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					Maternal Health Needs and
 Resources in a Changing
       Community
Monterey County Health Department,
        Salinas, California
        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 Health Department - DUI Project   2
   Monterey County

Salinas




                                         •    3,322 mi2
                                         •    417,185 people
                                         •    126 persons/mi2
                                         •    Largest city:
                                              Salinas – 151,030



          Monterey County Health Department - DUI Project    3
  1990 to 2000: Growth in Median
         Household Income
       King City



        Salinas



      California



Monterey County



        Carmel


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

                                        1990         2000



                          Monterey County Health Department - DUI Project                 4
Latinos: A Growing “Minority”
                                1990               2000
  California                    26%                32%
  Monterey County               34%                47%
  King City                     67%                80%
  Salinas                       51%                64%
  Carmel                         3%                 3%
  • 72,000 not citizens out of 181,000 Latinos
    in county


               Monterey County Health Department - DUI Project   5
       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



                Monterey County Health Department - DUI Project   6
   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?


               Monterey County Health Department - DUI Project   7
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


            Monterey County Health Department - DUI Project   8
         Objective

Identify „hot spots‟ for maternal
 health indicator within Monterey
  County in relation to services




         Monterey County Health Department - DUI Project   9
               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

                  Monterey County Health Department - DUI Project   10
             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



                Monterey County Health Department - DUI Project   11
Where People Live in Salinas




        Monterey County Health Department - DUI Project   12
% 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 limits
   0 0.250.5       1   1.5   2
                              Miles




                                      Monterey County Health Department - DUI Project   13
% 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 Limits
   0 0.250.5      1     1.5   2
                               Miles




                                       Monterey County Health Department - DUI Project   14
         Maternal Health Indicators
Indicator              Salinas 1998 Salinas 2002 County 2002
Births                     3,337 (49%)           3,575 (49%)            7,103 (100%)

Medi-Cal & No              1,894 (57%)           2,069 (58%)             3,958 (54%)
Insurance
Low Birth Weight           154 (4.7%)             183 (5.2%)               338 (5%)

Late Entry to              768 (21%)              511 (15%)                958 (14%)
Care
Teens (15-17)               174 (5%)               166 (5%)                308 (4%)

Teens (15-17)               58 (33%)*             82 (49%)*               161 (52%)*
Born in Mexico

* Percent of teen births
                              Monterey County Health Department - DUI Project          15
           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

           Monterey County Health Department - DUI Project   16
MediCal & No Insurance Births in 2002




            Monterey County Health Department - DUI Project   17
Low Birth Weight Births in 2002




         Monterey County Health Department - DUI Project   18
Late Entry to Care Births in 2002




          Monterey County Health Department - DUI Project   19
Teen (15-17 Years Old) Births in 2002




            Monterey County Health Department - DUI Project   20
     Change Hot Spots

  Negative     Little Change Positive




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


             Monterey County Health Department - DUI Project   21
Medi-Cal & No Insurance Change in
       Births 1998 to 2002




           Monterey County Health Department - DUI Project   22
Low Birth Weight Change in Births
          1998 to 2002




          Monterey County Health Department - DUI Project   23
Late Entry to Prenatal Care Change in
         Births 1998 to 2002




            Monterey County Health Department - DUI Project   24
Teen (15-17 Years Old) Change in
       Births 1998 to 2002




          Monterey County Health Department - DUI Project   25
Mexican Born Teen (15-17 Years Old)
   Change in Births 1998 to 2002




           Monterey County Health Department - DUI Project   26
        Medi-Cal Births and Hospitals
        1800
        1600
        1400
                                                                     Natividad
        1200                                                         Medical Center
Count




        1000
         800
                                                                     Salinas Valley
         600                                                         Memorial
                                                                     Hospital
         400
         200
           0
               1998   1999     2000      2001       2002

                             Monterey County Health Department - DUI Project          27
Medi-Cal OB Providers & Clinics in 2002




            Monterey County Health Department - DUI Project   28
          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

          Monterey County Health Department - DUI Project   29
      Accomplishments

• Identified meaningful indicators
• Spatially represented birth data
• Beginning to develop similar
  projects for children, injury, and
  cancer


           Monterey County Health Department - DUI Project   30
     Lessons Learned

• Difficult to match data to
  community resources
• Watch for database error
• Teamwork is essential for useful
  final result
  – Include community partners


          Monterey County Health Department - DUI Project   31
Thanks CityMatCH-DUI!
We are learning from you.




       Monterey County Health Department - DUI Project   32

				
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posted:8/25/2011
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