Surveillance for disparities in maternal health-related behaviors -- selected states, Pregnancy Risk Assessment Monitoring System (PRAMS), 2000-2001

PROBLEM/CONDITION: Disparities in maternal and infant health have been observed among members of different racial and ethnic populations and persons of differing socioeconomic status. For the Healthy People 2010 objectives for maternal and child health to be achieved (US Department of Health and Human Services. Healthy People 2010. 2nd ed. With understanding and improving health and objectives for improving health [2 vols.]. Washington DC: US Department of Health and Human Services, 2000), the nature and extent of disparities in maternal behaviors that affect maternal or infant health should be understood. Identifying these disparities can assist public health authorities in developing policies and programs targeting persons at greatest risk for adverse health outcomes. REPORTING PERIOD COVERED: 2000-2001. DESCRIPTION OF THE SYSTEM: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing state- and population-based surveillance system designed to monitor selected maternal behaviors and experiences that occur before, during, and after pregnancy among women who deliver live-born infants. PRAMS employs a mixed mode data-collection methodology; up to three self-administered surveys are mailed to a sample of mothers, and nonresponders are followed up with telephone interviews. Self-reported survey data are linked to selected birth certificate data and weighted for sample design, nonresponse, and noncoverage to create annual PRAMS analysis data sets that can be used to produce statewide estimates of different perinatal health behaviors and experiences among women delivering live infants in 31 states and New York City. This report summarizes data for 2000-2001 from eight states (Alabama, Colorado, Florida, Hawaii, Illinois, Maine, Nebraska, and North Carolina) on four behaviors (smoking during pregnancy, alcohol use during pregnancy, breastfeeding initiation, and use of the infant back sleep position) for which substantial health disparities have been identified previously. RESULTS: Although the prevalence of each behavior varied by state, consistent patterns were observed among the eight states by age, race, ethnicity, education, and income level. Overall, the prevalence of smoking during pregnancy ranged from 9.0% to 17.4%. Younger (aged 35 years, non-Hispanic women, women with more than a high school education, and women with higher incomes reported the highest prevalence of alcohol use during pregnancy. Overall, the prevalence of breastfeeding initiation ranged from 54.8% to 89.6%. Younger women, black women, women with a high school education or less, and women with low incomes reported the lowest rates of breastfeeding initiation. The size of the black-white disparity in breastfeeding varied among states. Overall, use of the back sleep position for infants ranged from 49.7% to 74.8%. Use of the back sleep position was lowest among younger women, black women, women with lower levels of education, and women with low incomes. Ethnic differences in sleep position varied substantially by state. INTERPRETATION: PRAMS data can be used to identify racial, ethnic, and socioeconomic disparities in critical maternal health-related behaviors. Although similar general patterns by age, education, and income were observed in at least seven states, certain racial and ethnic disparities varied by state. Prevalence of the four behaviors among each population often varied by state, indicating the potential impact of state-specific policies and programs. PUBLIC HEALTH ACTION: States can use PRAMS data to identify populations at greatest risk for maternal behaviors that have negative consequences for maternal and infant health and to develop policies and plan programs that target populations at high risk.sk. Although prevalence data cannot be used to identify causes or interventions to improve health outcomes, they do indicate the magnitude of disparities and identify populations that should be targeted for intervention. This report indicates a need for wider targeting than is often done. The results from this report can aid state and national agencies in creating more effective public health policies and programs. The data described in this report should serve as a baseline that states can use to measure the impact of policies and programs on eliminating these health disparitiesTanya M. Phares, Brian Morrow, Amy Lansky, Wanda D. Barfield, Cheryl B. Prince, Kristen S. Marchi, Paula A. Braveman, Letitia M. Williams.July 2, 2004.Also available via the World Wide Web as an Acrobat .pdf file (637.93 KB, 16 p.).Includes bibliographical references (p. 12-13).1522940

