Infant Mortality July 27, 2012 Shannon Walker Community Health - PowerPoint PPT Presentation

Strategies to address South LA Infant Mortality July 27, 2012 Shannon Walker Community Health Councils

Objectives • Understanding the Problem — Breakdown of SPA 6 Infant Mortality ▫ PPOR analysis ▫ Risk factors and demographics ▫ Focus Group Results • Potential Solutions — Policy Opportunities for CHC ▫ MLK recommendations ▫ Prevention strategies

PPOR Framework “The Perinatal Periods of Risk (PPOR) approach is a new analytic framework that enables urban communities to better understand and address fetal and infant mortality…[and] translate data into strategic action.” Source: Peck 2010

Stages of Growth 20 wks Birth 28 days 1 year Fetal Neonatal Postneonatal Infant Source: Dr Chao, LA County Public Health

PPOR Framework Age at Death Post- Fetal Neonatal Neonatal <1500 Maternal Health/Prematurity Birthweight grams Maternal Newborn Infant 1500+ grams Care Care Health Source: Dr Chao, LA County Public Health

PPOR for SPA 6 When excess deaths are calculated for SPA 6, Infant Health and Maternal Health are found to hold the greatest disparities Source: Dr Chao, LA County Public Health

PPOR Leads to Community Interventions ͢ PPOR Focus Area Potential Community Interventions ͢ Preconceptual Health Health Behaviors Maternal Health/Prematurity Perinatal Care Prenatal Care ͢ Maternal Care Referral System High Risk OB Care ͢ Perinatal Management Perinatal System Newborn Care Pediatric Surgery ͢ Sleep Position Breast-Feeding Infant Health Injury Prevention Source: Dr Chao, LA County Public Health

Risk Factors • Preterm Birth • Birthweight • Prenatal Care • Substance Use • Teenage Pregnancy • Racial Demographics • Access to Care • Socioeconomic and Health Status

South LA has the highest rate of preterm births Preterm births 14 12 10 Antelope Valley East Metro 8 Rate, % San Fernando San Gabriel 6 South South Bay 4 West Average 2 0 Source: LA County Perinatal Antelope East Metro San San South South West Average Valley Fernando Gabriel Bay Indicator Factsheet (2007 Data)

South LA has highest rate of LBW, and 2 nd highest rate of LBW Very Low Birthweight Low Birthweight 1.8 6.6 1.6 6.4 1.4 6.2 1.2 6 Rate, % Rate, % 1 5.8 0.8 5.6 0.6 5.4 0.4 5.2 0.2 0 5 Source: LA County Perinatal Indicator Factsheet (2007 Data)

Inadqueate/late entry into prenatal care does not correlate directly with birth outcomes 25 20 15 Rate, % California Los Angeles LA - SPA 6 10 5 0 Source: LA County Perinatal % Late Entry Into Prenatal Care % Inad. Prenatal Care Indicator Factsheet (2007 Data)

Late entry into prenatal care does not correlate with poor birth outcomes unless there is NO prenatal care Source: LA County Title V Perinatal Indicators, “Prenatal Care,” 2009

SPA 6 has the highest rate of teenagers who give birth Percent of babies born to Teen Rate of birth to teens aged 15- Moms 19 Southwest 18 80 Southeast Percent of live births to women under age 20 South 16 70 Compton 14 Antelope Valley SPA 6 60 East California 12 50 Metro United States Rate, % 10 San Fernando 40 San Gabriel 8 South 30 6 South Bay West 20 4 LA County 10 2 0 0 Location Teen Birth Source: LA County Dept Public Health – Source: California Dept of Public Health (2010), and CDC National Vital Statistics Key Indicators of Health by SPA (2009)

LA African American Mothers have the highest smoking prevalence & exposure Smoking Prevalence in Adults 20 18 16 14 Percent of mothers Los Angeles 12 White 10 Latina Black 8 Asian SPA 6 6 4 2 0 Source: 2007 Smoked in 6 months before Smoked during pregnancy Exposure to 2nd hand smoke LA County pregnancy during pregnancy Health Survey…LAMB?

