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The LAMB Advisory Summit
May 11, 2016Suzanne Bostwick, MCAH Director
Shin Margaret Chao, PhD; Diana Liu, MPH; Chandra Higgins, MPH;
Maternal, Child, and Adolescent Health ProgramsLos Angeles County Department of Public Health
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Today’s Agenda• 8:00‐8:30 Registration& Light Refreshments • 8:30‐8:45 Welcome and Introduction Suzanne Bostwick• 8:45‐9:00 Opening Remarks Cindy Harding• 9:00‐10:00 LAMB Background/Findings LAMB team• 10:00‐10:40 Poster Gallery Everyone • 10:40‐11:20 Small Group Break out Sessions Everyone • 11:20‐11:45 Small Group Report Back Suzanne Bostwick• 11:45‐12:00 Next Steps/feedback form Suzanne Bostwick
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Purpose of Today’s Summit Identify new ways to partner and collaborate Discuss how to incorporate LAMB findings to
better serve the MCAH community Expand channels for disseminating LAMB
Project findings
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Opening Remarks
Cindy Harding, MPH, Interim Director,Los Angeles County Department of Public
Health
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Live Births in 2013• US: ~ 4 million
•CA:
• LA County:
~ 500,000
~ 130,000
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For every 30 babies born in the US, one lives in Los Angeles County
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For every 4 babies born in California,One lives in Los Angeles County
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3.0
4.0
5.0
6.0
7.0
8.0
9.0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Perc
ent o
f Tot
al L
ive
Birt
hs
Year
Percent of Low BirthweightCalifornia vs. Los Angeles County, 2004-2013
California Los Angeles County Healthy People 2020
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6.0
7.0
8.0
9.0
10.0
11.0
12.0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Perc
ent o
f Tot
al L
ive
Birt
hs
Year
California Los Angeles County Healthy People 2020
g yPercent of Preterm Births
California vs. Los Angeles County, 2004-2013
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Number of Low Birth Weight Babies in US, 2013
State Low Birth WeightCalifornia. . . . . . . . . . . . . . . . . . . 33,753Texas. . . . . . . . . . . . . . . . . . . . . 32,159New York . . . . . . . . . . . . . . . . . . 18,847Florida . . . . . . . . . . . . . . . . . . . . 18,346Illinois . . . . . . . . . . . . . . . . . . . . 12,898Georgia . . . . . . . . . . . . . . . . . . . 12,064Ohio . . . . . . . . . . . . . . . . . . . . . 11,808Pennsylvania . . . . . . . . . . . . . . . . 11,219North Carolina. . . . . . . . . . . . . . . . 10,432Michigan . . . . . . . . . . . . . . . . . . . 9,331Los Angeles County . . . . . . 9,058
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African or Native American babies are:
MORE LIKELY TO BE BORN TOO SMALL OR TOO SOON THAN WHITE INFANTS
Low Birth Weight & Preterm in LAC
Native American 13.8% 16.4%
African American 12.1% 12.8%
White 6.5% 7.8%
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Barriers to Favorable Birth Outcomes and Health Trajectories
•Lack of health insurance•Poverty•Depression•Low educational attainment•Racism•Perceiving a neighborhood as unsafe•And Many More….
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Life Course Perspective•Considers health as an integrated continuum across the life course
•Health outcomes across the life span result from a complex interplay of biological, behavioral, social, and environmental factors
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Life Course Perspective•Critical developmental periods such as childhood, adolescence, and pregnancy differentially impact health trajectories
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What is LAMB ? Los Angeles Mommy and Baby (LAMB) Project
A population based survey of women who have recently delivered a baby
Collects comprehensive information about maternal behaviors and experiences that may influence a woman's pregnancy and birth outcomes
Ongoing surveillance system which monitors maternal and infant health
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What is LAMB Follow UP?Survey of mothers who complete the LAMB survey, two years after the index birth
Collects information about behaviors and experiences that influence the health of mothers and toddlers
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Why LAMB & Follow UP? LAC lacked timely population based
maternal and infant health data Birth certificate data The Maternal Infant Health Assessment (MIHA) project CDC Pregnancy Risk Assessment System (PRAMS) project
Local health departments and community partners need local data to identify at‐risk groups and develop programs/polices
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BackgroundIn 2004, we designed the LAMB survey. LAMB was first implemented in Antelope Valley to address the high infant mortality rate seen in the that region of LAC.
