Perspectives from community-based doulas and mothers: Neighborhood context and pregnancy

Objectives: Limited research explores the potential pathways by which neighborhoods influence pregnancy or how community members conceptualize and interpret how neighborhood contexts and living environments influence pregnancy and birth. Study Design: We applied participatory Concept Mapping and a series of focused discussions with community-based doulas and mothers. Methods: We collaborated with a community-based doula program to investigate how mothers and community doulas perceived the neighborhood to influence reproductive health. We conducted a series of focused discussions including ‘Brainstorming’ to uncover key themes related to how neighborhood context influenced pregnancy, ‘Sorting and Rating’ of key themes in association with pregnancy and birth outcomes, and further discussion to uncover potential relationships. Data from the ‘Sorting and Rating’ activities were entered into Concept Systems software to generate concept maps of the themes and ideas discussed. Results: The women identified 79 key themes/items related to the neighborhood context that they thought were important for pregnancy and birth. Participants ranked most of the neighborhood factors as moderate or high in importance in influencing pregnancy health and birth. These 79 items were further aggregated to develop 9 clusters related to various themes such as ‘Access/Potential Barriers to Adequate Care,’ ‘The Environment and Infrastructure,’ ‘Neighborhood History, Demographics and Dynamics,’ ‘Community, Relationships, and Autonomy.’ The group further discussed how neighborhood contexts have a particularly influence on individual behaviors such as physical activity; and how key infrastructure issues such as transportation may impede or facilitate access to resources important for health. Conclusion: This study provides additional insight into how neighborhoods may influence pregnancy and birth and how multiple neighborhood factors may act synergistically to influence health. Concept mapping and community perspectives reinforce the importance of participant and community input in developing future research and interventions

The effects of institutional racism, perceived discrimination and maternal stress on preterm birth

There are tremendous racial/ethnic disparities in preterm birth that have not been ameliorated. Individual health risks do not explain these disparities, and there is limited research exploring the social and contextual factors contributing to these disparities. This research explores institutional racism as a fundamental cause of the racial/ethnic disparities in preterm birth. The Home Mortgage Disclosure Act (HMDA) database was used to create a measure for residential redlining and the 2000 US Census was used to create measures for residential redlining and percentage black. The Stress Pregnancy Evaluation Community Project (SPEAC), a cohort of pregnant women (N=3949), had linked vital birth records and geocoded addresses, which were linked to measures of redlining, segregation and percent black on the census tract level. Multilevel logistic and linear regression models were used to examine the relationship between institutional racism and preterm birth (and change in gestational age) using SAS 9.2. The first dissertation paper examined the distribution of residential redlining in the neighborhoods where the SPEAC cohort lived. We also examined the racial/ethnic differences in residences in redlined neighborhoods. We found that the majority of the SPEAC population lived in redlined neighborhoods and that non-Hispanic black women were more likely to live in redlined neighborhoods. The second dissertation paper examined the relationship between residential redlining and perceptions of discrimination, stress and neighborhood quality. We also examined racial/ethnic differences in these same perception measures. Black non-Hispanic women had a greater mean residential redlining index, greater perceived everyday discrimination score, and more adverse ratings of neighborhood quality compared to women of all other racial/ethnic groups. Residential redlining was positively associated with perceived poor neighborhood quality but was not associated with perceived discrimination or stress for the overall SPEAC population. However, residential redlining was associated with perceived discrimination among non-Hispanic white women only. Residential redlining was moderately associated with percent black on the census tract level and residential segregation. The final dissertation paper examined the relationship between residential redlining and the risk of preterm birth (and change in gestational age). We also examined racial/ethnic differences in preterm birth and whether residential redlining contributed to the black-white disparity in preterm birth. Residential redlining and perceptions of stress, discrimination and neighborhood quality were not significantly associated with preterm birth. Additionally, residential redlining did not contribute to the black-white disparity in preterm birth

An Examination of the Perceived Importance and Skills Related to Policies and Policy Making Among State Public Health Injury Prevention Staff

The purpose of this research is to use the Public Health Workforce Interests and Needs Survey to assess in greater detail state injury prevention staff perceptions of policy development and related skills and their awareness and perception of “Health in All Policies” (HiAP)

A Black Women’s Health Agenda: Applying an Intersectional Systems Approach and Reproductive Justice Lens

The Reproductive Justice (RJ) framework states that it is a “human right to maintain personal bodily autonomy, have children, not have children, and parent children in safe and sustainable communities.” RJ is critical in addressing the glaring racial, ethnic, social and economic inequities that exist in Allegheny County and surrounding areas. Black women and femmes carry the disproportionate burden of health inequities in Allegheny County, but their lives and experiences are not centered in the development and execution of solutions. Black women/femmes throughout the county lead critical work to address a multitude of inequities, often with limited support and resources. Concurrently, they deal with multiple systems of oppression designed to devalue and derail their work. This Pitt Teaming Grant proposal is designed to: A) Uplift the ongoing work led by Black women and femmes; B) Interrogate systems that exacerbate inequities in health C) Develop plans for dismantling systems of oppression specifically in Allegheny County that have a disproportionate impact on the health and well-being of Black women/femmes. The specific aims of this proposal are: Aim 1. Investigate if and how systems (health and social) may or may not address the health and well-being of Black women and femmes in Allegheny County and surrounding areas. This will include an environmental scan of existing programs, policies and local funding resulting in Black Paper and compendium of equity assessment tools and frameworks for further use by the team and others in the larger community. Aim 2. Develop a strategic plan and health agenda focused on centering the health and well-being of Black women and femmes in Allegheny County that includes actions related to research, practice and policy. The Black Women’s Health Agenda for Allegheny County will be developed through continuous community engagement and facilitation from Black-women led experts in strategic development

