Introduction



Guidelines for Administering the Survey(s) Developed for Rural Counties

The surveys are available in English on the FHOP Website under “Planning Tools”. Spanish versions will be posted in January. Counties have piloted the English versions of the “core” Perinatal and Child Health Survey and four of its modules and the Adolescent Health Survey. Changes were made based on a review of the completed surveys and feedback from those administering them. The Perinatal and Child Health Survey obesity and asthma modules were not piloted.

Another version of the surveys and modules is available that includes references to the source documents for each question. To obtain this version, please contact either Judith Belfiori or Brianna Gass at FHOP, by calling 415-476-5283.

Survey Purpose

In conjunction with the California Maternal, Child and Adolescent Health Action (MCAH ACTION) rural caucus, two surveys have been developed to help counties obtain information about the health of women, adolescents and children. The objective of these surveys is to collect information to identify key problems that affect the health of the MCAH population in their communities. These data can be used for the county’s five-year maternal and child health assessment, as well as for other assessment and planning efforts. In most counties, the survey results will be in the form of frequencies and percentages and will be analyzed for descriptive information. Unless the survey is administered to a large enough randomly selected sample of the targeted population to generate statistically significant findings, you will need to be very careful about generalizing the data to your entire population. However, data collected from a smaller, non-random sample can still provide useful information about the group surveyed.

Selection of Survey Questions

Family Health Outcomes Project (FHOP) staff identified potential survey questions from existing, already tested and validated surveys such as the Pregnancy Risk Assessment Monitoring System (PRAMS). Questions were adapted to Healthy People 2010 objectives wherever possible. Members of the California MCAH Action Rural Caucus Survey Development Workgroup reviewed and selected the final survey questions using criteria adopted by the workgroup. To be included in the survey, a question needed to provide information relevant to at least one of the following criteria:

• Prevalence of health problem or risk factors

• Frequency of behavior or symptom

• Attitudes or knowledge about a problem or behavior

• Perception of problems within the community

• Access to resources / identification of barriers

Survey Content

There are two surveys. While these surveys can be administered as they are, any county can select particular questions to include in their survey depending on the specific needs and resources of the county. Counties are also encouraged to substitute terms and language appropriate to their local communities, such as local slang terms used to identify drugs and the names of specific programs or services in their counties.

The first survey is the Perinatal and Child Health Survey comprised of a “core” survey and five optional modules. It has been developed to survey three population groups: 1) women who are pregnant, have been pregnant within the past 3 years or are considering becoming pregnant within the next 3 years, 2) parents of or persons responsible for a child(ren) under 18 living in their home and 3) spouses or significant others of women who are pregnant or have been pregnant during the past three years. The five optional modules are Oral Health and Hygiene, Child Asthma, Child Nutrition and Physical Activity, Perinatal Substance Use, and Family Violence. One, some, or none of the modules can be done in conjunction with the “core” survey.

The optional survey modules were designed for use as attachments to the core survey, not as stand-alone surveys; thus, they do not contain demographic and socioeconomic questions. A module can be adapted to be a stand-alone survey. If a module is used in this way, it will be necessary to 1) add, either at the beginning or end of the module, the demographic/socioeconomic questions (from the core survey) and 2) assess whether a few non-threatening questions should be added to the module to assist the transition to sensitive questions.

The second survey is the Adolescent Health Survey to be completed by adolescents 12-17 years old. This survey is for use by counties where the Healthy Kids Survey has not been conducted or data is inaccessible to MCAH programs within the desired assessment timeframe. The survey contains an 18-20 age group option. This age group option has been included for two reasons: 1) you may be interested in this age group, in which case the data can be analyzed separately from the 12-17 age group. We recommend this separate analysis because there are usually significant differences between older and younger adolescents in attitudes and behavior. 2) It may also be used as a means of identifying surveys to be excluded from the analysis, e.g., when youth older than the desired age range of 12-17 were present in the group surveyed.

Guidelines for Using the Survey(s)

The following are guidelines for using the surveys. While they are presented in a sequential order, often you will be making decisions about several of these areas at the same time as you plan for administering the survey(s).

