How PRAMS (a maternal surveillance system) influences Public Health in AlabamaRhonda Stephens, Alabama PRAMS CoordinatorPresentation to UAB School of Public HealthFebruary 23, 2004
What is PRAMS? • Pregnancy Risk Assessment Monitoring System • CDCinitiative to reduce infant mortality and low birthweight babies • Population-based survey of women with live births in Alabama • ID and monitor selected maternal experiences and behaviors occuring before, during, and after birth
PRAMS in Alabama • February 1993 - AL began data collection • Works closely w/ Family Health Services • Revisions are made to reflect guidelines or emerging issues, & improve the questionnaire • PRAMS Steering Committee advises on survey questions, uses and dissemination of data, making contacts to put data to use
People involved in Alabama PRAMS • AL PRAMS team located in Center for Health Statistics, ADPH in Montgomery • CDC partners with states and oversees PRAMS project • Contract with UAB Survey Research Unit in Birmingham • Members of Steering Committee from all over Alabama
Data Collection • Data collection procedures and instruments standardized to allow state comparisons • Statewide-5 mailings(3 questionnaires) followed by phone follow-up for nonresponders • Preletter, Mail1, Tickler, Mail 2&3, Phone • Mail in English or Spanish, no Spanish phone • Core, State-specific, and State-developed questions on survey
State-Developed Question 64. During your most recent pregnancy, did a doctor, nurse, or other health care worker tell you that you had any of the following diseases or infections? For each one, circle Y (Yes) if you were told you had the disease or infection or circle N (No) if you were not told you had the disease or infection. Circle all that apply.No Yes a. Urinary Tract Infection (UTI)…………….N Y b. Yeast Infections……………………………N Y c. Group B Strep (Beta Strep)………………N Y d. Bacterial Vaginosis…………………………N Y e. Trichomoniasis (Trich)…………………….N Y f. Chlamydia…………………………………...N Y g. Genital warts (HPV)……………………….N Y h. Herpes……………………………………….N Y i. Gonorrhea…………………………………..N Y j. Syphilis………………………………………N Y k. Pelvic Inflammatory Disease (PID)……..N Y l. Human Immunodeficiency Virus (HIV)…N Y
Sampling • Approx. 160-200 women randomly sampled each month from birth certificate file 2-4 months after birth • Stratified Sampling Design: 4 strata • 1. Medicaid low birth weight • 2. Medicaid normal birth weight • 3. Non-Medicaid low birth weight • 4. Non-Medicaid normal birth weight • Mothers of low birth weight babies and Medicaid deliveries are oversampled
1. Unintended Births & Contraception • PRAMS is the source for unintended birth data in Alabama • Unintended births associated with poorer birth outcomes • Use of contraception could decrease unintended pregnancies • Healthy People 2010 goal is to increase percent of intended pregnancy to 70%
When Mother Intended to Become Pregnant (Q11), Alabama PRAMS 2001 Intended 51.1% Unintended 48.9%
Family Planning • Medicaid Family Planning Waiver –expanded Medicaid eligibility for FP services in 15 states • PRAMS data on intendedness, birth control, & sources of stress presented in planning stages • ‘PlanFirst’ 5-yr demonstration program began in Alabama on Oct. 1, 2000: • Alabama must prove it has met its objectives: • One is lowering the rate of unintended births in Alabama women to save Alabama money • Dr. Bronstein is an investigator
Unintended Births in Alabama(Q11), Alabama PRAMS 1993-2001 *No significant change in percent unintended from 1993 to 2001.
