Fetal Origins of Health Disparities: Transgenerational Consequences of Racism.

Despite advances in perinatal medicine, racial disparity in birth outcomes remains a public health problem in the USA. The underlying mechanisms for this long-standing racial disparity are incompletely understood. This review presents transgenerational risk factors for racial disparities in preterm birth, exploring the impact of interpersonal and structural racism, theoretical models of stress, and biological markers of racial disparities.

Trends in workplace homicides in the U.S., 1994-2021: An end to years of decline.

Workplace and non-workplace homicides in the United States (U.S.) have declined for over 30 years until recently. This study was conducted to address the change in trends for both workplace and non-workplace homicides and to evaluate the homogeneity of the change in workplace homicides by specified categories. Joinpoint and autoregressive models were used to assess trends of U.S. workplace and non-workplace homicides utilizing surveillance data collected by the Bureau of Labor Statistics and the Federal Bureau of Investigation from 1994 through 2021. Both workplace and non-workplace homicides decreased significantly from 1994 through 2014. Workplace homicides showed no significant trend from 2014 through 2021 (p = 0.79), while non-workplace homicides showed a significant average annual increase of 4.1% from 2014 through 2020 (p = 0.0013). The large decreases in the trend of workplace homicides occurring during a criminal act, such as robbery, leveled off and started to increase by the end of the study period (p < 0.0001). Declines in workplace homicides due to shootings also leveled off and started to increase by the end of the study period (p < 0.0001). U.S. workplace and non-workplace homicide rates declined from the 1990s until around 2014. Trends in workplace homicides varied by the types of the homicide committed and by the type of employee that was the victim. Criminal-intent-related events, such as robbery, appear to be the largest contributor to changes in workplace homicides. Researchers and industry leaders could develop and evaluate interventions that further address criminal-intent-related workplace homicides.

Lifetime Upward Economic Mobility and US-Born Latina Women's Preterm Birth Rates.

OBJECTIVES: To determine whether Latina women's upward economic mobility from early-life residence in impoverished urban neighborhoods is associated with preterm birth (< 37 weeks, PTB) . METHODS: Multivariate logistic regression analyses were performed on the Illinois transgenerational birth-file with appended US census income information for Hispanic infants (born 1989-1991) and their mothers (born 1956-1976). RESULTS: In Chicago, modestly impoverished-born Latina women (n = 1,674) who experienced upward economic mobility had a PTB rate of 8.5% versus 13.1% for those (n = 3,760) with a lifelong residence in modestly impoverished neighborhoods; the unadjusted and adjusted (controlling for age, marital status, adequacy of prenatal care, and cigarette smoking) RR equaled 0.65 (0.47, 0.90) and 0.66 (0.47, 0.93), respectively. Extremely impoverished-born Latina women (n = 2,507) who experienced upward economic mobility across their life-course had a PTB rate of 12.7% versus 15.9% for those (n = 3,849) who had a lifelong residence in extremely impoverished neighborhoods, the unadjusted and adjusted RR equaled 0.8 (0.63. 1.01) and 0.95 (0.75, 1.22), respectively. CONCLUSIONS FOR PRACTICE: Latina women's upward economic mobility from early-life residence in modestly impoverished urban neighborhoods is associated with a decreased risk of PTB. A similar trend is absent among their peers with an early-life residence in extremely impoverished areas.

The First-Year Mortality Rates of Singleton Infants Born at Term of US-Born and Foreign-Born Women: The Effect of Paternal Acknowledgment.

