Digital Commons Network^™

Expanding The Integrated Behavioral Health Workforce: The Interdisciplinary Integrated Primary And Behavioral Healthcare (I2pbh) Initiative, Maria Hernandez, J. Garza, Monica C. Perez, Deepu George

Research Colloquium

The I2PBH initiative offers a multi-faceted training model that integrates graduate coursework, technology-based education, and hands-on clinical experience. Students receive foundational and advanced instruction in the PCBH model, including brief evidence-based interventions, team-based care principles, population-based approaches, and culturally responsive practices. Trainees participate in interprofessional training within primary care settings under supervision, gaining exposure to the real-time pace and complexity of integrated behavioral health care.

Medical Guidelines For Fibrodysplasia Ossificans Progressiva, Frederick S. Kaplan, Mona Al Mukaddam, Genevieve Baujat, Alberto Hidalgo Bravo, Matthew Brown, Amanda Cali, Tae-Joon Cho, Corrie Crowe, Carmen L. De Cunto, Patricia L. R. Delai, Robert J. Diecidue, Elisabeth Marelise W Eekhoff, Lisa Friedlander, Clive S. Friedman, Zvi Grunwald, Nobuhiko Haga, Edward C. Hsiao, Richard Keen, Joseph A. Kitterman, Charles Levy, Vrisha Madhuri, Rolf Morhart, J. Coen Netelenbos, Christiaan Scott, Eileen M. Shore, Michael Zasloff, Keqin Zhang, Robert J. Pignolo

Department of Oral and Maxillofacial Surgery Faculty Papers

Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare genetic condition characterized by congenital malformations of the great toes and progressive heterotopic ossification (HO) in specific anatomic patterns. Present management summarized here is focused on early diagnosis, assiduous avoidance of injury and iatrogenic harm, symptomatic amelioration of painful flare-ups, and optimization of residual function. Twenty-one members of the International Clinical Council on FOP (ICC) and seven consultants from 15 countries, chosen for their clinical expertise in FOP, developed this summary statement. Further advances in therapeutics will be based on rigorous clinical trials to assess novel and emerging treatment and prevention strategies. A …

Validation Of The Jefferson Health-Related Social Needs Screener, Sara Beachy, Kristin L. Rising, Richard W. Hass, Terry Hyslop, Isabella Muti, Mackenzie Kemp, Rhea E. Powell, Cara Martino, Baligh R. Yehia, Joseph G. Cacchione, Patricia C. Henwood

Jefferson Hospital Staff Papers and Presentations

INTRODUCTION: Screening for health-related social needs (HRSN) is a growing national health priority. While multiple HRSN screening tools currently exist, none to our knowledge have been evaluated using robust statistical analyses. The goal of this work is to provide results from a validation study of the Jefferson HRSN screener conducted across inpatient and outpatient settings.

METHODS: This retrospective cross-sectional psychometric study included HRSN assessments conducted across inpatient and outpatient settings with adult patients from March 2023 to May 2024. The study was conducted across a 17-hospital academic health system serving a diverse community in a 9-county area crossing two states …

Two Essays On Health And Health Behavior In China, Jiamin Tan

Lingnan Theses (MPhil & PhD)

This thesis consists of two empirical studies on elderly mental health and on health behaviors. The first study investigates the long-term impact of childhood hunger on mental health in later life, using data from two nationally representative surveys in China. The study finds that childhood hunger exposure significantly increases the risks of depression and anxiety in later life. These effects are most pronounced among individuals exposed after age 5, suggesting that autobiographical memory formation plays an important role beyond socioeconomic and health pathways. The findings further indicate these impacts can be mitigated through economic interventions, such as welfare programs, and …

Experiences With Social Media Social Comparison In Women Ages 18-28: A Qualitative Study, Olivia Oakley Dr.

