1. A New Model Law for Vital Statistics National Center for Health Statistics Division of Vital Statistics

2. Model law revision Model State Vital Statistics Act and Regulations: Provides detailed guidance to States that are considering revision of their own State vital statistics laws and regulations. Promotes uniformity among states in definitions, registration practices, disclosure and issuance procedures, and in the many other functions that comprise a state system of vital statistics. Initially established in 1907, has been revised in 1941, 1959, 1977, 1992 http://www.cdc.gov/nchs/nvss/model_law_revision.htm

3. Why update? Security Electronic environment Assisted reproduction Confidentiality and disclosure Establishing new records of live birth Same-sex marriage COOP (Continuity of Operations Planning)

4. Model law revision work group Chairperson Alvin T. Onaka, Ph.D., Hawaii Department of Health Members Catherine Molchan Donald, Alabama Department of Public Health Karen R. Hampton, J.D., Oregon Department of Human Services Ronald Hyman, Colorado Department of Public Health and Environment Wilfredo Lopez, J.D., General Counsel Emeritus, New York City Department of Health and Mental Hygiene Patricia W. Potrzebowski, Ph.D., Formerly, Pennsylvania Department of Health; Executive Director, NAPHSIS Steven Schwartz, Ph.D., New York City Department of Health and Mental Hygiene Linette T. Scott, M.D., M.P.H., California Department of Public Health

5. Model law revision work group Centers for Disease Control and Prevention National Center for Health Statistics, Division of Vital Statistics, Registration Methods Staff Judy M. Barnes Julia L. Kowaleski George C. Tolson Dewey LaRochelle Centers for Disease Control and Prevention Deborah Tress, J.D. Office of General Counsel

6. Functional focus areas Registration Issuance Preservation Dissemination Security Authorities Fees Penalties  Cathy Molchan Donald  Karen Hampton  Ron Hyman  Trish Potrzebowski  Linette Scott  Alvin Onaka  Steve Schwartz  Wilfredo Lopez The Model Act and Regulations were divided by functional focus areas with a Work Group member assigned as lead for each area

7. Objectives Implementation of revised Model Law and Regulations in jurisdictions Improved uniformity of process Use as a resource to support justifications for actions in the jurisdictions regarding the vital records system

8. Legislative research Assisted reproductive technology Adoption laws Electronic records and signatures Aspect of breach of confidentiality Same-sex parentage

9. Accomplishments Surveys of NAPHSIS Membership developed by the Workgroup Model Law Survey – 32 states responded Issuance Survey – 35 states responded Other Surveys of NAPHSIS Membership used by the Workgroup: Fees Charged Fee Retention Levying Fines Verification Charges

10. Accomplishments Solicitation of Comments on NCHS web site Received feedback from NAPHSIS Members National Archives and Records Administration CSTE Subcommittee on Tribal Epidemiology US Department of Justice, Witness Security Division Vermont Notary Public West VA Funeral Directors Association American College of Nurse Midwives National Funeral Directors Association Lambda Legal ACLU LGBT Rights Project National Center for Lesbian Rights Gay and Lesbian Advocates and Defenders Others

11. Accomplishments 2009/2010 NAPHSIS/VSCP Joint Meetings Presentations Roundtables Town Hall Workgroup Meetings began in 2009 April, July, September, November 2009 January, April, July, September, November 2010 March, May 2011

12. Accomplishments October/November 2010 Workgroup Webinars Total of 8 December 23, 2010 – Draft Model Law sent to NAPHSIS Membership

13. Accomplishments January Webinars with NAPHSIS–Purpose Provided background on development process for Draft Model Law & Regulations Provided overview of changes Answered clarifying questions Comments on draft were due from NAPHSIS Members February 11, 2011

14. Statistical Uses of Vital Records Data

15. Identifying and measuring public health problems Planning and evaluating programs at local, State, national, and international levels Providing baseline data for city, county, state, and U.S. comparisons Statistical uses of the data