Colorectal cancer

"Colorectal cancer is the #2 cancer killer in the US among cancers that affect both men and women. But it doesn't have to be. Screening can find precancerous polyps (abnormal growths) so they can be removed before they turn into cancer. Screening can also find colorectal cancer early when it is easiest to treat. A new CDC report says that rates of new cases and deaths of colorectal cancer are decreasing and more adults are being screened. Between 2003 and 2007, approximately 66,000 colorectal cancer cases were prevented and 32,000 lives were saved compared to 2002. Half of these prevented cases and deaths were due to screening." -p. 1Fact sheet released by the Centers for Disease Control and Prevention's Office of Surveillance, Epidemiology and Laboratory Services (OSELS) in association with: Vital signs: colorectal cancer screening, incidence, and mortality -- United States, 2002-2010 published: MMWR. Morbidity and mortality weekly report ; v. 60, early release, July 5, 2011, p. 1-6."223580-B.""April 2011.""Publication date: 07/05/2011."Title from title screen (viewed July 5, 2011).Mode of access: World Wide WebText document (PDF)

Prevention Research Centers Program: researcher-community partnerships for high-impact results

The Prevention Research Centers (PRC) Program, administered and funded by the Centers for Disease Control and Prevention (CDC), is a network of academic, community, and diverse public health partners that conducts research aimed at reducing the leading causes of death and disability. The researchers are based at schools of medicine and public health across the country; in 2011, 37 academic centers were funded. Each PRC focuses on an area of expertise (e.g., controlling obesity, preventing cancer, or enabling healthy aging). The centers analyze the effectiveness of public health policies, and produce interventions, training programs, dissemination approaches, and other strategies that align with national and global initiatives to improve public health (Ammerman, Harris, Brownson, Tovar-Aguilar, & PRC Steering Committee, 2011). Each PRC's research is tailored to specific communities comprising largely underserved populations, such as Hispanics, older Americans, or rural residents, for whom the burden of chronic disease is greater than for the United States as a whole. The PRCs partner with members of the community that their research is intended to benefit; these partnerships give a voice to vulnerable populations not often heard in prevention research. Community members help choose research topics and assist in the research process, ensuring that real- world conditions are taken into consideration and thereby improving the contextual quality of the research. These collaborations increase the likelihood that successful research results will be appropriate for and used by the community. Other partners, including community-based organizations, health care systems, health advocacy groups, local and state health departments, and the business community, help in disseminating research results and effective programs by facilitating changes in policies, systems, and environments. These partnerships enable the results of the community research to spread well beyond the original study population. The PRC model is useful in targeting not only chronic disease but other public health problems as well, including immunization, infectious diseases such as HIV and sexually transmitted diseases, unintentional injury, and environmental health risks.Diane Hawkins-Cox, Jeffrey R. Harris, Ross C. Brownson, Alice Ammerman, Barbara Sajor GrayExcerpted from Thomas P. Gullotta & Martin Bloom (Editors). Encyclopedia of Primary Prevention and Health Promotion. 2nd ed. New York: Springer Science+Business Media, in press. Preprinted with permission."CS231390."Includes bibliographical references (p. 16-19)

Binge drinking: a serious, under-recognized problem among women and girls

Binge drinking is a dangerous behavior but is not widely recognized as a women's health problem. Drinking too much --including binge drinking-- results in about 23,000 deaths in women and girls each year. Binge drinking increases the chances of breast cancer, heart disease, sexually transmitted diseases, unintended pregnancy, and many other health problems. Drinking during pregnancy can lead to sudden infant death syndrome and fetal alcohol spectrum disorders. About 1 in 8 women aged 18 years and older and 1 in 5 high school girls binge drink. Women who binge drink do so frequently --about 3 times a month-- and have about 6 drinks per binge. There are effective actions communities can take to prevent binge drinking among women and girls.Fact sheet released by the Centers for Disease Control and Prevention's Office of Surveillance, Epidemiology and Laboratory Services (OSELS) in association with: Vital signs: Binge drinking among women and high school girls--United States, 2011, published: MMWR. Morbidity and mortality weekly report ; v. 62, early release, January 8, 2013, p. 1-5."CS236885-B.""January 2013.""Publication date: 01/08/2012 [i.e., 2013]."Title from title screen (viewed January 8, 2013).Introduction -- Problem -- Who's at risk? -- What can be done -- Science behind this issue -- Related links -- Social media -- Read associated MMWRMode of access: World Wide WebText document (PDF)