Dissertations

This qualitative study aimed to understand young women’s experience using social media and their reported mental health connections, such as self-esteem and comparison. As inferred in recent research, a wide range of social media content is being produced and consumed, from promoting the “thin ideal” to newer campaigns advocating for body positivity (Cohen et al., 2019, Grabe et al., 2008; Groesz et al., 2002). In a time where there is so much online content to consume, it is important to continue to evaluate the lived experiences of those using social media. This phenomenological qualitative research captured the lived experiences of …

The Inflammatory Potential Of Diet In Adults With Knee Osteoarthritis: Sex-Specific Associations With Quality Of Life, Sleep, Fatigue And Mental Health, Lynette Law, Joshua J. Heerey, Brooke L. Devlin, Peter Brukner, Alysha M. De Livera, James Hébert Scd, Sherry Price, Nathan P. White, Adam G. Culvenor

Faculty Publications

Background:

Knee osteoarthritis (OA) is a disabling condition—characterized by pain, stiffness, and impaired quality of life—that affects more females than males. Chronic systemic inflammation is a key feature of knee OA and can be modulated by diet. We evaluated the sex-specific relationship between the inflammatory potential of diet and health-related quality of life (HRQOL), sleep quality, energy and fatigue levels, and psychological distress in individuals with knee OA.

Methods:

This cross-sectional study analyzed baseline data from 144 participants (64% female) aged 45–85 years with symptomatic knee OA enrolled in the FEAST (eFEct of an Anti-inflammatory diet for knee oSTeoarthritis) randomized …

Study Of Clinical And Bacteriological Profile Of Culture-Positive Neonatal Sepsis At A Tertiary Care Hospital, Qudsiya Ansari, Vaibhav Pawar, Kailas Randad, Poonam Wade

Digital Journal of Clinical Medicine

Background: Neonatal sepsis is a significant global health challenge, leading to substantial morbidity and mortality among neonates. Its clinical manifestations and causative agents show regional and temporal variations, necessitating localized studies to guide effective management. This study aimed to assess the clinical features, bacteriological profile, and antimicrobial resistance patterns in culture-positive neonatal sepsis at a tertiary NICU. Methods: This retrospective observational study analyzed records of 131 inborn neonates with culture-proven sepsis admitted between April 2019 and March 2020. Data on demographic characteristics, clinical presentations, causative organisms, and treatment outcomes were examined. Antibiotic susceptibility patterns were also evaluated. Results: Of the …

Turn On, Tune In, Drop Shame: Exploring The Unique Therapeutic Potential Of Psychedelics For Sexual And Gender Minority Populations, Nicholas Carlisle

All ETDs from UAB

Sexual and gender minority (SGM) individuals face significant disparities in mental and physical health compared to their heterosexual and cisgender counterparts, due in part to chronic exposure to distal and proximal minority stressors. Shame – a self-focused characterized by a global sense of personal deficiency or unworthiness – has emerged as a key intrapersonal mechanism linking minority stressors to adverse health outcomes. This dissertation explores the role of shame in SGM health inequities and investigates the emerging potential of psychedelics to reduce shame and improve health and wellbeing in these populations. This three-paper dissertation begins with a scoping review (Paper …

Access To Care, Structural Barriers, And Recovery Identity In Mental Health And Substance Use Disorder Treatment, Yahya Alnashri

All ETDs from UAB

Substance use disorders (SUDs) remain one of the most pressing public health and economic challenges in the United States, with growing recognition that recovery is a multidimensional process shaped by clinical, social, and structural factors. This dissertation explores recovery at the levels of health policy, population, and experiential levels to assess gaps in access to recovery support services, identify patterns and predictors of recovery identity, and highlight the lived experiences of individuals with opioid use disorder. First, we evaluated whether state Medicaid expansion under the ACA (2010–2019) was associated with changes in the availability of consumer-run peer support services in …

Radio And Television Media And Health-Seeking Behavior Among Women In Rural Northern Nigeria, Olufolake Akeju

Walden Dissertations and Doctoral Studies

Poor maternal health-seeking behavior (MHSB) has contributed to persistently high maternal mortality in rural northern Nigeria. Despite increasing access to health information via media platforms, little is known about the association between media exposure and MHSB in this region. In this study, the association between mass media exposure (radio and television) and MHSB was investigated using institutional delivery as a proxy. The health belief model was applied as the theoretical framework for this study and sought to answer two key questions focused on whether there is an association between media exposure and MHSB in rural northern Nigeria and what the …

Spatial-Temporal Variation Of Diarrhea Among Children Under 5 Years Old Between 2010-2020 In Rwanda, Amans Ntakarutimana Dr., Patrick A. Tschida Dr., Elias Nyandwi Dr.

