Tyan Parker Dominguez, PhD, MPH, MSW School of Social Work, University of Southern California

1. Tyan Parker Dominguez, PhD, MPH, MSWTyan Parker Dominguez, PhD, MPH, MSW
School of Social WorkSchool of Social Work
University of Southern CaliforniaUniversity of Southern California
PSYCHOSOCIAL STRESS ANDPSYCHOSOCIAL STRESS AND
PERSISTENT RACIALPERSISTENT RACIAL
DISPARITIES IN ADVERSEDISPARITIES IN ADVERSE
BIRTH OUTCOMESBIRTH OUTCOMES

2. 1)1) Review the nature of persistent racialReview the nature of persistent racial
disparities in adverse birth outcomesdisparities in adverse birth outcomes
2)2) Discuss the stress and pregnancyDiscuss the stress and pregnancy
paradigm, highlighting physiologicalparadigm, highlighting physiological
mechanismsmechanisms
3)3) Present research findings from work onPresent research findings from work on
stress and birth outcomesstress and birth outcomes
OBJECTIVESOBJECTIVES

3. Infant MortalityInfant Mortality
deaths before age 1 per 1000 live birthsdeaths before age 1 per 1000 live births
OVERALL 6.8
NONHISPANIC WHITE 5.7
HISPANIC 5.4
ASIAN/PACIFIC
ISLANDER
4.7
NONHISPANIC BLACK 13.5
Mathews, Menacker, & MacDorman, 2003Mathews, Menacker, & MacDorman, 2003

4. Preterm BirthPreterm Birth
< 37 weeks gestation< 37 weeks gestation
Martin, Hamilton, Sutton, Ventura, Menacker, & Munson, 2003Martin, Hamilton, Sutton, Ventura, Menacker, & Munson, 2003
OVERALL 12.1%
NONHISPANIC WHITE 11.0%
HISPANIC 11.6%
ASIAN/PACIFIC
ISLANDER
10.4%
NONHISPANIC BLACK 17.7%

5. OVERALL 7.8%
NONHISPANIC WHITE 6.9%
HISPANIC 6.5%
ASIAN/PACIFIC
ISLANDER
7.8%
NONHISPANIC BLACK 13.4%
Martin, Hamilton, Sutton, Ventura, Menacker, & Munson, 2003Martin, Hamilton, Sutton, Ventura, Menacker, & Munson, 2003
Low BirthweightLow Birthweight
< 2500 grams< 2500 grams

6. Disparity not explained by establishedDisparity not explained by established
SociodemographicSociodemographic
BehavioralBehavioral
MedicalMedical
risk factorsrisk factors
Berkowitz & Papiernik, 1993; Collins & David, 1990; David & Collins, 1991; Frisbie, Biegler, de Turk, Forbes, & Pullum, 1997;Berkowitz & Papiernik, 1993; Collins & David, 1990; David & Collins, 1991; Frisbie, Biegler, de Turk, Forbes, & Pullum, 1997;
Kleinman & Kessel, 1987; Shiono, Klebanoff, Graubard, Berendes, & Rhoads, 1986; Wise, 1993Kleinman & Kessel, 1987; Shiono, Klebanoff, Graubard, Berendes, & Rhoads, 1986; Wise, 1993

7. P s y c h o s o c i a l S t r e s sP s y c h o s o c i a l S t r e s s
Environmental demands that tax orEnvironmental demands that tax or
exceed the adaptive capacity of anexceed the adaptive capacity of an
organism, resulting in physiologicalorganism, resulting in physiological
and psychological changes that mayand psychological changes that may
place the organism at risk forplace the organism at risk for
diseasedisease
Cohen, Kessler, & Gordon, 1995Cohen, Kessler, & Gordon, 1995

8. African-American pregnant women reportAfrican-American pregnant women report
more stress exposure and greater emotionalmore stress exposure and greater emotional
distress from that exposure than otherdistress from that exposure than other
groupsgroups
Feldman, Dunkel-Schetter, Woo & Hobel, 1997; Zambrana et al., 1999Feldman, Dunkel-Schetter, Woo & Hobel, 1997; Zambrana et al., 1999

9. A Biopsychosocial ModelA Biopsychosocial Model
NeuroendocrineNeuroendocrine
systemsystem
ImmuneImmune
systemsystem
CardiovascularCardiovascular
systemsystem
STRESSSTRESS
BirthBirth
outcomesoutcomes

