Neighborhood Environment and Perceived Stress Before and During the COVID-19 Pandemic Among Childbearing Black Women.

PURPOSE: The purpose of this study among pregnant and postpartum Black women was twofold: (1) to compare levels of perceived stress, depressive symptoms, social support, and neighborhood disorder and crime before the pandemic vs during the pandemic; and (2) to examine the association of perceived stress, depressive symptoms, and social support with neighborhood disorder and crime at both time points. METHODS: This was a prospective study as part of the Biosocial Impact on Black Births, a longitudinal study that examined the role of maternal factors on preterm birth among Black women. A sample of 143 women were included who responded to survey questions during pregnancy prior to the pandemic and again after birth, during the pandemic. Women completed the COVID survey between May 21, 2020, and January 28, 2021. RESULTS: The levels of perceived stress (70.75 and 76.28, respectively, P < .01) and social support (17.01 and 18.78, respectively, P < .01) were lower during the pandemic than prior to the pandemic. Social support, perceived stress, and depressive symptoms were significantly correlated with the pre-pandemic measures of perceived neighborhood disorder and crime. Perceived stress and depressive symptoms were also significantly correlated with pandemic measures of perceived neighborhood. CONCLUSION: Women reported lower levels of perceived stress during the pandemic than prior to the pandemic, but neighborhood characteristics were consistently associated with perceived stress and depressive symptoms both prior to and during the pandemic. Further exploration is warranted to better understand these relationships.

A Mixed Methods Approach to Understand Mother-Father Relationship and Perceived Stress Among Black Pregnant Women.

BACKGROUND: Black women in the United States report moderate to high levels of perceived stress during pregnancy. Though lower levels of involvement and support from father of the baby (FOB) and higher levels of conflict have been associated with higher levels of maternal perceived stress, it is not clear how Black pregnant women experience the mother-father relationship and its influence on perceived stress. PURPOSE: To examine and describe the mother-father relationship and its role in experiences of perceived stress from the perspective of Black pregnant women. METHODS: Using a convergent, mixed methods approach with ideal-type analysis, we conducted a secondary analysis of data among 60 Black pregnant women enrolled in the Biosocial Impact on Black Births study. Women completed online self-report questionnaires and participated in a semi-structured interview by telephone. RESULTS: Participants who reported more conflict with FOB also reported higher levels of perceived stress (ρ(47) = .431, P= .002). Themes (importance, communication, support, conflict, satisfaction, and stress) emerged from the data. Five distinct mother-father relationship typologies were identified following an ideal-type analysis of the combined dataset: Cared For; Managing Expectations; Just Friends, For the Kids; It's Complicated; and Can't be Bothered. CONCLUSIONS: These findings are an innovative exemplar of ideal-type analysis and provide a deeper understanding of the nuance and dynamics within the mother-father relationship and how it influences perceived stress among Black pregnant women. IMPLICATIONS: Clinicians must recognize the significance of the mother-father relationship and, when appropriate, encourage paternal involvement or intervene if there is conflict during pregnancy.

The associations of objective and perceived neighborhood disadvantage with stress among pregnant black women.

BACKGROUND: Neighborhood disadvantage may impact risk of preterm birth through stress. Few studies have examined how neighborhood disadvantage relates to stress during pregnancy, especially for Black women. METHODS: Secondary data analysis of 572 women in a prospective cohort in Detroit, MI and Columbus, OH. Participants completed questionnaires including the ROSS Neighborhood Disorder Scale, the crime subscale of the Perceived Neighborhood Scale (PNS), and the Perceived Stress Scale. An objective neighborhood disadvantage index (NDI) was created using principal components analysis after geocoding residential addresses and linking to Census data. RESULTS: All models used logistic regression. Adjusted for maternal age and annual household income, perceived stress was positively associated with perceived neighborhood disorder (p < .01). In a separate model, perceived neighborhood crime was positively associated with perceived neighborhood disorder (p = .005). In a joint model adjusted for age and income, the association of disorder with stress was similar in magnitude (p < .01) but the association between crime and stress weakened. The NDI was not associated with perceived stress before or after adjustment for confounders. CONCLUSIONS: Perceived neighborhood disadvantage may capture a different dimension than objective neighborhood disadvantage. Future studies should test stress as a pathway by which neighborhood environment increases risk of preterm birth.

