Birth Weight and Mothers' Adverse Employment Change

Author(s): David Dooley and Joann Prause

Source: Journal of Health and Social Behavior, Vol. 46, No. 2 (Jun., 2005), pp. 141-155
Published by: American Sociological Association
Stable URL: http://www.jstor.org/stable/4150394
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Birth Weight and Mothers'
Adverse Employment Change*
DAVID DOOLEY
JOANN PRAUSE
Universityof California,Irvine

Journalof HealthandSocialBehavior2005,Vol46 (June):141-155

Low birthweighthas been linkedat the aggregatelevel to unemployment rates

and at the individuallevel to subjectivedistress. Wehypothesizethat maternal
underemployment, includingunemployment, involuntary part-timework,and low
wage workpredictsdecreasedbirthweight.Therelationshipof birthweight to
maternalemploymentchanges duringpregnancywas studiedprospectivelyin
1,165 singletonfirst birthsin theNationalLongitudinalSurveyofYouthdataset.
Controllingfor othersignificantriskfactors, womenwhoshiftedfrom adequate
employment to underemployment hadsignificantlylighterbabies.Plausiblemedi-
ators of this relationshipwere explored,includingprenatal health care, gesta-
tional age, and mother'sweightgain, with resultsvaryingby type of underem-
ployment.Twointeractionsalso suggested that underemployment reducedthe
beneficial effect of mother'sweightgain on birth weight. Thesefindings were
partially replicated for low birth weight (< 2,500 grams), indicating the
medicalsignificanceof the effect.

BIRTHWEIGHTAND STRESS orders, and decreased academic achievement

Do parentalemploymentchanges affect chil-
dren's health? Birth weight is a useful indica-
tor in this regardfor several reasons. Low birth
weight is a common and increasinglyfrequently
occurring pregnancy complication. Some 7.7
percent of all U.S. newborns in 2001 weighed
less than2,500 grams(about5.5 pounds),up 13
percentsince the mid-1980s (Martinet al. 2002).
Low birth weight predicts both neonatal mor-
tality (Paneth 1995) and numerous long-term
developmental difficulties (Hack, Klein, and
Taylor1995). The latterdifficulties include ele-
vated rates of health problems such as cerebral
palsy, asthma,andrespiratoryinfections as well
as higher risks of such psychosocial problems
as lowered intelligence, elevated conduct dis-
* This researchwas supportedby grant 041107
fromthe SubstanceAbusePolicyResearchProgram
of theRobertWoodJohnsonFoundation. Addresscor-
respondenceto DavidDooley,Department of Psy-
chology and Social Behavior, School of Social
Ecology,Universityof California,Irvine,CA 92697
(email:cddooley@uci.edu).
(Hack et al. 1995). Finally, low birth weight is
measured before child-parent interactions or
otherenvironmentalfactorsthatmight influence
(as possible confounding variables) later indi-
cators of child well-being.
One cause of low birth weight is intrauter-
ine growthretardation(also referredto as small
for gestational age), which is associated with
the mother's health habits and nutrition
(Cogswell and Yip 1995). The experience of
stressful life events might lead to low birth
weight via maladaptivematernalcoping involv-
ing risky health behaviors such as increased
smoking, which has been linked to low birth
weight (Martinet al. 2002).
A more importantcause of low birth weight
is prematuredelivery.The risk factorsfor short-
ened gestation are not fully understood
(Cogswell and Yip 1995), but maternal stress
may play a causal role (Copper et al. 1996).
Stress may compromise the immune function
(Arnetz et al. 1987), which can increasethe risk
of infections affecting intrauterinegrowth or
durationof gestation (Goldenberget al. 1990).
Stress may also release critical neurochemical

