maternal, child, and family health data book

Maternal,

Child, and

Family Health

Data BookMultnomah County, Oregon

UpdatedSeptember 2014

Multnomah County Health DepartmentCommunity Epidemiology ServicesCommunity Health Services 426SWStarkStreet,8thfloor Portland,Oregon97204

Contact: JessicaGuernsey,MPH MaternalChildHealthDirector 503-988-3674 [email protected]

Authors/Collaborators: SarahTran,MPH,MCHEpidemiologist AshleyBorin,MPH,CDC-CSTEAppliedEpidemiologyFellow HeatherHeater,MPH,HealthEducator,EarlyChildhoodServices JaimeWalters,MPH,EpidemiologyResearchAssociate AmyGredler,ProgramCommunicationsCoordinator AileenDuldulao,MSW,PhD,MCHEpidemiologist

Multnomah County Health Department Contributors: RobertJohnson,MD,Manager,CommunityEpidemiologyServices ClaireSmith,SeniorResearchAnalyst,HealthAssessmentandEvaluation BenDuncan,Manager,HealthEquityInitiative DavidBrown,MPH,RD,LD,Manager,WICProgram MarisaMcLaughlin,MPH,QualityImprovementSpecialist,Community EpidemiologyServices ElizabethCarroll,EarlyChildhoodServices

Graphic Design: KevinKitamura,GraphicDesigner,MultnomahCountyHealthDepartment

www.mchealth.org

– 3Maternal, Child, and Family Health Data Book – Multnomah County

Family Planning ..................................................................................... 20 Pregnancy Intention; Contraception Use; Birth Spacing; Repeat Teen Births2

Preconception Health .......................................................................... 26 Multivitamin/Folic Acid Intake; Smoking; Alcohol Use; Binge Drinking; Weight Before Pregnancy

3

Pregnancy Health ................................................................................. 33 Smoking During Pregnancy; Smoking Cessation; Alcohol Abstinence; Prenatal Care; Weight Gain; Depression

4

Birth Outcomes - Morbidity and Mortality .......................................... 41 High Risk Pregnancies; Poor Birth Outcomes; Low Birthweight; Preterm Births; Small for Gestational Age; Infant Deaths; NICU Admissions; Low-Risk Cesarean Delivery; Repeat Cesarean

5

Postpartum Health ................................................................................ 51 Postpartum Depression; Household Smoking; Sleep on Back; Breastfeeding Initiation6

Child Growth and Development ......................................................... 57 No Screen Time; Screen Time; TV in Bedroom; Reading to Child7

Home, Family, and Community .......................................................... 63 Father Uninvolvement; Child Outings; Family Eats Together; Childcare8

Health Disparities and Inequities ......................................................... 14 Disparities by Race/Ethnicity; Disparities by Medicaid Status; Disparities by Education Level1

Table of Contents

Executive Summary ................................................................................ 4How to Use this Data Book ................................................................... 10Multnomah County Demographic Information.................................. 12

Conclusions ........................................................................................... 70Technical Notes Indicators ............................................................................................ 71 Data Sources ...................................................................................... 80


Executive Summary

Executive Summary

Effectivepublichealthinterventionsandpoliciesarefoundedin,andguidedby,reliabledata.Gooddataanddeliberateplanning,whencombinedwithcommunitywisdomandmeaningfulcommunityinput,createasoundfoundationforimprovingcommunityhealth.

ThegoaloftheMultnomahCountyMaternal, Child, and Family Health Data Bookistoprovideandhighlightdatathatcanbeusedtodesign,implement,monitorandevaluatematernal,child,andfamilyprogramsandinterventionsthroughoutMultnomahCounty.Thisreportprovidespolicymakers,publichealthprofessionals,healthcareproviders,andcommunitymemberswithcriticaldataonhealthissuesaffectingwomen,theirchildren,andtheirfamiliesbefore,during,andafterpregnancy.

Role of Multnomah County Health Department Acorefunctionofapublichealthdepartmentistomonitorthehealthstatusofindividualsandgroupsinordertoidentifyandaddresscommunityhealthproblems.OnewaytheMultnomahCountyHealthDepartmentfulfillsthisfunctionisthroughpublichealthsurveillance–thecontinuousgatheringandanalysisofdatatodescribeapopulation’shealthinordertohelppreventillnessandpromotehealth.Surveillanceprovidesdatathatareneededfor:

•Monitoringtrendsandpatterns • Identifyingemerginghealthissues • Developingandevaluatinginterventions • Settingresearchpriorities •Monitoringqualityofcare • Identifyingunderservedpopulations • Planningservices1

InMultnomahCounty,maternal,child,andfamilyhealthsurveillanceisconductedusingthreeprimarydatasources:vitalstatistics(e.g.,birthanddeathrecords)andtwolargeCentersforDiseaseControlandPrevention-sponsoredhealthsurveys:thePregnancyRiskAssessmentMonitoringSystem(PRAMS)andthetwo-yearfollow-upsurvey,PRAMS-2.Tolearnmoreaboutthesedatasources,pleaseseetheTechnical Notessection.

Localhealthdepartments,includingtheMultnomahCountyHealthDepartment,


playavitalroleinadvancingtheeffectiveuseofpublichealthdatatodrivepoliciesandimproveservicesformothers,children,andfamilies,including:

• Advocatingforstronghealthpolicies • Conveningcommunitydiscussions • Leading,supportingandparticipatingincommunitypartnerships • Educatingthepublic • Providingclinicalcaretochildrenandadultsinneed • Enforcinghealthregulations

Data Book Development Thisdatabookwasdevelopedthroughacollaborative,cross-disciplinaryprocesswithintheHealthDepartment.Theindicatorsusedwereselectedfromdataacross51potentialindicators.Eachindicatorwasstratifiedbysevendemographicgroupings:maternalrace,ethnicity,age,education,Medicaidstatusattimeofbirth(OregonHealthPlan-OHP),maritalstatus,andforeign-bornstatus.Collectiveexpertisewasusedtoselectdataresultsthatwerestatisticallysignificantandhadastorytotell,aswellastoidentifykeyfindingsandthemesforeachchapter.

Thedatainthisdatabookwasorganized,analyzed,andinterpretedusingtheMaternal,ChildHealthLifeCourseFramework.2Theframeworkisanupdatedandbroaderwayoflookingathealth,overalifespan–notasdisconnectedstagesunrelatedtoeachother,butasanintegratedwhole.Theframeworksuggeststhatacomplexinterplayofbiological,behavioral,psychological,social,andenvironmentalfactorscontributetohealthoutcomesacrossthecourseofaperson’sentirelife.3

Healthy People 2020 SomeindicatorsinthebookaremeasuredusingHealthyPeople2020(HP2020)asetoften-yearnationalhealthgoalsforhealthpromotionanddiseaseprevention.ThegoalswerecreatedbytheU.S.DepartmentofHealthandHumanServicesforcommunitiestoreachby2020.WhereverHealthyPeople2020targetsexistwithinanindicator,thosetargetsarenoted.Becauseoftheuniquelifecourseapproachtoorganizingthedata,severalindicatorsdonothaveHP2020targetsassociatedwiththem.

Data Limitations Thoughthedatainthisreportprovideareasonablygoodpictureofthehealthofmothers,childrenandfamiliesinMultnomahCounty,somesignificantgapsremain.Additionaldatathatwouldcontributetothispictureinclude:informationon

Executive Summary

Executive Summary


hospitalizationsandemergencydepartmentvisits;adolescenthealthindicators;communitycohesionandneighborhoodcharacteristics;themalehealthexperiencebefore,during,andafterpregnancy;mentalhealth;andmoresocialdeterminantsofhealth(thoseeconomicandsocialconditionsunderwhichpeoplelivethatdeterminetheirhealth).Inaddition,moreinformationisneededabouthouseholdsotherthantwo-biological-parenthouseholds,includingsingle-parent,lesbian/gay/bisexual/trans,andintergenerationalhouseholds

Datathatiscurrentlyavailablemayalsofailtoreflectcommunity-levelconceptsofhealthandwell-being.Moreworkmustbedonetoengagecommunitiesinthedevelopmentofcomprehensive,culturallysensitivedatasets.Further,sincesurveillanceisfocusedongivingusasnapshotofhealthatapointintime,moreresourcesareneededtoexplaintrendsincertainhealthburdens.

Community Snapshot Finally,whilethedatagivethecommunityanimportantsnapshotofinformationaboutmaternalandchildhealthinMultnomahCounty,theydonotprovidemuchinformationontrendsduetoarelativelynewdatasource(PRAMS-2)andtheuniquesetofindicatorsused.However,thesedatacanserveasabaselineagainstwhichfutureprogresscanbemeasured.

Summary of Key Findings

Disparities Overall,womenofcolor,womenwithlowerincome,womenwithlesseducation,andtheirchildrenareexperiencingmoredisparitiesthantheircounterparts.Chapter1summarizesthedirehealthdisparitiesexperiencedbygroupsofrecentmothersincludingBlack/AfricanAmericanmothers,AmericanIndian/AlaskaNativemothers,mothersontheOregonHealthPlanandmotherswithlessthanahighschooleducation.Forexample,relativetotheircounterparts,allofthesegroupshavehigherproportionsofunintendedpregnancy,lowerproportionsofearlyandadequateprenatalcare,andhigherproportionsofpostpartumdepression.

Family Planning Awoman’sabilitytolimitandspaceherpregnancieshasadirectimpactonherownhealthandwell-being,aswellasontheoutcomeofeachpregnancyandherchild’shealthandwell-being. • FouroutoftenpregnanciesresultinginalivebirthinMultnomahCountywere unplanned.Sixty-twopercentofrecentmothersreportedthattheirpregnancies wereintended.

Executive Summary

Executive Summary


Executive Summary

• Youngerwomen,womenwithlesseducation,andunmarriedmotherswere significantlylesslikelytohavehadanintendedpregnancyresultinginalive birthcomparedtotheircounterparts. •Womenofcolorwerelesslikelytohavehadanintendedpregnancyresultingin alivebirththannon-LatinaWhitewomen.

Preconception Health Goodpre-pregnancyhealthisimportantforhealthybirthoutcomes.Healthybabiesbeginwithhealthymothers. • ThepercentageofwomeninMultnomahCountywhoabstainfromsmoking anddrinkingbeforepregnancyisbelowtheHealthyPeople2020target. • Approximately1in5,or20percent,ofrecentmothersreportedsmoking beforepregnancy.ThispercentageishigherthantheHealthyPeopletarget oflessthan15percent. • About3in5,or60percent,ofrecentmothersdrankalcoholbeforepregnancy. TheHealthyPeopletargetislessthan44percent. •Whilesmokingbeforepregnancywasmostcommonamongsomewomenof color,youngerwomen,andthoseontheOregonHealthPlan(OHP),regular drinkingandbingedrinkingweremostcommonamongnon-LatinaWhite, older,andnon-OHPrecentmothers.

Pregnancy Health Onceawomanbecomespregnant,herhealthandwell-beinghaveasignificanteffectonthehealthofherdevelopingfetus.Healthybehaviorsduringpregnancycontributetopositiveoutcomesduringbirthforbothamotherandherbaby. • Only7outof10,or70percent,ofrecentmothersinMultnomahCounty receivedearlyandadequateprenatalcare.TheHP2020targetis77.6percent. - Womenwithlowerincome,foreign-bornwomen,womenwithlesseducation, youngerwomenandwomenofcolorwerealllesslikelytohavereceivedearly andadequateprenatalcare • Nearly18percentofallrecentmothersreportedsymptomsofdepression duringpregnancy. - Womenwithlesseducation,womenwithlowerincome,andwomenofcolor weremorelikelythanaveragetohavereportedthesesymptomsduring pregnancy. - Nearly33percent,oroneinthreeBlack/AfricanAmericanrecentmothers reportedsymptomsofdepressionduringpregnancy.


Morbidity and Mortality Themorbidityandmortalitydata(theprevalenceofdisease,disability,poorhealth,anddeath)includesindicatorsofmotherandbabyhealthsuchaspretermbirth,lowbirthweightandinfantmortality.Thisdataiscomparabletoprevioussurveillanceandcanbeusedtoassesstrends. • Overall,about15percentofbabieswerebornwithahealthissue–weredelivered atlowbirthweight,werepre-term,hadanewbornconditionorcongenitalanomaly, orwereadmittedtotheNeonatalIntensiveCareUnit(NICU). - Womenofcolorhadhigherratesofbirthswithoneofthesepooroutcomes, with21.3percentofBlack/AfricanAmericanrecentmothersexperiencing pooroutcomes. • Black/AfricanAmericanrecentmothershadthehighestproportionoflow birthweightbabiesandpretermbirths. • AmericanIndian/AlaskaNativerecentmothers,alongwithBlack/African Americanrecentmothers,werenearlytwotimesmorelikelythantheir non-LatinoWhitecounterpartstohaveaninfantdieinthefirstyearoflife.

Postpartum Health Postpartumhealthindicatorsprovideaglimpseintoawoman’shealthafterbirthasitaffectsherabilitytobondwithandcareforhernewinfant. • Overall,about1in10recentmothersreportedfeelingsymptomsofpostpartum depression;however,thepercentagesvarieddramaticallybyrace/ethnicityand educationlevel. - About1in5womenwithlessthanhighschooleducation,Black/African Americanwomen,andAmericanIndian/AlaskaNativewomenreported experiencingsymptoms. • ProportionsofinitiatingbreastfeedinginMultnomahCountyarehighacrossall racialandethnic,income,andeducationlevels,andareuniversallyhigherthan theHP2020targetforbreastfeedinginitiation.

