1. 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. 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. 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. 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. 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. 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. 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 months every other year  Continuous model: steady, less intensive effort to collect same amount of data (about 48,000 households) over 24 months

8. 8 CHIS sample  CHIS sample by cycle and age group Age Group20012003200520072009 Adult (18+)56,27042,04443,02051,04847,614 Child (0-11)12,8028,52611,3589,9138,945 Teen (12-17)5,7334,0104,0293,6383,379

9. 9 CHIS Topics & Content

10. 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. 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. 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. 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. 14 Access to CHIS Data & Findings

15. 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. 16 Thank you