maternal child health and chronic disease wphi presentation... · 2008-07-22 · results and...
TRANSCRIPT
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Maternal Child Health and Chronic Disease
The Odd Couple
orA Marriage Made in Heaven?
AMCHP Women and Perinatal Health Information Series July 17, 2008
Joan Ware, MSPH, RN, Consultant, Women’s Health Council, National Association of ChronicDisease Directors
Maternal Child Health and Maternal Child Health and
Chronic DiseaseChronic DiseaseThe Odd CoupleThe Odd Couple
oror
A Marriage Made in Heaven?A Marriage Made in Heaven?
AMCHP Women and Perinatal Health Information Series
July 17, 2008July 17, 2008
Joan Ware, MSPH, RN, Consultant, WomenJoan Ware, MSPH, RN, Consultant, Women’’s Health Council, National Association of Chronics Health Council, National Association of Chronic
Disease DirectorsDisease Directors
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
OutlineOutlineOutline•• What is NACDD?What is NACDD?
•• Why chronic disease and MCH?Why chronic disease and MCH?
•• Why gestational diabetes?Why gestational diabetes?
•• What is the Gestational Diabetes What is the Gestational Diabetes
Collaborative ProjectCollaborative Project
•• What can MCH programs do?What can MCH programs do?
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
PRAMSPRAMSPregnancy Risk Assessment andPregnancy Risk Assessment and
Monitoring SystemMonitoring System
CollaboratorsCollaborators
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Who is NACDD?Who is NACDD?Who is NACDD?•• The The ““AMCHPAMCHP”” for Chronic Diseasefor Chronic Disease
•• More than 800 members from every US More than 800 members from every US
state and territory state and territory
•• 16 Councils and special interest groups 16 Councils and special interest groups
supporting state public health activities supporting state public health activities
focusing on specific chronic disease focusing on specific chronic disease
and health promotion areasand health promotion areas
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Councils and Special Interest Groups
Councils and Special Councils and Special
Interest GroupsInterest Groups
•• AsthmaAsthma
•• ArthritisArthritis
•• CancerCancer
•• DiabetesDiabetes
•• Heart Disease and Heart Disease and
StrokeStroke
•• School HealthSchool Health
•• WomenWomen’’s Healths Health
•• OsteoporosisOsteoporosis
•• ObesityObesity
•• Healthy AgingHealthy Aging
•• Health DisparitiesHealth Disparities
•• Physical ActivityPhysical Activity
•• Vision and Eye Vision and Eye
HealthHealth
•• Tobacco Use Tobacco Use
PreventionPrevention
•• DepressionDepression
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Why Link MCH and Chronic Disease/Health Promotion?
Why Link MCH and Chronic Why Link MCH and Chronic
Disease/Health Promotion?Disease/Health Promotion?
•• Preconception care is important, especially for Preconception care is important, especially for women with chronic diseaseswomen with chronic diseases
–– Risk factors and conditions can be identified Risk factors and conditions can be identified early and addressedearly and addressed
•• Pregnancy can unmask a potential for chronic Pregnancy can unmask a potential for chronic diseasesdiseases
•• Pregnancy is an entry point into health care and Pregnancy is an entry point into health care and an opportunity for primary prevention of chronic an opportunity for primary prevention of chronic diseasesdiseases
ChronicChronicDiseaseDisease
MCMCHH
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Why Chronic Disease?Why Chronic Disease?Why Chronic Disease?
Among women of child bearing age:Among women of child bearing age:
•• Asthma (medication risk)Asthma (medication risk) 6.1%6.1%
•• Hypertension/CVD Hypertension/CVD 6.4%6.4%
•• DiabetesDiabetes 9.3%9.3%
•• Smoke during pregnancySmoke during pregnancy 11.4%11.4%
•• Overweight or obeseOverweight or obese 55.0%55.0%
•• 250,000 breast cancer250,000 breast cancer
survivors under age 40survivors under age 40
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Why Chronic Disease?Why Chronic Disease?Why Chronic Disease?Of women who are pregnant:Of women who are pregnant:
•• 33--8% will develop gestational diabetes8% will develop gestational diabetes
•• 1010--15% will develop postpartum depression15% will develop postpartum depression
•• If overweight prior to pregnancy, her offspring is 3 times more If overweight prior to pregnancy, her offspring is 3 times more likely to be overweight by age 7likely to be overweight by age 7
•• If preeclampsia developed in pregnancy there is an increased If preeclampsia developed in pregnancy there is an increased lifetime risk of metabolic syndrome, ischemic heart disease and lifetime risk of metabolic syndrome, ischemic heart disease and stroke stroke
•• Postpartum state confers 5Postpartum state confers 5--fold risk of newfold risk of new--onset rheumatoid onset rheumatoid arthritis, especially after first pregnancyarthritis, especially after first pregnancy
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Why Now?Why Now?Why Now?
