Infertility and Impaired Fecundity in Women and Men in the United States, 2015-2019.

Objectives-Using National Survey of Family Growth data from 2015-2019, this report presents updated national estimates of infertility in U.S. women and men and estimates of impaired fecundity (physical ability to have children) in U.S. women. Detailed demographic breakdowns are also presented, and overall estimates for 2015-2019 are compared with those for 2011-2015. Methods-Data for this report come primarily from the 2015-2019 National Survey of Family Growth, which consisted of 21,441 interviews with men and women ages 15-49, conducted from September 2015 through September 2019. The response rate was 65.9% for women and 62.4% for men. Results-The percentage of women ages 15-44 who had impaired fecundity did not change between 2011-2015 and 2015-2019. The percentage of married women with impaired fecundity also remained stable over this time period. Among all women, 13.4% of women ages 15-49 and 15.4% of women ages 25-49 had impaired fecundity in 2015-2019. The percentage of married women ages 15-44 who were infertile rose from 2011-2015 (6.7%) to 2015-2019 (8.7%). Among married and cohabiting women ages 15-49 in 2015-2019, 7.8% had infertility. Both infertility and impaired fecundity were associated with age for nulliparous (never had a live birth) women after adjusting for other factors. Some form of infertility (either subfertility or nonsurgical sterility) was seen in 11.4% of men ages 15-49 and 12.8% of men ages 25-49 in 2015-2019. . Conclusion-Although these findings are not nationally representative, this report illustrates how linked NHCS-HUD data may provide insight into maternal health outcomes of patients who received housing assistance compared with those who did not.

Receipt of Selected Preventive Health Services for Women and Men of Reproductive Age - United States, 2011-2013.

