Data to Action Success Story: New York

Monitoring Oral Health Care During Pregnancy Using New York State PRAMS Data

Problem Overview

Some studies have shown that there is a relationship between a mother’s periodontal disease, or chronic infection of the gums, and premature birth and low birth weight in her infant. Improving oral health during pregnancy may help reduce the risks of poor birth outcomes and help prevent cavities in early childhood. Dental decay is an infectious disease, and mothers can pass the decay-causing germs in their saliva to their babies by sharing a spoon, cleaning a dropped pacifier by mouth, or wiping the baby’s mouth with saliva. Because oral health problems are common during pregnancy, it is important for pregnant women and women of childbearing age to take good care of their teeth and gums before, during, and after pregnancy. Good oral health for moms can mean good oral health for their babies.

Program Activity Description

In 2005, the New York State (NYS) Department of Health, Bureau of Dental Health (BDH) convened an expert panel to develop recommendations for assisting health care professionals in addressing oral health care during pregnancy and early infancy.  As a result of this collaboration, the Oral Health Care During Pregnancy and Early Childhood Practice Guidelines were released by the NYS Bureau of Oral Health in 2006. The guidelines recommended to include oral health assessments and referral services into routine prenatal care for pregnant women, and to provide appropriate treatment for pregnant women and young children.

In November 2007, following the release of the Oral Health Practice Guidelines, the University at Albany (New York) School of Public Health produced and broadcast a webinar on oral health that included PRAMS data as part of a maternal and child health continuing education series. In 2009, a poster on the importance of oral health care during pregnancy was sent to oral health care providers around the state.  In early 2014, further supporting the dissemination of the guidance, the BDH began developing a toolkit based on the recommendations in the guidelines, which can be used by oral health care providers and other partners to guide their care of women during pregnancy.

The BDH also uses PRAMS data to inform programs and providers about the oral health of pregnant women in New York through newsletters and the BDH website. PRAMS data on oral health in New York State are also used to justify requests for funding. In 2013, after submitting an application that cited findings from analyses of New York PRAMS data, the BDH received a grant to implement interventions for Medicaid-enrolled pregnant women.

Program Activity Outcomes

Since these activities began in 2005, data from New York PRAMS indicate improvement in the prevalence of women who report talking to their health care provider about the care of their teeth and gums and who go to the dentist or dental clinic during pregnancy. Importantly, receipt of oral health care during pregnancy has improved—the proportion of women who report having their teeth cleaned during pregnancy increased 13% from 39.2% in 2006 to 44.3% in 2011. Recognizing the value of the PRAMS data in understanding the oral health needs of pregnant women, the BDH funded NYS PRAMS to insert additional questions on oral health care during pregnancy during 2014 to continue monitoring progress toward improving the oral health of women in New York State.

New York City: Making Breastfeeding the Norm in NYC

Problem Overview

The New York City Department of Health and Mental Hygiene (DOHMH) set forth an objective to make breastfeeding the norm in NYC by working at individual, community, institutional, and policy levels. Take Care New York, launched in 2004, aims to help New Yorkers live longer and healthier lives. “Take Care New York 2008” included a breastfeeding objective to improve maternal and infant health by encouraging healthy breastfeeding for infants. “Take Care New York 2012” took the 2008 objective a step further with the creation of Priority Area #9, which focused on healthy children, and set a target to increase the number of women who exclusively breastfeed their infants for at least 2 months to 45%.1 DOHMN plans to support policies that encourage exclusive breastfeeding for at least 6 months.

Program Activity Description

In 2006, NYC collaborated with the New York City Health and Hospitals Corporation (HHC) to implement the Breast Milk Friendly Hospital Initiative (BMFHI), based on the WHO/UNICEF Baby Friendly Hospital Initiative (BFHI). The BMFHI is a collaborative effort between NYC and 11 public hospitals that include the training of all nurse, physician, and mid-level health providers in the BFHI principles. Principles include initiating breastfeeding within 1 hour of life, promoting rooming-in, eliminating formula company incentives, and encouraging only breast milk unless medically indicated. NYC PRAMS data from 2007, which were used to guide the program, showed that public hospitals had high prevalence rates of breastfeeding initiation (86%), but low rates of breastfeeding continuation and exclusivity (32% exclusive breastfeeding at 2 months).

Further, in 2009, NYC PRAMS breastfeeding data were used to guide aspects of a Public Health Detailing Kit on breastfeeding. The Public Health Detailing Program works with primary health care providers to improve patient care around key public health challenges. As part of the program, DOHMH representatives deliver brief, targeted messages to doctors, physician assistants, nurse practitioners, nurses, and administrators at their practice sites. The Detailing Kits, which contain clinical tools, resources for providers, and patient education materials, are distributed during site visits. In addition, PRAMS data about why mothers stop breastfeeding was used in developing educational materials for providers, as well as a Breastfeeding Guide for mothers.

Program Activity Outcomes

Preliminary data indicate that these programs are on their way in the mission to make breastfeeding the norm in NYC and have been successful in increasing breastfeeding initiation in the hospitals city wide from 54% to 80%, and exclusive breastfeeding in the hospitals from 15% to 29%, from 2004–2008.

In 2008, NYC implemented a similar initiative in Staten Island. NYC PRAMS data showed lower rates of breastfeeding initiation, continuation, and exclusivity in Staten Island as compared with other boroughs. This information was used to secure a $75,000 grant from the United Hospital Fund for each hospital in Staten Island to promote breastfeeding-friendly hospital practices, and Staten Island University Hospital received a Certificate of Intent to become a Baby-Friendly Hospital.

1 Summers C, Cohen L, Havusha A, Slinger F, Farley T. Take Care New York 2012: A Policy for a Healthier New York City. New York Department of Health and Mental Hygiene, 2009pdf iconexternal icon. Accessed July 28, 2011.