To evaluate structural racism in the neonatal intensive care unit (NICU) by determining if differences in adverse social events occur by racialized groups.
Retrospective cohort study of 3290 infants ...hospitalized in a single center NICU between 2017 and 2019 in the Racial and Ethnic Justice in Outcomes in Neonatal Intensive Care (REJOICE) study. Demographics and adverse social events including infant urine toxicology screening, child protective services (CPS) referrals, behavioral contracts, and security emergency response calls were collected from electronic medical records. Logistic regression models were fit to test the association of race/ethnicity and adverse social events, adjusting for length of stay. Racial/ethnic groups were compared with a White referent group.
There were 205 families (6.2%) that experienced an adverse social event. Black families were more likely to have experienced a CPS referral and a urine toxicology screen (OR, 3.6; 95% CI, 2.2-6.1 and OR, 2.2; 95% CI, 1.4-3.5). American Indian and Alaskan Native families were also more likely to experience CPS referrals and urine toxicology screens (OR, 15.8; 95% CI, 6.9-36.0 an OR, 7.6; 95% CI, 3.4-17.2). Black families were more likely to experience behavioral contracts and security emergency response calls. Latinx families had a similar risk of adverse events, and Asian families were less likely to experience adverse events.
We found racial inequities in adverse social events in a single-center NICU. Investigation of generalizability is necessary to develop widespread strategies to address institutional and societal structural racism and to prevent adverse social events.
Disparities in adverse birth outcomes for Black women continue. Research suggests that societal factors such as structural racism explain more variation in adverse birth outcomes than ...individual-level factors and societal poverty alone. The Index of Concentration at the Extremes (ICE) measures spatial social polarization by quantifying extremes of deprived and privileged social groups using a single metric and has been shown to partially explain racial disparities in black carbon exposures, mortality, fatal and non-fatal assaults, and adverse birth outcomes such as preterm birth and infant mortality. The objective of this analysis was to assess if local measures of racial and economic segregation as proxies for structural racism are associated and preterm birth and infant mortality experienced by Black women residing in California. California birth cohort files were merged with the American Community Survey by zip code (2011–2012). The ICE was used to quantify privileged and deprived groups (i.e., Black vs. White; high income vs. low income; Black low income vs. White high income) by zip code. ICE scores range from − 1 (deprived) to 1 (privileged). ICE scores were categorized into five quintiles based on sample distributions of these measures: quintile 1 (least privileged)–quintile 5 (most privileged). Generalized linear mixed models were used to test the likelihood that ICE measures were associated with preterm birth or with infant mortality experienced by Black women residing in California. Black women were most likely to reside in zip codes with greater extreme income concentrations, and moderate extreme race and race + income concentrations. Bivariate analysis revealed that greater extreme income, race, and race + income concentrations increased the odds of preterm birth and infant mortality. For example, women residing in least privileged zip codes (quintile 1) were significantly more likely to experience preterm birth (race + income ICE OR = 1.31, 95% CI = 1.72–1.46) and infant mortality (race + income ICE OR = 1.70, 95% CI = 1.17–2.47) compared to women living in the most privileged zip codes (quintile 5). Adjusting for maternal characteristics, income, race, and race + income concentrations remained negatively associated with preterm birth. However, only race and race + income concentrations remained associated with infant mortality. Findings support that ICE is a promising measure of structural racism that can be used to address racial disparities in preterm birth and infant mortality experienced by Black women in California.
OBJECTIVE:To describe the clinical presentation, symptomology, and disease course of coronavirus disease 2019 (COVID-19) in pregnancy.
METHODS:The PRIORITY (Pregnancy CoRonavIrus Outcomes RegIsTrY) ...study is an ongoing nationwide prospective cohort study of people in the United States who are pregnant or up to 6 weeks postpregnancy with known or suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We analyzed the clinical presentation and disease course of COVID-19 in participants who tested positive for SARS-CoV-2 infection and reported symptoms at the time of testing.
RESULTS:Of 991 participants enrolled from March 22, 2020, until July 10, 2020, 736 had symptoms of COVID-19 at the time of testing; 594 tested positive for SARS-CoV-2 infection and 142 tested negative in this symptomatic group. Mean age was 31.3 years (SD 5.1), and 37% will nulliparous. Ninety-five percent were outpatients. Participants who tested positive for SARS-CoV-2-infection were a geographically diverse cohort34% from the Northeast, 25% from the West, 21% from the South, and 18% from the Midwest. Thirty-one percent of study participants were Latina, and 9% were Black. The average gestational age at enrollment was 24.1 weeks, and 13% of participants were enrolled after pregnancy. The most prevalent first symptoms in the cohort of patients who tested positive for SARS-CoV-2 infection were cough (20%), sore throat (16%), body aches (12%), and fever (12%). Median time to symptom resolution was 37 days (95% CI 35–39). One quarter (25%) of participants who tested positive for SARS-CoV-2 infection had persistent symptoms 8 or more weeks after symptom onset.