A Qualitative Approach to the Dimensions of Segregation among Pregnant Black Women.

This study compares and contrasts residents' perceptions of segregation measures using qualitative and quantitative data. Most studies exploring racial residential segregation and health outcomes use large-scale, metropolitan-wide measures. As a result, we have limited understanding of racial residential segregation outside of Census data, particularly about the firsthand experiences of those living in segregated areas. The purpose of this study was to compare data from Census-based measures of racial residential segregation with qualitative descriptions of these same constructs by pregnant, Black women in two US cities. Using novel qualitative interview questions, we explored the dimensions of segregation and neighborhood racial distribution among a sample of 27 pregnant, Black women between April and November 2019. The participants included in this sample had perceptions about their neighborhood segregation and demographic composition that were often different from the data derived from existing residential US Census data. The differences between qualitative and quantitative measures and the possible reasons for the discordance suggest new approaches to measurement and new directions for the study of segregation and health.

Association of maternal and paternal psychosocial stress and infant hair cortisol among Arab American immigrants: A pilot study.

Acculturative stress is unique among immigrants and refers to the stress associated with maintaining cultural values and traditions in the host country. Immigrant parents confront psychosocial variables such as acculturative stress, anxiety, and depression that might result in intergenerational negative consequences on their infants. Measurement of hair cortisol concentration (HCC), an outcome of neuroendocrine dysregulation, is one relatively noninvasive approach to gauge stress in infants. No published studies have evaluated associations among parents' psychosocial variables and infants' HCC among immigrant families. Therefore, the purpose of this study was to: (1) examine the relationship between maternal and paternal psychosocial stress variables; and (2) examine the association between psychosocial variables of both parents (acculturative stress, anxiety, and depression) and infants' HCC among immigrant Arab American families. A sample of 31 immigrant Arab American triads (mother-father-infant) was recruited. During one home visit, each parent completed the study questionnaires separately when the baby was 6-24 months old and a hair sample was collected from the infant for HCC. Parents reported significant symptoms of anxiety (33% mothers; 45% fathers) and depression (33% mothers; 35.5% fathers). Paternal acculturative stress, anxiety, and depressive symptoms were significantly correlated to infants' HCC. Acculturative stress, anxiety, and depressive symptoms were significantly correlated between mother-father dyads. Future research should continue to focus on immigrant families and include both parents to better understand and improve infant health.

A Mixed-Methods Study of Experiences During Pregnancy Among Black Women During the COVID-19 Pandemic.

Pregnant women experienced disruptions in their prenatal care during the coronavirus disease-2019 (COVID-19) pandemic. While there is emerging research about the impact of COVID-19 on experiences of pregnancy, the majority of studies that have reported on prenatal care and birth during COVID-19 have not incorporated the first-person accounts of Black women. The purpose of this mixed-methods study was to explore the perspectives of Black women on prenatal care, labor, and birth during the pandemic. A total of 33 participants completed questionnaires. Fourteen of these 33 women and an additional 2 participated in qualitative interviews. Descriptive statistics and a mixed-methods analysis were employed. Participants expressed disappointment about disruptions in their experiences of pregnancy including the way their prenatal care was experienced, cancellation of planned "rites of passage," and visitor policy restrictions during and after the birth. Forty-five percent of participants reported being worried about getting COVID-19 and (61%) about their infant getting COVID-19. Many participants experienced a sense of loss that may permeate through other aspects of their lives. Providing extra support and points of contact can help lessen feelings of isolation during the pandemic and can also offer more explanation for rapidly changing policies and procedures.

Racial residential segregation, neighborhood disorder, and racial discrimination among black pregnant women.

