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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 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


Getting down to business l.jpg
Getting down to business

  • Local data overview

  • PPOR findings

  • Women’s Health Assessment

  • Preconception health



Infant mortality rates u s texas tarrant county 1995 2005 l.jpg
Infant Mortality RatesU.S., Texas, Tarrant County 1995-2005

Source: Tarrant County Public Health, 2010


Infant mortality rates among the five most populous texas counties 1997 2005 l.jpg
Infant mortality rates among the five most populous Texas counties, 1997-2005

Source: Tarrant County Public Health, 2010


Infant mortality rates among texas cities with 5 000 live births 2005 l.jpg
Infant mortality rates among Texas cities with counties, 1997-2005 5,000 live births, 2005

Source: Tarrant County Public Health, 2010


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Disparities in Infant Mortality Rates counties, 1997-2005Tarrant County, 1995-2005

Source: Tarrant County Public Health, 2010


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What Accounts for These Differences? counties, 1997-2005

Is it education?


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Infant Mortality Rates by Education counties, 1997-2005

Source: National Center for Health Statistics, 2002


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Whites counties, 1997-2005

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 counties, 1997-2005

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 counties, 1997-2005

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 counties, 1997-2005

  • 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 2001-2003

Maternal Health/ Prematurity

mortality rate among VLBW babies

VLBW births

Interventions

Preconception Health

Perinatal

Care


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To Summarize… 2001-2003

Maternal Health/ Prematurity

PPOR-Phase I

PPOR-Phase II

VLBW births

Interventions

Preconception Health


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Women’s Health Assessment, 2007 2001-2003

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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Infant Mortality 2001-2003WHA 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 2001-2003

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 2001-2003

  • 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 2001-2003

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 2001-2003

  • 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 2001-2003

  • 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 2001-2003

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 2001-2003

  • 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 2001-2003to 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 2001-2003

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 2001-2003

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 2001-2003

  • 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! 2001-2003

www.centerforcommunityhealth.org


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