1. Core State Indicators for Monitoring Preconception Health: A Multi-state Selection Process Danielle L. Broussard, PhD, MPH Former CDC/CSTE Applied Epidemiology Fellow Division of Family Health Services Florida Department of Health

2. Objectives Explain the need for indicators Explain the need for indicators Describe the selection process Describe the selection process Present the indicator domains Present the indicator domains Discuss recommendations for future efforts Discuss recommendations for future efforts

3. Critical Periods of Fetal Development 4 5 6 7 8 9 10 11 12 Central Nervous System Heart Arms Eyes Legs Teeth Palate External genitalia Ear Missed Period Mean Entry into Prenatal Care Week

4. CDC’s Preconception Health Efforts Recommendations Journal publications Workgroups to develop strategies Evaluations and best practices Technical assistance to programs National summit

5. Preconception Health in States Many states identified preconception health- related indicators in Title V Block Grant applications and annual reports (2004, 2006) Many states identified preconception health- related indicators in Title V Block Grant applications and annual reports (2004, 2006) Some states already developed preconception health reports that included indicators Some states already developed preconception health reports that included indicators Source: Boulet SL, et al. MCHJ 2006; 10(Suppl 1):13-20.

6. Standard, nationally-recognized preconception health measures were needed Standard, nationally-recognized preconception health measures were needed

7. Core State Preconception Health Indicator Initiative Purpose Working group: 7 states Working group: 7 states CA, DE, FL, MI, NC, TX, & UTCA, DE, FL, MI, NC, TX, & UT Already developed and utilized indicatorsAlready developed and utilized indicators Review and evaluate potential indicators Review and evaluate potential indicators Recommend an initial set of core state indicators Recommend an initial set of core state indicators

8. Core State Preconception Health Indicator Initiative Assumptions Measured frequently– optimally on an annual basis Measured frequently– optimally on an annual basis State-level, population-based State-level, population-based Reasonably valid and reliable Reasonably valid and reliable Women of reproductive age (18-44); adolescents and men require their own set of measures Women of reproductive age (18-44); adolescents and men require their own set of measures

9. Core State Preconception Health Indicator Initiative Process Identify domains of preconception health Identify domains of preconception health Review available state data sets for potential indicators within domains Review available state data sets for potential indicators within domains Identify potential indicators Identify potential indicators Evaluate potential indicators on 5 criteria Evaluate potential indicators on 5 criteria Score potential indicators on 5 criteria Score potential indicators on 5 criteria

10. Core State Preconception Health Indicator Initiative Process Select and recommend core indicators Select and recommend core indicators Make available for public review and comment Make available for public review and comment Consulted expert advisory panel at various decision making points Consulted expert advisory panel at various decision making points

11. Core State Preconception Health Indicator Initiative Domains General Health Status General Health Status Social Determinants Social Determinants Health Care Health Care Reproductive Health/ Reproductive Health/ Family Planning Family Planning Nutrition/Physical Activity Nutrition/Physical Activity Tobacco, Alcohol, and Substance Use Tobacco, Alcohol, and Substance Use Mental Health Chronic Conditions Emotional / Social Support Infections Genetics / Epigenetics

12. Core State Preconception Health Indicator Initiative State-level Data Sets Abortion reporting Abortion reporting Assisted Reproductive Technology Surveillance System Assisted Reproductive Technology Surveillance System BRFSS BRFSS Census / Current Population Survey Census / Current Population Survey Cancer registry Cancer registry PRAMS PRAMS Pregnancy Nutrition Surveillance System Pregnancy Nutrition Surveillance System Notifiable STD reporting Notifiable STD reporting National Vital Statistics System National Vital Statistics System

13. Core State Preconception Health Indicator Initiative 5 Evaluation Criteria General public health importance General public health importance State program/policy priority State program/policy priority Data availability (frequency, accessibility) Data availability (frequency, accessibility) Data quality (representativeness, validity, reliability, missing data) Data quality (representativeness, validity, reliability, missing data) Complexity of calculations Complexity of calculations

14. Core State Preconception Health Indicator Initiative Proposed Indicators 45 indicators within the 11 domains 45 indicators within the 11 domains Detailed descriptions posted on the CSTE website Detailed descriptions posted on the CSTE website Data sourceData source Numerator and denominator for calculationsNumerator and denominator for calculations SignificanceSignificance LimitationsLimitations

15. Core State Preconception Health Indicator Initiative Proposed Indicators Full descriptions on CSTE web site: www.cste.org Full descriptions on CSTE web site: www.cste.org www.cste.org Publication describing indicator selection process Publication describing indicator selection process Broussard DL, et al. MCHJ 2011; 15(2):158-68.

16. Core State Preconception Health Indicator Initiative Challenges Preconception health is an emerging field (little data on population effects of programs) Preconception health is an emerging field (little data on population effects of programs) Many measures not captured or not captured well in existing surveillance systems Many measures not captured or not captured well in existing surveillance systems Defining the population at risk Defining the population at risk Large number of indicators Large number of indicators Gaps in data (e.g., disease severity, genetic testing for specific heritable conditions) Gaps in data (e.g., disease severity, genetic testing for specific heritable conditions)

17. Core State Preconception Health Indicator Initiative Recommendations Improve existing surveillance items or create new data sources Improve existing surveillance items or create new data sources Limited resources and competing surveillance priorities means collaboration with other public health programs is essential (e.g., chronic diseases) Limited resources and competing surveillance priorities means collaboration with other public health programs is essential (e.g., chronic diseases)

18. Core State Preconception Health Indicator Initiative California  Moreen Libet, PhD  Kiko Malin, MPH, MSW Delaware  Charlan Kroelinger, PhD Florida  Danielle Broussard, PhD, MPH  Bill Sappenfield, MD, MPH Michigan  Violanda Grigorescu, MD, MSPH  Chris Fussman, MS North Carolina  Alvina Long Valentin RN, MPH  Sarah McCracken Cobb, MPH Texas  Gita Mirchandani, PhD, MPH  Charlotte Brooks, MEd Utah  Nan Streeter, MS, RN  Lois Bloebaum, MPA  Shaheen Hossain, PhD