Vital and

Health Statistics

Advance Data

From Vital and

Health Statistics:

Numbers 51-60

Series 16:

Compilations of Advance Data From Vital

and Health Statistics

No. 6

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

age and other variables on ambulatory medical care; changes in cigarette

smoking practices; fats, cholesterol, and sodium intake in the diet; reproductive

impairments among currently married couples; wanted and unwanted births

reported by mothers; remarriages of women whose first marriage ended in

divorce; and trends in breast feeding, Estimates are based on the civilian

noninstiiutionalized population of the United States, These reports were originally

published in 1979 and 1980,

US, DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Centers for Disease Control

National Center for Health StatiWlcs

Hyaftsville, Maiyland

August 1991

DHHS Publication No, [PHS) 91-1865
Copyright Information

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

reproduced or copied without permission: citation as to source, however, IS

appreciated.

Suggested Citation

Nat}onal Center for Health Statistics. Advance data from wtal and health

statistics nos 51-60 National Center for Health Statistics. Vital Health Stat

16(6). 1991,
National Center for Health Statistics

.

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

Robert A. Israel, Deputy Direcfor

Jacob J. Feldman, Ph. D., Associate Director for Arza@sis

and Epidemiology

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

Extramural Programs

Peter L. Hurley, Associate Director for Vital and Health

Statistics Systems

Robert A. Israel, 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

David L. Larson, Assistant Directoc Atlanta
Overweight Adults inthe United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 6. . . . . . . . . . No. 51

Changes in Cigarette Smoking and Current Smoking Practices Among AduIts: United States, 1978 . . . . . . . . i. No. 52

Office Visits Involving X-rays, National Ambulatory Medical Care Survey United States, 1977 . . . . . . . . . . . . . No. 53

Fats, Cholesterol, and Sodium Intake in the Diet of Persons 1-74 Years: United States . . . . . . . . . . . . . . . . . . . No. 54

Reproductive Impairments Among Currently Married Couples: United States, 1976 . . . . . . . . . . . . . . . . . . . . . . No. 55

Wanted and Unwanted Births Reported by Mothers 15-44 Years of Age: United States, 1976 . . . . . . . . . . . . . . No. 56

Office Visits for Diabetes Mellitus, National tibulatory Medical Care Survey: United States, 1977 . . . . . . . . . No. 57

Remarriages of Women 15-44 Years of Age Whose First Marriage Ended in Divorce: United States, 1976... No. 58

Trends in Breast Feeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No, 59

1978 Summary: National Ambulatory Medical Care Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . No. 60
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STA TISTIC.S

U.S. DEPARTMENT OF HEALTH, ● Public Health Serwce

ED UCATION, ANC) WELFARE Office of Health Research, Statistics, and Technology Number 51 ● August 30, J979

Overweight Adults in the United States

This report presents estimates of the percentages and numbers of overweight adults in

the U.S. population developed from height

and weight measurements obtained as part of

the Health and lNutrition Examination Survey

(HANES) conducted by the National Center

for Health Statistics. Also presented is a

profile of selected body measurements of

these overweight persons.

Estimates of the prevalence of overweight

in this report are estimates of excess body

weight above desirable weight (mean weights

for men and women aged 20-29 years) by

height.

While weight gained after the twenties is

presumed to be due to fat, the gross estimates

in this report are not true estimates of excess

body fat other than what can be inferred

from the deviation of observed weight from

the desirable weight. Such estimates will not

yield information of how much of the weight

difference is accounted for by excess fat.

However, findings from HANES in which

obesity was defined by criteria ranging from

measures that included all body components

(e.g., body fat, width of skeletal size, and

muscle) to those that included only body fat,

will be analyzed and discussed in a future

report. 1 Only selected data from that report

are presented here (tabIes 1-6 and figures 1

and 2).

HANES is a program in which measures of

nutritional status are collected for a scientifically desiegned sample representative of the

civilian noninstitutiomdized population of the

aThis report was prepared by Sidney Abraham

and Clifford L. Johnson, M.S.P.H., Division of

Health Examination Statistics.

United States over a broad range of ages, 1-74

years.

These HANES findings are based on the

examination of the 13,131 persons aged 20-74

years seIected from a total sample of 20,74-9

examined persons aged 1-74 years. A nationwide probability sampIe of 28,043 persons

was selected to be examined from eligible

households in the 65 primary sampling units

that were visited between April 1971 and June

1974. The H.WNES nutrition excu-nination

included a general medical examination by a

physician to identify indicators of nutritional

deficiencies, a skin examination by a dermatoIog-ist, and a dental examination by a dentist. Body measurements were taken by a

trained technician, dietary information was

obtained by the 24-hour recall method, and a

food frequency questionnaire was administered. Numerous laborato~ tests were

performed on whole blood, serum, plasma,

and urine. A description of the sampling process and the H.WES operation has been published.~

The findings in this report are shown m

national estimates based on weighted observations, i.e., the data obtained for each examined

person wet-e inflated to the level of the total

population of which the sample was representative. The appropriate weights were used

to account for both sampling fractions and

response results.

Method

In this report excess body weight is obtained by comparing the observed height and

weight with those shown in the HANES table

of desirable weights (table 1). Excess body
2 achancedata

Table 1. Desirable weightsl for men and woman aged 20-74 years

by height: United States, 1971-74

Weight in pounds

Height

Men Women

57 inches ................................... ........

. . . 113

58 inches ...... ................... ......... ...... ...

..- 111

59 inches .......... .... ..... ........... .. .......... .

. . . 120

60 inches ............. ...... ................. .......

..- 123

61 inches .... ................ ................ .. .....

--- 127

62 inches ................ ... ............ ............ 136 130

63 inches .... ....... ................ ...... .......... 140 134

64 inches ................. ... ......... ..... ..... .. .. 145 137

65 inches ................... .... .. .................. 150 140

66 inches ............................. ...... .. ...... 155 144

67 inches ......... ..... ........... ...... ............ 159’ 147

68 inches.., ............................. .......... . 163 151

69 inches ......... .......... ........................ 168 154

70 inches .... ............ ........... .. ... ... .... .... 173 158

71 inches ............... .............. .............. 178 . . .

72 inches ................... ......... .. ............ . 182 . . .

73 inches .......... ................. ......... ....... 187 . . .

74 inches .... .... ............ ...... .... ...... ...... . 192 . . .

1 ~sed on average weights estimated from regression equation

of weight on height for men and women aged 20-29 years.

NOTES: Height measured without shoes. Clothing ranged

from 0.20 to 0.62 pounds which was not deducted from weights

shown. Derived fro m data of the Health and Nutrition Exa mina -

tion Survey, 1971-74.

weight status is defined as the deviation of

observed weight from desirable weight, times

100.

The desirable weight was developed using

a regression equation of weight on height

measurement for men and women aged 20-29

years as the standard for desirable weight.

This method follows the principle of “desirable

weight” that the increase in body weight in

adulthood with age is undesirable and is based

on the concept that after the twenties an

individual should not gain weight, presumably

fat, with each year of age. The standard,

although not exactly ideal for some persons in

the age group 20-29 years, minimizes the observed increase in fat in men and women during maturity. This is in contrast to the standard weight that uses the average weight of

men and women of each age group as the

standard.

We considered the deviation of 10 and 20

percent above desirable weight, more so the

latter, as arbitrary estimates that represent a

presumption of obesity. There is no universal

agreement on this definition, Ten percent

above the desirable weight falls in the upper

20 percent of the distribution of relative

desirable weight of men and women aged

20-29 years. The corresponding percentage of

20 percent above the desirable weight is 8

percent for men and 11 percent for women.

There is little or no question that the markedly

overweigh t individual is obese.

A profile of selected body measurements

of overweight persons was made of those persons with observed weight deviation 10 and 20

percent or more above desirable weights.

In addition to height and weight data from

HANES, skinfold thickness (triceps plus subscapular) and height-weight indices, a power

function of height in relation to weight, were

used in the profile.

While direct anatomical and chemical

methods for the estimation of body fat are

not suitable for Iarge-scaIe epidemiologicaI

surveys, an indirect method such as the

measurement of skinfold thickness meets the

need for a simple test of relative fatness for

the estimation of prevalence of obesity. If

skinfold measurements are not availabIe, there

is general a~greement that the most satisfactc)ry

measure is the body mass index.3’4

During the HANES, two measurements

were made of skin folds plus subcutanecws

tissue: One was made over the triceps midway

between the eIbow and the shoulder, and the

other was made over the tip of the scapular.

These measurements were recommended by

the Committee on Nutritional .4nthropometry

(Food and Nutrition Board) for the gene:raI

population.5 The two measurements were

added into a single measure of leanness-fatness.

This method obtained normative values based

on the distribution of added measurements.

The power function of height in relation

to weight avoided the use of population reference standards by calculating a power function

of height in a height-weight index, kV/l<P (in

kg/meterP ). Using the formula of Berm, we

computed the optimal power value from the

HANES data and obtained a value ofp=2 for

men and p=l.5 for women.6

Findings

Table 2 presents body weight measurements for each em.rnined person whose weight

was 10 or 20 percent or more above the desir-
.

acimncedata 3

Table 2. Mean of selected body measurements for men and womeri aged 20-74 years with relative desirable weight measurements 10

and 20 percent or more above desirable weight 1, by age: United States, 1971-74

Weight in pounds Height in inches Body mass index2

Skinfold thickness

Sex and age

in millimeters

10 percent 20 percent 10 percent 20 percent 10 percent 20 percent 10 *rcent 20 percent

or more or more or more or more CT more or more or more or more

Men .

20-74 years . .. .......... 202 219 69 69 29.97 32.52 39 45

20.24 years ........................ 210 225 70 70 29.73 32.52 42 52

25-34 years .............. ... ....... 212 231 70 69 30.67 33.75 41 49

3544 years.., ... .................. 203 219 68 69 29.78 32.04 37 41

46-64 years ....... ................. 202 217 69 69 30.05 32.52 39 45

56-64 years ................ ........ 198 215 68 68 30.02 32.57 37 42

65-74 years .... ...... .. .... ........ 180 204 67 67 29.54 31.74 37 42

Women

20-74 years . ............ 176 188 64 63 38.91 41.84 58 64

20-24 years.., .. ............. ...... 174 196 64 64 37.95 42.57 58 67

25-34 years ..... ...... ..... ........ 183 194 64 64 39.76 42.55 61 67

3S44 years .............. .......... 182 195 64 64 39.76 42.69 60 65

46-54 years .... ...... .............. 176 187 64 63

55-64 years

38.90 41.55 60

172

66

......... ..... .......... 182 53 63 38.93 41.18 58 62

65-74 years ... ...... ............... 167 177 62 62 38.15 40.52 53 56

lH on average ~eightg estimated from rewession eqwtions of weight on height for men and women aged 20-29 yeas”

2(~/@) ~ kg/meterp, where p=2 for men and P=l.5 for women.

3Sk~foId thickness = tZiCr3pS phIS Subscapuk.

able weight for each measurement. The mean

values shown in this table are graphically shown

in figures 1 and 2.

The mean height for men 10 percent or

more above the desirable weight was about 69

inches, and their mean weight ranged from

190 pounds at ages 65-74 to 212 pounds at

ages 25-34 years. The mean weight for the age

range 20-74 years was about 202 pounds.

Comparable data for men 20 percent or more

above the desirable weight showed the mean

height to be 69 inches and mean weight to

range from 204 pounds at ages 65-74 to 231

pounds at ages 25-34 years. The mean weight

for ages 20-74 was about 219 pounds. The

National Center for Health Statistics has previously reported that the mean weight and

height of men in the United States aged 20-74

years was 172 pounds and 69 inches, For men

10 percent or more above desirabIe weight,

the mean observed weight was 30 pounds

above that of the general male poptdation.

Corresponding data for men 20 percent or

more above the desirable weight showed the

mean observed weight to be 47 pounds above

the mean weight of the general male population.5

Table 2 ako shows that in terms of the

body mass index, W/W, the mean heightweight index for all age ~groups was about

30 kg/(mp) for men 10 percent or more above

desirable weight and 33 kg/(’mp) for those 20

percent or more above desirable weight.

The mean value of skinfoId thickness

measurement was 39 mm for men 10 percent

or more above the desirabIe weight and 45 mm

for those 20 percent or more above the desirable weight in ages 20-74 years.

The mean value. of the body mass index

(l\’/W) of 33 kg/(mP,) for men of all ages who

were 20 percent or more above the desirable

weight was about equal to the mean plus 2

times the standard deviation of the distribution of the height-weight indices for men o f

the same ages in the generaI population:

25.5 + 2(4.2) = 34.

The mean value of skinfold thickness of

45 mm for men of all ages who were 20 percent or more above the desirable weight was

more than the mean plus 1 times the standard

deviation of the distribution of the tricep plus

subscapular of men of the same ages in the

generaI population: tri + sub = 28.2 + 1( 12.5)

=41.
4 dwmdata

I

Figure 1. MEAN OF SELECTED BODY MEASUREMENTS OF

MEN ANO WOMEN AGED 20-74 YEARS WHO ARE 10

PERCENT OR MORE ABOVE DESIRABLE WEIGHT, BY

SEX AND AGE: UNITED STATES, 1971-74

70

r

TRIcEPS PL1!S SU13SCAPULAR

SK INFOLOIMILLIMETERSI

L-– 60 y . . . . .-----

.!! . . . . . .._. .. . . . . . . . . . .. . . . . . . . . $8

. . . . . . . . . . .

.....:~

50

42

.,

40 31 39

37 37

50

r

BOOY MASS INOEX [W/WO I

1

41j38’Q~ .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...??.. . . . . . . . . . .39. . . . . . . . . ...*

30 30 3’ 30 m

10 30

— Men

. . . . . Women

w(H * 5

Wlti ~

220 r

WEIGHT (POUNOSI

:: :\\

190 -

!90

183 / . . . . . . . . . . . ...2

180 - ....” -.... -.

,74 . ..-

. . . .!.7.s

..-

-- . . . . ...! 72

170 - -.”%.....:.67

160OLLdJJJ

70

70

70 HEIGHT (INcHESI

[

60

ea

‘%7

66

t

I

64 =.. . . . . . . . . ...%. . . . . . . ...%.. . . . . . . ...?... . . . .

-... m

-%...

6:~

20.24 25.34 35.44 45.54 55.64 65.74

AGE IN YEARS

A similar profile was made for women of

comparable ages. Table 2 shows that the

average height of women 10 percent or more

above the desirable weight was 64 inches,

which was about equal to the average height

of women in the general population.7 Women

10 percent or more above the desirable weight

had an average weight of 176 pounds, which

was on the average 33 pounds above the

Figure 2. MEAN OF SELECTED BODY MEASUREMENTS OF

MEN AND WOMEN AGED 20-74 YEARS WHO ARE 20

PERCENT OR MORE ABOVE DESIRABLE WEIGHT, BY

SEX AND AGE: UNITED STATES, 1971-74

TRICEPS PLUS SUESCAPULAR

[

SKINFOLO(MILLIMETERSI 70 67 67 — Mm

.........”...... . . . . . . . . . .. . . . . . . . . . . . . . . . . . . 62 . ..- Women

60

. . . . . . . . .

“%,..%

~>1 $

51

50 49

●

4, 42

40+

42

0

‘r SODV MASS INoEX (W/HD )

50 1- 43 ,3

41 ~,/fl.5

. . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . .

40

$3 34

32 33 Ss 31

20

WIH 2

240

fWEIGMT W0UN051

: :%.

m I=

. . . . . . . . . . ..!??..........!%...

.....

1s0- . . . !s7

. . . . . . .

. . . . ..!.2

1s0 ., “-% . . . ..!77

~1,,,,1 64 ‘ .....--.....~-....-.....~.

.......... ~ m.

. .. . . . . . . . . . . . . .. .. .

62 . . . ...62

0

20.24 25.34 3544 4s-54 55.s.4 65-74

AGE IN YEAFlS

reported average weight of 143 pounds for

alI women aged 20-74 years.7 For women 20

percent or more above the desirable weight,

the average height was about equaI to th(e

average reported for women in the general

population.T Their average weight was 188

pounds, which was on the average 45 pounds

above the average weight previously reported

for women in the general population.T
ackmdaa5

The mean value of the body mass index

(W/kP.5,)was 39 kg/(mp) and 42 kg/(mp), respectively, for women 10 percent or more and

20 percent or more above desirable weights in

all age groups. The corresponding skinfold

thickness measurements were 58 mm and

64 mm for the two selected criteria of overweight in all age groups.

For the body mass index of women who

were 20 percent or more above desirable

weight, the mean vzhue (42 kg/(mp ) was more

than the mean plus 1 times the standard deviation of the distribution of height-weight index

(W/Hi”5) of women aged 20-74 years in the

general population: W/Hl.s = 31.8 + 1(6.9)

= 39. For the skin fold measurement, the mean

value (64 mm) exceeded the mean plus 1 times

the distribution of triceps plus subscapular of

women aged 20-74 years in the general population: tri + sub = 42.3 + 1(17.4) =60.

The body mass indices for men and women

10 percent or more above the desirable weight

were in the upper 12 and 14 percent, respectively, of the distribution of this index for the

general population aged 20-74 years. For men

and women 20 percent or more above the

desirable weight, the indices were in the upper

4 and 8 percent, respectively, of the distribution. Corresponding percentages for men who

were 10 percent or more and 20 percent or

more above the desirable weight were in the

upper 16 and 10 percent, respectively, of the

distribution of skin fold thickness measurements. For women the percentages were in

the upper 19 percent for those 10 percent or

more above the desirable weight and in the

upper 12 percent for those 20 percent or

more above the desirable weight.

Table 3 shows that about a third of the

men aged 20-74 years in the United States or

an estimated 18.4 million were 10 percent or

more above the desirable weight. The corresponding value for men 20 percent or more

above the desirabIe weight was 14 percent, or

8.0 million men. Among women of comparable

ages, the proportions were higher for each of

the selected percents above the desirable

weight—3 6.4 percent, or 23.4 million, for

those 10 percent or more above the desirable

weight and 23.8, or 15.3 million, for those 20

percent or more above the desirable weight.

The proportions of men above the desirable 3. Number of examined persons and estimated population a~d 20-74 years and number and percent of persons 10 and 20

percent or more above desirable weight 1, by sex and age: United States, 1971-74

—Men

20-74 years

k

... ....... ...... ................ ...... .................. 5,001

20-24 years ................ .. ................ ......................... ....... 513

25-34 years ..................... ....... ............. .......... ............... 804

35-44 years ........ ............. ........ ..................................... 665

45454 years ................................. ..................... ............ 765

55-64 years ..... ............................................................. 597

65-74 years ...................... ........ ...... .......... ... ................. 1,657

Estimated

population

in thousands

Percent deviation from desirable weight

10 percent or more

Number Percent

T

18,434 32.1

1,522 18.5

3,866 30.3

4,222 39.1

4,023 35.7

3,022 34.0

1,784 32.5

T

23,394 36.4

1,729 19.4

3,526 25.2

4,30!5 36.6

5,266 42.9

5,001 50.2

3,565 49.0

20 percent or more

Number Percent

8,041 14.0

612 7.4

1,742 13.6

1,839 17.0

1,778 15.8

1,339 15.1

737 13.4

Women

20-74 years .............. .. .... ...... .............................. 9,130

20-24 years ........................ .......... ................................ 1,243

25-34 years .......... .............................. .......... ................ 1,895

35-44 yea B .. ............. .................. ......... ........ ..... ........... 1,663

45-64 years ....................................... ... ........................ 836

55-64 years ...... .................... .... .................................... 670

65-74 ymrs ...... ............ ............................ .. ................ .. 1,822

l“Based on average weights estimated from regression equations of weight on height for men and women aged 20-29 years.

57,431

8,217

12,766

10,804

11,260

8,888

5,496

84,181

8,919

13,996

11,772

12,264

9,953

7,277

15,268 23.8

859 9.6

2,390 17.1

2,864 24.3

3,411 27.8

3,449 34.7

2,281 31.5
6 admncedata

able weight increased with advancing age and

peaked at ages 35-44 years, where about 40

percent were 10 percent above the desirable

weight and 17 percent were 20 percent above

that weight. For women, the proportions also

increased with advancing age and peaked at

older ages (55-64 years), than men and then

declined.

Women in the youngest age group and at

ages 45 years or over showed a larger percent

of deviation from desirable weight in the 10

percent or more category than men did. This

direction was not evident for ages 25-44 years,

where the differences we’re much smaller

between men and women than they were in

the older age groups.

Comparison of the relative frequency of

men and women above desirable weight from

HANES was made with that from the Health

Examination Survey (HES), 1960-62. However, since the average weights were higher in

HANES than in the HES7 , the desirable

weights estimated from regression equations

of weight on height for men and women aged

20-29 years obtained from HANES were used

as the base for the findings in HES.

Overweight as defined by the percent of

persons deviating from desirabIe weight was

as prevalent among U.S. adults aged 20-.74

years in 1971-74 (HANES) as it was in 1960-

62 (HES) (tabIe 4). The prevalence rate for

men 10 percent or more above desirable

weight from the two surveys was identicaI. The

prevalence rates for those 20 percent or more

above the desirable weight differed no more

than expected from sampling variability. .4

similar pattern in prevaiance rates was also

evident for women of comparable age range.

At these ages the observed differences in proportions were 1.7 percent at 10 percent or

more above desirable weight and 1.3 percent

at 20 percent or more above desirabIe weight.

Table 4 also shows that the prevalence

rates for men 10 and 20 percent or moire

above desirable weight in the HES sampIe

were higher than the prevalence rates for men

in the HAJNES sample in the youngest age

~group and age 45 years and over. The actual

differences in prevalence rates are numerically

small. At these ages for those 10 percent or

more above desirabIe weight, the HES data

range was from 1.0 percent to 3.7 perce!nt

Table 4. Comparison of the percent of men and women aged 20-74 years in HES (1960-62) and HANES (1971-74) 10 and 20 pmcent I by =x and age:united States

or more above desirable weight ,

=

Percent deviating from desirable weight

Sex and age 10 percent or more 20 percent or more

HES HANES Excess2 H ES HANES Excess2

—Men

20-74 years ............................................................. 32.1 32.1 14.5 14.0 -0.5

20-24 years ..... ................................ ..... ........................ 22.2 18.5 -3.7 9.6 7,4 -2.2

25-34 years ..... ......... ................................... ................. 28.7 30.3 +1.6 13.3 13.6 +0.3

35-44 years ...... .... ........................ .................... ............ 37.8 39.1 +7.3 14,9 17.0 +2.1

45-54 years ...... ............................ ........ ............ ........ .... 36.9 35.7 -1.2 16.7 15.8 -0.9

55-84 years .. ........................................ ........ ................ 36.4 34.0 -2.4 15.8 15.1 -0.7

65-74 years .......... ..... .................. ................................. 33.5 32.5 -1.0 14.6 13.4 .1.2

Women

20-74 years .............. .......... ..................................... 38.1 36.4 -1.7 25.1 23.8 -1.3

20-24 years .......... ...... ...................... .................... ........ 18.8 19.4 +0.6 9.1 9.6 +0.5

25-34 years .......... ...... .. ............................ .... .............. .. 24.3 25.2 +0.9 14.8 17,1 +2.3

35-44 years ..... ............ ................... .................. ............ 34.6 36.6 +2.0 23.2 24.3 +1.1

45-54 years ........... ............................... .... ........ ............ 43.4 42.9 -0.5 28.9 27.8 -1.1

55-64 years ... ............................. ...... .... .............. ........,. 56.2 50.2 -6.0 38.6 34.7 -3.9

65-74 years .... ............ ......... ............. ..... ....... ...... ......... . 56.2 49.0 -7.2 38.8 31.5 -7.3

—

lDes~able weight esti~ted from regression equations of weight on height for men and womenwed Zo-zgYeers, obtained fl~m

Health and Nutrition Examination Survey (HANES) and used as the base for the findings in Health Examination Survey (HES).

2&cew of HANE,s Over ‘Es-
alhncedata 7

greater than the HANES data. The corresponding differences for those 20 percent or

more above desirable weight range from 0.7

percent to 2.2 percent. In contrast, HANES

prevalence rates were higher than HES prevalence rates at ages 25-44 years for both criteria

of overweight. The maximum difference is 7.3

percent at ages 35-44 years with the differences ranging from O.3 percent to 2.1 percent

for both criteria of overweight.

A similar pattern was observed for women

in each age ~group with the exception of the

youngest age ‘group, where the HANES prevalence rate was higher than that for HES. The

maximum differences were 7.2 percent and

7.3 percent, respectively, at the oldest age

group for both criteria of overweight.

In HES, the proportion of women 10 percent or more above the desirable weight

was less than that for men under 35 years of

age and greater than that for men 35 years

and over. The corresponding proportion for

women in comparison with men in HMNES

was more for women at the youngest age

group 20-24 years, less than that for men at

ages 25-44 years, and greater than that for

men in the older age <groups. The proportion

of women 20 percent above the desirable

weight in HES was about the same as that for

men in ages 20-24 years, and in HES and

HANES exceeds that for men beyond this age

group.

Table 4 shows that the overweight prevalence rate for both criteria from HES and

I-LANES sets of data increase with advancing

years. For men, HES data reach a maximum at ages 45-54 years where 37 percent of the men \vere 10 percent or more

above desirable weight and 17 percent were

20 percent or more above desirable weight.

For HANES, the prevalence rates peaked a

decade earlier at about the same proportions

for 10 and 20 percent or more above desirable

weight. For HES and HAINES the greatest increase in proportions occurs from the twenties

to thirties.

For women, the prevalence rates continued

to rise with age and peaked at ages 55-64

years, where more than 50 percent of the

women from HES and H.WJES were 10 percent or more above desirable weight and more

than 1 out of every 3 were 20 percent or

more above desirable ;veight.

The proportion of men and women whose

relative weight exceed any other specified

criteria may be found in tables 5 and 6.

Table 5. Cumulative percent distribution of relative weight (observed weight/desirable weight for height x 100 ) for men aged 20-74 years

in HES (196C-62) and HANES (1 971 -74), by age: United States

Relative 20-74 years 20.24 years 25-34 years 35-44 years

dasirable

45-54 years 55-64 years 66-74 years

weight 1960- 1971- 1960- 1971- 1960- 1971- 1960- 1971- 1960- 1971- 1960. 1971 - 1960- 1971-

in pounds 62 74 62 74 62 74 62 74 62 74 62 74 62 74

Undar 85 ........... 10.5 10.5 18.1

Under 90 .......... 19.7 18.5 30.6

Under 95 ........... 31.3 29.9 48.2

Under 100 ........ 43.9 41.6 60.2

Under 105 ........ 56.0 54.1 70.9

Under 110 ........ 67.9 67.9 77,8

Under 115 ......... 77.6 78.1 86.4

Under 120 ........ 85.5 86.0 90,4

Under 125 ........ 91.5 90.8 93.1

Under 130 ........ 94.7 94.2 95.0

Urder 135 ........ 96.8 96.0 96.3

Under 140 ......... 98.2 97.4 97.4

Under 145.,, ..... 98.7 97.9 97.4

Under 150 ........ 99.5 98.7 100.0

Under 155 ........ 99.6 99.1 100.0

Under 160., ...... 99.7 99.3 100.0

20.2

32.0

48.1

60.4

71.8

81.5

89.0

92.6

94.7

96.6

98.0

98.6

98.6

99.2

99.8

100.0

13.3

23.7

34.4

46.9

58.1

71.3

78.9

86.7

92.3

95.5

96.9

98.2

98.4

99.6

99.7

99.7

Cumulative percent distribution

9.8

19.0

32.9

* 46.7

58.5

69.7

78.6

86.4

90.2

93.1

94.9

96.3

97.1

98.2

98.5 !

98.7,

6.7

13.8

24.1

38.5

53.8

68.2

77.9

85.1

90.9

94.8 !

96.9

98.0 I

98.8 ~

99.0 ~

99.3 I

3

6.4

12.6

22.9

32.1

45.0

60,9

73.2

83.0

89.8

95.0

96.5

97.7

98.1

99.0

98.0

99.2

6.7

14.5

27.0

39.0

51.2

63.1

72.9

83.3

90.0

93.7

86.5

98.6

99.1

99.6

99.9

99.9

8.6

14.6

23.2

33.9

48.2

64.3

74.4

84.2

89.5

92.9

95.2

97.3

97.9

98.1

98.8

88.0

10.3

19.1

28.7

41.1

53.1

63.6

74.7

84.2

92.9

95.6

97.5

98.4

98.6

88.0

98.0

98.3

9.8

17.4

27.2

38.3

50.1

66.0

77.3

85.0

80.3

93.2

95.3

96.9

97.6

88.0

88.3

88.4

14.1

25.0

34.8

47.2

55.8

66.5

79.4

85.4

90.3

93.7

96.8

98.5

88.1

100.0

100.0

100.0

11.2

18.5

27.9

40.9

53.7

67.5

79.3

86.6

91.9

85.4

97.3

80.4

98.8

88.4

99.7

88.8
8 admmedata

Table 6. Cumulative percent distribution of relative weight {observed/desirable weight x 100 ) for women aged 20-74 years in HES

(1960-62) and HANES (1971-74), by ege: United States

~

Relative 20-74 years 20-24 years 25-34 years 35-44 years 45-54 years 55-54 years 65-74 years

desirable

weight 1960- 1971- 1960- 1971- 1960- 1971- 1960- 1971- 1960- 1971- 1960- 1971- 1960- 1971 -

in pounds 62 74 62 74 62 74 62 74 62 74 62 74 <62 74

Under 85 .......... 10.2

Under 90 .......... 19.7

Under 95..., ...... 31.9

Under 100 ........ 42.9

Under 105 ........ 52.8

Under 110 ........ 61.9

Undar 115, ....... 69.2

Under 120 ........ 74.9

Under 125., ...... 80.3

Under 130 ........ 84.6

Under 135 ........ 88.1

Under 140 ........ 90.9

Under 145 ........ 93.3

Under 150 ........ 95.0

Under 160 ........ 97.1

Under 170 ........ 98.4

Under 180 ........ 99.2

Under 190 ........ 99.6

12.7 23.1

22.1 38.2

34.0 55.8

45.2 66.6

55,1 75.9

63.6 81.2

70.3 87.2

76.2 90.9

80.9 93.1

84.6 94.7

88.0 96.0

90.7 96.2

92.8 96.8

94.4 97.3

96.6 98.5

98.0 99.0

98.8 99.9

99.2 100.0

23.5

36.8

53.7

65.6

75.3

80.6

87.3

90.4

92.6

93.7

95.1

95.8

96.9

97.2

9%.3

99.1

88.3

88.6

16.2

30.1

47.1

59.6

70.4

75.7

81.1

85.2

88.2

91.4

93.1

94.9

96.0

97.5

98.5

99.0

99.5

99.8

Cumulative percent distribution

18.0

31.5

44.3

57.6

66.2

74.8

79.6

82.9

85.8

68.1

90.9

92.5

93.8

95.3

97.0

98.2

98.8

99.4

8.8 10.1

19.0 19.3

34.0 31.7

46.9 45.1

56.3 55.6

65.4 63.4

72.2 69.8

76.8 75.7

81.9 80.2

85.8 82.8

88.6 86.1

91.3 88.7

93.3 91.1

94.3 93.1

96.1 95.8

98.2 97.5

99.2 98.0

99.6 98.8

6.4

13.2

21.5

32.9

42,7

56.6

64.6

71.1

76.5

80.2

85,3

89.3

92.7

94.1

96.7

97.9

98.6

99.1

7.6

15.0

27.0

36.6

46.5

57,1

64.2

72.2

77,7

83.2

86.6

89.8

92.1

93.4

95.6

97.0

98.8

88.4

3.8

8.9

14.5

23.4

34,1

43,8

53.1

61.4

68.8

76,3

81.1

85.6

89.1

9? .9

95.6

96.8

98.4

99.0

9.1

14.3

23.2

31.0

40.9

49.8

58.1

65.3

72.4

77.3

83.2

87.4

90.7

93.2

96.5

97.9

98.6

98.8

4.5

9.2

76.7

23.8

34.8

43.8

52,5

61.2

72.2

78,2

84.4

87.1

91.8

94.6

97.8

99.7

100.0

100.0

6.4

13.0

20.3

30.3

42,2

51.0

59.7

86.5

75.6

81.5

85.8

88.9

92.4

94.5

97.2

98.5

99.3

88.5

.—

REFERENCES

1National Center for Health Statistics: Obesity 5Committee on Nutritional .+nthropometry, Food

of adults, 20-74 years of age, United States, 1971-

74, by S. Abraham. Vital and Health Statistics.

Series 11. Public Health Service, DHEW, Hyattsville,

Md. To be published.

2National Center for Health Statistics: Plan and

operation of the Health and Nutrition Examination

Survey, United States, 1971-73, by H. W. Miller. Vital

and Health Statistics. Series 1-Nos. 10a and 10b.

DHEW Pub. No. (PHS) 79-1310. Public Health Service. Washington. U.S. Government Printing Office,

June 1979.

3Keys, A., et al: Indices of reIative weight and

obesity. J. Chron. Dis., 25:329-343, 1972.

4Womersly, J., and Durnin, J. ‘V. G. A.: A Corn- ‘

parison of the skinfold method with extent of overweight and various weight-height relationships in the

assessment of obesity. Br. ,/. Nutr. 38: 271-284, 1977.

and ,Nutrition Board. National Research Council:

Recommendations concerning body measurements

for the characterizations of nutritional status, in J.

Brozek, cd., Body Measurements and Human Nutrition. Detroit. Wayne University Press, 1956.

6Benn, R. J.: Some mathematical properties of

weight for height indices as measures of adiposity.

Br. J. Prev. Sot. Med. 25:42-50, 1971.

7.National Center for Health Statistics: Weight and

height of adults, 18-74 years of age, United States,

1971-74, by S. Abraham, C. L. Johnson, and M. F.

Najjar. Vital and Health Statistics. Series 11-No. 211.

DHEW Pub. No. (PHS) 79-1659. Public Health

Service. Washington. U.S. Government Printing Office,

May 1979.
ackmdaa9

TECHNICAL NOTES

The sampling plan for the 65 examination

locations in the Health and Nutrition Examination Survey (HANES) followed a highly

stratified multistage probability design in

which a sample of the civilian noninstitutionalized population of the conterminous United

Statesaged 1-74 years was selected. Successive

elements dealt with in the process of sampling

were the primary sampling unit, census enumeration district, se<gment(a cluster of households), household, eligible person, and sample

person. The sampling design provided for oversampIing among persons living in poverty

areas, preschool children, women of childbearing age, and the elderly.

The excess weight determinations are

shown as population estimates, that is,

the fmdkgs for each individud have been

“weighted” by the reciprocal of the probability

of selecting the person. An adjustment for persons in the sample who were not examined

and poststratified ratio adjustments were also

made ‘so that the final sampling estimates of

the population size were brought into closer

alignment with the independent U.S. Bureau

of the Census estimates for the civilian noninstitutionalized population of the United

States as of November 1, 1972, by race, sex,

and age.
FROM VITAL & HEALTH STA Tt3TlCS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

U.S.DEPARTMENT OF HEALTH, . public Health Serv’ce

ED UCATION, ANU WELFARE Office of Health Research, Stattstlcs,and Technolow Number 52 . September 19, 1979

Changes in Cigarette Smoking and Current Smoking

PracticesAmong Aduits: United States, 1978’

Since the 1950’s, the prevalence of cigarette

smoking among adult males in the U.S. noninstitutionaIized population has steadily declined.

In contrast, the proportion of female smokers

rose from the mid-fifties to the mid-sixties and

since then, the rates have only dropped slightIy.

Furthermore, the smoking rates for men and

women are more similar now than in emIier

years. The average number of cigarettes cons~lmcd daiIy per smoker has nevertheless increased. Over one-half of the persons who currently smoke cigarettes have made at least one

serious attempt to stop. One in 5 smokers who

tried to quit smoking in the past year were

successful. Over one-fourth of cigarette smokers

now use lower tar cigarettes..

Beginning in 1965, the hTational Center for

Health Statistics has periodically incIuded cigarette smoking questions in its household Health

Interview Survey (HIS) conducted among the

U.S. civilian nortinstitutionalized population.

The items selected for inclusion have identified

the smoking status of the adult population and

in some vears have also elicited information cm

their smoking practices and attempts to quit

smoliin~.

This report presents the latest avaiIabIe data

on smokin~ for the 6-month period Juiy 17,

1978. through January 14, 1979. These data

were obtained in response to the Department of

Health, Education, and Welfare’s Office on

Smoking and Health’s request for current

prevalence estimates on cigarette smokers. (Provisional smoking estimates based on 9 weeks of

l~k report was prepared by Abigail Jean Moss, Div-

~ of Health [ntemiew Statistics.

these data appear in Smoking and Health, a report of the Surgeon General released earlier this

year.) The 1978 HIS questionnaire contained

items to identify current and former smokers. It

inciuded questions on approximate numbers of

cigarettes presently smoked, numbers smoked

during the period of heaviest consumption, and

quitting attempts. Information needed to

identify tar and nicotine levels of cigarettes most

frequently smoked was also eiicited.

Data presented in this reporr. were obtained

from seIf-respondents. The sampIe consisted of a

one-third subsampIe of the usual HIS sample of

persons 17 years of age and over and included

approximately 12,000 persons. Tables 1-5

include data on both reqdar and occasional

smokers; tables 6-11 include data on regular

smokers only since these data w“ere not obtained

from persons classified as occasional smokers.

The 1978 smoking questions will remain (m

the HIS questionnaire throughout 1979. This

data-collection period is somewhat longer thm

usual. It wilI ( 1) expand the smoking data base,

enabling a more detailed breakdown of the estimates into smaller population subgroups, and

(2) enable the observation of chartqes in smoking

habits over time, particularly before and ~fter

the release of the Surgeon General’s report

Smoking and Health in January 1979.

In this report, summary statistics on smoking status and behavior are shown by sex, certain

ages, and for white and black perscms. ~ However, these estimates are preliminary since a

2Statistics are wailable For additional aW qroups,

family income, and education of the indi~,idual. They

wiII be provided upon request by the Division of Health

Interview S mtisrics.
2 advancedata ——

Table 1. Percent of persons 17 years and over, by cqarerte frnokmg status, sex, and age: United States, 1970, 1974, and 1978

[ Data are based on household interwews of the civilbn noninsr!ruc,[)nalized pvpulztcion. The source of I-LIGI. wmpling, wrd Iimiutions

WJ quulifimtions (It’ Duta me gwen m the cechnicul IICI(eS[

~

Presen~ smoker Never smoked Former smoker

Sexand age

1978 1974 1970 1978 1974 1970 1978 1974 1970

Both sexes Percent 1

All ages 17years and over., ....... .... .... 33.7 36.8 36.9 45.6 44.1 45.’I

17-24 years ...... ..... ....................................... 32.6 36.2 35.4 58.7 54.6 56.3

25-44 years ... .... ...... ................. ..... .. ...... ....... 39.0 44.5 44.6 41.0 37.1 36.6

45-64 years .. .. .......... ..... .. ...... ................. ...... 36.5 37.7 38.6 36.9 37.5 39.7

65 years arid over ...... ............ ...... .......... ....... 16.5 17.3 16.1 55.4 59.4 62.6

Male

.

All ages 17 years and over .... ............ . 37.4 42.7 43.5 34.7 30.1 30.9

17-24 years ....... ........... .......... .. ....... ............. 33.9 40.3 41.2 56.4 48.5 49.3

2!%$4 yw* ................... ............. ..... ...... ...... 42.3 50.7 50.9 33.1 26.0 25.8

45-64 years .......... ....................... ................. 39.9 42.6 44.8 22.6 21.0 23.1

65 years and over ....... ............ ...... .... ...... ...... 22.9 24.8 23.1 30.3 33.6 37.3

Female

All ages 17 years and over ... .............. 30.4 31.9 31.1 55.3 55.7 57.5

17-24 years .............. ...... ............................ .. 31.4 32.6 30.5 60.8 60.0 62.3

25-44 years ................ ................ ....... ...... .... . 35.9 39.2 38.8 48.5 46.6 46.6

45-64 years .............................................. .... 33.4 33.4 33.0 49.7 51.6 54.8

65 years and over .......................... .............. 11.9 12.0 11.0 72.9 77.4 81.4

1 Excjudes persons with unknown smoking s~a[us,

20.3 19.2 18.0

I I

8.4 9.2 8.3

19.5 18.4 18.8

26.0 24.8 21,7

28.0 23.3 21.3

I I

T

27.4 27.2 25.6

9.2 11.2 9.5

24.1 23.3 23.3

36.9 36.3 32.2

46.4 41.6 39.6

f

13.9 12.5 ~1.4

7.5 7.5 73

15.2 14.2 14.~

16.2 14.9 12.:.

15.2 10.6 7.6

more c[)mplcte ec[it of the data, planned for

[ater this year, m:iy produce slight vari~tions

hetWCr3t_I these figures Znci final results. .A ITI(JK

detailed rcptjrt in Set_ics 10 () f Vitc( a)2d lIruft/2

Statistics, scheduicd for” release ncx L yetir, wi]]

include the cornhincd cigarct Lc smokin,q results

from the 1978 and 1979 suwcys.

Dots from Lhis ]qtest sumey show that ~Lt>our

1 out of 3 adults (33.7 percent) in the U.S. civilian noninstitut ionalized population are cig~rette

smokers-down slightly from 36.8 pcrccllt in

1974 and 36,!3 percent in 1970 (t:d>les 1-3).

This latest estim:ltc represents the lowest proportion OF cigarette smokers, as J group, since

the 1950’s. The 1974 tincl 1978 results \vcre

obminct{ From self-respondents while in 1970

proxy respt)ndcnts lvcrc aiso LIsec[. Tile recent

decline in cigm-eltc smokers hiis occurrcci primarily Imorlg rndcs (from 43.5 percent in 1970

ro 37.4 percent in 1978). In c[)ntmst, the proportif)n (JI” Fcm:de snlokcrs 17 ye:lrs of :l~c .mci

over has remained ~bout the same (3 1.1 pet--

cent in ]970 and 30.4 percemt in 1978).

A person is clussifkd m a present cigarcctc

smoker if he reports thtit hc has sm(~kcd Jt

least 100 cigarettes (five packs) during his entire life and that he is presendy smoking. Present

ci,gmt.te smokers arc furthe’r classified as r’wular smokers and ~jccassiorral smokers. .A prrxrrt

occasional s,no~cr smokes cigarettes notv

but vo[urrteers thm he has never srnokcd rcqulady when asked: .“.Al)(N~t how OIC{ iverc

yOLI when ~(ILI first started Smokins cigarettes

fairly regularly?” Present regular smokers ;arc

all other present smokers. .A similar dichotomy

is used to classify former cigarette smokers.

The differences which have occurred in the

ci,y~rctte smokin,q htibits of men md worncn

from 1970 to 1978 tire JIs() ~pparerrt in estimates of pers[~ns who have nelwr sm(jkcd.

\Vhiic the proportion of aciuft males who h~vc

never smoked is increasing -30.9 pcrccnt,..ic
dwlcedm 3

Table 2. Number of persons 17 years and over, by cigarette smoking status, race, sex. and age: Umted States. 1978

I Dtim we based on household interviews of the civilian nonins[itutionaiizmi population. The source of clam, wrnpling, and Iimim;iorrs

and qualifications of Data are gwen in the rechnid notes.[

Fresent smoker Former srrmker

Total AH Regular Regular Never Ail OCpopu- smokersl Regular Regular and oc- and occasional

Iation smoker

smoked

casional casionai smoker smokers

smoker only smoker only

Race, sex, and age

All races2 Number in thousands

Both sexes 17 years

and over ................ 84,524

13.139

33,772

27,391

10,222

47,884

52.348

10,386

22.337

15,854

3,772

27,408

51,685

10,224

21,992

15,723

3,746

27,151

31,547

2,658

11,165

11,301

6,423

20,102

155,452

31,817

57,251

43.463

22,921

73,381

29,237

2.372

10,306

10,520

6,039

18.730

70,854 3,165

18,664 488

23,479 1,282

16,025 985

12,687 410

17-24 years........................

25-44 years........................

45-64 years., ......................

65 years and over...............

MsIe 17 years and

over............................ 2S,471 ] 1,710

17.24 years........................

25-44 years........................

45-64 years........................

65 years and over ...............

15,482

27,828

20,616

9,445

82.070

16,32S

28,423

22,846

13,475

136,807

6,741

18,621

15,952

6,570

36,641

5,258

11.763

8,225

2,161

24,940

5,176

11,615

8,199

2,161

24,535

1,427

6,697

7,597

4,381

11,445

1,232

4,468

3.704

2,042

28,982

1,233

6,157

7,205

4,134

10,507

8,737 290

9,207 729

4,665 444

2,863 247

Female 17 years and

over............................

T

45,383 1.455

9,927 198

14,273 553

11,360 541

9,823 163

17-24 years........................

25-44 wars. .......................

45.64 years .............. .... .... ..

65 years and over ...............

6,399

15.150

11,440

3,652

75,323

5,127

10,573

7,629

1,610

45,761

-

8,945

19,153

14,224

3,439

23,815

21,946

5,278

5,048

10.377

7,524

1,585

45,200

1,139

4,148

3,315

1,805

26,849

White

17 years and over ......... 61,225 I 2,872

17-24 years..., ....................

25-44 years........................

45-64 years ................. ..... ..

65 years and over, ..............

27,168

49,726

38,985

20,728

64,936

71,671

14,572

11,381

28,655

24,874

9,413

42,655

32,668

7,231

8,810

18,861

14,115

3,414

23,613

21,587

5,189

2,340

10,243

10,451

5,947

18,492

10,488

1,904

2,081

9,487

9.695

5,587

17,227

9,623

1,762

15,787 435

20,071 1,126

14,065 925

11,302 386

22,269 1,535

38,956 1,337

Msie ......... ............... ...... .....

Fen-ale ...............................

81ack

17 years and over ......... 7,341 243

17-24 years.., ... .......... ........

25-44 years........................

45.64 years .......... ..... ........ .

65 years and over ...............

3,587

5,540

3,633

1,812

6,256

8,316

1,306

3,165

2,142

618

3,918

3,313

1,068

2,520

1,394

296

2,730

2,548

1,054

2,468

1,371

296

2,675

2,515

239

634

710

322

1,162

742

212

555

697

298

1,069

693

2,281 ●41

2,375 130

1,491 *48

1,195 “24

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

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

2,338 161

5,033 ●82

~Include~ smokers with unknown pres-anrsmoking ‘tatUs.

21ncludes aII other roces, which are nOt shw”n separately -

NOTE: When a figure is shown with an asterisk, it is presented only for the purpose of combining with other cells. An estmsate has a

relative standard error of less than 30 percent when the aggregate IS at least 12S .000.
4 ixlvancedata

Table 3. Percent distribution of permrss 17 years and over by cigarette smoking s~atus, according to race, sex, and age:

United Stales, 1978

[ Da[I ire bused un household” intervwws of the c]wlion n{)n,nsticutionulized populfirwn. The source of d~ra, sumpiing, and lirnKatium

~nd qu~lificarions of Datis are givers ‘m the !echrr!cal nuresj

——

Presenr smoker

I

Former smoker I

Total

All Regular Regular Never

All OC.

popu. smokers2 and OC. Regu tar Regular casional

lationl

and ocsmoker

smoked

casional casionai smoker smokers

smoker only smoker only

Race, sex, and age

All racesz Percent dism!burlon

Bath sexes 17 years

and over, ........ ....... 33.7

32.6

39.C

36.5

16.5

37.4

33.2

32.1

384

36.2

16.2

37.0

20.3 18.8

I

45.6

58.7

41.0

36.9

55,4

34.7

56.4

33.1

22.6

30.3

55.3

2.0

.Z

1.5

2.2

2.3

1.8

2.3

I

17-24 years ..... ......... ..........

25-44 years ............ ............

45-64 years .. .......... ..... .......

66 years and over..., ......... ..

100.0 41.3

100.0 59.0

100.0 63.0

100.0 44.6

8.4 7.5

19.5 18.0

26.0 24.2

28.0 26.3

-4- 27.4 25.5

9.2 8.0

Msle 17 years and

over ..... ................. ..... .

t

100.0 66.3

100.0 43.5

100,0 66.9

100,0 77.4

100.0 69.6

17-24 years ..... ......... ..........

25-44 years ..... ...... .... ...... ...

45-64 years ............. .... .......

65 years and over ......... .... ..

33.9

42.3

39.9

22.9

30.4

33.4

41.7

39.e

22.9

29.9

1.9

2.6

2.2

2.6

1.8

24.1 22,1

36.9 34.9

46.4 43.8

Female 17 years and

over .......... ...... ...... ...... 100.0 44.6 13.9/ 12.8

17-24 years .............. ..........

.25-44 years ................ ..... ...

45-64 years ........... ..... ..... ...

65 years and over ............. .

100.0 39.2

100.0 51.5

100.0 50.1

100.0 27.1

30,9

35.3

32.9

11.8

33.1

7.5 7.0

15.2 14.1

16.2 14.5

15.2 14.1

31.4

35.9

33.4

11.9

33.5

60.8

48.5

49,7

72.9

44.8

1.2

1.9

2.4

1.2

2.1

Wh!te

17 yaars and over ......... 100.0 55.1 21.2 19.7

8.6 7.7

20.6 19.1

26.8 24.9

28.7 27.0

17-24 years .... ................... .

2544 years ..... .............. .....

45-64 years ...... .......... ........

65 years and over ....... .. .... ..

100.0 47.9

100.0 59.6

100.0 63.8

100.0 45.4

32.9

38.5

36.5

16.6

36.7

30.6

36.2

32.4

37,9

36.2

16.5

36.4

30.1

35.6

58.1

40.4

36.1

54.5

34.3

54,4

50.4

1,6

2.3

2.4

1.9

2.4

1.9

1.7

28.5 26.5

14.6 13.4

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

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

100.0 65.7

100.0 45.6

13.1 12.1

Black I

17 years and Over ...... ... 100.0 49.6

1

T

6.7 5.9

17.4 10,0

19.5 19.2

17.8 16.4

17-24 years,, .... ................ ..

24-44 years ......... .............. .

45-64 years ................. .. .....

65 years and over ..............

100.0 36.4

100.0 57.1

100.0 59.0

100.0 34.1

29.8

45.5

38.4

16.3

43.6

30.6

29.4

44.5

37.7

16.3

42.8

30.2

63.6

42.9

41.0

65.9

37,4

60.2

+1!1

2.3

●1 .3

al ,3

2.6

●1 .0

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

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

lExclude,, persons with unknown smoking status.

21nclude~ sm~ker~ ~th unknown present smoking status.

31”c[ude~ ~11other rzces, which are not shown separately.

NOTE: When a figure is shown with an asterisk, it is presented only for the purpose of combining with other cel[s. An estimate hiss a

relative standard error of less than 30 percent when the aggregate is at least 125,000.
admncedata 5

1970 and 34.7 percent in 1978-the proportion

of femules has remained about the same (5 7.5

and 55.3 percent, respectively).

Although estimates of male present smokers

and smokers 25-44 years of age are declining,

the average number of cigmettes consumed daily

per smoker is increasing. In 1970, 23.3 percent

of all adult cigarette smokers smoked 25 cigarettes or more a day, while in 1978, 27.9 percent of all smokers reported smoking at this

level ([ab]es 4 and 5). In addition :retiwr proportions of adults smoked less than 15 cigarettes

per day in 1970 than in 1978 (32.9 compared

with 29.4 percent). This trend is found among

both men and women and in all age groups.

These findings probably reflect several phenomena; among them w-e changes in the cigarette product itself, increased smoking by

some smokers who have switched to lower

tar cigarcttcs, Jnd ii c{isprf]l)(lrti~)[l:ltc [Ittmbcr

of PC I”SOI)S smoking fcwwr ciqarcttcs m:ty bc

quitting.

The 1978 ci~m-eLte consumption ciata also

show that persons smoking hxs than 15 cigarettes daily were mom often female, black,

and either under 25 years of age or 65 years

and over. In contrast., persons smoking 25 cigarettes or more a day were predominantly 25-64

years of age, male, md white.

The Health Intelvicw SLinty d~tu from 1978

further show that the majority of peopIe who

now smoke cigarettes have made at least one

serious attempt to quit during their smoking

years. About 60 percent of the over 50 million

current adult cigarette smokers have tried to

stop smoking at some time, of whum an estimated 13% miHion have made an attempt during the past year (table 6). These data were

Table 4. Percent of present smokers 17 years and over by amount snmked daily, sex, and age: United States, 1970,1974, and 1978

[DatLs are based on household irstertiew of the civilian noninstitutioncdized populminrt. The source of dam, sampling, and limitations

and qualifications of Data are given in the technicaI notes]

Sex and age

%th sexes

All ages 17 years and over ............... .......... ........

17.24 yaws .............. .......................... .. ........ ........ ........

25.44 years ... .... .......................... .. ...... .... ................ .....

45.64 years .. .... ..... .... ...... ............. ........... ........... ...... ....

56 years and over ............. ........... ............... .. .... ..... .......

Male

All ages 17 years and over .............. ........... ........... ..

17-24 years ......... .. .............................. .. ..... ...... ...........

2544 years ............ .......................... ................ ....... ....

45.64 ywrs .............................. ..... ........ ........... .... ... ....

65 ymrs and over .. ........x ..... ......................... ..............

Female

All ages 17 years and over ....................... .......... .... .

17-24 years ......... .. .. ...... ........ ...................j ...... .............

25-44 years ......... .. .. ..................... ............................ ....

45.64 years ..... ............ ........................................ .........

65 years and over .. ..... .. ... ............. ........ .......... ...... ...... ..

Amount smoked daily

Less Than 15 cigarettes I 25 cigarettes or nmre

1978 1974

I

1970 I

1978 1974 1970

Percent of present smokersl

29.4

37.8

26.9

25.3

38.7

23.4

33.1

20.3

18.5

36.0

36.0

42.6

34.2

32.8

42.3

32.i

43.6

28.1

27.Z

44.C

26.3

38.1

22.1

20.8

39.3

38.7

48.5

34.7

35.3

50.7

32.9

43.4

28.3

30.8

45.5

27.8

38.7

22.8

24.5

44.5

39.1

47.7

34.8

38.4

47.2

27.9 24.9 23.3

17.3 14.3 13.9

30.7 29.2 26.7

32.6 27.3 25.7

19.6 17.7 14.7

34.1 30.6 27.7

18.9 15.4 15.6

37.3 35.2 30.8

42.4 36.9 32.4

22.3 18.8 16.8

21.0 I 18.5 ! 18.0

l“fidudes present smokers with unknown amounts smoked.
6 adwncedata

Table 5. Number of present smokers 17 vears and over and percent dktnbut!on by number of cigarettes smoked dally, according to race,

sex, and age: UniIed S~res, 1978

[ Data we based on household Interviews of the civtlrvn noninstltut!{),,~lized populatwn. The source ,,t’ &Jcu, wmpling, and Iim:tati(ms

imd qualifiv~tiuns of DJta ore given m the technir~l no(esl

Number I

Number of cigarettes smoked daily

k

Race, sex, and age

of present

smokers In Tote 11 Less than 15-24 25-34 35 or

thousands 15 more

Al I races 2

6oth sexes 17 years and over ........... ................ .

Percent distribution

-1 2’”4!42”7 14.9

=~

6.4

16.0

20.3

8.3

18.7

13.0

10.9

14.7

12.3

11.3

15.4

10,386

22,337

15,854

3,772

100.0 37.8

100.0 26.9

100.0 25.3

100.0 38.7

44.9

42.3

42.0

41.8

17.24 years . .......................... ...... .... ...... .. .......... .. ........

2544 years ......... ..................... .. .................... .............

45-64 years . ................... .. ........ .... ... ................ ...... ... ...

65 years and over ............................... .. ........ ...............

27,408 I100.0 II Male 17 years and over ........... ........... ......... ..... ...... 23.4 42.5

5,258

11,763

8.225

2.161

100.0 33.1

100.0 20.3

100.0 18.5

100.0 36.0

17-24 years ...... ................... ....... ................ .......... ....... 48.0

2544 y=rS ............. ............. ... ..... .......... .....................

4?%84 ymrs . ............. .. .... ...... .... ..... ............... .... ...........

65 years and over ............. ........................ ... ................

12.3

16.8

15.5

14.3

10.4

9.5

12.4

8.9

●7.1

14.1

11.8

16.3

13.4

11.4

16.5

11.5

3.9

2:::

26.9

8.0

10,6

——

1?:

13..3

8.8’

16.2

42.4

38.2

41.7

T

100.0 36.0

100.0 42.6

100.0 34.2

100.0 32.8

100.0 42.3

Female 17 years and over .... ................ .... ...... .. ...... ] 24,940 43.0

17-24 y~rs . ....................... ......... .......... ...... .... ............

254 ywrs .......................... .... ......... ...... ......... .. .. .......

46.64 ymrs ...... .......... .............. ........ ..#..... ............. ......

6S years and over ...... ........ ... ..... .................... .......... ....

5,127

10,573

7,629

1,610

41 .a

42.2

45.1

41.8

Whrte I

I

17 years and over ..... ..... .......... .......... ..................... 45,761 100.0 II 25.6 44.1

17-24 years ..... ..... .... ........ ... ..... .. .... ......... ......... ............

25-44 ymrs ...................... ..... ........ ............. ............ ..... .

45-64 years ..... . . .... . .... . .. .. .. .. . . . .. . .. .. . . ... . . ... . .. .. .. . .. .. . .. . . .. . .

65 years and over ............................. .. ...... ....... .......... ...

8,945

19,153

14,224

3,439

100.0 II 33.7 47.3

44.0

42.6

42.6

7,2

17,5

22.1

8.3

20.4

11.7

5.3

100.0 22.3

100.0 21.9

100.0 37.7

tile ...... ............ .............. ... .................... .... ..................

Femle ...................... ........... ................................. .. .... .

23,815

21,946

100.0/ 19.5 43.5

100.0 32.1 44.7

Black

i

100.0 57.9 32.9

100.0 68.1 28.0

100.0 56.o 32.7

100.0 56.0 36.9

100.0 45.6 ‘33.4

17 years and over ............. .. ......... ..... .............. ..... ...

r

5,278

17-24 y@rs .......... ........... ..... ......... ......... .... .................. 1,068

25-44 years .... ....... ........... ..... ..... ........... ....... ............... . 2,520

45-64 years ...... ..................... ....................................... 1,394

65 years and over ........................ .................. ......... ...... 286

tile . ...... ....................... ........ ................ ........ ........ ....... 2,730

Femle .......... .... ....... ..... ................... ..... ........... ..... .. .. ... 2,548

“4.0

“3.6

“3.0

“1 0.5

5.8

●1.9

+.

7.7

+4.1

+10.5

7.6

●2.8

100.0 51.4 35.1

100.0 64.7 30.6

lExciude~ present smokers with unknown amounts smoked.

2[nc1udes ~11Other races which are nOf shown *ParateiY.

NOTE:When a figure is shown with an asterisk, it is presented only for the purpose of combining with other cells. An estimate has a

relative standard error of leas than 30 percent when the aggregate is at least 1 2S,000.
aciwncedata 7

Table 6. Number of present regular smokers 17 years and over and percent disrrlbuuon by never attempting and ever attempting TO quit

smoking and attempts to quit in pasl year, according to race, sex, and age: United Stares, 1978

[ Data are based rsn household interviews of the civilf~n rsoninstitutiormiizeti popula!xsn. The source of data, sumpling, and limitut ions

and qualifications of DJCa are given in rhe technical not.ts \

Number 01

present

regular

smokers in ‘5”~~~~km=F Ever attempted to quit smokmg

smokersl

Race, age, and sex

All races3 Percent distribution

Both sexes 17 years and over .......

17-24 years ........... .................................

2!5-44 years ........... ..... .......................4....

45-64 yeers ............ ................................

65 years and over ....................... ..... .......

Male 17 years and over ............ .........

17-24 years ....... .... ............ ...... ...... .........

25-44 years ............................................

45.64 years ...... ..... ...................... ...... .....

65 years and over ...................................

Female 17 years and over ..................

17-24 years ........ ...... ..... .......... .............. .

25-44 years ....... ................ ............ ..... ..

45-64 years . ............ .... ........ .... ...............

65 years and over ...................................

White

17 years and Over ............ ..... ..... .. .....

17-24 years ......................... ...................

25-44 years ............. ......... ......................

45-64 years ...... ................ ......................

65 years and over ....................... .......... ..

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

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

Black

17 years and over .............. ...............

17-24 years., ....... ................. ... ...............

25.44 years ............................. ... ............

45-64 years .......... ................... ....... ........

65 years and over ....... .. .......... ................

Mile ..... .... ....... .......... .. ......... ........... .......

Femle ..... ...... ...... ..... ........................... ..

51,685

10,224

21,992

15,723

3,746

27,151

I oo.a 40.7

4

59.3

54.0

61.3

60.3

57.6

60.1

54.3

61.4

61.8

61.4

58.4

32.7 I17.8 8.4

100.0

100.0

100.0

100.0

100.0

46.C

38.7

38.7

42.4

39.9

17.3 26.2

35.7 18.1

38.6 13.2

31.9 12.4

10.5

7.3

7.8

11.9

35.5 [ 16.7 7.7

17.7

37.6

43.3

37.3

25.4

16.E

12.0

I 4.0

5,176

11,615

8.199

2,161

24,535

100.0

100.0

100.0

100.0

1Oil.o

45.7

38.7

38.2

38.7

41.6

11.3

7.0

6.0

8.9

9.2

9.7

7.6

9.7

15.8

7.6

29.5 19.1

53.7

61.3

58.7

52.4

59.7

5,048

10,377

7,524

1,585

45,200

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

46.3

38.7

41.3

47 .g

40.3

16.9

33.5

33.6

24.7

27.1

19.8

14.6

10.3

34.3 17.5

8,810

18,861

14,115

3,414

23,613

21,587

5,189

45.4

37.8

39.7

42.8

38.8

41.8

42.8

54.6

62.2

60.3

57.2

61.2

58.2

57.2

51.6

56.7

61.5

tY3.5

53.6

60.9

17.9

38.0

39.8

33.1

26.2

17.7

13.0

12.5

10.5

6.3

6.9

10.5

7.0

8.3

14.3

37.3 ‘ 16.6

30.9 18.5

20.1 22.3

●11.6 30.9

19.5 - 23.0

28.0 17.8

“1 8.6 ●8.4

1,054

2,468

1,371

296

2,675

2,515

100.0

100.0

100.0

100.0

100.0

1a).o

48.4

43.3

38.5

“39.5

46.4

39.1

%).1

13.8

15.8

●29 .4-

12.1

16.5

21.5 19.5

18.7 25.2

1 ~xciude~ unknc,wn if ever attempted to quit smOkin6.

.21n~lude~ unkno~vn number of attempts in Pas ye~r.

31nc]udes ~11Other races which are not shown separately.

NOTE: When a figure is shown with an asterisk, it is presented only for the purpose of combining w-ith other ~el[s. An estima[e h~~ a

relative standard error of less than 30 percent when the aggregate is irt least 125,000.
8 ackncedata

clerived from [JV{J qucs[i(~ns: ““~~aic YOLL ever

m~de a serious ~ttcmp[ L(J stop sm(~klng ciq:trettes? “ and “Durin, q the pwt 12 months. th~t is

since (dute) z year ago, ~bf)ut how many times

would you say vou m~de a PairIy serious attempt

to stop smoking cigarettes en[irely?”

About the same percent of black and white

present smokers have attempted to quit It some

time. However, data show a higher percent of

black smokers than of white smokers \vith one

attempt or more within the past year (36.6 and

25.1 percent, respectively). .Mthough a slightly

higher proportion of maie smokers have ever

attempted to quit, proportionately more women

than men have made one attempt or more to

quit during the year (28.3 and 24.4 percent, respectively). This sex difference is more apparent

among black smokers (41.7 compared with 31.6

percent) than among white smokers (?6.8 and

23.6 percent).

Young smokers–those 17-24 years of agemore frequently reported attempts to quit

smoking cigarettes in the last year than smokers

25 years of age or older did (about 37 compared

with about 24 percent).

Respondents who attempted to quit smoking in the past year were asked: “How long did

you acturdly stay off cigarettes the last time?”

While this question was desi,qned to eiicit a specific number of days, weeks, etc. that persons

actually stopped smoking, about 11 percent of

the respondents instead said that they did not

stay off. Since no followup question was asked

to determine specifically what was meant by

this response—less than a day, less than a week,

or some other interval-persons answering this

way are shown in a separate category in table 7.

Almost two-thirds (60.5 percent) of the current smokers who attempted to quit in the past

year stopped for 1 week or longer during their

last attempt. A slightly higher percent of male

than of femaie smokers (62.9 and 58.2 percent)

were abie to stay off ci,qarettes for 1 v{eek or

more. The reverse pattern is seen for the internal 1 month or more; 28.5 percent of male

smokers and 30.5 percent of female smokers

who attempted to quit stayed off cigarettes for

this length of time.

Young adults had appreciably greater success

(if success is measured by length of time stayed

off) -a.lmost 70 percent stayed off cigarettes for

1 week or more–than persons 45-64 years did.

For the laLtcr gr(mp, aboLIt 50 perccnc stuppcci

for 1 week or more. N() ~ppreciuhle clifferences

were found in the len~th ot’ time black and

white smokers stayed off cig~rettes.

For this suney u former smoker is defineri

as a person who has smoked at least 100 cigarettes during his lifetime but is not smoking

now. Overall, about one-third of all adults

ck.ssified as former smokers reported quitting

within the past 3 years (table 8). Perhaps more

meaningful statistics are deri~’ecl when estimates

of former smokers who quit smoking during the

past 12 months are combined with present

smokers.

Data in table 9 show that 30.8 percent of

recent smokers-persorrs who smoke now or

smoked sometime during the past year—made

an attempt or actually quit smoking during the

past year. Of those who tried to quit, 1 in 5

persons was successful. Proportionately more

young smokers (4 1.9 percent) attempted to quit

smoking than other persons did. Midd!e-agecl

smokers—45-64 years-were -least likely to try

to quit and were least Iikely to succeed o f ail

age groups. WhiIe a slightly higher proportion of

female than of male smokers attempted to quit

(32.7 compared with 29.1 percent), male

smokers were siighdy more likely to succeed

(21.5 compared with 18.8 percent). Similarly-,

while a higher proportion of black smokers than

white smokers made an attempt to quit (39.1

and 29.9 percent), the rate of success was higher

among white smokers (21.4 and 10,3 percent).

The abGve estimates represent a crude measure of a “quit rate, ” as they contain alI persons

who have recently stopped. Included are persons

who quit only several days before the interview

and may have resumed smoking. In contrast, excluded are persons who reported at the time o f

interview that they smoked but actually were in

the process of quitting and may have subsequently been successful The effects of these imprecise incisions and exclusions may cancel

each other out. Further analysis of these data

and the results from another smoking survey

now being designed should provide further

insight regarding the extent of this phenomenon.

This is the first year the HIS questionnaire

has contained questions to identify tar and

nicotine IeveIs o f cigarettes smoked most often

(tables 10 and 11).

Since much of the current interest in tar
admncedata 9

Table 7. Number of presenr regular srmkers 17 years and over who attempted COqulr smsking and percent disrrlbut!on by length of ttme

off cigarettes, according to race, sex, and age: Umted States, 1972

[DOCLI we bawl ,,n ht)uselwld interviews O( the c:wlidn r,on,ns[itutionaltized p~:ou[titwn. The source of Jots. wmpling. und Iim,tations

Race, sex, and age

—

All racesz

Both sexes 17 years

and over, . ... ......... ..

17.24 years ............... ...... ...

25-44 years .......... ....... ... ....

4S.64 years . .......................

65 years and over ....... ........

Male 17 years and

over ............................

17-24 years ....................... .

25-44 years .............. ..... .... .

45-64 years ........................

65 years and over ............ ...

Female 17 years and

over .................... .... ....

17-24 years .............. ......... .

25-44 years ........................

4!5-64 years .............. ..........

65 years and over ... .......... ..

Wh!ze

17 years and over, ..... ...

17-24 years ........................

25-44 years ...................... ..

45-64 years ...................... ..

65 years and over., ....... .... ..

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

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

Black

17 years and over .... .....

17-24 y~rs ...... .. ...... ..... ....

25-44 years ...... ...... ...........

45-64 years ...................... .

65 years and over ..............

tile ..................................

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

Number of

smokars

who

attempted

to quit in

thousands

30,434

5,492

13,359

9,449

2,134

16,188

2,788

7,032

5,059

1,310

14,246

2,704

6,327

4,390

824

26,845

4,793

11,648

8,474

1,930

14,362

12,463

2,935

529

1,384

843

179

1,403

1,532

Length of tI me off cigaret~es

2 weeks 1 month

Total 1

Oid not Less than 7-13 but less but less 3 months

s~ay off 1 week days than 1 than 3 or more

month months

Percent distribution

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

I m.o

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

1M).o

100.0

100.0

1O.t

7...

10.:

14.:

●12.s

9.:

6.7

10.:

9.1

*1 3.6

12.:

7.5

11.:

18.2

●1 2.1

11.C

7.7

10.7

14.1

*1 5.1

9.9

12.0

10.7

●6.1

●11 ,2

*1 6.6

-.

“5.3

15.0

IExciudes smokers ~th unknown length of time off cigarettes,

21ncludes 111M her races which me not shown Separately.

28.8 ! 12.4

23.4 11.g

28.3 10.4

35.3 15.4

30.0 16.1

T

27.9 13.C

23.6 12.6

28.3 9.2

34.0 19.2

“25.2 ●I 6.8

28.51 11.8

23.1 11.1

28.3 11.5

36.3 12.3

35.7 ●1 5.3

28.6 I 13.1

23.0 12.0

28.6 11.4

34.7 16.2

29.5 17.0

27.0 13.3

30.0 13.0

28.4 9.3

●22.7 “1 0.2

27.0 *7.1

34.3 ●1 1.9

“37.5 ‘1 1.6

32.5 ●1 2.3

25.3 ‘7,0

18.6 14.8 14.6

1 I

24.4 17.8 15.3

18.s 15.7 16.3

13.8 12.4 9.0

*11 .9 “7.2 21.7

21.4 15.4 13.1

31.2 12.6 13.3

19.3 18.1 14.9

14.8 17.4 *5.6

●1 4.5 “5.5 “24.5

15.9 14.5 16.0

17.4 23.2 17.2

17.8 13.4 17.7

13.1 8.4 11.7

●9.2 “9.2 “1 8.4

+4-++

17,2 16.2 ‘ 15.9

12..5 13.3 9.2

●1 0.0\ “5.0 23.6

20.7 15.6 13.4

14.9 14.6 15.5

24.3 12.9 14.3

“26.1 “1 8.5 “1 6.3

“23.5 *1 2.8 18.3

●23.3 “5.4 “8.5

●27 .7 “23.2 *.

NOTE: When a figure is shown with an asterisk, it is presented only for the purpose of combining with other cells. An estimate has a

relative standard error of less than 30 percent when the aggregate is at least 125,000.
10 advancedata

Table 8. Number of former regu Iar smokers 17 years and over and percent distribution by length of time since smoked cigarettes, according to race, sex,’and age: United States, 1978

[Data :!re based on household interviews of the ciwliun nonlnsritutionalized popuh~tion. The source of data, samplirI’&, ond linliIations

~rsd qualifiw(:ons of Duta fire given !n the techmcal notes]

Race, sex, and age

All races2

Both sexes 17 years and over .......

17-24 years ..... ................ .......... ....... ...... .

2544 years . ..... ......... .. .... ... .....................

4!%4 years ................ ... ........... .... .......... .

65 years and wer .. ..... .. ......... ........ ...... . ..

Male 17 years and over ....... ...............

17-24 years ..... ..... ............ ..... ..................

2S-44 years ......... ... .................. .... .. .........

45-54 years ............................. .............. ..

65 years and over ........... ...................... ..

Female 17 years and over ........... .......

17-24 years ........... .. .......... ..... .................

2S-44 years .... ................ ..... ....................

45-64 ye~s ......... ................................. ...

65 years and over ..... ............................. ..

White

17 years and over ..... ..... ..... ......... .. ....

17-24 years ...... ........... ...................... .. ....

25-44 years ...... ..................... ..................

45-64 ymrs ............................ .................

65 years and over ... .................................

hle ..... ..... ........... .... ......... ........ ....... ......

%male . ..... ............ .......... ................. ......

Black

17 years and over ...... .... ........ ...... ......

17-24 years ................ ...... ..... ..................

2544 y-rs .. .... .. .. ........ ..... .... .......... ........

45-64 ymrs ....................... .. .... ............. ...

65 years and over .......... ............ .......... ....

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

Femle ........ ...................................... ......

Uumber of

former

regular

mokers in

housands

29,237

2,372

10,306

10,520

6,039

18,730

1,233

6,157

7,205

4,134

10,507

1,139

4,148

3,315

1,905

26,849

2,081

9,467

9,695

5,587

17<227

9,623

1,762

212

555

697

298

1,069

683

Length of time since smoked cigarettes

Totail l_es than 1-3 4-7 8-11 12 years

1 year years years years or more

‘OO”O1l11”7

100.0 38.8

100.0 15.4

100.0 6.2

100.0 4.1

100.0 9.7

100.0 36.4

100.0 12.4

100.0 6.1

100.0 3.5

100.0 II 15.3

:

100.0 41.4

100.0 19.8

100.0 6.5

100.0 ●5.5

100.0 11.5

100.0 35.6

100.0 15.6

100.0 6.6

100.0 4.0

100.0 9.4

100.0 15.3

100.0 I 12.3

100.0 65.1

100.0 ‘8.7

100.0 ‘1.8

100.0 ● 4.9

100.0I

‘9.7

100.0 ●1 5.9

lExcl”des former smokers ~th unknowrt length of time SiIICe smoked C@rettes.

2~nc]”&S all ~ther races which are not shown sewatew.

Percent distribution

20.3

43.4

25.5

15.3

10.8

18.5

39.7

25.9

14.4

8.0

23.4

47.5

24.8

17.2

16.7

19.8

44.8

24:9

15.1

9.9

18.2

22.6

25.4

●34.4

29.6

●1 8.1

“29.6

21.4

31.3

18.7

15.3

22.9

17.3

15.2

18.3

19.1

22.1

18.2

12.5

19.3

●1 1.2

24.0

15.4

20.9

18.8

16.7

22.2

17.7

15.7

18.6

19.3

14.9

●✎

35.4

+7 0.5

●.

●1 3.1

+1 7.5

T

18.6 30.8

“2.5 ●

205 15.7

21,3 39.8

16.8 53.1

18.5 35.0

t

●4.8 ●

21.9 17.7

19.7 41.5

15.5 60.5

18.6 23.3

*

-.

18,5 12.9

24.7 36.2

19,5 37.4

T

18.3 31.5

‘2.9 ●

20.9 16.4

20,6 40,1

16.1 54,4

17.8 36.1

19.4 23.4

20.9 26.4

●✍ ☛✎

*1 8.6 ●7.6

25.2 44,2

“30.0 ● 35.4

28.5 27.3

“1 0.0 25.2

NOTE: When a figure is shown with an asterisk, it is presented only for the purpose of combining with olher cells. An estimate has a

relative standard error of less than 30 percent when the aggregate is at least 125,000.
aduancedata 11

Table 9. Number of recent snwkers (Persons smokmg ,n past year) 17 years and over and number and percent who attempted or quit

smoking in peat year, by present smoking status, race, sex, and age: United States, 1978

[Dam are based on household interviews of the civilian noninstitutiormlized oooulatiors. The source of data, sampling, m.1 Iimimtions

and qualifications of Data are given in the Cechnical notes]

r

Sma kers

Snm kars attempting

attempting to quit

or quitting and who

in pest year succeeded

in pest year

I

Recent smokers artempling to

suit or auittin~ in c=wx veer

All recent

smokers

m

Race, sex, and age

All racesl Number in thousendsz Percent2

Both sexes 17 yews and

Over .............. ............. ..... 55,106

=

16262 13,541 3,421 30.8 20.2

17-24 ymrs .......... ........ .. ..............

25.44 years .............................. ....

45-64 years. ..... ......... .......... ..... ....

65 years and over ........................

11,144

23,579

16,375

3,994

4.672 3,752

5,586

3,318

910

6.625

92C

1,587

65i

24

1,817

41.9

30.4

24.2

28.0

19,7

22.1

16.4

21.4

7,173

3,970

1;158

Male 17 years and over .... ..... .. 28.968 8,442

2.349

3,504

1,916

640

28.1 21.5

5,625

12.378

8,638

2,306

1,900

2,741

1,476

495

6,943

41.8

28.3

22.2

27.8

19.1

21.8

23.0

22.7

17-24 years ............ .............. ........

~5-44 years ............ ... .. .... .............

45-64 years ..................................

65 years and OF........................,

Fermsle 17 ymrs and over ....... 26,143 8,551 32.7 18.8

17-24 years ..................... ..... ........

25-44 years ....... .... ................... .. ..

45-64 years ............ ............... .......

65 years and over ........ ..... ...........

5,520

11,198

7,739

1,580

2,330

3,664

2,043

519

1,858

2,843

1,828

414

42.2

32.7

20.3

22.4

10.5

“20.2

26.4

30.7

White

17 years and over ....... ............ 48,288 14.433 11,345 3,08S 29.9

41.6

29.5

23.4

27.7

21.4

18.6

24.6

18.6

22.1

17-24 years ................ ..................

25-M years ...................... .......... ..

45-64 years ....... ...........................

66 years and oar .............. .... .... ...

9,551

20,341

14,755

3,637

3,974

6,007

3,449

1,008

3,233

4,527

2,809

785

5,573

5,785

741

1,48C

MC

223

1,619

1,472

tile ... ........................................ ..

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

25,232

23.059

7,192

7.257

28.5

31.5

22.5

20.3

Black

17 years and oar .............. ...... 5,406 2,116 1,888 217 39.1 10.3

17-24 years .... ................ ......... .....

2544 years .............................. ....

46-64 years ........... .......... ........ .....

65 years and over ..... ........... .........

1,192

2.516

1,384

311

560

956

474

127

422

908

461

●112

845

1,049

13a

“4

“13

●15

“104

●11O

47.0

38.0

34.2

40.8

24.6

“5.0

“2.7

●11.8

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

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

849

1,159

2,779

2,625

34.1

44.2

●11.0

‘9.5

1 Includes all other races not shown separately.

2~x~udes Ocmdonal smo Iters.

NOTE: When a figure is shown with an asterisk. it is Oreaented only for the gurDose of combining with other cells. ~ estimate has a

Mative standard erro= less than 30 percent when the aggr&ate is at laa;t 12S,000. -
12 adwimeckfta

Table 10. Number of present regular smokers 17 years and over and oercent disributlon by tar level of cigareues smoked, acccrding TO

race, sex, and age: Un!red States, 1978

[Data ~re based on huusehokl mtervwws of the cwdifln !I(,nlnstltutlc)nulized popukt[iun. Tiw source Of dam. sumpliilg, and Iimltaci(]ns

tnd qualifiwtions IIf Data are gwen in the technical notes]

All racesz

Both sexes 17 years and over ...... 51,685

17-24 years .............. .... ........ ........ .... ...... . 10,224

25.44 ymrs ............ ............... ............ .. .... 21,992

45-64 years .. .... ............... ....................... . 15,723

65 years and over .................................... 3,746

Male 17 years and over .. .... .............. .. 27,151

17-24 years ... ........... ........... .................... 5,176

25-44 years ....................... ...................... 11,615

45-64 years ........................... .................. 8,199

65 years and over, ...... ............ ......... ........ 2,161

Femaie 17 years and over ... ....... ........ 24,535

17-24 years ........................... .................. 5,048

25-44 years .......... ............ ....................... 10,377

45-64 years ..... ..... ..... .............. ............. ... 7,524

65 years and over ........ ...... ........ .............. 1,585

White

17 years and over, ...... ..... .............. .... 45,200

17-24 y~rs .......... .................... ....... ........ 8,810

25-44 ymrs ........................ ............. ........ 18,861

45-64 years, ............................... ............ . 14,115

65 years and over ........... ............ ..... ....... . 3,474

~le ................................. ........... .. .......... 23,613

Female ..... .... ........ ............ ....................... 21,587

Black

17 years and over ........................ ..... . 5,189

17-24 yWfS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,054

25-44 years ............ ..... ........... ......... ........ 2,468

46-64 years ..... ...... ............ ................... ... 1,371

65 years and over .............. .............. ...... . 286

Mle ....................... .... ...................... ...... 2.675

Femle ....... ........ ... ........ ............ ....... ...... 2,515

Tar level of cigarettes smoked

Tota 11 Less than 5-9 10-14 15-19 2C) mg

5 mg m9 m9 m9 or more

Percent diszrlburmn

100.0 I

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

I

4.2

1.3

4,1

4.9

9.6

3.3

‘0.8

3.4

3.1

9.0

5.2

●1 .9

4.8

6.9

10.5

Jr 100.0 4.7

100.0 1.5

100.0 4.5

100.0 5.5

100.0 10.5

100.0 3.7

100.0 5.8

100.Q ‘0.5

1

100.0 +-

100.0 “1.0

100.0 ●.

100.0 *-

100.0 *.

100.0 ●1.O

7.5

5.9

7.6

7.8

9<5

6.2

4.9

6.9

5.8

6.8

8.9

6.9

8.4

10.0

12.9

8.1

6.5

8.5

8.2

9,6

6.6

9.6

2.8

“2.7

‘1 .6

“4.5

●4.6

●2.7

*2.8

17.1

19.4

18.1

15.2

12.6

13.5

13.4

14.9

12.2

10.6

21.1

25.4

21.7

18.5

15.3

18.0

20.0

19.3

16.1

13.5

14.4

21.9

9.6

12.8

10.2

●7.5

“4.2

5.6

13.7

61.4

71.8’

62.6

54.7

53.2

63.5

78.5

63.6

55.9

55.0

59.1

65.0

61.6

53.5

50.8

59.5

70.5

60.3

53.3

51.9

62.2

56.6

76.8

83.2

79.0

69.0

72.2

74a

78.8

9.8

=~

1.6

7.5

17.3

15.1

13.6

2.4

11. ?

