Studying Health Within the NLSY(97, 79 & Child,Youth surveys)

1. Studying Health Within the NLSY(97, 79 & Child,Youth surveys) Pamela J. Salsberry College of Nursing & Patricia B. Reagan Department of Economics

2. 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

3. 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

4. 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

5. 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

6. 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

7. Adult Health Before Age 40 • Height • Weight • Does health limit amount or kind of work respondent can do? • 1979, 1980 specific conditions causing limitation

8. 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

9. 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

10. 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

11. Health Services Utilization- Adults Health at 40 Module • Health services use (last saw a health provider) • Important for ambulatory use sensitive conditions, like asthma

12. 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)

13. Health – Children of the NLSYContinued • Birth weight • Length of gestation • Length • Maternal behaviors • Prepregnancy weight • Smoking during pregnancy • First trimester health care visit

14. Risky Behaviors • Asked only of those 10-14 • Drug, alcohol, sexual activity

15. Health Insurance for the Child • Is child covered by health insurance provided by an employer or an individual plan? • Is child covered by Medicaid?

16. 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

17. 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

18. Risky behaviors and Health—Young Adults Self report booklet— Sex & birth control Drugs & alcohol Abortions

19. Health Insurance for the Young Adults • Source of coverage—parent, employer, self • Covered by Medicaid?

20. 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

21. NLSY 97 Health • General Health • Height • Weight • Perceptions about weight • Chronic conditions Rounds 1 & 6 • Age of menarche (females)

22. NLSY97 Risky Behaviors • Age>=14 • Cigarettes, alcohol, drugs • Sexual behavior • Birth control

23. NLSY97- Health Insurance and Utilization of Services • Insurance coverage- Rounds 1 & 6 • Visit doctor in past 12 months- Round 6

24. Research Applications • Birth Outcomes • Development of childhood overweight

25. Birth Outcomes- Mothers are NLSY79 Respondents Issues to consider: Children born to teens occurred in the earliest years of the survey—by mid-1980s 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

26. 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

27. Variables of interest • Individual: • 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

28. Determining Prepregnancy BMI Recording of data slightly different Height asked at three time points(1981, 1982, 1983(for women only) and 1985) 1981=400=4 feet, 0 inches 1983=feet and inches 1985=inches There are some out of range values Only self-report measures

29. 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.

30. 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

31. 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

32. Studying Child Overweight Questions slightly different Need to convert to percentile rankings for age and sex Use of CDC program to standardize BMI Height in inches Weight in ounces Sex Age in months

33. 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,

34. 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.

35. 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

36. 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

37. Comments/Discussion