Municipality Jared Parrish, PhD
Health trajectories ▪ Assets and deficits impact development ▪ Timing of prevention and intervention can have different impacts ▪ Lifetime burden (risk) can inform public health prevention Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents . 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017
Project overview – measuring trajectories 2009:2011 CUBS Survey 2014 2015 2016 2017 2018 PFD, Vital Core annual Linked for special projects Records, & CDR administrative Law Legal Medical Education DJJ Child Protection linkages reports
Pregnancy Risk Assessment Monitoring System (PRAMS) ▪ 47 States Currently Participate ▪ Randomly samples: ▪ ~1/6 of all live births in Alaska ▪ Administered 2-6 months after birth ▪ Weighted to represent the entire birth cohort ▪ Mail with phone follow-up ▪ Core questions (used by all PRAMS programs) ▪ IRB (Federal and local)
Childhood Understanding Behaviors Survey (CUBS) ▪ Follow-up survey to PRAMS ▪ Resamples all PRAMS respondents when their child is age 3 ▪ Mail with phone follow-up ▪ IRB (local) ▪ 5 States have PRAMS follow-up surveys: Alaska, Oregon, New Mexico, Missouri, and Oklahoma ▪ Unique questions in each state
Demographics N Weighted Mean Represents Married Yes 777 63.1(9.7, 66.5) 7676 No 467 36.9(33.5, 40.3) 4496 Mom Graduated HS Yes 1048 89.5(87.2, 91.8) 10514 No 124 10.5(8.2, 12.8) 1228 Medicaid Yes 552 45.8(42.3, 49.3) 5493 No 674 54.2(42.3, 49.3) 6494 Maternal Race Alaska Native 282 16.1(14.5, 17.8) 1946 Non-Native 900 83.9(82.2, 85.5) 10116
Cumulative Incidence of OCS First Report N Weighted Mean [0,1) 9.2(7.1, 11.3) [1,2) 15.5(12.5, 18.6) [2,3) 18.7(15.3, 22.1) [3,4) 23.0(19.0, 26.9) [4,5) 27.1(22.6, 31.6) [5,6) 29.9(25.0, 34.7) [6,7) 33.8(28.4, 39.2) [7,8) 35.2(29.5, 40.9) [8,9) 37.0(30.6, 43.4)
PEAKS Reading Scores (PEAKS) 3 rd grade A (best), P, BP, FBP (worst) N Weighted Mean Represents Adequate/Progressing 180 41.5(36.0, 47.0) 1872 Below Progressing/Far Below Progressing 262 58.5(53.0, 64.0) 2640
ADP Kindergarten developmental profile (ADP) 13 developmental goals tested Point for each goal met, range 0-13 N Weighted Mean Represents Developmental Standard (11+ Goals Met) 255 33.0(29.0, 36.9) 2724 Below Standard (<11 Goals Met) 574 67.0(63.1, 71.0) 5532
ATTN Attendance data # 𝑒𝑏𝑧𝑡 𝑏𝑢𝑢𝑓𝑜𝑒 Proportion of # 𝑒𝑏𝑧𝑡 𝑝𝑔 𝑡𝑑ℎ𝑝𝑝𝑚 Collected each year from 2015-2019 N Weighted Mean Represents Adequate Attendance (>=90%) 741 86.2(83.5, 89.0) 7605 Chronically Absent (<90%) 147 13.8(11.0, 16.5) 1214
Adverse Childhood Experiences (ACEs) Collaborative study between CDC researchers and Kaiser Permanente 1 >17,000 participants of an HMO asked about events before age 18 • 75% white (54% female, 46% male) • mean age 57 • 75% at least some college. Source: Centers for Disease Control and Prevention Credit: Robert Wood Johnson Foundation 1) Felitti, Vincent J., et al. "Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study." American journal of preventive medicine 14.4 (1998): 245-258.
ACEs in Anchorage among 3yr olds ACE Score N Weighted Mean Represents 0 349 53.3(48.1, 58.6) 6903 147 1 23.0(18.5, 27.5) 2977 74 2 13.0(9.3, 16.7) 1684 31 3 3.9(1.7, 6.1) 502 40 4+ 6.8(3.9, 9.6) 877
PRAMS Questions used to quantify ACEs pre-birth household dysfunction During the 12 months before pregnancy: I visited a During the 12 months before birth: My husband health care worker to be checked or treated for or partner or I went to Jail depression or anxiety • • During the 12 months before birth: I was in a During the 12 months before birth: Someone physical fight very close to me had a problem with drinking • During the 12 months before or during pregnancy or drugs • pushed, hit, slap, kick, choke, or physical hurt by During the 3 months before pregnancy husband or partner engaged in binge drinking 2 or more times • During the last 3 months of pregnancy drank any amount of alcohol • During the 12 months before or During pregnancy smoked marijuana During the 12 months before birth: I got separated or divorced from my husband or partner
Pre-Birth Household Dysfunction Household N Weighted Mean Represents Dysfunction 0 833 31.7(28.4, 34.9) 3856 1 695 32.4(29.1, 35.7) 3940 2 344 14.4(12.0, 16.8) 1758 3 189 8.3(6.4, 10.2) 101 4+ 243 13.2(10.8, 15.6) 1604
Pre-birth household dysfunction During the 12 months prior to Child welfare reports before age 9 years birth/pregnancy
Pre-birth household dysfunction predicting OCS Contact Household HR (95% CI) Dysfunction 0 ref 1 1.4(0.9, 2.0) 2 2.7(1.8, 4.1) 3 3.5(2.2, 5.5) 4+ 6.2(4.2, 9.2)
Health Equity Index
Spatial Autocorrelation Between the HEI and Child Maltreatment (2017 OCS and ACS Data)
Geographically Weighted Regression: Modeling Child Maltreatment with the HEI
Thank You Contact: Jared Parrish, PhD (907) 269-8068 jared.parrish@alaska.gov http://dhss.alaska.gov/dph/wcfh/Pages/mchepi/ALCANlink
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