Life-Course Stress, Preterm Birth and African American Women
This dissertation is a qualitative study of African American (AA) women and their experiences of life-course stress. In depth interviews were conducted with 25 women, half of whom delivered preterm. Data were transcribed verbatim and analyzed with dimensional analysis grounded theory method. An overall conceptualization of life-course stress was developed. The context of stress included personal identifiers, social and physical geographies and individual perspective. Conditions of stress included relationships, traumatic events, financial strains, daily activities and interactions with "The System". The most pertinent conditions reported were child abuse and neglect, living with substance abusing parents, separation from family members through death or placement in foster care and traumatic events such as rape, kidnapping and murders. The trigger of stress was not important in isolation. Each woman was embedded in the context of her life and experienced circumstances differently. Experiencing stress included cognitive, affective (fear, anger, shame and sadness) and physical dimensions. The roles of powerlessness, threat to social self and positions within hierarchies were explored. Coping, through constructive and destructive means, was integral to the stress experience. Consequences included choices made, conscious and unconscious burdens. The lasting effects included increased resiliency, an intensified stress experience, or lingering conscious or unconscious stress burdens. Several intensifiers of the stress experience were identified including social isolation, a limited perspective, magnitude and multiplicity of stressors. Resiliency was characterized by personal strength, perseverance, optimism and peace. Preterm and fullterm birth groups were compared for differences in life-course stress experiences; the most pronounced being the magnitude of the stressors, the social and physical geographies of women's lives, and position within macro- and micro- social hierarchies. These factors may be of particular concern when examining women's life-course trajectories. The data demonstrate how life-course stress may impact reproductive outcomes. It provides insight into the stress experience of AA women and demonstrates the dynamic relationship between stress, intensifiers, coping and women's resiliency. The findings address why previous assessment of reported stress and preterm birth has not been effective and give an evidence-based foundation to build on for future assessment of stress and preterm birth in AA women.