Financial Stressors Research Articles

Does Despair Really Kill? A Roadmap for an Evidence-Based Answer.

Two seemingly associated demographic trends have generated considerable interest: income stagnation and rising premature mortality from suicides, drug poisoning, and alcoholic liver disease among US non-Hispanic Whites with low education. Economists interpret these population-level trends to indicate that despair induced by financial stressors is a shared pathway to these causes of death. Although we now have the catchy term "deaths of despair," we have yet to study its central empirical claim: that conceptually defined and empirically assessed "despair" is indeed a common pathway to several causes of death. At the level of the person, despair consists of cognitive, emotional, behavioral, and biological domains. Despair can also permeate social relationships, networks, institutions, and communities. Extant longitudinal data sets feature repeated measures of despair-before, during, and after the Great Recession-offering resources to test the role that despair induced by economic decline plays in premature morbidity and mortality. Such tests must also focus on protective factors that could shield individuals. Deaths of despair is more than a phrase; it constitutes a hypothesis that deserves conceptual mapping and empirical study with longitudinal, multilevel data.

The impact of financial strain and external locus of control on psychological distress among single CAF members with children

Introduction: Military families are often confronted with unique financial stressors related to the military lifestyle, including relocations, loss of spousal job, or child care expenses. Moreover, the impact of financial stressors may be exacerbated in single-parent military families. Although there is an increasing number of single-parent families in the Canadian Armed Forces (CAF), research concerning the role of financial stressors in their psychological well-being is limited. Methods: The goal of this study was to examine the role of financial stressors in the psychological well-being of single and married CAF members with and without children ( n = 1,781). Results: Single CAF members with children reported significantly higher financial strain and psychological distress than other CAF members. In addition, hierarchical regression analyses revealed that financial strain and an external locus of control played important roles in psychological distress even when family structure was taken into account. Discussion: Organizational implications, including recommendations related to financial education services aimed at single CAF members with children and the development of programs to promote an internal financial locus of control, are discussed.

Financial stress, financial stability, and military spousal well-being

Introduction: Not only do military families face similar financial stressors as civilian families, but they also face a number of unique financial stressors as a result of the military lifestyle. In this article, we explore factors that contribute to military spouses’ perceived financial stress and the effect of financial stability on military spouses’ psychological well-being and life satisfaction. Methods: The data sets used in the analyses include female civilian spouses of Canadian Armed Forces (CAF) Regular Force members who completed the Quality of Life (QOL) survey administered in 2009 ( N = 1,518) and 2013 ( N = 1,189). In Study 1, we conducted a series of analyses to assess whether CAF spouses’ socio-demographic and military lifestyle characteristics contribute to their perceived level of financial stress (2009 QOL data). In Study 2, we conducted a series of analyses to assess whether financial stress and stability contribute to CAF spouses’ well-being and life satisfaction (2009 and 2013 QOL data). Results: Results showed that socio-demographic and military lifestyle characteristics predicted military spouses’ financial stress and that more financial stress and less financial stability reduced their psychological well-being and life satisfaction. Discussion: These findings suggest that reducing military spouses’ financial stress and improving their financial stability may enhance their well-being.

The Construct of Financial Toxicity and Association with Quality of Life in Poor Populations (TH341A)

