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Racial Disparity in Infant Mortality Among African American Women in Florida: A Comparative Study: 

Racial Disparity in Infant Mortality Among African American Women in Florida: A Comparative Study Fran T. Close, Ph.D. Florida A&M University College of Pharmacy Institute of Public Health 9th Annual Summer Public Health Videoconference on Minority Health

Outline: 

Outline Introduction Background Theoretical Foundation Methodology Results Discussion Conclusions Acknowledgements

Introduction: 

Introduction

Infant Mortality: 

Infant Mortality Number of deaths within the first 12 months of life One of the leading measures of the health and social conditions of a community Affects families across all racial and ethnic groups

Infant Mortality: 

Infant Mortality In US African American babies die 2-3 times more often Large disparity between overall and cause specific rates

Leading causes of infant deaths: 

Leading causes of infant deaths Congenital malformation Low birth weight Sudden Infant Death Syndrome Maternal complications Respiratory distress

Infant Mortality Rates by Race and Ethnicity: 

Infant Mortality Rates by Race and Ethnicity

Infant Mortality: 

Infant Mortality African American infant mortality rate is four times higher from low birth weight Respiratory distress and maternal complications are highest among African Americans

BACKGROUND: 

BACKGROUND

Reach 2010 Priority Areas: 

Reach 2010 Priority Areas Breast and Cervical Cancer Cardiovascular Disease Child and/or Adult Immunizations Infant Mortality Diabetes HIV/AIDS

Florida REACH 2010PURPOSE: 

Florida REACH 2010 PURPOSE To examine the root causes of the disparity in infant mortality rates between African American populations and white populations in Gadsden and Hillsborough Counties

Florida REACH 2010Goal: 

Florida REACH 2010 Goal To involve the African American health care and related communities in planning, developing and implementing interventions to reduce or eliminate disparity in infant mortality rates in Florida

Gadsden County: 

Gadsden County Rural county in Northern Florida Panhandle Population (2000): 45,087 African American- 57% White Population- 39%

Hillsborough County: 

Hillsborough County Urban, semi-tropical county on the Gulf Coast of Florida Population (2000): 988,948 African American- 15% White Population- 75%

Infant Mortality Rates: 

Infant Mortality Rates

Infant Mortality Rates 1999: 

Infant Mortality Rates 1999

Infant Mortality Rates 2000: 

Infant Mortality Rates 2000

Infant Mortality Rates 2001: 

Infant Mortality Rates 2001

Infant Mortality Rates (African American): 

Infant Mortality Rates (African American) Hillsborough County: 3 times higher Gadsden County: 4 times higher

THEORETICAL FOUNDATION: 

THEORETICAL FOUNDATION Periods of Risk Model

Total Fetal/Infant Deaths per 1000 Live Births + Late Fetal Deaths = New Measure of Maternal and Infant Health : 

Total Fetal/Infant Deaths per 1000 Live Births + Late Fetal Deaths = New Measure of Maternal and Infant Health

Slide23: 

BWPRate=(Number of deaths in a given weight group)/(Total live births  late fetal deaths in all weight groups) X 1000

METHODOLOGY: 

METHODOLOGY

Florida REACH 2010Partners: 

Florida REACH 2010 Partners Florida Department of Health Gadsden Citizens for Healthy Babies Healthy Start of Hillsborough County Central Healthy Start of Hillsborough Florida State University Center for Prevention and Early Intervention Policy

Florida REACH 2010Partners: 

Florida REACH 2010 Partners The Lawton and Rhea Chiles Center at University of South Florida Florida A&M University College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health

Florida REACH 2010Phase I: Strategies: 

Florida REACH 2010 Phase I: Strategies Conduct a targeted community-specific assessment to examine the disparity Initiate a community awareness/education campaign Develop a Phase II Community Action Plan

Community Sites: 

Community Sites Project Site Manager Florida A&M University Graduate Research Assistant Housed at local Healthy Start Coalition Offices Local Taskforce

Florida REACH 2010 Activities: 

Florida REACH 2010 Activities Quantitative data collection Qualitative data collection Consumer and Provider Marketing Campaign Plan

Sample: 

Sample African American Women 15-44 Gadsden County- Surveys: 467 Focus groups: 13 Hillsborough County- Surveys: 430 Focus Groups: 14

Instruments: 

Instruments Behavioral Psychosocial Socioeconomic/Political

RESULTS : 

RESULTS Quantitative Data

Gadsden County Findings: 

Gadsden County Findings

Age of Respondents: 

Age of Respondents

What grade did you complete?: 

What grade did you complete?

