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.


Receipt of Pelvic Examinations Among Women Aged 15–44 in the United States, 1988–2017

June 26, 2019

Using National Survey of Family Growth (NSFG) data through 2017 for women aged 15–44, a new NCHS report describes trends overall and by age since 1988 in the receipt of pelvic examinations in the past year, and differences by Hispanic origin and race, education, poverty status, and health insurance status for 2015–2017.

Key Findings:

  • A decreasing trend in the receipt of pelvic examinations in the past 12 months among women aged 15–44 was observed from 1988 through 2017.
  • A decreasing trend in the receipt of pelvic examinations among women aged 15–20 and 21–29 was observed from 1988 through 2017.
  • During 2015–2017, receipt of a pelvic examination in the last 12 months was highest among non-Hispanic black women, followed by non-Hispanic white women and Hispanic women.
  • During 2015–2017, receipt of a pelvic examination in the past 12 months increased with increasing levels of education.

Current Contraceptive Status Among Women Aged 15–49: United States, 2015–2017

December 19, 2018

Using data from the 2015–2017 National Survey of Family Growth, a new NCHS report provides a snapshot of current contraceptive status, in the month of interview, among women aged 15–49 in the United States.

In addition to describing use of any method by age, Hispanic origin and race, and education, patterns of use are described for the four most commonly used contraceptive methods: female sterilization; oral contraceptive pill; long-acting reversible contraceptives (LARCs), which include contraceptive implants and intrauterine devices; and male condom.

Key Findings:

  • In 2015–2017, 64.9% of the 72.2 million women aged 15–49 in the United States were currently using contraception. The most common contraceptive methods currently used were female sterilization (18.6%), oral contraceptive pill (12.6%), long-acting reversible contraceptives (LARCs) (10.3%), and male condom (8.7%).
  • Use of LARCs was higher among women aged 20–29 (13.1%) compared with women aged 15–19 (8.2%) and 40–49 (6.7%); use was also higher among women aged 30–39 (11.7%) compared with those aged 40–49.
  • Current condom use did not differ among non-Hispanic white, non-Hispanic black, and Hispanic women (about 7%–10%).
  • Female sterilization declined and use of the pill increased with higher education. Use of LARCs did not differ across education (about 10%–12%).

Adoption-related Behaviors Among Women Aged 18–44 in the United States: 2011–2015

July 19, 2018

Questions for Lead Author Chinagozi Ugwu, Statistician and Author of “Adoption-related Behaviors Among Women Aged 18–44 in the United States: 2011–2015

Q: Why did you decide to focus on adoption-related behaviors in the United States?

CU: Adoption is one way people build their families, and this report provides some basic statistics on adoption in the United States. The National Survey of Family Growth (NSFG) is one of few sources of nationally representative data on adoption and adoption seeking among adult women in the U.S.


Q: How did the findings vary by age groups?

CU: This report documented some differences by age groups in adoption-related behaviors. Women in the oldest age category (35-44 years) were more likely to be seeking to adopt than women of younger ages, and were also more likely to have ever adopted.

Approximately 1.5% of women aged 35-44 in 2011-2015 were currently seeking to adopt, followed by 1.4% of women aged 25-34 and 0.6% of women aged 18-24. The percentage of women who had ever adopted a child increased with increasing age (0.1%, aged 18–24; 0.5%, aged 25–34; 1.3%, aged 35–44).


Q: Were there any major changes in adoption-related behaviors from previous years?

CU: In this report, we did not study trends in these adoption-related behaviors.  We focused more on providing a snapshot of the demographic characteristics of U.S. adult women who had engaged in these three adoption-related behaviors: ever considered adoption, currently seeking to adopt, and ever adopted a child.


Q: Do you have data for adoption-related behavior data on women older than age 44?

CU: The NSFG data used for this report reflect survey years when the age range extended only to age 44.  Beginning in 2015, the NSFG expanded its age range to 15-49, so future analyses can include adults 18-49.  The public use files for 2015-2017, which will reflect the expanded age range of 15-49 are expected to be released later this year.


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

CU: While the percentages of adult women aged 18-44 with adoption-related experience are relatively low, this report documents key variations by demographic characteristics, including age and current fertility problems. More women with fertility problems than those without had ever considered adopting or were currently seeking to adopt a child. Higher percentages of women in the oldest age (35-44 years) category were currently seeking to adopt or had ever adopted, than women in the youngest age (18-24 years) category.


