Trends & Forecasts in Florida Jane Correia, HSEE Coordinator, Florida Birth Defects Registry Bureau...

Trends & Forecasts in Trends & Forecasts in FloridaFloridaJane Correia, HSEEJane Correia, HSEECoordinator, Florida Birth Defects RegistryCoordinator, Florida Birth Defects RegistryBureau of Community Environmental HealthBureau of Community Environmental HealthFlorida Department of HealthFlorida Department of Health

Kimberlea Hauser, MBAKimberlea Hauser, MBAProject Director, Birth Defects Surveillance ProgramProject Director, Birth Defects Surveillance ProgramDepartment of PediatricsDepartment of PediatricsUniversity of South FloridaUniversity of South Florida

TrendsTrends

Do we know what percentage of Do we know what percentage of Florida women of childbearing Florida women of childbearing age are consuming alcohol?age are consuming alcohol?

Do we know who is using Do we know who is using alcohol during pregnancy?alcohol during pregnancy?

Do we know the rate of FAS in Do we know the rate of FAS in Florida?Florida?

Data SourcesData Sources

Behavioral Risk Factor Survey Behavioral Risk Factor Survey System (BRFSS)System (BRFSS)

Pregnancy Risk Assessment Pregnancy Risk Assessment Monitoring System (PRAMS)Monitoring System (PRAMS)

Florida Birth Defects Registry Florida Birth Defects Registry (FBDR)(FBDR)

Florida BRFSSFlorida BRFSS

A Population-based random sampling A Population-based random sampling telephone survey, following CDC telephone survey, following CDC survey protocol survey protocol

Monitors behavioral risk factors and Monitors behavioral risk factors and chronic diseaseschronic diseases

Surveys residents 18 years and older Surveys residents 18 years and older

Conducted annually since 1986Conducted annually since 1986

Over Over 7,100 completed interviews7,100 completed interviews in in 20042004

Strengths and Strengths and LimitationsLimitations Strengths:Strengths:

– Population-based survey Population-based survey – Conducted every yearConducted every year– Flexible and relatively inexpensive Flexible and relatively inexpensive – Data are comparable to other Data are comparable to other

states states

Limitations:Limitations:– Selection bias: telephone coverage Selection bias: telephone coverage

and participationand participation– Sample size and sampling errorsSample size and sampling errors– Self-reportSelf-report

Current Alcohol Use (Past 30 Current Alcohol Use (Past 30 days) among Women in Florida, days) among Women in Florida,

Ages 18-44, 2004Ages 18-44, 2004

11.7%

0.4%

33.7%

5.4%

13.8%

1.2%

35.3%

2.0%

13.7%

33.4%

2.9%

0% 10% 20% 30% 40%

1-5 days/ wk

> 5 days/ wk

1-10 days/ mth

>10 days/ mth

35-44 25-34 18-24

Current Binge Drinking (Past 30 Current Binge Drinking (Past 30 Days) among Women in Florida, Days) among Women in Florida, Ages 18-44, 2004Ages 18-44, 2004

3.8%

1.0%

1.3%

0.8%

7.7%

6.5%

3.0%

0.9%

2.6%

6.0%

8.1%

1.0%

2.2%

14.4%

6.0%

0% 5% 10% 15% 20%

>4 Times

4 Times

3 Times

2 Times

1 Time

35-44 25-34 18-24

Heavy or Binge Drinking among Heavy or Binge Drinking among Women in Florida by County, Women in Florida by County, 20022002 Counties with the Counties with the

highesthighest percentages: percentages:

– Monroe: 17.8%Monroe: 17.8%

– Brevard: 14.6%Brevard: 14.6%

– Alachua: 14.5%Alachua: 14.5%

– Desoto: 13.2%Desoto: 13.2%

– Jefferson: 12.4%Jefferson: 12.4%

– Dade, St. Johns, & Dade, St. Johns, & Seminole: 11.0%Seminole: 11.0%

Counties with the Counties with the lowestlowest percentages: percentages:

– Bradford: 2.4%Bradford: 2.4%

– Hardee: 3.0%Hardee: 3.0%

– Sumter: 3.1%Sumter: 3.1%

– Osceola & Osceola & Suwannee: 3.2%Suwannee: 3.2%

– Gadsden & Gadsden & Hamilton: 3.3%Hamilton: 3.3%

– Holmes & Madison: Holmes & Madison: 3.5%3.5%

Use of Birth Control Methods Use of Birth Control Methods among Women in Florida, among Women in Florida, Ages 18-44, 2004Ages 18-44, 2004

61.6

24.0

14.3

72.1

21.1

6.8

69.2

19.9

10.9

0

25

50

75

100

Yes No No Partner, NotSexually Active

Percent

18-24 25-34 35-44

Youth Risk Behavior Youth Risk Behavior Survey (YRBS)Survey (YRBS) School-School-based self-reported survey of health based self-reported survey of health

risk behaviors among risk behaviors among high school high school studentsstudents First cFirst conducted onducted in Florida in in Florida in 19911991, ,

administered every Spring inadministered every Spring in odd-numbered odd-numbered yearsyears

Since 2001, in collaboration with the Since 2001, in collaboration with the Department of EducationDepartment of Education

Administered as part of the Florida Youth Administered as part of the Florida Youth SurveySurvey

In 2003, approx. 4100 students completed In 2003, approx. 4100 students completed the YRBSthe YRBS

Health Risk Behaviors Health Risk Behaviors MonitoredMonitored One of a number of surveillance systems One of a number of surveillance systems

utilized by the CDC to monitor health risk utilized by the CDC to monitor health risk behaviors that contribute to disease behaviors that contribute to disease morbidity and mortality, including:morbidity and mortality, including:

– Tobacco use Tobacco use – Unhealthy dietary behaviorsUnhealthy dietary behaviors– Inadequate physical activity Inadequate physical activity – Alcohol and other drug use Alcohol and other drug use – Sexual behaviors that contribute to unintended Sexual behaviors that contribute to unintended

pregnancy and sexually transmitted diseases, pregnancy and sexually transmitted diseases, including HIV infection including HIV infection

– Behaviors that contribute to unintentional injuries Behaviors that contribute to unintentional injuries and violence and violence

Current Alcohol Use (Past 30 Days) Current Alcohol Use (Past 30 Days) among Florida High School Students, among Florida High School Students, 20032003

44.9%42.7%

37.4%

42.0%44.4%

39.6%

45.8%43.8%

38.5%

44.5% 45.8%

40.6%

0%

10%

20%

30%

40%

50%

60%

US FL Miami Ft.Lauderdale

Palm Bch Orange

Percent

Total Girls

Binge Drinking among Florida Binge Drinking among Florida High School Students, 2003High School Students, 2003

28.3%

23.2%

16.8%

20.2%

24.5%

17.4%

27.5%

20.5%

13.6%

20.3% 21.2%

16.8%

0%

10%

20%

30%

40%

US FL Miami Ft.Lauderdale

Palm Bch Orange

Percent

Total Girls

Current Sexual Activity (Past 3 Current Sexual Activity (Past 3 Months) among Florida High School Months) among Florida High School Students, 2003Students, 2003

34.3%36.2%

37.7% 37.5%39.0%

34.5% 35.2% 36.3% 36.9% 36.0%

0%

10%

20%

30%

40%

50%

US FL Miami Ft. Lauderdale Palm Bch

Percent

Total Girls

Among Florida High School Students Who Among Florida High School Students Who Were Currently Sexually Active, the Were Currently Sexually Active, the Percentage Who Drank Alcohol or Used Percentage Who Drank Alcohol or Used Drugs Before the Last Time They Had Drugs Before the Last Time They Had Sexual Intercourse, 2003Sexual Intercourse, 2003

25.4%

21.9%

14.6%

18.7%

24.2%

21.0%

17.4%

11.8%

17.3% 16.8%

0%

10%

20%

30%

40%


Percent

Total Girls

Percentage of Florida High School Percentage of Florida High School Students Who Had Been Pregnant or Students Who Had Been Pregnant or Gotten Someone Pregnant One or More Gotten Someone Pregnant One or More Times, 2003Times, 2003

