Ninth Annual Maternal and Child Health Epidemiology Conference / December 10-12, 2003
PETER VAN DYCK: Thank you, Jessie. Sake of time, I am not going to show some of the slides that I have. It is really fun to get around and be on a speaker’s table and hear about grants that we have done in Maternal and Child Health Bureau. It is really fun for me to hear these. (I am always impressed by articulate). The folks are how good the data is, and it is really wonderful for me to hear this kind of things. I am going to talk to you about two things briefly. One is a new effort by the department to look into the causes of preterm birth and low-birth weight, and the second is a new effort by the department, which you do not know about yet, which is going to be announced shortly. I do not have handouts because both of these are in embargoed, but I am going to discuss them very briefly.
There is a Secretary’s Advisory Committee on Infant Mortality. It has been active for about 10 years. Many of you in this room attend meetings or have spoken at the meeting and the purpose of this committee is to advice the secretary on how the department can better address the issues of infant mortality. One of the great concerns of the committee was the problem of low birth weight as you have heard, I am sure throughout the meeting and as you heard just this afternoon. And the SACM or Secretary’s Advisory Committee recommended to the secretary to form a Low Birth Weight Committee across the department that would address the issues around the low birth weight and they wanted the issues… the challenging issues that pertain to assuring adequacy of data on low birth weight and preterm births, uncovering new knowledge and developing a coordinated research agenda on preterm birth and preterm birth and low birth weight. I am using interchangeably and delivering and financing relative healthcare. The secretary agreed and the committee has been set up this last summer just three to four months ago.
Co-chairing Committee Secretary named me one of the co-chairs and Duane Alexander, the Director of the National Institute of Child Health and Human Development as the other co-chair. Members of the committee by agency or the agency for Healthcare Research and Quality, CDC, several centers, the National Center on Birth Defects, Development or Disabilities, and the National Center for Chronic Disease Prevention and Health Promotion, the National Center for Health Statistics, Medicaid, HRSA both the Bureau of Primary Health Center and Maternal and Child Health Bureau, the Indian Health Service, National Institute for Child Health and Human Development, the office of Unit Government Affairs, Assistant Secretary for Planning Evaluation, some of the offices within the secretary’s office, Disease Prevention and Health Promotion, Minority Health, Women’s Health, SAMSA, and aging is also now been named as well as the agency for children and family. So, it is really meant by the secretary to be a committee, which addresses the broad issues particularly around research of the problem of low birth weight. What we have decided to do, is look into first research, research that is underway across the department, research that is planned across the department, and research of the agency would like to do, but is not yet currently planned. And what we are doing is, we are griding this material, We’re gritting our teeth, but also griding the material, and what we have are the beginnings of a grid, that looks like this. And this grade is preterm birth prevention by every agency across a width of the page and down the left research by biological, societal, or social environmental behavioral population or multiple factors, individual or community research and then issues related to healthcare delivery and translating research into practice. So, every piece of research that every agency is undertaking is being put in one of these cells.
And then behind this are the narratives or the abstracts of that particular research project. So, there is one for preterm birth prevention. There is one for low birth weight prevention. There is one for low birth weight or preterm birth weight for infants and its sequelae. Hopefully, once this can be put together and finished and will be made available, it will help in several areas. One is, it will help us in the department. See what research is being done obviously and what has been planned. It will help us to identify holes and gaps where research could be done and it will help us, I think, identify areas where we could collaborate better and the last it will help us translate research into practice I think much more successfully and quickly. So, stay tuned to this.
These charts, grids, and reports will be made available to you probably in early spring. Now, the second issue I want to talk about. This is by the way a very big commitment from the secretary to have some real success for this low birth weight committee and it is a first time the federal government department at least has really put this much effort into cataloging all the activities across the department. This is called closing the health gap initiative on infant mortality and it is an initiative being planned at the present time, which will be released in the next couple of months. I do not know the time, but sooner or rather than the later. In 2001, some racial and ethnic minorities continue to experience the highest rates of infant mortality from low birth weight SIDS. And you’ve seen some of the data and you know some of the data obviously.
