16
Using Preconception Health Indicators to Shape Programs and Policy in California 3 rd National Summit on Preconception Health and Health Care Improving Preconception Health in a New Era of Health Care Tampa/St. Petersburg, FL June 13, 2011 Flojaune Griffin, PhD, MPH Preconception Health Coordinator

Using Preconception Health Indicators to Shape Programs and Policy in California 3 rd National Summit on Preconception Health and Health Care Improving

Embed Size (px)

Citation preview

Page 1: Using Preconception Health Indicators to Shape Programs and Policy in California 3 rd National Summit on Preconception Health and Health Care Improving

Using Preconception Health Indicators to Shape Programs and Policy in California

3rd National Summit on Preconception Health and Health CareImproving Preconception Health in a New Era of Health Care

Tampa/St. Petersburg, FLJune 13, 2011

Flojaune Griffin, PhD, MPHPreconception Health Coordinator

Page 2: Using Preconception Health Indicators to Shape Programs and Policy in California 3 rd National Summit on Preconception Health and Health Care Improving

Acknowledgements

• Preconception Health at the California Department of Public Health, Maternal, Child and Adolescent Health Division is funded by Title V federal block grant

• Centers for Disease Control and Prevention for providing travel funding

• CDPH Preconception Health Team• Connie Mitchell, MD, MPH• Sangi Rajbhandari, MPH• Moreen Libet, PhD• Michael Curtis, PhD• Jennifer Troyan, MPH• Shabbir Ahmad, DVM, MS, PhD

• Preconception Health Council of California and the March of Dimes

Page 3: Using Preconception Health Indicators to Shape Programs and Policy in California 3 rd National Summit on Preconception Health and Health Care Improving

Presentation Objectives

The participant will be able to:• Explain how California has used select California MIHA

preconception health indicators (now included in Healthy People 2020) to identify statewide needs

Describe the value of the state-wide Preconception Health Council of California

Describe California Department of Public Health initiatives that were developed from the indicator surveillance

Page 4: Using Preconception Health Indicators to Shape Programs and Policy in California 3 rd National Summit on Preconception Health and Health Care Improving

Maternal & Infant Health Assessment (MIHA)

Annual population-based survey of California women with a recent live birth, since 1999– ~ 7000 women since 2010 with WIC funding; before ~ 3000-

3500– Mailed survey with telephone follow-up to non-respondents– Available in English and Spanish– Ages 15 and older– Random stratified sample

Regions include top 20 birthing counties– Response rates ~70%

Based at MCAH Similar to CDC’s Pregnancy Risk Assessment Monitoring

System (PRAMS)

Page 5: Using Preconception Health Indicators to Shape Programs and Policy in California 3 rd National Summit on Preconception Health and Health Care Improving

Selected MIHA Preconception Health Indicators

Folic Acid– During the month before you got pregnant with your new baby, how

many times a week did you take a multivitamin, a prenatal vitamin, or a folic acid vitamin?

Page 6: Using Preconception Health Indicators to Shape Programs and Policy in California 3 rd National Summit on Preconception Health and Health Care Improving

Daily folic acid use during the month before pregnancy California Maternal and Infant Health Assessment 2009

CA 15-19 20-24 25-29 30-34 35+ Black Hispanic Asian/PI White0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

32.9%20.3% 22.6%

29.8%39.5% 44.4%

27.1% 25.7%

40.8% 43.2%

Pe

rce

nt

(95

% C

I)

Source: California Department of Public Health, Maternal, Child and Adolescent Health Program, Maternal and Infant Health Assessment Data are weighted to reflect the population of women delivering a live birth in the survey year.

Page 7: Using Preconception Health Indicators to Shape Programs and Policy in California 3 rd National Summit on Preconception Health and Health Care Improving

Selected MIHA Preconception Health Indicators

Folic Acid– During the month before you got pregnant with your new baby, how

many times a week did you take a multivitamin, a prenatal vitamin, or a folic acid vitamin?

Smoking– Have you smoked any cigarettes in the past 2 years? – During the 3 months before you got pregnant, how many cigarettes or

packs of cigarettes did you smoke on an average day?

Page 8: Using Preconception Health Indicators to Shape Programs and Policy in California 3 rd National Summit on Preconception Health and Health Care Improving

Did not smoke during the three months before pregnancy California Maternal and Infant Health Assessment 2009

CA 15-19 20-24 25-29 30-34 35+ Black Hispanic Asian/PI White0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

88.0% 88.0% 83.9% 85.2% 90.4% 93.0%81.6%

91.8% 91.4%81.9%

Pe

rce

nt

(95

% C

I)

Source: California Department of Public Health, Maternal, Child and Adolescent Health Program, Maternal and Infant Health Assessment Data are weighted to reflect the population of women delivering a live birth in the survey year.

