West Virginia OMCFH used data and information provided from various programs, advisories, data sources and stakeholders to inform the priority needs selection for the 2020 Needs Assessment.  Priority needs were selected based upon the findings from collected data and ranking of selected National Performance Measures by staff and stakeholder groups.  Capacity, existing resources, feasibility and potential impact were all considered when selecting the priority needs.  In addition, while the identified needs are aligned with the larger public health focus in West Virginia, Title V remains unique in its focus on maternal and child health, including children with special health care needs, population groups.  

Based upon findings from the 2020 Needs Assessment, West Virginia chose the following priority need areas for 2020-2025:

1. Smoking in pregnancy and smoke exposure in the home
2. Infant mortality
3. Preterm birth
4. Injury – specifically bullying and suicide (attempted)
5. Substance use in pregnancy and in youth/teens
6. Breastfeeding initiation and duration
7. Medical home
8. Obesity in children
9. Oral health in pregnancy
10. Transition

Discussed below are the impacts WV has made in the selected priority areas over the last year despite challenges of the COVID pandemic, the ongoing drug epidemic and changes in Bureau leadership.

Smoking – Maternal

Tobacco use remains high across all WV populations, but most alarmingly in pregnant women. Maternal smoking during pregnancy can result in multiple adverse consequences for the neonate, such as preterm birth, low birth weight, and birth defects.

PRAMS examined the smoking habits of WV women before and during pregnancy. Respondents were asked if they smoked any cigarettes in the three months prior to pregnancy and the last three months of pregnancy. Those mothers who responded they smoked during either time-periods were asked additional questions about their smoking habits during the perinatal period. While 10.3% of women in 2021 smoked during the last trimester of pregnancy, this is lower than the 24.9% of women that reported smoking in the three months before pregnancy in 2018.

Maternal smoking three months before pregnancy is most common among mothers at or below 100% Federal Poverty Level (PFL), those who receive Medicaid, and those with less than a high school degree; an alarming 36.7%% and 20.6%of those mothers without a high school degree reported smoking in the 3 months before pregnancy and the last trimester of pregnancy, respectively, in 2021. A higher percentage of mothers who had a low-birth-weight newborn reported preconception smoking than those with a normal birth weight newborn. Though fewer women reported smoking in the last trimester of pregnancy, the demographic trends are like those who reported smoking before pregnancy.

Smoking - Home Exposure

Infants are particularly vulnerable to the effects of second- and third-hand smoke because they are still developing physically, have higher breathing rates than adults, and have little control over their indoor environments and thus cannot escape exposure to smoke. Infants exposed to high doses of secondhand smoke are at greater risk of developing serious health effects such as asthma, pneumonia, ear infections, and SUID.

PRAMS data showed that the number of homes with infants where smoking was allowed decreased from 8.5% in 2019 to 4.9% in 2020. In 2021, smoking was allowed in at least part of the home in less than 2% (1.87%) of homes.

Infant Mortality

Infant mortality is the result of a complex set of biological and social factors, and infant deaths have long been viewed as an important indicator of a population’s health. The three leading causes of infant death in West Virginia are in line with the leading causes of infant death in the U.S.: prematurity, birth defects, and sudden unexplained infant death.

The most recent calendar year data available from the Infant and Maternal Mortality Review Panel is 2017, the Panel has met and reviewed infant deaths for 2018, has plans to review 2019 and 2020 before end of year and will have the calendar year report ready for the 2024 legislative session.  For calendar year 2017, 133 infant deaths were reviewed by the IMMRP.  The manner of death was listed as 88 (66%) natural, 36 (27%) undetermined, three (2%) homicide and six (5%) accidentals.

The infant mortality rate for West Virginia in 2017 was 7.12 infant deaths per 1,000 live births (calculated as 133 infant deaths divided by 18,679 resident births - 2017 Health Statistics Center data). In 2018, the CDC reported the U.S. infant mortality rate as 5.81 infant deaths per 1,000 live births.

Premature Birth

The West Virginia Health Statistics Center reports preliminary data from 2021 showing 12.8% of births were preterm. This was a slight increase in overall preterm births from 2020, which was reported as 12.0%.

