Abstract
Purpose
To examine whether ethnic differences in low birth weight babies of low-income women may be explained in part by group differences in prenatal health behaviors and psychosocial factors.
Method
A prospective survey of 1,071 low-income, primiparous African-American and Mexican-origin women was conducted in Los Angeles County, California. In face-to-face interviews, data were obtained on substance use, prenatal stress, social support, attitudes toward pregnancy, initiation of prenatal care, and medical risk. Medical chart data were abstracted regarding medical risk factors and labor, delivery, and neonatal data. Interview data were linked with birth outcome data retrieved from maternal medical records. Structural equation modeling was used to test a hypothesized model in which differences in birth weight were expected to be mediated by ethnic differences in substance use, psychosocial factors, and medical risk.
Results
As expected, African-American women delivered babies of earlier gestational age and lower birth weight than did women of Mexican origin. Direct predictors of low birth weight were use of drugs and cigarettes, prenatal stress, and positive attitudes toward pregnancy; together, these factors accounted for the observed ethnic differences in birth weight.
Conclusion
These data contribute to our understanding of the factors that may account for ethnic-associated differences in low birth weight.
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References
Troubling Trends: the Health of America's Next Generation. Washington, DC: National Committee to Prevent Infant Mortality; 1990.
Institute of Medicine:Prenatal Care: Reaching Mothers. Reaching Infants. Washington, DC: National Academy Press; 1988.
Rumbaut RG, Weeks JR. Unraveling a public health enigma.Res Soc Health Care. 1996; 13B:337–391.
Paneth NS: The problem of low birth weight.Future Child. 1995;5(1):19–34.
Shiono PH, Rauh VA, Park M, Lederman SA, Zuskar D. Ethnic differences in birth weight: the role of lifestyle and other factors.Am J Public Health. 1997;87(5):787–793.
Singh GK, Yu SM. Adverse pregnancy outcomes: differences between US- and foreign-born women in major US racial and ethnic groups.Am J Public Health. 1996;86(6): 837–843.
Chomitz VR, Cheung LWY, Lieberman E. The role of lifestyle in preventing low birth weight.Future Child. 1995;5(1):121–138.
Adler NE, Boyce WT, Chesney MA, Folkman S, Syme L. Socioeconomic inequalities in health.JAMA. 1993;269(24):3140–3145.
James, SA. Racial and ethnic differences in infant mortality and low birth weight.Ann Epidemiol. 1993;3:130–136.
Combs-Orme T, Risley-Curtiss C, Taylor R. Predicting birth weight: relative importance of sociodemographic, medical, and prenatal care variables.Soc Serv Rev. 1993;67:617–630.
Williams DR. Socioeconomic differentials in health.Soc Psychol Q. 1990;53(2):81–99.
Rowley D. Research issues in the study of very low birth weight and preterm delivery among African American women.J Natl Med Assoc. 1994;86:761–764.
Zimmer-Gembeck MJ, Helfand M. Low birth weight in a public prenatal care program: behavioral and psychosocial risk factors and psychosocial intervention.Soc Sci Med. 1996;43(2):187–197
Norbeck JS, Dejoseph JF, Smith RT. A randomized trial of an empirically-derived social support intervention to prevent low birthweight among African American women.Soc Sci Med. 1996;43(6):947–954.
Elbourne D, Oakley A. An overview of trials of social support during pregnancy. In: Berendes H, Kessel S, Yaffe S, eds.Advances in the Prevention of Low Birth Weight. Washington, DC: National Center for Education on Maternal and Child Health; 1991: 39–54.
Sherraden MS, Barrera RE. Poverty, family support, and well-being of children: Mexican immigrant women and childbearing.J Sociol Soc Welfare. 1996;23(2):27–54.
Dunkel-Schetter C, Sagrestano LM, Feldman P, Killingsworth C. Social support and pregnancy. A comprehensive review focusing on ethnicity and culture. In: Pierce GR, Sarason BR, Sarason IG, eds.Handbook of Social Support and the Family. New York: Plenum Press; 1996:375–412.
McLean DE, Hartfield-Timajchy K, Wingo PA, Floyd RL. Psychosocial measurement: implications for the study of preterm delivery in black women.Am J Prev Med. 1993; 9(6):39–81.
Wadhwa PD, Sandman CA, Porto M, Dunkel-Schetter C, Garite TJ. The association between prenatal stress and infant birth weight and gestational age at birth: a prospective investigation.Am J Obstet Gynecol. 1993;169:858–865.
