BETTER BEGINNINGS
Healthy Families
A Report on the Health of Women, Children, and Families in Spokane
Amy S. Riffe, MA, MPH/Elaine Conley, DirectorSpokane Regional Health District
Community Health Assessment, Planning, and Evaluation
Demographics – Spokane County
472,650 residents in 2011
111,470 women of childbearing age
5,867 births
Births 2007-2011 8% 15-19 years 59% 20-29 years 31% 30-39 years 2% 40-49 years
47% Medicaid
90% White
11% <High school ed
Birth rate12.4 per 1,000 residentsDecreased from 07-11Lower than WA
Teen birth rate, 15-17 11.3 per 1,000 womenNo trendSimilar to WA
Demographics - continued
Cost of a Birth – Spokane County 2007-2011
Full term infant 93% of full term ≤ 3
days $6,800
Preterm infant 40% ≤ 3 days $55,900
6.5% of births 64% of charges
The average hospital stay for a newborn was 3 days
The average charge was $10,000
P O O R M E N TA L H E A LT H17.0% of women 18-44No trendSimilar to WANo difference by ageDecreased with income
Preconception Health
<$15,000 $15k-$25k $25k-$50k $50,000+0
1020304050
36.825.6
15.37.2
Poor Mental Health by IncomeSpokane County Women 18-44, 2006-
2010
Perc
ent
Preconception Health
Pre-pregnancy obesity 24.1% obese before
becoming pregnant Increased from 07-11 Lower than WA
Increased with age Higher for Medicaid Higher for black, AIAN
15-19 20-29 30-39 40-49 Med-icaid
Non-Med-icaid
White Black AIAN API His-panic
0
10
20
30
40
50
12.622.7 24.1 28.7 25.9
19.2 22.231.5 28.2
15.422.6
Pre-Pregnancy Obesity by DemographicsSpokane County, 2007-2011
Perc
ent
of b
irths
Preconception Health
Unintended pregnancy 36.1% of birth were
unintended pregnancies
Similar to WA
Decreased with age Higher for Medicaid No difference by race
15-19
20-29
30-49
Medica
id
Non-M
edica
id0
25
50
75
100 81.0
39.919.5
55.6
21.6
Unintended Pregnancy by DemographicsSpokane County, 2006-2010
Perc
ent
of b
irths
Family Health
Family Structure, Spokane County, 2011 108,605 children 0-17 years 52,489 family households with children
23.4% were a female householder, no husband• 6,196 children 0-5 years live with a single mother
8.7% were a male householder, no wife
Family Health
ACEs 12% of kids K-6 have
3+ 46% of women have 4-
8 Higher than WA No difference by age Decreased with
income
Low social support 18.9% with low
support No trend Similar to WA No difference by age Decreased with
income
<$15,000 $15k-$25k $25k-$50k $50,000+0
25
50
75 64.4 62.852.9
31.7
High ACEs Score by IncomeSpokane County Women 18-44, 2009-
2010
Perc
ent
<$15,000 $15k-$25k $25k-$50k $50,000+0
10
20
30
40 33.325.7
14.25.8
Low Social Support by IncomeSpokane County Women 18-44, 2006-
2010Pe
rcen
t
Family Health
Child abuse 5,264 victims in 2011 Increased from 07-11 Higher than WA
Smoking in home 16.9% allow it No trend Higher than WA No difference by age Decreased with
income
2007 2008 2009 2010 20110
10
20
30
40
50
60
42.6 41.0 40.045.3 48.1
34.1 31.6 31.9 31.8 33.7
Child Abuse Over Time
Spokane County Washington State
Rate
per
1,0
00 ch
ildre
n 0-
17
$15k-$25k $25k-$50k $50,000+0
10
20 17.9
10.16.4
Allows Smoking in the Home by IncomeSpokane County Women 18-44, 2006-
2010Pe
rcen
t
Family Health
Stressors 13.5% of mothers had
4+ stressors during 06-11
Higher for women 20-29
Higher for Medicaid Higher for non-whites
Women with 4+ stressors Nearly 10x more likely
to have postpartum depression
Almost 6x more likely to have a LBW infant
15-19
yrs
20-29
yrs
30-49
yrs
Medica
id
Non-M
edica
idWhit
e
Non-whit
e0
10
20
30
6.6
18.9
4.5
26.5
2.512.1
26.7
4+ Life Stressors by DemographicsSpokane County, 2006-2010
Perc
ent
of b
irths
Maternal Health
Short IPI 40.8% had a short IPI Decreased from 07 to
11 Higher than WA No difference by
income or race Decreased with age
Prenatal care, 1st tri 88.7% had 1st tri PNC Increased from 07 to
11 Higher than WA Increased with age Lower for Medicaid Lower for non-white
15-19 20-29 30-39 40-490
25
50
75 69.0
46.636.1 36.0
Short Interpregnancy Interval by AgeSpokane County, 2007-2011
Perc
ent
of b
irths
15-19
30-39
Non
Medica
id White
AIAN
Hispan
ic50
75
10078
87 90 86 8193 88 82 76 76 77
First Trimester Prenatal Care by De-mographics
Spokane County, 2007-2011Pe
