7th National Changing Patterns of Cancer in Native Communities: The Power of Partnerships:

American Indians and Alaska Natives: The California Health Interview Survey Data

Findings and How to Use CHIS September, 2007

Delight E. Satter, M.P.H. (Confederated Tribes of Grand Ronde)

Director, American Indian and Alaska Native Research Program

UCLA Center for Health Policy Research

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Presentation Objectives Report cancer specific data findings from several studies conducted by AIANRP. Provide overview information on accessing the CHIS data, available to the public. Lastly, it will provide step-by-step instructions with examples on using AskCHIS,

the CHIS on-line data query system. This section of the presentation will be interactive, live, and web-based. The audience will determine the data requests we run together. Examples of data queries the audience might request are:

Estimating breast cancer screening rates for urban California Native women aged 40+ and pooling CHIS 2001, 2003 and 2005 data.

Comparing cervical cancer screening rates for urban versus rural Native women across time.

Estimating tobacco use rates for Native adults residing in Northern California versus Southern California.

Comparing obesity rates for male versus female Natives by age groups (e.g. 18-44, 45 – 64, 65+).

Identifying differences in access to Indian Health Service by tribal affiliation.

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American Indians and Alaska Natives in California Background

More AIAN reside in CA than any other single state in the US. California is home to AIAN from 107 federally recognized tribes. AIAN residing in CA are extremely diverse with most being members from reservations outside the state as compared to those who are members from reservations inside the state.

The majority of AIAN in CA live in urban areas, with Los Angeles being home to the largest urban population of AIAN in the country.

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What is CHIS?

A unique resource for California A public-private sponsored collaborative research project of:

UCLA Center for Health Policy Research California Dept. of Health Services Public Health Institute

Provides comprehensive information about the health of Californians Over time By geographic area (county) By population group/s

Race/ethnic Poverty level Age Etc.

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What is CHIS?

A population-based telephone health survey

Three separate interviews Adults (age 18+) Adolescents (age 12-17) Children (age 0 to 11)

Widely disseminated Publications Public Use Files (PUFs) AskCHIS Internet query system

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How is CHIS done?

Conducted every other year since 2001 Statewide random digit dial telephone survey

Sufficient adult interviews in each of 41 counties to provide statistically stable estimates

Oversamples of Koreans & Vietnamese (and AIAN in 2001)

One adult selected at random in each household; children and teens as appropriate

Conducted in English, Spanish, Chinese (Cantonese and Mandarin), Korean, and Vietnamese

Through a sub-contract with Westat, Inc. Nearly 2 million phone calls made in CHIS 2005

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New for CHIS 2007

Cell phone only sample – to address this growing population

Cell phone numbers are not included in RDD sample frames

Method pilot tested in 2005

CHIS 2007: expand to a statewide sample of 800-1,000 and include in adult data files

Area probability sample – to address declining response rates

Area probability sample in Los Angeles County (sample of addresses rather than phone numbers)

Telephone and in-person recruitment

Compare estimates from RDD and area probability frames to explore non-response bias

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CHIS sample design

Change in geographic stratification Increased total number of strata from 41 to 44

Increased individual county strata from 33 to 41 New—Monterey, Humboldt, Nevada, Mendocino, Lake, Yuba, Sutter, San

Benito

Reduced multi-county strata from 8 (with 25 counties)to 3 (with 17 counties) Tehama-Glenn-Colusa

Sierra balance (Tuolumne, Calaveras, Amador, Inyo, Mariposa, Mono, Alpine)

New—Northern balance (Siskiyou, Del Norte, Lassen, Trinity, Modoc, Plumas, Sierra)

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What information does CHIS collect?

Rich demographic data, including: Age, sex, race/ethnicity, marital status Country of birth, years in US, citizenship, mother/father’s country of

birth, language/s spoken at home, English proficiency Employment status, income, poverty level, educational attainment AIAN specific data: tribal affiliation(s), enrolled in state or federally

recognized tribe, where enrolled

Health behaviors, including: Alcohol and tobacco, illicit drugs (teens) use Physical activity, dietary intake, environmental Cancer screening, flu shot, HIV/STD testing, use of seat belts and

bike helmets

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What information does CHIS collect?