Abortion surveillance -- United States, 2003

PROBLEM/CONDITION: CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions. REPORTING PERIOD COVERED: This report summarizes and describes data voluntarily reported to CDC regarding legal induced abortions obtained in the United States in 2003. DESCRIPTION OF SYSTEM: For each year since 1969, CDC has compiled abortion data by state or area of occurrence. During 1973-1997, data were received from or estimated for 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. In 1998 and 1999, CDC compiled abortion data from 48 reporting areas. Alaska, California, New Hampshire, and Oklahoma did not report, and data for these states were not estimated. During 2000-2002, Oklahoma again reported these data, increasing the number of reporting areas to 49, and for 2003, Alaska again reported and West Virginia did not, maintaining the number of reporting areas at 49. RESULTS: A total of 848,163 legal induced abortions were reported to CDC for 2003 from 49 reporting areas, representing a 0.7% decline from the 854,122 legal induced abortions reported by 49 reporting areas for 2002. The abortion ratio, defined as the number of abortions per 1,000 live births, was 241 in 2003, a decrease from the 246 in 2002. The abortion rate was 16 per 1,000 women aged 15-44 years for 2003, the same as for 2002. For the same 47 reporting areas, the abortion rate remained relatively constant during 1998-2003. During 2001-2002 (the most recent years for which data are available), 15 women died as a result of complications from known legal induced abortion. One death was associated with known illegal abortion. The highest percentages of reported abortions were for women who were unmarried (82%), white (55%), and aged 15 weeks' gestation, including 4.2% at 16--20 weeks and 1.4% at > or =21 weeks. A total of 36 reporting areas submitted data documenting that they performed and enumerated medical (nonsurgical) procedures, making up 8.0% of all known reported procedures from the 45 areas with adequate reporting on type of procedure. INTERPRETATION: During 1990-1997, the number of legal induced abortions gradually declined. When the same 47 reporting areas are compared, the number of abortions decreased during 1996-2001, then slightly increased in 2002 and again decreased in 2003. In 2000 and 2001, even with one additional reporting state, the number of abortions declined slightly, with a minimal increase in 2002 and a further decrease in 2003. In 2001 and 2002, as in the previous years, deaths related to legal induced abortions occurred rarely. PUBLIC HEALTH ACTION: Abortion surveillance in the United States continues to provide the data necessary for examining trends in numbers and characteristics of women who obtain legal induced abortions and to increase understanding of this pregnancy outcome. Policymakers and program planners use these data to improve the health and well-being of women and infants.Lilo T. Strauss, Sonya B. Gamble, Wilda Y. Parker, Douglas A. Cook, Suzanne B. Zane, Saeed Hamdan, division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion.November 24, 2006.Includes bibliographical references (p. 9-10)

