Applying a public health approach: the role of state health departments in preventing maltreatment and fatalities of children.

Child maltreatment prevention is traditionally conceptualized as a social services and criminal justice issue. Although these responses are critical and important, alone they are insufficient to prevent the problem. A public health approach is essential to realizing the prevention of child abuse and neglect. This paper discusses the public health model and social-ecology framework as ways to understand and address child maltreatment prevention and discusses the critical role health departments can have in preventing abuse and neglect. Information from an environmental scan of state public health departments is provided to increase understanding of the context in which state public health departments operate. Finally, an example from North Carolina provides a practical look at one state's effort to create a cross-sector system of prevention that promotes safe, stable, and nurturing relationships and environments for children and families.

Surveillance of births conceived with various infertility therapies in Massachusetts, January-March 2005.

OBJECTIVE: Nationally, infertility therapies (IFTs) are increasingly used to overcome fecundity issues. However, it is unclear to what extent noninvasive IFTs are used compared with assisted reproductive technology. To better understand outcomes related to the increasing use of all types of IFTs, we compared self-reported IFT use from a Massachusetts pilot Pregnancy Risk Assessment Monitoring System (MA-PRAMS) to IFT use recorded on birth certificates (BCs). METHODS: In 2005, Massachusetts conducted a three-month pilot study modeled after the Centers for Disease Control and Prevention's PRAMS, a population-based surveillance system that monitors pregnancy experiences. Descriptive and bivariate analyses compared responses to MA-PRAMS survey questions regarding IFT use with data collected on BCs from the same women sampled. RESULTS: According to MA-PRAMS, 6.1% of live births were conceived using IFTs compared with 3.1% reported on BCs. Reported IFT use varied by maternal age and plurality. For women aged 18-34 years, IFT use reported on MA-PRAMS (5.0%) was 2.5 times higher than that reported on BCs (2.0%). For women aged 35 years or older, reported IFT use was comparable in both systems. For women giving birth to singletons, IFT use reported on MA-PRAMS (5.5%) was three times higher than that reported on BCs (1.8%). CONCLUSIONS: Higher use of IFTs was reported by MA-PRAMS than on BCs, particularly among younger women and those having singleton births. These findings suggest that self-reported IFT use might be a more sensitive method for states to use in assessing population-based IFT usage among women and monitoring trends in adverse birth outcomes.

Pregnancy-associated mortality at the end of the twentieth century: Massachusetts, 1990-1999.

OBJECTIVES: 1) to report Massachusetts pregnancy-associated mortality ratios (PAMRs) and maternal mortality ratios (MMRs) from 1990 to 1999 and pregnancy-related mortality ratios (PRMRs) from 1995 to 1999; 2) to identify disparities in PAMRs by race and Hispanic ethnicity, payer at delivery, age, and age by medical and injury cause of death; 3) to report distributions of pregnancy-associated deaths by cause, preventability, and timing in relation to pregnancy. METHODS: Pregnancy-associated deaths from 1990 to 1999 were identified using enhanced methods, including linkage of vital records. Preventability and pregnancy relatedness were determined by case review (1995-1999). Trends in ratios and aggregate PAMRs by key characteristics were calculated. RESULTS: The 10-year PAMR and MMR were 27.2 and 3.3 per 100,000 live births, respectively, with no significant changes from 1990 to 1999. The PRMR was 6.1 for 1995 to 1999. The leading cause of pregnancy-associated death was homicide. The PAMRs for black non-Hispanic and Hispanic women were 3.1 and 1.8 times higher than that for white non-Hispanic women. The PAMR was 3.2 times higher for women with public than with private payers and 3.4 times higher among women age 40 to 44 than among women age 25 to 39. The injury PAMR for women younger than 25 was 3 times higher than it was for women age 25 to 39. Injuries caused one-third of pregnancy-associated deaths. Fifty-four percent of deaths from 1995 to 1999 were deemed preventable. CONCLUSIONS: Pregnancy-associated deaths are rare, yet many are preventable. Public health prevention strategies should extend beyond the traditional postpartum period and address disparities for black non-Hispanic and Hispanic women, low-income women, older women for medical causes, and younger women for injury causes.