Background Preterm birth (PTB) accounts for the majority of perinatal morbidity and mortality in developed nations, accounting for 9.9% of all births in the U.S. in 2016. Prior research has primarily focused on disparities between Black and white mothers’ rates of PTB due to racial segregation. However, population health scholarship has been limited on the fastest growing population in the U.S., Asian and Pacific Islanders (API). Racial residential segregation has been well studied, but relatively little research examines the effects of economic segregation on perinatal health. This cross-sectional analysis examines how economic segregation modifies risk for PTB among various API ethnic groups. Methods U.S. natality data were used to identify 134 Metropolitan Statistical Areas (MSA) with >500 API births from 2015 to 2017 (n = 766,711). Economic segregation was calculated for each MSA using 2017 income data using the Rank-Order Information Theory Index (H Index). Generalized Estimating Equations estimated the log-odds of PTB, allowing for modification by ethnicity. Results There is heterogeneity in PTB prevalence by ethnicity and the association of economic segregation is non-linear. The risk for PTB is higher in MSAs with both high and low H Index for Chinese, Filipino, Japanese, Korean, Vietnamese, and Other Pacific Islander mothers. The risk for PTB follows highest in MSAs with mid-range values of standardized H Index for Indian, Hawaiian, Guamanian, and Samoan mothers. Filipino, Hawaiian, Guamanian, and Other Pacific Islander mothers had the highest predicted risk for PTB at mean levels of economic segregation while Chinese mothers had the lowest. Conclusion These findings are examined through the lens of immigration histories related to European colonialism, U.S. imperialism, and globalization. Importantly, the results suggest that current practices of aggregating API health data mask disparities in health and how socially stratifying processes like economic segregation may differ by ethnic group.

Over the last decade, the number of older adults (people over the age of 50) who misuse opioids doubled and continues to increase. People over the age of 50 also represent one of the fastest growing groups entering into and sustaining medication assisted treatment (MAT) (i.e., methadone and buprenorphine) for opioid use disorder (OUD). Despite increasing awareness of this growing at-risk population, significant knowledge gaps regarding their support and care needs persist. To begin to address these gaps, we conducted interviews with 20 treatment staff, focus groups with 18 patients and surveys with 100 patients over the age of 50 at eight diverse Opioid Treatment Programs (OTPs) participating in a 1-year pilot study (Bender, PI) funded by the Georgia Clinical and Translation Science Alliance supported by the National Center Advancing Translational Sciences. Patients in this study do not always disclose their use of MAT to non-OTP providers. When they do, participants reported numerous negative experiences with non-OTP providers, including perceived discrimination, stigma, and misunderstanding by providers about MAT. These negative experiences potentially contribute to an over reliance on OTP providers to manage age-related health conditions (e.g., COPD, hypertension). Providers report minimal training about aging and varied levels of confidence to manage these conditions. We present the experiences of patients and providers with suggestions for improving care coordination. We conclude with recommendations to improve communication among providers working with older adults in recovery from OUD.