PROBLEM/CONDITION: Receipt of key preventive health services among women and men of reproductive age (i.e., 15-44 years) can help them achieve their desired number and spacing of healthy children and improve their overall health. The 2014 publication Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs (QFP) establishes standards for providing a core set of preventive services to promote these goals. These services include contraceptive care for persons seeking to prevent or delay pregnancy, pregnancy testing and counseling, basic infertility services for those seeking to achieve pregnancy, sexually transmitted disease (STD) services, and other preconception care and related preventive health services. QFP describes how to provide these services and recommends using family planning and other primary care visits to screen for and offer the full range of these services. This report presents baseline estimates of the use of these preventive services before the publication of QFP that can be used to monitor progress toward improving the quality of preventive care received by women and men of reproductive age. PERIOD COVERED: 2011-2013. DESCRIPTION OF THE SYSTEM: Three surveillance systems were used to document receipt of preventive health services among women and men of reproductive age as recommended in QFP. The National Survey of Family Growth (NSFG) collects data on factors that influence reproductive health in the United States since 1973, with a focus on fertility, sexual activity, contraceptive use, reproductive health care, family formation, child care, and related topics. NSFG uses a stratified, multistage probability sample to produce nationally representative estimates for the U.S. household population of women and men aged 15-44 years. This report uses data from the 2011-2013 NSFG. The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, state- and population-based surveillance system designed to monitor selected maternal behaviors and experiences that occur before, during, and shortly after pregnancy among women who deliver live-born infants in the United States. Annual PRAMS data sets are created and used to produce statewide estimates of preconception and perinatal health behaviors and experiences. This report uses PRAMS data for 2011-2012 from 11 states (Hawaii, Maine, Maryland, Michigan, Minnesota, Nebraska, New Jersey, Tennessee, Utah, Vermont, and West Virginia). The National Health Interview Survey (NHIS) is a nationally representative survey of noninstitutionalized civilians in the United States. NHIS collects data on a broad range of health topics, including the prevalence, distribution, and effects of illness and disability and the services rendered for or because of such conditions. Households are identified through a multistage probability household sampling design, and estimates are produced using weights that account for the sampling design, nonresponse, and poststratification adjustments. This report uses data from the 2013 NHIS for women aged 18-44 years. RESULTS: Many preventive health services recommended in QFP were not received by all women and men of reproductive age. For contraceptive services, including contraceptive counseling and advice, 46.5% of women aged 15-44 years at risk for unintended pregnancy received services in the past year, and 4.5% of men who had vaginal intercourse in the past year received services in that year. For sexually transmitted disease (STD) services, among all women aged 15-24 years who had oral, anal, or vaginal sex with an opposite sex partner in the past year, 37.5% were tested for chlamydia in that year. Among persons aged 15-44 years who were at risk because they were not in a mutually monogamous relationship during the past year, 45.3% of women were tested for chlamydia and 32.5% of men were tested for any STD in that year. For preconception care and related preventive health services, data from selected states indicated that 33.2% of women with a recent live birth (i.e., 2-9 months postpartum) talked with a health care professional about improving their health before their most recent pregnancy; of selected preconception counseling topics, the most frequently discussed was taking vitamins with folic acid before pregnancy (81.2%), followed by achieving a healthy weight before pregnancy (62.9%) and how drinking alcohol (60.3%) or smoking (58.2%) during pregnancy can affect a baby. Nationally, among women aged 18-44 years irrespective of pregnancy status, 80.9% had their blood pressure checked by a health care professional and 31.7% received an influenza vaccine in the past year; 54.5% of those with high blood pressure were tested for diabetes, 44.9% of those with obesity had a health care professional talk with them about their diet, and 55.2% of those who were current smokers had a health professional talk with them about their smoking in the past year. Among all women aged 21-44 years, 81.6% received a Papanicolaou (Pap) test in the past 3 years. Receipt of certain preventive services varied by age and race/ethnicity. Among women with a recent live birth, the percentage of those who talked with a health care professional about improving their health before their most recent pregnancy increased with age (range: 25.9% and 25.2% for women aged ≤19 and 20-24 years, respectively, to 35.9% and 37.8% for women aged 25-34 and ≥35 years, respectively). Among women with a recent live birth, the percentage of those who talked with a health care professional about improving their health before their most recent pregnancy was higher for non-Hispanic white (white) (35.2%) compared with non-Hispanic black (black) (30.0%) and Hispanic (26.0%) women. Conversely, across most STD screening services evaluated, testing was highest among black women and men and lowest among their white counterparts. Receipt of many preventive services recommended in QFP increased consistently across categories of family income and continuity of health insurance coverage. Prevalence of service receipt was highest among women in the highest family income category (>400% of federal poverty level [FPL]) and among women with insurance coverage for each of the following: contraceptive services among women at risk for unintended pregnancy; medical services beyond advice to help achieve pregnancy; vaccinations (hepatitis B and human papillomavirus [HPV], ever; tetanus, past 10 years; influenza, past year); discussions with a health care professional about improving health before pregnancy and taking vitamins with folic acid; blood pressure and diabetes screening; discussions with a health care professional in the past year about diet, among those with obesity; discussions with a health care professional in the past year about smoking, among current smokers; Pap tests within the past 3 years; and mammograms within the past 2 years. INTERPRETATION: Before 2014, many women and men of reproductive age were not receiving several of the preventive services recommended for them in QFP. Although differences existed by age and race/ethnicity, across the range of recommended services, receipt was consistently lower among women and men with lower family income and greater instability in health insurance coverage. PUBLIC HEALTH ACTION: Information in this report on baseline receipt during 2011-2013 of preventive services for women and men of reproductive age can be used to target improvements in the use of recommended services through the development ofresearch priorities, information for decision makers, and public health practice. Health care administrators and practitioners can use the information to identify subpopulations with the greatest need for preventive services and make informed decisions on resource allocation. Public health researchers can use the information to guide research on the determinants of service use and factors that might increase use of preventive services. Policymakers can use this information to evaluate the impact of policy changes and assess resource needs for effective programs, research, and surveillance on the use of preventive health services for women and men of reproductive age.

Sexual Behavior, Sexual Attraction, and Sexual Orientation Among Adults Aged 18-44 in the United States: Data From the 2011-2013 National Survey of Family Growth.

OBJECTIVE: This report provides national estimates of sexual behavior, sexual attraction, and sexual orientation among women and men aged 18-44 in the United States, based on the 2011-2013 National Survey of Family Growth (NSFG). METHODS: Data for the 2011-2013 NSFG were collected through in-person interviews with 10,416 women and men aged 15-44 in the household population in the United States. In this report, data are shown only for 9,175 adults aged 18-44. The data presented in this report were primarily collected using audio computer-assisted self-interviewing, in which the respondent enters his or her answers into the computer without telling them to an interviewer. The overall response rate for the 2011-2013 NSFG was 72.8%. RESULTS: Regarding opposite-sex sexual behavior, 94.2% of women and 92.0% of men aged 18-44 had ever had vaginal intercourse; 86.2% of women and 87.4% of men had ever had oral sex; and 35.9% of women and 42.3% of men had ever had anal sex. Almost three times as many women (17.4%) reported any same-sex contact in their lifetime compared with men (6.2%) aged 18-44. Feelings of attraction "only to the opposite sex" were more common for men (92.1%) compared with women (81.0%) aged 18-44. Among those aged 18-44, 92.3% of women and 95.1% of men said they were "heterosexual or straight"; 1.3% of women and 1.9% of men said they were "homosexual, gay, or lesbian"; 5.5% of women and 2.0% of men said they were bisexual; and 0.9% of women and 1.0% of men said "don't know" or "refused" (i.e., "did not report") on sexual orientation. Sexual attraction and sexual orientation correlate closely but not completely with reports of sexual behavior. Sexual behavior, sexual attraction, and sexual orientation vary by age, marital or cohabiting status, education, and race and Hispanic origin.

Supply of and demand for assisted reproductive technologies in the United States: clinic- and population-based data, 1995-2010.

OBJECTIVE: To study national-level trends in assisted reproduction technology (ART) treatments and outcomes as well as the characteristics of women who have sought this form of infertility treatment. DESIGN: Population-based study. SETTING: Not applicable. PATIENT(S): For CDC: All reporting clinics from 1996-2010. For NSFG: for the logistic analysis, sample comprising 2,325 women aged 22-44 years who have ever used medical help to get pregnant, excluding women who used only miscarriage prevention services. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): CDC data (number of cycles, live birth deliveries, live births, patient diagnoses); and NSFG data (individual use of ART procedures). RESULT(S): Between 1995 and 2010, use of ART increased. Parity and age are strong predictors of using ART procedures. The other correlates are higher education, having had tubal surgery, and having a current fertility problem. CONCLUSION(S): The two complementary data sets highlight the trends of ART use. An increase in the use of ART services over this time period is seen in both data sources. Nulliparous women aged 35-39 years are the most likely to have ever used ART services.

HIV Testing in the Past Year Among the U.S. Household Population Aged 15-44: 2011-2013.

KEY FINDINGS: Overall, 19% of persons aged 15-44 in 2011-2013 had been tested for HIV in the past year, including 22% of females and 16% of males. Higher percentages of HIV testing in the past year were seen for persons aged 15-34 compared with those aged 35-44, and for non-Hispanic black persons compared with other race and ethnicity groups. Four of 10 males who had same-sex sexual contact in the past year had been tested for HIV in the past year, compared with 2 of 10 who had opposite-sex sexual contact in the past year. Levels of HIV testing in the past year were higher for persons with behaviors that increase HIV risk, including having one or more same-sex partners or higher numbers of opposite-sex sexual partners in the past year.

Infertility service use in the United States: data from the National Survey of Family Growth, 1982-2010.

