Data to Action Success Story: Alaska
Alaska: PRAMS Data Informs Maternal and Child Health Activities in the North Slope Borough
In 2006, the Alaska Bureau of Land Management began an environmental assessment to evaluate the potential land- and health-related effects of a proposed plan to lease oil and gas rights in northern Alaska. To provide a more robust analysis of the potential health issues associated with the leasing of oil and gas rights, the North Slope Borough (NSB) Health Department undertook a health impact assessment, with plans to include the findings in the final environmental impact statement. After the health impact assessment was completed, the NSB Health Department obtained a National Petroleum Reserve-Alaska Impact Grant to build a local program to monitor health issues. As a result, the NSB Baseline Community Health Analysis, a report on health issues in the North Slope rural villages, was developed and released in 2012 to inform future health impact assessments and guide public health and community planning efforts.
The report, using the most recent data available at the time from Alaska PRAMS, along with vital registries and other sources, identified disparities in many maternal and child health indicators between the North Slope region and the rest of the state. Alaska PRAMS data from 2004–2008 showed that, compared with the entire state, the northern region of Alaska had lower breastfeeding initiation rates (79% vs. 91%, respectively) and lower rates of continuation of breastfeeding at 4 weeks postpartum (64% vs. 80%, respectively). In addition, the 2004–2008 reported prevalence of cigarette smoking during the last 3 months of pregnancy was more than twice as high among women from NSB compared with Alaska women statewide (37% vs. 17%, respectively). Furthermore, compared with Alaska women statewide, women from NSB reported a higher prevalence of physical abuse by a husband or partner 12 months before (10.5% vs. 4.4%) or sometime during (8.9% vs. 3.3%) pregnancy.
Program Activity Description
Based on analyses of Alaska PRAMS data and other health data, the North Slope Borough Baseline Community Health Analysis recommended prioritizing children and young families in community planning efforts. The NSB Health Department visited all of the 8 rural villages to conduct a series of “community cafés,” or community health and leadership forums, in 2012 and 2013 to bring this information to the villages and to get community input that would inform a series of strategic planning meetings designed to translate information into community-driven action.
Program Activity Outcomes
In 2012, in response to the results of the baseline analysis and the report recommendations, the NSB Health Department began putting into action a number of activities designed to improve maternal and child health in North Slope communities. The department collaborated with the Indian Health Service hospital to streamline the prenatal care referral process, making it easier for women to schedule prenatal appointments at local health clinics serving clients with high social or medical risk factors. To help improve rates of breastfeeding initiation and duration among new mothers, the region’s only hospital has conducted breastfeeding workshops and provides breastfeeding peer counseling training to their staff. Additionally, department staff have provided education on ways to prevent child obesity at health fairs in each NSB village, and a slope-wide obesity prevention coalition has been developed to address nutrition and physical activity issues among North Slope residents. The NSB also received grant funding to develop policies and prevention activities related to tobacco use. The department uses PRAMS data to aid in strategic planning to develop goals, objectives, and activities for the year.
The NSB Health Department plans to continue using PRAMS data to monitor trends in prenatal care initiation, breastfeeding rates, prepregnancy overweight and obesity, physical abuse, and rates of alcohol and cigarette use among NSB women as well as other maternal child health indicators not mentioned above.
Alaska has a long history of tolerance towards marijuana use. In 1975, the Alaska Supreme Court ruled that the right to privacy explicitly guaranteed by the Alaska Constitution protected an adult’s right to possess and use small amounts of marijuana in the home. Use of medical marijuana became legal in 1998. With some restrictions, recreational marijuana use also became legal in Alaska in early 2015. The active compound of marijuana, tetrahydrocannabinol (THC), passes freely through the placental barrier, raising concerns about its potential effects on unborn babies. Recent studies indicate that prenatal exposure to THC is associated with an increased risk of low birth weight.1
Program Activity Description
Before marijuana use was decriminalized in Alaska, the Alaska Department of Health and Social Services established a marijuana task force to raise public awareness of the health effects of marijuana use. The task force was responsible for establishing focused, standard messaging regarding how this new law would affect the public’s health. Pregnancy Risk Assessment Monitoring System (PRAMS) data from 2002-2011 on marijuana use were analyzed and the results were published in the Alaska State Epidemiology Bulletin (http://www.epi.alaska.gov/bulletins/docs/b2015_05.pdfpdf iconexternal icon ) on February 24, 2015, the day that recreational marijuana use became legal in Alaska. Findings from the Bulletin highlighted that, in 2011, marijuana use during the 12 months prior to pregnancy was reported by over 15% of Alaska women. Marijuana use during pregnancy more than doubled between 2002 and 2011, from 3.5% to 7.8%.
Program Activity Outcomes
The task force created a website providing information on marijuana use from a public health perspective, and linked the website to the Alaska State Epidemiology Bulletin article. The task force also helped create a public service announcement regarding the potential health effects of marijuana use. The information was presented as a TV ad, radio spot, social media posts on sites such as Facebook, and was incorporated into the new website.
The timing of the Epi Bulletin fueled media interest in PRAMS data on marijuana use, which led to several media outlet interviews, and increased exposure of the issue. Data from PRAMS were featured on two local Anchorage TV stations, including an on-camera interview with the author of the Epi Bulletin. PRAMS data were also featured in a media station’s blog and by the Epi Bulletin’s author during an interview aired by the public radio station in the capital city of Juneau.
Additionally, PRAMS staff gave several presentations on marijuana use, including a training session for dieticians with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program. A rack card with information about legal substance use was developed for distribution at WIC clinics and included the statement, “Legal is not the same as safe.” These efforts were intended to heighten awareness among health professionals and the general public about the health implications of marijuana use around the time of pregnancy.
1Gunn JKL, Rosales CB, Center KE, et al. Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis. BMJ Open 2016;6:e009986. doi:10.1136/bmjopen-2015-009986