CONCLUSION:COVID-19 has a prolonged and nonspecific disease course during pregnancy and in the 6 weeks after pregnancy.
CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov, NCT04323839.
The largest poverty alleviation program in the US is the earned income tax credit (EITC), providing $60 billion to over 25 million families annually. While research has shown positive impacts of EITC ...receipt in pregnancy, there is little evidence on whether the timing of receipt may lead to differences in pregnancy outcomes. We used a quasi-experimental difference-in-differences design, taking advantage of EITC tax disbursement each spring to examine whether trimester of receipt was associated with perinatal outcomes.
We conducted a difference-in-differences analysis of California linked birth certificate and hospital discharge records. The sample was drawn from the linked CA birth certificate and discharge records from 2007-2012 (N = 2,740,707). To predict eligibility, we created a probabilistic algorithm in the Panel Study of Income Dynamics and applied it to the CA data. Primary outcome measures included preterm birth, small-for-gestational age (SGA), gestational diabetes, and gestational hypertension/preeclampsia.
Eligibility for EITC receipt during the third trimester was associated with a lower risk of preterm birth compared with preconception. Eligibility for receipt in the preconception period resulted in improved gestational hypertension and SGA.
This analysis offers a novel method to impute EITC eligibility using a probabilistic algorithm in a data set with richer sociodemographic information relative to the clinical and administrative data sets from which outcomes are drawn. These results could be used to determine the optimal intervention time point for future income supplementation policies. Future work should examine frequent income supplementation such as the minimum wage or basic income programs.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In alignment with previous literature, NICU parents reported experiencing racism and NICU staff reported witnessing racism in the NICU. Our study also uniquely describes personal experiences with ...racism by staff in the NICU. NICU staff reported witnessing and experiencing racism more often than parents reported. Black staff reported witnessing and experiencing more racism than white staff. Differences in reporting is likely influenced by variations in lived experience, social identities, psychological safety, and levels of awareness. Future studies are necessary to prevent and accurately measure racism in the NICU.
Racial inequities in maternal and child health outcomes persist: Black women and birthing people experience higher rates of adverse outcomes than their white counterparts. Similar inequities are seen ...in coronavirus disease (COVID-19) mortality rates. In response, we sought to explore the intersections of racism and the COVID-19 pandemic impact on the daily lives and perinatal care experiences of Black birthing people.
We used an intrinsic case study approach grounded in an intersectional lens to collect stories from Black pregnant and postpartum people residing in Fresno County (July–September 2020). All interviews were conducted on Zoom without video and were audio recorded and transcribed. Thematic analysis was used to group codes into larger themes.
Of the 34 participants included in this analysis, 76.5% identified as Black only, and 23.5% identified as multiracial including Black. Their mean age was 27.2 years SD, 5.8. Nearly half (47%) reported being married or living with their partner; all were eligible for Medi-Cal insurance. Interview times ranged from 23 to 96 min. Five themes emerged: (1) Tensions about Heightened Exposure of Black Lives Matter Movement during the pandemic; (2) Fear for Black Son's Safety; (3) Lack of Communication from Health Care Professionals; (4) Disrespect from Health Care Professionals; and (5) Misunderstood or Judged by Health Care Professionals. Participants stressed that the Black Lives Matter Movement is necessary and highlighted that society views their Black sons as a threat. They also reported experiencing unfair treatment and harassment while seeking perinatal care.
Black women and birthing people shared that exposure to racism has heightened during the COVID-19 pandemic, increasing their levels of stress and anxiety. Understanding how racism impacts Black birthing people's lives and care experiences is critical to reforming the police force and revising enhanced prenatal care models to better address their needs.
•Black women and birthing people are impacted by intersecting systems of oppression.•Black women and birthing people have collective trauma, worry, and fear for the safety of their children.•Racial discrimination results in unfair treatment and poor experiences and outcomes.
Background
Exposures to structural racism has been identified as one of the leading risk factors for adverse maternal and infant health outcomes among Black women; yet current measures of structural ...racism do not fully account for inequities seen in adverse maternal and infant health outcomes between Black and white women and infants. In response, the purpose of this study was to conceptualize structural racism from the perspectives of Black women across the reproductive lifespan and its potential impact on adverse maternal and infant health outcomes.