10. The health of minority groups is intimatelyThe health of minority groups is intimately
connected to theconnected to the HIGH STRESS STATESHIGH STRESS STATES
created by a social system that condones,created by a social system that condones,
reinforces, and perpetuates racialreinforces, and perpetuates racial
discrimination.discrimination.
Myers, 1982
Negative Self-Society DialecticNegative Self-Society Dialectic

11. RACISM LINKED TORACISM LINKED TO
Decreased life satisfactionDecreased life satisfaction
PRETERM DELIVERYPRETERM DELIVERY
LOW BIRTHWEIGHTLOW BIRTHWEIGHT
INFANT MORTALITYINFANT MORTALITY
Cardiovascular diseaseCardiovascular diseaseStrokeStroke
High blood pressureHigh blood pressure
Psychological distressPsychological distress DepressionDepression
Lower self-esteemLower self-esteem

12. ALLOSTATIC LOADALLOSTATIC LOAD
Physiologic toll of repeated and/or chronicPhysiologic toll of repeated and/or chronic
stress system activationstress system activation
StressStress
BaselineBaseline
RecoveryRecovery
AllostasisAllostasis Allostatic LoadAllostatic Load
BaselineBaseline
McEwen & Stellar, 1993; Sterling & Eyer, 1988McEwen & Stellar, 1993; Sterling & Eyer, 1988

13. RACISM AND ADVERSERACISM AND ADVERSE
PREGNANCY OUTCOMESPREGNANCY OUTCOMES
A Program of ResearchA Program of Research

14. • Prospective, repeated measures surveyProspective, repeated measures survey
• Psychosocial, medical, physiological variablesPsychosocial, medical, physiological variables
• 480 ethnically/SES diverse pregnant women480 ethnically/SES diverse pregnant women
• Recruited in clinics or referred by MDsRecruited in clinics or referred by MDs
• Fluent EnglishFluent English
• >> 18 yrs18 yrs
• << 18 wks gestation, non substance using18 wks gestation, non substance using
Multi-Site Behavior in Pregnancy StudyMulti-Site Behavior in Pregnancy Study
1997-20021997-2002

15. STUDY 1
Does stress mediate racial
differences in birth outcomes?
Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2005

16. N = 124N = 124
 African-American (n=51)African-American (n=51)
Nonhispanic White (n=73)Nonhispanic White (n=73)
 Born and raised in U.S.Born and raised in U.S.
 Live-born infantLive-born infant
 T1, T2, birth outcome dataT1, T2, birth outcome data
STUDY SAMPLESTUDY SAMPLE

17. RACISM EXPOSURERACISM EXPOSURE
• personal/vicarious experiencespersonal/vicarious experiences
• childhood/adulthoodchildhood/adulthood
• across different life domainsacross different life domains
Have you ever felt that you (or someone close toHave you ever felt that you (or someone close to
you) were (was) discriminated against or the targetyou) were (was) discriminated against or the target
of prejudice because of race in interpersonal,of prejudice because of race in interpersonal,
housing, employment, educational, other situations?housing, employment, educational, other situations?

18. Sobel test of mediation = -1.64, p < .10 (one-tailed)
Mediation Models
DV = BW Step 1 Step 2 Step 3
GA .65*** .67*** .65**
Medrisk .05 .03 .04
Spont. Labor -.01 -.00 .01
Parents’ Educ .06 .03 .05
Race -.18* -.13+
Racism-Life -.13+

19. Sobel test of mediation = -1.97, p < .05 (one-tailed)
Mediation Models
DV = BW Step 1 Step 2 Step 3
GA .65*** .67*** .64**
Medrisk .05 .03 .03
Spont. Labor -.01 -.00 .02
Parents’ Educ .06 .03 .05
Race -.18* -.13+
Racism-ChV -.16*

20. K E Y F I N D I N G
Racism exposure, particularly
vicarious childhood
experiences, predicts BW and
attenuates race effects on BW,
controlling for confounders

21. STUDY 2
Are there physiological
factors that link racism
to birth outcomes?
Parker Dominguez, Hilmert, Dunkel Schetter, Glynn, Sandman, & Hobel, 2005

22. C R H
A C T H
C O R T I S O L
Assayed from blood at
10-12 weeks, 18-20 weeks, 24-26 weeks,
30-32 weeks, and 34-36 weeks gestation
Neuroendocrine VariablesNeuroendocrine Variables
++
--
mothermother
++
++
placentaplacenta

