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Explaining Disproportionately High Rates of Adverse Birth Outcomes Among African Americans: The Impact of Stress, Racism, and Related Factors in Pregnancy
   
CITATION: Giscombe, C.L., Lobel, M. (2005)  Explaining Disproportionately High Rates of Adverse Birth Outcomes Among African Americans: The Impact of Stress, Racism, and Related Factors in Pregnancy   Psychological Bulletin September 2005 Vol. 131, No. 5, 662-683

ABSTRACT:  Compared with European Americans, African American infants experience disproportionately high rates of low birth weight and preterm delivery and are more than twice as likely to die during their 1st year of life. The authors examine 5 explanations for these differences in rates of adverse birth outcomes: (a) ethnic differences in health behaviors and socioeconomic status; (b) higher levels of stress in African American women; (c) greater susceptibility to stress in African Americans; (d) the impact of racism acting either as a contributor to stress or as a factor that exacerbates stress effects; and (e) ethnic differences in stress-related neuroendocrine, vascular, and immunological processes. The review of literature indicates that each explanation has some merit, although none is sufficient to explain ethnic disparities in adverse birth outcomes. There is a lack of studies examining the impact of such factors jointly and interactively. Recommendations and cautions for future research are offered.

References

Aldwin, C. M., & Revenson, T. A.. (1987). Does coping help? A reexamination of the relation between coping and mental health. Journal of Personality and Social Psychology, 53, 237-248. 

Alexander, G. R., Baruffi, G., Mor, J. M., Kieffer, E. C., & Hulsey, T. C.. (1993). Multiethnic variations in the pregnancy outcomes of military dependents. American Journal of Public Health, 83, 1721-1725. 

Alexander, G. R., Hulsey, T. C., Robillard, P., De Caunes, F., & Papiernik, E.. (1994). Determinants of meconium-stained amniotic fluid in term pregnancies. Journal of Perinatology, 14, 259-263. 

Alexander, G. R., Kogan, M. D., Himes, J. H., Mor, J. M., & Goldenberg, R.. (1999). Racial differences in birthweight for gestational age and infant mortality extremely low-risk U.S. populations. Paediatric and Perinatal Epidemiology, 13, 205-217. 

Alexander, G. R., Tompkins, M. E., Allen, M. C., & Hulsey, T. C.. (1999). Trends and racial differences in birth weight and related survival. Maternal and Child Health Journal, 3, 71-79. 

Allen, M. C., Alexander, G. R., Tompkins, M. E., & Hulsey, T. C.. (2000). Racial differences in temporal changes in newborn viability and survival by gestational age. Paediatric and Perinatal Epidemiology, 14, 152-158. 

American Heart Association. (2001). Cardiovascular disease statistics. Retrieved July 8, 2002, from http://www.americanheart.org.presenter.jhtml?identifier=4478 

Ananth, C. V., Peedicayil, A., & Savitz, D. A.. (1995). Effect of hypertensive diseases in pregnancy on birthweight, gestational duration, and small-for-gestational age births. Epidemiology, 6, 391-395. 

Anderson, N. B. (Ed.). (2004). Fifty years of Brown vs. Board and psychology [Special issue]. American Psychologist, 59(6) 

Anderson, N. B., & Armstead, C. A.. (1995). Toward understanding the association of socioeconomic status and health: A new challenge for the biopsychosocial approach. Psychosomatic Medicine, 57, 213-225. 

Anderson, N. B., McNeilly, M., & Myers, H.. (1991). Autonomic reactivity and hypertension in African Americans: A review and proposed model. Ethnicity & Disease, 1, 154-170. 

Appley, M. H., & Trumbull, R.. (1986). Development of the stress concept. In M. H. Appley & R. Trumbull (Eds.), Dynamics of stress: Physiological, psychological, and social perspectives (pp. 3-18). New York: Plenum Press.

Arias, E., MacDorman, M. F., Strobino, D. M., & Guyer, B.. (2003). Annual summary of vital statistics—2002. Pediatrics, 112, 1215-1230. 

Austin, M. P., & Leader, L.. (2000). Maternal stress and obstetric and infant outcomes: Epidemiological findings and neuroendocrine mechanisms. Australian and New Zealand Journal of Obstetrics and Gynaecology, 40, 331-337. 

Barbosa, G. A.. (2000). The association of life events to gestational age at delivery among low-income, urban, African American women. Journal of Perinatology, 20, 438-442. 

Barker, D. J. P.. (2000). In utero programming of cardiovascular disease. Theriogenology, 53, 555-574. 

Bennett, G. G., Merritt, M. M., Sollers, J. J., Edwards, C. L., Whitfield, K. E., Brandon, D. T., & Tucker, R. D.. (2004). Stress, coping, and health outcomes among African Americans: A review of the John Henryism hypothesis. Psychology and Health, 19, 369-383. 

Benschop, R. J., Geenen, R., Mills, P. J., Naliboff, B. D., Kiecolt-Glaser, J. K., Herbert, T. B., et al. (1998). Cardiovascular and immune responses to acute psychological stress in young and old women: A meta-analysis. Psychosomatic Medicine, 60, 290-296. 

Berg, C. J., Wilcox, L. S., & d'Almada, P. J.. (2001). The prevalence of socioeconomic and behavioral characteristics and their impact on VLBW in African American and European American infants. Maternal and Child Health Journal, 5, 75-84. 

Berkowitz, G. S., & Kasl, S. V.. (1983). The role of psychosocial factors in spontaneous preterm delivery. Journal of Psychosomatic Research, 27, 283-290. 

Betancourt, H., & López, S. R.. (1993). The study of culture, ethnicity, and race in American psychology. American Psychologist, 48, 629-637. 

Blackmore, C. A., Ferre, C. D., Rowley, D. L., Hogue, C. L. R., Gaiter, J., & Atrash, H.. (1993). Is race a risk factor or a risk marker for preterm delivery? Ethnicity & Disease, 3, 372-377. 

Branscombe, N. R., & Ellemers, N.. (1998). Coping with group-based discrimination: Individualistic versus group-level strategies. In J. K. Swim & C. Stangor (Eds.), Prejudice: The target's perspective (pp. 243-266). San Diego, CA: Academic Press.

Branscombe, N. R., Schmitt, M. T., & Harvey, R. D.. (1999). Perceiving pervasive discrimination among African Americans: Implications for group identification and well-being. Journal of Personality and Social Psychology, 77, 135-149. 

