II: / & ( ) , APPENDIX III: MCH

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TABLE OF CONTENTS EXECUTIVE SUMMARY ...6 QUANTITATIVE DATA...13 Population Data ...13 Poverty ...17 Uninsured/Underinsured ...18

Pregnant Women / Pregnancy Outcomes...23

Births...23

Teen Births ...24

No Prenatal Care ...28

Low/Very Low Birthweight ...29

Maternal Tobacco Use...30

Drug/Alcohol Use ...37

Magee-Women’s Hospital Drug & Alcohol Study (1997-2002)...37

Infants and Children ...40

Infant Mortality ...40

Healthy Start ...43

SIDS ...46

Intentional and Unintentional Injury: Infants and Children ...47

Immunizations...48

Adolescents ...49

Intentional and Unintentional Injury: Adolescents...49

Dropouts ...50

Children with Special Health Care Needs ...51

Early Intervention ...51

Childhood Obesity ...56

ACHD Program Data ...58

Women, Infants and Children (WIC)...58

Breastfeeding...59

Childhood Lead Poisoning Prevention ...61

Dental ...62

Resource Mothers Program...63

Sexually Transmitted Disease ...66

QUALITATIVE PRESENTATION OF DATA ...70

2001 Allegheny County Health Department Strategic Planning Session ...71

Maternal and Child Health Planning Session ...76

Needs Assessment Survey of Pediatricians...83

RESOURCE/SERVICE ASSESSMENT...93

NEEDS ANALYSIS...128

APPENDIX I: Participants involved in the 2001 Strategic Planning Process...131

APPENDIX II: Participants Involved in the Maternal and Child Health Planning Session February 10, 2004...135

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Table 1: Allegheny County Population ...13

Table 2: City of Pittsburgh Population ...13

Table 3: Allegheny County/Pittsburgh Gender ...14

Table 4: Allegheny County Age Distribution (in years) ...14

Table 5: City of Pittsburgh Age Distribution (in years) ...14

Table 6: Population by Age - Female ...15

Table 7: Population by Age - Male...15

Table 8: Change in Residents Aged 17 and Younger...16

Table 9: Race/Ethnicity for County and City - 2000 ...16

Table 10: Hispanic Breakdown ...16

Table 11: Allegheny County Poverty Levels by Age - 2000...17

Table 12: Children Enrolled in Medicaid or CHIP...17

Table 13: Children Receiving TANF/AFDC...17

Table 14: Health Professional Shortage Areas ...21

Table 15: Numbers of Births by Race: 1998-2002 ...23

Table 16: Selected Birth Statistics by Race 2002 ...23

Table 17: Pregnancy Outcome by Age 2002 ...24

Table 18: Number of Births and % (1998-2002)...24

Table 19: Select Birth Statistics by Age, 1998-2002...25

Table 20: Allegheny County Teen Births by Race and Age (1998 - 2002) ...25

Table 21: Pittsburgh Teen Births by Race and Age (1998 - 2002) ...25

Table 22: No Prenatal Care in First Trimester - 1998-2002 ...28

Table 23: No Prenatal Care in First Trimester by Race 1998-2002-County ...28

Table 24: No Prenatal Care in First Trimester by Race 1998-2002-City ...28

Table 25: Low Birthweight Infants: 1998-2002 ...29

Table 26: Very Low Birthweight Infants: 1998-2002 ...29

Table 27: Maternal Tobacco Use for Resident Live Births-1998-2002-County ...30

Table 28: Maternal Tobacco Use for Resident Live Births-2002-County ...30

Table 29: Maternal Tobacco Use for Resident Live Births-1998-2002-City ...31

Table 30: Maternal Tobacco Use for Resident Live Births-2002-City ...31

Table 31: Birthweights Among Smokers & Nonsmokers-1998-2002-City ...32

Table 32: Birthweights Among Smokers & Nonsmokers-2002-City...33

Table 33: Birthweights Among Smokers & Nonsmokers-1998-2002-County ...34

Table 34: Birthweights Among Smokers & Nonsmokers-2002-County...35

Table 35: Most Prevalent Substances Abused in Allegheny County ...37

Table 36: Alcohol Consumption - Race ...38

Table 37: Alcohol Consumption – Race & Age...38

Table 38: Cocaine Use - Race ...38

Table 39: Cocaine Use – Race & Age ...38

Table 40: Marijuana Use - Race ...39

Table 41: Marijuana Use – Race & Age...39

Table 42: Narcotic Addiction - Race ...39

Table 43: Narcotic Addiction – Race & Age...39

Table 44: 2002 Infant Mortality Allegheny County/Pittsburgh ...40

Table 45: Infant Mortality by Area 1998-2002 Allegheny County/Pittsburgh ...40

Table 46: Infant Mortality by Race Allegheny County ...41

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Table 50: Mortality due to Specific Injuries: Allegheny County - Ages 5 - 9 Years ...47

Table 54: Public Secondary School Dropouts ...50

Table 55: Alliance Diagnoses ...52

Table 56: Alliance Referrals...52

Table 57: Pittsburgh Public Schools EI Program 2003-2004 School Year ...52

Table 58: Allegheny County 2003 Inpatient Discharges 0-4yr ...54

Table 59: Allegheny County 2003 Inpatient Discharges Ages 5-9yr...54

Table 62: Allegheny County 2003 Inpatient Discharges Ages 0-19 White ...55

Table 63: Allegheny County 2003 Inpatient Discharges Ages 0-19yr Black ...55

Table 64: Allegheny County 2003 Inpatient Discharges Ages 0-19yr Other Race...56

Table 65: Allegheny County Health Department WIC Program 2004...58

Table 66: WIC Breastfeeding Data – Initiation 1992-2005...59

Table 67: USA Breastfeeding Data – Duration 1990-2003...59

Table 68: PA/ACHD WIC Breastfeeding Data - Average Duration ...60

Table 69: PA/ACHD WIC Breastfeeding Data - Long Term Duration ...60

Table 70: Allegheny County Managed Care Organizations...102

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Figure 1: Geographic Access to Health Care ...20

Figure 2: Medicaid HMO Obstetric Providers & Patients...21

Figure 3: Teen Birth Rate Allegheny County 1998 - 2002 ...26

Figure 4: Teen Birth Rate Pittsburgh 1998 - 2002 ...27

Figure 5: Infant Mortality Rates 1990 - 2002...42

Figure 6: Infant Mortality Rates - Healthy Start...43

Figure 7: Low Birthweight - Healthy Start...44

Figure 8: SIDS Deaths 1990 - 2003...46

Figure 9: RMP/Allegheny County Infant Mortality ...63

Figure 10: RMP/Allegheny County Infant Mortality Change...63

Figure 11: RMP/Allegheny County Low Birthweight ...64

Figure 12: RMP/Allegheny County Low Birthweight Change ...64

Figure 13: RMP/Allegheny County 1st Trimester Care ...65

Figure 14: RMP/Allegheny County 1st Trimester Care Change...65

Figure 15: Allegheny County STD Reported Morbidity...66

Figure 16: Allegheny County HIV Test Results...68

Figure 17: Allegheny County HIV Cases by Age Group & Sex ...69

Figure 18: Allegheny County Reported HIV Cases by Race, by Sex ...69

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EXECUTIVE SUMMARY

This assessment of the health status and needs of the maternal and child population of Allegheny County was completed, in part, to fulfill the contractual requirements with the Pennsylvania Department of Health. Such an assessment is a component of the Maternal and Child Health Services Block Grant (Title V). It was completed utilizing “Needs Assessment and Planning Guidelines for County and Municipal Health Departments” (February 2004) distributed by the Pennsylvania Department of Health, Bureau of Family Health. It represents an update and enhancement of an assessment report submitted in 2001.

