I

Vital and

Health Statistics

Advance Data

From Vital and

Health Statistics:

Numbers 221–230

Series 16:

Compilations of Advance Data

From Vital and Health Statistics

No. 23

Data in this report include provisional data on teenage attitudes about smoking and

smoking practices; visits made to otolaryngologists during the period from March 1989

to December 1990; visits made to non-federally employed, ofice-based obstetricians

and gynecologists during 1989–90; frequencies and precent distributions for data iterns

collected from the 1989 Teenage Atitudes and practices SurveJca summary of

National Health Interview Survey (1991) data concerning adults’ knowledge about

acquired immunodeficiency syndrome and human immunodeficiency virus (HIV) and

adults’ experience with HIV antibody testing; visits made in the United States during

1989 and 1990 to non-federally employed, otice-based cardiovascular disease

specialists; statistics based on data from the medical records of approximately 274,W10

patients discharged from 484 short-stay non-Federal hospitals; visits made to private,

office-based non-Federal general surgeons from March 1989 through December 1990;

characteristics of all discharges from short-stay hospitals in 1980 and 1990; and data

highlights from the 1991 National Ambulatory Medical Care Survey.

US. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

Hyaftsville, Maryland

July 1$95

DHHS Publ[catlon No. (PHS) 95-1882
Copyright information

All material appearing in this report is in the public domain and may be

reproduced or copied without permission; citation as to source, however, is

appreciated.

Suggaatad citation

National Center for Health Statistics. Advance data from vital and health

statistics: numbers 221 –230. National Center for Health StatMcs. VW Health

Stat 16(23). 1995
National Center for Health Statistics

Jack R. Anderson, Acting Director

Jemifer H. Madans, Ph.D., Acting Depufy Director

Jacob J. Feldman, Ph.D., Associate Director for Analysis,

Epidemiology, and Health Promotion

Gail F. Fisher, Ph.D., Associate Director for Planning and

Extramural Programs

Peter L. Hurley, Associate Director for Wal and Health

Statistics Systems

(Vacant), Associate Director for International Statistics

Stephen E. Nieberding, Associate Director for

.Management

Charles J. Rothwell, Associate Director for Data

Processing and Services

Monroe G. Sirken, Ph.D., Associate Director for Research

and Methodology
Contents

Recent Trends in Adolescent Smoking, Smoking-Uptake Correlates, and Expectations About the Future . . . . . . . . . . . .

Office Wits to Otolaryngologists 1980-90, National Ambulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . . . . .

Office Wits to Obstetricians and Gynecologists: United States, 1989–90. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Teenage Tobacco Use: Data Estimates From the Teenage Attitudes and Practices Survey, United States, 1989. . . . . . . .

AIDS Knowledge and Attitudes for 1991: Data From the National Health Interview Survey. . . . . . . . . . . . . . . . . . . . . .

Office Visits to Cardiovascular Disease Specialists: United States, 1989–90. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1991 Summary: National Hospital Discharge Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Office Vkits to General Surgeons 1989–90, National Ambulatory Medical Care Survey. . . . . . . . . . . . . . . . . . . . . . . . . .

Lcmg-Stay Patients in Short-Stay Hospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

National Ambulatory Medical Care Survey: 1991 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Ill
Number 221 ● December 2, 1992

Advance

Data

From Vii and Heaith Statistics of the CENTERS FOR DISEASE CONTROL AND PREVENTION/National Centerfor Health Statistics

Recent Trends in Adolescent Smoking, Smoking-Uptake

Correlates, and Expectations About the Future

by Abigail J, Moss and Karen F. Allen, M. B.A., Division of Health Interview Statistics, National Center for Health

Statistics, and Gary A. Giovino, Ph. D., Office on Smoking and Health, Centers for Disease Control and Prevention,

and Sherry L. Mills, M. D., M. P.H., National Cancer Institute, National Institutes of Health

Highlights

In 19S9, the National Center for

Health Statistics (NCHS) conducted

the National Health Interview Survey

(NHIS) on Teenage Attitudes and

Practices (TAPS), a national survey

of adokxcents interviewed about their

use of tobacco. Among the findings

are the following highlights:

●

●

●

About 1.7 million youths had

smoked a whole cigarette before

their 12th birthday. An estimated

3.7 million U.S. teenagers

(16 percent) were current

cigarette smokers. An additional

6.S million teenagers (29 percent)

had experimented with cigarettes.

Among 16–lS-year-olds, about

60 percent were either current[y

smoking (25 percent) or had

experimented with cigarettes

(34 percent). About the same

proportions of boys and girls

reported that they currently

smoked.

Proportionately more black

teenagers (63 percent) than white

teenagers (52 percent) said that

they had never smoked.

●

●

●

●

Teenagers were three times more

likely to smoke (37 percent) if

their parents and at least one

older sibling smoked than if no

one in the household smoked

(12 percent).

Teenagers with no best friends of

the same sex who smoked seldom

smoked (about 3 percent).

However, almost half of those

with at least two best friends who

smoked were smokers themselves.

About 40 percent of teenagers

who smoked reported using

cigarettes daily. Proportionately,

twice as many white teenage

smokers smoked every day

(42 percent) as did black

adolescent smokers (22 percent).

About one in five 16–18-year-olds

who smoked averaged at least 20

cigarettes per day.

About three teenaqers in four

who were current ;mokers (2.:

million adolescents) had made at

least one serious attempt to quit

smoking cigarettes. Ninety-two

percent of all adolescents did not

expect to be smoking 1 year later.

Background

Over the past 25 years, cigarette

smoking practices of U.S. adolescents

have undergone a number of marked

changes. In 196S, 17 percent of

teenage boys and 10 percent of

teenage girls 12–1S years of age

reported smoking cigarettes regularIy

or occasionally (l). In 1974, while the

proportion of boys who smoked

remained virtually unchanged

(16.3 percent), there was about a

60-percent increase in the proportion

of teenage girls who smoked

(15.9 percent). That year marked the

first time the percentages of girls and

boys who smoked were about the

same. Between 1974 and 1979, a

decrease in cigarette smoking rates

was obsen’ed among both sexes, but,

because the rate of decline was

greater among teenage boys, the

percent of girls who smoked actually

exceeded that of boys (13 percent

compared with 11 percent) (2–5).

Throughout most of the 19S0’s, the

percentages of teenagers who smoked

remained fairly stable, though,

according to some surveys, more

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

c

nPublic Health Service

Centers for Disease Control and Prevention

National Center for Health Statist~cs

—w

CENTSRS FOR KDISEASE COFi7TiiOL

ANO PREVSh710N
2 Advance Data No. 221 ● December 2, 1992

teenage girls smoked than did

teenage boys. It now appears,

however, that teenage smoking levels

are similar for both sexes (6,7).

Even with the vast body of

information now available regarding

the adverse effects of cigarette

smoking and recent efforts to

encourage smokers to quit and young

people not to start, cigarette smoking

continues to appeal to millions of

teenagers. In fact, teenagers are

beginning to smoke at younger ages,

with the age of initiation decreasing

especially among girls (6).

Furthermore, teenage smoking tends

to establish habits leading to

subsequent adult addiction, which, in

turn, often leads to significant

morbidity and premature death.

This report contains estimates of

adolescent tobacco-use patterns

derived from the h’ational Center for

Health Statistics’ 1989 Teenage

Attitudes and Practices Survey

(TAPS).

Data and Methods

In 1989, the National Center for

Health Statistics (NCHS), in

collaboration with the Centers for

Disease Control Office on Smoking

and Health (OSH] and the National

Cancer Institute (NCI) and as part of

its National Health Interview Survey

(NHIS), conducted the Teenage

Attitudes and Practices Survey

(TAPS). The TAPS was conducted to

provide national household-based

smoking data on teenagers between

the ages of 12 and 18. In addition to

providing updated and detailed

estimates of adolescent smoking

practices, the TAPS also was

designed to provide a data base for

collecting longitudinal data on future

smoking behaviors of TAPS

adolescents.

Prior to the TAPS, the last

national household-based survey

focused primarily on teenage smoking

practices was conducted in 1979 by

telephone by Chilton Research

Services for the U.S. Department of

Health, Education, and Welfare (l).

More recent national estimates of

teenage smokers are available from

school-based sumeys from the

National Institute on Drug Abuse

(NIDA) (University of Michigan 1991

Monitoring the Future Project) and

the Youth Risk Behavior Surveys

(YRBS) (7,8). These estimates

excluded high school dropouts and

teenagers with high absentee records,

two population groups at greatest risk

to smoke (9). Further, many details

about teenage smoking behavior

contained in the TAPS were not

included in these surveys.

The TAPS sampling frame

consisted of all teenagers between the

ages of 12 and 18 (on November 1,

1989) who resided in households

interviewed for the NHIS during the

last two quarters of 1988 and the first

two quarters of 1989. The final

TAPS-eligible sample contained

12,097 adolescents. Of that number,

9,965 (about 82 percent) were

subsequently interviewed. All figures

presented in this report were based

upon these sample persons and were

weighted to produce national

estimates.

Data were primarily collected

with computer-assisted telephone

interviews (CATI). However, mail

questionnaires were also used for

those teenagers who could not be

reached by telephone (that is, those

living in homes without telephones,

those with unknown telephone

numbers, and those whose telephones

were not answered). By necessity, the

maiI questionnaire represented an

abbreviated version of the CATI and

did not contain all of the questions

asked in the telephone interview.

The technical notes in this report

contain more detailed descriptions of

the sample design, response rates,

data collection procedures employed,

and the definitions of certain terms.

Methods for constructing

approximate standard errors and tests

of significance for estimates and

percents presented in this report also

appear in these notes. Unless

otherwise noted, the comparisons

made within the text are significant at

the .05 level.

Included in this report are

estimates of the number and percent

distribution of adolescents in the

United States according to their

current smoking practices (table 1).

The adolescent smoking status

categories used to classify adolescents

were: “never smoked” (subdivided by

future expectations in regard to

smoking, that is, “no intention” or

“may smoke”), “experimenter:,”

“former smoker,” and “current

smoker” (characterized as “heavy,”

“light,” and “occasional”), These

categories are described more fully in

the technical notes. Tables 2, 3, and 5

contain data that characterized

current smokers’ past and current

smoking practices, including number

of days they smoked in the past

month; average number of cigarettes

smoked per day, per weekday, and

per weekend day; and number of quit

attempts. Table 4 contains figures on

predicted future smoking practices of

teenagers (that is, whether or not

they reported they expected to be

smoking 1 year from the interview).

Table 6 includes estimates of ages

adolescents reported smoking their

first whole cigarette. Table 7 contains

estimates for several known correlates

of adolescent smoking-uptake

behavior, incIuding smoking practices

of other household members and best

friends of the same sex (3,4,10--20),

and participation in organized

physical activities (20,21). In table 8,

data are presented according to

several school-related smoking-uptake

correlates, including type of student,

attitude toward school, and schoolskipping occurrence (14,20-23). In

table 9, estimates are presented for

four types of risk-taking behavior

(24,25): fighting in the past year,

riding a motorcycle or minibike,

riding with a drunk driver or someone

on drugs, and enjoyment of risktaking activities. Data on several

measurements of smokhsg knowledge

and beliefs are presented in table 10.

Findings

Prevalence of teenage smokers

Table 1 contains estimates of the

number and percent distribution of

adolescents in the United States

according to their current smoking

practices. These estimates are shown
Advance Data No. 221 ● December 2, 1992 3

by the following demographic and

socioeconomic indicators: sex, age,

race, Hispanic origin, famiiy income,

poverty status, highest level of

education attained by family,

geographic region, and place of

residence. Results from the Teenage

Attitudes and Practices Survey

(TAPS), as stated earlier, were

representative of all U.S. teenagers

12-18 years of age.

In 1989, an estimated 3.7 million

teenagers (16 percent) were current

cigarette smokers (table 1). About

the same proportions of boys and

girls reported that they currently

smoked. This trend was noted

regardless of age. For the TAPS, a

“current” smoker was defined as

someone who smoked any time within

30 days of the date of the interview.

An additional 6.8 million teenagers

(29 percent) had experimented with

cigarettes. “Experimenters” included

teenagers who had ever tried

cigarette smoking but had smoked

fewer than 100 cigarettes and had not

smoked any cigarettes in the past 30

days. While only 4 percent of 12- and

13-year-olds were current smokers, an

additional 21 percent of adolescents

at those ages reported having

experimented with cigarettes. Among

16-18-year-olds, about 60 percent

were either currently smoking

(25 percent) or had experimented

with cigarettes (34 percent).

Experimentation with cigarettes

among adolescents appears to have

occurred with about the same

frequency, regardless of gender, race,

or ethnicity. However, among the

youngest adolescents, more boys

reported experimenting with

cigarettes than did girls (24 percent,

compared with 18 percent).

Propoflionately more black

teenagers (63 percent) than white

teenagers (52 percent) reported that

they never smoked at all. Teenagers

of Hispanic origin were also

somewhat more IikeIy never to have

smoked (57 percent) than were

non-Hispanic adolescents

(53 percent) (0.10 level of

significance).

Among the youngest group of

teenage smokers, only about one out

of seven was classified as a heavy

smoker. By 16-18 years of age, half of

all teenagers who smoked were heavy

smokers. A “heavy” smoker, by the

TAPS’s definition, was someone who

had smoked at least 10 days in the

past month and averaged 5 or more

cigarettes daily during the past 7

days. Differences were also noted in

smoking levels of teenage boys and

girls, particularly among older

teenagers. Overall, a somewhat higher

proportion of teenage boys who

smoked were heavy smokers

(47 percent, compared with

40 percent of girls who smoked).

Anong smokers 16-18 years of age,

55 percent of male smokers and

46 percent of female smokers met

the TAPS heavy-smoker criteria.

Smoking practices of current

teenage smokers

Table 2 provides details about

the teenage smoking practices of

current smokers, measured by the

number of days smoked in the past

month and the average number of

cigarettes smoked daily. Distributions

of cigarette smoking behavior on

weekdays and weekend days are

presented in table 3. Estimates in

tables 2 and 3 are shown by age, sexj

race, and Hispanic origin.

Similar proportions of teenage

male and female smokers smoked on

about the same number of days a

month, but females reported smoking

fewer cigarettes on the days that they

did smoke (table 2).

About 40 percent of teenagers

who smoked reported using cigarettes

daily. Daily cigarette smoking was

directly proportional to the age of the

smoker, from 17 percent among 12-

and 13-year-oIds to 48 percent of

those 16-18 years of age.

Proportionately, about twice as many

white teenage smokers smoked every

day as did black teenagers

(42 percent, compared with

22 percent). Hispanic youths who

smoked were ako less likely to be

daily smokers (26 percent).

As with daily cigarette

consumption, the average number of

cigarettes smoked by teenagers also

increased with age. Proportionately’,

about twice as many smokers 12 and

13 years of age averaged fewer than

five cigarettes a day as did those

between the ages of 16 and 18

(64 percent, compared with 32

percent). No teenagers in the

youngest age group averaged 20

cigarettes or more a day, but about 1

in 5 teenagers 16-18 years of age who

smoked reported smoking at this

level.

Among the youngest smokers,

boys and girls smoked at similar

levels: about 90 percent of each

gender averaged fewer than 10

cigarettes daily on the days they did

smoke. However, older adolescent

girls who smoked consumed fewer

cigarettes on the days they did smoke

than did their male counterparts. For

example, whereas about one-fourth of

male 16-18 -year-olds who smoked

averaged 20 cigarettes or more a day,

ordy about 15 percent of females

16-18 years old reported smoking at

this level.

In patterns similar to those seen

in adults, black adolescents smoked

on fewer days and averaged fewer

cigarettes per day than did white

adolescent smokers. Proportionately,

about twice as many white teenage

smokers smoked every day

(42 percent) as did bIack adolescent

smokers (22 percent). About half of

black female adolescent smokers

reported using cigarettes from 1 to 4

days in the past month compared

with 23 percent of white female

teenagers. Similarly, Hispanic youths

also smoked less often and smoked

fewer cigarettes on average than did

non-Hispanic teenagers who smoked.

Almost 60 percent of Hispanic

adolescent smokers averaged fewer

than five cigarettes a day, compared

with about 36 percent of

non-Hispanic teenage smokers who

reported smoking fewer than five

cigarettes a day.

Overall, teenage smokers appear

to smoke slightly more on weekend

days than on weekdays: 20 percent

reported smoking 20 cigarettes or

more per weekend day, compared

with 16 percent for weekdays

(table 3). However, on average, only

slight variations are seen between the
4 Advance Data No. 221 ● December 2, 1992

estimates presented in this table for

teenagers’ weekday smoking levels

and those for weekends, and some of

the observed differences may be due

to sampling variation.

Expected smoking behavior and

quit attempts

When adolescents were asked

whether they thought they would be

smoking 1 year Iater, 92 percent

answered “no” (table 4). &nong

current smokers, proportionately

twice as many adolescents 16-18

years of age predicted future smoking

(45 percent) as did adolescents 12-13

years of age (20 percent). Black

teenagers who currently smoked were

more optimistic about smoking

cessation than were their white

counterparts (24 percent and

45 percent, respectively, predicted

smoking the next year).

There was also a direct

relationship between the percent of

smokers expecting still to be smoking

in 1 year and the amount currently

smoked. Only 16 percent of

“occasional” smokers (those who had

smoked 1-9 days in the previous 30

days) predicted smoking 1 year later.

However, 46 percent of “light”

smokers and 66 percent of “heavy”

smokers said they would be still

smoking in 1 year. For the TAPS

definition, both light and heavy

smokers had smoked 10 or more days

in the previous 30 days; however,

light smokers averaged fewer than 5

cigarettes daily in the past week, and

heavy smokers averaged 5 cigarettes

or more a day. Less than 1 percent of

teenagers who had never smoked

predicted becoming a smoker within

the year.

Table 5 contains estimates of

unsuccessful attempts to quit smoking

among current adolescent smokers,

classified by age, sex, race, and

Hispanic origin. About three

teenagers in four who currently

smoked (2.7 million adolescents) had

made at least one serious attempt to

quit smoking cigarettes. For more

than half of these teenagers, the

attempt(s) took place in the 6 months

preceding the TAPS interview.

Furthermore. regardless of age, sex,

or race, estimates revealed that the

adolescent smokers who had tried to

quit outnumbered those who had not,

ranging from 66 percent of black

male smokers to 84 percent of 12-

and 13-year-old boys who smoked.

The percent of teenage smokers

who made at least one attempt to

quit smoking in the previous 6

months decreased from 73 percent of

12- and 13-year-olds to 52 percent of

16-18-year-olds. Similarly,

proportionately fewer teenagers 16-18

years of age reported ever attempting

to quit (73 percent, compared with

82 percent of youngest smokers).

Smoking initiation

Table 6 presents estimates of

adolescents’ reported ages for

smoking their first whole cigarette by

age, sex, race, and Hispanic origin.

About 1.7 million youths had smoked

a whole cigarette before their 12th

birthday. Boys were somewhat more

likely to have smoked their first whole

cigarette at a younger age. By the age

of 14, however, gender differences

had disappeared.

While similar proportions of

black, white, and Hispanic adolescent

girls reported first smoking at a given

age, white and non-Hispanic male

adolescent smokers tended to smoke

their first cigarette somewhat earlier

than did their black and Hispanic

male counterparts. For example,

44 percent of white male adolescent

smokers between 16 and 18 years of

age had smoked by age 13, compared

with about 31 percent of black males.

Similarly, Hispanic boys were more

likely to have had their first whole

cigarette at an older age than were

non-Hispanic boys. Of teenagers

16-18 years of age, 32 percent of

Hispanic males had smoked by 12

years of age, compared with

43 percent of non-Hispanic males.

Correlates of smoking uptake

Tables 7–9 present estimates of

adolescents’ current and expected

smoking behavior, according to

variables that appear to be associated

with teenage smoking practices.

Estimates for all of the measures in

tables 7-9 described above are shown

by age and sex.

Adolescents living in households

where no one smoked were the least

likely to smoke (table 7). Arncmg this

group, about 61 percent of teenagers

had never smoked, and only

12 percent currently smoked.

Teenagers were three times more

Iikely to smoke (37 percent) if their

parents and at least one oIder sibIing

smoked than if no one in the

household smoked (12 percent).

The smoking practices of older

brothers or sisters living at home

were more closely associated with

teenager smoking than was parentaI

smoking. Thirty percent of

adolescents reported currently

smoking in homes where only older

sibIings smoked, compared with

15 percent of teenagers from homes

where only their parents smoked.

The TAPS included a question to

determine the number of best friends

of the same sex who smoked. As

exTected, the smoking patterns for

both teenage boys and girls were

highiy correlated with the smoking

practices of their closest friends.

Teenagers with no best friends of the

same sex who smoked seIdom smoked

(about 3 percent). However, aImost

haIf of adolescents with at least two

best friends who smoked were

smokers themselves.

The relationship adolescents had

with their parents, as measured by

whether teenagers talked to them

about serious problems, was

associated with smoking status.

Among teenagers who said that they

discussed serious problems with their

parents, only 11 percent currently

smoked. ln contrast, proportionately

more than twice as many teenagers

who confided only with friends —and

not with a parent, other relative, or

another adult —were smokers

(23 percent).

Another correlate of adolescent

smoking is the level of involvement in

organized activities, including

athletics (20,21 ). Proportionately,

almost twice as many teenagers who

did not participate in organized team

sports currently smoked (21 percent)

as did teenagers involved in
Advance Data No. 221 ● December 2, 1992 5

competitive sports activities

(12 percent). Involvement in sports

was not found to be a determining

factor, however, for young

adolescents.

Dramatic differences in teenage

smoking practices were also found

among adolescents through selfreported school performance ratings

and attitudes toward school. Of

adolescents who classified themselves

as “above average” students, only

10 percent currently smoked; in

contrast, 44 percent of “below

average” students smoked (table 8).

Similarly, proportionately about three

times as many adolescents who

reported not liking school very much

were current smokers (35 percent) as

were teenagers who said that they

liked school a lot (11 percent).

There also appeared to be a

direct relationship between the

number of unsupervised hours

adolescents were left at home before

and after school and their current

smoking behavior. About twice as

many teenagers who were left alone

for 15 hours or more a week currently

smoked as teenagers who were never

without adult supervision (18 percent,

compared with 8 percent).

Several data items were obtained

in the TAPS to identify adolescents

who might be considered prone to

problems. Two items of this type are

shown in this report: skipping any full

days from school in the previous 2

weeks and physical fighting in the

previous year with someone other

than a family member. Adolescents

who participated in certain kinds of

risk-taking behavior were identified in

the TAPS, and data for three of these

items are also shown: whether they

had ridden a motorcycle or minibike

in the previous year, if they had

ridden with a driver in the past

month who had used alcohoI or

drugs, and if they agreed that “I get a

kick out of doing things every now

and then that are a little risky or

dangerous.”

Proportionately, about twice as

many adolescents who skipped school

were current smokers (38 percent) as

youths who had not (17 percent).

This 2-to-1 ratio was also found for 3

of the 4 risk-taking behaviors

mentioned previously. That is,

compared with other teenagers,

proportionately about twice as many

youths who smoked had been in

fights, had ridden a motorcycle or

minibike, or enjoyed risky activities

now and then (table 9). For the

fourth measure, proportionately,

more than three times as many

teenagers who had ridden with a

driver who used alcohol or drugs

currently smoked (43 percent) as

teenagers who did not report this

activity (12 percent).

Smoking knowledge and beliefs

The TAPS questionnaire

contained a series of questions to

assess teenagers’ knowledge and

beliefs about cigarette addiction,

health risks associated with cigarettes,

and perceived benefits from smoking.

Table 10 contains data for a few of

these indicators by age and sex.

The TAPS interview ascertained

whether teenagers had ever taken a

class or course at school in which the

health risks of smoking were

discussed. About the same proportion

of teenagers who said they had taken

a course of this type were currently

smoking as were teenagers who had

not taken a ciass where heahh risks

were discussed.

Similarly, TAPS polIed teenagers

about recent media exposure —

through television, radio, newspapers,

or magazines – to information on the

health risks of smoking, and the

findings parallel those of classroom

exposure. Among teenagers the

percentage of smokers was the same

regardless of whether they had

recently seen, heard, or read

materials about the adverse effects of

smoking (16 percent).

While similarities in teenage

smoking practices were found

regardless of their reported exposure

to information on the health risks

associated with cigarette smoking,

teenagers’ perception of derived

benefits and some common myths

about smoking reveal substantial

differences in smoking behavior.

These findings were illustrated by the

following three TAPS statements with

which respondents agreed or

disagreed: 1) “it’s safe to smoke for 1

or 2 years,” 2) “cigarettes help people

relax,” and 3) “smoking helps keep

weight down.”

Teenagers who assigned positive

attributes to cigarettes were 2-4 times

more likely to be smokers as were

other adolescents. For example, about

one-third of adolescents who said that

cigarettes help people relax were

smokers. In contrast, of teenagers

who disagreed with this statement,

only 9 percent smoked. Among those

who said it was safe to smoke for 1 or

2 years, almost half (46 percent)

smoked, compared with 13 percent of

the teenagers who did not agree with

this statement.

Discussion

Even infrequent experimentation

with cigarette smoking among

adolescents has been found to

increase the likelihood of becoming a

smoker in adulthood by a factor of

16, compared with adolescents who

had never tried smoking (26).

According to the Teenage Attitudes

and Practices Survey (TAPS),

experimentation with cigarettes

occurred with about the same

frequency among adolescents

regardless of gender, race, or

ethnicity. However, among the

youngest adolescents interviewed,

more boys reported experimenting

with cigarettes than did girls, a

finding that was reported in another

study (10). The TAPS results also

showed that about the same

proportions of boys and girls in each

age group reported that they

currently smoked, and these findings

were similar to those of other recent

national and smaller surveys.

With leveis pf morbidity and

mortality as criteria, cigarette

smoking has been called the most

serious and widespread form of

addiction in the world (27). One way

to observe the habit-forming

properties of cigarette smoking is to

compare the smoking levels of

preadolescent and older teenage

smokers. According to the TAPS,

among the youngest group of teenage

smokers, only about one out of seven
6 Advance Data No. 221 ● December 2, 1992

was a “hea\y smoker.” By 16-18

years of age, however, half of all

teenagers who smoked were “heavy

smokers,” by the TAPS criteria.

When the smoking habits of

teenage smokers were compared with

those of adult smokers (that is,

frequency of smoking and number of

cigarettes smoked), teenage smoking

was, by comparison, “light” (28).

Even so, about 4(I percent of

teenagers who smoked reported using

cigarettes daily. Daily cigarette

smoking was directly proportional to

the age of the smoker. As with daily

cigarette consumption, the average

number of cigarettes smoked by

teenagers also increased with age.

Whereas virtually no teenagers in the

youngest age group averaged 20

cigarettes or more a day, about 1 in 5

smokers 16-18 years of age reported

smoking at these levels. The increases

found in the frequency of daily

smoking and average numbers of

cigarettes smoked daily among

teenagers by age group further reflect

the addiction known to result from

the use of tobacco products over time

(6).

The TAPS finding that the vast

majority of teenagers (92 percent)

did not expect to be smoking in 1

year parallels those of other studies

conducted in the late 1960’s and

1970’s in which about 9 out of 10

teenagers did not expect to be

cigarette smokers 5 years later (1,5).

Given the substantial body of

evidence establishing that cigarettes

and other forms of tobacco are

addictive (6), these expected

behaviors about future smoking reveal

most adolescent smokers’ nai~rete

about difficulties encountered when

attempting to quit. Nonetheless,

teenagers and adults who smoke are

likely to experience similar

withdrawal s,ymptoms (29), so

cessation is no easier for young

smokers than for their older

counterparts.

Other studies also have found

that the best predictor of adolescents’

future smoking was their previous or

current smoking behavior (11,32,33).

The TAPS finding that teenage quit

attempts decreased w’ith age

(73 percent of 12- and 13-year-olds

had made at least one attempt to quit

smoking in the previous 6 months,

compared with 52 percent of

teenagers 16-18 years old) may, in

part, have reflected a gradual

realization that their cessation

attempts would be unsuccessful. The

TAPS also estimated that only about

342,000 adolescents (1.5 percent of

U.S. teenagers who ever smoked) had

quit successfully. If expected smoking

behaviors were to reflect actuaI future

smoking, particularly among

teenagers who currently smoked,

more than 50 percent of current

adolescent smokers would have to

have quit.

It is widely recognized that

preventing the onset of smoking in

adolescence (and early adulthood) is

the best means to eliminate smokinginduced illness (32). Furthermore,

children who begin to smoke at a

young age are more likely to consume

more cigarettes daily than those who

start later in life (33). Children 4-10

years of age represent the most

impressionable age group where

appropriately designed and repetitive

antismoking campaigns may be

especially important (34). Given that

the age of smoking initiation has

declined over time, particularly

among women (6), and that about 1.7

million youths have smoked a whoIe

cigarette before their 12th birthday,

these and other TAPS findings

support other recent

recommendations that antismoking

education start before the age of 9

(35).

Consistent with findings from

other surveys (6), TAPS results found

that, up to the age of 14, boys were

somewhat more likely to smoke their

first whole cigarette at an earlier age

than were girls. Also, other recent

study results were replicated by the

TAPS finding that, for the most part,

white teenagers were more likely to

smoke their first cigarette at an

earlier age than were black teenagers

(6).

The TAPS also found that black

and Hispanic adolescents smoked on

fewer days and averaged fewer

cigarettes per day than did white and

non-Hispanic adolescent smokers and

were more IikeIy never to be smokers.

Cigarette advertising campaigns are

now targeting these specific mhtori~

groups in recognition of this potential

“untapped” cigarette-smoking market

(36).

The TAPS findings reveaIed that

older adolescent girls who smoked

consumed fewer cigarettes on the

days they did smoke than did their

maIe counterparts. Another study has

suggested that females experience

greater sociaI pressures to smoke

than do boys but have a higher

sensitivity to nicotine, which is

resolved by smoking both at lower

levels and choosing low nicotine

cigarettes (37).

Both current and future smoking

practices among teenagers are greatly

influenced by the smoking practices

of persons with whom these young

people are most often in contact:

parents, brothers, sisters, and friends

(3,4,10-20). Findings from previous

studies differ somewhat as to which

group or combination of groups

provides the best predictors of

adolescent smoking. However, with

few exceptions, studies consistently

have found that teen:lgers who smoke

are more likely to have friends,

siblings, and parents who smoke. The

TAPS results paralIeI these findings.

Adolescents who lived in households

where no one smoked were the least

Iikely to be smokers themselves.

Teenagers were three times more

likely to smoke if their parents and at

Ieast one oIder sibling smoked than if

no one in the household smoked.

Studies have aIso found that

smoking is positively correlated with

the use of alcohol and other drugs,

with escalation from cigarettes to

alcohol the most prevalent pattern

found (38,39). Certain types of risktaking behavior, such as drug and

alcohol use, also have been shown to

be predictive of smoking uptake

(24,25). Findings from a recent study

that concluded that problem-prone

youths are most likely to smoke (40)

were also demonstrated in the TAPS

results. Teenage smoking practices

varied markedly among adolescents,

based on self-reported school
Advance Data No. 221 ● December 2, 1992 7

performance ratings and attitudes

toward school. Proportionately, four

times as many adolescents who

classified themselves as below average

students smoked as above average

students, those who reported not

liking school very much were three

times as likely to be current smokers

as those who liked school a lot, and

twice as many adolescents who

skipped school were current smokers

as other youths. For three other

troublesome behaviors – youths who

smoked had been in fights, ridden a

motorcycle or minibike, or enjoyed

risky activities now and then —this

same 2-to-1 ratio occurred. SimiIarly,

teenagers who had ridden with a

driver who used alcohol or drugs

were three times more likely to

smoke as were other teenagers.

The TAPS attempted to assess

teenagers’ knowledge and beliefs

about cigarette addiction, health risks

associated with cigarettes, and

perceived beneficial results from

smoking through a series of detailed

questions. The TAPS also assessed

whether teenagers had ever taken a

ciass or course at school in which the

health risks of smoking were

discussed or whether they had been

exposed recently to the adverse

effects of smoking through television,

radio, newspapers, or magazines.

Unfortunately, the TAPS

questionnaire did not obtain details

about the school course curriculum or

media exposure to enable further

analysis of the TAPS result that

showed similar estimates of teenage

smokers regardless of their exposure

to these “smoking education” efforts.

Somewhat contradictory restdts have

also been presented in other studies

regarding the effectiveness of

educational efforts in reducing

smoking among youths (12,37,38,41).

Other TAPS results showed that

teenagers who perceived smoking to

be beneficial –helped keep weight

down or helped people rekx~ for

example - were 24 times more likely

to smoke than were adolescents who

did not attribute benefits to smoking.

Nevertheless, from these and other

TAPS findings presented in this

report, it appears that continued

educational efforts are still needed to

further sensitize teenagers to the

health risks associated with smoking.

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Advance Data No. 221 ● December 2, 1992 9

Table 1. Number and percent distribution of teenagers by smoking status, according to seiected characteristics: United States, 1989

Never smoked Type of current smoker

.41

All .41 never No May

Characteristic

Expen- Former current

statuses smoked’ intention smoke reenter smoker smoker# Heavy Light Occasional

Age

Allteenagera3”4. . . . . . . . . . . .

12-13 yeare . . . . . . . . . . . . .

14-15 years . . . . . . . . . . . . .

16-18 years . . . . . . . . . . . . .

6,826 342

*15

al

245

206

*1O

62

136

133

●5

●19

109

319

198

120

●9

“8

●2

316

200

116

●25

●9

●17

85

91

122

●38

293

●33

139

165

66

86

109

81

256

66

1,615

756

493

367

667

3,688

241

645

2,601

1,957

114

448

1,394

1,731

127

397

1,207

3,361

1,772

1,569

217

130

87

3,419

1,817

1,602

1,619

●36

257

1,326

919

●13

133

773

700

●23

124

553

1,530

861

23,528

6,567

6,465

10,476

12,561

4,925

3.656

4,071

6,299

2,455

1,855

1,969

6,263

2,470

1,711

2,082

9,774

4,910

4,864

2.234

1,101

1,133

11,266

5,623

5,645

1,294

676

616

2,948

2,683

5,080

1,596

10,153

1,533

4,491

6,487

2,390

3,181

4,284

2,696

9,472

3,090

10,098

3,796

2,850

3,452

5,004

1,874

1,443

1,687

5,094

1,922

1,407

1,766

7,976

3,993

3,964

1,695

790

S05

9,233

4,544

4,689

632

●38

164

410

260

*17

73

1,206

145

323

738

634

77

195

382

572

66

127

376

1,067

560

507

113

61

52

1,083

576

517

112

58

5s

280

273

528

159

895

151

451

601

267

310

3s1

278

689

317

1,362

1,943

3,520

3,698

Sex and age

Male . . . . . . . . . . . . . . . . . . .

12-13 years . . . . . . . . . . . . .

14-15 yeara . . . . . . . . . . . . .

15-18 years . . . . . . . . . . . . .

12,219

3,391

3,434

5,394

11,309

3.176

3,051

5,082

366 800

291 1,049

1,646

3,129

563

6s4

1,672

5,533

2,892

2,541

1,068

564

504

6,146

3,351

2,795

681

347

334

1,593

1,T46

2,577

608

5,559

881

2,629

3,316

1,183

1,816

2,471

1,354

5,011

1,815

188 190

Female . . . . . . . . . . . . . . . . . .

12-13 yeare . . . . . . . . . . . . .

14-15 yeara . . . . . . . . . . . . .

16-18 years . . . . . . . . . . . . .

746

367

202

178

1,282

672

610

352

’22

111

219

557

242

314

Race and sex

White . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . .

Femate . . . . . . . . . . . . . . . .

19,066

9,915

9,153

3,552

1,814

1,738

669

Black . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . .

259 50

*4O

●1o

1,538

876

661

81

43

’39

447

378

574

201

1,315

300

742

577

374

451

’33

158

101

1,342

●15

’18

560

258

323

61

H~panic origin and sex

Non-Hispanic . . . . . . . . . . . . .,

Male . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . .

21,243

11,036

10,206

2,285

1,162

1,103

725

617

273

142

131

404

398

603

Hispanic . . . . . . . . . . . . . . . . . 268

Male . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . .

866

461

405

2,158

2,332

4.311

1,063

a,415

1,006

3.614

5,449

1,953

2,629

139

12s

950

649

1,465

%?2

●29

147

157

265

64

Family income

Under$20,000 . . . . . . . . . . . . .

$20,000-334,999 . . . . . . . . . . . .

$35,0000rmore . . . . . . . . . . . .

5.633

5,595

9,260

Poverty status

Inpoverty . . . . . . . . . . . . . . . .

Notin poverty . . . . . . . . . . . . . .

2,956

19.091

236 468

1,255

267

3,025

556

1,571

1,558

702

1,015

1,130

781

2,748

940

536

Highest education level

offamilymember

Lessthan12years . . . . . . . . . .

12years . . . . . . . . . . . . . . . . .

13yeareormore . . . . . . . . . . . .

3,011

8,894

11,544

60

566 282

768 267

Geographic region

Northeast . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . .

south . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . .

4.441

6,123

6,050

4,914

269 105

423 t84

3,357 535 50s 178

2,160

7,565

2,514

366 265 167

Place of residence

MSA . . . . . . . . . . . . . . . . . . . .

NotMSA . . . . . . . . . . . . . . . . .

17,556

5,972

1,263

353

1,246

374

452

178
10 Advance Data No. 221 ● December 2, 1992

Table 1. Number and percent distribution of teenagers by smoking status, according to selected characteristics: United States,

1989-Con.

Never smoked Type of current smoker

All

A/l All never No May Experi- Forrner current

Characteristic statuses smoked’ retention smoke reenter smoker smoken? Heavy tight Occasional

Age

Allteenagets3’5 . . . . . . . . . . . . .

12–13 years . . . . . . . . . . . . .

14-15 years . . . . . . . . . . . . .

18-18 years . . . . . . . . . . . . .

Sex and age

Male . . . . . . . . . . . . . . . . . . .

12-13 yeare . . . . . . . . . . . . .

14-15 yeare . . . . . . . . . . . . .

18-18 yeara . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . .

12-13yeers . . . . . . . . . . . . .

14-15yeere . . . . . . . . . . . . .

18-18yeam . . . . . . . . . . . . .

Race and sex

White . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . .

Blac k . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . .

Hispanic origin and sex

.

,Non-Hwpemc . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . .

Hispanic . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . .

Famityincorne

lJnder$20,000 . . . . . . . . . . . . .

Wo,oom-w,ew.. . . . . . . . . . .

$3W3000rmore . . . . . . . . . . . .

Poverty statue

Inpoverty . . . . . . . . . . . . . . . .

Notin poverty . . . . . . . . . . . . . .

Hgheet education level

offemilymember

Lessthan 12yeare . . . . . . . . . .

12yeare . . . . . . . . . . . . . . . . .

13yeare ormore . . . . . . . . . . . .

Geographic region

Northeast . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . .

south . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . .

Place of residence

MA.. . . . . . . . . . . . . . . . . . .

NotMSA . . . . . . . . . . . . . . . . .

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

53.6

75.3

55.4

39.0

51.8

72.6

54.3

37.1

55.6

78.1

56.6

41.1

51.5

49.7

53.4

63.3

61.1

85.7

53.3

51.2

55.6

57.1

57.7

58.3

52.9

51.8

55.0

54.9

53.4

51.4

50.9

56.3

54.1

52.1

53.6

55.1

54,2

52.1

43.1

58.0

44.3

33.1

41.1

55.5

42.3

31.4

45.3

60.7

48.6

34.8

42.0

40.4

43.7

48.0

43.8

52.4

43.7

41.3

462

382

39.3

36.9

38.7

41.9

46.6

37.2

44.2

33.7

40.9

47.3

44.2

43.1

41.9

44.1

43.4

42.4

6.9

11.5

7.7

3.5

7.1

11.5

8.5

3.5

6.6

11.6

6.7

3.5

6.8

6.6

6.7

7.3

&7

5.9

6.3

6.6

6.1

12.0

12.2

11.9

7.2

7.1

6.5

8.1

6.6

9.0

6.4

6.7

6.1

6.9

6.7

7.9

7.2

5.9

Percent distribution

29.2

20.8

30.2

33.7

30.4

23.7

30,7

34.4

27.8

17.8

29.6

33.0

28.1

30.3

27.9

30.3

31.3

29.2

29.1

30.5

27.5

30.0

29.6

30.4

28.6

31.4

27.9

27.8

29.2

28.9

29.8

26.6

26.8

29.8

30.9

27.7

26.7

30.6

1.5

●0.2

1.3

2.4

1.7

*0.3

1.6

2.5

1.2

●O.1

“0.6

2.2

1.7

2.0

1,3

“0.3

90.4

●o.1

1,5

1.6

1.1

●1.1

“0.7

●I .5

1.6

1.8

1.3

●1.3

1.5

●1.1

1.6

1.4

1.5

1.4

1.4

1.7

1.5

1.4

15.7

3.7

13.1

24.9

16.1

3.4

13.1

26.0

15.4

4.0

13.1

23.8

17.7

17.9

17.4

6.2

7.2

5.0

16.2

16.5

15.8

11.6

11.9

11.6

17.0

15.2

15.8

16.1

15.9

18.6

17.6

13.5

17.7

16.6

74.1

15.6

15.7

15.8

6.9

“0.6

4.0

12.7

7.6

‘0.4

3.9

14.4

6.2

●O.?

4.1

10.9

8.1

6.7

7.3

1.4

●2.2

“0.6

7.3

8.0

6.5

3.6

3.6

*3.6

8.0

6.8

6.2

6.9

6.9

10.1

8.4

5.0

8.5

7.4

6.4

5.6

7.1

6.3

2.7

*0.6

2.9

3.9

2.3

●0.5

2.1

3.6

3.1

●0.7

3.7

4.3

2.9

2.5

3.4

●0.9

“0.8

●1.O

2.7

2.3

3.2

2.2

●1.9

%?.7

2.6

2.6

2.9

2.2

2.8

2.0

3.2

2.5

2.4

3.0

2.2

3.4

2.6

3.0

5.1

2.2

5.0

7.1

5.2

2.3

5.7

6.7

5.1

2.2

4.2

7.4

5.6

5.7

5.6

3.2

3.4

3.0

5.2

5.2

5.1

4.9

4.9

5.0

5.0

4.9

5.7

5.5

5.2

5.1

5.1

5.2

6.0

5.1

4.4

5.7

5.1

5.3

>wltdes unknwn mlenbons.

Irldudesunknocvn !ypOOfcwrrmlsrdxar.

31Kiudosallother ra~.unknwmfatrwiy !moime.unkrwm pcwunvmetusfmd unkrKw70CltKWkYrI.

‘Indudesunkncrwn smokmgstaius

%xdudesunknwm srnokingstsh.

NOTE:MSAmmMmpdnan sfa!tsbcalarea.
Advance Data No. 221 ● December 2, 1992 11

Table 2. Percent distribution of teenage current smokers by number of days smoked in the past month and average number of cigarettes

smoked daily, according to selected characteristic= United States, 1989

Days smoked in past month Cigarettes smoked daily

Less than 5 5-9 lr329 Every

Characteristic

Less

Total’ days

20 or

days days day Tots? than 5 5=9 10-19 more

Age

All teenage current smokers. . . . .

12-13 years . . . . . . . . . . . . .

14-15 years . . . . . . . . . . . . .

16-18 years . . . . . . . . . . . . .

Sex and age

Male . . . . . . . . . . . . . . . . . . .

12-13 years . . . . . . . . . . . . .

14-15 years . . . . . . . . . . . . .

16-18 yeara . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . .

12-13 yeara . . . . . . . . . . . . .

14-15 years . . . . . . . . . . . . .

16-18 years . . . . . . . . . . . . .

Race and sex

Whfie . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . .

Hispsnicoriginand sex

Non-Hispanic . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . .

Hispanic . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . .

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

t 00.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

10Q.O

10Q.O

100.0

24.1

51.9

28.4

20.0

23.9

57.5

31.1

18.8

24.3

47.0

25.5

21.4

23.4

23.5

23.4

37.0

%29.5

4s.2

23.5

23.3

23.8

30.7

31.2

“30.2

8,7

●8.3

9.8

8.4

a.5

●10.1

12.5

7.1

8.9

●6.7

●6a

9.9

6.4

6.1

8.7

●15.O

‘1 7.3

●I 1.4

8.5

8.4

8.7

●11.2

●1O.1

●12.3

26.4

23.3

34.5

24.1

26.6

●24.3

30.9

25.4

26.2

●22.3

36.5

22.5

26.2

26.3

26.0

26.5

●24.6

%?8.4

26.0

26.0

25.9

31.8

34.3

●28 .2

Percantdistributions

40.6

●16.5

27.3

47.5

41.0

●8.1

25.5

46.7

40.6

●24.O

29.3

46.1

42.0

42.1

41.9

21.6

●28.6

●11.O

42.0

42.3

41,6

26.3

‘24.4

●28.3

100.0

100.0

moo

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

37.9

64.3

55.5

31.6

33.9

‘70.7

52.8

27.5

42.7

●58.3

58.3

36.7

36.6

32.7

41.4

60.3

●52.7

*71 .0

36.3

32.1

41.3

59.2

58.9

59.6

20.4

●24.6

17.2

21.1

19.3

●ia.4

16.0

20.2

21.6

●30.5

18.4

22.2

20.1

19.0

21.4

420.5

%22.6

●17.5

20.2

16.9

21.7

22.5

‘24.3

●20.7

25.7

*11 .0

23.0

27.2

27.6

●10.6

26.9

28.4

23.5

“112

19.0

25.7

26.5

28.3

24.4

●16.3

●I 9.7

●11.5

26.9

26.6

24.8

●11.6

●I 4.3

●8.7

16.0

0.0

●4.3

20.1

19.2

0.0

*4.2

23.9

12.1

0.0

*4.4

*1 5.3

16.8

20.0

12.9

*2.9

●5.O

●0.O

16.7

20.4

12.2

●6.6

●2.6

●11.0

‘Exdudesunknowr numberofdayssmeked.

%idudesUnlrnom rwmbwdcigm$tes Smc&cddaiymd nonasnwkedur~ wk.
12 Advance Data No. 221 ● December 2, 1992

Table 3. Percent distribution of teenage current smokers by average number of cigarettes smoked per weekday and per weekend day,

according to seleoted characteristics: United States, 1989

Cigarettes smoked per weekday Cigarettes smoked per weekend day

Less 20 or Less

Characteristic Total r

20 or

!han 5 5-9 10-19 more Tota/2 than 5 5-9 10-19 more

Age

All teenage current smokers. . . . .

12-13 years . . . . . . . . . . . . .

14-15 yeara . . . . . . . . . . . . .

16-18 years . . . . . . . . . . . . .

Sex and age

Male . . . . . . . . . . . . . . . . . . .

12-13 years . . . . . . . . . . . . .

14-15 years . . . . . . . . . . . . .

16-18 yesre . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . .

12-13 yeare . . . . . . . . . . . . .

14-15 yean . . . . . . . . . . . . .

16-18 yeare . . . . . . . . . . . . .

Race and sex

White . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . .

Hispanic origin and sex

Non-Hispanic . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . .

Hispanic . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . .

100.0

I m.o

100,0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100,0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

39.7

72.9

57.3

33.1

35.9

*76.5

55.5

29.1

44.3

●89.5

59.1

38.0

38.4

34.9

42.7

61.8

49.8

7a.7

38.0

34.2

42.7

61.2

58.9

83.7

19.5

●16.1

15.8

20.7

17.4

*I 2.7

“13.4

18.7

22.0

●19.3

16.3

23.3

19.0

16.7

21.8

●23.9

“28.3

917.7

19.4

16.9

22.4

“20.6

●24.3

●16.6

24.6

‘11.0

22.2

26.1

27.2

“10.6

26.1

28.1

21.8

●11.2

I a.2

23,6

25.7

26.0

22.9

●11.3

●16.9

●3.6

25.8

26.2

22.9

●11.6

914.3

●6.7

16.0

0.0

“4.7

20.1

19.5

0.0

“5.0

24.1

11.9

0.0

●4.4

15.0

16.9

20.4

12.6

●2.9

●5.O

●0.O

16.8

20.7

12.0

●6.6

●2. 6

*11 .0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

10Q.O

1OQ.O

100.0

100.0

100.0

100.0

100.0

100.0

100.0

37.7

66.0

52.1

32.1

33.5

%4.1

52.1

27.3

42.7

●67.6

52.0

38.3

36.5

32.4

41.3

58.9

“47.s

*75.9

35.8

31.6

40.9

61.8

58.9

54.9

16.6

●19.6

16.6

19.1

16.4

●23.7

●71.7

17.4

21.2

●16.0

21.7

21.3

18.0

15.4

21.1

●22.7

●32.8

“7.7

18.7

16.2

21.6

●17.3

●19.O

●15.4

23.6

*6.6

22.7

24.6

26.3

●12.2

28.J

26.3

20.5

●5.9

17.1

22.3

24.3

27.1

20.8

*1 5.5

*15.O

●16.4

24.5

27.0

21.5

*12.7

●16.8

●8.2

20.1

*5.5

8.7

24.2

23.6

0.0

●6.2

28.9

15.7

●1O.5

*9.2

16.1

21.2

25.0

16.7

●2.8

‘4.7

●0.O

21.0

25,2

16.0

●8.3

*5.3

●11.5
Advance Data No. 221 ● December 2, 1992 13

Table 4. Percent distribution of teenagers by expected smoking status in 1 year, according to selected characteristics United States,

1989

Will smoke W// not smoke

Chsracteristb Total’ Total Defrrite/y Probsbty Total Definitely Probably

Allteenagers . . . . . . . . . . . . . . . .

Smoking status

Never smoked . . . . . . . . . . . . . . .

No intention . . . . . . . . . . . . . . .

Maysmoke . . . . . . . . . . . . . . . .

Experimenter . . . . . . . . . . . . . . . .

Fcmnersmoker. . . . . . . . . . . . . . .

Currentsmoker . . . . . . . . . . . . . . .

Heavy . . . . . . . . . . . . . . . . . . .

tight . . . . . . . . . . . . . . . . . . . .

Occasional . . . . . . . . . . . . . . . .

Agesndsmoking status

12-13yeers . . . . . . . . . . . . . . . . .

Neversmoked . . . . . . . . . . . . . .

Experimenter . . . . . . . . . . . . . . .

Currentemoker . . . . . . . . . . . . .

14-15years . . . . . . . . . . . . . . . . .

Neversmoked . . . . . . . . . . . . . .

Experimenter. . . . . . . . . . . . . . .

Currentarnoker . . . . . . . . . . . . .

16-18yeare . . . . . . . . . . . . . . . . .

Neversmoked . . . . . . . . . . . . . .

Experimenter . . . . . . . . . . . . . . .

Currentsmoker . . . . . . . . . . . . .

Sex and smoking status

Male . . . . . . . . . . . . . . . . . . . . .

Neversmokad . . . . . . . . . . . . . .

Experimenter . . . . . . . . . . . . . . .

Currentsmoker . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . .

Neversmoked . . . . . . . . . . . . . .

Experimenter . . . . . . . . . . . . . . .

Currentsmoker . . . . . . . . . . . . .

Raceandsmoking status

Whit e . . . . . . . . . . . . . . . . . . . .

Neversmoked . . . . . . . . . . . . . .

Experimenter . . . . . . . . . . . . . . .

Currentsmoker . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . .

Neversmoked . . . . . . . . . . . . . .

Experimenter . . . . . . . . . . . . . . .

Currentsmoker . . . . . . . . . . . . .

Hispanic origin and smoking status

Non-Hispanic . . . . . . . . . . . . . . . .

Neversmoked . . . . . . . . . . . . . .

Experimenter . . . . . . . . . . . . . . .

Clrrrentsmoke r . . . . . . . . . . . .

Hispanic . . . . . . . . . . . . . . . . . . .

Neversmokect . . . . . . . . . . . . . .

Experimenter . . . . . . . . . . . . . . .

Currentsmoker . . . . . . . . . . . . .

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

1CQ.o

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Iwo

100.0

100.0

100.0

1OQ.o

100.0

100.0

100.0

100.0

100.0

lW.O

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

lW.O

100.0

7.5

0.6

4.6

1.3

4.8

43.5

66.0

46.4

15.7

1.7

0.5

*3.O

20.1

6.6

●O.?

●1.1

44.7

11.8

‘0.7

●o.a

45.3

7.6

0.7

●1.2

42.2

7.5

“0.5

1.5

45.0

8.5

0.6

1.3

44.8

2.8

●1.O

1.7

24.4

7.5

0.4

1.2

43.3

7.8

●2.5

‘2.3

46.9

1.0

●0.1

●0.9

‘0.2

0.0

5.6

10.6

●5.1

90.2

“0.3

●o.1

●0.6

●3.9

0.7

●O.1

0.0

4.9

1.5

●0.2

*0.1

6.0

1.1

●0.1

●0.2

6.0

0.9

●O.1

●O..1

5.2

1.1

●o.1

“0.2

5.6

“0.5

●0.2

●0.2

5.5

1.0

●0.1

●0.1

5.4

91.2

‘0.2

“0.7

●8.O

Percent distribution

6.5

0.5

3.7

1.2

●4.8

37.9

55.4

41.2

15.4

1.3

0.4

2.4

●16.2

5.9

‘0.6

*1.1

39.6

10.2

‘0.6

“0.6

39.3

6.5

0.6

●1.O

36.2

6.6

‘0.4

1.5

39.9

7.5

0.5

1.1

39.2

2.1

*O.8

1.5

18.8

6.5

‘0.3

1.1

37.6

6.6

“22

●1.6

3s.9

91.9

89.1

100.0

93.7

98.3

93.4

64.2

30.9

51.4

63.1

97.8

9s.2

96.1

78.8

92.6

98.0

98.7

53.2

87.6

88.2

96.9

52.3

91.7

96.9

98.4

55.6

92.1

99.4

66.2

52.7

90.6

S9.2

96.4

53.1

86.9

98.6

86.0

73.6

91.9

99.4

96.4

54.5

91.3

96.8

97.3

50.0

16.7

10.5

100.0

76.0

18.7

26.1

33.6

23.6

43.6

42.3

16.3

11.7

29.3

38.4

17.2

11.6

20.9

32.3

16.5

6.0

13.7

33.8

17.6

10.9

19.2

35.4

15.7

10.0

18.2

31.8

17.3

10.5

19.5

33.5

13.0

9.9

14.0

36.2

16.2

9.6

16.0

33.7

21.3

16.5

25.7

35.3

75.2

68.7

17.7

79.6

67.3

20.5

7.3

7.8

40.a

81.5

67.5

66.9

40.4

75.6

87.4

77.7

20.9

71.0

91.2

65.2

16.5

74.2

87.9

79.2

20.1

76.4

89.4

80.0

20.9

73,5

68.7

78.9

19.6

83.9

88.7

84.0

35.4

75.6

69.6

80.4

20.9

70.0

60.3

71.6

●I 4.8

‘ Includ.sunknownexpectedsmddrqsinus.
14 Advance Data No. 221 ● December 2, 1992

Table 5. Percent distribution of teenage current smokers by whether they had ever attempted to quit, and percent who attempted ‘to quit

In past 6 months, according to selected characteristics: United States, 1989

Ever quit smoking

,4terrrpted to quit

Characferktk Total ‘ Yes No in past 6 rrwntha

Age Percent distribution Percent

/dlteenage current smokers2 . 100.0 74.2 25.6 57’.1

12-13 yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 81.S ●18.2

14-15yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . .

72.6

100.0 77.4 22.6 68.5

16-18yeam . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 72.6 27.4 52.0

Sex and age

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 72.0 28.0 55.8

12-13yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 83.9 ●16.1 70.0

14-15years . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 73.2 26.S 67.2

16-18years . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 70.6 29.4 51.0

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 76.S 23.2 58.6

12–13yesm . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 79.5 *20.5 75.2

14-15yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 82.1 17,9 69.9

16-18years . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 74a 25.2 53.3

Race and aex

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 74.6 25.5 57,4

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 72.6 27.4 56.1

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 76.6 23.4 56.9

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 70.5 29.5 51.7

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 68.3 %33.7 49.1

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 77.3 ●22.7 *55.9

Hispanic origin and sex

Non-Hispanic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 74.5 25.5 57.4

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 72.2 27.6 55:9

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 772 22.8 59.1

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 70.3 2%7 63.7

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 66.9 ●31.1 64.ID

Female. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 71.8 ●28.2 63;3

‘Exdudesurho.m quiiaiiellwls

2Exdu5eso.Inenl srtw+erswho- smokedregulariy,
Advance Data No. 221 ● December 2, 1992 15

Table 6. Number of teenagers who ever smoked and cumulative percent by age at which they smoked first whole cigarette, according to

seiected characteristics: United States, 1989

Age smoked first whole cigarerte

All Under Under Under Under Under Under Under Under Under

teenagers who 10 11 12 13 14 15 16 17

Chamcteristic ever smoked’ Total 2

16

years years years years yeare years years yeara years

Age

Number in

thousands Cumulative percent

100.0

100.0

100.0

100.0

100.0

100.0

100.0

1OQ.o

100.0

17.5

8.5

5.0

19.3

10.1

6.6

15.5

6.5

3.0

17.0

8.6

5.0

●18.6

●1O.O

●5.5

●5.6

●7.2

‘4.4

18.5

8.6

5.1

18.6

10.3

6.7

15.3

6.4

3.0

●21 .9

●10.6

●8.2

●13.6

●9.9

●1.S

34.4

14.9

9.0

36.3

18.S

11.7

32.2

10.2

6.0

34.1

15.2

9.3

●31 .4

●15.O

●6.8

914.1

●16.4

●6.5

36.2

14.8

9.3

37.0

19.3

12.1

30.9

10.4

6.1

●26.5

●19.3

●8.9

‘40.3

●9.9

●3.9

59.6

23.0

13.3

62.9

26.1

15.7

56.2

19.3

10.6

59.5

23.7

13.6

60.0

●17.9

‘8.9

‘32.4

●21 .7

11.0

62.3

23.2

13.5

64.1

26.7

16.4

54.4

20.1

10.6

●56.7

●22. 1

●9.4

●67.9

●12.9

“8.0

6s.4

44.0

25.7

87.2

4s.2

100.0

71.5

402

100.0

75.1

42.2

100.0

67.2

38.0

100.0

72.2

41.0

100.0

63.6

34.6

10+3.0

66.4

31.3

100.0

72.0

41.0

100.0

75.3

43.6

100.0

58.6

37.9

100.0

75.6

30.6

. . .

‘50.7

40.2

. . .

95.4

55.4

. . .

96.2

55.4

. . .

94.3

55.4

. . .

95.3

56.1

. . .

95.7

46.3

. . .

84.1

49.5

. . .

96.5

55.9

. . .

96.3

56.8

. . .

94.1

55.4

. . .

93.1

44.7

. . .

96.9

46.7

. . .

100.0

75.4

. . .

100.0

75.8

. . .

100.0

75.0

. . .

1C4).O

76.2

. . .

100.0

68.3

. . .

100.0

65.1

. . .

100.0

76.4

. . .

100.0

76.9

. . .

100.0

75.3

. . .

100.0

67.9

. . .

100.0

68.9

. . .

. . .

82.6

. . .

. . .

92.9

. . .

. . .

92.3

. . .

. . .

92.9

. . .

. . .

91.1

...

...

66.6

. . .

. . .

93.?

,..

. . .

93<3

. . .

. . .

92.5

. . .

. . .

91.5

. . .

. . .

90.3

. . .

. . .

86.9

. . .

. . .

98.8

. . .

. . .

99.0

. . .

. . .

Ss.o

. . .

. . .

66.7

. . .

. . .

88.5

. . .

. . .

98.8

. . .

. . .

38.1

. . .

. . .

9s.9

. . .

. . .

97.7

. . .

. . .

100.0

12-13 yeers . . . . . . . . . . . . . . .

14-15 yeare . . . . . . . . . . . . . . .

16-18 years . . . . . . . . . . . . . . .

802

2,032

5,131

Sex and age

Male

12-13 years . . . . . . . . . . . . . . .

l+15years . . . . . . . . . . . . . . .

18-16 years . . . . . . . . . . . . . . .

483

1,111

2,727 28.0

Female

12-13 years . . . . . . . . . . . . . . .

14-15 years . . . . . . . . . . . . . . .

16-18 years . . . . . . . . . . . . . . .

419

920

2,404

89.7

38.6

23.0

86.9

45.4

26.3

90.0

28.6

19.9

85.9

40.6

18.7

88.6

44.2

26.3

66.7

49.5

29.5

89.1

40.5

22.7

●85.3

●31 .9

●14.6

100.0

●25.6

27.0

Race and age

Whiie:

12-13 yesre . . . . . . . . . . . . . . .

14-15 yeare . . . . . . . . . . . . . . .

16-18 yeare . . . . . . . . . . . . . . .

787

1,647

4,593

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

10Q.O

100.0

100.0

100.0

100.0

Black

12-13 years . . . . . . . . . . . . . . .

14-15 years . . . . . . . . . . . . . . .

18-16 years . . . . . . . . . . . . . . .

70

143

414

Hispanic origin and age

Hispanic

12-13 years . . . . . . . . . . . . . . .

l+15years . . . . . . . . . . . . . . .

16-18 years . . . . . . . . . . . . . . .

71

152

429

Non-Hispanic:

12-13 years . . . . . . . . . . . . . . .

14-15 yeara . . . . . . . . . . . . . . .

16-lSyears . . . . . . . . . . . . . . .

830

1,679

4,702

Race, sex. and age

Whtie tile

12-13 yeara . . . . . . . . . . . . . . .

14-15 years . . . . . . . . . . . . . . .

16-18 years . . . . . . . . . . . . . . .

424

1,009

2,433

White female

12-13 years . . . . . . . . . . . . . . .

14-15 years . . . . . . . . . . . . . . .

18-16 years . . . . . . . . . . . . . . .

373

836

2,159

Black male:

12-13 years . . . . . . . . . . . . . . .

14-15 yeare . . . . . . . . . . . . . . .

18-16 years . . . . . . . . . . . . . . .

46

73

242

Black female

12-13 yeare . . . . . . . . . . . . . . .

14-15 years . . . . . . . . . . . . . . .

l&18years . . . . . . . . . . . . . . .

*24

70

172
16 Advance Data No. 221 ● December 2, 1992

Table 6. Number of teenagers who ever smoked and cumulative percent by age at which they smoked first whole cigarette, according to

selected characteristics: United States, 1989-Con.

Age smoked first wire/e cigarette

Afl Under Under Under Under Under Under Under Under Under

tearragem Mro 10 11 12 13 14 15 16 17 18

Characteristic ever smoked’ ToW 2 years years yeara yeara years yeara yeara yeara years

Number in

Hispanic origin, sex, and age thousands Cumulative percent

Hispanic male:

12-13 years . . . . . . . . . . . . . . . ●31 100.0 “0.0

14-15 yeare . . . . . . . . . . . . . . . 68 100.0 ●10.0

l&18 years . . . . . . . . . . . . . . . 239 100.0 ●3.2

Hispanic female:

12-13 years . . . . . . . . . . . . . . . ●4O 100.0 ●10.4

14-15 years . . . . . . . . . . . . . . . 85 100.0 ●5.5

16-18 years . . . . . . . . . . . . . . . Iefl 100.0 ●6.5

Non-Hispanic male:

12-13 years . . . . . . . . . . . . . . . 452 100.0 20.6

14-15 years . . . . . . . . . . . . . . . 1,044 100.0 10.1

16-18 years . . . . . . . . . . . . . . . 2.468 100.0 7.2

Non-Hispanic female:

12-13 years . . . . . . . . . . . . . . . 376 100.0 16.1

14-15 years . . . . . . . . . . . . . . . 836 100.0 6.7

18-18 yeara . . . . . . . . . . . . . . . 2,214 100.0 2.7

●0.O

“10.7

●5.3

*24.3

●14.3

●7.8

36.9

18.8

12.4

33.1

9.8

5.8

●22.6

“25.0

●9.3

●39.3

919.3

●13.1

65.7

26.2

16.3

56.1

19.3

10.4

“67.0

*43.3

17.6

100.0

*39.2

●19.8

88.6

48.5

29.0

86.6

36.8

23.3

100.0 . . .

77.0 92.5

32.3 46.8

100.0 . . .

57.3 94.5

30.2 53.0

100.0 . .

75.0 96.5

43.2 56.2

100.0 . .

66.2 94.3

38.7 55.6

... . . .

100.0 . .

56.9 84.2

. . . . . .

100.0 . . .

72.9 89.9

. . . . . .

100.0 . .

77.5 93.7

. . . . . .

100.0 ...

75.2 92.5

. . .

. . .

100,0

. . .

. . .

98.7

. . .

. . .

98.7

. . .

. . .

ee.o

~b~td MtWnaQeB WhOM%Or@ ’’YeS’’t0tiequ0*0n “l+sveWusversrrwkeda agarette7

Excludes unknown age wtmn smoked risi wide agarssm

NOTE: Est,mates of teenagers who ever smoked m this table are lower than the estlmales of teenage smokers who ever smoked presented in table 1. Someteenagersanswered %0” to this dale

ttem (see footnote 1) but SIN were dassiied as Experimenters since rhey responded” yes” 10a subsequent questiom “Have you ever fdad or expWmentad with dgarette smoking, Wen a fewpuffs?”
Advance Data No. 221 ● December 2, 1992 17

Table 7. Number of teenagers, percent distribution by smoking status, and percent expecting to smoke In 1 year, according to selected

smoking-uptake correlates, age, and sex United States, 1989

Smoking status Teenagers

Selected smoking-uptake correlates All

expecting to

Never Expen- Current

by age and sex Total ‘

smoke in

teenagem smoked reenter smoker 1 year

Number in

Smoking status of household thousands Percent distribution Percent

All ages

Nonsmoker s . . . . . . . . . . . . . . . . . . .

Parents, but no older siblings. . . . . . . . .

Older siblings, but no parents. . . . . . . . .

Parents and older siblings . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . .

12,534

8,322

748

1,088

So4

100.0

100.0

100.0

100.0

100.0

60.7

51.1

38.5

31.7

38.7

b4.3

69.1

61.7

47.7

73.8

61.7

53.1

42.6

32.3

47.5

44.9

37.6

24.7

24.4

21.6

57.9

46.9

32.3

34.5

36.1

63.9

53.3

44.4

28.6

41.2

26.0

32.1

28.5

27.8

31.6

14.3

26.4

22.4

28.6

?20.9

26.4

32.6

31.9

33.7

33.3

33.2

35.7

31.9

24.1

3s.4

27.6

33.6

35.4

24.3

35.6

24.1

30.6

24.2

31.6

27.9

12.0

15.2

26.7

36.9

27,7

5.1

6.1

13.6

20.4

16.8

12-13 years:

Nosmokera . . . . . . . . . . . . . . . . . . . .

Parents. but no older siblings. . . . . . . . .

Older siblings, but no parents. . . . . . . . .

Parents and older siblings . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . .

3,520

2,413

163

243

191

100.0

100.0

100.0

100.0

100.0

1.3

4.1

*1 4.2

20.6

●52

*0.9

2.2

●4.4

●8.2

●0.O

14-15 years

Nonsmoker s . . . . . . . . . . . . . . . . . . .

Parents, but no older siblings. . . . . . . . .

Older siblings, but no parents. . . . . . . . .

Parents end older siblings . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . .

3,520

2,322

204

2s1

141

100.0

100.0

100.0

100.0

100.0

10.7

12.4

24.5

32.6

●19.1

5.0

6.3

*1 4.2

16.9

●15.6

1S-18yeara:

Nonsmoker s . . . . . . . . . . . . . . . . . . .

Parente, butnoolder siblings. . . . . . . . .

Okferslblings, butwparents. . . . . . . . .

Parenfs and older siblings. . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . .

5,495

3,586

361

553

472

100.0

100.0

100.0

100.0

100.0

le.7

24.6

40.4

46.3

39.6

7.9

13.2

17.7

26.8

23.9

Male:

Nosmokera . . . . . . . . . . . . . . . . . . . .

Parents, butno older siblings. . . . . . . . .

Older siblings, butnoparenfa. . . . . . . . .

Parents smdoldersiblings. . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . .

6,645

4,241

lQO.O

100.0

100.0

100.0

100.0

13.0

15.4

31.2

36.0

26.3

5.3

7.7

18.5

21.7

14.5

356

5s3

399

Female

Nosnwkers . . . . . . . . . . . . . . . . . . . .

Parents, butnoolder siblings. ..’ . . . . . .

Older siblings, but no parents. . . . . . . . .

Parente endoidersiblings. . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . .

s,aeo

4,081

3e2

525

405

1W.o

100,0

100.0

100.0

100.0

10.9

15.0

26.6

35.6

29.1

4.9

6.5

●9.2

19.0

19.0

Beet friends of the same sex who smoke

N agez

None . . . . . . . . . . . . . . . . . . . . . . .

I friend . . . . . . . . . . . . . . . . . . . . . . .

2friends ormore . . . . . . . . . . . . . . . . .

14,444

3,561

5.164

100.0

100.0

100.0

66.3

41.5

20.2

27.5

36.5

26.9

3.3

17.7

.49.0

1.2

6.7

26.1

12-13 years

None . . . . . . . . . . . . . . . . . . . . . . . .

l friend . . . . . . . . . . . . . . . . . . . . . . .

2friendsormore . . . . . . . . . . . . . . . . .

5,278

646

535

100.0

100.0

100.0

81.3

57.6

35.0

17.0

34.5

40.4

1.4

7.3

27.7

“0.7

*3.3

10.3

1&15 years

None . . . . . . . . . . . . . . . . . . . . . . . .

l friend . . . . . . . . . . . . . . . . . . . . . . .

2~endsormore . . . . . . . . . . . . . . . . .

4,095

8s7

1,287

10Q.O

100.0

100.0

66.2

42.1

23.1

26.3

39.7

26.2

2.3

14.6

46.1

1.0

6.5

24.9

16-18years

None . . . . . . . . . . . . . . . . . . . . . . . .

I friend . . . . . . . . . . . . . . . . . . . . . . .

2friendsormore . . . . . . . . . . . . . . . . .

5,072

1,918

3.371

100.0

100.0

100.0

54.9

35.8

16.7

37.7

39.2

24.2

6.0

22.7

S4.4

1.9

6.1

29.0

Male

None . . . . . . . . . . . . . . . . . . . . . . . .

l friend . . . . . . . . . . . . . . . . . . . . . . .

2frlendeormore . . . . . . . . . . . . . . . . .

7,673

1,820

2,s2S

lm.o

100.0

100.0

652

37.1

19.5

30.3

3e.7

24.1

3.4

19.8

52.1

1.4

6.9

27.2
18 Advance Data No. 221 ● December 2, 1992

Table 7. Number of teenagers, percent distribution by smoking status, and percent expecting to smoke in 1 year, according to selected

smoking-uptake correlates, age, and sex: United States, 1989 -Con.

Snruking status Teermgere

Selected smokmg-uptske correlates 4/

expecting to

Never Experiby age and sex

Current smoke in

teenagers Total ‘ smoked reenter smoker 1 year

Best friends of the serne Number in

sex who smoke – Con. thousands Percent distribution Percent

——

Female:

None . . . . . . . . . . . . . . . . . . . . . . . . 6,771 100.0 71.8 24.3 3.1 1,0

I friend . . . . . . . . . . . . . . . . . . . . . . . 1,740 100.0 46.0 37.2 15.4 6.6

2friends or more . . . . . . . . . . . . . . . . . 2,685 100.0 20.8 29.5 46.0 25.0

Talks abouf problems to -

All ages:

Parent . . . . . . . . . . . . . . . . . . . . . . .

Frien d . . . . . . . . . . . . . . . . . . . . . .

Ofherperson . . . . . . . . . . . . . . . . . . .

None . . . . . . . . . . . . . . . . . . . . . . .

12-13 years:

Parent . . . . . . . . . . . . . . . . . . . . . . .

Friend . . . . . . . . . . . . . . . . . . . . . . .

Otherperson . . . . . . . . . . . . . . . . . . .

Noone . . . . . . . . . . . . . . . . . . . . . . .

1+1 5 years

Parent . . . . . . . . . . . . . . . . . . . . . . .

Friend . . . . . . . . . . . . . . . . . . . . . . .

Otherpereon . . . . . . . . . . . . . . . . . . .

Noone . . . . . . . . . . . . . . . . . . . . . . .

16-18years

Parent . . . . . . . . . . . . . . . . . . . . . . .

Friend . . . . . . . . . . . . . . . . . . . . . . .

Otherperson . . . . . . . . . . . . . . . . . . .

None . . . . . . . . . . . . . . . . . . . . . . .

Male:

Parent . . . . . . . . . . . . . . . . . . . . . . .

Friend . . . . . . . . . . . . . . . . . . . . . . .

Otherperson . . . . . . . . . . . . . . . . . .

None . . . . . . . . . . . . . . . . . . . . . . .

Female:

Parent . . . . . . . . . . . . . . . . . . . . . . .

Friend . . . . . . . . . . . . . . . . . . . . . . .

Otherperson . . . . . . . . . . . . . . . . . . .

None . . . . . . . . . . . . . . . . . . . . . . .

12,317

4,51s

5,517

1,015

100.0

100.0

100.0

100.0

61.8

41.3

50.1

49.5

25.7

332

31.3

29.3

11.4

23.2

16.9

19.3

5.4

11.2

8.7

10.5

4,126

662

1,462

264

100.0

100.0

100.0

100.0

61.0

63.1

69.4

73.9

16.5

28.1

24.6

25.4

2.4

7.6

5.7

‘0.8

1.2

*3.5

●1.IB

*4.,2

3,398

1,148

1,620

2i7

100.0

1000

1cu).o

100.0

61.7

46,4

52.6

57.0

27.7

32.8

29.7

28.9

9.5

19.5

15.3

*1 2.6

4.:2

943

9.4

●5.13

4,792

2,710

2,436

474

100.0

100.0

100.0

100.0

45.2

33.8

37.0

31.4

32.1

24.5

36.3

31.6

20.5

26.6

24.6

33.5

9.7

13.5

12.:1

16.9

6,654

2,004

2,853

619

100.0

100.0

100.0

100.0

59.2

36.0

48,4

48.3

27.7

32.9

33.8

2a.4

71.8

28.0

15.9

20.2

6.3

13.3

8.0

10.2

5,663

2,514

2,665

3e8

1CK1.o

100.0

100.0

100.0

64.8

45.5

52.0

51.0

23.2

33.4

26.6

29.0

10.9

19.4

16.0

17.9

5.4

9.4

9.4

11.1

Participates in organized

physical activities

All ages

Yes. . . . . . . . . . . . . . . . . . . . . . . . . 15,317 100.0 57.5 26.9 12.2 5.4

No . . . . . . . . . . . . . . . . . . . . . . . . . . 8,083 100.0 48.7 27.9 21.4 11.6

12-13 years:

Yes . . . . . . . . . . . . . . . . . . . . . . . . . 4,643 100.O 75.8 20.5 3.5 1.4

No . . . . . . . . . . . . . . . . . . . . . . . . . . 1,678 100.0 77.6 16.1 3.6 2.4

14-15 years:

Yes . . . . . . . . . . . . . . . . . . . . . . . . . 4,416 100.0 57.6 28.5 11.1 5.2

No . . . . . . . . . . . . . . . . . . . . . . . . . . 2,029 100.0 53.5 28.7 16.6 9.7

16-16 years:

Yes . . . . . . . . . . . . . . . . . . . . . . . . . 6,056 100.0 42.8 35.3 20.0 8.6

No . . . . . . . . . . . . . . . . . . . . . . . . . 4,3S6 100.0 35.3 31.3 30.3 16.0

Male

Yes . . . . . . . . . . . . . . . . . . . . . . . . . 8,730 100.0 55.9 30.3 12.2 5.3

No . . . . . . . . . . . . . . . . . . . . . . . . . . 3,427 100.0 43.0 29.2 25.5 13.4

Female:

Yes . . . . . . . . . . . . . . . . . . . . . . . . . 6,587 100.0 59.7 27.1 12.3 5.5

No . . . . . . . . . . . . . . . . . . . . . . . . . . 4,666 100.0 52.9 26.9 18.3 10.3

1

Inclwlesorhermdunknownsnwk,ngslatus.
Advance Data No. 221 ● December 2, 1992 19

Table 8. Number of teenagers, percent distribution by smoking status, and percent expecting to smoke in 1 year, according to selected

school-related smoking-uptake correlates, age, and sex United States, 1989

Smoking status Teenagers

Selected school-related expecting to

smoking-uptake correlates All Never Experi- Currant smoke in 1

by age and sex teenagers Totaf ‘ smoked reenter srrrnker year

Type of student Percent

Number in

Percent dtib~”on

100.0 82.2 26.3 10.4

1(20.0 47.7 31.8 18.8

1W.o 26.1 26.1 44.2

All ages

Belter than average . . . . . . . . . . . . . . .

Average . . . . . . . . . . . . . . . . . . . . . .

Below averege . . . . . . . . . . . . . . . . . .

12,307

10,204

924

4.3

9.1

32.6

12-13 years

Better than averege . . . . . . . . . . . . . . . 3,636

2,7S8

203

100.0 82.5 14.6 27

100.0 70.6 25.1 3.9

100.0 47.8 37.4 ●I 4.8

90.8

1.9

●13.3

Average . . . . . . . . . . . . . . . . . . . . . .

Below average . . . . . . . . . . . . . . . . . .

14-15 years

B@tertian averege . . . . . . . . . . . . . . .

Average . . . . . . . . . . . . . . . . . . . . . .

Below avemge . . . . . . . . . . . . . . . . . .

3.6

8.1

30.7

3,403

2,811

251

100.0 63.9 26.8 8.4

100.0 49.4 32.2 16.3

100.0 327 30.7 35.5

16-18 years

Better then average . . . . . . . . . . . . . . .

Average . . . . . . . . . . . . . . . . . . . . . .

Belowevarege . . . . . . . . . . . . . . . . . .

5,366

4,s07

470

100.0 47.7 33.8 16.8

100.0 32.8 35.1 28.3

100.0 132 18.7 61.5

6.9

142

42.1

Male

Betterthanaversge . . . . . . . . . . . . . . .

Average . . . . . . . . . . . . . . . . . . . . . .

Belowaverege . . . . . . . . . . . . . . . . . .

4.1

9.0

30.3

6,069

5,563

54a

100.0 60.3 27.7 10.7

100.0 46.0 327 19.1

100.0 25.9 26.5 42.0

Female:

Bettertharraverege . . . . . . . . . . . . . . .

Average . . . . . . . . . . . . . . . . . . . . . .

BeIowavereg e . . . . . . . . . . . . . . . . .

lW.O 64.0 26.0 10.1

100.0 49.7 30.2 1s.4

100.0 26.3 226 47.3

6@8

4,641

376

4.4

9.3

85.9

Howmucfrlikedechool

ANage~

Abet . . . . . . . . . . . . . . . . . . . . . . . .

Some . . . . . . . . . . . . . . . . . . . . . . . .

Utt!eornotatall . . . . . . . . . . . . . . . . .

12-13 year’s

Abet . . . . . . . . . . . . . . . . . . . . . . . .

Some . . . . . . . . . . . . . . . . . . . . . . . .

Liltleornotatall . . . . . . . . . . . . . . . . .

14-15 yearS

Abe t . . . . . . . . . . . . . . . . . . . . . . .

Some. . . . . . . . . . . . . . . . . . . . . . . .

LltUeorrxrtstall . . . . . . . . . . . . . . . . .

1S-18 years

Abet . . . . . . . . . . . . . . . . . . . . . . . .

seine . . . . . . . . . . . . . . . . . . . . . . . .

Utfteornotatatl . . . . . . . . . . . . . . . . .

Male:

Abet . . . . . . . . . . . . . . . . . . . . . . . .

some . . . . . . . . . . . . . . . . . . . . . . . .

Uttfeornotatall . . . . . . . . . . . . . . . . .

Femalec

Alit . . . . . . . . . . . . . . . . . . . . . . . . .

Some . . . . . . . . . . . . . . . . . . . . . . . .

Littleormtatell . . . . . . . . . . . . . . . . .

9.4s1

11,170

2,s36

100.0

100.0

100.0

80.6

52.2

34.0

26.9

31.1

282

112

14.6

34.7

4.1

6.7

21.9

2704

3,175

882

lW.O

100.0

100.0

80.9

73.8

56.0

15.4

226

34.1

32

3.0

8.8

●1.0

1.5

●5.4

7.4

13.4

282

3.4

5.9

19.3

2,486

3,178

7s4

100.0

100.0

100.0

63.4

52.9

37.3

27.9

31.5

30.6

lUI.O

100.0

100.0

45.9

37.4

21.6

33.7

38.5

24.0

18.5

23.0

602

6.6

10.6

31.3

4.2s1

4,616

3,362

4,434

6,076

1,8s7

100.0

100.0

100.0

56.2

51.3

241

28.6

31.6

SO.4

11.7

14.7

32.3

3.9

6.7

2Q.3

10.7

14.5

37.9

4.3

6.6

24.1

4,ss7

5,0s4

1,161

100.0

100.0

100.0

827

53.2

34.0

25.5

30.5

25.1
20 Advance Data No. 221 ● December 2, 1992

Table 8. Number of teenagera, percent distribution by smoking status, and percent expecting to smoke in 1 year, according to seiected

schooi-reiated smoking-uptake correlates, age, and sex: Urrtted States, 1989- Con.

Srrmking status Teenagers

Selected schoo-related expecting to

smoking-uptake correlates .4// Never

by age and sax

Eqrert- Current

teenagecs Total ‘

smoke in

smoked reenter smoker 1 year

Skipped school in past 2 weeks

Number in

Percent distribution Pement

All age5

No . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . .

100.0

100.0

49.2

22.3

31.9

35.4

26.2

35.69

35.5

32.7

33.4

36.2

34.3

38.3

29.7

33.0

25.6

24.7

28.4

32.5

32.9

18.0

20.5

21.0

26.1

22.6

29.2

25.4

29.S

34.9

34.5

35.7

33.7

35.9

37.3

36.7

27.2

26.6

31.2

34.3

34.0

23.7

22.6

25.5

30.4

3Z0

17.3

37.6

5.2

18.3”

17.7

40.9

26.0

39.7

16.7

32.8

18.0

41.7

8.4

9.0

11.9

12.7

18.4

3.0

3.6

5.1

●3.8

●4.8

10.7

12.6

13.4

15.9

21.5

16.4

15.2

16.6

20.1

24.5

8.4

6.9

12.2

14.4

16.5

8.4

9.1

11.7

10.6

16.3

7.7

17.5

12-13 years:

No . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . .

1,472

104

100.0

100.0

67.7

40.4

●1I.6

1 4.4*

14-15 yeara:

No. . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . .

1,566

206

100.0

100.0

45.6

21.6

9.1

23.6

16-18years:

No . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . .

1,978

639

100.0

100.0

38.0

19.6

11.1

16.0

Mate

No . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . .

2,473

436

100.0

100.0

47.6

23.9

6.9

16.3

female

No . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . ..d.. . . . . . .

2,645

515

100.0

100.0

50.7

21.0

a.4

16.4

Hours (per week) alone

beforeand/orafter school

All ages

None . . . . . . . . . . . . . . . . . . . . . . . .

l-5houra . . . . . . . . . . . . . . . . . . . . .

6-10 hours . . . . . . . . . . . . . . . . . . . .

11-15 houm . . . . . . . . . . . . . . . . . . . .

Morefhsn 15houra . . . . . . . . . . . . . . .

6,401

4,950

2,612

1,140

1,040

100.0

100.0

100.0

100.0

100.0

65.2

65.0

58.4

54.2

47.4

4.2

4.5

5.3

6.6

7.8

12-13 years

None . . . . . . . . . . . . . . . . . . . . . . . .

l-5hours . . . . . . . . . . . . . . . . . . . . .

6-10hours . . . . . . . . . . . . . . . . . . . .

11-15houra . . . . . . . . . . . . . . . . . . . .

Morethsn 15houm . . . . . . . . . . . . . . .

2,737

2,244

644

394

252

100.0

100.0

100.0

100.0

100.0

76.9

75.6

73.3

70.1

72.6

1.6

*1.6

●2.6

●2.O

●0.O

14-15yasrs:

None . . . . . . . . . . . . . . . . . . . . . . . .

l-6 hours . . . . . . . . . . . . . . . . . . . . .

6-10hours . . . . . . . . . . . . . . . . . . . .

ll-lstrours . . . . . . . . . . . . . . . . . . . .

Morethan 15hours . . . . . . . . . . . . . . .

2,502

1,600

1,146

476

469

100.0

100.0

100.0

100.0

100.0

59.1

59.7

55.3

46.5

42.6

5.3

7.3

5:9

9.2

10.2

16-18 yaaw

None . . . . . . . . . . . . . . . . . . . . . . . .

l-5hours . . . . . . . . . . . . . . . . . . . . .

6-10houra . . . . . . . . . . . . . . . . . . . .

11-15hours, . . . . . . . . . . . . . . . . . . .

Morethsn 15hours . . . . . . . . . . . . . . .

S.ID

6.1

7.$)

●6.6

*1 0.7

1,162

905

622

266

318

100.0

100.0

100.0

100.0

100.0

46.0

49.5

43.9

41.0

34.9

Msk

None . . . . . . . . . . . . . . . . . . . . . . . .

l-5hwra . . . . . . . . . . . . . . . . . . . . .

&lOhours . . . . . . . . . . . . . . . . . . . .

ll-lshoura . . . . . . . . . . . . . . . . . . . .

More lhan15 houra . . . . . . . . . . . . . . .

3,335

2,615

1,319

612

509

100.0

100.0

100.0

100.0

100.0

63.4

62.9

54.6

60.3

47.2

4.1

3.9

6.’1

5.[$

7.7

4.:j

5.:?

4.$

7.0

8.1

None . . . . . . . . . . . . . . . . . . . . . . . .

l-5hours . . . . . . . . . . . . . . . . . . . . .

6-10hours . . . . . . . . . . . . . . . . . . . .

11-15 hours . . . . . . . . . . . . . . . . . . . .

Morethan 15hours . . . . . . . . . . . . . . .

3,066

2,335

1,292

527

631

100.0

100.0

100.0

100.0

100.0

67.1

67.5

62.3

59.0

47.6

lkldUdUdhWMd tmkmwnsmdms -.
Advance Data No. 221 ● December 2, 1992 21

Table 9. Number of teenagers, percent distribution by smoking status, and Percent expecting to smoke in 1 year, according to selected

risk-taking behaviors, age, and sex: United States, 1989

Smcking status Teenagera

expecting to

Selected risk-taking All Never Experi- Current

behaviors by age and sex

smoke m

teenagers Total 1 smoked reenter smolrer 1 year

Number in

Fought in past year thousands Percent distribution Percent

All ages:

Yes . . . . . . . . . . . . . . . . . . . . . . . . . 6,446 100.0 38.5 33.6 24.8 12.8

No . . . . . . . . . . . . . . . . . . . . . . . . . . 17,001 100.0 59.0 27.4 12.2 5.5

12-13 years

Yes . . . . . . . . . . . . . . . . . . . . . . . . . 1,877 100.0 58.0 32.9 7.9 2.8

No . . . . . . . . . . . . . . . . . . . . . . . . . . 4,657 100.0 81.6 16.0 2.0 1.3

14-15 year=

Yes . . . . . . . . . . . . . . . . . . . . . . . . . 1,857 100.0 37.6 35.3 23.3 13.2

No . . . . . . . . . . . . . . . . . . . . . . . . . . 4,608 100.0 62.0 27.8 8.9 3.9

16-18 year!x

Yes . . . . . . . . . . . . . . . . . . . . . . . . . 2,712 100.0 25.3 32.9 37.5 19.4

No . . . . . . . . . . . . . . . . . . . . . . . . . . 7,736 100.0 43.6 33.9 20.3 9.0

Malw

Yes . . . . . . . . . . . . . . . . . . . . . . . . . 4,706 100.0 40.5 33.7 22.5 1~.4

No, . . . . . . . . . . . . . . . . . . . . . . . . . 7,469 100.0 58.4 26.1 12.0 5.1

Female:

Yes . . . . . . . . . . . . . . . . . . . . . . . . . 1,738 100.0 32.9 33.1 31.1 16,6

No . . . . . . . . . . . . . . . . . . . . . . . . . . 9,532 100.0 59.5 26.7 12.4 5.8

Rode a motorcycle

or minibike in past year

All ages:

Yes . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . .

9,375

14,044

100.0

100.0

42.4

62.6

32.6

25.6

22.8

10.4

11.1

5.1

12-13 years

Yes . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1

1.0

2,144

4,362

100.0

100.0

66.0

81.5

27.2

16.0

6.4

2.2

14-15years:

Yes . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . .

16-18 year%

Yes . . . . . . . . . . . . . . . . . . . . . . . . .

No. . . . . . . . . . . . . . . . . . . . . . . . . .

30.8

28.1

21.4

7.1

11.2

3.5

2,620

3,836

100.0

100.0

45,5

63.6

100.0

100,0

29.7

47.6

36.1

31.6

31.2

18.8

14,6

9.2

4,611

5,627

Male

Yes . . . . . . . . . . . . . . . . . . . . . . . . .

No. . . . . . . . . . . . . . . . . . . . . . . . . .

6,003

6,157

100.0

100.0

43.1

61.2

32.8

27.2

21.9

10.2

10.6

4.5

Female:

Yes . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . .

3,372

7,867

100.0

100.0

41.2

63.7

32.3

24.7

24.5

10.6

12.1

5,5

Rode with driver using alcohol

and/or drugsin past year

All ages:

Yes . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . .

2,556

20,860

100,0

100.0

23.4

56.3

30.9

28.3

42.7

12.0

22.7

5.6

12-13 years:

Yes . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . .

274

6,259

100.0

100.0

60.9

77.0

26.8

19.4

●9.1

3.3

*5.8

1.5

14-15 years:

Yes ., . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . .

18.8

5.4

584

5,870

100.0

100.0

31.6

56.9

32.0

28.9

32.5

10,9

16-18 years:

Yes . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . .

1,698

8,732

100.0

100.0

14.4

44.5

30,8

24.2

51.8

19.0

26.7

8.7
22 Advance Data No. 221 ● December 2, 1992

Table 9. Number of teenagers, percent distribution by smoking status, and percent expecting to smoke In 1 year, according to selected

risk-taking behaviors, age, and sex United States, 1989-Con.

Smoking status Teenagers

Selected rfsk-taking

expecting to

All Never Expenbehawors by age and sex

Current smoke in

teenagers Total 1 smoked reenter smoker 1 year

Rode with drrver using alcohol

andlor drugs m past year- Con.

Number in

thousands Percent distribution Percent

Male:

Yes .,. . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . .

1,4C4

10.756

100,0

100.0

25.0

55.8

27.1

30.4

44.6

12.2

2:3.6

5,4

Female’

Yes. , . . . . . . .

No . . . . . . . . . . . . . . . . . .

1,152

10,104

100.0

100.0

21.6

60.9

35.5

26.1

40.5

11.8

21.6

5.8

Enjoyed risk-taking acwitles

All ages:

Yes, . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . .

9,867

11,672

100,0

100.0

38.4

65,4

36.5

22.9

22.7

10.0

11.1

4.5

12-13 years:

Yes . . . . . . . . . . . . . . . . . . . . . . . . .

No, ,, . . . . . . . . . . . . . . . . . . . . . . .

2.014

3,965

100.0

100,0

59.4

82.2

32.0

15,4

7.5

1.9

3.7

“0.6

14-15years:

‘fed . . . . . . . . . . . . . . . . . . . . . . .

No. . . . . . . . . . . . . . . . . . . . . . . . .

18-18 years:

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . .

2,792

3,129

100.0

100.0

40.4

68.2

38.0

22.4

19.5

7.5

10.7

3.3

5,061

4,556

100.0

100.0

26.9

48,9

37.5

29.9

30.4

18.9

14.3

6.7

Male:

Yes, ,,.., . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . .

5,780

5,512

100,0

100,0

38.6

63.8

36.7

24,1

22.0

10.3

10.5

4.8

Female:

Yes . . . . . . . . . . . . . . . . . . . . . .

~o, ,,, ,,, . . . . . . . . . . . . . . . . . .

