CROSS-CUTTING ISSUES IN MATERNAL AND CHILD...
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CROSS-CUTTING ISSUES IN MATERNAL AND CHILD HEALTH Georgia Title V Needs Assessment
Transcript of CROSS-CUTTING ISSUES IN MATERNAL AND CHILD...
CROSS-CUTTING ISSUES IN MATERNAL AND CHILD HEALTH
Georgia Title V Needs Assessment
Cross-Cutting Issues in Maternal and Child Health
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Cross-Cutting Issues in Maternal and Child Health Q U A N T I T A T I V E A N A L Y S I S
INTRODUCTION This section will explore the various cross‐cutting issues in Maternal and Child Health (MCH), which are
public health issues that impact multiple MCH populations and have an influence throughout the life‐
course. Issues such as oral health, tobacco use, and insurance status are often central to an individual’s
overall health status. Despite this, oral health is often neglected due to numerous barriers, including lack of
access, oral health education and insurance.
In Georgia, particularly in the areas of improving oral health outcomes, reducing tobacco use, and
increasing insurance status for a greater population, great progress has been seen. Despite this, there
remains room for improvement, in particular in addressing disparities by race/ethnicity, income and
education. People with less access to preventive oral health services are at a greater risk for oral health
disease and other chronic diseases. Poor insurance status has led to delay in care and greater number of
poor health outcomes. Tobacco use has led to the increasing heart and lung disease, and for mothers who
smoke during pregnancy, premature birth and low birth weight infants.
This section will explore the various cross‐cutting issues in Maternal and Child Health (MCH), which are
public health issues that impact multiple MCH populations and have an influence throughout the life‐
course. This section will explore Georgia’s health outcomes with respect to the following topics:
Oral hygiene for mothers and children
Smoking during pregnancy
Tobacco use among adolescents
Insurance status for children and women
The data sources are the National Children’s Health Survey (NCHS), Pregnancy Risk Assessment Monitoring
System (PRAMS) and the Youth Risk Behavior Survey (YRBS). The section will conclude with
recommendations for future areas of focus.
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ORAL HEA
Pregnant
The percent o39.5% in 200younger motteeth cleanedstratifying byonly 20.5% ofcompared to relatively comof mothers in
Source: PRAMS 200
t is importan
teeth cleanin
pregnancy co
women with
of those with
56
0
10
20
30
40
50
60
Wh
P
ssues in Mate
ALTH
Women
of mothers g9 to 46.5% inhers. For exad the year bey race/ethnicf Hispanic m56.7% of no
mparable, win rural areas.
09‐2011
nt to make no
ng. Women w
ompared to t
insurance fro
h Tricare/Mili
.7
3
ite B
Percent of w
rnal and Child
getting their tn 2011. Additample, in 201efore their prity and urbanothers reporn‐Hispanic Wth 47.7% of m
ote about the
who had insu
hose who we
om their jobs
itary insuran
38.9
Black
women who by race/ethn
d Health
teeth cleanetionally, olde11, only 38.2regnancy comn and rural strt having theiWhite womenmothers in u
e correlation
rance from t
ere insured b
s got a clean
ce.
20.5
Hispanic
had their teenicity and ur
d during the er mothers ar% of 20 to 24mpared to 66tatus, some sir teeth cleann. Surprisinglrban areas re
n between pa
heir job were
by Medicaid
ing compare
54.0
Other
eth cleaned rban/rural st
year prior tore more likel4 year old m6.1% of mothsignificant dined the yearly, the rates eporting tee
ayor status a
e most likely
or Military c
ed to only 8.4
the year betatus, Georg
o pregnancy ly to report hothers reporhers who areisparities appr before theirin urban verseth cleanings
nd the likelih
y to get a clea
overage. For
4% of Medica
47.7
Urban
fore their prgia, 2011
increased frohaving cleanirted having te 35 and oldepear. For exar pregnancy sus rural arecompared to
hood of getti
aning the yea
r example, 64
aid patients a
43
n Rur
regnancy
om ngs than heir er. Upon ample,
as were o 43.5%
ing a
ar before
4.7% of
and 4.7%
.5
ral
Cross-Cutting Issues in Maternal and Child Health
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Percent of women reporting having a teeth cleaning the year before pregnancy by payor, Georgia,
2011
Payor Percent
Insurance paid by job 64.2%
Insurance paid by someone else 5.8%
Insurance paid by Medicaid 8.4%
Insurance paid by TRICARE/Military 4.7%
Insurance paid by PeachCare 1.4%
Insurance paid by Other 1.0%
No Insurance 20.6%Source: PRAMS 2009‐2011
Fewer women overall received a dental cleaning during pregnancy. Although 38% of women overall
reported having their teeth cleaned during pregnancy, only 29.4% of mothers less than 20 years old saw a
dentist or dental hygienist during pregnancy, compared to 47.2% of women over 35 years of age. Significant
disparities are also present when stratified by race/ethnicity. Non‐Hispanic white women (46.4%) were far
more likely than their Non‐Hispanic Black and Hispanic (33.9% and 19.6%) counterparts to receive a dental
cleaning. As education level increases, so does the likelihood that women will receive a dental cleaning
during pregnancy.
Source: PRAMS 2012
38.0
29.4 28.6
40.8
47.2 46.4
33.9
19.620.8
34.2
44.3
0
5
10
15
20
25
30
35
40
45
50
Percent of women who had their teeth cleaned during pregnancy, Georgia, 2012
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Children
Georgia’s chi
national aver
overall perce
however, the
Source: NSCH 2007
Furthermore,
than their co
excellent/ver
statistic rema
50
55
60
65
70
75
80
ssues in Mate
and Ado
ldren reporte
rage across th
ntage of chil
e increase wa
7 and 2011/12
, children res
unterparts n
ry good cond
ained true fo
70.7
Percent of cb
rnal and Child
lescents
ed having tee
he each time
dren with ve
as greater for
siding in Geo
ationally in e
dition was gre
r both Georg
72
2007
hildren agesby year, Geo
d Health
eth that are
e point meas
ery good or e
r children in
orgia experien
every age cat
eatest among
gia and the n
s 1‐17 whosergia compar
in excellent/
ured. Compa
excellent teet
Georgia.
nced excelle
tegory. The p
g 1 to 5 year
nation as a w
e teeth are ired to the US
/very good co
aring the dat
th increased
nt/very good
percent of ch
olds and low
hole.
