NATIONAL CENTER Series 22 

For HEALTH STATISTICS INumber 3‘ — 

VITAL and HEALTH STATISTICS 

DATA FROM THE NATIONAL VITAL STATISTICS SYSTEM 

Methods and 

ResponseCharacteristics 

National Natality Survey 

United States, 1963 

Description of sources of information and methods used in the 1963 

National “Natality Survey and a discussion of response characteristics, nonresponse, and imputation of data. 

~~op.mf i3FTIE 

PIJSLICAT!ONS!3,RMJCh 

ENMW LIBRARY 

Washington, D.C. September 1966 

U.S. DEPARTMENT OF 

HEALTH, EDUCATION, AND WELFARE Public Health Service 

Wi 1Iiam H. Stewart John W. Gardner 

Secretary Surgeon GeneraI 

i 
,.. 

., .’ 

Public Health Service Publication No. 1000-Series 22-No. 3 

For sale by the Superintendent of Documents, U.S. Government Printing Office 

Washington, D. C., 20402- Price .30 cents 
NATIONAL CENTER FOR HEALTH STATISTICS 

FORREST E. LINDER, PH. D., Director 

THEODORE “D.WOOLSEY,Deputy Director 

OSWALD K. SAGEN,PH. D.,Z/s$hztztDirector 

WALT R.SIMMONS,M.A+ Stathtical Advisor 

ALICEM. WATERHOUSE, M.D.,Medical i4dvifor 

JAMES E.KELLY,D.D.S.,Dewtal Advisor 

LOUISR.STOLCIS,M.A.,Executive Qficer 

DIVIS1ON OF HEALTH RECORDS STATISTICS 

MONROE G. SIRKEN, PH. D., Chiej 

E.EARL BRYANT, M.A.,Ckiej, Institutional Population Swvey Branch 

MILTON C. ROSSOFF, M. S., Chief, Ho~pital Discharge Survey Branch 

GORDONF. SUTTON,PH. D., Chiej, VW Records Survey Branch 

Public Health Service Publication No. 10004eries 22-No. 3 

Library o/ Congress Catalog Card Number 6,6-61820 
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CONTENTS 

Introduction


Survey Procedures andMetiods


Sources of Data ----------------------------------------------------


The Questiomaires


Collection of Data --------------------------------------------------


Processing of Data -------------------------------------------------


Sample Desi~-----------------------------------------------------


Estimation


Reliability of Estimates


Response Characteristics


Response From Metiers


Response From Medical and Dental Sources


Nonresponse and Imputation of Misstig Data -----------------------------

Mothers


Xicians, Dent &d Medical Facilities


7Birti Records


References


Detailed Tables


Appendix I. Definitions of Certain Terms Used in ’Ihis Report


Appendix II. Source Forms


Standard Certificate of Live Btiti


Survey Questiomaire for Metiers


Survey Questionnaire for Physicians


Survey Questiomaire for Me&cal Facilities


Survey Questiomaire for Dentists


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IN THIS REPORT the methods andpyocedwes used in the 1963 National 

Natality Swvey aye descvibed and selected findings on vesponse and 

completeness of the data ave pvesented. The 1963 survey was designed 

primayily to provide natiotil estimates of the amount awl type of exposuve to ionizi~ radiation expe~ienced by women ch,wing pvegnancy. In-~ 

foymation was also obtained on selected socioeconomic chayactevistics 

of families in which biyths occuwed. 

The national sample consisted of approximately 4,100 bivth vecovds selected jkom cwrent shipments veceived in the National Centev fov Health 

Statistics fvom each Of the bivth ye~”stvation ayeas of the United States. 

Information in addition to that on the bizth record was obtained by mail 

swvey of the mothev, the hospital wheve the child was bona, the attending 

physician, and othey physicians and dentists who may have treated the 

mothey during pregnancy. National estimates based upon the suYvey weve 

prepayed using a post-stratified Yatio estimate pyoceduve. Estimates of 

ewov due to sampling we ye pyepayed by means of a replication technique. 

About 86pevcent of the mothe~s included in the suvvey vetwrned the questionnaire. The vesponse Yate by age of mothev vayied between 86 and 90 

peycent except among those undev20 yeazs of age, of whom only 76 peYcent Yesponded. Response of mothen vayied m.aykedly by CO1OY.Not 

only was the vesponse Yate lowe~ fov nonwhite than fov white mothevs, 

but moye followup was Yequired to achieve the level of response. An 

inveyse Relationship was obsevved “between family income—as well as 

education of mothey-and the numbev o~ attempts to obtain response. 

NonYesponse to items on the questionnaires Yetunzed by mothevs was minimal in most instances and accounted fov no more than 3 .peYcent fov 

any single item. The pvincipal pyoblem of incompleteness in YetuYned 

qwestionnaiyes avosefiom failuve to obtain infovmationabout family income; this pvoblem was found disproportionately among motherrs undev 

25 yeavs and among mothe~s having theiv fkst ~hild ov theiv jlj?h child 

ov moye. 

The total Yesponse Yate fo~ physicians, dentists, and medical facilities 

was move than 90 pevcent. Response from sowces questioned about white 

mothevs was higher than that from souvces Yeporting about nonwhite 

rnothevs. All items on the questionnaire Yetuvned by physicians, dentists, 

wzd medical facilities weve complete with few exceptions. 

SYMBOLS 

Data not available-----------------:-----

I Category not applicable . . . I 

Quantity zero -

Quantity more than O but less than 0.05 ----- 0.0 

Figure does not meet standards of * reliability or precision 
METHODS AND RESPONSE CHARACTERISTICS


NATIONAL NATALITY SURVEY, 1963 

Gooloo S. Wunderlich, Divisi~ 

INTRODUCTION 

This is the first of a series of reports 

based on ,data obtained in the National Natality 

Survey from a probability sample of 4,000 families 

in which births occurred during the year 1963. 

Annual birth statistics for the United States 

derived from information reported on the birth 

record alone are not sufficient to meet the increasing needs for natality and related data in 

public health, demography, and other related 

fields. 1 Data collected in the 1963 National 

Natality Survey should permit preparation of estimates of births and of families having births by” 

characteristics not previously available in national statistics. As a result, answers to many 

social and economic questions about” matters relating to the health of the population” in the United 

States may be made available. 

The 1963 natality survey, conducted by the 

Division of Health Records Statistics in part under 

contract with the Division of Radiological Health, 

Public Health Service, was designed primarily to 

provide national estimates of the amount. and type 

of exposure to ionizing radiation, particularly 

X-ray, experienced by women during pregnancy. 

Information was also obtained on selected socioeconomic and demographic characteristics of the, 

families in which births occurred during 1963. 

This report describes the methods and procedures used in the 1963National Natality Survey 

as weil as selected findings on response and 

completeness of the data. The discussion which 

follows is divided into three main “sections. The 

of Health Recovds Statistics 

first section describes the procedures and methods used in the survey; the second section discusses response characteristics; and the third 

deals with nonresponse and imputation of missing 

data. 

SURVEY PROCEDURES 

AND METHODS 

4 

Sources of Data . 

Survey procedures included a questionnaire 

mailed to each mother selected in the sample, 

to the attendant at birth, and to the hospital 

reported as the place of birth. These sources 

of information are identified on the birth record 

itself and are referred to in this report as 

primary sources. 

Each of these primary sources was requested 

to identify other physicians, dentists, or medical 

facilities from whom the mother received any 

care during the year prior to the birth of 

her child. These additional sources of informs- ,, 

tion are referred to as secondary sources. 

Questionnaires were also mailed to these secondary sources. Regardless of whether they 

were primary or secondary, the same information was obtained from all medical and dental 

sources. Information on X-ray examinations or 

treatments was obtained from physicians, dentists, and medical facilities. only; the questionnaire sent to each mother was limited to the 

identification of the physicians and dentists from, 

1 
.

whom she received care and to selected socioeconomic and demographic information. 

The Questionnaires 

Facsimilies of the questionnaires used in 

the survey as well as of the birth certificate are 

shown in Appendix 11. 

The questionnaire sent to physicians differed 

only slightly from that sent to institutions. The 

respondent to this questionnaire was asked if the 

mother had received any examination or treatment 

by X-ray during the 12 months preceding the 

birth of her child. If so, he was asked to give 

the number of such examinations, the date on 

which each such examination was performed, 

the major class of equipment used, the type of 

examination, the primary body area exposed to 

radiation, the number of exposures taken, whether 

the examination was performed by the respondent 

or by some other physician or institution, and the 

name and address of such other physician or 

institution. Whether the mother had received 

an X-ray examination or not, the respondent to 

this questionnaire was asked to report the number 

of times the mother had been seen for medical 

care during the 12 months prior to the birth of 

the child and the dates of the first and the last 

visit during that period. 

The questionnaire sent to dentists was similar 

to that sent to physicians and institutions, except 

that fewer questions were asked ~bout the X-ray 

examinations, because dental X-rays are more 

easily classified without the need for additional 

questions. 

,The questionnaire sent to mothers was different in content from the questionnaire for dentists and physicians. This questionnaire asked 

. for information on selected socioeconomic characteristics of the mother and the family, such as 

the educational attainment of the mother and 

father, the father’s employment status at the 

time the child was born, the employment status 

‘of the mother during pregnancy, and the family 

income during the preceding calendar year. The 

mother was also asked to identify the attendant 

at birth as well as the physicians, dentists, 

clinics, and hospitals where she may have received care during the year prior to the birth of 

her child. 

Collection of Data 

Data for the 1963 National Natality Survey 

were collected primarily by mail. 

For mothers, followup procedures consisted 

of a certified mailing 2 weeks after the initial 

mailing and a regular first-class mailing 3 weeks 

after the certified mail. Telephone or personal 

interviews were conducted by Bureau of the Census 

interviewers with mothers who did not respond 

after all three mailings and who lived in one of 

the field survey areas of the Current Population 

Survey program of the Bureau of the Census. 

These procedures resulted in a response rate of 

86.4 percent from mothers included in the survey. 

Followup procedures for physicians, dentists, 

and institutions were similar to those for mothers, 

with two differences: (1) The first followup was 

by first-class mail, and the second followup was 

by certified mail. (2) No telephone or personal 

interviews were conducted after the three 

mailings. The total response rate from these 

sources was more than 90 percent. 

:Processing of Data 

The completed questionnaires were edited 

and coded in accordance with predetermined 

specifications. The questionnaires were checked 

for completeness and for consistency of response 

to eliminate “impossible” response for each 

item. If the reported data were inadequate forcertain essential items, further mail inquiries were 

made specifically for these items. Approximately 

13 percent of the questionnaires returned by 

mothers did not pass editing criteria for one or 

more items and required further inquiry. Acceptable response was increased from 87.3 percent to . 

92.7 percent as a result of these additional 

inquiries (table A). 