Fertility of Men and Women Aged 15–44 in the United States: National Survey of Family Growth, 2011–2015

July 11, 2018

Questions for Gladys Martinez, Statistician, and Lead Author of “Fertility of Men and Women Aged 15–44 in the United States: National Survey of Family Growth, 2011–2015

Q: Why did you decide to examine fertility measures in the United States?

GM: This report provides basic information about four fertility measures for the nation using data from the 2011-2015 National Survey of Family Growth for women and men aged 15-44: percentage of men and women who have ever had a biological child, how many children they have, the timing of first births, and birth spacing. Differences are shown by age, marital or cohabiting status, education, income, and Hispanic origin and race.


Q: How did the rates estimates vary by gender for women and men?

GM: Some comparisons of the fertility estimates in this report are made for women and men, but these differences were not the focus of the report. Some differences for women and men include the percentage who have ever had a child. By age 40-44, 85.0% of women and 80.4% of men have ever had a child. Among women and men who have ever had a child, the average age at first birth was 23.1 for women and 25.5 for men, similar to the estimates from 2006-2010. The average number of births was 1.2 for women and 0.9 for men.


Q: How did the rates estimates vary by Hispanic origin and race?

GM: Some differences by Hispanic origin and race that are shown in the report include that non-Hispanic Asian women had the highest mean age at first birth (26.7) across all groups shown (24.1 for non-Hispanic white women, and 21.5 for Hispanic women and 21.2 for non-Hispanic black women ). The probability of having a first birth before age 20 was highest for Hispanic and non-Hispanic black women (28%) and lowest for non-Hispanic Asian women (4%).


Q: How did the estimates vary by educational level?

GM: Some differences by educational attainment included that women and men with lower levels of education were more like to have had a birth, to have had more children, and have had their first child at a younger age. For example, among women aged 22-44 who have ever had a child, 53.9% of women with less than a high school education had their first birth before age 20. This percentage for women with a Bachelor’s degree or higher was 5.5%. In this report, education was measured at the time of interview, not at the time of the child’s birth. Differences by education are shown for women and men aged 22-44 since many of those ages 15-21 have not completed their education.


Q: Were there any major changes in the fertility estimates from previous years?

GM: In this report some comparisons of the overall estimates for the percentage of men and women who have ever had a biological child, how many children they have, the timing of first births, and birth spacing for 2011-2015 are made with 2006-2010. Most estimates were similar across the two time points. One difference was that the average number of children born to women decreased from 1.3 in 2006-2010 to 1.2 in 2011-2015 .


A Demographic, Attitudinal, and Behavioral Profile of Cohabiting Adults in the United States, 2011–2015

May 31, 2018

Questions for Colleen Nugent, Statistician, and Lead Author of “A Demographic, Attitudinal, and Behavioral Profile of Cohabiting Adults in the United States, 2011–2015

Q: What did you think was the most interesting finding in your report?

CN: We took a snapshot of adults aged 18-44 in 2011-2015 and see that demographically, attitudinally, and behaviorally, cohabiters represent a unique group.  Demographically, one interesting finding is that cohabiters have lower educational attainment than other marital status groups–current cohabiters were more likely than both currently married and unmarried, noncohabiting men and women to have not received a high school diploma or GED.  Cohabiting men and women also hold different attitudes when it comes to fertility and family formation.

One interesting finding here is that a higher percentage of cohabiting women and men agreed with the statement, “It is okay to have and raise children when the parents are living together but not married,” compared with both married and unmarried, noncohabiting individuals.

In terms of family-formation and fertility behaviors, an interesting finding is that a higher percentage of cohabiting men and women had their first sexual intercourse before age 18 than both married and unmarried, noncohabiting persons.


Q: Why is the CDC examining trends in cohabitation in the U.S.?

CN: We aren’t examining trends because we don’t compare any estimates to a prior point in time.  But we felt it was important to profile cohabiters because cohabiting is becoming more prevalent among U.S. adults, and births to unmarried women are most likely to happen in a cohabiting union.


Q: Were there any major differences between men and women on attitudes and fertility behavior involving cohabitation?

