Demographic, Health Care, and Fertility-Related Characteristics of Adults Aged 18-44 Who Have Ever Been in Foster Care: United States, 2011-2017

January 22, 2020

Questions for Colleen Nugent, Health Statistician and Lead Author of “Demographic, Health Care, and Fertility-Related Characteristics of Adults Aged 18-44 Who Have Ever Been in Foster Care: United States, 2011-2017,”

Q: Why did you decide to do a report on adults who have ever been in foster care?

CN: The National Survey of Family Growth is one of the few U.S. nationally representative surveys that collects information on having ever been in foster care during childhood from adult respondents across the full reproductive age span.  Combining that with other content specific to the NSFG provides a rare opportunity to get nationally representative estimates on how outcomes related to health service access and use and fertility related milestones might differ between those who had ever been in foster care and those who had not.


Q: How did the data vary by adults who have ever been in foster care?

CN: Women and men who had been in foster care had lower levels of educational attainment, had higher percentages receiving public assistance in the past year, and were less likely to be currently working or attending school than adults who had never been in foster care.  Those who had been in foster care were less likely to have private health insurance, were more likely to experience time without health insurance in the past year, and were less likely to use a private doctor’s office as their usual place of care.  Adults ever in foster care also had higher probabilities of first sexual intercourse and first births at younger ages than those never in foster care.


Q: Was there a specific finding in the data that surprised you?

CN: Although those who had never been in foster care were more likely to have completed a bachelor’s degree or higher than those who had ever been in foster care, the rates of those completing some college were actually more similar for both groups.


Q: What were some of the limitations when interpreting the data?

CN: There are several limitations.  One is that we didn’t have information on what ages respondents were in foster care, how long ago they exited, and what types of foster care settings they were in—whether those were relative or nonrelative family foster homes, group homes, or institutional settings. Differences in outcomes could vary by the timing of foster care in a child’s development, and also by the type of foster care setting.  Another is that these analyses are bivariate and cross-sectional and cannot be used to assess causation. This means that outcomes may not be due solely to foster care itself and may be linked with characteristics of those entering foster care that preceded their experience in the system.


Q: Will you have an update to this report in the future?

CN: The number of respondents who have ever been in foster care is relatively small in our survey and we needed to combine data over several file releases to be able to produce reliable estimates. If we update this report in the future, it will require waiting for several more data releases that we can combine to have a large enough sample of respondents ever in foster care.


QuickStats: Percentage of Emergency Department Visits for Pain at Which Opioids Were Given or Prescribed, by Geographic Region of the Hospital — United States, 2005–2017

January 17, 2020

The percentage of emergency department visits for pain at which an opioid was given or prescribed increased from 37.4% in 2005 to 43.1% in 2010 and then decreased to 30.9% in 2017.

A similar pattern was observed in all four regions. Percentages for the Northeast were lower than for the nation as a whole for all years analyzed.

In 2017, the percentage was 21.1% in the Northeast, compared with 32.0% in the Midwest, 32.0% in the South, and 34.7% in the West.

Source: National Center for Health Statistics. National Hospital Ambulatory Medical Care Survey, 2005–2017. https://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htm.


QuickStats: Expected Number of Births over a Woman’s Lifetime — National Vital Statistics System, United States, 1940–2018

January 10, 2020

During 1940–2018, the expected number of births a woman would have over her lifetime, the total fertility rate (TFR), was highest for women during the post-World War II baby boom (births during 1946–1964). In 1957, the TFR reached a peak of 3.77 births per woman.

The TFR generally declined for the birth cohort referred to as Generation X from 2.91 in 1965 to 1.84 in 1980.

For the birth cohorts referred to as Millennials (Generation Y) and Generation Z, the TFR first increased to 2.08 in 1990 and then remained generally stable until it began to decline in 2007.

By 2018, the expected number of births per women fell to 1.73, a record low for the nation. Except for 2006 and 2007, the TFR has been below the level needed for a generation to replace itself (2.10 births per woman) since 1971.

Source: National Vital Statistics System. Birth data, 1940–2018. https://www.cdc.gov/nchs/nvss/births.htm.

https://www.cdc.gov/mmwr/volumes/69/wr/mm6901a5.htm


Trends in Opioids Prescribed at Discharge From Emergency Departments Among Adults: United States, 2006–2017

January 8, 2020

Questions for Lead Author Anna Rui, Health Statistician, of “Trends in Opioids Prescribed at Discharge From Emergency Departments Among Adults: United States, 2006–2017.”

Q: Why did you decide to look at opioid prescribing at emergency department discharges?

