TABLE 3—

Psychosocial Factors and Preterm Births Among African American and White Women: Women With Pregnancies Initiated April 1996–August 2000

	African American Women			White Women
Model	No. Term	No. Preterm	Adjusted RR (95% CI)	No. Term	No. Preterm	Adjusted RR (95% CI)
External stressors: life events, sum of negative counta,b
Low stressc	152	17	1.0	338	36	1.0
Medium-low stress	164	20	1.1 (0.6, 2.0)	273	33	1.3 (0.8, 2.0)
Medium-high stress	116	17	1.3 (0.7, 2.4)	201	26	1.3 (0.8, 2.1)
High stress	188	29	1.3 (0.8, 2.3)	219	39	1.8 (1.2, 2.8)
Enhancers of stress: depressionb,d
Low level of symptomsc	298	41	1.0	669	84	1.0
Medium level of symptoms	137	16	0.9 (0.5, 1.5)	172	23	1.1 (0.7, 1.6)
High level of symptoms	196	29	1.1 (0.7, 1.7)	191	28	1.1 (0.8, 1.7)
Buffers of stress
Social support, sum of scaleb,e
Highc	138	27	1.0	320	49	1.0
Medium-high	166	17	0.6 (0.3, 1.1)	257	36	0.9 (0.6, 1.4)
Medium-low	145	15	0.7 (0.4, 1.2)	277	28	0.7 (0.4, 1.1)
Low	183	28	0.8 (0.5, 1.4)	180	22	0.8 (0.5, 1.3)
Living with a partnerb,f
Yesc	284	37	1.0	874	105	1.0
No	301	42	1.2 (0.8, 1.8)	113	23	1.8 (1.2, 2.7)
Importance of religionb,g
Very importantc	378	52	1.0	455	63	1.0
Fairly important	89	15	1.2 (0.7, 2.1)	296	34	0.9 (0.6, 1.3)
Fairly unimportant	8	2	. . .h	75	12	1.3 (0.7, 2.2)
Not at all important	110	10	0.8 (0.4, 1.5)	165	20	0.9 (0.6, 1.5)
Church attendanceb,i
≥ 49 times/yearc	172	26	1.0	228	32	1.0
13–48 times/year	144	24	1.1 (0.6, 1.8)	158	27	1.2 (0.8, 2.0)
1–12 times/year	120	13	0.7 (0.4, 1.4)	274	32	0.9 (0.6, 1.5)
None	151	16	0.7 (0.4, 1.3)	333	38	0.9 (0.6, 1.5)
Coping style
Distancing from a problemb,j
Lowc	153	15	1.0	411	51	1.0
Medium	224	28	1.3 (0.7, 2.3)	318	42	1.1 (0.7, 1.6)
High	248	42	1.8 (1.0, 3.2)	297	41	1.1 (0.7, 1.6)
Escape–avoidance of a problemb,k
Lowc	131	15	1.0	478	48	1.0
Medium	224	29	1.2 (0.6, 2.1)	306	49	1.5 (1.0, 2.2)
High	270	41	1.4 (0.8, 2.5)	242	37	1.5 (1.0, 2.2)
Response to unfair treatmentb,l
Talk about it, act on itc	226	35	1.0	512	57	1.0
Talk about it, accept it	72	12	1.0 (0.6, 1.9)	109	14	1.0 (0.5, 1.7)
Don’t talk about it, act on it	30	7	1.2 (0.5, 2.6)	27	7	1.9 (0.9, 3.7)
Don’t talk about it, accept it	47	3	. . .h	41	8	1.6 (0.8, 3.1)
Discrimination
Perceived racial discriminationb,m
Nonec	310	33	1.0	880	119	1.0
Some	133	15	1.1 (0.6, 2.1)	98	10	0.8 (0.4, 1.4)
High	181	35	1.8 (1.1, 2.9)	51	4	. . .h
Perceived gender discriminationb,m
Nonec	396	48	1.0	661	93	1.0
Some	139	16	1.0 (0.5, 1.7)	231	26	0.8 (0.5, 1.2)
High	92	19	1.6 (0.9, 2.6)	139	15	0.8 (0.5, 1.3)
Perceived neighborhood safetyb,n
Safec	154	23	1.0	470	60	1.0
Medium safe	120	16	0.9 (0.5, 1.6)	228	24	0.8 (0.5, 1.3)
Unsafe	176	22	0.9 (0.5, 1.5)	105	20	1.4 (0.9, 2.3)
Perceived stress from life events and pregnancy anxiety
Life events, sum of negative impactb,o
Low stressc	123	12	1.0	284	27	1.0
Medium-low stress	144	20	1.4 (0.7, 2.7)	271	36	1.5 (0.9, 2.5)
Medium-high stress	171	25	1.4 (0.7, 2.8)	281	34	1.5 (0.9, 2.4)
High stress	182	26	1.4 (0.7, 2.7)	195	37	2.2 (1.3, 3.5)
Pregnancy-related anxiety, sum of negative impactb,p
Low anxietyc	273	23	1.0	393	37	1.0
High anxiety	293	55	2.0 (1.3, 3.2)	578	90	1.6 (1.1, 2.3)

