The National Survey of Family Growth Stephanie J. Ventura, M.A. National Center for Health Statistics Presented at the American Public Health Association Continuing Education Institutes November 4, 2007 Washington, DC

Outline Background: Role, purpose, history of NSFG Resources on the NSFG web site: www.cdc.gov/nchs/nsfg.htm Analyses you can do with NSFG 2002 (Cycle 6) data Interviewer-administered data Self-administered (ACASI) data Continuous Interviewing in the NSFG has begun. How to contact the NSFG team

The NSFG’s Role Responds to Sec 306 of the PHS Act: “NCHS...shall collect statistics on family formation, growth, and dissolution.” Extends the birth registration system by providing data on behaviors that explain birth & pregnancy rates---e.g. sexual activity, contraception, infertility, & breastfeeding. Serves the needs of other DHHS programs NICHD, OPA, OASPE, ACF’s OPRE & Children’s Bureau CDC’s DRH; HIV Prevention Program (DHAP); & OWH.

Intermediate variables Fertility Social factors Intercourse variables: Timing of first intercourse Percent of women who ever had intercourse Time spent in marriage (separation, divorce, cohabitation) Frequency of intercourse Race/ethnicity Religion Labor force participation Education Income Access to health care Family background Community environment (economic, social, etc) Conception variables: Contraceptive use Sterilization Infertility Pregnancy outcome (gestational) variables: Miscarriage and stillbirth Induced abortion Live births

NSFG history in brief Cycle Year Scope # of Interviews Over-Samples Average Length Incentive 1 1973 Ever-Married Women 15-44 9,797 Black Women 60 Minutes No 2 1976 8,611 3 1982 All Women 15-44 7,969 Teens 4 1988 Women 15-44 8,450 70 Minutes 5 1995 10,847 Black Women Hispanic Women 100 Minutes $20 6 2002 Men 15-44 (First time) 12,571 W = 7,643 M = 4,928 Blacks Hispanics Ages 15-24 W= 85 min M= 60 min $40 7 2006+ (contin-uous) Men 15-44 Goal: 5,000 per year W=80 min M=60 min

Available NSFG data files Public use files for Cycles 1 thru 6 are available free on CD-ROM: NSFG@cdc.gov ACASI data files—which contain the sexual behavior data for Cycle 6 (2002)—are available on request. Application is on the web site. The file is free. Contextual data file can be used thru NCHS Research Data Center. 1,000 variables at state, county, tract, block group are available. For a complete listing, see the NSFG web page. You can also add your own variables.

2002 NSFG data collection Contractor: Institute for Social Research (ISR), University of Michigan National sample in 121 areas Blacks, Hispanics, teens over-sampled In-person interviews using laptop computers Interviewers did first 3/4 of the interview. Last ¼ was done by respondent entering answers him/herself into the laptop. (“ACASI”) Interviews in both English and Spanish (929 in Spanish)

Selected NSFG 2002 Content Interviewer-Administered: Pregnancy history (women); fatherhood history (men); Marriage & cohabitation history,* sexual partner history Contraceptive history;* Wanted & unwanted births* Attitudes about marriage, parenthood, children Self-administered: Sexual behavior, sexual orientation and attraction. drug use, forced sex, income. *more detailed for women than for men.

New on the NSFG web site: Link to subscribe to the NSFG’s listserv. PDF files of all 11 NCHS reports on Cycle 6 Codebooks for all 6 cycles Questionnaires for all 6 cycles Lists of publications for all 6 cycles Describes continuous interviewing (Cycle 7) Coming soon on the web site: a list of findings, alphabetized by topic Downloadable data files for all 6 cycles (All 6 cycles available now on CD-ROM, free).

Webdoc: NSFG-6 online codebook

Examples of analyses you can do with NSFG Cycle 6 CAPI/Public Use data Contraceptive use and method choice Reproductive health Teen Sexual Activity Breast-feeding Use of Reproductive Health Services-Men & Women ACASI: Sexual Behavior HIV Risk Behaviors HIV Testing

Percent of women contraceptors 22-44 who were currently using female sterilization or the pill, by education: US, 2002 Female Sterilization Pill SOURCE: Mosher WD, Martinez GM, Chandra A, Abma JC, Willson SJ. Use of Contraception and Use of Family Planning Services in the United State: 1982-2002. Dec 2004. National Center for Health Statistics. Advance Data 350.

Women who were not using a birth control method the last time they had an unintended pregnancy: percent giving specified reasons for non-use: US, 2002 Gm: We showed them this one before …would vote for deletion JA: you mean at a prior debriefing? yes SOURCE: Chandra A, Martinez GM, Mosher, WD Abma JC, Jones, J. Fertility, Family Planning, and Reproductive Health of U.S. Women: Data from the 2002 National Survey of Family Growth. Vital & Health Statistics. Series 23, Number 25. Dec 2005. Hyattsville, MD: National Center for Health Statistics.

Percent of women 15 to 44 years of age ever treated for PID by whether ever douched in last 12 months, according to Hispanic origin and race: US, 2002 SOURCE: Chandra A, Martinez GM, Mosher, WD Abma JC, Jones, J. Fertility, Family Planning, and Reproductive Health of U.S. Women: Data from the 2002 National Survey of Family Growth. Vital & Health Statistics. Series 23, Number 25. Dec 2005. Hyattsville, MD: National Center for Health Statistics.