OBJECTIVES: This report presents nationally representative estimates and trends for infertility service use among women aged 15-44 and 25-44 in the United States in 1982-2010. While greater detail on types of infertility service is shown for women, basic data on types of infertility service use, as reported by men aged 25-44, are also presented. METHODS: Data for this report come primarily from the 2006-2010 National Survey of Family Growth (NSFG), consisting of 22,682 interviews with men and women aged 15-44, conducted from June 2006 through June 2010. The response rate for females in the 2006-2010 NSFG was 78%, and for males was 75%. Selected trends are shown based on prior NSFG cycles. RESULTS: Twelve percent of women aged 15-44 in 2006-2010 (7.3 million women), or their husbands or partners, had ever used infertility services. Among women aged 25-44, 17% (6.9 million) had ever used any infertility service, a significant decrease from 20% in 1995. Thirty-eight percent of nulliparous women with current fertility problems in 2006-2010 had ever used infertility services, significantly less than 56% of such women in 1982. In all survey years, ever-use of medical help to get pregnant was highest among older and nulliparous women, non-Hispanic white women, women with current fertility problems, and women with higher levels of education and household income. The most commonly used infertility services among women aged 25-44 in 2006-2010 were advice, testing, medical help to prevent miscarriage, and ovulation drugs. Ever-use of infertility services was reported by 9.4% of men aged 25-44 in 2006-2010, similar to levels seen in 2002.

Correlates of self-reported pelvic inflammatory disease treatment in sexually experienced reproductive-aged women in the United States, 1995 and 2006-2010.

BACKGROUND: Few studies have examined recent temporal trends in self-reported receipt of pelvic inflammatory disease (PID) treatment. We assessed trends in receipt of PID treatment and associated correlates using national survey data. METHODS: We used data from the National Survey of Family Growth, a multistage national probability survey of 15- to 44-year-old women. We examined trends in self-reported receipt of PID treatment from 1995, 2002, to 2006-2010. In addition, we examined correlates of PID treatment in 1995 and 2006-2010 in bivariate and adjusted analyses. RESULTS: From 1995 to 2002, receipt of PID treatment significantly declined from 8.6% to 5.7% (P < 0.0001); however, there was no difference from 2002 to 2006-2010 (5.0%, P = 0.16). In bivariate analyses, racial differences in PID treatment declined across time; in 2006-2010, there was no significant difference between racial/ethnic groups (P = 0.22). Also in bivariate analyses, similar to 1995, in 2006 to 2010, some of the highest reports of receipt of PID treatment were women who were 35 to 44 years old (5.6%), had an income less than 150% of poverty level (7.5%), had less than high school education (6.7%), douched (7.7%), had intercourse before age 15 years (10.3%), and had 10 or more lifetime partners (8.0%). In adjusted analyses, differing from 1995, women at less than 150% of the poverty level were more likely (adjusted odds ratio [AOR], 2.60; 95% confidence interval [CI], 1.79-3.76) than women at 300% or more of the poverty level to have received PID treatment in 2006-2010. CONCLUSIONS: Receipt of PID treatment declined from 1995 to 2006-2010, with the burden affecting women of lower socioeconomic status.

Use of family planning and related medical services among women aged 15-44 in the United States: National Survey of Family Growth, 2006-2010.

OBJECTIVE: This report presents national estimates of the use of family planning services and related medical services among women aged 15-44 in the United States in 2006-2010. Selected indicators are compared with similar measures for 2002 and 1995 to examine changes over time. METHODS: Data for this report come primarily from the 2006-2010 National Survey of Family Growth (NSFG), which included 12,279 interviews with women aged 15-44. The response rate for women in the 2006-2010 NSFG was 78%. RESULTS: In 2006-2010, 43 million women aged 15-44 received a family planning or related medical service in the previous 12 months. A Pap test and a pelvic exam were the most common services received by women in the previous year, followed by receipt of a method of birth control. About 18% of women received a family planning or related medical service from a clinic in the past 12 months and one-half of these women received it from a Title X-funded clinic. In contrast, 53% of women received a family planning or related medical service in the past 12 months from a private doctor. Use of Title X-funded clinics was more common among women in cohabiting unions, black and Hispanic women, those who lived in nonmetropolitan areas, those below the poverty level, and those without health insurance.

Infertility and impaired fecundity in the United States, 1982-2010: data from the National Survey of Family Growth.