71.3
2011/1
n excellent/S, 2007 and
ondition at a
ta from 2007
for both the
d oral health
hildren with t
west among 6
74.1
12
/very good co2011/12
higher rate
to 2011/12,
e nation and
at a greater
teeth in
6 to 11 year
ondition
than the
the
Georgia;
rate
olds. This
US
Georgia
S
D
e
n
c
e
c
Source: NSCH 2007
Disparities ca
excellent/ver
nationally an
condition in c
excellent tee
children are l
0
10
20
30
40
50
60
70
80
90
7 and 2011/12
an be seen ac
ry good cond
d in Georgia,
comparison t
th when com
ess likely to
78.583.4
0‐5 years old
Percent of
cross race an
dition at a hig
, were about
to White chil
mpared to ma
have teeth in
4
d
f children agcondition b
nd ethnic gro
gher level tha
t 50% less lik
dren. In Geo
ales, which is
n good or exc
66.2
6‐11 yea
es 1 to 17 yey age, Georg
ups with Wh
an any other
ely to report
orgia, female
s in contrast
cellent condi
69.5
ars old
ears whose tgia compare
Cross-Cuttin
hite children
racial/ethnic
t having teeth
children we
to the nation
ition when c
70.
12‐1
teeth are in ed to the US,
ng Issues in Ma
reporting ha
c group. Hisp
h in excellen
re less likely
nal data whic
ompared to
.5 71.1
17 years old
excellent/ve, 2011/12
aternal and Ch
aving teeth in
panics, both
t/very good
to have very
ch shows tha
females
ery good
N
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hild Health
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n
y good or
at male
ationwide
eorgia
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2
3
4
5
6
7
8
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Source: NSCH 2007
80.3 8
0
10
20
30
40
50
60
70
80
90
White
ssues in Mate
7 and 2011/12
66.8
1.2
7
e Blac
Percent ofcondition b
rnal and Child
53.4
72.8
k Hispa
f children agby race/ethn
d Health
72.3
52.0
anic Ot
ges 1to 17 yenicity and ge
73.4
her
ears whose tnder, Georg
69.
M
teeth are in eia compared
.673
75.8
Male F
excellent/ved to the US,
3.0 72.2
Female
ery good 2011/12
Na
Ge
ationwide
eorgia
S
I
i
i
t
C
g
s
Source: NSCH 2007
n Georgia an
ncome. The
ncrease is m
those at 400%
Children and
good or exce
seen in Georg
52.6
0
10
20
30
40
50
60
70
80
90
100
0 ‐ 99%
c
7 and 2011/12
nd nationally,
increase is st
arginal amon
% FPL or high
Youth with s
llent conditio
gia and natio
63.861.4
% FPL 100 ‐ 1FP
Percent of condition by
, the likeliho
teady nation
ng children w
her.
special health
on when com
onally as well
7872.9 7
199%L
200 ‐ 3FP
children ageincome and
od of childre
wide, with co
with 100 to 1
h care needs
mpared to ch
l.
85.1
74.8
8
399%L
400% Fhigh
es 1 to 17 yed special hea
en reporting v
onsistent inc
99% of FPL t
s (CYSHCN) a
ildren witho
87.8
PL orer
ears whose tealth care stat2011/12
Cross-Cuttin
very good or
creases as inc
o 200 to 399
re less likely
ut special he
72.97
non‐CYS
eeth are in etus, Georgia
ng Issues in Ma
r excellent te
come rises. I
9% FPL and in
to report ha
ealth care ne
64.9
75.4
6
SHCN CYSHC
excellent/vecompared t
aternal and Ch
eeth increase
n Georgia, th
ncreases sha
aving teeth in
eds; this patt
68.9
CN
ry good to the US,
Nat
Geo
hild Health
Page 7
es with
he
rply for
n very
tern is
tionwide
orgia
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i
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Source: NSCH 2007
The age grou
nationally an
such, 22.5 %
than 10% of 1
children gene
earning to be
mportance o
group.
