Building Women's Health Equity (PCHHC)                                                                                                                                          Summer 2019
CityMatCH Webinar on Resources to Improve the Well Woman

In May, Dr. Sarah Verbiest presented to the CityMatCH Cohort on resources to improve the well woman visit. She included some of the lessons learned from sites in the PCC CoIIN project! Dr. Diana Ramos and the Women's Preventive Services Initiative (WPSI) team also shared information that teams can utilize to find resources that may be beneficial in your practice and community. 
You can download the WPSI social media kit and the Final Report (2016) here. If your team would like physical copies of any WPSI materials, please contact Michelle Jones  or click this link to request materials.

Preconception Health Research Highlights

Are you signed up to receive the CDC's bi-weekly updates on preconception and interconception health? The latest research, articles, new campaigns and resources will be sent straight to your inbox. Email  Cheryl Robbins ( with "subscribe." A great resource for everything happening in the industry, across the country - and world!  Here are a few highlights from some of our PCHHC partner the last few research updates:
Preconception health in England: a proposal for annual reporting with core metrics, The Lancet - this report discusses public health and individual strategies to monitor preconception health in England with the proposal of annual report cards using metrics from multiple routine data sources. Such a report card should serve to hold governments and other relevant agencies to account for delivering interventions to improve preconception health. Great to see England also setting preconception care benchmarks.

In Honor of Father's Day: Engaging Men and Fathers in Family Planning and Care
Fathers: Powerful Allies for Maternal and Child Health, NICHQ Insights - great article written by NICHQ President and CEO Dr. Scott Berns that urges public health professionals to seek solutions that support all caregivers: mothers, fathers, step-parents, grandparents, siblings, aunts, uncles, and the many other members of the diverse family structures that nurture children.

Sperm matters! A new study found that partners and children of men who become fathers at an older age were at increased risk for health problems. The study found that men 45 and older can experience decreased fertility and put their partners at risk for increased pregnancy complications such as gestational diabetes, preeclampsia and preterm birth. Infants born to older fathers were found to be at higher risk of premature birth, late still birth, low Apgar scores, low birth weight, higher incidence of newborn seizures and birth defects such as congenital heart disease and cleft palate. As they matured, these children were found to have an increased likelihood of childhood cancers, psychiatric and cognitive disorders, and autism. This Rutgers study stated, "Men who delay fatherhood should consult their doctor and consider banking sperm before age 35." Read the study here.

The intention to make preconception lifestyle changes in men: Associated socio-demographic and psychosocial factors, Midwifery

Advanced paternal age and the risk of spontaneous abortion: an analysis of the combined 2011-2013 and 2013-2015 National Survey of Family Growth, American Journal of Obstetrics & Gynecology

Expanded Preconception Carrier Screening in Clinical Practice: Review of Technology, Guidelines, Implementation Challenges, and Ethical Quandaries, Clinical Obstetrics & Gynecology

The U.S. Centers for Disease Control and Prevention has tips on  preconception health for men.
Power to Decide: Shared Narrative on 
Reproductive Well-being Index
Our team continues to engage with the Power to Decide's work to create a blueprint for communities to utilize to support young adults in their reproductive well being. Our team has been joining their Steering Committee meetings to discuss complex topics including pregnancy planning, reproductive agency, and equitable support. Here's a shot from their recent May meeting in DC. Details about their Reproductive Wellbeing Index Blueprint will be released this fall.
Related studies:

Posting about your healthy summer fun? Tag #MyHealthySummer for a chance to receive some goodies from the Show Your Love team. No limit on entries or eligibility.
Upcoming CoIIN Events

All Infant Mortality CoIIN Webinars (Abt Associates)
Data visualization  was covered in a TA webinar held on June 11th (Understanding and Using Data to Drive Improvement and Share your Success), a recording of which will be available soon in the Resources section on the  Platform.

HRSA's IM CoIIN Quarterly Stakeholder call will be held on July 29, 2019 - 3:30 pm to 5:00 pm ET. Please use this link to register.

