CHIS Multicultural TAC

April 12, 2012

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W l d I t d tiWelcome and Introductions

Ellen Wu, MPHExecutive Director, California Pan‐Ethnic Health Network

E. Richard Brown, PhDProfessor, UCLA School of Public Health

Principal Investigator California Health Interview Survey

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Principal Investigator, California Health Interview SurveyFounding Director Emeritus, UCLA Center for Health Policy Research

N i ti Ad b C tNavigating Adobe Connect

Bonnie Hatcher

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M ti G lMeeting Goals

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Meeting goals Brief report on CHIS 2009 and 2011 2012 Brief report on CHIS 2009 and 2011‐2012 Sample design and production

Ad lt ti i t t h Adult questionnaire content changes

A decade of change in the California population Census 2000 vs. 2010

CHIS 2013‐2014 Planning Content planning timeline

NCI discrimination module update

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p

Questionnaire content planning

CHIS 2009 dCHIS 2009 and 2011‐2012 Reportsp

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CHIS 2009 d t C l t d lCHIS 2009 update – Completed sample CHIS 2009 data collection

Began Sept. 19, 2009

Ended May, 2010

Continued May thru Sept, 2010 for a special oversample of The California Endowment’s 14 Building Healthy Communities sites

Total sample completed (not including TCE oversample)Total sample completed (not including TCE oversample)

49,811 households

47,614 adults (age 18 and over)

3,379 adolescents (age 12 to 17)

8,945 children (age 0 to 11)

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CHIS 2009 d t C l t d lCHIS 2009 update – Completed sample Sample highlights

About 7% (n = 3,047) of the RDD adult sample conducted by cell phone

Overall adult response rate was 17.7% (compared to 19.1% in 2007)

Humboldt, Marin, and San Diego counties sponsored oversamples

The National Cancer Institute sponsored an oversample of Koreans and Vietnamese as part of a racial discrimination pilot testp p

958 Korean adults

1,423 Vietnamese adults

12% of adult interviews were conducted in a language other than English 12% of adult interviews were conducted in a language other than English

8% Spanish

4% Asian

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CHIS 2009 d t D t filCHIS 2009 update – Data files CHIS 2009 data file production

Began during data collection, but many components of the process could not start until the completion of all data collection (Sept. 24, 2010)

Funder file delivery began mid‐February 2011 ( less than 5 months post‐data collection)

Public Use Files (PUF) released, and AskCHIS updated, in mid‐February

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CHIS 2011‐2012 update Beginning of CHIS as a “continuous survey” – with data collectedBeginning of CHIS as a  continuous survey   with data collected 

continuously throughout the year for 24 months

CHIS still treats two years as data collection cycley y

Over 2 years, sample equals former biennial CHIS sample (~48K HHs)

Retain same questions through both years (with exceptions)

Public Use File (PUF) release and updates to AskCHIS will occur after completion of a full, 2‐year CHIS cycle

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CHIS 2011 2012 l d i hi hli htCHIS 2011‐2012 sample design highlights

Continue the same geographic stratification of past CHIS cyclesContinue the same geographic stratification of past CHIS cycles

39 independent county sampling strata

17 counties combined into 3 “multi‐county” sampling strata

2 counties with sub‐county strata

8 Service Planning Areas (SPAs) in Los Angeles County

6 H lth S i R i i S Di C t 6 Health Service Regions in San Diego County

Oversampling 

San Diego CountySan Diego County

Koreans and Vietnamese adults (to reach a total of 500)

American Indian/Alaska Native (additional 300 households)

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CHIS 2011 2012 l d i hi hli htCHIS 2011‐2012 sample design highlights Major increase in the cell phone sample (from about 7% in CHIS 

2009 to 20% in CHIS 2011‐2012)

Adds significantly to data collection cost, as cell phone sampled b t 35% i th l dlicases are about 35% more expensive than landline cases

Reimbursement for minutes of air time

Cell phones must be manually dialed per FCC regulations Cell phones must be manually dialed per FCC regulations

Increase in cell sample important for several reasons:

Reduce dependence on weights to adjust sample for populationReduce dependence on weights to adjust sample for population

Follows continuing trend of growing cell‐phone only households in the population

Overcomes weighting difficulties sometimes encountered when combining landline and cell samples in medium and small counties12

CHIS 2011 2012 t tCHIS 2011‐2012 status CHIS 2011‐2012 data collection

Data collection started in June 2011

Plan to collect our full sample (target of 48K households) over a 24‐month period (24K per year; 2K per month)period (24K per year;  2K per month)

