Births and Birth Outcomes for Single- and Multiple-Race American Indian and Alaskan Native Mothers Brady E. Hamilton, Ph.D. National Center for Health Statistics (NCHS) Division of Vital Statistics Reproductive Statistics Branch The NAPHSIS/NCHS Collaboration Past Successes and Future Challenges Salt Lake City, UT June 3rd – 7th, 2007

Acknowledgements Stephanie J. Ventura, M.A., NCHS Joyce A. Martin, M.P.H., NCHS David P. Johnson, B.S., NCHS James A. Weed, Ph.D., NCHS

Background On October 30, 1997, the Office of Management and Budget (OMB) revised the standards for the classification of Federal data on race and ethnicity, established by Statistical Policy Directive 15 (May 12, 1977) The 2003 revision of the U.S. Standard Certificate of Live Birth incorporates, as stipulated by OMB, the minimum set of five categories (see below) used by Federal agencies for identification of race and option to report one or more races for mother and father Categories:American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White States that reported multiple-race in 2004:

Background (Continued) Because all states have not yet revised their birth certificates to reflect the new standards, it is necessary to ‘‘bridge’’ birth data for multiple-race mothers (and fathers) “Bridging” is the process whereby multiple-race data is imputed into the single race categories of the 1977 OMB race standard (four races) within the NCHS edit program For discussion of bridging procedure, see NCHS Procedure for Multiple-Race and Hispanic Origin Data: Collection, Coding, Editing, and Transmitting (released May 7, 2004), available at: /data/dvs/Multiple_race_docu_ pdf California Florida (from March 1 only) Hawaii Idaho Kentucky Michigan (for selected facilities only) Minnesota New Hampshire (from July 19 only) New York State (excluding NYC) Ohio Pennsylvania South Carolina Tennessee Utah Washington

Objective Compare characteristics and outcomes of births for bridged-race, single-race and multiple-race American Indian and Alaskan Native (AIAN) mothers Identify issues associated with collecting and processing multiple-race AIAN data

Data Collection and Analysis Data based on 2004 births to residents of California, Hawaii, Idaho, Kentucky, Minnesota, New York State, Ohio, Pennsylvania, South Carolina, Tennessee, Utah, and Washington (that occurred in these states) Excludes data for Florida, New Hampshire, and Michigan Data for U.S. bridged race based on all (bridged) AIAN births Race is self-reported by mother and recorded from checkbox items and literals Excludes data for race categories with fewer than 500 births Results shown are preliminary, DO NOT QUOTE OR CITE

Categories One race: Single-race AIAN More than one race: Multiple-race AIAN, AIAN reported in combination with one or more other races (i.e., White, Black, Asian, and or NHOPI) AIAN-White: AIAN in combination with White AIAN-Black: AIAN in combination with Black Bridged AIAN: Single-race AIAN and a portion of multiple-race AIAN imputed to AIAN alone

Distribution of births to mothers reporting one, two, and more than two races: 12 state reporting area, 2004 SOURCE: CDC/NCHS, National Vital Statistics System.

Percentage of births to AIAN mothers reporting one race or more than one race and percentage of births to AIAN mothers reporting two-races or more than two races: 12 state reporting area, 2004 SOURCE: CDC/NCHS, National Vital Statistics System.

Area and race Bridged race Bridged race One race AIAN-White AIAN-Black More than one race United States12 state reporting area SOURCE: CDC/NCHS, National Vital Statistics System. Number of births to AIAN women: bridged race, United States, and bridged race, one race, more than one race, and two-races in selected combinations, 12 state reporting area, 2004 Number of births (in thousands)

Total fertility rate for AIAN women: bridged race, United States, and bridged race, one race, more than one race, and two-races in selected combinations, 12 state reporting area, 2004 Rate per women Area and race Bridged race Bridged race One race AIAN-White AIAN-Black More than one race United States12 state reporting area SOURCE: CDC/NCHS, National Vital Statistics System. Data not available

Mean age at first birth for AIAN women: bridged race, United States, and bridged race, one race, more than one race, and two-races in selected combinations, 12 state reporting area, 2004 Age Area and race Bridged race Bridged race One race AIAN-White AIAN-Black More than one race United States12 state reporting area SOURCE: CDC/NCHS, National Vital Statistics System.

Percentage of births to unmarried mothers for AIAN women: bridged race, United States, and bridged race, one race, more than one race, and two-races in selected combinations, 12 state reporting area, 2004 Percent Area and race Bridged race Bridged race One race AIAN-White AIAN-Black More than one race United States12 state reporting area SOURCE: CDC/NCHS, National Vital Statistics System.

Percentage of preterm births for AIAN women: bridged race, United States, and bridged race, one race, more than one race, and two-races in selected combinations, 12 state reporting area, 2004 Percent Area and race Bridged race Bridged race One race AIAN-White AIAN-Black More than one race United States12 state reporting area SOURCE: CDC/NCHS, National Vital Statistics System.

Percentage low birthweight births for AIAN women: bridged race, United States, and bridged race, one race, more than one race, and two-races in selected combinations, 12 state reporting area, 2004 Percent Area and race Bridged race Bridged race One race AIAN-White AIAN-Black More than one race United States12 state reporting area SOURCE: CDC/NCHS, National Vital Statistics System.

Summary and Conclusion Women reporting AIAN in any combination (either single-race or multiple-race) were about equally likely to report their race alone as to report other races (more than one race) Differences between single-race and multiple-race (more than one race and two-race) mothers were significant Differences between single-race and bridged race mothers were not significant Differences between single-race AIAN and multiple-race AIAN mothers illustrate the importance of reporting and analyzing race in detailed multiple combinations

Summary and Conclusion (Continued) Findings were based on twelve states that differ markedly in terms of socio-economic and demographic characteristics from each other and from the US More detailed analysis is needed to better understand the confounding and contextual factors associated with the findings AIAN tribes differ markedly and may not be affected similarly by the reporting of more than one race Characteristics of Births to Single- and Multiple-Race Women: California, Hawaii, Pennsylvania, Utah and Washington, 2003 (released May 3, 2007), available at: