CHIS: A Tool for Monitoring Migrant Health 11 th Summer Institute on Migration and Global Health June 14, 2015 The California Endowment Conference Center Oakland, CA Bogdan Rau, MPH Manager, Online Dissemination & Visualization California Health Interview Survey UCLA Center for Health Policy Research
Overview Overview: The California Health Interview Survey (CHIS) CHIS Introduction Methodology and sample Topics and content Immigrant health research topics Access to CHIS data Public use files (PUFs) Data Access Center (DAC) AskCHIS AskCHIS Neighborhood Edition Health Profiles
CHIS Introduction The California Health Interview Survey: Largest state-based health survey in the U.S. The most comprehensive source of health data on California s diverse population. More than 20,000 adults, teenagers, and children interviewed each year.
CHIS Introduction Designed from the ground up to provide data that has been used to: Support decision making at the local level and statewide: Policy analysis, development, and advocacy. Public health surveillance. Community health needs assessments. Public health and health care research. Understand the social determinants of health: examining ethnic, geographic, age, gender, social class disparities.
CHIS Introduction
CHIS Introduction Funded by a variety of state and local agencies, California and national foundations, and others.
CHIS Methodology Conducted every other year since 2001. Switch to continuous survey in 2011. Random digit dial (RDD) telephone survey designed to provide statistically reliable estimates. At local level (counties) for adults and statewide. For major racial/ethnic groups and many ethnic subgroups. Participants chosen at random (one adult from each household, plus one teen and one child if available). Landline (since 2001) and cellphone (since 2007).
CHIS Methodology Conducted in 7 different languages: English, Spanish, Chinese (Cantonese and Mandarin), Korean, Vietnamese and Tagalog. Questionnaires available at: www.chis.ucla.edu/chis/design Ethnic oversamples Koreans, Vietnamese, and Japanese. Three separate interviews: Adult (age 18+): ~35 minutes Adolescent (age 12-17): ~20 minutes Child (age 0-11, by adult proxy): ~15 minutes
CHIS Methodology Direct estimates at county & sub-county levels 39 individual county strata. 3 grouped county strata containing the 17 smallest counties. Los Angeles County: 8 Service Planning Areas (SPAs). San Diego County: 6 Health Regions (HHSAs). 56 total geographically defined strata
CHIS Sample Age Group 2001 2003 2005 2007 2009 2011-2012 2013-2014 Adult (18+) 56,270 42,044 43,020 51,048 47,614 42,935 40,240 Teen (12-17) 12,802 8,526 11,358 9,913 8,945 7,334 5,512 Child (0-11) 5,733 4,010 4,029 3,638 3,379 2,799 2,253
CHIS Content Rich demographic data, including: Age, sex, race/ethnicity, marital status, sexual orientation. Employment status, income, poverty level, educational attainment, veteran status. Citizenship and immigration. Languages and English proficiency. Health behaviors, including: Alcohol consumption, tobacco use, illicit drug use. Physical activity, dietary intake. Cancer screening, flu vaccine. Sexual activity, contraceptive use, HIV testing.
CHIS Content Health conditions, including: General health. Chronic conditions (asthma, diabetes, heart disease, hypertension, etc.). Healthcare access and utilization, including: Health insurance coverage or lack of. Usual source of care & delays in care. Doctor visits and emergency room use. Insurance eligibility. Marketplace (CoveredCA) experiences.
CHIS: Immigrant Health Research Topics Race and Ethnicity Country of birth (self, mother, father) Languages Spoken at home Of TV shows, radio, newspapers English proficiency Citizenship and Immigration U.S. citizen Permanent resident w/green card Years lived in the U.S.