141
142 OFHEALTH
JOURNAL ANDSOCIAL
BEHAVIOR
messengersthatcan shortenthe gestationperiod tunately,this individual-levelinterpretationrisks
(Lockwood 1999). Maternal stress appears to the ecological fallacy (Robinson 1950). Cross-
raise levels of placental corticotropicreleasinglevel analysis, as used in this study, can clarify
hormone(CRH) thatcan affect neuroendocrine, whether the community's economic climate
immune-inflammatory, or vascularmechanisms operates via the mother's individual-level
that lead to shortened gestation (Hobel et al. employmentexperienceor, controllingfor such
1999; Wadhwa,Sandman,and Garite2001). personalemploymentchange,by affectingsome
Employmentchange may be one of the stres- community-level factor such as social capital
sors that contribute to such undesirable preg- and related levels of perceived social support
nancy outcomes. Variantsof the stress model that have been linked to birth weight (Buka et
have emphasized different costs of underem- al. 2003).
ployment ranging from the loss of income and Most studies of the social costs of adverse
the sense of agency thatit providesto such psy- employment change have focused on job loss,
chosocialfunctionsas status,social support,and and a substantialliteraturelinks unemployment
time structure(Dooley and Prause2004). What- to behavioral disorder (Dooley and Catalano
ever the most stressful component of under- 1980). But other forms of underemployment
employmentmay be, a largeliteraturehas linked have been prevalentin recent decades (Jensen
it with such stress-relatedoutcomes as depres- and Slack 2003), and a few studies have found
sion and alcohol abuse (Dooley and Prause that falling from an economically adequate to
2004). This study tests whethermaternalunder- an economicallyinadequatejob (includinginvol-
employmentalso predictsloweredbirthweight. untary part-time and poverty wage work) can
produce psychological consequences similar
to those produced by job loss, for example,
ADVERSE EMPLOYMENTCHANGE elevated depression(Dooley, Prause,and Ham-
AND BIRTHWEIGHT Rowbottom 2000). Thus, adverse employment
change involving different forms of underem-
Numerous studies have assessed the link to ployment could affect variablesthat have been
pregnancy outcomes such as fetal growth linked to poor pregnancy outcomes including
retardation,small size for gestational age, and higher depression (Hoffman and Hatch 2000),
pretermbirthsfromphysicallydemandingwork psychiatric disorders (Federenkoand Wadhwa
such as prolonged standing and long working 2004), decreased optimism (Lobel et al.
hours. A metaanalyticreview of this literature 2000), and depleted personal resources (Rini
found that physically stressful work raised the et al. 1999). Consequently, this study consid-
risk of pretermbirths by 22 percent and small ers as potential stressors not only job loss but
for gestational age infants by 37 percent also transitionsinto inadequateemployment.
(Mozurkewich et al. 2000). In contrast, few
studieshave exploredjob or income loss as risk
factors for decreased birth weight. One large HYPOTHESES
sample study reported no direct link to birth
weight from such economic stressorsas unem- This studytests a series of hypotheseslinking
ployment but did find that such stressors adverse employment change to lowered birth
might operateindirectlyvia addictivebehaviors weight within a stress model. Adverse employ-
(Sheehan 1998). ment change will be categorized as becoming
However,aggregatetime-series studies have unemployed, moving to involuntarypart-time
found associations between low birth weight employment, or moving to poverty wage
incidence and male unemployment rates employment.The analyseswill be replicatedon
(Catalano, Hansen, and Hartig 1999). Aggre- two indicators of birth weight, first as a con-
gate cross-sectionalstudieshave linkedlow birth tinuous measure(grams) and then as a dichoto-
weight to neighborhoodindicatorsof economic mous measure(<2,500 grams)in orderto reflect
disadvantage, including local unemployment clinically serious low birth weight.
rates (Buka et al. 2003; Pearl, Braveman,and Based on the aggregate-level studies linking
Abrams 2001). Such aggregate-level associa- unemploymentrates to low birth weight rates,
tions may reflect the indirect effect of the the first hypothesisis that,controllingfor poten-
economy via adverse personal employment tial confounding variables, women who expe-
events that in turn affect birth weight. Unfor- rience adverse employmentchange in the year
 CHANGE
BIRTHWEIGHTAND MOTHERS'ADVERSEEMPLOYMENT
leading up to their first child's birth will have
lower birth weight infants than women who
remain adequately employed. Variables that
cause a greaterrisk of both adverseemployment
change and decreased birth weight could
produce a spurious association between them.
For example, race and ethnicity must be con-
trolled in order to estimate the effect of
adverse employmentthat is not confoundedby
well-established racial differences in the rates
of both unemployment and low birth weight.
Similarly other contextual variables (noted in
the methods section) that operate as signifi-
cant confoundersare statisticallycontrolled in
the initial model.
The stress of adverse employment change
mightoperatethrougheithermaladaptivebehav-
ior that indirectly affects pregnancy (e.g.,
increasedsmoking) or biological change via the
hypothalamus-pituitary-adrenal (HPA)axis that
directly affects pregnancy (Federenko and
Wadhwa2004). Measuresof these mechanisms
(e.g., of CRH changes resulting from stimula-
tion of the HPA axis) are not available in the
datato be analyzedin this study.However,more
proximal mediators of their influence are
available. Specifically, it is hypothesized that
the stressful influence of adverse employment
change might operatevia three differentmedi-
ators that are likely to be significant precur-
sors of decreasedbirthweight. First,becoming
underemployedmightleadto foregoingor delay-
ing prenatalhealthcaresuchthatotherwisetreat-
able problems result in decreased gestational
age or maternalweight gain that in turn affect
birthweight. Next, as discussed earlier,the psy-
chologicalstressof adverseemploymentchange
might shortenthe lengthof gestationthatin turn
woulddecreasebirthweight.Finally,afteradjust-
ing for prenatalcare and gestational age, such
stress might influence birth weight by reduc-
ing mother'sweight gain duringpregnancy.To
the extent that one or another of these vari-
ables operatesas a mediator,its additionto the
analytic model should decrease the initial
associationbetweenadverseemploymentchange
(andpotentiallyotherprecursorsincludingprior
mediators)and birth weight.
Finally,it is possible thatthe effect of adverse
employment change on birth weight, if any,
differs between differentgroups of people. For
example, adverse employment change might
have greateror smaller effects on birth weight
depending on the mother'srace or educational
level. To our knowledge no prior research has
143
studiedsuchpotentialmoderators;consequently,
the analysesof possible interactionsin this study
are exploratory.
METHODS
Sample
The National Longitudinal Survey of Youth
(NLSY79) is a nationallyrepresentativesample
of 12,686 individualswho werebetweenthe ages
of 14 and 22 years when first surveyed in
1979 (Center for Human Resource Research
2000). Due to funding constraints,two groups
of the sample were dropped, including 1,079
membersof the militarysubsamplein 1984 and
1,643 members of the economically disadvan-
taged, non-African American, non-Hispanic
supplementalsubsamplein 1990. Annual inter-
views were conductedbetween 1979 and 1994
and every other year thereafter. The NLSY
reported an 89.2 percent retention rate (N =
8,89 1) as of 1994 (Centerfor HumanResource
Research2000). The NLSY gives the following
reasonsfor noninterviewof eligible respondents
in 1994 (N = 1,073):respondentrefusal(55.1%),
inability to locate (13.3%), deceased (20.6%),
not refieldedbecausevery difficultcase (8.7%),
and other (2.3%).
The NLSY surveysrecordthe life experiences
of the sample,includingwork,education,marital
and family characteristics, health, and geo-
graphical information about the respondent's
residence.In addition,all childrenbornto female
membersof the samplehave been followed,and
their data are available in the child and young
adult files.
The present study uses data from both the
adult files and the child and young adult files
focusing on singleton first births to female
respondentsof the NLSY79 occurringbetween
1981 and 1994 (N = 2,961). The sample was
limited to women who were interviewedimme-
diatelyprecedingtheirpregnancyand who were
reinterviewedsometime duringtheirpregnancy
(N = 2,156) and furtherlimited to women who
were adequatelyemployed(neitherpovertywage
nor involuntarypart-time)at the pre-pregnancy
interview (N = 1,208). A total of 948 women
were excluded for not being adequately
employedat the pre-pregnancyinterview,includ-
ing 270 unemployed (28.5%), 317 low wage
(33.4%), 64 involuntarypart-time (6.8%), and
297 out of the laborforce (31.3%). Of the 1,208
144 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR
adequately employed women, 1,165 had data
available on birth weight and other essential
study variables.
The resultingsample of 1,165 consists of rel-
atively advantaged female respondents to the
NLSY, in thatthey all enjoyedadequateemploy-
ment prior to their pregnanciesand differed in