OBJECTIVES: This report presents nationally representative estimates and trends for infertility and impaired fecundity-two measures of fertility problems-among women aged 15-44 in the United States. Data are also presented on a measure of infertility among men aged 15-44. METHODS: Data for this report come primarily from the 2006-2010 National Survey of Family Growth (NSFG), which consisted of 22,682 interviews with men and women aged 15-44, conducted from June 2006 through June 2010. The response rate for women in the 2006-2010 NSFG was 78%, and for men was 75%. Selected trends are shown based on prior NSFG years. RESULTS: The percentage of married women aged 15-44 who were infertile fell from 8.5% in 1982 (2.4 million women) to 6.0% (1.5 million) in 2006-2010. Impaired fecundity among married women aged 15-44 increased from 11% in 1982 to 15% in 2002, but decreased to 12% in 2006-2010. Among all women, 11% had impaired fecundity in 2006-2010. Both infertility and impaired fecundity remain closely associated with age for nulliparous women. Among married, nulliparous women aged 35-44, the percentage infertile declined from 44% in 1982 to 27% in 2006-2010, reflecting greater delays in childbearing over this period. Among married women in 2006-2010, non-Hispanic black women were more likely to be infertile than non-Hispanic white women. Some form of infertility (either subfertility or nonsurgical sterility) was reported by 9.4% of men aged 15-44 and 12% of men aged 25-44 in 2006-2010, similar to levels seen in 2002.

Fertility of men and women aged 15-44 years in the United States: National Survey of Family Growth, 2006-2010.

OBJECTIVE: This report presents national estimates of the fertility of men and women aged 15-44 years in the United States in 2006-2010 based on the National Survey of Family Growth (NSFG). Data are compared with similar measures for 2002. METHODS: Descriptive tables of numbers, percentages, and means are presented and discussed. Data were collected through in-person interviews of a nationally representative sample of the household population aged 15-44 years in the United States between July 2006 and June 2010. The 2006-2010 NSFG sample is comprised of 22,682 respondents including 10,403 men and 12,279 women. The overall response rate for the 2006-2010 NSFG was 77%, 75% for men and 78% for women. RESULTS: Many of the fertility measures among men and women aged 15-44 based on the 2006-2010 NSFG were generally similar to those reported based on the 2002 NSFG. The mean age at first child's birth for women was 23 and the mean age at first child's birth for men was 25. One-half of first births to women were in their 20s and two-thirds of first births were fathered by men who were in their 20s. On average, women aged 15-44 have 1.3 children as of the time of the interview. By age 40, 85% of women had had a birth, and 76% of men had fathered a child. In 2006-2010, 22% of first births to women occurred within cohabiting unions, up from 12% in 2002. These measures differed by Hispanic origin and race and other demographic characteristics.

HIV risk-related behaviors in the United States household population aged 15-44 years: data from the National Survey of Family Growth, 2002 and 2006-2010.

OBJECTIVE: This report presents national estimates of selected HIV risk-related behaviors among men and women 15-44 years of age in the United States, based on the 2006-2010 National Survey of Family Growth (NSFG). Data from the 2006-2010 NSFG are compared with data from the 2002 NSFG. METHODS: Data for 2006-2010 were collected through in-person interviews with a national sample of 22,682 men and women aged 15-44 years in the household population of the United States. The measures presented in this report were collected using audio computer-assisted self-interviewing (ACASI), in which the respondent enters his or her own answers into the computer without telling them to an interviewer. The response rate for the 2006-2010 NSFG was 77%, 78% for women and 75% for men. HIV risk-related behavioral measures examined in this report include sexual risk, drug risk, and recent STD treatment. RESULTS: Approximately 10% of men and 8% of women in 2006-2010 reported at least one of the HIV risk-related behavioral measures examined in this report, representing 6.5 million men and 4.9 million women in the general U.S. household population. This represents a decline from the 13% of men and 11% of women who reported one or more of these measures in 2002. This decline appears to be due to a decrease in sexual risk behaviors reported in 2006-2010, however further analysis as well as comparisons with other household surveys are needed to fully understand and describe trends over time. Significant variations were seen by demographic and socioeconomic characteristics including age, race and Hispanic origin, sex, education, and poverty level income. Among men, those with recent prison experience were more likely than other men to report one or more HIV risk-related behaviors in the past year.

