Core State Indicators for Monitoring Preconception Health:

A Multi-state Selection Process

Danielle L. Broussard, PhD, MPHDanielle L. Broussard, PhD, MPHFormer CDC/CSTE Applied Epidemiology Fellow

Division of Family Health ServicesDivision of Family Health ServicesFlorida Department of HealthFlorida Department of Health

ObjectivesObjectives

• Explain the need for indicatorsExplain the need for indicators• Describe the selection processDescribe the selection process• Present the indicator domainsPresent the indicator domains• Discuss recommendations for future Discuss recommendations for future

effortsefforts

Critical Periods of Fetal Development

4 5 6 7 8 9 10 11 12

Central Nervous SystemCentral Nervous System

HeartHeart

ArmsArms

EyesEyes

LegsLegs

TeethTeeth

PalatePalate

External genitaliaExternal genitalia

EarEar

Missed Period Mean Entry into Prenatal Care

Week

CDC’s Preconception Health EffortsCDC’s Preconception Health Efforts

• Recommendations• Journal publications• Workgroups to develop strategies• Evaluations and best practices• Technical assistance to programs• National summit

Preconception Health in StatesPreconception Health in States

• Many states identified preconception health-Many states identified preconception health-related indicators in Title V Block Grant related indicators in Title V Block Grant applications and annual reports (2004, 2006)applications and annual reports (2004, 2006)

• Some states already developed preconception Some states already developed preconception health reports that included indicatorshealth reports that included indicators

Source: Boulet SL, et al. MCHJ 2006; 10(Suppl 1):13-20.

Standard, nationally-recognized Standard, nationally-recognized preconception health measures preconception health measures

were neededwere needed

Core State Preconception Health Core State Preconception Health Indicator InitiativeIndicator Initiative

PurposePurpose

• Working group: 7 statesWorking group: 7 states• CA, DE, FL, MI, NC, TX, & UTCA, DE, FL, MI, NC, TX, & UT• Already developed and utilized indicatorsAlready developed and utilized indicators

• Review and evaluate potential indicatorsReview and evaluate potential indicators• Recommend an initial set of core state Recommend an initial set of core state

indicatorsindicators

Core State Preconception Health Core State Preconception Health Indicator InitiativeIndicator Initiative

AssumptionsAssumptions

• Measured frequently– optimally on an Measured frequently– optimally on an annual basisannual basis

• State-level, population-basedState-level, population-based• Reasonably valid and reliableReasonably valid and reliable• Women of reproductive age (18-44); Women of reproductive age (18-44);

adolescents and men require their own set adolescents and men require their own set of measuresof measures

Core State Preconception Health Core State Preconception Health Indicator InitiativeIndicator Initiative

ProcessProcess

• Identify domains of preconception healthIdentify domains of preconception health• Review available state data sets for Review available state data sets for

potential indicators within domainspotential indicators within domains• Identify potential indicatorsIdentify potential indicators• Evaluate potential indicators on 5 criteriaEvaluate potential indicators on 5 criteria• Score potential indicators on 5 criteriaScore potential indicators on 5 criteria

Core State Preconception Health Core State Preconception Health Indicator InitiativeIndicator Initiative

ProcessProcess

• Select and recommend core indicatorsSelect and recommend core indicators• Make available for public review and Make available for public review and

commentcomment• Consulted expert advisory panel at various Consulted expert advisory panel at various

decision making pointsdecision making points

Core State Preconception Health Core State Preconception Health Indicator InitiativeIndicator Initiative

DomainsDomains• General Health StatusGeneral Health Status• Social DeterminantsSocial Determinants• Health CareHealth Care• Reproductive Health/Reproductive Health/ Family PlanningFamily Planning• Nutrition/Physical ActivityNutrition/Physical Activity• Tobacco, Alcohol, and Tobacco, Alcohol, and

Substance UseSubstance Use

•Mental Health•Chronic Conditions•Emotional / Social Support•Infections•Genetics / Epigenetics

Core State Preconception Health Core State Preconception Health Indicator InitiativeIndicator Initiative

