Measuring lifetime stress exposure and protective factors in life course research on racial inequality and birth outcomes

Abstract

There has been a long-standing interest in better understanding how social factors contribute to racial disparities in health, including birth outcomes. A recent emphasis in this context has been on identifying the effects of stress exposure and protective factors experienced over the entire lifetime. Yet despite repeated calls for a life course approach to research on this topic, very few studies have actually assessed how stressors and protective factors occurring over women’s lives relate to birth outcomes. We discuss this issue here by describing how challenges in the measurement of lifetime stress exposure and protective factors have prevented researchers from developing an empirically-based life course perspective on health. First, we summarize prevailing views on racial inequality and birth outcomes; second, we discuss measurement challenges that exist in this context; and finally, we describe both new tools and needed tools for assessing lifetime stress exposure and suggest opportunities for integrating information on stress exposure and psychosocial protective factors. We conclude that more studies are needed that integrate information about lifetime stress exposures and the protective factors that promote resilience against such exposures to inform policy and practice recommendations to reduce racial disparities in birth outcomes.

Keywords:

• Stress
• social support
• measurement
• resilience
• birth outcomes
• health
• racial disparities

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Preparation of this commentary was supported by funding to the first and second authors from March of Dimes Prematurity Research Center Ohio Collaborative and the Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, and by National Institutes of Health grant K08 MH103443 and a Society in Science – Branco Weiss Fellowship to George Slavich.