Child Growth and Development Ensuringthatchildrenarehealthyandreadytolearnatagefiveisagoalthatdrivesmanyearlychildhoodservices.Indicatorsinthissectionincludethosethathelpcreateasafe,healthy,andstimulatingenvironmentforchildrentolearnandgrow. • Screentimeexposurevarieddramaticallybyraceandethnicity,maternal educationlevelandhouseholdincome. • Thirty-fivepercentoftwo-year-oldslivinginhigher-incomehouseholdshadno screentime,whileonlysixpercentofthoselivinginlower-incomehouseholds hadnoscreentime.

Executive Summary

Executive Summary


• About7in10toddlerswerereadtodailybyaparentorguardian.Thisexceeds theHP2020goal,butmajordisparitiesexistbymaternalraceandethnicity, age,education,andhouseholdincome.

Family, Home, and Community Thehomes,families,andcommunitiesinwhichchildrengrowanddevelophelpshapethemintohealthyadults. • Forabout10percentofinfants,onlythemother’snameisincludedonthe birthcertificate.Anamedfatherisacommonproxyformeasuringfather involvement. •Morethanhalfoftwo-year-oldsreceivedchildcareeitherfromalicensed facilityorfromsomeoneotherthantheparents. • Currentdataarelimitedtohouseholdswithbothmaleandfemalebiological parents.Moredataareneededonotherhouseholds,includingsingle-parent, lesbian/gay/bisexual/trans,andinter-generationalhouseholds.

CONCLUSIONS

Individualchoiceisonlyapartofwhatdetermineshealthoutcomesformothersandchildren.Anindividual’schoiceissignificantlyinfluencedbytheenvironmentsinwhichfamilieslive,play,workandlearn.Socialdeterminantsofhealth—includingsocioeconomicstatus;discriminationbyrace,ethnicity,gender,and/orclass;accesstohealthcareandotherservices;aswellasothersocialandenvironmentalstressors—arefactorsinfluencingthedataanddisparitiesoutlinedinthisreport.

InorderforMultnomahCountywomen,childrenandtheirfamiliestoachievehealthandwell-being–andforthecommunitytoreachthenationalgoals–thesefactorsmustbeacknowledgedandaddressed.

Executive Summary

Executive Summary

References1. HallHI,CorreaA,YoonPW,BradenCR;CentersforDiseaseControlandPrevention.Lexicon, definitions,andconceptualframeworkforpublichealthsurveillance.MMWRSurveillSumm.2012 Jul27;61Suppl:10-4.]23.

2. FineAandKotelchuckM(2010).RethinkingMCH:TheLifeCourseModelasanOrganizing Framework.ConceptPaper;PreparedfortheU.S.DepartmentofHealthandHumanServices,Health ResourcesandServicesAdministration,November2010.[Online]. Available:http://mchb.hrsa.gov/lifecourse/rethinkingmchlifecourse.pdf

3. Lu,M.C.&Halfon,N.(2003).Racialandethnicdisparitiesinbirthoutcomes:Alife-course perspective.MaternalandChildHealthJ7(1):13-30.


Thisdatabookisdividedintosevenmainchaptersthatarelooselyorganizedbythestagesofthelifecourse:familyplanning;preconceptionhealth;pregnancyhealth;morbidityandmortality;postpartumhealth;childgrowthanddevelopment;andhome,familyandcommunityfactors.Inaddition,thereisachapterfocusedonthecurrentdemographicsofMultnomahCountyresidents,aswellasachapteronhealthdisparities.Thediagramsbelowshowhowtointerpretthedisparitiesandlifecourseindicatorcharts.

Indicatornameanddatasource.Percent of recent mothers who were obese (BMI >30) before pregnancy, Multnomah County.DataSource:PRAMS,2009-2010

Oregon

21.1%

Multnomah County

16.0%

HP2020 Target

≤30.5% HP = Healthy PeopleNWS-9: <30.5% of persons aged 20 years and older are obese.

0 10 20 30 40

35+25-3420-24

<20 yrs

**Ref

8.318.2

21.75.2

Asian/PIAI/AN

Hispanic/LatinoBlack/AANH White

*

Ref

*11.8

34.816.2

25.314.6

Among women with a live birth

HP

PiechartsshowtheprevalenceforthisindicatorforMultnomahCountycomparedtoOregonandtheHealthyPeopletarget.

Theasteriskindicatesthatthedifferencebetweenthatgroupandthereferentgroup,“ref,”isstatisticallysignificantatthe95%confidencelevel.Thereferentgroupiseitherthebestorworstgroup.

TheshadedarrowbehindthebargraphindicatesthedirectionfromtheHP2020targetlinethatis“good”fortheindicator.

How to Use this Data Book


Smoking before pregnancy

Late or inadequate prenatal care

Unintended pregnancy

Low birth weight

Postpartum depression

Not read to daily by a family member

0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Worse than

n/a

1.2

2.5

1.5

1.3

2.7

Better thanDescriptionofthedenominator

Thevalueof1.0(purpleline)onthechartrepresentsnodifferencebetweenthetwogroupsbeingcompared.Ifthevalueintheboxisgreater(totheright)oftheline,thenthegroupbeingcomparedisworseoffthantheother(“referent”)group.Ifthevalueintheboxistotheleftoftheline,thenthegroupbeingcomparedisbetteroffthantheother(“referent”)group.

Health Inequities and Disparities Chapter Data

Life Course Indicator Data


MultnomahCountyHealthDepartmentencouragestheuseofthedatainthisbooktoimprovethehealthofwomen,children,andfamiliesinMultnomahCounty.Thiscouldmeanapplyingthenarrativesinconversationswithfriendsorcolleagues;usingthefiguresinpresentations;usingthedatatoinformprogrammingorservicedecisions;ordiscussingthedataimplicationswithyourpoliticalrepresentative.

Please note: The Technical Notes section of this book contains important background information regarding the data sources and the analytic methods that were employed. Understanding the data limitations and surveillance methods is important to correctly interpreting and using the data.




Population Composition by Race/Ethnicity Groupings, Multnomah County, Oregon.DataSources:2009-2011AmericanCommunitySurvey3-YearEstimates

Population Composition by Maternal, Child, and Male Health Groupings, Multnomah County, Oregon.DataSources:2009-2011AmericanCommunitySurvey3-YearEstimates,VitalStatistics2010-2011

Race/Ethnicity* Non-LatinoWhite ..............................................532,164 72.1 3,007,822 78.3 Black/African-American .....................................51,516 7.0 98,989 2.6 Hispanic/Latino(ofanyrace) ............................80,483 10.9 452,447 11.8 AmericanIndian/AlaskaNative ........................16,944 2.3 108,882 2.8 Asian/PacificIslander ........................................66,216 9.0 213,686 5.6

Total Population .........................................................................................737,743

Children0-4years ......................................................................................... 46,416 6.3%

Children5-9years .........................................................................................43,633 5.9%

Adolescents10-14years ..............................................................................37,548 5.1%

WomenofChildbearingAge15-44years ..................................................170,847 23.2% TeenWomen15-19years ......................................................................... 20,144 2.7% AdultWomen20-44years ......................................................................150,704 20.4%

MenofChildbearingAge15-44years .......................................................173,239 23.5% TeenMen15-19years ..............................................................................20,789 2.8% AdultMen20-44years ...........................................................................152,450 20.7%

Total Population ..................................................737,743 3,839,598

Count % Count %

Count %

* all races may not add up to the total population

OregonMultnomah County

Demographics Info

Demographic Information


Total Births by Maternal Characteristics, Multnomah County, Oregon.Source:VitalStatistics2010-2011

Total births ..........................................................................................18,917

MaternalRace/Ethnicity Non-LatinoWhite ................................................................................11,937 63.1 Black/African-American ....................................................................... 1,579 8.3 Hispanic/Latino ....................................................................................2,938 15.5 AmericanIndian/AlaskaNative ..............................................................409 2.2 Asian/PacificIslander ..........................................................................1,830 9.7 Other*(*3andmoreraces ..................................................................224 1.2 selectedorunknown/missing)

MateralAge <20years .............................................................................................. 1,075 5.7 20-24years ........................................................................................... 3,210 17.0 25-34years .........................................................................................10,500 55.5 35+years ...............................................................................................4,131 21.8

MaternalEducation Lessthanhighschool(<HS) .................................................................3,110 16.4 Highschool(HS) ...................................................................................7,433 39.3 Beyondhighschool(HS+) ....................................................................8,239 43.6

MaritalStatus Married ................................................................................................ 12,474 65.9 Notmarried ...........................................................................................6,338 33.5

MedicaidStatus OregonHealthPlan .............................................................................. 7,221 38.2 NotOregonHealthPlan .....................................................................11,696 61.8

Nativity Foreign-born .......................................................................................... 5,246 27.7 U.S.-born ..............................................................................................13,557 71.7

Count %

Demographics Info

Demographic Information


What are health disparities and health inequities? Healthdisparitiesarepreventabledifferencesintheburdenofdisease,injury,violence,oropportunitiestoachieveoptimalhealththatareexperiencedbysociallydisadvantagedpopulations.1Healthdisparitiesarecapturedinourdatasystemsasdifferencesinhealthoutcomes.

Healthinequitiesaretheunderlyingcausesofthesedisparitiesandstemfromavarietyofsocialfactorssuchasincomeinequality,economicforces,educationalquality,environmentalconditions,individualhealthbehaviorchoices,andaccesstohealthcare.AccordingtotheNationalAssociationofCityandCountyHealthOfficials(NACCHO),“healthinequitiesresultfromanunequalstructuringoflifechances,basedongrowingsocialandeconomicinequality.”2 Inotherwords,thedifferencesinexperiencesandopportunitiesassociatedwithanindividual’ssocialsituationcanleadtodifferencesinhealththatcertainpeopleandcommunitiesareexperiencing.

Thischaptersummarizestherecurringhealthdisparitiesexperiencedbythefollowinggroupsofrecentmothers,asseenthroughoutthedatausedforthisreport: •WomenofBlack/African- Americanracecomparedtonon- LatinaWhitewomen.

•WomenofAmericanIndian/Alaska Nativeracecomparedtonon-Latina Whitewomen. •WomenwithOHPinsuranceatthe timeoflaborcomparedtonon-OHP. •Womenwithlessthanahighschool educationcomparedtothosewith greaterthanahighschooleducation.

Thedisparitiesdataareshownonaratioscaleusingprevalencedataforeachgroupforthefollowingindicators:unintendedpregnancy(Chapter2),smokingbeforepregnancy(Chapter3),late/inadequateprenatalcare(Chapter4),lowbirthweight(Chapter5),postpartumdepression(Chapter6),andnotreadtodailybyafamilymember(Chapter8).

Why are inequities important? TheNorthwestHealthFoundationpointsoutinitsCase for Equity,“Wehaveasharedfate―asindividualswithinacommunityandcommunitieswithinasociety.Allcommunitiesneedtheabilitytoshapetheirownpresentandfuture.Equityisboththemeanstohealthycommunitiesandanendthatbenefitsusall.”3

Communitiesofcolor,immigrantsandrefugees,andotherminoritygroupsarebearingthenegativeconsequencesofpoorhousing,exposuretopollutants,andunequaleducationalandeconomicsystemsthatleadtopersistentnegative

Health Disparities and Inequities

Continued on next page

Health Disparities and Inequities1


ContinuedHealth Disparities and Inequities

1

Health Disparities and Inequities

healthoutcomesanddisparities(someofwhicharehighlightedinthischapter).

Healthinequitiesareunfairandavoidable.AsMultnomahCountybecomesincreasinglydiverse,governmentagencies,healthorganizations,andcommunitypartnershaveanethicalandafiscalresponsibilitytoassurethewellnessofall peopleinourcommunities.Indoingso,wecanuncoverandunderstandtheconditionsthatmakepeoplehealthyorunhealthy.Thisunderstandingenablesustoallocateresourcesappropriatelyandjustly,buildpartnershipswithnon-traditionalallies,andworkwithcommunitiesexperiencinginequitiestoensurelifelonghealthforeveryone.

References

1.TrumanBI,SmithKC,RoyK,ChenZ,MoonesingheR,ZhuJ,CrawfordCG,ZazaS;CentersforDiseaseControlandPrevention(CDC).2011.Rationaleforregularreportingonhealthdisparities

andinequalities-UnitedStates.MMRWSurveillSumm;Jan14;60Suppl:3-10.

2.HofrichterRandBhatia,R.eds.Tacklinghealthinequitiesthroughpublichealthpractice,2ndedition.NewYork:OxfordUniversityPress;2010.

3.NorthwestHealthFoundation.TheNWHFCaseforEquity.[On-line].Available:http://nwhf.org/ about/values/.

– 16Maternal, Child, and Family Health Data Book – Multnomah County Health Disparities and Inequities

Disparities by Race/EthnicityHealth Disparities and Inequities

1



Unintended pregnancyresulting in a live birth

Low birthweight



0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Worse than

Comparison of Black/African-American vs. non-Latina White women on measures of maternal, child, and family health using a ratio scale based on prevalence.

1.7

1.0

1.2

2.1

2.3

3.4

Better than


Disparities by Race/EthnicityHealth Disparities and Inequities

1

Comparison of American Indian/Alaska Native women vs. non-Latina White women on measures of maternal, child, and family health using a ratio scale based on prevalence.