Infants of black in Puerto Rican mothers have the highest infant mortality rates and low birth weight. Their rates were approximately four and two times that of infants born to White mothers, for SIDS infants of Black mothers had a rate two-and-a-half times that of White. Infants of American-Indian mothers had a rate of 3.2 times that of White mothers. In September this year, the new 2001 link birth data set was available from MCHS. And we know that they overall infant death rate was 6.8 per 1000 live births. And they are similar, although lower than 2000 which was 6.9, the largest decline in cost specific infant mortality rates between 2000 and 2001 was for SIDS which declined by 11% continuing its rapid decline during the 1990s. When examined by race and ethnicity, SIDS declined by 12% for White mothers, by 21% for Hispanics, and by 27% for Mexican mothers.
The decline for Black mothers was 7%, but was not statistically significant nor was the decline for American-Indians/Alaskan Natives significant either. I am building up to the purpose for this initiative. The Aberdeen area Indian Health Service, which serves communities North Dakota, South Dakota, Nebraska and Iowa has the highest rate of infant mortality among American-Indians and that infant mortality rate is largely result of the higher rate of SIDS deaths for American-Indians in this area. A study on infant mortality in South Dakota showed that in 2001 the infant mortality rate in South Dakota was 7.5, which was an increase from 5.5. And an examination of the causes of infant death shows South Dakota’s mortality rates due to SIDS and congenital anomalies both increased that year. SIDS rates in the state had been decreasing, but the rate for 1999 and 2001 was over twice the national rates for 2000. For American-Indians in South Dakota rate was twice as high as it was for White infants and higher than the rate noted nationally for American-Indians.
Other reports indicated three times as many American-Indian/Alaskan Native woman is 4.5% versus 1.5% used alcohol during pregnancy compared to the overall rate for all races and that 32% placed their babies asleep on their stomachs, 32% of American-Indian/Alaskan Natives, while the national rate for babies being put asleep on their stomach is less than 20%. So the proposal of the department is putting force to utilize a comprehensive departmental model trying to use the best efforts of all its operating agencies of which you know and the goals are thre, to reduce African-American infant deaths for low birth weight, to reduce African-American infant deaths from SIDS, and to reduce American-Indian/Alaskan Native infant deaths from SIDS. So, it is a low birth weight and SIDS in African-Americans and SIDS in American-Indian/Alaskan Native populations. The Closing the Gap initiative on infant mortality includes three components, research, risk reduction, and collaboration. The research coordination will be done by this Low Birth Weight Committee that I talked about, previously. And has been charged with accumulating and assessing and finding the gaps and making recommendations for all research activities in the department related to the low birth weight and SIDS, but the SIDS being new in the charter for this Low Birth Weight Committee.
The collaboration piece, which is the third piece research, risk reduction, and collaboration is meant to be a National Media Campaign pointing out the importance of putting babies to sleep on their backs targeted towards American-Indians and Alaskan Natives and the Black population. And the second piece of risk reduction will be largely a set of pilot studies in various states, and for the African-American initiative to reduce low birth weight and SIDS. Actually, the selection criteria for the pilot projects are the states must rank high in overall infant mortality and must have significant African-American populations. They must rank in the top states for highest percentage of African-Americans with low birth weight and they must have a disproportionately high percentage of SIDS deaths for African-American infants. In the American-Indian/Alaskan Native initiatives, states must rank high in overall infant mortality and of course, SIDS. When all these data are crunched, there are four states that come out the highest for the African-American initiative, which is the low birth weight and SIDS and those states are South Carolina, Michigan, Mississippi, and Illinois. And those four states will be states that will be recommended its potential sites for pilot programs for this initiative. For the American-Indian/Alaskan Native SIDS initiative both the Aberdeen area which is South Dakota, North Dakota, Nebraska, and Iowa, and the Billings area, which is Montana and Wyoming will be targeted for pilot projects. There will probably be an opportunity for other states to apply for pilot projects, or be selected for pilot projects other than those four depending on how much money can be raised.
I wanted to alert you to these issues. I wanted to alert you to this embargoed opportunity from the department, watch for it. If you have ideas or would like to discuss any of these, give me a call and I will be happy to discuss what your ideas and what might be useful for pilot projects, and I will be happy to answer questions at the end of the session. So, those were two major initiatives in the department related to low birth weight and SIDS. Thank you.