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Preconception Health and Preterm Birth Differences Among U.S.-Born and Foreign-Born Black Women Sheree Holmes Keitt Walden University

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Preconception Health and Preterm Birth Differences Among U.S.-Born and Foreign-Born Black Women Sheree Holmes Keitt Walden University Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2019 Preconception Health and Preterm Birth Differences Among U.S.-Born and Foreign-Born Black Women Sheree Holmes Keitt Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Public Health Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral study by Sheree Holmes Keitt has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Patrick Tschida, Committee Chairperson, Public Health Faculty Dr. Egondu Onyejekwe, Committee Member, Public Health Faculty Dr. Simone Salandy, University Reviewer, Public Health Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2019 Abstract Preconception Health and Preterm Birth Differences Among U.S.-Born and Foreign-Born Black Women by Sheree Holmes Keitt Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Public Health Walden University May 2019 Abstract Foreign-born Black women giving birth in the United States have superior preterm birth outcomes compared to their U.S-born Black peers. Many studies have focused on tobacco use and medical risk factors, but few have focused solely on preconception health. The purpose of this study was to examine preconception health and preterm birth differences among U.S.-born and foreign-born Black women. Three theoretical frameworks guided this study: the life course theory, healthy migrant theory/immigrant paradox, and weathering theory. Primary research questions assessed (a) if there were an association between chronic preconception risk factors, prepregnancy obesity, diabetes, and hypertension, in U.S.-born and foreign-born Black women, (b) if U.S.-born Black women had a higher risk of having a preterm infant compared to foreign-born Black women, and (c) if weathering existed in U.S.-born and foreign-born Black women. A quantitative design using the 2017 Natality Public Use File was employed that included non-Hispanic Black women ages 15 to 44 years. Chi-square test and binary logistic regression were used for the data analysis. Key findings revealed (a) a statistically significant association between preterm birth and chronic preconception health risk factors in both groups of women, (b) U.S.-born women were roughly 1.4 times more likely to have a preterm infant than foreign-born women, and (c) both groups experienced weathering. This study might positively impact social change by offering an alternative perspective to the reproductive health advantage of foreign-born Black women. This perspective can aid in advancing policy and systems change strategies to address the root causes of racial and ethnic disparities in birth outcomes, advance health equity, and improve maternal health. Preconception Health and Preterm Birth Differences Among U.S.-Born and Foreign-Born Black Women by Sheree Holmes Keitt Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Public Health Walden University May 2019 Dedication For Coby and Chaz: You are my inspiration and greatest blessing. To have monoamniotic twins who were preterm, at 30 weeks and 6 days, and at a time I was writing a study to improve the birth outcomes of preterm infants, was very discouraging. But you both inspired me to continue my path, and I thank God every day for bringing you both into my life and for your health. Acknowledgments “I can do all things through Christ which strengthens me” - Philippians 4:13 First and foremost, I give honor and glory to God. I express sincere appreciation and gratitude to the following people: • My husband, Charles Keitt, thank you for the numerous sacrifices you have made with me during this process. I appreciate your encouragement and willingness to share me with Walden University since the start of our relationship. I love you. • My children, Coby and Chaz, you mean the world to me. Thank you for making mommy smile on the hard days. • My family and close friends, thank you for support and encouragement throughout this process, I appreciate you. • My chair, Dr. Patrick Tschida, I truly appreciate your wisdom, guidance, and understanding. Thank you for everything! This doctoral study would not exist without your support. • My committee members, Dr. Egondu Rosemary Onyejekwe and Dr. Simone Salanday, Research Coordinator Dr. Tammy Root, Program Director Dr. Nancy Rea, Doctoral Specialist Jared Yogert, and all the Walden University faculty that I have encountered during my program, thank you for your guidance and support. • My colleagues in the Walden University Doctoral Peer Mentor Program, thank you for everything that you do. Table of Contents List of Tables ..................................................................................................................... iv Section 1: Foundation of the Study and Literature Review .................................................1 Introduction ....................................................................................................................1 Problem Statement .........................................................................................................4 Purpose of Study ............................................................................................................6 Research Questions and Hypothesis ..............................................................................7 Theoretical Foundation of Study ...................................................................................9 Nature of the Study ......................................................................................................12 Literature Search Strategy............................................................................................13 Literature Review Based on Key Variables/Key Concepts .........................................14 Preterm Birth ......................................................................................................... 14 Preconception Health ............................................................................................ 15 Foreign-born Reproductive Health Advantage ..................................................... 17 Definitions....................................................................................................................26 Assumptions .......................................................................................................................27 Scope and Delimitations ....................................................................................................27 Significance and Summary ................................................................................................29 Section 2: Research Design and Data Collection ..............................................................31 Introduction ..................................................................................................................31 Research Design and Rationale ...................................................................................31 Methodology ................................................................................................................32 i Population ............................................................................................................. 32 Sampling and Sampling Procedures ..................................................................... 32 Instrumentation and Operationalization of Constructs Operationalization .......... 33 Operationalization of Variables ............................................................................ 35 Data Analysis Plan ................................................................................................ 39 Threat to Validity .........................................................................................................44 Ethical Procedures ................................................................................................ 45 Summary ......................................................................................................................46 Section 3: Presentation of the Results and Findings ..........................................................47 Introduction ..................................................................................................................47 Data Collection of Secondary Data Set .......................................................................50 Study Results ...............................................................................................................50 Demographic Characteristics of the Sample ......................................................... 50 Chi-Square Test and Binary Logistic Regression ........................................................57 Summary ......................................................................................................................69 Section 4: Application to Professional Practice and Implications for Social
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