•Explain three predictors of quality of life for vulnerable populations diagnosed with cancer.•Illustrate how the construct of financial toxicity may need to be operationalized differently based on the unique needs of vulnerable patient populations. There is growing recognition that patient reported outcome (PRO) measures complement traditional biomedical measures in conveying important information for cancer care decision making. With increasing cancer care costs understanding how the cost of medical care affects patient outcomes, particularly for patients in vulnerable populations, is imperative. This is a sequential mixed methods study (n=115) that aims to identify financial, psychosocial, and cancer related factors that affect patient outcomes. Our secondary aim was to explore the construct of financial toxicity among the poor and underserved populations diagnosed with cancer. Adult (age 18+) patients diagnosed with cancer requiring drug therapy at an infusion center focused on serving uninsured, underinsured and low income patients were enrolled in the PRO study and data was collected at 2 time-points. Standardized assessment instruments were used including: the Functional Assessment of Cancer Therapy (FACT-G), the CAHPS Cancer Care Survey, the PROMIS NIH (Anxiety, Depression, Fatigue, Pain Interference, and Physical Function), and the Comprehensive Score for Financial Toxicity (COST). Qualitative interviews were conducted to assess the relevance and utility of the COST measure for patient’s financial stressors. •61.5% of our study population has a household income less than $25,000 (compared to 21.4% of patients in the national CanCORS II cancer cohort study).•20% of our study population had private insurance (compared to 80% of patients in CanCORS II).•Depression, pain interference, and financial toxicity were found to be consistently significant predictors of quality of life in our study population, controlling for demographics and disease specific variables. Financial toxicity continues to be a strong predictor of quality of life but qualitative data reveal the specific financial burdens experienced by financially vulnerable populations differ from typical cancer populations reported in the literature.

The role of sources of social support on depression and quality of life for university students

ABSTRACTPrevalence of mental health problems in university students is increasing and attributable to academic, financial and social stressors. Lack of social support is a known determinant of mental health problems. We examined the differential impact of sources of social support on student wellbeing. University students completed an online survey measuring depressive symptoms (Patient Health Questionnaire (PHQ-9)), social support (Multidimensional Perceived Social Support (MPSS)), and quality of life (WHOQOL-BREF). The sample was 461 students (82% female, mean age 20.62 years). The prevalence of depressive symptoms was 33%. Social support from family, and friends was a significant predictor of depressive symptoms (p = 0.000*). Quality of life (psychological) was significantly predicted by social support from family and friends. Quality of life (social relationships) was predicted by social support from significant others and friends. Sources of social support represent a valuable resource for universities in protecting the mental health of students.

Family challenges created by unemployment

ABSTRACTThe detrimental effects of job loss and unemployment are not limited to the unemployed worker but ripple out to affect those closest to him or her. These ripple effects most notably impact the unemployed worker’s family, including a spouse or partner and/or children. Previous research related to the impacts on marital or partner relationships and families and the particular effects of unemployment on children is explored. Financial or economic stressors and strain brought about by job loss; the effects of stress and reduced mental health among unemployed workers and their spouses; and protective resources for coping with job loss are also discussed. The impact on children, in particular their mental health, development, and educational/human capital attainment are outlined. Implications for future interventions and unemployment policy are highlighted.

Don't spend, eat less, save more: Responses to the financial stress experienced by nursing students during unpaid clinical placements

Using an online survey, this study explored the impact of participation in unpaid clinical placements on the financial wellbeing of 160 nursing students attending an Australian university. The research found that the majority of respondents struggle financially during clinical placements, yet are financially adequate or secure outside of semester or during normal periods of study. Increased transport costs and loss of income are the most significant financial stressors during this time, with additional meals, work-appropriate clothing, purchasing additional resources and materials, and childcare costs other causes of financial stress. Most students used savings, budgeting, borrowing, and changed expenditure patterns to cope with the financial impact of unpaid placement. These findings have important implications for the ability of students to successfully complete their nursing degree and draw into question the equity of unpaid clinical placements as a formal degree requirement. However, while participation in unpaid clinical placements can impact financial well-being in the short term, participation does have the potential to increase the financial resilience of students over time, as students learn and grow from these experiences. To achieve this, however, greater attention must be placed on the financial support and personal finance education available for nursing students.

Predictors of Perceived Stress among Medical and Nonmedical College Students, Minia, Egypt.