several ways from other NLSY female respon-
dents with childrenas of 1994 (N = 3,149 with
measures on comparison variables). This
study'ssamplehadmoreyearsof educationwhen
comparedto otherfemalerespondents(M = 13.4,
SD = 2.2 vs. M = 12.3, SD = 2.3, p <.01), higher
aptitudeas measuredby theArmedForcesQual-
ificationsTest(M = 49.4, SD = 26.6 vs. M = 33.8,
SD = 26.6, p < .001), parentswith more years
of education(M = 12.3, SD = 3.2 vs. M = 11.1,
SD = 3.4, p < .05), and less risk of living in
poverty (4.5% vs. 19.2%, p < .001). Of the
studied sample, 67.6 percent were non-His-
panic and non-African American comparedto
53.6 percentof the otherfemalerespondents,and
16.1 percentwere AfricanAmericancompared
to 29.2 percentof the other female respondents
(p< .01).
Measures
Key variables. Birth weight was opera-
tionalized as a continuous measure (in grams)
andas a dichotomyreflecting"lowbirthweight"
where "1" indicates a birth weight less than
2,500 grams(6.8% in this sample)and "0"indi-
cates a birth weight of 2,500 grams or more.
The key independent variable was mother's
employment status change from the pre-preg-
nancyinterview,whenall womenwereadequately
employed,to her employmentstatusat the inter-
view duringpregnancy.The NLSY characterizes
employmentstatus in a mannerconsistentwith
the CurrentPopulation Survey, which is con-
ductedby the U.S. Bureauof the Census for the
U.S. Department of Labor.At each interview
the respondent'slabor force activity duringthe
week preceding the interview is characterized
as employed,unemployed,out of the laborforce,
or in the active military forces. We extended
to recognize"economicunder-
this categorization
employment,"which includes not only unem-
ployment but also such inadequate forms of
employmentas involuntarypart-timework and
employmentwith povertywages (Clogg 1979).
Involuntarypart-timework involves working
fewerthan35 hoursduringthe week priorto the
survey for one of the following economic
reasons: slack work, materialshortages, equip-
ment or plant repair,start of a new job or end
of an old one, or inabilityto find full-timework.
Povertywage is defined here as averageweekly
earningsless than 1.25 times the federalpoverty
level for unrelatedindividualsless than65 years
old (following Clogg and Sullivan 1983).
Reported annual earnings in the previous cal-
endaryearwere dividedby weeks workedduring
this sametime frameand comparedto 1.25 times
the U.S. poverty level (adjusted to a weekly
basis).
We also extended the NLSY categorization
of unemployment to include "discouraged
workers,"who are usually assigned by the CPS
to the categoryof "outof the laborforce"(OLF).
A discouragedworkerwantsa regularjob, either
full- or part-time, but is not seeking employ-
ment because she could not find work, had
nowhereto look, thoughtno workwas available,
felt lacking in necessary skills, felt too young
or too old, or had other handicaps in finding a
job. We reassigned such discouraged workers
from OLF to the unemployedgroup.
In summary, we define change in employ-
ment status from the pre-pregnancyinterview,
when all were adequatelyemployed,to the inter-
view during the pregnancy using the cate-
gories of continuing adequately employed,
change to unemployment (including discour-
aged workers), change to involuntary part-
time employment, change to poverty wage
employment,and changeto OLF (excludingdis-
couraged workers).
Contextualvariables. Personalvariablescol-
lected at the pre-pregnancyinterview included
mother'sethnicity,age, years of education,self-
esteem as measured in 1980 by the Rosenberg
self-esteem scale (Rosenberg 1965), and apti-
tude as originally measured in 1980 by a per-
centile score on the ArmedForcesQualification
Testandwhichwas subsequentlyrevisedaccord-
ing to new procedures in 1989. The test
reflectsgeneralaptitudeandis used by the armed
forces to help determine enlistment (Center
for Human Resource Research 1999).
Environmentalvariablesincludedgeographi-
cal region of residence and the unemployment
rate for the standard metropolitan statistical
areaof the mother'sresidence.Familyvariables,
also measured at the pre-pregnancyinterview,
included marital status, family poverty status,
total family income, and years of parentaledu-
cation (using the higher of either parent'sedu-
 CHANGE
BIRTHWEIGHTAND MOTHERS'ADVERSEEMPLOYMENT
cation as a proxy for parental socioeconomic
status).Characteristicsof the mother'sjob at the
time of the pre-pregnancyinterview included
occupation(professional,clerical,laborer,service,
or missing), industry of job, number of hours
worked per week, overtime work (defined as
workingmore than 50 hoursper week), number
of differentjobs held duringthe fourweeksbefore
the pregnancy,and global job satisfaction.
Several health factors were evaluated for
motherand baby.Because of the small number
of women who smoked one or more packs per
day (5.5%) we coded this measureas a dummy
reflecting smoking versus nonsmoking during
pregnancy.The NLSY measuredthe frequency
of drinking during pregnancy (as opposed to
quantity) using an eight-level scale. Because
of the small number of women who reported
drinking three or more days per week (N =
10), we coded this variablein three categories:
no alcohol duringpregnancy,less thanonce per
month, and once a month or more often.
Mother's pre-pregnancy weight, weight gain
during pregnancy, length of pregnancy (in
months) at the second interview,and trimester
of firstprenatalcare were also measured.Infant
characteristicsinclude gender and gestational
age (in weeks).
Manyvariableswere consideredas potentially
confoundingthe relationshipbetween employ-
mentchangeandbirthweight.Some of thesevari-
ables(e.g., aptitude,ethnicity,familyincome,and
TABLE1. DescriptiveStatisticsfor All First SingletonBirths to AdequatelyEmployedWomenof
National Longitudinal Survey of Youth during 1981-1994 (N = 1,165)
Maternalbackgroundcharacteristics: time 1
Age (years)
Maritalstatus
Married
Divorced/separated
Never married
Ethnicity
AfricanAmerican
Hispanic
Non-African American and Non-Hispanic
Familypoverty status
Not in poverty
Poverty
Missing
Total family income
< $20,000
$20,001-$30,000
$30,001-$40,000
$40,001-$50,000
$50,001-$75,000
> $75,000
Missing
145
yearsof education)arepotentiallyrelatedto both
employment change and birth weight. Others
reflect change in family or work conditions
between the pre-pregnancy and pregnancy
interviews that coincided with employment
changeandmighthaveaffectedbothemployment
change and laterbirthweight. We tested several
such change variables including changes in
maritalstatus,familypovertystatus,local unem-
ployment rate, geographical region of resi-
dence,occupation,overtimework,numberofjobs
held, andjob satisfaction,but none provedto be
significantpredictorsof birthweight.
As noted,potentialmediatorsavailablein the
NLSY data set include use of prenatal care,
gestationalage, andmother'sweight gain. Medi-
ation of the relationship between employment
change and birthweight was tested by three cri-
teria(Baronand Kenny 1986). These include an
association between the mediator and birth
weight, a change in the association between
employmentchangeandbirthweightupon intro-
duction of the mediator, and an association
between employmentchange and the mediator.
Moderators of the relationship between
employment change and birth weight were
also investigatedby constructingmultiplicative
terms for interactionsbetween potential mod-
erating variables and the employment change
variables.Table 1 describesthe importantstudy
variables.
M Percent SD
24.6 4.2
57.8
6.3
36.0
16.1
16.3
67.6
85.7
4.5
9.9
27.4
17.2
12.6
10.1
9.9
5.4
17.4
(Continuedon nextpage)
146 JOURNALOF HEALTHAND SOCIALBEHAVIOR
TABLE 1. (Continued)
M Percent SD
Unemploymentrate
< 6.0 percent 30.7
; 6.0 percent 61.3
Missing 8.0
Yearsof education 13.4 2.2
Armed Forces Qualifying Test 49.4 26.6
Self-esteem in 1980 32.9 4.0
Parentalyears of education 12.3 3.2
Maternal employmentcharacteristics: time 1
Employmentstatus (change from time 1 to time 2)
Remained adequatelyemployed 73.0
Change from adequateemploymentto
Unemployment 4.2
Underemployment 7.1
Involuntarypart-time .9
Povertywage 6.2
Out of the labor force 15.7
Occupationof mothera
Professional 29.6
Clerical 40.0
Laborer,farm, or service worker 19.3
Missing 11.2
Percentworked over 50 hours/week 5.7
Averagenumberhours worked/week 39.4
Number of differentjobs held
1 job 88.6
2 jobs 9.4
- 3 jobs 2.0
Job satisfaction
Like very much 45.2
Like fairly well 42.1
Dislike somewhat 10.3
Dislike very much 2.3
Prenatal characteristics
Smoked duringpregnancy
Did not smoke 78.3
< 1 pack/day 16.2
1 pack/day 5.5
-
Alcohol use duringpregnancy
No alcohol 60.9
< once/month 19.1
2 once/month 20.0
Mother'spre-pregnancyweight (kg) 61.1 12.4
Mother'sweight gain duringpregnancy(kg) 15.3 6.2
Trimesterof first prenatalcare
No care .3
Firsttrimester 85.3
Second trimester 9.1
Thirdtrimester 3.5
Missing 1.7
Month of pregnancyof time 2 interview 5.1 2.9
Infant characteristics
Percentmale 51.8
Birth weight (g) 3,325.3 537.0
Percent< 2,500 g 6.8
Length of gestation (weeks) 38.8 2.1
a
Professional includes professional, technical, managers,officials, and proprietors.Clerical includes sales workers,
clerical, craftsmen,and foremen. Laborer,farm, or service workerincludes operatives;laborersincluding farm,
farmers,farmer'sforemen, and farm managers;and service workersincluding privatehousehold.
BIRTH WEIGHT AND MOTHERS' ADVERSE EMPLOYMENTCHANGE 147

