Exploring Direct and Intergenerational Effects of Discrimination on the Sleep Health of Pregnant Black American Women and Their Children Restricted; Files Only

Cohen, Madeleine (Summer 2022)

Permanent URL: https://etd.library.emory.edu/concern/etds/73666570n?locale=en


This dissertation explores the association between discrimination and poorer sleep health in pregnant Black American women and their young children. Consistent with an intersectionality framework, we expanded upon the racial/ethnic discrimination and sleep health literature by also examining pregnant Black American women’s lifetime experiences of gendered racism as an additional discriminatory stress exposure variable. In Study 1, we investigated the association between pregnant Black American women’s lifetime exposure to discrimination – using the Krieger Experiences of Discrimination measure and the Jackson, Hogue, Phillips Contextualized Stress measure – and their self-reported sleep quality – using the Patient Reported Outcomes Measurement Information System Sleep Disturbance Short Form – during the first and second trimesters of pregnancy. Greater lifetime exposure to racial/ethnic discrimination or gendered racial stress was associated with poorer sleep quality at both timepoints in pregnancy, even when we statistically controlled for women’s concurrent prenatal depressive symptomatology – using scores from the Edinburgh Postnatal Depression Scale. In Study 2, we employed an intergenerational study design informed by the life course approach to development. We explored whether pregnant Black American mothers’ lifetime exposure to discrimination was associated with maternal reports of poorer sleep health in their two-year-old children, and whether these associations were mediated by women’s prenatal sleep quality and/or depressive symptoms. We found partial support for our proposed model, in that greater lifetime exposure to racial/ethnic discrimination was indirectly associated with poorer sleep health in two-year-old children – as measured by the Children’s Sleep Habits Questionnaire, Abbreviated – via women’s prenatal depressive symptomatology. In contrast, higher levels of lifetime exposure to gendered racism were directly associated with poorer sleep health in women’s two-year-old children. Taken together, efforts to mitigate the harmful interpersonal effects of racism and gendered racism on Black American women may benefit their sleep quality during pregnancy and the sleep health of their two-year-old children. Findings from the current dissertation highlight the need to consider important contextual factors such as exposure to discrimination when examining maternal child health outcomes. 

Table of Contents

Table of Contents 

General Introduction 1 

Paper 1: Discrimination is Associated with Poor Sleep Quality in Pregnant Black American 


Title 12 Abstract 13 

Introduction 14 

Method 19 

Results 25 

Discussion 36 

Paper 2: Intergenerational Effects of Gendered Racial Stress and Discrimination on Black American Children’s Poor Sleep Health 

Title 45 Abstract 46 

Introduction 48 

Method 54 Results 62 

Discussion 70 

General Discussion 80 

References 95 

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