In Search of The Promised Land: Birth and Mental Health Outcomes among African Americans of The Great Migration

Abstract

The overall aim for this dissertation was to examine the extent that the Great Migration was associated with birth and mental health outcomes. Although Great Migration movers and their children experienced economic gains in education and earnings, literature has suggested that their health may not have followed the same trajectory. Compared to non-migrators, migrators experienced increased risks in adult mortality and infant mortality. However, there are sizable research gaps remaining. The degree that these findings apply to other health outcomes and the potential mechanisms that might explain the worsened health outcomes documented in literature are unknown. This dissertation, situated towards the latter half of the Great Migration (between 1940 to 1980), aimed to answer a fraction of the many lingering questions that remain about the health of Great Migration migrators. In the first chapter, I assessed the association between internal migration and low birth weight among Southern African American mothers born between 1950 and 1969. I analyzed 1.64 million birth records from 1975 to 1999 maintained by the US National Center for Health Statistics. To tease out the effect from moving and destination contextual effects, I compared two migration groups to non-migrators: (1) migrators moving out of the South and (2) migrators moving within the South. Non-migrators were matched to migrators using coarsened exact matching. I estimated the relationship between migration status and low birth weight stratified by birth-year cohorts. I found positive selection in education and marriage among migrators moving out of the South and within the South (p.001). Results did not show differences in the odds of low birth weight in either migration groups compared to Southern non-migrators. Despite moving to better economic opportunity, migrating out of the South may not have improved low birth weight outcomes of Black mothers during the last decades of the Great Migration. In the second chapter, I measured the association between county socioeconomic opportunity in the North and West and the odds of low birth weight during the last decade of the Great Migration. I used the US Census from 1970 as well as the birth records of first-time African American mothers who migrated from the South collected through the National Center of Health Statistics from 1973 to 1980 (n=154,346). I examined three measures of area-based opportunity: racial and economic residential segregation, Black male high school graduation rate, and Black poverty rate. I used multilevel logistic regression where mothers were nested within US counties. After adjusting for individual risk and protective factors for low birth weight, there was no relationship between county socioeconomic opportunity and low birth weight. High socioeconomic opportunity in the North and West may not have ensured better birth outcomes among Great Migration mothers. This is one of the first studies to my knowledge to assess the relationship between the residential environment on the health outcomes of people during the Great Migration. In the third chapter, I measured the relationship between migration and the odds of mental health disorders among children of migrators and examined the extent that experiences of discrimination explained the relationship between migration status and mental health disorders. The sample was comprised of 3004 African Americans adults from the National Survey of American Life. I used the birthplaces of participants and their mothers to categorize adults into three migration groups: (1) Southern Stayers, (2) Migrators, and (3) Northern Stayers. The outcomes were lifetime occurrence of any mental health, mood, anxiety, and substance use disorders. I used weighted logistic regressions where I adjusted for demographic, socioeconomic status, and experiences of everyday and major lifetime discrimination. I found that migration status was associated with increased odds of mental health disorders. Migrators had higher odds of any mental health disorder as well as higher odds of any mood, anxiety, and substance use disorder compared to Southern Stayers in the fully adjusted model. Northern Stayers also had higher odd ratios of any mental health, mood, anxiety, and substance use disorders. Migrators and Northern Stayers were more likely to report perceived discrimination. Discrimination partially attenuated the relationship between migration status and mental health disorder outcomes. This study highlights the potential most-migration adversities that families may have experienced.