Vital and

Health Statistics

Advance Data

From Vital and

Health Statistics:

Numbers 181–1 90

Series 16:

Compilations of Advance Data

From Vital and Health Statistics

No. 19

Data in this report from health and demographic surveys present statistics by age

and other variables on adoption; use of contraceptives and famiiY Plannin9

services; wanted and unwanted childbearing; child care arrangements;

developmental, learning, and emotional problems of children; and AIDS

knowledge and attitudes, Estimates are based on the civilian noninstitutionalized

population of the United States. These reports were originally published in 1990.

U,S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control and Prevention

National Center for Health Statistics

May 1995

DHHS Publication No, (PHS) 95-1878
Copyright information

All material appearing in this report IS m the publlc domam and may be

reproduced or copied wthout permsslon; citation as to source, however, is

appreciated.

Suggested citstion

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

statistics; number 181–1 90. Nationai Center for Health Statistics. Vital Health

Stat 16(1 9), 1995.
National Center for Health Statistics

Jack R. Anderson, Acting Director

Jennifer H. Madans, Ph.D., Acting Deputy 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 V2tal and Health

Statistics Systems

Robert B. Hartford, Ph.D., Acting 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
Adoption in the 1980’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 181

Contraceptive Use in the United States, 1973-88 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 182

AIDS fiowledge and Attitudes for July-September 1989 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 183

Use ofFamily Pkmning Serviees inthe United States: 1982 and1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 184

1988 Summary: National Hospital Discharge Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 185

AIDS Knowledge andAttitudes for October-December 1989: Provisional Data From the National Health

Interview Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 186

Child Care Arrangements: Health of Our Nation’s Childre% United States, 1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 187

Health Insurance and Medical Care: Health of Our Nation’s Children, United States, 1988 . . . . . . . . . . . . . . . . . . . . . . No. 188

Wanted and Unwanted Childbearing in the United States 1973-88: Data from the National Survey of

Family Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 189

Developmental, Learning, and Emotional Problems: Health of Our Nation’s Children, United States, 1988 . . . . . . . . . . No. 190
Number 181 . Januarv.,- 5, 1990

Advance

Data

From Vital and Health Statistics of the National Center for Health Statistics

Adoption inthe 1980’s

by Christine A. Bachrach, Ph.D., National Institute of Child Health and Human Development

Patricia F. Adams, Division of Health Interview Statistics, National Center for Health Statistics

Sokdad Sambrano, Ph.D., Administration for Children, Youth and Families

Kathryn A. London, Ph. D., Division of Vial Statistics, National Center for Health Statistics

Introduction

Adoption has long provided a

mechanism for the care of children

whose biological parents are unable to

provide for them and an alternative

means of creating a family for couples

unable to have biological children.

During most of the 1970’s and 1980’s,

when legal abortion and the

development of new reproductive

technologies created additional

alternatives to unwanted pregnancy

and infertility, there has been a need

for information on adoption trends, on

the characteristics of children placed

for adoption, on the characteristics of

adoptive families and persons seeking

adoption, and on the outcomes for

children, biological parents, and

adoptive parents. This information is

necessary for formulation of adoption

policies at the Federal level as well as

for State and local public child welfare

agencies. Three major developments

in recent years have heightened the

need for information: (1) the emphasis

on findhg permanent homes for

children in the foster care system; (2)

the belief that all waiting children are

“adoptable”; and (3) the belief that

foster families could seine as

permanent families for children who

could not return to their own families.

Despite the salience of these

issues, information about adoption in

the United States is very limited.

Information on adoptions arranged

through the public sector has been

available since 1982, when the Office

of Human Development Sem-ces

implemented the Voluntary

Cooperative Information System

(VCIS) to collect data annuaIly from

State child welfare agencies on

children in substitute care (l).

National estimates of all types of

adoption have not been produced by

the Federal Government since the

mid-1970’s (2). Estimates have been

developed by a private organization

for 1982 and 1986, but are subject to

variability in the completeness of

reporting from State to State (3,4).

These national estimates are used for

indicating likely trends in adoption and

for describing a limited number of

characteristics, but cannot be used to

assess the determinants and

consequences of adoption on the

individual level.

This report presents information

on adoptions reported by a national

sample of women 20-54 years of ag?

in 1987. Results suggest that the

proportion of ever-married women

20-44 years of age who have ever

adopted may have declined during the

mid-1980’s; that the proportion of

unrelated adoptions (those in which

the adoptive parent and child are not

related before the adoption) in which

children are placed in adoptive homes

as infants may be lower in the 1980’s

than in the 1970’s and that the

proportion of unrelated adoptions

involving white adoptive mothers was

lower in the 1980’s than in the 1970’s.

The results also indicate that the

proportions who have adopted

unrelated children are lower among

black women and women of Hispanic

origin than among nonminority

women, and lower among women of

low socioeconomic status, as indicated

by educational and income level,

compared with their more advantaged

counterparts. Interracial adopt ions,

which constituted about 8 percent of

all adoptions reported by women

20-54 years of age, consisted primarily

# -’%=, &.

4g

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

e+ Public Health Service

g

< Centers for Disease Control

s National Center for Health Statistics

%

%

>

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

+’*+dao
2 Advance Data

of the adoption of children of races

other than black or white by white

adoptive mothers.

Data and methods

Survey data on adoption have

been collected by the National Center

for Health Statistics (NCHS)

periodically since 1973. By providing

measurement on an individual basis,

such data may add substantially to the

understanding of factors that influence

adoption and its outcomes. However,

most survey data on adoption are

extremely limited. Adoption takes

place rarely, and affects only a small

fraction of the population. A a result,

extremely large national surveys are

required to produce sufficient

numbers of cases for detailed analyses

of adoption. Previous reports based on

the NCHS survey the National Survey

of Family Growth (NSFG) have been

useful in providing some basic

estimates of adoption, relinquishment,

and social and economic outcomes,

but have been severely limited in

scope and precision by the small

numbers of cases available for

analysis (5-8).

In the mid-1980’s, NCHS and the

Administration for Children, Youth

and Families (ACYF) initiated a

collaborative effort to improve the

precision and usefulness of survey data

on adoption by expanding the range of

adoption items included in the NSFG

and including a comparable set of

basic items on another large national

survey conducted by NCHS—the

National Health Interview Survey

(NHIS). As a result of this effort, a

comparable set of questions on

adoption was asked of more than

30,000 women 20-54 years of age

participating in the 1987 NHIS, and of

more than 8,400 women 1544 years

of age participating in the 1988 NSFG.

Because the samples for these two

surveys were selected from the same

sampling frame, the results can

eventually be combined to produce

estimates of greater precision than

either would produce alone. This

report presents estimates based on the

data collected in the 1987 NHIS along

with comparative estimates based on

the 1982 NSFG.

The purpose of adoption items on

the NHIS questionnaire was to

provide information on the

characteristics of women who adopt

and on the adoptions themselves.

Women were asked if they had ever

adopted a child and, if so, the number

adopted. Information on the date of

birth, place of birth (United States or

other), date of adoptive placement,

relationship to the child before the

adoption, and means of arranging the

adoption was collected for up to tsvo

(most recently adopted) children. In

addition, a broad range of social,

demographic, and health information

was collected about the women and

about those adoptive children who

were still living in the home.

Questions were directed to women

20-54 years of age both because this

age group is believed to account for

the vast majority of adoptions and also

to avoid double counting of adoptions

involving both male and female

petitioners (adoptive parents). The

limitation to females differentially

affects estimates of unrelated

adoptions and related adoptions.

Related adoptions include adoptions

of stepchildren and other children

related to the adoptive parent by

blood or marriage. Unrelated

adoptions include adoptions where no

prior relationship existed between

adoptive parent and child, and

adoptions of foster children by their

foster parents. Estimates of unrelated

adoptions are not materially affected

by the limitation to females because

the vast majority involve a married

couple (9). However, related

adoptions are underestimated to the

extent that such adoptions, a large

proportion of which are stepparent

adoptions, involve only male

petitioners. Unrelated adoptions are of

particular interest because they are

most likely to signal a real change in

parenthood. In related adoptions, the

adoption signals a formalization of a

preexisting relationship that may or

may not have been previously

characterized by parenting.

Data collected in the NHIS were

evaluated carefully for internal

consistency, comparability to previous

survey data and to existing national

estimates relating to adoption.Results

of this evaluation, along with

procedures for estimating standard

errors of estimates, are provided in

the technical notes.

Adoption trends and

differentials in the 1980’s

The percent of ever-married

women who have ever adopted a child

is presented in table 1 according to

relationship to the adopted child and

other selected characteristics. To

facilitate comparisons over time, data

from both the 1987 NHIS and the

1982 NSFG are limited to

ever-married women 20-44 years of

age, the age group for which

comparable questions were asked in

both surveys.

The estimates in table 1 suggest a

decline in adoption during the 1980’s.

The estimated proportion of those

who had ever adopted any child was

2.2 percent in 1982 and 1.7 percent in

1987. The estimated proportion of

those who had ever adopted an

unrelated child was 1.7 percent in

1982 and 1.3 percent in 1987. The

apparent decline in the adoption of

unrelated children is most striking in

those age groups where adoption

typically occurs most frequently the

late twenties and early thirties.

However, these differences between

1982 and 1987 are not statistically

significant. Estimates for both years,

but those particularly for 1982, lack

sufficient precision to say with

reasonable certainty that a decline in

adoption has taken place. However,

similarity behveen the estimates for

1982 and those for earlier years (5,6),

and close correspondence behveen the

estimates from the 1987 NHIS and

unpublished preliminary estimates

based on the 1988 NSFG, increase

confidence that a decline in adoption

did occur.

Previous studies of adoption based

on survey data have indicated

substantial differences in the

likelihood of having adopted,

differences according to age, marital

status, the number of biological

children ever born, and the ability to

bear children (5,6,8). These results
Advance Data 3

Table 1. Number of ever-married women 20-44 years of age and peroent who ever adopted a child, by relationship to child before the

adoption, andselected characteristics: United States, 1982 and 1987

[Data are based on trous8hold interviews of the civilii nonhmtitutbnauzed pcpulatbn. The survey designs, general quaiiiitbns, and Irtforrnatkxr on the reliiiltly of

me estimates are given in the technical notes]

Relaikvrsh@ fo child

Number ofawr-~

Chatacteristk7

Unratatad Related

twrnetl h-l#ousan@ Any child’ child child

1967 Natbrwd Health Interview Survey Percent

TotalZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3a,on 1.7 1.3 %.4

Age at Interview

ZO-24years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,596 WI *O.1

25-29 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

W.o

8,218 0.6 “0.3

30=34 yearn . . . . .

●0.2

. . . . . . . . . . . . . . . . . . . . . . . . . . 9.166 1.5 1.1

35-39 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

*0.3

8,79e 24 1.9

40-44years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

W.3

7.277 3.4

MaWtstrduS

28 ●0.4

Cumentlymanfad . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31,695

Previouslymamied . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.8 1.4 0.2

Race:

6,362 1.3 1.0 W. 4

WTMe . . . .

Black....lltl:l::lll::: EIC1lI::l:E::::;U1

32.694 1.8 1.4 0.2

3,770 1.5 *0.8 W.6

Hisparricori@n:

Hlspanb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,111 WJ.8 *0.4

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

*0.4

34,766 1.8

Educatbn:

1.4 0.3

Lesaihan12years . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,367 1.0 “0.5

12yeaJS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

+0.5

16,705 1.5 1.1

13yearaormore . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

W.2

15,642 22

Family krccmw

1.9 ●0.2

Beiowpcverly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,614 +0.9 *0.4

Atorabovepcverty . . . . . . . . . . . . . . . . . . . . . . . . . . .

+0.5

32,393 1.9 1.5 0.2

Under$15,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,399 0.9

$15,fX)0-24,S98 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

●0.4 W.4

7,482

S25,000-34,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.6 1.2 %.3

7,326 1.8

$35,0000rmons . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.4 +0.2

12,713 23 1.9 %.2

lW32NaficnalSurvey ofFarnllyGrcwth

TotalZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34,253 22 1.7 ●o.4

Age at Interview

20-24years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,818 ●0.7

26-29year3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

*0.O +0.7

7,776 ●0.9

30-34years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

*0.9 +0.o

8,218 ●3. 1

35-39years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%?.9 W.3

7,349 %zI

4&44years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

●1.6 W.4

6,090 *4.3 %2.9 W.9

Markalstatus

Currentlymarried . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27,620 22

PrevbusiyrnamkKJ . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.8 ●0.3

6,633

Race: .

25 ●1.5 ●1.O

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30,419 23

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

1.9 ●0.3

3,440 ●1.6

Hispanioorigln:

●0.9 W8

Hispanic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,n3 WJ.7 “0.2

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

W.6

31,460 24

Education

1.9 *0.4

Lessthen 12years . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,576 *1.6

12yeers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

*0.4 ●1.2

14.844 %23

13yearsormore . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

%2.0 Y).2

13,515 %25

Family Income

●21 ●0.3

8elow~verty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,128 +22 W.8

Atorabove~verty . . . . . . . . . . . . . . . . . . . . . . . . . . .

●1.4

30,607 23 1.9 “0.3

Under$15,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,014 %?.3

$15,030-24,9S9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

*I .6 +0.7

7,575 %?.0

S25,000-34,999. .. . . . . . . . . . . . . . . . . . . . . . . . . . . .

●1.8 *0.3

6,326 %28 %27

$35,&10crmore . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

“0.2

8,556 -3 *1.7 ‘0.3

‘Thssumqfthspce titi*@dumldddmMtictiMwqti#tbpmti~~~~MUbwdtiqiti~ti_ Wlmadojxedchkhmninboth

C.degoks.

%lckxiea wmnendcttw—tiwcmen rlxWllOrnl~~~~ebf=t~ti.
4 Advance Data

have shown, not surprisingly, that

adoption is most likely among married

couples who are unable to have

biological children and that the

likelihood of having adopted increases

with age. These studies have also

noted tendencies for adoption to occur

most commonly among couples of

high socioeconomic status, but the

studies have lacked the precision to

demonstrate such relationships

conclusively. The greater precision

of the NHIS data provides an

opportunity to reexamine the extent to

which adoption varies among different

groups in the population.

Results of the NHIS, shown in the

top panel of table 1, confirm the

expected relationship between age at

the time of survey and the likelihood

of ever having adopted a child. Less

than 1 percent of ever-married

worn en in their twenties, 2 percent of

women in their thirties, and 3 percent

of women in their forties had adopted

a child at some time in their lives. This

relationship results primarily from the

fact that older women have had more

time to discover that they cannot have

biological children and to initiate and

complete the adoption process.

Differences by marital status in the

percents adopting were not statistically

significant: Women who were married

at the time of the survey and women

who were not married but had been

married previously were about equally

likely to have adopted by the time of

the survey. However, this does not

mean that marital status has no effect

on the likelihood of adoption As

previous studies have shown, the

ovenvhelming majority of adopting

parents are married at the time of the

adoption (5).

The percents of white and black

ever-married women who had ever

adopted any child were similar (1.8

and 1.5 percent, respectively).

However, the percent who had

adopted an unrelated child was

substantially higher among white

women (1.4) than among black women

(0.8). By contrast, black women

appeared more likely to have adopted

a child related to them than white

women (0.6 percent compared with

0.2 percent), although the statistical

significance of this difference fell short

of the 5-percent level.

Women of Hispanic origin were

significantly less likely to have adopted

a child or to have adopted a child

unrelated to them than women who

were not of Hispanic origin. Among

non-Hispanic women 1.8 percent had

adopted a child and 1.4 percent had

adopted an unrelated child, compared

with 0.8 percent and 0.4 percent,

respectively, of Hispanic women. The

percents reporting having adopted a

related child were similar among these

two groups of women.

Results shown in table 1 ako

indicate a positive association between

educational attainment and the

likelihood of having adopted. Women

who had completed at least 1 year of

college were more than twice as likely

to have adopted than women who had

not finished high school (2.2 compared

with 1.0 percent), and they were

nearly four times as likely to have

adopted a child unrelated to them (1.9

compared with 0.5 percent). Although

differences were not statistically

significant, women with lower

educational attainment appeared

somewhat more likely to have adopted

related children than women with

higher educational levels.

Results by family income followed

a similar pattern: Women with family

incomes below the poverty level were

less likely to have adopted any child,

and less likely to have adopted an

unrelated child, compared with women

whose family incomes equaled or

exceeded the poverty level. Differences

by absolute levels of family income

were similac The percent who had

adopted any child and the percent who

had adopted an unrelated child were

both lowest at the lowest income level

and highest among those with the

highest incomes. Related adoption did

not differ significantly by poverty or

income level, but appeared to be

highest at the lowest income levels.

Estimates from the 1982 NSFG,

shown in the lower panel of table 1,

display similar patterns of adoption by

age, marital status, race, Hispanic

origin, educational attainment, and

family income in most but not all

cases. Their similarity adds to the

confidence that the patterns of

differentials observed in 1987 reflect

true population differences.

Interpretation of the NSFG data is

limited, however, by its lack of

precision (most statistics have relative

standard errors in excess of

30 percent). Because of this, many

differences are not statistically

significant.

These results clearly indicate a

lower prevalence of unrelated

adoption among members of minority

groups such as black and Hispanic

women, and among those with

relatively low socioeconomic status, as

indicated by educational attainment

and poverty. Because minority women

are disproportionately poor and of low

educational attainment, it is very likely

that these findings are interdependent.

Minori& women may adopt unrelated

children less often because they lack

the required economic resources, or

because of other factors such as

higher marital instability, lower levels

of childlessness, or less favorable

attitudes toward the adoption of

strangers. When minority or poor

women do adopt, these data clearly

suggest they are most likely to adopt a

related child. This pattern may reflect

a greater orientation toward the

extended family as a mechanism for

providing for children in need of care

among these groups, or a greater pool

of related children needing care fnom

which to adopt.

Characteristics of adopted

children

Characteristics of children

adopted by women 20-54 years of age

in 1987 are shown in table 2. This

table is limited to unrelated adoptions,

because related adoptions are

incompletely represented by the

NHIS. Estimates are shown for all

adoptions, and for those occurring

during the 1970’s and 1980’s

separately. All estimates, especially

those for adoptions in a given decade,

are characterized by relatively high

standard errors. Small or even

moderate changes in characteristics

over time, therefore, may not reflect

actual change in the population of
Advance Data 5

Table 2. Number of unrelated children ever adopted by women 20-54 years of age and

percent distribution by selected characteristics, according to year of adoption: National

Health Interview Survey, 1987

[Data era based on household Intervlavm of the Civilian noninsfitutbnallzed populetiin. The survey dasgn,

general qualirmtiins, and inforrnatiin on the relLsbilii of the estimates era given in the technbat notesl

Ymr ofadopmrr

Characferi3tk All yaws’ 1970-79 198&87

Atlchlldrenz . . . . . . . . . . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Child’s ptace of birlh

Unfiad States . . . . . . . . . . . . . . . . . . . . . . .

Foreign counhy. . . . . . . . . . . . . . . . . . . . .

How adopfbn arranged

Publlcagency . . . . . . . . . . . . . . . . . . . . . .

Prkstea gency. . . . . . . . . . . . . . . . . . . . . .

lnde~ndent . . . . . . . . . . . . . . . . . . . . . . .

Age of chiid at placement

Under lyeer . . . . . . . . . . . . . . . . . . . . . . .

I year . . . . . . . . . . . . . . . . . . . . . . . . . . .

2years . . . . . . . . . . . . . . . . . . . . . . . . . . .

3-5years . . . . . . . . . . . . . . . . . . . . . . . . .

6yearsorwer . . . . . . . . . . . . . . . . . . . . . .

Child’s current health statuss

Anyllmifatbnorfairorpoorheatth . . . . . . . . .

Nolimitationand good,ve~good, orexcellcmt

health . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age of adopttve mother at placement

24yeareorurrder . . . . . . . . . . . . . . . . . . . .

26-29yeam . . . . . . . . . . . . . . . . . . . . . . . .

30-34years . . . . . . . . . . . . . . . . . . . . . . . .

3M9yeara . . . . . . . . . . . . . . . . . . . . . . . .

40yearsorover . . . . . . . . . . . . . . . . . . . . .

Raceofadoptlva mother

Whle . . . . . . -

Black::::::::::::::::: : :: :.......

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

H@enicoriginof adopttvemolher

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

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

Education of adopltve mother

Lesslhan 12yaara . . . . . . . . . . . . . . . . . . .

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

13yearaormore . . . . . . . . . . . . . . . . . . . .

Race of adopt~e mother end child3

Semerace . . . . . . . . . . . . . . . . . . . . . . . .

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

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

other . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Differentrace . . . . . . . . . . . . . . . . . . . . . . .

Wtvtemother,blackchll d..... . . . . . . . . . .

Whfiemother, child ofraceother then black . . .

Motherofo!herrece, whitechilcl. . . . . . . . . . .

Allolher . . . . . . . . . . . . . . . . . . . . . . . . . .

1,061

Ico.o

91.4

8.6

40.7

35.3

23.9

81.1

5.1

%3.4

Y3.6

6.7

6.7

91.3

127

34.2

35.4

13.3

4.4

93.2

4.5

%L3

25

97.5

6.6

39.4

54.0

92.4

65.4

5.9

●1.1

7.6

●1.2

4.8

*I.6

W.o

Numberinthousands

404

Percentd!shibution

Ilxl.o

68.4

11.6

4+.4

35.8

227

a29

*3.7

%2.9

●5. 1

●5.6

. . .

---

---

---

---

---

---

96.0

●3.6

W4

●3.5

%.5

●9.O

36.8

52.3

---

---

---

-..

---

---

-..

.-.

---

315

100.0

eo.3

9.7

36.5

35.4

2&l

72.8

9.0

4,6

3.3

10.3

---

---

.-.

..-

..-

. . .

---

87.0

9.0

4.1

3.0

97.0

1.9

325

65.6

. . .

-..

. . .

. . .

---

. . .

---

..-

. . .

Ilmbd=domd c~~mn~rwbm dare~acloptionnd asceti”nedandchdd mnado@Abe- 1970-

‘Irwbdesadopled chidrenforwtmm informatlononspecific characteristics isrmt ascedain@Prcec4 distriixtbrab.$ed on

known -.

3Ba.mdonadoptii chikhenkmto belMnginhc-ehcdd wUadoptiinmtter attimecfemay.

adopted children. Even those

comparisons that meet the criterion of

statistical significartce must be

interpreted with eaution, because in

estimates based onasamplesom e

significant differences will oecurby

chance.

Amongall unrelated adoptions

reported bywomen 20-54yearsof age

in 1987, about9 percent involved

children bom outside the United

States. Despite the fact that data from

the Immigration and Naturalization

Service (INS) show a doubling in the

number of immigrant children

admitted tothe United States for the

purpse of adoption—from nearly

5,000 in1981to more than 10,000in

1987 (3,10)–the NHIS-NSFG

estimate for foreign adoptions

oecurnng during the 1980’s is not

significantly different from that for the

1970’s. Because the INS data are

widely believed to be accurate, it is

likely that the absence of an increase

in the NHIS data results from

sampling or reporting errors (see the

technical notes for a discussion of

sampling error).

Since the mid-1970’s, national

estimates of adoptions have been

limited mainly to those arranged

through State social service agencies,

but almost no information has been

available on the percent of all

adoptions arranged in this way. As of

1975, the last year for which a Federal

ageney published national adoption

estimates, 39 percent of unrelated

adoptions were arranged through

public agencies, 38 percent through

private agencies, and 23 percent

independently, through lawyers or

other means (11). Estimates made by

the National Committee For Adoption

for 1982 and 1986 indicated a similar

percent arranged through public

ageneies (38 in 1982 and 39 in 1986),

a lower percent arranged through

private agencies (29 in both 1982 and

1986), and a higher percent arranged

independently (33 percent in 1982 and

31 percent in 1986) (3,4).

Estimates based on NHIS data

(table 2) are generally consistent with
6 Advance Data

these earlier estimates. Overall,

41 percent of unrelated adoptions

were arranged through public

agencies, 35 percent through private

agencies, and 24 percent

independently. Differences between

adoptions in the 1970’s and 1980’s

were not statistically significant, but

they do suggest a slightly higher

percent arranged independently in the

1980’s (28 percent versus 23 percent),

consistent with data from the National

Committee For Adoption.

There is some evidence from the

estimates in table 2 that su~est that

the proportion of unrelated adoptions

involving children placed into adoptive

homes as infants may have declined.

For adoptions occurring in the 1970’s

this proportion was 83 percent; for

those occurring in the 1980’s, the

estimated proportion was 73 percent.

The difference, however, was

significant at only the 10-percent level.

An apparent increase in the percent of

unrelated children adopted at 6 years

of age or older was not statistically

significant. A decline in the proportion

of adopted children placed as infants

could be of some concern in view of

evidence suggesting that the older the

child at the age of adoption, the

greater the likelihood of behavior and

learning problems (12). Viewed

differently, however, such a dedine

could also reflect success in placing

older children in permanent homes.

By linking information on

adoptions reported by mothers with

information on the children

themselves, estimates were derived of

the current health status of adopted

children who were still living in the

household at the time of the survey

(about 78 percent of all unrelated

adoptions). These estimates indicate

that the vast majority of adopted

children are in good health: Only

about 9 percent reported any

limitation in activities due to health

problems or reported health to be

only fair or poor. Furthermore,

adopted children appear to be as

healthy as children in general: The

percent of adopted children who were

limited in activities and the percent in

fair or poor health were similar to

those observed for all children under

18 years of age (13).

Data on the age of the adoptive

mother at the time of the adoption

confirm the findings of earlier studies

that most adoptions involve adoptive

mothers between the ages of 25 and

34. About 70 percent of unrelated

adoptions to women 20-54 years of

age in 1987 had involved women in

this age range, a percent similar to

that observed for women 15-44 years

of age in the 1982 National Survey of

Family Grovlh (76 percent) (5).

Estimates by age of mother are not

shown by decade of adoption because

of truncation bias: Women adopting in

the 1970’s are less likely to be

represented in the NHIS adoption

data the greater their age at adoption.

For example, a woman who adopted in

1970 at age 40 would be 57 at the

time of the NHIS survey, and she

therefore would not have been asked

about adoption. A woman who

adopted in 1970 at age 30 would be

only 47 at the time of the survey, and

she would have been asked these

questions and represented in the data.

Because of this systematic bias,

comparisons by decade in the age at

adoption would be misleading.

The overwhelming majority

(93 percent) of unrelated adoptions by

women 20-54 years of age in 1987

involved white adoptive mothers, but

there is some evidence that this

percent may have declined. The

estimated percent involving white

mothers was 96 among adoptions

occurring in the 1970’s, and 87 among

those occurring in the 1980’s. This

difference was statistically significant

at the 5-percent level. There were

apparent increases in the percent of

unrelated adoptions involving both

black mothers and mothers of other

races between the two decades, but

both fell short of the 5-percent

significance level. Mothers of Hispanic

origin accounted for only 2.5 percent

of all unrelated adoptions by women

20-54 years of age in 1987, and there

was no evidence of any change

between the 1970’s and 1980’s.

Given the higher proportions of

women who had ever adopted

unrelated children among

college-educated women than among

women who had not completed hi,gh

school, observed in table 1, it is not

surprising that more than half of

unrelated adoptions involved mothers

with at least some college education.

This proportion appears to have

increased between the 1970’s and

1980’s, from slightly more than half to

nearly two-thirds, but this apparent

change is significant at only the 10-

percent level. A parallel decline in the

percent of unrelated adoptions

involving women who had not

completed high school, from 9 percent

during the 1970’s to 2 percent during

the 1980’s, was significant at the 5-

percent level. These changes may

reflect general advances in the

educational attainment of women of

childbearing age over the 2 decades as

well as a greater concentration of

unrelated adoptions among the more

advantaged segments of the population

in the 1980’s.

Interracial adoption

Researchers and policymakers

seeking estimates of the prevalence of

interracial adoption in the United

States have had few resources with

which to work. In 1975, the most

recent year for which such estimates

were available, the necessary data

were reported by only 23 States. Of

the nearly 12,000 unrelated adoptions

reported by these States, 16 percent

involved parents and children of

different racial or ethnic groups, and

about 2 percent involved black

children placed with parents who ‘were

not black (9).

Estimates of interracial adoption

were derived from the 1987 NHIS by

linking information on the race of the

adoptive mother with that of the

adopted child. Estimates are limited to

adoptions in which the child was still

living in the adoptive mother’s

household at the time of the survey.

Of these adoptions, only 8 percent

involved parents and children of

different races. Five percent were

adoptions of children of races other

than white or black by white mothers,

1 percent were adoptions of black

children by white mothers, and

2 percent were adoptions of white
Advance Data 7

children by mothers ofother races. No

instances of interracial adoption by

black mothers or of black children by

mothers of races other than white

were apparent in the NHIS data.

Because many of these interracial

adoptions are likely to involve children

born outside the United States, the

prevalence of interracial adoption

among U.S.-born children may be

quite low.

References

1<

2,

3.

Administration for Children, Youth

and Families. Child welfare statistical

factboo& 1985. Washington: Maximus,

Inc. 1988.

Maza P. What we do—and don’t—

know about adoption statistics.

Permanency report, Child Welfare

League of America: Permanent

Families for Children, vol 3 no 2.

1985.

National Committee For Adoption.

Adoption factbooli: United States

dat% issues, regulations and resources.

Washington National Committee For

Adoption. 1985.

4. National Committee For Adoption.

Adoption factbook: United States

data, issues, regulations and resources.

Washingtotx National Committee For

Adoption, 1989.

5. Bachrach CA. Adoption plans,

adopted children and adoptive

mothers. J Marriage Fam

48(2):243-53. 1986.

6. Bachrach CA. Adoption as a means of

family formation data from the

National Sumey of Famiiy Growth. J

Marriage Fam 45(4):859-65. 1983.

7. Bachrach CA. Children in families:

characteristics of biological, step- and

adopted children. J Marriage Fam

45(1):171–79. 1983.

8. Bonham GS. Who adopw the

relationship of adoption and socialdemographic characteristics of women.

J Marriage Fam 39(2):295–306. 1977.

9. National Center for social Statistics.

Adoptions in 1975. Department of

Health, Education, and Welfare, pub

no (SRS) 77-03259. National Center

for Social Statistics report E-10 (1975).

1977.

10. U.S. Immigration and Naturalization

Service. 1988 statistical yearbook.

11.

12.

13.

Washington: U.S. Government

Printing Office. 1989.

Maza P. Adoption trends 1944-1975.

In: Child welfare research notes, no 9.

Washin@on: Administration for

Children, Youth and Families. 1984.

Zill N. Behavior and learning

problems among adopted children:

Findings from a U.S. National Survey

of Child Health. Paper presented at

the biennial meeting of The Society

for Research in Child Development,

April, Toronto. 1985.

Schoenbom CA, Marano M. Current

estimates from the National Health

Intefiew Suwey United States, 1987.

National Center for Health Statistics.

Vital Health Stat 10(166). 1988.

14. Bachrach CA Horn MC, Mosher WD,

Shimizu I. National Smvey of Family

Growth, cycle III, sample design,

weighting, and variance estimation.

National Center for Health Statistics.

Vital Health Stat 2(98). 1985.

15. Bachrach CA. Adoption plans,

adopted children, and adoptive

mothex United States, 1982. National

Center for Health Statistics working

paper no 22.1985.
8 Advance Data

Technical notes

The National Health Interview

Survey (NHIS) is a continuous crosssectional nationwide survey conducted

by household interview. Each week a

probability sample of households in

the civilian noninstitutionalized

population of 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. A description of the survey

design, methods used in estimation,

and general qualifications of the NHIS

data is provided in Current Estimates

from the National Health Interview

Survey United States, 1987 (13).

The NHIS sample for 1987 was

composed of 47,240 households

containing 122,859 persons. The total

noninterview rate was 4.7 percent.

Questions on adoption were asked of

all women 20-54 years of age

enumerated in the NHIS household.

Of a total of 31,124 such women, 566

reported ever having adopted a child;

416 had adopted one child; 128 had

adopted two; and 22 had adopted

three or more. If more than two

children were adopted, detailed

information was obtained only for the

two children adopted most recently.

Information was obtained for 716

adopted children, including 555 who

were reported to be unrelated to the

adoptive mother before the adoption.

Additional information on topics such

as health and demographic

characteristics collected in the core

NHIS interview is available for up to

two most recently adopted children

who were still living in the NHIS

household at the time of the interview.

The NationaJ Survey of Family

Growth (NSFG) is a periodic survey

conducted by the National Center for

Health Statistics to provide data on

fertility, family planning and related

aspects of maternal and child health.

The third cycle of the NSFG,

conducted in 1982, is based on

interviews with a national probability

sample of 7,969 women 1544 years of

age. Detailed information on the

design, procedures, estimation

procedures, and reliability of sample

estimates for the NSFG Cycle HI is

available elsewhere (14). Data on

adoption from the NSFG Cycle III are

presented in this report for

comparative purposes. These data are

based on the reports of 94 sample

respondents who reported they had

adopted one or more children.

Evaluation of data

The quality of data on adoption

collected in the NHIS was assessed in

several ways. Comparisons with earlier

survey data indicated reasonable levels

of consistency, taking into account

sampling error and the likelihood of

some change over time. Estimates

were also compared with independent

estimates of adoptions available on a

national basis.

Estimates of yearly adoptions

based on the NHIS data would be

expected to fall short of the annual

numbers of adoptions occurring

nationally for several reasons. Men

were not asked about adoption; nor

were women outside 2&54 years of

age. Adoptions that occurred many

years before the survey would be

particularly susceptible to

undercountingq because a greater

proportion of the adopting parents

would have died, entered an

institution, or attained age 55 and

become ineligible for the questions.

Because independent information on

age of adopting parents is not

available, it is impossible to assess

what percent of adoptions in the years

immediately preceding the survey

would involve women outside 20-54

years of age. However, the percent is

presumed to be relatively small.

Exclusion of men should primarily

affect the estimates of related

adoptions, because most unrelated

adoptions involve a married couple.

Although current information is not

available, estimates prepared by the

National Center for Social Statistics

show that only 0.4 percent of children

adopted by unrelated petitioners in

1975 were adopted by men who were

not married at the time of the

adoption (8). Estimates of unrelated

adoptions for the years immediately

preceding the 1987 survey, therefore,

should be relatively complete, and

relatively less complete as time

between the adoption and the survey

lengthens.

To evaluate the completeness of

adoption reporting in the NHIS,

estimated numbers of annual

adoptions of unrelated children were

compared with independent nation,al

estimates for those years in which

such data are available, and with

comparable estimates based on the

1982 National Survey of Family

Growth (15). Results are shown in

table 1. The estimates derived from

the two surveys are three-year

averages (for example, the estimate

for 1980 is the average number of

unrelated adoptions for the years.

1979-81). They have also been

adjusted for nonresponse to items on

adoption, using the assumption that

nonresponses to specific items would

be distributed proportionately to

responses. Standard errors for the

adjusted 3-year totals on which the

averages are based are shown in

parentheses. Clearly, sampling error

alone places a wide confidence interval

around each of these annual estimates.

However, the general level of the

estimates is very much in line with the

few estimates available that are based

on annual State reports, and it is

generally consistent as well with

estimates based on the 1982 NSFG,.

The only years for which serious bibs

appears to exist are those before 1974,

a bias that reflects the expected

tendency for coverage to decrease as

time since the adopt ion increases.

These estimates suggest that the

NHIS provides relatively good

coverage of unrelated adoptions.

Much of the data presented by this

report, however, is additionally

affected by missing information on the

items relating to adoption. For

example, information on whether the

woman had ever adopted was missing

for 2.5 percent of women. Of the

adopted children reported, information

on the relationship before the

adoption was missing for 7.4 percent.

Of those adopted children known to
Advance Data 9

Table L Estimates of number (with standard error) of unrelated adoptions by survey,

annual State reports, and year of adoption

Survey

Annual

1967IVafbnatf-tsalltr1962Mwonel Surwy State

Year Intetview Survey of Fmity Gtvwlh reporls

1966.... .. ... ..... .. . .. .. ..... 49,200 (7,700) --- 51,157

1985.. ..... .. ..... .. . .. . ... . .. 43,300 (7,300) -.. ---

19s4.... .. ....... ... . .. .. .. ... 48,400 (7,700) --- ---

1962... ... ....... ... . .. .. ... .. 44,100 (7,300) --- .-.

1962.... .. ... .... ... . .. .. .. ... 46,700 (7,500) --- 50,720

1981... ... ........ .. . .. . ... ... 43,500 (7.3ca) 67,700 (2e,9co) ---

1960.... .. ........ ... .. . . .. . .. 42,200 (7,200) 49,9C0 (25,7CO)

1979.... .. ... ..... ... .. .. ..... 46,600 (7,S33) 56,400 (27,600) :::

1978.... .. ....... ... ... .. .. ... 44,600 (7,4W) 50,700 (25,900) ---

1977 ... .. ........ .. ... .. ... .. 47,200 (7,600) 46,900 (24,9W) ---

1976.... ... .. ..... .. . .. .. ..... 50,700 (7,600) 23,700 (17,700) ---

1975...... ... .... ... . .. .. ... .. 50,eoo (r)m) 25,400 (16,300) 47,700

1974...... . .. ..... ... .. .. ... .. 49,200 (7,700) 29,6C0 (19,aoo) 49,700

1973... ... . ... .... .. . ... . ... .. 36,100 (6,600) 40,200 (23,0ao) 5e,200

1972... ... . ..... .. .. . .. . . ... .. 24,000 (6,400) 42,C03 (23,6430) 67,300

NOIE.StE#inmte8ambawdcmamamlSiatereparlsfwyeam 19~-75=wMMinMqlW.=iti=til*ti 19B6

amfmm Nalkmai Convnillw FwAdop6cq 1S85 and 19&I. AN esthatesam based on inwmpkhdataand adjustedto

appm”nmtermtiond btals.Esihu!esbaaed onawmydaiaam 3yearw8rages8d@led fwnonmsponse. Slardarderrorsfor

2-yearavemguam shc+vnlnpamriimses

be unrelated, information foryearof

the adoption and how the adoption

was arranged were each missing for

3.2 percent, although informationon

place of birth was complete. In

addition, information was ascertained

only forthehvo children adopted most

recently by each woman. Other

adopted children for which no effort

was made to ascertain information

constitute approximately3 percent of

the adoptions reported by NHIS

respondents. To the extent that

children for whom information is

unavailable differ from those for

whom it is, the results shown in this

report will be biased.

ReiiabiIity of estimates

Because the estimates shown in

this report are based on samples of

the population rather than on the

entire population, they are subject to

sampling error. A measure of

sampling error is given by the standard

error. Appropriate standard errors for

estimated percents in tables 1 and 2 of

this report are given by the formula

where SE is the standard error, p is

the estimated percent, b is the

parameter associated with the

numerator characteristics, and y is the

denominator. The b parameter is

3,640 for estimates based on NHIS

datq approximately 39,S09 for

estimates relating to white women or

women of all races from NSFG Cycle

III data, and approximately 6,346 for

NSFG CycIe III estimates relating to

black women. The approximate

standard error of a difference between

percents is given by the formula

SE(XI - X ~) = ~ SE(X ~)z+ SE(X2)2

where x ~ and x ~ are the two percents

being compared, xl – X2 is the

difference between them, and SE(X J

and SE(Xz) are the standard errors of

the two percents.

The relative standard error of a

statistic is the ratio of the standard

error to the statistic. Estimates with

relative standard errors of 30 percent

or greater are indicated with asterisks.

The reader may wish to combine these

estimates with related estimates to

produce a more reliable overall estimate for a broader category.

In this repor~ terms such as “similar” and “the same” mean that no

statistically significant difference was

detected between the statistics being

compared. Terms relating to difference (for example, “greater” or

“less”) indicate that differences are

statistically significant. A two-tailed

t-test was used to test all comparisons

discussed. A difference was considered

statistically significant at the 5-percent

level if the difference (x ~ – x J was at

least 1.96 times as large as its standard

error, and as statistically significant at

the lo-percent level if it was at least

1.65 times as large as its standard error. Because the statistics presented in

this report have relatively high standard errors, the failure to detect a statistically significant difference between

two statistics does not necessarily

mean that no such difference exists in

the population. Lack of comment regarding the difference be~een any

tNVOstatistics does not mean that the

difference was tested and found to be

not significant.
10 Advance Data

Symbols

..- Data not available

. . . Category not applicable

. Quant”~ zero

0.0 Quant”kymore than zero but less

than O.O5

z Quantity more than zero but less

than 500 where numbers are

rounded to thousands

● Figure does not meet standard

of reliability or precision

# Figure suppressed to comply with

confidential”~ requirements
Number 182 ● March 20, 1990

Advance

Data

From Vital and Health Statistics of the National Center for Health Statistics

Contraceptive Use in the United States, 1973-88

by William D. Mosher, Ph.D., and William F. Pratt, Ph.D., Division of Vital Statistics

The percent of married couples

using sterilization as a method of

contraception increased dramatically

between 1973 and 1982, and continued

its increase until 1988—more than

doubling in 15 years (figure 1). In

contrast, the percent of married

couples using the pill declined sharply

between 1973 and 1982, but that

decline did not continue between 1982

and 1988. Among never married

women, the proportion using the pill

increased between 1982 and 1988. The

pill was the leading method among

never married women in both 19S2

and 1988. In contrast, female

sterilization was the leading method

among currently married couples and

formerly married women in 1982 and

1988. Use of the condom has been

suggested as a protection against

human immunodeficiency virus (HIV)

infection and other sexually

transmitted diseases. The percent

using the condom did not change

significantly among married couples,

but it did increase significantly among

never married women, for whom it

was the second leading method, after

the pill. These findings are based on

the 1973, 1982, and 19S8 National

Condom

●

●

,~

1973 1982 1983

Year

Figure 1. Percent of married couples (wives 15-44 years of age) using sterilization, the

pill, and the condom: United States, 1973, 1982, and 1988

* 5Hwrc&~{,* #

&

$

-r U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

* Public Health Service

~-

Centers for Disease Control z

*- National Center for Health Statistics

%

%+

>

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

40d7”
2 Advance Data

Table 1. Number of women 1+44 years of age and percent distribution by current

contraceptive status and method, according to race: United States, 1982 and 1988

(Statktks are based on samples of the female Populatbn of the conlenmlnous Uniled States. See Technical

notes for estimates of sampling varfebillty end definibcms of lermS..Data for 1966 are preliminary)

All races’ WFrlfe

Corwacepwe

Black

slatusarrdmethod 1988 1982 1988 1982 1988 1982

All women . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . .

Sterile . . . . . . . . . . . . . . . . .

Surgically sterile . . . . . . . . . .

Contraceptiiely sterile . . . .

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

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

Nonoontraceptrvely sterile. . .

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

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

Nonsurgkxdly sIerile. . . . . . . .

Pregnant or postpartum . . . . . .

Seeking pregnancy . . . . . . . . .

Other nonuse# . . . . . . . . . . .

Never had intercourse . . . . . .

No intercourse In last

3 months . . . . . . . . . . . . . .

Intercourse in leaf 3 months. . .

Nonsurgical con!raceptora . . . . .

Pnl

IUD::::::::::::::::::

Diaphragm . . . . . . . . . . . . .

Condom . . . . . . . . . . . . . . .

Foam . . . . . . . . . . . . . . . . .

Periodic aballnenceg . . . . . . .

Natural family planning . . . .

Withdrawa l . . . . . . . . . . . .

Douche . . . . . . . . . . . . . . .

Other methods . . . . . . . . . . .

57,eoo

100.0

29.7

28.3

23.6

16.6

7.0

4.7

4.7

0.0

1.4

4.8

3.8

25.0

11.5

6.2

6.5

36.7

16.5

1.2

3.5

8.6

0.6

1.4

0.4

1.3

0.1

1.2

54,098

100.0

27.2

25.7

19.0

12.9

6.1

6.6

6.3

0.3

1.5

5.0

4.2

26.9

13.6

5.9

7.4

36.7

15.6

4.0

4.5

6.7

1.3

2.2

0.3

1.1

0.1

1.3

Number in thousands

47,0i7 45,3G’

Percent distribution

100.0

30.5

29.2

24.5

16.1

8.4

4.7

4.6

0.0

1.3

4.8

3.7

23.8

11.0

6.2

5.7

37.2

16.4

1.1

3.6

9.2

0.6

1.4

0.4

1.3

0.0

1.2

100.0

27.7

26.1

19.4

12.5

6.9

6.7

6.3

0.3

1.6

4.8

4.0

26.2

13.9

6.0

6.4

37.2

15.1

3.9

5.0

7.2

1.4

22

0.4

1.2

0.0

1.2

7,679

100.0

29.6

27.8

22.1

21.6

●0.5

5.7

5.7

+0.0

1.6

5.0

3.9

26.9

9.7

6.3

10.2

34.6

21.6

1.7

1.1

5.8

*0.6

1.2

●O.1

0.8

W.2

1.6

6,965

100.0

23.7

22.2

16.3

15.6

●0.7

5.9

5.9

0.0

1.5

5.6

2X

10.3

5.8

13.5

35.7

19.8

4.7

1.8

3.2

1.4

1.6

0.1

0.7

0.7

1.7

‘ Irckfdes whale, i?Jack,and otbr races.

‘Irchdes women wha M intemume onfy once, not shmvn separately.

31rwhdes natural rsmilyplannkg andothertypesor pariodii atati~.

SOURC& Ndiond SurreyC4FamilyGrowth,Natioral CenterforHealth%tlsks. Datsfor 12S8mu prulim”nary.oats for1982 are

basedon a H“* dsssiication of th calrscaptive ir#er4d stefllizatkxojmratia-s,intendedto be comMMMo to the 1368

dassifcatlon

Surveys of Family Growth. The 1988

data are the most recent national

estimates of contraceptive use in the

United States.

The National Survey of Family

Growth is conducted by the National

Center for Health Statistics. The

interview includes information on a

number of topics related to

childbearing, family planning, and

related aspects of maternal and child

health. The 1988 data in this report

are from ~cle lV of this survey,

which was based on personal

interviews eanducted between January

and August 1988 with 8,450 women

15-44 years of age in the

noninstitutional population of the

United States. The other data in this

report are from Cycle III of the

National Survey of Family Growth,

conducted in 1982, and Qcle I,

conducted in 1973. The design of the

survey and estimates of sam~ling

variability are discussed in the

Technieal notes.

Findings

In 1988 about 60 percent of

women 1544 years of age were

currently using contraception: 24

percent were using contraceptive

sterilization, and 37 percent were

currently using other contraceptive

methods (table 1). This means that of

the 57.9 million women of

reproductive age, about 35 million

were using contraception in 1988. In

1982 about 30 million out of the 54

million women of reproductive age

were using contraception (calculated

from table 1).

Some women who usually use

contraception were not currently using

it, because they Were currently

pregnant, postpartum, trying to

bwome pregnant, noncxmtraceptively

sterile, or nonsurg”eally sterile. About

40 percent of women were not

currently using contraception. Of this

40 pereent, only 7 percent were at risk

of having an unintended pregnaney—

those who were classified as “other

nonusers” who had “intercourse in the

last 3 months.” The other 33 percent

(out of 40 percent) who were not

using contraception were not at risk of

unintended pregnancy 5 percent were

sterilized for noneontraceptive (health)

reasons; 1 percent, sterile for reasons

other than surge~ 5 percent were

currently pregnant or had been

pregnant less than 2 months before

they were interviewed (pregnant or

postpartum); 4 percent were trying to

become pregnant, 12 pereent had

never had intercourse, and 6 percent

had not had intercourse in the 3

months before the interview.

Thus, many women of

reproductive age are not at risk of

unintended pregnancy. If we calculate

the percent using amtraception among

those currently at risk of unintended

pregnrmey, the percentage currently

using was 90 percent in 1988 and 88

percent in 1982. Those who are at risk

of unintended pregnancy include those

currently using ccmtraeeption plus

those classified as “other nonusers”

who had “had intercourse in the last 3

months.”

Among the 6 percent of women in

table 1 who were not trying to get

pregnant but had intercourse without

contraception in the last 3 months,,

about one-third of that 6 percent had

had intercourse in the last 3 months,

but were not having intercourse during

the month of interview about one..

fourth had fecundity impairments and

thought their chances of conceiving

were low, others may have been

indifferent to the possibility of a

pregnaney, had personal objections to

using contraception, or health

concerns about contraceptive use.

If male and female sterilization

are counted as one method, then the
Advance Data 3

leading method in 1988, as in 1982,

was sterilization, used by 24 percent of

women (or their husbands or

partners), followed by the pill (19

percent). If male and female

sterilization are counted as separate

methods, then the leading method in

198S (as in 1982) was the pill (19

percent), followed by female

sterilization (17 percent). The other

methods, in rank order, were the

condom (9 percent), male sterilization

(7 percent), the diaphragm

(4 percent), periodic abstinence (which

includes calendar rhythm, temperature

rhythm, and natural family planning),

withdrawal, and the IUD (1 percent

each), and foam and douche with less

than 1 percent each.

The number of contraceptors

increased by 4.8 million between 1982

and 1988, an increase of 16 percent.

The numbers of users of 3 methods

increased by more than 25 percent

each: the pill, female sterilization, and

the condom. About 10.7 million

women were using the pill in 1988,

compared with just 8.4 million in

1982. In 198S, 9.6 million women were

using female sterilization, up from 7.0

million in 1982. About 5.1 million

were using the condom, compared

with 3.6 million in 1982—a 41-percent

increase. The number using the

intrauterine device (IUD) dropped by

two-thirds, from 2.2 mil!ion in 1982 to

0.7 million in 1988, probably because

some companies stopped distributing

the IUD in the United States.

If we add the percents

“contraceptively sterile” and

“nonsurgical contraceptors” in tables

1–3, we get the percent using some

form of contraception (these percents

are also shown in the second column

of table 4). The percent using a

Table 2. Number of women 1!5-44 years of age and percent distribution by current

contraceptive status and method, according to age: United States, 1982 and 1988

(Statistics are based on samples of the female population of the conterminous United states. See Technical

notes for estimates of sampling variabllii and definitions of terms. Data for 1966 are preliminary)

75-24 years 25-34 years

Contraceptive

25-44 years

status and method 1988 1982 1988 1982 1988 Isw

All women . . . . . . . . . . . . . . .

Total . . . . . . . . . . . . . . . . . . .

Sterile . . . . . . . . . . . . . . . . . .

Surgically sterile. . . . . . . . . .

Contraceptively sterile . . . . .

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

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

Noncontraceplively sterile. . .

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

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

Nonsurgically sterile . . . . . .

Pregnant or post partum . . . . . .

Seeking pregnancy . . . . . . . . .

Other nonuser’ . . . . . . . . . . . .

Never had Intercourse . . . . . .

No Intercourse in lest

3 months . . . . . . . . . . . . . .

Intercourse in last 3 months. . .

Nonsurgical contraceptora. . . . .

Pill

IUD::::::::::::::::::

Diaphragm . . . . . . . . . . . . .

Condom . . . . . . . . . . . . . . .

Foam . . . . . . . . . . . . . . . . .

PerkJd!C abstinence . . . . . . .

Naturat family planning . . . .

Withdrawa l . . . . . . . . . . . .

Douche . . . . . . . . . . . . . . .

Other methods . . . . . . . . . . .

18,592

Iwo

3.1

2.4

2.2

1.6

●0.6

‘0.2

+0.2

●0.O

0.7

5.0

2.7

45.7

30.0

5.4

7.8

43.5

29.7

W. 1

1.3

9.5

*0.3

*0.6

“0.2

1.5

●0.O

●0.5

20,1541

100.0

3.2

2.6

2.4

f .3

1.1

*0.2

0.2

●0.O

●0.6

6.3

3.5

48.6

32.5

6.9

9.2

38.4

23.5

1.4

3.7

5.5

0.8

1.2

*O. 1

1.2

●O.1

1.0

Number in thousands

21,726 19,644

Percent dtstribuutiirr

100.0

27.0

26.0

23.3

16.6

6.7

2.7

2.7

0.0

0.9

7.6

5.8

16.7

3.6

6.4

6.4

43.0

21.6

1.4

4.8

9.1

0.8

1.7

0.5

1.9

0.0

1.7

100.0

27.9

26.4

21.5

14.8

6.7

4.9

4.6

0.3

1.5

6.5

6.2

14.2

27

5.1

8.5

45.2

17.1

6.5

6.8

7.6

E

0.6

1.2

0.1

1.6

17,562

100.0

61.3

58.7

46,7

32.5

14.2

12.0

11.9

0.0

27

1.1

Iti

1.6

6.8

5.0

21.6

3.0

2.1

4.1

7.7

0.8

1.8

0.4

0.6

0.2

1.4

14,305

100.0

60.1

57.3

39.0

26.6

12.2

18.3

17.4

0.8

2.8

1,0

2.5

13.8

20

5.8

6.0

226

23

4.2

2.4

7.0

1.8

26

0.3

0.8

0.3

1.1

‘ lnchdes women who hava M intercourse only ome, nd shown separately.

%kdss IVMJralfamily plmning snd otherfps of peticdic.sbsIirerms.

SOURU2 NatiomII Suivay of Family Growth, National Center for Health .SWistics. Oata for 19S% era prelimimsry. OaIa for 19S2 am

bassd on a ravisad classification of tha corsraceptiva intent of sterilization operations, intanckd to ba comparable to the 1988

classikation.

method increased between 1982 and

1988, from 56 to 60 percent. For white

women, the increase was from 57

percent using a method in 1982 to 62

percent in 1988. For black women, the

percent currently using a method

increased from 52 percent in 1982 to

57 percent in 1988. A look at the

“contraceptively sterile” and

“nonsurgical cmtraceptors” lines in

table 1 shows that overall and for both

white and black women separately, the

increase in the percent using

contraception was due to an increase

in the use of sterilization, not in the

percent using nonsurgical methods.

This, in turn, is partially due to

changing age composition: in 1988,30

percent of all women 15-44 years of

age were 3544 years of age—the

group most likely to be sterilized—

compared with 26 percent in 1982.

Age

Current contraceptive use varies

sharply by the age of the woman, as

shown in table 2. The percent

contraceptively sterile increased

rapidly with age in both 1982 and

1988. For example in 19S8, the

percent contraceptively sterile was 2

percent at age 15-24,23 percent at

25-34, and 47 percent at age 35-44. In

contrast, the percent currently

pregnant or postpartum was 5 percent

at age 15–24, 8 percent at 25–34, and

only 1 percent at age 35+$. The

percent who had never had

intercourse was 30 percent in the

youngest age group and 2 percent in

the oldest. For this reason,

comparisons of the percents using

particular methods are strongly

affected by these different proportions

who have never had intercourse; so

comparisons between age groups

should be made among women using

contraception, as shown later in this

report. However, the leading methods

in each age group can be gleaned,

from table 2. The leading method in

the youngest age group was the pill in

both 1982 and 1988, followed by the

condom. In the oldest age group—

35-44 years of age–the leading

method was female sterilization,

followed by male sterilization and the

condom.
4 Advance Data

Table 3. Number of women 15-44 years of age and percent distribution by current contraceptive status and method, according to

marital status: United States, 1982 and 1988

(Slahslics are based on samples of the femate population of the conterminous Uniiad States. See TechnioaI notes for estimates of sampling varfablllty and definttlons

of terms, Data for 1968 are preliminary)

Never married

Contracapttve

Currently marrW Widow&, dtvorc+, or saparafed

sfatus arrd mettrcd 1968 1962 1988 1962 1973 1986 1982 1973

Number In thousands

All women . . . . . . . . . . . . . . . . . 21,056 19,164 2e,147 28,231 26,646 7,695 6,704 3,601

Percent distribution

Total . . . . . . . . . . . . . . . . . . . . . 100.0 100.0 100.0 100.0 100.0 leo.o 100.0 100.0

Sterile. . . . . . . . . . . . . . . . . . . 5.2 3.2 44.0 40.9 23.9 42.6 30.0

Surgically sterile . . . . . . . . . . . 4.3

21.4

26 42.4 38.9 22.9 40.9 36.1

Contraceptrvely sterile . . . . . . . 3.4

20.9

1.9 36.2 29.5 16.4 31.3 23.6 12.5

Female . . . . . . . . . . . . . . . 2.7 1.3 23.4 18.7 8.6 29.2 21.8 12.3

Male . . . . . . . . . . . . . . . . . 0.7 0.6 12.9 10.8 7.8 21 ●1.9 *O.1

Noncontraceptively sterile . . . . . 0.9 0.7 6.2 9.3 6.5 9.7 12.5 8.4

Female . . . . . . . . . . . . . . . 0.9 0.7 6.1 0.7 6.3 9.7 12.5 8.4

Male . . . . . . . . . . . . . . . . 0.0 0.0 “0.0 0.6 0.2 0.0 ●0.O

Nonsurglcally sterile. . . . . . . .

*0.O

1.0 0.7 1.6 2.0 0.9 1.7 ●1.9

Pregnant or post partum. . . . . . . . .

*0.5

2.4 2.5 7.1 7.2 7.3 2.5 2.6

Seeking pregnancy. . . . . . . . . . . .

2.9

1.3 1.2 6,0 6.7 7.0

Other nonueer’ . . . . . . . . . . . . . .

2.0 2.1 *0.O

52.5 5e.7 4.8 5.0 8.7 26.6 25.6 45.3

Never had intercourse. . . . . . . . . 31.5 38,4

No Intercourse in lest 3 months. . . 9.4 11.2 *0.3 +0.2 19.5 15.1

Intercoumeln laet3montns . . . . .

. . . . . .

9.0 10.1 4.5 4.a 7.1 10.4

Nonsurgical cuntraceptors . . . . . . .

--- . . .

36.5 33.3 3a.1 40.1 53.2 26.3 31.6 30.3

Pill . . . . . . . . . . . . . . . . . . . . . 24.7 18.7 15.1 13.4 25.1 14.5 T5.8 18.1

IUD . . . . . . . . . . . . . . . . . . . . 0.6 1.9 1.5 4.8 6.7 2.1 6.4 7.2

LJaphmgm . . . . . . . . . . . . . . . . 21 4.7 4.6 4.5 2.4 3.0 3.7

Condom . . . . . . . . . . . . . . . . .

1.3

8.2 4.1 10.6 9.6 9.4 3.4 ●0.6

Foam . . . . . . . . . . . . . . . . . . .

●0.9

0.2 0.4 1.0 20 3.5 0.5 ●1.1 “0.7

Perlodtc abstinemx. . . . . . . . . . 0.6

Wfihdrawa, douche, and other

0.9 2.1 3.2 2.8 1.1 *1.4 *0.4

mellmds. . . . . . . . . . . . . . . . . 21 26 3.2 2.3 3.4 1.7 2.7 1.7

‘lnctideswwnen whohevehadhterccurse onlyor!c.e,ndshewn separately.

Marital status

Table 3 shows differences in

contraceptive use bymarkd status.

Trend data are shown for 1973,1982,

and 1988 for currently married and

formerly married women. Data for

never married women areshown only

for 1982 and1988beeause most never

married women were not represented

in the 1973 survey. The ’’other

nonuser” categoryin 1973 isnot

divided into those who had interecmrse

in the 3 months before the survey, and

those who did not, because those data

are not available for 1973. Finally, the

question on whether a sterilization

operation was done for contraceptive

or noneontraceptive reasons was asked

differently in 1973 than it was in 1982

and 1988, but this difference in

question wording does not obscure the

very large increase in sterilization that

occurred between 1973 and 1988 (see

the discussion of sterilization for

currently married and formerly

married, below). See the Definitions

of terms for more details on how

sterilization operations were classified

in each survey year.

If we add the categories

“contraceptively sterile” and

“nonsurgical eontraceptors” in table 3,

we obtain the percent using some

form of contraception (the percent

using any method is also shown in the

second column of table 4). The

percent currently using contraception

varies sharply by marital status, from

42 percent of never married women to

74 percent of currently married

women.