StatisticalAnalyses homoscedasticity and normality and were con-

Single factor analysis of variance and odds
ratios were used to measurethe bivariateasso-
ciations of employment change with both the
potential mediators (mother's weight gain,
gestationalage, prenatalcare) and the two birth
weight measures.The multivariablerelationship
betweenbirthweight in gramsand employment
change was evaluated using ordinary least
squares(OLS)regressionfollowingthe approach
described by Mirowsky (1999) for explaining
associations by progressive adjustments. The
key predictor consists of a series of indicator
variablesrepresentingthe various employment
changecategorieswith the adequatelyemployed
group serving as the reference group. Sequen-
tial OLS models were used to estimatethe effect
of employmentchange on birth weight adjust-
ing for confoundingvariables,then to estimate
the effect of employmentchangeon birthweight
when the mediatorsare included in the model,
and finally to test for moderators of the rela- RESULTS
tionshipbetween employmentchange and birth
weight. For parsimony,only variablesreaching BivariateAssociations
the p = .05 level of significance were retained
in the final models. Residualswere screenedfor
sidered appropriatefor inferentialpurposes.1
The relationshipbetween dichotomous birth
weight (< 2,500 grams vs. = 2,500 grams) and
change in employment status was evaluated
using a multivariable logistic regression. To
achieve model parsimony and to avoid "over-
fitting"the logistic regressionmodel, only vari-
ables thatwere significantlyassociatedwith the
probability of low birth weight were included
in the final models (Bagley,White, and Golomb
2001; Hosmer and Lemeshow 2000). As with
the OLS analyses, the key predictor variables
reflected employment change, and a sequence
of multiple logistic regressionmodels was fit to
estimate the effect of employment change on
low birthweight first when controlling for con-
founding variables,then adjustingfor potential
mediators, and finally evaluating the potential
moderators(Mirowsky 1999).
Table 2 describes the bivariate association

TABLE 2. Birth Weight, Gestational Age, Mother's Weight Gain, and Number of Low Birth Weight
Infants by Change in Employment Status
First
Birth Gestational Mother's Trimester Less
Weight Age Weight Prenatal than
(g)a (weeks)b Gain (kg)c Cared 2,500 g