23.0

18.7

5.7

.—

“0.$

3,cr

11.2

10.5

9.7

.—

●1.4

7.4

16.9

14.5

13.0

6.0

10.3

.—

●I .4

8.3

19.1

*79.4

16.9

‘3.7

lExc]udes present Smokers with unknown tar levels.

Zlnciudes ~11Other races which are not shown Separately.

NOTE: When a figure is shown with an asterisk, it is presented only for the purpose of combining with other cells. An estimate has a

relative standard erro; of less than 30 percent when the at®ate is at least 125,000.
aduancedata 13

Table 11. Number of present regu Iar smokers 17 years and over and percent distribution by mcotme level of cigarettes smoked,

according to race, sex, and age: Untted States, 1978

[ Dam are bwed on household interviews of the civi]hn non:nsritutiorl~ lized popuiJtIon. The source of I-Ma, simplmg, md Ilmutilit)ns

and qualifications of Data me given m [he rechnwd notes I

Number of

present

Race, sex, and age regu Iar

smokers in

thousands

Nicotine level of cigarettes smoked

Totall Less than 0.5-0.9

0.5 mg m9

1.0-1.19 1.2-1.39 1.4 mg

m9 m9 or more

All races2 percent discnbution

Both sexes 17 years and over .... ... 51,685 1Oo.c 4.3 I 26.7 34.6 24.G

41.0 26.0

35.1 24.5

30.0 22.9

32.1 20.4

10.3

17-24 years ..... ......... ........ ....... .... ..... .... ...

25-44 years ...... ... .... .... ..... .................... ...

45-64 years ......... .... ........ ........... .............

65 years and over ........ .... .. .... .................

10,224

21,992

15,723

3,746

1Oo.c

1Oo.c

1Oo.c

1Oo.c

1Oo.c

1.3 28.5

4.3 28.2

5.1 24.5

10.0 22.8

3.1

7.9

17.5

14.7

Male 17 years and over ......... ............. 27,151 3.3 I 19.9 36.6 \ 26.2 14.0

17-24 years .. ..... ......... ..... ......... ............. ..

2544 years ........... ..... .... ........ ...... ...........

45&.years .... ...... ......... ..... .....................

65 years and war ..... .... .... ............ ..........

5,176

ll,sls

8.199

2,161

1Oo.c

1Oo.c

1Oo.c

1Oo.c

100.0

100.0

I00.0

100.0

100.0

100.0

●0.8 I 18.3 47.1 I 29.7 4.1

11.3

23.2

18.0

6.4

*2.1

4.2

11.5

10.5

10.0

3.6 22.1

3.1 18.3

9.0 17.4

37.5 2S.6

29.3 26.0

33.7 21.9

Female 17 years and over ...... ............ 24,535 5.5 I 34.2

T

*1.9 38.9

5.1 34.9

7.2 31.0

11.3 29.8

32.3 I 21.6

‘7.24 years ..... ..... .... ... .......... ... ...............

Z5-44 years ... ... ..... .... ....... .... .......... ... ......

45-64 years ..... ......... ........ .... ....... ..... .......

65 vears and over ................................. ...

5,048

10,377

7,524

1,585

34.8 22.3

32.6 23,3

30.7 19.6

30.0 18.5

4.9 28.2 35.1 21.8

White

17 years and over .............................. 45,200

17.24 years ..... ......... ................ ... ............ 8,810

25.44 years.., .......... ... .......... ...... ........ ..... 18,861

45.64 years ...... ..... ....... .... ........... ...... ...... 14,115

65 years and over ............. ......... .. ............ 3,414

~le ............. ........................ ...... ............. 23,613

Femle ............ ..... ... ......... .. ..................... 21,587

Black

17 years and over .......... ..... .. ..... ..... ... 5,189

77-24 years ................ ..... .... ............ ........ 1,054

25-44 years .. ....... ....... ............... .............. 2,468

45-64 years., ...... .... ............ ..................... 1,371

65 years and over ........... ...................... .. 296

Mle ...... .. ........... ....... .... .............. ............ 2,675

Femle .................. ............................... ... 2,515

100.0

100.0

100.0

100.0

100.0

100.0

100.0

1.5 29.8

4.8 30.1

44.0 22.0

35.0 22,4

2.6

7.7

16.9

14.1

13.3

6.4

12.6

5.7 25.7

10.9 23.8

30.2 I 21.6

32.5 I 18.8

j

3.7 I 21.3 37.5 I 24.1

6.1 35.7 32.5 19.3

“0.5 15.0 27.7 ~ 44.2

100.0

100.0

103.0

100.0

100.0

100.0

*. 16.7

*1.0 15.7

●. 13.9

*. ‘8.8

18.2 I 59.7

30.2 43.4

29.8 34.4

●31 ,0 *4T .2

“5.4

9.7

22.0

“19,4

18.7

6.6

*-- 8.8

.’*I .0 21.2

1 ~c]udes present smokers with unknown nicotine levels.

21nclude~ ajl other races which me not shown WJar~~f$lY.

NOTE: When a figure is shown with an asterkk, it is presented only for the pupose of combining with other celIs. .Mr esrlmate has a

relative standard error of less than 30 percent when the aggregate is at least 12.S,000.
14 adwtncedata

levels centers on the use of lower tm cigarettes - pcrcent) [him men (!?3 percent) smoke these

defined for this report as those containin<q lCSS cigwe Ctcs. Datu also show that lower tar ci~

than 15 mg of tar-table 10 includes three lower arettcs are used by a higher proportion of white

tar categories. Over one-fourth of adults who smokers (30.8 percent) than black smokers ( 12.9

currently smoke (28.8 percent) use lower tur percent).

cigarettes. A higher proportion of women (35.2

SYMBOLS

Data not available .—— --- I

Categov not applicable——-—-—-—-——— . . .

I

Quantity zero–———-—-–———

Quantity more than Obut less than 0.05--– 0.0

Figure does not meet standards of

reliability or precision (more than

30 percent relative standard error)--—— *
advancedata 15

SOURCE OF DATA

TECHNICAL NOTES

The data presented in this report were obtained from household interviews in the Health

Intetview Survey. These intemiews were conducted during the final 2 quarters of 1978 in a

probability sample of the civiIian noninstitutionalized population of the United States.

During that period there were approximately

~0,0()() interviewed household containing about

55,000 persons. The cigmett: smoking questions

w’ere asked of each househo id member 17 years

of age ancl over who was identified as a “sample

person.” This subsample included approximately

12,000 persons. Sample persons were required

to answer the cigarette smoking questions for

themselves unless some physical or mentai

heaIth problem precluded their participation.

SAMPLING

The sampling pattern for sample person

selection was based on the total number of rela[ed and unrelated household members. Sample persons (approximately J one-third subsample o f the Health Intervie\v Sumey sample)

were selected by the intcwimver at the time of

Table 1. Standard errors of est]mates of aggregates

Size of estimate

[n thousands

50. . . . . . . . . . . . . . . . . . . . . .

70 . . . . . . . . . . . . . . . . . . . . . . .

100 . . . . . . . . . . . . . . . . . . . . . .

125 . . . . . . . . . . . . . . . . . . . . . .

300 . . . . . . . . . . . . . . . . . . . . . .

500 . . . . . . . . . . . . . . . . . . . . . .

700 . . . . . . . . . . . . . . . . . . . . . .

1,000 . . . . . . . . . . . . . . . . . . . .

5,000 . . . . . . . . . . . . . . . . . . . .

10,000 . . . . . . . . . . . . . . . . . . . .

20,000 . . . . . . . . . . . . . . . . . . . .

30,000 . . . . . . . . . . . . . . . . . . . .

50,000 . . . . . . . . . . . . . . . . . . . .

100,000 . . . . . . . . . . . . . . . . . . .

Standard error

In thousands

24

29

35

38

60

77

91

109

243

342

478

579

731

970

Table 11. Standard errors, expressed in percentage points, of

estimated percemages

Base of percentage

in thousands

‘al . . . . . . . . . . . . . .

70 : : ::: : : . . . . . . . . . . . . . .

100 . . . . . . . . . . . . . . . . . . . .

300 . . . . . . . . . . . . . . . . . . . .

500 . . . . . . . . . . . . . . . . . . . .

700 . . . . . . . . . . . . . . . . . . . .

1,000 . . . . . . . . . . . . . . . . . .

5.000 . . . . . . . . . . . . . . . . . .

10,000 . . . . . . . . . . . . . . . . .

m,om . . . . . . . . . . . . . . . . .

30,000 . . . . . . . . . . . . . . . . .

50,000 . . . . . . . . . . . . . . . . .

100,000 . . . . . . . . . . . . . . . .

—

Estimated percentage

m

6.8 10.7 14.7 19.6

5.8 9.0 12.4 16.5

4.8 7.5 10.4 13.8

2.8 4.3 6.0 8.0

2.2 3.4 4.6 6.2

1.8 2.8 39 5.2

1.5 2.4 3.3 4.4

0.7 1.1 1.5 2.0

0.5 0.8 1.0 1.4

0.3 0.5 0.7 1.0

0.3 0.4 0.6 0.8

0.2 0.3 0.5 0.6

0.2 0.2 0.3 0.4

50

24.4

20.7

17.3

10.0

7.7

6.5

5.5

2.4

1.7

1.2

1.0

0.8

0.s

interview. To determine which household member to designate as a sample person, the interviewer referred to a preselected Llashcfirci JtetIisting alI reIated w-id unrelated persons in the

household on the questionnaire. The flashcm-d

contained, for each household size, one persfm

number or more that were to be identified as

sample persons.

Since the estimates shoum arc based on J

sample rather than on the m-ttirc population.

they arc subject to samp[ing error. Standarcl

errors appropriate for estimates ~jt’the number

of persons m-e shuwm in table 1; standard et-rot-s

appropriate for estimated percrmtws are sh(~~vn

in table II.

LIMITATIONS AND QUALIFICATIONS

OF DATA

All the limitations and qualifications that

appIy in ,general to Health Interview Survey

data apply to the data show-n in this report. .+

fuil statement of these limitations and qualifications may be fcmnd in any report in Series 10 {Jt’

Vital and Health .$tatisties.
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

u.S. DEPARTMENT OF HEALTH, , Public Health Serwce

EDUCATION, AND WELFARE Office of Health Research, Statistics, and Technology Number 53 0 September 11, 1979

Office Visits Involving X-rays, National Ambulatory

Medical Care Survey: United States, 19771

Based on findings of the 1977 National Ambulatory Medical Care Survey, this report examines the use of X-rays by office-based physicians. An X-ray is defined as any single or

multiple X-ray examination for dia,vostic or

screening purposes. Radiation therapy is not

included. When the phrase X-ray uisit appears in

these pages, it applies to any office visit where

an X-ray was either provided or ordered.

The National Ambulatory Medical Care Survey (NAMCS) is a continuing sample survey

conducted annually by the Division of Health

Resources Utilization Statistics of the National

Center for Health Statistics. The survey-national

in range exqept for Alaska and Hawaii-is designed

to explore the provision and utilization of ambulatory care in the offices of non-Federal, officebased physicians. Since the statistics used in

this report are based on a sample rather than on

the entire universe of office-based physicians,

they are estimates only and subiect to samP1ing

variability. .Mong with more information on the

survey design and definitions of terms used in

NAMCS, the Technical Notes at the end of the

report provide guidelines for iud.qing the precision of the estimates presented.

DATA HIGHLIGHTS

In 1977 an estimated 570,052,000 visits

were made to office-based Physicians within

the NAMCS scope. An estimated 7.8 percent

(44,662,000) of these were X-r-w visits involving the provision or ordering of single or multi1This report was prepared by Hugo Koch and

Raymond O. Gagnon, Division of Health Resources

Utilization Statistics.

ple X-ray examinations for diagnostic or screening purposes.

Table 1 shows the 15 reasons-that is,

symptoms, complaints, or nonsymptomatic

problems–most commonly motivating Patients

to make X-ray visits; the reasons are ranked according to the frequency of X-ray visits associated with each. Note, hotvever, that these were

principal reasbns onI\’. Up to two other reasons

could have been given by the patient, often

creating symptom clusters, which, though they

are not analyzed in this brief report, undoubtedly

influenced the physician’s choice of diagnostic

mechanisms, including the use of X-rays. .\s a

.goup these 15 principal reasons accounted for

43 percent of all X-ray visits; The importance

of the .X-ray as a routine screening mechanism

is evident from the finding that the largest single

block of X-rav visits (an estimated 2,8 15,000)

\vas associated \vith patients’ requests for .qeneral

medical examinations—annual physical ex.uninations, routine checkups, c tc. .% ti dia,qnostic

mechanism-clearly their chief role—X-rays

were applied most frequently to symptoms or

complaints of the musculoskeletal system. iNine

of the 15 reasons listed in table 1 center on

musculoskeletal problems.

Tables 2 and 3 focus tittention on the involvement o f .S-rays in the physicians’ diagnoses of the symptoms presented by patients.

As with the principal reasons motivating patients

to make X-ray visits, these tabulations are basccl

on the principal diagnoses only-that is, the di+gnoses most closely linked t{) the chief problems

presented by patients. Up t{) two other concurrent conditions could have been listed, and it is

possible that the use of X-r+s Jvas prompted in

\\rhole or in p:lrt by the presence of these (>tht”r
2 achancedata

Table 1. Nutier and percent distribution of X-ray wslts; number of all visits and percent involving X-rays, by the 15 leading principal

Rank

1

2

3

4

5

6

7

8

9

la

11

12

13

14

15

reasons for visits gwen by patients (ranked accord!ng to the frequency of X-ray visits): United States, 1977

Patient’s principal reason for

visit and NAMCS codel

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

General medical examination ..............................X1OO.O

Back symptoms (excludes injuries) .......... ...... ...... S805.0

Chest pain and related symptoms (not

referable to body system) ............................... ... S050.O

Cough..................................................................w.o

Knee symptoms- (excludes injuries) ...... ....... .... ..... S825.O

Abdominal pain, cramps, spasms ..... ............ .... .....S55O.O

Foot and toe symptoms (excludes injuries) . ........ S335.O

Low back symptoms (excludes injuries) .... ...........S91 O.O

Shou/der symptoms (excludes injuries) ................ S84O.O

Neck symptoms (excfudes injuries) ......................S9OO.O

Blood pressure tew ..............................................X32O.O

Hip symptoms (excludes injuries) ........................s915.0

Headache .................. ................. ....................... ... S21 0.0

Lag symptoms (excludes injuries) ................. ....... S920.0

Ankle symptoms (excludes injuries) ......... .. ...... ... S830.0

All othar reasons ................................................ residual

X.ray visits2

Number in

thousands

44,662

2,815

2,194

1,801

1,562

1,459

1,425

1,239

1,020

944

830

822

795

771

752

707

25,526

Percent

distribution

100.0

6.3

4.9

4.0

3.5

3.3

3.2

2.8

2.3

2.1

1.9

1.8

1.8

1.7

1.7

1.6

57.1

All visits

Number in

thousands

570,052

20,659

10,696

8,388

13.937

5,309

8,715

3,976

4,594

4,388

4,915

14,990

2,144

9,458

5,161

1,873

450,839

Percent

involving

X-rays

—.

7.8

13.6

20.5

21.5

11.2

27,5

16.4

31.2

22.2

21.5

16.9

5.5

37.1

8.2

14.6

37.7

5.7

1~~ed on ~ ~Iass~lcation of patients’reasons for visits developed for usc in NAMCS 4

‘An X-ray visit is an y visit involving t he use of a single or multiple X-ray examination for d iegnostic or screening purposes.

conditions. Table 2 shows the 15 specific cliag

noses most commonly assigned to X-ray visits

ranked according to the frequency o f X-ray

visits associated with each diagnosis. The importance of the X-ray as a screening mechanism

is again reinforced by the finding that the largest

single block of X-ray visits (2,037,000) was associated with preventive examinations. In their

chief role of diagnostic mechanism X-rays were,

predictably, most often used in association with

musculoskeletal disease or injury. Note, for example, that 3 of every 5 visits for fracture of the

radius or ulna invoIved the use of X-rays. Table

3, by gathering all specific diagnoses into diagnostic groups, offers a broader perspective of the

use of X-rays throughout the clinical spectrum.

The diagnostic groups most commonly associated with X-ray procedures were accidents,

poisonings, and violence; diseases of the musculoskeletal system; diseases of the digestive systems; and symptoms and ill-defined conditions.

X-rays are generally applied early in the diagnostic process. This is confirmed by the findings

in table 4, which show that most X-ray visits (54

percent) occurred at the new-condition ~isit,

that is, when the physician encountered a

condition in a patient for the first time. This

could be any condition presented by a new

patient or any new condition presented by a

patient already established as part of the doctor’s practice. Evidence for an overall conservatism in the diagnostic use of X-rays lies in the

finding that, in the course of 1 year, an average

new-condition visit that involved the use of an

X-ray or X-rays entailed fewer than 1 (0.9)

return visits at which X-rays were used (a

rough approximation, obtained by dividing

the 20,493,000 return visits involving X-rays by

the 24,169,000 new-condition visits involving

X-rays).

X-rays were most likely to be appIied with

new patients referred by other physicians. As

table 4 makes evident, the frequency with which

X-rays were applied at referred visits–1 6.2 percent of the total 28,412,000 referred visits—was

more than double the average frequency of

X-ray use (in 7.8 percent of all visits).

Along the continuum of patient age, the in-
dvame@a3

Table 2. Number and percent distribution of X-ray visits; number of all vkts and percent involving X-rays, by the 15 leading principal

diagnoses assigned by physicians (ranked according to frequency of X-ray visits): United States, 1977

Rank

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

Principal diagnosis and ICDA codel

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

Medical or special examination .... ......... .......... ..........YOO

Essential benign hypertension .................................. 401

Osteoarthritis and allied conditions ...................... .... 713

Medical and surgical aftercare .................... ...............yl O

Synovitis, bursitis, and tenosynovitis ........................731

Sprains and strains of ankle and foot ........................845

Chronic ischemic haert disaase .... ......... .....................4l 2

Sprains and strains of other and unspecified

parts of back .......... ............ ....................... ..............847

Bronchitis .... ... ..................... .................... ......... .. ......~

Fracture of radius and ulna .......................................8l 3

Sprains and strains of sacroiliac region., ......... ...........846

Other illdefined and unknown causas of

nmrbidity and monaiity ......... ................... .... .........796

Fracture of one or mora phalanges of hand . ............. 816

Other nonarticuiar rheumatism .............. .................. 717

Acute uppar respiratory infection ......... ................ ....465

X-ray visits2

Number in

thousands

44.662

2,037

1,665

1,431

1,352

1,078

1,064

911

862

842

726

661

576

565

557

527

All other principal diagnoses ..... ............ ...... ....... residual I 28,808

Percent

distribution

100.0

4.6

3.7

3.2

3.0

2.4

2.4

2.0

1.9

1.9

1.6

1.5

1.3

1.3

1.3

1.2

66.7

All visits

Number in

thousands

570,052

41,716

24,837

5,866

19,524

5,331

2,136

11,943

4,981

6,597

1,200

2,478

2,797

1,056

4,027

17,925

417,638

Percent

involving

X-rays

7.8

4.9

6.7

24.4

6.9

20.2

49.8

7.6

17.3

12.8

60.5

26.7

20.6

53.5

13.8

2.9

7.1

18ased on Erghth Revision Intermtiorrai CIasrs.fication of Di.wose~ Adapted for Use in the Unired States (lCDA).

2~ x<a ~ ~j5it i$ any “j~jt involving the use of a single or multiple X-ray examination for diagnostic or screening PurPoses.

tensity of X-ray usage showed three conspicuous

peaks (table 5). The first is noticeable in the

injury-prone period of the teens; .X-ray visits

composed as much u 8.5 percent of all visits

made by patients in this age interval. The second

peak–the highest of the three–appears in the

5-year span 55-59 years; here X-ray procedures

were applied at 1 I. 1 percent of all visits. A third

peak is evident in the interval from 70-74 years.

The latter two peaks reflect the onset and X-ray

diagnosis of the chronic, musculoskeletal diseases common to advancing years, the second

peak being linked in large part to the X-ray

diagnosis of rheumatoid arthritis and the third

to that of osteoarthritis.

As a group, males were X-rayed at an estimated 9.6 percent of their visits, a proportion

half again as high as the proportion of 6.7 percent found among females (table 5). Table 6 and

figure 1 reveal that this difference was especially prominent in the age internal 20-50 years;

during this period the frequency with which

men were X-rayed (at 11.9 percent of visits)

was about ttvice the frequency found for women

(5.8 percent of visits).

In the sheer volume of X-ray procedures that

they provided or ordered, the prima~-cm-e specialties of general, famiIy, and intemd medicine

accounted for the majority (36 percent) of all

the X-ray visits made to office-based practitioners (tabIe 7). However, in the relative frequency with which they employed X-rays, the

most visited specialities are in a different order,

more clo~eIy reIated to cIinical focus than to

primary-care function. From this point of view

orthopedic surgeons were by far the most active

; users of X-ray procedures; they were followed at

. a respectable distance by internists, cardiovascular

specialists, urologists, and general surgeons, each

of which exceeded the m’erage tendency to use

X-rays (at 7.8 percent of visits).
4 ackincedata

Table 3. Number of visits to office-based physicians, percent involving X-rays, and number and percent distribution of X-ray visits by

diagnostic groups: United States, 1977

Diagnostic group and ICDA ~desl

All principal diagnosas .................... ............................ .. ..

hsfective and parasitic diseases .............................. .............000-1 36

Neoplasms ....................... ........................... .......... ............. .140-239

Endocrine, nutritional, and rrwtabolic diseasas ...................24O-279

Mental disorders . .. ....... .... ........................... ........................29O.3l 5

Diseases of the nervous system and sense orWns ...... ..........~O.3~

Diseases of the circulatory system ... .......................... .........390-458

biseases of the respiratory sytiem ......... ..... ........................46O.5l9

Diseases of the digestive system ......................... ................ 520.577

Diseases of the genitourinary system ............ .................... ..58O-629

Diseases of the musculoskeletal system ......... ............ ...... ...7l 0.738

Arthritis and rheumatism ....... ................. ......................71 0-718

Symplonw and iildefinad conditions . ....... .. .... ...................78O.796

Accidents, poisonings, and violence ...................................8oo.g8()

Fratiures ..... .............. ........ ......................... .................. 800.829

Dislocations and spmins . ............... .......................... ..... 830.848

Special conditions and examinations without sickne~ ......yltj.yl 3

Other diagnoses and diagnosis “none” or unknown ............residual

All visits

Number in

thousends

570,052

22,668

14,286

24.287

24,522

46,281

54,702

82,466

18,451

36,473

32,983

17,665

25,695

43,761

8,309

14,044

96,008

45,458

Percent

involving

X-rays

7.8

2.8

6.8

4.4

2.4

2.7

7.8

5.9

14.5

5.1

20.1

16.9

13.2

25.8

54.1

29.2

3.9

2.9

X-ray visitsz

Number in

thousands

44,662

643

970

1,065

579

1,285

4,275

4,879

2,681

1,864

6,633

2,982

3,393

11,281

4,493

4,105

3.771

1,334

——

Percent

distribution

2.2

2.4

1.3

2.9

9.6

10.9

6.0

4.2

14.9

6.7

7.6

25.3

10.1

9.2

8,4

3.0

l&sedon Eighth Revin-on Intermtioml ~~ifimtbn of Diseases, Adapted for Ux in the United States, (lCDA).

2An x.ray ~~it i5 any ~5it involv~g the use of a single or multiple X-ray examination fOr diagnostic Or 5CreeninS P~PIJ~S

Table 4. Number of visits to office-basal physicians, percent involving X-ravs. and number and oarcent distribution of X-ray visits by

petient<ondition status and refer~l status; United States, 1977

Patient-co nditron status and referral status

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

Condition status

New Xtient ........... .. .......... ...... ............................................. ........... .

Old patient ....... .................. .. ........................ ................................ ....

New condition ............................ .............!...... .............................

Old condition ..................................... ....... ... .............. ...... ...........

New-condition visitz ............... ........ ...... ........... .................................

Return visit ........... ........ ........................................ ............................

Whether referred by another physician

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

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

All visits

Number in

thousands

570,052

87,230

482,822

142,037

340,785

229,267

340,785

28,412

541,640

Percent

involving

X-rays

7.8

13.2

6.9

8.8

6.0

10.5

6.0

16.2

7.4

X-ray visits~

Number in

thousands

44,662

11,551

33,111

12,618

20,493

24,168

20,493

4,600

40,062

Percent

distribution

100.0

25.9

74.2

28.3

45.9

54.1

45.9

10.3

89.7

lAn X.ray visit is any visit involving the we of a single or multiple X-ray examination fOr diagnostic Or screening P~PO*s.

2An~ “i5it by a new patient, Or any visit by an old patient hSVOh’@ a IW.V condition.
dmcedaa5

Table 5. Number of visits to officetised physicians, percent inmlving X-rays, and number and percent distribution of X-ray

visits by age and sex of patients: United States. 1977

Age and sex

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

—Age

Under 6 years ..............

6-10 years ......... ...........

11-14 years ................. .

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

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

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

3&34 years .......... ........

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

40-44 yams.., ........ .......

4549 years .. ................

50-54 years .............. ....

55-59 years .............. ....

60-64 years ..................

66.68 years ................. .

70-74 years ..................

75-79 years ...... ............

80 years and over ....... ..

—8ex

Fwrrele...( ................ ....(

Maie ..... .......................(

All visits

Uumber

n thousands

i70,052

54,913

27,266

21,578

39,507

46,254

46,808

40,185

30,653

28,683

33,280

36,744

37,910

34,229

32,136

25,515

18,385

16,007

45,187

!24,865

Percent

involving

X-rays

7.8

2.4

5.1

8.5

7.8

5.6

7.0

8.1

8.8

9.2

9.8

9.4

11.1

9.2

10.0

10.5

8.7

6.7

6.7

9.6

X-ray visitsl

Number

n thousands

44,662

1,337

1,393

1,835

3,070

2,568

3,263

3,257

2.690

2,635

3,251

3,443

4,213

3,148

3,208

2,670

1,601

1,078

22,975

21,687

Percent

distribution

100.0

3.0

3.1

4.1

6.9

5.7

7.3

7.3

6.0

5.9

7.3

7.7

9.4

7.0

7.2

6.0

3.6

2.4

51.4

48.6

lti X.ray vi5it i5 any v~t involving the use of a akzle or

mult iplc X-ra-y examination for d isgnosti; or screening Purp-oaes.

Table 6. Number of visits to office-based physicians, percent involving X-rays, and number and percent distribution of X-ray

visits by sex and age of patients: United States, 1977

All visits I X-ray visitsl

Sex and age Number

in thousands

Total ................. 570,052

Female

Under 11 years ......... ... 39,599

11-19 years ................. 34,360

20-29 years ................. 65,436

30-39 yews . ................ 46,359

40.49 years ................. 38,530

50-59 years., ............. . 44,312

60.69 years ................. 38,515

70-79 years ................. 27,787

70-74 years ........... 15,945

75-79 years.., ......... 11,842

80 years and over . ....... 10,289

Mile I

Under 11 years ............ 42,579

11-19 years .................. 26,735

20.29 yews. ................. 27,626

30-39 yews ...... ............ 24,470

40-49 years .................. 23,434

50-59 years ..... ............ . 30,341

60-68 years .................. 27,851

70-79 years ................. . 16,112

70-74 years ..... ........ 9,570

75-79 years ............. 6,542

80 years and over ......... 5,718

Percent

nvolving

X-rays

7.8

3.1

6.4

4.0

6.9

7.5

9.4

8.8

9.6

9.7

9.4

6.5

3.5

10.2

11.7

11.3

12.8

11.6

10.6

9.9

11.7

7.3

●7.1

Number

in thousands

44,662

1,221

2,187

2,598

3,177

2.888

4,150

3,398

2,674

1,552

1,122

672

1,511

2,718

3,232

2,770

2;988

3,506

2,959

1,596

1,117

“479

“406

Percent

distribution

100.0

2.7

4.9

5.8

7.1

6.5

9.3

7.6

6.0

3.5

2.5

1.5

3.4

6.1

7.2

6.2

6.7

7.9

6.6

3.6

2.5

●1.1

“0.9

1A X.ray ~5it ~ ~nY visit involving the use Of a single nr

multiple X-ray examination for diagnostic or screening purposss.
6 dvancedata

Table 7. Number of visits to office-based physicians, percent in- /

volving X-rays, and number and percent distribution of X-ray Fqure 1. PERCENT OF ALL OFFICE VISITS INVOLYING X-RAYS, BY SEX

visits by physician specialties: United States, 1977

AND AGE OF PATIENTS: UNITEO STATES, 1977 I

1

All visits X-ray visitsl

Physician specialty Number Percent Number Percent

in thou- Involving ‘in thou- distrismds X-rays sands bution

Total ......... ........ 570,052 7.8 44,662 100.0

General and family

practice ......... ............. 222,919 6.9 15,331 34.3

Internal medicine ......... 64,959 14.6 9,486 21.2

Orthopedic surgery ..,.... 20,201 43.2 8,733 19.6

General surgery ............. 36,124 9.5 3,443 7.7

Pediatrics ...................... 54,762 2.5 1,390 3.1

Urology ................ ..... ... 11.,205 I 0.3 1,154 2.6

Obstetrics and

gynecology ... .............. 49,273 1.8 682 2.0

Cardiovascular disease.. 6,218 “12.8 793 1.8

(ltolaryngology .......... . 15,716 4.1 640 1.4

All other specialties ...... 68,675 3.2 2,810 6.3

lm ~.ray visit is any visit involving the use of a si@e or

mrrltiple X-ray examination for diagnostic or screening purposes.

I

I 130

120

U) 110

$ ,.,O

x

: 9,0

,-

~ 8,0

I ; 7.0

z

t 6.0

$2

> 5.0

5

1- 4,0

z

.

: 3.0

Y *O

1.0

0

I

I

—Male

. . . . . . . . Female

~_Lu:~ Ij.lg2@29 3a39 4049 5059 60.69 70.74 7s.7e 8~v:~

I AGE IN YEARS 1

TECHNICAL NOTES

SOURCE OF DATA

The information presented in this report is

based on data collected by the National Ambulatory lNledical Care Survey (NAMCS) from

January-December 1977. The target universe of

NAMCS is composed of office visits made within

the coterminous United States to non-Federal

physicians who are principally engaged in office

practice and are not in the specialities of anesthesiology, pathology, or radioIogy. The National Opinion Research Center, under contract

to the National Center for Health Statistics, was

responsible for the survey’s fieId operation.

SAMPLE DESIGN

NAMCS utilizes a multistage probability

design that involves samples of primary sampling

units (PSU’S), physician practices within PSU’S,

and patient visits within practices. Each year a

sample of practicing physicians is selected from

master files maintained by the American Medical

Association and American Osteopathic Association. For 1977 a total of 3,000 physicians

were included in the sample. Of those found

eligible for the survey, 77.5 percent participated.

Characteristics of the physician’s practice–for

example, primary speciaIty and type and location of practice—were obtained or confirmed

during an induction interview. Participating

physicians were requested to complete encounter forms (Patient Records) for a systematic

random sample of their office visits during a

randomIy assigned weekly reporting period.

During 1977, 51,044 Patient Records were

completed. The Record contained an item to be

checked whenever the use of X-rays was incIuded in the diagnostic procedures ordered or

provided at the visit. A total of 4,141 Records

indicated the use of single or multiple X-r~y

procedures.
dwlceda7

SAMPLING ERRORS

The standard error is primarily a measure of

the sampling variability that occurs by chance

because only a sample, rather than the entire

universe, is suzweyed. The relative standard error

of art estimate is obtained by dividing the

standard error of the estimate by the estimate

itself and is expressed as a percentage of the

cstimfitc. Relative stanchu-d errors of selected aggregate statistics are shown in table I. The

standard errors appropriate for estimated percentages of visits are shown in table II.

Table i. Approximate relative standard wors of estimated

numbers of office visits, NAMCS 1977

ktimated number of Relative standard

visits in thousands error in percent

1.wo ............................................................

2.000 ....................................... ....... ........... ...

5.000 ................................... ...................... ...

10,000 ..........................................................

20.m .................................... ......................

m.ooo ........................ ......................... .... .....

100,000 ................ . ... ................. ..... .............

5oo.om .......... ...... ...... ..................................

29.0

26.5

20.7

14.9

9.9

7.6

6.1

4.9

4.5

4.1

Example of use of tabk: An aggregate estimate of 7s,000,000

visits has a relative standard error of 4.7 percent or a standard

error of ‘3,52 S,000 visits (4.7 percent of 7S,000,000).

Table II. Approximate standard errors of percentages of estimated

numbers of office visits, NAMCS 1977

Base of percentage

(estimated nutier of

visits in thousands)

500 ... .. .........................

Oslo...... .... ....................

1,000 ....... .................. ..

2,000 ...... ................... ..

5,000 ............... ............

10,000 ................ .........

20,000 ..................... ....

50,000 ..................... ....

100,000 ...................... .

500,000, ........... .......... .

Estimated percentage

~

Standard error in percentage points

2.9

2.6

2.0

1.4

0.9

0.6

0.5

0,3

0.2

0.1

6.3 8.6 11.5

5.7 ,7.9 10.5

4.4 6.1 8.1

3.1 4.3 5.7

2.0 2.7 3.6

1,4 1.9 2.6

1.0 1.4 1.8

0.6 0.9 1.1

0.4 0.6 0.8

0.2 0.3 0.4

13.2

12.0

9.3

6.6

4.2

2.9

2.1

1.3

0,9

0.4

14.4

13.1

10.2

7.2

4.5

;:

1.4

1.0

0.5

Example of use of table: An estimate of 30 percent based on

an aggresate Of 15,000,000 visits has a standard-error of 2..s percent. The relative standard error of 30 percent is 8.3 percent (2.5

percent + 30 percent).

ROUNDING OF NUMBERS

Estimates of office visits have been rounded

to the nearest thousand. For this reason detailed

figures \vithin tabIes do not always adcl to totals.

Percents were calculated on the basis of origins.1,

unrounded figures and will not necessarily agree

precisely with percents which might be calculated from rounded data.

DEFINITIONS

Ambulatoy patient.–An ambr.datory patient is an individual presenting himself for

personal health services who is neither bedridden

nor currently admitted to any health care

institution on the premises.

Office. -An office is a place that the physician identifies as a location for his ambcdato~

practice. Responsibility over time for patient

cm-e and professional seniccs rendered there

generally resides with the indi\’iduaI physician

rather than an institution.

Physician.–A physician is a duly Iicensed

doctor of medicine (M.D.) or doctor of osteopathy (D.O. ).

Visit.-A visit is a direct personal exchange

between an arnbuIato~ patient and a physician

or a staff member working under the physician’s

supemision for the purpose of seeking care and

rendering health semices.

X-ray .- An X-ray is any single or multiple

X-ray examination for diagnostic or screening

purposes. Racliati{jn therapy is not included;

X-ray zlisit.–An X-ray visit is any office visit

where an .Y-ray is either provided or ordered.

SYMBOLS

Data not available-------–—-— -------------------- ---

Category not applicable ---------------------- . . .

Quantity zero ----------------------------------- -

Quantity more than O but less than 0.05 ----- 0.0

Figure does not meet standards of

reliability or precision-—— ------------------

*
From Vital and Health Statistics of the National Center for Health Statistics Number 54 ● February 27, 1sw

Reissued to correct Number 54. December 17, 1979

Fats, Cholesterol, and Sodium Intake in the Diet of Persons 1-74 Years:

United States

by Sidney Abraham and Margaret D. Carroll, M.S.P.H., Division of Health Examination Statistics

introduction

Several dietary components of the current diet in

the United States may be risk factors in the development of major diseases, particularly cardiovascular

diseases and cancer.1 -1Z Because of the importance

of the reported relationship between dietary components and disease patterns, this report provides

reference data on the consumption patterns and

food groups that are the major sources of these

components.

The dietary data were obtained during the first

National Health and Nutrition Examination Survey

NHANES I. The survey is a program in which measures of nutrition status are collected for a scientifically designed sample representative of the civilian

noninstitutionalized population of the United States

in a broad range of ages.

Of the 28,043 sample persons selected to represent 194 million persons aged 1-74 years in the U.S.

population, 20,749 persons, or 74 percent, were

examined. This is an effective response rate of 75

percent when adjustment is made for the effect of

oversampling among preschool children, women of

childbearing age, the poor, and the elderly.

The NHANES I nutrition examination component included a general medical examination by a

physician for indicators of nutritional deficiencies, a

skin examination by a dermatologist, and a dental

examination by a dentist. Body measurements were

taken by a trained technician; a dietary interview,

consisting of a 24-hour recall of food consumption

and a food frequency questionnaire, was administered by professional dietary staff; and numerous

laboratory tests were performed on whole blood,

serum, plasma, and urine. A description of the sampling process, NHANES I operations, and response

rates has been published. 13

Estimates in this report were based on weighted

observations, i.e., data obtained on examined persons

are inflated to the level of the total population using

appropriate weights to account for both sampling

fractions and response results. “

Findings on the consumption patterns and sources

of food groups from dietary components will be analyzed and discussed in a future report.14 Selected

data from that report are presented in tables 1-8 and

figure 1.

Information on food intake was obtained by the

24-hour recall method for the day, midnight to midnight, preceding the interview and accounted for all

regular meals eaten as well as for between-meal foods

or snacks. Food recall included foods eaten onMonday

through Friday but generaHy excluded foods eaten on

weekends which may pertain to unusual food intakes.

Foods reported by individuals were grouped under

18 main headings (figure 1). Eleven of these food

groups were major sources of the nutrients, cholesterol, and sodium intake and are shown in tables 1-7.

These 11 food groups and the other 7–sources of

only small proportions of nutrients, cholesterol, and

sodium-are shown in table 8. Contents of food

groups 1-18 referred to in this report are presented

int-igurel.

Fat intake

NHANES I provided data on dietary intake of

total fat and saturated fat. The data did not permit

evaluation of total polyunsaturated and monounsaturated fatty acids, but intake data were availabie

for Iinoleic and oleic fatty acids.

The quality and kind of fat in the diet affects the

serum lipid concentration, Saturated fat tends to elevate and polyunsaturated tends to decrease the serum

cholesterol levels. Polyunsaturated fatty acids considered essential for nutrition are linoleic, linolenic,

and arachidonic. Of the three, Iinoleic is relatively

more abundant in foods than the other two. Monounsaturated fat, of which oleic acid is the most

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service, Office of Health Research, Statistics, and Technology
2 adfancedata

Figure 1. Food or food groups contributing to fat, cholesterol, and sodium intakes

FOOO OR FOOD GROUP

1 Milkand milk products. , . . . . . . . . . .

2 Meat . . . . . . . . . . . . . . . . . . . . . .

Organ meats . . . . . . . . . . . . . . . . . . .

3 Fatsand oils . . . . . . . . . . . . . . . . . . .

4 Desserts and sweets . . . . . . . . . . . . . . .

5 Mixed protein dishes with carbohydrates.

starches or vegetables. . . . . . . . . . .

6 Cereals . . . . . . . . . . . . . . . . . . . . . . .

7 Poultry . . . . . . . . . . . . . . . . . . . . . .

8 Fish orshellfish . . . . . . . . . . . . . . . . .

9 Eggs. . . . . . . . . . . . . . . . . . . . . . . .

10 Fruits andvagetables. . . . . . . . . . . . . .

11 Salty snacks . . . . . . . . . . . . . . . . .

12 Grain products ...,.... . . . . . . . . .

13 Alcoholic beverages. . . . . . . .

14 Sugar free andlow calorie beverages . .

15 soups . . . . . . . . . . . . . . . . . . . . . . .

16 Legumes and nuts . . . . . . . . . . . . . . . .

17 Miscellaneous . . . . . . . . . . . . . . . . . .

18 Sugar andprimarily sugar products. . . . . .

EXPLANATION OF FOOD ITEMS

Includes milk drunk as a beverage or used oncereals; flavorad milk drinks ;cocoa

made with milk; skim milk, yogurt, or buttermilk ;ice milk; icecrear norpuddings

made with milk; cheese and cheese dishes. EXCEPTION: CREAM CHEESE

Includes beef, pork, lamb, veal, luncheon meam, canned meats, frankfurters

Includes liver, kidney, heart, spleen, etc.

Includes butter, margarine, salad oils, salad dressings, bacon, cream cheese, cream,

peanut butter, non-dairy cream

Includes cake, pie, cookies, fruit puddings, doughnuts (cake-type and yeasttype), sherbert, sweet snacks. EXCEPTIONS: ICE CREAM, ICE MILK

Includes casseroles, pot pies, pizza, spaghetti with meat, etc. EXCEPTICINS:

PLAIN CHEESE OISHES

Includes breakfast cereals either dry such as cornflakes or cooked such as oatmeal.

Includes chicken, turkey, duck, game birds, cornish hen, etc.

Includes all varieties of fish and shellfish regardless of whether canned, fresh,

frozen, dried or salted.

