Flojaune Griffin, PhD, MPH Preconception Health Coordinator

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Presentation transcript:

Flojaune Griffin, PhD, MPH Preconception Health Coordinator Using Preconception Health Indicators to Shape Programs and Policy in California 3rd 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

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 By identifying populations in greatest need and targeting programming efforts in preconception and interconception health

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 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 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 Healthy Weight just before pregnancy (BMI 18.5-24.9 kg/m2) California Maternal and Infant Health Assessment 2009 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 Checkup California Maternal and Infant Health Assessment 2009 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 Central clearinghouse for CA preconception health information Addressing high risk factors in clinical care during the preconception and interconception time period High prevalence of reported PP visit, retooled goal of increasing adhere

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 Indicators used to target campaigns Because of the low prevalence of preventive factors and high prevalence of risk factors, BIH moved from an individual to a group intervention model, focusing on lifecourse and addressing the importance of risk factors with high prevalence among AA in CA Additional risk of maternal complications for women with comorbidities (smoking, obesity) Greater need for postpartum follow up for glycemic control and preconception counseling about pregnancy readiness and improvement of health status – addressing reproductive planning in program content Given the needs expressed in MIHA and other state data (BSMF, CWHS, PAMR) IOM recommendations

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, MPH Preconception Health Coordinator Maternal, Child and Adolescent Health Division Program Development Branch Flojaune.Griffin@cdph.ca.gov (916) 341-6333