Prevalence and timing of oral sex with opposite-sex partners among females and males aged 15-24 years: United States, 2007-2010.

OBJECTIVE: This report presents data on the prevalence of oral sex with opposite-sex partners and the timing of first oral sex relative to first vaginal intercourse among females and males aged 15-24 based on the National Survey of Family Growth (NSFG) data from 2007-2010. The question on timing, added to the NSFG in 2007, asked females and males whether first oral sex occurred before, after, or on the same occasion as their first vaginal intercourse. METHODS: Descriptive tables of numbers and percentages are presented and discussed. The current report is based on a nationally representative subsample of 6,346 interviews conducted from July 2007 to June 2010-3,242 with women and 3,104 with men aged 15-24 years. The measures presented in this report were collected using audio computer-assisted self-interviewing, in which the respondent enters his or her own answers into the computer without telling them to an interviewer. The overall response rate for the 2006-2010 NSFG was 77%, 78% for women aged 15-44 years, and 75% for men aged 15-44 years. RESULTS: About two-thirds of females (66%) and males (65%) aged 15-24 years in 2007-2010 had ever had oral sex. Among females aged 15-24 years. 26% had first oral sex before first vaginal intercourse; 27% had oral sex after intercourse; 7.4% had oral sex on the same occasion as first intercourse; and 5.1% had oral sex, but no vaginal intercourse. Among males aged 15-24 years, 24% had first oral sex before first intercourse; 24% had oral sex after first intercourse; 12% had oral sex on the same occasion as first intercourse; and 6.5% had oral sex, but no vaginal intercourse.

HIV testing in the U.S. household population aged 15-44: data from the National Survey of Family Growth, 2006-2010.

OBJECTIVES: This report presents nationally representative estimates and trends for human immunodeficiency virus (HIV) testing among the U.S. household population aged 15-44. Data are presented for lifetime experience with HIV testing and HIV testing in the past year, including testing done as part of prenatal care. METHODS: Data for this report come from the 2006-2010 National Survey of Family Growth (NSFG), consisting of 22,682 interviews with men and women aged 15-44, conducted from June 2006 through June 2010. The overall response rate for the 2006-2010 NSFG was 77%: 78% for women and 75% for men. RESULTS: Among U.S. women aged 15-44, the percentage ever tested for HIV outside of blood donation increased significantly from 35% in 1995 to 55% in 2002, and to 59% in 2006-2010. Among men aged 15-44, the percentage ever tested outside blood donation fell from 47% in 2002 to 42% in 2006-2010. Within gender groups in 2006-2010, the proportions ever tested for HIV outside of blood donation were similar for Hispanic and non-Hispanic white persons: roughly 6 out of 10 among women and 4 out of 10 among men. However, a higher percentage of non-Hispanic black women (75%) and non-Hispanic black men (61%) had ever been tested for HIV outside of blood donation. Based on 2006-2010 data, 21% of women were tested for HIV within the 12 months prior to interview, compared with 13% of men. While NSFG data cannot ascertain the temporal sequencing of risk-related behaviors and HIV testing, the data indicate that testing within the past year occurs more often among individuals reporting potential HIV risk-related behaviors.

Sexual behavior, sexual attraction, and sexual identity in the United States: data from the 2006-2008 National Survey of Family Growth.

