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Rachel Tolbert Kimbro, Ph.D.

RWJF Health & Society Scholar 2005-2007

Understanding How Relationships Impact Health Behaviors During Pregnancy

The Problem: A mother’s health behavior during pregnancy affects her baby’s health and development. Research had shown a relationship between marital status and health behaviors, but little was known about which characteristics of these relationships influence maternal health behaviors.

Grantee Perspective: Family sociologist Rachel Tolbert Kimbro, Ph.D., had just earned her doctorate from Princeton University. She wanted to study the influence of the mother’s relationship with the father on prenatal health behaviors, but needed more training in population health.

In Robert Wood Johnson Foundation Health & Society Scholars, Kimbro got the training she needed. She began her two-year interdisciplinary fellowship at the University of Wisconsin, one of six participating universities, in 2005.

Health & Society Scholars was a perfect way to get training in population health and to be able to collaborate with people in other disciplines, which is a rare opportunity,” says Kimbro.

Results: Using data from Princeton University’s Fragile Families and Child Wellbeing Study (supported by the Robert Wood Johnson Foundation [RWJF]), Kimbro explored the influence of relationship status and dynamics on prenatal health behaviors. She found that married mothers had the best prenatal health behaviors, followed by mothers who were living with, and then those who were dating, the father. Mothers who had broken-up with the father were most likely to receive inadequate prenatal care, and to smoke, drink or abuse drugs during pregnancy.

Mothers were more likely to report substance abuse during pregnancy if they had a stressful relationship with the father or the relationship worsened after the pregnancy. Being physically abused or involved with a father with a drug or alcohol problem also led to substance abuse. Kimbro reported the findings in a presentation to the Population Association of America (2007).

In another project, Kimbro collaborated with a developmental psychologist at Columbia University (another program site) and a sociologist at Princeton University to explore racial/ethnic disparities in overweight or obese preschoolers. They found that Hispanic children are twice as likely to be overweight or obese as Caucasian and African-American children (American Journal of Public Health, 97(2): 2007). Although they could not identify factors that accounted for the racial and ethnic differences, a high birthweight, taking a bottle to bed and having an obese mother were important predictors of obesity at age 3.
The Associated Press, Reuters, the Wall Street Journal and other media covered the study.

The University of Kentucky Center for Poverty Research’s Regional Small Grants Program recently funded an extension of the project, which will investigate the children’s overweight trajectories from ages 3 to 5,.

“The program helped me design and execute my research projects and has set the stage for lifelong collaborations,” said Kimbro, who joined the sociology faculty at Rice University (in Houston) after completing her fellowship.

As of October 2007, Kimbro was working on two projects she started during the program. In one, she was interviewing pregnant women about risk: what they consider healthy and unhealthy behaviors, and their concerns about behaviors that affect the baby. The Robert Wood Johnson Foundation supported this research through its grant to the University of Wisconsin as part of funding to universities participating in the Health & Society Scholars Program to help them develop population health research and teaching capacity.

Kimbro was also studying how socioeconomic levels and health vary by race, ethnicity and nativity (the country where a person was born) under a Health Disparities Scholar grant from the National Institutes of Health.

RWJF Perspective: RWJF created Health & Society Scholars in 2001 to build the field of population health. “There’s been a growing recognition that there are social, behavioral, environmental and economic, as well as biological, determinants of health,” said Senior Program Officer Pamela G. Russo, M.D., leader of RWJF’s Public Health Team.

“The program seeks to integrate paradigms and knowledge from a variety of disciplines to develop an understanding of how these determinants affect the health of populations, and thereby to design interventions with greater power to reduce health disparities,” said Russo.