Background:Nowadays, stress has been tagged a global phenomenon. Many undergraduate students undergo considerable stress, and a variety of sources of stress have been identified among university students. The aim of this study is to identify the level of perceived stress and its predictors among medical and nonmedical Minia University students.Methods:This was a cross-sectional study comparing between medical and nonmedical students in Minia University, conducted during the period from March to April 2017. The sample consisted of 314 medical and 291 nonmedical students chosen through cluster random sampling as a section was chosen randomly from each academic year and collectively form the final sample. Data were collected through interview by a questionnaire inquiring about sociodemographic data, common stressors as academic, financial, family, and transportation stressors and Cohen Perceived Stress Scale 10.Results:The prevalence of perceived stress was slightly higher (88.9%) among medical students than among nonmedical students (83.5%). Severe stress was found among (18.8%) of medical students compared to (12.4%) among nonmedical students (P < 0.05). The significant predictors of perceived stress were academic stressors, no exercise and being female among medical students, and were academic and financial stressors among nonmedical students.Conclusions:Medical students perceived more stress than nonmedical students. The academic stressors were significant predictors among all students; hence, there is a need for the establishment of students counseling unit, to facilitate coping with the stress of study and examination.

Stressful life events and quality of life in patients with somatoform disorders

Background: Stressful life events are associated with somatoform disorders. Somatoform disorders can influence the quality of life (QOL). These factors are culture-specific and less studied in the Indian population. Objective: The objective of this study was to evaluate the stressful life events and QOL in patients with somatoform disorders. Materials and Methods: This cross-sectional observational study was done by examining the life events and QOL of 112 consecutive patients who were diagnosed with somatoform disorders. Mini Neuropsychiatric Interview Plus, Presumptive Stressful Life Events Scale (PSLES), and WHO Quality of Life-Bref scales were administered. Results: The study sample had undifferentiated somatoform disorder (32.1%), persistent somatoform pain disorder (26.7%), and somatization disorder (25.9%). The common stressful life events experienced by somatoform disorder patients were financial issues (27.7%), marital conflicts (20.5%), family conflicts (18.7%), and illness in family members (16%). Males reported predominantly financial and job-related stressors, whereas females reported stress in family and interpersonal domain. The mean stress score using PSLES among the participants was 114.9, and the score of mean life events experienced by the participants was 2.03. QOL scores in domains such as physical, psychological, social relationship, and environment were 44.3, 41.4, 46.6, and 47.7, respectively. These were low when compared to population norms. There was a significant positive correlation between the duration of the somatoform disorder and the stress scores and a negative correlation which was not significant between the duration of illness and QOL. Conclusions: There is a difference between stressors experienced between the two genders, the knowledge of which would help in tailoring individual needs in management. There is significant impairment in the QOL in people with somatoform disorder.

Influence of Life Events on the Financial Satisfaction of Individuals

This study aims to determine the effect of financial knowledge and financial socialization on the financial satisfaction of the individuals when unexpected life events happen and to examine the mediating role of the financial stressor and financial behavior between them. The data collected from 243 respondents who had experienced any unexpected hospitality in the state of Azad Jammu and Kashmir. Grab sampling method utilized for data collection. Confirmatory factor analysis (CFA) and Structural Equation Modeling (SEM) utilized for data analysis. Results of study reveal that: 1) financial knowledge and financial socialization have positive influence on financial satisfaction; 2) financial knowledge has positive effect on financial satisfaction with the mediating role of the financial stressor and financial behavior when an unexpected life event happens; and 3) financial socialization has positive effect on financial satisfaction with the mediating role of the financial stressor and financial behavior when an unexpected life event happened. This study provides clear insight toward the financial satisfaction of the individuals while confronting the unexpected life events. Practitioners and financial planners use this article for increasing the financial satisfaction of their customers. There is a plethora of researches conducted in different perspective except life events of individuals. This study utilized confirmatory factor analysis, which is necessary when research carried out from a different perspective.