•• The perinatal period is too late to modify maternal The perinatal period is too late to modify maternal
behaviors, health conditions and risk factorsbehaviors, health conditions and risk factors
•• Rising prevalence of obesity and diabetes and the Rising prevalence of obesity and diabetes and the
trend to delay child bearing until later in life mean trend to delay child bearing until later in life mean
women are more likely to have chronic disease risk women are more likely to have chronic disease risk
factors which complicate pregnancyfactors which complicate pregnancy
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Why Now?Why Now?Why Now?
New Target Populations for New Target Populations for
Prevention of Chronic DiseasePrevention of Chronic Disease
•• PreconceptionPreconception
•• InterpregnancyInterpregnancy
•• PostpartumPostpartum
•• InterconceptionInterconception
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Collaboration Issue: Gestational Diabetes
Collaboration Issue: Collaboration Issue:
Gestational DiabetesGestational Diabetes
As defined by the As defined by the Hyperglycemia and Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) Study Adverse Pregnancy Outcomes (HAPO) Study Cooperative Research Group :Cooperative Research Group :
““GGlucose intolerance with onset or first lucose intolerance with onset or first recognition during pregnancy.recognition during pregnancy.
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Why Gestational Diabetes?Why Gestational Diabetes?Why Gestational Diabetes?• Gestational diabetes (GDM) is the Gestational diabetes (GDM) is the
most common metabolic disorder of most common metabolic disorder of
pregnancypregnancy
•• GDM is a leading cause of maternal GDM is a leading cause of maternal
hospitalizations prior to delivery, and hospitalizations prior to delivery, and
results in longer hospital staysresults in longer hospital stays
•• Method to promote healthier moms and Method to promote healthier moms and
offspring, and prevent a major offspring, and prevent a major
chronic disease at the same time chronic disease at the same time
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Prevalence of GDMPrevalence of GDMPrevalence of GDM
•• Prevalence ranges between 1%Prevalence ranges between 1%--14% 14% 11
•• Complicates 4% of all pregnancies annually Complicates 4% of all pregnancies annually 11
•• Affects 150,000Affects 150,000--200,000 pregnancies each year200,000 pregnancies each year
in the United States in the United States 22
1. Diagnosis and Classification of Diabetes Mellitus. ADA. Diabetes Care. Volume 30, Supplement 1, January 2007.
2. CDC Division of Diabetes Translation, 2007 Teleconference Presentation to Connecticut Data Surveillance Work Group
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
What are the Concerns?What are the Concerns?What are the Concerns?
•• 14% of risk of developing type 2 diabetes in 20 weeks 14% of risk of developing type 2 diabetes in 20 weeks after pregnancyafter pregnancy
•• 5050--65% risk of GDM with next pregnancy65% risk of GDM with next pregnancy
•• 2020--30% risk of type 2 in 730% risk of type 2 in 7--10 years10 years
•• 5050--70% risk of type 2 progression in lifetime70% risk of type 2 progression in lifetime
•• Increased risk of type 2 DM in children of mothers Increased risk of type 2 DM in children of mothers with GDMwith GDM
Kim, C., Newton, K.M., and Knopp, R.H. 2002. . Gestational diabetes and the Incidence of Type 2 Diabetes. Diabetes Care. 25:1862-1868.
