California Health Interview Survey Research Articles

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 California Health Interview Survey data from 2013-2021. In 2021, 23.4% (CI: 22.4-24.4) 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 [PR]: 1.89, CI: 1.4-2.5) and older workers (PR: 1.27, CI: 0.9-1.8). 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).

Disparities in Screening for Adverse Childhood Experiences.

Screening for adverse childhood experiences (ACEs) in the clinical setting is set to become more commonplace with continued efforts to reimburse clinicians for screening. However, an examination of disparities in ACEs screening and related attitudes and beliefs is needed. Using the 2021 California Health Interview Survey (CHIS), this study examined if several measures of socioeconomic status, access to care and identities were associated with 3 outcomes: 1) getting screened for ACEs by a clinician; 2) beliefs about the importance of screening and 3) satisfaction with efforts to address the impacts of ACEs. Logistic regressions were used to estimate odds of the outcomes. Black, Latinx, and Asian individuals had lower odds of being screened for ACEs than non-Hispanic Whites. A recent doctor's visit, higher burden of ACEs, and serious psychological distress were associated with higher odds of being screened. Latinx individuals, women, bisexual individuals, those with a recent doctor's visit and those with serious psychological distress had higher odds of believing clinicians asking about ACEs was very important, relative to their counterparts. Latinx individuals, American Indian or Alaska native individuals, Asian individuals, those with higher educational attainment and those with serious psychological distress had lower odds of being very satisfied with providers' efforts to address the impact of ACEs, relative to their counterparts. Efforts to expand ACEs screening should consider the disparities in screening that currently exist. Given the wide-ranging impacts that ACEs have on health, an equitable approach to screening is necessary.

RACE/ETHNICITY DISPARITY FOR PEOPLE WITH LTSS NEEDS IN CALIFORNIA: DISABILITY, FINANCE, AND HEALTH AND WELL-BEING

Abstract Older adults and people with disabilities have high needs for Long-Term Services and Supports (LTSS). Disability status, financial difficulties, and health and well-being are likely not uniformly experienced by all people with LTSS needs. Subgroups of older adults and people with disabilities, such as racial/ethnic minorities, may be at significant risk of experiencing financial difficulties and stress about making ends meet. This study used the first cycle of data (2019-2020) from the California Long-Term Services and Supports (CA-LTSS) survey, merged with select data from the California Health Interview Survey (CHIS) (N = 2,030). Multivariate Regressions and Conditional Process Analysis (CPA) were applied to test the hypothesized relationships. Findings show that black/African American and Asian participants with LTSS needs were more likely to have cognitive impairments. Black/African American participants with LTSS needs were more likely to report difficulties in activities of daily living. Racial/ethnic minorities with LTSS needs experienced diverse and more financial difficulties on average than their white counterparts. Asian participants with LTSS needs reported worse psychological distress than other racial/ethnic groups. American Indians and Alaska Natives with cognitive impairments were more likely to have more financial difficulties, and those with difficulty in instrumental activities of daily living were more likely to report worse self-rated health. This study moves beyond the typical white/black disparities analyses and focuses on diverse racial/ethnic groups. We need to address the financial needs of various racial/ethnic groups of people with LTSS needs and target policies and service programs to meet their mental health needs.

EXTREME WEATHER AND HEALTH AMONG OLDER POPULATIONS: INDIVIDUAL AND CONTEXTUAL-LEVEL VULNERABILITY AND RESILIENCE

Abstract Intense, frequent extreme weather events pose a significant public health threat, particularly for middle-aged and older adults who may be at elevated health risk. Yet, the social and environmental factors that determine their vulnerability and resilience remain largely unexplored. This study investigates individual and contextual determinants associated with exposure to and the health effects of extreme weather. Data were from the 2021 California Health Interview Survey of adults aged 50+ (N=14,726). Respondents were asked whether they had experienced any hazardous weather events such as heat waves, floods, and wildfires in the past two years and whether mental or physical health was harmed by these events. About 53% were exposed to extreme weather events. Among the exposed group, 18% and 17% reported harm to mental and physical health, respectively. Logistic regression analysis revealed increased exposure risk among middle-aged adults (age 50-64), those with chronic conditions, people living alone, and residents of rural and unsafe neighborhoods. Similarly, mental and physical health harms were more prevalent among these groups, along with females and those with unstable housing conditions. Conversely, living in cohesive neighborhoods was identified as a resilient factor, associated with reduced mental (OR=0.78, p&amp;lt; 0.05) and physical health risks (OR=0.70, p&amp;lt; 0.01). This study reveals pronounced vulnerabilities to climate change risks among populations identified as socioeconomically disadvantaged. Moreover, the findings emphasize the role of contextual conditions in shaping vulnerability and resilience. Our study contributes valuable insights to develop targeted climate change mitigation strategies, fostering resilience among older populations and supportive communities.