Stressors and coping mechanisms of older adults teaching in higher education institutions in Manila

This study explored the stressors and coping mechanisms of older adults, 60 years old and over, who teach in three state higher education institutions in Manila, Philippines. Descriptive correlation method of research was employed. One hundred eighty-eight were randomly selected from the roster of 356 target participants. The Older Adults Life Stress Inventory was used to identify the severity of stressors as experienced by the respondent senior professionals for the past 3 years along the areas of physical, health, social, family, occupational and financial domains. The Coping Strategy Inventory Short Form 32 was used to determine typical coping strategies that involve problem-solving, cognitive restructuring, express emotions and social contact. Tests of correlation, however, revealed that all the six stressors areas have a significant positive correlation with problem avoidance, wishful thinking, self-criticism and social withdrawal (p &lt; 0.01). Multiple regression analyses disclosed that older adult men have a greater preponderance to experience stressors than older adult women&#x0D; &#x0D; Keywords: Older adult professionals, stressors, coping mechanisms, physical-related stressors, health-related stressors, social-related stressors, family-related stressors, occupational stressors, financial stressors.

A pilot study assessing the burden of caregivers of elderly patients at University College Hospital UCH.

12 Background: Caregiver burden is defined as “the perception of stress and fatigue caused by the sustained effort required in caring for persons with chronic illness or other conditions with special needs for care”. It is a type of stress or strain experienced by caregivers, which is directly/ indirectly related to the challenges/problems they face as a result of the health status of the person cared for. Stucki et al. 2000, described the carers burden as “strain or load borne by a person who cares for a chronically ill, disabled, or elderly family member”. Caregiver burden is response to physical, psychological, emotional, social, and financial stressors associated with the caregiving in a multidimensional way. It is the psychosocial and physical reaction to the imbalance of demands placed on the caregiver by various factors, including personal time, multiple roles, physical and emotional states, financial resources, and formal care resources. The caregiver's perception of the burden, rather than the perception of other family members or healthcare providers, determines the impact of this burden on his or her life. Methods: Caregivers of elderly patients attending the geriatric and medical outpatient’s clinics at UCH completed a caregiver strain index scale, over a 2 month period. Demographic information regarding gender, age, were obtained and scaled questions were ticked. Data was analysed using IBM SPSS statistics 21. Results: Eighty-five participants completed the caregiver strain index scale. The socio-demographic data described age and gender. Most participants fell in the 31 - 40 and 41 - 50 age groups (41.2% for each group). Fifty-eight (68.2%) were females while 27 (31.8%) were males. Most common strain variable was demand on time with percentage 54.1% (46). Twenty-nine (34.1%) had moderate level of stress (4 - 6) , while 32 (37.6%) had mild level of stress, and 17 (20.0%) had high level of stress. One participant had the highest score index was 11 while 13 (15.3%) had scores of 3 and 13 (15.3%) had scores of 5. Conclusions: The study showed that caregivers of elderly patients have high burden in the demand on their time and need supportive/collaborative systems which includes palliative care to help with the task of caring for these elderly ones.

Characterization of psychiatrically hospitalized college students

Objective: To characterize contemporary college students requiring psychiatric hospitalization. Participants and methods: Sociodemographic and diagnostic information was gathered retrospectively and analyzed from the electronic medical records (EMRs) of the consecutive inpatient hospitalizations of 905 college students admitted to a psychiatric inpatient unit. Results: Significantly more females compared to males experienced the following: more hospitalizations, more family and financial stressors, more depression, and less psychotic and bipolar disorder. The most frequent diagnosis was a depressive disorder, followed by bipolar disorder, psychotic disorder, and personality disorder, most frequently borderline personality disorder. Half of participants had comorbid diagnoses with substance abuse most common. More than two-thirds of students endorsed social or intimate relationship, academic, and family challenges as psychosocial stressors. In all, 15% of participants had repeat admissions. Conclusions: The present study provides demographic data from a sample of psychiatrically hospitalized college students. Findings can help improve screening and identification of decompensation in college students.

Development of a financial navigation program to ease the burden of financial toxicity.

