and unsafe neighborhoods, and they do not have adequate community resources for responding to health and medical emergencies. Including these communitylevel factors in studies of stress and preterm delivery requires group-level measurements of exposure. Such factors have not been utilized widely in epidemiological research in these areas, but a few studies are beginning to confirm the utility of pursuing these contextual causes.

Social position, Rich-Edwards noted, is an example of a strong predictor of preterm birth, which has implications for the timing of chronic stress. Women’s education level is a predictor of low birth weight births across racial and age lines. In all categories, however, African-American women are more likely to have low birth weight babies than Caucasian women. For example, a college-educated African-American mother still has twice the risk of having a low birth weight baby compared to a Caucasian college-educated mother. Further, among African American infants, mortality is lower in cities with less residential segregation (an example of institutional racism), a finding that is independent of the effect of poverty on infant mortality. In addition to the growing evidence that institutionalized and interpersonal racism adversely affects the health of African-American infants, racism in the United States may also affect the reproductive health of Mexican Americans.

Women’s education level is a predictor of low birth weight births across racial and age lines.

Janet Rich-Edwards


Coping strategies, in contrast to coping resources, describe specific behavioral or cognitive attempts to manage stressful demands. Problem-focused coping is more likely to be used when the stressor is perceived as controllable or modifiable, while emotion-focused coping is used more frequently when the stressor is perceived as uncontrollable. To date, research results are inconclusive regarding whether either strategy is more effective in buffering the effects of stressors, according to Hogue. Another important buffer may be spirituality, or reliance on a force beyond the individual. This too has yet to be explored with respect to preterm delivery. Among the most common coping strategies known to have deleterious effects on the outcome of pregnancy are alcohol use, drug dependence, and cigarette smoking.

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