Among never married women, the

proportion who had never had

intercourse dropped markedly from 38

percent in 1982 to 32 percent in 1988.

To compare the percentages using

ecmtraception in 1982 and 1988, then,

we need to adjust for the higher

proportion having intercourse in 1988,

by computing the proportion using

contraception as a percent of those

having intercourse in the 3 months

before the survey. If we set aside

women who had never had intercourse

(31.5 percent in 1988) and those who

did not have intercourse in the 3

months before the survey (9.4 percent

in 1988), we are left with 59.1 percent

who had intercourse in the last 3

months. If the percent using

contraception (3.4 plus 38.5 equalls

41.9 in 1988), is divided by the 59.1

percent who had intercourse in the

last 3 months, the result is that 71

percent of sexually active never

married women were using

contraception in 1988. A similar

procedure yields 70 percent of sexually

active never married women using

contraception in 1982, a smaIl

difference. Changes in eontraceptiive

methods used by never married

women will be discussed in connection

with table 4.

Among currently married couples,

the proportion surgically sterile (by

vasectomy, tubal operation,

hysterectomy, or other operation) for

contraceptive reasons

(“contraceptively sterile”) more than

doubled between 1973 and 1988, ~from
Advance Data 5

Table 4. Number of women 15-44 years of age, percent using any method of contraception, and percent distribution of contraceptors by

method of contraception, according to age, race, and marikd status: United States, 1982 and 1988

(Statistics are based on samples of the female population of the conterrnlnous United States. Sae Technical notes for estimates of sampling variability and definitions

of terms. Data for 19SS are preliminary)

Number of Psrcent Ferrraie Male

Age, race,and women in ushg any All sferilk sfarfil- Other

mar/faI status thousands method mettrods zaibn mflon Pil[ IUD D@hragm Condom melhcds

3WS ParCent dkstnbufiorr

All women . . . . . . . . 57Soo 60.3 100.0 27.5 11.7 30.7

64.9

32.6

4.3

2e.8

3s.0

58.0

20.4

25.3

28.0

57.6

25.7

3.7

26.7

36.0

Xt.o

19.3

28.4

20 5.7 14.6 7.7

Age

15-24 . . . . . . . . . . .

25-34 . . . . . . . . . . .

35-44 . . . . . . . . . . .

27

7.3

6.0

20.6

13.7

11.2

6.5

9.1

6.9

16,592

21,726

17,5s2

45.7

66.3

66.3

100.0 3.6 ●1.3

10.2

20.8

Yr.2

21

3.1

100.0 25.0

Ioo.o 47.6

Race

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

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

7.5

7.8

47,0i7

7,679

61.8

56.7

100.0

100.0

26.1

36.1

13.6

●0.9

6.2

1.9

14.9

10.3

Maritalstatus

Never married. . . . . .

Currently married . . .

Formerly married. . . .

21,056

2e,147

7.695

41.9

74.3

57.6

100.0

100.0

100.0

6.4

31.4

50.7

+1.8

17.3

3.6

1.3

20

3.6

4.9

6.2

5.3

19.6

14.3

5.9

7.0

8.4

5.7

1982

Allwomen . . . . . . . . 54.099 55.7 100.0 23.2 10.9 7.1 8.1 120 10.7

Age

1S-24 . . . . . . . . . . .

25-34 . . . . . . . . . . .

35-44 . . . . . . . . . . .

13.5

11.4

11.3

10.6

10.7

10.8

20,150

19,644

14,305

40.6

66.7

61.6

100.0

100.0

100.0

3.2

221

43.5

%2.7

10.1

19.9

3.4

9.7

6.9

9.0

10.3

4.0

Race

While . . . . . . . . . . .

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

45,367

6,9S5

56.7

52.0

100.0

100.0

221

30.0

122

●1.4

6.9

9.1

8.6

3.5

127

6.2

10.7

11.7

Marital status

Never married. . . . . .

Currently married . . .

Formerly married. . . .

35.3

69.7

55.5

100.0

100.0

100.0

3.7

26.9

39.2

‘1.6

15.5

+3.4

5.4

6.9

11.5

13.4

6.5

6.7

11.6

14.1

*1.5

11.1

70.6

9.2

19,164

26,231

6,704

SOURCE Data for 1SS2am H on a ravbed classificationof Iha codrscaptiva irtari of stedlizaticmoparsfias, intardadto be uxpsmbie to ttm lSW clSific@.kxL

statistically significant. These three

changes are all in the direction of less

exposure to HIV infection (AIDS)

and other sexually transmitted

diseases.

Three of the major changes in

contraceptive practice among formerly

married women were similar to those

for currently married women: first,

the proportion using female

mntraceptive sterilization rose sharply,

from 22 percent in 1982 to 29 percent

in 1988. Secondly, there was no

significant change in the percent using

the pill among formerly married

women between 1982 and 1988.

Thirdly, the proportion using the

IUD decreased sharply, from 6

percent in 1982 to 2 percent in 1988.

Changes in other categories were

generally small.

16 percent in 1973 to 36 percent in

1988 (table 3 and figure 1). In turn,

most of this increase was in female

sterilization 9 percent used female

sterilization in 1973, 19 percent in

19S2, and 23 percent in 1988. The

proportion using male sterilization was

8 percent in 1973, 11 percent in 1982,

and 13percent in 1988.

As the proportion of married

couples using sterilization increased

from 1973 to 1988, the proportion

using other methods of contraception

declined, from 53 percent in 1973to

40 percent in 1982 and 38 percent in

19S8. The proportion using the pill

declined from 25 percent in 1973 to 13

percent in 1982; the increase to 15

percent in 1988 was not statistically

significant. Use of the IUD declined

from 7 percent in 1973 to 5 percent in

1982 and 2 percent in 1988. Use of

the condom did not change

significantly among married couples

between 1982 and 1988.

The number of widowed, divorced,

and separated (or formerly married)

women more than doubled, from 3.6

million in 1973 to 7.7 million in 1988,

as a result of increasing numbers of

women aged 2544, rising rates of

separation and divorce and declim”ng

rates of remarriage, particularly in the

1970’s (l). The proportion of women

not using a method beeause they were

not having intercourse in the 3 months

before the intemiew increased fkom 15

percent in 1982 to 20 percent in 1988.

At the same time, the proportion

having intercourse but not using any

method declined from 10 to 7 percent.

Neither of these changes was

statistically significant, but the increase

in the percent using the condom was
6 Advance Data

Contraceptors

Groups classified by marital

status, race, age, and other factors

differ sharply in the percent currently

using contraception. These differences

are due primarily to the differing

percentages of each group who had

not had intercourse recently or ever,

and the proportions pregnant or trying

to become pregnant. Because these

groups have differing proportions

using any method, they will also have

different proportions using particular

methods. It is, therefore, often useful

to compare method choices only

among women who are using some

method of contraception or

“contraceptors.” This kind of

comparison is shown in table 4, for

1982 and 1988 (the years in which

women of all marital statuses were

interviewed).

Among contraceptors under

25 years of age and never married

contraceptors, the leading method by

far was the pill in both 1982 and 1988.

For example, in 1988, 59 percent of

never married contraceptors were

using the pill, while only 20 percent

were using the second leading method,

the condom. Among currently married

and formerly married women, the

leading method was female

sterilization in both 1982 and 1988.

For example, in 1988,31 percent of

currently married and 51 percent of

formerly married contraceptors were

using female sterilization.

As shown in table 4, black women

were less likely to be using

contraception than white women

(57 percent of black women and 62

percent of white women in 1988; 52

and 57 percent in 1982). Black women

were more likely than white women to

have had intercourse in the last 3

months and not be using a method

(10 percent compared with 6 percent,

table 1).

The data in table 4 show that in

1982 and 1988, black women were less

likely than white women to use a

method. But among those who did use

a method, black women using

contraception were significantly more

likely than white contraceptors to use

the two most effective female

methods- female sterilization

(38 percent compared with 26 percent

in 1988) and the pill (38 percent

compared with 30 percent in 1988). In

contrast, black contraceptors in 1988

were less likely to rely on male

sterilization (1 percent compared with

14 percent), the diaphragm (2 percent

compared with 6 percent), and the

condom (10 percent compared with

15 percent).

Overall, between 1982 and 1988,

the percent of contraceptors using

female sterilization increased from 23

to 28 percent. The data suggest that

the proportion using the pill rose from

28 to 31 percent. The proportion using

the condom increased from 12 to 15

percent; and the proportion using the

IUD dropped sharply, from 7 percent

to 2 percent of contraceptors. The

decrease in use of the IUD occurred

in all groups, but the changes in

female sterilization, the pill, and the

condom occurred mainly in certain

subgroups.

The largest increase in use of

female sterilization occurred among

formerly married contraceptors: from

39 percent in 1982 to 51 percent in

1988, an increase of 12 percentage

points. Among currently married

contraceptors, the increase was from

27 to 31 percent–only about 4

percentage points. Use of female

sterilization increased by 8 percentage

points—from 30 to 38 percent—

among black contraceptors between

1982 and 1988. In contrast, the

increase in the percent using female

sterilization among white

contraceptors was only 4 percentage

points (22 to 26 percent).

The percent using the pill

increased among contraceptors aged

15–24 (58 to 65 percent) and those

aged 25-34 (26 to 33 percent). The

data suggest that the percent using the

pill also rose among never married

women, from 53 percent in 1982 to 59

percent in 1988.

Given the increased concern in the

1980’s about HIV infection, as well as

other sexually transmitted diseases, the

changes in condom use are of interest.

By age, the percent using the condom

increased significantly only among

those 15–24, from 14 to 21 percent.

By race, the percent using the condom

increased from 6 to 10 percent among

black contraceptors. By marital status,

the percent of never married

cmtraceptors using the condom

increased from 12 percent in 1982 to

20 percent in 1988, and from 2 to 6

percent of formerly married

contraceptors. There was no

significant change in the proportion of

currently married ccmtraceptors using

the condom (14 percent in both

years).

Current condom users

The measure used in this report,

current contraceptive status, is

designed to measure the exposure of

women of reproductive age to the risk

of pregnancy in the month of

interview. Women coded as using

more than one method are coded in

the order that the methods are listed

in tables 1 and 2: female sterilization,

male sterilization, pill, IUD,

diaphragm, condom, foam, periodic

abstinence, withdrawal, douche, and

other. Therefore if a woman is using

the pill and the condom, she is coded

as using the pill, because the pill is

more effective in preventing pregnancy

than the condom (2). To obtain a

complete estimate of the numbers

using the condom, the data were

retabulated to show all those using the

condom, regardless of what other

methods they may have been using.

This retabulation, not shown in the

tables, reveals that, in addition to the

5.1 million using the condom under

the contraceptive status classification

used in tables 1A of this report,

another 0.7 million were currently

using the condom usually in

combination with other methods, for a

total of 5.8 million condom users in

1988. The comparable numbers in

1982 were 3.6 million using the

condom under the contraceptive status

classification, plus 0.5 million other

current condom users, for a total

number of 4.1 million current condom

users in 1982. Thus, the total number

of current condom users increased

from 4.1 million in 1982 to about 5.8

million in 1988, or from about 7

percent of all women 15-44 years of

age in 1982 to 10 percent in 1988.
Advance Data 7

References

1.

9“.

National Center for Health Statistics.

Vital statistics of the United States,

1984, vol III, marriage and divorce.

Washington: Public Health Semite.

1988.

Grady WR, Hayward M, Yagi J.

Contraceptive failure in the United

State* Estimates from the 1982

National Sumey of Family Growth.

Fam Plann Perspect 18(5): 200-209.

1986. “

3. Mosher WD, Bachrach CA.

Contraceptive use, United States,

1982. National Center for Health

Statistics. Vital Health Stat 23(12). 5.

1986.

4. Bachrach CA, Horn MC, Mosher WD,

Shimizu IM. National Suwey of

Family Growth, Cycle Ill sample

design, weighting, and variance

estimation. National Center for Health

Statistics. Vital Health Stat 2(98).

1985.

Ford K Contraceptive utilization,

United States. National Center for

Health Statistics. Vital Health Stat

23(2). 1979.
8 Advance Data

Technical notes

The National Survey of Family

Growth (NSFG) is a periodic survey

conducted by the National Center for

Health Statistics to collect data on

factors affecting childbearing

cxmtraception, infertility, and related

aspects of maternal and infant health.

The suivey is jointly funded by the

IQational Center for Health Statistics,

the National Institute for Child Health

and Human Development, and the

Office of Population Afftirs, all of the

U.S. Department of Health and

Human Services. Fieldwork was

conducted under contract by Westat,

Inc., in 1982and 1988, respectively.

For the 1988 survey (Cycle IV),

personal interviews were conducted

with a national sample of women who

were 15-44 years of age on March 15,

1988. The interviews were conducted

between January and August of 1988.

In 1982 the population covered

women 15-44 years of age living in the

civilian noninstitutionalized population

of the conterminous United States. In

1988 Alaska and Hawaii were

included, so the population covered

was the civilian noninstitutionalized

population of the entire United States.

Interviews were completed with 7,969

women in 1982 and 8,450 women in

1988. Further details on the sample

design and procedures of the 1982

survey (Cycle III)are given in

references 3 and 4. Fieldwork for

Cycle I was conducted by the National

Opinion Research Center in 1973.

Interviews were completed with 9,797

women. Further details on the 1973

survey may be found in any of the

reports based on it, such as

reference 5.

Interviews for Cycle IV of the

survey were conducted between

January and August of 1988 from

households which had been

interviewed in the National Health

Interview Survey (NHIS) between

October of 1985 and March of 1987.

The N[ 11Sis also conducted by

NCHS. As in previous cycles of the

NSFG, black women were

oversamp]ed. Interviews were

conducted in person in the

respondent’s home by trained female

Table L Preliminary estimates of the

parameters A and B for estimating

standard errors for women, by race

Race Parameter A Parameter B

Total or white . . . -0.00018 10736

Black . . . . . . . . . -0.000626 5181

interviewers and last ed an average of

about 70 minutes. The interview

focused on the woman’s pregnancy

histo~, her past and current use of

contraception; ability to bear children

(fecundity and infertility); use of

medical services for family planning,

infertility, and prenatal care, her

marital history, occupation and labor

force participation, and a wide range

of social, emnomic, and demographic

characteristics.

Reliability of estimates

Because the statistics presented in

this report are based on a sample, they

may differ by chance variations from

the statistics that would result if all

57.9 million women represented by the

NSFG had been interviewed. The

standard error of an estimate is a

measure of such differences. The

standard error of a number or percent

is calculated by using the appropriate

values of A and B from table I in the

equations,

SE(N)= V(A + B/N) N

and

SE (P)=~ B p (l:–P)

where N = the number of women

P = the percent

X= the number of women in

the denominator of the

percent

The parameters shown in table I

were used to generate table II, which

shows preliminary estimates of

standard errors for percents of total or

white women, and table HI, which

shows preliminary estimates of

standard errors for percents of black

women.

A similar table for the Cycle III

(1982) survey is given in reference 3.

The chances are about 68 out of

100 (about 2 out of 3) that a sample

Table IL Preliminary estimates of standard errors expressed In percentage points for

percents of total or white women: 1988 National Survey of Family Growth

Estimated percent

&isad 2 or 5or 10 or 20 or 3oor 40 or

percent 96 95 so 80 70 w 50

Standard errvr in percentage points

Ioo,om . . . . . . . . . . . . . . . 4.6 7.1 9.8 13.1 15.0 16.1 16.4

500,003 . . . . . . . . . . . . . . . 21 3.2 4.4 5.9 6.7 7.2 7.3

I,ooo,ooo .............. 1.5 23 3.1 4.1 4.7 5.1 5.2

5,000,000 . . . . . . . . . . . . . . 0.6 1.0 1.4 1.9 2.1 2.3 2.3

10,000,030 . . . . . . . . . . . . 0.5 0.7 1.0 1.3 1.5 1.6 1.6

30,000,000 . . . . . . . . . . . . 0.3 0.4 0.6 0.8 0.9 0.9 0.9

!xm30,000. . . . . . . . . . . . 0.3 0.4 0.6 0.7 0.7 0.7

58,000,001 . . . . . . . . . . . . E 0.3 0.4 0.5 0.6 0.7 0.7

Table Ill. Preliminary estimates of standard errors expressed in percentage points for

percents of black women: 1988 National Survey of Family Growth

Estimated percent

Base of 2 or 5 or 10 or 20 or w or 40 or

percent 96 95 90 S0 70 60 50

Standard error in percentage points

Ioo,m . . . . . . .. . . . . . . . 3.2 5.0 6.8 9.1 10.4 11.2 11.4

5oo,c00 . . . . . . . . . . . . . . . 1.4 2.2 3.1 4.1 4.7 5.0 5.1

l, OW,OOO. . . . . . . . . . . . . . 1.0 1.6 2.2 2.9 3.3 3.5 3.6

5,000,0+30. . . . . . . . . . . . . . 0.5 0.7 1.0 1.3 1.5 1.6 1.6

7,5CKI,000 . . . . . . . . . . . . . 0.4 0.6 0.8 1.1 1.2 1.3 1.3
Advance Data 9

estimate would fall within one

standard error of a statistic based on a

complete count of the population

represented by the NSFG. The

chances are about 95 in 100 that a

sample estimate would fall within two

standard errors of the same measure

obtained if all people in the

population were interviewed.

Differences between percents

discussed in this report were found to

be statistically significant at the

5-percent level using a 2-tailed normal

deviate test. This means that in

repeated samples of the same type and

size, a difference as large as the one

observed would occur in only 5

percent of samples if there were, in

fact, no difference between the

percents in the population.

In the text, terms such as

“greater,” “less; “increase? or

“decrease” indicate that the observed

differences were statistically significant

at the 0.05 level using a 2-tailed

normal deviate test. Statements using

the phrase “the data suggest” indicate

that the difference was significant at

the 0.10 (10 percent) level but not the

0.05 (5 percent) level. Lack of

comment in the text about any two

statistics does not mean that the

difference was tested and found not to

be significant.

The relative standard error (or

coefficient of variation) of a statistic is

the ratio of the standard error to the

statistic and usually is expressed as a

percent of the estimate. In this report

statistics with a relative standard error

of 30 percent or more are indicated

with an asterisk (*). These estimates

may be viewed as unreliable by

themselves, but they may be combined

with other estimates to make

comparisons of greater precision.

Statistics in this report also may

be subject to nonsampling error, that

is, errors or omissions in responding

to the interview, recording answers,

and processing data. The data have

been adjusted for nonresponse by

means of adjustments to the sample

weights assigned to each case. Other

types of nonsampling error were

minimized by a series of quality

control measures as described in

reports on Cycle III (such as

reference 3).

Definitions of terms

Current contraceptive status

Sterile-A currently mam”ed

woman was classified as sterile under

the current contraceptive status

classification if she reported that it

was impossible for her to have a baby,

or her husband to father a child, for

any reason, including sterilization

operations or other causes. AII

unmarried woman was classified as

sterile if she reported that it was

impossl%le for her to have a baby, or if

her current method of contraception

was male sterilization.

Nonsu~”cd-A woman or couple

was classified as nonsurgically sterile if

she reported that it was impossible for

her to have a baby, or impossible for

her husband to father a child, for any

reason other than surgical sterilization.

Nonsurgical reasons for sterility

include menopause, sterility from

accident, iflness, congenital causes, or

unexplained inability to conceive.

SuW”caZ-A woman(or couple)

was classified as surgically sterile if

she or her husband were completely

sterile due to an operation.

Surgical sterilizations were

classified as contraceptive or

noncontraceptive because, while most

are obtained because of their

effectiveness in preventing pregnancy,

some are obtained for therapeutic

reasons. This classification in

successive cycles of the survey has

been affected by changes in the

wording of questions. In the 1973

(Cycle I) survey, a sterilizing operation

was classified as contraceptive if the

respondent answered “yes” to the

question “Was the operation done at

least partly so that you would not have

any more children?” However, since

all sterilizing operations are

contraceptive in effect, though not by

intention, this question was

ambiguous; for example, this question

classified many hysterectomies as

“contraceptive.” In 1976 the question

was revised to reflect more clearly the

motive of family limitation, asking

‘Was one reason for the operation

because you had all the children you

wanted?” This question resulted in a

lower proportion of hysterectomies

reported as contraceptive, but it also

resulted in lower proportions of other

operations reported as cOntraceptive—

because it excluded women who would

have liked more children, but for

whom pregnancy would be a health

risk. This problem was investigated in

the 1982 sumey and rectified in the

1988 survey.

The figures for 1982 and 1988 are

highly comparable. In this report,

noncontraceptive operations in 1982

and 1988 are those for which the

respondent reported that the main or

only reason for the operation was

“medical problems with my femaIe

organs (such as infections, cancer,

etc.).” All other operations were

classified as contraceptive, in its literal

sensex to prevent pregnancy, regardless

of why she wanted to prevent

pregnancy. Reasons for contraceptive

operations in 1982 and 1988 included

the following she had all the children

she wanted, or wanted none, her

husband wanted no more; a pregnancy

would have been dangerous to her

health; she could not carry the

pregnancy to term; she could not

afford or take care of more children;

or she did not like her previous

method of birth control. The data on

the contraceptive intent of sterilization

operations for 1973 may not be

perfectly comparable to those in 1982

and 1988 because the later surveys

contained these explicit answer

categories for a number of reasons for

sterilizations, while the 1973 question

did not. It is not clear how women

who had operations because

pregnancywould be dangerous to

their health would have answered the

question in 1973.

It should be noted that the

estimates of male contraceptive

sterilization show the number of

women rely”ng on this method, and not

necessarily the number of men who

have been sterilized for contraceptive

reasons.
10 Advance Data

Pregnant-A woman was classified

as pregnant if she answered “yes” to

the question, “Are you pregnant

now?” or for those in doubt, “Well, do

you think you are probably pregnant

or not?” However, a woman who

reported that the onset of her last

menstrual period was within the last

30 days before the intervew was

aut oruatically classified as not

currently pregnant.

Seeking pregnanq—A woman was

classified as seeking pregnancy if she

reported that she was not using a

method at the date of the interview

because she wanted to become

pregnant as soon as possible.

Post partum —A woman was

classified as post partum if she

reported that she was not currently

using a method, was not trying to

become pregnant, and her last

pregnancy had terminated within 2

months before the date she was

interviewed.

Other nonusers-Women (or

couples) who reported that they were

currently using no contraceptive

method and could not be classified in

any of the preceding categories of

noncontraceptors were classified here.

Among these are women who had

never had intercourse, had had

interwurse only once, had not had

intercourse in the hst 3 months, were

indifferent to the chances of

pregnancy, had a very low risk of

pregnancy due to a fecundity

impairment, or objected to

contraceptive methods for personal or

religious reasons.

Never had intercourse-A woman

was classified as never having had

intercourse if she was not

currently using a method and she

had never had sexual intercourse

at any time up to the date of

interview, or if she had had sexual

intercourse, but not since her

menstrual periods began.

Intercoume only once—These

women reported that they had had

intercourse only once. They are

not shown as a separate catego~

in tables 1-3, but they are

included in the overall “other

nonusers” category.

No intercoume in last 3 months—A

woman was classified as not

having had intercourse in the last

3 months if she was not currently

using a method and reported not

having sexual intercourse at all in

any of the 3 months preceding the

interview.

Intemouzre in last 3 months-A

woman (or couple) was classified

as having intercourse in the last 3

months if she was not currently

using a method and was having

sexual intercourse currently or in

any of the 3 months preceding the

intemiew.

Contraceptors-A woman (or

couple) who reported using a method

at the date of interview was classified

according to the specific method used.

When more than one method was

currently being used, they were coded

using the following priority orde~

female sterilization, male sterilization,

pill, IUD, diaphragm, condom, foam,

periodic abstinence, withdrawal,

douche, and other. Methods used by

extremely small proportions of the

population, such as jelly, cream,

suppositories, or abstinence, not in

combination with any other methods,

were grouped into the category

“other.”

Demographic Terms

Age—Age is classified by the age

of the respondent in completed years

as of March 15, 1988, the approximate

midpoint of interviewing.

Race-Race refers to the race of

the woman interviewed and is

classified as blaclq white, or other. In

Cycles III (1982) and IV (1988), race

was classified amrding to the

woman’s report of the race that best

described her.

Marital status-Women were

classified by marital status as currently

married, widowed, divorced, separated,

or never married. In Cycles 111(1!982)

and IV (1988), in order to improve

the comparability of NSFG data on

marital status over time and with

other sources of data, informally

married or cohabiting women—who

reported that they were not married

but living with their sexual partnerwere classified by their legal marital

status. In all NSFG surveys, women

who were married but separated from

their spouse were classified as

separated if the reason for the

separation was marital discord, and as

currently married otherwise.
Advance Data 11

Cooperating agencies

Cycle IV of the National Survey of

Family Growth was supported in part

by the National Institute of Child

Health and Human Development,

National Institutes of Health, and the

Office of Population Affairs, Offfice of

the Assistant Secretary of Health.

These agencies also participated in the

design of the questionnaire.

Symbols

- -- Data not available

. . . Catego~ 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

# Figure suppressed to comply with

confidentiality requirements
12 Advance Data

Recent Issues of Advance Data From Vital and Health Statistics

No. 18L Adoption in the 1980’s No. 179. AIDS Knowledge and No. 177. Utilization of Controlled

(January 5, 1990) Attitudes for April-June 19S9 Drugs in Office-Based Ambulatory

No. 180. Characteristics of Persons (November 1, 1989) Care: National Ambulatory Medical

Dying From Cerebrovascular Diseases No. 178. Firearm Mortality Among Care Survey, 1985 (August 29, 1989)

(Feb;uary 8, 1990) Children and Youth (November 3,

19s9)

Suggested citation

Mosher WD, Ph.D., Pratt WF, Ph.D.

Contraceptive use in the United States,

1973-88. Advance data from vital and health

statistic no 182. Hyattaville, Ma@and:

National Center for Health Statistics. 1990.

Copyright information

This report may be reprinted without further

permission.
Number 183 . March 14.1990

Advance

Data

From Vital and Health Statistics of the National Center for Health Statistics

AIDS KnowledgeandAttitudesforJuly-September1989

Provisional Data From the National Health Interview Survey

by Deborah A. Dawson, Ph. D., Division of Health Interview Statistics

Introduction

The National Center for Health

Statistics (NCHS) has included a

special set of supplemental questions

on the adult population’s knowledge

and attitudes about acquired

; mmunodeficiency syndrome (AIDS)

. the National Health Interview

Survey (NHIS). The first AIDS

Knowledge and Attitudes Survey was

in the field from August through

December 1987. Provisional results of

that survey were published on a

monthly basis in Advance Data From

Wfal and Health Statistics (Nos. 146,

1-IS, 150, 151, and 153). A public use

data tape containing the information

collected in 1987 is available from

NCHS.

During the first 4 months of 1988,

the NHIS AIDS questionnaire was

revised to meet current program needs

for information about AIDS

awareness. The revised AIDS

Knowledge and Attitudes Survey

entered the field in May 1988.

Provisional findings for the remainder

of 198S were published periodically

(Ad}ance Data From Vital and Health

.$tcuisfics Nos. 160, 161, 163, 164, 167,

and 175); in addition, two special

reports focusing on minori~

populations were published from the

1938 data (Advance Data From Vital

and Health Statistics Nos. 165 and

166). A public use data tape of the

1988 AIDS Knowledge and Attitudes

Survey is now available. The NHIS

AIDS questionnaire used in 1988 was

continued throughout 1989. Reports

based on the 1989 data are being

issued on a quarterly basis. This

report presents provisional data for

the period July-September 1989.

The Adl’ante Data reports

describing the NHIS AIDS data have

been restricted to simple descripti~~e

statistics to facilitate their timely

release. Thus, these reprts do not

attempt to explm”nor interpret

differences among population

subgroups or to examine relationships

among various measures of knowledge

and AIDS-related behavior (e.g.,

testing). The NHIS AIDS data bases

permit more complex analyses than

those presented in this series of

Advance Data reports, and such

analyses are being undertaken by

various groups in the Public Health

Service.

The AIDS questionnaires were

designed to estimate public knowledge

about AIDS virus (HIV) transmission

and its prevention. The data were

needed as input for the planning and

development of AIDS educational

campaigns and for monitoring major

educational efforts, for example, the

series of radio and television public

service announcements entitled

“America Responds to AIDS” and the

brochure “Understanding AIDS,”

both developed by the Centers for

Disease Control.

The NHIS AIDS questionnaires

were developed by the National

Center for Health Statistics and

interagency working groups

established by the Information,

Education and Risk Factor Reduction

Subcommittee of the Public Health

Service Executive Task Force on

AIDS. The working groups included

representatives from the Centers for

Disease Control; the National

Institutes of Health; the A1cohol,

Drug Abuse and MenCal Health

Administration; and the Heal[h

Resources and Services

Administration.

The 1988 and 1989 AIDS

questionnaires included items on

sources of AIDS information; selfassessed levels of AIDS knowledge;

~St Wcs$ ~,fl

#P

‘$ 7 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

W* Public Health Service

1=

z Centers for Disease Control

: National Center for Health Statistics

“9

%4

>

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

%vdla
2 Advance Data

basic facts about the AIDS virus

(HIV) and how it is transmitted; blood

clonalion experience; awareness of and

experience with the blood test for

HIV; personal acquaintance with

persons with AIDS or HIV; and

willingness to take part in a proposed

national seroprevalence survey. A

general risk behavior question, similar

to that asked by the Red Cross of

potential blood donors, was included

in the 19SS and 19S9 AIDS

questionnaires.

This report presents provisional

data for July–September 19S9 for

most items included in the AIDS

questionnaire. Table 1 displays

percent distributions of persons 18

years of age and over by response

categories according to age, sex, race,

and education. In most cases, the

actual questions asked of the

respondents are reproduced verbatim

in table 1 along with the coded

response categories. In a few cases,

questions or response categories have

been rephrased or combined for

clearer or more concise presentation

of rcsuhs. Refusals and other

nonresponse categories (generally

comprising 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 questionnaire

uses the phrase “the AIDS virus”

rather than “HIVfl because it was felt

that the general population might not

be familiar with the more scientific

terminology at the time the survey

began. In this report, the two terms

will be used synonymously.

Selected findings

The following highlights clescribe

various aspects of AIDS knowledge

and attitudes as observed in the July—

September 19S9 data from [he NHIS

AIDS survey, Unless otherwise noted

in the text, all measures described

remained stable over this 3-month

period. Any differences cited in the

text are statistically significant at the

.05 level (see table II for provisional

standard errors of estimates).

Sources o] AIDS injonn oiion –

Throughout 19S9 there has been no

change in the proportions of adults 1S

years of age and over who reported

having seen or heard public service

announcements (PSA’S) about AIDS

on television (79 percent) or on the

radio (44 percent) in the month

preceding the NHIS interview. Less

than one-fourth of the adults who had

seen PSA’S about AIDS reported that

they were part of the series entitled

“America Responds to AIDS.” The

percentage of adults claiming to have

read brochures or pamphlets about

AIDS in the preceding month

decreased slightly since the start of the

year—from 24 percent in the first

quarter of 198S to 22 and 21 percent,

respectively, in the second and third

quarters. The proportion of adults

who said they had ever read brochures

or pamphlets about AIDS remained

steady, 62 percent in July-September

19S9. As in preceding months, the

most frequently cited sources of

informational brochures and

pamphlets were through the mail

(26 percent) and at doctors’ offices

(22 percent).

Adults 50 years of age and over

were less likely than younger adults to

have seen or heard PSA’S or to have

read brochures and pamphlets about

AIDS. This has been true throughout

1988 and 1989. Black and white adults

were equally likely to have seen

AIDS-related PSA’S on the television,

but exposure via the radio was

reported more frequently by black

than white persons. Black adults were

also more likely than white adults to

have read brochures or pamphlets

about AIDS in the preceding month

(29 versus 19 percent in

July-September 1989) and to have

ever read brochures or pamphlets

about AIDS (66 versus 62 percent).

The latter difference represents a

departure from previous months;

formerly, black and white adults were

equally likely to have ever read AIDS

brochures. As in previous months,

educational attainment was directly

related to the probability of having

seen, heard, or read about AIDS.

Sixty-three percent of adults with

children age 10–17 years reported

having discussed AIDS with these

children; 62 percent said [hey had

discussed AIDS with friends or

relatives. These percentages have

remained fairly stable for many

months. Sixty-five percent of adults

with children age 1o-17 years stated

that their children had receil~~ AIDS

education in school, about the same as

in the second quarter of 19s9

(64 percent) but higher than in the

first quarter (61 percent).

Se&msessed /.no%slcdgc-Adults’

perceptions of how much they know

about AIDS have not changed in

1989. In July-September 19S9, as in

earlier months, 23 percent of adults

stated that they knew a lot about

AIDS, and 44 percent said they knew

“some.” Twenty-five percent claimed

that they knew a little about AIDS,

and 8 percent felt that they knew

nothing about the disease. As in

preceding months, self-assessed level

of knowledge increased sharply with

education. The proportion of persons

who report ed knowing a lot about

AIDS was more than 3 times as high

for persons with more than 12 years of

school (35 percent) as for those with

less than 12 years of school

(11 percent). Although black and

white adults were equally likely to

state that they knew a lot about AIDS,

black adults were almost twice as

likely to feel that they knew nothing

about AIDS, 13 compared with

7 percent. Nearly one-fifth

(18 percent) of adults age 50 years

and over said they knew nothing about

AIDS, 6 times the proportion for

younger adults (3 percent).

General know/edge–During 1989

there has been virtually no change in

the general public’s knowledge albout

AIDS, as measured by the items in the

NHIS AIDS questionnaire. Awareness

of the basic facts concerning AIDS

continues to be high. In

July–September 1989, three-fourths or

more of U.S. adults stated that it was

definitely true that AIDS can reduce

the body’s natural protection against

disease (75 percent), that AIDS leads

to death (84 percent), and that HIV

can be spread via shared needles,

sexual intercourse, and pcrinatal

transmission (94 percent, S3 percent,

and 80 percent, respcctivcly). Threefotlrlhs or more stated thtit it was
Advance Data 3

definitely false that AIDS is especially

common in oldcr people (75 percent)

and that teenagers cannot get AIDS

@ percent).

One aspect of AIDS knowledge

showed a slight decline between July

and September 19S9. The percentage

of adults who thought it definitely

false that there is a vaccine for AIDS

declined from 75 percent in July (the

same as in the second quarter) to

73 percent in September. The decline

was most pronounced among (persons

with less than 12 years of education,

for whom the proportion fell from

60 percent in the second quarter to

54 percent in the third quarter. This

may reflect confusion on the part of

the public about the difference

between a vaccine for AIDS and the

AIDS treatments that have been

heavily publicized, such as AZT

(zidovudine).

While black and white adults

generally demonstrated similar levels

of knowledge about AIDS, some racial

differences existed. Black adults were

the more likely to realize that AIDS

can damage the brain and that AIDS

leads to death, while white acluks were

the more likely to understand that

AIDS affects the immune system, that

a person can be infected with HIV

and not have AIDS, that a person

infected with HIV can look and feel

healthy, and that there is no vaccine

for AIDS. Other demographic factors

that showed a more consistent

association with AIDS knowledge

were education (positively related) and

age (lowest levels of knowledge for

persons agc 50 years and over, highest

for those age 30-49 years).

fl!ispcrccplions about HIV

Wansnris.rion—The 1X37, 19SS, and

19S9 NHIS AIDS surveys included a

series of questions addressing

misperceptions about HIV

transmission by means of various

forms of casual contact. Accurate

knowledge in this area, as expressed

by dle proportion of adults who

dlOLl!#titvery unlikely or definitely

X possible to spread HIV through

~sua] contact, improved throughout

19S7 and between bfay and .JuIy 1X38.

After that, the proportions of adults

responding correctly to these questions

declined slightly, so that by December

19SS, responses were similar to those

recorded in Nfay of that year.

Throughout 19S9 there has been

no meaningful change in the Ievel of

misperceptions surrounding HIV

transmission through casual contact,

despite occasional fluctuations of 1 or

2 percentage points in the proportions

of adults answering the individual

items correctly. As was true in 19SS,

the activities perceived as riskiest are

those involving potential exposure to

the saliva of a person infected with

HIV. For example, only 23 percent of

adults stated that it was very unlikely

or definitely not possible to become

infected with HIV by kissing (with

exchange of saliva) a person with the

virus.

Blood donotion and testing–In

July-September 19S9, 40 percent of

adults report ed ever having donated

blood. This includes 15 percent who

donated blood since March 19S5,

when routine screening for HIV

antibodies began, and 7 percent who

claimed to have donated blood in the

preceding year. These figures have

remained stable for many months.

Three-fourths (74 percent) of adults

had heard of the blood test for the

AIDS virus (i.e., the test to detect

HIV antibodies), and two-thirds

(66 percent) thought blood donations

are routinely tested. Si~ percent of

adults said that they had received a

blood transfusion behveen 1977, when

HIV is thought to have entered the

United States, and 19S5, when routine

screening began. About half

(47 percent) of all adults thought IJIC

present supply of blood is safe for

transfusions. AI1 of these estimates are

similar to those reported throughout

19s9.

As of July-September 19S9,

21 percent of adults age 1S years and

over were estimated to have had their

blood tested for HIV. This proportion

is fairly evenly dividecl behvcen

persons who reported having been

tested (11 percent) and those who did

not report testing but had donated

blood since automatic screening of

donations was initiated (10 percent).

The percentage of U.S. adults tested

for HIV has increased steadily over

the last year, up from 16 percent in

May 19SS.

The proportion of adults tested

decreased sharply with age, from

29 percent of those age 1S-29 years

to 9 percent of those 50 years of age

and over. Sixty-eight percent of [he

individuals who had been tested for

HIV reported being tested as a part of

blood donation and 1 percent as part

of a blood transfusion. Eighteen

percent voluntarily sought testing, and

17 percent were tested as part of

some other activity that requires a

routine blood test (up from

14 percent in the first quarter of

1989).

Seven percent of adults reported

plans to have their blood tested in the

year following interview. There has

been no change in this figure during

19S9. This proportion decIined with

age, from 10 percent of persons age

1S-29 years to 8 and 2 percent,

respectively, of those age 30-$9 years

and 50 years and over. Black adults

were almost twice as likely as white

adults to report plans to be tested, 11

versus 6 percent. Of persons who

reported plans to be tested, nearly half

(46 percent) said that the test would

be sought voluntarily as opposed to

performed routinely in connection

with some other activity.

Pw\mfit’e mcrrsurcs-During the

first three quarters of 19S9, there was

a slight clccrease in the perceived

effec[ivencss of condoms as a

method for preventing HIV

transmission during sexual in[crcourse.

In July–September 19S9, 33 percent

rated condoms as very effective. and

52 percent statccl that they \\tre

somcwdlat effective; in Januar:->larch

19S9, 37 percent thought condurns

were very cffcctivc. and 54 percent

considered them somewhat effculive,

Throughout 1989 more than half of all

adults stated that diaphragms,

spermicides, and vasectomies \vere not

at all effective, while more than

SO percent considered mutual

monogamy with an uninfected partner

to be very effective.

Risk of getting HIV— During

July-September 19S9, 2 percent of

adults reported belonging to one or

more of the groups \vith behuviors
4 Advance Data

associated with increased risk of AIDS 1 percent as high. Seventy-eight Fourteen percent of U.S. adults

(e.g., hemophiliacs, intravenous drug percent of adults felt that they had no reported knowing someone with AIDS

users, and homosexual men). This chance of becoming infected, i.e., “of or HIV. This percentage has more

proportion has not varied since the getting the AIDS virus.” This than doubled since Augst 1987.

question was introduced in May 19SS. proportion rose steadily in 19S7 and Adults age 30J19 years were the most

Eighty-three percent of U.S. 19SS, but has remained stable likely to report knowing someone with

adults felt there was no chance of throughout 1989. The proportions who AIDS or HIV (I7 percent), followed

their already being infected with HIV, stated that their chances of getting by persons 1S-29 years (14 percent)

i.e., of “having the AIDS virus.” HIV were low, medium, and high and those 50 years of age and over

Thirteen percent assessed their were 17, 2 and less than 1 percent, (9 percent).

chances of having HIV as low, respectively.

2 pm-cent as medium, and ICSSthan

Suggested citation

Dawson DA. AIDS knowledge and attitudes for

July-Septembec Provisional data from the

National Health Interview Survey. Advance

data from vital and health statistics; no. 183.

Hyattsville, Maryland: National Center for

Health Statistics. 1990.

Copyright information

This repoR may be reprinted without further

permission.

Symbols —

Quantity zero

o Quantity more than zero but 1[?ss

than 0.05
Advance Data 5

Table 1. Provisional estimates of the percent of persons 18 years ofageandoverwitfr selected AIDS knowledge andati”tudes from the

1988 National Health Interview Survey, by selected characteristics: United States, July-September 1989

~aia are b6Sed on household in!efVieW5 of the CiVilEMnoninsfitulionafiied population. The survey design, general quahfiiatkars, and informatiirr on the rehabilify of

e estimates are given in technical notes]

Age sex Race Eductilkm

13-W W-49 50&us Lassthan More than

AIDS knowtedgeor affitude T&e/ years yews end over Mete Female WIMe BIack 12YEWS 12years 12years

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...100

1.

la

1b.

2

3.

4.

5.

15.

16.

21.

22

23a

In the past month, have you–

Seen any public aervke armouncemenfs about AIDS on

Ielevlsk.n?

Ye.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Donlknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Heard anyputrllcservks announcemenlsabouf AIDSon

the radb?

Ye.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Weraanyofthose publlcsefvkeannouncernenfe called

“AmerkaResponds IoAIDS’7

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

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

Don’tlrnow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

NeUher Wnor Ww~puMk S*aMnamn@. .

Inthepastmonth, haveywreadany brochuresorpamphlefs

about AIDS?

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

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

Donlknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Have you ever read any txuhures or pamphlets about AtOS?

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

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

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Where did you gel the pamphlets or brochurea?12

Clinic, olherlhanworkclinic . . . . . . . . . . . . . . . . . . . .

Doctor’soffice( HMO) . . . . . . . . . . . . . . . . . . . . . . . .

Drugstore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Publicheatthdepartment . . . . . . . . . . . . . . . . . . . . . .

Received inmailwithoutasking. . . . . . . . . . . . . . . . . .

RedCross/RedCrossblooddonalkm . . . . . . . . . . . . . .

Ofherblooddonalbn . . . . . . . . . . . . . . . . . . . . . . . . .

school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sent/phonedfor/requestedil... . . . . . . . . . . . . . . . . .

Faderal/State/lcealgovemmenf . . . . . . . . . . . . . . . . . .

Work,otherttmnctinioornurse . . . . . . . . . . . . . . . . . .

Work, nurseorciinic . . . . . . . . . . . . . . . . . . . . . . . . .

Ocher. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Haveyou ev$r disCUssad AIDS wlh any of your children

aged 10-17?

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

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

Donlknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Have any or all of y~urchildren aged l&17 had inSttUCtbn at

scfroolaboutAIDS?

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

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

Don’fknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

How much would you say you know about AIDS?

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

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

Aliftle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Don?know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

To the best of your knowledge, is /here a difference &Xwaen

having the AIDS virus and having the dlsaeee AIDS?

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

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

other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Donllmow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

AIDS can reduce the body’s nafurat protactbn against disease.

79

19

2

44

52

4

23

12

47

17

21

78

1

62

37

1

4

22

2

3

2s

3

1

11

1

14

15

5

17

5

83

37

0

85

12

23

23

44

25

6

0

67

15

0

18

Definifelytrue . . . . .. . . . . . . .. . . . . . . .. . . . . . . . . . . 75

Probablytme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Probablyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Deflnflelyfalsa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Donlknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

100

81

19

1

51

45

4

33

13

40

15

25

74

1

68

31

1

5

23

2

4

17

3

1

21

0

1:

5

19

3

:

56

22

23

26

49

22

3

z

o

12

77

12

2

3

5

100

81

18

2

48

47

4

25

12

47

16

24

75

1

70

2e

1

4

22

1

2;

4

1

9

1

15

16

5

17

4

84

3e

o

85

12

22

28

48

21

3

0

74

15

0

11

62

9

1

;

100

n

20

3

34

61

4

15

12

53

20

14

85

1

46

51

1

2

19

2

2

35

2

0

4

1

17

12

1:

7

53

47

84

9

27

1s

35

32

18

0

59

11

0

30

84

14

2

3

17

100

80

~8

2

49

47

4

22

14

48

16

19

80

1

58

40

1

3

19

1

3

26

4

1

11

1

14

17

3

18

6

!s0

49

0

82

10

28

24

43

26

8

0

67

16

0

17

76

12

1

3

6

Percent dibtribufiinf

lrxl 100

78

20

2

40

56

4

25

:

18

22

77

1

65

34

1

4

24

2

2$

3

1

11

1

73

13

6

16

4

73

27

0

67

15

18

23

45

24

6

0

67

14

0

19

73

11

2

4

10

79

19

2

43

52

4

22

12

49

17

79

80

1

62

37

1

3

22

2

3

27

4

1

11

1

15

14

4

16

5

83

37

0

85

13

22

23

45

25

7

0

88

15

0

17

77

11

1

3

8

lca

60

19

1

50

47

3

26

14

4f

17

2e

71

1

66

34

1

7

20

2

2:

:

8

1

8

18

6

22

4

e6

34

0

85

10

25

24

37

26

13

0

59

19

22

83

13

3

6

15

100

73

25

2

35

67

3

z?

2

23

15

85

1

40

56

1

5

22

2

;

:

7

1

11

7

2

21

5

57

43

@

12

x

11

27

38

25

0

42

17

0

41

51

16

4

2:

100

60

18

2

45

51

4

2!5

11

46

16

20

60

1

82

37

1

3

23

2

3

27

3

1

9

0

12

74

4

16

5

61

38

0

83

13

24

16

49

28

5

0

88

17

1:

75

12

2

4

7

100

82

17

2

49

47

4

22

15

49

15

2e

74

1

74

26

1

3

20

1

4

25

4

1

14

1

16

i8

6

16

4

E

o

88

12

20

35

48

15

2

0

80

12

;

87

8

1

2

3
6 Advance Data

Table 1. Provisional estimates of the percent of persons 18 years of age and over with selected AIDS knowiedge and attitudes from the

1988 National Health Interview Survey, by selected characteristics: United States, July-September 1989-Con.

[Data are basedon household mterwews Ofthe cwihan nonmstrtulionalued populatkm. The suwey design, general quahficetmns, and information on the raliabllity of

the estlmales are grven in techrucal noies]

Age Sex Race Education

l&?9 .50-49 50 years Less than

AIDS knowledge or afflfude

More than

Total years yeats and over Male Female Whfle Black 12 years 12 years 12 years

23b. AIDS Is especially common In older people.

Defmtely lrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Probably lrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Probably false . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Defrutel yfals e . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

Don’t know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

23c. AIDS can damage the brain.

Defmtelyt rue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Probably true . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Probably false . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Definitelyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

23d. AIDS usually leads to heart disease.

Definitelytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Probablylrue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Probablyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Defirritelyfalse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

23e.AIDSisan Infectiousdseasa causedbyavrus.

Definifelytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Probablytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Probablyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Defmitelyfafse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Don’l know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

23f. Teenagera cannot get AIDS.

Defmifelytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Probablytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Probablyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Defmitelyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

23g. AIDS leads to death.

Defmitelytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Probablylrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Probablyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Deflnifeiyfalae. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

23h. A Derson can be infected Wlh the AIDS virus end not have the

23.

23j.

23k.

d~easeAIDS.

Defmilelytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

Probablytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Probablyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Definlelyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Looklngataperson Isenoughtotellif heorshehaethe

AIDS virus.

Defirdfelyfrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Probablytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Probablyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Defmitelyfalae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Anypersonwfln theAIDSviruscen peasitontosomeone else

during sexual intercourse.

Defmitelytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Probablytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Probablyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Defmtelyfatse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

ADersonwhohas lheAIDSvlruscan Iookandfeelheal!hy

andwell.

Defmitelylrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Probablyfrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Probablyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Defmfelyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Don’tknow, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

231. A$Negnant woman whohasthe AIDSv!rus cangivelhe AIDS

virus to her baby.

Defimfelylrue . . . . . . . . . . . . . . . . . . . . . . . . . . . ~

Probablytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Probablyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Defmllelyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Don’t know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

1

1

17

75

5

22

30

13

11

24

8

:

18

32

70

18

2

4

7

1

0

2

96

1

65

11

1

1

1

61

19

4

6

11

:

13

74

6

66

10

1

1

2

53

28

6

5

8

64

13

0

0

2

1

1

14

79

5

28

29

10

11

21

9

23

20

20

28

71

16

2

5

6

1

0

2

95

1

64

14

1

1

1

64

19

3

5

9

3

4

12

76

6

64

12

1

1

2

55

27

5

4

8

63

12

0

1

3

1

1

17

70

10

29

29

7

5

29

10

22

13

12

43

53

19

3

5

20

1

1

5

89

5

64

11

0

0

4

50

20

4

3

23

3

6

16

59

17

79

13

1

1

7

37

29

9

6

19

74

16

0

0

9

1

1

16

76

7

27

30

10

9

23

9

20

19

19

32

67

17

2

4

10

1

0

3

94

2

83

13

1

1

59

19

4

5

14

3

5

13

70

9

62

13

1

1

3

51

27

7

4

11

77

16

0

1

5

Percent dlstribuhonl

1

i

16

75

7

27

28

10

9

26

9

22

17

15

37

62

15

2

5

12

1

1

3

92

3

66

11

0

1

56

20

3

4

15

2

4

13

69

11

63

11

1

1

4

46

29

7

5

12

63

12

0

0

5

1

1

17

76

6

26

30

11

9

25

8

21

19

17

35

64

16

2

5

10

1

0

3

94

2

64

13

1

1

2

60

20

3

4

13

2

4

13

71

9

83

12

i

1

3

50

29

6

4

11

80

15

0

1

5

1

2

;:

10

36

27

5

7

25

16

23

12

~4

35

65

15

2

4

14

1

0

4

89

6

66

7

0

1

3

52

20

4

5

19

;

14

62

14

63

10

0

1

5

45

25

8

7

15

63

10

1

0

6

1

2

16

65

16

2S

27

5

5

34

12

22

8

10

47

50

19

3

4

24

1

1

4

86

6

66

8

0

:

39

19

4

6

33

;

15

51

23

78

11

:

9

32

25

9

8

26

73

15

1

0

12

1

1

15

79

4

26

30

10

9

25

10

22

17

15

3s

63

19

3

6

9

1

0

3

94

1

66

11

1

1

1

56

21

4

5

13

2

5

15

70

9

65

10

1

1

3

46

31

8

5

11

82

14

0

1

3

0

1

:

4

26

30

13

12

19

2:

24

22

26

74

15

2

4

6

1

0

2

96

1

81

16

1

1

1

70

19

3

4

6

2

3

11

79

4

82

14

1

1

2

61

27

4

3

5

63

14

0

1

3

See footnotesal erd of table.
Advance Data 7

Table 1. Provisional estimates of the Percent of Persons 18 years of age and over with selected AIDS knowledge and attitudes from the

1988 National Health Interview Survey, by selected characteristics: United States, July-September 1989—Con.

?ata are based on household intemiews of the CiVili6innonins!flulhnalized PoPulaIDn. The survey desgn, general qualifiiat~ns, and information on the reliability of

s estimates are given in technical notes]

Age sax Race Education

l&29 3(W9 50 years Less than More than

AIDS knowledge or attitude Total years years and over Male Female Whife Black 12 years 12 years 12 years

23m.Ttrere is a VaCCine available to the public that protects a parson

from ge!ting the AIDS virus.

Definileiyt rue. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Probably true . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Probably false . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Definitely false . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

23n. There Is no cure for AIDS at present.

Definitely true . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Probablytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Probablyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Defimtelyfalse. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Donlknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

24. Howlikely doyouthink itisthat aparson will gel AlDSorlhe

AIDSvirusinfecfion from—

24a Living near a hospital or home for AIDS patients?

Veryllkely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Somewhatlikely, . . . . . . . . . . . . . . . . . . . . . . . . . . .

Somewhaturrlikely . . . . . . . . . . . . . . . . . . . . . . . . . .

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Definilelynotpossible . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

24b.Workingnear someonewifhthe AIDSWUS?

Verylikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

S%mewhatlikely . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8omewhatunlikely . . . . . . . . . . . . . . . . . . . . . . . . . .

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Definifelynolpossible . . . . . . . . . . . . . . . . . . . . . . . .

Don’tlmow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

24c. Eating inarestaurarrlwherethecookhastheAIDSvirus?

Veryiikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.somewhatlikely . . . . . . . . . . . . . . . . . . . . . . . . . . .

Somewtmtunlikely . . . . . . . . . . . . . . . . . . . . . . . . . .

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

DefinitalynotpossibIe . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

24d. Kfssing-with exchange of saliva-a person who has the

AIDSW’US?

Verylikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Somewhat lilrely . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Somewhatunlikely . . . . . . . . . . . . . . . . . . . . . . . . . .

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Defmrtelynotpossible . . . . . . . . . . . . . . . . . . . . . . . .

Don’t know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

24e. Shaking hands, touching, or kissing on the cheek someone

whohastheAIDS virus?

Verylikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Somewhatlikely . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Somewhatunlikely . . . . . . . . . . . . . . . . . . . . . . . . . .

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Defirxtelynotposslble . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

24f. Sharing platas, forks, orglesses with someone who hasthe

Alt3Svirus?

Verylikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8omewhatlikely . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SOmewhatuniikely . . . . . . . . . . . . . . . . . . . . . . . . . .

Veryurrlikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Defimtelvnotoossible . . . . . . . . . . . . . . . . . . . . . . . .

2

3

10

73

12

1

3

7

37

46

6

2

9

11

40

31

7

26

26

13

16

7

10

2

6

13

39

33

6

3

3

11

74

9

85

8

1

2

3

1

3

7

3a

47

4

2

9

12

41

32

4

6

78

18

31

21

7

22

28

15

19

9

7

2

5

:

38

3

8

18

2

22

Don’tkn.ow. ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IOC 7

24g. Using public toilets?

Verylikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 5

somewhallikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 12

.%mewhatunlikely . . . . . . . . . . . . . . . . . . . . . . . . . . 12 13

Veryunlikely. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 33

Definitelynotpossible . . . . . . . . . . . . . . . . . . . . . . . . 26 31

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 6

2

2

9

79

9

87

7

1

2

3

1

3

7

37

49

4

2

8

12

41

33

4

6

17

16

32

m

9

25

28

14

17

8

7

1

6

:

35

4

8

21

;

19

7

5

11

13

36

29

6

2

3

10

65

19

82

8

1

2

7

2

3

6

37

41

11

3

10

10

37

27

12

8

17

12

28

16

19

31

27

9

11

1:

3

7

12

39

28

11

$

;

16

16

8

13

:

20

17

Percent distribufiint

2

2

10

74

11

64

8

1

2

4

1

3

7

38

43

6

2

9

12

40

30

6

7

18

16

31

f8

10

26

m

13

18

:

2

6

14

41

31

6

9

20

:

18

9

5

12

13

35

27

9

2

3

10

72

13

85

7

1

2

5

1

3

7

35

48

6

2

9

::

32

7

7

17

14

30

19

13

27

27

12

15

7

11

2

6

2

36

6

9

20

13

28

19

11

7

12

?2

33

26

11

2

2

10

75

11

86

8

1

2

4

1

2

6

37

47

6

2

9

12

40

31

6

6

17

15

31

19

11

26

28

13

16

:

2

6

13

40

34

5

;

~

19

10

5

12

12

34

27

9

5

3

10

63

19

82

7

1

2

8

2

5

10

36

37

10

5

9

z

28

9

10

77

13

26

17

16

30

26

10

13

7

15

3

7

14

39

28

10

12

21

G

14

13

9

12

13

33

20

14

4

5

11

54

26

76

9

1

2

11

2

4

8

35

34

16

4

10

11

33

25

17

11

18

10

23

13

24

31

25

6

11

6

18

4

7

12

37

25

15

13

20

:

14

20

11

14

9

26

18

21

2

2

11

73

12

66

8

1

2

4

1

3

7

38

45

5

3

10

12

39

31

5

7

18

s

19

11

28

28

12

15

:

2

7

14

40

32

5

10

21

14

27

17

10

6

13

E

25

10

1

2

8

63

6

aa

8

1

2

2

1

2

6

37

52

2

1

7

11

44

34

3

4

16

17

36

21

6

22

29

16

19

8

6

1

5

13

41

39

2

7

18

;

22

5

3

9

14

36

32

4

%3efodcafesa!end ~ftable.
8 Advance Data

Table 1. Provisional estimates of the percent of persons 18 years of age and over with selected AIDS knowledge and attitudes from the

1988 National Health Interview Survey, by selected characteristics: United States, July-September 1989-Con.

[Data are based on household irrlemiws of the civilian noninsfiiulioneltzed population. The survey desgn, general qualfkafiins, and information on the reliability of

the estimates are given In technical notes]

Age sex Race Education

16-s 3&49 50 years Less than More than

AIDS knokwedge or afmde Total years years and over MaJe Fernale White Black 12 yams 12yem 12 years

24h. Sharing needlee for drug use wIh someone who tree the

24L

24J.

24k

25.

AIDS vkus?

Verylikeiy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

Sornewhaf likely . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Sornewhaf unlikely . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Definitely notposslbie . . . . . . . . . . . . . . . . . . . . . . . . 0

Don’t know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Seing coughed or sneezed on by someone who has the

AIDS virus?

Very fikeiy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Somewhat likeiy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Somewhat unlikely . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Veryuniiieiy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Definitely notposaMSa . . . . . . . . . . . . . . . . . . . . . . . . 16

Don’fknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Aftendhg school wHh a chkf wtrohas theAIDS virus?

Vefylikely. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Sornewharnkety. . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Somewhatunfiiefy . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

DeftnltefynotposSbte . . . . . . . . . . . . . . . . . . . . . . . . 33

Donlfmow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Mosquloesorother hsacfs?

Verylikeiy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Somewhaflikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Somewhatunlikely . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Veryunllkely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Definitelynotpossible . . . . . . . . . . . . . . . . . . . . . . . . 19

Don’ttmow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Have you ever donated blood?

Y&.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Donlknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

26a. Haveyoudonated bloodsinceMarch 1966?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Don’tlrnow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

26b. Have vou donated bkxrd in the osef 12 months?

27.

2s.