Compton has highest rate of smoking cessation counseling Percent of children whose moms were advised about dangers of environmental tobacco smoking 120.00% 100.00% Percent of Children (age 0-5yrs) 80.00% 60.00% 40.00% 20.00% 0.00% Compton South Southeast Southwest Los Angeles Source: 2007 Location LA County Health Survey

SPA 6 Mother is more likely to be African American or Hispanic Other (non-Hispanic) 100% Asian/Pacific Islander (non- 90% Hispanic) Black (non-Hispanic) 80% White (non-Hispanic) 70% % Hispanic 60% Applications: 50% -Blacks have higher smoking, asthma, illegal drug use, STDs, 40% babies sleeping on stomachs 30% (SIDS) -Hispanics are less likely to 20% have insurance; Foreign-born 10% have better health, birth outcomes 0% California Los Angeles SPA 6 Source: IPODR 2008

Infant and Fetal Mortality Rates* SPA 6 vs. Countywide Infant & fetal Death per 1,000 live births plus fetal deaths 2001-2009 Countywide SPA 6 SPA 6 African American 25 23.5 23.1 22.2 22.1 22.0 21.3 20.8 20.6 19.6 20 15 13.1 12.5 12.4 12.2 12.2 12.2 12.1 11.8 11.5 10.4 10.3 10.3 10.3 10.2 9.9 9.8 9.6 9.6 10 5 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 *2001-2009 vital statistics files Source: Dr Chao, LA County Public Health

Access to Care • SPA 6 has the highest rate of uninsurance in adults (32.9%) and children (9.7%) compared to other SPAs • SPA 6 reports the most difficulty in accessing medical care (38.8%) • SPA 6 has 20.9% of inhabitants with no regular source of care (above average for LA) • Yet, highest rate of PAP smears within past 3 years? Source: LA County Dept Public Health – Key Indicators of Health by SPA (2009)

Socioeconomic and Health Status • SPA 6 has the highest rates of following SES indicators: ▫ Most Poverty ▫ Least education ▫ Most unemployment ▫ Most unsafe neighborhood • SPA 6 has the highest rates of following health indicators: ▫ Obesity ▫ Hypertension ▫ Mental Illness ▫ Also high rates of: asthma, cancer, high cholesterol Source: LA County Dept Public Health – Key Indicators of Health by SPA (2009)

Focus Group Results: Highlighting Additional Risk Factors • Lack of preconception, interconception health care as shown by PPOR • Stress & lack of social support • Substance abuse • Lack of education about detrimental effects of certain health behaviors (i.e. nutrition, substance abuse, SIDS, etc)

Focus Group Results: Potential Strategies • Community Prevention Efforts ▫ Interconception Health (T.H.E. Clinic, BBC) ▫ Progesterone Treatments during prenatal care ▫ Implementation of pre-conception guidelines ▫ Peer pre-conception counselors ▫ School-based pre-preconception efforts • MLK Recommendations ▫ NICU (mixed feedback) ▫ Transportation coordination and education ▫ Wellness Center / Centering Pregnancy ▫ Midwifery program? ▫ Community Festival? • Infant Health Education Initiatives

CHC Policy & Advocacy Opportunities • MLK Hospital “Menu” of Options • Local Clinics ▫ Expanding Data-Driven Interconception Care Plan ▫ Implementing Preconception Care Guidelines • Medi-cal ▫ Better coverage for preconception women ▫ Lowering costs of progesterone treatments ▫ More provider incentives for preconception care visits

More Opportunities for CHC • PPOR Analysis with LA County Public Health? • Increase awareness of racism among perinatal providers through the LA County Action Learning Collaboration • Collaborate with LA County to support bereaved parents and provide interconception health education through Grief Share

Keep up the hard work – it was GREAT working with you! 