Methods
We conducted a series of focus groups with 32 Black women across the reproductive lifespan (5 preconception, 13 pregnant, and 14 postpartum). Study criteria including self-identifying as Black, residing in Oakland or Fresno, California and representing one of three reproductive life tracks (preconception, pregnant, postpartum). We consulted with study participants and an expert advisory board to validate emergent domains of structural racism.
Results
Nine domains of structural racism emerged from a ground theory constant comparative analysis:
Negative Societal Views
;
Housing
;
Medical Care
;
Law Enforcement
;
Hidden Resources
;
Employment
;
Education
,
Community Infrastructure
; and
Policing Black Families
.
Conclusions for Practice
Findings from this study suggest that there is an interplay among structural racism, and social and structural determinants of health which has negative impacts on Black women’s sexual and reproductive health. Furthermore, findings from this study can be used to develop more comprehensive medical assessments and policies to address structural racism experienced by Black women across the reproductive lifespan.
Objectives
Social and contextual factors underlying the continually disproportionate and burdensome risk of adverse health outcomes experienced by Black women in the US are underexplored in the ...literature. The aim of this study was to use an index based on area-level population distributions of race and income to predict risk of death during pregnancy and up to 1 year postpartum among women in Louisiana.
Methods
Using vital records data provided by the Louisiana Department of Health 2016–2017 (n = 125,537), a modified Poisson model was fit with generalized estimating equations to examine the risk of pregnancy-associated death associated with census tract-level values of the Index of Concentration at the Extremes (ICE)—grouped by tertile—while adjusting for both individual and tract-level confounders.
Results
Analyses resulted in an estimated 1.73 (95% CI 1.02–2.93) times increased risk for pregnancy-associated death for those in areas which were characterized by concentrated deprivation (high proportions of Black and low-income residents) relative to those in areas of concentrated privilege (high proportions of white and high-income residents), independent of other factors.
Conclusions for Practice
In addition to continuing to consider the deeply entrenched racism and economic inequality that shape the experience of pregnancy-associated death, we must also consider their synergistic effect on access to resources, maternal population health, and health inequities.
ABSTRACT
BACKGROUND
Adolescence is a critical phase of development and experimentation with delinquent behaviors. There is a growing body of literature exploring individual and structural impacts of ...discrimination on health outcomes and delinquent behaviors. However, there is limited research assessing how school diversity and discrimination impact students' delinquent behaviors. In response, the purpose of this study was to assess if individual‐ and school‐level indicators of discrimination and diversity were associated with student delinquent behaviors among African American and White students.
METHODS
We analyzed Wave I (1994‐1995) data from the National Longitudinal Study of Adolescent Health. Our analysis was limited to 8947 African American and White students (73% White, 48% male, and 88% parent ≥ high school education). We used multilevel zero‐inflated negative binomial regression to test the association of individual‐ and school characteristics and discrimination with the number of self‐reported delinquent behaviors.
RESULTS
Race, sex, perceived peer inclusion, and teacher discrimination were predictors of students' delinquent behaviors. The average school perceived peer inclusion and percentage of African Americans in teaching roles were associated with delinquent behaviors.
CONCLUSIONS
Findings from this study highlight the potential for intervention at the interpersonal and school levels to reduce delinquency among African American and White students.
Introduction
Agency in contraceptive decision‐making is an essential aspect of reproductive autonomy. We conducted qualitative research to investigate what agency means to patients seeking ...contraceptive care to inform the development of a validated measure of this construct.
Methodology
We held four focus group discussions and seven interviews with sexually‐active individuals assigned female at birth, ages 16–29 years, recruited from reproductive health clinics in Northern California. We explored experiences in contraceptive decision‐making during the clinic visit. We coded data in ATLAS.ti and by hand, compared codes across three coders, and used thematic analysis to identify salient themes.
Results
The sample mean age was 21 years, with 17% of participants identifying as Asian, 23% as Black, 27% as Latinx, 17% as Multiracial/other, and 27% as white. Overall, participants reported active and engaged decision‐making in their recent contraceptive visit but noted experiences that had undermined their agency in the past. They described how non‐judgmental care allowed them to communicate openly, affirming their ability to make their own decisions. However, several mentioned how unexpected contraceptive side effects after the visit had reduced their sense of agency over their decision in retrospect. Several participants, including those who identified as Black, Latinx, and/or Asian, described prior experiences where pressure to use a contraceptive method had undermined their agency and where they had switched providers to regain agency over their contraceptive decisions.
Discussion
Most participants were aware of their agency during contraceptive visits and how it varied in different experiences with providers and the healthcare system. Patient perspectives can help to inform measurement development and ultimately the delivery of care that supports contraceptive agency.
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