Abstract

Applying Diffusion of Innovation to the Texas Mother Friendly Worksite Program: Does early adoption lead to lower rates of infant mortality?

Jessyca Cripps, MPH¹, Julie St. John, DrPH, MPH, MA, CHWI², Jeff Dennis, PhD³, Chwan Li-Shen, PhD⁴ (1)Texas Tech University Health Science Center School of Medicine, (2)TTUHSC School of Public Health, (3)TTUHSC Department of Public Health, (4)TTUHSC School of Medicine

APHA 2022 Annual Meeting and Expo

Background: In 2018, the infant mortality rate (IMR) in Texas was 6.93 deaths per 1,000 infants—fluctuating the past three decades. Research has shown breastfeeding as a strong predictor of infant mortality due to a strong relationship between infant mortality and early initiation of breast milk. Past research strongly recommends effective policies focused on early initiation of breastfeeding. In response, Texas created the Texas Mother Friendly Worksite Program (TMFWP) in 1995, fully implemented in 1998; mother-friendly worksites proactively support employees choosing to breastfeed and meet criteria set by the TMFWP. Yet, little research has explored the potential impact of the rate of adoption of the TMFWP by employers on county-level IMRs. It is hypothesized that infant mortality will decline as the number of TMFWP sites increase.

Methods: This observational study used secondary data from the CDC Wonder data set (IMR) and from the TMFWP (annual number of worksites who adopted the policy) for two large metropolitan counties in Texas—Bexar and Travis Counties—from 2003-2018. Multivariate regression analysis examined a potential linear relationship between IMR and four independent variables of interest in this study. The researchers compared the 𝑅𝑅2 of two models to evaluate the regression models and identify the best-predicted model that significantly explains the variance in IMR.

Results: After controlling for year and number of sites, Travis County had a lower infant mortality rate by 1.27. For every additional site added, infant mortality went down by 0.006 (p=0.005).

Conclusion: Our findings suggest TMFWP may contribute to reduction of the IMR in Texas. Future research should explore additional Texas counties to examine effects of the TMFWP more broadly. The TMFWP initiative should use the results of the present study to encourage and promote adoption of the program by new Texas businesses.