# The Racial Social Structure and Unequal Risk of Adverse Birth Outcomes among Black Infants

> **NIH NIH R21** · UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH · 2021 · $195,824

## Abstract

PROJECT SUMMARY/ABSTRACT
Relative to Whites, Black mothers have higher odds of preterm birth (PTB) and small-for-gestational-age birth
(SGA), leading to racial differences in infant mortality. Compelling evidence exists for racial discrimination and
residential segregation as determinants of such adverse birth outcomes. Yet, more complete assessments of
the racial social structure are needed to identify the role of additional structural factors and maternal mediating
pathways. We will elucidate structural predictors of Black PTB and SGA risk by testing two Specific Aims.
 Aim 1: Systematically test structural predictors of unequal risk of preterm and small-for-gestational-
age birth for Black mothers, and the role of maternal- and area-level mediators. Structural factors will be
assessed at the county or metropolitan statistical area (MSA) using diverse public data sources and include: 1)
area anti-Black prejudice from aggregated web-based measurements of bias and racism; 2) Black residential
segregation as the isolation index; 3) Black socioeconomic disadvantage from a multidimensional composite;
4) neighborhood violent crime exposure and incarceration risk for Black residents; and 5) structural barriers to
healthcare, measured as a) spatial access to primary care, b) availability of Black physicians, c-d) uninsurance
and inadequate prenatal care rates for Black mothers, and e) availability of public health and contraceptive
services. Black-White (B-W) differences in structural factors also will be examined. Using national birth records
(2014-2017), the sample will include singleton births to non-Hispanic US born Black and White mothers in
MSAs with at least 10,000 Black residents. Multilevel models will allow for prediction of PTB and SGA risk for
Black mothers, area variance in risk, and area-specific B-W differences in risk. Mediation of structural factors
by maternal- and area-level sociodemographic and health variables will be tested. Mothers with prior PTB also
will be considered as structural factors may restrict access to needed health interventions for this population.
 Aim 2: Estimate the effect of racial societal stressors on Black preterm birth risk. Variation in timing
and location of high publicity killings of Black persons, likely to be viewed as unjust or racially motivated, will be
exploited to create a natural experiment. Black preterm birth risk is expected to increase after high publicity
Black killings, particularly for exposure in the first four gestational months, for the most publicized killings, and
in areas proximate to the killing. Due to their potential for intense media coverage, killings of Black persons will
come from datasets of police-perpetrated and extremist-perpetrated killings. Number of media stories within
60-days of the killing will be used to identify high publicity killings (top decile; ~35 killings).
 The project will provide novel and rigorous tests of the racial social structure and racial societal st...

## Key facts

- **NIH application ID:** 10159308
- **Project number:** 5R21MD014281-02
- **Recipient organization:** UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH
- **Principal Investigator:** David Stuart Curtis
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $195,824
- **Award type:** 5
- **Project period:** 2020-05-05 → 2024-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10159308

## Citation

> US National Institutes of Health, RePORTER application 10159308, The Racial Social Structure and Unequal Risk of Adverse Birth Outcomes among Black Infants (5R21MD014281-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10159308. Licensed CC0.

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