General Release Notes
In 2020 we started using the 2014+ version of mother's education level. This means that data from prior to 2014 is no longer available on the site. If you need a report with pre-2014 education level data, please contact HHDW.
Also, in 2020 we added three new sub-categories to better organize the indicators: Oral Health (under the During Pregnancy category), Postpartum Care (under the After Pregnancy category), and Preconception Health Care (under the Before Pregnancy category).
New PRAMS indicators in 2020There are several new indicators available:
- Birth control - any at conception
- Breastfeeding information - from another source
- Breastfeeding information - from baby's doctor
- Breastfeeding information - from family or friends
- Breastfeeding information - from hotline
- Breastfeeding information - from lactation specialist
- Breastfeeding information - from mother's doctor
- Breastfeeding information - from nurse, midwife or doula
- Breastfeeding information - from support group
- Chronic disease - asthma during pregnancy
- Chronic disease - depression during pregnancy
- Chronic disease - PCOS before pregnancy
- Complications - eclampsia
- E-cigarettes - smoked 3 months before pregnancy
- E-cigarettes - smoked last 3 months of pregnancy
- E-cigarettes - smoking 3-6 months after pregnancy
- HCW - asked about type of work before pregnancy
- HCW - asked if down or depressed before pregnancy
- HCW - asked if they smoked cigarettes before pregnancy
- HCW - asked if they were hurt emotionally or physically before pregnancy
- HCW - talked about birth control before pregnancy
- HCW - talked about controlling medical conditions before pregnancy
- HCW - talked about having children before pregnancy
- HCW - talked about improving health before pregnancy
- HCW - talked about maintaining healthy weight before pregnancy
- HCW - talked about sexually transmitted infections before pregnancy
- HCW - tested them for HIV before pregnancy
- HCW - told to take vitamin with folic acid before pregnancy
- Health care - any visit in 12 months before pregnancy
- Health care - fam planning/birth cntrl visit in 12 months before pregnancy
- Health care - family doctor visit in 12 months before pregnancy
- Health care - illness/chronic condition visit in 12 months before pregnancy
- Health care - injury visit in 12 months before pregnancy
- Health care - mental health visit in 12 months before pregnancy
- Health care - OB/GYN visit in 12 months before pregnancy
- Intention - trying to get pregnant at conception
- Marijuana - used before pregnancy
- Marijuana - used during pregnancy
- Marijuana - used since delivery
- Oral health - dental clinic visit during pregnancy
- Oral health - knew teeth and gum care importance
- Oral health - teeth cleaned after pregnancy
- Oral health - teeth cleaned before, during or after pregnancy
- Oral health barriers - cost
- Oral health barriers - practice accepting Medicaid
- Oral health barriers - practice accepting pregnant women
- Oral health barriers - thought unsafe during pregnancy
- Physical abuse - by anyone 12 mos before pregnancy
- Physical abuse - by anyone during pregnancy
- PNC - asked about abuse by HCW
- PNC - asked about alcohol use by HCW
- PNC - asked about breastfeeding by HCW
- PNC - asked about cigarette smoking by HCW
- PNC - asked about depression by HCW
- PNC - asked about drug use by HCW
- PNC - asked about post partum birth control by HCW
- PNC - asked by HCW if want HIV test
- PNC - discussed prescription meds with HCW
- PNC - discussed weight gain with HCW
- PNC - received early and adequate prenatal care (2016+)
- PPV - asked if down or depressed
- PPV - asked if they smoked cigarettes
- PPV - asked if they were being hurt emotionally or physically
- PPV - birth control discussion
- PPV - healthy eating, exercise and weight loss
- PPV - inserted birth control
- PPV - prescribed birth control
- PPV - tested for diabetes
- PPV - timing next pregnancy
- PPV - told to take vitamin with folic acid
- SHS - lived with a cigarette smoker during pregnancy
- SHS - lives with a cigarette smoker
- Sleep - alone, in room with mother
- Sleep - alone, past 2 weeks
- Sleep advice - items in bed with baby
- Sleep advice - place baby in a crib
- Sleep advice - place baby on back
- Sleep advice - place crib in mother's room
- Sleep where - couch, sofa or armchair
- Sleep where - crib, bassinet or pack and play
- Sleep where - in a crib with bumper pads
- Sleep where - in a sleeping sack or wearable blanket
- Sleep where - infant car seat or swing
- Sleep where - twin or larger mattress or bed
- Sleep where - with a blanket
- Sleep where - with toys, cushions, or pillows
- Tdap shot - received during pregnancy
The number of completed interviews for the 2019 survey is smaller than normal. The first 6 months of PRAMS 2019 data collection did not meet CDC's data quality standards due to issues with the data collection contractor. These issues were resolved, and the last 6 months met the CDC quality standards and the response rate requirement for weighted data. CDC recommended only releasing the 6-month dataset containing July - December births. Note: with the 2020 data load HHDW applied a constant multiplier (2) to the final weights in 2019 so that the counts and average annual estimated population will more accurately reflect a full year of births.
