1. Correlates of Infant Mortality by Race across Florida Counties F. Stephen Bridges, Ed.D. and Karla Caillouet, M.S. Department of Health, Leisure, and Exercise Science University of West Florida

2. Presentation Objectives Study background Methods Purpose, data source, correlates explored, statistics Results Conclusion References

3. Study Background Why is the Infant Mortality Rate High in the US relative to other developed countries? The rate of infant mortality is much higher in the US among minorities, and is connected often to not only deaths for infants but also health risks to mothers. The infant mortality rate ( IMR ) is ~ 7 deaths per 1,000 births and is double the rate of most other industrialized countries (WHO, 2011). Black babies are reported dying at more than twice the rate of white babies (Mathews & MacDorman, 2011). The reasons cited by researchers are inequitable access to health care, esp. among those who are very poor, & among teens who have children, and health care not always equally available (CDC, 2011).

4. Dr. Nicholas Eberstadt, 1991 America’s infant-mortality puzzle. The Public Interest, 105, 30-47. Reported that unmarried mothers are far less likely to seek prenatal care than are married mothers and suggested that this difference may be responsible for low birth weights and high rates of mortality.

5. Lester, 1992 Dr. David Lester using time series and ecological designs reported the changing rate of infant mortality over time and the variation in the rate of infant mortality across states were both found to be associated with rates of illegitimacy. Infant Mortality and Illegitimacy Social Science and Medicine, 35(5 ), 739-740. Reported previous research on individuals * had indicated that the high infant mortality rate ( IMR ) in the US might be the result of the high incidence of illegitimate births, which results in poor prenatal care and low birth weights. So he examined whether illegitimacy rates could account for the varying rate of IMR (for infants 0-27days) in the US over time and across states. He used two research designs: a times series and an ecological one. Time series (1940 – 1986): changing IMR over time, i.e., IMR declined in recent years and was lower in years when the rate of illegitimacy was lower; full regression both variables contributed significantly to multiple R of 0.99 for year and for rate of illegitimacy. Ecological study : the correlation between IMR and rates of illegitimacy over the states was 0.8 0 ( P =0.001). In the full regression only illegitimacy and the % of black residents contributed significantly, and the multiple R was 0.87. In sum, IMR could be accounted for by the rate of illegitimacy though other factors were also important such as % of black residents across the states and year for the time series (perhaps an indication of improving medical care).

6. Lester, 1995 Infant Mortality in Caucasians and African Americans Psychological Reports, 77, 962. Used race-specific data for 33 US states in 1980 for which data were available Explored the correlates * of infant mortality for African Americans and Caucasians  An association was found for IMR (for infants 0-27days) and rates of illegitimacy but only for African Americans and not Caucasians

7. Methods The present study explored the correlates of infant mortality among blacks and whites Location: 66 of 67 Florida counties 2010 IMR data per 1,000 live births

8. Profile Reports tool Minority Health Profile - Black

9. Methodology CHARTS http://www.floridacharts.c om/charts/chart.aspx http://www.floridacharts.c om/charts/chart.aspx Infant Death Indicator Viewer http://www.floridacharts.c om/FLQUERY/InfantMor tality/InfantMortalityRpt.as px http://www.floridacharts.c om/FLQUERY/InfantMor tality/InfantMortalityRpt.as px Data source: Florida Community Health Assessment Resource Tool Set

10. Correlates Explored Race-specific data for percentage of: Births among unwed mothers ages 15–19 (illegitimacy rate, 2008-2010) Births among unwed mothers ages 20–54 (illegitimacy rate, 2008-2010) Births to mothers > 18 yrs w/o high school ed (2008- 2010) Births by mother’s marital status (not married, 2010), & Median household income (not a %, but in $, 2000)

11. Statistics Stepwise Multiple Regression

12. Results Blacks One correlate predicted the black IMR (multiple R =.38) Rates of illegitimacy (percent of births to unwed mothers ages 15- 19 years only; beta = -0.38, p =.001) Whites One correlate predicted the white IMR (multiple R =.25) Rates of illegitimacy (percent of births to unwed mothers ages 15-19 years only; beta = -0.25, p =.042)

13. Results The association between IMR and illegitimacy was found for both white and black residents of Florida.

14. Conclusion Unlike Lester’s (1995) national study using race- specific correlates, IMR in the present study was associated with both white and black rates of illegitimacy for Florida county residents *. * Given the differences in IMR, i.e., for infants 0-364 days versus Lester’s infants aged 0-27days, and illegitimacy, i.e., 15-19 years versus Lester’s mothers of all child-bearing ages.

15. Implications Conventional explanations attributing the high IMR in the US to the prevalence of poverty and lack of adequate health care do not tell the whole story. Contributions of parental behavior, lifestyles, and public health care availability versus utilization must be examined in determining public policies to address the problem.

16. References Fact Sheet CDC Health Disparities and Inequalities Report – United States, 2011. (www.cdc.gov/minorityhealth/reports/CHDIR11/FactSheet.pdf) Lester, D. (1992) Infant mortality and illegitimacy. Social Science & Medicine, 35(5), 739-740. Lester, D. (1995) Infant mortality in Caucasians and African Americans. Psychological Reports, 77, 962. Mathews, T. J. & MacDorman, M, F. (2011) Infant Mortality Statistics From the 2007 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports, 59(6), June 29, 2011. (http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_06.pdf) World Health Statistics 2011. World Health Organization. WHO Press, p 45-55, Geneva, Switzerland. (http://www.who.int/whosis/whostat/EN_WHS2011_Full.pdf)

17. Infant Mortality is a Personal Tragedy! Good medical advice and monitoring of a pregnancy is an important contributing factor to babies born at an appropriate birth weight, born full-term, and most importantly born healthy.