Page 9: Using Preconception Health Indicators to Shape Programs and Policy in California 3 rd National Summit on Preconception Health and Health Care Improving

Selected MIHA Preconception Health Indicators

Folic Acid– During the month before you got pregnant with your new baby, how

many times a week did you take a multivitamin, a prenatal vitamin, or a folic acid vitamin?

Smoking– Have you smoked any cigarettes in the past 2 years? – During the 3 months before you got pregnant, how many cigarettes or

packs of cigarettes did you smoke on an average day? Healthy Weight (Calculated BMI)

– Just before you got pregnant, how much did you weigh?– How tall are you without shoes?

Page 10: Using Preconception Health Indicators to Shape Programs and Policy in California 3 rd National Summit on Preconception Health and Health Care Improving

Healthy Weight just before pregnancy (BMI 18.5-24.9 kg/m2)California Maternal and Infant Health Assessment 2009

CA 15-19 20-24 25-29 30-34 35+ Black Hispanic Asian/PI White0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

52.6%59.7%

52.3% 50.3% 52.9% 52.2%43.2% 46.2%

65.6%58.5%

Pe

rce

nt

(95

% C

I)

Source: California Department of Public Health, Maternal, Child and Adolescent Health Program, Maternal and Infant Health Assessment Data are weighted to reflect the population of women delivering a live birth in the survey year.

Page 11: Using Preconception Health Indicators to Shape Programs and Policy in California 3 rd National Summit on Preconception Health and Health Care Improving

Selected MIHA Preconception Health Indicators

Folic Acid– During the month before you got pregnant with your new baby, how

many times a week did you take a multivitamin, a prenatal vitamin, or a folic acid vitamin?

Smoking– Have you smoked any cigarettes in the past 2 years? – During the 3 months before you got pregnant, how many cigarettes or

packs of cigarettes did you smoke on an average day? Healthy Weight (Calculated BMI)

– Just before you got pregnant, how much did you weigh?– How tall are you without shoes?

Postpartum Visit– Since your most recent birth, have you had a postpartum checkup (the

medical checkup that is done about 6 weeks after a woman gives birth)?

Page 12: Using Preconception Health Indicators to Shape Programs and Policy in California 3 rd National Summit on Preconception Health and Health Care Improving

Six Week Postpartum Medical CheckupCalifornia Maternal and Infant Health Assessment 2009

CA 15-19 20-24 25-29 30-34 35+ Black Hispanic Asian/PI White0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

87.4%81.0% 82.5% 87.6% 91.2% 89.9% 88.6%

83.2%90.5% 92.8%

Pe

rce

nt

(95

% C

I)

Source: California Department of Public Health, Maternal, Child and Adolescent Health Program, Maternal and Infant Health Assessment Data are weighted to reflect the population of women delivering a live birth in the survey year.

Page 13: Using Preconception Health Indicators to Shape Programs and Policy in California 3 rd National Summit on Preconception Health and Health Care Improving

Preconception Health Council of California Activities

EveryWomanCalifornia Website– Public and Health Professionals

California Adoption of Colorado Guidelines for Clinical Care– Standardize the content of well women visits– Health Assessment– Management of Chronic Conditions– Appropriate contraception

Interconception Care Project of California– Standardize the content of postpartum visits

Page 14: Using Preconception Health Indicators to Shape Programs and Policy in California 3 rd National Summit on Preconception Health and Health Care Improving

California Department of Public Health Activities

Social Marketing Campaigns− HRSA First Time Motherhood Grant

Latina Folic Acid African American Youth (ages 15-24)

Black Infant Health Program Curriculum– Group life course intervention– 10 prenatal and 10 postpartum visits

Diabetes and Pregnancy Program– Provider training for pregnancy readiness

Institute of Medicine Recommendations– Gap in USPSTF Recommendations– Essential Health Care Benefit

Family Planning, Preconception and Interconception health services

Page 15: Using Preconception Health Indicators to Shape Programs and Policy in California 3 rd National Summit on Preconception Health and Health Care Improving

Conclusions

MIHA is useful in identifying areas of need and guiding program development

Strengths– MIHA response rate is 70%– Reflective of the annual population giving birth in California

Limitations– Preconception period is long and variable– Difficult to measure impact of targeted campaigns– MIHA only assesses live births

MIHA is useful, but not sufficient in measuring preconception health– Need more indicators of preconception health (morbidity and wellness)– Need data measuring health status and behaviors of

All women of reproductive age Pregnant women with embryo or fetal deaths

Page 16: Using Preconception Health Indicators to Shape Programs and Policy in California 3 rd National Summit on Preconception Health and Health Care Improving

For Additional Information or Questions Contact:

Flojaune Griffin, PhD, MPHPreconception Health Coordinator

Maternal, Child and Adolescent Health DivisionProgram Development [email protected]

(916) 341-6333