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Background

Background. Baltimore City: Highest rate of infant death in Maryland In 2009 4th worst infant mortality rate in the U.S. Infant mortality rate 10.5 per 1000 live births (2 nd year decline from 13.5 in 2009) 93 infants died in 2010 (from 128 in 2009) Average of over 7 babies per month

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  1. Background Baltimore City: Highest rate of infant death in Maryland In 2009 4th worst infant mortality rate in the U.S. Infant mortality rate 10.5 per 1000 live births (2nd year decline from 13.5 in 2009) 93 infants died in 2010 (from 128 in 2009) Average of over 7 babies per month African American: 14.5 per 1,000 White: 3.6 per 1,000

  2. Infant Mortality in Baltimore City

  3. Causes of Death: Baltimore and US Leading Causes of Infant Mortality Data Source: Baltimore City Health Department analysis of data from the Maryland Vital Statistics Administration; U.S. Data from the NCHS Infant Mortality Statistics, 2005 Period Linked Birth-Death Data Set report

  4. Intended Outcomes Reductions in the following: • Rate of pre-term births by at least 10% (283 fewer preterm babies) • Rate of low birth weight infants by at least 10% (259 fewer low birth weight babies) • Number of deaths from unsafe sleep by at least 30% (12 infants)

  5. Factors Affecting Birth Outcomes Health of the mother and father before conception Medical and social support during pregnancy Access to critical knowledge and services after birth

  6. Increased identification of women at risk Policies and tools improved Improved Triage Project Conceptual Model Increased Use of Quality High Impact Services Service Provider Outreach Increased Co-ordination Improved Referral Improved Birth Outcomes Community Mobilization Exposure to Messages Ideational factors Improved Behaviors Mass media

  7. BHB’s Organization Structure

  8. Implementation Timeline: 10+ years 4 years of initial funding Intervention: Families/Individuals, Communities, Services, Policy/Systems Entry Points: Postpartum/Pregnancy/Preconception Phases of Communication: Healthy Parenting, Healthy Pregnancies, Healthy Baltimore 12 Communities – 2 selected through RFP process

  9. Upton/ Druid Hts Patterson Park North and East

  10. Families and Individuals Families and individuals at risk use available services and practice behaviors that improve birth outcomes • Using voices/opinions/stories from community members and professional stakeholders for branding and to develop each of the phase of implementation

  11. Communities Communities know their role in supporting improved birth outcomes and buy into strategy • Mobilization at City Level • Remembrance Ceremonies • Mass media • Targeted community education at Jury duty, DSS waiting rooms, detention centers • Rattle and Roll Day • Tree planting

  12. Communities Mobilization at Funded Community level • Youth employment and outreach • Social Marketing: Text4Baby • Group-based: Baby Basics

  13. Services Agencies and partners providing services adhere to policies and guidelines for risk assessment and referral with goal of increasing access • Cadre of trainers trained as change agents and disseminators of messages • Provision of safe sleep service provider toolkit • Development of safe sleep checklist for home visiting programs • Provision of cribs

  14. Policy and Systems Policy for coordinating risk assessment and referral is in place • Mayoral safe sleep and stop smoking proclamations • Hospital postpartum discharge policy for infant safe sleep • Child Fatality Review Team/Fetal and Infant Mortality Review Team – Community Action Team – Neighborhood Action Teams

  15. Baltimore City Child Fatality Review Update on Sleep-Related Infant Deaths (SRIDs)—October 2012 12-Year Average—19.2

  16. Numberof infant and sleep-related deaths per year, Baltimore City, 2009-2011 Correlation between change in IMR and change in number of sleep-related deaths = 0.74

  17. Surveys of mothers of infants <1 year of age attending pediatric health care services • Highlandtown Healthy Living Center (n=96) • Pediatrics at the Harbor (n=133) • Data collected between Summer 2011 and Spring 2012 Data

  18. In which one position did you most often lay your baby down to sleep? How often did your baby sleep in the same bed with you or anyone else? Safe sleep behaviors among mothers of infants <1 year of age

  19. Sources of Information about Safe Sleep *Difference between English and Spanish; p<0.05

  20. Percent of mothers reporting that they never co-sleep with their infant, by exposure to safe sleep information * * Controlling for Age, Education, Age of child, Receipt of cash assistance, Has Health Insurance *Different from No Exposure; p<0.05

  21. Percent of mothers reporting that they put their infant on their back, by exposure to safe sleep information Controlling for Age, Education, Age of child, Receipt of cash assistance, Has Health Insurance *Different from No Exposure; p<0.05

  22. Weekly weigh-in data from Weight Watchers • Participant surveys every 12 weeks • Comparison data collected at 2 WIC sites • Not yet started; IRB approval delayed due to HIPAA issues B’more Fit Data

  23. B’more Fit: Average weekly weekly weight change (in pounds), by site and duration of attendance Data through end of September, 2012

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