1. Decide which surveys you will implement. Consider what information is needed in your county. To guide your decision, ask:

• Are you interested in an overall picture of your population and/or in specific subjects, e.g., child nutrition and physical activity? It will help to set local survey objectives. An example of local objectives might be:

Objective 1) Identify the perinatal health problems in the county (or in a specific geographic area or subgroup of the population, e.g., low income women).

Objective 2) Determine the characteristics of persons using substances during pregnancy (for the purpose of targeting education or services).

Often it is useful to think about and outline what type of information you think a report of your findings would contain. Does it match the information the responses to the survey questions would yield?

• Will the survey provide information or data that you are not able to obtain from other sources?

• What resources are available to conduct and analyze survey results? Are available resources adequate to analyze the data you collect? Consider the number of surveys and the sampling methodology that you will need to meet your objectives (refer to #3 below). The information will be useless if you don’t have the resources or time to analyze and interpret it.

• Do you need to change or shorten the survey? If so, what revisions will need to be made? If you change the survey or shorten it, you should pilot it with a group that is as similar as possible to the group you are targeting for your survey(s). The purpose of piloting is to be sure respondents understand the instructions, understand the questions and interpret them in the same way and that the survey can be completed within the intended time.

2. Decide whether and which community organizations and groups should be involved. It may be useful to collaborate with agencies and groups outside of MCAH for assistance in sponsoring, administering and/or analyzing the survey. For example, to target some of the pregnant women in your county, you may choose to work with the WIC clinics. Consider the practical and political advantages and disadvantages of collaborating. Consider whether the results will be shared with others or only used internally. If the results are shared with others, what will be the implications for confidentiality and Human Subjects Review requirements? If the decision is to involve others, what staff resources will be required to provide oversight and management of the process and timeline?

3. Determine survey method. Will the survey be self-administered? For most counties this is the most feasible method. Generally, fewer resources are required to administer the survey this way as compared to other methods. Research shows that people, especially teens, are more honest when answering questions on a self-administered survey than to an interviewer-administered survey. Will the survey be delivered door to door, mailed to residents, or handed out at selected sites? Which method of distribution seems most likely to reach the population group you want to survey? Which is most culturally appropriate and most likely to elicit a response?

There may be reasons to consider other methods. For example, if literacy is an issue, you may choose to have an interviewer administer the survey to all participants or to those for whom literacy is an issue. In that case, you will want to adapt the survey to an interview format, develop training procedures/materials and provide training to those who will be conducting the interviews.

Self-administered surveys may be administered to individuals in a group situation. In this case, you would identify sites where the target population is likely to be found. For example, if targeting parents, the sites may include a WIC program, a church, or a day care center. Although each participant fills out her/his survey, a staff member or other trained person would explain the purpose of the survey and use of the information collected, inform the group of confidentiality protections, pass out the surveys, read the directions, read each question if needed, answer respondents’ questions and collect the surveys after they have been completed. This method will allow respondents to ask for clarification on questions when needed. However, be aware that respondents may feel less comfortable answering some of the more sensitive survey questions in this type of group setting.

The surveys have been designed to be confidential and anonymous. Names should not be collected and data collected for this survey should remain confidential. The use of an ID number instead of a name is recommended to serve as an identifier for consistency throughout the data collection, entry, and analysis process. This number should be uniquely assigned to each survey that is distributed and should appear on each page of every completed survey. This will allow you to track non-response rates as well as track individual responses to different questions in different modules of the survey during the analysis phase. See #6 below for additional information on confidentiality.

4. Determine the population to be surveyed and the sample size needed. Unless you are able to survey the entire target population, you will need to select a sample from your population. The process of selecting this sample--who and how many--will have a great influence on the nature of the conclusions you can draw from the results of your survey. When determining the population you will survey and the number of completed surveys needed, consider the time and resources available to administer the survey and which sampling method is doable within these resources.

