North Dakota PRAMS Point-in-Time Study Year 2002

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North Dakota PRAMSPoint-in-Time StudyYear 2002

• Presented by Kay Olson

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PRAMS Overview

• Rationale for Point-in-Time Surveillance
• Results of survey operations
• Response rates
• Survey highlights
• Challenges
• Lessons learned
• Overall plans for the future

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Rationale for Point-in-Time PRAMS

• Total population 642,200
• Geographic area 70,665 sq. miles
• (9 people/sq. mile)
• Majority of Counties frontier (six or less
  people/sq. mile)
• Births on the decline (1985 to current)
• 7,676 births in 2000
• 7,664 births in 2001

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Results of Survey Operations

• Four batches totaling 1,246 final weighted birth
  tape indicates 1,245
• There were 16 late surveys that were incorporated
  into their respective batches
• 909 completed surveys
• 134 back page comments (15)

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Response rates

• Overall 73 (N909)
• Non-Medicaid 82 (N607)
• Medicaid 60 (N302)
• Focus of analyses will be on Non-Medicaid and
  State-wide

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Survey Highlights
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Maternal age

• 76 were married
• 66.3 had 13 or more years of education
• 89.6 were white 8.1 were Native American

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Whether mom was a Medicaid recipient

• 36.3 were on WIC
• 57.4 had previous live births

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Pregnancy Intendedness

• "Very excited! We wanted to be pregnant for 8
  years!"
• "I felt too old."
• "I wanted to have a baby to get some support so I
  could be on my own if didn't have a baby, can't
  get Medicaid-tried to get help and past bills are
  too old."

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How mom felt about becoming pregnant
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Whether mom was trying to become pregnant
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Of moms who were not trying to become pregnant,
whether methods were used for prevention
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Reasons for not trying to prevent pregnancy
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Access to prenatal care

• " I was surprised the clinic didn't want to see
  me sooner than they did."
• " was scared to tell I was pregnant."
• "I was six months pregnant when I moved to the US
  from Cameroon and I was told my International
  Student's Insurance couldn't cover my pregnancy
  because it was a pre-condition."

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Number of weeks along when mom was sure she was
pregnant

• Range1 to 34
• Mean5.4

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Number of weeks pregnant when mom had first
prenatal visit

• Range1 to 34
• Mean9.4

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Whether mom got prenatal care as early as she
wanted
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Barriers to getting prenatal care for moms who
didnt get care as early as they wanted
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Health and physical activity

• "The dentist that I went to never told me to take
  a lot of calcium when I was pregnant with my 4
  year old. So my teeth fell out. So now at 23 I
  have false teeth."
• " Wish there was an exercise "group" for pregnant
  women to walk together once a week or something.
  Its hard to go alone and harder to go with
  someone who is not pregnant. Also fun to talk to
  other women."

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Number of times mom took multivitamin one month
prior to pregnancy
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Moms pre-pregnancy BMI
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Adequacy of weight gain for underweight, normal,
overweight, and obese moms
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Moms exercise habits during pregnancy
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Last time mom had teeth cleaned
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At risk behaviors

• "Even though you may not think much about it or
  think, like I do, "It won't happen to me", it can
  happen. Guilt is one of the worst feelings in
  the world. Every day I wonder if I might have
  caused a problem with my baby. So far, nothing
  is wrong, but, maybe someday I'll find out
  differently. I pray that day will NEVER come.
  If it does, I will have no one else to blame but
  myself. Message to all STAY FREE!"

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What health care worker told mom about smoking
during pregnancy
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Whether mom smoked the last 3 months of pregnancy

• Number of cigarettes smoked per day
• Range1 to 60
• Mean9.3

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Whether mom is smoking now

• Number of cigarettes smoked
• Range1 to 40
• Mean11.8

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Changes in smoking from before pregnancy to now
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Whether mom was exposed to secondhand smoke at
her job during pregnancy
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Whether mom had any alcoholic drinks 3 months
before she got pregnant
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Whether mom had any alcoholic drinks in the last
3 months of pregnancy
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What health care worker told mom about drinking
alcohol during pregnancy
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Whether mom was physically abused during her most
recent pregnancy
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Whether health care worker talked with mom about
physical abuse to women by their husbands/partners
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Whether stresses occurred in the 12 months before
babys birth
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Total number of stresses mom experienced in the
12 months before babys birth
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Delivery and after care

• "I think doctors, or nurses, or whoever should
  help other pregnant women understand and deal
  with post-partum blues, cause I'm am still
  struggling with it. The one thing I knew about
  it was what friends told. No doctors told what
  to do if I got them. I still have episodes when
  all I want to do is scream and cry, and there's
  no reason I can think of, why I'm crying or
  whatever."

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Infant birth weight

• Range737 to 4,965 grams
• Mean3421.3

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Whether infant was placed in intensive care
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Length of time baby stayed in hospital after birth
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Whether mom breastfed or pumped after delivery
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Whether mom is still breastfeeding or pumping at
time of survey
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Reasons for stopping breastfeeding
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Whether baby was seen by a health care provider
in the first week after leaving the hospital
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How baby is most often laid down to sleep
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Challenges

• Increasing response rates of Medicaid/vulnerable
  populations
• Time frame flexibility in contacting hard to
  reach moms

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Lessons learned

• Mailings should be first class due to problems
  with bulk mail
• Allow more time between mailings
• Rule of thumb for data entry code mother as
  highest risk

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Overall plans for the future

• Internet link to PRAMS data
• PRAMS publications
• Ongoing versus another Point-in-Time study
• Work with WIC to reach moms with bad addresses or
  no listed phone numbers

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• "Concerns about a single mother like me, working
  most of the time and hard-up, working so hard to
  support kids and to pay bills. I'm glad and
  thankful for this opportunity for your concern
  about babies and moms. It's really a great
  pleasure for me to answer these questions.
  Thanks a lot."
• Sherry U.

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NDSU IACC 424 Fargo, ND 58105
http//www.ndsu.edu/sdc