Accelerated data collection schedule (4K per month) for 2011 to make up for the first 6‐months, with a goal of 24K households collected in 2011

CHIS 2011 data collection results (June thru Dec 2011)

22,580 adult (94% of 24K target), ( g )

1,335 adolescent

3,488 children

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CHIS 2011‐2012 data file prep & release

CHIS 2011‐2012 data collection will end December 2012

Expect funder file delivery will begin in May 2013p y g y

Expect Public Use File (PUF) and AskCHIS release in June 2013

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CHIS 2011 2012CHIS 2011‐2012

Content UpdateContent Update

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CHIS 2011‐2012 adult: deletions Family history of cancer f d Family history of cancer

PSA screening

Sun exposure, tanning devices

Deficit Reduction Act (DRA) requirements

Medical debtSun exposure, tanning devices

Moderate, vigorous physical activity

Medical debt

Long term care giving

Emergency preparedness Childbirth

Menarche, menopause

H l i

Discrimination module (NCI pilot test)

I l i l Hormonal contraceptive use Interpersonal violence

High‐sugar content foods

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CHIS 2011‐2012 adult: deletions Collected on partial sample only (June thru October):Collected on partial sample only (June thru October):

Colorectal cancer screening

CT/CAT scan lung cancer screeningg g

Mammography, lumpectomy & follow up

Hormone therapy

Pap tests

Teen/child receipt of HPV vaccine (asked of parent)

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CHIS 2011‐2012 adult: additions StrokeStroke

Arthritis

Elderly fallsy

Changed usual source of care

Access to timely medical appointments

Internet use and competency

Access to fresh, affordable foods

R i d di l h Revised content to assess medical home

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CHIS 2011‐2012 child: deletions Parental concerns about child’s development

Developmental assessment

Emotional health 

Doctor discussed child’s nutrition with parent

Weekend computer, TV, video use

Educational TV programming

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CHIS 2011‐2012 child: additions

Parent’s Internet use to get health information

Satisfaction with child’s preschool Satisfaction with child s preschool

School food environment

Ti l di l i t t Timely medical appointments

Child’s doctor listens, explains clearly

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d l iCHIS 2011‐2012 teen: deletions Sun exposure, tanning devicesp , g Fruit juice consumption High‐sugar content foods

k d d Weekend computer, TV, video use Adult supervision Teen receipt of HPV vaccine (asked of parent)Teen receipt of HPV vaccine (asked of parent)

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CHIS 2011‐2012 teen: additions  Health related quality of life Health‐related quality of life

Epilepsy

Access to timely medical appointmentsAccess to timely medical appointments

Physically active last time at park

School food environment, meals in cafeteria, access to and consumption of drinking water

Changing schools, non‐school club participation 

C f h / d l h l Care, encouragement from teacher/adult at school

Bullying, personal safety, interpersonal violence

Suicide ideation attempts Suicide ideation, attempts

Neighborhood cohesion22

CHIS 2013‐2014 Content planning and timelineContent planning and timeline

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CHIS 2013 – 2014 timeline

Content development Technical Advisory Committees March – April 2012

Workgroup meetings May – June 2012

Content discussion with funders May – July 2012

Content submission deadline July 31, 2012

Initial IRB submission (UCLA) July 2012

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CHIS 2013 – 2014 timeline

Questionnaire preparation and testing English simplification Aug 2012

Pre‐testing (paper and pencil) Mid Aug 2012

IRB submission (pilot testing) Aug 31, 2012

CATI programming preparation Sept 2012

CATI programming Sept – Oct 2012

Pilot testing Late Oct 2012

IRB submission (Final English) Nov 2, 2012

B i d t ll ti (E li h) J 1 201325

Begin data collection (English) Jan 1, 2013

CHIS 2013 – 2014 timeline

Questionnaire translation Spanish translation & cultural adaptation Nov – Dec 2012

Asian Lang. translation & culturaladaptation

Nov – Dec 2012

Spanish CATI programming Jan – Feb 2013

Begin data collection (Spanish) Mid Feb 2013

Asian Lang CATI programming Feb Mar 2013 Asian Lang. CATI programming Feb – Mar 2013

Begin data collection (Asian Languages) Mid Mar 2013

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Topics for CHIS 2013‐2014: Criteria for retaining adding orCriteria for retaining, adding or 

droppingpp g

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Topic recommendations Is it important for public health or health care policy?Is it important for public health or health care policy? Emerging public health issues

Public health issues lacking population‐based data

Who will need and use the data?