In order to perform a quantitative analysis of the survey results that is statistically meaningful and generalizable to your target population, a method for random sampling should be used and the sample should be large enough to be statistically representative of the target population(s). In the “real world” it can be difficult to obtain a pure random sample, given limited time and resources. Therefore, we have laid out some other options. When determining how large and what type of sample is needed, assess the type of information you want. Must it be a statistically sound and representative sample, or are you trying to capture the diversity of experiences or obtain insight into the needs or attitudes of a particular group? When resources are very limited, determine how you can select the group(s) you will survey to get the information you most want. For example, if you want to know about the attitudes of women who are using substances during pregnancy (rather than the prevalence of the problem in the population) you will want to administer the survey in places where you think you are most likely to reach women using substances. There will be limitations to how you can interpret these data; however, you will have obtained the desired information about the group of women you are interested in within the means of your available resources. Likewise, you may choose to target other populations of particular interest, e.g., low-income women, women/families living in specific geographic areas, etc.

The following section discusses sampling options and the types of conclusions you can appropriately draw from the data yielded by each option. If you choose one of these alternatives note this in your analysis, and explain the limitations in interpreting the results.

Option 1: Random sample of adequate size

A random sample, by definition, is a sample in which every individual in the target population had an equal chance of being selected. Think of putting all of the names of people in your county into a hat, and drawing them one by one until you had the amount desired for your sample.

Some advantages of random sampling are that you will know the precision, or standard error, of your survey results, and you are most likely to generate a sample that is representative of your population. Another significant advantage of random sampling is that it reduces conscious and unconscious selection bias.

Simple random sampling could include choosing numbers from a telephone book at random and calling those households to schedule a time to fill out the survey, or mailing surveys to randomly selected addresses. This method may exclude homeless individuals and those who may not have a home telephone line. Simple random sampling may not pick up large enough proportions of smaller subgroups of interest to detect any differences among these subgroups.

In contrast, convenience sampling, a method often used by counties, in which the survey is only administered to those who are easy to survey, e.g., pregnant women who visited their prenatal provider on a day staff were present to administer the survey, excludes those individuals who are most likely to provide the information on unmet needs (e.g. pregnant woman that do not access health care services such as substance abusing women, uninsured persons, and homeless families).

An adequate sample size that assures the statistical reliability of your results would be one in which it is possible to calculate a 95% confidence interval. This means that there is only a 5% chance that the differences you observe among groups surveyed are due to chance. In order to calculate an adequate sample size for the “core” Perinatal and Child Health Survey, you must first estimate the number of individuals who fall into each of the target populations: Category 1) pregnant women, women who have been pregnant within the past 3 years and/or women who plan to be pregnant within the next 3 years; Category 2) parents or persons responsible for a child living in his/her home and Category 3) spouses or significant others of a woman who is now pregnant or has been pregnant during the past three years. If the person taking the survey is both pregnant or has been pregnant within the past 3 years, or plans to be pregnant within 3 years or is a spouse or significant other of a pregnant women or woman who has been pregnant within the past 3 years, and is a parent or person responsible for a child living in his/her home, the survey can be counted in population categories 1 or 3 and category 2, thus reducing the total number of respondents needed for the core survey.

You can determine the appropriate number of surveys for your target population(s) by using the table in Appendix I or the calculator available on the web at: . As you can see from the table, as the total population increases, the sample size needed becomes a smaller proportion of the total.

Remember that administering surveys to a randomly selected and statistically representative sample of the target population will provide you with findings that can be generalized to the entire population. It probably will not give you a large enough sample to generalize for smaller subgroups, e.g., age or race/ethnic groups. If your objective is to obtain statistically significant information for a particular subpopulation, such as Latinos or residents of a particular geographic area, you will need to collect enough surveys from that particular subpopulation to be able to generate a 95% confidence interval. If you have access to an epidemiologist, statistician or expert within your health department or at a college or university, who is experienced in the implementation and analysis of surveys, we suggest you work closely with him/her to determine your sampling methodology. If you think that you will be able to survey a statistically representative sample and need help selecting a sampling method call FHOP for technical assistance.

