Stress, Resilience, and Place: Drivers of Perinatal Risk for Hispanic Mothers Pubblico
Stanhope, Kaitlyn (Spring 2020)
Abstract
A growing body of work links restrictive immigration policies and enforcement practices to adverse health outcomes for immigrants, their families, and communities. By creating a stressful environment before and during pregnancy, these policies may result in increased risk of adverse birth outcomes, including very preterm birth, for both foreign-born and U.S. born Hispanic mothers. The goal of this dissertation is to explore the effect of immigration policy related contextual stressors, protective supports, and place on the risk of very preterm birth to foreign-born and U.S.-born Hispanic mothers across U.S. states.
In aim 1, I fit multilevel models to estimate the effect of living in a state with a restrictive immigration policy climate on very preterm birth (VPTB) among foreign-born and U.S.-born Hispanic women. Conditional on state, county, and individual level confounders, living in a state in the most restrictive quintile of immigration climate was associated with an increase in the odds of very preterm birth among all Hispanic women (OR: 1.07 (1.04, 1.1)) without effect modification by nativity. In aim 2, I fit spatial Bayesian varying coefficient conditional autoregressive models to estimate the effect of adopting a 287(g) immigration enforcement agreement on very preterm birth rates to Hispanic women in the county. For foreign-born Hispanic women only, adoption of a 287(g) agreement was associated with a slight increase in the odds of VPTB (aOR: 1.04 (1.01, 1.12)). This effect varied spatially, with the strongest effects in counties in North Carolina and Virginia. In aim 3, I conducted surveys and in-depth interviews with pregnant Latina women in metro Atlanta, measuring stress and resilience-promoting factors. While the majority of women described experiencing at least one external stressor, many did not describe experiencing emotional stress reactions. In interviews, women described resilience promoting factors including reliance on family, maturation and growth following traumatic or challenging experiences across the life course, and a perceived capability to control their emotional reactions to stress.
This dissertation contributes to the growing body of work demonstrating an association between exposure to restrictive immigration policies or enforcement practices and adverse birth outcomes. Future work should explore variation in women’s reaction to these environmental stressors and possible modifiers of the effect of immigration climate on health, including interpersonal and individual resilience-promoting factors.
Table of Contents
ABSTRACT
ACKNOWLEDGEMENTS
INTRODUCTION
AIM 1. RESTRICTIVE SUB-FEDERAL IMMIGRATION POLICY CLIMATES AND VERY PRETERM BIRTH RISK AMONG US-BORN AND FOREIGN-BORN HISPANIC MOTHERS IN THE UNITED STATES, 2005-2016
Introduction
Conceptual Framework
Methods
Results
Discussion
AIM 2. SPATIAL VARIATION IN VERY PRETERM BIRTH TO HISPANIC WOMEN ACROSS THE UNITED STATES: THE ROLE OF INTENSIFIED IMMIGRATION ENFORCEMENT
Background
Methods
Results
Discussion
Supplement
AIM 3. PERCEPTIONS OF STRESS AND RESILIENCE AMONG LATINA WOMEN ENROLLED IN PRENATAL CARE IN METRO ATLANTA THROUGH AN ECOSOCIAL LENS
Background
Methods
Results
Discussion
CONCLUSION AND FUTURE DIRECTIONS
REFLEXIVITY STATEMENT
BIBLIOGRAPHY
APPENDIX A: DISSERTATION PROPOSAL
1. Significance:
2. Approach
APPENDIX B. STANHOPE DISSERTATION AIM 3 APPROACH DETAIL
I. Recruitment Procedures
II. Data Collection Procedures
III. Quantitative Survey Analysis
IV. Qualitative Interview Analysis
V. Data Triangulation
VI. Anticipated Deliverables
VII. Anticipated Challenges
APPENDIX C: IN-DEPTH INTERVIEW GUIDE
APPENDIX D. MONITORING AND EVALUATION FRAMEWORK
About this Dissertation
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