23. NE levels rise across pregnancy course in both
ethnic groups
ETHNIC COMPARISON
Evidence of possible NE dysregulation in African Americans:
- high ACTH, low CRH and Cortisol
- smaller level of change in CRH and Cortisol
HOWEVERHOWEVER

24. Racism, NE Function and BW
Vicarious Childhood Exposure
+
CRH 34-36 weeks Birthweight

25. Sobel_ChV = -1.91, p < .05; Sobel_NE = -1.71, p < .05
Mediation Models
DV = BW Step 1 Step 2 Step 3
GA .53*** .50*** .51**
Medrisk .17 .15 .10
Spont. Labor .00 .02 .02
Parents’ Educ .06 .10 .08
Race -.30** -.22* -.22+
Racism-ChV -.22* -.16+
CRH 32-36wks .20*

26. K E Y F I N D I N G S
1. Evidence of NE dysregulation in AfrAms
2. Racism associated with AfrAm NE
pattern
3. Late term CRH predicts BW and
mediates ChV racism effects on BW

27. STUDY 3
Are there differences across
multiple racial/ethnic groups in
exposure to and impact of racism?
Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2004

28. 7070 LatinasLatinas
177177 Nonhispanic WhitesNonhispanic Whites
2525 Asian/Pacific IslandersAsian/Pacific Islanders
5151 African-AmericansAfrican-Americans
with racism datawith racism data
MS-BIPS SAMPLE consisted ofMS-BIPS SAMPLE consisted of

29. Variable AfrAm API Latina White p-value
DSCR_C 3.2(3.2) 3.1(2.4) 1.4(1.9) 1.0(1.7) 0.000
DSCR_D 72.5% 88.0% 54.3% 40.7% 0.000
RACISM EXPERIENCESRACISM EXPERIENCES
LIFETIMELIFETIME
Unadj: APIs & AfrAms / Latinas & Whites
Adj: Latinas / Whites
Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2004Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2004

30. DISTRESSDISTRESS
AfrAms and Latinas
were significantly less
distressed than APIs
and Whites

31. RESPONSERESPONSE
•AfrAms significantly
more likely to keep racism
experiences to themselves
•AfrAms significantly
more likely to accept
unfair treatment as a fact
of life

32. Associations with RacismAssociations with Racism
VariableVariable rr bb
PSSPSS 0.270.27**** 0.230.23****
STAISTAI 0.300.30**** 0.300.30****
Preg AnxPreg Anx 0.240.24**** 0.220.22****
CES-DCES-D 0.180.18**** 0.150.15**
ResourcesResources -0.14-0.14** -0.14-0.14**
* p<0.05, ** p<0.01* p<0.05, ** p<0.01
Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2004Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2004

33. Associations with RacismAssociations with Racism
VariableVariable rr bb
BWBW -0.13-0.13** -0.08-0.08
GAGA -0.12-0.12** -0.10-0.10
*p<0.05*p<0.05
Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2004Parker Dominguez, Dunkel Schetter, Glynn, Hobel, & Sandman, 2004

34. Interaction EffectsInteraction Effects
β = .22, p < .05
APIs: β = .07, p > .10
AfrAms: β = -.36, p < .05
Racism and BW
African Americans X APIs

35. K E Y F I N D I N G S
• Ethnic differences in racism exposure,Ethnic differences in racism exposure,
distress, and copingdistress, and coping
• Racism impacts psychosocial fx of allRacism impacts psychosocial fx of all
groupsgroups
• Evidence race may moderate racismEvidence race may moderate racism
effects on birth outcomeseffects on birth outcomes

36. Improved racism measuresImproved racism measures
Multi-level studiesMulti-level studies
Lifespan ApproachLifespan Approach
CBPRCBPR
Interdisciplinary teamsInterdisciplinary teams
Looking ahead…..

37. Christine Dunkel SchetterChristine Dunkel Schetter
Department of Psychology, UCLADepartment of Psychology, UCLA
Laura GlynnLaura Glynn
Department of Psychiatry, UC-IrvineDepartment of Psychiatry, UC-Irvine
Calvin J. HobelCalvin J. Hobel
Department of Maternal/Fetal Med, Cedars-SinaiDepartment of Maternal/Fetal Med, Cedars-Sinai
Curt SandmanCurt Sandman
Department of Psychiatry, UC-IrvineDepartment of Psychiatry, UC-Irvine
AcknowledgementsAcknowledgements