Option 2: Large, non-random sample

What if your county can administer the appropriate number of surveys, but is unable to administer the survey to a random sample? The survey will be valuable for several reasons. If your selection of distribution sites is likely to achieve a representative range of respondents and you have a good survey response rate, you can report data about the group that is surveyed and this data can lead to insights about needs, attitudes, and perceptions of this population. Your primary concern will be reaching the population that you want information about. The selection of sites and methods of survey distribution will be important. Do you want to get information about the range and diversity of the surveyed population? If so, set targets for how many surveys you want from each site and determine how many different types of sites (for example to reach a diversity of parents you might identify churches, schools, daycare centers, workplaces, substance abuse treatment programs, and recreational sites including parks, bars, gyms,) you want to distribute among. Are you primarily interested in data about difficult to reach populations? Low income populations? At risk teens? Determine your distribution sites and methods accordingly.

It is very important that you note the limitations of a non-random sample and identify the biases in the data in your analysis and results. Consider the target population, and how you drew your sample, and note any portion of the target population that may have been missed as a result of your sampling process. For example, if you went to pediatricians’ offices to target parents of children, you may have missed those parents in your community who do not regularly take their children in for check-ups. You will need to determine whether or not it is acceptable for your purposes to leave these groups out of your sample. If not, you will need to target that particular population through other means. In any case, be sure to note the limitations to your sample, and any additional samples your county drew to compensate for this, in the survey analysis and results.

Option 3: Small non-random sample

It is likely that most counties will be unable to get a sample large enough to be statistically sound, and therefore will be limited in the possible analyses of the survey. For those counties where this is a problem, FHOP recommends that counties try to target at least 50 survey respondents from each category, and use the data gathered to develop a descriptive picture of the surveyed population. In this case, rather than trying to achieve a statistically representative sample or trying to assess prevalence in the overall population, you will be concentrating on reaching an “information rich” sample. Again, it is important to consider what kind of information you are looking for. For example, if you wish to survey low-income women, you will try to identify survey sites where it is likely you will reach this population.

If you are seeking information about families affected by childhood asthma you may want to utilize data that is already available to you to determine which groups are important to target for the purposes of this survey. For example, you may know the number of emergency room visits made each year among children with asthma, but you do not have detailed information on which subgroups of the general population, if any, might be disproportionately affected by this problem and why. You may choose to target only those families who visit the emergency room due to asthma during a specific time period for your sample. Fifty surveys from this group would yield much richer information about asthma in your community than would 50 surveys from the other sources, in which only a few children may be affected by asthma.

5. Develop a survey administration and management work plan and timeline. (See example plan in Appendix II) Think through the decisions needed and the tasks of administering the survey and develop a detailed plan. Use it to help you structure and monitor the administration and analysis of the survey. List decisions and tasks needed, begin and end dates for each task, person responsible and resources needed. When setting the timeline and task due dates, you should work backwards from the target finish date. Appendix II provides an example of the types of decisions and tasks that might be included. It shows some tasks not described in this guidance, such as promoting the survey (PR planning) and deciding about incentives. Your work plan should be specific to your situation.

6. Develop informational sheets/cover letter, survey disclosure sheets and/or consent forms as determined by your Health Department’s policies. It is important to have a survey information sheet or disclosure sheet when surveying residents. This sheet should either be attached to the survey or handed out with it. It should tell potential respondents the purpose of the survey, the survey sponsor(s), how the information obtained from the survey will be used, what, if any, benefit there will be, and inform them of confidentiality protections and anonymity, and that their participation in the survey is voluntary. It should also supply contact information in the event of questions or concerns.

We do not anticipate that completing this survey will cause significant risks or discomforts to respondents. We urge you to provide an informational sheet and, to consider, especially for the adolescent population, whether you want to utilize an informed consent or waiver of consent form. Even when it is not legally necessary, if you think individuals or groups, e.g., parent(s), may be concerned about some of the information you are collecting, a consent or negative consent form is advised.

Since the survey does not include personal identifiers, you will not be using the data you obtain for research purposes, and the data is being collected and analyzed by the health department for purposes of program planning, it is likely you will not need Institutional Review Board (IRB) approval. HIPPA requirements, which primarily apply to clinical data, will also not apply. If you do collect identifying information, approval of your survey from your local IRB or the State Committee for the Protection of Human Subjects may be needed. In all cases, it is necessary that you check with your Department regarding its policies.