4,087

6.160

100.0

100.0

38.1

66.9

36.3

21.9

23.6

9.8

12.1

4.3

1Inctudes other and unknown smoking s:atus.
Advance Data No. 221 ● December 2, 1992 23

Table 10. Number of teenagers and percent distribution by smoking status, according to selected smoking-knowledge indicators, age,

and sex: United States, 1989

Smoking status

Smoking-knowledge All Never Experi- Current

indicators by age and sex teenagers Total’ smoked reenter smoker

Number in

Taken class about health risks thousands Percent distribution

All ages:

Yes . . . . . . . . . . . . . . . . . . . . . . 17,688 1OQ.o 53.5 29.6 15.2

No . . . . . . . . . . . . . . . . . . . . . . . 5,665 lW.O 57.6 25.5 15.7

12-13 years

Yes . . . . . . . . . . . . . . . . . . . . . . 4,S42 100.0 76.1 20.3 3.3

No . . . . . . . . . . . . . . . . . . . . . . . 1,852 1OQ.o 77.1 18.6 4.0

1615 years:

Yes . . . . . . . . . . . . . . . . . . . . . . 4,634 100.0 55.7 30.2 12.6

No . . . . . . . . . . . . . . . . . . . . . . . 1,620 1(0.0 58.6 26.0 13.9

16-18 years:

Yes . . . . . . . . . . . . . . . . . . . . . . 8,213 100.0 39.4 34.5 23.5

No . . . . . . . . . . . . . . . . . . . . . . . 2,193 100.0 40.3 31.0 27.0

Male:

Yes . . . . . . . . . . . . . . . . . . . . . . 9,158 1Coo 51.0 31.0 16.0

No . . . . . . . . . . . . . . . . . . . . . . . 2,866 100.0 56.1 27.3 15.2

Female:

Yes . . . . . . . . . . . . . . . . . . . . . . S,531 100.0 56.1 26.2 14.3

No . . . . . . . . . . . . . . . . . . . . . . . 2,699 1CO.o 59.1 23.6 16.3

T.V., radio, or other media exposure

All ages

Yes . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . .

12-13 years

Yes . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . .

14-15 yeara:

Yes . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . .

16-16 years

Yes, . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . .

Male

Yas . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . .

Female

Yes . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . .

15.2

16.4

19,264

4,212

lCQ.O

ltll.o

54.7

53.4

26.6

28.4

3.5

3.8

5,409

1,143

100.0

100.0

76.1

77.7

20.1

+8.2

IOQ.o

100.0

56.3

56.5

29.5

26.6

12.8

13.0

5,351

1,107

8,504

1,962

100.0

100.0

40.1

37.6

33.5

34.3

24.0

25.6

52.8

49.0

30.0

30.5

15.4

18.7

10,078

2,113

100.0

100.0

100.0

100.0

56.8

57.9

27.1

26.4

14.9

14.1

9,185

2,099

“Most doctors are against

smoking cigarettes”

All ages:

Agree . . . . . . . . . . . . . . . . . . . . .

Disagree . . . . . . . . . . . . . . . . . . .

12-13 years

Agree . . . . . . . . . . . . . . . . . . . . .

Disagree . . . . . . . . . . . . . . . . . . .

f615yesrx

Agree . . . . . . . . . . . . . . . . . . . . .

Diasagree . . . . . . . . . . . . . . . . . .

16-18 years

Agree . . . . . . . . . . . . . . . . . . . . .

Disagree . . . . . . . . . . . . . . . . . . .

1s,743

4,165

100.0

100.0

53.7

523

26.7

30.8

15.8

148

19.6

24.9

3.6

4.4

5,219

1,154

10+3.0

100.0

78.0

70.2

55.2

54.7

29.7

31.7

5,042

1,244

100.0

100.0

13.5

10.7

1OQ.o

100.0

8,461

1,767

39.0

38.9

33.6

34.1

24.7

24.4
24 Advance Data No. 221 ● December 2, 1992

Table 10. Number of teenagers and percent distribution by smoking status, according to seiected smoking-knowiedge indicator, age, and

sex: United States, 1989 —Con.

Smoking status

Smoking-knowledge A/l Never Expen. Current

mdlwfors Oy age and sex teenagers Total ‘ smoked reenter smoker

“Most doctors are against Number in

smokmg cigarettes” – Con. thousands Percent distribution

Male:

Agree . . . . . . . . . . . . . . . . . . . . . 9,807 100.0 52.1 30.2 15.7

Disagree . . . . . . . . . . . . . . . . . . . 2,087 100.0 49,0 31.3 17.2

Female:

Agree, . . . . . . . 8,936 100.0 55.4 27.1 16.0

Disagree, . . . . . . . . . . . 2,078 100.0 55.5 30.3 12.4

“Safetosmokel or2 years”

All ages:

Agree . . . . . . . . . . . . . . . . . . . . .

Disagree, . . . . . . . . . . . . . . . . . .

12-13 years:

Agree . . . . . . . . . . . . . . . . . . . . .

Disagree, . . . . . . . . . . . . . . . . ,.

14-15 years:

Agree . . . . . . . . . . . . . . . . . . . . .

Disagree. . . . . . . . . . . . . . . . .

18-18 years:

Agree. . . . . . . . . . . . . . . . . . . . .

Disagree . . . . . . . . . . . . . . . . . .

Male:

Agree . . . . . . . . . . . . . . . . . ,,..

Disagree . . . . . . . . . . . . . . . . .

Female:

Agree. . . . . . . . . . . . . . . . . . . .

Disagree . . . . . . . . . . . . . . . . . . .

1,631

21,471

100.0

100.0

24.0

55.9

26.5

29.2

45.7

13.2

302

6,144

100.0

100.0

41.7

76.8

38.4

19.8

20.2

2,8

364

5,961

100.0

100.0

29.7

57.1

27.6

30.1

36.2

‘11.3

844

9,366

100.0

100.0

16.1

41.4

22.5

34.8

57.7

21.2

1,048

10,932

100,0

100.0

21.5

54.7

27.6

30.6

fi6.6

12.9

583

10,539

100.0

100.0

28.6

57.2

24.7

27.8

44.1

13.5

“Cigarettes help people relax”

All ages:

Agree. . . . . . . . . . . . . . . . . .

Disagree . . . . . . . . . . . . . . . . . . .

12-13 years:

Agree . . . . . . . . . . . . . . . . . . . . .

Disagree . . . . . . . . . . . . . . . . . . .

6,265

16,397

100.0

100.0

32.8

61.2

29.9

28.6

34.4

8.7

1,129

5,148

100.0

100.0

61.4

76.3

30.0

16.6

7.4

2.7

14-15 years:

Agree . . . . . . . . . . . . . . . . . . . . .

Disagree . . . . . . . . . . . . . . . . . .

1,678

4.583

100.0

100.0

38.4

61.4

29.9

29.8

29.0

7.2

16-18years:

Agree . . . . . . . . . . . . . . . . . . . . .

Disagree. . . . . . . . . . . . . . . . . .

Male:

Agree. . . . . . . . . . . . . . . . . . . . .

Disagree . . . . . . . . . . . . . . . . . .

3,458

6,666

100.0

100.0

20.7

47.9

29.9

35.5

45.9

74.4

3,591

8,136

100.0

100,0

32.8

59.5

30.7

30.2

33.2

8.7

Female:

Agree . . . . . . . . . . . . . . . . . . . . .

Disagree . . . . . . . . . . . . . . . . . . .

2,674

8,261

100.0

100.0

32.6

63.0

28.8

27.1

36.0

8.7
Advance Data No. 221 ● December 2, 1992 25

Table 10. Number of teenagers and percent distribution by smoking status, according to selected smoking-knowledge indicators, age,

and sex: United States, 1989-Con

Smokhg status

Smoking-know4edge .41 Never EXpen- Current

indicators by age and sex teenagera Total ‘ smoked mentar smoker

Numberin

“Smoking helps keep weight down” thousands Percent distribution

All ages:

Agree, . . . . . . . . . . . . . . . . . . . . 4,178 100.0 40.6 30.8 26.2

Disagree . . . . . . . . . . . . . . . . . . . 18.786 100.0 57.6 26.0 13.0

12-13 years:

Agree . . . . . . . . . . . . . . . . . . . . . 852 100.0 67.3 26.2 6.0

Disagree . . . . . . . . . . . . . . . . . . . 5,532 100.0 77.6 19.0 3.1

1+15 years

Agree . . . . . . . . . . . . . . . . . . . . . 1,045 100.0 43.2 32.9 21.6

Disagree . . . . . . . . . . . . . . . . . . . 5,292 100.0 59.2 28.2 11.3

16-18 years

Agree . . . . . . . . . . . . . . . . . . . . . 2,280 100.0 29.6 31.6 35.9

Disagree . . . . . . . . . . . . . . . . . . . 7,963 100.0 42.6 34.2 21.0

Male

Agree . . . . . . . . . . . . . . . . . . . . . 2,027 100.0 38.1 31.8 27.7

Disagree . . . . . . . . . . . . . . . . . . . 9,859 100.0 55.2 29.6 13.6

Female:

Agree . . . . . . . . . . . . . . . . . . . . . 2,151 100.0 43.0 29.9 24.9

Disagree . . . . . . . . . . . . . . . . . . . 8,926 100.0 60.2 26.3 12.4

1Includes other md unknwn srmking 6talus.
26 Advance Data No. 221 ● December 2, 1992

Technical notes

Source and description of data

This report contains data from

the 1989 Teenage Attitudes and

Practices Sumey (TAPS). The TAPS

was a targeted population study of

U.S. teenagers 12-18 years of age.

The study was conducted by the

National Center for Health Statistics’

National Health Intemiew Survey

(NHIS) and co-sponsored by the

Centers for Disease Control Office on

Smoking and Health (OSH) and the

National Cancer Institute (NCI).

The TAPS was designed to obtain

national household data about

current cigarette-smoking behavior

and lifetime smoking practices of

adolescents and their beliefs about

smoking. Selected correlates of

smoking uptake were also addressed

in the study.

The TAPS sample was derived

from NHIS’S household interviews

conducted during the final two

quarters of 1988 and the fh,: two

quarters of 1989. All teenagers living

in households contacted and

interviewed during this period that

were 12--18 years of age as of

November 1, 1989, were included in

the sample. The eligible sample for

the TAPS was 12,097 persons.

The TAPS utilized two modes of

data collection. The primary method

consisted of computer-assisted

telephone interviewing (CATI) in

households where a telephone

number was provided during the

original NHIS interview. In addition,

self-administered questionnaires were

mailed to sample teenagers living in

households without telephones or an

available telephone number. Mail

questionnaires were also sent to those

teenagers living in households with an

original telephone number but who

were never reached using the CATI

method, Telephone interviews and all

other data collection activities were

performed by U.S. Bureau of the

Census personnel. Data collection

began in August 1989 and. except for

late receipt of some mail

questionnaires, concluded in

December 1989.

Unlike the original NHIS

interview, all teenagers responded for

themselves, However, prior to the

initial telephone contact, advance

letters were mailed to a responsible

related adult and to each eligible

teenager in the household explaining

the sponsorship and objectives of the

upcoming sutvey and assuring

confidentiality.

The total interviewed TAPS

sample included 9,965 adolescents,

9.135 from CATI intemiews and the

remaining 830 cases from completed

mail questionnaires. The total

combined response rate for the TAPS

from these 2 data-collection

procedures was 82 percent. Most of

the nonresponse resulted from

teenagers’ failure to return the mail

questionnaire. Only 3.7 percent of

interviews of adolescents reached by

telephone ended in a refusal either

because of the parent’s or teenager’s

initiaI refusal or subsequent

termination of the interview. Item

nonresponse was less than 1 percent

for the questions discussed in this

report. More details about

nonresponse are available in a recent

report (42).

Sampling errors

Because estimates shown in this

report are based on a sample of the

population rather than on the entire

population, they are subject to

sampling error. When an estimate or

the numerator or denominator of a

percent is small, the sampling error

may be relatively high. In addition,

the complex sample design of the

NHIS has the effect of making the

sampling errors larger than they

would be had a simple random

sample of equal size been used.

The following method for

computing sampling errors is

presented for the convenience of

readers who want a simple method to

use in calculating standard errors for

estimates in this report. More precise

methods, such as that available in the

software program SUDAAN (43),

which estimates standard errors for

complex sample surveys using Taylor

linearization, are recommended for

detailed analysis of NHIS data.

Approximate standard errors of

the estimated numbers (x) in this

report (except for age, sex, and race

for all teenagers when the standard

error is assumed to be 0.0) may be

calculated using the formula

SE(x) = ~ 0.0000307(x)2 + 3,640~)

Except as noted below,

approximate standard errors of the

estimated percents in this report may

be calculated using the formula

‘E@=r)

where p isthe estimated percent and

y is the population denominator.

Approximate standard errors for

the percents in table 1 by age, sex,

and race only and the percents for

the “all teenagers” category in

table 4 may be calculated by using

the formula

SE(p) =p~O.0000307 + 3,640/x

where p isthe estimated percent and

x =py/100 withy = the population

denominator.

If x ~and x ~ are two estimates,

then the approximate standard error

of the difference (x l-x J can be

computed as follows:

~SE(x J2+SE(x2)2-2r SE (XJSE(X2)

where SE(.X1) and SE (x z) are

computed using the appropriate

formulas previously presented in this

section, and r is the correlation

coefficient between x ~ and x z

(assuming r =0.0 will result in an

accurate standard error if the txvo

estimates are actually uncorrelated

and will result in an overestimate of

the standard error if the correlation is

positive or an underestimate if the

correlation is negative).

In this report, unless othenvise

noted, a difference was considered

statistically significant at the

5 percent level if the difference

(x ~-x J was at least twice as large as

its standard error.

Related documentation

More detailed discussion

sample design of the NHIS,

of the
Advance Data No. 221

● December 2, 1992 27

estimating procedures, procedures for

estimating standard errors,

nonsampling errors, and definitions of

other sociodemographic terms used in

this report has been published in Vinzl

and Health Statistics, Series 10, nos.

160 and 176; Series 1, no. 18; and

Series 2, 110 (44--47). A public use data file based on

the 1989 TAPS was released in

February 1992. Information regarding

the purchase of the public use tape

may be obtained by writing to the

Division of Health Interview

Statistics, National Center for Health

Statistics, 6525 Belcrest Road,

HyattsviI1e, Maryland 20782.

Definition of terms–TAPS

smoking status categories

Never smoked– Never smokeda

cigarette.

Never smoked, no intention–

Never smokeda cigarette or tried or

experimented with cigarette smoking

wilI not trya cigarette soon; and

definitely will not be smoking in1

year,

Never smoked, may smoke– Never

smokeda cigarette or tried or

experimented with cigarette smokin~

may trya cigarette soon or may be

smoking in1 year.

.Eperimenter-Has either smoked

a cigarette or tried or experimented

with cigarette smoking, but has not

smoked 100 cigarettes and has not

smoked in the past 30 days.

Former smoker– Has smoked at

least 100 cigarettes, but has not

smoked in the past 30 days.

Current smoker– Has smokeda

cigarette in the past 30 days.

Current light smoker–Has smoked

10 or more days in the past 30 days,

and has smoked an average of fewer

than5 cigarettes per day in the past7

days.

Current heavy smoker– Has

smoked 10 or more days in the past

30 days, and has smoked an average

of5 cigarettes or more per day in the

past7 days.

(3w=ent occasional smoker– Has

smoked1 to9 days in the past 30

days.

Symbols

--- Data not available . . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less

than 0.05

z Quantity more than zero but less

than 500 where numbers are

rounded to thousands

* Figure does not meet standard of

reliability or precision
28 Advance Data No. 221 ● December 2, 1992

Suggested citation Copyright information National Center for Health Statistics

Moss AJ, Allen KF, Giovino GA, Mills SL. This report may be reprinted without further

Recent trends in adolescent smoking, permission.

smoking-uptake correlates, and expectations

about the future. Advance data from vital and

health statistics; no 221, Hyattsviile, Maryland:

National Center for Health Statistics, 1992,

Director

Manning Feinleib, M. D., Dr. P.H.

Acting Deputy Director

Jack i% Anderson
Number 222 ● December 8, 1992

Advance

Data

From Vial and Health Statistics of the CENTERS FOR DISEASE CONTROL AND PREVENTION/National Centerfor Health Statistics

Office Visits to Otolaryngologists 1989-90,

National Ambulatory Medical Care Survey

by David A. Woodwell, Division of Health Care Statistics

This report describes visits made

to otolaryngologists during the period

from March 1989 to December 1990.

The information was collected by

means of the National Ambulatory

Medical Care Survey (NAMCS), an

ongoing probability sample survey of

the private office-based, non-Federal

physicians practicing in the United

States. NAMCS excIudes physicians

who specialize in anesthesiology,

pathology, or radiolo-q and physicians

who are principality engaged in

teaching, research, or administration.

This survey excludes those visits made

to hospitaI emergency or outpatient

departments. NAMCS was conducted

annually from 1973 through 1981,

again in 1985, and annually beginning

in 1989 by the Division of Health

Care Statistics, National Center for

Health Statistics, Centers for Disease

Control and Prevention.

Data in this report are from the

1989 and 1990 NAMCS, which were

conducted in identical fashion using

the same survey instrument,

definitions, and procedures. The two

data sets were combined to obtain

more reliable estimates. The figures

presented in this report are estimated

from a sample, not the entire

universe of visits to ambulatory care

physicians, and are therefore subject

to sampIing variability. AII estimates

contained in this report, incIuding the

number of visits, the number of drug

mentions, and the visit rates, have

been adjusted to represent annual

statistics. The technical notes at the

end of the report provide guidelines

for judging the precision of the

estimates. Definitions of key terms

used in the survey are also provided.

A facsimiIe of the patient record form

used for data collection in both 1989

and 1990 is shown in figure 1 and will

be usefuI when reading the survey

results.

Survey data show that of the

visits made to otoIaryngoIogists, more

than four-fifths (83 percent) were to

physicians who reported they were

board certified in otoIaryngoIogy,

approximately 16 percent were to

physicians who reported no board

certification, and the remaining

1 percent were to physicians who

were certified in surgery.

Data highlights

As shown in table 1, an estimated

annual average of 16,957,000 visits

were made to otolaryngoIogists in

1989 and 1990. These 16.9 million

visits represent about 2 percent of all

visits to ambulatory care physicians in

the United States and produce a visit

rate of 7 visits per 100 persons. In the

combined survey years 1975 and 1976,

the estimated annual average number

of visits to otolaryngoIogists was

13,596,000, again representing about

2 percent of alI visits made to

ambulato~ care physicians, not

significantly different from 1989 and

1990. The visit rate for the combined

years 1975 and 1976 was 7 visits per

100 persons, the same as that for

1989 and 1990 (l).

Patient characteristics

Table 2 shows the percent

distribution of visits by age and sex of

the patient. Most of the visits to

otolaryngologists were made by

patients under 15 years of age and by

patients 25-64 years of age, who

together represented about 70 percent

of the visits. This relationship held

true for both males and females.

There were fewer visits made by

young adults and elderly patients.

The visit rate dropped from 8 visits

per 100 persons for those under 15

years of age to 4 visits per 100

persons for patients 15-24 years of

age. The rate then increased by two

visits for each age group thereafter.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

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National

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Center for

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Health

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CENI’ERS CKFOR OISEPS.E COhlROL

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—2 --------- Advance -—Data-----No..——222- ● December 8.1 !292 ----.--—- -- >----

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NInun.1 Cmtef for Health Stmmtc%

1, DATE OF VISIT PATlENT RECORD OMB No. 092043234

~ NATIONAL AMBULATORY MEDICAL CARE SURVEY

Exoims 8.31 -s9

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20 ZIP CODE 4-SEX 5mCX)~OR G. EWfNICllY 7 EXPECTEO SOURCEIS) OF PAYMENT

“[Check all that apply]

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9 PATIENT’S COMPLAINTISI, SYMPTOM(S), OR OTHER

“REASON(S) FOR THIS VISIT [in prment’s own words]

10. PHYSICIAN’S OULGNOSES 1 q . ;:;.4&o:E;:s$,

a, MOST IMPORTANT s, PRINCIPAL 01AGNOSISPROS4EM ASSJJCIATEO WITH flEM 9s.

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b OTHER

IF YES, FOR 7HE CONOITION

b, OTHER SIGNIFICANT CURRENT DIAGNOSES IN ITEM 10s7

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14 NON-MEDICATION TH-

- [Check all ordered or ptvvidfd]

1 0 NONE 7 Q BLOOD PRESSURE CHECK 13 ~ ORAL GLUCOSE TOL, 1 Q NONE 1 ❑ NONE

2 ~ PAP TEST 8 ❑ URINALYSIS 14 Q CHOLESTEROL MEASURE 2 0 WEIGHT REOUCTION 2 ❑ P5YCMOTHERAPY

3 ❑ PELVIC EXAM 9 ❑ CHEST X-RAY 15 Q HIV SEROLOGY 3 ❑ CHOLESTEROL REOUCTION 3 ❑ CORRECTIVE LENSES

4 ~ 6REAST PALPATION 10 ❑ OIGITAL RECTAL EXAM

4 ❑ SMOKING CESSATION 4 ❑ AMBULATORY SURGERY

16 ❑ 0THE13 t3LOO0 TEST

5 @ MAMMOGRAM

5 ❑ I+IV TRANSMISSION 5 ❑ PNYSIOTNERAPY

11 ❑ PROCTfSIGMOIDOSCOPY 17 ❑ OTHER /sprcI/y/

6 a OTHER /&xiW

6 ❑ VISUAL ACUITY 12a STOOL EILOOD EXAM

6 ❑ BREAST SELF.EXAM

7 ❑ OWER

1 s. ME~CA~NW~Y/Rwtiollnewormnttnu&mti{mriomo&w&orpmvid&af !his visit. Use(heSome

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actunlly

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physicnmj

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PNYSICIAN

4 ‘cl 20 In 20

7 ❑ AOMIT TO HOSPITAL ~tr

5, ICI ZD ICI 20 8 D OTHER ISPCCVY)

Figure 1. Patient record form

There were more femaie visits to

otolaryngologists than male visits —

55 percent as compared with

45 percent, respectively. Females

under 15 years of age were the only

age group to have a smalIer percent

of visits than their male counterparts,

The pattern of patients under 15

years of age and of patients 25-64

years making most of the visits was

also evident for both males and

females. Male and female visit rates

are similar for all age :roups and are

not statistically different. The higher

frequeney and percent of femaIe visits

to otolaryngologists are due to the

fact that there are more females in

the general population, explaining the

similari~ in the visit rates.

As shown in table 3, more visits

were made to otolaryngologists by

white persons (90 percent) than by

black persons (about 6 percent),

figures that are not statistically

different from the corresponding

percents for visits made to all

. u.S. GOVWWIMEN7 PRINTING 0FFIC=1S8S-22%11

physician specialities. However, there

was a significant difference in the visit

rate between white and black

patients. White maIes had visit rates

that were 2.3 times higher than those

for black males, and white females

had rates that were 3 times higher

than those for black females.

Expected sources of payment

Patients paid for all or part of the

visit (including deductibles and
Advance Data No. 222 ● December 8, 1992 3

copayments) in an estimated

28 percent of the visits. Fee-forservice insurance. other than Blue

Cross/Blue Shield, was a source of

payment in about 24 percent of the

visits to otolaryngologists compared

with Blue Cross/Blue Shield, which

was used in about 18 percent of the

visits. Prepaid plans such as health

maintenance organizations (HMO’s),

individual practice associations

(IPA’s), and preferred provider

organizations (PPO’S) were used in

about 13 percent of the visits.

Government insurance, Medicare and

Medicaid, represented approximately

16 and 7 percent of the visits,

respectively. Except for Blue Cross/

Blue ShieId, aI1 expected sources of

payment to otoIaryngologists were

similar to the corresponding percents

for all physicians. Blue Cross/Blue

Shield was an expected source of

payment for about 18 percent of the

visits to otolaryngologists as compared

with almost 12 percent of visits to all

physicians (figure 2).

Patient status

As shown in table 4. about

17 percent of patients visiting

otolaryngologists in 1989 and 1990

were referred by another physician.

This is significantly greater than the

referral rate for all physicians (about

6 percent of their visits were referred

by another physician).

New patients to otolaryngolo-tits

represented nearly 33 percent of the

visits, twice the 16 percent of new

patient visits to all physicians. Most

w-sitsto otola~mgoiogists, nearly

60 percent, were made by “old patients””

(patients who had seen the physician on

a prior occasion j \vith an ‘“oldproblem””

(a problem that had been treated

previously by the physician). Old

patients with ne~vproblems represented

about 8 percent of the visits, which is

considerably less than the approximately

23 percent for ail physicians. No

differences were found in these percents

for otolaqmgologists between 1989-90

and 1975-76.

Patient’s reason for visit

Tables 5 and 6 display the

principal reason for visit as expressed

Table 1. Average annual number, percent distribution, and rate of office visits, by

physician specialty: United States, 1989-90

Average annual Average annual

number of vists Percent number of visits

Physician specialfy in rhcusarrds distribution per 100 persons

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . 698,653 100.0 285

General and family practice . . . . . . . . . . . . . . . . . 208,045 29.8 85

internal med!cine . . . . . . . . . . . . . . . . . . . . . . . . 87,719 12.6 36

Pediatricians . . . . . . . . . . . . . . . . . . . . . . . . . . 84,280 12.1 34

Obstetrics and gynecology . . . . . . . . . . . . . . . . . 59,812 8.6 24

Ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . 41,302 5.9 17

Oflhopedic surgery . . . . . . . . . . . . . . . . . . . . . . 34,033 4.9 ?4

Dermatology . . . . . . . . . . . . . . . . . . . . . . . . . . 25,164 3.6 10

General surgery . . . . . . . . . . . . . . . . . . . . . . . . 23,691 3.4 10

Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,790 2.7 8

Otolafyngology . . . . . . . . . . . . . . . . . . . . . . . . . 16,957 2.4 7

Cardiovascular disease . . . . . . . . . . . . . . . . . . . . 11,040 1.6 5

Urological surgery . . . . . . . . . . . . . . . . . . . . . . . 9,852 1.4 4

Neurology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,167 0.9 3

All others specialties . . . . . . . . . . . . . . . . . . . . . . 71,603 10.2 29

Table 2. Average annual number and percent distribution and average annual rate of office

visits to otolaryngologists, by sex and age: United States, 1989-90

Average annwd Average annual

number of vis)ts Percent number of wsits

Sex at?d age in thousands distribution per 100 persons

Total visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,957 100.0 7

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . 4,166 24.7 8

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . f ,464 8.6 4

2544ye2rs . . . . . . . . . . . . . . . . . . . . . . . . . 4,574 27.0 6

45-84 years, . . . . . . . . . . . . . . . . . . . . . . . 3,470 20.5 6

6S74 years . . . . . . . . . . . . . . . . . . . . . . . . . 1,665 11.0 10

75 years and over . . . . . . . . . . . . . . . . . . . . 1,399 8.2 12

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,652 45.1 6

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . 2.378 14.0 9

15-24 years . . . . . . . . . . . . . . . . . . . . . . . . . 641 3.6 4

25-44 years . . . . . . . . . . . . . . . . . . . . . . . . . 1,618 10.7 5

4W34yea,s . . . . . . . . . . . . . . . . . . . . . . . . . 1,465 8.6 7

65-74 ye2rs . . . . . . . . . . . . . . . . . . . . . . . . . 845 5.0 11

75 years And over . . . . . . . . . . . . . . . . . . . . . .506 3.0 12

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,305 54.9 7

Under 15 years . . . . . . . . . . . . . . . . . . . . . . . I ,eo9 10.7 7

15–24 years . . . . . . . . . . . . . . . . . . . . . . . . . 823 4.9 5

25-44 years . . . . . . . . . . . . . . . . . . . . . . . . . 2,756 16,3 7

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . 2,004 11.6 8

65-74 years . . . . . . . . . . . . . . . . . . . . . . 1,020 6.0 10

75years aPd over . . . . . . . . . . . . . . . . . . 893 5.3 12

by the patient. The principal reason

for visit is the problem, complaint, or

cause listed first on item90f the

patient record form. These data have

been classified and coded according

to the Reason for PZsit Classification

for Artbuhxy Care (RVC) (2).

The RVC is divided into eight

modules (or groups of reasons), as

detailed intable5. Forotola~mgologist visits, the symptom module

was most often cited, accounting for

about 73 percent of the visits. Within

this module, symptoms referable to

the eyes and ears and symptoms

referable to the respiratory system

accounted foraImost 34 percent and

24 percent of the visits, respectively.

The treatment moduIe, disease

module, and the injury and adverse
4 Advance Data No. 222 ● December 8, 1992

Table 3. Average annual number. percent dlstrlbution, and rate of visits to

otolaryngologlsts, by race and sex: United States, 1989-90

4;ferage annual Average annual

?U-oer of WSJL5 Percent number of wits

Race and sex ,,7 twusands d!stnbut)on per 700 persons

Total vmts 16,957 100,0 7

Black ... ,.. 962 5,7 3

Male, ., ,. ., 400 “2.4 3

Female. , ... 562 3.3 3

Wh!te, ,, 15,254 90,0 8

Male, , ,,, ,. 6 @57 404 7

Female, ,,. ,, ,.. 8.397 49,5 9

Other’. , ,, ,. ,, 455 27 5

Male ,.,, ,, ,, 230 “1 4 6

Female ,.. 225 ‘1,3 5

i

Inc, deshsal am Faclf!c Is)amer and Ar_e,,ca-, :?a,aq es. -; a?c %eu:

NOTES: D&a WIII m. eoual total oecause 1% u-sxchea CZ$;Z., 286003 WSIIS, IS included m total,

l—

Eotohyngokgists ~Allphy*icians

M&pay Government BC18S CMerz

hwrance 1 CoR%Ld FEO%N

PPO

SKwce of payment

‘Includes Medraw ald Mt?d,ca,d

‘Incluaes nochwge and un.nown

NOTES, BCIBS IS Wo CrossKl!ue Sh,eld HMO IPA?PO 6 he%- maintenance organmst!on,mdwtdual pracim assmat,on,

and preferred prowoer organuauon

SOURCE Natmna: Cenler for MeaiIh StaIIsIIcs. Dm>onof Hean- ~are StatiStiCSNahonal ,lmb.lalorj Medcal Care Suwey,

Flgure2. Expected source of payment tootolatyngologists: United States, 1989-90

effects module accounted for around most frequent reason for visit to

14, 7, and 3 percent of the visits. otolaryngologists in 1989–90 was for

respectively. an earache or an ear infection,

Table 6 lists the top 20 reasons accounting for 11.3 percent of the

for visit to otolaryngologists in visits. Patients with hearing

1989–90, which accounted for more dysfunction accounted for 8.1 percent

than three-quarters of a[l visits. The of the 16,957,000 average annual

\’isits, the second most frequent

reason for visit, Symptoms referable

to throat and other symptoms

referable to ears represented

6.3 percent and 5.8 percent of the

visits, respectively. The 20 most

frequent diagnoses are quite similar

to the 20 most frequent reasons for

visit to otolaryngologists found in the

1975-76 NAMCS.

Physician’s diagnosis

Data on the principal diagnosis

rendered by otolaryngologists are

shown in tables 7 and 8. The

principal diagnosis is the firstrecorded diagnosis in item 10a of the

patient record form and is associated

with the principal reason for visit as

recorded in item 9a. The principal

diagnosis was coded and classified

according to the International

Classification of Diseases, 9th

Revision, Clinical Modification

(ICD-9-CM) (3).

As shown on table 7, the ICD-9-

CM is organized into broad categories

relating to the major systems of the

body. Diseases of the nervous system

and sense organs represented the

largest percent of diagnosis by the

otolaryngologist, about 38 percent,

which was followed by diseases of the

respiratory system, approximately

30 percent. The three ICD-9-CM

classes —supplementary classifications;

symptoms, signs, and ill-defined

conditions; and injury and

poisoning —represented almost 9, 6,

and 4 percent, respectively, of the

principal diagnoses. As would be

expected, the percent of visits with

diagnoses of diseases of the nervous

system and sense organs (mostly ear

and nose) and diseases of the

respiratory system (mostly throat) is

more than double the percent for all

physicians – approximately 38 percent

and 30 percent, respectively, for

otolaryngologists as compared with

11.1percent and 13.9percent,

respectively, for all physicians. The

percent of visits for supplementary

classifications (including general medical

exam and normal pregnancy exams) for

otolaryngologists was about half that for
Advance Data No. 222 ● December 8.1992 5

aU physicians, nearly 9 percent

compared with 15 percent, respectively.

The top 20 principal diagnoses

made by otolaryngologists are shown

in table 8. The first three diagnoses,

accounting for about one-quarter of

the visits (26.1 percent), are related to

problems of the ea~ suppurative and

unspecified otitis media (9.4 percent),

disorders of external ear (8.5 percent),

and nonsuppurative otitis media and

eustachian tube disorders (8.2 percent).

Following the first three diagnoses are

two diagnoses involving the respiratory

system: allergic rhinitis (7.1 percent) and

chronic sinusitis (5.2 percent). The 20

most frequent diagnoses are quite

similar to the 20 most frequent

diagnoses found in the 1975-76

NAMCS.

Medication therapy

As shown in table 9,

otolaryngologists prescribed or

administered medication in nearly

47 percent of the office visits in 1989-90,

significantly Iess often than most other

physicians specialties. All physicians

prescribed or administered medication

in 60.2 percent of the visits.

A visit in which the patient was

administered or prescribed any type

of medication by the physician is

called a “drug visit.” Of the drug

visits to otolaryngologists, about

63 percent were visits when one drug

was prescribed or administered,

24 percent were visits when two drugs

were prescribed or administered, and

13 percent were visits when three

drugs or more were prescribed or

administered. Of all the drugs

prescribed or administered by

office-based ambulato~ care

physicians, otolaryngologists

prescribed or administered only

1.9 percent.

Table 10 classifies the drug

mentions into therapeutic categories

as defined by the 19S5 edition of the

National Drug Code Directoxy (4).

Antimicrobial agents accounted for

approximately one-third of the

otolaryngologists’ drug mentions, in

addition to respiratory tract drugs,

which accounted for about 18 percent.

Antimicrobial agents included such

Table 4. Average annual number and percent distribution of offfce visits to

otolaryngologists, by patients’ referral status and visit statwx United States, 1989-90

Average annual

number of w’sits Percent

Referral and visit status in thousands distribution

AJlvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16.957 100.0

Patient referred

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,950 17.4

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,007 82.6

visit status

New patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,542 32.7

Oldpatient, new problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,2S4 7.6

Oldpatient, old problem . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . 10,132 59.7

Table 5. Average annual number and percent distribution of office visits to

otolaryngologista, by principal reason for visit moduk

United States, 1989-90

Average annusf

Principal reason for number of visits Percent

vfsit module and RVC code’ in thousands distribution

AIIprincipsf reasons forvisit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,957 100.0

Symptom module . . . . . . . . . . . . . . . . . . . . . . . . . . ... S100-S999 12,346 72.8

Symptoms referable to the eyes and ears. . . . . . . . . . . . 3300-8399 5,710 33.7

Symptoms referable to the respiretory system . . . . . . . . . 8400+499 4,019 23.7

Okeaae module . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Ct301-D989 1,129 6.7

Oiagnoatic, screening, and preventive module . . . . . . . . . . .X1 OC-X599 253 1.5

Treatment module . . . . . . . . . . . . . . . . . . . . . . . . . . ..-TIOGT899 2.388 14.1

lnjr.r~and adverse effects module . . . . . . . . . . . . . . . . . .. JWl-J889 520 3.1

Another modules2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321 1.9

‘eased on “A ReasonforVisitCls.wricst!onforAmbulatoryCare.. (RVC)(2).

%cJudestestresultsandadminisbatlvemcdules,and uncodsbleand b!ankentries.

Table 6. Average annual number, percent distribution, and cumulative percent of the 20

most common reasons for visit to otolaryrrgologists: United States, 1988-90

Average annual CumulaPrincipal reason rbr number of visits Percent tiva

Rank visit and RVC code’ h thousands distribution percent

1

2

3

4

5

6

7

6

9

10

11

12

13

14

15

16

17

18

19

20

Aflreasons forvisit . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Earache oresrinfecfion . . . . . . . . . . . . . . . . . . . .. S355

Haaring dyefunctfon . . . . . . . . . . . . . . . . . . . . . . .. S345

Symptoms referable to throat . . . . . . . . . . . . . . . . . . S455

Ofher symptoms referable to ears . . . . . . . . . . . . . . . S365

Nasal congestion. . . . . . . . . . . . . . . . . . . . . . . ...8400

Plugged feelirrg in ear . . . . . . . . . . . . . . . . . . . . . .. S360

Other symptoms of nose . . . . . . . . . . . . . . . . . . . . . S405

Vertigo, dizziness . . . . . . . . . . . . . . . . . . . . . . . .. S225

8inus problems . . . . . . . . . . . . . . . . . . . . . . . . . .. S410

Discharge from ear . . . . . . . . . . . . . . . . . . . . . . .. S350

Allergy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. S090

Headache, pain in head . . . . . . . . . . . . . . . . . . . .. S210

Allergy medication . . . . . . . . . . . . . . . . . . . . . . . . ..TIOO

Cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..SW

Disorders of voice . . . . . . . . . . . . . . . . . . . . . . ...8480

Upper respiratory infections except tonsilfiis. . . . . . . . . 06W

Preoperafiie visit for specified and unspecified types

ofsurgey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..T200

otiis media . . . . . . . . . . . . . . . . . . . . . . . . . . . ..W50

Symptoms referable tomouth . . . . . . . . . . . . . . . . . . S51O

Head and face . . . . . . . . . . . . . . . . . . . . . . . . . . ..JO05

16,957

1,908

1,370

1,071

981

896

895

477

459

427

387

370

348

326

311

2e2

268

252

206

159

144

100.0 ---

11.3 11.3

8.1 19.4

6.3 25.7

5.8 31.5

5.3 36.8

5.3 42.1

2.8 44.9

2.7 47.6

2.5 50.1

2.3 52.4

2.2 54.6

2.1 56.7

1.9 58.6

1.8 60.4

1.7 62.1

1.6 63.7

1.5 65.2

1.2 66.4

0.9 67.3

0.9 68.2

‘@as.edon “A Reason for VisitClessiicatlonforAmbulatorycare” (RVC)(2).
6 Advance Data No. 222 ● December 8, 1992

drugs as penicillin (11.0 percent),

cephalosporin (9.3 percent), and

e~thromycin and Iincosamide

(4.1 percent). Respiratory tract drugs

included such drugs as nasal

decongestants (7.0 percent);

antitussives, expectorants, and

mucolytics (4.0 percent); and

antihistamines (6.9 percent). The

therapeutic category skin and mucous

membrane represented 9.4 percent of

the drug mentions and consisted

almost completely of derrnatologics,

8.S percent. The top 20 generic

substances prescribed by

otolaryngologists are shown in

table 11, \vith amoxicillin being the

most utilized, 9.3 percent. The

generic substances beclomethasone,

neomycin, hydrocortisone, and

phenylephrine followed, accounting

for 7.7, 6.7, 6.6, and 5.7 percent of

the drug mentions, respectively.

Duration and disposition

of visits

Visits to otolaryngologists had a

mean duration of roughly 14 minutes,

excluding those visits of zero minutes.

More than three-quarters (77.7 percent)

of the visits lasted no longer than 15

minutes, significantly higher than the

68.1 percent of visits to all physicians.

The duration of visit does not include

time waiting for the physician or time

receiving care from someone else on

the physician’s staff. Visits of zero

minutes, in which the patient had no

face-to-face contact with the

physician, represented almost

3 percent of the visits (table 12).

In addition, table 12 shows that

57 percent of most visits to

otolaryngologists resulted in the

physician instructing the patient to

return at a specific time, and about

27 percent were instructed to return

if needed, compared with approximately 50 percent and 27 percent,

respectively, in 1975–76.

Table 7. Average annual number and percent distribution of office visits to

otolaryngologists, by major ICD-9-CM class: United States, 1989-9o

Average annual

Principal diagnoses and number of visits Percent

/CO-9-CM codes’ in thousands distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,957 100.0

Infectious and paraaitic diseases. . . . , . , . . . . . . . 001-139

Neoplasm. . . . . . . . . . . . . . . . . . . . . . . . . ..l4&239

Diseases of the nervous system and sense organs . 320-389

Diseases of the respiratory system. . . . . . . . . . . . 460-519

D!seases of the digestive system. . . . . . . . . . . . . 520-579

Dseases of the skin and subcutaneous tissue . , . . 680-709

Symptoms, signs, and ill-defined condtions. . . . . . . 760-799

lnjuryand poisomng . . . . . . . . . . . . . . . . . . . ...800-999

Supplementary classifications. . . . . . . . . . , . . . .VOO1-V082

137

529

6,467

5,135

5aa

274

1,002

615

1,475

‘0.8

3.1

38.1

30.3

3.5

1.6

5.9

3.6

8.7

Another diagnoses2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365 2.2

Unknown dlagnoses3 . . . . . . . . . . . . . . . . . . . . . . . . . . . 370 2.2

‘ Baseo on /rrlernat,omsJC/z?ssIficatJonof Llseases, 91hRevision, Clmicd Modificafmn (lCD-S-CM) (3).

21ncludes endocrine, ntirmonal, and metabolic dE.esses and immundy drsorders (240-279); d!seases of the tslcmd-lorming

organs (2S0-289): mental d!sorders (29C-31 9); d!seases of the circulato~ system (39C=159); d!sesses of the gemtourmary

sys!em (580-E29); compl!ca!lons of pregnancy, childbirth, and the puerperwm (630-S76); dmeases of musculoskeletal system

and annectwe tissue (710-739); congenial anomatiea (740-759); and certain conditions originating in the perinatril period

(7SG-779).

31ncludes blank diagnoses, noncodable diagnoses, and dleglble diagnoses.

Table 8. Average annual number, percent distribution, and cumulative percent of Office

visits to otolaryngologists by principal diagnoses most frequently rendered by the

physician: United States, 1989-90

Average

anncra/

number of CumulaMo.st common principal dia~noses visits Percent tive

Rank and ICO-9-CM code in thousands distribution precerrf

Allprincipal diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . 16,957 100.0 ---

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Suppurative and unspecified otitis media. . . . . . . . . ...382 1,602 9.4 9.4

Disorders of external ear . . . . . . . . . . . . . . . . . . . ...380 1,435 8.5 17.9

Nonsuppurative otitis media and eustachian tube

disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...361 1,394 S,2 26.1

Allergic rhmitis . . . . . . . . . . . . . . . . . . . . . . . . . ...477 1,203 7.1 33.2

Chronic sinusitis . . . . . . . . . . . . . . . . . . . . . . . . ...473 881 5.2 38.4

Ofherpostsurgical states . . . . . . . . . . . . . . . . . . . ...045 741 4.4 42.8

Hearing loss . . . . . . . . . . . . . . . . . . . . . . . . . . . ...389 662 4.0 46.6

Chronic pharyngitls and nasopharyngitis . . . . . . . . . . . .472 560 3.3 50.1

Chronic disease of tonsils and adenoids . . . . . . . . . . ..474 514 3.0 53.1

Symptoms involving head and neck. . . . . . . . . . . ...784 484 2.9 56.0

Deviated nasal septum . . . . . . . . . . . . . . . . . . . . ...470 343 2.0 58.0

Other diseases of upper respiratory tract. . . . . . . ., ..478 341 2.0 60.0

Other disorders of ear . . . . . . . . . . . . . . . . . . . . . ...388 339 2.0 62.0

Acute tonsilhtis. . . . . . . . . . . . . . . . . . . . . . . . . ...463 261 1.5 63.5

General symptoms . . . . . . . . . . . . . . . . . . . . . . . ...760 256 1.5 65.0

Other disorders of tympanic membrane. . . . . . . . ..384 240 1.4 66.4

Verhginous syndromes and other disorders . . . . . . . .386 237 1.4 67.8

Fracture of face bones . . . . . . . . . . . . . . . . . . . . ...802 233 1.4 69.2

Acute pharyngttis . . . . . . . . . . . . . . . . . . . . . . . . ...462 229 1.4 70.6

Ofher disorders of middle ear and mastoid. . . . . . . . . . . 3a5 192 1.1 71.7

1Basad on Intemafiond C/sssfricarionof D~eases, 9fh Rewion, C/mica/kfodiricatiorr(ICPS-CM) (3).
Advance Data No. 222 ● December 8, 1992 7

Table 9. Average annual number and percent distribution of office visits to

otolaryngologists, by type of visit and number of medications prescribed or ordered:

United States, 1988-90

Average annual

Type of visrt and number of wsits Percent

number of medications in thousands distribution

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,957 100.0

Type of visit

Nondrugvisit (Omedications) . . . . . . . . . . . . . . . . . . . . . . . . . . 9,018 53.2

Drugvisit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,939 46.8

Number of medications

1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,991 62.9

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,896 23.9

3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 694 8.7

4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 2.4

5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172 2.2

Table 10. Average annual number and percent distribution of drug mentions to

otolaryngologists by therapeutic category United States, 1989-90

Average annual

numberofvisits Percent

Therapeutic categocv’ inthouaands distribution

References

1.

2.

3.

4.

Koch H. Office visits to otolaryngologistx National Ambulatory

Medical Care Survey, United

States: 1975–76. Advance data

from vital and health statistics; no.

34. Hyattsville, Maryland: National

Center for Health Statistics. 1978.

Schneider D, Appleton L,

McLemore T. A reason for visit

classification forambuiatory care.

National Center for Health Statistics. VitaIHealth Stat2(78). 1979.

Public Health Service and Health

Care Financing Administration.

International Classification of Diseases, 9th Revision, clinical modification. Washington: Public Health

Sewice. 1980.

Food and Drug Administration.

National Drug Code Directory,

1985 Edition. Washington: Public

Health Sewice. 1985.

Alldrug menfions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antimicrobial agente . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Penicillins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cephalosporins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Erythromycins andlincosamides . . . . . . . . . . . . . . . . . . . . . . .

Cardiovascular-renal drugs . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychopharmacologic druga . . . . . . . . . . . . . . . . . . . . . . . . . .

Radiopharmaceutical or contrast media. . . . . . . . . . . . . . . . . . . .

Gsetrointestinal agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hormones andagents affecting hormonal mechanisms. . . . . . . . . .

Skin ormucous membrane . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dermatologics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ophthalmicdrugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otologicdrugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drugsusedforreliefofpain... . . . . . . . . . . . . . . . . . . . . . . . .

Respiratorytractdrugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nasaldecongestants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antitussives, expectorants, mucOiytiCS . . . . . . . . . . . . . ..- . . .

Antihistamines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unclassifiedormiscellaneous.. . . . . . . . . . . . . . . . . . . . . . . . .

Allothersz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12,435

3,879

1,362

1,155

504

252

128

669

204

645

1,169

1,097

330

417

447

2,291

871

498

862

1,910

●96

lW.O

31.2

11.0

9.3

4.1

2.0

1.0

5.4

1.6

5.2

9.4

8.8

2.7

3.4

3.6

18.4

7.0

4.0

6.9

15.4

0.8

‘Therapeuticclsssbssedonthe standarddrugdsssdic-ationusedln~eNafionalDmgCdeOir@oy, 7985Edifion(4),

21ncludes Anesthetic drugs, hema!ologic agents. me!abolvs and num”ent sgents, and neurobglc drugs.
8 Advance Data No. 222 ● December 8, 1992

Table 11. Average annual number and percent distribution of the top 20 generic

Ingredients most often utilized by otolaryrrgologists: United States, 1989-90

Average annual

number of mentions’ Percent

Rank Generic Ingredient in thousands distribution

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

AJl drug mentions . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amoxicilfin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Beclomethaeone . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neomycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hydrocortisone . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenylephrine . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Polymixin B . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenylpropanolamine . . . . . . . . . . . . . . . . . . . . . . . .

Sacmacin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cefaclor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Guaifenesin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Chlorpheniramine . . . . . . . . . . . . . . . . . . . . . . . . . .

Terfenadine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Trimethoprim . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.%lfamethoxazole . . . . . . . . . . . . . . . . . . . . . . . . . .

Cefonicndsodium . . . . . . . . . . . . . . . . . . . . . . . . . . .

Methylprednisolone . . . . . . . . . . . . . . . . . . . . . . . .

Penioillln . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Acetaminophen . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cephalexin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Erythromycln . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12,435

1,157

963

835

822

716

709

572

540

459

443

438

391

293

293

263

252

246

248

237

226

100.0

9.3

7.7

6.7

6.6

5.7

5.7

4.6

4.3

3.7

3.6

3.5

3.1

2.4

24

2.1

2.0

2.0

2.0

1.9

1.8

‘Frequency04mantbn cmnbmasamg!emgradernagents% mwbms of the agentsas an ingradienlin a mrnbmatka drug (4).

Table 12. Average annual number and percent distribution of office visits to

otolaryngologists, by duration and disposition: United States, 1989-90

Average annual

numberofvkits Percent

Duration and disposition infhouaands distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Duration of visit’

Zerominutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l-5 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-10minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11–15minufes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16-30minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

31-60 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

61+ minties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Disposition of visit

Nofollowupplanned . . . . . . . . . . . . . . . . . . . . . . . . . . .

Retumatspecifictime . . . . . . . . . . . . . . . . . . . . . . . . . .

Return ifneeded, . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Telephonefollowup planned.. . . . . . . . . . . . . . . . . . . . . .

Refemedto other physician.,.. . . . . . . . . . . . . . . . . . . .

Referredto referring physician. . . . . . . . . . . . . . . . . . . . .

Admittohospifal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

16,957

495

1,930

5,732

5,505

2,946

322

“27

1,592

9,670

3,756

471

322

263

288

1,063

100.0

2.9

11.4

33.8

32.5

17.4

1.9

●0.2

9.4

57.0

22.2

2.8

1.9

1.7

1.7

6.4

‘Mean duration ofvwlwes 13.8 minutes.
Advance Data No. 222 ● December 8, 1992 9

Technical notes

Sources of data and

sample design

The information presented in this

report is based on data collected by

means of the National &nbulatory

Medical Care Survey (NAMCS) from

March 20, 1989, through December

30, 1990. The target universe of

NAMCS includes office visits made in

the United States by ambulatory

patients to nonfederally employed

physicians who are principally

engaged in office practice but not in

the specialties of anesthesiology,

pathology, or radiology. Telephone

contacts and nonoffice visits are

excluded.

A multistage probability sample

design is used in NAMCS, involving

samples of primary sampling units

(PSU’S), physician practices within

PSU’S, and patient visits within

physician practices. A sample of 2,535

non-Federal, office-based physicians

was selected in 1989 and 2,528

non-Federal, office-based physicians

were selected in 1990 from master

files maintained by the Anerican

Medical Association and American

Osteopathic Association. The sample

included 104 otolaryngologists in both

1989 and 1990, of which 89 were

eligible in 1989 and 84 were eligible

in 1990. The physician response rate

for the 1989 NAMCS was 74 percen$

in 1990, it was 75 percent. Otolaryngologists had a response rate of

71 percent in 1989 and 70 percent in

1990. Sample physicians were asked

to complete patient records (figure 1)

for a systematic random sample of

office visits occurring during a

randomly assigned l-week reporting

period. Responding physicians

completed 38,384 patient records in

1989 and 43,469 in 1990. Otolaryngologists completed 1,790 patient

record forms in 1989 and 2,185 in

1990. Characteristics of the

physician’s practice, such as primary

specialty and type of practice, were

obtained from the physicians during

an induction interview. The U.S.

Bureau of the Census, Housing

Surveys Branch, was responsible for

the survey’s data collection.

Processing operations and medical

coding were performed by the

National Center for Health Statistics,

Hospital Discharge and Ambulatory

Care Survey Section, Research

Triangle Park, North Carolina.

Sampling errors

The standard error is primarily

measure of the sampling variabiii~

that occurs by chance when only a

sample, rather than an entire

universe, is surveyed. The relative

standard error of an estimate is

obtained by dividing the standard

a

error by the estima;e itselfi the result

is then expressed as a percent of the

estimate. Approximate relative

standard errors (RSE’S) of selected

aggregate statistics are shown in

table I, and the re[ative standard

errors of the estimated number of

drug mentions are shown in table II.

All frequencies in this report are

average annual figures and must be

doubled before a significance test can

be performed. Relative standard

errors for aggregate visits and drug

estimates may be calculated using the

following general forrmda, where x is

the aggregate of interest in

thousands, and A and 1? are the

appropriate coefficient from table IV.

RSE (x)=

v

A+g X 100.0

x

Approximate relative standard errors

for estimates of the percent of visits

are shown in table III. The RSE’S for

percent may be calculated using the

following general formula, where p is

the percent of interest and x is the

denominator of the percent in

thousands, using the appropriate

coefficient from table IV.

Adjustments for nonresponse

Estimates from NAMCS data

were adjusted to account for sample

physicians who were in scope but did

not participate in the study. This

adjustment was calculated to minimize the impact of response on final

Table L Relative standard errors for

estimated numbers of office visits:

National Ambulatory Medical Care

Survey, f989-90

Estimated number

of ofice tisits All Otcrlarynin Urousands specialties gologist

Relative standard error

(RSE) in percent

100 . . . . . . . . . . . . . . 72.7 31.1

200 . . . . . . . . . . . . . . 51.5 23.4

300 . . . . . . . . . . . . . 42.1 20.1

400 . . . . . . . . . . . . . . 36.5 18.3

500 . . . . . . . . . . . . . . 32.6 17.1

7W . . . . . . . . . . . . . . 27.6 15.6

1,000 . . . . . . . . . . . . . 23.2 14.4

2@oo... . . . . . . . . . . 16.5 12.9

5,000 . . . . . . . . . . . . . 10.7 11.9

7,000 . . . . . . . . . . . . . 9.2 11.7

Io,ooo . . . . . . . . . . . . 7.9 11.5

30,000 . . . . . . . . . . . . 5.2 11.2

50,000 . . . . . . . . . . . . 4.5 11.2

100,000 . . . . . . . . . . . 3.9 11.2

500,0Q0. . . . . . . . . . . 3.3 11.1

700,000 . . . . . . . . . . . 3.2 11.1

1,400,000 . . . . . . . . . . 3.2 . . .

NOTE:Oroleryngologst 30 percent RSE - 110,OLMJ all

apeciaties 30 percent RSE = 593,000.

Example of use of tabk An aggregate eatimale of 5 milhon

vieii to a oto!aryngobgist has a relatke standard estimateof

11.9 percent or a standard error of 595 thousand kwts

(11.S percent of 5 mrliion).

Table il. Relative standard errors for

estimated numbers of drug mentions:

National Ambulatory Medical Care

Suwey, 1989-90

Estimated number

Of dNg ff?WftiOflS All Oto/arynin tfrouearrds specialfles gologist

Relative standard error

(RSE) in percent

100 . . . . . . . . . . . . . . 90.3 36.1

2C0 . . . . . . . . . . . . . . 63.9 27.0

300 . . . . . . . . . . . . . . 52.3 23.3

400 . . . . . . . . . . . . . 45.3 21.1

500 . . . . . . . . . . . . . . 40.6 19.7

700 . . . . . . . . . . . . . . 34.3 18.0

1,000 . . . . . . . . . . . . . 28.8 16.6

2,000 . . . . . . . . . . . . . 20.6 14.7

5,000 . . . . . . . . . . . . . 13,4 13.5

7,000 . . . . . . . . . . . . . 11.5 13.3

10,000 . . . . . . . . . . . . 9.9 13.1

30,0W. . . . . . . . . . . . 6.5 12.8

50,000 . . . . . . . . . . . . 5.7 12.8

100,000 . . . . . . . . . . . 4.9 12.7

500,000 . . . . . . . . . . . 4.2 12.7

7cNmoo .. . . . . . . . . . 4.1 12.7

1,4C0,000 . . . . . . . . . . 4.0 . . .

NOTE Otolaryngofcqist 30 percent RSE . 155,CCCK efl

speckitfes 30 percent RSE = 922,CO0.

Example of use of table An aggregate esomate of 2 m,llion

drug mentions by an otolafyngolog!st has a relatwe standard

estimate of 14.7 parcent or a standard error of 294 W3usand

drug menllons (14.7 percent of 2 mtilion).
10 Advance Data No. 222 ● December 8, 1992

Table Ill. Standard errors for percents of estimated numbers of office visits for the National Ambulatory Medical Care Survey

United States, 1989-9o

Estimated percent

B8se of percent

(visits h thousands) 1 or 99 5 or 95 10 or 90 20 or 80 30 or 70 50

S=ndard error in percentage pointa

100 . . . . . . . . . . . . . . . . . . . . . . . . 9.2 20.1 27.6 36.8 42.2 46.0

200 . . . . . . . . . . . . . . . . . . . . . . . . 6.5 14.2 19.5 26.0 29.8 32.5

500 . . . . . . . . . . . . . . . . . . . . . . . 4.1 9.0 12.3 16.5 18.9 20.6

700, ,, . . . . . . . . . . . . . . . . . . . . . 3.5 7.6 10,4 13.9 15.9 17.4

1,000, . . . . . . . . . . . . . . . . . . 2.9 6.3 6.7 11.6 13.3

2.000. . . . . . . . . . . . . . . . . . . ,,,.

14.6

2.1 4.5 6.2 8.2 9.4

5,000, . . . . . . . . . . . . . . . . . .

10.3

1.3 2.8 3.9 5.2 6.0 6.5

7,000. . . . . . . . . . . . . . . . . . . . 1,1 2,4 3.3 4.4 5.0

10,000 . . . . . . . . . . . . . . . . . . . . .

5.5

09 2.0 2.6 3.7 4.2

20,000 . . . . . . . . . . . . . . . . . . . .

4.6

0.6 1.4 2.0 2.6 3.0 3.3

30,000 . . . . . . . . . . . . . . . . . . . . . . 0.5 1.2 1.6 2.1 2.4 2.7

50,000 . . . . . . . . . . . . . . . . . . . . . 0.4 0.9 1.2 1.7 1.9 2.1

80,000 . . . . . . . . . . . . . . . . . . . . . . 0.3 0.7 1.0 1.3 1.5 1.6

100,000 . . . . . . . . . . . . . . . . . . . . . 0.3 0.6 0.9 1.2 1.3 1.5

500,000 . . . . . . . . . . . . . . . . . . . . . 0.1 0.3 0.4 0.5 0.6 0.7

1<400,000 . . . . . . . . . . . . . . . . . . . 0.1 0.2 0.2 0.3 0.4 0.4

Example of use of table An estlma!e of 30 percent based on an aggregate estlma!e of 10 milhon visits haa a smdard error of 4.2 percent or a relative standard error of 14.0 percent (4.2 percent

dw!ded by 30 percent),

estimates by imputing to nonresponding physicians data from visits to

similar physicians. For this purpose,

physicians werejudged similar ifthey

had the same special~ designation

and practicedin the same PSU.

Test of significance and

rounding

In this report, the determination

of statistical inference is based on a

two-sided ~-test. The Bonferroni

inequality was used to estimate the

critical value for statistically

significant differences (0.051evelof

significance). Terms relating to

differences such as ’’higher,’’ ’’less,”

and so forth indicate that the

differences are statistically significant.

Terms such as ’’similar’’ or”no

difference’’ mean that no statistical

significance exists benveen the

estimates being compared. In the

tables, estimates ofoffice visits have

been roundedto the nearest

thousand. Consequently, estimates

will not always add to totals. Rates

and percents were calculated from

original unroundedtigures and do not

necessarily agree with percents

calculated from rounded data.

Definition ofterms

Ambulatory patieru – An

ambulatory patient is an individual

seeking personal health services who

is not currently admitted to any

health care institution on the

premises.

Drug mention –A drug mention is

thephysician’s entry ofa

pharmaceutical agent –by any route

of administration —for prevention,

diagnosis, or treatment. Genericas

well as brand:name drugs are

included, as are nonprescription and

prescription drugs. Along with all new

drugs, the physician also records

continued medications if the patient

was specifically instructed during the

visit to continue the medication.

Drug visit –A drug visit is a visit

in which medication was prescribed

or provided by the physician.

Ofice – Offices are the premises

physicians identifi as locations for

their ambulatory practice; these

customarily include consultation,

examination, or treatment spaces that

patients associate with the particular

physician.

Ololaryrrgologist–A physician who

specializes in the diseases of the ear,

nose, and throat.

Physician –A physician is a duly

licensed doctor of medicine (M. D.) or

doctor of osteopathy (D. O.) who is

currently in office-based practice and

who spends some time caring for

ambulatory patients. Excluded from

Table W. Coefficients appropriate folr

determlrring relatlve standard errors, by

type of estimate and physician specialty

National Ambulatory Medical Care Survey,

1989-90

Type of estimate Coeft7cienl

and

physician specialty A B

Visits

Overall totals . . . . . . 0.00097549 52779.52164

Otolaryngologist . . . . 0.01236777 64645.29550

Drug mentions

Overall totals . . . . . 0.00157151 61470.54833

Otolaryngologist . . . . 0.01603645 11420.09384

NAMCS are physicians who are

hospital-based; who specialize in

anesthesiology, pathology, or

radiolo~ who are federally

employed; who treat only

institutionalized patients; or who are

employed full time by an institution

and spend no time seeing ambulatory

patients.

K3it –A visit is a direct personal

exchange between an ambulatory

patient and a physician (or a staff

member working under the

physician’s supervision), for the

purpose of seeking care and

rendering personal health services.
Advance Data No. 222 ● December 8, 1992 11

Symbols

--- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less than

0.05

z Quantity more than zero but less than

500 where numbers are rounded to

thousands

* Figure does not meet standard of

reliability or precision (estimate is

based on fewer than 20 births in

numerator or denominator)
Advance Data No. 222 ● December 8, 1992

Suggested citation Copyright information National Center for Health Statistics

Woodwell DA. Office visits to otolaryngoiogists This repotl may be reprinted without further Director

1989-90, National Ambularoty Medical Care permission. Manning Feinleib, M.D., Dr. P.H.

Sutvey. Advance data from vital and health

statistics; no 222. Hyattsville, Maryland:

Acting Deputy Direcior

National Center for Health Statistics. 1992.

Jack R. Anderson
Number 223 ● January 13, 1993

Advance

Data

From Vii and Health .9atistk of the CENTERS FOR DISEASE CONTROL AND PREVENTION/National Center for Health Statistics

Office Visits to Obstetricians and Gynecologists:

United States, 1989-90

by Susan M. Schappert, M.A., Division of Health Care Statistics

Introduction

Over the 2-year period 1989-90,

there were approximately 119.6

million visits made to nonfederally

employed, office-based physicians in

the United States who specialized in

the practice of obstetrics and

gynecology-an average of about 59.8

million visits per year. This report

summarizes data pertaining to these

visits in terms of patient

characteristics, physician practice

characteristics, and visit

characteristics. Other reports are

available that present data on office

visits to obstetricians and

gynecologists for previous years (l-3).

Some of the findings from these

reports will be discussed in light of

current survey data.

The information presented in this

report is based on data obtained from

the National Ambulatory Medical

Care Survey (NAMCS), a national

probability sample survey conducted

by the Division of Health Care

Statistics of the National Center for

Health Statistics, Centers for Disease

Control and Prevention. This survey

was conducted annually from 1973

through 1981, and again in 1985. It

resumed an annual schedule with the

1989 survey.

The 1989 and 1990 NAMCS

shared identical survey instruments,

definitions, and procedures. The

resulting two years of data have been

combined to provide more reliable

estimates, and the reader should be

aware that the estimates, percent

distributions, and rates presented in

this report, unless otherwise

indicated, reflect average annual

estimates for 1989 and 1990 based on

the combined data. The Patient

Record, the survey instrument

utilized by participating physicians to

record information about their

patients’ office visits, is shown in

figure 1.

The reader should keep in mind

that the estimates presented in this

report are based on a sample, rather

than on the entire universe of office

visits, and are subject to sampling

variability. The sample design,

sampling errors, and guidelines for

judging the precision of NAMCS

estimates are discussed in the

technical notes. Several publications

are available that discuss overall

findings from the 1989 and 1990

NAMCS (4-6), and reports on special

topics are also available (7-10).

Additional reports on visits made

during 1989 and 1990 to other

physician specialties are forthcoming.

Data Highlights

Patient characteristics

Approximately 99.4 percent of

visits to obstetricians and

gynecologists were made by females,’

and, of these, 85.7 percent were made

by females between the ages of 15

and 44 years. These percentages

reflect the principal reason for visits

to this specialty: routine prenatal

examination. Visits by females

according to age and race are shown

in table 1.

aThis report focuses primar~ly on visits made to

obstetricians and ,gyccolog!sts by females (an

average of 59,475,000 visits pcr year for 19S9

and 1990). The estimated number of visits by

males (an average. of 337,000 per vcar for 1989

and 1990) is too small to be statis;iczlly reliable

and thus does not permit meaningful analysis.

A general discussion of visits made by males to

what is essentially a specialty dealing with

women’s reproductive health issues can be found

in an earlier publication (2).

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers

National

for Disease

Center for

Control

Health

and

Statistics

Prevention CDC CENTERS FOR DISEASE CONIROL

AND PRSWNTION
9 Advance Data Nn. Z!!? ● Januanr t3. 1993 & . . -..”....- ---- ..-. --- --. .-—.. -, ---- J

A..WW!CO of ConNd.mdlw -All ml.rrn.ws. which would Pmm$l 10.. NA.91W of .n Dep.rtwmnf of Hoa!th ●.cI HUM*II S* WiC**

mdwa..l, a DzactOc*, 0, . . .st9b1#shmem w!! be held CO. f,denl ml,wall be .SM only by C..tm for D,s.as. Co.Irol

0+1s..s ●.Q.aod 1.8.6 for me P.rwses 01 the wwv . ..5 wll not be dwctosed of rcseased lhbl!c He.llh Smvtce

to ottw Wf.ons or .*.O for .nv otn. r K.u,D.*. N.t,on.l C.m., for H..l1ti Statlnt$CS B

1●DATE OF VISIT PATlENT RECORD 0M8 No. 09200234

~ NATIONAL AMBULATORY MEDICAL CARE SURVEY

ExPw?Js 8.31.89

[PHS) 6105B

2.21P CODE 4-SEX 5.CO~R OR 6, ErHNlclTY 7.;:h5:::E;:~p(S) OF PAYMENT 8 WAS PATIENT

“REFERREDFOR

lDvws 6LUE CROSS(

:;!;$;: 8r

1 D sELF.pAy 4 ❑ EWE SHIELD

, 1 ❑ FE6AALS HISPANIC

‘ ❑ OffilN

7 ❑ $w3 CHASGE

3, DATEOFSIRTH 2 ❑ SLACK PHYSICIAN?

ASIAN,?ACIFIC

3 ❑ ISLANDER

2 •1 “’”’cARE 5 •1 l?x&$&’ERc’AL s •1 ‘G,, ,~y,, ,~No

~ 2 Q ‘*E

2 ❑ :?:AN!C

“ c :5%%LKY 3 c “’’c”” o c1 l%%%%

9 PATrEwr’s COMMINT(SI, SYMPTOM(SI, OR OTHER

● REASON(SI FOR THIS W&NT [In paftent k own word$r

I (), PHYSICIAN’S DIAGNOSES I 1 HAVE YOU SEEN

“ PATlENT BEFORE?

. MOST IMFwRTANT m PRINCIPAL DIAGNOSISHIOBLEM ASSOCIATED WITH ITEM 9a

I ❑ YES 2DN0

+

IF YES, FOR THE CONDITION

b OTHER b OTHER SIGNIFICANT CURRENT OIAGNOSES IN ITEM 10#?

1 ❑ YES 2DN0

—-. —— .- ——

‘12“ &%m!%%l%%:::d;fs

13. COUNSELING/ADVICE

[Chffk all ordered or provided]

q 4mNo:Kwm:;:::-

1~ NONE 7 ❑ BLOLIO PRESSURE CHECK 13 ❑ ORAL GLuCOSE TOL I ~ NONE 1 ❑ NONE

2 ~ PAP TEST 8 ❑ uRINALYSIS 14 ❑ CHOLESTEROL MEASURE 2 ~ WEIGHT REDuCTION z ❑ PSYCHOTHERAPY

3 ~ PELVIC EXAM 9 ❑ CHEST X RAY 15 ❑ HIV SEROLOGY 3 ❑ CHOLESTEROL REOUCTION 3 ❑ CORRECTIVE LENSES

4 D AMBULATORY SURGERY

4 ~ BREAST PALPATION 10 0 DIGITAL RECTAL EXAM 16 D OTHER 8LOO0 TEST

4 ❑ SMOKING CESSATION

5 ❑ PHYSIOTHERAF4

5 r, MAMMOGRAM 11 ❑ PROCTJSIGMOIDOSC OPY

5 ❑ HIV TRANSMISSION

17 ❑ OTHER /SD@17

6 ~ PREAST SELF EXAM

6 j_j OTHER /SIWiv/

6 ~ VISUAL ACUITY 12 ❑ STOOL BLOOD EXAM

7 ~ OTHER

15. MEDlCA~ONTHERAPY(RKordotlnewormn,,nutimtiico,romorderedorpmvidedo!!h&vkif. Use!l!esarw 16. /Dl;KP&S;ll:J THK,VISIT 17* glRA;~h

brandnome orgenenc name entersd or! any Rx or o.ffim medmlnmnd Include m?munivrfg mrddansiiiang agenls.f

Vlsrr

IF NONE. CHECK HERE ❑ ., NEW b, FOR OX 1 ❑ NO FOLLOW.UP PLANNEO /Time

MEDICATION> IN ITEM 10.7 QCrually

YES 2 ❑ RETURN AT SPECIFIED TIME spat wtfh

1 ! Q ,“; !’; &

physician]

3 ❑ RETURN IF NEEOEO, P R N,

2, ‘020’020

. ~ ::LJJW&AE FOLLOW”P

3

5 ❑ ‘EFERREo 70 OTHER PHYSICIAN

‘n 20 ‘cl 2CI

6 ❑ FWTy~WT:l:~TO REFERRING

4 IIJ ZD IU 20 7 ❑ AOP.ilT TO HOSPITAL MonuIes —

s ‘c! 20 ‘cl 20 8 ❑ OTHER /SP?C{lrJ

. U S GOVERNMEN7 PRINTING OFFICE, !9SS.%

Figure 1.1989 National Ambulatory Medical Care Survey Patient Record

The age distribution of visits by

females to obstetricians and

gynecologists has shifted over the

years. While 32.7 percent of these

visits were made by patients 15–24

years of age in 1975-76, only

21.4 percent were made by patients in

this age group in 1989-90.

Correspondingly, females aged 25-44

years comprised 51.7 percent of the

totaI in 1975–76, but had increased

their share to 64.3 percent by 1989–90

(figure 2).

However, visit rates appeared not

to have changed significantly over the

years within any of the five age

groups analyzed (figure 3). Females in

the age group 25-44 years had the

highest rate of visits to obstetricians

and gynecologists (94.5 visits per 100

females in 1989-90), followed by

females aged 15-24 years (71.6 visits

per 100). Females under age 15 were

the least likely to visit this specialty,

wfith only 1,3 visits per 100 females.

White females made 84.7 percent

of all female visits to obstetricians

and gynecologists during 1989-90,

while black females accounted for

8.6 percent, and AsianPacific

Islanders accounted for 3 percent.

The visit rate for white females was

higher (47.7 visits per 100) than the

corresponding rate for black females

(31.8 visits per 100). Visit rates for

white females did not appear to

change significantly during the years
Advance Data No. 223 ● January 13, 1993 3

S27

■ 1975-76 H 19s0-s1 RI 19a2-90

84.3

25 2.4 =

Leas thsn 15 15-24 yaars 25_44years 4+64y86uS 65yaamand

years evar

Patient’sage

No-r!zauul cn%yaravmgea

Figure 2. Change In age distribution of office visits by females to obstetricians and

gynecologists: United States 1975-90

analyzed. Moreover, no significant

differences were found in visit rates

for black females in 1975-76

compared with 1989–90, although a

somewhat lower visit rate was noted

in 1980-81.

Physician practice

characteristics

Obstetrics and gynecology was

the fourth most visited physician

specialty after general and family

practice, internal medicine, and

pediatrics, and accounted for an

average of 8.6 percent of all office

visits for 1989 and 1990 (table 2).

This percentage did not differ

appreciably from figures reported in

1975 and 1980-81.

Of the average number of office

visits made by women during 1989

and 1990 to aII specialties, about

14.1 percent were made to

obstetricians and gynecologists.

However, among women aged 15-44

years, this share was 29.1 percent

(figure 4). General and family

practice physicians received

30.4 percent of the total for this age

group, with other specialties receiving

significantly smaIIer percentages.

Visit characteristics

More than two-thirds of alI visits

made by females to obstetricians and

gynecologists (69.6 percent) were

made by patients who had seen the

physician previously and were

returning for care of their condition.

This reflects, to some extent, the

ongoing character of prenatal care.

Only 4.7 percent of visits were the

result of a referral from another

physician (table 3).

Private insurance (including

commercial insurance and Blue

Cross/BIue Shield) was listed as an

expected source of payment at nearly

half (48.1 percent) of all visits

(table 4). Self-payment was the

expected source of payment at

26.7 percent of visits, followed by

HMO/prepaid plan (14.4 percent). It

should be noted that, physicians were

alIowed to list more than one

expected source of payment per visit.

The patient’s principaI reason for

visit is shown in tables 5 and 6. Data

in table 5 are categorized according

to the eight reason for visit modules,

or groups of reasons, outlined in A

Reason for I&it Classij5cation for

Ambulatory Care (RVC) (10). The 15

most frequently mentioned principal

reasons for visiting obstetricians and

gynecologists are listed in table 6.

The principal reason for visit

(item 9a on the Patient Record) is

the patient’s most important

complaint, symptom(s), or other

reason(s) for this visit expressed in

the patient’s own words. Up to three

reasons per visit may be coded based

upon the classification system found

in the RVC.

More than half (59.6 percent) of

all visits by females to obstetricians

and gynecologists were classified

within the diagnostic, screening, and

preventive module, reflecting the

large percentage of visits

(32,8 percent) made for the specific

reason of routine prenataI

examination. Visits made because of

a symptomatic probIem or complaint

accounted for 23.7 percent of the

total; symptomatic problems or

complaints were most often reIated to

the genitourinary system.

Diagnostic services ordered or

provided at the visit are shown in

table 7. The vast majori~ of visits

inchxded some type of diagnostic

service (94.4 percent), and

36.5 percent of visits included four or

more diagnostic semices, a

significantly higher percentage than
4 Advance Data No. 223 c January 13, 1993

R 1975-76 •l WaO-sl H Ire-w

100 r

9.3 g.1 9.6

EYl!L

Leesthan 15 15-24 yaars 25-4years &_64y0tvs S5yaarsand

years 04ar

Flaure 3. Annual visit rates for femalas to obstetricians and gynecologists by patient’s

ag>: United States, 197S-90

that found at visits to all other

specialties.

The most frequently performed

service was a bIood pressure check

(72.7 percent of visits), followed by

pelvic exam (58.5 percent), urinalysis

(45.4 percent), pap test

(34.7 percent), and breast palpation

(32,1 percent).

Data on principal diagnoses

rendered at visits to obstetricians and

gynecologists are shown in table 8.

Item 10a of the Patient Record

requests that the physician record the

principal diagnosis associated with the

patient’s most important reason for

visit. Diagnoses are classified and

coded according to the In~emarional

Ciassificalion of Diseases, 9th Revision

Clinical Mod$carion, (ICD-9-CM)

(12). They are shown according to

major ICD-9 coding classes in table 8

and by the 15 most frequently

mentioned principal diagnoses in

table 9.

Paralleling the principal reason

for visit data, the majority

(55.6 percent) of visits reported a

principal diagnosis in the

supplementary classification (ICD9-CM codes VO1-V82), which

includes all diagnoses that are not

related to illness or injury. About

22.2 percent of visits reported

diagnoses classified as diseases of the

genitourinary tract (ICD-9-CM codes

580-629).

Normal pregnancy was the most

frequently reported principal

diagnosis, Iisted at 31,3 percent of

visits. The most frequently reported

morbidity-related principal diagnosis

was menopausal and postmenopausal

disorders, Iisted at 3.6 percent of

visits, (Morbidity-reIated diagnoses

are those referable to illness or

injury.)

Therapeutic services ordered or

provided by the physician are shown

in tabIe 10. Less than half of the visits

(47.3 percent) included some form of

counseling or advice by the physician;

breast self-exam was the specific type

of counseling reported most

frequently, occurring at 10.6 percent

of visits. However, 35.1 percent of

visits included a reference to “other”

counseling, which may incIude various

forms of medical, social, and family

counseling. More detailed data in this

area have been collected in the 1991

NAMCS.

Less than half (44.0 percent) of

visits to obstetricians and

gynecologists included a mention of

medication therapy, compared with

61.7 percent of visits to all other

specialties, again reflecting the

predominance of visits made for

reasons other than illness and injury.

As used in the NAMCS, the term

“drug” is interchangeable with the

term “medication” and includes all

new or continued medications

ordered or provided at the visit,

including both prescription and

nonprescription preparations,

immunizing agents, and desensitizing

agents. Am earlier report is available

that describes the method and

instruments used in collecting and

processing NAMCS drug data (13).

The number of drug mentions by

therapeutic classification is shownl in

table 11. The classification system

used here was adapted from the

therapeutic categories found in the

NationaI Drug Code Directory, 1985

(14). In cases where a particular drug

was classifiable to more than one

therapeutic category, it was listed

under the category for which it was’

most frequently prescribed.

“Drug mentions” refer to the

total number of medications listecl in

item 15 of the Patient Record.

Physicians may record multiple

medications per visit, 30 that the total
------- Advance------Data Nn- ------ 223---● Januarv .. ---- J

13.1993 -,. 5

3s r

I 30.4

Gelled

tamiiy

practice

29.1

Obetetlka

gyne-

*Y

3.8 3.7

17.1

29

htemal

medii

oermapedic

surgay

t%ychiatry General

surgery

alar

Ptlysiciarl speciaIty

Figure 4. Percent distribution of office visits by females 15-44 years, according to

physician specialty United States, 1989-90.

number of drug mentions may exceed

the total number of visits. This was

not the case for visits to obstetricians

and gynecologists, however, where

ordy about 1.3 drugs were prescribed

per drug visit, and where just 6

mentions of medication were made

for every 10 visits in general. “Drug

visit” refers to visits with at least one

mention of medication ordered or

provided by the physician.

Of the average yearly estimate of

34.7 miIlion drug mentions at visits to

obstetricians and ~qnecologists for

1989 and 1990, the largest percentage

of mentions (34.8 percent) was for

hormones and agents affecting

hormonal mechanisms. This was

followed by metabolic and nutrient

agents, which accounted for

23.5 percent of aII drug mentions.

The 20 most frequently used

generic substances occurring in drug

mentions by obstetricians and

gynecologists are listed in table 12.

The most frequently mentioned

generic substance was estradiol, listed

as an ingredient in 15.5 percent of

drug mentions. (It is important to

note that the rank ordering presented

in this and other tabIes in this report

may not always be reliable because

near estimates may not be

significantly different from each other

due to sampling variability.) &nong

the top 20 generic substances were

5 hormonal agents, and 10 metabolic

and nutrient agents. The 10 most

frequently mentioned medications

according to the entry name of the

drug, that is, the actual reference

made to it by the physician on the

Patient Record, whether by brand

name, generic name, or therapeutic

effect, is shown in table 13.

Data on disposition of visit are

displayed in table 14. Most visits to

obstetricians and gynecologists by

females included an instruction to

return at a specified time

(76.7 percent).

Duration of visit is shown in

table 15. More than half of all visits

by femaIes (69.3 percent) lasted 15

minutes or less. Average duration of

physician-patient contact (excIuding

visits of zero minutes duration in

which no direct face-to-face contact

benveen physician and patient

occurred) was 15,5 minutes for visits

to obstetricians and ~necologists.

Selected visit characteristics for

obstetricians and ~qnecologists as

compared with all other specialties

are shown in tables 16 and 1?. Visits

to obstetricians and gynecologists

were more likely to be made by

female patients and by patients aged

15-44 years than were visits to all

other specialties (table 16). Other

areas of difference involve the greater

likelihood of private insurance as an

expected source of payment at visits

to this specialty, the predominance of

diagnostic, screening, and preventive

reasons for visit as opposed to

symptomatic complaints, the greater

likelihood of nonillness and noninjury

diagnoses, the higher number as well

as the type of diagnostic services

performed, the greater likelihood of

counseling for breast selfexamination, the lower percentage of

visits at which medication therapy was

mentioned, and the higher proportion

of visits at which a return visit was

scheduled.

Data in table 17 represent the

distribution of visits by physician

specialty for 10 reasons for visit and

10 diagrroses selected from those

reported most often at visits to

obstetricians and gynecologists.

Obstetricians and gynecologists

received 79.1 percent of all visits for

routine prenatal examination

compared with 19.1 percent for

general and family practitioners, On

the other hand, general and family

practitioners received about half

(50.1 percent) of all visits made for

the reason of having a pap smear,

which is not significantly different

than the proportion made to

obstetricians and gynecologists

(41.3 percent).

For the 10 diagnoses listed in

table 17, obstetricians and

gynecologists received a significantly

greater proportion of visits for each

diagnosis listed, with two

exceptions –visits having a diagnosis

of candidiasis and visits with a

diagnosis of inflammatory disease of

the cervi,,, vagina, and vulva. General
6 Advance Data No. 223 ● January 13, 1993

and family practitioners received a

substantial proportion of visits with

these diagnoses (35.9 percent and

40.6 percent, respectively).

References

1. Ezzati T. Office visits to obstetriciangynecoiogists, National Ambulatory

Medical Care Survey, United States,

1975. Advance data from vital and

health s[fitistics; no. 20. Hyattsville,

hfaryland: h’ationid Center for Health

Statistics. 1978.

2. Cypress B. Patterns of ambulatory

care in obstetrics and gynecology, The

National Ambulatory Medical Care

Survey, United States, January 1980-

December 1981. National Center for

Health Statistics. Vital Health Stat

13(76). 1984.

3. Department of Health Economics

Analysis. Office visits [0 U.S.

obstetricians-gynecologists: 1975 and

1989. Economic Impact. The

American College of Obstetricians

and Gynecologists. July 1991.

4. DeLozier JE, Gagnon, RO. 1989

Summary, National Ambulatory

Medical Care Survey. Advance data

from vital and health statistics; no.

203. Hyattsville, hfaryland: National

Center for health Statistics. 1991.

5. Schappert, SM. National Ambulatory

Medical Care Survey, 1989 Summary.

National Center for Health Statistics.

Vital Health Stat 13(110). 1992.

6. Schappert, SM. National Ambulatory

Medical Care Sun’ey, 1990 Summary.

Advance data from vital and health

statistics; no. 213. Hyattsville,

Maryland: National Center for Health

Statistics. 1992.

7. Woodwell, DA. Office visits to

8.

9.

I

10.

pediatric specialists, 1989. Advance

data from vital and health statistics;

no. 208. Hyattsville, Maryland:

National Center for Health Statistics.

1992.

Schappert, SM. Office Irisits for

diabetes mellitus, Uni(ed States, 1989.

Advance data from vital and health

statistics; no. ?1 I. Hyattsville,

Maryland: National Center for Health

Statistics. 1992.

Woodwell, DA. Office visits to

internists, 1989. Advance data from

vital and health statistics; no. 209.

Hj’attsvillej Nlanland: National

Center for Health Statistics. 1992.

Schappert, SIM.Office visits for otitis

media, United States, 1975-90.

Advance data from vital and health

11.

12.

13.

14.

15.

16.

statistics; no. 214. Hyattsville,

Maryland: National Center for Health

Statistics. 1992.

Schneider D, Appleton L, McLemore

T. A reason for visit classification for

ambulatory care. National Center for

Health Statistics. Vital Health Stat

2(78). 1979.

Public Health Service and Health

Care Financing Administration.

International Classification of

Diseases, 9th Revision, clinical

modification. ]Vashington: Public

Health Senice. 1980.

Koch H, CampbeH W, The collection

and processing of drug information,

National Ambulatory Medical Care

Survey, 1980. National Center for

Health Statistics. Vital Health Stat

2(90). 1982.

Food and Drug Administration.

National Drug Code Directory, 1985

Edition. Washington: Public Health

Service. 1985.

National Center for Health Statistics.

Public Use Data Tape

Documentation, 1989 National

Ambulatory Medical Care Survey.

Hyattsville, Maryland. 1991.

National Center for Health Statistics.

Public Use Data Tape

Documentation, 1990 National

Ambulatory Medical Care Survey.

Hyattsville, Maryland. 1992.
Advance Data No. 223 ● January 13, 1993 7

Table 1. Annual number, percent distribution, and rate of office visits by females to

obstetricians and gynecologists, by patient’s age and race, averaged over a 2-year period:

United States, 1989-90

Table 3. Annual number and percent

distribution of office visits by females to

obstetricians and gynecologists by

patient’s referral status and prior-visit

status, averaged over a 2-year period:

United States, 1989-90

Number of Visit rate

visits in Percent per 100

Patient characteristic thousands dktnbution fema/esl

Number of

visits in Percent

Wit characteristic thousands distribution

Allvisits . . . . . . . . . . . . . . . . . . .

Age

Less than 15 years . . . . . . . . . . . .

15-24 years . . . . . . . . . . . . . . . .

25-44 yeara . . . . . . . . . . . . . . . .

45-84 years . . . . . . . . . . . . . . . .

65years and over. . . . . . . . . . . . .

59,475 100.0 47.2

349

12.749

38,247

6,476

1,6S5

2::

84.3

10.9

2.8

7;::

94.5

26.8

9.6

AIl visits . . . . . . . . . . . . 59,47s 100.0

Patient’s referral status

Patient was referred to

this visit by another

physician . . . . . . . . . . 2,818 4.7

Patient was not referred

to thk visit by another

physician . . . . . . . . . . 56,657 95.3

Race

~l~te..........,.,...,...

Lessthan 15 years . . . . . . . . . . .

15-24 years . . . . . . . . . . . . . . .

2544years . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . .

65 years And over . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . .

Less than 15 years . . . . . . . . . . .

15-24 yeare . . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . .

65years And over . . . . . . . . . . .

Asian/Pacific Islander. . . . . . . . . . .

American Indian/Alaskan Native . . . .

Unspecified . . . . . . . . . . . . . . . . .

50,403

264

84.7

0.4

17.6

54.4

9.7

2.6

8.6

47.7

7;:

95.9

27.8

10,485

32,349

5,783

1,523

Patient’s prior-visit status

Newpatient . . . . . . . . . 7,725 13.0

Old patient, new

problem . . . . . . . . . . . 10,352 17.4

Old patient, old

problem . . . . . . . . . . . 41,398 69.6

9.8

31.8

●1.5

55.6

62.0

12.3

‘3.7

5,113

1,x

3,173

324

●54

●O.1

2.5

5.3

0.5

*0. I

1,783

152

2,046

3.0

0.3

3.4

lVI.M rates are based on U.S. Bureau of the Census estimates of lhe cwlfian, noninstituttonahzed U.S. female population for July

1 of 1989 and lS80, averaged over the2-yearperlod,

Table 2. Annual number, percent distribution, and rate of office visits by physician

specialty, averaged over a2-year period: United States, 1989-90

Table 4. Annual number and percent

distribution of office visits by females to

obstetricians and gynecologists by

patient’s expected source of payment,

averaged over a 2-year period:

United States, 1989-90

Number of Visit rate

visits in Percent

Physician specialty thousands

per 100

distribution persons~

Allvisits . . . . . . . . . . . . . . . . . . .

General and family practice. . . . . . .

Internal medicine . . . . . . . . . . . . .

Pediatrics . . . . . . . . . . . . . . . . . .

Obstetrics and gynecology . . . . . . .

Ophthalmology . . . . . . . . . . . . . .

Orthopedlcsurgery. . . . . . . . . . . .

Dermatology . . . . . . . . . . . . . . . .

General surgery . . . . . . . . . . . . . .

Psychiatry . . . . . . . . . . . . . . . . . .

Otolaryngology . . . . . . . . . . . . . . .

Cardiovascular diseasea. . . . . , . . .

Urological surgery. . . . . . . . . . . . .

PJe::logy . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . .

698,653

208,045

67,719

84,280

59,812

41,302

34,033

25,165

23.891

I a,790

16,958

11,040

9,652

6,167

71,603

100.0

29.8

12.6

12.1

6.6

5.9

4.9

3.6

3.4

2.7

2.4

1.6

1,4

1:;

265.4

65.0

35.8

34.4

247.2

16,9

13.9

10.3

9.8

7.7

6.9

4.5

4.0

2$2

Number of

Expected source visits in Percent

of paymerrtl thousands distribution

Allvislts . . . . . . . . . . . . 59,475

20,357

15,852

8,568

8,254

4,579

1,963

1,411

1,439

2,423

100.0

Commercial insurance. . 34.2

26.7

14.4

13.9

7.7

;::

2.4

4.1

Self-pay . . . . . . . . . . . .

H!.tO/Prepaid plan . . . .

Blue Crossj Blue Shield . .

Medicaid . . . . . . . . . . .

No charge . . . . . . . . . .

Medicare . . . . . . . . . . .

Other . . . . . . . . . . . . .

Unknown . . . . . . . . . . .

Ivisit rates are based on U.S. Bureau of the Census est]males of Ihe awllan. nomnstmaonafized population Of the United StateS

for Jufyl of1989and 1290, averagad overthe 2-yesrpenod.

2Rate based on female v!sits and iemsfe populauon. Females made 99.4 percent of M visits to this SPeCiaftY during 198%90, fOr

en average annuel estimate of 59,475,0(B3visns.

t Number may cot add to totals because more than one source

of payment may be coded for each visit.
8 Advance Data No. 223 ● January 13, 1993

Table 5. Annual number and percent distribution of office visits by females to

obstetricians and gynecologists by patient’s principal reason for visit, averaged over a

2-year period: United States, 1989-90

Number of

W.ws m Percent

Principal reason for vi.wfand WC code! thousands distribution

Allvts!ts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59,475 100.0

Symptom module;..,.. . . . . . . . . . . . . . ..S001-S999 14,125 23,7

Symptoms referable to the genitourinary system .S640-S829 9,741 16.4

Dfsease module, . . . . . . . . . . . . . . . . . . ..DooD99999 1,645 2.8

Diagnostic, screening, andpreventwe module . .X1OO-X599 35,473 59.6

Treatment module. . . . . . . . . . . .TIOO-T899 4,236

Injury andadverse effects module JOO1–J999 “57 “:::

Tes: results module, ,R1OC-R7OO 1,884

Aommstrahvemodule . .;;;’.;~;;’.’, .A1OO-A14O ●38 “;:?

Other . . . . . . . . . . . . . . . . . . . . . .U99D-U999 2,019 3.4

lBasedon ''AReason for V(sltClass(fimtlonfor~bub!o~ Care,`' (RVC),VtalHealthStat2 (78), Feb. 1979.

%cluaes bla”ka, problems, and comp!atnts not elsewhere dass!f!ed, entries of “none,” and ilie9ible entnes.

Table 6. Annual number and percent distribution of office visits by females to

obstetricians and gynecologists bythe 15 most frequently mentioned principal reasons

forvisit, averaged over a2-year period: United States, 1989-90

Number of

Vi.ws /n Percent

Principal reason for visit and RVC codel thousands distribution

Allvtslts . . . . . . . . . . . . . . . . . . . . . . . . . . . ,,. 59,475 100.0

Routmeprenatal exammatlon. . . . . . . . .X205 19,530 32.8

General medlcalexammatlon. . . , . . . .X1OO 6,971 11.7

Postoperatwevtsit, ,, .,.,,, ., ., . . . . . . . . . ..T2O5 2,363 4,0

Postpartum examlnatton. . . . .X215 2,051

Pap smear . . . . . . . . . . . . . . . . . . . . . . . . . . . ..X365 1,749 :.:

Forcytologyfmdmgs . . . . . . . . . . . . . . . . . . . . ..R3OO 1,573 2.6

Gynecologlcai examinabon . . . . . . . .X225 1,990 3.3

Othervagmalsymploms. .,.... ... . . . . . . . . ..S765 1,264 2,1

Family planning, notothemvise specified. . . . . . . .X500 1,031 1.7

Absence ofmenstruation . . . . , . . . . . . . .S730 1.4

Stomach pare, cramps, and spasms . . . . . . . . . . .S545 ;$ 1.4

Utennean dvaglnalbleedmg . .

Problems ofpregnancy andthepostpartum pe;lod :: :=

791 1.3

735 1.2

Menopausal symptoms, . . . . . . . . . . . . . .S750 718 1.2

Pelvlcsymptoms, . . . . . . . . . ., . . . . . . . . . . ..S775 774 1.2

All otherreasons . . . . . . . . . . . . . . . . . . . . . . . . 16,342 27.5

lBasadon ''AReason for V!slt Clesslflmtlon fofhbulato~ Care; `( RVC), Vital HeaHh S@12(78), Feb. 1979.

Table 7.Annual numberandpercenlt

distribution of office visits by females to

obstetricians and gynecologistsby

diagnostic service, averaged over a2-year

period: United States, 1989-90

Nurnberof

Diagnostic and visfts in Percent

screening service thousands distribution

Allvisi!s. .,,...,.,..

Number of diagnostic

services performed

at visit

0 . . . . . . . . . . . . . . . .

1 . . . . . . . . . . . . . . . .

2 . . . . . . . . . . . . . . . .

3 . . . . . . . . ...4....

