Understanding Race-Related Health Disparities among Rural, Low-SES Mothers and Children

Mothers and their young children in rural low-income areas disproportionately face disparities in health which have immediate negative consequences and can create lifelong vulnerability for poor physical and mental functioning. Further racial and ethnic minority families face unique inequities in maternal and child health (MCH) which can be further exacerbated by a lack of healthcare access in rural areas. The public health importance of MCH disparities in rural low-income areas requires investigation of multifaceted determinants of MCH. Guided by the biopsychosocial model and minority stress theory this project proposes to examine biopsychosocial determinants influencing MCH disparities over 3 years while addressing unique challenges racial minority families face in a rural low-income setting. The proposed project aligns closely with the Maternal and Child Health Bureau�s strategy plans by addressing health equity among MCH populations informing programs for quality and equitable health services and building collaborative partnerships with government and MCH experts. Aim 1 of the proposed project examines risk and resilience profiles that differentiate MCH outcomes over 3-year postpartum and examine whether such profiles differ by race of mothers and children (Black and White) among rural low-SES families. Aim 2 analyzes time-sensitive risk and resilience factors predicting MCH and examine whether the time-sensitiveness is dependent on maternal and child race (Black and White) among rural low-SES families. Aim 3 investigates racial stress and discrimination as moderators towards the salience of risk and resilience factors on MCH among rural low-SES Black families. Aim 4 incorporates three national longitudinal datasets to compare MCH outcomes among rural low-SES urban low-SES and urban middle-class with three racial and ethnic groups (Black White and Hispanic). To address the specific aims we seek one-year support for a project conducting secondary data analyses using the Family Life Project (1 286 rural low-SES families) the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (1 324 urban middle-class families) and the Fragile Families and Child Wellbeing Study (4 692 urban low-SES families). We will use advanced statistical modeling with personcentered and variable-centered analytic techniques that match the longitudinal nature of the study and multifaceted relations among variables. This study is highly significant in that 1) it addresses a largely under-studied yet vulnerable MCH population; 2) it moves the field forward into a systematic investigation of multilevel risk and resilience factors; 3) it highlights the importance of minority stress in shaping multiple aspects of MCH; 4) comparison among rural and urban families increases the robustness of our findings and will provide much needed evidence to inform healthcare policy and intervention.