Health of the foreign-born population: United States, 1989-90.

The health status of immigrants is of vital interest to health policy planners as the number of immigrants in the United States increases. This report has shown that, overall, foreign-born persons had better health than the U.S.-born population, although this health advantage varied by length of residence in the United States. In virtually every measure of health status, and with regard to almost every sociodemographic characteristic, the most recent immigrants were healthier than foreign-born persons who have lived in the United States 10 years or more as well as healthier than the U.S.-born population. Immigrants who had lived in the United States 10 years or longer were generally healthier than U.S.-born adults, although the differences were not as striking as between recent immigrants and the native-born population. These findings may be explained in several ways. First, recent cohorts of immigrants may have been healthier than earlier cohorts of immigrants at the time of immigration. If so, as their duration of residence in the United States increases, they will continue to be significantly healthier than native-born persons. Second, earlier cohorts of immigrants may have been as healthy as recent cohorts at the time of immigration, but their health has deteriorated with increased duration of residence in the United States. This suggests that immigrants had or acquired physical conditions or behaviors that put them at risk in their new environment or that access to health care has been limited. It also suggests that more recent cohorts of immigrants could experience a similar deterioration of health as their duration of residence in the United States increases. Finally, these findings may reflect a combination of these influences or other factors not considered. To understand these patterns will require additional research, including comparative studies of the health of immigrants in the United States with the health of nonmigrants (stayers) in the countries of immigrant origin.

Trends and differential use of assistive technology devices: United States, 1994.

OBJECTIVE: This report presents data on annual estimates of the prevalence of use of selected assistive technology devices for vision, hearing, mobility, and orthopedic impairments, including missing limbs. Also presented are statistics on trends in the prevalence of use of selected mobility assistive technology devices for the years 1980, 1990, and 1994. METHODS: The data used for this report are from the 1994 National Health Interview Survey on Disability (NHIS-D), Phase I, which was co-sponsored by a consortium of U.S. Federal agencies and private foundations. All estimates are based on data from the NHIS-D, Phase I, which represent the civilian, noninstitutional population of the United States. RESULTS: An estimated 7.4 million persons in the U.S. household population used assistive technology devices for mobility impairments, 4.6 million for orthopedic impairments (including missing limbs), 4.5 million for hearing impairments (not including impairments fully compensated by hearing aids), and 0.5 million for vision impairments. Use of any mobility device for all ages had the highest prevalence rate at 28.5 per 1,000 persons. There was a positive correlation between an increase in age and the increase in the prevalence rate of device usage; for example, of persons in the age group 65 years and over, the rate of mobility, hearing, and vision device usage was more than 4 times the rate for the total population. CONCLUSION: Assistive technology use has increased because of population size, age composition changes, and a change in the rate of use. Medical and technological advances along with public policy initiatives have also contributed to increased usage.

Serious mental illness and disability in the adult household population: United States, 1989.

The major significance of the current report is that it provides estimates and characteristics for that portion of the civilian SMI population living in households. Survey results show that approximately 3.3 million adult Americans have mental disorders that seriously interfere with one or more aspects of daily life and that about 2.6 million of these persons are currently limited in one or more functional areas. These results suggest that the household component of the SMI population is comprised of between 2.6 and 3.3 million adults, depending upon the criteria employed for inclusion. Undoubtedly, both of these numbers are conservative because of the likelihood of underreporting in the survey. Placed in the context of the entire adult population, these findings suggest that the SMI population can be conservatively estimated to include 4 to 5 million adult Americans, or 2.1 to 2.6 øpercent of the adult population. In addition to the household population, it is estimated that 200,000 SMI persons are homeless on any given day (13). An additional 1 million to 1.1 million are residents of nursing homes (14), approximately 50,000 to 60,000 are patients of mental hospitals, and approximately 50,000 are inmates of State prisons (15). A major remaining need is to collect similar data on all SMI persons, whether their residence is a household, an institutional or noninstitutional group quarter, or some other setting, including streets and shelters. In order to formulate more effective national policy to address the needs of these disabled Americans, a need exists to examine the longitudinal relationship between course of disorder and functioning as they relate to service and program participation.

National study of knowledge of AIDS, testing patterns, and self-assessed risk among health care workers.