Bresnahan, K., Zuckerman, B., & Cabral, H.. (1992). Psychosocial correlates of drug and heavy alcohol use among pregnant women at risk for drug use. Obstetrics and Gynecology, 80, 976-980. 

Brett, K. M., Strogatz, D. S., & Savitz, D. A.. (1997). Employment, job strain, and preterm delivery among women in North Carolina. American Journal of Public Health, 87, 199-204. 

Broman, C. L.. (2000). The experience and consequences of perceived racial discrimination: A study of African Americans. Journal of African American Psychology, 26, 165-180. 

Brondolo, E., Rieppi, R., Kelly, K. P., & Gerrin, W.. (2003). Perceived racism and blood pressure: A review of the literature and conceptual and methodological critique. Annals of Behavioral Medicine, 25, 55-65. 

Buka, S. L., Brennan, R. T., Rich-Edwards, J. W., Raudenbush, S. W., & Earls, F.. (2003). Neighborhood support and the birth weight of urban infants. American Journal of Epidemiology, 157, 1-8. 

Cabral, H., Fried, L. E., Levenson, S., Amaro, H., & Zuckerman, B.. (1990). Foreign-born and U. S.-born African American women: Differences in health behaviors and birth outcomes. American Journal of Public Health, 80, 70-72. 

Carver, C. S., Scheier, M. F., & Weintraub, J. K.. (1989). Assessing coping strategies: A theoretically based approach. Journal of Personality and Social Psychology, 54, 267-283.

Chambers, J. W., Kambon, K., Birdsong, B. D., Brown, J., Dixon, P., & Robbins-Brinson, L.. (1998). Africentric cultural identity and the stress experience of African American college students. Journal of African American Psychology, 24, 368-396. 

Chideya, F.. (2000). The thin European American line: Will European American Americans stand against police brutality? Pop and Politics., Retrieved December 3, 2001, from http://www.popandpolitics.com/articles.cfm 

Chomitz, V. R., Cheung, L. W. Y., & Lieberman, E.. (1995). The role of lifestyle in preventing low birth weight. The Future of Children, 5, 121-138. 

Chrousos, G. P., & Gold, P. W.. (1998). A healthy body in a healthy mind—and vice versa—the damaging power of “uncontrollable” stress. Journal of Clinical Endocrinology and Metabolism, 83, 1842-1845. 

Clark, R., Anderson, N. B., Clark, V. R., & Williams, D. R.. (1999). Racism as a stressor for African Americans: A biopsychosocial model. American Psychologist, 54, 805-816. 

Cohen, S., Kamarck, T., & Mermelstein, R.. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385-396. 

Cohen, S., Tyrrell, D. A. J., & Smith, P.. (1991). Psychological stress and susceptibility to the common cold. New England Journal of Medicine, 325, 606-612. 

Collins, J. W., David, R. J., Symons, R., Handler, A., Wall, S., & Andes, S.. (1998). African American mothers' perception of their residential environment, stressful life events, and very low birthweight. Epidemiology, 9, 286-289. 

Collins, J. W., David, R. J., Symons, R., Handler, A., Wall, S. N., & Dwyer, L.. (2000). Low-income African American mothers' perception of exposure to racial discrimination and infant birthweight. Epidemiology, 11, 337-339. 

Collins, J. W., Wu, S.-Y., & David, R. J.. (2002). Differing intergenerational birth weights among the descendants of U.S.-born and foreign-born Whites and African Americans in Illinois. American Journal of Epidemiology, 155, 210-216. 

Collins, N. L., Dunkel-Schetter, C., Lobel, M., & Scrimshaw, S. C. M.. (1993). Social support in pregnancy: Psychosocial correlates of birth outcomes and postpartum depression. Journal of Personality and Social Psychology, 65, 1243-1258. 

Conger, R. D., Wallace, L. E., Sun., Y., Simons, R. L., McLoyd., V. C., & Brody, G. H.. (2002). Economic pressure in African American families: A replication and extension of the family stress model. Developmental Psychology, 38, 179-193. 

Conley, D., & Bennett, N. G.. (2000). Is biology destiny? Birth weight and life chances. American Sociological Review, 65, 458-467. 

Crocker, J., & Quinn, D.. (1998). Racism and self-esteem. In J. L. Eberhardt & S. T. Fiske (Eds.), The problem and the response (pp. 169-187). Thousand Oaks, CA: Sage. 

Crocker, J., Voelkl, K., Testa, M., & Major, B.. (1991). Social stigma: The affective consequences of attributional ambiguity. Journal of Personality and Social Psychology, 60, 218-228. 

Culhane, J. F., Rauh, V., McCollum, K. F., Elo, I. T., & Hogan, V.. (2002). Exposure to chronic stress and ethnic differences in rates of bacterial vaginosis among pregnant women. American Journal of Obstetrics and Gynecology, 187, 1272-1276. 

Culhane, J. F., Rauh, V., McCollum, D. F., Hogan, V. K., Agnew, K., & Wadhwa, P. D.. (2001). Maternal stress is associated with bacterial vaginosis in human pregnancy. Maternal and Child Health Journal, 5, 127-134. 

Curhan, G., Chertow, G. M., Willett, W. C., Spiegelman, D., Colditz, G. A., Manson, J. E., et al. (1996). Birthweight and adult hypertension and obesity in women. Circulation, 94, 1310-1315. 

Din-Dzietham, R., & Hertz-Picciotto, I.. (1998). Infant mortality differences between European Americans and African Americans: The effect of maternal education. American Journal of Public Health, 88, 651-656. 

Dole, N., Savitz, D. A., Hertz-Picciotto, I., Siega-Riz, A. M., McMahon, M. J., & Buekens, P.. (2003). Maternal stress and preterm birth. American Journal of Epidemiology, 157, 14-24. 

Dole, N., Savitz, D. A., Siega-Riz, A. M., Hertz-Picciotto, I., McMahon, M. J., & Buekers, P.. (2004). Psychosocial factors and preterm birth among African American and White women in Central North Carolina. American Journal of Public Health, 94, 1358-1365. 

Dowling, P. T., & Fisher, M.. (1987). Maternal factors and low birthweight infants: A comparison of Blacks with Mexican-Americans. The Journal of Family Practice, 25, 153-158. 

Dunkel-Schetter, C., Gurung, R. A. R., Lobel, M., & Wadhwa, P. D.. (2001). Stress processes in pregnancy and birth: Psychological, biological, and sociocultural influences. In A. Baum, T. A. Revenson, & J. E. Singer (Eds.), Handbook of health psychology (pp. 495-518). Mahwah, NJ: Erlbaum.

