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背景因素，超越个人风险因素和行为。先前的研究调查了个人层面的种族歧视，但很少有研究探讨种族主义的制度措施作为与早产的种族和民族差异相关的潜在社会、背景因素。该研究项目将采用多层次的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）和居住隔离形式衡量的制度性种族主义与孕产妇压力和孕妇早产的关系。具体目标是：（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，探索制定“红线”和居住隔离等形式的制度性种族主义措施，以测试其与孕产妇压力和早产的关系； (2) 了解个人自我报告的歧视措施与制度性种族主义措施之间的关系； (3) 衡量城市地区妇女群体自我报告的个人介导的歧视、制度性种族主义、压力和早产之间的关联。拟议研究的主要假设是，个人和机构形式的种族主义与压力和出生独立且共同相关。 早产。为了检验这一假设，将从 HMDA 数据库中探索“红线”衡量标准，并从美国人口普查中探索和创建居住隔离指数。将进行二级多层次逻辑回归分析，将来自压力、怀孕和评估社区项目（SPEAC）的关于感知歧视、母亲压力和其他社会人口因素的个人层面数据与关于“红线”和居住隔离的社区层面数据联系起来。 SPEAC 是一项针对与出生记录相关的孕妇的横断面研究，最初旨在了解压力与细菌性阴道病之间的关系。探索影响围产期健康的制度和结构性社区因素对于公共卫生具有重要意义。拟议研究的结果可能会为公共卫生政策和干预措施提供建议，旨在消除早产方面的种族/民族差异，这也将影响美国婴儿死亡率的差异。

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.