We conducted a study to assess the level of AIDS knowledge, testing behavior patterns, and self-assessed risk of contracting AIDS for a representative sample of health care workers in the United States. The study was based on data collected in the 1989 AIDS Knowledge and Attitudes Supplement to the National Health Interview Survey. Health care workers in four occupational groups were compared with other members of the labor force and with one another. The survey included 1,620 respondents identified as health care workers and 25,217 respondents with occupations other than in health care. Health care workers were more knowledgeable about AIDS than were other workers; approximately 55% and 25%, respectively, reported knowing a lot about AIDS. They were also more likely to have been tested (34%) than other workers (24%) and to have done so voluntarily (28% versus 14%). Health care workers also believed they had higher risk of contracting AIDS (8% versus 3%), although they were about equally likely to report being in one of the six high-risk groups. Among health care workers, those in the health diagnosing occupations were the most knowledgeable about AIDS (74% reported knowing a lot) and were the most likely to have been tested (41% were tested at least once). Health service workers were the least knowledgeable; only 38% reported knowing a lot about AIDS and only 26% reported being tested.

Use of services for family planning and infertility: United States.

PIP: The statistics presented in this report on the use of family planning and infertility services in the United States are based on interviews with a national sample of 6428 currently married women 15-44 years of age, which were conducted by the National Center for Health Statistics. The statistics are presented in text tables, figures, and detailed tables. 2 measures of the use of family planning services are included in this report: ever use refers to ever having had a discussion with a health care provider regarding family planning methods to delay or prevent a pregnancy; and recent use refers to those discussions in the 3 years before interview. Most nonsterile married women had talked with a physician or other professional about family planning in the 3 years before their interview in 1976 (58.6%). Recent family planning visits were more common among white (59.9%) than among black (46.9%) or Hispanic women (51.8%). Younger women (15-29 years of age) were more likely than older women (30-44 years of age) to have made a recent family planning visit (70.8% and 44.5%, respectively). This difference by age existed independently of race or ethnicity. Among women with a family planning visit in the 3 years before the interview in 1976, most made their latest visit to their personal physician. Only 15.9% made their latest visit to a family planning clinic or other organized medical services. Recent visitors who were black or Hispanic women, were more likely than white recent visitors to have made their latest visit to an organized medical service. Young visitors were more likely to have gone to an organized medical services (18.3%) than older women (11.5%). During their most recent family planning visit, it was recommended to many women that they begin using a method of contraception or that they change from 1 method to another. The method most often recommended by both personal doctors and organized medical services was the oral contraceptive. About 6.9% of nonsterile married women used infertility services in the 3 years before their interview in 1976.^ieng

Trends in breast feeding among American mothers.

PIP: The primary source of data for this study of trends in breast feeding among American mothers was Cycle 1 of the National Survey of Family Growth (NSFG) conducted in 1973. Interviews were held with a nationwide, area probability sample of 9797 women aged 15-44 years who had ever been married or who had children of their own living in the household. Study focus was on trends and differentials in the proportion of women who breastfed their babies, not the proportion of babies who were breastfed. With this focus, the findings presented in this report show the comparative frequency with which mothers in different groups have breastfed their infants. Both the NSFG and the 1965 National Fertility Study data show the marked decline in the incidence of breastfeeding in recent generations of American women. Trends by birth cohorts of women show that 2/3 of the women born in the 1920s breastfed their 1st infant, but only 1/4 of the women born in the late 1940s and early 1950s did so. Over 70% of 1st born infants in the 1930s were breastfed, but less than 30% in the late 1960s and early 1970s. The decline leveled off in the early 1970s, but it is too soon to tell if this is an indication of a rise in the rate of breastfeeding. More than 2/3 of the women breastfed their infants in recent years had stopped by the time the child was 3 months old. 2nd born infants were considerably less likely than 1st born to be breastfed. The level and trend in breastfeeding varied widely across various socioeconomic and cultural categories. Among the groups that had experienced the most precipitous declines in breastfeeding levels over the past 2 decades were black women, women with less than 12 years of education, and women who never worked outside the home.^ieng

Working women and childbearing: United States.

PIP: This report presents statistics on age at marriage, number of children ever born, length of interval between births, and expected completed family size according to indicators of women's participation in the U.S. labor force, such as employment, occupation, and earnings. The statistics, presented in tables, are based on personal interviews with a nationally representative sample of currently married women 15-44 years of age, conducted in 1976. Generally, labor force participation was associated with a later age at 1st marriage, a smaller number of children ever born, longer birth intervals, and a lower expected family size. These associations between employment and family formation were not equally strong or even consistent across all combinations of age, race, education, and other demographic and socioeconomic variables. Approximately 73% of all currently married women had been employed for 6 months or more prior to their 1st marriage, and this premarital employment was strongly associated with a later age at 1st marriage. For all races, ages, and educational levels combined nearly 3/4 of premaritally employed women married after reaching 19 years of age compared with less than 2/5 of nonpremaritally employed women. The most marked differences in age at marriage occurred between wives with low educational levels and no premarital employment and wives with a college education who were employed prior to marriage. About 84% of wives had been employed at some time since their 1st marriage. In the aggregate, these women had borne an average of 2.0 children compared wth an average of 2.3 children ever born to wives with no work experience outside the home. The sharpest fertility differentials by this employment measure were found among women 30-44 years of age. The overall difference in the average number of children ever born to women currently in the labor force (1.8) versus those not in the labor force (2.3) was 0.5. Variations in cumulative fertility by labor force participation were greatest among younger women (15-29 years) with a college education. For white wives, those who earned less than 25% of their family incomes had borne 1 more child on the average than those who earned 50% or more. Labor force participation in the intervals between births was related to lower levels of childbearing. Generally, women who worked during any particular birth interval had lower subsequent fertility than women who did not.^ieng

