2.  Local data overview  PPOR findings  Women’s Health Assessment  Preconception health

4. Source: Tarrant County Public Health, 2010

8. Is it education?

9. Source: National Center for Health Statistics, 2002

10. TC Infant Mortality Rate Hispanics Whites Blacks Infant Mortality Rates by Maternal Education Level, Tarrant County 2002-2004 0 2 4 6 8 10 12 14 16 < High School DiplomaHigh School DiplomaSome College/Degree Education Level Infant Mortality Rate Source: Tarrant County Public Health, 2010

11. TC Infant Mortality Rate Hispanics Whites Blacks Infant Mortality Rates by Maternal Age, Tarrant County 2002-2004 Infant Mortality Rate Source: Tarrant County Public Health, 2010

12. Developed by McCarthy & WHO Simple approach Strong conceptual basis Mobilizes communities Prioritizes prevention efforts CityMatCH PPOR: http://www.citymatch.org/ppor_index.php

13.  Examines the four “Periods of Risk”: 1. Maternal Health / Prematurity 2. Maternal Care 3. Newborn Care 4. Infant Health for various population groups  Identifies groups and periods of risk with the most deaths, highest rates  Uses comparison groups to estimate “excess deaths” for these groups and periods of risk

14. *Feto-infant mortality per 1,000 live births & fetal deaths Infant Health 1.7 Newborn Care 1.4 Maternal Care 1.7 Maternal Health/Prematurity 3.1 FETO-INFANT MORTALITY RATES, ALL RACIAL/ETHNIC GROUPS: 2001-2003

15. Maternal Health/ Prematurity Preconception Health Perinatal Care mortality rate among VLBW babies VLBW births Interventions

16. Maternal Health/ Prematurity Preconception Health VLBW births Interventions To Summarize… PPOR-Phase I PPOR-Phase II

17. Targeted women 18-44 in specific zip codes Face-to-face survey assessed health status, health behaviors, knowledge, neighborhood and organizational factors affecting their health 405 respondents

18. 18

19. Source: The Annie E. Casey Foundation, State Level Data Online, Tarrant County Infant Mortality Task Force, 2005 Healthy People 2010 Goal: 4.5

20. , Source: National Center for Health Statistics, BRFSS, Texas, 2004-2006, Females 18-44, National Center for Health Statistics, NHANES, United States 2003-2006, Females 20-44

21.  Lack of fruits and vegetables › 88% eat less than five fruits and vegetables a day  Lack of grocery stores in designated area

22. 22 Source: CDC Health Date for All Ages (HDAA)http://209.217.72.34/HDAA/TableViewer/tableView.aspx?ReportId=161, Texas, BFRSS, 2004-2006 US, NHIS, 2004-2006.

23. 25% reported feeling down, depressed or hopeless every day, or nearly everyday over the past 2 weeks 8% of women experienced intimate partner violence in the past year

24.  Women are unhealthy, compromising their opportunity for healthy pregnancy  Improving the health of women holds great promise in improving the health of babies  Many opportunities to address and improve women’s health through prevention and promotion  Everyone has an important role to play

25. CDC defines preconception health as “a set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman’s health or pregnancy outcome through prevention and management”

26.  Prevention and management of health risks and conditions  Includes management of fertility, including contraception, in order to empower women to plan and prepare for pregnancies Source: Kent H, Johnson K, Curtis M, Richardson Hood J, Atrash H. Proceedings of the Preconception Health and Health Care Clinical, Public Health, and Consumer Workgroup Meetings. Atlanta, GA: CDC; 2006.

27.  Perinatal periods of risk analyses indicate that interventions should focus on African American women and on the maternal health/ prematurity period of risk  Consistent with preconception health, including family planning and addressing health behaviors such as smoking and drug abuse

28. From -- Anticipation and Management to Health Promotion and Prevention From -- Healthy Mothers, Healthy Babies to Healthy Women Healthy Mothers Healthy Babies Paradigm Shift

29. To promote the health of women of reproductive age before conception and thereby improve pregnancy-related outcomes … A LIFE COURSE APPROACH Preconception Care - Goal

30.  Dr. Anita Kurian, Tarrant County Public Health  Micky Moerbe, Tarrant County Public Health  Amy Raines, Fort Worth Women’s Health Initiative  Dr. Hani Atrash, CDC