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Ann Epidemiol. 2016 Jan;26(1):7-13.e1. doi: 10.1016/j.annepidem.2015.10.005. Epub 2015 Oct 17.

Racism in the form of micro aggressions and the risk of preterm birth among black women.

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Department of Doctoral Nursing Programs, College of Nursing & Health Professions, Drexel University, Philadelphia, PA; Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA. Electronic address:
Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI.
Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor.
Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis.
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada.
Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI.
Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA.



This study sought to examine whether perceived interpersonal racism in the form of racial micro aggressions was associated with preterm birth (PTB) and whether the presence of depressive symptoms and perceived stress modified the association.


Data stem from a cohort of 1410 black women residing in Metropolitan Detroit, Michigan, enrolled into the Life-course Influences on Fetal Environments (LIFE) study. The Daily Life Experiences of Racism and Bother (DLE-B) scale measured the frequency and perceived stressfulness of racial micro aggressions experienced during the past year. Severe past-week depressive symptomatology was measured by the Centers for Epidemiologic Studies-Depression scale (CES-D) dichotomized at ≥ 23. Restricted cubic splines were used to model nonlinearity between perceived racism and PTB. We used the Perceived Stress Scale to assess general stress perceptions.


Stratified spline regression analysis demonstrated that among those with severe depressive symptoms, perceived racism was not associated with PTB. However, perceived racism was significantly associated with PTB among women with mild to moderate (CES-D score ≤ 22) depressive symptoms. Perceived racism was not associated with PTB among women with or without high amounts of perceived stress.


Our findings suggest that racism, at least in the form of racial micro aggressions, may not further impact a group already at high risk for PTB (those with severe depressive symptoms), but may increase the risk of PTB for women at lower baseline risk.


Depression; Premature birth; Psychological; Racism; Stress

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