Y&+ . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . 7

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Don’fknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Haveyoueverheard ofabloodleslthaf candelecltheAIDS

virusinfecfiin?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Don’flmow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Tothebeetofyour knowiedge,areblood donetionsroutineiy

testednowforlhe AIDSvirushfacflorr?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Donlknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Neverheardoftesf’ . . . . . . . . . . . . . . . . . . . . . . . . . 26

29aHaveyouever receivedoounselrng orhadatatkwifh atrealfh

professicrreJabouf takinglheAIDSwms fast?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

Donlknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Nevarheerdoftest’ . . . . . . . . . . . . . . . . . . . . . . . . . 26

29b.Wasthediscussbn-i’5

Wthaprivatedocfor? . . . . . . . . . . . . . . . . . . . . . . . . 46

Atafamily-plenntngclmlc? . . . . . . . . . . . . . . . . . . . . . 9

OnanAIDShotline? . . . . . . . . . . . . . . . . . . . . . . . . . 2

Ataprenatalclinic? . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Atari STDoreexuallytransmNed diiaseclinlc? . . . . . . . 4

A!an AIDS/HfV counseimg andlestingsife? . . . . . . . . . . 10

WWtsomeotherheallhprofessbnai?. . . . . . . . . . . . . . . 41

Wflhsomeothercounseloi? . . . . . . . . . . . . . . . . . . . . 8

30. During thaId!scusslon. dKJyoureceive information about how

to avoid getting or psssmg on the AIDS virus?5

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Donlknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

ea

2

0

1

0

1

5

18

19

31

19

7

2

3

11

41

40

3

9

19

11

24

19

18

32

66

0

21

78

0

8

91

0

61

16

3

72

3

6

19

7:

0

19

46

11

0

9

4

8

3a

11

67

32

0

96

2

0

1

0

1

6

20

16

32

17

8

2

5

10

45

34

4

9

16

9

27

20

20

42

5a

o

18

81

0

9

91

0

63

15

3

74

4

5

17

5

77

0

17

60

8

4

4

4

11

43

7

55

43

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3

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0

0

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10

23

14

24

11

18

3

5

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47

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13

9

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17

29

42

56

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93

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15

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31

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66

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1

PercentdMrtbufbnl

94

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z

16

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20

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66

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94

0

74

22

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66

3

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6a

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2a

53

12

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10

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10

37

6

54

45

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ea

2

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7

20

17

30

16

10

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4

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43

34

6

6

16

$

20

22

41

59

0

16

64

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92

0

76

20

4

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3

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0

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47

9

2

6

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42

6

57

42

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11

22

14

26

12

15

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41

28

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$

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33

67

0

11

69

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65

31

4

64

4

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60

13

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41

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72

28

—

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3

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11

21

13

22

;

4

6

10

37

26

17

13

16

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72

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93

1

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97

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53

40

6

43

3

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17

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6

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21

43

59

41

96

2

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16

29

15

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5

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33

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18

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3a

64

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74

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3

;

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71

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47

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78

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78

4

4

14

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14

47

6

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4

4

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45

7

55

44

1

Seefm4notesatend oftable.
Advance Data 9

Table 1. Provisional estimates of the percent of persons 18 years of age and over with selected AIDS knowledge and attitudes from the

1988 National Health Interview Survey, by selected characteristics: United States, July-September 1989-Con.

rDataare based on trouseholdinterviewsof the cMlian nonlnstiiufionaliasdpopulatiirr.The surveydesign,general qualifications,and informationon the retiibilii of

.he estimatesare given in Iachnlcal notes]

Age sax Race Education

13-29 30-49 .50 years Less than More than

AIDS knowledge or affflude Total yaws years and over Mafe Female White Black 12 years 12 years 12 years

31. Have you ever bean advised by a heetthprofessionalnotto

have the blood teatfor the AIDS vims infactiin?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

Don’t know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Never heerdoftest’ . . . . . . . . . . . . . . . . . . . . . . . . . 26

32. Have you ever been advtsedby frbnds or relattvesnotto have

the blood test forthe AIDS virusInfect&n?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

Donlknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Never heard oftesl’ . . . . . . . . . . . . . . . . . . . . . . . . . 26

33. Haveyou hadyour blood testadforthe AIDSvkusinfecfbn?

Yes* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Neverheardoftast’ . . . . . . . . . . . . . . . . . . . . . . . . . 24

35a. How many ttmeshave you had your bloodtestedforthe AIDS

vlruslnfeofbn?’

Once. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Twice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

3-5times . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

6-12tlmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Moretharr 2times

a

. . . . . . . . . . . . . . . . . . . . . . . . . . 0

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Neverheardofornevertooklests. . . . . . . . . . . . . . . . . 60

35b. How many times in the past 12 monthshgweyou fradyour

36.

38.

41.

42

blood testad for the AIDS virusInfectbn?’

Noneinthepast12months . . . . . . . . . . . . . . . . . . . . .

Once . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Morethan rice . . . . . . . . . . . . . . . . . . . . . . . . . . . % Don’t know

Neverheardof.o;;~je;i&k&iB: ::::::::::::::::

Was me test/were any of the tests,includingthose you had

before the peal 12 months-l

Partofablooddonatbn?a”’. . . . . . . . . . . . . . . . . . . .

Partofabloodtranjfusbn?E . . . . . . . . . . . . . . . . . . . .

Voluntarily sought? . . . . . . . . . . . . . . . . . . . . . . . . .

Pert of some olher activftythat requiresa bfoodsampfa?g..

Did you get the resultsof your tesf/anyof your tests?g

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

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

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Doyouexpectto haveabtoodtest fortheAIDSvkus infacfbn

In the next 12 months?

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

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

Donlknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neverhaardoftest4 . . . . . . . . . . . . . . . . . . . . . . . . .

Will the test be-l.10

Partofablooddonatbn? . . . . . . . . . . . . . . . . . . . . . .

Voluntaritysought?. . . . . . . . . . . . . . . . . . . . . . . . . .

Partofsomeotheractiviithatraqulresabloodsarnple? . .

44a Dldyouhave abloodtranfusion atenytimebehveen

1977ancf1865?

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

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

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

44b.Doyouthink thepresentsuppiy ofbloodissafefor tranfusbns?

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

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

Oftrer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45. Herearesomemethodspeople useto preventgettfngtheAfOS

Wusthroughsexuat activity.Howeffecfhrets45at.fsingadiaphragm?

Veryeffeclive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Somewtiateffective . . . . . . . . . . . . . . . . . . . . . . . . . .

Notafalleffactive . . . . . . . . . . . . . . . . . . . . . . . . . . .

Donlknowhoweffacttve . . . . . . . . . . . . . . . . . . . . . .

Oonlknowmethod . . . . . . . . . . . . . . . . . . . . . . . . . .

3

6

2

10

60

66

1

16

17

57

42

1

45

46

20

2

13

58

20

7

0

81

19

0

81

19

29

53

2

16

9

3

2

r!)

%

5

8

2

14

71

63

1

1:

62

36

0

;

6

19

40

62

23

3

96

1

51

27

2:

2

:

15

7

0

62

0

17

0

62

0

17

25

56

1

16

:

2

;

;:

;

3

11

75

67

1:

17

54

45

1

8

70

4

17

48

42

21

2

1

49

29

2:

2

12

66

16

5

0

58

40

0

58

0

40

9

51

2

38

2

0

0

0

:

S2

1

2

1

5

82

60

2

15

6

55

44

1

2

55

2

40

51

46

17

:

2

41

29

0

31

3

13

47

27

10

0

75

0

25

0

75

2

25

51

2

7

2

2

:

;:

4

7

3

12

76

68

1:

20

54

46

1

8

63

2

50

43

22

5

94

1

51

26

0

23

3

12

58

20

6

0

73

0

26

:

0

26

17

57

2:

6

1

;

o

:

3

5

1

8

63

66

2:

13

62

36

1

:

3

26

40

51

la

6

93

1

44

30

2

2

13

E

6

0

76

0

24

0

76

0

24

21

56

2

22

:

7

:

;

3

5

2

$

70

i

16

17

55

44

1

6

67

3

24

52

41

19

6

93

1

49

28

0

23

2

33

61

19

6

0

65

0

35

0

64

0

35

19

46

2

33

7

2

1

;

4

2

7

2

8

62

52

d

16

66

32

0

11

46

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35

24

66

19

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94

1

33

35

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11

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53

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47

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53

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11

42

2

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4

:

:

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1

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68

56

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66

32

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27

63

13

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33

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33

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11

39

30

47

0

74

26

0

74

0

26

18

57

2

24

5

1

t

1

0

9

62

3

5

2

9

82

65

1:

77

55

44

0

6

64

4

26

43

51

20

6

93

1

46

28

2:

2

12

61

19

6

0

65

0

14

0

65

0

14

28

56

2

12

4

8

3

14

72

71

1

17

16

56

43

1

9

73

4

14

53

36

23

5

84

1

55

25

0

20

1

14

67

14

3

aserodmtm at endoftable.
10 Advance Data

Table 1. Provisional estimates of the percent of persons 18 years of age and over with selected AIDS knowledge and attitudes from the

1988 National Health Interview Survey, by selected characteristics United States, July-September 1989-Con.

[Data are based on household Interviews of the cMlmrI noninsfiiufkmrefizad pOpU181h. The survey design, general quellficatbns, end Infonnatbn on the reliebifii of

the estimates are grven in technical nOteS]

Age sax Race Education

16-29 3G49 m years Less thars More than

AIDS knowledge or aflitude Total years years and over Male Female Whtte Black 1.?ymfs 12 yeaci 12 years

45b. Using a condom?

Veryeffecfiie . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Somewhat effacfike . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Notatall effecfiie . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Don’tknow howeffectiie . . . . . . . . . . . . . . . . . . . . . . 7

Don’tlmow method . . . . . . . . . . . . . . . . . . . . . . . . . . 2

45c, Using a spermiskfat jelly, foam, or cream?

Vefyeffectrve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Somewhat effective . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Notatall ettective . . . . . . . . . . . . . . . . . . . . . . . . . . . 5’

Don’tknow howeftective . . . . . . . . . . . . . . . . . . . . . . 21

Don’tlmow method . . . . . . . . . . . . . . . . . . . . . . . . . . 6

45d. Having a vasecfomfl

VeryeffaclNe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Somewhat effective . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Notatall effecfiie . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

Don’tknow howeffecfive . . . . . . . . . . . . . . . . . . . . . . 16

Don’t know method . . . . . . . . . . . . . . . . . . . . . . . . . . 7

45e. Two people who do not have the AfDS virus havtng sex only

46.

47.

49.

52.

53.

54.

55.

with each other?

VeryettaclNe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Somewhat effective . . . . . . . . . . . . . . . . . . . . . . . . . .

Notatall eftecfiie . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’fknow howeffacfive . . . . . . . . . . . . . . . . . . . . . .

Don’t knowmethod . . . . . . . . . . . . . . . . . . . . . . . . . .

What are your chances of having the AIDS virus?

High . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Low. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

What are your chances of getting the AIDS virus?

HI@I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Medium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Low. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Don’l know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

HlghchanceofalreadyhavingAIDSvlrus. . . . . . . . . . . .

Do you say yo!+~chance of geffhg AIDS ts high or medium

because youHave hadabloodtransfusion?. . . . . . . . . . . . . . . . . . .

Have had sexual contact with someone who might have

thevkus?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Someolherreason? . . . . . . . . . . . . . . . . . . . . . . . . .

Have you ever discussed AIDS wth a frkend or relative?

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

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

Don’lknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

When was the last time you discussed AiDS with a friend or

relative?

0-3daysago . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4-7daysago . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-14daysago. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l!5-31 daysago . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Morethan 31 daysago . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow. . .

Neverdlscusediz::::::::::::::::::::::::::

Have you ever parsonafly known anyone wflh AIDS or the

AIDS VIrUS?

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

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

Don’t know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

How long has k been since you saw this person?

Wfihinpast2weeks . . . . . . . . . . . . . . . . . . . . . . . . . .

63

8

2

5

2

0

2

13

83

2

0

2

17

76

3

0

9

18

54

62

36

0

6

7

6

12

25

5

39

14

65

2

1

2weeks-lessthan l month . . . . . . . . . . . . . . . . . . . . . 1

lmonth-lessthan3 months.. . . . . . . . . . . . . . . . . . . 1

3months-lessthan 6monlhs . . . . . . . . . . . . . . . . . . . 1

6monthsormore . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Don’t know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

NeverknewanyonewithAlDS13... . . . . . . . . . . . . . . . 66

39

51

5

4

1

1

16

63

15

5

3

4

73

14

6

64

9

4

3

1

0

2

19

78

2

0

3

23

70

3

0

6

22

49

70

30

0

6

8

6

13

32

5

30

14

85

1

1

1

;

9

0

66

37

53

5

4

1

2

14

64

16

4

1

2

62

11

4

87

7

2

3

1

0

2

15

81

2

0

2

75

2

0

7

17

63

70

30

0

7

8

7

14

28

5

30

17

81

2

1

1

2

2

12

0

63

25

51

5

14

5

1

12

45

31

11

2

G

24

9

78

9

2

9

3

0

1

7

90

2

0

1

8

87

3

0

17

13

46

46

54

0

4

5

5

9

17

2

9

89

2

0

0

1

1

7

0

91

36

52

5

6

2

2

15

M

22

6

2

3

74

15

6

66

:

4

1

0

2

14

82

2

0

3

18

76

3

0

6

17

50

59

41

0

6

7

,5

12

24

6

42

13

66

1

1

1

1

1

9

0

67

31

52

6

9

3

1

13

59

21

7

2

2

72

17

7

62

9

2

:

0

1

12

85

2

0

2

15

w

2

0

11

19

59

64

35

0

7

8

6

13

27

4

36

14

64

2

1

1

1

1

10

8:

33

53

5

7

2

1

14

56

21

6

2

2

75

15

5

65

8

2

4

1

0

1

13

64

1

0

2

17

78

2

0

8

16

55

62

36

0

6

7

6

12

26

5

36

14

85

1

1

1

1

1

10

4

34

46

8

8

3

2

13

53

23

6

3

3

64

21

10

74

13

5

7

2

1

2

12

60

5

0

3

13

77

6

1

6

25

54

62

36

0

9

9

7

10

22

5

36

17

62

2

1

1

i

11

0

63

25

43

7

18

7

2

9

42

33

14

2

2

53

27

15

71

10

4

11

4

0

1

6

8a

5

0

2

9

63

6

0

12

28

47

42

57

0

5

5

5

7

15

4

58

7

91

2

1

0

1

1

5

0

93

34

53

6

6

1

1

13

60

21

5

2

3

74

15

5

66

8

2

4

1

0

2

12

84

1

0

2

14

61

2

0

9

14

45

61

39

0

5

7

5

12

26

6

39

10

89

1

1

0

1

1

7

0

90

3$

54

4

3

1

1

17

63

15

4

2

2

82

10

3

86

8

2

2

1

0

2

17

60

1

0

2

23

73

2

0

6

16

69

72

28

0

8

8

6

15

30

5

26

21

78

2

1

1

2

2

15

0

79

.%efodndesaterd oftable.
Advance Data 11

Table 1. Provisional estimates of the percent of persons 18 years of age and over with selected AIDS knowledge and attitudes from the

1988 National Health Interview Survey, by selected characteristics: United States, July-September 1989–Con.

&da are based on household interviews of the ctvilierr nonlnstrtutionakzed POpulafton. The survey desgn, general quetikXNiins, and inforrnatiin on the reliatxltly of

+~e estimates are given In technicai notes]

Age sex Race Education

1%29 3&49 50 years Less than

AIDS knowledge oraffitude

Mof’s than

Total p?efs yeas end over Male Fetrrale Write Black 12 yasfs 12 yeas 12 yearn

56. How well do you know th~ parscm?

Verywell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Fairtywell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Notverywell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Don’treatiy knowpersorrally . . . . . . . . . . . . . . . . . . . . 2

Dfher . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Don’tknow howwell . . . . . . . . . . . . . . . . . . . . . . . . . -

Never knawanyone wilh AlDS13 . . . . . . . . . . . . . . . . . . 66

57. Is any of these statements true for you?

a You have hemophilia and have received ctofting factor

concentrates since 1977.

b. You are a native of Haiti or Cenhat or East Africa MO has

entered the United States since 1977.

c. You are a man who has had sex with ano3trer man at some

time since 1977, even 1 tirrre.

d. You have taken illegal drugs by neadie at any time skme

1977.

e. Since 1977, you are or have been the sex partner of any

person who would answer yes to any of the items above

(57 a-d).

f. You have had sex for money or drugs at any fiie since

1.!2T. . . ..

Yestoat leestl statement . . . . . . . . . . . . . . . . . . . . .

Notoall statements . . . . . . . . . . . . . . . . . . . . . . . . .

Refused . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’t know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

56. The U.S. Public Heatttr Sarvfae has said WitAIDS k one of the

major health problems in the country but exactly how many

peopie it effects is not known. The Surgeon GeneraJ has

proposed that a study be conducted and blood samples be

taken to help find out how widespread the problem t% tf you

were selected In this national sample of people to have their

blood tested with assurancesof privacy of test results,would

you have the test?

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

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

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

Don’t know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

59. Why wouldn’t you take part in the test?14

Don’twanlto knowtil have NDS . . . . . . . . . . . . . . . . .

Don’twant anycounseling abo@AtDS. . . . . . . . . . . . . .

Feert’ll get AIOS . . . . . . . . . . . . . . . . . . . . . . . . . . .

Donlliketo give blood . . . . . . . . . . . . . . . . . . . . . . .

Don’ttrust Govemmentprograms. . . . . . . . . . . . . . . . .

Itisawaste of money . . . . . . . . . . . . . . . . . . . . . . . .

Don’t belleve AtDS oan reatly be cured an~ay . . . . . . . .

Dfher . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tftnow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

61. When Federal public health offtoMs gM~forrnafbntiW

AtDS, do you believe whet they say or are you doubtful about

the infomratbn they give?

E@l@ve. . . . . . . . . . . . . . . . . . . . . .

Doubtful. . . . . . . . . . . . . . . . . . . .::::::::::::

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

62. When they [publko heatthoffkSats] gNeatieabo@ howto

help keep from getting AIDS, do you believe their advioe or are

you doubtful about what they say?

Believe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Doubtful . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dorr’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

96

0

0

73

21

1

6

4

1

5

14

6

3

1

51

1

82

14

4

2

4

6

2

1

66

4

06

0

0

78

17

1

4

8

1

5

21

6

1

1

40

0

74

22

4

87

10

3

2

4

6

3

2

63

3

97

0

0

75

16

1

5

5

1

5

17

6

3

2

47

1

70

27

4

64

14

2

1

2

4

1

1

91

0

99

0

0

:

1

6

1

1

5

9

5

4

d

1

:

9

75

17

7

2

3

5

2

1

87

2

97

0

0

75

19

:

4

1

6

14

9

3

1

49

1

66

26

5

62

14

4

Percent rtiitributioni

2

3

6

2

1

6a

2

ee

o

0

71

22

1

6

4

1

5

15

4

3

2

1

69

25

6

61

14

4

2

3

5

2

1

66

2

e6

o

0

74

20

1

5

4

1

s

14

:

4

1

z

5

62

14

4

3

4

6

3

1

m

3

97

0

69

23

1

7

3

1

5

17

5

2

3

41

2

69

24

7

60

14

5

2

2

2

1

0

93

2

ea

o

0

E

1

7

3

1

6

10

6

3

1

49

1

5a

30

13

71

19

11

1

2

4

2

1

90

2

ee

o

0

4

1

6

14

6

3

2

49

1

6a

26

4

63

14

3

2

5

9

3

2

79

2

9a

o

0

77

16

1

4

5

1

4

17

7

3

1

54

1

73

24

3

87

11

2

‘Multiple res@amm rrrsy sum@ nmre then 100.

‘Eased on persom -ring yes to questhm 4 @eludes yas to questicm 3).

3-on ~Mm -eriW ~ I. ~=ti II, ‘DO yca hsve my d-i!dmn aged 10 through 17?” CU&im 12 w-”* W* W ~mp

4Perems erewerirg m or donl kmw to question 27.

5Ba.9ed on persom —ring yee to q+.lesliul 2ea

e[~~d~s W- -efl~ yos to question ‘2I3s &d m or don’t kmw to qu=fio~ 27 ~ ~.

A on yes enswers 10 question 33. * footncle 6.

mom answerimg m or don’tkrmwto questions26.s,27, end 33.

desed on persons enawe.ring yes to questim q eXCIUCASSp,smm — WI yee to question ZSe.

10- on ~~m ernwer-ifig yeb to W=tlon 41-

1I_ on ~mm -~ high or IMdiUM fo qu~~n 46.

IZ=d on ~mm ~we@ m or donK kmw to qu~ion 52.

13- on ~Bom ~weri~ m or don?knowto qu~tion ~.

14kd on ~mm Mt ~mwri~ yes to question’.
12 Advance Data

Technical notes

The National Health Interview

Survey (NHIS) is a continuous, crosssectional household interview survey.

Each week, a probability sample of the

civilian noninstitutionalized population

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. The

1989 National Health Interview Survey

of AIDS Knowledge and Attitudes is

asked of one randomly chosen adult

18 years of age or over in each family.

The estimates in this report are based

on completed intewiews with 10,277

persons, or about 87 percent of

eligible respondents.

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 men who have had their

blood tested for HIV. The population

figures in table I are based on 1988

data from the NHIS; they are not

official population estimates. Table II

shows approximate standard errors of

estimates presented in table 1. Both

the estimates in table 1 and the

standard errors in table H are

provisional. They may differ slightly

from estimates made using the final

data file because they were calculated

using a simplified weighting procedure

that does not adjust for all the factors

used in weighting the final data file. A

final data file covering the entire data

collection period for 1989 will be

available at the end of 19’30.

Table L Sample sizes for the 1988 Nation? I

Health Interview Survey of AIDS

Knowledge and Attitudes and estimated

adult population 18 years of age and over,

by selected characteristics: United States,

July-September, 1989

Estimated

Sample population

Charactetit)c size /n ttrowem%$

All adults . . . . . . . . . . .

Age

16-29 years . . . . . . . . .

3&49years . . . . . . . . .

50years and over . . . . .

Sex

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

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

Race

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

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

Education

Less than 12 years. . . . .

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

More than 12 years. . . . .

10,277

2,266

4,197

3,814

4,378

5,099

8,453

1.427

2,300

3,924

4,005

177,321

46,957

68,986

81,377

84,131

93,190

149,510

19,457

39,502

68,301

67,872

Table Il. Standard errors. exDressed in ~ercentaae Doints. of estimated Dercents from the National Health Interview Survev of AIDS

Knowledge and Attitudes, b~ selected ;haracterkti&: Unked States, Juiy-September, 1989

Age sax Race Education

18-.!?9 30-49 50 years Less man Mo=>

Estjmaied percent Total years years and over Male Femete Wtrife Black 1.2years 12 years 12 years

5or95 . . . . . . . . . . . . . . . . . . . . . . 0.3 0.6 0.4 0.5 0.4 0.4 0.3 0.7 0.6 0.4 0.4

100r90 . . . . . . . . . . . . . . . . . . . . . 0.4 0.8 0.6 0.6 0.6 0.5 0.4 1.0 0.8 0.6 0.6

150r85 . . . . . . . . . . . . . . . . . . . . . 0.5 ~.o 0.7 0.7 0.7 0.6 0.5 1.2 1.0 0.7 0.7

200r80 . . . . . . . . . . . . . . . . . . . . . 0.5 1.1 0.8 0.8 0.8 0.7 0.6 1.4 1.1 0.8 0.8

250r75 . . . . . . . . . . . . . . . . . . . . . 0.5 1.2 0.9 0.9 0.8 0.7 0.6 1.5 1.2 0.9 0.9

300r70 . . . . . . . . . . . . . . . . . . . . . 0.6 1.2 0.9 1.0 0.9 0.6 0.6 1.6 1.2 0.9 0.9

350r65 . . . . . . . . . . . . . . . . . . . . . 0.6 1.3 0.9 1.0 0.9 0.8 0.7 1.6 1.3 1.0 1.0

400r60 . . . . . . . . . . . . . . . . . . . . . 0.6 1.3 1.0 1.0 1.0 0.8 0.7 1.7 1.3 1.0 1.0

450r55 . . . . . . . . . . . . . . . . . . . . . 0.6 1.3 1.0 1.0 1.0 0.6 0.7 1.7 1.3 1.0 1.0

50 . . . . . . . . . . . . . . . . . . . . . . . . . 0.6 1.4 1.0 1.0 1.0 0.8 0.7 1.7 1.3 1.0 1.0
Number 184 . April 11, 1990

Advance

Data

From Vital and Health Statistics of the National Center for Health Statistics

Use of Family Planning Services in the United States:

1982 and 1988

by William D. Mosher, Ph.D., Division of Vital Statistics

Introduction

About 20 million women had one

visit or more for family planning

services in the 12 months before the

1988 National Survey of Family

Growth. This was about the same

number who had one visit or more in

the 12 months before a similar sumey

conducted in 1982. Women 20-24

years of age were most likely to have

had a visit for family planning in the

last year (59 percent), and women

4044 were least likeIy (only 6

percent). Black women were more

likely to have received services in the

past year than white women (39 versus

34 percent). About two-thirds of

women who used services in the last

year (64 percent) reeeived their most

recent family planning services at the

oflices of a private doctor, group of

doctors, or Health Maintenance

Organization (HMO); another onethird (36 percent) received that service

from a cIinic. Black women, poor

women, and teenagers were more

Iikely to rely on clinics for their family

planning senrices than white, higherincome, and older women.

These findings are based on

preliminary data from Qcle lV of the

National Survey of Family Growth

(NSFG), conducted by the National

Center for Health Statistics. They are

the most recent estimates of the use of

family pkmning semices in the United

States. The 1988 data in this report

are from Cycle IV of the smvey, which

was based on personal intemiews

conducted between January and

August of 1988 with 8,450 women

15-44 years of age in the civilian

noninstitutionalized population of the

United States. The other data in this

report are from Cycle III of the

National Survey of Family Growth,

conducted in 1982. The NSFG

intemiew incIudes information on a

number of topics related to

chiIdbearin~ family planning and

maternal and infant health. The design

of the 1988 survey and estimates of

sampling errors are discussed further

in the technical notes.

Findings

In the 1982 and 1988 sumeys, a

detrded series of questions was asked

on family planning services that

women reeeived in the 12 months

before the interview, services received

at the Iast w-sit,regardless of when it

occurred; and savices received at the

first family phuming visit the woman

ever had. The specific services asked

&out are listed in the technical notes,

but the major ones are getting a new

method of birth control, continuing a

method already being used, checking

for side effects of a method, and birth

control counseling.

Table 1 shows the number of

women 1544 years of age in 1982 and

1988 and the percent who had one or

more family planning visits in the 12

months before the survey. In both

years, about 20 million women had

one or more family planning visits.

The proportion of women who had a

family planning visit in the last 12

months was not significantly different

in 1982 (37 percent) and 1988 (35

percent). In fact, none of the changes

between 1982 and 1988 in table 1,

either overall or by age or poverty

level income, was statistically

significant at the 5-percent level. In

other words, there was no significant

change between 1982 and 1988 in the

proportion who used family planning

services in any age or income group.

However, use of family planning

services varied strongly by age in both

1982 and 1988. In 1988, the percent

@scwIc&*,

&*q #

*+

#

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

S*

< Centers for Disease Control

z National Center for Health Statistics

%

>

~+ ~ Manning Feinleib, M. D., Dr. P.H., Direetor

%+*/za
2 Advance Data

Table 1. Number and percent of women who had 1 family planning visitor more in the

last 12 months, by age, poverty level income, and race: United States, 1982 and 1988

All races’ while Blaok

Age and puwrtylevelInwme 1938 1s62 1968 1962 19W 1982

Age

15-44years. . . . . . . . . . . . . .

15-19 year3 . . . . . . . . . . . . . .

20-24 years . . . . . . . . . . . . . .

25-29 yeers . . . . . . . . . . . . . .

30-34 years . . . . . . . . . . . . . .

3R39years . . . . . . . . . . . . . .

40-14 years . . . . . . . . . . . . . .

PovertylevelIncome

0-149percenl. . . . . . . . . . . . .

150percentormore. . . . . . . .

Age

lS44years . . . . . . . . . . . . . .

15-19 years . . . . . . . . . . . . . .

20-24 years . . . . . . . . . . . . . .

25-29 years . . . . . . . . . . . . . .

30+4yeare . . . . . . . . . . . . . .

35-39 yeers . . . . . . . . . . . . . .

40-t4yeers . . . . . . . . . . . . . .

Povertylevel income

f&149 percent . . . . . . . . . . . . .

150parcent ormore . . . . . . . . .

57,900

9,179

9,413

10,796

10,930

9,!sS3

7,999

13,%1

44,339

34.5

30.4

59.0

53.0

34.9

17.0

6.0

36.2

34.0

54,099

9,521

10,629

10,263

9,361

7,893

6,412

13,643

40,266

36.5

30.6

56.2

55.7

33.9

19.4

7.0

40.0

36.3

Number in thousands

47,077 45,367

7,313 7,815

7,401 8,655

8,672 8,569

9,010 7,916

7,936 6,697

6.745 5,515

9,052 10,093

36,024 35,275

Percent

34.3 35.8

29.2 26.6

54).8 54.9

54.5 55.9

34.8 33.4

17.0 19.4

5.7 7.0

3s.7 39.2

34.0 34.8

7,679

1,409

1,364

1,459

1,406

1,170

672

3,601

4,078

39.3

40.9

66.5

62.1

36.0

15.6

8.0

39.9

36.8

6,965

1,416

1,472

1,335

1,144

664

734

3,336

3,647

43.0

43.4

65.1

56.7

36.3

20.0

7.9

43.8

42.2

1Inchdes white, tik, and aitmr races.

NOTE For defiririm or terms sea technical notes. Because ef mmllng 04 esilrnaks. figures my ml add to tcxals.

who had a family planning visit in the

last year increased from 30 percent at

ages 15-19 to 59 percent at ages

20-24, and then decreased to 35

percent at ages 30-34, 17 percent at

ages 35-39, and 6 percent at ages

40-44. In 1988, this general age

pattern, with a peak at ages 20-24 and

a low at ages 40-44, was observed for

both white and black women (table 1).

The pattern was similar in 1982, but

the peak at ages 20-24 was less

pronounced in that year.

The age pattern observed in table

1 is probably a result of the

contraceptive methods used by women

in the various age groups. Ages 20-24,

the peak of the use of family planning

services, are the ages when the oral

contraceptive pill is the leading

method (l). Using the pill requires

regular visits to a doctor to renew the

prescription and check for side effects.

As women age and complete their

families, use of the pill declines and

use of sterilization increases. By ages

35-44, over half of women or their

husbands are sterile from operations,

either for contraceptive or healthrelated reasons (2). As sterility

becomes more common (at the older

ages), fewer women seek out family

planning services.

In both 1982 and 1988, black

women were significantly more Iiiely

than white women to have had a

family planning visit in the past year.

In 1988, 39 percent of black women

and 34 percent of white women had

had a visit in the past 12 months. The

difference by race was largest among

teenager~ in 1988,41 percent of black

teenagers and 29 percent of white

teenagers had had a family planning

visit in the last 12 months (table 1).

One possible reason for this difference

may be that higher proportions of

black teenagers begin intercourse at

an earlier age than white teenagers

(3), and are therefore more likely to

need family planning services during

their teenage years. Differences by

race at ages 20 and over were not

statistically significant in 1988.

In 1982, low-income women were

significantly more likely to have had a

family planning visit than high-income

women (40 versus 35 percent). The

difference by poverty level income in

1982 was significant only at the 10-

percent level for white women (39

versus 35 percent), and it was not

significant for black women. In 1988,

36 percent of low-income women and

34 percent of high-income women had

had a family planning visit in the last

12 months. This is not a significant

difference further, the differences by

poverty level income for white and

black women separately are also not

statistically significant in 1988.

Apparently in 1988, the two income

groups were about equally likely to

use family planning services of some

kind. However, they differed strongly

in where they obtained their family

planning services, as shown below.

Most recent source of service

Women who reported in the

survey that they had received family

planning services were shown a card

that listed the different kinds of clinics,

doctors’ offices, and counselors where

women might get these services. The

types of clinics listed included hospital

clinics, family planning clinics,

community health center clinics, public

health department clinics, and other

clinics. The types of doctors’ offices

included private doctor, private group

practice, co-op, and HMO. Counselors

included minister, priest, or religious

counselor, school counselor, youth

center, and other counselor. While

visits to private doctors are usually

paid for by insurance and the patient’s

own income, visits to clinics are often

subsidized by Federal, State, or loud

governments and by private charitable

groups. Tables 2-4 show some of the

characteristics of women who use

clinics and those who use private

doctors.

Table 2 shows the 20 million

women who used family planning

services in the last 12 months, by

whether they used a private doctor,

clinic, or counselor for their most

recent visit. About 64 percent of

women used a private doctor for their

most recent visit; 36 percent used a

cliniq and less than 1 percent used a

counselor. Black women were much

more likely to use clinics than white

women in both 1982 and 1988. III

1988, 53 percent of black women and
Advance Data 3

Table 2 Number of women who have had 1 family planning visitor more in the last 12

months and percent distribution by the most recent source of service, according to rat=

United States, 1982 and 1988

Number of Pnvele

wvrnen in All medical

Race thoussnds Soum Servbe airlb Couns910r

196a Percent dislrlbutbn

All races’ . . . . . . . . . . . . . 19,991 100.0 64.1 35.5 0.4

While . . . . . . . . . . . . . . . . 16,151 100.0 67.5 321 0.4

Black. . . . . . . . . . . . . . . . 3,018 100.0 46.5 53.2 0.3

1982

All races’ . . . . . . . . . . . . . 19,762 1OiLo 67.7 31.1 1.3

wane . . . . . . . . . . . . . . . . 16,224 100.0 720 26.6 1.3

Black . . . . . . . . . . . . . . . . 3,CCH lCQ.O 44.4 54.5 1.1

l,m~,-JmtiitO,~=k ‘i-r-.

NOTRFordeflnitbrn ofterrna8wtrxhdcal rx@Y.

Table 3. Number of women 15-44 yeara of age who had 1 family plannktg vlsft or more in

the last 12 months ●nd percent who used a clinic at their most recent family planning

visitj by race, age, and poverty level income: United States, 1982 and 1988

M taces’ Write week

Age endpov@y

level income 1966 1.962 1933 W&? 1966 1962

Age Number [n lhousands

15-14 years . . . . . . . . . . . . . . 19,991 19,762 16,151 16,224 3,018 3,001

15-19 years . . . . . . . . . . . . . . 2,787 2,915 2.136 2,236 576 614

20-24 yeers . . . . . . . . . . . . . . 5,556 5,972 4,424 4,666 956

25-29 years . . . . . . . . . . . . . . 5,724 5,722 4,727 4,790 761 757

3H4years . . . . . . . . . . . . . . 5,923 5,154 4,664 4,332 767 872

Poverty level income

O-149 parcent . . . . . . . . . . . . .

150parcant ormore . . . . . . . . .

Age

15-44 years . . . . . . . . . . . . . .

15-19 yeara . . . . . . . . . . . . . .

20-24 years . . . . . . . . . . . . . .

26-29 years . . . . . . . . . . . . . .

30-44 years . . . . . . . . . . . . . .

Poverty level income

O-149 percent . . . . . . . . . . . . .

lStlparcent ormore . . . . . . . . .

4,911

15,060

3s.5

622

422

29.4

225

60.2

27.4

5,533

14,z2e

31.1

51.0

36.3

26.7

16.6

46.0

24.5

3,228 3,959

12,921 12,265

Percant

321 26.6

60.6 44.0

2a.2 31.7

25.3 229

20.6 16.1

56.1 40.1

26.1 223

1,437

1,s61

53.2

65.4

624

51.6

3S.6

67.0

40.7

1,462

1,539

54.5

73.7

56.9

49.3

36.8

67:9

41.8

‘Incbdeswhite,black,and otter-.

NOTE For definitions of terms sea !echrkal notes. Because of ramding of estimates, figures my nd add to tcial%

only 32 percent of white women used

a clinic at their most recent m.sit.For

both white and bIack women,

nonmedical counselors not located in

medical clinics or doctors’ offices were

not an important source of family

planning serviceq probably because

they cannot provide medical services

and supplies that are needed for the

contraceptive methods that most

women use.

Table 3 shows the number of

women who used family planning

services in the last 12 months by the

age, race, and poverty status (income)

of the woman, and focuses on the

percent who used a clinic at their most

recent visit. The percent of black

women using clinics was substantially

higher than the percent of white

women using clinics in every age

category (except teenagers in 1988)

and every income group in both 1982

and 1988 (table 3). Explaining the

greater reliance of black women than

white women on cfinics is complex and

is an appropriate subject for further

research. Some studies have

suggested, however, that black women

are more likely to reIy on clinics for

family planning services because they

are less likely than white women to

have health insurance mverage or

sufficient income to pay the fees of

private doctors (4). Another recent

study cited lack of insurance coverage

and lack of a regular source of

medical care as major reasons why

some women use clinics rather than

private doctors (5). Other factors, such

as the location of clinics and private

doctors’ offices, may also help to

explain the greater use of clinics by

black women.

In 1982, black teenagers were

much more likeIy to use clinics than

white teenagers (74 versus 44

percent). But the difference shrank

from 30 percentage points in 1982 to

only 4 percentage points in 1988 (65

versus 61 percenfi not significant).

This shrinkage was the result of two

changes. FirsL there was a sharp and

significant increase, from 44 to 61

percent, in use of clinics by white

teenagers between 1982 and 1988.

There was also an apparent decrease,

which was not statistically significant,

in the proportion of black teenagers

who used clinics (from 74 percent in

1982 to 65 percent in 1988).

However, at age 20 and older, the

differences by race in the percent

using a clinic were quite large in both

1982 and 1988. For example, in 1988,

62 percent of black women and 38

percent of white women ages 20-24

used a clinic at their most recent visit.

By age, the percent using a clinic

is highest for teenagers and declines

sharply and sigm”ficantlyas age

increases. In 1988, 62 percent of

teenagers and 23 percent of women 30

and over used a clinic at their most

recent visit. In 1982, 51 percent of

teenagers and 19 percent of women 30

and over used a clinic. Previous

studies (cited in reference 4) suggest

that many teenagers use clinics

because clinics cost less than private

doctors, and because clinics promise

that the visit will remain confidential.

Many of the Federal, State, and

local programs that fund cIinic services

are intended to serve low-income

women (4). Table 3 also shows the

percent who used a clinic at last visit

by poverty level income-the total

family income divided by the poverty

level, expressed as a percent. Lowincome women were much more likely

than high-income women to rely on
4 Advance Data

Table 4. Number of women 15-24 years of age who have ever had a family planning visit

and percent who used a clinic at their first visi$ by race and ●ge at first vlalti

United States, 1982 and 1988

.4JIraces’ WMe Black

Age 1988 1962 lsm 1982 1988 1962

Number in thousands

15-24 years . . . . . . . . . . . . . . 9,960 9,440 7,828 7,597 1,761 1,613

Under 18yeam . . . . . . . . . . . . 4,761 4.903 3,492 3,760 1,114 1,066

l&19 years . . . . . . . . . . . . . . 3,304 2,869 2,679 2,410 475 36s

20-24 years . . . . . . . . . . . . . . 1,695 1,637 1,667 1,408 172 182

Percent

15-24 years . . . . . . . . . . . . . . 57.8 47.3 64.4 42.5 70.2 69.4

Under 18years . . . . . . . . . . . . 66.4 55.2 63.2 50.0 727 72.9

18-19 years . . . . . . . . . . . . . . 56.8 40.3 54.9 36.1 64.7 62.7

20-24 years . . . . . . . . . . . . . . 38.0 36.6 34.8 34.3 68.8 627

‘ Inchdes while, black, end other races.

NOTE For definltiom of terms s technical mtes. Because of roucdirtg C4eshates, figures may nof add to tchls.

clinics for their family planning

services. For example in 1988, 60

percent of low-income women used a

clinic for their most recent visit,

compared with only 27 percent of

women with incomes of 150 percent of

poverty or more. The proportion using

a clinic was 56 percent for low-inwme

white women and only 26 percent for

higher-income white women, and 67

versus 41 percent for black women.

Looking at trends in table 3, the

apparent drop in the percent of black

teenagers using a clinic (from 74

percent in 1982 to 65 percent in 1988)

was not statistically significant. As

noted above, the increase for white

teenagers, from 44 to 61 percent, was

significant. Changes in other age

groups were smafler and none were

significant.

The percent of low-income white

women using a clinic increased

significantly, from 40 percent in 1982

to 56 percent in 1988 (which means

that low-income white women were

relying more on clinics for their family

planning services in 1988 and were

less likely to use private doctors). In

the much larger group with incomes of

150 percent of poverty level or more,

the change was not significant, and

was much smaller (22 to 26 percent).

An additional question was asked

of women who used a clinic at the

most recent visit, to determine the

name and address of the clinic. The

name and address of the clinic was

then used to determine whether the

clinic was funded by Title X of the

Public Health Service Act, rdso called

the Population Research and

Voluntary Family Planning Programs

Act. At estimated 3.74 million women

used a Title X clinic at their last visit

in the last 12 months; of these, 2.57

million were whit e, 1.05 million were

black and the rest were of other

races. The characteristics of Title X

and other clinic users will be explored

further in future reports.

First visit

Asindicated earlier, family

planning services include getting a new

method of birth control, renewing a

prescription for a method already

being used, checking for side effects of

method use, counseling on birth

control methods, and other services.

Women 15–24 years of age at the date

of the survey were asked the type of

doctor’s office, clinic, or counselor

they went to the first time they

received any family planning services.

In 1988, about 58 percent of

women 15–24 who had ever had a

famify planning visit used a clinic at

their first visit (table 4); about 42

percent used a private doctor, and less

than 1 percent used a nonmedical

counselor (not shown). As at the most

recent visit, black women were much

more likely than white women to use

clinics at the first visit (70 percent of

black women and 54 percent of white

women used a clinic at the first visit;

table 4). The higher use of clinics at

the first visit by black women in 1982

has been reported before (4, 6, 7).

For women of all races combined

and for white women, but not for

black women, the percent using a

clinic at their first visit was highest at

the youngest ages (table 4). For

example, in 1988, 66 percent of

women who made their first visit

before they were 18 used a clinic at

that fwst visit, compared with 57

percent at ages 18-19 and only 38

percent at age 20 and older. For black

women, especially as reported in the

1988 survey, there was no significant

variation by age at the first visit in the

percent using a clinic.

References

1. Pratt W. Mosher W. Bachrach C.

2.

3.

4.

5.

6.

7.

8.

9.

Horn M: Understanding U.S. fe~ility:

Findings from the National Survey of

Family Growth, Cycle III. Popul IBuII

39(5). December 1984.

Mosher W, Pratt W. Contraceptive use

in the United States, 1973-88.

Advance data from vitaf and health

statistics, no 182. National Center for

Health Statistics. 1990.

Hofferth S, Kahn J, Baldwin W.

Premarital sexual activity among U.S.

teenagers over the past three decades.

Fam Plann Perspect 19(2):46-53.

hfarch/if@i] 1987.

Mosher W, Horn M. Source of service

and visit rate for family planning

services: United States, 1982. Public

Health Rep 101(4):405-416.

July/August 1986.

Radecki S, Bernstein G. Use of clinic

versus private family planning care by

low-income women: access, cost, and

patient satisfaction. Am J Public

Health 79(6): 692-697, June 1989.

Mosher W, Horn M. First family

planning visits by young women. Fam

Plann Perspect 20(1):3.3-40.

Januaty/February 1988.

Horn M, Mosher W. Use of services

for family planning and infertility

United States, 1982. National Center

for Health Statistics. Vital Health Stat

23(13). 1986.

Bachrach C, Horn M, Mosher W,

Shimizu I. National Sumey of Family

Growth, Cycle III: sample design,

weighting, and variance estimation.

Vital Health Stat 2(98). 1985.

U.S. Bureau of the Census. Povertv.in

the United States, 1987. Current

population reports; series P-60, no

163. Washington: U.S. Department of

Commerce. 1989.
Advance Data 5

Technical notes

The National Survey of Family

Growth (NSFG) is a periodic survey

conducted by the National Center for

Health Statistics to collect data on

factors affecting childbearing,

contraception, infertility, and related

aspects of maternal and infant health.

The survey is jointly funded by the

National Center for Health Statistics,

the National Institute of Child Health

and Human Development, and the

Office of Population Affairs, all of the

U.S. Department of HeaIth and

Human Services. Fieldwork was

conducted under contract by Westat,

Inc., in both 1982 and 1988.

For the 1988 survey (Cycle IV)

personal interviews were conducted

with a national sample of women who

were 1544 years of age on March 15,

1988. The interviews were conducted

between January and August of 1988.

In 1982, the population covered was

women 15-44 years of age living in the

civilian noninstitutionalized population

of the conterminous United States. In

1988, Alaska and Hawaii were

included, so the population awered

was the civilian noninstitutionalized

population of the entire United States.

Interviews were completed with 7,969

women in 1982 and 8,450 women in

1988. Further details on the sample

design and procedures of the 1982

survey are given in references 7 and 8.

Interviews for Cycle IV of the

survey were conducted between

January and August of 1988 from

households that had been interviewed

in the National Health Interview

Sumey (NHIS) betsveen October of

1985 and March of 1987. The NHIS is

also conducted by NCHS. As in

previous cycles of the NSFG, black

women were oversampled. Interviews

were conducted in person in the

respondent women’s homes by trained

female interviewers and lasted an

average of about 70 minutes. The

interview focused on the woman’s

pregnancy histo~ her past and

current use of contraception; ability to

bear children (fecundity and

infertility); use of medical services for

family planning, infertility, and

prenatal care; her marital history,

occupation and labor force

participation, and a wide range of

social, economic, and demographic

characteristics.

Reliability of estimates

Because the statistics presented in

this report are based on a sample, they

may differ by chance variations from

the statistics that would result if all

57.9 million women represented by the

NSFG had been interviewed. The

standard error of an estimate is a

measure of such differences. The

standard error of an estimated

number or percent is calculated by

using the appropriate values of A and

B from table I in the equations,

SE(N)= ~(= N

and

SE(P)=~B p (1OO-P)

x

where N = the number of women

P = the percent

X = the number of women.in

the denominator of the

percent

Table L Preliminary estimates of the

parameters A and B for estimating

standard errors for women, by race

Parameters

Rata A B

Total or wirlte . . . -0.0M)18 10,736

Black. . . . . . . . . -o.oo0828 5,181

The parameters shown in table I

were used to generate table II, which

shows preliminary estimates of

standard errors for percents of total or

white women, and table II]., which

shows preliminary estimates of

standard errors for percents of black

women.

A similar table for the Cycle III

(1982) survey is given in reference 7.

The chances are about 68 in 100

(about 2 in 3) that a sample estimate

would fall within one standard error of

a statistic based on a complete count

of the population represented by the

NSFG. The chances are about 95 in

100 that a sample estimate would fall

within two standard errors of the same

measure obtained if all people in the

population were interviewed.

Differences betsveen percents

discussed in this report were found to

be statistically significant at the

5-percent level using a 2-tailed normal

deviate test. This means that in

repeated samples of the same type and

size, a difference as large as the one

observed would occur in only 5

percent of samples if there were, in

fact, no difference between the

percents in the population.

In the text, terms such as

“greater,” “less,” “increase,” or

“decrease” indicate that the observed

differences are statistically significant

at the 0.05 level using a two-tailed

normal deviate test. Statements using

the phrase “the data suggest” indicate

that the difference is significant at the

0.10 (10 percent) level but not the

0.05 (5 percent) level. Lack of

comment in the text about any two

Table IL Preliminary estimates of standard errors for percents of total or white women:

1988 National Survey of Family Growth

EsMnatedpe?cent

2or 5C+ 10 m mor 3ooi 40 or

Bass ofpenxnt 96 .% 5?3 60 m 60 50

100,000 . . . . . . . . . 4.6 7.1

500,000 . . . . . . . . . 21 3.2

I,ooo,ooo . . . . . . . . 1.5 2.3

5,0C0,000 . . . . . . . . 0.6

Ioswo,ooo.. . . . . . . 0.5 c%

3J),000,C00. . . . . . . . 0.3 0.4

50,000,000. . . . . . . . 0.2 0.3

5a,oC0,coo . . . . . . . . 0.2 0,3

Standard error inpercentagepoints

9.8

4.4

3.1

1.4

u

0.4

0.4

13.1

5.9

4.1

1.9

;:

0.6

0.5

15.0

6.7

4.7

21

E

0.7

0.6

16.1 16.4

7.2 7.3

5.1 5.2

2.3 2.3

u ::

0.7 0.7

0.7 0.7
6 Advance Data

Table J1l. Preliminary estimates of standard errors for estimated percents of black women:

1988 National Survey of Family Growtfr

Esflmaiadpercent

2or 5or 70or 20or 3oor 40 or

Base of parwnt 96 95 90 60 70 60 50

Standard error In p+mentage points

100, BOO . . . . . . . . . 3.2 6.8 9.1 10.4 11.2 11.4

500,000 . . . . . . . . . 1.4 E 3.1 4.1 5.0 5.1

I,ooo,ooo . . . . . . . . 1.0 1.6 2.2 29 R 3.5 3.6

5,000,000 . . . . . . . . 0.5 0.7 1.0 1.3 1.5 1.6 1.6

7,500,000 . . . . . . . . 0.4 0.6 0.8 1.1 1.2 1.3 1.3

statistics does not mean that the

difference was tested and found not to

be significant.

The relative standard error (or

coefficient of variation) of a statistic is

the ratio of the standard error to the

statistic, and usually is expressed as a

percent of the estimate. In this report,

statistics with a relative standard error

of 30 percent or more are indicated

with an asterisk (*). These estimates

may be viewed as unreliable by

themselves, but they may be combined

with other estimates to make

comparisons of greater precision.

Statistics in this report also may

be subject to nonsampling error, that

is, errors or omissions in responding

to the interview, recording answers,

and processing data. The data have

been adjusted for nonresponse by

means of adjustments to the sample

weights assigned to each case. Other

types of nonsampling error were

minimized by a series of quality

control measures as described in

reports on Cycle III (such as

reference 7).

Definitions of terms

Family planning services-In the

1982 and 1988 surveys, women were

asked a series of questions about

whether they had used any of the

following services: to get a new

method of birth control, renew a

prescription, or get supplies for a

method already being used; to get a

sterilizing operation; to check for

correct use or fit of a method or for

side effects of a method; or to get

counseling about birth control, about

having a sterilizing operation, or what

to do about a pregnancy. Women who

reported receiving one or more of

these services were classified as having

used family planning services. These

questions were asked separately about

services received in the 12 months

before the intemiew, services at the

last (most reeent) visit, and the first

visit ever. Women were also asked if

they received a pregnaney test. This is

not considered a family planning

service, but is often the main reason

women first go to a family planning

provider. First visits at which women

reeeived only a pregnancy test, and no

other family planning services, were

not counted as family planning visits in

this report or in another analysis (6).

Source of famiiyplanning

services—Women who had reeeived

family planning sem”ces were shown a

card containing the following list of

types of placex “Clinics” included

hospital clinics, family planning clinics,

community health center clinics, public

health department clinics, and other

clinics. Private medical services or

private doctors included private

doctors in solo or group practices,

HMO’s (health maintenance

organizations), and co-ops.

“Counselors” included minister, priest,

or religious counselor, school

counselor, social or family service

agencies, youth centers, and other

counselors, at places where medical

family planning services are not

offered.

Age atfuxt visit—This is the

woman’s age in completed years at the

time she made her first visit for family

planning semices.

Demographic terms

Age—Age is classified by the age

of the respondent in completed years

as of March 15, 1988, the approximate

midpoint of interviewing.

Race-Race refers to the race of

the woman interviewed and is

classified as black white, or other. In

Cycles III (1982) and IV (1988), race

was classified according to the

woman’s report of the race that best

deseriied her.

Pov~ level income—The poverty

level index is calculated by dividing the

total family income in 1987 by the

1987 poverty level threshold for the

woman’s family size, as published by

the U.S. Bureau of the Census. This

definition takes into account the

number of persons in the family (9).

For a substantial number of

respondents (22 percent in 1982 and

11 percent in 1988), total family

income was not ascertained. Missing

values of poverty level income were

imputed from similar respondents with

known data. Because of these

relatively high levels of missing dat~

small differences between poverty

level income categories should be

interpreted with caution.
Acivanca Data 7

Cooperating agencies

Cycle IV of the National Survey of

Family Growth was supported in part

by the National Institute of Child

Health and Human Development,

National Institutes of Health, and the

Office of Population Affairs, Offfice of

the Assistant Secretary of Health.

These agencies also participated in the

design of the questionndre.

Symbols

--- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less

than 0.05

* Figure does not meet standards of

reliability or precision
8 Advance Data

Recent Issues of Advance Data From Vital and Health Statistics

No. 183. AIDS Knowledge and No. 18L Adoption in the 1980’s No. 179. AIDS Knowledge and

Attitudes for July-September 1989 (January 5, 1990) Attitudes for April-June 1989

(March 8, 1990)

.

No. MO. Characteristics of Persons (November 1, 1989)

No. 182. Contraceptive Use in the Dying From Cerebrovaseukr Diseases No. 178. Firearm Mortality Among

United States, 1973–88 (In press) (February 8, 1990) Children and Youth (November 3,

1989)

Suggested citation

Mosher WD. Use of Family Planning Services

in the United States 1982 and 1988. Advance

data from vital and health statistic% no 184.

Hyattsville, Maryland: National Center for

Health Statistics. 1990.

Copyright information

This reporl may be reprinted without further

permission.
Number 185 . June 19, 1990

Advance

Data

From Vital and Health Statistics of the National Center for Health Statistics

1988 Summary: National Hospital Discharge Survey

by Edmund J. Graves, Division of Health Care Statistics

Introduction

During 1988, an estimated 31.1

million inpatients, excluding newborn

infants, were discharged from shortstay non-Federal hospitals in the

United States. These patients used

203.7 million days of inpatient hospital

care. The discharge rate was 128

discharges per 1,000 civilian

population and the average length of

stay was 6.5 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 1988, data were

abstracted from the medical records of

approximately 250,000 patients

discharged from 422 short-stay nonFederal hospitals. 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 “Teehnical 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 and

earlier years due to the redesign of the

Suwey.

Medical data for hospitalized

patients are coded according to the

International Classificationof Diseares,

9th Revision, ClinicalModificatwn

(ICD-9-CM) (2). Up to seven

disposes 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 National

Hospital Discharge Survey, 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 numbers of occurrences or

because they are of special interest.

Residual categories of the diagnostic

and procedure classes, however, are

not included in the tables. More

detailed analyses of NHDS data are

published in Series 13 of the NCHS

J4tal cmdHeaIth Statisticsreports.

Starting in 1985, some hospitals

have submitted machine-readable data

tapes through commercial abstracting

services. In 1988, approximately 37

percent of the hospitals used this

method to submit data. fialysis

indicates that a greater number of

nonsurgical procedures per patient are

recorded from these hospitals than

from hospitals submitting data in the

traditional manual mode (see

“Technical notes”). A portion oft he

increases from 1984 to 1988 in the

estimates for miscellaneous diagnostic

and therapeutic procedures and.

therefore, for total procedures may be

due to this change in data collection

methods.

SC! WICE$ # f,= #

$

*

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

** Public Health Service

~= Centers for Disease Control <

2 National Center for Health Statistics

*.

%

>

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

%d3a
2 Advance Data

Data highlights are shown by selected patient and

Utilization by patient and hospital

hospital characteristics in tables 1-3.

The 31.1 million patients discharged

characteristics from short-stay hospitals during 1988

The number, rate, and average comprised an estimated 12.6 m-illion

length of stay of patients discharged males and 18.5 million females. The

from short-stay non-Federal hospitals rate per 1,000 population for females

Table 1. Number of Inpatients discharged from short-stay hospitals by selected

characteristics: United States, 1988

[Discharges from non-Federal hospkals. Excludes newborn infants]

Botrr

Selected characterisfk saxas Male Female

Allpatlents . . . . . . . . . . . . . . . . . . . . . .

Age

Under 15yeam . . . . . . . . . . . . . . . . . . .

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

4S-64 years . . . . . . . . . . . . . . . . . . . . .

65years and over . . . . . . . . . . . . . . . . .

Region

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

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

South . . . . . . . . . . . . . . . . . . . . . . . . .

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

Number of patients discharged in thousands

31,146 12,642 16,504

2,610 1,486 1,125

11,934 3,485 8,448

6,4560 3,221 3,235

10,146 4,450 5,698

7,078 2,975 4,104

7,832 3,288 4,584

10,845 4,244 6,801

5,391 2,155 3,238

Table 2. Rate of inpatients discharged from short-stay hospitals by selected

characteristics: United States, 1988

[Discharges from non-Federal hospitals. Excludes newborn infants]

Selected charactetitk

Both

sexes Male Female

All patients . . . . . . . . . . . . . . . . . . . . . .

Age

Under15years . . . . . . . . . . . . . . . . . . .

15-44yeare . . . . . . . . . . . . . . . . . . . . .

45-64years . . . . . . . . . . . . . . . . . . . . .

65yearsandover . . . . . . . . . . . . . . . . .

Region

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

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

South . . . . . . . . . . . . . . . . . . . . . . . . .

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

Rate of patients discharged par 1,000 population

127.6 106.9 147.0

49.2 64.6 43.4

104.0 61.5 145.6

140.5 146.4 135.1

334.1 360.3 316.2

140.2 123.3 155.8

131.1 112.6 148.6

129.4 105.1 152.1

107.6 87.3 127.3

Table 3. Average length of stay for inpatients discharged from short-stey hospitals by

selected characteristics: United States, 1988

[Discharges from non-Federsl hospitals, Excludes newborn infants]

Both

Se/ected characterrsfic sexes Male Female

Average length of stay in days

All patients . . . . . . . . . . . . . . . . . . . . . . 6.5 7.1 62

Age

Under 15years . . . . . . . . . . . . . . . . . . . 5.0 5.0 4.9

15-44years . . . . . . . . . . . . . . . . . . 4.7 6.3 4.1

4S-64years . . . . . . . . . . . . . . . . . . . . . 6.8 6.8 6.8

65yearsandover . . . . . . . . . . . . . . . . 6.9 6.6 9.1

Region

Notiheast . . . . . . . . . . . . . . . . . . . . . . 7.7 8.1 7.4

Midwest . . . . . . . . . . . . . . . . . . . . . . . 6.4 6.7 6.2

South . . . . . . . . . . . . . . . . . . . . . . . . 6.2 6.8 5.9

West . . . . . . . . . . . . . . . . . . . . 5.8 6.8 5.2

was 147, which was37 percent higher

than the rateof 107 formales. The

number and rate of discharges are

higher for females than for males

because of the large number of

women in their childbearing years

(1544 years of age) who are

hospitalized fordeliveries and

pregnancy-related conditions.

The average length of stay was 7.1

days for males and 6.2 days for

females during 1988. The average

Iengthof stayof the3.8 million

women who were hospitalized for

deliveries was 2.9 days. The average

length of stay was 5.0 days for patients

under 15 years ofage,4.7 days for

patients 15-44 years of age, 6.8 days

for patients 45–64 years of age, and

8.9 days for patients 65 years of age

and over.

The number of discharges from

short-stay hospitals by geographic

region during 1988 ranged from 10.8

million in the South to 5.4 million in

the West. Regional differences in the

number of discharges are accounted

for in part by variations in the

population sizes. The rates per 1,000

population ranged from 140 in the

Northeast region to 108 in the West.

Average lengths of stay by geographic

region were 5.8 daysin the West, 6.2

days in the South, 6.4 days in the

Midwest, and 7.7 days in the

Northeast.

Utilization by diagnosis

Diseases of the circulatory system

ranked first in 19880 fthe ICD–9-CM

diagnostic chapters as a principal or

first-listed diagnosis for patients

discharged from non-Federal shortstay 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) (4.3

million discharges) and diseases of the

digestive system (3.3 million

discharges). About 40 percent of the

patients discharged from non-Federal

short-stay hospitals were includecl in

these three ICD-9-CM diagnostic

chapters.

Th,e diagnostic categories

presented in this report were selected
Advance Data 3

either because they appear as principal

or first-listed diagnoses with great

frequency or because the conditions

are of special interest. Many of these

categories (such as malignant

neopksms, 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 and fractures.

Excluding deliveries, these last three

diagnostic categories were the most

common first-listed diagnoses for both

males and females. Some of the more

common diagnoses for patients under

15 years of age were pneumonia,

acute respiratory infections, asthma,

and chronic diseases of tonsils and

adenoids. For patients 15-44 years of

age, frequent diagnoses were

deliveries, psychosis, fractures, and

abortions and ectopic pregnancies. For

patients 45-64 years of age and 65

years of age and over, heart disease

and malignant neoplasms were major

causes of hospital use. The average

length of stay for all patients ranged

from 1.2 days for chronic disease of

tonsils and adenoids to 15.1 days for

psychoses.

