1. “Stir-Fried” Strategies for Women’s Health Jennifer Opalek, R.N., M.S.N., M.P.H. and Jane Bambace, M.Ed. St. Petersburg, Florida

2. Part 1: Utilizing PPOR Results to Develop Strategic Interventions Pinellas County PPOR analysis conducted during 1998-2000.

3. Local Results...

4. Feto-Infant Mortality All Births, Pinellas County, 1998-00 291 Feto-Infant Deaths 29,085 Fetal Deaths & Live Births Maternal Health & Prematurity 136 deaths 4.7 Maternal Care 68 deaths 2.3 Newborn Care 41 deaths 1.4 Infant Care 46 deaths 1.6 Overall Rate: 10.0

5. Feto-Infant Mortality Black Race, Pinellas County, 1998-00 82 Feto-Infant Deaths 4,569 Fetal Deaths & Live Births Maternal Health & Prematurity 46 deaths 10.1 Maternal Care 14 deaths 3.1 Newborn Care 6 deaths 1.3 Infant Care 16 deaths 3.5 Overall Rate: 17.9

6. Excess Feto-Infant Mortality Pinellas County 1998-00 _ = All Races Florida DOH Reference Excess 4.7 2.31.41.6 10.0 2.3 1.60.91.0 5.84.2 2.4 0.70.50.6

7. Phase 2 Analysis Findings Kitagawa: Over HALF of excess feto-infant mortality is due to the LARGE NUMBER of VLBW births From Birth Certificate Anemia Chr. Hypertension Smoking Alcohol/Drugs 3 rd Trimester PNC No PNC Examples of risk factors examined:Examples of risk factors examined: From Prenatal Screen Appointments Moved Unsafe Hungry High Stress Unwanted Pregnancy

8. Leading Prevention Strategy Provide preconceptional and interconceptional care to women of reproductive age

9. Program Map InputActivitiesOutputs Physician Referral for High Score Outreach Pregnancy Testing Self Referral Results Physician Referral for Other Factors Care Coordination Interconceptional Care Community Consortium Building Family Planning Identify stress and mental health issues Improved Access to Healthcare for WCBA Education on Women’s Health Issues Counseling/Referrals Peer Support Groups Early Entry into Prenatal Care Targeted Outreach Repeat Births at Least 2 years after Last Fewer Women Smokers Improved Maternal Nutrition Fewer GU Infections during Pregnancy Improved Mental Health during Pregnancy/Postpartum Fewer LBW and VLBW Births Fewer Premature Births Lower Fetal and Infant Mortality Social Agency Referral for Other Factors PPOR Findings Improved Women’s Health

10. Mapping revealed addressing Maternal Health was vital to reducing the poor birth outcomes experienced in Pinellas County Maternal Health/ Prematurity Preconceptional Health Healthy Behaviors Perinatal Care Before Pregnancy

11. 4 Opportunities Healthy Start Home Visiting Screening Tool for Women Linkage to Existing Health Programs Community Health Education

12. Pre/Interconceptional Current and Future Activities 1-on-1 Education Chronic Disease and Obesity Prevention Programs

13. “What About Mom” “Beauty Talk”

14. Women’s Health Questionnaire “While You Wait”

15. Part 2: Integrating Interconceptional Education and Counseling into Healthy Start: A+ Best Practice Pinellas County Home Visiting Program for Pregnant Women and Infants

16. Why develop another Healthy Start Enhanced Service?  More than 50% of pregnancies are unplanned.  Untreated/Unmanaged Chronic Health conditions prior to pregnancy may increase risk of poor birth outcomes.  Healthy Start participants need correct information about their personal health.

17. Including Interconceptional Education and Counseling in Pinellas County Primary Goals X 2 Ensure Annual Well-Woman Visit Achieve Baby Spacing

18. Interconceptional Care is what we know as “Women’s Health” which includes family planning, healthy lifestyles, and medical care of any health problems. Interconceptional Care

19. Interconceptional Education and Counseling 1. Assesses the woman’s current health status using Women’s Health Questionnaire. 2. Provides activities that educate and inform the Healthy Start woman about specific topics related to Women’s Health. 3. Uses a Risk Reduction Approach

20. Interconceptional Education and CounselingTopics Environmental risk factors Stress & Mental Health Substance use/smoking Chronic Health Problems Physical ActivityNutrition Baby spacingMaternal Infection Access to Health careWomen’s Health

21. 10 Brochures to prompt discussions in each risk factor topic area.

22. Health Statistics Facts about Women’s Health Leading Causes of Death Pinellas County 2002 Heart Disease 3,345 Pneumonia/Influenza 254 Cancer 2,683 Liver Disease 132 Stroke 728 SIDS/HIV 65 Emphysema 739 Suicide 154 Accidents 423 Homicide 59 Diabetes Mellitus 296

23. Routine Health Maintenance and Family Planning for Women Health status screening and physical activity Physical exam, including STD screening Dietary/nutritional assessment Screening for tobacco, alcohol and other drugs Screening for abuse and neglect

24. Screening for Medical Conditions Diabetes High blood pressure Cardiac Disease Thyroid Disorders Epilepsy Asthma HIV Infection Systemic Lupus Thromboembolic Disease (clotting) Renal Disease Hemoglobinopathies (Sickle Cell) Cancers STD’s and Bacterial Vaginosis

25. Screening for Maternal Infections STDs (gonorrhea, syphilis and Chlamydia) HIV Hepatitis Bacterial Vaginosis Safe sex knowledge and practice (condoms) Dental Access and Utilization Screening for Periodontal Disease

26. Teratogens/Genetics Self or prior child with congenital defect Family history of genetic disease Refer to geneticist for recurrence risk counseling and/or prenatal testing

27. Substance Use Patient education as to effects of substances on fetus Risk screening and assessment Referral for treatment program Pregnancy may be a strong motivator for change

28. Smoking Effects of smoking effects on birth outcomes- preterm and low birthweight Smoking in the household is associated with SIDS, childhood respiratory illness, asthma, and otitis media Risk screening and assessment Referral for smoking cessation

29. Domestic Violence DV screening Provide education: Two million women each year are abused by a partner Referral and assistance

30. Nutrition Assessment by weight/height and BMI Education about risk - Underweight (BMI < 18.5 pre pregnancy) - Overweight (BMI 25-29.9) - Obese (BMI 30 or greater) Nutrition counseling and referral

31. Physical Activity Daily and Weekly Physical Activity

32. Prevention of Neural Tube Defects folic acid for all women of childbearing potential

34. Documentation in Healthy Start Records Establish separate record for woman and baby.

35. MEASUREABLE RESULTS 6New Encounter Code 8013 6Information Given 6Referral Made 6Services Received

36. Promotion of women’s health needs should be a collaborative approach within the medical community and community-at-large. What else is there to know?

37. Statewide agency support was gained through the efforts of Florida’s Perinatal Periods of Risk Practice Collaborative model. A new chapter has been added to the HS Standards and Guidelines. What barriers might be experienced?

38. Women are concerned less for themselves when the baby is born and often forget to pay attention to their own needs. Interconceptional education and counseling is an opportunity to focus on the health needs of the entire family. Remaining Advice?

39. jane_bambace@doh.state.fl.us jennifer_opalek@doh.state.fl.us Additional Information