CHIS Multicultural Technical Advisory Committee Meeting

(1)

CHIS 2017-2018 Multicultural Technical

Advisory Committee Meeting

April 6, 2016 2:30 pm – 5 pm

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Welcome and Introductions

Jahmal Miller, MHA

Deputy Director, CDPH Office of Health Equity

Ninez Ponce, PhD, MPP

Professor, UCLA Fielding School of Public Health Department of Health Policy and Management

(3)

Navigating Adobe Connect

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Meeting Goals

Jahmal Miller

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Meeting goals



Update TAC members on CHIS project status

 Brief report on CHIS 2013-2014 and 2015-2016

 _{Disseminating CHIS data and findings}  _{New data collection subcontractor—RTI}  _{Sample design}

 _{Data collection status}

 _{Multicultural questionnaire content changes}



_{TAC member input on CHIS questionnaire}

 _{CHIS 2017-2018 Planning and Discussion}

 _{Content planning timeline}

(6)

CHIS 2013-2014 Update

Ninez Ponce

(7)

Dissemination update



Shift to one-year data files

 One-year data files: 2013 and 2014 released in August 2015

as separate public use data files

 2011-2012 re-released as one-year data files in Jan. 2016  Allows more timely access to data, more flexibility for users



Two-year data files available as SURF by request



AskCHIS: separate data files 2011, 2012, 2013, 2014



One-year data caution: pooling two + CHIS cycles may

(8)

AskCHIS Neighborhood Edition (NE)



Public launch on Nov. 14, 2014



_{Update indicators w/ 2013-2014 CHIS data—available}

Spring 2016



_{New indicators added}

 _{Age 0 to 5 ACS indicators for First 5 California (poverty status}

and race/ethnicity)

 _{Life expectancy (in progress)}

 _{Income Inequality (GINI index from ACS)}

(9)

AskCHIS Neighborhood Edition (NE)



API developed with support of CHCF



Several API customers:

 _{Healthy City/Advancement Project}  St. Joseph’s Hospital System

(10)

CHIS 2015-2016 Update

Vendor and Sample Design

(11)

New vendor for CHIS 2015-2016



CHIS data collection contractor determined by

competitive bid by UCLA Purchasing Dept. (since 2003)



Each round won by Westat… until 2015



Three high-quality bids

 _Westat  _Abt/SRBI

 _{RTI International}



RTI was the winner of the 2015-2016 competition

 _{Highest points in technical review}  _{Lowest cost}

(12)

New vendor for CHIS 2015-2016, cont.



RTI International: HQ in Research Triangle Park, NC



_{Large firm (3,700+ employees), conduct several major}

federal, and other, surveys:

 _{National Survey of Drug Use and Health}

 _{National Intimate Partner and Sexual Violence Survey}  _{National Survey of Family Growth}

(13)

New vendor for CHIS 2015-2016, cont.



Transition from Westat to RTI has been challenging

 _{Contract signed in November 2014}

 _{Data collection started in}May 2015 (4-5 months late)

 _{Major push to interview 20,000 households in CY 2015 – goal}

achieved

 However, still falling short (to date):

 Uneven yield by strata

 Child and teen yield

 Korean and Vietnamese yield

 _{RTI committed to “getting it right”}

 _{Created a lot of additional effort for CHIS staff to monitor, review, and}

support decision making

(14)

CHIS 2015-2016 Sample Highlights



_{Same geographic stratification as past CHIS cycles}



Dramatic increase in cell sample—50%



_{County oversamples}

 _{Marin (2015: +890 households, maximize yield of Latinos and children)}  _{San Diego (2016: + 1,500 households)}



_{TCE’s Building Healthy Communities (BHC) Initiative}

 _{Sample of 14 neighborhoods throughout California}  _{Target of 400 household interviews per site (n=5,600)}  _{Data collection from Oct. 2015 through April 2016}

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CHIS 2015-2016 Data Collection Status

Completed interviews as of April 4, 2016

Age Group _(complete)CHIS 2015 _{(in progress)}CHIS 2016

Adult 20,986 5,782

Teen 754 187

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CHIS Child Sample

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CHIS 2015-2016 Data Production Timeline



