CHIS: A Policy Tool to Assess Immigrant Health Access, Health, and Integration 10 th Summer Institute on Migration and Global Health June 22, 2015 The California Endowment Conference Center Oakland, CA Ninez Ponce, PhD, MPP Principal Investigator, California Health Interview Survey Associate Center Director, UCLA Center for Health Policy Research Professor, UCLA School of Public Health Director, UCLA Center for Global and Immigrant Health

Overview  Workshop Part 1:  CHIS Introduction  Accessing CHIS Data  Current Immigration Measures on CHIS  Survey non-response  CHIS Immigration Data  Future Immigration Measures on CHIS  Workshop Part 2: Demo  Mr. Bogdan Rau, Program Manager, AskCHIS & AskCHISNE

CHIS History & Aims  Conceived out of need for better data on health insurance coverage in California  First fielded in 2001 and conducted as a biennial survey through 2009 and continuously beginning in  2013/2014 data to be released in August 2015  Currently in the field for CHIS 2015/2016  Specific Aims:  To support decision making at the local level and statewide in public health and health care  To understand and measure health needs and disparities in California — characterized by ethnic, geographic, and social class diversity

CHIS introduction  The California Health Interview Survey (CHIS) is the most comprehensive source of health data on California’s diverse population and the largest state health survey in the U.S.  50,000 Californians (adults, teens, and children) are interviewed by CHIS.  Data from CHIS is used by policymakers, health departments, hospitals, CBOs, and researchers in public health and health care.

Methods: how is CHIS done?  CHIS has been collected every other year since 2001  Became a continuous survey in 2011  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  Participants are chosen at random.  One adult from each household, plus one teen and one child if available.  CHIS is funded by federal and state health agencies, California and national foundations, and others.

Methods: How is CHIS Done?  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 (excluding LA and San Diego)  3 grouped county strata containing the 17 smallest counties (by population)

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 7 languages: English, Spanish, Chinese (Cantonese and Mandarin), Korean, Vietnamese, and Tagalog  Beginning 2015, cell phone sample will be 50% of sampling frame

CHIS Sample See CHIS Sample Size by Age Age Group Adult (18+)56,27042,04443,02051,04847,61442,935 Child (0-11)12,8028,52611,3589,9138,9457,334 Teen (12-17)5,7334,0104,0293,6383,3792,799

CHIS Content  Demographic  Age, sex, race/ethnicity, marital status  Employment status, income, poverty level, educational attainment  Citizenship and immigration  Health behaviors  Alcohol consumption, tobacco use  Physical activity, dietary intake  Cancer screening, flu shot, HIV testing  Health conditions  Chronic conditions (asthma, diabetes, heart disease, high BP)  Disability  Mental health  Healthcare access and utilization  Health insurance coverage or lack of  Usual source of care, visits to doctor, ER use

CHIS Interviews  Interviews are conducted several languages:  English  Spanish  Chinese (Cantonese, Mandarin)  Korean  Vietnamese  Tagalog (began in February 2014)  Translated questionnaires are available online 

Accessing CHIS Data ( 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 (PUF)  Available at no cost for download through the CHIS web site (chis.ucla.edu)  Excludes sub-state geographic identifiers and highly sensitive variables like mental health and citizenship status  Data files for each cycle – adult, adolescent, and child  Available in SAS, SPSS, STATA format  Data dictionary for each file  Questionnaires are also available with the PUFs

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 the Internet: ask.chis.ucla.edu  Custom queries of CHIS data with quick results  Allows for analysis at the county, region, and/or state level of numerous health indicators and demographic characteristics  Includes many sensitive variables (unlike PUFs), all estimates weighted and rounded to nearest 1,000

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)

Health Profiles:  Legislative Districts: health profiles for each of the 80 Assembly Districts, 40 Senate Districts, and 53 U.S. Congressional Districts. Each profile displays estimates for various health topics for a given district.  Adults: one-page fact sheets containing health statistics for adults ages in all 58 California counties, as well as regions, Los Angeles Service Planning Areas (SPAs), San Diego Health and Human Service Agency Regions (HHSA).  Child and Teen: one-page fact sheets containing health statistics for children and teens (ages 17 and under) in all 58 California counties, regions. 19

Current Immigration Measures on CHIS

CHIS Adult Survey  Race and Ethnicity  Country of birth ( self, mother, father)  Generational status  Citizenship and Immigration  U.S. citizen  Permanent resident w/green card  Years lived in the U.S.

CHIS Adult Survey  Languages  Languages spoken at home, with friends  Languages of TV shows, radio, newspapers  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

Citizenship and Immigration Status in CHIS Citizenship and Immigration Status n (%) U.S. Born 31,801 (74.1%) Naturalized citizen 6,741 (15.7%) Non-Citizen w/Green Card 2,824 (6.6%) Non-Citizen w/o Green Card 1,569 (3.7%) Source: California Health Interview Survey (CHIS)

CHIS Immigration Data

Future Immigration Measures on CHIS  New questions have been added to the adult survey and are currently in data collection for CHIS  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 California’s California Immigration Research Initiative [CIRI])

Thank you