Unintended pregnancy resulting in a live birth

Low birthweight



0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Worse than

1.4

2.0

1.1

1.1

3.0

2.5

Better than


Disparities by Medicaid StatusHealth Disparities and Inequities

1

Comparison of women on OHP vs. non-OHP on measures of maternal, child, and family health using a ratio scale based on prevalence.




Low birthweight



0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Worse than

n/a

1.2

2.5

1.5

1.3

2.7

Better than


Disparities by Education LevelHealth Disparities and Inequities

1

Comparison of women with less than a high school education vs. women with high school education or more on measures of maternal, child, and family health using a ratio scale based on prevalence.




Low birthweight



0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Worse than

n/a

1.7

1.9

1.3

2.6

3.6

Better than

– 20Maternal, Child, and Family Health Data Book – Multnomah County Family Planning

What is family planning? Familyplanningisoneofthegreatpublichealthachievementsofthetwentiethcentury.1Itallowsindividualsandcouplestochooseandattaintheirdesirednumberofchildren,aswellasthespacingandtimingoftheirbirths.

Familyplanningisaccomplishedthroughtheuseofcontraceptivemethodsandthetreatmentofinfertility.Awoman’sabilitytolimitandspaceherpregnancieshasadirectimpactonherownhealthandwell-being,aswellasontheoutcomeofeachpregnancyandherchild’shealthandwell-being.

TheindicatorsusedtotrackfamilyplanninginMultnomahCountyinclude:prevalenceofintendedpregnancies,contraceptionuse,birthspacing,andteenbirths.ThedatacamefrombirthrecordsandthePregnancyRiskAssessmentMonitoringSystem(PRAMS)survey.

Why is family planning important? Raisingachildrequiressignificantamountsoftimeandsocial,financial,andcommunityresources.Unintendedpregnanciesareassociatedwithinadequateordelayedprenatalcare,smokingordrinkingduringpregnancy,havingalowbirthweightinfant,thereducedlikelihoodofbreastfeeding,delayedphysicalandmentaldevelopment,poormother-childattachment,andmaternaldepression.2,4,5,6

Teenbirthsareofparticularimportancebecauseveryfewteenshavetheresourcesneededtoensureahealthypregnancyandagoodoutcomefortheirchildren.Researchshowsthatonceateenbecomespregnant,sheismorelikelythanotheryoungwomentodropoutofschoolandliveinpoverty.3

Inaddition,althoughtimingmaynotbeeverything,researchsuggeststhatabirth-to-pregnancyspacingofatleast18monthscouldhelpreducetheriskofadversebirthoutcomes.3Researchershavefoundthatinfantsborntowomenwhoconceivedlessthansixmonthsaftergivingbirthhada40%increasedriskforbeingbornprematurelyanda61%increasedriskoflowbirthweight,comparedwithinfantsborntomotherswhowaited18monthstotwoyearsbetweenpregnancies.3

Givingbabiesthebestchanceforahealthyliferequiresthatparentshaveaccesstosafehousing,livingwagejobs,medicalcareandgoodsupportsystemstohelpcareforandparenttheirchildren.People’sabilitytoplanandspacepregnanciesisavitalcomponenttohavingallchildreninourcommunitybebornhealthyandachievetheirhighestpotentials.

Family Planning2


Key FindingsIn Multnomah County:► Onlyabouthalfofrecentmothers

whodidnotplanongettingpregnantwereusingabirth

controlmethod.

► 4outof10pregnanciesthatresutledinalivebirthwereunplanned.

•Sixty-twopercentofrecent mothersreportedthattheir pregnancieswereintended.

•Recentmotherswhowere younger,lesseducated,or unmarriedweresignificantlyless likelytohavehadanintended pregnancy,comparedtotheir counterparts.

•Womenofcolorhadlower proportionsofintendedpregnancy

thannon-LatinaWhitewomen.

► Amongwomenwhohadarecentrepeatbirth,about30%werespacedlessthan18monthsfrom

apreviousbirth.TheHealthyPeople2020targetforthisindicatoris

30%orless.

► Theaveragebirth-to-pregnancyspacingamongteenmotherswas16months,comparedto39monthsamongallwomenwhohadarepeatbirth.

Key FindingsFamily Planning

2

Family Planning

References

1.CentersforDiseaseControlandPrevention.Achievementsinpublichealth,1900–1999:Familyplanning.MMWRWeekly.1999Dec3;48(47):1073-80.[Online].Available:www.cdc.gov/mmwr/preview/mmwrhtml/mm4847a1.htm

2.LoganC,HolcombeE,ManloveJ,etal.Theconsequencesofunintendedchildbearing:Awhitepaper[Internet].Washington:ChildTrends,Inc.;2007May.[Online].Available:www.thenationalcampaign.org/resources/pdf/consequences.pdf

3.Conde-AgudeloA,Rosas-BermudezA,Kafury-GoetaAC.Birthspacingandriskofadverseperinataloutcomes:ameta-analysis.JAMA.2006Apr19;295(15):1809-23.

4.ChengD,SchwarzE,DouglasE,etal.Unintendedpregnancyandassociatedmaternalpreconception,prenatalandpostpartumbehaviors.Contraception.2009Mar;79(3):194-8.

5.KostK,LandryD,DarrochJ.Predictingmaternalbehaviorsduringpregnancy:Doesintentionstatusmatter?FamPlannPerspect.1998Mar–Apr;30(2):79-88.

6.D’AngeloD,GilbertBC,RochatR,etal.Differencesbetweenmistimedandunwantedpregnanciesamongwomenwhohavelivebirths.PerspectSexReprodHealth.2004Sep–Oct;36(5):192-7.

7.HoffmanS,MaynardR,eds.KidsHavingKids:EconomicCostsandSocialConsequencesofTeenPregnancy,2nded.Washington:UrbanInstitutePress;2008.


Percent of recent mothers who reported that their pregnancy was intended, Multnomah County.DataSource:PRAMS,2009-2010

Multnomah County

62.1% 61.1%

Oregon

0 20 40 60 80

Not MarriedMarried Ref

* 39.1

74.7

Not OHPOHP *

Ref 72.245.5

High School+High School

<High School *

Ref 69.554.8

47.4

35+25-3420-24

<20 yrs**

*

Ref 81.566.0

41.134.6

Asian/PIAI/AN

Hispanic/LatinoBlack/AA

Non-Latino White Ref*

62.552.2

60.141.5

65.5


Pregnancy IntentionFamily Planning

2

Family Planning

NoTarget

HP2020 Target

*


Percent of recent mothers who were using contraception when they got unintentionally pregnant, Multnomah County.DataSource:PRAMS,2009-2010

Among women with a live birth from an unintended pregnancy

Asian/PIAI/AN


Non-Latino White

0 20 40 60 10080

*

*Ref

34.5

52.2

62.3

45.9

52.0

HP

Family Planning

Contraception UseFamily Planning

2

51.4%

Multnomah County

≥91.3%

HP2020 Target

51.7%

Oregon

HP = Healthy People FP-6: 91.3% at risk of unintended pregnancy used contraception at most recent sexual intercourse.


Birth SpacingFamily Planning

2

Family Planning

Percent of births conceived within 18 months of a previous birth, Multnomah County.DataSource:VitalStatistics,2010-2011

Among women having a second or higher birth

Among women having a second or higher birth

29.7%

Multnomah County

≤29.8%

HP2020 Target

29.3%

Oregon

HP

0 20 40

*Ref

**

Ref

28.431.2

31.3

28.4

22.6

34.4

31.1

Not OHPOHP

Asian/PIAI/AN


Non-Latino White

HP = Healthy PeopleFP-5: ≤29.8% of pregnancies conceived within 18 months of a previous birth.

Prevalence of multiparous women who had a birth-to-pregnancy spacing of less than 18 months, Multnomah County.

<6 mos

6-11 mos

12-17 mos

Asian/PI

AI/AN

Hispanic/Latino

Black/AA

Non-Latino White

0 20 40

5.8 10.9 14.5

6.0 14.7 7.8

3.8 7.3 11.5

8.3 13.6 12.5

3.9 11.1 16.0


Prevalence of repeat teen births, Multnomah County.DataSource:VitalStatistics,2010-2011

0 20 40

17.5%

Multnomah County

NoTarget

HP2020 Target

15.7%

Oregon

*

Ref

12.3

21.6

22.4

16.1

14.4

Asian/PI

AI/AN

Hispanic/Latino

Black/AA

Non-Latino White

*Ref

9.9

20.2

Not OHP

OHP

*

Ref

15.7

16.1

18.5

High School+

High School

<High School

Repeat Teen BirthsFamily Planning

2

Family Planning

Among teen women (<20 years) with a live birth

– 26Maternal, Child, and Family Health Data Book – Multnomah County Preconception Health

What is preconception health? Preconceptionhealth,alsoknownaspre-pregnancyhealth,includesthethingswomenandmencandobeforeandbetweenpregnanciestoincreasethechancesofhavingahealthybaby.Preconceptionhealthincludesunderstandinghowhealthconditionsandriskfactorscanaffectawomanorherunbornbabyifshebecomespregnant.

Duetolimitationsoftheavailabledatasources,thisreportfocusesonpreconceptionhealthforwomenonly.Theindicatorsanalyzedincludesmokingandalcoholusebeforepregnancy;takingfolicacidtopreventbirthdefects;andtheprevalenceofobesitypriortopregnancy.DataforpreconceptionhealthwereobtainedfromthePRAMSsurvey.

Why does preconception health matter? Byage25,abouthalfofallwomenintheU.S.haveexperiencedatleastonebirth,andapproximately8outof10U.S.womenhavegivenbirthbyage44.1 Goodpre-pregnancyhealthisimportantforhealthybirthoutcomes.Ahealthypopulationbeginswithhealthybabies,andhealthybabiesbeginwithhealthymothers.

TheUnitedStatesPublicHealthServicerecommendsthatallwomenofchildbearingagewhoarecapableof

becomingpregnantshouldconsume0.4mgoffolicacidperday.Thiscanreducetheirriskofhavingababyaffectedwithspinabifidaorotherdefectsofthebrain,spine,orspinalcord.2

Inadditiontohavingpropernutritionandabstainingfromsubstanceuse,awomanwhostartsapregnancyatahealthyweightcanincreaseherchanceofhavingahealthybaby.Researchshowsthatmaternalpre-pregnancyobesityisassociatedwiththeriskofdevelopmentaldelayinearlychildhoodamongthosebornmoderatelypreterm.3 Further,womenwhowereexposedtostressevenbeforebecomingpregnanthavebeenshowntobeatincreasedriskforadversebirthoutcomes,includinginfantmortality.4

Bothindividualbehaviorsandourenvironments—wherewelive,play,workandlearn—playasignificantroleinpre-pregnancyhealthpromotion.Promotingpopulationhealthbyensuringthatcommunitieshaveaccesstofreshfruitsandvegetables,theopportunitytosafelyengageinphysicalactivity,andaccesstoqualityhealthcareservicescanhelpimprovethechancesthatwomenarehealthybeforetheyconceive.

3 Preconception Health


Key FindingsIn Multnomah County: ► Slightlymorethan1in3recent

mothersreportedtakingadailymultivitaminorfolicacidinthemonthpriortogettingpregnant.Overall,thismeetstheHealthyPeople2020targetforthismeasure.However,significantdisparitiesexistbyrace/ethnicity,age,education,andMedicaidstatus.

► ThepercentageofwomeninMultnomahCountywhoabstain fromsmokinganddrinkinginthemonthsbeforepregnancyisbelowtheHealthyPeople2020target. •Approximately1in5,or20%,of

recentmothersreportedsmoking beforepregnancy,whichishigher thantheHealthyPeopletarget oflessthan15%.

•About3in5,or61%,ofrecent mothersdrankalcoholbefore pregnancy,whichissubstantially higherthantheHealthyPeople targetoflessthan44%.

► SmokingbeforepregnancywasmostprevalentamongAmericanIndian/AlaskaNativerecentmothers(52%)andleastcommonamongLatinaandAsian/PacificIslanderrecentmothers(about6%).

► Smokingbeforepregnancywasmorecommonamongsomewomenofcolor,youngerwomen,andthoseonOHP.

► Regulardrinkingandbinge drinking(having5ormoredrinks

inasitting)beforepregnancyweremostcommonamongrecentmotherswhowerenon-LatinaWhite,older,andnotonOHP.

► TheprevalenceofbeingobesebeforepregnancywashighestamongAmericanIndian/AlaskaNativerecentmothers(34%),andlowestamongAsian/PacificIslanderrecentmothers(11%).

Preconception Health

Key Findings Preconception Health

3

References

1.U.S.CensusBureauPopulationDivision.Table2:annualestimatesofthepopulationbyselectedagegroupsandsexfortheUnitedStates:April1,2000,toJuly1,2004.Washington,DC:U.S.Census.

2.CentersforDiseaseControl.Recommendationsfortheuseoffolicacidtoreducethenumberofcasesofspinabifidaandotherneuraltubedefects.MMWR1992;41.

3.KerstjensJM,deWinterAF,SollieKM,Bocca-TjeertesIF,PotijkMR,ReijneveldSA,BosAF.Maternalandpregnancy-relatedfactorsassociatedwithdevelopmentaldelayinmoderatelypreterm-bornchildren.ObstetGynecol.2013Apr;121(4):727-33.

4.ClassQA,KhashanAS,LichtensteinP,LangstromN,D’OnofrioBM.Maternalstressandinfantmortality:Theimportanceofthepreconceptionperiod.PsycholSci.2013May7.