Utilization by procedures

One or more surgical or

nonsurgical procedures were

performed for an estimated 19.9

million of the 31.1 million inpatients

discharged from short-stay hospitals

during 19S8. A total of 39.2 million

procedures, or an average of 2.0 per

patient who underwent at least one

procedure, were recorded in 1988.

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 extraction of lens and

hysterectomy) are presented as single

categories even thowzh thev are “

divided into more precise ~ubgroups in

ICD-9-CM.

Three-fourths of all the surgical

and nonsurgical procedures performed

during 1988 are listed in just five of

the 16 procedure chapters. These were

diagnostic and therapeutic procedures

(10.8 million), obstetrical procedures

(6.0 million), operations on the

digestive system (5.3 million),

operations on the cardiovascular

system (3.6 million), and operations

on the musculoskeletal system (3.1

million).

The number and rate of all-listed

procedures in 1988 for each

ICD-9-CM procedure chapter and

selected procedure categories are

shown by sex and age in tables 7 and

8. Of the 39.2 million procedures

performed during 1988, 15.7 million

were for males and 23.5 million were

for females. The corresponding rates

per 100,000 population were 16,054.0

for both sexes, 13,309.3 for males, and

18,631.2 for females. Frequent

procedures for males were

arteriography and angiocardiography

and computerized axial tomography.

Procedures commonly performed on

females were episiotomy, diagnostic

ultrasound, cesarean section, and

computerized axial tomography.

The rate of procedures per

100,000 population ranged from

3,860.0 for patients under 15 years of

age to 41,761.8 for patients 65 years of

age and over. Commonly performed

procedures for patients under 15 years

of age were spinal tap and

tonsillectomy with or without

adenoidectomy; for patients 15-44

years of a~e, episiotomy and cesarean

section; for patients 45–64 years of

age and 65 years of age and over,

computerized axial tomography,

arteriography and angiocardiography,

diagnostic ultrasound, and circulatory

monitoring.

References

1.

2.

3.

4.

Simmons WR. Development of the

design of the NCHS Hospital

Discharge Sumey. National Center for

Health Statistics. Vital Health Stat

2(39). 1970.

Public Health Service and Health Care

Financing Administration.

International Classification of

Diseases, 9th Revision, Clinical

Modification. Washington: Public

Health Service. 1980.

SIvIG hfarlceting Group, Inc. Hospital

Market Database. Chicago: Healthcare

Information Specialists. 1989.

Shah BV. SESUDAAN Standard

Errors Program for Computing of

Standardized Rates from Sample

Survey Data. Research Triangle Park,

North Carolina: Research TriangIe

Institute. 1981.

Symbols

––- Data not available

. . . Category not applicable

0.0

z

*

#

Quantity zero

Quantity more than zero but less

than 0.05

Quantity more than zero but less

than 500 where numbers are

rounded to thousands

Figure does not meet standards of

reliability or precision (see

Technical notes)

Figure suppressed to comply with

confidentialityy requirements
4 Advance Data

Table 4. Number of inpatients discharged from short-stay hospitals, by category of first-fisted diagnosis, sex, and age: United States,

1988

[Dscharges from non-Federal hospitals. Excludes newborn Infants. Diagnosfii groupings and code number Inclusions are based on tfw /rrterrrathna/ C/aSK71km of

D/seases, 9th Rev/sion, Ck?bel Modifiitiw? ([CD-9-CM)]

Sex Age

Under 15

Category of rwet-listad diagnosis and ICLQ-CM code

1$44 45-64 #years

Total Male Fanrale years years years and over

Number of patkmts discharged in thousands

Allcondtbons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

InfecIlous and parESflC disa~s. . . . . . . . . . . . .001-139

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . ...14&239

Mahgnant neoplasms . . . . . . . ...140-208.23&234

Mal!gnant neoplasm of large Inlesllne and

rectum . . . . . . . . . . . . . . . . . .,..153-154,197.5

Mahgnanl neoplasm of trachea bronchus, and

lung, . . . . . . . . . . . . . . . . . . . . .162,197.0,197.3

Mahgnanl neoplasm of breast. . . . . .174-175.198.81

Benign neoplasms and neoplasms of uncertain

behawor and unspectied nature . . . ,210-229, 235-239

Endocrine, nutritional and metabolc diseases, end immunity

dmorders . . . . . . . . . . . . . . . . . . . . . . . . ...24&279

Dmbetes mellifus . . . . . . . . . . . . . . . . . . . . . . ..25o

Dweases of the blood and blood-forming organs ..260-289

Mental disorders . . . . . . . . . . . . . . . . . . . . ...290419

Psychoses, . . . . . . . . . . . . . . . . . . . . . . ..29G2sM

Alcohol dependence syndrome. . . . . . . . . . . . ..303

Diseases oflhenervous sysIemand eensaorgam .320-389

Dtseases of thecentral nervous system .32R336,340-349

Cataract . . . . . . . . . . . . . . . . . . , . . . . . . . ...386

Diseases of theearand mastoid prooess, . . ...360-369

D]seases of thecirculato~ system. . . . . . . . . . .3W59

Heart disease . . . . . . . . . .391-392.0,393+98,402,404,

410-416,42&429

Acute myocardial infarction . . . . . . . . . . . . . , ,41O

Alherosclerotlc hearldsease. . . . . . . . . . . . . .414.o

Other lschemic heart dseaee. ., ,411+ 12,414.lA14.g

Cardiac dysrhythmme. . . . . . . . . . . . . . . . . ...427

Congestive fIearlfailure ., . . . . . . . . . . . . ...428.0

Cerebrovascuiar dfsease . . . . . . . . . . . . . . . .43&138

Dieeases of therespiratory system . . . . . . . . . ..460-519

Acute respiratory infections, except Infiuenza . ..460-466

Chronic disease of tonsils and adenoids . . . . . . ...474

PIWUMOnks,SIl lfOn7rS. . . . . . . . . . . . . . . . ..4W86

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493

Diseases of thedlgesfive system, . . . . . . . . . ...520-579

Uicersof thestomacha ndsmalllnlestine. . . . . .531-534

Gaslrilsa ndduodenifie. . . . . . . . . . . . . . . . . ...535

Appendlclti s . . . . . . . . . . . . . . . . . . . . ...540-543

Inguinal hernia . . . . . . . . . . . . . . . . . . . . . . . ..55o

Nonlnfectlous enteritis andcolifis . . . . . . . .555-556,558

Cholelithiasie . . . . . . . . . . . . . . . . . . . . . . . ...574

Diseases of thegenitourinary system. . . . . . . . . .56&8z

Calculus ofkdneyandureler. . . . . . . . . . . . . . ..592

Hyperplaaa of prostate . . . . . . . . . . . . . . . . . ..6oo

Complications of pregnancy, childbirth, and the

puerperium’ . . . . . . . . . . . . . . . . . . . . . . ...630-676

Abortions andectoplc and molar pregnancies. .631H339

Diseases of theskmand subcutaneous lEsue . . .860-709

Diseases of the musculoskeletal system and conneclwe

Issue,. . . . . . . . . . . . . . . . . . . . . . . . . ...710-739

Arthropathles andrelaled disorders . . . . . . . ..710-719

Intervertebral dscdlsorders . . . . . . . . . . . . . . .722

Congeruta lanomaliae . . . . . . . . . . . . . . . . ...740-759

Certain conditions originating in the perinatel

period . . . . . . . . . . . . . . . . . . . . . . . . . ...76&779

Symptoms, signs, andlll-defmed condfiions. ..780-799

Injury and poisoning . . . . . . . . . . . ., . . . . ...800-999

Fractures, allsttes . . . . . . . . . . . . . . . . . ...80&629

Fracture ofneck of femur . . . . . . . . . . . . . . ...820

.Spralns andstralns of back (mcludmg neck). . ..846-647

lM3CrWWd Inp-mes (excluding lhose wrth skull

fracture) . . . . . . . . . . . . . . . . . . ... ,., .850+S4

Laceratkmsando penwounds. . . . . . . ..870-904

Supplementary classifications . . . . . . .VO1-V82

Females with dehvenes. . . . . . . . ., . . . . . . . . ..V27

31,146

693

2,096

1,670

165

236

177

428

1,036

454

2e5

1,559

781

237

922

348

92

200

5,286

3,641

716

411

921

491

634

764

2,937

445

197

924

479

3,266

256

146

242

257

333

464

2,204

287

247

837

266

460

1,647

459

417

227

158

398

2,817

1,014

254

97

201

232

4,295

3,761

12,642

333

851

772

77

136

●

78

414

209

140

765

341

179

430

169

33

99

2.722

1,955

451

278

491

228

277

336

1,464

224

87

472

210

1,515

137

57

141

232

122

132

828

183

247

. . .

. . .

234

774

191

247

128

92

200

1,535

506

66

48

124

176

217

. .

16,504

359

1,247

896

87

100

176

350

623

245

155

793

440

56

492

179

59

102

2,574

1,666

265

134

431

283

357

448

1,473

221

110

452

270

1,753

118

66

101

25

211

352

1,376

104

. . .

337

266

226

872

267

170

98

66

198

1,281

5oa

186

49

78

56

4,078

3,781

2,610

191

53

37

●

●

16

102

28

47

56

21

●

194

57

*

106

25

14

●

●

●

●5

*

*

699

166

125

164

164

274

●

●6

52

30

96

●

71

●

●3

●

46

54

18

●

150

158

50

348

107

●

●

46

34

88

10

11,934

211

378

167

●5

8

20

191

229

125

86

e62

429

lea

222

119

●

37

419

243

45

24

53

36

14

32

540

80

70

111

110

992

52

45

145

65

115

183

922

137

*

833

264

154

621

129

223

45

●

175

1,216

356

10

81

103

155

3,929

3,768

6,456

104

706

566

41

102

81

142

250

134

52

288

157

63

leo

69

17

26

1,628

1,162

241

191

386

131

107

171

525

70

●

139

93

631

66

41

24

78

52

146

512

106

56

●

●

108

495

118

142

24

*

105

498

lE-I

24

22

26

27

138

*

10,146

167

958

880

118

125

76

79

456

166

110

251

174

14

317

103

72

32

3,224

2,223

430

197

502

320

510

578

1.172

148

●

490

112

1,171

136

64

20

84

70

154

700

41

191

. . .

. . .

152

477

196

51

‘8

*

69

755

398

217

12

16

17

139

. . .

'F!~-l!sled d,agm!s for femAesw!th de,,wrles !scodd V27, shc+munde r”Wppfernenia yclessif!callons,”
Advance Data 5

Table 5. Rate of inpatients discharged from short-stay hospitals, by category of first-listed diagnosis, sex, and age: United States, 1988

[Discharges from non-Federat hosptfals. Excludes newborn Infants. Diagnostic groupings end code number Inclusions are based on the h?ternafimal C/assfnatbn of

f?iseases. 9f/r RevLsbn, Clinical ModifkWicfr (ICD-9-CM)l

sex Age

Under 15 75-44 45-64 65 years

Category of first-llskt diagnosis and ICD-SWM ocda Total Mate Fetnete years v yesrs and over

Rate of tnpatlents discharged per 10,000 population

Atlcondttbns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectious and parasttio dbeases. . . . . . . . . . ...001-139

Neoplasm . . . . . . . . . . . . . . . . . . . . . . . . ..l@-2W

Mst!gnant neoplasms. . . . . . . . . . . .140-206,230-234

MsUgnsnt neoplasm of large Intestine and

rectum . . . . . . . . . . . . . . . . . . . ..153-154 s197.5

MeJignant neoplasm of tracheq bronchus, and

tung . . . . . . . . . . . . . . . . . . . . ..l62. 197.0,197.3

Malignant neoplasm of breast . . . . . .174-175.198.81

Bentgn neoplesms end neoplasms of uncertain

behavior and unspecified nature. . . . .210-229,2=239

Endocrine, nu!rttbnal and metabolio diseases, and Immunify

disorders . . . . . . . . . . . . . . . . . . . . . . . . . ..2W279

Diabetes mellttus . . . . . . . . . . . . . . . . . . . . . . ..2W

Dfseasas of the tiood and bfood-forming orgsns ..260-289

Menteldtsordet% . . . . . . . . . . . . . . . . . . . . .._19

Psychoses . . . . . . . . . . . . . . . . . . . . . . ...290-299

Alcohol dep+rndenca syndrome. . . . . . . . . . . . ...303

Dlse6ses of the nervous system 8nd senw organs .320-369

Diseases of the centrst nervous system .320-336,340-349

Cataraof. . . . . . . . . . . . . . . . . . . . . . . . . . ...366

Dlseeees of the ear and m=told proc6ss. . . . . .36W369

Dlseasas of the clrculafoty system. . . . . . . . . . . .=59

He8ftdis8ss8 . . . . . . . . . .391-392.0,393+96,402404,

41&41 6,420-429

Acute m_ Lstlnfraotion . . . . . . . . . . . . . ...410

Alherosclerotlc heart dtseese. . . . . . . . . . . . ..414.0

Ofher Ischemk heart disease. . ..411-413.414.1-414.9

Cardiac dysfhyihmlas . . . . . . . . . . . . . . . . . ...427

Congestive heart failure . . . . . . . . . . . . . . . ..428.O

Cerebrovaecular dbease. . . . . . . . . . . . . ...43-0+2$

Dtseases of the respirato~ system . . . . . . . . ...460-519

Acute respiratory infecfbns, except Influerm . ..460-466

Chronk dk-aase of tonsils end adenoids . . . . . . ...474

PneumonQ all forms . . . . . . . . . . . , . . . ...480-466

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493

Diseases of the digestive system. . . . . . . . . . ....520-579

Ulcers of the stomach and smatl intestine. . . ...531-534

Gesttftfs andduodenltla . . . . . . . . . . . . . . . . . ...535

Appendicii!9 . . . . . . . . . . . . . . . . . . . . . ...540-543

tngulnal hemie . . . . . . . . . . . . . . . . . . . . . . ...550

Nonlnfeotbus enterttis and colttls . . . . . . . .55S+56.556

Choleltthiasis . . . . . . . . . . . . . . . . . . . . . . . ...574

Diseases of the gentfouftnary system. . . . . . . . . .580+?9

Catculusof kklneyand ureter . . . . . . . . . . . . . ...592

Hyperplasis of prostate . . . . . . . . . . . . . . . . ...600

Complkatio~s of pregnanoy, childbirth, and the

puerpertum . . . . . . . . . . . . . . . . . . . . . . . ..K!&676

Aboftbns and ectopic and molar pregnancies. . .63&839

D!seeses of the skin and subcutaneous tissue . ...660-709

Diseases of the musculostreletal system and conneofNe

tissue . . . . . . . . . . . . . . . . . . . . . . . . . . ...710-739

Arthropathiee and related disorders . . . . . . . . .71*719

Intervertebral d!sc disorders . . . . . . . . . . . . . . ...722

Congenital anomalies . . . . . . . . . . . . . . . . ...74&759

Ceftaln conditbns originating in the perlnafal

pared . . . . . . . . . . . . . . . . . . . . . . . . . ...760-779

Symptoms, signs, end 111-definedconditbns. . . ...760-799

In]uryend poisoning . . . . . . . . . . . . . . . . . . ..6CKM88

Fracfurae, allsKes . . . . . . . . . . . . . . . . . . ..800—629

Fracture ofneokoffemur . . . . . . . . . . . . . . ...620

Sprains and strains of back (including neck). . ..846-647

Intracranial Injuries(excludhg those with skull

fracture) . . . . . . . . . . . . . . . . . . . . . . . ...650-654

Lsceratbns end open wounds. . . . . . . . . . . . .87&904

Supplementary clessificatbns . . . . . . . . . . . . . .VO1-V62

Females with deltveriss . . . . . . . . . . . . . . . . . . ..V27

fFIW.IISS~ dlag~ls fm femsi~ withdeliveriesis codedV27. ShCWII undef ““WPFkIM~.WY ~~fi~tion$.”

1,275.8

26.4

85.9

66.4

6.7

9.7

7.2

17.5

42.5

18.6

121

63.6

320

9.7

37.8

14.3

3.8

8.2

216.9

149.2

2e.3

16.9

37.7

20.1

26.0

321

120.3

18.2

8.0

37.9

19.6

1X3.9

10.5

6.0

9.9

10.5

13.6

19.8

92.3

11.8

10.1

34.3

10.9

18.8

67.4

18.8

17.1

9.3

6.5

16.3

115.4

41.5

10.4

4.0

8.2

9.5

175.9

154.9

l,06e.3

28.2

72.0

65.3

6.6

11.5

●

6.6

35.0

17.7

11.8

64.7

28.8

15.1

36.4

14.3

2.8

8.3

230.2

165.4

3s.1

23.5

41.5

19.3

23.5

28.4

123.8

18.9

7.4

40.0

17.7

128.1

11.6

4.8

11.9

19.6

10.3

11.2

70.1

15.5

20.9

. . .

. . .

19.8

65.5

16.2

20.9

10.9

7.8

16.9

128.9

42.8

5.7

4.1

10.4

14.9

18.3

. . .

1,468.7

28.6

98.1

71.3

6.9

7.9

14.0

27.8

49.5

19.5

12.3

63.0

35.0

4.8

39.1

14.2

4.7

6.1

204.5

133.9

21.1

10.6

34.2

20.9

28.3

35.6

117.0

17.6

8.7

35.9

21.4

139.3

9.4

7.0

8.0

2.0

16.7

23.0

109.3

8.3

. . .

66.5

21.1

17.9

69.3

21.2

13.5

7.6

5.3

15.7

101.8

40.4

14.8

3.9

6.2

4.5

323.9

300.3

491.5

35.9

10.0

6.9

●

●

3.0

19.2

5.2

8.9

10.9

4.0

●

36.5

10.8

●

20.0

4.7

2.6

*

*

*

●1.O

●

●

131.7

31.6

23.5

34.7

31.0

51.5

*

●1.1

9.9

5.6

18.1

●

13.3

*

‘0.6

●

6.6

10.1

3.4

*

26.2

29.8

9.3

65.6

2U.I

●

●

8.7

6.3

16.6

2.0

1,040.5

16.4

33.0

16.3

“0.5

0.7

1.7

16.7

20.0

10.9

7.5

63.9

37.4

13.8

19.3

10.4

●

3.2

36.5

21.2

3.9

2.0

4.6

3.1

1.3

2.8

47.1

5.2

6.1

9.7

9.6

66.5

4.6

3.9

12.7

5.7

10.0

16.0

80.3

11.9

*

72.6

23.0

13.5

54.1

11.3

19.5

3.9

●

15.2

106.0

31.0

0.9

5.3

9.0

13.5

342.5

326.6

1,404.9

22.6

154.1

123.3

8.9

22.2

17.6

30.8

54.4

29.3

11.3

627

3-4.1

13.8

41.3

14.9

3.8

5.6

354.4

2526

52.4

41.5

79.7

26.4

23.2

37.2

114.2

15.2

●

30.3

20.3

160.8

14.3

9.0

5.2

17,0

11.4

31.7

111,4

23.0

12.1

●

●

23.4

107.6

252

3a.9

5.2

●

22.8

106.3

33.4

5.2

4.6

5.7

5.9

30.1

●

3,341.2

61.6

315.6

269.7

3e.o

41.2

25.0

25.9

150.3

54.8

36.2

625

57.5

4.6

104.3

33.6

23.8

10.5

1,061.6

731.9

141.6

64.8

165,4

105.4

168.1

190.4

386.0

46.7

●

161.3

36.8

365.7

44.9

17.7

6.7

27.6

23.0

50.8

230.5

13.6

62,6

. . .

. . .

50.1

156.9

64.4

16.7

●2.5

*

22.7

248.6

131.1

71.4

3.9

8.4

5.7

45.9

. . .
6 Advance Data

Table 6. Average length of stay for inpatients discharged from short-stay hospitals, by category of first-listed diagnosis, sex, and age:

United States, 1986

[Dlschargas from non-Faderal hospltefs. Excludes newborn Infants. Dbgnostlc groupings and code number Inclusions are based on the /rrternatLms/ C/ass/f’iit/orr of

Diseases, 9th RevMon, C!inlcal ModKh%dbfr(lCD-%CM)]

sex Age

Under 15 15+4 45-64 65 J@W5

Category of first-lkted diagnosk and ICD-9-CM code Total Male Female years yam years and over

Allcondttkms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Infectious and parasNc diseases. . . . . . . . . . . . .001-139

Neoplasms . . . . . . . . . . . . . . . . . . . . . . . ...14&239

Mahgnant naoplasms . . . . . . . . . . .140-208, 23&234

Mahgnant neoplasm of large Intestine and

rectum . . . . . . . . . . . . . . . . . . ...153-154.197.5

Malignant neoplasm of trachea, bronchus, and

lung . . . . . . . . . . . . . . . . . . . . . .162,197,0,197.3

Mahgnanl neoplasm of breast. . . . . . .174-175.198.81

Benign neoplasms and neoplasms of uncertain

behavior end unspecified nature . . . .21 W229, 23%239

Endocrine, nutntiinal end metabolk d!seases, and immunity

disorders . . . . . . . . . . . . . . . . . . . . . . . ...240-279

Diabetes mellifus . . . . . . . . . . . . . . . . . . . . . . ..25Q

Diseases of the blood and blood-forming organs ..280-289

Mental disorders . . . . . . . . . . . . . . . . . . . . . ..w19

Psychoses . . . . . . . . . . . . . . . . . , . . . . ...29&299

Alcohol dependence syndrome. . . . . . . . . . . . . . .303

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

Diseases of the central newous system .320-336,34W349

G31WaC1 . . . . . . . . . . . . . . . . . . . . . . . . . . ...366

Diseases of the ear and mastokt process . . . . . .380-3a9

Diseases of the circulatory system. . . . . . . . . . ..390-459

Heart disease . . . . . . . . . .391 -392.0,393-396,402,404,

410-416,420-429

Acute myocardiel Infarction . . . . . . . . . . . . . . . .410

Atherosclerotic heart dseaee . . . . . . . . . . .414.0

Dther ischemic haart disease. . . .411413,414.1414.9

Cerdlac dysmythmlas . . . . . . . . . . . . . . . . . . ...427

tifSg?SWVa heart failure. . . . . . . . . . . . . . . . . . .426.0

Carebrovescular disaese . . . . . . . . . . . . . . .,42.0438

Diseases of the rasplrato~ system . . . . . . . . ...480-519

Acute respiratory Infeclbns, exoept Inffusmza . ..460-488

Chronic disease of tonsils and adenoids . . . . . . ...474

Pneumonia, afl forms . . . . . . . . . . . . . . . ...480-486

Asthma . . . . . . . . . . . . . . . . . . . ., ..,......493

Diseases of the digesttve system. . . . . . . . . . ...520-579

UICetS of the stomach and smafl Inlastlna. . , . ..531-534

Gastritis andduodenttls . . . . . . . . . . . . . . . . . ...535

Appendicitis . . . . . . . . . . . . . . . . . . . . . ...540-543

Ingulnal hamh. . . . . . . . . . . . . . . . . . . . . . ...550

Noninfactksus enterttis and colifls. . . . . ...555-556. 558

Cholelfthiasii . . . . . . . . . . . . . . . . . . . . . . . ...574

Dlseesas of the genltourinafy system. . . . . . . ...580-629

Calculus of kdney and ureter . . . . . . . . . . . . . ...592

Hyperpkisiaofprostate . . . . . . . . . . . . . . . . ...600

Complications of pregnancy, chiktbwth, and the

puerperium’ . . . . . . . . . . . . . . . . . . . . . . ...630-676

Ab+mltonsend ectoplc and molar pregnancies, ..630-639

Diseases Ofthe skin and subcutaneous tiisue . . . .680-709

Diseases of the musculoskeletal system and connective

tissue . . . . . . . . . . . . . . . . . . . . .,.......710-739

Arfhropathies and related disorders . . . . . . . .710-719

Intefvailebrel disc disorders . . . . . . . . . . . . . . . . .722

Congenital anomalies . . . . . . . . . . . . . . . . ...740-759

Ceftam condtuons originating in the perinatal

period . . . . . . . . . . . . . . . . . . . . . . . . . ...76&779

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

Injury and fmsonlng. . . . . . . . . . . , . . . . . ...600-999

Fractures, alls!tes . . . . . . . . . . . . . . . . . ...800-829

Fracture ofnackof femur . . . . . . . . . . . . . . ...820

Sprains and strains of back (including neck) . ...648-847

Intracranial injuries (excluding those wih skull

fracture) . . . . . . . . . . . . . . . . . . . . . . . . ..65C-854

Lacerations and open wounds. . . . . . . . . . . .87W304

Supplamantary classifications . . . . . . . . . . . .VOI-V62

Females wtth deliveries . . . . . . . . . . . . . . . . . . ..V27

6.5

8.1

6.5

9.4

13.1

9.5

5,6

4.9

7.5

6.2

6.2

13.0

15.1

11.2

5,4

9.4

1.4

2.5

7.5

7.1

9.0

6.1

5.3

5.6

8.8

9.7

6.6

5.1

1.2

8.4

4.8

6.2

7.2

4.4

5.2

2.5

4.7

6.5

5.3

3.1-

6,3

2.7

2,3

8.1

6,3

7,4

5.9

5.9

12.4

3.3

6.6

6.4

13.4

4.8

5.5

4.1

3.3

2.9

7.1

8.2

9.0

9.4

12.6

9.1

*

5.0

7.5

7.8

6.2

12.4

14.3

11.1

6.0

10.5

1.5

2.3

7.4

6.9

8.8

5.7

5.1

5.6

6.6

9.8

6.6

4.8

1.4

8,3

4,4

5.8

6.8

4.1

5.4

2.5

4.6

7.4

5.5

2.8

6.3

. . .

. . .

7.9

5.8

6.1

5.5

5.8

12.1

2.8

6,4

7,2

13,0

4.6

6.4

4.3

6.6

. . .

6.2

8,0

8.1

9.4

13.4

10.0

5.6

4.9

7.5

8.6

6.2

13.7

15.8

11.4

4.9

6.4

1.3

27

7.7

7.4

9.3

6.9

5.5

5.7

8.9

9.6

6.7

5.4

1.1

8.6

5.0

6.5

7.7

4.6

4.9

2.3

4.8

6.2

5.1

3.8

. . .

2.7

2.3

6.3

6.8

8.4

6.5

6.2

13.0

3.8

7.3

9.7

13,6

5,0

4.1

3.7

3.1

2.9

Averaga length of stay in days

5.0

4.1

6.5

7.9

●

*

3.1

4.6

5.2

4.2

25.0

26.0

*

3.7

6.5

●

2.1

6.8

6.6

●

●

*

*4.6

*

●

3.2

3.3

1.2

4.6

2.8

3.6

●

‘2.8

4.e

1.6

2.9

●

3.9

●

●2.4

●

4.0

4.8

3.8

*

5.9

12.4

2.7

4.1

5.0

*

●

2,5

3,0

6.1

3.0

4.7

7.5

5.8

7.3

●12.4

11.3

5.0

4.3

%

5.5

12.6

14.7

11.9

5.4

7.2

●

2.2

5.7

5.7

6.8

5.0

3.8

3.2

6.8

7.9

4.5

3.9

1.2

7.3

4.0

4.8

5.5

3.6

3.9

2.0

4.5

5.1

4.0

2.5

*

2.7

2.3

5.6

4.6

4.1

5.4

4.5

●

2.9

5.3

6.0

14.2

4.6

5.9

4.0

2.9

2.9

6.8

10.9

8.1

6.9

11.5

9.4

5.3

5,0

7,2

8.3

6.5

11.9

14.1

6.9

5.5

10.5

1.3

2.5

6.4

6.2

8.1

5.1

4.6

4.7

9.3

8.7

7.1

5.7

●

8.4

5.7

6.3

6.7

4.5

7.1

2.3

5.8

6.2

5.1

3.2

7.2

*

●

8.2

5.9

6.8

6.0

6.6

●

3.5

7.1

8.2

12.5

4.6

6.9

4.5

4.7

*

IB.9

11.3

9.9

10.2

13.6

!3.5

6.0

6.6

!9.4

10.5

7.4

1:3.3

15.5

8.5

43.4

12.9

‘1.4

4.0

8.4

7.8

9.7

7.1

5.9

6.3

8.7

10.1

9.4

7.5

●

1[).2

7.6

[Lo

8.2

5.3

12.8

3.3

6.7

8,6

7.2

4.6

6.0

. . .

.,.

11.8

9.2

10.4

&3

%’.2

*

4.7

10.2

11.6

13.5

6.6

ELo

6.8

9.5

.,,

1.Fws!.listed diagrosts for femsies with delr,wes IS coded V27, shown under ‘.sup@ementary clsssif!cations.”
Advance Data 7

Table 7. Number of all-listed procedures for inpatients discharged from short-stay hospitals, by procedure category, sexj ●nd age:

United States, 1988

[Discharges from non-Federal hospilals. =cludes newborn Infants. Pr@.Xture groupings end code number inclusbns era based on the krhwrretbnal C/essikeKm of

Dk?ases, 9fh RevMrrr, Clirr&l Modlfkatk.M (lCO-9-CM)]

sax Age

Under 15 1s-44 45-64 65 years

Procedure category and ICB9-CM code Total Male Female jwlrs. WV and over

All procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Opera[tons on the nervous system. . . . . . . . . . . . . . ...01-05

Splnsttap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..~.31

Opwalbns on the endwtne system . . . . . . . . . . . . ...06-07

Operalbnson theaye . . . . . . . . . . . . . . . . . . . . . . ..W16

Extractbn of lens . . . . . . . . . . . . . . . . . . . . . ...13.1-13.6

Insartbn ofprosthetio lens (pseudophakos). . . . . . . . ...13.7

Operatbnson theear . . . . . . . . . . . . . . . . . . . . . . ..1=20

Operations on the nose, mouth, and pharynx. . . . . . . ...21-29

Rhinoplasty andrepeirof nose..... . . . . . . . . . . . ...21.8

Tonsillectomy wkh or wthout adenoIdectomy. . . ...28.2-28.3

Operafbns on the respiratory system. . . . . . . . . . . . . . .30+I

Bronchoscopy . . . . . . . . . . . . . . . . . . . . . . . .33.21 +33.23

Operafbns on the cardiovascular system . . . . . . . . . ...35-39

Removal of coronary artery obstrucfbn . . . . . . . . . . ...36.0

Direct hetutrevascularimtbn . . . . . . . . . . . . . . . . . ...36.1

Cardiac cefhetertzafbn. . . . . . . . . . . . . . . . . . .37.21 -37.23

Pacemaker Insertbn, replacement, removet, repair. . .37.7-37.8

Operatbns on the hemlc and lymphatic system . . . . . ...40-41

Operalbns on the digestive system . . . . . . . . . . . . . ...42-54

Esophagoscopy and gastroscopy (natural orWe) . .42.23,44.13

Partial gastrectomy and reserxbn of

Intestine . . . . . . . . . . . . . . . . . . . . . .43S-43.8,45.6-45.8

Endoscopy of large intestine (netumt orifice) . . . . . . ...45.24

Appendectomy, excluding incidental. . . . . . . . . . . . ...47.0

Hemorrhoklectomy . . . . . . . . . . . . . . . . . . . . .49.4%49.46

Cholecysteotomy . . . . . . . . . . . . . . . . . . . . . . . . ...51.2

Repair oflnguinelhemla . . . . . . . . . . . . . . . . ...53.0-53.1

Dlviston ofpantoneal adhesbns . . . . . . . . . . . . . . . ...54.4

Operatbns onlhe urinary system . . . . . . . . . . . . . . ...55-59

Endoscopbe (natural orifke) . . .55.21 -%.22,56.31,57.32,56.22

Operetbns on the male genilai organs. . . . . . . . . . . ...60-64

Prostatectomy . . . . . . . . . . . . . . . . . . . . . . . ...60.2-60.6

Operations on the femete genital organs. . . . . . . . . . ...65-71

Oophorectomy arrd salplngo-cmphorectomy. . . . ...85.3-65.6

Bilateral destruction or rxckrsbn of fallopian tubes. . .66.2-66.3

Hysterectomy . . . . . . . . . . . . . . . . . . . . . . . ...66.3-68.7

Dilatbn and curettage of uterus . . . . . . . . . . . . . . . ...69.0

Repair of cysbcele and rectocele. . . . . . . . . . . . . . ...70.5

Obstetrical procedures . . . . . . . . . . . . . . . . . . . . . ...72-75

Episbtomy with or without forceps or vacuum

extractbn . . . . . . . . . . . . . . . .72.1,72.21,72.31,72.71,73,6

Cesareansectbn. . . . . . . . . . . . . . . . .74.&74.2,74.4,74.99

Repalrot current obstetric laceratbn. . . . . . . . . ...75.5-75.6

Operafbns on the musculoskeletal system . . . . . . . . ...76-64

Open reduction of fracture except

Jaw . . . . . . . . . . . . . . . . . . . . .76.79,79.2-79.3,79.5-79.6

Ofher reduction of fracture except

Jaw. . . . . . . . . . . . . . . . . . . . .76.70,76.78.79.0-79.1,79.4

Excisbn or destrucfbn of Inteweflelml disc end spinal

fusbn . . . . . . . . . . . . . . . . . . . . . . . . . . . ...80.5.81.0

Arthropiasty and replacement of knee . . . . . . . . .81.41 +1.47

Arthroplasty and replacement of hip. . . . . . . . . . . .81.5+31.6

Operations on muscles, tendons, fascia. and

burst . . . . . . . . . . . . . . . . . . . . . . ...62-83.1.63.3-63.9

Opera!bns on the integumentary system. . . . . . . . . . . . M-66

Mastectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . ...65.4

Excision or destruction of Iesbn or tissue of skin or

subcutaneous tissue . . . . . . . . . . . . . . . . . . ...662-66.4

Skin graft (except lip or mouth). . . . . . . . . . . . ...66.543.7

Miscellaneous diagnostic and therapeutic procedures . ...87-99

(Xmputertzed axial tomography .87.03,87.41 ,87.71,&3.01,66.38

Pyelogfam . . . . . . . . . . . . . . . . . . . . . . . . . .87.7347.75

Nterbgraphy and anglocefcibgraphy Using CIXWSCI

materiel . . . . . . . . . . . . . . . . . . . . . . . . . . ...66.4-66.5

Diagnostic ultrasound . . . . . . . . . . . . . . . . . . . . . ...86.7

Circulatory monflorlng . . . . . . . . . . . . . . . . . . . . . ...89.6

Radioisotope scan . . . . . . . . . . . . . . . . . . . . . ..92.&92.l

39,192

696

353

111

547

113

106

196

620

97

213

991

145

3,626

227

353

930

291

392

5,257

127

292

273

74

497

m

296

1,706

833

356

2,501

451

406

578

279

136

6,042

1,660

933

690

3,143

456

183

340

204

206

ws

1,475

124

531

148

10,654

1,613

324

1,624

1,562

846

704

15,735

467

183

31

243

40

35

loe

436

56

94

561

64

2,220

160

270

598

165

1%?

2,277

66

123

63

147

42

132

261

51

1,018

424

633

356

. . .

. . .

. . .

. . .

. . .

. . .

. . .

,..

. . .

. . .

1,648

235

101

206

95

66

181

639

●

291

91

5,262

775

191

e95

599

430

315

Number of atl-listad procedures In thousands

23,457

429

171

79

304

73

71

66

285

39

119

433

61

1,406

67

63

332

125

200

2,961

59

170

119

126

32

365

29

245

68s

164

. . .

. . .

2,501

451

406

57/3

279

136

6,042

1,6W

933

6S0

1,496

221

62

134

102

140

124

236

123

24+

56

5,593

133

629

863

415

3eo

2,050

216

154

●

33

●

●

107

220

●6

135

69

22

169

●

20

●

24

233

6

●7

●

56

●

*

36

●4

48

9

60

. . .

10

●

●

●

16

●6

●

●

203

32

44

●4

*

●

36

105

●

37

21

544

60

9

20

97

32

17

15,520

279

79

43

80

*

●

46

372

66

75

leo

28

422

18

15

93

8

91

1,544

23

3$

26

182

28

191

70

146

398

98

54

●

1,773

246

$’?

34

6,024

1,674

931

1,325

185

62

178

78

10

140

537

14

194

51

2,342

374

122

189

476

127

124

8,939

200

48

39

126

22

18

25

135

18

●

2el

36

1,358

117

167

432

56

106

1,335

36

81

50

2e

31

150

66

66

426

139

128

67

516

165

●

168

40

54

●

*

●

*

747

6.2

24

110

34

36

81

393

51

124

31

3,112

80

734

348

217

215

12,682

ml

72

26

308

85

67

19

94

●6

*

441

57

1,676

92

170

365

223

172

2,145

60

169

124

24

15

155

98

79

833

343

400

2eo

202

39

. . .

50

16

49

. . .

. . .

. . .

. . .

866

157

53

48

Iz

48

440

5a

177

44

4.856

771

102

680

641

469

348
—8 Advance Data

Table 8. Rate of all-listed procedures for inpatients discharged from short-stay hospitals, by procedure category, sex, and agr%

United States, 1988

[Dlscriarges from non-Federal hospifats. Excludes newborn Infants. Procedure groupings and code number Inclusions are based on the /rrterna@re/ C/assh7k?aWr of

Diseases, Wr Revisbn, Clinh?alWxWiitim (ICD+-CM)]

sax Age

Under 15 15-44 45-64 65 years

Procedure ca!egoiy and ICD-%CM code Total Male Female yew years yeara and over

Rate of all-listed procedures per 100,000 population

Allproceduras . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Operahons on the nervous system. . . . . , . . . . . . . . ...01-05

Spmaliap . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...03.31

Operations on the endocrine system . . . . . . . . . . . . ...06-07

Operallons on theeye . . . . . . . . . . . . . . . . . . . . . . ..W16

Ex!ractlons of lens . . . . . . . . . . . . . .,......,.13.1-13.6

Inseriion of prosthetw lens (pseuciophekos). . . . . . . . ...13.7

Operations ontheesr . . . . . . . . . . . . . . . . . . . . . . ..l&2o

Operations on the nose, mouth, and pharynx. . . . . . . ...21-29

Rhmoplastyand repalrof nose. . . . . . . . . . . , . . . . ...21.8

Tonsillectomy wtth or without adenoidactomy. . . . . .2&2-28.3

Operations on the respiratory system. . . . . . . . . . . . ...30-34

Bronchoscopy . . . . . . . . . . . . . . . . . . . . . . . .33.21 -33.23

Operations on the cardomeculer system . . . . . . . . . ...35-39

Removal of coronary attery ObStNctlon . , . . . . . . . . . ..36.0

Dlrecl heart revescularizefkm . . . . . . . . . . . . . . . . . . ..36.1

CardMc catheterization. . . . . . . . . . . . . . . . . . .37.21 +7.23

Pacemaker insertion, replacement, removal, repair. . .37.7-37.6

Operations on the heroic and Iymphattc system ., . . . . ..40-41

Operations on the digasltve system . . . . . . . . . . , . . ...42-54

Esophagoscopy and gastroscopy (natural orifbe) . .42.23,44 .13

Partial gastreofomy and raeecfiin of

inteSline. . . . . . . . . . . . . . . . . . . . . .43.5+3.6, 45,6+5.8

Endoscopy of large Intestine (natural orifice) . . . . . . ...45.24

Appendectomy, excluding lnckfentaJ . . . . . . . . . . . . . . .47.o

Hemorrhoidectomy. . . . . . . . . . . . . . . . . . . . .49.43-49.46

Cholecystectomy . . . . . . . . . . . . . . . . . . . . . . . . ...51.2

Repalro fingumath Ella. . . . . . . . . . . . . . . . . ..53.W.l

Dtision ofpertloneat adhesions, . . . . . . . . . . . . . . ...54.4

Operations ontheurlnarysyslem . . . . . . . . . . . . . . ...55-59

Endoscopies (naturatorlfiie) . . .55.21 -55.22,56.31,57.32,58.22

0peratk3ns onthemale genlf.alorg.sns. . . . . . . . . . . ...60-64

Prostatectomy . . . . . . . . . . . . . . . . . . . . . . . ...60.2-80.6

Operations onthefemale genitat organs. . . . . . . . . . . .65-71

OopfIorectomy andsalping@oophoraotomy. . . . . . .65,3-65.6

Bilateral destruction orocclusbn of fallcfxantubas. . .66.2-66.3

Hysterectomy . . . . . . . . . . . . . . . . . . . . . . . . ..6s3.3-68.7

Dilation andcuretfage ofulerus. ., . . . . . . . . .. ’.....69.0

Repair ofoystocele andrectocele . . . . . . . . . . . . . . . ..7O.5

Obstefricd proceduree . . . . . . . . . . . . . . . . . . . . . ...72-75

Episiotomy with or wiihouf forceps or vacuum

extraction . . . . . . . . . . . . . . . .72.1,72.21,72.31,72.71,73.6

Cesareanseclbn. . . . . . . . . . . . . . . . .74.&74.2.74.4,74.99

Repalrof current obstetric laceratbn. ., . . . . . . ...75.5-75.6

Operatmns onthemusculoskeletal system . . . . . . . . . . .76-S4

Open reducfion of fracture axcepl

jaw . . . . . . . . . . . . . . .76,79,79.2-79.3,79.5-79.6

Other reduction of fracture except

jaw . . . . . . . . . . . . . . . . . . . . .76.70,76.78,79.0-79.1,79.4

Excision or destruction of intervertebral dsc and spinet

fuskJn . . . . . . . . . . . . . . . . . . . . . . . . . . . ...80.5.61.0

Arthroplasty andreplacement of knee. . . . . . . . .81.41 +1.47

Arfhroplasty anclreplacement ofhlp. . . . . . . . . ...81.5-81.6

Operations on muscles, Iendons, fascia, and

bursar . . . . . . . . . . . . . . . . . . . . . . . .8%83.1.83.3-83.9

Operations ontheintegumentary system. . . . . . . . . . . . ,85-66

Mastectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . ...65.4

EXCISIOnor destruction of Iesbn or Iiesue of skin or

$Ilbculaneous tssue, . , . , . . . . . . . . . . . , . . .M.2A8.4

Skin graft (except lipormouth). ., , . . . . . . . . . . .66. S-86.7

Mscellaneous diagnostic andtherapeutb procedures . ...87-99

Computenzeda xialtomography .87.03,87.41,87.71,68.01,88.36

Pyebgram, . . . . . . . . . . . . . . . . . . . . . . . . .87.73-87 .75

Artenography and anglocardiography using contrast

material . . . . . . . . . . . . . . . . . . . . . . . . . . ...88.4-86.5

Dlagnosfic ultrasound . . . . . . . . . . ., . . . . . . . . . ...88.7

Circulatory monilormg . . . . . . . . . . . . . . . . . . . . . ...89.6

Radioisotope scan . . . . . . . . . . . . . . . . . . . . . ..92. G92.1

16,054.0

367.0

144.8

45.3

224.0

46.4

43.5

80,9

336.0

39.7

87.3

406.0

59.3

1,485.2

92.6

144.6

380.9

119.2

160,7

2,153.5

52.2

119.7

.82.7

111.9

30.5

203.6

116.7

121.2

698.7

240.6

250.2

146.5

1,024.6

164.7

166.3

236.9

114.4

55.7

2,474.9

888.3

382.3

262.8

1,287.6

186.7

74.9

139.1

83.5

84.6

124.9

604.1

50.6

217.6

60.5

4,446.2

660.6

132.7

665.2

639.8

346.3

286.5

13,309.3

395.4

154.6

26.5

205.4

34.0

29.7

92.3

366.4

49,1

79.3

474.5

70.8

1,677.8

135.3

228.1

505.6

139.9

162.7

1,925.6

57.7

103.7

69.9

124.0

35.7

111.4

220.4

43.1

861.0

358.5

535.2

302.4

. . .

. . .

,..

. . .

. . .

. . .

. . .

. ..

. ..

1,393.7

199.0

65.8

173.8

80.3

55.9

153.1

540.2

●

245.8

77.3

4,450.6

655.5

161.6

841.3

506.5

363.8

266.2

16,631.2

340.4

135.6

63.0

241.4

58.0

56.6

70.2

305.7

30.8

94.8

341.6

48.4

1,116.6

52.9

86.2

263.8

99.6

158.8

2,357.5

47.1

134.7

94.7

100.4

25.6

290.1

23.2

194,5

546.3

130.4

. . .

. . .

1,986.7

358.1

322.5

459.4

221.8

108.0

4,708.6

1,334.7

741.4

548.3

7,767.9

175.2

64.8

108.5

86.6

111.5

98.3

664.1

97.3

191.1

44.8

4,442.1

665.3

105,5

499.7

764,9

329.9

309.4

3,660.0

407.4

290.8

●

61.3

●

*

201.2

413.5

*11 .2

254.4

130.3

41.2

319.0

●

37.0

●

45.5

437.8

15.8

●12.4

●

109.1

●

*

68.2

●7. 1

91.1

16.2

94.9

. . .

18.5

●

●

●

29.5

●1O.4

●

●

382.9

60.0

83.0

●7.3

●

●

68.5

197.1

●

69.5

38.8

1,024.8

151.4

17.5

36.4

181.6

61.0

32.6

13,532.0

243.0

69.2

37.4

70.0

*

*

40.4

324.5

58.9

65.6

165.5

24.2

367.9

15.4

13.2

81.5

7.4

79.1

1,346.3

20.3

31.0

23.1

141.4

24.4

166.2

61.3

127.6

346.9

85,2

47.4

●

1,546.2

214.2

352.1

296.4

193.2

29.3

5,252.3

1,459.5

811.7

599.6

1,155.0

161.0

54.3

155.3

68.2

8.6

121.8

468.0

12.3

166.6

44.8

2,042.0

325.7

106.8

165.0

415.0

110.7

106.1

f 9,453.4

435.6

104.0

85.9

274.0

47.4

40.0

54.8

293.5

36.1

●

632.5

81.7

2,956.0

255.0

362.7

940.5

127.2

229.6

2,905.5

78.1

176,6

109.1

63.3

66.2

326.5

186.5

144.2

928.0

301.8

278.5

146.7

1,122.6

359.3

●

410.0

67.6

116.6

●

●

●

●

1,625.6

177.9

52.2

239.5

74.0

62.9

176.2

654.9

112.0

269.5

66.1

6,772.0

643,8

195.8

1,597.9

758.3

471.7

468.6

41,761.8

661.2

236.6

64.2

1,014.4

279.3

265.9

63.2

30s.4

*19. O

*

1,453.6

169.2

5,519.6

302.0

558.6

1,266.3

733.1

565.9

7,065,1

197.1

555.8

409.0

78.2

49.7

509.5

321.3

261.6

2,743.3

1,129.4

1,316,9

953.9

665.6

128.3

!..

164.7

53,9

160,1

. . .

. . .

. . .

,..

2,656.8

518.6

173.3

156.7

295.5

51!3.2

157.3

1,450.2

19:LI

5&~.4

146.4

15,99’1.1

2,5313.6

336.6

2,238.8

2,110,3

1,545.8

1,144.6
Advance Data 9

Technical Notes

Survey methodology

Source of data

The National Hospital Discharge

Survey covers discharges from

noninstitutional hospitals, exclusive of

Federal, military, and Veterans

Administrative hospitals, located in the

50 states and the District of Columbia.

Only short-stay hospitals (hospitals

with an average length of stay for all

patients of less than 30 days) or those

whose specialty is general (medical or

surgical) or children’s general are

included in the survey. These hospitals

must also have six or more beds

staffed for patient use.

Beginning with 1988, the NHDS

sampling frame consists of hospitals

Table L Approximate relative standard errors of estimated numbers of discharges and

diagnoses: United States, 1988

lJnfMr 15 .41

s&e Ofesthate pSIS of age other ages

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5000 M. . . . . . . . . . . . . . . . . . . . . . . . . . . .

100,030. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

500,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

l,ocmOO .. . . . . . . . . . . . . . . . . . . . . . . . . . .

3,000,00Q. . . . . . . . . . . . . . . . . . . . . . . . . . . .

5,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Io,ooo,ooo . . . . . . . . . . . . . . . . . . . . . . . . . .

20,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . .

30,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . .

40,0m300 . . . . . . . . . . . . . . . . . . . . . . . . . . .

302

32.8

14.3

12.8

11.5

11.4

11.3

. . .

. . .

. ..

. . .

28.7

20.5

9.8

7.5

4.9

4.5

4.2

4.1

4.0

4.0

4.0

4.0

Table IL Approximate relatfve standard errors of estimated numbers of all listed

procedures: United States, 1988

Urrdw 15 .4/1

Ske ofasthnate yams of age other ages

5,0Q0.. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Io,ooo . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Wm300...... . . . . . . . . . . . . . . . . . . . . .

500,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . .

3,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . . .

5,0cmoo .. . . . . . . . . . . . . . . . . . . . . . . . . . .

10,OOO,WO. . . . . . . . . . . . . . . . . . . . . . . . . . .

20,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . .

30,000,C00. . . . . . . . . . . . . . . . . . . . . . . . . . .

40,000,000. . . . . . . . . . . . . . . . . . . . . . . . . . .

33.0

24.7

14.9

13.2

11.7

11.5

11.3

. . .

. . .

. . .

. ..

. . .

30.4

21.8

10.9

8.6

6.2

R

5.5

5.5

5.5

5.5

5.5

thatwere listedin theApri11987

SMGHospital Market Tape (3),met

the above criteria, and began

accepting patients by August 1987.

For 1988, thesamp1e cxmsistedof542

hospitals. 0fthe542 hospitals, ll

were foundto beout ofscope

(ineligible) because they went out of

business orotherwise failed tomeet

the criteria for the NHDS universe. Of

the 531 in-scope (eligible) hospitals,

422 respondedto the survey.

Sampledesignand data collection

The NCHS hasconducted the

NHDScontinuously 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 certain~ 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 (1).

Beginning in 1988, the NHIX

sample includes with certainty all

hospitals with 1,000 or more beds or

40,000 or more discharges annually.

The remaining sample of hospitals is

based on a stratified three-stage

design. The fwst stage consists of

selection of 112 primary sampling

units (PSU’S) that comprise a

probability subsample of PSU’S used

in the 1985–94Nationa1 Health

Interview Survey. The second stage

consists of 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 cdection 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 37 percent of the

respondent hospitals in 1988, that

involved the purchase of data tapes

from abstracting service organizations.

In the manual system, the sample

selection and the transcription of

information from the hospital records

to abstract forms were performed at

the hospitals. The completed forms,

aIong with sample selection control

sheets, were forwarded to NCHS for

coding, editing, and weighting. A few

of these hospitals submitted their data

via computer printout or tape. Of the

hospitals using the manual system in

1988, about two-thirds had the work

performed by their own medical

records staff. In the remaining

hospitals using the manual 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 machinereadable medical record data from

abstracting service organizations.
10 Advance Data

Records were systematically sampled

by NCHS.

The medical abstract form and the

abstract service data tapes contain

items relating to the personal

characteristics of the patient, including

birth date, se% race, and marital status

but not 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.

Since 1977, patient ZIP, Code

expected source of payment, and dates

of surgery have also been collected.

(The medical record number and

patient ZIP Code are confidential

information and are not available to

the public.)

Presentation of estimates

The selection of estimates for

publication is based on the relative

standard error of the estimate and the

number of sample records on which

the estimate is based (referred to as

the sample size). Based on

consideration of the complex sample

design of the NHDS, the following

guidelines are used for presenting the

NHDS estimatex

. If the sample size is less than 30,

the value of the estimate is not

report ed. Only an asterisk (*) is

shown in the tables.

. If the sample size is 30-59, the

value of the estimate is rep&ted

but should not be assumed to be

reliable. The estimate is preceded

by an asterisk (*) in the tables.

. If the sample size is 60 or more

but the approximate relative

standard error is over 30 percent,

the estimate is reported but

should not be assumed to be

reliable. The estimate is preceded

by an asterisk (*) in the tables.

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 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 SESUDMN

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

approach it uses has been published

(4).

Table I provides the estimate of

sampling variability for discharges and

first-listed diagnoses for patients under

15 years of age and all other variables.

Table II provides the estimates of

sampling variability by all-listed

procedures for patients under 15 years

of age and all other variables.

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”

ancl “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

cnmpared. 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.

Definition of terms

Terms relating to hospitals and

hospitalization

Hospital—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 NHDS, except

Federal hospitals and hospital units of

institutions. Hospitals must have six

beds or more staffed for patient use.

Patient-A person who is formally

admitted to the inpatient service of a

short-stay hospital for observation,,

care, diagnosis, or treatment. In thlis

report, patients refers to the number

of discharges during the year,

including any multiple discharges of

the same individual from one or more

short-stay hospitals. Infants admitted

on the day of birth, directly or by

transfer from another medical facility,

with or without mention of disease,

disorder, or immaturity, are included.

All newborn infants, defined as those

admitted by birth to the hospital, are

excluded from this report. The tenrns

“patient” and “inpatient” are used

synonymously.

Di.rcbge-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.

Di.rchqe rate—The ratio of the

number of hospital discharges during

the year to the number of persons in

the civilian population on July 1 of

that year.

Dqys of care-The total number of

patient days accumulated at time alf

discharge by patients discharged from

short-stay hospitals during a year. 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.

Average length of stq–The total

number of days of care accumulated

at time of discharge by patients

discharged during the year, dividedl by

the number of patients discharged.
Advance Data 11

Terms relating to diagnoses and

procedures

Dischqge diagnoses-One or

more diseases or injuries (or some

factor that influences health status and

contact with health services that is not

itself a current illness or injury) listed

by the attending physician on the

medical reeord of a patient. In the

NHDS, discharge (or final) diagnoses

listed on the face sheet (summary

sheet) of the medical recmd are

transcribed in the order listed. Each

sample discharge is assigned a

maximum of seven five-digit codes

according to ICD–9–CM (2).

principal diagnosis-The cmdition

established after study to be chiefly

responsible for occasioning the

admission of the patient to the

hospital for care.

First-1isted diagnosis-The coded

diagnosis identified as the principal

diagnosis or listed first on the face

sheet of the medical reeord if the

principal diagnosis cannot be

identified. The number of first-listed

diagnoses is equivalent to the number

of discharges.

Procedure-One or more surgical

or nonsurgical operations, procedures,

or special treatments listed by the

physician on the medical record. In Region States included

~he NHDS, all terms listed on the face

sheet (summary sheet) of the medical

record under the caption “operation,”

“operative procedures,” “operations

and/or special treatment,” and the like

are transcribed in the order listed. A

maximum of four procedures are

coded.

Rate of procedures—The ratio of

the number of all-listed procedures

during a year to the number of

persons in the civilian population on

July 1 of that year determines the rate

of procedures.

Demographic terms

Age–Refers to the age of the

patient on the birthday prior to

admission to the hospital inpatient

service.

Population —Civilian population is

the resident population, excluding

members of the Armed Forces.

Geographic re~”on—Hospitals are

classified by Ioeation in one of the

four geographic regions of the United

States eorresponding to those used by

the U.S. Bureau of the Census:

Northeast . . . .Maine, New Hampshire,

Vermont,

Massachusetts, Rhode

Island, Connecticut,

New York, New Jersey,

Pennsylvania

Midwest . . . . . .Michigan, Ohio, Illinois,

South. . . . .

Indiana, Wisconsin,

Minnesota, Iowa,

hfissouri, North

Dakota, South Dakota,

Nebraska, Kansas

.Delaware, Maryland,

District of Columbia,

Virginia, West Virginia,

North Carolina, South

Carolina, Georgia,

Florida, Kentuc@,

Tennessee, Alabama,

Mississippi, &kansas,

Louisiana, Oklahoma,

Texas

West . . . . . . . .Montana, Idaho,

Wyoming, Colorado,

New Mexico, Arizona,

Utah, Nevada,

Washington, Oregon,

California, Haw7aii,

AIaska
12 Advance Data

Recent Issues of Advance Data From Vital and Health Statistics

No. 184. Use of Family Planning No. 182. Contraceptive Use in the No. MO. Characteristics of Persons

Services in the United States: 1982 United States, 1973-88 (March 23, Dying From Cerebrovascular Diseases

and 1988 (April 13, 1990) 1990) (February 8, 1990)

No. 183. AIDS Knowledge and No. ltll. Adoption in the 1980’s No. 179. AIDS Knowledge and

Attitudes for July-September 1989 (January 5, 1990) Attitudes for April-June 1989

(March 8, 1990) (November 1, 1989)

Suggested citation

Graves EJ. 1988 Summary ;ational Hosp”til

Discharge Survey. Advance data from vital and

health stati.%icq no 185. Hyattsviile, Maryland:

Nationai Center for Heaith Statistics. 1990.

Copyright information

~“is report maybe reprinted without further

permission.
Number 186 . June 25, 1990

Advance

Data

From Vital and Health Statistics of the National Center for Health Statistics

AIDSKnowledge and Attitudesfor October-December 1989

Provisional Data From the National Health Interview Survey

by Ann M. Hardy, Dr.P.H., Division of Health Interview Statistics

Introduction

The National Center for Health

Statistics (NCHS) has included a

special set of supplemental questions

on the adult population’s knowledge

and attitudes about acquired

immunodeficiency syndrome (AIDS)

in the National Health Interview

Survey (NHIS). The first AIDS

Knowledge and Attitudes Survey was

in the field from August through

December 1987. Provisional results of

that survey were published on a

monthly basis in Adwmce Data From

Wzl and Health Statistics (Nos. 146,

148, 150, 151, and 153). A public use

data tape containing the information

collected in 1987 is available from

NCHS.

During the first 4 months of 1988,

the NHIS AIDS questionnaire was

revised to meet current program needs

for information about AIDS

awareness. The revised AIDS

Knowledge and Attitudes Survey

entered the field in May 1988.

Provisional findings for the remainder

of 1988 were published periodically

Advance Data Fi-oIn VW and Health

Statistics Nos. 160, 161, 163, 164, 167,

and 175); in addition, two special

reports focusing on minority

populations were published from the

1988 data Advance Data From V7tal

and Health Statistics Nos. 165 and

166). A public use data tape of the

1988 AIDS Knowledge and Attitudes

Survey is also now available. The

NHIS AIDS questionnaire used in

1988 was continued throughout 1989.

Reports based on the 1989 data are

being issued on a quarterly basis. This

report presents provisional data for

the period October-December 1989.

The Advance Data reports

describing the NHIS AIDS data have

been restricted to simple descriptive

statistics to facilitate their timely

release. Thus, these reports do not

attempt to explain or interpret

differences among population

subgroups or to examine relationships

among various measures of knowledge

and AIDS-related behavior (e.g.,

testing). The NHIS AIDS data bases

permit more complex analyses than

those presented in this series of

Advance Data reports, and such

analyses are being undertaken by

various groups in the Public Health

Service.

The AIDS questionnaires were

designed to estimate public knowledge

about AIDS virus (HIV) transmission

and its prevention. These data are

needed to plan and develop AIDS

educational campaigns and to monitor

major educational efforts, for example,

the series of radio and television

public service announcements entitled

“America Responds to AIDS” and the

brochure “Understanding ATDS,”

both developed by the Centers for

Disease Control.

The NHIS AIDS questionnaires

were developed by the National

Center for Health Statistics and

interagency working groups

established by the Information,

Education, and Risk Factor Reduction

Subcommittee of the Public Health

Service Executive Task Force on

AIDS. The working groups included

representatives from the Centers for

Disease Control; the National

Institutes of Health; the Alcohol,

Drug Abuse and Mental Health

Administration; and the Health

Resources and Services

Administration.

The current AIDS questionnaire

includes items on sources of AIDS

$Hwlcf~ # f,= *.* $

7 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

* Public Health Service

~

4 Centers for Disease Control

2 National Center for Health Statistics

%

%.