Bullying and Suicidal Behaviors (middle school)

The 2019 and 2021 West Virginia Youth Risk Behavior Survey revealed the following trends of bullying and suicidal behaviors reported by WV middle school students. There were slight increases/decreases (not significant) reported in all the listed areas.

Bullying and Suicidal Behaviors (high school)

The 2019 and 2021 West Virginia Youth Risk Behavior Survey revealed the following rates of bullying and suicidal behaviors reported by WV high school students.  There were slight increases/decreases (not significant) reported in all the listed areas.

Substance use in pregnancy.

Substance use and overdoses are national public health issues but are particularly widespread in WV.  OMCFH funded early research into and service provision to address the opioid crisis. In 2009, a “Cord Blood Drug Study” was sponsored by the OMCFH using Title V funds to assess the prevalence of maternal substance abuse. According to the study, the prevalence of drug use in pregnancy appeared to be increasing, based on increasing numbers of infants diagnosed with NAS. Eight hospitals across WV collected cord blood samples anonymously from infants and all samples were tested for methamphetamine, cocaine, cannabinoids, opiates, methadone, benzodiazepines, buprenorphine, and alcohol. Evidence of drugs or alcohol was found in 19% of the samples. This study supported the theory that WV had a greater number of women using drugs and/or alcohol during pregnancy than was previously estimated. 

In 2011, the OMCFH partnered with the Perinatal Partnership to develop the Drug Free Moms and Babies (DFMB) project, to support pregnant and postpartum women on their journey to recovery from substance use disorder (SUD). The DFMB Project is a comprehensive and integrative medical and behavioral health program for pregnant and postpartum women. The project supports healthy baby outcomes by providing prevention, early intervention, addiction treatment, and recovery support services. In 2012, the West Virginia Perinatal Partnership awarded funding to four pilot project sites. Since 2018, the Drug Free Moms and Babies Project has expanded to twelve additional facilities.

The federal Child Abuse Protection and Treatment and Comprehensive Addition and Recovery Acts (CAPTA/CARA) of 2016 requires WV Hospitals to report a newborn that is affected by maternal substance use to the child welfare system. While SUD alone is not cause for removal, Child Protective Services is required to open a case, which may eventually result in infant or child removal from the home and placement into state care. Thus, maternal substance use impacts the foster care system, which has been overwhelmed by the effects of the opioid crisis and currently serves over 7,000 children at any given time.

In 2022, MRS indicated 7.0% of pregnant respondents reported a problem with drugs or alcohol currently and 8.6% reported problem with drugs or alcohol in the past. In 2021, 6.6% of pregnant respondents reported a problem with drugs or alcohol currently and 8.0% reported problem with drugs or alcohol in the past. MRS also found that, of those PRSIs submitted in 2022, 2.3% reported current opioid abuse treatment and 1.6% reported previous opioid abuse treatment. In 2021, 1.8% reported current opioid abuse treatment and 1.3% reported previous opioid abuse treatment. 

The Birth Score Program collects incidence of intrauterine substance exposure (IUSE) and signs of NAS in infants through the Birth Score collection tool. Every baby born in the state receives a birth score as mandated by state code. The percent of infants with IUSE has hovered just below 14% from 2017 to 2022 and the percent of infants born with signs of NAS has decreased from 5.48% to 4.87% in 2022.

Substance use in youth/teens

West Virginia continues to experience some of the highest national averages of substance use morbidity and mortality based on its population.  These substances use behaviors can develop in youth and adolescence, making prevention and intervention at a young age critically important in our state.

The most recent data available (2021) from the Youth Risk Behavior Surveillance System (YRBSS) indicates that some areas of alcohol and other drug use are more likely in West Virginia than in the United States.  Specifically, West Virginia high school respondents were more likely to: report that the largest number of drinks they had in a row was 10 or more (WV – 3.6% v. US – 2.7%); ever use synthetic marijuana (WV – 6.3% v. US – 6.5%); ever use methamphetamines (WV – 0.8% v. US – 1.8%); and ever injected any illegal drug (WV – 1.3% v. US – 1.4%).

