72 - Associations of Lifetime Experiences of Racial/Ethnic Discrimination (EOD) with Household Material Hardships among Mothers of Young Children

Poster Number: 72
Publication Number: 72.210

Stephanie Ettinger de Cuba, Boston University School of Medicine, Boston, MA, United States; Felice Le-Scherban, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States; Lindsey Rateau, Boston University School of Public Health, BOSTON, MA, United States; Timothy Heeren, Boston University School of Public Health, Boston, MA, United States; Kelly Courts, St. Christopher's Hospital, Philadelphia, PA, United States; Sarah K. Canale, Boston Medical Center, Boston, MA, United States; Deborah Frank, Boston University School of Medicine, Brookline, MA, United States; Diana B. Cutts, Hennepin Healthcare, Minneapolis, MN, United States; Allison Bovell-Ammon, Boston Medical Center - Children's HealthWatch, Boston, MA, United States; Megan T. Sandel, Boston University School of Medicine, Boston, MA, United States

Background: Material hardships have known adverse child and family health impacts. There is a growing but still nascent body of evidence exploring relationships of experiences of racial/ethnic discrimination (EOD) to material hardships, particularly food and housing insecurity. It is particularly important to understand the family-wide associations of maternal EOD, as material hardships are potentially remediable as one means of mitigating ongoing and intergenerational health & other effects of maternal EOD.

Objective: To examine associations between lifetime EOD and odds of having a hardship-free household among mothers of young children.

Design/Methods: We used cross-sectional survey data (2019-2020) of mothers with children < 4 years in 4 US cities presenting for care at emergency departments (ED) or primary care clinics in hospital settings. The predictor was self-reported maternal lifetime EOD, with frequency assessed in 11 settings. An EOD frequency score (range 0-33) was calculated by summing frequency categories across settings, and then categorized based on response distribution as 0, 1-2, 3-5, 6+. The outcome was being hardship-free, defined as reporting none of the following household hardships: food insecurity, energy insecurity (inability to afford utilities), housing instability (homelessness, behind on rent, multiple moves) and/or healthcare hardship (forgone health care for child or other household member or difficulty paying for household basic needs as a consequence of medical costs). Adjusting for covariates, logistic regression evaluated associations of maternal EOD and hardship-free status.

Results: Among 1,920 mother/child dyads, 84.2% of children had public insurance. Half of mothers self-identified as Black, non-Latina and one quarter were Latina. Almost a third (32%; n=605) of mothers reported at least one experience of discrimination; 12% had a frequency score ≥6. Compared to families of mothers with no EOD, adjusted analyses showed odds of being hardship-free were 44% lower (AOR=0.56, [95% CI] 0.40–0.79) among those with maternal EOD score 1–2, 57% lower (AOR=0.43, 0.31–0.60) among those with maternal EOD score 3–5, and 75% lower (AOR=0.25, 0.18–0.35) among those with maternal EOD score ≥6 (trend p< .0001).Conclusion(s): Frequency of maternal lifetime EOD was associated with lower odds of being hardship-free. Healthcare provider education on trauma is important in order to be cognizant of and sensitive about the interplay of lived experience & basic needs access for providing trauma-informed patient care and hardship intervention.