Targeted Investment and Meaningful Engagement to Improve MCH Outcomes and Rectify Historical Structural Racism: The TIME Study

有针对性的投资和有意义的参与可改善妇幼保健成果并纠正历史结构性种族主义：《时代》杂志研究

• 批准号: 10622527
• 负责人: Deena Chisolm
• 金额: $ 62.16万
• 依托单位: RESEARCH INST NATIONWIDE CHILDREN'S HOSP
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-15 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10622527
• 关键词: African American population; Birth; Black Populations; Black race; Caring; Cessation of life; Child; Child Welfare; Cities; Communities; Community Developments; Complex; Developed Countries; Discrimination; Disparity; Economic Development; Economic Factors; Education; Environmental Risk Factor; Equipment and supply inventories; Family; Generations; Geography; Goals; Health; Health Food; Housing; Inequity; Infant Health; Infant Mortality; Interview; Investments; Life Cycle Stages; Link; Live Birth; Longevity; Low Birth Weight Infant; Maps; Maternal Health; Maternal and Child Health; Measures; Medical; Minority; Modeling; Neighborhoods; Not Hispanic or Latino; Ohio; Outcome; Pediatric Hospitals; Personal Satisfaction; Persons; Phase; Policies; Population; Poverty; Pregnancy; Probability; Race; Recording of previous events; Reproductive Health; Research; Research Personnel; Resources; Risk Factors; Science; Side; Societies; Stress; Structural Racism; Structure; Sum; System; Tilia; Time; Time Study; Woman; Work; black women; community partnership; design; experience; federal poverty level; food insecurity; formative assessment; health care availability; health care delivery; health disparity; health inequalities; housing instability; implementation evaluation; improved; innovation; lens; multidisciplinary; premature; prenatal; primary outcome; racial disparity; racism; segregation; social; social factors; social health determinants; theories

Project Summary In Columbus Ohio’s Linden neighborhood, a historically segregated and disinvested community that has been devastated by decades of discriminatory race-based policies, infant mortality rates (IMR) are over 20 deaths per 1,000 live births (2%) with racial disparity ratios nearing three. Researchers have linked infant mortality and poor birth outcomes to maternal education, maternal experiences of stress and discrimination, pove rty, lack of access to healthy foods, lack of stable housing, and lack of access to prenatal/medical care. These risk factors are concentrated in majority minority neighborhoodsdue to historical and contemporary policies and practices rooted in structural racism (e.g., redlining, restrictive covenants, unfavorable zoning) that segregated both people and resources within communities. Linden is apredominately Black (63%) neighborhood with apopulation of 180,000 residents, of which approximately 45% live below the federal poverty level. Building on Nationwide Children’s Hospital’s (NCH) history of housing and community development through its Health Neighborhoods/Healthy Families community partnership on the city’s south side, NCH targeted re-investments in Linden are intended to improve housing quality and affordability, educational outcomes, access to healthcare, economic development, and social connections of residents. Informed by Life Course Theory (LCT), the objective of this proposal is to describe discriminatory policies influencing IMR and other maternal and child health experiences and outcomes across generations of Black women and importantly, demonstrate how community re-investment can be designed to target and rectify historic and contemporary structural racism and discrimination. Specifically, we aim to: (1) examine the experiences of multiple generations of Black women on the intersection of structural racism and reproductive health through the lens of historical and contemporary policies that effect communities; (2) conduct real-time formative evaluation of a targeted community investment initiative explicitly informed by the community’s history of structural racism; and (3) measure relative changes in short term infant and maternal health disparities in the target community and a statistically matched comparison geography.

项目概要 在俄亥俄州哥伦布市的 Linden 社区，这是一个历史上隔离和撤资的社区，现已被 由于数十年基于种族的歧视性政策的破坏，婴儿死亡率 (IMR) 每人死亡 20 人以上 1,000 名活产婴儿 (2%)，种族差距比率接近 3。研究人员将婴儿死亡率与贫困联系起来 出生结果对孕产妇教育的影响、孕产妇的压力和歧视经历、贫困、缺乏机会 缺乏健康食品、缺乏稳定的住房以及无法获得产前/医疗护理。这些风险因素是 由于根植于历史和当代的政策和实践，集中在占多数的少数族裔社区 结构性种族主义（例如红线、限制性契约、不利的分区）将人和种族隔离 社区内的资源。林登 (Linden) 是一个以黑人 (63%) 为主的社区，人口为 180,000 居民，其中约 45% 生活在联邦贫困线以下。以全国儿童为基础 医院 (NCH) 通过其健康社区/健康项目进行住房和社区发展的历史 NCH 在林登进行有针对性的再投资，旨在建立城市南侧的家庭社区伙伴关系 提高住房质量和负担能力、教育成果、医疗保健、经济发展、 以及居民的社会关系。根据生命历程理论（LCT），该提案的目标是 描述影响 IMR 和其他孕产妇和儿童健康经历的歧视性政策，以及 几代黑人妇女的成果，重要的是，展示了社区再投资如何能够 旨在针对和纠正历史和当代的结构性种族主义和歧视。具体来说， 我们的目标是：（1）研究多代黑人女性在结构性交集上的经历 通过影响历史和当代政策的视角来看待种族主义和生殖健康 社区； (2) 对目标社区投资计划进行明确的实时形成性评估 了解社区结构性种族主义的历史； (3) 测量短期婴儿的相对变化 目标社区的孕产妇健康差异以及统计上匹配的比较地理。