Social stressors and inflammation: A mixed methods approach to preterm birth

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ABSTRACT Black women are more likely to become ill with COVID-19 than Whites, with disparities reported in many cities including Detroit, one of our sites. Black women are overrepresented in the low-wage essential workforce and more likely to live in disadvantaged neighborhoods (e.g., crowded housing) facing challenges in social distancing. Blacks have less in the way of savings and possibly less flexible employers than Whites, increasing risks for economic hardship (e.g., loss of jobs). Black women may experience discrimination in obtaining testing and medical care for COVID-19 symptoms for themselves and their families. Due to “shelter in place” policy and job losses with the pandemic, Black women may also experience increased conflict with their partner and higher rates of intimate partner violence (IPV) due to families spending nearly all waking and sleeping time together. Racial disparities -- in COVID-19 prevalence and death rates, employment, neighborhood conditions, economic hardship, IPV, and discrimination in testing and medical care -- may all increase psychological distress (e.g., depressive symptoms) for Black women. However, no published research has examined Black women’s experiences during a viral pandemic such as we are now experiencing. We hypothesize that Black women will experience more discrimination, economic hardship, conflict with partner, IPV and psychological distress as well as lower levels of support during the pandemic than pre-pandemic. Our cohort is comprised of 658 Black women from the Detroit, MI and Columbus, OH metropolitan areas. As part of the R01 study, women completed questionnaires during their pregnancies (T1=pre-pandemic). For this supplemental study, women will complete an online survey (T2= during the pandemic) on a smart phone or another device. The T2 survey will include key domains from the T1 survey (e.g., depressive symptoms, social support, IPV) and provide a second critical time point in the context of the pandemic. We expect some domains to be especially impacted by the pandemic (e.g., discrimination, stress). We also added items to capture COVID-19 specific issues, including experiences within their network (e.g. family members sickened), as well as measures pertinent to the situation (e.g., social isolation). A subsample of women will participate in qualitative interviews for an in-depth understanding of their experiences. We aim to: (1) Examine associations of disadvantaged neighborhoods, racial discrimination and economic hardship with psychological distress at both time points (T1 and T2); (2) Examine whether relationship with the partner, IPV, and psychological distress are impacted by the pandemic by comparing the pre-pandemic and during pandemic time points; (3) Examine how social isolation and social support relate to relationship with the partner, IPV, and psychological distress during the pandemic; and (4) Explore pregnant women’s experiences during the COVID-19 pandemic through qualitative interviews. Black women are especially vulnerable during the pandemic. The time-sensitive nature of the COVID-19 pandemic demands the immediate exploration of women’s experiences.