California African-American Infant Mortality Prevention: A Prospective Study

Infant mortality continues to be a significant national public health problem. African-American infant mortality in the United States remains as high as or higher than those of some developing countries. In the state of California the continuing gap between African-American and Caucasian infant mortality rates is cause for alarm among public health providers. Studies repeatedly indicate that the underlying causes of infant mortality are social, economic, environmental, cultural, political, racial and historical, though not in equal measure. Children born at a socioeconomic disadvantage have less chance of survival than have children of any particular race. To address the disproportionate gap between black and white infant mortality, the California Department of Health Services funds Black Infant Health (BIH) projects in sixteen health jurisdictions. The projects implement six best practice intervention models. Plans have been made to assess the interventions\u27 statewide impact by means of the Black Infant Health Evaluation Project. To date, African-American infant mortality research has concentrated almost exclusively on between-race comparisons rather than on the intragroup variability within that community, leading to the erroneous conclusion that race alone explains infant mortality levels. Such an approach hinders the development of culturally appropriate programs designed to address the problems of high African-American infant mortality. To complement the statewide evaluation design, this study researched intragroup variability and the impact of culturally appropriate interventions through a prospective study design of African-American women participating in four of the California BIH intervention models: Outreach and Tracking, Case Management, Health Behavior Modification, Social Support and Empowerment. Fourteen of the California BIH health jurisdictions were included in the research, which was conducted from July 1, 1996 to June 30, 1998. Sociodemographic, behavioral characteristics and reproductive and perinatal factors were studied to identify their association with low birthweight and their usefulness in developing low birthweight predictive models. Results revealed that BIH participants experienced a lower percentage of low birthweight during the two-year study period than the statewide percentage reported for 1996–1997. Univariate analysis and multivariate modeling using logistic regression techniques consistently found that prematurity, history of poor pregnancy outcomes and cigarette, alcohol and drug use during pregnancy were predictors of low birthweight in the BIH population. This study sought to offer a clearer insight into the causes of African-American infant mortality by providing a better understanding of the differences in sociodemographic, behavioral characteristics, reproductive and perinatal factors that continue to place African-American women at greater risk for poor pregnancy outcomes