18.7
0
5
10
15
20
25
30
35
40
Ov
ssues in Mate
7 and 2011/12
p with the h
d within Geo
of 6 to 11 ye
1 to 5 year o
erally have m
e more indep
of oral hygien
18.6
verall
Percent of cin the
rnal and Child
ighest rate o
orgia are child
ear old childr
lds and 21.9%
much adult su
pendent and
ne. As such, i
hildren agese past 12 mo
d Health
of oral health
dren 6 to 11
en in Georgia
% of 12 to 17
upervision wh
may not hav
t is importan
11.0
1‐5 yrs
s 1 to 17 yeaonths by age,
problems, d
years old, fo
a had one or
7 year olds. T
hen brushing
ve the matur
nt to focus m
2
9.8
s old 6
rs who had , Georgia co
defined as de
ollowed close
r more oral h
This is not su
g teeth, while
rity to fully u
more oral hyg
5.3
22.5
6‐11 yrs old
one or morempared to t
ecayed teeth
ely by the 12
health issues
rprising, as 1
e 6 to 11 yea
nderstand an
giene awaren
18.5
2
12‐17 yrs
e oral healththe US, 2011
or cavities, b
to 17 year o
compared to
1 to 5 year ol
ar olds are ju
nd appreciat
ness targeting
21.9
old
h problems 1/12
N
G
both
olds. As
o less
d
st
te the
g this age
Nationwide
Georgia
S
T
l
c
o
l
Source: NSCH 2007
There were n
owest rate o
counterparts
oral health pr
ikely to repo
14.9
1
0
5
10
15
20
25
30
Whit
i
7 and 2011/12
notable differ
of oral health
. For exampl
roblems such
ort oral health
22.8
13.2
2
te Blac
Percent of cin the past 1
rences in the
problems in
e, 24.7% of B
h as cavities a
h problems c
24.924.72
k Hispa
hildren ages12 months by
e data when s
n both Georg
Blacks, 23.7%
and/or tooth
compared to
18.9
23.7
anic Oth
s 1 to 17 yeay race/ethni
stratified by
ia as well as
% of Hispanic
h decay. Add
males both
15.3
er
rs who had icity and gen2011/12
Cross-Cuttin
race and eth
nationally, c
cs, and 15.3%
ditionally, fem
nationally an
18.5
Ma
one or morender, Georgia
ng Issues in Ma
hnicity. White
ompared to
% of “Other”
male children
nd in Georgia
19.0
15.2
ale Fem
e oral healtha compared
aternal and Ch
e children ha
their minorit
children repo
n were also m
a.
22.2
male
h problems to the US,
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hild Health
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ad the
ty
orted
more
Nationwide
Georgia
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Source: NSCH 2007
Not surprisin
owest incom
highest incom
FPL, at 11.8%
25.9 2
0
5
10
15
20
25
30
0 ‐ 99%
Pp
ssues in Mate
7 and 2011/12
gly, the perc
me bracket, b
me group wa
% nationally a
23.1
25.7
2
% FPL 100 ‐ 1FPL
ercent of chpast 12 mont
rnal and Child
ent of childr
oth national
s nearly 2.5 t
and 9.9% in G
16.7
20.7
1
99%L
200 ‐ 3FPL
ildren 1 to 1ths by incom
d Health
en who had
ly and in Geo
times lower t
Georgia.
11.8
17.6
99%L
400% FPhighe
17 years whome and speci
one or more
orgia, at 25.9
than those w
9.9
PL orer
o had one orial needs sta2011/12
e oral health
9% and 25.7%
who lived in f
17.9 1
non‐CYS
r more oral hatus, Georgia
problems wa
% respectivel
families earn
22.0
17.7
2
SHCN CYSH
health probla compared
as highest in
y. The perce
ing 0 to 99%
22.0
CN
ems in the to the US,
Na
Ge
the
ent in the
% of the
ationwide
eorgia
S
Wrco
Source: NSCH 2007
When comparates of childchildren repoof children go
0
10
20
30
40
50
60
70
80
90
Pa
7 and 2011/12
aring US and ren reportinorting oral heoing to preve
71.374.1
Excellent Teet
Percent of chnd preventiv
Georgia datag excellent teealth problementive visits i
1
th
hildren ages ve visits in th
a, there are neeth, at 74.1ms is roughlys 77.2% US c
18.7
Oral Health P
1 to 17 yearhe last 12 m
no notable d1% compared just under 1compared to
18.6
Problems
rs with excelmonths, Geor
Cross-Cuttin
isparities. Ged to a 71.3% 19%, both in 75.9% in Ge
77.2
Preve
llent teeth, orgia compare
ng Issues in Ma
eorgia is surpnational aveUS and Geororgia.
2 75.9
entive Visits
oral health ped to the US
aternal and Ch
passing the nrage. The pergia, and the
problems, S, 2011/12
Na
Ge
hild Health
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national ercent of percent
tionwide
orgia
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2
a
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Source: NSCH 2007
Within Georg
2011/12. As s
and cleanings
73.9
6
50
55
60
65
70
75
80
85
90
Hispa
c
ssues in Mate
7 and 2011/12
gia, the most
such, only 69
s), compared
79.7
69.6
nic White, Hispa
Percent of ccare visits in
rnal and Child
significant e
9.6% of Hispa
d to 73.9% na
75.977.5
non‐anic
Black, Hispa
children agesthe last 12 m
d Health
ethnic dispar
anic children
ationally, and
73.575.6
non‐anic
OtherHisp
s 1 to 17 yeamonths by r
the
ity was in His
had one or m
d 77.5% of W
77.6
, non‐anic
ars old who hace/ethnicite US, 2011/1
spanic childr
more preven
White children
76.7
M
had one or mty and gende12
en ages 1 to
ntive dental c
n in Georgia.
77.675.6
Male Fem
more prevener, Georgia c
17 years old
care visits (ch
.
676.2
male
ntive dental compared to
d in
heck‐ups
o
Nationwide
Georgia
S
N
t
t
a
n
Source: NSCH 2007
Not surprisin
to 17 in Geor
to 87.3% of t
a higher rate
needs (74.3%
68.0
0
10
20
30
40
50
60
70
80
90
100
0 ‐ 99%
P
7 and 2011/12
gly, the data
rgia had one
hose in the h
of preventiv
%).
73.067.3
% FPL 100 ‐ 1FP
ercent of chvisits in th
are similar w
or more prev
highest incom
ve dental care
79.7
71.9
199%PL
200 ‐ 3FP
hildren ages he last 12 m
G
when stratifie
ventive dent
me category.
e visits (82.3
85.0
77.4
399%PL
400% Fhigh
1 to 17 yearonths by incGeorgia com
ed by income
tal care visits
Interestingly
%) compared
87.3
FPL orher
s who had ocome and spmpared to US
Cross-Cuttin
e. Only 67.3%
in the last 1
y, children w
d to their pee
75.6
non‐CY
one or more pecial healthS, 2011/12
ng Issues in Ma
% of low‐inco
2 months in
with special h
ers with no s
83.1
74.3
YSHCN CYSH
preventive dh care needs
aternal and Ch
ome children
Georgia, com
ealth care ne
special health
82.3
HCN
dental care status,
N
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hild Health
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n ages 1
mpared
eeds had
h care
ationwide
eorgia
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r
H
h
d
a
O
r
7
p
h
n
T
PHM
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Source: NSCH 2007
When looking
race (75.6% t
Hispanic child
have oral hea
disparities by
about 30% m
One of the m
receiving fluo
74.6% of peo
population to
has exceeded
nation.