Dunkel-Schetter, C., & Lobel, M.. (1998). Pregnancy and childbirth. In E. A. Blechman & K. D. Brownell (Eds.), Behavioral medicine and women: A comprehensive handbook (pp. 475-482). New York: Guilford Press.

Dunkel-Schetter, C., Sagrestano, L. M., Feldman, P., & Killingsworth, C.. (1996). Social support and pregnancy: A comprehensive review focusing on ethnicity and culture. In G. R. Pierce, B. R. Sarason, & I. G. Sarason (Eds.), Handbook of social support and the family (pp. 375-412). New York: Plenum Press.

Escobar, G. J., Littenberg, B., & Petitti, D. B.. (1991). Outcome among surviving very low birthweight infants: A meta-analysis. Archives of Diseases of Childhood, 66, 204-211. 

Fang, J., Madhavan, S., & Alderman, M. H.. (1999). The influence of maternal hypertension on low birthweight: Differences among ethnic populations. Ethnicity & Disease, 9, 369-376. 

Fiscella, K.. (1996). Racial disparities in preterm births: The role of urogenital infections. Public Health Reports, 111, 104-113. 

Fiscella, K.. (2004). Racial disparity in infant and maternal mortality: Confluence of infection, and microvascular dysfunction. Maternal and Child Health Journal, 8, 45-54. 

Fiscella, K., Franks, P., Kendrick, J. S., & Bruce, F. C.. (1998). The risk of low birthweight associated with vaginal douching. Obstetrics and Gynecology, 92, 913-917. 

Foster, H. W., Wu, L., Bracken, M. B., Semenya, K., Thomas, J., & Thomas, J.. (2000). Intergenerational effects of high socioeconomic status on low birthweight and preterm birth in African Americans. Journal of the National Medical Association, 92, 213-221. 

Franklin, J. H., & Moss, A. A.. (1994). From slavery to freedom: A history of African Americans (7th ed.). New York: McGraw-Hill.

Fuentes-Afflick, E., & Hessol, N.. (1996). Maternal birth place and infant birthweight: Variable effects of ethnicity. Pediatric Research, 39, 265. 

Gamble, V. N.. (1993). A legacy of distrust: African Americans and medical research. American Journal of Preventive Medicine, 9. , 35-38. (Suppl. 6) 

Geronimus, A. T.. (1992). The weathering hypothesis and the health of African American women and infants: Evidence and speculations. Ethnicity & Disease, 2, 207-221. 

Geronimus, A. T.. (2001). Understanding and eliminating racial inequalities in women's health in the United States: The role of the weathering conceptual framework. Journal of the American Medical Women's Association, 56, 133-136. 

Geronimus, A. T., Andersen, H. F., & Bound, J. B.. (1991). Differences in hypertension prevalence among U.S. African American and European American women of childbearing age. Public Health Reports, 106, 393-399. 

Glaser, R., & Kiecolt-Glaser, J.. (1994). Handbook of human stress and immunity. San Diego, CA: Academic Press.

Godfrey, K. M., Barker, D. J., Robinson, S., & Osmond, C.. (1997). Maternal birthweight and diet in pregnancy in relation to the infant's thinness at birth. British Journal of Obstetrics & Gynaecology, 104, 663-667. 

Goldenberg, R. L., & Andrews, W. W.. (1996). Editorial: Intrauterine infection and why preterm prevention programs have failed. American Journal of Public Health, 86, 781-783. 

Goldenberg, R. L., Andrews, W. W., Yuan, A. C., MacKay, H. T., & St. Louis, M. E.. (1997). Sexually transmitted diseases and adverse outcomes in pregnancy. Clinics in Perinatology, 24, 23-41. 

Goldenberg, R. L., Cliver, S. P., Mulvihill, F. X., Hickey, C. A., Hoffman, H. J., Klerman, L. V., & Johnson, M. J.. (1996). Medical, psychosocial, and behavioral risk factors do not explain the increased risk for low birthweight among African American women. American Journal of Obstetrics and Gynecology, 175, 1317-1324. 

Goldenberg, R. L., Klebanoff, M. A., Nugent, R., Krohn, J. A., Hillier, S., & Andrews, W. W.. (1996). Bacterial colonization of the vagina during pregnancy in four ethnic groups. American Journal of Obstetrics and Gynecology, 174, 1618-1621. 

Golding, J. M.. (1994). Sexual assault history and physical health in randomly selected Los Angeles women. Health Psychology, 13, 130-138. 

Golding, J. M.. (1996). Sexual assault history and limitations in physical functioning in two general populations samples. Research in Nursing and Health, 19, 33-44. 

Golding, J. M.. (1999). Sexual assault history and headache: Five general population studies. Journal of Nervous and Mental Disease, 187, 624-629. 

Gomez Ponce de Leon, R., Gomez Ponce de Leon, L., Coviello, A., & De Vito, E.. (2001). Vascular maternal reactivity and neonatal size in normal pregnancy. Hypertension in Pregnancy, 20, 243-256. 

Gould, J. B., & LeRoy, S.. (1988). Socioeconomic status and low birthweight: A racial comparison. Pediatrics, 82, 896-904. 

Green, N. L.. (1995). Development of the Perceptions of Racism Scale. Image, 27, 141-146. 

Guthrie, B. J., Young, A. M., Williams, D. R., Boyd, C. J., & Kintner, E.. (2002). African American girls' smoking habits and day-to-day experiences with racial discrimination. Nursing Research, 51, 183-190. 

Guyll, M., Matthews, K. A., & Bromberger, J. T.. (2001). Discrimination and unfair treatment: Relationship to cardiovascular reactivity among African American and European American women. Health Psychology, 20, 315-325. 

Hack, M., Klein, N. K., & Taylor, H. G.. (1995). Long-term developmental outcomes of low birth weight infants. The Future of Children, 5, 176-196. 

Hamvas, A., Wise, P. H., Yang, R. K., Wampler, N. S., Noguchi, A., Maurer, M. M., et al. (1996). The influence of the wider use of surfactant therapy on neonatal mortality among African Americans and European Americans. New England Journal of Medicine, 334, 1635-1640. 

Haney, C., & Zimbardo, P.. (1998). The past and future of U.S. prison policy: Twenty-five years after the Stanford prison experiment. American Psychologist, 53, 709-727. 

Harburg, E., Blakelock, E. H., & Roeper, P. J.. (1979). Resentful and reflective coping with arbitrary authority and blood pressure: Detroit. Psychosomatic Medicine, 41, 189-202. 

