1. Infant Hearing Screening in the US, 2001: Results from the ECLS-B Study May S. Chiu, B.S. Magdaliz Gorritz, B.S. Howard J. Hoffman, M.A. National Institute on Deafness and Other Communication Disorders (NIDCD) National Institutes of Health (NIH) National Institutes of Health (NIH) Bethesda, Maryland 20892

2. Faculty Disclosure Information In the past 12 months, I have not had a significant financial interest or other relationship with the manufacturer(s) of the product(s) or provider(s) of the service(s) that will be discussed in my presentation. This presentation will (not) include discussion of pharmaceuticals or devices that have not been approved by the FDA or if you will be discussing unapproved or “off-label” uses of pharmaceuticals or devices.

3. Sponsoring Agencies  U.S. Department of Education, National Center for Education Statistics National Center for Education Statistics  U.S. Department of Health and Human Services National Center for Health Statistics, CDC National Center for Health Statistics, CDC National Institute of Child Health and Human Development National Institute of Child Health and Human Development National Institute on Deafness and Other Communication Disorders National Institute on Deafness and Other Communication Disorders Health Resources and Services Administration - Health Resources and Services Administration - Maternal and Child Health Bureau Office of Minority Health Office of Minority Health  Other Federal agencies

4. Early Childhood Longitudinal Study  Multi-dimensional study focusing on the early home and educational experiences of children through first 6 years of life  Birth cohort (ECLS-B), 2001  Nationally representative sample

5. ECLS Conceptual Model Care and Education Neighborhood and Community School Family Child

6. Study Design of ECLS-B  N=10,688  Oversamples Minorities Minorities Very low birth weight (<1500 g) Very low birth weight (<1500 g) Moderately low birth weight (1500 - 2499 g) Moderately low birth weight (1500 - 2499 g) Twins Twins  Household surveys conducted by trained personnel at 9 months  Bayley exams (modified for ECLS-B) conducted at 9 months and 2 years

7. Early Childhood Longitudinal Study For more information visit: http://nces.ed.gov/ecls/index.asp

8. EHDI vs. ECLS-B, 2001 EHDI  Annual data collection  State-level outcome data Hearing screening Hearing screening Hearing loss Dx Hearing loss Dx Enrollment in intervention program Enrollment in intervention program  Global screening rate ≈ 65% before discharge ECLS-B  One year (2001) births only  Person-level outcome data Hearing screening Hearing loss Dx Receiving hearing services  Global screening rate ≈ 70% before discharge 78% by 9 months

9. Why ECLS-B? Child Health Physical Activity Nutrition Physical growth Cognitive Language Motor skills Parent Demographics Health Physical Mental Nutrition Marital/partner relationship Family organization Child care Care/ Education Provider Background and experience Learning environment Teaching practices School/ Teacher School demographics Children’s development School programs Educational goals and objectives Additional information is available, for example:

10. ECLS-B Analysis of Variables Related to Hearing Screening

11. Demographics (n=10,531) Region % Screened OR 95% CI Northeast76%1.00— Midwest75%0.92 0.55 – 1.53 West70%0.70 0.46 – 1.08 South86%1.87 1.19 – 2.95 Source: 9-month composite variables

12. Demographics (cont’d) County Pop. Size % Screened OR 95% CI < 100,000 82%1.00— 100,000-250,00076%0.72 0.47 – 1.11 250,001-500,00085%1.30 0.83 – 2.04 500,001-1,000,00076%0.71 0.46 – 1.11 1,000,000+72%0.40 0.40 – 0.78 Source: birth certificate data

13. Demographics (cont’d) Gender % Screened OR 95% CI Male78%1.03 0.89 – 1.19 Female78%1.00— Source: 9-month composite variables

14. Demographics (cont’d) Race % Screened OR 95% CI Non-Hispanic White 79%1.00— Non-Hispanic Black 82%1.20 0.94 – 1.54 Hispanic/Latino73%0.71 0.57 – 0.90 Other77%0.87 0.68 – 1.11 Source: 9-month composite variables