CONDUCTING A COUNTYWIDE ALZHEIMER’S DISEASE AND RELATED DEMENTIAS CAREGIVER LANDSCAPE ANALYSIS

Abstract In Los Angeles County (LAC), approximately 1 in 5 caregivers provide care to older adults with dementia and cognitive impairment. By 2040, a projected 1.5 million Californians will be living with Alzheimer’s disease and related dementias, foreshadowing an unprecedented need for family caregivers across the state. In 2021, the LAC Department of Public Health launched the Centers for Disease Control and Prevention-funded LA BOLD initiative with the intent of developing a strategic plan to address dementia awareness and care in LAC, including improving local infrastructure for supporting unpaid family caregivers. To support this effort, LA BOLD commissioned the University of Southern California Family Caregiver Support Center to conduct a landscape analysis of the caregiver population in LAC. The analysis used a multi-method approach that included: primary analysis of community-based organization surveys, stakeholder interviews, focus groups with family caregivers, and secondary analyses of California Health Interview Survey and California Caregiver Resource Center System CareNav™ data and an environmental scan of best-practice caregiving models in use in other states. Results informed the development of three functional recommendations specific to LAC caregivers: 1) Leverage existing infrastructure to strengthen and build family caregiver services and supports; 2) Promote health care payer, provider, and system recognition of and support for family caregivers; and 3) Increase respite services for caregivers. This presentation highlights the methods and the findings from the landscape analysis, providing insights into the barriers and opportunities that a growing caregiver population of persons with dementia may pose to LAC.

Exploring the characteristics and health outcomes of working from home: Analysis of 2021 California Health Interview Survey data.

Working from home (WFH) may affect health behaviors and mental health. The coronavirus disease-2019 (COVID-19) pandemic saw many USemployees transition to WFH, which has persisted in various job sectors and significantly impacted employees. However, its effects on health outcomes have remained unclear. We aimed to explore the characteristics and health outcomes of, and health-related differences between, WFH and not-WFH groups. Using the 2021 California Health Interview Survey data, we analyzed health behaviors (smoking, alcohol consumption, and fruit-related nutrition) and the mental health status of 12,438 individuals using descriptive statistics, Pearson's χ2 test, and regressions. A total of 39% were WFH and 61% were not-WFH. Overall, the WFH group had worse health behaviors and mental health than the not-WFH group. Age was associated with smoking in both groups (WFH: b = 0.37; not-WFH: b = 0.35), but with fruit-related nutrition only in the WFH group. Household income and occupation were associated with alcohol consumption in both groups. Age (WFH: b = -1.58; not-WFH: b = -1.39), household income (WFH: b = -0.75; not-WFH: b = -0.34), and job duration (WFH: b = -0.34; not-WFH: b = -0.40) were associated with mental health in both groups; those who were younger and had lower household incomes and job durations had worse mental health. Health management is a clear necessity for the WFH group. Irrespective of WFH status, young workers with shorter than 5 years'job duration reported mental distress, highlighting a need for distress assessment and management for the young workforce.

Abstract A090: Association between breast cancer screening adherence and food insecurity in women with low income from California

Abstract Background: Food insecurity has been associated with delayed breast cancer screening among low-income individuals and communities in the United States (US). However, it is unclear if this association is due to poverty and related factors more generally (e.g., education, access to health care) or food insecurity specifically. Hence, we tested the association of food insecurity with being up-to-date with breast cancer screening recommendations in women with low-income from California. Methods: Individual-level information on breast cancer screening and food security status from females ages 50-74 years with an annual household income below 200% of the federal poverty level (FPL) was obtained from 2015-2016 California Health Interview Survey publicly available data. Bivariate and multivariate weighted logistic regression models were employed to test the association between breast cancer screening adherence and food insecurity, factoring in sociodemographic covariates including age, race/ethnicity, English use and proficiency, poverty level (dichotomized as 0-99% vs. 100-199% FPL), educational attainment, marital status, health insurance status, usual source of care, working status, and rurality. Results: The total sample included 3598 women with low-income from California, the majority of whom reported to be ages 50-59 years old (46.6%), Hispanic (50.5%), have health insurance (89.0%) and a usual source of health care (84.5%), live in an urban area (91.6%), and identify as food secure (51.1%). Most women reported being up-to-date with breast cancer screening (78.3%), of which 52.8% had food security and 47.2% experienced food insecurity. In comparison, among women not up-to-date with screening (21.7%), only 44.9% had food security while a majority of 55.1% experienced food insecurity. In the multivariable model, food insecurity was associated with lower odds of being up-to-date with breast cancer screening (odds ratio [OR]: 0.69; 95% confidence interval [CI]: 0.44–1.07) at a suggestive level of statistical significance. This observed difference may be explained by the correlation between food insecurity and other important factors known to be associated with screening behavior, including history of cancer and other socioeconomic metrics such as income amount, financial security, and housing instability. Conclusions: Food insecurity was inversely associated with being up-to-date with breast cancer screening. There is an imperative need to address breast cancer screening among low-income women in California, especially those who experience food insecurity. Impact: Future studies should combine food insecurity and breast cancer screening interventions to improve screening rates. Citation Format: Charlotte L. Bergheimer, Laura Fejerman. Association between breast cancer screening adherence and food insecurity in women with low income from California [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A090.