Percent of recent mothers who took a daily multivitamin/folic acid before pregnancy, Multnomah County.DataSource:PRAMS,2009-2010


0 10 3020 40 50

Not OHPOHP *

Ref 43.222.0


<High School**

Ref 45.024.7

19.6

35+25-3420-24

<20 yrs**

Ref 44.241.1

18.316.5

Asian/PIAI/AN


Non-Latino White*

Ref 39.824.5

29.921.8

38.2

HP

Multivitamin/Folic Acid IntakePreconception Health

3

Oregon

32.1%

Multnomah County

35.6%

HP2020 Target

≥33.1% HP = Healthy PeopleMICH-16.2: ≥33.1%% females delivering a recent live birth took multivitamins/folic acid everyday in month prior to pregnancy.


*


Percent of recent mothers who smoked before pregnancy, Multnomah County.DataSource:PRAMS,2009-2010

600 20 403010 50

Not OHPOHP *

Ref 13.636.4

35+25-3420-24

<20 yrs*

Ref 11.619.4

35.4

27.4


HP

HP2020 Target

<14.6%

Oregon

26.1%

Multnomah County

21.7%

HP = Healthy PeopleMICH-16.3: <14.6% of recent mothers smoked in the 3 months prior to pregnancy.


Asian/PIAI/AN


Non-Latino White

*

**

6.052.1

5.627.1

26.8

Ref

SmokingPreconception Health

3


<High School*Ref 15.8

34.826.8


Percent of recent mothers who drank alcohol before pregnancy, Multnomah County.DataSource:PRAMS,2009-2010

Oregon

56.8%

Multnomah County

61.0%

HP2020 Target

<43.6%

HP = Healthy PeopleMICH-16.4: 43.6% of recent mothers drank alcohol in the 3 months prior to pregnancy.

60 70 800 20 403010 50

Not OHPOHP

*Ref

70.743.3


<High School

74.253.0

29.6

35+25-3420-24

<20 yrs***

**

Ref

Ref

68.364.3

56.726.0

Asian/PIAI/AN


Non-Latino White

*

**

34.064.5

24.448.6

76.4


HP

Ref

Alcohol UsePreconception Health

3



Percent of recent mothers who engaged in binge drinking† before pregnancy, Multnomah County.DataSource:PRAMS,2009-2010

HP2020 Target

No Target

Oregon

21.5%

Multnomah County

24.1%

0 20 403010

35+25-3420-24

<20 yrs**Ref

16.429.8

23.76.3

Asian/PIAI/AN


Non-Latino White **

10.822.2

10.420.5

30.5

Ref



Binge DrinkingPreconception Health

3

† Bingedrinkingisdefinedashaving5+drinksinonesitting.


Percent of recent mothers who were obese (BMI >30) before pregnancy, Multnomah County.DataSource:PRAMS,2009-2010

Weight Before PregnancyPreconception Health

3

Oregon

21.1%

Multnomah County

15.5%

HP2020 Target

≤30.5% HP = Healthy PeopleNWS-9: <30.5% of persons aged 20 years and older are obese.

0 10 20 30 40

35+25-3420-24

<20 yrs

**Ref

8.318.1

19.85.2

Asian/PIAI/AN


Non-Latino White*

Ref

*11.3

34.216.2

25.414.0


HP


Percent of recent mothers who were at normal weight (BMI of 18.5 - 24.9) before pregnancy, Multnomah County.DataSource:PRAMS,2009-2010

Oregon

50.9%

Multnomah County

57.0%

HP2020 Target

≥53.4%

HP = Healthy PeopleMICH-16.5: ≥53.4% of recent mothers had a normal weight (a BMI of 18.5-24.9) prior to pregnancy.

0 10 20 30 40 50 60 70

Asian/PIAI/AN


Non-Latino White*

Ref

*62.7

42.448.6

43.360.3


HP

*

– 33Maternal, Child, and Family Health Data Book – Multnomah County Pregnancy Health

What is pregnancy health? Pregnancyhealthincludesthehealth-relatedbehaviorsandconditionsthatoccurduringpregnancyanduptolaboranddelivery.Thepregnancyhealthindicatorsinthisreportincludesmoking;alcoholandtobaccoabstinence;healthyweightgain;receiptofearlyandadequateprenatalcare;andprevalenceofdepressionduringpregnancy.ThedatasourcesforthischapterwerebirthrecordsandthePRAMSsurvey.

Why is pregnancy health important? Onceawomanbecomespregnant,herhealthandwell-beinghaveasignificanteffectonthehealthofherdevelopingfetus.Engaginginhealthybehaviorsduringpregnancysuchaseatingwell,seekingprenatalcareearly,managingchronicconditionssuchasdiabetes,andbeingphysicallyactivecancontributetopositiveoutcomesduringbirthforbothamotherandherbaby.

Womenexperiencingpoorhealthduringpregnancyaremorelikelytohaveababythatisborntooearlyortoosmall.Thesebabiesareatriskforlife-longhealthissueslikediabetesandheartdisease.1,2,3

Whilegoodprenatalcarecanidentifyproblemsearlyandhelpinvolveandassureparentsofthebaby’sdevelopment,ahealthypregnancyalsodependsonotherfactors.Itisimportantforawomanandherfamilytohaveaccesstoresourcesandhealth-promotingcommunityassets.Supportssuchasaccesstofull-servicegrocerystores,adequatetransportation,andasafeneighborhood,aswellasaccesstoculturally-specificsupportsystemscanenablewomenandtheirfamiliestomakehealthierchoices.

Pregnancy Health4


Key FindingsPregnancy Health

4

Key FindingsIn Multnomah County:► Only7in10women,or70%,who

hadarecentbirthreceivedearlyandadequateprenatalcare.Womenofcolorwerelesslikelytohavereceivedadequateprenatalcarewith63%ofLatinawomen,66%ofBlack/AfricanAmericanwomen,and68%ofAsian/PacificIslanderwomenreceivingearly

andadequatecare.TheHP2020targetis77.6%.

► About89%ofallrecentmothersreportedabstainingfromtobaccoduringthelastthreemonthsofpregnancy.Only85%ofthemabstainedfromalcoholduring

thesameperiod.

► ThemajorityofallrecentmothersdidnotachievetheidealweightgainduringpregnancyasrecommendedbytheInstitute

ofMedicine(IOM).

•Youngerwomen,womenwith lesseducation,OHPclients, andU.S.-bornwomenweremore

likelytohavegainedexcess weightduringpregnancy. •Black/AfricanAmericanand

AmericanIndian/AlaskaNative womenweremorelikelytohave gainedexcessweightthan non-LatinaWhitewomen.

► Almost18%ofwomenreportedsymptomsofdepressionduringpregnancy.

•Womenofcolorweremore likelytohavesufferedfrom

depressionduringpregnancy. AfricanAmericanwomenwere

thehighestgroup,with1in3who reportedexperiencingsymptoms ofdepressionduringpregnancy.

•OHPclientsandthosewithless educationwerealsomorelikely

tohavesufferedfromdepression duringpregnancy.

Pregnancy Health

References

1.KajantieE,OsmondC,BarkerDJ,ErikssonJG.Pretermbirth--ariskfactorfortype2diabetes? TheHelsinkibirthcohortstudy.DiabetesCare.2010Dec;33(12):2623-5.

2.OsmondC,KajantieE,ForsénTJ,ErikssonJG,BarkerDJ.Infantgrowthandstrokeinadultlife:theHelsinkibirthcohortstudy.Stroke.2007Feb;38(2):264-70.

3.OsmondC,BarkerDJ.Fetal,infant,andchildhoodgrowtharepredictorsofcoronaryheartdisease,diabetes,andhypertensioninadultmenandwomen.EnvironHealthPerspect.2000Jun;108

Suppl3:545-53.


Percent of recent mothers who abstained from smoking during the last three months of pregnancy, Multnomah County.DataSource:PRAMS,2009-2010

Multnomah County HP2020 Target

≥98.6%

Oregon

88.9%89.2%

HP = Healthy PeopleMICH-11.3: ≥98.6% of recent mothers reported abstaining from smoking during pregnancy.

Pregnancy Health

Smoking During PregnancyPregnancy Health

4


60 70 80 90 1000 20 403010 50

Not OHPOHP *

Ref 97.274.6


<High School

93.882.582.0

35+25-3420-24

<20 yrs

Ref 93.891.4

81.879.8

Asian/PIAI/AN


Non-Latino White

**

**

97.177.5

99.284.0

86.3

HP

Ref

Ref

**

rev.061714


Smoking CessationPregnancy Health

4

Percent of recent mothers who smoked before pregnancy and quit while pregnant, Multnomah County.DataSource:PRAMS,2009-2010

HP2020 Target

NoTarget

Multnomah County

50.4%

Oregon

58.2%

60 70 800 20 403010 50

Not OHPOHP *

Ref 79.430.5

Among women with a live birth who smoked before pregnancy

Not MarriedMarried Ref

* 38.077.3

Pregnancy Health


Alcohol AbstinencePregnancy Health

4

Percent of recent mothers who abstained from alcohol during the last three months of pregnancy, Multnomah County.DataSource:PRAMS,2009-2010

Multnomah County HP2020 Target

≥98.3%

Oregon

85.0%

HP = Healthy PeopleMICH-11.1: ≥98.3% of pregnant women reported abstaining from alcohol in the past 30 days.


60 70 80 90 1000 20 403010 50

Not OHPOHP *

Ref 92.281.1

35+25-3420-24

<20 yrs*

*

Ref

79.282.8

93.894.6

HP

Asian/PIAI/AN


Non-Latino White *

93.489.5

95.193.6

80.0

Ref

Pregnancy Health

92.0%


Percent of recent mothers who received early and adequate prenatal care†, Multnomah County.DataSource:VitalStatistics2010-11

Multnomah County

70.0%

HP2020 Target

≥77.6%

Oregon

75.2%

HP = Healthy People MICH 10.2: ≥77.6% of pregnant women received early and adequate prenatal care.

Among live births

60 70 80 900 20 403010 50

Not OHPOHP *

Ref 75.061.8


<High School

77.766.4

58.4

35+25-3420-24

<20 yrs**

*

Ref 76.871.0

62.356.9

Asian/PIAI/AN


Non-Latino White

**

**

67.870.9

63.266.3

72.6

HP

Ref

Ref

**

Pregnancy Health

Prenatal CarePregnancy Health

4

Foreign-BornU.S.-Born

*Ref

62.373.1

† EarlyandadequateprenatalcarebasedontheKotelchuckIndex,alsocalledtheAdequacyofPrenatalCareUtilization(APCU)Index.Moreinformationat:http:/www.mchilibrary.info/databasesHSNRCPDFs/ overview_APCUIndex.pdf.


Weight GainPregnancy Health

4

Percent of recent mothers who achieved Institute of Medicine (IOM)-recommended weight gain† during pregnancy (singleton births only), Multnomah County.DataSource:VitalStatistics,2010-11

HP2020 Target

No Target

Multnomah County

34.3%

Oregon

32.6%

Among live singleton births

0 20 403010

Not OHPOHP *

Ref 36.131.4


<High School

38.630.2

33.2

35+25-3420-24

<20 yrs**

*

Ref 38.434.5

30.029.8

Asian/PIAI/AN


Non-Latino White

*

*

35.725.5

34.529.9

34.9Ref

Ref

**

Pregnancy Health

† SeeTechnicalNotessectionfortheIOMrecommendationsguidelines.



Percent of recent mothers who reported symptoms of depression during pregnancy, Multnomah County.DataSource:PRAMS,2005-2007

Multnomah County Oregon HP2020 Target

NoTarget

18.1%17.9%

0 20 403010

Not OHPOHP *

Ref 13.026.4


<High School

10.327.0

24.1

Asian/PIAI/AN


Non-Latino White

*

**

* 18.425.9

22.733.4

13.3Ref

Ref

**

Pregnancy Health

DepressionPregnancy Health

4

– 41Maternal, Child, and Family Health Data Book – Multnomah County Birth Outcomes

What is morbidity and mortality? Morbidityandmortalitydescribetheprevalenceofnegativebirthoutcomes,newbornhealthconditions,andinfantdeathsafterbirthorduringthefirstyearoflife.

Thereareanumberofindicatorsthatareusedtotrackmorbidityandmortality.Theyincludetheoverallprevalenceofwomenwhowereconsideredmedicallyhigh-riskduringtheirpregnancy;theprevalenceoflow-riskCesareandeliveries;repeatCesareanbirths;andtheprevalenceoflowbirthweight(<2,500grams),pretermdelivery(<37weeks),smallforgestationalage,andadmittancetotheNeonatalIntensiveCareUnit(NICU);aswellasinfantmortality.

BeingatlowriskforaCesareandeliveryisdefinedbytheHealthyPeople2020Initiativeasafirst-timebirthwheretheinfantisterm(atleast37weeks),isasingleton(notamultiplebirth),andispresentedheadfirst(vertexpresentation).Aninfantthatissmallforgestationalageisdefinedashavingabirthweightthatisbelowthetenth percentileforthatgestationalage.Thedataforthischapterwerederivedfrombirthanddeathrecords.

Why are morbidity and mortality important? Nationallyandinternationally,theinfantmortalityrateisawidelyused

indicatorforthehealthstatusofanationorjurisdiction.Theinfantmortalityrateisdefinedasthenumberofdeathsoccurringinthefirstyearoflifeper1,000livebirths.