OBJECTIVE: To compare and contrast pregnant, Black women's voices with quantitative measures of racial residential segregation, neighborhood disorder, and racial discrimination. DESIGN AND SAMPLE: Using a convergent design for the parent study, surveys and qualitative interviews were completed by Black pregnant women (n = 27). MEASURES: Content analysis was conducted and data were analyzed to assess for congruency or divergence for each concept related to structural racism (racial residential segregation, neighborhood disorder, and discrimination). RESULTS: No single concept had 100% agreement across qualitative and quantitative approaches. Participants disclosed experiences during some interviews that were not captured by the surveys. The qualitative interviews offered a more detailed description of the concepts which along with the quantitative measures, provided insights about how participants perceived these mechanisms. DISCUSSION: While important relationships about the mechanisms of structural racism and preterm birth can be examined using a single approach, using mixed methods can offer more insights about how those most impacted by preterm birth relate to these mechanisms. Future work will best add to the understanding of structural racism and preterm birth when study measures accurately reflect the experiences of the people who experience racism.

Physical activity changes among non-Hispanic Black pregnant women.

OBJECTIVE: To examine aerobic physical activity (PA) among non-Hispanic Black pregnant women. DESIGN: Longitudinal prospective cohort study. SAMPLE: A subset of 161 non-Hispanic Black pregnant women from the Midwestern US participating in a larger study completed questionnaires about aerobic physical activity (PA) before pregnancy (reported at 24.46±2.13 weeks gestation), mid-pregnancy (24.46±2.13 weeks gestation), and late pregnancy (31.78±1.95 weeks gestation). MEASUREMENTS: Aerobic PA was measured using the Rapid Assessment of Physical Activity (RAPA). RESULTS: Most participants reported being active prior to pregnancy (n = 101, 63%), with 60 (37%) underactive/sedentary. Aerobic RAPA scores were highest pre-pregnancy (3.29±1.11, median = 4, interquartile range [IQR] = 1) compared with mid-pregnancy (3.05±1.26, median = 4, IQR = 2) and late pregnancy (3.05±1.24, median = 4, IQR = 2). Pre-pregnancy scores were significantly higher than mid-pregnancy scores (Wilcoxon test = 1472, p = .008) and late pregnancy scores (Wilcoxon test = 1854, p = .01). CONCLUSION: Most Black pregnant participants reported high levels of aerobic PA both before pregnancy and during pregnancy. However, many were underactive or sedentary. Aerobic PA decreased during pregnancy compared with pre-pregnancy, without the drop in third trimester PA found in other populations. Providers should assess PA across pregnancy and promote adequate PA for maternal and infant health, particularly among Black women.

Stress and coping among pregnant black women during the COVID-19 pandemic.

OBJECTIVE: This study explored stress and coping among pregnant Black women prior to and during the COVID-19 pandemic. DESIGN: Prospective, longitudinal, cohort study. SAMPLE: Thirty-three women enrolled in the Biosocial Impact on Black Births study prior to the COVID-19 pandemic and who were still pregnant during the pandemic. MEASUREMENTS: Questionnaires included the Perceived Stress Scale, Prenatal Coping Inventory, and questions related to sociodemographic characteristics, worry about COVID-19, and coping strategies used during the pandemic. RESULTS: Women reported very much being worried about my child getting COVID-19 (46%) and my family member getting COVID-19 (46%). Women reported specific active coping strategies very much reduced their feelings of discomfort during COVID-19: God, religion, or spirituality (24%), social media (24%), and following government advice (24%). Higher use of avoidance coping prior to the pandemic was associated with higher levels of stress both prior to (r = 0.60, p < .001) and during (r = 0.47, p < .01) the pandemic. CONCLUSION: Women reported worries about COVID-19 and used various strategies to cope with feelings of discomfort due to the pandemic. Nurses should assess the stress level of pregnant Black women and recommend active coping strategies during the pandemic.

Intimate partner violence, prenatal stress, and substance use among pregnant Black women.