4 . . . . . . . . . . . . . . . .

5 . . . . . . . . . . . . . . . .

Morethan 5 . . . . . . . . .

Diagnostic and screening

services performed

at visit!

Blood pressure check. . .

Pelvic exam . . . . . . . . .

Urinalysis . . . . . . . . . . .

Pap test . . . . . . . . . . . .

Breast palpation. . . . . . .

Otherbloodtest. . . . . . .

Dtgital-rectal exam . . . . .

Mammogram. . . . . . . .

Cholesterol measure. . .

Stoolbloodexam. . . . .

Oral glucose tolerance. . .

HlVserology2 . . . . . . . .

Chestxray . . . . . . . . . .

Visualacuify . . . . . . . . .

Proctoscopy/

slgmoidoscopy. . . . . . .

Other diagnostic serf ice. .

59,475

3,326

10,157

13,203

11,029

7,431

5,296

9,033

43,234

34,796

27,060

20,642

19,114

8,853

7,660

3,932

2,268

2,223

939

273

207

190

17,;;:

100.0

5.6

17,1

22.2

18.5

12.5

6.9

15.1

72.7

58.5

45,4

34.7

32.1

14.9

12.9

6.6

3.8

3.7

;:

:::

●O.1

29.2

lNumber may not add to totals because more than one

diagnostic sewice may be performed at each vlsiL

2HlVm human immunodef!ciency vtrus.
Advance Data No. 223 ● January 13, 1993 9

Table 8. Annual number and percent distribution of office visits by females to

obstetricians and gynecologists by principal diagnosis, averaged over a 2-year period:

United States, 1989-90

Number of

visits h-r Percent

Principal diagnosis and ICD–9-CM codel thousands disfnbution

Allvisits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59,475 100.0

lnfectitws and parasitic diseases . . . . . . . .001–139 1,864 3.1

Neoplasm, . . . . . . . . . . . . . . . ... . . . . . . ..l4&239 1,161 2.0

Endocrine, nutritional, and metabolic diseases

and lmmunitydisorders . . . . . . , . . . . . . . .240-279 732

Mental disorders.,......,,. . .,.........290-319 171 ;:

Diseases of the nervous system and sense organs .320-389 174 0.3

Diseases ofthe circulatory system , . . . . . . . . . .390-.459 336 0.6

~lsease so ftherespirato ~system . . . . . . .46c!-519 526 0.9

Diseases of the digestive system . . . . . . . , .52C-579 342 0.6

Diseases of thegemtourmarys ystem. . . . . . . ,580-629 13,180 22.2

Diseases of theskin and subcutaneous tissue. . . .680-709

Dseases of the musculoskeletal svstem

315 0.5

andconnectwe tissue. . . . . . . c .71c-739 150

symptoms, signs, andill-defined con~~ons” ::::.780-799 1,478 $;

Injuryandpoisoning . . . . . . . . . . . . . . . . . ...800-999 188

Supplementary classlficetion. . . . . . . . . . . . . . .VO1-V82 33,060 5::

Allotherdiagnoses2 . . . . . . . . . . . . . . . . . . . . . . . . . . 3,764 6.3

Unknowns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,036 3.4

lBmtion thelnternatlonal ClaS!f!catlon of Dlsemes, 3hRev{sion, Cllniml Mod!fi~tion (ICO-S-CM).

21ncfudeadseaaes of the blood and blood-forming organs (28C-289); COMpl!CdtlOnsof pregnancy, ch!ldbirfh, and the puepenum

$:c~:); congenital a“omahes (740-759); and certain condmms cmgmatmgin the perinatal period f760-79g).

blank diagnosea, uncodable d!agnoses, and illeg!bfe diagnoses.

Table 9. Annual number and percent distribution of office visits by females to

obstetricians and gynecologists by the 15most frequently mentioned principal diagnoses,

averaged over a2-year period: United States, 1988-90

Number of

visits in Percent

Principal diagnosis and lCD-9-CM codel thousands distribution

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59,475 100.0

Normal pregnancy . . . . . . . . . . . . . . . . . . . . . . ..v22 18,701 31.3

Generai medical examination. . . . . . . . . . . , . . . . . .v70 4,399 7.4

Menopausal and postmenopausal disorders . . . . . ...627

Dkorderso fmenstruationa ndothera bnormahties . ...628

2,126 3.6

2,062 3.4

Contraceptive management. . . . . . . . . . . . . . . . . .V25 2,015 3.4

Special investigations andexammations. . . . . . . . . . .V72 1,764 2.9

Postpartum care andexaminatlon. . . . . . . . . . . . , . .V24 1,668 2.8

Inflammatory disease of cervix, vagina, and vulva . . . . .618 1,643 2.7

Pain and other symptoms associated wth female

genital organs . . . . . . . . . . . . . . . . . . . . . . . ...625 1,416 2.4

Noninflammatory disorders of cervix . . . . . . . . . . ..622 1,109

Other postsurgical states . . . . . . . . . . . . . . . . . . . .V45

Candidiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . ..I12

930 ;::

814

Female infertiiify . . . . . . . . . . . . . . . . . . . . . . . ...628 797 ;::

Observation andevaluatlon forsuspected conditions. .W’l 747 1.2

Nonspecdic abnormal %tological and immunological

findings . . . . . . . . . . . . . . . . ..795

All other diagnoses . . . . . . . . . ...-.”.”.....”...”.”.’.”.. . . .

700

18,570 3;::

1Besed on tha Internaftonal Classdicatmn of Oiseases, arh Revmon, Clvwal Modftceuon (ICPS-CM).

Table 10. Annual number and percent

distribution of office visits by females to

obstetricians and gynecologists by

therapeutic service ordered or provided,

averaged over a 2-year period:

United States, 1989-90

Number of

Therapeutic semice w.sits in Percent

ordered or providefl thousands dist[)bution

Allvisits . . . . . . . . . . . .

New or continuing

medication . . . . . . . . .

Co;w~ling/advice

Weigh~~ed~%o;: ::::

Cholesterol reduction. .

Smoking cessation. . . .

HIVtransmission. . . . .

Breast self-exam. . . . .

other . . . . . . . . . . . .

Other non-medication

theraov

None . . . . . . . . . . . . .

Psychotherapy . . . .

Ambulatory surgery . . .

Physiotherapy. . . . . . .

Other . . . . . . . . . . . .

59,475 100.0

26,148 44.0

31,351 52.7

2,876 4.8

1,014 1.7

1,137 1.9

●134 *0.2

6,294 10.6

20,900 35.1

54,587 91.8

201 0.3

821 1.4

●114 ‘0.2

3,764 6.4

lNumbers may not add to totals because more than one type

of therapy may ba ordered or provided at each visit.

Table 11. Annual number and percent

distribution of drug mentions at office visits

by females to obstetricians and

gynecologists by therapeutic classification,

averaged over a 2-year period:

United States, 1989-90

Number of

drug ment!ons Percent

Therapeutic c/aea&etiorrl irrfhousands distribution

Aflmenfions . . . . . . . . .

Hormones and agents

affecting hormonal

mechanisms . . . . . . .

Contraceptive agents . .

Estrogens and

progestms . . . . . . . .

Mefabollc and nutnent

agents . . . . . . . . . . . .

Vitamins: minerals. . . .

Anhmicroblal. . . . . . . . .

Tetracycline . . . . . . .

Penicillins . . . . . . . . .

Skin, mucous

membrane .,.......

Dermatologics . . . . . .

Pamrehef . . . . . . . . . . .

Anfiarthrltice. . . . . . . ,

Hematologic. . . . . . . . .

Agents used to treat

def~ciency anemias, . .

Resrxratory tract. . . . . . .

Cardiovascular-renal. . . .

Psychopharmacologic . .

Gastrointestinal . . . . . . .

Immunologic. . . . . . . . .

Necrologic . . . . . . . . . .

Ophthalmic. . . . . . . . . .

Otherand unclassified2 . .

34,736

?2,088

6,243

4,709

8,167

7,946

4,334

1,063

761

2,989

2.736

1,934

1,146

1,154

1,127

752

437

437

312

123

●65

“40

1,S08

100.0

34.8

18.0

13.6

23.5

22.9

12.5

3.1

2.2

;::

:::

3.3

z::

1.3

::;

::

●0. I

5.5

lllerapeutic Claasdrication is baaed on the standard drug

Clss.wrkatlonused inthe Nabonal Drug Code Oirectory, lga5

Edhtion.

%cludes anes[hews, oncolytics. otolog!cal drugs, antipare.

s!bc agents, and other unclassified and miscellaneous agents.
10 Advance Data No. 223 ● January 13, 1993

Table 12. Annual number, percent distribution, and therapeutic classification of drug

mentions at office visits by females to obstetricians and gynecologists by the 20 moat

frequently used generic substances, averaged over a 2-year period: United States,

1989-80

Number of

drug mentions Percent Therapeutic

Generic substance in thousarrdsl distribution claeeificatiorrz

All mentions . . . . . . . . . . . . . .

Estractiol . . . . . . . . . . . . . . . .

Ergocslciferoi . . . . . . . . . . . . .

Viamin A . . . . . . . . . . . . . . . .

Riboflavin. . . . . . . . . . . . . . . .

Pyridoxine . . . . . . . . . . . . . . .

Thiamine . . . . . . . . . . . . . . . .

Norethindrone. . . . . . . . . . . . .

Iron preparations. . . . . . .

Estrogens . . . . . . . . . . . . . . .

Medroxyprogeeterone. . . . . . .

Calcium ion . . . . . . . . . . . . . .

~tjmm~yaal. . . . . . . . . . . . . . .

Norgestrei;:~~~~:~;~~::;:

Viamin E . . . . . . . . . . . . . . . .

Terconszole . . . . . . . . . . . . . .

Miconazole . . . . . . . . . . . . . . .

Doxycycline . . . . . . . . . . . . . .

Metronidszole . . . . . . . . . . . . .

Naproxen, . . . . . . . . . . . . . .

34,738

5,370

5,287

5,272

4,660

4,642

4,031

3,157

2,997

2,445

1,673

1,644

1,498

1,080

1,038

978

%

636

631

599

100.0 ...

15.5 Contraceptive agents

15.2 Viamins, minerals

15.2 Vitamins, minerals

13.4 Viimins. minerals

13.4 Viimins; minerals

11.6 Vitamins, minerals

9.1 Contraceptive agents

8.6 Vitamins, minerals

7.0 Estrogens and progeatins

4.8 Estr~ens and progeetins

4.7 Viim!ns, minerals

4.3 Vitsm!ns, minerals

3.1 Vitamms, minerals

3.0 Contraceptive agents

2.8 Vitamins, minerals

Dermatologics

!:: Derrnatologics

1.8 Tetra clines

1.8 Miscel7 aneous antibacterial agents

1.7 Antiarthritics

lFrequencyof mention combines single-ingredient agents with mentions of the agent es en ingredient in e combination drug.

%erepeutic classification is based on the standard drug classification used in the National Drug Code Directory, 1985 Edtion.

Incaseswhereageneric substancehedmore Wnonetherapeutic classiricetion, itwes Msdintheclaesilication fortichitwas

most frequently used.

Table 13. Annual number, percent distribution, and therapeutic classification of the 10

drugs moat frequently prescribed at visits by females to obstetricians and gynecologists

by entry name of drug, averaged over a 2-year period: United States, 1988-80

Number of

drug mentions Percent Therapeutic

Entry name of drugl in thousands distribution classficatiorrz

Total mentions . . . . . . . . . . . .

Premarin . . . . . . . . . . . . . . . .

Prenatal vitamins. . . . . . . . . .

Ortho-novum . . . . . . . . . . . . .

Prenatal formula (vitamins). . . . .

Matema . . . . . . . . . . . . . . . . .

Provers . . . . . . . . . . . . . . . . .

Contraceptive agent. . . . . . . . .

Terszol . . . . . . . . . . . . . . . . .

Natalins . . . . . . . . . . . . . . . . .

Anaprox . . . . . . . . . . . . . . . . .

34,738 100.0 ...

2,296 6.6 Estr~ens and progeatins

2,065 5.9 Vitamms, minerals”

2,053 5.9 Contraceptive agents

1,7e6 5.2 Wamins, minerals

4.7 Vimins, minerals

;;% 4.5 Estrogens and progeetins

725 2.1 Contraceptive agents

665 1.9 Dermatologice

Vitamins, minerals

% 4:: Antiarthritics

lThe trade or gensric name used by the physician on the prescription w other medical remrds.

~herspeutic clsesfication is bassd onthe standard drug classification used in tie Natiorvd Drug Code Directmy, 1982 EdWon.

In cases where a drug hed more than one therapeutic classfficstion, it wee listed in the claeefication for which it was most

frequently used.

Table 14. Annual number and percent distribution of office visits by females to

obstetricians and gynecologists by disposition of visit, averaged over a 2-year period:

United States, 198S80

Number of

visits in Percent

Disposition of visitl thousands distribution

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . 59,475 100.0

No followup planned . . . . . . . . . . . . . . . . . . 2,808 4.7

Retumat specified time . . . . . . . . . . . . . . . . 45,641 76.7

Retumif needad . . . . . . . . . . . . . . . . . . . . . 9,307 15.6

Telephone followup planned . . . . . . . . . . . . . 1,479 2.5

Refer to other physician . . . . . . . . . . . . . . 1,463 2.5

Retumto referring physician . . . . . . . . . . . . . 306 0.5

Admit to hospital . . . . . . . . . . . . . . . . . . . . . 766 1.3

Other disposition. . . . . . . . . . . . . . . . . . . . . 1,063 1.8

1Number may not add to totals Ixxause more than one disposition maybe coded for each visit.

Table 15. Annual number and percent

distribution of office visits by females to

obstetricians and gynecologists by

duration of visit, averaged over a 2-yaar

period: United States, 1988-90

Number of

visits in Percent

Duration of visit tiousands distribution

All visits . . . . . . . . . . . . 59,475 “100.0

Ominutesl . . . . . . . . . . 0.7

l-5 minutes . . . . . . . . . 6,% 11.0

6-10 minutes . . . . . . . . 16.269 27.4

11-15 minutes. . . . . . . 17;962 30.2

16-30 minutes. . . . . . . . 15,599 26.2

31-60 minutes. . . . . . . . 2,::; 4.4

More than 60 minutes. . . *o.1

i~~~of~e~minutesdureti~n are~o~einwhichMerewas

no face-tc-face contact betw’sen the physician end the patient.
Advance Data No. 223 ● January 13, 1993 11

Table 16. Annual number and percent of office visits to obstetricians and gynecologists

and to all other physician specialties by selected visit characteristics, averaged over a

2-year period: United States, 1989-90

Obstetricians

and A// ofher

Se/ected visit characteristic gynecologists specialties

Number of visits in thousands

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . 59,812 638,841

Percent

56.8

32.9

Female patients . . . . . . . . . . . . . . . . . . . . .

Patients 1544years ofage . . . . . . . . . . . . . .

99.4

85.5

Patients returning for care of previously

treated condition . . . . . . . . . . . . . . . . . . . .

Private insurance as expected pay source

(includes commercial insurance and

Blue Cross/ 81ue Shield) . . . . . . . . . . . . . . .

69.5 60.3

47,9 33.2

60.0

11.6

0.8

Principal reason forvisit in symptom module .

Prlnc19al reason for vist in diagnostic,

Screening, and preventive module. . . . . . .

Principal reason for visit of routine

prenatel exam . . . . . . . . . . . . . . . . . . . . . .

priflCiPal diaanosis in diseases of the

24.0

59.4

32.7

geniiourinafisystem . . . . . . . . . . . . . . . . . 22.1

Pnncioal diaanosis in suoolementaw

4.2

11.3

0.8

cla5sificati& . . . ...’.’... . . .’ . . . . . . . . .

Principal diagnosis ofnormal pregnancy. . . . . .

Three ormarediagnostic services performed. . .

Bloodpressurecheck . . . . . . . . . . . . . . . . .

Pelvicexam . . . . . . . . . . . . . . . . . . . . . . . .

Urinalysis . . . . . . . . . . . . . . . . . . . . . . . . .

55.3

31.3

54.9

72.6

58.2

10.4

33.4

2.6

9.7

H

45.3

34.5

32.0

6.6

10.5

44.1

76.6

Paptest . . . . . . . . . . . . . . . . . . . . . . . . . .

BreaStDalDatiOfl . . . . . . . . . . . . . . . . . . . . .

Mammogram . . . . . . . . . . . . . . . . . . . . . . .

Counseling for breast self-exam . . . . . . . . . . .

Drugvisits . . . . . . . . . . . . . . . . . . . . . . . . .

1.1

6;:?

Returnvisitscheduled .,..... . . . . . . . . . . 60.3

Tabie 17. Annual number and percent distribution of office visits by physician specialty according to selected principal reasons for visit

and principal diagnoses, averaged over a2-year period: United Statesfl 989-90

Numberof

Wits in Obstetricsand General and

Principal reason for visd and princlpai diagnosis

A// other

thousands Total gynecology tanvly practice speclalfies

Percent distribution

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422,324 100.0 14.1 30.0 55.9

Principal reason for visit and RVC code!

Routine prenatal examination. . . . . . . . . . . . . ..X205

Stomach pama. cramgs. andsoasms . . . . . . . . .S545

24,663

6,311

4,233

2,689

2,315

2,209

2,008

1,362

1,333

1,048

100.0

1000

100.0

100,0

100.0

100.0

100.0

100.0

100.0

100.0

79.1

9.8

41.3

47.0

88.6

71.2

74.2

75.7

59.3

80.4

19.1

36.1

50.1

37.0

*9.7

1785

13.6

●16.0

27.6

●14.5

5::?

Papsmear . . . . ..~.” . . ..~.. , . . . . . . . . ..X365 8.6

Othervaginalsymptoms . . . . . . . . . . . . . . . ..S765

Postpartum exammation. . . . . . . . . . . . . . . . , .X215

Forcytologyfindings . . . . . . . . . ,. .. R300. ..R3oo

Gynecologcele xamination. . . . . . , . . . . . . . . .X225

Family planning, notothenvise specified . . . . . . .X500

Utermeand vaginal bleeding. . . . . . . . . . . . . . .S755

Absence ofmenstruation . . . . . . . . . . . . . , . . .S730

16.0

●1.7

*11,3

●12.2

●8.3

●13.1

●5.1

Princloal diagnos!s arm ICD-9.CM codez

Normal pregnancy . . . . . . . . . . . . . . . . . . . . ..V22 23,570

Menopausal and postmenopausal disorders. . . ...627 3,719

Inflammato disease ofcervix, vagina, and vulva. . .616

Disorders 7 Menstruation andother abnormalrfies ..626

3,554

3,012

cOfltraCeV~e Management . . . . . . . . . . . . . . ..V25 2,816

100.0

100.0

100.0

100.0

100.0

79.3

57.2

46.2

68.5

71.6

64.5

83.5

39.6

73.0

80.7

19.1

30.1

40.6

24.4

19.8

16.5

14.2

35.9

●13.3

●9.6

1;:;

13.2

●7. 1

‘8.6

19.0

●2.3

24.5

*1 3.7

*9.5

Pain and “other sym@oms associated with female

genitelorgans . . . . . . . . . . . . . . . . . . . . . ...625

Postpartum care end examination . . . . . . . . . . . .V24

Candidiasis . . . . . . . . . . . . . . . . . . . . . . . ...112

Noninflammatory dieordersofcervix . . . . . . . . ...622

Femaleinfertility . . . . . . . . . . . . . . . . . . . . . ...628

2,194

2.022

2,017

1,519

987

1Based on “A Reason for VW Classification for Ambulatory Care.” (RVC), VItsl Health Stat 2(i’a), Feb. 1978.

2B~w On the [nt~matIonal cl~i~tjon O! o,~~~~~, ~ R~v@o”, c~ni@ M~dfi~tion, [CD.9.CM.
12 Advance Data No. 223 ● January 13, 1993

Symbols

--- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less

than 0.05

z Quantity more than zero but less

than 500 where numbers are

rounded to thousands

* Figure does not meet standard of

reliability or precision
Advance Data No. 223 ● Januarv 13.1993 13

Technical Notes

Source of data and sample

design

The information in this report is

based on data collected through the

National Ambulatory Medical Care

Survey (NAMCS) over the 2-year

period 1989-90. The target universe

of NAMCS incIudes office visits made

in the United States by ambulatory

patients to nonfederally empIoyed

physicians who are principally

engaged in office practice, but not in

the specialties of anesthesiology,

pathology, or radiology. Telephone

contacts and nonoffice visits are

excluded.

A multistage probability sample

design is used in NAMCS, involving

samples of primary sampling units

(PSU’S), physician practices within

PSU’S, and patient visits within

physician practices. Physicians were

stratified into 15 specialty groups

during the second stage of the sumey

design. Detailed descriptions of the

1989 and 1990 NAMCS survey design

have been published (5,15,16), and

the reader is urged to consuit these

sources for further technical

information.

The 1989 NAMCS physician

sample included 2,535 physicians who

were se[ected from master files

maintained by the American Medical

Association and the American

Osteopathic Association; 164 of these

were obstetricians and gynecologists.

Physicians were screened at the time

of the survey to ensure that they were

eligible for survey participation, based

upon a set of design criteria. Of those

screened, 608 physicians, including 31

obstetricians and gynecologists, were

ruled ineligible (out-of-scope) due to

reasons such as being retired or

employed primarily in teaching,

research, or administration. Of the

remaining 1,927 physicians, 74 percent

responded to the survey, including

133 obstetricians and gynecologists, or

71 percent of those surveyed.

Sample physicians were asked to

complete Patient Records (see

figure 1) for a systematic random

sample of their office visits occurring

during a randomly assigned l-week

reporting period. Responding

physicians completed 38,384 Patient

Records, inciuding 2,504 forms

completed by obstetricians and

gynecologists.

For 1990, a sample of 3,063

non-FederaI, office-based physicians

was selected from master fiIes

maintained by the American Medical

Association and American

Osteopathic Association. Of this

number, 197 were obstetricians and

gynecologists. The overal[ response

rate for the 2,269 in-scope physicians

was 74 percent; the rate was

73 percent for the 157 in-scope

obstetricians and gynecologists.

Responding physicians completed

43,469 Patient Records, incIuding

2,969 forms from obstetricians and

gynecologists.

Characteristics of the physician’s

practice, such as primary specialty

and type of practice, were obtained

from the physicians during an

induction interview. The U.S. Bureau

of the Census, Housing Surveys

Branch, was responsible for collecting

the survey data. Processing operations

and medical coding were performed

by the National Center for HeaIth

Statistics, Hospital Discharge and

Ambulatory Care Survey Section,

Research Triangle Park, North

CaroIina.

The 1989 and 1990 NAMCS were

identical in terms of survey

instruments, definitions, and

procedures. The resulting NO years

of data have been combined to

provide more reliable estimates. AN

estimates, percent distributions, and

rates, unless otherwise noted, reflect

1989”and 1990 data that were

averaged over the 2-year period.

Sampling errors

The standard error is primariIy

measure of the sampling variability

that occurs by chance when only a

sample, rather than an entire

universe, is surveyed. The relative

standard error of an estimate is

obtained by dividing the standard

error by the estimate. The result is

then expressed as a percent of the

a

estimat~. Relative st~ndard errors for

estimated numbers of total office

visits to obstetricians and

gynecologists in 1989-90 are shown in

table I, and relative standard errors

for estimated numbers of drug

mentions are shown in table 11.

Readers wishing to utilize these

tables should keep in mind that the

numbers refer to combined years of

data rather than average annual

estimates. Stafidard errors for

Table LRelatlvestandard errors for

estimated numbers of office visits by

selected physician specialties: Nationel

Ambulatory Medical Care Survey, 1989-90

Estimated Physician specia/i~

numbers

of oftice visits Obstetrics and General and

in thousands Ant gynecolog~ family practic$

Relative standard error in percent

M::

5W. .

1,000.

2,000.

5,000.

1O,CQO

20.oiM

. . . . . 72.7

. . . . . 51.5

. . . . . 32.6

. . . . . 23.2

. . . . . 16.5

. . . . . 10.7

. . . . . 7.9

. . . . . 6.0

49.2

35.3

23.3

17.6

13.9

11.1

9.9

9.3

61.4

43.7

28.1

20.5

15.2

50,CQ0 . . . . . 4.5 9.0 7.3

Ioo,cilo. . . . . 3.9 8.8

200,000 . . . . . 3,5 8.6 U

500.000 . . . . . 3.9 8.7 6.8

1,Oti.000 . . . 3.2 8.7 6.8

1,400,000 . . . 3.2 8.7 6.6

1For all spec a,!les, the smallest rehable estimate IS 593,000

vrsits. Esttmales below this figure have a relabve standard error

$Jt~JJ~,~~SY~~~ecolqy, the smallest reliable estima:e

is 2S5, W0 wsk

3For ge”erd and family pracke, the smallest reliable estimate

is 437,CO0 Vlexe.

Example of use of teblo An aggregale estimate of 1 mllficfr

v!sits to obstetrcrans and gynacolog!sts has a relative standard

error of 17.a percent or a standard error of 176,000 VISIW (17.6

percent of 1 m,lhcm).

Table il. Relative standard errors for

estimated numbers of drug mentions at

visits to obstetricians and gynecologists:

National Ambulatory Medical Care Survey,

1989-90

Estimated number Re/atwe standard

of drug mentions error in

in Urousandd percent

100 . . . .

200 . . . .

;000 . .

2:000 ::

5,000 . .

10,000. .

20,000. .

50,000. .

lm,ooo.

1,000,000

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

1. . . . . . . . . . .

36.1

27.0

19.7

16.6

14.7

13.5

13.1

12.9

12.8

12.7

12.7

llle amalleeI reltable estimate IS 155,000 menbons. Eatima:es

below th!s figure have a relative standard errw greater than

30 percent.

Example of use of table An aggregate estimate of 10 million

drug mentions haa a relative standard error of 13.1 percent or

a s2mdard error of 1,310,000 menuons (13.1 percent of

10 million).
14 Advance Data No. 223 ● January 13, 1993

estimated percents of visits are shown

in table III.

Alternatively, relative standard

errors for aggregate estimates may be

calculated using the following general

formula, where x is the aggregate of

interest in thousands, and A and B

are the appropriate coefficients from

table IV.

‘SE(X) =W”l”””

Similarly, relative standard errors

for percents may be calculated using

the following general formula, where

p is the percent of interest and x is

the denominator of the percent in

thousands, using the appropriate

coefficient from table IV.

Adjustments for non-response

Estimates from NAMCS data

were adjusted to account for sample

physicians who were in scope but did

not participate in the study. This

adjustment was calculated to

minimize the impact of response on

final estimates by imputing to

nonresponding physicians data from

visits to similar physicians. For this

Table 111,Standard errors for percents of estimated numbers of office visits to

obstetricians and gynecologists: National Ambulatory Medical Care Survey, 1989-90

Est/mated percent

Base 0) percent

(visits in thousands) 1 or 99 5 or 95 10 or 90 20 or 80 30 or 70 50

Standard error in percentage points

100 . . . . . . . . . . . . . . . . . 4.8 10.6

200. . . . . . . . . . . . . . . . . 34 7.5

500. . . . . . . . . . . . . . . . . 2.2 4.7

1,000, . . . . . . . . . . . . . . . 1.5 3.3

2000. .,...... . . . . . 1.1 2.4

5.000 . . . . . . . . . . . . . . . . 0.7 1,5

10,000 . . . . . . . . . . . . . . . 0.5 1.1

20,000 . . . . . . . . . . . . . . . 0.3 0.8

50.000 . . . . . . . . . . . . . . . 0.5

100,000, . . . . . . . . . . . . .

::;

0.3

200.000 . . . . . . . . . . . . . . 0.1 0.2

509;000. . . . . . . . . . . . . . 0.1 0.2

1,000,000 . . . . . . . . . . . . . 0.1 0.1

14.5

10.3

65

4.6

3.3

2,1

1.5

1.0

0.7

0.5

0.3

0.2

0.1

19,4 22.2 24.2

13.7 15.7 17.1

8.7 9.9 10.8

6.1 7,0 7.7

4.3

2,7

1.9

1.4

0.9

0.6

0,4

0.3

0.2

5.0 5.4

3.1 3.4

2.2 2.4

1.6 1.7

U :::

0.5 0.5

0.3 0.3

0.2 0.2

ExampleOfuseof W.ble:Anest[mateof20 percentbasedm a~ aggregateestlmaleof5 mkm VISI!Shas a standarderrorOf2.7

percentor a relat!vestandarderrorOf13.5 percent(2.7 percentd!wdedby 20 percent).

Table IV. Coefficients appropriate for determining relative standard errors by type of

estimate and physician groups: National Ambulatory Medical Care SUt’VeY, 1989-90

Coeficienf

Type of estimate and

physician group A B

Visfts

Overall totals . . . . . . . . . . . . . . . . . . . . . . . . . . . .

General and family practice, internal medlcme .

Pediatrics, obstetrics and gynecology . . . . . . . .

Doctors of osteopathy, general surgery, orthopedic

surgery, cardiovascular disease, psychiatry, urological

surgery, dermatology, neurology, ophthalmology,

otola~ngology . . . . . . . . . . . . . . . . . . . . . . . . .

Another. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drug mentions

Overall totals . . . . . . . . . . . . . . . . . . . . . . . . . . .

General and famrly practice, internal medicine . . ,

Psychiatry .,, . . . . . . . . . . . . . . . . . . . . .

Doctors of osteopathy, general surgery, orthopedic

surgery, cardiovascular disease, urological surgery,

dermatology, neurology, ophthalmology,

otolaryngology, obstetrics and gynecology, pediatrics.

Another. . . . . . . . . . . . . . . . . . . . . . . . . . .

0.00097549

0.00456412

0.00755165

0.01236777

0.01169917

0.00157151

0.00589721

00296738

0.01603845

0.01677082

52.77952184

37.27953208

23,43030623

8.46452955

39.38793804

81.47054833

59.72807201

30.9506771

11.42009384

70.35063675

purpose, physicians were judged

similar if they had the same specialty

designation and practiced in the same

Psu.

Test of significance and

rounding

In this report, the determination

of statistical inference is based on the

t-test. The Bonferroni inequality was

used to establish the critical value for

statistically significant differences

(0.05 level of confidence). Terms

relating to differences such as

“greater than” or “less than” indicate

that the difference is statistically

significant. No comment about the

difference between any two estimates

does not mean that the difference was

tested and found to be not significant.

In the tables, estimates of office

visits have been rounded to the

nearest thousand. Consequently,

estimates will not always add to

totals, Rates and percents were

calculated from original unrounc[ed

figures and do not necessarily agree

with percents calculated from

rounded data.

Definition of terms

Ambulatory patient –An

ambulatory patient is an individual

seeking personal health services who

is not currently admitted to any

health care institution on the

premises.

Physician –A physician is a duly

licensed doctor of medicine (M. D.) or

doctor of osteopathy (D,().) who is

currently in office-based practice and

\vho spends some time caring for

ambulatory patients. Excluded from

the NAMCS are physicians who are

hospital-based; who specialize in

anesthesiolo=q, pathology, or

radiology; who are federally

employed; who treat only

institutionaIized patients; or who are

empIoyed full time by an institution

and spend no time seeing ambulatory

patients.

Ofice– An office is the space

physicians identify as a location for

their ambulatory practice. Offices

customarily include consultation,
Advance Data No. 223

c January 13, 1993 15

examination, or treatment spaces that

patients associate with the particular

physician.

VW-A visit isa direct personal

exchange between an ambulatory

patient anda physician (ora staff

member working under the

physician’s supervision), for the

purpose of seeking care and

rendering personal health sewices.

Dng mention-A drug mention is

the physician’s ent~ ofa

pharmaceutical agent -by any route

of administration-for prevention,

diagnosis, or treatment. Generic as

well as brand-name drugs are

incIuded, as are nonprescription and

prescription drugs. Along with all new

drugs, the physician a[so records

continued medications if the patient

was specifically instructed during the

visit to continue the medication.

Drug vkit -A drug visit isa visit

in which medication was prescribed

or provided by the physician.

Obstem”csand gynecology-The

physician practice special~ of

obstetrics and gynecology includes

physicians who reporta specialty to

the American Medical Association in

any of the following areasgynecology, gynecological oncology,

maternal and fetal medicine,

obstetrics, obstetrics and gynecology,

and reproductive endocrinology.
16 Advance Data No. 223 ● January 13, 1993

Suggested citation Copyright information National Center for Health Statlstlcs

Schappert SM. Office visits to obstetricians This report may be reprinted without further Director

and gynecologists: United States, 1989-90. permission. Manning Feinleib, M. D., Dr. P.H.

Advance data from vital and health statistics;

no 223. Hyattsville, Maryland: National Center

Acting Deputy Director

for Health Statistics. 1992.

Jack R. Anderson
Number 224 ● February 1, 1993

Advance

Data

From Viii and Health Statistics of the CENTERS FOR DISEASE CONTROL AND PREVENTION/National Center for Health Statistics

Teenage Tobacco Use:

Data Estimates From the Teenage Attitudes and Practices Survey,

United States, 1989

by Karen F. Allen, M. B.A., and Abigail J. Moss, Division of Health Interview Statistics, National Center for Health

Statistics; Gary A. Giovino, Ph. D., Office on Smoking and Health, Centers for Disease Control and Prevention;

Donald R. Shopland, National Cancer Institute, National Institutes of Health; and John P. Pierce, Ph. D.,

Introduction

Cigarette smoking has been

identified as one of the leading

preventable causes of disability and

premature death in the United States

(l). The relationship between

smoking and disease has made the

reduction in smoking prevalence one

of the major public health goals of

the Nation. The United States Public

Health Service has set a goal that

smoking prevalence in the United

States be reduced to 15 percent by

the year 2000 (2). Achievement of

this goal will require a major

reduction in the uptake of smoking by

young Americans. Rates for

adolescent smoking prevalence differ

among various surveys (l); however,

prevalence as high as 36 percent has

been reported (3). Uptake of smoking

by adolescents is one of the primary

barriers to reducing smoking

prevalence. Teenage smoking

behavior has remained relatively

steady throughout the 1980’s,

although smoking among the adult

population has decreased (l).

University of California at San Diego

In addition, use of smokeless

tobacco products, particularly chewing

tobacco and snuff, increased

substantially during the 1970’s and

1980’s (4). National estimates indicate

that at least 10 million Americans

used some form of smokeless tobacco

during 1991 (5), with use increasing

especially amc ng male adolescents

and young male adults (1). The

increased use and appeal of these

products assume major public health

importance because the evidence

reveals that smokeless tobacco can

cause oral cancer and other oral

conditions and can lead to nicotine

addiction and dependence. In 1986,

two-thirds of men who had ever used

smokeless tobacco reported having

started before age 21 (l).

Chronic use of tobacco is not an

all-or-none behavior. The level of use

changes over time. The different

levels of use can be described as an

uptake continuum. Determining

where adolescents are on this

continuum is important in planning

preventive interventions. The 1989

Teenage Attitudes and Practices

Survey (TAPS), a targeted-population

study from the National Health

Interview Survey, was undertaken by

the National Center for Health

Statistics, the Office on Smoking and

Health, the National Cancer Institute,

and the knerican Cancer Society to

provide data for in-depth analysis of

teenage smoking behavior and to

describe the uptake continuum for

sub-populations of adolescents.

Methods

The 1989 TAPS was designed

with the intention of providing

regular surveillance of teenage

smoking behavior and attitudes

beginning with the collection of

baseline data in 1989 and conducting

periodic cross-sectional and/or

longitudinal surveys every 3-4 years.

The TAPS sample included all 12-18-

year-olds living in households

contacted and interviewed in the last

two quarters of the 1988 and the first

tsvo quarters of the 1989 National

Health Interview Survey. The TAPS

obtained information on prevalence

and for classification by smoking

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers

National

for Disease

Center for

Control

Health

and

Statistics

Prevention CK CENTERS FoR DISEASE CONTROL

MD PREVENTION
2 Advance Data No. 224 ● February 1, 1993

status, knowledge of smoking risks,

attitudes about smoking, and

correlates of smoking uptake – such

as attitudes about school, risk-taking

behavior, and peer smoking practices.

The primary method of data

collection for the TAPS was

computer assisted-telephone

interviewing (CATI), whereby

interviewers conducted a telephone

interview by reading questions from a

computer screen and recording

responses electronically. Teenagers in

the TAPS who were not available by

telephone were sent a mail

questionnaire. Overall, 9,965

interviews were completed either by

telephone or mail with a resulting

survey response rate of 82 percent.

For a description of the survey

design, see Allen, Moss, Botman,

et al. (6).

This report presents frequencies

and/or percent distributions for

virtually all the data items from the

TAPS questionnaire. It is intended to

provide a convenient source of

comprehensive data related to the use

of tobacco products by adolescents

and to encuurage interested readers

to undertake further analysis of the

TAPS data. For other reports on the

TAPS survey, see references 7-10.

Estimated percentages for the

United States population of

noninstitutionalized youths 12–18

years old are presented in this report

by age, sex, race, ethnicity, and

adolescent smoking status. Generally,

except for knowledge questions that

accept “don’t know” as an

appropriate response, “don’t know”

and other unacceptable responses

have been excluded from the

denominator in the calculation of the

percent estimates. When possible, the

actual question wording is shown

along with response categories in

tables. However, many of the

questions have been paraphrased

combined,

Selected findings

the

or

Table 1 shows respondents’ selfperception of peer attitudes regarding

various health-risk behaviors. For

most behaviors, current teenage

smokers reported that their peers

cared less about behaviors that

affected their heahh than did

teenagers who had never smoked.

Half of the teenagers who had never

smoked cared “a lot” about staying

away from drugs, compared with one

in five teenagers that currently

smoked. Of those who never smoked

tobacco, 57 percent cared a lot about

not using marijuana, compared with

23 percent of current tobacco

smokers. Current smokers cared more

about keeping their weight down than

did those who had never smoked:

79 percent cared a lot or cared

somewhat, compared with 73 percent

of teenagers who had never smoked.

This perception was consistent with

current smokers’ response to the

question “Do you believe smoking

helps peop[e keep their weight

down?” (table 7); 30 percent of

current smokers believed this to be

true, and only 13 percent of those

who had never smoked reported

believing this. The functional utility

smoking was perceived to be much

greater by current smokers than by

those who had never

smoked —current smokers also

of

perceived their peers as caring more

about controlling their weight than

teenagers who had never smoked

(table 1).

Among all current teenage

smokers in 1989, brand preference

was overwhelmingly Marlboro:

68 percent of those who usually

bought their own cigarettes bought

that brand. The most striking

difference in brand preference among

sociodemographic subgroups is shown

in table 2 for race. White teenagers

clearly preferred Marlboros

(70 percent, versus 9 percent of black

teenagers). However, black teenagers

bought Newports most often

(61 percent, compared with 6 percent

of white teenagers). Data pertaining

to the brand of choice by most

adolescent current smokers also

indicated a definite increase in the

number of adolescents smoking

Camels (11).

Regardless of age, sex, race, or

ethnicity, adolescent smokers

purchased cigarettes more often from

small stores, such as convenience

stores, than from vending machines

or large stores: 69 percent often

bought cigarettes from small stores,

6 percent often bought cigarettes

from vending machines, and

26 percent often bought cigarettes

from large stores,

Of currently smoking teenagers

who had ever seriously thought about

quitting smoking, 86 percent reported

having tried to quit at least once, and

76 percent of those who had ever

tried to quit reported having tried to

quit in the past 6 months, When

asked the question “Do you think you

will be smoking 1 year from now?”,

more than half of all teenage smokers

said they would definitely or probably

not be smoking in a year. Considering

the percentage of teenagers who had

tried to quit and failed, especially in

the past 6 months, it is somewhat

surprising to note that so many

current teenage smokers (54 percent)

still believed that they would not be

smoking in 1 year. These statistics

clearly illustrate the naivete of

adolescents with regard to the

addictiveness of cigarette smoking.

Adolescents who had never

smoked a cigarette or never tried or

experimented with cigarette smoking

reported on all measures of

“intention to smoke” that they had

no intention to smoke in the future,

with very little variation by

sociodemographic subgroups. When

asked “Do you think you will txy a

cigarette soon?”, adolescents,

regardless of age, were consistent in

their resolve not to smoke even

though their exposure to and the

availability of cigarettes is shown by

this data to increase with age. More

than 97 percent of 16-18-year-olds,

96 percent of 14-15-year-olds, and

94 percent of 12-13-year-olds

reported that they would not txy a

cigarette soon (table 3). At ages

12–13, only 24 percent of teenagers

reported having been offered a

cigarette, but more than half

(54 percent) of the teenagers who had

never smoked had been offered a

cigarette by the time they were

between 16 and 18 years of age,

Older teenagers also believed it

would be easy for them to get
Advance Data No. 224 ● February 1, 1993 3

cigarettes if they wanted some:

89 percent of 16-18-year-olds said it

would be easy to get cigarettes if they

wanted some, compared with

67 percent of 14-15-year-olds and

only 39 percent of 12-13 -year-olds.

A strong correlate of smoking

uptake among adolescents is the

smoking practices of family and peers

(l). Of all current teenage smokers,

17 percent reported living with an

older sibling who smoked, but only

5 percent of teenagers who had never

smoked lived with siblings who

smoked (table 4). Teenagers who

smoked also reported more frequently

having a parent who smoked:

46 percent of current teenage

smokers reported that their parents

smoked, and 36 percent of teenagers

who had never smoked lived with at

least one parent who smoked.

Current teenage smokers associated

more with other smokers than did

teenagers who had never smoked.

When asked the question “Of your

four best maIe/female friends, how

many smoke?”, 82 percent of current

smokers reported having at least one

best male friend, and 78 percent cited

at least one best female friend who

smoked. In response to this same

question, of adolescents who had

never smoked, only 20 percent

reported having at least one best

male friend, and 18 percent reported

having at least one best female friend

who smoked.

Teenagers who smoked tobacco

also reported knowing more people

who used chewing tobacco, snuff,

marijuana, crack, or cocaine; drank

alcohol; and had had sex than did

teenagers who had never smoked. In

addition, at least half of all current

smokers said that most or all of the

people they knew who were their age

smoked cigarettes, drank alcohol, got

drunk at least once a month, or had

had sex.

School performance and attitudes

about school were also strong

correlates of smoking uptake among

adolescents, Again, more current

smokers than teenagers who had

never smoked reported liking school

Iess, doing poorly in school, and

perceiving what they learned in

school as less useful to them later in

life. Current smokers also missed

more time from school in the 2 weeks

prior to the interview and reported

cutting school more often.

In table 4, a scale to measure

depression was adapted for telephone

interviewing from a scale originally

designed for self-enumeration

application (12). Teenagers who

currently smoked were tired; had

trouble sleeping were sad or

depressed; felt hopeless, tense, or

nervous; and worried more often than

teenagers who had never smoked.

Adolescents who smoked were

more likely to be involved in risky

behaviors, another correlate of

smoking uptake, than teenagers who

have never smoked. Teenage smokers

were twice as likely to have been

involved in one or more physical

fights in the past year and ridden a

motorcycle or minibike often or

sometimes in the past year. Smokers

were almost three times more likely

to rarely or never wear seat belts and

six times more likely to have ridden

in a car driven by someone who had

been using drugs or drinking tharl

those teenagers who had never

smoked.

Estimates from the TAPS ako

showed an important difference

between teenagers who smoked and

those who had never smoked, in

terms of social and family

functioning. For example:

Seventy-eight percent of

teenagers who had never smoked

reported that they strongly

disliked being around people who

were smoking, and 94 percent

preferred to date nonsmokers,

but only 19 percent of current

smokers strongly disliked being

around others who were smoking,

and 51 percent preferred to date

nonsmokers.

More than 90 percent of

teenagers who smoked, compared

with 57 percent who have never

smoked, had had a steady

boyfriend or girlfriend. AImost

half of those teenage smokers

reported that their boyfriend or

girlfriend also smoked, but only

●

●

●

●

8 percent of teenagers who had

never smoked reported having a

boyfriend or girlfriend who

smoked (table 4).

Teenage smokers had more

spendable income than teenagers

who had never smoked. More

than 45 percent of current

smokers had more than $20.00 a

week to spend any way they

wanted to, compared with half as

many teenagers who had never

smoked. Teenage smokers

consequently had more money to

spend for cigarettes (table 4).

Teenagers who smoked were

likely to go to a friend if they

needed help with a serious

problem, but teenagers who had

never smoked were more likely to

confide in a parent (table 4).

Almost twice as many teenagers

who smoked were left alone at

home without parental or adult

supervision for 10 or more hours

a week as were teenagers who

had never smoked (table 4).

More than half the teenagers who

smoked attended religious

services rarely or never,

compared with fewer than a third

of teenagers who have never

smoked (table 4).

As shown in table 5, prevalence

for males who “ever used” and “ever

regularly used” smokeless tobacco

products, such as chewing tobacco or

snuff, increased with age and was

more common among white

respondents than among black

respondents, and more common

among non-Hkpanics than among

Hispanics. When asked the question

“How many of the peopIe you know,

who are about your age, use chewing

tobacco or snuff?”, 14 percent of

teenagers who had ever used

smokeIess tobacco reported that most

or aIl of the people they knew used

some form of smokeless tobacco,

compared with only 3 percent of

teenagers who had never used

smokeIess tobacco (table 6).

Twenty-two percent of male teenagers

had ever used chewing tobacco or

snuff regularly (table 5). More than

29 percent of these teenagers

reported that all or most of the
4 Advance Data No. 224 ● February 1, 1993

people they knew used smokeless

tobacco. hfore than 95 percent knew

that using smokeless tobacco can

cause cancer (table 6).

A significant number of teenagers

reported having been exposed to

information related to the health risks

of smoking regardless of adolescent

smoking status. More than 80 percent

of both current smokers and

teenagers who had never smoked said

they had heard or seen something in

the media recently about the risks of

smoking, and more than 70 percent

had taken a class or course at school

about the health risks of smoking

(table 7). More than 80 percent of

current smokers and teenagers who

had never smoked also believed that

almost all doctors are strongly against

ci~lrette smoking. Despite similar

knowledge levels about smoking

health risks, current smokers were

more likely than teenagers who had

never smoked to believe that it was

safe to smoke for a year or 2, that

there was no harm in having an

occasional cigarette, and that they

could stop smoking anytime they

wanted to (table 7).

What teenagers believed to be

true about smoking was clearly

influenced by the benefits they

perceived from smoking. Current

adolescent smokers were significantly

more likely to believe that cigarette

smoking helps people when they are

bored, helps people relax, helps

reduce stress, helps people feel more

comfortable in social situations, and

helps keep their weight down. For

current teenage smokers, the

perceived functional utility of

smoking clearly outweighed the risks

of smoking.

Discussion

These data highlight several areas

of concern. For many adolescents, the

perceived benefits of smoking

outweighed the risks involved.

Adolescent smokers appeared to

overestimate their ability to quit

smoking. As reported, quit attempts

are often met with failure, a symptom

of nicotine addiction (13). In

addition, the ease of adolescent

access to cigarettes, shown in the

TAPS and elsewhere (14,15),

highlights the need for better control

of tobacco sales to minors.

The United States Public Health

Service is committed to reducing the

initiation of tobacco use among our

Nation’s youth (2). One national

health objective (Objective 3.10) calls

for the establishment of tobacco-free

environments and the inclusion of

tobacco-use prevention in the

curricula of all elementary, middle,

and secondaxy schools, preferably as

part of quality school health

education (2). Another goal

(Objective 3.13) is to enact and

enforce laws that prohibit the sale

of tobacco products to minors in all

50 States and the District of

Columbia (2). As of September

1992, 49 States and the District of

Columbia had laws in place

restricting the sale of tobacco products

to minors (CDC, unpublished data).

Although there appears to be

widespread support for effective minors’

access laws (16), such laws are only

rarely enforced (17).

Many perceptions of adolescents

about cigarette smoking may result

from image-based advertisements

(1,2,11). The national health

objectives also call for the elimination

or severe restriction of tobaccoproduct advertising and promotion to

which youths are likely to be exposed

(Objective 3.15) (2). Other effective

strategies may include the

development of statewide tobaccocontrol plans to reduce tobacco use,

especially among youth (Objective

3.14) (2) and raising state excise taxes

on tobacco products (1,18). Progress

in the reduction of tobacco-use

initiation among adolescents will be

enhanced by cooperative efforts

among local and state health and

education officials, parents, physicians

and other health care providers,

media, legislators, regulatory

agencies, and community youth

organizations (3\.

References

1.

2,

3,

4.

5.

6.

7.

8.

9.

10.

Centers for Disease Control.

Reducing the health consequences of

smoking 25 years of progress – a

report of the Surgeon General.

Rockville, Ma@and: Public Health

Service, 1989.

Public Health Semite. Healthy people

2000 national health promoticm and

disease prevention objectives --full

report, with commentary. Washington:

U.S. Department of Health and

Human Services, 1991.

Centers for Disease Control. Tobacco

use among high school

students – United States, 1990.

MMWR vol 40 no 41:712-5.1990.

U.S. Department of Agriculture.

Tobacco outlook and situation

report: 1-24. Washington: Government

Printing Office. 1985.

Alcohol, Drug Abuse and Mental

Health Administration. National

household survey on drug

abuse - population estimates 1991.

Rockville, Maryland: Public Health

Service. 1991.

Allen KF, Moss AJ, Botman S, et al.

Teenage attitudes and practices

survey “TAPS”: methodology and

response rates [Abstract]. In: Program

and abstracts of the 119th Annual

Meeting of the American Public

Health Association. Washington:

American Public Health Association.

1991.

Centers for Disease Control.

Cigarette smoking among youth[,

United States, 1989. MMWR: VOI

no 41:712-5.1991.

Centers for Disease Control.

Comparison of cigarette brand

preferences of adult and teenage

40

smokers, United States, 1989, ~nd 10

U.S. communities, 1988 and 1990.

MMWFC vol 41 no 10169-3, 180-1.

1992.

Centers for Disease Control.

Accessibility of cigarettes to youths

aged 12-17 years, United States, 1989.

MMWFC vol 41 no 27:485-8.1992.

Moss AT, Atlen KF, Giovino GA,

Mills SL. Recent trends in adolescent

smoking,smoking uptake correlates

and expectations about future

smoking:Advance data from vital and

health statistics; no.221. Hyattsville,

Maryland: National Center for Health

Statistics. 1992.

–Q .,
Advance Data No. 224 QFebruary 1, 1993 5

11.

12.

13.

14.

15.

DiFranza JR, Richards JW, Paulman

PM, et al. RJR Nabisco’s cartoon

camel promotes Camel cigarettes to

children. JAMA 266:3149-53.1991.

Kandel DB, Davies M. Adult

sequelae of adolescent depressive

symptoms. Arch Gen Psychiatry

43:255-62.1986.

Centers for Disease Control. The

health consequences of smoking

nicotine addiction – a report of the

Surgeon General. Rocldle,

Maryland: Public Health Service.

1988.

Altman DG, Rasenick-Douss L,

Foster V, Tye J. Sustained effects of

an education program to reduce sales

of cigarettes to minors. Am J Public

Health 81:891-3.1991.

Feighery E, Altman DG, Shaffer G.

The effects of combining education

16.

17.

18.

19.

and enforcement to reduce tobacco 20. Moss AJ. Parsons VL. Current

sales to minors. JAMA 266:3168-71.

1991.

Centers for Disease Control. Public

attitudes regarding limits on public

smoking and regulation of tobacco 21.

sales and advertising- 10 U.S.

communities, 1989. MMWR 40344-5,

351-3.1991.

Office of Evaluation and Inspections.

Youth access to cigarettes. New York: 22.

U.S. Department of Health and

Human Services, Office of Inspector

General. 1990.

Cummings KM, Sciandra R. The

public health benefits of increasing 23.

tobacco taxes in New York State. NY

State J Med 90174-5.1990.

Shah BV. Software for Survey Data

Analysis (SUDAA.N) version 5.30

[software documentation]. Research

Triangle Park, North Carolinx

Research Triangle Institute. 1989.

estimates from the National Health

Interview Survey United States, 1985.

National Center for Health Statistics.

Vital Health Stat 10(160). 1986.

Adams PF, Benson V. Current

estimates fkom the National Health

Interview Survey: United States, 1989.

National Center for Health Statistics.

Vital Health Stat 10(176). 1990.

Kovar MG, Poe GS. The National

Health Interview Survey Design,

1973-84, and procedures, 197S83.

National Center for Health Statistics.

Vhal Health Stat 1(18). 1985.

Massey JT, Moore TF, Parsons VL,

Tadros W. Design and estimation for

the National Health Interview Survey,

1985-94. National Center for Health

Statistics. Vital Health Stat 2(110).

1989.

Symbols

--- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less

than 0.05

z Quantity more than zero but less

than 500 where numbers are

rounded to thousands

* Figure does not meet standard of

reliability or precision
6 Advance Data No. 224 ● February 1, 1993

Table ‘1. Number and percent dlatributlon of teenagers by perceived peer risk behaviors, according to adolescent smoking status:

United States, 1989

Never smoked Current smoker

All

All never

All

No May Former

Perceived peer risk behaviors statuses smoked

current

retention smoke Experimenter smoker smokersl Heaty Light occasional

Allteenagers2, . . . . . . . . . . . . . . . .

Care about wearing seat belts

Don’t care . . . . . . . . . . . . . . . . . . . .

Care a lot . . . . . . . . . . . . . . . . . . .

Care somewhat . . . . . . . . . . . . . . . . .

Care a little . . . . . . . . . . . . . . . . . . .

Care about keeping weight down

Don’t care . . . . . . . . . . . . . . . . . . . .

Care a lot . . . . . . . . . . . . . . . . . . . .

Care somewhat . . . . . . . . . . . . . . . . .

Care alttle. . . . . . . . . . . . . . . . . . .

Care about staying away from druga

Don’tcare, . . . . . . . . . . . . . . . . . . .

Care alot . . . . . . . . . . . . . . . . . . . .

Caresomewhat. . . . . . . . . . . . . . . . .

Carea little . . . . . . . . . . . . . . . . . . .

Care about not getting

high on alcohol

Don’tcare . . . . . . . . . . . . . . . . . . . .

Carealot . . . . . . . . . . . . . . . . . . . .

Care somewhat . . . . . . . . . . . . . . . . .

Carealittle . . . . . . . . . . . . . . . . . . .

Care about not getting

drunk on alcohol

Don’tcare . . . . . . . . . . . . . . . . . . . .

Carea lot . . . . . . . . . . . . . . . . . . . .

Caresomewhat . . . . . . . . . . . . . . . . .

Care a little . . . . . . . . . . . . . . . . . . .

Care aoout staying off cigarettes

Don’tcare . . . . . . . . . . . . . . . . . . . .

Care a lot . . . . . . . . . . . . . . . . . . . .

Caresomewhat . . . . . . . . . . . . . . . . .

Carealittle . . . . . . . . . . . . . . . . . . .

Care about eating healthy foods

Don’tcare, . . . . . . . . . . . . . . . . . .

Care a lot . . . . . . . . . . . . . . . . . . . .

Care somewhat . . . . . . . . . . . . . . . . .

Care alittle . . . . . . . . . . . . . . . . . . .

Care about staying away from marijuana

Don’tcare . . . . . . . . . . . . . . . . . . . .

Carea lot . . . . . . . . . . . . . . . . . . . .

Caresomewhat. . . . . . . . . . . . . . . . .

Carealittle . . . . . . . . . . . . . . . . . . .

Care about not drinking and driving

Don’tcare . . . . . . . . . . . . . . . . . . . .

Carealot . . . . . . . . . . . . . . . . . . . .

Caresomewhat . . . . . . . . . . . . . . . . .

Carealittle . . . . . . . . . . . . . . . . . . .

Care about being fit and exercising

Don’tcare . . . . . . . . . . . . . . . . . . . .

Care a lot . . . . . . . . . . . . . . . . .

Care somewhat . . . . . . . . . . . . . . . . .

Carealittle . . . . . . . . . . . . . . . . . . .

23,528

13,445

2.236

4,919

2,495

2,984

12,272

5,455

2,447

4,821

9,306

6,842

1,835

11,070

5,013

4,364

1,869

12,253

4,899

3,648

1,764

10,138

5,831

5,057

1,942

15,015

1,952

4,073

2,206

4,883

10,882

5,572

1,617

4,589

12,244

4,765

1,437

6,320

6,664

7,703

2.455

12,561

6,762

1.263

2,741

1,537

1,709

6,297

2,882

1,441

1,842

6,184

3,258

955

4,7s3

3,654

2,445

1,022

5,446

3,521

2,041

990

4,321

4,072

2,845

1,060

7,703

1,229

2,261

1,232

1,878

7,213

2,482

744

2,200

6,863

2,455

754

3!303

3,676

4,033

1,376

10,098

5,390

1,035

2,340

1,241

1,292

5,265

2,276

1,166

1,459

5,120

2,673

727

3,915

3,015

2,026

808

4,472

2,918

1,615

830

3,479

3,410

2,306

829

6,306

907

1,861

1,003

1,494

5,938

1,992

588

1,723

5,661

2,013

596

2,660

2,948

3,341

1,104

1,615

956

119

269

247

271

685

404

228

236

723

426

197

590

416

319

195

676

413

333

133

598

427

359

205

945

186

293

165

221

856

:;;

308

806

331

143

449

460

474

224

Number in thousands

6,826

4,045

642

1,400

625

822

3,613

1,677

625

1,552

2,302

2,243

505

3,640

932

1,285

608

3,964

966

1,090

524

3,179

1,380

1,532

567

4,561

424

1,090

650

1,550

2,693

1,861

542

1,446

3,403

1,407

450

1,850

1,937

2,194

714

342

226

::

“15

*33

197

90

“16

122

12

●21

213

●32

63

●19

231

*34

51

*12

200

46

64

●24

230

*13

63

27

119

1z;

“27

1%

65

*15

82

1;;

*32

3,688

2,332

274

717

304

377

2,114

793

354

1,277

721

1,195

352

2,402

370

552

218

2,549

354

452

234

2,391

295

608

266

2,445

271

648

287

,312

857

,102

298

817

,794

808

213

1,048

934

1,327

324

1,619

1,131

2::

126

153

915

394

130

661

260

510

112

1,129

144

196

75

1,145

163

174

96

1,174

86

223

83

1,130

117

259

95

710

288

439

125

398

743

380

86

524

393

558

125

632

358

*19

161

53

57

434

85

46

218

1::

75

377

1U

44

415

49

91

’40

413

*37

105

42

400

*36

128

54

206

119

220

42

129

:;:

44

173

160

233

49

1,206

709

133

252

101

134

R

152

328

301

413

128

753

136

202

77

847

122

152

70

669

153

218

126

766

*95

224

114

337

380

355

114

245

599

278

61

298

317

447

126

See footnoteat end oftable.
Advance Data No. 224 ● February 1, 1993 7

Table 1. Number and percent distribution of teenagers by perceived peer risk behaviors, according to adolescent smoking statu=

United States, 1989-Con.

Adolescent smoking status

Never smoked Current smoker

All All

All never No May Former

Perceived peer risk behaviors smoked

current

statuses intention smoke Experimenter smoker smokerd Heavy L/ght Occasional

Allteenagera2 . . . . . . . . . . . . . . . . . .

Care about wearing seat belts

Don’tcsre . . . . . . . . . . . . . . . . . . . .

Care a lot . . . . . . . . . . . . . . . . . . . .

Care somewhat . . . . . . . . . . . . . . . . .

Care alitfle . . . . . . . . . . . . . . . . . . .

Care about keeping weight down

Don’tcare . . . . . . . . . . . . . . . . . . . .

Carealot . . . . . . . . . . . . . . . . . . . .

Caresomewhat . . . . . . . . . . . . . . . . .

Carealittle . . . . . . . . . . . . . . . . . . .

Oare about staying away from drugs

Don’toare . . . . . . . . . . . . . . . . . . . .

Carealot . . . . . . . . . . . . . . . . . . . .

Caresomewhat . . . . . . . . . . . . . . . . .

Carealiie . . . . . . . . . . . . . . . . . . .

Care about not getting

highonaloohol

Don’tcare . . . . . . . . . . . . . . . . . . . .

Carealot . . . . . . . . . . . . . . . . . . . .

Caresomewhat . . . . . . . . . . . . . . . . .

Carealittle . . . . . . . . . . . . . . . . . . .

Care about not getting

drunkonalcohol

Don’tcare . . . . . . . . . . . . . . . . . . . .

Carealot . . . . . . . . . . . . . . . . . . . .

Caresornewhat . . . . . . . . . . . . . . . . .

Carealittle . . . . . . . . . . . . . . . . . . .

Care about staying off cigarettes

Don’tcare . . . . . . . . . . . . . . . . . . . .

Carealot . . . . . . . . . . . . . . . . . . . .

Caresomewhat . . . . . . . . . . . . . . . . .

Carealtftle . . . . . . . . . . . . . . . . . . .

Care about eating healthy foods

Don’tcare . . . . . . . . . . . . . . . . . . . .

Carealot . . . . . . . . . . . . . . . . . . . .

Caresomewhat . . . . . . . . . . . . . . . . .

Cerealiie . . . . . . . . . . . . . . . . . . .

Care about staying away

from marijuana

Don’tcare . . . . . . . . . . . . . . . . . . . .

Carealot . . . . . . . . . . . . . . . . . . . .

Carescmewhat . . . . . . . . . . . . . . . . .

Carealiie . . . . . . . . . . . . . . . . . . .

Care about not drinking and driing

Don’tcare. . . . . . . . . . . . . . . . . . . .

Carealot . . . . . . . . . . . . . . . . . . . .

Carexwrewhat . . . . . . . . . . . . . . . . .

Carealiie . . . . . . . . . . . . . . . . . . .

Care about being fk and exercising

Don’toare . . . . . . . . . . . . . . . . . . . .

Carealot . . . . . . . . . . . . . . . . . . . .

Caresomewhat . . . . . . . . . . . . . . . . .

Carealiile . . . . . . . . . . . . . . . . . . .

100.0

57.1

2::

10.6

12.6

52.2

23.2

10.4

20.5

39.6

29.1

7.6

47.1

21.3

16.5

7.9

52.1

20.8

15.5

7.5

43.1

24.8

21.5

8.3

63.8

8.3

17.3

9.4

20.6

48.3

23.7

6.9

19.5

52.0

20.3

6.1

26.9

2e.3

32.7

10.4

100.0

%J.;

21:8

12.2

13.6

50.1

22.9

11.5

14.7

49.2

25.9

7.6

38.1

29.1

19.5

6.1

43.4

:::3

7:9

34.4

32.4

22.6

6.4

81.3

9.8

1s.0

9.8

15.0

::;

5:9

17.5

54.6

19.5

6.0

26.3

29.3

32.1

11.0

100.0

53.4

10.2

;;:

12.6

52.1

22.5

11.5

14.4

50.7

26.5

7.2

38.8

29.9

20.1

e.o

44.3

28.9

16.0

8.2

34.5

33.6

22.6

8.2

62.4

9.0

16.4

9.9

14.8

56.6

19.7

5.8

17.1

56.1

19.9

5.9

26.3

29.2

33.1

10.9

100.0

59.2

1;;

15.3

16.8

42.4

25.0

14.1

14.6

44.6

26.5

12.2

36.5

25.9

19.6

12.1

41.9

25.6

20.6

8.2

37.0

26.4

22.2

12.7

58.5

11.5

18.1

11.5

13.7

53.0

23.3

8.7

19.1

49.9

20.5

8.9

27.6

26..S

29.3

13.9

Percent distribution

100.0

59.3

2;;

12.0

52.9

24.6

9.2

H

32.9

7.4

53.3

13.7

18.6

6.9

46.6

20.2

22.4

8.6

67.1

6.2

16.0

9.5

22.7

39.5

27.3

7.9

21.2

49.9

20.6

6.6

27.1

26.4

32.1

10.5

100.0

86.1

13.2

15.5

“4.4

*9.6

57.6

26.3

●4.7

35.7

15.6

36.6

●6.1

62.3

“9.4

:S/J

67.5

*9.9

14.9

●3.5

58.8

13.5

18.7

●7.O

67.3

●3.8

18.4

●7.9

34.8

21.9

31.9

●7.9

27.2

40.9

24.9

●4.4

24.0

26.9

35.7

●9.4

100.0

63.2

1::

6.2

10.2

57.3

21.5

9.6

34.6

19.5

32.4

9.5

65.1

10.0

15,0

5.9

69.1

1x

6.3

64.8

1H

7.2

66.3

7.3

17.6

7.6

35.6

23.2

29.9

8.1

22.2

48.6

21.9

5.0

28.4

25.3

36.0

8.8

100.0

69.9

1:::

7.6

5:::

24.3

e.o

42.1

16.1

31.5

6.9

69.7

6.9

12.1

4.6

70.7

10.1

10.7

5.9

72.5

5.3

13.8

5.1

69.8

7.2

16.0

5.9

43.9

17.8

27.1

7.7

24.6

45.9

23.5

5.3

32.4

24.3

34.5

7.7

100.0

56.6

‘3.0

28.6

8.4

6;:;

13.4

7.3

34.5

15.2

30.5

11.9

59.7

11.2

17.7

7.0

65.7

12:

*6.3

65.3

●5.9

16.6

6.6

63.3

*5.7

20.3

8.5

32.9

18.8

34.8

6.6

20.4

51.1

17.9

7.0

27.4

25.3

36.9

7.8

100.0

56.8

11.0

20.9

6.4

11.1

53.4

22.0

12.6

27.2

25.0

34.2

10.6

62.4

11.3

16.7

6.4

70.2

10.1

12.6

5.6

55.5

12.7

16.1

10.4

63.5

7.9

16.6

9.5

27.9

31.5

2;.:

20.3

49.7

23.1

5.1

24.7

26.3

37.1

10.4

IIIICMOS unknown type of current StIt&Or.

zf~ud~s unk-~.
8 Advance Data No. 224 ● February 1, 1993

Table 2. Number and percent distribution of current teenage smokers by accessibility of C19aretteS, quit atternptS, and future uSe,

according to age, sex, race, and Hispanic origin: United States, 1989

Age Sex Race Hispanic origin

Accessibi/ty, quit attempts, Current

and future use smokersl 12–13 14-15 18-18 Male Female White Black Hispanic /Vor+/ispanic

Number in thousands

Tofs12 . . . . . . . . . . . . . . . . . . . . . . .

“Usually buy your own clgarettea?”

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . .

“What brand usually buy?”

Marlboro . . . . . . . . . . . . . . . . . . . . .

Winsto n . . . . . . . . . . . . . . . . . . . .

Camel . . . . . . . . . . . . . . . . . . . . . .

Newpofi . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . .

“How often buy from

a vending machine?”

Often . . . . . . . . . . . . . . . . . . . . . . .

Sometimes . . . . . . . . . . . . . . . . . . .

Rarely . . . . . . . . . . . . . . . . . . . . . . .

Never . . . . . . . . . . . . . . . . . . . . . . .

“How often buy from a large store?”

Often . . . . . . . . . . . . . . . . . . . . . . .

Sometimes . . . . . . . . . . . . . . . . . . .

Rarely . . . . . . . . . . . . . . . . . . . . . . .

Never . . . . . . . . . . . . . . . . . . . . . .

“’How often buy from a small store?”

Often . . . . . . . . . . . . . . . . . . . . . . .

Sometimes . . . . . . . . . . . . . . . . . . .

Rarely . . . . . . . . . . . . . . . . . . . . . .

Never . . . . . . . . . . . . . . . . . . . . . . .

“Ever aerlously thought about qu!tting?”

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . .

Never smoked regularly . . . . . . . . . . .

“How many times have

you tried to quit?”a

Never. . . . . . . . . . . . . . . . . . . . . . .

One ormore times . . . . . . . . . . . . . .

Once. . . . . . . . . . . . . . . . . . . . .

Twoorthreetimes . . . . . . . . . . . . .

Fourormoretimes . . . . . . . . . . . . .

“Have you tried to quit in

the past 6 months?”4

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . .

“Longest time you

stayed oft cigarettes?”

l-6 days5 . . . . . . . . . . . . . . . . . . . .

7–29 days . . . . . . . . . . . . . . . . . . . .

l-3 months . . . . . . . . . . . . . . . . . . .

4-6months . . . . . . . . . . . . . . . . . . .

7–ll months . . . . . . . . . . . . . . . . . .

12 months ormore . . . . . . . . . . . . . .

“Thlrrk you will be smokmg

one year from now?”

Definite~yes . . . . . . . . . . . . . . . . . .

Probablyyes ..,,,......,.. . . . .

Probablynot .,,, . . . . . . . . . . . . .

Definitelynot, ,,, . . . . . . . . . . . . . .

Don’tknow, . . . . . . . . . . . . . . . . . .

See footnoteal end of table,

3,620

2,291

1,329

1,558

72

164

167

269

141

157

876

,116

605

564

673

450

.

1,588

396

220

86

2,717

471

4%

341

2,339

748

996

595

1,799

571

369

664

549

400

49

176

203

1,373

1,223

741

81

234

54

180

*36

“5

“5

“4

●5

*5

“6

*I7

●26

“5

*2

“21

●26

●29

●

. . .

●2O

●6

166

*23

50

●12

154

50

62

42

137

*2O

“22

46

●38

*19

●

. .

“17

‘:

90

95

*2

634

413

421

321

●5

●36

●2O

●27

47

“34

166

166

103

62

119

109

272

66

44

*30

657

91

93

75

571

223

216

132

505

76

7s

161

139

101

●11

41

41

332

270

174

“17

2,552

1,824

728

1,202

62

741

163

237

69

117

693

924

497

460

533

314

1,287

330

156

51

1,691

357

351

254

1,615

474

719

422

1,158

473

269

477

3?2

260

’37

116

153

1,003

863

472

61

1,948

1,272

677

665

45

137

91

117

103

89

464

615

349

296

345

zao

672

209

125

67

1,424

267

260

203

1,206

401

522

263

935

264

182

382

293

214

●1O

94

117

706

690

392

43

1,672

1.020

“652

694

*27 72

47 178

96 120

152 239

3,332

2,149

1,183

1.519

●38 125

68 143

412 836

502 1,045

256 569

266 535

326 623

170 422

716 1,493

189 373

95 203

*19 81

1,294 2,496

204 427

234 431

138 310

1,133 2,151

347 694

474 897

312 560

865 1,659

287 523

1a6 347

301 639

257 502

186 371

●38 41

82 163

187

6% 1,305

532 1,116

349 652

“38 72

212

103

110

“9

●

. . .

;:

’28

●9

‘12

*26

55

*23

*18

44

*J6

70

●13

‘15

*5

157

“27

●33

●26

128

’38

63

●27

94

●37

“12

●31

●34

●2O

●5

●13

●12

●4O

81

75

●A

241

120

121

73

*

. . .

*9

●15

*22

●

. . .

*17

50

52

●4O

*28

*32

*2O

79

●29

*7

●5

187

●39

42

*26

154

59

48

47

118

41

:

● 29

*20

●3

●23

●19

94

65

*36

●7

3,387

2,172

1,206

1,486

72

175

172

247

141

140

826

1,064

565

536

641

430

1,508

370

213

61

2,530

431

452

315

2,185

689

949

546

1,682

529

361

629

525

380

48

153

184

‘1,279

“1,136

705

73
Advance Data No. 224 ● February 1, 1993 9

Table 2. Number and percent distribution of current teenage smokers by accessibility of cigarettes, quit attempts, and future use,

according to age, sex, race, and Hispanic origin: United States, 1989-Con.

Age Sex Race Hispanic origin .

Accessibility, quit atfempts, Current

and future use smokersl 12-13 1415 16-18 Male Female White Black Hispanic Non-Hispanic

TotalZ . . . . . . . . . . . . . . . . . . . . . . .

“Usuaily buy your own cigarettes?”’

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . .

“What brand usua[iy buy?”

Marlboro . . . . . . . . . . . . . . . . . . . . .

Winston

Camel.:::::::::::::::: :::::

Newport . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . .

“How often buy from

a vending machine?”

Often . . . . . . . . . . . . . . . . . . . . . . .

Sometimes . . . . . . . . . . . . . . . . . . .

Rarely . . . . . . . . . . . . . . . . . . . . . . .

Never . . . . . . . . . . . . . . . . . . . . . . .

‘“How often buy from a large store?”

Often . . . . . . . . . . . . . . . . . . . . . . .

Sometimes . . . . . . . . . . . . . . . . . . .

Rarely. . . . . . . . . . . . . . . . . . . . . . .

Never . . . . . . . . . . . . . . . . . . . . . . .

“Howoftenbuyfrom asmallstore?”

Often . . . . . . . . . . . . . . . . . . . . . . .

Sometimes . . . . . . . . . . . . . . . . . . .

Rarely . . . . . . . . . . . . . . . . . . . . . . .

Never . . . . . . . . . . . . . . . . . . . . . . .

“Ever seriously thought about quitting?”

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . .

Neversmoked regularly . . . . . . . . . . .

“HOW many times have you

tried to quit?”s

Never . . . . . . . . . . . . . . . . . . . . . . .

Oneormoretimes . . . . . . . . . . . . . .

Once . . . . . . . . . . . . . . . . . . . . . .

Two orthreetimes . . . . . . . . . . . . .

Fourormoretimes . . . . . . . . . . . . .

“Have you tried to quit in

the past 6 months?”4

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . .

“Longest time you ateyed

off cigarettes?”

I-adayss . . . . . . . . . . . . . . . . . . . .

7-29days . . . . . . . . . . . . . . . . . . .

l-3 months . . . . . . . . . . . . . . . . . . .

4-6months . . . . . . . . . . . . . . . . . . .

7-n months . . . . . . . . . . . . . . . . . .

12 months ormore . . . . . . . . . . . . . .

“Think you will be smoking

one year from now?”

Definitelyyes . . . . . . . . . . . . . . . . . .

Probablyyes . . . . . . . . . . . . . . . . . .

Probablynot . . . . . . . . . . . . . . . . . .

Definitely not . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . .

100.0

63.3

36.7

6&O

3.1

6.0

8.2

11.7

x

38.2

46.7

26.4

24.6

29.4

19.6

69.3

17.4

9.6

3.6

73.7

12.8

13.4

12.6

66.1

27.5

36.7

21.9

75.7

24.0

16.4

30.4

24.4

17.8

2.2

7.6

5.6

37.9

33.6

20.5

2.2

100.0

23.1

76.9

●66.7

●9.3

*9.3

97.4

●9.3

●9.3

●11.1

●31 .5

●48. 1

●9.3

●3.7

●38.9

●48. 1

●53.7

●

. . .

*37. o

●11.1

69.7

●9.5

20.7

‘7.1

91.7

29.6

36.9

25.0

67.3

●12.7

●15.4

32.2

●26.6

●13.3

*

. . .

●11.9

*3.6

●16.2

36.5

40.6

+0.9

100.0

49.5

50.5

77.7

●1.2

*9.2

●4.6

●6.5

fl.4

●8.2

40.2

40.2

24.9

19.9

26.6

26.4

65.9

16.5

10.7

*7.3

77.8

●1O.8

11.0

11.4

86.9

33.9

32.9

20.1

86.6

13.4

14.5

29.9

25.8

18.7

*2.O

7.6

3::

32.4

20.9

●2.O

100.0

71.5

26.5

65.9

3.4

7.7

8.9

13.0

4.9

6.4

36.0

50.7

27.2

26.3

29.2

17.2

70.6

18.1

:;

72.7

13.7

13.5

13.4

65.4

25.1

36.0

22.3

70.7

26.9

17.2

30.4

23.7

17.9

●2.4

7.5

6.0

39.3

33.8

18.5

2.4

Percent distribution

100.0

65.3

34.6

68.0

1::

7.2

9.2

?:

36.5

48.3

27.4

23.4

27.1

22.0

68.6

16.4

9.8

5.3

72.6

13.6

13.3

14.3

64.6

26.2

36.7

19.9

76.6

23.3

15.3

32.2

24.7

18.0

●0.8

7.9

6.0

36.2

35.4

20.1

2.2

100.0

61.0

39.0

66.0

●2.6

4.6

1%

●3.7

6.7

40.4

49.2

25.1

26.1

32.2

16.7

70.2

16.5

9.3

*1.9

74.6

11.6

13.5

10.7

67.5

26.8

36.6

24.1

74.6

24.6

17.5

26.3

24.2

17.5

●3.6

7.7

5.1

39.9

31.6

20.9

●2.3

100.0

64.5

35.5

70.7

3.4

u

11.1

5.8

6.7

38.9

46.6

26.5

24.9

29.0

19.6

69.5

17.4

E

74.3

12.7

12.8

12.4

86.1

27.8

35.9

22.4

75.9

23.9

16.6

30.6

24.1

17.6

2.0

7.6

3?:

33.5

19.6

2.2

100.0

46.6

51.9

●6.7

●

. . .

*2.9

61.2

27.2

*8.7

●11.7

*25.2

53.4

●22.3

●I 7.5

42.7

●I 7.5

63.0

●12.O

‘1 4.6

●4.9

72.4

●I 2.4

●15.2

●16.e

81.5

“24.2

40.1

●17.2

71.6

●28.2

●10.3

●26.7

●29.3

●17.2

●4.3

●11.2

●5.7

●18.9

38.2

35.4

●1.9

100.0

49.8

60.2

60.6

●

. . .

●7.5

●12.5

●18.3

●

. . .

●14.2

41.7

43.3

*33.3

●23.3

●26.7

●16.7

65.6

●24.2

●5.8

●4.2

69.6

*1 4.6

15.7

●13.9

82.4

31.6

25.7

25.1

72.6

25.3

●5.7

36.6

●17.9

*1 4.3

●2.1

●16.4

*7.9

39.0

35.3

14.9

●2.9

100.0

64.3

35.7

66.4

3.3

?:

11.4

6.5

3U

49.0

26.0

24.7

29.5

19.6

69.4

17.0

:$

74.0

12.6

13.2

12.5

86.4

27.2

37.5

21.7

75.9

23.9

17.1

29.6

24.9

16.0

2.2

7.3

3%

33.7

20.9

2.2

1l“~ludes all other races.

2Diferencei nnumbero ftotslc urrents mokersfromtsblel dueto Computer-AslSed TelepWne lntewiwing (W~wmus ~~lmple s&e(see Technld notes).

Includes unknown accessibility, quit attempts and future use.

%cludes persons who ever thought seriously abmr qurtt!ng smoking.

41ncludes peraore who ever trisd to qu!t smokmg.

Slncludeslsasrhanl day.
10 Advance Data No, 224 ● February 1, 1993

Table 3. Number and percent distribution of teenagers who have never smoked a whole cigarette by smoking IntentIon, according to age,

sex, race, and Hispanic origin: United States, 1989

Age Sex Race

Never

Hispanic odgln

Smoking intention smokefl 12-73 14-15 1S-18 Male Female Write Black Hispanic Norr-Hispanic

Number in thousands

9,991

175

9,551

Tc!s12, . . . . . . . . . . . . . . . . . . . . . .

“’Think you will try a cigarette aeon?”

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . .

“Have you ever been

offered a cigarette?”

Yes . . . . . . . . . . . . . . . . . . . . . . .

No. . . . . . . . . . . . . . . . . . . . . . . . .

“Smoke cigarette If best friend offered?”

Definitely or probably yes . . . . . . . .

Definitely or probably not. . . . . . . . .

“Would It be easy or hard to get

cigarettes ifyou wanted some?”

Easy . . . . . . . . . . . . . . . . . . . . . . .

Hard . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . .

I 2,a22

220

12,255

347

5,027

7,786

112

12,663

8,084

4,528

230

82

12,711

100.0

1.7

95.6

2.7

39.2

60.7

0.9

98.9

62.9

35.3

1.8

0.6

99.1

5,017

118

4,704

194

1,225

3,7a9

45

4,954

1,939

2,931

146

●24

4,974

100.0

95

3.9

24.4

75.5

0.9

9a.9

38.6

58.4

2.9

●0.5

99.1

3,651

73

3,491

a7

1,539

2,105

42

3,604

2,431

1,168

52

●27

3,615

100.0

2.0

95.6

2.4

42.2

57.7

1.2

96.7

66.6

32.0

1.4

+0.7

29.0

4,154

●29

4,080

85

2,263

1,891

●25

4,115

3,694

429

●32

“31

4,121

100.0

“0.7

97.7

1.6

54.5

45.5

●0.6

99.1

86.9

10.3

“0.8

●O.?

99.2

8,386

116

6,068

204

2,664

3,714

49

6.310

4,149

2,116

120

4a

6,314

6,436

104

6,189

143

2,383

4,073

63

6,373

3,915

2,412

109

“34

6,397

2,289 1,234 411,588

186

‘11,139

261

●3O ●32

1,116

as

2,154

’265 65

4,465

7,097

4,001

5,982

63

9,681

6,338

3,481

173

56

9,916

887

1,402

542

●21

2,268

“10

1,221

102

?1,462

1,421

830

“38

679

525

●29

7,3a5

4,003

200

“Do you think you will be smoking

1 year from now?”

Definitely orprobably yes . . . . . . . . . .

Definitely orprobabty not. . . . . . . . . . .

●23

2,256

●3O

1,164 11,5$

Percent distribution

Tota1’2. . . . . . . . . . . . . . . . . . . . . . . 100.0

“Thhk you wiil try a cigarette soon?”

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . .

“Hava you ever been offered

a cigarette?”

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No. . . . . . . . . . . . . . . . . . . . . . . . .

“Smoke cigarette if best friend offered?”

Definitely orprobablyyea . . . . . . . . . .

Definitelyorprobably not.. . . . . . . . . .

“Would it be easy or hard to get

cigarettes if you wanted some?”

Easy . . . . . . . . . . . . . . . . . . . . . . .

Hard . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . .

“Do you think you will be smoking

1 year from noti”

Definitely orprobablyyes . . . . . . . . . .

Definitely or probably not. . . . . . . . . . .

100.0 100.0 100.0 100.0 100.0

1.8 1.6 1.8

95.0 96.2 95.6

3.2 2.2 2.7

●1.3

95a

z.a

●2.6

60.4

6.9

38.S

61.2

43.9

55.9

3s.7

61.2

41.7 36.7 40.0

56.2 63.3 59.9

0.8

98.8 9:; 9::

●1.0

99.1

●0.8

9a.9

65.0 60.8 63.4 62.1

33.1 37.5 34.6 36.3

1.9 1.7 1.7 ●1.7

55.0

42.5

●2.4

K1.7

*0.5 0.6

9::; 99.4 99.2

*2.4

98.8

●1.0

98.6

1Includes all other races.

2Dfleren~e int~~numbero fO,n~~r~~ked,#f ~~~lablel duemtimpmer.ksisted Telephone lntetieMng (WTl)wrsus WT%dlwple sb(See Tetinl@f~teS).

Insfudes unknown intent 10 smoke exsept for Vhmk you will try a cigarene s.xm?”
Advance Data No. 224 ● February 1,1993 11

Table 4. Number and percent distribution of teenagers by correlates of smoking uptake and rfsk-taking behaviors, according to smoking

status United States, 1989

Smoking .snWus

Never smoked Current smoker

All All

Correlates of smoking uptake All never No Former

s%%e Experimenter

current

and risk-taking behaw”ors statuses smoked intention smoker smokers~ Heavy Light Occasional

Allteenagers 2 . . . . . . . . . . . . . . . . .

Allteenagers . . . . . . . . . . . . . . . . . .

Pereons in household who smoke

Nonsmoker . . . . . . . . . . . . . . . . . . .

Both parenta and no older sibling(s). . . .

Both parenta and older sibling(s). . . . . .

Either parent and no older sibling(s). . . .

Ether parent and older sibling(s). . . . . .

Older sibling(s) and no parent . . . . . . .

All others, excluding parent(s)

and older sibling(s). . . . . . . . . . . . . .

Relaffves not in household who smoke

Nonsmoker . . . . . . . . .

Both parents and no older ~b~~g(;): :::

Both parenta and older sibling(s). . . . . .

Either parent and no older sibling(s). . . .

Either parent and older sibling(s). . . . . .

Older sibling(s) and no parent ., . . . . .

All others, excluding parent(s)

and older sibling(s). . . . . . . . . . . . . .

“Of your four best male friends,

how many smoke?”

None . . . . . . . . . . . . . . . . . . . . . . .

One . . . . . . . . . . . . . . . . . . . . . . . .

Two . . . . . . . . . . . . . . . . . . . . . . .

Three . . . . . . . . . . . . . . . . . . . . . . .

Four . . . . . . . . . . . . . . . . . . . . . . . .

“Of your four best female friends,

how many smoke?”

None . . . . . . . . . . . . . . . . . . . . . . .

One . . . . . . . . . . . . . . . . . . . . . . .

Two . . . . . . . . . . . . . . . . . . . . . . .

Three . . . . . . . . . . . . . . . . . . . . . . .

Four . . . . . . . . . . . . . . . . . . . . . . . .

“How you think your best friends would

feel about ousmokingone ormore pa~~~of@@&a da~

Approve . . . . . . . . . . . . . . . . . . . . .

Disapprove . . . . . . . . . . . . . . . . . . .

Notoare . . . . . . . . . . . . . . . . . . . . .

“DO friends who smoke ever say

they should quit’?”

pod . . . . . . . . . . . . . . . . . . . . . . . .

No.ti;;n~;$o;rn;~;:::::: ::::::

“How many people your

age smoke cigarettes?”

None . . . . . . . . . . . . . . . . . . . . . . .

Anew . . . . . . . . . . . . . . . . . . . . . . .

Some . . . . . . . . . . . . . . . . . . . . . . .

Mostorall . . . . . . . . . . . . . . . . . . .

“How many people your age use

chewing tobaooo or snuff?”

None . . . . . . . . . . . . . . . . . . . . . . .

Anew . . . . . . . . . . . . . . . . . . . . . . .

Some . . . . . . . . . . . . . . . . . . . . . . .

Mostorall . . . . . . . . . . . . . . . . . . .

“How many people your age

smoke merijuanaT’

None . . . . . . . . . . . . . . . . . . . . . . .

Anew . . . . . . . . . . . . . . . . . . . . . . .

Some . . . . . . . . . . . . . . . . . . . . . . .

Mostorall . . . . . . . . . . . . . . . . . . . .

23,524

100.0

53.3

9.8

2;;

2.9

3.2

3.4

27.3

o.a

0.2

5.0

0.7

6.7

sa.o

61.7

14.0

9.3

4.7

8.0

64.0

13.4

9.9

4.7

6.1

7::

25.4

54.2

26.6

I 8.a

13.9

38.0

27.8

19.s

52.8

26.6

13.2

4.3

54.0

25a

12.6

5.7

12,822

100.0

59.3

8.6

2i:

E

2.4

31.0

●0.3

*0.O

3.7

●0.2

4.1

59.1

77.3

1o.a

5.3

2.0

2.2

80.1

10.4

4.a

1.5

1.4

8;;

17.3

43.3

31.0

27.0

%:

25.2

9.4

61.0

23.9

10.8

3.2

69.7

19.0

H

11,055

100.0

60.1

8.6

1.0

24.3

H

2.4

31.4

“0.3

*1 .0

3.6

●0.2

3.9

56.9

80.4

9.9

4.9

2:

82.5

9.7

4.3

1.3

1.4

aE

15.7

41.0

30.1

2S.3

21,9

43.3

25.2

9.5

60.4

25.0

11.0

3.1

70.2

19.5

7.3

2.1

1,766

100.0

54.8

8.6

●1.2

26.2

2.3

3.5

2.7

:$;

● .

. . .

3.1

●O.1

5.4

60.5

87.8

17.2

7.6

●2.4

2.7

73.6

14.2

7.2

●1.7

●1.1

●2.2

69.0

27.3

43.3

37.0

18.9

18.6

40.1

30.0

10.6

63.2

21.5

11.0

3.0

70.3

I a.3

7.6

●2. 1

Number in thousands

6,717 322

Percent distribution

100.0

48.5

11.2

1.8

26.6

2.6

3.3

3.8

24.2

1.2

●0.1

6.0

U

57.7

59.7

17.7

11.3

4.4

4.7

60.3

16.9

11.8

5.4

3.9

6$:

28.3

83.0

23.5

13.1

“5.7

42.1

32.7

19.0

47.3

30.8

15.4

5.6

44.6

:$;

6:0

100.0

46.3

*9.9

●2.5

25.S

●6.8

●4.3

●5.O

14.6

●3.1

●

. . .

●5.3

●3.7

●10.9

61.2

28.4

24.9

17.5

●9.1

18.1

33.9

18.7

20.2

●10.2

12.9

;0:6

4a.a

62.9

16.8

“0.6

*1.2

19.0

33.6

46.2

28.4

$:

●8:5

21.9

31.9

30.1

●11.4

3,620

100.0

41.6

11.7

2%!

7.0

6.1

6.2

21.4

1.6

*0.9

7.7

1.7

11.4

54.5

16.2

17,4

18.0

14.2

32.8

19.7

16.9

22.6

13.6

25.3

5Z

46.6

60.6

17.9

1.4

1H

26.7

54.5

37.6

::;

5:3

21.2

36.1

24.2

16.4

1,554

1W.o

32.4

13.4

2:;

9.8

5.9

8.0

17.1

●2.6

●1.7

9.6

1::

52.3

1::

15.6

18.1

47.6

1!$

21.6

17.0

39.4

3%

59.1

86.4

13.3

● 0.3

‘0.8

1U

70.5

36.3

40.7

18.0

4.4

15.1

30.0

29.3

24.0

572

10Q.O

41.6

12.1

●4. 7

24.1

*6.3

●6.3

●5. 1

22.0

●0.3

●0.3

8.6

●1.7

10.3

54.9

14.2

19.1

20.9

13.4

26.8

14.6

19.5

20.3

15.5

24.5

*1.9

61.0

36.9

77.1

22.4

●0.5

‘0.8

14.6

32.4

51.9

36.7

36.1

18.8

●6.O

17.2

39.7

22.6

15.5

1,250

f W.o

50.9

9.4

●2.2

21.4

3.8

7.1

5.0

27.3

●1.4

*

. . .

5.7

●0.8

7.7

56.6

30.2

25.8

17.7

lE

36.6

21.0

23.0

R

●1.8

61.2

36.6

75.0

21.4

3.3

●1.7

29.4

33.8

34.5

38.0

37.9

17.6

6.6

29.3

40.9

19.4

8.7

Seefodrroteaterrd cJteble.
12 Advance Data No. 224 ● February t, 1993

Table 4. Number and percent distribution of teenagers by correlates of smoking uptake and rlak-taking behaviors, according to smoking

status: United States, 1989-Con.

Smoking swus

Correlates of smoking uptake

and risk-taking behaviom

New smoked Current smoker

,4//

A/l

M

never No Former current

statuses smoked intention s%%e Experimenter smoker smokers+ Heavy Light Occasional

‘“How many people your age use

cocaine or crack?”

None . . . . . . . . . . . . . . . . . . . . . . .

A new . . . . . . . . . . . . . . . . . . . . . . .

Some

Most or’ail: :::::::::::::::: :::

“How many people your age drink

alcohol at least once a week?”

None . . . . . . . . . . . . . . . . . . . . . . .

A new . . . . . . . . . . . . . . . . . . . . . . .

Some . . . . . . . . . . . . . . . . . . . . . . .

Mostorall . . . . . . . . . . . . . . . . . . . .

‘“How many people your age at drunk

at least once a month.$

None . . . . . . . . . . . . . . . . . . . . . . .

Anew . . . . . . . . . . . . . . . . . . . . . . .

Some . . . . . . . . . . . . . . . . . . . . . . .

Mostorall . . . . . . . . . . . . . . . . . . . .

“How many people you know

have ever had sex?”

None . . . . . . . . . . . . . . . . . . . . . . .

Afew . . . . . . . . . . . . . . . . . . . . . . .

Some . . . . . . . . . . . . . . . . . . . . . . .

Mostorall, . . . . . . . . . . . . . . . . . . .

“How much do/did you like schoot?”

Alit . . . . . . . . . . . . . . . . . . . . . . .

Some . . . . . . . . . . . . . . . . . . . . . . .

Veryhttla. . . . . . . . . . . . . . . . . . . . .

Notatall . . . . . . . . . . . . . . . . . . . .

“How do/did you do in school?’”

Much betterthanaverage . . . . . . . . . .

Befterthenaverage .,....... . . . . .

Average . . . . . . . . . . . . . . . . . . . . .

Belowaverage . . . . . . . . . . . . . . . . .

“How useful do you think the things

you are learning in school will be to

you later in life?”

Veryusefui . . . . . . . . . . . . . . . . . . .

Somewhat useful . . . . . . . . . . . . . . . .

Notatall useful . . . . . . . . . . . . . . . .

“IS there a rule at your school that

students are not aflowed to smoke

on school propetty?”

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . .

“HOW many students who smoke

obey that rule?”

None . . . . . . . . . . . . . . . . . . . . . . .

Afew . . . . . . . . . . . . . . . . . . . . . . .

Some . . . . . . . . . . . . . . . . . . . . . . .

Most . . . . . . . . . . . . . . . . . . . . . . .