Despiteourwealth,theUnitedStateshasthe28thlowestinfantmortalityrateamongindustrializedcountries.1 Whileavarietyofconditionscancauseinfantdeath,themajorityofbabiesdiebecausetheyarebornwithaseriousbirthdefect,areborntoosmalland/ortooearly,arevictimsofsuddeninfantdeathsyndrome(SIDS),orareaffectedbymaternalcomplicationsofpregnancy.2Babieswhostartlifewithalowbirthweightorwhoarebornprematurelyhaveincreasedriskfordelayedgrowthanddevelopment,andchronicconditionslaterinlifeiftheysurvivetheirfirstyear.3,4,5

Thehealthofababyatbirthisgreatlyinfluencedbyfactorsoutsideofthemedicalcaresetting.Thesocial,physical,andeconomicenvironmentsinwhichthepregnantwomanlives,works,andgrowscaneitherhelporhinderhermakinghealthypersonalchoices.Resourcesthatenhancequalityoflifecanhaveasignificantinfluenceonpopulationhealthoutcomes.Examplesoftheseresourcesincludesafeandaffordablehousing,accesstoeducation,publicsafety,availabilityofhealthyfoods,qualitylocalemergency/healthservices,andenvironmentsfreeoflife-andhealth-threateningtoxins.

Morbidity and Mortality5


Key FindingsIn Multnomah County► Morethan1in4women(about27%)

whowereconsideredlowriskforhavingaCesareansection(firstbirth,singlebaby,withaheadfirstpresentation)endedupdeliveringtheirbabiesbyCesarean.ThisisslightlyhigherthantheprevalenceforOregon(25%).TheHealthyPeople2020targetislessthan24%.

► Overall,approximately15%ofbabieswerebornwithahealthissue–theyweredeliveredatlowbirthweight,werepreterm,hadanewborncondition,hadacongenitalanomaly,orwereadmittedtotheNeonatalIntensiveCareUnit.

► Morethan1in5,or21%,of babieswhowereborntoBlack/

AfricanAmericanwomenhada poorbirthoutcome.

► About6%ofallbabieswerebornwithalowbirthweight(<2,500grams)and8%werebornpreterm(<37weeks).WhilethisputsMultnomahCountyingoodstanding

whenmeasuredagainstthe HealthyPeople2020targetsfor lowbirthweight(7.8%)andpreterm

births(11.4%),significantdisparitiesexistbyrace/ethnicity,education,age,andOHPstatus.

•Black/AfricanAmericanwomen weretwotimesaslikelytohave alowbirthweightbabyas

non-LatinaWhitewomen. •Infantsborntowomenwithless

educationorwhowereonOHP weremorelikelytobelowbirth- weightorbebornpretermthan infantsofwomenwithhigher educationandwhowerenot

onOHP.

► InfantsborntoBlack/AfricanAmericanandAsian/PacificIslanderwomenwerethemostlikelytobesmallforgestationalage.

► Morethan100infantdeaths,or 5.5deathsper1,000livebirths,

occurredduringthesurveillanceperiod.Themajorityofinfantdeathsoccurredduringtheneonatalperiod(first28daysoflife).

Birth Outcomes

Key FindingsMorbidity and Mortality

5

References1.CentersforDiseaseControlandPrevention,NationalCenterforHealthStatistics.Health,UnitedStates,2011.http://mchb.hrsa.gov/chU.S.a12/hs/hsi/pages/iim.html,AccessedMay2013.

2.HoyertDL,XuJQ.Deaths:Preliminarydatafor2011.Nationalvitalstatisticsreports;vol61no6.Hyattsville,MD:NationalCenterforHealthStatistics.2012.

3.KajantieE,OsmondC,BarkerDJ,ErikssonJG.Pretermbirth--ariskfactorfortype2diabetes?TheHelsinkibirthcohortstudy.DiabetesCare.2010Dec;33(12):2623-5.

4.OsmondC,KajantieE,ForsénTJ,ErikssonJG,BarkerDJ.Infantgrowthandstrokeinadultlife:theHelsinkibirthcohortstudy.Stroke.2007Feb;38(2):264-70.

5.OsmondC,BarkerDJ.Fetal,infant,andchildhoodgrowtharepredictorsofcoronaryheartdisease,diabetes,andhypertensioninadultmenandwomen.EnvironHealthPerspect.2000Jun;108Suppl3:545-53.


High-Risk Pregnancies/Poor Birth OutcomesMorbidity and Mortality

5

Percent of births to women who had a previous poor birth outcome or chronic condition†, Multnomah County.DataSource:VitalStats,2010-2011

Multnomah County

8.5% 7.5%

Oregon HP2020 Target

NoTarget

Birth Outcomes

† Thewomanhadatleastoneoftheseriskfactors:previouspretermbirth,previouspoorbirthoutcome,pre-pregnancydiabetesorhypertension.

Among live births0 2010

U.S.-BornForeign-Born

10.57.7

Asian/PIAI/AN


Non-Latino White

*

**

7.412.2

12.89.7

7.2Ref

Percent of births that resulted in a poor outcome†, Multnomah County.DataSource:VitalStatistics2010-2011

Oregon HP2020 Target

No Target

Multnomah County

15.3% 15.0%

† Infantwasbornwithanewborncondition,congenitalanomaly,lowbirthweight,preterm,orwasadmittedtotheNICU.

0 20 3010

Asian/PIAI/AN


Non-Latino White

*

*

* 16.717.9

14.521.3

14.2Ref

Among live births


Percent of births that were low birthweight (<2,500 grams), Multnomah County.DataSource:VitalStatistics2010-2011

Among live births

HP2020 Target

≤7.8%

Oregon

6.2%

Multnomah County

6.3%

6 8 12100 2 4

Not OHPOHP *

Ref 5.77.3


<High School

5.66.6

7.5

35+25-3420-24

<20 yrs

*

*

Ref

7.75.5

6.48.1

Asian/PIAI/AN


Non-Latino White

*

*

7.86.05.9

11.35.5

HP

Ref

Ref

**

Low BirthweightMorbidity and Mortality

5

Birth Outcomes

HP = Healthy People MICH-8.1: ≤7.8% of live births are lowbirth weight.


Percent of births that were delivered preterm (<37 weeks), Multnomah County.DataSource:VitalStatistics2010-2011

HP2020 Target

≤11.4%

Oregon

7.7%

Multnomah County

7.6%

Among live births

6 8 12100 2 4

Not OHPOHP *

Ref 7.18.3


<High School

6.88.1

8.5

35+25-3420-24

<20 yrs

*

*

Ref

9.06.9

7.68.5

Asian/PIAI/AN


Non-Latino White*

8.28.9

7.111.2

7.1

HP

Ref

Ref

**

Birth Outcomes

Preterm BirthsMorbidity and Mortality

5

HP = Healthy PeopleMICH-9.1: ≤11.4% of live births are preterm.


Percent of births that were small for gestational age (SGA), Multnomah County.DataSource:VitalStatistics2010-2011

6 8 161412100 2 4

Not OHPOHP *

Ref 8.210.5


<High School

7.99.8

10.8

35+25-3420-24

<20 yrs**

Ref

8.58.3

10.614.6

Asian/PIAI/AN


Non-Latino White**

* 13.69.0

9.710.6

8.2Ref

Ref

**

Small for Gestational AgeMorbidity and Mortality

5

Birth Outcomes

HP2020 Target

NoTarget

Oregon

8.1%

Multnomah County

8.7%

Among live singleton births


Number of infant deaths, Multnomah County.DataSource:VitalStatistics2009-2010

Birth Outcomes

Infant DeathsMorbidity and Mortality

5

6 121080 2 4

Not OHP

Multnomah County

OHP

Oregon

4.5

5.3

6.7

4.8


<High School

4.06.4

6.3

35+25-3420-24

<20 yrs

5.24.2

7.38.9

Asian/PIAI/AN


Non-Latino White

3.710.1

3.410.1

5.3

Rate per 1,000 live births

HP

HP = Healthy PeopleMICH-1.3: ≤ 6.0 infant deaths per 1,000 live births.

HP2020 TargetOregonMultnomah County

≤64.85.3


Percent of births that resulted in a stay in the Neonatal Intensive Care Unit, Multnomah County.DataSource:VitalStatistics2010-2011

HP2020 Target

NoTarget

Oregon

6.9%

Multnomah County

7.8%

Among live births

NICU AdmissionsMorbidity and Mortality

5

6 8 12100 2 4

Not OHPOHP *

Ref 7.18.9


<High School

7.37.9

8.8

35+25-3420-24

<20 yrs

*

*Ref

8.67.7

6.98.6

Asian/PIAI/AN


Non-Latino White*

*8.4

11.58.0

10.47.1Ref

Ref

*

Birth Outcomes


Percent of Cesarean deliveries among low-risk† women having a first birth, Multnomah County.DataSource:VitalStatistics2010-2011

Multnomah County

27.1%

HP2020 Target

≤23.9%

Oregon

25.4%

Among first live births

20 40300 10

35+25-3420-24

<20 yrs**

*

Ref 38.7

27.4

21.1

18.3

HP

Asian/PIAI/AN

Hispanic//LatinoBlack/AA

Non-Latino White

*28.3

36.1

25.8

28.0

26.6Ref

Birth Outcomes

Low-Risk Cesarean DeliveryMorbidity and Mortality

5

HP = Healthy PeopleMICH-7.1- 23.9% first births of low risk women (vertex position, singleton, term) undergoing c-section.

†Infantisterm(atleast37weeks),isasingleton(notamultiplebirth),andispresentedheadfirst(vertexpresentation).


Percent of Cesarean deliveries among low-risk† women that had a previous Cesarean delivery, Multnomah County.DataSource:VitalStatistics2010-2011

Multnomah County

77.8%

HP2020 Target

≤81.7%

Oregon

86.5%

504030 907060 800 10 20

Asian/PI

AI/ANHispanic//Latino

Black/AA

Non-Latino White

**

**

85.4

83.6

71.9

79.4

78.4

HP

Ref

Among women with a previous Cesarean delivery

Birth Outcomes

Repeat CesareanMorbidity and Mortality

5

HP = Healthy People MICH 7.2: 81.7% low risk women with previous c-section undergoing another.

†Infantisterm(atleast37weeks),isasingleton(notamultiplebirth),andispresentedheadfirst(vertexpresentation).

– 51Maternal, Child, and Family Health Data Book – Multnomah County Postpartum Health

What is postpartum health? Postpartumhealthdescribesthehealthstatusandwell-beingofwomenafterarecentlivebirth.

Theindicatorsinthischapterincludeprevalenceofpostpartumdepression;householdrulesregardingindoorsmoking;whetherinfantsareputtosleepontheirbacks,therecommendedposition;andprevalenceofbreastfeedinginitiation.TheprimarydatasourcesforpostpartumhealthwerebirthrecordsandthePRAMSsurvey.

Why is postpartum health important? Althoughthebirthofababymaybringexhilarationandfeelingsofnewbeginnings,itcanalsobeatimeofgreatstress.Thereareenormouschangesforthenewmotherandherfamily.Postpartumhealthindicatorsprovideaglimpseintoawoman’shealthandhabitsthatmayaffectherabilitytobondwithandcareforhernewinfant.

InOregonandMultnomahCounty,1in10recentmothersreportedexperiencingsymptomsofpostpartumdepression.Studiesonnewmothersshowthatthosewithsymptomsofdepressionpossessmorenegativeperceptionsofthemselvesasmothersandoftheirbabies.1Theyalsohavelessverbalinteractionandplaylessfrequentlywiththeirinfants.2

Inturn,infantsofmotherswithsymptomsofdepressionshowedlesssecureattachmenttotheirmothers,andexperiencedmoreanxietyandothernegativeemotionaloutcomes.Accordingtoanotherstudy,theeffectsofthemother’sdepressivesymptomsonchildren’scognitiveandemotionaldevelopmentcouldlastaslongas14years.3

Depressioninmenisseldomdiscussedanddatais,unfortunately,notreadilyavailable.However,a2010studyfoundthatupto14%ofU.S.menfeeldepressedinthemonthsfollowingthebirthoftheirchild.4

Oneofthebestthingsthatawomancandoforherselfandherbabyinthepostpartumperiodistobreastfeed.Studiesshowthatnotbreastfeedingisconsistentlyariskfactorforpostpartumdepression.5,6Inaddition,breastmilkcontainsallthevitaminsandnutrientsthatbabiesneedinthefirstsixmonthsoflifeandstrengthensbabies’immunesystems.7

Asinotherstagesofpregnancyandchildrearing,community-levelfactorscancontributetoamother’smentalandphysicalhealthfollowingthebirthofherbaby.Theseincludelifetimestressorssuchaslivinginpovertyorbeingavictim/survivorofviolence.Theyalsoincludethequalityofheremployment,herrelationships,hersocialsupportsystems,andherhousingstatus.

Postpartum Health6


Key FindingsIn Multnomah County:► Overall,about1in10recent

mothersreportedfeelingsymptomsofpostpartumdepression.Thisprevalencevarieddramaticallybyrace/ethnicityandeducationlevel.

•About1in5Black/African AmericanandAmericanIndian/ AlaskaNativerecentmothers reportedexperiencingsymptoms ofpostpartumdepression.

► Morethan3in4recentmothers(78%)saidthattheyputtheirinfantstosleepontheirbacks.However,onlyslightlymorethanhalf(54%)ofBlack/AfricanAmericanwomensaidtheydid.

► EverydemographicgroupassessedhasexceededtheHealthyPeople2020targetforbreastfeedinginitiation(96%initiationratein

thecountyoverallversus82% fortheHealthyPeopletarget).

