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Sarojini Kanotra, MPH, PhD Seth Siameh, MPHc Amanda Wilburn, MPH

Preconception Health Indicators Among Women Residing In Urban, Semi-rural And Rural Counties In Kentucky. Sarojini Kanotra, MPH, PhD Seth Siameh, MPHc Amanda Wilburn, MPH. 3rd National Summit on Preconception Health and Health Care June 12-14, 2011 Tampa/St. Petersburg, Florida.

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Sarojini Kanotra, MPH, PhD Seth Siameh, MPHc Amanda Wilburn, MPH

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  1. Preconception Health Indicators Among Women Residing In Urban, Semi-rural And Rural Counties In Kentucky Sarojini Kanotra, MPH, PhD Seth Siameh, MPHc Amanda Wilburn, MPH 3rd National Summit on Preconception Health and Health Care June 12-14, 2011Tampa/St. Petersburg, Florida

  2. Objective • To assess the preconception health of women in Kentucky using the core state preconception health and health care indicators (PCHI) developed by the seven state work group • To create a preconception health profile of women in Kentucky

  3. Methods • KY Behavioral Risk Factor Surveillance System (BRFSS) 2000-2009 • Seventeen core state preconception health indicators (PCHI) were analyzed • Target population: non-pregnant female respondents aged 18-44 years (n=15,695) • Three subpopulations were created based on the Rural-Urban Continuum Codes provided by the US Department of Agriculture

  4. Sample Size for KY BRFSS Data

  5. Core State Preconception Health Indicators by Domain and Sub-Domain for Women Aged 18-44 Years

  6. Core State Preconception Health Indicators by Domain and Sub-Domain for Women Aged 18-44 Years

  7. Methods • The indicators from NVSS were analyzed from 2004 - 2009 • Also analyzed some indicators using PRAMS • KY does not have PRAMS but used information from pilot test for PRAMS conducted in 2009 • Sample size very small in the first pilot test hence used information from the second pilot test

  8. Core State Preconception Health Indicators • Self-rated Health: Percentage of women who report good, very good or excellent health • Education: Percentage of women with a high school education/GED or greater • Poverty: Percentage of women who live at or below 200% of the Federal Poverty Threshold • Access to and Utilization of Health Care: Percentage of women who currently have some type of health care coverage

  9. Core State Preconception Health Indicators • Access to and Utilization of Health Care: Percentage of women who had a routine checkup in the past year • Reproductive Health Care: Percentage of women who had a pap test within the past three years • Smoking: Percentage of women who currently smoke everyday or some days • Alcohol Consumption: Percentage of women having a live birth who smoked cigarettes during the three months prior to pregnancy

  10. Core State Preconception Health Indicators • Alcohol Consumption: Percentage of women who participated in binge drinking on at least one occasion in the past month • Fruit & Vegetable Consumption: Percentage of women who consume fruits and vegetables at least five times per day • Obesity and Overweight: Percentage of women who are overweight or obese based on body mass index (BMI) • Exercise/Physical Activity: Percentage of women who participate in enough moderate and/or vigorous physical activity in a usual week to meet the recommended levels of physical activity

  11. Core State Preconception Health Indicators • General Mental Distress: Percentage of women who report that their mental health was not good for at least 14 out of the past 30 days • Adequacy of Support: Percentage of women who always or usually get the social and emotional support they need • Diabetes: Percentage of women who have ever been told by a health care provider that they had diabetes including gestational diabetes

  12. Core State Preconception Health Indicators • Hypertension: Percentage of women who have ever been told by a health care provider that they had hypertension including hypertension during pregnancy • Asthma: Percentage of women who currently have asthma • Immunizations: Percentage of women who received an influenza vaccination within the past year

  13. TRENDS of SOME INDICATORS FROM KY BRFSS

  14. Percentage of women who currently have no health care coverage Data Source: KY BRFSS

  15. Percentage of women who currently smoke everyday or some days

  16. Percentage of women who are overweight or obese based on body mass index (BMI ≥ 30 kg/m2 )

  17. Percentage of women who have ever been told by a health care provider that they had diabetes including gestational diabetes

  18. Percentage of women who report that their mental health was not good for at least 14 out of the past 30 days

  19. Percentage of women who did not have a pap test within the past three years

  20. TRENDS of SOME INDICATORS FROM BIRTH FILES & NSTD

  21. Percentage of women having a live birth who had less than 18 months between their previous live birth and the start of the most recent pregnancy

  22. Percentage of women having low birth weight infants

  23. Percentage of women having preterm births

  24. Rates of Chlamydia per 100,000 Population for Females Age 18-44 by County, Kentucky, 2008

  25. Rates of Gonorrhea per 100,000 Population for Females Age 18-44 by County, Kentucky, 2008

  26. PREVALENCE OF CORE INDICATORS USING BRFSS DATA

  27. Prevalence of Core State Preconception Health Indicators from KY BRFSS, 2000-2009

  28. Prevalence of Core State Preconception Health Indicators from KY BRFSS, 2000-2009

  29. Odds Ratios

  30. Odds Ratios

  31. PREVALENCE OF CORE INDICATORS USING KY PRAMS PILOT DATA

  32. Core State Preconception Health Indicators – KY PRAMS • Percentage of women having a live birth who had health care coverage during the month prior to pregnancy • Percentage of women having a live birth who had their previous live birth more than three weeks before the due date • Percentage of women who experienced a miscarriage, fetal death or stillbirth in the 12 months prior to getting pregnant with their most recent live born infant • Percentage of women having a live birth who reported having an unintended or unwanted pregnancy • Percentage of women having a live birth who reported that they or their husbands or partners were currently doing something to keep from getting pregnant

  33. Core State Preconception Health Indicators – KY PRAMS • Percentage of women having a live birth who experienced depressive symptoms after pregnancy • Percentage of women having a live birth who were physically abused by their partner during the 12 months prior to pregnancy • Percentage of women having a live birth who before their most recent pregnancy had ever been told be a health care provider that they had Type I or Type II diabetes • Percentage of women having a live birth who reported that they had hypertension during the 3 months before their most recent pregnancy

  34. Core Indicators from KY-PRAMS

  35. Core Indicators from KY-PRAMS

  36. LIMITATIONS • The source of majority of this data is a national telephone survey so individuals with no landline telephones are excluded, selection bias. • All information is self-reported, recall bias • KY does not have PRAMS • Some questions in BRFSS are asked only in odd years

  37. CONCLUSION • The data demonstrate that preconception health indicators for women residing in rural counties of Kentucky are poor as compared to those living in semi-rural and urban counties. • The results suggest that policies are needed to ensure that women, especially those living in rural counties in Kentucky have appropriate access to preconception health.

  38. Importance of this Data to KY • Create Kentucky’s first preconception health profile • Direct the limited resources to the population in greatest need • Integrate the data from these indicators into use

  39. NEXT STEPS • Review which years of data to use for the KY Report • Analyze data by sub-groups such as age, race, education, income etc. • Look for associations, if any • Research impact of policy on certain indicators • Develop the Kentucky Preconception Health Indicator Report

  40. Contact Information • E-mail: Sarojini.Kanotra@ky.gov Seth.Siameh@ky.gov Amanda.Wilburn@ky.gov • Phone: (502) 564 – 7996 Ext 4284 Sarojini Ext 3529 Seth (502) 564 – 3236 Ext 3815 Amanda • Fax: (502) 564-4667 • Mail: Kentucky BRFSS Program Chronic Disease Prevention Branch Department for Public Health 275 East Main St, HS2 W-E Frankfort, KY 40621

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