Worry about racial discrimination: A missing piece of the puzzle of Black-White disparities in preterm birth?

Objectives: The causes of the large and persistent Black-White disparity in preterm birth (PTB) are unknown. It is biologically plausible that chronic stress across a woman's life course could be a contributor. Prior research suggests that chronic worry about experiencing racial discrimination could affect PTB through neuroendocrine, vascular, or immune mechanisms involved in both responses to stress and the initiation of labor.

Economic Hardship in Childhood: A Neglected Issue in ACE Studies?

Objectives Adverse childhood experiences (ACEs) have been linked with ill-health in adulthood, but ACE literature has focused on family disruption or dysfunction (e.g., child abuse, parental separation), with less attention to economic adversity.

Physical education policy compliance and Latino children's fitness: Does the association vary by school neighborhood socioeconomic advantage?

Objectives: To investigate the contribution of school neighborhood socioeconomic advantage to the association between school-district physical education policy compliance in California public schools and Latino students' physical fitness.

Methods: Cross-sectional Fitnessgram data for public-school students were linked with school- and district-level information, district-level physical education policy compliance from 2004-2005 and 2005-2006, and 2000 United States Census data. Multilevel logistic regression models examined whether income and education levels in school neighborhoods moderated the effects of district-level physical education policy compliance on Latino fifth-graders' fitness levels.

Latina Birth Outcomes in California: Not so Paradoxical.

Objectives To investigate Latina-White differences in birth outcomes in California from 2003 to 2010, looking for evidence of the often-cited "Latina paradox" and assessing the possible role of socioeconomic factors in observed differences. MethodsUsing statewide-representative data from the California Maternal and Infant Health Assessment, an annual population-based postpartum survey, we compared rates of preterm birth (PTB) and low birth weight (LBW) in five groups: U.S.

Association between competitive food and beverage policies in elementary schools and childhood overweight/obesity trends: differences by neighborhood socioeconomic resources.

Importance: To our knowledge, few published studies have examined the influence of competitive food and beverage (CF&B) policies on student weight outcomes; none have investigated disparities in the influence of CF&B policies on children's body weight by school neighborhood socioeconomic resources.

Objective: To investigate whether the association between CF&B policies and population-level trends in childhood overweight/obesity differed by school neighborhood income and education levels.

Design, Setting, And Participants: This cross-sectional study, from July 2013 to October 2014, compared overweight/obesity prevalence trends before (2001-2005) and after (2006-2010) implementation of CF&B policies in public elementary schools in California.

The role of socioeconomic factors in Black-White disparities in preterm birth.

Objectives: We investigated the role of socioeconomic factors in Black-White disparities in preterm birth (PTB).

Methods: We used the population-based California Maternal and Infant Health Assessment survey and birth certificate data on 10 400 US-born Black and White California residents who gave birth during 2003 to 2010 to examine rates and relative likelihoods of PTB among Black versus White women, with adjustment for multiple socioeconomic factors and covariables.

Results: Greater socioeconomic advantage was generally associated with lower PTB rates among White but not Black women.

Physical education policy compliance and children's physical fitness.

Background: Physical education policies have received increased attention as a means for improving physical activity levels, enhancing physical fitness, and contributing to childhood obesity prevention. Although compliance at the school and district levels is likely to be critical for the success of physical education policies, few published studies have focused on this issue.

Purpose: This study investigated whether school district-level compliance with California physical education policies was associated with physical fitness among 5th-grade public-school students in California.

When do we know enough to recommend action on the social determinants of health?

The Robert Wood Johnson Foundation Commission to Build a Healthier America was charged to identify strategies beyond medical care to address health disparities in the U.S. related to social and economic disadvantage.

The social determinants of health: coming of age.

In the United States, awareness is increasing that medical care alone cannot adequately improve health overall or reduce health disparities without also addressing where and how people live. A critical mass of relevant knowledge has accumulated, documenting associations, exploring pathways and biological mechanisms, and providing a previously unavailable scientific foundation for appreciating the role of social factors in health. We review current knowledge about health effects of social (including economic) factors, knowledge gaps, and research priorities, focusing on upstream social determinants-including economic resources, education, and racial discrimination-that fundamentally shape the downstream determinants, such as behaviors, targeted by most interventions.

Socioeconomic disparities in adverse birth outcomes: a systematic review.

Context: Adverse birth outcomes, such as preterm birth and low birth weight, have serious health consequences across the life course. Socioeconomic disparities in birth outcomes have not been the subject of a recent systematic review. The aim of this study was to systematically review the literature on the association of socioeconomic disadvantage with adverse birth outcomes, with specific attention to the strength and consistency of effects across socioeconomic measures, birth outcomes, and populations.

Socioeconomic disparities in health in the United States: what the patterns tell us.

Objectives: We aimed to describe socioeconomic disparities in the United States across multiple health indicators and socioeconomic groups.

Methods: Using recent national data on 5 child (infant mortality, health status, activity limitation, healthy eating, sedentary adolescents) and 6 adult (life expectancy, health status, activity limitation, heart disease, diabetes, obesity) health indicators, we examined indicator rates across multiple income or education categories, overall and within racial/ethnic groups.

Results: Those with the lowest income and who were least educated were consistently least healthy, but for most indicators, even groups with intermediate income and education levels were less healthy than the wealthiest and most educated.

Father's education: an independent marker of risk for preterm birth.