Key FindingsPostpartum Health

6

Postpartum Health

References1. FowlesE.R.Therelationshipbetweenmaternalroleattainmentandpostpartumdepression. HealthCareWomenInt.1998;19:83–94.

2. Righetti-VeltemaM,BousquetA,ManzanoJ.Impactofpostpartumdepressivesymptomson motherandher18-month-oldinfant.EurChildAdolescPsychiatry.2003;12:75–83.

3.BeckCT.Theeffectsofpostpartumdepressiononchilddevelopment:Ameta-analysis.Archivesof PsychiatricNursing.1998;12:12–20.

4. PaulsonJF,BazemoreSD.Prenatalandpostpartumdepressioninfathersanditsassociationwith maternaldepression:ameta-analysis.JAMA.2010May19;303(19):1961-9.

5. GrossKH,WellsCS,Radigan-GarciaA,DietzPM.Correlatesofself-reportsofbeingverydepressedinthemonthsafterdelivery:resultsfromthePregnancyRiskAssessmentMonitoringSystem.MaternalandChildHealthJournal.2002;6(4):247-253.

6. McLennanJD,KotelchuckM,ChoH.Prevalence,persistenceandcorrelatesofdepressivesymptomsinanationalsampleofmothersoftoddlers.JAmAcadChildAdolescPsychiatry.2001;40:1316-23.

7.OddyWH.Breastfeedingprotectsagainstillnessandinfectionininfantsandchildren:areviewoftheevidence.BreastfeedRev.2001Jul;9(2):11-8.


Postpartum DepressionPostpartum Health

6

Percent of recent mothers who reported symptoms of postpartum depression, Multnomah County.DataSource:PRAMS,2005-2007


NoTarget

HP2020 TargetMultnomah County

10.9%

Oregon

11.7%

10 30200


<High School

7.810.5

20.3

Asian/PIAI/AN


Non-Latino White

14.523.7

15.218.1

8.0Ref

Ref

*

Postpartum Health


Household SmokingPostpartum Health

6

Postpartum Health

Percent of recent mothers who reported that smoking was not allowed in their household, Multnomah County.DataSource:PRAMS,2009-2010

HP2020 Target

NoTarget

Multnomah County

98.0%

Oregon

98.4%


<High School

98.399.3

96.0

35+25-3420-24

<20 yrs**

Ref 99.799.0

94.396.8

Ref

*

30 40 70 80 90 10060500 10 20

Not OHPOHP *

Ref 98.697.1

Asian/PIAI/AN


Non-Latino White**

* 99.098.098.5

97.097.9Ref


Percent of recent mothers who put their infants to sleep on their backs, Multnomah County.DataSource:PRAMS,2009-2010

Multnomah County

77.8%

HP2020 Target

≥75.9%

Oregon

78.3%

Sleep on BackPostpartum Health

6

Postpartum Health

HP = Healthy PeopleMICH-20: ≥75.9% of infants are put to sleep on their backs.

Not OHPOHP

Ref 80.273.5

30 40 50 908070600 10 20

35+25-3420-24

<20 yrs *

Ref 81.879.2

75.860.8

Asian/PIAI/AN


Non-Latino White*

73.674.3

76.653.9

81.5Ref


HP


Breastfeeding InitiationPostpartum Health

6

Percent of recent mothers who initiated breastfeeding, Multnomah County.DataSource:PRAMS,2009-2010

Multnomah County

96.0%

HP2020 Target

≥81.9%

Oregon

94.4%

Postpartum Health

HP = Healthy People MICH-21: ≥81.9% of infants are ever breastfed.


100908020100 30 40 50 60 70

35+25-3420-24

<20 yrs *

Ref

95.397.5

94.0

91.8

Asian/PIAI/AN


Non-Latino White*

92.993.0

96.589.4

97.8

HP

Ref

Not OHPOHP *

Ref 98.591.5


<High School 89.794.1

98.7Ref

**

– 57Maternal, Child, and Family Health Data Book – Multnomah County Child Growth and Development

What is child growth and development? Childgrowthanddevelopmentreferstothechangesandgrowththatoccurinchildrenfrombirthtoadolescence.Althougheverychildisunique,healthychildrengrowandreachcertainphysical,cognitiveandemotionaldevelopmentalmilestonesonapredictableschedule.

Inthisreport,theindicatorsusedtoassesschildgrowthanddevelopmentincludewhetherthechildisreadtoonadailybasis;howmuchTVandvideoviewingtimetheyhave;andwhetheraTVispresentinthechild’sbedroom.ThedataforthischapterwerederivedfromthePRAMS-2survey,atwo-yearfollow-upsurveytoPRAMS.

Why is child growth and development important? EnsuringthatchildrenarehealthyandreadytolearnatagefiveisagoalthatdrivesmanyearlychildhoodservicesinMultnomahCountyandnationally.Thisincludescreatingasafe,healthy,andstimulatingenvironmentforchildrentolearnandgrow.Forinstance,childrenwhoarereadtobecomebetterreadersandachievemoreinschool,regardlessoftheireconomicandeducationalfamilybackgrounds.1

Excessivescreentime,ontheotherhand,hasbeenlinkedtoobesity,impairedchildhooddevelopment,andlesstimeforimportantdevelopmentalplay.2,3TheAmericanAcademyofPediatricsrecommendsthatchildrenolderthantwoyearsbelimitedtonomorethantwohoursof“qualityprogramming”perday,thattelevisionsnotbepresentinachild’sbedroom,andthatchildrenundertwoyearshavenoTVorinternetexposure.4

Everyenvironmentwherechildrenspendtime—home,childcaresettings,andschool—hasaneffectonchildgrowthanddevelopment.Ensuringhealthyenvironmentscanhelpsupportfamiliesintheireffortstoraisehealthychildren.

Child Growth and Development7


Key FindingsIn Multnomah County:► 1in5toddlersundertheageof

twohadnoscreentimeinatypicalweek.ThisisbelowthetargetsetbytheHealthyPeople2020goal

ofatleast2in5toddlershaving noscreentime.

► Screentimeexposurevarieddramaticallybyrace/ethnicity,maternaleducationlevel,andhouseholdincome.Forexample,while35%oftwo-year-oldslivinginhigherincomehouseholds(incomegreaterthan185%ofthefederalpovertylevel)hadnoscreentime,only6%ofthoselivinginlowerincomehouseholds(incomelessthan185%federalpovertylevel)hadnoscreentime.

► Largedisparitiesalsoexistintheprevalenceoftwo-year-oldswithoutaTVintheirbedroom.ToddlersofLatinamothers,youngermothers,motherswithlesseducation,andmotherswithlowerhouseholdincomeweremorelikelytohaveaTVinaroomwherethetoddlersleeps.

► About7in10toddlerswerereadtodailybyaparentorguardian.ThisexceedstheHealthyPeople2020goalofatleast5in10beingreadtoeveryday.However,majordisparitiesexistbymaternalrace/ethnicity,age,education,andhouseholdincome.Forexample,whilemorethan8in10toddlers

ofnon-LatinaWhitewomenwerereadtodaily,only4in10toddlersofLatinamotherswere.

Child Growth and Development

Key FindingsChild Growth and Development

7

References

1.Wells,G.(1985).Preschoolliteracy-relatedactivitiesandsuccessinschool.Literacy,Language,andLearning.Eds.D.Olson,A.Hildyard,andN.Torrance.NewYork:CambridgeUniversityPress.

2.ChristakisDA.TheeffectsofinfantmediaU.S.age:whatdoweknowandwhatshouldwelearn.ActaPediatrica2009;98:8--16.

3.DennisonBA,ErbTA,JenkinsPL.Televisionviewingandtelevisioninbedroomassociatedwithoverweightriskamonglow-incomepreschoolchildren.Pediatrics2002;109:1028--35.

4.AmericanAcademyofPediatricsCommitteeonPublicEducation.Children,adolescents,andtelevision.Pediatrics2001;107:423--6.


Percent of two-year-olds that have no TV or video viewing time in a typical day, Multnomah County.DataSource:PRAMS-2,2006-2007

Multnomah County

21.6%

HP2020 Target

≥44.7%

Oregon

17.3%

30 40 60500 10 20

Not OHPOHP

*Ref

35.16.1


<High School

28.814.4

8.2

Asian/PIAI/AN


Non-Latino White *

13.0insufficient data12.9

6.728.8

HP

Ref

Ref

*

Not MarriedMarried

Ref 15.4

24.1

Among 2-year-olds

No Screen TimeChild Growth and Development

7


HP = Healthy PeoplePA-8.1: ≥44.7% of children ages 0-2 years view no TV/video on ;an average weekday.


Percent of two-year-olds that have less than two hours of TV or video viewing time in a typical day, Multnomah County.DataSource:PRAMS-2,2006-2007

Multnomah County

79.5%

HP2020 Target

≥83.2%

Oregon

79.7%

30 40 70 80 9060500 10 20

Not OHPOHP

*Ref

86.970.0

Not MarriedMarried

Ref 68.983.5

Asian/PIAI/AN


Non-Latino White

68.171.3

80.168.4

82.4

HP

Ref


<High School

86.962.1

77.7Ref*

Among 2-year-olds


Screen TimeChild Growth and Development

7

HP = Healthy PeoplePA-8.2.1: ≥83.2% of children ages 2-5 years view TV, videos, or video games for <2 hours a day.


Percent of two-year-olds that do not have a TV in the room where they sleep, Multnomah County.DataSource:PRAMS-2,2006-2007

HP2020 Target

NoTarget

Multnomah County

85.8%

Oregon

81.7%

30 40 70 80 1009060500 10 20

Not OHPOHP

*Ref

98.172.3


<High School

95.582.6

56.7

35+25-3420-24

<20 yrs***

Ref

96.289.1

78.739.9

Asian/PIAI/AN


Non-Latino White**

* 84.273.1

58.680.6

96.3

Ref

Ref**

Among 2-year-olds

TV in BedroomChild Growth and Development

7



Percent of two-year-olds that are read to daily by a family member, Multnomah County.DataSource:PRAMS-2,2006-2007

HP2020 Target

≥52.6%

Multnomah County

69.2%

Oregon

61.5%

30 40 70 80 9060500 10 20

Not OHPOHP

*Ref

83.254.6


<High School

83.353.8

39.3

35+25-3420-24

<20 yrs

**

Ref

79.772.2

60.432.8

Asian/PIAI/AN


Non-Latino White**

* 55.460.8

39.647.3

84.4

HP

Ref

Ref**

Among 2-year-olds


Reading to ChildChild Growth and Development

7

HP = Healthy PeopleEMC-2.3: ≥52.6% of children ages 0-5 years have parents who report that someone in their family read to the child everyday.

– 63Maternal, Child, and Family Health Data Book – Multnomah County Home, Family, and Community

What is home, family, and community? Parentsandfamiliesarebabies’firstandmostimportantteachers.Thehomeenvironmentisallbabiesknowforatime.Oncechildrenentertheworldaroundthem,theirimmediatecommunity—neighborhoods,childcarecenters,parksandschoolsandthenon-familyadultsthatinteractwiththem—becomeanextensionofthehomeenvironment.Thehomes,familiesandcommunitiesinwhichchildrengrowanddevelophelpshapethemintohealthyadults.

Theindicatorsinthischapterincludetheprevalenceofpaternalinvolvement,childoutings,familymealtimeandchildcareuse.

Asmentionedelsewhereinthisreport,amajorgapinthematernalandchildhealthliteratureandsurveillancedataisthatsurroundingtheroleoffathersinhouseholds.Becauseadirectmeasureofpaternalinvolvementdoesnotexistincurrentavailabledatasources,thisreportusesmissingfather’snameonthebirthcertificateasaproxyforestimatingfatheruninvolvement.Thisisconsistentwiththecurrentpracticesforestimatingfatheruninvolvementinthematernalandchildhealthliterature.1,2 ThedataforthischapterwereobtainedfrombirthrecordsandthePRAMSandPRAMS-2surveys.

Why are home, family, and community important? Positiveearlyexperiencesprovideafoundationforhealthydevelopment.Conversely,earlylifestressorssuchasviolence,poornutritionandlivinginunsafehousingandunsafeneighborhoodsweakenthatfoundation.

Together,home,familyandcommunitycreateacontinuumofexperiencesforadevelopingchildthatrangefromresponsivecaregivingtoneglectfulorabusiveinteractions,andfromsafetounsafeplacestoplayandlearn.Childrenwhoexperienceearlylifestressorssuchasviolence,orwhogrowupinresource-poorneighborhoodswithlittleopportunityforhealthynutrition,play,andqualityeducationalexperiences,aremorelikelytoexperiencehealthandsocialrisksaschildrenandadults.3

Oneindicatorthatservesasaproxyforthestabilityofthehomeenvironmentiswhetherchildrenaregrowingupintwo-parenthouseholds.Numerousstudieshavefoundthatchildrenwholivewiththeirfathersaremorelikelytohavegoodphysicalandemotionalhealth,tohavegoodeducationalattainmentandtoavoiddrugs,violenceanddelinquentbehavior.4,5 Childrenwithbiologicalfatherspresentinthehouseholdwerealsofoundtobe43%morelikelytoearnA'sinschooland33%lesslikelytorepeatagrade.4Current

Continued on next page

Home, Family, and Community8


ContinuedHome, Family, and Community

8

Home, Family, and Community

dataarelimitedtohouseholdswithbothmaleandfemalebiologicalparents.Moredataareneededonfactorsthatsupportgoodoutcomesforchildrenraisedinnon-traditionalhouseholds,includingsingle-parent,lesbian,gay,bi-sexual,transgender,queer,andinter-generationalhouseholds.