I didn't mind 35.6 Thought I could 25.7 not get pregnant 21.7 Husband/Partner did not want to Had side effects use anything 13.5 from birth control 9.0 Thought 4.4 husband/partner or I was sterile Problems getting 0 20 40 birth control Percent Mother Not Planning Pregnancy Using Birth Control at Conception (Q12,13,&14), Alabama PRAMS 2001
2. Folic Acid • PRAMS has had questions on folic acid awareness and use of multivitamins • Worked with March of Dimes to publish a fact sheet in October, 2003
Percent of Mothers Who Took A Multivitamin Before Pregnancy (Q3),Alabama PRAMS 2001
3. Smoking • Alabama Smoking Cessation-Reduction in Pregnancy Trial (SCRIPT) • PRAMS data showed: • 14.5% of AL mothers smoked during pregnancy • Medicaid mothers almost twice as likely to smoke as Non-Medicaid mothers • UAB and ADPH collaborated to launch SCRIPT in 8 counties from Oct. 1996 – Sept. 2001
Percent of Mothers who Smoked (Q29,30,&31), Alabama PRAMS 1993-2001 *No significant change in percent who smoked from 1993 to 2001.
3. Smoking (cont.) • SCRIPT participants more than twice as likely to quit smoking (17%) as control group (9%). • Because SCRIPT’s methods were effective, they are now taught as “best practice” for caring for pregnant smokers in Alabama. • PRAMS smoking data used for training • Led to ATOFF, smoking cessation program for all women 18-44 and their partners in SCRIPT counties
4. Breastfeeding and WIC • Provide WIC with annual analysis of topics by WIC status during & after pregnancy • The WIC program is interested in increasing the rates of breastfeeding among their clients. • Published a Breastfeeding Fact sheet with WIC for their educators and physicians – August, 2003 • Questions added to PRAMS for WIC to better serve clients
Receipt of Breastfeeding Information at WIC Visits (Q77), Alabama PRAMS 1996 - 2001 *Statistically significant decline in percent receiving info from 1996 to 2001.
Breastfeeding question added to PRAMS for WIC 47. What were your reasons for not breastfeeding your new baby? Check all that apply I had other children to take care of I had too many household duties I didn’t like breastfeeding I didn’t want to be tied down I was embarrassed to breastfeed I went back to work or school I wanted my body back to myself Other Please tell us:_________________
4. Breastfeeding and WIC (cont.) • Alabama Breastfeeding Conversion Initiative (ABC) began November 3, 2003 • Pilot program to increase breastfeeding rates through education during pregnancy • Alabama PRAMS data on breastfeeding was presented to the breastfeeding educators on Oct. 17, 2003 • Collaborated with Gift of Life to: • Design study design – control and intervention group • Develop pretest and posttest, using some PRAMS questions
5. Dental Care • Presented Dental Care data at MCH Epi meeting • CDC PRAMS analyzing several states’ data • Collaborating with Alabama Dental Director to produce fact sheet and present data to Alabama OB/GYNS annual meeting
6. SIDS • Present updates of data to subcommittee of State Committee of Public Health • Annually include in Infant Mortality report to State Health Officer, Dr. Williamson
Percent of Infants Sleeping on Back (Q54), Alabama PRAMS 1996-2001 * Rate per 100,000 births *Significant increase from 1996 to 2001.
7. Medicaid • Medicaid is a variable that we stratify by, so all data analyzed by Medicaid status • Present PRAMS data by Medicaid status to Medicaid meetings • Alabama Medicaid Director presents data to Alabama OB/GYN meetings • Data requests for Medicaid data
Unintended Births by Method of Payment for Delivery, Alabama PRAMS 1993-2001 * No significant change in either category from 1993 to 2001.
PRAMS Fact Sheets & Special Reports • MCH Chartbook – Oct, 2002 • Unmarried Chartbook– Feb, 2003 • Breastfeeding fact sheet– Aug, 2003 • Folic Acid fact sheet– Oct, 2003 • Hispanic Databook – March, 2004 • Dental Care fact sheet in planning stages • Low Birth Weight fact sheet is planned
PRAMS Information • Website: www.adph.org • Click ‘Fast Find’, ‘Health Statistics’ • Click ‘PRAMS’ • Latest publications are on the website • Alabama PRAMS Coordinator: Rhonda Stephens • PRAMS phone number: (334)206-2700