OBJECTIVES: We examine the mediation effects of prenatal stress on the associations between intimate partner violence (IPV) experience and the most common forms of substance use (i.e., cigarette smoking, alcohol drinking, and marijuana use) among pregnant Black women. DESIGN: Cross-sectional. SAMPLE: Black women (N = 203) from metropolitan Detroit, Michigan and Columbus, Ohio, were recruited between 8 and 29 weeks of gestation. MEASUREMENTS: Women were asked about IPV experience during 12 months prior to the start of the pregnancy, perceived stress during pregnancy, and substance use during pregnancy. RESULTS: Intimate partner violence prior to pregnancy was positively associated with cigarette smoking and marijuana use but not with alcohol use during pregnancy. IPV prior to pregnancy was also positively associated with higher levels of perceived stress during pregnancy after controlling for covariates. Path analysis indicated that IPV had an indirect effect on marijuana use through perceived stress (standardized indirect effect = 0.026, SE = 0.020, 95% CI = 0.005-0.064, p =.017). CONCLUSIONS: Perceived stress during pregnancy partially mediated the association between previous experience of IPV and marijuana use among pregnant Black women. Interventions are needed to reduce IPV that would lower stress during pregnancy and consequently substance abuse to improve pregnancy outcomes and maternal and newborn health.

Family involvement in pregnancy and psychological health among pregnant Black women.

Social determinants of health influence psychological health in pregnancy and contribute to health inequities in birth outcomes. This study examines the association between family involvement during pregnancy and psychological health among Black women. Pregnant women in Detroit, MI and Columbus, OH were recruited between 8 and 29 weeks' gestation (n = 203). Higher family involvement was associated with lower depressive symptoms (CES-D; ß = -1.3, p < 0.001), perceived stress (ß = -0.8, p < 0.001), and anxiety (ß = -0.39, p < 0.01), and higher levels of psychological well-being (ß = 2.2, p < 0.001). Family involvement may be a protective factor for pregnant Black women.

You're From Where, Again? A Critical Assessment of Institutional Diversity in the Society for Epidemiologic Research.

The Society for Epidemiologic Research (SER) has recently taken laudable steps toward increasing diversity, equity, and inclusion within the society, including participation in the annual meeting. In this essay, we argue that there is one critical piece of the diversity and inclusion equation that is, however, overlooked: institution. At the 2019 Annual Meeting, a mere 8 institutions accounted for a disproportionate number of both oral concurrent sessions and symposium speakers. This lack of institutional diversity, unless addressed, will hinder SER's ability to address other aspects of diversity, equity, and inclusion.

Neighborhood-Level Mass Incarceration and Future Preterm Birth Risk among African American Women.

While evidence for neighborhood effects on adverse birth outcomes is growing, no studies have examined whether living in a neighborhood impacted by mass incarceration is associated with preterm birth risk. We used modified Poisson regression to test whether residence in a neighborhood impacted by mass incarceration predicted future risk of preterm birth, among African American women. We linked data from the Justice Atlas of Sentencing and Corrections to survey and medical record data from the Life-course Influences on Fetal Environments study (n = 681). We also tested for effect modification by age and marital status. The association between prison admission expenditures and future risk of PTB varied by maternal age at birth, with younger women (< 35) having a modest increase in risk (relative risk (RR) 1.07; 95% confidence interval (CI) 0.99, 1.15), and older (35+ year old) women having lower risk (RR 0.86; 95% CI 0.69, 1.07). The association between the number of prison admissions due to new court cases and future risk of PTB varied by marital status, with evidence that married women may be protected (RR 0.75; 95% CI 0.61, 0.92), while little evidence of association was observed among unmarried women (RR 1.02; 95% CI 0.80, 1.30). The association between residence in an area impacted by mass incarceration and future risk of PTB among African American women may vary by age and marital status. Future research to identify the mechanisms of these associations is warranted.

How Depressive Symptoms among African American Women Relate to Measures of Social Disorder in Her Childhood and Pregnancy Neighborhood.

