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The Life Course Approach: Why it is Relevant to Tarrant County. Katie Cardarelli, Ph.D., Director Center for Community Health UNT Health Science Center. Getting down to business. Local data overview PPOR findings Women’s Health Assessment Preconception health.

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The Life Course Approach: Why it is Relevant to Tarrant County

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The life course approach why it is relevant to tarrant county l.jpg

The Life Course Approach: Why it is Relevant to Tarrant County

Katie Cardarelli, Ph.D., Director

Center for Community Health

UNT Health Science Center


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Getting down to business

  • Local data overview

  • PPOR findings

  • Women’s Health Assessment

  • Preconception health


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Burden of the local problem


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Infant Mortality RatesU.S., Texas, Tarrant County 1995-2005

Source: Tarrant County Public Health, 2010


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Infant mortality rates among the five most populous Texas counties, 1997-2005

Source: Tarrant County Public Health, 2010


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Infant mortality rates among Texas cities with  5,000 live births, 2005

Source: Tarrant County Public Health, 2010


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Disparities in Infant Mortality RatesTarrant County, 1995-2005

Source: Tarrant County Public Health, 2010


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What Accounts for These Differences?

Is it education?


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Infant Mortality Rates by Education

Source: National Center for Health Statistics, 2002


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Whites

16

Blacks

14

Hispanics

12

TC Infant

Mortality Rate

10

Infant Mortality Rate

8

6

4

2

0

< High School Diploma

High School Diploma

Some College/Degree

Education Level

Infant Mortality Ratesby Maternal Education Level, Tarrant County 2002-2004

Source: Tarrant County Public Health, 2010


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Whites

Blacks

Hispanics

TC Infant

Mortality Rate

Infant Mortality Ratesby Maternal Age, Tarrant County 2002-2004

Infant Mortality Rate

Source: Tarrant County Public Health, 2010


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Perinatal Periods of Risk (PPOR) Approach

Developed by McCarthy & WHO

Simple approach

Strong conceptual basis

Mobilizes communities

Prioritizes prevention efforts

CityMatCH PPOR: http://www.citymatch.org/ppor_index.php


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PPOR Approach

  • Examines the four “Periods of Risk”:

    • Maternal Health / Prematurity

    • Maternal Care

    • Newborn Care

    • Infant Health

      for various population groups

  • Identifies groups and periods of risk with the most deaths, highest rates

  • Uses comparison groups to estimate “excess deaths” for these groups and periods of risk


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FETO-INFANT MORTALITY RATES, ALL RACIAL/ETHNIC GROUPS: 2001-2003

Maternal Health/Prematurity

3.1

Maternal Care

1.7

Newborn Care

1.4

Infant Health

1.7

*Feto-infant mortality per 1,000 live births & fetal deaths


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PPOR - Phase II

Maternal Health/ Prematurity

mortality rate among VLBW babies

VLBW births

Interventions

Preconception Health

Perinatal

Care


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To Summarize…

Maternal Health/ Prematurity

PPOR-Phase I

PPOR-Phase II

VLBW births

Interventions

Preconception Health


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Women’s Health Assessment, 2007

Targeted women 18-44 in specific zip codes

Face-to-face survey assessed health status, health behaviors, knowledge, neighborhood and organizational factors affecting their health

405 respondents


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Map of Assessment


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Infant MortalityWHA Assessment Area, 2005

Healthy People 2010 Goal: 4.5

Source: The Annie E. Casey Foundation, State Level Data Online, Tarrant County Infant Mortality Task Force, 2005


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High Blood Pressure, Women 18-44

Source: National Center for Health Statistics, BRFSS, Texas, 2004-2006, Females 18-44, National Center for Health Statistics, NHANES, United States 2003-2006, Females 20-44

,


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Limited Consumption and Access

  • Lack of fruits and vegetables

    • 88% eat less than five fruits and vegetables a day

  • Lack of grocery stores in designated area


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Smoking Among Women, 18-44

Source: CDC Health Date for All Ages (HDAA)http://209.217.72.34/HDAA/TableViewer/tableView.aspx?ReportId=161,

Texas, BFRSS , 2004-2006 US, NHIS, 2004-2006.


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Mental Health

  • 25% reported feeling down, depressed or hopeless every day, or nearly everyday over the past 2 weeks

  • 8% of women experienced intimate partner violence in the past year


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WHA Summary

  • Women are unhealthy, compromising their opportunity for healthy pregnancy

  • Improving the health of women holds great promise in improving the health of babies

  • Many opportunities to address and improve women’s health through prevention and promotion

  • Everyone has an important role to play


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Preconception Health

CDC defines preconception health as “a set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman’s health or pregnancy outcome through prevention and management”


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Preconception Health

  • Prevention and management of health risks and conditions

  • Includes management of fertility, including contraception, in order to empower women to plan and prepare for pregnancies

Source: Kent H, Johnson K, Curtis M, Richardson Hood J, Atrash H. Proceedings of the Preconception Health and Health Care Clinical, Public Health, and Consumer Workgroup Meetings. Atlanta, GA: CDC; 2006.


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Applying CDC Recommendations to Tarrant County

  • Perinatal periods of risk analyses indicate that interventions should focus on African American women and on the maternal health/ prematurity period of risk

  • Consistent with preconception health, including family planning and addressing health behaviors such as smoking and drug abuse


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Paradigm Shift

From --

Anticipation and Management

to

Health Promotion and Prevention

From --

Healthy Mothers, Healthy Babies

to

Healthy Women Healthy Mothers Healthy Babies


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Preconception Care - Goal

To promote the health of women of reproductive age before conception and thereby improve

pregnancy-related

outcomes …

A LIFE COURSE APPROACH


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Acknowledgments

  • Dr. Anita Kurian, Tarrant County Public Health

  • Micky Moerbe, Tarrant County Public Health

  • Amy Raines, Fort Worth Women’s Health Initiative

  • Dr. Hani Atrash, CDC


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Join Us!

www.centerforcommunityhealth.org


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