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Advisory Committee Chair

Peter M Ginter

Advisory Committee Members

Susan L Davies

Charles R Katholi

Andrew C Rucks

Martha S Wingate

Document Type

Dissertation

Date of Award

2018

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

Despite consistent and substantial investments, the United States’ infant mortality rate (IMR) has not decreased significantly in the 21st century and disparities between racial and ethnic groups have increased. This study investigates the impact of social and health factors, and public policies on IMR at the state level. The research aims were to: 1) evaluate which state-level social factors and public policies were associated with state IMRs using principal component (PC) analysis; and 2) evaluate whether states cluster on their PC scores and IMRs using cluster analysis. The data used were six composite index scores based on social factor and public policy indicators developed by the Institute for Women’s Policy Research. PC analysis was used to account for correlation among the predictive composite index scores by transforming them into six independent PCs to be used as uncorrelated predictors. The four most predictive PCs were retained for cluster analysis to evaluate whether states clustered on their social factor and public policy indicators as well as their IMRs. Finally, the PCs were back-transformed to evaluate the best predictors of state IMRs. 2012 and 2015 state IMRs were used as the outcome variables. When all of the PCs were included in the 2012 regression, 62% of the variation in state IMRs was explained (R2=0.62); in the 2015 regression, 52% of the variation was explained (R2=0.52). PCs 3 and 6 explained the least amount of variance and were removed from subsequent analyses. The removals of additional PCs decreased the 2012 R2 to below 0.60 and the 2015 R2 to below 0.50, therefore PCs 1, 2, 4, and 5 were retained for cluster analysis. When the states were clustered using these four PCs, five clusters emerged. When the principal components were back-transformed, the “Health and Wellbeing” (p-value <0.0001), “Poverty and Opportunity” (p-value <0.03), and “Reproductive Rights” (p-value<0.10) were predictive in the 2012 model; only “Health and Wellbeing” (p<0.0001) was predictive in the 2015 model. These findings suggest that states should prioritize policies that improve women’s health outcomes, increase reproductive rights, and reduce poverty in order to reduce infant mortality.

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