Selected practice recommendations for contraceptive use

The U. S. Selected Practice Recommendations for Contraceptive Use 2013 (U.S. SPR), comprises recommendations that address a select group of common, yet sometimes controversial or complex, issues regarding initiation and use of specific contraceptive methods. These recommendations are a companion document to the previously published CDC recommendations U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 (U.S. MEC). U.S. MEC describes who can use various methods of contraception, whereas this report describes how contraceptive methods can be used. CDC based these U.S. SPR guidelines on the global family planning guidance provided by the World Health Organization (WHO). Although many of the recommendations are the same as those provided by WHO, they have been adapted to be more specific to U.S. practices or have been modified because of new evidence. In addition, four new topics are addressed, including the effectiveness of female sterilization, extended use of combined hormonal methods and bleeding problems, starting regular contraception after use of emergency contraception, and determining when contraception is no longer needed. The recommendations in this report are intended to serve as a source of clinical guidance for health-care providers; health-care providers should always consider the individual clinical circumstances of each person seeking family planning services. This report is not intended to be a substitute for professional medical advice for individual patients. Persons should seek advice from their health-care providers when considering family planning options.Introduction -- Methods -- -- How to use this document -- Summary of changes from WHO SPR -- Contraceptive method choice -- -- Maintaining updated guidance -- -- How to be reasonably certain that a woman is not pregnant -- -- intrauterine contraception -- Implants. -- -- Injectables -- -- Combined hormonal contraceptives -- -- Progestin-only pills -- Standard days method -- Emergency contraception -- -- Female sterilization -- -- -- male sterilization. -- -- When women can stop using contraceptives -- -- Conclusion -- -- Acknowledgment -- References -- Appendix A: Summary chart of U.S. medical eligibility criteria for contraceptive use, 2010 -- -- Appendix B: When to start using specific contraceptive methods -- -- Appendix C: Examinations and tests needed before initiation of contraceptive methods -- -- Appendix D: Routine follow-up after contraceptive initiation -- -- Appendix E: Management of women with bleeding irregularities while using contraception -- -- Appendix F: Management of the IUD when a Cu-IUD or an LNG-IUD user is found to have pelvic inflammatory disease.prepared by Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion.Corresponding preparer: Kathryn M. Curtis, PhD, Division of Reproductive Health, CDC.Includes bibliographical references p. 38-46).23784109Chronic DiseasePrevention and ControlSupersede

Abortion surveillance -- United States, 2002

PROBLEM/CONDITION: CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions. REPORTING PERIOD COVERED: This report summarizes and describes data voluntarily reported to CDC regarding legal induced abortions obtained in the United States in 2002. DESCRIPTION OF SYSTEM: For each year since 1969, CDC has compiled abortion data by state or area of occurrence. During 1973-1997, data were received from or estimated for 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. In 1998 and 1999, CDC compiled abortion data from 48 reporting areas. Alaska, California, New Hampshire, and Oklahoma did not report, and data for these states were not estimated. For 2000-2002, Oklahoma again reported these data, increasing the number of reporting areas to 49. RESULTS: A total of 854,122 legal induced abortions were reported to CDC for 2002 from 49 reporting areas, representing a 0.1% increase from the 853,485 legal induced abortions reported by the same 49 reporting areas for 2001. The abortion ratio, defined as the number of abortions per 1,000 live births, was 246 in 2002, the same as reported for 2001. The abortion rate was 16 per 1,000 women aged 15-44 years for 2002, the same as for 2001. For the same 48 reporting areas, the abortion rate remained relatively constant during 1997-2002. The highest percentages of reported abortions were for women who were unmarried (82%), white (55%), and aged 15 weeks' gestation, including 4.1% at 16-20 weeks and 1.4% at > or =21 weeks. A total of 35 reporting areas submitted data stating that they performed and enumerated medical (nonsurgical) procedures, accounting for 5.2% of all known reported procedures from the 45 areas with adequate reporting on type of procedure. INTERPRETATION: During 1990-1997, the number of legal induced abortions gradually declined. When the same 48 reporting areas were compared, the number of abortions decreased during 1996-2001, then slightly increased in 2002. In 2000 and 2001, even with one additional reporting state, the number of abortions declined slightly, with a minimal increase in 2002. PUBLIC HEALTH ACTION: Abortion surveillance in the United States continues to provide the data necessary for examining trends in numbers and characteristics of women who obtain legal induced abortions and to increase understanding of this pregnancy outcome. Policymakers and program planners use these data to improve the health and well-being of women and infants.Lilo T. Strauss, Joy Herndon, Jeani Chang, Wilda Y. Parker, Sonya V. Bowens, Cynthia J. Berg, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion.November 25, 2005.Also available via the World Wide Web as an Acrobat .pdf file (306.36 KB, 36 p.).Includes bibliographical references (p. 5-10)

