Research and Evaluation

The Research and Evaluation Team (RET) of the Applied Sciences Branch works to improve women’s health and reproductive health outcomes by monitoring chronic disease and chronic disease risk factors among women of reproductive age, and by developing, evaluating, and promoting effective interventions and policies that reduce chronic disease and chronic disease risk factors.

Monitoring Chronic Disease and Related Risk Factors

Pregnancy Risk Assessment Monitoring System (PRAMS) Data Quality Improvement Project (Chronic Disease and HIV Measures) PRAMS collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy. PRAMS data are important because state health officials can use these data to identify groups of women and infants at high risk for health problems, monitor changes in health status, and measure progress towards goals for improving the health of mothers and infants. In FY 2010, CDC’s Division of Reproductive Health (DRH) and CDC’s Division of HIV/AIDS Prevention, Epidemiology Branch co-funded the Vermont Department of Health and the New York City Department of Health and Mental Hygiene to conduct a PRAMS data quality improvement project. The project involves comparing PRAMS data to data found on hospital delivery and prenatal care records. The project evaluates the validity of PRAMS data, specifically data on chronic disease, related risk factors, and HIV testing. Data collection will be completed by fall 2011 and publications explaining the results are expected in 2012.

Comparing Pre-pregnancy Smoking and Quitting Estimates From PRAMS and the Birth Certificate
Using PRAMS data, this analysis will assess differences in self-reported pre-pregnancy smoking and quit estimates from PRAMS and the birth certificate among states implementing the 2003 revised birth certificate. Results are expected to be published in 2012.

Evaluating PRAMS Depression Measures
PRAMS collects information on postpartum depression. This project, a collaboration with researchers from the University of Iowa, evaluates depression measures in PRAMS, comparing responses to depression scales in PRAMS to other validated scales and to diagnosed depression. Results are expected to be published in 2012.

Monitoring Depression Prevalence and Treatment 
Using data from the National Survey on Drug Use and Health, this analysis will describe the prevalence of past-year major depressive episode and use of mental health treatment by treatment modality among U.S. pregnant and nonpregnant women of reproductive age. Results are expected to be published in 2012.

Monitoring Advice and Actions Taken To Control Hypertension Among
Women of Reproductive Age
Using data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS), this analysis describes 1) lifestyle modification advice (e.g., change eating and exercise  habits, reduce salt intake) received from health care professionals and 2) subsequent lifestyle changes made among U.S. hypertensive women aged 18–44 years. Results are expected to be published in 2012.

Screening and Interventions That Address Chronic Disease and Related Risk Factors Among Reproductive Age Women

Quality Improvement Project To Increase Postpartum Diabetes Testing Rates Among Women with Gestational Diabetes
RET, in collaboration with CDC’s DRH Maternal and Infant Health Branch and Kaiser Permanente Northwest (KPNW), is conducting a quality improvement project to increase postpartum diabetes testing among women with gestational diabetes. An initial study found that postpartum diabetes testing rates at KPNW increased from 56% in 1999 to 68% in 2006.¹ The goal of the quality improvement project is to increase postpartum diabetes testing rates to 90%. The intervention focuses on provider education and feedback for current postpartum testing rates, as well as system changes to remind providers to order the lab test and to remind patients to complete it. The final summary is expected in 2012.

Evaluating an Intervention To Reduce the Risk of Cardiovascular Disease Among American Indian/Alaska Native (AI/AN) Women
Early detection of chronic diseases can be missed in women of reproductive age (18–44 years) because the type of medical care they seek is typically focused on their reproductive health care needs. Yet, chronic disease risk factors, such as smoking and obesity, are common in this age group and can be treated when evidence-based interventions are offered. RET supports a 4-year (2010–2014) Special Interest Project with the University of Washington to evaluate an intervention to reduce cardiovascular disease (CVD)-related risk factors among American Indian/Alaska Native (AI/AN) women of reproductive age. This project will document the prevalence of chronic diseases and their risk factors among AI/AN women at one urban and one rural health clinic. We will also evaluate a 16-week contingency management (CM) intervention, providing incentives to change behavior, to encourage smoking cessation and weight loss among overweight and obese smokers of reproductive age who attend reproductive health visits at the clinics.

Systematic Review of the Effectiveness of Screening for Depression Among Women of Reproductive Age
It is unclear whether routine screening for depression among non-pregnant women of reproductive age improves rates of identification and treatment. Therefore, RET conducted a systematic review that addressed five key questions specific to women of reproductive age: 1) What are the current national recommendations for depression screening?; 2) What are the prevalence and predictors of screening?; 3) What screening tools exist?; 4) Does screening lead to diagnosis, treatment, and improved outcomes?; and 5) What are the most effective treatment methods?  We performed searches of bibliographic databases for English language, full-length articles published between 1990 and 2010. This systematic review is published in the November 2011 issue of Preventing Chronic Disease.

Systematic Review of the Effectiveness of Screening and Treatment for Hypertension and Dyslipidemia Among Women of Reproductive Age
During 2010, RET collaborated with an external contractor to conduct a systematic literature review for evidence on the impact of lifestyle interventions on cardiovascular disease risk factors in women of reproductive age, evidence-based guidelines on hypertension and dyslipidemia screening, and population-based prevalence studies on hypertension and dyslipidemia screening. This systematic review is published in the November 2011 issue of Preventing Chronic Disease.

Telephone Smoking Cessation Quitline Use Among Pregnant and Non-Pregnant Women
Using 2006–2008 data from the American Cancer Society’s Quitline, this analysis describes characteristics, referral sources, service use utilization, and self-reported quit rates by pregnancy status among reproductive-aged smokers who received services from the quitline in 10 states.  Results are expected to be published in 2012. 

Do State Tobacco Control Policies Reduce Prenatal Smoking and Improve Birth Outcomes?
CDC, in collaboration with economists from Emory University, will evaluate the effect of state tobacco policies on prenatal smoking and on low birth weight and gestational age. PRAMS data from 2000–2005 that are linked to data on state tobacco tax and public smoking bans will be analyzed and results are expected to be published in 2012.

Tobacco and Pregnancy Group
The Tobacco and Pregnancy Group, an internal CDC collaboration, works to help women around the world to be tobacco-free before, during, and after pregnancy to improve reproductive and overall health outcomes by analyzing and disseminating population-based surveillance and survey data. Activities include—

• Conducting and synthesizing epidemiologic studies on health effects of tobacco on reproductive health.
• Evaluating and promoting evidence-based interventions for prevention and cessation of tobacco use among women.
• Serving as CDC subject matter experts and providing technical assistance to public health organizations.
• Promoting collaboration with internal and external partners.

For more information see tobacco use and pregnancy.

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¹ Dietz PM, Vesco KK, Callaghan WM, Bachman DJ, Bruce FC, Berg CJ, England LJ, Hornbrook MC. Postpartum screening for diabetes after a gestational diabetes mellitus-affected pregnancy. Obstet Gynecol 2008;112(4):868–874.

² Rogers EM. Diffusion of Innovations. New York: Free Press; 1995.

³ Lumley J, Chamberlain C, Dowswell T, Oliver S, Oakley L, Watson L. Interventions for promoting smoking cessation during pregnancy (Cochrane Review). In: The Cochrane Library: 2009: Issue 3.