4.2%5.0%

7.7%

4.7%5.4%

7.9%

5.7%

10.3%

5.5% 5.6%

3.5%4.3%

4.9%

3.7%

5.3%

0%

5%

10%

15%


Percent

Total Girls Boys

Florida PRAMSFlorida PRAMS

A population-based surveillance A population-based surveillance system of maternal behaviors and system of maternal behaviors and experiences before and during a experiences before and during a women’s pregnancy and during women’s pregnancy and during early infancy of her babyearly infancy of her baby

Overall goal is to reduce infant Overall goal is to reduce infant morbidity and mortality by morbidity and mortality by changing maternal behaviors both changing maternal behaviors both before and during pregnancy and before and during pregnancy and early infancyearly infancy

PRAMS MethodologyPRAMS Methodology

Random selection of Florida Random selection of Florida residents who gave birth to a residents who gave birth to a live-born infantlive-born infant

Six sampling strataSix sampling strata– Low birth weight among Whites, Low birth weight among Whites,

Blacks, and minorsBlacks, and minors– Normal birth weight among Normal birth weight among

Whites, Blacks, and minorsWhites, Blacks, and minors

Strengths/LimitationsStrengths/Limitations

StrengthsStrengths– Flexible and relative inexpensive for Flexible and relative inexpensive for

collecting public health data (use of a collecting public health data (use of a mail/phone surveillance system)mail/phone surveillance system)

– Population-based surveyPopulation-based survey– Conducted in 32 states over multiple yearsConducted in 32 states over multiple years

WeaknessesWeaknesses– Self-reported informationSelf-reported information– Limited number of complete interviews Limited number of complete interviews

(75% in 2003)(75% in 2003)– Complex sampling method subject to Complex sampling method subject to

sampling errorssampling errors

Percent of Alcohol Use Percent of Alcohol Use Before Before Pregnancy Among Women in Pregnancy Among Women in Florida, 2003Florida, 2003

27.0

%

23.5

%

31.0

%

35.2

%

22.2

%

37.2

%

38.5

%

45.8

%

37.3

%

34.2

%

42.3

%

46.4

%56.5

%

49.5

%56.0

%

53.6

%

49.1

%

0%

25%

50%

75%

Race Age Education Income Married Medicaid

Perc

ent Y

es

Yes

No

No

NH

Wh

ite

NH

Bla

ck

His

pan

ic

<=

19 2

0 -

24

25 -

34

35 +

< 1

2 y

rs 12 y

rs>

12 y

rs

<=

$15600

$15,6

01 -

$39,6

00

>

$39,6

00

Overall : 42.5%

Percent of Binge Drinking Percent of Binge Drinking Before Before Pregnancy Among Women in Pregnancy Among Women in Florida, 2003Florida, 2003

21.8

%

22.8

%

22.0

%

19.5

%

17.6

%

22.5

%

18.6

%

20.3

%

17.0

%

13.2

%

27.1

%

21.5

%

26.3

%

27.9

%

23.7

%

24.0

%

24.2

%

0%

10%

20%

30%

40%

50%


Perc

ent

Yes

Yes

No

NoN

H W

hit

eN

H B

lack

His

pan

ic

<=

19

20 -

24 25 -

34

35 +

< 1

2 y

rs12 y

rs>

12 y

rs

<=

$15600

$15,6

01 -

$39,6

00

>

$39,6

00

Overall : 21.8%

Percent of Alcohol Use Percent of Alcohol Use During During Pregnancy Among Women in Pregnancy Among Women in Florida, 2003Florida, 2003

2.7

%

3.5

%

5.3

%

5.9

%

2.7

%

5.3

%

6.7

%

7.2

%

6.5

%

7.4

%

7.5

%

8.2

%

8.0

%

8.3

% 10.2

%

8.4

%

9.0

%

0%

5%

10%

15%


Perc

ent

Yes

YesNo

No

NH

Wh

ite

NH

Bla

ck

His

pan

ic

<=

19 2

0 -

24

25 -

34

35 +

< 1

2 y

rs 12 y

rs > 1

2 y

rs

<=

$15600

$15,6

01 -

$39,6

00

>

$39,6

00

Overall : 7.1%

Percent of Binge Drinking Percent of Binge Drinking During During Pregnancy Among Women in Pregnancy Among Women in Florida, 2003Florida, 2003