Responses from physicians, dentists, and 

medical facilities were edited and evaluated in a 

manner similar to that used for questionnaires 

returned by mothers. In the process of editing 

these questionnaires, missing data on an X-ray 

examination from one respondent could sometimes 

be obtained from a report of the same” examination provided, by another responding physician or 

medical facility. Approximately 15 percent of the 

questionnaires returned by physicians and 20 

percent of those returned by medical facilities 

2 
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1 

Table A. Proportion of responses considered acceptable before and after additional 

inquiries were made: 1963 National Natality Survey


Percent of total 

response edited 

Total acceptable 

Type of source number of 

respondents 

Origina 1 Final 

respcmse response 

Mothers 3,218 87.3 92.7 

Physicians 4,164 85.1 90.4 

Medical facilities 4,327 80.5 92.4 

Dentists 1,320 96.9 97.1 

required further inquiry. Acceptable response 

from physicians and medical facilities was increasedto 90.4 percent and 92.4percent, respectively, as a result of these additional inquiries. 

In contrast, almost all questionnaires received 

from dentists were acceptable (table A). 

After the edited and coded data were transcribed onpunchcards the datawereprocessedon 

electronic computers.l%is includedassignmentof 

weights and carrying out internal edits, consistency checksto eliminateerrors inediting,coding, 

or processing, and imputation for missing data. 

Sample Design


The sampling frame for the 1963 National 

Natality Survey was the file of microfilms of 

birth records received each monthbythe National 

Center for Health Statistics from the 54 birth 

registration areas of the United States. As a 

general rule, for each registration area these 

microfilm images are assigned a number prior 

to or during filming of the birth record. Each 

thousand consecutive images are defined as a 

“reel” and assigned a reel number starting 

from zero. Within each reel, the images are 

numbered from 1 to 1,000. 

The sampling for the survey was based on a 

probability design which made use of these preassigned reel and image numbers on the birth 

records. Each reel of the microfilm copies of the 

birth certificates constituted a primary sampling 

unit. Within each reel one record was chosen 

on a random selection basis. Thus, a sample of 

1 out of 1,000 births was selected from the 

monthly shipment of records from the registration 

areas. 

The national sample included a total of 4,096 

births for the year 1963. Of these4,096births, 

214 were reported as illegitimate on the birth 

record. However, legitimacy is reported in only 

35 of the 54 registration areas in the United 

States. Hence, a procedure was developed to 

infer legitimacy on the basis of indirect evidence 

on the birth certificate for the 19 registration 

areas not reporting this item. Thus, if on the 

‘birth record the surname of th,efather was different 

from the surname of the child or if the surname 

of the father was not reported on the birth 

record, the birth was imputed to be illegitimate. 

On the basis of this procedure 102 births in the 

sample were inferred to be illegitimate in addition 

to those mentioned above. Table 1 shows the 

distribution of the births selected in the sample 

by the legitimacy status (both reported and 

inferred), age of mother, and color. 

These 316 illegitimate births plus an additional 54 births were excluded from the survey 

of mothers .a Thus, the final sample included in 

aThe State of Missouri withdrew from the Surv+y after June 

1963. Thus, 45 births selected in the sample from Missouri 

for the period July through December 1963 were excluded from 

the survey. 9 additional births were excluded from the survey 

either because residence was outside the United States or 

because no usable mailing address was available. 

3

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Table B. Total number of births in the United States and the number in the survey of


mothers: 1963 National Natality Survey.


Item I Size 

Total count of births in the United States 4,098,000


Number of births selected in the sample 4,096


Number of births excluded from survey:


Number of illegitimatebirths 316


Number of births from Missouri: July-December 1963----------------- 45


Other-------------------------------------------------------------- ‘9


Number of births includedfor the survey of mothers------------------ 3,726


thesurveyofmotherswas 3,726births.
TableB


shows the original sample and the final
sample


usedforthesurveyofmothers.


ln contrastwiththe surveyof mothers,in


which illegitimate birthswere excluded,
medical


inquirieswere sent in allinstanceswhere a


medica~ source of informationwas identified.


Hence,statistics relatingto radiation
exposure


whichdidnotrequireinformation
 providedbythe


motherrelatetoallbirthsselected
 inthesample.


Live-birth
 Group Age


Estimation 

Statistics
 basedon thesurveypreestimates


prepared by the use of a post-stratified
 ratio


estimation
procedure.The purposeofratioesti-


mationis to takeintoaccountavailable
 relevant


informationin the estimation
process;thereby


reducingthe variability of the estimate.
This


procedurewas carriedoutforeachofthefollowing


24 groups:


Live-birth


order Group Age order


White


1 Under 20 years


2 Under 20 years


20-24 years


: 20-24 years


5 20-24 years


6	 25-29 years


25-29 years


Nonwhite


1 Under 20 years 1 

2+ Under 20 years 2+ 

1 17 20-24 years 1-2 

2 18 20-24 years 3+ 

3+ 

25-29 years 1-2 

1 25-29 years 3-4 . 25-29 years 5+ 

; 25-29 years 3-: 

9 25-29 years 5+ 30-34 years 1-4 

10 

11 

12 

30-34 years 

30-34 years 

30-34 years 

1-2 

3-4 

5+ 

24 

30-34 years 

35 years or more 

5+ 

ALL 

13 35 years or more 1-4 

14 35 years or more 5+ 

4

For each group, the ratio of the number of 

births in the United States in 1963 based on a 

50-percent sample to the number of births in 

the sample in that group was determined.2 

These 24 ratios comprised the sample weights 

used in estimating national totals for each of 

the 24 groups. The effect of this ratio adjustment 

was to make the estimates from the sample 

consistent with the complete count of births with 

respect to the population of all births as well as 

for the groups used in the estimation procedure. 

Thus, estimates of characteristics from the 

sample are produced using the following formula: 

where 

X’	 is the estimate of the characteristic obtained by use of ratio estimation. 

xi	 is the count of sample births with the 

characteristic in the ithgroup. 

Yi is the count of all sample births in the 

ith group,. and 

Yi is the total number of births in the i th 

group based on the 50-percent sample. 

Reliability of Estimates 

Since the statistics derived from this survey 

are estimates based on a sample, they may differ 

from the figures that would have been obtained 

had a survey covering all births in 1963 been 

conducted using the same questionnaires and 

procedures. As in all surveys, in addition to 

sampling errors, survey results are subject 

to measurement errors which include, among 

others, those errors resulting from errors in 

conceptual formulation, ambiguities in definitions 

and in the questionnaire construction, coding 

errors, biases due to nonresponse or incomplete 

response, mistakes in editing, and tabulation 

errors. 

The probability design of the sample for the 

survey makes possible the calculation of sampling 

errors. The standard error is a measure-of the 

sampling variation in the survey statistics that 

occurs by chance because only a sample rather 

than the entire population is surveyed. The chances 

are about 68 out of 100 that an estimate from 

the sample differs from the value obtained from 

a survey of the entire ‘population by less than 

the standard error. The chances are about 95 

out of 100 that the difference is less than twice 

the standard error. The standard error of a 

difference between two sample estimates is 

approximately the square root of the sum of 

squares of each standard error considered separately. This formula represents the actual standard error quite accurately for the difference 

between separate and uncorrelated characteris -

tics, although it is only a rough approximation 

in most other cases. 

The variance of a statistic depends not only 

on the design of the sample, but also on the 

distribution of the statistic itselfi the variance is 

greater for measurements which are highly 

variable from one individual to another, and 

lower for measurements which are less variable. 

Since the estimates of the sampling error are 

obtained from the sample data, they are themselves subject to samp~”g error, which may be 

large in some instances. 

Estimates of sampling variability for the 

statistics derived from this survey were based on 

20 random half-sample replications. This technique yields overall variability through observation of variability among random subsamples of 

the total sample. It reflects both the error that 

arises from sampling and a part of the measurement error, but it does not measure any systematic biases in the data. A general discussion 

of the development and evaluation of a replication 

technique for estimating variance has been published elsewhere.?_ However, the procedures and 

,computations required to estimate variances by 

this method in the 1963 natality survey are 

briefly described below. 

For the survey, each record from the entire 

file of records was assigned systematically to a 

random group between 1 and 40. Twenty pairs of 

random groups were created from these 40 groups. 

A half sample was formed by randomly selecting 

one group from each of the 20 pairs. This process 

was repeated until 20 “replicate half samples” 

5 
1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Table C. Composition of the 20 half-sample replicates 

Halfsample 

replicates 

-

Random groups included 

11 13 15 18 19 22 23 26 28 30 32 33 35 38’40 

11 13 16 17 20 21 24 26 28 30 31 33 36 37 40 

11 14 15 1% 19 22 24 26 28 29 31 34 35 37 40 

20.22242627293233 .353840 

11 14 15 18 20 22 24 25 27 30 31 33 36 38 40 

12 13 16 18 20 22 23 25 28 29 31 34 36 3740 

11 14 16 18 20 21 23 26 27 29 32 34 35 37 40 

12 14 16 18 19 21 24 25 27 30 32 33 35 3740 

1922232528303133 

”12141517 2021232628293133 

1921242627293133 

2224252729313435 

2223252729,323336 

2123252730313435 

2123252829323336 

2123262730313436 

2124252829323436 

1922232627303234 

2124252830323435 

2224262830323436 

353740 

353840 

363740 

3840 

3740 

3840: 

3840 

3840 

3840 

363740 

3740 

3840 

1 3 6 8 9 

1 4 6’7 9 

2 4 5 7 9 

2357912131617 

1 3 5 710 

1 3 5 8 9 

1 3 6 710 

1 4 5 8 9 

23671012141617 

145810 

23681012131518 

1468101113161719 

24689,1114151720 

246791213151820 

2457101113161819 

235891114161719 

136791214151719 

14571012131517 

2358101113151720 

2468101214161820 

were formed from which variance 

derived. The composition of the 

shown in table C was determined 

plan. 

After the composition of 

estimates were x~is the estimate of X based on the ith half 

20 half samples sample. 

by an orthogonal 

Standard errors of published statistics will be’ 

each of the half presented along with the analysis of the data 

samples was determined, all the estimation proce - collected from ~he survey. 

dures used to produce the final estimates from ‘ 

the entire sample were applied separately to each 

RESPONSE CHARACTERISTICS of the resulting half samples. 

An estimated variance .s~, of an estimated 

statistic X’ of the parameter X is obtained by ,Response From Mothers 

applying —- the following formula:

A total response rate of 86.4 percent was 

S:, =J- ? (x: - X’)z obtained from the 3,726 mothers included in the 20 i=] 

where survey. Approximately 45.3 percent of the mothers 

x’ is the estimate of X based on the entire responded to the original mailing. The certified 

sample, and mail followup added 29.0 percent, and the’ second 

6 
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Table D. Response	 received from mothers, physicians, medical facilities,and dentists, 

by mailing waves: 1963 National Natality Survey 

Response status Mothers Physicians ~:cp1yt;e5 Dentists 

Number included in survey 3>726 I 4,474 4,432 I 1,360 

I Percent 

Total response 

Response to original mail 

Response to second mail 

Response to third mail 

Response to interview . 

Nonresponse 

mail followup broughtin an additional 6.8percent 

of the total response received. Personal visitsor 

telephone followup by Bureau of the Census 

interviewers added another 5.1 percent to the 

total response (table D). 

