OBJECTIVES: To determine whether African American women's coping behaviors modify the relationship between exposure to interpersonal racial discrimination in public settings and preterm birth (<37 weeks). DESIGN: A case-control study was performed among African American women delivering infants at two tertiary care hospitals in Chicago, IL between July 2001-June 2005. A structured questionnaire was administered to measure maternal perceived exposure to interpersonal racial discrimination in public settings and coping behaviors. RESULTS: A greater percentage of African American mothers of preterm infants had high lifetime and past year exposure to racism in public settings than their peers who deliver term infants; odds ratios (OR) and 95% confidence intervals (95% CI) equaled 1.5 (0.9-2.8) for lifetime and 2.5 (1.2-5.2) for past year exposure. Active coping, especially "working harder to prove them wrong" led to attenuated ORs (interaction P value<.05 for lifetime and <.10 for past year. CONCLUSIONS: African American women's exposure to racism in public settings is a risk factor for preterm birth; active coping behaviors weaken this relationship.