California Health Interview Survey Research Articles

Factors associated with breast cancer detection method in California women: an analysis of California Health Interview Survey data.

Breast cancer mortality has significantly declined in the U.S. due in part to effective clinical screening methods. However, previous studies have found many women first detect their breast cancers through means other than their providers. Given that detection method has been shown to be an important prognostic factor, we examined the association between breast cancer detection method and various demographic and health-related factors in a representative sample of female breast cancer patients aged 40 + in California. We analyzed data from the 2009 and 2011-2012 California Health Interview Survey. Weighted percentages of breast cancer patients by detection method were calculated. A multivariable logistic regression model was used to quantify each factor's association with the likelihood of having a patient-detected versus clinically detected breast cancer using odds ratios (ORs) and 95% confidence intervals (CIs). 36% of female breast cancer patients first detected their cancer themselves. Compared to U.S.-born women, those who had spent 40% or less of their lifetime in the U.S. were more than twice as likely to report their breast cancer being patient-detected versus clinically detected (OR = 2.27, 95% CI 1.06-4.86, p = 0.035). Rural women were also more likely to report a patient-detected breast cancer than urban women (OR = 1.51, 95% CI 1.01-2.11, p = 0.044). Recent immigrants and those residing in rural areas were more likely to report self-detecting their breast cancer. Given the persistent disparities with regard to breast cancer mortality, particularly among underserved communities, strategies addressing barriers to screening uptake in these populations may be warranted.

Fast-Food Consumption and Asthma-Related Emergency Room Visits in California

Introduction Asthma is common, affecting up to 8% of adults in the United States. Several studies have shown an association between poorer diet and asthma. Despite the prevalence of fast-food consumption in the Western diet, research examining fast food consumption and asthma is limited. Objective This study aimed to examine the association between fast food consumption and asthma-related emergency room visits among adults with asthma in California from 2011-2016. Methods This cross-sectional study focused on 11,561 adults with asthma in California. Publicly available data from the California Health Interview Survey was used. The independent variable included fast food consumption, and the dependent variable was emergency room visits due to asthma. This study used logistic regression models and controlled for sex, race, self-reported overall health, BMI, and current smoking status. Survey weights were applied to ensure the analysis represented the general population. Results Consumption of fast food ≥3 times per week was associated with increased odds of emergency room visits for asthma among adults with asthma in California (unadjusted model: OR = 1.64 CI: 1.13-2.40, p = 0.01; adjusted model: ORadj =1.53, CI: 1.03-2.26, p = 0.03). Conclusion Our findings suggest that high consumption of fast food among adults with asthma may result in higher odds of asthma-related emergency room visits. Thus, decreasing fast food consumption may benefit adults with asthma by reducing emergency room visits.

Changes in Mental Health Services Use Under the ACA in One State: Role of Mental Health Provider Shortages.

This study aimed to examine whether changes in mental health services use under the Patient Protection and Affordable Care Act (ACA) differed in Mental Health Professional Shortage Areas (MHPSAs) versus non-MHPSAs. Multiple waves of data from the California Health Interview Survey (2011-2018) were analyzed. The sample (N=10,497) was restricted to adults (ages 18-64) who reported experiencing serious psychological distress (SPD) during the past 12 months. MHPSAs were identified by using scores from the Health Resources and Services Administration and were matched to respondents' zip codes. Weighted logistic regression and generalized linear models were used to identify adjusted changes in the rates of four measures of mental health services use (any primary care visit for mental health reasons, any specialty mental health care visit, any prescription psychiatric medication, and total number of outpatient visits for mental health) before and after implementation of the ACA. Rates of uninsured nonelderly adults with SPD in MHPSAs and non-MHPSAs decreased under the ACA. Changes in rates of specialty mental health services use under the ACA were statistically significant only in non-MHPSAs. Changes in mental health services use did not differ significantly between MHPSAs and non-MHPSAs for any of the four measures. Changes in the four measures of mental health use under the ACA did not differ in MHPSAs versus non-MHPSAs. Future research into the ACA's long-term effects should examine systemic and structural barriers to mental health care and to having sufficient numbers of mental health professionals.

