7th national changing patterns of cancer in native communities: the power of partnerships: american...
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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
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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. 18-44, 45 – 64, 65+).
Identifying differences in access to Indian Health Service by tribal affiliation.
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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.
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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.
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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
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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
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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
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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)
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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
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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
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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)
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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
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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 www.healthpolicy.ucla.edu
In journal articles
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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 . . .
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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 . . .
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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
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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
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An example of unweighted and weighted estimates
Has a doctor ever told you that you had a cancer of any kind?
YES 4,272 11.2 2,127,075 8.3
NO 37,717 88.8 23,469,986 91.7
Total 42,044 100.0 25,597,061 100.0
N Percent
Unweighted Weighted
N Percent
Source: CHIS 2003 Adult Public Use File
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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
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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
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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 ([email protected])
DAC applications and additional DAC information are available online at www.chis.ucla.edu
Confidential data can be accessed in person at the DAC or remotely through emailed programming code and results by contracting with the Center’s Statistical Support and Programming team (submit programming, or hire programmer)
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Technical Assistance
Additional documentation on CHIS survey methods, use of weights, data dictionaries, and the questionnaires are available on the CHIS web site at www.chis.ucla.edu
Technical assistance on the Public Use Files is available at:
Email: [email protected]
Telephone: 866-275-2447 - Brandon Traudt
Technical assistance on developing research question specific to Native studies: Delight Satter – [email protected]
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CHIS total sample sizes
2001 2003 2005
Adult (18+) 56,270 42,044 43,020
Child (0-11) 12,802 8,526 11,358
Teen (12-17) 5,733 4,010 4,029
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Source: A Pleasant, but Puzzling Surprise: Twice as Many AIAN Are Found in a Large Health Survey in California, AHSR, 2002, Yen and Satter
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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
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Adult sample size by race/ethnicity - Single Race definition only
2001 2003 2005
Latino 9,460 7,135 6,369
Native Hawaiian Pac Islndr 219 152 120
Am Indian Alaska Natives 781 580 554
Asian 4,798 3,875 3,941
African American 2,764 2,691 1,954
White 36,729 26,506 28,979
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Data collection results
Graph 1. CHIS AIAN Sample Yields by Questions - Percent of All RDD Known Race (52,451)
2694
2138
332 311
0
1000
2000
3000
N 2694 2138 332 311
Percent 5.1% 4.1% 0.6% 0.6%
Any mention of AIAN
Named tribal heritage
Enrolled MemberNamed the
Enrolled Tribe
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.
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Adult, teen & child sample size by - American Indian or Alaska Native one or more races definition
2003 2005
Adult 1897 1845
Teen 313 365
Child 463 370
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Cancer Data published by AIANRP www.healthpolicy.ucla.edu
Click on American Indian Research Program
Click on Publications
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How to use AskCHIS
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How to get CHIS data and information on the health of Natives from www.healthpolicy.ucla.edu
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
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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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Who are those people who report more 2+ races?
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Felt Downhearted, sad, blue (from SF12) by gender, AIAN
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Did see a health professional for mental/emotional problems by Access to IHS
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Binge Drinking past month, AIAN, CASource: 2005 California Health Interview Survey, Race - Census 2000
* = statistically unstable
Adol. (12-17) Adult (18-64) Senior (65+) All Ages
% 95% C.I.
% 95% C.I.
% 95% C.I.
% 95% C.I.
Binge
drinking
7.2* (1.4 - 13.0)
24.9 (20.1 - 29.8)
6.4* (0 - 13.1)
19.9 (16.0 - 23.7)
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Binge drinking, past month, AIAN, CA
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Tested for HIV by Sexual Orientation, AIAN, 2005
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Current Smoking status by Gender, 21 years old +, Any mention AIAN
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Disability status by Gender, AIAN any-mention, CA
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Physical Activity by CA Region, AIAN adults
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Heart Disease (CVD) by Diabetes, AIAN adults
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Live Interactive Session
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UCLA Center for Health Policy Research
For the Health of All Generations
Contact Information
Delight Satter, M.P.H.Director, American Indian and Alaska Native Research Program
UCLA Center for Health Policy [email protected]
310 794 2686