Triple Consciousness: Investigating Determinants of Chemical and Psychosocial Stress Exposures, Perinatal Impacts, and Introducing the Generative Report-Back Framework in the Atlanta African American Maternal Child Cohort Open Access
Eatman, Jasmin (Spring 2025)
Abstract
Introduction: African American (AA) women are disproportionately burdened by endocrine disrupting chemical (EDC) and psychosocial stress exposures. These disparate exposures are individually associated with adverse pregnancy outcomes and widen existing racial disparities in maternal health. Few studies investigate chemical and non-chemical exposures in combination among AA pregnant people, and fewer qualitative studies explore best practices for report-back of research results. This dissertation addresses these gaps by leveraging data from the Atlanta African American Maternal Child Cohort (ATL-AA) through primary, secondary, and qualitative data analyses.
Methods: Through a prospective cohort study design, 706 participants were recruited into the ATL-AA cohort and provided biologic samples (blood, urine) and self-reported experiences of psychosocial stress through validated survey measures. Multivariable linear regression and latent clustering analysis were used to explore determinants of chemical and psychosocial stress exposure. Geospatial and environmental mixture methods, including quantile g-computation, measured associations between multiple stress exposure types and adverse birth outcomes. Qualitative thematic analysis of focus group discussions among ATL-AA cohort participants assessed perceptions and best practices for Generative Report-Back (GRB), a novel methodology introduced in this dissertation.
Results: Personal care product use was associated with elevated urinary phthalate levels during pregnancy. Reduced chemical exposure and greater neighborhood racial homogeneity were significantly associated with less frequent experiences of racism among AA pregnant people. Racialized economic segregation was significantly associated with soil concentrations of lead (Pb). Combined chemical and psychosocial stress exposures — including racism, anxiety, depression, and biologic EDC burden — were significantly associated with reductions in infant birthweight. Qualitative analysis of GRB focus groups identified seven themes, emphasizing racial congruence, multimodal data representation, and community translation of findings as central to effective report-back.
Conclusions: Among a socioeconomically diverse cohort of AA pregnant people, determinants of chemical and psychosocial stress exposure include multiple manifestations of structural racism, including racialized economic polarization and environmental injustice. Combined exposures have significant impacts on gestational age and birthweight at delivery. GRB is an effective, culturally responsive tool for returning research results to communities. Broader implications include establishing clinical guidelines and public policy naming racism as a social determinant of perinatal health, and centering AA women in future environmental epidemiologic research.
Table of Contents
CHAPTER 1: INTRODUCTION 1
1.1 EXPOSURE TO ENDOCRINE DISRUPTING CHEMICALS 2
1.2 HEALTH IMPACTS OF ENDOCRINE DISRUPTING CHEMICALS IN PREGNANCY 3
1.3 EXPERIENCES OF RACISM AND PREGNANCY OUTCOMES 4
1.4 RACISM CAN ENHANCE THE HARMFUL EFFECTS OF EXPOSURE TO ENDOCRINE DISRUPTING CHEMICALS 4
