This document provides an overview of using data and evidence to support public health program development and decision making. It discusses finding health statistics from sources like the CDC to determine community needs, promote evidence-based practices, and secure funding. Tutorials cover identifying the type of data needed, accessing CDC sources like the Breastfeeding Report Card and PRAMS surveillance system, and developing competencies in critical thinking, database navigation, and monitoring systems. A case study example examines Louisiana breastfeeding data to argue for including the state in a national breastfeeding promotion program.

1. Data Driven and Evidence-based Program Development “Finding, understanding and disseminating data and statistics: From the CDC to YOU!”

2. Overview “It is important in decision-making, policy development, and the establishment of new programs to improve public health that these initiatives be supported by scientific evidence. “ (www.phpartners.org) The ability to find, use and disseminate health statistics and data allows the PH practitioner to: Determine specific needs of various groups at the community, state and national levels Promote behavior modification through evidence-based practices Provide convincing arguments to secure funding when grant-writing

3. Tutorial Breakdown The Five W’s + H Data at the National and State Levels: Using CDC Data and Statistics Monitoring Programs Case study- WIC and Breastfeeding

4. Learning Objectives At the end of this module you will be able to: Identify strategies to critically determine what type of data you need by utilizing the 5W (and H) method for finding data Navigate and understand how to access two main sources of health statistics information from the CDC: Breastfeeding Report Card (summary statistics) and PRAMS (interactive surveillance system) Search for resources to help stay informed of developments and events related to your field of interest related to working with women and children

5. Supported Competencies Acquisition of the knowledge and skill set in this web tutorial will develop competencies in: Critical Thinking: Determining what type of data and data sources will benefit the individual Database Navigation: Feeling comfortable utilizing the CDC website and other data websites Using Monitoring Systems : Understanding how to use monitoring systems such as PRAMS

6. Who Who are you interested in? Gender Age Race Socioeconomic Status (SES) Geography

7. What What Health Indicator are you Interested in? Breastfeeding! Breastfeeding immediately after delivery After 4 months? After 6 months? Other Health Indicators Pregnancy rates STD rates Pneumonia Ect. Ect. Ect.

8. Where At what level are we interested in? National State Local/Community level Using national statistics to support your state and local statistics

9. When During what time period are you interested in investigating? This year? This month? The past decade? Are you interested in conducting a comparison? Has your health indicator improved this year as compared to last year?

10. Why Why do you want this data? What do you hope to achieve? Use for clinical work Grant-writing Public education Submission to financial backers

11. How The following slides will go step by step how to find and understand data. The Breastfeeding Report Card and the Pregnancy Risk Assessment Monitoring System (PRAMS) were chosen and tools to find data at the national and state levels. Both are funded by the CDC and are continuously updated

12. CDC- Breastfeeding Example While data and statistics can of course be found on a variety of health indicators related to various disease this tutorial will focus on those strictly related to breastfeeding The Center for Disease Control (CDC) is your best bet for finding up to date data and statistics on breastfeeding www.cdc.gov In the A-Z index: Choose B Choose Breastfeeding from the Alphabetical list of topics Under topics choose Data and Statistics Summarized Information Search for particular data/statistics through surveillance databases

13. Data and Statistics Benefits to using data from the CDC The data given matches what you are looking for You need quick and easy-to-understand facts You want to use ready-made graphs or charts

14. Data and Statistics (2) Some things to consider with summary data before using it: Who is the data looking at? Only certain races? Only one gender? What is the data looking at? Is it your question? Slightly different? Where was the data collected? Only in one geographic region? Population-based? When was the data collected? A lot of data is collected periodically. You can make inferences from data collected several years ago if that is all that available to you just make sure you state that. How was the data collected? Was it a valid method? Does it make sense to you? Why was the data collected? If it was collected by the CDC you can trust that it is an objective source. Some sources may have ulterior motives and can present data in certain ways to satisfy their objectives and funders

15. Data and Statistics (3)Findmore information on each survey at cdc.gov Breastfeeding Report Card Provides state-by-state data Measures types of support in key community settings Provides the most current data on the breastfeeding goals outlined in Healthy People 2010. U.S. National Immunization Survey (NIS) Infant Feeding Practices Survey II Maternity Care Practices Survey HealthStyles Survey

16. Data and Statistics (4) National Health and Nutrition Examination Survey (NHANES) National Survey of Family Growth (NSFG) National Birth Certificate Data The Pregnancy Nutrition Surveillance System (PNSS) The Pediatric Nutrition Surveillance System (PedNSS) The most recent national PedNSS annual reports and a Web-based training module with user-friendly "How-To" information for PedNSS and PNSS are available online

17. Interactive Surveillance System Pregnancy Risk Assessment Monitoring System (PRAMS) Surveys in selected states provide representative data on the incidence and duration of breastfeeding. Most recent data is 2007, some 2008

18. State and City Public Health Offices Each state and city have offices of public health (OPH) Each OPH has a website with data and statistics Remember! Not all statistics are always posted Contact you OPH at the state or city level via email or phone call to discuss how to get the most up-to-date statistics available Your community health department may have data you are interested in, each community is different

19. Case Study National WIC Breastfeeding Promotion Plan: Loving Support Campaign (See “The 4 P’s of Social Marketingand Breastfeeding”) Objectives: Increase the number of breastfeeding women. Increase the average duration of breastfeeding among WIC program participants. Increase the # of referrals to WIC for breastfeeding support and technical assistance. Increase acceptance/support for breastfeeding among public. Louisiana was not included in the pilot states for the program

20. Case Study Let’s say that as someone working with WIC mothers and children in Louisiana, you think that Louisiana should be included in the “Loving Support Campaign” when its expanded Use data and statistics to support your argument that Louisiana should be an included state Look at the objectives of the program and search for statistics that will reference these objectives specifically to women in Louisiana How many women in Louisiana breastfeed? For how long do most women in Louisiana who are on WIC breastfeed? How many referrals do WIC mothers in Louisiana receive for breastfeeding support and technical assistance? Is breastfeeding supported/accepted among the public in Louisiana?

