1. Oceana County: Maternal & Infant Health MICHELLE ROBINSON, SHANNON BALDWIN, AMY NOHEL, DENISE PRESTON NURSING 340, COMMUNITY HEALTH FERRIS STATE UNIVERSITY NOVEMBER, 2015

2. Problem Statement Oceana County has an increased risk of infant mortality among teen age mothers, compared to the State of Michigan. This may be related to low birth weight due to increased smoking and decreased access to pre- and post natal health care. (DHD #10, 2014)

3. Age Age, younger than 17 as well as race and ethnicity (African American) also increase the risk of delivering a low birth weight baby. (Dietz, 2010)

4. Oceana County High amount of Medicaid paid births High amount of teen pregnancies Larger percentage of smoking during pregnancy Higher infant mortality rate and higher low birth weight rate (DHD #10, 2014)

5. Low Birth Weight The definition of a low birth weight baby is any baby who is born weighing less than 5 pounds 8 ounces.

6. Statistics of the State of Michigan compared to Oceana County

7. Smoking Smoking, substance and alcohol use during pregnancy increase the risk of delivering a low birth weight baby.

8. Assessment 19.9% Below poverty level in Oceana County 30.9% Had no access to healthcare in 2014 (US Department of commerce, 2015)

9. S.M.A.R.T GOAL BY DECEMBER 2020, REDUCE THE RATE OF INFANT MORTALITY AMONGST TEEN MOTHERS TO 6% OR BELOW. (DHD #10, 2014)

10. Oceana’s Situation Nearest birthing hospital is 33 minutes (Ludington) to 37 minutes (Fremont) away Nearest NICU hospital is over 2 hours away in Traverse City Patients per primary care physicians, 2040:1 CDC (2015)

12. PLANNING Identify local agencies that can offer family planning, prenatal and post natal care to teens Prepare to educate teens on ways to prevent pregnancy Locate heath providers for pregnant teens Locate educators for new mothers on proper infant care Encourage others to breast feed Find local health agencies that can provide home visits for new mothers

13. INTERVENTIONS Teach the use of contraception and its importance Teach family planning or abstinence Increase access to health care clinics (family planning, prenatal, postnatal) Increase access to insurance (Medicaid, Medicare)

14. Interim Outcomes to Track Number of teens in the county compared to how many are involved in at least one program in the clinic Number of teen pregnancies in the county Smoking rate of teens Teen breastfeeding rates Low birth weights from teen pregnancies Infant mortality rates from teen pregnancies

15. Current Trackable Measures Statistics are currently being collected in the following areas: Teen pregnancy Teen smoking Teen Pregnancy Statistics (2009). Retrieved from: http://www.teenpregnancystatistics.org/content/smoking-and-teen-pregnancy.html

16. Reevaluation of Interim Outcome Measures The availability of the clinic hours and programs offered versus school hours Look at offering a day clinic at the school If teen pregnancy rates are declining then continue the current programs Look at additional nutrition programs New programs or approaches need to be looked at if no improvement

17. Length of Time Needed to Reach Outcomes Acceptance of new clinic Getting the information to teens Community support to the teen population for seeking help and education Hours of operation Positive feedback to teens Available transportation to the clinic

18. DESIRED OUTCOMES Decrease in infant deaths Reduction in teen birth rates Reduction in teen pregnancies Increased amount of teens who abstain from sex Increased in use of condoms and other contraceptives Increase in pre and postnatal care Increase amount of mothers breast feeding Expand home-visit programs Decrease infant mortality rates Increase infant birth weights Decrease smoking during pregnancy

19. References: Bhutta, Z., Cabral, S., Chan, C., & Keenan, W. (2012). Reducing maternal, newborn, and infant mortality globally: An integrated action agenda. International Journal of Gynecology & Obstetrics. Volume 119 (Supp. 1), pg. S13- S17. doi: 10. 1016/j.igo.2012.04.001. Center for Disease Control and Prevention, (2015). About teen pregnancy. Retrieved from: http://www.cdc.gov/teenpregnancy/about/index.htm. http://www.cdc.gov/teenpregnancy/about/index.htm DHD #10. (2014). Ocean County Health Profile Summary 2014. Retrieved from District Health Department #10: http://dhd10.org/files/Summary_Oceana_Chartbook_2014.pdf http://dhd10.org/files/Summary_Oceana_Chartbook_2014.pdf Dietz, P. M., England, L. J., Shapiro - Mendoza, C. K., Tong, V. T., Farr, S. L., & Callaghan, W. M. (2010). Infant Morbidity and Mortality Attributable to Prenatal Smoking in the U.S. American Journal of Preventative Medicine, 39(1), 45-52. doi:10.1016/j.amepre.2010.03.009 Harkness, G. & DeMarco, R. (2016). Framework for health promotion, disease prevention, and risk reduction. Community and Public Health Nursing: Evidence for Practice. Pg. 97. Wolters Kluwer: Philadelphia, PA..

20. References continued: Graczyk, K. (2007). Adolescent maternal mortality: An overlooked crisis. Advocates for Youth: Rights. Respect. Responsibility. Retrieved from: http://www.advocatesforyouth.org/publications/publications-a- z/436-adolescent-maternal-mortality-an-overlooked-crisis.http://www.advocatesforyouth.org/publications/publications-a- z/436-adolescent-maternal-mortality-an-overlooked-crisis Jarlenski, M., Bleich, S. N., Bennett, W. L., Stuart, E. A., & Barry, C. L. (2014). Medicaid enrollment policy increased smoking cessation among pregnant women but had no impact on birth outcomes. Health Affairs (Project Hope), 33(6), 997-1005. doi:10.1377/hlthaff.2013.1167 Meghea, C. I., Zhiying, Y., Raffo, J., Leach, R. E., & Roman, L. A. (2015). Statewide Medicaid Enhanced Prenatal Care Programs and Infant Mortality. The American Academy of Pediatrics, 136(2), 334-342. doi:10.1542/peds.2015-0479 Teen Pregnancy Statistics (2009). Retrieved from: http://www.teenpregnancystatistics.org/content/smoking-and-teen-pregnancy.html http://www.teenpregnancystatistics.org/content/smoking-and-teen-pregnancy.html U.S. Department of Commerce. (2015). Oceana County Population. Retrieved from United States Census Bureau: http://quickfacts.census.gov/qfd/states/26/26127.html

21. References continued: World Health Organization, (2012). Newborns: reducing mortality. Retrieved from: http://www.who.int/mediacentre/factsheets/fs333/en/http://www.who.int/mediacentre/factsheets/fs333/en/.