Tobacco Treatment Disparities among California Medicaid Members with and without Chronic Disease who Smoke

Introduction: People who are covered by Medicaid have a higher smoking prevalence than the general population and are at increased risk for tobacco-related disease, a major driver of Medicaid costs. California has the largest Medicaid program, called Medi-Cal, whose members also have higher tobacco use rates and tobacco-related disease. Quitting is beneficial at any age and health professional advice and assistance is a key indicator of smoking cessation. As Medi-Cal transforms to improve population health and health equity, this study aimed to understand both prevention and treatment of tobacco-related disease by comparing health professional advice and assistance among all Medi-Cal members with and without chronic disease who smoke. Materials and Methods: Using data from the California Health Interview Survey (2014, 2016-2018), we examined 3,517 Medi-Cal current smokers (age ≥18) who consulted a health professional and reported about having a chronic disease. The outcomes were receipt of health professional advice or assistance to quit smoking. Adjusted logistic regression models were conducted to examine the association between chronic disease and the outcomes, including adjusting for frequency of office visits. Results: Among 1,227,154 Medi-Cal members who smoke, over half (51.9%) of whom had at least one chronic disease, approximately half received cessation advice, and less than one-third received smoking cessation assistance. Smokers with chronic disease, compared to those without chronic disease, were more likely to receive health professional advice (63.9% vs. 33.7%, P < .001) and assistance (37.7% vs. 20.5%, P < .001). In adjusted models, smokers with chronic disease, compared to those without chronic disease, were almost twice as likely to receive advice (OR=1.97, 95% CI: 1.39, 2.78) and 1.5 times as likely to receive assistance (OR=1.50, 95% CI: 0.94, 2.38), but the latter was not statistically significant. Conclusions: Medi-Cal members who smoke have tobacco treatment disparities by whether they are with or without chronic disease, even after adjusting for the number of office visits. Medi-Cal population health strategies for tobacco cessation treatment will need to improve prevention, not just treatment, of tobacco-related disease to reduce the long-term burden on the health care system and associated costs.

Adult Mental Health Associated with Adverse and Positive Childhood Experiences Among 1st and 2nd Generation Asian Americans.

Adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) impact adult health. However, differences in ACEs, PCEs, and mental health have not been extensively studied among Asian Americans. To examine the association between childhood experiences and adult mental health in first and second generation Asian Americans. This study used data from the 2021-2022 California Health Interview Survey (CHIS), an address-based sampling of noninstitutionalized Californians conducted online or by phone. Asian American respondents aged 18-65 years. Fifteen different ACEs and seven different PCEs. Adjusted prevalence ratios (aPR) of severe psychological distress for each generation. Survey weights were applied to all analyses for population-based representation. 5,744 Asian Americans (48.0% male, 16.4% aged 18-25) were included in the current study. We found that second generation Asian Americans experienced a greater prevalence of ACEs (65.4% reported ≥1 ACE vs 47.5% in first generation Asian Americans) and lower prevalence of PCEs (32.1% reported ≤2 PCEs vs 22.6% in first generation Asian Americans). Second generation Asian Americans were more likely to report ≥4 ACEs (aPR, 1.46; 95% CI, 1.13 to 1.88) and ≤2 PCEs (aPR, 1.51; 95% CI, 1.29 to 1.78) relative to first generation Asian Americans. Second generation Asian Americans with ≥4 ACEs or ≤2 PCEs were more likely to report severe psychological distress (aPR, 2.54; 95% CI, 1.55 to 4.17 and aPR, 1.48; 95% CI, 1.03 to 2.13, respectively) relative to first generation Asian Americans. When examining ACEs and PCEs individually, domestic, physical, and verbal abuse; divorce; racism; and lacking support systems were significantly associated with severe psychological distress in second generation Asian Americans. Second generation Asian Americans are more likely to experience more ACEs, fewer PCEs, and poorer mental health as a result. Our study indicates that physicians should screen for childhood experiences and leverage trauma-informed care among Asian American subpopulations.

Assessing Narrative Patterns in Health Access, Outcomes, and Behaviors Across Three Data Sets From England, the United States, and California for Sexual Minority Adults.