Notes. BMI = body mass index; CI = confidence interval; RR = relative risk.

^aAfrican Americans: none; Whites: prenatal care site, BMI. The external stressors scale summed 39 life events from the Life Experiences Survey19 that the woman indicated she had experienced since she got pregnant and considered to have had a negative impact on her life. Cutpoints of 0–2, 3–5, 6–8, and > 8 events were used.

^bConfounder for the model. See other footnote for factors (in italics).

^cReferent.

^dAfrican Americans: none; Whites: none. The Center for Epidemiologic Studies Depression Scale20 was used to assess depression symptoms using a 20-item scale with Likert response categories about feelings and activities the respondent experienced during the past week. A sum was calculated and cutpoints of 0–16, 17–24, > 24 were used.

^eAfrican Americans: BMI; Whites: none. The MOS Social Support Scale21 assessed the participant’s perception of the availability of social support using a five-category Likert response for 19 items. Responses were summed and cutpoints of > 89, 79–88, 65–78, and 19–64 were used.

^fAfrican Americans: maternal age; Whites: parity, BMI.

^gAfrican Americans: maternal education; Whites: BMI.

^hThere were too few cases to calculate a risk ratio.

ⁱAfrican Americans: none; Whites: BMI.

^jAfrican Americans: maternal education; Whites: none. The 66-item Ways of Coping Questionnaire22 uses four-point Likert response categories. Participants were asked to indicate, since they got pregnant, how often they used each coping approach when they “had a problem.” The distancing from a problem subscale included six items to assess cognitive efforts to be detached or minimize the significance of a situation. Quartile cutpoints for the entire cohort were used.

^kAfrican Americans: maternal age, parity; Whites: none. The 66-item Ways of Coping Questionnaire22 uses four-point Likert response categories. Participants were asked to indicate, since they got pregnant, how often they used each coping approach when they “had a problem.” The escape-avoidance subscale used eight items that assess wishful thinking and behaviors to escape or avoid a problem. Quartile cutpoints for the entire cohort were used.

^lAfrican Americans: height, parity, marital status; Whites: parity, BMI. Asked only if respondent also said she felt she had been treated unfairly. Questions developed by Krieger and Sidney23,24 assessed whether individuals felt they had been treated unfairly, and if so, their responses to that treatment.

^mAfrican Americans: height, BMI; Whites: none. Based on discrimination questions developed by Krieger and Sidney23,24 each participant was asked whether she felt she had been discriminated against because of her race or color at school, when trying to get a job, at home, when trying to get medical care for this pregnancy, when she tried to get housing, or in her dealings with the police or in a court. Sums of yes responses were calculated and cutpoints of 0, 1, or > 1 were used. Additionally, each participant was asked whether she felt she had been discriminated against because she was women at school, when trying to get a job, at home, or when trying to get medical care for this pregnancy. Sums of yes responses were calculated and cutpoints of 0, 1, or > 1 were used.

ⁿParticipants were asked about perceived safety of the neighborhood at night, during the day, frequency of property crimes, personal crimes, shootings, police arrests, and drug dealing. These items were used to assess how stressful they perceived their contextual environment to be.

^oAfrican Americans: none; Whites: prenatal care site, BMI. Life events from the Life Experiences Survey19 allowed women to assign any of the 39 events an impact level from −3 to +3. A sum of the negative impacts (−1 to −3) was calculated and used to measure perceived stress from life events. Cutpoints of absolute values were 0–4, 5–8, 9–15, and > 15.

^pSix items from the Prenatal Social Environment Inventory26 were used to assess the participant’s anxiety about the pregnancy and becoming a parent. A sum of the negative impacts (−1 to −3) was calculated and used to measure perceived stress from pregnancy-related anxiety. Cutpoints of absolute values were 0–2 and > 2.