4.13 Health

Chapter 4 contents


This section details the health-related data collected from respondents. These data take three distinct forms. First, information on the respondent's physical health was gathered during many of the surveys. Second, the post-1981 surveys collected information on the respondent's and her family members' health insurance coverage. Third, measures of psychological well-being are available at select survey points.

Physical Health

A comprehensive set of health-related variables is available for all respondents. In the early survey years, this data collection focused on health as related to employment, with questions in most interviews about whether the respondent's health limited her work activity or prevented her from working altogether. Information was collected in four surveys regarding whether any of the health problems were the result of an accidental injury and whether the most serious injury occurred on the job. Respondents were also asked at multiple survey points to identify one or more specific workplace characteristics that they would have trouble working under because of their health (e.g., places that were hot, damp, or that had fumes or noise).

Most surveys also asked respondents about their current health status and perceived health changes over time. Each respondent was asked during the 1967, 1986, and 1992-2003 surveys to rate her health as excellent, good, fair, or poor compared to other women her age. Periodic questions were also fielded on whether the respondent considered her health to have remained about the same or to have changed for the better or worse over a set period of time (e.g., the past five years, since the last interview). Self-reported height and weight data are available for respondents interviewed in 1992 and 1997-2003; weight was also asked in 1995.

As the cohort aged, the health collection expanded. Information on the specific diseases that limited the amount or kind of work that the respondent could do was collected during the 1989 and 1992 surveys. Details on up to four health conditions (e.g., cancer, heart trouble, diabetes, hypertension, senility) and the length of time that the respondent had been limited by the primary health condition were coded during each year. In 1997-2003, a similar series of questions asked all respondents about high blood pressure, cancer, and heart disease, including some limited information about treatment.

In 1971, 1977, 1982, 1987, and 1989, respondents who reported that health limited the amount or kind of work they could do were also asked if their health problems prevented them from performing a predetermined set of other activities such as walking, using stairs, stooping or crouching, etc. In 1995 and 1999-2003, a similar set of activity questions was addressed to all respondents. During each of these surveys except 1999, respondents were also asked whether they experienced certain health-related problems (e.g., pain, tiring easily, weakness, aches or swelling, fainting spells or dizziness, anxiety or depression, and/or shortness of breath).

In 1995-2003, two additional sections expanded the health module's focus. First, a new menopause section determined the respondent's current ovulation status. If the respondent had stopped ovulating, she dated her last ovulation and stated why her period stopped. Additional questions asked if the respondent had had surgery to remove her ovaries or uterus. This section ended by querying about hormonal supplements and birth control pill usage to control menopausal or aging symptoms.

A second series in 1995-2003 informs researchers about these women's day-to-day driving activities. The section asked if the respondent ever drove a car and if she had driven over the last 12 months. Those who had driven in the last 12 months were asked the number of miles driven and whether they drove after dark. Those who had not driven in the last 12 months, but who had during their lifetime, stated when and why they stopped driving.

Respondents were asked in 1991 and again in 2003 whether they had had any overnight stays in the hospital since the last interview and if so, the number of times and the number of nights spent. In 2003, for the first and only time, the women were asked if they had fractured or broken a bone in the last 10 years.

In 2003 a series of questions was introduced regarding prescription drug use. Respondents were asked if they took all the medication they were prescribed and, if applicable, the reasons why not. They were also queried on per month out-of-pocket expenses for their prescriptions.

A single question was also asked in 2003 about whether a respondent got at least 30 minutes of exercise three or more times a week.

In 2003, for the first and only time, proxies of deceased respondents were asked a series of questions about the health of the respondent between the last interview and the respondent's death, including cause of death, length of illness, and working status at time of death. The proxies were also asked about the deceased's medical care prior to death.

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Health Insurance

During the 1981, 1986, and 1989-2003 surveys, information was collected on whether the respondent and/or other family members were covered by health insurance. This series gathered information on whether any family member was covered by medical or hospital insurance and the specific source of the coverage for each family member (e.g., a group policy through the respondent's or spouse's employment, a policy purchased directly from the company, Medicaid, or Veterans benefits). Table 4.13.1 depicts respondents reporting health care coverage by provider.

The 1992-2003 surveys asked those respondents who were covered by health insurance through their current or former employer whether they and their husbands expected to be covered by health insurance after the respondent retired. In these interviews, respondents who had employer-provided health care also stated whether they contributed toward the cost of the policy.

Table 4.13.1 Medical Insurance Coverage of Respondent by Provider (Unweighted): 1981-2003
Source of Insurance 1981 1986 1989 1992 1995 1997 1999 2001 2003
Total respondents interviewed 3677 3335 3094 2953 2711 2608 2467 2318 2237
R or any member of R's household covered by medical insurance 3023 2980 2791 2741 2520 2385 2285 2209 2115
R's provider:
From R's job 1045 1015 718 522 304 194 135 83 62
From husband's/partner's job1 1392 1007 486 258 179 129 89 85 56
Directly from insurance company 369 452 416 475 265 255 229 248 249
Medicaid -- 171 212 217 278 80 90 91 94
Veterans benefits -- 40 22 12 4 6 8 3 11
From R's former job -- -- 233 267 207 199 191 156 166
From husband's/partner's former job -- -- 438 437 367 312 275 204 222
From other family member's job -- -- 9 5 2 5 6 2 2
Medicare -- -- -- 404 736 1063 1141 1273 1176
Other 107 172 129 34 49 44 41 24 31
Don't know/Refused 5 13 8 16 17 6 10 11 17
Total Rs covered 2918 2870 2671 2647 2408 2293 2215 2180 2086
Source: This table is based on R05142.00, R05144.00, and R05146.00 in 1981; R07374.00 and R07376.00 in 1986; R09440.00 and
R09442.00 in 1989; R10776.00 and R10778.00 in 1992; R33708.00, R33711.00, and R33764.00 in 1995; and R41396.00, R41399.00,
R41401.00 in 1997; R50972.00, R50975.00, and R50978.00 in 1999; R61904.00, R61907.00, and R61936.00 in 2001; R72962.00,
R72965.00, and R72990.00 in 2003.
1 Partner was added to this question beginning with the 1989 survey.

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Psychological Well-being

In 1989 and in 2003, the full 20-item CES-D (Center for Epidemiological Studies Depression) scale was administered to the Mature Women respondents (R09791.00-R09810.00). This scale measures symptoms of depression and discriminates between clinically depressed individuals and others; it is highly correlated with other depression rating scales (see Radloff 1977; Ross and Mirowsky 1989). The 1995-2001 surveys contained a reduced set of seven items from the original 20-item CES-D scale. The CES-D items can be found in the data set by searching for the term "CES-D" in the variable titles.

The complete 10-item Affect Balance Scale developed by Norman Bradburn (1969) was administered to the Mature Women respondents in 1981 (R05226.00-R05235.00). This measure of positive and negative feelings in the weeks before the interview provides an indication of the respondent's general psychological well-being. The statements ask, for example, whether the respondent felt particularly excited or interested in something in the past few weeks, whether she was so restless she could not sit long in a chair, and whether she felt that things were going her way.

At four survey points, the Mature Women gave responses to a measure of internal-external locus of control. Internal control refers to the perception of events as being under personal control; external control involves events being perceived as unrelated to one's own behavior. In 1969, 1972, and 1977, an 11-item abbreviated version of Rotter's (1966) Internal-External Control Scale was used. The abbreviated scale was constructed by including only those items of the original 23-item Rotter scale which were the most general and oriented to the adult world of work (see Parnes et al. 1974, Appendix to Chapter VI). Reducing the number of items would have required an overall reduction in the range of scores. To avoid this situation, the response format was modified to four choices rather than two as in the original scale. The respondent was thus asked how closely each of the 11 statements represented her own view of the issue. The total score is obtained by summing the values of all 11 items, resulting in a range of 11 to 44 in order of increasing external control. The modified scale has been shown to be highly correlated with the original 23-item scale (see Parnes et al. 1974, Appendix to Chapter VI). The 2001 survey included a modified four-item scale.

More questions related to mental health were added in 2003. Respondents were asked a single question on whether they were currently taking any medication for depression or nerves. Also, in a series on pet ownership, respondents provided information about the number and type of pets owned.

Related Variables: Additional information on the respondent's general satisfaction with life can be found in the "Attitudes & Expectations" section of this guide. Questions on job satisfaction can be found in the "Job Satisfaction" section of this guide.

Survey Instruments: Health and health insurance questions are located within the "Health" section of the questionnaires. The CES-D scale items for 1989 can be found in the "Retirement and Pension" section of the survey instrument. In 1995-2001, the reduced CES-D scale items are located in the "Health" section of the questionnaire. Components of the Rotter scale can be found in the "Work Attitudes" section of the appropriate survey year questionnaires.

References

Bradburn, Norman M. The Structure of Psychological Well-Being. Chicago: Aldine, 1969.

Parnes, Herbert S., Adams, Arvil V.; Andrisani, Paul J.; Kohen, Andrew I.; and Nestel, Gilbert. The Pre-Retirement Years: Five Years in the Work Lives of Middle-aged Men, Vol. 4. Columbus, OH: Center for Human Resource Research, The Ohio State University, 1974.

Radloff, Lenore. "The CES-D Scale: A Self Report Depression Scale for Research in the General Population." Applied Psychological Measurement. 1 (1977): 385-401.

Ross, Catherine E. and Mirowsky, John. "Explaining the Social Patterns of Depression: Control and Problem Solving--or Support and Talking?" Journal of Health and Social Behavior. 30 (June 1989): 206-9.

Rotter, Julian B. "Generalized Expectancies for Internal vs. External Control of Reinforcements." Psychological Monographs. 80,609 (1966): 1-28.