We examined peer-reviewed publications analyzing data from the English GP Patient Survey (GPPS), U.S. National Health Interview Survey (NHIS), and California Health Interview Survey (CHIS) to explore how the health of sexual minority populations varies across settings and subgroups. We searched for English language articles published 2011-2022, screening abstracts (n = 112), reviewing full text (n = 97), and extracting data (n = 85). We conducted a content analysis to identify patterns across settings for sexual minority people compared with heterosexual counterparts and each other. Across all settings, sexual minority adults had poorer health care access, worse health outcomes and patient experiences, more detrimental health behaviors, and greater health care services utilization (reflecting risk awareness and need). When subgroup data were reported, differences were greater among women, except for HIV and related cancers, which were most prevalent among sexual minority men. Sexual minority people generally reported significantly worse health access, outcomes, and behaviors in all three settings.

Abstract A093: Assessing cigarette smoking intensity among California adults and the need for tailored interventions to reduce health disparities

Abstract Background: Smoking causes about 20% of all cancers and about 30% of all cancer deaths in the U.S (ACS, 2024). Smoking increases the risk for cancers of the mouth, larynx, pharynx, esophagus, kidney, cervix, breast, liver, bladder, pancreas, stomach, colon, and acute myeloid leukemia and there is no safe form of tobacco smoke (CDC, 2023; ACS, 2024). This study aims to inform public health strategies that can mitigate smoking related disparities and improve health outcomes for marginalized populations. Methods: This study assessed the prevalence of cigarette smoking by demographic characteristics among California adults. We used secondary data from the 2019 California Health Interview Survey (CHIS) that was collected through a random-digit dial telephone survey. Adults ages 18+ were interviewed. We utilized secondary data comprised of 22,160 participants. We conducted interactions between gender and race/ethnicity, and one's smoking status. Multinomial logistic regression test was conducted to predict the probability of participants' level. This study was approved by the researchers Institutional Review Board. Results: Majority or participants were non-smokers (93.1%), mostly females (51.2%,). Many had a bachelor’s degree (23.9%) or some college, vocational training, or an associate degree (22.8%). Many participants (59.8%) were married/living with a partner, and (25.7%) were single. Most participants spoke English (55.4%) and the largest race/ethnic groups were White (40.2%) followed by Latinos (21.8%). Age distribution was as follows: 18–29 (22.9%), 30–39 (17.6%), and 40–49-year-olds (16.2%). For low-intensity smokers , in terms of race/ethnicity, Latino participants were less likely to be low-intensity smokers relative to non-smokers in comparison to White participants (RRR = .411, p = .043). For moderate-intensity smokers , education was statistically significant, with participants holding a graduate degree being significantly less likely to be moderate-intensity smokers relative to non-smokers in comparison to participants who had a HS degree (RRR = .068, p = .025). For high-intensity smokers , single participants were more likely to be high-intensity smokers compared to those married or living with a partner (RRR = 2.72, p = .011). In terms of age, only participants that were 30 to 39 years old were statistically significant, with this group more likely to be high-intensity smokers relative to non-smokers in comparison to participants who were 20 to 29 years of age (RRR = 3.40, p = .031). Conclusion: Findings suggest that one’s demographics characteristics does play a role in smoking consumption rates. Addressing disparities in smoking and cancer requires a multifaceted approach that includes policy changes, targeted interventions, and improved access to healthcare and smoking cessation resources. Hence, public health efforts should create evidence-based interventions and consider the social, economic, and cultural contexts of target populations to reduce disparities in smoking and cancer. Citation Format: Salome Kapella Mshigeni, Anhthu Nguyen, Julian C Sacdalan, Elizabeth Pinder-McSwain, Felipe Aperador Tarazona. Assessing cigarette smoking intensity among California adults and the need for tailored interventions to reduce health disparities [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A093.

Stigma and Barriers to Care, Online Mental Health Tools, and Suicidality in California's Veterans.

