Louisiana: Investigating the contribution of birth weight to infant mortality across Louisiana
State: LA

Skill Area: Data Analysis and Monitoring

Internship summary
The Maternal and Child Health (MCH) Program in the State of Louisiana Department of Health and Hospitals serves to assure access to primary and preventive health care services for pregnant women, women of childbearing age, infants, children, and youth in Louisiana. The Louisiana MCH Program strives to identify leading causes and risk factors of morbidity and mortality among women and children in order to create targeted public health campaigns to prevent negative health outcomes and promote prevention and healthy lifestyles. The MCH Program offers a multi-disciplinary team approach to using data driven decisions to guide program activities. Within the MCH Program, the MCH Epidemiology Unit, staff by five full-time epidemiologists, provides superior support and expertise on data use, analysis, and translation for all MCH staff and partners. As part of that effort, the Louisiana State Systems Development Initiative (SSDI) provides specific focus on data linkages. The MCH Program is located in downtown New Orleans amidst the Central Business District and only two blocks away from the Medical District, where two Schools of Public are located (Tulane and LSU). This physical proximity to public health resources and leaders enables strong partnerships and continual collaboration.

Purpose
Louisiana consistently ranks among the worst US states for high infant mortality, therefore analytic projects to drive program and policy decisions are crucial. In 2002, the MCH program initiated the Louisiana Infant Mortality Reduction Initiative to address high infant mortality rates across the state. In 2004, phase 1 Perinatal Periods of Risk (PPOR) analyses using period linked data were completed for the time periods 1997-99 and 2000-02. In late 2009, phase 1 PPOR analyses using cohort linked data (the preferred method) were completed for the State of Louisiana overall and each of its nine Public Health Regions time periods 1997-99, 2000-02, and 2003-05. These results were successfully shared with communities across Louisiana as part of the 2010 Title V needs assessment process. PPOR recommendations suggest the continuation of analytic techniques after the completion of phase 1 analyses to further guide interventions and community planning.
The overarching purpose of this internship is to assist the Louisiana MCH Program with completion of selected phase 2 analyses using the PPOR approach. In order to begin to identify causal pathways or biologic mechanisms for excess fetal and infant mortality, a methodology known as the Kitagawa formula can be used to partition excess mortality in the two components of birth weight distribution and birth weight specific mortality. Depending on which component contributes more heavily to the mortality experience in the geographic region under study, specific recommendations can be made for potential interventions to help reduce future mortality.

Goals
Specific goals for the intern include:
1. To learn about the Perinatal Periods of Risk (PPOR) approach by
- reviewing examples of PPOR phase 1 and phase 2 analyses from other cities and states;
- learning how to complete the analytic portion of the Kitagawa methodology; and
- translating the findings into useful community level presentations
2. To become familiar with vital records data, including mastering skills to appropriately manipulate data using SAS software;
3. To become familiar with data linkage methodology and techniques;
4. To advance writing and oral presentation skills through a summary report and oral presentation to stakeholders.

Objectives
Specific objectives include:
1. Use 2003-2005 cohort linked data to calculate Kitagawa tables and graphs to evaluate birth weight specific mortality and birth weight distribution components for the State of Louisiana and each of the nine Public Health Regions.
2. Demonstrate competency in understanding data linkage by writing an appropriate data linkage section in the final report.
3. Summarize finding in the form of a written report and powerpoint presentation. Each summary should include a discussion of regional comparisons highlighting any differences found between communities.
4. Work with MCH epidemiology and program staff to create appropriate recommendations based on analysis results.
5. Present data and recommendations to at least one stakeholder group.

Data or analytic tasks and activities involved
The main focus of the internship will be to learn the basic and advanced PPOR methodology and complete the specific advanced PPOR data analysis proposed. The intern will use Louisiana Vital Records cohort linked data from 2003-2005 to complete the specified state-wide and regional PPOR analyses. A pre-linked data-set is available, although the intern will have the opportunity to learn data linkage (birth – death), data concatenation (birth-death to fetal death), and data manipulation skills if desired. Data translation competency will be demonstrated through the summary oral and written reports.

Required data or analytic skills
A successful intern will be proficient in Microsoft Excel, and preferably SAS (although SPSS is also acceptable for this project). The primary skills required for this internship include proficiency in data manipulation, including recoding existing data into new categories. Advanced analytic methods specific to this project and the PPOR methodology will be presented as part of the internship experience.

Begin date
05/17/2010

Housing assistance available?
Short-term housing is available in the area and we can provide some options to consider if requested.

Public transportation available?
Public Transportation available via streetcar and bus line from some locations within Orleans Parish, otherwise a car is needed.