Bruce B. Cohen

Declining maternal smoking prevalence did not change low birthweight prevalence in Massachusetts from 1989 to 2004

BACKGROUND Maternal smoking is associated with low birthweight (LBW). LBW prevalence is increasing in the US. However, it is unclear whether a fall in maternal smoking has any impact on the LBW prevalence in Massachusetts, a state with a comprehensive tobacco control program since 1993. METHODS Temporal patterns in prenatal maternal smoking and in LBW prevalence were quantified between 1989 and 2004, using Massachusetts Community Health Information Profile database. Yearly population-attributable-risk (PAR %) of singleton LBW live-births among pregnant smoking mothers were estimated based on a summary relative risk. The expected number of LBW babies attributable to reductions in maternal smoking in 2004 relative to 1989 was compared to the actual number of LBW babies in 2004. RESULTS Of 88 929 and 74 554 singleton live-births, 4297 and 4004 LBW births occurred in 1989 and 2004, respectively. Between 1989 and 2004, maternal smoking prevalence significantly declined yearly by >or=6% (from 19.9% to 6.8%) but overall LBW prevalence increased yearly by <1% (from 4.8% to 5.4%), with a significant yearly increase (<1%) in moderately LBW (1500-2499 g) prevalence. Yearly PAR % declined from 20.3% (n = 872) to 8.0% (n = 320), with an expected total of 3745 [4297 - (872 - 320)] LBW babies in 2004 relative to 1989. However, actual LBW babies numbered 4004 in 2004. The 259 above predicted (4004 - 3745) LBW babies born in 2004 being attributed to factors other than prenatal maternal smoking. CONCLUSIONS Massachusetts experienced a decline in prenatal maternal smoking prevalence, but an increase in moderately LBW prevalence has offset the potential gains apparently achieved due to reductions in maternal smoking prevalence.

Perspectives on the Massachusetts Community Health Information Profile (MassCHIP): developing an online data query system to target a variety of user needs and capabilities.

The Massachusetts Community Health Information Profile (MassCHIP) has many distinctive features. These features evolved to maximize the usefulness of this query system for a broad group of users with varied needs, differing levels of knowledge about public health, and diverse experience using public health data. Three major features of MassCHIP help target our large user population. These features are as follows: (1) multiple avenues of entry to initiate queries ranging from an alphabetical list of simple topics to detailed International Classification of Disease codes; (2) the inclusion of data sets from other state agencies in addition to those of the Massachusetts Department of Public Health to reflect a broad view of public health; and (3) the capacity to retrieve data for multiple levels of geography, from the neighborhood through the state, including planning districts and hospitals. In this article, we discuss the history and design of MassCHIP, and focus on the features of MassCHIP that target a great variety of user needs and capabilities, and which are distinctive among Web-based data query systems.

Setting the standards for collecting ethnicity data in the Commonwealth of Massachusetts.

The 1997 revision to Federal Office of Management and Budget (OMB) Directive No. 15 Race and Ethnic Standards for Federal Statistics and Administrative Reporting provides standard classifications for reporting broad race categories and Hispanic/non-Hispanic ethnicity. However, the current system may be masking disparities in health behaviors and outcomes across ethnic groups. Since 2000, the Massachusetts Department of Public Health has been developing an alternative approach to collecting race, ethnicity, and language preference data to better serve the local population. Our data collection tool adheres to OMB standards but captures detailed ethnicity data independent of broad race categories. We believe that training personnel is an essential component of data collection, and we are planning to develop online training materials. Although we encourage states to learn from our experience, data need to be comparable within and across states as well as over time to monitor health disparities.

Identifying Health Maintenance Organization membership through self-report of health plan name: ascertainment and reliability.

OBJECTIVE To evaluate the feasibility and reliability of (1) identifying Health Maintenance Organization (HMO) membership by ascertaining self-reported health plan name in a telephone survey and (2) using external information to determine whether the plan was an HMO. METHODS Respondents to the 1999-2001 Massachusetts Behavioral Risk Factor Surveillance System (BRFSS) and the 1999 Massachusetts Colorectal Cancer (CRC) survey were asked to name their health plan. The authors used information from external sources to classify the plan as an HMO or a non-HMO. Test-retest reliability of reported plan name was examined overall, by demographic characteristics, and by health plan name. Reliability of HMO classification was tested with the kappa statistic. RESULTS More than 88 percent of respondents with commercial health insurance provided their health plan name; 84 percent reported a plan that could be assigned as either an HMO or a non-HMO. The percentage whose HMO status could be assigned differed by demographic characteristics. Among those assigned, the distribution of specific HMOs among survey respondents was similar to the distribution reported by the Massachusetts Division of Insurance. In a subsample, 78 percent reported the same health plan during a follow-up interview. Agreement was higher for men, and differed according to the plan reported at the first time point. Kappa for HMO classification from health plan name was 0.87. CONCLUSIONS Self-report of health plan name is a feasible and reliable method to ascertain health insurance information in a telephone interview.

Affordable Care Act standards for race and ethnicity mask disparities in maternal smoking during pregnancy

OBJECTIVE This study compared maternal smoking during pregnancy between the new Patient Protection and Affordable Care Act (ACA) data collection standards and Federal Office of Management and Budget (OMB) standards. METHOD Data were from the Massachusetts Standard Certificate of Live Births on 1,156,472 babies from 1996 to 2010. A parent reported whether the mother smoked during pregnancy (yes/no), her race (5 options) and, separately, her ethnicity (39 categories). Prenatal smoking rates were compared between the ACA and OMB standards. Detailed ethnicity from the birth certificate was then examined within all broad categories of the ACA standards: White, Black/African American, Other Hispanic, Other Asian/Pacific Islander, and Other categories. RESULTS For Hispanic/Latina and Asian mothers, the ACA standards captured the variability in smoking across and within racial/ethnic groups more than the OMB standards. However, for White and Black/African American mothers, the broad ACA categories masked striking differences in prenatal smoking. While the overall prevalence among Whites was 10.2%, this ranged from 0.8% for Iranians to 21.0% for Cape Verdeans. Among Black/African Americans (7.6%), this ranged from 0.5% for Nigerians to 12.9% for African Americans. The ACA standards also combined ethnic groups with sizeable populations into Other Hispanics and Other Asian/Pacific Islanders. CONCLUSION When population health surveys and other reporting tools are being revised, state and federal agencies should consider expanding all race/ethnicity categories to capture detailed ethnicity on everyone.