Age of Mother, Color ,and 

Live-Birth Order 

Ascertain key characteristics ofthefamilies 

included in.the survey are available on the birth 

record itself and not from the survey questionnaire, it is possible to show the relationshipof 

these variables to the response rate. 

The response rate by age ofmother varied 

between 85.8and 89.8 percent except amongthose 

under 20years of age, of whom only76.4 percent 

responded. Mothers under 20 years of age, 

compared with the older mothers, also had a 

relatively low response to the first mail (table 2). 

Response in the survey varied markedlyby 

color. About 88 percent of the white mothers, 

compared with 78percentofthe nonwhitemothers, 

responded to the survey questionnaire. Not only 

was the response rate lower for nonwhitethan for 

white mothers, but more followup was required 

to achieve this level of response (fig. 1). This 

color differ”ence prevailed, in general, for all age ... 

86.4 I 93.1 97.6 97.0 

45.3 66.5 77.4 81.2 

29.0 17.6 15.3 11.5 

6.8 9.0 4.9 4.3 

5.1 . . . . . . . . . 

13.6 / 6.9 I 2.4 I 3.0 

groups, Dut it was most pronounced for mothers 

20-29 yearsof age. 

Of the total response received, 54.7 percent 

for the white mothers ,comparedwith 36.Opercent 

for the nonwhite mothers, was obtained by the 

first mail (table E). Only 5.1 percent of the total 

response for white compared with 12.1 percent 

PERCENT RESPONSE 

‘i 

C*. 

White 

/ / // / 

/ / ,’ +’,/’ 

/ / // 

Nonwhite 

m@ammm 

First Second T## mail i~~f~eo~ Nonrespons& mail 

Figure 1. ‘Cumulative percent response; by


number of mailinq for white and nonwhite


mothers.


7

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Table E. Cumulative percent of responding mothers, by number of mailing and color: 

1963 National Natality Survey 

Cumulative percent of 

respondents by mailhg 

Number of Color respondents 

First Second Third Personal 

mail mail mail interview 

All mothers 3,218 52.4 86.2 94.1 100.0 

White 2,821 54.7 87.2 94.9 100.0 

Nonwhite 397 36.0 78.6 87.9 100.0 

for nonwhite mothers was obtained by personal Table 4showsa definiterelationship between 

interview after three attempts to obtain response the income of the family and the number of 

by mail. attempts to obtain response. Asthefamilyincome 

Differences in response rates by live-birth increased, the number of successive mailings 

order were marginal (table 3). The response required to obtain response decreased. Thus,


pattern by live -birth order for whitemothers was 42.4 percentof therespondents withfamilyincome


similar to that observed for white and nonwhite of less than $3,000, compared with 61.4 percent


combined. For nonwhite mothers, however, the of those with an income of $7,000 or more,


response rate decreased as live-birth order responded to the original mailing. At the other


increased to a low of 71.8 percent for third extreme, apersonalinterviewafterthree attempts


birth; it then increased slightly for fourth birth to obtain response by mail was required for9.3


or more. Not only was”theresponseratelower for percent of the respondents with family incomeof


nonwhite mothers having their third childthan for


the other nonwhite mothers,butmore followupwas


required (fig. 2).


Socioeconomic Characteristics PERCENT RESPONSE 

As stated earlier in this report, data were ‘~ 

obtained in the surveyon selected socioeconomic 

characteristics of families in which a birth 

occurred during 1963. Two such characteristics 

are the education of the mother and the income //‘ 

/ /’ ,, 

/’ 

/ /“2’ 

/1 

~ 

/ /’ 

of the family during the preceding calendar year. Third birth A discussion of differences in response rates


according to these socioeconomic characteristics


is not possible since the data needed for such g~=mfggg
 rates are contained in the questionnaire itself
 First S:oyd Third Personal Nonresponse and are therefore unknown for families who did mail moil interview 

not respond to the survey questionnaire. However, 

a discussion of the relationship of these characteristics to the number of mailings required to obtain Figure 2. Cumulative 

by 

percent 

of

response for 

nonwhite mothers, number mail ing and 

response to the survey is presented. 1 ive-birth order. 

8

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Table F. Percent distribution of surveyed mothers, by age for respondents ~d non- . 

respondents to the survey: 1963 National Natality Wrvey 

Total Respondents I Nonrespondents 

Age of mother I 

I Number I Percent Number 

I I ==F=F== 

All ages 

~ 

Under 20 years 488 

Zb-zb years 1,252 

25-29 years 1,056 

30-34 fears 549 

35 years and over----------------” 381_ 

less than $3,000 as compared with only 2.5 

percent ofthose with $7,0000rrnore. 

When respondents were further classified by 

age of mother, this relationship prevailedin all 

age groups. The differenceinresponsebyincome, 

especially to the original mailing, became more 

pronounced asage of mother increased. 

The number of successive mailings required 

to obtain response was also inversely relatedto 

the educational attainment of the mother (tables5 

and 6). This relationship prevailed over all age 

groups as well as over all birth-order groups. 

Response From Medical and Dental Sources 

A total response rate of 93.1 percent was 

obtained from the 4,474 physicians included in 

the survey. Of these physicians, 66.5 responded 

to the original mailing; an additional 17.6percent 

respondedto the second mailing, and9.Opercent, 

to the third mailing. Response patterns from 

medical facilities and dentists were similar to 

the pattern observed forphysicians .Theresponse 

rate was 97.6 percent for the 4,432 facilities 

and 97.0 percent for the 1,360 dentists included 

in the survey (table D). 

Reporting of the medical X-ray examinations 

was relatively independent of the mother. However, the identification of dentists as sources 

of information for dental X-ray examinationswas 

completely dependent on the reports from mothers; as a result there was underreporting of 

dental X-ray visits dueto the number ofmothers 

not surveyed and to the number who did not 

respond. 

3,218 100.0 508 100.0 

13.1 373 

33.6 1,074 

28.3 948 

“1X7 486 

10.2” _ 337

Tables 7 and 8 show response rates from 

medical and dental sources by color and ageof 

mother. Responseratesfromthesesourcesvaried 

by color ofmother .Responsefrom thephysicians, 

medical facilities, and dentists questioned about 

white mothers was higher than that obtainedfrom 

these sources reporting about nonwhitemothers. 

This color difference in response rates prevailed 

for each mailing. Variation in response bycolor 

was more pronounced for dentists than for 

physicianshd medical facilities. Responserates 

from both physicians anddentists were about the 

samebythe age ofthemother forwhomthey were 

reporting. Slight differences were observed in 

response from dentists byage ofmother. 

NONRESPONSE AND IMPUTATION 

OF MISSING DATA 

Failure to obtain response represents one of 

the main sources of error in asurvey. The extent 

of nonresponse and imputation of missing data 

in the 1963 natality survey are discussed below 

in terms of the sources of information used in 

the survey to obtain information. 

Mothers 

A total of 508 mothers, or 13.6 percent, had 

not responded after all followup procedures were 

completed. A large proportion ofthisnonresponse 

was accounted for by mothers in the younger 

ages. Almost 57.6 percent of the 508 mothers not 

responding, compared with 45.0 percent of the 

respondents, were less than 25 years of age 

(table F). 

9 
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Table G. Percent of 

of mother 

Age of mother 

and 

live-birth order 

Total 

Age of mother 

Under 20 years 

20-24 years 

25-29 years 

30-34 years 

35 years and over--

L?ve-birth order 

First 

Second 

Third 

Fourth 

Fifth birth 

and over 

respondents for whom specified items were not ascertained, 

and live-birth order: 1963 National Natality Survey 

Total Family Education Education Mother’s 

number of income of mother of father employment 

respondents status 

by age 

Father’s 

employment 

status 

0.7 

0.8 

0.8 

0.3 

1.4 

0.3 

0.6 

.!:: 

0.7 

1.0 

3,218 3.1 

373 6.2 

1,074 3.0 

948 1.8 

486 3.3 

337 3.9 

864 4.2 

777 2.1 

595 2.4 

409 2.2 

573 4.5 

Percent not ascertained 

0.2 0.8 0.1 

0.; ::2 

0.3 O.i 

006 ?:: 0.4 

0.3 1.2 

0.2 

0.4 

0.5 

0.5 ::: 

0.9 1.4 0.5 

Besides these mothers whorepresented “unit 

nonresponse “ in the survey, missing information 

on returned questionnaires also affects the 

qualityof data derived from the survey.b Nonresponse to items on questionnaires returned by 

mothers was minimal in most instances and 

accounted for no more than 3.1 percent for any 

single item. Table G shows the percent not 

ascertained for specified items byage ofmother 

and live-birth order. The principal problem 

of incompleteness in the returned questionnaires 

arose from failureto obtain informationaboutthe 

total income of the family, aproblem which was 

found disproportionately among mothers under 25 

years of age and among mothers who werehaving 

their first child or their fifth child or more. 

In order to reduce the effect ofnonresponse 

on the estimates, statistics derived from the 

survey of mothers were adjusted for unit nonresponse by imputing to nonrespondents the 

bzs of the 3,218 respondence returned the questionnaires 

substantially incomplete; for the purposes of processing the 

data, these respondents were treated in the same manner as 

unit nonrespondents. 

characteristics of “similar’’respondents.S imilar 

respondents were mothers who respondedtolater 

mailings within each of the 24 age-of-mother, 

color, and live-birth-order groups shown on 

page 4. Two assumptions are inherent inthis 

imputation procedure. The three birth-record 

characteristics— age of mother, color, and livebirth order—are available for responding as 

well as nonresponding mothers and are relatedto 

the socioeconomic variables on the questionnaire 

sent to mothers; and the nonrespondents would 

be more like those who responded to the later 

mailings than those to the first mail. The latter 

assumption is based on the pattern of response 

by mailing waves observed in relation to the 

education and income level of the respondents. 

Thus, an array of known walueswasestablished in the computer using the respondentsto 

later mailings within the 24 homogeneous groups 

as the known population of similar respondents 

from which values were imputed to the nonresponse records. Values in the cellsofthearray 

were continually replaced by successive known 

values as the file ofrecords was processed; as a 

nonresponse record was read, values from the 

10 
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--

-----

-----

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appropriate cell of the array were imputed to 

the nonresponse record. 

Data are also adjusted for item nonresponse. 

Imputation procedures for missing data on questionnaires returned by mothers were based on the 

. ,ptemise that “the presence of several correlated 

variables permits a reasonably good prediction 

of the missing variable. . ..”4 

Thus, missing data for items on employment 

of father, education of father, and family income 

were imputed. on the computer on the same 

principle as . for unit nonresponse, that is, 

imputation was made by assigning within homogeneous groups the characteristics of respondents 

to later mailings. with known data to those 

respondents with missing data. The array by age 

of mother, color, and live-birth order used for 

imputation of unit nonresponse was also used 

for imputation of missing data on employment 

of father. Missing information on education of 

father and family income was imputed using the 

following arrays: 

1. For education of fathw: 

Years of school 

completed by mother 

Age of father . 

