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Healthy Families. Better Beginnings. A Report on the Health of Women, Children, and Families in Spokane. Amy S. Riffe, MA, MPH/Elaine Conley, Director Spokane Regional Health District Community Health Assessment, Planning, and Evaluation. Demographics – Spokane County.

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Healthy families

Healthy Families

Better Beginnings

A Report on the Health of Women, Children, and Families in Spokane

Amy S. Riffe, MA, MPH/Elaine Conley, Director

Spokane Regional Health District

Community Health Assessment, Planning, and Evaluation


Demographics spokane county

Demographics – Spokane County

472,650 residents in 2011

111,470 women of childbearing age

5,867 births

  • Births 2007-2011

    • 8% 15-19 years

    • 59% 20-29 years

    • 31% 30-39 years

    • 2% 40-49 years

    • 47% Medicaid

    • 90% White

    • 11% <High school ed


Demographics continued

Demographics - continued

Birth rate

12.4 per 1,000 residents

Decreased from 07-11

Lower than WA

Teen birth rate, 15-17

11.3 per 1,000 women

No trend

Similar to WA


Cost of a birth spokane county 2007 2011

Cost of a Birth – Spokane County 2007-2011

  • The average hospital stay for a newborn was 3 days

  • The average charge was $10,000

  • Full term infant

    • 93% of full term ≤ 3 days

    • $6,800

  • Preterm infant

    • 40% ≤ 3 days

    • $55,900

    • 6.5% of births

    • 64% of charges


Preconception health

Preconception Health

Poor mental health

17.0% of women 18-44

No trend

Similar to WA

No difference by age

Decreased with income


Preconception health1

Preconception Health

  • Pre-pregnancy obesity

    • 24.1% obese before becoming pregnant

    • Increased from 07-11

    • Lower than WA

  • Increased with age

  • Higher for Medicaid

  • Higher for black, AIAN


Preconception health2

Preconception Health

  • Unintended pregnancy

    • 36.1% of birth were unintended pregnancies

    • Similar to WA

  • Decreased with age

  • Higher for Medicaid

  • No difference by race


Family health

Family Health

  • Family Structure, Spokane County, 2011

    • 108,605 children 0-17 years

    • 52,489 family households with children

      • 23.4% were a female householder, no husband

        • 6,196 children 0-5 years live with a single mother

    • 8.7% were a male householder, no wife


Family health1

Family Health

  • ACEs

    • 12% of kids K-6 have 3+

    • 46% of women have 4-8

    • Higher than WA

    • No difference by age

    • Decreased with income

  • Low social support

    • 18.9% with low support

    • No trend

    • Similar to WA

    • No difference by age

    • Decreased with income


Family health2

Family Health

  • Child abuse

    • 5,264 victims in 2011

    • Increased from 07-11

    • Higher than WA

  • Smoking in home

    • 16.9% allow it

    • No trend

    • Higher than WA

    • No difference by age

    • Decreased with income


Family health3

Family Health

  • Stressors

    • 13.5% of mothers had 4+ stressors during 06-11

    • Higher for women 20-29

    • Higher for Medicaid

    • Higher for non-whites

  • Women with 4+ stressors

    • Nearly 10x more likely to have postpartum depression

    • Almost 6x more likely to have a LBW infant


Maternal health

Maternal Health

  • Short IPI

    • 40.8% had a short IPI

    • Decreased from 07 to 11

    • Higher than WA

    • No difference by income or race

    • Decreased with age

  • Prenatal care, 1st tri

    • 88.7% had 1st tri PNC

    • Increased from 07 to 11

    • Higher than WA

    • Increased with age

    • Lower for Medicaid

    • Lower for non-white


Maternal health1

Maternal Health

  • Maternal smoking

    • 15.9% smoked

    • Decreased from 07-11

    • Higher than WA

    • Decreased with age

    • Higher for Medicaid

    • Higher for black, AIAN

  • Alcohol use

    • 37.3% drank in last trimester

    • Similar to WA

    • No difference by age, Medicaid, or race


Child health

Child Health

  • Low quality of life

    • 23.7% of youth reported a low QOL

    • Decreased from 06 to 10

    • Higher for low education

    • Higher for blacks


Child health1

Child Health

  • Kindergarten readiness

    • Washington Kindergarten Inventory of Developing Skills

    • Fall 2012

      • Social/emotional

      • Physical

      • Language

      • Cognitive

      • Literacy

      • Math


Summary

Summary

  • Better than WA

    • Dental sealants

    • Hypertension

    • Prenatal care first trimester

    • Pre-pregnancy obesity

    • Vaccine preventable illness

  • Worse than WA

    • ACEs

    • Birth defects

    • Breastfeeding

    • Child abuse

    • Chlamydia

    • Immunization exemption

    • Maternal smoking

    • No flu shot in the last year

    • Short IPI

    • SIDS

    • Smoking allowed in home


Summary1

Summary

  • Good trend

    • Breastfeeding

    • Low quality of life

    • Maternal smoking

    • Prenatal care first trimester

    • Preterm birth

    • Short IPI

    • Vaccine preventable illness

  • Bad trend

    • Child abuse

    • Chlamydia

    • Diabetes

    • Good general health

    • Hypertension

    • Immunization exemption

    • Pre-pregnancy obesity


Concerns

Concerns

  • Many of the indicators are getting worse

  • Many of the measures show a disproportionate impact on:

    • Individuals on Medicaid

    • Racial minorities

  • Many of the issues are deeply rooted in inequities such as:

    • Educational attainment

    • Household income

    • Neighborhoods in which people live


What can we do

What Can We Do?

  • Traditional public health approaches are not sufficient to address many of these problems

  • Community wide initiatives that impact the root causes of these issues will need to be initiated and/or expanded


What can we do continued

What Can We Do? (continued)

  • Need a continuum of activities that address all levels of the socio-ecological model


What can we do continued1

What Can We Do? (continued)

  • Focus on policy and system-level change while simultaneously focusing on social, organizational and individual behavior change

  • We must develop a shared vision for the future of children and families in the community


Recommendations

Recommendations

Four major areas of recommendations…..


Recommendations continued

Recommendations (Continued)

  • Mitigate and/or prevent the impacts of ACEs on children and families

    • Build community resilience by promoting community connectivity

    • Support a variety of providers, organizations parents and community members in adopting trauma-sensitive practices in their work and in the community

    • Promote positive community norms about parenting programs and acceptable parenting behaviors


Recommendations continued1

Recommendations (Continued)

  • Mitigate and/or prevent the impacts of ACEs on children and families (Continued)

    • Continue to support best practice one-on-one interventions such as Nurse Family Partnership for the most vulnerable families

    • Invest in mental health resources

    • Strengthen safe, stable, nurturing relationships at the community level

    • Establish peer support models for expectants mothers

    • Build connectivity among women through low cost activities like exercise


Recommendations continued2

Recommendations (Continued)

  • Ensure That Children Enter School Ready to Learn

    • Develop and implement universal developmental screening for children 0-5 years of age.

    • Invest in quality early childhood education

    • Address the achievement gap between white and non-white students


Recommendations continued3

Recommendations (Continued)

  • Address Inequities in Spokane County

    • Promote policies that meet families’ basic needs including:

      • Affordable housing

      • Access to food

      • Access to health care

    • Provide adequate income support for young families

    • Increase minority representation on governing boards to assist in decision making that supports all people

    • Develop policies utilizing a child and family sensitive lens and advocate for a “health in all policies” standard


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