Maternal & Child Health Epidemiology: An Overview of Selected Data Systems

1. Maternal & Child Health Epidemiology: An Overview of Selected Data Systems Data Users Conference November 17, 2004 Presented by Susan Nalder, EdD, MPH, CNM MCH Epidemiology Program Manager New Mexico Department of Health

2. MCH Epidemiology, Population Based Uses data variety of data and data sources covering population characteristics, health status by natality, mortality, morbidity and injury, healthy & health risk behaviors, access to and use of primary preventive care Hand-out shows kinds of data used to monitor this population Presentation will focus on PRAMS Special mention of selected projects

3. MCH Epidemiology, Population Based National Survey of Children with Special Health Care Needs: Federal MCH-B and NCHS New Mexico sample 751 Data collected in 2001; reported in 2002 Used SLAITS methodology – need to use STATA or combination of SAS+SUDAAN Data files and data reports may be accessed: www.cdc.gov/slaits Data report: www.cdc.gov/nchs/slaits.htm

4. MCH Epidemiology, Population Based National Survey of Child Health: Federal MCH-B and NCHS New Mexico sample ~2,000 Data collected in 2004 Data files available early 2004 Used SLAITS methodology – need to use STATA or combination of SAS+SUDAAN Data files and data reports will be posted: www.cdc.gov/slaits

5. MCH Epidemiology, Population Based NM Child Fatality Review and NM Maternal Mortality Review Data bases developed and in testing 2004; reviews ongoing since 1996 Reports are at www.doh.state.nm.us Program contact: Anne Worthington, MPH Anne.Worthington@doh.state.nm.us tel 505-476-8888

6. MCH Epidemiology, Population Based Comprehensive MCH data and information available through the Title V MCH Block Grant program Over 60 indicators of health status and access to/use of care www.mchb.hrsa.gov Online data; can see NM data and any other state

7. From Data to Action NM Pregnancy Risk Assessment Monitoring System

8. Acknowledgements The NM PRAMS team • Ssu Weng, MD, MPH, PRAMS Epidemiologist • Dorin Sisneros, PRAMS Operations Manager • Eirian Coronado, MA, PRAMS Coordination and Epidemiology The PRAMS Sample Source - The team in the NM Office of Vital Records and Health Statistics The Telephone Follow-up - The team in the Survey Unit, Division of Epidemiology & Response The CDC PRAMS Team - Nedra Whitehead, PhD, NM PRAMS Advisor

9. Funding Support and TA The Title V Maternal & Child Health Block Grant (1995 to present) The PRAMS Project in the Program Services Branch, Division of Reproductive Health, Centers for Disease Control & Prevention in Atlanta (1996-present) The Medicaid Program, NM Human Services Department (1998 to present) The Family Preservation & Support Project, Prevention & Intervention, NM Children, Families and Youth Department (1995-1999)

10. PRAMS is a multi-state, ongoing surveillance project (32 states)

11. The Purpose of NM PRAMS • To improve the health of New Mexico’s mothers, infants and families

12. The Purpose of NM PRAMS • To reduce significant disparities in maternal, infant and family health measures: • Disparities: geographic areas, age, race or ethnicity, education, poverty, families with Medicaid paid services • Measures: health status, healthy & health risk behaviors, exposure to stressors, access to/use of health & health related services

13. The Purpose of NM PRAMS • To produce data and information, and foster its use for • Strategic analysis with local groups, translation of data to action • Informed Policy • Informed decisions about programs, selection of evidence-based services • Education of policy makers, providers, present and future mothers & fathers, and the public • Monitoring and reporting status and trends over time

14. About NM PRAMS • A multi-year, population-based surveillance system • Monitors over 100 selected behaviors and experiences of mothers and infants that occurred before, during or after a pregnancy & live birth … against a background of socio-demographic, economic and cultural characteristics

15. About NM PRAMS • Preconceptional Period ~ up to 12 months before pregnancy • Health insurance before pregnancy • Use of multivitamins • Height & Weight, BMI calculations • Intention of pregnancy • Tobacco, Alcohol, Physical Abuse • Knowledge about Emergency Contraceptive Pill