Amother’semploymentstatusisrelatedtohouseholdincome,abilitytopurchasequalitychildcare,andwhetherornotafamilyeatsmealstogether.Morethan70%ofU.S.motherswithchildrenyoungerthan18yearsworkedoutsidethehomein2012.6 Manyoftheirchildrenareenrolledinsomeformofchildcareoutsideofthehome,wherechildrenmayadoptearlynutrition,physicalactivity,andtelevisionviewingbehaviors.Thesebehaviorscaninfluencechildhoodobesity,whichisamajorproblemamongallU.S.adultsandchildren.7,8


Key FindingsIn Multnomah County:► About10%ofinfantshada father’snamemissingontheir birthcertificate,suggestingfather

uninvolvement.InfantswhosemotherswereBlack/AfricanAmerican,whosemotherswereyoungerorhadlesseducation,orwhosemotherswereonOHPwerethemostlikelytohavemissingfather’snamesonbirthcertificates.

► Morethanhalfoftwo-year-oldsreceivedchildcareeitherfroma

licensedfacility(13%)orfromsomeoneotherthanthe

parents(38%).

► About47%oftwo-year-oldsparticipatedinfourormoreoutingsinthepastweek,suchasgoingtothepark,playground,library,orotherchildren’sprogramoractivity

► About83%oftwo-year-oldslive inhouseholdswherethefamily

usuallyoralwayseatsmealstogether.

References

1.GaudinoJAJr.,JenkinsB,RochatRW.Nofathers’names:ariskfactorforinfantmortalityinthe StateofGeorgia,U.S.A.SocSciMed.1999Jan;48(2):253-65.

2.AlioAP,MbahAK,KornoskyJL,WathingtonD,MartyPJ,SalihuHM.Assessingtheimpactof paternalinvolvementonracial/ethnicdisparitiesininfantmortalityrates.JCommunityHealth. 2011Feb;36(1):63-8.doi:10.1007/s10900-010-9280-3.

3.Brooks-GunnJ,DuncanGJ,KlebanovPK,SealandN.Doneighborhoodsinfluencechildandadolescentdevelopment?AmJSociol.1993;99:353–395.

4.NordCandWestJ(2001).Fathers’andmothers’involvementintheirchildren’sschoolsbyfamilytypeandresidentstatus[On-line].Available:http://nces.ed.gov/pubs2001/2001032.pdf.

5.HornWandSylvesterT(2002).U.S.DepartmentofHealthandHumanServices,SubstanceAbuseandMentalHealthServicesAdministration(SAMHSA).(1996).Therelationshipbetweenfamilystructureandadolescentsubstanceabuse.Rockville,MD:NationalClearinghouseforAlcoholandDrugInformation.

6.UnitedStatesDepartmentofLabor,BureauofLaborStatistics(2013).Economicnewsrelease:EmploymentCharacteristicsofFamilySummary.[On-line].Available:www.bls.gov/news.release/famee.nr0.htm.

7.Benjamin,SE,Cradock,A,Walker,EM,Slining,M,andGillman,MW.(2008).Obesityprevention inchildcare:AreviewofU.S.stateregulations.BMCPublicHealth,8:188,1-10.

8.CentersforDiseaseControlandPrevention(CDC).Addressingobesityinthechildcaresetting:programhighlights.[On-line].Available:www.cdc.gov/obesity/downloads/obesity_program_highlights.pdf.


Key FindingsHome, Family, and Community

8


Estimated prevalence of father uninvolvement†, Multnomah County.DataSource:VitalStatistics2010-2011

Multnomah County

9.4% 8.9%

HP2020 Target

No Target

Oregon

20 300 10

Not OHPOHP *

Ref 4.118.1


<High School

1.913.6

19.0

35+25-3420-24

<20 yrs**

*

Ref 5.36.6

17.229.1

Asian/PIAI/AN


Non-Latino White**** 6.6

18.111.5

27.46.5Ref

Ref

**

Among live births


Father UninvolvementHome, Family, and Community

8

† Weusedmissingfather’snamesonbirthcertificatesasaproxyforfatheruninvolvement.


Percent of two-year-olds that had four or more outings† in past week, Multnomah County.DataSource:PRAMS-2,2006-2007

HP2020 Target

NoTarget

Multnomah County

46.9%

Oregon

39.5%

Among 2-year-olds

30 40 7060500 10 20

Not OHPOHP

*Ref

58.731.0


<High School

60.031.3

19.7

35+25-3420-24

<20 yrs

**Ref

61.746.7

43.814.9

Asian/PIAI/AN


Non-Latino White

35.544.5

28.836.5

55.8

Ref

Ref

**

Child OutingsHome, Family, and Community

8


† Outingssuchasgoingtoapark,playground,library,orotherchildren’sprogramoractivity.


Percent of two-year-olds living in households where the family usually or always† eats meals together, Multnomah County.DataSource:PRAMS-2,2006-2007

HP2020 Target

No HPTarget

Multnomah County

83.4%

Oregon

86.5%


Family Eats TogetherHome, Family, and Community

8

† Respondentscouldchoose“always”,“usually”,“sometimes”,or“never”todescribehowoftenthefamilyeatsmealstogether.

30 40 70 90 1008060500 10 20

Not MarriedMarried

89.681.5


<High School

85.277.7

85.0

35+25-3420-24

<20 yrs

77.483.1

91.576.3

Asian/PIAI/AN


Non-Latino White

86.690.3

76.286.0

84.6

Among 2-year-olds

– 69Maternal, Child, and Family Health Data Book – Multnomah County Home, Family, and Community

Percent of two-year-olds that are in childcare, by type of childcare setting, Multnomah County.DataSource:PRAMS-2,2006-2007

HP2020 Target

No HPTarget

Multnomah County

ChildcareHome, Family, and Community

8

Among 2-year-olds

30 40 7060500 10 20

Not OHP

Multnomah County

OHP

Oregon

19

13

7

12

43

39

35

40

35+25-3420-24

<20 yrs

28 32

10 43

13 35

6 29

Asian/PI

AI/AN

Hispanic/Latino

Black/AA

Non-Latino White

18 36

9 53

5 14

22 43

14 48

High School+

High School<High School

19 41

6 50

191

Licensed Informal

52%

Oregon

52%


Acomplexinterplayofsocial,environmentalandbiologicalfactorsestablisheseachindividual’sfoundationforlife-longhealthorillhealth.Ahealthycommunitydependsoncreatingthestrongestfoundationspossibleforallmothersandtheirchildren.

WhilemanymothersandchildreninMultnomahCountyarehealthyanddoingwell,significantdisparitiesbasedonincome,education,age,andrace/ethnicitycanbeseenthroughoutthelifecourseandassociatedindicators.Ingeneral,womenofcolor,womenwithlowerincome,youngerwomen,andwomenwithlesseducationinMultnomahCountyareexperiencingmoreadversehealthissuesandhealthoutcomesthantheircounterparts.

Althoughwecannotassesstrendsusingthedatainthisreport,numerousotherreportsandstudieshaveshownthatpersistentdisparitiesexistinourcounty,suchasthosearoundinfantmortalityandadversebirthoutcomes,whichhavenotimprovedovertime.

Itisimportanttonotethatwhilesomehealthoutcomesrelyonindividualchoices,theenvironmentsinwhichwomenlive,play,workandlearnshapeavailablechoicesandhaveaprofoundimpactonhealth.Socialdeterminantsofhealth—includingsocioeconomicstatus;discriminationbyrace,ethnicity,gender,and/orclass;accesstohealthcareandotherservices;aswellasothersocialandenvironmentalstressors—arefactorsintheresultsanddisparitiesoutlinedinthisreport.Ifwearetomakeprogressinimprovingthehealthandwell-beingofallmothersandchildreninMultnomahCounty,thesefactorsmustbeacknowledgedandaddressed.

Conclusions

Conclusion

– 71Maternal, Child, and Family Health Data Book – Multnomah County Technical Notes

Technical Notes

Race and EthnicityTheraceandethnicityofmotherswascategorizedaccordingtoinformationprovidedontheinfant'sbirthcertificate.Thefivecategoriesusedarenon-LatinoWhite,AmericanIndian/AlaskaNative,Asian/PacificIslander,Black/AfricanAmerican,andHispanic/Latino.Ifamotheridentifiedonlyoneraceandethnicity,shewasplacedintothatcategory.Ifamotheridentifiedherselfasmultiracial,shewasplacedintothecategorywithlessrepresentationinMultnomahCounty.Forexample,ifamotheridentifiedasBlack/AfricanAmericanandnon-LatinoWhite,shewouldbeplacedintotheBlack/AfricanAmericancategorysincetheBlack/AfricanAmericancommunityissmallerthanthenon-LatinoWhitecommunityinMultnomahCounty.Theraceandethnicityofinfantsisbasedontheraceandethnicityoftheirmothersonly.

Family Planning IndicatorsPregnancy IntentionPercentofrecentmotherswhoreportedthattheirpregnancywasintended.Numerator:Weightednumberofwomenwitharecentlivebirthwhoreportedthat theyhadwantedtobepregnant“sooner”or“[right]then”whentheyfoundout theywerepregnantwiththeirnewbaby.Denominator:Weightednumberofwomenwitharecentlivebirth.Data Source:PregnancyRiskAssessmentMonitoringSystem(PRAMS)

Contraception UsePercentofrecentmotherswhowereusingcontraceptionwhentheygot unintentionallypregnant.Numerator:Weightednumberofwomenwitharecentlivebirthfromanunplanned pregnancywhosaid“yes”whenaskedwhethersheorherpartnerwasdoing anythingtokeepfromgettingpregnant.Denominator:Weightednumberofwomenwitharecentlivebirthwhosaidtheir pregnancieswereunplanned.Data Source:PRAMS

Birth SpacingPercentofbirthsthatwereconceivedlessthan18monthsfromapreviouslivebirth.Numerator:Numberofbirthsofthesecondorhigherorderwherethebirthwas conceivedlessthan18monthsfromapreviouslivebirth.Denominator:Totalnumberofbirthsthatwereofthesecondorhigherorder.Data Source:VitalStatistics

Repeat Teen BirthsPercentofrepeatteenbirths.Numerator:Numberofrepeatlivebirthstoteenwomen<20yearsofage.Denominator:Totalnumberofbirthstoteenwomen<20yearsofage.Data Source:VitalStatistics


Multivitamin IntakePercentofrecentmotherswhotookadailymultivitamin/folicacidonemonth beforepregnancy.Numerator:Weightednumberofwomenwitharecentlivebirthwhoreportedthat theytookamultivitamin,prenatalvitamin,orfolicacidvitamineverydayofthe weekduringthemonthbeforepregnancy.Denominator:Weightednumberofwomenwitharecentlivebirth.Data Source:PRAMS

SmokingPercentofrecentmotherswhosmokedbeforepregnancy.Numerator:Weightednumberofwomenwitharecentlivebirthwhoreportedthat theysmokedanynumberofcigarettesonanaveragedayduringthethreemonths beforetheygotpregnant.Denominator:Weightednumberofwomenwitharecentlivebirth.Data Source:PRAMS

Alcohol UsePercentofrecentmotherswhodrankalcoholbeforepregnancy.Numerator:Weightednumberofwomenwitharecentlivebirthwhoreportedthat theyhadanyalcoholicdrinksinanaverageweekduringthethreemonthsbefore theygotpregnant.Denominator:Weightednumberofwomenwitharecentlivebirth.Data Source:PRAMS

Binge DrinkingPercentofrecentmotherswhoengagedinbingedrinkingbeforepregnancy.Numerator:Weightednumberofwomenwitharecentlivebirthwhoreportedthat theydrankfourormorealcoholicdrinksinonesittingatleastonceduringthe threemonthsbeforetheygotpregnant.Denominator:Weightednumberofwomenwitharecentlivebirth.Data Source:PRAMS

Weight Before PregnancyPercentofrecentmotherswhowereobesebeforepregnancy.Numerator:Weightednumberofwomenwitharecentlivebirthwhosebodymass index(BMI)was30andabove.BMIiscalculatedbydividingtheirweightin kilogramsbyheightinmeterssquared:weight(kg)/[height(m)]2

Denominator:Weightednumberofwomenwitharecentlivebirth.Data Source:PRAMS

Technical Notes

Preconception Health Indicators


Smoking During PregnancyPercentofrecentmotherswhosmokedduringthelastthreemonthsofpregnancy.Numerator:Weightednumberofwomenwitharecentlivebirthwhoreportedthat theysmokedanynumberofcigarettesonanaveragedayduringthelastthree monthsofpregnancy.Denominator:Weightednumberofwomenwitharecentlivebirth.Data Source:PRAMS

Smoking CessationPercentofrecentmotherswhosmokedbeforepregnancyandquitwhilepregnant.Numerator:Weightednumberofwomenwitharecentlivebirthwhoreportedthat theysmokedcigarettesduringthethreemonthsbeforepregnancy,butnotduring thelastthreemonthsofpregnancy.Denominator:Weightednumberofwomenwitharecentlivebirthwhoreportedthat theysmokedcigarettesduringthethreemonthsbeforepregnancy.Data Source:PRAMS

Alcohol AbstinencePercentofrecentmotherswhoabstainedfromalcoholduringthelastthreemonthsofpregnancy.Numerator: Weightednumberofwomenwitharecentlivebirthwhoreportedthat theyhadanyalcoholicdrinksinanaverageweekduringthelastthreemonths ofpregnancy.Denominator:Weightednumberofwomenwitharecentlivebirth.Data Source:PRAMS

