An assessment of environmental and neighborhood-level risk factors for subfertility among Black women in the U.S.

Project summary This application for the Research Supplement to Promote Diversity in Health-Related Research (PA-23-189) proposes a research and career development plan to develop the independence of Dr. Brittney Francis through a study titled, “An exploration of segregation, neighborhood-level contextual factors and maternal

hypertension among Black women in the U.S. using causal inference methods” for the award period of 07/01/24-06/30/26 to enhance the parent grant, “An assessment of environmental and neighborhood-level risk factors for subfertility among Black women in the U.S.” (R01-ES035053; PI- Dr. Amelia Wesselink). The

proposed supplement study will conduct a secondary analysis using causal mediation methods with the overarching goal of examining the complex association between racial residential segregation, neighborhood level contextual factors, and hypertensive disorders of pregnancy (HDP) in the Black Women’s Health Study

(BWHS). HDP is an important public health problem for many reasons. A person impacted by an HDP is more likely to experience other maternal complications and adverse sequalae associated with them which has immediate and long-term health impacts across an individual’s lifecourse and their offspring. This study will use

existing (through parent grant) and new data linkages to the BWHS to specifically examine food access and exposure to environmental toxins as mediators between the relationship of racial and economic segregation and HDPs among Black women. This proposed diversity supplement will significantly contribute to furthering

our understanding of the role of structural racism in shaping risk of maternal HDP and points of intervention that can decrease the health inequities we see for Black women on a population level. This proposed research is critical, timely and can be translated to impact current policy decisions about neighborhood infrastructure

and development that will advance reproductive health equity, promote reproductive justice, create safe and healthy neighborhoods, and reduce the costs due to health disparities in this country.