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NURS 519 Social Determinants of Preterm Birth

Team Nurseoblasts

Sooyoung Yeom

on 1 August 2015

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Transcript of NURS 519 Social Determinants of Preterm Birth

Closing 소돗ㅅ솓ㅅㄷthe Gap
Social Determinants of Preterm Birth

NURS 519 Team Nurseoblasts
College of Nursing, University of Illinois

Problem Statement
Although infant mortality has declined overall in the United States, significant racial disparities appear when comparing rates of
infant mortality
of babies born to
non-Hispanic black women
and babies born to
non-Hispanic white women.
(CDC, 2002)
Conceptual Model
Potential intervention Points
1. Reducing Racial/Ethnic and Socioeconomic Disparities in Preterm and Low Birth weight Births (2006). (Policy No. 20062). Retrieved from American Public Health Association: http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1326
2. Center for Disease Control. (2010). Addressing High Infant Mortality Rates among African Americans. CDC at Work, Retrieved http://www.cdc.gov/washington/~cdcatWork/pdf/infant_mortality.pdf
3. Center for Disease Control. (2002). Infant Mortality and Low Birth Weight Among Black and White Infants-United States, 1980-2000. Morbidity and Mortality Weekly Report, Volume 51 No.27 Retrieved http://www.cdc.gov/mmwr/PDF/wk/mm5127.pdf
4. Culhane, R.L., (2011). Racial disparities in preterm birth. Seminars in Perinatology. 35(4) (2011), pp. 234-239. Doi: 10.1053/j.semperi.2011.02.020.
5. Diez Roux, A. (2012). Conceptual approaches to the study of health disparities. Annual Review of Public Health, 3341-58.
6. Kramer, M., Hogue, C., Dunlop, A., & Menon, R. (2011). Preconceptional Stress and Racial disparities in preterm birth: An overview. Acta Obstetricia ET Gynecologica Scandinavica, 1307-1316.
7. MacDorman, M.F., Mathews, T.J. (2011). Understanding Racial and Ethnic Disparities in U.S. Infant Mortality Rates. NCHS Data Brief, No. 74. Retrieved http://www.cdc.gov/nchs/data/databriefs/db74.pdf.
8. Strain, T.H., MacLowry, R., & Stange E. (2009). Unnatural Causes: When the BoughBreaks. USA: The National Minority Consortia.

It is obvious through the above discussion that there are gross inequities between the infant mortality rates of non-Hispanic black and non-Hispanic white women.

This can be explained in part by
lower socioeconomic status and education levels
experienced by higher proportions of African-American women, but even when these risk factors are controlled for, preterm birth amongst U.S-born African-American women is still disproportionately high.

This is linked to physiologic effects of
the stress of racism and discrimination.
Due to the chronic stress of discrimination, the bodies of African-American women experience wear and tear because of continuous activation of the body’s stress response.

High levels of stress hormones on pregnant women can lead to inflammation of the uterus and the limitation of placental blood flow. The daily physiologic toll of chronic stress, in addition to the deleterious effects of stress during pregnancy, lead us to believe

that African-American women experience higher levels of infant mortality due to preterm birth in part because of
the chronic stress of racism and discrimination
The greatest opportunity for eliminating the disparity in the occurrence of preterm and low birth weight newborns, among African-American mothers, is to
implement new public policies
that alter the lived experiences, over the course of the lifespan, of black women in the US.

Society must address
institutionalized racism
in order to make progress on a larger scale and not just on an individual level.

Changes in
public policy
allow us to influence the mechanisms of institutionalized racism, as well as personally-mediated, and internalized racism.
Background of the interventions
Intervention point 1
racial minorities and at risk women
, across the lifespan but with increased focus on childbearing years

An example of this would be to mandate the allocation of money to develop
clinics in predominantly African-American communities
, which provide support services to black woman throughout the lifespan.

The rationale for this intervention is that with increased support the effects of chronic stress can be better managed.
Source : CDC/NCHS, linked birth/infant data set, (MacDorman & Mathews, 2011)
According to the 2007 linked birth/infant death data set analyzed by the CDC, non-Hispanic black women have an infant mortality rate
2.4 times
the rate of non-Hispanic white women. (MacDorman & Mathews, 2011)
Socioeconomic status
Prenatal care
Individual risk factor
Infant Mortality Rates (per 1,000 live births), by race and Hispanic origin of mother: United States, 2007
Social Determinants of Preterm Birth
Black Female

Health Policy

Stress of
Access to Care
Figure 1. Conceptual model of social determinants of preterm birth among Black women in the United States (US).
Alysha Hart
Colleen Cappitelli
Evangeline Kuhn
Gabriela Serratos
Kathryn Dresser
Megan Gordon
Sooyoung Yeom

About this model
• Figure 1 is based on the conceptual model designed by Diez-roux (2012). This model is consistent with the idea that
cultural factors
are causally related to
(Diez-Roux, 2012).
About this model con't
• Figure 1 departs from Diez-Roux’s conceptual model in that ‘
socioeconomic position/status
’ is a mediator for the stress response that leads to preterm births in Black women.
Low birth weight and preterm birth (delivery of a newborn before 37 weeks of gestation) have extremely negative impact on the neonate at time of birth and throughout the lifespan

A negative impact on the health of
and carries with
a large financial burden
The Diez-Roux Conceptual structure holds true that with improved socioeconomic status there are less low birth weight and preterm births for both White and Black American populations
Hidden Points
It does not account for the racial disparities that occur when
socioeconomic and other health risk factors are negated
. These risk factors include, but are not limited to, low education, smoking, alcohol-use, recreational drug-use, poor diet, diabetes, and hypertension.
Independent factors
Social determinants of preterm births in Black women include
maternal nativity
(whether or not the mother was born in the US).

Health policy
, or lack thereof, leads to preterm births in Black women.
• Low maternal education
• Low income
• Cigarette smoking
• Cocaine use
• Chronic co-morbidities such as hypertension and diabetes

Social factors
• “Approximately half of low birth weight/ preterm newborns” of African American women have no risks factors other than being African American(Strain el al 2009).
Possible outcomes
Promote public policy for health care and health education
Intervention point 2
An example of this would be to ensure that
job opportunities, wages or promotions, and access to higher education
be based on the merits of each individual without the possibility of making assumptions about that individual based on their race.

The rationale for this intervention is that it will reduce the chronic stress that African-American women experience throughout their lives.
Address structural racism and inequities
through education and policy
Physical factors

Psychological stress
can precipitate pre-term labor in African Americans.

• Chronic stress such as caring for an ill family member, living in poverty, or being exposed to constant discrimination can result in
wear and tear on the body’s stress response systems
permanently alter immune and vascular function
thus affecting pregnancy health.
(Strain et al, 2009)
(American Public Health Association Policy, 2006)
(American Public Health Association Policy, 2006)
(American Public Health Association Policy, 2006)
(Strain et al, 2009)
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