16. Uses of natality data Population composition and growth Estimate size of population and project increases and decreases Influence on economic and social institutions (schools, labor market, commercial uses)

17. Life expectancy Teenage birth rates Births to unmarried mothers Uses of natality data

18. Adverse birth outcomes Low birth weight babies Racial differentials Multiple births Uses of natality data

19. Natality data used to: Determine need for birthing centers and hospitals Target prenatal care to certain populations Develop educational programs Add warning labels to certain products

20. Infant mortality Teenage suicide Deaths due to violence Motor vehicle mortality Maternal mortality Uses of mortality data

21. Mortality data used for: Allocation of health facilities Epidemiological research Discovery of emerging problems

22. Latest available NCHS data Final Birth–2008 Preliminary Birth–2009 Final Death–2008 Preliminary Death-2009

23. NOTE: Prior to 1933, data are for death-registration States only. Deaths per 100,000 standard population 2008 Life expectancy and age-adjusted death rates: U.S., 1900-2008 Life expectancy Age-adjusted death rates

24. NOTES: Beginning with 1959, trend lines are based on registered live births; trend lines for 1930-59 are based on live births adjusted for underregistration. SOURCE: CDC/NCHS, National Vital Statistics System. 2008 Live births and fertility rates: United States, 1930-2008 Number Rate

25. Fertility rates by race and Hispanic origin: United States, 1920–2006 192019301940195019601970198019902000 50 Hispanic Black White, total Non-Hispanic White Asian/PI NOTE: Data for black women for years prior to 1960 are for women of all races other than white. In 1960, 92% of "all other" births were to black women. Data for 2006 are preliminary. 100 150 200 Births per 1,000 women aged 15-44 in specified group (plotted on a log scale) 2006 American Indian

26. Number of births Birth rate Percent Number of births, birth rate, and percent of births to unmarried women Births per 1,000 unmarried women 15-44 Births in 1000’s SOURCE: National Vital Statistics System, National Center for Health Statistics, CDC.

27. Percent of births to unmarried women, US, selected years, 1980–2008 SOURCE: Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention 19801990 1995 200020052008 18.4 32.2 33.2 36.9 40.6 28.0 Percent

28. Birth rate for unmarried women, selected years, 1980–2008 SOURCE: Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention 19801990 1995 200020052008 29.4 44.3 44.1 47.5 52.5 43.8 Rates per 1,000 unmarried women aged 15–44

29. Triplet/+ birth rates Triplet/+ birth rates NOTE: Triplet/+ births are births in triplet and higher order multiple deliveries. SOURCE: CDC/NCHS, National Vital Statistics System.

30. Cesarean delivery by race and Hispanic origin of mother SOURCE: CDC/NCHS, National Vital Statistics System. Percent Hispanic Non-Hispanic black Non-Hispanic white 0 2008

31. Per 100 births NOTE: Data for 2009 are preliminary. SOURCE: CDC/NCHS, National Vital Statistics System. Race and Hispanic origin Non-Hispanic black HispanicAmerican Indian or Alaska Native Asian or Pacific Islander Non-Hispanic white Cesarean delivery rates by race and Hispanic origin of mother 0

32. Twin birth rates by age of mother: United States, 1990, 2000, and 2008 Twin birth rates by age of mother: United States, 1990, 2000, and 2008 Per 1,000 NOTE: The twin birth rate is per 1,000 live births. The birth rate for women 45-49 for 1990 is not shown because of the small number of births. Years of age 0 40 80 120 160 200 15–1920–2425–2930–3435–3940–4445–49 199020002008

33. Birth rates for teenagers 15-19 years SOURCE: National Vital Statistics System, National Center for Health Statistics, CDC Rates per 1,000 women aged 15-19 years

