Champions of infant vitality

BGSU partners with local agencies to reduce Ohio's high infant mortality rates

By Julie Carle

Ohio ranks third in the nation for high mortality rates for Black children, behind Mississippi and Louisiana. Locally, the statistics are equally concerning. In Lucas County between 2015-2017, the Centers for Disease Control and Prevention reported mortality rates for Black infants were nearly three times higher than for white infants.

A team of Bowling Green State University researchers from political science, geography and the Center for Research and Development and several community partners are working together to reduce the infant mortality rates in northwest Ohio and beyond.

BGSU, the Hospital Council of Northwest Ohio (HCNO), its Northwest Ohio Pathways HUB and ProMedica Health Systems have been awarded an Ohio Third Frontier grant to improve infant mortality rates in the state.

The $270,000 grant is authorized by the Ohio Department of Higher Education in support of Ohio Gov. Mike DeWine’s initiative to “highlight the importance of home visitation programs to improve infant mortality rates in Ohio.” 

At the root of the issue are social and economic influences such as persistent poverty, pervasive and subtle racism, and the chronic stresses and psychological and environmental barriers associated with these conditions.

Since 2007, the Northwest Ohio Pathways HUB has been focused on improving local infant mortality rates by connecting moms to resources that help them overcome the barriers with the assistance of community health workers (CHWs). The impact is significant; the local Pathways HUB is making a difference in infant mortality rates, but there is still room for improvement.

“When this opportunity came about to do a program evaluation, we wanted to be a part of it,” said Carly Salamone, director of the Northwest Ohio Pathways HUB. “We are so busy implementing the day-to-day services we don’t have time to look at all the data, talk to the people to identify any barriers they might be experiencing. We will take this information from the evaluation to learn, better our program and improve our outcomes in the community to help our community be healthy.”

According to Teanya Norwood-Ekwenna, health outcomes manager for the ProMedica Social Determinants of Health Institute, "We know that the future of the next generation has to do with our moms and babies. It’s imperative that we prioritize initiatives around infant vitality for the future of or community and our nation.

“As an anchor institution in the region, we know that within our own footprint, within some of the zip codes that have poor birth outcomes, ProMedica can make a difference. We are deeply rooted in the community, and infant vitality is a priority that we consider critical,” she said.

Addressing social justice issues in communities

The BGSU team of Drs. Justin Rex, Nichole Fifer and Karen Johnson-Webb, is united by a desire to address social justice issues within communities. The grant enables them to tackle the issue of infant mortality at the local level. Together with the community partners, graduate student Maddi Georgoff and undergraduate student Crystal Martin, they are interviewing current participants in the Northwest Ohio Pathways HUB and their caregivers, and looking at data from past years. 

They each bring a special expertise to the team: Rex is an assistant professor of political science who is keenly interested in doing community-based research. Fifer is assistant director of the Center for Regional Development who brings her applied research skills and dedication to community improvement to this initiative. Johnson-Webb, who is a faculty member in the School of Earth, Environment, and Society, joins the team with a research focus on race and health outcomes, including Black infant mortality.

For Georgoff and Martin, the research aligns with their career interests and provides them valuable real-world experience. Georgoff hopes to go into program evaluation in the area of social determinants of health. For Martin, who plans to attend medical school, the project is helping her to gain an understanding of the social context of practicing medicine.

“This is a great example of the opportunities we can provide for students, to give them valuable experience,” Rex said.

“With the Pathways Hub in Northwest Ohio being one of the oldest and best-functioning HUBs in the nation, there is such a robust program. The best approach for us is to look at what’s in place and find ways to improve it,” Fifer said.

“Karen’s background in race and health outcomes and the demographic of the communities” rounded out the team, Fifer said.

COVID changes the interview plans

In collaboration with the community partners, the team is interviewing seven research groups, including participants in the Pathways Program and community health workers, who work closely with the participants. 

The original plan was to conduct the interviews in person, but COVID-19 changed those plans. Instead, the interviews are conducted through Zoom meetings, phone calls and even Facebook Live. While technology can be an asset in these trying times, issues with poor internet access or limited minutes on a phone have made the process cumbersome and sometimes impossible, Fifer said.

“They are in the program because they are low-income, so trying to schedule time is challenging because of access to technology and also because they are mothers who are juggling the demands of new babies on top of everything else,” Fifer said.

Once all the data is collected, they will analyze it all and offer some ideas about how to reduce the number of infant deaths in northwest Ohio, specifically, and eventually the number of pre-term babies.

“I’ve been studying Black infant mortality for about five years, specifically in Ohio because it’s where I live and I can do the field work locally,” Johnson-Webb said about the project, which is personal for her as a Black geographer. “The year I really started looking at it, infant mortality was at .1 per thousand for white babies and 12 per thousand for Black babies.”

Evaluating social determinants of health

Poor birth outcome, including a baby being born too soon or too small, is the leading cause of infant death, Salamone said.

The rates have improved slightly in the past five years, but Johnson-Webb’s interest in the research is aligned with the concern about premature births.

“Babies that are born prematurely are open to more issues where they can’t thrive,” she said. “We feel prematurity is preventable and it’s a huge part of the problem, which is why the hubs are important.”

The hubs focus on many areas of life, assisting in everyday affairs that would lower some of the daily stress levels.

“We are looking at a lot of different ways the participants are interacting with the hub, the services they are utilizing and how the community health workers are acting as intermediaries,” Fifer said. “We are asking them about their stress and anxiety and if the relationship with the community health workers is helping them with stress.”

Interviews are also conducted with mothers whose children are older than 1 or out of the infant mortality range. Their input is important to assess if they felt the program impacted their health and the health of their babies.

“We also are trying to track what keeps people in, what pushes people out, what are the barriers and challenges,” Fifer said.

In addition to the survey and interview results, the team will also analyze a couple years’ worth of secondary data on all the hub participants, including how they moved through the program, their demographics and risk factors. The quantitative data will look at more of the aggregate factors that predict success in the hub, according to Rex.

“When the study is over, we will be reporting back to the partners, the Toledo hub, and if the findings are applicable or useful or other hubs, we will disseminate the information through the network,” Rex said.

Remember the people behind the research

This project is a collaboration of community partners, local organizations and care provider organizations working together to try to solve this problem.

“We are grateful for the research and the evaluation, but it’s important for people to understand that behind the research there are people whose lives are being impacted every single day by things that they can’t control,” Salamone said. “The data is telling, but the research is still research on real people who are willing to share their stories.”

“This work is fitting squarely into the mission and vision of the University,” Johnson-Webb said.

“We are finding that nexus where we can combine our powers to address an important social issue like infant mortality,” Rex said.

“Everyone is putting in all they can. People are dedicating their lives, energy and time to do this work,” Fifer said. “If we can help them and use the resources through the University and our experiences to do that work better, then that’s our obligation that we should be doing this work. They deserve our support”