The California Health Interview Survey: A Tool for Monitoring Migrant Health David Grant, PhD

1. The California Health Interview Survey: A Tool for Monitoring Migrant Health David Grant, PhD UCLA Center for Health Policy Research Director, California Health Interview Survey

2. This morning’s presentation • Overview of the California Health Interview Survey (CHIS) • CHIS introduction • CHIS methodology & sample • CHIS topics and content • CHIS specific content for immigrant health research • Access to CHIS data

3. CHIS introduction • The California Health Interview Survey (CHIS) is California’s source of state and local population-based health data • CHIS is designed from the ground up to provide easily accessible data that can be used: 1. To support decision making at the local level and statewide in public health and health care • For policy analysis, development and advocacy • For State and county surveillance of public health indicators • For service and program planning, development, and evaluation 2. To understand and measure health needs and disparities in California — characterized by ethnic, geographic, age, and social class diversity

4. CHIS introduction • Conducted every other year since 2001 • Became a continuous survey in 2011 • Funded by federal and state health agencies, California and national foundations, and others • CHIS data is widely used by • State agencies • County health departments • Academic researchers and students • Advocacy groups and CBOs

5. Methods: how is CHIS done? • Large, geographically stratified random digit dial (RDD) telephone survey designed to provide statistically reliable estimates: 1. At the local level for counties (adults) and statewide 2. For major racial/ethnic groups and many ethnic subgroups • Geographic stratification • 56 total geographically defined strata • 2 counties with sub-county strata • Los Angeles: 8 Service Planning Areas (SPAs) • San Diego: 6 Health Regions • 39 individual county strata • 3 grouped county strata containing the 17 smallest counties

6. Methods: how is CHIS done? • Two separate RDD samples: 1. Landline telephone numbers at stratum level (56 strata) 2. Cellular telephone numbers (since CHIS 2007) at “region” level (7 regions) • Ethnic oversamples • Koreans and Vietnamese oversampled in each CHIS cycle through: • Geographic targeting • Surname list sample • Interviews conducted in 6 languages: English, Spanish, Chinese (Cantonese and Mandarin), Korean, and Vietnamese

7. Methods: how is CHIS done? • One adult selected at random in each household, plus children and teens if available • Three separate interviews • Adult (age 18+) ~ 30 to 35 minutes • Adolescents (age 12-17) ~ 20 minutes • Children (age 0-11, by adult proxy) ~ 15 minutes • Proxy responses for frail or ill elders (age 65+) • CHIS became a “continuous” survey in 2011 • Previous cycles—intensive data collection effort for 7 to 9 monthsevery other year • Continuous model: steady, less intensive effort to collect same amount of data (about 48,000 households) over 24 months

8. CHIS sample • CHIS sample by cycle and age group

9. CHIS Topics & Content

10. What information does CHIS collect? • Health behaviors, including: • Alcohol consumption and binge drinking • Tobacco use (past and current) • Illegal drug use (teens) • Physical activity, dietary intake • Cancer screening, flu shot, HIV/STD testing, use of seat belts and bike helmets • Health conditions: • General health • Chronic conditions such as asthma, diabetes, heart disease, high blood pressure, stroke, COPD, etc. • Cancer diagnoses and family history • Disability

11. What information does CHIS collect? • Access to and use of health care services • Usual source of care • Visits to doctor, ER use • Hospitalizations • Health insurance coverage: • Current coverage • Coverage type (employer-based, private purchase, MediCal, Healthy Families, MediCare) • HMO enrollment and plan details • Coverage past 12 months • Uninsured • Reasons for lack of coverage • Medi-Cal and Healthy Families eligibility (age < 65) • Eligibility for coverage under ACA (expanded Medicaid/Exchange)

12. What information does CHIS collect? • Mental health • Mental health status, past 30-days and past 12-months • Perceived need for use of mental health services • Utilization of and barriers to use of mental health services • Other topics & information • Food security and hunger • Public program participation • Geocoding of households and schools • Social relationships and neighborhood conditions (2003) • Inter-personal violence (2007 & 2009) • … and numerous other topics

13. What information does CHIS collect? • Rich demographic data, including: • Age, sex, race/ethnicity, ethnic origin/ancestry, marital status, sexual orientation • Country of birth, years in US, mother/father’s country of birth • Language of interview, language/s spoken at home, English proficiency • Employment status, income, poverty level, educational attainment, Veteran’s status • Other useful content for immigrant health research • Communication with doctor, language concordance, need for translator • Health literacy (information from doctor’s office, Rx) • Citizenship status (citizen, green card, pending, other) • Ability to link adult, teen, and child records

14. Access to CHIS Data & Findings

15. Easy access to CHIS data & findings • Dissemination of data & findings through multiple formats is a hallmark of CHIS • Publications on the web • AskCHIS online query tool • Data files • Public use • Confidential Much more information on access to CHIS data at the Wednesday afternoon CHIS workshop

16. Thank you