State-level Data SetsState-level Data Sets• Abortion reportingAbortion reporting• Assisted Reproductive Technology Surveillance SystemAssisted Reproductive Technology Surveillance System• BRFSS BRFSS • Census / Current Population SurveyCensus / Current Population Survey• Cancer registryCancer registry• PRAMSPRAMS• Pregnancy Nutrition Surveillance SystemPregnancy Nutrition Surveillance System• Notifiable STD reportingNotifiable STD reporting• National Vital Statistics SystemNational Vital Statistics System

Core State Preconception Health Core State Preconception Health Indicator InitiativeIndicator Initiative

5 Evaluation Criteria5 Evaluation Criteria

• General public health importanceGeneral public health importance• State program/policy priorityState program/policy priority• Data availability (frequency, accessibility)Data availability (frequency, accessibility)• Data quality (representativeness, validity, Data quality (representativeness, validity,

reliability, missing data)reliability, missing data)• Complexity of calculationsComplexity of calculations

Core State Preconception Health Core State Preconception Health Indicator InitiativeIndicator Initiative

Proposed IndicatorsProposed Indicators

• 45 indicators within the 11 domains45 indicators within the 11 domains• Detailed descriptions posted on the CSTE Detailed descriptions posted on the CSTE

websitewebsite• Data sourceData source• Numerator and denominator for calculationsNumerator and denominator for calculations• SignificanceSignificance• LimitationsLimitations

Core State Preconception Health Core State Preconception Health Indicator InitiativeIndicator Initiative

Proposed IndicatorsProposed Indicators

• Full descriptions on CSTE web site: Full descriptions on CSTE web site: www.cste.org

• Publication describing indicator selection Publication describing indicator selection process process

Broussard DL, et al. MCHJ 2011; 15(2):158-Broussard DL, et al. MCHJ 2011; 15(2):158-6868..

Core State Preconception Health Core State Preconception Health Indicator InitiativeIndicator Initiative

ChallengesChallenges• Preconception health is an emerging field (little Preconception health is an emerging field (little

data on population effects of programs)data on population effects of programs)• Many measures not captured or not captured Many measures not captured or not captured

well in existing surveillance systemswell in existing surveillance systems• Defining the population at riskDefining the population at risk• Large number of indicatorsLarge number of indicators• Gaps in data (e.g., disease severity, genetic Gaps in data (e.g., disease severity, genetic

testing for specific heritable conditions)testing for specific heritable conditions)

Core State Preconception Health Core State Preconception Health Indicator InitiativeIndicator Initiative

RecommendationsRecommendations• Improve existing surveillance items or create Improve existing surveillance items or create

new data sourcesnew data sources• Limited resources and competing surveillance Limited resources and competing surveillance

priorities means collaboration with other public priorities means collaboration with other public health programs is essential (e.g., chronic health programs is essential (e.g., chronic diseases)diseases)

Core State Preconception Health Core State Preconception Health Indicator InitiativeIndicator Initiative

CaliforniaCalifornia Moreen Libet, PhDMoreen Libet, PhD Kiko Malin, MPH, MSWKiko Malin, MPH, MSWDelawareDelaware Charlan Kroelinger, PhDCharlan Kroelinger, PhDFloridaFlorida Danielle Broussard, PhD, MPHDanielle Broussard, PhD, MPH Bill Sappenfield, MD, MPHBill Sappenfield, MD, MPHMichiganMichigan Violanda Grigorescu, MD, MSPHViolanda Grigorescu, MD, MSPH Chris Fussman, MSChris Fussman, MS

North CarolinaNorth Carolina Alvina Long Valentin RN, MPHAlvina Long Valentin RN, MPH Sarah McCracken Cobb, MPHSarah McCracken Cobb, MPH

TexasTexas Gita Mirchandani, PhD, MPHGita Mirchandani, PhD, MPH Charlotte Brooks, MEdCharlotte Brooks, MEd

UtahUtah Nan Streeter, MS, RNNan Streeter, MS, RN Lois Bloebaum, MPALois Bloebaum, MPA Shaheen Hossain, PhDShaheen Hossain, PhD