Under 8-

8 11 12 ::- 16+ 

Under 20 years 

20-29 years 

30-39 years 

40+ years 

2. Fov family income: 

Years of school 

completed by father 

Age of father 

Under 8- 13- 16+ 

8 I 11 12 15 I

Under 20 years 

20-29 years 

30-39 years 

40+ years 

Missing data on employment status of mother 

during pregnancy for three cases and on educati~q 

of mother for eight cases were imputed arbitrarily. 

Physicians, Dentists, and Medical Facilities 

The nonresponse rate for medical and dental 

sources was much lower than that for mothers. 

Only 6.9 percent of the physicians, 2.9 percent 

of the dentists, and 2.4 percent of the medical 

facilities included in the survey did not respond 

after all followup procedures were completed 

(table 7). 

All items on the questionnaires returned by 

physicians, dentists,. and medical facilities were 

complete with the exception of 1 instance for type 

of equipment used, 2 relating to the primary 

body area, and 12 relating to the number of films. 

No imputation for unit nonresponse was 

undertaken because of the relatively low nonresponse rate and the high probability of a given 

X-ray examination’s being reported by more than 

one source. The few cases enumerated above 

for which information was missing were adjusted 

manually with the aid of professional medical 

opinion. 

Birth ,Records 

With the exception of color of child for 

births selected from New Jersey, age of father, 

and completed weeks of pregnancy, information 

on the birth record was in most cases complete. 

During 1962, the item on color of child was 

removed from the New Jersey birth record. 

Although this item was replaced in late 1962, 

almost all births occurring during 1963 were 

registered on birth records not containing the 

cfuestion on color. Thus, information on color 

of child was missing on approximately 100 records 

from New Jersey selected in the sample. Imputation for color of child was carried out by means 

of a procedure using detailed geographic information on place of residence of mother and proportion of nonwhite population in that location according to the 1960 census. 

In addition, information on completed weeks 

of pregnancy was unknown on 214 birth records; 

number of previous fetal deaths was unknown 

for 92 records; and age of father was, missing 

11 
on 255 records. Imputation for these items was array described earlier. For items such as birth 

also carried out on the computer by substituting weight, sex of child, and birthplace of mother, 

known values within the homogeneous groups where the number of unknown cases was small, 

created by the age? color, and live-birth-order imputation was made arbitrarily. 

REFERENCES 

lSirken, M. G.: Research usee of vital records in vital Surveys. Paper presented at a joint session of the Epidemistatistics surveys. Milbank Mere. Fund Quart. XLI(3):309~ ology and Statistic: Sections at the Ninety-Third Meeting of 

July 1963. the American Public Health Association, Chicago, C)ct. 18, 

1965; and National Center for Health Statistics: Replication, 

2 National Center for Health statistics: Vi~al Sta~~ti~~ of an approach to the analysis of data from complex surveys. 

the United States, 1963, Vol. I. Public Health Servioe. Wash- Vital and Hea2th Statistics. PHS Pub. 1000-Series 2-No. 14. 

ington. U.S. Government. Printing Office, 1964. sec. 1, table Public Health Service. Washington. U.S. Government Print1-46. ing Office, April 1966. 

3McCarthy, P. J., Simmons, W. R., and Garrie, J. L.: Rep- %ish, L.: Survey Sampling. tie,w York. John Wiley&Sons, 

lication Techniques for Estimating Variances From Complex Inc., 1965. p. 559. 

000 

12 
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Table 1.


2.


3.


4.


5.


6.


7. 

8.


DETAILED TABLES 

Page


Number of births selected in the sample, by legitimacy status, color, and age of


mother: 1963 National Natality Smvey --------------------------------------------- 14


Percent distribution of surveyed mothers, by response status according to color


and age of mother: 1963 National Natality Survey---------------------------------- 15


Percent distribution of surveyed mothers, by response statua according to color


and live-birth order: 1963 National Natality Survey------------------------------- 16


Percent distribution of respondents in the survey of mothers,by number of mailing


according to age of mother and family income during preceding year: 1963 National


Natality Swvev 17


Percent distribution of respondents in the survey of mothers,by number of mailing


according to age and years of school attended by mother: 1963 National Natality


SwveY ---------------------------------------------------------------------------- 18


Percent distribution of respondenta in the survey of mothers, by number of mailing


according to live-birth order and years of school attended by mother: 1963 National


NataLity Swvey ------------------------------------------------------------------- 19


Percent distribution of surveyed physicians, medical facilities, and dentists, by 

response status according to age of �other: 1963 National Natality Survey--------- 20 

Percent distribution of surveyed physicians, medical facilities, snd dentists, by


reaponae status according to color of mother: 1963 National Natality Survey------- 21


‘.. 

13


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Table 1. Number of births selected in the sample, by legitimacy status, color, and age of mother:


1963 National Natality Survey


Total Illegitimate


Color and age of mother


sample
 ‘nki-&=b=Total Reported Inferred 

Total Number of births


All ages 4,096 3,780 2,529 1,251 316 214 102 

Under 20 years 640 498 346 152 142 102 40 

20-24 years 1,375 1,276 850 426 99 63 36 

25-29 years 1,103 1,067 714 353 36 25 11 

30-34 years 578 551 354 197 27 17 10 

35 years and over 400 388 265 123 12 7 5 

White


All ages 3,391 3,268 2.166 1,102 123 79 44
 -.—


Under 20 years 482 432 297 135 50 33 17


20-24 years 1,150 1,111 735 376 39 25 14


25-29 years 935 918 613 305 17 11 6


30-34 years 480 468 296 172 12 6 6


35 years and over 344 339 225 114 5 4 1


Nonwhite


All ages 705 512 363 149 193 135 58 

Under 20 years 158 66 49 17 92 69 23 

20-24 years 225 165 115 50 60 38 22 

25-29 years 168 149 101 48 19 14 5 

30-34 years 98 83 58 25 15 11 4 ,’ 

35 years ’and over 56 49 40 9 7 3 4,.--” ,,- —. 

II 

,A% . 

#-

I 

14

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Table 2, Percent distribution of surveyed mothers, by response status according to color and age


of mother: 1963 National Natality Survey


Number of Respondents by number of mailing


mothers Non -
 Color and age of mother included in


Second Third Personal respondents


survey mail mail interview


Total


All ages-----------


Under 20 years


20-24 years


25-29 years


30-34 years


35 years and over


White


All ages


Under 20 years


20-24 years


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


30-34 years


35 years and over


Nonwhite


All ages


Under 20 years


20-24 years


25-29 years


30-34 years


35 years and over


I I 1 

Percent distribution 

3,726 86.4 45.3 29.2 6.8 5.1 13.6


488 76.4 35.0 27.7 6.6 7.2 23.6 

1,252 85.8 45.6 27.6 6.5 6.1 14.2 

1,056 89.8 48.5 30.2 7.7 3.4 10.2 

549 88.5 45.5 32.2 5.8 4.9 11.5 

381 88.5 48.0 29.1 6.8 4.5 11.5 

3,218 87.7 48.0 28.5 6.7 4.4 12.3


423 77.1 35.0 27.2 7.3 7.6 22.9 

1,088 87.7 48.4 27.? 6.5 5.1 12.3 

910 91.8 51.9 29.8 7.4 2.7 8.2 

465 88.2 49.7 29.5 5.4 3.7 11.8 

332 89.2 50.0 28.3 6.6 4.2 10.8 

508 78.1 28.1 33.3 7.3 9.4 21.9


65 72.3 35.4 30.8 1.5 4.6 27.7 

164 73.2 26.8 26.8 6.7 12.8 26.8 

146 77.4 27.4 32.9 9.6 7.5 22.6 

84 90.5 22.6 47.6 8.3 11.9 9.5 

49 83.7 34.7 34.7 8.2 6.1 16.3 

15

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Table 3. Percent distribution of surveyed mothers, by response status according to color and


live-birth order: 1963 National Natality Survey


Number of Respondents by number of mailing I 

Color and mothers Non- I I I live-birth !order .ncluded in rotal re- First Second Third Personal respondents 

survey spondents mail mail mail interview


Total Percent distribution


All birth orders--- 3.726 86.4 45.3 29.2 6.8 5.1 13.6


First birth 986 87.6 50.0 27.4 5.5 4.9 12.4 

Second birth 906 85.8 45.1 29.7 6.4 4.5 14.2 

Third birth 676 88.0 44.5 28.7 8.4 6.4 12.0 

Fourth birth 475 86.1 46.3 28.8 5.7 5.3 13.9 

Fifth birth and over 683 83.9 38.8 31.8 8.3 5.0 16.1 

) 

White


All birth orders--- 3,218 87.7 48.0 28.5 6.7 4.4 12.3 

First birth 898 88.3 50.9 26.9 5.6 4.9 11.7 

Second birth 814 86.6 46.4 29.7 6.8 3.7 13.4 

Third birth 598 90.1 48.3 28.9 8.4 4.5 9.9 

Fourth birth 403 87.8 48.9 29,0 5.2 4.7 12.2 

Fifth birth and over 505 85.1 44.2 28.5 7.9 4.6 14.9 

Nonwhite


All birth orders--- 508 78.1 28.1 33,3 7.3 9.4 21.9


First birth 88 80.7 39.8 31.8 4.5 4.5 19.3


Second birth 92 78.3 33.7 29.3 3.3 12.0 21.7


Thi~d birth 78 71.8 15,4 26.9 9.0 20.5 28.2


Fourth birth 72 76.4 31.9 27.8 8.3 8.3 23.6


Fifth birth and over 178 80.3 23.6 41.0 9.6 6.2 19.7


16

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Table 4. Percent distribution of respondents in the survey Of mothers, by number Of ~iling ac.


cording to a“geof mother and family income during preceding year: 1963 National Natality Survey


Respondents by number of mailing


Number


Age of mother and family income of


respondents	 Total re- First Second Third Personal


spondents mail mail mail interview


All ages Percent distribution


All incomes--------------------- 3,218 100.0 52.4 33.8 7.9 5.9 

Under $3,000-------------------------- 632 100.0 42.4 37.5 10.8 9.3 

3,000-$4,999------------------------- 814 100.0 50.0 35.5 7.2 

$5,000-$6,999------------------------- 794 100.0 58.1 30.5 M $7,000 and over 849 100.0 61.4 30.9 H 2.5 

Not available 129 ... ... ... ... ... 

Under 20 years


All incomes 373 100.0 45.8 36.2 8.6 9.4 

Under $3,000-------------------------- 165 100.0 44.2 36.4 8.5 10.9 

$3,000- 4,999------------------------- 124 100.0 50.8 33.1 9.7 6.5 

$5,000-i6,999------------------------- 43 100.0 55.8 34.9 9.3 

$7,000 and over 13 100.0 * * * * 

Not available 28 ... ... ... ... ... 

