Browsing by Subject "Birth outcomes"

This dissertation consists of three studies exploring the effects of natural disasters in North Carolina on the longer term outcomes of children. The first study looks at the effect of prenatal natural disaster exposure on maternal health behaviors and birth outcomes for twenty cohorts of children born in North Carolina. Combining North Carolina administrative and survey data on births with disaster declarations from the Federal Emergency Management Agency (FEMA) allows me to identify children who were exposed to disasters in each trimester of prenatal development. Using a county fixed effect strategy, I compare these children to other children born in the same county who were not exposed to disasters while in utero. Results indicate that prenatal natural disaster exposure, especially exposure to hurricanes, has a significant effect on some maternal health behaviors, but this study provides only limited support for the theory that natural disaster exposure negatively affects birth outcomes, as measured by birth weight and gestational age.

The second study looks at the impact of exposure to natural disasters during pregnancy on the educational outcomes of North Carolina children at third grade. A broad literature relates negative birth outcomes to poor educational performance, and a number of recent studies examine the effect of prenatal exposure to natural disasters on birth outcomes. This study takes the next step by considering how prenatal exposure affects later outcomes. The children identified in the first study as exposed to disasters prenatally are compared to other children born in the same county who were not exposed to disasters while in utero. Results suggest that children exposed to hurricanes prenatally have lower scores on third grade standardized tests in math and reading. Those exposed to flooding or tornadoes also have somewhat lower math scores. Additionally, results suggest that these negative effects are more concentrated among children in disadvantaged subgroups, especially children born to Black mothers.

The third study addresses the question of whether the disruption caused by a natural disaster has an impact on student academic outcomes in the school year during which the natural disaster occurs. The effects of disasters on school performance are important because natural disasters often constitute a major community disruption with widespread impacts on the lives of children. The educational data in this study comes from administrative records for all school districts in North Carolina. Results suggest that hurricanes have a negative overall impact on reading test scores, with the effect concentrated among middle schools. However, winter storms have a positive effect on both math and reading scores in middle school. This difference in effect and additional analysis of mechanisms suggests that mobility is more important than missed days of schools in mediating negative effects of hurricanes on school performance.

In the United States, geographic and racial-ethnic disparities in adverse birth outcomes have increased over the past decade. High and rising rates of low birth weight, preterm delivery, and infant mortality are concentrated in the South and Midwest and among non-Hispanic Black and other birthing persons of color. These divergent trends are rooted in structural and social systems of inequality, such that cumulative experiences of discrimination and disparate access to resources related to policy contexts and one’s social standing systematically place some birthing persons at greater risk of adverse birth outcomes compared to others. Because these outcomes are associated with both birthing persons’ social positioning and offspring’s later-life socioeconomic status and health, they become mechanisms through which inequality is passed across generations. This dissertation explores the structural and social determinants of intergenerational health inequities by examining how the state policy contexts and discrimination that a mother is exposed to contribute to differences in adverse birth outcomes across US states and two distinct but related status characteristics: race and ethnicity and skin tone. Chapters 2 and 3 use birth cohort-linked birth/infant death restricted-use micro-data from the National Center for Health Statistics. Chapter 2 focuses on a single policy context and evaluates how rates of preterm birth and infant mortality responded to two policies restricting access to reproductive health care in Texas between 2005 and 2017. Using demographic standardization and decomposition techniques, I find that age-education-prenatal care standardized rates of infant mortality increased significantly in the years immediately following restrictions to family planning care (2011), but only for births to non-Hispanic (NH) Black mothers. Standardized preterm birth rates increased slightly and temporarily following 2013 restrictions on abortion providers across all racial-ethnic groups. These salient findings underscore the need to consider the infant health and heterogeneous consequences of rapidly evolving reproductive rights across the US. Chapter 3 takes a multidimensional policy approach to consider, first, how state policies and related characteristics co-occur to form distinct, underlying policy contexts and, second, how those contexts are related to low birth weight and infant mortality. Building on the World Health Organization’s structural determinants of health framework and compiling state-level data from several publicly available sources, results from the latent profile analysis suggest three distinct contexts. Contexts defined by high intervention or high constituent engagement (compared to low intervention) are negatively associated with risks of low birth weight and infant mortality. Overall, the protective effects are most pronounced among births to NH white mothers (compared to NH Black or Hispanic). These findings demonstrate how state policies and characteristics combine to shape health and underscore the importance of considering how racialized experiences may reduce the benefits of certain state contexts among minoritized groups. In Chapter 4, I marry weathering and skin tone stratification frameworks to examine how risks of low birth weight differ across maternal age and skin tone, a marker of cumulative discrimination, among NH Black mothers. Using data from the National Longitudinal Study of Adolescence to Adult Health, I find that, despite similar risks of low birth weight across skin tone at maternal age 16, risks diverge with age such that mothers with the darkest skin tones experience the sharpest increases. These findings underscore the transgenerational consequences of life course exposures to discrimination. Overall, these findings contribute to health equity, maternal and child health, and life course studies by demonstrating how both “protective” and “harmful” policies contribute to racial-ethnic disparities in birth outcomes and by underscoring the importance of considering heterogeneous experiences across the life course and within racial-ethnic groups when addressing birth inequities. Future research should continue to interrogate how the “protective” effects of policies and contexts vary across race and ethnicity to clarify if such policies exacerbate or mitigate inequities, as well as examine how other cumulative and early life course stressors shape birth outcomes.