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.

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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.


Main Reasons for Never Testing for HIV Among Women and Men Aged 15–44 in the United States, 2011–2015

January 25, 2018

Isaedmarie Febo-Vazquez, M.S., Epidemiologist at NCHS

Questions for Isaedmarie Febo-Vazquez, M.S., Epidemiologist and Lead Author of “Main Reasons for Never Testing for HIV Among Women and Men Aged 15–44 in the United States, 2011–2015

Q: What made you decide to focus on the reasons Americans aren’t getting HIV tests for the subject of your new report?

IFV: Our main motivation for conducting this study was our curiosity about why a large number of women and men aged 15-44 have never been tested for HIV. The 2011-2015 National Survey of Family Growth, or NSFG, provides nationally representative data on HIV testing among women and men aged 15-44. Despite the considerable evidence of the benefits of early detection of HIV and initiatives to promote routine HIV testing, there is a significant proportion of adults aged 15-44 in the United States that have never been tested for HIV. Our NSFG data on the reasons why people haven’t been tested for HIV recently became available, and we were curious to investigate these reasons.


Q: Was there a result in your study that you hadn’t expected and that really surprised you?

IFV: The survey question which asks what is the main reason for never testing for HIV is a relatively new question in the NSFG — since 2011. And this is the first time we’ve analyzed this important data. Some interesting findings include differences in the reasons Americans have never tested for HIV — by level of education. For example, a higher percentage of men and women aged 22-44 with Bachelor’s degrees or more education said that the main reason they had never been tested for HIV was because they were unlikely to have been exposed to HIV — compared with those who had less than a high school diploma. We were expecting to see some variations by level of education but were not sure which group would present a higher percentage for this reason for never being tested.


Q: What differences or similarities did you see among race and ethnic groups, and various demographics, in this analysis?

IFV: There are a number of interesting demographic findings in this report. Non-Hispanic Black men and women aged 15-44 were less likely to have never been tested for HIV, compared to other race and ethnic groups. A higher proportion of non-Hispanic white women and men said the main reason they had never been tested for HIV was because they were unlikely to have been exposed to HIV. In contrast, Hispanic men and women were most likely to report they were never offered an HIV test compared with other race and ethnic groups.


Q: What sort of trend data do you have on this topic so we can see how attitudes and behaviors have evolved over time?

IFV: This is the first time we have published data on the main reasons for never testing for HIV. There are prior published reports about HIV testing using NSFG data, but we did not focus on comparing data over time in this report.  Instead, we provide additional information related to HIV testing that could help guide national prevention strategies.


Q: How is the data in this report different or the same when compared to the other National Center for Health Statistics surveys that measure HIV testing, like the National Health Interview Survey and the National Health and Nutrition Examination Survey?   

IFV: The data on HIV testing that comes from different surveys at our agency offers a comprehensive picture of this important public health measure. The overall HIV-testing-question series in the NSFG is patterned after the National Health Interview Survey, or NHIS, and other surveys, where generally a distinction is made between testing done passively as part of donating blood or blood products and all other contexts for HIV testing. The NHIS currently collects data on ever having an HIV test outside of a blood donation, while the NSFG collects data on HIV testing as both part of blood donation and outside of blood donation. Also, the response categories for the question on the main reason for never having been tested for HIV are not the same for NHIS and NSFG.


Q: What is the take-home message of this report?

IFV: I think the take-home message of this report is that despite the considerable evidence of the benefits of early detection of HIV and initiatives to promote routine HIV testing, there is a significant proportion of adults aged 15-44 in the United States that have never been tested for HIV. Overall, 38.8% of women and more than half of men aged 15-44 have never tested for HIV outside of donating blood or blood products. The most common reason reported by women and men for never testing for HIV was that they were “unlikely to have been exposed to HIV,” followed by they had “never been offered an HIV test.” The NSFG continues to provide valuable nationally representative information to help evaluate and guide national HIV prevention strategies.  


Urban and Rural Variation in Fertility-related Behavior Among U.S. Women, 2011–2015

January 9, 2018

Questions for Kimberly Daniels, Ph.D., Statistician and Lead Author of “Urban and Rural Variation in Fertility-related Behavior Among U.S. Women, 2011–2015.”

Q: Why did you decide to examine fertility-related behavior among U.S. women in urban and rural areas?

KD: We decided to examine fertility-related behavior among U.S. women based on urban and rural residence because while there are many National Survey of Family Growth (NSFG) reports on fertility, they do not usually include information about place of residence.  Two NCHS reports were recently published that use Vital Statistics data from birth certificates and focus on urban and rural differences.

One of those reports was on urban and rural differences in infant mortality rates and the other on urban and rural differences in teen birth rates.  After seeing the differences shown in those reports, we decided to work on an NSFG report focusing on fertility-related behavior and place of residence.


Q: Are there any findings among the urban-rural differences that surprised you?

KD: As far as what findings in this report surprised me, based on other publications we reviewed before starting this report I expected that the percentage of currently married women would be higher in rural areas compared with urban areas.  The results in this report showed that the percentage of women who were currently married in each area was similar, around 40%.  I also expected that there would be a difference for cohabitation; although I am not sure which group I expected would be higher.

The results for age at first sexual intercourse may be surprising to readers of the report.  This report uses data from women ages 18-44.  Place of residence is measured at the time of interview.  Among adult women who have ever had sex, the average age at first sexual intercourse was lower for women living in rural areas, 16.6 years on average, compared with 17.4 for women living in urban areas.


Q: Do you have any older trend data to this report from the National Survey of Family Growth for urban and rural fertility-related behavior?