Email Katherine Bryant with questions.
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Stay connected! Follow along and join the conversation: 
Welcome to Summer! 
Thank you to all who joined our June all site virtual gathering. There was excitement around exploring digital tools that could be used to engage young adults, such as mobile apps, texting services, and social media. To follow up, our summer issue focuses on top trends in consumer digital health that relate to women's health. We also offer a lot of other summer reading to keep you in the know on the latest news in our field! Hope you enjoy the long, light days of the season!
Digital and Online Tools to Reach Young Adults
With 96% of Americans 18-29 years old owning a smartphone , and a majority of them spending more than two hours per day online, it's clear the way to reach young adults must include mobile as a component.
Most American young adults have used the Internet for health-related purposes. Not only is the Internet the most common source for health information, but research has found that young adults are actively seeking credible sources of information when it comes to health-related topics. A survey of college students found that 67% were interested in using a free app to manage their sexual health.
Because most people now rely on their phones to access the Internet, rather than a desktop or laptop computer or other device, there is a growing interest in the power of mobile health.
A growing number of researchers are using m-health technology to reach adolescents with accurate and reliable sexual and reproductive health information. 

Telemedicine and m-health are growing field s and offer benefits in accessibility, cost savings, efficiency, quality and continuity of care. Use of m-health apps can improve self-management of chronic conditions, empower clients and improve overall health care quality. We've shared some preconception health apps and resources below. Our own Dr. Diana Ramos, MD, Chair, PCHHC, spoke about the power of digital health tools at our TEDxUNC. 
Consumer Mobile and Digital Resources

Show Your Love " Wellness Resources" section of this consumer preconception health resource has the top resources for young adults to utilize in their efforts towards healthier choices. There is also a " Well Visit 101" section that covers FAQs and information to navigate the well visit and insurance. In the "Wellness Resources" section, we have a list of the top rated consumer resources and mobile apps. Below are some good ones!

Scheduling a Well or Health Visit:
  • ZocDoc - Find doctors in your area, see their reviews, book appointments through the app. Allows notification and direct conversations with clinics through the app. Great blog on important topics as well. Free.
  • Planned Parenthood Direct: mobile phone app that allows users to order birth control and get treatment for UTI right from their phone, usually with no appointment necessary. If an exam is necessary, an appointment will be set up through the app. It also has comprehensive information on different birth control methods, prescriptions for birth control pills and auto-refills prescriptions. This service is available in California but not DE, NC or OK (at least not yet!).
General Health & Wellness Tracking:
  • LA FAMILIA: text messaging program from the Los Angeles Department of Public Health, which focuses on family planning, active living, maintaining a healthy weight, improving nutrition, reducing stress, and addressing abuse. Each message links to the FAMILIA website, which has more information, apps, blogs, and videos related to that topic. Participants receive three healthy living texts each week for three months, and can choose to receive messages in English or Spanish. Text LA FAMILIA to 55000 to join.
  • Crush (Healthy Teen Network): smartphone based, digital tool. Empowers adolescent women by providing on-demand access to comprehensive, medically accurate health information (in English and Spanish). Topics include healthy relationships, sexual health and anatomy, pregnancy and clinical services. Also includes a texting service, CrushTEXT. Crush is interactive and uses text, animation, videos, quizzes, graphics, calendars and clinic locator tools. 
  • Tactio Health: track and manage a wide range of health data, syncs and connects with other apps/devices, such as Fitbit, MyFitnessPal and more. Also features a connected logbook that allows user to generate a PDF to share with providers. Health coaches send messages and reminders about healthy behaviors and chronic disease control. 

