Migration, Dynamic Social Environments, and Birth Outcomes

项目总结 不良的分娩结局，如早产、低出生体重和小于胎龄儿，有严重的 不仅在婴儿期，而且在整个生命过程中都会产生健康后果。过去的研究表明，一名移民 与在美国出生的女性相比，出生结果更具优势；然而，最近的研究 越来越多的研究表明，移民女性的生育结果比非西班牙裔白人女性更差。大有可为 在移民与生殖、孕产妇和儿童健康的交叉点上，研究的重点是个人 暴露和风险因素。然而，越来越多的证据表明，移民政策等结构性因素 与健康差距有关，对社会和政策的过程了解有限 环境影响个体水平的母婴医学结果。本K01指导研究 科学家发展奖侧重于概念化这种结构背景及其对 妇女通过结构性耻辱、社会劣势和 空间隔离。三个拟议的培训领域将允许候选人发展独立的研究 职业生涯侧重于移民和围产期健康的结构性决定因素：1)围产期流行病学和 人口学，2)空间和数据科学技术，3)定性方法。具体目标将是 利用国家卫生统计中心实现的与时期挂钩的婴儿出生-死亡数据，全国调查 关于家庭成长的数据，以及关于移民在社会和政策环境中的经历的定性数据 在项目期间。这些数据将用于实现以下目的：1)多层次审查 社会和政策环境对外国和美国出生的妇女怀孕和生育结果的影响，2) 调查地区层面的社会和政策环境措施以及外国和美国出生的妇女 怀孕和分娩结果，以及3)探索移民妇女因社会和经济原因而承受压力的经历 目的地的政策环境及其对出生结果的影响。预期结果是严格的 了解结构性环境对妊娠和分娩结果以及卫生系统的影响 美国移民出生结局的先兆。这项研究的发现既可以识别移民 对社会和政策环境的反应，并提出教育和行为干预建议 改善移民对结构性环境压力源的反应、获得产前护理的机会和生育结果。 该项目的培训和洞察力将导致开发一项大规模R01研究，以扩展这一系列 研究并将进一步帮助制定促进孕产妇、围产期和儿童健康的政策。

PROJECT SUMMARY Adverse birth outcomes, such as preterm birth, low birth weight, and small for gestational age, have serious health consequences not just during infancy but across the life course. Past research shows an immigrant advantage in birth outcomes compared to women born in the United States; however, recent studies increasingly show that immigrant women have worse birth outcomes than non-Hispanic white women. Much research at the intersection of migration and reproductive, maternal, and child health has focused on individual exposures and risk factors. Yet there is growing evidence that structural factors such as migration policies are associated with health disparities, and there is limited understanding of the process by which social and policy environments impact individual-level maternal–fetal medicine outcomes. This K01 Mentored Research Scientist Development Award focuses on conceptualizing this structural context and its potential impact on women’s pregnancy and birth outcomes through pathways of structural stigma, social disadvantage, and spatial isolation. Three proposed areas of training will allow the candidate to develop an independent research career focused on migration and structural determinants of perinatal health: 1) perinatal epidemiology and demography, 2) spatial and data science techniques, and 3) qualitative methods. The specific aims will be achieved using National Center for Health Statistics period-linked infant birth–death data, the National Survey of Family Growth, and qualitative data on immigrant experiences of social and policy environments collected during the project period. These data will be used to carry out the following aims: 1) to examine multilevel effects of social and policy environments on foreign and US-born women’s pregnancy and birth outcomes, 2) to investigate area-level measures of social and policy environments and foreign and US-born women’s pregnancy and birth outcomes, and 3) to explore immigrant women’s experiences of stress due to social and policy environments at destination and their implications for birth outcomes. Expected outcomes are rigorous knowledge of the impact of structural contexts on pregnancy and birth outcomes as well as health system precursors of birth outcomes for immigrants in the US. Findings from this research can both identify immigrant responses to social and policy environments and suggest educational and behavioral interventions that could improve immigrant responses to structural environment stressors, access to prenatal care, and birth outcomes. Training and insights from this project will lead to development of a large-scale R01 study extending this line of research and will further help develop policies that promote maternal, perinatal, and child health.