OBJECTIVE: To determine the whether a greater percentage of deaths of infants born at term among US-born (vs foreign-born) women is attributable to paternal nonacknowledgement. STUDY DESIGN: Using a cross-sectional population-based design, stratified and multivariable binomial regression analyses were performed on a subset of the 2017 National Center for Health Statistics linked live birth-infant death cohort dataset of singleton infants born at term (37-42 weeks) of US-born (N = 2 127 243) and foreign-born (N = 334 664) women. RESULTS: Infants of US-born women had a prevalence of paternal nonacknowledgement of 11.3% vs 7.5% for foreign-born women, P < .001. The infant mortality rate of term births to US-born women with paternal nonacknowledgment equaled 5.0/1000 vs 2.0/1000 for those with paternal acknowledgment; relative risk (RR) = 2.47 (2.31, 2.86). The infant mortality rate of term births to foreign-born women with paternal nonacknowledgment equaled 2.5/1000 vs 1.6/1000 for those with paternal acknowledgment, RR = 1.61 (1.24, 2.10). The adjusted (controlling for selected covariates) RR of first-year mortality of term births among US-born and foreign-born women with nonacknowledged (vs acknowledged) fathers equaled 1.43 (1.33, 1.54) and 1.38 (1.04, 1.84), respectively. The population-attributable risk percent of deaths in infants born at term for paternal nonacknowledgement among US-born and foreign-born women equaled 4.9% (246 deaths) and 2.8% (15 deaths), respectively. CONCLUSIONS: Paternal nonacknowledgement is associated with a 40% greater infant mortality rate among term births to US-born and foreign-born women; however, a greater proportion of first-year deaths among term births to US-born (vs foreign-born) women is attributable to paternal nonacknowledgment. These findings highlight the importance of a father's involvement in the outcomes of infants born at term.

Mexican-American Women's Lifelong Residence in the United States Is Associated with an Increased Risk of Gastroschisis: A Population-Based Study.

OBJECTIVE: To determine whether nativity is associated with abdominal wall defects among births to Mexican-American women. STUDY DESIGN: Using a cross-sectional, population-based design, stratified and multivariable logistic regression analyses were performed on the 2014-2017 National Center for Health Statistics live-birth cohort dataset of infants of US-born (n = 1 398 719) and foreign-born (n = 1 221 411) Mexican-American women. RESULTS: The incidence of gastroschisis was greater among births to US-born compared with Mexico-born Mexican-American women: 36.7/100 000 vs 15.5/100 000, RR = 2.4 (2.0, 2.9). US-born (compared with Mexico-born) Mexican-American mothers had a greater percentage of teens and cigarette smokers, P < .0001. In both subgroups, gastroschisis rates were greatest among teens and decreased with advancing maternal age. Adjusting for maternal age, parity, education, cigarette smoking, pre-pregnancy body mass index, prenatal care usage, and infant sex), OR of gastroschisis for US-born (compared with Mexico-born) Mexican-American women was 1.7 (95% CI 1.4-2.0). The population attributable risk of maternal birth in the US for gastroschisis equaled 43%. The incidence of omphalocele did not vary by maternal nativity. CONCLUSIONS: Mexican-American women's birth in the US vs Mexico is an independent risk factor for gastroschisis but not omphalocele. Moreover, a substantial proportion of gastroschisis lesions among Mexican-American infants is attributable to factors closely related to their mother's nativity.

The Relation of Neighborhood Racial and Income Polarity to Preterm Birth Rates in Chicago.

OBJECTIVES: To investigate the extent to which spatial social polarization is associated with preterm birth among urban African-American and non-Latinx white women, and whether prenatal care modifies this relationship. METHODS: We performed multilevel logistic regression analyses on a 2013-2017 dataset of Chicago vital records (N = 29,179) with appended Index of Concentration at the Extremes (ICE) values for race and income. RESULTS: Women who resided in the bottom ICE quintile neighborhoods had a preterm birth rate of 11.5%, compared to 7.3% for those who live in the top ICE quintile areas; adjusted odds ratio (aOR) equaled 1.72 (95% confidence interval [CI] = 1.39, 2.12). This disparity widened for early (< 34 weeks) preterm birth rates, aOR = 2.60 (1.77, 3.81). These associations persisted among women with adequate prenatal care utilization. CONCLUSIONS FOR PRACTICE: Spatial polarization of race and income in urban African-American and non-Latinx white women's residential environment is strongly associated with preterm birth rates, even among those who receive adequate prenatal care. These findings highlight the benefit of using ICE to contextualize the impact of urban neighborhood-level characteristics on preterm birth rates.

Explaining the Link Between Paternal Socioeconomic Position and Small for Gestational Age Birth: The Effect of Maternal Unhealthy Behaviors.