To explore the association between paternal education and preterm birth, taking into account maternal social and economic factors. We analyzed data from a population-based cross-sectional postpartum survey, linked with birth certificates, of women who gave birth in California from 1999 through 2005 (n = 21,712). Women whose infants' fathers had not completed college had significantly higher odds of preterm birth than women whose infants' fathers were college graduates, even after adjusting for maternal education and family income [OR (95% CI) = 1.

Poverty, near-poverty, and hardship around the time of pregnancy.

To describe income levels and the prevalence of major hardships among women during or just before pregnancy. We separately analyzed 2002-2006 population-based postpartum survey data from California's Maternal and Infant Health Assessment (n = 18,332) and 19 states participating in CDC's Pregnancy Risk Assessment Monitoring System (n = 143,452) to examine income and several hardships (divorce/separation, domestic violence, homelessness, financial difficulties, spouse/partner's or respondent's involuntary job loss or incarceration, and, in California only, food insecurity and no social support) during/just before pregnancy. In both samples, over 30% of women were poor (income View Article and Find Full Text PDF

"It's the skin you're in": African-American women talk about their experiences of racism. an exploratory study to develop measures of racism for birth outcome studies.

Objectives: Stress due to experiences of racism could contribute to African-American women's adverse birth outcomes, but systematic efforts to measure relevant experiences among childbearing women have been limited. We explored the racism experiences of childbearing African-American women to inform subsequent development of improved measures for birth outcomes research.

Methods: Six focus groups were conducted with a total of 40 socioeconomically diverse African-American women of childbearing age in four northern California cities.

Pandemic influenza planning in the United States from a health disparities perspective.

We explored how different socioeconomic and racial/ethnic groups in the United States might fare in an influenza pandemic on the basis of social factors that shape exposure, vulnerability to influenza virus, and timeliness and adequacy of treatment. We discuss policies that might differentially affect social groups' risk for illness or death. Our purpose is not to establish the precise magnitude of disparities likely to occur; rather, it is to call attention to avoidable disparities that can be expected in the absence of systematic attention to differential social risks in pandemic preparedness plans.

Potential implications of missing income data in population-based surveys: an example from a postpartum survey in California.

Objectives: Income data are often missing for substantial proportions of survey participants and these records are often dropped from analyses. To explore the implications of excluding records with missing income, we examined characteristics of survey participants with and without income information.

Methods: Using statewide population-based postpartum survey data from the California Maternal and Infant Health Assessment, we compared the age, education, parity, marital status, timely prenatal care initiation, and neighborhood poverty characteristics of women with and without reported income data, overall, and by race/ethnicity/nativity.

Early postnatal care among healthy newborns in 19 States: pregnancy risk assessment monitoring system, 2000.

Objective: To examine early postnatal care among healthy newborns during 2000 in 19 states.

Methods: Using data from the Pregnancy Risk Assessment Monitoring System, a multistate population-based postpartum survey of women, we calculated prevalences of early discharge (ED; stays of < or =2 days after vaginal delivery and < or =4 days after Cesarean delivery) and early follow-up (within 1 week) after ED. We used logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) describing how ED and lack of early follow-up were associated with state legislation and maternal characteristics.

Socioeconomic status in health research: one size does not fit all.

Problems with measuring socioeconomic status (SES)-frequently included in clinical and public health studies as a control variable and less frequently as the variable(s) of main interest-could affect research findings and conclusions, with implications for practice and policy. We critically examine standard SES measurement approaches, illustrating problems with examples from new analyses and the literature. For example, marked racial/ethnic differences in income at a given educational level and in wealth at a given income level raise questions about the socioeconomic comparability of individuals who are similar on education or income alone.

An approach to studying social disparities in health and health care.

Objective: We explored methods and potential applications of a systematic approach to studying and monitoring social disparities in health and health care.

Methods: Using delayed or no prenatal care as an example indicator, we (1) categorized women into groups with different levels of underlying social advantage; (2) described and graphically displayed rates of the indicator and relative group size for each social group; (3) identified and measured disparities, calculating relative risks and rate differences to compare each group with its a priori most-advantaged counterpart; (4) examined changes in rates and disparities over time; and (5) conducted multivariate analyses for the overall sample and "at-risk" groups to identify particular factors warranting attention.

Results: We identified at-risk groups and relevant factors and suggest ways to direct efforts for reducing prenatal care disparities.

Newborn length of stay, health care utilization, and the effect of Minnesota legislation.

Objective: To describe newborn length of stay, postdischarge follow-up, and health care utilization in the context of Minnesota's early discharge legislation.

Design And Setting: Retrospective study using claims data from a large managed care organization.

Participants: Term newborns born from January 1995 through February 1999 (N = 22 944).

Newborn early discharge revisited: are California newborns receiving recommended postnatal services?

Context: Responding to safety concerns, federal and state legislation mandated coverage of minimum postnatal stays and state legislation in California mandated coverage of follow-up after early discharge. Little is known about the postnatal services newborns are receiving.

Objective: To describe rates of early discharge and of timely follow-up for early-discharged newborns.

Timing of insurance coverage and use of prenatal care among low-income women.

Objectives: This study examined the relationship between timing of insurance coverage and prenatal care among low-income women.

Methods: Timeliness of prenatal care initiation and adequacy of number of visits were studied among 5455 low-income participants in a larger cross-sectional statewide survey of postpartum women in California during 1994-1995.

Results: Although only 2% of women remained uninsured throughout pregnancy, one fifth lacked coverage during the first trimester.