CARE Women’s Health receives NIH grant

JOHNSON CITY, Tenn. (Nov. 22, 2021) —  Dr. Michael Smith, program and policy director at East Tennessee State University’s Center for Applied Research and Evaluation in Women’s Health (CARE Women’s Health), is examining how policies affect birth outcomes across generations thanks to a $1.86 million R-01 grant from the National Institutes of Health (NIH).

Smith, who is also an assistant professor in the ETSU College of Public Health, is a co-investigator on the study titled “Structural Racism and Adverse Birth Outcomes in the U.S. South: A Multigenerational Perspective.” His collaborators include Dr. Nancy Fleischer of the University of Michigan and Dr. Annie Ro of the University of California, Irvine, who are the co-principal investigators on the study. 

“We are studying the ways in which the policy environment can impact the trajectory of health for the  mother and child,” Smith said. “The goal is to understand how policies related to criminal justice, housing, employment and education might change birth outcomes. In other words, over the course of generations, can changing policies narrow the disparities in birth outcomes?”

To address this question, the research team is using data from South Carolina birth certificates dating back to 1989. The birth certificates are a rich source of information, ranging from details about the mother’s medical history to the baby’s birth weight and other important factors at birth. 

“Fast forward to records from 2005, and some of those babies from the early 1990s are showing up as mothers,” Smith said. “So now we have information from three generations – the mother, her child, and the grandchild – in this data set. We linked this data set in a maternal family tree structure across generations.”

The new grant funding will allow Smith and his fellow researchers to add years onto the multi-generational set. They will also be able to bring in data from the U.S. Census Bureau and other sources like the Bureau of Justice Statistics to look at the policy environment that was present when the grandmother gave birth to the mother and then the mother gave birth to her child.

“As we’ve looked at some of the birth outcomes across generations, we’ve observed some things that have been known in the maternal/child health field for a while,” Smith said. “We can see that people who were born with low birth weight were more likely to have low birth weight babies. Is that genetic, or a product of environment across generations?”

The researchers have examined social mobility as a contributing factor.

“We saw some pretty stark differences in social mobility in birth outcomes based on race and ethnicity, with white women being the most likely to start out at a high-socioeconomic status and stay at a high socioeconomic status compared to minority racial and ethnic groups.”

As they collect evidence, Smith and his colleagues will work with local and national organizations that are interested in and influencing policy in the areas of criminal justice, housing, employment and education. 

“Ultimately, we want to find the best ways to move forward to help make sure that everyone who is born has the best chance they can have of enjoying a healthy and productive life,” Smith said.

To learn more about CARE Women’s Health, which is housed in the ETSU College of Public Health, visit www.etsu.edu/cph/care-womens-health.