KD: As far as trends over time, we do not show trend data in this report on urban and rural variation in fertility-related behavior.  Some older NSFG reports do include that information, such as this one on fertility, family planning, and reproductive health using 2002 data.  The variable that classifies women as living in an urban or rural area is available on our public use datasets.  It is available to download from our website so researchers could examine time trends or differences in other topical areas by place of residence.


Q: What did your report find on contraceptive use among women in urban and rural areas?

KD: The report looked at contraceptive method use at last sexual intercourse among women ages 18-44 who had sex in the last 12 months.  Contraceptive methods were grouped into four categories based on effectiveness at preventing pregnancy; no method, a less effective method, a moderately effective method, and a most effective method.  The results showed that similar percentages of women in urban and rural areas used no method of contraception, 21.0%.  A higher percentage of women in urban areas used a less effective method, such as a condom, compared with women in rural areas.  A higher percentage of women in urban areas also used a moderately effective method, such as the oral contraceptive pill, compared with women in rural areas.  A higher percentage of women in rural areas used one of the most effective methods of contraception such as a sterilizing operation or an intrauterine device compared with women in urban areas.

As we note in the report, the percentages we show for contraceptive use and the other measures do not account for other factors that could play a role.  For example, the figure that describes differences in number of births shows that women in rural areas are more likely to have had any births and have a higher average number births.  So, some of the differences in contraceptive use across the two groups could be related to differences in plans for future childbearing.


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

KD: The takeaway messages are shown in the key findings and summary in the report.  Among women aged 18-44, on average, women living in rural areas had their first sexual intercourse at younger ages than women living in urban areas. Similar percentages of women in urban and rural areas were currently married, cohabiting, or never married. A higher percentage of women living in rural areas were formerly married compared with women in urban areas. Women living in rural areas were more likely than women living in urban areas to have had any births and had a higher average number of births. Among women aged 18–44 who had sexual intercourse in the past year, a higher percentage of women living in rural areas used one of the most effective methods of contraception at their last intercourse compared with women in urban areas.  It is important to remember that place of residence was measured at the time of interview.

Some of the outcomes in the report occurred when the woman lived in another geographic location.  Also, as I mentioned above the results do not account for other factors that could play a role in the urban and rural differences presented in the


Condom Use During Sexual Intercourse Among Women and Men Aged 15-44 in the United States: 2011-2015 National Survey of Family Growth

August 10, 2017

Questions for Casey Copen, Ph.D., M.P.H., Statistician and Author of “Condom use during sexual intercourse among women and men aged 15-44 in the United States: 2011-2015 National Survey of Family Growth

Q: Why did you decide to examine condom use in this report?

CC: There are about 20 million new sexually transmitted infections (STI) in the United States each year. These infections can lead to long-term health consequences, such as infertility. Condoms can provide protection against most STIs but are often used incorrectly and inconsistently. Similarly, condoms can reduce the risk of pregnancy but have one of the highest rates of contraceptive failure of any contraceptive method.

The purpose of this report was to examine recent trends in condom use during vaginal (sexual) intercourse and measure the prevalence of condom use, alone or in combination with another contraceptive method. This information can be used to plan health services and educational programs in the U.S.


Q: Has the data in this report been previously published?

CC: Data on condom use has been collected for women since 1973 and for men, since 2002. Starting in 2013, questions on problems with condom use were asked of women aged 15-44 who used a condom during intercourse in the past 4 weeks. Periodically, the National Survey of Family Growth (NSFG) publishes reports on current contraceptive use, which includes condoms, to measure how contraceptive use among women has changed over time.

Last month, NSFG released a report on contraceptive use among female and male teens aged 15-19 that included information on condom use at first and most recent intercourse (https://www.cdc.gov/nchs/data/nhsr/nhsr104.pdf). However, the data on condom use problems have not been previously published.


Q: What do you think were the main findings of your report?

CC: In 2011-2015, 23.8% of women and 33.7% of men aged 15–44 used a condom at last sexual intercourse in the past 12 months. Among condom users aged 15-44, the majority of women and men used only a condom and no other method during last intercourse in the past 12 months (59.9% of women and 56.4% of men); another 25.0% of women and 33.2% of men used condoms plus hormonal methods; and 15.1% of women and 10.5% of men used condoms plus non-hormonal methods. Almost 7% of women aged 15–44 who used a condom in the past four weeks said the condom broke or completely fell off during intercourse or withdrawal and 25.8% said the condom was used for only part of the time during intercourse.


Q: How has the percentage of condom use in the U.S. during sexual intercourse changed since 2002?

CC: The percentages of women aged 15-44 who used condoms at last sexual intercourse in the past 12 months were similar from 2002 to 2011-2015, but for men aged 15–44, the percentages increased from 29.5% in 2002 to 33.7% in 2011–2015. Percentages of female and male condom users aged 15–44 who used condoms only at last intercourse in the past 12 months decreased from 67.9% of women and 63.0% of men in 2002 to 59.9% and 56.4% in 2011-2015. Alongside this decline, percentages of female condom users aged 15–44 who used condoms plus non-hormonal methods at last intercourse increased from 11.9% in 2006–2010 to 15.1% in 2011–2015.


Q: What is the take-home message of your report?

CC: This report showed that the majority of women and men aged 15-44 in each NSFG survey period did not use a condom at all during last sexual intercourse. It is important to note that there are many factors associated with condom nonuse, such as being in a monogamous relationship, using hormonal or other methods to prevent pregnancy or trying to get pregnant. Although this report could not address each of these factors directly, these findings indicate there are differences in condom use by age, education, Hispanic origin and race, relationship at last sexual intercourse and number of sexual partners in the past 12 months. About one-quarter of women aged 15-44 who used a condom during intercourse in the past 4 weeks reported that the condom was used for only part of the time during intercourse (25.8%), suggesting that condoms are often used inconsistently.