Additionally, this needs assessment was completed to provide a foundation upon which Allegheny County Health Department and other institutions and agencies can plan and

implement interventions to reduce risks and improve the health status of child-bearing families in our area. It is hoped that many will find the assessment information useful as we work together toward the Healthy People 2010 goals. Achieving these goals for healthy children and families will require the participation and commitment of every segment of society. Health care

providers, education, voluntary agencies, business, the faith community, civic groups,

foundations and government all have critical roles in promoting and maintaining the health status of our community.

The quantitative data in this report are comprised of population and health indicators frequently used in conducting MCH needs assessments. Qualitative data are derived from two strategic planning sessions attended by participants from various Allegheny County agencies focusing on the needs of the maternal, infant, child and adolescent populations. A survey of pediatricians was conducted to gather information regarding children with special health care needs. Through analysis of the quantitative and qualitative data, specific needs were prioritized utilizing the APEX strategy. The ranked needs were then reviewed in relation to the 2010 Healthy People Objectives.

The top six prioritized health needs of the maternal and child population identified are: reduce infant mortality, reduce very low birth weight infants, reduce low birth weight infants, reduce prenatal exposure to smoking, increase breastfeeding rates and address children with special health care needs medical care coordination with emphasis on a “medical home.”

The Title V work plan is designed to address the prioritized health needs. The work plan is structured under three components: Primary and Preventive Maternal and Infant Services, Primary and Preventive Child Health Services and Services for Children with Special Health Care Needs.

Demographic Data

The analysis of data included in this report is based on the 2000 census. The population of both Allegheny County and the City of Pittsburgh has been declining since 1970. The

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ethnic diversity within the City of Pittsburgh than the County of Allegheny as a whole. The population of Allegheny County has a median family income of $49,815 and the median income in the City of Pittsburgh is $38,795.

In Allegheny County, 11.2% of individuals are below the poverty level and in the City of Pittsburgh, 20.4% of individuals live in poverty. In Allegheny County, greatest proportion of people living in poverty is the 18-24 year olds and children under 5 years of age. In Allegheny County in 2003, one in four children received Medicaid. The number of children enrolled in Children’s Health Insurance Program (CHIP) has increased by 10% in the past 4 years. In Allegheny County, it is estimated that a little over 6% of children do not have health insurance compared to 8.3% of Pennsylvania ‘s three million children.

Welfare reform has reduced the Temporary Assistance to Needy Families (TANF). This is the cash assistance program that replaced Aid to Families with Dependent Children (AFDC). The lowest rate of children receiving TANF occurred in 2003. One in 15 children received TANF in Allegheny County vs. one in 18 children in the State of Pennsylvania.

Geographic Access to Health Care

Allegheny County had nine areas federally designated as Health Professional Shortage Areas (HPSA) in 2000 and in 2002 twelve areas were identified. The HPSA are defined by four criteria: the proportion of the population below the poverty level, the ratio of full time primary care physicians to population, the infant mortality rate and the fertility rate of the population. Seven of the twelve HPSA are in the City of Pittsburgh. Four out of nine delivery hospitals are in the City of Pittsburgh. The three Medicaid managed care organizations in Allegheny County have adequate obstetric providers. Many of the providers’ offices are within the City of

Pittsburgh.

Pregnant Women and Infants

The number of births to Allegheny County women has been declining. Births to

teenagers have also been declining, so the proportion of birth to teens has shown little change. In 2002, the group that had the most births were women 30 and over. Teenagers were less likely than women 20 years and older to initiate prenatal care during the first trimester of pregnancy and they were more likely to deliver low birth weight infants. Women who live in Pittsburgh were also less likely than Allegheny County women to receive early prenatal care and were more likely to have a low birth weight infant. African American teenagers delivered more infants than teenagers of other racial groups. Other comparison by race revealed that low birth weight rates, very low birth weight rates, late entry into prenatal care and infant mortality rates were higher for African Americans.

In 2002, the white infant mortality rate for Allegheny County was 4.6 infants per

thousand and the black infant mortality rate was 21.1 infants per thousand. The Pittsburgh white infant mortality rate was 6.8 and black infant mortality rate was 21.5. The Allegheny County white rate met the Healthy People 2010 objective but efforts need to continue for the African American population in both the City and Allegheny County. Intensive, sustained efforts will be required on many fronts to reduce poverty and eliminate racial disparities indicators such as infant mortality and low birth weight rates.

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The incidence and duration of breastfeeding among Allegheny County WIC participants have increased since 1992 when only 13% of women breastfed their infants. In January 2005, 31.8% of WIC postpartum women initiated breastfeeding. Duration expressed in weeks has increased from 9.8 weeks in 1992 to 15 weeks in 2004. The Healthy People 2010 breastfeeding goal is to have 75% of women breastfeeding at hospital discharge, 50% breastfeeding at six months postpartum and 25% of women continuing to breastfeed until their infants are one year of age.

Cigarette smoking during pregnancy contributes to low birth weight infants. In Allegheny County in 2002, with the exception of the under 19 year old group, a higher percentage of African American mothers reported smoking than white mothers. However, in 2002, smoking rates had begun to decrease from the 1995-1999 rate of 25.5% of total births in Pittsburgh. The 2002 rate of maternal smoking in Pittsburgh is 21.4%. Maternal smoking is more prevalent in the City of Pittsburgh than Allegheny County.

In Allegheny County, alcohol abuse is the most prevalent substance requiring services by the Department of Human Services Drug and Alcohol programs. Abuse tends to increase with age. Heroin ranks second in need for treatment. Data was not available by race or pregnancy status. From a study of 45,649 women conducted at the largest birthing hospital in Allegheny County, Magee-Womens Hospital, between 1997-2002, less than .5% of mothers reported alcohol use, 1.6% reported marijuana use and .4% reported using a narcotic. Pregnant women used marijuana more than other drugs.

Infants, Children and Adolescents Immunizations

Immunization levels among school age children are high but efforts must be maintained especially among those two years of age and younger.

SIDS

Sudden Infant Death Syndrome (SIDS) is the major cause of infant death after the first month of age and has no known cause. Despite decreases in the incidence of SIDS from the early 1990’s since the “Back to Sleep” campaign was initiated, SIDS remains the leading cause of infant death beyond the neonatal period. Education on the risks factors such as smoking and bed sharing should continue. In Allegheny County, there were ten deaths attributed to SIDS in 2002 and six deaths attributed to SIDS in 2003.

Deaths Due to Intentional and Unintentional Injury

Infants, children and adolescents are at risk from deaths due to intentional and

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drowning, fire and smoke and homicides. The overall death rate among blacks 10-14 year olds (18.5) is 7.7 times greater than for whites (2.4). In the same time period, more white adolescents between 15-19 years died due to motor vehicle crashes and suicide than black adolescents. More black adolescents 15-19 and 20- 24 die of homicide.

Secondary School Dropout Rates

The public secondary school dropout rate for grades 9-12 remains fairly stable in

Allegheny County and is below the State rate. In 2002-2003,the Allegheny County rate was 1.8 per 100 students enrolled: the State rate was 2.1. Pennsylvania dropout rates have consistently declined from 1996-97 to 2002-2003.

Children with Special Health Care Needs

According to the 2000 census, Allegheny County has 314,875 children birth through 19 years. Utilizing the new Federal definition of Children with Special Health Care Needs, researchers estimate between 13% and 18% of children birth through 19 years have a special health care need. Estimates of special needs children in Allegheny County may range from 40,000-56,000 children birth through nineteen. Children from birth to age five receive services from the Early Intervention Programs, primary care physicians and specialty physicians. School age children and teens with special needs have their academic needs in combination with special needs addressed by the local intermediate units. Health needs continue to be met by the primary care physician and specialty physicians. The care coordination system for the school age child is not as well defined as that for pre school children.

