AgendaNCHS missionOverview of major NCHS data systemsNHANESNHISNHCSNVSSCloser look at data sets related to reproductive and perinatal health

NCHS MissionTo monitor the nations health by providing data that are:accuraterelevanttimelyTo support the broader CDC mission:SAFER HEALTHIER PEOPLE

NCHS Data Are Used ForComparisons across populations, providers, and geographic areasPlanning/assessing public health programsIdentifying health problems, risk factors, and disease patterns

Quality Control at Every StageData collectionInstrument designInterviewer (or data collector) trainingData analysisEvaluation of data qualityInformation dissemination

Four Major Data Systems at NCHSNational Health and Nutrition Examination SurveyNational Health Interview SurveyNational Health Care SurveyNational Vital Statistics System and surveys

NHANESData sourcesPersonal interviews (including ACASI)Physical examinationsLaboratory testsNutritional assessments

NHANES sample design30,000 persons aged 2 months or olderOversampleAfrican AmericansMexican AmericansAdolescents aged 12-19Older persons aged 60+Pregnant womenOP96031

Mobile Examination Center (MEC) Trailer used for NHANES

Some Uses of NHANESEstimate the prevalence and distribution of health conditions and related risk factors in the populationDescribe awareness, treatment and control of selected diseasesMonitor trends in health, risk behaviors, and environmental exposures over timeOP96023

Some Uses of NHANES (contd)Study the relationship of diet, nutrition and healthDevelop growth charts for evaluating child developmentExplore emerging public health issuesEstablish a national probability sample of genetic material for future researchOP96024

Mean serum folate concentrations: Women

ng/mL

Years

National Health Interview Survey (NHIS)Data sourcePersonal interviews with household members

Sample41,000 households annually(approximately 110,000 people)Oversample African Americans and Hispanics

NHIS Components

Core questionnaireTopical modulesPeriodic modules

NHIS Core Questionnaire

Collects minimal information onHealth behaviorsChronic and acute conditionsHealth care utilizationHealth status and limitations

NHIS ModulesTopical modules collect data on:Emerging problems or specific health problemsCancerHealthy People 2000 and 2010 indicatorsDiabetesPeriodic modules collect more detailed information on one of the four areas of health above.

NHIS Module Topics Have IncludedHealth status and disabilityInsurance coverageAccess to careUse of health servicesImmunizationHealth behaviorsFamily practices

Children aged

27-1a. Current Cigarette Smokers:Adults 18 and Older

Education Level*

Sex

9-11 yrs.

Total

Family Income Level

HS grad.

College

Poor

Near Poor

Mid./High

Age-adjusted percent

1998 Baseline

2001

Age adjusted to the 2000 Standard Population. I 95% confidence interval. *Preliminary data: January-September 2002.

SOURCE: National Health Interview Survey (NHIS), NCHS, CDC.

5-13. Annual Dilated Eye Examinations: Persons with Diabetes, by Race/Ethnicity

White, notHispanic

Black, notHispanic

2010 Target

Total

Hispanic

1998

1999

Age-adjusted percent

Note: Data for American Indians/Alaska Natives are for IHS Service Areas. Asian/Pacific Islander data are not shown due to small cell sizes.

I 95% confidence interval.

American Indian/Alaska Native

Sources: National Health Interview Survey (NHIS), CDC, NCHS, and Indian Health Service.

Early cancer detection procedures:by income level, 2000

Age-adjusted percent

I 95% confidence interval.* Exam includes sigmoidoscopy, colonoscopy, or proctoscopy.Note: Data are age adjusted to the 2000 standard population.Source: National Health Interview Survey (NHIS), CDC, NCHS.