Abortion surveillance -- United States, 2007

"Problem/Condition: Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. Reporting Period Covered: 2007. Description of System: Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). This information is provided voluntarily. For 2007, data were received from 49 reporting areas. For the purpose of trend analysis, data were evaluated from the 45 areas that reported data every year during the preceding decade (1998--2007). Abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births) were calculated using census and natality data, respectively. Results: A total of 827,609 abortions were reported to CDC for 2007. Among the 45 reporting areas that provided data every year during 1998--2007, a total of 810,582 abortions (97.9% of the total) were reported for 2007; the abortion rate was 16.0 abortions per 1,000 women aged 15--44 years, and the abortion ratio was 231 abortions per 1,000 live births. Compared with 2006, the total number and rate of reported abortions decreased 2%, and the abortion ratio decreased 3%. Reported abortion numbers, rates, and ratios were 6%, 7%, and 14% lower, respectively, in 2007 than in 1998. Women aged 20--29 years accounted for 56.9% of all abortions in 2007 and for the majority of abortions during the entire period of analysis (1998--2007). In 2007, women aged 20--29 years also had the highest abortion rates (29.4 abortions per 1,000 women aged 20--24 years and 21.4 abortions per 1,000 women aged 25--29 years). Adolescents aged 15--19 years accounted for 16.5% of all abortions in 2007 and had an abortion rate of 14.5 abortions per 1,000 adolescents aged 15--19 years; women aged >_35 years accounted for a smaller percentage (12.0%) of abortions and had lower abortion rates (7.7 abortions per 1,000 women aged 35--39 years and 2.6 abortions per 1,000 women aged >_40 years). During 1998--2007, the abortion rate increased among women aged >_35 years but decreased among adolescents aged _21 weeks' gestation. During 1998--2007, the percentage of abortions performed at _16 weeks' gestation decreased by 13%--14%, and among the abortions performed at 13 weeks' gestation. Among the 62.3% of abortions that were performed at <_8 weeks' gestation, and thus were eligible for early medical abortion, 20.3% were completed by this method. Deaths of women associated with complications from abortions for 2007 are being investigated under CDC's Pregnancy Mortality Surveillance System. In 2006, the most recent year for which data were available, six women were reported to have died as a result of complications from known legal induced abortions. No reported deaths were associated with known illegal induced abortions. Interpretation: Among the 45 areas that reported data every year during 1998--2007, the total number, rate, and ratio of reported abortions decreased during 2006--2007. This decrease reversed the increase in reported abortion numbers and rates that occurred during 2005--2006; however, reported abortion numbers and rates for 2007 still were higher than they had been previously in 2005. In 2006, as in previous years, reported deaths related to abortion were rare. Public Health Action: Abortion surveillance in the United States continues to provide the data needed to examine trends in the number and characteristics of women obtaining abortions. Policymakers and program planners can use these data to guide and evaluate efforts to prevent unintended pregnancies." - p. 1-2Karen Pazol, Suzanne B. Zane, Wilda Y. Parker, Laura R. Hall, Sonya B. Gamble, Saeed Hamdan, Cynthia Berg, Douglas A. Cook, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC."February 25, 201"Cover title.Also available via the World Wide Web.Includes bibliographical references (p. 10-11)

