Laurin Kasehagen, MA, PhDMCH Epidemiologist / CDC Assignee to CityMatCHMaternal & Child Health Epidemiology ProgramApplied Sciences Branch, Division of Reproductive HealthNational Center for Chronic Disease Prevention & Health Promotion

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Workshop Objectives

Locate and obtain data on child health and school readiness from national surveillance systems

Explain some limitations of local level data and how these limitations can affect conclusions

Describe ways in which outcomes for cities and counties differ from each other and from state / national outcomes

Provide hands-on opportunity to work with surveillance data

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Introduction & Overview

Importance of local data

Introduction to local data sources

What’s available How to use it Advantages and

limitations of these data sources

How city/county level outcomes differ from state/national level outcomes

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Why is local data important? “. . . . [Such] data are

essential in identifying communities most at risk of poor health outcomes,

exploring the determinants of such variations in health, and

ultimately guiding community health programs and policies.”

From: Shah, Whitman & Silva in “Variations in the Health Conditions of 6 Chicago Community Areas: A Case for Local-Level Data”

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Misperceptions about local-level data Not available Not accessible Too difficult to use Don’t have what I need

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Table 1. National Surveillance Systems and Surveys of Infant &

Child PopulationsSurvey Name Age

Range

Survey Purpose Survey Interval

Local Level?

Pediatric Nutrition Surveillance System (PedNSS)

0-5 years*

describes the nutritional status of low-income children attending federally-funded MCH / nutrition programs

Routinely,

annually

Yes**

National Immunization Survey (NIS)

19-35 month

s

estimates of vaccination coverage rates for all childhood vaccinations recommended by the ACIP‡

Annually Yes^

National Survey of Children’s Health (NSCH) #

0-17 years

examines the physical and emotional health of children, including medical homes, family interactions, parental health, school and after-school experiences, and neighborhoods

Every 4 years

Yes^£

National Survey of Children with Special Health Care Needs (NS-CSHCN) #

0-17 years

assesses the prevalence and impact of special health care needs among children

Every 4 years

Yes^£

Pregnancy Risk Assessment Monitoring System (PRAMS)

<6 month

s

Collects data on maternal attitudes and experiences before, during, and shortly after pregnancy

Annually Yes**

National Health and Nutrition Survey †

<18 years

assesses the health and nutritional status

Routinely,

annually

Yes**

National Health Interview Survey (NHIS) †

<18 years

assesses amount, distribution, and effects of illness / disability and the services rendered for / because of the conditions

Routinely,

annually

Yes**

* some data on 0-20 years; ** access to local level data through local WIC agencies / local health department or state health department; # survey samples both children and youth with special health care needs as well as a smaller sample of children and youth without special health care needs; ‡ Advisory Committee on Immunization Practices (ACIP); ^ access to local level data by written request to National Center for Health Statistics; data for MSA/non-MSA and broad rural / urban categories is publically available; £ on-line, interactive CAHMI web-site provides data by Rural Urban Community Area taxonomy for urban core, suburban, large town, and small town/rural geographic categories; † surveys at the household level of both adults and children

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Table 2. National Surveillance Systems and Surveys of Adolescent

& Adult PopulationsSurvey Name Survey Purpose Survey

IntervalLocal Level?

Youth Risk Behavior Surveillance System (YRBSS)

monitors priority health-risk behaviors and the prevalence of obesity and asthma among youth and young adults

Annually Only for certain large

school districts

National Survey of Family Growth (NSFG)

gathers information on family life, marriage and divorce, pregnancy, infertility, use of contraception, and men's and women's health

Periodic Yes^

Pregnancy Surveillance System (PNSS)

monitors risk factors associated with infant mortality and poor birth outcomes among low-income pregnant women who participate in federally funded public health programs

Routinely, annually

Yes**

Pregnancy Risk Assessment Monitoring System (PRAMS)

collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy

Annually Yes**

Behavioral Risk Factor Surveillance System (BRFSS)

collects information on health risk behaviors, preventive health practices, and health care access primarily related to chronic disease and injury

