BETTER BEGINNINGS

Healthy Families

A Report on the Health of Women, Children, and Families in Spokane

Amy S. Riffe, MA, MPH/Elaine Conley, DirectorSpokane Regional Health District

Community Health Assessment, Planning, and Evaluation

Demographics – Spokane County

472,650 residents in 2011

111,470 women of childbearing age

5,867 births

Births 2007-2011 8% 15-19 years 59% 20-29 years 31% 30-39 years 2% 40-49 years

47% Medicaid

90% White

11% <High school ed

Birth rate12.4 per 1,000 residentsDecreased from 07-11Lower than WA

Teen birth rate, 15-17 11.3 per 1,000 womenNo trendSimilar to WA

Demographics - continued

Cost of a Birth – Spokane County 2007-2011

Full term infant 93% of full term ≤ 3

days $6,800

Preterm infant 40% ≤ 3 days $55,900

6.5% of births 64% of charges

The average hospital stay for a newborn was 3 days

The average charge was $10,000

P O O R M E N TA L H E A LT H

17.0% of women 18-44No trendSimilar to WANo difference by ageDecreased with income

Preconception Health

<$15,000 $15k-$25k $25k-$50k $50,000+0

10

20

30

40

5036.8

25.615.3

7.2

Poor Mental Health by IncomeSpokane County Women 18-44, 2006-

2010

Perc

ent

Preconception Health

Pre-pregnancy obesity 24.1% obese before

becoming pregnant Increased from 07-11 Lower than WA

Increased with age Higher for Medicaid Higher for black, AIAN

15-19 20-29 30-39 40-49 Med-icaid

Non-Med-icaid

White Black AIAN API His-panic

0

10

20

30

40

50

12.6

22.7 24.128.7 25.9

19.2 22.2

31.528.2

15.422.6

Pre-Pregnancy Obesity by DemographicsSpokane County, 2007-2011

Perc

ent

of

bir

ths

Preconception Health

Unintended pregnancy 36.1% of birth were

unintended pregnancies

Similar to WA

Decreased with age Higher for Medicaid No difference by race

15-1

9

20-2

9

30-4

9

Med

icaid

Non-M

edica

id

0

25

50

75

10081.0

39.919.5

55.6

21.6

Unintended Pregnancy by DemographicsSpokane County, 2006-2010

Perc

ent

of

bir

ths

Family Health

Family Structure, Spokane County, 2011 108,605 children 0-17 years 52,489 family households with children

23.4% were a female householder, no husband• 6,196 children 0-5 years live with a single mother

8.7% were a male householder, no wife

Family Health

ACEs 12% of kids K-6 have

3+ 46% of women have 4-

8 Higher than WA No difference by age Decreased with

income

Low social support 18.9% with low

support No trend Similar to WA No difference by age Decreased with

income

<$15,000 $15k-$25k $25k-$50k $50,000+0

25

50

75 64.4 62.852.9

31.7

High ACEs Score by IncomeSpokane County Women 18-44, 2009-

2010

Perc

ent

<$15,000 $15k-$25k $25k-$50k $50,000+0

10

20

30

40 33.325.7

14.2

5.8

Low Social Support by IncomeSpokane County Women 18-44, 2006-

2010Perc

ent

Family Health

Child abuse 5,264 victims in 2011 Increased from 07-11 Higher than WA

Smoking in home 16.9% allow it No trend Higher than WA No difference by age Decreased with