In 2003, hospital discharge data for children demonstrated the major reasons younger children 0-14 years were hospitalized. They were hospitalized for disease/conditions of the respiratory system and mental health diseases/disorders. Children 15-19 years of age were hospitalized/discharged with diagnostic categories of pregnancy/child birth, mental health diseases and diseases/disorders of the digestive system.

Childhood obesity has become a serious public health problem. In Allegheny County Health Department WIC Program, 18 percent of children in 2004 qualified for WIC because they were either obese or at risk for becoming obese. School age children are being identified for obesity by the administration of the BMI (Body Mass Index) measurements. Parents, schools and health practitioners need to address the children’s nutritional requirements as well as the need for physical exercise.

Allegheny County Health Department Programs for Women and Children

In 2004, at 10 WIC offices, 16,118 pregnant, postpartum and breastfeeding women and children up to 5 years of age received service. Eight per cent (8%)were pregnant women. Three (3%) breastfeeding women and twelve (12%) postpartum women were active participants. Infants and children were the largest group of participants, 30% and 40% respectively.

The Allegheny County Childhood Lead Poisoning Prevention Program provided door to door screening, medical case management and environmental investigation for lead poisoning identification in designated high risk neighborhoods. In 2004, there were 49 confirmed cases of

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The Allegheny County Health Department’s Dental Program provided

preventative/corrective clinical dental services for children and adolescents 2 ½ to 21 years of age from low income families. The Dental Program strived to reduce the prevalence of dental caries in children by placing sealant on the molars of second grade children, by providing dental examination for these children and by making a dental education programs available for all elementary school children in targeted schools.

In the Allegheny County Sexually Transmitted Disease Clinic, chlamydia and gonorrhea were the two most commonly identified sexually transmitted diseases. In 2003, female

adolescents aged 15-19 years of age represented 41.8% of the total female chlamydia infections in Allegheny County. Also, during 2003, there were no congenital syphilis cases identified in Allegheny County. The highest number of AIDS cases in both sexes is the 30-39 year age range. For 2003, 8519 people were HIV tested with 35 positives tests; 27 males and 8 women. The largest group requesting testing for males and females were those 20-29 years of age.

Prioritized Needs Addressed in the MCH Title V Workplan

The top ranked health needs of the maternal and child health populations of Allegheny County as determined by the needs analysis are: reduce the infant mortality rate, reduce very low and low birth weight rates, reduce prenatal substance exposure to smoking, increase

breastfeeding rates and address children with special health care needs medical care coordination with the emphasis on a “medical home”.

The MCH Title V work plan is divided into three sections: Primary and Preventive Maternal and Infant Services, Primary and Preventive Child Health Services and Services for Children with Special Health Care Needs. The manner in which the prioritized needs are integrated into the work plan is as follows:

Primary and Preventive Maternal and Infant Services

All organizations, institutions, foundations, agencies and consumers of health care desire healthy outcomes for pregnant women and infants born in Allegheny County. The Allegheny County Health Department’s Maternal and Child Health Program services are designed to embrace and work with these groups in our efforts to improve birth outcomes. It takes a community to raise a child.

With our SIDS program, education shall be given to individual families, providers of childcare, medical personnel and other groups on methods to prevent further SIDS deaths. Through utilization of the Perinatal Periods of Risk (PPOR) methodology, we plan to identify Allegheny County’s specific issues dealing with fetal and infant mortality and develop strategies to reduce fetal and infant deaths. The PPOR team also looks at maternal factors that lead to prevention of very low and low birth weight infants.

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outside the Healthy Start target areas. Public health nurses provide prenatal and postpartum home visiting services to families. All services to pregnant, postpartum women and their infants provide assessment, education and referral to community agencies. Education is given on importance of regular and early prenatal care, nutritional needs during pregnancy, smoking cessation, danger signs of pre term labor, anticipatory guidance for infant care, safe sleeping, infant nutrition, child development, immunizations and the need for consistent well child care.

Prenatal smoking is a MCH prioritized need. Unfortunately, the City of Pittsburgh has a very high rate of maternal smoking. The Smoke Free Mothers/Smoke Free Families Coalition has been formed under the leadership of the Allegheny County Health Department. Members include the University of Pittsburgh, community and voluntary agencies, insurance providers, hospitals and clinics. Consensus has been reached on an action plan that includes enforcing policies and regulation, engaging people at the neighborhood level, collecting data to measure progress and reporting outcomes publicly, getting health care providers involved and giving everyone an opportunity to contribute in reducing maternal smoking. All MCH Title V staff has been trained in smoking cessation techniques and are knowledgeable of referral sources for smoking cessation counseling available to Allegheny County MCH families.

WIC breastfeeding rates have been improving but efforts need to continue to improve the proportion of mothers who initiate and maintain breastfeeding for the first year of their infants’ lives. The MCH Title V Breastfeeding Promotion Program maintains a Breastfeeding Telephone Helpline with hours from 8:00 am to 10:00 pm daily (including holidays). International Board Certified Lactation Consultants service the line and provide home visits to breastfeeding women to help mothers establish and continue breastfeeding. Prenatal home visits are made as well to promote breastfeeding as the norm in Allegheny County.

Reducing infant deaths and illness through post partum care teaching/interventions is the goal of Project LAMB (Love And Mother your Baby) Program. This program provides home visits that targets women who had little or no prenatal care during their pregnancy.

Primary and Preventive Child Health Services

The goal of this section of the work plan is to promote optimal health of children age one through 18 years. Through the Pediatric Nurse Home Visiting Program, children seen are administered a developmental screening and parents receive education in home safety, child health, discipline, nutrition and child development. Specific medical concerns are addressed based on the child’s needs and medical conditions. The nurses discuss the importance of regular well child care, immunizations and the need for a medical home. Similar home visiting efforts occur in the Resource Mothers Program.

Program development in the child health area is a goal in this grant period. The Title V MCH Program plans to develop and implement a follow-up program to ensure all school age children are completely immunized and assist the schools in following up on children that are not. A second priority is to implement a pre-conceptional counseling/teaching program for preteens, teen and young adults.

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Services for Children with Special Health Care Needs (CSHCN)

The goal in this section of the Title V work plan is to improve the developmental outcomes for CSHCN. Home visiting nurses provide health screening and education to parents of children in the Alliance For Infants and Toddlers Program. These children (birth to 3) are entered into Allegheny County’s early intervention program due to specific developmental at risk categories. The MCH/ACHD role is to provide ongoing medical/health assessment and

developmental tracking.

A Care Coordination Pilot Program will be developed to increase the proportion of children with special health care needs who have a “medical home”. Centralized coordination of care for all children with special needs is paramount to each child’s progress. The public health nurses will work with families, their doctors, insurance companies, schools and community agencies to access and arrange for services. An assessment of the child’s needs will hopefully lead to a design of a care coordinated system for children with special health care needs and the designation of a medical home.

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QUANTITATIVE DATA Population Data

Allegheny County is located in southwestern Pennsylvania and covers an area of 730.9 square miles. More than 95% of the population is classified as urban. Less than 5% of the

population is classified as rural. The 2000 U.S. Decennial Census reports 1,281,666 people living in Allegheny County.

The largest minor civil division in Allegheny County is the City of Pittsburgh. The City is 55.38 square miles with a 2000 population of 334,563 residents. Although the City of Pittsburgh accounts for only 7.6% of Allegheny County’s area, it contains 26.1% of the county’s

population. The socio-economic and racial composition of the City of Pittsburgh differs from Allegheny County. Since various health outcomes, such as infant mortality, low birth weight, and certain injuries have been associated with race and socioeconomic status, it is important to designate and report population and health indicators for the City of Pittsburgh as well as Allegheny County.

