Area racism and birth outcomes among Blacks in the United States

• Type of Material: Article
• Authors: David H. Chae, Auburn University; Sean Clouston, State University of New York at Stony Brook; Connor D. Martz, Auburn University; Mark L. Hatzenbuehler, Columbia University; Hannah Cooper, Emory University; Rodman Turpin, University of Maryland; Seth Stephens-Davidowitz, University of Pennsylvania; Michael R Kramer, Emory University
• Language: English
• Date: 2018-02-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 Elsevier Ltd
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.socscimed.2017.04.019
• Title of Journal or Parent Work: Social Science and Medicine
• ISSN: 0277-9536
• Volume: 199
• Start Page: 49
• End Page: 55
• Grant/Funding Information: MRK was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award Number K01HD074726.; DHC was supported by the National Institute on Aging of the National Institutes of Health under Award Number K01AG041787.
• Keywords: MATERNAL EXPERIENCES; PRETERM BIRTH; NEIGHBORHOOD ENVIRONMENT; HEALTH; Big data; DISCRIMINATION; PHYSICAL-ACTIVITY; MULTILEVEL ANALYSIS; FUNDAMENTAL CAUSE; African Americans; Racism; Science & Technology; Biomedical Social Sciences; Social Sciences, Biomedical; Public, Environmental & Occupational Health; Social Sciences; AFRICAN-AMERICAN WOMEN; Life Sciences & Biomedicine; RESIDENTIAL SEGREGATION; Birth outcomes; USA
• Research Categories: Health Sciences, Public Health; Sociology, Public and Social Welfare

Abstract

There is increasing evidence that racism is a cause of poor health outcomes in the United States, including adverse birth outcomes among Blacks. However, research on the health consequences of racism has faced measurement challenges due to the more subtle nature of contemporary racism, which is not necessarily amenable to assessment through traditionally used survey methods. In this study, we circumvent some of these limitations by examining a previously developed Internet query-based proxy of area racism (Stephens-Davidowitz, 2014) in relation to preterm birth and low birthweight among Blacks. Area racism was measured in 196 designated market areas as the proportion of total Google searches conducted between 2004 and 2007 containing the “n-word.” This measure was linked to county-level birth data among Blacks between 2005 and 2008, which were compiled by the National Center for Health Statistics; preterm birth and low birthweight were defined as <37 weeks gestation and <2500 g, respectively. After adjustment for maternal age, Census region, and county-level measures of urbanicity, percent of the Black population, education, and poverty, we found that each standard deviation increase in area racism was associated with relative increases of 5% in the prevalence of preterm birth and 5% in the prevalence of low birthweight among Blacks. Our study provides evidence for the utility of an Internet query-based measure as a proxy for racism at the area-level in epidemiologic studies, and is also suggestive of the role of racism in contributing to poor birth outcomes among Blacks.