Looking at WV 2021 YRBSS data comparing males and females, female respondents were more likely to: ever used cocaine (female – 4.0% v. male – 0.8%); ever used methamphetamines (female – 1.1% v. male – 0.4%); ever used ecstasy (female – 3.3% v. male – 5.8%); and ever took prescription pain medicine without a doctor’s prescription or differently than how a doctor told them to use it (female – 17.7% v. male – 7.0%).

Analysis of data from West Virginia’s Prescription Drug Monitoring Program (PDMP), also known as the Controlled Substance Monitoring Program (CSMP), shows that adolescent males ages 5-17 were more likely than females (13%, 7%) to have been prescribed a stimulant in 2022. According to the 2021 National Survey on Children’s Health, this number is considerable higher than the national average (males-7.2%, females-3.5%). Additionally, in some counties in the states, the prescribing of stimulants greatly exceeds the prevalence of ADD/ADHD in the population, specifically for males. The state saw an increase in stimulant prescribing from 2021-2022 for both males and females ages 5-17 with a percent increase of 4.6% and 5.3% respectively. This analysis will be continued to identify potentially inappropriate prescribing among prescribers to adolescents who do not have a corresponding ADD/ADHD diagnosis.

Breastfeeding Initiation and Duration

The National Immunization Survey 2022 Breastfeeding Report Card (based up 2019 births) indicates WV’s ever breastfed rate at 59.8%.  The WV Health Statistics Center reports infants breastfeeding at time of discharge after delivery as 66.7% in 2021 and 70.5% in 2022 (provisional).  The report card also lists WV’s total mPINC score for 2020 at 80, compared to the US National score of 81.

In 2021, WV PRAMS indicates that 70.6% of women ever breastfed and only 49.9% of women were breastfeeding at the time of the survey (4-6 months postpartum).  Among women who weren’t breastfeeding at the time of the survey, around 12.7% of women indicated they breastfed for less than a week, compared to the 44.9% that breastfed greater than 8 weeks.

Medical Home and Transition

In the 2020/2021 combined Survey of Children’s Health data, only 43.3% of CSHCN in WV reported receiving coordinated, ongoing, comprehensive care within a medical home.  This is slightly up from 41.9% in 2019/2020, but within the 95% confidence interval.  Sixty-two-point five percent of CSHCN in WV received needed care coordination.  The CSHCN Program is well-positioned to improve this metric.

While not a component of the medical home measure, transition services are integral to ensuring youth with special health care needs (YSHCN) are receiving services in a well-functioning system.  Upon reaching adulthood, these youth face changing insurance, health care providers, and potentially losing community services and supports they have depended on.  While all components of transition are lacking, the most profoundly lacking is pediatric health care providers taking the time to discuss and prepare the YSHCN to shift to adult health care providers.

1*Please interpret with caution.

Obesity in Children

Healthy lifestyles need to be promoted among all individuals, especially in a state with such a high burden of overweight and obesity like West Virginia. Pediatric overweight and obesity initiates a pattern that continues into adulthood which puts individuals at increased risk of diseases such as cardiovascular disease and diabetes. These behaviors are also taught, so children of adults who are overweight and obese may learn this practice, perpetuating the cycle further.

Obesity puts children at risk for developing heart disease, high blood pressure, cancer, asthma, and diabetes.  These obesity-related conditions, and the resulting burden on finances, quality of life, life expectancy, and the health care system, may be prevented by intervening early with children and adolescents by promoting a healthy lifestyle.

WV WIC rates in 2–4-year-olds was 14.4% in 2010.  WV was only one of three states that had increasing obesity rates (from 14.4% in 2010 to 16.4% in 2014). In 2016, even though obesity rates in this population were still increasing, the increase was at a much lower velocity (i.e., 16.4% up to 16.6%).  The results are reported as WV had a 2.2% increase in prevalence (14.4% to 16.6%).  The most recent data available (2020) for WIC participants ages 2-4 that are obese is 16.5% (remaining unchanged from the 2018 prevalence. in West Virginia, ranking fifth nationally behind Delaware, Massachusetts, California, and Maryland.

Oral Health and Pregnancy

PRAMS 2021 data shows that 50.3% of women received teeth cleanings prior to pregnancy and only 32.7% of women received cleanings during pregnancy.  This leaves 67.2% of pregnant women that did not partake in teeth cleanings as part of their prenatal care.