CHIS 2015

 Data collection began: May 2015  _{End data collection: February 2016}

 _{Cleaned/edited data from vendor: mid-March 2016}  _{Preliminary data files: June 2016 (upcoded, imputed)}  _{Quality control review complete: July 2016}

 1-year 2015 PUFs and AskCHIS data release: August 2016



_{CHIS 2016}

 _{Data collection began: January 2016}  _{End data collection: December 2016}

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CHIS Questionnaires

 English Questionnaires (2001 – 2013/2014)  http://healthpolicy.ucla.edu/chis/design/Pages/questionnairesEnglish.aspx  _{Translated Questionnaires (2003 – 2013/2014)}  _Spanish  _Chinese  _Korean  _Vietnamese  _{Tagalog (2013/2014 only)}  http://healthpolicy.ucla.edu/chis/design/Pages/Questionnaires%20(Translated) .aspx

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CHIS 2015-2016 Content Changes

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CHIS 2015-2016 Adult Q: deletions from 2013-14



Medical care for asthma, diabetes, heart disease

• Delayed, did not get prescriptions

• Delayed, did not get other medical care • ER visits, hospital admissions



Partial scope Medi-Cal utilization

 _{Hospital admissions}  Prenatal care

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CHIS 2015-2016 Adult Q: deletions from 2013-14



Health behaviors

 Milk, water, sugary drink consumption (2016)  _{Alcohol consumption and binge drinking (2016)}



Confidence in ability to complete application online



Demographics

 _{Young adult lives with parents}

 Language of media respondent watches, listens to,

(22)

CHIS 2015-2016 Adult Q: additions from 2013-14



Public program eligibility

 _{Social services disability determination}  _{Six new property assets questions}



Used paid child care past month, cost



Receiving TANF or CalWORKS



Women’s health

 _{How long provider advised until next mammogram}



Current contraceptive method (men and women)



_{Health behaviors}

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CHIS 2015-2016 Adult Q: additions from 2013-14



_{Health care access and utilization}

 _{Used tele-medicine past 12 months, type of health problem}  _{Discrimination when receiving medical care}

 _{Ever a time when would have gotten better medical care if you had}

belonged to a different race or ethnic group?

 _{If yes, how long ago did that happen?}

 _{Over entire lifetime, how often treated unfairly when getting medical}

care?

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CHIS 2015-2016 Adult Q: additions from 2013-2014



Immigration and visa status

 _{If naturalized citizen, year of naturalization}  _{Visa type: tourist, student, work permit, other}  _{Clarify if DACA or DAPA}

 _{Deferred Action for Childhood Arrivals}

(25)

CHIS 2015-2016 Adult Q: additions from 2013-2014



Japanese or Japanese descent



Generational status



Memose’s Sekentei 12-item scale

 _{Attitudes toward social and familial relationships}  Social behaviors

(26)

CHIS 2017-2018

Planning and Timeline

(27)

CHIS 2017 – 2018 timeline



Content development

 Technical Advisory Committees March – April 2016  Workgroup meetings May – June 2016  Content discussion with funders April – July 2016  Content deadline July 31, 2016  IRB submission (UCLA + CPHS) August 31, 2016

(28)

CHIS 2017 – 2018 timeline



Questionnaire preparation and testing

 Pre-testing (paper and pencil) Mid-Oct 2016  CATI programming preparation Oct 2016

 CATI programming Nov – Dec 2016  IRB submission (Final English) Late Oct 2016  Pilot testing Jan 2017

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CHIS 2017 – 2018 timeline



Questionnaire translation

 Spanish translation & cultural adaptation Nov – Dec 2016  Asian Lang. translation & cultural

adaptation Nov – Dec 2016

 _{Spanish CATI programming} _{Jan – Feb 2017}  _{Begin data collection (Spanish)} _{Mid Feb 2017}  _{Asian Lang. CATI programming} _{Feb – Mar 2017}  _{Begin data collection (Asian Languages)} _{Mid Mar 2017}

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Sexual Orientation

& Gender Identity (SOGI)

Matt Jans

(31)

Sexual Orientation (SO): Timeline



2001: Self-identified SO

(straight, gay, lesbian, bi-sexual, other)



2003: Sexual behaviors

(number and sex of sex partner/s)



2003: Limited questions to age 18 through 70

(high misclassification of older respondents)



Age 71+ added 2015



2009: Added same-sex spouse/registered

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SO: Other Languages



Spanish translation problems well known



New evidence that Spanish, Chinese, and

Vietnamese definitions are problematic



_{Revision: “By heterosexual we mean men who like}

women or women who like men. By homosexual we

mean men who like men or women who like

women. Bisexual means men who like men and

women or women who like men and women.”