7. Develop training materials and train those implementing the survey. Develop training materials as needed. The materials should be geared to the knowledge of the persons receiving the training. How familiar are they with the survey? If they have not been involved in its development, provide materials that are concise, easy to read and anticipate questions or problems that might arise for them.

Provide an orientation/training for those who will be distributing and/or administering the survey. Review the purpose of the survey, the benefits of conducting it (how the results will be used) and the specifics of their role in administering it. (See Appendix II for an example) At this session make sure that each person understands the importance of consistency in the way the survey is conducted and the importance of staying on schedule. If there are training materials, review them with the participants.

8. Conduct the survey. Now it is time to put the planning and organizing of the administration of the survey to work. Be sure there is someone in charge who is monitoring the survey administration using your survey administration and management work plan and timeline. This person should be available to all of those persons involved to answer questions and troubleshoot any problems that may arise.

9. Data entry and analysis. Think ahead of time about the resources and needs you have for data analysis, and decide accordingly upon the software you will use. FHOP is developing a data entry template for use with Epi Info software; however, you may use any data analysis program that is locally available and in which staff are trained. When entering data, be sure to be consistent in the numbers and symbols you use. For example, for a yes or no question, decide to code this in data entry consistently as a lowercase n or y. If capital N’s or Y’s are used in addition to lowercase, the software may count these answers differently when performing analyses. It is also important that someone cleans the data for duplicates, missing responses, and decides how to code for this prior to performing any analyses.

For the analyses, in most cases, you will be using frequencies and percentages to describe the population and to report responses. Frequencies represent the number of times a certain response was reported for a particular question. When reporting percentages, indicate the number of cases (N) from which the percentage is calculated. Remember to report on the number who answered a question and to indicate the number of “missing” responses. If you have adequate numbers, you can do further analyses to assess how often answers to certain questions were associated with the answers to other questions or compare among subgroups, e.g., women and men. For these more complex analyses, we recommend that you consult with an Epidemiologist or Statistician.

For comparison purposes, the Healthy People 2010 Objectives associated with the survey content are listed in Appendix III.

10. Report and use of survey results. When interpreting and presenting the data, describe what information the survey was intended to collect and from what population(s). If the data is not generalizable to an entire population group explain its limitations. Then provide the demographics and other descriptors of the respondents. When reporting on the results, use language that is suggestive, such as “the data suggests”, or “the implications are”, rather than stating definitive conclusions. When reporting results in the MCAH 5 Year Needs Assessment, provide a summary of the important survey findings, the implications of the findings, the limitations of the data and how the findings will be used to inform the planning and development of interventions.

|Appendix I. Recommended sample sizes for two different precision levels |

| | | |

| |Author: |Ellen Taylor-Powell is a program development and evaluation specialist for | |

| | |Cooperative Extension, University of Wisconsin-Extension. | |

APPENDIX II: Example Survey Administration and Management Work Plan and Timeline

|Tasks and Decisions |Begin-end date |Person responsible |Resources needed |Comments/Other |

|Identify and convene partners |December 15 –January 10|MCH Director/ staff | | |

|Determine which surveys will be used adapted | | | | |

|Assign roles and responsibilities | | | | |

|Determine sample size and procedures (how respondents will be identified) | | | | |

|Determine/complete changes to survey contents and format | | | | |

|Develop survey distribution plan. Identify sites, target # of completed surveys | | | | |

|at each site, liaison to site, dates of distribution, method, scheduling process | | | | |

|Determine sample size and procedures | | | | |

|Determine pilot groups/ conditions and pilot survey(s) to groups as similar to the| | | | |

|target group as possible / revise survey if necessary | | | | |

|Develop promotional or informational materials (if needed). Determine if/what/how | | | | |

|incentives will be used | | | | |

|Develop/adapt cover letter and/or disclosure sheet, consents | | | | |

|Organize/develop materials needed for training staff to administer and/or | | | | |