>

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

%+P,J30
2 Advance Data

information; self-assessed levels of

AIDS knowledge; basic facts about the

AIDS virus (HIV) and how it is

transmitted; blood donation

experience; awareness of and

experience with the blood test for

HIV, personal acquaintance with

persons with AIDS or HIV; and

willingness to take part in a proposed

national seroprevalence survey. A

general risk behavior question, similar

to that asked by the Red Cross of

potential blood donors, is also

included.

This report presents provisional

data for October-December 1989 for

most items included in the AIDS

questionnaire. Table 1 displays percent

distributions of persons 18 years of

age and over by response categories

according to age, sex, race, and

education. In most cases, the actual

questions asked of the respondents are

reproduced verbatim in table 1 along

with the coded response categories. In

a few cases, questions or response

categories have been rephrased or

combined for clearer or more concise

presentation of results. Refusals and

other nonresponse categories

(generally comprising 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 questionnaire

uses the phrase “the AIDS virus”

rather than “HIV,” because it was felt

that the general population might not

be familiar with the more scientific

terminology at the time the survey

began. In this report, the two terms

are used synonymously.

Selected findings

The following highlights describe

various aspects of AIDS knowledge

and attitudes as observed in the

October-December 1989 data from

the NHIS AIDS survey. Unless

otherwise noted in the text, all

measures described remained stable

over this 3-month period. Any

differences cited in the text are

statistically significant at the .05 level

(see table II for provisional standard

errors of estimates).

Sources of AIDS information –The

proportion of adults 18 years of age

and over who report ed having seen or

heard public service announcements

(PSA’S) about AIDS on television or

on the radio in the month before the

NHIS interview (80 percent and

45 percent, respectively) remained

stable throughout 1989. For both, the

proportion who had seen or heard

these announcements increased with

years of education. Black adults were

more likely than white adults to report

having heard radio PSA’S (51 percent

compared with 44 percent), a

difference which has been noted since

the question was introduced in 1988.

As in previous months, approximately

one quarter of those who had seen or

heard these announcements recalled

that they were part of the “America

Responds to AIDS” series.

Twenty-one percent of adults

reported that they had read AIDS

brochures or pamphlets in the

previous month. This figure also

remained essentially unchanged

throughout 1989, but is much lower

than the 52 percent figure recorded in

June and July 1988, coincident with

the national mailout of the

“Understanding AIDS” brochure. The

proportion who reported ever having

read brochures or pamphlets

(61 percent) was similar to figures

reported for previous months. Black

adults were more likely than white

adults to report having read brochures

in the previous month (29 percent

compared with 19 percent), However,

the proportion who reported ever

having read AIDS brochures was

essentially the same in both racial

groups. Proportions having read

brochures in either time period

increased with educational attainment;

females were more likely than males

to have read this type of information.

Sixty-two percent of parents with

children between the ages of 10 and

17 years said they had ever discussed

AIDS with them and 63 percent said

their children in this age group had

received instruction about AIDS in

school. In addition, 61 percent of all

adults had ever discussed AIDS with a

friend or relative. All of these figures

were higher for females than males

and increased with increasing years of

education. All figures remained

essentially unchanged throughout

1989.

Selj-assessed knowledge—Levels of

self-assessed knowledge about AIDS

among adults did not change in 1989

with 68 percent of the adult population

claiming to know at least something

about AIDS and the remainder stating

that they knew little or nothing. While

similar proportions of black and white

adults said they knew a lot about

AIDS (23 percent and 25 percent,

respectively), a higher proportion of

black adults than white adults claimed

they knew little or nothing (41 percent

compared with 30 percent). Other

groups with a high proportion claiming

little or no knowledge about AIDS

included those with less than 12 years

of education (50 percent) and those

50 years of age and over (49 percent).

General knowledge–The

responses to most of the questions

dealing with general AIDS knowledge

remained unchanged during 1989.

Knowledge about the three major

modes of HIV transmission (sexual,

through sharing contaminated needles

for drug use, and from mother to baby

during pregnancy), remained high in

all demographic subgroups examined,

The proportion who said it was

definitely true that a pregnant wc]man

with the AIDS virus could give it to

her baby increased slightly from

81 percent in October and November

1989 to 84 percent in December 1989.

There were also slight increases

between the first and last quarters of

1989 in the proportion of adults who

felt it was definitely true that a person

can be infected with the AIDS virus

and not have the disease AIDS (from

55 percent in quarter 1 to 58 percent

in quarter 4) and in the proportion

who stated it was definitely true that a

person with the AIDS virus can IIook

and feel healthy (from 48 percent to

51 percent).

As in previous months, general

AIDS knowledge increased by

education and was higher for those

under 50 years of age than for those

50 years and over. There also

remained racial differentials seen in

previous months with white adults

giving the correct definitive response

more often than blacks. However, in
most instances, this differential was

10 percentage points or less.

Mispexeptions about HIV

transmrkrion—Responses to most

questions dealing with the possibility

of HIV transmission by casual contact

showed a slight increase in correct

perceptions about this type of

transmission from December 1988 to

the fourth quarter of 1989. For these

questions, the proportion of adults

who thought it very unlikely or

definitely not possible to spread HIV

through casual contact increased by 3

to 5 percentage points (see figure 1).

The two questions showing the largest

increase dealt with the likelihood of

transmission by shaking hands,

touching or kissing on the cheek

someone with the AIDS virus and by

attending school with a child who has

AIDS. These improvements were

noted in most demographic subgroups

examined with slightly larger increases

for black adults and those with less

Blood donation and testing—In

October-December 1989, as in

previous months, 40 percent of adults

reported ever having donated blood

including 16 percent who donated

blood since March 1985 when routine

screening for HIV antibodies began,

and 7 percent who reported donating

blood in the 12 months before

interview. AISOunchanged throughout

1989 was the proportion who said they

had heard of the blood test for the

AIDS virus (74 percent). This

proportion remained lower among

black adults (66 percent) compared

with white adults (76 percent), among

those 50 years of age or over

(61 percent) compared with those who

were younger (82 percent), and among

those with less than a high school

education (55 percent) mmpared with

those with at least a high school

education (79 percent). Sixty-five

percent of adults believed that blood

donations are routinely tested for HIV

Advance Data 3

transfusion. Again, these figures have

remained stable for many months.

In October-December 1989,

21 percent of adults indicated that they

had been tested for the AIDS virus

infection. As in the past, the majority

of those who were tested had their

testing done as part of a blood

donation (67 percent), 19 percent

sought testing voluntarily, and

17 percent were tested as part of

another activity which required routine

testing (such as a physical examination

for military induction). The percent

who have been tested has been rising

steadily since May 1988 when the

figure was 16 percent. Increases in the

proportion who have been tested were

noted during 1989 for five subgroupx

those 18-29 years of age (from

26 percent in quarter 1 to 30 percent

in quarter 4), maIes (from 22 to

26 percent), white adults (from 19 to

22 percent), black adults (from 15 to

20 percent), and those with more than

than 12 years of education. antibodies and 49 per&nt felt the 12 ~ears of-education (from 26 to

present blood supply was safe for 30 percent). Seven percent of adults

❑ ❞❞✎❞✌❇❞ ❑ OC!Ober-Oem-nbef 19S9

Lwing near a hospital or twine for AIDS patienls Using publii toilets

::::fi:::j..>:.fi.>:.>):.::.. .. . .... ... .. .. . ... .... . . .

. ................ . . ..... .... .. ... ...-... ....... ......... .... ...........

....................................................>......)x.* ....)..\wfi?..... ...WX+. W,. >..W..} 3:3:.:.

........%..+............:.:.:.:.:.:...%%. .... . .. ... .. .... .. ... . . ..............................,. ., ..,,.,.,, . ...... ... ... .............................................. . ..............................,..... ....,,.,.,.,..

Mending school with a child who has the AIDS virus Eating in a restaurant where the soak has the AIDS virus

.>};.:.:.:..>: Y..:.:.:x.>:w..>%:.x.:.x.:.:.:.:.:. x :.:::.3:.mx.x...........................V.:.:

........................................................................

~

‘“ ‘“.”””:.’””:’”’.””’”47

................. .................. .;.,.,,.,,,,,, ::,:::.:;::. 51 ..................... ............... .... ............................... .... ...

Shaking hands, touching, or kissing on the cheek someone Sharing plates, forks, or giassas with swneorre who has the

who has lhe AIDS virus AIDS VitUS

....x .......x..................................................................

Working near someone with the AIDS virus Being coughed or sneezed on by somecme who has the AIDS virus

.,.......... . ......................

.:,W:?+X...3 :+:,:,:+x,:.::.>W:.>3, ...................

::::w:::::::::.:::.::::..:::.:.:.::,::::~;::::.:::.:::

I 1 I I I

I I

I I I I J

20 40 m so loa 20 40 60 80 T&l

Percent Percent

Figure 1. Provisional estimates of percent of adults who thought It very unlikely or definitely not possibie to become infected with HIV h

selected ways, December 1988 and October-December 1989
4 Advance Data

interviewed in October-December

1989 indicated that they expected to

be tested for the AIDS virus infection

in the next 12 months; this figure also

remained stable during 1989.

Preventive measures-h the fourth

quarter of 1989, 86 percent of adults

felt that using condoms were

somewhat or very effective in

preventing HIV transmission through

sexual activity. The perception that

this prevention method was at least

somewhat effective was high in all

sociodemographic subgroups

(71 percent or greater). These figures

remained essentially the same during

1989. A monogamous relationship

between two uninfected people was

viewed as a very effective method of

prevention by the majority of adults in

all subgroups (74 percent or more).

While the overall proportion who

stat ed that monogamy was very

effective remained stable throughout

1989, the proportion rose among black

adults from 70 percent in quarter 1 to

79 percent in quarter 4.

R&k of getting HIV-During

October-December 1989, 83 percent

of adults felt that they had no chance

of having HIV infection and

77 percent felt they had no chance of

getting HIV infeetion. Both of these

proportions remained unchanged from

previous months. For both, females

were more likely than males to report

no chance of having or getting HIV.

Those 50 years of age and over and

those with 12 or fewer years of

education were also more likely to

report no chance of infection than

younger arid more educated persons.

AS in previous months, a small percent

of adults (2 percent) reported

belonging to one or more of the

groups with behaviors associated with

increased risk of AIDS (e.g.,

intravenous drug users and

homosmally active men).

K%owingsomeone w“thAIDS or

HIV infection —Fourteen percent of

U.S. adults interviewed during

October-Deeember 1989 reported

knowing someone with AIDS or HIV.

This percentage has increased steadily

since the survey began in August

1987. Increases in the proportion who

reported knowing someone with AIDS

were noted for several groups in 1989:

those 18-29 years of age (from 11 to

14 percent), females (from 12 to

15 percent), white adults (from 11 to

14 percent), black adults (from 13 to

17 percent), and those with more than

12 years of education (from 17 to

20 percent).

Suggested citation

Hardy AM. AIDS knowledge and attitutes for

October-Decembec Provisional data from the

National Health Interview Survey. Advance

data from vital and health statistics; no 186.

Hyattaville, Maryland: National Center for

Health Statistics. 1990.

Copyright information

This report may be reprinted without further

permission.

Symbols

Quantity zero

o Quantity more than zero but less

than 0.05
Advance Data 5

Table 1. Provisional estimates of the percent of persons 18 years of age and over with seiected AIDS knowledge and attitudes from the

1989 National Health Interview Survey, by selected characteristics: United States, October-December 1989

[Data are based on household Intet’VbWe of me civilian nOnlnStlfUt&nSllZ6dpopulailon. The survey design, general quahfkatior!s. and Inforrnatbn on the reliability of

the estimates are given In taohnioal notes]

Age sex Race Educ?tion

1s29 3&49 50 years Lessttran More thm

AIDS knowledge or attflude Tot& years yeas and over Male Female White Black 12yews f2years 72yems

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...100

1.

la

lb.

2.

3.

4.

5.

15.

16.

21.

22.

In the past month, have you—

Seen any public .swWce announcements about AtDS on

television?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Don’l know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Heerd any publlo servke announcements about AtDS on

the raclb?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Were any of those publk service announcements called

““AmerksrResponds to AIDS’?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Don’tkrrow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

Nenherheard noreawanypubtii servlceannouncements. . 17

In the past month, have you read any brochures or pamphlets

about AIDS?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Donlknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Have you ever read any brochures or pamphlets about A!DS?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Where d!d you get the pamphlets or brochures?tg

Clinic, otherthanworl(cllnio . . . . . . . . . . . . . . . . . . . . 3

Dootor’soffioe(HMO) . . . . . . . . . . . . . . . . . . . . . . . . 23

Drugstore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Publiiheatthdepartment . . . . . . . . . . . . . . . . . . . . . . 3

Racemdinmaifwtihoutaskhg. . . . . . . . . . . . . . . . . . 23

RedCross/RadCrossblooddon8tbn . . . . . . . . . . . . . . 3

Otherblooddonatbn . . . . . . . . . . . . . . . . . . . . . . . . .

school . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1:

Sent/phonadfor/raquestedit..... . . . . . . . . . . . . . . . 1

Fedecai/S!ate/localgovernmerrt . . . . . . . . . . . . . . . . . . 12

Wortr, otherthanclinkornume . . . . . . . . . . . . . . . . . . 14

Worlcnurseorcllnk . . . . . . . . . . . . . . . . . . . . . . . . .

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1:

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Have you ev$r discussed AIDS wlh any of your children

aged 10-17?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Don’timow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Haveanyor6Jlof y~urchildranaged 10-17hadlnshuctbn at

schoolaboutAIDS?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Donlknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Howmuchwouldyou sayyouknowabout AtDS?

ADo! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Some . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

Ailttle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

None . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

To the best of your knowledge, Lsthere a dffferenca between

havingtheAtDkvirus andh&Jngtheds&rsa AIDS?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Donlknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

23aAlDScanreduce Ihebody’snaturat protectbnagafnstdLsaase.

Definiletytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

ProbabIytme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Probabtyfatse . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Definttelyfetse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

100

79

19

1

51

46

3

*

12

36

17

24

75

1

69

31

1

5

23

2

4

17

4

1

24

1

7

10

3

19

4

z

42

:;

26

z

3

67

23

0

11

79

12

1

:

too

62

17

2

54)

45

5

26

13

46

15

25

74

1

70

2e

1

3

24

2

2

4

1

11

1

13

18

6

17

4

63

36

0

65

12

23

31

48

19

:

73

17

0

10

83

9

;

5

too

78

20

2

35

61

4

14

13

53

20

13

88

1

45

54

1

2

20

2

2

2

0

4

1

16

11

3

18

8

55

45

60

:

15

:

16

0

55

13

4

64

14

2

4

17

60

18

2

49

47

4

24

14

46

17

19

60

1

66

41

1

2

19

2

3

23

4

1

12

1

13

16

3

19

7

49

51

0

58

:

24

:

:

65

18

0

17

77

11

:

8

IN

60

19

2

41

55

4

25

12

46

18

22

77

1

2

1

2

2

2:

3

1

14

i

12

13

5

17

4

73

27

0

69

;$

24

45

24

;

66

16

0

18

74

11

;

10

100

60

ie

2

44

52

4

24

13

47

17

19

60

1

61

36

1

s

2

2

4

1

13

1

14

14

4

17

6

62

37

0

63

13

24

25

45

23

7

0

66

16

0

16

76

11

:

7

100

79

20

1

51

47

3

31

12

40

17

29

70

1

63

36

1

6

23

4

6

16

2

0

9

1

6

17

6

22

2

61

36

0

69

:

23

:

11

0

55

21

2:

61

12

2

7

18

1(U

71

27

2

33

64

3

22

11

42

25

13

87

1

41

58

1

6

25

2

2:

2

1

8

1

11

6

2

19

6

48

52

0

56

:

;

36

22

0

43

18

0

a

53

16

2

2:

100

62

17

2

45

w

4

25

13

47

16

20

60

1

59

40

1

3

23

2

3

23

3

1

10

1

13

14

3

18

5

61

32

0

63

1!

20

$

5

0

64

19

0

17

76

11

:

8

100

83

16

2

51

45

4

26

14

47

14

26

74

1

74

26

1

2

2

3

24

4

1

16

1

12

16

6

17

5

70

30

67

12

21

35

46

15

2

79

14

0

7

86

9

:

2

Seefcdnoresetend oftable.
6 Advance Data

Table 1. Provisional estimates of the percent of persons 18 years of age and over with selected AIDS knowledge and attitudes from the

1989 National Health Interview Survey, by selected characteristics: United States, October-December 1989-Con.

[Data are based on household intewmm of the ctvfhan nonlnstitutlonelized popUlfdiOn. The survey daslgn, general qualiilcafions, and Information on the reliability of

the estimates are given in Iechmcal notes]

Age sax Race Education

1S29 3&f9 50 yeas Less men More than

AIDS knowledge or attitude Total years years and over Male female White Black 12 years 12 years 12 years

23b. AIDS is aspeciafly oommon in o!der people.

Deflnilely lrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Probably lrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Probably false . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Definitely false . . . . . . . ..’...... . . . . . . . . . . . . . . 76

Don’t know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

23c. AIDS can damage Ihe brain.

Defmltely lrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Probably true . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Probably false . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Definitely false . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Don’ltmow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

23d. AIDS usually leads to hearl disease.

Definitely !rue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Probably true . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Probably faise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Detinltely falsa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Don’tlrnow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

23e. AIDS Is an Infectious disease caused bv a virus.

23f.

23g.

Definilelytrue . . . . . . . . . . . . ~ . . . . . . . . . . . . . . . . 64

Probablytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Probablyfaisa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Deflnifelyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Teenagers cannot get AIDS.

Definitelylrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Probablytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Probablyfalsa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Deflnitelyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

Donllrnow. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

AIDSleadstodeath.

Defrritelylrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Probablytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Probablyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Defirritelyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

23h. A person can be infected with fhe AfDS virus end not have the

disease AIDS.

Defmttelytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Probablytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Probablyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Deflntfelyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Don’fknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

231. Look!ng ataperson isenough totellif heorshe hasthe

AIDS virus.

Deflnitelyfnre . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Probablytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Probablyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Definttelyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

23J. Anyperson wtfhthe AIDSvims canpase ttontosomeoneelsa

during sexual Inlercouwe.

Detinttelytrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Probablytrue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Probablyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Deflnitelyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Don’l know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

23k. A person who has the AIDS virus can look and feel heallhy

and well.

Defuwfelytru e . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Probablylrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Probablyfalee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Defmitelyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Don’t know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

231. ApregnantwomanwhohastheAIDSviruscsn givetheAIDS

virus to her baby.

Defhmtelytrue.. . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Probablylrue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Probablyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Defmifelyfalse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

1

2

17

75

5

23

30

13

::

2:

21

16

31

69

19

2

4

6

1

0

d

1

64

13

1

2

1

61

19

5

7

9

2

4

:

5

66

11

1

1

2

56

26

6

5

6

85

12

0

1

2

1

1

15

79

4

27

29

12

11

21

10

21

22

20

26

72

15

2

5

6

1

0

2

1

85

12

1

1

1

65

19

3

5

8

3

4

11

i7

6

85

11

1

1

2

!$a

26

5

5

7

86

11

0

0

3

1

1

%

10

30

31

6

5

29

11

22

14

12

41

52

20

3

6

20

1

1

4

89

5

64

11

0

1

4

49

22

4

4

23

3

4

16

ea

17

79

13

1

1

7

36

29

9

6

19

76

15

1

1

7

Percent d!stributionl

1

2

E

7

26

30

10

9

22

11

21

xl

18

WI

67

17

2

4

10

1

0

3

94

2

64

13

1

1

2

56

20

4

6

12

2

5

13

71

9

82

12

1

1

4

53

26

6

5

10

80

14

0

1

5

1

1

15

77

7

26

30

10

9

26

9

22

18

16

35

62

18

2

6

12

1

1

3

94

2

86

11

1

1

2

59

19

4

4

15

3

4

13

71

10

84

11

1

1

3

46

27

7

6

11

64

11

0

1

4

1

1

E

6

z

11

9

24

2:

20

18

32

64

18

2

1:

1

0

3

94

2

84

12

1

1

2

60

20

3

4

12

2

4

13

73

8

83

12

1

1

3

52

27

6

5

10

62

13

0

1

4

2

1:

73

10

35

26

6

2:

E

10

13

35

65

14

2

5

14

2

0

2

91

4

89

:

1

3

51

16

5

9

19

5

5

13

63

14

64

10

1

1

5

44

24

6

9

18

63

11

0

1

6

2

3

16

65

15

29

30

5

4

32

14

23

10

9

44

50

21

2

2

1

1

4

86

8

85

6

0

1

6

40

20

5

6

2e

4

5

17

53

21

79

11

1

1

8

33

25

10

8

24

73

16

0

1

10

1

1

15

78

5

28

30

9

8

25

11

22

17

15

35

64

18

2

6

10

:

3

95

1

67

10

0

1

1

57

21

4

5

13

2

4

13

72

8

65

10

1

1

3

50

28

6

6

10

64

12

1

1

3

0

1

16

ea

4

26

30

13

12

19

&

25

22

25

72

15

2

5

8

:

2

97

0

62

15

1

1

1

69

18

3

4

6

3

4

10

60

4

63

13

1

1

2

61

27

:

4

85

12

0

:

%sfocimtesat endofteble.
Advance Data 7

Table 1. Provisional estimates of the percent of persons 18 years of age and over with salected AIDS knowledge and attitudea from the

1989 National Health Interview Survey, by selected characteristics: United Statas, Octobar-December 1989-Con.

[Data are based on household Interviews of the civilian noninstitutbnafizad population. The survey design, general qualiflcatkms. and Information on the reliability of

me estimates are given In technical notes]

Age sex Ewe Educat&n

16-29 3549 50 years Lass than Mm? It/an

AIDS knowledge or arfaude TottrJ YS8RS years and oker Mafe Female WrUe slack 12Y0sre 12years 12Years

23m,There is a vaccine available to the public Ihat protects a person

from getting Ihe AIDS virus.

Deflnttely true . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Probably true. . ,, .,,,..,. , .,.,,,,., . . . . . . . .

Probsblyfalse, .o . . . . .. o....... . . . . . . . . . . . .

Definitely false . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’t know, ,,, . . . . . . . . . . . . . . . . . . . . . . . . . . .

Percenl dlstribulbnl

2

;

76

10

84

i!

2

4

:

3:

45

5

2

1:

39

32

6

1:

::

19

10

25

29

Y

7

0

2

6

X

32

6

6

20

14

31

18

9

5

11

:

27

8

2

:

73

14

85

7

:

5

:

3:

49

8

2

9

11

37

34

7

1;

:

21

13

28

29

;:

9

10

2

6

:;

37

6

9

19

13

27

21

10

6

12

z

27

10

1

:

77

11

86

7

;

4

:

3;

49

5

2

9

11

39

34

5

1:

::

20

11

24

30

!:

8

9

2

6

12

40

36

5

8

19

14

30

20

9

5

11

:

28

9

2

3

7:

12

;

8:

7

66

6

:

3

2

3

3:

51

4

:

;:

35

4

1;

:;

23

6

26

2e

12

18

;

2

5

11

40

3a

3

9

19

14

30

21

7

5

10

2

31

7

:

:

20

02

:

3

7

3

4

3;

40

Q

1:

2

31

9

10

17

12

27

18

14

31

26

10

13

8

11

3

8

10

39

31

9

12

21

70

28

17

11

11

14

3:

23

12

3 2

: :

56 75

26 12

23n. There Is no cure for AIDS at pmeenl.

Deflnilely true . .,!...,,, . . . . . . . . . . . . . . . . . . .

Probably true, .,, .,,.,,. , .,,,,,,.. !., ,,, ,,.

Probably false ,,, ,., !.,, ,0, ,,, ..,. ... .!,,!,

Deflnlfely fake. . . ,,, .,,,,.. . . . . . . . . . . . . . . . .

Don’t know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

85

7

76 86

9 7

1

:

1: 3

2

2

24. How likely do you Ihlnlr if ts that a person will get AIDS or lha

AIDS virus Infeolkm from24& Living near a hospitat or home for AIDS patients?

Very likely. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Somewhat llkely . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Somewhat unlikely . . . . . . . . . . . . . . . . . . . . . . . . . .

Vefyunlilrely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Definitely nolposslble . . . . . . . . . . . . . . . . . . . . . . . .

Don’t know. , . . . . . . . . . .,, ,,, ,,. . . . . . . . . . ,.

24b. Working near someone with the AfDS virus?

VeWllkely. . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Somewhat llkely, . . . . . . . . . . . . . . . . . . . . . . . . . . .

Somewhat unlikely . . . . . . . . . . . . . . . . . . . . . . . . . .

VeryunlJkely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Definitely nolposslbie . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

24c, Eating In a restaurant where ltw cod has the AIDS virus?

Very likely..,.,......,...,,,., . . . . . . . . . . . .

Somewhal llkely . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Somewhat unlikely . . . . . . . . . . . . . . . . . . . . . . . . . .

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Definitely notpoaslble . . . . . . . . . . . . . . . . . . . . . . . .

Donl know. . .,, ,,, ,,, ,. ..,. . . . . . . . . . . . . . .

24d. Kfsslrrg-with exchange of saflva-a person who has the

AIDS ViI’US?

Verylikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Somewhatl[kely, . ...,..... . . . . . . . . . . . . . . . . .

Somewhatunlikely . . . . . . . . . . . . . . . . . . . . . . . . . .

Veryunlikely, . .,, , ..,,,,.,, , .,,,,..,.,,,,.

Deflnttelynotpossible . . . . . . . . . . . . . . . . . . . . . . . .

Don’tKnow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

24e.Shaklnghands, touching, orkiselng Onthecheeksomeone

who has the AIDS virus?

Veryllkely, . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Somewhatlikely, . . . . . . . . . . . . . . . . . . . . . . . . . . .

Somewhatunhkely . . . . . . . . . . . . . . . . . . . . . . . . . .

Veryunllkeiy, ,, ..,,....,,,,. . . . . . . . . . . . . . .

Definitelynotposslble . . . . . . . . . . . . . . . . . . . . . . . .

Don’t know, . . . . . . . . . . . . . . . . . ,. .,.... . . . . .

24f. Sharing plates, forks, orgLssseswifhsomeonew hohaathe

AIDSvlrus?

VeWlikely. .,, . . . . . . . . . . . . . . ., .0.... . . . . . .

Somewhatlikely, . . . . . . . . . . . . . . . . . . . . . . . . . . .

Somewhatunlikely . . . . . . . . . . . . . . . . . . . . . . . . . .

Veryuniikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Deflnitelynotpossible ..,.... . . . . . . . . . . . . . . . . .

Don’tknow, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

24g. using public toilets?

Veryllkely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Somewhatlikely . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Somewhatunllkely . . . . . . . . . . . . . . . . . . . . . . . . . .

Veryunllkely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Definilelynotposslble . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3

s

:

38

15

2

9

:

33

6

7

19

:

20

11

30

27

1:

7

19

3

9

13

34

26

15

2

6 :

12 11

41 41

34 47

5 2

6

20

13

28

20

9

1;

12

22

15

19

2

14

27

18

9

6

17

;

24

5

9

16

Y

19

19

6

13

:

28

10

8aa fodnoles a! ad of table.
8 AdvanceData

Table 1. Provisional estimates of the percent of persona 18 years of age and over with seiected AIDS knowiedge and ●ttitudes from the

1989 National Health interview Survey, by seiected characteristics: United States, October-December 1989-Con.

[Data are based on household Interviews of Ihe ctvihan norwnstilutbnallzad population. The survey design, general qualifkatbns, and Information on Ihe fWebiltty of

the estimates are given m technical notesl

Age sax Race Educatbrr

16-26 30-49 50 years Less mars Mom than

AIDS knowledge or affltuae Tolal years years and over Mete Female WWte B&ok 12 yasra 12 yesra 12 yaws

24h. Sharing needles for drug use wlh someone who hSSthe

AIDS VhUS?

Verylikely. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

Somewhat likely . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Somewnat unliKeiy . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Vetyunhkely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Definitely nolfxxslble . . . . . . . . . . . . . . . . . . . . . . . . 0

Donlknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

241. Being coughed or sneezed on by someone who has the

AIDS virus?

Very fikely . . . .. c . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Somewhal likely . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Somewhaf unllkely . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Definitely nolposslble . . . . . . . . . . . . . . . . . . . . . . . . 17

Donl know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

24J. Attending schml wiih a child who has the AIDS virus?

Vetyllkely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Somewhal likely . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Somewhal unlikely . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Vetyunllkely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Defimtely notpossible . . . . . . . . . . . . . . . . . . . . . . . . 35

Don’t know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

241c Mosquitoes or olher insects?

Veryllkely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Somewhaf likely . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Somewhatunllkely . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Veryunlikely . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Defmifely nolposslble . . . . . . . . . . . . . . . . . . . . . . . . 20

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

25. Haveyou everdonatedblaod?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

Donlknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

26a Have you donated blood since March 1SS5?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Donlknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

26b. Have You donated blood In the -! 12 monlhs?

27.

28.

29aYes . . . . . . . . . . . . . ..”...... . . . . . . . . . . . . . . . 7

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Don’lknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Haveyoueverheard ofabloodtestttmt candetacftheAIDS

virusinfectksn?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Don’lknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

To the best of your knowledge, are blood donatbns routinely

tested now for the AIDS virus hfactbn?

Yak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Neverheardoftest’ . . . . . . . . . . . . . . . . . . . . . . . . . 26

Have vou ever racewed counsalha ar had a talk with a health

profe&ionalabout takingtheAID~virus test?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

Donlknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Neverheardoflast’ . . . . . . . . . . . . . . . . . . . . . . . . . 26

29b, Was the discussion-l’5

Wiihaprfvatedoclofl . . . . . . . . . . . . . . . . . . . . . . . . 52

Atafamlly-planningclinlc?..., . . . . . . . . . . . . . . . . . 9

OnanAIDSholllne? . . . . . . . . . . . . . . . . . . . . . . . . . 2

Alaprenalafclinic? . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Al an STDorsexuallyIransmlted dlseaaeclink? . . . . . . . 3

Alan AIDS/HIV counseling andtes!lng site? . . . . . . . . . . 7

Wlthsome olherhealth professional?. . . . . . . . . . . . . 42

Wlthsomeolhercounselor? . . . . . . . . . . . . . . . . . . . . 9

30. During lhafdiscusslon, didyourecerve inform$ian about how

to avod getting or passing on the AIDS virus?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Don’lknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

96

2

0

1

0

0

5

18

17

33

Xl

7

1

4

9

42

40

3

10

20

10

24

19

16

33

67

0

22

77

0

9

90

0

80

18

2

71

4

8

20

7

73

0

20

51

15

2

10

4

5

39

12

71

29

97

2

0

0

0

1

7

19

17

32

19

7

1

5

71

43

37

4

10

15

9

25

22

16

43

57

0

19

81

0

9:

0

82

15

3

73

4

5

16

7:

0

18

50

5

1

3

9

47

7

57

42

1

92

3

0

0

0

4

9

23

15

23

12

17

2

6

10

41

29

12

9

17

7

22

18

28

42

57

0

7

93

1

9;

1

61

33

7

51

3

6

39

5:

0

39

72

6

2

1

2

;:

8

33

67

95

2

0

0

0

1

6

21

~7

30

16

10

2

5

10

45

33

6

11

18

9

25

19

18

51

49

0

19

60

0

6

91

1

74

22

4

65

:

26

7:

0

26

48

6

2

1

4

11

49

9

65

35

0

94

2

0

0

0

2

8

19

16

28

17

12

2

5

11

39

37

7

9

16

8

22

21

24

31

69

0

12

66

0

5

95

0

74

22

4

65

:

26

6;

o

26

58

13

1

9

3

4

35

10

56

43

0

95

2

0

0

0

2

7

20

$

17

10

1

5

10

43

38

6

9

17

9

24

21

21

42

56

0

16

63

0

7

93

0

76

20

4

67

4

5

24

7;

o

24

53

8

2

4

3

6

42

9

57

43

1

93

3

0

1

0

3

11

20

15

26

16

12

4

6

10

39

30

11

+4

17

6

20

2

34

66

0

13

66

1

:

1

66

29

5

5a

;

34

;

o

34

54

17

14

6

4

36

6

85

15

89

4

0

0

1

6

10

22

14

20

12

21

3

1;

E

16

z

7

17

14

30

29

70

0

5

94

1

9;

1

55

39

6

45

:

45

5:

0

45

52

21

2

11

3

5

20

16

66

32

96

2

0

:

1

7

22

17

28

16

10

2

5

10

43

34

5

11

17

9

23

19

22

36

64

0

14

66

0

:

0

73

22

4

64

4

6

27

7:

0

27

51

13

2

8

7

6

44

8

63

37

97

2

0

0

0

1

5

17

17

:34

20

6

:

9

44

40

2

7

‘fs

9

28

25

16

50

60

0

23

77

0

:

0

65

12

3

77

4

5

15

6

79

0

15

63

5

1

2

2

9

45

9

58

41

1

See fcdnotes at endoftable.
Advance Data 9

Table 1. Provisional estimates of the percent of persons 18 years of age and over with selected AIDS knowledge and attitudes from the

1989 National Health Interview Survey, by selected characteristics: United States, October-December 1989-Con.

[Data are based on household inlerviawsof the ctvillannonlnslitulkrnalizedpopulafkm.The surveydesgn, generat quattibatiins, and informationon the reliabmyof

the estimatesare grfen in lechnicatnotes]

Age Sex Race Educatbn

law 3449 50 years

AIDS knowledge oraff#ude

LessIhan t#OfSthan

Totef years years and owr Male Female Whife Black 12yeecs 12years 12w

31. Have you ever been advised by a health professionalnot to

have the bloat test for the AIDS virusinfection?

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

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

Donl know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Never heard obtest’ . . . . . . . . . . . . . . . . . . . . . . . . .

32. Have you ever bean advised by frbnds or relativesnot to have

the bloodtest for the AiDS virusinfection?

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

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

Don’Iknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neverheardoftest’ . . . . . . . . . . . . . . . . . . . . . . . . .

33. Haveyou hadyour bicxrdtestedforlhe AIDSvWsinfwtbn?

Yeas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Don’tfmow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Neverheerdoftast’ . . . . . . . . . . . . . . . . . . . . . . . . .

0

74

26

21

52

2

24

35t%How many times have you had your bloodtestedfor the AIDS

vtrusinfactlon?’

Once. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Twioa . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .

3-5times . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

6-12tlmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Morethan fumes . . . . . . . . . . . . . . . . . . . . . . . . . . 0

1 Donlknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Neverheardofornevertookteslm. . . . . . . . . . . . . . . . . 79

35b. How many times in the past 12 monlhahjaveyou had your

bloodtestedforthe AIOSvimstrrfecf&n?

Noneinthepast12months. . . . . . . . . . . . . . . . . . . . . 4

36.

36.

41.

42.

44a

Once . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Morethan rice . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 Oon’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1:

NeverheardofornevertooktestB. . . . . . . . . . . . . . . . . 79

Wastheteswere anyofthetesls, tnctudingthoseyouhad

beforethepestl 2montfrs-1

Partofabtooddonatlon?8”7. . . . . . . . . . . . . . . . . . . . 67

Partofabloodtran fusbn?9. . . . . . . . . . . . . . . . . . . . I

Voluntarilysought?$

. . . . . . . . . . . . . . . . . . . . . . . . . 19

Pertofsome olheracfivity fhafrequires abitisample?g. . 17

Dtd you get fhe results of yourtesfhny of your tests?a

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Don’fknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Doyouexpectto haveabloodfest fortheAtOSvlms infacfton

tnthenexf12months?

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

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . &

Donlknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Neverheardoftest’ . . . . . . . . . . . . . . . . . . . . . . . . . 26

WNlthalestbe-l”*O

Partofablooddonation?. . . . . . . . . . . . . . . . . . . . . . 45

Voluntarilysought? . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Pertofsome ottieracttvity thatrequuesabl~mple? . . 18

D!dyouhaveabiood tranfusionafanv tIrnebetween

197?and1965?

Yes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I

44b. Do you think the present supplyof blood is safe fortranfusbns?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

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

Don’lknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2]

45. HereeresomemethodspeopleuWtopmvent getfingtheAiDS

vlrusthroughsexual actfvity.Howeffactiie is45a. Usinga d!aphragm?

Veryeffective. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Somewhafeffacfive . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Notafetieffecltve . . . . . . . . . . . . . . . . . . . . . . 61

Oorr’tknowhoweffecti ve . . . . . . . . . . . . . . . . . . . . 20

Donlknowmethod . . . . . . . . . . . . . . . . . . . . . . . . . . 6

1

79

20

0

79

0

20

30

60

2

17

10

2

3

1

0

14

70

6

:

14

70

65

1

17

22

57

41

1

11

63

6

20

40

48

22

9;

o

:

0

19

2

2

16

5

1

81

18

0

81

0

16

26

55

2

17

9

2

2

1

0

13

74

5

7

2

12

74

66

1

21

16

59

41

0

8

69

4

18

49

41

15

6

93

1

52

26

2:

1

10

70

14

4

0

61

39

0

61

3:

5:

2

3s

2

0

0

0

0

6

91

2

1

1

5

91

74

1

14

13

50

49

1

2

57

2

3e

4e

47

14

7

91

2

42

28

0

30

3

12

49

29

8

Percentdiitribufiinl

o

74

26

0

74

2

26

49

2

23

:

2

/)

13

74

5

:

13

74

68

1

16

21

55

44

0

9

61

4

2a

49

40

20

5

94

1

53

25

;

2

12

60

m

6

0

73

26

0

74

0

26

17

56

2

25

6

1

1

0

0

8

63

3

4

1

6

63

65

2:

13

60

39

1

5

65

2:

:

14

9:

1

45

29

0

25

2

::

19

6

0

75

24

0

75

0

24

22

53

2

23

7

:

1

0

X

4

5

2

11

78

66

1

17

17

55

44

1

6

86

3

24

51

37

18

5

93

1

51

26

2:

2

12

63

19

5

0

56

34

0

66

34

20

47

1

31

:

2

0

9

60

3

6

2

9

60

56

2

32

15

72

28

12

46

8

34

27

70

16

2

1

40

34

4

3

:;

25

8

0

54

45

0

54

46

10

43

2

45

5

:

0

4

W

3

3

1

4

w

49

2

23

30

73

27

5

45

5

45

23

65

20

9:

2

34

33

~

3

10

43

32

12

0

73

27

0

73

G

2

2

25

6

:

1

:

62

:

2

9

81

6s

1

19

17

64

45

1

:

4

27

3a

52

19

2

1

48

26

0

24

2

:

20

5

1

84

15

:

1:

30

55

2

13

9

2

2

:

:

6

7

3

14

70

69

1

18

16

56

44

1

4

4

15

56

34

17

5

94

1

58

24

0

19

1

12

71

13

3

8esfodrmtesatendoftsble.
10 Advance Data

Table 1. Provisional estimates of the percent of persons 18 years of age ●nd over with selected AIDS knowledge and attitudes from the

1989 National Health Interview Survey, by selacted characteristlca: United States, October-December 1989-Con.

[Data are based on household Inlervlawaof the chIiUannOnlnSltIUtlOnSfiZWJpOpUlalkM.The survey dSSlffn, general quslificatkme, and Informatbn on the relisbllfty Cf

the estimates are given In technksl notes]

Age sax Race Educef/on

W-22 3&49 50 years Leas than Mom than

AIDS knowledge or attlfude Total yearn yeaIs errd over Male Female Wtrlte Black 12years 12~ 12~ars

45b. Using a condom?

Ve~effeclNe, ... .,. d o,, . . . . . . . . . . . . . . . . . . . 33

Somewhat effecflve, ,,, .,,...,,,,. . . . . . . . . . . . 53

Nolal Wleffecllve, ,,, ..,,.,,.. . . . . . . . . . . . . . . 5

Don’lknow howeffecttve ..,,,,., , .,,,,.,.,,,.. 7

Don’t know method ., . . . . . . . . . . . .,, , ... .,,,., 2

45c0Using a spermlcldal Jelly,foam, or cream?

Ve~effNINe, ,., . ..oo. o.. o,. .,, .$....,,,.. 1

Somewhat affective ,, !,.,,,,.. .,, ,,, ,0,, ,,, ,,

Nctatdl eflecttie, . . . . . . . . . . . . . . . . . . . . . . . . . . ;:

Don’tknow howeffwtlvo, . . . . . . . . . . . . . . . . . . . . . 22

Don’tkncwmethod . . . . . . . . . . . . . . . . . . . . . . . . . . S

4Sd. Having a vesactom~

Vefyeffectlve . . . . . . . . . . . . . . . . . . . . . . . . . . ...< 2

Somewhateffecllve, ,. .,,.... . . . . . . . . . . . . . . . . 2

Notatall effecltve, ,, ..,...... . . . . . . . . . . . . . . . 74

Don’lknow howeffactive , . . . . . . . . . . . . . . . . . . . . . 15

Don’tknowmelhod, ,, ..,,,.,, . . . . . . . . . . . . . . . 6

45e.TWODeOOleWh0 donothavetheAIDS vkushavinasexonlv

46.

4?,

49.

52,

53,

64.

S5.

with each other?

Vefyeffeclive. ( . .,, . . . . . . . . . . . . . . . . . . . . . . . . S6

Somewhateffective . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Notatalleffectlve. . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Don’lknowhoweffaotlve .,.,,. . . . . . . . . . . . . . . . . 4

Don’l knowmethod, . . . . . . . . . . . . . . . . . . . . . . . . . 1

What are your chances of having the AIDS vlrua?

High, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Medium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Low, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

None, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Whatareyourchances ofgetthglheAIDS virus?

High . .,, , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Medium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

LOW. .,......,.....,.,.. . . . . . . . . . . . . . . . . 18

None. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Don’tknow, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 3

HlghchanceofalreadyhavingAIDS virus. . . . . . . . . . . . 0

Do YOUsay yoy~ chance of 9ettk19 AIDS la h19hor medium

because youHave hadabloodtransfuskm?. . . . . . . . . . . . . . . . . . . 7

Have had sexual contact wMI someone who might have

thevirus? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Someotherreason?, . . . . . . . . . . . . . . . . . . . . . . . . 61

Have you ever discussed AIDS wllh a friend or rebttva?

Yes. , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Don’tlmow. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Whenwasthelast tlmeyoudlsoussad AIDSwlthafr&nd or

relatlve?

0-3daysago . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

4-7daysago . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

8-14daysago. .,, . . . . . . . . . . . . . . . . . . . . . . . . . 6

15-31 daysago .,......,.,.. . . . . . . . . . . . . . . . 12

Morethan 31 daysago, ..,.. . . . . . . . . . . . . . . . . . 26

Don’lknow. .

Neverdkcutiiz”:::::::::::::::::::::::::: ~

Have you ever personally kncwn anyone wRhAIDS or the

AIDSWUS?

Yes, ..,,.,.,...,...,,, . . . . . . . . . . . . . . . . . 14

No, ,,, , ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86

Don’tknow. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

How long has ii been since you saw this person?

Wllhlnpast2weeks . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2weeks-lessthan l month.... . . . . . . . . . . . . . . . . . 1

lmontti-lessthan3months. . . . . . . . . . . . . . . . . . . . 1

3months-lesslhan6monlhs . . . . . . . . . . . . . . . . . . . 1

6monthsormore . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Don’t know. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

NeverknewanyonewtthAtDS1s... . . . . . . . . . . . . . . . 86

40

62

:

1

2

E

16

4

3

7:

13

6

85

9

3

3

1

0

2

16

78

1

0

2;

6s

3

0

2

27

64

69

31

0

6

!

13

31

3:

;

1

1

1

1

1

:

66

35

55

:

1

1:

67

16

3

2

2

:

88

:

2

1

0

2

15

81

2

0

2

21

74

2

0

8

20

61

70

30

0

7

;

14

30

4

16

81

2

1

1

1

1

13

0

62

25

62

7

13

4

1

::

33

9

2

6:

24

8

60

;

8

3

0

1

2

3

0

1

2

4

0

16

:

44

55

0

:

4

9

17

$

8:

2

1

0

0

;

o

91

,

35

53

:

1

1

#

23

5

2

7:

15

5

86

:

4

1

:

15

80

2

0

2:

73

3

1

6

z

56

42

0

5

6

1:

24

4

42

13

85

2

1

1

1

:

8!

31

53

;

2

1;

61

21

6

2

7:

16

6

64

:

5

2

0

2

11

85

2

0

2

:

2

0

9

16

65

64

36

0

6

:

12

27

3;

15

84

1

1

1

1

1

10

0

85

33

54

:

2

1

~

21

5

2

7;

15

5

66

:

4

1

0

2

:

2

0

2

;

2

0

5

::

61

38

0

6

:

12

26

3:

14

85

1

1

1

1

1

10

0

86

34

48

1:

2

1:

54

26

6

3

6:

21

6

79

:

7

2

:

13

80

5

:

#

6

1

15

31

64

60

39

1

;

7

10

23

4:

17

81

2

1

1

;

11

0

83

25

46

1:

6

:

44

35

11

2

5:

28

13

74

9

1:

4

0

2

8

85

5

0

2

::

6

0

13

29

46

41

59

0

4

:

7

17

5:

7

91

2

0

0

0

1

5

0

93

31

55

6

6

1

1

x

23

5

2

7;

15

5

86

7

3

4

1

0

2

E

2

0

2

u?

2

0

6

17

65

61

39

0

6

:

12

28

5

40

11

86

1

1

0

1

:

0

69

See fodmtes aterdof table.
Advance Data 11

Tablo 1. Provisional astimat~s of tho pcrcont of porsorm 18 years of w ●nd ovor with soloctcd AIDS knowlodgo ●nd ●tudo$ from tho

1989 Natlonsl Haalth Intorvlow Survey, by saloctod oharaotarlstlos: Unltod Statao, Octobor-Dooombor 1989-Con.

[Data are based on household Interviews of the civlllan nonlnsfkutbnahd Populatbn. Tho wway dsslgn, ganarai quattfkatbna, MCI Information on tho ranablltty of

the Ostlmates are gken In technlcd notes]

Age sex Race Education

18-29 30-49 m years Less than More than

AIDS knowledge or attlrude Tofal years years and over Male Female Wtrlfe Black 12years 12yem 12years

58.

57.

58.

59.

61.

62.

How well do you know this person?

Verywell . o, ., .,, . . . . . . . . . . . . . . . . . . . . . . . . 2

Fdrlywell, ,,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Notverywell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Don’lreall yknowpersonall y . . . . . . . . . . . . . . . . . . . ~

Dfher, ., .,, . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow howwell . . . . . . . . . . . . . . . . . . . . . . . . . -

Never lrnewanyone wtts AlDSf3 . . . . . . . . . . . . . . . . . . ~

Is any of these statements true for you?

a You have hemophill.s and have received clottlng factor

concentrates since 1977.

b. You area natlva of Haiti or Central or East Africa who MS

entered the United Slates since 1977.

c. You area man who has had sex wlfh another man at some

time since 1977, even 1 llme.

d. You have taken Illegal drugs by needle at my time shca

1977.

e. Since 1977, you are or have bean the sex pafiner of any

person who would answer yes to any of the items above

(57 a-d).

f. You have had sax for money or drugs at MY time since

1977.

Yestoat leaetl statement . . . . . . . . . . . . . . . . . . . . . 2

Notoall statements . . . . . . . . . . . . . . . . . . . . . . . . . 97

Refused . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

The U.S. Publb Health Service has said that AIDS ts one of me

ma]or health problems in the cwntry but exactly how many

people It affects Is not known. The Surgeon General has

proposed that a study be conducted and blood samples be

taken to help find out how widespread the problem Is. If you

were selecled In Ibis national sample of people to have their

blood !ested wlfh assurances of privacy of test results, would

you have the test?

Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74

No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~

other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Why wouldn’t you take part in the test?14

Don’twanl toknowifl have AIDS..... . . . . . . . . . . . . 4

Don’t want any counseling about AtDS. . . . . . . . . . . . . . 1

Fearl’ll get AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Don’tlike togiveblood . . . . . . . . . . . . . . . . . . . . . . . 14

Don’Itrust Government programs. . . . . . . . . . . . . . . . . 7

Itisawaste ofmoney . ..o . . . . ..oo. . . . . . . . . . . . ~

D&;;\ beliave AIDScan really becurad anYWay . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Don’tkMw: : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

When Federaf public health ofllckls give inforfnatlon about

AtDS, do you believe what they say or are you doubtful afmut

the Informatlorr they give?

Believe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Doubtful . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . 27

Don’l know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

When they [public heallh offlckfs] give advke about how to

help Keep from getting AIDS, do you believe fhelr advice or are

yoti ~~f~l ai%ut what they saj?

81

Doubtf;i: ::::::::::::::::::: ::::::::::::: 15

Cron’tknow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

2

3

6

2

1

88

4

96

0

0

60

15

;

7

i

18

6

2

1

43

1

75

21

4

66

12

2

3

4

7

2

1

82

9;

o

76

18

:

4

:

14

11

3

2

48

1

62

28

3

64

14

2

Percent distributfonl

2

3

5

2

1

67

9;

:

78

19

:

4

;

12

9

4

1

49

2

66

29

5

62

15

3

2

4

6

2

1

66

2

0

0

72

21

1

6

5

1

4

15

:

1

49

1

86

26

6

81

15

4

2

3

6

2

1

66

2

97

0

0

75

19

1

5

4

1

4

13

7

4

1

51

2

67

28

5

82

15

3

4

5

5

3

1

63

9;

o

0

71

22

:

5

;

15

9

3

4

47

2

66

26

7

81

15

5

2 2 2

3 5

: 4 8

2 3

: 1 1

93 89 so

4 4 4

1 2 1

6 5 4

14 14 13

5 7 10

2 4 4

1 1

44 49 54

2 1 2

59 66 72

29 29 25

12 5 3

72 81 87

19 16 12

9 3 1

lMuhjpI. m~nm maysum b mom~~ 100.

z- a p.reom anewaing yes to qusalicm 4 (includesyes to qu.etion 3).

SB~ ~ -IU ~wetiW ~= to qu@atimII, Mm ycu IWO ●ny chlldr.n sg.d 10 through 17?” C+Mltion 12 WM “t+w W dO W ~v@”

4pemw -erim ~ Or don’tkmw to qudon 27.

6B~ ~ -m amw.ri~ yOS tO qU*Sti~ 29-

elm~dw persorw answering yss to question 26a and m or don’tknowtO WSdbM 27 ~ ~.

7-~ ~m -em to question 33. See fcotrnto 6.

Spemti -WIW no or don? knc+v to qUSetlOM 26m =. ~ ~.

oa~ ~ ~i-sors SMWCfiW yOS to quesbr 3* excludes pamorn -wafi~ v- ~ qu-ibn *

10~ On Pwaom amvmfing yes to question 41.

11- on pomona anewering high or mailum to qu.atbn 46.

lZ~ on pmom answering no or don? knew to queetion S2.

13- on pemons wmwering w or don’t krc+w to queethm S4

14x on pdreora not answuring yes to quedlon S3.
12 Advance Data

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 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. The

1989 National Health Intemiew Survey

of AIDS Knowledge and Attitudes is

asked of one randomly chosen adult

18 years of age or over in each family.

The estimates in this report are based

on completed interviews with 11,007

persons, or about 87 percent of

eligible respondents.

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 men who have had their

blood tested for HIV. The population

figures in table I are based on 1988

data from the NHIS; they are not

official population estimates. Table II

shows approximate standard errors of

estimates presented in table 1. Both

the estimates in table 1 and the

standard errors in table II are

provisional. They may differ slightly

from estimates made using the final

data file because they were calculated

using a simplified weighting procedure

that does not adjust for all the factors

used in weighting the final data file. A

final data file covering the entire data

collection period for 1989 will be

available at the end of 1990,

Table L Sample sizes for the 1989 National

Health Interview Suwey of AIDS

Knowledge and Anitudee and estimated

adult population 18 years of age and over,

by selected characteristics: United States,

October-December 1989

Estimated

sample populakm

Cherectertstks stze in ttrousancfs

Ail adults . . . . . . . . . . . 11,007 177,321

Age

16-29 years . . . . . . . . . 2,566 46,967

30-49 Yeats . . . . . . . . . 4,434 6a,966

50years and over . . . . . 3.987 61,377

Sax

Male . . . . . . . . . . . . . . 4,6S3 64,131

Female . . . . . . . . . . . . 6,324 93,190

Race

While . . . . . . . . . . . . . 9,095 14!3,510

Black . . ; . . . . . . . . . . 1,465 19,457

Education

Less than 12 years. . . . . 2,347 3950-2

12yeers . . . . . . . . . . . . 4,032 6il,301

More than 12 years. . . . . 4,577 ~f,872

Table IL Standard errors, expressed in percentage points, of estimated percents from the National Health Interview Survey of AIDS

Knowledge and Attitudea, by selected characteristics: United States, October-December 1989

Age Sex Race EducaUorr

16-29 30-49 50 years Less then More tiran

.EWmatad penwrt Total yearn years end over Mab Female Wh/te Black 12 years 12 years 12 years

5or95 . . . . . . . . . . . . . . . . . . . . . . 0.3 0.5 0.4 0.4 0.4 0.3 0.3 0.7 0.6 0.4

loor60 . . . . . . . . . . . . . . . . . . . . . 0.4

0.4

0.7 0.6 0.6 0.5 0.5 0.4 1.0 0.8 0.6

150r85 . . . . . . . . . . . . . . . . . . . . . 0.4 0.9

0.5

0.7 0.6 0.6 0.5 1.1 0.9 0.7

200r60 . . . . . . . . . . . . . . . . . . . . . 0.5 1.0

0.7

0.7 ;; 0.7 0.6 0.5 1.3 1.0 0.8 0.7

250r75 . . . . . . . . . . . . . . . . . . . . . 0.5 1.1 0.8 0.6 0.8 0.7 0.6 1.4 1.1 0.6

300r70 . . . . . . . . . . . . . . . . . . . . . 0.5 1.1

0.8

0.9 0.9 0.8 0.7 0.6 1.5 1.2 0.9

350r65 . . . . . . . . . . . . . . . . . . . . .

0.8

1.2 0.9 0.9 0.9 0.7 0.6 1.5

u 1.2

1.2 0.9 0.9

400r60 . . . . . . . . . . . . . . . . . . . . . 0.9 1.0 0.9 0.8 0.6 1.6 1.3 1.0 0.9

450r65 . . . . . . . . . . . . . . . . . . . . . 0.6 1.2 0.9 1.0 0.9 0.8 0.6 1.6 1.3 1.0

50 . . . . . . . . . . . . . . . . . . . . . . . . . 0.6

0.9

1.2 0.9 1.0 0.9 0,8 0.6 1.6 1.3 1.0 0.9
Number 187 . October 1, 1990

Advance

Data

From Vital and Health Statistics of the National Center for Health Statistics

Child Care Arrangements

Health of Our Nation’s Children, United States, 1988

by Deborah A. Dawson, Ph. D., Division of Health Interview Statistics, and Virginia S. Cain, Ph.D.,

National Institute of Child Health and Human Development

Introduction

Increasingly, the care of children

in our sckiety is a major toncem for

both parents and policymakers. The

changing composition of families in

the United States means that many

chiIdren live in single-parent families

in which the mother is the primary

source of eeonom”c support. Even in

families with two parents, frequently

the mother is in the labor force. With

60 percent of the women with

children 5 years of age and under

being in the labor force, the number

of children who spend a significant

amount of time in a care arrangement

while their mothers work is

substantial (l). However, not only

famiIies in which the mother is

employed arrange for care for their

young children. Many families with

mothers who are not in the labor force

arrange for the care of their children,

either to prow”de enrichment in the

child’s life or to provide care while the

mother participates in school,

volunteer work, Ieisure actiw”ties, or

household work.

Given the basic need or desire for

child care, the choices that parents

make regarding the provider, the

location, and the quality of care can

differ greatly. Most child care research

has examined the choice of child care

arrangements for the children of

employed mothers. This research

indicates that the choice of care

arrangement varies with characteristics

of the mother, the family, the child,

and the care situation itself. Research

showing a relationship between the

mother’s edueation, race, and ethnicity

and the parent’s choice of child care

arrangement treats the maternal

variables as proxies for underlying

preferences (2). The ability to pay for

care limits the types of care the famiIy

may choose. Family income and

mother’s earnings have been shown to

relate to choice of child care

arrangements (3). The geographic

location of the family may affect the

availability of certain care

arrangements (4,5).

The characteristic of the child

most likely to influence choice of care

arrangement is age (2). Parents of an

infant or toddler may believe that the

most appropriate care is care in their

own home, where the child reeeives

individual attention and is not exposed

to the variety of infectious diseases

found within groups of children (6-8).

Further constraining factors on the

pIacement of very young children in

group care situations are age

restrictions adopted by the provider or

regulated by licensing agencies. For

the older preschool child, the sociaI

interactions and educational programs

available in nursery schools and day

ea.re centers maybe viewed as

beneficial (6).

Characteristics of the type of care

have been related to the choices that

parents make regarding child care and

to child outcome measures. Highquality child care is generally regarded

as care that is stable, that has a Iow

child-to-staff ratio, and in which the

provider has had training in child

development and/or early childhood

education (6).

This report examines child care

arrangements for preschool children

with respect to characteristics of the

,Uw+.

●#“% +4 4

U.S. DEPARTMENTOF HEALTH AND HUMAN SERVICES

{

L

Public Health Service

Centers for Disease Control

‘%.*m National Center for Health Statistics

Manning Feinleib, M. D., Dr. P.H., Director
2 Advance Data

children and their families. Data on

child care use have been collected not

only about the children of employed

women but also about children in

families in which the mother is not

employed. Several aspects of the

quality of these child care

arrangements are also examined.

Data and methods

This report is based on the

National Health Interview Survey on

Child Health (NHIS-CH), conducted

in 1988 by the National Center for

Health Statistics, The National

Institute of Child Health and Human

Development and the U.S. Health

Resources and Services

Administration cosponsored this study.

Information was collected on a

nationally representative sample of

children 17 years of age and under.

Details of the sample design and data

collection procedures are presented in

the technical notes.

Interviewers administered the

NHIS-CH questionnaire to the adult

household member who knew the

most about the sample child’s health.

For 80 percent of the sample children,

the respondent was the child’s mother;

for 10 percent, the child’s father was

the respondent, The questionnaire

addressed a broad range of healthrelated topics, including child care

arrangements; marital history of the

child’s mothe~ accidents, injuries, and

medical conditions; birth weight and

prenatal care; exposure to cigarette

smoke; bedtime and sleeping

arrangements; school attendance;

developmental, learning, emotional,

and behavioral problems; and sources

of medical care.

Questions on child care

arrangements were asked for all

children 5 years of age and under, of

whom there were 6,209 in the

NHIS-CH sample. For this analysis,

current use of child care was

determined on the basis of a series of

questions that varied according to the

child’s age and whether he or she

attended regular school (kindergarten

or first grade):

1,

2.

3.

4.

Children ages 4-5 years who

attended first grade were counted

as receiving child care if the

respondent answered affirmatively

to the question, “Other than

[kindergarten/first grade/nursery

school/preschool], in the past four

weeks, has _ been cared for

in ANY kind of regular child care

arrangement such as a day care

center, playgroup, by a babysitter,

relative, or some other regular

arrangement ?“ If the interviewer

had determined that the child’s

mother worked during hours other

than when the child was in school,

this question was coded “yes”

automatically without asking it.

The questions used to establish

mother’s work were, “[Have

youfhas _’s mother] worked

at a job or business for pay in the

last 4 weeks?” and “[Do you/does

she] work only while — is in

(school level) or [do you/does she]

work other hours?” Additional

questions were asked to determine

the types of child care

arrangement used.

Children ages 4-5 years who

attended kindergarten were

counted as currently receiving

child care if they met the

conditions specified above or if

they were reported as attending a

kindergarten extended day care

program.