income

2007 2008 2009 2010 20110

10

20

30

40

50

60

42.6 41.0 40.045.3 48.1

34.1 31.6 31.9 31.8 33.7

Child Abuse Over Time

Spokane County Washington State

Rate

per

1,0

00 c

hildre

n 0

-17

$15k-$25k $25k-$50k $50,000+0

10

20 17.9

10.1

6.4

Allows Smoking in the Home by IncomeSpokane County Women 18-44, 2006-

2010Perc

ent

Family Health

Stressors 13.5% of mothers had

4+ stressors during 06-11

Higher for women 20-29

Higher for Medicaid Higher for non-whites

Women with 4+ stressors Nearly 10x more likely

to have postpartum depression

Almost 6x more likely to have a LBW infant

15-1

9 yr

s

20-2

9 yr

s

30-4

9 yr

s

Med

icaid

Non-M

edica

id

White

Non-w

hite

0

10

20

30

6.6

18.9

4.5

26.5

2.5

12.1

26.7

4+ Life Stressors by DemographicsSpokane County, 2006-2010

Perc

ent

of

bir

ths

Maternal Health

Short IPI 40.8% had a short IPI Decreased from 07 to

11 Higher than WA No difference by

income or race Decreased with age

Prenatal care, 1st tri 88.7% had 1st tri PNC Increased from 07 to

11 Higher than WA Increased with age Lower for Medicaid Lower for non-white

15-19 20-29 30-39 40-490

25

50

75 69.0

46.636.1 36.0

Short Interpregnancy Interval by AgeSpokane County, 2007-2011

Perc

ent

of

bir

ths

15-1

9

30-3

9

Non

Med

icaid W

hite

AIAN

Hispan

ic50

75

100

7887 90 86 81

93 8882

76 76 77

First Trimester Prenatal Care by De-mographics

Spokane County, 2007-2011P

erc

ent

of

bir

ths

15-1

9

20-2

9

30-3

9

40-4

9

Med

icaid

Non

Med

icaid W

hite

Black

AIAN

API

Hispan

ic0

10

20

30

4030.6

18.510.1 9.1

27.7

7.4

16.821.4

29.9

4.99.2

Maternal Smoking by DemographicsSpokane County, 2007-2011

Perc

ent

of

bir

ths

Maternal Health

Maternal smoking 15.9% smoked Decreased from 07-11 Higher than WA Decreased with age Higher for Medicaid Higher for black, AIAN

Alcohol use 37.3% drank in last

trimester Similar to WA No difference by age,

Medicaid, or race

Child Health

Low quality of life 23.7% of youth

reported a low QOL Decreased from 06 to

10 Higher for low

education Higher for blacks

Mom <HS ed

Mom >=HS

ed

White Black AIAN API0

10

20

30

40

5040.0

20.8 22.4

34.028.9

24.6

Low Quality of Life by DemographicsSpokane County, 2010

Perc

ent

of

youth

Child Health

Kindergarten readiness Washington Kindergarten Inventory of Developing

Skills Fall 2012

Social/emotional Physical Language Cognitive Literacy Math

Cheney

East Valley

Spokane

West Valley

5

4

3

3

5

6

7

7

WaKIDS, 2012

Met 6 of 6 domains Not met 6 of 6 domains

Summary

Better than WA Dental sealants Hypertension Prenatal care first

trimester Pre-pregnancy obesity Vaccine preventable

illness

Worse than WA ACEs Birth defects Breastfeeding Child abuse Chlamydia Immunization exemption Maternal smoking No flu shot in the last

year Short IPI SIDS Smoking allowed in home

Summary

Good trend Breastfeeding Low quality of life Maternal smoking Prenatal care first

trimester Preterm birth Short IPI Vaccine preventable

illness

Bad trend Child abuse Chlamydia Diabetes Good general health Hypertension Immunization

exemption Pre-pregnancy obesity

Concerns

• Many of the indicators are getting worse• Many of the measures show a disproportionate

impact on:o Individuals on Medicaido Racial minorities

• Many of the issues are deeply rooted in inequities such as:o Educational attainmento Household incomeo Neighborhoods in which people live

What Can We Do?

• Traditional public health approaches are not sufficient to address many of these problems

• Community wide initiatives that impact the root causes of these issues will need to be initiated and/or expanded

What Can We Do? (continued)

• Need a continuum of activities that address all levels of the socio-ecological model

What Can We Do? (continued)

• Focus on policy and system-level change while simultaneously focusing on social, organizational and individual behavior change

• We must develop a shared vision for the future of children and families in the community

Recommendations

Four major areas of recommendations…..

Recommendations (Continued)

Mitigate and/or prevent the impacts of ACEs on children and families

Build community resilience by promoting community connectivity

Support a variety of providers, organizations parents and community members in adopting trauma-sensitive practices in their work and in the community

Promote positive community norms about parenting programs and acceptable parenting behaviors

Recommendations (Continued)

Mitigate and/or prevent the impacts of ACEs on children and families (Continued) Continue to support best practice one-on-one

interventions such as Nurse Family Partnership for the most vulnerable families

Invest in mental health resources Strengthen safe, stable, nurturing relationships at

the community level Establish peer support models for expectants

mothers Build connectivity among women through low cost

activities like exercise

Recommendations (Continued)

Ensure That Children Enter School Ready to Learn

Develop and implement universal developmental screening for children 0-5 years of age.

Invest in quality early childhood education Address the achievement gap between white and

non-white students

Recommendations (Continued)

Address Inequities in Spokane County Promote policies that meet families’ basic needs

including: Affordable housing Access to food Access to health care

Provide adequate income support for young families Increase minority representation on governing boards

to assist in decision making that supports all people Develop policies utilizing a child and family sensitive

lens and advocate for a “health in all policies” standard