Core State Preconception Health Indicators: A Voluntary, Multi-state Selection Process
- 532 Downloads
This report describes the consensus-based selection process undertaken by a voluntary committee of policy/program leaders and epidemiologists from seven states to identify core state indicators to monitor the health of reproductive age women (aged 18–44 years). Domains of preconception health were established based on priority areas within maternal and child health and women’s health. Measures (i.e., potential indicators) addressing the domains were identified from population-based, state level data systems. Each indicator was evaluated on five criteria: public health importance, policy/program importance, data availability, data quality, and the complexity of calculating the indicator. Evaluations served as the basis for iterative voting, which was continued until unanimous consent or a super majority to retain or exclude each indicator was achieved. Eleven domains of preconception health were identified: general health status and life satisfaction; social determinants of health; health care; reproductive health and family planning; tobacco, alcohol and substance use; nutrition and physical activity; mental health; emotional and social support; chronic conditions; infections; and genetics/epigenetics. Ninety-six possible indicators were identified from which 45 core indicators were selected. The scope of preconception care and the public health components to address preconception health are still under development. Despite this challenge and other measurement limitations, preconception health and health care indicators are urgently needed. The proposed core indicators are a set of measures that all states can use to evaluate their preconception health efforts. Furthermore, the indicators serve as a basis for improving the surveillance of the health of reproductive age women.
KeywordsHealth indicators Preconception health Public health surveillance Reproductive health Women’s health
The authors wish to acknowledge our fellow Core State Preconception Health Indicators Working Group members: Moreen Libet, PhD and Kiko Malin, MPH, MSW, Maternal, Child and Adolescent Health Program, Center for Family Health, California Department of Public Health; Deborah Ehrenthal, MD, FAACP, Christiana Care Health Services, Delaware; Alvina Long Valentin, RN, MPH and Sarah McCracken Cobb, MPH, Women’s and Children’s Health Section, North Carolina Division of Public Health; Gita G. Mirchandani, PhD, MPH and Julie Stagg, MSN, Office of Program Decision Support, Division of Family and Community Health Services, Texas Department of State Health Services; and Laurie Baksh, MPH, Lois Bloebaum, MPA, BSN, Shaheen Hossain, PhD, and Nan Streeter, MS, RN, Maternal and Child Health Bureau, Division of Community and Family Health Services, Utah Department of Health. The authors also acknowledge the Senior Scientific Advisory Committee for invaluable input. The lead author and project coordinator was supported in part by an appointment to the Applied Epidemiology Fellowship Program administered by the Council of State and Territorial Epidemiologists (CSTE) and funded by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement U60/CCU007277.
- 3.Institute of Medicine. (1985). Preventing low birth weight. Washington, DC: National Academy Press.Google Scholar
- 4.U.S. Department of Health and Human Services. (1989). Caring for our future: The content of prenatal care: A report of the Public Health Service Expert Panel on the Content of Prenatal Care. Washington, DC: US Department of Health and Human Services, Public Health Service.Google Scholar
- 5.US Department of Health and Human Services. (1991). Health People 2000: National health promotion and disease prevention objectives—Full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service. DHHS Publication No. 91-502212.Google Scholar
- 6.Johnson, K., Posner, S. F., Biermann, J., Cordero, J. F., Atrash, H. K., Parker, C. S., et al. (2006). Recommendations to improve preconception health and health care—United States: A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR, 55(RR06), 1–23.PubMedGoogle Scholar
- 9.Kendrick, J. (2004). Preconception care of women with diabetes. The Journal of Perinatal & Neonatal Nursing, 18, 14–25.Google Scholar
- 13.American Academy of Neurology. (1998). Practice parameter: Management issues for women with epilepsy (summary statement). Report of the quality standards subcommittee of the American Academy of Neurology. Neurology, 51, 944–948.Google Scholar
- 15.American Association of Clinical Endocrinologists. (2002). Medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocrine Practice, 8, 457–469.Google Scholar
- 21.Moos, M., Dunlop, A., Jack, B., Nelson, L., Coonrod, D. V., Long, R., et al. (2008). Healthier women, healthier reproductive outcomes: Recommendations for the routine care of all women of reproductive age. American Journal of Obstetrics and Gynecology, 199(6 Suppl 2), S280–S289.CrossRefPubMedGoogle Scholar
- 31.Prue, C., & Daniel, K. (2008). Social marketing: Planning before conceiving preconception care. Maternal and Child Health Journal, 10(Suppl 1), S79–S84.Google Scholar
- 34.Takahashi, E. R., Libet, M., Ramstrom, K., Jocson, M. A., & Marie, K. (Eds.) (2007). Preconception health: Selected measures, California, 2005 [Internet]. Sacramento, CA: Maternal, Child and Adolescent Health Program, California Department of Public Health [cited Aug 9, 2009]. Available from: http://www.cdph.ca.gov/HealthInfo/healthyliving/childfamily/Documents/MO-preconceptionHealthOct07.pdf.
- 35.North Carolina Preconception Health Strategic Plan: September 2008–September 2013 [Internet]. North Carolina Department of Health and Human Services, North Carolina Division of Public Health, Women’s Health Branch; 2008 [cited Aug 9, 2009]. Available from: http://whb.ncpublichealth.com/Manuals/PreconceptionHealthStrategicPlan-3-6-09.pdf.
