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5/1/2019Approved1816
  
CHIS Journal ArticleCaitlin Patler

​Undocumented immigrants and their children have worse self-reported health than documented immigrants and U.S. citizens do. Evidence suggests that the Deferred Action for Childhood Arrivals (DACA) program, which was created in 2012 by President Barack Obama and which granted some rights to undocumented immigrants who arrived as children, improved the well-being of recipients and their children in the first three years after the program’s introduction.

However, DACA is subject to executive discretion, and the U.S. presidential campaign that began in 2015 introduced substantial uncertainty regarding the program’s future. The authors examined whether DACA’s health benefits persisted beyond 2015 using the 2007–17 waves of the California Health Interview Survey and dynamic treatment effects models. 

Findings show that self-reported health improved for Latina/o DACA-eligible immigrants and their children from 2012 to 2015 but worsened after 2015. The authors' results suggest that the political climate of the 2016 presidential election may have underscored the politically contingent nature of the DACA program and eroded the program’s health benefits for eligible immigrants and their children.

Journal Article: Uncertainty About DACA May Undermine Its Positive Impact on Health for Recipients and Their ChildrenCalifornia Health Interview Survey (CHIS)N1592Net al
4/25/2019Approved1815
  
Policy BriefMiranda Dietz

California made historic gains in health insurance coverage under the Affordable Care Act (ACA), but several million Californians remain uninsured and many struggle to afford individual market insurance. If the state takes no action, the number of Californians uninsured is projected to increase to 4.4 million in 2023 due to the elimination of the individual mandate penalty as well as other trends such as premium growth, population growth, and changes in eligibility due to minimum wage increases. Similarly, if the state takes no action the individual market is projected to be smaller and have a less healthy risk mix, resulting in higher premiums that would further reduce affordability.

Many California policymakers have expressed a desire and commitment to resist federal sabotage of the ACA, control health care costs, and achieve universal health care coverage. As the state explores ways to fundamentally redesign our health care delivery system — including by adopting a single payer or other unified public financing approach — state policymakers are also considering near-term policies that do not require federal approval but address the immediate challenges of improving affordability and expanding coverage. Options currently being considered include:

  • Expanding Medi-Cal to all low-income California adults regardless of immigration status;
  • Providing robust help with individual market premium and out-of-pocket costs for those already eligible for ACA subsidies and eliminating the ACA eligibility cliff at four times the federal poverty level (FPL); and
  • Implementing a state individual mandate penalty that mirrors the federal ACA penalty that was eliminated starting in 2019.
If these affordability improvements, along with Medi-Cal expansion and an individual mandate, were fully implemented by 2023, 3.6 million Californians would benefit, relative to projections if no action is taken. This includes 1.7 million Californians who would be enrolled in coverage instead of being uninsured in 2023, and 2.3 million people enrolled in the individual market who would either receive state assistance with health care costs or experience lower premiums.
 
Approximately 400,000 Californians are counted in both totals — they would enroll in the individual market instead of being uninsured and would also benefit from lower costs, resulting in there being 3.6 million people who are better off relative to the status quo. These projections are based on version 2.4 of the UCLA-UC Berkeley California Simulation of Insurance Markets (CalSIM) model.
 
Policy Brief: 3.6 Million Californians Would Benefit if California Takes Bold Action to Expand Coverage and Improve AffordabilityUC Berkeley Labor CenterCalifornia Simulation of Insurance Markets (CalSIM)N945YLaurel LuciaSrikanth Kadiyala, PhDN1570Petra Rasmussen, MPHhttp://laborcenter.berkeley.edu/author/laurel-lucia/
3/19/2019Approved1812
  
External PublicationScott Graves

​More than two million undocumented immigrants live in California. They make significant contributions to our state, comprising nearly one-tenth of the workforce and paying about $3 billion in state and local taxes each year. Yet even though undocumented Californians work and pay taxes, the vast majority face significant challenges when it comes to accessing health care.

