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Introduction: Preterm Birth (PTB) is an independent risk factor for future cardiovascular disease (CVD). Nativity-related disparities in CVD risk profile and risk of PTB have been shown among non-Hispanic Black (NHB) women; however, studies exploring these disparities among women of other races are limited. We hypothesized that foreign-born NHB, White, and Hispanic women will have better CVD risk profile and lower risk of PTB compared to their US-born counterparts. Methods: We utilized data from 6096 women with mean age 27.5(±6.3) years in the Boston Birth Cohort who self-identified as NHB (2699), White (997), or Hispanic (2400). We examined differences in sociodemographic characteristics and CVD risk factors such as smoking, obesity, and hypertension by nativity status. Using multivariable logistic regression models, we examined the association of nativity and length of U.S. residence with PTB by race. Results: Of the total sample, 27.2% delivered preterm (29.1%, 29.8%, and 24.1% among NHB, White, and Hispanic women, respectively). Compared to foreign-born women, US-born women in each of the three racial groups were younger and more likely to be obese, single, smoke in pregnancy, and report severe stress. After adjusting for sociodemographic characteristics and CVD risk factors, foreign-born NHB women had lower odds of PTB compared to U.S-born NHB women (adjusted odds ratio, aOR: 0.79; 95%CI: 0.65-0.97). Similarly, foreign-born Hispanic women had lower odds of PTB compared to U.S-born Hispanic women (aOR: 0.72; 95%CI: 0.56-0.93). In all 3 racial groups, shorter ((Figure) Conclusions: US-born women in all three racial groups had a higher prevalence of CVD risk factors including smoking, obesity, and stress, compared to foreign-born women. The “foreign-born advantage” which is protective of PTB was not observed among foreign-born women with ≥10 years of U.S. stay.

Background Self-help group (SHG) interventions have been widely studied in low and middle income countries. However, there is little data on specific impacts of health layering, or adding health education modules upon existing SHGs which were formed primarily for economic empowerment. We examined three SHG interventions from 2012-2017 in Bihar, India to test the hypothesis that health-layering of SHGs would lead to improved health-related behaviours of women in SHGs. Methods A model for health layering of SHGs – Parivartan – was developed by the non-governmental organisation (NGO), Project Concern International, in 64 blocks of eight districts. Layering included health modules, community events and review mechanisms. The health layering model was adapted for use with government-led SHGs, called JEEViKA+HL, in 37 other blocks of Bihar. Scale-up of government-led SHGs without health layering (JEEViKA) occurred contemporaneously in 433 other blocks, providing a natural comparison group. Using Community-based Household Surveys (CHS, rounds 6-9) by CARE India, 62 reproductive, maternal, newborn and child health and nutrition (RMNCHN) and sanitation indicators were examined for SHGs with health layering (Pavivartan SHGs and JEEViKA+HL SHGs) compared to those without. We calculated mean, standard deviation and odds ratios of indicators using surveymeans and survey logistic regression. Results In 2014, 64% of indicators were significantly higher in Parivartan members compared to non-members residing in the same blocks. During scale up, from 2015-17, half (50%) of indicators had significantly higher odds in health layered SHG members (Parivartan or JEEViKA+HL) in 101 blocks compared to SHG members without health layering (JEEViKA) in 433 blocks. Conclusions Health layering of SHGs was demonstrated by an NGO-led model (Parivartan), adapted and scaled up by a government model (JEEViKA+HL), and associated with significant improvements in health compared to non-health-layered SHGs (JEEViKA). These results strengthen the evidence base for further layering of health onto the SHG platform for scale-level health change. Study registration ClinicalTrials.gov number NCT02726230