1.5 TRANSLATING RESEARCH TO ACTION THROUGH REPORT-BACK OF RESEARCH RESULTS 5
CHAPTER 2: REVIEW OF LITERATURE AND JUSTIFICATION OF RESEARCH AIMS 6
2.1 ENDOCRINE DISRUPTING CHEMICALS 6
2.2 PSYCHOSOCIAL STRESS MEASURES 8
2.3 REPORTING BACK RESEARCH RESULTS 8
2.4 JUSTIFICATION OF RESEARCH AIMS 10
2.5 CONFOUNDERS AND COVARIATES 12
CHAPTER 3: PERSONAL CARE PRODUCT USE IS ASSOCIATED WITH ELEVATED URINARY PHTHALATE METABOLITE LEVELS DURING PREGNANCY IN THE ATLANTA AFRICAN AMERICAN MATERNAL CHILD COHORT 15
3.1 INTRODUCTION 16
3.2 MATERIALS AND METHODS 17
3.2.1 Study Design and Population 17
3.2.2 Assessment of PCP Usage 17
3.2.3 Measurement of Phthalate Metabolites 18
3.2.4 Covariates 18
3.2.5 Statistical Analysis 19
3.3 RESULTS 19
3.4 DISCUSSION 23
3.5 CONCLUSIONS 25
CHAPTER 4: CHAPTER 4: MAPPING CUMULATIVE CHEMICAL AND SOCIOECONOMIC EXPOSURES AND EXPLORING ASSOCIATIONS WITH SELF-REPORTED GENDERED RACIAL STRESS IN THE ATLANTA AFRICAN AMERICAN MATERNAL CHILD COHORT 29
4.1 ABSTRACT 29
4.2 INTRODUCTION 30
4.3 METHODS 31
4.3.1 Study Population 31
4.3.2 Exposure Assessment 31
4.3.3 Index of Concentration at the Extremes 32
4.3.4 Assessment of Discrimination-Related Psychosocial Stress 32
4.4 STATISTICAL ANALYSIS 33
4.4.1 Environmental Sampling and Residential Segregation 33
4.4.2 Joint Exposure Assessment and Discrimination-Related Stress 33
4.5 RESULTS 33
4.5.1 Population Characteristics 33
4.5.2 Environmental Sampling Study and Residential Segregation 34
4.5.3 Joint Exposure Assessment and Discrimination-Related Stress 34
4.6 DISCUSSION 35
4.7 CONCLUSIONS 36
CHAPTER 5: EXPOSURE TO PHTHALATE METABOLITES, BISPHENOL A, AND PSYCHOSOCIAL STRESS MIXTURES AND ADVERSE PREGNANCY OUTCOMES IN THE ATLANTA AFRICAN AMERICAN MATERNAL-CHILD COHORT 42
5.1 ABSTRACT 42
5.2 INTRODUCTION 43
5.3 METHODS 44
5.3.1 Study Design and Population 44
5.3.2 Measurement of Phthalate Metabolites and Bisphenol A (BPA) 44
5.3.3 Assessment of Stress Response and Psychosocial Stress Exposure 45
5.3.4 Birth Outcomes 46
5.3.5 Covariates 46
5.3.6 Statistical Analysis 47
5.4 RESULTS 49
5.5 DISCUSSION 50
5.6 CONCLUSIONS 53
CHAPTER 6: ASSOCIATIONS BETWEEN SELF-REPORTED EXPERIENCES OF DISCRIMINATION, SOCIOECONOMIC AND RACIAL POLARIZATION, AND BIRTH OUTCOMES IN THE ATLANTA AFRICAN AMERICAN MATERNAL CHILD COHORT 62
6.1 ABSTRACT 62
6.2 INTRODUCTION 63
6.3 METHODS 64
6.3.1 Study Design and Population 64
6.3.2 Geocoding of Address During Pregnancy 65
6.3.3 Assessment of Structural Racism using the Index of Concentration at the Extremes 65
6.3.4 Assessment of Self-Reported Experiences of Racial and Gender Discrimination 65
6.3.5 Birth Outcomes 66
6.3.6 Covariates 66
6.3.7 Statistical Analysis 67
6.4 RESULTS 67
6.5 DISCUSSION 70
6.6 CONCLUSIONS 73
CHAPTER 7: FROM RESULTS TO RELATIONSHIP: INTRODUCING GENERATIVE REPORT-BACK AS A TRANSFORMATIVE COMMUNITY-ENGAGED METHODOLOGY IN THE ATLANTA AFRICAN AMERICAN MATERNAL-CHILD COHORT 78
7.1 INTRODUCTION 79
7.2 METHODS 80
7.2.1 Study Design and Participants 80
7.2.2 Data Collection 80
7.2.3 Facilitation and Positionality 81
7.2.4 Data Analysis 81
7.3 RESULTS 82
7.3.1 Partner Characteristics 82
7.3.2 Focus Group Findings 82
7.4 DISCUSSION 88
7.5 STRENGTHS AND LIMITATIONS 89
7.6 IMPLICATIONS FOR POLICY ACTION 90
7.7 CONCLUSION 90
CHAPTER 8: GENERAL DISCUSSION 96
CHAPTER 9: RELEVANCE OF FINDINGS TO CLINICAL PRACTICE 103
CHAPTER 10: FUTURE DIRECTIONS 106
REFERENCES 108
APPENDICES 135
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