Health characteristics of large metropolitan statistical areas: United States, 1988-89.

Annual average estimates of rates or percents of limitation of activity, respondent-assessed health status, restricted-activity days, bed-disability days, work-loss days, school-loss days, physician utilization, hospital utilization, incidence of selected acute conditions, and prevalence of selected chronic conditions are shown by geographic region for all large U.S. metropolitan statistical areas combined and for individual metropolitan statistical areas with populations of at least 1.1 million persons.

Current estimates from the National Health Interview Survey, 1996.

OBJECTIVES: This annual report presents national estimates, based on data from the National Health Interview Survey (NHIS), on the incidence of acute conditions, percent of medically attended acute conditions, number of disability days, episodes of persons injured and associated activity restriction, persons with activity limitation due to chronic conditions, restricted activity days associated with acute and chronic conditions, physician contacts and short-stay hospitalizations, as well as prevalence of chronic conditions and respondent assessed health status. This edition includes a section on trends in health statistics for 1982-96. SOURCE OF DATA: NHIS is a multistage probability sample survey conducted annually by interviewers of the Bureau of the Census for the National Center for Health Statistics. Data is collected during in-home interviews of the civilian noninstitutionalized U.S. population. Data collection procedures were similar from 1982 through 1996, but were changed after 1996. HIGHLIGHTS: In 1996 there were 163.5 acute conditions per 100 persons, (67.9% were medically attended) and 624.0 associated days of restricted activity per 100 persons. Of acute injuries, 91.4% were medically attended. The highest rates for chronic conditions per 1000 persons included arthritis (127.3), sinusitis (125.5), deformity and orthopedic impairment (111.6), and high blood pressure (107.1). Activity limitation due to chronic conditions was reported by 14.4% of persons. There were six physician contacts per person per year and 7.3% of the population had a hospitalization in the past year. During 1982-96, the prevalence of asthma increased and the rate and duration of hospitalizations decreased.

Does breast-feeding protect against malocclusion? An analysis of the 1981 Child Health Supplement to the National Health Interview Survey.

Recent increases in breast-feeding in the United States have renewed interest in its associated health effects. In addition to known protective effects related to diarrheal disease in infancy and allergies, breast-feeding may be related to other health and developmental concerns with health cost implications. Data from the Child Health Supplement to the 1981 National Health Interview Survey were analyzed to assess the association between breast-feeding and malocclusion. Increased durations of breast-feeding were associated with a decline in the proportion of children with malocclusion, an association that remains when controlled for known associated variables. Our study adds sufficient strength to the findings in this area that we can recommend that health practitioners inform expectant mothers about this additional benefit of breast-feeding.

Evidence from the National Survey of Family Growth. Work during pregnancy and subsequent hospitalization of mothers and infants.

Large and increasing proportions of women work late into pregnancy and resume work soon after delivery. If work in those periods injures their health or that of their infants, this trend would be of public health concern. Data on ever-married primaparas from the National Survey of Family Growth conducted by the National Center for Health Statistics were used to investigate the relationship between working in the last trimester of pregnancy and two indicators of illness--hospitalization of women for complications of pregnancy and hospitalization of their infants during the first year of life. Hospitalization of the mother or child occurred for 15.0 percent of the primaparas. For primaparas who worked in the last trimester of pregnancy, the percentage was slightly higher--17.1 percent. In two groups, black women and women without hospital insurance for delivery, the percentage of mothers or infants hospitalized was much higher among the mothers who worked in the third trimester than among those who did not. The association of working late in pregnancy with higher rates of hospitalization does not mean, necessarily, that working is a cause of hospitalization. It does indicate, however, the need for epidemiologic and medical research on the relationship.

Analysis of the reversal in breast feeding trends in the early 1970s.