Children ages 4-5 years who did

not attend kindergarten or first

grade and all children ages 2-3

years were counted as currently

receiving child care if they met the

conditions specified in item 1

above or if they were reported to

attend nursery school or

preschool. Nursery or preschool

attendance was not asked for

children in regular school.

Children under 2 years of age

were counted as currently

receiving child care if the

respondent replied affirmatively to

the question, “In the past four

week% has — been cared for

in ANY kind of regular child care

arrangement such as a day care

center, playgroup, by a babysitter,

relative, or some other regular

arrangement?” If the interviewer

determined that the child’s mother

worked, this question was

automatically coded ‘yes” without

asking it. Additional questions

were asked about the types of

child care arrangement used,

Nursery or preschool attendance

was not asked for children under

2 years of age.

In summary, children were coded

as currently receiving child care if they

attended a kindergarten extended day

care program, if they attended nursery

school or preschool, if they were

reported to have another form of

regular child care arrangement, or if

they were assumed to have such an

arrangement because the mother

worked during hours other than when

the child was in school. Regular school

attendance in kindergarten or first

grade was not counted as a form of

child care.

The questions used to determine

whether the mother worked during

nonschool hours (listed above) were

asked as part of the series of questions

concerning child care arrangements.

Maternal employment status as

determined through these questions

was inconsistent with maternal

employment status as reported in the

basic health questionnaire (on the

person reeord for the individual later

identified as the mother figure) for

7 percent of the children 5 years of

age and under. For these inconsistent

cases, the independent variable for

mother’s employment was set to

unknown, but the coding of current

child care use was left as determined

through the questions in NHIS-CH.

This high level of inconsistency may

reflect respondent confusion in some

households as to who the mother

figure was or to errors in selecting the

correct wording of the question based

on the alternate choices listed on the

questionnaire (“Do you/did _‘s

mother. . .“).

For this analysis, children who

currently received child care were

automatically counted as having ever

received child care. For children not

counted as currently receiving chilcl
Advance Data 3

care, having ever received child care

was determined using the question,

“Was _ ever cared for in any

regular child care arrangement?”

Whether a child had ever received

child care (ever use) may have been

more narrowly interpreted than

current use. There were no questions

on whether the child ever attended

nursery school, preschool, or a

kindergarten extended day care

program, nor were there questions on

whether the mother ever worked

during nonschool hours. It is

impossible to determine how broadly

respondents interpreted the question

on having ever received child care.

The NHIS-CH interviewers asked

the number of hours spent in each

type of child care arrangement

reported, including nursery school,

preschool, and kindergarten extended

day care. The main source of child

care was defined as the arrangement

in which the child spent the greatest

number of hours per week. When

multiple child care arrangements were

reported but the number of hours

spent in any of these arrangements

was unknown, the main source of care

could not be determined.

The codes for whether the child’s

main source of care was outside the

home and whether the main care

provider was related to the child were

based on the main source of care, as

shown in table 1. For the purposes of

this analysis, all care by the father was

assumed to have been in the child’s

home.

Children were coded as having

multiple sources of care if they were

reported as having more than one

form of regular child care

arrangement, including kindergarten

extended day care, nursery school, and

preschool. Changes in child care

arrangements were a.wertained using

the question, “How many times

has —’s main child care

arrangement changed in the past

year?”

The number of children sharing

care was measured using the question,

“Including _, how many children

are usually cared for together, in the

Tablo 1. Basis for coding $olootsd ●rlbuto$ of child w’. ●rrangcmonq by main sourco of

car.: Unltod Stet9s, 1988

MM Wurwor MalrrcaN ptvvlder

Makreoumeofoa4v arm Outewhome? relatedto child?

Dayramc anter. . . . . . . . . . . . . . . . . . . . . . . . . . .

Unralatad provkferln chlld’s home. . . . . . . . . . . . . . . .

Unraiated provider In provkJer’s home . . . . . . . . . . . . .

Fefhercaree fwchiid . . . . . . . . . . . . . . . . . . . . . . .

Mother cares for child while working at home. . . . . . . . .

Molher cares for child while working oulskie ofhome.. . .

Daycam? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Relalhfe, atchlld’s home . . . . . . . . . . . . . . . . . . . . .

Relative,l somewhere else. . . . . . . . . . . . . . . . . . . . .

Relative,istteunknown . . . . . . . . . . . . . . . . . . . . . . .

Nursaryorpreschool . . . . . . . . . . . . . . . . . . . . . . . .

IUndergarten extended daycare, . . . . . . . . . . . . . . . .

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

Unknown . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

Yes

No

::

Yea

Y%

Unknown

Yes

Yes

Unknown

Unknown

No

No

No

Yes

Yes

Yas

No

Yes

Yes

Yes

No

No

No

Unknown

same group, at the same time? Do not

include children in the entire school or

program.” The ratio of children to

providers was calculated using this

question and another: “How many

adults usually supervise the children in

the same group as_. ?“ This ratio

could not be ascertained for

one-fourth of all children because of

missing data in either the numerator

(number of children sharing care) or

the denominator (number of

supervisory adults). Although the

responses provided look reasonable in

relation to type of child care

arrangement, the issue of potential

nonresponse bias must be considered

in interpreting these data.

An even larger item nonresponse

rate was obtained for questions

concerning special training received by

the main child care provider.

Approximately one-third of the

respondents to whom these Questions

should have been addressed d not

provide an answer, either bec~.:e they

did not know or because of

interviewer error. Although provider

training is a useful measure of child

care quality, these data were not

included in this analysis because of the

high nonresponse rate.

Findings

Use of child care

Data from the 1988 NHIS-CH

revealed that two-thirds (68 percent)

of U.S. children 5 years of age and

under had been in a child care

arrangement at some point in their

lives (table 2). The proportion who

had ever received care increased with

age, from 56 percent of children

under 2 years of age to 80 percent of

t%ose ages 4-5 years who were n~t in

school. Receipt of child care was

strongly associated with socioeconomic

status. Children with annual family

incomes of $40,000 or more were far

more likely than children with family

incomes of less than $10,000 to ever

have received care, 79 percent

compared with 48 percent. The

percent of children ever cared for in a

regular child care arrangement

increased with mother’s education as

well, from 47 percent of those whose

mothers did not complete high school

to 78 percent of those whose mothers

had attended college. Although

mother’s employment is clearly an

important factor in the use of child

care, even among children of mothers

not currently employed, more than

one-third had been in a child care

arrangement at some time.

In 1988, 60 percent of children

5years of age and under were

currently being cared for in a regular

child care arrangement; that is, they

had received care in the 4 weeks

preceding the NHIS-CH interview.

Child care was commonly reported for

even the youngest children, 50 percent

of those under 2 years of a~e. As with

those who ever had received child

care, current users of care were not
4 Advance Data

Table 2. Number of children 5 years of age and under and percent ever and currently

cared for in a regular child care arrangement, by selected social and demographic

characteristics: United States, 1988

[Dala are based on household interviews of the civilii noninstItufiinalized population. The survey design,

general qualifications, and information on the reliebihfy of the estimates are given In the techmcal nolea]

Cl?lld care status

Ew cared for Currently cared for

Number of

ctdtdren Sfancfard Standard

Charade ftstic In thousands Penxnt error Percent error

Allchildrenl . . . . . . . . . . . . . . . .

Age and school status

Under 2years . . . . . . . . . . . . . . .

2-3years . . . . . . . . . . . . . . . . . .

4-5 years, not in school. . . . . . . . .

4-5yeafa, in school . . . . . . . . . . .

Race

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

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

Hispank origin

H!s+ank..................

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

Family income

Lesslhan $10,000 . . . . . . . . . . . . .

$10,COO-$24,999 . . . . . . . . . . . . .

$25,00C-$39,999 . . . . . . . . . . . . .

S40,0000rmore . . . . . . . . . . . . . .

Gaograph!c region

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

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

South . . . . . . . . . . . . . . . . . . . .

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

Place of residence

MSA

Centralcify . . . . . . . . . . . . . . . .

Noncentral city . . . . . . . . . . . . .

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

Mother’s education

Lessthan12years . . . . . . . . . . . .

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

Morethan 12years . . . . . . . . . . . .

Mother’s employment status

Employed* . . . . . . . . . . . . . . . . .

NotemPloyad . . . . . . . . . . . . . . .

22,107

7,535

7,369

4,709

2,304

17,828

3,336

2,537

18,644

3.046

6;278

5,550

4,905

4,055

5,675

7,642

4,735

7,03s

9,666

5,163

3,959

9,071

9,078

10,174

10,136

67.?

55.6

69.5

60.4

74.3

6s.5

63.5

59.8

66.8

47.6

66.4

73.3

78.2

60.6

70.5

a9.3

67.8

65.1

69.5

67.8

47.4

:.:

98.6

34.9

0.6

1.3

1.2

1.5

2.2

0.8

1.9

2.2

0.8

2.1

1.4

1.3

1.3

2.1

1.4

1.3

1.4

1.4

1.0

1.5

21

1.2

1.0

0.1

1.2

60.0

50.1

62.4

72.7

57.4

60.9

54.9

53.3

60.6

%

65.5

73.7

55.3

61.a

60.1

61.5

57.3

62.5

56.7

37.6

56.5

71.0

98.9

20.1

0.6

1.3

1.2

1.7

2.6

0.8

2.0

U

2.0

1.4

1.5

1.4

1.9

3.7

1.3

1.5

1.4

1.0

1.6

2.0

1.2

1.1

0.3

1.0

llncbdesracaaothw thanwhiteorblack ardunkrmwnmigin, lncorne,educafii, andemploymemt.

21n5udes Ioeking for work SInd not in lhe Iator force.

NOTES Care errangemd includes rurae~ school, preschool, and kicciergr@?n extended day care. Percents exclude unknown

values foraerand current care from rumeralor mddenominatoc rwmbera ofctildren inclucte ttosswith unknswnvaluas. MSA

is metropolitan statistkal area.

restricted to the children of employed

women. One-fifth of the children of

mothers who were not employed

currently received some form of child

care.

Main source of care

Asshown in table 3, the most

esrmmonly used child care

arrangements for children 5 years of

age and under were nursery schools or

preschools (used by23 percent of the

children receiving care), care provided

by a nonrelative in a home other than

thechild’s ownhome (21 percent),

and care provided by thechild’s father

(13 percent) .Eightpercent of the

children were cared for in their own

homes by unrelated providers; other

sources of care provided within the

child’s home were grandparents

(6 percent) and other relatives

(3 percent). Grandparents and other

relatives also provided care in homes

other than the child’s home—

9 percent and 3 percent, respectively.

Five percent of the children receiving

care were cared for by their mothers

while they worked. In addition to the

large proportion of children receiving

group care in nursery or preschools,

8 percent attended day care centers,

including kindergarten extended day

care programs and day camp. Thus,

the proportions of children cared for

in group settings, in their own homes,

and in other homes were about onethird each.

The children’s main source of care

varied according to their age. For

children under 2 years of age, the

most common source of care was a

nonrelative in a private home other

than that of the child—family day

care. For children ages 2-3 years and

those ages 4-5 years who were not in

school, the most common source of

care was a nursery or preschool. For

children ages 4-5 years who were in

school, the most common form of care

was a day care center. In general, the

proportion of children cared for in

their own homes deereased with the

age of child; however, home care also

was common for children ages 4-5

years who were in sehool and

presumably required only before- or

after-school care.

Sources of child care differed

sharply for children of employed and

unemployed mothers. The latter

strongly favored nursery schools or

preschools, which together accounted

for 63 percent of all care for this

group. The distribution of care

arrangements used by employed

mothers was far more dispersed.

Two-thirds of all children who

received some form of child care in

1988 were cared for outside their

homes, either in another home or in

an institutional group care setting

(table 4). Children ages 4-5 years who

were not in school were the most

likely to receive care outside their

homes (77 percent); least likely were

children ages 4-5 years who did attend

school (56 percent) and children

under 2 years of age (57 percent).

Of the children who received care,

38 percent were related to their main

care providers. The proportion of
Advance Data 5

Table 3. Number of children 5 years of age and under currently cared for in a regular child care arrangement and percent distribution by

main source of care, according toselected social anddemographic characteriWcs: United States, 1988

[Data are based on household Interviews of the civilian noninstitufionalized population. The survey design, general qualiiicalions, and information on the reliebiliIy of

line esllmates are given in the technical notes]

Care /n ctrild!s home CW8 I_nanother home Group care

Number of (Xher Other Nursery /Uothe&

children

Character&t&

G~d- rela- Nonrela- Grand- rela- Nonrel+ orpr~ Day cam while

in thousands ToL4 Father Darent ttie ifwr parent tive Uve school center’ Workina Other

Allchildren3 . . . . . . . . . . . . . .

Age end school ?Jalus

Under 2years . . . . . . . . . . . . .

2-3years . . . . . . . . . . . . . . . .

4-5years, notinschoaL . . . . . .

4-5years, lnschool . . . . . . . . .

Race

While . . . . . . . . . . . . . . . . . .

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

HlsPanicori@n

Hiepanlc . . . . . . . . . . . . . . . .

Non-Hispenic . . . . . . . . . . . . .

Fsmllyincome

Leesthan$lO,OOO . . . . . . . . . .

$10,00G$24,999. . . . . . . . . . .

$25,000-$39,999 . . . . . . . . . . .

S40,0000rmore . . . . . . . . . . .

f3eographbregion

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

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

South . . . . . . . . . . . . . . . . . .

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

Place of residence

hfsl%

Centrslctl y . . . . . . . . . . . .

Notcentratcfiy . . . . . . . . . . .

NoIMSA . . . . . . . . . . . . . . . .

Mother’s educstbn

Lesstharr 12yesrs . . . . . . . . . .

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

Morethsn 12yeare . . . . . . . . .

Mothei’sernployment status

%’&:p*&&lK::::: :::

13,259

3,772

4,609

3,421

1,323

10,654

1,830

1,352

11,331

1,119

3,635

3,635

3,613

2,242

3,492

4,596

2,913

4,035

6,182

3,042

%%

6,446

10,060

2,033

100.0 12.9

100.0 1!3.4

100.0 12.5

100.0 9.6

100.0 16.4

100.0 13.2

100.0 9.2

10Q.O 10.1

100.0 128

100.0 12.6

Ieo.o 17.9

100.0 13.4

100.0 8.5

100.0 17.0

100,0 14.7

100.0 10.0

100.0 12.1

100.0 10.9

100.0 13.5

100.0 14.3

100.0 16.5

100.0 13.3

100.0 11.7

100.0 15.6

100.0 ●0.9

6.0

8.8

4.7

3.1

9.5

4.7

11.0

8.0

5.6

6.7

5.7

4.7

4.6

8.3

5.1

5.8

5.5

E

4.1

6.8

7.7

4.4

&

2.6

2.5

23

*2.6

●3.8

21

5.8

8.1

2.0

●5.5

3.6

*1.5

●1.8

1.8

*2.3

2.7

3.4

4.2

1.5

27

::

1.1

26

●0.7

7.6

10.2

7.5

4.5

8.7

8.2

%3.3

6.7

7.7

5.5

5,5

6.4

10.7

10.5

7.6

z

7.5

7.6

7.6

6.6

6.5

6.7

7.5

6.4

6.7

9.7

9.3

7.0

7.6

7.6

16.2

10.2

8.6

13.0

10.2

9.3

6.2

9.8

7.2

10.6

6.1

9.9

6.9

10.6

10.3

9.6

7.4

9.8

4.0

26

3.7

2.8

1.3

●1.5

23

4.3

4.9

23

‘3.4

2.9

2.6

1.6

●2O

2.0

3.3

●25

R

28

*3.6

3.5

1.6

28

0.9

21.3

28.1

21.1

14.7

19.1

229

15.2

227

21.2

13.1

21.9

23.7

221

17.5

26.5

19.1

21.3

18.9

21.4

24.1

15.3

21.5

22.4

24.2

6.8

23.4

28.8

49.7

23.6

21.4

21.1

23.8

25.1

18.2

22.7

28.7

20.0

20.1

25.8

26.2

24.1

25.3

?8.7

19.7

21.4

25.9

16.0

62.7

7.8

11.8

3.6

2.7

25.7

7.6

10.5

5.1

8.1

6.5

6.0

9.0

6.5

6.9

6.1

10.2

6.9

7.3

9,0

6.3

3.7

7.2

9.3

8.4

5.2

4.8

6.6

4.5

3.6

*3.3

5.4

●1.4

*I .9

5.2

5,5

6.1

4.6

3.5

4.5

5.5

3.8

5.6

3.4

5,0

6.1

4.2

4.1

5.4

5.6

●O.1

2.5

3.0

2.6

●1.2

4.3

2.5

*1.7

●1.2

27

●3. 1

2.1

2.0

3.6

1.7

2.6

2.3

*3.3

;:

●2. 6

*3.9

2.6

2.1

1.3

7.1

~lnc!udesklndergwl.n axfandaddaycare uddaycamo.

children related to the main care

provider was far greater for black than

for white children (48 percent

compared with 35 percent) and

somewhat greater for non-l%spanic

than for Hispanic children (44 percent

versus 37 percent). The probability of

a child’s being related to his or her

main care provider was inversely

related to the child’s socioeconomic

status.

Children whose mothers were

employed were four times as likely to

be related to their main care providers

as children whose mothers were not

employed—43 percent compared with

10 percent. Children ages 4-5 years

who were not in school were the least

likely to have a relative as their main

care provider.

Stability of child care

arrangements

The 1988 NH18-CH addressed

two aspects of stability in child care

arrangements-use of multiple

sources of child care and changes in

source of care. Multiple sources of

care may be as permanent as a single

source; in fact, children cared for in

multiple arrangements were only
6 Actvance Data

Table 4. Number of children 5 years of age and under ourrently cared for in a regular

chiid care arrangement, percent whose main source of care is outside the home, and

percent whose main care provider is a reiative, by seiected social and demographic

characteristics: United Statas, 1988

[Dala are based on household Inlerviaws of the cMlisn nonlnslitullonallred population. The survey deS19n,

general qualificaflons, and Informatbn on the reliability of the estimates are given in the Wchnlcst notes]

Main source

ofc&f#ls rueirr care

ou!slde pmvktar

the home k a ratatiw

Number of

children Standard Standarcf

GtrarscleMh7 In thousands Percent error percent errvr

Allchildrenf . . . . .. t . . . . . . . . .

Age and school status

und@r2yem ... . . ..i . . . ..t.

2Gyeam, .;m . . . . .. B.. . . ..o

+5yeam, notlnschM1 . ..o. .o. .

4-5yeafe, ln school . . . . . . . . . . .

Race

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

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

Hlspank origin

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

Non-Hlspanlc . . . . . . . . . . . . . . . .

Family Income

Lessthan $10,000 . . . . . . . . . . . . .

$10,000-$24,999 . . . . . . . . . . . . .

$25,000-$39,999 . . . . . . . . . . . . .

$40,0000r more . . . . . . . . . . . . . .

Geographic region

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

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

Sough . . . . . . . . . . . . . . . . . . . .

Weal . . . . . . . . . . . . . . . . . . . . .

Place of residence

fdsA

Cenlralctly. . . . . . . . . . . . . . . .

Noncentralcity. . . . . . . . . . . . .

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

Mother’s education

Lesslhan 12yeare . . . . . . . . . . . .

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

Morethsn 12years . . . . . . . . . . . .

Mo!her’sempbyment status

Employed . . . . . . . . . . . . . . . . . .

Notemployadz . . . . . . . . . . . . . . .

13,256

3,772

4,602

3,421

1,323

lo,e54

1,830

1,362

11,331

1,119

3,635

3,635

3,613

2,242

3,50s

4,566

2,913

4,035

6,162

3,042

1,4s8

5,308

6,445

10,06U

2,033

66.4

68.6

66.6

77.1

56.0

66.8

69.3

65.6

66.7

63.4

62.3

69.6

70.2

56.2

64.6

72.2

65.9

84,7

8841

65.5

55.2

66.3

69.1

63.3

87.7

0.9

1.6

1,6

1s7

3,s

2:

2.9

1.0

3.4

1.6

1.6

1.6

1.6

1.8

1.7

2.3

1.7

1.2

1.6

3.3

1.6

1.4

1.0

1.7

37.5

46.9

E:

42.3

35.3

47.9

43.5

36.6

46,6

46.5

36.3

26.4

43.5

36.9

3s.5

35.4

39.6

34.6

40,7

51.0

41.0

31.6

42.7

9.9

0.9

;::

!!

z

3.4

1.0

3.6

1.7

1.7

1.6

2.0

1.7

;:

1.6

;:

3.2

1.4

1.2

1.0

1.6

1lm~des ,sce$ ~t~r t~ ~~ts or black ard unknevm Cdgln, income, @J~tiOn, ~ emP1oYmti ‘tatUs.

‘Incbdes looking for work amdmatin VWIator force.

NOTES Cwaarrmgorceti Includrn numeryschooi, preschcol,and klndergsrlsn exletieddaycare. Permntsexdude unkrmvn

values for I=stlon and reletiomhip of main source of csre fmm rwmerslor and deromlnalofi rumtem of children Inclucb !*

with urimawn valuee. M2.AIe metropolitan slallsllcel are~

slightly rnorelikely than those with a

single sourceof care to have changed

caretakersin the preceding year

(28 percent compared with

22 percent).

0verall,28 percent of the

children receiving child care in 1988

had multiple sources of care (table 5).

The children most likely to have more

than a single source of care were

those ages 4-5 years who were not jn

school (38 percent). Children whose

mothers were not employed were the

least likely to use multjple sources of

child care.

One-fourth of the children

receiving child care in 1988 had

changed child care arrangementsat

least once in the 12 months preceding

the NHIS-CH interview. Children

4-5 years of age who were in school

were the most likely to have changed

arrangements,31 percent. Changesin

child care arrangements were far more

common among children whose

mothers wereemployed (27 percent)

than among those whose mothers were

not employed (16 percent).

Use of multiple child care

arrangements and changes in child

care arrangements appeared to vary

aeeording to main source of care

(table 6), but a larger sample is

needed to confirm any differences.

Because of the numerous categories

for main source of care and the

reladvely large standard errors

associated with each estimate, very few

of the differences shown in table 5 are

statistically significant.

The NHIS-CH data suggest that

children cared for by their fathers or

in nursery schools or preschools were

the most likely to use more than a

single source of care and that those

cared for by grandparents or relatives

in the child’s own home were the least

likely to do so, Children cared for

primarily by their mothers appeared to

be the least likely to have experienced

a change in care, 10 percent. The

children who appeared to be most

likely to have changed child care

arrangements in the preceding year

were those cared for by nonrelativcs,

in either the child’s or another home,

and those attending day care centers.

For children cared for in group care

situations, such as day care centers or

nursery schools, these estimates of

change are somewhat low in that they

do not reflect staff changes within a

specific setting.

Number of children sharing care

One measure of chj]d care quality

is the number of children cared for by

the same provider, Not only is the

child-to-provider ratio indjcatjve of’ the

level of supervision, but the actual

number of other children to whom a

child k exposed on a regular basis

influences the likelihood of infectjcm

with communicable diseases.

According to the NHIS-CH data,

23 percent of the children recejving

care in 1988 were cared for alone

(table 7). Thirty-five percent were
Advance Data 7

Table 5. Number of children 5 years of age and under currentfy cared for In a regular

child care arrangement percent with multiple chiid care arrangements, and percent

whose main source of care changed in last year, by seiected sociai and demographic

characteristics: United States, 1988

[Data are baaed on household Interviews of the civillsn noninslitutbnallzed fmpulstbn. The survey design,

general qualltkalbns, and Informatbn on the raliabllity of the estimates are given in the taohnicel notael

Mw’t@e Main souma of

chid care care changed In

arrangements hstyear

Numb#

of chlldrwr S@rdarrt standard

CtrarecteristJc &r thousands Peicent error Fafcant error

Allchildrenl . . . . . . . . . . . . . . . .

Age end school status

Under 2years . . . . . . . . . . . . . . .

2-3yean3 . . . . . .. o . . . . . . . . . .

4-5yesrs, notlnschool . . . . . . . . .

4-5years, lnaohool . . . . . . . . . . .

Ra2e

Write. . . . . . . . . . . . . . . . . . . . .

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

Hispanic origin

Hlspanlo . . . . . . . . . . . . . . . . . . .

Non-H!spanic . . . . . . . . . . . . . . . .

Family Income

Lessthen $10,000 . . . . . . . . . . . . .

$io,ooci-$24,999 . . . . . . . . . . . . .

$25,c0#39,9e9 . . . . . . . . . . . . .

$40,0000rmore . . . . . . . . . . . . . .

Geographic region

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

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

South . . . . . . . . . . . . . . . . . . . .

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

Place of residence

MSA:

Central cify. . . . . . . . . . . . . . . .

Notcentratctty . . . . . . . . . . . . .

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

Mother’saducatiin

Lesstfmn12years. . . . . . . . . . . .

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

Morethan 12years . . . . . . . . . . . .

Molher’sempbyment sfafus

Employed . . . . . . . . . . . . . . . . . .

Notemployedz . . . . . . . . . . . . . . .

13,259

3,m

4,608

3,421

1,323

10,854

1,630

1,3s2

11,331

1,119

3,635

3,635

3,813

2,242

3,5C6

4,596

2,913

4,035

6,162

3,042

1,486

5,309

6,446

10,O6U

2,033

27.7

19.4

28.2

38.0

21.4

20.1

20.9

23.0

28.3

23.3

26.6

20.5

26.5

30.9

26.2

25.4

26.0

26.5

28.6

27.3

E:

29.0

30.9

13.6

0.8

1.2

1.5

1.7

2.4

0.9

2.1

2.5

0.9

3.1

1.6

J.?

1.5

2.1

1.4

1.6

1.5

1.4

1.2

21

2.4

1.5

1.2

1.0

1.6

24.7

22.3

26.9

22.1

30,6

25.5

20.1

22.1

24.8

24.9

26.1

24.6

25.4

19.7

24.6

26.0

26.6

24.2

25.1

24.8

20.7

24.8

25.5

26.6

15.8

0.8

1.5

U

2.8

0.9

2.1

2.5

1.0

3.0

1.8

1.7

1.7

1.3

7.7

i .4

1.9

1.6

1.3

1.6

27

1.4

1.0

1.0

22

‘l~~d~~t~~- amjunkmnodgin,Income,eduudbft ~--d-s.

zlm~d=~kj~ fofWOrk@notinhhbrrom.

NOTESOaraarreegemeti Ircludasrureeryscbl, preschool,andkirdcrgertenexterdaddaycare. Percentsexdudeunkmwn

va!ues fm rumberof srd changesin child care arrergementa from nurmrakxand derxminalo~ rumbre of children kclude tbse

w)thurWxxmvalu~ M= is metmpalitan statistical area

reported to be cared for in agroupof

2–3 chi1dren;20 percent were ina

group of 4-6 children. Overall, then,

more than three-fourths of the

children in formal child care

arrangements were reported to be

cared for in a group of ahaIf dozen or

fewer children. Twelve percent were

cared for in a group of 7-12 children,

and 11 percent were cared for in a

group of 13 or more children. These

group sizes do not represent the full

enrollment of a group care facili~

they include only the children actually

cared for together, for example, within

a single group at a day care center.

The mean ratio of children to

child care providers was 3.5 to 1. This

ratio increased with age of the child

and was primarily a function of the

type of child care arrangement

selected (table 8). The child-toprovider ratio was highest in group

care settings-nursery schools or

preschools (7.1 to 1) and day care

centers (6.4 to 1). The lowest child-toprovider ratios were observed for care

arrangements in the child’s home and

those provided by relatives in a home

other than that of the child. In these

settings, the mean ratio ranged from

2.0 to 2.7 to 1. For children in family

day care, that is, cared for by

unrelated providers in the providers’

homes, the mean ratio of children to

providers was 3.3 to 1.

Summary

In 1988, 13.3 million children

5 years of age and under were

reported to be in some type of child

care arrangement. Of these,

approximately 83 percent were

children in families in which the

mother was employed. The other

17 percent were in families in which

the mother was not employed. In

general, the younger children tended

to be in less formal care arrangements

and the older children were more

likely to be in formal, organized group

care situations. The data on the

stability of care show that a substantial

proportion of the children had

experienced a change in their child

care arrangements during the course

of the preceding year. There is

surprisingly little variation with age of

the child in the stability of child care

arrangements.

In addition to variation by age of

the child and mother’s employment,

characteristics of child care

arrangements varied according to a

number of socioeconomic and

demographic characteristics. These

included race and ethnicity, region and

place of residence, famiIy income, and

mother’s education. Further analysis

of these differentials, employing a

multivariate approach, will add to our

knowledge of the factors that influence

choices about types of child care

arrangements.

References

1. Bureau of Labor Statistics. Newsrelease; no 88-431. Washington: U.S.

Department of Labor. 1988.
Advance Data

Table 6. Number of children 5 years of age and under currently cared for in a regular

child care arrangemen~ percent with multiple child care arrangements, and percent

whose main source of care changed in last year, by main source of care: United States,

1988

[Data are based on household interviews of the ctvilian nonlnslllutlonallzed population. The survey design,

general qualifications, and information on the reliability of the estimates are given In the techn!eal notes]

Mu/t/P/e Main soume of

c/r//d care care changed in

arrangements last year

Number

of children Siandard Standard

Mahr source of care in tfrouaands Percent error Percent error

All sources . . . . . . . . . . . . . . . . . 13,259 27.7 0.8 24.7 0.s

Care in child’s home

Father . . . . . . . . . . . . . . . . . . . . 1,709 33.4 2.6 20.0 2.2

Grandparent . . . . . . . . . . . . . . . . 7s9 13.5 2.6 15.6 3.0

OIher relative . . . . . . . . . . . . . . . . 344 15.7 5.6 2Q.5 5.8

Nonrelative . . . . . . . . . . . . . . . . . 1,001 23.9 2.8 31.0 3.2

Care in another home

Grandparent . . . . . . . . . . . . . . . . 1,149 28.4 2.5 18.4 2.5

Another relative . . . . . . . . . . . . . . 32e 17.5 4.4 21.2 4.5

Nonrelative, . . . . . . . . . . . . . . . . 2.s22 24.6 1.6 32.3 1.8

Group care

Nursery or preschool. . . . . . . . . . . 3,1rM 31.2 1.8 21.5 1.5

Daycarecenterl . . . . . . . . . . . . . 1,037 29.8 3.5 34.6 2.7

Mother, while working . . . . . . . . 633 21.4 3.6 9.8 2.5

Other . . . . . . . . . . . . . . . . . . . . . 332 23.2 5.2 27.6 9.3

1

lnc!udesdaycampard kindergarten extended dey care.

NOTES Care arrangementincludes rwmq school, preschcol, and kmcfergarten extended day care. Percents exclude unkmwn

values fc+ fumber of and charges in childcare arrangements from rwmeraior and dencminatoc rwmbers of children im.lude those

with umnown values.

?“!

3.

4.

Leibowitz A, Waite LJ, Witsberger C.

Child care for preschool children:

Differences by chil d’s age.

Demography 25:205-20.1988.

Lehrer E. Determinants ofchild care

mode choice: An economic

perspective. Soc Sci Res 12:69-80.

1983.

Duncan GJ, Hill CR. Model choice in

child care arrangements. In: Duncan

5.

GJ, Morgan JN, eds. Five thousand

American families–patterns of

economic progress; vol 3. Ann Arbor,

Michigan: Institute for Social

Research. 1977.

Duncan GJ. The child care mode

choice of working mothers. In: Duncan

GJ, Morgan JN, eds. Five thousand

American families— patterns of

6.

7.

8.

9.

10.

——.

.,.

0.0

*

economic progres, vol 3. Ann Arbor,

Michigan: Institute for Social

Research. 1977.

Phillips DA, ed. Quality in child care:

What does research tell us?

Washington, D.C.: National

Association for the Education of

Young Children. 1987.

Johnson A, Lcibowik A, Waite LJ.

Child care and children’s illness. Am J

Public Health 28:1175-7.1988.

Presser HB. Place of child care and

medicated respiratory illness among

young children. J Marriage Fam

50:995-1005.1988.

Shah BV. SESUDAAN Standard

errors program for computing

standardized rates from sample survey

data. Research Triangle Park, North

Carolina Research Triangle Institute.

1981.

Levy PS, Lemeshow S. Sampling for

health professionals. Belmont,

California: Wadsworth, Inc. 1980,.

Symbols

Data not available

Category not applicable

Quantity zero

Quantity more than zero but less

than 0.05

Figure does not meet standards of

re~ability or precision
Advance Data 9

Table 7. Number of children 5 years of age and under currently cared for in a regular child care arrangement, percent distribution by

number of children cared for in arrangement, and mean ratio of children to providers, according to selected characteristics: United

States, 1988

[Data are based on household Interviews of the civilian noninshtutbnalized population. The survey design, general qualiicahons, and information on the reliability of

the estimates are given in the technical notes]

Mean ratio of

Number of children cared for

Numbar of

children to providem

ci?ildren in 13

CharacteiWfc

Standard

thousands Total 1 2-3 4-6 7-12 or more Ratio error

Percent distribukxt

All children* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Age and school slalus

Under2years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2-3yea= . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4-5years, notlnschool . . . . . . . . . . . . . . . . . . . . . . .

4-5yesrs, lnschool . . . . . . . . . . . . . . . . . . . . . . . . . .

Race

Wolfe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Hf-spanicorigin

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

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

Family inmme

Leeslhen$lO,OOO . . . . . . . . . . . . . . . . . . . . . . . . . . .

$lo@oo-$24,999. . .. . . . . . . . . . . . . . . . . . . . . . . .

$25,000-$39,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$40,0000rmore . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Gaographfcregbn

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

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

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

west . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Place of residence

MS.%

Centralctly . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Notcentralcity . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Mother’s education

Lessthan 12years . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Morethan 12yeare . . . . . . . . . . . . . . . . . . . . . . . . . .

Mother’s employment status

Employed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Notemployad2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13,259

3,772

4,60e

3,421

1,323

10,854

1,630

1,352

11,331

1,119

3,635

3,635

3,613

2,242

3,506

4,596

2,913

4,035

6,182

3,042

1,486

5,306

6,446

10,060

2,033

100.0

100.0

IC+3.O

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

100.0

100.0

100.0

100,0

100.0

100.0

100.0

22.7

2e.7

22.2

15.4

15.1

21.7

25.0

27.2

220

%

21.7

19.9

27.8

18.8

242

21.5

Z2.o

21.1

26.7

23.3

24.4

21.1

225

224

34.7

35.9

34.1

33.7

34.6

34.6

35.4

40.3

33.7

30.7

40.1

34.0

31.7

34.8

34.2

35.4

34.2

35.6

35.7

31.8

47.3

35.3

31.6

35.3

27.8

19.9

21.2

23.8

14.2

14.6

20.8

17.6

16.9

20.5

21.1

17.6

18.8

22.9

16.6

24.8

15.5

21.6

19.7

19.4

21.0

17.0

19.0

21.2

20.1

19.6

11.7

9.5

11.3

16.3

11.6

124

&9

6.6

12.4

10.7

9.1

14.2

13.0

7.2

13.5

12.4

11.6

11.7

11.9

11.5

6.2

11.2

13.3

11.4

17.2

11.0

3.6

8.5

20.4

24.1

10.5

13.1

9.1

11.3

7.9

9.0

11.2

12.5

11.7

6.6

12.5

11.1

11.1

12.0

9.0

*6.2

10.1

12.6

10.8

13.0

3.5

2.7

3.5

4.3

4.9

3.6

3.4

3.2

3.6

3.3

3.2

3.7

3.7

3.1

3.4

3.7

3.7

3.4

3.6

3.6

2.6

3.5

3.7

3.6

3.6

0.1

0.1

0.1

0.2

0.3

0.1

0.2

0.2

0.1

0.4

0.1

0.2

0.1

0.2

0.1

0.1

0.2

0.1

0.1

0.2

0.2

0.1

0.1

0.1

0.2

‘Irrcbdesotherreces andunknxvnorigin, irmmrw,education, andercploymentsrabm

‘Includeslookicg forworkarwrm.t inihelabxforw.

NOTE2cCareerrangament includeerwswyschcol, preecfxmf,end kimdergsden exiendeddaycare. Percer,4sexclude unknownvaluesfor cumberofchildren shanrgcarefrom rurneratorard

denomirwto~ rumba% of children include tfmee with unknswn values. M2A is rrutropditen ststisfical sm.
——10 Advance Data

Tablo & Number of children S years of ●go ●nd under currently cared for In ● rogulw ohlld ear. ●rrsngomontj percent dl$trlbutlon by

number of ehlldron cared for In ●rrangomon$ ●nd moan ratio of chlldron to providsrs, ●ccording to main sourco of cm’.: United Stat@s,

1988

[Data are based on household Inlerviewsi of the cMllan nonlnslttutkmalized populatbn. The sunrey deelgn, general queftflcdfbns, and Informakm on Ihe rellablllty of

the estimates are given In the tachnioal nolas]

Mean retJo

of children

Number of

Number of children cared for to providers

children 13 Standard

Main source of owe in thousends Total 1 2-3 4=6 7-12 or more Rat/o error

Percenf diilrfbutiin

Allsourc-es . . . . . . . . . . . . . . . 13,259 100.0 22.7 34.7 19.9 11.7 11.0 3.5 0.1

Care in child’s home

Father . . . . . . . . . . . . . . . . . . 1,709 100.0 27.7 S3.2 *9. 1 ●6.8 ●6.2 2.7 0.3

Grandparent . . . . . . . . . . . . . . 789 100.0 44.4 45.0 ●4.9 *1.1 *4.6 2.2 0,3

Other relative . . . . . . . . . . . . . 344 100.0 32.0 47.5 *18.9 ●1.6 2.2 0.2

Nonrelative . . . . . . . . . . . . . . . -1,001 100.0 26.5 59.2 6.2 ●4.7 ●1.3 2.3 0.1

Care In another home

Grandparent . . . . . . . . . . . . . . 1,149 100.0 48.9 37.8 5.5 *3. 1 4.7 2.0 0.1

Another relative . . . . . . . . . . . . 338 100.0 33.5 43.6 17.7 ●4.2 ‘0.7 2.4

Nortelative . . . . . . . . . . . . . . . 2,822 100.0 15.6 36.2 36.5 7.8 2.0 3.3 E

Group care

Nursery or preschool . . . . . . . . 3,104 100.0 *2.4 *5.3 9.0 38.1 45.3 7.1 0.3

Daycare center’ . . . . . . . . . . . 1,037 100.0 ●0.9 5.6 21.9 30.6 40.9 6.4 0.3

Mother, while working. . . . . . . . 633 100.0 ‘50.6 *44.7 ●4.7 3.1 1.4

Other . . . . . . . . . . . . . . . . . . 332 100.0 ●27.O ●12.2 30.0 24.0 ●6.8 3.8 0.6

1Includicg day camp and kindergaen extended day care.

NOTES Care arrangemmf includes rummy schcol, preschml, and kindergarten esierded day csre. Percents exclude unknown values for rumber of children sharing care from rurnerator and

denomimatoc ~mbers of children in-dude tlmse with mlssirg values.
AdvanceData 11

Technicai notes

The estimates presented in this

report are based on data from the

National Health Interview Survey

(NHIS), an ongoing survey of U.S.

households conducted by the National

Center for Health Statistics. Each

week, a probability sample of the

civilian noninstitutionalized population

of the United States is interviewed by

personnel of the U.S. Bureau of the

Census. Interviewers obtain

information about the health and

other characteristics of each member

of the households included in the

NHIS sample.

NHIS consists of two parts (a) a

basic health questionnaire that

remains the same each year and is

completed for each household

member and (b) special topics

questionnaires that vary from year to

year and usually are asked of just one

person in each family. In 1988, the

special topics included acquired

immunodeficiency syndrome (AIDS)

knowledge and attitudes, medical

device implants, occupational health,

alcohol, and child heahh.

The total sample interviewed for

1988 for the basic health questionnaire

consisted of 47,485 households

containing 122~10 individwds. The

total response rate was 95 percent.

For the National Health Intewiew

Survey on Child Health (NHIS-CH),

one sample child 17 years of age and

under was selected from each family

with children in that age range.

Interviews were completed for 17,110

children 17 years of age and under,

95 percent of those identified as

eligible on the basis of the basic health

questionnaire. Ths overall response

rate for NHIS-CH was 91 percent,

the product of the response rates for

the basic and the child health

questionnaires.

Because the estimates presented

in this report are based on a sample of

the population, they are subject to

sampling errors. Standard errors of

most estimates have been included in

the tables. In a few tables where lack

of space prohibited inclusion of

individual standard errors, estimates

were asterisked whose relative

standard errors (the standard error

divided by the estimate itself)

exceeded 30 percent. The standard

errors for this report were calculated

using SESUDAAN, a SAS-based

software package designed to produce

standard errors for estimates based on

compl~ multistage sample

designs (9). Standard errors based on

such survey designs are typicallyabout

20 percent larger than those that

would be obtained with a simple

random sample of the same size.

In this report, persons for whom

valid responses were not available for

certain items were excluded from both

the denominators and the numerators

of percents and percent distributions.

This exclusion of unknowns implicitly

assumes that the response distribution

for these persons is the same as that

for those for whom valid responses

were provided. Item nonresponse on

the child care variables considered in

this report was fairly high, generally

5-8 percent, because of the complex

skip instructions and because many of

the measures used were derived from

a large number of independent

questions.

All differences cited in this report

are statistically significant at the 0.05

level. The t-test, with a critical value

determined by the number of response

categories for an individual

variable (10), was used to test all

pairwise comparisons. Lack of

comment regarding the difference

between any two estimates does not

mean that the difference was tested

and found not to be statistically

significant.
12 Advance Data

Recent Issues of Advance Data From Vital and Health Statistics

No. 186.AIDS Knowledge and No. 184. Use of Family Planning No. 182. Contraceptive Use in the

Attitudes for October–December Services in the United States: 1982 United States, 1973–88 (March 2:3,

1989 (June 25, 1990) and 1988 (April 11, 1990) 1990)

No. 185.1988 Summary National No. 183. AIDS Knowledge and No. 181.Adoption in the 1980’s

Hospital Discharge Survey Attitudes for July–September 1989 (January 5, 1990)

(June 19, 1990) (March 8, 1990)

Suggested citation

Dawson DA, Cain VS. Child care

arrangements: Health of our Nation’s children,

United States, 1988. Advance data from vital

and health statistics; no 187. Hyattsville,

Maryland: National Center for Health

Statistics. 1990.

Copyright information

This report may be reprinted without further

permission.
Number 188 . October 1, 1990

Advance

Data

From Vital and Health Statistics of the National Center for Health Statistics

Health Insurance and Medical Care

Health of Our Nation’s Children, United States, 1988

by Barbara Bloom, M. P.A., Division of Health Interview Statistics

Introduction

This report on health insurance

and sources of medical care for

children is based on data from the

National Health Interview Survey on

Child Health (NHIS-CH), conducted

in 1988 by the NationaI Center for

HeaIth Statistics. The National

Institute of Child Health and Human

Development and the HeaIth

Resources and Services

Administration cosponsored this

study. Through NHIS-CH,

information was colIected on a

nationally representative sarnpIe of

chiIdren 17 years of age and under.

Questions on health insurance and

sources of medical care were asked

for aIl 17,110 children in the

NHIS-CH sample. Basic details of

the sampIe design and data collection

procedures are presented in the

technical notes. Further information

on the National Health Interview

Sumey sample design and estimating

procedures, definitions of terms, and

a complete copy of the 1988

questionnaires can be found in the

1988 edition of the annual report

Czorent Estimates From the National

Health Interview Survey (l).

Interviewers administered the

NHIS-CH questionnaire to the adult

household member who knew the

most about the sample child’s heaIth.

For 80 percent of the sample

chiIdren, the respondent was the

chiId’s mothe~ for 10 percent, the

child’s father was the respondent.

The questionnaire addressed a broad

range of health-related topies,

including child care arrangements;

maritaI history of the child’s mothe~

accidents, injuries, and medical

conditions; birth weight and prenatal

care; exposure to cigarette smoke;

bedtime and sleeping arrangements;

school attendance; developmental,

learning, emotionaI, and behavioral

problems; health insurance; and

sources of medical care.

This report is one of four reports,

subtitled Health of Our Nation 5

Children, which present findings from

the 1988 NHIS-CH. IncIuded in this

group are reports on child care

arrangements; developmental,

Ieaming, and emotional problems;

and exposure to environmental

cigarette smoke.

Results

Health insurance

In 1988, 83 percent of our

Nation’s children ages 17 years and

under were covered by a health

insurance plan, either a private-pay

plan or Medicaid (tabIe 1). OveraII,

the proportion of white children

covered by a heaIth insurance plan,

84 percent, was greater than the

proportion of black children covered,

81 percent. For infants under 1 year

of age, however, there was no

difference in health insurance

coverage by race. For toddIers

(l-4 years of age) and for older

children, there was no ciear trend in

the health insurance coverage of

white and black children.

For alI ages, 70 percent of

Hispanic chiIdren, compared with

85 percent of non-Hispanic children,

were enroIIed in a heaIth insurance

plan. The proportion of Hispanic

SUms.o

@ r.

#

+

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health SeNice

$ Centers for Disease Control

;

%.> National Center for Health Statistics

Manning Fein{eib, M.D., Dr. P.H., Director
2 Advance Data —

Table 1. Percent of children 17 years of age and under covered by a health Insurance plan

or Medkaid, by age and selected characterlstlcs: United States, 1988

[Data are based on household interviews of the civilian noninstrtutionallzed population. The survey design,

general qualifi=tions, and information on the reliability of the estimates are given in the technical notes]

All Under 1-4 5-7 e-11 12-14 1s17

Characteristic ages 1 year yaara yaara years yeara years

All children’ . . . . . . . . . . . . . .

Sex

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

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

Race

While . . . . . . . . . . . . . . . . . .

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

Hispac: origin

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

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

Family structure

Biological mother and father. . . .

Biological mother and

stepfather . . . . . . . . . . . . . . .

biological mother andothe?. . . .

Another .. . . . . . . . . . . . . . . .

Family income

Lessthan $10,090. . . . . . . . . .

$10,000-$24,999 . . . . . . . . . ,.

$25,000-$39,999 . . . . . . . . . .

$40,0000rmore . . .8.......

Place of residence

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

Central city . . . . . . . . . . . . .

Notcentralcity . . . . . . . . . . .

Not MSA . . . . . . . . . . . . . . .

Assessed health status

Excellent, verygood, or good. . .

Fairorpoor . . . . . . . . . . . . . .

83.1

S3.5

82.7

83.7

80.9

70.0

84.9

85.5

79.7

80.9

77.?

71.8

76.1

69.8

92.4

83.5

81.5

84.9

81.7

83.3

76.0

ao.1

80.4

79,7

60,7

81.2

62.2

82.8

81.6

0.0

76.9

75.3

74.0

75.1

S5.6

93.3

80.5

81.8

79.5

78.5

80.1

85.7

83.7

83.5

84.0

84,4

80.5

75,2

65.2

85,4

80.1

82.4

76.6

75.3

76.9

90.5

93.2

64,1

63.4

64.5

82.5

84.2

74.2

Percent

83.3

83.7

83.0

64.3

79,7

76.3

84.3

84.7

78.6

83.2

79.0

73.9

78.2

89.4

91.7

84.3

81.5

66.1

80.3

83.3

82.2

63.6

83.8

S3.8

83.6

84.1

65.0

86.3

85.9

81.5

60,6

60.2

71.0

75.3

92.1

92.0

83.4

81.3

84.8

84.9

84.0

83.6

S3.o

84.3

61.4

83.7

81.7

68.7

85.1

66.4

74.4

80.8

78.6

69.7

73.5

90.2

93.2

63.9

81.3

65.6

60.0

83.0

az.o

62.3

63.1

81.3

83.5

77.6

66.3

a3.a

86.9

82.6

7a.5

72.6

64.4

76.6

67.4

91.8

62.8

78.6

86.2

60.6

82.8

70.2

‘Includes other races and unknown family Income.

Zlndudes families mh mother on~.

NOTE MSA is metropolitan statisticalarea.

children who were covered bya

health insurance plan ranged from

62 percent for infants under 1 year

ageto 76 percent for children

5-7 years of age. Within every age

group, the percent of Hispanic

children covered was significantly

Jowerthan the figure for

non-HisPanic children.

of

Mo~erate and higher incomes are

usually associated with employment

that provides free or low-cost health

insurances an employee benefit.

Therefore. it is not surprising that

enrollment in a health insurance plan

was strongly associated with family

income. Children in families with an

annual income of $40,0000r more

were much more likely than children

in families ~vith an annui} income of

less than $lO,OOOto have had

insurance coverage –92percent

compared with72 percent. Health

insurance coverage was relatively

uniform across all age groups within

each family income category.

To a large extent, family structure

maybe aproxy for income, because

two-parent families generally have

higher incomes than families of other

compositions have (2). Therefore,

family structure may be an important

factor in health insurance coverage.

For this analysis, families were coded

into four categories: (a) both

biological parents present is coded as

“both parents,” (b) biological mother

and stepfather present is coded as

“mother and stepfather,”

(c) biological mother only or

biological mother and another

unrelated person present is coded as

“mother and other,” and (d) “all

other’’ includes all other families.

Eighty-six percent of children in

families with both parents present

were covered by health insurance

plans, more than in families with

mother and other (81 percent),

mother and stepfather (80 percent),

or other family structure (77 percent).

This basic pattern was found for all

age groups.

Routine doctor visits

In 1988, 64 percent of children

17 years of age and under had visited

adoetor for routine health care

during the past year (table 2).

Routine visits, that is, visits for

routine checkups and immunizations

when nothing is wrong, were most

common among infants under 1 year

of age (94 percent), followed by

toddlers 1-4 years of age

(82 percent), children 5-7 years of

age (66 percent), children 12-14 years

of age (55 percent), and teenagers

15-17 years of age (54 p~rcent).

Children 8-11 years of age were the

least likely to have had a routine

doctor visit during the past year,

50 percent. This decline in routine

visits may be expected, because

infancy and early childhood are the

times of the most rapid growth anld

development, requiring closer

monitoring of health status than in

later years. In addition, virtually all

routine immunizations are given by

the time children enter

kindergarten (3).

There were no differences

between the percent of boys and of

girls under age 12 years with a

routine visit in the past year. Of 12-

to 14-year-old children, more boys

than girls had had a recent routine

visit, 58 percent versus 52 percent,

This may be due to the routine

physical examinations required for

boys playing contact sports (4). Fen_

15- to 17-year-old teenagers, there

was no difference by sex between the

percents with a routine visit.

The same percent of black

children as of white children of all
Advance Data 3

Table 2. Percent of children 17 years of age and under who had visited a doctor for

routine health care during the past 12 months, by age and aeiected characteristics: United

States, 1988

[Dats are based on household interviews of the civilian noninstitutionalized population. The survey design,

generaI qualifications, and information on the reliability of the estimates are given in the technical notes]

Al Under 14 5-7 6-11 12-14 15-17

Characteristic ages 1 year years years yeara yeara yeara

Allchildren’ . . . . . . . . . . . . .

Sex

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

Female,................

Race

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

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

Hispanic origin

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

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

Family structure

Biologicalmotherandf ather. . . .

Biological mother and

stepfather . . . . . . . . . . . . . . .

Biological mother andothe#. . . .

Another. . . . . . . . . . . . . . . . .

Family income

Lessttran $10,000 . . . . . . . . . .

$10,OOH24,999. . . . . . . . . . .

$25,00M39,999 . . . . . . . . . . .

S40,0Wor more . . . . . . . . . . .

Place of residence

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

Centrality, . . . . . . . . . . . .

Notcentralcity . . . . . . . . . . .

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

Assessed health status

Excellent,verygood, orgood. . .

Fairorpoor . . . . . . . . . . . . . .

Health insurance

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

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

63.9

64.1

63.7

63.7

65.0

63.4

63.6

65.2

54.5

62.9

64.3

62.9

61.6

64.3

66.0

65.9

67.3

65.0

57.7

63.7

70.7

66.8

56.9

93.8

M

95.1

87.6

93.5

93.5

95.5

0.0

93.7

66.3

S7.4

96.1

94.9

97.2

93.7

92.1

95.0

94.3

93.6

97.s

86.1

91.8

SI.5

81.3

81.7

61.4

62.6

82.3

81.1

81.S

78.6

78.5

83.8

78.9

80.4

82.5

85.8

82.8

84.8

81.4

77.2

81.6

77.5

83.4

79.3

Percent

66.0

65.9

66.0

65.7

66.6

70.4

65.2

64.1

69.2

68.2

70.4

65.6

62.8

67.7

70.0

69.3

70.0

6S.9

55.7

65.5

76.0

68.6

58.9

49.6

49.4

49.9

47.9

55.7

49.5

49.5

49.1

44.4

51.2

53.7

49.5

43.7

47.1

56.3

52.3

55.8

50.1

41,5

49.4

58.2

52.6

39.0

54.6

57.6

51.6

56.0

51.7

51.9

55.0

55.5

47.3

55.9

55.7

53.5

47.9

54.3

62.5

57.0

54.0

56.S

48.0

54.5

66.8

56.6

42.1

53.9

52.5

55.3

54.0

55.7

45.5

54.s

53.7

56.6

57.1

49.1

45.9

52.6

56.9

58.4

54.5

54.5

54.5

52.2

53.8

61.7

57.7

44.3

linc,”des otherrSGeSand LM!W3WI f~i~ ‘nmme+

21nclude~ @mihes withmotherOnk.

NOE MSA is metropolitanstatisticalare&

ages had visitedadoctorfor routine

care inthe past year.However,

among children under Iyear ofage,

95 percent ofwhite infants, compared

with 88 percent of bIack infants, had

had a recent routine doctor visit

(significant at the 0.1 IeveI). Among

children 1-7 years of age, the visit

rates were simiIarforbIack and for

white children. Among older children,

there was no clear difference by race

in routine visits.

The percents of aIl children who

had had a routine visit in the past

year did not differ by Hispanic origin.

This was true for infants and

toddIers, as well. Among 15- to 17-

year-oIds, non-Hispanic teens were

more IikeIyto have had a recent

routine visit (55 percent) than were

Hispanic teens (46 percent).

As expected, family income and

enrollment in a heaIth insurance pIan

were important factors in the decision

to make a routine doctor visit (5,6).

At all ages, children in the highest

incom; families were more likeIy to

have had a recent routine visit than

were children in the lowest income

families. Similarly, chiIdren of all ages

whose families were enroIIed in a

health insurance pIan were more

IikeIy than others to have had a

recent routine doctor visit.

Regular source of health care

In 1988, the great majority of

chiIdren had a reguIar source of

routine medicaI care, that is, a

particular clinic, heaith center,

hospital, doctor’s office, or other

place where they went for routine

health care. The proportion with a

regular source of care ranged from

83 percent for teens ages 15-17 years

to 92 percent for toddlers (table 3).

There was no difference in source of

routine care between boys and girIs at

any age.

Twelve percent of our Nation’s

children did not have a reguIar source

of care; 20 percent of black infants,

compared with 8 percent of white

infants, had no regular source of

routine care in 1988. At 8 years of

age and over, the same proportions of

white and black children had a

regular source of care.

In contrast, there was no

difference in the proportions of

Hkpanic and non-Hispanic infants

and toddIers with a reguIar source of

routine care. However, at 5 years of

age and over, Hispanic chiIdren were

significantly Iess IikeIy to have a

regular source of care than were nonHispanic chiIdren.

Having a regxdar source of

routine heaIth care was also a

function of economic status. More

children in families with incomes of

$40,000 or more than chiIdren in

families with incomes of less than

$10,000had a regular source of care,

92 versus 84 percent. More children

in two-parent families than children

in other famiIies had a regular source

of care, 90 percent versus 83 percent.

Finally, more chiIdren in families with

health insurance coverage than

children with no insurance had a

source of routine care, 92 percent

versu3 79 percent.

For chiIdren of aII ages, the

Iocation of the chiId’s residence had a

slight effect on whether the child had

a regular source of routine health

care, Eighty-seven percent of innercity chiIdren, S8 percent of rural
4 Advance Data

Table 3. Percent of children 17 years of age and under who had a regular source of

routine health care, by age and selected characterlstlcs: United States, 1988

[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 m the technical notes]

All Under ‘7-4 5-7 8-17 12-14 15-17

Characteristic ages 1 year years yeara years years years

All children’ . . . . . . . . . . . . . .

Sex

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

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

Race

While, . . . . . . . . . . . . . . . . .

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

Hispanic origin

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

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

Family structure

Biological mother and father. , . .

Biological mother and

stepfather . . . . . . . . . . . . . . .

Biological motherand othe#. . . .

Another.. . . . . . . . . . . . . . . .

Family income

Lessthan$l0,000 . . . . . . . . . .

$10,000-$24,999 . . . . . . . . . . .

$25,000-$39,999 . . . . . . . . . . .

$40,0000rmore . . . . . . . . . . .

Place of residence

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

Central icy. . . . . . . . . . . . .

Notcentralcity, . . . . . . . . . .

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

Assessed health elatus

Excellent, very good, orgood. . .

Fairorpoor . . . . . . . . . . . . . .

Health insurance

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

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

88.0

87.6

88.5

08.6

86.5

81.1

86.9

90.4

82.6

86.1

62.8

83.8

86.0

91.1

92.4

88.1

87.3

88.8

87.8

88.1

87.9

91.9

79.0

89.9

90.1

89.6

92.1

79.8

88.2

69.8

92.5

0.0

85.1

81.3

82.4

92.7

91.3

94.4

90.1

88.8

91.2

89.1

89.6

97.6

93.0

85.7

92.3

92.0

92.6

93.0

90.3

89.2

92.9

93.3

84.7

93.0

87.7

88.3

92.5

94.6

96.5

92.4

92.6

92.3

92.1

92.5

90.2

94.9

88.5

Percent

80.8

89.9

91.7

91.3

87.9

82.1

91.9

91.6

88.7

69.9

67.9

88.8

88.3

94.6

94.7

90.9

67.1

93.3

90.4

90.7

90.9

94.0

83.4

86.9

88.0

87.9

87.2

86.4

81.6

67.6

89.4

82.4

83.2

84.5

80.8

63.7

89.4

93.0

87.5

86.9

67.9

85.1

87.1

83.6

90.9

75.8

85.0

85.J

64.9

8S.1

86.2

72.6

86.6

87.5

78.8

83.8

81.5

7::

69.3

90.5

85.2

85.2

85.2

64.5

85.0

66,7

90.0

70.3

82.9

82.6

63.3

83.4

82.9

72.2

84.2

86.5

81.9

81.9

74.2

74.8

81.1

86.1

87.0

62.1

81.4

82.5

85.4

82.9

84.3

68.2

70.7

‘Includes other races and unknown fsrnl~ income.

‘Includes famhes with mother only.

NOTE MSA is metrooolilan stntisticslarea.

children, and 89 percent ofsuburban

children had aregular source ofcare

in 1988. Eighty-nine percentof

infants who lived in either a central

city of a metropolitan statistical area

(MSA) or a rural area (not MSA)

had a regular source ofcare,

compared with 91 percent of infants

wholived in the suburbs. The

percents ofchildren l-4years ofage

with a regular source of care were

similar for all places of residence.

Private care and clinic care

Most children with aregular

source of care visited a doctor’s

office, private clinic, health

maintenance organization (HMO), or

prepaid group practice for their

routine health needs. In this report

the term “private care” refers to

medical care received from these

types of providers.

The remaining 8.7 million

children, or 16 percent of all children

with a regular source of care, went to

other types of providers (table 4).

These children visited hospital

outpatient clinics, hospital emergency

rooms, walk-in or emergency care

centers, and other clinics or health

centers for their routine health care.

In this report, the term “clinic care”

refers to medical care received from

these types of facilities.