15. Family Information Household Income % Screened OR 95% CI ≤$15,000 78%1.00— $15,001-$30,00077%0.91 0.77 – 1.07 $30,001-$50,00076%0.87 0.72 – 1.05 $50,001-$100,00079%1.04 0.85 – 1.28 >$100,00080%1.09 0.79 – 1.49 Source: 9-month parent CAPI instrument and parent questionnaire

16. Family Information (cont’d) Mother’s Education % Screened OR 95% CI College graduate 84%1.00— Some college 79%0.74 0.58 – 0.96 High school diploma 76%0.62 0.47 – 0.82 No high school diploma 75%0.60 0.45 – 0.80 Source: 9-month composite variables

17. Other Significant Factors Mother Medical Risk Factor % Screened OR 95% CI Pre-Eclampsia Yes92%3.40 1.50 – 7.74 No78%1.00— Uterine bleeding Yes96%7.67 3.06 – 19.20 No78%1.00— Source: Birth certificate data

18. Infant Information Birth Weight % Screened OR 95% CI Normal (≥ 2500 g) 77%1.00— Moderately low (1500 – 2499 g) 84%1.51 1.27 – 1.78 Very low (< 1500 g) 94%4.97 3.55 – 6.97 Source: 9-month composite variables

19. Infant Information (cont’d) Gestational Age % Screened OR 95% CI ≤20 – 27 wks 97%8.16 4.46 – 14.94 28 – 30 wks 88%2.20 0.98 – 4.94 31 – 33 wks 85%1.68 1.04 – 2.71 34 – 36 wks 81%1.22 1.02 – 1.47 Term: 37+ wks 77%1.00— Source: Birth certificate data

20. Infant Information (cont’d) Child Condition % Screened OR 95% CI Failure to thrive Dx Yes93%4.07 1.33 – 12.42 No78%1.00— Home apnea monitor prescribed Yes90%2.54 1.51 – 4.29 No78%1.00— Source: 9-month parent CAPI instrument and parent questionnaire

21. Infants Receiving Hearing Services at 9 Months (n=105) ― Univariate Associations CharacteristicOR 95% CI Twin 2.7 2.7 1.5 – 4.9 Very low birth weight 24.2 13.1 – 44.6 Moderately low birth weight 3.8 3.8 1.9 – 7.5 Gestational age: <=27wks 27.7 13.4 – 57.2 Gestational age: 28-30 wks 10.2 5.1 – 20.3 5.1 – 20.3 Longer stay in hospital 14.7 6.7 – 32.2 6.7 – 32.2 Difficulty seeing 71.8 27.1 – 190.5 27.1 – 190.5 Cleft lip 66.3 16.3 – 268.9 Heart defect 5.4 5.4 2.8 – 10.3 Problem using hands 74.8 26.8 – 209.0

22. Other Services OR 95% CI Vision services 8.8 3.7 – 21.0 3.7 – 21.0 Physical therapy 4.8 2.1 – 10.8 2.1 – 10.8 Social work services 4.0 2.0 – 7.9 Home services 7.0 3.2 – 15.3 3.2 – 15.3 Parent support/training 3.7 1.8 – 7.6 Source: 9-month parent CAPI instrument and parent questionnaire Infants Receiving Hearing Services at 9 Months (n=105)

23. Summary of Findings  Lower screening rate for Hispanic/Latino infants  Lower mother’s education associated with lower screening rate  Infants with low birth weight and associated conditions have a higher rate of screening  Infants receiving hearing services at 9 months also receive many additional services

24. Prospectus  EHDI Annual data collection allows trend analysis to document increase in newborn hearing screening Annual data collection allows trend analysis to document increase in newborn hearing screening Anticipate more extensive data will come in future years Anticipate more extensive data will come in future years  ECLS-B Longitudinal study allows tracking of children with hearing problems (9 months of age – this study) Longitudinal study allows tracking of children with hearing problems (9 months of age – this study) Future data will be collected for children when 2, 4, 5 (kindergarten), and 6 (first grade) years old Future data will be collected for children when 2, 4, 5 (kindergarten), and 6 (first grade) years old

25. Any Questions?