Addressing racial disparities in perinatal care for African American/Black individuals in the Chicago community health setting: a qualitative study.

BACKGROUND: There are persistent disparities in maternal and infant perinatal outcomes experienced by Black birthing persons compared with non-Hispanic white (NHW) individuals in the US. The differences in outcomes arise from not only socioeconomic factors and individual health behaviors but also structural racism. Recent research is beginning to elucidate the benefits of patient navigation to support underserved minoritized individuals who experience this constellation of barriers to equitable care. Qualitative research that utilizes both the experiences of Black birthing individuals and the expert opinion of healthcare providers working with them can serve to guide a patient navigation intervention to further decrease disparities in perinatal outcomes. METHODS: We conducted 30 interviews between August and December 2020 with Black birthing individuals in the Chicago metropolitan area and healthcare providers who care for this population both in Chicago and across the nation to explore their experiences, perceptions of barriers to care and ways to decrease inequities. RESULTS: Clinical care team members acknowledged the presence of health disparities experienced by Black pregnant individuals compared with their NHW counterparts stemming from racism, discrimination, and lack of resources. Patients similarly reported personal experiences with these disparities and barriers to care. The successful methods used by clinical care teams to help decrease these differences in the past included patient education on important topics such as breastfeeding and the use of patient advocates. Effectively screening for social determinants of health by someone the patient trusts was also cited as important. Regarding perinatal care practices, clinical care team members described the importance of patient education needs and care team cultural competency. Patients' reported positive and negative experiences corroborated these findings, emphasizing the importance of trust, listening, education, access to care, support, and patient advocacy. Finally, the care team members and patients agreed that active trust-building can help the provider/patient relationship and ultimately improve outcomes. CONCLUSIONS: These qualitative research findings improve the understanding of barriers to care and will help guide development of an intervention to reduce the health disparities experienced by Black pregnant persons.

Growth CO2 concentration modifies the transpiration response of Populus deltoides to drought and vapor pressure deficit.

Cottonwood (Populus deltoides Bartr. ex Marsh.) trees grown for 9 months in elevated carbon dioxide concentration ([CO2]) showed significant increases in height, leaf area and basal diameter relative to trees in a near-ambient [CO2] control treatment. Sample trees in the CO2 treatments were subjected to high and low atmospheric vapor pressure deficits (VPD) over a 5-week period at both high and low soil water contents (SWC). During these periods, transpiration rates at both the leaf and canopy levels were calculated based on sap flow measurements and leaf-to-sapwood area ratios. Leaf-level transpiration rates were approximately equivalent across [CO2] treatments when soil water was not limiting. In contrast, during drought stress, canopy-level transpiration rates were approximately equivalent across [CO2] treatments, indicating that leaf-level fluxes during drought stress were reduced in elevated [CO2] by a factor equal to the leaf area ratio of the two canopies. The shift from equivalent leaf-level transpiration to equivalent canopy-level transpiration with increasing drought stress suggests maximum water use rates were controlled primarily by atmospheric demand at high SWC and by soil water availability at low SWC. Changes in VPD had less effect on transpiration than changes in SWC for trees in both CO2 treatments. Transpiration rates of trees in both CO2 treatments reached maximum values at a VPD of about 2.0 kPa at high SWC, but leveled off and decreased slightly in both canopies as VPD increased above this value. At low SWC, increasing VPD from approximately 1.4 to 2.5 kPa caused transpiration rates to decline slightly in the canopies of trees in both treatments, with significant (P = 0.004) decreases occurring in trees in the near-ambient [CO2] treatment. The transpiration responses at high VPD in the presence of high SWC and throughout the low SWC treatment suggest some hydraulic limitations to water use occurred. Comparisons of midday leaf water potentials of trees in both CO2 treatments support this conclusion.