County Level Study (CLS)

The Bureau of Epidemiology and Vital Statistics (BEVS) proposes to collaborate with the University of Missouri-Columbia Health and Behavioral Risk Research Center (HBRRC) to conduct a 2022 Missouri County-level Study (CLS). The last CLS in Missouri was done in 2016 and was received very well across the state for its ability to provide county level data on a variety of chronic / MCH indicators.

The Missouri Behavioral Risk Factor Surveillance System has been in existence for over 25 years and is the primary surveillance system that combines demographic information as well as social and environmental factors (e.g. health care access) with information on chronic diseases (e.g. diabetes) or other related health conditions (e.g. obesity) and behaviors associated with health outcomes (e.g. smoking or physical activity). The MO BRFSS survey is conducted annually with partial funding from the Centers for Disease Control and Prevention (CDC). One of the major limitations of the MO BRFSS is that current funding levels only provide for approximately 7,000 surveys per year. This sample size is insufficient to address county-level health questions. The MO BRFSS program recommends enhancing data collection by adding up to 10,000 additional survey responses per year.

The CLS is modelled after the MO BRFSS. Earlier versions of this study were successfully conducted in 2007, 2011, and 2016 using funding sources that are no longer available. Since many public health interventions are implemented at county or sub-county levels, an estimated 60,000 surveys are required to provide detailed data to inform prevention and planning at these local levels. The CLS is similar to the MO BRFSS in terms of following the CDC’s best practices for sampling, data collection, and weighting methodologies; however, MO DHSS has greater control over the survey design and the opportunity to collect a sample size sufficient for county- and sub-county-level analyses. The intended target of the study is approximately 60,000 Missouri adults ages 18 and older, distributed across all 114 Missouri counties and the City of St. Louis. The interviews will be conducted via randomly selected landline and cell telephone numbers using a standard questionnaire developed in collaboration with internal and external public health partners that will be tailored to address data collection needs surrounding COVID-19.

Collecting comprehensive, granular information through state and local needs assessments enables data-driven intervention planning and allocation of resources to more effectively target populations for public health interventions.

Pregnancy Risk Assessment Monitoring System (PRAMS) – Opioid Call Back Survey (OCBS)

Missouri has been a CDC PRAMS state since 2006 and has been collecting data through PRAMS supplemental questionnaires during various public health crises such as the 2009 H1N1 pandemic and the Zika epidemic. Opioid overdose deaths in the US and Missouri have been steadily increasing during the past decade. In 2018, Missouri resident overdose deaths reached a record high of 1132 (graph below). Keeping in line with the ability of PRAMS to collect timely surveillance data among women with a recent live birth, Missouri PRAMS implemented the Opioid Call Back Survey (OCBS) for one year beginning in 2019. Missouri is amongst a select group of states that successfully implemented the PRAMS OCBS and recently received the weighted OCBS data set from CDC and plans to analyze the data for program planning and evaluation.

Pregnancy Risk Assessment Monitoring System (PRAMS) – COVID-19 Vaccine Supplement

The Council of State and Territorial Epidemiologists (CSTE) is partnering with the Centers for Disease Control and Prevention (CDC) Division of Reproductive Health (DRH) to fund and provide technical assistance to state, local and territorial public health agencies for the implementation of routine population-based data collection to inform public health’s understanding of the effects of Coronavirus Disease 2019 (COVID-19) on the behaviors and experiences of pregnant and recently postpartum women and their infants through this project. CSTE will support the capacity building of state, local, and territorial public health surveillance to specifically assess aspects of the COVID-19 vaccine. Specifically, the project supports jurisdiction to collect timely jurisdiction-specific information about COVID-19 vaccine experiences and attitudes among women with a recent live birth, including receipt of COVID-19 vaccination before, during and shortly after pregnancy, and reasons for not obtaining COVID-19 vaccination among those who are unvaccinated. Participating jurisdictions will implement a COVID-19 vaccine questionnaire supplement as part of their population-based, jurisdiction-specific, routine maternal child health data collection, such as Pregnancy Risk Assessment Monitoring System (PRAMS) or similar systems, across jurisdictions to collect population-based data on the impact of COVID-19 on pregnant and postpartum women and infants. Missouri PRAMS has been implementing the COVID-19 vaccine supplement and collecting data since March 2021. While CSTE funding was only received for a 6-month period, additional funding was not requested, and data collection will continue for a full year.

Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) - Surveillance for Emerging Threats to Mothers and Babies (Project W)

CDC’s Surveillance for Emerging Threats to Mothers and Babies

• Detects the effects of new health threats, like COVID-19, on pregnant people and their babies by collecting data from pregnancy through childhood
• Uses evidence-based, actionable information to help save and improve the lives of mothers and babies

Through this effort, state, local, and territorial health departments work with CDC to identify the impact of emerging health threats to pregnant people and their babies. This approach serves as a preparedness network that can be expanded should new threats emerge for mothers and babies.

Goals and Impact: Combatting Emerging Health Threats to Help Mothers and Babies Thrive

Surveillance for Emerging Threats to Mothers and Babies collects information on pregnant people and their children through the first 3 years of life. This system aims to figure out how health threats, such as COVID-19, hepatitis C, syphilis, and Zika, affect these populations. It may also track birth defects, developmental problems, and other disabilities as these children age. CDC scientists use these data to:

• Monitor and improve the health of pregnant people and infants;
• Link families to medical and social services to get recommended care;
• Strengthen laboratory and clinical testing to find emerging health threats quickly; and
• Ensure public health is ready and prepared to meet the needs of pregnant people and infants during emergencies.

This surveillance builds upon the US Zika Pregnancy and Infant Registry. The Registry collected health information on pregnant people and their infants with laboratory evidence of Zika infection during pregnancy. A key part of this unique surveillance is the ability to find exposures during pregnancy and link them with health outcomes of pregnant people and infants. This innovative and nimble approach enables CDC and state, local, and territorial health departments to monitor exposures of concern during pregnancy and collect follow-up data on affected infants over time.

Missouri is one of the 31 jurisdictions participating in this study and has been linking COVID-19 case data to vital statistics files in an effort to assess the impact of COVID-19 infection on adverse pregnancy outcomes such as infant death, low birth weight and preterm births.