Among children with a regular

source of care, black children were

three times aslikely as white children

to receive routine care in a clinic

setting. Thirty-five percent of all

black children, compared with

11 percent of all white children,

received routine cIinic care. Nearly

one-half of black infants under 1 year

of age, 47 percent, received routine

care in a clinic setting, compared with

16 percent of white infants.

A clinic was the source of routine

care for about twice the proportion of

Hispanic as of non-Hispanic children,

26 versus 14 percent. This difference

was most pronounced for infants,

with 48 percent of Hispanic infants

and 19 percent of non-Hispanic

infants receiving their well-baby care

in a clinic setting.

Whether a child received private

care or clinic care was highly

dependent on economic factors.

Thirty-seven percent of children in

families with annual incomes of Iess

than $10,000 received clinic care,

compared with 22 percent of children

in families with incomes of

$10,000-$24,999,9 percent of

children in families with incomes c)f

$25,000-$39,999, and 6 percent of

children in families with incomes c]f

$40,000 or more. Children in famillies

with both biological parents present

received clinic care less often

(11 percent) than did children in

families with the biological mother

and other present (27 percent) or

other family structures (23 percent).

Finally, children with health

insurance coverage used clinic cam

less than children with no insurance

coverage, 13 percent versus

32 percent.

Inner-city children of all ages

were more likely (23 percent) to hlave

received clinic care than were

suburban children (11 percent) or

rural children (16 percent). Infants in

the inner city were more likely

(33 percent) to have received clinic

care than suburban infants

(16 percent) or rural infants

(16 percent). The percents of rural

children who received clinic care

more closely resembled those of

suburban children than of inner-city

children, with the one exception clf
Advance Data 5

Table 4. Percent of children 17 years of age and under with regular source of care whose

regular source of care was not a private physician or health maintenance organization

(HMO), by age and selected characteristics: United States, 1988

[Dataare baaed on household interviews of the civilian noninstitutlonaliied population. The survey design,

genersl qualifications, and information on the rellabilii of the estimates are given in the technical notes]

All Under l-f 5-7 8-11 12-f4 15-17

Characteristic ages 1year years yeara years years yeara

Allchildren’ . . . . . . . . . . . . . .

Sex

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

Female . . . . . . . . . . . . . . . . ,

Race

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

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

HispanicOrigin

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

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

Family structure

131010gical mother and father. . . .

Biological mother and

stepfather . . . . . . . . . . . . . . .

Biologicalmotherand othe? . . . .

Another.. . . . . . . . . . . . . . . .

Famllyincome

Lessthan$lO,OOO . . . . . . . . . .

$10,000-.S24,999.. . . . . . . . . .

$25,000-S39,999. . . . . . . . . . .

$40,0000rmore . . . . . . . . . . .

Place of residence

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

Centralc~ . . . . . . . . . . . . .

Notcentrslcity . . . . . . . . . . .

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

Assessed health status

Excellent, ve~good, or good. . .

Fakorpoor . . . . . . . . . . . . . .

Health Insurance

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

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

15.5

15.1

15.9

11.2

35.2

26.2

14.2

11.1

13.1

26.6

22.6

36.5

22.4

9.2

5.7

15.5

23.3

10.6

15.5

15.2

23.2

13.0

32.3

22,0

23.9

19.6

16.0

46.5

47.6

18.7

15.5

0.0

30.6

46.8

35.9

32.2

11.9

4,2

23.6

33.4

15.7

16.1

22.3

16.9

~8.1

40,2

16.6

17.9

19.3

14.1

40.6

27.e

17.3

14.0

16.2

34.3

27.2

39.5

27.9

9.e

8.6

16.7

23.1

12.2

25.2

18.4

22.6

16.2

32.7

Percent

74.8

13.6

16.0

9.9

37.0

21.1

14.1

10.2

12.2

27.3

22.3

34.9

20.0

9.1

4.4

14.5

20.0

11.3

15.7

14.3

25.8

12.0

32.9

13.1

13.4

12.8

9.8

29.3

23.2

11.9

9.1

13.8

23.7

16.6

36.7

20.0

z

14.3

22.8

9.1

9.3

13.2

12.5

10.5

32.1

14.3

13.2

15.6

10.1

33.5

25.2

13.0

9.4

13.2

26.7

19.2

35.9

19.6

6.8

5.7

14.6

23.3

9.5

12.6

13.9

24.6

11.7

33.3

13.3

12.9

13.7

9.1

30.3

23.6

12.3

6.9

11.7

22.1

17.9

33.0

16.1

10.2

8.9

13.6

22.8

In

12.8

30.7

11.6

25.7

I]ncludasother racesand unknown faml~Imms.

a,n~ud~$familiesWthroomerOn@

NOTEMSAis metropolitanatstiatlcsl area.

children l-4 years ofage, Rural

toddlers (25 percent) andinner-ci~

toddlers (23 percent) received clinic

care more often than did suburban

toddlers (12 percent).

Summary

The findings in this report show

that black newborns and infants were

two to three times more likely to have

lacked a routine visit for a checkup or

any immunization during the crucial

first year of life than were white

newborns and infants. Hispanic

children were twice as likely to have

lacked public or private health

insurance coverage as were

non-l%spanic children. Poor children

with a regular source of care were six

times more likely to have received

routine care in a clinic or hospital

emergency room than were children

from more affluent families.

Inner-city children were twice as

likely to have received their routine

care in a clinic or emergency room as

were suburban children.

Insurance coverage for and health

services received by our Nation’s

children vary greatly among racial,

ethnic, and socioeconomic groups.

Black children, Hispanic children,

poor children, or inner-city children

do not receive the same medical

services as do their white,

non-Hispanic, affluent, suburban

counterparts. The health care needs

of all our children continue to be an

issue of great concern.

References

1.

2.

3.

4.

5.

6.

Adams PF, Hardy AM. Current estimates from the National Health Interview Survey, 1988.National Center

for Health Statistics. Vital Health Stat

10(173). 1989.

U.S. Bureau of the Census. Studies in

marriage and the family. Current

population report$ series P-23, no

162.Washington: U.S. Department of

Commerce. 1989.

Department of Health and Human

Services, Office of Maternal and

Child Health. Child health USA ’89.

Washington: U.S. Government

Printing Office. 1989.

Risser WL, Hoffman HM, Bellah GG,

Green LW. A cost-benefit analysis of

preparticipation sports examinations

of adolescent athletes. J School

Health 55(7) W2-3. 1985.

Cronin C, Hartman R. The corporate

perspective on maternal and child

health. Washington: Washington

Business Group on Health. 1989.

U.S. House of Representatives, Select

Committee on Children, Youth, and

Families. U.S. children and their

farnilies: current conditions and

recent trends, 1989.Washington: U.S.

Government Printing Office. 1989.
6 Advance Data

Technical notes nonresponse for the variables used in

this report was low, ranging from less

than 1 to 4 percent.

Because the estimates shown in

this report are based on a sample,

they are subject to sampling error.

The standard error is a measure of

the sampling error. Approximate

standard errors for estimated

percents in this report are determined

using the formula

estimated base of the percent. Tlm

bases of the percents for tables 1, 2,

and 3 are presented in table I; the,

bases of the percents shown in table 4

are presented in table II.

The approximate standard error

of a difference between percents is

given by the formula

The estimates presented in this

report are based on data from the

National Health Interview Survey

(NHIS), an ongoing sumey of

households in the United States

conducted by the National Center for

Health Statistics, Each week, a

probability sample of the civilian

noninstitutionalized population of the

United States is interviewed by

personnel of the U.S. Bureau of the

Census, Interviewers obtain

information about the health and

other characteristics of each member

of the households included in the

NHIS sample.

NHIS consists of two parts: (a) a

basic health questionnaire that

remains the same each year and is

completed for each household

member and (b) special topics

questionnaires that vary from year to

year and usually are asked of just one

person in each family. In 1988, the

special topics included acquired

immunodeficiency syndrome (AIDS)

knowledge and attitudes, medical

device implants, occupational health,

alcohol, and child health. These data

d

8,307p (1 -p) where x 1 and X2are the two percents

SE =

Y

being compared, xl -xz is the

difference between them, and SE(XJ

where SE is the standard error, p is and SE(XJ are the standard errors of

the estimated percent, and y is the the two percents.

Table L Number of children 17 years of age and under, by age and selected

characteristics: Unitad States, 1988

[Data are based on household interview of the civilian noninstitutionalized population. The survey design,

general qualifications, and information on the reliabilii of the estimates are given in the technical notee]

AfI Under 14 5-7 8-11 12-14 ‘=7

Characteristic ages 1year yeara yeara yeare yeare ,yeam

Number In thousands

10,639

5,433

5,206

S.S44

All children’...........,.. 83,569 3,s50 14,536 11,037 13,635 9,872

Sex

Male . . . . . . . . . . . . . . . . . . . 32,526

Female . . . . . . . . . . . . . . . . . 31,04S

5,224

4,646

2,030

1,820

7,360

7,156

5,597

5,439

6,862

6,774

sets can be linked to provide

additional sources for analysis.

The total sample interviewed

1988 for the basic health

questionnaire consisted of 47,485

households containing 122,310

Race

White . . . . . . . . . . . . . . . . . . 51,380

Black . . . . . . . . . . . . . . . . . . 9,820

3,017 11,60S

2,136

8,910

1,736

11,071

2,079

7,930

1,557 1;6S3

for

Hispanic origin

Hispanic . . . . . . . . . . . . . . . . 7,239

Non-Hispanic . . . . . . . . . . . . . 55,031

1,655

11,886

1,120

8,646

1,067

9,507

5,408

1,166

2,215

1,848

1,060

2,462

2,525

3,196

8,049

2,974

5,076

2,590

10,167

363

8,751

1,466

510

3,146

1,671

12,202

1,216

9,642

Family structure

Biological mother and father. . . . 36,999

Biological mother and

stepfather. . . . . . . . . . . . . . . 4,477

Biological mother and othe?. . . . 11,356

Another.. . . . . . . . . . . . . . . . 6,738

individuals. The total response rate

was 95 percent. For the National

Health Interview Survey on Child

Health (NHIS-CH), one sample child

17 years of age and under was

selected from each family with

children in that age range.

Information about the sample child

was collected by face-to-face

interview with the adult member of

the family present who knew most

about the sample child’s health, in

most cases the child’s mother.

Interviews were completed for 17,110

children 17 years of age and under,

95 percent of those identified as

eligible on the basis of the basic

health questionnaire. The overall

response rate for NHIS-CH was

91 percent, the product of the

response rates for the basic and the

child health questionnaires. Item

7,007 8,040 5,513

999

1,942

1,418

2,7a8 10,242

1,302

2,s40

1,654

0

442

620

327

2,130

1,837

682

1,987

1,360

Family income

Less than $lO,OOO. . . . . . . . . . 7,924

$10,OOC-S24,999. . . . . . . . . . . 16,708

$25,00C+$39,889., . . . . . . . . . 15,737

$40,0000r more . . . . . . . . . . . 16,071

1,722

3,568

3,419

3,484

1,062

2,470

2,457

2,736

619

1,108

864

774

1,965

4,134

3,649

3,306

1,496

2,967

2,822

2,576

Place of residence

MA. . . . . . . . . . . . . . . . . . . 48,314

Central ctty . . . . . . . . . . . . . 1S,972

Noncentral city . . . . . . . . . . . 29,342

Not MSA . . . . . . . . . . . . . . . . 15,255

10,307

3,96a

6,344

3,329

7,481

2,887

4,575

2,411

2,989

1,367

1,622

860

11,191

4,569

6,603

3,344

8,316

3,193

5,122

2,721

Aaseased health statue

Sxcellent, very good, or good . . . 61,173

Fairorpoor . . . . . . . . . . . . . . 1,7S8

13,926

481

10,647

309

13,169

287

9,558

256

3,666

91

Health insurance

Yes . . . . . . . . . . . . . . . . . . . 52,812

No . . . . . . . . . . . . . . . . . . . . 8,962

9,197

1,522

11,424

1,861

6,189

1,366

3,082

673

12,170

2,053

‘Includes other rsces and unknown tsmliy income

‘Includes ramhes wth mother only.

NOTE MSA is metropolksn statwtcsl area.
Advance Data 7

Table IL Number of children 17 years of age and under with a regular source of care, by

age and seleeted characteristics: United States, 1988

[Data are based on household intervievm of the civilian noninstitutionaliied population. The survey design,

general qualiicatione, and information on the reliability of the estimates are given in the technical notes]

All Under 14 5-7 6-11 12-14 15-17

Charsctedat/c ages 1 year years yearn years years years

Allchildren’ . . . . . . . . . . . . . .

Sex

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

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

Race

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

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

Hispanic origin

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

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

Familystructure

81010gicslmotherand father... .

Biologicaimother and

stepfather . . . . . . . . . . . . . . .

Blologioal motherand othef . . . .

Another., . . . . . . . . . . . . . . .

Famliyincome

LesethanSIO,OOO . . . . . . . . . .

$10,000-324,S99. . . . . . . . . . .

$25,000-$39,999 . . . . . . . . . . .

$40,0000rmore . . . . . . . . . . .

Place of residence

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

Centrality. . . . . . . . . . . . .

Notcentralclfy. . . . . . . . . . .

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

Aeseesedhealthstatus

Excellent, verygood, orgood. . .

Fakorpoor . . . . . . . . . . . . . .

Health insurance

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

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

55,970

28,469

27,461

45,502

8,480

5,871

46,922

35,253

3,699

9,763

7,235

6,640

14,368

14,336

14,856

42,582

16,571

26,011

13,388

53,869

1,571

48,532

7,081

3,460

1,829

1,631

2,779

514

450

2,826

2,580

37:

504

510

1,027

789

731

2,6S4

1,214

1,460

766

3,303

89

2,867

577

13,422

6,793

6,630

10,977

1,931

1,461

11,332

9,554

277

1,981

1,611

1,735

3,825

3,452

3,169

10,343

4.249

6,093

3,079

12,876

434

11,551

1.817

10,018

5,030

4,968

8,136

1,528

696

S,6S7

6,431

605

1,787

1,195

1,329

2,619

2,670

2,439

7,558

2,781

4,776

2,460

9,682

261

8,646

1,269

11,653

5,902

5,951

9,656

1,796

1,350

10,418

7,165

1,073

2,197

1,398

1,391

2,967

3,056

3,240

9,020

3,445

5,575

2,833

11,491

240

10,360

1,406

8,394

4,446

3,946

6,749

1,342

613

7,465

4,626

767

1,627

1,155

864

1,913

2,164

2,476

6,357

2,460

3,898

2,037

6,126

222

7,367

974

8,823

4,488

4,335

7,205

1,379

770

6,002

4,679

957

1,815

1,372

793

1,997

2,174

2,762

6,609

2,422

4,187

2,213

6,431

306

7,720

1,037

All differences cited in this report

are statistically significant at the

0.05 level unless otherwise noted. The

t-test, with a critical vaIue of 1.96, was

used to test all comparisons that are

discussed. Lack of comment regarding

the difference between any two

estimates does not mean that the

difference was tested and found not

to be statistically significant.

1,nd”de~otherracesmd unknown~V In=m*m

21ndude~~mille$withmetier ‘“V.

NOTR MSAIsmowopolitsnots!lsticalsroa.
8 Advance Data

Recent Issues of Advance Data From Vital and Health Statistics

No. 187. Child Care Arrangements: No. 185.1988 Summary: National No. 183. AJDS Knowledge and

Health of Our Nation’s Children, Hospital Discharge Survey Attitudes for July-September 1989

United States, 1988 (October 1, 1990) (June 19, 1990) (March 8, 1990)

No. 186. AIDS KnowIedge and No. 184. Use of Family Planning No. 182. Contraceptive Use in the

Attitudes for October–December Services in the United States: 1982 United States, 1973-88 (March 23I,

1989 (June 25, 1990) and 1988 (April 11, 1990) 1990)

Suggested citation

Bloom B. Health insurance and medical care:

Health of our Nation’s children, United States,

1988. Advance data from vital and health

statistics; no 188. Hyattsville, Maryland:

National Center for Health Statistics. 1990.

Copyright Information

This report may be reprinted without further

permission.
Number 189 . Sentember 26.1990

Advance

Data

From Vital and Health Statistics of the National Center for Health Statistics

Wanted and Unwanted Childbearing in the United States:

Data from

by Linda B. Williams,

Introduction

Of the nearly 16.5 million births

to ever-married women that occurred

from 1983 through 1988,

approximately 5.8 million, or

35 percent, were unintended. Of

those, about 30 percent were

unwanted, and the other 70 percent

were mistimed (wanted at a later

time). Statistics from the most recent

National Survey of Family Growth

(NSFG) reveal an apparent increase in

unwanted births for the first time since

the widespread acceptance of the most

effective methods of contraception.

Between surveys conducted in 1973

and 1982, the proportion of recent

births to ever-married women that

were unwanted at the time of

conception was cut almost in half,

from 14.3 percent to 7.7 percent.

~Morerecent data suggest, however,

that the proportion of unwanted births

to that group of women has once

again risen to over 10 percent.

Although many of the percentage

increases in unwanted conceptions

observed from 1982 to 1988 fail to

meet the tests of statistical

1973-88

the National Survey of Family Growth

Ph. D., and William F. Pratt, Ph. D., Division of Vital Statistics

significance, the pattern of increasing

proportions of unintended and

unwanted births is remarkably

consistent across subgroups of age,

race, marital status, and level of

income.

The findings presented in this

report are based on data from

Cycle IV of the NSFG, conducted by

the National Center for Health

Statistics. Data were collected from

January through August 1988 using a

multistage area probability sample of

women ages 15-M years. Interviews

were conducted with 8,450 women of

all marital statuses, 2,771 of whom

were bIack, 5,354 of whom were white,

and 325 of whom reported

identification with another racial

group. All belonged to the

noninstitutionalized population of the

United States.

Comparative data from Cycle I of

the NSFG, conducted in 1973, and

Cycle III, conducted in 1982, are also

analyzed. Like Cycle IV, the previous

cycles were based on multistage

probability samples of women ages

15-44 years. Trends for never-married

women are examined ordy for 1982

and 1988, because most never-married

women were excluded from the

sample in 1973 (l). Estimates

discussed in this report are derived

from samples and are subject to

sampling vtuiability. Information about

sampling variability, the survey design,

and the definitions of most of the

terms utilized in this report can be

found in the technical notes.

Concept of wontedness

The terms “wanted” and

“unwanted” are used in this report to

describe pregnancies that ended in a

live birth within 5 years of the survey

date, and they refer to the mother’s

attitude toward the pregnancy at the

time of conception. It should be noted

that births that were unwanted at

conception do not necessarily become

unwanted children. Mothers who

report a pregnancy as unwanted at the

time of conception nonetheless may

cherish the child born as the result of

that pregnan~.

Whether a birth was “wanted” was

determined from a series of questions

about the respondent’s use or nonuse

scwrc&. & ++

Jg U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ●

# Public Health Semite

~

3

Centers for Disease Control

%++

>

National Center for Health Statistics

%,afl Manning Feinleib, M. D., Dr. P.H., Director
2 Advance Data

of contraception at the time of

conception and about her attitude

toward her pregnancy once she found

that she was pregnant. If contraception

had not been used or had been

discontinued before the respondent

became pregnant, she was asked,

“Was the reason you (had stopped/

were not) using any methods because

you yourself wanted to become

pregnant?” Women who answered

“no” to that question were then asked,

’61[is sometimes difficult to recall

these things but, just before that

pregnancy began, would you say you

probably wanted a(nother) baby at

So}?ic time or probably not?” Women

WIYOsaid they had not used or had

discontinued using contraception prior

to a pregnancy because they had

wanted to become pregnant and

women who said they had probably

wanted to have a(nother) baby at

some time were then asked, “Did you

become pregnant sooner than you

wanted, later than you wanted, or at

about the right time?”

Pregnancies that occurred at a

time kvhen a respondent had not been

using or had discontinued

contraception because she wanted to

become pregnant were classified as

“wanted,” as were those that occurred

when a respondent was using

contraception but still felt that she

want ed (or probably wanted) to have

a(nother) baby at some time. Births

that were want ed but occurred sooner

than the respondent would have

preferred were classified as

“mistimed.” Those that occurred later

than the respondent would have

preferred are not considered mistimed

for this report, because, in most cases,

the delay was not the result of a

failure of planning or choice. A birth

was classified as “unwanted” if the

respondent reported that she had not

wanted (or probably had not wanted)

a(nother) child at the time of

conception or at any point in the

future. “Unintended” births are those

that were either mistimed or

unwanted.

If the respondent said she did not

know whether she wanted to have

a(nother) child then or in the future,

the “wantedness” status of the

pregnancy was categorized as

“undetermined.” That happened only

rarely, however. Of the births that had

occurred during the 5 years

immediately preceding each survey,

only 0.1 percent in 1973 and 1982 and

0.2 percent in 1988 were classified as

undetermined. Births categorized as

wanted or unwanted, therefore, are

basically complementary.

Trend in wontedness of births

to ever-married women

As has been noted, among

ever-married women, the proporticm

of recent births that were unwanted at

the time of conception decreased

sharply, from over 14 percent to

under 8 percent, from 1973 to 1982

(table 1). During the same time

period, the proportion of births that

were mistimed remained constant.

Although the proportion of mistimed

births has remained essentially

unchanged since 1982, the data

suggest that the proportion of recent

births that were unwanted at

conception has risen again to over

10 percent.

As in 1973 and 1982, the 1988

data show that the proportions of

births that were unwanted at

conception increased with age among

ever-married women. Although the

differences between contiguous age

groups were not all statistically

significant in 1988, all differences

Table 1. Number of children born in the last 5 years to ever-married women 15-44 years of age and percent distribution by wontedness

status, according to age and race of mother: United States, 1973, 1982, and 1988

[Slat!stlcs are based on samples of the female population of the UnHad Stales; sea technical notes for estimates of sampllng VStiabiltfy and definitions of terms.

Because of rounding of estimates, figures may not add to totals]

Wanted at conceptkm

Birttrs in the last 5 years Total Misttmed Unwanted at conception

All

Age and race 1988 1982 1973 birihs 1988 1982 1973 1988 1982 1973 1988 1982 ;1973

All races’ Number In thousands Percent distribution

—

Alleges . . . . . . . . . . . . 16,466 16,300 15,901 lCJJ.O 89.5 92.1 85,6 25.0 24.0 24.0 10.3 7.7 “14.3

15-24 years. . 2,982 4,133 5,028 100.0 91,1 94.3 91,8 42.6 43.6 39.4 6.6 *5.7 8.0

25-34 years . . . . . . . . . . . 10,794 10,176 9,105 100.0 90.8 93.1 66.3 23.3 18.5 18.3 9.0 6.7

35+44 years . . . . . . . . . . . .

13.5

2,690 1,991 1,768 100.0 82.2 82.7 64.2 12.2 *1 1.3 9.5 17.6 17.1 35.6

Whfle

Alleges . . . . . . . . . . . . . . 13,962 14,296 13,978 100.0 91.0 93.2 87.6 25.6 23.6 23.4 6.8 6.7 “12.3

15-24 years . . . . . . . . . . . . 2.599 3,666 4,297 100.0 92.3 95.2 93.3 43.4 44.1 38,3 7.4 ●4.8 6.5

25-34 years . . . . . . . . . . . . 9,131 8,862 8,164 100.0 92.0 94.1 88.3 23.6 17.6 18.0 7.6 5.8 “11.6

35-44 years........,.. 2,231 1.767 1,517 lCIO.O 85,1 84.4 67.6 12.7 ●11.2 9,8 14.6 15.6 :32.2

Black

Alleges . . . . ... ,., 1,472 1,598 1,724 100,0 766 a3,7 69.5 26.2 2a. 1 28,9 22a 15.9 30.5

15-24 years . ., . . . . . . . . . 302 410 702 100.0 64.4 85.3 82.5 36.3 40.2 45,9 *15.6 *J4.8 “17.5

2S-34 yeare . . . . . . . . . . . . 909 1,020 820 100.0 80.2 84.2 66.5 26.4 25.2 20.1 19.1 15.6 33,4

35-44 years . . . . . . . . . 262 167 202 100.0 55,9 77.5 36.6 *13.5 *1 6.6 ●5,6 44.1 *20.4 63.4

3

~!~cludeswhite, black, and otner races

klcluoes nirlhs C# unknown Wanledness Stelw.
Advance Data

between the age groups 15-24 years

and 3544 years were significant, as

were differences between the age

groups 25–34 years and 3544 years.

The same general pattern has been

observed among ever-married women

at all three survey dates covered in

this report, and the association

behveen age and unwanted

childbearing thus appears clear.

Conversely, the proportion of

births that were mistimed consistently

decreased with age among all evermarried women over time. Again,

although some of the differences

be&veen adjacent age groups were not

statistically significant, all of the

differences between the women in the

youngest and the oldest age categories

were significant.

Among ever-married women,

births that are reported as mistimed

continue to outnumber those that

were unwanted at the time of

conception. Although mistimed births

in the 5 years leading up to the 1973

survey were 1.7 times as prevalent as

unwanted births, by 1982 they

outnumbered births that were

unwanted by more than 3 to 1. Even

with the apparent recent increase in

unwanted childbearing, mistimed

births were more than twice as

common as unwanted births in 1988.

Earlier authors have intimated

that growing numbers of mistimed

births, especially among younger evermarried women, might accompany

shifts in contraceptive use away from

more effective methods and toward

barrier methods (2), such as the

diaphragm, cervical cap, condom, or

foam. Although that explanation may

have been plausible during the 1970’s,

more recent evidence suggests that the

current trend in contraception favors

more effective methods such as the

pill and sterilization, and many of the

less effective methods have become

less popular (3).

Births in the 5 years before the

survey that were considered unwanted

at the time of conception were almost

twice as common among formerly

married women as they were among

currently married women in 1973 and

more than twice as common among

formerly married women as among

currently married women in both 19S2

and 1988 (table 2). Although the

pattern of differences between those

currentIy and formerly married was

the same among both white and biack

women, only the differences among

white women were statistically

significant.

In previous research, a possible

link has been noted between the

occurrence of out-of-wedlock births,

many of which are unwanted at

conception, and the likelihood that

muples who later marry will

eventually separate or divorce (4).

Because formerly married women

tend to be older and to have borne

more children than currently married

women and because increases in both

age and parity are associated \vith

increases in unwanted childbearing (2), it has also been argued

that the associations between these

variables warrant further study.

Although the proportion of

unwanted births to both currently

married white women and currently

married black women decreased

significantly from 1973 to 19S2, there

has been no statistically significant

change since that time. In addition,

the gap appears to have narrowed

somewhat between levels of unwanted

childbearing among formerly married

white women and formerly married

black women. Although differences

between the hvo groups were

statistically significant through 19S2,

that was not the case in 19S8.

Currently married black women,

on the other hand, have consistently

reported higher proportions of

unwanted births than have currently

married white women at aII three

survey dates. As of 1988, unwanted

births were more than twice as

prevalent (as a percentage) among

currently married bIack women as

among currentIy married white

women.

Table 2. Number of children born in the last 5 years to ever-married women 15-44 years of age and percent distribution by wontedness

status, according to marital status and race of ‘mother: United States, 1973, 1982, and 1988 - -

[StatJSflCSare based on samples of the female population of the United Slates; see technical notes for est:mates of samphng varmbllily and defmriions of terms.

Because of rounding of estimates, figures may not add 10 totals]

Wankd at cixrception

Birttrs m the lest 5 years Total Mstfmad

All

Urwantea at carrception

Mental status and race 1988 1962 1973 brth-s 1988 1962 1973 1988 1982 1973 1988 1982 1973

Number in thousands’ Percent dtstrbution

Aliracesz . . . . . . . . . . . . . 16,466 16,300 15,eol 100.0 89.5 92.1 85.6 25.0 24.0 24.0 10.3 7.7 14,3

Currently marrkad . . . . . . . . 14,427 14,442 14,248 100.0 91.1 93.2 a6.9 24.4 22.5 23.4 8.7 6.7 13.0

Forrnerty married . . . ., . . . 2,039 1,858 1,653 100.0 77.8 84.5 74.4 28.8 36A 29.0 21.9 15.4 25.2

While . . . . . . . . . . . . . . . 13,962 14,2e6 13,978 100.0 91.0 93.2 87.6 25.6 23.6 23.4 8.6 6.7 12.3

Currentty married . . . . . . . . 12,489 12,921 12,654 100.0 92.1 93.7 66.2 25.1 22.1 22.8 7.7 6.1 11.7

Formerly married . . . . . . , . 1,473 1,374 1,124 100.0 81.4 87.8 80,3 29.4 37.4 29.9 16,6 ‘12.3 19.2

Black . . . . . . . . . . . . . . . . 1,472 1,598 1,724 100.0 76.8 83.7 69.5 26.2 28.1 26.9 23,8 15.9 30.5

Currently married . . . . . . . . 1,010 1,173 1,195 100.0 80.5 726 25.2 27.3 29.7

Formerty married . . . . . . . .

19.5

462 425 529

?1,7 27.2

100.0 66.5 E 62.1 28.1 30,5 27.3 30.1 273 37,9

‘Includes births d unkmn wmfedness stsrus.

2

Irwtides white, black, acd other races.
4 Advance Data

Among all ever-married women,

the gap between the level of unwanted

childbearing among black women and

white women diminished from 1973 to

1982, then widened considerably from

1982 to 1988. In 1973, unwanted

births were more prevalent among

black women than among white

women by 18 percentage points. By

1982, that difference had narrowed to

9 percentage points, but the size of

the difference between the two groups

has since risen to 14 percentage

points.

There are several reasons why

large differences remain between the

proportions of unwanted births to

white women and to black women.

Black teens initiate sexual activity

before white teens do, and therefore

they are exposed to the risk of

childbearing at an earlier age and

generally reach their desired family

size earlier. In addition, black teens

are less likely than white teens to use

contraception, and their pregnancies

are less apt to end in abortion (4).

Although black teens are more likely

than white teens to have had a family

planning visit in the past year (5), such

visits among either group may occur

as the result of an unintended

pregnancy rather than as an attempt to

prevent one. Why the gap between the

two racial groups has widened since

1982 is not known, however.

Data illustrating the pattern of

change in unintended childbearing

among ever-married women having

different levels of income relative to

poverty are presented in table 3.

Although it appears that the unwanted

portion of unintended childbearing has

increased among all ever-married

women since 1982, recent percentage

point increases have been most

pronounced among women living

below the poverty level. From 1982 to

1988, the proportion of unwanted

births among women in poverty rose

by almost 75 percent.

At the time of the first NSFG,

differences in unwanted childbearing

by race were observed across income

cat egories. In 1973, ever-married

black women reported more unwanted

pre~ancies than did white women at

every level of income. By 1982,

differences by race within income

groups were no longer statistically

significant, except among women with

incomes below the poverty level, and

the differences that remained between

black women and white women in that

category were significant only at the

0.10 level. According to data from

1988, however, the levels of unwanted

childbearing among ever-married

black women and white women in

poverty have again diverged; the

percentage among poor black women

is once again more than double that

obsewed among poor white women

(35 and 17 percent, respectively).

Trend in wantedness of births

to never-married woman

The data suggest that, since 1982,

unwanted births to never-married

black women 20-24 years of age have

also increased (table 4). No

statistically significant changes have

taken place in the proportions of

mistimed births to never-married

women in any age category.

Notably, however, unintended

childbearing among never-married

white women over the age of 24 has

declined. Although the percentagepoint decrease in mistimed births to

women in that age group was not

statistically significant, unwanted

Table 3. Number of children born in the last 5 years to ever-married women 15-44 years of age and percent distribution by wontedness

status, according to poverty ststus and race of mothec United States, 1973, 1982, and 1988

[Statistics are based on samples of the female populafkm of the United States; see technical notes for estimates of sampling variablhly and defmifions of terms.

Because of rounding of estimates, figures may not add to tolafs]

Wanted d conception

Bkfhs in the last 5 years Total

Ail

Mistimed Urrwurted at concepfkm

Poverty level Income and race 1988 1982 1973 blrihs 1988 t982

—

1973 1988 198.2 1973 1988 1982 7973

All racesl

All levels . . . . . . . . . . . . . .

Below poverty . . . . . . . . . .

10GI49 percent, . .

150-199 percent, , . . ., . .

200 percent or more .

Whfle

All levels . . . . . . . . . . . . . .

Below poverty . . . . . . . . . .

100-149 percent. . .

150-199 percent. . . . .

200 percent or more . . . .

Black

All levels . . . . . . . . . . . . . .

Below poverty,,,....,,,

100-149 percent. . . . .

150-199 percent. ., . . .

200 percent or more . . . . .

Number In thoueandsz Percent distribution

16,466 16,300 15,901

2,469 2,790 2,271

1,763 2,007 2,010

2,173 2.291 2,403

10,042 9,212 9,217

100.0 69.5 92.1 85.6 25.0 24.0 24.0 10.3 7.7 1’4,3

100.0 78.9 86.1 73.6 34.3 31.5 25.3 20.7 11.9

100.0 65.8 86.9

26.1

62.7 32.3 33.7 27.6 14.1 12.4 17.3

100.0 91.6 94.4 65.6 22.9 22.1 24.8 8.3 *5.5 14.2

100.0 92.2 94.0 69.2 21.6 20.2 22,7 7.5 6.0 10.7

13,962 14,296 13,978

1,901 2,226 1,619

1,417 1,699 1,637

1,890 2,037 2,165

6,753 8,334 8,558

1,472 1,598 1,724

422 494 637

223 257 326

162 212 214

666 634 547

100.0 91.0 93.2 87.6 25.6 23.6 23.4 8,8 6.7 12.3

100.0 82.2 69.8 80.5 37.3 31.0 27.5 17.4 *1O.2 19.1

100.0 67.5 68.0 84.5 32.4 33.3 25.1 12.4 *11.2

100.0 92.6

15.5

95.3 87.1 24.0 21.5 24.9 7.2 *4.7 12.6

100.0 93.1 94.7 89.6 22.3 20.2 21.6 6.7 5.4 10.2

100.0 76.8 83.7 69.5 26.2 26.1 28.9 22.8 15.9 30.5

100.0 63.8 78,4 56.2 27.1 31.5 20.3 35.3 21.0 43.8

100,0 75.0 77.0 72.3 *35.7 32.0 36.1 *24. O ●23. O 27.6

Ioa.o 75.5 65.1 73.1 ●27.9 ●26. 2 26.7 ’24.3 ●14.O 26.6

100.0 85.9 90.1 81.9 22.0 24,5 34.3 ●14,1 *9.6 16.0

1hc!udeswh!te, back, and otter races

‘Includes births c/ unkmwn wontedness sta!us
Advance Data 5

Table 4. Number of children born in the last 5 years to never-married women 15-44 years of age and percent distribution by wontedness

status, according to age and race of mothe~ United States, 1982 and 1988

[Statls.tbs are trassd on samples of the female populatbn of the Unltsd Stateq see teohnieal notas for estimates of sampling varfabllily and defkrilbns of terms.

Because of rounding of estimates, f!gures may not add to totals]

Wanted at wrrceptkm

Blrttr.sIn ttre lest 5ywa Total Mlst,tnad Unwanted at conception

All

Age and race

.—.

1968 1962 b&ths 1986 1962 1966 1962 1968 1982

All races’ Number in thousrmdsz Percent dlstributhx

Alleges . . . . . . . . . . . . . . . . . . . . . 2,481

428

1,162

891

2141

473

1,022

100.0

100.0

Iwo

100.0

74.5 74.6

76.8 75.5

73.9 63.9

74.0 59.1

85.5 79.7

89.7 S5.f

83.6 91.5

86.8 5%9

64.0 89.1

87.9 68.2

625 76.1

63.8 58.4

39.6 47.1

63.5 54.7

426 51.4

24.6 34.8

25.4

%23.2

26.1

25.7

25.3

24.5

16.1

40.6

1519years . . . . . . . . . . . . . . . . . . .

20-24 years . . . . . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . . . . . .

White

981

122

953

218

424

311

100.0

Ieo.o

1W.o

100.0

45.7 54.9

70.6 61.3

49.5 59.6

320 44.1

14.5

●I 0.3

16.5

13.2

20.3

*1 4.9

●6.5

40.1

Al[ages . . . . . . . . . . . . . . . . . . . . .

V5-19years. . . . . . . . . . . . . . . . . .

20-24 years . . . . . . . . . . . . . . . . . .

2544years . . . . . . . . . . . . . . . . . .

605

364

Black

Alleges . . . . . . . . . . . . . . . . . . . . . 1,363 1,117

245

537

100.0

100.0

Iwo

100.0

34.5 39.9

57.5 49.2

36.3 44.1

%0.3 26.2

35.7

●321

37.5

36.6

30.8

31.8

23.9

41.1

15-19 years . . . . . . . . . . . . . . . . . .

20-24 yeem . . . . . . . . . . . . . . . . . .

25-44 years . . . . . . . . . . . . . . . . . .

289

5s8

Ea5

‘ Incbdeswhhs,Mck, and otlmr-.

zlmhd~~ bifih C#WIkI’)CWnwtid- ‘*s’

births to women in that group

decreased by about 27 percentage

points, or 67 percent. If there has

been a real increase in the proportion

of wanted births among these women,

it raises the possibility that the rising

rates of births among unmarried

women reflect dell%erate choices to

accept singIe parenthood. hong

unmarried women ages 25-29 years,

the birth rate rose from 26.8 births per

1,000 women in 1976 to 44.3 per 1,000

women in 1987. Among unmarried

women ages 35-39 years, the birth

rates rose from 9.0 to 13.5 per 1,000

in the same years (6).

1973-82. Advance data horn vital and

health statistics; no 108. HyattsvilIe,

Ma@nd: National Center for Health

Statistics. 1985.

3. Mosher WD, Pratt WF. Contraceptive

use in the United States, 1973-88.

Advance data from vital and health

statistiW no 184. Hyattsville,

Maryland: National Center for Health

Statistics. 1990.

4. Farley ~ Allen WR. The color line

and the quality of life in America. New

York: Gxford University Press. 1989.

5. Mosher WD. Use of family planning

population, 1973. Current population

reports series P-60, no 98.

Washington U.S. Department of

Commerce. 1975.

Munson ML. Wanted and unwanted

births reported by mothers 1544 years

of age: United States, 1973. Advance

data horn vital and health statistiw,

no 9. HyattsvilIe, Maryland: National

Center for Health Statistics. 1977.

U.S. Bureau of the Census. Money

income and poverty status of families

and persons in the United States,

1982. Current population report%

series P-60, no 140. Washington U.S.

Department of Commerce. 1983.

Mosher WD, Bachrach CA.

Contraceptive use, United States,

1980. National Center for Health

Statistics. Vital Health Stat 23(12).

1986.

U.S. Bureau of the Census. Poverty in

the U.S.: 1987. Current population

report.y series P–60, no 163.

Washington: U.S. Department of

Commerce. 1989.

8.

9.

10.

11.

serviees in the United States: 1982 and

1988. Advance data ffom vital and

health statisti=, no 184. Hyattsviile,

Maryland: National Center for Health

Statistics 1990.

National Center for Health Statistics.

Advance report of final natality

statistic+ 1987. Monthly w-talstatistics

repo~ vol 38 no 3, suppI. Hyattsville,

Ma@and: Public Health S-mice. 1989.

U.S. Bureau of the Census.

Characteristics of the low-income

References

1. French DK National Survey of Family

6.

7.

Growth, Cycle E sample design, esti- -

mation procedures, and variance estimation. National Center for Health

Statistics. Vital Health Stat 2(76).

1978.

Pratt WF, Horn MC. Wanted and

unwanted childbearing United States,

2.
6 Advance Data

Technical notes

The National Survey of Family

Growth (NSFG) is a periodic survey

conducted by the National Center for

Health Statistics (NCHS). During the

survey, data are collected on factors

affecting childbearing, contraception,

infertility, and related aspects of

maternal and infant heaIth. The survey

is jointly planned and funded by the

National Center for Health Statistics,

the National Institute for Child Health

and Human Development, and the

Office of Population Affairs. All are

part of the U.S. Department of Health

and Human Services. Fieldwork was

conducted under contract by Westat,

Inc., in 1982 and 1988, and by the

National Opinion Research Center in

1973.

Qcle IV interviews were

conducted with a national sample of

women who were 15-44 years of age

as of March 15, 1988. The interviews

took place from January through

August of the same year. In 1973 and

1982, the population represented was

women 1544 years of age in the

civilian noninstitutionalized population

of the conterminous United States. In

1988, Alaska and Hawaii were

included, so the population

represented was the civilian

noninstitutionalized population of the

entire United States. Interviews were

completed with 9,797 women in 1973,

7,969 women in 1982, and 8,450

women in 1988.

Households selected for Cycle IV

of the survey had been interviewed in

the National Health Interview Survey

(NHIS), conducted from October

1985 through March 1987. (NHIS is

also conducted by NCHS.) As in

previous cycles of the NSFG, black

women were oversampled. Interviews

were conducted in person, generally in

the respondents’ homes, by trained

female interviewers. Interviews lasted

an average of 70 minutes and focused

on the woman’s pregnancy history;

past and current use of contraception;

ability to bear children (fecundity and

infertility); use of medical services for

family planning, infertility, and

prenatal care; marital history,

occupation, and labor force

participation; and a wide range of

social, economic, and demographic

characteristics.

Reliability of estimates

Because the statistics presented in

this report are based on a sample, they

may differ by chance variations from

the statistics that would result if all

57.9 million women represented by the

NSFG had been interviewed. The

starldard error (SE) of an estimate is a

measure of such differences. The SE

of an estimated number or percent is

calculated by using the appropriate

values of A and B from table I in the

equations

and

SE(P)=-

where N = the number of women

P = the percent

X = the number of women in

the denominator of the

percent.

Table L Preliminary estimates of the

parameters A and B for estimating

standard errors for women, by race

Race A B

Total or while . . . -0.00018 10,738

Black . . . . . . . . . -0.000626 5,161

The parameters shown in table I

were used to generate table II, which

shows preliminary estimates of

standard errors for percents of births

to total or white women, and table III,

which shows preliminary estimates of

standard errors for percents of black

women. A similar table for Cycle III

(1982) is included in (2).

The chances are about 68 out of

100 that a sample estimate would fall

within one standard error of a statistic

based on a complete count of the

population represented by the NSFG.

The chances are about 95 in 100 th,at

a sample estimate would fall within

two standard errors of the same

measure if all people in the population

were interviewed. Differences among

percents discussed in this report were

found to be statistically significant at

the 5-percent level using a two-tailed

normal deviate test. This means that in

repeated samples of the same type and

size, a difference as large as the one

observed would occur in only

5 percent of samples if there were, in

fact, no difference between the

percents in the population.

In the text, terms such as

“greater,” “less/’ “increase:’ or

“decrease” indicate that the observed

differences are statistically significant

at the 0.05 level using a two-tailed

normal deviate test. Statements using

the phrase “the data suggest” indicate

that the difference is significant at the

0.10 level (or 10-percent level), but

not the 0.05 level (or 5-percent level).

Lack of comment in the text about any

Table IL Preliminary estimates of standard errors for percents of pregnancies of total or

white women: 1988 National Survey of Family Growth

Estimafed percent

2 or 5 or 10 or 20 or 30 or 40 or

Base ofpercant 98 95 s 30 70 60 50

—

Standard error in percentage points

100,000 . . . . . . . . . . . . . . . . . 7.9 10.9 14.5 16,7 17.8 18.2

250,000 . . . . . . . . . . . . . . . . . :; 5.0 6.9 9.2 10.6 11.3 11.5

5C0,000.. . . . . . . . . . . . . . . . 23 3.5 4.9 6.5 7.5 8.0 8.1

1,000,000 . . . . . . . . . . . . . . . . 1.6 2.5 3.4 4.6 5.3 5.6 5.7

5,000,000 . . . . . . . . . . . . . . . . 0.7 1.1 1.5 2.1 2.4 2.5 2.6

Io,ooo,ooo . . . . . . . . . . . . . . . 0.5 0.8 1.1 1.5 1.7 1.6 1.8

20,0m,ooo . . . . . . . . . . . . . . . 0.4 0.6 0.8 1.0 1.2 1.3 1.3

30,000,000 . . . . . . . . . . . . . . . 0.3 0.5 0.6 0.8 1.0 1.0 1.0

50,000,0CM3. . . . . . . . . . . . . . . 0.2 0.4 0.5 0.7 0.7 0.8 0.8

75,000D00.. . . . . . . . . . . . . . 0.2 0.3 0.4 0.5 0.6 0,7 0.7

Ioo,ooo,ocm. . . . . . . . . . . . . . 0.2 0.3 0.3 0.5 0.5 0.6 0.6
Advance Data 7

Table ill. PreilmInary estimates ofstindard errors forpercents ofpregnancIes of black

women: 1988 National Survey of Family Growth

EstImaladNrcent

2or 5or 10or 20or 30 or 40 or

8ase of pement 98 95 90 80 70 60 50

Standarderrorinpercentagepoints

100,000. . . . . . . . . . . . . . . . . 2.9 4.6 6.3 8.4 9.6 10.3 10.5

250,000. . . . . . . . . . . . . . . . . 1.9 29 4.0 5.3 6.1 6.5 6.6

5oa,om. . . . . . . . . . . . . . . . . 1.3 20 2.8 3.8 4.3 4.6 4.7

I,oco,ooo... . . . . . . . . . . . 0.9 1.4 2.0 2.7 3.0 3.3 3.3

5,000,000. . . . . . . . . . . . . . . . 0.4 0.6 0.9 1.2 1.4 1.5 1.5

lo,wo,ooo. . . . . . . . . . . . . . . 0.3 0.5 0.6 0.8 1.0 1.0 1.0

25,000,000. ...... ..... .. 0.2 0.4 0.5 0.7 0.8 0.8 0.9

two statistics does notmean that the

difference was tested and found not to

be statistically significant.

The relative standard error (or

coefficient of variation) of a statistic is

the ratio of the standard error to the

statistic and usually is expressed as a

percent of the estimate. In this report,

statistics with a relative standard error

of 30 percent or more are indicated

with an asterisk (*). These estimates

may be viewed as unreliable by

themselves, but they may be combined

with other estimates to make

comparisons of greater precision.

Statistics in this report also may

be subject to nonsampling error, that

is, errors or omissions in responding

to the interview, recording answers,

and processing data. The data have

been adjusted for nonresponse by

means of adjustments to the sample

weights assigned to each case. Other

Iypes of nonsampling error were

minimized by a series of quality

control measures, as described in

reports on Cycle III (such as (l)).

Definitions of terms

Wantedne.ss-For this report,

pregnancies that ended in a live birth

within 5 years of the survey date have

been classified as either “wanted” or

“unwanted.” A pregnancy was

classified as wanted at conception if

the woman had stopped, or had not

used, contraception because she

wanted a pregnancy, or if she had

become pregnant while using

contraception but nonetheless had

wanted, or probably wanted, a(nother)

baby at some time. Similarly, a

pregnancy was classified as unwanted

at conception if the woman had

stopped, or had not used,

contraception for reasons other than

seeking pregnancy, or if she had

become pregnant while using

contraception and had not wanted, or

probably had not wanted, a(nother)

baby at some time. Births that were

wanted but occurred sooner than

desired have been subclassified as

“mistimed.” If the woman had become

pregnant later than desired, the

pregnancy was not classified as

mistimed because it did not represent

a failure in family planning and was

not subject to contraceptive control.

Births that were either unwanted or

mistimed have been classified as

“unintended.” If the respondent said

she did not know whether she wanted

to have a(nother) child then or in the

future, the wontedness status of the

pregnancy was categorized as

undetermined. Pregnancies that ended

in multiple births have been counted

only once because only the pregnancy

was subject to contraceptive control.

Births within Syears of the sunvy—

In Qcle IV, interviews were

conducted from January through

August 1988. Births that occurred

within 5 years of the exact date on

which the woman was interviewed

were considered “births in the past

5 years” for the sake of this analysis.

For the 1988 survey, the births

counted in this way occurred during

the period January 1983 through

August 1988, which is just over 5 1/2

years. However, because the births to

each woman interviewed were counted

over ordy 5 years, not all births from

January through August of either 1983

or 1988 are included. Thus, the

estimated numbers of births in this

report are equivalent to the births that

occurred from May 1, 19S3, through

May 1, 1988. The same definition was

used to define births that occurred

within 5 years of the survey date both

in 1982 and in 1973.

Age—Age was classified by the

age of the respondent in completed

years as of March 15, 1988, the

approximate midpoint of the

interviewing.

Race—Race refers to the race of

the woman interviewed and is

reported as black, white, or other. In

Cycles Ill (1982) and IV (19SS), race

was classified according to the

woman’s report of the race that best

described her. In Cycle I, race was

classified by the observation of the

interviewer. Data from Cycles 111and

IV indicate that results using the hvo

methods of classification are very

similar.

Mcnitcr[stcmts—Women were

classified by marital status as married,

widowed, divorced, separated, or never

married. In the three cycles analyzed

in this report— Cycle I (1973),

Cycle III (19S2), and Cycle IV

(1988) –informalIy married or

cohabiting women, who reported that

they were not married but were living

with their sexual partner, were

classified by their legal marital status.

Women who were married but

separated from their spouse were

classified as separated if the reason for

the separation was marital discord;

otherwise they were classified as

currently married.

Po~’e}~status-The poverty index

ratio was calculated by dividing the

total family income by the weighted

average poverty threshold income of

nonfarm residents in households

headed by persons under age 65. For

Cycle I, the ratio was based on the

poverty levels defined by the U.S.

Bureau of the Census in Current

Population Repoiis, Series P-GO,

No. 98 (7), as discussed in a previous

NCHS report (8). The definition of

pover~ status took into account the

sex of the family head and the number

of persons in the family. Total family

income includes income from all
8 Advance Data

sources for all members of the

respondent’s family. For Cycle III, the

ratio was expressed as a percent of

poverty levels defined by the U.S.

Bureau of the Census in Current

PopuIczion Reports, Series P-GO,

No. 140 (9), as discussed in a previous

NCHS report (10). In Cycle IV, the

ratio was based on the poverty levels

shown in Current Popuhtz”on Repom,

Series P-60, No. 163 (11).

Suggested citation

WilliamsLB and PrattWF, Wanted and

unwantedchildbearingin the United States:

1973-88. Advance data from vital and health

statistics;no 189. Hyattsvilie,Maryland:

NationalCenter for HealthStatistics.1990.

Cooperating agencies

Cycle IV of the National Survey of

Family Growth was supported in part

by the National Institute of Child

Health and Human Development,

National Institutes of Health, and the

Office of Population Affairs, Office of

the Assistant Secretary of Health.

These agencies also participated in the

design of the questionnaire.

Symbols

--- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than zero but less

than 500 where numbers are

rounded to thousands

* Figure does not meet standard of

reliability or precision

# Figure suppressed to comply with

confidentiality standards

Copyright information

This report may be reprintedwithoutfutther

permission,
Number 190 . November 16.1990

Advance

Data

From Vital and Health Statistics of the National Center for Health Statistics

Developmental, Learning, and Emotional Problems

Health of Our Nation’s Children, United States, 1988

by Nicholas Zill, Ph. D., Child Trends, Inc., and

Charlotte A. Schoenborn, M.P. H., Division of Health Interview Statistics

Introduction

Asmany of the infectious diseases

that affect:d children in the past are

conquered or ameliorated, a growing

share of pediatric practice involves

developmental delays, learning

difficulties, and emotional and

behavioral problems. These conditions,

and others such as aIIergies, asthma,

and eating disorders, have been

labeled the “new morbidity of

childhood” (l). All of these conditions

have a substantial psychological

component, and none fits easiIy into

the physical disease paradigms with

which medicine is used to dealing.

There are several reasons why these

conditions should be of concern to

public health professionals and

policymakers.

To begin with, these kinds of

conditions appear to be quite

prevalent and may be becoming more

so (2; 3, pp. 32-34). Increases in

childhood psychological disorders have

been attributed to the growing

proportions of children who

experience parental divorce, were born

outside of marriage (4), or are raised

in conflict-filled families or lowincome, low-education, single-parent

households. Childhood Ieaming and

behavior problems may aIso be

multiplying because of the increased

survival rate of extremely Iow-birthweight babies (5), the possibIe effects

of environmental contamination (6),

and the rising numbers of babies born

to crack-addicted mothers (7).

The fact that many young people

are affected by developmental delays,

learning disabilities, or emotional

problems does not mean that such

disorders are transient or

inconsequential; some have profound

and Iasting effeets on famiIy

functioning and children’s Iife chances.

These conditions often interfere with a

child’s academic success and peer

relationships and put a strain on

parental resources and equanimity.

Developmental disorders and mental

illness in children are also costly and

burdensome to society, requiring

special services in schools and other

institutions and sometimes

necessitating long-term care at State

expense (8).

Another area of concern is that

the medicaI care system is not yet well

equipped to handle these kinds of

childhood problems. The etiology of

most developmental and behavioral

disorders is not well understood.

Although there is evidence that

counseling and treatment can help

(9,10), there is uncertainty and

sometimes lack of consensus about

appropriate modes of treatment for

specific disorders —for example,

disputes over the use of the drug

Ritalin in treating hyperactive

youngsters (11). Many famiIy

physicians have not been adequately

trained to recognize and deal with

these types of problems, and

procedures for referring children for

psychological diagnosis and treatment

are not standardized. There is believed

to be a substantial group of young

people with developmental or

behavioral disorders whose problems

go untreated and perhaps even

unrecognized (12, pp. 24-27). There is

also concern that, although conduct

probIems of middle-class \vhite youths

are handIed within the mental health

system, the same sorts of problems

among Iower class black or Hispanic

youths often go untreated, only to be

dealt with eventually by the criminal

justice system.

Reliable national data on the

incidence and prevalence of

developmental and behavioral

* SWms.ti

#’

#

%

#

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

g Public Health Service

s Centers for Disease Control

;“%.> National Center for Health Statistics CENTEW CDC f~$l X5EASE C2NTRCt

Manning Feinleib, M.D., Dr. P.H., Director
2 Advance Data

conditions in childhood have been

hard to come by, partly because of

definitional ambiguities and changes in

medicaI and educational terminology

(12, chapter 2). Prevalence estimates

based on small and unrepresentative

samples have tended to vary over an

implausibly wide range —for instance,

from 6 percent to 37 percent in one

review of studies of emotional and

behavioral problems in children (2), In

addition, earlier estimates have often

been ambiguous with respect to the

time period involved.

In this report, data from the 1988

National Health Interview Survey of

Child Health (NHIS-CH), conducted

by the National Center for Health

Statistics (NCHS), are presented.

Statistics are given on the proportions

of young people 17 years of age and

under who were reported by their

parents to have ever had (a) a delay in

growth or development, (b) a learning

disability, or (c) an emotional or

behavioral problem that lasted

5 months or more or required

psychological! treatment. Information

is presented on when the condition

\vas first noticed and whether

treatment, counseling, or special

educational services were received for

it. Survey-based prevalence estimates

are compared with estimates based on

clinical studies, U.S. Department of

Education data on the receipt of

special education services, and earlier

health survey data on the receipt of

psychological help by children and

adolescents. Variations in prevalence

by age, sex, family income, mother’s

education, race, Hispanic origin, and

family structure are examined.

Alternative explanations for observed

group differences and for changes over

time in the receipt of counseling and

educational services for these

conditions are discussed.

Data and methods

Survey procedures

The source of the data reported

here is the 1988 National Health

Intervie\v Survey of Child Health. This

\vas a sumey of 17,110 children 17

years of age and under that was

cosponsored by the Office of

Maternal and Child Health, the

National Institute of Child Health and

Human Development, and NCHS (13,

PP. Z2.4-Z50).NCHS conducts the

National Health Interview Survey to

collect data on the health status and

medical care use of the U.S.

population, using a probability sample,

drawn by the U.S. Bureau of the

Census, of persons Ii\’ing in

households in the United States

(14,15). For NHIS-CH, there was a

further random selection of one child

per family in any family with children

17 years of age and under at the time

of the survey.

The data collection method

cons;sted of in-person interviews by

trained US. Bureau of the Census

interviewers with an informed adult

member of the family, usually the

mother. In about 95 percent of cases,

the respondent was a parent of the

sample child, and in this report, the

respondent is often referred to as the

parent. The overall completion rate

for the child portion of the survey was

91 percent. The interviewers obtained

a considerable amount of background

information on the family and

measures of the child’s physical health,

behavioral and emotional adjustment,

school performance, and receipt of

medical and psychological care. All

data are based on reports by the adult

respondent. The su~ey questionnaire

has been published (13, pp. 224-250),

and a public use data tape is available

through the Division of Health

Interview Statistics of NCHS. A

similar National Health Interview

Survey of Child HeaIth was conducted

in 1981 (16,17).

Questions on developmental

conditions

Parent respondents to the 1988

NHIS-CH were asked the following

questions:

● “Has _ ever had a delay in

_‘s growth or development?”

● “Has _ ever had a learning

disability?”

● “Has _ ever had an emotional

or behavioral problem that lasted

3 months or more?”

The first question was put to parents

of children of all ages, but the latter

two were put only to those whose

children were ages 3 years and over.

If the respondent answered

affirmatively to any of the questions,

she or he was asked a series of

followup questions on when each

condition \vas first noticed, whether

the child \vas treated for the condition

(ever and in the last 12 months), the

effects of the condition on school

attendance and need for special

education, and whether any

medication was taken for the

condition.

Parents of children ages 3–17

years who had not reported that their

child had a developmental, learning, or

behavioral problem were asked, “Has

_ ever seen a psychiatrist,

psychologist, doctor, or counselor

about any emotional, mental, or

behavioral problem?” Those who

responded negatively to this question

were asked, “During the past 12

months, have you felt, or has anyone

suggested, that _ needed help for

any emotional, mentaI, or behavioral

problem?” If the parent answered

affirmatively to either question, the

child was counted as having had an

emotionaI or behavioral condition,

even if the parent had answered the

initial question about such conditions

in the negative.

This report focuses on the

reported Iifetime prevalence of

deveIopmental, learning, and

behavioral problems in the overall

child population and in selected

demographic and social groups. Only

limited information from the followup

questions is presented.

Before reporting the prevalence

figures, it might be well to mention

some of the specific conditions that

the survey designers thought WOUIC1be

elicited by each question. It was

expected that respondents who

answered the question on delay in

growth and development in the

affirmative would consist partly of

parents whose children had Iimitecl or

tempora~ deficits in growth or

development, perhaps associated with

premature birth or an early illness or

injury, and partly of parents whose
Advance Data 3

children had severe and long-lasting

deficits, such as those produced by

Down syndrome or other

chromosomal abnormalities,

hereditary factors, prenatal infection,

birth injury, or chiIdhood diseases.

Ideally, the item on learning

disabili~ would be answered .

affirmatively for children who had

exceptional difficulty learning to read,

write, or do arithmetic but whose

learning problems did not stem from

mental retardation, impairment of

sight or hearing, emotional problems,

or lack of cultural and educational

opportunities. That is the technical

definition of Iearning disability (18,

p. 395). It is likeIy, however, that

parents applied the term not only to

children with specific incapacities,

such as dyslexia, but aIso to some

chiIdren with deficits in general

intelligence or behavioral problems

that interfered with their Iearning.

The reader may wonder why the

interviewers did not specifically ask

about mental retardation. The reason

is that there was such a question in

the 1981 NHIS–CH, and it produced

only a handful of positive responses.

Nowadays the term “mentaIIy

retarded” is apparently seen as

limiting or sti=aatizing by parents of

children with developmental

disorders, and many are reluctant to

use it (19). Clinicians have also

become hesitant about applying the

term, especially to minority children.

It was hoped that the “developmental

delay” and “learning disability”

questions would resuIt in more of

these chiidren being identified in the

1988 survey, and this seems to have

been the case.