|distribute the survey | | | | |

|Orient/train those distributing or administering the survey | | | | |

|Administer the survey | | | | |

|Data entry | | | | |

|Clean data, provide data (frequencies, percentages) | | | | |

|Analyze / Interpret data | | | | |

|Data presentation for priority setting |April 5,2003 |MCH Director | | |

|Prepare summary for 5 Year Needs Assessment |May 15,2003 |MCH staff(name) | | |

Appendix III. HEALTHY PEOPLE 2010 OBJECTIVES RELEVANT TO

RURAL HEALTH NEEDS ASSESSMENT SURVEYS

ASTHMA

24-3 Reduce hospital emergency department visits for asthma

Children under age 5 years

Target Rate/10,000: 80

Baseline: 150.0

Data Source: National Hospital Ambulatory Medical Care Survey (NHAMCS)

24-5 Reduce the number of school or work days missed by persons with asthma due to asthma (Developmental)

Potential data source (NHIS)

24-6 Increase the proportion of persons with asthma who receive formal patient education, including information about community and self-help resources, as an essential part of the management of their condition.

Target : 30%

Baseline: 8.4% of persons with asthma received formal patient education (1998)

Data Source: National Health interview Survey (NHIS)

CHILD NUTRITION AND PHYSICAL ACTIVITY

19-3 Reduce the proportion of children and adolescents who are overweight or obese

Children aged 6 to 11 years Target 5% Baseline 11%

Adolescents aged 12 to 19 years “

Children and adolescents aged 6 to 19 “

Data Source: National Health and Nutrition Examination Survey (NHANES) CDC, NCHIS

19-5 Increase the proportion of persons aged 2 years and older who consume at least two daily servings of fruit

Target: 75%

Baseline: 28 % (1994-96)

Data Source: Continuing Survey of Food Intakes by Individuals (CSFII) USDA

19-6 Increase the proportion of persons aged 2 years and older who consume at least three daily servings of vegetables with at least one-third being dark green or orange vegetables

Target: 50%

Baseline: 3%

Data Source: Continuing Survey of Food Intakes by Individuals (CSFII (2 day average), USDA

22-11 Increase the proportion of adolescents who view television 2 or fewer hours on a school day

Target: 75%

Baseline: 57% of students in grades 9 through 12

Data Source: YRBSS, CDC

22-6 Increase the proportion of adolescents who engage in moderate physical activity for at least 30 minutes on 5 or more of the previous 7 days.

Target: 35%

Baseline: 27%

Data Source: YRBSS

22-7 Increase the proportion of adolescents who engage in vigorous physical activity that promotes cardiorespiratory fitness 3 or more days per week for 20 or more minutes per occasion.

Target: 85%

Baseline: 65% of students in grades 9 thru 12

Data source: YRBSS

DENTAL

21-10 Increase the proportion of children and adults who use the oral health care system each year

Target: 56%

Baseline: 44% of persons aged 2 years and older visited a dentist during the previous year

Data source: Medical Expenditure Panel Survey (MEPS)

21-12 Increase the proportion of low-income children and adolescents who received any preventive dental service during the past year

Target: 57%

Baseline: 20% of children and adolescents under age 19 years at or below 200 % of the Federal poverty level received any preventive dental service (1996)

Data source: Medical Expenditure Panel Survey (MEPS)

FAMILY VIOLENCE

15-34 Reduce the rate of physical assault by current or former intimate partners

Target: 3.3 physical assaults per 1,000 persons ages 12 years or older

Baseline: 4.4 physical assaults per 1,000 persons aged 12 years or older by current or former intimate partners

Data source: National Crime Victimization Survey (NCVS), U.S. Department of Justice, Bureau of Justice Statistics

15-33 Reduce maltreatment of children

Target: 10.3 per 1,000 children under age 18 years

Baseline: 12.9 child victims of maltreatment per 1,000 children under age 18 years

Data source: National Child Abuse and Neglect Data Systems (NCANDS), administration on Children, Youth and Families, Administration for Children and Families (ACF), Children’s Bureau

PERINATAL SUBSTANCE USE

16-17 Increase abstinence from alcohol, cigarettes, and illicit drugs among pregnant women