  • Apple Health: did you know the iPhone will track your steps? Anyone with an iPhone can look at the Apple Health App to see how many steps they've taken that day. (Only works when the phone is being carried). The health app highlights four main areas: activity, sleep, mindfulness, and nutrition. It can also sync with your other apps to serve as a health dashboard on your phone.
Contraception / Fertility / Period Tracking:
  • Planned Parenthood SpotOn: mobile phone app that allows users to track periods and symptoms, activities (i.e. exercise, sex, sleep), manage birth control, and access resources like FAQs and locating a Planned Parenthood health center.
  • My Birth Control: developed by UCSF, online resource with comprehensive contraceptive information. Beyond the Pill: website by UCSF with educational materials including counseling charts, posters, brochures and videos. Providers can download the materials or order printed copies/DVDs. Most are available in English and Spanish.  
  • My Life, My Plan - resource with great prompts to set goals and consider how you'll reach those life goals. Be sure to download the Power Me A2Z Life Planning booklet. Great personalized PDF for consumers to fill-in. See their site for information about receiving hard copies of the booklets.
  • Clue: track period, flow and menstrual products. Gives predictions and calendar reminders before periods and ovulation. Monitor and track mood, sex, energy, cervical fluid and more. Keep a log of birth control and set reminders. Free. 
  • Bedsider: an online birth control support network for women 18-29. The Bedsider website has comprehensive information on contraceptive methods and sexual health, as well as links to locate clinics. They also provide a service that women can use to get reminders about appointments or birth control, either through their mobile phone app or through text messaging.   
STI Screening / Clinic Locator:
Substance Tracking / Tobacco Cessation:
  • Smoke Free: this app offers over 20 different, evidence-based techniques to help people quit smoking. It allows users to see how much money they've saved, how many cigarettes they haven't smoked, how long they've been smoke free and how their health is improving. Users can log their cravings and get tips for dealing with them. Free
  • Nomo: users can create sobriety clocks, which tell them how long they've been sober (they can make multiple clocks, not just for alcohol, but also for smoking, drugs, etc.). Let's users find accountability partners, see how much money they've saved, earn chips when milestones are reached and play mini-distraction games when feeling tempted. Free 
  • Pear ReSET: free, but requires a prescription. This is the first mobile app to be approved by the U.S. Food and Drug Administration (FDA) to help treat substance use disorders, reSET uses a 12-week program schedule that includes lessons, quizzes, and virtual rewards.
Nutrition Tracking: 
  • MyFitnessPal: track food intake with a large food database and barcode scanner, or by importing recipes or logging menu items from restaurants. Features food insights to make healthier choices, a calorie counter and nutrient tracking. Also allows users to log workouts, track steps and syncs with 50+ apps and devices. Free. 
  • Fooducate: offers tracking of food intake, exercise, mood, hunger and sleep, as well as the quality of calories. Allow personalization for age, gender, weight and height. Syncs with other apps and devices. Free
  • ShopWell: users enter their fitness and nutrition goals and food sensitivities during set up of the app. Then while grocery shopping, they can scan items they're buying to find out nutrition information, plus upload a picture of their receipt for an analysis of how well their purchases align with their stated goals. Free
Sleep / Meditation: 
  • Insight Timer: offers thousands of guided meditations and talks, music tracks, ambient sounds, meditation timer, discussion groups, and tracking of stats and milestones. Free.
  • Headspace: (expensive but highly rated!) offers hundreds of guided meditations on different subjects like focus, exercise or sleep, including 2-3 minute mini meditations. Daily meditations and mindfulness moments, SOS moments for panic, anxiety and stress, track progress and time spent meditating. Also offers guided meditation and mindfulness exercises for kids. The Basics Course is a free 30 day trail to teach fundamentals of meditation and mindfulness. After that, subscription-based.
  • Mental Health America Self-Screening Tool to help understand different types of mental health challenges.
See full list of preconception health and well-being app on . Know of a great tool you don't see listed? Email

So Many Apps, What Makes a Great One?
With the majority of Americans owning smartphones, and m-health apps becoming more popular, many health care organizations are turning to m-health to find new ways of reaching patients. There are a lot of pros in this approach. Research has shown that use of m-health apps can improve self-management of chronic conditions, increase physical activity, and improve health care quality. M-health apps also offer accessibility, cost savings, efficiency, and continuity of care. But developing an app can be a complicated process, and many apps are not successful. In fact, research has shown that the average app loses  77% of its daily users within the first three days after install. Below find some challenges in app development in general, along with some specific concerns for m-health apps. 

  • Data security & privacy: since health apps often collect users' data, security is a big concern, especially if collecting info that is protected under HIPPA. 
  • Making the app accessible & engaging: many health apps fail to engage users and/or contain content that is too difficult or complex for the user to understand. 
  • Support: apps need strong technical support to deal with bugs, glitches and any technical difficulties reported by users
  • Updating: apps are not a one-time investment. They need continuous updating based on user feedback, as well as support for new operating systems
  • Different devices & screen sizes: apps need to be made to function well on different types of devices (phones, tablets, laptops) as well as different screen sizes
  • Funding: developing a high quality app can cost anywhere from $25,000 to one million dollars. And that doesn't include budgeting for marketing and updates
Given the sheer volume of app and digital options available, it can be confusing for both providers and consumers to know where to look for credible sources of information. Consumers often choose apps without consulting a provider, or considering the quality of information, basing their decisions more on ratings given by other app users.  systematic review  of mobile apps to prevent pregnancy identified almost 7,000 apps available on iTunes and Google Play. Despite some challenges and special considerations, m-health technology is a growing field and presents unique opportunities to reach adolescents and young adults with high quality, evidence based sexual and reproductive health information. Before exploring the possibility of developing an app, a lot of research needs to go into not only what resources are already on the market and how an app might solve an issue or provide an experience for the user, but consumer research about whether or not an app is the most valuable tool to provide the health information. Focus groups with the end-user will help to identify if an app will be used consistently, rated well, trusted, and valued by a consumer.