Dietary Factors Affecting Asthma Outcomes among Asthmatic Children in California

Asthma is one of the principal causes of absenteeism from school and the leading cause of emergency department visits for children in the United States. Some dietary habits are associated with asthma prevalence and play a role in the pathogenesis and control of symptoms. The objective of this study was to characterize dietary factors that may affect asthma outcomes among children with asthma in California. The California Health Interview Survey (CHIS) is the largest state health survey in the nation. This cross-sectional study included 7687 surveys, representing an estimated annual 710,534 children (ages 2–11) reported to have asthma between 2001 and 2015. Analysis was survey-weighted. We used multivariable regression, adjusting for covariates, to examine the association between dietary factors and asthma outcomes. Asthmatic children consuming two or more servings of sodas per day had more symptoms of asthma than those who did not consume soda daily (OR = 1.50, 95% CI: 1.04, 2.15). Moreover, those consuming two servings of fruits per day had lower odds of missing school due to asthma. Children with asthma may be affected by certain pro-inflammatory foods that are energy dense. This study provided an additional reason to discourage the consumption of sodas and sugary drinks due to the negative respiratory impact, in addition to their effect on childhood obesity, oral health problems, and future chronic diseases.

Real-World Adoption of Mental Health Support Among Adolescents: Cross-Sectional Analysis of the California Health Interview Survey

Abstract Objective We aim to examine: (a) the extent to which patterns of adoption of counseling services and digital mental health interventions (DMHIs) shifted in recent years (2019–2021); (b) the impact of distress on adoption of mental health support; and (c) reasons related to adolescents’ low adoption of DMHIs when experiencing distress. Methods Data were from three cohorts of adolescents aged 12–17 years (n = 847 in 2019; n = 1,365 in 2020; n = 1,169 in 2021) recruited as part of the California Health Interview Survey. We estimated logistic regression models to examine the likelihood of using mental health support as a function of psychological distress, sociodemographic characteristics, and cohorts. We also analyzed adolescents’ self-reported reasons for not trying DMHIs as a function of distress. Results The proportion of adolescents reporting elevated psychological distress (∼50%) was higher than those adopting counseling services (&amp;lt;20%) or DMHIs (&amp;lt;10%). A higher level of distress was associated with a greater likelihood of receiving counseling (OR = 1.15), and using DMHIs to connect with a professional (Odds ratio (OR) = 1.11) and for self-help (OR = 1.17). Among those experiencing high distress, adolescents’ top reason for not adopting an online tool was a lack of perceived need (19.2%). Conclusion Adolescents’ main barriers to DMHI adoption included a lack of perceived need, which may be explained by a lack of mental health literacy. Thoughtful marketing and dissemination efforts are needed to increase mental health awareness and normalize adoption of counseling services and DMHIs.

Asthma heterogeneity among Asian American children: The California Health Interview Survey

BackgroundThe Asian American (AsA) population is heterogenous and rapidly growing; however, little is known regarding childhood asthma burden among AsA ethnic groups. The relation between obesity and asthma in AsA ethnic groups also remains unclear. ObjectiveTo evaluate asthma prevalence and the relation of obesity to asthma risk among children in 7 AsA ethnic groups. MethodsWe analyzed data from the California Health Interview Survey from 2011 to 2020. AsA ethnicities were self-reported. Body mass index z-scores, calculated from self-reported height/weight, were used to categorize children by obesity status, based on body mass index-for-age growth charts. Prevalence of self-reported lifetime doctor-diagnosed asthma and asthma attack in the last 12 months was calculated. We performed multivariable logistic regressions adjusting for age and sex. ResultsOf 34,146 survey respondents, 12.2% non-Hispanic White and 12.5% AsA children reported lifetime asthma. Among AsA ethnic groups, however, lifetime asthma ranged from 5.1% (Korean American) to 21.5% (Filipino American). Non-Hispanic White children and AsA children had a similar lifetime asthma prevalence (adjusted odds ratio [aOR], 1.05; 95% CI, 0.71-1.55; P = .81), but prevalence was lower in Korean American children (aOR, 0.37; 95% CI, 0.19-0.73; P = .004) and higher in Filipino American children (aOR, 1.97; 95% CI, 1.22-3.17; P = .006). The lifetime asthma prevalence of different AsA ethnic groups persisted even when stratified by obesity status. ConclusionChildhood lifetime asthma prevalence varied among AsA ethnic groups, with lowest prevalence in Korean American children and highest prevalence in Filipino American. Further characterization of asthma burden among AsA ethnic groups may help guide asthma screening and prevention measures and offer new insights into asthma pathogenesis.

