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THE EFFECTS of INSTITUTIONAL RACISM, PERCEIVED DISCRIMINATION and MATERNAL STRESS on PRETERM BIRTH Dara D. Mendez a Dissertatio

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THE EFFECTS of INSTITUTIONAL RACISM, PERCEIVED DISCRIMINATION and MATERNAL STRESS on PRETERM BIRTH Dara D. Mendez a Dissertatio THE EFFECTS OF INSTITUTIONAL RACISM, PERCEIVED DISCRIMINATION AND MATERNAL STRESS ON PRETERM BIRTH Dara D. Mendez A dissertation submitted to the faculty of the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Maternal and Child Health in the School of Public Health. Chapel Hill 2009 Approved by: Advisor: Vijaya Hogan Reader: Jennifer Culhane Reader: Jon Hussey Reader: Steve Marshall Reader: Dan Bauer © 2009 Dara D. Mendez ALL RIGHTS RESERVED ii ABSTRACT DARA D. MENDEZ: The Effects of Institutional Racism, Perceived Discrimination and Maternal Stress on Preterm Birth (Under the direction of Dr. Vijaya K. Hogan) There are tremendous racial/ethnic disparities in preterm birth that have not been ameliorated. Individual health risks do not explain these disparities, and there is limited research exploring the social and contextual factors contributing to these disparities. This research explores institutional racism as a fundamental cause of the racial/ethnic disparities in preterm birth. The Home Mortgage Disclosure Act (HMDA) database was used to create a measure for residential redlining and the 2000 US Census was used to create measures for residential redlining and percentage black. The Stress Pregnancy Evaluation Community Project (SPEAC), a cohort of pregnant women (N=3949), had linked vital birth records and geocoded addresses, which were linked to measures of redlining, segregation and percent black on the census tract level. Multilevel logistic and linear regression models were used to examine the relationship between institutional racism and preterm birth (and change in gestational age) using SAS 9.2. The first dissertation paper examined the distribution of residential redlining in the neighborhoods where the SPEAC cohort lived. We also examined the racial/ethnic differences in residences in redlined neighborhoods. We found that the majority of the iii SPEAC population lived in redlined neighborhoods and that non-Hispanic black women were more likely to live in redlined neighborhoods. The second dissertation paper examined the relationship between residential redlining and perceptions of discrimination, stress and neighborhood quality. We also examined racial/ethnic differences in these same perception measures. Black non-Hispanic women had a greater mean residential redlining index, greater perceived everyday discrimination score, and more adverse ratings of neighborhood quality compared to women of all other racial/ethnic groups. Residential redlining was positively associated with perceived poor neighborhood quality but was not associated with perceived discrimination or stress for the overall SPEAC population. However, residential redlining was associated with perceived discrimination among non-Hispanic white women only. Residential redlining was moderately associated with percent black on the census tract level and residential segregation. The final dissertation paper examined the relationship between residential redlining and the risk of preterm birth (and change in gestational age). We also examined racial/ethnic differences in preterm birth and whether residential redlining contributed to the black-white disparity in preterm birth. Residential redlining and perceptions of stress, discrimination and neighborhood quality were not significantly associated with preterm birth. Additionally, residential redlining did not contribute to the black-white disparity in preterm birth. iv This dissertation is dedicated to the women and infants who made this research possible. May this research not be in vain but an avenue for understanding injustice and inequities in health. v ACKNOWLEDGEMENTS The following people have contributed to the development of this dissertation as well as my personal development as a scholar and researcher. First, I must acknowledge my husband, Jason, for loving me and supporting me in my work and all that I try to accomplish in life. I thank you for providing the support I needed to finish my dissertation in a short period of time. I am eternally grateful for my son, Cairen, for his laughs, smiles and encouragement in ways that he doesn’t know. To my parents, for their love and encouragement and allowing me to be myself and reach for my goals. I know that I could not have done this without you. To my sister, for her prayers and positive words during times when I thought this wasn’t possible. To my best friends, Leah and Kristen, for understanding me when no one else could. I also thank God for giving me the wisdom, faith and showing Your love in many ways. I could not have accomplished any of this without You. I also thank my mentor and dissertation advisor and chair, Vijaya Hogan for her continual support throughout my doctoral program, my dissertation work and career. I thank my dissertation committee members Jon Hussey, Jen Culhane, Dan Bauer and Steve Marshall for being flexible and providing the feedback and assistance I needed to complete my dissertation. My friends and cohort mates were invaluable as I completed the doctoral program and my work in maternal and child health: Serena Vaughn-Asante, Tammy Smith, Erika Jefferson, Stephanie Moultrie, Calpurnyia Roberts, Ushma Mehta, Aubrey Spriggs, Apu vi Agrawal, Rajeev Colaco, Anu M. Gomez, Cassandra Richards, Gwen Ellis, Tia Blake, Twyla Perryman, Dinushika Mohottige, Sharon Parker, Theresa Chapple-McGruder, the Minority Student Caucus, and the Rogers Road family. Thank you for encouraging me, allowing me to see the humor in life, and helping me to develop as a woman, mother, friend, researcher and advocate. This research was made possible through funding from Eunice Kennedy Shriver National Institute of Child Health and Human Development National Research Service Award (5F31HD057782-02). vii TABLE OF CONTENTS Page LIST OF TABLES ............................................................................................................... x LIST OF FIGURES ........................................................................................................... xii LIST OF ABBREVIATIONS ........................................................................................... xiii Chapter 1 INTRODUCTION ..................................................................................................... 1 Statement of the Problem ...................................................................................... 1 Research Questions and Hypotheses .................................................................... 3 2 REVIEW OF RELEVANT LITERATURE .............................................................. 7 3 RESEARCH DESIGN AND METHODS ............................................................... 25 4 MANUSCRIPT 1: A Multilevel Approach for Developing a Measure for Residential Redlining as a Form of Institutional Racism in Public Health Research ................................................................................................................... 48 Abstract ............................................................................................................... 48 Introduction ......................................................................................................... 51 Methods............................................................................................................... 54 Results ................................................................................................................. 62 Discussion ........................................................................................................... 65 5 MANUSCRIPT 2: Residential Redlining and Racial/Ethnic Differences in Perceptions of Discrimination, Stress and Neighborhood Quality Among Pregnant Women in Philadelphia, PA ..................................................................... 78 Abstract ............................................................................................................... 78 viii Introduction ......................................................................................................... 80 Methods............................................................................................................... 83 Results ................................................................................................................. 90 Discussion ........................................................................................................... 94 6 MANUSCRIPT 3: Residential Redlining, Perceptions of Discrimination, Stress, and Neighborhood Quality and the Risk of Preterm Birth Among Urban Pregnant Women ........................................................................................ 106 Abstract ............................................................................................................. 106 Introduction ....................................................................................................... 107 Methods............................................................................................................. 109 Results ............................................................................................................... 120 Discussion ......................................................................................................... 124 7 CONCLUSION...................................................................................................... 137 APPENDICES A CHAPTER 4 .........................................................................................................
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