The Rhode Island Toddler Wellness Overview Survey TWOS: An Opportunity for Data Linkages

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The Rhode Island Toddler Wellness Overview Survey
(TWOS) An Opportunity for Data Linkages

• Samara Viner-Brown, MS
• 12th Annual Maternal and Child Health
  Epidemiology Conference
• December 8, 2006

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ACKNOWLEDGEMENTS

• Meredith Bergey, MSc, MPH
• Rachel Cain
• Hanna Kim, PhD

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(No Transcript)
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OUTLINE

• Background
• TWOS methodology
• Preliminary Data
• Conclusions
• Limitations
• Implications

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BACKGROUND

• Rhode Island Population
• Total 1 million
• Births 13,000 per year
• Integrated Child Health Information System
  KIDSNET
• data from 10 programs serving children
• RI PRAMS
• 2,000 (15 of 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

• If consent is given, a reminder letter is sent
  at the time the child reaches their 1st
  birthday
• send any new contact information and reconfirm
  they will participate (2nd opportunity
  to opt out)
• 45 response rate to birthday letter and nearly
  100 agree to participate
• Access database created and those who agree
  are transferred 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 who agreed
  to be recontacted (80)
• Two mailings, no telephone follow-up
• 5 incentive with first mailing

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SURVEY TOPICS

• Child Care
• 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
• Family Planning
• Maternal Factors (depression, mobility)
• Demographics

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PRAMS-TWOS LINKAGE

• PRAMS and TWOS files linked in Access based on
  PRAMS ID and DOB
• SAS used for analysis
• TWOS January 2005-September 2006
• (PRAMS 2003 and 2004)
• Total linked population 1,090

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Preliminary and Unweighted DataJanuary
2005-September 2006
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Response Rates Among TWOS Respondents
Percent
(n 649)
(n 441)
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lt20 20-34 35 lt12 12 gt12 Married
Single Core Rest Priv Pub None
Selected Demographics Among TWOS Respondents
n 1090
Percent
AGE EDUCATION MARITAL
RESID INSURANCE
STATUS
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TWOS Respondents by Race/Ethnicity
Other (1.0)
Asian (3.4)
Black/African Amer (5.2)
White (90.2)
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Selected TWOS VariablesMaternal Mental Health
Percent
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Selected TWOS Variables Overwhelmed by Maternal
Depression
Percent
p lt 0.0001
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Selected TWOS Variables Maternal Depression by
Overwhelmed
Percent
p lt 0.0001
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Selected PRAMS Variables Among TWOS Respondents
Maternal Mental Health
Percent
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Maternal Mental Health (TWOS) by Pregnancy
Experience (PRAMS)
Percent
plt 0.0001
p lt 0.0001
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Maternal Mental Health (TWOS) by
Inconsolability (PRAMS)
Percent
p lt 0.001
p NS
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Maternal Mental Health (TWOS) by Postpartum
Depression (PRAMS)
Percent
p lt 0.0001
p lt0.0001
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Maternal Mental Health (PRAMS) by Overwhelmed
(TWOS)
Percent
p lt 0.001 p NS
p NS
p lt 0.0001
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Maternal Mental Health (PRAMS) by Depression
(TWOS)
Percent
p NS
p lt 0.0001 p lt
0.0001
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Overwhelmed (TWOS) by Insurance Status
Percent
p lt0.0001
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Infant Inconsolability (PRAMS) by Overwhelmed
(TWOS) by Insurance Status
Percent
p lt0. 001
p NS p lt
0.0001
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SUMMARY

• TWOS data were successfully linked to PRAMS
• Linkage provides multiple opportunities for
  examining important MCH issues
• Maternal Depression Example
• Experiences during and after pregnancy are
  associated with depression among mothers of two
  year-olds
• Hard time during pregnancy, infant
  inconsolability and postpartum depression were
  significantly associated with depression or
  feeling overwhelmed
• Depression diagnosis before or during pregnancy
  was not significantly related to later depression
  or feeling overwhelmed

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LIMITATIONS

• Unweighted data
• Small sample sizes can limit interpretation/
  significance
• Different methodologies PRAMS vs TWOS
• Instruments/questions slightly different
  between PRAMS and TWOS
• Selection bias (only those who agree to
  participate)

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LIMITATIONS (cont)

• Response rate lower than desired, which impacts
  n sizes (certain populations are more
  difficult to reach)
• 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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IMPLICATIONS

• Linkages provide an opportunity to better
  understand the health issues at pregnancy and
  can influence the health of mother and child
  later in life
• Importance of exploring these relationships
  further to determine potential influences of
  other variables

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IMPLICATIONS (cont)Maternal Depression Example

• Early identification and treatment of women
  who experience depressive symptoms may help
  in reducing the likelihood of future maternal
  depression
• Primary care providers, obstetricians and
  pediatricians are in a position to identify these
  women and provide them with support and referrals

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Samara Viner-Brown, MSChief, Data and
EvaluationRhode Island Department of
HealthDivision of Family Health3 Capitol Hill,
Room 302Providence, RI 02908Tel
401-222-5935E-mail samara.viner-brown_at_health.ri.
gov
CONTACT INFORMATION