OBJECTIVE: To determine the proportion of small for gestational age (weight < 10th percentile, SGA) births among fathers with lifelong low (compared to high) socioeconomic position (SEP) attributable to white and African-American women's unhealthy pregnancy-related behaviors. METHODS: Oaxaca-Blinder decomposition methods were conducted on the Illinois transgenerational dataset of infants (1989-1991) and their Chicago-born parents (1956-1976) with appended US census income data. The neighborhood income of father's residence at the time of his birth and at the time of his infant's birth were used to estimate his lifetime SEP. Maternal unhealthy pregnancy-related behaviors were defined as cigarette smoking, inadequate prenatal care, and/or low weight gain during pregnancy. RESULTS: Among African-American women, births (n = 4426) to fathers with lifetime low SEP had an SGA rate of 14.8% compared to 12.1% for those (n = 365) born to fathers with lifetime high SEP (p < 0.0001). Among white women, births (n = 1430) to fathers with lifetime low SEP had an SGA rate of 9.8% compared to 6.2% for those (n = 9141) born to fathers with lifetime high SEP (p < 0.0001). Adjusting for maternal age, marital status, education, and parity, African-American and white women's unhealthy pregnancy behaviors accounted for 25% and 33%, respectively, of the disparity in SGA rates among infants of lifetime low (compared to high) SEP fathers. CONCLUSION: A significant proportion of the disparity in SGA rates between fathers with lifelong low (compared to high) SEP is explained in both races by maternal unhealthy pregnancy behaviors.

Women's Economic Mobility and Small for Gestational Age Rates: The Effect of Paternal Early-Life Socioeconomic Position.

OBJECTIVE: To determine whether paternal early-life socioeconomic position (defined by neighborhood income) modifies the association of maternal economic mobility and infant small for gestational age (weight for gestational age < 10th percentile, SGA) rates. METHODS: Stratified and multilevel binomial regression analyses were executed on the Illinois transgenerational dataset of parents (born 1956-1976) and their infants (born 1989-1991) with appended U.S. census income information. Only Chicago-born women with an early-life residence in impoverished or affluent neighborhoods were studied. RESULTS: The incidence of impoverished-born women's upward economic mobility among births (n = 3777) with early-life low socioeconomic position (SEP) fathers was less than that of those (n = 576) with early-life high SEP fathers: 56% vs 71%, respectively, p < 0.01. The incidence of affluent-born women's downward economic mobility among births (n = 2370) with early-life low SEP fathers exceeded that of those (n = 3822) with early-life high SEP fathers: 79% vs 66%, respectively, p < 0.01. The adjusted RR of infant SGA for maternal upward (compared to lifelong impoverishment) economic mobility among fathers with early-life low and high SEP equaled 0.68 (0.56, 0.82) and 0.81 (0.47, 1.42), respectively. The adjusted RR of infant SGA for maternal downward (compared to lifelong residence in affluent neighborhoods) economic mobility among fathers with early-life low and high SEP were 1.37 (0.91, 2.05) and 1.17 (0.86, 1.59), respectively. CONCLUSIONS: Paternal early-life SEP is associated with maternal economic mobility (both upward and downward); however, it does not modify the relationship between maternal economic mobility and infant SGA rates.

Adverse Maternal Fetal Environment Partially Mediates Disparate Outcomes in Non-White Neonates with Major Congenital Heart Disease.

OBJECTIVE: To determine whether differential exposure to an adverse maternal fetal environment partially explains disparate outcomes in infants with major congenital heart disease (CHD). STUDY DESIGN: Retrospective cohort study utilizing a population-based administrative California database (2011-2017). Primary exposure: Race/ethnicity. Primary mediator: Adverse maternal fetal environment (evidence of maternal metabolic syndrome and/or maternal placental syndrome). OUTCOMES: Composite of 1-year mortality or severe morbidity and days alive out of hospital in the first year of life (DAOOH). Mediation analyses determined the percent contributions of mediators on pathways between race/ethnicity and outcomes after adjusting for CHD severity. RESULTS: Included were 2747 non-Hispanic White infants (reference group), 5244 Hispanic, and 625 non-Hispanic Black infants. Hispanic and non-Hispanic Black infants had a higher risk for composite outcome (crude OR: 1.18; crude OR: 1.25, respectively) and fewer DAOOH (-6 & -12 days, respectively). Compared with the reference group, Hispanic infants had higher maternal metabolic syndrome exposure (43% vs 28%, OR: 1.89), and non-Hispanic Black infants had higher maternal metabolic syndrome (44% vs 28%; OR: 1.97) and maternal placental syndrome exposure (18% vs 12%; OR, 1.66). Both maternal metabolic syndrome exposure (OR: 1.21) and maternal placental syndrome exposure (OR: 1.56) were related to composite outcome and fewer DAOOH (-25 & -16 days, respectively). Adverse maternal fetal environment explained 25% of the disparate relationship between non-Hispanic Black race and composite outcome and 18% of the disparate relationship between Hispanic ethnicity and composite outcome. Adverse maternal fetal environment explained 16% (non-Hispanic Black race) and 21% (Hispanic ethnicity) of the association with DAOOH. CONCLUSIONS: Increased exposure to adverse maternal fetal environment contributes to racial and ethnic disparities in major CHD outcomes.