Since 2005, LAMB project has expanded to entire LAC.
In 2014, we expanded the LAMB project again. The LAMB Follow‐Up began interviewing mothers who participated in the LAMB Project when their baby turned two years old.
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How do we implement LAMB and Follow UP?
LAMB participants are chosen randomly from birth certificate data
Follow Up participants include all mothers who completed LAMB
LAMB uses mixed methodology for data collection ‐mail and phone follow up
Follow UP: Mail only survey Strategies used to improve response rates: intro. letter, first
mailing, reminder postcard, second mailing, incentive, etc. Both surveys are conducted every two years
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LAMB Survey Topics Pre‐pregnancy health Prenatal careMaternal medical conditions during
pregnancy Risk‐taking behaviors Psychosocial experiences Neighborhood conditions Postpartum Health
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LAMB Follow Up Survey TopicsMother’s health Mother’s psychosocial experiences Child health Child’s psychosocial experiences Early childhood development
‐ developmental screening‐ school readiness, child care
Family Capacities building‐ parenting skills‐ quality time together‐ home safety
Program Participation (e.g. Home visitation services, WIC,
Head Start)
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How We Have Shared Our FindingsProducts: Data reports Health briefs Abstracts Journal articles
Distribution channels: First 5 LA Monday Morning Report MCAH Website Local meetings and national conferences
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What Makes LAMB Successful?
Strong study design; previously validated survey questions
Comprehensive and large sample size High response rate Cost‐effective Dedicated staff
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Special Thanks Cindy Harding, Suzanne Bostwick Health Resources & Services Administration
(HRSA),Dr. Michael Lu, MD, Associate Administrator ‐ 2008 LAMB
First 5 LA‐ 2010 LAMB ‐ 2012 LAMB ‐ 2014 LAMB ‐ 2012 Follow UP
All MOMs in LA !!
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Let’s Take a Look at the Data
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Who Are the 2014 LAMB Moms ?
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“ A united voice is powerful – A solo voice doesn’t get you far”
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Ever Experienced Discrimination
38%35%
38%
54%
32%
0%
10%
20%
30%
40%
50%
60%
Countywide White Latina African American Asian PacificIslander
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Ever Experienced Discrimination among African American mothers
Where?1 in 4 (26%) experienced discrimination at work1 in 4 (25%) when getting a job1 in 5 (20%) from police/courts1 in 6 (17%) when getting housing
Why?2 in 5 (40%) because of her race/color1 in 5 (22%) because of her pregnancy1 in 5 (19%) because of her gender
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Stressful Life Events During Pregnancy
9%
11%
11%
15%
18%
24%
25%
0% 10% 20% 30%
Mother lost job
Husband/Partner lost job
Someone close or important died
Family member was hospitalized
Had a lot of bills unable to pay
Argued more with husband/partner
Moved to a new place
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Social Support During Pregnancy
8%
5%
9%
19%
5%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Countywide White Latina AfricanAmerican
Asian PacificIslander
Percent of Mothers dissatisfied with support from baby's father
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Intimate Partner Violence During Pregnancy
13% 12%13%
22%
10%
0%
5%
10%
15%
20%
25%
Countywide White Latina AfricanAmerican
Asian PacificIslander
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Intimate Partner Violence During Pregnancy
13%
25%
18%
12% 11%
0%
5%
10%
15%
20%
25%
30%
All ages <20 20 to 24 25 to 34 35+
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Neighborhood Safety
14%
7%
17%
23%
5%
0%
5%
10%
15%
20%
25%
Countywide White Latina African American Asian PacificIslander
Unsafe Neighborhood
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Neighborhood Safety
14% 15%
9% 8%
17%
4%
31%
13% 13%
0%
5%
10%
15%
20%
25%
30%
35%
Unsafe Neighborhood
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Perinatal Mental Health
10%9% 10%
13%
11%11%
13%
10%
12%12%
0%
2%
4%
6%
8%
10%
12%
14%
16%
Countywide White Latina African American Asian PacificIslander
Anxiety & Depression Before Pregnancy
Depression Anxiety
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Perinatal Mental Health
69%64%
73% 74%
59%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Countywide White Latina African American Asian PacificIslander
