Community-based Infant Mortality Prevention/Reduction Projects Summary Report OKLAHOMA STATE DEPAR TMENT OF HEALTH/MATE RNAL AND CHILD HEALT H SERVICE December 31, 2013 Community-based Infant Mortality Prevention/Reduction Projects Summary Report Background Infant mortality is the death of a baby before its first birthday. The infant mortality rate (IMR) is defined as the number of infant deaths per 1000 live births. Although Oklahoma has seen a decline in the IMR since 2007 from 8.6 to 7.7 in 2012, there is still much to accomplish. On average in Oklahoma, approximately 400 infants die each year. Further, African American and Native American babies die at higher rates than White babies. The top three rankable causes of infant death in Oklahoma are: • Congenital malformations (medical condition present at birth) • Disorders related to short gestation (less than 37 weeks of completed pregnancy) and low birth weight (less than five pounds eight ounces) • Sudden Infant Death Syndrome (SIDS) A number of factors are associated with infant mortality such as maternal health, access to and quality of medical care, socioeconomic conditions, and public health practices. The Oklahoma State Department of Health (OSDH), along with many partners, is working to address these factors through the Preparing for a Lifetime, It’s Everyone’s Responsibility initiative. Multiple strategies are implemented through this statewide initiative to reduce infant mortality in Oklahoma, including community-based projects. Community-based Projects To increase reach with critical messages regarding ways to address the top three causes of infant mortality in Oklahoma, the OSDH extended an invitation to county health departments throughout the state to submit a budget and work plan to address infant mortality in their communities. Reaching out to communities also served as a follow-up strategy from the Oklahoma Leadership Summit on Infant Mortality conducted in October 2012. At the Summit, key leaders from across the state convened to learn about infant mortality and commit to taking action toward improving birth outcomes in Oklahoma. Community-based projects also provided opportunities to engage local partners in relevant activities and enhance the sustainability of the local work, with the overall intent of contributing to the reduction of infant mortality. The Oklahoma legislature supported the efforts of the community-based projects through funding to enhance and strengthen the infrastructure as well as address the issues that January 2014 contribute to the leading causes of infant death by focusing on preconception/interconception health and care, preterm birth, and infant safe sleep. Implementation An invitation was sent to County Health Department Regional Directors. Both rural and urban counties responded. Forty-eight of 77 counties, many of which have the highest infant mortality rates in the state, implemented community-based projects. A map identifying counties that implemented projects is presented below. Community -based Infant Mortality Reduction Projects Various activities were implemented by the community-based projects including local health events, such as community baby showers in which education and resources were provided to those who attended. Pregnant women, fathers, grandparents, adoptive parents, and care takers were among baby shower participants. A substantial minority population was reached through the baby showers held in both rural and urban areas across the state. Other activities included conducting presentations at local festivals on issues related to infant mortality such as the negative impact of smoking during pregnancy and the benefits of a smoke-free environment for babies. Other topics included infant safe sleep, infant injury prevention, the importance of a full-term pregnancy, and being healthy before and between pregnancies by specifically promoting folic acid to help prevent birth defects. Dissemination of educational materials was also a key activity. Materials developed by the Preparing for a Lifetime initiative, March of Dimes, and the Tobacco Settlement Endowment Trust (Oklahoma Tobacco Helpline) were among the informative resources distributed to thousands of individuals. January 2014 Social media was utilized to disseminate relevant educational messages through Facebook, Twitter, and Pinterest. Text4baby, a free text messaging service that provides health-related text messages on topics such as nutrition, prenatal care, labor and delivery, immunizations, and breastfeeding, was also promoted. Many pregnant women enrolled in Text4baby during the community baby showers. Local media campaigns were launched from March through September that included billboards, public service announcements on radio, television, and in movie theatres, as well as newspaper ads and inserts providing key messages and publicizing local baby showers. Multiple creative pieces were developed to meet specific needs of the community-based projects but will also be utilized for the overall Preparing for a Lifetime initiative. An inventory of products is available for use by local and state level partners. A report generated by VI Marketing and Branding (VI), the media contractor for the Preparing for a Lifetime initiative, is attached as Appendix A and provides details on local media campaigns. According to the report, local media campaigns coordinated by VI achieved an estimated 34,246,000 impressions. “Impressions” is defined as an estimate of the average audience that sees or hears the message. Evaluation Both process measures and short-term outcomes were noted regarding the community- based projects. Local activities were conducted that would not have been possible without the support provided at the state level. Populations were reached that would likely not have received the education and resources offered during community health events, in particular the community baby showers that were hosted in low-income rural areas. The magnitude of reach accomplished through the local media campaigns surpassed expectations. Millions of Oklahomans were exposed to messages geared toward preventing infant mortality. Short-term outcomes included an increased understanding of issues related to infant mortality as reported by participants of local health events. Partnerships with local groups were initiated and/or strengthened regarding the planning and implementation of local activities. Some of the partners include faith-based organizations, medical professionals, tribal entities, education, media outlets, local businesses and more. We also learned that community efforts will contribute to the sustainability of messages and activities to prevent infant mortality. Many of the projects indicated that community baby showers will become annual events. Some challenges were experienced through implementation of the projects. For example, some project coordinators communicated that the process was somewhat cumbersome because several entities were involved in the approval of activities. Also, no January 2014 incentives were provided with the legislative funding. However, this proved to be a positive point as local partners demonstrated their support by providing incentive items for health fairs and baby showers. Media products were specifically tailored based upon local feedback. As a result, billboard language was shortened and clarified resulting in a more streamlined, effective message. Successes noted as a result of the community projects are numerous. Communities experienced sizeable participation at community health events, including baby showers, which provided an opportunity to directly educate hundreds of individuals on issues related to infant mortality. Additionally, participants included populations and areas with high infant mortality rates and expanded beyond pregnant women to include fathers, grandparents, and others. When participants were asked on post-event surveys how they will use the information presented, some of the participant comments included, “be better prepared for my first born” (21-year-old female), “to take care of my baby” (18-year-old male), and “to take care of my grandbabies” (46-year-old female). Future Steps To help maintain the momentum initiated through the community-based projects, continued support will be provided in the form of technical assistance, educational resources, on-site presentations, and more. Infant Mortality Awareness Month will continue to be recognized through local activities each September. Products, e.g., public service announcements, will continue to be developed and an inventory of products will be maintained for use at the local level. Finally, regular contact will continue with local projects to learn about challenges and successes and approaches for continued support and success. Conclusion In order to impact Oklahoma’s infant mortality rate, multiple strategies must take place at multiple levels – both state and local. The community-based projects achieved successes beyond initial expectations. Communities enthusiastically committed to addressing infant mortality locally. Awareness of the issue was raised. Partners were engaged in and supportive of local efforts. The diversity of local partnership was expanded to include non-traditional partners. And sustainability of efforts, e.g., local media campaigns and baby showers, is enhanced. In summary, the community-based projects to prevent/reduce infant mortality proved to be a warranted investment in the health and well-being of Oklahoma’s