Includes eggs eaten e.g., fried, boiled, poached, deviled, or egg salad. EXCEPTIONS: EGGS IN COOKED OR BAKED DISHES SUCH AS CUSTARDS, AND

PUDDINGS

Includes: a, All kinds: fresh. canned, frozen, cooked or raw; juices, including

fruit drinks

b. Fruits and vegetables rich in Vitamin A

c. Fruits and vegetables rich in Vitamin C

Includes potato chips, corn chips, puffed snacks, cheese snacks, saltad popcorn,

salted pretzels, etc.

Includes bread, rolls, biscuits, muffins, cornbread, crackers, unsalted pretzels.

Includes a) beer, b) wine, c) distilled liquors

Includes coffee (regular, and decaffeinated ), tea, bouillionr consomme and

diet carbonated dr!n ks

Includes milk and water-based; gravies and sauces (meat and vegetable based)

Includes dry beans and peas such as pinto beans, red beans, black-eyed peas, peanuts, soybeans, soy products, etc.

Includes mustard, gelatin, malt, beverage powders, chili powders, seeds, low fat

salad dressings, etc.

Includes candy, soft drinks, lemonade, Iimeade.
3

Table 1. Mean daily fat intake and percent of calories provided by fat, by sex and age: United States, 1971-74

Both saxes Male Female

A@ Mean fat i%cent of Mean fat l%cent of Mean fat Fwcent of

intake calories intake calories intake calories

(gram) from fat (gram) from fat (gram) from fat

l-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 37 100 37 66 36

l-5years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 36 65 36 60 37

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 36 89 37 77 36

12-17years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 37 115 37 77 37

1844years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 37 114 37 68 36

45-64years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 37 93 37 60 36

65.74years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 35 74 36 51 35

common fatty acid, does not

serum lipids.

Findings from NHANES

average reported consumption

elevate or lower the

I showed that the

of fat was 83 mum

on ti-e da~ of recall. Fat_ represented 37perc&tof

t.lmcalorie sconsumeddaily (table l). Males reported

ahigherfatintake, ameanof100 gramsperday, than

females (66grarns) did. The percent ofcalones from

fat was 37 percent for males and 36 percent for

females.

The daily mean fat intake of females increased

with age from 60 grams at the youngest age group

(1-5 years) to a maximum of 77 grams at the age

group (6-1 7 years) and then declined in each successively older age group (table 1).

A somewhat similar pattern was found for males.

However, the mean fat intake was higher in each age

group than that for females (an expected occurrence

since the reported food intakes of males provided

more calories than the diets of females did).

The major souces of fat in the diet for both males

and females aged 1-74 years, in descending order of

their percent contribution, were meat, milk and milk

products, fats and oik, desserts and sweets, and grain

products. These five food groups provided more than

70 percent of the fat for each sex and age group in

the population (table 2).

Meat

The meat PJOUp includes beef, pork, lamb, veal,

luncheon meats, canned meats, frankfurters, and

organ meats. For both males and females the percent

contribution of meat to the fat value of the diet increased with age from the youngest ages ( 1-5 yeans),

peaked at the adult ages ( 18-44 years), and then deTable 2. Mean daily fat intake and percent of fat provided by selected major food groups, by sex and age: United States, 1971-74

Source of fat

Mean fat

Sex and age intake Milk and Fa8 and Desserts

(gram) Meat milk

Grain

oils and products Odrer

products Smts

Male

l-74years . . . . . . . . . . . . . . . . . . . . . . . . . . 100

l-5years . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . 88

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . 115

1844 years . . . . . . . . . . . . . . . . . . . . . . . . . 114

45-84 years . . . . . . . . . . . . . . . . . . . . . . . . . 93

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . 74

Percent

25 19 15 8 6 26

16 30 14 9 6 25

17 28 13 10 7 25

21 25 12 10 6 26

28 16 15 7 6 27

27 14 19 7 7 26

24 15 20 8 7 25

Female

l-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . 66 21 20 16 8 7 28

l-5years . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 16 31 13 9 5 25

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . . 77 17 29 13 9 7 26

12-17 years . . . . . . . . . . . . . . . . . . . . . . . . . 77 21 23 12 9 6 28

1844 years . . . . . . . . . . . . . . . . . . . . . . . . . 68 23 16 17 8 7 29

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . . 60 24 15 19 8 7 27

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . 51 21 16 22 8 8 26
4 ackincedata

clinecl slightly. Adult males consumed larger percents

of fat from meat than adult females did. There was

no difference in the percent contributions of meat

to total fat intake for males and females ages 1-17

years.

Milk and milk products

The milk and milk products group includes whole

milk, skim milk, or buttermilk reported as a beverage

or used on cereal, flavored milk drinks, cocoa made

with milk, yogurt, ice milk, ice cream, puddings made

with milk, and cheese and cheese dishes. Foods from

this group supplied more of the fat in the diets of

children 1-11 years of age than any other food group

did, accounting for roughly 30 percent of the total

fat consumed by young boys and girls. The percent

contribution of milk and milk products to fat intake

for males and females genemlly declined with age,

with the lowest percen~s falli;g

groups. This pattern for children

of that found for the meat group.

Fats and oils

in the older age

was the opposite

The fats and oils group includes butter, margarine, salad oils and dressings, bacon, cream cheese,

creamy peanut butter, and nondairy cream. Gravies

and low calorie salad dressings are not included. The

largest percent contribution of fats and oils to fat

intake was at the oldest age group (65-74 years) of

males and females where it accounted for 20 and 22

percent, respectively. However, a smaller percent

contribution of fats and oils was in the intakes of

children and adolescents.

Desserts, sweets, and grain products

The desserts and sweets and the grain products

groups were less important as sources of fat in the

U.S. diet. Desserts and sweets, excluding candy, contributed 7-10 percent of the daily fat intake, with the

percent contribution about the same iii each age

group and for both sexes.

Grain products generally contributed a slightly

smaller percent of fat to the diet than the desserts

and sweets groups did. By age, values ranged from 6-7

percent for males and 5-8 percent for females.

Saturated fat

Table 3 shows that the age patterns described for

total fat consumption of males and females were

also observed for saturated fat. TabIe 3 also shows

the seven food groups that were the major sources

of saturated fat. Altogether, these grou:ps provided

85 percent or more of the saturated fat for each agesex group. As with total fat intake, the milk and milk

products group is the major source of saturated fat

for chiIdren and adolescents of both sexes. For adults

the meat group was the major source.

Other sources of saturated fat were fats and oils,

mixed protein dishes, grain products, desserts and

sweets, and eggs.

Milk and milk products (table 3) supplied 29 percent of the saturated fat in the food intakes of males

and females ages 1-74 years. The age patterns found

in percent contributions of these foods to total fat

intake for males and femaIes were also found for

saturated fat. The largest percent was obsewed in the

lowest age group (1-5 years). After these ages the

Table 3. Mean daily saturated fat intake and percent of saturated fat provided by major food groups, by sex and age: United States, 1971-74

Sex and age

Mean

Source of saturated fat

saturated

fat intake

Milk and Fats and Mixed Grain Desserts

(gram)

milk Meat oils

promin products and Eggs Other

produce dishes swwets

Male

l-74 years . . . . . . . . . . 37

l-5 years . . . . . . . . . . . 25

6-n years . . . . . . . . . . 34

12-17 years . . . . . . . . . 42

18-44 years . . . . . . . . . 42

45-64 Vears . . . . . . . . . 34

65-74 years . . . . . . . . . 27

Female

l-74 years . . . . . . . . . . 24

l-5 years . . . . . . . . . . . 23

6-n years . . . . . . . . . . 30

12-17 years . . . . . . . 29

18-44 years ..,...... 25

45-64 years . . . . . . . . 22

65-74 years . . . . . . . . 18

29

43

41

36

24

21

23

29

45

42

34

24

23

24

28

17

19

24

33

32

27

25

17

19

24

27

28

25

12

10

9

10

12

16

17

13

9

9

9

13

17

18

Percent

5 5

5 4

6 5

6 4

6 5

4 5

4 5

6 5

5 4

6 4

5 4

6 5

5 5

5 6

5

5

5

5

5

4

5

5

5

5

6

6

5

6

4

5

3

2

4

5

7

4

5

2

2

4

6

6

12

11

12

13

13

12

11

13

11

13

15

14

12

12
advancedata 5

.

Table 4. Mean daily Iinoleic fatty acid intake and percent of Iinoleic fatty acids provided by major food groups, by sex and age:

United States, 1971.74

Mean Source of Iinoleic fatty acids

Iinoleic

Sex and age fetty acids Fats atrd Salty Fruits Desserts

intake and h.feat

Grain

oils snacks and Poultry products Odrer

(gram) veq tables sweets

Male

l-74 years . . . . . . . . . . 10

l-5years . . . . . . . . . . . 6

6-n years . . . . . . . . . . 8

12-17 years . . . . . . . . . 11

1844 yeara . . . . . . . . . 12

45-64 years . . . . . . . . . 9

65-74 years . . . . . . . . . 7

Female

l-74years . . . . . . . . . . 7

l-5years . . . . . . . . . . . 5

6-n years . . . . . . . . . . 7

12-17 years . . . . . . . . . 8

18-44 years . . . . . . . . . 8

45-64 years . . . . . . . . . 6

“65.74 years . . . . . . . . . 5

38

38

37

31

38

44

45

39

37

34

32

40

44

49

9

11

14

16

8

2

1

9

14

17

18

7

3

2

12

10

10

14

12

10

9

10

9

8

11

12

10

7

Percent

10 6

8 7

7 7

7 7

11 6

11 5

11 7

8 6

7 6

7 6

7 7

8

9 :

8 6

5

5

6

6

5

5

5

5

4

6

5

5

5

5

4

4

4

3

4

5

5

5

5

5

3

5

5

7

16

17

16

15

16

16

17

17

17

17

17

16

17

16

share of saturated fat from the milk group declined

with increased age, falling from 41 and 42 percent,

respectively, for males and females ages 6-1 I years

to about 23 percent in the oldest age group (65-74

years) for both sexes.

The meat group (table 3) supplied 28 and 25 percent, respectively, of the saturated fat in the food intakes of males and females ages 1-74 years. The percent contribution increased from the younger ages for

both sexes, peaked at ages 18-44 years for males and

at ages 45-64 years for females and then declined.

In the younger ages, both sexes showed a relatively larger share of saturated fat from milk and

milk products than from meat products. After ages

12-17 years, the share from meat was relatively higher

than that from milk and milk products.

The contribution of fats and oils to saturated fat

intake ranged from 9 to 17 percent for males; older

males reported the largest percent of their saturated

fat from fats and oils. A simiIar pattern was generaIIy

observed for females. The contributions of mixed

protein dishes, desserts and sweets, grain products,

and eggs to this dietary component were relatively

smaller. For each food group, the percents by each

sex-age group were fairly constant with no observable age pattern.

Linoleic acids

Fats and oil products were the major sources of

Iinoleic acids for males and females in all age groups

(table 4). The largest percent intake from this fatty

acid occurred after age 44 years–more than 40 percent for both males and females. At the younger ages

this food group contributed more than 30 percent of

the daily Iinoleic acid.

Salty snacks were the second major contributor

to linoleic acid for both males and females ages 1-17

years. The percent contribution of salty snacks to

linoleic acid decreased rapidly after ages 12-17 years

for both males and females. Fruits and vegetables

were the second major contributors to Iinoleic acid

for males ages 18-44 years and for females ages 18-64

years, while meat was the second major contributor

to linoleic acid for males ages 45-74 years and females

ages 65-74 years.

Other major contributors to linoleic acid were<

desserts and sweets, grain products, and poultry. Generally, the share of Iinoleic acids from these food

groups remained fairly stable with age.

Oleic acids

Meat, milk and milk products, fats and oils,

desserts and sweets, grain products, and mixed protein dishes were the major sources of oleic fatty acids,

providing about 80 percent of the oleic acids in the

intakes of most sex-by-age groups (table 5).

For the population aged 1-74 years, meat was the

major source of oleic acids. The percent contributed

by those foods peaked at ages 18-44 years for males

and at ages 18-64 years for females and then declined

slightly.

The share of oleic acids reported from the milk

and milk products group was largest among children

and adolescents, the pattern previously observed for
6 aduancedata

Table 5. Mean daily oieic fatty acid intake and percent of oleic fatty acids provided by major food groups, by sex and age: United States, 1971-74

Mean oleic Source of oleic fatty acids

Sex and age

fatty acids

Milk and

intake Fats and Desserts Grain Mixed

(gram)

Meat milk

oils and products protein Odrer

products sweets dishes

Male Percent

l-74 years . . . . . . . . . . . . . . . . . . 37 28 15 15 9 8 6 19

l-5 years . . . . . . . . . . . . . . . . . . . 24 18 24 16 10 8

6-n years . . . . . . . . . . . . . . . . . . 33

6

19 23

18

15 10 9

12-17years . . . . . . . . . . . . . . . . . 41

7

24 20

17

13 10 8

18-44years . . . . . . . . . . . . . . . . . 43

7

31

18

13 14 8 8

45-64years . . . . . . . . . . . . . . . . . 36

7

30 11

19

18 8 9

65-74years . . . . . . . . . . . . . . . . . 29

4

25 12

20

20 10 9 4 20

Female

l-74years . . . . . . . . . . . . . . . . . . 25 24 16 16 10 8 6 19

l-5years . . . . . . . . . . . . . . . . . . . 22

6-n years . . . . . . . . . . . . . . ..$. 28

18 25 15 9 7 6

20 24

18

14 9 8

12-17years . . . . . . . . . . . . . . . . . 28

7

24

17

19 13 10 8

1844years . . . . . . . . . . . . . . . . . 26

7

26 13

2(3

16 10

45-64yea~ . . . . . . . . . . . . . . . . . 23

8 7

26 12

20

19 9 8

65-74years . . . . . . . . . . . . . . . . . 20

5

23 12

20

22 10 9 4 19

other sources of fat. After age 18 the percent contribution of oleic acids from this food group decreased

most rapidly with age, declining to about 12 percent

in the older age groups.

The third source of oleic acids, the fats and oils

group, contributed 13-20 percent of the oleic acids

in the daily intake of males with a slight increase for

the oldest age group. A similar narrow range of 13-22

percent was noted for females of comparable ages,

with a slight increase also noted for the oldest age

group.

Desserts and sweets and grain products each contributed about the same percent of oleic acids with

no noticeable differences between sex and age groups.

Cholesterol intake

Eggs, meat, and milk and milk products were the

major sources of cholesterol, contributing 77 percent

of the daily intake of cholesterol for males and 74

percent for females (table 6). The desserts and sweets

group and the fats and oils group contributed 3-6 percent and 2-4 percent, respectively, of the cholesterol

for all the sex and age groups.

Eggs were the major source of cholesterol for children aged 1-5 years and for adults of both sexes. Each

of these subgroups reported more than a third of their

cholesterol from this source.

Adolescents aged 12-17 years reported relatively

more cholesterol intake from the meat food group–

more than one-fourth of their daily intake–than the

other major food sources.

Milk and milk products and eggs were the major

sources of cholesterol reported by boys ages 6-11

years (about 28 percent) but only milk and milk

products were the major sources of cholesterol reported by girls of similar ages (30 percent).

The percent contribution of eggs to cholesterol

intake generally declined with age after ages 1-5 years

for both sexes to a low at ages 6-11 years for females

and at ages 12-17 years for males and then increased

with age.

The largest percent of cholesterol intake from

meat occurred at ages 18-44 years for males and at

ages 12-17 years for females. The share of cholesterol

intake from meat then decreased with ag, declining

to 21 percent for males and,23 percent for females in

the oldest age group. The percent contribution of

cholesterol from milk and milk products peaked at

ages 6-11 years for both sexes with the foods from

this group supplying least of the cholesterol intake in

the older age groups (table 6).

The mean cholesterol consumption of males increased from age group 1-5 years, peaked at age

group 18-44 years, and then declined. The mean

cholesterol consumption of females increased with

age, peaked at age group 45-64 years, and then

declined; the average cholesterol consunnption for

females was the same for the youngest age group ( 1-5

years) and the oldest age group (65-74 years).

Sodium intake

NHANES I data on sodium intake were converted

to salt intake, assuming a ratio of 1 gram of salt to

400 mg. of sodium. The salt data from NHANES I
damdata7

Table 6. Mean daily dietary cholesterol intake and percent of cholesterol pro’vided by major food groups, by sex and age: United States, 1971.74

Sex and age

Mean

Soume of cholesterol

cholesterol

intake

MiJk and &ww-ts

Eggs Meat

Fats and

(mg) 1

milk and Other oiis

products StWets

Male

1.74years . . . . . . . . . . . . . . . . . . . . . . . . . .

1.5years . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17years . . . . . . . . . . . . . . . . . . . . . . . . .

18-44years . . . . . . . . . . . . . . . . . . . . . . . . .

45-64 years . . . . . . . . . . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . . . . . . . .

Female

l-74years . . . . . . . . . . . . . . . . . . . . . . . . . .

l-5years . . . . . . . . . . . . . . . . . . . . . . . . . . .

6-n years . . . . . . . . . . . . . . . . . . . . . . . . . .

12-17yeara . . . . . . . . . . . . . . . . . . . . . . . . .

1844years . . . . . . . . . . . . . . . . . . . . . . . . .

45-64years . . . . . . . . . . . . . . . . . . . . . . . . .

65-74years . . . . . . . . . . . . . . . . . . . . . . . . .

Percent

445 35 26 16 4 4 16

301 40 15 25 4 3 14

347 28 19 27 5 3 18

410 23 26 25 5 4 17

521 35 28 13 4 3 16

465 39 27 11 3 4 16

411 45 21 11 4 4 14

303 34 24 16 5 4 18

274 40 15 26 4 2 13

277 21 20 30 3 20

291 25 26 23 : 3 18

311 34 25 13 5 4 19

327 40 25 11 4 4 17

274 40 23 11 5 4 17

lMilligrarn

are incomplete because the values cover only natur- Arnong age groups, the differences in reported perally occurring sodium in foods and sodium addedby cent by sourceof sodium were small (tabIe 7).

processors. Table salt is not included in these data. Table 7 also shows the seven food groups that

Males reported an average daily consumption of supplied 78 percent ormore ofsodium forallsex and

2,701 mg. of sodium or about 7 grams of salt and age groups. Foods such as mustard, ketchup, worfemales reported an average daily consumption of cestershire sauce, and other condiments, the major

1,850 mg. of sodium or about 5 grams of salt. sources of sodium, accounted for onIy 0.2 percent in

Table 7. Maan daily sodium intake and percent of sodium provided by major food groups, by sex and age: United States, 1971-74

Mean

Swine of sodium

Sex and age

sodium

Milk and Mixed

intake Grain

Fruits

milk protein Fats and

(mg)’

soups Meat and

products

Other

products dishes oils vegetables

Male

l-74years . . . . . . . . . .

l-5years . . . . . . . . . . .

6-n years . . . . . . . . . .

12-17 years . . . . . . . . .

1844years . . . . . . . . .

45-64 years . . . . . . . . .

65-74 years . . . . . . . . .

Percent

2,701 24 13 12 10 9 7 6 19

1,886 20 18 11 12 7 6 6 20

2,532 23 16 13 9 7 6 5 22

2,965 23 15 14 8 8 6 5 21

3,032 23 12 13 9 10 8 6 18

2,540 25 11 8 11 10 8 8 19

2,229 26 11 6 13 9 8 7 21

Female

l-74years . . . . . . . . . . 1,850 23 14 11 10 8 8 6 19

l-5 years . . . . . . . . . . . 1,721 20 19 12 11 7 6 6 20

6-n years . . . . . . . . . . 2,238 23 16 12 10 7 7 5 20

12-17 yeara . . . . . . . . . 2,001 23 16 12 9 8 8 5 19

18-44 years . . . . . . . . . 1,863 23 13 13 10 9 8 7 18

45-64 years . . . . . . . . . 1,702 24 12 8 11 10 9 7 18

65-74 years . . . . . . . . . 1,526 27 13 5 11 7 8 8 21

‘Milligram

NOTE: HAN ES sodium intaka valuas converted to salt intake values assuming a ratio of 1 gram of salt to 400 mg of sodium.
8 ackncedata

Table 8. Percent distribution of dietary components provided by food groups appearing in the 24-hour recall of food consumption and

mean intake of dietary components of persons aged 1-74 years: United States, 1971-74

Food or food group

Pro tein Fat Sodium Saturated Linoleic

Calories fatty acid Oleic acid

(gram) (gram)

Cholesterol

(m9)’ (gram] acid

(gram) (gram) (m9)’

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

Skim milk or buttermilk . . . . . . . . .

Cheese and cheese products . . . . . . . .

Milk and milk products excluding

cheese . . . . . . . . . . . . . . . . . . .

Meat . . . . . . . . . . . . . . . . . . . . .

Poultry . . . . . . . . . . . . . . . . . . . .

Organ meats . . . . . . . . . . . . . . . . .

Fish orshellfish . . . . . . . . . . . . . . .

Eggs. . . . . . . . . . . . . . . . . . . . . .

soups . . . . . . . . . . . . . . . . . . . . .

Fatsand oils . . . . . . . . . . . . . . . . .

Legumesand nuts . . . . . . . . . . . . . .

Cereals . . . . . . . . . . . . . . . . . . . .

Grain products . . . . . . . . . . . . . . .

Fruits andvegetables. . . . . . . . . . . .

Sugar andprimari{y sugar products. . . .

Dessertsand sweets . . . . . . . . . . . . .

Miscellaneous . . . . . . . . . . . . . . . .

Mixed protaindishes. . . . . . . . . . . .

Alcoholic beverages. . . . . . . . . . . . .

Sugar free andlow calorie beverages . . .

Salty snacks . . . . . . . . . . . . . . . . .

Mean . . . . . . . . . . . . . . . . . . . . .

100.0

1.2

1.9

12.9

13.6

2.0

0.2

1.1

2.5

1.6

6.3

1.7

1.8

14.7

10.8

8.8

8.4

0.6

5.0

3.3

0.4

1.5

1,989

100.0

2.5

3.5

15.9

29.5

6.6

0.6

3.6

4.2

1.1

2.0

2.1

1.2

10.8

5.0

0.6

2.9

0.4

6.7

0.4

0.1

0.5

79

Percent distribution

100.0 100.0 100.0

0.4 1.3 0.1

3.4 4.1 4.9

15.8

22.9

2.3

0.4

1.2

4.6

2.0

15.6

1.6

0.4

6.4

5.1

1.9

8.2

0.3

5.4

2.2

83

8.2

8.7

0.2

0.1

0.7

3.1

9.9

6.3

2.0

3.3

23.4

7.6

0.6

6.5

0.3

11.4

0.3

0.6

1.5

2,262

23.9

26.5

1.9

0.3

0.8

4.1

1.7

12.3

1.2

0.1

4.7

3.3

1.9

!5.0

0.1

!5.4

1.6

30

100,0

0.1

2.9

12.5

25.7

2.5

0.4

1.1

4.9

1.7

15.5

1.7

0.1

8.2

3.5

2.2

9.1

0.1

6.3

1.4

31

100.0

1.0

8.7

4.6

0.3

1.4

3.0

2.6

38.8

2.2

0.5

5.1

11.1

1.6

6.4

1.2

2.7

8.8

9

100.0

0.2

2.4

13.6

22.9

4.1

2.0

2.5

34.2

0.6

3.6

0.2

3.6

1.1

0.1

4.3

4.5

0.1

372

‘Milligram

the 24-hour recall data because of minimal volume

consumption. NHANES I data indicate that grain

products are themajor contributing source of sodium

in the 24-hour recall data. Grain products contributed

about one-quarter of the sodium intake in all sex and

age subgroups, providing 20-27 percent in all groups.

The percents are fairly stable throughout the age

groups.

The milk and milk products group was generally

the second major source of sodium intake. Younger

males and females showed a higher percent of sodium

intake from milk and milk products than adults did.

This pattern is expected because of the higher consumption of milk and milk products by the younger

groups. Other major sources of sodium were mixed

protein dishes and soups.

Mixed protein dishes contributed 6-14 percent

of the daily sodium intake for males and 5-13 percent

for females. Both sexes aged 45-74 years showed

smaller shares of sodium from this group of foods

than those in the younger age group.

The percent contribution of soups to sodium

remained fairly stable with age ranging from 8-13

percent for males and from 9-11 percent for females.

Other food groups contributing smaller amounts

of sodium in the diets of the U.S. population were

meats, fruits and vegetables, and fats and oils. These

food groups generally contributed less sodium to the

daily intake in all population subgroups than grain

products, milk and miIk products, and mixed protein

dishes did. The differences between sexes in percent

of sodium intake were small. For each sex, age was

not a factor. The percent of dietary components provided by all food groups appearing in the 24-hour

recall of all persons aged 1-74 years in the United

States is presented in table 8.

Discussion

Reference data on dietary components implicated

in increased risk to disease have been presented and

analyzed by sex and age because of the medical interest in such data. These estimates are generalized

for the U.S. population and provide cross-sectional

data on the consumption of selected dietary components as reported by persons representing different

age groups in the U.S. population. The limitations of

cross-sectional data should be recognized in considering age group changes. The use of 24-hour recall to

estimate dietary habits is also a limitation. Recent

food intakes do not necessarily reflect lifetime

dietary habits. Since the disease processes of those

cited are long-term, it is questionable to relate recent

dietary habits to the risk of these diseases. The esti-
admncedata 9

mates in this report will be compared with NHANES

H data on food consumption patterns which will be

available in 1981.

There are limitations to the dietary estimates

obtained from NHANES I. The major source of

data for the basic nutritional values of food items is

from the U.S. Department of Agriculture Handbook

No. 8.1 S Because of the introduction of new food

items in the market, updated and added values for

new foods are made according to information provided by the U.S. Department of Agriculture (USDA),

food processors, and manufacturers. With the exception of cholesterol, all nutrient values for chicken,

steak, pork chops, and meat 1~af were calculated

using USDA Handbook No. 456. I GCholesterol values

were calculated using an article by R.F. Feeley, P.E.

Criner and B.K. Watts.l 7 However, despite the considerable data on the nutrient composition of foods,

information is less than optimal in those areas of the

macronutrients whose importance is of immediate

interest.

More of the data used in NHANES I, obtained

from the USDA data bank, are for commodities

than for brand name convenience foods.

Another problem is lack of information on the

lipid content of food served by institutions, restaurants, and fast food outlets;l a the main sources of

compiled data have covered onIy food eaten in the

home. The present dietary data bank was compiled

mainly for nutrients-e. g., vitamins A and C, calcium, and iron–whose deficiency led to the classical

nutritional diseases.

References

i~eric~ He@ Association: Inter-Society Commission fOr

Heart DiseaseResources:Primary preventionof atherosclerotic

diseases. Circwlrtion 42(6): A55, Dec. 1970.

2Turpeinen, O.: Effect of cholesterol-lowering diet on mortality from coronary heart disease and other causes. Circu&-

t-icm59(l): 1-7, 1979.

3Keys, A., cd.: Coronary heart disease in seven countries.

Circulation 41 (Supp. 1).,1970.

4Wynder, E. L.: Nutritional Carchogewsis 360-378. Annals

of the New York Academy of Sciences. Vol. 300. Food and

Nutrition in Health and Disease, 1977. Edited by N. H. Moss

and J. Mayer.

5McGandy, R. B., Hegsted, D. M., and Stare, F. J-: Dietary

fats, carbohydrates and atherosclerotic vascular disease. New

Engl J Med. 277:186,1967.

6Stamler, J.: Diet-related Risk Factors for Human Atherosclerosis: Hyperlipidemia, Hypertension, Hyperglycemia -

Current Status. In Diet and Atherosclerosis, edited by C.

Sirtori, G. Ricci, and S. Gorini, New York Plenum Press, 1973,

p. 125.

7Diet, Nutrition, and Cancer Program, National Cancer Institute, National Institutes of Health Status Report, 1977.

8Haqer, A. E.: Dietary goals - a skeptical view. Am. ~ Clin.

Nutr. 31:310-321, 1978.

9~efic~ He~th Foundation: Position statement of diet

and coronary heart disease. Prey. Med. I (1,2): 255-286, Mar.

1972.

1@JationaI Institutes of Health: Atherosclerosis–A report

by the National Heart and Lung Institute task force on arteriosclerosis. Vol. II. DHEW Pub. No. (NIH) 72-219. National

Institutes of Health, Washington. U.S. Government Printing

Office, June 1971.

1]National Academy of Sciences - National Research Council,

Food and Nutrition Board and American Medical Association,

The Council on Foods and Nutrition: Diet and Coronary Heart

Disease. Washington, D.C. National Academy of Sciences and

American Medical Association, July 1972.

12Dietary Go&j for the United States, Select Committee on

Nutrition and Human Needs, United States Senate, 2d edition.

Washington. U.S. Government Printing Office, Dec. 1977.

13Nation~ Center for He~th Statistics: Plan and operation of

the Health and Nutrition Examination Survey, United States,

1971-73. Vital and Halth Statistics. Series 1-Nos. 10a and,

10b. DHEW Pub. No. (HSM) 73-1310. Health Services and

Mental Health Administration. Washington. U.S. Government

Printing Office, Feb. 1973.

14Nationa1 Center for Health Statistics: Consumption patterns in the United States, 1971-1974. Vital and Health Statistics. Series 11. Public Health Sewice, DHEW, Hyattsville,

Md. To be published.

15Watt, B. K., ~d Merrill, A.: Composition of Foods-Raw,

Processed, Prepared. Agriculture Handbook No. 8 (rev.).

Washington. U.S. Department of Agriculture, 1963. Revised

Data Tape, Expansion (Mar. 1972).

16Adms, D. F.: Nutritive Value of &nerican Foods, In

Common Units - Agriculture Handbook No. 456, Washington.

U.S. Department of Agriculture, November 1975.

17Fee1ey, R. F., Criner, P. E., and Watts, B. K.: Cholesterol

Content of Foods, J. American Dietary Association, 61:

134-149, 1972.

18Food Qua~ty in Federal Food programs, Hearings before

the Select Committee on Nutrition and Human Needs of the

United States Senate. 95th Congress, First Session, Sept. 1977,

Part 2. Washington. U.S. Government Printing Office, Statement of Dr. Kent K. Steward, pp. 73-82.
10 advancedata

Technical notes

The sampling plan for the 65 examination locations in the National Health and Nutrition Examination Survey (NHANES) followed a highly stratified

multistage probability design in which a sample of the

civilian noninstitutiona.lized population of the conterminous United States aged 1-74 years was selected.

Successive elements used in the sampling process were

the primary sampling unit, census enumeration

district, segment (a cluster of households), household,

eligible person, and sample person. The sampling

design provided for oversampling among persons living

in poverty areas, preschool children, women of

childbearing age, and the elderly.

The dietary component vaIues are shown as population estimates, i.e., the findings for each individual

have been “weighted” by the reciprocal ctf the probability of selecting the person. An adjustment for

persons in the sample who were not examined and

post-stratified ratio adjustments were also made so

that the final sampling estimates of the population

size are brought into closer alignment with the independent U.S. Bureau of the Census estimates for the

civilian noninstitutiona.lized population of the United

States as of November 1, 1972, by race, sex, and age.
dmcedab 11

Symbols

--- Data not available

. . . Category not applicable

Quantity zero

0.0 Quantity more than O but less than 0.05

* Figure does not meet standards of

reliability or precision
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEAL 7H STATISTICS

U.S.DEPARTMENT OF HEALTH, . public Health Serv’ce

EDUCATION, ANI3 WELFARE Office of Health Research, Statistics, and Technology ● January 24, 1980

Reproductive Impairments Among Currently Married Couples:

United States, 1976’

INTRODUCTION

This report presents preliminary estimates of

fecundity imp,airmcnts-that is, involuntary

conditions that make it difficult or impossible to

have additional chiIdren–among currently married couples in the United States in 1976. These

are the latest national estimates of fecundity impairments and the first since those reported

from the 1960 Growth of American Families

Study.z The data are based on Cycle II of the

National Sumey of Family Growth (NSFG)

conducted in 1976 by the National Center for

Health Statistics.

In 1976 about 6.9 miIlion couples, or 25

percent of all married couples with the wife of

childbearing age, had fecundity impairments

(figure 1). Most of these couples had one child

or more and did not want additional children

(figure 2). A substantial minority of couples

with impaired fecundity—about 2.7 million—

wanted to have a baby or another baby. About

848,000 of these couples were childless and

688,000 had ordy one child. In all, couples

with impaired fecundity who wanted to have a

baby or another baby made up about 10 percent

of the married coupIes with the wife of childbearing age.

Statistics on couples with fecundity impairments may be of interest in determining the degree of need for appropriate medical services, in

assessing the demand for adoption, and in deterlThis report was prepared by WiIliam D. Mosher,

Ph. D., Division of Vital Statistics.

2 Whelpton, P. K., Campbell, A. .&, and Patterson,

J. E.: Fertility and Fa milv Planning in the United States.

Princeton, N.J. Princeton University Press, 1966, Chapter 4.

F@Ire 1. PERCENT OF ALL CURRENTLY MARRIED COUPLES WITH

WIFE 15-?4 YEARS OF AGE, EY FECUNDilW STATUS: UNITED

STATES, 1978

●l

)

Inlpatrtd

fec”ndtty

mew

Fgure 2. PERCENT OF ALL COUPLES WHO HAVE IMPAIRED

FECUNDllY’ AND ARE AT GIVEN PARITIES: UNITED

STATES, 1976

~ ‘t%’; lhimmn,e.dsr.hwa(~nolh~rl

~ Dwsno! .!..d,o.ave.(d.ot~rl baby

7 ,-

1

. . ......... :.:.}:.:!

<

,., .......j .: .:,:.:,

I

$ ’31_

g

2 –

U1. &

1

0

0 1 2 3 4 or more

PARITY [number of Chrldrm ever born)

,1 i.l, d.. n. m.... !r... i1,...l, .I. r!l, 1 !>, ,, .,..1 . .,! . .! !!,, . ,1. .
2 adwmC4m

mining the potential effects of fecundity impair- .

ments on birth rates.

The NSFG is bxed on personal interviews

with a multistage area probability sample of

women 15-44 years of age in the household

population of the conterminous United States.

Women were eligible for inclusion in the sample

if they were currently married, previously married, or were never married but had offspring

presently living in the household.

The interview focused on the respondents’

marital and pregnancy histories, their use of contraception and the planning status of each pregnancy, their use of maternal care and family

planning services, fecundity impairments, and a

wide range of social and economic characteristics. Between January and September of 1976,

3,009 black women and 5,602 women of other

races were interviewed. Because the estimates of

statistics in this report are based on a sample,

they are subject to sampling variability. Further

discussion of the survey design, definition of

terms, and sampling variability can be found in

the Technical Notes.

Statistics in this report refer to women who

were currently married at the time of the survey.

Characteristics reported, such as age, race, number of years since first marriage, and parity

(number of children ever born), all refer to the

-..: C- r’--. .-.-l:... ‘—--:-—--+- -“--- reported in

respondent

W1l C. rcLullul Ly l[llpdlllllcll L> Wc]c

response to questions on whether

couples had trouble having children.

CLASSIFICATION BY

FECUNDITY STATUS

For this report, fecundity is a characteristic

that was measured for all currently married

couples by a series of questions. All currently

married couples were classified into one of five

categories of fecundity status: contraceptively

sterile, noncontmceptively sterile, long interval,

sub fecund, or fecund.

Data on fecundity impairments were obtained by asking respondents whether it was

possible or impossible, or difficult or not difficult, for them to have a baby or another baby.

If the respondent said it was difficult or impossible, she was asked why. With a few exceptions

(explained below), respondents who said that it

was impossible for them to have a baby or

another baby were classified as sterile, and those

who said it was difficult were classified sub fecund. The first question on fecundity impairments was the following:

“It is physically impossible for some couples to have children. As far as you know, is

it possible or impossible for you and your

husband to conceive a(nother) baby, that is,

to get pregnant (again)?”

Respondents who replied that it was impossible

for them to have a baby or another baby were

asked:

“What is the reason you are unable to have

a(nother) baby?”

If the response was that they were sterile because of a surgical procedure, they were then

asked:

“What kind of operation was it?”

“Was one reason for the operation because

you had all the children you wanted?”

Contraceptively Sterile

This category consisted of women or their

current husbands who had sterilizing operations

at least partly because they had all the children

they wanted. In 1976, 18.6 percent of the couples in which the wife was 15-44 years of age

were contraceptively sterile. (This percent differs slightly from a preliminary estimate published in .4dzlancc Data Number 36, because of

revisions made in the data. See “Definition of

Terms.”) For this report, these couples are not

classified as having fecundity impairments because they have ended their fecundity voluntarily—that is, as a method of family Iirnitation

(table 1 and figure 1).

Noncontraceptively Sterile

Of those couples with fecundity impairments, the noncontraceptively sterile was the

largest group. Eleven percent of the currently

married couples in 1976, or about 3.0 million,

were noncontmceptively sterile (table 1 and

figure 1). These couples knew of specific reasons

why they were sterile. Noncontracel?tively

sterile women replied to the above questions

that it was impossible for them to have a baby
advancedata 3

Table 1. Number of all currently married womenl 15-44 vears of aae and Dercent distribution bv fecundity status, according to

Selected

characteristic

—Age

All ages . .................

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

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

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

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

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

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

3544 years ................ .......

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

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

Parity

o ......................................

1 ......................................

2 ..... .................................

3 .... ................. ..... ........... .

4 or more ........ ........... ...... .

Years since wife’s

first merriaga

Less than 5 years ............. ..

5-9 years ...... .....................

10-14 years .... ................ ...

15 years or more ............ ..

Hispanic origin3

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

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

{umber of

women in

:housends

27,488

6,020

1,043

4,977

12,179

6,443

5,736

9,288

4,814

4,474

5,235

5,571

7,638

4,744

4,300

7.039

6,389

4,972

8,750

1,699

25,726

selected characteristics: U;ited States, 1976

Impaired fecundity

Contra.

Tota I Fecund2 cept ivel y

Ail Noncontresterile Long

cept ivei y Subfecund impaired interval

sterile

Percent d istribut ion

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

56.1

85.3

90.1

84.3

58.7

68.7

47.5

33.8

36.3

31.2

73.0

70.9

56.1

43.2

32.3

86.5

66.7

43.2

31.8

63.5

55.6

18.6

3.5

‘0.8

4.0

19.1

12.5

26.5

27.7

28.9

26.4

●1 .5

3.8

23.3

30.7

36.6

1.8

13.7

28.3

30.2

10.7

19.1

25.3

11.3

9.1

11.7

22.2

18.8

26.1

38.5

34.9

42.4

25.5

25.2

.21.5

26.1

31.0

11.7

19.5

28.6

38.0

25.7

25.3

11.0

‘0.6

*2.2

7.3

8.1

5.4

11.1

21.5

18.8

24.5

7.8

5.9

9.7

15.5

18.8

2.0

3.8

13.4

21.8

8.7

11.2

3.9

●0.8

●0.1

●1.O

2.6

2.3

2.9

7.7

6.2

9.3

5.0

4.1

2.6

3.3

5.5

‘0.8

2.1

4.8

7.2

4.1

3.9

10.4

9.8

8.8

10.0

11.5

11.1

12.0

9.3

9.9

8.7

12.7

15.3

9.2

7,3

5.5

9.0

13.6

10.4

9.0

13.0

10.2

llnclude~ races Other than white and black.

2Fe~und is used in ~ different ~ay in th~ report than in previous ~~po~ts.SW “Definition Of Terms.”’

3Women of ~~panic Orjgin are included in the figures for white and black women if they were identified as such hy the interviewer.

or another baby because ( 1) the wife or husband sterile by type of operation and “on those who

had a sterilizing operation (such as a hysterec- intend to have sterilizing operations.

tomy) that was not done because they had all the

children they wanted, but for health reasons; or

(2) that it wx impossible for her to have a baby Long Interval

or another baby because of accident, illness, or This category consists of currently married

some other reason. couples who, during the 3 years of continuous

A future report in Series 23 of Vital and marriage before the interview, did not use conHealth Statistics will focus on the surgically traception and did not have a pregnancy. Many
4 zKivanCe&3ta

of these couPles are sterile, but some mi.~ht con- Fecund .

ceive in the future.3 In 1976, 1.1 million: or 3.9 “

pcrccnt, of currently married couples were

cl~ssified as ha~’ing a long interval (table 1 and

figure 1).

Subfecund

For women in this category, it may be possible for them to conceive and/or carry a pregnancy to term, but there are specific difficulties

in doing so. Most women classified sub fecund

responded affirmatively to the following

question:

“Some people are able to have a(nother)

baby, but they have difficulty getting pregnant or holding onto the baby. As far as you

know, is there any problem or difficulty for

you and your husband to conceive or deIiver

a(nother) baby?”

Women who answered this question affirmatively were then asked the following question:

“What is the reason it would be difficult for

you to have a(nother) baby?”

An estimated 2.9 million couples, or about

10.4 percent, were classified as sub fecund in

1976 (table 1 and figure 1). Of the subfecund

couples, an estimated 908,000 were aware of a

“physical difficulty getting pregnant,” while an

estimated 638,000 women had difficulty

carrying the pregnancy a full 9 months.