CN: We only directly compared male and female cohabiters in our report.  Men and women only differed on one attitude–“It is okay for an unmarried female to have and raise a child.”  Female cohabiters were more supportive of this situation than male cohabiters.  Female cohabiters were more likely than male cohabiters to be living with children under 18, but less likely than male cohabiters to have had an unintended birth.


Q: Is there any comparable trend data on cohabitation in U.S. older than 2011-2015 data?

CN: Past NSFG surveys have collected data on cohabitation, but we did not analyze the older data for this report.  Other published estimates using older data incorporate a wider age range of respondents (15-44 years), so we can’t directly assess the trend using these newer estimates based on adults 18-44 in 2011-2015.


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

CN: Cohabiting adults represent a unique group relative to married or other unmarried adults and thus may have distinct family planning and fertility needs and considerations.


Receipt of a Sexual Risk Assessment From a Doctor or Medical Care Provider in the Past Year Among Women and Men Aged 15–44 With Recent Sexual Activity

March 29, 2018

Questions for Casey Copen, Ph.D., M.P.H., Statistician and Author of “Receipt of a Sexual Risk Assessment From a Doctor or Medical Care Provider in the Past Year Among Women and Men Aged 15–44 With Recent Sexual Activity.”

Q: Why did you decide to examine the percentage of women and men aged 15-44 in the U.S. who received a sexual risk assessment?

CC: Sexually transmitted infections (STIs) including chlamydia and gonorrhea are among the most common reportable infections nationwide. If left untreated, STIs can result in serious health consequences, including infertility.   The first step in the prevention of HIV and other STIs is to identify the people who may be at risk.  Health care providers who talk to their patients about aspects of their sexual experience may make them aware of behaviors that may increase their risk, such as not using condoms and having multiple sexual partners.  In 2011 (for men) and 2013 (for women), four questions were added to the audio computer-assisted self-interview portion of the National Survey of Family Growth (NSFG) that asked whether a doctor or other medical care provider had questioned them in the past year about 1) their sexual orientation or the sex of their sexual partners; 2) their number of sexual partners; 3) their use of condoms; 4) the types of sex they have, whether vaginal, oral or anal.  Taken together, these questions comprise what is referred to in this report as a sexual risk assessment.  I conducted these analyses because it is important to have a general sense for whether doctors or other medical care providers ask their patients these types of questions.

Q: What are we seeing with the overall percentage of U.S. adults with recent sexual activity who received a sexual risk assessment?

CC: Overall, 47% of women and 23% of men aged 15-44 with recent sexual activity (i.e., sex with an opposite-sex or same-sex partner in the past year) received a sexual risk assessment from a doctor or other medical care provider in the past year.

Q: What differences did you see in the receipt of a sexual risk assessment by selected social, demographic and behavioral characteristics in this analysis?

CC: Receipt of a sexual risk assessment was higher among women and men aged 15-24, those who were Hispanic and Non-Hispanic black, those who had income below 300% of the poverty level, or who had public health insurance.  Additionally, receipt of a sexual risk assessment was higher among men who identified as gay or bisexual, lived in urban areas , or who had a usual place to go for medical care. Higher receipt of a sexual risk assessment was also seen for women and men who had two or more opposite-sex partners in the past compared with those who had only 1 opposite-sex sexual partner and for men who had a same-sex sexual partner in the past year or who had any HIV-related sexual risk behaviors in the past year.

Q:  Were there any findings that surprised you?

CC: It is not surprising that studies on the prevalence of sexual risk assessment are generally concerned with clinic populations (i.e., those who may be most at risk for HIV/STI infection).  However, I do find it interesting that, to my knowledge, this is the first time a nationally representative household survey has provided estimates of sexual risk assessment receipt in the general reproductive-aged population.

Q: What overall message do you hope to leave with the general public when it comes to sexual risk assessment?

CC: A sexual risk assessment is a primary prevention tool that can help identify persons at risk of HIV/STIs.  While about half of women aged 15-44 received a sexual risk assessment in the past year, for men, receipt was more focused among those who engaged in HIV risk-related behaviors in the past year.  In addition, both women and men who received a sexual risk assessment were more likely to have been tested for HIV/STI in the past year.  This positive relationship suggests that where clinical conversations about sexual behavior occur, HIV/STI testing may follow.