Veterans have a higher national suicide rate than non-veterans (31.6 versus 18.0 per 100,000). Psychotherapy and other treatments are effective at reducing suicidality, yet stigma and barriers to care reduce willingness to seek help. For veterans who do seek help, they are often undertreated leaving them still in need of help. Online mental health tools (OMHTs) provide another option for obtaining help; however, there is limited research regarding the relationship between stigma and barriers to care, OMHT use, and suicidality. We hypothesized that stigma and barriers are related to higher likelihood of OMHT use and OMHT use is related to lower likelihood of suicidality. The California Health Interview Survey is a population-based state health survey that collects data over a 2-year cycle via web and phone interviews. The sample was 4,435 veterans (91% male, 75% White, and average age 67 years old). The study was institutional review board exempt because data storage and analyses were done at the Data Access Center at University of California-Los Angeles. Logistic regressions showed endorsing stigma and barriers indicated a higher likelihood of using OMHTs. Additionally, use of OMHTs was unexpectedly associated with greater suicidality. Findings reinforce the need for research aimed at identifying ways to reduce stigma and barriers toward seeking help. Online mental health tools are a viable option for individuals experiencing stigma and barriers and for individuals who previously experienced suicidality.

Exposure to climate events and mental health: Risk and protective factors from the California Health Interview Survey

There is increasing awareness of the effects of climate change on mental health, but more work on understanding risk and protective factors is needed. The 2021 California Health Interview Survey included new questions about exposure to extreme weather events and mental health responses. This study aims to identify how individual factors and neighborhood social cohesion are associated with negative mental health effects of exposure to extreme weather events. In this cross-sectional, representative study, we used data from the 2021 California Health Interview Survey to analyze the association between respondent characteristics and self-report of negative mental health effects following exposure to extreme weather events. Univariate and multivariate logistic regression models were used, adjusting for individual-level sociodemographics and measures of neighborhood social cohesion. We found that 53% of the sample reported being affected by climate events (n = 12,955), and of these, 22.8% (n = 2,955) reported a negative impact on their mental health. Respondents who were younger, White, female, college-educated, or living in a rural area were more likely to report adverse mental health effects of climate events for themselves or household members. Individuals who had experienced property damage were much more likely to report negative mental health effects due to climate events [property damage adjusted OR 3.73, 95% CI 2.82–3.76]. This study identifies subgroups that may have higher vulnerability to the mental health effects of climate change events. Future research is needed to develop targeted prevention and outreach interventions to these subgroups to build individual- and community-level resilience.

Estimating dementia incidence in insured older Asian Americans and Pacific Islanders in California: an application of inverse odds of selection weights.

Literature shows heterogeneous age-standardized dementia incidence rates across US Asian American, Native Hawaiian, and Pacific Islanders (AANHPI), but no estimates of population-representative dementia incidence exist due to lack of AANHPI longitudinal probability samples. We compared harmonized characteristics between AANHPI Kaiser Permanente Northern California members (KPNC cohort) and the target population of AANHPI 60+ with private or Medicare insurance using the California Health Interview Survey. We used stabilized inverse odds of selection weights (sIOSW) to estimate ethnicity-specific crude and age-standardized dementia incidence rates and cumulative risk by age 90 in the target population. Differences between the KPNC cohort and target population varied by ethnicity. sIOSW eliminated most differences in larger ethnic groups; some differences remained in smaller groups. Estimated crude dementia incidence rates using sIOSW (versus unweighted) were similar in Chinese, Filipinos, Pacific Islanders and Vietnamese, and higher in Japanese, Koreans, and South Asians. Unweighted and weighted age-standardized incidence rates differed for South Asians. Unweighted and weighted cumulative risk were similar for all groups. We estimated the first population-representative dementia incidence rates and cumulative risk in AANHPI ethnic groups. We encountered some estimation problems and weighted estimates were imprecise, highlighting challenges using weighting to extend inferences to target populations.