Social isolation, social media use, and poor mental health among older adults, California Health Interview Survey 2019–2020

BackgroundOlder adults’ engagement on social media may be a resource to reduce loneliness and improve mental health. Purpose: This study aimed to examine loneliness and social media use and its association with severe psychological distress among older adults and whether social media use moderated the association of loneliness on severe psychological distress among older adults.MethodsThis study is a secondary analysis of the 2019–2020 California Health Interview Survey. The Kessler 6-item Psychological Distress Scale (K6) assessed symptoms of psychological distress, with a K6 score ≥ 13 associated with severe mental illness. Loneliness was measured using a revised Three Item Loneliness Scale (TILS) score. Multiple regression analyses were conducted to examine associations between loneliness and severe psychological distress.ResultsLoneliness, health status, and identification as Asian, remained strong predictors of severe psychological distress among older adults when adjusting for other factors. In bivariate analysis, high-frequent social media users, but did not remain significant when accounting for covariates. Social media use did not moderate the association between loneliness and severe psychological distress.ConclusionThis study underscores the significant impact of loneliness on poor mental health among older adults, emphasizing that while frequent social media use correlates with severe psychological distress, it may not alleviate the association of loneliness on poor mental health, thus highlighting the urgent need to address social isolation and promote genuine social connectedness, particularly among Asian older adults.

Low-Income Asian Americans: High Levels Of Food Insecurity And Low Participation In The CalFresh Nutrition Program.

Little is known about food insecurity and the extent of Supplemental Nutrition Assistance Program (SNAP) participation in the heterogeneous Asian American population. Using California Health Interview Survey data from the period 2011-20, we examined both issues among low-income Asian American adults from six origin groups: Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese. We found high and varied levels of overall food insecurity, with the highest burden among Filipino adults (40percent). Food insecurity by severity was also heterogenous; very low food security affected 2percent of Chinese adults but 9percent and 10percent of Filipino and Japanese adults, respectively. Participation in CalFresh (California-implemented SNAP) ranged from 11percent and 12percent among Korean and Chinese adults, respectively, to 20percent among Vietnamese adults. Compared with English-proficient low-income Asian American adults, those with limited English proficiency were no less likely to participate in CalFresh, possibly reflecting language assistance required by California law and provided by community-based organizations. These results underscore the importance of collecting and reporting disaggregated data by Asian origin group that could inform targeted outreach and interventions.

A cross-sectional study on social determinants of mental health during COVID-19 among adults in California.

To explore the impact of structural and intermediary social determinants of health (SDoH) on Californian adults' mental health during the early phase of the COVID-19 pandemic. This cross-sectional study used data from the 2020 cycle of the California Health Interview Survey, the largest US state-level population health survey. Descriptive statistics and logistic regression were used to analyse the data. Using a general social determinant of health framework, we operationalized different survey questions to measure structural and intermediary determinants of mental health. Mental health during the early phase of COVID-19 among adults in California was associated with age, gender, health conditions, delayed care, employment status (loss of job or reduced income) and discrimination. People in higher social strata were more likely to have better mental health for many of these factors. This study supports the assertion that material circumstances (such as employment status) and discrimination are associated with experiencing mental health issues among adults in California during COVID-19. Racism is a public health issue, and as nurses, addressing racism is critical. In addition, much work is needed to address SDoH to improve health outcomes, especially among marginalized populations. This study addressed the knowledge gap concerning the social determinants of mental health among Californian adults during the early phase of the COVID-19 pandemic. Those who had reduced income and those who lost their jobs during the COVID-19 pandemic were 46% and 56%, respectively, more likely to report mental health problems. Those who experienced discrimination in healthcare were 304% more likely to report mental health issues. This research will increase the understanding of the social determinants of health, particularly for those with chronic illnesses and mental health issues during the COVID-19 pandemic. No patient or public contribution, as we used an existing US state dataset. However, California Health Interview Survey is the largest state health survey in the United States and interviews more than 20,000 households each year representing the health care needs of Californians.