Pamela J. Salsberry
College 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 NLSY
Continued
 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 Outcomes
 Development 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