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Preterm Birth and the Perception of Risk Among African Americans Wayne State University Wayne State University Dissertations 1-1-2012 Preterm Birth And The eP rception Of Risk Among African Americans Gwendolyn Simpson Norman Wayne State University, Follow this and additional works at: http://digitalcommons.wayne.edu/oa_dissertations Recommended Citation Norman, Gwendolyn Simpson, "Preterm Birth And The eP rception Of Risk Among African Americans" (2012). Wayne State University Dissertations. Paper 610. This Open Access Dissertation is brought to you for free and open access by DigitalCommons@WayneState. It has been accepted for inclusion in Wayne State University Dissertations by an authorized administrator of DigitalCommons@WayneState. PRETERM BIRTH AND THE PERCEPTION OF RISK AMONG AFRICAN AMERICANS by GWENDOLYN S. NORMAN DISSERTATION Submitted to the Graduate School of Wayne State University, Detroit, Michigan in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY 2012 MAJOR: ANTHROPOLOGY Approved by: ______________________________ Advisor Date ______________________________ ______________________________ ______________________________ ______________________________ ©COPYRIGHT BY GWENDOLYN S. NORMAN 2012 All Rights Reserved DEDICATION There are so many important people in my life that I love with all my heart, and to whom I would like to dedicate this work. I have to start with my parents, Henry and Lucille Simpson, who raised me with a strong moral foundation, a joy for life, a love and passion for education, a critical concern for the health and well being of all living things, and the knowledge that learning never ends. My love and respect for them is beyond description. To my sister, Diane Simpson, who is a role model for me, and my lifelong best friend. Her high and unwavering standards have always encouraged me to do my best, and it is an honor to follow in her footsteps. I could not have completed this monumental task without Diane’s keen eye for editing, her strong moral support, and her commitment to hang in there with me, night after night, until the task was completed. There are no bounds to my love and admiration for her, and my debt to her is eternal. To my beautiful daughters, Latrice and Termina, my niece India, and my grandchildren who have been so understanding when mommy, auntie, or nana, has had to say, “not now.” To my husband, Joe L. Norman, who has been my rock through all the ups and downs of this journey, and who has never complained. And finally, to Clifton Eric Banks, my dear cousin and eternal cheerleader, who had far too much personal knowledge of the illness experience. Clifton anxiously awaited this day, but did not live to see it. ii ACKNOWLEDGMENTS I would like to acknowledge all of those who have assisted me in this research effort and who have promoted the rigorous attention necessary for the analysis of these case studies. Because the combination of working full time at a demanding job, and going to school is never easy, I would like to thank my three consecutive bosses who have supported me throughout this endeavor. First, I would to like to thank Dr. Mitchell Dombrowski, a long time professional friend and boss, who was there when I initiated this process and offered me his enthusiastic encouragement. Second, I am immensely grateful for Dr. Yoram Sorokin, with whom I worked so closely for so long, and who was extremely kind and understanding when I left my position of 17 years, in part, so that I could complete my doctoral requirements. And finally, I must thank Dr. Robert Sokol, who saw me through to the finish line, and took time out of his unbelievably busy schedule to serve as the outside member on my committee. All three of these physicians have dedicated their lives to research, and to the care and treatment of women with high risk complications of pregnancy. They have not only been a support to me, but an inspiration as well. Each course I took in the department of Anthropology at Wayne State University was engaging and unique, but I do want to thank Dr. Guérin Montilus, whose diachronic approach to teaching anthropological theory helped me to fully appreciate all that anthropology has been, and all that it can be. I also have to express my appreciation to Dr. David Barondess, who introduced me to the fascinating fields of physical and forensic anthropology. He also lent his expertise to me as my committee member while iii he was on the faculty at Wayne State. My studies with him provided me with an essential and extensive understanding of the role of anthropology in the construction, and deconstruction of race. Dr. Mark Luborsky, who stepped in and joined my committee, has been an absolute life saver, helping me to understand the importance of personhood, and how to shape my scattered thoughts into cogent concepts. Next, I am extremely thankful to Dr. Sherylyn Briller, my very first professor in the anthropology department at Wayne State. I was new, and she was new, but her engaging Saturday morning seminars confirmed for me the fact that I would one day become a medical anthropologist. She has served faithfully on my committee, and I thank her for going the extra mile to help me see the nuances of my data, and how the anthropological gaze was essential in the analysis of meaning. My final deepest and heartfelt gratitude goes to Dr. Andrea Sankar, my outstanding chair, whose support, scholarly wisdom, enduring patience and exceptional insight into the challenges faced in this research have placed me forever in her debt. This research was partially supported by a grant from the Blue Cross Blue Shield of Michigan Foundation [Grant #1562.SAP]. iv PREFACE It has been a long journey to get to this point, but it is a good place to be. My career in research began in 1983 when I was hired as the Perinatal Research Nurse Coordinator in the Detroit Medical Center at Wayne State University. It was a rather lonely position at first because I was the only research nurse in the hospital. However, at a major teaching institution that served a large, urban, high risk population, there was an abundance of research that kept me extremely busy. Many of the studies I was involved with focused on the problem of prematurity, and I was frequently in the position of consenting women who were at risk for preterm delivery. Far too often, when I entered the room of a woman in this condition, I was confronted by someone who was under tremendous stress. The women would share heart-rending stories of complex social issues that were making their confinement to bedrest all but impossible to maintain. Invariably, the women were African American. Without having researched the literature, I was seeing one of the most prominent risk factors for preterm delivery. This experience piqued my interest in health disparities and race. In the summer of 1990 I had the opportunity to present some research findings at the annual conference of the International Society on Hypertension in Blacks. Although the study had shown a statistically significant inverse association between the dietary intake of magnesium and blood pressure readings, the actual impact on hypertension was negligible, and I recognized that my research was not a major breakthrough in the understanding and treatment of hypertension. I was very happy I attended that conference, however, because of what I heard from one of the other presenters. The v presenter mentioned that he was from West Africa, and in addressing the issue of hypertension, he stated that Americans are seriously misdirected in our research efforts if we are considering the people we call “black” in this country a racial group. He said that what we are really studying is a social/cultural group, and not a race of people. He pointed out how many of the serious medical conditions that are prevalent among black Americans are simply not found with any comparable frequency among their counterparts in the areas of Africa that are most likely the land of their ancestry. His comments were particularly intriguing because they supported a developing concern I had. Because of my undergraduate experience in the school of nursing, I pursued my master’s degree in public health immediately after receiving my BSN in 1974. Although the majority of my undergraduate education dealt with understanding the basic process of disease, and the multiple intervention techniques to effect treatments and cure, I was most excited by my public health rotation. That was because the emphasis in public health was on health behaviors, and primary prevention, as opposed to secondary and tertiary levels of care. I much preferred the idea of preventing disease, to treating it. In order to prevent disease, I would have to know what causes it, and therefore I found epidemiological research interesting. In published epidemiology studies, race, gender and age are the primary demographic host factors cited when identifying a population at risk. These demographics are generally followed by a description of health behaviors that further define the at risk group. The logical sequence in primary prevention is to identify the medical condition, identify the causative factors that lead to the condition, identify those at risk for the condition, and finally identify what the at risk group must do vi to reduce their susceptibility. Simply stated, in order to reach out to the at risk group, the group must be clearly identified. However, if black race had no biological referent, why was it such a profound risk factor in medical research? In 1996 I had the opportunity to share in the authorship of a publication of research conducted as part of the Maternal Fetal Medicine Units Network of NICHD.
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