Provider Asked Mothers About Feeling Anxious or Depressed During Prenatal Care Visit
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Breastfeeding Duration
38%
59%
30% 32%
46%
0%
10%
20%
30%
40%
50%
60%
70%
Countywide White Latina African American Asian PacificIslander
Exclusive Breastfeeding at 3 Months
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Breastfeeding Support•From Health Care Provider: 19% •From Friends and Family: 42% •Employers provided lactationaccommodation: 57%
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Overweight & Obesity
25% 24%
30% 30%
16%
0%
5%
10%
15%
20%
25%
30%
35%
Countywide White Latina African American Asian PacificIslander
Overweight/Obesity among Toddlers Up to 3 years Old by Mother's Race/Ethnicity
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“Children don’t magically do better when tested more, they do better when adults create supportive and enriched learning environments, that nurture and nourish children as whole human beings, with social, emotional and creative needs, not just as data pointsand test scores…” ‐The Art of Learning Project
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Early Childhood Development
•Stressful Life Events Among Toddlers:1 in 5 (19%) experienced a change in household members including a new sibling.
1 in 7 (15%) witnessed conflicts between parents.1 in 10 (10%) experienced a death of a family member.
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Early Childhood Development•Did doctor conduct developmental screening?
41%
51%
54%
0% 10% 20% 30% 40% 50% 60%
Had her fill out survey/checklist about child’s learning development or
behavior
Had her fill out survey/checklist abouthow child acted, got along or showed
feeling
Asked her if she had concerns aboutchild's learning, development or
behavior
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Early Childhood Development•1 in 5 (18%) mothers had concerns about her child’s learning, development or behavior
•7 in 10 (73%) mothers who had concerns about her child’s learning, development or behavior, received specific information to address these developmental concerns
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Child Care•1 in 2 (50%) mothers had regular arrangement of child care for her toddlers
•Most common child care arrangement:Grandparents (44%)Baby Sitter/Friends/Neighbors (18%)Other Relatives (17%)
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Maternal Resilience
13%
5%6% 6%
0%
5%
10%
15%
At First Survey At Follow Up
Low Maternal Resilience By Mother's Age
Younger than 26 years old 26 years or older
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Maternal Resilience
13%
6%7%
5%
0%
5%
10%
15%
At First Survey At Follow Up
Low Maternal Resilience By Receipt of Home Visitation Services
Received Home Visitation Services Did Not Receive Home Visitation Services
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“Filling out this survey again bring joy to my face because I like any opportunity to help others in my similar situation. Right now I am in a very good place, I have evolved and making a pathway for my daughter's future by going to school full time and being a single parent. Life is hard no one said it's easy and life does throw you many curveballs, but never give up and never let anyone put you down. NEVER! Thank you!”
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“Thank you very much for sending this inquiry. It helped me let out some things I needed someone else to know other than to just keep it bottled up inside. I went through a few accidents in these two years and I have been going through a whole bunch of different range of emotions. I'm glad to hear you guys care truly about my opinions. It's nice to know that my personal experiences will have a positive impact amongst other wonderful mothers such as myself. Thank you.”
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Break/Poster Gallery 10:00‐10:40
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Small Group Discussions1O:40‐11:20
1. Has your agency utilized LAMB data in the past?2. If your agency has used LAMB data, how has your agency used LAMB data? 3. In what ways can you see LAMB data being utilized by your agency, or other
agencies/groups you may work with, in the future? 4. In what ways could LAMB improve its data dissemination activities to reach a
wider audience and better serve the MCAH community?5. How can LAMB continue to grow, be of service, and be sustainable?
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Small Group Report Back11:20‐11:45
We Want to Hear From You!
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Next Steps11:45‐ 12:00
Please complete feedback form