124 Background: Due to the rising cost of cancer care, even well-insured patients are at risk for financial toxicity. Cancer treatment costs can be challenging for patients and families because of increasing deductibles, increasing premiums and frequent co-payments. At Cleveland Clinic Cancer Centers, our goal is to identify patients at risk for financial distress and help ease the financial stress and hardship associated with cancer care. Methods: The Financial Navigator (FN) role was created in 2016 to complete benefits investigations to determine covered services and minimize the patient’s out of pocket expenses. We are participants in the Oncology Care Model and are expected to provide and document the estimated out-of-pocket costs in the patient’s medical record. Navigators conduct telephone outreach calls with treatment patients to educate them on their benefits. The FN also assists with applications on copay assistance and free drug options. Finally, the FN will connect patients with resources for premium assistance and household expenses when copay assistance isn’t an option. The FN team has grown to 7 FTE’s since 2016. Results: Since 2016 the dollar amount approved through copay assistance applications has increased by 65%, the free drug value received increased by 62%, and YTD 2018 data shows that we have surpassed all of 2017 in what we collected towards patient out of pockets from copay assistance programs. We have also been able to comply with the out of pocket expense metric for OCM, not only for our Medicare patients, but for all of our treatment patients and compliance has risen from 44% in December 2017 to 98% in April 2018. Conclusions: In conclusion our Navigators have built relationships with Social Workers, Care Coordinators, and community services that are available to patients. This added benefit helps patients with non-medical financial stressors. The team can connect patients to organizations that can assist with household utilities, childcare concerns, food concerns, and mortgages. Utilization of the FN role has helped the healthcare team and patients to identify ways to mitigate the costs of care and distress related to financial concerns.

Completion rates and psychosocial intervention effectiveness in an Australian substance use therapeutic community

BackgroundProgram attrition is a major problem in substance use treatment. It is not clear which client and treatment variables are related to successful completion. This study aimed to identify client variables associated with Therapeutic Community (TC) completion. A secondary aim was to investigate changes in entry and exit scores on psychosocial outcome measures.MethodsRetrospective quantitative analysis of data collected from 193 Australian TC residents, over 3.5 years. Variables measured included: demographics; Depression, Anxiety, Stress Score (DASS-21) and World Health Organisation Quality of Life 8 questions (WHOQOL-8).ResultsCompletion rates were 30.6%. High Money WHOQOL-8 scores, suggestive of minimal financial stressors, positively predicted completion. Multivariate analyses showed that negative predictors of completion were: amphetamine being primary substance of concern, aggression, high Relationship WHOQOL-8 scores, suggestive of positive relationships, and younger or older age. Those in the program demonstrated clinically significant psychological improvement and significant improvement in all quality of life scores over time. The degree of psychometric improvement was most pronounced in those who completed the course, with the exception of depression, stress, and money problems.ConclusionThe findings provide an understanding of specific predictors of program completion which may help to identify high-risk clients and inform program improvement. Early attrition rates may be reduced by monitoring and supporting high-risk clients. Overall, psychometric improvement occurred amongst both completers and non-completers overtime but is most prominent amongst course completers, with the exception of depression, stress, and money problems. Future research could potentially focus on amphetamine users and shortened TC programs, focusing on acute psychosocial intervention.

Problem gambling and psychological distress: a cross-national perspective on the mediating effect of consumer debt and debt problems among emerging adults