Hargraves, M., & Thomas, R. W.. (1993). Infant mortality: Its history and social construction. American Journal of Preventive Medicine, 9. , 17-26. (Suppl. 2)

Herman, A. A.. (1996). Toward a conceptualization of race in epidemiologic research. Ethnicity & Disease, 6, 7-20. 

Herrara, J. A., Alvarado, J. P., & Martinez, J. E.. (1998). The psychosocial environment and cellular immunity in the pregnant patient. Stress and Medicine, 4, 49-56. 

Hertz-Picciotto, I., & Din-Dzietham, R.. (1997). Comparisons of infant mortality using a percentile-based method of standardization for birthweight or gestational age. Epidemiology, 9, 61-67. 

Hillier, S. L., Nugent, R. P., Eschenbach, D. A., Krohn, M. A., Gibbs, R. S., Martin, D. H., et al., for the Vaginal Infections and Prematurity Study Group (1995). Association between bacterial vaginosis and preterm delivery of a low-birth-weight infant. New England Journal of Medicine, 333, 1737-1742. 

Hobel, C. J., Dunkel-Schetter, C., Roesch, S. C., Castro, L. C., & Arora, C. P.. (1999). Maternal plasma corticotropin-releasing hormone associated with stress at 20 weeks' gestation in pregnancies ending in preterm delivery. American Journal of Obstetrics and Gynecology, 280, S257-S263. 

Hobfoll, S. E.. (1989). Conservation of resources: A new attempt at conceptualizing stress. American Psychologist, 44, 513-524. 

Hoffman, S., & Hatch, M. C.. (1996). Stress, social support and pregnancy outcome: A reassessment based on recent research. Paediatric and Perinatal Epidemiology, 10, 380-405. 

Hogan, V. K., Njoroge, T., Durant, T. M., & Ferre, C. D.. (2001). Toward eliminating disparities in perinatal outcomes—lessons learned. Maternal and Child Health Journal, 5, 135-140. 

Hogan, V. K., Richardson, J. L., Ferre, C. D., Durant, T., & Boisseau, M.. (2001). A public health framework for addressing African American and European American disparities in preterm delivery. Journal of American Medical Women's Association, 56, 177-180. 

Hogg, M. A., & Abrams, D.. (1988). Social identifications: A social psychology of intergroup relations and group processes. London: Routledge.

Hogue, C. J. R., & Hargraves, M. A.. (1993). Class, race, and infant mortality in the United States. American Journal of Public Health, 83, 9-12. 

Holzman, C., Bullen, B., Fisher, R., Paneth, N., Reuss, L., the Prematurity Study Group. (2001). Pregnancy outcomes and community health: The POUCH study of preterm delivery. Paediatric and Perinatal Epidemiology, 15, 136-158. 

Holzman, C., Jetton, J., Siler-Khodr, T., Fisher, R., & Rip, T.. (2001). Second trimester corticotropin-releasing hormone levels in relation to preterm delivery and ethnicity. Obstetrics and Gynecology, 97, 657-663. 

Hoyert, D. L., Freedman, M. A., Strobino, D. M., & Guyer, B.. (2001). Annual summary of vital statistics: 2000. Pediatrics, 108, 1241-1255. 

Hummer, R. A., Rogers, R. G., Nam, C. B., & LeClere, F. B.. (1999). Race/ethnicity, nativity, and U.S. adult mortality. Social Science Quarterly, 80, 136-153. 

Hutchins, E., & DiPietro, J.. (1997). Psychosocial risk factors associated with cocaine use during pregnancy: A case-control study. Obstetrics and Gynecology, 90, 142-147. 

Hyman, D. J., Ogbonnaya, K., Pavlik, V. N., Poston, W. S. C., & Ho, K.. (2000). Lower hypertension prevalence in first-generation African-immigrants compared to U.S.-born African Americans. Ethnicity & Disease, 10, 343-349. 

Innes, K. E., Byers, T. E., Marshall, J. A., Barón, A., Orleans, M., & Hamman, R. F.. (2002). Association of a woman's own birth weight with subsequent risk for gestational diabetes. JAMA, 287, 2534-2541. 

Jackson, F. M., Phillips, M. T., Rowland Hogue, C. J., & Curry-Owens, T. Y.. (2001). Examining the burdens of gendered racism: Implications for pregnancy outcomes among college-educated African American women. Maternal and Child Health Journal, 5, 95-107. 

James, S. A.. (1993). Racial and ethnic differences in infant mortality and low birthweight: A psychosocial critique. Annals of Epidemiology, 3, 130-136. 

Jones, C. P.. (2000). Levels of racism: A theoretical framework and a gardener's tale. American Journal of Public Health, 90, 1212-1215. 

Jones, J. M.. (2003). TRIOS: A psychological theory of the African legacy in American culture. Journal of Social Issues, 59, 217-242. 

Kaiser, C. R., & Miller, C. R.. (2001). Stop complaining! The social costs of making attributions to discrimination. Personality and Social Psychology Bulletin, 27, 254-263. 

Kaplan, J. B., & Bennett, T.. (2003). Use of race and ethnicity in biomedical publication. JAMA, 289, 2709-2716. 

Kiecolt-Glaser, J., Marucha, P., Malarkey, W., Mercado, A., & Glaser, R.. (1995). Slowing of wound healing by psychological stress. Lancet, 346, 1194-1196. 

Kiecolt-Glaser, J. K., McGuire, L., Robles, T. F., & Glaser, R.. (2002). Psychoneuroimmunology: Psychological influences on immune function and health. Journal of Consulting and Clinical Psychology, 70, 537-547. 

Kleinman, J. C., Fingerhut, L. A., & Prager, K.. (1991). Differences in infant mortality by race, nativity, and other maternal characteristics. American Journal of Diseases of Children, 145, 194-199. 

Kleinman, J. C., & Kessel, S. S.. (1987). Racial differences in low birthweight: Trends and risk factors. New England Journal of Medicine, 317, 749-753. 

Klerman, L. V., Ramey, S. L., Goldenberg, R. L., Marbury, S., Hou, J., & Cliver, S. P.. (2001). A randomized trial of augmented prenatal care for multiple-risk, Medicaid-eligible African American women. American Journal of Public Health, 91, 105-111. 

Klonoff, E. A., & Landrine, H.. (1999). Cross-validation of the Schedule of Racist Events. Journal of Black Psychology, 25, 231-254. 

