Municipality Jared Parrish, PhD Health trajectories Assets and - - PowerPoint PPT Presentation

Municipality

Jared Parrish, PhD

Health trajectories

▪ Assets and deficits impact development ▪ Timing of prevention and intervention can have different impacts ▪ Lifetime burden (risk) can inform public health prevention

Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017

CUBS Survey PFD, Vital Records, & CDR Medical Education Legal Child Protection reports

2009:2011

2014

Core annual administrative linkages

2015 2016 2017 2018

Linked for special projects

DJJ Law

Project overview – measuring trajectories

Pregnancy Risk Assessment Monitoring System (PRAMS)

▪ 47 States Currently Participate ▪ Randomly samples: ▪ ~1/6 of all live births in Alaska ▪ Administered 2-6 months after birth ▪ Weighted to represent the entire birth cohort ▪ Mail with phone follow-up ▪ Core questions (used by all PRAMS programs) ▪ IRB (Federal and local)

Childhood Understanding Behaviors Survey (CUBS)

▪ Follow-up survey to PRAMS ▪ Resamples all PRAMS respondents when their child is age 3 ▪ Mail with phone follow-up ▪ IRB (local) ▪ 5 States have PRAMS follow-up surveys: Alaska, Oregon, New Mexico, Missouri, and Oklahoma ▪ Unique questions in each state

Demographics

N Weighted Mean Represents Married Yes 777 63.1(9.7, 66.5) 7676 No 467 36.9(33.5, 40.3) 4496 Mom Graduated HS Yes 1048 89.5(87.2, 91.8) 10514 No 124 10.5(8.2, 12.8) 1228 Medicaid Yes 552 45.8(42.3, 49.3) 5493 No 674 54.2(42.3, 49.3) 6494 Maternal Race Alaska Native 282 16.1(14.5, 17.8) 1946 Non-Native 900 83.9(82.2, 85.5) 10116

Cumulative Incidence of OCS First Report

N Weighted Mean [0,1) 9.2(7.1, 11.3) [1,2) 15.5(12.5, 18.6) [2,3) 18.7(15.3, 22.1) [3,4) 23.0(19.0, 26.9) [4,5) 27.1(22.6, 31.6) [5,6) 29.9(25.0, 34.7) [6,7) 33.8(28.4, 39.2) [7,8) 35.2(29.5, 40.9) [8,9) 37.0(30.6, 43.4)

PEAKS

Reading Scores (PEAKS) 3rd grade A (best), P, BP, FBP (worst)

N Weighted Mean Represents Adequate/Progressing 180 41.5(36.0, 47.0) 1872 Below Progressing/Far Below Progressing 262 58.5(53.0, 64.0) 2640

ADP

Kindergarten developmental profile (ADP) 13 developmental goals tested Point for each goal met, range 0-13

N Weighted Mean Represents Developmental Standard (11+ Goals Met) 255 33.0(29.0, 36.9) 2724 Below Standard (<11 Goals Met) 574 67.0(63.1, 71.0) 5532

ATTN

Attendance data Proportion of

# 𝑒𝑏𝑧𝑡 𝑏𝑢𝑢𝑓𝑜𝑒 # 𝑒𝑏𝑧𝑡 𝑝𝑔 𝑡𝑑ℎ𝑝𝑝𝑚

Collected each year from 2015-2019

N Weighted Mean Represents Adequate Attendance (>=90%) 741 86.2(83.5, 89.0) 7605 Chronically Absent (<90%) 147 13.8(11.0, 16.5) 1214

Adverse Childhood Experiences (ACEs)

Source: Centers for Disease Control and Prevention Credit: Robert Wood Johnson Foundation

Collaborative study between CDC researchers and Kaiser Permanente1

>17,000 participants of an HMO asked about events before age 18

• 75% white (54% female, 46% male)
• mean age 57
• 75% at least some college.

1) Felitti, Vincent J., et al. "Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study." American journal of preventive medicine 14.4 (1998): 245-258.

ACEs in Anchorage among 3yr olds

ACE Score N Weighted Mean Represents

349 53.3(48.1, 58.6) 6903

1

147 23.0(18.5, 27.5) 2977

2

74 13.0(9.3, 16.7) 1684

3

31 3.9(1.7, 6.1) 502

4+

40 6.8(3.9, 9.6) 877

PRAMS Questions used to quantify ACEs pre-birth household dysfunction

During the 12 months before pregnancy: I visited a health care worker to be checked or treated for depression or anxiety During the 12 months before birth: I got separated or divorced from my husband or partner During the 12 months before birth: My husband

• r partner or I went to Jail
• During the 12 months before birth: Someone

very close to me had a problem with drinking

• r drugs
• During the 3 months before pregnancy

engaged in binge drinking 2 or more times

• During the last 3 months of pregnancy drank

any amount of alcohol

• During the 12 months before or During

pregnancy smoked marijuana

• During the 12 months before birth: I was in a

physical fight

• During the 12 months before or during pregnancy

pushed, hit, slap, kick, choke, or physical hurt by husband or partner

Pre-Birth Household Dysfunction

Household Dysfunction N Weighted Mean Represents

833 31.7(28.4, 34.9) 3856

1

695 32.4(29.1, 35.7) 3940

2

344 14.4(12.0, 16.8) 1758

3

189 8.3(6.4, 10.2) 101

4+

243 13.2(10.8, 15.6) 1604

Pre-birth household dysfunction

During the 12 months prior to birth/pregnancy Child welfare reports before age 9 years

Pre-birth household dysfunction predicting OCS Contact

Household Dysfunction HR (95% CI)

ref

1

1.4(0.9, 2.0)

2

2.7(1.8, 4.1)

3

3.5(2.2, 5.5)

4+

6.2(4.2, 9.2)

Health Equity Index

Spatial Autocorrelation Between the HEI and Child Maltreatment (2017 OCS and ACS Data)

Geographically Weighted Regression: Modeling Child Maltreatment with the HEI

http://dhss.alaska.gov/dph/wcfh/Pages/mchepi/ALCANlink

Thank You

Contact: Jared Parrish, PhD (907) 269-8068 jared.parrish@alaska.gov