Allegheny County Maternal and Child Heath Indicators Report 2014 Michael Balke Faculty Advisor: Dr. Christina Wassel, PhD, MPH, FAHA Site Preceptor: Dr. Ronald Voorhees, MD, MPH Pittsburgh Summer Institute in Applied Public Health

Project Description and Goal MCH Indicators Report Describe the current state of maternal and child health in Allegheny County (AC) in an accessible report Goal Identify where maternal and child health (MCH) is succeeding and lacking in Allegheny County Start a community discussion about MCH in AC Allow the report to guide future intervention and policy decisions regarding MCH issues

MCH Indicators Report Objectives Identify and explain health indicators pertinent to maternal and child health Compare indicators between Allegheny County and its peer counties and PA counties Determine if Allegheny County, peer counties, and PA counties meet Healthy People 2020 goals Highlight MCH indicators that are in need of improvement Recommend future policy and intervention targets

Methods, part 1 Selection of Health Indicators: Used the Dept. of Health and Human Services (HHS) Indicators Warehouse, CDC WONDER Database, and HHS’s Health People 2020 goals to identify important and relevant MCH indicators Indicators Selected: Pregnancy Indicators – Teen pregnancy, 1 st trimester prenatal care, and tobacco use during pregnancy Infant Indicators – Infant mortality, preterm birth, low birth weight, and breastfeeding Childhood and Adolescence Indicators – Uninsured children, graduation rate, and homicide. Peer County Selections: Used Centers for Disease Control and Prevention’s (CDC) Community Health Status Indicators to identify peer counties for Allegheny County

Methods, part 2 Main Data Sources: CDC WONDER Database HHS Health Indicators Warehouse PA Dept. of Health EPI QMS database Robert Wood Johnson County Health Rankings Analysis: Each indicator was defined and its importance to public health described Data for Allegheny County and the other peer and PA counties was compiled and graphed When possible, data was analyzed by race to detect racial disparities Nearly all indicators were compared to a Healthy People 2020 goal

Infant Mortality Defined as the number of infant deaths less than 1 year of age per 1,000 live births Public health importance: Rate is closely tied to many population level environmental, social, and health risks Infant mortality offers insights into the wellbeing of a population Global and comparable indicator of MCH Higher infant mortality rates (IMR) often indicate a generally less healthy population with more poor social and environmental determinants present

Infant Mortality Trends A large racial disparity exists between blacks and whites for both AC and its peers IMR for blacks in AC is significantly higher than peer counties and the Healthy People 2020 goal The white IMR in AC is three times less than that of blacks and sits just below the Healthy People 2020 goal Source: CDC WONDER Linked Birth and Infant Death Records

Infant Mortality Comparisons The average black IMR for AC was nearly 16 deaths per 1,000 live births between , while the average white IMR for AC was just over 5 deaths per 1,000 live births. Both white and black average IMR was higher than the median IMR of the peer counties

Teen Pregnancy Defined as the number of births to mothers 19 years and younger per 1,000 live births Public health importance: Childbearing during the teenage years places a severe burden on the mother, newborn, family, and society Teen mothers are more likely to have lifelong financial troubles and rely on public assistance Children of teen mothers are more likely to have poorer health, education, and behavioral outcomes compared to children of non-teen mothers Teen pregnancy rates could not be compared to a Healthy People 2020 goal due to data limitations

Teen Pregnancy Trends Starting in 2008, teen pregnancy significantly decreased for blacks A large and consistent racial disparity exists between blacks and whites for both AC and the peer counties The AC teen birth rate for blacks is 4 times higher than whites Source: CDC WONDER Natality Records

Teen Pregnancy Comparisons Compared to its peer counties, the average Allegheny County teen pregnancy rate from 2007 to 2012 for white mothers fell well below the median and was one of the lower rates seen in the group. The average teen pregnancy rate for blacks in Allegheny County far surpasses the median and is one of the highest out of the Peer Counties

First Trimester Prenatal Care Defined as the percent of pregnant mothers who begin receiving prenatal care during the first trimester Public Health Importance: Timely prenatal care is a marker for both the health of the mother and developing child Delayed prenatal care can be associated with other risk factors like poverty and use of tobacco or other substances Prenatal care visits also allow the development of the fetus to be monitored and allow mothers to have conversations with their doctors about health issues and risky behavior

First Trimester Prenatal Care Trends Whites in AC continually surpassed the Healthy People 2020 goal of 77.9% Blacks in AC met the Healthy People 2020 goal in 2010 after a steady rise in mothers receiving care between 2007 and 2010 AC has remained substantially ahead of its peers between 2007 and 2011 Source: CDC WONDER Natality Records

First Trimester Prenatal Care Comparisons AC has one of the highest average percentage of mothers receiving first trimester prenatal care for both blacks and whites compared to the peer counties White prenatal are attainment greatly surpassed the Healthy People 2020 goal, while black attainment fell just below A racial disparity of roughly 10% exists between blacks and whites in AC

Results Three indicators were determined to be especially lacking in AC Infant Mortality: Severe racial disparity between blacks and whites Preterm Birth: Large racial disparity between blacks and whites, with overall high rates for both races Smoking during pregnancy: Unacceptably high rate of pregnant mothers smoking for both blacks and whites

Conclusions The final MCH Health Indicators report: Details the health and wellbeing of the maternal and child health population in Allegheny County using ten MCH indicators Highlights areas of success and areas in need of improvement in Allegheny County Graphs and text presented in an accessible manner for those with little public health knowledge The report will allow ACHD and community partners to target new maternal and child health policy and interventions

Internship Experience The PSI allowed me to see the inner workings of a public health agency and further strengthened my desire to work in the field of applied public health I learned how to think critically about population health statistics and what measures are most meaningful for targeting policy and interventions Writing the MCH Indicators Report allowed me to practice scientific writing intended for general audiences I had the opportunity to take part in many other activities around ACHD, such as work on a foodborne illness outbreak and tour a water treatment plant

Acknowledgements The Pittsburgh Summer Institute was sponsored by ACHD and the Center for Public Health Practice at the University of Pittsburgh Graduate School of Public Health Co-writers: Becky Kimsal & Kasia Baca Preceptor: Dr. Ronald Voorhees, MD, MPH The staff of the MCH Office in Wilkinsburg, PA Academic Advisor: Christina Wassel, PhD, MPH, FAHA