As a whole, the City residents are not as affluent as the County. The population of Allegheny county has a median family income of $49,815, and the median income for City residents is $38,795. In the County, 11.2% of individuals are below poverty level, and in the City, 20.4% of individuals live in poverty. There are significantly more City people living in poverty. Pittsburgh residents are 90% more likely to be in poverty than County residents as a whole.

The populations of both Allegheny County and Pittsburgh have changed during the past four decades. The following tables present city and county population changes based on the U.S. Census Bureau’s last four decennial censuses. Since 1970 there has been substantial loss of population for both the city and the county. However, the rate of loss appears to be slowing, as reflected in the percent change between 1990 and 2000.

Table 1: Allegheny County Population

1970 1980 1990 2000 Change from ’80-‘90 Change from ’90-‘00 % Change from ’80-‘90 % Change from ’90-‘00 Total 1,605,016 1,450,085 1,336,449 1,281,666 -113,731 -54,783 -7.8 -4.1 Male 762,488 685,320 626,732 607,002 -58,588 -19,730 -8.5 -3.1 Female 842,528 764,765 709,717 674,664 -55,048 -35,053 -7.2 -4.9

Table 2: City of Pittsburgh Population

1970 1980 1990 2000 Change from ’80-‘90 Change from ’90-‘00 % Change from ’80-‘90 % Change from ’90-‘00 Total 520,117 423,938 369,879 334,563 -54,059 -35,316 -12.8 -9.5 Male 242,343 196,451 171,722 159,119 -24,729 -12,603 -12.6 -7.3 Female 277,774 227,487 198,157 175,444 -29,330 -22,713 -12.9 -11.5

The population of both Allegheny County and the City of Pittsburgh has been declining since 1970. The population has declined by about 20% from 1970 to 2000. The decline is

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Table 3: Allegheny County/Pittsburgh Gender

Allegheny County Pittsburgh % Reside in Pittsburgh

1990 2000 1990 2000 1990 2000

Females 709,717 674,664 198,157 175,444 27.9% 26.0%

Males 626,732 607,002 171,722 159,119 27.4% 26.2%

Total 1,336,449 1,281,666 369,879 334,563 27.7% 26.1%

Men make up a smaller proportion of both Allegheny County (47.4%) and the City of Pittsburgh (47.6%) than women (52.6%, 52.4%).

The population of Allegheny County is aging. There was a 36.5% increase in the number of people over the age of 85 between 1990 and 2000. The median age of the population has been slowly but steadily increasing since 1970. It is currently 4.3 years higher than the median age of the population of the United States (35.3), but only slightly higher (1.6 years) than the median age of PA residents (38.0).

Table 4: Allegheny County Age Distribution (in years)

Table 5: City of Pittsburgh Age Distribution (in years)

1970 1980 1990 2000 Change from ’80-‘90 Change from ’90-2000 % of Change from ’80-‘90 % of Change from ’90-2000 Under 5 34,726 22,383 22,788 17,607 405 -5,181 1.8 -22.7 5 - 17 113,200 68,445 50,591 48,901 -17,854 -1,690 -26.1 -3.3 18 - 20 31,672 28,966 23,941 23,294 -5,025 -647 -17.3 -2.7 21 - 24 35,032 38,067 27,751 26,167 -10,316 -1,584 -27.1 -5.7 25 - 44 106,223 102,801 111,340 95,730 8,539 -15,610 8.3 -14.0 45 - 54 1970 1980 1990 2000 Change from ’80-‘90 Change from ’90-2000 % of Change from ’80-‘90 % of Change from ’90-2000 Under 5 116,350 79,245 84,113 71,081 4,868 -13,032 6.1 -15.5 5 - 17 394,264 266,909 198,070 210,095 -68,839 12,025 -25.8 6.1 18 - 20 76,464 77,570 56,138 50,319 -21,432 -5,819 -27.6 -10.4 21 - 24 88,972 105,597 73,732 59,172 -31,865 -14,560 -30.2 -19.7 25 - 44 358,857 372,068 416,724 363,251 44,656 -53,473 12.0 -12.8 45 - 54 218,623 165,882 133,938 181,542 -31,944 47,604 -19.3 35.5 55 - 59 96,132 97,421 64,860 63,512 -32,561 -1,348 -33.4 -2.1 60 - 64 79,393 85,802 76,963 54,278 -8,839 -22,685 -10.3 -29.5 65 - 74 109,143 125,260 137,054 112,549 11,794 -24,505 9.4 -17.9 75 - 84 54,382 58,690 74,238 87,724 15,548 13,486 26.5 18.2 85 plus 12,436 15,641 20,619 28,143 4,978 7,524 31.8 36.5 Median Age _{32.1 35.7 36.7 39.6}_{+1.0 +2.9 2.8 7.9}

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The City of Pittsburgh is younger than the surrounding region (Allegheny County). The median age of the city population is increasing, but has not reached that of the county. The median age of Pittsburgh residents (35.5 years) is very similar to that of the United States as a whole, and is younger than the state of PA (38.0).

Table 6: Population by Age - Female

Age Categories for Females Allegheny County City of Pittsburgh

1990 2000 1990 2000 0 - 4 41,156 34,721 11,176 8,644 5 - 9 39,193 38,610 10,154 9,355 10 - 14 36,073 40,548 9,328 9,340 15 - 19 40,160 39,916 13,470 12,951 20 - 24 47,352 37,861 18,380 17,105 25 - 29 53,801 38,593 15,869 12,396 30 - 34 59,283 43,097 15,641 11,316 35 - 39 54,269 49,714 13,833 11,601 40 - 44 47,016 54,439 11,080 12,120 45 - 49 37,846 50,560 8,942 11,584 50-54 33,840 43,412 8,319 9,800 55-59 35,043 34,191 8,777 7,847 60-64 41,969 29,781 11,181 7,117 65-69 42,550 29,787 11,723 7,026 70-74 36,838 34,199 10,587 8,308 75-79 29,321 31,427 8,954 7,828 80-84 18,841 23,373 5,910 5,822 85+ 15,166 20,435 4,833 5,284 Total Females 709,717 674,664 198,157 175,444

Table 7: Population by Age - Male

Age Categories for Males Allegheny County City of Pittsburgh

1990 2000 1990 2000 0 - 4 42,957 36,360 11,612 8,963 5 - 9 40,897 40,775 10,591 9,649 10 - 14 37,611 42,140 9,364 9,567 15 - 19 41,260 41,805 13,184 12,930 20 - 24 45,394 37,931 17,812 17,465 25 - 29 50,757 38,125 15,723 13,383 30 - 34 56,284 41,462 15,369 11,765 35 - 39 51,841 46,567 13,318 11,540 40 - 44 43,473 51,254 10,507 11,609 45 - 49 33,320 47,724 7,488 10,781 50-54 28,932 39,846 6,690 8,917 55-59 29,817 29,321 7,129 6,295 60-64 34,994 24,497 8,606 5,489 65-69 32,692 23,464 8,513 5,423 70-74 24,974 25,099 6,603 5,726 75-79 17,157 20,426 4,782 4,760 80-84 8,919 12,498 2,640 2,952 85+ 5,453 7,708 1,791 1,905

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The number of people in most age groups in both the Allegheny County and Pittsburgh populations are declining. During the 1990 census, there were 80,090 children aged 5-9. In 2000, this cohort, now aged 15-19, totaled 81,721. This small proportion of the population has shown a small increase. The population in their late 20’s to early 30’s seems to be declining, though. This may indicate that as the population enters the workforce, they are moving elsewhere to find employment.