What is your yearly income level?: 

What is your yearly income level?

Age at First Pregnancy: 

Age at First Pregnancy

Who is the person you go to most often to get advice about your general health? : 

Who is the person you go to most often to get advice about your general health?

Whose advice do you trust most to have a healthy baby? : 

Whose advice do you trust most to have a healthy baby?

About how often would you say that you use a douche?: 

About how often would you say that you use a douche?

Have you ever experienced discrimination at:: 

Have you ever experienced discrimination at:

How much stress in your life has been caused by your experience with racism? : 

How much stress in your life has been caused by your experience with racism?

Have you ever had a baby that was born too soon or weighed less than 5 pounds?: 

Have you ever had a baby that was born too soon or weighed less than 5 pounds?

My relationship with my baby’s father makes me feel:: 

My relationship with my baby’s father makes me feel:

Are there any special foods or herbs or homemade medicines that you or other women you know take because you/they think it’s good for you when you are pregnant?: 

Are there any special foods or herbs or homemade medicines that you or other women you know take because you/they think it’s good for you when you are pregnant?

Why do you think that Black babies die in your community at more than 2.5 times the rate of White infants?(Respondents chose top 3 reasons): 

Why do you think that Black babies die in your community at more than 2.5 times the rate of White infants? (Respondents chose top 3 reasons)

Is the financial support you get from your baby’s or children’s father?…: 

Is the financial support you get from your baby’s or children’s father?…

Hillsborough County Findings: 

Hillsborough County Findings

Age of Respondents: 

Age of Respondents

What grade did you complete?: 

What grade did you complete?

What is your yearly income level?: 

What is your yearly income level?

Age at First Pregnancy: 

Age at First Pregnancy

Who is the person you go to most often to get advice about your general health? : 

Who is the person you go to most often to get advice about your general health?

Whose advice do you trust most?: 

Whose advice do you trust most?

About how often would you say you use a douche?: 

About how often would you say you use a douche?

Have you ever experienced discrimination at:: 

Have you ever experienced discrimination at:

How much stress in your life has been caused by your experience with racism?: 

How much stress in your life has been caused by your experience with racism?

Have you ever had a baby that was born too soon or weighed less than 5 pounds?: 

Have you ever had a baby that was born too soon or weighed less than 5 pounds?

Why do you think that Black babies die in your community at more than 2.5 times the rate of White infants?(Respondents chose top 3 reasons): 

Why do you think that Black babies die in your community at more than 2.5 times the rate of White infants? (Respondents chose top 3 reasons)

Qualitative Data: 

Qualitative Data Gadsden County

Behavioral: 

Behavioral Douching: “I douche after my cycle. I started when I was 16 years old.” “I seen my sister doing it, so I just tried it.”

Behavioral: 

Behavioral Periodontal Disease “Every time I was pregnant I had to get a tooth pulled. The first one was a wisdom tooth and the second was a cavity…” “The dentist would not pull my teeth because I was pregnant.”

Behavioral: 

Behavioral Home remedies: “Grandma knows more than the doctor.” “I would go to my grandmother or mother for a home remedy to prevent using antibiotics during pregnancy.”

Psychosocial: 

Psychosocial Discrimination “Sometimes at the doctor’s office. I have sat there like 30 minutes and other people come in and they wait on them. So I have just gotten up and left.” “You don’t get any respect if you do not have insurance or are on Medicaid.”

Psychosocial: 

Psychosocial Stress “…It is a stress everyday even though I do provide for my children to have what I couldn’t have…” “Men. They give us a hard time.”

Socio-economics: 

Socio-economics “ I feel safe in a way and in a way I don’t. Cause it’s so much going on out here.” “Half the time you have to beg somebody to take you somewhere and you paying them.”