Klonoff, E. A., & Landrine, H.. (2000). Is skin color a marker for racial discrimination? Explaining the skin color-hypertension relationship. Journal of Behavioral Medicine, 23, 329-338. 

Klonoff, E. A., Landrine, H., & Ullman, J. B.. (1999). Racial discrimination and psychiatric symptoms among Blacks. Cultural Diversity & Ethnic Minority Psychology, 5, 329-339. 

Kramer, M. S., Goulet, L., Lydon, J., Seguin, L., McNamara, H., Dassa, C., et al. (2001). Socio-economic disparities in preterm birth: Causal pathways and mechanisms. Paediatric and Perinatal Epidemiology, 15. , 104-123. (Suppl. 2)

Krantz, D. S., & McCeney, M. K.. (2002). Effects of psychological and social factors on organic disease: A critical assessment of research on coronary heart disease. Annual Review of Psychology, 53, 341-369. 

Krieger, N.. (1990). Racial and gender discrimination: Risk factors for high blood pressure. Social Science and Medicine, 30, 1273-1281. 

Krieger, N., & Sidney, S.. (1996). Racial discrimination and blood pressure: The CARDIA study of young African American and European American adults. American Journal of Public Health, 86, 1370-1378. 

Kwate, N. O., Valdimarsdottir, H. B., Guevarra, J. S., & Bovbjerg, D. H.. (2003). Experiences of racist events are associated with negative health consequences for African American women. Journal of the National Medical Association, 95, 450-460. 

Landrine, H., & Klonoff, E. A.. (1996). African American acculturation: Deconstructing race and reviving culture. Thousand Oaks, CA: Sage.

Lane, S. D., Cibula, D. A., Milano, L. P., Shaw, M., Bourgeois, B., Schweitzer, F., et al. (2001). Racial and ethnic disparities in infant mortality: Risk in social context. Journal of Public Health Management and Practice, 7, 30-46. 

LaVeist, T. A.. (1996). Why we should continue to study race … but do a better job: An essay on race, racism and health. Ethnicity & Disease, 6, 21-29. 

Lazarus, R. S., & Folkman, S.. (1984). Stress, appraisal, and coping. New York: Springer.
Lederman, R. P.. (1995). Relationship of anxiety, stress, and psychosocial development to reproductive health. Behavioral Medicine, 21, 101-112. 

Leonard, J. A., Keys, C. B., Suarez-Balcazar, Y., Taylor, R. R., & Davis, M. I.. (2004). Participatory community research: Theories and methods in action. Washington, DC: American Psychological Association.

Leserman, J., Jackson, E. D., Petitto, J. M., Golden, R. N., Silva, S. G., Perkins, D. O., et al. (1999). Progression to AIDS: The effects of stress, depressive symptoms, and social support. Psychosomatic Medicine, 61, 397-406. 

Leserman, J., Petitto, J. M., Golden, R. N., Gaynes, B. N., Gu, H., Perkins, D. O., et al. (2000). Impact of stressful life events, depression, social support, coping, and cortisol on progression to AIDS. American Journal of Psychiatry, 157, 1221-1228. 

Lespinasse, A. A., David, R. J., Collins, J. W., Handler, A. S., & Wall, S. N.. (2004). Maternal support in the delivery room and birthweight among African American women. Journal of the National Medical Association, 96, 187-195. 

Light, K. C.. (2001). Hypertension and the reactivity hypothesis: The next generation. Psychosomatic Medicine, 63, 744-746. 

Light, K. C., Girdler, S. S., Sherwood, A., Bragdon, E. E., Brownley, K. A., West, S. G., & Hinderliter, A. L.. (1999). High stress responsivity predicts later blood pressure only in combination with positive family history and high life stress. Hypertension, 33, 1458-1464. 

Lobel, M.. (1994). Conceptualizations, measurement, and effects of prenatal maternal stress on birth outcomes. Journal of Behavioral Medicine, 17, 225-271. 

Lobel, M.. (1998). Pregnancy and mental health. In H. Friedman (Ed.), Encyclopedia of mental health (pp. 229-238). San Diego, CA: Academic Press.

Lobel, M., & Dunkel-Schetter, C.. (1990). Conceptualizing stress to study effects on health: Environmental, perceptual, and emotional components. Anxiety Research, 3, 213-230. 

Lobel, M., Dunkel-Schetter, C., & Scrimshaw, S. C. M.. (1992). Prenatal maternal stress and prematurity: A prospective study of socioeconomically disadvantaged women. Health Psychology, 11, 32-40. 

Lobel, M., & Graham, J.. (2002, February). Explaining stress effects on birth outcomes: Health behaviors, ethnicity, and socioeconomic status. In R. Zambrana (Chair), Translating psychosocial research into culturally competent health care. Symposium conducted at the Enhancing Outcomes in Women's Health Interdisciplinary Conference sponsored by the American Psychological Association, Washington, DC.

Lockwood, C. J.. (1999). Stress-associated preterm delivery: The role of corticotropin releasing hormone. American Journal of Obstetrics and Gynecology, 180, S264-S266. 

Lu, G. C., & Goldenberg, R. L.. (2000). Current concepts on the pathogenesis and markers of preterm births. Clinical Perinatology, 27, 263-283. 

MacDorman, M. F., Martin, J. A., Mathews, T. J., Hoyert, D. L., & Ventura, S. J.. (2005). Explaining the 2001-02 infant mortality increase: Data from the linked birth/infant death data set. National Vital Statistics Report, 24, 1-22. 

Macera, C. A., Armstead, C. A., & Anderson, N. B.. (2001). Sociocultural influences on health. In A. Baum, T. A. Revenson, & J. E. Singer (Eds.), Handbook of health psychology (pp. 427-440). Mahwah, NJ: Erlbaum.

Mackey, M. C., Williams, C. A., & Tiller, C. M.. (2000). Stress, pre-term labour and birth outcomes. Journal of Advanced Nursing, 32, 666-674. 

Mathews, T. J., MacDorman, M. F., & Menacker, F.. (2002, January 30). Infant mortality statistics from the 1999 period linked birth/infant death data set. National Vital Statistics Report, 50(4), 1-27. 

Mathews, T. J., Menacker, F., & MacDorman, M. F.. (2003, September 15). Infant mortality statistics from the 2001 period linked birth/infant death data set. National Vital Statistics Report, 52(2), 1-28. 

