Date of Conferral

2019

Degree

Ph.D.

School

Public Health

Advisor

Patrick A. Tschida

Abstract

Tennessee ranks high for infant mortality (IM) in the United States. Despite public health efforts, the IM rate for Blacks is twice that of Whites mimicking what is observed nationally. Several risk factors for IM have been identified; however, it was still unclear how places of residence and prenatal care (PNC) affect IM for Tennesseans. The purpose of this study was to assess the relationship between places of residence (conceptualized by rurality and racial concentration), PNC, and IM among racial groups across Tennessee and to determine if race modified these associations. This was a cross-sectional study using data from the Tennessee PRAMS survey (2009-2011) and geocoded to 2010 U.S. Census Bureau and U.S. Department of Agriculture data. The study was grounded on the theory of racial residential segregation and concentrated poverty. General linear model and hierarchical binomial logistic regression were used to analyze the data. High racial concentration was associated with IM for Non-Hispanic women and remained significant even after controlling for demographic variables (aOR = 5.33, 95%CI [1.11, 25.67]). Disparity in PNC access for Blacks, Other races, and Hispanics were observed based on racial concentration and rurality; however, PNC was not a risk factor for IM. Black race modified the relationship between high racial concentration and IM. Implications for social change include greater public awareness, education on risk factors, advocacy to decrease disparities in access to care, and resource allocation to highly impacted areas potentially mitigating health outcomes for the most vulnerable women and infants.

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