Table 8: Change in Residents Aged 17 and Younger

The number of children aged 17 years and younger have steadily declined over the past two decades in both the county and the city. The effect of this decrease in population among those 17 years and younger coupled with an increase in our elderly population can be seen when comparing the median age of the population between 1970 and 2000. In 1970 the median age of Allegheny County was 32.1 years. For 2000 the median age of county residents is nearly 40 years (39.6). The overall population of children in Allegheny County and the City of Pittsburgh has declined since 1980. The bigger change occurred between 1980-1990, but has declined slightly since 1990, as well. The City experienced a greater loss of children than the County as a whole.

Table 9: Race/Ethnicity for County and City - 2000

There is more ethnic diversity within the City of Pittsburgh than the County of Allegheny as a whole.

Table 10: Hispanic Breakdown

Change from 1980 - 1990 Percent change from 1980 - 1990 Change from 1990 - 2000 Percent change from 1990 - 2000 Allegheny County -63,971 -18.5 -1,007 -0.4 City of Pittsburgh -17,449 -19.2 -6,871 -9.4 White African- American American Indian and Alaskan Native Asian Native Hawaiian and Other Pacific Islander Some other race Two or more races Allegheny County 1,080,800 159,058 1,593 21,716 335 4,399 13,765 Percent 84.3% 12.4% 0.1% 1.7% 0.03% 0.3% 1.1% Pittsburgh 226,258 90,750 628 9,195 111 2,218 5,403 Percent 67.6% 27.1% 0.2% 2.7% 0.03% 0.7% 1.6 % Living in Pittsburgh 20.9% 57.1% 39.4% 42.3% 33.1% 50.4% 39.3% Hispanic Mexican Puerto Rican Cuban Central American

All other Hispanic or Latino

Allegheny

(17)

Poverty

Table 11: Allegheny County Poverty Levels by Age - 2000

under 5 5-11 12-17 18-24 25-44 45-64 65 plus total under 100% 17.4% 16.4% 12.2% 23.9% 9.2% 7.4% 9.0% 11.2% 100-129% 5.4% 5.2% 4.5% 6.2% 3.4% 2.7% 6.2% 4.3% 130-184% 10.7% 10.8% 9.8% 9.9% 8.0% 5.7% 13.3% 9.0% 185-199% 2.4% 2.9% 2.6% 2.4% 2.2% 1.6% 3.7% 2.4% 200% plus 64.1% 64.7% 70.8% 57.6% 77.4% 82.6% 67.9% 73.1%

In Allegheny County, the age group with the greatest proportion of people living in poverty is the 18-24 year olds; 23.9% of all within this age group live in poverty. The next most impoverished group is those under 5 years of age; 17.4% of them live in poverty. The group whose fewest members live in poverty is those aged 45-64. In all age groups, most people have an income that exceeds 200% of the poverty limit.

Table 12: Children Enrolled in Medicaid or CHIP

Medicaid CHIP

County State County State

Dec.2000 67,087 708,501 9,846 104,326 Dec.2001 68,663 739,441 10,967 118,047 Dec.2002 70,531 767,578 11,761 125,424 Dec.2003 73,918 808,300 12,853 137,429 4yr change +6,831 +99,799 +3,007 +33,103 2003 one in 1 in 4 1 in 4 1 in 23 1 in 22

The number of children enrolled in the Childrens Health Insurance Program (CHIP) has increased by about 10% in the past 4 years. Similar enrollment increases were seen in the state and its urban areas.

Table 13: Children Receiving TANF/AFDC

per 100 children under 18

County State 1993 rate 15 13.7 2003 total 17,991 161,231 2003 rate 6.5 5.6 rate change -8.4 -8 2003 one in 1 in 15 1 in 18

TANF Numbers Reduced

Welfare reform has indeed reduced child participation in Temporary Assistance to Needy Families (TANF), the cash assistance program that replaced Assistance to Families with

Dependent Children(AFDC). Examination of the rates in Allegheny County show the highest rate of participation occurred in 1993. The lowest rate occurred in 2003. There was a sharp decline beginning in fiscal year 1995-96, when welfare reform was implemented, and it is characterized by an average annual reduction of 1.6 marks this reduction. Thus, welfare reform appears to be reducing the TANF rolls.

Poverty data are from “The State of the Child in Pennsylvania – 2004”, Pennsylvania Partnerships for Children.

(18)

Uninsured/Underinsured

In Pennsylvania there are three major insurance programs for those who do not have health insurance. Children’s Health Insurance Program provides basic health insurance coverage for eligible children based on income. Adult Basic Program provides basic health insurance coverage for $30 per month to adults with income below 200% of the poverty level is a vital source of health insurance for the working poor, low middle income, and the unemployed. Medical Assistance provides health coverage for the very poor.

According to Pennsylvania Partnerships for Children, it is estimated in Pennsylvania that about half of uninsured children, or almost 126,000 are eligible for medical assistance benefits but are not enrolled. More than one-fourth, or 73,000 children, are estimated to be eligible for the Children’s Health Insurance Program but are not enrolled. The remaining 59,000 children are estimated to be ineligible for coverage under any government program. More children than ever before are eligible for CHIP. Increases in income guidelines, plus additional considerations for families’ work and child care expenses, bring more children into the program. In Allegheny County, it is estimated that a little over 6% of children do not have health insurance compared to 8.3% of Pennsylvania’s three million children.

Regarding adults without health insurance coverage, it is estimated that 1.38 million Pennsylvanians are health uninsured. According to Consumer Health Coalition, for many, Adult Basic is the only health insurance option. As a result, Adult Basic is an extremely popular program even though it provides bare bones coverage (physician and hospital coverage.) 54% of enrollees have earned income (47% under $10,000 income; 39%, $10,000–20,000, 14% over 20,000); 62% are female. Almost half enrolled because they lost employment, or the job stopped coverage or raised the cost of health insurance. According to Pennsylvania Health Law Project 39,121 are enrolled in the Adult Basic Insurance program, 100,000 are on the waiting list.

The Allegheny County Health Department has reported data on health care coverage and utilization from a survey, which assessed behavioral health risks in adults of nearly 5,000 households countywide. The Behavioral Risk voluntary survey, the first of its kind in any local health department, was conducted in 2002 and gathered information in telephone calls to randomly selected households. Participants were questioned about health issues and personal behaviors known to have a strong effect on health. Sponsored by the Health Department and other local, state and national agencies, the survey was carried out by the University of Pittsburgh Graduate School of Public Health.

According to this survey, ten percent of adults reported they had no health insurance coverage; lower than the statewide (13%) and nationwide (14%) percentages, based on 2002 state and national surveys. The countywide uninsured percentage was significantly higher for African-Americans (16%) than whites (10%) and for males (13%) than females (8%).

(19)

Twenty-one percent of the uninsured had no coverage in the last six months; 34% in the past year; 13% in the past two years; and 32% in the past two to five years or longer.

Seven percent of adults said they needed to see a doctor in the past year but could not because of the cost. The percentage was significantly higher for African-Americans (11%) than whites (7%), but varied little between males (8%) and females (7%). It was drastically higher for the uninsured (37%) versus the insured (5%).

The percentage who could not afford a doctor decreased with age; 18-29, 13%; 30-44, 8%; 45-64, 7%; 65+, 2%; differed significantly with education: less than high school, 6%; high school, 9%; some college, 8%; college degree, 4%; and decreased with income: less than

$25,000, 14%; $15,000-24,999, 14%; $25,000-49,999, 5%; $50,000-74,999, 5%; $75,000+, 3%. The insured were significantly more likely than the uninsured to have an annual checkup, 83% versus 43%; have their blood cholesterol checked, 77% versus 45%; have a mammogram in the past year, 75% versus 49%; have a breast exam in the past year, 83% versus 71%; have a digital rectal exam for prostate cancer in the past year, 65% versus 34%; and have a sigmoidoscopy or colonoscopy for colorectal cancer in the past two years, 66% versus 48%.

