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The California Health Interview Survey:A Tool for Monitoring Migrant Health

David Grant, PhDUCLA Center for Health Policy Research

Director, California Health Interview Survey

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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

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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

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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

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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 statewide2. 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

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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

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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

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CHIS sample CHIS sample by cycle and age group

Age Group 2001 2003 2005 2007 2009

Adult (18+) 56,270 42,044 43,020 51,048 47,614

Child (0-11) 12,802 8,526 11,358 9,913 8,945

Teen (12-17) 5,733 4,010 4,029 3,638 3,379

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CHIS Topics & Content

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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

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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)

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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

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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

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Access to CHIS Data & Findings

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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

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Thank you