- 37.Centers for Disease Control and Prevention; Council of State and Territorial Epidemiologists; Association of State and Territorial Chronic Disease Program Directors. (2004). Indicators of chronic disease surveillance. MMWR, 53(RR11), 1–6.Google Scholar
- 39.Pregnancy Risk Assessment Monitoring System [Internet]. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention [cited Aug 9, 2009]. Available from: http://www.cdc.gov/prams.
- 40.Behavioral Risk Factor Surveillance System [Internet]. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention [cited Aug 9, 2009]. Available from: http://www.cdc.gov/BRFSS/.
- 42.National Vital Statistics System [Internet]. Hyattsville, MD: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics [cited Aug 9, 2009]. Available from: http://www.cdc.gov/nchs/nvss.htm.
- 44.Annual Social and Economic Supplement [Internet]. Washington, DC: United States Bureau of the Census, Current Population Survey Branch [cited Aug 9, 2009]. Available from: http://www.cdc.gov/std/stats.
- 45.Weinberg, D. H. (2006). Income data quality issues in the CPS. Monthly Labor Review, 129, 38–45. [Internet] Available from: http://www.bls.gov/opub/mlr/2006/06/art4full.pdf.
- 46.National Sexually Transmitted Diseases Database. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, Division of Sexually Transmitted Disease Prevention [cited Aug 9, 2009]. Available from: http://www.cdc.gov/std/stats.
- 47.Gorwitz, R. J., Webster, L. A., Nakashima, A. K., & Greenspan, J. R. (1994). Sexually transmitted diseases. In Wilcox L. S., & Marks J. S. (Eds.), Reproductive health of women: from Data to Action—CDC’s public health surveillance for women, infants and children [Internet]; Atlanta, GA: Centers for Disease Control and Prevention, Division of Reproductive Health [cited Jul 13,2009]. Available from: http://www.cdc.gov/Reproductivehealth/ProductsPubs/DatatoAction/pdf/rhow2.pdf.
- 48.Preconception Health and Health Care [Internet]. California Department of Public Health, Maternal, Child and Adolescent Health Program [cited Aug 9, 2009]. Available from: http://www.cdph.ca.gov/programs/preconception/Pages/default.aspx.
- 49.Excerpts of State Initiatives in Preconception Health [Internet]. University of North Carolina at Chapel Hill, Center for Maternal and Infant Health [cited Aug 9, 2009]. Available from: http://www.mombaby.org/UserFiles/File/State%20Initiatives%20on%20Preconception%20Health.doc.
- 50.Preconception Care Programs [Internet]. Delaware Department of Health and Social Services, Division of Public Health [cited Aug 31, 2009]. Available from: http://dhss.delaware.gov/dhss/dph/chca/impreconceptioncare.html.
- 51.Preconception/Women’s Health [Internet]. Utah Department of Health, Reproductive Health Program [cited Aug 31, 2009]. Available from: http://health.utah.gov/rhp/rhp-public.htm.
- 52.Association of Maternal and Child Health Programs. Preconception Health Success Stories. AMCHP Pulse Monthly Newsletter [Internet]. 2008 Nov [cited Aug 9, 2009]. Available from: http://www.amchp.org/AboutAMCHP/Newsletters/Pulse/November08/Pages/SuccessStories.aspx.
- 53.Harding, C. A. (2007). Preconception Health Collaborative Project [slide presentation]. Los Angeles, CA: Los Angeles County. Available from the National Association of County and City Health Officials website: http://www.naccho.org/topics/HPDP/mch/resources/emch/callseries/07-08/upload/NACCHOwebcast_7_19_07_LA.ppt.
- 54.Assessment of Preconception Care in California Title X Clinics [Internet]. March of Dimes Foundation, California Chapter [cited Aug 9, 2009]. Available from: http://cdc.confex.com/cdc/pcs2007/techprogram/P13600.HTM.
- 55.Every Woman Florida [Internet]. Florida Department of Health, Bureau of Infant, Maternal and Reproductive Health [cited Aug 9, 2009]. Available from: http://www.everywomanflorida.org/.
- 56.Every Woman California [Internet]. California Department of Public Health, Maternal, Child and Adolescent Health Division [cited Sept 14, 2009]. Available from: http://www.everywomancalifornia.org.
- 57.D’Angelo, D., Williams, L., Morrow, B., Cox, S., Harris, N., Harrison, L., et al. (2007). Preconception and interconception health status of women who recently gave birth to a live-born infant—Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 26 reporting areas, 2004. MMWR Surveillance Summaries, 56, 1–35.Google Scholar
- 58.Bensyl, D. M., Iuliano, D., Carter, M., Santelli, J., & Gilbert, B. C. (2005). Contraceptive use—United States and Territories, Behavioral Risk Factor Surveillance System, 2002. MMWR Surveillance Summaries, 54, 1–72.Google Scholar
- 66.Collins, J. L., Lehnherr, J., Posner, S. F., & Toomey, K. E. (2009). Ties that bind: Maternal and child health and chronic disease prevention at the Centers for Disease Control and Prevention. Prev Chronic Dis, 6(1). [cited Aug 9, 2009]. Available from: http://www.cdc.gov/pcd/issues/2009/Jan/pdf/08_0233.pdf.