M SD M SD M SD N % N % ORe
Remainedadequatelyemployed (N = 851) 3,356.1 537.0 38.7 2.1 15.1 5.9 734 86.3 53 6.2 -
Changed from adequateemploymentto
Unemployment(N = 49) 3,136.4 496.0 38.5 2.5 16.2 8.0 35 71.4 6 12.2 2.1
Inadequateemployment(N = 82) 3,233.2 585.5 39.0 2.3 14.4 6.1 67 81.7 10 12.2 2.1*
Involuntarypart-time(N = 10) 2,922.8 809.2 37.0 3.8 15.1 5.5 7 70.0 3 30.0 6.4*
Povertywage (N = 72) 3,276.3 537.0 39.2 1.8 14.3 6.2 60 83.3 7 9.7 1.6
Out of the labor force (N = 183) 3,274.0 509.5 39.1 2.1 16.3 6.9 158 86.3 10 5.5 .9
Total (N = 1,165) 3,325.3 537.0 38.8 2.1 15.3 6.2 994 85.3 79 6.8
* p < .05
a Birth
weight is significantly differentamong the groups, F(df) = 4.2(4,1160), p < .01. Infants of women who became
unemployedand who became involuntarilypart-timeemployed weighed significantly less at birth than infants of
women who remainedadequatelyemployed (Dunnett,p < .05). None of the remaininggroups was different from the
group who remainedadequatelyemployed.
b Gestationalage is significantly differentamong the groups, Welch statistic(df) = 2.7(4,54.7), p < .05. Gestational age
for infants of women who became involuntarilypart-timeemployed was significantly less than infants of women who
remainedadequatelyemployed. None of the remaining groups was differentfrom the group who remained adequately
employed.
c Mother's
weight gain duringpregnancywas not significantly differentamong the groups.
d Percentreceiving prenatalcare
during first trimester. Chi-square(df)= 15.288(6); p < .05.
e Odds of an infant less than 2,500 grams at birth for the given employment change relative to remaining
weighing
adequatelyemployed.
148 JOURNALOF HEALTHAND SOCIALBEHAVIOR
of employment change with both birth weight
in grams and low birthweight. Babies weighed
significantly less if theirmothersexperienceda
change to either unemployment (M = 3,136.4
grams)or involuntarypart-timeemployment(M
= 2,922.8 grams) than if they remained ade-
quately employed (M = 3,356.1 grams, both p
< .05). The odds of low birth weight (< 2,500
grams) were 6.4 times greaterfor women who
became involuntarilypart-timeemployed rela-
tive to remainingadequatelyemployed(p < .05).
Table2 also describesthe associationof employ-
ment change with gestationalage, weight gain,
and prenatal care during pregnancy,the three
suspectedmediatorsof the relationshipbetween
employment change and birth weight. Weight
gain during pregnancy was not significantly
associated with change in employment.Gesta-
tion was shorterin women who became invol-
untarilypart-timeemployedcomparedto women
who remainedadequatelyemployed (p < .05).
Fewerwomen who becameunemployedor inad-
equatelyemployedreceivedprenatalcareduring
the first trimesterof their pregnancycompared
to women who remainedadequatelyemployed
(p < .05).
The unemployment rate of the standard
metropolitan statistical area of the respon-
dent'sresidencewas not significantlyassociated
with birth weight in this sample of women
who were adequatelyemployedat the interview
precedingtheirpregnancy(F(df)= .871(2,1162),
p < .5). The association between employment
change and the unemploymentrate was signif-
icant (chi-square(df)= 16.107(8),p < .05), sug-
gesting thata smallerpercentageof women who
remained adequately employed or changed to
poverty wage employment lived in areas with
greater than 6 percent unemployment (59.0%
and 61.1%, respectively) when compared to
those who became unemployed, involuntarily
part-timeemployed,or OLF (71.4%,70.0%,and
68.4%, respectively).
OLSAnalyses of Birth Weight
Table 3 presents results of the OLS models
predicting birth weight, first controlling for
potential confounding variables(model 1) and
then addingthe hypotheticalmediatingvariables
(models2, 3, and4). Age of the mother,smoking
duringpregnancy,and being AfricanAmerican
were each significantly negatively associated
with birth weight in the initial model. Male
infants weighed more than female infants, and
the mother's pre-pregnancy weight (in kilo-
grams) was positively associated with birth
weight (bothp < .05). Otherbackgroundvari-
ables were found not to be significant predic-
tors of birth weight, including family poverty
status, marital status, local unemployment
rate,yearsof education,aptitude,familyincome,
and parental years of education. No variable
reflecting change from the pre-pregnancyinter-
view to the interviewduringthe pregnancy(e.g.,
change in marital status or poverty status) sig-
nificantly predictedbirth weight.
Controlling for these variables and com-
pared to those who remained adequately
employed, change to unemploymentwas asso-
ciated with a 185.43 grams decrease in birth
weight, and change to involuntary part-time
employment was associated with a 418.05
gram decrease in birth weight (both p < .05).
As shown in model 2, relative to those who
received first trimester prenatal care, birth
weight was lower among those who received
no prenatalcare and those whose prenatalcare
data were missing (b = -837.07 and b =
-227.32, respectively, bothp <.05). However,
the adverse effect of no prenatalcare, although
in the expected direction, is based on a group
of only four women. The association between
adverse employment change and birth weight
remained essentially unchanged when con-
trolling for prenatalcare, suggesting no medi-
ation by this variable.
In model 3, gestational age (in weeks) was
positively associated with birth weight (b =
135.80, p < .05). When gestational age is con-
trolled,the unemploymenteffect remained sig-
nificant, but the effect of involuntarypart-time
employment droppedbelow significance, sug-
gesting that gestational age mediates the rela-
tionship between this employment change and
birthweight.In contrast,changeto povertywage
employment and being out of the labor force
both became statistically significant with the
adjustmentfor gestational age. Including ges-
tational age also appearedto reduce the effect
of mother'sage on birthweight from the previ-
ously strong negative association to nonsignif-
icance andto reducethe adverseeffect of a prior
mediator,the absenceof prenatalcarein the first
trimester.
In model 4, mother's weight gain (in kilo-
grams) during pregnancy was positively asso-
BIRTH WEIGHT AND MOTHERS' ADVERSE EMPLOYMENTCHANGE 149
TABLE 3. Association of Change in Employment Status and Birth Weight (in grams): Ordinary Least
SquaresRegression(N = 1,165)
Model 1 Model 2 Model 3 Model 4

PredictorVariable b Beta b Beta b Beta b Beta

Age (years) -10.76 -.09 -12.07 -.10 -1.89 -.02 -2.37 -.02
(-2.77)* (-3.11)* (-.57) (-.54)
Child sex (1 = male) 92.74 .09 93.00 .09 90.10 .08 85.72 .08
( 3.04)* ( 3.06)* ( 3.53)* ( 3.44)*
AfricanAmerican (1 = yes) -158.59 -.11 -158.50 -.11 -141.23 -.10 -140.24 -.10
(-3.76)* (-3.77)* (-4.00)* (-4.07)*
Weightpriorto pregnancy(kg) 6.46 .15 6.40 .15 4.66 .12 5.23 .12
(5.07)* (5.05)* (4.37)* (4.99)*
Alcohol use duringpregnancya
Less than once/month 75.86 .06 72.07 .05 35.12 .03 43.92 .03
(1.88)t (1.79)t (1.04) (1.33)
More than once/month 17.34 .01 13.10 .01 4.89 .004 15.21 .01
(.43) (.32) (.14) (.46)
Smoking duringpregnancy(1 = yes) -205.57 -.16 -198.53 -.15 -199.08 -.15 -214.78 -.17
(-5.32)* (-5.15)* (-6.16)* (-6.79)*
Change from adequateemploymenttob
Unemployment -185.32 -.07 -187.96 -.07 -137.72 -.05 -154.97 -.06
(-2.40)* (-2.44)* (-2.13)* (-2.45)*
Povertywage -76.32 -.03 -75.30 -.03 -109.14 -.05 -91.73 -.04
(-1.17) (-1.16) (-2.00)* (-1.72)t
Involuntarypart-time -418.05 -.07 -416.44 -.07 -184.24 -.03 -193.36 -.03
(-2.53)* (-2.53)* (-1.33) (-1.43)
Out of the labor force -46.95 -.03 -52.43 -.04 -85.20 -.06 -98.05 -.07
(-1.08) (-1.21) (-2.34)* (-2.75)*
Trimesterof first prenatalcare visitc
No prenatalcare -837.07 -.09 -333.69 -.04 -386.33 -.04
(-3.22)* (-1.52) (-1.80)t
Second or third visit -50.92 -.03 -29.65 -.02 -23.32 -.01
(-1.10) (-.76) (-.61)
Missing -227.32 -.06 -200.95 -.05 -178.93 -.04
(-1.94)* (-2.04)* (-1.86)t
Weeks of gestation 135.80 .53 129.94 .51
(22.01)* (21.38)*
Weight gain duringpregnancy(kg) 15.29 .18
(7.48)*
Constant 3,223.36 -3,273.53 -2,137.60 1,929.75
F(df) 8.49 7.97 42.63 45.37
(11, 1153)* (14, 1150)* (15, 1149)* (16, 1148)*
AdjustedR2 .066 .076 .349 .379
tP < .10; *p < .05
Note: Numbers in parenthesesare t-ratios.
a
Relative to never used alcohol.
b
Relative to remaining adequatelyemployed.
c Relative to first prenatalcare visit in the first trimester.

