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

1. The Life Course Approach: Why it is Relevant to Tarrant County Katie Cardarelli, Ph.D., Director Center for Community Health UNT Health Science Center

2. Getting down to business • Local data overview • PPOR findings • Women’s Health Assessment • Preconception health

3. Burden of the local problem

4. Infant Mortality RatesU.S., Texas, Tarrant County 1995-2005 Source: Tarrant County Public Health, 2010

5. Infant mortality rates among the five most populous Texas counties, 1997-2005 Source: Tarrant County Public Health, 2010

6. Infant mortality rates among Texas cities with  5,000 live births, 2005 Source: Tarrant County Public Health, 2010

7. Disparities in Infant Mortality RatesTarrant County, 1995-2005 Source: Tarrant County Public Health, 2010

8. What Accounts for These Differences? Is it education?

9. Infant Mortality Rates by Education Source: National Center for Health Statistics, 2002

10. 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

11. 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

12. 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

13. 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

14. 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

15. PPOR - Phase II Maternal Health/ Prematurity mortality rate among VLBW babies VLBW births Interventions Preconception Health Perinatal Care

16. To Summarize… Maternal Health/ Prematurity PPOR-Phase I PPOR-Phase II VLBW births Interventions Preconception Health

17. 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

18. Map of Assessment

19. 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

20. 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 ,

21. 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

22. 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.

23. 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

24. 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

25. 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”

26. 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.

27. 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

28. Paradigm Shift From -- Anticipation and Management to Health Promotion and Prevention From -- Healthy Mothers, Healthy Babies to Healthy Women Healthy Mothers Healthy Babies

29. Preconception Care - Goal To promote the health of women of reproductive age before conception and thereby improve pregnancy-related outcomes … A LIFE COURSE APPROACH

30. 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

31. Join Us! www.centerforcommunityhealth.org