Journal of Social, Behavioral, and Health Sciences

We used secondary data from the Rwanda Demographic and Health Surveys of 2010, 2015, and 2020 to assess the spatial-temporal variation of diarrhea among children under 5 years old between the years 2010 and 2020 in Rwanda. Stratified descriptive statistics, pairwise comparisons, and logistic regression designs were used for data analysis in SPSS. A statistically significant variation of diarrhea among children under 5 years old was observed across districts, regions, and urban–rural areas but not at the national level between 2010–2020. Some districts of the Western region, including Nyabihu (OR = 2.5), Ngororero (OR = 2.3), and Karongi …

The "Secret Of Seven Stones": Short-Term Efficacy Of An Online Intergenerational Sexual Health Education Game For Early Adolescents And Their Parents, Sara Dube, Johnny M Wilkerson, Elizabeth Baumler, Laura Armistead, Pooja Chaudhary, Hsing-Yi Song, Angela Spencer, Jeffery Mclaughlin

Faculty, Staff and Student Publications

Objectives: Intergenerational games offer a potential channel to impact parent-youth sexual health communication. The "Secret of Seven Stones" (SSS) is an 18-level online adventure game and parent website designed to engage parents and youth (11-14 years) in conversations about healthy dating relationships and sexual behavior and to provide sexual health skills training to youth. Study hypotheses were that SSS exposure would increase sexual health parent-child communication, increase youth intentions to delay sexual debut, and reduce youth exposure to situations that promote sexual activity.

Materials and Methods: SSS was evaluated in the homes of parent-youth dyads randomly assigned to intervention ( …

Neurobehavioral Symptom Profiles For The Behavioral Assessment Screening Tool In Chronic Traumatic Brain Injury, Fedora Biney

Faculty, Staff and Student Publications

Objective: To identify neurobehavioral symptom profiles among persons with chronic traumatic brain injury (TBI) using the Behavioral Assessment Screening Tool (BAST) and to consider participant characteristics that differ between profile groups.

Setting: Community.

Participants: Participants (n = 615) were English-speaking adults (≥18) and had a self-reported history of at least one TBI of any severity.

Design: Secondary analysis of cross-sectional data.

Main measures: The BAST measures neurobehavioral symptoms in the domains of Negative Affect, Fatigue, Executive Dysfunction, Impulsivity, and Substance Misuse.

Results: Using latent profile analysis (LPA), we identified 3 different neurobehavioral profiles. Overall symptom frequency and differences in the …

Sleep Architecture And Dementia Risk In Adults: An Analysis Of 5 Cohorts From The Sleep And Dementia Consortium, Christopher E Kline, Qiong Yang, Rebecca Bernal, Alycia Bisson, Dibya Himali, Marina Cavuoto, Antoine Weihs, Alexa Beiser, Rebecca F Gottesman, Yue Leng, Oscar Lopez, Pamela L Lutsey, Shaun M Purcell, Susan Redline, Sudha Seshadri, Katie L Stone, Kristine Yaffe, Sonia Ancoli-Israel, Eleni Okeanis Vaou, Jayandra J Himali, Matthew P Pase

Faculty, Staff and Student Publications

Study objectives: Poor sleep may play a role in the risk of dementia. However, few studies have investigated the association between polysomnography (PSG)-derived sleep architecture and dementia incidence. We examined the relationship between sleep architecture and dementia incidence across five US-based cohort studies from the Sleep and Dementia Consortium.

Methods: Percent of time spent in stages of sleep (N1, N2, N3, rapid eye movement sleep), wake after sleep onset, sleep maintenance efficiency, apnea-hypopnea index, and relative delta power were derived from a single night home-based PSG. Dementia was ascertained in each cohort using its cohort-specific criteria. Each cohort performed Cox …

Sex-Specific Associations Between Early Life Unpredictability And Trajectories Of Body Mass Index From Infancy To Adolescence, Emily M. Melnick, Lilybelle K. Deer, Jenalee R. Doom, Hal S. Stern, Curt A. Sandman, Laura M. Glynn, Elysia P. Davis

Psychology Faculty Articles and Research

Objective:

Unpredictability in early life is an understudied aspect of early life adversity that provides important signals to the child about their environment. Recent work shows the predictability of patterns of parental signals on a moment-to-moment timescale sculpts the developing brain during sensitive windows, offering a potential pathway through which early life experiences shape child development. Both experimental non-human animal models and observational human research show sex-specific links between early life exposure to unpredictable patterns of parental sensory signals and aberrant offspring development. The impact of predictability of sensory signals on physical health outcomes, such as BMI, remains unknown. Here …

A Scoping Review Of Epilepsy Care In Low-Resource Settings: Addressing Stigma, Healthcare Disparities, And Socioeconomic Barriers, Michael Mncedisi Willie

Journal of Indonesian Health Policy and Administration

Epilepsy affects around fifty million people worldwide, with stigma and limited healthcare access posing significant challenges, especially in low-resource settings. This scoping review aimed to identify key barriers to epilepsy care, focusing on stigma, healthcare access, and socioeconomic factors in sub-Saharan Africa and similar contexts. Using the Arksey and O’Malley framework, a systematic search was conducted across online databases for peer-reviewed studies published. The review found that stigma significantly delayed diagnosis, increased social isolation, and reduced treatment adherence. Healthcare barriers included a lack of trained professionals and inadequate treatment protocols. Socioeconomic challenges, such as poverty and rural residency, were linked …

Identifying Barriers And Place-Based Solutions To Physical Activity For Older Adults In East Tennessee, Lydia Hoskins, Jodi Southerland

Journal of Appalachian Health

Introduction: Older adults in East Tennessee (TN), the fastest growing demographic, face significant health challenges, with 44% reporting four or more chronic conditions. The state ranks 45th in physical inactivity among older adults, exacerbating chronic disease risks, fall-related injuries, and mental health issues. Urban-rural disparities in East TN further complicate efforts to promote active living, particularly for rural residents.

Purpose: This qualitative study explored socioecological barriers and solutions to increase physical activity (PA).

Methods: In April 2024, two focus group were conducted in East TN, with a total of 11 participants composed of six community partners and five older adults. …

Person-Centered Trauma-Informed Care (Pctic): A Training Needs Assessment For Home And Community-Based Services In West Virginia, Ranjita Misra, A. Brianna Sheppard, Natalie Wilson, Megan C. Govindan, Matthew Myers, Amanda Acord-Vira, Steven Wheeler, Heather Henderson, Christena Ross, Laura Cooper, Rachel A. Goff

Journal of Appalachian Health

Introduction: Person-centered, trauma-informed care (PCTIC) is a combined, holistic service model promoting the well-being and empowerment of trauma survivors.

Purpose: This study examined the PCTIC knowledge, skills, and abilities needed by West Virginia (WV) Medicaid Home and Community-Based Services (HCBS) direct service professionals (DSPs) to serve clients that may have experienced trauma.

Methods: Semi-structured interviews were conducted with diverse stakeholders (n = 32) from 19 organizations that provide HCBS services in all 55 counties. Interviews focused on identifying current training, needs and knowledge gaps, and priority areas for additional PCTIC training. ATLAS.ti software was used to manage and code. Validity …

The Impact Of Communication And Job Satisfaction On Registered Nurse Turnover, Kingsley Kenechukwu Onyeama

Walden Dissertations and Doctoral Studies

Health care leaders are challenged with ongoing nursing shortages. The purpose of this quantitative, correlational study was to examine the impact of communication and job satisfaction on registered nurses’ turnover intentions. The conceptual framework integrated Maslow’s Hierarchy of Needs, Herzberg and Mausner’s Motivation-Hygiene Theory, and Social Exchange Theory. Two research questions guided the study: the relationship between communication variables and intent to leave a healthcare organization, and the relationship between job satisfaction and intent to leave. A randomized sample of 156 registered nurses in California, aged 23 to 65 and identified through the California Nurses Database, was recruited via SurveyMonkey. …

Improving The Reporting On Health Equity In Observational Research (Strobe-Equity): Extension Checklist And Elaboration, Omar Dewidar, Larissa Shamseer, G J. Melendez-Torres, Elie A. Akl, Jacqueline Ramke, Xiaoqin Wang, Oyekola Oloyede, Taryn Young, Stuart G. Nicholls, Zulfiqar Ahmed Bhutta

Institute for Global Health and Development

Data on health equity to inform societally relevant evidence based decisions and policy making are lacking in the research literature. Observational studies have the potential to provide data on health equity. Yet, guidance on how to report health equity data and considerations in observational research is inadequate. The STROBE-Equity extension addresses this gap by providing a structured set of criteria to enhance the reporting of health equity data and considerations.