The uninsured were significantly more likely than the insured to suffer from severe mental illness, 19% versus 8%, based on responses indicating difficulties dealing with life situations.

(20)

Figure 1: Geographic Access to Health Care

(21)

Table 14: Health Professional Shortage Areas

HPSA Score HPSA Score

Arlington Heights/St. Clair 19 Low Income Clairton 13 Hill District 17 McKees Rocks - Stowe 11 Manchester 17 South Pittsburgh-Homeless 10 West End 16 McKeesport 7 Homewood Brushton 15 North Braddock 7 Hazelwood 14 South Braddock 7

Health professional shortage areas are defined by three criteria: the proportion of the population below poverty level, the ratio of full-time primary care physicians to population, the infant mortality rate, and the fertility rate of the population. Based on these criteria, Allegheny County had nine areas federally designated as Health Professional Shortage Areas in 2000, and in 2002 had twelve areas, as seen above.

(22)

The map above displays information about Medicaid-HMO activity in Allegheny County, OB/GYN practices which participate in the 3 major MA-HMO plans, and women who received select obstetric services from these OB/GYNs and paid for by these plans. The 3 major plans are Gateway, MedPLUS+ and UPMC for You. The OB/GYN office street addresses were retrieved from their respective plan websites. Their addresses were geocoded using ArcGIS v8.3. Data for women were gleaned from Health Care Cost Containment Council (HC4) hospital discharge records using Data Bay Navigate v4.1 (formerly HCMAS). Resident street addresses were not available for women patients. Zipcode of residence was available and used to create dot-density maps. Dot-density maps represent quantities by a random pattern of dots within a polygonal feature, e.g. zipcode. The greater the value, the more dots are displayed. They convey quantities precisely but the random distribution within zipcode may be different from exact location of residence.

The services selected for inclusion in this analysis were the following Diagnosis Related Groups:

370 - CESAREAN SECTION WITH CC 371 - CESAREAN SECTION WITH NO CC

372 - VAGINAL DELIVERY W COMPLICATING DIAG WI 373 - VAGINAL DELIVERY W/O COMPLICATING DIAG 374 - VAGINAL DELIVERY W STERILIZATION &/OR D&C 375 - VAGINAL DEL W OR PROC EXC STERIL &/OR D&C 376 - POSTPART & POST ABORTION DIAG W/O OR PROC 377 - POSTPART & POST ABORTION DIAG W OR PROC 378 - ECTOPIC PREGNANCY WITH NO CC

379 - THREATENED ABORTION WITH NO CC 380 - ABORTION W/O D&C WITH NO CC

381 - ABORTION W D&C, ASPIR CURET OR HYSTEROT 382 - FALSE LABOR WITH NO CC

383 - OTHER ANTEPARTUM DIAG W MEDICAL COMPLIC 384 - OTHER ANTEPARTUM DIAG W/O MEDICAL COMPL

(23)

Pregnant Women / Pregnancy Outcomes Births

Table 15: Numbers of Births by Race: 1998-2002

The table above highlights that between 1998-2002, more black women 19 years of age and younger delivered infants than other racial groups. For example, approximately 22% of all the births to black women occur to mothers who are 19 years old or younger compared to 5% of births to mothers in the same age group who are white. Other birth statistics provide additional comparisons between races. The numbers of low birth weight infants, births to mothers under 18 years of age, and no prenatal care during the first trimester are higher for blacks than whites. The following table provides an illustration for 2002.

Of all new mothers less than 15 years old, 81.7% are black. Only 12.4% of the

population of Allegheny County is black. African-Americans are disproportionately represented in this group of mothers less than age 15. Statistical testing confirmed (p<.05) that Allegheny County blacks have a higher proportion of their births occurring in mothers less than 15 or 15-19 than whites or other races.

Table 16: Selected Birth Statistics by Race 2002

The table above suggests that public health efforts should be targeted towards black families because they are more likely to deliver low weight infants and start prenatal care late. Significantly (p<.05) more black residents (17.3%, 15.0-17.8) than white residents (5.8%, 5.3-6.2) go without prenatal care in the first trimester. In addition, black residents are more likely (p<.05) to have a low birthweight pregnancy outcome. Fifteen percent (13.6-16.4) of black mothers have a low birthweight baby, while only 6.9% (6.5-7.5) of whites have a low birthweight outcome.

Mothers Less than 15 Years Old

Mothers 15 to 19 Years Old Mothers 20 Years and Older Total Births by Race White 20 (0.04%) 2,698 (5.0%) 51,533 (95.0%) 54,252 Black 103 (0.8%) 2,904 (21.6%) 10,424 (77.6%) 13,433 Other 1 (0.04%) 68 (2.9%) 2,280 (97.1%) 2,349 All Races 126 (0.18%) 5,719 (8.1%) 64,408 (91.7%) 70,264 Births to Mothers Under 18 years (%) No Prenatal Care

First Trimester (%) Low Birthweight (%) Total Births by Race

White 150 (1.5%) 579 (5.8%) 704 (6.9%) 10,134

Black 261 (10.0%) 426 (17.3%) 390 (15.0%) 2,605

(24)

Table 17: Pregnancy Outcome by Age 2002

Age Live Births

under 15 27

15 - 17 393

18 - 19 664

20 - 29 5,689

30 and over 6,616

Total - incl. unknown age) 13,391

All 2002 Allegheny County births are described above by age of mother. Maternal age, poverty, residence, race and smoking status all play a role in birth outcome, as shown in

subsequent tables. Teen Births

The group that had most births were age 30 and over. Only 0.2% were to mothers under the age of fifteen. Three percent were to mothers less than 17 years of age. A total of eight percent of all Allegheny County births were to mothers less than 20 years of age. As the following tables demonstrate, the number of births to teenagers has been declining. However, since births to all Allegheny County women are also declining, the proportion of births to teens has shown little change.

Table 18: Number of Births and % (1998-2002)

Less than 15 Years Old (%)

15 - 19 Years Old (%)

20 plus Years Old (%)

Allegheny County

(% of 70264) 126 (0.2%) 5,719 (8.1%) 64,408 (91.7%) Pittsburgh

(% of 19259) 79 (0.4%) 2,624 (13.6%) 16,550 (85.9%)

The City of Pittsburgh is faring worse than the County as a whole. While in the whole County, only 8.3% of births are to mothers less than 20, 14.0% of all Pittsburgh moms are less

(25)

Table 19: Select Birth Statistics by Age, 1998-2002 Age 1998 1999 2000 2001 2002 <15 19 24 31 25 27 Allegheny County _15-19 _1,197 _1,210 _1,166 _1,089 ₁₀₅₇ <15 8 21 21 16 13 Pittsburgh 15-19 571 531 548 502 472

Table 20: Allegheny County Teen Births by Race and Age (1998 - 2002)

<15 yrs. 15 yrs. 16 yrs. 17 yrs. 18 yrs. 19 yrs.

White 20 (15%) 93 (27.5%) 268 (39.7%) 476 (44.5%) 732 (47.0%) 1,129 (54.2%) Black 103 (81.7%) 238 (70.4%) 394 (58.5%) 573 (53.6%) 793 (51.0%) 906 (43.5%) Other 1 (0.7%) 1 (0.3%) 5 (0.7%) 11 (1.0%) 17 (1.1%) 34 (1.6%) Unknown 2 (1.5%) 6 (1.8%) 7 (0.9%) 9 (0.8%) 14 (0.9%) 13 (0.6%)

All Races 126 338 674 1,069 1,556 2,082

Table 21: Pittsburgh Teen Births by Race and Age (1998 - 2002)

<15 yrs. 15 yrs. 16 yrs. 17 yrs. 18 yrs. 19 yrs.