Infant Mortality Rates Among US-Born and Foreign-Born Latinx Women: The Effect of Black Race.

OBJECTIVE: To determine the extent to which Black race is associated with the infant mortality rate (< 365 day, IMR) of births to US-born and foreign-born Latinx women. METHODS: Stratified and multivariable binominal log-linear regression analyses were performed on the 2010-2013 National Center for Health Statistics linked birth-death certificate files of singleton infants. RESULTS: The IMR of births to US-born Black Latinx women (N = 54,542) exceeded that of births to US-born White Latinx women (N = 1,320,084): 5.7/1000 vs 4.2/1000, RR = 1.4 (1.2, 1.5). In contrast, the IMR of births to foreign-born Black Latinx women (N = 35,544) approximated that of births to foreign-born White Latinx women (N = 1,372,172): 3.8/1000 vs 3.6/1000, RR = 1.0 (0.9, 1.2) The adjusted (controlling for maternal age, education, prenatal care, high parity, and region of residence) RR of infant mortality for births to US-born and foreign-born Black (versus non-Latinx White) Latinx women equaled 1.4 (1.2, 1.6) and 1.0 (0.8, 1.2), respectively. The adjusted RR of infant mortality for births to US-born and foreign-born White (versus non-Latinx White) Latinx women equaled 1.0 (0.9, 1.0) and 0.8 (0.7, 0.8), respectively. CONCLUSIONS: Black race is associated with a 1.4-fold higher IMR among births to US-born Latinx women. A similar phenomenon does not occur among foreign-born Latinx women. These intriguing findings highlight that the social construct of Black race across the life-course of Latinx women are detrimental to infant outcome.

Teen Birth Across Generations Among Non-Latino Whites and African-American Women: The Effect of Race and Neighborhood Income.

OBJECTIVES: To examine the extent to which lifelong neighborhood income modifies the generational association of teen birth among White and AA women in Cook County, IL. METHODS: Stratified and multilevel logistic regression analyses were conducted on the Illinois transgenerational dataset of singleton births (1989-1991) to non-Latina White and AA mothers (born 1956-1976) with appended U.S. census income information. We calculated rates and risks of teen births according to race, maternal age, and lifelong neighborhood economic environment. RESULTS: Teen birth occurred at a rate of 9.5% and 52.9% for White and AA women, respectively. White women whose mothers were teens when they were born had an over five-fold increased risk of becoming teen mothers themselves. For AA women, the risk was smaller, but statistically significant. For both races, women who experienced downward economic mobility had the highest risk of teen birth, while women with upward mobility had the lowest risk, even compared to women in lifelong high income neighborhoods. While White women exposed to lifelong low income had almost threefold increased risk of teen birth compared to those in lifelong high income neighborhoods, AA women in lifelong high and lifelong low income neighborhoods had similar risk of teen birth. CONCLUSIONS FOR PRACTICE: Understanding the racial differences in intergenerational patterns of teen birth is important for effective program planning and policy making, given that interventions targeted at daughters of teen mothers may differ in effectiveness for White and AA teens.

The Excess Preterm Birth Rate Among US-Born (Compared to Foreign-Born) Black Women: The Role of Father's Education.