20-24 years


All incomes 1,074 100.0 53.2 32.1 7.6 7.1 

Under $3,000-------------------------- 231 100.0 45.0 35.1 11.7 8.2 

$3,000-$4,999------------------------- 323 100.0 54.5 31.3 5.9 8.4 

$5,000-$6,999------------------------- 284 100.0 59.9 29.2 5.3 

$7,000 and over 193 100.0 57.5 33.7 2:; 3.1 

Not available 43 ... ... ... ... . . . 

25-29 years


All incomes 94[ 100.0 54.0 33.6 8.5 3.8 

Under $3,000-------------------------- 11( 100.0 36.2 42.2 12.9 8.6 

$3,000-$4,999------------------------- 22: 100.0 48.0 38.6 5.4 

$5,000-$6,999------------------------- 26[ 100.0 58.2 29.5 1::: 1.9 

$7,000 and over 31[ 100.0 63.2 29.6 5.7 1.6 

Not available ... ... ... ... ... 

30-34 years


\ All incomes 48( 100.0 51.4 36.4 6.6 5.6 

Under $3,000-------------------------- 100.0 37.9 39.4 12.1 10.6 

$3,000- 4,999------------------------- 100.0 43.0 41.9 6.5 8.6 

$5,000-$6,999------------------------- 100.0 55.5 33.6 3.9 

$7,000 and over 100.0 60.7 33.3 H 2.7 

Not available ... ... ... ... . . . 

35 years and over


All incomes 33; 100.0 54.3 32.9 7.7 5.0 

Under $3,000-------------------------- 5L 100.0 44.4 38.9 7.4 9.3 

$3,000-$4,999------------------------- 51 100.0 41.2 43.1 

$5,000-$6,999------------------------- 71 100.0 56.3 31.0 ::; i:! 

$7,000 and over 

Not available 

14i 

1$ 

100.0 

... 

66.9 

... 

23.2 

... 

6.3 

... 

3.5 

. . . 

17

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Table 5. Percent distribution of respondents in the survey of mothers, by number of mailing


according to age and year5 of school attended by mother: 1963 National Natality Survey


Respondents by number of mailing


Age and years of school Number
 of
 attended by mother respondents Total re- First Second Third Personal


spondents mail mail mail interview


All ages Percent distribution


Total 3.218 100.0 52.4 33.8 7.9 5.9 _ 

None or elementary 326 100.0 35.9 40.8 13.5 9.8 

High school: 

1-3 years 694 100.0 42.9 37.5 10.7 

4 years or more 1,454 100.0 56.8 32.1 ::; 4.3 

College-1 year or more 708 100.0 62.2 30.2 5.5 2.1 

Not available 36 ... ... ... ... . . . 

Under 20 years 

Total 373 100.0 45.8 36.2 8.6 9.4 

None or elementary 37 100.0 * * * * 

High school: 

1-3 years 160 100.0 39.4 40.6 12.5 

4 years or more 152 100.0 52.6 32.9 ;:2 5.9 

College-1 year or more 19 100.0 * * * * 

Not available 5 . . . ... ... ... ... 

20-24 years


Total 1,074 100.0 53.2 32.1 7.6 7.1 

None or elementary 54 100.0 31.5 42.6 16.7 9.3 

High school: 

1-3 years 218 100.0 45.1 30.0 11.1 13.8 

4 years or more 534 100.0 56,2 32.2 6.0 5.6 

College-1 year or more 257 100.0 59.9 31.5 5.4 3.1 

Not available 11 ... ... ... ... . . . 

25-29 vears


Total 948 100.0 54.0 33.6 8.5 3.8


None or elementary 100.0 33.7 40.8 14.3 11.2 

High school: 

1-3 years 175 100.0 40.0 45.1 8.0 6.9 

4 years or more 434 100.0 57.8 31.6 8.5 2.1 

College-1 year or more 232 100.0 66.8 25.9 6.o 1.3 

Not available 9 . . . ... ... ... ... 

30-34 years 

Total 486 100.0 51.4 36.4 6.6 5.6 

13 

None or elmentary 72 100.0 33.3 44.4 13.9 8.3 

High school: 

1-3 years 85 100.0 45.9 35.3 8.2 10.5 

4 years or more 195 100.0 56.9 32.8 5.1 

College-1 year or more 131 100.0 58.0 37.4 3,8 ;:: 

Not available 3 ... ... ... ... ... 

35 years or over 

Total 337 100.0 54.3 32.9 7.7 5.0 

None or elementary 65 100.0 36.9 40.0 13.8 9.2 

High school: 

1-3 years 100.0 49.1 36.8 5.3 

4years or more 100.0 60.4 30.9 R 

College-1 year or more 69 100.0 66.7 24.6 4.3 :::
 Not available 7 ... ... ... ... ...


18

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Table 6. Percent distribution of respondents in the survey of mothers, by number of mailing ac­
 cording to live-birth order and years of school attended by mother: 1963 National Natality Survey


Respondents by number of mailing


Number
 Live-birth order and years of of
 school attended by mother respondents Total re- First Second Third Personal


spondents mail mail mail interview


All live births Percent distribution


Total 3,218 100.0 52.4 33.8 7.9 5.9 

None or elmentary 326 100.0 35.9 40.8 13.5 9.8 

High school: 

1-3 years 694 100.0 42.9 37.5 10.7 

4 years or more 1,454 100.0 56.8 32.1 ::: 4.3 

College-1 year or more 708 100.0 62.1 30.2 5.5 2.1 

Not available 36 . . . ... ... ... . . . 

First birth


Total 864 100.0 56.9 31.3 6.3 5.6 

None or elementary 32 100.0 .:. %k * * 

High school: 

1-3 years 145 100.0 40.7 38.6 13.1 

4 years or more 429 100.0 60.1 30.1 n 4.7 

College-1 year or more 250 100.0 63.2 28.4 6.4 2.0 

Not available 8 ... ... ... ... ... 

Second birth


Total 777 100.0 52.6 34.6 7.5 5.3


None or elmentary 44 100.0 38.6 40.9 9.1 11.4 

High school: 

1-3 years 152 100.0 40.1 38.8 10.5 10.5 

4 years or more 372 100.0 54.8 33.9 4.0 

College-1 year or more 200 100.0 62.5 31.5 ;;: 1.5 

Not available 9 . . . ... ... ... ... 

Third birth


Total 595 100.0 50.6 32.6 9.6 7.2 

None or elementary 62 100.0 22.6 45.2 16.1 16.1 

High school: 

1-3 years---------------------------- 142 100.0 43.0 36.6 10.6 9.8 

4 years or more ’262 100.0 56.9 29.4 8.0 5.7 

College-1 year or more 126 100.0 60.3 29.4 7.1 3.2 

Not available 3 . . . ... ... ... ... 

Fourth birth


‘Petal 409 100.0 53.8 33.5 6.6 6.1 

None or elementary 40 100.0 52.5 27.5 12.5 7.5 

High school: 

1-3 years 104 100.0 51.9 27.9 13.5 

4 years or more 198 100.0 53.0 37.4 2:: 

College-1 year or more 64 100.0 60.9 32.8 3.1 ::!? 

Not available 3 . . . ..< !.. ... .,. 

Fifth birth and over


Total 573 100.0 46.2 37.9 9.9 5.9 

None or elmentary 148 100.0 32.4 43.9 14.9 8.8 

High school: 

1-3 years 151 100.0 41.7 42.4 8.6 

4 yeara or more 193 100.0 57.0 31.1 G 

College-1 year or more 68 100.0 61.8 32.3 ::: 1.5 

Not available 13 ... ... ... ... ... 

19

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Table 7. percent distribution of surveyed physicians, medical facilities, and dentists, by re­


sponse status according to age of mother: 1963 National Natality Survey


Type of source and age of mother


Physician


All ages


Under 20 years


20-24 years


25-34 years


35 years and over


Medical facility


All ages


Under 20 years


20-24 years


25-34 years


35 years and over


Dentist


All ages


Under 20 years 

20-24 years 

25-34 years 

35 years and over 

Respondents by number of mailing I Number 

in the 

survey Total re- First s~=~d Third respondents 

spondents mail mail


Percent distribution


4,474 93.1 66.5 17.6 9.0 6.9
 — —


597 94.0 66.5 17.6 9.9 6.0 

1,484 92.5 66.5 17.6 8.4 7.5 

1,926 93.2 66.7 17.6 8.9 6.8 

467 93.1 65.7 18.0 9.4 6.9 

4,432 97.6 77.4 15.3 4.9 2.4


681 98.1 76.5 15.7 5.9 1.9 

1,522 97.2 76.3 15.7 5.2. 2.8 

1,813 97.8 79.3 14.1 4.4 2.2 

416 97.4 74.5 18.3 4.6 2.6 

1,360 97.1 81.2 11.5 .4.4 2.9


101 94.1 72.3 18.2 8.0 5.9 

445 96.9 79.6 12.1 5.2 3.1 

676 97.3 83.6 10.5 3.2 2.7 

138 98.6 81.9 12.3 4.4 1.4 

20

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Table 8. Percent distribution of surveyed physicians, medical facilities ~ and dentists, by re­
 sponse status according to color of mother: 1963 National Natal~ty Survey


Respondents by number of mailing


Number


T~e of source and color of mother in the Nonsurvey First I Second Third respondents 

spondents mail mail mai 1 

Total re- 11

Physician Percent distribution 

Total 4,474 93.1 66.5 17.6 9.0 6.9 

White 4>012 93.5 67.8 17.0 8.7 6.5 

Nonwhite 462 89.2 55.2 22.7 11.3 10.8 

Medical facility


Total 4.432 97.6 77.4 15.3 4.9 2.4


White 3,685 98.0 78.5 15’.0 4.5 2.0


Nonwhite 747 95.7 72.0 17.0 6.7 4.3


Dentist


Total 1.360 97.1 81.2 11.5 4.4 2.9


White 1,275 97.7 82.4 11.2 4.1 2.3


Nonwhite 85 87.1 63.5 15.3 8.3 12.9


21

APPENDIX I 

DEFINITIONS OF CERTAIN 

Age of mother. —Age of mother is recorded or 

derived from entries on the birth certificate. 

Color. —Color is recorded or derived from entries 

on the birth certificate for color or race as white or 

nonwhite. The category “white” includes births to 

parents classified as white, Mexican, or Puerto Rican. 

Nonwhite births include births toparents classified as 

Negro, American Indian, Chinese, Japanese, Aleut, 

Eskimo, Hawaiian, or part-Hawaiian. 

Live-8ivth order. —Live-birth order is derived 

from entries on the birth certificate and refers to 

the number of children ,@rn alive to the mother. 

Legitimacy status. —For States reporting legitimacy data on the birth record, legitimacy status of a 

birth is recorded from entries on the birth certificate; 

for States not reporting legitimacy on the birth record, 

it is inferred from other evidence on the birth certificate. The following 16 States did not report legitimacy 

statistics on the birth record in 1963: Arizona, Arkansas, 

TERMS USED IN THIS REPORT 

California, Colorado, Connecticut, Georgia, Idaho, 

Maryland, Massachusetts, Montana, Nebraska,. New 

Hampshire, New Mexico, New York, Oklahoma, and 

Vermont. 

