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Regional Action Plan (RAP) - Currently Suspended

1. Role of various Regional Perinatal Members in Development / Implementation of the Regional Action Plan:

A. Regional Perinatal Forum Steering Committee Members

A variety of key stakeholders representing organizations ranging from insurance companies to March of Dimes to County Health Departments bringing expertise in health care form different perspectives.

B. Regional Perinatal Forum Action Committees

- Access to Care/Data Committee
- Lactation Committee
- Public Health Nursing Committee - to be organized based on recent stakeholders' requests in 2008.

C. Annual Conference Participants

The RPF holds an annual perinatal public health educational conference. Each conference dedicates time for participants to be actively involved in the identification of regional perinatal health issues and towards actions to address these issues through breakout sessions or audience participation sessions and panel discussions. This gives a broader stakeholder perspective and allows additional input into the formation of the RAP.

- Conference participants have included regional hospital and community nurses, physicians, health care students, lactation consultants, midwives, representatives from the 7 county departments of health, administrators, social workers, community based organizations, insurance companies, lactation consortia, March of Dimes, epidemiologists, public health workers and many others.

D. Mechanism of Roles

The Steering Committee utilizes input from the Steering committee members, the Access to Care/Data committee members' expertise, Lactation Committee members' expertise and a variety of the RPF annual conference participants' input for formulating the RAP.

2. Analysis of Available Data/Regional Perinatal Issues and Service Gaps:

A. Racial and Ethnic Disparities in Healthcare

- Nationally, racial and ethnic disparities are increasingly associated with poor perinatal health outcomes. Besides disparities in important outcomes such as infant mortality, there are racial and ethnic disparities in contributing factors such as access to care.

- The Hudson Valley Region (Seven counties of Dutchess, Putnam, Rockland, Westchester, Orange, Sullivan, and Ulster) have high numbers of births each year and in addition to high numbers, the live births of those counties are also ethnically diverse, having a high percentage of live births to foreign born mothers. Each of the counties in the region posses their own unique issues with racial and ethnic disparities in perinatal outcomes, reinforcing the fallacy that these are the wealthiest counties without issues.

- While the prematurity rate has increased nationally (13% since 1992), in minorities, the rate has increased over 50% in some NY Hudson Valley Counties. Examples of these racial and ethnic disparities include a 24.1% increase in premature births among Hispanics in Putnam County. In Rockland County, premature births to African Americans increased by 55.3% The Healthy People 2010 goal for premature births is 7.6%. The Hudson Valley Region's percentage of 10.61% in 2002 is 28.4% higher than the goal. (NYSDOH, 2000 - 2002)

- The picture is bleaker for low birth weight babies in the Hudson Valley. Between 2000 & 2002, there was a 4.5% increase in the number of babies born below the optimal birth weight. In the Hudson Valley Region for the year 2000, 6.66% of babies were born with low birth weight compared to 6.93% in 2002. Racial and ethnic disparities also exist; in Dutchess County, for example, there was a 44.7% increase In Hispanic Low birth weight babies. In Sullivan County low birth weight births is 5.0%. The Hudson Valley region percentage of 6.93% in 2002 is 27.84% higher than the goal. (NYSDOH, 2000- 2002).

B. Maternal morbidities, behavior, and environment (i.e. Obesity, stress, violence, tobacco, lack of prenatal care, and racism impact perinatal health outcomes:

Prenatal care: Vintzileos et al. In 2002 found an adjusted risk of 2.9 in blacks and 3.4 in whites of fetal death due to lack of prenatal care.

Obesity: Henricksen (2006) describes complications associated with maternal obesity and gestational diabetes including asphyxia and hypoglycemia due to higher large for gestational age infants as well as increased risk of malformations. Kristensen et al. in 2005 demonstrated 2.8 risk for stillbirth and 2.6 risk of neonatal death for infants born to obese mothers. Callaway et al. a 2.8 risk of infants requiring intensive care and a 2.1 risk of being premature. We can expect these issues associated with maternal obesity to be on the rise as Ogden et al. (2006) have shown that prevalence of obesity is increasing in children and adolescents

Periodontal Disease: Bogess et al. (2006) showed a 2.3 risk for small for gestational age infants born to mothers with moderate to severe periodontal disease as compared with mild or no disease (13.8% vs. 3.2%). Periodontal disease has also been associated with a 2.4 higher risk of premature infants born to mothers with moderate to severe periodontal disease. (Offenbacher et al. 2006).

Domestic Violence: In 2004, Neggers et al. showed physical abuse was significantly associated with low birth weight and prematurity.

C. Regional Behavioral/Environmental Risk Factors:

- (Based on NY State County Health Assessment Indicators, Health Behaviors 2001 - 2003 and March of Dimes Peri-Stats) Ulster and Sullivan Counties have 25% of smoking adults vs. only 20% across the state. Putnam County has 57.1% of adults overweight or obese which is higher than the State's 56.7%. Rockland County has the lowest rate of physical activity in the last 30 days for the Hudson Valley Region of 72% vs. 78% in the State (excluding NYC). Early prenatal care is less than the State's 81% for Rockland County at 78% (sixth lowest in the state).

D. Ongoing Processes:

- Based on above mentioned data, prematurity, low birth weight, poor prenatal care, obesity, smoking and physical activity will be further scrutinized. Additional data will be acquired regarding other maternal morbidities and environmental and behavioral issues based on national data that suggest associations with pregnancy outcomes. These issues will be examined with regards to racial and ethnic disparities and trends over time and region.

- RPF Conference participants have listed key regional barriers including language, transportation, and financial, cultural, lack of insurance and undocumented immigrant fear of deportation. Social health marketing research is ongoing in two selected high risk zip codes (Mt. Vernon and Peekskill) as pilot programs which could then be replicated in additional high risk zip codes.

3. Region-Specific Perinatal Intervention Strategies:

Goals: To reduce overall rates and racial and ethnic disparities in prematurity, low birth eight, late or no prenatal care, obesity, smoking, and periodontal disease.

- Objectives: Educating the region as to these contributory factors will not only lead to better awareness, but also implementation of changes in practice to help prevent poor perinatal outcomes.

- The Regional Perinatal Forum Conference provides an opportunity for stakeholders to learn about national issues and how they play out on a local level, and then come together from multidisciplinary perspectives and plan for change to ultimately improve perinatal health on a local level.

Grand Rounds at regional hospitals on public health topics relevant to the RAP.

Mini-grants are offered to affiliate hospitals, community stakeholders and others interested in a project or activity that support the RAPs goals & objectives.

Website educational resources: March of Dimes, MISN, LHVPN & RPC.

RPC bi-monthly Perinatal Gazette Newsletter: educational articles incorporates pubic health themes, upcoming conferences, announcements, etc.

- Perinatal Network educational meetings/training sessions: ongoing with both Lower Hudson Valley Perinatal Network (LHVPN) & Maternal Infant Services Network (MISN).

- Recruitment of new members to the RPF through steering committee members & the RPF conference.

Ongoing efforts for current RPF members to represent forum RAP initiatives in their activities/communities/organizations.