Does a Rising Median Income Lift All Birth Weights? County Median Income Changes and Low Birth Weight Rates Among Births to Black and White Mothers

Abstract

r Policies that increase county income levels, particularly for middleincome households, may reduce low birth weight rates and shrink disparities between Black and White infants.r Given the role of aggregate maternal characteristics in predicting low birth weight rates, policies that increase human capital investments (e.g., funding for higher education, job training) could lead to higher income levels while improving population birth outcomes.r The association between county income levels and racial disparities in low birth weight is independent of disparities in maternal risks, and thus a broad set of policies aimed at increasing income levels (e.g., income supplements, labor protections) may be warranted.Context: Low birth weight (LBW; <2,500 grams) and infant mortality rates vary among place and racial group in the United States, with economic resources being a likely fundamental contributor to these disparities. The goals of this study were to examine time-varying county median income as a predictor of LBW rates and Black-White LBW disparities and to test county prevalence and racial disparities in maternal sociodemographic and health risk factors as mediators.

Highly public anti-Black violence and preterm birth odds for Black and White mothers

“…Similar to personal experiences with racism, observing racist acts may evoke stress responses and racism-related vigilance, even when the target is a stranger ( Bor, Venkataramani, Williams, & Tsai, 2018 ; Heard-Garris et al, 2018 , 2021 ; McFarland, Geller, & McFarland, 2019 ). Due to the large scale of exposure, highly visible and well-known racist acts may result in widely dispersed effects on psychological distress and mental health for the exposed population ( Bor et al, 2018 ; Curtis, Washburn, et al, 2021 ; Tynes, Willis, Stewart, & Hamilton, 2019 ). However, unknown is whether highly public anti-Black violence and other forms of visible racism in the US influence birth outcomes for Black pregnant women ( Premkumar, Nseyo, & Jackson, 2017 ).…”

“…The news reporting and public discussion for these incidents was often critical of law enforcement and highlighted systemic problems in the criminal justice system while a counter-perspective justified police actions and redirected criticism to protests and social issues disproportionately present in Black communities ( Freelon et al, 2016 ; Lee et al, 2018 ). Perceptions of unjust police killings accompanied by frequent discussion of race and racism may have amplified threat and stress levels for Black Americans ( Curtis, Washburn, et al, 2021 ; McFarland et al, 2019 ; Tynes et al, 2019 ). Moreover, legal sanctioning of police lethal force through non-indictment of the involved officers may exacerbate feelings of injustice, grief, and anger.…”

“…This decision is presumably based on the assumption that police killings are well-known in an area and that number of killings approximates for corresponding distress among Black residents. However, this assumption has not been tested and is a major limitation of prior research, as spillover may be unlikely for the many police killings that are either unknown by the public or perceived as justified ( Curtis, Washburn, et al, 2021 ). Health spillover from police killings also is unlikely constrained by area boundaries for incidents receiving widespread public interest and media coverage.…”

“…In national surveys during 2016–2017, more than two-thirds of Black and one-third of White Americans reported police violence toward minorities is a somewhat or very significant source of stress ( American Psychological Association, 2017 ), and protests for racial justice following select high-profile police killings were national in scale ( Buchanan et al, 2020 ). Moreover, one study showed Black Americans nationally reported higher poor mental health days following high publicity anti-Black incidents ( Curtis, Washburn, et al, 2021 ). Quantifying exposure to racial violence, based on spatial proximity and public interest, can thus strengthen evidence for spillover effects.…”

“…This study contributes to research on spillover from racial stressors to population health by exploiting the timing of 49 highly publicized incidents of anti-Black violence from 2014 through 2017 that are treated as national stress exposures for a large sample of live births in the US ( Curtis, Washburn, et al, 2021 ). National search interest in selected incidents and state variation in interest proxy for awareness of racial violence incidents, as we expected larger spillover effects on health when awareness was higher ( Curtis, Washburn, et al, 2021 ).…”