Because the sample size for 2019 is considerably smaller, many indicators may not be reportable for 2019. In these cases, users should consider aggregating years or reducing the number of filters selected to improve reliability and availability of the data.
Due to extenuating circumstances, PRAMS data collection operations were interrupted during the 2017 and 2018 calendar years. There is no survey data from this time period.
New Demographics categoryWe introduced a new demographics category in this release. This section allows users to view detailed information about the PRAMS population. Please note that some of the demographic information is self-reported by the mother, and some comes directly from the birth certificate. The source of the data can be found by hovering over the question mark by the indicator selection title and under the Question Wording sub-heading in the Data Notes section of the indicator report.
Two new dimensions are now available
- Gestational age, which comes from the birth certificate and is categorized as early preterm (<32 weeks), preterm (32-36 weeks), normal term (37-41 weeks) and post term (42+ weeks).
- Birthweight, which comes from the birth certificate and is categorized as low (<2,500 grams), normal (2,500-3,999 grams), or high (4,000+ grams).
New PRAMS indicators in 2016There are several new indicators available:
- Chronic disease - asthma before pregnancy
- Chronic disease - depression before pregnancy
- Chronic disease - thyroid problems before pregnancy
- Contraception after pregnancy - tubal ligation or vasectomy
- Contraception after pregnancy - used IUDs or implants
- Contraception after pregnancy - used pills, shots, rings or patches
- Contraception after pregnancy - used condoms
- Contraception after pregnancy - natural planning or withdrawal
- Contraception after pregnancy - abstinence
- Intention - intended pregnancy (2012+)
- Intention - pregnancy intention (2012+)
- Flu shot - offered by HCW in the 12 months b/f delivery
- Flu shot - received in the 12 months b/f delivery
- Oral health - dental visit for problem during pregnancy
- Oral health - dental insurance during pregnancy
- Infant - delivery type
- Infant's sex
- Mother's county of residence
- Mother's Census race
- Mother's DOH race-ethnicity
- Mother's program race
- Mother's education level
- Mother's ethnicity - Hispanic or Latina
- Mother's marital status
- Mother's poverty level (2 level): 0-185%, 186+%
- Mother's poverty level (3 level): 0-130%, 131-185%, 186+%
- Mother's poverty level (4 level): 0-100%, 101-185%, 186-300%, 301+%
- Mother's PRAMS age group: <20, 20-24, 25-34, 35+
- Mother's reproductive age group: 18-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45+
The primiparous dimension is not available in 2015 due to irregularities with the underlying data.
Mother's education level - this dimension comes from the birth certificate form. In 2014, the State of Hawaiʻi transitioned to a new birth certificate form and this transition resulted in irregularities in this data field. Accordingly, mother's education will only be used from 2014 forward, as the data cannot be trended with previous years. Starting in 2020, we switched to using the 2014+, so the old data is no longer available on the web site. If you need pre-2014 data please contact HHDW.