McCormick, M. C., Brooks-Gunn, J., Shorter, T., Holmes, J. H., Wallace, C. Y., & Heagarty, M. C.. (1990). Factors associated with smoking in low-income pregnant women: Relationship to birth weight, stressful life events, social support, health behaviors and mental distress. Journal of Clinical Epidemiology, 43, 441-448. 

McCubbin, J. A.. (1991). Diminished opiod inhibition of blood pressure and pituitary function in hypertension development. In J. A. McCubbin, P. G. Kaufmann, & C. B. Nemeroff (Eds.), Stress, neuropeptides, and systemic disease (pp. 445-466). San Diego: Academic Press. 

McCubbin, J. A., Lawson, E. J., Cox, S., Sherman, J. J., Norton, J. A., & Read, J. A.. (1996). Prenatal maternal blood pressure response to stress predicts birthweight and gestational age: A preliminary study. American Journal of Obstetrics and Gynecology, 175, 706-712. 

McEwen, B. S.. (1998). Stress, adaptation, and disease: Allostasis and allostatic load. In S. M. McCann (Ed.), Annals of the New York Academy of Sciences: Vol. 840. 

Neuroimmunomodulation: Molecular aspects, integrative systems, and clinical advances (pp. 33-44). New York: New York Academy of Sciences.

McEwen, B. S., & Stellar, E.. (1993). Stress and the individual mechanisms leading to disease. Archives of Internal Medicine, 153, 2093-2101. 

McGrady, G. A., Sung, J. F. C., Rowley, D. L., & Hogue, C. J. R.. (1992). Preterm delivery and low birthweight among first-born infants of African American and European American college graduates. American Journal of Epidemiology, 136, 266-276. 

McGregor, J. A., French, J. I., Parker, R., Draper, D., Patterson, E., Jones, W., et al. (1995). Prevention of premature birth by screening and treatment for common genital tract infections: Results of a prospective controlled evaluation. American Journal of Obstetrics and Gynecology, 173, 157-167. 

McKenna, M. C., Zevon, M. A., Corn, B., & Rounds, J.. (1999). Psychosocial factors and the development of breast cancer: A meta-analysis. Health Psychology, 18, 520-531. 

McLoyd, V.. (1998). Socioeconomic disadvantage and child development. American Psychologist, 53, 185-204. 

Meis, P. J., Goldenberg, R. L., Mercer, B. M., Iams, J. D., Moawad, A. H., Miodovnik, M., et al. (2000). Preterm prediction study: Is socioeconomic status a risk factor for bacterial vaginosis in African American or in European American women? American Journal of Perinatology, 17, 41-45. 

Miller, D. F.. (1995). Dimensions of community health (4th ed.). Madison, WI: Brown and Benchmark.

Moradi, B., & Subich, L. M.. (2003). A concomitant examination of the relations of perceived racist and sexist events to psychological distress for African American women. The Counseling Psychologist, 431, 451-469. 

Mullings, L., Wali, A., McLean, D., Mitchell, J., Prince, S., Thomas, D., et al. (2001). Qualitative methodologies and community participation in examining reproductive experiences: The Harlem birth right project. Maternal and Child Health Journal, 5, 85-93. 

Murrell, N. L.. (1996). Stress, self-esteem, and racism: Relationships with low birthweight and preterm delivery in African American women. Journal of National Black Nurses Association, 8, 45-53. 

Myers, D. G.. (1996). Social psychology (5th ed.). New York: McGraw-Hill.

Myers, H. F., Lewis, T. T., & Parker-Dominguez, T.. (2003). Stress, coping, and minority health: Biopsychosocial perspective on ethnic health disparities. In G. Bernal, J. E. Trimble, A. K. Burlew, & F. T. L. Leong (Eds.), Handbook of racial and ethnic minority psychology (pp. 377-400). Thousand Oaks, CA: Sage.

Naeye, R.. (1979). Causes of fetal and neonatal mortality by race in a selected U.S. population. American Journal of Public Health, 69, 857-861. 

Newnham, J.. (1998). Consequences of fetal growth restriction. Current Opinion in Obstetrics and Gynecology, 10, 145-149. 

Newton, E. R., Piper, J. M., Shain, R. N., Perdue, S. T., & Peairs, W.. (2001). Predictors of the vaginal microflora. American Journal of Obstetrics and Gynecology, 184, 845-855. 

Norbeck, J. S., & Anderson, N. J.. (1989). Psychosocial predictors of pregnancy outcomes in low-income Black, Hispanic, and White women. Nursing Research, 38, 204-209. 

Orr, S. T., James, S. A., Miller, C. A., Barakat, B., Daikoku, N., Pupkin, M., et al. (1996). Psychosocial stressors and low birthweight in an urban population. American Journal of Preventive Medicine, 12, 459-466. 

Ostrove, J. M., Adler, N. E., Kuppermann, M., & Washington, A. E.. (2000). Objective and subjective assessments of socioeconomic status and their relationship to self-rated health in an ethnically diverse sample of pregnant women. Health Psychology, 19, 613-618. 

Oths, K. S., Dunn, L. L., & Palmer, N. S.. (2001). A prospective study of psychosocial job strain and birth outcomes. Epidemiology, 12, 744-746. 

Parker-Dominguez, T., Dunkel-Schetter, C., Hobel, C. J., Glynn, L., & Sandman, C. A.. (2004, November). Racism and psychosocial functioning during pregnancy: A multiethnic comparison. In C. Rohweder (Chair), Delving into the black box: New perspectives on race, ethnicity, and birth outcomes. Symposium conducted at the 132nd annual meeting of the American Public Health Association, Washington, DC.

Petrie, K. J., Booth, R. J., & Pennebaker, J. W.. (1998). The immunological effects of thought suppression. Journal of Personality and Social Psychology, 75, 1264-1272. 

Phinney, J. S.. (1996). When we talk about American ethnic groups, what do we mean? American Psychologist, 51, 918-927. 

Rajamanoharan, S., Low, N., Jones, S. B., & Pozniak, A. L.. (1999). Bacterial vaginosis, ethnicity, and the use of genital cleaning agents: A case control study. Sexually Transmitted Diseases, 26, 404-409. 

Rawlings, J. S., & Weir, M. R.. (1992). Race- and rank-specific infant mortality in a U.S. military population. American Journal of Diseases in Childhood, 146, 313-316. 

Reid, P. T.. (2004). A postscript for research on Black women: New populations, new directions. Journal of Black Psychology, 30, 443-446. 