rcen
t of
birt
hs
15-19
20-29
30-39
40-49
Medica
idNon
Medica
id White
Black
AIAN API
Hispan
ic0
10
20
30
40 30.618.5
10.1 9.1
27.7
7.416.8 21.4
29.9
4.9 9.2
Maternal Smoking by DemographicsSpokane County, 2007-2011
Perc
ent
of b
irths
Maternal Health
Maternal smoking 15.9% smoked Decreased from 07-11 Higher than WA Decreased with age Higher for Medicaid Higher for black, AIAN
Alcohol use 37.3% drank in last
trimester Similar to WA No difference by age,
Medicaid, or race
Child Health
Low quality of life 23.7% of youth
reported a low QOL Decreased from 06 to
10 Higher for low
education Higher for blacks
Mom <HS ed
Mom >=HS
ed
White Black AIAN API0
1020304050 40.0
20.8 22.434.0 28.9 24.6
Low Quality of Life by DemographicsSpokane County, 2010
Perc
ent o
f you
th
Child Health
Kindergarten readiness Washington Kindergarten Inventory of Developing
Skills Fall 2012
Social/emotional Physical Language Cognitive Literacy Math
Cheney
East Valley
Spokane
West Valley
5
4
3
3
5
6
7
7
WaKIDS, 2012
Met 6 of 6 domains Not met 6 of 6 domains
Summary
Better than WA Dental sealants Hypertension Prenatal care first
trimester Pre-pregnancy obesity Vaccine preventable
illness
Worse than WA ACEs Birth defects Breastfeeding Child abuse Chlamydia Immunization exemption Maternal smoking No flu shot in the last year Short IPI SIDS Smoking allowed in home
Summary
Good trend Breastfeeding Low quality of life Maternal smoking Prenatal care first
trimester Preterm birth Short IPI Vaccine preventable
illness
Bad trend Child abuse Chlamydia Diabetes Good general health Hypertension Immunization
exemption Pre-pregnancy obesity
Concerns
• Many of the indicators are getting worse• Many of the measures show a disproportionate
impact on:o Individuals on Medicaido Racial minorities
• Many of the issues are deeply rooted in inequities such as:o Educational attainmento Household incomeo Neighborhoods in which people live
What Can We Do?
• Traditional public health approaches are not sufficient to address many of these problems
• Community wide initiatives that impact the root causes of these issues will need to be initiated and/or expanded
What Can We Do? (continued)
• Need a continuum of activities that address all levels of the socio-ecological model
What Can We Do? (continued)
• Focus on policy and system-level change while simultaneously focusing on social, organizational and individual behavior change
• We must develop a shared vision for the future of children and families in the community
Recommendations
Four major areas of recommendations…..
Recommendations (Continued)
Mitigate and/or prevent the impacts of ACEs on children and families
Build community resilience by promoting community connectivity
Support a variety of providers, organizations parents and community members in adopting trauma-sensitive practices in their work and in the community
Promote positive community norms about parenting programs and acceptable parenting behaviors
Recommendations (Continued)
Mitigate and/or prevent the impacts of ACEs on children and families (Continued) Continue to support best practice one-on-one
interventions such as Nurse Family Partnership for the most vulnerable families
Invest in mental health resources Strengthen safe, stable, nurturing relationships at
the community level Establish peer support models for expectants
mothers Build connectivity among women through low cost
activities like exercise
Recommendations (Continued)
Ensure That Children Enter School Ready to Learn
Develop and implement universal developmental screening for children 0-5 years of age.
Invest in quality early childhood education Address the achievement gap between white and
non-white students
Recommendations (Continued)
Address Inequities in Spokane County Promote policies that meet families’ basic needs
including: Affordable housing Access to food Access to health care
Provide adequate income support for young families Increase minority representation on governing boards
to assist in decision making that supports all people Develop policies utilizing a child and family sensitive
lens and advocate for a “health in all policies” standard
