Shedding Light on the Mechanisms Underlying Health Disparities Through Community Participatory Methods

Abstract

Health disparities are large and persistent gaps in the rates of disease and death between racial/ethnic and socioeconomic status subgroups in the population. Stress is a major pathway hypothesized to explain such disparities. The Eunice Kennedy Shriver National Institute of Child Health and Human Development formed a community/research collaborative—the Community Child Health Network—to investigate disparities in maternal and child health in five high-risk communities. Using community participation methods, we enrolled a large cohort of African American/Black, Latino/Hispanic, and non-Hispanic/White mothers and fathers of newborns at the time of birth and followed them over 2 years. A majority had household incomes near or below the federal poverty level. Home interviews yielded detailed information regarding multiple types of stress such as major life events and many forms of chronic stress including racism. Several forms of stress varied markedly by racial/ethnic group and income, with decreasing stress as income increased among Caucasians but not among African Americans; other forms of stress varied by race/ethnicity or poverty alone. We conclude that greater sophistication in studying the many forms of stress and community partnership is necessary to uncover the mechanisms underlying health disparities in poor and ethnic-minority families and to implement community health interventions.

Spiritual and Religious Resources in African American Women

“…This disparity parallels that of health outcomes generally (Dunkel Schetter et al, 2013), although some studies report no ethnic differences in postpartum depression or attribute them to socioeconomic disparities (e.g., Rich-Edwards et al, 2006; Wei, Greaver, Marson, Herndon, & Rogers, 2008). Interpretation of these findings is further complicated by existing evidence that African Americans overall experience lower—not higher—rates of depression than Whites (e.g., Gibbs et al, 2013), and by indications that endorsement of depressive symptoms may vary by race and culture (Breslau, Javaras, Blacker, Murphy, & Normand, 2008).…”

“…The current study was part of the Community Child Health Network (CCHN), a community-based participatory research effort with collaborating sites in Los Angeles, Chicago, Washington, D.C., Baltimore, and eastern North Carolina (Dunkel Schetter et al, 2013). Mothers were screened for the following inclusion criteria: 18-40 years of age; ability to complete interviews in either English or Spanish; residence in one of the identified communities for at least 6 months; having 4 or fewer children including the new infant; absence of plans to be surgically sterilized following birth.…”

Prenatal Maternal Stress and the Risk of Lifetime Wheeze in Young Offspring: An Examination by Stressor and Maternal Ethnicity

“…In the analysis, levels of maternal perceived stress, maternal negative life events and pregnancy stress differed by race/ethnicity within income categories (24) suggesting that racial/ethnic differences in stress burden persist independent of income. While our sample sizes within strata were small, we also found evidence for differences in risk of wheeze to the offspring of White and Latina mothers, with greater risk of wheeze incurred in the offspring of Latinas from pregnancy anxiety, 2+ negative life events, and low paternal support.…”

Thinking Across Generations: Unique Contributions of Maternal Early Life and Prenatal Stress to Infant Physiology

“…Consistent with a cumulative risk perspective, whereby multiple risk factors in concert typically explain more variance than individual factors, 42 we created a prenatal stress index consisting of 5 indicators: pregnancy-related anxiety, measured by the 10-item Pregnancy Related Anxiety Scale, 43 assessing mothers’ worry about health, labor, delivery, and infant care; chronic strain, measured with the Chronic Strain Questionnaire, 44 on which mothers rated frequency of 10 types of chronic stressors (e.g., having trouble paying bills); stressful prenatal life events, assessed with the Prenatal Life Events Scale–Revised, 45 assessing the presence or absence of 18 stressful life events during the prenatal period (e.g., experiencing a loss); perceived stress, measured by the 4-item version of the Perceived Stress Scale, 46 probing mothers’ appraisal of their lives as stressful; and prenatal depression, assessed by the 10-item Edinburgh Depression Scale, 47 shown to effectively detect prenatal depression. 48 …”