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The Rhode Island Toddler Wellness Overview Survey (TWOS): An Opportunity for Data Linkages

The Rhode Island Toddler Wellness Overview Survey (TWOS): An Opportunity for Data Linkages. Samara Viner-Brown, MS 12 th Annual Maternal and Child Health Epidemiology Conference December 8, 2006. ACKNOWLEDGEMENTS. Meredith Bergey, MSc, MPH Rachel Cain Hanna Kim, PhD. 2. OUTLINE.

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The Rhode Island Toddler Wellness Overview Survey (TWOS): An Opportunity for Data Linkages

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  1. The Rhode Island Toddler Wellness Overview Survey (TWOS): An Opportunity for Data Linkages Samara Viner-Brown, MS 12th Annual Maternal and Child Health Epidemiology Conference December 8, 2006

  2. ACKNOWLEDGEMENTS • Meredith Bergey, MSc, MPH • Rachel Cain • Hanna Kim, PhD 2

  3. OUTLINE • Background • TWOS methodology • Preliminary Data • Conclusions • Limitations • Implications 4

  4. BACKGROUND • Rhode Island Population • Total: ~1 million • Births: ~13,000 per year • Integrated Child Health Information System: KIDSNET • data from 10 programs serving children • RI PRAMS • ~ 2,000 (15% of all births) women surveyed annually 5

  5. WHY CONDUCT A TODDLER SURVEY? • Little or no data on the health and well-being of children between birth and adolescence • PRAMS provides an opportunity for longitudinal analysis • Can study the relationship between outcomes of young children and their mothers’ earlier experiences 6

  6. PRAMS FOLLOW-UP • Planned to conduct toddler survey when applied to become a PRAMS state (2001) • Obtained RI Dept of Health IRB approval for the toddler survey in 2001 • RI PRAMS survey asks respondents if they can be contacted again in two years 7

  7. FOLLOW-UP METHODOLOGY • If consent is given, a reminder letter is sent at the time the child reaches their 1st birthday • send any new contact information and reconfirm they will participate (2nd opportunity to opt out) • 45% response rate to “birthday letter” and nearly 100% agree to participate • Access database created and those who agree are transferred with selected fields • demographics, birth certificate number and PRAMS ID # 8

  8. SURVEY DESIGN • Designed in partnership with RI PRAMS Steering Committee (Toddler Work Group) • Questions gathered from multiple sources: • RI PRAMS • Oklahoma TOTS Survey • PEDS Survey • National Indicators Survey Database • Ages and Stages Questionnaire • Other Health Dept surveys (HIS and BRFSS) • Final instrument: 58 questions 9

  9. SURVEY METHODOLOGY • Survey sent to all PRAMS respondents who agreed to be recontacted (80%) • Two mailings, no telephone follow-up • $5 incentive with first mailing 10

  10. SURVEY TOPICS • Child Care • Health Status/Physical Characteristics (ht/wt) • Breastfeeding • Oral Health • Child Development • Behavior/Psychosocial Issues • Safety (car seat/tobacco smoke exposure) • Insurance • Health Care/Specialty Care • Family Planning • Maternal Factors (depression, mobility) • Demographics 11

  11. PRAMS-TWOS LINKAGE • PRAMS and TWOS files linked in Access based on PRAMS ID# and DOB • SAS used for analysis • TWOS January 2005-September 2006 • (PRAMS 2003 and 2004) • Total linked population = 1,090 12

  12. Preliminary and Unweighted DataJanuary 2005-September 2006

  13. Response Rates Among TWOS Respondents Percent (n = 649) (n = 441) 14

  14. Selected Demographics Among TWOS Respondents <20 20-34 35+ <12 12 >12 Married Single Core Rest Priv Pub None n = 1090 Percent AGE EDUCATION MARITAL RESID INSURANCE STATUS 15

  15. TWOS Respondents by Race/Ethnicity Other (1.0%) Asian (3.4%) Black/African Amer (5.2%) White (90.2%) 16

  16. Selected TWOS Variables:Maternal Mental Health Percent 17

  17. Selected TWOS Variables: Overwhelmed by Maternal Depression Percent p < 0.0001 18

  18. Selected TWOS Variables: Maternal Depression by Overwhelmed Percent p < 0.0001 19

  19. Selected PRAMS Variables Among TWOS Respondents: Maternal Mental Health Percent 20

  20. Maternal Mental Health (TWOS) by Pregnancy Experience (PRAMS) Percent p< 0.0001 p < 0.0001 21

  21. Maternal Mental Health (TWOS) by Inconsolability (PRAMS) Percent p < 0.001 p = NS 22

  22. Maternal Mental Health (TWOS) by Postpartum Depression (PRAMS) Percent p < 0.0001 p <0.0001 23

  23. Maternal Mental Health (PRAMS) by Overwhelmed (TWOS) Percent p < 0.001 p = NS p = NS p < 0.0001 24

  24. Maternal Mental Health (PRAMS) by Depression (TWOS) Percent p = NS p < 0.0001 p < 0.0001 25

  25. Overwhelmed (TWOS) by Insurance Status Percent p <0.0001 26

  26. Infant Inconsolability (PRAMS) by Overwhelmed (TWOS) by Insurance Status Percent p <0. 001 p = NS p < 0.0001 27

  27. SUMMARY • TWOS data were successfully linked to PRAMS • Linkage provides multiple opportunities for examining important MCH issues Maternal Depression Example: • Experiences during and after pregnancy are associated with depression among mothers of two year-olds • Hard time during pregnancy, infant inconsolability and postpartum depression were significantly associated with depression or feeling overwhelmed • Depression diagnosis before or during pregnancy was not significantly related to later depression or feeling overwhelmed 28

  28. LIMITATIONS • Unweighted data • Small sample sizes can limit interpretation/ significance • Different methodologies PRAMS vs TWOS • Instruments/questions slightly different between PRAMS and TWOS • Selection bias (only those who agree to participate) 29

  29. LIMITATIONS (cont) • Response rate lower than desired, which impacts “n” sizes (certain populations are more difficult to reach) • Loss of potential respondents due to attrition • Sensitivity of topics • Certain topics only captured with single question • Different interpretations of questions by respondents • Problems with generalizations (e.g., marital status = no support) 30

  30. IMPLICATIONS • Linkages provide an opportunity to better understand the health issues at pregnancy and can influence the health of mother and child later in life • Importance of exploring these relationships further to determine potential influences of other variables 31

  31. IMPLICATIONS (cont)Maternal Depression Example • Early identification and treatment of women who experience depressive symptoms may help in reducing the likelihood of future maternal depression • Primary care providers, obstetricians and pediatricians are in a position to identify these women and provide them with support and referrals 32

  32. CONTACT INFORMATION Samara Viner-Brown, MSChief, Data and EvaluationRhode Island Department of HealthDivision of Family Health3 Capitol Hill, Room 302Providence, RI 02908Tel: 401-222-5935E-mail: samara.viner-brown@health.ri.gov

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