1.4

%

1.2

%

1.0

%

2.8

%

2.1

%

0.7

%

1.1

%

0.4

%

3.0

%

2.6

%

0.5

%

2.2

%

1.4

%

2.1

%

0.9

%

3.3

%

2.3

%

0%

1%

2%

3%

4%


Perc

ent

Yes

Yes

No

No

NH

Wh

ite

NH

Bla

ck

His

pan

ic

<=

19 2

0 -

24

25 -

34

35 +

< 1

2 y

rs 12 y

rs>

12 y

rs

<=

$15600

$15,6

01 -

$39,6

00

>

$39,6

00

Overall : 1.4%

Surveillance of FASD in Surveillance of FASD in FloridaFlorida

Florida Birth Defects RegistryFlorida Birth Defects Registry Reliance on a single ICD-9 CM Reliance on a single ICD-9 CM

code: 760.71code: 760.71– Noxious influences (alcohol) Noxious influences (alcohol)

affecting fetus via placenta or affecting fetus via placenta or breast milkbreast milk

Used to describe full-blown FAS Used to describe full-blown FAS as well as alcohol exposureas well as alcohol exposure

Surveillance MethodsSurveillance Methods

PassivePassive– Uses 760.71 ICD-9 CM code from Uses 760.71 ICD-9 CM code from

secondary data sources to secondary data sources to identify casesidentify cases

– No confirmationNo confirmation ActiveActive

– Uses same code for identificationUses same code for identification– Medical record reviewed for Medical record reviewed for

confirmation of diagnosisconfirmation of diagnosis

Rates And Counts For Cases With Rates And Counts For Cases With 760.71 ICD-9 CM Code, 1998-2002760.71 ICD-9 CM Code, 1998-2002

77 83

53 50 42

3.94.2

2.6 2.42.1

0

20

40

60

80

100

1998 1999 2000 2001 2002

Count

0

1

2

3

4

5

Rate

/10,0

00 liv

e b

irth

s

Source: FBDR/Florida Department of HealthSource: FBDR/Florida Department of Health

Race/Ethnicity Of Cases With Race/Ethnicity Of Cases With 760.71 ICD-9 CM Code, 1998-760.71 ICD-9 CM Code, 1998-20012001

3.29 3.24

5.86

0.96 1.08

7.96

0

2

4

6

8

10

Overall NH White NH Black Hispanic Asian/ PI AmericanIndian

Rate

per

10,0

00 liv

e b

irth

s

Source: Birth Defects Research (Part A), October 2005, page 777

Maternal Age Of Cases With Maternal Age Of Cases With 760.71 ICD-9 CM Code, 1998-760.71 ICD-9 CM Code, 1998-20022002

6.6%

27.5%

55.1%

10.8%

0.0%

20.0%

40.0%

60.0%

<20 20 to 29 30 to 39 40 or over

Source: FBDR/Florida Department of HealthSource: FBDR/Florida Department of Health

Active Surveillance of FASD Active Surveillance of FASD Cases, 2003-2004Cases, 2003-2004

Catchment area: 50 hospitals in Catchment area: 50 hospitals in Escambia, Bay, Leon, Duval, Alachua, Escambia, Bay, Leon, Duval, Alachua, Pinellas, Hillsborough, Broward, and Pinellas, Hillsborough, Broward, and Miami-DadeMiami-Dade

Hospital submits list of cases based on Hospital submits list of cases based on ICD-9 CM discharge codes for surveillance ICD-9 CM discharge codes for surveillance conditionsconditions– CNS conditions, oral clefts, CNS conditions, oral clefts,

gastroschisis/omphalocele, trisomies (13,21,18), and gastroschisis/omphalocele, trisomies (13,21,18), and FASFAS

Abstractor reviews medical record to Abstractor reviews medical record to determine alcohol exposure for all cases determine alcohol exposure for all cases meeting surveillance criteriameeting surveillance criteria

Active Surveillance CasesActive Surveillance Cases

35 cases reviewed with 760.71 ICD-9 CM 35 cases reviewed with 760.71 ICD-9 CM code from hospital discharge informationcode from hospital discharge information

Cases by yearCases by year– 20032003 2222

– 20042004 1313

Counties with highest numbers (based on Counties with highest numbers (based on maternal or child residence)maternal or child residence)– Hillsborough:Hillsborough: 99