BackgroundSevere economic difficulties are common among younger generations who currently have an easy access to consumer credit and payday loans in many Western countries. These accessible yet expensive short-term loans may lead to more severe financial difficulties, including default and debt enforcement, both which are defined as debt problems within this study. This study hypothesized that consumer debt and debt problems mediate the relationship between problematic gambling and psychological distress. Excessive gambling can be funded with consumer debt, which in turn leads to the accumulation of financial stressors and, eventually, psychological distress.MethodsThree studies were conducted to examine the hypotheses. Study 1 used a demographically balanced sample of Finnish participants aged 18 to 25 years (n = 985, 50.76% female). Study 2 used a sample collected from Finnish discussion forums and social networking sites, with participants ranging from 18 to 29 years of age (n = 205, 54.63% female). Study 3 used a demographically balanced sample of American youths aged 18 to 25 years (n = 883, 50.17% female). Analyses were based on generalized structural equation models examining the role of problem gambling, consumer debt, and debt problems (i.e., default and debt enforcement) on psychological distress. Additional mediation analysis was run with treating both instant loans and debt problems as mediators.ResultsAll three studies showed that problem gambling was associated with consumer debt, which was further associated with debt problems. Both consumer debt (studies 1 and 2) and debt problems (study 3) were associated with psychological distress. Problem gambling was also directly associated with psychological distress in studies 1 and 3, but not in study 2. In Finland, consumer debt mediated the relationship between problem gambling and psychological distress (studies 1 and 2), while study 3 underlined the mediating role of debt problems in the USA, where consumer debt itself was not positively associated with psychological distress.ConclusionsThe results of the three studies indicate that problem gambling-related psychological distress is partly explained by consumer debt. Consumer credit and payday loans may provide resources for gamblers that enable them to keep up with the habit. This may eventually lead to debt problems and psychological distress. Cross-national differences exist, but in both Nordic and American models, similar mechanisms prevail. The results imply that limiting consumer debt among emerging adults could cushion the financial and psychological costs of problem gambling.

Association of behavioral health factors and social determinants of health with high and persistently high healthcare costs

A high proportion of U.S. health care costs are attributable to a relatively small proportion of patients. Understanding behavioral and social factors that predict initial and persistent high costs for these “high utilizers” is critical for health policy-makers. This prospective observational study was conducted at Kaiser Permanente Northern California (KPNC), an integrated healthcare delivery system with 4.1 million members. A stratified random sample of high-cost vs. non-high-cost adult KPNC members matched by age, gender, race/ethnicity, type of health insurance, and medical severity (N = 378) was interviewed between 3/14/2013 and 3/20/2014. Data on health care costs and clinical diagnoses between 1/1/2008 and 12/31/2012 were derived from the electronic health record (EHR). Social-economic status, depression symptoms, adverse childhood experiences (ACEs), interpersonal violence, financial stressors, neighborhood environment, transportation access, and patient activation and engagement were obtained through telephone interviews. Initial and subsequent high-cost status were defined as being classified in top 20% cost levels over 1/1/2009–12/31/2011 and 1/1/2012–12/31/2012, respectively. Psychiatric diagnosis (OR 2.55, 95% CI 1.52–4.29, p < 0.001), financial stressors (OR 1.97, 95% CI 1.19–3.26, p = 0.009), and ACEs (OR 1.10, 95% CI 1.00–1.20, p = 0.051) predicted initial high-cost status. ACEs alone predicted persistent high-cost status in the subsequent year (OR 1.12, 95% CI 1.00–1.25, p = 0.050). Non-medical factors such as psychiatric problems, financial stressors and adverse childhood experiences contribute significantly to the likelihood of high medical utilization and cost. Efforts to predict and reduce high utilization must include measuring and potentially addressing these factors.

Show cause analysis

Purpose The purpose of this paper is to detect and examine any trends in the self-reported causation of misconduct among officers being considered for dismissal. Design/methodology/approach The data utilised in this study consisted of show cause notice (SCN) responses. In the process of being considered for dismissal, officers’ may offer the causes of or mitigating factors to their misconduct as a means of avoiding dismissal. This study utilised these responses as a data source. Data collection occurred between January 2013 and October 2016, resulting in a cohort of n=100 responses comprised of between 1 and ~1,000 pages of free text. Qualitative methods were preferred, a conventional content analysis was performed with coding categories derived from SCN response text. Findings The results of this study indicate noteworthy levels of post-traumatic stress disorder (PTSD) and related mental health issues amongst this cohort, as well as pervasive financial and workplace stressors, which officers frequently link to the causation of their misconduct. Of particular note is the consistent co-occurrence of work-related stressors and health issues, most commonly through formally diagnosed PTSD. Research limitations/implications This study indicates an opportunity for support services to impact positively on mental health and stress, and subsequently misconduct among police officers. Originality/value There is still very little understanding of the causation of misconduct among police officers. This is the first time that this data have been utilised in any form of the research, it provides valuable insight into a potential alternative method of addressing misconduct to reactionary investigative action.