White 8 (10.1%) 22 (12.3%) 84 (25.5%) 124 (26.1%) 226 (30.8%) 349 (38.4%) Black 70 (88.6%) 154 (86.5%) 240 (72.9%) 341 (71.8%) 495 (67.4%) 543 (59.8%) Other - 1 (0.5%) 3 (0.9%) 6 (1.3%) 5 (0.7%) 9 (1.0%) Unknown 1 (1.3%) 1 (0.5%) 2 (0.6%) 4 (0.8%) 8 (1.1%) 7 (0.7%)

All Races 79 178 329 475 734 908

The greatest proportion of births to teenagers occurs in young black women of the City and County. This racial difference narrows significantly from the early teens (88.6% of 15 year olds in the City were black; 81.7% of 15 year olds in the County were black) to late teens (59.8% of 19 year olds in the City were black; 43.5% of 19 year olds in the County were black). The difference in the racial makeup of teen pregnancies is significant (p<.05) from age 15 (88.6% black CI=79.5-94.7%) to 19 (59.8% black CI=56.5-63.0%).

(26)

(27)

(28)

No Prenatal Care

Table 22: No Prenatal Care in First Trimester - 1998-2002 19 Years Old and Less (% of number of births for this age group)

20 Years and Older

(% of number of births for this age group)

Allegheny County 1,168 (20.8%) 4,803 (7.6)

Pittsburgh 571 (22.2%) 1,839 (11.5%)

Early prenatal care is considered important in assuring a healthy outcome. Ideally, a women is expected to initiate prenatal care in her first trimester of pregnancy. The following table presents the numbers of women in two different age groups who did not initiate prenatal care during their first trimester. The data are presented for both Allegheny County and Pittsburgh. Percentages are based on total births for specified age group, excluding those births where prenatal care is unknown.

Table 23: No Prenatal Care in First Trimester by Race 1998-2002-County

Allegheny County _{Less than 15 Years Old}Mothers _{15 to 19 Years Old}Mothers

Mothers 20 Years and Older White 6 (31.5%) 514 (19.5%) 2,900 (5.7%) Black 38 (38.4%) 579 (21.0%) 1,683 (16.9%) Other 1 (100%) 16 (25.0%) 190 (8.6%) All Races 46 (38.0%) 1122 (20.4%) 4,803 (7.6)

Table 24: No Prenatal Care in First Trimester by Race 1998-2002-City

Pittsburgh _{Less than 15 Years Old}Mothers _{15 to 19 Years Old}Mothers

Mothers 20 Years and Older White 3 (37.5%) 153 (19.5%) 742 (7.6%) Black 25 (37.3%) 379 (22.7%) 1,015 (18.7%) Other - (-) 3 (14.3%) 68 (8.3%) All Races 29 (38.2%) 542 (21.7%) 1,839 (11.5%)

Race and age are two predictors of seeking prenatal care. Unfortunately, young black women often do not have optimal birth outcomes – they are least likely to initiate prenatal care.

Percentages are based on total births for specified age group, excluding those births where prenatal care is unknown. All mothers less than 15 years of age were unlikely to get prenatal care in the first trimester [38.2% (26.1-48.3) did not receive care.] Those aged 15-19 were significantly (p<.05) more likely to receive first trimester care than those less than 15, although 21.7% did not receive care (19.1-22.3). Finally, those mothers aged 20 or greater were

(29)

Low/Very Low Birthweight

Table 25: Low Birthweight Infants: 1998-2002 19 Years Old and Less (% of number of births for this age group)

20 Years and Older (% of number of births for this age group)

Total Births <=19yr Total Births >19yr

Allegheny County total _{668 (11.4%)} _{5,074 (7.9%)} 5,845 64,421

Black _{416 (13.8%)} _{1,528 (14.7%)} 3,007 10,426 Other _{8 (11.6%)} _{172 (7.5%)} 69 2,280 Unknown _{4 (7.8%)} _{22 (NA)} 51 179 White 240 (11.4%) 3,352 (6.5%) 2,718 51,536 Pittsburgh total _{352 (13.0%)} _{1,654 (10.0%)} 2,703 16,558 Black _{270 (14.7%)} _{869 (15.2%)} 1,843 5,735 Other _{4 (16.7%)} _{64 (7.6%)} 24 841 Unknown _{1 (4.3%)} _{6 (8.7%)} 23 69 White _{77 (9.5%)} _{715 (7.2%)} 813 9,913

Table 26: Very Low Birthweight Infants: 1998-2002 19 Years Old and Less (% of number of births for this age group)

20 Years and Older (% of number of births for this age group)

Total Births <=19yr Total Births >19yr

Allegheny County total _{151 (2.6%)} _{1,044 (1.6%)} 5,845 64,421

Black _{105 (3.5%)} _{363 (3.5%)} 3,007 10,426 Other _{1 (1.5%)} _{18 (0.8%)} 69 2,280 Unknown _{1 (2.0%)} _{12 (0.02%)} 51 179 White 44 (1.6%) 651 (1.0%) 2,718 51,536 Pittsburgh total _{89 (3.3%)} _{369 (2.2%)} 2,703 16,558 Black _{73 (4.0%)} _{206 (3.6%)} 1,843 5,735 Other _{1 (4.2%)} _{8 (1.0%)} 24 841 Unknown _{0 (0.0%)} _{4 (5.8%)} 23 69 White _{15 (1.9%)} _{151 (1.5%)} 813 9,913

An indicator that is used to determine pregnancy outcome is the birth weight of the infant. Low birth weight and very low birth weight infants are considered to have increased health risks. The following tables present the numbers of low birth weight and very low birth weight infants from 1998 to 2002 for both the county and the city. The data are presented for two age groups: mothers 19 years old and less and mothers 20 years and older

The above tables suggest that public health efforts need to be concentrated in Pittsburgh. Women who do not receive first trimester prenatal care and deliver low birth weight infants are more likely to live in Pittsburgh than in the remainder of Allegheny County. They are also much more likely to be 19 years of age or less. Young girls aged less than 19 are more likely to have a low birthweight infant (11.4%, 10.6-12.2) than those greater than 20 years old (7.9%, 7.7-8.1). This difference is significantly different (p<.05).

(30)

Maternal Tobacco Use

Table 27: Maternal Tobacco Use for Resident Live Births-1998-2002-County SMOKERS: Allegheny County, Pennsylvania 1998 - 2002

Age of Mother

<19 20+ All Ages

Number Percent Number Percent Number Percent

White 1,041 38.3 7,787 15.1 8,829 16.3

Black 563 18.7 2,910 27.9 3,474 25.9

Other 11 15.9 94 4.1 105 4.5

Total 1,630 27.9 10,827 16.8 12,457 17.7

Cigarette smoking during pregnancy contributes to low birth weight infants. In a recent study of maternal smoking by the Annie E. Casey Foundation, the City of Pittsburgh ranked worst among the 50 largest cities in the United States. Pittsburgh had the highest rate of maternal smoking during pregnancy. In 1995-1999, 25.5% of the total births in Pittsburgh were to

mothers who smoked during pregnancy. This compares to a maternal smoking rate of 2.6% in New Orleans in 1997.

Exposure to secondhand smoke causes serious health risks to newborns and children. The following tables present data from birth records on maternal tobacco use for resident live births by race and age group for 1998-2002. In Allegheny County with the exception of the under 19 year old group, a higher percentage of black mothers reported smoking than white mothers.

By 2002, the prevalence of cigarette smoking had already decreased to an average of 16.8%. Just over 16% of white women smoked during pregnancy (16.0-16.6). More than 25% (25.1-26.1) of black women smoked. This pattern is not replicated in the youngest population of mothers (<19 years). Of the 2,718 white mothers under 19, 1,041 smoked during pregnancy (38.3%, 36.5-40.2). Of the 3,007 black mothers under age 19, only 563 (18.7%, 17.3-20.2) smoked. There is a significantly lower proportion of smoking in the young black population (p<.05).

