Continuance of a CSTE Fellowship Project in Alaska: A Decade of Data Collection By a PRAMS Follow-up Survey

BACKGROUND:   In 2006, a Maternal and Child Health CSTE/CDC Applied Epidemiology Fellow at the Alaska Division of Public Health led the design and implementation of a new surveillance program, the Alaska Childhood Understanding Behaviors Survey (CUBS). CUBS is a follow-up survey to the Alaska Pregnancy Risk Assessment Monitoring System (PRAMS). When CUBS began, there was a gap in population-based data about the health, behavior and experiences of young children in Alaska before they entered school. 

METHODS:   PRAMS sends a survey to approximately one of every six mothers of newborns in Alaska.  Following CDC protocol, mothers are randomly selected from birth records at the Bureau of Vital Statistics, and are contacted by mail approximately 2 to 6 months after their baby’s birth. If there is no response to repeated mailings, women are interviewed by telephone. When the child turns three years old, PRAMS respondents are contacted by CUBS. Like PRAMS, CUBS first sends the survey by mail, with phone follow-up.  CUBS collects information on child-focused topics that include height and weight, nutrition, health care utilization and access (including dental care), child care, parenting behaviors, immunizations, and safety. The survey also includes items specific to maternal and family experiences, such as smoking habits, family stressors, parenting support, food security and income. Survey questions are modified about every three years. CUBS data are weighted annually to represent the total birth population applicable for the child.

RESULTS:   Since ongoing implementation began in 2008, annual response rates to CUBS have ranged from 48%–65% of eligible participants. Of original PRAMS respondents, 18%–22% annually were deemed ineligible for CUBS due to residence outside of Alaska at follow-up or the child was not living with the mother when she responded to PRAMS. In total, 4,046 women have responded to CUBS (range 515–607 per year). Data from CUBS has been reported in two peer-reviewed articles, numerous state reports, and presentations at local and national conferences. CUBS data have been used to advocate funding for asthma prevention, target state obesity prevention and immunization programs, and inform a needs assessment examining school readiness among Alaska Native children in Anchorage.

CONCLUSIONS:   The CUBS program has collected high quality data about the health status and care of young Alaskan children for eight years and is looked to as a model by other states considering similar programs. CSTE Fellows have the opportunity to make significant and long-lasting contributions to their mentoring agency.