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The Experience of New Mothers in Minnesota: Purpose, Design, Analysis and Early Findings from Minnesota PRAMS

The Experience of New Mothers in Minnesota: Purpose, Design, Analysis and Early Findings from Minnesota PRAMS. Cynthia Turnure, PhD, Minnesota Department of Health Wendy Hellerstedt, PhD, University of Minnesota. Overview. Basics of public health surveillance

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The Experience of New Mothers in Minnesota: Purpose, Design, Analysis and Early Findings from Minnesota PRAMS

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  1. The Experience of New Mothers in Minnesota: Purpose, Design, Analysis and Early Findings from Minnesota PRAMS Cynthia Turnure, PhD, Minnesota Department of Health Wendy Hellerstedt, PhD, University of Minnesota

  2. Overview • Basics of public health surveillance • PRAMS: National and Minnesota Overview • MN PRAMS: Sample selection • MN PRAMS: Content • MN PRAMS: Findings so far • MN PRAMS: Dissemination

  3. PUBLIC HEALTH SURVEILLANCE

  4. • Surveillance • Overview • Sample • Content • Findings • Dissemination DEFINITIONS OF SURVEILLANCE D.A. HENDERSON, 1976 “Surveillance serves as the brain and nervous system for programs to prevent and control disease.”

  5. • Surveillance • Overview • Sample • Content • Findings • DisseminationCore Public Health Functions Assessment Policy development Assurance

  6. • Surveillance • Overview • Sample • Content • Findings • Dissemination • DEFINITIONS OF SURVEILLANCE • KEY ELEMENTS (Detels, 1989) • Collection of health data expressly for use in health planning, disease control/ prevention, and/or health promotion • Ongoing collection of data • Timely analysis • Easily understood • Dissemination of results • Action based on results • Periodic evaluation of system

  7. • Surveillance • Overview • Sample • Content • Findings • Dissemination • USES OF SURVEILLANCE SYSTEMS • To monitor changes or trends in health factors: • - Prevalence/incidence of disease and/or • risk factors • - Geographic distribution • - Risk group distribution • To provide health information on which to base rational intervention programs • To evaluate the effectiveness of intervention strategies (e.g., vaccines, health education/behavioral programs, legislation)

  8. SURVEILLANCE VS. SCREENING • Surveillance • Data collection to measure magnitude, changes, and trends in populations • Objective intervention in defined populations • Screening • Testing to identify individuals with infection or disease • Objective is either: • - Personal intervention • - Protection of the public (e.g., blood donors) • Measurement of prevalence in screened populations

  9. • Surveillance • Overview • Sample • Content • Findings • Dissemination • SURVEILLANCE SYSTEMS • SURVEILLANCE VS. FINDING THE RESERVOIR • For surveillance, want a representative sample • For finding the reservoir, want to find infected individuals

  10. SURVEILLANCE SYSTEMS • DEFINING A CASE • Establishing a functional case criteria • -Quickly and easily defined • Selecting the right test or definition • -Easy, specific • Clinical versus epidemiological diagnostic criteria • -Functional • Disease versus infection • - AIDS and HIV infection

  11. • Surveillance • Overview • Sample • Content • Findings • Dissemination SURVEILLANCE SYSTEMS SELECTING THE POPULATION • Defining the selection criteria • Gaining access • Obtaining and maintaining compliance

  12. • Surveillance • Overview • Sample • Content • Findings • Dissemination • SURVEILLANCE SYSTEMS • SELECTING THE APPROPRIATE STRATEGY • Need for cultural sensitivity • Understanding the implications and limitations of strategies • Selecting the appropriate surveillance strategy

  13. • Surveillance • Overview • Sample • Content • Findings • Dissemination • SURVEILLANCE SYSTEMS • OTHER CONSIDERATIONS • Timely data processing • Results and action • - Interpretation • - Facilitating appropriate action based on • surveillance results

