Community Events and Pathways to Inequities in Birth Outcomes

项目摘要/摘要 在美国，黑人女性经历早产(PTB)、低出生体重(LBW)婴儿或 与白人妇女相比，儿童在一岁前死亡。这种令人深感不安的不利的种族主义模式 只要有数据，生育结果就会持续下去。数十年的医学和公共卫生研究 记录了孕产妇和儿童健康中种族不平等的严重程度，而且这种情况持续存在，尽管婴儿总数 尽管努力改善获得产前护理和儿童早期倡议的机会，但死亡率有所下降。 这个问题的棘手之处表明了结构性种族主义--社会通过以下方式助长歧视 加强不公平的制度，这反过来又加强歧视性的信念、价值观和资源分配--作为一种 这些种族健康不平等的根本原因。拟议项目的总体目标是了解 哪些警察暴力行为--一种普遍存在的结构性种族主义--对生殖健康结果产生负面影响 在黑人妇女中的不平等现象，并在人口层面加剧了不良生育结果的不平等。该项目将测试 种族主义警察暴力事件与负面生育结果有直接和间接联系的假说 在黑人女性和白人女性中的比例。理解警察暴力民族化的机制 是黑人女性心理社会压力的来源将导致新的干预目标，可能减少种族不平等 在出生结果上。该项目有三个具体目标。目标1：量化肺结核和LBW在空间和空间上的风险 与警察杀害一名黑人和随之而来的内乱的社会距离很近。这项基于人群的队列研究 利用明尼苏达州卫生部的重要记录来评估黑人女性是否经历了更糟糕的分娩 在菲兰多·卡斯蒂尔被警察击毙和随后的内乱之后的结果。它还将评估空间 靠近事发地点和内乱增加了所有妇女更糟糕的生育结果的风险。目标2： 量化警察暴力对黑人女性肺结核和LBW风险的影响。使用准实验因果关系 框架，并利用美国每个县13年的出生记录，该目标评估事件 美国各地警察暴力事件的发生与黑人女性患肺结核和LBW的风险更高有关。目标3： 说明种族主义警察暴力在怀孕期间如何影响黑人妇女的亲身经历。一个在线的 对200名怀孕并生活在两个高发病率社区的黑人妇女进行了调查 简介警察暴力(明尼苏达州双城和洛杉矶巴吞鲁日)将评估与警察暴力有关的心理社会压力， 随后在每个城市对妇女进行了50次深入访谈，以表征警察暴力对生育的影响 结果，并确定模式和机制。这个项目的长期目标是消除出生不平等现象。 黑人女性的结果。这一及时而紧迫的项目不仅符合NICHD预防怀孕的目标-- 相关并发症和减少孕产妇和婴儿死亡，但这将进一步突显 将警察对社会的暴力种族主义，支持了大规模改变警察与社区互动的论点。

PROJECT SUMMARY/ABSTRACT Black women in the US are twice as likely to experience a preterm birth (PTB), a low birth weight (LBW) infant, or the death of a child before age one compared to white women. This profoundly disturbing racialized pattern of adverse reproductive outcomes has endured for as long as data have been available. Decades of medical and public health research have documented the magnitude of racial inequity in maternal and child health, and it persists although the total infant mortality rate has declined and despite efforts aimed at improving access to prenatal care and early childhood initiatives. The intractability of this problem suggests structural racism—the ways in which societies foster discrimination by reinforcing inequitable systems that in turn reinforce discriminatory beliefs, values, and distribution of resources—as a root cause of these racial health inequities. The overall objective of the proposed project is to understand the degree to which acts of police violence—a pervasive form of structural racism—negatively impact reproductive health outcomes among black women and exacerbate inequities in adverse birth outcomes at the population level. This project will test the hypothesis that incidences of racialized police violence have both a direct and an indirect link to negative birth outcomes among black women compared to white women. Understanding the mechanisms through which racialized police violence is a source of psychosocial stress for black women will lead to novel intervention targets that may reduce racial inequities in birth outcomes. The project has three specific aims. Aim 1: Quantify the risk of PTB and LBW related to spatial and social proximity to the killing of a black man by police and the ensuing civil unrest. This population-based cohort study leverages vital records from the Minnesota Department of Health to assess if black women experienced worse birth outcomes following the killing of Philando Castile by police and the subsequent civil unrest. It will also assess if spatial proximity to the site of the incident and civil unrest increased risk for worse birth outcomes among all women. Aim 2: Quantify the impact of police violence on PTB and LBW risk among black women. Using a quasi-experimental causal framework and leveraging 13 years of birth records available from every county in the US, this aim assesses if incidents of police violence across the US are associated with greater risk for PTB and LBW among black women. Aim 3: Illuminate the lived experience of how racialized police violence impacts black women during pregnancy. An online survey administered to black women (n=200) who were pregnant and living in two communities with incidents of high- profile police violence (Twin Cities, MN, and Baton Rouge, LA) will assess psychosocial stress related to police violence, followed by 50 in-depth interviews in each city with women to characterize the impact of police violence on birth outcomes and to identify patterns and mechanisms. The long-term goal of this project is to eliminate inequities in birth outcomes for black women. This timely and urgent project not only aligns with NICHD’s goal of preventing pregnancy- related complications and reducing maternal and infant death, but it will further underscore the negative impact of racialized police violence on society, bolstering arguments for large-scale change in police-community interactions.