Using scientific evidence to shape research, intervention programs, and policy in a statewide effort to reduce infant mortality, 2004-2009.

Based on steadily increasing rates from the mid-1990s through 2005 (e.g., rates reached a high of 9.3 deaths per 1,000 live births in the 2000-2004 time frame), the Delaware infant mortality initiative began in 2004. The initiative consisted of a synthesis of quantitative analyses and state-led programs at all public health agencies as directed from the Governor's Office. Throughout the first four years of implementation, Division of Public Health (DPH) staff utilized vital statistics data to produce a statewide research agenda that included reviewing vital record reporting procedures, highlighting infant mortality disparities by birthweight and race, studying the effect of plural births and other demographic factors on infant deaths, and using data to justify proposed research projects. Results indicated that black infants were dying at twice the rate of white infants (Disparity Ratio: 2.2), and extremely low birth weight infants were the biggest contributing population to infant mortality, specifically births of infants less than 500 grams. Further results indicated that intervention efforts should focus on preconception care for women of reproductive age and prevention of prematurity. These findings led to the implementation of research-based statewide surveillance programs and registries to identify women who experienced poor birth outcomes. Additionally, analyses provided the basis for implementing two major intervention programs, statewide education campaigns, and proposed revision of state standards. This paper illustrates the translation of research findings into practically applicable recommendations for statewide surveillance, programs, and policy development.