Allofthem . . . . . . . . . . . . . . . . . . .

“How many of the teachers In your

school smoke cigarettes?”

None . . . . . . . . . . . . . . . . . . . . . . .

Anew . . . . . . . . . . . . . . . . . . . . . . .

Some . . . . . . . . . . . . . . . . . . . . . . .

Moatorall . . . . . . . . . . . . . . . . . . . .

“’Have you ever taken a clesa or course

at school in which the heafth risks of

smoking were discussed?’

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . .

Seefootnoteat end oftable.

80.6

12.7

3.6

0.8

28.0

25.0

20.8

24.9

33.4

24.3

17.0

23.4

24.8

22.3

16.6

32.8

40.1

47.5

6.4

3.7

16.0

36.3

43.4

3.9

54.3

42.7

2.7

:3

14.8

25.3

16.6

25.1

17.5

11.s

37.8

31.2

11.3

75.2

24.1

85.3

9.3

2.7

0.6

39.0

:5.:

14.5

47.1

23.3

15.2

12.3

37.4

24.5

14.9

1&9

45.5

46.4

5.5

2.2

20.3

39.4

38.0

1.9

61.0

37.0

1.7

e8.9

9.0

13.7

23.7

16.1

24.0

21.5

15.8

39.4

27.4

9.3

73.7

25.4

65.9

9.7

::

39.4

25.s

19.0

15.1

47.1

23.7

15.3

13.0

37.7

g;

19:2

4s.0

45.2

4.6

1.9

21.3

40.1

36.7

1.5

61.6

36.6

1.5

88.7

9.4

14.1

23.5

15.7

23.6

22.0

15.6

39.3

27.7

6.9

74.9

24.5

65.5

9.6

2.6

●0.9

35.9

27.3

23.5

12.4

45.7

23.6

18.2

9.8

37.8

25.7

14.4

15.5

32.6

55.0

9.7

●22

13.9

34.7

46.1

4.4

57.0

39.5

2.8

90.6

6.7

11.2

25.0

18.5

26.5

18.0

15.7

39.6

25.6

11.5

66.7

31.6

Percent distribution

80.0

Ig

●0:6

19.0

26.8

23.9

29.3

22.5

28.9

19.2

27.9

13.8

24.0

20.1

39.5

37.2

51.0

8.1

2.7

13.0

35.3

46.0

3.6

50.2

47.4

2.2

65.1

14.0

14.6

26.5

17.4

26.8

14.3

65.5

27.6

‘4.4

‘0.9

●7.9

15.6

23.1

50.6

●11.1

16.7

22.2

49.4

●2.6

12.9

17.5

62.6

27.5

55.8

*7.9

*6.5

●7.1

28.9

55.3

“9.0

66.8

21.6

R

:;:

49:9

9.4

19.8

18.8

50.7

12;

15.8

65.1

28.6

44.3

16.5

10.2

2:;

52.9

11.3

61.0

25.0

X

1?:

17.2

55.2

1;;

16.1

60.6

:?

11.3

77.6

20.6

41.9

20.8

15.6

2%

53.6

17.2

68.7

18.4

●5.7

●2.8

1U

19.0

52.1

2%

17.9

47.3

4.3

10.1

20.1

62.3

30.2

44.6

16.3

6.5

a.2

25.9

56.1

9.6

72.6

1::

●0:9

12.4

21.6

21.8

43.4

13.0

23.4

21.2

41.5

6.3

19.1

16.9

51.4

36.6

46.5

9.6

5.1

10.6

34.1

50.2

5.2

39.0 34.0 42.5 42.5

::$ 53.8 53.9 53.3 !5~

●5.9 7.0 11.3 *4.2

75.5 80.4 76.4 80.4 83.8

23.0 18.9 22.4 19.2 15.6

24.7 18.7 22.6 17.4 14.7

19.3 29.5 35.0 26.3 26.6

18.5 17.2 14.7 19.6 16.5

::: 25.3 20.3 26.5 28.7

9.2 7.3 10.2 11.4

*2.2 *5.6 5.2

3K 31.1 3% 3::: 37.6 37.0

35.8 43.6 35.0 35.7 30.4 35.9

11.6 14.9 17.5 16.9 16.6 14.9

7s.0

21.5

62.0 74.4 73.7 77.1 74.2

18.0 24.6 24.4 22.6 25.4
Advance Data No. 224 ● Februarv 1, 1993 13

Table 4. Number and percent distribution of teenagers by correlates of smoking uptake and risk-taking behaviors, accordfrtg to smoking

status: United States, 1989- Con.

Smoking status

Correlates of smoking uptake

and rwk-taking behaviora

Never smoked Current smoker

All

All No

All

never May Former current

statuses smoked intention smoke .E@erimenter smoker smokend Heavy tight Occasional

“Reason and total time missed from

school in past 2 weeks?”4

Did not cut, missed no days . . . . . . . .

Did not cut, missed 1 or more days . . . .

Cut, missed 1 or more days. . . . . . . . .

“During the past year, how often have

you felt too tired to do things?

Otten . . . . . . . . . . . . . . . . . . . . . . .

Sometimes . . . . . . . . . . . . . . . . . . .

Rarely . . . . . . . . . . . . . . . . . . . . . .

Never . . . . . . . . . . . . . . . . . . . . . . .

“During the past year, how often have

you had trouble going to sleep

or staying asleep?”

Often . . . . . . . . . . . . . . . . . . . . . . .

~or;imes, . . . . . . . . . . . . . . . . . .

Never.::::::::::::::::::: :::

“During the past year, how often have

you felt unhappy, sad, or depressed?”

Often . . . . . . . . . . . . . . . . . . . . . . .

Sometimes . . . . . . . . . . . . . . . . . . .

Rarely . . . . . . . . . . . . . . . . . . . . . .

Never . . . . . . . . . . . . . . . . . . . . . . .

“During the past year, how often have

you felt hopeless about the future?”

Often . . . . . . . . . . . . . . . . . . . . . . .

Sometimes . . . . . . . . . . . . . . . . . . .

Rarely . . . . . . . . . . . . . . . . . . . . . . .

Never . . . . . . . . . . . . . . . . . . . . . . .

“During the past year, how often have

you felt nervous or tense7°

Often . . . . . . . . . . . . . . . . . . . . . . .

Sometimes . . . . . . . . . . . . . . . . . . .

~ey:. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . .

‘“During the past year, how often have

you worried tca much about things?”

Often . . . . . . . . . . . . . . . . . . . . . . .

Sometimes . . . . . . . . . . . . . . . . . . .

Rarely . . . . . . . . . . . . . . . . . . . . . . .

Never . . . . . . . . . . . . . . . . . . . . . . .

“During the past year have you had an

accident, injury, or poisoning that

required medical attention by a doctor,

nurse, or medical ~sistant?”

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . .

Frequency of fighting in past year

Never, . . . . . . . . . . . . . . . . . . . . . .

Once . . . . . . . . . . . . . . . . . . . . . . .

Twice . . . . . . . . . . . . . . . . . . . . . . .

Threetofivetimes . . . . . . . . . . . . . . .

Morethanfwetimes . . . . . . . . . . . . . .

Been infight, DKtimes . . . . . . . . . . . .

Frequency of riding on motorcycle

or minibike in past year

Often . . . . . . . . . . . . . . . . . . . . . . .

Sometimes . . . . . . . . . . . . . . . . . . .

Rarely . . . . . . . . . . . . . . . . . . . . . .

Never . . . . . . . . . . . . . . . . . . . . . . .

“How often do you wear a seat beit

when you drive or rfde in a car?”

Ahvaysormostofthetime. . . . . . . . . .

Sometimes . . . . . . . . . . . . . . . . . . .

Rarelyornever . . . . . . . . . . . . . . . . .

See fmtnote atend oftable.

56.2

21.2

4.0

15.4

33.8

41.7

8.7

14.7

24.6

33.5

26.7

14.0

33.5

38.1

13.7

7.7

14.6

30.9

46.0

18.6

37.7

30.3

12.9

25.9

32.6

26.8

14.2

23.2

76.3

72.3

10.0

2:

3.4

0.5

12.4

1U

59.7

62.4

18.3

18.9

63.2

19.5

1.6

12.7

33.4

43.0

10.5

11.3

23.5

34.5

30.2

10.5

31.1

40.5

17.2

1::

28.6

52.6

14.7

37.6

31.7

15.5

20.7

32.9

29.0

16.8

20.8

78.8

79.9

%

3.6

k:

?:

14.8

68.6

69.9

16.6

12.9

63.3

19.3

1.4

12.2

32.1

44.3

10.9

11.2

5:

31.1

10.4

30.3

41.1

17.6

1;:

28.4

53.9

14.3

37.3

32.5

15.5

20.5

32.1

29.6

17.2

21.0

78.6

82.0

7.6

5.1

3.0

1.5

*0.3

8.6

7.0

14.8

69.3

70.6

16.5

12.6

61.7

20.4

●1.6

15.6

41.3

34.8

7.6

12.1

28.6

33.5

24.7

11.3

36.1

36.9

14.1

1%

29.7

44.6

17.0

39.4

26.7

15.7

22.3

38.2

23.9

14.6

20.2

79.0

75.3

2;

6.0

●1.5

●1.O

10.3

10.1

14.7

64.1

65.1

19.1

15.1

Percent distribution

x

4.8

18.1

34.3

40.9

6.3

16.6

26.9

34.0

22.0

14.7

37.4

36.8

10.6

lx

34.5

40.1

21.4

37.5

30.1

10.6

30.5

33.5

24.6

11.0

25.3

74.2

68.1

11.6

8.9

H

0.4

14.0

10.3

21.2

54.1

59.0

19.5

21.2

46.5

19.3

9.4

25.8

36.3

31.1

*6.8

25.5

22.4

27.3

23.9

23.0

39.8

31.4

“5.9

●9.3

18.0

31.4

41.6

28.3

50.0

16.5

●.5.6

39.8

33.9

14.6

●12.1

27.3

73.0

55.8

●9.4

13.2

14.9

‘S.6

‘0.9

24.5

‘1 2.4

21.1

41.9

51.9

20.2

26.0

37.9

23.4

9.7

19.2

34.1

39.5

6.9

%

30.2

23.4

24.3

34.3

32.9

8.0

14.4

18.3

32.7

33.8

26.7

37.2

27.0

8.6

34.6

2::

11,0

27.5

72.0

56.3

12.9

1U

8.4

●0.4

21.0

14.0

24.0

40.5

43.7

21.3

34.6

27.3

20.2

11.2

19.6

32.0

40.6

6.8

25.7

21.4

27.5

24.5

27.0

31.7

33.1

7.4

18.0

17.6

31.5

31.4

29.3

35.1

~:

46,0

23.7

8.4

19.6

35.5

35.5

8.9

21.5

25.3

31.8

20.3

24.1

36.9

28.7

9.4

11.7

21.0

31.5

35.5

26.7

39.9

23.6

8.7

35.1 35.8

28.0 23.6

25.0 26.4

11.0 13.3

30.3

66.8

49.5

1;.:

13:5

12.4

*0.4

24.3

15.5

25a

33.4

34.0

21.4

43.6

24.5

75.0

55.2

12..9

11.9

13.1

6.6

“0.3

20.1

13.3

28.1

38.6

46.0

22.0

32.0

46.4

27.4

8.6

17.0

36.2

4:;

19.0

25.9

32.1

23.0

21.0

35.4

35.3

a.o

11.5

17.8

34.6

35.9

22.6

41,0

27.4

8.9

32.4

34.6

23.1

9.9

25.4

74.5

65.6

12.2

7.4

9.5

4.9

●0.3

16.7

12.8

19.0

49.4

52.3

21.2

26.5
14 Advance Data No. 224 ● February 1, 1993

Table 4. Number and percent distribution of teenagers by correlates of smoking uptake and risk-taking behaviors, according to smoking

status: United States, 1989- Con.

Smoking status

Correlates of smoking uptake

and risk-taking behaviors

Never smoked Current smoker

All

All

Af/

never No May Former current

statuses smoked intention smoke Experimenter smoker amokerd Heay Light Occssional

“During the last 4 weeks have you

ridden in a vehicle driven by someone

who had been drinking or using drugs?”

Yes . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . .

“Including Saturdays and Sundays,

how many nights a week do you

usually go out tor fun or recreabon?”

None, . . . . . . . . . . . . . . . . . . . . . .

Onetotwo nights . . . . . . . . . . . . . . .

Three to four nighte . . . . . . . . . . . . . .

.%enightso rmore . . . . . . . . . . . . . .

“Have you ever had a steady

boyfriendlgirlfriend?”

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . .

“Did he or she smoke?”

Ye, . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . .

“Abouthowmuch money doyou have

each week to spend on yourself

any way you want to?”

None . . . . . . . . . . . . . . . . . . . . . . .

$1-s5. . . . . . . . . . . . . . . . . . . . . . .

$E-$lo . . . . . . . . . . . . . . . . . . . . . .

$11-$20 . . . . . . . . . . . . . . . . . . . . .

$21-s30 . . . . . . . . . . . . . . . . . . . . .

$31-s50 . . . . . . . . . . . . . . . . . . . . .

More than.$50 . . . . . . . . . . . . . . . . .

“’in the past earhave you participatedin

any kindo ?competitive and organized

physical activity, such as team sports?”

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No, . . . . . . . . . . . . . . . . . . . . . . .

“If you hadsserious problem, to whom

would you talk ergo for help?”

None . . . . . . . . . . . . . . . . . . . . . .

Eltherparent . . . . . . . . . . . . . . . . . .

Other relative oraduft . . . . . . . . . . . . .

Friend . . . . . . . . . . . . . . . . . . . . . .

“Number of hours per week you are

athomewithout aparent

or adult around?’ 5

None ornoton regular basis . . . . . . . .

l-5 houra . . . . . . . . . . . . . . . . . . . .

6-10hours . . . . . . . . . . . . . . . . . . .

Morethan 10hours . . . . . . . . . . . . . .

“How often do you attend

religious services?”

Often . . . . . . . . . . . . . . . . . . . . . . .

Sometimes . . . . . . . . . . . . . . . . . . .

Rarely . . . . . . . . . . . . . . . . . . . . . .

Never . . . . . . . . . . . . . . . . . . . . . . .

“Have you ever seen or read warmng

labels on any bottles or cans containing

an alcohohc beverage?”

Neverseen . . . . . . . . . . . . . . . . . . .

Seen, neverread . . . . . . . . . . . . . . . .

Read, reported one or more correct

wCu’nmgs.., .,..,.... . . . . . . . .

Flead, reported nocorreclwamings. . .

10.9

88.7

9.8

49.5

29.7

10.0

69.0

30.6

19.4

80.6

7.3

17.9

21.2

21.1

8.4

10,7

10.1

65.1

34.4

52:

23.5

19.2

39.4

30.5

16.1

13,4

41.3

22.5

21,6

14,2

65,1

13.1

11.5

9.9

4,7

94.9

12.5

52.9

26.9

6.6

56.6

42.9

7.5

92.5

2::;

23.7

19.9

7.2

8.3

5.9

68.7

30.7

3.9

59.3

21.6

14.6

41.3

31.9

15.1

11.0

48.9

21.9

17.4

11.3

63.1

13.8

11,1

11.5

4.5

95.0

12.6

52.8

27.0

6.6

56.7

42.9

7.2

92.8

7.3

22.7

24.1

19.6

7.6

88

6.2

69.6

29.9

3.7

59.8

21.5

14.5

41.6

32.0

15.0

10.8

50.0

21.4

17.2

11.0

63.5

13.4

11.2

11.5

5.5

93.7

12.3

53.0

26.2

6.7

56.3

43.0

9.4

90.6

7.2

23.4

24.2

24.2

:::

4.0

63.0

38.1

5.5

56.2

21.9

15.2

39.6

31.0

15.4

12.4

42.1

25.0

18.5

13.6

61.0

16.3

10.8

11,2

Percent distribution

11.8 21.7 30.2 37.5 24.0

87.8 78.3 69.3 61.3 76.0

6.6 ●7.5 5.7 ●4.2

50.1 37.9 38.0 3:: 40.0

31.2 41.0 35.7 35.8 39.0

11.0 13.7 20.0 26.5 15.9

79.7

19.9

15.9

64.2

6.6

13.6

20.0

23.3

10.3

12.3

11.7

66.0

33.6

91.0

9.3

45,4

54.6

●8.6

*I 0.8

15.8

17.3

‘7.9

19.3

14.9

54.0

48.0

4.4 ●5.O

47.0 39.1

:;; 25.8

30.1

37.7

26.2

17.1

16.4

36.6

24.1

24.5

14.5

25.9

74.0

4:::

33.6

14.4

S0.6 93.9 91.6 85.6

9.0 5.2 6.0 14.4

49.1 42.7 29.3

50.9 & 57.3 70.5

5.6 5.4 6.5 5.5

1;:

21.8

9.2

15.0

21.1

6,2

11.7

19.2

1?;

28.0

10.8

16.9

:;;

10:6

17.1

1k:

23.2

10.6

14.3

14.5

51.6 41.0 52.3 63.2

47.7 58.0 47.7 36.8

●2.6 4.6

3;: 3;: 41.3 41.7

25.8 23.9 24.7 27.2

29.0 31.3 31.3 25.7

30.1 32.8 31.1 29.2 33.9

33.1 27.2 26.4 27.0 29.0

*23.3 19.0 14.6 16.0 23.3

*13.5 20.4 26.6 26.6 13.5

27.3 24.2 15.4 22.0 35.0

20.8 21.9 16.2 24,6 24.8

34.5 30.1 33.5 32.7 25.2

17.4 23.4 31.9 20.5 15.0

66.0 72.4 69.8 75.4 71.9

13.1 *6.4 10.6 8.2 9.8

12.4 13.0 11.3 8.6 9.6

8.2 ●6.2 7.6 6.7 8.2

64.6

14.1

13.1

8.0

1Includes unknown type of smoker.

2DMerencei ntotaln umberOfl eenagersfromtablel dueto Computer.&s]sted Telephone lntew!eting (CATl)versus CATl*ail %mpleeize (see Technimln0tes).

Includes unknown smokmgslalus, correlates oismokmg uptaka and risk behawors.

30ne pack comams 20 c[g~rerte$.

4Excludes adolescents nol enrolled m school atbme of mlerwew.

Slncludea only 12-16-year.olda.

NOTE: Sums may not equal toials due to rounding.
Advance Data No. 224 ● February 1, 1993 15

Table 5. Number and percent distribution of male teenagers by smokeless tobacco-use

status, according to age, race, and Hispanic origin: United States, 1989

Smokeless tobaccwse status

Age, race, and Male Never Ever Total Used Never used

Hispanic origin teenagers! used used ever used regu/ar/y regular(y

TotalZ. . . . . . . . . . . . . . . .

Age

12-13 years . . . . . . . . . . . .

14-15 yeara . . . . . . . . . . . .

18-18 years . . . . . . . . . . . .

Race

White . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . .

Hispanic origin

Hispanic . . . . . . . . . . . . . .

Non-Hispanic. . . . . . . . . . .

TotalZ . . . . . . . . . . . . . . . .

Age

12-13years . . . . . . . . . . . .

14-15years . . . . . . . . . . . .

16-18years . . . . . . . . . . . .

Race

White . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . .

Hispanic origin

Hispanic . . . . . . . . . . . . . .

Non-H!spanic. . . . . . . . . . .

12,219

3,391

3,434

5,394

9,915

~,ai4

1,182

11,038

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

0.386

2,961

2.466

2,959

6,370

1,601

1,024

7,362

66.6

87.3

71.8

54.9

64.2

88.3

86.6

66.7

Number in thousands

3,619 3,619

422 422

969 969

2,426 2,428

3,530 3,530

213 213

156 156

3,660 3,660

Percentdiatnbution

31.3 100.0

12.4 100.0

28.2 100.0

45.0 100.0

35.6 100.0

11.7 100.0

13.4 100.0

33.2 100.0

a40

607

6(YJ

●16

●I5

625

22.0

12.1

16.0

25.0

22.7

●7.5

●9.5

22.5

2,979

371

786

1,821

2,731

197

143

2S36

78.0

87.9

81.1

75.0

G

60.5

77.5

1Includesunknownsmokeless !obaccc-use sratus.

Zlncludes all other races.
16 Advance Data No. 224 ● February 1, 1993

Table 6. Number and percent distribution of male teenagers by correlate of use, according

to smokeless tobacco-use status: United States, 1989

Smokeless tobacccwse status

Correlates of srnoke/ess Male Never Ever Used Never used

tobaccc+use teenagerel used used regularly regulady

Totai2 . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . .

Persons in household who use

chewing tobacco or snuff

No user of smokeless tobacco . . . . . .

Father and no older brother(s) . . . . . . .

Father and older brother(s) . . . . . . . . .

older brother(s) and not father . . . . . . .

All others, excluding father and older

brother(s) . . . . . . . . . . . . . . . . . . . .

Relatties not in household who use

chewing tobacco or snuff

No user of smokeless tobacco . . . . . . .

Father and no older brother(s) . . . . . . .

Older brother(s) and not father . . . . . . .

All others, excluding father and older

brother(s) . . . . . . . . . . . . . . . . . . . .

“HOW you think your best friends

would feel about you using

chewing tobacco or snuff regularly?”

Approve . . . . . . . . . . . . . . . . . . . . .

Disapprove . . . . . . . . . . . . . . . . . . .

Not care . . . . . . . . . . . . . . . . . . . .

“How many people your age use

chewing tobacco or snuff?”

None . . . . . . . . . . . . . . . . . . . . . .

A new . . . . . . . . . . . . . . . . . . . . . . .

Some . . . . . . . . . . . . . . . . . . . . . . .

Mostorall . . . . . . . . . . . . . . . . . . . .

“Doyou believe using chewing

tobacco and snuff can cause cancer?”

Yes, . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . .

12,219

100.0

91.9

4.2

‘0.2

1.9

1,6

78.3

0.5

1.1

17.6

2.2

65.3

31.8

47.2

30.2

15.4

6.1

94.4

2.8

2.6

Number m thousands

8,441 3,766 763

Percent distribution

100.0

95.3

2,6

“0.1

0.8

1.1

63.4

●0.3

0.5

13.4

1.4

74.6

23.1

59.9

26.0

10.3

2.5

93.3

3.1

3.4

I00.0

844

7.9

●0.5

4.4

2.8

66.9

1,2

2.5

27.1

4.0

44.5

51.4

19.2

39.7

26.8

13.9

96.6

“::4

100.0

73.6

11.1

●1.9

9.1

●4.3

51.9

●2.6

5.4

39.1

12.1

24.6

62.6

●4.6

36.5

26.5

29.2

95.6

●3.2

‘0.7

2,983

100.0

67.2

E

3.2

2.3

70.9

0.8

1.7

24.0

1.8

49.7

46.3

23.3

40.0

26.9

9.6

97.0

1.8

*1.O

‘Includes unknown smokeless tobacco-use status.

%dudes unknown correlates of use.
Advance Data No. 224 ● February 1, 1993 17

Table 7. Number and percent distribution of teenagers by knowledge and attitudes about smoking and exposure to smoking risks,

according to smoking status: United States, 1989

Smoking status

Never smoked Current smoker

All All

Knowledge, attitudes, All never No May

and rislt exposure statuses smoked

Former current

intention smoke Experimenter smoker smokers; Heavy Light Occasional

Allteenagersl . . . . . . . . . . . . . . . . . .

Allteenagers . . . . . . . . . . . . . . . . . .

‘iMedia,TV, radio exposureto

healthrisksof smoking?”

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . .

“Do you believe it is safe to smoke

for only a year or 2?”

:.s . . . . . . . . . . . . . . . . . . . . . . . .

Do;i~;o-w” ::::::::::::: ::::::

“DO you believe there is any harm in

having an occasional cigarette?”

“Do you believe smoking can help

people when they are bored?”

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . .

“Do you believe cigarette smoking

helps people relax?”

:.s . . . . . . . . . . . . . . . . . . . . . . . .

Do+{k~ow ::::::::::::: ::::::

“Do you believe cigarette smoking

helps reduce stress?”

:.s . . . . . . . . . . . . . . . . . . . . . . . .

Do;’i~;ow :::::::::::::: :::::

“Do you believe smoking helps

people feel more comfortable in social

situations?”’

yes . . . . . . . . . . . . . . . . . . . . . . . .

DoiiRow :::::::::::::: :::::

“’Do you believe smoking helps people

keep their weight down?”

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . .

“Do you believe almost all doctors are

strongly against smoking?”

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . .

“Do you believe using chewing tobacco

and snuff can cause cancer?”

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . .

“1 strongly dislike being around people

whoaresmoking.”

Agree . . . . . . . . . . . . . . . . . . . . . . .

Disagree . . . . . . . . . . . . . . . . . . . . .

No opinion . . . . . . . . . . . . . . . . . . . .

23,528

100.0

81.9

17.9

9?;

0.9

66.6

32.4

0.9

9;:

0.8

26.6

69.7

3.5

19.5

77.7

2.6

39.1

58.1

2.6

17.8

79.8

2.2

79,7

J7,7

2.5

94.5

2.3

3.0

64.9

22.4

12.5

12,822

100.0

62.2

17.6

9;;

0.6

75.6

23.3

1.0

9%!

0.9

16.4

79.9

3.6

12.0

84.9

3.0

29.7

66.8

3.3

13.2

64.4

2.2

80.1

17.3

2.5

94.2

H

77.8

12.9

9.0

11,056

100.0

82.0

17.7

2.8

96.5

0.6

77.7

21.4

0.7

9:::

0.8

15.7

61.5

2.6

10.9

86.2

2.8

26.6

66.2

3.1

13.0

84.7

2.2

82.3

16.1

1.5

95.3

k;

79.6

12.1

6.0

1,766

100.0

83.5

16.4

9::

●1.5

62.5

34.9

2.3

9:;

●1.5

24.3

72.4

3.0

18.7

77.2

3.7

36.9

5:.:

15.1

82.1

2.4

76.7

21.4

●1.4

93.3

;:

;;:

15:2

Number in thousands

6,717 322

Percent distribution

100.0

82.1

17.8

9!?;

1.0

62.6

36.3

0.9

9!M

*0.5

27.5

68.8

3.7

18.7

78.5

2.5

45.8

51.8

2.2

19.2

78.4

2.3

78.6

16.8

2.3

84.9

?:

88.0

18.9

14.9

100.0

81.1

19.3

15.2

84.2

●0.6

55.0

42.9

●2.2

8;:

*0.6

47.4

49.1

*2.3

29.8

68.9

●1.6

53.1

46.0

‘0.9

25.5

73.9

“0.9

80.1

17.3

*2.6

93.0

“2.0

+5.0

37.6

38.2

24.2

3,620

100.0

80.6

19.1

20.6

76.1

1.3

42.8

56.7

●0.5

16.6

80.3

●0.7

58.5

38.7

2.6

46.5

51.7

1.6

58.6

40.0

1,3

30.3

67.5

2.0

80.5

16.7

2.6

95.4

2.1

2.2

19.4

60.9

19.4

1,554

100.0

80.0

19.6

25.2

72.6

●2.O

4s.7

55.7

●0.5

23.0

75.3

●1,3

63.6

:$:

54,4

43.1

●2. 1

57.5

40.5

●1.6

36.2

61.4

*1.9

81.6

15.7

●2.4

94.6 ●$:

10.9

73.9

14.5

572

100.0

79.0

20.3

20.6

79.0

●0.3

43.5

55.9

*0.5

18.7

8~.3 *

. . .

63.0

30.2

6.6

53.0

45.1

●1.7

65.4

33.7

“0.9

28.8

69.4

*1.7

79.6

16.3

●4.1

95.6

*1.7

●2.5

15.4

68.2

16.4

1,250

100.0

81.6

16.0

15.0

64.2

●0.9

41.6

57.4

●0.8

14.1

85.3

●0.6

48,9

49.6

*1.2

33.9

;.;

55.9

42.8

●1,3

24.3

73.2

*2.5

80.1

17.7

●2.2

95.6

●2.6

●1.8

32.3

40.2

27.3

See foornote a! end of table.
18 Advance Data No. 224 ● February 1, 1993

Table 7. Number and percent distribution of teenagera by knowledge and attltudea about smoking and exposure to smoking risks,

according to smoking status: United States, 1989-Con.

Smoking status

Knowledge, attitudes,

and risk exposure

Never smoked Current smoker

Afl

All No

A/I

never May Former current

statuses smoked intention smoke Experimenter smoker smokeral Heavy Light Occasional

“When I’m older my parenta won’t

mmd if I smoke.”

Agree . . . . . . . . . . . . . . . . . . . . . . .

Disagre e . . . . . . . . . . . . . . . . . . . .

Noopinlon. . . . . . . . . . . . . . . . . . . .

“Seeing someone smoking

turns me off.”

Agree . . . . . . . . . . . . . . . . . . . . . .

Disagree . . . . . . . . . . . . . . . . . . . . .

Noopinion . . . . . . . . . . . . . . . . . . . .

‘Td rather date people who

don’t smoke.”

Agree . . . . . . . . . . . . . . . . . . . . . . .

Disagree . . . . . . . . . . . . . . . . . . . . .

Noopinion . . . . . . . . . . . . . . . . . . . .

“(If I started) I could stop smoking

anytime I wanted.”

Agree . . . . . . . . . . . . . . . . . . . . . . .

Disagree . . . . . . . . . . . . . . . . . . . . .

Noopinion. . . . . . . . . . . . . . . . . . . .

“1 personally don’t mind being around

paoplewho areamoking.”

Agree . . . . . . . . . . . . . . . . . . . . . . .

Disagree . . . . . . . . . . . . . . . . . . . . .

Noopinion . . . . . . . . . . . . . . . . . . . .

“1 get a kick out of doing things every

now and then that are a little

risky or dangerous.”

Agree . . . . . . . . . . . . . . . . . . . . . . .

Disagree . . . . . . . . . . . . . . . . . . . . .

Noopinion . . . . . . . . . . . . . . . . . . . .

“Have you ever taken a class or course

atschool inwhich the health risks of

smoking were discussed.”

Yes . . . . . . . . . . . . . . . . . . . . . . . .

No. . . . . . . . . . . . . . . . . . . . . . . . .

17.2

77.6

4.8

67.1

22.4

10.2

S5.9

7.9

5.9

17.8

72.6

9.0

34a

58.0

6.8

41.9

49.6

7.9

75.2

24.1

10.6

84.5

4.5

78.5

12.9

6.2

94.1

3.2

2.4

11.4

7a.7

9.3

22.3

70,9

6.5

30.2

60.a

8.4

73.7

25.4

9.a

85.9

3.9

ao.9

11.6

7.3

94.7

2.7

2.3

11.3

79.0

9.2

20.5

73.2

6.0

26.5

62.5

a.s

74.9

24.5

15.7

75.6

7.9

63.9

21.5

14.2

90.2

6.2

3.1

11.9

76.6

10.0

33.6

56.3

9,7

37.5

49a

12.1

66.7

31.6

Percent distribution

17.8

77.8

4.1

71.0

la.1

10.7

16.1

72.1

9.3

35.1

57.0

7.7

52a

39.2

7.6

7a.o

21.5

25.5

70.2

●4.3

39.6

41.6

16.6

71.4

●9.6

19.3

29.8

66.8

●3.4

57.5

34.6

●al

59.1

33.6

●7.3

r32.o

I a.o

38.7

53.9

7.2

22.3

62.2

15.2

50.9

29.4

19.4

36.5

53.0

8.0

76.7

16.6

6.2

60.6

31.6

7.1

74.4

24.6

49.9

42.1

7.4

11.1

76.5

11.6

32.7

47.7

24.8

19.0

7;.;

85.5

9.7

4.1

59.9

32.7

6.5

73.7

24,4

41.6

48.7

8,4

15.2

70.5

14.3

43.4

32.7

23.6

46.7

46.5

●6.8

a4.6

1o.a

*4.4

66.5

26.7

●6.2

77.1

22.6

24.7

69.7

5.6

37.5

42.4

20.1

74.2

13.6

11.9

56.1

35.5

[1.4

6.2.2

27.1

10.0

5%4

31 .a

8.9

74.2

25,4

1Includes unknown type of current smoker.

2~fleren~jn ;~~ln”mber~ fteenager~f r~mfablel due;~~mPuter.&sisted Teleph~ne lntewiewing (w~lversus Cattail sample size (See T~nimlnOteS).

Includes unknowns.
Advance Data No. 224 ● February 1, 1993 19

Technical notes

Source and description of data

This report contains data from

the 1989 Teenage Attitudes and

Practices Survey (TAPS). The TAPS

was a targeted population study of

U.S. teenagers 12-18 years of age.

The study was conducted by the

National Center for Health Statistic’s

National Health Interview Survey

(NHIS) and co-sponsored by the

Centers for Disease Control’s Office

on Smoking and Health, the National

Cancer Institute, and the American

Cancer Society.

The TAPS survey was designed to

obtain current national household

data about current cigarette-smoking

behavior and lifetime smoking

practices of adolescents and their

beliefs about smoking. Selected

correlate measures associated with

smoking uptake were also addressed

in the study.

The TAPS sample was derived

from NHIS household interviews

conducted during the final two

quarters of 1988 and the first two

quarters of 1989. Included in the

sample were all sample teenagers

living in households contacted and

interviewed during this period that

were 12-18 years of age as of

November 1, 1989. The eligible

sample for the TAPS was 12,097

persons.

TAPS utilized two modes of data

collection. The primary method

consisted of computer-assisted

telephone interviewing (CATI) in

households where a telephone

number was provided during the

original NHIS interview. In addition,

self-administered questionnaires were

mailed to sample teenagers living in

households without telephones or an

available telephone number. Mail

questionnaires were also sent to those

teenagers that could not be reached

using the CATI method. Telephone

interviews and all other datacollection activities were performed

by U.S. Bureau of the Census

personnel. Data collection began in

August 1989 and continued through

March 1990.

Unlike the original NHIS

interview, the TAPS survey design

required that all teenagers respond

for themselves. However, prior to the

initial telephone contact, advance

letters were mailed to a parent or

guardian and to each eligible

teenager in the household explaining

the sponsorship and objectives of the

upcoming survey and assuring

confidentiality.

The total interviewed TAPS

sample included 9,965

adolescents— 9,135 responded in

CATI interviews and 830 completed

mail questionnaires. The total

combined response rate for the TAPS

from these two data collection

procedures was 82.4 percent. Most of

the nonresponse resulted from

teenagers’ failure to return the mail

questionnaire. Only 3.1 percent of

interviews of adolescents reached by

telephone ended in a refusal, either

because of the parents or teenagers

initial refusal or because of

subsequent termination of the

interview. Item nonresponse was less

than 1 percent for the questions

discussed in this report. More details

about non-response are available in a

recent report (17).

Sampling errors

Because estimates shown in this

report are based on a sample of the

population rather than on the entire

poptdation, they are subject to

sampling error. When an estimate or

the numerator or denominator of a

percent is small, the sampling error

may be relatively high. In addition,

the complex sample design of the

NHIS has the effect of making the

sampling errors larger than they

would be had a simple random

sample of equal size been used.

The following method for

computing sampling errors is

presented for the convenience of

readers who want a simple method to

use in calculating standard errors for

estimates in this report. More precise

methods, such as that available in the

software program SUDA4N (19),

which estimates standard errors for

complex surveys using TayIor

linearization, are recommended for

detailed analysis of NHIS data.

Approximate standard errors of

the estimated numbers (x) in this

report (except for all teenagers, by

age, race, and sex when the standard

error is assumed to be 0.0) may be

calculated using the formula

SE(x) = ~0.0000307(x)2 + 3,640(x)

Except as noted, approximate

standard errors of the estimated

percents in this report maybe

calculated using the formula

v“”-” SE@) =

,640 ~) (100 -p)

Y

where p is the estimated percent and

y is the population denominator.

Approximate standard errors for

the percents in table 5, by age and

race, may be calctdated by using the

formula

SE@) ‘p ~0.0000307 +3,640/x

where p is the estimated percent and

x =py/100 withy = the population

denominator.

If xl and X2are two estimates,

then the approximate standard error

of the difference (xl .X.) can be

computed as follows:

tiSE(xJ2 + SE(XJ -> SE(XI) SE(XZ)

where SE(X1) and SE (X2) are

computed using the appropriate

formulas previously presented in this

section, and r is the correlation

coefficient betieen xl and X2

(assuming r = 0.0 will result in an

accurate standard error if the two

estimates are actually uncorrelated

and wiI1resuh in an overestimate of

the standard error if the correlation is

positive or an underestimate if the

correlation is negative).

In this report, unless otherwise

noted, a difference was considered

statistically significant at the

5-percent level if the difference

(xl -xJ was at least twice as large as

its standard error.
20 Advance Data No. 224 ● February 1, 1993

Related documentation

More detailed discussion of the

sample design of the NHIS,

estimating procedures, procedures for

estimating standard errors,

nonsampling errors, and definitions of

other sociodemographic terms used in

this report have been published in

1.4ta[ and Health StatWcs, Series 10,

numbers 160 and 176; Series 1,

number 18; and Series 2, number 110

(20-23).

A public use data file based on

the 1989 TAPS was released in

Februa~ 1992. Information regarding

its purchase may be obtained by

writing to the Division of Health

Interview Statistics, National Center

for Health Statistics, 6525 Belcrest

Road, Hyattsville, Maryland 20782.

Suggested citation

AflenW, Moss AJ, GiovinoGA, et al.

Teenage tobacco use: Data estimates from

the Teenage Attitudeaand PracticesSuwey,

United States, 1989. Advance data from vital

and healthstatistics:no 224. Hyattsville,

Maryland: NationalCenter for Health

Statistics.1992.

Definition of terms- TAPS

Adolescent smoking

status categories

Never smoked -Never smoked a

cigarette.

Never smoked no intentionNever smoked a cigarette or tried or

experimented with cigarette smoking

will not try a cigarette soon; and

definitely will not be smoking in

1 year.

Never smoked, may smoke – Never

smoked a cigarette or tried or

experimented with cigarette smoking

may try a cigarette soon or may be

smokhg in 1 year.

Experimenter– Has either smoked

a cigarette or tried or experimented

with cigarette smoking, but has never

Copyright Information

This reportmay be reprintedwithoutfurther

permission.

The use of trade names is foridentification

only and does not imply endorsementby the

Public HealthServiceof the U.S. Department

of Health and Human Services.

smoked 100 cigarettes and has not

smoked in the past 30 days,

Former smoker-Has smoked at

least 100 cigarettes but has not

smoked in the past 30 days.

Cuvent smoker-Has smoked a

cigarette in the past 30 days.

Current light smoker–Has smoked

10 or more days in the past 30 days,

and smoked an average of fewer than

five cigarettes per day in the past 7

days.

Current heavy smoker– Has

smoked 10 or more days in the past

30 days, and smoked an average of

five cigarettes or more per day in the

past 7 days.

Current occasional smoker- Has

smoked 1 to 9 days in the past 30

days.

National Center for Health Statlstlc=

Director

ManningFeinleib, M.D., Dr. P.H.

ActingDeputy Director

Jack R. Anderson
Number 225 ● January 6, 1993

Advance

Data

From Vital and Health Statistics of the CENTERSFORDISEASECONTROLANDPREVENTION/NationalCenterfor Health Statistics

AIDS KnowledgeandAttitudesfor1991

Data From the National Health Interview Survey

by Sheila M. Aguilar and Ann M. Hardy, Dr.P.H., Division of Health Interview Statistics

Highlights

In 1991, levels of knowledge

about the major modes of

transmission of human immunodeficiency virus (HIV) remained high

in all sociodemographic groups

examined. Knowledge about other

aspects of acquired immunodeficiency

syndrome (AIDS) was more variable,

with older and less-educated adults

generally being less knowledgeable.

Several changes in responses to

survey items between 1990 and 1991

were noted, including

An increase from 19 to 29 percent

in the proportion who felt they

knew “a lot” about AIDS.

An increase from 79 to 86 percent

in the proportion who had heard

the AIDS virus referred to as

“HIv.,,

An increase of 3–6 percentage

points in the percent of adults

stating that various forms of casual

contact were “very unlikely” or

“definitely not possible” ways to

transmit HIV.

A slight increase in the proportion

who reported ever havin-g HIV

antibody testing —excluding blood

donation (from 11 to 15 percent)

and testing through all means

(from 26 to 29 percent).

In addition, some changes in

responses were noted during 1991,

particularly in the fourth quarter

compared with earlier quarters.

Noteworthy changes seen during 1991

included:

●

●

●

●

●

The proportion who received

information about AIDS from

television programs in the month

before the interview increased

from 72 to 78 percent.

The percentage of parents who

had ever discussed AIDS with

their children rose from 66 percent

in the first quarter to 72 percent in

the last quarter of 1991.

The proportion who knew a

person can be infected with the

AIDS virus and not have the

disease AIDS increased by

5 percentage points (from 77 to

82 percent).

Those pIanning future testing for

HIV antibodies who indicated such

testing wouId be voluntaxy

increased from 65 to 71 percent.

The proportion who had heard of

zidofid{ne (also known as AZT or

azidothymidine and by the brand

name “Retrovir”) increased from

50 to 55 percent.

Introduction

The National Center for Health

Statistics (NCHS) has included

questions about HIV and AIDS as

part of the National Health Interview

Survey (NHIS) since 1987. The

purpose of these questions is to

provide population-based data on

adults’ knowledge about AIDS and

transmission of HIV and on their

experience with HIV antibody testing.

Such information is used to help plan

and monitor various educational and

prevention programs. The

questionnaire used in 1991 is the

fourth version of this survey (l).

Although new questions have been

introduced in each version to meet

changing data needs, many questions

have been used repeatedly to allow

for examination of trends. NCHS has

routinely published results from this

suxvey in Advance Data From 141al

and Health Statistics (2-9). In

addition, public use data tapes of the

1987-90 surveys are currently

available rmd more detailed

exploration of the data is encouraged.

The NHIS AIDS questionnaires

have been developed by NCHS and

an Interagency Task Force created by

the Public Health Service Data Policy

Committee. The Task Force includes

representatives from other centers

w~hin the Centers for Disease

Control and Prevention and from the

Office of the Assistant Secretary for

*m$’let*.

# %,

***

+

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

g Public Health Seivice

?!

.%

Centers for Disease Control and Prevention %+--aa >

National Center for Health Statistics CENTERS CKFOR DISE4SE CONTROL

ANO PREVENTION
2 Advance Data No. 225 ● January 6, 1993

Health; the National AIDS Program

Office; the National Institutes of

Health; the Alcohol, Drug Abuse,

and Mental Health Administration;

the Food and Drug Administration;

the Office of Population AfYairs;the

Indian Health Service; the Agency for

Health Care Policy and Research;

and the Health Resources and

Services Administration.

Data and methods

This report presents a summary

of data for the entire 1991 datacollection year. Thus there is some

overlap with the earlier report that

described results from the first

quarter of 1991 (9). UnIess otherwise

stated, the results described were

consistent throughout 1991. For

certain items, some differences were

noted for the fourth quarter of 1991,

and these are pointed out. While the

exact cause of these variations for

that particular quarter is not known,

most readers are probably aware of

the considerable amount of publicity

that occurred in the fourth quarter of

1991 after Earvin “Magic” Johnson

announced that he was infected with

HIV. Further analyses are underway

to determine the impact of this

announcement on responses to the

NHIS and other AIDS surveys. Also,

1990 data cited in this report for

comparison refers to data reported

from the fourth quarter of 1990 (8).

Details about the sample design and

the estimation procedure can be

found in “Technical notes” at the end

of this report.

Table 1 shows percent

distributions by response categories to

most of the items included in the

NHIS AIDS questionnaire for the

entire adult population as well as

various subgroups defined by age, sex,

race and ethnici~, and education. In

most cases, the actual questions are

reproduced verbatim in the tables

along with the response categories.

Refusals and other nonresponse

categories (generally less than

1 percent of total responses) are

excluded from the denominator in the

calculation of estimates, but

responses of “don’t know” are

included. The NHIS AIDS survey

uses the phrase “the AIDS virus”

rather than “HIV” because it is felt

to be more widely recognized;

however, in this report the two terms

are used synonymously.

When interpreting trend data,

revisions in the questionnaire,

whether in actual wording or in

context and location of questions,

must be considered. There were

several important changes and

additions to the 1991 version of the

survey. First, the series of knowledge

items that contain selected statements

about HIV and AIDS (question 5 in

the 1991 survey) had five possibIe

responses in earIier versions of the

questionnaire: “definitely true,”

“probably true, “ “probably false,”

“definitely false,” and “don’t know.”

In 1991, the distinction between

definitely and probably was

eliminated Ieaving “true,” “false,”

and “don’t know” as the only possible

response choices.

Before 1991, the section on HIV

antibody testing began with a

question assessing whether persons

had heard of the blood test to detect

the AIDS virus infection; those who

were not aware of the test were

skipped past the remainder of this

section. In 1991, this lead-in was

eliminated because of concern about

people attempting to end the survey

prematurely, Persons who truly were

not familiar with HIV antibody

testing still had the option of

responding “don’t know” to questions

in this section.

Several new items were added to

the 1991 survey, including the

perceived likelihood of becoming

infected by receiving care from an

infected health care worker or by

donating blood. Reasons why persons

had not been tested for HIV were

examined. Items were added to assess

respondents’ knowledge about the

HIV antibody test, about AZT, and

about the proper use of condoms.

Finally, in 1991, a distinction was

made between having a co-worker

with HIV or AIDS and having other

friends or relatives with the disease.

Selected findings

The following highlights describe

survey results of the NHIS AIDS

Knowledge and Attitudes Survey for

1991. Unless otherwise noted in the

text, all measures described remained

stabIe over this period. All .diffe.rences

cited in the text are statistically

significant at the .05 level. Table II

shows provisional estimates of lthe

standard errors associated with these

results.

Sources of information

In 1991, 86 percent of adults

stated that they had received

information about AIDS in the past

month. This was consistent with the

figure reported for 1990. Of all

categories listed, the primary sources

of information were television

programs (73 percent), newspaper

articles (47 percent), magazine

articles (40 percent), and radio

programs (35 percent). From the

third to fourth quarter of 1991, there

was a notable increase in the

proportion receiving AIDS

information. During this time the

percent of adults hearing or seeing

information from any of the sources

mentioned above rose from 1 to

6 percentage points.

When specifically asked about

exposure to public service

announcements (PSA’S) in the

previous month, 80 percent reported

viewing them on television, 45 percent

hearing them on radio, and 9 percent

seeing posters in airports. For all

three sources, those 18-29 years old,

and those with more than 12 years of

education appeared to have had more

exposure to PSA’S than had their

counterparts.

Of parents of 10-17-year-olds,

69 percent reported ever discussing

AIDS with those children. Overall,

white and black parents were more

likely to talk to their children about

AIDS than were Hispanic parents

(70 percent, compared with

61 percent). Women and those 3G49

years old were also more likely to

discuss the topic. The percentage of

parents discussing AIDS with their

children increased with years of
Advance Data No. 225 ● January 6, 1993 3

education, from 56 percent for those

with less than 12 years of education

to 75 percent for those with more

than 12 years of education. Seventyfour percent of parents reported that

their children received instruction

about AIDS at school. This figure is

similar to the percent reported for

1990. The percentage of parents who

reported talking to their children

about AIDS increased in the fourth

quarter of 1991 (72 percent,

compared with the earlier quarters’

range of 66-69 percent).

General knowledge about AIDS

In 1991, of the adults asked to

assess their knowledge of AIDS,

29 percent stated they knew “a lot,”

and 44 percent stated they knew

“some.” The percentage of those who

knew “a lot” had increased

10 percentage points since 1990,

whereas the percent answering

“some” remained stable throughout

1991. The percentages decreased for

those who answered “a little”

(25 percent in 1990 to 19 percent in

1991) and “nothing” (10 percent in

1990 to 8 percent in 1991).

AIso in 1991, a higher percentage

of people reported having heard the

AIDS virus called “HIV” –86 percent

in 1991, compared with 79 percent in

1990. Awareness was lower among

persons with less than 12 years of

education, those over 50 years old,

and those of Hispanic descent

(67 percent, 78 percent, and

72 percent, respectively).

In 1991, new sets of responses

were used for questions pertaining to

knowledge about AIDS. Prior to

1991, four responses were possible,

ranging from “definitely true” to

“definitely false.” In 1991, the

response categories were changed to

“true” or “false. “ “Don’t know” also

remained an acceptable response in

the 1991 questionnaire. This decrease

in categories may have accounted for

the change in proportions with

correct responses from 1990.

Ninety-five percent of adults

knew that AIDS is transmissible

through sexual intercourse, 94 percent

believed a pregnant woman infected

with AIDS can give it to her baby,

92 percent knew there is no cure for

AIDS at present, 85 percent knew

AIDS reduces the body’s natural

protection against disease, and

81 percent knew it is an infectious

disease caused by a virus. Persons

who commonly answered incorrectly

included those 50 years old and over

and those with 12 or fewer years of

education. However, more individuals

answered “don’t know” than provided

the incorrect true-false response.

Correct responses to other

AIDS-knowledge questions were

lower. Eighty percent of adults knew

that a person who has the AIDS virus

can look and feel healthy, but

78 percent knew that a person can be

infected with HIV and not have the

disease AIDS. Sixty-seven percent of

adults were aware of the availability

of drugs that can lengthen the life of

a person infected with AIDS. For

these items, the proportion with the

correct response was 4-5 percentage

points higher in the fourth quarter of

1991 than in previous quarters.

Also in 1991, more than half of

all adults knew that early treatment

of HIV can reduce symptoms in an

infected person and that AIDS can

damage the brain. As before,

knowledge levels were lower for older

individuals and those with less

education.

Misconceptions about HIV

transmission

The NHIS AIDS supplement

provides information on respondents’

perceptions of the likelihood of HIV

transmission associated with several

forms of contact. There were five

response categories, which ranged

from “very likely” to “definitely not

possible.” The proportion of adults

who believed the various modes of

transmission were “very unlikely” and

“definitely not possible” remained

stable throughout 1991 but for most

were slightly higher than in 1990. For

these two response categories, the

highest percentages were reported for

questions that assessed transmission

by working near someone with AIDS,

attending school with a child who has

AIDS, using public toilets, eating in a

restaurant where the cook has AIDS,

and being coughed or sneezed on.

Although general knowledge

levels about AIDS were high,

perceived likelihood of transmission

persisted for questions evaluating

transmission through casual contact

with a health care worker (27 percent

reported “very likely,” and 33 percent

reported “somewhat likeIy”); by

sharing plates, forks, or glasses (10

and 18 percent); and through

mosquitoes or other insects (9 and

16 percent). As with previous reports,

younger persons, those with more

education, and white adults were

more likely to view these modes as

unlikeIy or impossible factors in HIV

transmission.

Blood donation and blood

screening

Patterns of past blood donation

were similar in 1991 to those seen in

previous years. Overall, 42 percent of

adults reported ever having donated

bIood; 18 percent had donated since

March 1985 (when routine screening

of donated blood for HIV began);

and 6 percent had donated in the past

year. In general, men were more

likely to have donated than women,

and donations increased with years of

education.

In 1991, 60 percent of adults

knew that a person could not get

HIV while donating blood for use by

others 30 percent believed that they

could; and 10 percent did not know.

Misconceptions about transmission of

HIV by donating blood were higher

among black adults (43 percent

believed that AIDS could be

transmitted this way, compared with

27 percent of white adults), and those

with less than 12 years of education

(38 percent, compared with

24 percent of those with more than 12

years of schooling). It should be

noted that the data did not

distinguish between a respondent who

believed that such transmission was

likely and one who thought it was just

a theoretical possibility if standard

blood bank practices were not

followed. AIso, despite attempts to
d Advance Data No. 225 QJanuary 6, 1993

rake the w’orciingclear, some

respondents may still have mistakenly

believed that the question referred to

getting HIV from receiving blood.

Further refinement of this question

may help clarify the responses being

elicited.

Seventy-six percent of adults in

1991 believed that b]o~d donations

were routinely tested for the AIDS

\ :Tus. This figure remained stable’

throughout 1991, but it was higher

than that reported in the last quarter

cf 1990 (68 percent), Also, the

proportion who did not know the

answer to this question more than

doubled between 1990 and 1991

(from 7 to 16 percent). These changes

rr.ay have been due in part to the

elimination in 1991 of the question

sequence that first asked if persons

were aware of the blood test to detect

HIV infection and then proceeded to

o:her questions related to HIV

testing.

HIV antibody testing

Considering HIV testing done for

all reasons (including blood

donation), an estimated 29 percent of

adults in the United States reported

having been tested for antibodies to

HIV. In 1991, the percent of adults

ever tested for HIV— apart from

blood donation –was 15 percent, up

s[ightly from 11 percent in the last

quarter of 1990. In the remainder of

this report, all reference to HIV

testing is restricted to testing for

reasons other than blood donation.

In 1991, the NHIS asked those

adults who had not been tested for

HIV why they had not. The most

common response, given by

84 percent of those never tested, was

that they did not consider themselves

to be at risk for AIDS. Very few

respondents (less than 2 percent)

chose recognized barriers to

testing—such as fear of

discrimination, not knowing where to

go for testing, and not trusting the

medical community to keep results

confidential – as reasons they had not

been tested. The remainder listed

fear of needles (1 percent), chose

another unspecified reason

(6 percent), or said they did not know

why they had not been tested

(9 percent). These figures remained

essentially the same through all of

1991.

For those who had ever been

tested, about two-thirds had been

tested once, and one-third had been

tested more than once, This pattern

was similar in all subgroups

examined. About one-half of those

who had been tested had had the test

in the 12 months before the

interview.

The reported reasons for HIV

antibody testing were similar in 1991

to those reported in 1990. Twenty-five

percent of those tested did so solely

to find out if they were infected.

Another 6 percent cited referral by

their doctor, the health department,

or their sex partner. Fourteen percent

had been tested in preparation for

hospitalization or a surgical

procedure, 14 percent to apply for

health or life insurance, and 7 percent

each for military induction or service

and for employment. Although

immigration was mentioned by only

6 percent of all adults tested, it was

the reason most commonly cited by

Hispanic persons (31 percent). A in

1990, most of those in 1991 who

reported being tested had had their

last test at their doctor’s office or

health maintenance organization

(HMO) (30 percent); at a hospital,

emergency room, or outpatient clinic

(25 percent); or at a community

health clinic (7 percent).

As in the past, about threequarters (79 percent) of those tested

received their results. This figure

decreased with age and was higher

among Hispanic adults who were

tested than among black or white

adults who were tested (85 percent

compared with 81 and 78 percent,

respectively). In 1991, 60 percent of

those who were tested received their

results in person. This figure showed

a slight decrease in the second half of

1991 from the first half (62 percent

compared with 57 percent). In 1991,

almost all adults tested said they felt

their results were accurate

(99 percent) and that their results

were handled properly in terms of

confidentiality (95 percent).

The proportion who indicated

intention to be tested in the next year

was 9 percent, similar to that

reported previously. The figure was

highest among black adi.dts

(21 percent). Of those who planned

to be tested, most (67 percent) said

they would be tested voluntarily

because they wanted to know if they

were infected. The proportion of

those planning testing who mentioned

this as a reason increased slightly

from 65 percent in the first quarter of

1991 to 71 percent in the last quarter.

In addition to this reason, another

19 percent said they would be tested

as part of a blood donation, and

8 percent each indicated it would be

to apply for a job or for insurance

(health or life), The percentages for

the places where respondents said

they would go to have their blood

tested were similar to those for places

cited by those already tested.

Seven!y-four percent of adults

recognized that “after a person is

infected with the AIDS virus, there

can be a period of time before the

[bloodJ test shows the infection”;

23 percent responded “don’t know”

to this statement. The proportion

with the correct response to this item

increased slightly in 1991 (70 percent

correct in the first quarter compared

with 76 percent in the last quarter).

Persons less likely to be aware of this

fact included those with less than 12

years of education (55 percent

correct), Hispanic adults (61 percent

correct), and those 50 years and cwer

(64 percent correct).

Awareness about zidovudine

A new question was added to the

1991 NHIS AIDS supplement to

assess an individual’s awareness of

zidovudine (also known as AZT or

azidothymidine and by the brand

name “Retrovir”). AZT was the first

antiviral drug approved for use in the

treatment of HIV. More than

one-half of all adults reported that

they had heard of this drug. A

notable increase in awareness

occurred from the third to fourth
Advance Data No. 225 ● January 6, 1993 5

quarter of 1991 (50 to 55 percent).

Persons between the ages of 30 and

49 (59 percent), and those having

higher levels of education were more

familiar with the drug (24 percent for

adults with less than 12 years of

education compared with 69 percent

for those with more than 12 years of

education). Hispanic adults were less

aware of AZT than white or black

adults (32 percent compared with 55

and 43 percent, respectively).

Among persons who had heard of

AZT, 89 percent were aware that

AZT does not cure people with

AIDS, 81 percent knew it can delay

or slow down the symptoms of HIV

infection, and 59 percent knew of the

drug’s side effects. Thirty-four

percent knew AZT is only

appropriate for an HIV-infected

individual at certain times during the

illness. Proportionately more people

answered “don’t know” to this

question (55 percent), as opposed to

those giving the incorrect response

(11 percent). Half of the adults

surveyed knew there are other drugs

available to treat AIDS-related

illnesses. Behveen the third and

fourth quarters, this percentage rose

five points (from 49 to 54 percent).

However, 35 percent answered

“don’t know,” and 14 percent did not

belieye other drugs existed. Slight

percentage fluctuations across all

sociodemographic groups indicated no

specific pattern for those who

answered “don’t know” as opposed to

the correct response. For each

question, more people answered

“don’t know” rather than giving the

incorrect response.

Perceptions about condom use

As in previous years, the 1991

NHIS asked respondents to evaluate

the efficacy of condom use as a

means of preventing sexual

transmission of HIV. Overall, since

1990, the percentages responding

“very effective” and “don’t know”

increased (25 and 15 percent in 1990

compared with 28 and 17 percent in

1991, respectively), and those who

answered “somewhat effective”

decreased from 53 percent in 1990 to

49 percent in 1991.

The proportions of individuals

who answered “very effective” stayed

consistently beIow one-third

throughout 1991. For the adults who

believed condom use to be

“somewhat effective” in preventing

HIV infection, there was a 2-percent

increase between the third and fourth

quarters of 1991 (49 to 51 percent).

Persons least likely to believe in the

efficacy of condoms were females,

black adults, those of Hispanic

descent, and those with Iess than 12

years of education (19, 22,21, and

32 percent, respectively).

Two new questions in the 1991

AIDS supplement gauged knowledge

of correct condom use. These

questions evaluated respondents’

ability to distinguish the relative

effectiveness of latex versus naturalmembrane condoms and whether they

knew the dangers of using oil-based

lubricants with latex condoms. For

both of these questions, more people

chose “don’t know” than the correct

response.

Although 77 percent of aduhs

considered condom use at least

somewhat effective in preventing HIV

infection, 61 percent of adults did not

know if there was a difference

between the effectiveness of latex and

natural-membrane condoms.

Nineteen percent recognized that

there was a difference, and 1Spercent

felt there was no difference in

effectiveness between the two types of

condoms. Persons 30-49, white

persons, and those with more than 12

years of education were more likely

to provide the correct response;

however, even in these groups more

than half responded “don’t know.”

Similarly, only 27 percent knew that

oil-based lubricants cause latex

condoms to break, and 65 percent

were unsure of this effect. Six percent

called the statement “false.” Males

and younger individuals were more

likely to give the correct answer (31

and 36 percent, respectively). Correct

responses increased with years of

education – 16 percent for those with

less than 12 years of education up to

34 percent for those with more than

12 years of education. Those more

likely to respond “don’t know”

included females (70 percent), those

50 years of age and over (76 percent),

individuals of Hispanic descent

(67 percent), and persons with less

than 12 years of education

(73 percent).

Risk of HIV infection

In 1991, 80 percent of adults felt

they had no chance of being infected

with HIV, and 72 percent said they

had no chance of getting it in the

future. Black adults were somewhat

less likely than white or Hispanic

persons to rate their chances of

having or getting HIV as “none.”

Also, those 18–29 years of age were

less likeIy than older persons to feel

they had no chance of being or

becoming infected. Only 1–2 percent

of adults felt their chances of having

or getting HIV were “high” or

“medium” (these proportions varied

little among the sociodemographic

groups). As in the past, only a small

proportion of adults (3 percent)

reported being in any of the behavior

categories associated with an

increased risk of HIV infection.

Knowing someone with AIDS

In the past, the NHIS AIDS

survey has asked respondents if they

had ever personally known someone

with HIV infection or AIDS. In 1991,

the distinction was made between

having a co-worker with HIV or

AIDS and knowing others (friends or

relatives) with the infection. Four

percent of adults reported having had

a co-worker with HIV or AIDS. This

figure increased with years of

education, from 2 percent of those

with less than 12 years to 7 percent

for those with more than 12 years.

Nke percent of persons reported

having a friend or relative with the

disease. This also increased with

years of education and was higher for

those 30-49 years of age than for

younger or oIder persons. For both

situations, the proportion who said

they personally knew someone with

AIDS was stable throughout 1991.
6 Advance Data No. 225 ● January 6, 1993

References 4.

1.

2.

3.

Adams PF, Benson V. Current

estimates from the National

Health Interview Survey, 1991.

National Center for Health

Statistics. Vital Health Stat

10(184). 1992.

Dawson DA, Thornberry OT.

AIDS knowledge and attitudes for 5.

December 1987: provisional data

from the Xational Health

Interview Survey. Advance data

from vital and health statistics;

no 153. Hyattsville. Maryland:

National Center for Health

Statistics. 1988.

Hardy A\l, Dawson DA. AIDS 6.

knowledge and attitudes for

December 1988: provisional data

from the National Health

Interview Survey. Advance data

from vital and health statistics;

no 175. Hyattsville, Maryland:

National Center for Health

Statistics. 1989.

Hardy AM. AIDS knowledge and

attitudes for October-December

1989: provisional data from the

National Health Interview Survey.

Advance data from vital and

health statistics; no 186.

Hyattsville, Maryland: National

Center for Health Statistics. 1990.

Dawson DA. AIDS knowledge and

attitudes for January-March 1990:

provisional data from the National

Health Interview Survey. Advance

data from vital and health

statistics; no 193. Hyattsville,

Maryland: National Center for

Health Statistics. 1990.

Fitti JE, Cynamon M. AIDS

knowledge and attitudes for

April-June 1990: provisional data

from the National Health

Interview Survey. Advance data

from vital and health statistics;

no 195. Hyattsville, Ma@and:

National Center for Health

Statistics. 1990.

7.

8.

9.

Adams PF, Hardy AM AIDS

knowledge and attitudes for

July-September 1990: provisional’

data from the National Health

Intemiew Survey. Advance data

from vital and health statistics;

no 198. Hyattsville, Maryland:

National Center for Health

Statistics. 1991.

Hardy AM. AIDS knowledge ancl

attitudes for October-December

1990: provisional data from the

National Health Interview Survey.

Advance data from vital and

health statistics; no 204.

Hyattsville, Maryland: National

Center for Health Statistics. 1991,

Hardy AM. AIDS knowledge and

attitudes for January-March 1991;

provisional data from the National

Health Interview Survey. Advance

data from vital and health

statistics; no 216. Hyattsville,

Maryland: National Center for

Health Statistics. 1992.

Symbols

--- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less

than 0.5

z Quantity more than zero but less

than 500 where numbers are

rounded to thousands

* Figure does not meet standard of

reliability or precision (estimate is

based on fewer than 20 biflhs in

numerator or denominator)
Advance Data No. 225 ● January 6, 1993 7

Table 1. Estimates of the percent of persons 18 years of age and over with selected AIDS knowledge and attitudes from the 1991

National Health Interview Survey, by selected characteristics: United States, 1991

[Data are based on household interviews of the civilian noninstitutionalized population. The survey design, general qualifications, and information

on the reliability of the estimates are given in technical notes]

Race or ethnicf!y

Age Sex Non-Hispanic Education

18–29 30-49 50 ears

3

Less than 12 More than

AIDS knowledge or ati”tude Total years years an over Male Female WNte Black Hispanic 12 years yeara 12 yeara

Total

1.

2.

2a.

2b.

2C.

3.

4.

5.

5a

5b.

SC.

5d.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

How much would you say you know about AIDS?

A lot . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Some . . . . . . . . . . . . . . . . . . . . . . . . . . .

Alittle . . . . . . . . . . . . . . . . . . . . . . . . . . .

Nothing . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

In the past month have youSeen any public service announcements about AIDS

on television?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Heardan pubficservice announcement.$ about

AIDS& ;e radio?

No.:::::::::::::::::::: ::::::::

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Donitknow . . . . . . . . . . . . . . . . . . . . . . . .

lnthepast month, have oureceived information

about AIDS from any oft Kese sources?’

Televisionprograms . . . . . . . . . . . . . . . . . .

Radioprograms . . . . . . . . . . . . . . . . . . . . .

Magazine tiicles . . . . . . . . . . . . . . . . . . . .

Newspaperarticles . . . . . . . . . . . . . . . . . . .

Streetsignsbillboards. . . . . . . . . . . . . . . . .

Store displaysdstore-dietributedbrochures . . . .

Bus/streetcar/subwaydisplays. . . . . . . . . . . .

Heaith department brochures . . . . . . . . . . . .

Workplacedistributed brochures . . . . . . . . . .

Schooldistributed brochures . . . . . . . . . . . .

Church-distributed brochures . . . . . . . . . . . .

Community organization . . . . . . . . . . . . . . .

Friend/acquaintance . . . . . . . . . . . . . . . . . .

AIDS hotiine . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Received no AIDS information in past month. . .

Have ouheard the AIDSvirus celled bythe name

“Hl~’$

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Tellmewhstheryou thinkthefollowing etatementeare

true or false or f you don’t know II they are true or false.

$4ES.nracfucethe bcdy’anaturel protection against

Tre e . . . . . . . . . . . . . . . . . . . . . . . . . . .

False. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

AIDScendamage thebrain.

True . . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknrnv . . . . . . . . . . . . . . . . . . . . . . . .

AIDSisan infectiousdisaasecausedby avirus.

True . . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . . .

IX)n’tkrmv . . . . . . . . . . . . . . . . . . . . . . . .

Aperaoncanbeinfactad withtheAIDSvirus andnot

havethediseaaeAIDS.

True . . . . . . . . . . . . . . . . . . . . . . . . . . . .

False. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Seafcubwtesarerd ofteble.

100

29

44

19

8

0

80

18

2

45

52

3

9

89

2

73

35

40

47

16

7

6

13

10

7

4

4

a

1

3

1

14

86

12

2

85

4

11

55

16

29

81

6

13

78

6

15

100

32

50

16

3

0

82

17

1

53

45

2

11

87

1

74

41

43

41

22

9

10

19

10

14

3

4

11

1

3

0

13

91

9

1

88

4

8

46

26

28

S8

5

8

81

9

10

100

34

47

ts

3

0

82

16

2

49

48

3

10

86

2

75

39

43

50

17

7

6

14

14

8

4

4

9

1

4

1

12

91

a

1

91

3

6

56

;;

86

6

8

65

6

9

10Q

20

37

27

17

0

77

20

3

33

63

4

6

91

2

72

26

34

49

9

4

3

8

5

;

3

5

0

2

1;

78

19

4

76

5

19

60

8

32

70

7

24

69

5

26

100

28

44

21

8

0

S1

17

2

50

4a

3

10

86

2

75

40

38

49

18

8

7

12

11

:

4

8

:

1

14

86

12

2

87

3

10

56

17

27

63

5

12

78

7

15

F’ercent cf!strmutton

100

29

45

18

7

0

80

18

2

40

57

3

8

91

2

72

31

42

46

13

6

5

15

10

6

4

3

8

;

1

14

86

12

2

64

4

12

54

:

79

7

14

78

6

16

100

29

4s

18

6

0

81

17

2

43

54

3

2

2

74

34

41

49

15

6

5

12

9

;

3

7

0

3

1

14

69

10

1

8S

3

9

54

17

29

81

8

13

81

5

13

100

26

38

23

13

0

63

16

1

52

46

2

12

87

2

75

41

38

42

20

10

13

19

15

10

6

6

11

;

1:

85

12

3

73

8

19

60

E

82

5

14

72

9

19

100

26

38

23

11

74

25

2

50

47

3

13

63

4

71

41

37

42

16

10

9

Is

10

10

6

1:

1

3

1

16

72

24

3

77

4

19

58

;

79

4

16

6s

2

100

15

31

31

23

0

72

25

3

34

63

3

6

92

2

68

27

24

33

9

5

4

10

4

:

2

6

:

2:

67

28

!5

65

6

28

55

3:

68

5

27

59

3!

100

24

48

22

5

0

82

18

2

45

52

3

9;

1

75

35

39

46

14

7

5

13

9

6

4

3

8

:

1

14

88

10

1

86

4

10

55

:

81

7

13

79

7

14

100

39

47

12

2

0

83

16

2

50

47

3

12

86

2

75

39

49

56

20

8

1:

14

9

4

5

9

1

4

1:

94

5

1

95

2

3

54

21

25

88

5

7

88

5

7

.... . . -.
8 Advance Data No. 225 ● January 6, 1993

Table 1. Estimates of the percent of persons 18 years of age and over with selected AIDS knowledge and attitudes from the 1991

National Health Interview Survey, by selected characteristics: United States, 1991 -Con.

[Data are based on household interviews of the civilian noninstitutionalized population. The survey design, general qualifications, and information

on the reliability of the estimates are gwen in technical notes]

Race or efhnicity

Age Sex Non-Hispanic Ecfucation

18–29 3049 50 ears

C/’

Less than

A/DS know/edge or attffude

72 More than

Total years years an over Male Female White Black HLspanic 12 years years ?2 years

Se,

5f.

5g.

5h.

5i.

5j.

5k.

6.

6a.

6b.

6c.

6d.

ANY person with the AIDS virus can pass it on to

someone else through sexual intercourse.

True . . . . . . . . . . . . . . . . . . . . . . . .

False .,, . . . . . . . . . . . . . . . . . . .

Don’t know . . . . . . . . . . . . . . . . . . . . .

A pregnant woman who has the AIDS virus can gwe

it to her baby.

True, . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’t know . . . . . . . . . . . . . . . . . . . . . . . .

A person who has the AIDS virus can look and feel

well and healthy.

True . . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow. . . . . . . . . . . . . . . . . . . . . . .

There are drugs available which can lengthen the

life of a person infected with the AIDS virus.

‘ True . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Early treatment of the AIDS virus infect!on can

reduce symptoms in an infected person.

True” . . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow. . . . . . . . . . . . . . . . . . . . . . . .

There is a vaccine available to the publlc that

protects a person from getting the AIDS virus.

True . . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

There is no cure for AIDS at present.

True . . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow, . . . . . . . . . . . . . . . . . . . . . . .

Howhkel do outhink itwthat aperson will get

AIDSort lbeAl Svirus infection fromWorking near someone with the AIDS virus?

Verylikely . . . . . . . . . . . . . . . . . . . . . . . .

Somewhat likely . . . . . . . . . . . . . . . . . . . .

Somewhat unlikely . . . . . . . . . . . . . . . . . . .

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . .

Definitely not possible . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Eating in a restaurant where the cook has the

AIDS virus?

Verylikely . . . . . . . . . . . . . . . . . . . . . . .

Somewhat likely . . . . . . . . . . . . . . . . . . . .

Somewhat unlikely . . . . . . . . . . . . . . . . . . .

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . .

Definitely not possible.. . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Sharing Iates, forks, orglasses with someone who

hsa the I lDSvlrus?

Very likely . . . . . . . . . . . . . . . . . . . . . . .

Somewhat likely . . . . . . . . . . . . . . . . . . . .

Somewhatunlikely . . . . . . . . . . . . . . . . . . .

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . .

Defmitelynotpossible . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Usina Dubiic toileta?

~eryllkely . . . . . . . . . . . . . . . . . . . . . . . .

Somewhat hkely. . . . . . . . . . . . . . . . . . . .

Somewhat unlikely . . . . . . . . . . . . . . . . . . .

Very unlikely...,.....,.. . . . . . . . . . . .

Definitely not posslbla . . . . . . . . . . . . . . . . .

Don’t know. . . . . . . . . . . . . . . . . . . . . . . .

.%afootnotesatend Oftable.

95

1

4

94

1

6

80

8

12

67

9

24

56

12

33

4

82

15

92

2

5

2

5

6

41

39

6

6

16

12

35

20

10

10

18

12

31

19

10

6

11

10

36

28

9

97

1

2

96

0

4

85

7

8

66

12

23

56

14

31

6:

11

94

2

4

2

4

6

41

45

3

5

16

15

36

22

6

7

16

12

34

25

5

5

10

11

38

33

5

97

1

2

96

0

3

86

6

8

72

9

19

61

12

27

6:

9

95

2

3

2

5

6

42

42

3

6

16

12

37

22

7

10

18

13

33

20

7

5

9

10

39

31

5

92

1

7

90

1

10

69

10

21

62

8

31

49

10

41

4

72

24

86

2

9

3

5

6

41

32

12

8

17

10

30

17

18

12

20

10

27

14

17

7

13

9

33

21

16

95

1

4

93

:

81

7

12

68

10

22

57

12

31

6:

13

93

2

5

2

5

6

43

38

6

6

17

12

36

20

9

10

18

12

31

19

9

5

11

10

37

29

8

Percent distribution

95

1

4

95

0

5

79

6

13

66

9

25

54

11

34

3

80

17

92

2

6

2

5

6

40

40

7

6

16

12

33

20

11

10

18

;;

20

10

6

11

10

35

26

10

96

1

3

95

0

5

e3

6

11

70

6

22

57

11

32

8:

12

94

2

4

2

4

6

43

40

5

6

16

;:

20

10

9

18

12

32

19

9

5

10

10

36

29

8

94

1

5

93

:

75

10

15

58

14

27

50

15

35

7

72

21

69

3

8

4

6

7

39

35

9

10

~e

11

31

17

13

13

20

10

29

16

12

9

13

10

33

23

12

94

1

5

93

;

68

13

19

58

G

51

11

38

7

71

22

85

4

11

4

6

8

32

42

9

7

16

13

27

23

13

10

17

11

26

23

12

8

12

11

30

26

11

90

1

10

87

1

12

60

12

28

50

10

40

40

11

49

6

64

30

62

4

14

4

6

7

36

31

le

9

18

10

25

15

22

13

20

9

24

15

20

10

14

8

26

20

19

96

1

3

95

:

80

1;

65

11

24

54

13

34

3

83

14

94

2

4

2

5

7

42

39

5

7

18

;

19

10

12

19

12

30

19

9

6

12

11

35

26

6

97

1

2

97

0

3

90

4

5

77

6

15

65

11

24

9;

8

97

1

2

1

4

5

44

44

2

4

14

13

4!

24

5

7

16

13

36

22

5

3

1:

41

:33

4
Advance Data No. 225 ● January 6, 1993 9

Table 1. Estimates of the percent of persons 18 years of age and over with selected AIDS knowledge and attitudes from the 1991

National Health Interview Survey, by selected characteristics: United States, 1991 -Con.

[Data are based on household interviews of the civilian noninstitutionalized population. The survey design, general qualifications, and information

on the reliability of the estimates are given in technical notes]

Race or effrmcity

Age Sex Non-Hispanic Education

18-28 3049 50 ears

1

Less than

AIDS knowledge or attitude

12 More than

Total years years an over Male Female White Black Hispanic 12 years years 12 years

6e.

6f.

6g.

6h.

ei.

7.

10.

11.

:2.

13a.

13b.

Sharing needles for drug use w!th someone who

has the AIDS virus?

Verylikely . . . . . . . . . . . . . . . . . . . . . . . .

Somewhat fikely . . . . . . . . . . . . . . . . . . . .

Somewhat unlikely . . . . . . . . . . . . . . . . . . .

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . .

Definitely not possible . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Bein coughed or sneezed on by someone who has

the ADS ~ virus?

Verylikely . . . . . . . . . . . . . . . . . . . . . . . .

Somewhat fikely . . . . . . . . . . . . . . . . . . . .

Somewhat unfikely . . . . . . . . . . . . . . . . . . .

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . .

Definitely notpossible . . . . . . . . . . . . . . . . .

Don’t know . . . . . . . . . . . . . . . . . . . . . . . .

Attending schml with a child who has the AIOS

virus?

Veryfikely . . . . . . . . . . . . . . . . . . . . . . . .

Somewhatiikely . . . . . . . . . . . . . . . . . . . .

Somawhatunlikely . . . . . . . . . . . . . . . . . . .

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . .

Definitely notpossible . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Mosquitoes or other insects?

Verylikely . . . . . . . . . . . . . . . . . . . . . . . .

Somewhatlikely . . . . . . . . . . . . . . . . . . . .

Somewhatunlikely . . . . . . . . . . . . . . . . . . .

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . .

Definitely not possible.. . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Being cared for by a nurse, doctor. dentist. or other

health care worker who has the AIDS virus?

Very likely . . . . . . . . . . . . . . . . . . . . . . . .

Somewhat likely . . . . . . . . . . . . . . . . . . . .

Somewhatuniikely . . . . . . . . . . . . . . . . . . .

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . .

Definitelynotpossible . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Can a person get AIDS or the AIDS virus infection

while giving or donating blood for use by others?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Have you ever discussed AIDS with any of your

children 10-17 years ofage?z

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Have any or all of your children 10-17 years of age

had instruction at school about AIDS?Z

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Have you ever given or donated blood?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Have you donated blood since March 1985?

Yes . . . . . . . . . . . . . . . . . . . . . . . . ...’.

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Have vou donated blood intheoast 12 months?

95

2

0

0

0

3

9

16

13

31

17

11

2

4

7

41

39

7

9

16

8

25

22

21

27

33

13

15

4

7

30

60

10

69

31

0

74

9

17

42

56

0

Y& . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . 1

See footnotes at end of table.

97

1

0

0

0

1

6

15

14

36

23

7

1

3

6

40

47

3

9

18

10

25

22

16

22

33

16

18

6

5

31

61

7

55

41

0

53

16

27

35

65

0

26

73

0

9

91

0

97

:

1

0

1

8

16

14

33

16

6

2

4

7

42

41

4

9

16

9

27

24

16

25

35

14

17

4

5

29

65

6

U

o

75

9

16

45

54

0

22

77

1

6

91

1

91

2

0

0

0

6

:

11

26

11

19

3

5

7

40

31

14

9

15

6

23

19

29

32

32

10

12

2

12

30

55

16

60

37

75

5

17

44

56

0

a

91

1

3

96

1

95

:

1

0

2

8

18

14

32

17

10

2

5

7

42

38

7

10

17

8

26

21

16

25

33

14

17

4

7

31

60

9

57

42

0

70

7

22

53

47

0

22

77

1

8

92

1

Percent distribution

95

2

0

0

0

3

9

18

13

31

17

12

2

4

7

40

40

7

9

15

a

24

22

22

28

33

12

14

4

6

26

61

11

79

20

0

77

10

12

32

67

0

15

84

1

5

94

1

96

;

o

0

2

6

16

13

33

17

11

1

4

6

4s

39

6

8

15

8

26

23

20

25

35

14

16

3

6

27

65

9

70

29

0

74

9

17

45

54

0

20

80

1

7

92

1

92

3

0

1

0

4

12

18

11

2s

15

14

3

6

3;

35

10

;

7

21

16

22

35

29

9

12

5

11

43

44

13

70

29

77

6

16

35

65

0

14

85

1

4

96

i

64

:

1

0

4

11

17

13

26

19

14

3

5

7

31

45

10

13

18

8

:

22

29

29

10

13

6

12

37

49

14

:

73

11

16

27

73

0

13

86

1

9:

1

89

2

0

0

0

8

13

19

9

23

13

22

3

6

6

34

32

18

13

17

6

17

15

31

34

27

8

11

5

16

38

41

21

56

43

69

2:

28

71

0

9:

0

2

97

1

96

2

0

1

0

2

10

19

::

17

11

2

5

7

41

39

6

10

17

8

24

20

21

31

35

11

13

4

6

32

59

9

z

o

72

9

18

39

60

0

17

63

1

6

94

1

97

:

0

0

1

1:

15

37

19

6

1

3

6

44

43

3

6

74

9

30

26

15

20

35

17

20

4

4

24

71

5

75

25

0

77

9

14

51

46

0

26

74

1

9;

1
10 Advance Data No. 225 ● January 6, 1993

Table 1. Estimates of the percent of persons 18 years of age and over with selected AIDS knowledge and attitudes from the 1991

National Health Interview Survey, by selected characteristics: United States, 1991 -Con.

[Data are based on household interviews of the civilian noninstiiutionalized population. The survey design, general qualifications, and information

on the reliability of the estimates are given in technical notes]

Race or ethnicity

Age Sex Non-Hispanic Education

18-.?S 30-49 50 ears

A/DS /mow/edge or attitude J

Less than 12 More than

Total yeara years an over Male Female White Black Hispanic 12 years years 1,2years

14.

15.

16.

17a.

17b.

18.

19,

20.

How manytimes in the psst 12 monthshave you

donated blood?

Once, . . . . . . . . . . . . . . . . . . . . . . . . . .

Twice . . . . . . . . . . . . . . . . . . . . . . . . .

Threet!mes ormore . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Didnotdonate blood inpast12months3. . . . .

Tothe best of ourknowledge, are blood donations

routinely teste J for the AIDS vrus infection?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . .

No. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’t know..........,.. . . . . . . . . . . .

Was one of your reasons for donating blood

because vou wanted to be tested for the AIDS virus

infecfion?a

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’t know . . . . . . . . . . . . . . . . . . . . . . . .

Except for blood donations since 1985, have you

had your blood tested for the AIDS virus infect! on?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Whyhaven’t you been tested?:.s

Don’tcona]der myself atrisk of AIDS . . . . . . .

Oon’t believe anything can be done If I am

positive, . . . . . . . . . . . . . . . . . . . . . . . .

Don’tlike needles ..,,..... . . . . . . . . .

Afraid of losing job, insurance, housing, friends,

fam!iyifpeople knewlwasposrfwe . . . . . . . .

Don’t trust medcel clinmjlmaptals to keep

testresultaconfldent!a.l . . . . . . . . . . . . . . . .

Already knowwhether lhavetheAIDSvirua

infectmn. . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknowwhereto gofofatest. . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknuw . . . . . . . . . . . . . . . . . . . . . . . .

Howmanytimeshave youhadyourblcod tested for

the AIDS virus infecbon, not including blcod donabons?

Once . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Twice . . . . . . . . . . . . . . . . . . . . . . . . . .

Threetimesormore . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Neverhadte& . . . . . . . . . . . . . . . . . . . . .

How many times in the past 12 months have you had

your blood tested for the AIDS virus infecbon,not

Includingblooddonabons?

Node. . . . . . . . . . . . . . . . . . . . . . . . . . .

Once . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Twice, . . . . . . . . . . . . . . . . . . . . . . . . . .

Threefimesormore . . . . . . . . . . . . . . . . . . .

Don’tkncxv. . . . . . . . . . . . . . . . . . . . . . . .

Neverhadte@ . . . . . . . . . . . . . . . . . . . . .

Didyouhaveany oftheAIDSblood teats:l.7

Forhosptahahonor asurgicel procedure?. . . . .

Toapplyforhea~ insurance?. . . . .

Toapptyfor lie insurance? . . . . . . . . . . . . . .

Foremployment? . . . . . . . . . . . . . . . . . . . .

Toapptyfora marriagell~nSe?. . . . . . .

Formilrtaryinductionormiliaryservice?. . . . . . .

Forimmlgrabon? . . . . . . . . . . . . . . . . . . . . .

Justtofmd oufifyouwere infected? . . . . . . .

Becauseofreferrel bythedcctor? . . . . .

Because ofreferral bythe HealthDeperlment? . . .

Referred byyoursexperiner?. . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don<!kncw .,,........,.. . . . . . . . .

3

2

:

94

76

8

16

3

90

0

t5

79

6

84

0

1

0

0

1

1

7

8

10

3

2

0

86

7

6

1

0

0

86

14

4

10

7

5

7

6

25

4

1

1

20

0

5

2

1

0

92

80

7

13

8;

o

22

74

4

77

0

2

0

0

1

1

9

12

14

4

3

0

78

10

10

1

1

0

78

12

2

5

8

6

12

7

27

4

1

1

20

0

4

2

2

9:

82

7

11

2

91

17

78

5

84

1

1

0

0

1

1

7

8

12

3

2

0

83

9

7

1

0

0

63

14

5

13

7

4

5

6

24

4

0

1

19

0

1

1

:

97

67

9

24

2

93

6

86

8

87

0

0

0

0

0

0

6

6

4

1

:

94

3

3

0

0

9:

21

3

8

5

;

4

23

4

0

0

21

1

4

2

;

92

7e

8

16

4

89

0

17

77

6

83

0

1

0

0

1

1

7

9

10

3

3

0

84

8

7

1

0

0

64

10

4

12

8

5

12

7

25

3

0

1

16

0

Percent distribution

3

1

Cl

95

76

8

16

2

91

13

81

5

84

0

1

0

0

1

1

7

8

9

2

1

0

87

6

6

1

0

6!

19

3

6

6

4

2

6

26

5

1

0

24

0

4

:

0

93

79

7

14

2

91

0

13

82

6

85

0

1

0

0

1

0

7

7

8

2

2

0

e8

6

5

1

0

8;

14

5

12

6

6

8

1

24

4

0

2;

o

2

1

:

96

67

13

20

6

a5

21

73

6

76

1

2

0

0

1

2

8

12

12

5

3

1

79

8

10

2

1

7;

16

2

5

11

2

7

2

36

5

1

1

la

o

2

1

1

96

84

11

25

5

87

24

70

6

79

1

1

0

0

1

1

9

10

18

4

2

0

76

13

9

2

0

0

76

13

1

5

6

3

4

31

23

3

0

1

15

0

1

:

0

98

59

11

30

8

83

13

80

7

79

0

1

0

0

1

1

7

11

9

2

1

0

87

6

5

1

0

8;

19

1

2

5

3

2

18

26

4

1

1

19

0

3

1

:

94

77

9

15

3

90

0

13

81

6

83

0

1

0

0

1

1

;

9

2

2

0

67

6

6

1

0

8!

15

3

:

5

9

3

26

5

1

2:

0

5

2

2

91

84

6

10

2

9t

17

78

5

86

0

1

0

0

1

0

7

5

11

3

2

0

64

e

7

1

0

0

63

12

5

15

7

5

8

4

24

3

0

2:

0

seefcxmotes a! end oftab!e.
Advance Data No. 225 ● January 6, 1993 11

Table 1. Estimates of the percent of persons 18 years of age and over with selected AIDS knowledge and attitudes from the 1991

National Health Interview Survey, by selected characteristics: United States, 1991- Con.

[Data are based on household interviews of the civilian noninstitutionalized population. The survey design, general qualifications, and information

on the reliability of the estimates are given in technical notes]

Race or efhrricity

Age Sex Non-Hispanic Education

AIDS knowledge or attitude

18-29 3C49 50 ears

J’

Less than 12 More than

Total yeara yeara an over Male Female White Black Hispanic 12 yeara years 12 Years

21.

22.

23.

25.

26.

2a.

2s.

When was your last AIDS blood test for the AIDS

virusinfection not including blcod dcmetiin?7

1991 . . . . . . . . . . . . . . . . . . . . . . . . . . .

1890 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1889 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1966 . . . . . . . . . . . . . . . . . . . . . . . . ...4

1987 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19s6 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1985 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Did you have your last AIDS blcmdtest- ‘.7

Fcfhospiteli=tion orasurgical procedure?. . . . .

Toapplyforheeifh insurance?.. . . . . . . . . . . .

Toapplyforliieinsuranca? . . . . . . . . . . . . . .

Fwemploy’nent? . . . . . . . . . . . . . . . . . . . .

Toappiyforamarriagelicense?. . . . . . . . . . . .

Formilkaryindu~’onormiliiryseM”ce?. . . . . . .

Fcrimmigration? . . . . . . . . . . . . . . . . . . . . .

Juattofindoutifyouwereinfacted? . . . . . . . . .

Becauseofreferralbythedcctor? . . . . . . . . . .

Becsuee ofreferral bythe Heaith Department?. .

Referred byyoursexpatiner?. . . . . . . . . . . .

other . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dcm’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Notlnduciingablo@ donetion,wheradid youhave

vourlestbloodteet fortheAlDSvitus?7

AIDSclinicbunseling/testingste. . . . . . . . . . .

-munityh-Mchnb . . . . . . . . . . . . . . . .

Clinicrunbyempbyer . . . . . . . . . . . . . . . . .

Ccctor/HMO . . . . . . . . . . . . . . . . . . . . . . .

H~pi@l/emergenWrooin/ourpatientcliniC. . . . . .

STDclinio . . . .. c . . . . . . . . . . . . . . . . . . .

Famiiyplenningclinic . . . . . . . . . . . . . . . . . .

Prenatslclinio. . . . . . . . . . . . . . . . . . . . . . .

Tubercalosisclinic . . . . . . . . . . . . . . . . . . . .

Publicclinb . . . . . . . . . . . . . . . . . . . . . . . .

OfhercKnic . . . . . . . . . . . . . . . . . . . . . . . .

Drugtreatmentfacilii . . . . . . . . . . . . . . . . . .

Miliilnductiartrsenbsite. . . . . . . . . . . . . .

Immgrstionsde. . . . . . . . . . . . . . . . . . . . .

other . . . . . . . . . . . . . . . . . . . . . . . . . . .

DcWtknow . . . . . . . . . . . . . . . . . . . . . . . .

Didyougetthereautts ofyourlasttest?’

Yea . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dcn’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Weathksbecauseyou daddedyouddn’t wantthe

reeuHsorwaeit becauseyouwere unebletogetthe

rasuffi?a

CM_ftwm . . . . . . . . . . . . . . . . . . . . . . . .

Unabletoget . . . . . . . . . . . . . . . . . . . . . . .

Both . . . . ! . . . . . . . . . . . . . . . . . . . . . . .

(XhSr . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dcm’tknmv . . . . . . . . . . . . . . . . . . . . . . . .

Were the resuite gtien in pemon, by telephone, by mall,

orinaomeother Way?g

Inpereon . . . . . . . . . . . . . . . . . . . . . . . . .

Bytelephone . . . . . . . . . . . . . . . . . . . . . . .

Eymail . . . . . . . . . . . . . . . . . . . . . . . . . .

other . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oonlknow . . . . . . . . . . . . . . . . . . . . . . . .

Doycubelievethe resutteofyourfast testwera

accurate?g

25

29

16

10

5

3

1

6

14

3

9

7

4

7

2

4

0

1

20

0

1

7

3

30

25

0

1

0

3

3

0

7

2

11

0

79

20

1

9

21

1

53

13

60

17

15

6

0

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . se

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Ocdtknow. . . . . . . . . . . . . . . . . . . . . . . . 1

.%O&lnO@Seterd Of!abb.

27

31

77

11

4

2

1

4

11

2

5

7

5

11

7

27

4

1

1

21

0

1

10

2

28

23

1

1

1

:

0

11

2

10

0

63

17

1

9

26

1

51

11

83

15

16

7

0

88

0

1

23

29

1s

10

7

3

:

13

5

13

7

4

5

6

24

3

0

1

19

0

2

6

3

30

24

0

0

0

3

3

0

6

1

13

0

79

21

0

9

20

4

12

56

19

15

9

0

es

o

1

26

26

12

s

4

3

2

6

22

2

6

5

1

2

4

23

4

0

2:

1

1

4

2

35

32

0

0

:

3

0

9

0

72

27

0

11

15

2

51

20

55

16

13

6

8s

o

1

26

28

17

10

5

3

;

10

4

12

e

4

12

6

24

3

0

1

17

0

2

7

3

28

20

0

0

0

3

3

0

11

2

14

0

76

22

0

10

24

d

14

5s

15

1s

9

0

88

0

1

Percent distribution

24

31

16

10

:

1

5

18

3

6

:

2

6

26

5

1

0

25

0

1

6

2

33

30

0

1

1

3

3

0

2

:

0

81

1s

1

9

17

1

59

13

62

19

12

7

0

%)

o

1

24

29

17

10

5

3

1

5

14

4

12

6

5

8

1

23

4

0

d

o

2

6

2

30

24

0

1

0

;

o

8

0

13

0

78

21

1

9

19

1

56

13

54

20

16

9

0

88

0

1

33

32

13

8

4

2

0

7

16

2

4

11

2

7

2

36

5

1

1

16

0

1

12

3

26

31

0

1

1

4

2

0

:

8

0

81

18

1

13

21

2

44

17

70

12

13

4

0

%

o

1

20

26

19

74

9

2

1

6

11

2

5

6

2

3

31

22

3

0

0

16

0

2

11

2

33

19

0

2

1

5

3

:

;

o

es

14

0

;;

A

10

75

6

13

4

0

9s

1

1

22

2s

14

13

7

3

;

18

1

1

5

3

2

18

26

5

1

1

20

1

1

10

1

29

31

1

1

1

6

2

0

2

5

5

1

62

17

1

9

27

3:

24

78

13

:

0

86

1

1

24

30

17

10

5

3

2

6

14

3

6

6

4

9

3

26

4

:

z?

o

1

8

2

30

26

0

0

1

i

3

0

9

1

10

0

7s

21

0

11

19

:

15

61

17

15

7

0

96

0

1

26

29

17

9

5

3

1

4

11

5

15

7

4

8

4

23

3

0

1

20

0

2

6

3

30

21

0

1

0

2

3

0

7

14

0

76

21

0

6

20

5:

9

S3

18

18

10

0

es

o

1
12 Advance Data No. 225 ● January 6, 1993

Table 1. Estimates of the percent of persons 18 years of age and over with selected AIDS knowledge and attitudes from the 1991

National Health Interview Survey, by selected characteristics: United States, 1991- Con.