– Miami-Dade:Miami-Dade: 66

– Sarasota:Sarasota: 33

Alcohol ExposureAlcohol Exposure

3 infants with FAS facial features 3 infants with FAS facial features and exposure notedand exposure noted

15 infants with maternal alcohol 15 infants with maternal alcohol exposure noted ranging from 1 exposure noted ranging from 1 drink in first trimester to known drink in first trimester to known alcoholic but no defects notedalcoholic but no defects noted

17 infants with no alcohol 17 infants with no alcohol exposure noted in chart and no exposure noted in chart and no birth defects notedbirth defects noted

Maternal Conditions of Maternal Conditions of 760.71 ICD-9 CM Code 760.71 ICD-9 CM Code CasesCases Tobacco smokingTobacco smoking 2121

Illicit drug useIllicit drug use 1717

InfectionsInfections 1616

OTC/Prescription DrugsOTC/Prescription Drugs 1212

VitaminsVitamins 6 6

Do we know what percentage Do we know what percentage of Florida women of of Florida women of childbearing age are childbearing age are consuming alcohol?consuming alcohol? In the past 30 daysIn the past 30 days

– Approximately 1/3 of Florida women of Approximately 1/3 of Florida women of child bearing age have consumed child bearing age have consumed alcoholalcohol

– 14.4% of 18-24 year olds have had 2 14.4% of 18-24 year olds have had 2 drinking bingesdrinking binges

– 44% of Florida high school girls have 44% of Florida high school girls have consumed alcoholconsumed alcohol

– 21% of Florida high school girls have 21% of Florida high school girls have had a drinking bingehad a drinking binge

Do we know who is using Do we know who is using alcohol during alcohol during pregnancy?pregnancy? Before PregnancyBefore Pregnancy

– Non-Hispanic White, 25 to 34 year Non-Hispanic White, 25 to 34 year old, upper SES, married womenold, upper SES, married women

During PregnancyDuring Pregnancy

– Non-Hispanic and Hispanic, 25 to 34 Non-Hispanic and Hispanic, 25 to 34 year old, upper SES, married womenyear old, upper SES, married women

Do we know the rate of Do we know the rate of FAS in Florida?FAS in Florida?

Identification of FAS at birth is Identification of FAS at birth is difficultdifficult

Only 8% of cases using the Only 8% of cases using the ICD-9 CM code had FAS facial ICD-9 CM code had FAS facial features noted in chartfeatures noted in chart

The ICD-9 CM code may only The ICD-9 CM code may only be useful as a proxy for in-be useful as a proxy for in-utero alcohol exposure not FASutero alcohol exposure not FAS

Impact of Alcohol UseImpact of Alcohol Use

2004 Florida live births – 218,0482004 Florida live births – 218,048

Overall alcohol use by women during Overall alcohol use by women during pregnancy – 7.1% (5.2-8.9)pregnancy – 7.1% (5.2-8.9)

Overall binge drinking by women during Overall binge drinking by women during pregnancy – 1.4% (0.3-2.5)pregnancy – 1.4% (0.3-2.5)

Potential impactPotential impact

– Alcohol exposed infants: 11,000 to 19,000Alcohol exposed infants: 11,000 to 19,000

– Binge drinking exposed infants: 600 to 5,400 Binge drinking exposed infants: 600 to 5,400

What lies ahead?What lies ahead?

Younger women are common Younger women are common alcohol usersalcohol users

Older women may not know risks Older women may not know risks and waiting until later in life to and waiting until later in life to become pregnantbecome pregnant

Current methods of surveillance Current methods of surveillance do not identify casesdo not identify cases

FASD 100% preventable by FASD 100% preventable by stopping alcohol consumption stopping alcohol consumption during pregnancyduring pregnancy

For more informationFor more information

BRFSSBRFSS– Melissa MurrayMelissa Murray

[email protected][email protected]

PRAMSPRAMS– Curtis MillerCurtis Miller


FBDRFBDR– Jane CorreiaJane Correia


Trends & Forecasts in Florida Jane Correia, HSEE Coordinator, Florida Birth Defects Registry Bureau...

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