Neighbourhood characteristics, leisure-time walking, and mental health in older veterans

ABSTRACT This study examined the extent to which neighbourhood cohesion and safety are related to leisure-time walking, mental health, and the health-related perceptions of older veterans. Using data from the 2016 California Health Interview Survey (CHIS), we focused on 1,501 respondents who reported they were veterans 65 years of age and older. Results of a path analysis indicated that older veterans living in neighbourhoods characterized by high social cohesion and safety tended to report better mental health and more positive health perception compared to those residing in neighbourhoods with lower levels of social cohesion and safety. In addition, older veterans with higher levels of leisure-time walking were more likely to report better mental health and health perception compared to those who engaged in lower levels of leisure-time walking. These results add to the existing body of knowledge that describes how safe and socially cohesive neighbourhoods and leisure time physical activity play an important role in shaping mental health and health perception in older veterans. Practical implications for promoting health-related behaviours and health in the older veteran population are discussed.

Unmet Mental Health Needs Among California Workers Since the Start of the COVID-19 Pandemic.

We sought to identify worker groups with high prevalence of unmet mental health needs to inform employer benefits programs and outreach to increase access to care. We conducted a repeated cross-sectional study to understand unmet mental health needs among workers since the start of the COVID-19 pandemic using the California Health Interview Survey data from 2013 to 2021. In 2021, 23.4% (confidence interval: 22.4 to 24.4) reported unmet mental health needs, an absolute increase of 3.9% from 2019. Relative increases were highest among workers in the information industries (prevalence ratio: 1.89, confidence interval: 1.4 to 2.5) and older workers (prevalence ratio: 1.27, CI: 0.9 to 1.8). Increases in needing help were not met with comparable increases in seeking care. Unmet mental health needs increased for California workers during the pandemic. Employers should dedicate resources and implement strategies to increase access to care and promote worker well-being.

Predictors of healthcare usage among Asian Americans during the COVID-19 pandemic in California

ABSTRACT The purpose of this study was to examine the role of gender in determining healthcare usage among Asian Americans, with specific attention to preventive care and early intervention through doctor visits during COVID-19. The authors used retrospective data from the 2021 California Health Interview Survey (CHIS) by selecting 3,962 Asian Americans who resided in California during the pandemic. The logistic regression analysis found several predictors of healthcare usage. The study concluded that Asian American women are more likely to use both preventive care and doctor visits than Asian American men. In addition, married and older Asian residents are significantly more likely to use both preventive care and doctor visits than their married and younger counterparts. Having health difficulties increases the likelihood of using both preventive care and doctor visits. Interestingly, being employed decreased the likelihood of using preventive care. Lack of use of health care services by Asians with specific backgrounds warrants appropriate health interventions.

Persistent effects of legal status on healthcare access and outcomes: findings from a state-wide representative cross-sectional survey in California

BackgroundTo examine how legal status and past undocumented status are associated with healthcare access and health outcomes.MethodsData were collected between 2018 and 2020 as a follow-on, cross-sectional survey to the...

Improving the Efficiency of Outbound CATI As a Nonresponse Follow-Up Mode in Address-Based Samples: A Quasi-Experimental Evaluation of a Dynamic Adaptive Design

Abstract This article evaluates the use of dynamic adaptive design methods to target outbound computer-assisted telephone interviewing (CATI) in the California Health Interview Survey (CHIS). CHIS is a large-scale, annual study that uses an address-based sample (ABS) with push-to-Web mailings, followed by outbound CATI follow-up for addresses with appended phone numbers. CHIS 2022 implemented a dynamic adaptive design in which predictive models were used to end dialing early for some cases. For addresses that received outbound CATI follow-up, dialing was paused after three calls. A response propensity (RP) model was applied to predict the probability that the address would respond to continued dialing, based on the outcomes of the first three calls. Low-RP addresses were permanently retired with no additional dialing, while the rest continued through six or more attempts. We use a difference-in-difference design to evaluate the effect of the adaptive design on calling effort, completion rates, and the demographic composition of respondents. We find that the adaptive design reduced the mean number of calls per sampled unit by about 14 percent (relative to a modeled no-adaptive-design counterfactual) with a minimal reduction in the completion rate and no strong evidence of changes in the prevalence of target demographics. This suggests that RP modeling can meaningfully distinguish between ABS sample units for which additional dialing is and is not productive, helping to control outbound dialing costs without compromising sample representativeness.