The long downward trend in the practice of breast feeding was reversed during the 1972-73 period. Data from the National Survey of Family Growth conducted by the National Center for Health Statistics were used to investigate the social correlates of breast feeding during the periods 1970-72 and 1973-75 to determine if these factors were related to the reversal in the breast feeding trend. A multivariate log linear modeling technique was used to test hypotheses regarding the direct and indirect effects of education, race, employment status, and source of prenatal care. While education, race, and employment status were directly related to the breast feeding decision, the analysis showed that the trend in breast feeding was unrelated to these correlates. Two alternate conclusions may be drawn from these findings: first, it is possible that changes in infant feeding practices occur earlier in some groups than in others, but the characteristics that distinguish such groups are not included in conventional social demographic data. Alternately, it is possible that the practice of breast feeding appeals equally to all social groups, and changes in the practice occur in response to broad social forces which affect society as a whole.

Infant health consequences of childbearing by teenagers and older mothers.

The association of childbearing at early and late ages with various adverse outcomes of pregnancy was explored in data collected in the 1980 National Natality and Fetal Mortality Surveys. The characteristics of interest for teenage mothers were marital status at conception and the trimester of pregnancy in which prenatal care was begun. For married mothers aged 30 years and older, the variables considered were employment status and occupation during the year preceding childbirth and smoking status before and during pregnancy. The pregnancy outcome variables analyzed were the same for both groups of mothers: fetal loss, low birth weight, and low 1-minute Apgar scores. Although more than half of all births to teenage mothers were to unmarried women, an additional one-quarter of these births were to women who married between the time of conception and the birth of the child. Generally there was little difference in outcomes for teenage mothers who were married at the time of delivery, regardless of their marital status at the time of conception. Pregnancy outcomes for teenagers who did not marry prior to delivery were considerably less favorable. Nearly 90 percent of women aged 30-34 years who had a first birth in 1980 were employed during the year before delivery, an extraordinarily high labor force participation rate. More than half of these employed mothers were in professional occupations, consistent with their very high levels of educational attainment. Although the analysis is limited by the small numbers of births involved, it appears that professionally employed women generally have the best pregnancy outcomes. When mother's smoking status is taken into account,nonsmokers had more favorable outcomes, with births to professionally employed mothers generally most favored.

A comparison of the childhood health status of normal birth weight and low birth weight infants.

We analyzed previously unavailable data to describe the national health status in 1981 of noninstitutionalized children who were low birth weight infants. They were compared with normal birth weight children. All data contained in the analysis were based on weighted national estimates. Low birth weight children in general were found to have more chronic conditions, more hospitalizations, more days in bed because of illness, more limitations of activity, poorer health status as perceived by parents, and more school days lost because of illness. However, numbers of physician visits were not different even for low birth weight children younger than 2 years, which is inconsistent with the higher proportions of multiple hospitalizations, chronic conditions, and other illness measures. The proportions of children in the younger age groups at risk for health problems associated with low birth weight should be increasing. The proportion of very low birth weight children in the younger age groups with higher excessive morbidity measures tends to support the possibility. The increased survival of high-risk infants raises concern about their future requirements for special medical and educational services, and about the resulting stress on their families. Normal birth weight children were found to make a major contribution to the prevalence of morbidity. It is not the children identified as at risk as a result of low birth weight that comprise most of those with illnesses. The physical, social, and psychological environment after birth probably has the largest impact on the health status of our children. The attributable risk of excessive morbidity associated with low birth weight and very low birth weight reinforces the concept that while the overall impact is not large, the consistent pattern of poorer health for children born with low birth weight, compared to those of normal birth weight, shown in this analysis, is striking. The pattern reinforces concerns with the many factors associated with low birth weight and their effects on the present and future health of the population.

Terrorism and the international classification of functioning, disability and health: a speculative case study based on the terrorist attacks on New York and Washington.

PURPOSE: To argue that there is a need for a standard classification of functional status to track the consequences of large scale human disasters, such as the terrorist attacks on New York and Washington on September 11, 2001; and that the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) can meet that need. METHOD: The need for tracking functional status following the September 11 attacks is assessed, and three hypothetical case studies of victims of terrorist attacks are presented and coded using a clinical short form of the ICF. RESULTS: It is demonstrated that typical clinical case histories can be coded to the ICF and that the resulting information is useful for tracking the functional consequences of large scale terrorist attacks on civilian populations. CONCLUSIONS: ICF research, development, and training should proceed with the goal of implementing the classification in professions and settings concerned with the functional consequences of terrorist attacks and other human disasters.

Findings from the Dental Care Supplement of the National Health Interview Survey, 1983.

This report describes the prevalence of edentulism, problems associated with use of dentures, and reported use of fluoride products in the civilian noninstitutionalized population of the United States. The statistics reported are based on a sample of 105,182 people about whom information was collected using the 1983 Dental Care Supplement to the National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics.