New Report Shows Link between Community Environment and Women’s Health Outcomes

For Release: April 22, 2003

Contact: NCHS/CDC Public Affairs, (301) 458-4800


Community Environment and Women’s Health Outcomes: Contextual Data. Series Report 23, No. 23. 81 pp. (PHS) 2003-1999. [PDF – 5.3 MB]

A new report from the National Center for Health Statistics, Centers for Disease Control and Prevention, shows that several measures of the social and economic status and resources of a woman’s community are closely associated with her health and health-related behaviors. The research team related measures of the characteristics of neighborhoods (counties, census tracts, and block groups) from the 1990 census to measures of behavior in 1995.

The report used community characteristics such as median family income, unemployment rates, poverty rates, the percentage of adults who have college degrees, and the occupational composition of the area’s work force. The report shows that these are often important factors in accounting for delayed childbearing, use of female sterilization for contraceptive purposes, breast-feeding, and cigarette smoking in 1995.

The study was based on the National Survey of Family Growth (NSFG) contextual data file. The NSFG is a nationally representative survey focused on women’s health and reproductive patterns and is based on personal interviews with a sample of women 15-44 years of age. The contextual data file for the NSFG combines the interview data with a rich array of measures of the characteristics of the county, census tract, and block group in which she lived. The contextual data file is now available to researchers, and the report describes the procedures for obtaining access to the file.

The report includes nine Hierarchical Linear Models to show the independent effects of the community characteristics (controlling for individual characteristics such as age, race, Hispanic origin, and the woman’s education, or her family’s income). Among these findings, the report shows that:

  • The proportion of women who are childless at 20-34 years of age increases markedly as the median family income of the neighborhood increases (controlling for the individual characteristics listed above).
  • Women living in low-income communities are far more likely to rely on female sterilization as their contraceptive method than women in high-income communities (controlling for individual characteristics).
  • Community median family income was also independently associated with increased use of male condoms, but not with use of oral contraceptive pills.
  • In communities with a higher proportion of the work force employed as professionals or managers (that is, a highly-educated work force), women were much more likely to breast-feed their babies, than in communities with smaller fractions of such workers.
  • In communities with higher poverty rates and fewer professionals and managers in the work force, women were more likely to practice vaginal douching, a known risk factor for pelvic infection, infertility, and cervical cancer (controlling for the woman’s age, race, and education).
  • In communities with higher percentages of adults with college degrees in 1990, women were less likely to smoke cigarettes in 1995 than in communities with a less-educated population (after controlling for the woman’s age, race, and income).

The report contains other information about the contextual data file, including information on the variables that are in the file, how to apply for access, and information on statistical techniques and software. “Community Environment and Women’s Health Outcomes: Contextual Data” is available to view or download on the NCHS web site at or at the NSFG web page