Graduation Date

Summer 8-11-2023

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Promotion and Disease Prevention Research

First Advisor

Dr. Melissa Tibbits


Despite being preventable, adverse maternal health outcomes continue to be a problem in the United States, which fares worse at preventing these issues than other industrialized nations. Although our understanding of the factors that play a role in the etiology of adverse maternal health outcomes has improved over time, there is still a lot left to understand regarding the role of contextual factors, the upward trajectory of outcomes such as severe maternal morbidity (SMM), and the disproportionate impact of adverse maternal health outcomes on non-Hispanic Black women. This thesis attempted to evaluate the factors that influence procedure-related severe maternal morbidity (PR-SMM) at a compositional-level and at a contextual-level. This was accomplished through the statistical analysis of secondary, National Inpatient datasets accessed through the Healthcare Cost and Utilization Project. In addition, the thesis sought to gain insight into the perspectives of non-Hispanic Black women on the role of social determinants of health (SDOH) on their maternal health experiences healthy or otherwise. This was accomplished by conducting interviews with non-Hispanic Black women residing in Omaha, and Lincoln, Nebraska. Known compositional factors such as race/ethnicity, maternal age, and type of insurance coverage were associated with PR-SMM. Whereas community income quartile, location of patient-residence, and hospital location influenced PR-SMM at a contextual-level. Non-Hispanic Black women perceived SDOH pertaining to economic stability, education, neighborhoods, healthcare access and quality, and the social community context, as vital to their maternal health outcomes.


2023 Copyright, the authors

Available for download on Thursday, July 31, 2025