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PRAMS Data Release Notes

General Release Notes

2020 PRAMS

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 2020

There are several new indicators available:

2019 PRAMS

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.

2017-2018 PRAMS

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.

2016 PRAMS

New Demographics category

We 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

New PRAMS indicators in 2016

There are several new indicators available:

2015 PRAMS

The primiparous dimension is not available in 2015 due to irregularities with the underlying data.

2014 PRAMS

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.

All Years

Race/Ethnicity Data

The 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:
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.

Race/Ethnicity Classifications
Source Race/EthnicityProgram Race/Ethnicity (PRG)DOH Race/Ethnicity (DOH)Census Race (Census)
Asian IndianAsian IndianOther AsianAsian
BlackBlackBlackBlack or African American
GuamanianGuamanianOther Pacific IslanderNative Hawaiian and Other Pacific Islander
HawaiianHawaiianNative HawaiianNative Hawaiian and Other Pacific Islander
Part HawaiianPart HawaiianNative HawaiianNative Hawaiian and Other Pacific Islander
IndianIndianNative Alaskan/American IndianNative Alaskan/American Indian
KoreanKoreanOther AsianAsian
Puerto RicanPuerto RicanOtherOther
SamoanSamoanOther Pacific IslanderNative Hawaiian and Other Pacific Islander
VietnameseVietnameseOther AsianAsian


Documentation 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 Documentation

The 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:

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:

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

Other Information

Note about indicator/dimension changes:

The PRAMS is constantly changing. HHDW staff carefully review the PRAMS survey instrument each year to assess how changes in the survey instrument impact indicators and dimensions within the HI-IBIS system. If you have questions, check the Question Wording in the Data Notes section of the report.