  14. • Surveillance • Overview • Sample • Content • Findings • Dissemination • SURVEILLANCE SYSTEMS • EVALUATION AND REVISIONS • Importance of ongoing evaluation • Revising the surveillance program • - When and why

  15. • Surveillance • Overview • Sample • Content • Findings • Dissemination • SURVEILLANCE SYSTEMS • SURVEILLANCE STUDY DESIGNS • Cohort studies • Cross-sectional studies • Serial cross-sectional studies • Surveys • Mortality surveillance • Sentinel surveillance

  16. • Surveillance • Overview • Sample • Content • Findings • Dissemination • SURVEILLANCE SYSTEMS • ACTIVE VS. PASSIVE SURVEILLANCE • Passive = reporting • Active = searching

  17. • Surveillance • Overview • Sample • Content • Findings • Dissemination • SURVEILLANCE SYSTEMS • TESTING STRATEGIES TO REDUCE SELECTION BIAS • Unlinked anonymous • Voluntary anonymous • Voluntary confidential • Routine confidential • Mandatory • Compulsory

  18. • Surveillance • Overview • Sample • Content • Findings • Dissemination SURVEILLANCE SYSTEMS OPTIMAL VS. FEASIBLE Recognizing what is optimal versus what is feasible for the specific culture

  19. • Surveillance • Overview • Sample • Content • Findings • Dissemination • EVALUATION OF A SURVEILLANCE SYSTEM • Sensitivity • Timeliness • Representativeness • Acceptability • Flexibility • Simplicity • Cost/benefit • Dissemination of results • Appropriate action taken

  20. • Surveillance • Overview • Sample • Content • Findings • Dissemination • EVALUATION OF A SURVEILLANCE SYSTEM • SENSITIVITY • What proportion of “cases” are identified? • Does the system give an accurate picture of trends and magnitudes?

  21. • Surveillance • Overview • Sample • Content • Findings • Dissemination • EVALUATION OF A SURVEILLANCE SYSTEM • TIMELINESS • Is information disseminated rapidly enough to permit timely action based on the surveillance system?

  22. • Surveillance • Overview • Sample • Content • Findings • Dissemination • EVALUATION OF A SURVEILLANCE SYSTEM • REPRESENTATIVENESS • Do reported cases differ from unreported cases?

  23. • Surveillance • Overview • Sample • Content • Findings • Dissemination • EVALUATION OF A SURVEILLANCE SYSTEM • ACCEPTABILITY • Does the system stimulate the cooperation of respondents? • Does the process discourage participation?

  24. • Surveillance • Overview • Sample • Content • Findings • Dissemination • EVALUATION OF A SURVEILLANCE SYSTEM • FLEXIBILITY • Can changes be easily made in the system to reflect changes in trends, magnitude, and other relevant factors?

  25. • Surveillance • Overview • Sample • Content • Findings • Dissemination • EVALUATION OF A SURVEILLANCE SYSTEM • SIMPLICITY • Can the system be simplified and still obtain the necessary information?

  26. • Surveillance • Overview • Sample • Content • Findings • Dissemination • EVALUATION OF A SURVEILLANCE SYSTEM • COST/BENEFIT • Is the system worth the cost? • Can costs be reduced without sacrificing the essential quality of the system?

  27. • Surveillance • Overview • Sample • Content • Findings • Dissemination • EVALUATION OF A SURVEILLANCE SYSTEM • DISSEMINATION OF RESULTS • To decision-makers • To data collectors • To the general public

  28. • Surveillance • Overview • Sample • Content • Findings • Dissemination • EVALUATION OF A SURVEILLANCE SYSTEM • APPROPRIATE ACTION TAKEN • Are appropriate actions taken in response to the surveillance data? • Does surveillance lead to effective intervention?

  29. PRAMS: Overview PRAMS = Pregnancy Risk Assessment Monitoring System

  30. • Surveillance • Overview • Sample • Content • Findings • Dissemination What Is PRAMS? • PRAMS is a Centers for Disease Control & Prevention (CDC) Initiative to reduce infant mortality and low birthweight; started in 987 • PRAMS is an ongoing, state-specific, population-based surveillance system designed to identify and modify selected maternal behaviors and experiences before, during and after pregnancy.