ciated with birth weight (b = 15.29, p < .05).
After adjusting for mother's weight gain, the
association between birth weight and change
to unemployment remained statistically sig-
nificant (b = -154.97, p < .05), but the rela-
tionship between birth weight and change to
poverty wage employment was somewhat
reduced and nonsignificant (b = -91.73, p <
.10).
Interactionsbetween potential confounding
variables (e.g., ethnicity, mother's education,
age, pre-pregnancyweight, and family income)
and employment change were evaluated, but
none reached statistical significance. Of the
interactionsinvolving the employment change
variables,only two were statisticallysignificant.
Both involvedmother'sweight gain duringpreg-
nancy, one with unemployment and the other
with poverty wage employment. Further
analysesof these interactionsshowedthatweight
gain duringpregnancywas positively associated
with birthweight in motherswho remainedade-
150 JOURNAL OF HEALTHAND SOCIAL BEHAVIOR

quately employed but that there was very little
association between birth weight and weight
gain in mothers who changed to poverty wage
employmentor became unemployed.
Logistic RegressionAnalyses of Low Birth
Weight
In contrastto the OLS analyses, trimesterof
firstprenatalcare,althoughsignificantlyrelated
to low birthweight(p < .05 in the logisticregres-
sion analysis), was problematicbecause of the
small sample size in the "no care in first
trimester"category(N = 4). The estimatedodds
of low birth weight for this group (relative to
the group who received care in the first
trimester)was unrealisticallylargeand unstable
as reflectedby the wide confidenceinterval(OR
= 15.03, 95% CI = 2.1, 108.5). The odds of
low birth weight were not significantly differ-
ent for women who receivedprenatalcare in the
second or third trimester relative to the first
trimester (OR = 1.46, p > .05) or for women
who had missing data on time of first prenatal
care (OR = 1.67, p > .05). As a result of these
findings, we elected to exclude this variableto
improvethe stabilityof the multivariablemodel.
Table4 summarizesthe main effect resultsof
a multivariablelogistic regression showing the
relationship between adverse employment
change and low birthweight. As seen in model
1, the odds of a low birth weight infant are
overtwice as greatforAfricanAmericanwomen
compared to women of other ethnicities (p <
.05), and the odds of a low birth weight infant
tend to fall with increases in the mother'spre-
pregnancyweight(p < .10). Controllingforthese
variables,the odds of a low birth weight infant
were about seven times greater for women
changing to involuntarypart-timeemployment
relative to continuing adequateemployment (p
< .05). The odds of low birthweight for the other
adverse employment change groups, although
elevated,were not statisticallysignificant.There
was no significant association of low birth
weight with use of alcohol during pregnancy,
smoking during pregnancy,age, years of edu-
cation, family poverty status, change in family
poverty status, region of residence, marital
status, change in marital status, or the local
unemploymentrate.
When gestational age was added in model
2, the odds of a low birth weight infant fell by
55 percent for each additional week of gesta-
tion (OR = .45,p < .05). As with the OLS analy-
ses, gestational age reduced the relationship
between involuntarypart-timeemploymentand
birth weight (the coefficient drops below sig-
nificance with the inclusion of gestationalage),
and povertywage employmentbecomes signif-
icantly associated with increased risk of low
birth weight (OR = 3.31, p < .05). As seen in
model 3, the odds of a low birth weight infant
fell by 7 percent for each kilogram increase in
the mother'sweight gain duringpregnancy(OR
= .93, p < .05). However,unlike the OLS analy-
ses, the association between low birth weight
and change to poverty wage employment
remainedstatisticallysignificant when control-
ling for weight gain.
Interactionsinvolvingthe employmentchange

TABLE4. Associationof Changein EmploymentStatusandLowBirthWeight(< 2,500grams):Logis-