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
The Risks of GDMThe Risks of GDMThe Risks of GDM•• Miscarriages and stillbirthMiscarriages and stillbirth
•• Increased inductions and CIncreased inductions and C--sectionssections
•• MacrosomiaMacrosomia
•• Intrauterine developmental and growth abnormalitiesIntrauterine developmental and growth abnormalities
•• PreeclamsiaPreeclamsia
•• DepressionDepression
•• Birth and neonatal complications (e.g. shoulder dystocia)Birth and neonatal complications (e.g. shoulder dystocia)
•• Offspring predisposed to obesity and type 2 diabetesOffspring predisposed to obesity and type 2 diabetes
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
GDM ScreeningGDM ScreeningGDM Screening
•• Screening recommended at 24Screening recommended at 24--28 weeks gestation, 28 weeks gestation,
even if no high risk factorseven if no high risk factors
•• Some guidelines recommend earlier screening if Some guidelines recommend earlier screening if
high risk to rule out type 2 diabeteshigh risk to rule out type 2 diabetes
•• First screening test should be 1First screening test should be 1--hr GCT hr GCT 11
•• If elevated level, then women undergo a 2If elevated level, then women undergo a 2--hr or 3hr or 3--hr hr
OGTT to confirm OGTT to confirm 11
1. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care, Volume 30, Supplement I, January 2007, pp S42-S47
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Screening RecommendationsScreening RecommendationsScreening Recommendations
High Risk for GDMHigh Risk for GDM
–– Age > 35 yearsAge > 35 years
–– BMI > 29 kg/mBMI > 29 kg/m2 2 beforebefore pregnancypregnancy
–– Personal history of GDMPersonal history of GDM
–– Previous macrosomic infantPrevious macrosomic infant
–– History of GDM related obstetric complicationsHistory of GDM related obstetric complications
–– Racial/ethnic group with high prevalence of GDMRacial/ethnic group with high prevalence of GDM
–– First degree relative with diabetesFirst degree relative with diabetes
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Goals of the ProjectGoals of the ProjectGoals of the Project
•• Compare PRAMS data to medical recordsCompare PRAMS data to medical records
•• Examine routinely collected data to assess quality of Examine routinely collected data to assess quality of
data data
•• Summarize findingsSummarize findings
•• Make recommendations for improving quality of data Make recommendations for improving quality of data
systems and applications to improve caresystems and applications to improve care
•• Enhance collaboration among public health programsEnhance collaboration among public health programs
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Why Did DDT Fund This Project?
Why Did DDT Fund Why Did DDT Fund
This Project?This Project?
•• Establish 6Establish 6--state collaboration to identify, catalogue, state collaboration to identify, catalogue, and validate routinely collected data about GDMand validate routinely collected data about GDM
•• Identify gaps in quality of GDM prevalence data Identify gaps in quality of GDM prevalence data
•• Develop recommendations for improving data Develop recommendations for improving data qualityquality
•• Determine implications for careDetermine implications for care
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Five State CollaborativeFive State CollaborativeFive State Collaborative•• MichiganMichigan
•• North CarolinaNorth Carolina
•• OklahomaOklahoma
•• UtahUtah
•• West VirginiaWest Virginia
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
BackgroundBackgroundBackground
•• Prevalence rates of gestational diabetes from Utah Prevalence rates of gestational diabetes from Utah 2004 PRAMS and 2004 birth certificates were 2004 PRAMS and 2004 birth certificates were comparedcompared
•• 6.1% reported high blood sugar level according to 6.1% reported high blood sugar level according to PRAMS weighted dataPRAMS weighted data
•• 2.4% had GDM recorded on birth certificates2.4% had GDM recorded on birth certificates
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
PRAMS 2004 Questions on Blood Sugar
PRAMS 2004 Questions on PRAMS 2004 Questions on
Blood SugarBlood Sugar
Did you have any of these problems during Did you have any of these problems during your most recent pregnancy?your most recent pregnancy?
High blood sugar (diabetes) thatHigh blood sugar (diabetes) that
started before this pregnancystarted before this pregnancy YesYes NoNo
High blood sugar (diabetes) thatHigh blood sugar (diabetes) that
started during this pregnancystarted during this pregnancy YesYes NoNo
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Study QuestionStudy QuestionStudy Question
How does gestational diabetes How does gestational diabetes
identified on PRAMS and NOT on identified on PRAMS and NOT on
the birth certificate compare with the birth certificate compare with
medical records?medical records?