OBJECTIVE: This report presents national estimates of several measures of sexual behavior, sexual attraction, and sexual identity among males and females aged 15-44 years in the United States, based on the 2006-2008 National Survey of Family Growth (NSFG). These data are relevant to demographic and public health concerns, including fertility and sexually transmitted infections among teenagers and adults. Data from the 2006-2008 NSFG are compared with data from the 2002 NSFG and other national surveys. METHODS: Data for 2006-2008 were collected through in-person interviews with a national sample of 13,495 males and females in the household population of the United States. The measures presented in this report were collected using audio computer-assisted self interviewing (ACASI), in which the respondent enters his or her own answers into the computer without telling them to an interviewer. The overall response rate for the 2006-2008 NSFG was 75%. RESULTS: Sexual behaviors among males and females aged 15-44 based on the 2006-2008 NSFG were generally similar to those reported based on the 2002 NSFG. Among adults aged 25-44, about 98% of women and 97% of men ever had vaginal intercourse, 89% of women and 90% of men ever had oral sex with an opposite-sex partner, and 36% of women and 44% of men ever had anal sex with an opposite-sex partner. Twice as many women aged 25-44 (12%) reported any same-sex contact in their lifetimes compared with men (5.8%). Among teenagers aged 15-19, 7% of females and 9% of males have had oral sex with an opposite-sex partner, but no vaginal intercourse. Sexual attraction and identity correlates closely but not completely with reports of sexual behavior. Sexual behaviors, attraction, and identity vary by age, marital or cohabiting status, education, and race and Hispanic origin.

Marriage and cohabitation in the United States: A statistical portrait based on cycle 6 (2002) of the National Survey of Family Growth.

OBJECTIVE: This report provides an overview of marital and cohabiting relationships in the United States among men and women aged 15-44 in 2002, by a variety of characteristics. National estimates are provided that highlight formal and informal marital status, previous experience with marriage and cohabitation, the sequencing of marriage and cohabitation, and the stability of cohabitations and marriages. METHODS: The analyses presented in this report are based on a nationally representative sample of 12,571 men and women aged 15-44 living in households in the United States in 2002, based on the National Survey of Family Growth, Cycle 6. RESULTS: Over 40% of men and women aged 15-44 were currently married at the date of interview, compared with about 9% who were currently cohabiting. Men and women were, however, likely to cohabit prior to becoming married. Marriages were longer lasting than cohabiting unions; about 78% of marriages lasted 5 years or more, compared with less than 30% of cohabitations. Cohabitations were shorter-lived than marriages in part because about half of cohabitations transitioned to marriage within 3 years. Variations--often large variations-in marital and cohabiting relationships and durations were found by race and Hispanic origin, education, family background, and other factors.

Infertility service use among U.S. women: 1995 and 2002.

OBJECTIVE: To examine trends in use of medical services for infertility, by individual characteristics of women. DESIGN: Pooled data from two cycles (1995 and 2002) of the National Survey of Family Growth, a periodically conducted, nationally representative, cross-sectional survey of women 15-44 years of age. PARTICIPANT(S): The analysis sample was composed of 2,005 women 22-44 years of age with current fertility problems. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Ever having used infertility services, and highest level of services used. RESULT(S): Between 1995 and 2002, ever-use of infertility services by fertility-impaired women age 22-44 years continued to be closely associated with older age, nulliparity, formal marital status, and higher socioeconomic status (education, household income, and private health insurance). Net of these factors, race and Hispanic origin, showed no significant association with either the use of services overall or the highest level of services used. After controlling for compositional changes in these individual characteristics, a slight decline was seen in ever-use of services overall from 1995 to 2002. No effect of survey year was noted in the highest level of services. CONCLUSION(S): Infertility service use among fertility-impaired women remains closely tied with socioeconomic factors. The "threshold effect" of these factors has shifted upward to the receipt of more costly services such as assisted reproductive technologies. These higher level services remain a relatively small fraction of the services reported in a general population sample of fertility-impaired women.

A public health focus on infertility prevention, detection, and management.

In 2002, 2 million American women of reproductive age were infertile. Infertility is also common among men. The Centers for Disease Control and Prevention (CDC) conducts surveillance and research on the causes of infertility, monitors the safety and efficacy of infertility treatment, and sponsors national prevention programs. A CDC-wide working group found that, despite this effort, considerable gaps and opportunities exist in surveillance, research, communication, and program and policy development. We intend to consult with other federal agencies, professional and consumer organizations, the scientific community, the health care community, industry, and other stakeholders, and participate in the development of a national public health plan for the prevention, detection, and management of infertility.