Percentage of women 22-44 who douched at all in the last year, by Hispanic origin and race and education: US, 2002 JA: Replace with slide from women’s report showing family planning service receipt SOURCE: Chandra A, Martinez GM, Mosher, WD Abma JC, Jones, J. Fertility, Family Planning, and Reproductive Health of U.S. Women: Data from the 2002 National Survey of Family Growth. Vital & Health Statistics. Series 23, Number 25. Dec 2005. Hyattsville, MD: National Center for Health Statistics.

Percent of never-married 15-19 year olds who were sexually experienced, by age: US, 1995 & 2002 Males Females SOURCE: Abma JC, Martinez GM, Mosher WD, and Dawson BS. Teenagers in the United States: Sexual Activity, Contraceptive Use, and Childbearing, 2002. Vital and Health Statistics. Series 23, No. 24. Hyattsville, MD: National Center for Health Statistics. 2004.

Percent of babies breastfed at all: single births 1990-93 & 1997-2000 SOURCE: Chandra A. New Data on Breastfeeding. DataSpeak Web Conference, May 11, 2005. Data from NSFG Cycles 5 and 6.

Use of Family Planning or Medical Services by Women 15-44 in Past Year: US, 2002 Percent About 26% of M ♀ had a fp service in last 12 months SOURCE: Chandra A, Martinez GM, Mosher, WD Abma JC, Jones, J. Fertility, Family Planning, and Reproductive Health of U.S. Women: Data from the 2002 National Survey of Family Growth. Vital & Health Statistics. Series 23, Number 25. Dec 2005. Hyattsville, MD: National Center for Health Statistics.

Percentage of men 15-44 years of age who used at least 1 health or family planning service from a medical provider in the last 12 months : US, 2002 Percent SOURCE: Martinez GM, Chandra A, Abma JC, Jones J, and Mosher WD. Fertility, Contraception, Fatherhood: Data on Men and Women from Cycle 6 (2002) of the National Survey of Family Growth. Vital and Health Statistics. Series 23, Number 26. May 2006. Hyattsville, MD: National Center for Health Statistics.

Data collected in the 2002 NSFG’s self-administered section (ACASI) Height and weight Alcohol, tobacco & drug use in last 12 months Non-voluntary sex (18-44 only) Sexual orientation and attraction STIs – ever diagnosed or treated in the last 12 months Pregnancies had (women) or fathered (men) Types of sexual contact

Percent of males & females 25-44 years of age reporting each type of sexual contact, as reported in ACASI: US, 2002 SOURCE: Mosher, WD, Chandra A, & Jones J. Sexual Behavior and Selected Health Measures: Men and Women 15-44 Years of Age: United States, 2002. Sep 2005. Hyattsville, MD: National Center for Health Statistics Advance Data Number 362.

Self-administered section - HIV & STD risk (uses CDC HARS categories) Behaviors in the last year Drug-related risk: Injection of non-prescription drugs Use of illicit drugs Sex-related risk: If male: sexual contact with other males; If female: sex with men who have had sex with men Sex with an HIV-positive partner Sex with an IV drug user Number of sexual partners in last year Exchange of sex for drugs or money Testing or treatment for sexually transmitted infection

Percent of males 15-44 who had HIV risk behaviors in the last 12 months: Male-Male sex, 5 or more female sex partners, exchanged sex for money or drugs, or had an STD: US, 2002 SOURCE: Anderson JE, Mosher WD, and Chandra A. Measuring HIV Risk in the U.S. Population Aged 15-44: Results from Cycle 6 of the National Survey of Family Growth. Advance Data from Vital and Health Statistics, No. 377. Hyattsville, MD: National Center for Health Statistics.

Percent of men & women 20-44 who are at increased risk of HIV due to their recent sexual or drug use behavior or recent STD treatment, by poverty status: US, 2002 Source: Anderson JE, Mosher WM, and Chandra A. (2006) Measuring HIV Risk in the US Population aged 15-44: Results from Cycle 6 of the National Survey of Family Growth. Advance Data from Vital and Health Statistics, No. 377, October 2006. Hyattsville, MD: National Center for Health Statistics.

Percent tested for HIV in last year by number of opposite-sex partners in the last year: US, 2002 SOURCE: Anderson JE, A Chandra, & WD Mosher. HIV Testing in the United States. Nov 2005. Hyattsville, MD: National Center for Health Statistics, Advance Data Number 363.

Continuous interviewing for NSFG Interviewing began June 2006 5,500 interviews completed in the first year. (better than expected). Why continuous interviewing? More timely & more cost effective data on (e.g.): HPV vaccine New contraceptive methods on the market Emergency contraception (ever, last 12 months, provider) Assessing populations at risk for HIV/STD and Unintended pregnancy

Schedule for Data Release from Continuous Interviewing Fall 2009: First dataset released, including around 12,000 interviews conducted in 2006-2008. Fall 2011: Second dataset released, including around 20,000 interviews conducted in 2006-2010. Release dataset every 2-3 years beginning in 2009

How to contact us Mail: NSFG Team, NCHS, 3311 Toledo RD, Rm 7318, Hyattsville, MD 20782 E-mail: nsfg@cdc.gov Voice mail: 301-458-4222 Web site: www.cdc.gov/nchs/nsfg.htm NSFG staff: Joyce Abma, Anjani Chandra, Jo Jones, Paula Goodwin, Gladys Martinez, Brittany McGill, Bill Mosher