Family income. —Family income refers to ‘the 

total of all income received during the preceding year 

by all persons related to each other by blood, marriage, 

or adoption and living in the household when the baby 

was born. Income from all sources is included, 

such as wages, salaries, unemployment compensation, 

and help from relatives. 

Educational attainment.—The categories of educational attainment shqwn in this report refer to the 

highest grade of regular school attended. 

Medical facility. —Medical facility refers to a hospital, clinic, or other institution where the mother may 

have received care during the year prior to ‘the birth 

of her child. 

ooo — 

22 
?

APPENDIX II 

SOURCE FORMS 

Standard Certificate of Live Birth 

Form..m., cd.


Budcm Bureau No. .W-R3742


CERTIFICATE OF LIVE BIRTH iTATE or BIRTH. No, 

PLACE OF BIRTH .2. L)~A\RESI DE?LCE OF MOTHER $~hc&J mofhu liw?) 

.2. COUNTY 

(I. CITY. TOWN. OR LOCATION c. cm, TOWN. OR L02A710N 

1 

c. NAMEOF (IJnd in hospital, giu atred addrew) d. STREET ADDRESS 

HOSPITALOR 

INSTIITION 

d. is PLACEOF BIRTH INSIDE CITY LIMITS? c 1SRESIDENCEINSIDE CITY LIMITS? J. IS RESIDENCEON A FARM7 

YES � NO � \ YES � NO � YEs � NO � 

3.	 NAME Fir*f Middle Zfmt 

$k#P; or 

:


? 4, SEX 5.. THIS BIRTH 5b. IF TWIN OR TRIPLET. WAS CHILD BORN 6. DATE Jfonfh Dog Ye.,


SINGLE � TWIN � TRIPLET n 1ST � an 3D � BI%H 

7. NAME First Middle L.lsl 8. COLOROR RACE 

: 

c I 

~ 9. AGE (At lime oJ1hiJ blrlh) 10. BIRTHPLACE (stale or peipn munlrfl) 110. USUALOCCUPATION 1lb. KIND OF BUSINESSOR 1NDUSTR% 

I YEARS 

12. MAIDEN NAME Ffr8t ZKiddk .Lmf 13. COLOROR RACE .

~ 

j 14. AGE (A; lime OJ/hiz blrfh) 15. BIRTHPLACE(Stat. or rortign cowtlru) 16. PREVIOUS DELIVERIESTo MOTHER (Do NOT inctudz this birth] 

YEARS	 a. How I,W”U b. How m“. OTHER Ail. ,. nolo m.” r.,.{ d..,b 

OTHER .kifd?c,, :4 y:;, km al{,, b., are y&;,::$A:n;,.v 1’ 

7. INFORMANT arc .I.J.O1{.im.f 

1 I I 

8. MOTHERS MAILING ADDRF.35 

. 134, SIGNATURE 18b. A’17ENDANTAr BIRTH 

I bertbv cai~v that thu cbdd M. D. � D. 0. � MIDWIFE � OTHER (Spccifv) 

,0., & $% 

on ISC. ADDRESS . 13d, DATE SIGNED 

a(afed abow. 

I I 

3. DATE RECD. BY LOCALREG. 20. REGISTRARS SIGNATURE 21. DATE ON WHICH GIVEN NAME ADDED 

BY (R,gistm,) 

FOR MEDICAL AND HEALTH usE ONLY 

(Thb .wfio. MUST be filltd .m2) 

?.3. LENGTH OF PREGNANcY 22b. wEIGHr AT BIRTH 23. LEGITIMATE 

~OE;OMyTED LB. oz. YE5D NOD 

(spAcE FOR ADDITIOti OF MEDICAL AND HEAI_TNITEMS BY indiVidUal 3TATE3) 

23 
Survey Qu,estionnafire for Mothers 

& ‘%? 

: : DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE 

i+ / PUBLIC HEALTH SERVICE WASH1N(3TON q, D. C. 

@ u.. 

r


L


The U. S. Public Health Service is doing a national study to find out how 

much and what kinds of medical and dental care women are receiving during 

the yeex before the birth of a child.. Nothing is known about the extent 

of the cexe recefved by expectant mothers, even though such care is of $he 

greatest importance for the future health ’ofboth mother and baby. A 

knowledge of what is actually happening throughout the Nation till go a 

long way in helping to improve the health of mothers and babies. 

The information needed for this study will be based on the experience of 

the mothers of 4,0Q0 babies out of the bsuillion born during 1963. These 

mothers were selected as a random sample of all mothers who have a baby, 

and you are one of those so selected. we are therefore asking you to answer 

the questions on the following pages of this form, and to return i’tto us 

in the enclosed envelope which requires no postage. 

Please notice that #n tha first pert of the foqn the questions ask about


every doctor, dentist, hospital, or c_Llnicfrom which you received any care


during the entire year before your baby was born. Your auswers shouid not


be just for~c~—connected with pregnancy, but for,~y and all medical


&nd dental cexe or checkups during these 12 months.


All information about you and your baby willbe kept completely confidential.


Your answers will be used for health research only and for no other purpose.


As you might expect, it is particularly important that we receive your


answers end those of all the other 4,000 mothers, since each of you really


represents 1,000 mothers.


Your cooperation in this study is deeply appreciated.


Sincerely yours,


&e/p


O. K. Sagen, . D., Chief


Rational Vital Statistic Division


National Center for”Eealth Statistics


‘Name of Child


Date of Birth File Number


24 
CONFIDENTIALITY has b.. n ass.’r. d th. individual . . p. bli. h.d in tha Fed. rml Ragi, t.r H.y 20, 1959 

FORM APPROVED


BUDGEr BUREAU no 68.X823


SURVEY OF MEDICAL AND DENTAL CARE 

PART I. SOURCESOF MEDICALANODENTAL CARE DURINGONE-EAR PERIODBEFORE CHlLDB1RTH 

L. Please provide the information requested 3. Were you seen by a dentist during this 

kelnw about the physician, chiropractor or one-year ~riod? 

midwife who attended you at the racent 

birth of your child. DYES � IIO (Go on to Q.esti.an 4) 

Name 1


Complete a section below


Address for each dentist.


—— . Name City (&I) and StateA&kess Row many time. w~ie you seen by this 

doctor during the one-year period? I 

City (tom) .5mdState 

!. Were you seen by any other physician 

or chiropractor during the one-year Row many times mere you seen by this 

period bsfora the recent birth of den tis t during the one-year period? 

your child?


� YES � MO (Go o“ t. Question 3) Name 

1
 Addre.s


Complete 

each doctor or chiropractor. II 

City ( tom) a“d Stat. 

Name 

How many times were you see” by this 

Address dentist during the .“e-year period?

a secticm below for


I 4. During this one-year perind, were you traated
 City (tam) and State or examined i? a clinic or hcspital not


reported above? <IncI.de health check up.’ a t


lb. many time. .o=e you s..” by this work, visi ts to mobile health units, etc. )


doctor	 durind the one-year period? 

� YES � uo (Go,o. to next page) 

rime 1


.kklress	 Complete a section below for each 

place where Y.. were treated or ex8mined. 

II


Ci ty-(toun> and State


Row many times were you seen by tfiis 

doctor during the one-year period? 

‘Nke ‘ 1-

Address Nare-”


III ,“


City (tomij
 and State Address “


II


Eow”mmmy times were YOU see” by this City (tam) ‘d State


doctor durine the one-year period?


S.’42S.1Q t.... 2\ 

i3 ”””- PIEKE.GCI ONTO PART11~ 

25 
-----------------

----------

--------------

-----------------

----

-----------

--------------

PART II. RELATED INFORMATION 

L.	 Wers you employed outside your home at any time 4, Was your husband employed at the time of your 

during youE.recent pregnancy? child~s birth? 

~FULL-TIIIET 

UYES (Answer sand DIIO (Go o“ c. DYEs ~ Was he working 

b below) Question 2)4 (check one) 

{ iJp4RT-TIHE7, IJllo 

a. Did you work full-time at all during


your recent pregnancy?


5. What kind of work was your husband doing at the DYES ok o time of your childts birth?. (If he wam noi 

1 working then, please give information for his 

last j,ob) When did you stop working full-time? GIVE POLL DESCRIPTION (For example: grocery 

Hon th I Day I Year clerk, auto mechanic, elementary school teacher> 

19 

b. Did you work part-time at all during


your recent pregnancy?


� YES I-J o 

1 

When did you stop working part-time?


6. What was the total incoms of your family during 

Me”th I Day I Year. 1962? (Include all income such a. wages, salariea, 

unemployment compensation,help from relet ivea, 

19—	 etc. , recexved by all members of the family living 

with YOU when your baby was born) 

2. What was t~e highest grade (or year) of regular


schml that you ever attended? � IIOHE � s4,000- $8,999 (Circle highest grade otte”ded) 

DUIIOER si, ooo � $5, 000- S6,999 

MOUE o � $1,000 - $1,999 � s7,000 -$9,999 

ELEMENTARY SCHOOL---- 1 2 3 II 5 6 7 s I-JS2,000 - $2,999 lJslo, ooo - $1*,999 

HIGH SCHOOL 1 2 3 k �$3,000 -$3,999 � 615,000 OR OVER 

COLLEGE 1 2 3 s ~ ~+ 

Did you COWPLETE this grade? � YES I-Jo 7.	Where did you live when your baby was born? 

(Please give your bo,ne address) 

1,	 What was the highest grade (or year) of regular 

school that your husband ever attended? 

(Circle highest g.nde .attend.d) 

IIOME O 

ELEMENTARY SCHOOL i 2 > II 5 6 7 8 = 

HIGH SCHOOL i 2 3 1! 

Is this place on a city lot (or in an 

CO LLEGE 1 2 9 8 5 6+ apartment building)? 

� YES � llo 

Did he COMPLETE this grade? � VES � ilo 

. ..= .“ ,---- . . ..-. “”- ...=-.= {P-a. ., 

4-63 

(Name a“d address of person completing. this f?rm) 

PIEAsEmE BAcKPAGEmcoMMENTs


26 
Survey Questionnaire for Physicians 

>,..E...+, *’, 

6* $ . : DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE 

i , :. @ ,+..$ PUBLIC HEALTH SERVICE WASHINGTON 25, D. C. *... @ ,,. 

r


1-

Your assistance is needed in a small but important sample survey conducted


by the U. S, Fublic Health Service with the approval of your State Health


Department. The primaxy purpose of this survey is to estimate how often


mothers are exposed to ionizing radiation in the year preceding a birth.


The survey will also provide useful ilataon the extent to which expectant


mothers avail themselves of medical care. The mothers on whom data exe


being collected were identified from a random sample of about &,000 births


out of the k million occurring in the TJhiteaStates during 1963. 

According to our records, the mother nemed below was seen or treateiiby 

you at some time fhrringthe yeex prior to the recent birth of her cMM. 

We ask your cooperation in answering the questions on the following pages, 

which relate to the medical care she receivd during the one-year periofl


preceding childbirth. The exact dates coveretby.this period are shown


below. Information is needd on each exposure to ionizing radiation this


womm experiences Fhring this perioti,irrespective of its relationship


to pregnancy.


