PRAMS Special Projects
The Pregnancy Risk Assessment Monitoring System (PRAMS) Opioid Supplement and Call-Back Survey used the existing PRAMS infrastructure to collect data on opioid use and misuse around the time of pregnancy in 2019. The PRAMS Prescription Opioid Supplement collects information on prescription opioid pain reliever use during pregnancy. The Prescription Opioid Supplement was implemented in 2019 in 32 PRAMS sites and 2 non-PRAMS sites using existing maternal and infant health surveys. The PRAMS Opioid Call-back Survey collects information about prescription opioid pain reliever use and treatment postpartum, as well as infant health from PRAMS survey respondents 9-10 months after a live birth. The Call-back survey was implemented in 7 PRAMS sites.
Data from these surveys will help state health departments, clinical health providers, CDC, and other federal agencies develop programs and policies to ensure access to recommended clinical care.
CDC’s Division of Reproductive Health (DRH), with support from the Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE), is working in partnership with the Association of State and Territorial Health Officials (ASTHO) to better understand patient-centered outcomes in maternal and child healthexternal icon. Alaska, New Mexico, Texas, and Washington have been selected to participate in a new learning community aimed at linking Pregnancy Risk Assessment Monitoring System (PRAMS) data to clinical or social services data, such as Medicaid claims, hospital discharge records or home visiting data. These linkages support maternal and child health Patient-Centered Outcomes Research to inform clinical and programmatic improvement initiatives that help patients and those who support them communicate and make informed healthcare decisions.
The Pregnancy Risk Assessment Monitoring System (PRAMS) has played a unique role in supplementing surveillance activities related to Zika virus awareness and prevention around the time or pregnancy in US states and Puerto Rico. PRAMS activities related to Zika surveillance began in 2016 with two initiatives: 1) a questionnaire supplement for use by PRAMS projects in US states, and 2) a special PRAMS Zika Postpartum Emergency Response (ZPER) project in Puerto Rico.
PRAMS has collected information from women with a recent live birth since inception of the project, but in doing so encounters a data gap related to information from women who have a pregnancy that results in a loss such as a stillbirth. The Division of Reproductive Health funded Emory University to conduct formative researchexternal icon on the feasibility of using the PRAMS methodology to sample births from the fetal death certificate, as opposed to the traditional sampling from the live birth certificate. The methodology was piloted in Georgia in 2013 and found to be appropriate for expanded implementation.
CDC PRAMS funded the Utah Department of Health in 2016 to use a Stillbirth Model Protocol in their state. Utah developed the Study of Associated Risks of Stillbirths (SOARS) survey, and will be implementing the project in 2018 to gather essential data for monitoring stillbirth and related factors such as prenatal, obstetric and postpartum health care after a pregnancy loss.
The important role that men play in improving reproductive health within their families is being increasingly recognized. CDC’s Division of Reproductive Health has been partnering with researchers at Northwestern University to conduct formative research on the feasibility of conducting a PRAMS-like survey with new fathers. In an effort to better understand the experiences of new fathers, PRAMS has 2 initiatives targeting fathers of recently born live infants.
- PRAMS for Dads Pilot project using the PRAMS mail and phone methodology to experiment with contacting fathers in conjunction with the maternal PRAMS survey, and/or independently of the maternal survey. Georgia will be the pilot site, and the anticipated start date is late 2018.
- Hospital-based survey of fathers/partners of women with a recent live birth in Puerto Rico. This study was completed in December of 2017 with a 77% response rate. For more information, please see the PRAMS-ZPER 2.0 survey information.
Beginning in 2016, 11 PRAMS states were selected to participate in a collaborative evaluation project with the Human Resources Service Administration (HRSA) to evaluate the impact of the HRSA funded Healthy Start Programexternal icon. These 11 states are: Alabama, Connecticut, Georgia, Iowa, Louisiana, Massachusetts, Michigan, Missouri, New York, Oregon, and Pennsylvania. Healthy Start Projects serve a wide range of eligible pregnant and postpartum women in selected communities within each state. For the PRAMS evaluation piece, selected states agreed to oversample Healthy Start Program participants who had a livebirth in their state during 2017-2018. All of the Healthy Start participants received the PRAMS survey so that the information they provide can be compared to that of other PRAMS participants who are not Healthy Start participants. In this manner, the impact of the Healthy Start Program on maternal and infant health outcomes that are asked about on PRAMS can be assessed. The Healthy Start PRAMS oversample is schedule to last for one year.
In 2011, the PRAMS began working with the W.K. Kellogg Foundation (WKKF) to enhance the existing PRAMS surveillance systems in four states—Louisiana, Michigan, Mississippi, and New Mexico. Within each state, the PRAMS Project expanded the number of women sampled in specific areas (i.e., certain counties and Orleans Parish in Louisiana). Each of the states developed alternative outreach strategies to reach women in these areas. These strategies include distributing and collecting survey questionnaires in person during WIC clinic visits, making prompt calls, and sending text messages to reach women before sending the survey. The data collected by this effort are used to develop sampling and outreach methods to reach women who are traditionally less likely to respond to mail or phone surveys in PRAMS. The data will also assist the W.K. Kellogg Foundation in assessing the effectiveness of their programs to promote maternal and infant health among low-income and minority populations. The project was completed in 2015.
The PRAMS Tribal Flu Project was a 2-year initiative with the goal of disseminating representative data from American Indian (AI) mothers about their perceptions of and experiences with H1N1 and seasonal influenza. Three states—New Mexico, Oregon, and Washington—were funded to conduct this project from 2011–2013. Funded state health departments were charged with adapting their PRAMS-related epidemiologic and managerial support to work collaboratively with tribes in a manner respecting tribal sovereignty, with the ultimate project goal to establish or improve partnerships with tribes, increase response rates among AI women, and increase data sharing with tribes.
By the conclusion of the project, the three funded states had initiated or enhanced ongoing partnerships with tribes or tribal organizations within their states. New Mexico PRAMS partnered with the Albuquerque Area Tribal Epidemiology Center (TEC), the Navajo Epidemiology Center, Tribal WIC Directors, and the Navajo area PRAMS to hire a permanent tribal liaison dedicated to maternal and child health issues. Washington partnered with the American Indian Health Commission, Northwest Portland Area Indian Health Board, and Seattle Indian Health Board to promote PRAMS and share influenza materials with tribes throughout the state. Interest and activities spread to other states, including a request from a North Carolina tribe to share the State of Washington’s printed influenza materials, and three states—Alaska, Michigan, and Wyoming— significantly enhanced their PRAMS outreach to tribal communities without additional funding from CDC.
The PRAMS Teen Oversample project was a 3-year initiative designed to gather more information and insight into sexual behaviors, attitudes, and contraceptive use among teens who have had a live born infant to address teen pregnancy prevention efforts. Understanding the experiences of teen mothers can provide insight to guide program and policy strategies to prevent repeat pregnancies among teen parents, as well as first pregnancies among teens. Two states—Mississippi and New York—were funded to conduct this oversample from 2011–2014. In addition to sampling more teens, activities included adding teen-specific questions to the PRAMS survey and experimenting with different incentives and rewards to increase teens’ participation in PRAMS. Data collection ended in 2014.