Using Geographical Information Systems (GIS) to Represent Sexual Health Outcome Trends in El Paso

County, Texas

Sheetal Malhotra, MBBS, MSNancy Ronquillo

Katherine A Hendricks, MD, MPH&TM

Innovative Evaluation Practices

• Geographical Information Systems (GIS)

• Example

− show changes in sexual health outcomes such as chlamydia and teen births

GIS

• Mapping tool − a strategy to show data on maps.

• Maps− allow easy visualization of health events or

problems− how they change over time− visualize results easily

Example of GIS Mapping-Texas Birth Rate for 10- to 19-Year-Olds

1996 1998

2000 2002

Using GIS for Program Evaluation• Get updated area maps

− state, city, county, or school district levels

• Geocode data

− assign a location to the data.

• Place data on a map

− cases

− rates (for better comparisons)

• Maps displayed as shades of the same color or different colors to signify different categories

Advantages

• Identify problem areas and factors that may be contributing to the health care problems

• Compare sexual health outcomes

─ geographically

─ temporally

• More sophisticated analyses

─ spatial analyses

Birthrates for 15- to 19-Year-Olds

• US 65/1000

• TX 77/1000

• El Paso County 89/1000

• San Elizario & Fabens ISDs 190/1000

• ~ 70% of county births are to teen mothers

Source: DSHS Office of Border Health

STI Rates/100,000 Populationby Area

Source: Texas Department of Health. 2001 Selected Health Fact Sheets. Available from: http://www.dshs.state.tx.us/chs/cfs/cfs01/Texas01.pdf

STI El Paso Border Texas

Gonorrhea 42 28 141

Chlamydia 342 292 328

AIDS 18 11 14

HIV 13 11 20

Paso a Paso: Purpose

• Promote abstinence/risk avoidance among youth aged 12-18 years in 2 independent school districts (ISDs) in El Paso County

• Provide community-based sexual health education

− abstinence-based

− relationship skills training

Paso a Paso: Goals & Objective

• Goals: implement community-wide activities to support

− abstinence education (adolescents)

− parenting education (adults)

• Objectives:

− promote the practice of abstinence until marriage

− promote return to abstinence

Paso a Paso: Components

• Medical Institute Project, El Paso

− school-based curriculum, grades 6-12

− parenting adult curriculum

− community mobilization

− evaluation

− geocode chlamydia & pregnancies

What does evaluation involve?

• Surveys

− pre-tests – before the program

− post-tests – soon after the program

− follow-up – next school year

• GIS

− births

− chlamydia cases

Measures to Protect Participant Rights• Approval from

− Institutional Review Board (IRB)

• Partnership with

− State Health department

− County Public Health department

GIS Mapping

• Data from health department

− chlamydia case reports

− teen births

• Data geo-coded by residence

• Geo-coded data used to map outcomes

• Maps easily show

− areas of need

− increase/decrease over time

Teen Birth Rates 2006-07

Teen Birth Rates 2007-08

Chlamydia Rate 2006-07

Chlamydia Rate 2007-08

Challenges

• Data integrity

• Electronic transfer

• Security and privacy

• Address matching

• STI underreporting

• Updated boundary lines

• Population data for school districts

Funding for the Study

This study was supported by grant # 90AE0147 from the Administration of Children and Families (ACF). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the ACF, the Department of Health and Human Services or the U.S. government.

Thank You!

For more information contact

Sheetal Malhotra

smalhotra@medinstitute.org

512-328-6268