Maternal Health Needs and Resources in a Changing Community Monterey County Health Department,...

Maternal Health Needs and Resources in a Changing

Community

Monterey County Health Department,

Salinas, California

Monterey County Health Department - DUI Project 2

DUI Project Team

• Krista Hanni, Research Analyst, Presenter• Dr. Linda Velasquez, Health Officer• Dr. Alicia Paris-Pombo, Epidemiologist• Susan McNelley, Perinatal Services Coordinator• Darryl Tyler, GIS Analyst, Information

Technology• Robbie Gonzales Dow, Perinatal Outreach

Coordinator• Joyce Brown, Head of Public Health Nursing • Linda McGlone, Injury Prevention• Judy Garrison, Program Director, Cancer

Detection Programs


Monterey County

• 3,322 mi2

• 417,185 people• 126 persons/mi2

• Largest city: Salinas – 151,030

Salinas


$- $10,000 $20,000 $30,000 $40,000 $50,000 $60,000 $70,000

Carmel

Monterey County

California

Salinas

King City

1990 2000

1990 to 2000: Growth in Median Household Income


Latinos: A Growing “Minority”

• 72,000 not citizens out of 181,000 Latinos in county

1990 2000

California 26% 32%

Monterey County 34% 47%

King City 67% 80%

Salinas 51% 64%

Carmel 3% 3%


County Latino Profile

Compared to Whites in 2000, Latinos:

• Younger

• Lower household income

• Larger household size

• Households more overcrowded

• Less likely to own house

• Less education


County Health Profile 2002

• Monterey County saw improvements for most of 36 indicators over past ten years

• Met HP 2010 objective for 6 indicators

• Better than California for 24 indicators

• Disparity in health within county?


Socioeconomic Disparities and Health

• Socioeconomic disparities shown to affect health outcome

• Poverty one of the better geographic indicators of health

• Mother’s use of services correlated with childrens’ health


Objective

Identify ‘hot spots’ for maternal health indicator within Monterey

County in relation to services


Identification

• Area-based Socioeconomic Measure– % in Poverty

• Maternal Health Indicators– Births by payment method– Birth weight– Entry to prenatal care– Teen births

• Born in Mexico

• Services– Hospitals– Clinics


How we did it

• GIS – Geographic Information Service• Focus on Salinas for today’s presentation• 1990 and 2000 census data by census

tract• 1998 and 2002 county birth data with

addresses– Use address to map out birth locations


Where People Live in Salinas


% in Poverty in 1990 by Census Tract

Legend

% Below Poverty 1990

0 - 7

7 - 14

14 - 21

21 - 28

28 - 35

Highways

Major Roads

city limits0 0.5 1 1.5 20.25

Miles


% in Poverty in 2000 by Census Tract

Legend

% Below Poverty 2000

0 - 7

7 - 14

14 - 21

21 - 28

28 - 35

Major Roads

Highways

City Limits0 0.5 1 1.5 20.25

Miles


Maternal Health IndicatorsIndicator Salinas 1998 Salinas 2002 County 2002

Births 3,337 (49%) 3,575 (49%) 7,103 (100%)

Medi-Cal & No Insurance

1,894 (57%) 2,069 (58%) 3,958 (54%)

Low Birth Weight 154 (4.7%) 183 (5.2%) 338 (5%)

Late Entry to Care

768 (21%) 511 (15%) 958 (14%)

Teens (15-17) 174 (5%) 166 (5%) 308 (4%)

Teens (15-17) Born in Mexico

58 (33%)* 82 (49%)* 161 (52%)*

* Percent of teen births


Hot Spots• Density – 1000 x 1000 ft sq grabs

data within square mile• Square is color coded to indicate

range

low middle high

• Deeper red areas are our hot spots


MediCal & No Insurance Births in 2002


Low Birth Weight Births in 2002


Late Entry to Care Births in 2002


Teen (15-17 Years Old) Births in 2002


Change Hot Spots

Negative Little Change Positive

• Extremes are most (+) or (–) difference between 1998 and 2002


Medi-Cal & No Insurance Change in Births 1998 to 2002


Low Birth Weight Change in Births 1998 to 2002


Late Entry to Prenatal Care Change in Births 1998 to 2002


Teen (15-17 Years Old) Change in Births 1998 to 2002


Mexican Born Teen (15-17 Years Old) Change in Births 1998 to 2002


Medi-Cal Births and Hospitals

0

200

400

600

800

1000

1200

1400

1600

1800

1998 1999 2000 2001 2002

Co

un

t

NatividadMedical Center

Salinas ValleyMemorialHospital


Medi-Cal OB Providers & Clinics in 2002


Summary

• Hot spot: East Salinas• Hospitals located fine, but

concern about closure of hospital with most Medi-Cal deliveries

• Identified area of need for obstetric providers and clinics accepting Medi-Cal


Accomplishments

• Identified meaningful indicators

• Spatially represented birth data

• Beginning to develop similar projects for children, injury, and cancer


Lessons Learned

• Difficult to match data to community resources

• Watch for database error

• Teamwork is essential for useful final result– Include community partners


Thanks CityMatCH-DUI!We are learning from you.

Maternal Health Needs and Resources in a Changing Community Monterey County Health Department,...

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