Assisted reproductive technology surveillance -- United States, 2000

Problem/Condition: In 1996, CDC initiated data collection regarding assisted reproductive technology (ART) procedures performed in the United States to determine medical center-specific pregnancy success rates, as mandated by the Fertility Clinic Success Rate and Certification Act (FCSRCA) (Public Law 102-493, October 24, 1992). ART includes fertility treatments in which both eggs and sperm are handled in the laboratory (i.e., in vitro fertilization and related procedures). Patients who undergo ART treatments are more likely to deliver multiple-birth infants than women who conceive naturally. Multiple births are associated with increased risk for mothers and infants (e.g., pregnancy complications, premature delivery, low-birthweight infants, and long-term disability among infants). Reporting Period Covered: 2000. Description of System: CDC contracts with a professional society, the Society for Assisted Reproductive Technology (SART), to obtain data from fertility medical centers located in the United States. Since 1997, CDC has compiled data related to ART procedures. The Assisted Reproductive Technology Surveillance System was initiated by CDC in collaboration with the American Society for Reproductive Medicine, the Society for Assisted Reproductive Technology, and RESOLVE: The National Infertility Association. Results: In 2000, a total of 25,228 live-birth deliveries and 35,025 infants resulting from 99,629 ART procedures were reported to CDC from 383 medical centers that performed ART in the United States and U.S. territories. Nationally, 75,516 (76%) of ART treatments were freshly fertilized embryos using the patient's eggs; 13,312 (13%) were thawed embryos using the patient's eggs; 7,919 (8%) were freshly fertilized embryos from donor eggs; and 2,882 (3%) were thawed embryos from donor eggs. The national live-birth delivery per transfer rate was 30.8%. The five states that reported the highest number of ART procedures were California (13,194), New York (11,239), Massachusetts (8,041), Illinois (7,323), and New Jersey (5,506). These five states also reported the highest number of live-birth deliveries and infants born as a result of ART. Overall, 47% of women undergoing ART-transfer procedures using freshly fertilized embryos from their own eggs were aged 42 years. Among ART treatments in which freshly fertilized embryos from the patient's eggs were used, substantial variation in patient age, infertility diagnoses, history of past infertility treatment, and past births was observed. Nationally, live-birth rates were highest for women aged <35 years (38%). The risk for a multiple-birth delivery was highest for women who underwent ART-transfer procedures using freshly fertilized embryos from either donor eggs (40%) or from their own eggs (35%). Among women who underwent ART-transfer procedures using freshly fertilized embryos from their own eggs, further variation by patient age and number of embryos transferred was observed. Of the 35,025 infants born, 44% were twins, and 9% were triplet and higher order multiples, for a total multiple-infant birth rate of 53%. Patient's residing in states with the highest number of live-birth deliveries also reported the highest number of infants born in multiple-birth deliveries. Interpretation: Whether an ART procedure was successful (defined as resulting in a pregnancy and live-birth delivery) varied according to different patient and treatment factors. Patient factors included the age of the woman undergoing ART, whether she had previously given birth, whether she had previously undergone ART, and the infertility diagnosis of both the female and male partners. Treatment factors included whether eggs were from the patient or a woman serving as an egg donor, whether the embryos were freshly fertilized or previously frozen and thawed, how long the embryos were kept in culture, how many embryos were transferred, and whether various specialized treatment procedures were used in conjunction with ART. ART poses a major risk for multiple births. This risk varied according to the patient's age, the type of ART procedure performed, and the number of embryos transferred. In addition, the increased risk for multiple births has a notable population impact in certain states. Public Health Actions: As use of ART and ART success rates continue to increase, ART-related multiple births are an increasingly important public health problem nationally and in many states. The proportion of infants born through ART in 2000 that were multiple births (53%) was substantially higher than in the general U.S. population during the same period. Data in this report indicate a need to reduce multiple births associated with ART. Efforts should be made to limit the number of embryos transferred for patients undergoing ART. In addition, continued research and surveillance is key to understanding the effect of ART on maternal and child health.Victoria C. Wright, Laura A. Schieve, Meredith A. Reynolds, Gary Jeng, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion.Include bibliographical references (p. 8)

Preventing and controlling cancer: the nation's second leading cause of death

Describes CDC's Division of Cancer Prevention and Control (DCPC) cancer prevention and control activities."January 2008."Mode of access: World Wide web.Text (PDF), graphic