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Disproportionate Premature Birth in ...

Goldstein, Nicolas P. N.

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Disproportionate Premature Birth in Women of Low Socioeconomic Status: A Psychological and Physiological Stress Explanation of Financial Risk Removal.

Record Type:	Electronic resources : Monograph/item
Title/Author:	Disproportionate Premature Birth in Women of Low Socioeconomic Status: A Psychological and Physiological Stress Explanation of Financial Risk Removal./
Author:	Goldstein, Nicolas P. N.
Published:	Ann Arbor : ProQuest Dissertations & Theses, : 2018,
Description:	402 p.
Notes:	Source: Dissertation Abstracts International, Volume: 80-02(E), Section: B.
Contained By:	Dissertation Abstracts International80-02B(E).
Subject:	Public health. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=10824350
ISBN:	9780438380691

Disproportionate Premature Birth in Women of Low Socioeconomic Status: A Psychological and Physiological Stress Explanation of Financial Risk Removal.
Goldstein, Nicolas P. N.

Disproportionate Premature Birth in Women of Low Socioeconomic Status: A Psychological and Physiological Stress Explanation of Financial Risk Removal. - Ann Arbor : ProQuest Dissertations & Theses, 2018 - 402 p.

Source: Dissertation Abstracts International, Volume: 80-02(E), Section: B.

Thesis (Ph.D.)--University of Rochester, 2018.

Objectives: Mothers of low socioeconomic status (SES) and of non-Hispanic black race deliver prematurely more often. The goal of my dissertation was to improve understanding of the mechanism of disproportionate premature birth in low SES women. I tested a psychological and physiological stress explanation of prematurity risk, estimated the effect of the Affordable Care Act (ACA) Medicaid expansion on gestational age (GA), and estimated how the ACA Medicaid expansion effect was influenced by race. Data and Methods: I developed a conceptual framework of how psychological and physiological stress increase premature birth risk utilizing Appraisal and pathophysiology theory. I generated hypotheses about how financial risk removal would impact GA and tested them utilizing variation in expansions in Medicaid eligibility for pregnant women in three matched state pairs and distribution of the Earned Income Tax Credit (EITC). I utilized data from the Pregnancy Risk Assessment Monitoring System and performed multivariate ordinal regressions. I also used national birth record data and exploited state variation in ACA Medicaid expansion status to estimate the impact on GA in non-Hispanic black and all other mothers using multivariate linear regressions and linear probability models.

ISBN: 9780438380691Subjects--Topical Terms:

534748
Public health.

Disproportionate Premature Birth in Women of Low Socioeconomic Status: A Psychological and Physiological Stress Explanation of Financial Risk Removal.
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245 1 0 $a Disproportionate Premature Birth in Women of Low Socioeconomic Status: A Psychological and Physiological Stress Explanation of Financial Risk Removal.
260 1 $a Ann Arbor : $b ProQuest Dissertations & Theses, $c 2018
300 $a 402 p.
500 $a Source: Dissertation Abstracts International, Volume: 80-02(E), Section: B.
500 $a Adviser: Peter J. Veazie.
502 $a Thesis (Ph.D.)--University of Rochester, 2018.
520 $a Objectives: Mothers of low socioeconomic status (SES) and of non-Hispanic black race deliver prematurely more often. The goal of my dissertation was to improve understanding of the mechanism of disproportionate premature birth in low SES women. I tested a psychological and physiological stress explanation of prematurity risk, estimated the effect of the Affordable Care Act (ACA) Medicaid expansion on gestational age (GA), and estimated how the ACA Medicaid expansion effect was influenced by race. Data and Methods: I developed a conceptual framework of how psychological and physiological stress increase premature birth risk utilizing Appraisal and pathophysiology theory. I generated hypotheses about how financial risk removal would impact GA and tested them utilizing variation in expansions in Medicaid eligibility for pregnant women in three matched state pairs and distribution of the Earned Income Tax Credit (EITC). I utilized data from the Pregnancy Risk Assessment Monitoring System and performed multivariate ordinal regressions. I also used national birth record data and exploited state variation in ACA Medicaid expansion status to estimate the impact on GA in non-Hispanic black and all other mothers using multivariate linear regressions and linear probability models.
520 $a Results: Hypothesis testing based on two of the three Medicaid expansion for pregnant women state pairs and the EITC analyses resulted in significant evidence (one-sided p-values < 0.05) for a direct pathway between psychological stress concerning financial risk, physiological stress, and GA. The ACA Medicaid expansion was associated with an increase in GA for non-Hispanic black mothers (+34 hours), a decrease for all other mothers (--6 hours), and a 3% decrease (95% CI = --5% to --2%) in the incidence of early term or shorter gestation births for non-Hispanic black mothers.
520 $a Conclusions: Decreasing financial risk for low SES women with Medicaid or the EITC is associated with increased GA. The higher premature birth risk in this population is likely the result of a direct pathway involving psychological and physiological stress. Other financial risk removal strategies should be investigated. The ACA Medicaid expansion did not meaningfully influence GA on a weekly scale but did moderately decrease overall preterm birth risk in non-Hispanic black mothers.
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