34. MT WY ID WA OR NV UT CA AZ ND SD NE CO NM TX OK KS AR LA MO IA MN WI IL IN KY TN MS AL GA FL SC NC VA WV OH MI NY PA MD DE NJ CT RI MA ME VT NH AK HI DC Teenage birth rates for 15-19 year olds by State, 2009 Significantly higher than the U.S. 10 highest Not significantly different from U.S. Significantly lower than U.S. 10 lowest

35. NOTE: Data for 2009 are preliminary. SOURCE: CDC/NCHS, National Vital Statistics System. 18-19 years 15-19 years 15-17 years 2009 Birth rate for teenagers by age Rate per 1,000 women in specified age

36. * Non-Hispanic SOURCE: CDC/NCHS, National Vital Statistics System. Teen birth rates by race and Hispanic origin, final 1991, 2005, 2007, and 2009

37. Number of births and birth rate for teenagers 15-19 years SOURCE: CDC/NCHS, National Vital Statistics System. Number of births Birth rate NOTE : Data for 2009 are preliminary.

38. Birth rates for teenagers 15-17 years by race and Hispanic origin * Non-Hispanic NOTE : Data for 2009 are preliminary. SOURCE : CDC/NCHS, National Vital Statistics System

39. MT WY ID WA OR NV UT CA AZ ND SD NE CO NM TX OK KS AR LA MO IA MN WI IL IN KY TN MS AL GA FL SC NC VA WV OH MI NY PA MD DE NJ CT RI MA ME VT NH AK HI DC Change in birth rate for women aged 15-17 years by State, 2007 and 2009 Decreased significantly Ten largest significant decreases No significant difference Increased significantly NOTE: Data for 2009 are preliminary. SOURCE: CDC/NCHS, National Vital Statistics System. U.S. teen birth rate for ages 15-17 was 22.1 per 1,000 in 2007 and 20.1 in 2009

40. MT WY ID WA OR NV UT CA AZ ND SD NE CO NM TX OK KS AR LA MO IA MN WI IL IN KY TN MS AL GA FL SC NC VA WV OH MI NY PA MD DE NJ CT RI MA ME VT NH AK HI DC Change in birth rate for women aged 18-19 years by State, 2007 and 2009 Decreased significantly Ten largest significant decreases No significant difference NOTE: Data for 2009 are preliminary. SOURCE: CDC/NCHS, National Vital Statistics System. U.S. teen birth rate for ages 18-19 was 73.9 per 1,000 in 2007 and 66.2 in 2009

41. Preterm and low birthweight rates Preterm Low birthweight 0

42. Note: Data prior to 1933 contain death-registration States only. Heart disease Influenza & Pneumonia Age-adjusted death rates for heart disease and influenza and pneumonia

43. Leading causes for U.S. 1900 Influenza & Pneumonia Tuberculosis Diarrhea Heart disease Stroke 2008 Heart disease Cancer Stroke Chronic lower respiratory diseases Accidents (unintentional injuries) NOTE: Prior to 1933, data are for death-registration States only.

44. Deaths per 100,000 standard population 1- Diseases of heart 2- Malignant neoplasms 3- Cerebro- vascular diseases 4- Chronic lower respiratory diseases 5- Accidents (unintentional injuries) Trends in leading causes of death, United States, 2003-2008

45. 2008 10-14 years 15-19 years 1-4 years 5-9 years Childhood death rates by age at death Deaths per 100,000 population SOURCE: CDC/NCHS: National Vital Statistics System, 1900-2008

46. Maternal mortality rates, 1915-2007 NOTE: Prior to 1933, data are for birth-registration States only. 2007

47. Infant Neonatal Postneonatal NOTES: Death registration area complete for 1933-2002. Infant, neonatal, and postneonatal mortality rates

48. www.cdc.gov/nchs/nvss.htm

49. Vital Statistics Core of our health data system Base for public health, social science, economic planning and program development Monitor key indicators of health world-wide and at the local, state and national level Track progress to goals Identify disparities Alert to emerging problems

50. Need for complete and accurate information Every certificate is important!