TOBACCO
PregnantHealthy PeoMICH‐11.3: In
73.9
6
50
55
60
65
70
75
80
85
90
Hispa
c
ssues in Mate
7 and 2011/12
g specifically
to 77.6%), bu
dren were le
alth problem
y gender amo
more likely to
many successe
oridated wat
ople do natio
o be served b
d these stand
O USE
Women ople 2020 Gncrease abst
79.7
69.6
7
nic White, Hispa
Percent of ccare visits in
rnal and Child
y at children i
ut was lower
ss likely to ha
s with nearly
ong children
experience o
es Georgia ha
er. In Georgi
nally. The He
by communit
dards and thi
Goal inence from
75.977.5
non‐anic
Black, Hispa
hildren agesthe last 12 m
d Health
in Georgia, re
among child
ave preventi
y a quarter o
receiving pre
oral health p
as had in ter
a, 96.3% of G
ealthy People
ty water syst
is serves as a
cigarette sm
73.575.6
non‐anic
Other,Hispa
s 1 to 17 yeamonths by ra
the
eceipt of pre
dren of Hispa
ve oral healt
f children ag
eventive ora
roblems.
ms of oral he
Georgia’s res
e (HP) 2020 g
ems with op
an example w
moking among
77.6
non‐anic
rs old who hace/ethnicitye US, 2011/1
eventive visit
nic ethnicity
th visits, Blac
ge 1 to 17 rep
l health care
ealth is in the
sidents receiv
goal is to incr
timally fluor
where Georgi
g pregnant w
76.7
Ma
had one or my and gende12
s did not ten
y (69.6%). Int
ck children w
porting probl
, however, fe
e proportion
ve fluoridate
rease the pro
idated water
ia is leading t
women to 98
77.675.6
ale Fem
more prevener, Georgia co
nd to vary mu
erestingly, w
were the most
lems. There a
emale childre
of the popu
ed water whi
oportion of t
r to 79.6%. G
the rest of th
8.6%
76.2
male
ntive dental ompared to
N
G
uch by
while
t likely to
are no
en are
lation
le only
he US
Georgia
he
Nationwide
Georgia
F
j
t
a
p
w
c
l
m
m
S
T
s
p
o
r
From 2008 to
ust shy of me
the rates of s
ages 20 to 24
pregnancy wa
women acros
compared to
ess than 1%.
months of pr
months at 8.9
Source: Vital Recor
The prevalen
some high sc
pregnancy at
only 0.9% and
rates of risky
10.3
0
2
4
6
8
10
12
14
16
18
20
Whit
o 2012, the p
eeting the H
smoking duri
4 at 9.1%. On
as among Am
ss the state. W
the state av
Similar patt
egnancy, wit
9% in 2011 c
rds 2008‐2012
ce of smokin
hool educati
t 14.1%. The
d 0.4%. This
behavior suc
3
3.7
te Blac
Percent of
percent of mo
P 2020 goal o
ng pregnanc
nce stratified
merican India
White mothe
erage. Asian
erns were fo
th White mot
ompared to
ng during pre
on, but not a
rates droppe
data is consi
ch as smokin
7
0.
ck Hispa
mothers wh
others who s
of 98.6% of m
y were highe
by race and
an/Alaska Na
ers were 1.5
mothers we
ound among
thers having
only 0.4% of
egnancy is aff
a high schoo
ed dramatica
stent with th
ng during pre
9 0.
anic Asi
ho smoked d20
smoked durin
mothers rem
est among m
ethnicity, th
ative mothers
times more
ere the least
mothers who
the greatest
f “Other” rac
fected when
l degree, we
ally for those
he conclusion
egnancy.
.6
13
ian AI/
during pregn009 to 2012
Cross-Cuttin
ng pregnancy
maining abstin
others ages
e highest pro
s at 13.2%, m
likely to smo
likely to repo
o reported sm
t likelihood o
e mothers.
stratified by
re most likel
mothers wit
n that increa
3.2
3
/AN PaIsla
ancy by race
ng Issues in Ma
y remained s
nent from sm
18 to 19 at 8
oportion of s
more than tw
oke during pr
ort smoking d
moking durin
of smoking du
y education.
y to report s
th bachelor d
sed educatio
3.94
acificander
Mul
e/ethnicity, G
aternal and Ch
steady at abo
moking. Addit
8.9% and mot
smoking duri
wice the avera
regnancy wh
during pregn
ng the last th
uring the last
Women with
moking durin
degrees or hi
on leads to lo
4.5
tiracial Un
Georgia,
hild Health
Page 15
out 6%,
tionally,
thers
ng
age of
en
nancy, at
hree
t three
h at least
ng
igher, to
ower
3.3
known
C
P
S
T
p
w
Cross-Cutting I
Page 16
Source: Vital Reco
The table bel
public health
women on re
P
N
N
N
C
F
C
E
D
L
S
N
E
W
4.0
0
2
4
6
8
10
12
14
16
8th gradless
Pe
ssues in Mate
ords 2008‐2012
ow shows ho
district. This
eproductive a
Percent of m
Public Health
Northwest He
North Georgi
North Health
Cobb/Dougla
Fulton Health
Clayton Coun
East Metro H
DeKalb Health
LaGrange Hea
South Centra
North Centra
East Central H
West Central
14.1
e or 9th to <12No diplom
ercent of mo
rnal and Child
ow the perce
s may provid
ages.
