Community Events and Pathways to Inequities in Birth Outcomes

项目总结/摘要 这一紧急的竞争性修订将解决两个公共卫生紧急情况-COVID-19和种族主义-如何 影响黑人产妇健康。父项目的总体目标是阐明 普遍存在的结构性种族主义形式-种族化的警察暴力-以及不利的生殖健康后果。这次 一个敏感的要求有很大的潜力，进一步革命性地了解种族主义对黑人的影响， 孕产妇健康，探索COVID-19和结构性种族主义的双重流行病是如何被乔治弗洛伊德的 在警察拘留期间死亡影响了黑人产妇的健康。 拟议的紧急修订加强了目前的R 01，增加了两个目标，以解决 2020-2019冠状病毒病大流行以及乔治弗洛伊德在明尼阿波利斯警方和 随后的内乱-黑人母亲的健康。目标1（a）量化乔治弗洛伊德的死亡对 早产（PT B）和低出生体重（LBW）;（B）量化与空间接近度相关的PT B和LBW风险。 乔治弗洛伊德被明尼阿波利斯警方杀害，随后发生内乱;及（c）探讨COVID-19疫情是否 调节乔治弗洛伊德的死亡与PTB和LBW风险之间的关系。早产（<37周） 在种族主义和反种族主义措施方面， 应力因此，PTB可以揭示很多关于乔治弗洛伊德的创伤性死亡和COVID-19的压力是如何 在怀孕的黑人妇女的生活中发挥作用。目标2：阐明艾滋病毒/艾滋病双重流行病如何影响人类健康的实际经验。 2019冠状病毒病和结构性种族主义（乔治弗洛伊德的死亡暴露了这一点）对2019年怀孕的黑人妇女产生了影响。 2020.修订将扩大对黑人妇女的父母补助金在线调查的范围和样本规模， 怀孕并居住在父母R 01（明尼苏达州和路易斯安那州）评估的两个社区 与乔治弗洛伊德之死、COVID-19大流行和结构性种族主义有关的社会心理压力。我们还将进行 对明尼苏达州黑人妇女进行了25次深入采访，她们完成了调查，以阐明黑人孕产妇健康 生活在乔治弗洛伊德去世的社区的妇女的结果。 这一及时而紧急的修订提案直接响应了NOSI NOT-OD-21-071的区域2：调查 2019冠状病毒病大流行背景下的结构性种族主义对人类健康和福祉的影响 怀孕和产后一年。拟议的目标以重要和创新的方式扩展了总体目标， 父母R 01的目标; COVID-19大流行的时间和严重程度以及乔治弗洛伊德的死亡不可能 在最初的提议中就已经预见到了。资助的项目和修订请求都标志着一个重要的 公共卫生框架的改变，从一个错误的名称种族-一个似乎不可改变的特征-作为一个“风险 将“种族主义因素”改为将种族主义确定为卫生不平等的根本原因。

PROJECT SUMMARY/ABSTRACT This urgent competitive revision will address how two public health emergencies—COVID-19 and racism—have impacted Black maternal health. The overall objective of the parent project is to elucidate the association between a pervasive form of structural racism—racialized police violence—and adverse reproductive health outcomes. This time sensitive request has significant potential to further revolutionize our understanding of the impact of racism on Black maternal health by exploring how the dual pandemics of COVID-19 and structural racism laid bare by George Floyd’s death while in police custody have impacted Black maternal health. The proposed urgent revision enhances the current R01 by adding two aims to address the implications of the events of 2020—the COVID-19 pandemic and the death of George Floyd while in the custody of Minneapolis Police and the ensuing civil unrest—for Black maternal health. Aim 1 (a) quantify the impact of George Floyd’s death on trends in preterm birth (PTB) and low birth weight (LBW); (b) quantify the risk of PTB and LBW related to spatial proximity to the death of George Floyd by Minneapolis police and the ensuing civil unrest; and (c) explore if the COVID-19 pandemic moderates the relationship between the death of George Floyd and risk of PTB and LBW. Preterm birth (<37 weeks gestation) is a critical marker that is sensitive to the well-being of a community—in regard to racism and measures of stress. Thus, PTB can reveal a lot about how the traumatic death of George Floyd and the stress of COVID-19 have played out in the lives of pregnant Black women. Aim 2: Illuminate the lived experience of how the dual pandemics of COVID-19 and structural racism (laid bare by George Floyd’s death) have impacted Black women who were pregnant in 2020. The revision will enhance the scope and sample size of the parent grant online survey of Black women who were pregnant and living in the two communities that are the focus of the parent R01 (Minnesota and Louisiana) to assess psychosocial stress related to George Floyd’s death, the COVID-19 pandemic, and structural racism. We will also conduct 25 in-depth interviews with Black women in Minnesota who complete the survey to illuminate Black maternal health outcomes for women living in the community where George Floyd died. This timely and urgent revision proposal is directly responsive to Area 2 of NOSI NOT-OD-21-071: Investigate the impact of structural racism in the context of the COVID-19 pandemic on the health and well-being of persons during pregnancy and up to one year postpartum. The proposed aims extend in significant and innovative ways the overarching goal of the parent R01; the timing and severity of the COVID-19 pandemic and the death of George Floyd could not have been anticipated at the time of the original proposal. Both the funded project and revision request mark an important change in public health framing from one that incorrectly names race—a seemingly immutable characteristic—as a “risk factor” to one that identifies racism as a fundamental cause of health inequities.