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The Rhode Island Toddler Wellness Overview Survey (TWOS)

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 13 th Annual Maternal and Child Health Epidemiology Conference December 14, 2007.

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The Rhode Island Toddler Wellness Overview Survey (TWOS)

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  1. 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

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

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

  4. 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

  5. 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

  6. 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

  7. 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 #

  8. 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

  9. 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

  10. Associated Costs • Development (~$25,000) • Focus groups • Survey design • Ongoing (~$50,000/year) • Printing • Postage • Staff • Incentives

  11. 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

  12. PRAMS-TWOS Linkage • PRAMS and TWOS files linked on PRAMS ID# using SAS—merged file • SUDANN used for analysis • 2005-2006 TWOS linked with 2003-2004 PRAMS data • Total linked population = 1,207

  13. Weighting Methodology Three-Step Process: • Sample Weights: same as PRAMS • Response Weights: Modified PRAMS • Stepwise logistic regression • Non-Coverage Weights: same as PRAMS

  14. TWOS Response Rates 2005-2006 Percent (n = 649) (n = 548)

  15. Selected Demographics Among TWOS Respondents n = 1,207 Percent <20 20-34 35+ <12 12 >12 Married Single Core Rest Priv Pub None <20 20-34 35+ <12 12 >12 Mar Sing White Blk Hisp Non Core Rest Priv Public AGE EDUCATION MARITAL RACE ETHNICITY RESID INSURANCE STATUS

  16. DATA LINKAGE EXAMPLES

  17. Difficult Pregnancy Experience by Maternal Depression* Among TWOS Respondents p < 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?

  18. Difficult Pregnancy Experience by Frequency of Feeling Overwhelmed* Among TWOS Respondents Percent p < 0.05 *Over the past 12 months, how often have you felt overwhelmed by the demands of your child or children?

  19. Examples of Other Analyses • Significant relationship between pregnancy experience and mother’s: • Diagnosis of depression • Concerns about child behavior and development • Rating of child’s general health TWOS

  20. Examples of Other Analyses • Significant relationship between birth outcome, e.g., birth weight and gestational age (PRAMS/birth certificate) with toddler’s: • General health • Specialty care • EI enrollment • Hospitalizations • Child developmental & behavioral index • Parent’s concerns re: development TWOS

  21. 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)

  22. 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

  23. 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 (RI’s integrated child health information system) for longitudinal analyses

  24. 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@health.ri.gov www.health.ri.gov

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