The question on emotional or

behavioral probIems was meant to

identify children with common

psychological syndromes (20), such as

aggressive or antisocial conduct

(21,22), attention-deficit hyperactivity

disorder (23), phobias and anxiety

disorders (24), childhood depression

(25), and adjustment reactions to

traumatic events such as parental

divorce (26). More severe conditions

such as autism and schizophrenia

would also be picked up, but in very

small numbers, given the rarity of

these conditions (18, chapter 12).

Originally, in an open-ended

fol!owup question, parents were asked

to describe the specific emotional or

behavioral disorders their chiIdren

had. This question was deleted in

pretesting when many of the

responses turned out to be vague or

to refer to the situation that led to

the emotional reaction rather than to

the reaction itself. Analysis of

responses to related questions in

NHIS–CH, such as a 28-item

Behavior Problems Index and items

in the core NHIS questionnaire,

should help to cIarify the kinds of

conditions that were identified by

these questions.

Prevalence of problems

According to their parents,

4.0 percent of U.S. children ages 17

years and under have had a delay in

their growth or development

(tabIe 1). This means that an

estimated 2.5 million children have

developmental delays. In addition,

6.5 percent of children ages 3–17

years, or 3A million, have had a

learning disability (table 2). Also,

13A percent of children ages 3-17

years, or 7 million, have had an

emotional or behavioral problem that

lasted 3 months or more or required

psychological treatment (table 3).

When the items are combined, the

result is that a total of 19.5 percent

of children ages 3-17 years, or nearly

10.Z mi]lion, ha~,e had one or more

developmental, learning, or emotional

disorders (table 4). When the 488,000

children ages 2 years and under who

had developmental deIays are added

in, the total number affected by one

or more of these conditions comes to

aImost 10.7 million.

By way of comparison, here are

the estimated numbers of American

young people having some of the

chronic physical conditions that are

common in childhood: chronic

bronchitis, 3.5 million; asthma,

3.Q million; dermatitis, ~.~ mi]lion;

orthopedic impairments, 1.8 million;

heart murmurs, 1.1 miIlion (13,

table 62). Clearly, the psychological

disorders rank among the most

prevalent heaIth conditions of modem

childhood.

Another indication of the

importance of these conditions in the

overall child health picture is that

35 percent of children ages 3-17

years who were currently described as

being in fair or poor health had a

developmental, learning, or

behavioral probIem (tabIe 4).

Treatment

Parents who reported that their

chiId had a delay in development, a

learning disability, or an emotional or

behavioral problem were asked

whether the child “has ever received

treatment or counseling” for the

condition (table 5). Two percent of

all children ages 17 years and under

had received treatment or counseling

for a delay in growth or development.

This amounted to 49 percent of those

reported to have had such a delay.

One percent of all children were

reported to have received treatment

for developmental delays within the

previous 12 months.

.\bout 5 percent of all children

ages 3–17 years, or more than threequarters of those with Iearning

disabilities, had received treatment or

counseling for their disabilities. More

than 3 percent of children ages 3-17

years were reported to have received

treatment for learning disabilities

within the previous 12 months.

Ten percent of all children ages

3–17 years, or about three-quarters of

those with emotional or behavioral

problems, had received treatment or

counseling for these problems. Five

percent were reported to have

received this help within the previous

12 months.

Receipt of special educational

services

Parents who reported that their

child had one of the subject

conditions were also asked whether

the condition made it necessary for

the child “to attend special classes, or
4 Advance Data

a special school, or get special help at

school” during the past 12 months.

Less than 1 percent of children ages

6-17 years had received special

educational services because of delays

in growth or development. This

amounted to about 23 percent of

those reported to have had such

delays.

About 5% percent of all schoolaged children, or about 70 percent of

those reported to have learning

disabilities, received special

educational assistance for their

disabilities. Approximately

1.7 percent of school-aged children,

or one-quarter of those reported to

have emotional or behavioral

problems that had lasted 3 months or

more, received special educational

heIp because of these problems. (The

question about special educational

services was asked only of parents

who reported that their child had an

emotional or behavioral problem that

had lasted 3 months or more.)

Comparisons with other data

sources

Questions about children’s

psychological disorders have rarely

been asked of parents in large

national sample surveys of children.

Consequently, there are few earIier

data points that are precisely

comparable with those from the

National Health Interview Survey of

Child Health, Prevalence estimates

based on parental reports in

NHIS-CH can be compared with

estimates based on other sources of

information, such as clinical studies

or school-based data on children

receiving special educational semices

for specific types of handicaps. In

addition, there are earlier survey data

on the receipt of psychological help

by children. Some of this comparative

information is summarized in the

following sections.

Developmental delays

As mentioned in the introduction.

it was expected that the question

about delays in growth or

development would identify children

with mental retardation and other

profound developmental disorders, as

well as some with less devastating

abnormalities. Before the term

“mentally retarded” became

unfashionable, it was common to see

estimates that the retarded

constituted 3-4 percent of the overall

population (27). In recent years, the

term has been restricted to more

severe cases, and prevalence

estimates of 1–2 percent are now

given (20, p. 189). Autism and other

pemasive developmental disorders are

comparatively rare, with estimates of

their prevalence ranging from around

10 to 15 cases per 10,000 population

(20, p. 189).

Data from the U.S. Department

of Education show that the

proportion of students receiving

special educational services for the

mentally retarded was 1.6 percent of

total public school enrollment in

1987, down from 2.2 percent in 1977

(28, table 61). In contrast, the

proportion of children in NHIS-CH

who were reported to have

developmental delays and to have

received special educational services

for them was just 0.9 percent. Thus,

there would appear to have been

some underidentification or

underreporting of retardation in

NHIS-CH, It is also possible that

some parents with retarded

youngsters described their children as

having learning disabilities. As

described below, the underidentification of retardation is likely

to have been concentrated among

black and Hispanic children.

Learning disabilities

In contrast to the apparent

underreporting of retardation, the

proportion of children who were

reported in NHIS–CH to have

learning disabilities was higher than

the proportion known to be receiving

special educational services according

to school-records data. Of total public

school children, 4.8 percent were

recorded as receiving special

educational services for learning

disabilities in 1987, more than double

the 1.8 percent recorded in 1977 (2S,

table 61). As noted above, however,

6.5 percent of all children ages 3–17

years were reported in the 1988

NHIS–CH to have learning

disabilities, and 5.5 percent of those

ages 6-17 years were reported to have

attended special classes or a special

school because of such disabilities.

The relatively small discrepancies

between the survey estimates and the

school-records figures may represent

children who were in the process of

being qualified for special education

services or inaccuracies in school

records. They may aIso represent

misunderstanding by some parents as

to the types of help their children

were getting in school. Figures are

not available from the U.S.

Department of Education on the

number of children who were in need

of special educational services but did

not receive them. Despite the

apparent excess of learning

disabilities in the survey data, there is

evidence (discussed below) that

learning disabilities were

underidentified by minority parents.

Emotional and behavioral

problems

The Institute of Medicine, the

Office of Technology Assessment,

and other groups have estimated that

12-15 percent of U.S. children suffer

from mental disorders (3; 12, chapter

2). These estimates would appear to

be in close agreement with the figure

of 13.4 percent of children with

emotional or behavioral problems

found in NHIS–CH. However, the

clinical estimates are ambiguous with

respect to the conditions they include

and the time period to which they

refer. Does the figure of 12–15

percent refer to children who have

ever had a mental disorder, to those

who have had one within the last

year, or to those who have one right

now? A close look at the clinical

studies on which the estimates are

based also shows a good deal of

unexplained variation from study to

study. NHIS–CH and clinicaI stuclies

agree, though, in finding behavioral

disorders to be among the most

prevalent chronic conditions of

childhood.
Advance Data 5

An earlier survey of child health,

the 1981 National Health Interview

Survey, included a question about the

receipt of psychological help by

chiIdren and youths. In that survey, it

was found that 6.5 percent of

children ages 3–17 years had seen a

psychologist or psychiatrist at some

point about an emotional, mental, or

behavioral probIem (29). The

comparable proportion in the 1988

NHIS–CH was 10 percent, indicating

that the use of psychological

assistance for children had increased

by more than 50 percent between the

two surveys. (Part of the increase may

have been due to differences in the

questions used in the two surveys, but

it is unlikely that this is the full

explanation for the rise in the use of

psychological help.)

Although serious emotional and

behavioral problems appear to be

widespread among today’s youth,

relatively few receive special

educational assistance for these

problems. According to U.S.

Department of Education data, only

about 1.0 percent of public school

students were recorded as receiving

special education for the seriously

emotionally disturbed in 1987 (28,

table 61). This was Iess than the

1.7 percent of children ages 6-17

years who were reported in

NHIS-CH to have attended special

cIasses for emotional or behavioral

problems (table 5). Again, the

discrepancy may have been due to the

processing of children for special

education, to inaccuracies in school

records, or to misunderstanding by

parents as to what kinds of help their

children were getting in school. There

are also conditions, such as the

attention deficit-hyperactivity

svndrome, that straddle the boundary

~etween behavioral problems and

learning disabilities.

Age trends

Developmental delays

It was expected that almost all of

the delays in growth and development

would have occurred or been evident

in early chiIdhood. Therefore, little or

no increase in the prevalence of

delays after the first years of life was

anticipated. Except for minor

sampling fluctuations, this is what was

found. The proportion of children

with developmental delays was

4.3 percent for 2 years of age and

under, 4.4 percent at ages 3-5 years.

4.1 percent at ages 6-11 years, and

3.6 percent in the adolescent years,

ages 12–17 (table 1).

When parents were asked the

child’s age at the time they first

noticed the developmental delays.

25 percent of those who reported

delays said they had been apparent

since birth (table 6). Forty-five

percent of delays were noticed before

the child’s first birthday. The median

age at which delays in growth or

development were noticed was 1 year

2 months (table 7).

Learning disabilities

In contrast to developmental

delays, most Iearning disabilities are

not fully apparent until the child gets

to school and starts trying to read,

write, and calculate. Therefore, a

substantial rise in the prevalence of

learning disabilities as chiIdren

reached school age was expected.

This is what was found. The

proportion of children with learning

disabilities jumped from 1.6 percent

at ages 3–5 years to 6.8 percent in

the elementary school ages, 6–11

years. There ~vas a further increa~e<

to 8.8 percent, in the junior high and

high schooI ages, 12–17 years

(table 2).

When parents were asked at \vhat

age their children’s learning

disabilities were first noticed, only

about 6 percent of those who

reported learning problems said they

had been apparent since birth or

before the child’s first birthday

(table 6). One-quarter of the learning

disabilities became apparent during

the nursery school or kindergarten

years (ages 3-5 years), and another

45 percent were first noticed in early

elementary school (ages 6-8 years ).

The median age at which learning

disabilities were noticed was 6 years

7 months (tab[e 7). Learning

disabilities were not picked up until

late elementary or secondary school

for about 16 percent of the children.

Emotional and behavioral

problems

The most severe and pemasive

disorders of childhood tend to appear

before the age of 2Y5years, as with

autism, or after the age of 12 years,

as with schizophrenia (18, p. 420; 30).

Less drastic emotional and behavioral

problems may occur in children of

any age, depending on the timing of

stressful Iife events and the unfolding

of developmental processes that are

not well understood. Some of these

prob!ems are resolved within a few

months, perhaps to reemerge at a

later age. Others continue for years

or indefinitely.

Thus, the cumulative proportion

of children who have ever had

emotional or behavioral problems

should increase fairly steadily with

age. Continued increases were found

in NHIS-CH, although the rate of

increase was found to decline after

the early elementary years. The

proportion of chiidren who had ever

had an emotional or beha~~ioral

problem rose from 5.3 percent at

ages 3-5 years, to 12.7 percent at

ages 6-11 years, to 18.5 percent at

ages 12–17 years (table 3).

Parents who reported that their

chiIdren had emotional or behavioral

problems that had lasted 3 months or

more were asked at what age the

emotional or behavioral problems

were first noticed. Only 5 percent

said it was before the child’s first

birthday (table 6). Less than

15 percent of the emotional problems

were noticed during the first 3 years

of life. One-quarter emerged during

the preschool years (3-5) and another

quarter. during the early elementary

years (6-8). The rate of problem

emergence tapered off in the late

elementary years, with 15 percent of

the conditions appearing during ages

9-11 years. Twenty-two percent

became evident during the adolescent

years (12-17). The median age at

which persistent emotional or

behavioral problems were noticed was

7 years 2 months (tabIe 7).
6 Advance Data

Based on evidence from the

National Survey of Children (31) and

other earlier surveys, it seems

possible that the increase in the

Iifetime prevalence of behavioral

problems with age would be more

pronounced were it not for parental

forgetting. When responding to

surveys, parents sometimes do not

recall emotional problems that their

children had several years earlier.

even when those problems \vere

severe enough to require professional

assistance.

Combined problems

As would be expected from the

above findings, the combined lifetime

prevalence of developmental.

learning, and emotional problems

increased substantially with age, more

than doubling from ages 3–5 years

(9.5 percent) to 12-17 years

(25.2 percent), as shown in table 4.

One teenager in four was reported to

have had a developmental deIay,

learning disability, or emotional or

behavioral problem.

Sex differences

Previous research has shown that

males are m,ore vulnerable than

females to a variety of developmental

disorders, Sex differences are

especially pronounced for learning

disabilities, with boys outnumbering

girls in special education classes by

more than 2 to 1. Male pupils also

outnumber females in classes for the

mentally retarded, but by smaller

margins (32, table 6). Sex differences

in emotional and behavioral problems

depend on the type of problem

involved, with males predominating

among youths who show aggressive or

hyperactive conduct, but with sex

ratios being more nearly equal or girls

predominating for problems such as

depression and anxiety (33). Overall,

the prevalence of emotional and

behavioral problems tends to be

higher among boys (1S.34).

The results of the 198S

NHIS–CH were generally consistent

with these earlier findings.

Differences were relatively slight for

developmental delays. hou e~er. \vith

males exceeding females by only

11 percent overall – 4.2 percent of

males versus 3.8 percent of females

were reported to have had delays in

g,rowlh or development —and some

age groups showing minimal

differences or even reversals

(table 1).

In contrast, the rate of learning

disabilities was almost twice as high

among males as among females,

8.6 percent versus 4.4 percent for

ages 3-17 years. By adolescence,

more than twice as many males as

females – 12.1 percent versus

5.2 percent – were described as

having learning disabilities (table 2).

For emotional and behavioral

problems, the overall prevalence was

36 percent higher among males:

15.4 percent versus 11.3 percent for

females. Sex differences were most

pronounced for children of

elementary school age (6-1 1 years),

with 15.6 percent of the boys versus

9.8 percent of the girls in this age

range experiencing such problems

(table 3).

For all three types of problems

combined, the prevalence for males

exceeded that for females by

43 percent: 22.9 percent compared

with 16.0 percent. Among adolescents

(ages 12-17 years), the male rate

exceeded the female rate by

40 percent: 29.2 versus 20.8 percent

(table 4). Nearly 3 teenage boys in 10

had had a developmental delay,

learning disability, or emotional or

behavioral problem.

Differences related to parental

education and family income

There are several reasons for

expecting learning difficulties and

emotional and behavioral problems to

be more common among children

from families with low parental

education and income levels than

among those with more educated and

affluent parents. Children in the

former group are less likely to receive

intellectual stimulation at home

(35.36) and more likely to be exposed

to a variety of environmental hazards

(37-39). In addition, it could be

argued that. because of a tendency to

downward social mobility, parents

with low intelligence or emotional

disorders are more likely to be found

among lower education and income

groups (40).

Education- and income-related

differences in achievement indicators

such as grade repetition, cognitive

test scores, remedial instruction and

special education placement, and lhigh

school completion have consistently

been found (32,41-43), Similar

differences in children’s emotional!

and behavioral problems have been

observed, although the findings are

not as extensive and consistent

(32,34,44). The evidence for classrelated differences in developmental

delays is even less clear cut.

Chromosomal abno.pnalities, prenatal

infections, and birth complications

can occur among infants of any class,

and some developmental disabilities,

such as autism, are actually more

common among middle and upper

class families (18, pp. 425-426),

One phenomenon that

complicates the measurement of

class-related differences in child

development through household

surveys is that better educated

parents tend to be more “productive”

survey respondents than do less

educated parents (45). If

developmental problems are more

common among children of less

educated parents, differences in

comprehension and recall will tend to

reduce class-related differences,

because better educated parents

report proportionately more of their

children’s problems to survey

interviewers than do Iess educated

parents. As a consequence, incomeand education-related differences are

usually more pronounced when

problem indicators are based on test

scores, teacher reports, or official

records than when they are based on

survey reports of parents.

Developmental delays

Differences across parental

education and income groups in the

proportion of children who had

delays in growth or development were

relatively small and, for the most

part, not statistically significant
Advance Data 7

(table 1). Among family income

groups, onIy the contrast between the

lowest category– less than $10,000

per year–and the highest –$40,000

or more per year—was statistically

reIiable. Of chiIdren in the former

group, 5.4 percent had developmental

deIays, but of those in the latter

group, 3.9 percent had deIays.

Learning disabilities

Of the three types of chiIdhood

problems discussed here, learning

disabilities showed the strongest

relationships with parental education

and family income: The prevalence of

learning problems decreased with

increasing years of education or

increasing income. Thus, the

proportion of youngsters reported to

have learning disabilities was

8.7 percent for chiIdren of mothers

with less than 12 years of schooling,

6.8 percent for those whose mothers

had 12 years of education, and

4.9 percent for children whose

mothers had more than 12 years of

schooling. SimiIar patterns were

observed in all age groups (table 2).

The prevalence of learning

disabilities was 8.4 percent among

children from families with incomes

less than $10,000 per year and

decreased as income rose, reaching

5.8 percent among children in

families with incomes of $40,000 or

more. Except for a few nonsignificant

fluctuations, similar patterns were

found for all age groups (table 2).

Emotional and behavioral

problems

The prevalence of childhood

emotional and behavioral problems

showed significant variation across

famiIy income groups, with children

from less advantaged backgrounds

standing a somewhat greater chance

of exhibiting such problems. The

prevalence declined from

15.8 percent among children from

families with incomes less than

$10,000 per year to 12.8 percent

among those with famiiy incomes of

$40,000 or more. Income-related

differences were more pronounced

among elementary school chiIdren

and adolescents than among

preschoolers (table 3).

The total proportion of emotional

or behavioral problems did not vary

meaningfully with parental education.

However, when those problems that

had persisted for 3 months or more

were examined, some significant

differences were found across

maternal education groups. The

prevalence of persistent problems was

7.2 percent among children whose

mothers had not completed high

school, 6.1 percent among chi[dren of

high school graduates, and

5.5 percent among children whose

mothers had more than 12 years of

schooling. SimiIar patterns were

observed within specific age groups,

although with some fluctuations.

Combined problems

Significant variation by family

income, but not by parental

education, was found when all three

types of conditions were combined.

The proportion of children ages 3-17

years with one or more of these

problems feIl from 22.8 percent

among children in families with

incomes beIow $10,000 to

18.6 percent among those with famiIy

incomes of $40,000 or more (tabIe 4).

The proportion was 20.3 percent

among chiIdren of mothers with less

than 12 years of education and

19.3 percent among those whose

mothers had more than 12 years of

schooling.

It seems likeIy that differences in

childhood learning and behavioral

problems across education and

income groups were understated

because of the association beween

these variables and minority ethnic

status. As described in the ne,xt

section, there was an apparent

underreporting of children’s learning

and behavioral probIems by bIack and

Hispanic parents.

Differences by race and

Hispanic origin

In the 1988 National Health

Interview Survey of Child Health,

black parents were less likely than

white parents to report that their

children had developmental delays or

emotional problems and about

equalIy likely to report learning

disabilities. Hispanic parents also

reported slightiy fewer developmental

problems in their children than did

non-Hispanic parents. Thus, the

overaII prevalence of developmental

delays was 2.1 percent among black

and 4.4 percent among white

children; 3.4 percent among Hispanic

and 4.2 percent among non-Hispanic

children (tabIe 1).

The proportion ages 3-17 years

with learning disabilities was

6.2 percent among black and

6.7 percent among white children;

5.8 percent among Hispanic and

6.6 percent among non-Hispanic

children (table 2). The proportion

ages 3–17 years reported to have had

emotional or behavioral problems was

10.3 percent among black and

14.2 percent among white children;

12.0 percent among Hispanic and

13.6 percent among non-Hispanic

children (tabIe 3). When all three

types of childhood conditions were

combined, the proportion of children

with one or more conditions was

14.9 percent among black and

20.7 percent among white children;

17.2 percent among Hispanic and

19.9 percent among non-Hispanic

children (tabIe 4).

On the average, black and

Hispanic families have lower parental

education and income levels than

white non-Hispanic families (28). In

addition, black children are known to

be overrepresented among Iow-birthweight babies, children in

single-parent and foster-care families,

reported abuse and negIect cases,

speciaI education and remedial

instruction cIasses. and pupils who

are suspended or expelled from

school for conduct problems (28,32).

For these reasons. one would expect

black and Hispanic chiIdren to show a

higher than average prevalence of

learning and emotional problems and

at least an average prevalence of

developmental delays.

One explanation for the obsewed

results is that black and Hispanic

parents were less familiar than

nonminority parents with the terms
8 Advance Data

used in the three questions listed

above and so were apt to answer

them in the negative. Such lack of

familiarity could be a product of

lower Iiteracy levels, lower quality

pediatric care and educational

counseling, or both. Differential recall

of past events may also have played a

role.

Differences in reporting by race

or ethnic group have been found in

other areas of child health. For

example, black parents typically

report fewer acute illnesses, injuries,

and restricted-activity days for their

children than white parents do, even

though black parents are more likely

to rate their children as being in poor

or fair health (46).

Differences by family structure

Previous research has shown that

children in single-parent famiIies are

at greater risk of emotional problems

and academic difficulties than those

in intact, two-parent families (26,47).

The differences are partly due to the

stress of family conflict and

disruption and the deprivations of a

single-parent upbringing.

Single-parent families also tend to

have lower parental education and

income leve_lsthan two-parent

families. Children in stepfamilies

show an elevated risk of

maladjustment and school failure,

even though the income levels of

these families are more like those

families in which both biological

parents are present (29).

Based on previous findings, it

expected that there would be

significant differences in the

prevalence of emotional and

behavioral problems across family

of

was

types and t~at learning disabiIiti&

would show similar but less

pronounced differences. It was not

expected that developmental delays

would show significant variation by

family structure, although there was

the possibility that couples whose

children had developmental

difficulties would be more likely to

get divorced than those with normal

children.

Developmental delays

The prevalence of developmental

deIays showed Iittle significant

variation across family types

(table 1). The prevalence of

developmental delays was 3.8 percent

among children from mother-father

families, 4.5 percent among children

in mother-only families, 3.7 percent

in mother-stepfather families, and

4.8 percent in all other family

situations (children living with fathers

only or fathers and stepmothers, with

grandparents or other relatives, or in

adoptive or foster families).

Learning disabilities

There was significant variation

across family types in the prevalence

of learning disability, with children in

disrupted or reconstituted families

showing higher rates of learning

problems than those in mother-father

families. Children in motherstepfather families appeared to show

slightly higher rates of learning

problems than those in mother-only

families, but this may be attributable

to the fact that black and Hispanic

persons, with their lower rates of

problem reporting, were

overrepresented in the mother-only

group but not in the motherstepfather group. The prevalence of

learning disabilities was 5.5 percent

among children in mother-father

families, 7.5 percent in mother-only

families, 9.1 percent in motherstepfather families, and 8.3 percent

in other family situations (table 2).

Emotional and behavioral

problems

As expected, the frequency of

emotional and behavioral problems

showed the greatest variation across

family types, with children in singleparent families and stepfamilies

showing higher problem rates than

those in mother-father families.

Children in other types of families

also showed elevated rates. The

prevalence of emotionaI and

behavioral problems was 8.3 percent

in mother-father families,

19.1 percent in mother-only families,

23.6 percent in mother-stepfather

families, and 22.2 percent in othe:r

family situations (table 3). Again, the

frequency of problems among

children in mother-only families may

have been understated because of the

large proportions of black and

Hispanic persons in this group.

Combined problems

Children in disrupted families

were nearly twice as likely as those in

mother-father families to have had a

developmental, learning, or

behavioral problem, The prevalence

for children ages 3-17 years were

14.6 percent in mother-father

families, 24.8 percent in mother-only

families, 29.6 percent in

mother-stepfather families, and

28.2 percent in other family types

(table 4).

Summary and conclusions

The data presented in this report

show that developmental, learning,

and behavioral disorders are among

the most prevalent chronic conditions

of childhood and adolescence.

Overall, nearly 20 percent of young

people ages 3-17 years were found to

have had one or more of these

conditions. By the time they reached

ages 12-17 years, 1 in 4 adolescents,

and nearly 3 in 10 male adolescents,

had experienced one of these

disorders. When very young children

with developmental delays were

included, the total number of U.S.

children affected came to about 10.7

miIlion.

As high as these figures may

seem, it is altogether possible that

they are underestimates of the true

prevalence of the conditions. The

only childhood disorders counted in

NHIS-CH were those that had been

recognized by parents or identified by

physicians, psychologists, or teachers

and communicated to parents with

sufficient clarity that the parents were

able to report them to survey

interviewers. There is reason to

believe that some developmental,

learning, and emotional disorders of

children are not recognized as such,
Advance Data 9

or the assessments of teachers or

health professionals are not

understood or not accepted by

parents. Confusion over changing

diagnostic terminology and simpIe

forgetting of problems that occurred

in the past probabIy work to reduce

the reporting of these conditions as

well.

Despite the limitations of

parental reporting, it is useful to have

data on the prevalence of

psychological disorders in young

people based on standard survey

questions put to the parents of a

large and nationally representative

sample of children. Estimates derived

from NHIS-CH provide national

benchmarks on the overalI frequency

of recognized psychological disorders

in children and on the reIative

frequency of such probIems in

different population groups. The

findings with regard to overaI1

prevalence were that 4.0 percent of

all children 17 years of age and under

had deIays in growth or development,

6.5 percent of children ages 3-17

years had learning disabilities, and

13.4 percent had significant

emotional or behavioral problems.

The proportions of all chiIdren ages

3–17 years who had ever received

treatment or counseling for the

conditions were about 2 percent for

developmental delays, just over

5 percent for Iearning disabiIities,

and more than 10 percent for

emotionaI or”behavioral problems.

These proportions fall within the

range of prevalence estimates that

have appeared in the Literature.

However, comparisons with an earlier

NHIS-CH indicate that the

proportion of young people who have

received treatment or counseling for

emotional or behavioral probIems

increased by more than 50 percent

from 1981 to 1988, rising from

6.5 percent to 10 percent of all

chiIdren ages 3-17 years. It is not

clear whether the increase was due to

an expansion of the underlying need

for psychological help, to greater

availability and acceptabili~ of

mental heaIth services, or both. It is

clear that the proportion of U.S.

children not Iiving with both parents

has grown over time and that the

prevalence of emotional problems

and the rate of use of psychological

services are higher for these children

than for those living with both

biological parents.

Survey findings with regard to

variations in prevalence across

demographic groups were generaIIy in

agreement with what was expected

based on developmental theory and

the results of previous research. Thus,

the prevalence of a delay in growth

and development was found to vary

little with age, and most delays were

detected within the first 2 years of

life. In contrast, the prevalence of

learning disabilities increased

markedly as chiIdren reached schooI

age, indicating that most of these

conditions were detected in school.

The lifetime prevalence of emotional

or behavioral problems also rose with

age, with significant increases

continuing into the adolescent years.

Learning disabilities were nearIy

twice as common among males as

among femaIes, and the frequency of

emotional or behavioral problems

among males exceeded that among

femaIes by 36 percent. In contrast,

developmental delay showed no

significant gender differences. A

simiIar pattern prevailed with respect

to family income and parental

education groups. Learning

disabilities showed the greatest

variation across these groups;

emotional or behavioral probIems

showed significant but smaller

fluctuations; and developmental

deIays showed practically no

socioeconomic variation. Learning

and behavioral problems were

somewhat more common among

children from low-income and Ioweducation families than among those

from more advantaged families. Even

the largest differences were relatively

modest, however. It is possible that a

greater awareness of childhood

probIems among more educated

parents and fuller survey reporting by

these parents worked to artificially

lessen the size of socioeconomic

disparities in problem prevalence.

Black and Hispanic parents

reported fewer developmental,

learning, and behavioral problems in

their children than did nonminority

parents. However, teacher reports

and school records suggest that

psychological problems are more

common among minority chiIdren.

The disparity between parent- and

schooI-based data may be due to

culturaI divergences in the awareness

and acceptance of childhood

psychological disorders or to

differences in survey recall and

reporting.

Young people from single-parent

families or stepfamilies \vere 2 to 3

times more IikeIy to have had

emotionaI or behavioral problems

than those who had both of their

biological parents present in the

home. Learning disabilities showed

similar but less pronounced

differences; deIays in development

varied little by famiiy type.

The alarmingly high prevalence of

emotional and behavioral problems

among today’s chiIdren and the

observed relationship between family

disruption and youthful problem

behavior reinforce pubIic concerns

about the increasing number of U.S.

children who are being raised in

something other than harmonious

two-parent families. The survey

findings also underscore concerns

about minorily youth and the extent

to which their learning and behavioral

problems go unrecognized and

untreated. Further research is needed

to understand the apparent underreporting of childhood learning and

emotional problems by black and

Hispanic parents and the extent to

which it reflects inadequacies in the

medical care and educational

counseling that they and their

chiIdren receive.

References

1. Haggerty R, Roghmann ~ Pless IB.

Child health and the community. New

York John Wiley and Sons. 1975.

2. Gould M, Wunsch-Hitzig R,

Dohrenwend BP. Estimating the

prevalence of childhood

psychopathology. J Am Acad Child

Psychiatry 20:462-76. 19S1.
—10 Advance Data

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

Institute of!vledicine. Research on

children and adolescents with mental,

beha~ioral and developmental

disorders: Mobilizing a national

initiative. Washington: National

Academy Press. 1989.

Hetherington EM, Arasteh JD, eds.

Impact of divorce, single parenting,

and stepparentirtgon children.

Hillsdale, N’ewJersey Lawrence

Erlbaum. 1988.

Shapiro S, McCormick MC, Starfield

BH, Crawley B. Changes in infant

morbidity associated with decreases in

neonatal mortality. Pediatrics

72:408-15.1983.

Konvood C. At highest risk:

Environmental hazards to young and

unborn children. New York: McGrawHill. 19S0.

Alcohol, Drug Abuse, and Mental

Health Administration. The high risk

of cocaine, other drugs. ADAMHA

News. Nov-Dec 1989.

Birenbaum A, Guyot D, Cohen HJ.

Reality and policy in financing the

health care of children and young

adults with serious chronic conditions.

Bronx, New York Albert Einstein

College of Medicine. 1989.

Casey RJ, Berman JS. The outcome

of psychotherapy with children.

Psychol Bull 98:388-97.1985.

Weisz JR, Weiss B, Alicke MD, Klotz

ML. Effectiveness of psychotherapy

with children and adolescents: A

meta-analysis for clinicians. J Consult

Psychol 55:542-9.1987.

Kohn A. Suffer the restless children.

Atlantic Monthly 264(5):90-100. 1989.

Office of Technology Assessment.

Children’s mental health: Problems

and services-A background paper.

Washington: U.S. Congress. 1986.

Adams PF, Hardy AM. Current

estimates from the National Health

Intemiew Survey: United States, 1988.

National Center for Health Statistics.

Vital Health Stat 10(173). 1989.

National Center for Health Statistics.

Health Interview Survey procedure,

1957-1974. National Center for

Health Statistics. Vital Health Stat

1(11). 1975.

h’atiorml Center for Health Statistics,

Ko\’ar MG, Poe GS. The National

Health Interview Survey design,

1973-84, and procedures, 1975-83.

National Center for Health Statistics.

Vital Health Stat 1(18). 1985.

h’ational Center for Health Statistics.

Current estimates from the National

Health Interview Survey: United

17.

18.

19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

States, 1981. National Center for

Health Statistics. Vital Health Stat

10(141). 1982.

Poe GS. Design and procedures for

the 1981 Child Health Supplement to

the National Health Intemiew Survey.

Working paper series. Hyattsville,

Maryland: National Center for Health

Statistics. 1986.

Achenbach TM. Developmental

psychopathology. New York: John

Wiley and Sons. 1982.

Boston Children’s Medical Center,

Feinbloom RI. Child health

encyclopedia. Boston: Delacorte.

1975.

Tuma JM. Mental health setwices for

children: The state of the art. Am

Psychol 44(2) :18S-99. 1989.

Kazdin AE. Developmental

psychopathology Current research,

issues, and directions. Am Psychol

44(2):180-7. 1989.

Patterson GR, DeBarsyshe BD,

Ramsey E. A developmental

perspective on antisocial behavior.

Am Psycho] 44(2):329-40. 1989.

Henker B, Whalen CK. Hyperactivity

and attention deficits. Am Psychol

44(2):216-23. 1989.

Schaefer CE, Millman HL. How to

help children with common problems.

New York: Van Nostrand Reinhold.

1981.

Kovacs M. Affective disorders in

children and adolescents. Am Psychol

44(2):209-15. 1989.

Emery RF. Marriage, divorce and

children’s adjustment. Developmental

clinical psychology and psychiatry, vol.

14. Newbury Park, California: Sage.

1988.

Smith LH. The encyclopedia of baby

and child care. Englewood Cliffs, New

Jersey Prentice-Hall. 1972.

Select Committee on Children,

Youth, and Families. U.S. children

and their families: Current conditions

and recent trends. Washington: U.S.

House of Representatives. 1989.

Zill N. Behavior, achievement, and

health problems among children in

stepfamilies: Findings from a national

survey of child health. In:

Hetherington EM, Arasteh JD, eds.

Impact of divorce, single parenting,

and stepparenting on children.

Hillsdale, New Jersey: Lawrence

Erlbaum. 1988.

Rutter M. The development of

infantile autism. Psycho] Med

4:147-63.1974.

31.

32.

33.

34.

35.

36.

37.

38.

39.

40.

41.

Zili N, Peterson JL. Marital

disruption and children’s need for

psychological help. Washington: Child

Trends. 1983.

Zill N. The school-aged handicapped:

A statistical profile of special

education students in elementary and

secondary schools in the United

States. Washington: National Center

for Education Statistics. 1985.

Achenbach TM, Edelbrock CS.

Behavioral problems and

competencies reported by parents of

normal and disturbed children aged

four through sixteen. Monogr Soc Res

Child Dev 46(1):1-82. 1981.

Rutter M, Tizard J, Whitmore K.

Education, health and behavior.

London: Longman Group. 1970.

Clarke-Stewart A. Child care in the

family: A review of research and some

propositions for policy. New York:

Academic Press. 1977.

Zill N, Moore KA, Stief T. Adult

welfare recipients as potential

employees and the quality of the

home environments experienced by

welfare children: Analysis of data on

AFDC families from national survey

data bases, Progress report and

summary of findings. Washington:

Child Trends. 1990.

Genes K. A profile of violence toward

children in the United States. In:

Gerbner G, Ross CJ, Z]gler EF, eds.

Child abuse: An agenda for action.

h’ew York: Oxford University Press.

19s0.

Hampton RL, Newberger EH. Child

abuse incidence and reporting by

hospitals: Significance of severity,

class and race. Am J Public Health

75(1):56-60. 1985.

Overpeck M, Moss A. Children’s

exposure to environmental cigarette

smoke before and after birth: United

States, 19S8. Paper presented at the

annual meeting of the American

Public Health Association. Chicago.

Oct. 22-26, 1989.

Herrrtstein RJ. IQ in the meritocracy.

Boston: Little Brown and Company.

1971.

Btyant EC, Glaser E, Hansen MH,

Kirich A. Associations between

educational outcomes and background

variables: A review of selected

literature. Monograph of the National

Assessment of Educational Progress.

Westat, Inc. Denver: Education

Commission of the States. 1974.
Advance Data 11

42. White KR. The relation between

socioeconomic status and academic

achievement. Psychol Bull

91(3) :461-S1. 19S2.

43. National Assessment of Educational

Progress. The reading report card,

1971-S8: Trends from the nation’s

report card. Report no. 19-R-01.

Princeton: Education Testing Service.

1990.

44. Rutter M, GiIIer H. Juvenile

delinquency: Trends and perspectives.

New York: Guilford Press, 1983.

45, Zill N. Peterson JL. Guide to federal

data on children. youth, and families.

Washington: Child Trenc!s. 1990.

46. Andersen RM, Mullner Rll,

Cornelius LJ. Black-white differences

in health status: Methods or

substance? Milbank Mem Fund Q

65(suppl 1):72-99. 1987.

47. McLanahan S. The consequences of

simjeparenthood for subsequent

generations. Focus 2(3):16-21. 198S.
12 Advance Data

Table 1. Percent of children 17 years of age and under who ever had a delay in growth or development, by age and selected

characteristics: United States, 1988

[Data are based on household intewiews of the clw[ian noninstitutlonalized population. The survey design, general qualifications, and information on the reliability of

the estimates are given in the technical notes]

A// ages

17 years 2 years 3-5 6-11 12-17

Characteristic and under and under years years years

Percent

Allchildrenl . . . . . . . . . . . . . . . . . . . . . . . . 40 4.3 4.4 4.1 3.6

Sex

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

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

Race

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

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

4.2

3.8

4.4

2.1

4.0

4.6

4,5

2.5

4.6

4.2

4,7

1.4

4.0

4.2

4.5

2.3

4.4

2.7

4.0

2.0

H6panic ongm

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . 3.4 1..9 4.2 3.7

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

3.7

4.2 4.7 4,5 4.2 3.6

Family income

Lessthan SIO,OOO. ..,,..... . . . . . . . . . . 5.4 6.9 5.8 5,4

S10.00G$24,999 . . . . . . . . . . . . . . . . . . . .

3.8

4.0 4.4 4.1 3.3

S25,000-$39,999 . . . . . . . . . . . . . . . . .

4.4

4.0 2.6 6.1 4.5

S40,0000rmore . . . . . . . . . . . . . . . . . . . . .

3.3

3.9 5,0 2,5 4.3 3.6

Place of residence

MA. . . . . . . . . . . . . . . . . . . . . . . . . . . 3.8 3.7 3.5 4.2

Central icy, . . . . . . . . . . . . . . . . . . . . .

3.6

3.1 26 3.1 3.6 2.9

Notcentralcity . . . . . . . . . . . . . . . . . . . . 4.2 4,4 3.8 4.6 4.0

Not MSA . . . . . . . . . . . . . . . . . . . . . . . . . . 4.7 6.1 7.1 3.7 3.8

Assessed health status

Excellent, verygood, orgood, . . . . . . . . 3.7 3.7 3.7 3.8

Fa!ror poor . . . . . . . . . . . . . . . . . . . . .

3.5

15.2 210 245 14.0 6.5

Mother’s education

Lessthan 12years . . . . . . . . . . . . . . . . . . 3,3 4.2 4.3 3.2 2.6

12yeara . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2 4.8 5.4 3.6

Morethan 12years . . . . . . . . . . . . . . . . . . .

3.8

4.2 3.8 3.4 5.0 4.2

Family structure

Biological mothersndfather . . . . . . . . . . . 3.6 3.4 4.4 3.6

Biological mother and stepfather . . . . . . . . . .

3.9

3.7 10.1

Biological motheronl~ . . . . . . . . . . . . . . . . .

3,6 4.5 2.6

4.5 5.5 3.8

Another, . . . . . . . . . . . . . . . . . . . . . . . . .

4:2

4,8 9,5 6.5 z 2.6

llncludes other races and unknown soc!odemographicand heakhcharactenstcs.

%cludesfsmlies in which the molheriived with the chitd’s grandmother or o!her adult relativa,

NOTE. MSAismetropol, tan statist!cal area.
Advance Data 13

Table 2. Percent of children 3-17 years of age who ever had a learning disability, by age and seiected characteristics: United States,

1988

[Data are based on household interviews of the civilian noninstiufionalized population. The survey design, general qualifications, and information on the reliability of

the estimates are given in the technical notes]

All ages 3-5 &ll 12-17

Characteristic 3-17 years years years years

Percent

Allchildrenl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5 1.6 6.8 8.8

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.6 1.7 8.4

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

12.1

4.4 1.6 5.1 5.2

Race

White. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.7 1.6 7,0

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

9.2

6.2 2.0 6.6 7.8

Hispanic origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.8 2.1 6.8

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

6.7

8.6 1.6 6.8 8.9

Family income

Lessthan$lO,OOO . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.4 3.8 9.1

$10,000-s24,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.3

7.2 1.4 7.3

$25,000-$39,998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.6

1.7 5.5

$40,0000rmore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.4

:: 1.2 6.5 7.2

Place of residence

MA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5 1.6 7.1

Centrelcity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.6

5.9 1.8 6,5

Notcentralcity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.9 1.5 7.4 z

NotMSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.5 1.8 5.9 9.5

Assessed health status

Excellent,verygood, Osgood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.3 S.5

Fairorpoor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.6

15.1 E 17.7 15.6

Mother’s education

Lessthan 12years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8.7 2.8 8.0

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

11.7

6.8 1.9 7.5

Morethan 12yeare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.5

4.9 0.9 5.2 7.1

Femilystructure

Biologicalmotherandfather.... . . . . . . . . . . . . . . . . . . . . . . . . . . 5.5 1.2 5.7

Blologicalmotherand stepfather.. . . . . . . . . . . . . . . . . . . . . . . . . . .

8.2

9,1

Biologicalmotheronl~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.1 9.2 10.1

7.5 3.0 7.2

Another. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.8

8.3 1.1 10.6 8.6

‘Includes other races andunknown sododemographicand heakhcharaclenstics.

z,n~udea f~i~es in which the mother lived w!th the chdd’s grandmother or other aduti relal~e.

NOTE: MSA is metmpokten statistical area.
14 Advance Data

Table 3. Percent of children 3-17 years of age who ever had an emotional or behavioral problem that lasted 3 months or more or

required psychological help, by age and selected characteristics: United States, 1988

[Data are based on household interviews of the civilian noninst!tut!onallzed population. The survey design, general qualifications, and information on the reliability of

the estimates are given m the technmal notes]

A// ages 3-5 6-11 12–17

Characteristic 3-17 years yeare years years

Percent

Allchildrenl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.4 5.3 12.? 18.5

Sex

Male, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

15.4

11,3

6.1

4.5

15.6

9.8

20.4

16.5

Race

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

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

14.2

10.3

5.6

2.4

13.6

9.2

19.5

15.1

Hispanic origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,.,.,

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

4.5

5.4

13.4

12.7

14.8

18.9

120

13.6

Family income

Lessthan $10,000 ...,..... . . . . . . . . . . . . . . . . . . . . . . . . .

S10,000-$24,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . .

S25,000-$39,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

S40,0000rmore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15,8

14,5

13,4

12.8

4.7

6.0

5.9

4.8

16.2

15.0

11.5

11.4

22.5

19.3

19.6

17.6

Place of residence

MA. , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Central icy.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,,.

Noncentral city ., .,....., . . . . . . . . . . . . . . . . . . . . . . . .

Not MSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13.7

13.6

13,8

12.4

5.2

4.7

5.5

5.5

12.9

13.1

12.8

12.0

19.1

19.1

19.1

16.5

Assessed health status

Excellent,verygood, Osgood... . . . . . . . . . . . . . . . .

Fairorpoor. , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13.1

23.3

5.0

8.4

12.5

20.4

18.1

31.8

Mother’s educat!on

Lessthan 12years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Morethan 12years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13.6

12.5

13.7

5.2

6.2

4.2

12.3

11.8

13.3

18,5

16.7

20.1

Family structure

Biological motherandfather. . . . . . . . . . . . . . . . . . . . . . . .

Biological motherand stepfather.. . . . . . . . . . . . . . . . . . . . . . . . . . .

Biological motheronly2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Another . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.6

29.1

25.5

25.8

8.3

23.6

19.1

22.2

4.0

12.0

6.6

10.0

6.0

19.6

18<9

22.6

1Includes other rsces and unknown soc!odemographic and health charactensiws.

‘Includes famhes in whrch the mother hved wllh the ch(ld’s grandmother or other adult relatlVe.

NOTE: MSA is metropoh(anSlatlatlcalarea
Advance Data 15

Table 4. Percent of children 3-17 years of age who ever had a delay in growth or development, a learning disability, or an emotional

problem that lasted 3 months or more or required psychological help, by age and selected characteristics: United States, 1988

[Data are based on household interviews of the civilian nomnstitutionalized population. The survey design, general qualifications, and information on the reliability of

the estimates are given in the technical notes]

All ages 3-5 6-11 12-17

Characteristic 3-77 years years years years

Percent

Allchlldren’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.5 9,5 19.1 25.2

Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.9 10.5 22.8

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

29.2

16.0 8.5 15.4 20.8

Race

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20,7 10.0 20.3

Slack. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

26.7

14,9 5.0 14.8 19.5

Hispanic origin

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17.2 8.5 19.6

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

19.2

19.9 9.7 19.1 25.8

Fsmilyincome

Lessthan$lO,OOO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.6 11.5 23.8

$10,00(M324,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

26.6

21.0 10.1 21.3

$25,00GS39,999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

27,3

19.5 11.3 17.6

$40,0000rmore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

26.0

16.6 6.8 18.0 24.1

Place of residence

MA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.6 8.5 19.5

Centrality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25.4

18.7 8.0 19.2

Notcentralcity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

24.1

20.1 8.9 19.6

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

26. t

19.4 12.3 17.9 24.6

Assessed health status

Excellent,verygood, orgcad. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.1 8.9 18.7

Fairorpoor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

24.8

35.3 25.7 35.7 39.3

Mother’s education

Lessthan 12years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.3 10.2 18,4 26.2

12years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.0 11.2 16.8

Morethan 12years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

23.2

19.3 7.3 19.4 26.3

Family structure

Biologicalmotherandfather.,, . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,6 8.1 14.4

Biological motherand stepfather. . . . . . . . . . . . . . . . . . . . . . . . . . . .

19.2

29.6

Biological motheronl~ .,..... . . . . . . . . . . . . . . . . . . . . . . . . . .

14.4 27.0 34.5

24.8 11.7 24.5

Another . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

31.4

28.2 13.5 29.7 31.4

‘Includes o!her races and unknown sociodemograph!c and health character! sllcs.

21ncluda~fmlle~ in~~chtha mother llvedwlth thech!lds grandmother Orother acuhrelat1ve.

NOTE: M6A ia metropolitan statiatlcal area.
16 Advance Data

Table 5. Proportion of children ever treated and proportion receiving special education for delays in growth or development, learning

disabilities, and emotional or behavioral problems: United States, 1988

[Data are base5 on household interviews of the cwihan nonmstrtutionallzed population, The survey design, general qualifications, and information on the rehabilily of

the est!mates are g!ven in the technical notes]

Delays m growth Learning Emot!onal or

or development ckabihtjes behsviora/ prob/ems

Percent dcskibution Percent dts.fribution

Treatment and special

Percent distribution

Percent of of all children Percent of of all chi/dren Percent of

educa oon status all chddren

of all chi/dren

wrth condition all chkken with condition all children with condition

Ever recewed treatment

or counseling for condition

Total, ,,, ,, . . . . ,,

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

Within last 12 months.

More than 12 months ago

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

Attended s~ecial classes or

special scnool in past

Ages Ages

Ages 0-17 years Ages 3-17 years 3–1 7 years 3-17 years’

. . 4,0 100.0 65 100.0 13.4 100.0

. 2.0 49.4 51 77.7 10.0 74.5

. . 1.1 26.1 3.3 50.3 5.1

0.9 233

38.0

. . 18 27.4 4.7

2.0

35.3

. . 50.6 1.5 22.3 3.4 25.5

12 months because of “condition

Ages

Ages 6–1 7 years Ages 6–1 7 years &l 7 years2 Ages 8-17 years

Total . . . . . . . . . . . . . . . . . . . 3.9 100.0 7,8 100,0 6.9 1Oo.cl

Yes . . . . . . . . . . . . . . . . . . . 0,9 22.7 5.5 69.9 1.7

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

24.S1

3.0 77.3 2.3 30.1 5.2 75.~

llncludes unknown when trealed; excludes unknown whelhertrested,

‘Ouest!on about race!pl of special educational serwces asked only 01 those who reported an emononal or behavioral problem that lasted 3 months or longer.

NOTE, Numbers maynotadd tototals because of rounding

Table 6. Percent distribution and cumulative distribution of children 3-17 years of age with developmental, learning, and emotional

problems by age at which condition was first noticed, according to type of problem: United States, 1988

[Data are based on household interviews of the civifian nonmstitutionalized population. The survey design, general qualifications, and information on the reliability of

the estimates a:e given in the technical notes]

Delays m growth Emotions/ or

or deve/opmerr? Leammg disabilities behav/ora/ prob/em!;2

Cumulative Cumulative Cumulative

Age at tijctr corrd~fion Percent percent Percent percent Percerrt

was first noticed dlstributton distribution distribution distribution

percent

distribution distribution

At birth . . . . . . . . . . . . . . . . . 25 25 4 4 3

Before l year . . . . . . . . . . . . .

3

20 45 2 6 2

l-2 years . . . . . . . . . . . . . . . .

5

26 71 8 14 9 14

3-5years . . . . . . . . . . . . . . . . 12 83 25 39 25

6-8 years . . . . . . . . . . . . . . . .

39

9 92 45 84 24

9-n years . . . . . . . . . . . . . . .

63

5 97 11 95 15 78

12-17 years..,.,,....,,.. 3 100 5 100 22 100

‘Ages 0-17 years,

20uesti0n about age when noticed asked only of those who reporfed an emot,onal or behaworal problem that lasted 3 months or longer.

Table 7. Selected statistics onchildren 3-17 years ofage with developmental, Iearning, and emotional problems, by type of probhm:

United States, 1988

[Data are based on household interviews of the cwihan nonmsfitutlonahzed population. The survey design, general qualifications, and information on the reliability of

theestimates aregwenm thetechmcal notes]

Emotmnal or

Delays in grow?h

Item

Learning behavioral

or development’ disabJities problemsz

Med!anage at f!rstnotlce. . . 1 year2 months 6 years 7 months 7 years 2 months

Unwelghted rV. . . . . . . . . . . . . . . . . . . 630 862 833

Population es{lmate, . . . . . . . . . . . . . . 2,542,800 3,393,600 3,184,700

‘Ages 0-17 years

2These statlst!cs include only those who were reporlec! 10 have had a? emot$onal or behavmral problem that lasted 3 months or longer.
Advance Data 17

Technical notes

The estimates presented in this

report are based on data from the

lNational Health Interview Survey

(NHIS), an ongoing survey of

households in the United States

conducted by the National Center for

Health Statistics. Each week, a

probabili~ sample of the civilian

noninstitutionalized population of the

United States is intewiewed by

personnel of the U.S. Bureau of the

Census. Interviewers obtain

information about the health and

other characteristics of each member

of the households included in the

NHIS sample.

NHIS consists of two parts: (a) a

basic health questionnaire that

remains the same each year and is

completed for each household

member and (b) special topics

questionnaires that vary from year to

year and usually are asked of just one

person in each family. In 1988, the

special topics included acquired

immunodeficiency syndrome (AIDS)

knowledge and attitudes, medical

device implants, occupational health,

alcohol, and child health. These data

sets can be linked to provide

additional sources for analysis.

The total sample interviewed for

1988 for the basic health questionnaire

consisted of 47,485 households

containing 122,310 individuals. The

total response rate was 95 percent.

For the National Health Interview

Suwey on Child Health (NHIS-CH),

one sample child under the age of 18

years was selected from each family

with chiIdren in that age range.

Information about the sample child

was collected by face-to-face interview

with the adult member of the family

present who knew most about the

sample chiId’s health, in most cases

the mother. Interviews were

completed for 17,110 children 17 years

of age and under, 95 percent of those

identified as eligible on the basis of

the basic health questionnaire. The

overall response rate for NHIS-CH

was 91 percent, the product of the

response rates for the basic and the

child health questionnaires. Item

nonresponse was 24 percent for the

questions discussed in this report.

Because the estimates shown in

this report are based on a sample, they

are subject to sampling error. The

standard error is a measure of the

sampling error. Approximate standard

errors for estimated percents in this

report are determined using the

formula

‘E=v-Twhere SE is the standard error, p is

the estimated percent, and y is the

estimated base of the percent. The

bases of the percents are shown in

table 1.

The approximate standard error of

a difference between percents is given

by the formula

SE (xl – XJ = ~ SE(xl)’ + SE(xz)z

where XI and Xzare the two percents

being compared, xl - Xzis the

difference between them, and SE(X1)

and SE(XJ are the standard errors of

the two percents.

All differences cited in this report

are statistically significant at the 0.05

level. The t-test, with a critical value of

1.96, was used to test all comparisons

that are discussed. Lack of comment

regarding the difference between any

two estimates does not mean that the

difference was tested and found not to

be statistically significant.
18 Advance Data

Table 1. Number of children 17 years of age and under, by age and selected characteristics: United States, 1988

pata are based on household interviews of the civihan nonmstrtut!onal(zed oopulatlon, The survey design, general qualifications, and information on the reliability of

the estimates are gwen m the techn!cal notes]

A“ ages

17years 2 years

CharacterH’c

3-17 3-5 6-11 12–1 7

and under and under years years yeara years

Number in thousands

Allchlldrenl . . . . . . . . . . . . . . . . . . . . . . 63.569 11,360 52,209 10,748

5.428

5,320

8.762

1,526

1.263

9,132

1.342

3,006

2.800

2,473

8,132

3.275

4,856

2,616

10,332

290

1,841

4,596

4,120

7,327

398

2,196

829

20,986

10,522

10,414

16,966

3,267

2,519

18,242

2,760

5,526

5,207

5,234

15,886

6,102

9,784

5,060

20,263

509

4,104

9,105

7,422

12,643

1,789

4,573

1,962

20,495

10,642

9,854

16,566

3,217

2,182

18,14S

2,118

4,903

4,979

5,931

15,504

5,833

9,671

4,992

19,713

615

4,419

8,615

6,874

10,887

2,184

4,555

2,871

Sex

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

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

32,526

3i ,043

5,905

5,455

26,621

25,588

Race

L’/h!te, . . . . . . . . . . . . . . . . . . . . . . . . . . .

black, . . . . . . . . . . . . . . . . . . . . . . . . . . .

5-.380

9,620

9,066

1,810

42,314

8,009

Hispanic origin

Htspanlc . . . . . . . . . . . . . . . . . . . . . . . . .

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

7239

55,031

1,274

9,512

5,965

45.519

FamLyincome

Lessthan $10,000 . . . . . . . . . . . . . . . . . . .

S10,000-$24,999 . . . . . . . . . . . . . . . . . . . .

S25,000-$39,999, . . . . . . . . . . . . . . . . . .

S40,0000r more. ,,, . . . . . . . . . . . . . . . . .

7.924

16,708

15,737

16,071

1,705

3,274

2,750

2,432

6,219

13,435

12,986

13,836

Place of residence

).~SA .,...,..,.. . . . . . . . . . . . . . . . .

Central icy. . . . . . . . . . . . . . . . . . . . . . .

Noncentral city........,.. . . . . . .

Not MSA, . . . . . . . . . . . . . . . . . . . . . . . . .

48314

:8.972

29,342

15,255

8,793

3,763

S,030

2,567

39,521

15,210

24,311

12.688

Assessed health status

Excellent, veygood,orgood. . . .

Falror poor. ..,...... . . . . . . . .

6“.173

1,786

10,666

375

50,307

1,413

Mother’s education

Lessthan 12years . . . . . . . . . . . . . . . . . . .

12yaars. . . . . . . . . . . . . . . . . . . . . . . . .

Morethan 12years . . . . . . . . . . . . . . . . . . .

12,479

26,79t

22,899

2,118

4,475

4,484

10,362

22,315

18,416

Family structure

Biological motharandfather . .

Blolog!cal mother and stepfather. . . . .

B!ologlcal motheronlyz. . . . . . . .

Another . . . . . . . . . . . . . . . . . . . . . . . .

38,999

4.477

13,716

6.377

8,143

109

2,392

716

30,856

4,369

11.323

5.661

1Includes other races and unknown soaodemogramc anc health charac!?-!stcs.

z~n~,”de~ famille~ ,“ ~hlch :he mother hvedwdh the chdds grandmother 0’ other aduh relatlve

NOTE. MSA ISmetropoltian stamhcalarea,

‘U.S.GovemmentPrlntlngOfficw 1995-3S6-952/20212
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 collection 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, and contributionsto 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 cany the analyses furtherthan

the expository types of reports in the other series.

Documents and Committee Reports—These are final

reports of major committees concerned with vital and health

statistics and documents such as recommended model vital

registration laws and revised birth and death certificates.

International Vital and Health StatisticsReports-These

reports are analytical or descriptive reports 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 Survey 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 survey

instruments.

Data From the National Health Interview Survey-These

reports contain statistics on illness; unintentional injuries;

disabili~ 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

continuingnational household intewiew survey.

Data From the National Health Examination Survey, the

National Health and Nutrition Examination Surveys, and

the Hispanic Health and Nutrition Examination Survey—

Data from direct examination, testing, and measurement on

representative samples of the civilian noninstitutionalized

population provide the basis for (1) medically defined total

prevalence of specific diseases or conditions in the United

States and the distributionsof the population with respect to

physical, physiological,and psychological characteristics, 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 health care resources including ambulatory, hospital,

and long-term care services based on data collected directly

from health care providers and provider records.

SERIES 14.

SERIES 15.

SERIES 16.

SERIES 20.

SERIES 21.

SERIES 22.

SERIES 23.

SERIES 24.

Data on Health Resources: Manpower and Facilities—

Discontinued in 1990. Reports on the numbers, geographic

distribution, and characteristics of health resources are now

included in Series 13.

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.

Compilations of Advance Data From Vital and Health

Statistics-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.

Data on Mortality-These reports contain statistics on

mortality that are not included in regular, annual, or monthly

reports. Special analyses by cause of death, age, other

demographic variables, and geographic and trend analyses

are included.

Data on Natality,Marriage, and Divorce-These reports

contain statistics on natality, 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.

DateFrom the NationalMortalityand NatalitySurveysDiscontinued in 1975. Reports from these sample surveys,

based on vital records, are now published in Series 20 or 21.

Data From the National Survey of Family Growth—

These reports contain statistics on factors that affect birth

rates, including contraception, infertility, cohabitation,

marriage, divorce, and remarriag~ adoptiow use of medical

care for family planning and infertility; and related maternal

and infant health topics. These statistics are based on

national surveys of childbearing age.

Compilations of Data on Natality,Mortality, Marriage,

Divorce, and Induced Terminations of Pregnancy—

Theseinclude advance reports of births, deaths, marriages,

and divorces based on final data from the National Vital

Statistics System that were pubIished as supplements to the

Monthly Vi Statistics Report (MVSR). These reports provide

highlights and summaries of detailed data subsequently

published in Vita/ Statistics of the United States. Other

supplements to the MVSR published here provide seletied

findings based on final data from the National Vital Statistics

System and may be followed by detailed reports in Series 20

or 21.

For answers to questions about this report or for a list of reports published

in these series, contact

Data Dissemination Branch

National Center for HeaIth Statistics

Centers for Disease ControI and Prevention

Public Health Service

6525 Belcrest Road, Room 1064

Hyattsville, MD 20782

(301) 436-6500

E-mail: nchsquery@nchl Oa.em.cdc.gov

Internet http://www.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

6525 Belcrest Road

Hyattsville, Maryland 20782

OFFICIAL BUSINESS

PENALTY FOR PRIVATE USE, $300

E!!!!

DHHS Publication No. (PHS) 95-1878, Series 16, No. 19

5-1114 (5/95)