Rich-Edwards, J. W., Colditz, G. A., Stampfer, M. J., Willett, W. C., Gillman, M. W., Hennekens, C. H., et al. (1999). Birthweight and the risk for Type 2 diabetes mellitus in adult women. Annals of Internal Medicine, 130, 278-284. 

Rich-Edwards, J. W., & Gillman, M. W.. (1997). Commentary: A hypothesis challenged. British Medical Journal, 315, 1348-1349. 

Rich-Edwards, J. W., Krieger, N., Majzoub, J., Zierler, S., Lieberman, E., & Gillman, M.. (2001). Maternal experiences of racism and violence as predictors of preterm birth: Rationale and study design. Paediatric and Perinatal Epidemiology, 15, 124-135. 

Rini, C. K., Dunkel-Schetter, C., Wadhwa, P. D., & Sandman, C. A.. (1999). Psychological adaptation and birth outcomes: The role of personal resources, stress, and sociocultural context in pregnancy. Health Psychology, 18, 333-345. 

Robillard, P., Hulsey, T. C., Alexander, G. R., Sergent, M., de Caunes, F., & Papiernik, E.. (1994). Hyaline membrane disease in African American newborns: Does fetal lung maturation occur earlier? European Journal of Obstetrics and Gynecology and Reproductive Biology, 55, 157-161. 

Rodriguez, A., & Bohlin, G.. (2000). Psychosocial predictors of smoking and exercise during pregnancy. Journal of Reproductive and Infant Psychology, 18, 203-223. 

Rooth, G.. (1980). Low birthweight revised. Lancet, 1, 639-641. 

Rosenberg, L., Palmer, J. R., Wise, L. A., Horton, N. J., & Corwin, M. J.. (2002). Perceptions of racial discrimination and the risk of preterm birth. Epidemiology, 13, 646-652. 

Rowley, D. L.. (1994). Research issues in the study of very low birthweight and preterm delivery among African American women. Journal of the National Medical Association, 86, 761-764. 

Rowley, D. L.. (2001). Closing the gap, opening the process: Why study social contributors to preterm delivery among black women. Maternal and Child Health Journal, 5, 71-74.  

Royce, R. A., Jackson, T. P., Thorp, J. M., Hillier, S. L., Rabe, L. K., Pastore, L. M., & Savitz, D. A.. (1999). Race/ethnicity, vaginal flora patterns, and pH during pregnancy. Sexually Transmitted Diseases, 26, 96-102. 

Ruijter, I., & Miller, J. M.. (1999). Evaluation of low birthweight in African Americans. Journal of the National Medical Association, 91, 663-667. 

Sagrestano, L., Feldman, P., Killingsworth-Rini, C., Woo, G., & Dunkel-Schetter, C.. (1999). Ethnicity and support during pregnancy. American Journal of Community Psychology, 27, 869-898. 

Schensul, M., & Stull, J. D.. (1987). Collaborative research and social change: Applied anthropology in action. Boulder, CO: Westview Press.

Schneider, E. C., Zaslavsky, A. M., & Epstein, A. M.. (2002). Racial disparities in the quality of care for enrollees in Medicare managed care. JAMA, 287, 1288-1294. 

Schoendorf, K. C., Hogue, C. J. R., Kleinman, J. C., & Rowley, D.. (1992). Mortality among infants of African American as compared with European American college-educated parents. New England Journal of Medicine, 326, 1522-1526. 

Scholz, J. K., & Levine, K.. (2002, February 25). U.S. African American-European American wealth inequality: A survey. Retrieved August 26, 2002, from http://www.russellsage.org/special_interest/socialinequality/revWealth_survey_v5.pdf 
Schwartz, G. E.. (1990). Psychobiology of repression and health: A systems approach. In J. L. Singer (Ed.), Repression and dissociation (pp. 405-434). Chicago: University of Chicago Press.

Scott-Wright, A. O., Wrona, R. M., & Flanagan, T. M.. (1998). Predictors of infant mortality among college-educated African American and European American women, Davidson County, Tennessee, 1990-1994. Journal of the National Medical Association, 90, 477-483. 

Seeman, T. E., Rowe, J. W., McEwen, B. S., & Singer, B. H.. (2001). Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging. Proceedings of the National Academy of Sciences, USA, 98, 4770-4775. 

Seeman, T. E., Singer, B. H., Rowe, J. W., Horwitz, R. I., & McEwen, B. S.. (1997). Price of adaptation—allostatic load and its health consequences. MacArthur studies of successful aging. Archives of Internal Medicine, 157, 2259-2268. 

Seeman, T. E., Singer, B. H., Ryff, C. D., Love, G. D., & Levy-Storms, L.. (2002). Social relationships, gender, and allostatic load across two age cohorts. Psychosomatic Medicine, 64, 395-406. 

Shanks, N., & Lightman, S. L.. (2001). The maternal-neonatal neuro-immune interface: Are there long-term implications for inflammatory or stress-related disease? The Journal of Clinical Investigation, 108, 1567-1573. 

Shiono, P. H., Klebanoff, M. A., Graubard, B. I., Berendes, H. W., & Rhoads, G. G.. (1986). Birthweight among women of different ethnic groups. JAMA, 255, 48-52. 

Sigelman, L., & Welch, S.. (1991). Black Americans' views of racial inequality: The dream deferred. New York: Cambridge University Press.

Singh, G. K., & Yu, S. M.. (1996). Adverse pregnancy outcomes: Differences between U.S.- and foreign-born women in major U.S. racial and ethnic groups. American Journal of Public Health, 86, 837-843. 

Sjostrom, K., Valentin, L., Thelin, T., & Marsal, K.. (1997). Maternal anxiety in late pregnancy and fetal hemodynamics. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 74, 149-155. 

Skjaerven, R., Wilcox, A. J., Oyen, N., & Magnus, P.. (1997). Mothers' birth weight and survival of their offspring: Population based study. British Medical Journal, 314, 1376-1380. 

Smyth, J. M., & Pennebaker, J. W.. (2001). What are the health effects of disclosure? In A. Baum, T. A. Revenson, & J. E. Singer (Eds.), Handbook of health psychology (pp. 339-348). Mahwah, NJ: Erlbaum.

Stancil, T. R., Hertz-Picciotto, I., Schramm, M., & Watt-Morse, M.. (2000). Stress and pregnancy among African American women. Paediatric and Perinatal Epidemiology, 14, 127-135. 

Stangor, C., Swim, J. K., Van Allen, K. L., & Sechrist, G. B.. (2002). Reporting discrimination in public and private contexts. Journal of Personality and Social Psychology, 82, 69-74. 