Is this a key health indicator?

Has it been in CHIS before?  How often does data on it need to be collected? 

How quickly is change likely to be measureable?

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Topic recommendations Can be measured in structured telephone interviews?Can be measured in structured telephone interviews?

Can be measured in short amount of time?

CHIS f diti b h i l ti t CHIS focuses on conditions, behaviors, access relation to environment, knowledge

I h lik l d fi i f d f h i ? Is there a likely or definite funder for the topic?  CHIS staff have been successful in helping to secure funding for many topics proposed by TAC membersfor many topics proposed by TAC members

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CHIS Discrimination ModuleMulticultural TAC MeetingApril 12, 2012

Presentation Outline• CHIS DM Overview

• Highlights from 2007 + 2009 CHIS DM Field Tests▫ Recent Everyday Discrimination (Du Bois Review,

2011) 2011) ▫ Translation Workshop▫ 2009 Reports of Discrimination

• Next steps▫ Instrument and Field Test Data Dissemination▫ Instrument and Field Test Data Dissemination▫ Funding for DM items on CHIS 2013

CHIS Discrimination Module Objective• To develop a self-reported racial/ethnic discrimination measure

▫ valid and reliable for multiethnic, multilingual populations▫ state-of-the-science qualitative research psychometrics and health ▫ state-of-the-science qualitative research, psychometrics, and health

survey methodology

• Test the two most commonly used approaches for asking about discriminationdiscrimination▫ 1-stage: Asks respondents directly if they encountered discrimination

based on race/ethnicity: “How often have you been treated with less respect than other people

because you are Asian American?”because you are Asian American?▫ 2-stage: Asks respondents about their experiences of discrimination, and

later asks if this discrimination was based on race/ethnicity: “How often have you been treated with less respect than other

people?...What is the reason? [e.g., Race, ancestry/national origin, the way people?...What is the reason? [e.g., Race, ancestry/national origin, the way you speak English, gender,…]”

CHIS Discrimination Module Mixed Methods ApproachCHIS Discrimination Module Mixed Methods Approach

BehaviorC di

Draft BehaviorC di

Draft BehaviorC di

Draft

Cognitive Interviews

Field Test CHIS 2007(English)

Coding

StatisticalAnalyses

Translation

Instrument

Cognitive Interviews

Field Test CHIS 2007(English)

Coding

StatisticalAnalyses

Translation

Instrument

Cognitive Interviews

Field Test CHIS 2007(English)

Coding

Health

Psycho-metric

Analysis

Instrument

CHIS (Public Use)

LiteratureReview Psychometric

Analyses

(English)

In-languageCognitive

Interviews

Translation

Field Test CHIS 2009

(In-language)

CHIS (Public Use)

LiteratureReview Psychometric

Analyses

(English)

In-languageCognitive

Interviews

Translation

Field Test CHIS 2009

(In-language)

Dissemination & CHIS

(Public Use)

LiteratureReview Psychometric

Analyses

(English)Outcomes

TranslationField Test CHIS 2009

(In-language)TranslationWorkshop

External Advisors

External Advisors

External Advisors

External Advisors

External Advisors

External Advisors

2006 2007/2009 20132006 2007/2009 201

Adapted from Shariff-Marco et al, Ethnicity & Disease, 2009

CHIS DM 2007 & 2009 Field Tests• Reports• Reports

▫ Cognitive interviews▫ 2007 Field Test

Imputations, Weighting & Behavior Coding Fi ld T▫ 2009 Field Test

Imputations, Weighting & Behavior Coding Translation Workshop

▫ 2007 + 2009 pooled weights

• Dissemination▫ Presentations

6-AAPOR 2008,2009,2010, 20116 AAPOR 2008,2009,2010, 2011 3-APHA 2008, 2009, 2010 2-NIH 2008, 2011

▫ Publications Ethnicity & Disease, 2009Ethnicity & Disease, 2009 Du Bois Review, 2011

CHIS DM 2007 & 2009 Field Tests• In-progress▫ 2007 CHIS DM

h l h i 4 health outcomes manuscript (general health, distressed in past 12 months, smoking , and high blood pressure)

Lifetime discrimination in medical care and cancer screening Mental health and discrimination Exploration of stress appraisal and usual responses Multilevel behavior coding analysis

