Race and Infant Health Outcomes in the U.S. Military

美国种族不平等的一个持续指标是婴儿死亡率。非裔美国婴儿的死亡率是白人婴儿的两倍多。死亡率较高的主要原因是出生时体重过轻，黑人儿童出生时体重过轻的可能性是白人儿童的两倍。尽管有许多研究调查了为什么非洲裔美国婴儿的低出生体重和婴儿死亡率比白人婴儿高得多，但其原因尚不清楚。社会阶层和医疗保健的群体差异并不能完全解释种族差异，这反过来又导致了对生物学解释的关注。这项研究使用了一个新的、独特的数据集，可以对军事和民用环境下的出生情况进行详细的比较，以一种前所未有的方式评估了出生结果的种族差异。作为生物学方法的另一种选择，该研究评估了美国军队的出生结果，这是一个自然实验环境，将提供对婴儿健康结果中种族差异的结构性原因的见解。军队是美国社会中唯一一个非洲裔美国人不仅可以平等获得高质量医疗保健，而且经济、社会和种族不平等也大大减少的地方。以往的研究发现，平民人口中常见的许多其他种族差异在军事环境中消失甚至逆转。这项研究检验了这样一种假设，即在种族不平等的条件大大减少的情况下，婴儿健康状况不佳的种族差距也将大大减少，甚至消失。该研究采用自然实验设计，利用妊娠风险评估监测系统（PRAMS）的数据，评估平民出生与军人出生之间的种族差异。通过多变量分析，该项目评估了军人母亲在婴儿死亡率、低出生体重和早产发生率方面是否与平民母亲一样存在种族差异。然后，该项目研究在平民背景和军事背景下，与这些出生结果相关的特征是否以及如何因种族而异。研究设计的一个方法学创新是使用倾向得分匹配分析来解释个人参军的选择效应。研究结果有可能为有关婴儿健康状况不佳的种族差异的生物学理论提供信息。如果低出生体重方面的差距缩小（采用不太全面数据的研究结果很可能如此），那么遗传学所扮演的任何角色的相关性都将减弱，从而鼓励人们重新关注结构性改革。调查结果也将与更广泛的军事和医学界直接相关。通过塑造关于非裔美国婴儿高死亡率和低出生体重背后的结构因素和遗传因素的公众和专业辩论。此外，考虑到五角大楼是美国最大的雇主，尤其是非洲裔美国人的雇主，军人家属的医疗健康也具有直接的相关性。该项目还将为学术和专业社区提供一个独特的数据集，为其他寻求研究制度化人口的研究人员提供一个重要的资源。

SES-0751472Jennifer Hickes LundquistUniversity of Massachusetts, AmherstA continuing indicator of racial inequality in the United States is infant mortality rates. African American babies are more than twice as likely to die as white babies. The primary cause of higher mortality is low birth weight, with black children twice as likely as white children to be born underweight. Despite many studies investigating why low birth weights and infant mortality are so much higher among African American infants than white infants, the causes are not well understood. Group differences in social class and access to healthcare fail to fully explain the racial disparity, which has, in turn, led to a focus on biological explanations. Using a new, uniquely created dataset that allows for a detailed comparison of births across the military and civilian environments, this research evaluates racial disparities in birth outcomes in a way that has not been done before. As an alternative to the biological approach, the study evaluates birth outcomes in the U.S. military, a natural experiment setting that will provide insight into structural causes of racial disparities in infant health outcomes. The military is one of the only locations in U.S. society where African Americans not only have equal access to high-quality healthcare, but also where economic, social, and racial inequality is substantially lessened. Previous research has found that many other racial disparities common among the civilian population disappear or even reverse themselves in the military environment. The research examines the hypothesis that in a setting where conditions of racial inequality are considerably lessened, the race gap in poor infant health outcomes will also be considerably lessened, or even disappear. The study uses a natural experiment design which evaluates racial differences among civilian births compared to military births using data from the Pregnancy Risk Assessment Monitoring System (PRAMS). Using multivariate analyses, the project evaluates whether there are racial disparities in infant mortality, low birth weight, and the incidence of pre-term birth among military mothers as there are among civilian mothers. The project then studies whether and how the characteristics associated with such birth outcomes vary by race in the civilian context versus the military context. A methodological innovation of the research design is the use of propensity score matching analyses to account for selection effects of individuals into military service. Research findings have the potential to inform biological theories on race difference in poor infant health outcomes. If the gap in low birth weight diminishes, as is likely given findings from studies that employ less comprehensive data, any role played by genetics will lessen in relevance, encouraging renewed focus on structural reform. Findings will also be of immediate relevance to the military and medical community more generally. by shaping the public and professional debate over structural versus genetic factors behind high African American infant mortality and low birth weight. In addition, the medical health of military families is of immediate relevance given that the Pentagon is the largest employer in the U.S., particularly of African Americans. The project will also contribute a unique dataset to the academic and professional community, providing an important resource for other researchers seeking to examine institutionalized populations.