The Effects of Institutional Racism and Residential Segregation on Preterm Birth

描述（由申请人提供）：本研究计划的长期目标是了解影响围产期健康和早产的社会和环境因素，而不是个人风险因素和行为。以前的研究已经从个人层面调查了种族歧视，但很少有研究将种族主义作为与早产中种族和民族差异相关的潜在社会和背景因素的制度措施进行探讨。本研究项目将采用多层次方法来调查个人层面的歧视措施和以“红线”（基于种族的住房歧视）和与孕妇压力和早产有关的居住隔离形式衡量的制度性种族主义。具体目的是：(1)利用住房抵押贷款披露法案（HMDA）数据库和美国城市孕妇人口普查数据，探讨以“红线”和住宅隔离形式的制度性种族主义措施的发展，以检验其与母亲压力和早产的关系；(2)了解自我报告的个人介导歧视措施与种族主义制度措施之间的关系；(3)在城市妇女群体中，测量个人介导的歧视自我报告、制度性种族主义、压力与早产之间的关系。这项研究的主要假设是，个人和机构形式的种族主义与压力和出生有独立或共同的联系

DESCRIPTION (provided by applicant): The long-term objectives of this research proposal are to understand the social and contextual factors that influence perinatal health and preterm birth, beyond individual risk factors and behaviors. Previous studies have investigated racial discrimination on the individual level yet few studies explore institutional measures of racism as potential social, contextual factors in association with the racial and ethnic disparities in preterm birth. This research project will apply multilevel methods to investigate both individual-level measures of discrimination and institutional racism measured in the form of "redlining" (housing discrimination based on race) and residential segregation in association with maternal stress and preterm birth among pregnant women. The specific aims are to: (1) Explore the development of measures of institutional racism in the form of "redlining" and residential segregation by using The Home Mortgage Disclosure Act (HMDA) database and the US census among an urban population of pregnant women to test its association with maternal stress and preterm birth; (2) Understand the relationships between self-reported measures of individual personally-mediated discrimination and institutional measures of racism; and (3) Measure the associations between self-report of personally-mediated discrimination, institutional racism, stress and preterm birth among a group of women in an urban area. The primary hypothesis for the proposed study is that individual and institutional forms of racism are independently and jointly associated with stress and birth preterm birth. To test this hypothesis, a "redlining" measure will be explored from the HMDA database and an index for residential segregation will be explored and created from the US Census. Secondary multilevel logistic regression analyses will be conducted, linking individual-level data about perceived discrimination, maternal stress and other sociodemographic factors from the Stress, Pregnancy and Evaluation Community Project (SPEAC) with community-level data about "redlining" and residential segregation. SPEAC is a cross-sectional study of pregnant women linked to birth records based in Philadelphia, PA originally designed to understand the relationships between stress and bacterial vaginosis. Exploring institutional and structural community factors that influence perinatal health are of great public health importance. The findings from the proposed study will potentially provide recommendations for public health policy and interventions aiming to eliminate racial/ethnic disparities in preterm birth, which will also influence disparities in infant mortality in the US.