[Data are based on household interviews of the civilian noninstitutionalized population. The survey design, general qualifications, and information

on the reliability of the estimates are given in technical notes]

AIDS knowledge or attitude

Race or ethnici?y

Age Sex Non-Hispanic Education

18-29 30-49 50 ears

C)’

Less than 12 More than

Total years years an over Male Famale White Black Hispanic 12 years years 12 yeara

30.

31.

32.

33.

34.

34a.

34b.

37.

Do you feel that the confidential~ty of the results of

~d~~t$~~$~~ AIDS VIWS mfe~,on ~a~

Yes, ..,........,,,,. . . . . . .

No, . . . . . . . . . . . . . . . . . . .

Don’t know . . . . . . . . . . . . . . . . . . .

Do you expect to have a blood test for the AIDS

virus infection in the next 12 months?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . .

No,,,, . . . . . . . . . . . . . . . . . . . . . . . .

Don’t know . . . . . . . . . . . . . . . . . . . . . . .

Tell me if each of these statements excdams wh

you eXpeCt to have the blood test in the next 1J

months.l”

Because itwillbe parfofa blood donation. . . .

Because it will bepart of hospitalization or

surgeryyou expecttohave. . . . . .

Because you expect to apply for life or health

insurance . . . . . . . . . . . . . . . . . . . . . . . .

Because youexpect toapplyfor a job. . . . . . .

Because youexpect tojointhemilifa~ . . . . . .

Because you expect to apply for a mamage

license . . . . . . . . . . . . . . . . . . . . . . . . . .

Because youwant toknowthe results. . . . . . .

Becauseitwillbe arequiredpartof some

other activrty that includes automatic

AIDStesting . . . . . . . . . . . . . . . . . . . . . .

Where will you otohave abloodtest forthe

AIDS virusmfe .$lon?10

AIDS clinic/counseling/testings[te . . . . . . .

Communityheatthclinic . . . . . . . . . . . . . . . .

Clinicrun byemployer . . . . . . . . . . . . . . . .

Doctor/HMO . . . . . . . . . . . . . . . . . . . . . . .

Hospital/emergency room/outpattent clinic . .

STD clinic . . . . . . . . . . . . . . . . . . . . . . . .

Familyplannmgclinic .,..... . . . . . . . . .

Prenatal clinic . . . . . . . . . . . . . . . . . . . . .

Tuberculosis clinic . . . . . . . . . . . . . . . . . . .

Publicclinic . . . . . . . . . . . . . . . . . . . . . . .

Otherclinic . . . . . . . . . . . . . . . . . . . . . . . .

Drugtreatmentfacility . . . . . . . . . . . . . . . . .

Miliiryinductton/servicesite. . . . . . . . . .

Immigrafionsite, . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Tell mewhether youthink the following statements

about the blood test forthe AIDS virus infection are

true or false or if you do not know whether they are

true or false.

Sometimes the results ofabloodtestforthe AIDS

virus infectton can be wrong.

True, . . . . . . . . . . .. . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Aftera person becomes infected withtheAIDS virus,

there can be a period of time before the test shows

the infection.

True. . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

Have you ever heard of a drug called F(ZT, also

known as zidovudme or Retrovir?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . .

95

2

3

9

84

7

19

6

8

8

3

6;

21

2

10

3

39

17

0

1

0

0

3

2

4

0

2

6

73

6

21

74

3

23

51

45

4

95

2

2

15

75

9

18

6

9

10

5

12

74

18

3

12

3;

18

0

1

0

0

4

2

5

0

1

7

72

9

19

79

4

18

50

47

3

94

3

4

9

84

7

20

6

7

7

2

5

62

23

2

9

3:

16

0

1

0

—

3

2

5

2

5

77

7

16

79

3

18

59

38

3

96

2

2

4

90

6

18

10

4

2

1

59

25

1

7

2

46

21

0

0

2

2

2

3

3

69

3

28

64

2

34

42

53

5

94

3

3

10

82

7

22

5

9

9

5

8

64

23

2

10

4

36

16

0

0

0

0

3

2

7

0

2

6

74

6

20

74

3

23

52

45

3

Percent distribution

95

2

2

7

85

7

15

8

6

6

1

6

71

19

2

10

2

43

19

0

2

0

4

2

2

1

5

72

6

22

73

3

24

50

46

A

94

3

3

7

86

6

24

6

8

6

3

7

59

21

2

8

3

41

14

0

1

0

3

2

5

:

5

75

5

19

76

3

21

55

42

3

97

1

1

21

68

13

10

7

7

10

4

8

n

22

3

13

3:

23

0

1

:

5

1

5

1

5

68

8

24

71

3

26

43

53

5

92

3

5

15

74

11

15

6

7

8

2

8

78

19

1

14

5

33

19

2

4

3

1

0

1

9

61

9

30

61

4

35

32

62

6

94 95 95

2 2 3

4 2 3

8 9 9

61 64 85

11 7 6

11 20 21

9 7 5

3 e 8

79 66 61

17 21 23

2 2 2

15 11 6

2 3 3

35 40 40

22 ~8 14

0 0 0

1 0 1

::

6 3 3

3 2 2

1 6

:

1 2 :

7 4 6

58 73 80

6 6 8

36 21 14

55 74 82

3 3 3

41 23 15

24 46 69

70 50 29

5 4 3

See footnotes al end of table.
Advance Data No. 225 ● January 6, 1993 13

Table 1. Estimates of the percent of persons 18 years of age and over with selected AIDS knowledge and attitudes from the 1991

National Health Interview Survey, by selected characteristics: United States, 1991- Con.

[Data are based on household interviews of the civilian noninstitutionalized population. The survey design, general qualifications, and information

on the reliability of the estimates are given in technical notes]

Race or etfvvcdy

Age Sex Non-H;spanic .Educetion

78-29 30-49 50 ears

AIDS knowledge or attitude J’

Less than 12 More than

Total years yeara an over Male Female White Black Hispanic 12 years years 12 years

38.

38a.

38b.

38C.

38d.

38.9.

39.

40.

41.

42.

42a.

42b.

43.

Tell me whether you think the following statements

about AZ7 are true or falae or if you don’t know

whether they are true or false.’ T

AZT can delay or slow down the symptoms of AIDS

virus infection.

True . . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’t know . . . . . . . . . . . . . . . . . . . . . . . .

~ cures people with AIDS.

True . . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

UT has no known aide effects.

True . . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

UT is appropriate for a person with the AIDS virus

Infection only at cetiain ttmes during the illness.

True, . . . . . . . . . . . . . . . . . . . . . . . . . . .

Falae . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

There are other drugs available to treat AIDS-related

illnesses.

True . . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Did you have a blood transfusion at any time

between 1977 and 19E!5?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Do ouhavefrequent blood transfusions because of

sickTe cell or chronic anemia?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . .

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

How effective do you think the use of a condom is

to prevent getting the AIDS virus through sexual

aotiiity?

Veryeffective . . . . . . . . . . . . . . . . . . . . . .

Somewhat effectwe . . . . . . . . . . . . . . . . . .

Notatall effective . . . . . . . . . . . . . . . . . . .

Don’tknowhoweffectiie . . . . . . . . . . . . . . .

Don’tknowmethod . . . . . . . . . . . . . . . . . .

Tell mewhether youthink the followin statements

aretrue or false orwhetheryoudon’t 2nowlf they

are true or false.

Latex condoms and natural-membrane condoms are

equally good at preventing transmission of the AIDS

virus.

True . . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknowmethod . . . . . . . . . . . . . . . . . .

~~~~~ad lubricants can cauae latex condoms to

T&e . . . . . . . . . . . . . . . . . . . . . . . . . . . .

False . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknowmefhod . . . . . . . . . . . . . . . . . .

What are your chances of having the AIDS virus?

High . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medium . . . . . . . . . . . . . . . . . . . . . . . . . .

Low . . . . . . . . . . . . . . . . . . . . . . . . . . . .

None . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . .

Seafootnotesate ndofteble.

81

2

17

1

89

9

4

59

36

34

11

55

50

14

35

5

94

1

0

Iw

o

28

49

4

17

2

Ie

19

61

2

27

6

65

2

0

1

17

80

2

82

2

16

1

et

7

5

62

33

36

11

50

48

16

36

2

97

1

0

100

0

34

51

3

10

1

25

24

50

1

36

7

56

1

0

2

24

72

2

83

2

15

9;

7

4

64

32

36

12

51

55

14

31

4

95

1

0

I 00

0

31

52

4

12

1

19

24

5e

1

30

6

62

1

0

2

la

78

2

76

2

22

8:

14

5

50

45

25

10

64

44

14

41

7

91

2

0

100

0

19

43

4

29

4

11

11

74

4

15

4

76

4

0

1

10

87

3

et

2

16

1

90

9

:

35

34

12

53

54

14

32

5

94

1

0

100

0

32

48

3

15

2

21

22

55

2

31

7

80

2

0

2

18

78

2

Percent distribution

80

2

18

1

89

10

4

59

37

33

11

56

47

15

3a

5

94

1

0

100

0

24

50

4

19

3

14

17

66

3

22

4

70

3

0

1

15

81

2

81

2

17

1

eo

9

4

61

35

33

11

56

51

14

35

5

94

1

0

loa

o

28

51

3

16

2

17

21

61

2

27

5

65

2

0

1

17

80

1

75

3

21

2

84

13

8

52

39

36

13

50

46

16

37

5

94

1

0

89

0

29

41

5

22

2

23

14

60

2

27

8

83

2

:

:

5

7a

3

19

2

87

11

5:

41

37

13

51

45

19

37

3

96

1

0

99

0

27

41

5

21

6

19

14

61

7

20

6

67

7

1

2

12

el

4

71

3

26

3

80

17

7

43

50

27

11

62

36

18

46

6

93

2

0

99

0

19

37

5

32

6

15

e

71

6

16

5

73

6

0

2

10

83

5

77

2

20

1

8e

11

5

53

41

29

12

59

44

16

40

5

94

1

0

100

0

26

51

4

16

2

19

16

63

2

24

6

68

2

0

1

15

81

2

85

2

14

1

92

7

4

66

30

37

11

51

57

13

30

4

95

1

0

100

0

33

53

3

10

1

18

2s

53

1

34

6

se

1

0

1

21

77

1
14 Advance Data No. 225 ● Januarv 6, 1993

Table 1. Estimates of the percent of persons 18 years of age and over with selected AIDS knowledge and attitudes from the 1991

National Health Interview Survay, by selected characteristics: United States, 1991- Con.

[Data are based on household interviews of the civilian noninstitutionalized population. The survey design, general qualifications, and information

on the reliability of the estimates are givan in technical notes]

Race or et)srricity

AIDS knowledge or attitude

Age Sex Non-Hispanic Eduoatrbn

18-29 30-49 50 eara

J

Less than 12 More than

Total years years an over Male Femala White Black Hispanic 12 years years 12 years

44.

45.

46.

47.

What are your chances of getting the AIDS virus?

High . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Medium . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Low . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

None . . . . . . . . . . . . . . . . . . . . . . . . . . 72

Don’t know . . . . . . . . . . . . . . . . . . . . . . . . 2

N/A- High chance of already having the

AIDS vtrus . . . . . . . . . . . . . . . . . . . . . . 0

Have ou ever had a co-worker who had AIDS or

the AILS virus?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87

Never worked, never had ace-worker. . . . . 1

Don’t know . . . . . . . . . . . . . . . . . . . . . . . 7

Besides ace-worker, have youever hada friend or

relative who had AIDS orthe AIDS vrus?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . e7

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . 3

Are anv of these statements true for VOU?

a.

b.

c.

d.

e.

Yo~ have hemophilia or another ;Iotting disorder

and have received clotting factor concentrations

since 1977.

You are a man who has had sex w!th another

man at aome time since 1977, even 1 ttme.

You have taken illegal drugs byneedle at any

time since 1977.

You have had sex for monq~ or drugs at any

time since 1977.

Since 1977, you are or have been the sex

partner of any person who would answer yes to

anyoftheitema above (a-d)

Yestoatleast l statement . . . . . . . . . . . . 3

Notoallstatements . . . . . . . . . . . . . . . . 97

Don’tknow . . . . . . . . . . . . . . . . . . . . 0

1

3

30

63

2

0

8:

1

7

9

86

3

5

95

0

0

2

26

69

2

0

6

85

0

8

12

85

3

4

96

0

0

1

14

81

3

0

3

89

1

7

6

90

4

1

99

0

0

2

25

69

2

0

4

86

0

9

s

88

4

4

96

0

Percent distribution

o

2

21

74

3

0

5

68

1

6

10

87

3

3

97

0

0

2

24

72

2

0

8:

1

7

9

66

3

3

97

0

1

2:

67

5

1

5

84

1

10

13

61

6

4

96

0

0

3

le

74

4

1

5

84

2

8

11

65

4

4

96

0

0

2

13

79

5

0

2

90

2

6

6

90

4

3

97

0

0

2

21

74

2

0

3

69

1

7

8

89

3

3

97

0

0

2

30

e6

1

0

7

84

0

9

12

64

3

4

96

0

lMultlple responses mayaddto more than 100.

2Basedon persons answering `'yes' 'toquestlon 8,'' Doyouhave any children aged 10 through 177”

3Basedon persons an$werlng ''no' 'or`4don't Unow''!o quest! onsl2, 13a, or13b.

‘easedon persons answenng “’yes’’ to questions 13a and 15.

5Basedon persons answering “no’’mquestlon 17a.

6Basedon per.sonsanswermg “no’’or’’don’t &now”to question 17a.

7Basedon persons answering “yea’ato questjon 17a.

‘Based onpersonsanswenng “no’’or”’don’tk now’’toquest!on25.

‘Basedon persons answenn g’’yes’’t oquestlon25.

IOBaSed on perSo”S an~ermg “yes”to quest,On 31.

!j~ased ,3n perSOnSanSWerlng “yes’’t oquest10n37.

NOTE: HMO Is heailh mamtanance organization. STD la sexually transmitted disease.
Advance Data No. 225 ● January 6, 1993 15

Technical Notes

The National Health Interview

Survey (NHIS) is a continuous,

cross-sectional household interview

survey. Each week, a probability

sample of the civilian noninstitutionalized population residing

in the United States is interviewed by

personnel of the U.S. Bureau of the

Census to obtain information on the

health and other characteristics of

each member of the household.

Information on special health topics

is collected for all or a sample of

household members. For the 1991

National Health Interview Survey of

AIDS Knowledge and Attitudes, one

randomly chosen adult 18 years of

age or over was interviewed in each

family. The estimates in this report

are based on completed interviews

with 42,726 individuals. In 1991, the

response rate to the basic NHIS core

questionnaire was 96 percenc for the

NHIS AIDS supplement, it was

90 percent. Therefore, the overall

response rate to the 1991 AIDS

sumey was 86 percent.

Table L Sample sizes for 1991 Nationai Health Interview Survey of AIDS Knowledge and

Attitudes and estimated adult population 18 years of age and over, by selected

characteristics: United States, 1991.

Estimated

Sample

Characteristic

poprdat;on

size in thousands

Alladuits . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age

18-29 years . . . . . . . . . . . . . . . . . . . . . . . . . . .

30-49 years . . . . . . . . . . . . . . . . . . . . . . . . . . .

50yeas and over. . . . . . . . . . . . . . . . . . . . . . . .

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Race and ethnicity

Non-Hispanic

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Education

Lessthan 12years . . . . . . . . . . . . . . . . . . . . . .

12yeara . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Morethan 12 years . . . . . . . . . . . . . . . . . . . . . .

42,726

9,470

17,391

15.865

17,645

24.661

32,575

5,608

3,079

9,081

15,712

17,648

180.271

46,282

71,831

61.157

85,632

94,836

139,440

19,585

14,f18

36,782

72,418

70,036

Table I contains the estimated

population size of each of the

demographic subgroups included in

table 1 to allow readers to derive

provisional estimates of the number

of people in the United States with a

given characteristic–for example, the

number of women who have had their

blood tested for HIV

0.13 x 94,638,000 women tested

The population estimates in table I

are based on 1989 data from the

NI-HS inflated to national population

controls by age, race, and sex. The

population controls are based on the

1980 census carried forward to 1989.

These estimates, therefore, may differ

from 1990 census results brought

forward to the survey date.

Population controls incorporating

1990 census results wiI1be used for

survey estimation beginning later in

the decade.

Table II shows approximate

standard errors for most of the

estimates presented in table 1. These

standard error estimates were derived

by applying a design effect of 1.3 to

the standard errors that would have

been obtained with a simple randomsample design. The reader is

cautioned about comparing estimates

when the denominator is small (for

example, when looking only at those

persons who did not receive the

results of their HIV antibody test).

A final data file covering the entire

1991 data collection period will be

available at the end of 1992.

Table Il. Standard errors, expressed in percentage points, of estimated percents from the 1991 National Health Interview Survey of AIDS

Knowledge and Attitudes, by selected characteristics United States, 1991

Age Sex Race and ethrricity Education

16-2s 3049 50 years Less than 12 More than

Estimated percent Total yeare yeara and over Male Female White Black Hispanic 12 years yeans 12 yeara

5or95 . . . . . . . . . 0.1 0.3 0.2

100r90 . . . . . . . . 0.2 0.4 0.3

150r85 . . . . . . . . 0.2 0.5 0.3

200r60 . . . . . . . . 0.2 0.5 0.4

250r75 . . . . . . . . 0.3 0.6 0.4

300r70 . . . . . . . . 0.3 0.6 0.4

350r65 . . . . . . . . 0.3 0.6 0.5

400r60 . . . . . . . . 0.3 0.6 0.5

450r55 . . . . . . . . 0.3 0.7 0.5

50 . . . . . . . . . . . . 0.3 0.7 0.5

0.2

0.3

0.4

0.4

0.4

0.5

0.5

0.5

0.5

0.5

0.2 0.2 0.2 0.4

0.3 0.2 0.2 0.5

0.3 0.3 0.3 0.6

0.4 0.3 0.3 0.7

0.4 0.4 0.3 0.7

0.4 0.4 0.3 0.6

0.5 0.4 0.3 0.8

0.5 0.4 0.3 0.6

0.5 0.4 0.4 0.9

0.5 0.4 0.4 0.9

0.5

0.7

0.6

0.9

1.0

1.1

1.1

1.1

1.2

1.2

0,3

0.4

0.5

0.5

0.6

0.6

0.6

0.7

0.7

0.7

0.2

0.3

0.4

0.4

0.4

0.5

0.5

0.5

0.5

0.5

0.2

0.3

0.3

0.4

0.4

0.4

0.5

0.5

0.5

0.5
16 Advance Data No. 225 ● January 6, 1993

Suggested citation Copyright Information National Center for Health Statlstlcs

Aguilar SM, Hardy AM. AIDS knowledge and This report may be reprinted without further Director

attitudes for 1991: data from the National Permission. Manning Feinleib, M. D., Dr. P.H.

Health Interview Survey. Advance data from

vital and health statistics: no 225. Hyattsville,

Maryland: National Center for Health

Statistics. 1992.

Acting Deputy Director

Jack R Anderson
Number 226 ● Ma’rch 4, 1993

Advance

Data

From Vi and Heatth Statisticsof the CENTERS FOR DISEASE CONTROL AND PREVENTION/National Centerfor Health Statistics

Office Visits to Cardiovascular Disease Specialists:

United States, 1989–90

by Susan M. Schappert, M.A., Division of Health Care Statistics

Introduction

h estimated 22.1 million visits

were made in the United States

during 1989 and 1990 to nonfederally

employed, office-based physicians

specializing in cardiovascular

diseases–an average of about 11

million visits per year. This report

summarizes data pertaining to these

visits in terms of patient

characteristics, physician practice

characteristics, and visit

characteristics. Two earlier reports

provide information on office visits to

specialists in cardiovascular diseases

for the years 1975-76 and 1985 (1,2).

The information in this report is

based on data collected by means of

the National &nbulatory Medical

Care Survey (NAMCS), a national

probability sample survey conducted

by the Division of Health Care

Statistics of the National Center for

Health Statistics, Centers for Disease

Control and Prevention. This survey

was conducted yearIy from 1973

through 1981 and again in 1985. It

resumed an annual schedule with the

1989 survey.

The 1989 and 1990 NAMCS

shared identicaI survey instruments,

definitions, and procedures. The

resulting two years of data have been

combined to provide more reliable

estimates, and the reader shouId note

that the estimates, percent

distributions, and rates presented in

this report reflect average annual

estimates based on the combined

1989 and 1990 data. The Patient

Record, which is the survey

instrument used by participating

physicians to record information

about their patients’ office visits, is

shown in figure 1.

The estimates presented in this

report are based on a sample, rather

than on the entire universe, of office

visits, and are subject to sampling

variability. The sample design,

sampling errors, and guidelines for

judging the precision of NAMCS

estimates are discussed in the

technical notes. Several publications

are available that discuss overall

findings from the 1989 and 1990

NAMCS (3,4,5), and reports on

special topics are also avaiIable

(6,7,8,9,10). Additional reports on

visits made during 1989 and 1990 to

other physician specialties are

forthcoming.

Patient characteristics

Visits to specialists in

cardiovascular diseases by patient’s

age, sex, and race are displayed in

table 1. Overall, this specialty

received an average of 4.5 office visits

per 100 persons per year for 1989 and

1990. The visit rate increased with

age for both sexes and was highest

among persons 65 years of age and

over, who made an average of 20.3

visits per 100 persons per year. Visit

rates were not significantly different

for persons 65-74 years and 75 years

of age and over. AIso, no significant

differences were found by sex within

any of the five age groups analyzed

(figure 2). However, white persons

had a significantly higher rate of visits

to cardiovascular disease specialists

(4.8 visits per 100 persons per year)

than did black persons (2.2 visits per

100 persons per year). In general,

visit rates were not significantly

different than those noted in 1985.

Patients over the age of 44 years

accounted for 88.7 percent of all visits

to this specialty during the 2-year

period covered in this repor~ more

than half (5%7 percent) of all office

visits to cardiovascular disease

specialists were made by persons 65

years of age and over. This age

distribution is in sharp contrast to

that of visits to alI other specialists,

where, in general, less than half of

#+@lcq/

●.4 %

-#

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

~=

s

Public Health Service ‘++.> Centers

National

for Disease

Center for

Control

Health

and

Statistics

Prevention

cSNTSRS cmFOR DISSASE CONTROL

AND PREVENTION
2 .Advance .. . . . . Data __________ No. ___ 226. --.= March.=.. A 1 (2Q2 ., .“””

AWMU of tifidontmllty -All mbmatmn wh,ch wade pmwm 16Mwf,c. t,.. .+ . . Dw.nm.m of M..fth ..d Hum.. SSWOC..

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to otfw PW.LWSJw mm tot ..” .Jth*r purr..” N.tmn.l C.m.t for H..tih SUt,st,.. B

1,DATE OF VIStT

~

PATIENT RECORD OMS No. 0920-0234

NATIONAL AMBULATORY MEDICAL CARE SURVEY

Expires S.31-69

(PI+.}6105B

Zmmcoos 4. SEX 5.~OR OR & ~NiCITY

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1 ❑ SELF.PAY 4 ❑ ::~ ~~Es&/

THIS VISIT BY

1 ❑ %&;c

7 ❑ No CHA_qGE ANOTHER

30 DATEOFSRTH 2 ❑ KACK PHYSICIAN?

q ❑ pw.W&clRc 2 ❑ MEOICARE s ❑ o~ER commercial

~ ‘D”m

INSURANCE 8 ❑ o&=ti

2 •l YJANC

1(-J YES 2UN0

‘ ❑ 2:;%Z% 3 n MEOICAID E Q pRE-pAID pLAN w.toim~)ppo

9 PATEENT’SCOMPLAINTISL SYMPTOM(S), OR OTHER

“REASON(S) FOR THIS VISK //n FUWN’S own wrok/

1 (). PHYSICIAN’S DIAGNOSES

11. ;;;:;;;E:~R;7

t MOST IMPORTANT 8 PRINCIPAL DIAGNOSISIPROBLEM ASSOCIATED WITH ITEM 9,,

1 ❑ YES 2 [] NO

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IF YEs. FOR THE C13NIS1710N

b, OTHER b OTHER SIGNIFICANT CURRENT OIAGNOSES IN ITEM 10s7

1 Q YES 2DN0

—

1 z DIAGNOSTIC/SCREENING SERVICES

“ /Check alt ordered or pmvtdd]

13* :&:ys;y::;:;:::m,id&, I 4 NON-MEDICATION TP-

“ [Check all ordered or provided]

1 ❑ NONE 7 D BLOOO PRESSURE CHECK 13 ❑ ORAL GLUCOSE TOL. 1 ❑ NONE 1 ❑ NONE

2 ❑ PAP TEST 8 ❑ URINALYSIS 14 ❑ CHOLESTEROL MEASURE 2 ~ WEIGHT FfEOUCTION 2 ❑ PSYCHOTHERAPY

3 Q PELVIC EXAM 9 ❑ CHEST X. RAY 15 ❑ HIV SEROLOGY 3 ❑ CHOLESTEROL REOUCTION 3 ❑ CORRECTIVE LENSES

4 D BREAST PALPATION 10 ❑ OIGITAL RECTAL EXAM 16 ❑ OTHER 9LOOD TEST 4 ❑ SMOKING CESSATION 4 ❑ AMBULATORY SURGERY

5 ❑ MAMMOGRAM 11 ❑ PtEOCT/SIGMOIOOSCOPY 5 ❑ HIV TRAN5MIss10N s ❑ pHYS107H6RAPY

17 ❑ OTHER /sH,/,./

6 ❑ VISUAL ACUITY 12 ❑ STOOL BLOOO EXAM 6 ❑ F?REAST SELF.EXAM 6 ❑ OTHER /SJWCJ/Y/

~ ❑ OTHER

1 s. MEGtCA~NTHERAPY[Rmordol/"ewormntt"u&m&icat,omordemdorpmvidedo,,hkvki[. Usethesame

bmndname cwgenenc f?umsenten?don any Rxor offn mdic-dmmd. inciude immumting anddesen.o?iting agents.] 16, ,:;=P;;;:::;;,VISIT I 7. I))RAT:N

IF NOME, C14ECK HERE Q

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2 ❑ RETURN AT SPECIFIEO TIME spf’nf wirh

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3 ❑ RETuRN IF NEEDEO. P R.N.

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‘n2rJ1rJ2 r-J 4 ❑ PLANNED

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5 ❑ ‘EFERRED TO OTHER PHYSICIAN

6 ❑ ~EJ!m:l[~TO REFEflRING

t- ‘0 20 10 2rJ

7 ❑ AOMIT 70 HOSPITAL

~$r

‘O2D1O2CI 8n OTHER /Sprr,ZP)

! 1

Figure 1.1989 National Ambulatory Medical Care Survey Patient Record

. U.S. GOVERNMENT PRINTING OFFIC&, WS..CZ&,

the visits were made by persons over

the age of 44 years (figure 3).

No significant difference was

found in the percent of visits made by

males and females (50.2 percent

compared with 49.8 percent,

respectively). This pattern is strikingly

different from that found among visits

to all other specialties, where the

percent of visits by males was much

lower overall (39.4 percent) than the

percent of visits by females (60.6

percent). Among the 13 most visited

physician specialties, the percentage

of visits by females exceeded that of

visits by males for aIl but four

specialties – pediatrics, urology,

orthopedic surge~, and

cardiovascular diseases,

White persons made 90.2 percent

of all visits to specialists in

cardiovascular diseases and black

Dersons accounted for 6.1 percent of

Physician practice

characteristics

Specialists in cardiovascular

diseases received an average of 1.6

percent of the office visits made to

ambulatory care physicians for

1989-90, making them the llth most

visited physician specialty (table 2).

However, cardiovascular specialists

.

the visits. Approximately 2.3 percent received 2.5 percent of aIl visits made

of the visits were made by Asians/ by persons 45-64 years of age. The

Pacific Islanders. share was even higher for visits made

by older patients, with cardiovascular

specialists receiving 4.0 percent of alI
Advance Data No. 226 ● March 4, 1993 3

Table 1. Annual number, percent distribution, and rate of office visits to cardiovascular

disease specialists, by patient’s age, se% and race, averaged over a 2-year period:

United States, 1989-90

Number of Visit rate

wits in Percent per 100

patient characteristic thousands distribution personsx

Age

Alleges . . . . . . . . . . . . . . . . .

Less than 25 years . . . . . . . . . .

25-$4 years . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . .

75 years And over . . . . . . . . . . .

Sex and age

Female:

Alleges . . . . . . . . . . . . . . . . .

Less than 25years . . . . . . . . .

25--44 yeara . . . . . . . . . . . . .

45-64 yeara . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . .

75 years and over . . . . . . . . . .

Male:

Alleges . . . . . . . . . . . . . . . . .

Lessthan 25yesrs . . . . . . . . .

2!H4yeara . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . .

75yeara And over . . . . . . . . . .

Race

Whtie . . . . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . .

Asian/Pacific Islander. . . . . . . . .

American lndian/Eskimo/Aleut. . . .

Unspecified . . . . . . . . . . . . . . .

11,040

260

990

3,754

3,334

2.703

5,497

146

504

1,606

1,666

1,576

5,543

115

465

2,148

1,668

1.127

9,956

674

259

‘4s

109

100.0

2.4

9.0

34.0

30.2

24.5

49.8

1.3

4.6

14.5

15.1

14.3

50.2

1.0

4.4

19.5

15.1

10.2

90.2

6.1

2.3

‘0.4

1.0

4.5

0.3

1.2

8.1

18.6

23.4

4.4

0.3

1.2

6.6

16.7

21.7

4.7

0.3

1.2

9.7

20.8

26.4

4.6

2.2

---

---

---

‘VM rates are based on U.S. Bureau of the Census emmates of the cMian noninwtutionaliiad U.S. population fw JUIY1,

1989 snd 18S0, sveraged over the 2-year period.

o

0

ii

_ Male ~ Female

30 r 26.4

25

20

15

10

5

L

03 0.s

o

1.2 1.2

9.7

DZ!l

6.6

20.8

Less than 25-44 45-64 65-74 75 years

25 years years years years and over

Age of patient

NOIEStaftatlcaafa2-yearaveragsa.

Figure 2. Annual rate of office visits to cardiovascular disease speclailsts, by patient’s age

and sex: United States, 1989-90

visits made by persons 65 years of age

and over, an average of 6 million

visits per year by persons in this age

group.

Between 1975 and 1990, the

number of visits made to

cardiovascular disease specialists

increased by about 64 percent, from a

2-year total of 13.5 million for

1975-76 to a 2-year total of 22.1

million visits for 1989-90. The

1975-76 totaI represented 1.2 percent

of alI visits to office-based physicians

during that time. This was not

significantly different than their

1989–90 share.

Visit characteristics

Referral status and prior-visit

status

Nearly 10 percent of office visits

to specialists in cardiovascular

diseases were the result of a referral

by another physician, compared with

only 5.4 percent of visits to all other

specialities. The chronic nature of

cardiovascular diseases is underscored

by the fact that more than threequarters (78.7 percent) of the visits to

this specialty were made by patients

returning to the physician for care of

a previously treated condition. Of the

13 most visited physician specialties,

ordy psychiatry showed a higher

percentage of visits of this type. Visits

by referral status and prior-visit status

are summarized in table 3.

Expected source of payment

Private insurance (including Blue

Cross/BIue Shield and other

commercial insurance) and Medicare

were the expected sources of payment

listed most frequently at visits to

specialists in cardiovascular diseases

(74.8 percent and 50.8 percent of

visits, respectively), while selfpayrnent was recorded at onIy 17.5

percent of visits. (It shouId be noted

that more than one expected source

of payment maybe recorded per

visit.) The emphasis on Medicare as

an expected source of payment

reflects the older age distribution of

patients visiting this special~. In

contrast, among visits to all other
4 Advance Data No. 226 ● March 4, 1993

,s. . . . . . . . . .

. . . . . . . . . . .

Age:

❑

Less than ❑

. . 45-84 years

45 years .‘ R:

Visits to cardiovascular disease

specialists

NOTE: Slatistiisare 2-year averages.

4

“.

. . .

. . . . . . .

. . . . . . . . . . .

. . . . . . . . . . . . .

U

.

;; 20.9% ;:

. . . . . . . . . .

. . . . . . . . .

. . . . . . .

. . . . . .

,.. .

. . .

.

J

; ears

over

Visits to all other specialists

Figure 3. Percent distribution of office visits to cardiovascular disease specialists and to

all other specialists, by patient’s age: United States, 1989-90

Tabie 2. Annual number, percent distribution, and rate of office visits by physician

specialty, averaged over a 2-year period: United States, 1989-90

Number of Visit rate

vtsifs m Percent

Physician spec!aky

per 100

thousands dlstdbution persons’

AIlvisits . . . . . . . . . . . . . . . . .

General and family practice . . . . .

Internal medicine. , . . . . .

Pediatrics . . . . . . . . . . . . . . . .

Obstetrics and gynecology. . . . . .

Ophthalmology . . . . . . . . . . . . .

Orthopedic aurgery . . . . . . . . .

Dermatology . . . . . . . . . . . . . .

General surgery . . . . . . . . . . . .

Psychiat~ . . . . . . . . . . . . . . . .

Otolayngology . . . . . . . . . . . . .

Cardiovascular diseases . . . .

Urological surgery. . . . . . . . . .

Neurology . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . .

698,653

208,045

87,719

64,280

59,812

41,302

34,033

25,185

23,891

18,790

16,958

11,040

9,852

6,167

71,603

100.0

29.8

12.6

12.1

8.6

5.9

4.9

3.6

3.4

2.7

2.4

1.6

1.4

0.9

10.2

285.4

85.0

35.8

34.4

247,2

16.9

13.9

10.3

9.8

7.7

6.9

4.5

4.0

2.5

29.2

‘VMratesarebaaedonU. S Sureauof the Census estimates of thectilllan nontnst!tuttonallzed population tithe Untied States

for Julv 1 of 1989 and lS90. averaaed over tha2-vearoer!od.

‘Rate basw!on vwtsbyfemales endtemale pepulabon. Females made 99.4 percent ofallv!sits totlusspmally during

,.

1989-90, for an average annual est!mateof 59,475,000 vlsts.

specialists, Medicare was listed at

only 18.5 percent ofvisits, while

self-payment was mentioned at 31.4

percent. Visits to cardiovascular

specialists by expected sourceof

payment are shown in table 4.

Patient’s pmcipal reason for visit

The patient’s principal reason for

visiting the physician, according to the

eight reason for visit modules or

groups ofreasons outlined inA

Reasonfor Vuit Classij5cation for

Anbu/aroryCare(RVC) (Il),is

shownin table 5. The principal

reason for visit (item 9aonthe

Patient Record)is the patient’s most

important complaint(s), symptom(s),

or other reason(s) for this visit

expressed in the patient’s (or patient

surrogate’s) own words. Up to three

reasons per visit may be coded based

upon the classification system found

in the RVC.

Nearly half (47.7 percent) of all

visits to this specialty were due to a

symptomatic problem or complaint,

with the largest percentage of

symptoms falling into the general

category (17.7 percent). Also

prominent were the disease module

(16.8 percent) and the treatment

module (16.2 percent), followecl by

the diagnostic, screening, and

preventive module (12.3 percent of

~isits).

Specific reasons for visit are listed

in table 6. The single most frequently

mentioned principal reason for

visiting a cardiovascular specialist was

chest pain and related symptoms,

recorded at 13.1 percent of visits.

Ischemic heart disease and

hypertension were the second and

third most frequently mentioned

reasons (5.6 percent and 5.0 percent

of visits, respectively). It is important

to keep in mind that the rank

ordering in this and other tables in

this report may not always be reliable

because near estimates may not differ

from one another because of

sampling variability.

It should also be noted that a

large number of visits relating to

cardiovascular symptoms and diseases

were made to primary care

physicians. Cardiologists received

about 16 percent of all physicians’

office visits made for the reason of

chest pain during 1989-90. The

majority were directed to primary

care physicians, with general ancl

family practitioners receiving 37.IO

percent and internists receiving 29.2

percent. Similarly, about half of all

visits for hypertension (that is, visits

at which the patient’s principal

reason for visiting the physician was

recorded as hypertension) were made

to general and family practitioners

(50.1 percent) and an additional

one-third were made to internists

(32.9 percent). Cardiovascular

specialists received only 5.4 percent

of these visits. However, for visits

where patients expressed their

principal reason for the current visit

as ischemic heart disease, indicating

an established diagnosis and ongoing

treatment for this condition,

cardiovascular specialists received
Advance Data No. 226 ● March 4, 1993 5

Table 3, Annual number and percent distribution of office visits to cardiovascular disease

specialists and to all other specialists, by selected visit characteristics, averaged over a

2-year period: United States, 1988-90

V/sits to cardiovascular

disease specialists Visfts 10 all otherspecialists

Number of Number of

visits in Percent visits in Percent

Visit characteristic thousands disftibution thousands distribution

All visits . . . . . . . . . . . . . . . . 11,040 100.0 667,613 100.0

Patient’s referral status

Patient was referred to this visit by

another physician. . . . . . . . . . . 1,065 9.6

patient was t’IOt referred to this visit

37,160 5.4

byanother physician. . . . . . . . . 9,975 90.4 650,453 94.6

Patient’s prior-visit status

Newpatient . . . . . . . . . . . . . . . 1,401 12.7 113,008 16.4

Oldpatient, rrewproblem . . . . . . 953 6.6 156,685 22.8

Oldpatient, old problem. . . . . . . 8,667 78.7 417,920 60.8

Table 4. Annual number and percent distribution of office visits to cardiovascular disease

specialists and to ail other specialists, by patient’s expected source of payment, averaged

over a2-yearperlod: United States, 1988-90

Wsita towrdiomscular

disease specialisfe Wsits fo all other specialists

Number of Number of

w“sitsin Percent visitsin Percent

Expected source of psymerf+ thousands distribution thousands distribution

Allvisits . . . . . . . . . . . . . . . . .

Commercial insurance . . . . . . .

Medicare . . . . . . . . . . . . . . . . .

Blue Cross/Blue Shield. . . . . . . .

Self-pay . . . . . . . . . . . . . . . . .

Prepaid plan/HMO/lPA/PP02 . . . .

Medicaid . . . . . . . . . . . . . . . . .

Nocharge . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . .

Unknown . . . . . . . . . . . . . . . . .

11,040

5,647

5,613

2,604

1,930

572

510

69

392

146

100.0

51.2

50.6

23.6

17.5

5.2

4.6

0.6

3.6

1.3

687,613

235,238

127,422

79,015

216,132

102,770

56,134

12,820

37,861

13,976

100.0

34.2

18.5

11.5

31.4

14.9

8.2

1.9

5.5

2.0

‘Numbers may not add to totals because more than one pay source may be coded for eachvmt.

*HMO is heailh maimermnce Organization, IPA is independent practice Sssccrauon. and PPO is preferred provider .mganzat( on.

39.9 percent of the total, compared

with internists (31.1 percent) and

general and family practitioners (23.5

percent).

Diagnostic services

Visits made to cardiovascular

disease specialists were more likely to

inchde diagnostic services ordered or

provided by the physician than were

visits to all other specialists. About

89.5 percent of the former included

at least one diagnostic service,

compared with 62.3 percent of the

latter. About three-quarters (74.0

percent) of the visits included a blood

pressure check, compared with 36.1

percent of visits to all other

specialties. Other blood test,

cholesterol measure, and chest x ray

were also performed more often at

visits to cardiovascular specialists.

Visits by the number and type of

diagnostic services ordered or

performed at cardiovascular visits are

shown in table 7.

Principal diagnosis rendered by

the physician

Data on principal diagnoses made

at office visits are obtained from item

10a of the Patient Record, which asks

physicians to record the principal

diagnosis associated with the patient’s

most important reason for visit.

Diagnoses are classified and coded

according to the International

Classification of Diseases, 9th Revision,

Clinical Modij?cation (ICD-9-CM)

(12).

Nearly two-thirds (65.4 percent)

of all visits to specialists in

cardiovascular diseases resulted in a

principaI diagnosis classifiable to a

disease of the circulatory system

(table 8). The most frequently listed

diagnosis was “other forms of chronic

ischemic heart disease”= occurring at

20.3 percent of visits, followed by

essential hypertension, listed at 13.0

percent of visits (table 9).

The distribution of visits for

seIected cardiovascular diagnoses by

physician special~ is shown in figure

4. Cardiovascular specialists received

about 36.9 percent of aII visits in

which the principal diagnosis was

other forms of chronic ischemic heart

disease, 35.3 percent of all visits for

angina pectoris, and 26.5 percent of

all visits for cardiac dysrhythmias.

However, folIowing the pattern seen

with reasons for visit, cardiovascular

disease specialists received only 5.2

percent of all visits with a principal

diagnosis of essential hypertension.

More than half of visits with a

principal diagnosis of essential

hypertension were made to general

and famiIy practitioners (51.2

percent), and nearIy one-third were

to internists (32.0 percent).

Therapeutic services

Data on therapeutic services

ordered or provided at visits to

cardiovascular disease specialists are

presented in table 10. Ivfedication

therapy was mentioned most

frequently, at S0.2 percent of visits,

compared with 59.9 percent of visits

to all other specialists. More than

%e International Classification of Diseases, 9th

Revision, Clinical Modification (lCD-9-CM)

defines “other forms of chronic ischemic heart

disease” (ICD-9-CM code 414) to include coronary atherosclerosis, aneurysm of heart, other

specified forms of chronic ischemic heart disease, and chronic ischemic heart disease.

unspecified.
6 Advance Data No. 226 ● March 4, 1993

Table 5. Annual number and percent distribution of office visits to cardiovascular disease

specialists by patient’s principal reason for visit, averaged over a 2-year period:

United States, 1989-90

Number of

wslte in Percent

Principal reason for visit and RVC code’ thousands distribution

Nvisits.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,040 100.0

Symptommodule . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S001-S999 5,263 47.7

Generalsymptoms . . . . . . . . . . . . . . . . . . . . . . . . . ..S001-S099 1,954 17.7

S~ptoms referable topsychologi@l and mental disorders. .S100-S19S 70 0.6

Symptoms referable to the nervous system (exluding sense

organs) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S200-S259

Symptoms referable tothe cardiovascular and Iymphatlc

system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S26C-S299

Symptoms referable toeyesand ears . . . . . . . . . . . .S300-S399

Symptoms referable totherespiratory system . . . . . . ..S40C-S499

Symptoms referable tothedigestive system . . . . . . . . . .S500-S639

Symptoms referable to thegenitourinary system. . . . . . . . .S840-S829

Symptoms referable totheskin, hair, and nails . . . . . . . .S830-S899

Symptoms referable to the musculoskeletal system. . . . . ..S90&S999

Diseasemodule . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..DooI-D999

Dtagnoatic, screening, and preventive module. . . . . . .X1OO-X599

Treatment module . . . . . . . . . . . . . . . . . . . . . . . . . . . ..TIOO-T899

Injury andadverse effects module , . . . . . . . . .JOCJ1-J999

Test results module . . . . . . . . . . . . . . . . . . . . . . . . . . .. R1OO-R7OO

Admmmtrative module. . . . . . . . . . . . . .A1OO-A14O

othe~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..u99&U999

428

798

55

1,094

209

69

100

489

1,859

1,353

1,785

67

361

“36

319

3.9

7.2

0.5

9.9

1.9

0.6

0.9

4.4

16.8

12.3

16.2

0.6

3.3

“0.3

2.9

‘Based on Afieason for Vfsjt C/=sti=tton for Ambu/afo~Care (WC), Vital Hea~ Stat 2(78), Feb. 1979.

21ncludes blanks, problems, and complaints not elsewhere class fied, entne$ of “none,” and illegible errtrtes.

Table 6. Annual number and percent distribution of office visits to cardiovascular disease

specialists by the 20 most frequently mentioned principal reasons for vlslt, avaraged over

a2-year period: United States, 198+90

Number of

visits in Percent

Principal reason for visit and RVC code’ thousands distribution

All visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,040 100.0

Chest pain and related symptoms (not referable to body

system) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S050 1,447 13.1

Ischemic heart disease . . . . . . . . , . . . . . . . . . . . . . ..D515 623 5.6

Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..D51O 550 5.0

Abnormal pulsations and palpitations . . . . . . . . . . . . . . .S280 540 4.9

General medical examination. . . . . , . . . . . . . . . . . . . . .X1OO 533 4.8

Shortnessofbreath . . . . . . . . . . . . . . . . . . . . . . . . ..S415 432 3.9

Postoperativevisit . . . . . . . . . . . . . . . . . . . . . . . . . . ..T2O5 340 3,1

Blood pressuretest . . . . . . . . . . . . . . . . . . . . . . . . . ..X320 314 2.e

Otherheartdisease .,...... . . . . . . . . . . . . . . . ...0520 280 2.5

Forotherand unspecifiedtest results . . . . . . . . . . . . .R700 275 2.5

Vertigo-dizziness ..,,..... . . . . . . . . . . . . . . . . . ..S225 2?4 2.5

Otherheartsymptoms . . . . . . . . . . . . . . . . . . . . . . . ..S270 258 2.3

Labored ordifftcult breathing.. ., . . . . . . . .S420 223 2.0

Cough . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S440 195 1.8

Tiredness, exhaustion, ,... , . . . . . . . . . . . . . . . . . ..S015 159 1.4

Leg symptoms, . . . . . . . . . . . . . . . . . . . . . . . . . . ..S920 135 1.2

Otherbloodtest . . . . . . . . . . . . . . . . . . . . . . . . . . . ..X315 125 1.1

Otherspecial examination . . . . . . . . . . . . . . . . . . . . .X240 105 0.9

EKG, ECG, electrocardiogram, tread mill, stress testing . . . .X35O 96 0.9

Preoperative visit for specified and unspecified types of

surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..T200 93 0.8

All other reasons, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,051 36.7

'&sedOn AReBsOn for WsltC/asslfi@t/onfortibu/aro~ Care (RVC],V!tal Health Stat 2(78], Feb. 1979.

half (53.9 percent) of the being cited at18.8 percent and19.7

cardiovascular visits included some percent of visits, respectively. In

form ofcounseling oradvice, with comparison, oniy 6.lpercentofaI1

weight and cholesterol reduction other visits included counseling for

weight reduction, and 2.9 percent

mentioned counseling for cholesterol

reduction.

Data in tables 11, 12, and 13

present additional information

pertaining to the utilization of

medication therapy at visits to

cardiovasctdar disease specialists. As

used inthe NAMCS, the term “drug”

is interchangeable with the term

“medication” and includes all new or

continued medications ordered or

provided at the visit. This includes

both prescription and nonprescription

preparations, immunizing agents, and

desensitizing agents, “Drug mentions”

refer to the total number of

medications listed in item 15 of the

Patient Record. Because physicians

may record more than one

medication per visit, the total number

of drug mentions may exceed th(e

total number of visits. “Drugv isits”

refer to visits with at least one

mention of medication ordered or

provided by the physician. An earlier

report (13) describes in detail the

method and instruments used in the

collection andprocessing of NAMCS

drug data.

hong visits to cardiovascular

specialists, there were an average of

25.4 million drug mentions perylear

for 1989 and 1990, yielding about 2.9

mentions per drug visit and about 2.3

mentions per visit overall. The

number of drug mentions by

therapeutic classification, adapted

from therapeutic categories used in

the National Drug Code Directory,,

1985 edition (14), is shown in table

11. In cases where a particular drug

was classifiable to more than one

therapeutic catego~, it was listecl

under the category for which it was

most frequently prescribed. As

expected, cardiovascular-renal drugs

were prescribed most frequently (55.8

percent of drug mentions). Within

this broad category, antianginal

agents and antihypertensive drugs

represented 31.2 percent of all of the

drug mentions.

The generic substances used most

frequently in medications ordered or

provided at cardiovascular visits are

shown in table 12. The first six of

these —digoxin, aspirin, nitroglycerin,
Advance Data No. 226 ● March 4, 1993 7

Table 7. Annual number and percent distribution of office visits to cardiovascular disease

specialists and to all other specialists by diagnostic service, averaged over a 2-year

period: United States, 1988-90

Visits to cardiomscular

disease specia/is?s Wits to all other specialists

Number of Number of

visits in Percent w“sitsin Percent

Visit characteristic thousands distribution thousands distribution

Allvisits . . . . . . . . . . . . . . . . . 11,040 100.0 687,613 100.0

Number of diagnostic services

ordered or performed at visit

o . . . . . . . . . . . . . . . . . . . . . . 1.161 10.5 258,909 37.7

1 . . . . . . . .,., . . . . . . . . . . . . 3,895 35.3 219,563 31.9

2 . . . . . . . . . . . . . . . . . . . . . . 3,291 29.8 43,750 6.4

3 . . . . . . . . . . . . . . . . . . . . . . 1,522 13.8 43,750 6.4

4 . . . . . . . . . . . . . . . . . . . . . . 659 6.0 19,360 2.8

5 ormore . . . . . . . . . . . . . . . . 513 4.6 33,381 4.9

Diagnostic services

ordered or performed at vieit’

Blood pressure check. . . . . . . . .

Other blood test . . . . . . . . . . . .

Cholesterol measure . . . . . . . . .

Chest x ray . . . . . . . . . . . . . . .

Urinalysis . . . . . . . . . . . . . . . .

Stool blood exam . . . . . . . . . . .

Digital-reotalexam. . . . . . . . . . .

Breast palpation . . . . . . . . . . . .

oral glucose tolemnce . . . . . . . .

HIVserolog# . . . . . . . . . . . . . .

Visual acuity . . . . . . . . . . . . . . .

Mammogram . . . . . . . . . . . . . .

Peivic exam . . . . . . . . . . . . . . .

Pap test . . . . . . . . . . . . . . . . .

Proctoscopylslgmoldoscopy. . . . .

Other diagnoeticservice . . . . . . .

8,173

2,970

2,037

986

817

261

205

183

137

124

79

55

●36

“31

*25

4,667

74.0

26.9

18.5

8.9

7.4

2.4

1.9

1.7

1.2

1.1

0.7

0.5

●0.3

“0.3

“0.2

42.3

246,472

88,140

23,455

18,371

87,993

16,266

25,242

38,536

3,102

1,023

45,163

11,159

51,658

33,302

3,066

171,650

36.1

12.8

3.4

2.7

12.8

2.4

3.7

5.6

0.6

0.1

8.6

1.6

7.5

4.8

0.4

25.0

‘Numbers may not add 10 totals becsuse more than one diagnostic semlce may be performed at each vM.

2HIV is human !mmunodelicienq virus.

Table 8. Annual number and percent distribution of office visits to cardiovascular disease

specialists byprlncipal diagnosis, averaged over a2-yearperlod: United States, 1989-90

Number of

wsits in Percent

Principal diagnosis and [CD-9-CM code’ thousands distribution

Allvieifs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,040 100.0

Infectious and parasitic diseases. . . . . . . . . . . . . . . . ...001-139 ●2O ●0.2

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239 ●5O 0.5

Endocrine, nutritional and metabolic diseases and immunity

disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...24&279 400 3.6

Mentaldlsordera . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-319 108 1.0

Diseases of thenervous system and sense organs . . . . ...320-389 138 1.3

Diseases ofthe circulatory system. . . . . . . . . . . . . . . ...390459 7,225 65.4

Diseases ofthe respiratory system. . . . . . . . . . . . . . . . . .46&519 563 5.1

Diseases ofthedlgestive system. . . . . . . . . . . . . . . . ...520-579 136 1.2

Diseasee of thegenitourinaiy system. . . . . . . . . . . . . ...580-829 S4 0.9

Diseases of theskin andsubcutaneoua tissue . . . . . . . ...660-709 59 0.5

Diseases of the musculoakeletal system and connectWe

tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...710-739 300 2.7

Symptoms, signs, and illdefined conditions. . . . . . . . . ...780-799 8s4 5.9

Irtjuryend poisoning . . . . . . . . . . . . . . . . . . . . . . . . . ..800-W9 119 1.1

Supplementaryclaesificatlon . . . . . . . . . . . . . . . . . . . ..VO1-V82 848 8.6

Allotherdiagnosea2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 0.6

Unknown3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 1.5

‘Based Mtie/n?em8?iMd C/as(f@tion of Oisemm, wRehion, C/ini4M&rkafion (/CGg-CM).

21ncludesdiseasea olthebloodanci blcocl.forrning orgsns (280-289); mm@icatmns ofpregnancy. childbirthi and~e

guerperl.m (SS0-876): cnngemtal anomalies (740-7S9); and certain cmdmns on$m.sting in the pwinetst period (7ao-7ee).

Includes blink diagnoses, uncoctable diagnoses, and Illeglble dmgnoses.

diltiazem, furosemide, and

~ydrochIorothiazide –were foundin

32.5 percent ofa11 of the drugs

mentioned at cardiovascular visits. It

should be noted that drugs containing

more than one ingredient are listed in

thedata for each ingredient. For

example, acetaminophen with codeine

would be listed both under the count

for acetaminophen as well as the

count for codeine.

Drug mentions according to entry name,

that is, the name recorded by the

physician in item 15 of the Patient

Record, are shown in table 13. This could

be a trade name, generic name, or simply

a desired therapeutic effect. Cardizem

was the specific entry Iisted most

frequently (4.9 percent of mentions),

followed by Lanoxin (4.7 percent), and

La& (4.2 percent).

Disposition of visit

Vkits to cardiovascular specialists

were more likely to include

instructions toretum at a specific

time (80.2 percent) than were visits to

alI other specialities (61.4 percent).

Data indisposition of visit are shown

in table 14.

Duration of visit

About half (49.2 percent) of the

visits to cardiovascular disease

specialists lasted more than 15

minutes, compared with Iess than

one-third (29.9 percent) of the visits

to all other specialists (table 15).

Average duration of cardiovascular

visits was relatively long -21.8

minutes compared with 16.4 minutes

for visits to all other specialists.

Average duration is based on the

time spent indirect, face-to-face

contact between the physician and

the patient. It does not include visits

of ’’zero” minutes duration, that is,

visits in which the patient did not

meet with the physician directly.

References

1. Koch H. Office visits to cardiovascular

specialists, National Ambulatory

Medical Care Surfejc United States,

1975-76. Advance data from vital and

health statistics; no. 42. Hyattsville,
8 Advance Data No. 226 ● March 4, 1993

Table 9. Annual number and percent distribution of office visits to cardiovascular disease

specialists by the 20 most frequently mentioned principal diagnoses, averaged over a

2-year period: United States, 1989-90

Number of

visits in Percent

Pnncpal diagnosis and ICD-9-CM cude’ thousands distribution

Ailvisrts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other forms of chrome ischemlc heart disease . . . . . . . . . .414

Essential hypertension, . . . . . . . . . . . . . . . . . . . . . . . ...401

Carrliac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . ...427

Angina pectoris . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...413

Other diseases ofendocsrd!um . . . . . . . . . . . .424

Symptoms involwng respiratory system and other chest

symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..786

Observation andevaluatron forsuspected conolms. . . . . .V71

Heartfailure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .428

Otherpostsurgicalstates ..,... . . . . . . . . . . . . . . . . . ..V45

Diabetes melhtu s . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Cardiomyopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...425

Hypertensive heartdisease . . . . . . . . . . . . . . . . . . . . . . . .402

Old myocardial infarction . . . . . . . . . . . . . . . . . . . . . . ...412

Bronchit$, no!speciied asacute or chronic .’. . . . . . . ..490

Symptoms involving cardiovascular system. . . . . .785

Dkorderso flipoidmetabomm. . . . . . . . . . . . ..272

General medcale xaminat!on.. . . . . . . . . . . . . . . . . . . . ..W’O

Other acute andsubacute forms ofkchemic heart disease. . . .411

Chronic airway obstmction, notelsewhere ckssrfied . . . . .496

Osteoarthrosis andalliedd[sorders . . . . . . . . . . ..715

All otherdiagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11,040

2,242

1,4X3

848

765

423

349

344

2e2

218

181

154

153

124

121

112

108

104

103

91

91

2,786

100.0

20.3

13.0

7.7

6.9

3.6

3.2

3.1

2.6

2.0

1.6

1.4

1,4

1.1

1.1

1.0

1.0

0.9

0.9

0.8

0.8

25.2

'Sasedon the/nfernatJona/ Classlfimf,oo 0fOise8ses, &h Rewsion, atn/c8/ Modffiaf/on(lCBKM)

Physicianspaaalty:

❑

cardiovascular

•nIll

General and

•1

. . Internal

•1

Other

diseases family practice ““ medicine

Other forms of chronic

Essential hypertension ischemic heart disease

(ICD-9-CM code 401) (ICD-9-CMmde414)

Cardiacdyarhythmiaa Anginapactoris

(lCD-9-CMcode427) (lCD-9-CMcode413)

NOTES: Stsfistlcs ara2-year averages.

Di~ncsasand codssambasedonthe /nIemtiw/Ck=if=titiofDi*Sq

9fh Revision, Clinissl Mcdficatbn (ICD-9-CM).

Flgure4. Percent distribution of office vlsitsfor selected diagnoses, byphyslclan

specialty United States, 1989-90

Maryland: National Center for Health

Statistics. 1978.

2. Nelson C. Office visits to

cardiovascular disease specialists, 1985.

Advance data from vital and health

statistics; no. 171. HyattsvilIe,

Maryland: National Center for Health

Statistics. 1989.

3. DeLozier JE, Gagnon RO. 1989

Summary: National Ambulatory

iMedical Care Survey. Advance data

from vital andhealth statistics; no.

203. Hyattsville, Maryland: National

Center for Health Statistics, 1991.

4. Schappert SM. NationaI Ambulatory

Medical Care Stuvey: 1989 Summary.

National Center for Health Statistics.

Vital and Health Stat 13(110). 1992.

5. Schappert SM. National Ambulatory

Medical Care Survey: 1990 Summary.

Advance data from vital and heaIth

statistics; no. 215. Hyattsville,

Maqland: National Center for Health

Statistics. 1992.

6. Woodwell DA. Office visits to

pediatric specialists: 1989. Advance

data from vital and health statistics;

no. 208. Hyattsville, Maryland:

National Center for Health Statistics.

1992.

7. Schappert SM. Office visits for

diabetes mellitus: United States, 1989.

Advance data from vital and health

statistics; no. 211. Hyattsville,

Maryland: National Center for Health

Statistics. 1992.

8. Woodwell DA. Office visits to

internists: 1989, Advance data from

vital and health statistics; no. 216.

HyattsviIle, Maryland: National Center

for Health Statistics. 1992.

9. Schappert SM. Office visits for otitis

media: United States, 1975-90.

Advance data from vital and health

statistics; no, 217. Hyattsville,

Maryland: National Center for Health

Statistics. 1992.

10, Schappert SM. Office visits to

obstetricians and gynecologists:

1989-90. Advance data from vital and

health statistics; no, 223. HyattsviIle,

Maryland: National Center for Health

Statistics. 1993.

11. Schneider D, Appleton L, McLemore

T. A reason for visit classification for

ambulatory care. National Center for

Health Statistics. Vital and Health

Stat 2(78). 1979.

12. Public Health Service and Health Care

Financing Administration.

International Classification of

Diseases, 9th Revision, clinical
Advance Data No. 226 ● March 4, 1993 9

Table 10. Annual number and percent distribution of office visits to cardiovascular disease

specialists and to all other specialists by therapeutic service, based on a 2-year average:

United States, 198%90

Vis@ to cardiovascular

disease specia(rsts Visits to all other specialists

Number of Number of

7herapeautic service visits in Percent visits in Percent

ordered or provided at visifI thousands distribution thousands distribution

All visits . . . . . . . . . . . . . . . . . . . 11,040 100.0 687,613 100.0

New or continuing medication. . . . . . 8,S59 80.2 41 1,82S 59.9

Counseling/advice

None . . . . . . . . . . . . . . . . . . . . . 5.086 46.1 434,227 63.1

We!ght reduction . . . . . . . . . . . . . . 2.079 18.8 42,037 6.1

Cholesterol reduction. . . . . . . . . . . 2,180 19.7 19,s70 2.9

Smoking cessation. . . . . . . . . . . . . 560 5.1 14,463 2.1

HIVtransmission . . . . . . . . . . . . . . ●9 ‘0.1 1,3s3 0.2

Breastself-exam . . . . . . . . . . . . . . Sa 0.6 15,909 2.3

Other . . . . . . . . . . . . . . . . . . . . . 3,781 34.2 192,159 27.9

Other nonmedicsdkx therapy

None . . . . . . . . . . . . . . . . . . . . . 9.630 87.2 552,841 80.4

Psychotherapy . . . . . . . . . . . . . . . 108 1.0 24,445 3.6

Corrective lenses . . . . . . . . . . . . . . w 1 ●0.1 9,066 1.3

Ambulatorysurgery . . . . . . . . . . . . “23 90.2 13,831 2.0

Physiotherapy . . . . . . . . . . . . . . . . 110 1.0 16,279 2.4

Other . . . . . . . . . . . . . . . . . . . . . 1,194 10.8 75,874 11.0

‘Numbers may nOtaddtotOtak because more lhanone type of therapy maybe orcteredor protided ateachvmt.

Table 11. Annual number and percent distribution of drug mentions at office visits to

cardiovascular disease specialists bytherapeutIc classification, averaged over a2-year

period: United States, 1989-90

Number of

drug

mentions in Percent

7herepeutic classification’ thousands distribution

Allmentions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cardiovascular-renal . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antianginal agents . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antihypeflensiveagents . . . . . . . . . . . . . . . . . . . . . . . .

Diuretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cardiacglycosides . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antiarrhythmicagents . . . . . . . . . . . . . . . . . . . . . . . . .

Agents used inperipheral orcerebral vascular disorders . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pain relief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Metabolicand nufrientagents. . . . . . . . . . . . . . . . . . . . . .

Hormones andagents affecting hormonal mechanisms. . . . . .

Respiratorytract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychopharmacologic . . . . . . . . . . . . . . . . . . . . . . . . . . .

Gastrointestinal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antimicrobial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hematologic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

OtherZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Unclaasitied, miscellaneous.. . . . . . . . . . . . . . . . . . . . . .

25,369

14,158

3,995

3,931

2,466

1,739

1,176

751

102

2,543

1,797

1,609

846

644

737

690

560

529

1,060

100.0

55.8

15.7

15.5

9.7

6.9

4.6

3.0

0.4

10.0

7.1

6.3

3.3

3.3

2.9

2.7

2.2

2.1

4.2

modification. Washington: Public

HeaIth Service. 1980.

13.Koch H, Campbell W.The collection

and processingof drug information.

National Ambulatory Medical Care

Survey, 1980. National Center for

Health Statistics. Vital Health Stat

2(90). 1982.

14.Food and Drug Administration.

NationaI Drug Code Directory, 1985

Edition. Washington: Public Health

Service 1985.

15. Nationai Center for Health Statistics.

Public Use Data Tape Documentation,

1989 National Ambulatory Medical

Care Survey. Hyattsviile, MaryIand.

1991.

16. National Center for Health Statistics.

PublicUse Data Tape Documentation,

1990 National Ambulatory Medical

Care Survey. Hyattsville, Ma~iand.

1992.

‘TherapeuticclassnWMonisbased Onthestandard drug clsaslficmonused in the Nationa/ Dmg Ctie Dir~to~,198S Edrtlon.

‘Includes anesthetics, radiopharmaceuticalskontrsst media. oncalyt!cs, otolcgcel drugs, and antrparasit]c agents.
10 Advance Data No. 226 ● March 4, 1993

Table 12. Number, percent distribution, and therapeutic classification of drug mentions at office visits to cardiovascular disease

specialists by the 20 most frequently used generic substances, averaged over a 2-year period: United States, 1988-90

Number of dNg

mentions in Percent

Generic substance Zfrousands’ distribution Therapeutic classification 2

All mentions . . . . . . . . . . . . . . . . . . . 25,369 100.0 . . .

Dioxin. . . . . . . . . . . . . . . . . . . . . .

Aspirin . . . . . . . . . . . . . . . . . . . . . .

Nitroglycerin . . . . . . . . . . . . . . . . . . .

Diltiazem . . . . . . . . . . . . . . . . . . . . .

Furosemide, . . . . . . . . . . . . . . . . . .

Hydrochlorothiezide. . . . . . . . . . ., . .

Captopnl . . . . . . . . . . . . . . . . . . . . .

Triamterene . . . . . . . . . . . . . . . . . . .

Dipyndarnole . . . . . . . . . . . . . . . . . .

Nifedlpine . . . . . . . . . . . . . . . . . . . .

Potaaaium replacement solutions. . . . . .

Verapamil, . . . . . . . . . . . . . . . . . . .

lsosortide, . . . . . . . . . . . . . . . . . . .

Atenolol . . . . . . . . . . . . . . . . . . . . .

Propanolol . . . . . . . . . . . . . . . . . . . .

Lovastatin . . . . . . . . . . . . . . . . . . . .

Enalapril . . . . . . . . . . . . . . . . . . . . .

Warfarin . . . . . . . . . . . . . . . . . . . . .

Glyburide . . . . . . . . . . . . . . . . . . . .

Quinidine . . . . . . . . . . . . . . . . . . . .

1,697

1,644

1,459

1,254

1,144

1,073

764

?f 3

694

664

633

631

607

566

538

520

506

434

342

29s

6.7

6.5

5.7

4.9

4.5

4.2

3.1

2.6

2.7

2.6

2.5

2.5

2.4

2.2

2.1

2.0

2.0

1.7

1.3

1.2

Cardiac giycoside

General analgesic

Antianginal agent

Antianglnal agent

Diuretic

Diuretic

Antihypertensive agent

Diuretic

Agent used in peripheral or cerebral vascular disorders

Antianginal agent

Replenisher and regulator of water and electrolytes

Antlarrhythmlc agent

Antianginal agent

Antlhypertensive agent

Antihypertensive agent

Agent used to treat hyperfipidemia

Antihyperfensive agent

Anticoagulant or thrombolytic

Blood glucose regulator

Antia&hyfhmic agent

‘ Frequencjof mermon combines single-ingredient agenu vmh mentxma of rhe agfrm as an ingredient in a combinatmn drug.

‘Therapaulicclsasdicstion isbssadonthe atandard drugcJsasifcation usadInthefWiorra/ OrugCodeDiractory, 1985 Edtion.lncsaes whereageneric subatancehadmora thanona

lherafxutiicleasificstion, itvmsliatedlnthe categoryforwtkh itwaarnastfrsquenlly presczibad.

Tabie 13. Annual number, percent distribution, and therapeutic classification of the 10 drugs most frequently prescribed at office visits to

cardlovesc~lar disease specialists, byen~name ofdrug, averaged over a2.year period: United States, 1989-90

Number of drug

mentions in Percent

Entry name Of dNg’ tttousanda distribution 7tterapeutic ciassificatior?

All mentiona . . . . . . . . . . . . . . . . . . . 25,369 100.0 . . .

Cardizem . . . . . . . . . . . . . . . . . . . . 1,254 4.9 Antianginal agent

Lenoxin. . . . . . . . . . . . . . . . . . . . . . 1,204 4.7 Cardiac glycoside

Lasix . . . . . . . . . . . . . . . . . . . . . . . 1,075 4.2 Diuretic

Capote. . . . . . . . . . . . . . . . . . . . . 672 2.6 Antihypettenslve agent

Acetylsakyticacid( ASA.). . . . . . . . . . 656 2.6 General analgeslc

Persantine . . . . . . . . ...<... . . . . . 598 2.4 Agent used in peripheral or cerebral vascular disorders

Aspirin . . . . . . . . . . . . . . . . . . . . . . 570 2.2 General analgeaic

Procardia. . . . . . . . . . . . . . . . . . . . . 540 2.1 Antianginal agent

Tenorrnin. . . . . . . . . . . . . . . . . . . . . 524 2.1 Antlhypertensive agent

Mevacor . . . . . . . . . . . . . . . . . . . . . 520 2.0 Agent used to treat hyperlipidemia

‘The trade or generic name used by the phyekkm on the prescfipton or other medical records.

2Therapetic class fllmt!on is bas@onthe mMarddmg cl~eifimOon used inme NatiMel Dmg Ctie D/mdo~, l9B5Edfion. Incases where adrughad morethen one therapeutic

clsasikfmon, lt was kxed m the cstegory ter which It was most frequently prescmbed.
Advance Data No. 226 ● March 4, 1993 11

Table 14. Number and percent distribution of office visits to cardiovascular disease

specialists and to all other specialists by disposition of visit, averaged over a 2-year

period: United States, 1989-90

Visits to Cardiovascular

spec/a/isk visits to M other specialists

Number of Number of

wsits in Percent visits in Percent

Disposition of visi? thousands distribution thousands distribution

Allvisits . . . . . . . . . . . . . . . . . 11,040 100.0 687,613 100.0

No followup planned . . . . . . . . . 391 3.5 66,953 9.7

Return at specified time . . . . . . . 8,851 80.2 422,206 61.4

Return if needed . . . . . . . . . . . . 1,327 12.0 158,365 23.0

Telephone followup planned. . . . . 347 3.1 25,737 3.7

Refer to other physician . . . . . . . 357 3.2 21,149 3.1

Return to referring physician. . . . . 560 5.1 6,115 0.9

Admit to hospital . . . . . . . . . . . . 215 1.9 6,767 1.0

Other disposition. . . . . . . . . . . . 233 2.1 13,292 1.9

‘Numbers may not add 10 totals because more than one disposmon may be coded for each visit.

Table 15. Annual number and percent distribution of office visits to cardiovascular disease

specialists and to all other specialists by duration of visit, averaged over a 2-year period:

United States, 1989-90

Visits to cardiowscular

disease specialists Wsita to all ottrer specialists

Number of Number of

w“sitain Percent w“sifain Percent

Duration ofvisit thousands distribution thousands distribution

Allvisita . . . . . . . . . . . . . . . . . 11,040 100.0 687,613 100.0

Ominutes’ . . . . . . . . . . . . . . . . 278 2.5 11,595 1.7

l-5 minutes . . . . . . . . . . . . . . . 207 1.9 64,061 9.3

8-10 minutes . . . . . . . . . . . . . . 1,637 14.8 193,456 26.1

n-15 minutes . . . . . . . . . . . . . 3,487 31.6 212,826 31.0

16-30 minutes . . . . . . . . . . . . . 4,160 37.7 162,107 23.6

31-80 minutes . . . . . . . . . . . . . 1,064 9.6 40,582 5.9

Morethan80 minutes. . . . . . . . . 208 1.9 2,965 0.4

‘Viiits Ot zero mlnutas duration are those in which there was no taca-to-face contact behveen the physician and the patient.
12 Advance Data No. 226 ● March 4, 1993

Technical notes

Source of data and sample

design

This report is based on data

collected through the National

Ambulatory Medical Care Sunrey

(NAMCS) over the 2-year period

1989-90. The target universe of

NAMCS includes office visits made

the United States by ambulatoy

patients to nonfederally employed

physicians who are principally

in

engaged in office practice, but not in

the specialties of anesthesiology,

pathology, or radiology. Telephone

contacts and nonoffice visits are

excluded.

A multistage probability sample

design is used in NAMCS, involving

samples of primary sampIing units

(PSU’S), physician practices within

PSU’S, and patient visits within

physician practices. The PSU’S are

counties, groups of counties, county

equivalents (such as parishes or

independent cities), or towns and

townships (for some PSU’S in New

England). Physicians were stratified

into 15 specialty groups during the

second stage of the survey design.

Detailed descriptions of the 1989 and

1990 NAMCS design have been

published (4,15,16), and the reader is

urged to consult these sources for

further technical information.

The 1989 NAMCS physician

sample included 2535 physicians

selected from master files maintained

by the American Medical Association

and the American Osteopathic

Association; 118 of these were

specialists in cardiovascular diseases.

Physicians were screened at the time

of the survey to ensure that they were

eligible for sumey participation, based

upon a set of design criteria. Of those

screened, 608 physicians (incJuding 24

cardiovascular disease specialists)

were ruled ineligible (out-of-scope)

due to reasons such as being retired

or employed primarily in teaching,

administration, or research. Of the

remaining 1,927 physicians, 74

percent responded to the survey,

including 61 cardiovascular disease

specialists, or 65 percent of those

surveyed.

Sample physicians were asked to

complete Patient Records (see figure

1) for a systematic random sample of

their office visits occurring during a

randomly assigned l-week reporting

period. Responding physicians

completed 38,384 forms, including

1,087 forms completed by

cardiovascular specialists.

For 1990, a sample of 3,063

non-Federal, office-based physicians

was selected from master files

maintained by the Anerican Medical

Association and American

Osteopathic Association. Of this

number, 149 were specialists in

cardiovascular diseases. The overall

response rate for the 2,269 in-scope

physicians was 74 percent; the rate

was 67 percent for the 114 in-scope

cardiovascular disease specialists.

Responding physicians completed

43,469 patient records, including

1,243 forms from cardiovascular

disease specialists.

Characteristics of the physician’s

practice, such as primary specialty

and type of practice, were obtained

from the physicians during an

induction intemiew. The U.S. Bureau

of the Census, Housing Surveys

Branch, was responsible for the

survey’s data collection. Processing

operations and medical coding were

performed by the National Center for

Health Statistics, Hospital Discharge

and Ambulato~ Care Survey Section,

Research Triangle Park, North

Carolina.

The 1989 and 1990 NAMCS were

identical in terms of sutwey

instruments, definitions, and

procedures. The resulting 2 years of

data have been combined to provide

more reliable estimates. All estimates,

percent distributions, and rates

presented in this report, unless

otherwise noted, reflect 1989 and

1990 data that were averaged over

the 2-year period.

Table L Relative standard errors for

estimated numbers of office visits to all

specialists and to cardiovascular disease

specialists: National Ambulatory Medical

Care Survey, 1989-90

VISIZ3to

VkI& to Cardiovascular

Estimated number of all djsease

office wws in thousands specialisfa’ spefxa/M&

Relative standard error

in percent

100 . . . . . . . . . . . . . . . . . 72.7 311

200 . . . . . . . . . . . . . . . . . 51.5 23.4

500 . . . . . . . . . . . . . . . . . 32.6 17,1

1,003 . . . . . . . . . . . . . . . 23.2 14.4

2,000 . . . . . . . . . . . . . . . . 16.5 12.9

5,000 . . . . . . . . . . . . . . . . 10,7 11.9

Io,ooo . . . . . . . . . . . . . . . 7.9 11.9

20.000.. . . . . . . . . . . . . . 6.0 11.3

50,000 . . . . . . . . ...?... 4.5 11.2

Ioo,ooo . . . . . . . . . . . . . . 3.9 11.2

200,000 . . . . . . . . . . . . . . 3.5 11.1

500,000 . . . . . . . . . . . . . . 3.9 11.1

1.000,000 . . . . . . . . . . . . 3.2 11.1

1,400,000 . . . . . . . . . . . . . 3.2 11.1

‘ForM.SIU to aggregated speciahsfs, tie smallest rel!able

estwnate IS 593.CCO ws!ts. Estimates bekw thks figurO hsves

relsbw standard errof greater man SO pwcent.

2 For wits to card IOVSSCU15fdtaesse l@sMs., the StIlSh3t

nfkU-e estlnwtes 110,06a woks.

Essmple of use of table: An aggregate estimate of 2 mllkm

wsrts co cdrdmmsculsr d!sasse spsoahsls has @relatrw

stsndard enor of 12.9 pwcent, or a standard error o! 2S6,000

wsns (12.9 pemem of 2 milhon).

sample, rather than an entire

universe, is surveyed. The relative

standard error of an estimate is

obtained by dividing the standard

error by the estimate itself. The :result

is then expressed as a percent of the

estimate. Relative standard errors for

estimated numbers of office visits in

Table U. Relative standard errors for

estimated numbers of drug mentions M

visits to cardiovascular disease specialists:

National Ambulatory Medical Care Suwey,

1989-90

Estimated number of drug Re/stivs standard

mentions in thousands’ error m percant

100.................... 36.1

200. . . . . . . . . . . . . . . . . . . . 27.01

500 . . . . . . . . . . . . . . . . . . . . 19.7

1,000 . . . . . . . . . . . . . . . . . . . 16.6

2,000 . . . . . . . . . . . . . . . . . . . 74.7

5SW.. . . . . . . . . . . . . . . . . . 13.5

10.COO . . . . . . . . . . . . . . . . . . 13,1

20,000 . . . . . . . . . . . . . . . . . . 12.9

50,000 . . . . . . . . . . . . . . . . . . 12.8

Icmocl... . . . . . . . . . . . . . . 12.7

l,00Lmf30 . . . . . . . . . . . . . . . . 12.7

Sampling errors

The standard error is primarily a

measure of the sampling variability

that occurs by chance when only a

‘me sn-dsst rehable ●stlmato of drugmmfsms ●t v&its 10

Csrdwssculsr dmsse SPOUSIISMIS 15S.000. Eswnates

oetw mu fqurs hsve ● rcmtws stmdsrd wnx gromsr than

34 Psrcenf.

Exemplo of use of tsblti M qgrogew wfmsto of 10 milhw

drug manwns has a roiawe standard wmr of 13.1 peiwrfl

or ● stwmaro error of 1,310.000 mentwns (13.1 psrcwn of 10

milhon).
Advance Data No. 226 ● March 4, 1993 13

Table 111.Standard errors for percents of estimated numbers of office visits to

cardiovascular disease specialists: National Ambulatow Medical Care Survey: 1989-60

Estimatad percent

Base of percent

(visits in thousands) 1 or 99 5 or 95 70 or90 2U or 80 30 or 70 50

Standard error in percentage points

200 . . . . . . . . . . . . . . . . . . . . 2.1 4.5

500 . . . . . . . . . . . . . . . . . . . . 1.3 2.8

1,000. . . . . . . . . . . . . . . . . . . 0.9 2.0

2,000. . . . . . . . . . . . . . . . . . . 0.6 1.4

5,000 . . . . . . . . . . . . . . . . . . . 0.4 0.9

10,000 . . . . . . . . . . . . . . . . . . 0.3 0.6

20,000 . . . . . . . . . . . . . . . . . . 0.2 0.5

50,000 . . . . . . . . . . . . . . . . . . 0.1 0.3

100,000 . . . . . . . . . . . . . . . . . 0.1 0.2

600,000 . . . . . . . . . . . . . . . . . <.1 0.1

6.2

3.9

2.8

2.0

1.2

0.9

0.6

0.4

0.3

0.1

6.2

5.2

3.7

2.6

1.7

1.2

0.8

0.5

0.4

0.2

9.4 10.3

6.0 6.5

4.2 4.6

3.0 3.3

1.9 2.1

1.3 1.5

1.0 1.0

0.6 0.7

0.4 0.5

0.2 0.2

Exampleof USaof tabk An asmmate of 30percent based on an aggregate estimate of 10 mi!km tisits has ● sfsndsrd ernx of

1.3 percentor a rehfive stsndard error of 4.3 percent (1.3 percent dwlded by 30 percant).

Table IV. Coefficients appropriate for determining relative standard errors by type of

estimate and physician groups National Ambulatory Medical Care Suwey,1989-90

Coefi5clent

Type of estimate and

physician group A B

visits

Overalltotals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.00097549 52.77852184

Generslandfemily practice. internal medicine. . . . . . . . . 0.00456412 37.27953208

Pediatrics, obstetrics and gynecology. . . . . . . . . . . . . . 0.00755165 23.43030623

Doctors of osteopathy, general surgery, orthopedic

surgery, csrdiovaacular dkeeses, psychiat~, urological

surgery, dermatology, neurology, optithalrnolocv.

otolaryngology . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.01236777 6.46452955

Another . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.01169917 39.3S793604

Drug mentions

Overalltotak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.00157151 61.47054833

Generalandfamily practice,intemal medicine . . . . . . . . . 0.00589721 59.72807201

Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.0286738 30.9506771

Doctors of osteopathy, general surgery, orthopedic

surgery, cardiovascular diseeaes, urological surgery,

dermatology, neurology, ophthalmology,

otolaryngology, obstetrics andgynecology, pediatrics. . . 0.01603845 11.42008384

Another. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.01877082 70.35068675

1990 are shown in table I, relative

standard errors for estimated

numbers of drug mentions are shown

in table II, and standard errors for

estimated percents ofvisits are shown

in table III. Readers using these

tables should keep inmind that they

referto combined years ofdata

rather than average annual estimates.

Alternatively, relative standard

errors for aggregate estimates may be

calculated using the following generaI

forrnuk, wherex is the aggregate of

interesting thousands, andA andl?

are the appropriate coefficients from

table IV.

RSE(X) =

G

A+~ Xloo.o

Similarly, relative standard errors

for percents may be calculated using

the following general formula, where

p is the percent of interest and x is

the denominator of the percent in

thousands, using the appropriate

coefficient from table IV

‘SE’)=-10 ‘1000

Adjustments for nonresponse

Estimates from NAMCS data

were adjusted to account for sample

physicians who were in-scope but did

notparticipatein thestudy. This

adjustment was calculated to

minimize the impact of response on

final estimates by imputing to

nonresponding physicians data from

visits to similar physicians. For this

purpose, physicians were judged

similar if they had the same specialty

designation and practiced in the same

Psu.

Test of significance and rounding

In this report, the determination

of statistical inference is based on the

t-test. The Bonferroni inequality was

used to establish the critical value for

statistically significant differences

(0.05 level of confidence). Terms

relating to differences such as

“greater than” or “less than” indicate

that the dtierence is statistically

significant. Lack of comment about

the difference between any two

estimates does not mean that the

difference was tested and found to be

not significant.

In the tables, estimates of office

visits have been rounded to the

nearest thousand. Consequently,

estimates will not always add to

totals. Rates and percents were

cakulated from original unrounded

figures and do not necessarily agree

with percents calculated from

rounded data.

Definition of terms

Ambulatory patient –An

ambulatory patient is an individual

seeking personal health services who

is not currently admitted to any

health care institution on the

premises.

Physician–A physician is a duly

licensed doctor of medicine (M.D.) or

doctor of osteopathy (D. O.) who is

currently in office-based practice and

who spends some time caring for

ambulatory patients. Excluded from

the NAMCS are physicians who are

hospital-based; who specialize in
14 Advance Data No. 226 ● March 4, 1993

anesthesiology, pathology, or Drug visit – A drug visit is a visit

radiology; who are federally in which medication was prescribed

employed; who treat only or provided by the physician.

institutionalized patients; or who are

employed full time by an institution

and spend no time seeing ambulatory

patients.

Cardiovascular disease

specialist —A cardiovascular disease

specialist is a physician who has

self-designated the practice specialty

of cardiovascular diseases on the

American Medical Association’s

Physicians’ Professional Activities

Questionnaire. The physician’s

specialty is also verified during the

NAMCS interview, The practice

specialty of cardiovascular diseases is

defined as a medical specialty by the

AMA (other categories include

general practice, surgical specialties,

and other specialties), and the

American Board of Internal Medicine

certifies physicians in that specialty.

In the 1989 and 1990 NAMCS, 83.8

percent of all visits to cardiovascular

disease specialists were made to

physicians who were board certified

in internal medicine, while 15.8

percent of visits were made to

physicians who did not report board

certification.

Ofice –An office is the space that

physicians identi~ as a location for

their ambulatory practice. Offices

customarily include consultation,

examination, or treatment spaces that

patients associate with the particular

physician.

J%it – A visit is a direct personal

exchange between an ambulatory

patient and a physician (or a staff

member working under the

physician’s supervision), for the

purpose of seeking care and

rendering personal health services.

Drug mention – A drug mention is

the physician’s entry of a

pharmaceutical agent (by any route of

administration) for prevention,

diagnosis, or treatment. Generic as

well as brand-name drugs are

included, as are nonprescription and

prescription drugs. Along with aIl new

drugs, the physician also records

continued medications if the patient

was specifically instructed during the

~’isitto continue the medication.
Advance Data No. 226 ● March 4.1993 15

Symbols

--- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less

than 0.05

z Quantity more than zero but less

than 500 where numbers are

rounded to thousands

● Figure does not meet standard of

reliability or precision
16 Advance Data No. 226 ● March 4, 1993

Suggested citation Copyright information National Center for Health Statlstls

Schappert, SM. OfTice visits to cardiovascular All material appearing in this report is in the Director

disease specialists: United States, 1989-90.

Advance data from vital and health statistics;

public domain and may be reproduced or Manning Feinleib, M. D., Dr. P,H.

copied without permission: citation as to

no 226. Hyattsville, Maryland: National Center source, however, is appreciated. Acting Deputy Director

for Health Statistics. 1993. Jack R. Anderson

Trade name disclaimer

Director

The use of trade names is for identification

only and does not imply endorsement by the

Public Health Service, U.S. Department of

Health and Human Services
Number 227 ● March 3, 1993

Advance

Data

From Vi and Heatth Statistics ofthe CENTERS FOR DISEASE CONTROL AND PREVENTION/NationalCenterfor HealthStatistics

1991 Summary: National Hospital Discharge Survey

by Edmund J. Graves, Division of Health Care Statistics

Introduction

During 1991, an estimated 31.1

million inpatients, excluding newborn

infants, were discharged from

short-stay non-Federal hospitals in

the United States. These patients

used 199.1 million days of inpatient

hospital care. The discharge rate was

124.1 discharges per 1,000 civilian

population and the average length of

stay was 6.4 days.

These and other statistics

presented in this report are based on

data collected by means of the

National Hospital Discharge Survey

(NHDS), a continuous survey that has

been conducted by the National

Center for Health Statistics (NCHS)

since 1965. In 1991, data were

abstracted from the medical records

of approximately 274,000 patients

discharged from 484 short-stay

non-Federal hospitaIs. Beginning in

1988, a new three-stage stratified

sample design was put in operation.

A brief description of the new design,

data collection procedures, and

estimation process and definitions of

terms used in this report can be

found in the section entitled

“Technical notes.” A description of

the development and design of the

original NHDS, which was in

operation from 1965 to 1987, has

been published (l). Differences may

exist between data for 1988-91 and

earlier years because of the redesign

of the survey.

Medical data for hospitalized

patients are coded according to the

International Classification of Diseases,

9th Revisioq Clinical Moo!@cation

(lCD-9-CM) (2). Up to seven

diagnoses and four procedures are

coded for each discharge. Although

diagnoses included in the ICD-9-CM

section entitled “Supplementary

classification of external causes of

injury and poisoning” (codes

E800-E999) are used in the NHDS,

these diagnoses are excluded from

this report. The conditions diagnosed

and procedures performed are

presented here by chapter of

ICD–9-CM. Within these chapters, a

few diagnoses and procedures or

groups thereof also are shown. These

specific categories were selected

primarily because of their large

estimates or because they are of

special interest. More detailed

analyses of NHDS data are published

in Series 13 of the NCHS Mtal and

Health Statistics reports.

Starting in 1985, some hospitals

participating in the NHDS have

submitted machine-readable data

tapes. In 1991, approximately 33

percent of the hospitals used this

method to submit data. Analysis

indicates that a gxeater number of

nonsurgical procedures per patient

are recorded from these hospitals

Acknowledgments

This report was prepared in the Division of Health Care Statistics. Jean Kozak of the Hospital Care Statistics Branch, provided technical

assistance in developing the style and content of this report. George Wolfe of the Technical Services Branch, provided assistance in producing

estimates of reliability. Dorothy Graham of the Technical Sctices Branch verified the estimates in the report and CharIes Adams and Malcolm

Graham of the Technical Sewiccs Branch provided advice on the computer programming aspects of the report. This report was edited by

Klaudia Cox and typeset by Jaqueiine M. Davis of the Publications Branch, Division of Data Semites.

# wrc~,o

# ●.

%

-g

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

=* Public Health Service

s% Centers for Disease Control and Prevention %%.

>

‘4

+i.,,a

National Center for Health Statistics C~CDC FOR 0!SS4SE CONTROL

AND PRSVENITON
2 Advance Data No. 227 ● March 3,1993

Table 1. Number of inpatients discharged from short-stay hospitals by selected

characteristics: United States, 1991

[Discharges from non-Federal hospitals. Excludes newborn infants]

Both

Seeded charactetisfic sexes Male Female

Total. . . . . . . . . . . . . . . . . . . .

Age

Under 15 years . . . . . . . . . . . . . .

fS-44 yea-s . . . . . . . . . . . . . . . .

4&64yea-s . . . . . . . . . . . . . . . .

65years Andover . . . . . . . . . . . .

Region

Noflheast . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . ...<.... . . .

Number of patients discharged in thousands

31,098 12,478 18,620

2,498 1,435 1,064

11,620 3,248 8,372

6,173 3,088 3,085

10,806 4,708 6,098

7,153 3,047 4,106

7,315 2,995 4,321

11,2s0 4,418 6,671

5,340 2,018 3,322

Table 2. Rate of inpatients discharged from short-stay hospitals, by age, geographic

region, and sex: United States, l 991

[Discharges from non-Federal hospitals. Excludes newborn infants]

Both

Age and region sexes Male Fern&e

Total . . . . . . . . . . . . . . . . . . . .

Age

Under 15years . . . . . . . . . . . . . .

1544yaars . . . . . . . . . . . . . . . .

45-64years . . . . . . . . . . . . . . . .

65yearsandover . . . . . . . . . . . .

Region

Northeast . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . . .

south . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . .

Rate of patients dkcharged per 1,000 population

124.1 102.7 144.3

45.3 50.8 39.5

%.3 55.9 142.1

132.2 137.5 127.2

340.3 388.1 321.6

140.6 124.7 155,3

121.7 102.8 139.6

131.2 106.6 164.0

99.7 76.1 122.9

Table 3. Average Iengthofstayfor inpatients discharged from short-stay hospitals by

seleeted characteristics: United States, l 991

[Discharges from non-FederaI hospitals. Excludes newborn infants]

Both

Selected characteristic sexes M&e Femafe

Averagelengthof stayindap

Total . . . . . . . . . . . . . . . . . . . . 6.4 7.0 6.0

Age

Under 15yeara . . . . . . . . . . . . . . 4.8 4.9 4.6

15-44years . . . . . . . . . . . . . . . . 4.6 6.4 4.0

45-64years . . . . . . . . . . . . . . . . 6.5 6.5 6.5

65years Andover . . . . . . . . . . . . 6.6 6.3 6.8

Region

Northeast . . . . . . . . . . . . . . . . . 7.3 7.6 7.1

Midwest . . . . . . . . . . . . . . . . . . 6.5 6.9 6.2

South . . . . . . . . . . . . . . . . . . . 6.2 6.8 5.8

West . . . . . . . . . . . . . . . . . . . . 5.4 6.3 4.8

than from hospitals subrnittingdata in

the traditional manual mode (see

“Technical notes”). A portion of the

increases from 1984to 1991 in the

estimates for miscellaneous diagnostic

and therapeutic procedures and,

therefore, for total procedures may

be due to this change indata

collection methods.

In addition, the1991 data were

the first for which all ICD-9-CM

procedure codes were used in the

NHDS. In previous years, selected

codes were excluded. These were

primarily codes for certain

miscellaneous diagnostic and

therapeutic procedures.

Data highlights

Utilization by patient and hospital

characteristics

Thenumber, rate, andavlerage

length of stay of patients discharged

from short-stay non-Federal hospitals

are shown by age, geographic region,

andsex in tables l-3. The31.l

million patients discharged from

short-stay hospitak during 1991

comprised an estimated 12.5 rnillion

males and 18.6 million females. The

rate per 1,000 population for females

was 144, which was 41 percent higher

than the rate of 103 for males, The

number and rate of discharges, are

higher for females than for males

largely because of women 15-44 years

of age who are hospitalized for

deliveries and pregnancy-related

conditions.

The average length of stay was

7.0 days for males and 6.0 days for

females during 1991. The average

length of stay of the 4.0 million

women who were hospitalized for

deliveries was 2.8 days. The average

length of stay was 4.8 days for

patients under 15 years of age, 4.6

days for patients 15-44 years of age,

6.5 days for patients 45-64 years of

age, and 8.6 days for patients 65 years

of age and over.

The number of discharges from

short-stay hospitals by geographic

region during 1991 ranged from 11.3

milIion in the South to 5.3 million in

the West. Regional differences in the

number of discharges are accounted
Advance Data No. 227 ● March 3,1993 3

for in part by variations in the

population sizes. The rates per 1,000

population ranged from 141 in the

Northeast Region to 100 in the West.

Average lengths of stay by geographic

region were 5.4 days in the West, 6.2

days in the South, 6.5 days in the

Midwest, and 7.3 days in the

Northeast.

Utilization by diagnosis

Diseases of the circulatory system

ranked first in 1991 of the

ICD–9-CM diagnostic chapters as a

principal or first-listed diagnosis for

patients discharged from non-Federal

short-stay hospitals. These conditions

accounted for an estimated 5.3

million discharges. Other leading

ICD–9-CM diagnostic chapters were

supplementary classifications

(including females with deliveries)

(4.4 million discharges), diseases of

the digestive system (3.3 million

discharges), and diseases of the

respiratory system (3.1 million

discharges). Approximately

52 percent of the patients discharged

from non-Federal short-stay hospitals

were included in these four

ICD–9-CM diagnostic chapters.

The diagnostic categories

presented in this report were selected

either because they appear as

principal or first-listed diagnoses with

high frequency or because the

conditions are of special interest.

Many of these categories (such as

malignant neoplasms, psychoses, and

fractures) are groupings of more

detailed diagnoses.

The number and rate of

discharges and average length of stay

for each ICD-9-CM diagnostic

chapter and selected categories are

shown by sex and age in tables 4-6.

The most common diagnostic

categories for all patients were

deliveries and heart disease. Other

leading diagnostic categories were

malignant neoplasms, pneumonia, and

fractures. Excluding deliveries, these

last four diagnostic categories were

the leading first-listed diagnoses for

both males and females. Some of the

more common diagnoses for patients

under 15 years of age were acute

respiratory infections, pneumonia,

and asthma. For patients 15-44 years

of age, frequent diagnoses were

deliveries, psychoses, and fractures.

For patients 45-64 years of age and

65 years of age and over, heart

disease and malignant neoplasms

were major causes of hospitalization.

The average length of stay for alI

patients ranged from 1.2 days for

chronic disease of tonsils and

adenoids to 14.6 days for malignant

neoplasm of large intestine and

rectum.

Utilization by procedure

One or more surgical or

nonsurgical procedures were

performed for an estimated 21.0

million of the 31.1 million inpatients

discharged from short-stay hospitals

during 1991. A total of 43.9 million

procedures, or an average of 2.1 per

patient who underwent at least one

procedure, were recorded in 1991.

Procedures are grouped in the

tables of this report by the

ICD–9-CM procedure chapters.

Selected procedures within these

chapters also are presented by

specific categories. Some of these

categories (such as cesarean section

and hysterectomy) are presented as

single categories even though they are

divided into more precise subgroups

in ICD-9-CM.

More than three-fourths of all the

surgical and nonsurgical procedures

performed during 1991 are listed in

just 5 of the 16 procedure chapters.

These were miscellaneous diagnostic

and therapeutic procedures (14.8

million), obstetrical procedures (6.9

million), operations on the digestive

system (5.6 million), operations on

the cardiovascular system (4.1

million), and operations on the

musculoskeletal system (3.3 miIlion).

The number and rate of all-listed

procedures in 1991 for each

ICD-9–CM procedure chapter and

selected procedure categories are

shown by sex and age in tables 7 and

8. Of the 43.9 million procedures

performed during 1991, 17.3 million

were for males and 26.7 million were

for females. The corresponding rates

per 100,000 poptdation were 17,529.3

for both sexes, 14,204.6 for males,

and 20,661.0 for females. Frequent

procedures for males were

arteriography and angiocardiography,

computerized axial tomography, and

diagnostic ultrasound. Procedures

commonly performed on females

were episiotomy, fetal EKG and fetal

monitoring, and diagnostic

ultrasound.

The rate of procedures by age

per 100,000 population ranged from

4,054.9 for patients under 15 years of

age to 47,468.0 for patients 65 years

of age and over. Commonly

performed procedures for patients

under 15 years of age were

respiratory therapy, spinal tap,

computerized axial tomography, and

diagnostic ultrasound; for patients

15-44 years of age, episiotomy, fetal

EKG and fetal monitoring, and

cesarean section; for patients 45–64

years of age, arteriography and

angiocardiography, cardiac

catheterization, diagnostic ultrasound,

and computerized axial tomography;

for patients 65 years of age and over,

arteriography and angiocardiography,

computerized axiaI tomography, and

diagnostic ultrasound.

References

1.

2.

3.

4.

5.

Simmons WR. Development of the

design of the NCHS Hospital

Discharge Suwey. National Center for

Health Statistics. Vital Health Stat

2(39). 1970.

Public Health Semite and Health Care

Financing Administration.

International Classificationof

Diseases, 9th Revision, Clinical

Modification. Washington: Public

Health Service. 1980.

SMG Marketing Group, Inc. Hospital

Market Database. Chicago: Heahhcare

Information Specialists. 1989.

SMG Marketing Group, Inc. Hospital

Market Database. Chicago, Illinois:

HealthCare information Specialists.

April 1991.

Shah BV. SESUD* Standard

Errors Program for Computing of

Standardized Rates from Sample

Survey Data. Research Triangle Park,

North Carolinx Research Triangle

Institute. 1981.
4 Advance Data No. 227 ● March 3, 1993

Table 4. Number of Inpatients discharged from short-stay hospitals, by category of first-listed diagnosis, sex, and age United Statas,

1991

[Discharges from non-Federal hosptils. Excludes newborn infants. Diagnostic groupings and code number inclusions are based on the International Classlficstion of

Diseases, 9th Revision, Clinicsl Modification (lCD-g-CM)]

sex Age

Under 15-44 4SS4 65 years

category of first-listed diagnosis and lCD-%CM Code Total Male Female 15 years years yearn and over

All conditions, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectious and parasitic diseases . . . . . . . . . . . . . . . . . . . ..001-139

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...038

Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Malignant neoplasms . . . . . . . . . . . . . . . . . . . . . . . .140-208,23K?34

Mallaflaflt n~DlaSM Oflaraeitietifle andreclurn. . . . ...153-154.197.5

Mahtinant neoplasm of trafiea,

bronchus, and lung . . . . . . . . . . . . . . . . . . . . . ...162.197.0.197.3

Malignant neoplasm of breast. . . . . . . . . . . . . . . . . . .17&175,186.Bl

Benign neoplaams and neapkrns of uncertain

behavior andunspecifmdn ature . . . . . . . . . . . . . . .21 W229.23S239

Endocrine, nutritional and metabolic diseases,

endimmunity diaordera . . . . . . . . . . . . . . . . . . . . . . . . . . . . .240-279

Oiabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Volume depletion . . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . ...276.5

Diseases of the blood and blood-forming orgens . . . . . . . . . . . . . .28C-289

Mental disordera . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . ..29C-319

Psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-299

Alc’oholdependencesyndrome . . . . . . . . . . . . . . . . . . . . . . . . ...303

Diseases ofthenervous svetemand senseoraerrs. . . . . . . . . . ...320-369

Diseases ofthecentral hervoussystem . . .. . . . . . . . ...320-336.340-349

Diseaaesofthe earandmestoid process. . . . . . . . . . . . . . . ...380-369

Diseases ofthe circulatory system . . . . . . . . . . . . . . . . . . . . . ..39W59

Heartdiseaae . . . . . . . . . . .391 -392.0,39H98,402,404,41 0416,420-429

Acute myocardial infarction . . . . . . . . . . . . . . . . . . . . . . . . . ...410

Corona~atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . ...414.0

Other ischemic heart diseaea. . . . . . . . . . . . ...411413.414.1-414.9

Cardiac dysrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...427

Congestive heaflfailure . . . . . . . . . . . . . . . . . . . . . . . . . . ...428.0

Cerebroveecular disease . . . . . . . . . . . . . . . . . . . . . . . . . ...430-438

Diseases of therespiratory syetem . . . . . . . . . . . . . . . . . . . . . ..4W519

Acute respiratory infections . . . . . . . . . . . . . . . . . . . . . . . . ...460-466

$::u#o:/a=e aftonsils~dadeno& . . . . . . . . . . . . . . . . . . ...474

.460486

-thma..~~~~;~~~~~~~~~ ~~;~;~~~~~~~~~~~~~~~~ ~. ...483

Cliseasesofthedigestwesyetem . . . . . . . . . . . . . . . . . . . . . . ..520-579

Ulcers ofthestomach and smell intestine . . . . . . . . . . . . . . ...531-534

Appendicitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...540-543

Inguinalhemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ...550

Noninfectious enteritis andcdtis. . . . . . . . . . . . . . . . . . . . ...555-556

Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...574

Diseaseeofthe enitourinaryeystem . . . . . . . . . . . . . . . . . . . . ..58C%29

Calculusofkl 3 neyandureter. . . . . . . . . . . . . . . . . . . . . . . . . . ..592

Hyperpleeiaofprostate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..600

Complications ofpregnancy, childbbth,

ertdthe puerperiuml . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...63&676

Abo!tionsand ectopicand molarpregnencies . . . . . . . . . . ...630-839

Diseases oftheskin andsubcutsneous tissue. . . . . . . . . . . . . ...660-709

Cellulitisand abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . ...681-682

Diseases of the musculaskeletsl system

and connectivatissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..71o-739

Arthropathiesand related disorders . . . . . . . . . . . . . . . . . . .710-719

lntetvertebraldiscd!sorders... . . . . . . . . . . . . . . . . . . . . . . . ...722

Congenitalanomafies . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...740-759

Certain renditions originating in the

pednatalp eriod. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..760-779

Symptoms, signs, andilldefmed conditions . . . . . . . . . . . . . . ...780-799

Injuryand poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...80&999

Fractures, allsites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..80C-629

Fractureofneckoffemur . . . . . . . . . . . . . . . . . . . . . . . . . . . ..820

Intracranial injuries (excluding those with

skullfracture) ..,...... . . . . . . . . . . . . . . . . . . . . . . ...850454

Lecerattonsandopanwounds . . . . . . . . . . . . . . . . . . . . . . ..870-904

Supplementary clssSfications . . . . . . . . . . . . . . . . . . . . . . . . ..VO1-V82

Femaleswith dalivenes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V27

31,098

759

240

2,001

1,::

236

158

407

1,143

429

329

348

1,8&

228

755

331

144

5,338

3,704

697

384

876

536

.X

3,052

518

1,0;:

490

3,256

237

:;;

351

2,%

241

229

723

180

462

297

1,600

526

391

192

147

368

2,78S

1,034

300

160

193

4,438

3,973

Numberotpatients discharged inthouaends

12,478

363

103

860

781

86

147

●

78

437

185

121

167

%!

172

352

160

72

2,728

1,977

422

263

461

249

360

370

1,508

258

5%

221

1,455

125

:E

142

159

781

160

229

. . .

. . .

245

165

738

228

225

101

79

202

1,437

4s1

80

108

137

188

. . .

18,620

388

137

1,141

812

82

IE

328

%

208

181

817

486

4%

171

72

2,611

1,727

275

121

415

267

405

466

1,g

!%

269

1,801

112

103

14

%

1,29;

. . .

723

180

217

132

662

296

188

91

68

164

1,331

553

219

;:

4,250

3,973

2,498

207

20

52

40

*

●

*

13

95

21

50

:!

24

.

147

52

71

28

17

*

*

●5

●

●

736

220

2::

167

244

5;

22

91

7;

●

●

●

49

31

50

14

●

125

146

63

286

104

●

%

76

14

11,620

218

22

363

172

●5

;:

191

251

121

46

110

1,009

488

152

195

117

26

396

232

45

22

46

41

::

500

68

Iz

128

960

1%

1%

195

S47

117

●

718

178

142

94

548

125

209

37

●

148

1,102

320

10

98

128

4,069

3,956

a,173

101

39

626

498

39

101

59

126

269

128

44

3%

189

lg

64

22

1,509

1,095

228

172

313

128

126

156

530

75

15;

85

851

::

41

1%

457

84

49

●

●

108

77

;;:

132

21

116

492

158

27

20

24

105

●

10,806

232

159

960

863

124

125

73

77

528

160

189

121

260

201

2;:

98

26

3,405

2,361

424

190

514

361

615

540

1,286

156

58;

80

1,211

124

X

12

6::

180

. . .

. . .

182

95

553

261

51

10

●

62

888

452

259

34

16

169

. . .

lF!rsl.llsted diagmsis for females Mdellverles iswdWV27, shw under’’supplementsry cleestilcations.”
Advance Data No. 227 ● March 3,1993 5

Table 5. Rate of inpatients discharged from short.stay hospitals, by category of first-listed diagnosis, sex, and age United States, 1991

[Dischargesfrom non-Federalhospitals.Excludesnewborn infants.Diagnostic groupingsand code numberinclusionsare based on the International C/asshkatfon of

Diseases, 9th Revkion, Clinical Modification (ICLJ-9-CM)]

Sex Age

Under 15-44 4%64 65 yeara

Category of first-listed diagnosis and ICD-%CM Code Total Male Female 15 yeara yeara years and over

Allcondtions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectiousand paraeiticdiseases . . . . . . . . . . . . . . . . . . . . . . ..001-139

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..038

NaoPIssms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..140-239

Malignant neoplasms . . . . . . . . . . . . . . . . . . . . . . ..14C-208,230-234

Malignant neoplasm of large intestine

and rectum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153-154,197.5

Malignant neoplasm of trachea,

bronchus,andlung . . . . . . . . . . . . . . . . . . . . . . . .162,197.0.197.3

Malignant neoplasmof breast... . . . . . . . . . . . . . . . .174-175.198.81

Benignneoplasms andneoplaemsof uncerfain

behaviorend unspacified nature.. . . . . . . . . . . . . ...210-229.236-239

Endocrine, nutriilonef endmetaboficdiseeees,

andimmuni~disorders . . . . . . . . . . . . . . . . . . . . . . . . . . ...240-279

Dlabetesmelliis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Volumedepletion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...276.5

Diseasesofthe blood andblood-fomsing organs . . . . . . . . . . . ...280-289

Menteldieordere . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .290-319

Psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290-289

Alooholdependenoeeyndrome. . . . . . . . . . . . . . . . . . . . . . . . . ..3o3

Diseasas ofthenervous aystemend sense organs. . . . . . . . . . ...320-389

Dseases of thecentral nervous system. . . . . . . . . . . . .320-336,34W349

Diieesesofthe earendmestoid prooess. . . . . . . . . . . . . . . . ..3S0489

Dlseasesofthecirculatoryaystem . . . . . . . . . . . . . . . . . . . . . . .380-459

Heartdisease . . . . . . . . . . .381-392.0,383+98,402.404,41 0-416,425429

#wutemyocerdiefinfarotion... . . . . . . . . . . . . . . . . . . . . . . ...410

Coronaryatheroacleroais . . . . . . . . . . . . . . . . . . . . . . . . . ...414.0

Dtherisohemic heertdiseese. . . . . . . . . . . . . ...411-413.414.1-414.9

Cardiacdysrhyfhmiae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...427

Congestiveheartfailure . . . . . . . . . . . . . . . . . . . . . . . . . . ...428.0

Cerebrovasculardisease . . . . . . . . . . . . . . . . . . . . . . . . . ...430-438

Diseasesofthe respiratorjsyetem . . . . . . . . . . . . . . . . . . . . ...4519519

Acuterespiratoryinfections.... . . . . . . . . . . . . . . . . . . . . . ..460-466

Chmnicdisease oftonsilsand adenoids . . . . . . . . . . . . . . . . . . ...474

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...460-486

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..493

Diseases ofthedigestive system .’ . . . . . . . . . . . . . . . . . . . . . ..520-579

Ulcereofthestomachand small intestine . . . . . . . . . . . . . . ...531-534

ADDerrdicitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..540-543

inguinalhemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...550

Noninfectious enteritisandcolii. . . . . . . . . . . . . . . . . . . . ...555-558

Cholefiilasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,....574

Dlseasesofthe genitourinaryays.tem. . . . . . . . . . . . . . . . . . . ...580-829

Calculusofkidneyendureter.... . . . . . . . . . . . . . . . . . . . . . . . .592

Hyperplasiaofproatate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..600

Comriicationsoforecmancv. childbirth.

and”thepuerperiumi ...-;. . . . . . .. . . . . . . . . . . . . . . . . . ...83&876

Abortions andectopic andmoler pregnancies . . . . . . . . . . ...530-839

Diseases oftheskin and subcutaneous tissue. . . . . . . . . . . . . ...680-709

Cellulitisand abscess. . . . . . . . . . . . . . . . . . . . . . . . . . . . .681-882

Diseases of the musculoskeletel system

andconnectivetissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...710-739

Arthropathies and relatad disorders . . . . . . . . . . . . . . . . . . ., .710-719

Interverfebraldiscdisorders.... . . . . . . . . . . . . . . . . . . . . . . . ..722

Congenital anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..740-759

Certain condition originating in the

perinatel period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .760-779

Symptoms, signe, andill-cfefined condtions . . . . . . . . . . . . . . ...780-799

Injuryand poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .800-999

Fractures, allsites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..800-829

Fractureofneckoffemur . . . . . . . . . . . . . . . . . . . . . . . . . ..,.820

Intracranial injuries (excluding those with

skullfrecture) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...850-654

Laceretionsand openwounds . . . . . . . . . . . . . . . . . . . . . . . .870-904

Supplementary classifications . . . . . . . . . . . . . . . . . . . . . . . . ..VO1-V82

Femaleswithdeliveries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V27

1,241.1

30.3

9.6

79.9

63.6

6.7

9.4

6.3

16.2

45.6

17.1

13.1

13.9

66.1

3;.:

30.1

13.2

5.8

213.1

147.8

27.8

15.3

35.0

21.4

30.5

33.3

121.8

20.7

2:

19.6

129.9

9.5

9.2

1::

22.0

6:.;

9:2

26.8

7.2

18.4

11.9

%

15.6

7.7

5.9

15.4

110.5

41.3

12.0

%

177.1

156.6

Rate of inpatienta discharged per 10,000 population

1,026.7

29.8

8.5

70.7

64.3

7.0

12.1

●

6.4

35.9

15.2

10.0

13.7

69.1

34.2

14.2

:;;

6:0

224.4

162.6

34.7

21.7

37.9

20.5

29.6

30.4

124.1

21.2

2;

18.2

119.7

10.3

10.6

1%

13.1

64.2

13,2

18.9

. . .

. . .

20.1

13.6

60.7

18.7

18.5

8.3

6.5

16.6

118.2

39.6

6.6

8.7

11.3

15.5

. . .

I,443.1

30.7

10.6

88.4

53.0

6.4

6.9

12.1

25.5

54.7

19.0

16.1

14.1

%$

4.3

31.3

13.3

5.6

202.3

133.9

21.3

3:7

22.3

31.4

36.1

119.7

20.2

3.4

42.1

20.9

139.6

::

1;2

30.4

100.0

6.3

. . .

56.0

13.9

16.8

10.2

83.8

23.1

12.9

7.1

5.3

14.3

103.2

42.9

17.0

5.7

4.4

329.4

307.9

4532

37.5

3.7

9.5

7.2

●

●

●

23

17.2

3.7

9.1

10.7

11.0

4.3

●

26.6

9.5

12.8

5.1

3.0*

*

●1.0

●

●

133.6

39.8

32:

33.9

44.3

10.;

4.0

16.5*

13.0

●

●

*

%

9.0

2.6

●

22.6

26.4

11.3

51.9

18.9*

5.5

4.5

13.8

25

993.4

18.7

1.9

31.0

14.7

‘0.4

0.8

2.2

16.3

21.5

10.4

3.9

9.4

86.2

41.7

13.0

16.8

10.0

2.2

33.9

19.8

3.8

:;

3.5

:::

42.7

5.8

1.9

11.4

10.9

81.2

1:::

2.2

9.2

16,7

72.4

10.0*

61.4

15.3

12<1

8.0

46.8

10.7

17.8

3.1

*

12.5

94.2

27.4

0.9

1%

349.5

336.2

f ,321.6

21.7

8.3

133.9

106.9

8.3

21.6

12.5

27.0

57.6

27.4

9.4

12.4

70.3

40.5

12.9

32.8

13.7

4.7

323.1

234.3

48.8

36.8

E:

27.0

33.6

113.4

16.0

●

32.5

18.2

182.1

14.8

5.6

1::

39.9

97.9

18.0

10.4

●

●

23.2

16.5

96.3

26.7

28.3

4.4

24.6

105.4

33.8

5.8

2::

22.4

●

38403.1

73.2

50.2

302.3

278.1

39.0

39.3

23.1

24.3

166.4

50.3

59.6

38.2

81.9

63.3

5.0

82.2

30.8

82

1,072.4

743.5

133.5

60.0

161.7

113.6

193.6

201.5

405.2

49.2

185.;

28.5

381.5

39.1

3.6

14.5

28.4

53.0

218.9

12.6

56.7

. . .

. . .

51.1

30.0

174.1

82.3

15.9

3.2

●

19.7

279.5

142.4

81.4

10.8

5.0

53.2

. . .

1First-1isteddiagnosisfortw-nales wifh deliveries is coded V27,shown under “hppkmrentary classifications.”
6 Advance Data No. 227 ● March 3, 1993

Table 6. Average length of stay for inpatients discharged from short-stay hospitals, by category of first-listed diagnosis, sex, and age:

United States, 1991

[Discharges from non-Federal hospitals. Excludes newborn infants. Diagnostic groupings and code number inclusions are based on the hrferrratiorrd CLSssific#icm of

Diseases, 9th Revision, ClinicalModification (lCD-%CM)]

Sex Age

Under 1544 45-64 65 years

Category of first-listed diagnosis and ICP9-CM Code Tofel Male Female 15 yeare years years and over

All conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectious and parasitic diseases . . . . . . . . . . . . . . . . .W1-139

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...038

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . .

Malignantneoplasms . . . . . . . . . . . . . . . .

Malignant neoplasm of large intestine

end rectum . . . . . . . . . . . . . . . . . . . .

Malianant neooleem of trachea,

bronchus, andlung . . . . . . . . . . . . . . .

Malignant neoplasm ofbrea$t . . . . . . . . . .

Benign neoplasms and neoplasms of uncertak

behavior andunspecifiad nature. . . . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . .

.140-239

li4”&20k,230-234

. . .153-154,197.5

. .162,197.0,197.3

. .174-175,198 .81

.210-229,23$239

Endocrine, nutritional and metabolic diseases,

and immunitydisorders . . . . . . . . . . . . . . . . . . . . . . . . . . ...240-279

Diabetes melliius . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Volumedepletlon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...276.5

Diseases oftheblood andblood-forrning organs . . . . . . . . . . . ...280-289

Mentaldisorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..29R319

Psychoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..290-299

Aicoholdependenceayndrome. . . . . . . . . . . . . . . . . . . . . . . . ...303

CWeasesofthenewouss yatemends enseorgan.s. . . . . . . . . . . . .32W89

Diseases ofthecentrai nervous system . . . . . . . . . ...320-336.340449

Diseases oftheearand mastoid process. . . . . . . . ., . . . . . . ..380-389

Diseases ofthecirculatoryay.$tem . . . . . . . . . . . . . . . . . . . . . . .390-459

Heartdisease, . . . . . . . . . .391 -392.0,393-398< 402,404,41 0-41 6,42W29

Acutemvocardlal infarction . . . . . . . . . . . . . . . . . . . . . . . . . . ..410

Coronafiatherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . ..414.0

Other ischemic hearfdisease. . , . . . . . . . . ...411-413.414.1414.9

Cardiacdysrf?ythm!as . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..427

Congesti’.’ahearffailure . . . . . . . . . . . . . . . . . . . . . . . . . . . . .428.0

Cerebrovasculardiseaee . . . . . . . . . . . . . . . . . . . . . . . . . . . .43C-4W

Diseases ofthe respiratory system . . . . . . . . . . . . . . . . . . . . ...460-519

Acute respiratory infections... . . . . . . . . . . . . . . . . . . . . . . ..460+68

Chronic disease oftonsils andedenoids . . . . . . . . . . . . . . . . . . ...474

Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..480486

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493

Diseases ofthe digestive system . . . . . . . . . . . . . . . . . . . . . ...520-579

Ulcers ofthestomach andsmail intestine . . . . . . . . . . .531-534

Appendicitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , ..540-543

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...550

Noninfectious enteritis and colitis. . . . . . . . . . . . . . . . . . . .55$558

Cholelithiaais . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...574

Diseases ofthegemtourinarysystem. . . . . . . . . . . . . . . . . . . ...580-629

Calculus ofkidneyand ureter.. . . . . . . . . . . . . . . . . . . . . . . . ...592

Hyperplasiaofprostate .,.... . . . . . . . . . . . . . . . . . . . . . . . ...600

Complications of pregnancy, childbirth,

and the puerpertuml . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...630-676

Abortiona andactopic and molar pregnancies. . ., . . . . . . . . . .630-639

Diseases of theskin andsubcuteneous tissue. . . . . . . . . . . . . ...680-709

Cellulitlsand abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..681-682

Diseases of the musculoskeletal system

and connectivetissue. ..,. . . . . . . . . . . . . . . . . . . . . . . . ...71&739

Arthropath!es and relatedd]sorders . . . . . . . . . . .710-719

Intervertebral discdtsorders. . . . . . . . . . . . . . . . . . . . . . . . . . ...722

Congenitalanomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..740-759

Certain conditions originating m the

pennatalperiod . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76C-779

Symptoms, signs, and ill-defined condlfions . . . . . . . . . . . . ...780-799

Injuryand poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...600-999

Fractures, allsites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..800-829

Fracture ofneckoffernu r.... . . . . . . . . . . . . . . . . . . . . . . ...820

Intracranial irqunes (excluding those with

skull fracture) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...850-654

Leceratlons andopenwounds . . . . . . . . . . . . . . . . . . . . . . ..870-904

Sutmlementary classifications . . . . . .vol-V82

Femaleswith dehverie s... . . . . . . . . . . . . . . . . . . . . . . . . . . ..V27

6.4

8.5

11.6

:::

14.6

&6

4.4

4.5

7.1

7.1

7.5

6.2

11,4

13.5

9.5

5.7

8.8

2.8

7.3

R

;::

5.3

7.9

9.3

6.8

4.8

:::

4.5

5.9

6.9

4.2

%

5.0

4.8

2.7

5.3

2.9

2.4

8.4

7.1

6.4

7.4

5.0

6.2

10.7

3.0

6.9

8.4

12.3

5.8

4.9

3.3

2.6

7.0

8.9

11.7

9.2

9.7

16.7

8.5

●

4.6

7.1

6.8

6.5

6.1

11.0

13.:

5.8

R

7.0

6.7

7.5

g:;

5.0

7.5

9.1

6,4

4.1

1,3

7.9

4,1

5.9

6.6

4.2

2.4

5.8

5.3

5.3

:::

. . .

,..

8.0

7.0

5.7

6.6

4,5

6.2

11.3

3.0

6.3

7.3

10.9

6.2

3.7

7.5

.

Averagelengthof stayindays

6.0

8.1

11.5

::?

12.4

8.7

4.4

4,4

;:;

6.9

6.3

11.9

13.8

10.6

;;

3.0

7.6

7.0

9.1

::

5.5

8.4

9.6

i:

;;

4.9

5.9

7.3

4.3

2.5

5.4

4.6

4.5

3.2

. . .

2.9

2.4

8.9

7.3

7.0

6.0

5.6

6.2

10.1

3.0

7.6

9.4

12.8

5.2

7.8

3.1

2.6

4.8

3.8

6.1

?;

●

●

●

4.1

4.3

4.8

2.9

4.3

15.9

17.3

●

4.3

6.7

2.6

10,1

13.4

●

●

*4.O

●

●

3.5

3.1

1.2

4.1

3.0

3.7

●

3.9

::?3

●

4.0

●

●

●

::;

5.4

5.3

●

6.8

10.7

2.5

4.5

5.4

●

2.5

3.4

4.7

2,4

4.6

1?:

;::

*8.7

:::

3.8

4.6

4.7

4.0

5.6

11.0

13.1

9.9

4.6

5.6

3.2

5.6

5.5

5.9

5.4

?:

7.4

9.4

5.0

4.2

k:

4.5

4.8

4.8

3.7

::7

4.6

3.7

2.4

●

2.9

2.4

7.3

6.0

4.7

4.1

4.5

4.5

●

2.6

5.5

6.1

7.4

5.9

5.2

2.8

2.6

6.5

11.3

11.7

::

10.7

7.8

4.6

4.4

%

6.8

6.6

10.8

13.3

6.3

:::

2.5

::

7:2

6.0

4.3

4.6

7.6

7.9

::

*

7.9

5.2

5.5

5.6

5.7

;::

4.0

4.7

;::

●

●

7.8

7.2

5.5

6.7

4.7

5.9

2.7

6.5

7.2

10.4

8.0

4.3

5.8

●

8.6

11.3

12.3

1;:

16.1

9.5

4.5

6.1

8.9

6,9

9.8

7.5

12.8

14.1

9.5

7.2

13.7

3.3

7.9

7.2

6.8

::

5.6

7.9

9.7

%

I 0.;

7.2

7.6

8.5

::

7.7

6.4

~6

4.8

. . .

. . .

11.2

9.3

B.9

?:

:5.5

●

5.2

9.6

11.3

12.8

7.1

5.2

12.1

. . .

lFmWlsled d!agnoss for Iemaleswlrh dellvenests coded V27, shOwn under “supplementary Classiflcatlons. ”
Advance Data No. 227 ● March 3,1993 7

Table 7. Number of all-listed procedures for inpatients discharged from shoti-stay hospitais, by procedure category, ae~ and agfx

United States, 1991

[Discharges from non-Federal hospitals. Excludes newborn infanta. Procedure groupings and oode number inclusions are based on the /rrternationa/ C/assif&tion of

Diseases, SJthRevisionr Clinical Modification (ICB9-CM)]

Sex Age

Under I&# 45+4 65 years

Prooadure category and ICD-SLCM Code Totaf Male Female 15 years years years and over

All procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Operations onthenewous system... . . . . . . . . . . . . . . . . . . . . ..01-0s

Spinal tap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...03.31

Operations ontheendoorine system. . . . . . . . . . . . . . . . . . . . . . ..oIs-07

Operations ontheeye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...06-16

Operations ontheear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...18-20

Operations onthenose, mouth, andpha~nx. . . . . . . . . . . . . . . ...21-29

Tonsillectomy with orwithoutadenoidaotorny . . . . . . . . . . . ...28.2-28.3

Operations onthe respiratory system... . . . . . . . . . . . . . . . . . ...30-34

Bronchoscopy with orwithout biopsy. . . . . . . . . . . . . .33.21-33.24.33 .27

Operations onthecardiovascular system. . . . . . . . . . . . . . . . . . ...85-39

Rarnoval ofcoronaw artewobetruotion. . . . . . . . . . . . . . . . . . . ...36.0

Coronary artery bypass gdtl.. . . . . . . . . . . . . . . . . . . . . . . . ...36.1

Cardiac oathaterization . . . . . . . . . . . . . . . . . . . . . . . . . . .37.21-37.23

Insertion, re Iacement, removal, and revision

ofpacema 1!erleadsordevica . . . . . . . . . . . . . . . . . . . . . . .37.7-37.8

Shunt orvascular bypass . . . . . . . . . . . . . . . . . . . . . . . . ...39.0-39.2

Hemodialysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...39.95

Operations onthehemic and lymphatic system. . . . . . . . . . . . . . . ..40-41

Operations onthedi eetiiesyetem. . . . . . . . . . . . . . . . . . . . . ...42-54

Endoscmpyof smaYi mteetme with or

without biops . . . . . . . . . . . . . . . . . . . . . . . . . . . .45.1145.14.45.16

Endosoopyof rargeintestine wither

without biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45.2145 .25

Partial excision oflarge intestine . . . . . . . . . . . . . . . . . . . . . . . ...45.7

Amendeotomv, excluding incidental . . . . . . . . . . . . . . . . . . . . ...47.0

ChdeO@aOt&hy . . . .. ~....... . . . . . . . . . . . . . . . . . . . . . ..5lj2

Reoairofinouinalhemia . . . . . . . . . . . . . . . . . . . . . . . . . ..53.0-53.1

Ly&ofpei~onealadhesions . . . . . . . . . . . . . . . . . . . . . . . . . . ..54.5

Operationsonthe urina~system . . . . . . . . . . . . . . . . . . . . . . . ..65-59

Cystoscopywith orwithoutbiopsy. . . . . . . . . . . . . . . . . . . .57.31-57.33

Operationsonthe malegenitalorgans . . . . . . . . . . . . . . . . . . . . ..60-S4

PrOStSk3CtOITIy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80.2-60.6

Operationsonthefemale genitel organs . . . . . . . . . . . . . . . . . . . ..65-7I

Oophoractomy and salpingo-oophorectomy . . . . . . . . . . . . ...65.3-65.6

8ilateral destruction or occlusion of

Fallopiantubes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66.2+6.3

Hysterectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...68.-.7

Ddationandcurettageofuferus . . . . . . . . . . . . . . . . . . . . . . . ...69.0

Repairofcystooeleand rectocale. . . . . . . . . . . . . . . . . . . . . . . ..70.5

Obstetrioalprocedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...72-75

Episiotomywithor withoutforcepa

Orvacuum extraction. . . . . . . . . . . . . . . . . .72.1,72.21,72.31,72.71,73.6

Artiicialruptureofmembranes. . . . . . . . . . . . . . . . . . . . . . . . . ..73.o

Cesareanseotion. . . . . . . . . . . . . . . . . . . . . . . . .74.0-74.2.74.4.74.99

Fetal EKG (scalp) and fetal monitoring,

nototherwisespacified . . . . . . . . . . . . . . . . . . . . . . . . . .75.32,75.34

Repairofcurrentobstetric laceration. . . . . . . . . . . . . . . . . ...75.5-75.6

Operationsonthe musculoskeletal system . . . . . . . . . . . . . . . . . . ..76-B4

Partial excisionofbone. . . . . . . . . . . . . . . . . . . . . .76.2-76.3,77.6-77.8

Open reduction offracturewifh intemalfixation. . . . . . . . . . . . . . ...79.3

Excision ordeetruotion ofintervertebral disc. . . . . . . . . . . . . . . . . . .W5

Totalhip replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..81.51

Totalkneereplacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...81.54

Oparationsonthe integumentarysyetem . . . . . . . . . . . . . . . . . . ...85-66

Mastectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..65.4

Debridementofwound, infection, orbum. . . . . . . . . . . . . . . .86.22.86.28

Skingraft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...86.6-86.7

Miscellaneous diagnostic andtherapeuticprooadures. . . . . . . . . . ...87-99

Computerized axial tomography. . . . . . . . . .87.03,87.41,87.71,66.01,86.38

~e@JrSlll... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67.73-87.75

Arteriography and angiocardiography using

contrastmaterfal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..66.~.5

D!agnosticultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..88.7

Circulatorymonitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...89.6

Radioisotopescan . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...92.0-92.1

Respiratorytherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93.g

43,922

970

380

103

399

129

541

66

956

309

4,123

331

407

1,000

300

168

261

392

5,559

304

574

220

255

571

172

339

1,558

458

564

363

2,308

458

401

546

196

139

6,667

1,664

z!

1,327

795

3,323

216

418

306

117

160

1,324

118

326

99

14,785

1,459

245

1,718

1,592

703

1,E:

17,264

50a

203

28

189

75

286

40

561

188

2,383

223

%

145

1%

212

2,319

391

234

IE

166

155

60

864

333

564

363

. . .

. . .

. . .

. . .

. . .

,..

. . .

. . .

. . .

. . .

. . .

. . .

1,710

119

193

181

z

55:

181

60

6,981

701

133

969

652

339

228

596

Numberofall-listed procedurasin thousands

26,658

470

172

75

210

54

254

46

386

123

1,740

107

111

397

155

1%

180

3,241

413

2%

674

125

.. .

. . .

2,303

453

401

546

196

139

6,867

1,634

775

933

1,327

795

1,614

z

125

1%

773

117

145

39

7,804

757

112

729

%

311

618

2,235

236

183

*

25

66

118

54

60

18

l?

1:

*

●

*

20

221

11

●

●

5:

25

*5

47

9

46

. . .

9

*

*

*

*

24

%

*

*

*

●

208

;:*

*

75

1;

9

929

69*

22

;;

lx

17,090

328

94

41

65

36

237

28

173

45

477

24

%

9

::

77

1,571

145

E

156

194

1%’

376

64

40

●

1,624

246

~

40

6,839

1,;;;

931

1,321

792

1,32?3

Iz

162

*8*

466

1:;

40

3,397

360

93

182

424

118

105

193

9,524

188

46

33

85

15

96*

2eo

95

1,478

163

178

447

44

57

79

110

1,400

202

127

57

12

51

75

366

103

116

66

445

1.5JJ

16;

22

46

*

*

*

●

*

*

798

67

1:

36

330

42

62

22

3,743

328

61

723

354

167

AZ

15,073

210

57

25

224

13

y

433

152

2,022

143

:E

244

1%

185

2,367

446

:5$

1~

65

92

750

281

362

295

231

59

. . .

63

2

. . .

. . .

. . .

. . .

.,.

. . .

994

1%

42

1;?

431

1%

27

6,715

702

66

791

:E

270

588
Advance Data No. 227 ● March 3,1993

Table 8. Rate of all-listed procedures for inpatients discharged from short-stay hospitals, by procedure category, sex, and age:

United States, 1991

[Discharges from non-Federal hospitals. Excludes newborn infants. Procedure groupings and code number inclusions are based on the hrfematicma/ C/asaiibation of

Diseases, 9th Revision, Clinical Modification (lCD-g-CM)]

Sex Age

Under 154 45-64 65 years

Procedure category and ICD–9-CM Code Total Male Female 15 years yeara years and over

Rate of all-listed procedures per 100,000 population

All procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Operations onthenewous aystem. . . . . . . . . . . . . . . . . . . . . . ...01-05

Spinal tap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...03.31

Operations ontheendocrine syatem. . . . . . . . . . . . . . . . . . . . .OL?-07

Operations onthe eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...06-16

Operations onthe ear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...16-20

Operations onthenose, mouth, and pharynx. . . . . . . . . . . . . . . .21-29

Tonsillectomy with orwithout adenoidectomy . . . . . . . . . . . . .28.2–26.3

Operationa onthe respiratory system . . . . . . . . . . . . . . . . . . . . ..30-34

Bronchoscopy with orwithoutbiopay. . . . . . . . . . . . . .33.21 -33.24.33 .27

Operations onthecardiovascular syatem. . . . . . . . . . . . . . . . . . . .36-39

Removal ofcoronary artery obstruction. . . . . . . . . . . . . . . . . . . ...36.0

Coronary artery bypaesgraftl . . . . . . . . . . . . . . . . . . . . . . . . . ...36.1

Cardiac catheterization.. . . . . . . . . . . . . . . . . . . . . . . .37.21 -87.23

Insertion, re Iacement, removal, and revision

ofpacema Eerleada or device. . . . . . . . . . . . . . . . . . . . . . .37.7-37.8