P.L.A.Y. For All Pilot: Effects Of A Community-Based, Inclusive After-School Program On Physical Activity And Motor-Skill Outcomes, Allison R. Tsuchida, Karl-Richard Hennebach, Erin E. Centeio

International Journal of Physical Activity and Health

After-school programs for physical activity (PA) can contribute to helping children and youth achieve the suggested 60 minutes a day of PA. Previous research also suggests that developing motor competency can positively impact long-term PA participation. Additionally, parent and peer support can help children and youth overcome barriers to PA participation. The primary purpose of this pilot research study was to determine the effects of an inclusive after-school program on PA levels and motor-skill outcomes for children with and without disabilities. A secondary purpose was to examine parental support for physical activity and children’s physical activity and motor skills. 38 …

Neonatal Striatal Volume Is Associated With Infant Anhedonia, Melissa Nevarez-Brewster, Catherine H. Demers, Jessica L. Irwin, Laura M. Glynn, Martin A. Styner, Mercedes Hoeflich Haase, M. Camille Hoffman, Diego A. Pizzagalli, Benjamin L. Hankin, Elysia Poggi Davis

Psychology Faculty Articles and Research

Anhedonia is increasingly recognized as a transdiagnostic risk factor for psychopathology. New evidence demonstrates that anhedonia is present in infancy and early childhood. Structural variability in striatal regions involved in reward processing and pleasure seeking is concurrently linked to anhedonia, yet few studies have examined whether striatal differences presage anhedonia, and none have examined prospective associations before middle childhood. The present study examined whether neuroanatomical markers that confer risk for anhedonia can be detected as early as the neonatal period. Specifically, we tested whether the volume of striatal regions in neonates predicted the emergence of infant anhedonic behaviors at six …

Sociodemographic Determinants Of Telehealth Visits: A Comparison Of Mental Health And Substance Use Disorders With Other Services, Stanley Nkemjika, Orman Trent Hall, Jeanette Tetrault, Ayana Jordan

Department of Psychiatry and Human Behavior Faculty Papers

BACKGROUND/OBJECTIVES: Discrimination has wide-ranging implications, affecting patients' trust in healthcare professionals and their intentions to seek care. It can cause barriers that can affect access to care, especially among racial and ethnic minority groups in mental healthcare settings. Hence, we aim to examine the relationship between racial discrimination and reasons for using telehealth services.

METHOD: Using the 2022 Health Information National Trends Survey (HINTS-6), we isolated 6017 participants who reported on discrimination inquiry. The primary dependent variable in this study is self-reported discrimination in healthcare, while the main independent variable is the reason for the most recent telehealth visit, and …

Association Of Covid-19 Status With Maternal And Neonatal Outcomes Among Pregnant Women At Mombasa County Referral Hospital, Kenya, Salome Mghoi Rajab

MSc in Advanced Practice Midwifery

Background: COVID-19 pandemic has raised global concern regarding maternal and neonatal health owing to physiological and immunological changes that may heighten disease severity. Despite the global evidence linking COVID-19 infection with unfavorable pregnancy outcomes, data from Sub-Saharan Africa remain limited. This leaves an essential vacuum in our understanding of how COVID-19 status affects maternal and neonatal outcomes in counties like Mombasa, where health-care system problems may alter risks. Vertical transmission remains a puzzle to be solved.

Aim: To assess the association of COVID-19 status on maternal and neonatal outcomes between March 2020 to March 2022.

Methodology: A …

Knowledge, Attitude, And Practice Towards Cervical Cancer Screening Among Women Aged 20 Years And Above In Mysuru, India, Sneha Manosh Kumar, Rashmi S, Amogha Shree

Digital Journal of Clinical Medicine

Background: Cervical cancer remains the fourth most common cancer among women globally and a leading cause of cancer-related mortality in India. Despite being largely preventable through screening, uptake remains suboptimal due to socio-cultural and systemic barriers.

Methods: A community-based cross-sectional study was conducted among 300 women aged ≥20 years residing in urban and rural areas of Mysuru. Data were collected using a pre-tested, semi-structured questionnaire and analyzed with SPSS version 30.