OBJECTIVE: To ascertain the component of the excess preterm birth (< 37 weeks, PTB) rate among US-born (compared to foreign-born) Black women attributable to differences in acknowledged father's education attainment. METHODS: Stratified analyses and Oaxaca-Blinder decomposition methods were performed on the 2013 National Center for Health Statistics birth certificate files of singleton infants with acknowledged fathers. RESULTS: US-born Black women (N = 196,472) had a PTB rate of 13.3%, compared to 10.8% for foreign-born Black women (N = 51,334; Risk Difference (95% confidence interval) = 2.5 (2.3, 2.8). Infants of US-born black women had a greater a percentage of fathers with a high school diploma or less and a lower percentage of fathers with bachelor's degrees or higher than their counterparts of foreign-born women. In both subgroups, PTB rates tended to decline as the level of paternal education attainment rose. In an Oaxaca model (controlling for maternal age, education, marital status, parity, adequacy of prenatal care utilization, and chronic medical conditions), differences in paternal education attainment explained 15% of the maternal nativity disparity in PTB rates. In contrast, maternal education attainment accounted for approximately 4% of the disparity in PTB rates. CONCLUSIONS FOR PRACTICE: Acknowledged father's low level of education attainment, or something closely related to it, explains a notable proportion of the disparity in PTB rates between US-born and foreign-born Black women.

The promise and pitfalls of precision medicine to resolve black-white racial disparities in preterm birth.

Differences in preterm birth rates between black and white women are the largest contributor to racial disparities in infant mortality. In today's age of precision medicine, analysis of the genome, epigenome, metabolome, and microbiome has generated interest in determining whether these biomarkers can help explain racial disparities. We propose that there are pitfalls as well as opportunities when using precision medicine analyses to interrogate disparities in health. To conclude that racial disparities in complex conditions are genetic in origin ignores robust evidence that social and environmental factors that track with race are major contributors to disparities. Biomarkers measured in omic assays that may be more environmentally responsive than genomics, such as the epigenome or metabolome, may be on the causal pathway of race and preterm birth, but omic observational studies suffer from the same limitations as traditional cohort studies. Confounding can lead to false conclusions about the causal relationship between omics and preterm birth. Methodological strategies (including stratification and causal mediation analyses) may help to ensure that associations between biomarkers and exposures, as well as between biomarkers and outcomes, are valid signals. These epidemiologic strategies present opportunities to assess whether precision medicine biomarkers can uncover biology underlying perinatal health disparities.

Non-Hispanic White Women's Exposure to Decreased Neighborhood Income and Small for Gestational Age Births: A Population-Based Study.

BACKGROUND: The relationship between non-Hispanic White (NHW) women's decreased neighborhood income between early-life and adulthood, individual risk-status at delivery, and small for gestational age (weight for gestation < 10th percentile, SGA) rates is unknown. OBJECTIVE: To determine the extent to which NHW women's exposure to decreased neighborhood income is a risk factor for SGA births, and whether their own birth weight modifies this relationship. METHODS: Stratified and multilevel logistic regression analyses were executed on the Illinois transgenerational dataset of mothers (born 1956-1976) and their infants (born 1989-1991) with appended U.S. census income information. Only NHW women with an early-life residence in top income quartile Chicago neighborhoods were studied. RESULTS: NHW women (n = 4889) unexposed to decreased neighborhood income between early-life and adulthood had an SGA rate of 7.1%. In contrast, NHW women exposed to slightly (n = 5112), modestly (n = 2158), or severely (n = 339) decreased neighborhood income by the time of delivery had SGA rates of 8.2%, 10.8%, and 10.8%, respectively; RR (95% CI) equaled 1.2 (1.0-1.3), 1.5 (1.3-1.8) and 1.5 (1.1-2.1), respectively. The relationship between maternal exposure to modestly decreased neighborhood income and SGA rates was present only among former non-low birth weight (> 2500 g, non-LBW) mothers. In multilevel logistic regression models, the adjusted (controlling for age, parity, prenatal care usage, and cigarette smoking) OR of SGA birth for former low birth weight (< 2500 g, LBW) and non-LBW NHW women exposed to modestly (compared to no) decreased neighborhood income equaled 0.7 (0.4, 1.4) and 1.3 (1.1-1.6), respectively. CONCLUSIONS FOR PRACTICE: NHW women's exposure to modestly decreased neighborhood income is associated with an increased risk of SGA birth; this phenomenon is absent among former low birth weight women.

Excess Early (< 34 weeks) Preterm Rates Among Non-acknowledged and Acknowledged Low Socioeconomic Position Fathers: The Role of Women's Selected Pregnancy-Related Risk Factors.

