Date of Conferral



Doctor of Public Health (DrPH)


Public Health


Patrick A. Tschida


Foreign-born Black women giving birth in the United States have superior preterm birth outcomes compared to their U.S-born Black peers. Many studies have focused on tobacco use and medical risk factors, but few have focused solely on preconception health. The purpose of this study was to examine preconception health and preterm birth differences among U.S.-born and foreign-born Black women. Three theoretical frameworks guided this study: the life course theory, healthy migrant theory/immigrant paradox, and weathering theory. Primary research questions assessed (a) if there were an association between chronic preconception risk factors, prepregnancy obesity, diabetes, and hypertension, in U.S.-born and foreign-born Black women, (b) if U.S.-born Black women had a higher risk of having a preterm infant compared to foreign-born Black women, and (c) if weathering existed in U.S.-born and foreign-born Black women. A quantitative design using the 2017 Natality Public Use File was employed that included non-Hispanic Black women ages 15 to 44 years. Chi-square test and binary logistic regression were used for the data analysis. Key findings revealed (a) a statistically significant association between preterm birth and chronic preconception health risk factors in both groups of women, (b) U.S.-born women were roughly 1.4 times more likely to have a preterm infant than foreign-born women, and (c) both groups experienced weathering. This study might positively impact social change by offering an alternative perspective to the reproductive health advantage of foreign-born Black women. This perspective can aid in advancing policy and systems change strategies to address the root causes of racial and ethnic disparities in birth outcomes, advance health equity, and improve maternal health.

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