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Perceived Discrimination and Depressive Symptoms, Smoking, and Recent Alcohol Use in Pregnancy

Authors

  • Ian M. Bennett MD, PhD,

    1. Ian M. Bennett is Assistant Professor in the Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania; Jennifer F. Culhane is Associate Professor and David A. Webb is Senior Researcher in the Department of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia, Pennsylvania; James C. Coyne is Professor in the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Vijaya Hogan is Clinical Associate Professor in the Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Leny Mathew is Statistician at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Irma T. Elo is Professor in the Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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  • Jennifer F. Culhane PhD, MPH,

    1. Ian M. Bennett is Assistant Professor in the Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania; Jennifer F. Culhane is Associate Professor and David A. Webb is Senior Researcher in the Department of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia, Pennsylvania; James C. Coyne is Professor in the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Vijaya Hogan is Clinical Associate Professor in the Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Leny Mathew is Statistician at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Irma T. Elo is Professor in the Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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  • David A. Webb PhD,

    1. Ian M. Bennett is Assistant Professor in the Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania; Jennifer F. Culhane is Associate Professor and David A. Webb is Senior Researcher in the Department of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia, Pennsylvania; James C. Coyne is Professor in the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Vijaya Hogan is Clinical Associate Professor in the Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Leny Mathew is Statistician at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Irma T. Elo is Professor in the Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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  • James C. Coyne PhD,

    1. Ian M. Bennett is Assistant Professor in the Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania; Jennifer F. Culhane is Associate Professor and David A. Webb is Senior Researcher in the Department of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia, Pennsylvania; James C. Coyne is Professor in the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Vijaya Hogan is Clinical Associate Professor in the Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Leny Mathew is Statistician at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Irma T. Elo is Professor in the Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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  • Vijaya Hogan DrPH,

    1. Ian M. Bennett is Assistant Professor in the Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania; Jennifer F. Culhane is Associate Professor and David A. Webb is Senior Researcher in the Department of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia, Pennsylvania; James C. Coyne is Professor in the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Vijaya Hogan is Clinical Associate Professor in the Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Leny Mathew is Statistician at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Irma T. Elo is Professor in the Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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  • Leny Mathew MA,

    1. Ian M. Bennett is Assistant Professor in the Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania; Jennifer F. Culhane is Associate Professor and David A. Webb is Senior Researcher in the Department of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia, Pennsylvania; James C. Coyne is Professor in the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Vijaya Hogan is Clinical Associate Professor in the Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Leny Mathew is Statistician at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Irma T. Elo is Professor in the Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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  • Irma T. Elo PhD

    1. Ian M. Bennett is Assistant Professor in the Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania; Jennifer F. Culhane is Associate Professor and David A. Webb is Senior Researcher in the Department of Obstetrics and Gynecology, Drexel University School of Medicine, Philadelphia, Pennsylvania; James C. Coyne is Professor in the Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Vijaya Hogan is Clinical Associate Professor in the Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Leny Mathew is Statistician at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and Irma T. Elo is Professor in the Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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  • This work was partly funded by the National Institute of Child Health and Human Development (1ROl D36462-01A I), Bethesda, Maryland, and the Centers for Disease Control and Prevention (TS 312-15/15), Atlanta, Georgia. Dr Bennett is supported by a career development grant from the National Institute of Child Health and Human Development, National Institutes of Health (1K23HD048915-01A2), Bethesda, Maryland, USA.

Address correspondence to Ian M. Bennett, MD, PhD, 2nd Floor Gates Pavilion, 3400 Spruce Street, Philadelphia, PA 19104-4283, USA.

Abstract

Abstract:  Background:  Perceived discrimination is associated with poor mental health and health-compromising behaviors in a range of vulnerable populations, but this link has not been assessed among pregnant women. We aimed to determine whether perceived discrimination was associated with these important targets of maternal health care among low-income pregnant women.

Methods:  Face-to-face interviews were conducted in English or Spanish with 4,454 multiethnic, low-income, inner-city women at their first prenatal visit at public health centers in Philadelphia, Penn, USA, from 1999 to 2004. Perceived chronic everyday discrimination (moderate and high levels) in addition to experiences of major discrimination, depressive symptomatology (CES-D ≥ 23), smoking in pregnancy (current), and recent alcohol use (12 months before pregnancy) were assessed by patients’ self-report.

Results:  Moderate everyday discrimination was reported by 873 (20%) women, high everyday discrimination by 238 (5%) women, and an experience of major discrimination by 789 (18%) women. Everyday discrimination was independently associated with depressive symptomatology (moderate = prevalence ratio [PR] of 1.58, 95% CI: 1.38–1.79; high = PR of 1.82, 95% CI: 1.49–2.21); smoking (moderate = PR of 1.19, 95% CI: 1.05–1.36; high = PR of 1.41, 95% CI: 1.15–1.74); and recent alcohol use (moderate = PR of 1.23, 95% CI: 1.12–1.36). However, major discrimination was not independently associated with these outcomes.

Conclusions:  This study demonstrated that perceived chronic everyday discrimination, but not major discrimination, was associated with depressive symptoms and health-compromising behaviors independent of potential confounders, including race and ethnicity, among pregnant low-income women. (BIRTH 37:2 June 2010)

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