Date of Conferral





Health Services


Patrick A. Tschida DrPH, MPH


Infant mortality (IM) is a critical health-disparity problem in the United States. Of the 23000 infants who die each year, the highest number occurs among African Americans. Previous studies implicated a mix of health determinants and risk factors, but no study has explored the mechanisms by which IM predictably persists among African Americans. This study uncovers the complex network of risk factors that underlies racial death disparities in infants. Two theoretical lenses chosen for this study were social systems theory (SST) and critical race theory (CRT). SST explains human behavior as an intersection of interrelated systems. CRT interrogates inherent social contradictions. Two research questions are considered: the risk factors African American women identify and, the sociocultural factors they identify as buffers against adverse birth outcomes. Interviews with 6 African American women in Franklin County were analyzed using open, axial and selective coding to arrive at 4 themes of major risk factors, and 2 positive health determinants associated with improved pregnancy outcomes. A midrange substantive theory of racial death disparity emerges, implying that eliminating IM depends on the ability to predict and control risk and protective factors. The implications for positive social change include informing policy makers and healthcare providers about the vulnerability that women feel, to get them to listen and engage more intently. Averting threats of racial death disparities requires modification of the social determinants of health. That could be a major contribution to public health practice. Study offers a strong basis for quantitative research to test the new theory and, closes knowledge gaps and fosters equity-focused patient-centered practices.