The Effects of Institutional Racism and Residential Segregation on Preterm Birth

描述(由申请人提供)：本研究提案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，而不是个人的危险因素和行为。以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作为潜在的社会和背景因素与早产的种族和族裔差异有关的体制措施。这一研究项目将采用多层次方法，调查以“红线”(基于种族的住房歧视)形式衡量的个人层面的歧视措施和制度性种族主义，以及与孕妇的母亲压力和早产有关的居住隔离。其具体目的是：(1)利用住房抵押贷款公开法数据库和美国在城市孕妇中进行的人口普查，探索制定“红线”形式的制度性种族主义措施和居住隔离，以测试其与产妇压力和早产的关系；(2)了解自我报告的个人调解歧视措施与制度性种族主义措施之间的关系；以及(3)衡量城市地区一组妇女中自我报告的个人调解歧视、制度性种族主义、压力和早产之间的关系。拟议研究的主要假设是，种族主义的个人和机构形式与压力和出生有独立和共同的联系。 早产。为了验证这一假设，将从HMDA数据库中探索一种“红线”措施，并从美国人口普查中探索和创建住宅隔离指数。将进行二次多水平Logistic回归分析，将压力、怀孕和评估社区项目(SPEAC)中关于感知歧视、母亲压力和其他社会人口因素的个人层面数据与社区层面关于“红线”和居住隔离的数据联系起来。SPEAC是一项针对孕妇的横断面研究，与宾夕法尼亚州费城的出生记录相关联，最初旨在了解压力和细菌性阴道病之间的关系。探索影响围产期健康的制度性和结构性社区因素具有重要的公共卫生意义。这项拟议研究的结果可能会为旨在消除早产种族/民族差异的公共卫生政策和干预措施提供建议，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.