OBJECTIVE: To determine the proportion of the excess early preterm birth (< 34 weeks, PTB) rates among non-acknowledged and acknowledged low socioeconomic position (SEP) fathers attributable to White and African-American women's selected pregnancy-related risk factors for PTB. METHODS: Oaxaca-Blinder decomposition methods were performed on the Illinois transgenerational birth-file of infants (1989-1991) and their parents (1956-1976) with appended U.S. census income information. The neighborhood income of father's place of residence at the time of his birth and at the time of his infant's birth were used to measure lifetime SEP. RESULTS: Among non-Latina White women, the early PTB rate for non-acknowledged (n = 3260), acknowledged low SEP (n = 1430), and acknowledged high SEP (n = 9141) fathers equaled 4.02%, 1.82%, and 1.19, respectively; p < 0.001. White women's selected pregnancy-related risk factors for PTB (inadequate prenatal usage, suboptimal weight gain, and/or cigarette smoking) were responsible for 19.3% and 41.2% of the explained disparities in early PTB rates for non-acknowledged and acknowledged low (compared to acknowledged high) SEP fathers, respectively. Among African-American women, the early PTB rate for non-acknowledged (n = 22,727), acknowledged low SEP (n = 4426), and acknowledged high SEP (n = 365) fathers equaled 6.72%, 4.34%, and 3.29%, respectively; p < 0.001. African-American women's selected pregnancy-related risk factors for PTB were responsible for 21.4% and 20.2% of the explained disparities in early PTB rates for non-acknowledged and acknowledged low SEP fathers, respectively. CONCLUSIONS: Non-Latina White and African-American women's selected pregnancy-related risk factors for PTB explain a significant percentage of excess early PTB rates among non-acknowledged and acknowledged low (compared to acknowledged high) SEP fathers.

Adverse birth outcome across the generations: the contribution of paternal factors.

PURPOSE: There is literature suggesting an intergenerational relationship between maternal and infant size for gestational age status and preterm birth, but much less is known about the contribution of paternal birth outcome to infant birth outcome. This study seeks to determine the association between paternal and infant small-for-gestational-age status (weight for gestational age < 10th percentile, SGA) and preterm birth (< 37 weeks gestation, PTB) in a large, diverse population-based sample in the United States. METHODS: Stratified and log-binomial multivariable regression analyses were computed on the vital records of Illinois-born infants (1989-1991) and their Illinois-born parents (born 1956-1976). RESULTS: Among non-Hispanic Whites (n = 83,218), the adjusted (controlling for maternal SGA or PTB, age, parity, education, marital status, prenatal care, and cigarette smoking) relative risk (95% confidence interval) of infant SGA and PTB for former SGA (compared to non-SGA) and preterm (compared to term) fathers equaled 1.65 (1.53, 1.77) and 1.07 (0.92, 1.24), respectively. Among African-Americans (n = 8401), the adjusted relative risk (95% confidence interval) of infant SGA and PTB for former SGA (compared to non-SGA) and preterm (compared to term) fathers equaled 1.32 (1.14, 1.52) and 1.19 (0.98, 1.45), respectively. CONCLUSION: Paternal adverse birth outcome, particularly SGA, is a modest risk factor for corresponding adverse infant outcome, independent of maternal risk status. This phenomenon appears to occur similarly among non-Hispanic White and African-American women.

A Universal Assay for Aminopeptidase Activity and Its Application for Dipeptidyl Peptidase-4 Drug Discovery.

Aminopeptidases, such as dipeptidyl peptidase-4 (DPP-4, CD26), are potent therapeutic targets for pharmacological interventions because they play key roles in many important pathological pathways. To analyze aminopeptidase activity in vitro (including high-throughput screening [HTS]), in vivo, and ex vivo, we developed a highly sensitive and quantitative bioluminescence-based readout method. We successfully applied this method to screening drugs with potential DPP-4 inhibitory activity. Using this method, we found that cancer drug mitoxantrone possesses significant DPP-4 inhibitory activity both in vitro and in vivo. The pharmacophore of mitoxantrone was further investigated by testing a variety of its structural analogues.

Early and Late Preterm Birth Rates Among US-Born Urban Women: The Effect of Men's Lifelong Class Status.