Mammogram:Females 40+(in past 2 years)

Pap Test:Females 18+(in past 3 years)

Fecal Occult Blood Test:Adults 50+(in past 2 years)

Exam*:Adults 50+ (ever)

Poor

Near poor

Middle/High

The National Health Care Survey(Original Surveys)National Hospital Discharge SurveyNational Ambulatory Medical Care SurveyNational Nursing Home SurveyNational Health Provider Inventory

The National Health Care Survey (Newer Surveys)National Hospital Ambulatory Medical Care SurveyNational Survey of Ambulatory SurgeryNational Home and Hospice Care Survey

Some Uses of NHCS DataPrevalence of diagnosis and treatmentTrends in use of servicesCharacteristics of patients and providersPatterns of diseaseUse of technology drugs, and other treatmentsEmergence of alternative care sites

Overall hospitalizations declined from 158 to 103 per 10,000 population

Potentially avoidable hospitalizations increased from 99 to 134 per 10,000

Trends in hospitalizations (National Hospital Discharge Survey)

Holding up a mirror to the health care delivery system

Trend in rate of avoidable hospitalizations for those over 65, by race(NHDS)

Whites

Blacks

352.8

564

325.2

450

Other NCHS SurveysNational Immunization SurveyState and Local Area Integrated Telephone Survey (SLAITS)National Longitudinal Survey of Aging (LSOA)

National Vital Statistics SystemData sourceState vital registration

SampleAll births, deaths, and fetal deathsCounts of marriages and divorces

Hispanic and API Subgroups (since 1990s)Hispanic originMexican, Puerto Rican, Cuban, Central or South American, other/unknown Hispanic groupAsian American or Pacific IslanderChinese, Japanese, Hawaiian, Filipino, Asian Indian, Korean, Vietnamese, Samoan, Guamanian, Other Asian or Pacific Islander1 1 Categories in green are available only for selected States

Some Uses of Mortality DataLife expectancyFetal and Infant mortalityOccupational mortalityCauses of deathNational Death Index (for mortality ascertainment)

Life Expectancy at Birth, by Race and YearSource: National Vital Statistics System - Mortality, CDC, NCHS.Source: Arias E (2002). United States Life Tables, 2000. Natl Vital Statistics Reports 51(3). Hyattsville, MD: NCHS.

Motor vehicle crash deaths

Motor vehicle crash deaths and homicides

Homicides

Note: Data are age adjusted to the 2000 standard population. Source: National Vital Statistics System - Mortality, CDC, NCHS.

Age-adjusted rate per 100,000 standard population

2010 target

2010 target

Revised Death CertificateMultiple raceEducationMarital statusPlace of deathPregnancy statusIf transportation injury, decedents role with respect to vehiclesTobacco use

Some Uses of Natality DataBirth ratesNonmarital birthsBirths to teensPrenatal care and birthweightCesarean deliveryObstetric complicationsTiming of births (incl. delayed childbearing)Pregnancy rates (along w/other data)

