OBJECTIVES: This study examined associations between income inequality and mortality in 282 US metropolitan areas. METHODS: Income inequality measures were calculated from the 1990 US Census. Mortality was calculated from National Center for Health Statistics data and modeled with weighted linear regressions of the log age-adjusted rate. RESULTS: Excess mortality between metropolitan areas with high and low income inequality ranged from 64.7 to 95.8 deaths per 100,000 depending on the inequality measure. In age-specific analyses, income inequality was most evident for infant mortality and for mortality between ages 15 and 64. CONCLUSIONS: Higher income inequality is associated with increased mortality at all per capita income levels. Areas with high income inequality and low average income had excess mortality of 139.8 deaths per 100,000 compared with areas with low inequality and high income. The magnitude of this mortality difference is comparable to the combined loss of life from lung cancer, diabetes, motor vehicle crashes, human immunodeficiency virus (HIV) infection, suicide, and homicide in 1995. Given the mortality burden associated with income inequality, public and private sector initiatives to reduce economic inequalities should be a high priority.

SYNOPSISObjectives. To examine multiple dimensions of socioeconomic status and breastfeeding among a large, random sample of ethnically diverse women.Methods. This study used logistic regression analysis to examine the influence of a range of socioeconomic factors on the chances of ever breastfeeding among a stratified random sample of 10,519 women delivering live births in California for 1999 through 2001. Measures of socioeconomic status included family income as a percentage of the federal poverty level, maternal education, paternal education, maternal occupation, and paternal occupation.Results. Consistent with previous research, there was a marked socioeconomic gradient in breastfeeding. Women with higher family incomes, those who had or whose partners had higher education levels, and women who had or whose partners had professional or executive occupations were more likely than their counterparts to breastfeed. After adjustment for many potential confounders, maternal and paternal education remained positively associated with breastfeeding, while income and occupation were no longer significant. Compared with other racial or ethnic groups, foreign-born Latina women were the most likely to breastfeed.Conclusions. The significant association of maternal and paternal education with breastfeeding, even after adjustment for income, occupation, and many other factors, suggests that social policies affecting educational attainment may be important factors in breastfeeding. Breastfeeding rates may be influenced by health education specifically or by more general levels of schooling among mothers and their partners. The continuing importance of racial/ethnic differences after adjustment for socioeconomic factors could reflect unmeasured socioeconomic effects, cultural differences, and/or policies in Latin American countries.

Socioeconomic factors play an important but complex role in PTB disparities. The absence of Black-White disparities in PTB within certain socioeconomic subgroups, alongside substantial disparities within others, suggests that social factors moderate the disparity. Further research should explore social factors suggested by the literature-including life course socioeconomic experiences and racism-related stress, and the biological pathways through which they operate-as potential contributors to PTB among Black and White women with different levels of social advantage.

ObjectivesThe causes of the large and persistent Black-White disparity in preterm birth (PTB) are unknown. It is biologically plausible that chronic stress across a woman’s life course could be a contributor. Prior research suggests that chronic worry about experiencing racial discrimination could affect PTB through neuroendocrine, vascular, or immune mechanisms involved in both responses to stress and the initiation of labor. This study aimed to examine the role of chronic worry about racial discrimination in Black-White disparities in PTB.MethodsThe data source was cross-sectional California statewide-representative surveys of 2,201 Black and 8,122 White, non-Latino, U.S.-born postpartum women with singleton live births during 2011–2014. Chronic worry about racial discrimination (chronic worry) was defined as responses of “very often” or “somewhat often” (vs. “not very often” or “never”) to the question: “Overall during your life until now, how often have you worried that you might be treated or viewed unfairly because of your race or ethnic group?” Prevalence ratios (PRs) with 95% Confidence Intervals (CI) were calculated from sequential logistic regression models, before and after adjustment for multiple social/demographic, behavioral, and medical factors, to estimate the magnitude of: (a) PTB risks associated with chronic worry among Black women and among White women; and (b) Black-White disparities in PTB, before and after adjustment for chronic worry.ResultsAmong Black and White women respectively, 36.9 (95% CI 32.9–40.9) % and 5.5 (95% CI 4.5–6.5) % reported chronic worry about racial discrimination; rates were highest among Black women of higher income and education levels. Chronic worry was significantly associated with PTB among Black women before (PR 1.73, 95% CI 1.12–2.67) and after (PR 2.00, 95% CI 1.33–3.01) adjustment for covariates. The unadjusted Black-White disparity in PTB (PR 1.59, 95%CI 1.21–2.09) appeared attenuated and became non-significant after adjustment for chronic worry (PR 1.30, 95% CI 0.93–1.81); it appeared further attenuated after adding the covariates (PR 1.17, 95% CI 0.85–1.63).ConclusionsChronic worry about racial discrimination may play an important role in Black-White disparities in PTB and may help explain the puzzling and repeatedly observed greater PTB disparities among more socioeconomically-advantaged women. Although the single measure of experiences of racial discrimination used in this study precluded examination of the role of other experiences of racial discrimination, such as overt incidents, it is likely that our findings reflect an association between one or more experiences of racial discrimination and PTB. Further research should examine a range of experiences of racial discrimination, including not only chronic worry but other psychological and emotional states and both subtle and overt incidents as well. These dramatic results from a large statewide-representative study add to a growing—but not widely known—literature linking racism-related stress with physic...

The authors examined the relation between socioeconomic status, as defined by education level, and postmenopausal breast cancer incidence using data from the National Health and Nutrition Examination Survey I Epidemiologic Followup Study. Female participants in the study were followed from 1971-1974 to 1992-1993. Cox proportional hazards modeling was used to determine the relation between breast cancer incidence and education level. There was a direct dose-response association between education level and postmenopausal breast cancer risk. Several breast cancer risk factors, including height and reproductive-related risks such as nulliparity, were found to mediate this relation. Adjustment for these factors reduced, but did not eliminate, the positive relation between education level and risk of postmenopausal breast cancer; however, the association was no longer statistically significant. The association between higher education and increased risk of breast cancer appears to be largely explained by differences in the known risk factors for breast cancer.

The previously seen positive relationship between breast cancer mortality and education was found among US women of color but not non-Hispanic White women.

Objectives Food insecurity in the United States is a stubborn public health issue, affecting more than one in five households with children and disproportionately impacting racial and ethnic minority women and their children. Past research and policy has focused on household predictors of food insecurity, but neglected broader factors, such as perceived neighborhood social cohesion, that might protect those most vulnerable to food insecurity. Methods We use a racially and ethnically diverse data set from the Geographic Research on Wellbeing study (N = 2847) of women and their young children in California to investigate whether social cohesion influences food insecurity and whether it moderates the relationship between race/ethnicity and food insecurity. Results We find that lower levels of perceived residential neighborhood social cohesion associate with higher odds of food insecurity even after considering important household socioeconomic factors. In addition, our results suggest that social cohesion is most relevant for reducing the risk of food insecurity among racial and ethnic minority mothers. For example, the probability of food insecurity for immigrant Latina mothers is nearly 0.40 in neighborhoods where mothers perceive little to no cohesion and less than 0.10 in neighborhoods where mothers perceive high cohesion. Conclusions for Practice Higher levels of neighborhood perceived social cohesion are protective against food insecurity in households with children and especially so for racial and ethnic minority households who are at a heightened risk of food insecurity. Supporting programs that focus on building closer knit communities may be a key to reducing food insecurity overall and for reducing disparities in food insecurity by race and ethnicity.

Women who leave the hospital earlier than the standard recommended stay are at somewhat increased risk of terminating breastfeeding early.