▫ 2009 CHIS DMP h t i l i Psychometric analysis

Reports of discrimination Health outcomes Exploration of stress appraisal and usual responsesExploration of stress appraisal and usual responses Multilevel behavior coding analysis

CHIS DM 2007 Field Test

• Recent Everyday Discrimination (Du Bois Review, 2011)

“In the past 12 months how often have In the past 12 months, how often have . . .▫ you been treated with less respect than other people?▫ you been treated unfairly at restaurants or stores?

l i i i d h k?▫ people criticized your accent or the way you speak?▫ people acted as if they think you are not smart?▫ people acted as if they are afraid of you?▫ people acted as if they think you are dishonest?▫ people acted as if they’re better than you are?▫ you been threatened or harassed?”

• Shariff-Marco S, Breen N, Landrine H, Reeve BB, Krieger N, Gee GC, Williams DR, Mays VM, Ponce NA, Alegria M, Liu B, Willis G, Johnson TP. Measuring Everyday Racial/Ethnic Discrimination in Health Surveys: how best to ask the questions, in 1 or 2 stages, across multiple racial/ethnic groups? Du Bois Review: Social Science Research on Race. 2011;8(1):159-177.

CHIS DM 2009 Field Test

• Translation Workshop

• Percent Reporting Any Discrimination

CHIS DM Translation Workshopp

• 2009 behavior coding findings indicated need for improving translationsfor improving translations

• Goal: ensuring conceptual equivalence (rather • Goal: ensuring conceptual equivalence (rather than word-for-word translation) across all language versions g g▫ Frequency and stressfulness scales▫ Idioms

Translation Workshopp

• Recommendations ▫ Use an expert group based translation process▫ Use an expert-group based translation process▫ Focus on conceptual as opposed to literal translation▫ Adopt a de-centering approach to the source languagep g pp g g▫ Focus on the functioning of response scales

• Final CHIS DM instruments incorporate findings from translation workshop

CHIS DM 2009 Field Test

• Translation Workshop

• Percent Reporting Any Discrimination

Percent Reporting Any Recent Everyday Discrimination (2009)Everyday Discrimination (2009)

VIETNAMESE-VIETNAMESE SPEAKING

VIETNAMESE-ENGLISH SPEAKING

KOREAN-KOREAN SPEAKING

KOREAN-ENGLISH SPEAKING

VIETNAMESE VIETNAMESE SPEAKING

CHINESE-CANTONESE SPEAKING

CHINESE-MANDARIN SPEAKING

CHINESE-ENGLISH SPEAKING1-stage

2-stage

LATINO-SPANISH SPEAKING

LATINO-ENGLISH SPEAKING

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0

TOTAL

Percent Reporting Any Lifetime Discrimination (2009)Discrimination (2009)

VIETNAMESE VIETNAMESE SPEAKING

VIETNAMESE-ENGLISH SPEAKING

KOREAN-KOREAN SPEAKING

KOREAN-ENGLISH SPEAKING

VIETNAMESE-VIETNAMESE SPEAKING

CHINESE-CANTONESE SPEAKING

CHINESE-MANDARIN SPEAKING

CHINESE-ENGLISH SPEAKING1-stage

2-stage

TOTAL

LATINO-SPANISH SPEAKING

LATINO-ENGLISH SPEAKING

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0

TOTAL

CHIS DM 2007 + 2009 Summary Findings

• CHIS DM recent everyday discrimination scale (in English) provides a measure of racial/ethnic (in English) provides a measure of racial/ethnic discrimination that functions well across a range of racial/ethnic groupsof racial/ethnic groups

• The current instrument is too long (5-7 min in g (5 7English)

CHIS DM 2012-2013 Objectivesj• Dissemination▫ DM Instruments, Dec 2012 Long versions of both approaches, in multiple languages Supporting documentation NCI, CHIS websites and other federal, state, & university

itsites▫ DM field test datasets, Spring 2013 CHIS Data Access Center via SURF CHIS DM Fact Sheet CHIS DM Fact Sheet

• Discrimination items on CHIS 2013B i f i f i t t ( i )▫ Brief version of instrument (1-2 min)

▫ Identify funding

Funding for DM items on CHIS 2013g

• Discrimination items have not been available in the public use files (PUFs) since 2005in the public use files (PUFs) since 2005

▫ 2007, 2009 and 2011▫ Goal: put items back on for 2013 PUFp 3

• Timeline for CHIS 2013▫ Funding committed by Aug 2012▫ Final content, Sept/Oct 2012▫ Go into the field Jan 2013▫ Go into the field, Jan 2013