Ail Fecundity Impairments

This category includes noncontraceptiveIy

sterile coupIes, those with Iong intervals, and

sub fecund couples. In 1976, 25.3 percent, or

6,954,000 couples, were classified as having a

fecundity impairment. As stated previously,

this category does not include couples who have

used a sterilizing operation as a method of

family limitation. Those couples are called “contraceptively sterile. ”

.3Potter, R. G. and Parker, M, P.: Predicting the time

required to conceive. F’o@Aztion Studies. 18(1) :99-116,

Jldy, 1964.

In this report, fecund means that there was

no evidence as of the date of the intemiew that

the couple had J problem in conceiving or delivering a baby. These women reported no impair:

ments and stated that it was possible for thcm to

have a baby, that they did not have any difficulty conceiving or carrying to term, and they

did not have a 3-year (or longer) interval of nonuse of contraception without pregnancy immediately before the interview. About 15.4 million,

or 56.1 percent, of the currently married

couples were classified as fecund in 1976. As explained in the “Definition of Terms, ” this definition differs from the use .of the term fecund in

some other reports where the subfecund and

Iong-intervzd couples, for whom it may still be

possible to have children or additional children,

were not classified separately.

The passage of time, non use of cent raception, or an attempt to have children increase the

likelihood that couples will discover fecundity

impairments. (For example, couples who hat’e

ended their fecundity by contraceptive sterilization or who have always used contraception

without a pregnancy occurring may have undiagnosed impairments that wouId prevent, or make

difficult, their having children or additional

children if they later decided they wanted

m“ore.) Some effects of. the passage of time and

attempts to have children are indicated by age,

parity, and number of years since the wife’s first

marriage (tables 1-3 ).

FINDINGS

Table 4 distinguishes between fecundity impairments and the desire for children or additional children by showing the number and percent of women in each fecundity status-parity

category who would like or intend to have a

baby or another baby in the future.

A majority of couples with fecundity impairments wouId not Iike, or do not intend, to

have additional chiIdren. But a substantial

minority did express a desire to have a baby or

another baby —39.3 percent of wives with impaired fecundity (an estimated 2.7 million

women) said they would like to have a baby

or another baby. This was 9.9 percent of the

27,488,000 wives 15-44 yrears of age in 1976.
duancedata 5

Table 2. Number of currently married white women 15-44 y?ars of age and Percent dinribution by fecundity statusr according

Selected

characteristic

—Age

All ages...................

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

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

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

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

25-29 Wow%.................

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

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

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

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

Parity

o......................................

1 ......................................

2 ......................................

3 ......................................

4 or more. .........................

Yeers since wife’s

first rmrriage

Lessthan 5 years...............

5-9 years............................

10-14 years........................

15 years or more. ..............

Wmber of

women in

thousands

24,795

5,412

918

4,493

10,893

5,806

5,187

8,390

4,339

4,051

4,874

4,922

6,939

4,330

3,729

6,253

5,740

4,512

8,048

to selected character i~tics: Un~ed States, 1976

impaired fecundity

COntraTota I Fecundl cept ively All Noncontra -

Long

sterile imps ired ceptively Subfecund

sterile interval

Percent distribution

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

56.1

86.5

90.7

85.6

58.1

68.2

46.7

33.8

36.2

31.3

73.9

71.5

54.6

41.8

31.6

87.2

67.4

42.6

31.7

19.3

3.5

‘0.8

4.0

20.1

13.1

27.9

28.5

30.0

26.9

●1.5

4.2

24.9

31.8

37.5

1.8

14.6

29.4

30.7

24.6 II 11.0

10.0

8.5

10.4

21.8

18.6

25.4

37.7

33.9

41.8

24.6

24.3

20.5

26.4,

L

30.9

11.1

18.0

27.9

37.6

“0.6

“0.0

0.7

8.1

5.2

11.4

21.5

18.2

25.0

7.7

5.7

9.5

15.7

19.7

2.0

3.4

13.3

22.0

3.5

“0.6

●0.1

“0.7

2.3

2.0

2.6

7.0

5.7

8.5

4.9

3.5

2.1

3.3

4.7

‘0.7

1.5

4.4

6.5

10.1

8.9

8.4

9.0

11.4

11.3

11.5

9.2

10.0

8,3

12.0

15.0

8.9

7.4

6.5

8.4

13.1

10.2

9.0

1Fecund is “~ed in a differ~n~ way in this ~~port than in pretious repofts. See “~efiflltiOSl Of Terms. ”

However, a majority of chldk’ss couples Percent at parity one, 7.0 percent tit parity two,

with fecundity impairments (63.5 percent, or

about 848,000) would like to have a baby, and

49.0 percent (688,000) of couples with fecundity impairments who have one child (parity

one) would like to have another (table A). The

percent of couples ../anting a baby or aiiother

baby declined with parity in each category of

fecundity impairments. The one exception, in

the long interval category, is not statistically

significant.

Since noncontraceptively sterile couples are

not able to bear a child or another chiId, these

wives were asked: “Do you intend to adopt any

chiIdren?” Overall, 12.2 percent responded

affirmatively, including 39.1 percent of noncontraceptiveIy sterile wives at parity zero, 14.8

and 6.5 percent at parity three or more.

Sub fecund wives were asked: “In the past 3

years, have you talked tvith a doctor or other

trained person about i)zcrcusirzg your chances of

having a baby?” About 1 in -!, or 26.2 percent,

responded affirmatively; this represents ab(mt

749,000 women. This percent also declined tvith

parity, from 50.7 percent of sub fecund wives at

parity zero to 34.9 percent at parity one, 11.1

percent at parity two, and 5.5 percent at parity

three or more.

Calculations based on table 1 (but not

shown here) showed that couples \vith impaired

fecundity were oIder than fecund couples. Fecund wives, of whom Aout 38 percent ww-e

30-44 years of age, \vere the youngest of the
6 admncedata

Table 3. Number of currently married black women 15-44 years of age and percent distribution by fecundity status, according to

selected characterist ;cs: United States, 1976

II 1 I

Selected

characteristic

Age

All ages ...................

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

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

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

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

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

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

3544 years .......................

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

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

Parity

o ......................................

1......................................

2 ................... .......... .........

3 ......................................

4 or more ........... ............. .

Years since wife’s

first marriaae

Less than 5 years . .............

5-9 years ............. ..............

10-14 years .... ...................

15 years or more ...............

Uumber of

women (n

thousands

2,169

509

99

410

912

464

428

749

368

381

242

526

565

312

524

585

503

368

627

Impaired fecundity

ContraTotal Fecundl ceptively

Al I

Noncontrasterile Long

ceptively Subfecund impaired interval

sterile

Percent distribution

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

55.9

74.8

82.6

72.9

64.9

72.8

56.0

32.1

36.7

27.6

57.4

66.0

63.3

54.7

37.8

81.6

62.5

48.5

32.5

12.6

“4.0

●1 .2

● 4.7

9.6

6.8

12.8

22.2

22.0

22.4

90.8

“0.7

9.1

20.1

29.4

‘2.6

7.0

15.4

25.1

31.4

21.2

‘1 6.2

22.4

25.5

20.4

31.2

45.7

41.3

50.0

41.8

33.3

27.6

25.2

32.7

15.8

30.5

36.1

42.4

11.1

●1.5

*2.3

●1.3 I

8.5 ~

8.4

8.6 i

20.7

19.8

21.5

14.8

7.4

10.1

12.3

13.4

2.4

6.8

17.1

17.5

8.2

‘4.0

*0.O

‘5.0

5.6

‘4.2

●7.1

14.2

11.8

16.5

*9.7

8.5

6.4

“5.0

10.9

●2.1

7.9

●4.9

15.4

12.2

=~

15.7

13.9

16.2

11.4

7.8

15.4

10.8

9.7

12.0

17.2

17.4

11.2

*7.9

8.4

11.3

15.8

14.1

9.5

I Fecund is “s~d in a different W3Y in this report than in previous reports. See “Definition Of Terms. ”

fecundity stutus categories. Suhfecund wives, Tables 1, 2, and 3 show the distribution of

with about 5-! percent at 30-44 years of age,

were somewhat older. Noncontraceptively sterile

wives, of whom 87 percent were 30-44 years of

age, were the oldest of’ the fecundity status

groups.

Among those with fecundity impairments,

the distribution of the types of impairments

changes over time. For example, for those

married less than 5 years before the interview,

sub fecund couples accounted for about threefourths of all couples with fecundity impairments (table 1). However, for those married 15

years or more subfecundity accounted for about

one-fourth. These observations suggest that

some couples may discover, as well as develop,

impairments as they grow oIder, thereby moving

from subfecund to noncontraceptively steriIe.

currently married couples of reproductive age

in 1976, by fecundity status and selected characteristics of the wife. The prevalence of fecundity impairments increases with the age of

the wife. TabIe 1 shows that for couples of all

races the percent with impairments increased

from 11.7 percent at ages 20-24 years to 42.4

percent at ages 40-44. The percent fecund decreased from 84.3 percent to 31.2 percent at

the same ages, but much of that decrease was

due to contraceptive sterility, which is not classified as a fecundity impairment.

The estimated number of couples in which

the wife had no children (was of zero parity)

and a fecundity impairment was about

1,335,000, or 4.9 percent of all couples in 19’76.

Ot’ these, about 408,000, or 1.5 percent of all
adwincedata 7

Table 4. Number and percent of currently married women 1544

years of age with fecundity impairments who intend or would

like to have a future baby. by fecundity status and Daritv:

United States, 1976

parity

All parities . .......

o .................................

1 .................................

2 ...... ..... ....... .......... .....

3 ....................... ...... ... .

4 or mom ...... ...............

All parities . ...... ..

o ..................................

1 ..................................

2 ..... ........................ .....

3 ..................... .............

4 or more. .............. .......

II I I

Number who would like or intend a

future baby in thousands

=11=1==4=

848 238 118 490

688 176 ●46 468

506 324 ●37 145

347 264 ●12 ‘71

343 267 *27 ●4O

Percent who would like or

intend a future &by

39.3 I [ 42.0 ] 22.3 ~ 42.8

63.5 58.4 46.2 73.7

49.0 53.4 20.3 55.1

30.8 43.8 18.8 20.6

28.0 35.9 7.8 20.5

25.7 33.0 11.4 16.8

NOTE: Numbers may not add to the totals due to rounding.

Denominators of these percents were calculated from the numbers and percents in table 1.

couples, were noncontraceptively sterile and

had no children.

The fecundity status of coupIes was associated with the number of years bet~veen the

wife’s first marriage and the intemiew date

(table 1). For wives married less than 5 years

before the intemie~v date, 11.7 percent of the

couples had fecundity impairments; this percent increased about 10 percentage points for

each 5 years to 38.0 percent for women first

married 15 years or more before the interview.

For wives of Hispanic origin, 25.7 percent

reported fecundity impairments compared with

25,3 percent for other wives; this difference is

not statistically significant. Noncontraceptive

sterility was reported by 8.7 percent of Hispanic

wives compared with 11.2 percent of other

wives, not a statistically significant difference.

Tables 2 and 3 show data for white couples

and black couples, respectively. Among black

couples, 31.4 percent reported fecundity impairments compared w’ith Z-I..G percent of white

couples. Howe\’er, most of this 6.8 percentage

point difference is due to the Iargcr percent of

black couples with lung intervals (8.2 percent

compared with 3.5 percent of ~~~hite couples).

The rest of the difference is due to a slightly

(but not significantly) higher percent of bIack

couples classified as sub fecund ( 12.2 percent

compared with 10.1 percent). The percent of

couples reporting noncontraceptive sterility was

not significantly different by race ( 11.1 percent

of black couples and 11.0 percent of white

couples).

The percent of white and black couples who

were noncontracep tively sterile was not significantly different in any of the 10-year age groups

(tabIes 2 and 3). (To reduce sampling variability,

the comparisons by race are discussed here in

10-year age groups.) The main differences between black and white couples are in the sub fecund and long interval categories. At 15-24 years

of age, the principal difference is that black

couples have a higher percent sub fecund than

white couples do— 15.7 percent compared with

8.9 percent. In the age group 35-W years, the

percent of black couples with long intervak was

14.2 compared with only 7.0 percent of white

coupIes.

Finally, the percent of wives reporting fecundity impairments was 11.2 percentage points

higher for black couples than for white couples

at 15-24 years of age, and 8.0 percentage points

higher at 35-44 yew-s of age, but only 3.7 percentage points higher at 25-3-1 years of age. This

difference at ages 25-34 years was almost entirely due to a higher percent of black couples

with long intem’als.

The percent of all currently married couples

who had no children (were of parity zero) and

were noncontraceptively sterile was not significantly different by race. In 1976, the estimated

number was about 375,000, or about 1.5 percent, of the 24,795,000 white coupIes, and

about 36,000, or approximately 1.7 percent, of

the 2,169,000 black couples.

The percent of white and black couples who

reported a fecundity impairment and had no

children (parity zero) was not si.gnificantlv different–4.8 percent of white couples and 4.7

percent of black couples. Thus black couples

were no more likely than white couples to be

childless and have fecundity impairments.
8 ackincedata

The percent of couples with one or more

children who were noncontrocep tively steril&

was slightly (but not significimtly) lower for

black couples than for white couples–l 1.8 percent of the 19,920,000 white coupIes with one

child or more compared with 10.6 percent of

the 1,927,000 black couples with one child or

more.

Black wives 15-44 years of age had a larger

average number of children than white wives in

1976. For example, 11 percent of black couples

had no chiIdren (were at parity zero), compared

with 20 percent of white couples; and 24 percent had 4 or more children compared with 15

percent of white couples. Further, the percent

of couples at parity one or more with impairments was higher for black couples than for

white couples–30.2 percent of the 1,927,000

black couples with one chiId or more compared

with 24.7 percent of the 19,920,000 white

couples with one child or more. Thus the higher

percent of all black couples with impairments

(3 1.4 percent compared with 24.6 percent of

white couples) appears to be dtlc to ~ higher percent of’ black couples with children who m-e subfecund or have long intervals.

The prevalence of impairments WM higher

for bluck wives than for white wives in each 5-

year interval since the \vife’s first marriage,

although the differences at less than 5 years and

15 years or more are not statistically significant.

In each case at least half of the difference was

due to the long interval and subfccund categories.

A detailed report on fecundity impairments

is planned to appear in Series 23 of Vital and

Health “Statistics. That report will present

findings on the relation of fecundity status to

other characteristics of coupIes with special

emphasis on parity and the desire for additional

children.

TECHNICAL NOTES

Cycle II of the National Survey of Family

Growth (NSFG) was based on interviews with a

multistage area probability sample of women 15-

44 years of age in the household population of

the United States. The interviews were conducted between Januaryc and September of

1976. The sampling and estimation procedures

for Cycle I, conducted in 1973, arc described in

preceding reports based on the iNSFG, and

described in detaiI in “National Survey of Family

Growth, Cycle I: Sample Design, Estimation

Procedures, and Variance Estimation, ” Series 2,

No. 76, of l“ital and Health Statistics. A similar

report is planned for Cycle II.

Since the estimates in this report are based

on a sample of the population rather than on

the entire population, they are subject to

samp[ing error.

Sampling error, or the extent to which samples may differ by chance from a complete

count, is measured by a statistic called the standard error of estimate. Approximate standard

errors for estimated numbers and percents from

Cycle I are shown in tables I and II for white

women and women of all races combined and in

tables 111 m-id IV for the black population. Provisional estimates of standard errors for Cycle 11

for white women and women of all races combined can be obtained by multiplying the standard errors for these women from Cycle I by factors of 1.09 for the latter and 1.06 for white

women. Similarly, provisional estimates of

standard errors for Cycle 11 for bIack women can

be obtained by multiplying the standard errors

for black women from Cycle I by a factor of 1.14.

Table 1. Approximate standard errors for estimated numbers for

white women and women of all races combined: 197’3

National Survey of Family Growth

I [

Relative

Size of estimate Standard standard

error

error

I

50.000 ....................... ...... .......... ....... 30.0 15,000

loo.ooo ...................................... ..... . 21.2 21,000

2oo.ooo ... ................................... ...... 15.0 30)000

5oo<ooo ................... ......................... 9.5 47,000

1,ooo,ooo.., ...................................... 6.7 67,000

2,000,000 ............. ............................ 4.8 95 ,C)oo

5,000,000 ........ ........................... ...... 3.0 151,000

10,000,000, .... ...... ......... ................... 2.2 216,CIO0

20,000,000, ....................................... 1.5 311,000

—
admncedata 9

Table 11. Approximate standard errors for estimated percents ex- ‘ standard error. The relati~’e standard error is the

pressed !n percentage points for white women and women of

all races combined: 1973 National Survey of Family Growth

ratio of the standard error to the statistic being

estimated. In this report, numbers and percents

which have a relative standard error that is more

than 25 percent of the estimate itseIf are considered unreliable. They are marked with an

asterisk to caution the user but may be combined to make other types of comparisons of

greater precision.

For Cycle 11 of the NSFG, missing data

items were not imputed, and percent distributions are based cm cases with known data. The

fecundity status of about 15,000 women out of

an estimated 31,847,000 total e~’er-married

Estimated percent

20 or

80

30 or

70 50

8ase of percent 4001

60

2 or

98

t

5or 10or

95 90

4.6 6.4

2.1 2.8

1.5 2.0

0.8 1.2

0.6 0.9

0.5 0.8

0.5 0.6

100,000............

500,000 ............

1,000,000 .........

3,000,000 .........

5,000,000 .........

7,000,000 .........

10,000,000 .......

3.0

1.3

0.9

0.5

0.4

0.3

0.3

—

8.5

3.8

2.7

1.5

1.2

1.0

0.8

9.7

4.3

3.1

1.8

1.4

1.2

1.0

—

10.4

4.6

3.3

1.9

1.5

1.2

1.0

10.6

4.7

3.3

1.9

1.5

1.3

1.1

women (less than 0.1 percent) was not ascerTable I I1. Approximate standard errors for estimated numbers

for black women: 1973 National Survey of Family Growth

tained.

More extensive “Technical Notes” and “Definition of Terms” can be found in any of the earlier NS FG reports–for example, .4ckrance Data

Numbers 36, 43, and 45.

Relative

Size of estimate standard Standard

error

error

25.000 ..............................................

50.mo ..............................................

1oo,mo ............................................

150,000 ............................................

250.000 ............................................

350.000 ............................................

5m,ooo ............................................

750.000 ............................................

1,ooo,ooo .........................................

25.3

17.9

12.7

10.3

8.0

6.8

5.7

4.7

4.0

6,000

9,000

13,000

16,000

20,000

24,000

28,000

35,000

40,000

DEFINITION OF TERMS

Fecundity. –In this report, fecundity is i.t

characteristic of a currently married couple. It

refers to the ability of the couple to reproduce, “

that is, to have live-born children, at the date o f

the interview. Fecundity was measured using u

series of questions. The responses to these questions permit the classification of couples into 5

categories: contraceptively steriie, ncmcontnlceptively sterile, long internal, sub fecund, or

fecund.

Fecundity status. –This refers to the category of fecundity in which a couple is classiilcd.

Fecundity impairment. –.4 fecundity impairment, or reproductive impairment, is any’

medical, physical, or behavioral c{]nditi(]n th:lt

damages or diminishes a couple’s ability to hmc

children. Contraceptive sterilization [)perati[jns,

that is, operations done for put-p)scs ot’ contraception (family limitation) tire not cltissiilcd w

fecundity impairments. The conditions discussed, except for the Ion,g intelwal cate,qol~”,

Table IV. Approximate standard errors for estimated percents expressed in percentage points for biack women: 1973 Nattonal

Survey of Family Growth

I

Estimated percem

6ase of percent .2 or 5 or ,O.,

98 95 90

5)000 ................. 7.9 12.3 17.0

10,000 ............... 5.6 8.7 12.0

50,000 ............... 2.5 3.9 5.4

100,000 ............. 1.8 2.7 3.8

300,000. ............ 1.0 1.6 2.2

500,000 ............. 0.8 1.2 1.7

700,000 ............. 0.7 1.0 1.4

1,000,000 .......... 0.6 0.9 1.2T

20 or 30 or

80 70

22.6 25.9

16.0 18.3

7.1 8.2

5.1 5.8

2.9 3.3

2.3 2.6

1.9 2.2

1.6 1.8

40 or

60

50

27.7

19.6

8.8

6,2

3.6

2.8

2.3

2.0

28.3

20.0

8.9

6.3

3.6

2.8

2.4

2.0

I I I

were limited ;O conditions reported by women “in

The chances are about 68 out of 100 that an

estimate from the sampIe would differ from a

complete census by less than the standard error.

The chances are about 95 out of 100 that the

differences between the sample estimate and a

complete count would be less than twice the

response to the questions qu;ted in the text.

In a sumIey of ~vornen in the childbearing

years, success in measuring fecundity impairments depends on the ~mount of medical information respondents have about themselves, (m

their interest in .Iaving children in the future,
10 advancedata

and on the (jppt)rttlnitics they htilc had to

detect that a problem exists. Nonetheless, most

respondents do know the answers to th~

questions xkcct in the XS FG intcrvic~v: whe~her

or not they have had J sterilizing operation,

accident, illness, or congenital problem; whether

or not they hw’e been trying to get pregnant w-id

have not used contraception for a substantial

period of time; and whether or not a doctor has

told them they have medical conditions that

would make having a(nother) child difficult or

dangerous. Data of this kind can be grouped into

categories such M those used in this report, with

which to make comparisons between popultition

groups, and for use in making estimates of

needed services such as infertility services.

Fecund. –In this report a couple was classified as fecund if the respondent reported that

(1) it was possible to have a baby or another

baby, (2) there was no difficulty having

a(nother) baby, and (3) the couple had used

contraception sometime in the 3 years before

the interview or the wife had been pre,gnant in

that period of time. This is a more restricted use

of the term fecund than in previous NSFG reports,4 which used a 2-category classification—

“sterile” and “fecund. ” In those reports, “fecund” (meaning not sterile) included all women

classified in this report as fecund and sub fecund,

and most of those with long intervals.

Fecundity may be viewed as a characteristic

of a- couple that ranges from zero to high (or unimpaired). Couples classified as fecund have no

reported impairments and no 3-year interval of

nonuse of contraception without conception. As

shown in the text, the likelihood lhat a couple

will be classified as fecund is partly a function of

the amount of time since the wife’s first marriage, whether and how many times she has

attempted to have a child, whether contraception has been used, etc.

Sub-fecund. –Women (or couples) classified

as “subfecund” reported that they were not

sterile but that they had a problem or difficulty

in conceiving or delivering a(nother) baby for

some specific reason; or that a pregnancy in the

future would be so dangerous to the woman, or

the baby, or both that she wouid have a sterilizing operation or abortion if another preg4Advanc; Data Numbers 36 and 45.

ni.mc}’ occur rc’ri. Thus sub fecund coLIplcs are not

sterile, but they have some reason to believe thtit

their ability to reproduce is diminished or

impaired.

Long interval.–currentl~ married couples

m-e classified “long interval” if they have been

continuously married for 3 years or more

immediately before the interview, have not used

contraception, and have not conceived. About

three-fourths of these women reported that it

was possible, for them to have a baby or another

baby. Llost of the couples with long intervals are

steriIe, but a small proportion might conceive in

the futures

Noncontraceptively ste7-ile. -Women were

classified as ‘Lnoncontracep tively sterile” if they

indicated that it was impossible for them to have

a baby or another baby for some specific reason

other than family limitation—such as a medically

necessary operation, or a nonsurgical reason

such as accident, illness, or natural menopause.

For a few respondents, the contraceptive intent

of their sterilizing opemtion was not ascertained.

Contrawptively sterile. –Couples cIassi fied as

‘Lcontraceptively sterile” are not included among

those with fecundity impairments because they

have had a sterilizing operation at least partly as

a method of contraception or famiIy Imitation.

AS noted in the text, the number and percent of

currently married couples classified as contraceptively and noncontraceptively sterile in this

report differs slightIy from numbers and percents given in Advance Data Number 36, because data on sterilizations of married co L~ples in

which both husband and wife had been sur-

,gicaHy sterilized were recoded to give priority to

the wife’s operation. This procedure provides a

complete count of surgicaI sterilizations among

ever-married women. A complete estimate of

vasectomies cannot be obtained from this survey

because not all ever-married men are represented. Where both spouses had been sterilized,

the husband’s sterilization generally occurred

first and for contraceptive (family limitation)

reasons; the wife’s operation followed some time

later for therapeutic reasons. Consequently,

giving priority to the wife’s operations has Iowered somewhat the percent of couples with con5See reference cited in footnote 3.
ad’mncedata 11

traceptive steh]izations compared with the previously pubii~hed figures.

Would like (or intend) to kave a(no tlzer) ‘

baby. –Noncontraceptively sterile women were

asked: “even though it is unIikely or impossible

for you to have a(nother) baby, would you like

to have a(nother) baby?” Subfecund women and

women with long intervals were asked: “Do you

and your husband intend to have a(nother)

baby?” It is assumed that these questions ascertain a desire for additional children in reasonably comparable ways.

Pan”ty. –Parity refers to the number of live

births the respondent has had.

Years since wife’s j%t mania,ge. –This refers

to the number of years between the wife’s first

marriage and the interview date.

Man.ta[ status. –This report is based only

upon currently married women. Couples who

are tempormily separated for reasons other than

marital discord, such as vacation, iI1ness, or

Armed Forces, are classified as married.

SYMBOLS

Data not available---————--—— ------ ---

Category not applicable---———-—---- . . .

Quantity zero -——-— ——--—

Quantity more than Obut less than 0.05---- 0.0

Figure does not meet standards of

reliability or precision--————————— *
FROM VITA< & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

U.S.DEPARTMENT OF HEALTH. . public Health Service

ED UCATION, AND WELFARE Office of Health Research, Statistics. and Technolow ● January 24, 1980

Wanted and Unwanted Births Reported by Mothers

1544 Years of Age: United States, 1976’

According to results !rom the 1976 National

Survey of Family Growth, an estimated 8.1 million, or 12.0 percent, of a total of 67.8 milIion

live births that had occurred to mothers 15-44

years of age were unwanted. Of an average 2.5

births per mother, 2.0 were wanted at the time

of conception, 0.3 were unwanted at that time,

and 0.2 births were classified as “undetermined. ” More than four-fifths of the births to

white women were reported as wanted compared with only three-fifths of the births to

black women. The proportion of unwanted

births for black women (25.8 percent) was

almost 3 times that for white women (9.5 percent). The wontedness of another 13.8 percent

of births to black women and 7.0 percent to

white women was undetermined because the

women’s feelings at the time of conception

were not known.

These and other figures in this report indicate a modest, statistically nonsignificant clecrease in the proportion of unwanted births

since the 1973 National Survey of Family

Growth.~ However, the summary data in this

report do not provide the best basis for examining trends in wanted and unwanted fertility

in recent years because changes in these proportions between 1973 and 1976 might be obscured

lThi~ ~epo~ WM prepared by Eu~eniaEck~4 M-S-,

Division of Vital Statistics.

2Nation~ Center for He~th statistics: Wmted ad

unwanted births reported by mothers 15-44 years of

age: United States, 1973, by M. L. Munson. Advance

Data From Vital and Health Statktics, No. 9. DHEW

Pub. No. (HRA) 77-1250. Health Resources Administration. Hyattsville, Md. Aug. 10, 1977.

by the Iarge overlap of births occurring in 1973

and earIier years reported in both surveys. An

analysis of trends in wanted and unwanted childbearing based on more detailed data will be the

subject of a later report.

The data for Cycle II of the National Survey

of Family Growth, which was conducted by the

Nationid Center for Health Statistics, were colIected by means of personal interviews with a

multistage probability sample of women 15-44

years of age in the household population of the

conterrninous United States. Women were eligible for inclusion in the sample if they were

currently married, previously married, or never

married but with offspring presently living in the

household. From January through September

1976, 3,009 black women and 5,602 women of

other races were interviewed for Cycle II of the

survey. Further discussion of the survey design,

sampIing variability, and definition of terms

appears in the “Technical N70tes.”’

THE CONCEPT OF WANTEDNESS

For each pregnancy ending in a live birth, a

series of questions was asked to determine

whether or not the woman, at the time of conception, had wanted that pregnancy. If contraception had not been used or had been stopped

prior to a specified pregnancy, the woman was

asked: “Was the reason you (were not/stoppecl)3

using any methods because you, yourself,

wanted to become pregnant?” If she had avoidSpuentheses indicate that the intewiewer ~ho~e

the appropriate wording for respondent.
2 dwincedata —

ecl or stopped using contraception for some

other re~son, or if she had become pregnant

while using a method, she was asked: “At the

time you became pretgnant . . . , did you, yourself, actually want a(nother) baby at some

time?” To emphasize the importance of her

feelings at the time of conception, each woman

was asked: “As you recall, is that how you felt

before you became pregnant, or did you come

to f’eel that way Iatcr?” Finally, women who

reported that they did not know or remember

how they had felt at the time of conception

were asked whether they had “probably wanted

a(nother) baby sometime or probably not. ”

The pregnancy was classified as wanted at

conception if the respondent had stopped or was

not using contraception in order to become

pregnant, if she had wanted a(nother) child at

some time and had felt that way before she became pregnant, or if she probably wanted

a(rtother) child sometime. The pregnancy was

classified as unwanted if she had not wanted

a(nother) child sometime and fell that way before she became pre~ant or if she probably had

not wanted a(nother) child sometime. The wontedness of a pregnancy was classified as undetermined if the woman said she wanted a(nother)

child sometime but she came to feel that way

after ‘conception, if she did not want a(nother)

child sometime and felt that way after conception, or if’ her feelings about the pregnancy at

the time of conception were unknown altogether. It is important to emphasize that interest

is focused on wontedness of a pregnancy at the

time of conception rather than wontedness of

a particular child. For this reason the present

analysis treats multiple births as a single birth

outcome.

As may be seen in table 1, 79.9 percent of

births were wanted at conception and another

5.3 percent were wanted after conception, while

12.0 percent were unwanted at conception and

another 1.6 percent were unwanted ufter conception. The substantial proportion of births

which became wanted after conception (5.3 percent) is evidence that an unwanted or unintended pregnancy does not necessarily mean an

unwanted child. At the same time, these births

represent a sizable proportion of births that

would not have occurred or would have

occurred at J later time if these mothers had had

only the births that were wanted at conception.

HIGHLIGHTS OF FINDINGS

Table 1 shows that the proportion of births

that were wanted either at or ufter ccmception

decreased with age from about 90 percent

among mothers aged 20-29 years to about 81

percent among mothers aged 40-44. Teenage

mothers were an exception. In fact, the proportion of births wanted at conception by teenage

mother-s, who hacl had an averuge of (ml!; 1.2

births, was as low as that amc)ng mothers in

their early forties, who had had 3 times as many

births on the average (3.5 births).

The proportion of births that were unwanted at the time of conception was low among

mothers in their twenties ( 7 percent) and rose

to almost 16 percent among those 40-44 years

of age. Again the teenage mothers were an exception, reporting a higher proportion of their

births as unwanted at conception (9 percent)

than women in their twenties did.

There is a need to take a closer look at the

reporting of births unwanted at the time of conception among mothers under age 25, especially

among teenage mothers. Because these are

largely first ancl second births, these mothers

appear to have said that at the time of conception they wanted no births at all or no more

than one. Although this may be true, another

plausible view is that some births reported as unwanted ut conception actualIy were wanted, but

they were wanted at a later time because of the

circumstances under which they occurred. For

instance, the birth may have been the result of

a Premarital conception Or may have OCCUrreC[

during the dissolution of a marriage. In any case,

these earIy unwanted births suggest that when a

woman has more births over her childbearing

years than she wanted, the number unwanted

may have occurred at the beginning rather than

the end of her childbearing experience. In other

words, some of the unwanted births reported by

older mothers and by mothers with more than

one child were their first births.

Table 1 also reveals that the proportion of

births wanted at conception decreases with increasing numbers of children already born

(parity) among mothers with more than two

children. The proportions of births unwanted at

conception corresponciingly increase dranmtically from 1 in 25 (3.9 percent) ~mong mothers
admncedata 3

Table 1. Number of mothers 1544 years of age, number of live births, and percent distribution of births by whether wanted, unwanted,

or undetermined, according to race, aga, and parity: United States, 1976

Race, aga, and parity

RACE AND AGE

All races2

All ages . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

25-28 years ........... ............... ..............

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

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

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

White

All ages . . . ............. ..............

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

2Q-24 years ....................... .................

25-28 years .................. .....................

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

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

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

Black

All ages...................................

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

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

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

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

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

4044 years ..................... ........... ........

RACE AND PARITY

All races2

All ages ....................... ............

1 .......................................................

2 ............................................. ........ ..

3 ............. ....... ...................................

4 .......... ............... .................... ....... ...

5 ..... ..... ........................... ..................

6 or more ...... .............................. ..... ..

Whita

1.......................................................

2 ..... ....... ...........................................

3 ...................................... ............. ....

4 .......................................................

5 ..... ..................................................

6 or more ............. ..............................

Number of

nothers in

:housands

27,055

811

3,653

6,075

6,146

5,313

5,057

22,837

507

2,896

5,160

5,281

4,612

4,380

3,726

288

707

763

740

581

628

27,055

7,218

8.979

5,617

2,515

1,399

1,326

5,880

7,860

4,887

2,153

1,164

883

Number of

births in

67,849

972

5,384

11,574

15,863

16,168

17,888

56,238

586

4,128

9,637

13,411

13,657

14,818

10,525

380

1,193

1,670

2,158

2,240

2,885

67,849

7,218

17,891

16,637

9,921

6,922

9,260

5,890

15,666

14,473

8,496

5,754

5.980

Total

Undetermined

Wanted Unwanted

at con- at con. Wanted Unwanted

ception cept ion aftar con- after con- Unknown

ception ception

Percent distribution

100.0 75.2

100.0 83.2

100.0 85.6

100.0 82.1

100.0 77.8

100.0 75.4

i 00.0 83.4

T

100.0 80.9

100.0 87.8

100.0 88.9

100.0 84.9

100.0 81.2

100.0 79.5

100.0 50.4

100.0 65.8

100.0 66.7

100.0 66.9

100.0 63.3

100.0 55.4

100.0 55.0

100.0 79.9

100.0 88.3

100.0 90.1

100.0 80.2

100.0 77.9

100.0 70.1

100.0 62.4

100.0 80.7

100.0 92.6

100.0 82.1

100.0 80.0

100.0 72.8

100.0 72.1

12.0

“9.3

7.2

7.4

10.7

14.2

15,7

9.5

‘8.0

●3.9

5.5

8.6

11.6

12.7

25.8

●1 1.4

*1 8.5

18.9

24.1

31.9

31.3

12.0

“3.9

4.4

12.3

13.1

2Q.5

24.7

●2.4

3.4

11.0

11.6

18.9

16.9

5.3

●11.9

“6.9

5.2

4.6

5,1

5.3

4.7

●8.5

‘6.3

4.5

4.3

4.6

4.7

8.1

●17.2

●9.6

●9.7

●6.5

●8.3

●6.5

5.3

6.0

4.1

5.1

5.7

6.0

6.3

●5.3

3.6

4.7

5.4

“5.9

●5.3

1.6

●2.1

●1.2

“0.9

●1.5

●1.8

●2.1

1.1

0.0

“0.5

‘0.4

●1.O

●1.4

●1.8

“4.0

‘5.3

●3.9

●3.7

●4.5

●3.6

●4.1

1.6

“0.8

‘0.6

●1.3

‘2.0

●1.7

4.3

“0.4

‘0.4

●1.O

●1.7

●1 .1

“3.6

1.2

*1.7

●1 .5

●0.8

●1.3

*1.1

●1.6

1.2

●2.5

●1.5

“0.8

●1.2

*1 .2

●1.3

●1.7

●0.3

●1 .4

‘0.8

●1.7

“0.8

●3.1

1.2

●1.O

“0.7

●1.2

●1 .3

●1 .6

●2.2

*1 .2

●0.7

●1.2

●1 .4

●1.3

●2.1

See footnotes at end of table.
4

-

Table 1. Number of mothers 15-44 years of age, number of live births, and Percent distribution of births by whether wanted, unwanted,

or undetermined, according to race, age, and parity: United States, 1976-Con.

Race, age, and parity

RACE AND PARITY-Con.

Black

1 ............................................. .........

2 ......................... ..................... ........

3 ............. ........ ........................ .........

4 ............. ............... ..... .. ............ .......

5 ......... ........................... ...... ............

6 or more ..................................... .....

dumber of

nothers in

housands

1,159

867

616

331

223

431

I M~ltiple births are cotmted OIIIYOnce.

21ncludes white, black, and other races.

Number of

births in

thousendsl

1,159

1,922

1,829

1,288

1,106

3,211

of parity one to aImost 1 in 4 (24.7 percent)

among mothers of parity six or higher.

One of the largest differences observed in

table 1 is between white mothers, 83.4 percent

of whose births were reported as wanted at conception, and black mothers, who reported 23

percentage points fewer wanted births (60.4

percent). One-fourth of births to black mothers

(25.8 percent) were reported as unwanted at

conception. This is almost 3 times the proportion of births unwanted at conception by white

mothers (9.5 percent). The differences between

black and white mothers in the proportions of

wanted births are seen in all age groups, reaching

25.1 percentage points fewer wanted births by

black mothers 35 years and oIder, and are statistically significant in all but the teenage group.

Although black mothers had borne a greater

average number of children and had nearly

twice the proportion of women at parity five or

more, the differences between black and white

mothers within the same parity groups remained

and were statistically significant in three out of

the six comparisons by parity, Furthermore, the

proportion of wanted births to white mothers at

parity six or more was only 3 percentage points

lower than that for black mothers at parity one.

Table 2, unlike table 1, shows only one combined figure for the three different components

of the undetermined category and thus indicates

only the percent of births that were wanted or

unwanted at the time of conception. The

I

Wanted

Total at concept ion

Undetermined

Unwanted

at con. Wanted Unwented

ception after con. after con- Unknown

cept ion cept ion

Percent distribution

100.0 7%3 +11.3

100.0 74.3 ●I 3.4

100.0 65.6 22.6

100,0 62.3 23.8

100.0 54.4 30.4

100.0 45.0 39.5

●10.3

●8.5

●7.9

‘8.6

*7.1

●7.3

“2.9

“2.4

‘3.0

●4.6

●4.8

●5.6

“0.2

●1.4

“0.9

‘0.8

●3.3

●2.6

wontedness of births to women of Hispanic

origin (regardless of race) was about the same as

that for all white women—83. 1 percent compared with 83.4 percent of births wanted, 10.2

percent compared with 9.5 percent of births unwanted, and 6.8 percent compared with 7.0 percent undetermined among Hispanic women and

all white women, respectively.

There is no significant difference in the proportion of wanted births to women of different

geographic regions, although women in the

South reported a smaller proportion of their

births as wanted than women of all other regions

combined did. This may be attributed partly to

the fact that a higher proportion of black and

high-parity families live in the South.

The highest proportion of wanted births was

among those women whose leveI of education

was highest. For example, women with 4 or

more years of college reported 90.7 percent of

their births as wanted at the time they were conceived, while women with an elementary school

education (8 years or less) reported only ‘72.5

percent wanted. The proportion of unwanted

births among women with an elementary school

education ( 17.4 percent) was nearly 4 times that

among college graduates (4. 7 percent). These

educational differences are very Iikely associated

with the parity differences noted above, since

women with 4 or more years of college had

borne an average of 1.2 children, almost twothirds less than women with only m elementary
duame&h5

Table 2. Number of nwthers 15-44 years of age, number of live births, and percent distribution of births by whether wanted, unwanted,

or undetermined, according to selected characteristics: United States, 1976

Characteristic

Total ........................... .....-

Origin

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

All other ......................................

Geographic region

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

North Central ............. ......... ........

South .......... ............... ............... ...

kVest .. .......... .............................. ...

Women’s education

Elementary school, 8 years

or less....... ..................................

High school, 1-3 years ...... ............

High school, 4 years .....................

College, 1-3 years ...... .... ...............

College, 4 years or more .. ... ..........

Husband’s education

Elementary school, 8 years

or less........... ........ ............ ......... .

High school, 1-3 years . ..... ...... ......

High school, 4 years .....................

College, 1-3 years ........................ .

College, 4 years or more ... ............

Woman’s labor

force status

Not in labor force ........ ....... .. ........

In labor force ................ ...............

Working full time. ...................

Working pert time . ..................

Not working ............... .... .........

Poverty level income

Below 100 percent ........................

100-149 percent ....... ...... ..............

150 percent and above ........ ....... ...

Religion

Catholic ............ ..... ...... .................

Protestant ........ .............. .......... ....

Jewish ............. ............................ .

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

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

lMultiple births me counted on

Number of

mothers in

thousands

27,055

1.799

25,208

5,513

7,688

9,237

4,616

2,187

5,478

12,651

3,763

2,925

2,498

4,248

9,246

4,446

4,807

14,588

12,409

8,392

3,221

795

2,840

2,501

18,279

7,379

17,554

611

354

1,080

once.