Health conditions: General health Chronic conditions such as asthma, diabetes, heart disease, high

blood pressure, COPD, etc. Disability Mental health

Access to and use of health care services Usual source of care Visits to doctor, ER use Communication with doctor, need for translator, health literacy

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What information does CHIS collect?

Health insurance coverage: Current coverage Coverage type (employer-based, private purchase, MediCal,

MediCare, Healthy Families) HMO enrollment and plan details Coverage past 12 months Employer

Uninsured Reasons for lack of coverage MediCal and Healthy Families eligibility (age < 65)

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What information does CHIS collect?

Other topics & information Food security and hunger Public program participation Geocoding of households and schools Social relationships and neighborhood conditions (2003) Family history of cancer (2001, 2005) Inter-personal violence (2007)

… and numerous other topics

How to Get CHIS Data

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How to get CHIS data?

Public Use Files

Source Files at the Data Access Center

AskCHIS Internet query system

Publications on the Center’s webpage www.healthpolicy.ucla.edu

In journal articles

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CHIS Public Use Files (PUFs)

Publicly available for free from the CHIS website

Available separately for Adults, Children, and Adolescents

Available for 2001, 2003, and 2005

Microdata files – each record in the file is an individual case (i.e., a completed interview)

Available in SAS, STATA, and SPSS format

The CHIS Public Use Files are . . .

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CHIS Public Use Files (PUFs)

Include detailed demographic information, but do not include geographic identifiers or other sensitive variables that could disclose respondent identity

Include imputed values for missing data for most variables

Include sample weights

The CHIS Public Use Files . . .

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What are weights & How are they constructed?

Weights are variables that can be applied to the data to produce population estimates

There are separate weight variables for the adult, child, and adolescent files

The weights are constructed through a complex and iterative process

First, a base weight is calculated for each telephone number based on the probability of selection at the stratum level (county or group of small counties) and adjusted to produce a final household weight

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What are weights & How are they constructed?

The adult, child, and adolescent weights are produced in a similar fashion from the final household weight

The adult weight is adjusted based on the number of adults in the household and then “raked” in an iterative process to control for several demographic and socio-economic characteristics

The weights are raked to population totals at the county level based on California Department of Finance (DOF) population projections

The weights for each CHIS file (Adult, Child, and Adolescent) sum to the total California population living in households as projected by DOF

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An example of unweighted and weighted estimates

Has a doctor ever told you that you had a cancer of any kind?

YES 4,272 11.2 2,127,075 8.3

NO 37,717 88.8 23,469,986 91.7

Total 42,044 100.0 25,597,061 100.0

N Percent

Unweighted Weighted

N Percent

Source: CHIS 2003 Adult Public Use File

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How to use the weights?

The weight variables are included in the Public Use Files

The weight variable name is RAKEDW0 in the Adult, Child, and Adolescent files

Weights are applied differently in different software packages

Detailed instructions on how to apply the weights in SAS, SPSS, and STATA are available on the CHIS web site

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What are replicate weights?

In addition to the full sample weight (RAKEDW0), there are 80 additional “replicate weights” (RAKEDW1 through RAKEDW80)

Replicate weights are used to account for the geographically stratified CHIS sample design

The replicate weights allow accurate standard errors to be calculated (the estimates do not change), without revealing respondent geography

The replicate weights are used with software packages such as SUDAAN and WesVar

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CHIS confidential data

Confidential CHIS data is available to researchers through the UCLA Center for Health Policy Research Data Access Center (DAC) – contact Brandan Troudt (btraudt@ucla.edu)

DAC applications and additional DAC information are available online at www.chis.ucla.edu

Confidential data can be accessed in person at the DAC or remotely through emailed programming code and results by contracting with the Center’s Statistical Support and Programming team (submit programming, or hire programmer)