Shunt orvascular bypass . . . . . . . . . . . . . . . . . . . . . . . . ...39.0-39.2

Hemodialyais . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...39.95

Operations onthehemic andlymphatic ayatem. . . . . . . . . . . . . . . .4041

Operations onthedi estivesyatem .,. , . . . . . . . . . . . . . . . . . ...42-54

Endosoopy of sma7“I mteetme with or

Wlthoutbioq...,... . .45.11 -45.14,45.16

Endoscopyof argetntea&e”wi~h”or” “ “ “ “ “ “ “ “ “ “

without biopsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45.2145 .25

Partial exciaton oflarae intestine . . . . . . . . . . . . . . . . . . . . . . . ...45.7

l+ppendectomy,excl~dn gincidental . . . . . . . . . . . . . . . . . . . . ...47.0

Cholecystectomy . . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . . ...51.2

l?eDairofinauinal herni a..... . . . . . . . . . . . . . . . . . . . . . .68.0-53.1

Ly&sofper~onealadhesions . . . . . . . . . . . . . . . . . . . . . . . . . . . .54.5

Operafionaonthe urinarysystem . . . . . . . . . . . . . . . . . . . . . . . ..55-59

Cyetoscopy with orwithoutbiopsy. . . . . . . . . . . . . . . . . . . .57.31-57.33

Operationaonthemalegenitalorgans . . . . . . . . . . . . . . . . . . . ...60-64

Prostatactomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60.2-60.6

Operations onthefemale genital organs . . . . . . . . . . . . . . . . . . ...65-71

Oophorectomyand salpingo-oophorectomy . . . . . . . . . . . . ...66.3-65.6

Bilateral destruction or occlusion of

fallopiantubes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...66.2-66.3

Hysterectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...66.3-68.7

Dtlationand curettageofuterus . . . . . . . . . . . . . . . . . . . . . . . ...69.0

Repairofcyatoceleand rectocele . . . . . . . . . . . . . . . . . . . . . . ...70.5

Obatetricalprocedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...72-75

Episiotomy with or without forceps

orvacuum extraction. . . . . . . . . . . . . .72.1,72.21,72.31,72.71,73.6

Artificial ruptureofmembranes . . . . . . . . . . . . . . . . . . . . . . . . ...73.0

Cesareansection. . . . . . . . . . . . . . . . . ., . , . ,74.0-74.2,74.4,74.99

Fetal EKG (scalp) and fetal monitoring,

nototherwiseapecified . . . . . . . . . . . . . . . . . . . . . . . . . .75.32.75.34

Repair occurrent obstetric laceration. . . . . . . . . . . . . . . . . . .75.5-75.6

Operationsonjhe musculoskeletal system. , . . . . . . . . . . . . . .76-64

Partial excwtonofbone. . . . . . . . . . . . . . . . . .76.2–76.3,77.6-77.6

Open reduction offracture with internal fixation. . . . . . . . . . . . . . ...79.3

Excision ordestrucfion ofintewertebral disc. . . . . . . . . . . . . . . . ...80.5

Totalhip replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...81.51

Totalknee replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..81.54

Operationsonthe integumentary syatem. . . . . . . . . . . . . . . . .85-88

Mastectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...85.4

Debridement ofwound, infection, or burn. . . . . . . . . . . . . . . .86.22.86.28

Skin graft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..88.=6.7

Miscellaneous diagnostic andtherapeutic procedures. . . . . . . . . ...87-98

Computenzad axial tomography . . . . . . . . . .87.03.87.41.87.71 ,68.01,86.36

Pyelogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87.73-67.75

Arteriography and angiooardiography using

mntraatmaterial . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . ..83.4-6S.5

Oiagnosticultrasound . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...88.7

Circulato~monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...89.6

Radioisotopescan . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...92.0--92.1

Reapiratorytherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .93.9

17,529.3

387.3

151.6

41.0

159.2

51.6

216.1

34.1

381.6

123.4

1,645.5

131.9

162.6

399.1

119.6

87.2

104.0

156.3

2,218.8

320.9

229.0

87.7

101.8

227.8

68.8

135.4

621.8

182.6

233.2

145.1

921.3

182.7

160.1

218.0

78.0

55.3

2,740.4

672.2

309.2

372.5

529.4

317.3

1,326.3

86.2

166.7

122.2

46.6

64.0

528.5

47.2

130.0

39.5

5,800.5

562.4

97.8

685.8

635.2

280.5

215.0

484.5

14,204.6

411.5

171.1

22.9

155.7

61.7

236.7

32.5

461.2

163.4

1,860.3

183.5

243.5

486.0

119.3

75.7

106.0

174.3

I ,908.0

321.9

192.6

77.7

111.4

136.9

127.4

49.4

727.4

273.9

480.8

299.1

. . .

. .

. ..

. . .

. . .

. ..

. . .

. . .

. . .

. ..

. . .

1,406.7

97.8

156.4

149.3

41.1

49.4

453.8

149.:

49.0

5,743.6

577.4

108.3

813.8

536.2

278.9

187.5

4eo.1

20,661.0

364.5

133.2

58.1

162.4

42.0

196.7

35,7

306,6

95.2

1,348.9

83.3

88.4

307.9

119.9

59.1

102.2

139.4

2,511.6

320.0

2::;

92:7

313.4

13.6

216.5

522.3

98.7

. . .

. . .

1,769.0

354.8

310.9

423.4

151.6

107.4

5,321.8

1,305.3

600.4

723.4

1,028.1

616.1

i ,250.6

75.5

174.6

96.6

51.8

77.8

598.8

90.9

112.1

30.6

6,048.2

587.0

86.9

565.3

728.5

282.0

241.0

479.1

4,054.9

428.9

332.2

*

44.5

119.3

214.4

98.2

109.7

32.2

269.0

*

33.;

*

*

*

35.5

401.3

20.1

*

102.:

45.;

9.3

85.0

17.2

64.3

. . .

*1 4.9

*

*

*

*

43.4

*1 4,0

*

*

*

*

376.9

17.9

48,4

*

*

135.9

35.;

17.2

1,685.4

125.$

40.3

133.3

52.0

28.5

356.1

14,610.5

280.6

80.6

35.3

55.8

30.6

202.6

23.8

147.5

38.4

407.5

:::

75:9

7.8

11.9

52.5

66.2

1,342.6

123.9

77.3

19.8

133.4

165.8

26.8

142.8

321.2

54.7

33.9

●

1,388.0

211.8

34i .7

275.6

136.0

34.0

5,846.4

1,431.9

659.5

795.9

1,128.6

677.3

1,131.2

82.3

124.2

138.1

7,2

*

417.3

14.8

91.1

34.5

2,903.8

306.0

79.9

155.5

362.7

100.9

89.7

165.2

20,368.8

419.7

97.5

71.7

182.8

31.7

205.4

*

620.5

202.3

3,161.0

350.0

381.3

956.3

94.3

121.7

168.1

234.5

2,997.9

431.9

272.1

121.6

61.8

405.0

108.0

161.3

825.3

221.1

248.5

145.6

953.3

321.7

344.;

46.1

103.6

*

*

*

*

*

*

1,708.4

142.8

162.3

218.3

65.5

77.6

708.7

80.3

133.0

46.2

8,013.9

701.7

129.9

1,546.0

758.9

358.6

316.3

505.2

47,468.0

:;:;

77.2

704.3

40.3

264.2*

1,364.8

479.0

6,366.7

449.1

650.2

1,404.8

769.9

293.5

372.6

563.3

7,455.8

1,405.6

1,111.1

436.3

42.6

581.9

204.1

268.5

2,361.6

884.7

1,203.3

930.0

728.4

184.2

. . .

198.2

1%.;

. . .

. . .

.,.

. . .

. . .

. . .

3,131.8

136.0

535.6

131.4

244.5

382.3

1,357.2

164.0

433.6

84.0

21,146.8

2,210.6

272.0

2,492.2

2,328.6

‘1,226.9

851,8

1,853.0

1me ratep 1,ooo,~ ~wlation of ~schargd Patienk with a coronary bypass graft was 105.S.
Advance Data No. 227 ● March 3,1993 9

Technical notes

Survey methodology

Source of data

The National Hospital Discharge

Survey covers discharges from

noninstitutional hospitaIs, exciusive of

Federal, military, and Veterans

Administration hospitals, Iocated in

the 50 States and the District of

Columbia. OnIy short-stay hospitals

(hospitals with an average Iength of

stay for all patients of less than 30

days) or those whose speciahy is

general (medical or surgical) or

chiIdren’s general are inciuded in the

survey. These hospitaIs must also

have six beds or more sttied for

patient use.

From 1988 through 1990, the

NHDS sampling frame consisted of

hospitals that were listed in the ApriI

1987 SMG Hospital Market Tape (3),

met the above criteria, and began

accepting patients by August 1987. In

1991 the sampling frame was updated

to include hospitals from the 1991

SMG Hospital Database Tape (4).

For 1991, the sample consisted of 528

hospitals. Of the 528 hospitals, 7 were

found to be out of scope (ineligible)

because they went out of business or

otherwise failed to meet the criteria

for the NHDS universe. Of the 521

in-scope (eIigible) hospitaIs, 484

responded to the survey.

Sample design and data collection

The NCHS has conducted the

NHDS continuously since 1965. The

original sample was selected in 1964

from a frame of short-stay hospitals

listed in the National Master Facility

Inventory. That sample was updated

periodically with samples of hospitals

that opened later, Sample hospitals

were selected with probabilities

ranging from certainty for the largest

hospitals to 1 in 40 for the smallest

hospitals. Within each sample

hospital, a systematic random sample

of discharges was selected. A report

on the design and development of the

original NHDS was published (l).

Beginning in 1988, the NHDS

sample includes with certain~ all

hospitaIs with 1,000 beds or more or

40,000 discharges or more annually.

The remaining sample of hospitaIs is

based on a stratified three-stage

design. The first stage consists of a

selection of 112 primary sampling

units (PSU’S) that comprise a

probability subsample of PSU’S to be

used in the 1985-94 National Health

Interview Survey. The second stage

consists of a selection of noncertainty

hospitals from the sample PSU’S. At

the third stage, a sample of

discharges was selected by a

systematic random sampling

technique.

Two data collection procedures

were used for the survey. The first

was a manual system of sample

selection and data abstraction. The

second was an automated method,

used for approximately 33 percent of

the respondent hospitals in 1991, that

involved the purchase of data tapes

from abstracting service organizations,

state data systems, or hospitals.

In the manuaI system, the sample

selection and the transcription of

information from the hospital records

to abstract forms were performed at

the hospitals. The completed forms,

along with sample selection control

sheets, were forwarded to NCHS for

coding, editing, and weighting. Of the

hospitals using the manual system in

1991, about two-thirds had the work

performed by their own medical

records staff. In the remaining

hospitals using the manuaI system,

personnel of the U.S. Bureau of the

Census did the work on behalf of

NCHS.

For the automated system, NCHS

purchased tapes containing

machine-readable medical record

data that were systematically sampled

by NCHS.

The medical abstract form and

the automated data tapes contain

items relating to the personal

characteristics of the patient,

including birth date, sex, race, and

marital status but not name and

address; administrative information,

including admission and discharge

dates, discharge status, and medical

record numbeq and medical

information, including diagnoses and

surgical and nonsurgical operations or

procedures. Since 1977, patient ZIP

Code, expected source of payment,

and dates of surge~ have also been

collected. (The medical record

number and patient ZIP Code arc

confidential information and are not

available to the pubIic.)

Presentation of estimates

The reIative standard error of the

estimate and the number of sample

records on which the estimate is

based (referred to as the sample size)

are used to ident~ estimates with

relatively Iow reliability.

Because of the complex sample

design of the NHDS, estimates of less

than 5,000 are not presented; only an

asterisk (*) appears in the tables.

These estimates generally have a

relative standard error of more than

30 percent or are based on a sample

of Iess than 30 cases. Estimates of

5,000 to 9,000 are preceded by an

asterisk (*) to indicate that they

shouId not be assumed to be reliable.

These estimates are generally based

on less than 60 cases.

Sampling errors and rounding

of numbers

The standard error is primariIy a

measure of sampling variability that

occurs by chance because only a

sampIe rather than the entire

universe is surveyed. The relative

standard error of the estimate is

obtained by dividing the standard

error by the estimate itself and is

expressed as a percent of the

estimate. The resulting value is

multiplied by 100, so the relative

standard error is expressed as a

percent of the estimate.

Estimates of sampling variability

were calculated with SESUD&YN

software, which computes standard

errors by using a first-order Taylor

approximation of the deviation of

estimates from their expected values.

A description of the software and the

approach it uses has been

published (5).

The constants for relative

standard error curves for the National
10 Advance Data No. 227 ● March 3, 1993

Hospital Discharge Survey are

presented in table I. The constants

for 1990 are shown because 1991

constants were not available at the

time of publication and littIe

difference is expected in the constants

for the 2 years. The relative standard

error [RSE(X)] of an estimate X may

be estimated from the formula:

RSE(X) = 100 (~a + b/X)

where X, a, and b are as defined in

table I.

Estimates have been rounded to

the nearest thousand. For this reason,

figures within tables do not always

add to the totals. Rates and average

lengths of stay were calculated from

original, unrounded figures and will

not necessarily agree precisely with

rates or average lengths of stay

calculated from rounded data.

Tests of significance

In this report, statistical inference

is based on the two-sided test with a

critical value of 1.96 (0,05 level of

significance). Terms such as “higher”

and “less” indicate that differences

are statistically significant. Terms

such as “similar” or “no difference”

mean that no statistically significant

difference exists between the

estimates being compared. A lack of

comment on the difference between

any two estimates does not mean that

the difference was tested and found

not to be significant.

Terms relating to

hospitalization

HospitaLs– All hospitals with an

average length of stay for all patients

of less than 30 days or hospitals

whose specialty is general (medical or

surgical) or children’s general are

eligible for inclusion in the National

Hospital Discharge Survey, except

Federal hospitaIs, hospital units of

institutions, and hospitals with less

than six beds staffed for patients’ use.

PatierLt– A person who is formally

admitted to the inpatient service of a

short-stay hospital for observation,

care, diagnosis, or treatment. The

terms “patient” and “inpatient” are

used synonymously.

Newborn infant– A patient

admitted by birth to a hospital.

Discharge– The formal release of

a patient by a hospital; that is, the

termination of a period of

hospitalization by death or by

disposition to place of residence,

nursing home, or another hospital.

The terms “discharges” and “patients

discharged” are used synonymously,

Discharge rate – The ratio of the

number of hospital discharges during

a year to the number of persons in

the civilian population on July 1 of

that year.

Days of care – The number of

patient days accumulated at time of

discharge by a patient. A stay of less

than 1 day (patient admission and

discharge on the same day) is

Table L Estimated parameters for relative standard error equations for National Hospital

DLseharge Suwey statistics, by sex, age, and geographic region: United Statea, 1990

Number of discharges or

riret-kred diagnoses Number of procedures

Characteristic a b a b

Total . . . . . . . . . . . . . . . . . . . . .

Sex

Male, . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . .

Age

Under 15 years . . . . . . . . . . . . .

15-44 years . . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . . .

65 years and over, . . . . . . . . . . .

Reg!on

Northeast . . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . . .

West ..,.,.........,..,.,

0.00213

0.00152

0.00125

0.01597

0.00142

0.00157

0.00161

0.00274

0.00487

0.00375

0.00564

228.@34

313.079

311.632

47.116

299.762

234.543

263.223

56.268

183,531

343.892

318.914

0.00547

0.00410

0.00337

0.03171

0.00302

0.00491

0.00436

0.00588

0.00885

0.00781

0.01235

92.597

89.724

83.021

44.124

139.070

68.024

47.886

106.765

107.681

50.919

144.562

counted as 1 day in the summation of

totaI days of care. For patients

admitted and discharged on different

days, the number of days of care is

computed by counting aIl days from

(and including) the date of admission

to (but not including) the date of

discharge.

Average length of stay– The

number of days of care accumulated

by patients discharged during the year

divided by the number of these

patients.

Terms relating to diagnoses

Diagnosis-A disease or injury (or

factor that influences health status

and contact with health services that

is not itself a current illness or injury)

on the medical record of a patient.

Principal diagnosis – The condition

established after study to be chieily

responsible for occasioning the

admission of the patient to the

hospital for care.

First-listed diagnosis - The coded

diagnosis identified as the principal

diagnosis or listed first on the face

sheet or discharge summary of the

medical record if the principal

diagnosis cannot be identified. The

number of first-listed diagnoses is

equivalent to the number of

discharges.

Terms relating to procedures

Procedure– A surgical or

nonsurgical operation, diagnostic

procedure, or special treatment

reported on the medical record of a

patient. Beginning with the 1991 data,

all ICD-9-CM procedure codes are

used in the NHDS, Previously

selected codes, primarily codes for

miscellaneous diagnostic and

therapeutic procedures, were not

used.

M-1isted procedures – The number

of procedures on the face sheet of

the medical record. In the NHDS a

maximum of four procedures are

coded.

Rate of procedures – The ratio of

the number of procedures during a,

year to the number of persons in the

civilian population on July 1 of that

year determines the rate of

procedures.
Advance Data No. 227 ● March 3, 1993 11

Demographic terms

Population –The U.S. resident

population excluding members of the

Armed Forces.

Age- Patient’s age at birthday

prior to admission to the hospital.

Geographic region - Hospitals are

classified by location in one of the

four geographic regions of the United

States that correspond to those used

by the U.S. Bureau of the Census.

Regt”on States included

Northeast . . . Maine, New

Hampshire, Vermont,

Massachusetts, Rhode

Island, Connecticut,

New York, New Jersey,

and Pennsylvania

Midwest . . . . Michigan, Ohio,

II1inois, Indiana,

Wkiconsin, Minnesota,

Iowa, Missouri, North

Dakota, South Dakota,

Nebraska, and Kansas

South . . . . . . Delaware, Maryland,

District of Columbia,

Virginia, West Virginia,

North Carolina, South

Carolina, Georgia,

Florida, Kentucky,

Tennessee, Alabama,

Mississippi, Arkansas,

Louisiana, OkIahoma,

and Texas

West . . . . . . . Montana, Idaho,

Wyoming, Colorado,

New Mexico, Arizona,

Utah, Nevada,

Washington, Oregon,

California, Hawaii, and

Alaska

Symbols

--- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less

than 0.05

z Quantity more than zero but less

than 500 where numbers are

rounded to thousands

● Figure does not meet standard

of reliabilityor precision

(see Technical notes)

# Figure suppressed to comply with

confidentialityrequirements

. .. . —-. —- ...-— —
12 Advance Data No. 227 ● March 3, 1993

Suggested citation Copyright information Nationai Center for Health Statistics

Graves EJ. 1991 Summary National Hospital Afl material appearing in this report is in the Director

Discharge Survey. Advance data from vital public domain and may be reproduced or Manning Feinleib, M.D., Dr. P.H.

and health statistics; no 227. Hyattsville,

Maryland: National Center for Health

copied without permission; citation as to Acting Deputy Director

Statistics. 1993. source, however, is appreciated. Jack R. Anderson
Number 228 ● March 2, 1993

Advance

Data

From Vi and Health Statistics of the CENTERS FOR DISEASE CONTROL AND Prevention/National Center for Health Statistics

Office Visits to General Surgeons 1989-905 National

Ambulatory Medical Care Survey

by David A. Woodwell, Division of Health Care Statistics

This report describes visits made

to general surgeons from March 1989

through December 1990. The

information was collected by means

of the National Ambulatory Medical

Care Survey (NAMCS), a continuing

probability sample survey of the

private office-based, non-Federal

physicians practicing in the United

States. NAMCS excludes physicians

who specialize in anesthesioIogy,

pathology, or radiology and physicians

who are principally engaged in

teaching, research, or administration.

The survey ako excIudes those visits

made to hospital emergency or

outpatient departments. NAMCS was

conducted annually from 1973

through 1981, again in 1985, and

resumed as an annual suwey in 1989,

by the Division of Health Care

Statistics, National Center for Health

Statistics, Centers for Disease Control

and Prevention. Participation in the

NAMCS is voluntary.

Data in this report are from the

1989 and 1990 NAMCS, which were

conducted in identical fashion using

the same survey instruments,

definitions, and procedures. The data

were combined in order to obtain

more reliable estimates. The figures

in this report are estimated from a

sample, not the entire universe, of

visits to general surgeons, and are

therefore subject to sampling

variability. All estimates in this

report, including the number of visits,

the number of drug mentions, and

the visit rates, have been adjusted to

represent average annual statistics

and do not represent 2-year totals.

The technical notes at the end of the

report provide guidelines for judging

the precision of the estimates.

Definitions of key terms used in the

survey are also provided. The patient

record form used for data collection

in both 1989 and 1990 is shown in

figure 1.

Data highlights

During 1989-90, there was an

estimated annual average of 23.9

million visits to general surgeons

accounting for 3.4 percent of all office

visits to ambulato~ care physicians in

the United States (table 1). This

estimated annual average of 23.9

million visits is a significant decrease

from the estimated annual average of

30.5 million visits in 1980-81 (1) and

a further decrease from the estimated

41.2 milIion visits in 1975 (2). As a

percent of total visits to all

physicians, visits to general surgeons

also decreased during this period

from 7.3 percent in 1975 to 5.3

percent in 1980-81 to 3.4 percent in

1989-90. Whereas general surgeons

had an average annual visit rate of 20

visits per 100 persons in 1975, their

average annual visit rate in 1989-90

was only 10 visits per 100 persons, or

half the 1975 rate. The decIining

trend in the visit rate to general

surgeons could be attributed in part

to the fact that since 1980 the

number of generaI surgeo&, m a

percentage of aIi surgeons, has

decreased 14.3 percent. As a percent

of alI physicians, general surgeons

have decreased from 8.3 percent in

1980 to 6.8 percent in 1990–a

decrease of 18.1 percent (3,4).

Patient characteristics

As shown in table 2, seven of

every eight patients (88 percent) who

visited general surgeons were 25 years

of age or oIder. Visits made by

patients ages 25-64 years represented

over half of alI visits to the general

surgeon, with those ages 65–74 and

75 years and over accounting for

another 30 percent of the visits. The

visit rate increased with age from 2

visits per 100 persons for patients

under 15 years of age to 27 visits per

#* “’’’c”++

~

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES *

g Public Health Service

:

* Centers for D:sease Control and Prevention 5

%

>

National Center for Health Statistics CM

*-b,,a CENTERS FOR DISEASE CON1’ROL

ANO PREVENTION
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1,DATE OF VISIT PATlENT RECORD

~

OMB No. 0%!04234

NATIONAL AMBULATORY MEDICAL CARE SURVEY

Expires S-31 S9

IPH.W 6105B

2. ZJPCODE 4-SEX 5.CO:R OR 6. 1THNICIT% 7 EXPECTED SOURCE(S) OF PAYMENT

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10. PHYSICIAN’S DIAGNOSES q q . y’01_l.4s~-

. . MOST IMFURTANT ● PRINCIPAL DtAGNOSIS/PROSLEM ASSOCIATEO WmH ITEM 9s.

lDYES 2DN0

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IF YES. FOR THE COND1710N

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1 z DIAGNOSTIC/SCREENING SERVICES

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1 0 NONE 7 ❑ 8LOO0 PRESSURE CHECK 13 ❑ ORAL GLUCOSE TOL. 1 ❑ NONE 1 0 NONE

2 ❑ PAP TEST 8 ❑ URINALYSIS 14 ❑ CHOLESTEROL MEASURE 2 ~ WEIGHT REDUCTION 2 ❑ F’SY’CHOTHERAPY

3 ❑ PELVIC EXAM 9 0 CHEST X. RAY 1S ❑ HIV SEROLOGY 3 ~ CHOLESTEROL REOUCTION 3 ❑ CORRECTIVE LENSES

4 ❑ BREAST PALPATION 10 ❑ D, GITAL FIECTAL EXAM 16 Q OTHER 8LOO0 TEST 4 D SMOKING CESSATION 4 a AM.9ULATORY SURGERY

5 u MAMMOGFIAM I I D PROCT,SIGMO,DOSCOPy 5 ❑ HIV TRANSMISSION 5 D PHYSIOTHERAPY

17 0 OTHER /5wcIJ,./

6 ❑ VhuAL ACUITY 12 (J STOOL BLOOO EXAM 6 ❑ W4EAST SELF EXAM 6 ❑ OTHER ISPMYYJ

~ ❑ OTHER

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1,

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—. ‘02 D1D20 3 ❑ RETURN IF NEEL3E0. P.R.N.

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5, ‘D201O2O 8 m OTHER ISLWXI’)

I

.

!

8 u.S. GOVERNMEh7 PRINCING OFFtCE:l S.ESl.23S.W7

Figure 1. Patient record form

100 persons for patients 75 years of

age and over.

General surgeons had

significantly more visits by females

than visits by males in 1989-90.

About 62 percent of the visits were

made by females, which was similar

to the distribution in 1975 (2). For

both males and females, the percent

of visits for patients 25-44 years old

increased significantly from the

percent of visits for patients 15-24

years old. In addition, females

represented a significantly higher

percent of visits in the two age groups

25-44 and 45-64, about 37 percent

for females compared with about 21

percent for males. The visit rates

were not significantly different by

consecutive age groups, within or between maIe and female groups, but was

significant from the under 15 age group

to the 75 years and older age group.

Most of the visits to the general

surgeon were made by white persons,

nearly 82 percent, as compared with

black persons, 15 percent (table 3).

For both white and black persons,

females visited more often than

males. There was no significant

difference in the visit rate between

white and black persons. White

persons had an average annual visit

rate of 10 visits per 100 persons as

compared with black persons who, had

a visit rate of 12 visits per 100

persons. This similarity in the visit

rate indicates that general surgeons

had approximately the same
Advance Data No. 228 ● March 2, 1993 3

Table 1. Average annual number, percent distribution, and average annual rate of office

visits, by physician specialty United States, 1989-90

Average annual Average annual

number of vists Percent number of visits

Physician specialty in thousands distribution per 100 persons

Nlvisita.. . . . . . . . . . . . . . . . . . . . . . . . . . . . 698,653

General and family practice . . . . . . . . . . . . . . . . . 208,045

Internal medicine . . . . . . . . . . . . . . . . . . . . . . . . 87,719

Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84,280

Obstetrics and gynecology.. . . . . . . . . . . . . . . . . 59,812

Ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . 41,302

Orthopedic surgery . . . . . . . . . . . . . . . . . . . . . . 34,033

Dermatology . . . . . . . . . . . . . . . . . . . . . . . . . . 25,164

Generalsurge~ . . . . . . . . . . . . . . . . . . . . . . . . 23,891

Psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,790

Otoiaryngology . . . . . . . . . . . . . . . . . . . . . . . . . 16,957

Cardiovasculardiseases . . . . . . . . . . . . . . . . . . . 11,040

Urologiml surgery . . . . . . . . . . . . . . . . . . . . . . . 9,852

Neurology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,167

Allotherspecialties . . . . . . . . . . . . . . . . . . . . . . 71,603

100.0

29.8

12.6

12.1

8.6

5.9

4.9

3.6

3.4

2.7

2.4

1.6

1.4

0.9

10.2

285

85

36

34

24

17

14

10

10

8

7

5

4

3

29

Table 2. Average annual number and percent distribution and average annuai rate ofoffice

visitsto general surgeons, by sex andage: United States, 1989-90

Average annual Average annual

numberofvisits Percent numberofvisit.s

Sex and age in thousands distribution per 100 persons

Totelvisit.s . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under15years . . . . . . . . . . . . . . . . . . . . . . .

15-24yeara . . . . . . . . . . . . . . . . . . . . . . . . .

2544years . . . . . . . . . . . . . . . . . . . . . . . . .

45-64years . . . . . . . . . . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . . . . . . . .

75yeareand over . . . . . . . . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under15yeara . . . . . . . . . . . . . . . . . . . . . . .

15-24years . . . . . . . . . . . . . . . . . . . . . . . . .

2S-44yeara . . . . . . . . . . . . . . . . . . . . . . . . .

45-64years . . . . . . . . . . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . . . . . . . .

75yearsand over . . . . . . . . . . . . . . . . . . . . .

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under 15yeem . . . . . . . . . . . . . . . . . . . . . . .

lS-24years . . . . . . . . . . . . . . . . . . . . . . . . .

25-44yeam . . . . . . . . . . . . . . . . . . . . . . . . .

46-64years . . . . . . . . . . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . . . . . . . .

75yearsand over . . . . . . . . . . . . . . . . . . . . .

23,891

1,028

1,815

6,580

7,201

4,207

3,059

9,168

546

643

2,541

2,530

1,532

1,177

14,722

462

972

4,039

4,672

2,674

1,882

100.0

4.3

7.6

27.5

30.1

17.6

12.6

38.4

2.3

3.5

10.6

10.6

6.4

4.9

61.6

2.0

4.1

16.9

19.6

11.2

7.9

10

2

5

8

16

23

27

8

2

5

7

11

19

26

12

2

5

10

19

27

26

proportion ofvisits byrace asthe

proportion inthe general population.

Expected sources of payment

& shown in tabIe 4, Medicare

(almost 26 percent) and “other

commercial’’insurance (almost25

percent) were the most frequent

sources ofpayment for visits made to

general surgeons. For all physicians,

Medicare was used asa sourceof

payment in19 percent of thevisits, a

signifkantd inference of approximately

7percentrefiecting thehigh rateof

older patients that visit general

surgeons. Patients paid all orpart of

the visit cost in unestimated 16

percent of thevisits to general

surgeons, which is significantly Iower

than the estimated 31 percent for all

physicians. The visits in which the

patient was not charged (almost S

percent) was higher for general

surgeons as compared with all

physicians (about 2 percent).

Medicaid, Blue Cross/Blue Shield,

andpre-paid plans (HMO’s, IPA’s,

and PPO’s) were a payment source

for about 9 percent, 15 percent, and

13 percent of the visits respectively. If

a patient used more than one source

of payment, allsources were recorded

in item 170f the patient record form.

Patient status

As illustrated in table 5, of the

visits made to general surgeons in

1989-90, about 14 percent were

referred, as compared with about 6

percent of the visits for all physicians.

Unpublished data from the 1977 and

1980 NAMCS (1977 was the first year

referral data were collected) showed

that approximately 11 percent of the

vkits to general surgeons were

referred. In 1985, the percent of visits

referred was about 14percent, which

is not significantly different than the

estimates from 1977, 1980, or

1989-90.

The visit status of the patient

(item 11 on the patient record form)

shows that most of the visits were

made by patients the physician had

previously seen for the same

condition (about 65 percent). About

15 percent of the visits were made by

patients seen before who were

presenting a new problem, and about

20 percent of the visits were made by

new patients.

Patient’s reason for visit

The principal reason for visit to

the general surgeon, as expressed by

the patient, is shown in tables 6 and

7. The principal reason for visit is the

problem, complaint, or cause listed

first on item 9 of the patient record

form. These data have been classified

and coded according to the Reason

for V7?itClass$carion for Ambulatory

Care (RVC) (5).

The RVC is divided into eight

modules (or groups of reasons) as

detailed in table 6, For visits to

general surgeons, the symptom

module was most often cited,
4 Advance Data No. 228 ● March 2, 1993

Table 3. Average annual number, percent distribution, and average annual rate of office

visits to general surgeons, by race and sex: United States, 1989-90

Average annual Average annual

number of vistfs Percent number of visits

Race and sex in thousands distribution par 100 pereons

Total visits . . . . . . . . . . . . . . . . . . . . . . . . . . . 23,891 103.0 10

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,572 15.0 12

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,265 5.3 9

Female .,..,...,.,.,.. . . . . . . . . . . . . 2,306 9.7 14

White. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19,570 87.9 10

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,571 31.7 8

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,999 50.2 13

Other’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 510 2.1 6

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 0.9 5

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . 296 1.2 7

Unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . 239 1.0 . . .

llncJudes Asian and Pacific Islsnderemd Amancanlndurm Eskimo,sndP&ut.

Table 4. Average annual number and percent distribution of office vlslts to general

surgeons and percent distribution of office visits for all physicians by the expected

source of payment: United States, l 989-9o

Visits to all

tisi.% to general surgeons physicians

Average annua/

numberoftisits Percent Percent

Sourceofpeyment inthoussrrds distribution distribution

Totalvisits . . . . . . . . . . . . . . . . 23,891 100.0 100.0

Seifpay . . . . . . . . . . . . . . . . . 3,766 I 5.a 31.2

Medcere . . . . . . . . . . . . . . . . . 6,145 25.7 19.0

Medicaid. . . . . . . . . . . . . . . . . 2,237 9.4 8.1

BlueCross/BlueShield. . . . . . . . 3,567 14.9 11.7

othercommercial . . . . . . . . . . . 5,648 24.5 22,8

Pre-paidplan,HMO/lP~PPO’. . . . 3,046 12.7 14.6

Nocharge . . . . . . . . . . . . . . . . 1,614 7.6 1.8

Ocher . . . . . . . . . . . . . . . . . . . 1,620 6.a 5.5

Unknown . . . . . . . . . . . . . . . . . 4oe 1.7 2.0

‘HMO isheaHh mintewe organkatton, lPAlsindividuaf pr8ctice sssoclation, errd PPO is preferred provider orgardzaticm.

NOTE: Numbersmay not add to totals because more then one source was possible.

Table 5. Average annual number and percent distribution of office visits to general

surgeons, bypatient’s referrsl status andvislt status: Urrlted States, 1989-90

Average wrnual

number of kisits Percent

Referral and vkit status in thousands distdbufion

AllvMs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23,691 100.0

Patient referred

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,430 14.4

No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20,460 05.6

Visit status

New patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,735 19.’9

Old pattent, newproblem . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,606 15.1

Old patient,ol dproble m...... . . . . . . . . . . . . . . . . . . . . . . . 15,549 65.1

containing about 51 percent of all the

reasons for visit. Within the symptom

module,symptoms of the

muscr.doskeleta lsystem and the

genitourinary systems were the reason

forvisit in approximately 11 percent

and 10 percent of the visits

respectively. The treatment module

accounted for about one-fifth or

about21 percent of the reasons for

visit, more than doubIe the

corresponding percent foraII

physicians. This high percentage for

the treatment module reflects the

type of practice the general surgeon

has and the procedures performedas

compared with the other specialties.

The disease module, the diagnostic,

screening, and preventive modulle,

and theinjuxy and adverse effects

module, accounted for around 15, 6,

and4 percent ofthe visits

respectively,

The 20 most common principaI

reasons for visit to general surgeons,

as expressedby the patient, are listed

in tabIe 7. These reasons account for

approximately half of all visits to

general surgeons. The first listed

principal reason for visit was for lump

or mass ofbreast, which accounted

for about 4 percent of the average

annua123.9miIlion visits to general

surgeons. Lump ormass ofbreast

represented 4.3 percentof visits in

1989–90, whichis not significantly

different than the 1980-81 estimate of

3.1 percent (l). An additional 3.8

percent of the principal reasons for

visit were related to the breast,

including breast examination, other

symptoms referable to breast, and

pain or soreness of breast resulting in

a total of 8.1 percent. The lump or

mass of breast was followed by

stomach pain, cramps or spasms and

hernia of abdominal cavity with albout

4 percent and 3 percent respectively.

Overall, of the top 20 principal

reasons for visit in 1989-90, few have

changed significantly since 1980-81.

Physician’s diagnosis

Data on the principal diagnosis

rendered by the general surgeon are

shown in tab1es8and9. The

principaI diagnosis islisted on item
Advance Data No. 228 ● March 2, 1993 5

Table 6. Average annual number and percent distribution of office visits to general

surgeons by principal reason for visit module: United States, 1988-90

Average annual

number of visits Percent

Principal reason for visit module and WC code’ h thousands distribution

Allprincipal reasons forvisit . . . . . . . . . . . . . . . . . . . . . . . . . . . 23,891 100.0

Symptom module . . . . . . . . . . . . . . . . . . . . . . . . ..S100-S999 12,211 51.1

Symptoms referab[e to digestive system. . . . . . . . . .S500-S839 2,130 S.9

Symptoms referable to the genitourinary system. . . . . .S640-S829 2,274 9.5

Symptoms referable to skin, hair, and nails . . . . . . . . .S830-6899 2,175 9.1

Symptoms referable to the musculoskeletsl system . . . .S900-S999 2,601 10.9

Oiseasemodule . . . . . . . . . . . . . . ... . . . . . . . . .. DCIO1-D999 3,474 14.5

Diagnostic, screening, and preventive module. . . . . . . . .X1OO-X599 1,360 5.7

Treatment module . . . . . . . . . . . . . . . . . . . . . . . . ..TIOO-T899 4,920 20.6

Injury and adverse effects module. . . . . . . . . . . . . . . . .JOO1-J999 998 4.2

Another modulesz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 927 4.0

‘ Sesed on A Reason for Visit Ckmi%arIon for Ambulatory Care (RVC)(5).

‘includes testresultssnd administrativemodules.unsodeblesnd blankentries.

Table 7. Average annual number, percent distribution, and cumulative percent of office

visits by the 20 principal reasons for visit most frequently mentioned by patient=

United States, 1988-90

Average annual

number of w“aite Percent Cummulati

Rank Principal reason for vfsit and RVC code’ in thousands distribution percent

Allreasona forvisit . . . . . . . . . . . . . . . . . . . . . . . . 23,S91 100.0 ---

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

—

Lumpormaes of breast . . . . . . . . . . . . . ..S805

Stomach pain, cramps or spasms. . . . . . . . .S545

Hernia of abdominat cavity . . . . . . . . . . . . .D560

Skirs lesion . . . . . . . . . . . . . . . . . . . . . ..S865

Suture-insertion, removal . . . . . . . . . . . . . .T555

Neckaymptoms . . . . . . . . . . . . . . . . . . ..S900

Symptoms referable to anus-rectum . . . . . . .S605

Leg symptoms . . . . . . . . . . . . . . . . . . . ..S920

Backsymptoma . . . . . . . . . . . . . . . . . . ..S905

Bresstexamination . . . . . . . . . . . . . . . . ..X220

Pain, sifenot specfied . . . . . . . . . . . . . . ..S055

Other symptoms referable to breast. . . . . . . .S810

Other growth of skin . . . . . . . . . . . . . . . ..S855

General medical examination . . . . . . . . . . . .X100

For other and unspecified test results . . . . . .R700

Footand toe symptoms . . . . . . . . . . . . . ..S935

Pain or soreness of breast . . . . . . . . . . . ~ .S800

other diseases of skin . . . . . . . . . . . . . . ..D825

Skin rash . . . . . . . . . . . . . . . . . . . . . . ..S860

Chest pain & related symptoms . . . . . . . . . .S050

1,034

871

766

729

590

514

480

430

364

355

3s0

321

317

317

292

268

248

247

227

209

4.3

3.6

3.2

3.1

2.5

2.2

2.0

1.8

1.5

1.s

1.5

1.3

1.3

1.3

1.2

1.1

1.0

1.0

1.0

0.9

4.3

7.9

11.1

14.2

16.7

18.9

20.9

22.7

24.2

25.7

27.2

28.5

28.8

31.1

32.3

33.4

34.4

35.4

36.4

37.3

‘ Basadon A Reasonbr Wit C/assmicafionforAmbulatoryCare (RVC)(5).

10a of the patientrecord form and

corresponds with the principalreason

forvisit(item 9a). This information

was coded and classified according to

the International Classification of

Diseases, 9th Revision, Clinical

Modification (ICD-9-CM) (6).

The categories in table 8 are

divided among the major systems of

the body as defined by the

ICD-9-CM. Diseases of the digestive

system was the largest category with

nearly 16 percent of the diagnoses.

The supplemental classification,

neoplasms, and diseases of the

genitourinarysystem followedwith

approximately 13, 13, and 11 percent

of the visits respectively. The

distribution of visits to general

surgeons, as compared with all

physicians, differ greatly in their

diagnoses. For example, diseases of

the digestive system accounted for

almost 16 percent of the visits to

general surgeons compared with

around 4 percent of the visits to all

physicians. Diseases of the respiratory

system accounted for about 4 percent

of the principal diagnoses made by

general surgeons, which is much

smaller than the 14 percent made by

all physicians. Neoplasms accounted

for almost 13 percent of the primary

diagnoses by general surgeons, which

was significantly larger than the about

3 percent for all physicians.

The 20 most frequently diagnosed

conditions made by general surgeons

in 1989-90 is listed in table 9. Benign

mammary dysplasia accounted for

about 4 percent of the principal

diagnoseq when combined with other

disorders of the breast and malignant

neoplasms of the female breast,

diagnoses related to the breast

accounted for almost 11 percent of

the diagnoses by generaI surgeons in

1989-90 as compared with about 7

percent in 1980-81 (l). This is an

increase equal to about 47 percent.

Inguinal hernia accounted for an

estimated 3.9 percent of the

diagnoses. A few of the other

principal diagnoses have noteworthy

changes since 1980-81- acute upper

respirato~ infection of multiple or

unspecified sites in 1980-81 were an

estimated 2.4 percent of the visits (l),

but in 1989-90 fell to 0.8 percent of

the visits; sprains and strains of other

and unspecified parts of the back

increased from 0.7 percent in 1980-81

(1) to 2.2 percent in 1989-90.

Diagnostic services and

counseling

Most visits made to general

surgeons included at least one

diagnostic or screening service. As

shown in table 10, patients had their

blood pressure taken in about 23

pereent of the office visits to general

surgeons, which is significantly lower

than almost 37 percent for all

physicians. In addition, the “other

blood test” category accounted for

about 8 percent of the visits and

“urinalysis” accounted for 6 percent

of the visits, which are also lower

than the approximately 13 percent for

both diagnostic sewices for all

physicians. On the other hand, more

office visits to general surgeons

included a breast palpation and

mammogram as compared with all
6 Advance Data No. 228 ● March 2, 1993

Table 8. Average annual number and percent distribution of office VISHS to general

surgeons by principal diagnoses: United States, 1989-90

Average annual

number of visits Percerrf

Principal diagnoses and ICO-9-CM codes’ in thousands distribution

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23,891 100.0

infectious & parasitic diseases . . . . . . . . . . . . . . . . .001–139 518 2.2

Neoplasm.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .140-239 2,980 12.5

Endocrine, nutritional, and metabolic diseases and Immunity

disorder s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..240-279 691 2.9

Mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .290-319 121 ●0.5

Newoussystem andsenseorgans. . . . . . . . .320-389 324 1.4

Diseases ofthec!rculatory system . .390459 1,991 8.3

D!seases oftheresp!ratory system. . . . . . . .460-519 889 3.7

Diseases ofthed!gestive system . . . . . . . . .520-579 3,741 15.5

Dtseases ofthegenrtourinary system . . . . . . . . . . . . . . ...580-629 2,640 11,0

Diseases oftheskin and subcutaneous tissue. . . . . . . . . . . . .680-709 2,271 9.5

Diseases of themusculoskele~l system andmnnetivettssue . ,710-739 1,032 4.3

Symptoms, signs andill-defmed systems. . . . . .780-799 1,100 4.8

Injury and poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..80G999 2,189 9.2

Supplementary ciaasifications . . . . . . . . . . . ., . . . . . . . . .VOO1-V082 3,042 12.7

Another diagnosesz, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 0.7

Unknown diagnosess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228 1.0

'&edonlnfernation~ C/ass/fi@f/on of O/seases, 9fh Rews/on, CJ/n(d Mod/fitif/on(lC&%CM) (6).

21ncludes diseases of me blood- formmg organs (260-289); compbal,ons of pregnancy, cimldbirth, and the puerpanum (6SO676): congenital anomalies f740-759]: and cetiam condmons orlg!natmg m fhe penmstal period (76c+79).

%cludes blank diagnoses, noncodable diagnoses, and illeglble dlagnases.

Table 9. Average annual number, percent distribution, and cumulative percent of office

visits bythe20 principal diagnoses most frequently rendered bygenerai surgeons:

United States, 1989-90

Average anrrua/

Principal diagnosis and number of visits Percenr

Rank

Cumulative

lCL7-9-Cfd code’ m thousands distnbufion percent

AfI principal diagnoses . . . . . . . . . . . . . . . . . . . . . . . 23,891 100.0 .,.

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Benign mammary dysplasias. . . . . . . . . . . . ...610

Inguinal hernia . . . . . . . . . . . . . . . . . . . . ...550

CXherdisorcters of breast . . . . . . . . . . . . . . ...611

Malignant neoplasm of female breast . . . . . . ,174

Diseases of sebaceous gland. . . . . . . . . ...706

Other hernia of abdominal cavity without mention

of obstruction or gangrene . . . . . .553

Sprains and strains of other and unspecified

parts of back . . . . . . . . . . . . . . . . . . . . . ...647

Essential hypertension. , . . . . . . . . .401

Cholel!thiasis .,, . . . . . . . . . . . . . . . . . . ...574

Hemorrhoids, . . . . . . . . . . . . . . . . . . . . . ...455

Diabetes Mellrtus . . . . . . . . . . . . . . . . . . . ...250

Other disorders ofskinand subcutaneous tssue. .709

other malignant neoplasm ofskm . . . . . ..173

Bemgnneoplasmo fs km, . . . . . . . ...216

Observation and evaluation for suspected

conditio n. . . . . . . . . . . . . . . . . . . . . . . ..V7I

Var)cose veins oflowerextremties, . . . . .454

Lipoma . . . . . . . . . . . . . . . . . . . . . . . . . ...214

Otherdkorders ofgallbladder. . . . . . . . . ..575

Other symptoms involvingabdomen andpelvk.. ..769

Other cellultkabscess . . . . . . . . ...682

982

930

865

771

632

573

526

447

431

363

358

310

307

284

274

271

257

227

214

208

4.1

3.9

3.6

3.2

2.6

2.4

2.2

1.9

1.8

1.6

1.5

1.3

1.3

1.2

1.1

1.1

1,1

0.9

0.9

0.9

4.1

8.0

11.6

14.8

17.4

19.6

22.0

23.9

25.7

27.3

28.8

30.1

31.4

32.6

33.7

34.8

35.9

36.8

37.7

38,6

'Bas~on /nternat(onal C/ass/fimt/onof Diseases,~hRev(s!on, Clrniw/ Mod,fiml/on (lCD-%CM) (6).

physicians. A breast palpation mateIy6 percent and2 percent,

occurred in 9 percent of the office respectively, for all physicians.

visits to general surgeons with a Counseling or advice was ‘

mammogram occurring in 4 percent provided or ordered by the general

of the visits, compared with approxi- surgeon as shown in table 11. Patients

were counseled, advised, or educated

on breast seIf examinations in almost

7 percent of the visits, which is three

times higher than the 2.3 percent for

alI physicians. They counseled,

advised, or educated patients on

weight reduction during almost 4

percent of the visits, on cholesterol

reduction in about 1 percent of the

visits, and on smoking cessation

around 2 percent of the visits.

Medication therapy

As shown in table 12, most of the

visits made to generaI surgeons

resulted in no drugs being

administered or prescribed. Only

about one-third (32 percent) of th~e

visits were “drug” visits, that is, visits

in which one or more medications,

were administered or prescribed. ‘The

corresponding percentages for all

physicians are much higher, with 60

percent of the visits being “drug”

visits. Medication prescribed by

generaI surgeons represent only about

2 percent of all the medications

administered or prescribed by

office-based ambulatory care

physicians in the United States. Of

the drug visits, about 58 percent were

for visits in which one drug was

administered or prescribed, almost 20

percent were for two drugs, and

about 22 percent were for three or

more drugs administered or

prescribed (table 12).

There was an estimated annual

average of 13,923,000 medications

ordered or prescribed during visits to

general surgeons in 1989-90. The

“drug mentions” are categorized into

therapeutic categories as defined by

the 1985 edition of the National Dmg

Code Directory (7) and are shown in

table 13. Cardiovascular-renal drugs

accounted for almost 21 percent of

the drug mentions and included

antihypertensive agents (about 6

percent) and diuretics (around 7

percent), Drugs used for the relief of

pain accounted for about 15 percent

of the drug mentions and included

general analgesics (about 8 percent)

and antiarthritic agents (almost 7

percent).
Advance Data No. 228 ● March 2, 1993 7

Table 10. Average annual number and percent distribution of office visits to general

surgeons and percent distribution of office visits for aii physicians by diagnostic service

ordered or provided: United States, 1989-90

Visits to all

Visits to general surgeons phys;c~ans

Average annual

number of visits Percent Percent

Diagnostic semce ordered or prcwded in thousands distribution distribution

Total visite . . . . . . . . . . . . . . . . . . . . . . . 23,891 100.0 100.0

Blood pressure . . . . . . . . . . . . . . . . . . . . 5,514 23.1 36.7

Breestpalpation . . . . . . . . . . . . . . . . . . . 2,149 9.0 5.5

Other blood test . . . . . . . . . . . . . . . . . . . 1,986 8.3 13.0

Urinalysis . . . . . . . . . . . . . . . . . . . . . . . 1,441 6.0 12.7

Digitai-rectei exam . . . . . . . . . . . . . . . . . . 1,070 4.5 3.6

Mammogram . . . . . . . . . . . . . . . . . . . . . 952 4.0 1.6

Chest X-ray . . . . . . . . . . . . . . . . . . . . . . 672 2.6 2.8

Other . . . . . . . . . . . . . . . . . . . . . . . . . . 4.276 17.9 25.2

Note:Numbersmay notadd to totalsbscause more then one diagno~c service was pessible during the patient visit

Table 11. Average annual number and percent distribution of office visits to generai

surgeons by type of counseling and/or advice given: United States, 1989-90

Average annual

number of visits Percent

Type of cer.rnseling anoYor advice in thousands distribution

Total visits . . . . . . . . . . . . . . . . . . . . . . . . .

None . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Weight reduction . . . . . . . . . . . . . . . . . . . . .

Cholesterol reduction . . . . . . . . . . . . . . . . . .

Smoidng cessation . . . . . . . . . . . . . . . . . . . .

HIVtranamission . . . . . . . . . . . . . . . . . . . . .

Breastseif-exam . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . .

23,891

15,538

889

3c6

360

●a

1,639

5,953

100.0

65.0

3.8

1.3

1.5

‘0.0

6.9

24.9

Not.%Numbersmay notaddtototals becsusemorethan onetypeofcounsding eiadwcemsyhave been given.

The 20 medications most

frequently ordered orprescribedby

general surgeons according totheir

generic ingredients are shown intable

14. Ofthe first five generic

ingredients listed, three are for the

relief ofpain. These are

acetaminophen (approxirnately6

percent), codeine (almost 4 percent),

and ibuprofen (3 percent). The other

two drugs among the top five are the

diuretics hydrochIorothiazide and

furosemide, both approximately 4

percent of medications ordered or

prescribed.

Duration and disposition of

visit

Visits made to general surgeons

in 1989-90 had a mean duration of

almost 15 minutes, excluding visits of

zero minutes. Specifically, 13 percent

of the visits lasted 1 to 5 minutes,

almost 30 percent of the visits lasted

6 to 10 minutes, about 29 percent of

the visits lasted 11 to 15 minutes, and

nearly 23 percent of the visits lasted

16 to 30 minutes. Only about 3

percent of the visits lasted longer

than 30 minutes. The duration of visit

does not include time waiting for the

physician or time receiving care from

someone eIse on the physician’s stafl,

it includes only time spent in face-toface contact with the physician. Of

the visits made to general surgeons,

about 3 percent were for zero

minutes meaning that the patient had

no face-to-face contact with the

physician, but instead received

treatment from another member of

the physician’s staff (tabIe 15).

Most of the patient visits (64

percent) made to general surgeons

ended with a disposition to return at

a specific time while about one-fifth

were to return if needed. The patient

was admitted to the hospital in about

3 percent of the visits, which is higher

than the 1 percent for all physicians

(table 15). \ –,

References

1.

2.

3.

4.

5.

6.

7.

Cypress BIC Patterns of

ambulato~ care in office visits to

general surgeons: the National

Anbulatory Medical Care Survey,

United States, January 1980-

December 1981. National Center

for Health Statistics. Vital Health

Stat 13(79). 1984.

Gagnon RO. Office visits to

general surgeons: National

Ambulatory Medical Care Survey,

United States, 1975. Advance data

from vital and health statistics; no.

23. Hyattsville, Maryland: National

Center for Health Statistics. 1978.

Bidese CM, Danais DG. Physician

characteristics and distribution in

the United States, 1981 edition.

Chicago, Illinois American

Medical Association. 1982.

Ruback G, Randolph L, Seidman

B. Physician characteristics and

distribution in the United States,

1992 edition, Chicago, Illinois:

American Medical Association.

1992.

Schneider D, Appleton L,

McLemore T. A reason for visit

classification for ambulato~ care.

National Center for Health

Statistics, Vital Health Stat 2(78).

1979.

Public Health Service and Health

Care Financing Administration.

International Classification of

Diseases, 9th Revision, Clinical

Modification. Washington: Public

Health Service, 1989.

Food and Drug Administration.

National drug code directory, 1985

edition. Washington: Public Health

Service. 1985.

.—
8 Advance Data No. 228 ● March 2, 1993

Table 12. Average annual number and percent distribution of Office vlslts to general

surgeons, by type of visit and number of medications prescribed or ordered:

United States, 1989-90

Average annual

Type of visit and number of visits Percent

number of meditations in mousands distribution

Allvisite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23,891 100,0

Type of visit

Nondrug visit (O medications) . . . . . . . . . . . . . . . . . . . . . . . . . . 16,202 87.8

Drugvisit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,688 32.2

Numberofmedications

l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,473 58.2

2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,513 19.7

3ormore, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,697 22.1

Table 13. Average annual numberand percent dlstdbution ofdrug mentions to general

surgeons bytherepeutic category f.!nited States, 1989-90

Average annual

number of mentions Percent

Therapeutic category’ in thousands distribution

AII drug mentions . . . . . . . . . . . . . . . . . . . . . . . . . .

Antimicrobialagents . . . . . . . . . . . . . . . . . . . . . . . . .

Penicillins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cephalosporirts . . . . . . . . . . . . . . . . . . . . . . . . . .

Hemstologicagents . . . . . . . . . . . . . . . . . . . . . . . . .

Cardiovascular-renal drugs . . . . . . . . . . . . . . . . . . . .

Antihyperiensiveagents . . . . . . . . . . . . . . . . . . . . .

Oluretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychopharmacologic drugs . . . . . . . . . . . . ., . . . .

Gastromteatinalagente . . . . . . . . . . . . . . . . . . . . . . .

Metebolic&nutrientagenta.. . . . . . . . . . . . . . . . . . .

Hormones and agents affecting hormonal mechanisms. . .

Immunologicagenta . . . . . . . . . . . . . . . . . . . . . . . . .

SIdnlmucous membrane . . . . . . . . . . . . . . . . . . . . . .

Neurologicdrugs . . . . . . . . . . . . . . . . . . . . . . . . . . .

Oncoiytics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drugs usedforreliefofpain . . . . . . . . . . . . . . . . . . . .

Generalanalgesics . . . . . . . . . . . . . . . . . . . . . . . .

Antiantrrftks. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Respiratorytractdwgs . . . . . . . . . . . . . . . . . . . . . . .

Unclassified/miscellarreous. . . . . . . . . . . . . . . . . . . . .

Allotherez . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13,923

1,922

383

599

259

2,856

793

1,026

434

1,052

592

1,048

184

646

211

236

2,151

1,145

961

1,083

S42

409

100.0

13.8

2.6

4.3

1.9

20.5

5.7

7.4

3.1

7.6

4.3

7.5

1.3

4.6

1.5

1.7

15.4

8.2

6.9

7.8

6.0

2.9

‘Thempeuticclsss b%sedon theararrdsrd drugckassiiion usediniheNational DrugCodeDirectory,1985edkion (7).

‘Includes: Anesthetk drugs, radiophanrraceuticsUcontrnst medii ophthalmic drugs, otobgic drugs, sntlperesilic agents.
Advance Data No. 228 ● March 2, 1993 9

Table 14. Average annual number and percent distribution of the top 20 generfc

Ingredlente most often utilized by general surgeon% United States, 1989-90

Average annual

-..

number of mentions Peroent

Rank Generic hgredierr? in ffrouasnds dktributin “ ‘ “

Acefarninophen . . . . . . . . . . . . . . . . . . . . . . . .

Hydmcttlorothiazide.... . . . . . . . . . . . . . . . . .

Fumaemide . . . . . . . . . . . . . . . . . . . . . . . . . .

Codeine . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ibuprofen . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pofaaaium replaoementaolutiort . . . . . . . . . . . . .

Diltiazem . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cephslexin . . . . . . . . . . . . . . . . . . . . . . . . . .

Triamferene . . . . . . . . . . . . . . . . . . . . . . . . . .

Etythromyoin.. . . . . . . . . . . . . . . . . . . . . . . .

Phenyfpmpsnolamine . . . . . . . . . . . . . . . . . . . .

Naproxen . . . . . . . . . . . . . . . . . . . . . . . . . . .

Glyburide . . . . . . . . . . . . . . . . . . . . . . . . . . .

Phenylephrine . . . . . . . . . . . . . . . . . . . . . . . .

Aspiri n . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Metron’kkzokr.. . . . . . . . . . . . . . . . . . . . . . . .

-~e . . . . . . . - . . . . -- ------ . . . . . .

Brompheniramine . . . . . . . . . . . . . . . . . . . . . .

Theophyiline . . . . . . . . . . . . . . . . . . . . . . . . . .

Dioxin. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

683

510

4e5

483

417

300

241

Ze

219

213

206

1%

165

173

171

165

167

148

147

142

Alldrttgmentions . . . . . . . . . . . . . . . . . . . . . . . . . 13,923 100.0 -

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

8.3 0.0

3.7

3.6

3.5 z

3.0

22

1.7

1.6 ●

1.6

Symbols

Data not available

Category notapplioable

Quantityzero

Quantitymorethan zero butless

than 0.05

Quantity more than zero but less

than500where numbers are

rounded tothousands

Figure does notmeet standardof

reliability or precision

1.5

1.5

1.4

1.3

1.2

1.2

1.2

1.1

1.1

1.1

1.0

‘Fraquencyofmention combinessingla-irgradient drugswimmerrdons Ofhgrediintsln aoxrrbinationdrug.

Table 15. Average annual numberand percent distribution ofofficevisitsto general

surgeons, byduration anddispositiorx United States, l 989-90

Average annual

number of visits Percent

Dumfion and disposition inffrouaands dktnbufion

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23,881 100.0

Durationofvisfti

Zerominutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 672 28

l-5minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,0!34 13.0

S-lOminutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,066 29.6

11-15 minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,670 28.8

l&30minufes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,417 22.7

31+ minutes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 772 32

Disposition of visti

Nofollowupplanned . . . . . . . . . . . . . . . . . . . . . . . . . . .

Returnetspacifictime . . . . . . . . . . . . . . . . . . . . . . . . . .

Return ifneeded . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Telephonefollowupplanned . . . . . . . . . . . . . . . . . . . . . . .

Referredtootherphysioian . . . . . . . . . . . . . . . . . . . . . . .

Referredto refernngphysician . . . . . . . . . . . . . . . . . . . . .

Admittohospital. . : . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,6s7

15,381

4,477

498

720

493

799

1,320

7.1

64.4

18.7

21

3.0

2.1

3.3

5.5

‘Mean duration of visit wea 14.7 minutes.

2Numbers msy natadd to totals because more than one dispositiar may be reXWUKI per visit
10 Advance Data No. 228 ● March 2, 1993

Technical notes

Sources of data and

sample design

The information presented in this

report is based on data collected by

means of the National Ambulatory

Medical Care Survey (NAMCS) from

h4arch 20, 1989, through December

30, 1990. The target universe of

NAMCS includes office visits made in

the United States by ambulatory

patients to nonfederally employed

physicians who are principally

engaged in office practice but not in

the specialties of anesthesiology,

pathology, or radiology. Telephone

contacts and nonoffice visits are

excluded.

A multistage probability sample

design is used in NAMCS, involving

samples of primary sampling units

(PSU’S), physician practices within

PSU’S, and patient visits within

physician practices. The PSU’S are

counties, groups of counties, county

equivalents (such as parishes or

independent cities), or towns and

townships (for some PSU’S in New

England). A sample of 2,535 nonFederal, office-based physicians was

selected in 1989 and 2,528 nonFederal, office-based physicians were

selected in 1990 from master files

maintained by the American Medical

Association and American

Osteopathic Association. The sample

included 236 general surgeons in 1989

and 230 in 1990 of which 179 were

eligible in 1989 and 160 were eligible

in 1990 for the survey. The physician

response rate for the 1989 NAMCS

was 74 percent; in 1990, it was

75 percent. General surgeons had a

response rate of 77 percent in 1989

and 75 percent in 1990. Sample

physicians were asked to complete

patient records (figure 1) for a

systematic random sample of office

visits occurring during a randomly

assigned l-week reporting period.

Responding physicians completed

38,384 patient records in 1989 and

43,469 in 1990. General surgeons

completed 2,823 patient record forms

in 1989 and 2,897 in 1990.

Characteristics of the physician’s

practice, such as primary specialty

and type of practice, were obtained

from the physicians during an

induction interview. The U.S. Bureau

of the Census, Housing Surveys

Branch, was responsible for the

survey’s data collection. Processing

operations and medical coding were

performed by the National Center for

Health Statistics, Hospital Discharge

and Ambulato~ Care Survey Section,

Research Triangle Park, No~h

Carolina.

Sampling errors

The standard error is primarily

measure of the sampling variability

that occurs by chance when only a

sample, rather than an entire

universe, is surveyed. The relative

standard error of an estimate is

obtained by dividing the standard

a

error by the estimate itsel~ the result

is then expressed as a percent of the

estimate. Approximate relative

standard errors (RSE’S) of selected

aggregate statistics are shown in

table I, and the relative standard

errors of the estimated number of

drug mentions are shown in tabIe II.

All frequencies in this report are

average annual figures and must be

doubled before a significance test can

be performed. Relative standard

errors for aggregate visits and drug

estimates may be calculated using the

following general formula, where x is

the aggregate of interest in

thousands, and A and B are the

appropriate coefficient from table IV.

‘S’(x)=wx 1000

Approximate relative standard errors

for estimates of the percent of visits

are shown in table HI. The RSE’S for

percent may be calculated using the

following general formula, where p is

the percent of interest and x is the

denominator of the percent in

thousands, using the appropriate

coefficient from table IV.

‘s’”=- “000

Table L Relative standard errors for

estimated numbers of office vlslta:

National Ambulatory Medical Care

Survey, 1989-90

Estimated number

of office w“sits All General

in thousands specialties surgeon

100 . . . . . . . . . . . . . .

200 . . . . . . . . . . . . . .

300. . . . . . . . . . . . . .

400 . . . . . . . . . . . . . .

500 . . . . . . . . . . ...4

700 . . . . . . . . . . . . . .

I,ow . . . . . . . . . . . . .

2,000. . . . . . . . . . . . .

5,000. . . . . . . . . . . . .

7,000. . . . . . . . . . . . .

10,000. . . . . . . . . . . .

30,000. . . . . . . . . . . .

50,000. . . . . . . . . . . .

100,000. . . . . . . . . . .

500,000. . . . . . . . . . .

700,000. . . . . . . . . . .

1,400,000. . . . . . . . . .

Relative standard error

(RSE) in percent

72,7 31.1

51.5 23.4

42.1 20.1

36.5 18.3

32.6 17.1

27.6 15.6

23.2 14.4

16.5 12.9

10.7 11.9

9.2 11.7

7.9 11.5

5.2 11.2

4.5 11.2

3.9 11.2

3.3 11.1

3.2 11.1

3.2 . . .

NOTE Otolaryngologist 30 percent RSE - 110,000; all

specialties 30 percent RSE - 593,000.

Exampleof use of tsblw An aggregate estimate of 5 million

vmts to a a general surgeon has a relative standard error of

11.9 percent or a stsndard error of 595,000 VMS

(1 1.9 percant of 5 million).

Table Il. Relative standard errors for

estimated numbers of drug mentions:

National Ambulatory Medical Care

Suwey, 1989-90

Estimated number

of drug mentions .41 General

in thoussnds specialties surgeon

Relative standard error

(RSE) In percent

100 . . . . . . . . ...+.. 90.3 36.1

200 . . . . . . . . . . . . . . 63.9 2!7.0

300 . . . . . . . . . . . . . . 52.3 23.3

400 . . . . . . . . . . . . . . 45.3 21.1.

500 . . . . . . . . . . . . . . 40.6 19.7

700 . . . . . . . . . . . . . . 34.3 18.0

1,000 . . . . . . . . . . . . 26.6 16.6

2,000 . . . . . . . . . . . . . 20.6 14.7

5,000 . . . . . . . . . . . . . 13.4 13.5

7,000 . . . . . . . . . . . . . 11.5 13.3

10,000 . . . . . . . . . . . . 9.9 13.1

30,000 . . . . . . . . . . . . 6.5 12.8

50,000 . . . . . . . . . . . . 5.7 I z.a

100,000 . . . . . . . . . . . 4.9 12.7

500,000 . . . . . . . . . . . 4,2 12.7

700,000 . . . . . . . . . . . 4.1 12.7

1,400 >000 . . . . . . . . . . 4.0 . . .

NOTE Orolaryngolog!st 30 percent RSE = 155,0CKLall

speclafties 30 percent RSE - 922JXXI.

ExampleOfuse Oftable: An aggregate e~tlmate of 2 milhon

drug menhons by a general surgeon has a relabve standard

error of 14.7 percent or a .s03ndsrd error of 294 thousand

drug menbons (14.7 peCent of 2 ITIllllOn).
Advance Data No. 228 ● March 2, 1993 11

Table Ill. Standard errors for percents of estimated numbers of office visits for the National Ambulatory Medical Care Survey:

United States, 1989-90

Estimated percent

Base of percent

(visits in thousands) 1 or 99 5 or 95 10 or 90 20 or 80 30 or 70 50

Standard error in percentage points

100 . . . . . . . . . . . . . . . . . . . . . . . . 2.9 6.3 8.7 11.6 13.3 14.6

200 . . . . . . . . . . . . . . . . . . . . . . . . 2.1 4.5 6.2 8.2 9.4 10.3

500 . . . . . . . . . . . . . . . . . . . . . . . . 1.3 2.8 3.9 5.2 6.0 6.5

700 . . . . . . . . . . . . . . . . . . . . . . . . 1.1 2.4 3.3 4.4 5.0 6.0

1,000 . . . . . . . . . . . . . . . . . . . . . . . 0.9 2.0 2.8 3.7 4.2 4.6

2,000 . . . . . . . . . . . . . . . . . . . . . . . 0.6 1.4 2.0 2.6 3.0 3.3

5,000, . . . . . . . . . . . . . . . . . . . . . 0.4 0.9 1.2 1.7 1.9 2.1

7,000 . . . . . . . . . . . . . . . . . . . . . . . 0.4 0.8 1.0 1.4 1.6 1.7

10,000 . . . . . . . . . . . . . . . . . . . . . . 0.3 0.6 0.9 1.2 1.3 1.5

20,000 . . . . . . . . . . . . . . . . . . . . . . 0.2 0.5 0.6 0.8 1,0 1.0

30,000 . . . . . . . . . . . . . . . . . . . . . . 0.2 0.4 0.5 0.7 0.6 0.8

50,000 . . . . . . . . . . . . . . . . . . . . . . 0.1 0.3 0.4 0.5 0.6 0.7

80,000 . . . . .. . . . . . . . . . . . . . . . . 0.1 0.2 0.3 0.4 0.5 0.5

100,000 . . . . . . . . . . . . . . . . . . . . . 0.1 0.2 0.3 0.4 0.4 0.5

600,000 . . . . . . . . . . . . . . . . . . . . . 0.0 0.1 0.1 0.2 0.2 0.2

1,400,000. . . . . . . . . . . . . . . . . . . . 0.0 0.1 0.1 0.1 0.1 0.1

Example of use of tablw An estimate of 30 percenl based on an aggregate .. est!mate of 10 million visits has a stsrkdard error of 4.2 oarcent or a relatiie stsndsrd error of 14.0 Dercent (4.2 . percent

dtidedby 30 percent).

Adjustments for nonresponse

Estimates from NAMCS data

were adjustedto account for sampIe

physicians who were inscope but did

not participate in the study. This

adjustment was calculated to minimizethe impact of response on final

estimates by imputing tononresponding physicians data from visits to

similar physicians. For this purpose,

physicians werej udgedsimiIar ifthey

had the same specialty designation

and practiced in the same PSU.

Test of significance and

rounding

lnthisreport, the determination

of statistical inference is basedon a

two-sided t-test. The Bonferroni

inequality was used to estimate the

critical value for statistically

significant differences (O.05 levelof

significance). Terms relatingto

differences suchas “higher:’’ ’less:’

and so forth indicate that the

differences are statistically significant.

Terms such as “similar” or “no

difference” mean that no statistical

significance exists between the

estimates being compared. ln the

tables, estimates ofoffice visits have

been rounded to the nearest

thousand. Consequently, estimates

will not always add to totals. Rates

and percents were calculated from

original unrounded figures and do not

necessarily agree with percents

calculated from rounded data.

Definition of terms

Ambulatory patient -An

ambulatory patient is an individual

seeking personal health services who

is not currently admitted to any health

care institution on the premises.

Drug mention –A drug mention is

the physician’s entry of a

pharmaceutical agent –by any route

of administration-for prevention,

diagnosis, or treatment. Generic as

well as brand-name drugs are

included, as are nonprescription and

prescription drugs. Along with all new

drugs, the physician also records

continued medications if the patient

was specifically instructed during the

visit to continue the medication.

Drug visit –A drug visit is a visit

in which medication was prescribed

or provided by the physician.

General surgeon –A general

surgeon is a physician classified as a

specialist in general surgery in the

master fiIes of the AMA or AOA.

Ojjice-Offices are the premises

physicians identi~ as Iocations for their

ambulatory practice; these customarily

include consultation, examination, or

treatment spaces that patients associate

with the particular physician.

Table IV. Coefficients appropriate for

determining relative standard errors, by type

of estimate and physician specialty: National

AmbulatoryMedical Care Survey, 19W-90

TW of estimate CMkient

and

physician spadaHy A B

visits

CNerall totals. . . . . . . 0.00397549 52.77352164

General surgeon . . . . 0.01236777 8.46452955

Drugmenths

Ovemlltote.la . . . . . . . 0.00157151 81.47054833

General surgem . . . . 0.01603&5 11.42C09W4

Pl@cian –A physician is a duIy

licensed doctor of medicine (M.D.) or

doctor of osteopathy (D.O.) who is

currently in office-based practice and

who spends some time caring for

ambulatory patients. Excluded from

NAMCS are physicians who are

hospital-based; who specialize in

anesthesiology, pathology, or radiolo~

who are federalIy employed; who treat

only institutionalized patients or who

are employed fulI time by an institution

and spend no time seeing ambulatory

patients.

Vuit -A visit is a direct personal

exchange between an ambulatory

patient and a physician (or a staff

member working under the

physician’s supervision), for the

purpose of seeking care and

rendering personal health services.
12 Advance Data No. 228 ● March 2, 1993

Suggested citation Copyright information National Center for Health Statistls

Woodwell DA. Office visits to general All material appearing in this report is in the Director

surgeons 1989-90, National Ambulatory public domain and may be reproduced or Manning Feinleib, M. D., Dr. P.H.

Medical Survey. Advance data from vital and

health statistics; no 228. Hyattsville, Maryland:

copied without permission; citation as to

source, however, is appreciated.

Acting Deputy Director

National Center for Health Statistics. 1993. Jack R. Anderson
Number 229 ● March 11, 1993

Advance

Data

From Vitaland Health Statistics of the CENTERS FOR DISE4SE CONTROL AND PREVENTION/National Center for Health Statistics

Long-Stay Patients in Short-Stay Hospitals

by Margaret Jean Hall, Ph. D., and Lola Jean Kozak, Ph. D., Division of Health Care Statistics

Introduction

Patients hospitalized for more

than 3 weeks made up only 5 percent

of discharges from short-stay

hospitaIs in 1980 and 4 percent in

1990. However, in both years these

long-stay patients used more than a

quarter of the days of care in

short-stay hospitals. The large share

of days used by long-stay patients

make them an important group

for analysis. This report examines

the characteristics of long-stay

patients and compares them with

characteristics of all discharges from

short-stay hospitals in 19S0 and 1990.

The period 1980-90 was chosen

for analysis because it was a decade

of marked change in the health care

system. Concern about rising health

care costs led to several developments

that were intended to reduce hospital

use. In 1983, the method of payment

for hospitalized Medicare patients

was fundamentally changed with the

implementation of a prospective

payment system based on diagnosisreIated groups (DRG’s). A rapidly

growing number of surgical and

diagnostic procedures were shifted

from inpatient to outpatient settings

during the 1980’s. Health

maintenance organizations and

preferred-provider organizations

expanded during the period, and the

number and stringency of utilization

review programs increased (1–3).

Short-term hospital use declined

during the 1980’s. The total number

of discharges was 19 percent lower,

and the number of days of care was

reduced 28 percent in 1990 compared

with 1980. The number of discharges

and days of care declined for patients

with hospital stays of 3 weeks or less

and for those with stays of more than

3 weeks.

However, despite the pressures to

reduce hospital use, long-stay patients

hospitalized for more than 3 weeks

continued to account for the same

disproportionately large share of

hospital days in 1990 as they did in

1980. The extent to which the

characteristics of long-stay or all

patients changed during the 1980’s

will be examined in this report.

The data were collected by means

of the National Hospital Discharge

Survey (NHDS), a continuous

voluntary survey conducted by the

National Center for Health Statistics

since 1965. It is comprised of

information on patients discharged

from non-Federal short-stay hospitals.

In 1980, data for the survey were

abstracted from medical records of

approximately 224,000 patients

discharged from 420 hospitals. In

1990, 474 hospitals participated in the

survey supplying approximately

266,000 abstracts of medical records.

A hvo-stage, stratified sample

design was used for the NHDS during

the period 1965-87. A three-stage,

stratified sample design began in

1988. A brief description of these two

designs, data collection procedures,

and the estimation process are in the

“Technical notes” of this report. A

description of the two sumey desi~ns

and the effects of the design changes

on estimates from the survey has

been published (4).

Up to seven diagnoses and four

procedures were coded for each

discharge in the survey. Coding of

diagnoses and procedures was

performed according to the

International Classification of Diseases,

Acknowledgments I

This report WaS prepared at the Division of Health Care Statistics. Maria Owings, Hospital Care Statistics Branch, calculated relative

standard errors for estimates, and Dorothy Graham, Technical Scsvices Branch, verified the data. The report was edited by Klaudia Cox

and typeset by Zung T.N. Lc of the Publications Branch, Division of Data Scrviccs.

5WICCS ~ #

&●+

%

#

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

~+ Public Health Service

s

. Centers for Disease Control and Prevention b%+h-%a >

National Center for Health Statistics CSNTSRS CDC FOR DISSASE CONTROL

ANO PRWENTZW
2 Advance Data No. 229 ● March 11, 1993

9dl Re~ision, Clinical Modification

(ICD-9-CM) (5). Although diagnoses

included in the ICD–9–CM section,

“Supplementary classification of

external causes of injury and

poisoning” (codes E800-E999), are

used in the NHDS, they are excluded

from this report.

To interpret data and compare

them with available data from other

sources on short-stay hospital use,

one must become familiar with the

definitions used in NHDS. Definitions

of the terms in this report are in the

“Technical notes.”

Highlights

More than 50 percent of long-stay

patients were diagnosed with

diseases of the circulato~ system,

mental disorders, neoplasms,

injury, or poisoning.

Hospitalizations for septicemia,

psychoses, and miscellaneous

complications of surgical and

medical care were more frequent

in 1990 than in 1980 for all

patients and long-stay patients.

Long-stay patients were more

likely to have diagnoses such as

septicemia, malignant neoplasms,

psychoses, cerebrovascular disease,

and fractures than were all

patients.

The rate of procedures per 1,000

discharges was 50 percent higher

for long-stay patients than for all

patients; the rates in 1990 were

higher than the rates in 1980 for

both groups.

The majority of long-stay patients

had Medicare as their expected

principal source of payment in

1980 and 1990. Medicaid covered a

larger share and private insurance

covered a smaller share of

long-stay and all discharges in

1990 than in 1980.

The proportion of discharges

transferred to other health care

facilities was higher in 1990 than

in 1981 for both long-stay and all

patients. Long-stay patients were

more likely to be transferred or

discharged dead than were all

patients.

Table 1. Number of discharges, days of care, and average lengths of stay for patients

discharged from short-stay hospitals, by length of stay category: United States,

1980 and 1990

Length-of-stay category and measure of hospita/ use 1980 1990

All patients

Number of discharges in thousands. . . . . . . . . . . . . . .

Number of days of care in thousands. . . . . . . . . . . . ,

Average length ofstayln days.... . . . . . . . . . . . . . .

Short-stay patients’

Number of discharges in thousands. . . . . , . . . . ,

Number of days of care m thousands . . . . . . .

Average length ofstay in days.. . . . . . . . . . . . . . . . .

Long-stay patientsz

Number of discharges in thousands. . . . . . . . . . . . . . .

Number of days of care in thousands . . . . . . . . . . . . .

Average length ofstaym days... . . . . . . . . . . . . . . .

37,832

274,508

7.3

35,897

202,317

5.6

1,935

72,191

37.3

30,788

197,422

8.4

29,486

146,999

5.0

1,302

50,423

38.7

‘Shors-s!aypat!entshadlengthsofstayof 3 weaksorless.

‘Long-staypatientshadlengthsof slay of more than3 weeks.

Trends

The number of discharges was

lower in 1990 than in 1980 (table 1).

The total number of discharges

decreased 19 percent from 37.8

million in 1980 to 30.8 million in

1990. Discharges for patients

hospitalized 3 weeks or less dropped

18 percent; discharges for long-stay

patients hospitalized more than 3

weeks decreased by almost a third,

declining from 1.9 million in 1980 to

1.3 million in 1990.

Large decreases in numbers of

days of care also occurred during this

period. The number of days of care

for all patients declined 28 percent

from 274.5 million in 1980 to 197.4

million in 1990. Patients with stays of

3 weeks or less had a 27 percent

decrease in the number of days of

care during the period, and long-stay

patients had a 30 percent decrease

from 72.2 million days of care in 1980

to 50.4 million days in 1990.

The average length of stay for all

patients decreased from 7.3 days in

1980 to 6.4 days in 1990 and the

length of stay for short-stay patients

declined from 5.6 days in 1980 to 5.0

days in 1990. The average stay for

long-stay patients did not change

significantly: 37.3 days in 1980 and

38.7 days in 1990.

The objective of this report is to

compare characteristics of long-stay

patients to all patients. Therefore no

additional data are presented for

short-stay patients. Because shlort-stay

patients comprise such a large

percentage of all patients (95-

96 percent), the data for all and

short-stay patients are very similar.

Age and sex

Over time, the distribution of

discharges and days of care by sex has

been stable. Among long-stay

patients, 54 percent of discharges

were female and they used 54 percent

of long-stay days of care in both 1980

and 1990 (tabIe 2). Females made up

60 percent of total discharges and

57-58 percent of total days of care in

1980 and 1990. However, if

hospitalizations for deliveries are

excluded, the distributions of

discharges and days of care by sex are

almost the same for long-stay and all

patients. For example, in 1990

females made up 54 percent of total

discharges and days of care, excluding

deliveries.

In 1980 and 1990, approximately

half of long-stay discharges and days

of care were for patients 65 years of

age and over. The elderly made up

smaller proportions of total

discharges and days of care in both

years, but the proportions increased

over time, In 1980, the elderly

accounted for only 26 percent of total

discharges and 38 percent of totaI

days of care. By 1990, they were
Advance Data No. 229 ● March 11,1993 3

Table‘z.Number and percent distribution of discharges and days of care for patients discharged from short-stay hospitals, by sex and

age of patient, according to length-of-stay category: United States, 1980 and 1990

[Dischargesfrom non-Federalhospitals.Excludesnewborn infants]

A// patients Long-stay patients’ A// patients Longstsy patients’

Sex or age 1980 1990 1980 1990 1980 1990 1980 1990

Number of discharges in thousands Percent distribution of discharges

Total . . . . . . . . . . . . . . . . . 37,832 30,788 1,935 1,302 100.0 100.0 100.0 100.0

Male . . . . . . . . . . . . . . . . . 15,145 12,280 887 603 40.0 39.9 45.8 46.3

Female . . . . . . . . . . . . . . . . 22,686 18,508 1.048 699 60.0 60.1 54.2 53.7

Under 15years . . . . . . . . . . . 3,672 2,412 72 74 9.7 7.8 3.7 5.7

15+4years . . . . . . . . . . . . . 15,635 11,799 383 309 41.3 38.3 19.8 23.7

45-64years . . . . . . . . . . . . . 8,660 6,244 494 273 22.9 20.3 25.5 21.0

65yearsand over . . . . . . . . . 9,864 10,333 986 646 26.1 33.6 50.9 49.6

Number of days of care in thousands Percent distribution of days of care

Total . . . . . . . . . . . . . . . . . 274,508 197,422 72,191 50,423 100.0 100.0 100.0 100.0

Male . . . . . . . . . . . . . . . . . 116,267 85,067 32,996 23,438 42.4 43.1 45.7 46.5

Female . . . . . . . . . . . . . . . . 158,241 112,355 39,196 26,985 57.6 56.9 54.3 53.5

Under 15years . . . . . . . . . . . 16,191 11,655 3,029 3,337 5.9 5.9 4.2 6.6

15-44years . . . . . . . . . . . . . 81,951 54,062 14,743 11,805 29,9 27.4 20.4 23.4

45-64years . . . . . . . . . . . . . 71,008 42,153 18,287 10,575 25.9 21.4 25.3 21.0

65yearsand over . . . . . . . . . 105,358 89,552 36,133 24,707 38.4 45.4 50.1 49.0

‘Longstay patients had lengths of stay of more than 3 weeks.

34 percent ofdischarges and used

45 percent ofdays ofcare.

Patients 45–64years of age made

up approximately the same

proportion oflong,-stay and total

discharges in1980 and1990. The

proportion ofdischarges and daysof

care in this age category decreased

for both long-stay and all patients

from 1980 to 1990. When compared

with aI1patients, Iong-stay patients

under 45 years of age were

underrepresented. The proportion of

long-stay discharges and days of care

for patients under 45 years of age

were higher in 1990 than in 19S0,

although the share of total discharges

for this age group decreased during

the period.

Source of payment

In 19S0 and 1990, the majority of

long-stay discharges and days of care

were for patients with Medicare as

the expected principal source of

payment (table 3), which was

consistent with the majority being 65

years of age and over. The proportion

of discharges and days of care

covered by Medicare were not

significantly different in 1980 and

1990 for long-stay patients, although

the number of Medicare discharges

and days of care decreased for these

patients. For all patients, the

proportion of Medicare discharges

and days of care increased during

that period. The number of

discharges did not change

significantly, and number of days of

care decreased for all Medicare

patients.

The private insurance category

comprised all heaIth insurance

provided by nongovernmental sources,

including Blue Cross, other insurance

companies, private industry, and

philanthropic organizations. In 1980

and 1990, long-stay patients were less

likely to be covered by private

insurance than all patients, and the

number and proportion of discharges

and days of care covered by private

insurance have been decreasing for

long-stay and all patients. In 19S0,

private insurance was the payment

source for more than half of all

discharges but less than a third of

long-stay discharges. In 1990, only

39 percent of all discharges and

24 percent of long-stay discharges

\vere in the private insurance

category.

In contrast, the proportion of

discharges and days of care for

patients with Medicaid as their

expected principal source of payment

were higher in 1990 than in 1980 for

long-stay and all patients, although

the number of Medicaid discharges

and days of care did not change

significantly. Medicaid was the

expected source of payment for

7 percent of long-stay discharges and

days of care in 19S0and increased to

11-12 percent in 1990.

The self-pay category, where

payment for hospitalization was

expected from the patient, spouse,

famiIy, or next of kin, made up

5–6 percent of discharges and days of

care for long-stay and all patients in

1990. Neither the number nor the

proportion of discharges or days of

care in the self-pay category were

significantly different in 1980 and

1990.

These trend data show that

private insurers were the leaders in

reducing hospital use of long-stay and
4 Advance Data No. 229 ● March 11,1993

Table 3. Numberand percent distribution of discharges and days of care for patients discharged from short-stay hosptials, by expected

principal source of payment, according to length-of-stay category: United States, 1980 and 1990

[Discharges from non-Federal hospitals. Excludes newborn infants]

A// pat)ents Longstay patients’ A// patients Long-stay patients’

Source of payment 1980 1990 1980 1990 1980 1990 1980 18s0

All sources . . . . . . . . . . . . . . . .

Private msurarrce. . . . . . . . . . .

Me[jlcare. ,,, , . . . . . . . . . . .

Medicaid, . . . . . . . . . . . . . .

Self-pay . . . . . . . . . . .

O!hersources, . . . . . . . . . . . . . .

Notstated2, . . . . . . . . . . . . . .

All sources, . .,, .,.....,. . .

Private insurance, . . . . . . . . . . . .

Medicare. . . . . . . . . . . . . . . . . .

Medicaid. . . . . . . . . . . . . . . . . .

Self-pay . . . . . . . . . . . . . . . . . .

CXhersources. . . . . . . . . . . . . . .

Notstated2 . . . . . . . . . . . . . . . .

Number of discharges in thousands

37,832 30,788 1,935 1,302

19.597 11,926 607 310

10,766 10,625 1,049 691

3,374 3,582 134 140

2,057 1,788 73 63

2,037 1,875 72 64

992 34

Number of daya of care in thousands

274,508 197,422 72,191 60,423

114,947 58,531 22,625 11,708

113,583 92,353 38,500 25,980

21,531 20,860 5,150 6,276

11,447 9,743 2,906 2,599

13,000 10.283 3,010 2,672

5,652 1,188

Percent distribution of discharges

100.0 100.0 100.0 100.0

51.8 38.7 31.4 23.8

28.5 34.5 54.2 63.1

8.9 11.6 6.9 10.8

5.4 5.8 3.s 4.s

5.4 6.1 3.7 4.9

3.2 2.6

Percent distribution of days of care

100.0 100.0 100.0 100.0

41.9 29.6 31.3 23.2

41,4 46.8 53.3 51.5

7.8 10.6 7’.1 12.4

4.2 4.9 4.0 5.2

4.7 5.2 4.2 5.3

2.9 2,4

‘Long.s!ay patwmtshad lenglhs ofstayof more than 3 weeks,

21n1980asource ofpayment Wtmputed forpat,enls whodldnot lnd!ca!e one.

all patients. One reason may have

been that persons with private

insurance were generally youngeror

healthier than populations coveredby

Medicare or Medicaid. Medicare

covers the aged, disabled, and those

afflicted with end-stage renal disease.

In 1990, three-fourths of Medicaid

benefits were for disabled, aged, and

blind persons (6). Thus, hospital stays

for the privately-insured population

could have been shortened with less

riskto patients’ health, and they

would have been Iikely candidates for

treatment in outpatient settings.

Disposition

Changes overtime in the

dispositions of long-stay patients and

all patients are shown in table4. Data

for 1981 rather than 1980 are usedin

tab1e4 because the disposition

categories for the NHDS were the

same in 1981 and 1990. In 1980 and

earlier years, data were collected for

different disposition categories.

Most patients leave short-stay

hospitals as routine discharges.

However, long-stay patients were less

likely to be routine discharges than

all patients, and the proportion of

long-stay discharges in this category

decreased over time. In 1981,

67 percent of long-stay discharges

were classified as routine, but only

59 percent were in this category in

1990. For all patients, the proportion

of routine discharges was not

significantly different in 1981 and

1990.

The proportion of long-stay and

all patients transferred to other

institutions increased over time. In

1981, 14 percent of the Iongstay

discharges were transferred to

another facility or institution

compared with 20 percent in 1990.

For all discharges, 4 percent were

transferred to other facilities in 1981

compared with 8 percent in 1990. In

both years, more than three-quarters

of the transfers of long-stay patients

were to long-term care institutions

and two-thirds of all transfers were in

this category.

The increase in transfers may

indicate that hospitalized patients

were more seriously il[ in 1990 than in

1981, which is consistent with the

findings of other studies (1,7,8). Prior

research has also found that to

reduce lengths of stay, hospitals have

discharged patients in less stable

condition in recent years. Hence,

patients are now more likely to

require further care (l).

A larger proportion of long-stay

patients than all patients were

discharged dead in 1981 and 1S190.

However, the proportion discha~rged

dead in 1981 was not significantly

different than in 1990 for either

group. For long-stay patients,

10-11 percent were discharged dead

compared with 3percent of all

patients. If the severi~ of illness for

hospitalized patients has increased,

the proportion discharged dead would

be expected to grow, However, there

is evidence that an increase in the

severity of illness was combined with

an increased tendency for hospitals to

discharge terminally ill patients

before their deaths (l). Deaths in

short-stay hospitals made up

50 percent of all deaths in 1981, but

decreased to 41 percent of ail, deaths

in 1990 (9,10).

Region

The distribution of discharges

and days of care, by region, for

long-stay and all patients is shown in
Advance Data No. 229 ● March 11, 1993 5

Table 4. Number and percent distribution of discharges and days of care for patients discharged from short-stay hospitals, by

disposition, according to Iength-crf-stay category United States, 1981 and 1990

[Discharges from non-Federal hospitals. Excludes newborn infants]

Af/ patients Long-stay patlen?s’ A// patients Long-stay patfente’

Disposition f981 1990 1981 1990 1981 1990 1981 1990

Number of discharges in thousands Percent distribution of discharges

Alldisposifions . . . . . . . . . . . . . . . . . . 38.544 30,788 1,976 1,302 100.0 100.0 100.0 100.0

Routine discharge . . . . . . . . . . . . . . . . 31,879 25,713 1,327 764 82.7 83.5 67.2 58.7

Transfer to another short-term hospital . . . 539 805 49 58 1.4 2.6 2.5 4.4

Transfer to long-term care institution. . . . . 1,038 1,612 220 198 2.7 5.2 11.2 15.2

Other live discharges . . . . . . . . . . . . . . 3,449 1,284 157 116 8.9 4.1 8.0 8.9

Dead . . . . . . . . . . . . . . . . . . . . . . . . 982 877 193 137 2.5 2.8 9.8 10.5

Notstated . . . . . . . . . . . . . . . . . . . . . 657 498 28 29 1.7 1.6 1.5 2.2

Number of days of care in thousands Percent distribution of days of care

Alldispositions . . . . . . . . . . . . . . . . . . 277,230 197,422 72,560 50,423 100.0 lCO.O 100.0 100.0

Routine discharge . . . . . . . . . . . . . . . . 214,319 143,498 46,670 27,856 77.3 72.7 64.3 55.2

Transfer toanother short-term hospifel . . . 4,604 6,932 1,877 2,625 1.6 3.5 2.6 5.2

Transfer to long-term care instkution. . . . . 17,105 20,628 9,063 8,400 6.2 10.4 12.5 16.7

Other livedischarges . . . . . . . . . . . . . . 23,359 11,906 5,791 4,360 8.4 6.0 8.0 8.6

Dead. . . . . . . . . . . . . . . . . . . . . . . . 13,166 10,871 7,993 6,073 4.7 5.5 11.0 12.0

Notstated . . . . . . . . . . . . . . . . . . . . . 4,677 3,586 1,185 1,109 1.7 1.8 1.6 2.2

‘Longslay patian!shad lengthsof slay of more!han 3 weeks.

Table 5. Number snd percent distribution of discharges and days of care for patients from short-stay hospitals, by region, according to

length-of-stay category United States, 1980 and 1990

[Discharges from non-Federal hospitals. Excludes newborn infants]

A// pafierrfs Lorrg-stay patients’ Af/ patients Long-stay patients’

Region 1980 1990 1980 1980 1980 1890 1980 1S?0

Number of discharges in thousands Percent distribution of discharges

All regions . . . . . . . . . . . . . . 37,832 30,788 1,935 1,302 100.0 100.0 100.0 100.0

Northeast . . . . . . . . . . . . . . 7,866 6,895 577 426 20.8 22.4 29.8 32.7

Midwest . . . . . . . . . . . . . . . 70,678 7,620 615 302 28.8 24.8 31.8 23.2

South . . . . . . . . . . . . . . . . . 12,983 11.173 523 4G3 34.3 36.3 27.0 30.9

West . . . . . . . . . . . . . . . . . 6,103 5,100 220 171 16.1 16.6 11.4 13.1

Number of daya of care in thousands Percent distribution of days of care

All regions . . . . . . . . . . . . . . 274,506 197,422 72,191 50.423 100.0 100.0 100.0 100.0

Northeast . . . . . . . . . . . . . . 67,238 52,823 22.694 17,858 24.5 26.8 31.4 35.4

Midwest . . . . . . . . . . . . . . . 62.000 4S,698 22,070 10.702 29.9 24.7 30.6 21.2

South . . . . . . . . . . . . . . . . . 68,216 67,810 18,778 15,CE3 32.1 34.3 26.0 29.9

West . . . . . . . . . . . . . . . . . 37,054 28,091 8,649 6.779 13.5 14.2 12.0 13.4

‘Long-staypatientshad lengthsof stayof more than3 weeks.

table 5. The Northeast Region had

larger proportions of discharges and

days of care for long-stay patients

than for all patients in 1980 and 1990.

In 1990, 33 percent of the discharges

for long-stay patients were in the

Northeast as compared with

22 percent of aIl discharges;

35 percent of long-stay days of care

were also in the Northeast, but only

27 percent of all days of care were in

this region.

The Midwest Region was notable

for sizeable decreases in its

proportions of long-stay discharges

and days of care. In 1980, 32percent

of the discharges and31 percent of

the days of care forlong-stay patients

were in the Midwest. However, in

1990 the Midwest had on!y 23 percent

of long-stay discharges and 21 percent

of long-stay days. Although the total

discharges and days of care also

decreased in the Midwest during this

period, the proportion of discharges

and days of care were smaller in the

Midwest for long-stay patients than

for all patients in 1990.

The proportions of discharges

and days of care in the South Region
6 Advance Data No. 229 ● March 11, 1993

were smaller for long-stay patients

than for all patients in both 1980 and

1990. In 1990, for example, 36 percent

of all discharges, but only 31 percent

of long-stay discharges, were in the

South. The West, like the South, had

proportionately fewer discharges for

long-stay patients than for all

patients. The West accounted for

11-13 percent of long-stay discharges

as compared with 16-17 percent of all

discharges.

Diagnoses

Four of the diagnostic chapters in

the International Classification of

Diseases (5) accounted for 62 percent

of discharges of long-stay patients in

1980 and 58 percent in 1990 (table 6).

These chapters encompass diseases of

the circulatory system, mental

disorders, neoplasms, and injury and

poisoning. They accounted for only

34 percent of the discharges of all

patients in 1980 and 37 percent in

1990.

The proportion of long-stay

patients with diseases of the

circulato~ system decreased from

22 percent in 1980 to 19 percent in

1990, but was larger in both years

than the proportion of all patients

with circulatory diseases (14 percent

in 1980 and 17 percent in 1990).

Heart disease was the diagnosis for a

larger proportion of long-stay patients

than for all patients in 1980, but in

1990, the proportions were not

significantly different for these two

groups. In 1980 and 1990, long-stay

patients were more likely to have

diagnoses of cerebrovascular disease

and diseases of arteries, arterioles,

and capillaries than all patients. The

number and proportion of discharges

for ischemic heart disease, other than

acute myocardial infarction, were

lower in 1990 than in 1980 for

long-stay patients.

Mental disorders increased from

13 percent of long-stay diagnoses in

1980 to 19 percent in 1990. For all

patients, mental disorders accounted

for approximately 5 percent of

discharges in both years. Psychoses

was a major and dramatically

increasing diagnostic catego~ for

long-stay patients, making up

5 percent of long-stay discharges in

1980 and 12 percent in 1990. The

proportion of all patients with

diagnoses of psychoses also increased

from 1 to 3 percent. The number and

proportion of long-stay and all

discharges for neurotic and

personality disorders were lower in

1990 than in 1980.

,Neoplasms made up 15 percent of

long-stay discharges in 1980, but

decreased to 11 percent in 1990. Most

of these hospitalizations were for

treatment of malignant neoplasms,

which accounted for 14 percent of the

long-stay discharges in 1980, but

declined to 11 percent in 1990.

Among all patients, those with

neoplasms were 6–7 percent of

discharges and those with malignant

neoplasms were approximately

5 percent of discharges in 1980 and

1990. The number and proportion of

discharges with the diagnosis of

malignant neoplasm of trachea,

bronchus, and lung were lower in 1990

than in 1980 for long-stay patients, but

did not change significantly for all

patients during this period.

Injury and poisoning was the

diagnostic category for 12 percent of

long-stay discharges in 1980 and

10 percent in 1990. For all patients,

the injury and poisoning category

accounted for 10 percent of

discharges in 1980 and 9 percent in

1990. In 1980 and 1990, a larger

proportion of long-stay patients than

of all patients had fractures, including

fractures of the neck of the femur

(hip fractures). However, the number

and proportion of all fractures and

hip fractures were lower in 1990 than

in 1980for long-stay patients. For all

patients, the number and proportion

did not change significantly for all

fractures, but increased for hip

fractures. For long-stay and all

patients, the number and proportion

of discharges classified as

miscellaneous complications of

surgical and medical care were higher

in 1990 than in 1980.

Increases in long-stay discharges

were also found for other diagnostic

categories. For infectious and

parasitic diseases, in particular

septicemia, the number and

proportion of long-stay discharges in

1990 were two to four times those in

1980. By 1990, septicemia accounted

for half of the long-stay discharges in

the infectious and parasitic disease

category. The 1990 number and

proportion of all discharges with

septicemia were also more than three

times those in 1980.

In 1990,the number of Iong-stay

discharges assigned to the

supplementary classifications doubIed,

and the proportion more than tripled

what they had been in 1980. Within

this category, care involving use of

rehabilitation procedures was rarely

reported as a diagnosis in 1980, but in

1990, it accounted for more than half

of the long-stay discharges in thle

supplementary classification.

The proportion of long-stay

discharges for diseases of the

respiratory system increased from

6 percent in 1980 to 9 percent in

1990, although the numbers did not

change significantly. Pneumonia

increased from 2 to 4 percent of

long-stay discharges during this

period. Both the number and

proportion of all discharges for

pneumonia were higher in 1990 than

in 1980.

NotabIe decreases were seen in

discharges for other diagnostic

categories. The number and

proportion of discharges for diseases

of the musculoskeIetal system and

connective tissue were lower in 11990

than in 1980 for long-stay and all

patients. For long-stay patients, the

number of discharges for

arthropathies and related disorders

decreased by two-thirds, and the

proportion dropped 50 percent chrring

this period. Neither the number nor

the proportion of all discharges jfor

these disorders changed significantly.

Diabetes mellitus was a less common

diagnosis in 1990 than in 1980. The

number and proportion of discharges

with diabetes mellitus declined for

long-stay patients and all patients.

The number and percent

distribution of days of care for

long-stay and all patients are shown

by diagnostic categories in table ‘7.

The pattern and trend in days of care
Advance Data No. 229 ● March 11,1993 7

Table 6. Number and percent distribution of discharges from short-stay hospitals, by selected categories of first-listed diagnoses,

according to length-of-stay category United States, 1980 and 1990

[Discharges from non-Federal hospitals. Excludes newborn infants. Diagnostic groupings and code numbers are based on the International C/assir7catiorr of Diseases,

9fh Revision, C/krica/ Modification (ICD-8-CM)]

All patients Long-stay patients’ A// patients Long-stay patients’

First-listed diagnosis and ICD-9-GM code 1980 1990 1980 1990 1980 7990 1980 1990

Number of discharges in thousands Percent distribution of discharges

All conditions . . . . . . . . . . . . . . . . . . . . . . . . .

Infectious and parasitic diseases. . . . .001–139

Septicemia . . . . . . . . . . . . . . . . . . . . ...038

Neoplasm . . . . . . . . . . . . . . . . . . ...140-239

Malignant neoplasms. . . . . . . . 14C-208,23@234

Malignant neoplasm of large intestine and

rectum. . . . . . . . . . . . . . . . . 153-154.197.5

Malignant neoplasm of other digestive organs

and peritoneum. . . . . . . .150-152,155-159.

197.4,197 .6–197.8

Malignant neoplasm of trachea, bronchus

and lung . . . . . . . . . . . . . . 162.197.0,197.3

Endocrine, nutritional and metabolic diseases,

endimmuni~ disorders. . . . . . . . . . . . .240-279

Diabetes mellitus . . . . . . . . . . . . . . . . . ..25o

Mental disorders . . . . . . . . . . . . . . . ...290-319

Psychoses . . . . . . . . . . . . . . . . . . ..290-299

Nehrotic andpersonality disordera . . ..300-301

Alcohol dependence syndrome . . . . . . . ...303

Diseases of the nervous system and sense

organs . . . . . . . . . . . . . . . . . . . . ...320-389

Oisorders of the central nervous

system . . . . . . . . . . . . . . ..32O-336i34O-349

Diseases oflhe circulatory system. . . . ...390-459

Heart disease . . . . . . . . .391 -392,393-398,402,

404,41 0+1 6,420+29

Acute myocardial infarction. . . . . . . ..410

Other ischemic heart disease . . . . . . .411+14

Congestwe heart failure. . . . . . . . . . . ..428.0

Cerebrovascular disease . . . . . . . . ...430-438

Diseases of arteries, arterioles, and

capillaries . . . . . . . . . . . . . . . . . ...440-448

Oiseases of the respiratory system. . . . . .460-519

Pneumonia . . . . . . . . . . . . . . . . . ...460-486

Diseaees of the digestive system. . . . . ...520-579

Diseases of thegenitourinary system . . ...580-829

Diseases of the skin and subcutaneous

tissue . . . . . . . . . . . . . . . . . . . . . ...680-709

Diseases of the muscuioskeletal system and

connective tissue. . . . . . . . . . . . . . . . .710-739

Arthropathies and related disorders. . ...710-719

Disorders of bone and cartilage . . . . ...730-733

Injury and poisoning. . . . . . . . . . . . . ...800-999

Fractures, all sites. . . . . . . . . . . . . ...800-829

Fracture ofneck of femur. . . . . . . . . . ...820

Miscellaneous complications of surgical and

medical care . . . . . . . . . . . . . . . . ..99G999

Supplementary classifications. . . . . . . . . .VO1-V82

Care involving use of rehabilitation

procedures . . . . . . . . . . . . . . . . . . . . ..V57

Another conditiona . . . . 280-289,630-676,740-799

37.832

649

59

2,476

1,829

200

143

277

1,145

645

1,692

507

330

439

1,762

408

5,140

3,201

431

1,355

401

796

306

3,445

782

4,650

3,599

597

2,245

543

288

3,593

1,183

210

252

4,421

*

2,417

30,788

737

216

1,965

1,571

175

154

231

1,089

420

1,538

812

128

239

770

342

5,161

3,556

675

1,280

701

812

287

2,966

1,052

3,239

2,175

462

1,592

479

196

2,774

1,017

281

517

4,507

63

1,814

1,935

26

10

285

267

45

31

46

82

54

246

105

34

56

58

45

423

231

50

75

34

110

47

112

35

165

62

42

122

43

32

240

148

64

19

20

●

50

1,302

58

29

143

137

26

21

16

48

21

244

155

11

36

34

29

240

137

36

26

30

69

21

114

51

92

33

27

44

14

17

132

60

26

33

47

26

46

100.0

1.7

0.2

6.5

4.8

0.5

0.4

0.7

3.0

1.7

4.5

1.3

0.9

1.2

4.7

1.1

13.6

8.5

1.1

3.6

1.1

2.1

0.8

9.1

2.1

12.3

9.5

1.6

5.9

1.4

0.6

9.5

3.1

0.6

0.7

11.7

*

8.4

100.0

2.4

0.7

6.4

5.1

0.6

0.5

0.8

3.5

1.4

5.0

2.6

0.4

0.8

2.5

1.1

16.8

11.6

2.2

4.2

2.3

2.6

0.9

9.6

3.4

10.5

7.1

1.5

5.2

1.6

0.6

9.0

3.3

0.9

1.7

14.6

0.2

5.9

100.0

1.4

0.5

14.7

13.8

2.3

1.6

2.4

4.2

2.8

12.7

5.4

1.8

2.9

3.0

2.3

21.9

11.9

2.6

3.9

1.8

5.7

2.4

5.6

?.6

8.5

3.2

2.1

6.3

2.2

1.7

12.4

7.7

3.3

1.0

1.1

●

2.6

I 00.0

4.5

2.2

11.0

10.5

2.0

1.6

1.3

3.7

1.6

18.7

11,9

0.8

2.8

2.6

2.2

18.5

10.5

2.8

2.0

2.3

5.3

1.6

a.8

3.9

7.1

2.5

2.1

3.4

1.1

1.3

10.1

4.6

2.0

2.5

3.6

2.0

3.5

‘Long-stay patien!s had lengths ofstayof more than 3 weeks.
Advance Data No. 229 ● March 11, 1993

Table 7. Number and percent distribution of days of care for patients discharged from short-stay hospitals, by selected categories of

first-listed diagnoses, according to length-of-stay category: United States, 1980 and 1990

[Discharges from non-Federal hosp!tals Excludes newborn infants Dlagnostlc groupings and code numbers are baaed on the /rrtemationa/ C/assificafion of Diseases,

9f)r Revhon, C/hIca/ ?dodfficwon (ICD-9-CM)]

A// pat(ents Long-stay pat)ents’ A// patients Long-stay patients’

Firet-hsfed dlagnosm and /CD-9-CA4 code 1980 1990 1980 7%’0 1980 1990 1980 1990

Allcondit!ons, ,,, ,,, ,, ...,, ...,,,,

Infectious and parasitic diseases ,001-139

SetX!cemla . . . . . . . .038

Neoplasms 140-239

Mahgnant neoplasms. . ,140-208,230-234

Mahgnant neoplasm of large mtestme

and rectum. 153-154,197.5

Mahgnan: neoplasm of other d!gestlve organs

and peritoneum 150-152,

155-159,197 .4,’197.6-197 8

Mahgnant neoplasm of trachea, bronchus

and lung . 162,197.0,197,3

Endocrine, nutrllonal and metabohc diseases,

and immurvty disorders .240-279

Diabetes mellltus ..,...... , . . . . ...250

Mental d!sorders . . . , .290-319

Psychoses . . . . . . . . . . . ...290-299

Neurotic and personality d!sorders .300-301

Alcohol dependence syndrome , . . . ...303

D!seases of the nervous system and sense

organs, . . . . . . . . . . . . ...,,,.320-389

Dtsorders of the central nervous

system. . . . ,320-336,340-349

Diseases of the circulatory system . .390-459

Heart disease . . 391-392.0.393-398,

402.404,410416,420-429

Acute myocardlal infarction ,410

Other ischem!c heart dtsease . . .411-414

Congestwe heart failure. . . . 4280

Cerebrovascular disease . .430-438

Diseases of arteries, arterioles, and

capillaries . . . . . . . . . . . . . .,. .. ,440+48

Dcsaaaes of the respiratory system. . . .460-519

Pneumonia . . . . . . . . . . . . . . ...460-486

Diseases of the dlgestwe system . . ..520-579

Diseases of the gemtourinary system .580-629

Diseases of the skm and subcutaneous

tissue . . . . . . . . . . . . . . . . . . . . . ..680-709

Diseases of the musculoskeletal system

and connective tissue . . . . .710-739

Arthropathtes and related d!sorders .710-719

D!sorders of bone and carhlage ,730–733

Injurj and polsomng. . . . .800-999

Fractures, all s!tes. . .800-829

Fracture of neck of femur. . . . . .820

Miscellaneous comphcations of surgical and

medical care........,.. . . . . ..99 E-999

Supplementary classifications. . VO1-V82

Care mvolvmg use of rehabihtatton

procedures . . . . . . . . . . . . . . . . . . ..V57

All other conditions 280-289,630-676,740-799

Number of days of care in thousands Percent distribution of days of care

274.508

4,509

849

26004

22,009

3,143

2,251

3,56t

10,972

6,754

19,578

7,480

3,362

4,424

9.597

4,372

51,431

30,500

5,432

11,702

4,154

10,114

4,127

21,649

6.497

32,342

20,068

4,803

18,679

5,090

3,122

27,640

12,563

4,333

2,144

16,337

.

10,900

197,422

6,725

2,058

16,771

14,693

2,402

1,876

1,961

7,610

3,295

18,824

11,861

1,121

2,366

4,268

2,955

37,899

24,557

5,674

6,896

5,604

7,727

2,550

20,433

8,744

19,197

10,989

3,670

10,222

3,752

1,871

18,891

8,435

3,610

4,296

14,212

1,413

7,709

72,191

1,150

436

10,525

9,848

1,515

1,182

1,683

3,124

2,061

9,299

4,068

1,324

1,808

2,326

1,906

15,602

7,819

1,496

2,621

1,155

4,649

1,880

3,842

1,236

5,818

2,159

1,717

4,208

1,501

1,203

9,711

5,800

2,371

750

776

●

1,935

50,423

2.714

1,273

5,737

5,327

961

826

561

1.854

891

8,589

5.720

405

1,034

1,381

1,212

8,679

4,694

1,218

837

1,021

2,798

747

4,566

2,013

3,500

1,422

1,069

1,630

513

652

5,593

2,310

1,060

1,516

1,803

915

1,897

100.0

1.6

0.3

9,5

8.0

1.1

0.8

1.3

4.0

2.5

7.1

2.7

1.2

1.6

3.5

1.6

18.7

11.1

2.0

4.3

1.5

3.7

1.5

7.9

2.4

11.8

7.3

1.7

6.8

1.9

1.1

10.1

4.6

1,6

o.a

6.0

●

4.0

100.0

3.4

1.4

8.5

7.4

1,2

0.9

1.0

3.9

1.7

9.5

6.0

0.6

1.2

2.2

1.5

19.2

12.4

2.9

3.5

2.8

3.9

1.3

10.4

4.4

9.7

5.6

1.9

5.2

1.9

0.9

9.6

4.3

1.8

2.2

7.2

0.7

3.9

100.0

1,6

0.6

14.6

13.6

2.1

1.6

2.3

4.3

2.9

12.9

5.8

1.8

2.5

3.2

2.6

21.6

10.8

2.1

3.6

1.6

6.4

2.6

5.3

1.7

8.1

3.0

2.4

5.8

2.1

1.7

13.5

8.0

3.3

1.0

1.1

●

2.7

100.0

5.4

2.5

11.3

10.6

1.9

1.6

1.1

3.7

1.8

17.0

11.3

0.8

2.1

2.7

2.4

17.2

9.3

2.4

1.7

2.0

5.5

1.5

9.1

4.0

6.9

2.8

2.2

3.2

1.0

1.3

11.1

4.6

2.1

3.0

3.6

1.8

3.8

‘Long-stay Pdtleflk had Ieng!lns of slay of more than 3 weens
Advance Data No. 229 ● March 11, 1993 9

for diagnoses were generally similar

to those seen in the discharge data.

Diseases of the circulatory system,

mental disorders, neoplasms, and

injury and poisoning together

accounted for 63 percent of the days

of care for long-stay patients in 1980

and 57 percent in 1990.

As was the case with discharges,

the proportion of days of care for

diagnostic categories such as

septicemia; most malignant

neoplasms; mental disordery

cerebrovascular disease; diseases of

arteries, arterioles, and capillaries; all

fractures; and hip fractures was

higher for long-stay patients than for

all patients. Unlike discharges, the

proportion of days of care for

diseases of the circulato~ system was

lower for long-stay patients than for

all patients in 1990.

Days of care for long-stay

patients increased for infectious and

parasitic diseases (especially

septicemia), psychoses, pneumonia,

miscellaneous complications of

surgical and medical care, and the

supplementary classifications (where

care involving use of rehabilitation

procedures accounted for half of the

days in 1990).

Long-stay patients had decreases

in days of care for diagnostic

categories such as malignant

neoplasms of trachea, bronchus, and

lung; diabetes mellitus; neurotic and

personality disorders; ischemic heart

disease (other than acute myocardial

infarction); diseases of arteries,

arterioles, and capillaries;

arthropathies and related disorders;

all fractures; and hip fractures.

Procedures

The rate of procedures per 1,000

discharges for long-stay patients was

1,255 in 1980 and 2,046 in 1990, an

increase of 63 percent (table 8). For

all patients, the rate of procedures

per 1,000 discharges increased by

58 percent –from 830 in 1980 to 1,316

in 1990. In 1980 and 1990, the rate of

procedures per 1,000 discharges was

more than 50 percent higher for longstay patients than for all patients.

Although long-stay patients

accumulated more procedures per

hospitalization, they had fewer

procedures per hospital day. In 1990,

the rate of procedures per 100

hospital days was 5 for long-stay

patients compared with 21 for aIl

patients.

In 1990, 31 percent of the

procedures performed on long-stay

patients were in the category,

miscellaneous diagnostic and

therapeutic procedures. Operations

on the digestive system made up

19 percent of the procedures and

operations on the cardiovascular

system accounted for 17 percent of

procedures on long-stay patients.

Thus, more than two-thirds of the

procedures performed on long-stay

patients were in these three

categories. Only 52 percent of the

procedures for all patients were in

these three categories in 1990. In

1980, the same three categories of

procedures made up approximately

half of the procedures performed on

Iong-stay patients and a third of the

procedures for all patients.

The rate of miscellaneous

diagnostic and therapeutic procedures

per 1,000 discharges in 1990was more

than double the rate in 1980for

long-stay patients. The rate for all

patients more than tripled during this

period. Large increases can be seen

in the rates for a number of specific

procedures in this category. The rate

of computerized axiaI tomography

(CAT) scans more than tripled for

long-stay patients and increased

six-fold for all patients. Long-stay

patients had a rate of diagnostic

ultrasound per 1,000 discharges in

1990 that was 4.7 times the 1980 rate,

and the 1990 rate of diagnostic

ultrasound for all patients was more

than six times the 1980 rate.

Respiratory therapy and insertion of

endotracheal tube were reported

infrequently for long-stay and aII

patients in 1980, but were common

procedures in 1990. The rate per

1,000 discharges for arteriography and

angiocardiography using contrast

material was not significantly higher

for Iong-stay patients in 1990 than in

1980, but it more than tripled for all

patients. This was one of the few

diagnostic procedures for which aIl

patients had a higher rate per 1,000

discharges than long-stay patients in

1990.

The increases in miscellaneous

diagnostic and therapeutic procedures

were probably due in part to changes

in the methodology of the National

Hospital Discharge Survey (see

“Technical notes”). Beginning in

1985, some data for the sumey have

been obtained from abstracting

semice organizations. Analysis has

indicated that a greater number of

nonsurgical procedures per patient

were reported by hospitals using

abstract services than by hospitals

submitting data in the traditional

manual form. In addition, more

complete reporting of relatively minor

procedures has been linked to the

implementation of the 1983 Medicare

prospective payment system, which is

based on diagnosis-related groups

(DRG’s) (11-13).

Like the rate of miscellaneous

diagnostic and therapeutic

procedures, the rate of operations on

the cardiovascular system per 1,000

discharges in 1990was more than

double the 1980 rate for long-stay

patients and more than triple the

1980 rate for alI patients. A number

of cardiovascular procedures

contributed to these increases. The

rate of corona~ artery bypass grafts

per 1,000 discharges more than

tripled for long-stay and all patients.

The cardiac catheterization rate

doubled for long-stay patients and

more than tripled for all patients.

Puncture of vessel was also reported

at a much higher rate in 1990 than in

1980 for long-stay and all patients.

The rate of operations on the

digestive system was not significantly

different in 1980 as compared with

1990 for long-stay or all patien~s, but

rates of several specific digestive

system procedures increased during

this period. The rates per 1,000

discharges for gastrostomy and

endoscopy of the smaIl intestine more

than tripled for Iong-stay patients and

aII patients. Long-stay patients had an

86 percent higher rate of endoscopy

of the large intestine in 1990 than in

1980, and rates for Iysis of peritoneal
Advance Data No. 229 ● March 11, 1993

Table 8. Number of procedures and ratio of procedures to discharges for patients discharged from short-stay hospitals, by procedure

and length-of-stay categories: United States, 1980 and 1990

[Discharges from non-Federal hospitals. Excludes newborn infants. Diagnostic groupings and code numbers are based on the /rrtemationa/ C/assh7CStiorr of Diseases,

9ftI Revision,C/irrka/Modification (lCD-S-CM)]

A// patients Long-stay All patients

discharged

Long-stay

patients discharged pefienfa

——

Procedure category and ICO-9-CM code 1980 1990 1980 1990 1980 1990 1980 1990

All procedures..,...,....,., . . . . . . . . . . . . . . . .

Operations on the nervous system. . . . .01-05

Snmal tap . . . . . . . . . . . . . . . . . . . . . . . . . . ...03.31

Operations on the respiratory system ., . . . . . .30-34

Temporary tracheostomy . . , . . 31.1

Bronchoscopy with or without biopsy. 33.21-33.24,33.27

Incwion of chest wall and pleura. . , . . . . . 34,0

Operations on ths cardiovascular system. . . . . . . .35-39

Corona~ artery bypass graft . . . . . . . . . 36.1

Cardiac catheterization. . . . . . . . . . 37.21–37.23

Puncture of vessel . . . . . . . . . . . . . . . . . . . . ...38.9

Shunt or vascular bypass . . . . . . . . . . . ...39.0-39.2

Operations on the heroic and lymphatic system. . . ...40-41

Biopsy of bone marrow . . . . . . . . . . . . . . . . . ...41.31

Operations on the digestive system . . . . . . . . . . ...42-54

Gastrostomy . . . . . . . . . . . . . . . . . . . . . . . . ...43.1

Endoscopy of smallintestine. . . . . . . . 45.11-45.14,45.16

Endoscopy of large intestine . . . . . . . . . . . . 45.21=15.25

Resection of intestine. . . . . . . . . . . . . . . . 45.W5.8

Ileostomy, colostomy, and other enterostomy. . ..46.146.3

Cholecystectomy . . . . . . . . . . . . . . . . . . . . . ...51.2

Lysis of peritoneal adhesions. ., . . . . . . . . . . . 54.5

Operations on the urinary system . . . . . . . . . . . . . .55-59

Cystoscopy . . . . . . . . . . . . . . . . . . . . . . . 57.31 -57.33

Operations on the male genital organs . . . . . . . . ...60-64

Prostatectomy . . . . . . . . . . . . . . . . . . . . ...60.2-60.6

Opemtions on the female genital organs . . . . . . . . . 65-71

Operations 011the musculoskeletal system. . . . . . . .76-84

Open reduction of fracture with internaf f!xation . . . . 79.3

Amputation oflower limb . . . . . . . . . . . . . . . . ...84.1

Operations on the integumentary system. . . . . . ...85-66

Debridement of wound, infection, or burn . . . .86.22,86.26

Skin graft . . . . . . . . . . . . . . . . . . . . . . . ...86.&66.7

Miscellaneous dlagnosfic and therapeutic