Race/Ethnicity DataThe birth certificate allows for up to 4 race/ethnicities to be captured for both the mother and the father. The DOH Office of Health Status Monitoring (OHSM) uses the following algorithm to code a single race/ethnicity for each individual. Ethnicity of the child is based on the ethnicity of the father. It is based on the ethnicity of the mother when the ethnicity of the father is unknown.
Only one ethnicity is coded from the actual certificates. If more than one ethnicity is listed on the certificate, the following rules apply:
1. If Hawaiian is one of the multiple ethnicities listed, Part-Hawaiian is coded.
2. If a non-Caucasian ethnicity is listed with a Caucasian ethnicity, the non-Caucasian ethnicity is coded.
3. If there is more than one non-Caucasian ethnicity listed, the first one is coded.
4. If there is more than one Caucasian ethnicity listed, the first one is coded.
In HHDW, the most granular level is the program race/ethnicity (PRG) which rolls up into the DOH standard race/ethnicity (DOH), which rolls up into Census race reporting categories (Census). The table below illustrates how the data is aggregated.
|Source Race/Ethnicity||Program Race/Ethnicity (PRG)||DOH Race/Ethnicity (DOH)||Census Race (Census)|
|Asian Indian||Asian Indian||Other Asian||Asian|
|Black||Black||Black||Black or African American|
|Guamanian||Guamanian||Other Pacific Islander||Native Hawaiian and Other Pacific Islander|
|Hawaiian||Hawaiian||Native Hawaiian||Native Hawaiian and Other Pacific Islander|
|Part Hawaiian||Part Hawaiian||Native Hawaiian||Native Hawaiian and Other Pacific Islander|
|Indian||Indian||Native Alaskan/American Indian||Native Alaskan/American Indian|
|Puerto Rican||Puerto Rican||Other||Other|
|Samoan||Samoan||Other Pacific Islander||Native Hawaiian and Other Pacific Islander|
DocumentationDocumentation is available here to describe how we collect and map race/ethnicity, geography, and poverty level.
HHDW Race/Ethnicity Documentation
HHDW Geography Documentation
HHDW Poverty Level Documentation
Kotelchuck Index DocumentationThe Kotelchuck Index, also called the Adequacy of Prenatal Care Utilization (APNCU), uses two crucial elements obtained from birth certificate data-when prenatal care began (initiation) and the number of prenatal visits from when prenatal care began until delivery (received services). The Kotelchuck index classifies the adequacy of initiation as follows:
- pregnancy months 1 and 2,
- months 3 and 4,
- months 5 and 6,
- and months 7 to 9
with the underlying assumption that the earlier prenatal care begins the better. To classify the adequacy of received services, the number of prenatal visits is compared to the expected number of visits for the period between when care began and the delivery date. The expected number of visits is based on the American College of Obstetricians and Gynecologists prenatal care standards for uncomplicated pregnancies and is adjusted for the gestational age when care began and for the gestational age at delivery.
A ratio of observed to expected visits is calculated and grouped into four categories:
- Inadequate (received less than 50% of expected visits),
- Intermediate (50%-79%),
- Adequate (80%-109%),
- Adequate Plus (110% or more).
The final Kotelchuck index measure combines these two dimensions into a single summary score. The profiles define adequate prenatal care as a score of 80% or greater on the Kotelchuck Index, or the sum of the Adequate and Adequate Plus categories. The Kotelchuck Index does not measure the quality of prenatal care. It also depends on the accuracy of the patient or health care provider's recall of the timing of the first visit and the number of subsequent visits. The Kotelchuck Index uses recommendations for low-risk pregnancies, and may not measure the adequacy of care for high-risk women. The Kotelchuck Index is preferable to other indices because it includes a category for women who receive more than the recommended amount of care (adequate plus, or intensive utilization).
The rate of this number is per 100 live births where prenatal care adequacy using the Kotelchuck Index was known. Additional information on the Kotelchuck Index can be found here: OVERVIEW OF ADEQUACY OF PRENATAL CARE UTILIZATION INDEX