The Role of Home Visiting in the Association between Racial Discrimination and Preterm Birth among Black Women in the United States, PRAMS 2016 – 2019 Restricted; Files Only

Abstract

Objective: There is substantial evidence that home visiting is associated with lower odds of preterm birth among Black women. However, its role in the relationship between racial discrimination and preterm birth has yet to be explored. This study investigated: 1) if feeling upset about experiencing racial discrimination in the 12 months before giving birth was associated with preterm birth and 2) whether access to a home visitor during the prenatal period was an effect modifier for this relationship.

Methods: Data from the Pregnancy Risk Assessment Monitoring System were used for the analysis. The study population included Black respondents who gave birth between 2016 and 2019 from eight US states that included the survey questions about racial discrimination and home visiting (n = 6,793). Logistic regression was used to model the relationship between racial discrimination, home visiting, and preterm birth.

Results: Feeling upset about experiencing racial discrimination was weakly associated with preterm birth risk, adjusting for maternal education, maternal age, and adequacy of prenatal care (aOR = 1.08, 95% CI: 0.67 – 1.74). There was no evidence of statistically significant effect modification of the relationship between racial discrimination and preterm birth based on home visiting status when evaluated on the multiplicative scale (p-interaction = 0.12). Black women who had a home visitor and felt upset about experiencing racial discrimination had over four times the odds of preterm birth compared to those who experienced neither exposure (aOR = 4.68, 95% CI: 2.08 – 10.54).

Conclusions: Our study suggests that there is not a statistically significant difference in the relationship between racial discrimination and preterm birth based on access to home visiting during the prenatal period. Further research should consider the role of various home visiting models on the relationship between racial discrimination and preterm birth among Black women living in the United States.

Table of Contents

Introduction ......................................................................................... 1

Birth Outcomes ..................................................................................... 1

Racial Disparities in Birth Outcomes ....................................................... 2

Racism and Birth Outcomes ................................................................... 3

Home Visiting and Birth Outcomes ......................................................... 5

Research Question ................................................................................. 7

Methods ................................................................................................ 7

Data Source ........................................................................................... 7

Variables ............................................................................................... 8

Analysis ................................................................................................ 9

Results .................................................................................................. 10

Discussion ............................................................................................. 13

Findings ................................................................................................ 13

Comparisons to Similar Studies ............................................................... 13

Limitations ............................................................................................ 16

Recommendations .................................................................................. 17

Conclusion ............................................................................................. 18

References ............................................................................................. 19

Appendix ............................................................................................... 27

 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palavra-chave	Home Visiting Preterm Birth Racial Discrimination
Committee Chair / Thesis Advisor	Dr. Michael Kramer, Emory University

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