OBJECTIVE: To ascertain the relation of men's lifelong class status (as measured by neighborhood income) to the rates of early (< 34 weeks) and late (34-36 weeks) preterm birth (PTB). METHODS: Stratified and multilevel, multivariable binomial regression analyses were computed on the Illinois transgenerational birth-file of infants (born 1989-1991) and their parents (born 1956-1976) with appended U.S. census income information. The median family income of men's census tract residence at two-time periods were utilized to assess lifelong class status (defined by residence in either the lower or upper half of neighborhood income distribution). RESULTS: In Cook County Illinois, the preterm rate for births (n = 8115) to men with a lifelong lower class status was twice that of births (n = 10,330) to men with a lifelong upper class status: 13% versus 6.0%, RR = 2.2 (2.0, 2.4). This differential was greatest in early PTB rates: 3.9% versus 1.4%, RR = 3.0 (2.5, 3.7). The relation of men's lifelong class status to both PTB components persisted among non-teens, married, college-educated, and non-Latina White women, respectively. The adjusted (controlling for maternal demographic characteristics) RR of early and late PTB for men with a lifelong lower (versus upper) class status were 1.4 (1.1, 1.9) and 1.2 (1.0, 1.4), respectively. The population attributable risk of early PTB for men's lifelong lower class status equaled 16%. CONCLUSIONS: Men's lifelong lower (versus upper) class status is a novel risk factor for early preterm birth regardless of maternal demographic characteristics. This intriguing finding has public health relevance.

Low Birth Weight Among Infants Born to Black Latina Women in the United States.

Objectives To explore associations between race, nativity, and low birth weight (LBW) among Latina and non-Latina women, with special attention to the Black Latina subgroup. Methods Using US natality data from 2011 to 2013, we designed a population-based study to compare LBW (< 2500 g) rates across six groups of women with self-identified race (N = 7,865,264)-White and Black Latina, foreign-born and US-born; non-Latina Black; and non-Latina White-creating 4 models for analysis: unadjusted (Model 1) and adjusted for sociodemographic factors (Model 2), sociodemographic plus medical risk factors (Model 3), and Model 3 factors plus smoking (Model 4). Results Infant LBW rate for Black Latinas (7.9%) was higher than White Latinas (5.6%) and varied by nativity: US-born (8.9%) versus foreign-born (6.1%). Among all study groups, US-born Black Latinas' LBW rate (8.9%) was second only to non-Latina Blacks (11.0%). In unadjusted Model 1, US-born Black Latinas had 81% (odds ratio [OR]: 1.81; 95% confidence interval [CI]: 1.74-1.88) and foreign-born Black Latinas had 22% (OR: 1.22; 95% CI 1.15-1.29) higher odds of LBW than non-Latina White women (reference group). However, in Model 2, ORs for foreign-born Black Latinas were nearly identical to non-Latina Whites (OR: 1.03; 95% CI 0.97-1.1), while US-born Black Latinas' odds were still 47% higher (OR: 1.47; 95% CI 1.42-1.53). Model 3 ORs for each group were similar to Model 2. Conclusions for Practice A significant subgroup of Latina women self-identify as Black, and their LBW rates are higher than White Latinas. Black Latinas born in the United States fare worse than their foreign-born counterparts, implicating negative effects of Black race specific to the US context.

Neighborhood Gun Violence and Birth Outcomes in Chicago.

OBJECTIVES: To examine the association between gun violence and birth outcomes among women in Chicago. METHODS: Using a 5-year set of birth files (2011-2015) merged with census and police data, birth outcomes including low birth weight (LBW, BW < 2500 g), preterm birth (PTB, < 37 weeks gestation), and small-for-gestational-age (SGA, BW < 10th percentile) were examined among non-Hispanic (NH) white, NH black, and Hispanic women in Chicago. Gun violence rates were categorized into tertiles. Multilevel, multiple logistic regression examined the effects of gun violence and race/ethnicity on birth outcomes. RESULTS: Of 175,065 births, 10.6% of LBW, 10.6% of PTB, and 9.1% of SGA occurred in high violence tertile. Using white women in low violence tertile as reference, the OR for LBW among black women ranged 1.9-2.1 across all tertiles, and 0.8-1.2 among Hispanic women. OR for PTB for black women were 1.6-1.7 and 1.0-1.2 for Hispanic women, and OR for SGA for black women were 1.6-1.7 and for Hispanic women 0.9-1.0. CONCLUSIONS FOR PRACTICE: In Chicago, race/ethnicity was associated with birth outcomes, regardless of the level of exposure to gun violence, in 2011-2015. The differences in racial/ethnic composition across the violence exposure levels suggest that, rather than gun violence alone, residential segregation and the geographic inequities likely contribute to disparate birth outcomes.