PRAMS Data Release Notes

General Release Notes

2021 PRAMS

Race/Ethnicity Title Changes

With the 2021 data load we made a couple of changes to the race/ethnicity titles, to be consistent across data sets and years. Now, we are using "White" and "American Indian or Alaska Native" as category titles.
There were no new indicators or other changes with the 2021 PRAMS survey, since the survey is the same as the one completed in 2020.

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:

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

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

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 2016

There 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+

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/Ethnicity	Program Race/Ethnicity (PRG)	DOH Race/Ethnicity (DOH)	Census Race (Census)
American Indian	American Indian	American Indian or Alaska Native	American Indian or Alaska Native
Asian Indian	Asian Indian	Other Asian	Asian
Black	Black	Black	Black or African American
Chinese	Chinese	Chinese	Asian
Cuban	Cuban	Other	Other
Filipino	Filipino	Filipino	Asian
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
Japanese	Japanese	Japanese	Asian
Korean	Korean	Other Asian	Asian
Other Asian	Other Asian	Other Asian	Asian
Mexican	Mexican	Other	Other
Portuguese	Portuguese	White	White
Puerto Rican	Puerto Rican	Other	Other
Samoan	Samoan	Other Pacific Islander	Native Hawaiian and Other Pacific Islander
Vietnamese	Vietnamese	Other Asian	Asian
White	White	White	White

Documentation

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:

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

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.