Since the survey”is basea on only a small sample of nothers, it is particu­


larly importemt that we obtain full information on each. A postage-free


envelope is encloses for your convenience in replying. You maybe assurea


that your report willbe helilin strictest confidence amiusea only for


statistical research.


Your cooperation in thi6 study is aeeply appreciate


O. K. Ss+gen,~., Chief 

Mational Vital Statistics Division


National Center for Health Statistics


P


Name of Mother Maiden Name 

Address Place of Birth of Child


City-State Date of Birth File Number


PERIOD COVERED BY THIS SURVEY: FROM TO -

27 
CONFIDENTIALITY he. b.. . &.s. r.d the Individual S. published 1. the F*daral R.gistor M.Y 20, 19S9 

FORM APPROVED


EUDQKT BUREAU No. 68. Rs,,


SURVEY OF RADIOLOGICAL EXAMINATIONS 

PART I. Radiological EXAMINATIONS OR TREATMENTS DURINGONE-YEAR PERIODBEFORE CHlLDBlRTH 

To your knowledge, was The mother examined or treated by X-ray or fluoroscope at any time during


the one-year perind before childbirth as specified at the bottom of the preceding page?


� HO (Skip t.a Part IIcm !ast page) 

� YES +	 How many radiological examinations or treatments. 

did she receive during this one-year @eriod? 

~numb=r) (Completesection(s) below, then go on to Iaat page) 

� Complete a separate section below for EACH radiological examination or treatment performed during 

the ONE- YSAR PERIOD, whether or not related to pregnancy. 

� If the SAME TYPE of procedure was performed MORE THAN ONCE, please report E4CH SEPARATELY. 

� If more than one procedure was performed . . the SAME DATE, please report EACH SEPARATELY. 

�	 In reporting NUMBER OF EXPOSURES, please include those which may have been technically 

unsatisfactory. 

� If necessary, continue on a separate sheet. 

SECTION1. FIRSTRADIOLOGICAL EXAMINATION OR TREATMENT OURINGONE-YEAR PERlOD 

1. Type of radiological ; � IA GNOSTIC RADIOGRAPHY � OlkGHOSTIC fLuoROscOpY 

[ equipment used? ! � DIAGNOSTIC PHOTO FLU OROGRAPHY IJX-RAY THERAPY (check one) 

Date of 

lamination 

treatment? 2. Primary area of 

bcdy exposed?


3. Type of service : � PELvlttETRy � III TRAVEHOUS PYELOGRAH 

month) rendered to mother? 

(check one) : � IPLACENTOGRApHY � OTHER (specify) 

: � 80 UTl NE cHEs7 

( 

(day) 4. Number of exposures? ~ ~number) (includethose technically unsatisfactory) 

(year) 5. Place where 

Nanmof physician, hospital or clinic 

=“” lnDiAT-


28 
SECTION2. SECOND RADIOLOGICAL EXAMINATION OR TREATMENT DURINGONE-YEAR PERlOD€

1. Type of radiological ~ � DIAGNOSTIC RadiOgraphy � OIAGHOsTIC Fluoroscope 

equipment used? : � ID IAGtiOSTIC PHOTDFLUOROGRAPNY DX-RAY THERAPY 

(check one) 

Date of


examination


m treatment? 2. Primary area of”


body exposed?


3. Type of service : DpELv IHETRy a INTRAVENOUS PYELOGRAM€

rendered to mother? (month) (check one) : !3PLAcEIIT0GRApHY l_JOTHER (specify) 

: l_JROUTINE CHEST 

{ 

(day) 4. Number of exposures? ~ (include those technically unsatisfactory) 

{number) 

5. Place where (year) 

flame
of physician, hospital or clinic 

“d’ l“O{ATF====


SECTION3. THIRORADIOLOGICAL EXAMINATION OR TREATMENT OURINGONE-YEAR PERlOD€

1. Type of radiological ~ lJDIAGHOsTi C RAo IoGRApny l_JDl*GNosTIc FLUOROSCOPE€

equipment used? ! � DIAGNOSTIC PHOTOFLUOROGRAPHY � X-R*Y THERAPY (check one) 

Date of


examination


)r traatment? 2. Primary area of


bcdy exposed?


3. Typa of service : lJpELvlnETRy nlNTRAvEtiOUS p7ELOGRAFI€

(month) 

rendered to mother? ~ � lpLACEIITOGRApHY lJOTHER (specify) (check one) 

j DROUTIHE CHEST 

{€

(day) 4. Number of exposures? ~ ~“umber) (includethosetechnicallyunsatisfactory) 

(year) 5.	 Place whers j � DONE ATH7 OwN OFFICE 

examination or OR Nameof physician, hospital or clinic treatment was 

performed? .: s Address 

\ City-State 

.SECTION4. FOURTH RADIOLOGICAL EXAMINATION OR TREATMENT DURINGONE-YEAR PERlOD€

/ 1. Type of radiological ~ uOIAGIIOSTIC RADIOGRAPHY lJOIAfiHOsTIC FLuoRoscDPY


equipment used? i DIAGNOSTIC PHOTOFLUOROGRAPHY DX-RAY THERAPY (check on. ) 

Date of


examination


r treatment? 2. Primary area of


bcdy exposed?


3. Type of service : DPELvlnETRy QIN7RAvEH0us PyELOGRAn 

rendered to mother? : � pLAcEMTOGRApHY DOTHER <specify) (month) (check me) 

: � ROuTINE CHEST 

( 

(day) 4. Number of .sxpoaures?. ~ ~nwmber) (includethosetechnically unsatisfactory) 

(year) 5.	 Place where j � DONE AT HY OWN OFFICE 

examination or OR Name of physician, hospital or clinic treatment was 

performed? % Address 

City -St.9te 

.“,..42.$.1
 (P.K 2) I-63 (OVER)

29 
PART II. MEDICAL CARE RECEIVED BY MOTHER 

1.	 How”many times did you see this patient during the 

one-year pericd? (If exactnumber notknown, 

pleasedivebest estimate) 

Number of times


2. On what date did you see her for the first time


during the one-year pericd?


M.. th ‘ID=, year 

3. On what date did you see her for the last time


during the one-year pericd?


Mon tb i Day ~y= 

19


4. If this patient was referred to you, please give 

names and addresses of referring physicians, clinics


or hospitals.


Name


Address


City.. State


Name


Address


City-State


DURINGONE-YEAR PERIODBEFORE CHlLDBlRTH 

5. If you referred this patient to another physician,


or toa hospital or clinic, please give names and


addresses of physicians or institutionsto which


referred.


~


-


6, If this patient was seen or treated during the


one-year period by any other physician, hospital


or clinic not reported above or on the previous


page, please give names and addresses.


~


Name


Address


City-State


(Name of person c.xpleti.gthis form)


COMMENTS 

* 

GPO 943134


PHS .4425.1 (P,I~. 3) 

30 ‘-’3 
Survey Questionnaire for Medical Facilities 

#““”‘“”9+. 

.$ + 

~ DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE 

: , %.*@ PUBLIC HEALTH SERVICE WASHINGTON 2.5, D. C. @ %e ,+” U%* 

r


1-

Your assistanceis neededin a smallbut importantsamplesurveyconducted 

by the U. S. PublicHealthServicewith the approvalof your StateHealth 

I@artment. The primarypurposeof this surveyis to estimatehow often 

motherssxe exposedto ionizingradiationin the year precedinga birth. 

The surveywill alsoprovideweful ZWta on the extentto which expectant 

mothersavailthemselvesof medicalcare. The motherson whom data are 

being collectedwere identifiedfrom a randomsampleof about4,000births 

out of the 4 millionoccurringin the UnitedStatesduring1963. 

Accordingto our records,the mothernamedbelowwas seen or treatedat


your institutionat sometime duringthe year prior to the recentbirth of


her child..We ask your cooperationin answeringthe questionson the


followingpages,which relateto the medicalcaxe she receivedduringthe


one-yeaxperiodprecedingchildbirth.The exactdatescoveredby this


perio&are shownbelow. Informationis neededon each exposureto ionizing


radiationthisw- experiencesamiu thisperioa,irrespectiveof its


relationshipto pregnancy.


Sincethe surveyis basetion only a smallsampleof mothers,it is particu­


larlyimportantthatwe obtainfull informationon each. Apostsge-free


envelopeis enclosesfor your conveniencein replying. You maybe assurea


thatyour reportwillbe held in strictestconfidencea.rflusea
 only for


statisticalresearch.


Your cooperationin this studyis deeplyappreclatecl.


Sincerelyyours,


O K:~~&


ITational
 Vital StatisticsDtvision


I?ational
Centerfor HealthStatistics


I


Name of Mother Maiden Name 

Address Place of Birth of Child


City-State Date of Birth File Number


PERIOO COVERED BY THIS SURVEY: FROM To 

31

OOHFIOENTIALITY ha. b.. . .os. r.d th. I.dlv,ld..l .s Publfi ahad In tho F.d. ral Register Hay 20, 1959


POR# APPROVED, 

8uD0Er BUREAU NO. .s*. L423 

SURVEY OF RADIOLOGICAL EXAMNATIONS 

PART 1. RADIOLOGICAL EXAMINATIONS OR TREATMENTS OURING ONE-YEAR PERIOO BEFORE CHILDBIRTH 

To your knowledge, was the mother examined or treated by X-ray or fluoroscope at any time during 

the one-year period baf ore childbirth as specified at the bottom of the preceding paga ? 

❑ N 0 (Skip “to Part II on last page) 

❑ YES 4	 How many radiological examinations or treatments 

did she receive during this one-year period? 

(Complete section(s) below, then go o“ to lost page) (number) 

,~ Complete a separate section below for EACH radiological examination or treatment performed during 

the ONE-YEAR PERIOD, whether or not related to pregnancy. 

➤ If the SXME TYPE of procedure was performed MORE THAN ONCE, please report. E4CH SEPARATELY. 

➤ If more than one procedure was per formed on the SAME DATE, please report SAi21 SEPARATELY. 

➤ In reporting NUMBER OF EXPOSURES, pl,ease include those which may have been technically 

unsatisfactory. 

➤ If mscessary, continue .“ a separate sheet. 

SECTION 1. FIRST RADIOLOGICAL EXAMINATION OR TREATMENT DURING ONE-YEAR PERIOD 

1.	 Type of radiological ; ❑ IA GNOSTIC RADIOGRAPHY ❑ 01 A6H0sTIc FLUOROSCOPE 

equipment used ? i a DIAGNOSTIC PHOTOFLUOROGRAPHY ~ X-RAY THERAPY (check one) 

Date of 

xati nat i on 2. Primary area of treatment ? body exposed? 