AR: There is a large body of research reporting increases in opioid prescription rates from 1999 to 2010 but less is known about how rates have changed from 2010 on, particularly in the emergency department setting, where many patients present with pain symptoms and are likely to receive opioids for treatment. In response to the opioid epidemic, hundreds of local, state, and federal programs were implemented in recent years with the goal of changing prescribing practices. A goal of this report was to evaluate recent trends in opioid prescribing, in order to monitor the effects of public health policy.


Q: How did the data vary by patient/hospital characteristics and in the type of opioids prescribed at discharge?

AR: Variation in the rate of change was found for age, patient residence, and primary expected source of payment. The rate of decrease in the percentage of visits with an opioid prescribed at discharge by younger patients aged 18-44 from both the beginning of the study period (2006-2007) and from the inflection point (2010-2011) to the end of the study period (2016-2017) was the highest across all age groups. Similarly, the percentage of visits by patients living in medium or small metropolitan counties decreased by the highest percentage across the study period among all urban and rural categories. Both Medicaid and self-pay/no charge/charity experienced the highest rate of decrease from 2010-2011 through 2016-2017 whereas the percentage of visits by patients with Medicare that included an opioid prescribed at discharge remained stable across the study period.

In terms of hospital characteristics, among the four regions, the largest decrease in opioids prescribed at discharge from 2006-2007 to 2016-2017 was observed in the Northeast region. Generally, a higher percentage of visits at proprietary (or for-profit) hospital EDs, compared with nonprofit and government hospital EDs, included an opioid prescribed at discharge. Despite the high percentage, the rate of decrease among visits made to proprietary hospital EDs from 2006-2007 through 2016-2017 was modest.

In terms of the type of opioids prescribed, the percentage of opioid mentions with acetaminophen-hydrocodone (e.g., Vicodin) prescribed remained stable through 2012-2013 and decreased starting from 2014-2015. Corresponding to this decrease, the percentage of opioid mentions with tramadol and acetaminophen-codeine, which are known as having a lesser risk of dependence, increased starting in 2014-2015 and continued through 2016-2017.


Q: Was there a specific finding in the data that surprised you?

AR: One finding that surprised me was the magnitude of decrease in the percentage of opioids prescribed from 2010-2011 through 2016-2017 for most of the pain-related diagnoses. For example, the percentage of visits for extremity and back pain decreased by 68.8% and 49.1%, respectively, between 2010-2011 and 2016-2017.


Q: How did you obtain this data for this report?

AR: Restricted data (available from the Research Data Center) collected from the National Hospital Ambulatory Medical Care Survey were used for this report. Masked public use data are available for download from the Ambulatory Health Care Data website (https://www.cdc.gov/nchs/ahcd/datasets_documentation_related.htm)


Q: What is the take home message for this report?

AR: I think the take home message of the report is recent trends show a decrease in the percentage of visits with opioids prescribed at discharge from 2010-2011 through 2016-2017, and this trend was observed for most of the patient and hospital characteristics examined, as well as for most of the pain-related diagnoses prompting the ED visit.


Human Papillomavirus Vaccination Among Adults Aged 18−26, 2013−2018

January 7, 2020

A new NCHS report describes trends in self-reported HPV vaccination initiation and completion by selected demographic characteristics among adults aged 18−26.

  • Among adults aged 18−26, the percentage who ever received one or more doses of human papillomavirus (HPV) vaccine increased from 22.1% in 2013 to 39.9% in 2018.
  • The percentage of adults aged 18−26 who received the recommended number of doses of HPV vaccine increased from 13.8% in 2013 to 21.5% in 2018.
  • In 2018, non-Hispanic white adults were more likely than Hispanic adults to have ever received one or more doses of HPV vaccine.
  • Among adults aged 18−26 who ever received one or more doses of HPV vaccine, the majority received the first dose between the ages of 13 and 17 years.

QuickStats: Percentage of Adults Aged 18 Years or Older Who Had Lower Back Pain in the Past 3 Months, by Sex and Age Group

January 3, 2020

In 2018, 28.0% of men and 31.6% of women aged 18 years or older had lower back pain in the past 3 months.

The percentage of women who had lower back pain increased as age increased.

Among men, the percentage increased with age through age 74 years and then decreased.

Women in the age groups 18–44, 45–64, and 75 years or older were more likely to have lower back pain in the past 3 months than were men in the same age groups, but percentages were similar between men and women in the age group 65–74 years.

Source: National Health Interview Survey, 2018. https://www.cdc.gov/nchs/nhis/index.htm.