Cheri Pies, MSW, DrPHPadmini Parthasarathy, MPH

Family, Maternal and ChildHealth ProgramsContra Costa Health Services

A Life Course Approach to MCH Epidemiology: Practice and Policy

Overview

Who we are

What we have been doing

What we have struggled with

Where we are going (we hope!)

Where is Contra Costa County?

Contra Costa Demographics

Population is increasing in size– As of January 2007: 1,042,341– Increase of 29.7% since 1990 and 9.9% since

2000.– Will increase by an additional 3.2% by 2010

and 18.7% by 2020

19.6% of Contra Costa residents live below 200% of the poverty line

22

40

22

53

21

13 11

9

0

10

20

30

40

50

60

2005 2050

Percent White

Hispanic

Asian

Black

Racial/Ethnic Makeup ofContra Costa County, 2005 & 2050

The Life Course Initiative

15-year initiative

Engaging MCH Program and other county staff, as well as community partners

Reducing health disparities overall

Improving reproductive potential

New way of working in MCH

Why we are doing this

Paradigm shift

Changing the health of a generation

Current Life Course Epi Activities

Regular meetings of a Life Course Initiative Data Team

Survey of Family, Maternal and Child Health Programs staff– Evaluated staff understanding of Life Course

Perspective– Gathered ideas from staff about incorporating the

Life Course Perspective into their work

Current Life CourseEpi Activities, cont.

Identifying “intermediate outcomes” as measurements of success of Life Course-related activities (vs. long-term perinatal outcomes)

Examples of intermediate outcomes (for clients):– Improved life skills/coping skills– Improved sense of well-being, empowerment,

resiliency, self-efficacy – Increased bonding response to infants– Decreased stress– Improved financial stability

Challenges

Selecting which factors to measure and determining whether they in fact impact birth outcomes (i.e. racism, poverty, neighborhood characteristics, health outcomes)

Measuring factors over time

Lack of local information for many measures

Difficulty in identifying the appropriate measures for evaluating policy and system changes

Challenges, cont.

Often policy change has to precede behavior change

Local health departments and other local agencies are not research settings and may not have the epidemiological capacity to do this kind of work

The Life Course Perspectivein Practice

Preconception care for middle school-age youth: After-school groups for girls and boys– Health education– Reproductive life planning– Skills-building– Peer leadership– Links to school-based health services– Parent involvement and education

Discussion Questions

What measures should we use to evaluate the success of this project from a Life Course Perspective?

How would we obtain this information?

What would success look like?

Session Discussion Questions

What would we do differently if the Life Course Perspective were our current paradigm?

How do we measure the changes, if any, of this paradigm shift in the reduction of racial/ethnic disparities in birth outcomes?

What infrastructure changes would be needed to implement and measure the outcomes of Life Course intervention strategies?

What are the next steps?