3. Type of service : ❑ PELv IHETRY D INTRAVENOUS PYELOGRAM 

mmth) 

rendered t o mother? : ❑ lpLAc ENT06RApHY l_JOTHER (specify) (check one) 

: ❑ ROUTIHE CHEST 

{ 

- 4.	 Numbax. of exposures? : (in.1.d. those technically unsatisfactory) 

(number) 

(year) 5. Place where 

Name of physician; hospital or clinic 

“’” 1 “D;;AT32 
SECTION2. .-- . . SECOND RADIOLOGICAL EXAMINATION OR TREATMENT DURINGONE-YEAR PERIOD

I 1. Type of radiological : � IA GNOSTIC RADIOGRAPHY � DlA6H0STIC Fluoroscope 

equipment used? ~ � DIAGNOSTIC PHOTOFLUOROGRAPHY OX-RAY THERAPY (check one) 

Date of


examination 2. Primsly area of
 r treatment? bcdy exposed?


3. Type of service : � PELVIHETRy DIttTRAvEt10u5 PYELOGRA14 

rendered to mother? 

(month) (check one) : � PLACEIiTOGRAPHY l_JoTHER (specify) 

j � ROUTIHE CHEST . 

(day) 4. Number of exposures? ; (includethose technically u“satisfa. tory) 

(“umber) 

(year) 5. Place where 

Name of physician, hospital or clinic 

“;’”- 1 ‘D’;AT~


SECTION3. THIRDRADiOLOGICAL EXAMINATION OR TREATMENT DURINGONE-YEAR PERlOD 

1. Type of radiological ; � DIAGll OSTIC RADIOGRAPHY DO IAGti OsTIC FLUORDSCOPY 

equipment used? ; � DIAGNOSTIC PHOTOFLUOROGRAPHY IJX-RAY THERAPY (check one) 

Date of 

examination 2. Primary area of
 r treatment? bcdy exposed?


3. Type of service ~ � PELvltiETRy l_JlllTRAVEk OUS PYELOGRAM 

(month) 

rendered to mother? ~ � IPLACEtITOGRAPHY � DTHER (specify) (check one) 

: l_JROUTINE CHEST 

(day) 4. Number of exposures? : (include those technically unsatisfactory) 

(“uml,er) 

(year) 5. Place where 

Name of physician, hospital or clinic 

““ I“’iATE==


SECTION4. FOURTH RADIOLOGICAL EXAMINATION OR TREATMENT DURINGONE-YEAR PERIOD 

1. Type of radiological ~ lJ01AGt105TlcRAotoGrIAPrnY l_JOIAGiIOSTIC FLUOROSCOPE 

/ equipment used? j � DIAGNOSTIC PHOTOFLUOROGRAPHY IJX-RAY THERAPY (check one) 

Date of 

examination 2. Primary area of : treatment? bcdy exposed? 

3. Type of service j � PELVIMETRY l_JINTRAvEHOUS pYCLOGRAM 

renderad to mother? (month) (check one) : lJPLACEMTOGRApHY IJoTHER (specify) 

; l_JROUTIHE CHEST 

( 

(’lay> 4. Number of exposures? ; . (include those technically trnsati.sfactory) 

(“”ml>er) 

(year) 5. Place where j l_J00HEATTH15 lNsrl TurloN 

examination or” OR Name of physician, hospital or clinic 

treatmant was 

performed? %. Mdr css 

\ City -.Stat. 

..,,25.7 

63 

(P.*. 2) , ,.., --, (UVEK) 33 
PART II. MEDICAL CARE RECEIVED BY MOTHER DURINGONE-YEAR PERIOD BEFORE CHlLDBlRTH 

L.	 How many times was the patient seen at youP 5“ If your institution referred this patient to 

institution during the one-year pe~iod? another hospital or clinic or to a private 

(If	 exact number not known, please give best estimateJ physician, pleass give names and addresses of 

physicians or institutionsto which referred. 

Number of times 

2. On what date was she seen for the first time


during the one-year period?


Momth ‘ID=, year - ~ 

1. On what date was she seen for the last time


during the one-year period?


Month i Day ~y. ~ 

19 6. If this patient was seen or treated during the


one-year period by any other hospital, clinic or
 +. If this patient was referred to your in~tit”tio”, physician not reported above or on the previous
 please give names and addresses of referring


hospitals, clinics or private physicians.


Name 

Address 

City. Stafe 

Name


Address


City. Stafe


page, please give names and addresses.


~ 

Name 

Address 

City-State 

(Name of person ccunpletingthis form) 

COMMENTS 

PHS .4425.7 (pox, 3) 

+.63 GPO 943[31

34 
Survey Questionnaire for Dentists 

~+”””‘“”%+0 7- . : DEPARTMENT OF HEALTH> EDUCATION> AND WELFARE 

~ 

‘i. @ .: 

@%. ~~~ *+”’ 

PUBLIC H.SALTH SERVICE WASHINGTON 25, D. C. 

r


L 

Your assistance is needed in a small but important sample survey conducted 

by the U. S. Public Health Service with the approval of your State Health 

Department. The primary purpose of this survey is to estimate how often 

mothers axe exposetlto ionizing radiation in the year preceding a birth. 

The survey will also provide useful data on the extent to which expectant 

mothers avail themselves of dental care. The mothers on whom data are 

being collected were identifies from a raziiomsample of about b,OOO births 

out of the 4 million occurring in the Unites States auring 1963. 

According to our recoras, the mother namea below was seen or treatetiby


you at some time auring the year prior to the recent birth of her .chila.


We ask your cooperation in answering the questions on the back of this


letter, which relate to the dental care she received &uring the one-yeax


period preced.ingchildbirth. The exact dates coverea by this periofiare


shown below.


Since the surveyis basea on only a small sample of mothers, it is particu­


larly important that we obtain full information on each. A postage-free


envelope is enclosed for your convenience in replying. You maybe assurea


that your report will be hela in strictest confidence anduaefi only for


statistical research.


Your cooperation in this s-hayis deeply appreciatetl.


Sincerely yours, ~


~. IL Sagen, H.dif, chief 

National Vital Statistics Division 

National Center for Health Statistics 

Name of Mother Maiden Name


Address Place of Birth of Child


City-State Date of Birth File Number


I PERIOO COVERED BY THIS SURVEY: FROM TO I 

5

CONFIDENTIALITY hao been assured the individual . . p. b!i. h.d in the Federal Resister M.) 20, 1959 

FORM APPROVED 

BUDGET BUREAU NO 68. R823 

SURVEY OF DENTAL X-RAY EXAMINATIONS 

PART 1. DENTAL X-RAY EXAMINATIONS DURING ONE-YEAR PERIOD BEFORE CHILDBIRTH 

To your knowledge, did the patient receive any dental X-ray examinations during the one-year 

period before childbirth as specified at the bottom of the preceding page? 

� IIO (Skip to Part II below) 

,DY Es ~	 How many dental X-ray examinations did she 

receive during this one-year period? 

(.Umber)


\ \ W<- ... .. .. . . .. . ... . . . .. . .. . . . . . .. \ . . . . . . . , . . ,,,.. \ \ .. . \ .\ .. . . ... . .. .. . .. . . . . . . . . . . -

F	 Complete a separate section below for EACH dental X-ray examination that the patient received 

during the ONE-YEAR PERIOD before the birth of her child. 

b In reporting NUMBER OF EXPOSURES, include those which may have been technically unsatisfactory. 

b If necessary, continue on a separate sheet. 

Date of Exami nation Type(s) of X-ray Exposures(check .11 that apply) Number of Exposures 

I 1 

� FULL MouTn IJEIITE uiti G 

(m.. th .d.sy .ye.s r ) � OTHER _ (specify type) (number) 

� FULL MOUTH � BITE WIHG 

(m.. th -day -Year) ~OTHE R _ (specify type) 

cnmnber) 

IJFULL HOUTH I_JBITE WIHG 

(month-dcy.year) � oTHER _ (specify tYpe) (number) 

PART II. DENTAL CARE RECEIVED BY MOTHER DURINGONE-YEAR PERIODBEFORE CHlLDBlRTH 

1.	 About how many times did you see the patient 4. If the patient was seen by another dentist or 

during the one-year ?eriod? dental clinic during the one-year period, please 

give names and addresses below. Number of times 

Name


?.	Nhen did you see her for the first time during Address 

the one-year pericd? 

city-state 

Month I Day I Year 

19 

Name
 3. !+’hendid you see her for the last tiresduring 

the one-year pericxi? Addresb 

no” th I Day I Year 

city-state 

19 

~FIS-4425.13 (P.,. 2) . . 

(Name of persm completing this form) 

COMMENTS: GPO 943136 

36 

* U. S. GOVERNMENT PP.INT~G OFFICE: 1966 0-229-821 
OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH STATISTICS 

Public” Health Service Publication No. 1000 

Seyies 1. 

Series 2. 

Seyies 3. 

Sen”es 4. 

Sen-es 10, 

Seyies 11. 

Se7-ies 12. 

Series 20. 

Series 21. 

Series 22. 

PYog+rams and collection procedures. —Reports which describe the general programs of the National 

Center for Health Statistics and its offices and divisioni, data collection” methods used, definitions, and 

“other material necessary for understanding the data. 

Reports number 1-4 

l?ata evaluation and methods research. - Studies of new statistical methodology including: experimental 

tests of new survey methods, studies of vital statistics collection methcxis,, new analytical techniques, 

objective evaluations of reliability of collected data, contributions to statistical theory. 

Reports number 1-13 

Analytical studies. -Reports presenting analytical or interpretive studies based on vital and health statistics, oarrying the analysis further than the expository types of reports in the other series. 

Reports number 1-4 

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. 

Reports number 1-5 

Data Fvom the Health InteYview SuYvey. —Statistics on illness, accidental injuries, disability, use of 

hospital, medical, dental, and other services, and other health-related topics, based on data collected in 

a continuing national household interview survey. 

Reports number 1-32 

Data Fvom the Health Examination Survey. —Statistics based on the direct examination, testing, and 

measurement of national samples of the population, including the medically defined prevalence of specific diseases, and distributions of the population with reskct to various physical ‘and physiological 

measurements. 

Reports number 1-18 

Data FYom the Health Records Swvey. -Statistics from records of hospital discharges and statistics 

relating to the health characteristics of persons in institutions, and on hospiti, medical, nursing, and 

personal care received, based on national samples of establishments providing these services and 

samples of the residents or patients. 

Reports number 1-5 

Data on mortaWy .-Various statistics on mortality other than as included in annual or monthIy reportespecial analyses by cause of death, age, and other demographic variables, also geographic and time 

series analyses. 

Reports number 1-3 

Data on natality, marriage, and divorce. -Various statistics on natality, marriage, and divorce other 

than as included in annual or monthly reports-special analyses by demographic variables, also geographic and time series analyses, studies of fertility. , 

Reports number 1-9 

Data FYom the National Natality and Mortality Surveys. -Statistics on characteristics of bir@a and 

deaths not available from the ;ital records, based on sample surveys stemming from these records, 

including such topics as mortality by socioeconomic class, medical experience in the last year, of life, 

characteristics of pregnancy, etc. 

Reports number 1-3 

For a list of titIes of reports published in these series, write to:	 National Center for Health Statistics 

U.S. Public Health Service 

Washington, D.C. 20201