Number of

births in

thousendsl

67,849

4,516

63,X12

13,784

19,654

22,661

11,750

7,274

15,543

30,405

8,391

6,114

8,800

11,427

22,362

10,285

10,840

37,213

30,442

20,114

8,262

2,066

8,892

6,968

42,845

19,147

44,026

1,366

796

2,296

Wanted Unwanted

Total at con- at con- Undetermined

ception caption

Percent distribution

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

79.9

83.1

79.6

80.7

79.6

78.8

81.5

72.5

73.0

81.4

85.4

%.7

726

.74.7

81.8

85.3

89.0

81.1

78.4

77.3

81.6

77.0

66.3

77.3

84.2

83.0

78.3

88.8

88.0

77.5

12.0

10.2

12.1

10.3

12.7

12.5

11.8

17.4

15.5

11.2

9.3

●4.7

15.7

15.8

10.2

9.6

6.1

10.5

13.7

15.0

10.3

● 14.9

21.6

13.9

9.2

9.6

13.1

●5.2

●5.1

16.1

8.1

●6.8

8.3

9.0

7.7

8,8

6.7

10.1

11.5

7.4

5.3

“4.6

11.7

9.5

8.0

5.1

5.0

8.3

7.9

7.7

8.1

‘8.0

12.1

8.8

6.6

7.4

8.6

●6.O

●6.9

●6.4
6 acklncecklb

Table 2. Number of mothers 15-44 years of age, number of live births, and percent distribution of births by whether wanted, unwanted,

or undetermined, according to selected characteristics: United States, 1976-Con.

Characteristic

Previous marriages

One or more .... ..................... ..... ..

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

Never married .... ..... ......... ........... .

Fetal losses

No losses .....................................

1 10ss...........................................

2 losses or more...........................

Desired family size

at time of interview

No children .................................

1 child ....................................... ..

2 children .............................. ......

3 or 4 children ........................ .... .

5 or 6 children . ............................

7 children or more .......................

Number of

rrwthers In

thousands

4,111

21,858

1,071

19,956

4,842

2,257

725

1,412

11,865

10,222

1,963

590

1 Multiple buths are counted only once.

Number of

births in

thousandsl

11,395

54,614

1,785

47,545

13,342

6,963

1,842

2,176

25,528

27,472

7,183

2,656

education. The pattern for wontedness of births

by husbands’ education was the same as that

found with women’s education.

Mothers not in the labor force or working

only part time had a higher proportion of wanted births (8 1.2 percent) than mothers working

full time or not at work because of vacation, illness, or being between jobs (77.3 percent),

despite the fact that they had borne slightly

more children on the average.

Differences in the proportions of wanted

births between the income groups shown in

table 2 were as marked as the differences between educational groups. Mothers with a family

income below the poverty level had wanted only

two-thirds of their births at conception compared with more than four out of five births

wanted among mothers whose family income

was 150 percent of the poverty level or more.

These differences by income may also be reflected in the decreasing proportions of wanted

births among mothers of increasingly higher

parities; those with incomes below the poverty

level had borne almost one child more, on the

average, than mothers with the highest family

incomes had.

Wanted Unwanted

Tota I at con- at con- Undetermined

ception ception

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

Percent distribution

76.1

81.5

55.1

80.3

79.5

78.0

56.9

75.5

79.3

81.7

81.8

81,5

15.1 8.9

10.8 7.7

27.2 *17.8

11.3

12.9

15.0

33.7

●15.2

13.0

10.0

10.5

*I 0.3

8.5

7.6

7.1

*9.4

●9.3

7.7

8.4

7.7

●8.2

The proportion of wanted births reported by

Catholic; (8’3.0 percent) was higher thin that reported by Protestants (78.3 percent), and the

proportion of unwanted births was correspondingly lower among Catholic than among Protestant mothers. The proportion of undetermined

births was zdso lower for Catholic women than

for Protestant mothers, but the difference is not

statistically significant. Jewish mothers and

mothers of “other” religions combined had an

even Iarger proportion of wanted births (88.5

percent), although not significandy Iarger than

the proportion for Catholic mothers. ,Mothers

with no religious affiliation had a nonsignificantly higher proportion of unwanted births

( 16.1 percent) than any of the religious grcmps.

Mothers who had been married only once

had proportionately more wanted births (8 1.5

percent) than mothers who had been married

more than once (76.1 percent), and both had

higher proportions of wanted births than

mothers who had never been married (55. 1 percent). The wanted births to never-married

mothers should not necessarily be interpreted

to mean that these women wanted the births to

occur before marriage; mothers responded to the
aa@data7

question as to whether or not they, at the time

of conception, had wanted a baby sometime. It

is likely that these mothers also responded positively to a later question on whether they

became pregnant sooner than they had wanted

to.

The proportions of births that were wanted

at conception declined with increasing numbers

of fetal losses a mother had experienced; the

proportions of births that had been unwanted

at conception correspondingly increased with

the number of fetal losses. However, none of

these differences in the proportions wanted and

unwanted meet the test of statistical significance.

Women were asked about the total number

of children they desired at the time of the survey, that is, the number they would like to have

if they were able to begin their childbearing over

again. The response categories are shown in tabIe

2. As might be expected, mothers who had already borne more children than they desired had

relatively high proportions of unwanted births.

For instance, mothers who desired no children

at all had already had an average of 2.5 births,

one-third of which had been unwanted at conception and another 9 percent of which had

been undetermined. Women who desired one or

two children had also had, (m the average, more

than they desired. It is evident that mothers who

desired fewer than three children had wanted

between one-half and four-fifths of their births

at the time of conception, which suggests that

the number of chiIdren desired is a very changeable number over time. l~others who desired

three and more chiIdren, however, had not yet

borne this number on the average, but 10 percent of their births were reported as being unwanted at conception. Because these women expressed the desire for more children, it may be

that their unwanted births occurred early in

their childbearing.

Although the data in this report tell us little

about the causes of unintended pregnancies,

they revea.I the groups experiencing the greatest

numbers of unintended pregnancies (unwanted

and undetermined combined). In general, they

are the very young mothers and the oldest, the

mothers who have the largest number of children, those with the least education and income,

and the mothers who are without husbands or

who have experienced marital disruption. The

large ‘differences between white and black

mothers in the proportions of wanted and unwanted births probably reflect substantial differences in these sociaI and economic conditions.

TECHNICAL NOTES

The Survey Design

The National Survey of Family Growth

(NSFG) was desi,gned to provide data on fertility, family planning, and related aspects of maternal and child health. The NSFG is a cyclic

survey; that is, data are coilected every few years

by means of a sample survey. Fieldwork for

Cycle I was carried out by the National Opinion

Research Center from June 1973 through February 1974. Fieldwork for CycIe II was carried

out by Westat, Inc., from January through

September 1976.

A multistage probability sample of women

in the household population of the conterminous United States was used in both cycles.

Each time, approximately 33,000 households

were screened to identify the sampIe of women

eligible for the NSFG, i.e., women aged 15-44

years who were either currently married, previously married, or never married but with offspring presently living in the household. In

households with more than one eli,gible woman,

a random procedure was used to select only one

to be interviewed. Since the inten’iew was

always conducted with the sample person, the

term “respondent “ is synonymous with “sample

person.” For CycIe H, interviews were completed with 3,009 black women and 5,602

women of other races. A detailed description of

the sample design for Cycle II is in preparation.

The interview was highly focused on the respondent’s marital and pregnancy histories, use

of contraception, planning status of each pregnancy, intentions regarding the number and

spacing of future births, use of maternal and

famiIy planning services, and a broad range of

socioeconomic characteristics. The time needed

to complete interviews varied greatly; interviews

in Cycle H averaged about 58 minutes.
8 admncedata

Quality control” proceciures were applied ~t

all stages of the survey. ‘rhcse includecl a verification of listing completeness that brought

unlisted dwelling units into the sample, a preliminary field review of completed questionnaires for possible missing data or inaccurate

administration, a 10-percent sample recheck of

all households to be screened in the survey,

observation of intexwiews in the field, and an

independent recoding of a 5-percent subsample

of completed intemiews.

Reliability of Estimates

Since the statistics presented in this report

are based on a sample, they may differ somewhat from the figures that would have been

obtained if a compIete census had been taken

using the same questionnaires, instructions, interviewing personnel, and field procedures. This

chance difference between sampie results and a

complete count is referred to as sampling error.

In addition, the results are subject to nonsampling error due to respondent misreporting,

processing errors, and nonresponse. It is very

difficult, if not impossible, to obtain accurate

measures of nonsarnpling errors. These types of

error were kept to a minimum by the quality

control procedures and other methods incorporated in the survey design and administration.

Sampling error, or the extent to which samples may differ by chance from a complete

count, is measured by a statistic called the standard error of estimate. Approximate standard

errors for estimated numbers and percents from

Cycle I for all pregnancies, regardless of their

outcome, are shown in tables I and II. Profitable 1. Approximate standard errors for estimated numbers for

pregnancies: 1973 National Survey of Family Growth

I I

Relative

Size of estimate Standard

standard

error

error

loo.ooo ............................................

250.000............................................

5w,ooo ............................................

l,ooo,ooo .........................................

2,500,000 .. ........................... ........ ....

5,000,000.........................................

lo,ooo,ooo .......................................

25, 000,000 .......................................

50,000,000.......................................

46.4

29.3

20.7

14.6

9.2

6.4

4.5

2.6

1.6

46,000

73,000

104,000

146,000

230,000

322,000

445,000

658,000

811,000

Table 11. Approximate standard errors expressed in percentage

points for estimated percents for pregnancies: 1973 National

Survey of Family Growth

Estimated percent

8ase of

percent

‘ E

2 or 5 or 10or 2001 30 or 40 (or so

98 95 90 80 70 60

700,000............ 2.5 3.8 5.3 7.0 8.0 8.6 8.8

1,000,000...,..... 2.1 3.2 4.4 5.9 6.7 7.2 7.3

3,000,000......... 1.2 1.8 2.5 3.4 3.9 4,1 4.2

7,000,000......... 0.8 1.2 1.7 2.2 2.5 2,7 2.8

10,000,000 ...,... 0.6 1.0 1.4 1.9 2.1 2<,3 2.3

30,000,000....... 0.4 0.6 0.8 1.1 1.2 1,,3 1.3

70,000,000....... 0.2 0.4 0.5 0.7 0.8 0“9 0.9

siona.1 estimates of standard errors for Cycle II

for white women and women of all races combined can be obtained by multipl~-ing the standard errors for these women from Cycle I by factors of 1.09 for the latter and 1.06 for white

women. Similarly, provisional estimates of

standard errors for Cycle 11 for black women can

be obtained by multiplying the standard errors

for black women from Cycle I by a factor of

1.14.

The chances are about 68 out of 100 that an

estimate from the sample would differ from a

compIete census by Iess than the standard error.

The chances are about 95 out of 100 that the

differences between the sample estimate and a

complete count would be Iess than twi~ce the

standard error. The relative standard error is the

ratio of the standard error to the statistic being

estimated. In this report, numbers and percents

which have a standard error that is more than

25 percent of the estimate itself are considered

unreliable. They are marked with an asterisk to

caution the user but may be combined to make

other types of comparisons of greater precision.

In this report, terms such as “simiiar” and

“the same” mean that any observed difference

between two estimates being compared is not

statistically significant. Similarly, terms such as

“greater,” “less,” “larger,” and “smaller” indicate that the observed differences are statistically significant. The normal deviate test with a

.05 Ievel of significance was used to test all comparisons discussed in the text. A statistically

significant difference is one large enough that in

repeated samples of the same size and type as

this one such a large difference would be expected to be found in less than 5 percent of the
adwmxaa9

samples. Lack of comment in the text between

any two statistics does not mean the difference

was tested and found not to be significant.

Adjustment for nonsarnpling error due to

nonresponse w,as made in two ways. Nonrespondent cases, as distinct from missing data

items, were imputed by weighting for nonresponse within each primary sampling unit,

stratum, and age-race category. Cases with

missing data were allocated among the cells of

a table in proportion to the distribution of

known cases with the same characteristics.

Definitions of Terms

Wontedness. –The defin Ition of wontedness

is based on direct responses to questions about

each pregnancy a woman had conceived. For

women reporting that contraceptive use was

stopped prior to conception or that no contraceptive method was used in the interval preceding conception (which begins with the end of

the preceding pregnancy, if there is one), the

question on wontedness was phrased as follows:

“Was the reason you (were not/stopped) using

any method because you, yourself, wanted to

become pregnant?” An affirmative response to

this question indicated a “wanted” pregnancy.

If the woman answered negatively, she was

asked two further questions, “which were also

asked of all other respondents. These questions

are: “At the time you became pregnant (THIS

INTERVAL),4 did you, yourself, actualIy want

to have a(nother) baby at some time?” and “As

you recall, is that how you felt before you became pregnant, or did you come to feel that

way later?” A subsequent question for those

who did not know or care whether or not they

wanted to have a(nother) baby was: “It is sometimes difficult to recall these things, but as you

look back to just before that pregnancy began,

wouId you say you probably wanted a(nother)

baby sometime m- probably not?”

A pregnancy is defined as “wanted at conception” if the woman reported that (a) contraception was not used or was stopped prior to

conception because she wanted to become pregnant, (b) she wanted to have a(nother) baby at

4“TH1S lNTERv~L” means that the interviewer

inserted the name of the child or dates of the pregnancy

which defined the interval in question.

some time and felt that way before becoming

pregnant, or (c) she probably wanted a(nother)

baby at some time. A pregnancy is defined as

“unwanted” if the woman reported that she did

not want to have a(nother) baby at some time or

probably did not want a(nother) baby and felt

that way before becoming pregnant. “Undetermined” pregnancies include those that a woman

came to want sometime after conception, those

that came to be unwanted sometime after conception, and those for which her feelings at the

time of conception could not be reported.

Age. –Age is classified by the age of the respondent at her last birthday before the date of

interview.

Race. –Classification by race was based on

interviewer observation and was reported as

black, white, or other. It refers to the race of

the respondent.

Hispanic or@n. –A respondent was classified

as being of Hkpanic origin if she reported her

origin or descent as at least pardy lMexicano,

Chicano, Mexican American, Puerto llican,

Cuban, or other Spanish.

Geographic re~”on. – Region refers to the

part of the country where the respondent was

Iiving at the time of the survey chssified according to U.S. Bureau of the Census definitions.

Man”tal status. –Persons are classified by

marital status as married, widowed, divorced,

separated, or never married. ,Marned persons include those who reported themselves as married

or as informally married, such as living with a

partner or common-law spouse. Persons who

were temporarily separated for reasons other

than marital discord, such as vacation, illness, or

service in Armed Forces, are classified as

married. Divorced persons are those whose most

recent marriage was legally dissolved and who

were free to remarry. The annulled, while having

the legal status of never having been married, are

classified together with the divorced. The category “separated” incIudes those who were

legally or informally separated from their most

recent spouse due to marital discord. \Vomen

who were “never married” incIude those who

never hfid a formal marriage and did not classify

themselves in any of the preceding categories.

Single women with offspring in the household

were included in the NS FG.

Previous marn”agcs. –Women arc categorized
10 ackmeckda

according to their response to a question on

whether or not they had been married prior to

their current or last marriage.

Education. –The highest year of regular

schooling completed is used to define education

for the woman and her current or most recent

husband.

Labor force status. –A woman is categorized

as being in the labor force if she was working

full time (35 hours or more per week) or part

time; had a job but was not at work because of

temporary illness, vacation, or a strike; or was

unemployed, laid off, or looking for work.

Poverty level. –The poverty index ratio was

calculated by dividing the total family income

by the weighted average threshold income of

nonfarm families whose head was under 65 years

of age based on the poverty levels shown in:

U.S. Bureau of the Census, Current Population

Reports, Series P-60, No. 106, “Money income

in 1975 of famiIies and persons in the United

States,” table A-3. This definition takes into

account the sex of the family head and the number of persons in the family. Total famiIy income includes income from all sources for all

members of the respondent’s family. Due to a

high nonresponse rate on items pertaining to the

respondent’s famiIy income, the figures for

poverty leveI must be interpreted with caution.

Religion. –Women .were asked whether they

were Protestant, Catholic, Jewish, or something

else. “Protestant” includes most Christian

groups other than Roman Catholic. The

“other” category includes those reporting a

religious preference other than Protestant,

Catholic, or Jewish.

Parity. –Parity refers to the number of Iive

births the respondent has had.

Fetal losses. –Fetal losses are the number of

pregnancies reported by the respondent as

ending in miscarriage, stillbirth, or induced abortion.

Desired family size. –A woman was classified

according to the number of chiIdren she reported she would have if she could start life over

again and have exactly the number of children

she wanted.

SYMBOLS

Data not avail able -------------------------------------- ---

Category not applicable ------------------------------- . . .

Quantity zero --------------------------------------------- -

Quantity more than O but less than 0.05 ----- 0.0

Figure does not meet standards of

reliability or precision ---------------------------- *
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

u.S. DEPARTMENT OF HEALTH. . Publlc Health Serwce

EDuCATION, ANC) WELFARE Of f!ce of Health Research, Statlsrics, and Technology . January 25, 19~13

Office Visits for Diabetes IVlellitus, National Ambulatory

Medical Care Survey: United States, 1977a

Based on data collected “n the 1977 NationaI

Ambulatory Medical Care f urvey (NAMCS), an

estimated 11.0 million office visits were made at

which the principal or first-listed diagnosis was

diabetes rnellitus. The estimates presented in this

report are based on data collected in the

NAiiICS, an annuaI probability sample survey of

approximately 3,000 nonfederally employed

physicians who are in office-based practice in

the conterminous United States. Excluded from

the NAMCS are hospital-based physicians; those

specializing in anesthesiology, pathology, or

radiology; and those who are principally engaged

in teaching, research, or administration. The

survey sample is selected with the cooperation

of the .American Medical Association and

American Osteopathic Association from their

lists of nonfederally employed doctors of

medicine and osteopathy who a-e principally

engaged in office-based practice.

Figure 1 is a facsimile of the. 1977 Patient

Record used by participating physicians to record

information obtained during office visits for a

7-day reporting period and it may be usefuI as

a reference as selected sumey findings are

discussed.

Caution should be exercised when comparing the 1977 survey results with N.M4CS

data from previous years. Changes which were

made in the 1977 Patient Record that affect

comparability between sumey years have been

discussed in a previous report. 1

Since the estimates presented in this report

are based on a sample rather than on the entire

universe of office-based physicians, the data are

aThis report was prepared by Trena Ezzati, Division

of Health Resources Utilization Statistics.

subject to sampling variability. The “Technical

LNotes” at the end of this report provide a brief

expkmation and guidelines for judging the precision of the estimates presented. A more detailed description of the sample design and clcfinilions of certain tmms used in N.+JICS have

been published.2

DATA HIGHLIGHTS

Utilization patterns fur diabetic pa[icnts obtained from the Patient Record form (figure 1)

am presented in this report, \vhilc data available

from the Health Interview Sulvey (HIS) and the

Health and Nutrition Examination SuiYey

(HANES) provide various national prevdtxrcc

estimates of diabetes by dcmogmphic w-id socioeconomic status variables. .+ summa]~ of current

diabetes-related data mntilable from the National

Center for Health Sta~istics hw been publishcc!.~

Patient Characteristics

Of the 11.0 milIion office visits for diabetes

meilitus, 58 percent were by fcm.k (table l).

The nnual number of office visits tvith .i principal diagnosis of diitbetcs tends to increase w“iih

age. Approximately 69 percent uf the office

visits for diabetes were by p.(tients 55 years of

age and over: relatively few visits were mtide by

p&ons under 25 years of age. Thti majority ot’

office visits for diabetes were made by white

persons (86 percent); however, the m-tnud visit

rates were similar for white and all other persons.

For both maks and females the mntxd visit rate

increased with age–with a peak in the 63-74

year age group (figure 2). The visit rate for females was sli,ghtly ,grcater than that for males.
2 akm#&3b —

TIME OF

,Jlslr

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cm

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Figure 1.1977 ‘PATlENT RECORD

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.

1. OATEOF V,$,T PATl ENT RECORO

NATIONAL AM8UL.ATORY MEDICAL CARE SURVEY

M. (2W r,

2. 0ATEOF81R7H 3. SEX 4. CGLOn OR 5. WAS PATIENT

—

6. PATIENrS COWtilNTIS1. SYMP70M{Sl,0ROTH6R

RACE RCFERnCD FOR REAaNIsI SOH W.IISVISIT

T+Its VISIT OY 077zrm.wl O* edl

, c! WHITE ANOTMER

Wo 0.” v,

, :: 6GMa LL , - *t GAIJ PHYSICIAN> ● v~~~

BLAC* ,h4Po,a Tati r

_ VALE . is

—

,_ Or-e R

o UT*6O —

I

. t-d UNKNOW& : -; No

7. TIME SINCS ONSET 8. PHvSICtAN% OIAGNOSSS 9. @AvEYOUSEEU

OF COMPLAINT! PATIENT 8EFORE?

SYMPTOM IN ITEM ES ,. pmNcI*6L OIAcru Osts/*n O.SLe M ASSOCIATED W07M

(check O“*I ITSM 6, 4 :; “Es tCNO

11.DIAGNOSTIC SERVICES Tws

VLSIT (Cm@ ,11 Ordrrea 0, D,-o.&*,

I ‘: NON&

: ~ LIMITEDEX~M/-l STOnV

4 Z GEWnAGexAhi,w,smfa,

. c PaP TEST

, ~ CLINICAL LAS TEST

.CKFIAV

7 ~ EKG

. c VISIONTEST

.z ENOOSCOPV

!. c BLOOD Pa Ess”ne CHECK

, , !J OT.’SRLsm, f”/ -,

,9’?.,4.2

REv. 9-76

12. TF4EFtAPEU11C SERVICESTHIS

VISIT fchmh ,/1 .,a,ma 0/ ,wo”wl

, c .Nome

J ~ lMMUNIZArll>N

of Sf Nslrlz Ar!!YrQ

$ Q Onucs tPns. scm, PTto W

NOwPfi Esc RI PT!o Nl

. 2 316r SO UN5.5LING

$ C FAAR, LY PLAM?J,W’Z

. G ME O, CA1. CO UINSCL, NG

! u PI’lvsl OTHen APY

* ~ oFFICE SURG14FIV

. a PSVCH07HERAPV

Tii ERAu E”r, c L,sr, .,, W,..

,“ - or. cn K~,fy/

1

13, p~yxxwlosl THISVISIT

Ictmek,11ma,*O(”)

t U ?40 GOLLOW. W *LAt4Neo

‘ a RC7URN AT SPECIFIED TlhllI

‘ a nETunN I* NEeocu., R.N.

‘o. SERIOUSNESS OF

CfflOtTION IN

ITEM S.8fc/lrC* .2”.)

“ C lELEWONEGOLLO.N.UP .LANNCO

C O R6FERRc0 TO OT”E” Pli YSICIAN

, ~ RETunNeO 70 nEf EnmtNG

?I’4VSIC1AN

‘ g AOMIT TO HOSPITAL

‘ 2 OTHER (.%rcJfvl

IA IV OWE L. ARE

.M,, b,”

,74.,, r!cs

14. OUflATION OF

THIS Vlsll

/rJm* JCZWIIV

VJmtt LAwll

*“WIC,M)

_ MINUTES

(, M a. =s4. n149s

Physician and Specialty Characteristics

Visits to general and family practitioners (53

percent) and internists (28 percent) accounted

for four-fifths of alI office-based physician visits

for diabetes mellitus (table 2). Approximately

70 percent of all visits for diabetes were to solo

practitioners. This exceeded the percentage (59

percent) of visits to solo practitioners for all

diagnoses. The proportion of visits with a

principal diagnosis of diabetes was higher in

metropolitan areas (77 percent) than in nonmetropolitan areas (23 percent) in about the

same proportion as visits for all diagnoses.

Visit Characteristics

About 62 percent of the visits associated

with a diagnosis of diabetes had an onset of a

complaint or symptom of more than 3 months

(table 3). This reflects the chronic nature of diabetes. Data on prior visit status also reflect its

chronic nature: 89 percent of the office visits

for diabetes were by patients who had seer-t the

physician before for the same problem; ctnly 5

percent were by patients new to the physician’s

oft7ce practice.

Information obtained in item 6 of the Patient

Record (fi,gure 1) represents the reasons for
advameckita 3

Table 1. Number, Percent dktribudon, and number of office visits Per 100 persons per year for principal diagnosis of diabefes mellitus, by selected

patient characteristics: Unitad States, 1977

Patient characteristic

Allparients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

&

Under 25 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

45-54 years . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5&64 yearn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 yean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75yearaend wer, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sex and age

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

Under 25years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2S-34 yean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

45.54 yean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

Under 25years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25.34 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3544yean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 yean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75 yean and over . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Color and age

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

Under 25 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2534y ears., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3544 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,.

4tV54years . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65.74 yean. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75 years and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . .

All orher . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under 25 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

25.34 yean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3544 yean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

45-54 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

55-64 yean. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

65-74 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75yean and over, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number

of visits

in thousands

1?,023

“280

488

816

1,894

3,125

2.950

1,462

6,442

“119

“3C3

“381

932

1,745

1,957

999

4,581

“160

●188

●435

962

1,381

993

462

9,441

“236

●45 1

675

1,65d

2,480

2,589

1,380

1,582

’44

“44

●141

●244

666

’361

“81

Percent

distribution

100.C

“2.5

4.5

7.4

17.2

28.4

26.8

13.3

58.4

●1.1

*2.8

“3.5

8.5

15.8

17.8

9.1

41.6

*1.5

●1.7

“3.9

8.7

12.5

9.0

4.2

85.7

*2.1

“4.1

6.1

15.0

22.3

23.5

12.5

14.4

“0.4

“0.4

*1.3

“2.2

6.0

“3.3

“0.7

Number of visits

per 100 persons

per year

5.2

8.2

15.6

20.7

18.3

●1.9

●3.2

7.8

16.5

24.3

20.0

4.5

“0.4

●1.2

“3.9

8.6

14.6

16.1

15.4

5.2

“0.3

“1.6

3.4

8.1

13.6

20.2

19.0

5.6

0.3

“1.1

●4.9

“9.4

34.4

●26.2

●11.3
Figure 2. Annual offs veut tats per 100 persons for diabetes

meliitus by’ age and sex of panenc Umted Sfarea, 1977

26.0

240

22.0

a

a

* ~.o [

2.0F

.-.

Fund, / \.

i x.

j

\

“\

/

“.

/

/“

o

I I I I

I

Ullau 45 4s54 5s.s4 aa.74 75 years

v-n ywn w-= yams maw

AGE

Table 2. Number and percent distribution of office visils for principal

diagnosis of diabetes mellitus, by selected phvslctan characteristics:

United States, 1977

Number ~

Phys!cian charactermtc of visits

: in thousands

All . . . . . . . . . . . . . . . . . . . . . . .

=

I

Physlc!an specialty

General and famdy practice. . . . . . . . 5,891

Internai medicine . . . . . . . . . . . . . . . 3,075

Other medical specialties. . . . . . . . . 1,125

Suqlcal specialties. . . . . . . . . . . . . . . 876

Other spemalnes . . . . . . . . . . . “56

Type of practice

solo . . . . . . . . . . . . . . . . . . . . . . . . . . 7,737

Other . . . . . . . . . . . . . . . . . . . . . . . . 3,286

Location of pract}ce

MetropolitanZ. , . . . . . . . . . . . . . . . 8,469

Nonmetropolitan. . . . . . . . 2,554

Percent

distribution

100.0

53.4

27,9

10.2

8.0

“0.5

70.2

29.8

76.8

23.2

Table 3. Number and percent distnbuoon of office visits for c.nnclpal

diagnosis of diabetes mellitus, by selected vIsIt charac~eri$ocs:

Unrad States, 1977

Visit characteristic

All . . . . . . . . . . . . . . . . . . . . . . .

Time since onser of symptom

or complamt

Less than l week. . . . . . . . . . . . . . . .

l-3weeks . . . . . . . . . . . . . . . . . . . . .

1.3months . . . . . . . . . . . . . . . . . . . .

Morethan 3months . . . . . . . . . . . . .

Notapplicable~ . . . . . . . . . . . . . . . . .

Prior visit status

New patient . . . . . . . . . . . . . . . . . . .

Old patient . . . . . . . . . . . . . . . . . . . .

Newproblem . . . . . . . . . . . . . . . . .

Old problem . . . . . . . . . . . . . . . . .

Number

of visits

n thousands

11,023

461

576

895

6,803

2,288

537

10,486

646

9,840

Percent

distribution

100.0

4.2

20.8

4.9

95.2

5.9

89.3

1Ch!cfly visitsnot involwnga wmpwrn w ~~mpiaint.e.g.. Jnnualor I*’cIIbati~

examination.

visiting physicians’ offices as expressed by patients in their own words. These data were classified and coded according to A Reason for Visit

Cfussij$cation for Ambulatory Care.4 Table 4

presents reasons for visit associated with a principal diagnosis of diabetes. Diabetes mellitus and

giucose level determination accounted for approximately 55 percent of the patients’ reasons

for visits; general medical examination for 8 percent of the visits; tiredness, general weakness,

vision dysfunctions, leg, foot, and toe symptoms

for an additional 6 percent of the visits.

A generaI examination was ordered or provided for approximately 23 percent of all visits

for diabetes (table 5). The proportion (69 percent) of visits ~ which a clinical Iab test was

ordered or provided was nearly 3 times the proportion (21 percent) provided at visits for all

diagnoses. Further, the proportion of diabetes

visits involving a blood pressure check (67 percent) nearly doubled that for all diagnoses (34

percent).

About 62 percent of ail office visits for diabetes resulted in some type of drug therapy

(table 5) being ordered or provided at that visit.

About 37 percent of the visits involved diet

counseling, compared with 7 percent for ~1
advancedata 5

Table 4. Number and percem distribution of office visits, by principal

reasons for visit most frequently associated with a princmal diagnosis of diabetes mellitus: United States, 1977

Principal reason for visit

and RVC code!

All reasons . . . . . . . . . . . . . . . .

Diabetes meliitus. . . . . . . . . . . 020S

Glucose level determination . . X310

General medical

examination . . . . . . . . . . .. XlOU

Tiredness, general weakness, vision

dysfunctions, leg, foot, and toe

symptoms . . . . sol 5, S020, S305,

S920, S935

Number

of visits

in thousands

11,023

Percent

distribution

1CQ.o

4,903

1,111

921

683

44.5

10.1

8.4

6.2

1Based on .4 Reason for Vu!! (.’Lsssific.t:on for .-tmbulutory Care (RCV).

visits. An additional 32 percent of the visits

invoked some type of medical counseling.

Seriousness represents the extent of impairment that might result if no care were available.

Forty-two percent of all visits involving a principal diagnosis of diabetes meIIitus were judged

by the physician as serious or very serious (table

Table 5. Number and percent of office visits for principal diagnosis

Of diabetes mellitus by services ordered or Drovided: IJnlted stat~.

1977

1

Number

SerViCe$ ordered or provided of visits

in thousands

I

Diagnostic Services I

None . . . . . . . . . . . . . . . . . . . . . . . . .! “208

Limited examination or history. . . . . i 5,839

General exammauon or history. . . . . 2,493

Clinical lab test. . . . . . . . . . . ., ..,,

X.ray . . . . . . . . . . . . . . . . . . . . . . . . .

Electrocardiogram . . . . . . . . . . . . . . .

Vision test . . . . . . . . . . . . . . . . . . . .,

Blood pressure check. ., . . . . . . . . .

Other; . . . . . . . . . . . . . . . . . . . . . . . .

Therapeunc services

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

Drugs (prescnpuon or

nonprescripnon) . . . . . . . , . . . .

Dietcouns41ing . . . . . . . . . . . . . . . . .

7,635

“379

528

“312

7,382

569

1,464

6,869

4,125

Medical counsel ing . . . . . . . . . . . ...1 3,539

Otherz. . . . . . . . . . . . . . . . . . . . . . . . 814

Percent

*1.9

53.0

22.6

69.3

“3.4

4.8

“2.8

67.0

5.2

13.3

62.3

37.4

32.1

7.4

1[m IIMI.. I*,,P ILW. cmhm ,,IN md wthcr di,wumttc wswcm.

‘[n, IZLCILWtmnttm,< .,1!,,” or dcwnsmat8tm. f,, rn,iy pi.,n”mq. phvstothcrapy.

,Jlit r .urucrY. p., chothcrqx or thcrapcttttc Itsumme. w-d other ihcnapct:ttc

w-m ,, t-$.

6); the comparable proportion for d dia,~oses

was 18 percent. .Nine of eve~ 10 visits for a

principal diagnosis of diabetes involved the

physician advising the patient to return at a

specified time (tabIe 6).

Duration of the visit, as obtained in NAJICS,

represents only that amount of time spent by

the patient in face-to-face contact with the ph ysician. The mean duration of visits involving a

principaI diagnosis of diabetes was 15.1 minutes;

the mean duration of W visits was 15.4 minutes.

In addition to the principal or first-Iisted

diagnosis recorded in item 8 of the Patient Record, the physician was instructed to record

“other significant current diagnoses” (see figure

1) known to exist for the patient at the time of

the current visit. The second- and third-listed

diagnoses recorded were coded in the same manner as the first-~isted, that is according to the

Eighth Revision international Classification of

Diseases, Adapted foT Use in the United States. ~

Table 6. Number and percent distribution of office visits for principal

diagnosis of diabems mellims, by selected visit chamtenstics:

Umted States, 1977

Visit characrenstic

Ail visits . . . . . . . . . . . . . . . . . .

Seriousness of conditton .

Serious or very sar,ous. . . . . . . . . . . .

Siightly serious . . . . . . . . . . . . . . . . .

Not serious . . . . . . . . . . . . . . . . . . . .

DiWosmon of vmtl

No foilowup . . . . . . . . . . . . . . . . . .

Retumat specified use ..,..... . .

Retumlf needed . . . . . . . . . . . . . . . .

Telephone followup planned. . . . . . .

Otherz. . . . . . . . . . . . . . . . . . . . . . . .

——Durauon of visit

0 minums3 . . . . . . . . . . . . . . . . . . . .

1.5mlnutes . . . . . . . . . . . . . . . . . . . .

6-10 minutes . . . . . . . . . . . . . . . . . . .

11-15 minutes . . . . . . . . . . . . . . . . . .

16-30 mmutes . . . . . . . . . . . . . . . . . .

31 minutas or more... . . . . . . . . . . .

11,023 ~ 100.0

4,645 1 42.1

4,236 ‘ 38.4

2.142 19.4

“117

9,926

636

“365

511

“364

1.079

3,436

3,203

2,580

*36 1

“1.1

90.1

“:::

4.6

“3.3

9.8

31.2

29.1

23.4

“3.3

1I)WS nt, t add to 1000 wnrc mom thm one di<p<mtton wm powthlc

21ncludcs referral 10 other phvm MI. rcmmed to rcfcrnnq phi su’t.m. and

ddmtt to hospttal.

31teprcscrti VISI1%m whwh !hcrc W.S m, f.tcc. !o.(~< c t ontw t lnwwm the

pdtmrt .nd the phvw wt.
6 ackncedata

These chta provide ~dditional information

about [he total number of office visits involving

diabetes and also show which conditions most

frequently co-occur with a diagnosis of diabetes.

In addition to the 11.0 million visits in

which diabetes was the first listed-diagnosis,

there were art additional 7.8 million visits in

which diabetes was a second- or third-listed diagnosis. The total office visits in which diabetes

was a diagnosis, therefore, was 18.8 miIIion

(table 7).

The data in table 7 reveal that at nearly 20

percent of the 18.8 miIlion visits involving diabetes meIlitus there was a concomitant diagnosis

of essential benign hypertension. Other diagnoses

frequently associated with diabetes were chronic

ischemic heart disease ( 11 percent) and nonendocrine obesity (6 percent).

Table 7. Number and percent of office vkks with diabetes mellitus as

first., second., or third.listed diagnosis, by most frequent diagnoses

associatedwith a diagnosw of diabetes: United States, 1977

I

I Oiabetes mellitus as

first-, second-, or

I

M osz frequent third-l istad diagnosis

diagnosis and ICDA code; l~~n=ent

of visits of

in thousands visits

——

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

. . . . ...! 18,838 ~ 100.0

I

Essential benign hypertension. ..401 I 3,720 19.7

Chronic kchemic heart diseass ..412 2,081 11.0

Obesity, not specified as of

endocrine origin . . . . . . . . ...277 1,147 6.1

I I

REFERENCES

1Nation~ Center for He~th statis.ti~~: 1977 Sum.

mary: P4ationaJ Ambulatory Medical Care Survey, by T.

Ezzati and T, LMcLemore. ,4dvance Data From Vital and

Hea[th Statistics, No. 48. DHEW Pub. No. (PHS) 79-

1250. Public Health Sewice. Hyattsville, Md. Apr. 13,

1979.

2Nation~ Center for Health stati~tic~: The Na~on~

Ambulatory LMedicai Care Sumcy, 1975 Summary,

United States, January-December, 1975, by H. Koch and

T. lMcLemore. Vital and Health Statistics. Series 13-No.

33. DHEW Pub. No. (PHS) 78-1784. Public Health Service. Washington. U.S. Government Printing Office, Jan.

1978.

3American Diabetes Association: Summary of current diabetes-related data from the National Center for

Health Statistics. Diabetes Care. Voi. 2, No. 2, Mar. -Apr.

1979.

4Nation~ centerfor He~~ S tati~tics: A reason for

visit classification for ambulatory care, by D. Shneider,

L. Appieton, and T. McLemore. Vital and Health Statistics. Series ?-No. 78. DHEW Pub. No. (PHS) 79-1352.

Public Health Semite. Washington. U.S. Government

Printing Office, Feb. 1979.

5National Center for Health Statistics: Ei~htls Revision International Classification of Diseases, A dap ted

for Use in the United States. PHS Pub. No. 1693. Public

Health Service. Washington. U.S. Government Printing

Office, 1967.
dw~ 7

TECHNICAL NOTES

SOURCE OF DAT.A: The information presented

in this report is based on data collected in the

lNat i o nal Ambulatory Medical Care Survey

(NAMCS) during 1977. The target population of

NAJICS encompasses office visits within the

conterminous L’nited States made by ambulatory patients to physicians who are principally

engaged in office practice. The lNationaI Opinion

Research Center, under contract to the National

Center for Health Statistics, was responsible for

the survey’s field operations.

SA.MPLE DESIGN: The NAMCS utilizes a multistage probability design that involves samples of

primary sampling units (PSU’S), physician practices within PSU’S, and patient visits within

practices. For 1977 a sample of 3,000 nonFederal office-based physicians was selected

from master files maintained by the .4merican

Medical Association and American Osteopathic

Association. The physician response rate for

1977 was 77.5 percent. Sampled physicians were

requested to complete Patient Records (figure 1)

for a systematic random sample of office visits

taking place within their practice during a randomly assigned weekly reporting period. During

1977, 51,044 P~tient Records were completed

by sampIed physicians.

SAMPLING ERRORS: The standarci error is primarily a measure of the samp[ing vw-iabiiity that

occurs by chance becuuse only a sample, rather

than the entire universe, is surveyec{. The relative

stanch-d error of :m estimate is obtained by dividing the standard error of the estimate by the

estimate itself and is expressed as a percentage

of the estimate. Relati\’e standard errors of selected aggrcgzate St~LktiCS are shown in table L The

stundurd errc)rs ~ppr-opriate for estimated percentages of visits w-e shown in table II.

ROUNDING OF INLTJIBERS: Estimates of

office visits have been rounded to the nearest

thousand. For this reason detailed I@rcs within

tables do not always add to totals. Percents were

calculated on the basis of original, unrounded

figures and will not necessarily agree precisely

with percents which might be calculated from

rounded data.

DE FIN ITIO~NS: An am bz~latory patimt is an individual presenting himscl~ for- personul health

services \vho is neither bedridden nor currently

aclmittec{ to any hcdth care institution on the

premises.

Table 1. Approximate relatwe standard errors of est!mated

number of office viws, NAMCS 1977

Estimated number of office

Relative

standard visits in thousands

error in

percent

I

500 .........................................................................

600

29.0

........................................................................

1,000

26.5

...... ............... ............... ........... .......... .............

2,000

20.7

...................... ..... ........... .... ...... ...................... 14.9

5,000................................................................ ..... 9.9

1o.wo .............................. ..... ...............................

20,q30

7.6

.................................................................... 6.1

50,000 ...................................... ............................ 4.9

1w.m ...................... ........................................... 4.5

WO,of)o .................................................................. 4.1

Exzmpfe of use of rabfe: h aggregate estimate of 7s,000,000

visits has a relative strsndard error of 4.7 p.rrcenr or a standard :

error of 3, S25,000 visits (4.7 percent of 7S,000,000).

Table 1!. Approximate standard errors of percentages of estimated

number of office visits, NAMCS 1977

I

6aso of percentage .

Estimated percentage

(number of visits

H

1or 5 or lOor 20 w 30 or

in thousands) 99 95 90 80 70 5fJ

I Standard error in percentage powns

500 ............................

600 ............................

1,000 .........................

2,000 .........................

5,000 .. ......................

10.000 .......................

20,000 .......................

50,000 .......................

100,000 .....................

500,000 .....................