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SO: Next Tests



Remove technical wording (e.g., “heterosexual

and homosexual”)



Current best practice: Use “gay” and “lesbian” only



Experimentally test versions across all languages



_{Question wording and “if needed” text}



Digitally audio-record and code reading,

responses, and verbal behaviors

(34)

Gender Identity (GI): Pilot Test



2014 pilot test (with Williams Institute at UCLA

School of Law)



Selected two-step version (of 4 versions tested)



See Williams

GenIUSS report

for current best practice

1. “What sex were you assigned at birth, on your

original birth certificate?”

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GI: Full Sample 2015



0.2% (n = 43) transgender respondents



No misclassifications



2015-2016 wording experiment

 Original: “What sex were you assigned at birth, on your

original birth certificate?”

 0.7% Trans-identified  0.3% Not ascertained

 _{Revised: “On your original birth certificate, was your sex}

assigned as male or female?”

 0.5% Trans-identified

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Non-Citizen Visa Type & Status

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Current Q’s on Citizenship/Immigration

The next questions are about citizenship and

immigration.



Are you a citizen of the United States?



Are you a permanent resident with a green card?

Your answers are confidential and will not be

reported to Immigration Services.

(38)

New Immigration Q’s from UC-CIRI



_{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”?

(39)

Discrimination SURF & Module

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Discrimination Module (DM) SURF Overview

 The DM captures several dimensions of “unfair treatment”

 _{recent (past 12-months) everyday discrimination,}  _{lifetime discrimination,}

 _{stress appraisal of discrimination experiences, and}  _{usual responses to discrimination experiences.}

 2 versions of the DM instrument tested

 _{Version A first asks about “unfair treatment” and then asks about the reason}

for unfair treatment, including race/ethnicity, gender, age, sexual orientation, and other factors.

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Getting CHIS Discrimination Module SURF

This link contains documentation for the CHIS 2007

and 2009 Discrimination Modules (including brief

and detailed methodological summaries and

codebooks:

http://www.healthpolicy.ucla.edu/chis/data/Pages

/DM.aspx

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New (and old) Discrimination Q’s funded by

Office of Health Equity

These next questions are about things that have

happened to you while receiving medical care.



Was there ever a time when you would have

gotten better medical care if you had belonged

to a different race or ethnic group?



Think about the last time this happened. How

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New (and old) Discrimination Q’s funded by

Office of Health Equity



_{Over your entire lifetime, how often have you been}

treated unfairly when getting medical care? Would you

say… {never, rarely, sometimes, often, always}



Which of these do you think is the main reason why you

have been treated unfairly, over your entire lifetime?

Was it because of... {ancestry or national origin , gender

or sex, race or skin color, age, of the way you speak

(45)

Social Determinants Measures

(46)

SDoH Measures



Social penalties: race/ethnicity, age, gender, SOGI,

income, education, language, immigration/citizenship,

physical & mental disability



Housing: type, duration in house/neighborhood, moves



Social Cohesion & civic engagement

 _{Get along, trust, help neighbors (adults & teens)}

 _{Adults look out after kids in neighborhood (adults & teens)}  _{Volunteer, boards, neighborhood group to solve problems}

(adults)

(47)

CHIS 2017-2018 Topics:

Content Criteria for Inclusion

in CHIS

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Content Criteria



Is it important for public health or health care policy?

 Emerging PH issues and lack of population-based data  Who will need and use the data?



Is there another data source for the indicator/measure?



Is this a key health indicator? (Health Profiles, LGHC)



Has it been in CHIS before?

 _{How often does data on it need to be collected?}  Rapidly changing measure or stable over time?