Perspectives on flu vaccination advertisement messaging in the era of COVID-19: Thematic analysis centering adult Black voices

Influenza (flu) is an infectious, respiratory disease that causes substantial burden and mortality, and Non-Hispanic Black people experience profound disparities in flu disease burden in the United States. One contributor to flu disease disparities is lower flu vaccination rates among Black populations. This qualitative study was conducted during the COVID-19 pandemic and used the Public Health Critical Race Praxis framework to center and elicit Black adults’ perspectives of desired flu vaccine messaging. This work builds upon efforts to increase access to flu vaccinations and recommendations are provided to aid in tailoring flu vaccine messaging via a health equity lens. Recommendations for flu messaging include: 1) increased transparency in calling out racial disparities in flu disease burden through the use of local statistics, 2) being upfront with provision of flu vaccine information in easy-to-understand language when addressing concerns, and 3) providing desired education around what the vaccine is doing to one’s body, what the ingredients are, potential side effects and normalizing side effects, and the duration of protection elicited by vaccination. Recommendations also highlight the importance of incorporating the family/community/social context in flu vaccination messaging and for targeted messaging to address the most vulnerable while also providing reasons why persons who may consider themselves to not be vulnerable to the flu (i.e., healthy, no risk factors) should be vaccinated (e.g., get vaccinated in order to reduce exposure risk to your grandmother)

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Experiences of Community Doulas Working with Low-Income, African American Mothers

Purpose: The aim of this study was to learn from doulas the components of their services that might best serve low-income, African American (AA) women and to show the significance of doulas in helping these women have healthy, positive, birth experiences. Methods: Ten doulas were recruited from a local community doula program and through word-of-mouth referrals from participants and completed in-depth interviews. Interviews were transcribed verbatim and analyzed using Atlas.ti software to identify emerging themes. Thematic saturation was achieved in interviews. Results: Several themes emerged from the interviews including: (1) The influence of similarities of race, culture, and lived experience on doula care; (2) How doulas often provide birthing persons with support and resources beyond birth; and (3) How doulas recognize the institutional biases that exist in the health care system and try to mediate their effect on birthing persons. Conclusions: These themes highlight how doulas can support birthing persons to mitigate the negative effects of social determinants of health, specifically racism and classism, and highlight potential avenues for doulas to consider when working with birthing persons who have low income and are AA

Institutional Racism and Pregnancy Health: Using Home Mortgage Disclosure Act Data to Develop an Index for Mortgage Discrimination at the Community Level

The evidence of institutional racism may contribute to our understanding of health disparities. Residential redlining and mortgage discrimination against communities may be a major factor influencing neighborhood structure, composition, development, and wealth attainment. This residential redlining index as a measure for institutional racism can be applied in health research to understand the unique social and neighborhood contexts that contribute to health inequities

Racial Differences in the Biochemical Effects of Stress in Pregnancy

Prenatal stress has been linked to preterm birth via inflammatory dysregulation. We conducted a cross-sectional study on female participants who delivered live, singleton infants at University of Pittsburgh Medical Center Magee Women’s Hospital. Participants (n = 200) were stratified by cumulative risk scores using a combination of individual factors (maternal education, diabetes, hypertension, smoking, relationship status, obesity, depression) and neighborhood deprivation scores. We hypothesized that inflammatory cytokines levels differ by risk group and race. Multiplex analyses of IL-6, IL-8, IL-10, IL-13 and TNF-alpha were run. We found that Black birthing people had more risk factors for chronic stress and had lower levels of IL-6 compared to White birthing people. When stratified by risk group and race, low-risk Black birthing people had lower levels of IL-6 compared to low-risk White birthing people, and high-risk Black birthing people had lower levels of IL-8 compared to high-risk White birthing people. Higher area deprivation scores were associated with lower IL-6 levels. Our results suggest that the relationship between chronic stress and inflammatory cytokines is modified by race. We theorize that Black birthing people encounter repetitive stress due to racism and social disadvantage which may result in stress pathway desensitization and a blunted cytokine response to future stressors

A methodology for combining multiple commercial data sources to improve measurement of the food and alcohol environment: applications of geographical information systems

Commercial data sources have been increasingly used to measure and locate community resources. We describe a methodology for combining and comparing the differences in commercial data of the food and alcohol environment. We used commercial data from two commercial databases (InfoUSA and Dun&Bradstreet) for 2003 and 2009 to obtain infor- mation on food and alcohol establishments and developed a matching process using computer algorithms and manual review by applying ArcGIS to geocode addresses, standard industrial classification and North American industry classification tax- onomy for type of establishment and establishment name. We constructed population and area-based density measures (e.g. grocery stores) and assessed differences across data sources and used ArcGIS to map the densities. The matching process resulted in 8,705 and 7,078 unique establishments for 2003 and 2009, respectively. There were more establishments cap- tured in the combined dataset than relying on one data source alone, and the additional establishments captured ranged from 1,255 to 2,752 in 2009. The correlations for the density measures between the two data sources was highest for alcohol out- lets (r = 0.75 and 0.79 for per capita and area, respectively) and lowest for grocery stores/supermarkets (r = 0.32 for both). This process for applying geographical information systems to combine multiple commercial data sources and develop meas- ures of the food and alcohol environment captured more establishments than relying on one data source alone. This replic- able methodology was found to be useful for understanding the food and alcohol environment when local or public data are limited