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

Pamela J. SalsberryCollege of Nursing

&Patricia B. Reagan

Department of Economics

Outline

General comments about using the NLSY79 and related child files for health related research

Specific data elements available for analysis—adult, child, youth surveys

Examples Questions/comments

Why use the NLSY to study health—the positive argument

Interested in a life course perspective

Interested in sibling models to control for unobserved heterogeneity

Interested in the influence of family context on child health

Why use the NLSY to study health, continued

Interested in maternal influences on the health of her children

Examine health of the child’s impact on career trajectories of mothers

Examine the intersection of multiple influences on health outcomes across time

The negative argument or why the NLSY is not good to examine health Many data sets are available that may

be more appropriate to your research questions (NHIS, NHANES, MEPS, Medicare’s Current Beneficiary Survey)

Limited data on health status early on in NLSY79—related to ability to work

The negative argument, continued

Health data is self-reported No physiological measures to confirm

diagnosis, no laboratory data (e.g., BPs, Cardiovascular indicators, EKGs)

Population based sample which can only be used to study relatively common health conditions

Adult Health Before Age 40

Height Weight Does health limit amount or kind of work

respondent can do? 1979, 1980 specific conditions causing

limitation

Health Module for those 40 years of age

CESD—7 items (92, 20-items; 94-7 items)

Parents health status (living/dead, age of death, cause of death)

SF-12 Health conditions- CVD, diabetes,

asthma

Risky Behaviors and Health—Adults (selected years)

Smoking (could be important to track for any asthma study)

Drug use Seat belt use, attitudes towards risk No diet or exercise histories

Health Insurance--Adults

Limited to 89, 90, 92-2004 Determines coverage status and who

pays for the plan (e.g., private, Medicaid) Same set of questions about the children

and spouse

Health Services Utilization- Adults Health at 40 Module

Health services use (last saw a health provider)

Important for ambulatory use sensitive conditions, like asthma

Health – Children of the NLSY

Does health limit ability to attend school or play (for preschool children)?

List of health disabling conditions (most frequent are asthma and learning disability)

Injuries and accidents Height Weight Age of Menarche (females)

Health – Children of the NLSYContinued

Birth weight Length of gestation Length Maternal behaviors

Prepregnancy weight Smoking during pregnancy First trimester health care visit

Risky Behaviors

Asked only of those 10-14 Drug, alcohol, sexual activity

Health Insurance for the Child

Is child covered by health insurance provided by an employer or an individual plan?

Is child covered by Medicaid?

Health services use

Last time had routine health check Last dental visit Caution—question about required health

care—wording leaves open the possibility of needing, but not receiving

Seen by psychiatrist, counselor, psychologist

Health Module for Young Adults

Health limitations—work and school List of health conditions Health status question (Poor to

Excellent) Accidents or injuries Fertility modules Height Weight

Risky behaviors and Health—Young Adults

Self report booklet— Sex & birth control Drugs & alcohol Abortions

Health Insurance for the Young Adults

Source of coverage—parent, employer, self

Covered by Medicaid?

Health services use—Young Adult

Last time had routine health check Last time seen for treatment of an illness Caution—question about required health

care—wording leaves open the possibility of needing, but not receiving

NLSY 97 Health

General Health Height Weight Perceptions about weight Chronic conditions Rounds 1 & 6 Age of menarche (females)

NLSY97 Risky Behaviors

Age>=14 Cigarettes, alcohol, drugs Sexual behavior Birth control

NLSY97- Health Insurance and Utilization of Services

Insurance coverage- Rounds 1 & 6 Visit doctor in past 12 months- Round 6

Research Applications

Birth OutcomesDevelopment of childhood

overweight

Birth Outcomes- Mothers are NLSY79 Respondents

Issues to consider:

Children born to teens occurred in the earliest years of the survey—by mid-1980s all respondents were aged 20 --so that if you wish to ask questions about teen births then one must consider whether the time differences are important

Studying Birth Outcomes

Time trends in health care – for example “scheduled” preterm deliveries have increased over the last 20 years

Birth weights Gestational age—preterm deliveries SGA and LGA determination

Variables of interest

Individual: Age of mother, parity Interval between pregnancies Previous preterm infant Maternal prepregnancy weight Risk behaviors of the mother (smoking,

drinking, drug use) Individual SES—family income, marital

status, education

Determining Prepregnancy BMI

Recording of data slightly different Height asked at three time points(1981,

1982, 1983(for women only) and 1985) 1981=400=4 feet, 0 inches 1983=feet and inches 1985=inches

There are some out of range values Only self-report measures

Preterm Study: Reagan/Salsberry Social Science and Medicine 2005

Research Aim: To examine effect of social context on differences among blacks, whites, and Hispanics in rates of moderately preterm (gestation 33-36 weeks) and very preterm infants (<33 weeks) relative to term births.

Contextual Measure

Lifetime exposure to income inequality :

fraction of mother’s life since age 14 that she had spent in a state with a Gini coefficient above the yearly median

Findings

Blacks > very preterm First births < preterm/very preterm Short interval pregnancies >

preterm/very preterm Drug use during pregnancy>

preterm/very preterm Cumulative exposure to income

inequality Hispanics > very preterm

Studying Child Overweight

Questions slightly different Need to convert to percentile rankings

for age and sex Use of CDC program to standardize BMI

Height in inches Weight in ounces Sex Age in months

Studying Child Overweight

Measured vs. reported data Question asked if child can be measured

—if not, then measures are reported by the mother. There is a follow up question on how the data were obtained (except for 86—question not asked). Generally 70% or more are measured. We have found that measured heights and weights result in less overweight than the self-report data,

Development of overweight in Children: Salsberry/Reagan Pediatrics 2005

Research aim: To examine the timing and extent of early life influences on the development of overweight in children from birth through age 7.

Sample

Children of the NLSY NLSY79 Merged mom information, prenatal

information, with child information In this study we needed data at four time

points—needed birth information, and interviews at 2/3, 4/5, 6/7

Findings

Prepregnancy obesity & Smoking during pregnancy > overweight 2/4

Prepregnancy obesity & Smoking during pregnancy > overweight 4/6 and 6/8 conditional on prior overweight

Race/ethnic differences

Comments/Discussion