title: The impact of social disadvantage on preconception health, illness, and well-being: an intersectional analysis.
abstract: OBJECTIVE
  To understand how social and structural contexts shape individual risk, vulnerability, and interconception health-related behaviors of African-American women. APPROACH OR DESIGN: A longitudinal ethnographic study was conducted.
  
  
  METHODS
  The study was conducted in Philadelphia, Pennsylvania.
  
  
  METHODS
  The sample included 19 African-American women who were participants in the intervention group of a randomized clinical trial of interconceptional care.
  
  
  METHODS
  Data were collected through interaction with participants over a period of 6 to 12 months. Participant observation , structured and unstructured interviews, and Photovoice were used to obtain data; grounded theory was used for analysis. The analysis was guided by intersectional theory.
  
  
  RESULTS
  Social disadvantage influenced health and health care-seeking behaviors of African-American women, and the disadvantage centered on the experience of racism. The authors identify seven experiences grounded in the interactions among the forces of racism, class, gender, and history that may influence women's participation in and the effectiveness of preconception and interconception health care.
  
  
  CONCLUSIONS
  African-American women's health and wellness behaviors are influenced by an experience of racism structurally embedded and made more virulent by its intersection with class, gender, and history. These intersecting forces create what may be a unique exposure that contributes significantly to the proximal determinants of health inequities for African-American women. Health promotion approaches that focus on the individual as the locus of intervention must concomitantly unravel and address the intertwining structural forces that shape individual circumstance in order to improve women's interconceptional health and to reduce disparities.
authors.affiliation: Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7445, USA. vhogan@email.unc.edu
authors.forename: Vijaya K
authors.initials: VK
authors.lastname: Hogan
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Culhane
authors.forename: Kara Ja'Nice
authors.initials: KJ
authors.lastname: Crews
authors.forename: Cheryl B
authors.initials: CB
authors.lastname: Mwaria
authors.forename: Diane L
authors.initials: DL
authors.lastname: Rowley
authors.forename: Lisa
authors.initials: L
authors.lastname: Levenstein
authors.forename: Leith Patricia
authors.initials: LP
authors.lastname: Mullings
mesh_terms: D000328:Adult; D001741:Black or African American; D000884:Anthropology, Cultural; D005260:Female; D006304:Health Status; D054624:Health Status Disparities; D006801:Humans; D008137:Longitudinal Studies; D008962:Models, Theoretical; D010549:Personal Satisfaction; D015143:Philadelphia; D011203:Poverty; D016742:Preconception Care; D036301:Qualitative Research; D055815:Young Adult