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Technical Assistance

Additional documentation on CHIS survey methods, use of weights, data dictionaries, and the questionnaires are available on the CHIS web site at www.chis.ucla.edu

Technical assistance on the Public Use Files is available at:

Email: chis@ucla.edu

Telephone: 866-275-2447 - Brandon Traudt

Technical assistance on developing research question specific to Native studies: Delight Satter – delight@ucla.edu

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CHIS total sample sizes

2001 2003 2005

Adult (18+) 56,270 42,044 43,020

Child (0-11) 12,802 8,526 11,358

Teen (12-17) 5,733 4,010 4,029

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Source: A Pleasant, but Puzzling Surprise: Twice as Many AIAN Are Found in a Large Health Survey in California, AHSR, 2002, Yen and Satter

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Racial/Ethnic data collection and reporting

Race by Ethnicity

American Indian, Alaska Native

Native Hawaiian, Pacific Islander

Asian, Asian American

African American

White

Latino

Non-Latino

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Adult sample size by race/ethnicity - Single Race definition only

2001 2003 2005

Latino 9,460 7,135 6,369

Native Hawaiian Pac Islndr 219 152 120

Am Indian Alaska Natives 781 580 554

Asian 4,798 3,875 3,941

African American 2,764 2,691 1,954

White 36,729 26,506 28,979

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Data collection results

Graph 1. CHIS AIAN Sample Yields by Questions - Percent of All RDD Known Race (52,451)

2694

2138

332 311

0

1000

2000

3000

N 2694 2138 332 311

Percent 5.1% 4.1% 0.6% 0.6%

Any mention of AIAN

Named tribal heritage

Enrolled MemberNamed the

Enrolled Tribe

Includes persons interviewed in RDD survey and some county oversamples; it does not include listed oversamples.These sample sizes are preliminary and may change depending upon further data cleaning and processing.

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Adult, teen & child sample size by - American Indian or Alaska Native one or more races definition

2003 2005

Adult 1897 1845

Teen 313 365

Child 463 370

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Cancer Data published by AIANRP www.healthpolicy.ucla.edu

Click on American Indian Research Program

Click on Publications

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How to use AskCHIS

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How to get CHIS data and information on the health of Natives from www.healthpolicy.ucla.edu

Run your own customized search using AskCHIS - Instantly get state and local data on hundreds of health topics

Review publications and data reports

Learn about current research

Find out upcoming training workshop on AskCHIS

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Great Data –what about my community outside California?Use indirect estimates approach:

Rates x Population size in your community (by different age groups) = estimated # with disease/illness in your community.

(Call a researcher or your local county epidemiologist for help – that’s why we’re here. Download worksheet from Center’s HealthDATA training materials online.)

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Who are those people who report more 2+ races?

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Felt Downhearted, sad, blue (from SF12) by gender, AIAN

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Did see a health professional for mental/emotional problems by Access to IHS

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Binge Drinking past month, AIAN, CASource: 2005 California Health Interview Survey, Race - Census 2000

* = statistically unstable

  Adol. (12-17) Adult (18-64) Senior (65+) All Ages

 

% 95% C.I.

 

% 95% C.I.

 

% 95% C.I.

 

% 95% C.I.

Binge

drinking

 

7.2* (1.4 - 13.0)

 

24.9 (20.1 - 29.8)

 

6.4* (0 - 13.1)

 

19.9 (16.0 - 23.7)

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Binge drinking, past month, AIAN, CA

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Tested for HIV by Sexual Orientation, AIAN, 2005

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Current Smoking status by Gender, 21 years old +, Any mention AIAN

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Disability status by Gender, AIAN any-mention, CA

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Physical Activity by CA Region, AIAN adults

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Heart Disease (CVD) by Diabetes, AIAN adults

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Live Interactive Session

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UCLA Center for Health Policy Research

For the Health of All Generations

Contact Information

Delight Satter, M.P.H.Director, American Indian and Alaska Native Research Program

UCLA Center for Health Policy Researchdelight@ucla.edu

310 794 2686