PRAMS Dataset Details

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Overview of PRAMS in Colorado

PRAMS (Pregnancy Risk Assessment Monitoring System) is a population-based risk factor surveillance system designed to identify and monitor behaviors and experiences of women before, during, and after pregnancy. In September of 1996, the Colorado Department of Public Health and Environment was awarded a grant from CDC to establish PRAMS in Colorado, and data collection began in the spring of 1997.

Colorado continues to have one of the highest low birth weight rates in the nation for total births and for births in all major racial and ethnic groups. PRAMS provides a method for the collection and analysis of perinatal data to better understand not only low birth weight rates, but also maternal behaviors, access to prenatal care, pregnancy intendedness, and health care delivery to women and infants in Colorado. Ultimately, PRAMS data can assist Colorado in evaluating and improving services to women and infants so that poor pregnancy outcomes can be prevented.

PRAMS Survey Topics

The PRAMS questionnaire is mailed to a sample of Colorado women each month. Participants complete the surveys and return them to the health department where all answers are grouped to provide data for the entire state. The core set of questions and the questions developed specifically for Colorado collect information on many topics, including:

• attitudes and feelings about pregnancy
• prenatal care and barriers to care
• obstetric history
• psychosocial support and stress
• alcohol and tobacco use
• pregnancy-related morbidity
• infant health care
• economic status of the mother
• home safety and injury prevention
• health care coverage during pregnancy and delivery

PRAMS Data Collection and Analysis

PRAMS uses a combination of two data collection approaches: mailings of the surveys and telephone follow-up with women who do not return the survey by mail. The written questionnaires and telephone interviews can both be completed in English or Spanish. Approximately 240 women in Colorado receive the survey each month, with an expected response rate of at least 70 percent.

Data collected from women who gave birth in a given year are generally available for analysis and dissemination by late summer of the following year. Demographic and outcome information—maternal age, race, ethnicity, education, marital status, and infant birth weight—used as stratification variables, were obtained from Colorado’s birth certificate data. The PRAMS-eligible population in Colorado excludes non-resident mothers, out-of-state births to Colorado residents, infants given up for adoption, multiple births of four or more, and women less than 15 years of age. In addition, only one infant is selected from twin or triplet births.

Small numbers

Due to the relatively low number of surveys completed each year, multiple years may need to be combined to have more stable estimates, especially for county-level estimates. Since not all questions are asked each year, some estimates are based on only one year of data. Estimates are not provided for counties with fewer than 50 respondents for any given question.

Weighting

In Colorado, the sample is stratified by region of residence (Denver Metro, Other Metro, Rural) and birth weight (low, adequate) to ensure an adequate sample in the rural and low birth weight categories. The sample data is weighted to adjust for sampling probabilities, nonresponse, and noncoverage. For each respondent, the initial sampling weight is the reciprocal of the sampling fraction applied to the stratum. Nonresponse adjustment factors attempt to compensate for the tendency of women having certain characteristics (such as being unmarried or of a lower education) to respond at lower rates than do women without these characteristics. The frame noncoverage weights are derived by comparing the frame files for a year of births created by PRAMS with the calendar year of births file produced by Vital Records. Omitted records are usually due to late processing of the birth certificate. Multiplying together the sampling, nonresponse, and noncoverage weights yield the analysis weight. The weighted data can be interpreted as the number of women in Colorado who have characteristics similar to those of the respondent.

Confidence Intervals

The prevalence estimates reported on CoHID estimate the percent of all Colorado women who gave birth in any given year who exhibit certain behaviors (e.g., 10.2 percent of Colorado women who gave birth smoked during pregnancy in 2000). Since the estimates are based on a sample and not the entire population, there is some error. Confidence intervals take this error into account and present a range in which the “true value” is likely to fall (e.g. between 8.6 and 11.8 percent of Colorado pregnant women smoked during pregnancy in 2000).

Interval width is influenced both by the degree of certainty sought (e.g., 95 percent versus 99 percent certainty) and the standard error. A high degree of certainty (e.g. 99 percent) increases interval width, as does a small sample size. Wide confidence intervals are associated with less reliable estimates and should be interpreted with caution.

Definitions

Birth Weight: The first weight of the fetus or newborn obtained after birth. This weight preferably is measured within the 1st hour of life, before a significant postnatal weight loss has occurred.

Live Birth: The complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy, which, after such separation, breathes, or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached; each product of such a birth is considered live born. PRAMS data on CoHID are for live births only.

Low Weight Birth: Birth weight of less than 2,500 grams (less than 5lb 9oz).
Medicaid Recipient: Respondent having indicated that Medicaid helped pay for the expenses of prenatal care.

Multiple Birth: More than one child born resulting from a single pregnancy. Also called plural birth.

Premature Birth: Birth occurring prior to 37 completed weeks of gestation, but after that stage of viability at about 20 weeks gestation.

Prenatal Care: Medical care during pregnancy before birth. First trimester prenatal care is pregnancy related medical care received during the first trimester or first 3 months of pregnancy.

Singleton: Single birth.

Term: Births occurring between 37 and 41 completed weeks of gestation (259-293 days).

Trimester: A 3-month period of time. First trimester care, for example, refers to care initiated in the 1st three months of pregnancy.

WIC: Supplemental program for Women, Infants and Children. WIC is a nutrition program for low-income pregnant, and/or breastfeeding women, postpartum non-breastfeeding women (up to 6 months postpartum), infants and children up to 5 years of age.

Health Statistics Regions

These 21 Health Statistics Regions (HSRs) are aggregations of counties developed by the Health Statistics Section of the Colorado Department of Public Health and Environment (CDPHE) in partnership with state and local public health professionals. The HSRs were developed using statistical and demographic criteria. More information on the 21 HSRs is available by contacting Alyson Shupe, Health Statistics Section, CDPHE at health.statistics@state.co.us.

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