Ethnic variations in the relationship between multiple stress domains and use of several types of tobacco/nicotine products among a diverse sample of adults

IntroductionFinancial strain and discrimination are consistent predictors of negative health outcomes and maladaptive coping behaviors, including tobacco use. Although there is considerable information exploring stress and smoking, limited research has examined the relationship between patterns of stress domains and specific tobacco/nicotine product use. Even fewer studies have assessed ethnic variations in these relationships. MethodsThis study investigated the relationship between discrimination and financial strain and current tobacco/nicotine product use and explored the ethnic variation in these relationships among diverse sample of US adults (N = 1068). Separate logistic regression models assessed associations between stress domains and tobacco/nicotine product use, adjusting for covariates (e.g., age, gender, race/ethnicity, and household income). Due to statistically significant differences, the final set of models was stratified by race/ethnicity. ResultsHigher levels of discrimination were associated with higher odds of all three tobacco/nicotine product categories. Financial strain was positively associated with combustible tobacco and combined tobacco/nicotine product use. Financial strain was especially risky for Non-Hispanic Whites (AOR:1.191, 95%CI:1.083–1.309) and Blacks/African Americans (AOR:1.542, 95%CI:1.106–2.148), as compared to other groups, whereas discrimination was most detrimental for Asians/Pacific Islanders (AOR:3.827, 95%CI:1.832–7.997) and Hispanics/Latinas/Latinos (AOR:2.517, 95%CI:1.603–3.952). ConclusionsFindings suggest discrimination and financial stressors are risk factors for use of multiple tobacco/nicotine products, highlighting the importance of prevention research that accounts for these stressors. Because ethnic groups may respond differently to stress/strain, prevention research needs to identify cultural values, beliefs, and coping strategies that can buffer the negative consequences of discrimination and financial stressors.

Racial/Ethnic Inequities in Low Birth Weight and Preterm Birth: The Role of Multiple Forms of Stress.

Introduction Racial/ethnic inequities in low birth weight (LBW) and preterm birth (PTB) persist in the United States. Research has identified numerous risk factors for adverse birth outcomes; however, they do not fully explain the occurrence of, or inequalities in PTB/LBW. Stress has been proposed as one explanation for differences in LBW and PTB by race/ethnicity. Methods Using the Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2012 to 2013 for 21 states and one city (n = 15,915) we used Poisson regression to estimate the association between acute, financial and relationship stressors and LBW and PTB, and to examine the contribution of these stressors individually and simultaneously to racial/ethnic differences in LBW and PTB. Results Adjusting for age and race/ethnicity, acute (p < 0.001), financial (p < 0.001) and relationship (p < 0.05) stressors were associated with increased risk of LBW, but only acute (p < 0.05) and financial (p < 0.01) stress increased risk of PTB. Across all models, non-Hispanic blacks had higher risk of LBW and PTB relative to non-Hispanic whites (IRR 1.87, 95% CI 1.55, 2.27 and IRR 1.46, 95% CI 1.18, 1.79). Accounting for the effects of stressors attenuated the risk of LBW and PTB by 17 and 22% respectively, but did not fully explain the increased likelihood of LBW and PTB among non-Hispanic blacks. Discussion Results of this study demonstrate that stress may increase the risk of LBW and PTB. While stressors may contribute to racial/ethnic differences in LBW and PTB, they do not fully explain them. Mitigating stress during pregnancy may help promote healthier birth outcomes and reduce racial/ethnic inequities in LBW and PTB.