Annually Yes

^ access to local level data by written request to National Center for Health Statistics; data for MSA/non-MSA and broad rural / urban categories is publically available** access to local level data through local WIC agencies / local health department or state health department

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Table 3. Laurin’s Favorite On-line Interactive Websites and Web PortalsWebsite Unique Website Feature(s)

PeriStats -- http://www.marchofdimes.com/peristats/city, county, state, national maternal and infant health data

Premature Birth Report Card; PubMed literature search feature; indicators; map feature

CAHMI -- http://www.cahmi.org/pages/Home.aspxportal to the Data Resource Center for the NSCH and the NS-CSHCNquality measurement tools and strategies that assess the quality of care

Quality measurement tools and strategies; examples of applications of CAHMI tools and data use; mental health chartbooks; medical home portal; SSI data

Community Health Data Initiative -- http://www.data.gov/healthnational initiative to help consumers and communities to access health data in usable formats and to encourage effective efforts in disease prevention, health promotion, and measurement of health care quality and performance

Publically available data and tools with rating of data / tool

Health Data Interactive -- http://www.cdc.gov/nchs/hdi.htmtables with national health statistics for infants, children, adolescents, adults, and older adults

Tables can be customized by age, gender, race/ethnicity, and geographic location to explore different trends and patterns

Health Indicators Warehouse -- http://www.healthindicators.gov/over 1100 indicators by topic, geography, and initiativeportal to initiatives and data sources

Indicator mapping by state, county or hospital referral region; comprehensive data source resource list

Community Health Status Indicators -- http://www.communityhealth.hhs.gov/key health indicators for local communities (3141 US counties)

Ability to select county of interest and peer counties (counties of similar population size and frontier status)

NRCCWDT – National Resource Center for Child Welfare Data and Technology -- https://www.nrccwdt.org/index.htmlassists state, local and tribal child welfare agencies and the courts in improving outcomes for children and families through the use of data and information technology

Toolkits; training on using information and data in planning and measuring progress

National Center for Environmental Health -- http://www.cdc.gov/nceh/data.htmportal to nationally funded environmental public health data systems

Links to and descriptions of major data systems with a national scope where public health and environmental data can be downloaded

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WOW! There are a lot of different data sources! Where do I start? Known Data Source Topic Initiative / Indicator

Existing indicators linked to data sources Geography

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Table 4. Council of State and Territorial Epidemiologists (CSTE) Indicator Resources

Chronic Disease Chronic Disease Indicators

Environmental Health

CDC/NECH Environmental Public Health Indicators Project

Environmental Public Health Indicators

Injury State Injury Indicators Report: Fourth Edition

Maternal and Child Health

Core State Preconception Indicators

Occupational Health Occupational Health Indicators: A Guide for Tracking Occupational Health Conditions and Their Determinants

Note: To access these resources and publications go to the CSTE website: http://www.cste.org/

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Ways to measure the health of children under 10 years of age Healthy People 2020

42 Topic Areas 1,412 Objectives

262 are developmental objectives

Over 160 HP2020 objectives relate to children Maternal, Infant, and Child Health Early and Middle Childhood Immunization and Infectious Diseases Nutrition and Weight Status Oral Health Physical Activity

Local-level data is not available for all of these objectives

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Finding Local-Level Data Examples HealthyPeople.gov

http://healthypeople.gov/2020/default.aspx Mental Health Status Improvement

HP2020 Objective MHMD-6: Treatment for children with mental health problems

Maternal, Infant, and Child Health HP2020 Objective MICH-30: Increase the

proportion of child, including those with special health care needs, who have access to a medical home

Early and Middle Childhood HP2020 Objective EMC-2.3: Increase the

proportion of parents who read to their young child

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HP2020 Objective MHMD-6: Treatment for children with mental health problems; Data compiled at the Health Indicators Warehouse from the 2008 National Health Interview Survey

68.90%(62.70%, 75.10%)

82.51%(74.84%, 90.19%)

57.97%(48.79%, 67.15%)

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Is there local-level information on reading to young children?

