Indiana University-Purdue University Indianapolis (IUPUI) / Twice as many African American infants die each year when compared to white infants. While infant mortality rates have declined for all ethnic groups in the United States over the past fifty years, the racial gap has remained persistent, and is not fully understood despite numerous quantitative studies. The purpose of this study was to understand the lived experiences of African American women in relationship to the black gap in infant mortality. Thirteen African American women participated in either a focus group or in–depth interviews. Women were asked to use their life experiences to identify factors that would increase the understanding of African American infant mortality. Several themes emerged indicating that the experience of stress and racism are constant factors in African American women’s lives and are inseparable from their pregnancy experience.

Black health disparities are a salient public health issue with blacks in every socioeconomic level at a greater health disadvantage than their white counterparts. In particular, disparity in infant mortality rates between blacks and whites have widened in recent decades to differentials never before experienced in the United States. Social ecologists investigating the myriad of individual and environmental risk factors have failed to fully account for the persistent differential. This study examines the relationships between individual and environmental influences on the health risk experienced by blacks, whites, as well as the differential between the two populations. This multi-level analysis was conducted using five-year aggregate data centering on the 2000 decennial census (1998 - 2002) as the most recent census data available. During the study period, the 193 census tracts in Orange County, Florida, experienced 504 infant deaths which included 242 black and 241 white infant deaths. Using the infant mortality target rate developed for Healthy People 2000 as the ―normal‖ infant mortality rate, risk was calculated as the percentage of deviation from the ―normal‖. A rate was also calculated to demonstrate the difference between black and white percent deviations from the ―normal‖. Structural equation modeling was used to examine the relationship between socioeconomic influences (Socioeconomic Disadvantage), social risk factors (Social Disorganization), and behavioral risk factors (Poor Behavioral Choices) using a latent variable approach based on a conceptual model which integrated the social determinants of health framework and conflict theory. iv In this study, an inverse association was found between socioeconomic disadvantage and infant mortality risk for black infants. This finding is contradictory to the expected finding and may have been due to multicollinearity or the operationalization of the endogenous study variable for black infant mortality risk. Thus, this study highlights the complexity of unraveling the interrelationship between social and economic risk factors. The results of this study demonstrate the importance of the latent variable approach in public health research as well as the need to broaden the approach to selecting indicators. This study concludes with specific policy recommendations aimed at improving the health outcomes of vulnerable populations using the social determinants of health framework.