using preconception health indicators to shape programs and policy in california 3 rd national...
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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
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
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
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)
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?
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.
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?
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.
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?
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.
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)?
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.
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
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
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
For Additional Information or Questions Contact:
Flojaune Griffin, PhD, MPHPreconception Health Coordinator
Maternal, Child and Adolescent Health DivisionProgram Development [email protected]
(916) 341-6333