tic Regression(N = 1,165)
Model 1 Model 2 Model 3

Predictor OR 95% CI OR 95% CI OR 95% CI

AfricanAmerican 2.36* 1.38, 4.02 3.32* 1.74, 6.35 3.26* 1.69, 6.28
Mother'spre-pregnancyweight (kg) .98t .96, 1.00 .99 .96, 1.02 .99 .96, 1.02
Change from adequateemploymenttoa
Unemployment 1.76 .71, 4.39 1.32 .44, 3.97 1.54 .51, 4.66
Involuntarypart-time 7.38* 1.82, 29.89 3.01 .19, 48.35 3.67 .26, 40.62
Povertywage 1.56 .68, 3.59 3.31* 1.18, 9.23 3.15* 1.10, 8.96
Out of the labor force .81 .40, 1.63 1.02 .43, 2.40 1.03 .45, 2.56
Gestationalage (weeks) .45* .39, .52 .45* .40, .53
Mother'sweight gain (kg) .93* .88, .98
Likelihood ratio chi-square(df) 19.5(6)* 231.75(7)* 239.37(8)*
Hosmer-Lemeshowchi-square(df) 5.7(8) 7.92(8) 9.55(8)
tp<.10; *p<.05
Note: OR = odds ratio;CI = confidence interval;df = degrees of freedom.
a
Relative to adequatelyemployed.
 CHANGE
BIRTHWEIGHTAND MOTHERS'ADVERSEEMPLOYMENT
variables were also examined. Neither of the
OLS interactionsinvolvingmother'sweight gain
appeared in the low birth weight analyses.
However, the interaction between ethnicity
(AfricanAmericanvs. non-African American)
and change to poverty wage employment was
statistically significant (p < .05). Of the 10
AfricanAmericanwomen who became poverty
wage employed,five (50%)had low birthweight
infants compared to only 3.2 percent of the
non-African American women who became
poverty wage employed. Confidence in this
finding is limited by the small frequency of
AfricanAmericanwomen who became poverty
wage employed.Because therewere no African
American women who became involuntarily
part-time employed, the interaction of this
variablewith ethnicity could not be tested.
EmploymentCharacteristicsand Birth Weight
We examined employment-relatedfactors in
the subgroupof women who were employed at
both interviews (N = 933, i.e., excluding those
becomingunemployedor OLF).These included
job satisfaction, occupation, industry, hours
worked per week, overtime hours worked
(working more than 50 hours per week), and
numberof differentjobs held. Eachemployment
factorwas evaluatedat the pre-pregnancyinter-
view and as change in the factor between the
two interviews. For example, a change in job
satisfaction from satisfied to unsatisfied or a
change in occupation from professional to
laborermightbe associatedwith both an adverse
employment change (e.g., to poverty wage
employment) and decreased birth weight.
Among these variables, only pre-pregnancy
occupationapproachedsignificance, with pro-
fessionaland clericalworkershavingbabieswho
weighed more than those of laborers(b = 90.8,
p < .10 and b = 84.3, p < .10, respectively).
Changes in these factors between the two
interviewswerenot significantlyassociatedwith
birthweight.
Results for becoming involuntarilypart-time
or poverty wage employed remainedthe same
as described above for the larger sample that
included those who became unemployed or
left the laborforce. Specifically,becominginvol-
untarilypart-time employed was significantly
associatedwith decreasedbirthweight, and this
relationshipdecreasedwhen controllingfor ges-
tationalage. In contrast,becomingpovertywage
151
employed was significantly associated with
decreased birth weight when adjusted for ges-
tational age, but this relationship disappeared
when mother's weight gain during pregnancy
was addedto the model. Parallelto the findings
from our analyses of the larger sample, there
was a statisticallysignificantinteractionbetween
poverty wage employment and mother's
weight gain.Among motherswho remainedade-
quatelyemployed,weight gain duringpregnancy
was associated with increased birth weight,
whereas, among those who became poverty
wage employed,weight gain duringpregnancy
was not associated with increasedbirthweight.
DISCUSSION
GestationalAge as Mediator and Suppressor
Of the three hypothesized mediators of the
effects of adverse employmentchange on birth
weight, only gestational age met the criteriain
these analyses(BaronandKenny 1986). Women
falling into involuntarypart-timework had the
shortestgestationtimes, and the introductionof
gestational age reduced the previously signifi-
cant association between involuntarypart-time
status and birth weight to nonsignificance in
both analyses. Of women who remained ade-
quately employed,only 4.3 percent had prema-
ture (< 37 weeks), low birth weight (< 2,500
grams) babies, whereas a much higher propor-
tion (30%) of involuntarypart-timewomen did.
The unemployed group had the next short-
est gestationaltime, and the introductionof ges-
tational age somewhat reduced the magnitude
of the unemploymenteffect on birth weight in
both analyses. However,this reduction did not
change the significance level of the unemploy-
ment effect in either analysis (remaining sig-
nificant in one and nonsignificant in the other).
Why should falling into involuntarypart-time
employment(andpossibly into unemployment)
reduce gestational age more than falling into
povertywage employmentor voluntarilyleaving
the labor force? One speculation is that invol-
untarypart-timeemployment(along with unem-
ployment)leadsto increasedeffortsto find addi-
tionalhoursof workwhen one is simultaneously
experiencing the stress of decreases in job-
related time structure and social interaction.
Searching for work or reemployment could
depletethe mother'senergylevel and expose her
to a wider rangeof infectiousmicrobes.In com-
152 OFHEALTH
JOURNAL BEHAVIOR
ANDSOCIAL
bination with the challenge of maintainingher other than via mother'sdecreased weight gain.
part-time job and living within a decreased One possibility is the effect of stressto increase
income, these stressors might exacerbate a uterine artery resistance and, in turn, reduce
variety of neruoendocrine, immune, and vas- uterineblood flow andintrauterinegrowth(Teix-
cular mechanisms linked to preterm birth eira, Fisk, and Glover 1999).
(Wadhwa,Culhane, Rauh, and Barve 2001). However, for the OLS (but not the logistic
Gestational age also operated as a suppres- regression) model, mother's weight gain con-
sor variablefor two other employmentchange tributesto birthweight in anotherway, by inter-
groups. Shifting to poverty wage employment acting with both unemployment and poverty
and leavingthe laborforce both were associated wage employment.These two adverse employ-
with increasedgestationalage, which, of course, ment changes appearto limit the otherwiseben-
predictsgreaterbirthweight.Althoughthis asso- eficial effects of mothers' weight gain on their
ciation should not be interpretedto mean that babies' weight. For women who lose theirjobs
these adverse employment changes caused or fall into povertywage work,maternalweight
longer gestation, the resulting indirectpositive gain is not translatedproportionatelyinto baby's
associationseffectively maskedtheirdirectneg- weight gain. Perhapsthe mother'semployment
ative effects. The association of poverty wage stressors lead to increased psychological dis-
with birth weight becomes significant in both tress and depression (Dooley et al. 2000).
analyses when gestational age is included,and Such demoralizing effects might reduce the
a similar patternappears for leaving the labor mother'sattentionto her diet andprenatalhealth
force, although it is significant only in the care regimen or influence metabolic expendi-
OLS model. Voluntarily leaving the labor ture resulting in lower birth weight (Chomitz,
force might be expected to lengthengestational Cheung, and Lieberman 1995). Such maternal
age by providing increased rest and decreased disorders as preeclampsia (involving elevated
exposureto any work-relatedstressors.However, blood pressure)might be exacerbatedby either
it is unclear how continued employment at the psychological stress of adverseemployment