procedures, . . . . . . . . . . . . . . . . . . ., . . . . ...87-99

Computerized asial tomography . . . 87.03,67.41,87.71,

68.01,68.38

Arteriography and angiocardtography using contrast

material . . . . . . . . . . . . . . . . . . . . . . . ...88.4-88.5

Diagnostic ultrasound . . . . . . . . . . . . . . . . . . ...88.7

Radioisotope scan . . . . . . . . . . . . . . . . . . ..92. C-92.1

Respiratory therapy . . . . . . . . . . . . . . . . . . . . ...93.9

Insertion of endotracheal tube . . . . . . . . . . . . . .96.04

All other procedures. . . . . . . . . . . . . . . . . . . 06-29,72-75

Number of procedures in thousands

31<412

728

216

868

49

290

117

1,352

137

348

56

98

321

144

5,320

33

282

535

180

82

458

228

1,921

075

799

335

4,274

3,215

301

96

1,896

196

183

3,930

306

569

318

525

●7

14

8,788

40,506

952

396

975

41

298

180

3,881

392

995

515

162

361

157

5,271

115

765

548

266

89

522

323

1,664

527

594

364

2,440

3,132

391

107

1,387

332

110

11,890

1,506

1,735

1,608

603

1,164

297

7,959

2,428

106

33

192

32

63

26

236

24

28

17

31

61

2a

563

15

25

44

51

37

32

26

148

61

57

35

44

340

58

52

184

56

60

444

51

57

33

78

●

*

53

2,665

103

41

202

30

58

33

444

47

39

724

26

49

32

509

45

73

55

48

29

18

30

89

30

19

9

22

187

29

35

167

82

32

818

124

48

103

52

97

49

54

Procedures per 1,000 discharges

630.3

19.2

5.7

22.9

1.3

7.7

3.1

35.7

3.6

9.2

1.5

2.8

6.5

3.8

140.6

0.9

7.4

14.1

4.e

2.2

12.1

6.0

50.8

23..1

21.1

8.9

113.0

85.0

8.0

2.5

50.1

5.2

4.8

103.9

8.1

15.0

8.4

13.9

●0.2

0.4

179!4

1,315.6

30.9

12.9

31.7

1.3

9.7

5.8

126.1

12.7

32.3

16.7

5.2

11.7

5.1

171,2

3.7

25.5

17.6

8.6

2.9

17,0

10.5

54.1

17.1

19.3

11.8

79.2

101.7

12.7

3.5

45.1

10.6

3.6

386.2

46.9

56.4

52.2

19.6

37.8

9.7

258.5

1,254.8

54.8

17.1

99.2

16.5

32.6

13.5

122.2

12.1

14.4

8.7

16.1

31.3

14.7

290.8

7.6

12,9

22.9

26.2

18.9

16.6

13.3

76.3

31.3

29.5

17.9

22.5

175.7

29.9

26.9

95.3

29.0

30.8

229.5

26.6

29.3

17.0

40.6

*

●

27.6

2,046.3

78.8

31,8

155,4

23.2

43.0

25.6

341.1

36,4

29.7

95.3

20.2

37.6

24.4

391.1

34.3

56.2

42.5

37.1

22.3

13.9

23.4

68.2

22.7

14.9

7.0

17.3

143.4

21.9

26.5

128.5

63.2

24.3

628.2

94.8

36.7

79.3

39.6

74.2

38.0

41.6

‘Long-stay patients had Ienglha o! stay of more than 3 weeks.

adhesions increased approximately

75 percent for long-stay and all

patients. In contrast, the rates of

cholecystectomy per 1,000 discharges

were not significantly higher in 1990

as compared with 1980 for long-stay

or all patients.

Other significant changes

included a 57-percent-higher rate of

operations on the respiratory system

per 1,000 discharges for long-stay

patients in 1990 as compared with

1980. Within the respiratory category,

the rate for incision of the chest wall

and pleura per 1,000 discharges

increased 87–90 percent for long-stay

and all patients. Notable in other

categories was the change in the rate

for debridement of wound, infection,

and bum per 1,000 discharges, which

in 1990 was twice the 1980 rate. The

rate for spinaI tap aIso doubIed for all

patients and increased 86 percent for

long-stay patients during this period.

Unlike most rates, the rate of

operations on the maIe genitaI organs

per 1,000 discharges was lower for
Advance Data No. 229 ● March 11, 1993 11

long-stay patients in 1990 than in

1980. In particular, the rate of

prostatectomy per 1,000 discharges

decreased for long-stay patients, even

though it did not change significantly

for all patients during this period.

Prostatectorny was performed at a

higher rate per 1,000 discharges for

long-stay patients in 1980 but at a

higher rate for aI1 patients in 1990.

The rate per 1,000 discharges for

the “ail other procedures” category

was higher for all patients than for

long-stay patients in 1980 and 1990.

This category included obstetrical

procedures and operations on the

endocrine system, eye, ear, nose,

mouth, and pharynx.

Summary

In 1980 and 1990, only 4-5

percent of patients in short-stay

hospitals were hospitalized for more

than 3 weeks. The number of

discharges and days of care for these

long-stay patients were lower in 1990

as compared with 1980, but they

continued to use more than a quarter

of all hospital days in 1990. Long-stay

patients were more likely than all

patients to be 65 years of age and

over and have Medicare as their

expected principal source of payment.

For long-stay and all patients, private

insurance covered smaller proportions

of discharges and days of care, and

Medicaid covered larger proportions

in 1990 than in 19S0.

Long-stay patients were more

likely than all patients to be

discharged dead or transferred to

other hospitals or nursing homes.

Long-stay and all patients were more

likely to be transferred at discharge in

1990 than in 1981. The Northeast

Region had a larger proportion of

long-stay patients than of all patients,

and that proportion increased from

1980 to 1990. The proportion of

long-stay discharges and days of care

in the Midwest decreased during this

period.

In 1980 and 1990, more than

50 percent of the discharges and days

of care for long-stay patients were for

diseases of the circulatory system,

mental disorders, neoplasms, or injury

and poisoning. Despite the overall

decreases in hospital use by long-stay

patients, their discharges and days of

care increased significantly from 1980

to 1990 for diagnoses such as

septicemia, psychoses, and

miscellaneous complications of

surgical and medical care. Over time,

decreases were seen in long-stay

discharges and days of care for a

variety of diagnostic categories,

including malignant neoplasm of

trachea, bronchus, and lung; diabetes

mellitus; and fracture of the neck of

the femur.

Long-stay patients had a higher

rate of procedures per 1,000

discharges in 1990 than in 1980, and a

higher rate than all patients in both

years. Approximately half of all the

procedures performed on long-stay

patients in 1980 and two-thirds in

1990 were miscellaneous diagnostic

and therapeutic procedures,

operations on the cardiovascular

system, or operations on the digestive

system. The rates of numerous

procedures, especially diagnostic tests,

increased for long-stay and all

patients from 1980 to 1990.

References

1. Coulam RF, Gaumer GL.

Medicare’s prospective payment

system: a critical review. Health

Care Finan Rev Annual

Supplement. 1991.

2. Guterrnan S, Eggers PW, Riley G,

et al. The first 3 years of Medicare

prospective payment an overview.

Health Care Firm Rev 9(3):67-77.

198s.

3. Schramm CJ, Gabel J. Prospective

payment, some retrospective

observations. N Engl J Med

318(25):1681-82. 1988.

4. Haupt BJ, Kozak LJ. Estimates

from two survey designs National

Hospital Discharge Survey.

National Center for Health

Statistics. Vital Health Stat

13(111). 1992.

5. Public Health Service and Health

Care Financing Administration.

International Classification of

Diseases, 9th Revision, clinical

modification. Washington: Public

Health Service. 1980.

6. Levit KR, Lazenby HC, Cowan

CA, Letsch SW. National health

expenditures, 1990. Health Care

Finan Rev 13(1):29-49. 1991.

7. Sloan FA, Morrisey MA, VaIvona

J. Case shifting and the Medicare

prospective payment system. Am J

of Public HeaIth 1S(5):553-56.

19S8.

S. Prospective Payment Assessment

Commission. Medicare and the

American Health Care System.

Report to the Congress.

Washington, D.C. June 1991.

9. Graves EJ, Haupt BJ. Utilization

of short-stay hospitals: United

States, 1981, annual summaiy.

National Center for Health

Statistics. Vital Health Stat 13(72).

19s3.

10. Graves EJ. National Hospital

Discharge Survey annual

summary, 1990. National Center

for HeaIth Statistics. Vital Health

Stat 13(112). 1992.

11. Cohen BB, Pokras R, Meads MS,

Krushat WM. How will diagnosisrelated groups affect epidemiologic

research? Arn J EpidemioI

126(1):1-9. 1987.

12. Kozak LJ. Hospital inpatient

surgery United States, 19S3-87.

Advance data from \’ital and

health statistics; no 169.

HyattsvilIe, Maryland: National

Center for Health Statistics. 1989.

13. Steinwald B, Dummit LA.

Hospital case-mix change: sicker

patients or DRG creep? Health

Affairs 35-47. Summer 1989.

14. Simmons WR, Schnack GA.

Development of the design of the

NCHS Hospital Discharge Survey.

National Center for Health

Statistics. Vital Health Stat 2(39).

1977.

15. Shah BV. SESUDAAN: Standard

Errors Program for Computing of

Standardized Rates from Sample

Suwey Data. Research Triangle

Park, North CaroIina: Research

Triangle Institute. 19S1.

16. Haupt BJ. Utilization of short-stay

hospitaix annual summary for the

United States, 19S0. National

Center for Health Statistics. Vital

Health Stat 13(64). 1982.
12 Advance Data No. 229 ● March 11, 1993

Technical notes

Survey methodology

Source of data

The National Hospital Discharge

Survey (NHDS) covers discharges

from noninstitutional hospitals, except

Federal, military, and Veterans’

Administration hospitals, that are

located in the 50 States and the

District of Columbia. Only hospitals

with at least six beds and an average

length of stay of less than 30 days for

all patients were included in the

survey from 1965–87, Beginning in

1988, the universe also incIuded

hospitals whose specialty was general

(medical or surgical) or chiIdren’s

general, even if the hospital’s average

length of stay for patients was 30 days

or more.

The original universe for the

survey consisted of 6,965 hospitals

listed in the 1963 National Master

Facility Inventory (NMFI). The

universe was updated periodically

using NMFI data and data from the

American Hospital Association to

reflect new hospitals entering the

universe. Beginning in 1988, the

universe for the NHDS consisted of

hospitals that were listed in the April

1987 SMG Hospital Market Tape,

met the above criteria, and began

accepting patients by August 1987.

In 1980, the sampIe consisted of

544 hospitals, of which 52 were found

to be out-of-scope because they had

gone out of business or failed to meet

the criteria for the NHDS universe.

Of the 492 in-scope (eIigible)

hospitals, 420 participated in the

survey. In 1990, 542 hospitals were

sampled and 23 were found to be

out- of- scope. Of the 519 in-scope

hospitals, 474 responded to the

survey.

Sample design and data collection

From 1965 to 1987, the NHDS

had a stratified, two-stage design.

Sample hospitals were selected with

probabilities ranging from certainty

for the largest hospitals to 1 in 40 for

the smallest hospitals, Within each

sample hospital, a systematic random

sample was selected.

Beginning in 1988, the NHDS

sample included, with certain~, all

hospitals with 1,000 beds or more, or

40,000 discharges or more annually.

The remaining sample of hospitals

was based on a stratified, three-stage

design. The first stage consisted of a

selection of 112 primary sampIing

units (PSU’S) that were a probability

subsample of PSU’S to be used in the

1985–94 National Health Interview

Survey. The second stage consisted of

a selection of noncertainty hospitais

from the sample PSU’S. At the third

stage, a sample of discharges was

selected by a systematic randomsampling technique. A detailed

description of the old and new survey

designs has been published (4).

Two data collection procedures

were used for the survey. The first

was a manual system of sample

selection and data abstraction, which

was used for aII hospitals in 1980.

The second, an automated method

used for approximately 34 percent of

the respondent hospitals in 1990,

involved the purchase of data tapes

from abstracting services.

In the manual system, the sample

selection and transcription of

information from hospital records to

abstract forms were performed at the

hospitals. The completed forms, along

with sample selection control sheets,

were forwarded to the National

Center for Health Statistics (NCHS)

for coding, editing, and weighting. A

few of these hospitals have submitted

their data via computer printout or

tape in recent years. In about

55 percent of the hospitals that

participated in the survey in 1980,

and about two-thirds of hospitals

using this manual system in 1990, the

work was performed by their own

medical records staff. In the

remaining hospitals using the manual

system, the U.S. Bureau of the

Census personnel, on behaIf of

NCHS, did the work.

For the automated system, NCHS

purchased tapes containing machinereadable medical record data from

abstracting services and State data

systems. Records were systematically

sampled by NCHS,

The data collected for the survey

incIuded items relating to the

patient’s personal characteristics,

inc!uding birth date, sex, race, and

marital status (but not the patiient’s

name and address); administrative

information, including admission and

discharge dates, discharge status, and

medical record number; and medical

information, including diagnoses and

surgical and nonsurgical operations or

procedures. Beginning in 1977, data

pertaining to patient ZIP Code,

expected source of payment, and

dates of surgery were also collected.

(The medical record number and

patient ZIP Code are confidential

information and are not available to

the public.)

Presentation of estimates

The relative standard error

(RSE) of the estimate and the

number of sample records that the

estimate was based orI are used to

identify estimates with relatively low

reliability. Because of the complex

sample design of the NHDS,

estimates of less than 5,000 are not

presented; only an asterisk (*)

appears in the tables. GeneraIIy,

these estimates have an RSE of more

than 30 percent or are based on a

sample of less than 30 cases.

Estimates of 5,000-9,000 are

preceded by an asterisk (*) to

indicate they shotdd not be assumed

reliable, These estimates are usually

based on fewer than 60 cases.

Sampling errors and rounding

of numbers

The standard error is primarily a

measure of sampling variability that

occurs by chance, because only a

sample rather than the entire

universe is surveyed. The RSE of the

estimate is obtained by dividing the

standard error by the estimate itself.

The resulting value is multiplied by

100, so the RSE is expressed as a

percent of the estimate.

Estimates of sampling variability

for 1980 data were calculated using a

customized computer routine based
Advance Data No. 229 Q March 11, 1993 13

on an unbiased algebraic estimator of

the variance (14). The RSE’S for 1980

discharges or first-listed diagnoses,

days of care, and procedures are

shown in tables I and II.

SESUDAAN software was used

to calculate estimates of sampling

variability for 1990 data. This

software computes standard errors by

using a first-order Taylor

approximation of the deviation of

estimates from their expected values.

A description of the software and the

approach it uses has been published

(15). The constants for RSE curves

for 1990 NHDS estimates are

presented in table III. The RSE of an

Table L Approximate relative standard

errors of estimated numbers of discharges

or first-listed diagnoses and all-listed

procedures by size of estimate: United

States, 1980

Number of

discharges or Number of

first-listed a//-/isted

Size of estimate diagnoses procedures

5,000 . . . . . . . . .

10,000 . . . . . . . .

50,000 . . . . . . . .

100,000 . . . . . . .

300,000 . . . . . . .

500,000 . . . . . . .

1,000,000 . . . . . .

3,000,000 . . . . . .

5,000,000. . . . . .

Io,coo,ooo.., . . .

20,000,000. . . . . .

30,000.000. . . . . .

40,000,000. . . . . .

18.0

14.9

10.1

8.8

7,1

6.5

5.8

5.0

4.7

4.3

4.0

3.8

3.7

77.3

14.7

10.6

9.4

7.9

7.3

6.7

5.9

5.6

5.2

4.9

4.7

. ..

Table Il. Approximate relative standard

errors of estimated numbers of days of

care by size of estimate: United States,

1980

Number of

Size of estimate days of care

10,000.................. 24.7

30,000 . . . . . . . . . . . . . . . . . . 18.9

50,000 . . . . . . . . . . . . . . . . . . 16.8

100,000 . . . . . . . . . . . . . . . . . 14.3

300,0Q0 . . . . . . . . . . . . . . . . . 11.2

500,000 . . . .. . . . ...<..... 10.1

1,000,000. . . . . . . . . . . . . . . . 8.8

3,000,000. . . . . . . . . ...!... 7.1

5,000.000. . . . . . . . . . . . . . . . 6.5

10,000,000. . . . . . . . . . . . . . . . 5.7

50,000,000. . . . . . . . . . . . . . . . 4.4

100,000,000. . . . . . . . . . . . . . . 4.0

250,000,000. . . . . . . . . . . . . . . 3.5

estimate (X) can be estimated from

the formula:

RSE(X) = 100(<~~

where X, a, and b are as defined in

table III.

Estimates have been rounded to

the nearest thousand. For this reason,

figures within tables do not ahvays

add to the totals. Percents and rates

were calculated from original,

unrounded figures and do not

necessarily agree precisely with

percents and rates calculated from

rounded data.

Tests of significance

In this report, statistical inference

is based on the hvo-tailed t-test for

independent samp[es using the

Bonferroni critical values for post-hoc

multiple comparisons (0.05 level of

significance). Critical values were

determined for each set of

comparisons, that is, within each

table. In comparisons of data for all

discharges and long-stay discharges,

estimates were not from independent

samples; therefore, the t-test used is

conservative. Terms such as “higher”

and “iess”’ indicate that differences

are statistically significant. Terms

such as “similar” and “no difference”

mean that no statistically significant

difference exists between the

estimates being compared. A lack of

comment on the difference behveen

any two estimates does not mean that

the difference was tested and found

insignificant.

Definitions of terms

Age– Patient’s age at birthday

prior to admission to the hospital.

Average length of stay –The

number of days of care accumulated

by patients discharged during the year

divided by the number of patients.

Days of care-The number of

patient days accumulated by a patient

at time of discharge. A stay of less

than 1 day (patient admission and

discharge on the same day) is

counted as 1 day in the summation of

total days of care. For patients

admitted and discharged on different

days, the number of days of care is

computed by counting all days from

(and including) the date of admission

to (but not including) the date of

discharge. The terms days of care,

patient days, and hospital days are

synonymous.

Diagnosis –A disease or injury (or

other factor that influences health

status and contact with health

services) listed on the medical record

of a patient.

●

●

Principal diagnosis -The condition

established after study to be

chiefly responsible for occasioning

the admission of the patient to the

hospital for care.

Fint-listed diagnosis –The coded

diagnosis identified as the

principal diagnosis or listed first on

the face sheet or discharge

summary of the medical record if

the principal diagnosis cannot be

identified. The number of first-

[isted diagnoses is equal to the

number of discharges.

Dischnge –The formal release of

a patient by a hospital, that is, the

termination of a period of

hospitalization by death or disposition

to place of residence, nursing home,

another hospital, or other location.

The terms discharge, patient, and

inpatient are synonymous.

Disposition –The disposition of a

patient on termination of

hospitalization is classified in one of

six categories in this report:

Routine dkchaqe - Patients who

returned to their previous place of

residence after discharge.

Trtmsfer to another short-term

hospitaf-Patients who were

transferred to another short-term

hospital at discharge.

Transfer to long-term care

institution - Patients who entered a

nursing home or other long-term

care institution upon discharge

from the hospital.

O[her live discharges – Patients who

left the hospital against medical

advice, patients discharged alive

with dispositions other than

routine discharge or transfer, and

patients discharged alive whose

dispositions were not stated.
14 Advance Data No. 229 ● March 11, 1993

Table Ill. Estimated parameters for relative standard error equations for National Hospital Discharge Survey statistics by selected

characteristics: United States, 1990

Number of discharges Number of

first-listed diagnoses days of care

Characteristic a b a b

Total . . . . . . . . . . . . . . . . . . . . . . . 0.00213 228.834 0.00404 1,438.843

Sex

Male, .,, .,, . . . . . . . . . . . . . . . .

Female. . . . . . . . . . . . . . . . . . . . . .

Age

Under 15years, . . . . . . . . . . . . . .

1544years, . . . . . . . . . . . . . . . . . .

4E-S4 years . . . . . . . . . . . . . . . . . . .

65years Andover . . . . . . . . . . . . . . .

Region

Norlheasl . . . . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . . . . .

0.00152

0.00125

0.01597

000142

0.00157

0.00161

0.00274

0,00487

0.00375

0.00564

313.079

311.632

47.166

299.762

234.543

263.223

56.266

183.531

343.692

318.914

0.00311

0.00253

0.01976

0.00298

0.00278

0.00295

0.00432

0.012S9

0.00436

0.01456

1,853.369

1,907.568

1,248.390

1,225.181

1,551.060

2,110.341

972.7a2

1,493.015

‘1,406.247

‘1,361.642

Sourceofpayment

Privat e . . . . . . . . . . . . . . . . . . . . . 0.00141 356.276

Medicare . . . . . . . . . . . . . . . . . . .

0.00278 2,855.345

0.00233 147.206 0.00773 1,118,298

Med!ceid, . . . . . . . . . . . . . . . . . . . . 0.00542 225.144 0.07067 1,495,250

Setf pay . . . . . . . . . . . . . . . . . . . . . 0.00571 255.679 0.03949 1,337.799

Number of procedures

Total . . . . . . . . . . . . . . . . . . . . . . . 0.00547 92.597 . . . . . .

NOTE: Therelattve Sandard error (RSE)foran estimatB (~canbe determined byuingtheequat!on RSE(X) - 100(@~.

. Dead—Patients who died during

an inpatient stay.

. Notstated —Patients whose

discharge status, that is, alive or

dead, was not reported at

discharge.

Expected principal source of

paynent–Thee xpected principal

source of payment is reported by the

patient orthepatient’s representati~’e

at time of admission and may differ

somewhat from the actual sourceof

payment as determined after

discharge. In this report, payment

sources are grouped as follows:

● Pn”vateinsurance-insurance

provided by nongovernmental

sources, including Blue Cross and

other insurance companies, private

industry, and philanthropic

organizations.

. Medicare—A nationwide program

providing health insurance

protection to people 65 yearsof

age and over, people eligible for

Social Security disability payments

for more than 2 years, and people

with end-stage renal disease.

. Medicaid– A joint Federal-State

program that provides benefits for

people who meet their State’s

definition of “low income.”

● Self-pay–Patients who expect the

costs of hospitalization to be paid

for primarily by themselves,

spouses, parents, or next of kin.

● Other sources —Includes Worker’s

Compensation and other

government programs, such as

CHAMPUS (for dependents of

military personnel); other

nonprofit sources, such as church

welfare; hospitalizations for which

there was no charge; and sources

that could not be assigned to any

other category.

. Not sra(ed—In 1990, patients for

whom no source of payment was

indicated. In 1980, source of

payment was imputed for patients

who did not indicate one.

Geographic region – Hospitals are

classified by location in one of the

four geographic regions of the United

States that correspond to those used

by the U.S. Bureau of the Census.

Region States included

Northeast Maine, New Hampshire,

Vermont,

Massachusetts, Rhode

Island, Connecticut,

New York, New Jersey,

and Pennsylvania

Midwest Michigan, Ohio, Illinois,

Indiana, Wisconsin,

Minnesota, Iowa,

Missouri, North Dakota,

South Dakota,

Nebraska, and Kansas

South Delaware, Maryland,

District of Columbia,

Virginia, West Virginia,

North Carolina, South

Carolina, Georgia,

Florida, Kentucky,
Advance Data No. 229 ● March 11, 1993 15

Tennessee, Alabama,

Mississippi, Arkansas,

Louisiana, Oklahoma,

and Texas

West Montana, Idaho,

Wyoming, Colorado,

New Mexico, Arizona,

Utah, Nevada,

Washington, Oregon,

California, Hawaii, and

Alaska

Hospital–Hospitals with an

average length of stay of less than 30

days for ail patients. In 1990,

hospitals whose specialty was general

(medical or surgical) were also

included, even if the average length

of stay of all patients was 30 days or

more. Federal hospitals, hospital units

of institutions, and hospitals with less

than six beds staffed for patients’ use

were not included.

Long-stay patient – A patient

whose length of stay in the hospital

was more than 3 weeks.

Patient –A person formally

admitted to the inpatient service of a

short-stay hospital for observation,

care, diagnosis, or treatment.

Newborn infants, defined as those

admitted by birth to the hospital, are

excluded from this report. The terms

patient, inpatient, and discharge are

synonymous.

Population –The U.S. resident

population, excluding members of the

Armed Forces. The population

estimates are from tabulations

provided by the U.S. Bureau of the

Census. The 1990 estimates do not

include the results of the 1990

Census.

Procedure – Surgical or

nonsurgical operations, diagnostic

procedures, or special treatments

reported on the medical record of a

patient. In the NHDS, a maximum of

four procedures are coded. Certain

procedures that do not car~ an

operative or anesthetic risk or require

highly trained personnel, special

facilities, or special equipment were

not coded. Lists of the ICD-9–CM

codes not used are available in

previous reports (10, 16).

Symbols

--- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less

than 0.05

z Quantity more than zero but less

than 500 where numbers are

rounded to thousands

* Figure does not meet standard of

reliability or precision.
16 Advance Data No. 229 ● March 11, 1993

Suggested citation Copyright Information National Center for Health Statlstis

Hall MJ, Kozak LJ. Long-stay patients in All material appearing in this report is in the Director

short-stay hospitals. Advance data from vital public domain and may be reproduced or Manning Feinleib, M. D., Dr, P.H.

and health statistics: no 229. Hyattsville,

Maryland: National Center for Health

copied without permission; citation as to

source, however, is appreciated.

Acting Deputy Director

Statistics. 1993 Jack R Anderson
Number 230 . March 29, 1993

Advance

Data

From Vital and Health Statisticsof the CENTERS FOR DISEASE CONTROL AND PREVENTION/National Centerfor Health Statistics

National Ambulatory Medical Care Survey: 1991 Summary

by Susan M. Schappert, M.A., Division of Health Care Statistics

Introduction

During the 12-month period from

January 1991 through December

1991, an estimated 669.7 miIIion visits

were made to nonfederaIIy employed,

office-based physicians in the United

States– about 2.7 visits per person.

This rate is not statistically different

from office visit rates observed since

1975 (1,2,3).

This report presents data

highlights from the 1991 National

Ambulatory Medical Care Survey

(NAMCS), a nationaI probability

sample survey conducted by the

Division of Health Care Statistics of

the National Center for Health

Statistics, Centers for Disease Control

and Prevention. The data summarized

here should be considered provisional

because final editing may result in

minor changes in the estimates.

Statistics are presented on patient,

physician, and visit characteristics.

Because the estimates presented

in this report are based on a sample

rather than on the entire universe of

office visits, they are subject to

sampling variability. The technical

notes found at the end of this report

incIude a brief overview of the sample

design used in the 1991 NAMCS, an

explanation of sampling errors, and

guidelines for judging the precision of

the estimates.

The Patient Record is used by

physicians participating in the

NAMCS to record information about

their patients’ office visits. This form

is reproduced in figure 1 and is

intended to serve as a reference for

readers as they review the survey

findings presented in this document.

The 1991 Patient Record

included severaI questions that were

new to the National Ambulatory

Medical Care Survey. Through these

data items, information was coIIected

on whether the current office visit was

injury related, whether the patient

smoked cigarettes, and whether

ambulatory surgery was scheduled or

performed at the visit. In addition,

revisions were made to some of the

existing data items concerned with

diagnostic, screening, and therapeutic

services. These changes are discussed

in detail below.

The physician sample for the

NAL4CS was selected with the

cooperation of the American Medical

Association and the American

Osteopathic Association. Their

contribution to this effort is gratefully

acknowledged.

Patient characteristics

Office visits by patient’s age, sex,

and race are shown in table 1.

Females made 59.8 percent of all

office visits during 1991 and

accounted for a higher percent of

visits than males in all age categories

except the youngest (under 15 years).

Females also had significantly higher

visit rates than males did in each age

category with the exception of the

Youngest group(under 15 years) md

the two oldest groups (65-74 years

and 75 years and over). These

patterns were also observed in the

1990 NAMCS.

Visit rates tended to increase

with age after the age of 24. Persons

75 years of age and over had the

highest visit rate of the Sk age

categories analyzed, at 6.0 visits per

##*“’’’c%,

-& U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES *

c

~-

~’ Public Health Service

~

%>\

Centers for Disease Control and Prevention

National Center for Health Statistics A

--.,,-.,-, ..u-r..e L’,LLOR OISEASE CC,.TROL

kNO PRFJENTION
L muval JwG Wusu 1 --- r-wv - Sw*uawsa --, me-w

A..ur.nc. or C.. fld..tmymhllll !.1.nn.t,.n whwh would p.rrnl! nd..tlft~tt.n of.. CmpuIm.nt of 1+..lth .ne w.m.n s.t.m..

8.c IwwJ.. . m.. !,.., w.. .stabl!mm.nl w!II b. hda cenhd.ntml, WDIIM .na only by ti.t.m for Din..” control

w=... ww.d m ma (OI the P.rPO..$ of m. S.W.V ●nd w not b. d,sclo..d or P“bllc Ii,alth SW+’,.,

r.1..sec to or.., PWCO.S or u..d t.r *.Y .m.r p.rpos. N.tlon.l Cknt.r k+ H..ltn Smtl.tfcs ID

1. DATE OF VISIT

~

PATlENT RECORD OMB No. 0920-0234

NATIONAL AMBULATORY MEDICAL CARE SURVEY Expires 4-30-93

Month Day CDC 64.21D

2. DATE OF BIRTH 4. COLOR OR RACE 5. =HNICITY 6. EXPECTEO SOURCE(S) OF 7. WAS PATIENT S. IS THIS VISIT

~

PAYMENT [Check all rkz] .7Pp/y! REFERRED FOR INJURY RELATE13?

I ❑ Whlto Hispmxc I ❑ HMO/oth6r pmpzid 5 ❑ ,?&#W/ci~

THIS VISIT BY

1~ cmgm ANOTHER 1 fJ Yes 2 ❑ No

2 ❑ Black

2❑ Medtcue 6 n Patmnt paid PHYSICIAN7

3. SEx A2tan ) Pacfic Not S. DOES PATlENT

3❑ Islander 2 D H,spmnw 3❑ Medmaid 7 ❑ No charge l~Ya SMOKE CIGARE7TES7

, ~ Fc,m~I~2a f&I[e Amence.n IndmmI

7rJYe3

4 p Eskimo / AJeut 4 ❑ other government a ❑ 0th6r 2~N0 3 ❑ Unknown

2QN0

10. PATlENT’S COMPLAINT(S), SYMPTOM(S), 11. PHYSICIAN’S OIAGNOSES 12. HAVE YOU OR

OR OTNER REASON(S) FOR THIS VISIT

13. DOES PATIENT

ANYONE IN YOUR NOW HAVE

11.pontn! ‘s men words) PRACTICE SEEN fChcck all dw c7Pp/Y

. ~_~wl PATENT BEFORE? ,egwdlesx of any entry

m item 11]

s M:- nlmtimlo.t IDYDS 2QN0 I ❑ None of below

2 ❑ DepressIon

bcmO- bCUwr If Y63, fw the cundtion

in Item 11*? 3 ❑ Hyperiemwon

4❑ Hypercholesterolamia

CDm9r IDY64 2~N0

. . Otru 5❑ Obslty

i4. AMBULATORY SURGICAL 15. DIAGNOSTIC / SCREENING SERVICES

{Check all ordered orprovzdcdl

16. THERAPEUTIC SERVICES

PROCEDURE(S) [Check all ordered orprowded. Excltie medtcarton]

tRecord m? ourpaw.! dqnowc or I ❑ None 11 ❑ Pap test

thcraprunc procedurt For rhtfirsr,

check .ppWpt,lUt boxes j

2 a Blood pfessure IZ IJ Strep throat test I a Nd+Te 6a~abus6 OTHER THERAPY

3❑ Urmalyms 13D HfV ~rology

7❑ -hoi abuse

4❑ EKG - resting 14❑ CholezIerol measure COUNSELING / 13❑ Psychotherapy

EDUCATION

5❑ EKG - 0XWG130 15❑ Other lab test 8❑ 3mc40ng mazation

4

14❑ Comctwe len3a3

I ~ Scheduled 3 D Local anesthesia 6 ❑ Mammogmm 2 ❑ Dint !6 ❑ Hennng test M ❑ Hearing aid

2 ~ Pertornmd

B❑ Fmmly / sccial

4 D Reg!onal anes1h6sla 7 ❑ Chest x-ray I 7 Q W3ual acuity 3 ❑ Exermse 16❑ Physiotherapy

w ❑ Growth 1 development

s ~ General anesmesla 8 D other rad,ology 16❑ Mental status exam 4 ❑ Cholesterol reductmn 17❑ Other therapy [Spec)fy]

10 ❑ ~er ISPCC,fi/ 11❑ Family planning

9 Q Allergy mstmg 5 ❑ Wkughtreduction

12D Omef c.0un3011ng

b

10❑ SpwOmetW

17. MEDICATION ff none, check hem ❑ ~. N~~ m~~@”? 78. DISPOS~lON THIS VISIT 19. OURATION

{Record all aew Yes No

(Check all that ZIPpiyl

or conrt.ued

%5 vtsrr

mcdtcwons i ❑ No fOllOW-Up p16tll16d [Time acrually

1. ordered or ~n 20

Spc?tl Wtth

pro, ided at 2 ❑ %tum ●t speifmd time phywan]

/h,$ tw,I Usc

the mmc brand 2. 10 20 s ❑ Return If n66d8d, P.R.N.

nameor gentric

name entered on

4 ❑ Telephme follow-up plarmd

on%Rx o, of,cc 3, 10 21J

mrd:cal r?cord

5 ❑ Referrad to other physicmn

Include mtmu.rzt.~ 6 ❑ Rerwmd to rafwring physic,an

and de.mmti:mg 4. fci 20

agents 1 7 ❑ Mmlt to Im6pital

s. 10 20 6 ❑ Othu [Speci~j Mtnutes

Figure 1. Patient record

person. The pattern, however, was

found to be slightly different for

males and females. Among males,

rates increased with each age group

after the age of 24, with males

75 years and over having the highest

rate of 6.1 visits per person.

Females, despite a general trend

toward increasing visit rates with age

after the age of 24, showed no

statistical difference in the rates for

females aged 2544 years compared

with those aged 45-64 years, or in the

rates for females aged 65-74 years

compared with those aged 75 years

and over.

White persons made 87.8 percent

of all office visits during 1991, with

black persons and AsianPacific

Islanders accounting for 8.7 percent

and 3.0 percent, respectively. The

percent of visits made by white

persons was higher than that reported

in 1990, but this is probably due to a

change in the coding procedure. For

survey years before 1989, unspecified

responses to the race item were

randomly imputed a race designation.

The 1989 and 1990 NAMCS included

an “unspecified” category in the

race item, which resulted in a

significantly smaller proportion of

visits by white persons than in

previous survey years. The 1991

NAMCS reverted to the previous

method of imputation of unspecified

responses in order to maximize

comparability across years of survey

data. This method yielded a slightly

higher proportion of visits by white
Advance Data No. 230. March 29,1993 3

Table 1. Number, percent distribution, and annual rate of office visits by patient’s age, sex,

race, and geographic region: United States, 1991

Number of

Number of visIta per

Vlslts In Percent person per

Patient cfiaracterstic thousands distribution yearl

All visits . . . . . . . . . . . . . . . . . . . . . .

Age

Under 15 years . . . . . . . . . . . . . . . .

15-24 years . . . . . . . . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . . . . . . . . .

45-64years . . . . . . . . . . . . . . . . . . . . .

&5-74years, . . . . . . . . . . . . . . . .

75years Andover . . . . . . . . . . . . . .

Sex and age

Female . . . . . . . . . . . . . . . . . . . . . . . .

Under 15years . . . . . . . . . . . . . . . . . .

15-24years . . . . . . . . . . . . . . . . . . . .

2544years . . . . . . . . . . . . . . . . . . . .

45-84years . . . . . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . .

75years Andover . . . . . . . . . . . . . .

Male . . . . . . . . . . . . . . . . . . . . . . . . . .

Under 15years . . . . . . . . . . . . . . . . . .

15-24years . . . . . . . . . . . . . . . . . . . .

25-44years . . . . . . . . . . . . . . . . . . . .

45-S4years . . . . . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . . .

75 yearsand over . . . . . . . . . . . . . . . .

Race and age

White . . . . . . . . . . . . . . . . . . . . . . . . .

Under 15 years . . . . . . . . . . . . . . . . . .

15-24years . . . . . . . . . . . . . . . . . . . .

25-44years . . . . . . . . . . . . . . . . . . . .

45-64years . . . . . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . .

75 yearsand over . . . . . . . . . . . . . . . .

Black . . . . . . . . . . . . . . . . . . . . . . . . .

Under 15years. . ;........ . . . . . . .

15-24years . . . . . . . . . . . . . . . . . . . .

2544years . . . . . . . . . . . . . . . . . . . .

45-64years, . . . . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . . .

75years Andover . . . . . . . . . . . . . . . .

All other races

Asian/PacificIslander. . . . . . . . . . . .

Americertlndian/Eskimo/Aleut. . . . . . . . .

Geograpfmc region

Northeast . . . . . . . . . . . . . . . . . . . . . . .

Midwest . . . . . . . . . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . . . . . . .

West . . . . . . . . . . . . . . . . . . . . . . . . . .

669,689 100.0 2.7

125.025 16.7 2.2

61,534 9.2 1.8

185,267 27.7 2.3

141,994 21.2 3.0

63,669 12.5 4.6

72,181 108 6.0

400,485

60,157

40,447

122,449

83,210

49.475

44,747

269,205

64,868

21,088

62,818

58,783

34,214

27,434

587,800

103<174

54,099

161,071

125,363

76,306

67,787

58,494

16,377

5,213

17,198

11,660

4,682

3,364

59.8

9.0

6.0

18.3

12,4

7,4

6.7

40.2

9.7

3.1

9.4

6.6

5.1

4.1

87.8

15.4

6.1

24.1

18.7

11.4

10.1

8.7

2.4

o.a

2.6

1.7

0.7

0.5

3.1

2.2

2.3

3.0

3.4

4.9

5.9

2.2

2.3

1.2

1.6

2.6

4.2

6.1

2.0

2.3

2.0

2.4

3.1

4.7

6.2

1.9

1.9

1.0

1.6

2.4

2.9

3.5

20,127 3.0 . . .

3,269 0.5 ..-

154,669 23.1 3.1

166,680 24.9 2.8

193,071 28.8 2.3

155,070 23.2 2.8

lBasedon U.S. BureauOfthe Census estlmatea of thec!vlllan nonlnslltut!onal! zedpopulatiOn oflhe United SU!es~of

July 1, 1991.

persons compared with 1989 and1990

data. However, visit rates by age, sex,

and race were not statistically

different from rates observed in the

1989NAMCS.

Physician characteristics

The distribution of office visits

according to physician specialty for

the 13 most visited specialties is

presented in table 2. The largest

share of visits (24.6 percent) was

made to physicians specializing in

general and family practice (GFP);

this percentage, however, is

signilicantIy smaIIer than the one

notedin 1990 (29.8 percent). A

significant decrease was also seen in

thevisit rateto generaIandfamiIy

practitioners, from 85.2 visits per 100

persons in 1990 to 66.3 visits per 100

person in 1991. Visit rates to each of

the other 12specialties were not

significantly different from 1990

visit rates. However, provisional data

concerning these physician specialties

for 1991 indicates increa.ses in the

proportion ofvisits madeto

internists, orthopedic surgeons,

dermatologists, otola~ngologists, and

urologists compared with 1990 figures,

asweIl as a slight decrease in the

proportion ofvisits madeto

psychiatrists. No significant

differences were found in the

proportion of visits to pediatricians,

obstetricians and ~qnecologists,

ophthalmologists, general surgeons,

and neurologists.

A slightly higher proportionof

visits were made to doctorsof

osteopathyin 1991 (7.0percent) than

in 1990 (5.6 percent). Osteopathic

physicians received 18.8 visits per 100

persons during the year, compared

with 250.5 visits per 100 persons to all

other physicians.

Visit characteristics

Referral status and prior-visit

status

IngeneraI,6.2 percent of office

visits in 1991 were made as the result

of a referral from another physician,

an increase from the 5.5 percent

noted in 1990. The majority of office

visits (83.3 percent) were made by

patients who had seen the physician

on a pre~rious occasion, and more

than half (61.8 percent) of all visits

were made by persons who were

returning to the physician for care of

a previously treated problem

(table 5). Only 16.7 percent of visits

were made bynewpatients. These

percents are not significantly different

from those reported in 1990.

Expected source of payment

This item was revised slightly

from the 1990 NAMCS, with the

addition of the “privatejcommercial”

and “otherg overnment’’payment

categories. “Private/commercial”

replaces the former categories of

commercial insurance and BIue

Cross/Blue ShieId from the 1990

NAMCS. Data on expected source

payment are shown in table 4.

Expected sources of payment

were most often private, commercial

of
4 Advance Data No. 230. March 29.1993

Table 2. Number, percent distribution, and annual rate of office visits by physician

specialty and professional idantity: United States, 1991

Number of

Number of vkits per

wits in Percent 100 persons

Phys/c/an spec!alty thousands dMribution per yearl

All visits . . . . . . . . . . . . . . . . . . . ,.

General and family practice . . . .

Internal medicine. . . . . . . .

Pediatrics, . . . . . . . . . . .

Obstetm;sandgynecology.

Ophthalmology ,., ,. . . . . .

Orthopedic surgery . . . . . . . . . . . . .

Dermatology ., ...,,.,. . . . . . . . .

General surgery . . . . . . . . . . . . .

Otolaryngology . . . . . . . .

Psychiatry, ,,, ,. .,..., . . . . . . . . . .

Urological surgery . . . . . . . . . . . . . . .

Cardiovascular diseases. . . . . . . . .

Neurology . . . . . . . . . . . . . . .

All otherspeciallles . . . . . . . . . . . . . .

Professional identity

Doctorofosteopathy . . . . . . . . . . . . . . .

Doctorofmedicine . . . . . . . . . . . . . . . . .

669,689

164,857

102,923

74,646

56,834

41,207

35,932

29.659

21,285

19,101

15,720

12,758

11,629

6,798

76,341

46,727

622,962

100.0

24.6

15,4

11.1

8.5

62

5.4

4.4

3.2

2.9

2.3

1.9

1.7

1.0

11.4

7.0

93.0

269.3

66.3

41,4

30.0

22.9

16.6

14.4

11.9

8.6

7.7

6.3

5.1

4.7

2.7

30.7

18.8

250.5

lBasedon U.S. Bureau of the Census est!males of theclvilban nonlnst!tutlona fizedpopu!alion of the United States SOf

Jufy 1, 1991.

Table 3. Number and percent distribution of offica visits by refarral status and prior-vkit

status: United States, 1991

Numberof

visits in Percent

V/s/t characteristic thousands distribution

Allvlsits, . . . . . . . . . . . . . . . . . . . . . . . 669,689 100.0

Referral status

Referred byanother physician. . . . . 41,598 6.2

Not referred by another physician . . . . . . . 628,091 93.8

Prior-visit status

Newpatient, . . . . . . . . . . . . . . . . . . . . . . . . . lti,aol 16.7

Old patient . . . . . . . . . . . . . . . . . . . . . . . . . . . 557,888 83.3

New problem. , . . . . . . . . . . . . . . . . . . . . . . 144,190 21.5

Old problem . . . . . . . . . . . . . . . . . . . . . . . . 413,698 61.8

Table 4. Number and percent distribution of office visits by patient’s expected source of

payment: United States, 1991

Numberof

vistts in Percent

Expected source of psymentl thousands distnbufion

Allvislts, , ., .,, . . . . . . . . . . . . . . . . . 669,689 100.0

Prwate/commerclalmsurance . . . 239,425 35a

Patient-pa]d . . . . . . . . . . . . . . . . . . . . 157,834 23.6

Medicare, . . . . . . . . . . . . . . . . . . . . 141,679 21.2

HMO/otherprepaid..,...,. . . . . . . . . . 100,983 15.1

Medicaid . . . . . . . . . . . . . . . . . . . . . . . 63,411 9.5

0thergovernment2 . . . . . . . . . . . . . . . . 14,409 2.2

No charge . . . . . . . . . . . . . . . . . . . . . . 10,437 1.6

Other . . . . . . . . . . . . . . . . . . . . . . . 27,390 4.1

Unknown, . . . . . . . . . . . . . . . . . . . . . 13,828 2.1

1Number may exceed total number of wrs because more than one source of payment may be coded for each VIS1l.

2Calegorysnew on the 1991 Nat!onalAmbulaloV Medcal Care Swvey

insurance (35.8 percent ofvisits) and

patient-paid (23.6 percent). The

patient-paid category includes the

patient’s contribution toward ’’copayments” and “deductibles.” Medicare wasan expected payment source

at 21.2 percent of visits overall, a significant increase from the 19901evel

of19.8percent. For persons 65:years

of age and over, Medicare wasan

expected source of payment at

80.6 percent of visits.

“HMO/other prepaid” was

mentioned at 15.1 percent of visits,

which was not significantly different

from the19901eveI of14.5percent.

An increase was noted in the percent

of visits with Medicaid as unexpected

payment source, from 8.5percent in

1990 t09.5percent in1991. Readers

should note that physicians were

asked to check all of theapplicalble

payment categories for this survey

item, with the result that muItipIe

payment sources could be coded for

each visit.

Is this visit injury related?

The1991NAMCS incIudeda

new item on the Patient Record in

which the physician was asked to

record whether the visit was injuly

related. About 66.1 million visits, or

9.9 percent ofall office visits, were

injury related; more than half of

these visits (55.3 percent) were made

by males, and 41.1 percent were made

bypersons 25-44 years old. Males

had a higher injury-visit rate thar~

females did overall (30.3 visits pe:r

100 males compared with 23.1 visits

per 100 females), but these

differences were evidenced only in

the age groups 15-24 years and 25-44

years. Injury-visit rates for males and

females in the age groups under 15,

45-64, 65-74, and 75 years and over

were not found to differ significantly.

Among femaIes, injury-visit rates

were lowest for those in the age

group under 15 years (11.4 visits per

100 femaIes underage 15). Visit rates

forthe other age groups (15-24 years,

2544 years, 45-64 years, 65-74 years,

and 75 years and over) were higher

than that of the youngest group, but

were not significantly different from

each other. For males, injury-visit

. .
Advance Data No. 230. March 29,1993 5

rates were not statistically different

for the youngest and two oldest age

groups (under 15, 65-74, and 75 years

and over). Males 15–24 years, 25-44

years, and 45-64 years had higher

injury visit rates (37.4, 39.7, and 33.7

visits per 1(.)0males in each age group

respectively), but these rates were not

statistically different from each other.

Injury-re[ated office visits are

described in terms of the patient’s

age and sex in tab[e 5.

Does patient smoke cigarettes?

Another new item in the 1991

NAMCS collected data on whether

the patient currently smokes

cigarettes. Results from the survey

showed that 10.1 percent of all office

visits, or 67.7 million, were made by

patients who smoke cigarettes.

However, the patient’s smoking status

was not known for 27.7 percent of the

total, or 185.2 million office visits.

Data on visits according to patient’s

cigarette smoking status are

presented in tables 6 and 7.

Reason for visit

Item 10 of the Patient Record

asks the physician to record the

patient’s (or patient surrogate’s)

“complaint(s), symptom(s), or other

reason(s) for this visit in the patient’s

own words.” Up to three reasons for

visit are classified and coded from the

survey according to A Reason for Visit

classification for .-4mbulato?y Care

(RVC) (4). The principal reason for

visit is the problem, complaint, or

reason listed in item 9a.

The RVC is divided into the

eight modules or groups of reasons

disp[ayed in table & More than half

of all visits were made for reasons

classified as symptoms (57.6 percent).

Respiratory symptoms accounted for

11.5 percent of all visits, and

musculoskeletal symptoms accounted

for 11.4 percent.

The 20 most frequently

mentioned principal reasons for visit,

representing 3S.2 percent of all visits,

are shown in table 9. (It is important

to note that the rank ordering

presented in this and other tables in

this report may not always be reliable

Table 5. Number, percent distribution, and annual rate of iniury-related office visits

by patient’s age and sex: United States, 1991

Number of P:fc$t

Number of visits per

vists in Percent 100 9ersons ofice

Patient charecterhric thousands distribution #., oer vearl – visity

All injury-related visits. . . . , , 66,066 100.0 26.6 9.9

Age

Under 15 years . . . . . . . . . . 7,417 11.2 13.3 1.1

15-24 years . . . . . . . . . . . . 10,510 15.9 30.4 1.6

2544ye6rs . . . . . . . . . . . . 27,126 41.1 33.4 4.1

4S-84 years . . . . . . . . . . . . 14,222 21.5 30.2 2.1

6S-74 years . . . . . . . . . . . . 3,955 6.0 21.6 0.6

75 years And over . . . . . . . . 2,836 4.3 23.7 0.4

Sex and age

Female . . . . . . . . . . . . . . . 29,544 44.7 23.1

Under 15years . . . . . . . . . . 3,098 4.7 11.4 :::

15-24 years . . . . . . . . . . . . 4,094 6.2 23.5 0.6

25-44 years . . . . . . . . . . . . 11,300 17.1 27.4 1.7

45-64 years . . . . . . . . . . . . 6,596 10.0 26.9 1.0

65-74 years . . . . . . . . . . . . 2,510 3.6 24.8 0.4

75years And over . . . . . . . . 1,945 2.9 25.9 0.3

Male . . . . . . . . . . . . . . . . 36,522 55.3 30.3 5.5

Under 15 years . . . . . . . . . . 4,319 6.5 15.2 0.6

15-24 years . . . . . . . . . . . . 6,415 9.7 37.4 1.0

25-44 years. . . . . . . . . . . . 15,626 24.0 39.7 2.4

45-64 years. . . . . . . . . . . . 7,626 11.5 33.7 1.1

65-74 years. . . . . . . . . . . . 1,450 2.2 17.7 0.2

75years and over . . . . . . . . 691 1.3 19.9 0.1

1%sed an U.S. Buresu of me Census estimatesof the civilian ncminatitutfonalized population of the United States as of

JuIY1.1991.

2&ssd on an estimated total of 669,689,0W office visia in 1SS1.

Table 6. Number and percent distribution of office visits by patient’s cigarette-smoking

status: United States, 1991

Does patient smoke cigarettes?

Number of

vhts in

thousands

Percent

distribution

Allvisits . . . . . . . . . . . . . . . . . . . . . 669,689 100.0

Yes . . . . . . . . . . . . . . . . . . . . . . . . 67,674 10.1

No . . . . . . . . . . . . . . . . . . . . . . . . . 416,771 62.2

Unknown . . . . . . . . . . . . . . . . . . . . . 185,245 27.7

Patient characteristic

All visits by patients who smoke

cigarettes . . . . . . . . . . . . . . . . . . . . 67,674 100.0

Age

Under 15years . . . . . . . . . . . . . . . . . ’237 “0.4

15-24 years . . . . . . . . . . . . . . . . . . . 6,131 9.1

2W14years. . . . . . . . . . . . . . . . . . . 27,939 41.3

4S64 years . . . . . . . . . . . . . . . . . . . 22,652 33.5

65-74 years . . . . . . . . . . . . . . . . . . . 7,575 11.2

75 years And over . . . . . . . . . . . . . . . 3,139 4,6

sex

Female . . . . . . . . . . . . . . . . . . . . . . 39,308 58.1

Male . . . . . . . . . . . . . . . . . . . . . . . . 28,366 41.9

mentioned reason having to do with

because near estimates may not differ illness or injuxy (3.6 percent).

from each other due to sampling Eighteen of the top 20 reasons

variability.) General medical for 1991 were also listed among the

examination was the most frequently 20 most frequently mentioned reasons

mentioned reason for visit overall for 1990, albeit in slightly different

(4.4 percent of the total), while order. The other two, depression and

cough was the most frequently low back symptoms, each accounted
6 Advance Data No. 230 ● March 29, 1993

Table 7. Number and percent distribution of office visits by physician specialty, according

to patient’s cigarette-smoking status: United States, 1991

Does patient smoke cigarefles?

Number of

VISILSm Don’t

Phys/cian specjal~ thousands Total Yes No know

Allvwts.. . . ,,, ..,,,,

General and family practice,

Internal medicme . .

Pedkwics, , . . . . .

Otxwtncsan dgynecology

Ophthalmology,

Ortho~edic surgery

Dermatology : :

General surgery

Otolaryngology, :

Psychiatry, ..,,, ,,, ,,.

Urologcalsurgery .

Caralovascular diseases,

Neurology

Allotherspec;altlk : : :

669,689

164,857

102,923

74646

56,834

41.207

35,932

29.659

21.285

19.101

15,720

12,758

11,629

6.798

76.341

100.0

100.0

100.0

1000

100.0

100.0

1000

100.0

1000

1000

1000

1000

100.0

100.0

100.0

Percent dMibution

101 62.2

12.6 63.5

13.3 83.3

“0,4 96.8

118 61,9

6,6 43.0

9,2 3B.8

42 33.0

13,2 563

8.0 62.3

16,1 59.6

9.3 51.4

8.2 61,7

13,7 63.4

11.7 61.3

27.7

23.9

23.4

2.8

26.3

504

52.0

62.8

30.5

29.7

24.3

39.3

30.1

22.9

26.9

for about 7.1 million visits. Their

higher position on the rank-listing for

1991 was due mainly to a small but

significant decrease in the number of

visits for hypertension and chest pain

and related symptoms.

Diagnostic and screening services

Statistics on diagnostic and

screening services ordered or

provided by the physician during the

office visit are displayed in table 10.

The list of diagnostic and screening

services appearing on the Patient

Record is changed periodically to

reflect the changing needs of data

users, recommendations of advisors,

and anticipated future health data

needs. The 1991 NAMCS added a

number of services that either had

never appeared on the Patient

Record or had not been included for

several years. New categories for 1991

include the following: EKG - resting,

EKG - exercise, allergy testing,

spirometry, strep throat test, hearing

test, and mental status exam, In

addition, the former “other” category

was expanded to permit greater

specificity with the addition of the

“other radiology” and “other lab

test” categories.

More than half (64.8 percent) of

all office visits included one or more

diagnostic or screening service. The

most frequently mentioned diagnostic

service was blood pressure check,

recorded at 43.2 percent of visits. This

percent was significantly higher than

that recorded in 1990. (The

1990 percent was also higher “than

that found in 1989.) Also, blood

pressure checks were ordered or

provided at a higher percent of visits

by females (47.9 percent) than visits

by males (36.1 percent) in 1991, but

the percents for both sexes showed an

increase over 1990 figures,

Other frequently mentioned

diagnostic and screening services

included the new category of “other

lab test” (17.1 percent of visits),

urinalysis (12.7 percent), and visual

acuity (6.0 percent). Pap tests were

ordered or performed at 4.2 percent

of visits, while cholesterol measures

were taken at 4.0 percent of visits.

Also prominent among the new

categories for 1991 were visits at

which other radiology (that is,

radiology other than chest x ray) was

mentioned (5.5 percent), visits at

which a resting EKG was ordered or

provided (2.8 percent), and visits with

a test for strep throat (2.0 percent).

Ambulatory surgical procedures

The 1991 NAMCS included a

new item concerning ambulatory

surgical procedures that were

scheduled or performed at the

current visit. Physicians were asked to

record up to two outpatient

diagnostic or therapeutic procedures,

and additional data were collected on

the type of anesthesia used for the

first-listed procedure. Preliminary

results indicate that ambulatory

surgical procedures were reported at

6.2 percent of all office visits – about

44.4 million procedures scheduled or

performed. More detailed data on

these procedures will be reported in a

forthcoming publication.

Principal diagnosis

Item 11 of the Patient Record

asks the physician to record the

principaI diagnosis or problem

associated with the patient’s most

important reason for the current visit

as well as any other significant

current diagnoses. Up to three

diagnoses are coded and classified

according to the International

Classification of Dkeases, 9tA Revision,

Clinical Modification (ICD-9-CM)

(5).

Displayed in table 11 are office

visits by principal diagnosis using the

major disease categories specified by

the ICD–9-CM. The supplementary

classification, used for diagnoses that

are not classifiable to injury or illness

(for example, general medical

examination, routine prenatal

examination, and health supervision

of an infant or child), accounted for

15.1 percent of all office visits.

Diseases of the respiratory system

(13,8 percent) and diseases of the

nervous system and sense organs

(11.6 percent) were also prominent

on the list.

The 20 most frequently reported

principal diagnoses for 1991 are

shown in table 12. These are

categorized at the three-digit coding

level of the ICD–9–CM, and account

for 35.2 percent of all office visits

made during the year. The most

common diagnosis rendered by

physicians at office visits in 1991 was

essential hypertension, occurring at

3.5 percent of all visits. Essential

hypertension has been the most

frequently reported morbidity-related

diagnosis in every survey year since

the NAMCS began in 1973.

(Morbidity-related diagnoses are
Advance Data No. 230 c March 29,1993 7

Table 8. Number and percent distribution of office visits by patient’s principal reason for

visik United States, 1991

Number of

visits in Percent

Prh-rcioa/ reason for visit and RVC codel thousands distribution

Allvisi@ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 669,689 100.0

Symptom module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S001–S999 385,861 57.6

General symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S001+099 44,230 6.6

Symptoms referable topsychological/mental disorders. . . . . . . . .S100-S199 18,291 2.7

Symptoms referable tothenewoussystem

(excluding senseorgans) . . . . . . . . . . . . . . . . . . . . . . . . . .S200-S259 21.068 3.1

Symptomsreferab letothecardiovaacular/lym phatic

aystem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..S26&S299 3.417 0.5

Symptoms referable totheeyes and ears. . . . . . . . . . . .S300-S399 43,589 6.5

Symptoms referable totheresplratory system . . . . . . . . . . .S400-S499 76,764 11.5

Symptoms referable tothe digestive system . . . . . . . . . . . . . .S500–S639 27,074 4.0

Symptoms referable tothegenitourmary system. . . . . . . . . . . . .S640-S829 31,265 4.7

Symptoms referable totheskin, hair, andnalls. . . . . . . . . . . . . .S830-S899 43,809 6.5

Symptoms referable tothemusculoskeletal system. . . . . , . . . .S900-S999 76,356

Disease module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Doo1-D999

11.4

64.926 9.7

Diagnostic, screening, and preventive module . . . . . . . . . . . . . .X1OO-X599 101.002 15.1

Treatment module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..TIOO-T899 65,333 9.8

Injuries andadverse effects module . . . . . . . . . . . . . . . . . . . .JOO1-J999 20,462 3.1

Testresults module . . . . . . . . . . . ... . . . . . . . . . . . . . . . .. R1OO-R7OO 6,832 1.0

Ad:;;i:trative module . . . . . . . . . . . . . . . . . . . . . . . . . . . ..A1OO-A14O 7,122 1.1

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .U990–U999 18,150 2.7

1Based on A Reason for Km CLessrket;on for Arnbuktxy Care (RVC),(4).

21ncludesprob!ems andcomplaints notelsetiere c[=slfied, entries ot""none,"' blanb, and i[leglbleentriea.

Table 9. Number and percent distribution of office visits by the 20 principal reasons for

visit most frequently mentioned by patients: United States, 1991

Percent distribution of visits

Number of

visits in All

Reason for visit and RVC codel thousands visits Female Male

All visits . . . . . . . . . . . . . . . . . . . . . . . . . .

General medical examination. . . . . . . . . .X1OO

Cough . . . . . . . . . . . . . . . . . . . . . . ..S440

Routine prenatal examination. . . . . . . . . .X205

Symptoms referable to throat. . . . . . . . . .S455

Postoperative Visit. . . . . . . . . . . . . . . . .T205

Earache orear infection. . . . . . , . . . . . .S355

Well baby examination. . . . . . . . . . . . . .X105

Back symptoms . . . . . . . . . . . . . . . . ..S905

Skin rash . . . . . . . . . . . . . . . . . . . . ..S660

Stomach pain. cramps, andspeems . . . . .S545

Fever . . . . . . . . . . . . . . . . . . . . . . . ..S010

Headache, pain in head. . . . . . . . . . . . .S210

Wsion dysfunctions. . . . . . . . . . . . . . . .S305

Knee symptoms . . . . . . . . . . . . . . . . ..S925

Nasal congestion . . . . . . . . . . . . . . . ..S400

Blood pressure test. . . . . . . . . . . . . . . .X320

Head cold, upper respirato~ infection

Lsoryza) . . . . . . . . . . . . . . . . . . . . ..S445

Neck symptoms . . . . . . . . . . . . . ,.. ..S900

Depression . . . . . . . . . . . . . . . . . . . ..S110

Lcw back symptoms . . . . . . . . . . . . . ..S910

All other reasons . . . . . . . . . . . . . . . . . . . . .

669,689

29,720

24,263

19,675

17,882

16,308

13,404

13,278

12,977

12,119

11,106

10,318

10,126

10,011

9,522

8,444

7,645

7,616

7,193

7,060

7,051

413,971

100.0

4.4

3.6

2.9

2.7

2.4

2.0

2.0

1.9

1.6

1.7

1.5

1.5

1.5

1.4

1.3

1.1

1.1

1.1

1.1

1.1

61.8

100.0

4.8

3.6

4.9

2.7

2.3

1.9

1.7

1.9

1.7

1.8

1.5

1.2

1.5

1.2

1.1

1.2

1.1

1.0

1.2

0.8

60.9

100.0

3.9

3.7

2.6

2.7

2.1

2.4

2.0

2.0

1.4

2.1

1.5

1.5

1.7

1.5

1.1

1.2

1.1

0.9

1.4

63.2

lBasedon AReason fOr WsrtC/ass/ficaI/on for Ambu/atoy Care (RVC), (4),

those classifiable toillness or injury.

Xonmorbidity-related diagnoses

include routine prenatal examination,

health supervision of an infant or

child, and general medical

examination, among others.)

Of the 20 diagnoses shown in

table 12, 17 also appeared on the list

of the 20 most frequent diagnoses for

1990. New on the Iist for 1991 were

contact dermatitis and other eczema,

general symptoms, and special

investigations and examinations. The

latter is a diagnosis in the

supplementary classification and

includes routine examinations of

specific systems, for example,

gynecological, vision, and hearing

exams. Dropping out of the top 20

from 1990 were osteoarthrosis and

allied disorders, disorders of

refraction and accommodation, and

other forms of chronic ischemic heart

disease.

In order to assess the significance

of some of the changes in physicians’

diagnoses over the years, visit rates

for selected diagnoses from 1985-91

are compared in table 13. Between

1985 and 1991, increases were seen in

office visit rates for chronic sinusitis

and glaucoma, while decreases were

noted in visit rates for disorders of

refraction and accommodation and

neurotic disorders. Slight decreases

were also noted in visit rates for

essential hypertension and normal

pregnancy between 1985 and 1991.

Additional years of data will help to

put these apparent changes into

better perspective.

Physicians’ checklist of medical

conditions

In addition to the diagnostic data

reported in item 11 of the Patient

Record, selected information on the

patient’s current health status was

collected in item 13, another addition

to the 1991 NAM(XL Physicians were

given a list of four common

conditions —depression, hypertension,

hypercholesterolemia, and

obesity– and asked to record whether

the patient now had any of them,

regardless of what was recorded as

the current diagnosis in item 11 of

the survey form, Results from item 13

are shown in tables 14 and 15.

Nearly one-quarter (24.1 percent)

of the visits were made by patients

who were reported to have one or

more of the four conditions listed on

the survey form. Hypertension was

checked most frequently, at

12.7 percent of the total– about 85.3

million visits. This figure is

substantially higher than the number

of visits in which a first, second, or

third diagnosis of essentiai

hypertension (ICD-9-CM code 401)

was reported in item 11 of the Patient

Record (41.9 miI1ion visits or

6.3 percent of the total), and suggests
8 Advance Data No. 230. March 29, 1993

Table 10. Number and percent distribution of office visits by diagnostic and screening

services and patient’s sex: United States, 1991

F’ercenfdfstrdwfmn of wits

Number of

Diagnostic and screening serwces wits in All

ordered or prowded by physician thousands wits Female Male

Allvisrts ..,...,.. . . . . . . . . . . . . 669,669 100.0 100.0 100.0

None, ..,.,...,,.....,.. . . . . . . . 236.035 35.2 31,6 40.7

Blood pressure . . . . . . . . . . . . . . . . . . . 269,153 43.2 47.9 36.1

Urinalysis . . . . . . . . . . . . . . . . . . . . . . . 65,194 12.7 15.3 8.9

EKG- Restlng2, . .,, ,., . . . . . ... ,., 19,020 2.8 2.6 3.2

EKG- Exerclse2, ,., . . . . . . 2,661 0.4 02 0.7

Mam~ogram. ,,, ,. ., . . . . . . . . 11,558 1.7 2.9

Chest bray..,.,....,,. . . . . . . . . 16,307 2.4 2.2 2:7

Other radlologyz. . . . . . . . . . ,., 36.864 5.5 4.9 6.3

Allergy testmgz 1,445 0.2

Splromet~2...J;,j”I”I ;::::

0.2 0.3

2,486 0.4 0.3 0,4

Pap test ., ., . .,.,.,.., . . . . . . . . . 28,313 4,2 7.1 0.0

Stre?throattest2, . . . . . . . . . . . . . 13,650 2.0 2.0 2.1

HIVserology. ,.., . . . . . . . . . . . . 1.362 0.2 0.2 0.2

Cholesterol measure . . . . . . . . . . . . . . . 26,932 4.0 4.4 3.4

0therlabtest2. . . . . . . . . . . . 114.274 17.1 70.4 15.1

Hear!ngtest2. ,..,... . . . . . . . . 9,282 1.4 1,1 1.9

Vwa!acuty,,. .,,.,, . 40.374 6.0 5.6 6.7

Menfa!status exam2 .,.,.. ...,,,.., 8.664 1.3 1.1 1.5

Other . . . . . . . . . . . . . . . . . . . . . . . . 67,757 10,1 10.6 9.4

lNumoers may noladdlo!otals because more than onesemlce may berep.xed pervmt.

2Categoy IS new in the 1991 Nat!onal Ambulatory Medical Care Survey.

Table ll. Number and percent distribution of office visitsby principal diagnosis:

United States, 1991

Numberof

wsits m Percent

Print/pa/ diagnosis and ICD-9-CM codel thousands distribution

Allvists . . . . . . . . . . . . . . . ,..

Infectious andparasitrc diseases. . .

Neoplasm . . . . . . . . . . . . . . . .

Endocrine, nutritional and metabolic

dlsezse sand lmmunityd!sorders. .

Menta!d!sorders, ,. ..,.,. . . . .

Dtseases of the nervous system

and senseorgans . . . . . . . . . . .

Diseases of theclrculatory system.

Diseases of the respiratory system. .

Diseases of the digestive system. , .

Diseases of the genitourinary

system . . . . . . . . . . . . . . . . . .

Diseases of the skin

and subcutaneous tissue. .

Diseases of the musculoskeletal

system and connective tissue . . .

Symptoms, signs, anddl-defmed

condmons.. .,,...., ,.,...

Injury andpotsoning . , . . . .

Supplementary classtflcatlon . .

All otherdtagnoses2 .

Unknowns . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . .001-139

. . . . . . . . . . . . . . . . . . . . . .140-239

. . . . . . . . . . . . . . . . . . . . . . . .240-279

. . . . . . . . . . ,,..., . . . . . 290-319

. . . . . . . . . . . . . . . . . . . . . . .,320-389

. . . . . . . . . . . . . . . . . . . . . . . .39C-459

. . . . . . . . . . . . . . . . . . . . . .460-519

. . . . . . . . . . . . . . . . . . . . . . . .520-579

. . . . . . . . . . . . . . . . . . . . . . .58C-629

. . . . . . . . . . ,,,.. . . . . . . . . .680-709

. . . . . . . . . . . . . . . . . . . . . . .710-739

. . . . . . .,,.,. . . . . . . . . . . .760-799

. . . . . . . . . . . . . . . . . . .800-999

. . . . . . . . . . . . . . . . . . Vol -V82

. . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . .

669,689

24,570

23,308

27,312

26,167

77,724

50,226

92,100

22,724

39,308

39,578

45,829

25.694

53,400

101,433

9292

11,025

100.0

3.7

3.5

4.1

3.9

11.6

7.5

13.8

3.4

5.9

5.9

6.8

3.8

S.o

15,1

1.4

1.6

18ased on the /nternaf/ona/Classificationof Diseases,9fh Hew/s/on,C/tn/ca/ModificalJofl (lCD-9-CM) (5),

21ncluCes d!seases oflhebtood and blood-form! ng0rgans (28&z89): complications ofpregnancy, chlldbZti. and the

puerpenum (630-676); congemlal anomalres(74C-75S);and cenam concl!ttons ongmatmg m the perinatal period (760-799).

31ncluaes blank diagnoses, uncodable dmgnoses, and!llegtble diagnoses.

the possibility that physicians tend to at the office visit (item 16 on the

underreport chronic conditions in Patient Record) are shown in

item 11. table 16. This item underwent

substantial revision in the 1991

Therapeutic services hTAMCS, with an expanded list of

therapeutic categories permitting

Data on therapeutic services greater specificity in physicians’

ordered or provided by the physician responses.

About one-third (33.1 percent) of

all office visits included some form of

counseling, education, or other

nonmedication therapy. Diet

education or counseling was

mentioned most frequently, at

11.4 percent of the total, or 76.5

million visits. Other prominent

categories included exercise

(8.2 percent), drug abuse

(3.8 percent), weight reduction

(3.1 percent), and growth/

development (3, 1 percent),

Medication therapy

Data on medication therapy are

shown in tables 17–21, Medication

therapy was the most commoniy

mentioned therapeutic service in

1991, reported at 425.7 million office

visits or 63.3 percent of the total

(table 17). Physicians were instructed

to record all new or continued

medications ordered or provided at

the visit, including prescription and

nonprescription preparations, and

immunizing and desensitizing agents,

As used in the NAMCS, the term

“drug” is interchangeable with the

term “medication,” and the term

“prescribing” is used broadly to mean

ordering or providing any medication,

whether prescription or

over-the-counter. Visits with one or

more drug mentions are termed

“drug visits” in the NAMCS. As

many as five medications, or drug

mentions, could be coded per drug

visit, resulting in a total of 804.6

million drug mentions during 199:1.

This yields an average of 1.2 drug

mentions per office visit, or 1.9 drug

mentions per drug visit.

Data on number of drug visits

and drug mentions by physician

specialty are shown in table 18.

Internists and cardiovascular disease

specialists had the highest percentage

of drug visits, at 81.6 percent and

80.4 percent, respectively.

Drug mentions are displayed by

therapeutic class in table 19. This

classification is based on the

therapeutic categories used in the

National Drug Code Directory, 1985

edition (6). It should be noted that

some drugs have more than one

therapeutic application. In cases of
Advance Data No. 230 ● March 29,1993 9

Table 12. Number and percent distribution of office visits by the 20 principal diagnoses

most frequently rendered by physicians: United States, 1991

Percent distribution of visits

Number of

vwfs in All

Principal diagnosis and ICD-9-CM code; thousands visits Female Male

Allvkik . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Essent!al hypertension . . . . . . . . . ..401

Normal pregnancy . . . . . . . . . . . . . . . . . . ..V22

General medical examination . . . . . . . . . . . . .V70

Health supervision of infant or child . . . . . . . . .V20

Acute upper respiratory infections of multiple or

unspecified sites . . . . . . . . . . . . . . . . . . . . . .

Suppuratwe and unspectied otltis media. . .382

Diabetes mellitus . . . . . . . . . . . . . . . . . . ...250

Chronic smusltis . . . . . . . . . . . . . . . . . . ...473

Glaucoma . . . . . . . . . . . . . . . . . . . . . . ...365

Acute pharyngitis . . . . . . . . . . . . . . . . . ...462

Bronchitis, notspectfied asacute or chronic. ..490

Diseases ofsebaceous glands. . . . . . . . . ...706

Allergic rhinitis . . . . . . . . . . . . . . . . . . . ...477

Asthma . . . . . . . . . . . . . . . . . . . . . . . . ...493

Cataract . . . . . . . . . . . . . . . . . . . . . . . ...366

Contact dermatitis and other eczema . . . . . . . .692

Sprains and strains of other and unspecified

partsofback . . . . . . . . . . . . . . . . . . . ...847

Special investigations and examinations . .W’2

Neuroticdisorders . . . . . . . . . . . . . . . . . ...300

Generalsymptoms . . . . . . . . . . . . . . . . ...760

All otherdiagnoses . . . . . . . . . . . . . . . . . . . . . .

669,689 100.0

23,188 3.5

20,657 3.1

18,321 2.7

17,271 2.6

16.928 2.5

16,185 2.4

12,793 1.9

11,570 1.7

11,043 1.6

11,015 1.6

9,757 1.5

9,464 1.4

9,405 1.4

8,604 1.3

7,540 1.1

7,046 1.1

6,381 1.0

6,318 0.9

6,220 0,9

6,101 0.9

433.680 64.8

100.0

3.6

5.2

2.6

2.1

2.4

2.1

1.8

1.8

1.7

1.5

1.6

1.5

1.4

1.2

1.1

1.0

0.9

1.3

1.0

0.9

63.3

100.0

3.3

3.0

3.3

2.7

3.0

2.0

1.7

1.6

1.9

1.2

1.4

1.4

1.5

1.1

1.1

1.1

0.5

0.8

1.0

66.4

1Baaed on the Intemarional C)as.wficalionof Dseasas, 9fh Remon, Chmaf Modficaoon (ICD-9-CM) (5).

this type, each drug was assigned to

the category for which itwasrnost

frequently prescribed.

Cardiovascular-renal drugs accounted

for15.5 percent of all drug mentions,

while antimicrobial agents

(14.9 percent), pain reIief drugs

(10.6 percent) and respiratory tract

drugs (10.0 percent) were also

prominent.

The 20 most frequently used

generic substances for 1991 are shown

in table 20. In this table, drug

products containing more than one

ingredient (combination products) are

included in the data for each

ingredient. For example,

acetaminophen with codeine is

included in both the count for

acetaminophen and the count for

codeine. Amoxiciliin was the generic

ingredient most frequently used in

drugs ordered or provided by the

physician at office visits in 1991 (as

well as in 1990), occurring in

4.1 percent of drug mentions.

Seventeen of the 20 most used

generic ingredients for 1991 were also

on the list of the top 20 for 1990.

The 20 medications most

frequently ordered or supplied by

physicians at ofkice visits are shown by

entrv name of drus in table 21. Entrv

name refers to the actual designation

used by the physician on the Patient

Record form and may be a trade

name, a generic name, or simpIy a

desired therapeutic effect. AmoxiciIlin

was the medication most frequently

prescribed by physicians, with 18.0

million mentions, or 2.2 percent of

the total. lt was followed by Amoxil

(1.2 percent), Lasix (1.2 percent), and

Ceclor (1.2 percent).

The NAMCS drug data base

permits classification by a wide range

of variables, including specific product

name, generic class, entry form

chosen by the physician (that is,

brand name, generic name, or the

desired therapeutic effect),

prescription status (that is, whether

the product is prescription or

nonprescription), federally controlled

substance status, composition status

(that is, single- or multiple ingredient

product), and therapeutic category. A

report describing the method and

instruments used to collect and

process drug information for the

NAMCS is available (7).

Disposition of visit

About two-thirds (66.7 percent)

of all office visits included a

scheduled follow-up visit or telephone

call, while another 21.6 percent

included instructions to return if

needed. Less than one percent of

visits resulted in a hospital admission.

These percentages are not statistically

different than those reported in 1990.

Data on office visit disposition are

displayed in table 22.

Duration of visit

Data on the duration of office

visits are presented in table 23.

Duration of visit refers to the amount

of time spent in face-to-face contact

between the physician and the

patient. This time is estimated and

recorded by the physician and does

not include time spent waiting to see

the physician, time spent receiving

care from someone other than the

physician without the presence of the

physician, or time spent by the

physician in reviewing patient records

and/or test results. In cases where the

patient received care from a member

of the physician’s staff, but did not

actually see the physician during the

visit, duration was recorded as “zero”

minutes.

More than two-thirds

(68.3 percent) of office visits had a

duration of 15 minutes or less in

1991. The mean duration time for all

visits was 17.0 minutes.

Corresponding numbers for 1990

were 69.3 percent and 16.7 minutes,

respectively.

Additional reports that utilize

1991 NAMCS data are forthcoming in

the Advance Data from Wal and

Health Statistics series. In addition,

survey data will be available on

computer tape from the National

Technical Information Service at a

nominal cost beginning about June

1993. Questions regarding this report,

future reports, or the NAMCS may

be directed to the Ambulatory Care

Statistics Branch by calling (301)

436-7132.

References

1. Nelson C, McLemore T. The National

Ambulatory Medical Care Survey.

United States, 1975-S1 and 1985

trends. National Center for Health

Statistics. Vital HeaIth Stat 13(93).

19ss.
10 Advance Data No. 230. March 29, 1993

Table 13. Number, percent distribution, and annual rate of office visits by selected principal diagnoses, according to year of survey:

United States, 1985-91

Principal dtagnosis and ICD-9-CM codel 1985 1989 1991

Allvlsits .,......,.....,,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Essentialhypertens!on ..,... . . . . . . . . . . . . . . . . . . . . . ., . . . ...401

Normal pregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . ,, . . . . . . . . ..V22

Heaflhsupemwiono fmfantorchild . . . . . . . . . . . . . . . . . . . . ..V20

Suppurative and unspecifiedot!tw media, . . . . . . . . . . . . . .382

General med[cal exammation. , . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V70

Acute upper respratory infecftons ofmult!ple orunspecifledstes . . . ,465

D[abetes mellmds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . ...250

Neuroticd[sorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300

Acute pharyngttis . . . . . . ,., . . . . . . . . . . . . . . . . . . .,.462

Disorders of refraction andaccommodat!on . . , . . .367

Dlseasesofsebaceous glands. . . . . . . . . . . . . . . . . . . . . . . . . . . . ...706

Allergic rhm!lis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,..,...477

Bronchitis, notspeclfled asacute orchronic. . . . . . . . . . . . . . . . .490

Other forms ofchromci schemicheart disease . . . . . . . . . . . . . . . . . .414

Asthma. ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

Speciai investigations andexaminat!ons . . . . . . . . . . .V72

Contactdermat)tis andothereczema . . . . . . . . . . . . . . . . . . . . . . . ...692

Chfonicstnusltw . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . ...473

Osteoarthrosisand alheddtsorders . . . . . . . . . . . . . . . . . . . . . . ... ...715

Spramsand strains ofother andunspecified parts of back. . . . . . . . . . .847

Generalsymptoms. .,......, . . . . . . . . . . . . . . . . . . . . . ...780

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...365

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . ...401

Norma[ pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..v22

Health supemwonofi nfantorchild . . . . . . . . . . . . . . . . . . . . . . . . . ..V20

Suppurstwe and unspec!fledotitis medta, . . .362

General med[cal exammatlon .,. . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V70

Acute upper respiratory mfectlonsof multiple orunspecifled sites . . . .465

Dlabetesmelltus.. .,,.,,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Neurotlcd[sorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300

Acute pharynglis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...462

Disorders of refraction andaccommodat!on . . . . . . . . . . . . . .367

Dweasesofsebaceous glands.. . . . . . . . . . . . . . . . . . . . . ., . . . ...706

Allergic rhintits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...477

S3ronch!fis. not speciiedasacute orchronic. . . . . . . . . . . . . .490

Otherforms ofchrormclschemlc heartd!sease . . . . . . . . . . .414

Asthma, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

Special investigations andexammatlons . . . . . . . . . . . . . . . . . . . . . .V72

Contact dermatlhsa ndothereczema . . . . . . . . . . . . . . . . . . . . . . . . ...692

Chronicsinusitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...473

Osteoarthros!s andalhedd isorders . . . . . . . . . . . . . . . . . . . . . . . . . ...715

Spramsand strains ofother andunspecifted parts of back. . . . . . . . . . . .847

Generalsymptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...780

Glaucoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...365

Allvislts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Essential hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...401

Normal pregnancy, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V22

Health supervision ofinfantorchild . . . . . . . . . . . . . . . . . . . . . . ,.. . ..V2O

Suppurabve and unspecif(edotitts media. . . . . . . . . . . . . . . . . . . .362

General medical exammat!on. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..V70

Acute upper resplrato~ infections ofmultiple or unspecified sites . . . . . .465

DiabetesmellMm.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,.,.....250

Neurot!cdisordere . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...300

Acute pharyng[tis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..462

Disorders ofrefractlon andaccommodatlon . . . . . . . . . . . . . . . . . . . . . .367

Dlseasesofsebaceous giand$. . . . . . . . . . . . . . . . . . . . . . . . . . ...706

Ailerg!c rhinitfs, .,...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...477

Bronchitis. notspecifled as acute orchronic. . . . . . . . . . . . . . . . .490

Other forms ofchronic ischem!chearf disease . . . . . . . . . . . . . . . . . . . . .414

Asthma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493

Cataract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , ..,.,.366

Special mvestlgatlons andexammal!ons , . , . . . . . . . ., . . . . . .V72

Conlacf dermatitisand othereczema . . . . . . . . . . . . . . . . . . ...692

Chronlcsinus!tis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..473

Osteoarthros!sand aiheddlsorders . . . . . . . . . . . . . . . . . . . ...715

Sprains andatrams ofother andunspecif!ed parts of back. . . . . . . . . . . . . .647

General symptoms. .,.,... . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...780

Glaucoma . . . . . . . . . . . . . . . . . . . . .,.,.....,.,,,.......,365

636,386

26,049

24,182

17,068

15,607

14,916

14,691

12,302

9,320

9,302

8,266

8,104

7,835

7,563

6,732

6,503

6,265

6,638

5,837

5,675

5,522

5,322

4,874

4,304

100.0

4,1

3.8

2.7

2.5

2.3

2.3

1.9

1.5

1.5

1.3

1.3

1.2

1.2

1.1

1.0

1.0

0.9

0.9

0.9

0.9

0.8

0.8

0.7

274.1

11,2

10,4

7.4

6.7

6.4

6,3

5.3

4.0

4.0

3.6

3.5

3.4

3.3

2.9

2.8

2.7

2.5

2.5

24

2,4

2.3

2.1

1.9

Number of visits in thousands

692,702

27,708

23,578

15,669

20,033

20,166

15,765

13,237

8,511

10,958

7,686

8,146

11,631

11,160

5,712

6,622

6,335

4,261

6,542

6,700

6,259

7,614

5,550

4,952

Percent distribution

100.0

4.0

3.4

2.3

2.9

2.9

2.3

1.9

1.2

1.6

1.1

1.2

1.7

1.6

0.8

1.0

0.9

0.6

0.9

1.3

0,9

1.1

0.6

0.7

Number of visits per 100 personsz

264.4

11.4

9.7

6.4

8.2

8.3

6.5

5.4

3.5

4.5

3.2

3.3

4,8

4.6

2.3

2.6

2.6

1.7

2.7

3.6

2.6

3.1

2.3

2.0

669,689

23,186

20,657

17,271

16,185

18,321

16,928

12,793

6,220

11,015

5,420

9,464

9,405

9,757

5,713

8,804

7,540

6,318

7,048

11,570

5,513

6,381

6,101

11,043

100.0

3.5

3.1

2.6

2.4

2.7

2.5

1.9

0.9

1.6

0.8

1.4

1.4

1.5

0.9

1.3

1.1

0.9

1.1

1.7

0.’s

:::

1.6

269.3

9.3

8.3

6.9

6.5

7.4

6.6

5.1

2.5

4.4

2.2

3.8

3.8

3.9

2.3

3.5

3.0

2.5

2,8

4.7

2.2

2.6

2.5

4,4

lBasedon tho/nfernational Class! fiut!on of Diseases, 9th Rews!on, C/!n#cai Mod!f#mt/on(lC&XM) (5).

—

2Basedon U.S. Bureau Oithe Census es$,mates oflhec!v!ltan nonlnstltutlonallzed population of the Unlled States as of July 1 of each year.
Advance Data No. 230 ● March 29, 1993 11

Table 14. Number and percent distribution of office visits by selected med[cal conditions, according to patient’s age and sex:

United States, 1991

Patient’s age Patient’s sex

All Under 15 15-24 2$44 45-64 65-74

Medical conditiorrl

75 years

ages years years years years years and over Male Female

Number of vists in thousands

All visits . . . . . . . . . . . . . . . . . . . . . . . .

Depression . . . . . . . . . . . . . . . . . . . . . .

Hypertension . . . . . . . . . . . . . . . . . . . . .

Hypercholesterolemia . . . . . . . . . . . . . . .

Obesity . . . . . . . . . . . . . . . . . . . . . . . .

Noneoftheabove . . . . . . . . . . . . . . . . .

Allvisits . . . . . . . . . . . . . . . . . . . . . . . .

Depression . . . . . . . . . . . . . . . . . . . . . .

Hypertension . . . . . . . . . . . . . . . . . . . . .

Hypercholesterolemia . . . . . . . . . . . . . .

Obesity . . . . . . . . . . . . . . . . . . . . . . . .

None offheabove . . . . . . . . . . . . . . . . .

669,689

40,712

85,266

46,044

52,961

508,172

100,0

6.1

12.7

6.9

7.9

75.9

125,025

1,276

●524

’217

1,567

121,799

100.0

1.0

●0.4

‘0.2

1.3

97.4

61,534

1,863

●559

*174

2,653

56.761

100.0

3.0

“0.9

90.3

4.3

92.3

185,267 141,994 83,689

14,794 12,915 5,735

9,007 27,215 23,989

4,644 13,937 10,475

15,897 18,808 9,134

14S,782 89,606 46,764

Percent distribution

100.0 100.0 100.0

8.0 9.1 6.9

4.9 19.2 28.7

2.5 9.8 12.5

8.6 13.2 10.9

80.3 83.1 58.3

72,181

4,130

23,972

6,597

4,903

42,441

100.0

5.7

33.2

9.1

6.8

58.8

269,205

12,955

32,624

12,798

15,196

211,913

100.0

4.8

12.1

4.8

5.6

78.7

400,485

27,757

52,642

23,247

37,765

296,259

100.0

6.9

13,1

5.8

9.4

74.0

1Numbersmay notadd to totalsbecausepatientsmay have more than one cond!tion.

2. Schappert SM. National Ambulatory

Medical Care Survey 19S9 Summary.

National Center for Health Statistics.

Vital and Health Stat 13(110). 1992.

3. Scrapper! SM. National Ambulatory

Medical Care Survey 1990 Summaxy.

Advance data from vital and health

statistics; no. 213. Hyattsville,

Maryland: National Center for Heatlh

Statistics. 1992.

4. Schneider D, Appleton L, McLemore

T. A reason for visit classification for

ambulatory care. National Center for

Health Statistics. Vital and Health

Stat2(78). 1979.

5. Public Health Service and Health Care

Fhtancing Administration.

International Classification of

Diseases, 9th Revision, clinical

modification. Washington: Public

Health Service. 1980.

6. Food and Drug Administration.

National Drug Code Directory, 1985

Edition. Washington: Public Health

Service. 1985.

7. Koch H, Campbell W. The collection

and processing of drug information.

National Ambulatory Medical Care

Survey, 19S0. National Center for

Health Statistics. Vital Health Stat

2(90). 1982,

Table 15. Number and percent distribution of office visits by selected medical conditions

occurring singly and in clusters: United States, 1991

Number of

visits in Percent

Medical condition thousands distnbutiori

Allvislt s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 669,689 100.0

Oneoffour conditions . . . . . . . . . . . . . . . . . . . . . . 119,445 17.8

Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29,380 4.4

Hypetiension . . . . . . . . . . . . . . . . . . . . . . . . . . 50,676 7.6

Hypercholesterolemla . . . . . . . . . . . . . . . . . . . . . 12.147 1.8

Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27,242 4.1

Twooffour conditions . . . . . . . . . . . . . . . . . . . . . . 31,867 4.8

Depression and hypertension . . . . . . . . . . . . . . . . 3,433 0.5

Depression and hypercholesterolem!a. . . . . . . . . . . 951 0.1

Depression and obesity . . . . . . . . . . . . . . . . . . . . 2,800 0,4

Hypertension and hypercholesterolemia. . . . . . . . . . 10,800 1.6

Hypertension andobesify . . . . . . . . . . . . . . . . . . . 10,728 1.6

Hypercholesterolemia and obesiSy . . . . . . . . . . . 3,155 05

Three of four conditions . . . . . . . . . . . . . . . . . . . . . 9,016 1.3

Depression. hypertension, and hypercholesterolem!a 1,169 0.2

Depression, hypertension, and obes!ly . . . . . . . . . . 1,213 0.2

Depression, hypercholesterolemia, and obesity . . ●576 “0.1

Hypetiension. hypercholestero!emia, and obes!ty. 6,058 09

Al[ four conditions . . . . . . . . . . . . . . . . . . . . . . . . . 1,190 0.2

Depression, hyperlansion, hypercholesterolemia, and

obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,190 0.2
12 Advance Data No. 230. March 29, 1993

Table 16. Number and percent distribution of office visits by therapeutic services:

United States, 1991

Number of

Therapeutic sem”ca ordered or visits in Percent

provided by physicia+ thousands distribution

All visits...............,.. . . . . . . . . . . . . .

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Counseling/education

Diet2

Exerc&~: ::::::::::::: ::::::::::::::::

Cholesterol reduction . . . . . . . . . . . . . . . . . . . . . . .

Weightreauction . . . . .

Drug abuse2 . . . . . . . . . . . . . :::::::::::::::

Alcohol abuse2 . . . . . . . . . . . . . . . . . . . . . . . . . . .

Smoking cessation . . . . . . . . . . . . . . . . . . . . . . . .

Family/eocia12., . . . . . . . . . . . . . . . . . . . . . . . . .

Growth/developmentZ . . . . . . . . . . . . . . . . . . . . . .

Familyplanningz . . . . . . . . . . . . . . . . . . . . . . . . .

Othercounseling . . . . . . . . . . . . . . . . . . . . . . . . .

Other therapy

Psychotherapy, . . . . . . . . . . . . . . . . . . . . . . . . . .

Correctivelenses . . . . . . . . . . . . . . . . . . . . . . . . .

Hearing aid~, . . . . . . . . . . . . . . . . . . . . . . . . . . .

Physiotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . .

Othertherapy . . . . . . . . . . . . . . . . . . . . . . . . . . .

669,669

448,044

?6,476

54,617

20,818

25,761

1,570

3,187

13,013

12,466

20,560

5,456

55,911

17,769

7,934

’440

16,763

21,235

100.0

66.9

11.4

8.2

3.1

3.8

0.2

0.5

1.9

::7

0.6

8.3

2.7

1.2

‘0.0

2.5

3.2

f Numbers may not add to totals because more than one sategory may be reported per visit.

2CaIegory !snaw!n the 1991National ~bulaIory Medical Care Survey.

Table 17. Number andpercent distribution ofoffice visits bymedication therapy and

number ofmedications ordered orprovided by the physician: United Statea, 1991

Nwrrberof

visits in Percent

Medication therapy! Urouaands distribution

Allvisits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 669,669 100.0

Drug visits2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423,675 63.3

Visit.s without mention ofmedication . . . . . . . , . . . . . 246,014 36.7

Numberof medications ardered

orprovlded by physician

Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246,014 36.7

One . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217,766 32.5

Two . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107,800 16.1

Three-Five . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98,069 14.6

1Medications include prescription drugs, over-the-counter preparation, immunizing agents, and dosensllizhg agentS.

2Drug vmk are vista at Mich one or more medcstism Is orrJerad or SuppllefJ by the physician.

Tabie18. Number and percent distribution of drug visits and drug mentionsby physician

specialty United Ststes,1991

Number Number

Of drug of drug Percent

visits in Percent mentions Percent drug

Physician spec~a/ry thousands! distribution in thousands distribution visit.#

Alldrugvisits . . . . . . . . . . . . . . . .

General and family pracflce. . . . . . .

Internalmedicuse . . . . . . . .

Pediatrics . . . . . . . . . . . . . . . . . .

Obstetrmsa ndgynecalogy . . .

Ophthalmology . . . . . . . . . . . . . .

Dermatology . . . . . . . . . . . . . . . .

Psychiatry . . . . . . . . . . . . . . . . . .

Cardiovascular diseases, . . . . .

Orfhopedlc surgery. . . . . . . . .

Otalaryrtgalogy . . . . . . . . . . . . . . .

Generalsurge~ . . . . . . . . . . . . . .

Urological surgery. . . . . . . . .

Neurology. . . . . . . . . . . . . . . . . .

All otherspecialbes. . . . . . . .

423,675

119,003

83,975

51,903

27,106

19.125

16,979

10,161

9,350

9,309

8,744

6,920

5!093

4.210

51,797

100.0

26.1

19.6

12.3

6.4

4.5

4,0

2,4

2.2

2.2

2.1

1.6

1.2

1.0

12.2

804,615

222,158

193,229

81,746

35,507

32,259

31,809

16,320

30,029

12,115

12,405

13,498

6,616

6,625

110,499

100.0 63.3

27,6 72.2

24.0 61.6

10.2 69.5

4.4 47.7

4.0 46.4

3.9 57.2

2.0 64.6

3.7 80.4

1.5 25.9

1.5 45.6

1.7 32.5

0.6 39.9

0.8 61.9

13.7 67.6

1Drug vmts ere VISIIS at which one or more drugs are ordereci or supphed by the phy.wan.

2Number of drug wsts d!wded by number of Ofke VISI!S muiwhed by 1w.
Advance Data No. 230 ● March 29,1993 13

Table 19. Number and percent distribution of drug mentions by therapeutic classification:

United States, 1991

M_mrberof

drug mentions Percent

Therapeutic class ffkstior$ in thousands distribution

All drug mentions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cardiovascular-renal drugs . . . . . . . . . . . . . . . . . . . . . . . . . .

Antihyperfensive agenda, . . . . . . . . . . . . . . . . . . . . . . . . . .

Diuretics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antianginalagents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Cardiacglycosides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antiarrhythmicagents . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Agents used inperipheral orcerebral vascular disorders . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antimicrobial agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Penicillins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,.

Cephalosporins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Erythromycinsand lincosamides . . . . . . . . . . . . . . . . . . . . .

Tetracycline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sulfonemidesandtrimethoprim... . . . . . . . . . . . . . . . . . . .

Urinarytractanfiseptics . . . . . . . . . . . . . . . . . . . . . . . . . . .

Miscellaneous antibacterial agents . . . . . . . . . . . . . . . . . . . .

Antiviralagents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Anllfungal agents for systemicmycoses. . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drugs used forreliefofpain. . . . . . . . . . . . . . . . . . . . . . . . . .

Generalanalgesice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antiarthritics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Drugs used mgout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Respiratorytractdrugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bronchodilators. antiasthmatica . . . . . . . . . . . . . . . . . . . . .

Nasai decongestants . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antikseives,expectorants,muc olytice . . . . . . . . . . . . . . . . . .

Antihistamines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hormones and relatedagents. . . . . . . . . . . . . . . . . . . . . . . .

Adrenal corticosteroids . . . . . . . . . . . . . . . . . . . . . . . . . . .

Blood glucose regulators . . . . . . . . . . . . . . . . . . . . . . . . . .

Estrogens andprogestms . . . . . . . . . . . . . . . . . . . . . . . .

Agents used totreatthyro!d disease . . . . . . . . . . . . . . . .

Contraceptiveagents . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Psychopharmacologicdrugs.. . . . . . . . . . . . . . . . . . . . . . . .

Antidepressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,.

Antianxtetyagents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antipsychotlcdrugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sedatives and hypnotics . . . . . . . . . . . . . . . . . . . . . . . . . .

CNSstimulants, anorexiants . . . . . . . . . . . . . . . . . . . . . . . .

Skin/mucousmembrane . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dermatologlcs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Metabolicand nutrientagems. . . . . . . . . . . . . . . . . . . . . . . .

Viamins. minerals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Replenishers andregulators ofwater andelectrolyfes . . . . . . . .

Agents used totreathyperlipidemia . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ophthalmicdrugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ocular antAnfectwea ndantkinflammatory agents. . . . . . . . . . .

Agents usedto!reatglaLcoma . . . . . . . . . . . . . . . . . . . . . .

Miscellaneous ophthalmic preparations . . . . . . . . . . . . . .

Mydnaticsand cycloplegcs. . . . . . . . . . . . . . . . . . . . . . . .

Gastrointestinal agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Agents used in dlsordersofupper Gltract . . . . . . . . . . . . . .

Miscellaneous gastrointestinal agenta . . . . . . . . . . . . . . . . . .

laxatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Antidiarrheal agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Immunologicagents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Vaccinesand antiserum . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neurologicdrugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hematologlcagente . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Otherand unclassdied2. . . . . . . . . . . . . . . . . . . . . . . . . . . .

804,615

124,554

45,462

28,913

22,868

10,446

9,398

4,308

3,139

119,663

37,470

23,622

19,601

10,374

10,025

5,288

4,463

3,307

2,878

2,235

85,132

43,667

37,696

2,968

’780

80,758

24,992

20,084

18,323

17.300

●6O

76,507

24,180

17,188

13,254

10,843

8,516

2,528

49,588

19,722

16,209

5,824

5,282

2,551

43,912

41,053

2,859

36,964

16.579

8,948

8,631

’606

35,260

14,726

13,121

5,521

1,892

34,157

17,615

9,707

3,737

2,155

●942

28,440

27,959

’481

16,372

10,571

62,737

100.0

15.5

5.7

3.6

2.8

1.3

1.2

0.5

0.4

14.9

4.7

3.0

2.5

1.3

1.2

0.7

0.6

0.4

0.4

0.3

10.6

5.4

4.7

0.4

●o.1

10.0

3.~

2.5

2.3

2.2

*<.1

9.5

3.0

2.1

1.6

1.3

H

6.2

2.5

2.0

0.7

z

5.5

5.1

0.4

4.6

2.3

1.1

1.1

*0.1

4,4

1.8

1.6

0.7

0.2

4.2

2.2

1.2

0.5

0.3

●o. 1

3.5

3.5

●0.I

2.0

1.3

7.8

.

lTherapeulc classfksoon IS based on the srendard drug claealfical!on used in the Naflona/ Drug Coda Oirscmy, 1985 Edtion.

%cludesan esmest!cs.an tidotes, radmpharmaceuttcals,fcontrast meala,oncolylics,oto[ og!cs.antiparas! t!cs,a”d

Unclassfiedhmscellaneous dru~s.
14 Advance Data No. 230. March 29, 1993

Table 20. Number and percent distribution of drug mentions for the 20 most frequently

used generic substances: United States, 1991

M.mrber of

drug mentions Percent Therapeutic

Generic substance in thousands dktnbution classirkatior?

All drug mentions. . . 804,615 100.0 ...

Amoxicillln . 33.304 4.7 Penicillins

Acetaminophen . . . 28,387 3.5 General analgesics

Erythromycm. . . . . . 16,060 2.0 Erythromycins and Iincosamldes

Hydrochiorothiezide 15,727 2.0 D!uretics

Aspirin . . . . . . . . . . . . . 13,426 1.7 General analgesics

Ibuprofen . . . . . . . . . . . 13,321 1.7 Antiarthritics

Phenyiephnne. . . 12,900 1.6 Nasal decongestants

Codeine . . . . . . . . . . . 12,655 1.6 General analgesics

Pnenylpropanolamme 11,734 1.5 Nasal decongestants

A!wterol . . . . . . . . . . . 11,367 14 Bronchodilators, antlasthmat!cs

Ugoxin . . . . . . . . 10,411 1.3 Cardtac glycosides

Naproxen. . . . . . . . . . . 10,341 1.3 Antlarthritics

Guaifenesm . . . . . . . 10,281 1.3 Ant/tussives, expectorants, mucolytica

Furosemide . . . . . . . . . 10,257 1.3 Dwretlcs

Stamin a . . . . . . . . . . . 10,169 1.3 Vltamms, minerals

Riboflavin . . . . . . . . . . . 9,402 12 Vitamms, mmerals

Trlmethoprim. . . . . . 9,343 1.2 Sulfanomides and trimethoprim

Sulfamethoxezole. . . . 9,223 1.1 Sulfanomides and trimethoprim

Ergocslc!ferol . . . . . 9,165 1.1 Vitamins, minerals

Cefaclor . . . . . . . . . . . . 8,791 1.1 Cephalosporins

1Frequency of mention combines Single.!ngredlenl agenls wth menbons of rhe agent as an ingredient in a combination drug,

2Tnerapeut!c class,kelion is based on the Natjonai Drug Code Dmcro,y, 19SS Edlion (6), In cases where a drug had more

than one merapeut!c classifmalion, n was 18stedm me category tor whmh d was most frequently prescribed.

Table 21. Number, percent distribution, and therapeutic classficatlon for the 20 cirugs

most frequently prescribed at office visits, byentry name of drug: United States, 1991

Number of

dmg

mentions Percent

Entry name of dmgl m tfrousands dMr!trution

Therapeutic

c/assir7catiorF

All drug mentions. . . . . . . . 804,615

Amoxiclllin . . . . . . . . . . . . . . . 18,017

Amoxil . . . . . . . . . . . . . . . . . . 9,653

Lasix . . . . . . . . . . . . . . . . . . . 9,271

Ceclor . . . . . . . . . . . . . . . . . 8,791

Allergy relleforshots . . . . 7,737

Prednisone . . . . . . . . . . . . . . . 7,688

Synthroid . . . . . . . . . . . . . . . . 7,601

Lanolin . . . . . . . . . . . . . . . . . 7,566

Zantac . . . . . . . . . . . . . . . . 7,127

Motrin . . . . . . . . . . . . . . . . . . 7,033

Naprosyn . . . . . . . . . . . . . . . 7,021

Dlptheria Tetanus Toxoids

Pertussis . . . . . . . . . . . . . . . 6,996

Preman n . . . . . . . . . . . . . . . 6,879

Vasotec . . . . . . . . . . . . . . . . . 6.632

Cardizem . . . . . . . . . . . . . . . 6,516

Tylenol . . . . . . . . . . . . . . . . . 6,330

Seldane . . . . . . . . . . . . . . 5.897

Pohomyehtisvaccrre. . . 5,586

Proventtl . . . . . . . . . . . . . . . . 5,476

Reflex . . . . . . . . . . . . . . . . . . 5,422

100.0

2.2

1.2

1.2

1,1

1.0

1.0

0.9

0.9

0.9

0.9

0.9

0.9

0.9

0.6

0.8

0.8

0.7

0.7

0.7

0.7

.

Penicillins

Pemcillins

Dwretics

Cephalosporins

Diagnostics, nonradioactive and radiopaque

Adrenal corticosteroids

Agents used to treat thyroid diseaae

Cardiac glycosldes

Agents used in dieorders of upper GI tract

Anharthritics

Ant!arthritics

Vaccines and antiserums

Estrogens and progestins

Ant!hypertenswe agents

Antlanginal agents

General analgesics

Ant!htstammes

Vaccines and antiserums

Bronchodilators, antiasthmatics

Cephalosporms

lThe entry made by the physician on lhe prescription or other medcal records, This may be a trade name, generic name, or

des!red therapeutic effect.

~herapeubc classrkehon ISbesed on the NatIonel Drug Code LMectory, 1985Edlbon (6). In cases where a drug had more

than onetherapeutmc las$ifioebon, twSllst& lnthemtWov forwhlch ttwSmOst frequently prescribed.

Table 22. Number and percent distribution

of offlcevislts bydisposltlonof visiti

United States, 1991

Mrmberof

visits in Percent

Dispositior$ thousands distribution

Allvisita . . . . . . . . . . . . 669,689 100.0

Return atspecified time. . 423,7a5 63.3

Returrt ifneeded . . . . . 144,693 21.6

No followup planned. . . . 63,538 9.5

Telephone followup

planned . . . . . . . . . . . 22,813 3.4

Referred to other

physician . . . . . . . . . . 21,763 3.3

Admitto hospital . . . 5,856 0.9

Returned toreferring

physician. . . . . . . . . . 5,594 0,8

Other . . . . . . . . . . . . . 7,917 1.2

1Numbersmay no: add to totals because more than one

disposioonmaybe reponedpervisiL

Table 23. Number and percent distribution

of office visits by duration of visit

United States, 1991

Numberof

visits in FWrcent

Duration thousands distribution

Allvisits . . . . . . . . . . . . 669,669 100.0

Ominutesl . . . . . . . . . . 8,469 1.3

l–5 minutes . . . . . . . . . 59,584 8.9

6-10minutes . . . . . . . . 177,511 28.5

11-15minutes. . . . . . . . 211,340 31.6

16-30minutes. . . . . . . . 164,581 24.6

31 minutes and over. . . . 48,204 7.2

~Vista of zero mm.des duration are !hose in which there was

no face-to-face contact between the patient and the

physician.

..-

. . .

0.0

z

*

Symbols

Data not available

Catego~ nonapplicable

Quantity zero

Quantity more than zero but less

than O.05

Quantity more than zero but less

than 500where numbers are

rounded tothousands

FKwredoesnotmeet standarclof

re~ability or precision
Advance Data No. 230 ● March 29,1993 15

Technical notes

Source of data and sample

design

The information presented in this

report is based on data collected by

means of the National Ambulatory

Medical Care Sumey (NAMCS) from

January 1991 through December

1991. The target universe of NAMCS

includes office visits made in the

United States by ambulatory patients

to nonfederally employed physicians

who are principally engaged in office

practice, but not in the specialties of

anesthesiology, patholoa~, or

radiology. Telephone contacts and

nonoffice visits are excluded.

A multistage probability sample

design is used in NAMCS, involving

samples of primary sampling units

(PSU’S), physician practices within

PSU’S, and patient visits within

physician practices. The PSU’S are

counties, groups of counties, county

equivalents (such as parishes or

independent cities), or towns and

townships (for some PSU’S in New

England). For 1991, a sample of 2,540

nonfederal, office-based physicians

was selected from master files

maintained by the American Medical

Association and American

Osteopathic Association. Of this

group, 1,887 physicians were in scope,

or eligible to participate in the survey.

The physician response rate for the

1991 NAMCS was 72 percent.

Sample physicians were asked to

complete Patient Records (see

figure 1) for a systematic random

sample of office visits occurring

during a randomly assigned l-week

reporting period. Responding

physicians completed 33,795 patient

records.

Characteristics of the physician’s

practice, such as primary specialty

and type of practice, were obtained

from the physicians during an

induction interview. The U.S. Bureau

of the Census, Housing Surveys

Branch, was responsible for the

sumey’s data collection. Processing

operations and medical coding were

performed by the National Center for

Health Statistics, Hospital Discharge

and Ambulatory Care Survey Section,

Table L Relative standard errors for

estimated number of office visits: National

Ambulatory Medical Care Survey, 1991

Estomated number of Mce Relative sfandard

viwfs m thousands error in percent

100 . . . . . . . . . . . . . . . . . 72.1

200 . . . . . . . . . . . . . . . . . 51.1

500 . . . . . . . . . . . . . . . . . 32.5

1,000. . . . . . . . . . . . . . . . 23.1

2,000. . . . . . . . . . . . . . . . 16.6

5,000. . . . . . . . . . . . . . . . 11.0

10,000. . . . . . . . . . . . . . . 8.3

20.000. . . . . . . . . . . . . . . 6.6

50000 . . . . . . . . . . . . . . . 5.3

lCO.OOO. . . . . . . . . . . . . . 4.8

200,000 . . . . . . . . . . . . . . 4.5

500,000 . . . . . . . . . . . . . . 4.3

600,000 . . . . . . . . . . . . . . 4.3

700,000 . . . . . . . . . . . . . . 4.3

NOTE The smallest rel!able esomate for wsits to aggregated

spec!aloes IS 588,0CKI wsis. Estimates below th!s figure have

a rela!we slandard error greater than 30 percent and are

deemed unrehable by NCHS atandarda.

Example of use of table: M aggregate eaumate of 50 million

vmts has a relatwe standard error of 5.3 percent or a

standard error of 2,650,000 wsis (5.3 percent of 50 million).

Research Triangle Park, North

Carolina.

Sampling errors

The standard error is primarily

measure of the sampling variability

that occurs by chance when only a

sample, rather than an entire

universe, is sumeyed. The relative

standard error of an estimate is

obtained by dividing the standard

a

error by the estimate itselfi the result

is then expressed as a percent of the

estimate. Relative standard errors for

estimated numbers of office visits in

1991 are Sho,vn in table I, relative

standard errors for estimated

numbers of drug mentions are

presented in table II, and standard

errors for estimated percents of visits

are displayed in table HI.

Alternatively, relative standard

errors for aggregate estimates may be

calculated using the following general

formula, where x is the aggregate of

interest in thousands, and A and B

are the appropriate coefficients from

table IV.

RSE(X) =

c

A + B .100.0

Similarly, relative standard errors

for percents may be calculated using

the following general formula, where

p is the percent of interest and x k

the denominator of the percent in

Table Il. Relative standard errors for

estimated number of drug mentions:

National Ambulatory Medical Care Suwey,

1991

Estimated number of drug Relative standard

mentions in thousands error in percent

100. . . . . . . . . . . . . . . . . 78.1

200 . . . . . . . . . . . . . . . . . 68.6

500 . . . . . . . . . . . . . . . . . 43.7

1,000. . . . . . . . . . . . . . . . 31.2

2,000. . . . . . . . . . . . . . . . 22.4

5,000. . . . . . . . . . . . . . . . 14.6

10,BOO...<........!.. 11.2

20,000. . . . . . . . . . . . . . . 8.9

50.000. . . . . . . . . . . . . . . 5.8

100,000. . . . . . . . . . . . . . 6.5

200,000 . . . . . . . . . . . . . . 6.1

600,000 . . . . . . . . . . . . . . 5,8

800,000 . . . . . . . . . . . . . . 5.8

NOTE: The smallest rel!able esomale for drug menllons IS

1,083,000 menltons. Eshmalea below thrs figure have a

relaiwe standard error greater than 30 percent and are

deemed unreliable by NCHS standards.

Example of use of table An aggregate eat!ma!e of 50 milfion

drug men!mns haa a relative standard error of 5.8 percent or

a standard error of 2,9GQ,000 mentions (5.8 percent of 50

mllfion).

thousands, using the appropriate

coefficient from table IV.

Adjustments for nonresponse

Estimates from NAMCS data

were adjusted to account for sample

physicians who were in scope but did

not participate in the study. This

adjustment was calculated to

minimize the impact of response on

final estimates by imputing to

nonresponding physicians data from

visits to similar physicians. For this

purpose, physicians were judged

similar if they had the same specialty

designation and practiced in the same

Psu.

Test of significance and rounding

In this report, the determination

of statistical inference is based on the

t-test. The Bonferroni inequali~ was

used to establish the critical value for

statistically significant differences

(0.05 leveI of confidence). Terms

relating to differences such as

“greaterthan” or “lessthan” indicate

that the difference is statistically

significant. A lack of comment

regarding the difference between any
16 Advance Data No. 230. March 29, 1993

Table Ill. Standard errors for percents of estimated number of office visits: National

Ambulatory Madical Care Survey, 1991

Eshmfed percent

Base of percent

(wsits m tnousands) 1 or 99 50:95 10 or 90 20 or 80 30 or 70 50

100 .,.. . . . . . . . . 7,2

200, . . . 5.1

500,...,::::::::.::: 3.2

1,000 . .,, . . . . . . . . . . . . 23

2,000. 1,6

5,0?3, , .,,:::::.. 1,0

10,000, ,,, ,,, ,, ..,... 0.7

20,000 .,,, ,., . . . . 0.5

50,000, .,.. . . . . . . . . . 0.3

102,000. , . . . . . . . . . . . 0.2

600,000. ,,.. . . . . . . . . 01

703,00!3 . . . . . . . . . . . . . . 0.1

Standarderrorin percentage points

15.7 21.6 28,8

11.1 153 20.4

7.0 9.7 12,9

50 6.8 9.1

3.5 4.8 64

2.2 31 4,1

16 22 29

11 15 20

0,7 10 1.3

0,5 0.7 0.9

0.2 0,3 0,4

0.2 0.3 03

33.0 36.0

23.3 25.5

748 16,1

104 11.4

7.4 81

4.7 5,1

3.3 36

2,3 26

1.5 1.6

1.0 1,1

0.4 0,5

0.4 0.4

Exavale ofusecl table: Anesl,mate of30percent based managgregate estlmale 10m!lltolv!s,ts hasaslandard ermrof 3.3

percent or a rela:ve s:andara error of 11.0 percent (3.3 pezent CW(dedby 30 percenl).

Table IV. Coefficients appropriate for determining relative standard errors by type of

estimate and physician groups: National Ambulatory Medical Care Survey, 1991

CoetY/c/ent

Type of estlmafe and physvcian group A B

Visits

Overalltotals . . . . . . . . . . . . . . . . . . . . . . . . . . 0.001744284 51,82697927

Genwalandfam}ly practice . . . . . . . . . . . . . . . . 0,006617364 33.29640705

In!ernal med!cme . . . . . . . . . . . . . . . . . . . . . . . . . 001573396 45.1 OO67385

Docmrsof osteopathy, pediatncs,obstetr(csand

gynecology, general surgery, orthopedic surgery,

cardiovascular diseases, psychiatry, urological surgery,

dermatology, neurology, ophthalmology,

otolaryngology . . . . . . . . . . . . . . . . . . . . . . . . . . 0,0163602 10.90230286

Another. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.03340709 29.631108

Drug mentions

Overalltotals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.003224617 93.92631687

General and famdy practice,

internal medicine . . . . . . . . . . . . . . . . . . . . . . . . 0.0122584 57.64543271

Doctors of osteopathy, general surgery, orthopedic

surgery, cardiovascular diseases, urological surgery,

dermatology, neurology, ophthalmology,

otolaryngology, obstetrics and gynecology, pediatrics,

psychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.02764109 11.55212504

Another. . . . . . . . . . . . . . . . . . . . . . . . . . . o,04a35s2 46.53697419

two estimates does notmean that the

difference w’astested and found tobe

not significant.

In the tables, estimates of office

visits have been rounded to the

nearest thousand. Consequently,

estimates }vill not always add to

totals. Rates and percents were

calculated from original unrounded

figures and do not necessarily agree

with percents calculated from

rounded data.

Definition ofterms

Ambulatoq’ palient – An

ambulato?patient is an individual

seeking personal health sewices who

is not currently admitted to any

health care institution on the

premises.

Physician – A physician is a duly

licensed doctor of medicine (MD) or

doctor of osteopathy (DO) who is

currently in office-based practice and

who spends some time caring for

ambulatory patients. Excluded from

the NAMCS are physicians who are

hospital based; who specialize in

anesthesiology, pathology, or

radiology; who are federally

employed; who treat only

institutionalized patients; or who are

employed full time by an institution

and spend no time seeing ambulatory

patients.

Ofice –An office is the space that

physicians identify as a location for

their ambulatory practice. Offices

customarily include consultation,

examination, or treatment spaces that

patients associate with the particular

physician.

Viii[-A vkit k a direct personal

exchange between an ambulatory

patient and a physician (or a staff

member working under the

physician’s supervision) for the

purpose of seeking care and

rendering personal health services.

Drug mention – A drug mention is

the physician’s entry of a

pharmaceutical agent – by any route

of administration —for preventior~,

diagnosis, or treatment. Generic as

\rell as brand-name drugs are

included, as are nonprescription and

prescription drugs. Along with all new

drugs, the physician also records

continued medications if the patient

\vas specifically instructed during the

visit to continue the medication.

Drug visit –A drug visit is a visit

in which medication is prescribed or

provided by the physician.
20 Advance Data No. 230. March 29,1993

Trade name disclaimer

The use of trade names is for identification only

and does not imply endorsement by the Public

Health Service, U.S. Department of Heaith and

Human Services.

Suggested citation Copyright information National Center for Health Statistics

Schappert SM. Nationai Ambulatory Medical All materiai appearing in this report is in the Director

Care Survey: 1991 summary. Advance data public domain and may be reproduced or Manning Feinleib, M.D., Dr. P.H.

from vital and health statistics: no 230. copied without permission; citation as to

Flyaftsville, Maryland: National Center for source, however, is appreciated.

Acting Deputy Director

Health Statistics. 1993.

Jack R. Anderson
Vital and Health Statistics

series descriptions

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 5.

SERIES 6.

SERIES 10.

SERIES 11.

SERIES 12.

SERIES 13.

Programs and Collection Procedures—These reports

describe the data colled[on programs of the National Center

for Health Statistics.They include descriptionsof the methods

used to collect and process the data, definitions, and other

material necessary for understanding the data.

Data Evaluation and Methods Research—These reports

are studies of new statistical methods and include analytical

techniques, objective evaluations of reliability of collected

data, end mntributionsto statisticaltheory.These studies also

include experimental tests of new survey methods and

comparisons of U.S. methodology with those of other

countries.

Analytical and Epidemiological Studies-These reports

present analytical or interpretive studies based on vital and

health statistics.These reports carry the analyses futther then

the expository types of reports in the other series.

Documents and Committee Reports-These are final

reports of major mmmittees concerned with vital and health

statistics and documents such as recommended mode! vital

registration laws and revised birth and death certificates.

International Vital and Health Statistics Reports-These

reports are analytical or descriptive repoti that compare U.S.

vital and health statistics with those of other countries or

present other international data of relevance to the health

statistics system of the United States.

Cognition and Suwey Measurement—These reports are

from the National Laboratory for Collaborative Research in

Cognition and Survey Measurement. They use methods of

cognitive science to design, evaluate, and test suwey

instruments.

Date From the National Health lntewiew Suwey—These

reports contain statistics on illness; unintentional injuries;

disabilii use of hospital, medical, and other health services;

and a wide range of special current health topics covering

many aspects of health behaviors, health status, and health

care utilization. They are based on data collected in a

continuing national household interview survey.

Data From the National Health Examination Suwey, the

National Health and Nutrition Examination Suweys, and

the Hispanic Health and Nutrition Examination Suwey—

Data from direct examination, testing, end measurement on

representative samples of the civilian noninstitutionalized

population provide the basis for (1) medically defined total

prevalence of specific dkases or conditions in the United

States and the distributionsof the population with respect to

physical, physiological,and psychologicalcharacteristics, and

(2) analyses of trends and relationships among various

measurements and between survey periods.

Data From the institutionalized Population Surveys—

Discontinued in 1975. Reports from these surveys are

included in Series 13.

Data From the National Health Care Survey—These

reports contain statisticson health resources and the public’s

use of heakh care resources including ambulatory, hospital,

and long-term care setvices based on data collected directly

from health care providers and provider records.

SERIES 14. Data on Health Resources: Manpower and FacilitiesDiscontinued in 1980. Reports on the numbers, geographic

distribution, and characteristics of health resources are now

included in Series 13.

SERIES 15. Data From Special Surveys—These reports contain

statistics on health and health-related topics collected in

special surveys that are not part of the continuing data

systems of the National Center for Health Statistics.

SERIES 16. Compilations of Advance Data From Vital and Heaith

Statisti~Advance Data Reports provide early release of

information from the National Center for Health Statistics’

health and demographic surveys. They are compiled in the

order in which they are published. Some of these releases

may be followed by detailed reports in Series 10-13.

SERIES 20. Data on Mortality-These reports conta@ statistics on

mo”tilii that are not inc!uded in regular, annual, or monthly

reports. Special analyses by cause of death, age, other

demographic variables, and geographic and trend analyses

are included.

SERIES 21. Data on Natality, Marriage, and Divorc+These reports

contain statistics on natalii, marriage, and divorce that are

not included in regular, annual, or monthly reports. Special

analyses by health and demographic variables and

geographic and trend analyses are included.

SERIES 22. Data From the National Mortality and Natality SuweyeDiscontinued in 1975. Reports from these sample surveys,

based on vital records, are now published in Series 20 or 21.

SERIES 23. Data From the National Survey of Family Growth—

These reports contain statistics on factors that affect birth

rates, inciuding contraception, infertility, cohabitation,

marriage, divorce, and remarriag~ adoption; use of medical

care for family planning and infertilii and related maternal

and infant health topics. These statistics are based on

national surveys of childbearing age.

SERIES 24. Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy—

These include advance reports of births, deaths, marriages,

and divorces based on final data from the National Vital

Statistics System that were published as supplements to the

Monthly V%alStatistics RepOtt (MVSR). These reports provide

highlights and summaries of detailed data subsequently

published in Vital Statistics of the United States. Other

supplements to the MVSR published here provide selected

findings based on final data from the National Vtal statistics

System and may be followed by detailed reports in Series 20

or 21.

For answars to questions about this report or for a list of reports published

in these series, contact

Data Dissemination Branch

National Center for Health statistics

Centers for Disease Control and Prevention

Public Health Service

6525 Belcrest Road, Room 10S4

HyattsviIIer MD 20782

(301) 436-3500

E-mail: nchsquery@nchl Oa.em.cdc.gov

Internet http://vnvw.cdc.gov/nchsw/nchshome.htm
DEPARTMENT OF

HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

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Hyattsville, Maryland 20782

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