All ETDs from UAB

Advisory Committee Chair

Gwendolyn Childs

Advisory Committee Members

Andres Azuero

Nataliya Ivankova

Candace Knight

Rachel Sinkey

Irena Stepanikova

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Nursing


BACKGROUND: In the United States, infant mortality is a serious public health issue, particularly for the African American (AA) population. Despite ample research investigating explanations for the significantly higher infant mortality rate (IMR) for AA infants in the United States, the reason for the racial disparity remains unknown. Reports suggest that chronic, life-course stressors may increase risk of preterm birth (PTB), the leading contributor to the high IMR for AA infants. Adverse childhood experiences and perceived racial discrimination, experienced over the life course, have the potential to increase a stress response in AA women, leading to PTB. Psychosocial resources may modify the risk of PTB. METHODS: An explanatory sequential quan ® QUAL mixed methods research (MMR) study was conducted to explore the relationships among adverse childhood experiences, perceived racial discrimination over the life course, psychosocial resources, and length of gestation in a population of AA pregnant women. The quantitative strand of the study involved surveying participants (n= 98) for levels of exposure to adverse childhood experiences and experiences of discrimination. The qualitative strand of the study utilized in-depth, semi-structured interviews to explore psychosocial resources and coping strategies of high-scoring participants (n = 12). The overall MMR question, “What psychosocial resources provide a protective effect against PTB and/or shortened iii length of gestation among ‘high-scoring’ pregnant AA women living in Jefferson County, Alabama?” was answered by integrating the quantitative and qualitative data. RESULTS: For the quantitative strand, there was no significant relationship between adverse childhood experiences, experiences of racial discrimination, and length of gestation at birth. Participants who were eligible for the qualitative strand of the study had birth outcomes that were equivalent to those participants who were not eligible for the qualitative strand. The qualitative findings included themes and subthemes that revealed active coping skills, strong social support, and resilience. CONCLUSION: Grounded in the integrated results of MMR, this study found that an individual’s ability to cope with stressful life experiences may modify the effect of experiences of racism and/or adverse childhood experiences and adverse birth outcomes such as PTB. Findings from the study can be used to inform clinical practice, future research, and policy.

Included in

Nursing Commons



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