Health Literacy among Korean American Immigrant Women in the USA: Role of Social Support

ABSTRACT Health literacy is associated with health behaviors and outcomes. Using Andersen’s Behavioral Model of Health Services Use, this study examined the role of limited English proficiency (LEP) and social support for the health literacy of Korean American immigrant women, one of the most affected groups by LEP. Researchers surveyed 232 Korean American immigrant women in a metro area in a Southeastern state, U.S. Health literacy was measured by the CDC Behavioral Risk Factor Surveillance System Questionnaire and the California Health Interview Survey. Participants with better English proficiency and larger social support had higher health literacy. LEP and social support interaction was significantly associated with health literacy, illustrating social support as a buffer that mitigates the negative impact of LEP on health literacy. Community programs that enhance social support through community health advocates or peer educators may increase health literacy and reduce health disparities among Korean American immigrant women with LEP.

Health and economic cost estimates of short-term total and wildfire PM2.5 exposure on work loss: using the consecutive California Health Interview Survey (CHIS) data 2015–2018

InstructionTo help determine the health protectiveness of government regulations and policies for air pollutant control for Americans, our study aimed to investigate the health and economic impacts of work loss...

The Relation Between Perceived Racial Discrimination and Civic Engagement Among People of Asian Descent

Although people of Asian descent are the fastest-growing ethno-racial group in the United States, there has been limited research on how racialized experiences are related to their civic engagement behaviors. This study examines how perceived racial discrimination relates to political and community civic engagement among people of Asian descent living in California. Analyzing novel data from the 2021 California Health Interview Survey, we find that after the onset of COVID-19 people of Asian descent showed both the sharpest rise in perceived racial discrimination and the lowest level of civic engagement among all ethno-racial groups in California. Moreover, perceived racial discrimination was significantly associated with political engagement but not with community engagement among people of Asian descent. Finally, people of Asian descent showed some unique dynamics in comparison with other minoritized groups. We discuss the implications of these findings for nonprofit and voluntary sector research on the racialization of civic engagement.

Mental Health Outcomes of Immigrant- and US-Born Caregivers: California Health Interview Survey, 2019-2020.

Objectives. To compare the mental health outcomes of US-born with immigrant caregivers of adult care recipients. Methods. We conducted a cross-sectional secondary analysis of the 2019 California Health Interview Survey (CHIS), administered via web or telephone to 22 152 participants between September and December 2019. We characterized (1) caregivers and noncaregivers, and (2) US-born versus immigrant caregivers. Then, we estimated and compared (3) the relationship between caregiving status and severe psychological distress among US-born and immigrant respondents, and (4) correlates of severe psychological distress among US-born and immigrant respondents. Results. Caregivers were more likely than noncaregivers to report severe psychological distress (P < .05). Immigrant caregivers residing separately from their care recipient were significantly more likely to experience severe psychological distress (odds ratio = 3.76; P < .01). Conclusions. US-born and immigrant caregivers may experience different risk factors for psychological distress associated with caregiving. Clinical and community resources should be tailored to caregivers' distinct needs with consideration of how access to resources (e.g., language), circumstances (e.g., acculturation), and cultural norms (e.g., filial piety) may be associated with exacerbation of psychological distress among immigrants. (Am J Public Health. 2024;114(S2):S189-S199. https://doi.org/10.2105/AJPH.2023.307396).

Residential Mobility, Housing Costs, and Relationships among Neighbors

Drawing on the California Health Interview Survey, I test the hypothesis that cost-related movers—renters who recently moved due to unaffordable housing costs—are less likely to trust their neighbors and count on them for support than renters who recently moved for other housing-related reasons and renters who did not recently move. I find that, on average, trust and support are lower among cost-related movers. My findings suggest that cost-related movers might be less trusting because they tend to be more wary of strangers, which could include their neighbors. They further suggest that cost-related movers might be less likely to have neighbors they can count on for support because they are more likely to perceive their neighborhoods as unsafe. The findings contribute to the scholarship on residential mobility by demonstrating that beyond the frequency with which renters move, the types of moves they experience may also shape their local relationships.