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
2004 Utah PRAMS Surveys2004 Utah PRAMS Surveys2004 Utah PRAMS SurveysElevated BloodElevated Blood
Sugar on PRAMSSugar on PRAMS
N=136N=136
GDM on BirthGDM on Birth
CertificateCertificate
4646
(34%)(34%)
GDM Not on BirthGDM Not on Birth
CertificateCertificate
9090
(66%)(66%)
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Validation MethodsValidation MethodsValidation Methods
•• Selected all 90 women reporting Selected all 90 women reporting ““high blood sugar high blood sugar
levels during most recent pregnancylevels during most recent pregnancy”” on 2004 PRAMS on 2004 PRAMS
survey but GDM not recorded on birth certificatesurvey but GDM not recorded on birth certificate
•• Of these, 80 hospital medical records were available Of these, 80 hospital medical records were available
for reviewfor review
•• Conducted IRBConducted IRB--approved review of hospital records to approved review of hospital records to
validate GDM datavalidate GDM data
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Definition of GDM used in Medical Record Review
Definition of GDM used in Definition of GDM used in
Medical Record ReviewMedical Record Review•• 2 abnormal values on the 32 abnormal values on the 3--hour OGTT hour OGTT
(Carpenter/Coustan diagnostic criteria) (Carpenter/Coustan diagnostic criteria)
•• Physician or other health care provider wrote Physician or other health care provider wrote
““gestational diabetesgestational diabetes”” diagnosis in chartdiagnosis in chart
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Women who reported GDM on PRAMS but GDM was not
Indicated on the BC (n=80)
Women who reported GDM on Women who reported GDM on
PRAMS but GDM was not PRAMS but GDM was not
Indicated on the BC (n=80)Indicated on the BC (n=80)
100.0%100.0%TotalTotal
62.5%62.5%No GDMNo GDM
25.0%25.0%GDMGDM
12.5%12.5%No informationNo information
Medical Record ReviewMedical Record Review
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Documentation of GDM Tests Results and Follow-up
Documentation of GDM Tests Documentation of GDM Tests
Results and FollowResults and Follow--upup
100.0%100.0%TotalTotal
27.5%27.5%
Inadequate documentationInadequate documentation
(e.g. No testing or results (e.g. No testing or results
information; no followinformation; no follow--up test up test
on elevated 1on elevated 1--hr GTT tests)hr GTT tests)
72.5%72.5%1 hr screen and 31 hr screen and 3--hr OGTT hr OGTT
documented on chart reviewdocumented on chart review
Medical Record ReviewMedical Record Review
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
ConclusionsConclusionsConclusions
1.1. The PRAMS survey question is not specific for The PRAMS survey question is not specific for
GDM, and should not be used as a source for GDM, and should not be used as a source for
prevalence of gestational diabetes in Utah. prevalence of gestational diabetes in Utah.
2.2. Birth certificate data underestimated the Birth certificate data underestimated the
prevalence of GDMprevalence of GDM
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Problems with GDM SurveillanceProblems with GDM SurveillanceProblems with GDM Surveillance
•• There are no universally accepted There are no universally accepted ““Gold StandardGold Standard””guidelines. guidelines.
•• Guideline conflicts affect the prevalence of GDM. Guideline conflicts affect the prevalence of GDM.
•• Inconsistencies in reporting and data codingInconsistencies in reporting and data coding
•• Lack of documentation of testing and resultsLack of documentation of testing and results
••
•• Lack of followLack of follow--up on elevated screening levels up on elevated screening levels
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
Public Health ImplicationsPublic Health ImplicationsPublic Health Implications
•• Opportunity for MCH and chronic disease program Opportunity for MCH and chronic disease program collaboration to:collaboration to:
--Validate existing data sourcesValidate existing data sources
--Improve quality of data collectionImprove quality of data collection
--Promote appropriate GDM testing, Promote appropriate GDM testing,
diagnosis and carediagnosis and care
--Promote postpartum followPromote postpartum follow--up care up care
--Prevent onset of type 2 diabetesPrevent onset of type 2 diabetes
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
MCH Opportunities for CollaborationMCH Opportunities for CollaborationMCH Opportunities for Collaboration
•• Include chronic disease prevention and health promotion in Include chronic disease prevention and health promotion in your intervention strategiesyour intervention strategies
•• Invite chronic disease and health promotion team members to Invite chronic disease and health promotion team members to participate in planning and intervention effortsparticipate in planning and intervention efforts
•• Invite input for analysis and application of chronic disease or Invite input for analysis and application of chronic disease or health promotion data from PRAMS surveyhealth promotion data from PRAMS survey
•• Leverage the expertise of chronic disease and health Leverage the expertise of chronic disease and health promotion programs to develop intervention strategies, promotion programs to develop intervention strategies, especially for healthy weight, gestational diabetes, especially for healthy weight, gestational diabetes, hypertension and tobacco related activities hypertension and tobacco related activities
•• Consult the NACDD website for more ideas from other statesConsult the NACDD website for more ideas from other states
NATIONAL ASSOCIATION OFNATIONAL ASSOCIATION OF
CHRONIC DISEASE DIRECTORSCHRONIC DISEASE DIRECTORS
WOMENWOMEN’’S HEALTH COUNCILS HEALTH COUNCIL
For More InformationFor More InformationFor More Information
Please contact:Please contact:
Joan Ware, ConsultantJoan Ware, Consultant
National Association of Chronic Disease National Association of Chronic Disease
Directors (NACDD) WomenDirectors (NACDD) Women’’s Health Councils Health Council
Telephone: 801Telephone: 801--277277--2353l2353l
Email: [email protected] Email: [email protected]
Web:Web: www.chronicdisease.orgwww.chronicdisease.org