Results: Awareness of cervical cancer was reported by 90% of participants and of screening methods by 80%. However, only 21% had ever undergone screening and 17% within the preceding …

Towards Accessibility In Healthcare For Individuals With And Without Hearing Loss: Evaluation Of Usability, Fit, And Communicative Effectiveness Of A Transparent N95 Mask Prototype, Samuel R. Atcherson, Brooklyn Schultes, Jeanne Hahne, Barbara Debaun, Chris Showell

JADARA

The COVID-19 pandemic has underscored the necessity of effective face masks in both public and healthcare settings for mitigating the spread of disease. However, traditional face masks impede communication, posing significant challenges for approximately 13% of the general population and 10% of healthcare and social assistance workers who have hearing loss and who rely on lipreading and other non-verbal cues. Traditional surgical masks and N95 respirator masks serve important roles in healthcare, but they differ in levels of protection. Currently, a transparent surgical mask is available, but not an N95 version. Thus, this study aimed to evaluate the usability, fit, …

Assessing The Psychological Wellbeing And Resilience Of Frontline Health Workers In Uganda: A Cross-Sectional Study, Ahmed Sarki, Joseph Atukwatse, Gideon Mbithi, Sabina Odero, Mary Namuguzi, Bernard Mutwiri, Lestine Bitakwitse, Peninah Wachira, Kevinson Mwangi, Eunice Ndirangu, Amina Abubakar

Institute for Human Development, East Africa

Background: Health workers in the frontline are the major drivers of health systems in low- and middle-income countries. However, these health workers face both chronic and acute shocks and stressors that expose them to mental health problems which are often overlooked. We examined the prevalence of mental health problems, correlates of psychological functioning, and resilience of frontline health workers in Uganda.

Methods: We conducted a cross-sectional study comprising 1800 frontline health workers across all regions of Uganda from August through October 2023. We used tools such as the PC-PTSD-5, PHQ9, PSS, GAD-7, Oldenburg Burnout Inventory, and CD-RISC-10 to assess PTSD, …

Prevalence And Factors Associated With Depression, Anxiety And Post-Traumatic Stress Disorder Among Healthcare Workers From Sub-Saharan Africa: Systematic Review, Ezra Too, Peninah Wachira, Solomon Njenga, Sabina Odero, Eunice Ndirangu, Amina Abubakar

Institute for Human Development, East Africa

Background: Depression, anxiety and post-traumatic stress disorder (PTSD) are prevalent among healthcare workers (HCWs), including those from sub-Saharan Africa (SSA). However, there are limited summary data on the burden and factors associated with these disorders in this region. We conducted this systematic review (registration no. CRD42022349136) to fill this gap.

Aims: The aim of this review was to systematically summarise the available evidence on the prevalence and factors associated with depression, anxiety and PTSD, or their symptoms, among HCWs from SSA.

Method: We searched African Index Medicus, African Journals Online, CINAHL, PsycINFO and PubMed for articles published, from database inception …

Outcomes Of Bio-Psycho-Social-Spiritual Communitybased Drug Rehabilitation Program For Voluntary Vs. Court-Mandated Clients In The Philippines, Maria Regina M. Hechanova, Trixie Anne Co, Fessa R. Egusquiza

Psychology Department Faculty Publications

This study sought to evaluate the outcomes of a community- based rehabilitation program for voluntary and court-mandated drug users in the Philippines. Participants went through a bio-psycho-social-spiritual group-based program that aimed to develop their recovery skills and life skills. The program also included family modules to enhance their knowledge of drug use, its effects, and the role of family in recovery. A cohort design was used with pre- and posttest surveys administered before and immediately after the program. The sample consisted of 105 voluntary clients and 118 court-mandated clients who underwent screening or drug dependency evaluation and were recommended for …

Racial Moderation Of Infant Mortality Risk And Protective Factors In The United States, Temitope Oluwaseun Akinsola

Walden Dissertations and Doctoral Studies

The rate of infant mortality is a pressing health issue in the United States, as ethnic minorities are disproportionately affected. This study addressed how race controls the predictive power of demographic, socioeconomic, and geographic factors on infant mortality. Using a quantitative correlational design, secondary data from 181 individuals listed in the CDC-National Vital Statistics System database were used, which contains nationally aggregated data related to infant mortality rates. Bronfenbrenner’s social ecological model guided the study, and multiple regression and moderation models were used to examine socioeconomic status and access to healthcare on infant mortality outcomes. Results indicated that race significantly …