decreasedwages might lead to longergestation. change or the physical stress of certain types
If this latter association is replicable, the of inadequate employment and in turn limit
explanationmight be discovered in the nature the embryo'snutrition(Higgins et al. 2002).
of the jobs, that is, the balance between stress
and supportfactors in the work done by women
experiencing decreased wages. However, it is Limitationsand Implications
clear that after adjusting for gestational age,
poverty wage work is connected to decreased Only longitudinalmonitoringcan check these
birth weight, presumably through reduced speculations and illuminate the physiological
intrauterinegrowth. events thatconnectemploymentstressorsto low
birthweight.Forexample,researchmethodsthat
utilize biochemical samplingover the phases of
Mother's WeightGain Effect and Its pregnancy could be employed to check the
Moderationby Adverse EmploymentChange hypothesisthat some neurochemicalevent such
as elevated CRH mediates the link between
One mediator by which adverseemployment employment change and prematuredelivery or
change (e.g., poverty wage) might have otherdeterminantsof low birthweight(Wadhwa,
decreased intrauterine growth is inadequate Sandman,and Garite 2001).
weight gain by the mother due to poor nutri- In regardto futuredata collection, two other
tion or other risky health behaviors. However, improvementscan be recommended.One per-
mother's weight gain failed to mediate the tains to sample size, specifically the number
birth weight effect of unemployment or of women experiencing adverse employment
leaving the labor force in the OLS model or of change. Although the total sample of this
poverty wage in the logistic regression model studywas large,some of the employmentchange
(althoughslightlyreducingthis effect in the OLS groups were small (e.g., involuntarypart-time
model). This implies that the stress of unem- N = 10).Althoughseveralrelationshipsdid reach
ployment (in the OLS model) and of poverty statistical significance, extended analyses of
wage employment(bothmodels)can reduceges- interactionswere not feasible with the resulting
tation-adjustedbirthweightby some mechanism very small cell sizes. Another related issue
BIRTH WEIGHT AND MOTHERS' ADVERSE EMPLOYMENTCHANGE
involves the measurement of work conditions
that might have helped explain differences
observed between the inadequateemployment
groups,for example,why the low wage workers
differedfrom the involuntarypart-timeworkers
in the way their birth weights were related to
gestationalage and mother'sweight gain. Thus
future studies might seek larger subsamples
within adverse employmentgroups along with
finer-grained descriptions of the nature of
their work.
One ever-presentvalidity threatto such cor-
relational research is that of spuriousness
wherebysome traitof these women causedboth
adverse employment change and low birth
weightfor theirbabies.Sucha traitmightinvolve
life-managementskills and resourcesof the sort
that protect against job loss or demotion and
also against preventablepregnancy complica-
tions.To controlfor such a rivalexplanation,we
included several control variables that might
serve as proxies for such life skills, including
mother's age (as a proxy for emotional matu-
rity), years of education (as a proxy for knowl-
edge), self-esteem (as a proxy for sense of
self-efficacy), and the Armed Forces Qualifi-
cationsTest(as a proxyfor intelligence).In addi-
tion we includedseveralothervariablesto reflect
possible social and materialresources, such as
maritalstatus,family income andpovertystatus,
andparentaleducationallevel. Finally,although
we includedtrimesterof prenatalcareas a poten-
tial mediator,its additionto the analyses could
also be considered a control variablereflecting
mother's conscientiousness in protecting the
healthof her fetus.Althoughnone of these vari-
ablesexplainedthe severalassociationsbetween
employment change and birth weight, future
studies might usefully include still better mea-
sures of such potential confounding variables.
Another research issue concerns generaliz-
ability. This study focused on relatively well-
functioning women who enjoyed adequate
jobs at time 1, and on acute stressors, that is,
recent employmentchanges. Women with per-
sistent occupationalproblems may have fewer
resources(e.g., lower educationallevel) and be
at higherrisk of havinglow birthweight babies.
Thepresentsamplemay haverestrictedthe range
of some key variables(e.g., education)in ways
thatattenuatedtheireffects.This studyalso does
not measure the potentially adverse effect of
continuedunderemploymentor the potentially
beneficial effect of moving to more adequate
jobs. Future research needs to explore the
153
employment-birthweightrelationshipin women
experiencing underemploymentprior to their
pregnancy and who remain chronically under-
employedor who experience favorableemploy-
ment changes thatpotentiallybufferotherstres-
sors.
The present study had access to a limited
subset of the psychosocial variablesthat might
operate as confounders,mediators,or modera-
tors of the birth weight effect. For example,
marital status was included but not spouse's
employment status or change. Research has
demonstrated that a husband's job stressors
can harm his wife's psychological well-being
(Rook, Dooley, and Catalano 1991). Husbands
who reactto theirown employmentevents (e.g.,
job loss) by becoming symptomatic appear to
cause increased risk of psychological distress
for theirwives (Atkinson,Liem, and Liem 1986;
Dew, Bromet, and Schulberg 1987). If the
husband is experiencing both economic stress
and emotional symptoms,he may place an even
greaterburdenon his wife for emotionalsupport
and caregiving (Kessler and McLeod 1984).
Thus intrafamilialstress contagion needs to be
considered in a comprehensivemodel relating
bothparents'employmenteventsto birthweight.
The present results point to the importance
of work during pregnancy as it can influence
neonatal outcomes, and they show how this
researchapproachmight help in unpackingthe
effects of varying features of different forms
of underemployment,includingchanginghours
and wages. Beyond the value of these vari-
ables for developing theory in this area, their
connection to low birthweight suggests imme-
diatepracticaluse. Publichealtheffortsto reduce
the incidence of low birthweight might usefully
targetwomen experiencing such underemploy-
ment events for specialpreventiveinterventions.
NOTE
1. One reviewer suggested using propensity
score analysis to test these hypotheses. The
final OLS models (Table 3) were replicated
using the propensityscoremethod.The effec-
tive sample sizes were somewhat reduced
because of missing values of the additional
variablesused to createthe propensityscores.
However, the coefficients for the relation-
ships between the employmentchange vari-
ables and birth weight were quite similar in
the two approaches.
154 JOURNALOF HEALTHAND SOCIALBEHAVIOR
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David Dooley is professor of psychology and social behavior in the School of Social Ecology at the Uni-
versity of California,Irvine. His researchhas focused on the relationshipbetween employmentchange and
such mental health indicators as depression, alcohol abuse, and self-esteem. With JoAnn Prause, he has
recently published The Social Costs of Underemployment(CambridgeUniversity Press, 2004).

JoAnn Prause is a lecturerand researchspecialist in the School of Social Ecology at the University of Cal-
ifornia, Irvine. She has teaching interestsin applied statistics and researchmethods, as well as long-stand-
ing researchinterests in the social and health costs of underemployment.