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
• Womens Health Assessment
• Preconception health

3
Burden of the local problem
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Infant Mortality RatesU.S., Texas, Tarrant
County 1995-2005
Source Tarrant County Public Health, 2010
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Infant mortality rates among the five most
populous Texas counties, 1997-2005
Source Tarrant County Public Health, 2010
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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
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What Accounts for These Differences?

• Is it education?

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Infant Mortality Rates by Education
Source National Center for Health Statistics,
2002
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Infant Mortality Ratesby Maternal Education
Level, Tarrant County 2002-2004
Source Tarrant County Public Health, 2010
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Infant Mortality Ratesby Maternal Age, Tarrant
County 2002-2004
Infant Mortality Rate
Source Tarrant County Public Health, 2010
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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_inde
x.php
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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

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FETO-INFANT MORTALITY RATES, ALL RACIAL/ETHNIC
GROUPS 2001-2003
Maternal Health/Prematurity 3.1
Infant Health 1.7
Newborn Care 1.4
Maternal Care 1.7
Feto-infant mortality per 1,000 live births
fetal deaths
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PPOR - Phase II
Maternal Health/ Prematurity
mortality rate among VLBW babies
VLBW births
Interventions
Preconception Health
Perinatal Care
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To Summarize
Maternal Health/ Prematurity
PPOR-Phase I
PPOR-Phase II
VLBW births
Interventions
Preconception Health
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Womens 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

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Map of Assessment
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Infant MortalityWHA Assessment Area, 2005
Healthy People 2010 Goal 4.5
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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
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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

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Smoking Among Women, 18-44
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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

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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 womens
  health through prevention and promotion
• Everyone has an important role to play

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Preconception Health

• CDC defines preconception health as a set of
  interventions that aim to identify and modify
  biomedical, behavioral, and social risks to a
  womans health or pregnancy outcome through
  prevention and management

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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.
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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

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Paradigm Shift
From -- Anticipation and Management
to
Health Promotion and Prevention From --
Healthy Mothers, Healthy Babies
to Healthy
Women Healthy Mothers Healthy Babies
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Preconception Care - Goal
To promote the health of women of reproductive
age before conception and thereby
improve pregnancy-related outcomes A LIFE
COURSE APPROACH
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Acknowledgments

• Dr. Anita Kurian, Tarrant County Public Health
• Micky Moerbe, Tarrant County Public Health
• Amy Raines, Fort Worth Womens Health Initiative
• Dr. Hani Atrash, CDC

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