Ninth Annual Maternal and Child Health Epidemiology Conference / December 10-12, 2003

March of Dimes Presentation.

NANCY GREEN: Okay.  Thank you.  I can see people are getting restless.  So, I will make this very brief, but for those of you, who do not know or those of you who know, but do not understand.  I wanted to talk to you and I appreciate the opportunity to talk about the newly launched March of Dimes national campaign on prematurity and you know when I signed up for this I was told there is only five years.  But I am told now that we will stick it out for as long as, as we need to, so it is likely to be more than five years.  And this is really a nationwide very collaborative project and so it is a great opportunity to speak with all of you.  Because many of you are involved already or we would like to work with you in a variety of mechanism so we you know as with the model of folic acid and the neural tube prevention. 

And this needs to be even a broader collaborative effort.  And the structure of the campaign is really that each state chapter has its own board and chapter chair and programs, grants to communities, advocacy issues.  At a national level, we have sort of steering committee of three professional organizations; the American College Of OB/GYN, American Academy of Pediatrics, and the American Neonatal Nurses Association.  I am sorry I cannot at the moment remember what ‘A1’ stands for, but the reason that we do this is these are organizations that have tremendous professional overlap with the topics.  But also on a state level they have a state or regional organization that allows our chapters to interdigitate very well with them, so this has been a very productive partnership that we have just started.  In addition, we have something around 30, so-called alliance members; these are professional organizations that many of you are members of Public Health, Pediatric Nursing, and consumer organizations that have a tremendous overlap as well with us in terms of prematurity.  And we have already started working with a number of them on activities this year and into the next year.  The campaign has two goals; one is increase of public awareness. 

We do annual surveys, Gallop poll surveys that we know from the baseline survey in 2001 that the public surveyed about 20,000 people reported that prematurity is a serious public health problem or medical problem only about 38%, about one-third of adults.  We would like to pretty much double that to about 60% based on thei folic acid survey data.  We think that that is attainable within five years and I can tell you between the first year 2001 and most recent dated this summer in 2003 we have got from about 38% to 42%, so it is going in a right direction.  And, as we have done successfully again in a really remarkable collaborative way, on state and national levels, a lot of this is outreach in the media.  So, I do not know those of you remember the store cats so we are not store cats not as cute, but there is some other TV ads, a lot of print and web materials as well and a lot of outreach to the media,  prints, TV, Radio.  The other campaign goal is much more complicated and that is to decrease the rate of preterm birth as I mentioned earlier for by least 15% now, why 15%?  We wanted to be consistent with the healthy people 2010 goal, so this is consistent. 

We wanted to be ambitious, but not crazy and so we compromised by 15%, but with a great humility as I mentioned earlier that it is going to take a lot to get to that.  But some of the data I presented earlier I hope will convince you that I think for the most mildly affected, so those most mildly preterm with 35 and 36 weeks, so I think that there is a great opportunity for improving those outcomes.  And for the very preterm birth of 2%, 1.9% that are very preterm less than 32 weeks, we really need more research and then translation of that research into public health and medical practice.  And I showed the slide earlier just showing that it probably is moving in the wrong direction and we have these ambitious goals. 

So, the campaign is organized around five aims, one is really the public awareness that I mentioned and is off to a good start.  We have this annual prematurity awareness that just occurred for first time a couple of weeks ago and hit up over a press with sort of publicity stunt in Dallas.  So, we will continue to do that as well as it is a sort of an ongoing attempt to saturate the news media.  Aim#2 is to educate woman, particularly pregnant woman as to the signs and symptoms of preterm labor, understanding that, that is not going to likely decrease preterm delivery rates because of limitations of medical interventions like Tocolysis, but that really has remarkable impact on improving outcomes.  Certainly provider education is a big part of this. 

Certainly getting providers to focus on talking to woman about preterm birth about preconceptionally, prenatally, and interconceptionally, addressing issues of risk reduction I mentioned earlier.  The fourth aim is invest in research.  We have a research portfolio of March of Dimes and we are in the process of describing NRP for to be released in 2004 to be funded at the beginning of 2005 on specific areas of prematurity.  And as you will hear about in minute, we are involved with some efficacy at an national level to improve the bigger pot for research, which is prematurity at the federal level mostly through NIH.  And then five is to try to improve access through variety of legislative advocacy initiatives. 

I think I talked about this.  So, we have a variety of services and actually put a lot of resources into developing our websites so there is a section on consumers with a lot of material about health and a healthy pregnancy and as I mentioned earlier recognizing signs and symptoms of preterm birth.  Actually, we surveyed pregnant women in 2001 and remarkably few about half said that they could recognize signs and symptoms of preterm labor and knew what to do about it.  So that there is clearly lots that can be done on that front.  But also, as I said healthy lifestyles and then certainly you know as interventions hopefully that are knew or novel or better-implemented rise to the surface we’ll use this mechanism to inform consumers.  And then there is a variety of curricula materials and programs including as I mentioned earlier the Grand Rounds Program for health professionals.  That’s it.  Thank you.