Stanton, A. L., Lobel, M., Sears, S., & DeLuca, R. S.. (2002). Psychosocial aspects of selected issues in women's reproductive health: Current status and future directions. Journal of Consulting and Clinical Psychology, 70, 751-770. 

Stephen, E. H., Foote, K., Hendershot, G. E., & Schoenborn, C. A.. (1994). Health of the foreign-born population: United States, 1989-1990. Advance Data, 241, 1-12. 

Suro, R.. (1993, January 11). Pollution-weary minorities try civil rights tack. New York Times, p. A1.

Swim, J. K., & Hyers, L. L.. (1999). Excuse me—What did you just say?!: Women's public and private responses to sexist remarks. Journal of Experimental Social Psychology, 35, 68-88. 

Tavares, M., Rodrigues, T., Cardoso, F., Barros, H., & Leite, L. P.. (1996). Independent effect of maternal birth weight on infant birth weight. Journal of Perinatal Medicine, 24, 391-396. 

Teixeira, J. M., Fisk, N. M., & Glover, V.. (1999). Association between maternal anxiety in pregnancy and increased uterine artery resistance index: Cohort based study. British Medical Journal, 318, 153-157. 

Thompson, R. J., Gustafson, K. E., Oehler, J. M., Catlett, A. T., Brazy, J. E., & Goldstein, R. F.. (1997). Developmental outcome of very low birth weight infants at four years of age as a function of biological risk and psychosocial risk. Developmental and Behavioral Pediatrics, 18, 91-96. 

Troxel, W. M., Matthews, K. A., Bromberger, J. T., & Sutton-Tyrrell, K.. (2003). Chronic stress burden, discrimination, and subclinical carotid artery disease in African American and Caucasian women. Health Psychology, 22, 300-309. 

United States Census Bureau. (2002). Facts on African Americans/African American population. Retrieved August 14, 2002, from http://www.census.gov/pubinfo/www/afamho1.html 

United States Department of Health and Human Services. (2000). Eliminating racial and ethnic disparities in health. Retrieved August 25, 2002, from http://raceandhealth.hhs.gov/sidebars/sbinitOver.htm 

United States Department of Housing and Urban Development. (1999). What we know about mortgage lending discrimination in America. Retrieved August 25, 2002, from http://www.hud.gov/library/bookshelf18/pressrel/pr99-191.html 

United States Department of Justice. (2003). U.S. prison population rises 2.6 percent during 2002. Retrieved November 5, 2004, from http://www.ojp.usdoj.gov/bjs/pub/press/p02pr.htm 

University of Michigan. (2000). Net worth of U.S. households. Retrieved August 1, 2002, from http://www.umich.edu/?newsinfo/Releases/2000/Feb00./r020800a.html 

Utsey, S. O.. (1998). Assessing the stressful effects of racism: A review of instrumentation. Journal of Black Psychology, 24, 269-288. 

Utsey, S. O., & Ponterotto, J. G.. (1996). Development and validation of the index of race-related stress (IRRS). Journal of Counseling Psychology, 4, 490-501. 

Utsey, S. O., Ponterotto, J. G., & Reynolds, A. L.. (2000). Racial discrimination, coping, life satisfaction, and self-esteem among African Americans. Journal of Counseling and Development, 78, 72-80. 

Vasconcelos, A. G. G., Almeida, R. M. V., & Nobre, F. F.. (1998). The path analysis approach for the multivariate analysis of infant mortality data. Annals of Epidemiology, 8, 262-271. 

Virji, S. K., & Cottington, E.. (1991). Risk factors associated with preterm deliveries among racial groups in a national sample of married mothers. American Journal of Perinatology, 8, 347-353. 

Wadhwa, P. D., Culhane, J. F., Rauh, V., & Barve, S. S.. (2001). Stress and preterm birth: Neuroendocrine, immune/inflammatory, and vascular mechanisms. Maternal and Child Health Journal, 5, 119-125. 

Wadhwa, P. D., Culhane, J. F., Rauh, V., Barve, S. S., Hogan, V., Sandman, C. A., et al. (2001). Stress, infection and preterm birth: A biobehavioural perspective. Paediatric and Perinatal Epidemiology, 15, 17-29. 

Wadhwa, P. D., Dunkel-Schetter, C., Chicz-DeMet, A., Porto, M., & Sandman, C. A.. (1996). Prenatal psychosocial factors and the neuroendocrine axis in human pregnancy. Psychosomatic Medicine, 58, 432-446. 

Warren, W. B., Gurewitsch, E. D., & Goland, R. S.. (1995). Corticotropin-releasing hormone and pituitary-adrenal hormones in pregnancies complicated by chronic hypertension. American Journal of Obstetrics and Gynecology, 172, 661-666. 

Wasse, H., Holt, V. L., & Daling, J. R.. (1994). Pregnancy risk factors and birth outcomes in Washington State: A comparison of Ethiopian-born and U.S.-born women. American Journal of Public Health, 84, 1505-1507. 

Wilcox, A., & Russell, I.. (1990). Why small African American infants have a lower mortality rate than small European American infants: The case for population-specific standards for birthweight. The Journal of Pediatrics, 116, 7-10. 

Williams, D. R., Lavizzo-Mourey, R., & Warren, R. C.. (1994). The concept of race and health status in America. Public Health Reports, 109, 26-41. 

Williams, R. A., & Nesiba, R. F.. (1997). Racial, economic, and institutional differences in home mortgage loans: A case study analysis of St. Joseph County, Indiana. Journal of Urban Affairs, 19, 73-103. 

Wise, P. H.. (1993). Confronting racial disparities in infant mortality: Reconciling science and politics. American Journal of Preventive Medicine, 6, 7-16. 

Wise, P. H., Kotelchuch, M., Wilson, M. L., & Mills, M.. (1985). Racial and socioeconomic disparities in childhood mortality in Boston. New England Journal of Medicine, 313, 360-366. 

Yali, A. M., & Lobel, M.. (1999). Coping and distress in pregnancy: An investigation of medically high risk women. Journal of Psychosomatic Obstetrics and Gynecology, 20, 39-52. 

Yali, A. M., & Lobel, M.. (2002). Stress resistance resources and coping in pregnancy. Anxiety, Stress, and Coping, 15, 289-309. 

Zhang, J., Thomas, A. G., & Leybovich, E.. (1997). Vaginal douching and adverse health effects: A meta-analysis. American Journal of Public Health, 87, 1207-1211.