Background Stress is associated with adverse birth and postpartum health outcomes. Few studies have longitudinally explored racial differences in maternal stress in a birthing population in the United States during the ongoing COVID-19 pandemic. Objective This study aimed to do the following: (1) assess changes in reported stress before, during, and after initial emergency declarations (eg, stay-at-home orders) were in place due to the COVID-19 pandemic, and (2) assess Black-White differences in reported stress in a pregnant and postpartum population from Southwestern Pennsylvania. Methods We leveraged data from the ongoing Postpartum Mothers Mobile Study (PMOMS), which surveys participants in real time throughout the pregnancy and postpartum periods via ecological momentary assessment (EMA) and smartphone technology. We analyzed data from a subset of PMOMS participants (n=85) who were either Black or White, and who submitted EMA responses regarding stress between November 1, 2019, and August 31, 2020, the time frame of this study. We divided data into four phases based on significant events during the COVID-19 pandemic: “pre” phase (baseline), “early” phase (first case of COVID-19 reported in United States), “during” phase (stay-at-home orders), and “post” phase (stay-at-home orders eased). We assessed mean stress levels at each phase using linear mixed-effects models and post hoc contrasts based on the models. Results Overall mean stress (0=not at all to 4=a lot) during the pre phase was 0.8 for Black and White participants (range for Black participants: 0-3.9; range for White participants: 0-2.8). There was an increase of 0.3 points (t5649=5.2, P<.001) in the during phase as compared with the pre phase, and an increase of 0.2 points (t5649=3.1, P=.002) in the post phase compared with the pre phase (n=85). No difference was found between Black and White participants in the change in mean stress from the pre phase to the during phase (overall change predicted for the regression coefficient=–0.02, P=.87). There was a significant difference between Black and White participants in the change in mean stress from the during phase to the post phase (overall change predicted for the regression coefficient=0.4, P<.001). Conclusions There was an overall increase in mean stress levels in this subset of pregnant and postpartum participants during the same time as the emergency declarations/stay-at-home orders in the United States. Compared to baseline, mean stress levels remained elevated when stay-at-home orders eased. We found no significant difference in the mean stress levels by race. Given that stress is associated with adverse birth outcomes and postpartum health, stress induced by the ongoing COVID-19 pandemic may have adverse implications for birthing populations in the United States. International Registered Report Identifier (IRRID) RR2-10.2196/13569

This article summarizes and reviews the cross-discipline literature on violent crime in destination neighborhoods postrelocation in order to build a more comprehensive picture of risk factors for violence, as well as how and why housing policies influence risk of violence. High rates of violent crime continue to be a persistent problem in areas of concentrated poverty and public housing. Modern housing programs such as Moving to Opportunity and Housing Opportunities for People Everywhere are popular interventions for reducing the density of low-income people receiving public housing assistance by relocating residents of distressed housing projects. However, evidence suggests that relocated residents may not experience less violence or improved safety in their new communities.

Introduction In 2018, The Live Well Allegheny: Lifting Wellness for African Americans (LWA2) Initiative was developed to support six priority, Black communities in Allegheny County, Pennsylvania to address health equity in chronic disease. The LWA2 coalition members participated in ongoing anti-racism and racial equity sessions with a nationally recognized anti-racist facilitation team. The sessions included a 2-days experience in January 2020 along with follow up meetings throughout 2020. Methods Surveys were administered to understand their perceptions related to anti-racism and oppression and subsequent actions as a result of the sessions. Additionally, we conducted nine in-depth interviews with organizational partners (January -May 2020) to evaluate the overall effectiveness of the coalition and inform future activities. Results Ten participants completed the post session surveys. Seven out of 10 survey respondents felt they had a good understanding of how oppression (racism, sexism, capitalism) influenced their life and work. However, the majority indicated needing the tools to implement anti-racist strategies in their work. The in-depth interviews with organizational partners revealed that racial equity was of concern to all partners but there was variability in intentionality around racial equity as a core element of each organization’s mission, goals and subsequent actions. Discussion As a result of the interviews, coalition members developed a racial equity statement and theory of change for implementation in the coalition work and within individual organizations along with a plan for implementing an equity audit of the coalition. Coalitions of this kind should be intentional about implementing continuous strategies related to anti-racism for structural changes toward achieving racial equity in their overall work.

BACKGROUND Stress has been associated with adverse birth and postpartum health outcomes. Few studies have explored racial differences in maternal stress in a birthing population longitudinally in the United States (U.S.) during the ongoing COVID-19 pandemic. OBJECTIVE This study aimed to: (1) assess changes in reported stress before, during, and after initial emergency declarations (e.g., stay-at-home orders) were in place due to the COVID-19 pandemic and (2) assess Black-White differences in reported stress in a pregnant and postpartum population from Southwestern Pennsylvania. METHODS We leveraged data from the ongoing Postpartum Mothers Mobile Study (PMOMS) which surveys participants in real-time throughout the pregnancy and postpartum periods via ecological momentary assessment (EMA) and smartphone technology. We analyzed data from a subset of PMOMS participants (n=85) who were either Black or White, and who submitted EMA responses regarding stress between November 1, 2019 and August 31, 2020, the timeframe of this study. Data were divided into four phases based on significant events during the COVID-19 pandemic: a pre-phase (baseline), early-phase (first case of COVID-19 reported in U.S.), during-phase (stay-at-home orders), and post-phase (stay-at-home orders eased). We assessed mean stress levels at each phase using mixed-effects models and post-hoc contrasts based on the models. RESULTS Overall mean stress (min: 0, max: 4 as measured by a modified Cohen Perceived Stress Scale) during the pre-phase was 0.8 for Black and White participants [range for Black participants: 0-3.9, range for White participants: 0-2.8]. There was an increase of 0.26 points (t=5.19, d.f.=5649, p<.0001) in the during-phase as compared with the pre-phase, and an increase of 0.19 points (t=3.09, d.f.=5649, p=0.002) in the post-phase compared with the pre-phase (n=85). No difference was found between Black and White participants in the change in mean stress from the pre-phase to the during-phase (δ ̂= -0.016, p=0.867). There was a significant difference between Black and White participants in the change in mean stress from the during-phase to the post-phase (δ ̂ = -0.39, p<0.0001). CONCLUSIONS There was an overall increase in mean stress levels in this subset of pregnant and postpartum participants during the same time as the emergency declarations/stay-at-home orders in the US. Compared to baseline, mean stress levels remained elevated when stay-at-home orders eased. We found no significant difference in the mean stress levels by race. Given that stress is associated with adverse birth outcomes and postpartum health, stress induced by the ongoing COVID-19 pandemic may have adverse implications for birthing populations in the U.S. INTERNATIONAL REGISTERED REPORT RR2-10.2196/13569

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