Who marries and when? Age at first marriage in the United States: 2002.

During the latter half of the 20th century, there were notable increases in the age at first marriage among Americans and related increases in the proportion of unmarried and never-married adults. Research finds that, in comparison with unmarried persons, married persons tend to exhibit greater physical, emotional, and economic wellbeing, although the association may vary by outcome, sex, and other factors. Children in households with two married parents differ from those in other types of households on measures such as child achievement, but the causal processes are complex. Given the potential benefits of marriage, concerns over a decline in marriage have prompted a great deal of attention as well as investment in marriage promotion programs, such as the Department of Health and Human Services' Healthy Marriage Initiative. This report highlights what we know about the incidence and timing of first marriage among women and men 15-44 years of age in the United States, based on data from the National Survey of Family Growth (NSFG) conducted in 2002.

Prevalence and correlates of heterosexual anal and oral sex in adolescents and adults in the United States.

BACKGROUND: Heterosexual anal and oral sex are related to the acquisition of sexually transmitted infections, including human immunodeficiency virus infection. We examined the correlates of heterosexual anal and oral sex in the general population, using data from the National Survey of Family Growth. METHODS: The sample included 12,571 men and women aged 15-44 years (79% response rate). RESULTS: One-third of men and women had ever had anal sex, and three-quarters had ever had oral sex. Condom use during last oral or anal sex was relatively uncommon. In separate models for men and women, having ever had anal sex was associated with white race, age of 20-44 years, and having had a non-monogamous sex partner. White race, age of 20-44 years, being married, and having higher numbers of lifetime sex partners were related to having ever given oral sex in men and women. Giving oral sex was associated with having a non-monogamous sex partner in men. Ever receiving oral sex was associated with white race and a non-monogamous sex partner in men and women. CONCLUSIONS: It would be beneficial to track the prevalence of heterosexual anal and oral sex and associated condom use on a more frequent basis.

Measuring HIV risk in the U.S. population aged 15-44: results from Cycle 6 of the National Survey of Family Growth.

OBJECTIVE: This report presents national estimates of the percentage and number of persons in the U.S. population aged 15-44 who report behaviors that place them at increased risk for acquiring or transmitting human immunodeficiency virus, or HIV. The report also contains data on condom use and HIV testing by persons who report risk behaviors. In addition, estimates of self-reported risk for HIV from the Cycle 6 National Survey of Family Growth (NSFG) are compared with data from other recent national surveys. METHODS: Data from the NSFG Cycle 6, conducted by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS), are based on interviews with a national sample of the household population of the United States. In-person, face-to-face interviews were conducted in the homes of 12,571 males and females 15-44 years of age in 2002. Most of the data were collected by Computer-Assisted Personal Interviewing (CAPI), in which a laptop computer is used to select and present the questions, which an interviewer reads to the respondent. The more sensitive data, including the risk behavior items on which this report is based, were collected by Audio Computer-Assisted Self-Interviewing (ACASI), in which the respondent listens to a recording of each question and enters his or her own answers into the computer without involving an interviewer. RESULTS: Overall, 8.9 percent of persons 15-44 years of age had engaged in sexual behaviors in the past year that put them at increased risk of HIV, and 1.5 percent had engaged in drug use behaviors that put them at risk. In all, an estimated 9.9 percent engaged in either drug use or sexual behavior that placed them at increased risk for HIV. Including those who were treated for a sexually transmitted disease (STD) in the past year, 11.9 percent of persons 15-44 years of age--13.0 percent males and 10.8 percent of females+-were at risk of HIV in 2002. The 11.9 percent at risk is equivalent to an estimated 14.4 million persons aged 15-44 at higher risk of HIV through drug use, sexual behavior, or having been treated for an STD in the past year. Persons who were at increased risk reported greater condom use and higher rates of HIV testing, but among those at risk, 33.6 percent had never been tested for HIV and 60.4 percent did not use condoms at last sex.