Rates per 1,000 Women

15-19

15-17

18-19

Chart1

68.338.8114.7

64.538.2105.3

61.73996.9

59.338.591.2

57.537.388.7

55.636.185

52.834.180.5

52.833.980.9

51.532.279.8

52.332.381.3

5332.582.1

52.23280

52.432.379.4

51.431.877.4

50.63177.4

513179.6

50.230.579.6

50.631.778.5

5333.679.9

57.336.484.2

59.937.588.6

62.138.794.4

60.737.894.5

59.637.892.1

58.937.691.5

56.83689.1

54.433.886

52.332.183.6

51.130.482

49.628.780.3

48.527.479.2

45.925.375.8

15-19

15-17

18-19

Birth Rates for Teenagers by Age United States, 1970 - 2001

Sheet1

Teen birth rates by age, United States, 1970-2001

15-1915-1718-19

197068.338.8114.7

197164.538.2105.3

197261.739.096.9

197359.338.591.2

197457.537.388.7

197555.636.185.0

197652.834.180.5

197752.833.980.9

197851.532.279.8

197952.332.381.3

198053.032.582.1

198152.232.080.0

198252.432.379.4

198351.431.877.4

198450.631.077.4

198551.031.079.6

198650.230.579.6

198750.631.778.5

198853.033.679.9

198957.336.484.2

199059.937.588.6

199162.138.794.4

199260.737.894.5

199359.637.892.1

199458.937.691.5

199556.836.089.1

199654.433.886.0

199752.332.183.6

199851.130.482.0

199949.628.780.3

200048.527.479.2

200145.925.375.8

Sheet1

68.338.8114.7

64.538.2105.3

61.73996.9

59.338.591.2

57.537.388.7

55.636.185

52.834.180.5

52.833.980.9

51.532.279.8

52.332.381.3

5332.582.1

52.23280

52.432.379.4

51.431.877.4

50.63177.4

513179.6

50.230.579.6

50.631.778.5

5333.679.9

57.336.484.2

59.937.588.6

62.138.794.4

60.737.894.5

59.637.892.1

58.937.691.5

56.83689.1

54.433.886

52.332.183.6

51.130.482

49.628.780.3

48.527.479.2

45.925.375.8

15-19

15-17

18-19

Births

Teen Births by Age, United States,1970 - 2001

Sheet2

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

000

15-19

15-17

18-19

Rates per 1,000 Women

Birth Rates for Teenagers by Age: United States, 1970 - 2001

Sheet3

Pregnancy, Live Birth, Induced Abortion & Fetal Loss Rates, 1990 & 1995Rate per 1,000 Women19901995Source: Ventura et al, 2000

Revised Birth CertificateMore detail on cigarette smokingMethod of deliveryMore height & weight infoCongenital anomaliesInfertility treatmentWICInfections during pregMaternal morbidityBreast feedingPayment for deliverySeparate worksheets for mother & for facility, to encourage collection from best data sources.

Certificate Revision Website(birth & death)For everything you always wanted to know about the revision but were afraid to ask

www.cdc.gov/nchs/vital_certs_rev.htm

Other Datasets for Perinatal Health ResearchIn addition to the annual National Natality Datasets:Linked Birth/Infant Death FilesMatched Multiple Birth File (through RDC)Fetal Death Files

National Survey of Family Growth

Uses of NSFG dataCollect periodic data on the intermediate variablesSnapshot of U.S. fertility, family formation, and reproductive healthComplement vital statisticsTrack national health objectivesEvaluate health & social policiesResearch: demographic and public health

Social factorsIntercourse variables:Intermediate variablesTiming of first intercoursePercent of women who ever had intercourseTime spent in marriage (separation, divorce)Frequency of intercourseFertility(livebirths)Race/ethnicityReligionLabor force participationEducationIncomeAccess to health careFamily backgroundCommunity environment (economic, social, etc.)Pregnancy outcome(gestation) variables:Miscarriage and stillbirthInduced abortionConception variables:Contraceptive useSterilizationInfertility

NSFG sample (Cycles 1-5)

Nationally representative sample of womenCivilian non-institutionalized population of women 15-44Multi-stage probability sampleOversample black women and starting in 1995, Hispanic women1988 & 1995 based on NHIS sample

NSFG Cycles 1-5119739,797Ever-married219768,611 Ever-married319827,969All419888,450All4 (Tel)19905,686Reintv of 88& new teens5199510,847AllCycleYearNWomen 15-44

Innovations in 1995 NSFG, Cycle 5Major changes in questionnaire content and formatChanged mode of data collection to CAPI and Audio CASI$20 token of appreciation paid to respondents -- maintain response rates with longer, more sensitive interview

Selected Findings from the 1995 NSFG

Children Ever Born, by Womans Education, 1995Source: Abma et al, 1997, Table 4

Percent of Women 18-29 Who Had a Birth Before 18Source: 1995 National Survey of Family Growth, Contextual Data FilesMedian Family Income at Block LevelPercent

Father Figure During Adolescence: U.S. women 15-44 in 1995Source: Peterson, poster presented at PAA 1998PercentType of Father Figure:

Percent Likelihood that 1st Marriage Dissolves Within Ten YearsPercentSource: Bramlett & Mosher, 2002 Age at marriage

Type of Contraceptive Used Among Women 15-44 Who Currently Use Contraception: U.S., 1995Method:Source: Piccinino & Mosher, 1998

One-Year Failure Rates by Method: US, 1995(Chance of Having an Unintended Pregnancy in 1 Year of Using the Method)

Current contraceptors 20-44 who are using female sterilizationSource: Mosher et al., 2003, Table 9

Percent of Babies Born 1990-94 who were Breast-fed at allSource: Mosher et al., 2003, Table 15

Payment for Delivery for Womens Most Recent Birth, 1991-5Mothers Age at DeliverySource: Abma et al, 1997, Table 69

