|Institution:||University of Michigan|
|Department:||Health Behavior and Health Education|
|Keywords:||Racism and birth outcomes; Black Caribbean immigrants; Health disparities; Immigrant health; African Americans; Immigrant health paradox; Public Health; Health Sciences|
|Full text PDF:||http://hdl.handle.net/2027.42/111549|
Background: This dissertation explored racism and birth outcomes in U.S.- and foreign-born Black women and examined the degree to which commonly-measured risk factors could explain why Black Caribbean immigrants have lower rates of preterm birth than African Americans. It included: a review of how race- and nativity-based disparities have been conceptualized in perinatal health research; an examination of preterm birth predictors among Caribbean- and U.S.-born Black women; and an assessment of preterm birth risk by maternal age and immigrants??? duration of U.S. residence. Methods: Systematic literature review coupled with logistic regression analyses utilizing birth records from New York City (2000-2010) and the U.S. Virgin Islands (2000-2004). Results: The review produced no generalizable evidence for suggested causes of racial or Black ethnic disparities in birth outcomes. However, there is modest support that racism is associated with adverse birth outcomes, and the perinatal health advantage for Black immigrants is ascribed to selective migration and culturally-linked factors, although the evidence is sparse. In this study, Caribbean-born immigrants in New York City sustained lower odds of preterm birth relative to U.S.-born Blacks (OR = 0.85, 95% CI: 0.76, 0.94) and Caribbean-born residents in the Virgin Islands (OR = 0.54, 95% CI: 0.34, 0.89) despite adjustment for demographic, behavioral, and medical risk factors. Age and education were most influential in explaining the preterm birth advantage for Black Caribbean immigrants, and there was modest support for selective migration. However, the risks of preterm birth with advancing maternal age were similar between Caribbean-born immigrants (OR = 1.13, 95% CI: 1.10, 1.15) and U.S.-born mothers (OR = 1.15, 95% CI: 1.13, 1.17) in New York City. Further, the odds of preterm birth among Caribbean immigrants increased 7% for every 5 years of U.S. residence (OR = 1.07, 95% CI: 1.04, 1.11). Conclusions: The ???healthy migrant??? effect for Black Caribbean immigrants is conditional on national origin and length of time in the U.S. The worsening of immigrant mothers??? preterm birth risks with increased duration of U.S. residence warrants additional research into contextual factors, including racism, to yield greater insight into perinatal health disparities among native and foreign-born Black women.