2.9

26

2.0

1.4

0.9

0.6

0.5

0.3

0.2

0.1

6.3 8.6 11.5 13.2 14.4

5.7 7.9 10.5 12.0 13.1

4.4 6.1 8.1 9.3 10.2

3.1 4.3 I 5.7 6.6 7.2

2.0 2.7 I 3.6 4.2 , 4.5

1.4 1.9 I 2.6 I 2.9 3.2

1.0 1.41 1.8 2.1 2.3

0.6 0.9 1.1 1.3 1.4

0.4 0.6 0.8 0.9

0.2 0.3 I 0.4] 0.4 ;::

Example of use of ruble: ,An estimate of 30 percent based on an

Wreqte of 15J3Wooo viwts has J standard error of 2.s percent.

The relatwe Wandard error of 30 percent is S.3 percent (2.S percent + 30 pcrwnt).

.4n ofjice is ~ place that the physiciun identi fits

as a location for his ambulatory practice. Responsibility over time for patient cm-e and professional services rendered there generally resides

with the individud physician mther than an institution.

A visitis a direct personal exchange between an

ambulatory putient and a physician or a staff

member working under the physician’s supervision for the purpose of sce?iing care and rendering hcd~h scrviccs.
8 admncedata

A physician is u duly licensed doctor of

medicine (\[.D. ) or doctor of osteoptithy (D. O.)

currentiy in office-based practice who spends

time in caring for ambulatory patients. Excluded

from NA.i\lCS are physicians who are hospital

based; physicians who specialize in anesthe.

siology, pathology, or radiology; physicians who

are Federally employed; physicians who treat

only institutionalized patients; physiciaxis employed full time by an institution; and physicians who spend no time seeing ambulatory

patients.

SYMBOLS

Data not availabl e--------------------------------------- . . .

I

Category not applicable-— -------------------------- . . .

Quantity zero ------------------------------------------ .

Quantity more than O but less than 0.05---- 0.()

Figure does not meet standards of

reliab iIit y or precision-— ------------------

*
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

U.S. DEPARTMENT OF HEALTH, . Public Health Serwce

EDUCATION, AND WELFARE Office of Health Research, Statistic, and Technology Number 58 ● February 14, 1980

Remarriages of Women 1544 Years of Age Whose First

Marriage Ended in Divorce: United States, 19761

INTRODUCTION

In the United States in 1976 there were about

6 million women 15-44 years of age whose first

marriage had ended in divorce. About 21 percent of these women had entered a second marriage during the first year following divorce, and

about 71 percent had remarried within 5 years

after divorce. How’ever, the likelihood of remarriage varied depending on the social and demographic characteristics of these women. The most

important of these characteristics were race, age

at divorce, and educational attainment. Data

provide evidence that during the iirst 5 years

after divorce the likelihood of remarriage was

greater for white than for black ~vornen, greater

for those who were divorced before age 25 than

for those who were divorced later, and greater

for those with less than a high school education

than for those with one or more years of college.

These statistics on remarriage are from the

National Sumey of Family Growth, Cycle II,

conducted by” the National Center for Health

Statistics in 1976. Data were collected throllgh

personaI inteniews with women \vho were selected in a multistage probability sample of the

household population of the conterminous

United States. lVomen 15-44 years of age who

were currently married or previously married or

were never married but had offspring living in

the household ut the time of the survey were

eligible for inclusion in the sample.

The interview focused on the respondent’s

marital and pre~mancy histories; use of contra1This report was prepared by William R. Grady, Xl.:\.,

Division of Vital Statistics.

ception; pIanning status of each pregnancy; intentions regarding number and spacing of future

births; use of maternal care and family planning

services; and abroad range of social, demographic,

and economic characteristics. For Cycie H, 3,009:

black women and 5,602 women of ether races

were interviewed from January through Sep tem -

ber 1976. Further discussion of the survey

design and sampling variability is in the Technical

lNotes.

In this repot-t statistics are presented w-t the

likelihood of second marriage for womtm whose

first marriage ended in divorce and on group

differences in the likelihood of second marriage.

The basic statistics presented are cumulative probabilities of remarriage for each of the llrst 5 years

following divorce. The probabilities sh(nvn for

women with each chm-acteristic indicate the

approximate proporti(m of a gr(mp of worncm

with that characteristic thot rem~rrit’rl by the

end of each year since di~wrce occut-rcd. For ex -

ampIe, the .731 probability at the cnd of 4 yc.ws

for women who divot-cccl before age 25 (see t:ihlc

1) indicates that about 73 percent of wwmcn

who divorced before that age remarried ~i”ithin

4 years. By comparing different gr(]ups in terms

of their probabilities of remarriage tit the end of

each year following divorce, group differences in

the timing and frequency of remarri~ge can hc

determined.

Two types of probabilities are presented in

this report. The unadjusted probabilities found

in table 1 are calculated, as described in the

Technical Notes, directly from the marital experiences of \vomen \vith exh chaructrristic.

The adjusted probabilities for the various subgroups of each characteristic in table 2 .lrc those

that would have occurred if the cliflcrcnt sub-
2 admncedata

Table 1. Number of women, cumulative probabilities of remarriage by number of years after divorce and median years to remarriage, by

selected characteristics, with standard errors: United States, 1976

Characteristic

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

Race and origin

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

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

HispanicI . . . . . . . . . . . . . . . . .

Age at divorce

Under25yeam . . . . . . . . . . . . . .

26yearsandover . . . . . . . . . . . . .

Year of divorce

Before 1970 . . . . . . . . . . . . . . . .

19700rlater . . . . . . . . . . . . . . . .

Durationoffirst marriage

Lessthan 5years . . . . . . . . . . . . .

6yearsormore .,.,.... . . . . . .

Number of living children at divorce

Nochildren . . . . . . . . . . . . . . . .

I child . . . . . . . . . . . . . . . . . . .

2children . . . . . . . . . . . . . . . . .

3children ormore . . . . . . . . . . . .

Education

Lessthan12years . . . . . . . . . . . .

12year3 . . . . . . . . . . . . . . . . . .

Morethan 12years . . . . . . . . . . . .

Rei igion

Catholic . . . . . . . . . . . . . . . . . .

Protestant . . . . . . . . . . . . . . . . .

Otheror nona . . . . . . . . . . . . . . .

Place of residence

Metropolitan . . . . . . . . . . . . . . . .

Nonmetropolitan . . . . . . . . . . . .

Geographic region

Northeast . ., .,...,... . . . . .

North Central . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . .

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

Vumberof

women in

thousands

6.029

5,244

710

339

2,882

3,147

2,782

3,247

2,598

3,431

1,448

1,753

1,4S5

1,342

1,964

2,7543

1,309

1,111

4,281

637

4.447

1,582

799

1,772

2,087

1,371

Years after divorce

I

1 2 3 4 5

Probability

.206 I .396 I .553

I

.221

.097

.202

.230

.182

.238

.177

.233

.184

.184

.214

.242

.181

.268

.201

.137

,197

.209

“.203

.186

.261

.277

.176

.206

.213

,414

.231

.484

.469

.328

.457

.331

.443

.354

.408

.433

.381

.345

.507

.392

.253

.362

.404

.397

.350

.514

.361

.391

.408

.399

.578

.342

.761

.624

.478

.604

.498

.595

.517

.578

.602

.537

.479

.622

.570

.426

.501

.572

.494

.514

.657

.551

.510

.573

.580

.644

.668

.445

*

.731

.545

.696

.577

.712

.579

.679

.693

.622

.561

.731

.658

.487

.599

.665

.603

.607

.740

.645

.625

.659

.649

.706

.731

.485

●

.785

.611

.752

.628

.755

.633

.763

.720

.660

.672

.804

.715

.532

.625

.728

.694

.665

.804

.700

.693

.731

.683

Median

years to

remarriage

.—

2.7

.—.—

2.5

5.0+

2.0

2.3

3.3

2.3

3.0

2.4

2.9

2.5

2.4

2,8

3.3

2.0

2.6

“4.3

3.0

2.6

●3.1

2.9

1.9

2.7

2.9

2.6

2.6

See footnote at end of table.
admncedata 3

.——

.

Table 1. Number of women, cumulative probabilities of mmarriqe bynum&r ofyeamafier divorce andmedian years toremarri~e, by

selected characteristics, with standard errors: United States, 1976—Con.

Characteristic

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

Race and origin

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

Black . . . . . . . . . . . . . . . . . . . .“.

Hiapanicl . . . . . . . . . . . . . . . . . .

Age at divorce

Under25yaars . . . . . . . . . . . . . . .

25yearsandover . . . . . . . . . . . . . .

Year of divorce

Before 1970 . . . . . . . . . . . . . . . . .

19700rlater. .. o....... . . . . . .

Duration of first marriage

Lessthan 5years . . . . . . . . . . . . . .

5yearsormore . . . . . . . . . . . . . . .

Number of living children at divorce

Nochiidran . . . . . . . . . . . . . . . . .

I child . . . . . . . . . . . . . . . . . . . .

2 children . . . . . . . . . . . . . . . . . .

3childrenormore . . . . . . . . . . . . .

Educetion

Lessthan 12yaars . . . . . . . . . . . . .

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

Morethan 12years . . . . . . . . . . . . .

Religion

Catholic . . . . . . . . . . . . . . . . . . .

Protestant . . . . . . . . . . . . . . . . . .

Otharornone . . . . . . . . . . . . . . . .

Place of rasidence

Metropolitan. . . . . . . . . . . . . . . . .

Nonmetropolitan . . . . . . . . . . . . . .

Gersgrephicragion

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

North Central . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . . .

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

Standard

error of

numtxr of

women in

thousands

182

164

39

43

145

130

123

133

118

136

88

97

89

64

103

122

64

77

152

58

155

92

65

98

106

86

Yearaafterdivorce

1 2 3 4 5

.024

.Om

.010

.088

.038

.025

.035

.022

.042

.025

.032

.034

.036

.029

.Om

.031

.022

.043

.028

.%1

,02B

.028

.058

.027

.029

.046

Standard error of probability

.016

.020

.028

.089

.035

.027

.026

.023

.038

,018

.029

.024

.038

.030

.036

.026

.017

.052

.024

.064

.014

.038

.058

.032

.032

.061

.020

.021

.042

.109

.030

.033

.024

.031

.033

.027

.027

.035

.033

.048

.038

.024

.068

.036

.022

.063

.027

.036

.091

.046

.043

.039

.021

.022

.042

. . .

.060

.060

.023

.034

.037

.028

.049

.051

.024

.055

.035

.015

.081

.039

.048

.078

.025

.042

.070

.041

.041

.037

.024

.027

.046

---

.051

.062

.025

.034

.034

.030

.040

.048

.024

.053

.042

.027

.081

.041

.041

.085

.029

.045

.057

.027

.041

S)42

Standard

error of

median

years to

-emarriage

.09

.09

. . .

.33

:19

.45

.14

.31

.23

.17

.12

.15

.19

.60

.20

.11

1.31

.31

.12

.90

.15

.15

.39

.38

.22

.23

lIncludesa]lwOmen reporting any Hispanic origin, regardle~ of race or other ethnic origins reported; estimates forthe4th and Sth

yeara of divorce are not shown because the conditional probabilities produced for those years, from which thecumulative probabilities

precalculated, are based on fewer than 10 unweighed cases. Data for women of Hispamc tmgin are also included in the statistics by ruce.
4 adwancedata

.

Table 2. Number of women, adjustedl cumulative probabilities of remarriage by number of years after divorce and median years to

remarriage, byselected characteristics, with standard errors: United States, 1976

Characteristic

All women . . . . . . .

Race and origin

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

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

Hispanic, . . . . . . . . . .

Age at divorce

Under 25 years . . . . . . . .

25 years And over . . . . . . .

Year of divorce

Before 1970 . . . . . . . . . .

19700 r later . . . . . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

., ..,..

. . . . . . ,

. . . . . . .

. . . . . . .

. . . . . . .

Duration of first marriage

Lessthan 5years . . . . . . . . . . . . . .

5years ormore, . . . . . . . . . . . . . .

Number of living childran at divorca

No children, . . . . . . . . . . . . . . . .

I child . . . . . . . . . . . . . . . . . . . .

2 children . . . . . . . . . . . . . . . . . .

3children ormore . . . . . . . . . . . . .

Education

Lessthan 12years . . . . . . . . . . . . .

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

Morethan 12years . . . . . . . . . . . . .

Religion

Catholic . . . . . . . . . . . . . . . . . . .

Protestant . . . . . . . . . . . . . . . . . .

Other or none . . . . . . . . . . . . . . ,.

Place of residence

Metropolitan . . . . . . . . . . . . . . . . .

Nonmetropolitan . . . . . . . . . . . . . .

Geographic region

Northeast, . . . . . . . . . . . . . . . . .

North Central . . . . . . . . . . . . . . . .

South . . . . . . . . . . . . . . . . . . . . .

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

Jumber of

~omen in

tiousands

6,029

5,244

710

339

2,882

3,147

2,782

3,247

2,598

3,431

1,448

1,753

1,4B5

1,342

1,964

2,755

1,309

1,111

4,281

637

4.447

1,5B2

799

1,772

2,087

1,371

Yearsafterdivorce

1 /2]3] 415

.219

.114

●.21 3

.204

.208

.223

.191

.243

,lB1

.166

.204

.248

.206

.260

.198

.155

*.192

.206

“.229

.190

.250

.285

.170

.205

.219

.395

.40B

.279

.461

.433

.357

.432

.357

.398

.397

.39B

.419

.368

.369

.493

.390

.279

.375

.395

.430

.361

.485

.384

.3B9

.4W

,403

Probability

.5531

.574

.382 i

.757

.615 /

.491

.577

.530

I

.524

.580

.571

.583

.536

.517

.604

.567

.459

,497

.571

.511

.524

.630

.587

.512

.567

.570

.644

.663

.492

●

.710

.574

.665

.622

.648

.644

.651

a673

,631

,616

,713

.656

.525

.602

.661

.576

.620

,708

.671

.612

.655

.659

.705

.731

.493

●

.758

.649

.720

.695

.727

.689

.734

.686

.676

.736

.791

.774

.563

.621

,722

“,709

.674

.788

.732

.663

.733

.698

Median

years to

remarriage

2.7

————

2.6

5.0+

2.1

2.4

3.1

2.5

2.8

2.8

2.6

2.6

2.5

2.B

2.9

2.1

2.6

“3.6

3.0

2.6

“2.9

2.9

2.1

2.6

2.9

2.6

2.6

see footnotes at end of table.
admncedata 5

Table 2. Number of women, adjustedl cumulative probabilities, of remarriage by number of years after divorce and median years to

remarriage, by selected characteristics, with standard errors: United States, 1976–Con.

Characteristic

All women..........,.,

Race and origin

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

Black . . . . . . . . . . . . . . . . . . . ,,

Hisoanic2 . . . . . . . . . . . . . . . . .

Age at divorce

Under25years . . . . . . . . . . . . . . .

25 yearsand over . . . . . . . . . . . . .

Year Of divorce

Before 1970 . . . . . . . . . . . . . . . . .

19700rlater . . . . . . . . . . . . . . . . .

Duration of first marriage

Lessthan 5years . . . . . . . . . . . . . .

5yearsormore . . . . . . . . . . . . . . .

Number of living children at divorce

Nochildren . . . . . . . . . . . . ,.,.,

I child . . . . . . . . . . . . . . . . . . .

2children . . . . . . . . . . . . . . . . . .

3children ormore . . . . . . . . . . . . .

Education

Lessthan 12years . . . . . . . . . . . . .

12years . . . . . .. c...... . . . . .

Morethan 12years . . . . . . . . . . . . .

Religion

Catholic . . . . . . . . . . . . . . . . . . .

Protestant, . . . . . . . . . . . ,,...,

Otheror none........,.. . . . . .

Place of residence

Metropolitan . . . . . . . . . . . . . . . . .

Nonmetropolitan , . . . . . . . . . . . . .

Geographic region

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

North Central . . . . . . . . . . . . . . . .

South. ..,......,..,.. . . . . .

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

Standard

error of

number of

women in

thou sands

182

164

39

43

145

130

123

133

118

136

88

97

89

84

103

122

84

77

152

58

155

92

65

98

106

86

Years after divorce

I

1

12131415

.024

.026

.021

.091

.031

.030

.033

.025

.050

.031

.028

.039

.040

.037

,027

.032

.022

.049

.030

.067

.027

.026

.062

.025

.030

.049

Standard error of Probability

.016

.019

.023

.108

.037

.040

.026

.028

.060

.047

.029

.025

.043

.036

.035

.027

.022

.057

.022

.073

.028

.044

.077

.031

.031

.052

.020

.023

.051

.112

.041

.038

.027

.030

.059

.049

.037

.043

.035

.054

.037

.027

.070

.052

.024

.070

.021

.042

.091

.040

.041

.040

.021

.023

.044

. . .

.042

.033

.028

.039

.053

.045

.048

.052

.024

.058

.033

.015

.078

,045

.026

.047

.020

.064

.056

.041

.038

.036

.024

.029

.057

. . .

.037

.033

.030

.038

.051

.045

.046

.048

.030

.054

.041

.025

.076

.055

.032

.079

.026

.058

.050

.032

.043

.034

Standard

error of

median

years to

remarriage

.09

.10

. . .

.35

.18

.41

.15

.17

.48

.23

.16

.16

.23

.28

.27

.13

1.04

.45

.11

.81

.12

.28

.40

.32

.20

.25

1 ~obabi]ities for each characteristic are adjusted for the effects of all other characteristics in the table by means Of (fUmm> ‘v*riJble

multiple regression analysis. See the Technical Notes for further discussion of the adjustments.

21nc]udes all women reporting any Hispanic origin, rcgwdless of race m other ethnic origins reported; estimates for the ~th and Sth

years of divorce are not shown because the conditional probabilities produced for those years, from which the ~umu]ativc probabilities

are calculated, are based on fewer than 10 urrweigh ted cases. Datafor \vomen nf Hispanic origin ore als(I included in the statistics h} ruce.
6 achncedata ———

groups of a particular characteristic had included . riage). For white women this occurred after -.

~xactly the same proportions of women with -

each of the other characteristics in Lhe table. For

example, consider the characteristic “duration

of first marriage, ” which has been divided into

the two subgroups, “less than 5 years” and “5

years or more. ” The adjusted probabilities of

remarriage for e~ch of these two subgroups are

those that would have occurred if both groups

of women (those married less than 5 years and

those married 5 years or more) had contained

exactly the same proportions of white women,

black women, and Hispanic women; the same

proportions of women who were divorced prior

to age 25 and at 25 or older; the same proportions from metropolitan and nonmetropolitan

areas; and so on. This adjustment permits comparisons of the effects of each characteristic on

the chances of remarriage independent of the

effects of all other characteristics. Further discussion of this adjustment procedure can be

found in the Technical Notes.

In addition to cumulative probabilities of

remarriage, both table 1 and table 2 incIude the

median years to remarriage for each group of

women. This statistic represents the number of

years it took for the cumtdative probability of

remarriage to reach .50: the number of years it

took for half the women to remarry.

DIFFERENTIALS IN PROBAB

OF RENIARRIAGE

LITIES

An examination of table 1 reveals that white

women had a higher probability than black

women of remarrying within 1 year after divorce;

the probability was .221 for white women compared with only .097 for black women. Further,

this racial differential increased during the second

and third years following divorce, so that by the

end of the third year the difference was .236,

nearly twice the difference found at the end of

1 year. The difference was then maintained at

about this leveI during the next 2 years following

divorce, and by the end of 5 years the probability of remarriage was .731 for white women

and .485 for black women.

The magnitude of the racial difference in the

likelihood of remarriage is illustrated in the number of years it took for the probability of remarriage to reach .50 (median yew-s to remarabout 2.5 years, but for bIack women the probability was still less than .50 after 5 years.

An adjustment for the effects of the other

characteristics in the table has little effect on the

racial differences shown in table 1 (see figure 1).

Although the racial differences in the adjusted

probabilities shown in tabIe 2 are somewhat

smaller at each duration after divorce, all clifferences remain statistically significant. That the

adjustment has littIe effect indicates that raciaI

differences in the probability of remarriage are

Iargely unrelated to the other characteristics in

the table; that is, the greater probability of remarriage for white women was not due to other

characteristics in the table associated with high

probabilities of remarriage.

gure 1. UNADJUSTED AND ADJUSTED CUMUf.ATIVE PROBABILITY OF REMARRIAGE FOR WOMEN AGED 15-44 YEARS WHOSE 1S’7 MARRIAGE

ENDED IN DIVORCE, BY RACE AND NUMBER OF

YEARS AFTER DIVORCE: UNITED STATES, 1976

.80 r

!-

.70

White

.60

.50 ●. . . . ...*.

.40

.30

., . .

_ Unadjusted

¤=~==~ Adjusted

.10

.00 I I I I

1 2 3 4 5

YEARS AFTER DIVORCE
ackncedata 7

During the first year following divorce the

probuhility of remarriage for Hispanic women

was not si~nificantly different from that found

tor ciLhcr all white women or all black women.

Howmwr, their probability of remarriage increased rapidly over the next 2 years following

divorce and by the end of the third year had

reached .761. Although that probability is not

significantly different from the .578 found for

all white women, it is greater than the .342 found

for black women. Adjustment for the effects of

the other characteristics in the table has no effect

on thew relationships.

Women whose divorce occurred prior to age

25 had higher probabilities of remarriage by the

end of both the second and third years after divorce than those whose divorce occurred at an

older age. There is also some evidence that the

probabilities of remarriage were higher for the

younger women at the end of the fourth and

fifth years following divorce as well. The difference in probabilities between the two groups of

women ranges from a nonsignificant .048 at the

end of the first year to .186 at the end of 4

years. When the probabilities are adjusted for

the effects of the other chamcteristics, the differences are reduced, but the relationship persists: The younger wc)men were more likely to

have remarried by the end of the third and fourth

years after divorce, und there is some evidence

they were more likely to have remarried within

5 years as well. However, the difference at the

end of the fifth year is reduced from .174 to .109

(see figure 2).

A comparison of women who di~’orced before 1970 with thc>se who divorced in 1970 or

later shows that both groups of women had a

simiIar probability of remarrying within 1 yewafter divorce, but that at higher durations of divorce (seconcI through fifth years), women ~vho

divorced during the earlier time period were

more likely to have remarried (see table 1). This

does not mean that the probability of remarriage

has decreased over time for all groups, however.

Year of divorce and likelihood of remarriage are

related because women who were divorced before

1970 were more likely to have other characteristics in the table associated with high probabilities

of remarriage. The factors probably accounting

for most of the difference in the unadjusted

probabilities are age at divorce and educational

attainment. Women divorced before 1970 were

Figure 2. UNADJUSTED AND ADJUSTED CUMULATIVE PROBABILITY OF REMARRIAGE FOR WOMEN AGED 15-44 YEARS WHOSE 1ST MARRIAGE

ENDED IN DIVORCE. BY AGE AT DIVORCE AND

NUMBER OF YEARS AFTER DIVORCE: UNITED

STATES, 1976

.80 I_

Divorced under

.70

w

a

~

~ .60

;

a

$ .50

E Oivorced age 25

3 and over

$ .40

s

~

w

F

~

3

— Unadjusted

.10

I

. . . ..- Adiusted

1 2 3 4 5

YEARS AFTER DIVORCE

more likely to have divorced Prior to age 25

than those- divorced after 1970- (about 6~ percent compared with about 39 percent) and to

have had less than a high school education (about

39 percent compared with about 25 percent).

}Vhen the effects of these characteristics are removed throu~h the adjustment procedure, no

statistically significant differences in the probabilities of remarriage bet~veen the two groups

of women remuin (see table 2).

Similar results were found when the relationship between duration of first marriage and

probability of remarriage was examined. By the

end of the fourth year follotvin,q divorce, women

whose first marriage lasted less than 5 yew-s had

a significantly greater probability of having re-
8 aduancedata

married than women whose first marriage lasted

5 yew-s or lon~er. This excess tvx also mailltiIin C’d

clurin~ the fifth yetir, and there is some evidence

that it had already existed ut the end of the

second and third years as well. When the probabilities are adjusted, however, only n(jnsignificant differences remain, and no clear pattern of

differences is evident. The effects of the adjustment demonstrate that the duration of a woman’s

first marriage had little or no effect on the likelihood of her remarrying. Differences in the

probability ot’ remtirriage b}’ Icngth ot’ first marriage were due to differences in other characteristics in the table that were associated with a

high probability of remarrying. The factor probably accounting for most of the differences in

the unadjusted probabilities is age at divorce.

Women who had first marriages lusting less than

5 years were more likely to have divorced before

age 25 than those married 5 years or longer (about

77 percent compared with about ] 2 percent).

Table 1 shows no statistically si~ificant differences in remarriage probabilities by number

of children at any dumtion of divorce. Women

with no living children or only one child did

have consistently higher probabilities at each

duration than those with two or more living

chiIdren, but even these nonsignificant differences are reduced by the adjustment procedure.

The number of chiIclren a woman had when she

divorced had little influence on her pt-obabiiity

of remarrying during the first 5 yew-s after

divorce.

Probabilities of remarriage show a consistent

relationship with educational attainment at all

durations of divorce: the greater the education

attainment, the lower the probability of ha~ing

remarried. At the end of the first year follo~~ihg

divorce, women with less than 12 years of education were about twice as likely to have remarried as those with more than 12 years. They

were also significantly more likely to have remarried by the end of the first, second, and fifth

years after divorce, and there is evidence thut

they were more likely to have remarried by the

end of the third and fourth years. The difference

between those with less than 12 years of education and those with more than 12 yew-s ranges

from .131 at the end of 1 year of divorce to

.272 at the end of 5 years.

These substantial educational differences are

also reflected in the time it took for the probability of remarria~e to reach .50. Although the

differences w-e not statistically significant, the

median number of )’e~rs to remarriage was 2

years for women with less than 12 yews of edUcation compared with more than 4 years for

women with more than 12 years of education.

The statistical adjustment for the effects of

the other characteristics in the table has little influence on the relationship between educational

attainment and probability of remarriage (see

figure 3). M/omen with less than 12 yew-s of education remain significantly more likely thm

Figure 3. UNADJUSTED AND ADJUSTED CUMULATIVE PROBABILITY OF REMARRIAGE FOR WOMEN AGED 15.44 YEARS WHOSE 1ST MARRIAGE

ENDED IN DIVORCE, BY EDUCATION AND

NUMBER OF YEARS AFTER DIVORCE: UNITED

STATES, 1976

.90

[

.80

.20

t /4

t f’-●.*

Less than 12 years ●*.”

education -*

,.

- 12 Years

educmon

●✎

●☞

●☛

●☛☛

●✎✎

.“ ●**

●* ●.**

.* ●.*

,/

●**”

●* ●**

● ●“

●= ●*

+“

●*

.“

●*

~

●-

.’ ●*

●4 ●’

●*

●* ●*

.* J*

●*

●**

.**

I ●*

h

z-.* More than 12 years

b“ .** education

_ Unadjusted

r

.===-- Adjusted

“:L

1 2 3 4 5

YEARS AFTER DIVORCE
a&nce&a9

college-educated women to have remarried

during the first and second years after divorce,

and some evidence of a difference by the end of

the fifth year also remains. After adjustment,

the difference in remarriage probabilities between the two groups of women ranges. from

.105 at the end of 1 year to .228 at the end of

5 years.

The religion of a woman appears to have little relationship to her probability of remarrying.

Although Catholic women had consistently

lower probabilities of remarriage at every duration than Protestant women, no differences by

religion are statistically significant.

The probabilities of remarriage shown for

residents of metropolitan areas are Iower than

those shown for residents of nonmetropolitan

areas in the second through fifth years following

divorce, and there is some evidence of a difference in the first year. When the probabilities are

adjusted for the other characteristics in the table,

however, a substantial convergence occurs, with

statisticaHy significant differences remaining for

only the second and third years after divorce.

Thus, much of the residential difference in the

likelihood of remarriage was due to residential

differences in the likelihood of having the other

characteristics in the table. In particular, metropolitan residents were more Iikely than nonmetropolitan residents to be coIIege educated (about

24 percent compared with about 15 percent)

and more likeIy to be black (about 15 percent

compared with about 4 percent).

There is no consistent relationship between

geographic region of residence and the probability of remarriage. All differences for both unadjusted and adjusted probabilities are statistically

nonsignificant.

TECI-IN ICAL NOTES

SURVEY DESIGN

The National Survey of Family Growth

(NSFG) was designed to provide data on fertility,

family planning, and related aspects of maternal

and chiId health. The NSFG is a cyclic survey;

that is, data are coIlected every few years by

means of a sample survey. Fieldwork for CycIe II

was carried out by Westat, Inc., from January

through September 1976.

A multistage probability sample of women

in the household population of the conterrninous

United States was used in both cycles. Each time,

approximately 33,000 households were screened

to identify the sample of women eligible for

NSFG: women 15-44 years of age who were

either currently married, previously married, or

never married but with offspring presently living

in the household. For Cycle II, interviews were

compIeted with 3,009 black women and 5,602

women of other races. A detailed description of

the sample design for Cycle II is in preparation.

RELIABILIT.Y OF ESTIMATES

Since the statistics presented in this report

are based on a sample, they may differ somewhat from the figures that \vould have been obtained if a complete census had been taken using

the same questionnaires, instructions, intelwiewing personnel, and fieId procedures. This chance

difference between sample results and a complete

count is referred to as samp Iingerror. In addition,

the results are subject to nonsampling error due

to respondent misreporting, processing errors,

and nonresponse. it is very difficult, if not impossible, to obtain accurate measures of nonsampling errors. These types of errors were kept

to a minimum by the quality-control procedures

and other methods incorporated into the smvey

design and administration.

Sampling error, ox- the extent to which samples may differ by chance from a compltte count,

is measured by a statistic called the standard

error of the estimate. Estimates for standard
10 advancedata

errors of estimated numbers, probabilities, and

medians, all calculated by pseuctoreplication, arc

shown in tables 1 and 2.

The chances are about 68 out of 100 that an

estimate from the sample \vill differ from a complete census by less than the standard error. The

chances are about 90 out of 100 that the differences between the sample estimate and a

complete count will be less than 1.8 times the

standard error and about 95 out of 100 that the

difference will be less than 2.2 times the standard error. The relative standard error is the ratio

of the standard error to the statistic being estimated. In this report, numbers, probabilities,

and medians having a standard error more than

25 percent of the estimate itself are considered

unreliable. They are marked with an asterisk to

caution the user when interpreting results involving unreliable estimates.

In this report, terms such as “similar” and

“the same” mean that any observed difference

between two estimates being compared is not

statistically significant. Similarly, terms such as

“greater,” “less,” “larger,” and “smaller” indicate that the observed differences are st atis tically significant at the .05 level. Statements

about differences that are quzdified in some way

(e.g., by use of the phrase “some evidence”) indicate that the difference is significant at the

.10 level but not the .05 level. Significance at

the .05 level means that the difference is large

enough that in repeated samples of the same size

and type as this one, such a large difference

would be expected to be found in less than 5

percent of the samples. Significance at the .10

level means that such a large difference would be

expected to be found in less than 10 percent of

such repeated samples. The t-test (with 10 degrees of freedom) was used to test all comparisons. Lack of comment in the text does not

mean that the difference between any two

statistics was tested and found not to be significant.

Adjustment for nonsampling error due to

nonresponse is made in two ways. Nonrespon -

dent cases, as distinct from missing data items,

are imputed by weighting for nonresponse within each primary sampling unit, stratum, and agerace category. Cases with missing data are allocated among the cells of a table in proportion to

the distribution of known cases with the same

characteristics.

CALCULATION OF REMARRIAGE

PROBABILITIES

The basic statistics in this report are untidjusted and adjusted cumulative probabilities of

remarriage for selected subgroups of the population of women whose first marriage ended in

divorce. They are calculated as follows.

Unadjusted Probabilities

The unadjusted probabilities of remarriage

are calculated for each group by

(1)

(2)

(3)

Determining the conditional probability of remarriage for each of the first 5

years after divorce (the probability that

a woman will remarry during each year

given that she had not remarried during

any of the previous years).

Converting conditional probabilities of

remarriage to nonconditionzd ones (probabilities of remarrying during each year

following divorce).

Cumulating nonconditiomd probabilities

to produce cumulative probabilities of

remarriage (probabilities of remarrying

within a given number of years after

divorce).

In algebraic notation, let

x =

Mx =

Nx =

cQx =

Q. =

number of years after divorce

occurred;

number of women whose divorce occurred at least x years

ago who remarried during the

Fth year folIowing divorce;

number of women whose divorce occurred at least x years

ago who had not remarried by

the end of the xth year foHowing divorce;

conditional probability of remarriage during the xth year

following divorce;

nonconditional probability of

remarriage during the xth year

folIowing divorce; and
CUM(JX= cumulative probability of remarriage w’ith in x yew-s following divorce.

Then

CQX = MX / (.~~x + Nx ) ;

x-1

42)(= cQx (l.- ZQn); ancl

“.Q

CLWQX= “:1Q. .

The quantity described as the unadjusted

prc)bability of remarriage and discussed in detail in this report is CUMQX, the cumulative

probability of remarrying within x years folI(nving divorce.

Since C’QX is based on the marital experiences

of women who were divorced at Ieast x years before the survey date, the experiences of women

divorced less than 5 years are not represented in

all CQX values. For example, the experiences of

women divorced only 3 yew-s are included in the

calculation of CQ1 , CQ2, and C~, but not in

C~ and CQ5. Thus CIJ.\lQX is interpreted with

the assumption that women not yet divorced for

x years have the same probability of remarriage

during year x as those divorced x years or longer.

Adjusted Probabilities

The technique used to produce the adjusted

cumulative probabilities of remarriage for this

report is dummy-variable multiple regression

analysis. The effects of the adjustment m-e discussed in detail in the text, and the Ajustmcnt

procedure is discussed here.

Five sepuratc regressi[ms, one corresponding

to each 1-yew intend in the first 5 years following divorce, are used to produce the adjusted

probabilities. The dependent variable for each

intemwl-specific regrcssi(m is a dichotomous variable on which all ~w>men ~vh{)remarried during

the interval arc assi,gnect it score of 1, and all

other women are assigned a score of O. Since all

women who remarried during an intend are deleted from all regressions specific to subsequent

intervals, and since only women who were exposed to the chunces of remarriage for the entire interval we includ~d in the regression for

th~t interval, the mean value of the dependent

variable for each regression is the con ditiomd

probability of remarriage for all ~vt)men in that

interval.

The independent vuriables representing the

characteristics of women are also represented by

dichotomous, “dummy, ” \’ariables. The coefficients of these dummy independent variables

can be used to directly calculate adjusted ctmditional probabilities for women of each subgroup.

For example, adjusted conditional probabilities

for metropolitan and nonmetropolitan residents

are calculated as follows.

Let

cQx

C2X

CAQ:

.4 ~

Blx

l),x

Bix

Dix

Then

cQx

conditional probability of remarriage for all women during

the xth year foIlowing divorce;

adjusted conditional probability

of remarriage for nonmetropdi:

tan residents during the xth year

following divorce;

adjusted conditional probability

of remarriage for metropolitan

residents during the xth year

following divorce;

constant for the regression specific to the xth year following

divorce;

coefficient for the dummy inciependent variable, place of residence;

mean wdue of the dummy inckpendent variable, type of residence (\vhere metrop{)litan = I

and nonmetr{)poIitan = O);

coefficient for the ith independent variuble in the regressi(m

equation for the xth year f(d -

Iowing divt)rce; and

mean value for the ith independent variublc in the re,qmssion

for the x th year following di-

\’orce.

I-&
12 e~

where n=the number of independent ‘ year in the above manner, the crmditional

variables in the equution; probabilities are converted to nonconditional

probabilities and then to cumulative probabiliC?: = Ax +~2Bix”Dix; and ties by using the same procedure outlined for

unadjusted probabilities.

CAQ; = /fx +Blx +}2Bix.Dix

The same general procedure is used to calculate adjusted probabilities for women with other

characteristics. After adjusted conditional probabilities are determined for each subgroup and

SYMBOLS

Data not available ....................... ..................... ---

Category not applicable ................................... . . .

Quantity zero ........................ ...................... ....

Quantity more than O but less than 0.05 ......... 0,;

Figure does not meet standards of reliability

or precision ..... ........ .... ...... .. ...... .............. ...... *
FROM VITAL & HEALTH STATISTICS OF THE /UATIONAL CENTER FOR HEAL T’H STATISTICS

IJ.S. DEPARTMENT OF HEALTH, ● Public Health Serwce

EDUCATION, AND WELFARE Office of Health Research. Statistics, and Technology Number 59 ● March 28,1980

Trends in Breast Feeding’

INTRODUCTION

Findings presented in this report from Cycle

II of the National Survey of Family Growth

(NSFG) confirm a significant reversal of the

trends in breast feeding among American mothers

described in detail in an earlier report based on

CycIe I of the survey.z These data show that the

downward trend that had been in progress since

the 1950’s was reversed in the early 1970’s.

In 1973 the proportion of babies breast fed

was 25 percent; in 1975 it was 35 percent.

Breast feeding was more common among white

women than black women: 33 percent of the

babies born to white women in 1973-75 were

breast fed, compared with only 15 percent of

the babies born to black women. Also, breast

feeding was more common among women with

more years of education: 48 percent of babies

born in 1973-75 to mothers with more than 12

years of education were breast fed, compared

with 24 percent of the babies born to women

with 12 years of education or less.

These findings are based on a special analysis

of data from Cycle II, conducted in 1976 by the

National Center for Health Statistics, and are

reported in the Advance Data series because they

substantiate the tentative conclusion of the

earIier report that breast feeding was increasing.

The data were collected by personal interviews

1This report was prepared by Gerry E. Hendershot,

Ph. D., Division of Vital Statistics.

2 National Center for Health Statistics: Trends in

breast feeding among American mothers, by C. Hirschman and G. Hendershot. VitaI and Health Statistics.

Series 23-No. 3. DHEW Pub. No. (PHS) 79-1979. Public

Health Service. Washington. U.S. Government Printing

Office, Nov. 1979.

with women in a representative sample of households in the conterminous United States. Women

were eIigible for the interview if they were 15-44

years of age and either married, divorced,

widowed, or never married but with offspring

living in the household. The statistics in this

report are for babies born to women in the

sampIed population during 1973-75.

The statistics in this report may differ from

those which would be obtained from a complete

enumeration of the population because of

sampling variability. The sample desi,q, sampIing

variability, and definitions of terms are discussed

in the Technical lNotes.

To obtain information about breast feeding,

mothers were asked about each baby who had

lived with them for 2 months or more: “Did you

breast feed him (or her) at alI?” If she had breast

fed at all, she was also asked: “How many weeks

old was he (or she) when you quit breast feeding

him (or her) altogether?” Table 1 shows the

estimated number of babies born in 1973-75

and the percent breast fed at all (wholly or

partially), by year of the birth, birth order,

baby’s sex, mother’s race, and mother’s education.

FINDINGS

About 25 percent of the babies born in 1973

were breast fed, but that figure increased to

nearly 35 percent in 1975 for an average of 30

percent over the period 1973-75. Because these

estimates are based on small samples, differences

of a few percentage points may reflect chance

sampling variation, not true differences in the

population. However, the probability is less

than 0.10 that the difference between the 1973

and 1975 estimates resulted from chance. It is
2 advancedata

Table 1. Number of &bies who lived with their mother for 2 months or more and percent breast fed, by year of baby’s birth, baby’s

birth order, baby’s sex, mother’s race, and mother’s education: United States, 1973-75

Characteristic

Totall. .................. ................. ..... ...................

Birth order

Firw ................... ........................ ...... ....... ..... ...............

%cond .... ....................................................... .............

Sex of baby

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

Fernsle . .... .................... ..................... ............. .............

Mother’s race

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

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

Mother’s education

12 years or less................................................ ...... .....

More than 12 years ... ....... ................................. ... .......

Year of baby’s birth

973-75 1975 1974 1973

Number in thousands

9,379

3,903

3,068

4,689

4,690

7.743

1,425

6,978

2,383

2,939 3,269

I

1,176 1,318

960 1,175

1,424 1,704

1,515 1,564

2,401 2,761

491 458

2.162 2,410

775 852

3,171

-

1,410

934

1,561

1,610

2,581

476

2,416

755

973-75 1975 1974 1973

29.8

33.2

29.4

28.1

31.5

32.7

“14.9

23.5

48.1

Percent breast fed

w’

37.0 37.2 26.3

35.9 27.9 * 24.5

32.8 29.4 22.5

36.1 31.9 26.8

-_L1 37.8 33.6 27.1

●16.8 “15,6 ●12.3

28.2 23.6 19.2

51.9 49.9 42.2

1 Includes thud and higher order births, races other than white or black, and unknown ‘ducation”

likely, therefore, that the difference reflects a report cited before it was estimated that about

true increase in breast feeding. That conclusion

is supported by the consistency of the increase

in subgroups of the population: in every category of birth order, sex, race, and education

shown in table 1 the percent breast fed is greater

for 1975 than for 1973, although due to sampling

variability none of these individual differences

is statistically significant in itself.

The increase in breast feeding between 1973

and 1975 confirms the tentative observation in

an earlier report, 2 based on Cycle I of the

National Survey of Family Growth, that the

downward trend in breast feeding which had

been in progress since the 1950’s was reversed in

the early 1970’s. Although breast feeding still

was not as common in 1975 as it was in the

1940’s (when more than one-half of babies were

breast fed), it was more common in 1975 than

in the late 1960’s (when less than one-fourth of

babies were breast fed).