mothers who
District
ealth District
a Health Dist
District (Gain
s Health Distr
h District
ty Health Dis
ealth District
h District
alth District
l Health Distr
l Health Distr
Health Distric
Health Distri
8.7
2thma
HSGrad/GED
others who s
d Health
ent of mothe
e an indicati
smoke durin
2
(Rome)
rict (Dalton)
nesville)
rict
trict (Jonesbo
(Lawrencevil
rict (Dublin)
rict (Macon)
t (Augusta)
ct (Columbus
4.0
DSomecollege
smoked duri
rs who repor
on of areas t
g pregnancy
2008‐2012
oro)
lle)
s)
2.8
Associatedegree
ing pregnan2012
rt smoking d
to target smo
by public hea
0.9
Bachelor’s degree
cy by educat
uring pregna
oking cessati
alth district,
Percent
0.4
Master’s degree
Dd
tion, Georgi
ancy is distrib
on messages
Georgia,
14.4
5.9
6.3
2.9
2.7
3.5
2.5
1.8
10.0
12.6
10.4
6.9
7.1
0.4
Doctor'sdegree
Un
a, 2008 to
buted by
s to
3.4
nknown
W
p
c
t
m
p
a
m
p
e
i
S
S
S
S
C
N
U So
When educat
pregnancy, in
categories, 34
three months
mothers with
pregnancy co
among moth
mothers repo
post‐seconda
educated Bla
n those that
Source: PRAMS 200
0
5
10
15
20
25
30
35
40
Le
South Health
Southwest He
Southeast He
Coastal Healt
Northeast He
Unknown urce: Vital Record
tion level am
nteresting dif
4% of White
s of pregnan
h a high scho
ompared to 3
ers who have
orting smokin
ary educated
ck mothers.
smoke durin
09‐2011
15.7
34.
ess than high sc
Percent of
District (Vald
ealth District
ealth District (
h District (Sav
ealth District (
s 2008‐2012
mong Black an
fferences are
mothers wit
cy compared
ol degree we
3.1% of Black
e post‐secon
ng during the
White wom
This is notab
ng pregnancy
.0
chool
mothers whpregnancy b
dosta)
(Albany)
(Waycross)
vannah)
(Athens)
nd White mo
e revealed. W
th less than a
d to only 15.7
ere more like
k mothers wit
ndary educat
eir last three
en smoked d
ble as it is sho
y.
3.1
High schoo
ho reported by race & ed
others is com
White mother
a high school
7% of their B
ely to report
th a high sch
ion, with onl
months of p
during pregn
owing that de
15.3
ol graduate
smoking duducation, Ge
Cross-Cuttin
pared to ass
rs have the h
degree repo
Black peers. M
smoking dur
hool degree. T
y 4% of Blac
pregnancy. M
ancy, compa
espite educa
Post‐s
ring their lasorgia, 2009
ng Issues in Ma
sess smoking
highest rates
orted smokin
Moreover, 15
ring the last t
The differen
k mothers an
Most interest
ared to only 3
ation, race is
4.05.6
econdary educ
st three monto 2011
aternal and Ch
5.3
4.4
13.4
7.0
9.5
20.3
habits durin
of smoking i
ng during the
5.3% of Whit
three month
ce is less not
nd 5.6% of W
ing is that 5.
3.1% of high
still playing a
cation
nths of
hild Health
Page 17
ng
in all
eir last
e
s of
table
White
6% of
school
a factor
Black
White
C
P
A
p
w
a
s
“
A
e
S
C
N
r
n
h
w
G
Cross-Cutting I
Page 18
A final analys
pregnancy. A
with 56.9% q
among the yo
stratified by r
“Other” race
Additionally,
education, at
Source: PRAMS 200
Children
Nearly a quar
results are sim
not broken o
homes where
where someo
Georgia and
56.
0
10
20
30
40
50
60
70
80
90
100
Whi
ssues in Mate
sis was made
Among smoki
uitting in 200
oungest smo
race and edu
mothers at 9
the highest r
t 69.6%.
09‐2011
rter of childr
milar when c
ut by age gro
e someone s
one smokes c
nationally.
760.2
te Black
Percent of m
rnal and Child
e to examine
ng responde
09 compared
okers less tha
ucation, we n
90.9% and H
rate of quitti
en ages 0 to
categorized b
oups, we can
mokes. Whe
compared to
77.8
k Hispanic
mothers who
d Health
the percent
ents, the rate
d to 61.1% in
n 20 years at
notice that th
ispanic moth
ng during pr
17 years in G
by age (data n
n see that on
n stratified b
o 29.6% of W
90.9
c Other
o quit smoki
of mothers w
e of quitting d
n 2011. Addit
t 74.2% and
he highest rat
hers at 77.8%
egnancy was
Georgia live i
not shown),
ly a quarter o
by race/ethn
hite children
ng during pr
who reporte
during pregn
tionally, the r
oldest moth
te of quitting
% compared t
s among thos
in homes wh
and gender o
of children a
icity, 14.4% H
n. This racial/
34.2
< HS
regnancy, Ge
d quitting sm
nancy increas
rate of quitti
ers over 35 a
g during preg
to only 56.7%
se mothers w
here someon
of child. Whi
ges 0 to 17 y
Hispanic chil
/ethnic dispa
64.7
HS grad
eorgia, 2009
moking during
sed over the
ng was highe
at 75.5%. Wh
gnancy was a
% of White m
with post‐sec
e smokes. Th
ile Georgia’s
years old live
dren lived in
arity is seen in
69.6
> HS
9 to 2011
g
years,
est
hen
among
mothers.
