The Rhode Island Toddler Wellness Overview Survey TWOS

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The Rhode Island Toddler Wellness Overview Survey
(TWOS)
The Rhode Island Toddler Wellness Overview Survey
(TWOS) An Opportunity for Data Linkages
Samara Viner-Brown, MS Rhode Island Department of
Health 13th Annual Maternal and Child Health
Epidemiology Conference December 14, 2007
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ACKNOWLEDGEMENTS

• Hanna Kim, PhD, Epidemiologist
• Rachel Cain, PRAMS Coordinator
• Denise Cappelli, TWOS Coordinator

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(No Transcript)
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OUTLINE

• Background
• Survey Design and Methodology
• Data Linkage
• Weighting Methodology
• Examples
• Limitations
• Advantages

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Background

• Rhode Island Population
• Total 1 million
• Births 12,500 per year
• Integrated Child Health Information System
  KIDSNET
• data from 10 programs serving children
• RI PRAMS
• 2,000 (16 all births) women surveyed annually

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Why Conduct a Toddler Survey?

• Little or no data on the health and well-being of
  children between birth and adolescence
• PRAMS provides an opportunity for longitudinal
  analysis
• Can study the relationship between outcomes of
  young children and their mothers earlier
  experiences

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PRAMS Follow-Up

• Planned to conduct toddler survey when applied to
  become a PRAMS state (2001)
• Obtained RI Dept of Health IRB approval
  for the toddler survey in 2001
• RI PRAMS survey asks respondents if they can be
  contacted again in two years

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Follow-Up Methodology

• A reminder letter is sent at the time the child
  reaches their 1st birthday
• send any new contact information and reconfirm
  participation (opportunity to opt out)
• 45 response rate to birthday letter and nearly
  100 agree to participate
• PRAMS respondents are transferred to Access
  database with selected fields
• demographics, birth certificate number and PRAMS
  ID

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Survey Design

• Designed in partnership with RI PRAMS
  Steering Committee (Toddler Work Group)
• Questions gathered from multiple sources
• RI PRAMS
• Oklahoma TOTS Survey
• PEDS Survey
• National Indicators Survey Database
• Ages and Stages Questionnaire
• Other Health Dept surveys (HIS and BRFSS)
• Final instrument 58 questions

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Survey Methodology

• Survey sent to all PRAMS respondents, except
  those who asked not to be re-contacted
• Two mailings, no telephone follow-up
• 5 incentive with first mailing

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Associated Costs

• Development (25,000)
• Focus groups
• Survey design
• Ongoing (50,000/year)
• Printing
• Postage
• Staff
• Incentives

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Survey Topics

• Health Status/Physical Characteristics (ht/wt)
• Breastfeeding
• Oral Health
• Child Development
• Behavior/Psychosocial Issues
• Safety (car seat/tobacco smoke exposure)
• Insurance
• Health Care/Specialty Care
• Child Care
• Family Planning
• Maternal Factors (depression, stressors,
  mobility)
• Demographics

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PRAMS-TWOS Linkage

• PRAMS and TWOS files linked on PRAMS ID using
  SASmerged file
• SUDANN used for analysis
• 2005-2006 TWOS linked with 2003-2004 PRAMS data
• Total linked population 1,207

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Weighting Methodology

• Three-Step Process
• Sample Weights same as PRAMS
• Response Weights Modified PRAMS
• Stepwise logistic regression
• Non-Coverage Weights same as PRAMS

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TWOS Response Rates 2005-2006
Percent
(n 649)
(n 548)
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Selected Demographics Among TWOS Respondents
n 1,207
Percent
lt20 20-34 35 lt12 12 gt12 Married
Single Core Rest Priv Pub None
lt20 20-34 35 lt12 12 gt12 Mar Sing
White Blk Hisp Non Core Rest Priv Public
AGE EDUCATION MARITAL RACE
ETHNICITY RESID INSURANCE
STATUS
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• DATA LINKAGE EXAMPLES

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Difficult Pregnancy Experience by Maternal
Depression Among TWOS Respondents
p lt 0.0001
Percent
Over the past 12 months, have you had two or
more weeks in a row when you felt sad, blue or
depressed, or lost pleasure in things that you
usually cared about or enjoyed?
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Difficult Pregnancy Experience by Frequency of
Feeling Overwhelmed Among TWOS Respondents
Percent
p lt 0.05
Over the past 12 months, how often have you felt
overwhelmed by the demands of your child or
children?
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Examples of Other Analyses

• Significant relationship between pregnancy
  experience and mothers
• Diagnosis of depression
• Concerns about child behavior and development
• Rating of childs general health

TWOS
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Examples of Other Analyses

• Significant relationship between birth outcome,
  e.g., birth weight and gestational age
  (PRAMS/birth certificate) with toddlers
• General health
• Specialty care
• EI enrollment
• Hospitalizations
• Child developmental behavioral index
• Parents concerns re development

TWOS
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Limitations

• Loss of potential respondents due to attrition
• Sensitivity of topics
• Certain topics only captured with single
  question
• Different interpretations of questions by
  respondents
• Problems with generalizations (e.g., marital
  status no support)

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Limitations (continued)

• Small sample sizes can limit interpretation/
  significance
• Response rate lower than desired, which impacts
  n sizes (certain populations are more
  difficult to reach)
• PRAMS-TWOS linkage
• Different methodologies
• Different questions or variations of questions

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Advantages of a Toddler Follow-Up Survey (TWOS)

• Provides an opportunity to better understand the
  relationship between behaviors and experiences
  during the perinatal period that can influence
  the well- being of mother and child later in life
• Data can be linked to other data sets (e.g.,
  PRAMS, Vital Records, KIDSNET (RIs integrated
  child health information system) for longitudinal
  analyses

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Samara Viner-Brown, MS Chief, Data and
Evaluation Division of Community, Family Health
Equity Rhode Island Department of
Health 401.222.5935 samara.viner-brown_at_health.ri.g
ov www.health.ri.gov