Doctor of Philosophy, Case Western Reserve University, 2015, Nursing

The United States is one of three countries with the highest number of preterm births per year. Of 3, 953,591 infants born in 2011 in the United States, 11.72% were premature. The increasing incidence of preterm birth infants in the United States indicates that factors predicting preterm birth have not been sufficiently minimized or eliminated. One reason the factors may not have diminished could be a lack of identification of the risk factors and a lack of knowledge as to which factors make the greatest contribution to preterm birth.The purpose of a cross-sectional descriptive secondary analysis of the United States birth certificate data of 2011 was to determine how maternal and infant physiologic and socio-demographic risk factors contribute to preterm birth. The multiple regression analysis was to identify women who delivered infants with a gestational age < 37 weeks; women who gave birth with a gestational age < 32 weeks; women who gave birth with gestational age between 32 and 36 weeks; women who gave birth to male and female infants. Then, an analysis was conducted in which the two factors that were the strongest predictors, infant birth weight and pregnancy weight gain were omitted from analyses to statistically control for the two strongest predictors. The strongest risk factors that contributed to preterm birth in the United States in 2011 was infant birth weight. When infant birth weight and pregnancy weight gain were xv excluded from the analysis, the strongest risk factor was maternal race. The largest differences in predictive ability for preterm birth in <32 weeks GA vs 32-36 weeks GA subgroups was gestational hypertension. When infant birth weight and pregnancy weight gain were omitted from analyses, the largest difference in predictive ability for preterm birth in <32 weeks GA vs 32-36 weeks GA subgroups was cervical cerclage. For the males vs female subgroups, the largest difference in predictive ability for preterm birth we (open full item for complete abstract)

Committee: Susan Ludington (Advisor) Subjects: Nursing

Doctor of Philosophy, The Ohio State University, 2006, Public Health

Healthy People 2010 defines national health goals to increase both the quality and duration of healthy life and to eliminate health disparities among individuals. Evaluation of trends of maternal and child health indicators in Ohio related to Healthy People 2010 goals was performed using birth certificate data representing all live births from 1990-2003 (n=2,169,756). These data were evaluated to assess trends in the total population and by race and age categories. The health indicators evaluated were the rates of low and very low birth weight, early and adequate prenatal care, preterm delivery, alcohol and cigarette abstinence, and Cesarean section delivery. Linear models were developed to assess the trend in rates. Results – Between 1990 and 2003, Ohio progressed toward the Healthy People 2010 goals for all groups in some areas such as early and adequate prenatal care and abstinence from cigarettes. Movement away from the goals is occurring for most age and race groups in Ohio for low and very low birth weight, preterm births, and primary and repeat Cesarean section deliveries. The goal has been met in the areas of abstinence from alcohol in all groups of women in Ohio. The predicted 2010 rates for these indicators follow the same patterns. Conclusions – Between 1990 and 2003 Ohio has progressed toward the Healthy People 2010 goals in some maternal and child health indicator areas. Work remains to be done to achieve many of the goals. This dissertation provides a framework for future evaluation of Healthy People indicators. Additionally, knowledge of trends in health indicators can guide research and the creation of intervention programs. Identifying specific sub-populations for which interventions can be targeted is also a possibility. With limited funding and many women and children in need of help, focused research and interventions are necessary to establish good health in as many women and infants as possible. Programs to improve pregnancy related health outc (open full item for complete abstract)

Committee: Randall Harris (Advisor) Subjects: Health Sciences, Public Health

Doctor of Philosophy, The Ohio State University, 2024, Public Health

Introduction: Human milk is the recommended infant food for the first six months of life. Despite recommendations and known health benefits for infants and lactating parents, only a quarter of the infants in the United States meet the recommended human milk feeding goals. While human milk feeding is often a personal decision, engaging in this health behavior may be shaped by neighborhood- and systemic-level factors. Aims: This dissertation aimed to evaluate the association between human milk feeding behaviors and three factors: (1) neighborhood-level social determinants of health, (2) caregiver-reported social needs, and (3) neighborhood-level food access. Methods: I performed secondary analyses of electronic health record data from infants born from April 2019 through July 2022 who attended a well-child visit at Nationwide Children's Hospital (NCH) primary care clinics during the neonatal period. Infant records were linked to Ohio birth certificate data to obtain maternal demographic information and hospital breastfeeding data. During well-child visits at NCH, caregivers are asked about infant food intake. At each visit where feeding data was recorded in the first two years of life, I categorized an infant's human milk consumption as exclusive, mixed, or none. In Aim 1, neighborhood-level social determinants of health were measured using the Child Opportunity Index (COI) 2.0 and the Area Deprivation Index (ADI). In Aim 2, caregiver-reported social needs were assessed using data from routinely administered social needs screenings performed at NCH. In Aim 3, neighborhood-level food access was assessed using the Food Access Research Atlas. Multivariable interval-censored accelerated failure time modeling was used to evaluate the time to cessation of (1) exclusive human milk feeding and (2) any human milk feeding. In secondary analyses, multivariable logistic regression modeling was used to evaluate the odds of (1) breastfeeding initiation and (2) exclusive b (open full item for complete abstract)

Committee: Maria Gallo (Committee Chair); Fernanda Schumacher (Committee Member); Sarah Keim (Committee Member); Deena Chisolm (Advisor) Subjects: Epidemiology; Public Health