Pregnant African American women who report higher levels of social disorder (e.g., vacant housing, drug dealing) in their neighborhoods also report higher levels of depressive symptoms. The effects of social disorder in the neighborhood during childhood on depressive symptoms during pregnancy are not known. Also unknown is the interaction between social disorders in the neighborhood during childhood and during pregnancy regarding depressive symptoms during pregnancy. The purpose of this study was to examine whether higher levels of social disorder in the neighborhood during pregnancy buffered the association of social disorder in the neighborhood during childhood (at age 10 as reference) with depressive symptoms during pregnancy among African American women. We conducted a secondary data analysis of 1383 African American women from the Life-course Influences on Fetal Environments (LIFE) Study (Detroit, Michigan, 2009-2011). Women were interviewed in the hospital 24-72 h after the births. The Center for Epidemiological Studies-Depression (CES-D) scale measured depressive symptoms. Scales measuring social disorder in the neighborhood both during childhood and during pregnancy were also included in the interviews. Women with CES-D scores ≥ 16 were younger, were more likely to be single, and had lower levels of education and household income compared with women with CES-D < 16. There was a significant association between women who report social disorder in their neighborhoods during childhood and depressive symptoms during pregnancy. This effect was moderated by measures of social disorder in the neighborhood during pregnancy (p = .037). Women who reported both low levels of social disorder in their neighborhoods during childhood and during pregnancy had the lowest CES-D scores after controlling for maternal age, marital status, years of education, and family income. The model had a good fit to the data (χ2(6) = 6.36, p = .38). Health care providers should inquire about neighborhood conditions during childhood and during pregnancy and provide referrals for appropriate professional and community support for women who report social disorder in their neighborhoods and depressive symptoms.

Prenatal cigarette smoking as a mediator between racism and depressive symptoms: The Biosocial Impact on Black Births Study.

OBJECTIVE: This study examined whether cigarette smoking mediated the association of racial discrimination with depressive symptoms among pregnant Black women. DESIGN: Cross-sectional. SAMPLE: Two hundred Black women at 8-29 weeks gestation. MEASUREMENTS: Women completed questionnaires including the Experiences of Discrimination and the Center for Epidemiologic Studies-Depression (CES-D) scales, as well as questions about sociodemographic characteristics and cigarette smoking. RESULTS: The mean age of the sample was 26.9 ± 5.7 years and the mean gestational age at data collection was 15.6 ± 5.7 weeks. Approximately 17% of women reported prenatal cigarette smoking; 27% had prenatal CES-D scores ≥23, which have been correlated with depression diagnoses; and 59% reported ever (lifetime) experiencing discrimination in at least one situation (e.g., at work). Path analysis results indicated that the standardized indirect effect of experiences of racial discrimination on CES-D scores through prenatal smoking was statistically significant (standardized indirect effect = 0.03; 95% CI: 0.001, 0.094; p = .042). CONCLUSION: Cigarette smoking during pregnancy partially mediated the association between lifetime experiences of racial discrimination and prenatal depressive symptoms among pregnant Black women. Smoking cessation programs should focus on identifying and treating depressive symptoms among pregnant Black women.

Personal Versus Group Experiences of Racism and Risk of Delivering a Small-for-Gestational Age Infant in African American Women: a Life Course Perspective.

The majority of studies investigating the relationship between racism/racial discrimination and birth outcomes have focused on perceived experiences of racism/racial discrimination directed at oneself (personal racism). However, evidence suggests individuals report with greater frequency racism/racial discrimination directed at friends, family members, or other members of their racial/ethnic group (group racism). We examined how much African American (AA) women report lifetime experiences of perceived racism or racial discrimination, both personal and group, varied by maternal age. We also investigated whether reports of personal and group racism/racial discrimination were associated with the risk of delivering a small-for-gestational age (SGA) infant and how much maternal age in relation to developmental life stages (adolescence [≤ 18 years], emerging adulthood [19-24 years], and adulthood [≥ 25 years]) moderated the relationship. Data stem from the Baltimore Preterm Birth Study, a hybrid prospective/retrospective cohort study that enrolled 872 women between March 2000 and July 2004 (analyzed in 2016-2017). Spline regression analyses demonstrated a statistically significant (p value for overall association < 0.001) and non-linear (p value = 0.044) relationship between maternal age and the overall racism index. Stratified analysis showed experiences of racism overall was associated with a higher odds ratio of delivering an SGA infant among AA women aged ≥ 25 years (OR = 1.45, 95% CI 1.02-2.08). The overall racism index was not associated with the SGA infant odds ratio for emerging adults (OR = 0.86, 95% CI 0.69-1.06) or adolescents (OR = 0.92, 95% CI 0.66-1.28). Multiple aspects of racism and the intersection between racism and other contextual factors need to be considered.

The Impact of Neighborhood Conditions and Psychological Distress on Preterm Birth in African-American Women.

