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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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