Breast feeding became more common in the

early 1970’s, but it continued to be of relatively

short duration for most babies. In the Cycle I

7 percent of babies born in 1971-73 were breas-t

fed for 3 months or more. The CycIe II estimate

of that figure in 1973-75 is about 4 percent.

While the difference between these estimates

is not large enough to conclude with statistical

confidence that there was a decrease in longer

term breast feeding, it may be concIuded that

there was no significant increase. Thus, althlough

the proportion of babies receiving some breast

feeding increased in the early 19 70’s, the proportion breast fed for long periods did not

increase. For” a large majority of breast-fed

babies, breast feeding ended before age 3 months,

much younger than the 5-6 months recommended

by pediatric authorities.3

The large differences between the breastfeeding practices of black and white women

which were found in the Cycle I report continued

in 1973-75: in each of these years, babies born

3Fomon, S. J., et al... Recommendations for feeding

normal infants. Pediatrics 63(l) :52-59, Jan. 1979.
aduancedata 3

PERCENT OF BABIES WHO WERE BREAST

FED, BY YEAR OF BABY’S BIRTH

AND MOTHER’S EDUCATION: UNITED

STATES, 1973-75

Education:

= 12 years or less

- fvbre than 12 years

6or

n

UJ

L

40

30

20

10

0

49.9

51.9

1973 1974 1975

YEAR OF BABY’S BIRTH

to white mothers in the sample were more than

twice as likely to be breast fed as babies born to

black mothers. In fact, the racial difference in

breast feeding appeared to be larger in 1975

than in 1973, akhough the increase was not

statistically significant. The difference in breast

feeding by educational attainment noted in the

earlier report also continued in 1973-75: babies

born to women in the sample with more than

12 years of education were more than twice

as likely to be breast fed as other babies. By

1974 about one-half of babies born to women

with some college education were breast fed (see

the figure). Thus breast feeding continued to be

more prevalent in relatively advantaged segments

of the population.

Differences in the percent breast fed by birth

order and sex are not large (table 1), and in no

case are they statistically significant. However,

the slightly higher percent breast fed among

first-born babies than second-born babies also

was found in the Cycle I report. This consistency

between survey findings ;S evidence that the

difference by birth order for 1973-75 shown in

table 1 is probabIy real.
4 amcdata

TECHNICAL NOTES

SAMPLE DESIGN AND RELIABILITY

OF ESTIMATES

Table 11. Provisional approximate standard errors expressed in

percentage points for estimated percents of babies: National

Survey of Family Growth, 1976

In Cycle H of the National Survey of Family

Growth interviews were conducted with women

living in househo~ds selected by a multistage area

probability design. Sampling and interviewing

were done by Westat, Inc., from January through

September 1976. About 93 percent of sample

households (33,000) were successfully screened

for eligibIe women, and about 88 percent of

identified eligible women (8,6 11) were interviewed, an overall response rate of about 82 percent. The statistics in this report are estimates

for the national population and were computed

by multiplying each sampIe case by the number

of women she represented in the poptdation.

The mt.dtipliers, or “weights,” ranged from 647

to 43,024 and averaged 3,822.

Because the estimates are based on a sample

rather than the whole population, they are subject to sampling variability, chance differences

between the sample estimate and the actual

population vaiue. SampIing variability is measured by a statistic calIed the standard error.

Provisional ap~roximate standard errors for

numbers and percents of babies are shown in

tabIes I and II. Because of different sampling

rates for the sampIes of black women and

white women, standard errors for statistics

based on these two racial groups are somewhat

different. The estimates in tables I and II should

be multiplied by 1.05 for black women and by

0.97 for white women. Estimates for numbers

and percents not shown in the tables may be

approximated by interpolation. In this report

statistics whose standard error was 25 percent

Table 1. Provisional approximate standard errors for estimated

numbers of babies: National Survey af Family Growth, 1976

I

Size of estimate I

Standard

error

5oo.ooo .................................................................. 113,000

1.ooo.ooo ............................................................... 159,000

2.500.000 ............................................................... 251,000

5.000.000 ............................................................... 351,000

70.000.000 ............................................................. 485,000

‘arcent kR%i%k- Base of

700,000 ................................. 5.8 7.6 8.7 9.4 9.6

1,000,000 .............................. 4.8 6.4 7.3 7.8 8.0

3,000,000 .............................. 2.7 3.7 4.3 4.5 4.6

7,000,000 .............................. 1.9 2.4 2.7 2.9 3.1

10,000,000 ............................ 1.5 2.1 2.3 2.5 2.5

or more of the estimate itself’ were considered

unreliable, and they w-e marked with an asterisk.

Unreliable estimates should be used only with

great caution.

The differences between statistics in this

report are also subject to sampling variability.

AII differences mentioned in the text were

tested for statistical significance. If a difference

is asserted without qualification in the text, it

is significant at the 0.05 level—there is less than

1 chance in 20 that the difference resulted from

a chance sampling fluctuatio~ Where a significance IeveI of 0.10 was used—less than 1 chance

in 10 that a difference occurred by chance—that

is specified in the text. Differences described as

“not statistically significant” could have occurred

by chance in more than 10 percent of repeated

samples. Absence of comment about a difference

does not necessarily mean that it was tested and

found to be not statistically si~ificant.

Estimates of numbers of babies shown in

this report may differ from numbers of births in

the same period obtained from the vital registration system for several reasons: ( 1) These estimates are based on a sample, while the birth

registration system is a mechanism for registering

aII births occurring within the United States; (2)

the sampIe did not include AIaska and Hawaii,

miIitary bases, group quarters, or institutions;

(3) babies born in the period who did not live

with their mother for at least 2 months after

birth are not included in this report. For numbers

of births, Volume I of Vital Statistics of the

United States for 1973, 1974, and 1975 shcluld

be consulted.
danceda5

DEFINITIONS OF TERMS

Breast feeding. -Babies who lived with their

mothers for at least 2 months after birth and

whose mothers reported they had been breast

fed “at all” are classified as having been breast

fed. Included in this definition are both “longterm” breast feeding (3 months or more) and

“short-term” breast feeding (less than 3 months)

and both supplemented and unsupplemented

breast feeding.

Race. –Classification of the race of the respondent as white, black, or other is based on

observation by the interviewer.

Education. –Women are classified according

to the highest year of regular schooling they

reported having completed.

Birth order. –Babies are classified according

to their numerical order among the live births

reported by their mother—first, second, and so

on. Babies within multiple live births are assumed

to have been born in the order reported by their

mother.
6 advancedata

SYMBOLS

Data not available -—. . ..-

Category notapplicable——— . . .

Quantity zero————

(Quantity more than Obut Iess than 0.05-— 0,0

Figure does not meet standards of

reliability or precision (more than

30 percent relative standard error)—— *
FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS

U.S. DEPARTMENT OF HEALTH, . Publ IC Health Serwce

EDUCATION, AN(I WELFARE Office of Health Research, Stam.ucs, and Technology Number 80 ● April 23,1980

1978 Summary:

National Ambulatory

During 1978 an estimated 584.5 miIlion office visits-an average of 2.8 per person per

year-were made to nonfederally employed,

office-based physicians in the conterminous

United States. These and other estimates presented in this report highlight the findings of

the National Ambulatory Medical Care Survey

(NAMCS), a probability sample survey conducted yearly by the Division of Health Resources Utilization Statistics of the National

Center for Health Statistics. With cooperation

from the American Medical Association and

the American Osteopathic Association, the

survey sample is selected from a list of nonfederally employed doctors of medicine and

osteopathy who are principally engaged in

office-based practice. In its current scope,

NAMCS excludes physicians practicing in

Alaska and Hawaii and physicians whose specialties are anesthesiology, patholo~q, or radiology.

Figure 1 is a fkcsimile of the 1978 Patient

Record used by participating physicians to

record information about their office t’isits.

The body of the report consists of 9 tables

desiLgned to supply data on various aspects of

office-based ambuIato W care, as follows:

1This report was prepared by Hugo Koch and

Thomas McLemore, Division of Health Resources Utilization Statistics.

Medical Care Suweyl

Table 1: Physician speciaIty

practice

and type of

Table 2: Sex, age, and race of patient

Table 3: ReferraI information, time since :

onset of compIaint, and prior visit

status

Tables 4

and 5: Reason for the visit expressed by

the patient

Tables 6

and 7: Diagnosis rendered by the physician

Table 8: Diagnostic and therapeutic services

ordered or provided

Table 9: Seriousness of the problem and

duration and disposition of visit

Since the estimates presented in this report

are based on a sarnpIe rather than on the entire

universe of office-based physicians, the data are

subject to sampling variability. The Technical

Notes at the end of this report provide a brief

explanation and guidelines for judging the

precision of the estimates presented. A more

detailed description

finitions of certain

have been published.~

9

“lNational Center for

of th~ sample and determs used in NA31CS

Health Statistics: The National

Ambulatory NIedical Care Survey, 1975 Summary,

United States, January-December, 1975, by H. Koch and

T. Nlc Lcmore. C’ital and Health Statistics. Series 13-No.

33. DHEW Pub. No. (PHS) 78-1784. Public HeaIth

Service. Washington. U.S. Government Printing Office,

Jan. 1978.
2 adwlncedata

I

L

Figure 1. 1978 PATl ENT RECORD

ASSURANCE OF CONF ID ENTIA LIT Y-AI I Inform.xlon which would Wrmn M8ntlfk.tion of ● mdlvkav.1,

. Pr.ctl”, O. . . ..ut.lkhm.m WSI1ix h.ld .O.tid.ntl.1, wIII M .Ud onlv bv o.-.. .. LI..w.J1. .nd for D

m. c.ufwn.s 01 tho S.W.V ●a wIII not b. dlsclond or r.1..nd m otti mrwns or uud for .nv othw Purpom.

1. DATE OF VISIT PATIENT RECORD

.*

NATIONAL AMBULATORY MEDICAL CARE SURVEY

2. DATE OF BIRTH 3. SEX 4. COLOR OR 5. WAS PATIENT 6. PATIENT’S COMPLAINT(SL SYMPTOM(SI. OR oTHER

RACE REFERREO FOR REASON(S) FOR TNIS VISIT

THIS VISIT BY (In pmimt’c own wrds)

z7%-

I ❑ wHITE ANOTHER

1 ❑ FEMALE z ❑ NEGRO/ PUYSICIAN? ,. MOST

TIME OF

SLACK IMPORTANT

2 ❑ MALE I D YES

VISIT s a OTHER b. OTHGR

. 0 UNKNOWN ,ONO

*J= 7. TIME SINCE ONSET 8, PHYSICIAN’S DIAGNOSES 9. HAVE YOU SEEN 10. SERIOUSNESS OF

OF COMPLAINTI PATIENT EEFORE7

SYMPTOM IN ITEM 6s

CONDITION IN

●. PRINCIPAL OIAGNOSIS/PR06LEM ASSOCIATED WITH

mm (Cfnsk one) lTeM 6-

ITEM Ss Chssk GIW)

I ❑ YES ,ONO

, ~ LESS THAN 1 OAY

+

1 a vERY SERIOUS

IF YES, FOR THE

.. ●.= I ❑ sERiOUS

2 u 1.6 OAYS

CONDITION IN

b. OTHER SIGNIFICANT CURRENT DIAGNOSES ITEM S.?

* ~ 1-3wEEKS

~u

m

SUGHTLY

Sf Fuous

● O t-3MONTHS ● ~ NOT SE R1OUE

*m.

$ a YES 2DN0

Scl

MORE THAN

3 MONTHS

P.m. * u NOT APPLICABLE

,,m 11. DIAGNOSTIC SERVICES THIS 12. THERAPEUTIC SERVICES THIS 13. OISPOSITION THIS VISIT 14. OURATION OF

VISIT (Cimk ●ll oral-d or wovidsdl VISIT (Clwsk ●l) ordwsd or provtid) (Ch8ck #/i th.t ●I7PIV) THIS VISIT

I ❑ NONE I ~ NONE

n-ins @aullv

pm

1 ~ NO FOLLOW-UP PLANNEO

1 n LIMITEO EXAM/HISTOfl V

* O lMMUNlZA710N/

SPRW with

1 ~ GENERAL EXAMIHISTORY

DESENSITIZATION i D HETURN AT SPECIFIED TIME Phpitiwl

● m ● ~ PAP TEST

~ a DRUGS [PRESCRIPTION/ S O RETURN IF NE EOEO, P.R.N.

NONPRESCRIFTIONI

s D CLINICAL LAB TEST 4 ❑ TELEPHONE FOLLOW-UP PL.ANf4E0

. ~ DIET COUNSELING

* ❑ X. RAY

0.m.

s ❑ FAMILY ● LANNING i D REFERREO TO OTHER PHYSICIAN

T ~ EUG

MI IUUTES

t ❑ MEDICAL COUNSELING

6 ~ VISION TEST 7 ❑ PHYSIOTHERAPY

4 0 ‘ETURNED 70 REFERRING PHYSICIAN

9 a ENDOSCOPV * ❑ OFFICE SURGERY

1. n BLOOD PRESSURE CHECK

7 a AOMIT TO HOSPITAL

* ❑ ?sYcIIoTHERAPY/

“ a oT14Ef! (EfJscifv)

t t ~ OTHER (SpsCifV) THERAPEUTIC LISTENING

, , ❑ OTHE PI($~,fy)

HRA-34.2

REV. 9-76

PEPA~NT OF HEALTH, EDUCATION AND WELFARE O.M.& #68-il149m

PUa LIC HEALTH SERVICE

HEALTH F4ESOURCES ADMINISTRATION

NATIONAL CENTER FOR HEALTH STATISTICE
adwmxMa3

Table 1. Number and percent distribution of office wsits, by

physician specialty and type of practice: United States, 1978

Table 2, Number and percent distribution of office visits and

number of office visits per person, per year, by race, age, and

sex of patient: United States, 1978

percent

distribution

Number Percent

of visits distribution

in thousands

584,498 100.0

Physician characteristic Number of

visits per

person

par year

Number of

visits in

thousands

Patient characteristic

All visits ............... ... ,

All visits .. ....

I

584,498 100.0

89.0

11.0

183

14.8

26.3

24.2

16.1

59.8

2.8

Physician specialty

Race

White .....-r.............. ........ 520,435

All other races ............. 64,063

General and family practice ....

Medical specialties. ................. .

211,017 36.1

170,479 29.2

2.8

2.2 Internal medicine ..............

pediatrics ... ..... ..... .......... ...

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

68,331 11.7

60,159 10.3

41,989 7.2 Age

Under 15 years ............ 108,917

15-24 years ... .... ........... 86,495

25-44 years .................. 153,655

45-64 years .............. .... 141,508

65 years and over ......... 93,924

Surgical specialties .................. 179,805 I 30.8 2.2

2.2 ;

2.7

3.3

4.?

General surgery .................

C)batetricsand gynecology..

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

33,089 5.7

55,139 9.4

91,567 15.7

Other specialties ...... ........... .... 23,196 I

4.0 Sex and age

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

F

349.244

Under 15 years ..... ...... . 52,102

15-24 years ........... ....... 55,181

25-44 years ............ ..... 100,736

45-64 years .................. 83,986

65 years and over ... ...... 56,230

Psychiatry ..........................

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

15,316 2.6

7,880 1.4

3.7

8.9

9.6

17.2

14.4

9.6

40.2

9.7

5.2

9.1

9.8

6.5

2.6

3.3

4.0

4.2

4.6

Type of practice

.%10........................................

Otherl ............................... .....

Male ....................... 235,254 2.6 1 Includes partnership and grou P Practice.

Under 15 years .... ........

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

2544 years, ........ .........

45-64 years ........ ..........

65 years and over .........

56,815

30,314

52,919

57,511

37,694

2.7

1.8

2.2

3.1

4.5
4 aduancedata

Table 3. Number and percent distribution of office visits, by patient’s referral status, time since onset of complaint or symptom, and

patient’s prior visit status: United States, 1978

Vistt charactei-l~tlc

All visits .......................... ....................................... .... .. .................... ........................c...

Referral status

Referred by another physician ........ ..... .... ..................... ................ .................. ...................... ...... .

Not referred by another physician .............. .............. ...................... .... ...................... ............ .......

Time since onset of complaint or symptom

Less than 1 day ............. ............. ........... ...... .................................... .... ................ ...... ...... ...... ..... ..

l.6days .............. ............................. ................... ...... .... ........ .. ........ ...... ...... .... .......... ...................

1-3 weeks ........................ ...... ..... .......................... ................ .................... .. .................... .............

1-3 months .............................. ........ ...................................................... ................ ......................

More than 3 months ........ .... .. .. ............ ...... ...................................... ................ ........... ..... ............

Not applicable ..................... .... ............ ...... .... ................ ...... .............. ....................... ..... ............

Prior visit status

New patient ......... ...... ...... ............ ......... ................ .................... ..... .. .... ........ .................... ............

Old patient ................ .......... ........... .. ........ ........................ .............. ...... ...... .................................

New problem ........................................... ....... ...... ........ ........ ...... .......... .................. ..... .....

Old problem ......... .. ................ ........ ...... ...... ...... ................ ..... ....... ........... ......... .... .... .........

Number of

visits in

thousends

584,498

28,568

555,930

23,706

126,892

87,808

75,861

188,667

70,564

87,386

497,112

142,528

354,584

Percent

distribution

100.0

4.9

95.1

4.1

21.7 ~

15.0

13.0

34.2

12.1

15.0

85.1

24.4

60.7

l[ncludes ~hjefly visits not in~olving a symptom orcompbint, e.g., annual examination, \vell-buby examination.
dmceckm 5

Table 4. Nufierand ~rcentdistribution ofoffice visits, bythepatient's principal reason forvisit and NAMCSmde: United States, 1978

Principal reason for visit and codel

All reasons for visit . ..... .......... ........... ................... ............. ... .......... .. .... .................... ...

Symptom module ....................... ...... .......... ...... .......... ........ ..... ..... .... ............. ..... ....... S001 -S999

General symptoms ... ..... ... ............... .......... ...... .............. .... .... ..... ........................ ....... S001 -S099

Symptoms referable to psychological and mental disorders ........ .......................... S1 00-S1 99

Symptoms referable to the nervous system (excluding sense organs) ... .. .......... ..... S200-S259

Symptoms referable to the cardiovascular and Wmphatic systems ........................ S260-S299

Symptoms referable totheeyes and ears ....... .. .......... ........... ....... ... ............ ..... .... S3OO.S399

Symptoms ref~rable to the respiratory system ............ .... ..... ................ ................ S4C43-S499

Symptoms raferable to the digestive system .... ................ ........ .. ...... ..................... S500-S639

Symptoms referable to the genitour’nary system ................................................. S640-S829

Symptoms referable to the skin, nai s, and hair ....... ... .... ............... .. .............. ...... S830-S899

Symptoms rafereble to the musculoikaletal system ........ ..................... ........ ......... S900-S999

Disea= module ......... ............... .... ... ..... ................................................ ................ .... 0001-0999

Diagnostic, screening, artd preventive module ............... ........................ ........ .... ....... Xl 00.X599

Treatment tiule .............. ... ........ ................................... .. ................... ..................Tl 00-T899

Injuries and adverse effects module .... .. .... ................................................................. JOO1-J988

Teat results module ........ ................ ..... ...... ...................... ................ ...... .................. R700-R700

Administrative module ... .. .................... ...... ...... ............ .... .. .... ......... ....... .. .... . ......... A1OO.A14O

0ther2 .............. ...................................................................................................... U980-U999

Number of

visits in

thousznds

584,498

330,131

50,505

15,605

18,025

3,438

34,570

64,017

27,528

27,508

33,567

55,367

47,424

v07,246

55.177

Percent

distribution

100.0

56.5

8.6

2.7

3.1

0.6

5.9

11.0

4.7

4.7

5.7

9.5

8.1

18.4 ;

9.4

23,880 4.1

3,622 0.6

8,626 1.5

8,282 1.4

lNati~nal Center for Health Statistics: A reason for visit classification for ambulatory care, by D. Schneider, L. Appletmand T.

McLemore, Viral and Health Statistics. Series 2-No. 78, DHEW Pub. No. (PHS) 79-1352, Public Health Service. Washington. U.S.

Government Printing Office, Feb. 1979.

21ncludes blanks, problems and complaints not elsewhere classified, entries of “none, ” and illesibie entriesTable 5. Nufierof office visits bythe20 mMcommn principal symptoms and NAMCScode inrank order: UnmxStates,1978

Rank

1

:

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

fvbst common principal symptom and codel

Symptoms referable to thrmt ................ ............. ...... ............ ........ .. ...... .... ...... ...... ...... ... ........... .. .... ....S455

Cough . ...................... ....... ..... ..... .................... ..... ........... .... ............ ...................... .... .......................... S440

Back symptoms ........... ..... ........... .................. ....................... ........... ...... ...... .... ...... .... .. ...... .... .... .......... S805

Skin rash................................................................................................................................ ............. S860

Haad cold, uPPer respiratory infaction .. .. .... ...... ...... ............ ............ ...... .......... ...... .... .......~.. .......... .. ...SM5

Earache, or ear infection . ................. ............... .... ............ .... .. .......... .... ........ .......... .. .. .... .. ...... .... ...... ... S355

Cheat pain and related symptoms (not referable to body system) . ...... ...... ...... .... ...... ...... .......... ...... .. S050

Vision dysfunctions ............ .............. ................................... ...... ..... ....... .... ...... ........ ...... .................... .S305

Headache, pain in haad ........ .................... .......... ...... ....... ..... ...... ................ ...... ...... .... .......... ..... ..........s27o

Abdominal pain, cramps, spasms........................................................................................................S55O

Fever .......................................................................................................................................... ........ sol o

Weight gain .........................................................................................................................................SMO

Anxiety and nervousness . ....................... ..... ....... .................. ...................... ..... ..... .......... ................ ....Sl 00

Venigo.dzziness .............................. ............ .......... ..........$. ...... ............ .... ...... .... .......... .......... ...........S225

Knee symptoms .... .... .. ..... ........... .................... .............. ............ ...... ...................... .... ...... .... ...... .. ........ S925

Nesel congestion ... ..... ....................... ........ .............. ........ .......... ...... ...... ...... .... .......... ...... .... .. .... .......... S400

Lag symptoms .............. .... ..... ................. ................ ......................... ........... ...... .... .... .......... ................S92O

Acne or pimples .. ..... ....... ............................ .. ............................ ............ .... ...... ..... ........... .... ...... .........S83O

Low beck sympmms .. ..... ...... .............. .... .......... ...... .............. ................ ...... .... .......... ........... ...... ..... ....S9l O

Neck symptoms ..................................................................................................................................SWO

Number of

visits in

thousands

17,356

15,122

11,811

10,522

10,111

9,850

9,693

8,980

8,884

8,852

8,558

8,237

5,929

5,565

5,500

5,432

5,314

5,226

5,050

4,799

lNational Center for Health Statistics: A reason for visit classification for ambulatory care, bv D. Schneider, L. APPleton. and T.

McLemore, Vital and Health Statistics. Series 2-No. 78, DHEW Pub. No. (PHS) 79- I 352, Public Health Service. Washington. U.S.

Governmerit Printing Office, Feb. 1979.
6 advancedata

Table 6. Number and percent distribution of office vis]ts, by principal diagnosis and ICDA code: United States, 1978

Principal dlagnosls and ICDA codel

All diagnoses.. ........................ .........................................................................................

Infective and parasitic diseases, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...000.136

Neoplasm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...140-239

Endocrine, nutritional, and metabolic diseases . . . . . . . . . . . . . ,240.279

Mental disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...290.315

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

Diseases of the circulatory system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...390-458

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

Diseases of thedigestive system,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...520.577

Diseases of thegenitourinary system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..580$29

Diseases of the skin and subcutaneous tissue . . . . . . . . . . . . . . . . . , . . . . . . . .680.709

Diseases of themusculosketal syqtem. . . . . . . . . . . . . . . . . . . . . . ., ..,.,....710.738

Symptoms andill-defined conditions. . . , . . . . . . . . . . . . . . . . . . . . . . . . . .780.796

Accidentsr poisonings, andvlolence. . . . . . . . . . . . . . . . . . . . . , . . , . .800.999

Spatial conditions and examinations without sickness . . . . . . . , . . . . . , . . . . YOO-Y13

Another diagnosas2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Number of

visits in

thousands

584,498

22,964

16,095

25,224

22,896

54,319

55,167

83,290

20,109

34,751

37,519

31,874

26,227

46,896

85,581

8,201

Percent

distribution

100.0

.—

3.9

2.8

4.3

3.9

9.3

9.4

14.3

3.4

6.0

6.4

5,5

4.5

8.0:

14.6

1.4

lf.Jationa] Center for Health Stati5cics: Eighth Revision Inremafional Claxdficarion of Diseases, Adapted for use in the Unircd SrareS.

PHS Pub. No. 1693, Public Health Service. Washington. U.S. Government Printing Office, 1967.

z[n~l~des z80.2s9, diseases of the blood and blood-forming organs; 630.678 complications of pregnancv, childbirth. and the

puerperium: 740-759, congenital anomalies; 760-779, certain causes of perinatal mo’rbidit y and mortality; blank diagnosis; noncodahle

diagnosis; and illegible diugnosls.

Table 7. Number of office visits by the 20 most common principal diagnoses and ICDA code in rank order: United States, 1978

Rank

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Most common principal diagnosis and ICDA codel

Medical or special examination. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YOO

Essential benign hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...401

Prenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Y06

Acute upper respiratory infections of multlple or unspecified sites. . . . . . . . . . . . . . . . . . 465

Otitismedia without mention ofmastoiditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381

Neuroses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .300

Chronic ischemic heart disease.. . . . . . . . . . . . . . . . . . ...’ . . . . . . . . . . . . . . . ...412

Hay fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...507

Other eczema and dermatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...692

Medical andsurgical aftercare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..Y1O

Refractive errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...370

Acute pha~ngitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .462

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...250

Diseases of sebaceous glands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...706

Bronchitis, unqualified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...490

Sprains andstrains ofother andunspecified pares of back. . . . . . . . . . . . . . . - . . . . . 847

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...493

Synovitis, bursitis, andtenosynovitis . . . . . . . . . . . . . . . . . . . . . . ...-...........731

Observation, without need for further medical care . . . . . . . . . . . . . . . . . . . . 793

Other viral diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...-.....079

Number of

visits in

thousands

41,317

24,086

22,610

16,487

13,350

11,556

11,295

1,035

0,998

0,754

0,251

9,482

8,649

8,656

8,184

5,777

5,575

5,567

5,010

4,945

lNational Cen*erfor Health Statisti~s: Eighrh ReviSjon Intern= rionai Cl~$Sifi~~rion of Diseases, AdUpted for usein ?/ze UnitedStates.

pHSpuh, No 1693, ~“bji~Health servi~e, Washington, u,s.c~vernme”t printing office, 1967.
admncedata 7

Table8. Number and percent of of ficevisits, by diagnostic and

therapeutic services ordered or provided: United States, 1978

Diagnostic and therapeutic

services ordered or provided

Diagnosuc serwces

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

Limited examlnat!on ................

General examination ................

Pap test ..... ...............................<

Clinical lab test .. ...... .................

X-ray ........... ........... ..................

Electrocardiogram .......... ..........

Vision test ............................ ....

Endoscopy .............. ...... ...........

Blood pressure check ...............

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

Therapeutic services

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

Immunization or

desensitization . ........ .......... .... .

Drugs (prescription or

nonprescription) ... ..................

Diet counsel ing ................ .........

Famdy planning ......................

Medical counseling ....... .. .... .....

Physiotherapy .........................

Office surgery .........................

Psychotherapy or therapeutic

listening .................................

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

Number of

visits in

thousands

53,252

361,404

124,266

28,376

121,823

47,937

20,075

28,049

6,028

194,556

23,542

114,983

45,658

302,604

43,209

8,354

113,285

21,231

45,197

29,300

14,920

Percent

of

visits

9.1

61.8

21.3

4.9

20.8

8.2

3.4

4.8

1.0

33.3

4.0

19.7

7.8

51.8

7.4

1.4

19.4

3.6

7.7

5.0

2.6

Table 9. Number and percent distribution of office visits, by

seriousness of condition and disposition and duration of

visit: United States, 1978

Visit characteristic

All waits. ............... ...

SeriOUSne55 of Corrrjitlonl

Serious and very serious ...........

Slightly serious ......... ...............

Not serious ...... ...... ...................

Disposition of visit2

No followup .. .......................... .

Return at specified time ...........

Return if needed ............... .... ...

Telephone followup planned ....

Referred to other phys{c!an .... .

Returned to referring

physician ........................ .........

Admit to hospital ....... ..... .........

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

Duration of visit3

O minutes .................. ................

1-5 minutes ...............................

6-10 minutes ............... ..............

11-15 minutes ................... .. ......

16-30 minutes ......... .... ..............

31 minutes or more ...... ...... .......

Number of

visits In

thousands

584,498

108,909

i 86,918

288,671

65,234

353,784

131,078

21,627

14,285

4,226

13,200

5,032

19,696

89,753

170,829

156,935

114,730

32,496

Percent

distribution

100.0

18.6

32.0

49.4

11.2

60.5

22.4

3.7 ~

2.4

0.7

2.3

0.9

3.4

15.4

29.2

26.9

19.6

5.5

lTh~ physicj~n,s judgment w, to the degree tlf impairment

that might result if no treatment were given.

Zw{]l not add to 100.O since more than one disposition ~~us

Pns$h’e’ ~

0 nsmutes represents visits ~t which there was no face. tn.

face contact between the patient and the physicion. The mmn

duration of the visits that did involve physician-patient contact

was 1S.3 mmutes.
8 ZKhQncedata

TECHNICAL NOTES

SOURCE OF DATA AND SAMPLE DESIGN

The information presented in this report

is based on data collected in the National

Ambulatory Medical Care Survey (NAMCS)

during 1978. The target universe of NAMCS

encompasses office visits within the conterminous United States made by ambulatow patients

to non federally employed physicians who are

principally engaged in office practice. The

National Opinion Research Center, under

contract to the National Center for Health

Statistics, was responsible for the survey’s field

operations.

The NAMCS utilizes a multistage probability

design that involves samples of primary sampling

units (PSU’S), physicians’ practices within PSU’S,

and patient visits within practices. For 1978 a

sample of 3,007 non-Federal, office-based physicians was selected from master files maintained

by the American Medical Association and American Osteopathic Association. The physician response rate for 1978 was 72.8 percent. Sampled

physicians were asked to complete Patient Records (figure 1) for a systematic random sample

of office visits taking place within their practice

during a randomly assigned weekly reporting

period. During 1978, 47,291 Patient Records

were completed by sampled physicians.

SAMPLE ERRORS AND

ROUNDING OF NUMBERS

The standard error is primarily a measure

of the sampling variability that occurs by

chance because only a sample, rather than the

entire universe, is surveyed. The relative standard error of an estimate is obtained by dividing

the standard error of the estimate by the estimate itself and is expressed as a percentage o f

the estimate. Relative standard errors of selected

aggregate statistics are shown in tables I and

II. The standard errors for estimated percentages of visits are shown in tables III and IV.

Estimates of office visits have been rounded

to the nearest thousand. For this reason detailed figures within tables do not always add to

totals. Percents were calculated on the basis of

original, unrounded figures and will not neces -

sarily agree precisely with percents calculated

from rounded data.

Table 1. Approximate relative standard errors of estimated’

number of office visits based on all physician specialties:

NAMCS, 1978

~—

Fielativa

Estimated number of office sltanda rd

visits in thousands error in

percent

5oo ........................................................................... 25.8

1.ow ........................................................................ 18.4

2.0m ........................................................................ 13.3

5.0m ........................................................................ 9.0

lo.om ...................................................................... 7.0

20.0m ...................................................................... 5.7

50.000 ...................................................................... 4,8

loo.ooo .................................................................... 4.4

5oo.ooo .................................................................... 4.1

Example of use of table: An aggregate of 75.000,000 visits has is

relative standard error of 4.6 percent or u standard error of

3,450,000 visits (4.6 percent of 75,000,000).

Table II. Approximate relative standard errors of estimated

number of office visits based on an individual physician

specialty: NAMCS, 1978

~~

R(elative

Estimated number of office standard

visits in thousands error irl

pwcent

mo ....................................d.....................c............... 28.5

l.ooo ....................................................................... 21.0

2.000 ....................................................................... 15.9

5.000 ....................................................................... 11.9

lo.mo ..................................................................... 10.2

20.000 ..................................................................... 9.2

50.mo ..................................................................... 8.6

lm.ooo ................................................................... 8.3

2oo.ooo ................................................................... 8.2

Example of use of table: An aggregate of 15,000,000 visits has a

relative standard error of 9.7 percent or a standard error of

1,455,000 visits (9.7 percent of 15,000,000).
achfancedata 9

Table II 1. Approximate standard errors of percent of estimated

numbers of office visits based on all physician specialties:

NAMCS, 1978

Base of percent

(number of office

visits in thousands)

500..., ...........................

1,000., ..........................

2,000 ............................

5,000 ............................

10,000 ..........................

20,000 ..........................

50,000 ..........................

100,000 ........................

500,000 ........................

Estimated percent

1 or 5 or lOor 20 or ’30 or 50

99 95 90 80 70

Standard error in percentage points

2.5

1.8

1.3

0.8

0.6

0.4

0.3

0.2

0.1

—

5.5 7.6

3.9 5.4

2.8 3.8

1.8 2.4

1.2 1.7

0.9 1.2

0.6 0.8

0.4 0.5

0.2 0.2

10.2

7.2

5.1

3.2

2.3

1.6

1.0

0.7

0.3

11.7

8.2

5.8

3.7

2.6

1.8

1.2

0.8

0.4

12.7

9.0

6.4

4.0

2.8

2.0

1.3

0.9

0.4

Exmrpfe of use of table: An estimate of 30 percenr bused on m

aggreiiate if 15,000,000 visits has a standard error of 2.2 percent

or J relative standard error of 7.3 percent (2.2 percent + 30

pwcen t).

Table IV. Approximate standard errors of percent of estimated

numbers of office visits based on an individual physician

specialty: NAMCS, 1978

—

Base of percent

(number of office

visits in thousands)

500 ................................

1,000 .............................

2,000 .............................

5,000 .............................

10,000 ...........................

20,000 ...........................

50,000 ...........................

100,000 .........................

200,000 .........................

Estimated percent

Ior 5or 10or 200r 300r so

99 95 90 80 70

1 I 1 1

Standard error in percentage points

2.7

1.9

1.4

0.9

0.6

0.4

0.3

0.2

0.1

6.0 8.2

4.2 5.8

3.0 4.1

1.9 2.6

1.3 1.8

0.9 1.3

0,6 0.8

1-

0.4 0.6

0.3 0.4

10.9

7.7

5.5

3.5

2.4

?.7

1.1

0.8

0.5 1

12.5 13.7

8.9 9.7

6.3 6.8

4.0 4.3

2.8 3.1

2.0 2.2

1.3 1.4

0.9 1.0

0.6 0.7

Exarrmsfe .- of use of rabfe: An estimate of 90 percent hwed on an

uggregate of 7, Sob.000 visits has a standard tkor OF 2.2 percent.

or a relative standard error of’ 2.4 percent (2.2 percent + 90

percent).

DEFINITIONS

Ambulatory patient. –An ambulato~ patient is an individual presenting himseif for

personal health services who is neither bedridden

nor currentIy admitted to any health care

institution on the premises.

Office. –An office is a place that the physician identifies as a location for his ambulatory

practice. Responsibility over time for patient

care and pro fessional services rendered there

generally resides with the individual physician rather than an institution.

Visit. –A visit is a direct personal exchange

between an ambulatory patient and a physician

or a staff member working under the physician’s

supervision for the purpose of seeking care and

rendering health services.

Physician. –.4 physician is a duIy licensed

doctor of medicine (}I.D.) or doctor of osteopathy (D.O. ) currently in office-based pmc -

tice who spends time in caring for ambulatot~

patients. Excluded from NALICS are physicians

who are hospitaI based; physicians who specialize in anesthesioIo~, pathology, or radioIo,q:

physicians who are federally empIoyed; physicians who treat only institutionalized patients;

physicians employed fulI time by an institution;

and physicians \vho spend no time seeing

arnb ulatory patients.

* U.S. GOVERNMENT PRINTINGOFFICE: 1991–2 81 -798 / 400 ~ 4
Vital and Health Statistics

series description

SERIES 1.

SERIES 2.

SERIES 3.

SERIES 4.

SERIES 5.

SERIES 6.

SERIES 10.

SERIES 11.

SERIES 12.

SERIES 13.

SERIES 14.

Programs and Collection Procedures–Reports

describing the general programs of the National Center for

Health Statistics and its offices and dwisions and the data

collection methods used. They also include definitions and

other material necessary for understanding the data.

Data Evaluation and Methods Research - Studies of new

statistical methodology including experimental tests of new

survey methods, studies of vital statistics collection

methods, new analytical techniques, objective evaluations

of reliability of collected data, and contributions to statistical

theory. Studies also include comparison of U.S.

methodology with those of other countries.

Analytical and Epidemiological Studies – Reports

presenting analytical or interpretwe studies based on vital

and health statistics, carrying the analysis further than the

expository types of reports in the other series.

Documents and Committee Reports– 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.

Comparative International Vital and Health Statistics

Reports - Analytical and descriptive reports comparing

U.S. vital and health statisticswith those of other countries.

Cognition and Survey Measurement – Reports from the

National Laborato~ for Collaborative Reserach In Cognition

and Survey Measurement using methods of cognitwe

science todesign, evaluate, and test survey instruments.

Data From the National Health Interview Survey –

Statistics on illness, accidental Injuries, disabdity, use of

hospital, medical, dental, and other services, and other

health-releated topics, all based on data collected in the

continuing national household interwew survey.

Data From the National Health Examination Survey and

the National Health and Nutrition Examination Survey–

Data from direct examination,testing, and measurement of

national samples of the civilian noninstitutionalized

population provide the basis for (1) estimates of the

medically defined prevalence of specific diseases in the

United States and the distributions of the population with

respect to physical, physiological, and psychological

characteristics and (2) analysis of relationships among the

various measurements without reference to an explicit finite

universe of persons.

Data From the Institutionalized Population Surveys -

Discontinued in 1975. Reports from these surveys are

included in Series 13.

Data on Health Resources Utilization – Statistics on the

utilization of health manpower and facilities providing longterm care, ambulatory care, hospital care, and family

planning services.

Data on Health Resources: Manpower and Facilities –

Statistics on the numbers, geographic dlstributlon, and

characteristics of health resources including physlclans,

dentists, nurses, other health occupations, hospitals,

nursing homes, and outpatient facdities.

SERIES 15

SERIES 16,

SERIES 20,

SERIES 21.

SERIES 22.

SERIES 23,

SERIES 24.

Data From Special Surveys– Statistics on health and

health-related top!cs collected in special surveys that are

not a part of the continuing data systems of the National

Center for Health Statistics.

Compilations of Advance Data From Vital and Health

Statistics – These reports provide early release of data

from the National Center for Health Statistics’ health and

demographic suweys. f,lany ofthese releases are followed

by detailed reports in the Vital and Heath Statistics Series.

Data on Mortality –Various statistics on mortality other

than as included in regular annual or monthly reports.

Special analyses by cause of death, age, and other

demographic variables; geographic and time series

analyses; and statistics on characteristics of death not

available from the vitral records based on sample surveys

of those records.

Data on Natality, Marriage, and Divorce-Various

statistics on natality, marriage, and divorce other than as

included in regular annual or monthly reporta. Special

analyses by demographic variables; geographic and time s

series analyses; studies of fertility and statistics on

characteristics of births not available from the vital records

based on sample surveys of those records.

Data From the National Moriality and Natality SurveysDiscontinued in 1975. ReporIs from these sample surveys

based on vital records are included in Series 20 and 21,

respectwely.

Data From the National Survey of Family Growth -

Statistics on fertility, family formation and dissolution, family

planning, and related maternal and infant health topics

derived from a periodic survey of a nationwide probability

sample of women 15-44 years of age.

Compilations of Data on Natality, Mortality, Marriage,

Divorce, and Induced Termina~ons of Pregnancy–”

Advance reports of births, deaths, marriages, and divorces

are based on final data from the National Vital Statistics

System and are published annually as supplements to the

fvlonthlyVital Statistics Report (MVSR). These reports are

followed by the publication of detailed data in Vital

Statistics of the United States annual volumes. Other

reports including induced terminations of pregnancy issued

periodically as supplements to the MVSR provide selected

findings based on data from the National Vital Statistics

System and may be followed by detailed reports in Vital

and Health Statistics Series.

For answers to questions about this report or for a list of titles of reports

published in these series, contact

Scientific and Technical Information Branch

National Center for Health Statistics

Centers for Disease Control

Public Health Service

6525 Belcrest Road, Room 1064

Hyattsville, Md. 20762

301-436-8500
DEPARTMENT OF

HEALTH & HUMAN SERVICES

Public Health Service

Centers for Disease Control

National Center for Health Statistics

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Hyattsville, Maryland 20782

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