CHIS: Immigrant Health Research Topics Communication with health provider Hard time understanding doctor (due to language or health literacy) Language spoken by doctor Needed help understanding the doctor Who helped respondent understand the doctor Awareness of free interpreter during doctor visit
CHIS: Immigrant Health Research Topics Citizenship & Immigration n (%) U.S. Born 31,195 (77.5) Naturalized Citizen 5,782 (14.4) Non-Citizen 3,263 (8.1) Source: California Health Interview Survey (CHIS) 2013-2014 Knows Right to Interpreter n (%) Yes 2,510 (6.2) No 1,444 (3.6) Source: California Health Interview Survey (CHIS) 2013-2014 Language at Home n (%) English 28,837 (71.7) English & Spanish 4,501 (11.2) Spanish 2,231 (5.5) English & Other Asian Lang 1,105 (2.75) English & European Lang 865 (2.15) Korean 238 (0.59) Source: California Health Interview Survey (CHIS) 2013-2014
Future Immigration Measures on CHIS New questions have been added to the adult survey and are currently in data collection for CHIS 2015-2016. In what year did you become naturalized? Tell me if you are currently here on any of the following: a tourist visa, a student visa, a work visa or permit, or another document which permits you to stay in the U.S. for a limited amount of time? Was this visa or permit through Deferred Action for Childhood Arrivals or DACA or Deferred Action for Parental Accountability or DAPA? Is this visa or document still valid or has it expired? (Supported by the University of Californias California Immigration Research Initiative [CIRI])
Accessing CHIS Data (www.chis.ucla.edu) CHIS DATA HealthDATA Data. Advocacy. Training. Assistance. Health data capacity building Data Access Center (DAC) Secure network that holds data and analysis, protecting confidentiality. Public Use File (PUF) Available as free download in SAS, SPSS, and STATA format. AskCHIS Premiere online health data query tool. (Health Data All-Star 2013) AskCHIS Neighborhood Edition Granular health data beyond counties (SAEs) Health Profiles Reports on CHIS most requested health topics. PDF-based downloads.
Accessing CHIS Data: Public Use Files Questionnaire: specific question wording, position in the survey, skip instructions that define the universe for each question. Data dictionary: information on using sample weights, design, sample distribution. Constructed variables: highlights constructed variables and logic used to create them. Public use data files: SAS, SPSS, Stata Exclude sub-state geographic identifiers and highly sensitive variables like mental health and citizenship. FREE download: http://chis.ucla.edu
Data Access Center (DAC) DAC a secure physical space and a secure data network Maintains all CHIS data Designed to protect the confidentiality of CHIS respondents Accessing Confidential Data Research application reviewed by data disclosure committee Approval dependent on feasibility, risk of disclosure, variable selection Data analysis through DAC: 1. Researcher-provided code implemented on DAC network R, Stata, SAS, Mplus, SPSS, ArcGIS 2. Statistical & programming services through UCLA CHPR
Accessing CHIS Data: AskCHIS Free use interactive data query system, available 24-7 via http://ask.chis.ucla.edu Custom and instant queries of the CHIS data Allows for analysis at the state, region, and county level of various health variables and demographic characteristics Includes sensitive or identifiable variables, unlike PUF
Accessing CHIS Data: AskCHIS Neighborhood Edition (NE) Online data dissemination and visualization platform powered by CHIS Allows for searching of health topics at granular levels of geography (legislative district, county, city, zip code)
Accessing CHIS Data: AskCHIS Neighborhood Edition (NE)
Health Profiles: www.chis.ucla.edu/health-profiles Legislative Districts: health profiles for each of the 80 Assembly Districts, 40 Senate Districts, and 53 U.S. Congressional Districts. Adults: key health statistics for adults ages 18-64 in all 58 California counties, as well as regions, Los Angeles Service Planning Areas (SPAs), San Diego Health and Human Service Agency Regions (HHSA). Available as a dashboard at: http://healthpolicy.ucla.edu/health-profiles/adults/pages/dashboard.aspx Child and Teen: fact sheets containing health statistics for children and teens (ages 17 and under) in all 58 California counties, regions. 26 Race & Ethnic: key health indicators by major race/ethnicity and certain Latino and Asian sub-groups.
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Thank you! Questions? chis@ucla.edu (310) 794 0909 brau@ucla.edu