Table 28: Maternal Tobacco Use for Resident Live Births-2002-County SMOKERS: Allegheny County, Pennsylvania 2002

Age of Mother

<19 20+ All Ages

White 195 40.1 1,409 14.6 1,604 15.8

Black 89 15.7 521 25.6 610 23.4

Other 1 4.5 20 3.4 21 3.5

(31)

Table 29: Maternal Tobacco Use for Resident Live Births-1998-2002-City SMOKERS: Pittsburgh, Pennsylvania 1998 - 2002

Age of Mother

<19 20+ All Ages

White 345 42.4 2,006 20.2 2,351 21.9

Black 367 19.9 1,736 30.2 2,103 27.8

Other 4 16.7 31 3.7 35 4.0

Total 722 26.7 3,791 22.9 4,513 23.4

Table 30: Maternal Tobacco Use for Resident Live Births-2002-City SMOKERS: Pittsburgh, Pennsylvania 2002

Age of Mother

<19 20+ All Ages

White 60 43.8 344 19.2 404 21.0

Black 55 16.6 296 27.2 351 24.7

Other 1 6.7 7 3.3 8 3.5

(32)

Table 31: Birthweights Among Smokers & Nonsmokers-1998-2002-City

Based on self-report by mother on birth certificate PITTSBURGH RESIDENT BIRTHS: 1998 - 2002

Birthweight in Grams Smoked During Pregnancy

Did Not Smoke During Pregnancy Unknown All Births, Regardless Of Smoking Status All births: < 500 19 50 16 85 500-1499 111 250 10 371 1500-2499 574 932 43 1,549 2500-3499 2,891 7,847 178 10,916 3500-4499 898 5,141 77 6,116 4500+ 20 197 2 219 Unknown 0 3 0 3 Total 4,513 14,420 326 19,259

Very low birthweight (<1500g)

Number 130 300 26 456

Percent 2.9% 2.1% 8.0% 2.4%

Mothers who smoked during pregnancy were 1.4 times more likely to have a very low birthweight baby.

Low birthweight (<2500g)

Number 704 1,232 69 2,005

Percent 15.6% 8.5% 21.2% 10.4%

(33)

Table 32: Birthweights Among Smokers & Nonsmokers-2002-City

Based on self-report by mother on birth certificate

PITTSBURGH RESIDENT BIRTHS: 2002 Birthweight in

Grams

Smoked During Pregnancy

Did Not Smoke

During Pregnancy Unknown

All Births, Regardless Of Smoking Status All births: < 500 4 9 2 15 500-1499 20 48 3 71 1500-2499 103 190 12 305 2500-3499 487 1,516 50 2,053 3500-4499 153 930 21 1,104 4500+ 2 35 0 37 Unknown 0 2 0 2 Total 769 2,730 88 3,587

Number 24 57 5 86

Percent 3.1% 2.1% 5.7% 2.4%

Number 127 247 17 391

Percent 16.5% 9.0% 19.3% 10.9%

(34)

Table 33: Birthweights Among Smokers & Nonsmokers-1998-2002-County

ALLEGHENY COUNTY RESIDENT BIRTHS: 1998 - 2002 Birthweight in

Grams

Did Not Smoke

All Births, Regardless Of Smoking Status All births: < 500 38 129 43 210 500-1499 237 722 24 983 1500-2499 1,346 3,132 69 4,547 2500-3499 7,921 28,724 420 37,065 3500-4499 2,851 23,297 219 26,367 4500+ 63 1,005 4 1,072 Unknown 8 5 7 20 Total 12,464 57,014 786 70,264

Number 275 851 67 1,193

Percent 2.2% 1.5% 8.5% 1.7%

Number 1,621 3,983 136 5,740

Percent 13.0% 7.0% 17.3% 8.2%

(35)

Table 34: Birthweights Among Smokers & Nonsmokers-2002-County

ALLEGHENY COUNTY RESIDENT BIRTHS: 2002 Birthweight in

Grams

Did Not Smoke

All Births, Regardless Of Smoking Status All births: < 500 6 24 6 36 500-1499 46 133 10 189 1500-2499 247 645 27 919 2500-3499 1,414 5,618 154 7,186 3500-4499 518 4,267 81 4,866 4500+ 17 174 1 192 Unknown 0 2 1 3 Total 2,248 10,863 280 13,391

Number 52 157 16 225

Percent 2.3% 1.4% 5.7% 1.7%

Number 299 802 43 1,144

Percent 13.3% 7.4% 15.4% 8.5%

Mothers who smoked during pregnancy were 1.8 times more likely to have a low birthweight baby.

Mothers who smoked during pregnancy were 1.4 to 1.6 times more likely to have a very low birthweight baby. Mothers who smoked during pregnancy were 1.8 to 1.9 times more likely to have a low birthweight baby. These figures are independent of age or prenatal care. Young maternal age and lack of prenatal care may predict low birth weight. As can be seen from the previous tables, young mothers are likely to smoke and not receive prenatal care in the first trimester.

Agreement has been reached in Pennsylvania on how to spend the tobacco settlement money, the Master Settlement Agreement between 46 states and the five major tobacco companies. Pennsylvania’s share is approximately $11 billion over 25 years, with the first payment approximately $464 million. Twelve percent (an average of $48.6 million annually) is to support tobacco prevention and cessation programs, 70% of that amount for local programs and 30% for statewide tobacco control programs.

(36)

Locally, the Smoke Free Mothers/Smoke Free Families Coalition has been formed under the leadership of the Allegheny County Health Department. The Coalition will meet regularly to achieve the goal of reducing maternal smoking by 10% a year for five years. Members include the University of Pittsburgh, community and voluntary agencies, insurance providers, hospitals and clinics. Consensus has been reached on an action plan which includes enforcing policies and regulations, engaging people at the neighborhood level, collecting data to measure progress and reporting outcomes publicly, getting healthcare providers involved and giving everyone the opportunity to contribute.

Maternal smoking is more prevalent in the City of Pittsburgh than in Allegheny County as a whole.

Smoke Free Mothers/Smoke Free Families Coalition distributed “tool kits” to 1500 providers in Allegheny County who work with pregnant women and families with children. The tool kits were comprised of cards with names and phone numbers of all smoking cessation programs in Allegheny County. The coalition provided flyers with the Pennsylvania Free Quitline number: 877-724-1090 and the Great Start Pregnant Smokers Quitline: 866-667-8278. The Coalition publishes a newsletter “Tobacco Free Times” on a quarterly basis to update Allegheny County residents on new issues regarding pregnant women and smoking, cessation and legislative efforts in smoking reduction and new programs focusing on smoking in

pregnancy and effects of smoking on children.

On September 13, 2004, the coalition participated in a Senate Health and Welfare Committee Hearing on amendments to Senate Bill 833. This bill by Senator Jane Orie, would establish a comprehensive and concerted program by the State to reduce the incidence of smoking during pregnancy and childbearing years. The Commonwealth of Pennsylvania recently announced changes in DPW regulation increasing coverage of NRT for Medicaid patients, increasing coverage for counseling sessions, and removing restrictions on a provider counseling and being reimbursed at the same time as routine or “sick” office visits. These statewide changes were in response to changes requested by the local coalition in meetings with the Secretary of Welfare in December 2003, April 2004 and July 2004. A follow up meeting with DPW Secretary Estelle Richman was also held in November 2004 to discuss further implementation of the community/agencies smoking cessation plans.

An incentive program with Target Stores was initiated. Any pregnant woman who enrolls in a smoking cessation program and successfully completes the program is eligible for a $50 gift card to Target Stores. If the woman continues to be smoke-free at a 2 month follow-up visit, she will receive another $25 gift card.