  31. • Surveillance • Overview • Sample • Content • Findings • Dissemination Purpose of PRAMS • Supplement vital records data with data on maternal behaviors and experiences that can be used for program planning and assessment of perinatal health programs. • Standard format and data collection allows data to be compared among states.

  32. States Participating in PRAMS, 2004

  33. • Surveillance • Overview • Sample • Content • Findings • Dissemination PRAMS Goals • To Reduce Infant Mortality and Infant Morbidity • To Create a Statewide Data Collection System • To Translate Results from Analysis into Information for Planning and Evaluation

  34. • Surveillance • Overview • Sample • Content • Findings • Dissemination PRAMS Objectives • To collect population-based data • To conduct comprehensive analysis • To translate results from analyses into information for planning and evaluation • To build the capacity of states to collect, analyze and translate data to address public health issues

  35. PRAMS Logic Model Objective 2 Translation Objective 2 Analysis Programs Objective 1 Data Collection Data for Public Health Action PRAMS Surveillance System Low Birthweight Infant Mortality Maternal Health Policy Objective 4 Capacity

  36. • Surveillance • Overview • Sample • Content • Findings • Dissemination Uses of PRAMS Data (Cont) • Help health professionals incorporate new research finds into practice standards • Monitor progress toward state and national health objectives and goals

  37. • Surveillance • Overview • Sample • Content • Findings • Dissemination PRAMS Summary Data of All States • Over 20 maternal and infant indicators consistently reported in each state • Current year prevalence indicator data by state and sociodemographic characteristics are most common ways of describing data • Trend data reported by state • Takes a while for CDC to prepare summary reports: perhaps a 2-yr delay

  38. • Surveillance • Overview • Sample • Content • Findings • Dissemination Sources of Data for Analysis • Merged states (often see this in research reports) • Multi-state (selected states) • Individual state

  39. • Surveillance • Overview • Sample • Content • Findings • Dissemination Example of Multi-state Descriptive PRAMS Data • Example of some indicators reported by PRAMS: • Postpartum contraceptive use • Unintended pregnancy • Prenatal smoking • Breastfeeding initiation • Prenatal violence • Infant sleep position

  40. • Surveillance • Overview • Sample • Content • Findings • Dissemination Physical Abuse During Pregnancy • Pushing, hitting, slapping, kicking, or any other way of physically hurting • By husband or partner • At any time during pregnancy

  41. Physical Abuse During Pregnancy,PRAMS 1999 Range: 2.1 (ME) - 6.3 (NM)

  42. Physical Abuse During Pregnancy,PRAMS 1996-1999 • No statistically significant change over time • Not statistically significant, but decreases are observed: AL, AK, OK

  43. • Surveillance • Overview • Sample • Content • Findings • Dissemination Back Sleep Position • Placing the infant down to sleep on its back most of the time

  44. Back Sleep Position, PRAMS 1999 Range: 35.1 (LA) - 74.6 (UT)

  45. Back Sleep Position, PRAMS 1996-1999 • Statistically significant increase over time: ALL 12 STATES

  46. Minnesota PRAMS

  47. • Surveillance • Overview • Sample • Content • Findings • Dissemination Minnesota PRAMS Partners • Minnesota PRAMS Advisory Committee • Partnerships within the Minnesota Department of Health • Individuals and organizations interested in providing feedback/receiving results, but not able to actively serve on the committee

  48. Infant Mortality Rate Minnesota

  49. Design Considerations: Sample

  50. • Surveillance • Overview • Sample • Content • Findings • Dissemination Who Should Be Sampled? • PRAMS: women who have had a livebirth in past 2-6 months, identified by Birth Certificate • “Best” surveillance often considered to be representative of the population • “Oversampling” : sample women based on some kind of criteria and thus stratify sampling based on that criteria

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