1. Maternal Health Needs and Resources in a Changing Community Monterey County Health Department, Salinas, California

2. Monterey County Health Department - DUI Project2 DUI Project Team Krista Hanni, Research Analyst, Presenter Dr. Linda Velasquez, Health Officer Dr. Alicia Paris-Pombo, Epidemiologist Susan McNelley, Perinatal Services Coordinator Darryl Tyler, GIS Analyst, Information Technology Robbie Gonzales Dow, Perinatal Outreach Coordinator Joyce Brown, Head of Public Health Nursing Linda McGlone, Injury Prevention Judy Garrison, Program Director, Cancer Detection Programs

3. Monterey County Health Department - DUI Project3 Monterey County 3,322 mi 2 417,185 people 126 persons/mi 2 Largest city: Salinas – 151,030 Salinas

4. Monterey County Health Department - DUI Project4 1990 to 2000: Growth in Median Household Income

5. Monterey County Health Department - DUI Project5 Latinos: A Growing “Minority” 72,000 not citizens out of 181,000 Latinos in county 19902000 California26%32% Monterey County34%47% King City67%80% Salinas51%64% Carmel3%

6. Monterey County Health Department - DUI Project6 County Latino Profile Compared to Whites in 2000, Latinos: Younger Lower household income Larger household size Households more overcrowded Less likely to own house Less education

7. Monterey County Health Department - DUI Project7 County Health Profile 2002 Monterey County saw improvements for most of 36 indicators over past ten years Met HP 2010 objective for 6 indicators Better than California for 24 indicators Disparity in health within county?

8. Monterey County Health Department - DUI Project8 Socioeconomic Disparities and Health Socioeconomic disparities shown to affect health outcome Poverty one of the better geographic indicators of health Mother’s use of services correlated with childrens’ health

9. Monterey County Health Department - DUI Project9 Objective Identify ‘hot spots’ for maternal health indicator within Monterey County in relation to services

10. Monterey County Health Department - DUI Project10 Identification Area-based Socioeconomic Measure –% in Poverty Maternal Health Indicators –Births by payment method –Birth weight –Entry to prenatal care –Teen births Born in Mexico Services –Hospitals –Clinics

11. Monterey County Health Department - DUI Project11 How we did it GIS – Geographic Information Service Focus on Salinas for today’s presentation 1990 and 2000 census data by census tract 1998 and 2002 county birth data with addresses –Use address to map out birth locations

12. Monterey County Health Department - DUI Project12 Where People Live in Salinas

13. Monterey County Health Department - DUI Project13 % in Poverty in 1990 by Census Tract

14. Monterey County Health Department - DUI Project14 % in Poverty in 2000 by Census Tract

15. Monterey County Health Department - DUI Project15 Maternal Health Indicators IndicatorSalinas 1998Salinas 2002County 2002 Births3,337 (49%)3,575 (49%)7,103 (100%) Medi-Cal & No Insurance 1,894 (57%)2,069 (58%)3,958 (54%) Low Birth Weight154 (4.7%)183 (5.2%)338 (5%) Late Entry to Care 768 (21%)511 (15%)958 (14%) Teens (15-17)174 (5%)166 (5%)308 (4%) Teens (15-17) Born in Mexico 58 (33%)*82 (49%)*161 (52%)* * Percent of teen births

16. Monterey County Health Department - DUI Project16 Hot Spots Density – 1000 x 1000 ft sq grabs data within square mile Square is color coded to indicate range low middle high Deeper red areas are our hot spots

17. Monterey County Health Department - DUI Project17 MediCal & No Insurance Births in 2002

18. Monterey County Health Department - DUI Project18 Low Birth Weight Births in 2002

19. Monterey County Health Department - DUI Project19 Late Entry to Care Births in 2002

20. Monterey County Health Department - DUI Project20 Teen (15-17 Years Old) Births in 2002

21. Monterey County Health Department - DUI Project21 Change Hot Spots Negative Little ChangePositive Extremes are most (+) or (–) difference between 1998 and 2002

22. Monterey County Health Department - DUI Project22 Medi-Cal & No Insurance Change in Births 1998 to 2002

23. Monterey County Health Department - DUI Project23 Low Birth Weight Change in Births 1998 to 2002

24. Monterey County Health Department - DUI Project24 Late Entry to Prenatal Care Change in Births 1998 to 2002

25. Monterey County Health Department - DUI Project25 Teen (15-17 Years Old) Change in Births 1998 to 2002

26. Monterey County Health Department - DUI Project26 Mexican Born Teen (15-17 Years Old) Change in Births 1998 to 2002

27. Monterey County Health Department - DUI Project27 Medi-Cal Births and Hospitals

28. Monterey County Health Department - DUI Project28 Medi-Cal OB Providers & Clinics in 2002

29. Monterey County Health Department - DUI Project29 Summary Hot spot: East Salinas Hospitals located fine, but concern about closure of hospital with most Medi-Cal deliveries Identified area of need for obstetric providers and clinics accepting Medi-Cal

30. Monterey County Health Department - DUI Project30 Accomplishments Identified meaningful indicators Spatially represented birth data Beginning to develop similar projects for children, injury, and cancer

31. Monterey County Health Department - DUI Project31 Lessons Learned Difficult to match data to community resources Watch for database error Teamwork is essential for useful final result –Include community partners

32. Monterey County Health Department - DUI Project32 Thanks CityMatCH-DUI! We are learning from you.