21. Case Study To address these questions let’s use: Breastfeeding Report Card http://www.cdc.gov/breastfeeding/data/reportcard.htm PRAMS http://www.cdc.gov/PRAMS/CPONDER.htm

22. Breastfeeding Report Card Provides state-by-state data on breastfeeding initiation and duration Ever breastfed, breastfeeding at 6 months; breastfeeding at 12 months Exclusively breastfeeding Outcomes directly track Healthy People 2010 Breastfeeding objectives Provides state-by-state information on breastfeeding support systems Birth Facility Support Professional Support Mother to Mother Support Legislation Infrastructure

23. Data from Breastfeeding Report Card, 2010 From the Outcome Indicators: From the Process Indicators:

24. Breastfeeding Report Card, 2010(2) From the Outcome Indicators: Louisiana has lower rates in all breastfeeding categories as compared to the national rates Which indicator is most important for your purpose? The exclusive breastfeeding rate in Louisiana at 6 months is 7.8 which is lower than the national average of 11.9.

25. Breastfeeding Report Card, 2010 (3) From the Process Indicators: Summary Statement Louisiana has lower percentages in all support system availability than the national average with the exception of percent of infants under 2 days that receive formula. Which indicator is most important for your purpose? The number of Full-Time Equivalents (FTEs) devoted to breastfeeding in Louisiana is 1 as compared to the national average of nearly 97. Support your argument with further statistics from both the Outcome Indicator and Process Indicator report

26. Pregnancy Risk Assessment Monitoring System(PRAMS) Collects population-based data on maternal attitudes and practices before during and after pregnancy Surveillance Reports (1996-2002) Prevalence and Trends Database: CPONDER Users can design their own analysis by choosing from available variables Contains data from 2000-2008 54 variables by topic as the outcome variable 12 control variables to break out or stratify the requested analysis Analyses may be for a single state and year a single state and all available years all available states and a single year Use graphs to support your points

27. PRAMS (2) From the PRAMS website click Prevalence and Trend data- CPONDER system on the right hand side Choose Prevalence and Trend data- CPONDER system on the right hand side again From the pull down menu choose the state (or all states), year and topic of interest In this example lets look at the most recent data for Louisiana concerning breastfeeding State: Louisiana Year: All available Years Topic: Breastfeeding Questions related to the topic will appear if available

28. PRAMS (3) In this example lets choose “Indicator of whether the mother was still breastfeeding 8 weeks after delivery” In 2004 in Louisiana, 32.1% of women surveyed (n=1519) were breastfeeding 8 weeks after delivery. The confidence interval of 29.6-34.7 says that there is one can be 95% confident that the percentage of women breastfeeding at 8 weeks (32.1%) falls between 29.6 and 34.7.

29. PRAMS (5) USING BREAKOUT CATEGORIES In this example lets again choose “Indicator of whether the mother was still breastfeeding 8 weeks after delivery” Breakout categories appear in a drop down menu Let’s choose to break out whether the mother was on WIC during her pregnancy The results are based on the response being “yes” In Louisiana in 2004, 22.1% of women surveyed of who were breastfeeding 8 weeks after delivery (n= 502) were on a WIC. The confidence interval (CI) is (19.1-25.3).

30. Let’s draw some conclusions… and apply them to the case study! Our original purpose: Looking at breastfeeding rates among women on WIC in Louisiana to support Louisiana’s inclusion in the “Loving Support Campaign” What did we find out? Louisiana has lower breastfeeding rates in all categories than the national average and is not improving! Louisiana has worse support systems than the national average Louisiana has only 1 full-time state employee working in breastfeeding programming There is a lower percentage of women breastfeeding 8 weeks post delivery who are in WIC than those not in WIC All of these statistics address the objectives of the campaign and could be used in writing a grant to promote Louisiana’s inclusion in this campaign!

31. Using the data… This information can be used in Patient education Community-awareness Grant-writing at the community/statelevel Summary: For a complete picture use as many data sources as possible Start with CDC Use state-level office of public health Make sure your source is credible

32. Test your knowledge! Where does your state rank in exclusive breastfeeding at 6 months as compared to the other states and the national value in the most recent data available? What is the most recent data showing the percentage of births in your state that occur in a facility designated as a Baby Friendly Hospital Initiative? What is the most recent data that shows the percentage of women in your state that breastfed or used a breast pump to feed their new baby after delivery? Use your data navigation skills to find data on another health indicator in your state. What is the most recent data that shows the percentage of women in your state that had a BMI classified as “obese”, pre-pregnancy?

33. Additional Resources Data and Statistics Databases www.cdc.gov www.phpartners.org www.childstats.gov www.statehealthfacts.org http://communityhealth.hhs.gov Online Tutorials http://www.nlm.nih.gov/nichsr/usestats/index.htm http://nnlm.gov/training/healthstatistics/ http://phpartners.org/tutorial/03-hs/index.html http://www.pitt.edu/~super1/

34. Thank you! Thank you for participating in this tutorial. Your feedback is extremely important to the success of this program. Please take a few minutes to complete this short survey: http://www.surveymonkey.com/s/KLJ28ZK