The New Jersey Institute of Technology's
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Title:	Factors that affect the rate of preterm birth: An examination of the inter-related impacts of social determinants, behavior and physical health status
Author:	Hunter, Krystal Michelle
View Online:	njit-etd2021-082 (xvi, 214 pages ~ 3.0 MB pdf)
Department:	School of Management
Degree:	Doctor of Philosophy
Program:	Business Data Science
Document Type:	Dissertation
Advisory Committee:	Ehrlich, Michael A. (Committee chair) Chen, Yi (Committee member) Shi, Junmin (Committee member) Martin-Utrera, Alberto (Committee member) Mitchell-Williams, Jocelyn (Committee member)
Date:	2021-12
Keywords:	BMI Cost effectiveness Healthy behaviors Preterm birth Race Social determinants
Availability:	Unrestricted
Abstract:	The work seeks to examine the factors that have significant relationships to the rate of preterm birth (PTB) along with its cost to society. There are four papers within this work. This purpose of the first paper is to measure the impact that healthy behaviors have on the rate of PTB when modeled with other factors like household demographics, community deprivation, chronic disease and mental health. This work finds that positive health behaviors has a negative relationship with PTB. The interaction between body mass index (BMI) and social class and its relationship to PTB is examined in the second paper. This paper finds that there is a curvilinear between BMI and PTB for women who are of a lower socioeconomic status (LSES). This result is not present with women who are of a higher socioeconomic status. This work also finds an "obesity paradox" for LSES women where the rate of PTB decreases as BMI increases except for those who were morbidly obese. The third paper re-examines Black women's risk of PTB. This study results indicate that although Black women have a higher rate of PTB than other races of women, race itself is not a risk factor. Race's interaction with other health and social factors are more significant than race as an independent factor. The final paper is a cost effective analysis that examines the cost of free standing birth centers compared to standard hospital care with respect to the estimated reduction in PTB. The analysis shows that free standing birthing centers are the most cost effective alternative for low to no risk pregnant women. This option also has lower rates of PTB. The final conclusion of this paper is that promotion of birthing centers can not only potentially reduce the national rate of PTB, but also can save the healthcare system money in the cost of birth and preterm birth.