Percent of Recent Births that were Intended at ConceptionAge at birthSource: Abma et al., 1997, Table 14

Use of Family Planning or Medical Services in Past Year Among Women 15-44: U.S., 1995PercentSource: Abma et al, 1997, Table 74

Percent of Women 15-44 Ever Treated for PIDSource: Abma et al, 1997, Table 89

Age at first sexPercent

Source: 1995 National Survey of Family GrowthPercentPercent Uninsured Among Women 15-44

Percent of Unmarried Women Reporting 4 or More Male Sexual Partners in Past Year, Interviewer versus Self-administered modeSource: Abma et al, 1997, Table 27Percent

Using the 1995 NSFGSeveral data files availableCommon CASEID allows linkage of information across filesAccess procedures vary due to confidentiality and sensitivity of data

1995 NSFG data files availablePublic Use FilesRespondent filePregnancy (interval) fileOmitted Items FileFieldwork FileContextual Data Files

NSFG - variance estimationComplex sample design must be accounted for to make accurate inferencesRequirements for accurate estimation in 1995 NSFGFully adjusted weight (POST_WT)Collapsed strata variable (COL_STR)Panel identifier (PANEL)

For reference and further details: Series 2, #124

NSFG Public Use Data FilesAvailable on cartridge tape and CD-ROM (1982 NSFG CDROM coming soon)1995: extensive documentation (also on web)Users GuideCodebookCAPI Reference Questionnaire

1995 NSFG - Contextual data filesRestricted use (contact NCHS RDC)Community characteristics (over 1000)4 levels of aggregation (state, county, census tract, block group)3 points in time (1990, 1993, 1995)Rich potential for descriptive as well as detailed multilevel analyses.

NSFG related files available through NCHS Research Data CenterContextual data files State level indicators (user-supplied)NHIS linked analyses (1988 & 1995)

RDC Contact: Kenneth HarrisEmail:rdca@cdc.gov

Cycle 6 and beyondShorter intervals between CyclesCycle 6 in 2002 Cycle 7 planned for 2005 or 2006Sample independent from NHISContextual dataInclusion of males 15-44Moving toward continuous interviewing in Cycle 7

Inclusion of males 15-44Other half of fertility and family formation equation1996 Welfare Reform ActFatherhood Initiative (federal interagency effort)Information collected directly

Male NSFG will shed light on:Father involvement & activitiesChild supportMale reporting of pregnancies/birthssexual partnershipscontraceptive behaviorinfertilityMale role in unintended pregnancySTD/HIV risk & transmission

Female NSFG in Cycle 6All core topics maintained from Cycle 5Expanded Audio CASIStreamlined event historiesOther selected enhancements based on questionnaire design research

2002 NSFG Preliminary CountsFemaleMaleTotalTotal7,6464,92912,57515-191,1501,122 2,27220-241,364 938 2,30225-445,1322,869 8,001Data collection ended in March 2003. Final counts will be slightly lower, post-data editing & cleaning.

2002 NSFG (Cycle 6)Public use data files & documentation target = Summer 2004Web-based documentationCDROM for data filesContextual data about a year laterWatch our webpage for updates:www.cdc.gov/nchs/nsfg.htm

Quality Control Strategies in 2002 NSFGFull dress rehearsal Pretest in 2001 (n=600)Extensive input from research & policy worldCognitive testing of questionnaire components with key subpopulationsRigorous protocol for Spanish translationInterviewer training modules on cultural sensitivity and refusal aversionVerification interviews

Lets take a step back and consider other concerns about surveys

All surveys are facing challengesPeople are harder to find and talk to People are more reluctant to participate

Survey response rates suffer, or they cost more to maintain.

All surveys are facing challengesComputerization of survey instruments can simplify interviewers job to some extent, but Survey questionnaires tend to become more complexInnovative data collection strategies (including ACASI) require considerably higher cost in programming and testing

Overall survey costs increase

All surveys are facing challengesControlling survey costs requires Collection and use of process data in directing effort of interviewers in the fieldReal time modeling to balance cost control with response rate and error reduction goalsYOU, as data users, need to be aware of these survey management issues, as they may impact on your research.

Questions? Comments?

Source: 1995 National Survey of Family Growth, NCHS