16. About NM PRAMS • Pregnancy • When knew she was pregnant • Prenatal care, including barriers • Payor of care • Health education received (11 topics) • HIV testing • Oral health services • Services including WIC and 11 supportive services • Prenatal health problems (diabetes, pregnancy related, injuries)

17. About NM PRAMS • Pregnancy & Delivery • Experience of feeling treated unfairly when getting health care • Prenatal hospitalizations • Tobacco, alcohol, physical abuse • Life stressors (13 topics) • Payor of care for delivery • Length of stay after delivery

18. About NM PRAMS • Post-Partum to ~2 months • Post partum check up • Use of family planning method(s) • Barriers to using family planning • Supportive services (11 kinds) • Working or in school, or at home • Depression • Food security for the family • Household utilities

19. About NM PRAMS • Early Infancy to ~2 months • Hospitalization or NICU after delivery • Infant feeding • Several questions about breastfeeding • Second hand smoke exposure • Infant sleep position • Well child care • Infant car seat • Home visiting services • Family support for infant’s care

20. More About NM PRAMS • The Sample: random selection from NM live birth registration files IN: NM Residents, live birth in NM, singleton-triplet Excluded: Non-resident, Resident but out of state birth, adoption • Timing: 2-6 months post-partum • Method: mailed survey with telephone follow-up

21. Data collection Up to 3 mailings Telephone interview for non-responders Recall bias minimized • Mailed 2-6 months after delivery

22. More About NM PRAMS, 1997-2000 • 1997-2000 Sample Design: stratified sample, oversampled low birth weight & Native Americans • Statewide, 8,182 sampled; 5,711 responded, 70% response rate • 2001-Present, the Sample Design: stratified sample, oversampled by Health District

23. PRAMS Reports Mother’s Residence by Public Health Districts • District I Urban: Bernalillo, Torrance, Valencia, and zip codes for Bernalillo town & Rio Rancho • District I Rural: Sandoval (excludes Bernalillo town & Rio Rancho zip), McKinley, San Juan, Cibola • District II: Colfax, Harding, Los Alamos, Mora, Rio Arriba, San Miguel, Santa Fe, Taos, Union • District III: Catron, Dona Ana, Grant, Hidalgo, Luna, Otero, Sierra, Socorro • District IV: Chaves, Curry, DeBaca, Eddy, Guadalupe, Lea, Lincoln, Quay, Roosevelt

24. More on the PRAMS • Statewide Estimates and Other Analysis: Selected characteristics of the mothers are associated with outcomes, behaviors or other findings. • Age Groups • Race and Ethnicity • Education Levels • Marital Status • Any Previous Live Birth • Residence by Public Health District • Public Assistance • Payor of Care and I.H.S. • PNC & Delivery, Delivery Only

25. Point estimateAnalysis weights • Each respondent “speaks” for about 12 other women Not selected for sample or who did not respond • Weighting process complex • Done by CDC PRAMS • See PRAMS reports on DOH website

26. Potential bias from • Less than 100% response – about 30% do not participate • Mail survey: appeals to more educated women, but many less-advantaged women participate • Phone respondents vs. mail • Recall (2-6 months after birth) • Self-report by respondent

27. NM PRAMS • Annual Surveillance Report • Detailed reporting >20 topics • Multi-year reporting >20 topics • Special Reports • Teen report • Medicaid report • Topics of interest

28. NM PRAMS • Use of PRAMS by outside researchers • CDC PRAMS working on a public use data set … • NM PRAMS, qualified researchers may propose an analysis project and obtain data, a process is in place

29. Contact information for NM PRAMS email us at nmprams@doh.state.nm.us Erian Coronado, MA, PRAMS Coordinator Tel: 505-475-8895 Ssu Weng, MD, MPH, PRAMS Epidemiologist Tel: 505-476-8892 Susan Nalder, EdD, MPH PRAMS Director Tel: 505-476-8890 Maternal and Child Health Epidemiology Program Family Health Bureau NM Department of Health 2040 South Pacheco St, Santa Fe, NM 87505