condary
hese
data is
in
a home
n
S
G
9
a
s
c
Source: NSCH 2007
Georgia’s dat
99% FPL and
and in Georg
someone smo
children in th
18.3
1
0
5
10
15
20
25
30
35
Hispa
7 and 2011/12
ta are as exp
100 to 199%
ia. Families w
okes when c
he highest inc
26.1
14.4
2
nic Whit
Percent of crace/
ected when
% FPL, were m
within the low
ompared to
come level liv
25
29.6
2
te Black
children 0 to/ethnicity an
stratified by
more likely to
wer income b
children in th
ving in home
26.5
22.2
2
k Othe
o 17 years whnd gender, G
income, chil
o live in home
brackets wer
he two highe
es where som
28.4
er
ho live in hoGeorgia comp
Cross-Cuttin
dren in the t
es where som
re 30% more
er income cat
meone smoke
24.32
Male
mes where pared to the
ng Issues in Ma
two lower inc
meone smok
e likely to live
tegories, wit
es in 2011/12
23.925.3
2
e Fema
someone sme US, 2011/1
aternal and Ch
come catego
kes both natio
e in a home w
th only 10.8%
2.
24.5
ale
mokes by 12
Na
Ge
hild Health
Page 19
ories, 0 to
onally
where
% of
tionwide
orgia
C
P
S
A
h
B
a
Cross-Cutting I
Page 20
Source: NSCH 201
Although a sm
households w
Black children
and 3.6% of W
33.7
3
0
5
10
15
20
25
30
35
40
0 ‐ 99%
ssues in Mate
11/12
mall sample (
where someo
n lived in suc
White childre
31.430.9
3
% FPL 100 ‐ 1FPL
Percent of cincome an
rnal and Child
(N=65), data
one smokes i
ch homes in G
en.
22.6
34.4
2
99%L
200 ‐ 3FPL
children 0 tond special he
d Health
were also an
nside the ho
Georgia in 20
12.2
23.5
399%L
400% Fhigh
o 17 years wealth care ne
nalyzed for p
ome. 10.6% o
011/12. This
10.8
FPL orer
who live in hoeeds, Georgi
percent of ch
of “Other” rac
is compared
22.7
non‐CY
omes where a comapred
hildren ages 0
ce children a
d to only 1% o
29.8
23.7
YSHCN CYSH
someone smd to the US, 2
0 to 17 who l
as well as 7.4
of Hispanic c
29.8
HCN
mokes by 2011/12
N
G
lived in
4% of
children
ationwide
eorgia
S
T
w
b
c
c
c
Source: NSCH 2011
The data are
where someo
below 200% o
compared to
care needs liv
children with
1.9
0
2
4
6
8
10
12
Hispa
P
1/12
consistent fo
one smokes i
of the FPL. In
children wit
ved in house
h no special h
5.2
1.0
3
nic Whit
Percent of chinside the
or income ca
inside the ho
nterestingly,
hout special
holds with so
health care ne
9.0
3.6
7
te Black
hildren ages home by rac
tegories, wit
ome also livin
there was a
health care
omeone who
eeds (4.2%).
5.1
7.4
1
k Othe
0 to 17 whoce/ethnicity
2
th the largest
ng in househo
disparity am
needs, 8.2%
o smokes ins
0.6
r
o live in housand gender,2011/12
Cross-Cuttin
t percentage
olds where t
mong children
of children i
ide the home
5.0
3
Male
seholds wher, Georgia co
ng Issues in Ma
e of children
he total hou
n with specia
n Georgia w
e, nearly twi
4.8
3.6
6
e Female
ere someonempared to t
aternal and Ch
living in hom
sehold incom
l health care
ith special he
ce the perce
6.4
e
e smokes the US,
Nat
Geo
hild Health
Page 21
mes
me is
e needs
ealth
entage of
tionwide
orgia
C
P
S
A
G
a
2
Cross-Cutting I
Page 22
Source: NSCH 2007
Adolesce
Georgia’s hig
approximate
2013.
9.61
0
2
4
6
8
10
12
0 ‐ 99%
ssues in Mate
7 and 2011/12
nts
gh school stud
ly 12.8% with
7.1
10.0
% FPL 100 ‐ 1FP
Percent ofinside the h
rnal and Child
dents have m
h only 4.4% o
3.2
7.3
199%PL
200 ‐ FP
f children aghome by inc
d Health
met and exce
of high schoo
1.2
1.9
399%PL
400%hig
es 0 to 17 wome and spe
eeded this ob
ol students sm
0.4
% FPL orgher
who live in hoecial health US, 2011/12
bjective; the c
moking 20 o
4.2
non‐
ouseholds wneeds statu2
cigarette use
r more cigare
2
7.
4.2
‐CYSHSN C
where someos, Georgia c
e prevalence
ettes in a mo
78.2
YSHCN
one smokes ompared to
was
onth in
Nationwide
Georgia
S
H
c
h
f
Source: YRBS 2009
However, wh
compared to
high school st
female high s
0
2
4
6
8
10
12
14
16
18
20
P
‐2013
hen stratified
other racial/
tudents. Smo
school studen
16.9
6.3
8.5
13.7
2009
Percent of hi
by race, ciga
/ethnic group
okeless toba
nts compare
igh school st
Ever Smoke
Used Chewi
arette use w
ps and great
cco use was
d to White, H
tudents repo
d Cigarettes
ing Tobacco
as dramatica
er among ma
dramatically
Hispanic or m
17.0
7.5
9.6
17.8
2011
orting tobac2013
Smo
Smo
Cross-Cuttin
ally greater a
ale high scho
y lower amon
male student
co use by ye
oked 20 or mo
oked Cigars
ng Issues in Ma
among White
ool students
ng Black high
ts.
ear, Georgia,
ore Cigarettes
aternal and Ch
e high school
compared to
h school stud
12.8
4.4
9.5
13.5
2013
, 2009 to
hild Health
Page 23
students
o female
ents and
C
P
S
C
r
o
s
s
Cross-Cutting I
Page 24
Source: YRBS 2013
Cigar use was
respectively)
or more in 30
school studen
school studen
5.3
0.4
0
2
4
6
8
10
12
14
16
18
20
B
T
ssues in Mate
s dramaticall
compared to
0 days) was u
nts. Chewing
nts at 5.3%.