Qualitative Data: 

Qualitative Data Hillsborough County

Behavioral: 

Behavioral Douching: “What did [your mom] tell you about douching?” She said to keep your body clean.” “It keeps women having vaginal discharges and give’ em yeast. So I use douches only periodically.”

Psychosocial: 

Psychosocial Stress “…If you’re on Medicaid or any kind of assistance for medical procedures they don’t really care.” “…I know that you’re in pain but do you have your Medicaid number, Medicaid card…”

Psychosocial: 

Psychosocial Stress “It seems like the stress levels for Black women doubles that of the stress level for any other race. We have a lot more stress to deal with.” “Because me and my significant other…are so young and we are both trying to start out in life, it put like a lot of stress on the relationship.”

Socio-economics: 

Socio-economics “ …Sometimes we have to get up financially and hit the pavement running; some that might be able to jump into their cars, but others they might have to walk four blocks and take two buses.”

Socio-economics: 

Socio-economics “…I think welfare holds you down in a way because say you get a check and then decide to go and get a little part-time job…it doesn’t matter they cut the little money off that you need…you really need that money

Discussion: 

Discussion

Contributing Factors: 

Contributing Factors Pre-term births and low birth weights (LBW) Maternal infections Nutrition factors Maternal stress Low socioeconomic status

Pre-term births and Low birth weights: 

Pre-term births and Low birth weights Influenced by maternal infections, maternal age and smoking (Von Der Pool, 1998) Non-white women (2000:FDOH Office of Evaluation) Gadsden County: 2-3 times LBW Hillsborough County: 2 times LBW

Maternal Infections-Douching: 

Maternal Infections-Douching High percentage of the women douche at least once per month Learned habit from female family members Habit formed in adolescence or early teens Increases risk of Bacterial Vaginosis and Pelvic Inflammatory Disease (Kirshner, 2000)

Maternal Infections- Periodontal Disease: 

Maternal Infections- Periodontal Disease Disease of the supporting structures of the teeth More common among socio-economically disadvantaged groups Increase risk of pre-term delivery or low birth weight by 7 times A risk factor for pre-term LBW and pre-term delivery

Nutrition: 

Nutrition Anemia higher among African American women (CDC, 1996) African American women more likely to be diabetic, hypertensive and obese Pica

Maternal Stress: 

Maternal Stress Increases levels of corticotropin releasing hormone (Smith, 1999) Increases the risk of adverse pregnancy outcomes No variation in reaction or stress type by SES or education status Discrimination, racism and baby’s father relationship perceived as stressful

Socio-economic Status: 

Socio-economic Status High SES higher risk of infant mortality Low SES poor access to care exposure to environmental hazards poor nutrition high stress

Conclusions: 

Conclusions

Community Action Plan: 

Community Action Plan Primary data sources Survey data Focus group data Secondary data sources Florida Vital Statistics Fetal and Infant Mortality Review (FIMR) Periods of Risk Data

Community Action Plan-Gadsden: 

Community Action Plan-Gadsden Peer Support Networks Consumer Education Program Environmental Health

Community Action Plan-Hillsborough: 

Community Action Plan-Hillsborough Research into Black Infant Mortality Consumer Education Stress Reduction Strategies

Florida REACH Consumer and Provider Marketing Campaign : 

Florida REACH Consumer and Provider Marketing Campaign Provide awareness Establish linkages with community leaders, public officials and funders Develop culturally sensitive materials

Acknowledgements: 

Acknowledgements Florida REACH Coalition Florida Department of Health Gadsden Citizens for Healthy Babies Healthy Start Coalition of Hillsborough County Central Hillsborough Healthy Start FSU Center for Prevention and Early Intervention Policy Lawton and Rhea Chiles Center for Healthy Mothers and Babies FSU Center for Health Equity

Acknowledgements: 

Acknowledgements Florida REACH Site Managers Community Taskforces Florida A&M University COPPS/IPH Dr. C. Perry Brown Dr. Adrienne L. Hollis Dr. Cynthia Harris Ms. Vanisha Brown Mrs. Nichole Jefferson FAMU REACH Graduate Research Assistants

Acknowledgements: 

Acknowledgements PARTICIPANTS!! “FOOT SOLDIERS”