CHIS Discrimination Module Research TeamWORKGROUP MEMBERS:

• Nancy Breen, CHIS Project Officer & Health Disparities Coordinator, Applied Research Program (ARP), National Cancer Institute

EXTERNAL ADVISORS:

• Margarita Alegría, Harvard Medical School and Cambridge Health Alliance

• Gilbert Gee, Associate Professor, Community Health Sciences, UCLA School of Public Health

• David Grant, CHIS Director, Center for Health Policy Research UCLA

• E. Richard Brown, University of California, Los Angeles School of Public Health, Center for Health Policy and Research (CHIS PI)

• Timothy Johnson University of Illinois ChicagoPolicy Research, UCLA

• Benmei Liu, PhD, Surveillance Research Program, Division of Cancer Control and Population Sciences, NCI

Timothy Johnson, University of Illinois Chicago

• Nancy Krieger, Harvard School of Public Health

• Hope Landrine, East Carolina University

• Ninez Ponce, CHIS Co-PI & Associate Professor, UCLA School of Public Health

• Bryce Reeve, Associate Professor, UNC at Chapel Hill

• Vickie Mays, Center for Research, Education, Training and Strategic Communication on Minority Health Disparities, University of California, Los Angeles

• Salma Shariff-Marco, Research Scientist, Cancer Prevention Institute of California

• Gordon Willis, Survey Expert, ARP, National Cancer Institute

• David Takeuchi, University of Washington School of Social Work

• David Williams, Harvard School of Public HealthCancer Institute

Acknowledgementsg• CHIS Multicultural Technical Advisory Committee• CHIS & UCLA Center for Health Research & Policy• CHIS & UCLA Center for Health Research & Policy• Westat, Inc.▫ Kerry Levin, Martha Stapleton, Jocelyn Newsome▫ Lou Rizzo, Andrea Piesse

• Tim McNeel and William Waldron at Information Management SystemsManagement Systems

Thank You!&

Questions?

Healthcare Reform and Health B fit E hBenefits Exchange

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CHIS 2011 – 2012 healthcare reform WG A t C Access to Coverage ER visits, hospitalizations, usual source of care, delays in care, 

healthcare expenses, high‐deductible health plan, medicalhealthcare expenses, high deductible health plan, medical debt, individual market shopping experience and source of information, participation in the coverage initiative program, pre existing conditions employment industry firm sizepre‐existing conditions, employment industry, firm size

Medi‐Cal Changed usual source of care new income eligibility criteria Changed usual source of care, new income eligibility criteria

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CHIS 2011 – 2012 healthcare reform WG Preventive Services & Wellness Preventive Services & Wellness Cost‐sharing for preventive services, tobacco cessation 

counseling and nutrition counseling, utilization of preventive services and wellness programs

Medicare One‐time patient health status assessments, changes in 

Medicare Advantage

Long term Care Long‐term Care Long‐term care insurance

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CHIS 2011 – 2012 healthcare reform WG P ti t N i ti Patient Navigation Methods of finding and selecting health plan, 

consumer assistance, transparency and availabilityconsumer assistance, transparency and availability of information, knowledge of patient’s rights to an interpreter

Medical Home (separate WG) Personal doctor, comprehensive care management, 

patient centered care care coordination timelypatient‐centered care, care coordination, timely access to care, shared decision making, language concordance/need for interpreter

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Workgroup recommendations

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CHIS 2013‐2014 workgroups P b i t th t i i t i t Purpose: bring together experts in a given topic area to recommend specific questionnaire content appropriate for telephone administered population surveysfor telephone administered, population surveys

Workgroups Typically meet by teleconference several times during a 2‐3Typically meet by teleconference several times during a 2 3 month period, but varies by workgroup

Coordinated by CHIS staff at UCLA and PHI

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CHIS 2011‐2012 workgroups

Healthcare reform

Physical Activity

k Dietary Intake

Mental health

Native American/Alaska Native American/Alaska Native Oversample

Medical home

Social determinants of health

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CHIS 2013‐2014 workgroups: proposed Physical Activity Physical Activity 

Dietary Intake 

Women’s HealthWomen s Health

Mental Health

Medical Home

Healthcare reform and Health Benefit Exchange

Oral health

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TAC recommendations on new topics and workgroupsand workgroups

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Anything else?

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Review and Action Steps

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