Exposure to chronic stress and ethnic differences in rates of bacterial vaginosis among pregnant women

OBJECTIVE: The purpose of this study was to assess the contribution of chronic social stressors to race/ethnic differences in the rate of bacterial vaginosis among pregnant women in the inner-city area. STUDY DESIGN: We conducted a cross-sectional clinical prevalence study in a sample of 2304 women at the first prenatal visit (14.8 +/- 0.2 weeks of gestation). Bacterial vaginosis was diagnosed by Nugent's method. Stress was measured at the individual and community levels with the use of interviews and administrative records. Logistic regression was used to assess the effects of stress on the odds of bacterial vaginosis occurrence, after adjustment for demographic and behavioral risk. RESULTS: Black women had significantly higher rates of bacterial vaginosis (64%) compared with white women (35%). Exposure to chronic stressors; at the individual level differed by race (eg, 32% of the black women reported threats to personal safety compared with 13% of white women). There were significant racial differences in exposure to stress at the community level (eg, 63% of the black women lived in neighborhoods with aggravated assault rates that were above the citywide mean compared with 25% of the white women). After the adjustment for sociodemographic, behavioral risk, and perceived stress, the odds of the occurrence of bacterial vaginosis that was associated with the community level stressor of "homelessness" was significant (odds ratio, 6.7; 95% Cl, 1.6-27.8). Inclusion of both individual and community level stressors reduced the black/white bacterial vaginosis odds ratio by 27%. CONCLUSION: Stressful exposures are associated positively with bacterial vaginosis in pregnancy in a sample of women of low income in the inner city. The measurement of stressors at multiple levels explained a significant proportion of the racial disparity in the rates of occurrence of bacterial vaginosis.