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

2 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 , 45 – 64, 65+).  Identifying differences in access to Indian Health Service by tribal affiliation.

3 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.

4 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.

5 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

6 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

7 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

8 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)

9 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

10 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

11 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)

12 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

14 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  In journal articles

15 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...

16 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...

17 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

18 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

19 An example of unweighted and weighted estimates Source: CHIS 2003 Adult Public Use File

20 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

21 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

22 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 (  DAC applications and additional DAC information are available online at  Confidential data can be accessed in person at the DAC or remotely through ed programming code and results by contracting with the Center’s Statistical Support and Programming team (submit programming, or hire programmer)

23 Technical Assistance  Additional documentation on CHIS survey methods, use of weights, data dictionaries, and the questionnaires are available on the CHIS web site at  Technical assistance on the Public Use Files is available at:   Telephone: Brandon Traudt  Technical assistance on developing research question specific to Native studies: Delight Satter –

24 CHIS total sample sizes Adult (18+)56,27042,04443,020 Child (0-11)12,8028,52611,358 Teen (12-17)5,7334,0104,029

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

26 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

27 Adult sample size by race/ethnicity - Single Race definition only Latino9,4607,1356,369 Native Hawaiian Pac Islndr Am Indian Alaska Natives Asian4,7983,8753,941 African American2,7642,6911,954 White36,72926,50628,979

28 Data collection results 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.

29 Adult, teen & child sample size by - American Indian or Alaska Native one or more races definition Adult Teen Child463370

30 Cancer Data published by AIANRP   Click on American Indian Research Program  Click on Publications

31 How to use AskCHIS

32 How to get CHIS data and information on the health of Natives from 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

33 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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38 Who are those people who report more 2+ races?

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

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

42 Binge Drinking past month, AIAN, CA Source: 2005 California Health Interview Survey, Race - Census 2000 * = statistically unstable Adol. (12-17)Adult (18-64)Senior (65+)All Ages %95% C.I. % % % Binge drinking 7.2*( ) 24.9( ) 6.4*( ) 19.9( )

43 Binge drinking, past month, AIAN, CA

44 Tested for HIV by Sexual Orientation, AIAN, 2005

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

46 Disability status by Gender, AIAN any-mention, CA

47 Physical Activity by CA Region, AIAN adults

48 Heart Disease (CVD) by Diabetes, AIAN adults

49 Live Interactive Session

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Contact Information Delight Satter, M.P.H. Director, American Indian and Alaska Native Research Program UCLA Center for Health Policy Research