2. Learning from our Success: Building a Parent-Only RRFSS 3 rd Annual RRFSS Workshop, June 23, 2004 Ruth Sanderson Middlesex-London Health Unit ruth.sanderson@mlhu.on.ca

3. Outline  Background on MLHU Parent Survey  Breastfeeding Example  Next Steps & Implications

4. Current Situation Parent-Only Survey at MLHU. RRFSS-like. Built on success of RRFSS –same infra-structure, same modules, flexibility/ responsiveness, staff acceptability/familiarity etc.).

5. Why do this? Challenge to monitor local-level change related to child health –E.g. positive-parenting, breast-feeding duration. More ECD funding in 2003 for “traditional surveys” related to child health. Couldn’t buy “time” on RRFSS – thought we’d buy “sample”.

6. What was Done? Jan/ Feb 2003 – Special Request to augment MLHU’s RRFSS sample of parents of children < 12 years old. – 22% of RRFSS sample parents of children <12 yrs. 2003 – Consultation with ISR led to separate RRFSS-like Parent Survey, piloted, negotiated cost. Mar/Nov 2004 –Conducting Parent Survey.

7. Eligibility Questions Children under 12 in household. Completely or partially responsible for raising and looking after a child in this household.

8. Content Reproductive Health (Prenatal Care, Folic Acid Use) Breastfeeding Breastfeeding Policy and Awareness Bike Helmet Childhood Injury Prevention: Beliefs and Perceptions (added Campaign Awareness)* Car Seat Safety  Booster Seat* Positive Parenting*

9. Content (Demographics) Age Income Ethnicity Marital Status Child demographics Relationship to child (parent etc.)

10. Modifications to RRFSS Minimal development time required. Parent pre-selection required some modifications in the existing RRFSS modules to reflect that interviewer knows that these people are already parents of a child under 12. –E.g. bike helmet safety, positive- parenting /one index child

11. Parent Survey Details Sample frame –Households with children under 12 in Middlesex- London and adults that indicate they have responsibility for raising a child. Sample size –Approximately 100 / month for 900 total. Time frame –Mar.– Nov. 2004. Interview Length –12.6 minutes.

12. Response Rates Eligible households =14% of phone numbers –843 eligible households with parents of child under 12 years old of 6,081 phone calls (June 11, 2004) Response rate =62% –520 completions of 843 total estimated eligible Participation Rate =95% –520 completions of 547 complete and refusals

13. Sample Characteristics Relationship to Child: –Parent (92%), step-parent (3%), guardian/grandparent/other (4%). Gender: 61% female. Marital Status: 82% married/ living with partner. City or County: 75% City of London. Age Group: –18-24 yrs (4%), 25-34 yrs (33%), 35-44 yrs (49%), 45-54 yrs (12%), 55+ (1%).

14. Example: Breastfeeding To increase to 50% the percentage of infants breastfed up to six months by the year 2010 (MHPSG, 1997). 47% (42.8-51.2) in MLHU area in 1998 breastfed for 6 months or more (n=535).

15. Example: Breastfeeding Very difficult to measure improvement (difficult to have sufficient sample size for reasonable estimate). 6% of RRFSS sample eligible –70 females aged 18-49 years old reported having had children in past 5 years out of total adult sample of 1209 for MLHU (RRFSS 2002).

16. Example: Breastfeeding 30% of Parent Survey sample eligible –143 females aged 18-49 years old reported having had children in past 5 years out of total parent sample of 476 for MLHU. (Parent Survey, March-May 2004)

17. Example: Breastfeeding With an anticipated sample of 290 by year end we would be able to detect a difference if duration rate increased to 57% –57% (95% C.I. 51.3-62.7) from 47% (95% C.I. 42.8-51.2).

18. Breastfeeding Results 46% (37.9-54.3) breastfed > 6 months –Females (18-49) who reported having had a baby in the past 5 years (59/ 142 one no answer). 56.2% of those that initiated breastfeeding breastfed for > 6 months –Females 18-49 years old excluding those currently breastfeeding (59/105). (Parent Survey, March-May 2004)

19. What’s Next? MLHU is considering repeating Parent Survey in 2006. Encourage longer-term planning and co- ordination for information needs –Managers considering pooling resources.

20. Implications RRFSS infra-structure is solid base for other surveys. General RRFSS may not be sufficient to monitor change in public health indicators particularly for child health or other sub- populations.

21. Public Health Question Do we need an ongoing RRFSS-like survey that can monitor specific issues for children and families on the local level?