180 likes | 268 Views
Core State Indicators for Monitoring Preconception Health: A Multi-state Selection Process. Danielle L. Broussard, PhD, MPH Former CDC/CSTE Applied Epidemiology Fellow Division of Family Health Services Florida Department of Health. Objectives. Explain the need for indicators
E N D
Core State Indicators for Monitoring Preconception Health: A Multi-state Selection Process Danielle L. Broussard, PhD, MPH Former CDC/CSTE Applied Epidemiology Fellow Division of Family Health Services Florida Department of Health
Objectives • Explain the need for indicators • Describe the selection process • Present the indicator domains • Discuss recommendations for future efforts
4 5 6 7 8 9 10 11 12 Central Nervous System Central Nervous System Heart Heart Arms Arms Eyes Eyes Legs Legs Teeth Teeth Palate Palate External genitalia External genitalia Ear Ear Mean Entry into Prenatal Care Missed Period Critical Periods of Fetal Development Week
CDC’s Preconception Health Efforts • Recommendations • Journal publications • Workgroups to develop strategies • Evaluations and best practices • Technical assistance to programs • National summit
Preconception Health in States • Many states identified preconception health-related indicators in Title V Block Grant applications and annual reports (2004, 2006) • Some states already developed preconception health reports that included indicators Source: Boulet SL, et al. MCHJ 2006; 10(Suppl 1):13-20.
Standard, nationally-recognized preconception health measures were needed
Core State Preconception Health Indicator Initiative Purpose • Working group: 7 states • CA, DE, FL, MI, NC, TX, & UT • Already developed and utilized indicators • Review and evaluate potential indicators • Recommend an initial set of core state indicators
Core State Preconception Health Indicator Initiative Assumptions • Measured frequently– optimally on an annual basis • State-level, population-based • Reasonably valid and reliable • Women of reproductive age (18-44); adolescents and men require their own set of measures
Core State Preconception Health Indicator Initiative Process • Identify domains of preconception health • Review available state data sets for potential indicators within domains • Identify potential indicators • Evaluate potential indicators on 5 criteria • Score potential indicators on 5 criteria
Core State Preconception Health Indicator Initiative Process • Select and recommend core indicators • Make available for public review and comment • Consulted expert advisory panel at various decision making points
Core State Preconception Health Indicator Initiative Domains • General Health Status • Social Determinants • Health Care • Reproductive Health/ Family Planning • Nutrition/Physical Activity • Tobacco, Alcohol, and Substance Use • Mental Health • Chronic Conditions • Emotional / Social Support • Infections • Genetics / Epigenetics
Core State Preconception Health Indicator Initiative State-level Data Sets • Abortion reporting • Assisted Reproductive Technology Surveillance System • BRFSS • Census / Current Population Survey • Cancer registry • PRAMS • Pregnancy Nutrition Surveillance System • Notifiable STD reporting • National Vital Statistics System
Core State Preconception Health Indicator Initiative 5 Evaluation Criteria • General public health importance • State program/policy priority • Data availability (frequency, accessibility) • Data quality (representativeness, validity, reliability, missing data) • Complexity of calculations
Core State Preconception Health Indicator Initiative Proposed Indicators • 45 indicators within the 11 domains • Detailed descriptions posted on the CSTE website • Data source • Numerator and denominator for calculations • Significance • Limitations
Core State Preconception Health Indicator Initiative Proposed Indicators • Full descriptions on CSTE web site: www.cste.org • Publication describing indicator selection process Broussard DL, et al. MCHJ 2011; 15(2):158-68.
Core State Preconception Health Indicator Initiative Challenges • Preconception health is an emerging field (little data on population effects of programs) • Many measures not captured or not captured well in existing surveillance systems • Defining the population at risk • Large number of indicators • Gaps in data (e.g., disease severity, genetic testing for specific heritable conditions)
Core State Preconception Health Indicator Initiative Recommendations • Improve existing surveillance items or create new data sources • Limited resources and competing surveillance priorities means collaboration with other public health programs is essential (e.g., chronic diseases)
Core State Preconception Health Indicator Initiative California • MoreenLibet, PhD • KikoMalin, MPH, MSW Delaware • CharlanKroelinger, PhD Florida • Danielle Broussard, PhD, MPH • Bill Sappenfield, MD, MPH Michigan • ViolandaGrigorescu, MD, MSPH • Chris Fussman, MS North Carolina • Alvina Long Valentin RN, MPH • Sarah McCracken Cobb, MPH Texas • Gita Mirchandani, PhD, MPH • Charlotte Brooks, MEd Utah • Nan Streeter, MS, RN • Lois Bloebaum, MPA • ShaheenHossain, PhD