Website: http://www.nschdata.org/Content/Default.aspx; accessed 07/26/2011.

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Data on reading to young children is available on-line at the national, regional, state levels

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On-line data can be looked at and compared through a number of different subgroups

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How can you tell whether the statistic that you have is significant?

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How can you tell whether the statistic that you have is significant?

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Community Health Status IndicatorsComparison of Peer Counties: Risk Factors for Premature Death

Boone County, MO Deschutes County, OR

Santa Fe County, NM

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Why is local-level data so hard to get? Data may not be collected at the

household, city, or county level e.g., some national and state surveys collect

data only for large metropolitan areas, or select a few areas to represent all

Data may be reported only for jurisdictions with populations of 100,000 or more For smaller jurisdictions, data may be

aggregated21

If you do get your hands on local data, what do you need to watch out for? Confidentiality

e.g., “Hey look, this dataset has a family of 12 kids, including 3 sets of twins! I’ll bet that’s the Smiths from down the street. Whoa, it says here that Mrs. Smith only has an 8th grade education.”

Rare events / small numbers of “events” (death, birth defects) limited statistical power several years may need to be combined

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National, state, or MMSA level data may not capture events at the local level

1.000.80

0.60

1.00

1.50

1.80

2.40

0.00

0.50

1.00

1.50

2.00

2.50

3.00

United States Large Central Metro

Large Fringe Metro

Medium Metro Small Metro Micropolitan NonCore

Crude Mortality Rates per 100,000 from Fire/Flame<9 year-olds, 2003-2007, USA

Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1999-2007. CDC WONDER On-line Database, compiled f rom Com

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Small populations / rare events in a population can produce dramatic, erratic results

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Other concerns about data . . . Where did the numbers came from?

a source that collects information on ALL of the population (e.g. Census, Vital Records)

a representative sample of the population a convenience sample of some people

Quality of data is affected by practices related to Recording Collecting Reporting

Potential sources of data differ greatly per type of event – deaths, injuries, illnesses require complex surveillance systems

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Limitations: How well do county data represent city populations? Some public health issues that affect

cities will not be accurately represented using county-level data Generally, counties are larger

geographical areas that also include suburban and even rural areas

Some large cities are spread over several counties

Some counties do not include their urban central city

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Evidence-Based Practice for Public Healthhttp://library.umassmed.edu/ebpph/

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The Community Guide (CDC) http://www.thecommunityguide.org/

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Health Policy Guidehttp://healthpolicyguide.org

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PHPartnershttp://phpartners.org/

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YOU can put the pieces together

National vital records and state survey data provide broad context

“Where do we stand?”

Local survey and subpopulation data allow us to dig deeper

“What are underlying causes?”

Local investigation and action

“What do we know about our systems, our communities?”

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http://www.citymatch.org/citylights.php32

CityMatCH Mission

Improving the health and well-being of

urban women, children and families

by strengthening public health

organizations and leaders in their communities

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References

Shah, Whitman & Silva. Variations in the Health Conditions of 6 Chicago Community Areas: A Case for Local-Level Data. Am J Public Health 96(8): 1485-91 (2006).

Brownson, et al. Evidence-Based Decision-Making in Public Health. J Public Health Manag Prac 5:86-87 (1999).

The Cochrane Collaboration; www.cochrane.org Association of Maternal and Child Health

Programs (AMCHP) Best Practices; http://www.amchp.org/AboutAMCHP/BestPractices/Pages/default.aspx

National Association of City and County Health Officials; http://www.naccho.org/

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Contact Information

Laurin Kasehagen, PhD, MA

Senior MCH Epidemiologist / CDC Assignee to CityMatCH

lkasehagen@unmc.edulkasehagen@cdc.gov

CityMatCH at the University of Nebraska

Medical CenterDepartment of

Pediatrics982170 Nebraska

Medical CenterOmaha, NE 68198-2170402-561-7500

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