Early-life neighborhood context, perceived stress, and preterm birth in African American Women.

Stressors from multiple sources, across the life-course, may have independent and joint associations with preterm birth (PTB) risk in African American women. Using data from the Life-course Influences on Fetal Environments Study (LIFE; 2009-2011) of post-partum African American women from Metropolitan Detroit, Michigan (n=1365), we examined the association between perceived stress and PTB, and effect modification by perceptions of early-life neighborhood social control and disorder. We defined PTB as birth before 37 completed weeks of gestation. We used Cohen's Perceived Stress scale, and valid and reliable scales of early-life (age 10) neighborhood social control and social disorder to quantify exposures. We estimated prevalence ratios (PR) and 95% confidence intervals (CI) with log binomial regression models- with separate interaction terms for perceived stress and each early-life neighborhood scale. We considered p < 0.10 significant for interaction terms. PTB occurred in 16.4% (n=224) of the study participants. In the total sample, perceived stress was not associated with PTB rates. However, there was suggestive evidence of a joint association between perceived stress and early-life neighborhood social disorder (p for interaction = 0.06), such that among women who reported high early-life neighborhood social disorder (n=660), perceived stress was positively associated with PTB (adjusted PR: 1.31; 95% CI: 1.05, 1.63). There was no association between perceived stress and PTB for women in the low early-life neighborhood social disorder strata (n=651) (adjusted PR: 0.95, 95% CI: 0.75, 1.21). There was no evidence that early-life neighborhood social control modified the association between perceived stress and PTB. Our results suggest that early-life neighborhood stressors may magnify the association between current perceived stress and PTB rates, in African American women. More research to confirm and explicate the biologic and/or psychosocial mechanisms of the reported association is warranted.

Rural-Urban Residence and Stage at Breast Cancer Diagnosis Among Postmenopausal Women: The Women's Health Initiative.

BACKGROUND: Although social exposures have complex and dynamic relationships and interactions, the existing literature on the impact of rural-urban residence on stage at breast cancer diagnosis does not examine heterogeneity of effect. We examined the joint effect of social support, social relationship strain, and rural-urban residence on stage at breast cancer diagnosis. METHODS: Using data from the Women's Health Initiative (WHI) (n = 161,808), we describe the distribution of social, behavioral, and clinical factors by rural-urban residence among postmenopausal women with incident breast cancer (n = 7,120). We used rural-urban commuting area (RUCA) codes to categorize baseline residential addresses as urban, large rural city/town, or small rural town, and the surveillance, epidemiology, and end results staging system to categorize breast cancer stage at diagnosis (dichotomized as early or late). We then used univariable and multivariable logistic regression to estimate odds ratios (ORs) and associated 95% confidence intervals (95% CI) for the relationship between rural-urban residence and stage at breast cancer diagnosis. We included separate interaction terms between rural-urban residence and social strain and social support to test for statistical interaction. RESULTS: Of the social, behavioral, and clinical factors we examined, only younger age at WHI enrollment screening was significantly associated with late stage at breast cancer diagnosis (p = 0.003). Contrary to our hypothesis, rural-urban residence was not significantly associated with stage at breast cancer diagnosis among postmenopausal women ([adjusted OR, 95% CI] for urban compared with small town: 1.08 [0.76-1.53]; large town compared with small town: 1.16 [0.74-1.84]; and urban compared with large town: 0.93 [0.68-1.26]).The associations did not vary by social support or social strain (p for interaction between RUCA and social strain and social support, respectively: 0.99 and 0.17). CONCLUSIONS: Future studies should examine other potential effect modifiers to identify novel factors predictive or protective for late stage at breast cancer diagnosis associated with rural-urban residence.

Associations of racial discrimination and parental discrimination coping messages with African American adolescent racial identity.

Research links racial identity to important developmental outcomes among African American adolescents, but less is known about the contextual experiences that shape youths' racial identity. In a sample of 491 African American adolescents (48% female), associations of youth-reported experiences of racial discrimination and parental messages about preparation for racial bias with adolescents' later racial identity were examined. Cluster analysis resulted in four profiles of adolescents varying in reported frequency of racial discrimination from teachers and peers at school and frequency of parental racial discrimination coping messages during adolescents' 8th grade year. Boys were disproportionately over-represented in the cluster of youth experiencing more frequent discrimination but receiving fewer parental discrimination coping messages, relative to the overall sample. Also examined were clusters of adolescents' 11th grade racial identity attitudes about the importance of race (centrality), personal group affect (private regard), and perceptions of societal beliefs about African Americans (public regard). Girls and boys did not differ in their representation in racial identity clusters, but 8th grade discrimination/parent messages clusters were associated with 11th grade racial identity cluster membership, and these associations varied across gender groups. Boys experiencing more frequent discrimination but fewer parental coping messages were over-represented in the racial identity cluster characterized by low centrality, low private regard, and average public regard. The findings suggest that adolescents who experience racial discrimination but receive fewer parental supports for negotiating and coping with discrimination may be at heightened risk for internalizing stigmatizing experiences. Also, the findings suggest the need to consider the context of gender in adolescents' racial discrimination and parental racial socialization.