12.
4
4.4
12.1
lack
The percent
Ever Smok
rnal and Child
y higher in H
o White midd
uncommon in
g tobacco wa
.9
4.6
10.5
18.
Hispanic
of high scho
ked Smok
d Health
Hispanic and
dle school st
n middle sch
s highest am
18.5
7.4
12
1
White
ool students
gender
ked 20 or more
Black middle
udents at 2.9
ool students
mong White m
.5 12.7
e
reporting to
r, Georgia, 20
e Used C
e school stud
9% in 2013. H
s, particularly
middle schoo
1
obacco use b
013
Chewing Tobac
dents (6.8% a
Heavy tobacc
y in female a
ol students at
11.8
3.82.8
10
Female
by race/ethn
cco Smoke
and 7.1%,
co use (20 cig
nd Hispanic m
t 5% and mal
13.7
5.1
1
0.5
Mal
nicity and
ed Cigars
garettes
middle
le middle
15.716.2
le
S
TgNsTm
Source: YRBS 2013
The overall pgrade increasNon‐Hispanicstudents. MidThere are minmales are mo
4.6
0.7
0
2
4
6
8
10
12
14
16
B
Eve
ercent of higses. When stc Whites are ddle School snor differencore likely to s
3.
7
1.9
7.1
lack
The pe
er Smoked Ciga
gh school sturatifying by rmore likely tstudents are ces between smoke e‐ciga
8
1
5
2.9
White
ercent of mirace/
arettes Sm
dents reportrace/ethnicitto smoke e‐cless likely (4middle scho
arettes than t
5.0
0.3
4.1
Hispani
ddle school /ethnicity an
moked 20 or m
ting using e‐cty, there are cigarettes tha%) to report ool students otheir female
1
6.8
c
students whd gender, Ge
more cigarettes
Cross-Cuttin
cigarettes is 8similar pattean Non‐Hispae‐cigarette uof different rcounterpart
3.
ho report toeorgia, 2013
Chewing
ng Issues in Ma
8.6%. The prerns to traditanic Black anuse than highraces and gras.
6
0.3
2.1
3.9
Female
bacco use b3
tobacco S
aternal and Ch
revalence inctional tobaccnd Black high h school studade levels, ho
4.7
1.2
5.3
Male
y
Smoked Cigars
hild Health
Page 25
creases as o use. school dents. owever
36.2
s
C
P
S
S
Cross-Cutting I
Page 26
Source: YTS 2013
Source: YTS 2013
8.6
0
2
4
6
8
10
12
Overall
P
4.0
0.0
1.0
2.0
3.0
4.0
5.0
6.0
Overal
P
ssues in Mate
6.7
9th
Percent of hi
l
Percent of m
rnal and Child
7
9.2
h 10th
igh school stgrade, ra
3.5 3.5
6th 7th
middle schooby grade,
d Health
8.8
9.7
11th 12th
tudents whoace/ethnicity
4.7
8th
ol students wrace/ethnici
7
Hisp
o smoked e‐cy and gende
4.1
Hispani
who smoked ty and gend
7.2
5.6
panic NHBlack
cigarettes in r, Georgia, 2
4.7
ic NH BlackW
e‐cigaretteser, Georgia,
10.5
NHWhite
the past 30 2013
3.3
NHWhite
s in the past 2013
7.0
Female
days by
2.9
Female M
30 days
9.8
Male
5.0
Male
H
CW
c
5
2
a
S
W
a
h
f
w
HEALTH IN
Children When looking
category, bot
5 years old), a
2011/2012 G
and has fallen
Source: NSCH 2007
When stratifi
adequately in
households w
families in th
what is seen
80.8
8
50
55
60
65
70
75
80
85
90
0‐5 yr
NSURANC
Insurancg at insuranc
th in Georgia
and while Ge
eorgia’s child
n behind the
7 and 2011/12
ied by incom
nsured both
where the inc
e higher two
nationally.
74.
85.2
rs old 6‐11
2
Percent of c
CE
ce Status ce status, mo
a and in the U
eorgia report
dren experie
e nation for a
e, more than
nationally an
come lies bet
o income bra
.9 7
82
1 yrs old 12
2007
children ageGeorgia
ore than 70%
US. The highe
ted rates con
enced a loss o
ll age groups
n 80% of chil
nd in Georgia
tween 100 to
ckets is exac
73.7
77.2
‐17 yrs old
es 0 to 17 whcompared to
% of all childre
est rate of ins
nsistently hig
of insurance
s with the ex
dren 0 to 17
a, compared
o199% FPL. T
tly the same
80.780.5
0‐5 yrs old
ho are adequo the US, 20
Cross-Cuttin
en are adequ
surance was
gher than the
at a staggeri
xception of 12
years old in
to only 70.8%
The rate of in
in Georgia, t
75.774.4
6‐11 yrs old
2011/12
uately insure007 and 2011
ng Issues in Ma
uately insure
among very
e national ave
ng rate acro
2 to 17 year
the 0 to 99%
% of children
nsurance cov
this is a diffe
73.273.8
12‐17 yrs o
ed by year a1/12
aternal and Ch
d in every ag
y young child
erage in 200
ss each age c
olds.
