course in both ethnic groups ETHNIC COMPARISON Evidence of possible NE dysregulation in African Americans: - high ACTH, low CRH and Cortisol - smaller level of change in CRH and Cortisol HOWEVER

24 Racism, NE Function and BW Vicarious Childhood Exposure + CRH weeks Birthweight

25 Sobel_ChV = -1.91, p <.05; Sobel_NE = -1.71, p <.05 Mediation Models DV = BWStep 1Step 2Step 3 GA.53***.50***.51** Medrisk Spont. Labor Parents’ Educ Race-.30**-.22*-.22+ Racism-ChV-.22*-.16+ CRH 32-36wks.20*

26 K E Y F I N D I N G S 1.Evidence of NE dysregulation in AfrAms 2.Racism associated with AfrAm NE pattern 3.Late term CRH predicts BW and mediates ChV racism effects on BW

27 STUDY 3 Are there differences across multiple racial/ethnic groups in exposure to and impact of racism? Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2004

28 70 Latinas 177 Nonhispanic Whites 25 Asian/Pacific Islanders 51 African-Americans with racism data MS-BIPS SAMPLE consisted of

29 Variable AfrAm API Latina White p-value DSCR_C3.2(3.2)3.1(2.4)1.4(1.9)1.0(1.7)0.000 DSCR_D72.5%88.0%54.3%40.7%0.000 RACISM EXPERIENCES LIFETIME Unadj: APIs & AfrAms / Latinas & Whites Adj: Latinas / Whites Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2004

30 DISTRESS AfrAms and Latinas were significantly less distressed than APIs and Whites

31 RESPONSE AfrAms significantly more likely to keep racism experiences to themselves AfrAms significantly more likely to accept unfair treatment as a fact of life

32 Associations with Racism Variablerb PSS0.27**0.23** STAI0.30**0.30** Preg Anx 0.24**0.22** CES-D0.18**0.15* Resources-0.14*-0.14* * p<0.05, ** p<0.01 Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2004

33 Associations with Racism Variablerb BW-0.13*-0.08 GA-0.12*-0.10 *p<0.05 Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2004

34 Interaction Effects  =.22, p <.05 APIs:  =.07, p >.10 AfrAms:  = -.36, p <.05 Racism and BW African Americans X APIs

35 K E Y F I N D I N G S Ethnic differences in racism exposure,Ethnic differences in racism exposure, distress, and coping distress, and coping Racism impacts psychosocial fx of all groupsRacism impacts psychosocial fx of all groups Evidence race may moderate racism effects on birth outcomesEvidence race may moderate racism effects on birth outcomes

36 Improved racism measures Multi-level studies Lifespan Approach CBPR Interdisciplinary teams Looking ahead…..

37 Christine Dunkel Schetter Department of Psychology, UCLA Laura Glynn Department of Psychiatry, UC-Irvine Department of Psychiatry, UC-Irvine Calvin J. Hobel Department of Maternal/Fetal Med, Cedars-Sinai Curt Sandman Department of Psychiatry, UC-Irvine Acknowledgements


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