OBJECTIVE: Prior research suggests that adverse neighborhood conditions are related to preterm birth. One potential pathway by which neighborhood conditions increase the risk for preterm birth is by increasing women's psychological distress. Our objective was to examine whether psychological distress mediated the relationship between neighborhood conditions and preterm birth. DESIGN AND SAMPLE: One hundred and one pregnant African-American women receiving prenatal care at a medical center in Chicago participated in this cross-sectional design study. MEASURES: Women completed the self-report instruments about their perceived neighborhood conditions and psychological distress between 15-26 weeks gestation. Objective measures of the neighborhood were derived using geographic information systems (GIS). Birth data were collected from medical records. RESULTS: Perceived adverse neighborhood conditions were related to psychological distress: perceived physical disorder (r = .26, p = .01), perceived social disorder (r = .21, p = .03), and perceived crime (r = .30, p = .01). Objective neighborhood conditions were not related to psychological distress. Psychological distress mediated the effects of perceived neighborhood conditions on preterm birth. CONCLUSIONS: Psychological distress in the second trimester mediated the effects of perceived, but not objective, neighborhood conditions on preterm birth. If these results are replicable in studies with larger sample sizes, intervention strategies could be implemented at the individual level to reduce psychological distress and improve women's ability to cope with adverse neighborhood conditions.

Neighborhood Context and Preterm Delivery among African American Women: the Mediating Role of Psychosocial Factors.

Preterm delivery (PTD), or birth before 37 completed weeks of gestation, is a serious public health issue, and racial disparities persist. In a recently published study, perceptions of the residential environment (or neighborhood context) were associated with PTD rates among urban African American women with low educational attainment (≤12 years); however, the mechanisms of these associations are unknown. Given this gap in the literature, we used data from the Life Influences on Fetal Environments Study of postpartum African American women from Metropolitan Detroit, Michigan (2009-2011; n = 399), to examine whether psychosocial factors (depressive symptomology, psychological distress, and perceived stress) mediate associations between perceptions of the neighborhood context and PTD. Validated scales were used to measure women's perceptions of their neighborhood safety, walkability, healthy food availability (higher=better), and social disorder (higher=more disorder). The psychosocial indicators were measured with the Center for Epidemiologic Studies-Depression Scale, Kessler's Psychological Distress Scale (K6), and Cohen's Perceived Stress Scale. Statistical mediation was assessed using an unadjusted logistic regression-based path analysis for estimating direct and indirect effects. The associations between perceived walkability, food availability, and social disorder were not mediated by psychosocial factors. However, perceptions of neighborhood safety were inversely associated with depressive symptoms which were positively associated with PTD rates. Also, higher perceived neighborhood social disorder was associated with higher PTD rates, net of the indirect paths through psychosocial factors. Future research should identify other mechanisms of the perceived neighborhood context-PTD associations, which would inform PTD prevention efforts among high-risk groups.

Perceived Physical and Social Residential Environment and Preterm Delivery in African-American Women.

Perceptions of the residential environment may be associated with preterm delivery (PTD), though few studies exist. Data from the Life-course Influences on Fetal Environments (LIFE) Study (metropolitan Detroit, Michigan, 2009-2011) were used to examine whether perceptions of the current social and physical environment were associated with PTD rates among postpartum African-American women (n = 1,411). Perceptions of the following neighborhood characteristics were measured with validated multi-item scales: healthy food availability, walkability, safety, social cohesion, and social disorder. No significant associations between perceived residential environment and PTD were found in the total sample. However, education significantly modified 4 of the 5 associations (all interaction P's < 0.05). In women with ≤12 years of education, significant inverse associations were observed between PTD rates and perceptions of the following neighborhood characteristics: healthy food availability (unadjusted prevalence ratio (uPR) = 0.81, 95% confidence interval (CI): 0.68, 0.98), walkability (uPR = 0.77, 95% CI: 0.64, 0.95), and safety (uPR = 0.73, 95% CI: 0.56, 0.95). Women with ≤12 years of education also had higher PTD rates with higher social disorder (age-adjusted PR = 1.54, 95% CI: 1.10, 2.17). Null associations existed for women with >12 years of education. The PTD rates of women with lower education may be significantly affected by the physical and social residential environment.