% FPL were
n who live in
verage for ch
erent pattern
8
old
nd age,
Nat
Geo
hild Health
Page 27
ge
ren (0 to
7, as of
category,
ildren in
n then
ionwide
orgia
C
P
S
U
s
f
Cross-Cutting I
Page 28
Source: NSCH 2011
Upon stratify
significantly h
females gene
80.6 8
50
55
60
65
70
75
80
85
90
0 ‐ 99%
ssues in Mate
1/12
ying by race,
higher rate o
erally have si
75.6
80.4
7
% FPL 100 ‐ 19FPL
Percent ofspec
rnal and Child
we do not se
of insurance (
milar rates o
73.370.8
7
99% 200 ‐ 39FPL
f children agcial health ne
d Health
ee any notab
(82.9%) comp
of insurance,
77.26.5 7
99% 400% FPhighe
es 0 to 17 weeds status,
le disparities
pared to only
both nationa
6.5
PL orer
who are adeqGeorgia com
s, except tha
y 67.5% of “O
ally and with
77.976
non‐CYSH
quately insurmpared the
t Hispanic ch
Other” race c
hin Georgia.
70.8
6.774
HCN CYSHC
red by incomUS, 2011/12
hildren have
children. Ma
4.6
N
me and 2
Nat
Geo
a
les and
ionwide
orgia
S
T
s
h
1
c
Source: NSCH 2011
The data for c
starting in 20
health insura
12.8% of child
comparable t
75.7
82
0
10
20
30
40
50
60
70
80
90
Hispa
P
1/12
children ages
012, while the
nce compare
dren did not
to US data fo
77.1
2.9
75
nic Whit
Percent of ch
s 0 to 17 yea
e decline beg
ed to 7.3% in
have insuran
or that year.
78.15.7
7
te Blac
hildren ages gender
rs without h
gan nationall
n 2013. In 20
nce. But, in j
73.878
6
ck Othe
0 to 17 whor, Georgia co
ealth insuran
ly in 2010. In
12, there wa
ust a year th
7.5
er
o are adequaompared to t
Cross-Cuttin
nce coverage
n 2010, 9.8%
as a notable p
e rate fell ba
75.77
Mal
ately insuredthe US, 2011
ng Issues in Ma
e in Georgia h
of children in
peak in Geor
ack down to 7
77.374.8
7
le Fema
d by race/eth1/12
aternal and Ch
has begun to
n the US did
rgia data, wh
7.8%, which
77.9
ale
hnicity and
Na
Ge
hild Health
Page 29
o decline
not have
ere
is very
ationwide
eorgia
C
P
S
I
i
n
t
H
l
c
Cross-Cutting I
Page 30
Source: Current Po
n 2011/12, G
n insurance o
nationally an
than it is in G
However, the
acking insura
consistent ins
9
1
0
2
4
6
8
10
12
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2
P
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Georgia lagge
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Georgia, rang
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US Proport
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e Female
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rance in o the US,
Nati
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hild Health
Page 31
Not ompared
onwide
rgia
C
P
S
Cross-Cutting I
Page 32
Source: NSCH 2011
82.9
0
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20
30
40
50
60
70
80
90
100
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ssues in Mate
1/12
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Percent of chin the past
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hildren 0 to 12 months b
d Health
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400% Fhigh
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eorgia
Cross-Cutting Issues in Maternal and Child Health
Page 33
CONCLUSION This report has explored the status of Georgia’s mothers, children, and adolescences, with respect to oral
hygiene, tobacco use, and insurance status, using Health People 2020 objectives as the standard. Upon
stratifying the date by race/ethnicity, gender, education and income, there are many important
conclusions. Georgia is a leader in many areas. For example, Georgia has demonstrated excellence in
ensuring its residents have access to fluoridated water, with over 96.4% of individuals in Georgia having
regular access to fluoridated water. Increasing access to fluoridated water is not only a public health
success, but Georgia’s excellence in this area provides an example for other states to follow. Additionally,
Georgia’s mothers and children have shown steady improvement in oral hygiene, with respect to reporting
preventive oral health visits as well as poor oral health outcomes. There is room for improvement,
numerous disparities in race/ethnicity, income and education are present in the data and indicates the
need to focus on the following areas:
Increasing the awareness of the importance of oral health to overall health status and well‐being to
children ages 6 to 11 and to Hispanic and low income populations
Reducing smoking among White mothers during pregnancy and among adolescents
Improving health insurance coverage for Native Americans
Reducing smoking among adolescents
Improving oral health outcomes in lower income communities
Increasing dental visits during pregnancy
Because of the strong correlation that oral health and insurance status has with overall health status, it is
crucial for the state health department to pay special attention to these areas of concern and think about
the root causes for these disparities. For example, the data revealed that oral health problems such as
tooth decay and cavities were more likely in low‐income populations. This is likely because historically
lower income communities have less access to oral health care than those in higher incomes. Moreover,
they also are more likely to have other barriers to accessing oral health care, such as lack of flexible
schedule or dentists in their area. As such, it is recommended to think of innovative ways to increase access
to oral health care for lower income children, such as school‐based oral health screenings.
Analysis of smoking during pregnancy revealed that White mothers had higher rates of smoking during
pregnancy compared to other racial and ethnic groups. White adolescents also had higher rates of smoking
compared to their peers as well. Finally, children in lower income families were more likely to live in
households where someone smokes compared to those in higher income families. It is important to
increase efforts to raise awareness on the importance of smoking reduction as well as the health impact of
exposure to second hand smoke.
As such we recommend the following:
Focus should be on reduction of smoking during pregnancy, among adolescents, and inside the
home in the presence of children.
It is crucial to think about additional barriers to oral healthcare, such as cost or inflexible work
schedules, and work to increase access to oral health services and screenings using innovative
strategies.
Cross-Cutting Issues in Maternal and Child Health
Page 34
Increasing awareness and education efforts around oral health that are culturally‐sensitive may
improve understanding in minority communities.