Prenatal CarePercentofrecentmotherswhoreceivedearlyandadequateprenatalcare.Numerator:Numberofbirthswherethemotherinitiatedprenatalcareduringthe firsttrimesterandreceivedan“adequate”or“adequateplus”numberofprenatal visitsaccordingtotheKotelchuckIndex,alsocalledtheAdequacyofPrenatal CareUtilization(APNCU)Index.TheKotelchuckindexcomparesthenumberof prenatalvisitstotheexpectednumberofvisitsfortheperiodbetweenwhen carebeganandthedeliverydate.Adequacyofprenatalcareisclassifiedas Inadequate(received<50%ofexpectedvisits),Intermediate(50%-79%), Adequate(80%-109%),AdequatePlus(110%ormore).Denominator:Totalnumberofbirths.Data Source:VitalStatistics

Technical Notes

Pregnancy Health Indicators


Weight GainPercentofwomenwitharecentsingletonlivebirthwhoachievedtheInstituteof Medicine(IOM)-recommendedweightgainduringpregnancy.Numerator:Numberofbirthswherethemothergainedweightwithintherange recommendedbytheIOMbasedonherpre-pregnancybodymassindex: BMI<18.5:28-40lbs. BMI18.5-24.9:25-35lbs. BMI25-29.9:15-25lbs. BMI>30:11-20lbs.Denominator:Totalnumberofsingletonbirths.Data Source:VitalStatistics

DepressionPercentofrecentmotherswhoreportedsymptomsofdepressionduringpregnancy.Numerator:Weightednumberofwomenwitharecentlivebirthwhoreportedthat: 1)shealwaysoroftenfeltdown,depressed,orhopeless,and/or 2)shealwaysoroftenhadlittleinterestorpleasureindoingthings.Denominator:Weightednumberofwomenwitharecentlivebirth.Data Source:PRAMS

Technical Notes

Pregnancy Health Indicators continued


High-Risk PregnanciesPercentofbirthstowomenwhohadapreviouspoorbirthoutcomeorchroniccondition.Numerator:Numberofbirthswherethewomanhadatleastoneoftheseriskfactors: previouspretermbirth,previouspoorbirthoutcome,pre-pregnancydiabetesor hypertension.Denominator:Totalnumberofbirths.Data Source:VitalStatistics

Birth OutcomesPercentofbirthsthatresultedinapooroutcome.Numerator:Numberofbirthswithanewborncondition,congenitalanomaly,low birthweight,bornpreterm,orwheretheinfantwasadmittedtotheNICU.Denominator:Totalnumberofbirths.Data Source:VitalStatistics

Low BirthweightPercentofbirthsthatwerelowbirthweight,<2,500grams.Numerator: Numberofbirthsbornwithabirthweightunder2,500grams.Denominator:Totalnumberofbirths.Data Source:VitalStatistics

Preterm BirthsPercentofbirthsborn<37weeksgestation.Numerator:Numberofbirthsbornpriorto37weeksofgestation.Denominator:Totalnumberofbirths.Data Source:VitalStatistics

Small for Gestational AgePercentoflivebirthswhosebirthweightwasatorbelowthe10thpercentileforagivengestationalage.Numerator:Numberofbirthswhosebirthweightwasatorbelowthe10thpercentile foragivengestationalage.Denominator:Totalnumberofbirths.Data Source:VitalStatistics

Technical Notes

Morbidity and Mortality Indicators


Infant DeathsRateofinfantdeathsper1,000livebirths.Numerator:Numberofdeathsofinfantslessthanoneyearofage,duringa specifictimeperiod.Denominator:Totalnumberofbirthsduringthesametimeperiod.Data Source:VitalStatistics

Neonatal Intensive Care Unit (NICU) AdmissionPercentofbirthsthatresultedintheinfantstayingintheNeonatalIntensiveCareUnit(NICU).Numerator:NumberofbirthsthatwereadmittedtotheNICU,asindicatedon thebirthcertificate.Denominator:Totalnumberofbirths.Data Source:VitalStatistics

Low-Risk CesareanPercentofCesareandeliveriesamonglow-riskwomenhavingafirstbirth.Numerator:Numberoffirstbirthsthatwereterm(atleast37weeks),asingleton (notmultiple),hadavertexpresentation(headfirst),andweredeliveredby CesareanSection.Denominator:Totalnumberoffirstbirthsthatwereterm,asingleton,andhada vertexpresentation.Data Source:VitalStatistics

Repeat CesareanPercentofCesareandeliveriesamonglow-riskwomenthathadaprevious Cesareandelivery.Numerator:Numberofrepeatbirthsthatwereterm(atleast37weeks),asingleton, (notmultiple),hadavertexpresentation(headfirst),andweredeliveredby CesareanSection.Denominator:Totalnumberofrepeatbirthsthatwereterm,asingleton,andhada vertexpresentation.Data Source:VitalStatistics

Technical Notes

Morbidity and Mortality Indicators continued


Postpartum DepressionPercentofrecentmotherswhoreportedsymptomsofdepressionfollowingalivebirth.Numerator:Weightednumberofwomenwitharecentlivebirthwhoexperienced self-reportedpostpartumdepression.Denominator:Weightednumberofwomenwitharecentlivebirth.Data Source:PRAMS

Household SmokingPercentofrecentmotherswhoreportedthatsmokingwasnotallowedintheirhousehold.Numerator:Weightednumberofwomenwitharecentlivebirthwhoreportedthat smokingisallowedina)someroomsoratsometimes,and/orb)anywhere insidethehome.Denominator:Weightednumberofwomenwitharecentlivebirth.Data Source:PRAMS

Sleep on BackPercentofrecentmotherswhoputtheirinfantstosleepontheirbacks.Numerator:Weightednumberofwomenwitharecentlivebirthwhoreportedthat theymostoftenlaytheirbabydowntosleeponhis/herback.Denominator:Weightednumberofwomenwitharecentlivebirth.Data Source:PRAMS

Breastfeeding InitiationPercentofrecentmotherswhoinitiatedbreastfeeding.Numerator:Weightednumberofwomenwitharecentlivebirthwhoreportedever breastfeedingorpumpingbreastmilktofeedtheirnewbabyafterdelivery.Denominator:Weightednumberofwomenwitharecentlivebirth.Data Source:PRAMS

Technical Notes

Postpartum Health Indicators


No Screen TimePercentoftwo-year-oldsthathavenoTV/videoviewingtimeinatypicalday.Numerator:Weightednumberofwomenwhoreportedthattheirtwo-year-olddidnot watchanyTVorvideosinatypicalday.Denominator:Weightednumberofwomenwithatwo-year-oldthatrespondedto thefirstPRAMSsurvey.Data Source:PRAMS-2

Screen TimePercentoftwo-year-oldsthathavelessthantwohoursofTV/videoviewingtimein atypicalday.Numerator:Weightednumberofwomenwhoreportedthattheirtwo-year-oldwatched TVorvideosforlessthantwohoursinatypicalday.Denominator:Weightednumberofwomenwithatwo-year-oldthatrespondedtothe firstPRAMSsurvey.Data Source:PRAMS-2

TV in BedroomPercentoftwo-year-oldsthatdonothaveaTVintheroomwheretheysleep.Numerator:WeightednumberofwomenwhoreportedthatthereisnoTVintheroom wheretheirtwo-year-oldsleeps.Denominator:Weightednumberofwomenwithatwo-year-oldthatrespondedtothe firstPRAMSsurvey.Data Source:PRAMS-2

Reading to ChildPercentoftwo-year-oldsthatarereadtodailybyafamilymember.Numerator:Weightednumberofwomenwho,whenasked,“Howmanydaysina typicalweekdoyou,orsomebodyinyourhousehold,readabookorstoryto yourtwo-year-old,”responded:sevendaysperweek(e.g.,daily).Denominator:Weightednumberofwomenwithatwo-year-oldthatrespondedto thefirstPRAMSsurvey.Data Source:PRAMS-2

Technical Notes

Child Growth and Development Indicators


Father UninvolvementEstimatedprevalenceoffatheruninvolvement(usingmissingfather’snamesonthebirthcertificateasaproxy).Numerator:Numberofbirthswherethefather’sfirstandlastnamesweremissing onthebirthcertificate.Denominator:Totalnumberofbirths.Data Source:PRAMS-2

Child OutingsPercentoftwo-year-oldsthathadfourormoreoutingsinthepastweek.Numerator:Weightednumberofwomenwho,whenasked,“Howmanytimesina typicalweekhaveyouoranyfamilymembertakenyourtwo-year-oldonanykind ofouting,suchastoapark,playground,orotherchildren’sprogramoractivity,” responded:fourormoretimes.Denominator:Weightednumberofwomenwithatwo-year-oldthatrespondedtothe firstPRAMSsurvey.Data Source:PRAMS-2

Family Eats TogetherPercentoftwo-year-oldslivinginhouseholdswherethefamilyusuallyoralways eatsmealstogether.Numerator:Weightednumberofwomenwho,whenasked,“Inatypicalweek,how manydaysaweekdoesyourfamilyeatatleastonemealtogether,”responded: fourormoretimes.Denominator:Weightednumberofwomenwithatwo-year-oldthatrespondedto thefirstPRAMSsurvey.Data Source:PRAMS-2

ChildcarePercentoftwo-year-oldsthatareinchildcare.Numerator:Weightednumberofwomenwho,whenasked,“Inatypicalweek,what isthemaintypeofchildcareusedforyourtwo-year-old,”selectedeitheraformal type(childcarecenter,preschool,HeadStart),informal(carebyanon-relativeor relativeotherthanchild’sparents),ornochildcare(carebythechild’sparent/s).Denominator:Weightednumberofwomenwithatwo-year-oldthatrespondedtothe firstPRAMSsurvey.Data Source:PRAMS-2

Technical Notes

Home, Family, and Community Indicators


Vital Statistics Thevitalstatisticsdatausedinthisreportwerebirthanddeathrecords.VitalstatisticsdataiscompiledbytheCenterforHealthStatistics(CHS)attheOregonHealthAuthority.Throughadataagreementcontract,theMultnomahCountyHealthDepartmentreceivesdatafromCHSthatcontainsarecordforeverybirthanddeathoccurringtoMultnomahCountyresidents.Birthrecordscontainmotherandfather’sdemographicinformation(e.g.,race,ethnicity,age,etc.),mother’shealthrisksatthetimeofdelivery,methodofbirth,andbirthoutcomes.

Vitalrecordsdataareusedthroughoutthestateandthenationforanalysisofmaternalandchildhealthtrends,aswellasfordeterminingleadingcausesofdeath,lowbirthweightandpretermbabies,mother’sprenatalcareutilization,andmore.Formoreinformationaboutthisdatasource,contacttheCenterforHealthStatistics:http://public.health.oregon.gov/BirthDeathCertificates/VitalStatistics/Pages/index.aspx

Pregnancy Risk Assessment and Monitoring Surveillance System (PRAMS) PRAMSisastate-basedhealthsurveythatisadministeredtowomenwhohadalivebirthrecently.ThesurveyissponsoredbytheCenterforDiseaseControlandPrevention(CDC)incollaborationwiththeOregonHealthAuthorityandcollectsdataonmaternalattitudesandexperiencesbefore,during,andshortlyafterpregnancy.Fortystates(includingOregon)andNewYorkCitycurrentlyparticipateinPRAMS,representingapproximately78%ofalllivebirthsintheUnitedStates.

Eachmonth,recentmothersarerandomlyselectedfromtheOregonbirthcertificatesfileandaPRAMSquestionnaireismailedtothem.Aseriesofremindermailingsandtelephoneinterviewsareattemptedinordertoreachwomenwhohavenotreturnedthesurvey.Usingthisrigorousoutreachmethod,atotalof3,430Oregonwomencompletedthesurveyin2009and2010combined.Theweightedresponseratefor2009was70.2%,andfor2010itwas74.9%.ThesampledataareanalyzedinawaythatallowsfindingstoberepresentativeofallMultnomahCountywomenwhohaverecentlyhadalivebirth.FormoredetailsonthemethodologyofthePRAMSsurvey,pleasevisittheCDCwebsite:www.cdc.gov/prams/methodology.htm

Technical Notes

Technical Notes

Data Sources


Pregnancy Risk Assessment and Monitoring Surveillance System 2-Year Follow-Up Survey (PRAMS-2) PRAMS-2isthenewestdatasourceavailableformaternalandchildhealthsurveillanceinOregon.OnlyahandfulofstatesnationallyconductthePRAMS-2survey.InJanuary2006,OregonPRAMSbeganre-interviewingwomenwhogavebirthin2004andwhorespondedtothefirstPRAMSsurvey.AtthetimeofPRAMS-2survey,theirbabiesweretwoyearsold.Thewomenwereaskedabouttopicssuchaswellchildcarevisits,childnutrition,socialsupport,maternalphysicalactivityandmultivitaminuse,childcare,screentime,andmore.FormoreinformationaboutthePRAMS-2methodology,pleasecontacttheOfficeofFamilyHealthattheOregonHealthAuthority:http://public.health.oregon.gov/HealthyPeopleFamilies/DataReports/prams/Pages/index.aspx

Technical Notes

Technical Notes

Data Sources continued

Multnomah County Health DepartmentCommunity Epidemiology ServicesCommunity Health Services 426SWStarkStreet,8thfloor Portland,Oregon97204

www.mchealth.org

maternal, child, and family health data book

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