Increase in reported abstinence in past month from substances by pregnant women:

1996-97 baseline 2010 Target

a. Alcohol 86% 94%

b. Binge drinking 99% 100%

c. Cigarette smoking 87% 98%

d. Illicit drugs 98% 100%

ADOLESCENT HEALTH SURVEY

15-38 Reduce physical fighting among adolescents

Target: 32%

Baseline: 36% of adolescents in grades 9 thru 12 engaged in physical fighting in the previous 12 months (1999)

Data Source: Youth Risk Behavior Surveillance System (YRBSS)

15-39 Reduce weapon carrying by adolescents on school property

Target: 4.9%

Baseline: 6.9% of students in grades 9thr 12 carried weapons on school property during the past 30 days (1999)

Data Source YRBSS

19-3 Reduce the proportion of children and adolescents who are overweight or obese.

Children aged 6 to 11 Target 5% Baseline 11%

Children aged 12 to 19 years 5% 11%

Children and adolescents aged 6 to 19 5% 11%

Data Source: NHANES

19-5 Increase the proportion of persons aged 2 years and older who consume at least two daily servings of fruit

Target: 75%

Baseline: 28%

Data Source: CSFII

19-6 Increase the proportion of persons aged 2 years and older who consume at least three daily servings of vegetables, with at least one-third being dark green or orange vegetables

Target: 50%

Baseline: 3%

Data Source: CSFII

22-6 Increase the proportion of adolescents who engage in moderate physical activity for at least 30 minutes on 5 or more of the previous 7 days.

Target: 35%

Baseline: 27%

Data Source: YRBSS

22-7 Increase the proportion of adolescents who engage in vigorous physical activity that promotes cardiorespiratory fitness 3 or more days per week for 20 or more minutes per occasion.

Target: 85%

Baseline: 65% of students in grades 9 thru 12

Data source: YRBSS

PERINATAL AND CHILD HEALTH CORE SURVEY

1-4 Increase the proportion of persons who have a specific source of ongoing care.

Objective: Increase in persons with specific source of ongoing Care

Children and youth aged 17 years and under

Target: 97%

Baseline: 93%

Data Source: National Health Interview Survey (NHIS)

15-4 Reduce the proportion of persons living in homes with firearms that are loaded and unlocked

Target: 16%

Baseline: 19%

Data source: National Health Interview Survey (NHIS), CDC, NCHS

16-6 Increase the proportion of pregnant women who receive early and adequate prenatal care.

Target Baseline

Care beginning in first trimester of pregnancy 90% of Live Births 83

Early and adequate prenatal care 90% 74

Data Source: National Vital Statistics System

16-16 Increase the proportion of pregnancies begun with an optimum folic acid level.

Increase in Pregnancies Begun with Optimum Folic Acid Level

Consumption of at least 400 ug of folic acid each day from fortified foods or dietary supplements by nonpregnant women aged 15 to 44

Target : 80%

Baseline: 21%

Data Source National Health and Nutrition Examination Survey (NHANES)

16-19 Increase the proportion of mothers who breastfeed their babies

In early postpartum period Target 75% Baseline 64%

At 6 months 50 29

At 1 year 25 16

Data Source: Mother’s Survey, Abbott Laboratories, Inc., Ross Products Division

19-3 Reduce the proportion of children and adolescents who are overweight or obese.

Children aged 6 to 11 Target 5% Baseline 11%

Children aged 12 to 19 years 5% 11%

Children and adolescents aged 6 to 19 5% 11%

Data Source: NHANES

21-10 Increase the proportion of children and adults who use the oral health care system each year

Target: 56%

Baseline: 44% of persons aged 2 years and older visited a dentist during the previous year

Data source: Medical Expenditure Panel Survey (MEPS)

21-12 Increase the proportion of low-income children and adolescents who received any preventive dental service during the past year

Target: 57%

Baseline: 20% of children and adolescents under age 19 years at or below 200 % of the Federal poverty level received any preventive dental service (1996)

Data source: Medical Expenditure Panel Survey (MEPS)

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