Using Fragile Families Data to Study Health

Baseline Health Measures Mother: prenatal health behaviors (smoking drinking, drug use); prenatal care use (month); general health status (5 point scale); health insurance type Father: health behaviors (smoking, drinking, drug use) general health status (5 point scale); serious health problem that limits work (reported by mother) Child: birth weight

Follow-Up Measures (1 and 3 years) Mother: general health status (5 point scale); serious health problem that limits work; substance use (cigarettes, alcohol, illicit drugs— marijuana, other) 3 years only: prescribed medications; hospitalizations; ER use; height and weight; health insurance; regular source of health care Father: same as mothers Child: breastfeeding (1 year); general health status (5 point scale); physical disabilities; illnesses; injuries; ER use; hospitalizations (for accidents/injuries; for illnesses); asthma (diagnosis, attack, ER use); lead poisoning (3 years); weight; height (3 years); well child care; regular source of health care; second hand smoke

Collaborative Project: Medical Records and Neighborhoods Collect new data from hospital birth records of Fragile Families mothers and babies Geocode Fragile Families survey records and attach neighborhood characteristics Funded by NICHD and RWJ Foundation

Medical Records Data Pre-existing Medical Conditions Lab Test Results Psychosocial History Obstetrical History Labor/Delivery Complications Newborn Information Detailed Notes

So far… Medical Records Data Completed in 10 Cities: Austin, Corpus Christi, San Antonio, Oakland, San Jose, Baltimore, Philadelphia, Boston, Jacksonville, Norfolk …plus a subset of records in Newark Going into the field in Indianapolis next week

Sneak Preview 17% of mothers had STDs during pregnancy 32% of mothers had bacterial vaginosis or other genitourinary infection during pregnancy 38% of mothers were obese (BMI >= 30) 11% of mothers used illicit drugs prenatally 12% of infants in NICU

Neighborhoods Neighborhoods confer health disadvantages above and beyond those accruing from individual level poverty: Housing and other buildings old, in poor condition Environmental pollutants

Role of Neighborhoods Low birthweight: tract-level income Lead poisoning: areas with low housing values, where most homes were built before 1950, with higher density, with higher rates of poverty, with poorly educated population, with lower rates of owner- occupied housing Asthma: low-income neighborhoods, indoor and outdoor environmental pollutants

Two Sets of Analyses #1 Analyze determinants of poor infant and child health #2 Assess how poor child health affects family resources

Determinants of Child Health Effects of prenatal use of illicit drugs on preterm birth, low birth weight, and longer-term child health outcomes Effects of fathers on infant and child health outcomes (parents’ relationship status, behaviors) Neighborhood factors and racial disparities in preterm birth and low birth weight

Effects on Family Resources Poor child health (from survey): Decreases likelihood that parents of one year old children live together by 9-10 percentage points Reduces mother's probability of being employed by 8 percentage points and hours of work by 3 per week Reduces father’s probability of being employed by 8 percentage points and hours of work by 5 per week, net of effects on mother’s employment

Other Family Resources Living with extended family Public assistance Child support Subsequent education Child care Pediatric health care Participation in preschool programs