Transcript Studying Health Within the NLSY

Studying Health Within
the NLSY(97, 79 &
Child,Youth surveys)
Pamela J. Salsberry
College of Nursing
&
Patricia B. Reagan
Department of Economics
Outline
 General comments about using the
NLSY79 and related child files for health
related research
 Specific data elements available for
analysis—adult, child, youth surveys
 Examples
 Questions/comments
Why use the NLSY to study
health—the positive argument
 Interested in a life course perspective
 Interested in sibling models to control for
unobserved heterogeneity
 Interested in the influence of family
context on child health
Why use the NLSY to study
health, continued
 Interested in maternal influences on the
health of her children
 Examine health of the child’s impact on
career trajectories of mothers
 Examine the intersection of multiple
influences on health outcomes across
time
The negative argument or why the
NLSY is not good to examine
health
 Many data sets are available that may
be more appropriate to your research
questions (NHIS, NHANES, MEPS,
Medicare’s Current Beneficiary Survey)
 Limited data on health status early on in
NLSY79—related to ability to work
The negative argument,
continued
 Health data is self-reported
 No physiological measures to confirm
diagnosis, no laboratory data (e.g., BPs,
Cardiovascular indicators, EKGs)
 Population based sample which can only
be used to study relatively common
health conditions
Adult Health Before Age 40
 Height
 Weight
 Does health limit amount or kind of work
respondent can do?
 1979, 1980 specific conditions causing
limitation
Health Module for those 40
years of age
 CESD—7 items (92, 20-items; 94-7
items)
 Parents health status (living/dead, age of
death, cause of death)
 SF-12
 Health conditions- CVD, diabetes,
asthma
Risky Behaviors and Health—
Adults (selected years)
 Smoking (could be important to track for
any asthma study)
 Drug use
 Seat belt use, attitudes towards risk
 No diet or exercise histories
Health Insurance--Adults
 Limited to 89, 90, 92-2004
 Determines coverage status and who
pays for the plan (e.g., private, Medicaid)
 Same set of questions about the children
and spouse
Health Services UtilizationAdults Health at 40 Module
 Health services use (last saw a health
provider)
 Important for ambulatory use sensitive
conditions, like asthma
Health – Children of the NLSY
 Does health limit ability to attend school
or play (for preschool children)?
 List of health disabling conditions (most
frequent are asthma and learning
disability)
 Injuries and accidents
 Height
 Weight
 Age of Menarche (females)
Health – Children of the NLSY
Continued
 Birth weight
 Length of gestation
 Length
 Maternal behaviors
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Prepregnancy weight
Smoking during pregnancy
First trimester health care visit
Risky Behaviors
 Asked only of those 10-14
 Drug, alcohol, sexual activity
Health Insurance for the Child
 Is child covered by health insurance
provided by an employer or an individual
plan?
 Is child covered by Medicaid?
Health services use
 Last time had routine health check
 Last dental visit
 Caution—question about required health
care—wording leaves open the
possibility of needing, but not receiving
 Seen by psychiatrist, counselor,
psychologist
Health Module for Young
Adults
 Health limitations—work and school
 List of health conditions
 Health status question (Poor to
Excellent)
 Accidents or injuries
 Fertility modules
 Height
 Weight
Risky behaviors and Health—
Young Adults
 Self report booklet—
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Sex & birth control
Drugs & alcohol
Abortions
Health Insurance for the
Young Adults
 Source of coverage—parent, employer,
self
 Covered by Medicaid?
Health services use—Young
Adult
 Last time had routine health check
 Last time seen for treatment of an illness
 Caution—question about required health
care—wording leaves open the
possibility of needing, but not receiving
NLSY 97 Health
 General Health
 Height
 Weight
 Perceptions about weight
 Chronic conditions Rounds 1 & 6
 Age of menarche (females)
NLSY97 Risky Behaviors
 Age>=14
 Cigarettes, alcohol, drugs
 Sexual behavior
 Birth control
NLSY97- Health Insurance
and Utilization of Services
 Insurance coverage- Rounds 1 & 6
 Visit doctor in past 12 months- Round 6
Research Applications
 Birth Outcomes
 Development of childhood
overweight
Birth Outcomes- Mothers are
NLSY79 Respondents
Issues to consider:
Children born to teens occurred in the
earliest years of the survey—by mid1980s all respondents were aged 20 --so
that if you wish to ask questions about
teen births then one must consider
whether the time differences are
important
Studying Birth Outcomes
 Time trends in health care – for example
“scheduled” preterm deliveries have
increased over the last 20 years
 Birth weights
 Gestational age—preterm deliveries
 SGA and LGA determination
Variables of interest
 Individual:
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Age of mother, parity
Interval between pregnancies
Previous preterm infant
Maternal prepregnancy weight
Risk behaviors of the mother (smoking,
drinking, drug use)
Individual SES—family income, marital
status, education
Determining Prepregnancy
BMI
 Recording of data slightly different
 Height asked at three time points(1981,
1982, 1983(for women only) and 1985)

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1981=400=4 feet, 0 inches
1983=feet and inches
1985=inches
 There are some out of range values
 Only self-report measures
Preterm Study: Reagan/Salsberry
Social Science and Medicine 2005
 Research Aim: To examine effect of
social context on differences among
blacks, whites, and Hispanics in
rates of moderately preterm
(gestation 33-36 weeks) and very
preterm infants (<33 weeks) relative
to term births.
Contextual Measure
Lifetime exposure to income
inequality :
fraction of mother’s life since age
14 that she had spent in a state
with a Gini coefficient above the
yearly median
Findings
 Blacks > very preterm
 First births < preterm/very preterm
 Short interval pregnancies >
preterm/very preterm
 Drug use during pregnancy>
preterm/very preterm
 Cumulative exposure to income
inequality Hispanics > very preterm
Studying Child Overweight
 Questions slightly different
 Need to convert to percentile rankings
for age and sex
 Use of CDC program to standardize BMI
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Height in inches
Weight in ounces
Sex
Age in months
Studying Child Overweight
 Measured vs. reported data
 Question asked if child can be
measured—if not, then measures are
reported by the mother. There is a
follow up question on how the data were
obtained (except for 86—question not
asked). Generally 70% or more are
measured. We have found that
measured heights and weights result in
less overweight than the self-report data,
Development of overweight in
Children: Salsberry/Reagan
Pediatrics 2005
 Research aim: To examine the
timing and extent of early life
influences on the development of
overweight in children from birth
through age 7.
Sample
 Children of the NLSY
 NLSY79
 Merged mom information, prenatal
information, with child information
 In this study we needed data at four time
points—needed birth information, and
interviews at 2/3, 4/5, 6/7
Findings
 Prepregnancy obesity & Smoking during
pregnancy > overweight 2/4
 Prepregnancy obesity & Smoking during
pregnancy > overweight 4/6 and 6/8
conditional on prior overweight
 Race/ethnic differences
Comments/Discussion