Robins LN, Mills JL. Effects of in utero exposure of street drugs.Am J Public Health. 1993;83(Suppl):1–32.
Abma JC, Mott FL. Substance use and prenatal care during pregnancy among young women.Fam Plann Perspect. 1991;23(3):117–128.
Petitti DB, Coleman C. Cocaine and the risk of low birth weight.Am J Public Health. 1990;80(1):25–28.
US Surgeon General's Report.The Health Consequences of Smoking for Women. Rockville, Md: US Department of Health and Human Services; 1988.
Nordentoft M, Lou HC, Hansen D, et al. Intrauterine growth retardation and premature delivery: the influence of maternal smoking and psychosocial factors.Am J Public Health. 1996;86(3):347–354.
National Center for Health Statistics.Health United States 1995. Rockville, Md: US Department of Health and Human Services, 1996. DHHS Publication No. (PHS) 96-1232.
Balcazar H, Cole G, Hartner J. Mexican-Americans' use of prenatal care and its relationship to maternal risk factors and pregnancy outcome.Am J Prev Med. 1992;8(1):1–7.
Sherraden MS, Barrera RE. Healthy babies against the odds: maternal support and cultural influences among Mexican immigrants.Fam Soc. 1996;77(5):298–313.
Mercer R.First-Time Motherhood. New York: Springer; 1986.
Zambrana RE, Scrimshaw SCM, Collins N, Dunkel-Schetter C. Prenatal health behaviors and psychosocial risk factors in pregnant women of Mexican origin: the role of acculturation.Am J Public Health. 1997;87(6):1022–1026.
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress.J Health Soc Behav. 1983;24:385–396.
Collins NL, Dunkel-Schetter C, Lobel M, Scrimshaw S. Social support in pregnancy: psychosocial predictors of birth outcome and postpartum depression.J Pers Soc Psychol. 1993;65(6):1243–1258.
Lobel M, Dunkel-Schetter C. Conceptualizing stress to study effects on health: environmental, perceptual and emotional components.Anxiety Res. 1990;3:213–230.
Belloc NB, Breslow L. Relationship of physical health status and mortality.Prev Med. 1972;2:67–81.
Zuckerman B, Amaro H, Cabral H. Validity of self-reporting of marijuana and cocaine use among pregnant adolescents.J Pediatr. 1989;115(5):812–815.
Hobel CJ, Youkeles L, Forsythe A. Prenatal and intrapartum high-risk screening: risk factors assessed.Am J Obstet Gynecol. 1979;135:1051–1056.
Bentler PM.EQS: Structural Equations Program Manual. Los Angeles, Calif: BMDP Statistical Software; 1989.
DeVane D, Gary AR, Elftman S, Gallegos AA, Uretzky SA.Babies and Mothers at Risk: Perinatal Needs Assessment for Los Angeles County. burbank, Calif: March of Dimes Birth Defects Foundations; 1992.
Lillie-Blanton M, Martinez RM, Taylor AK, Robinson BG. Latina and African American women: continuing disparities in health.Int J Health Serv. 1993;23(3):555–84.
Berenson AB, Stiglich NJ, Wilkinson GS, Anderson GD. Drug abuse and other risk factors for physical abuse in pregnancy among white non-Hispanic, black, and Hispanic women.Am J Obstet Gynecol. 1991;164(6):1491–1499.
Amaro H, Fried LE, Cabral H, Zuckerman B. Violence during pregnancy and substance use.Am J Public Health. 1990;80(5):575–579.
Main DM, Richardson D, Gahe SG, Strong S, Weller SC. Prospective evaluation of a risk scoring system for predicting preterm delivery in black inner city women.Obstet Gynecol. 1987;6(9):61–66.
King G. Institutional racism and the medical/health complex: a conceptual analysis.Ethnicity Dis. 1996;6(1):30–462.
Foster HW, Thomas J, Semenya KA, Thomas J. Low birth weight in African Americans: does intergenerational well-being improve outcome?J Natl Med Assoc. 1993;85:516–520.
Cooper RS. Celebrate diversity—or should we?Ethnicity Dis. 1991;1(1):3–7.
Osborne NG, Feit MD. The use of race in medical research.JAMA. 1992;267(2):275–78.
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Zambrana, R.E., Dunkel-Schetter, C., Collins, N.L. et al. Mediators of ethnic-associated differences in infant birth weight. J Urban Health 76, 102–116 (1999). https://doi.org/10.1007/BF02344465
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DOI: https://doi.org/10.1007/BF02344465