The report shows that nearly 90 percent of undocumented adults with low incomes lack health care coverage. This is largely due to the fact that undocumented adults remain ineligible for Medi-Cal, California’s Medicaid program that provides health care services to low-income Californians.

Fact Sheet: Nearly 9 in 10 Undocumented Adults With Low Incomes Lack Health CoverageCalifornia Health Interview Survey (CHIS)Reducing Access Disparities in California by Insuring Low-Income Undocumented AdultsN1585
3/19/2019Approved1814
  
External PublicationLaurel Lucia

​More than 90 percent of Californians eligible for Medi-Cal are now enrolled in the program. However, 543,000 Californians ages 0-64 were estimated to be eligible for Medi-Cal but uninsured in 2016-2017, most of whom were adults (79 percent were over age 18), according to the California Health Interview Survey (CHIS). Why are some Californians uninsured in spite of their Medi-Cal eligibility?Examples include:

  • Some individuals may not be aware that they are eligible for Medi-Cal or that they can enroll with no monthly premium.
  • Others may be uninsured for short periods of time when they are between jobs or experience other changes in life circumstances. More than four out of ten (42 percent) of those eligible for Medi-Cal but uninsured at the time they were surveyed reported that they had insurance for at least part of the past year, according to CHIS 2016-2017.
  • Others may encounter difficulties in the application or renewal process.
  • Four out of ten uninsured California adults reported to a recent California Health Care Foundation/ Kaiser Family Foundation survey that they were very or somewhat worried that signing up for health insurance would draw attention to their own or a family member’s immigration status.
Fact Sheet: More than 500,000 Californians Estimated to Be Eligible for Medi-Cal but Uninsured in 2016-2017UC Berkeley Center for Labor Research and EducationCalifornia Health Interview Survey (CHIS)Y944http://laborcenter.berkeley.edu/author/laurel-lucia/
3/1/2019Approved1805
  
CHIS Journal ArticlePan Wang, PhD

​Mounting evidence has been made for the beneficial effect of green space on mental health among adults, but studies on the same topics are lacking for teens in the U.S. This study aimed to fill in this research gap by utilizing data from California Health Interview Survey (CHIS) 2011–2014. A total of 81,102 households — composed of 4,538 teens and 81,102 adults — were used for the main analyses. Surrounding greenness was assessed by the Normalized Difference Vegetation Index (NDVI) within varying buffers of home residence. Survey logistic regressions accounted for sampling weights and design were conducted to examine the effects of greenness on serious psychological distress (SPD), adjusted for major socio-demographic factors, neighborhood socioeconomic status (SES) and co-respondent's psychological distress level within the same household.

Findings: An inter-quartile increment of NDVI in 350-meter buffer predicted decreased odds of SPDs by 36 percent in teens. Mediation analyses revealed that this association remained almost unchanged even after adjusting for social cohesion. The NDVI-SPD association of adults was found to be significant only in the older group. This study is one of the first population-based U.S. studies extending the epidemiological evidence for benefits of green space on mental health from adults to teens.

 

Journal Article: Green Space and Serious Psychological Distress Among Adults and Teens: A Population-Based Study in CaliforniaCalifornia Health Interview Survey (CHIS)N1098YYing-Ying Meng, DrPHVanessa LamN1303Ninez A. Ponce, PhD, MPPLiving near green space boosts teenagers’ mental health316Living near green space boosts teenagers’ mental health
2/28/2019Approved1810
  
Journal Article​Bonnie T. Zima, MD, MPH

​The study describes the process of choosing a clinical outcome measure for a statewide performance outcome system for children receiving publicly funded mental health services in California. The recommendation is based on a five-phase approach, including an environmental scan of measures used by state mental health agencies; a statewide provider survey; a scientific literature review; a modified Delphi panel; and final rating of candidate measures by using nine minimum criteria informed by stakeholder priorities, scientific evidence, and state statute.

Only 10 states reported use of at least one standardized measure for outcome measurement. In California, the state Department of Health Care Services mandated use of the Pediatric Symptom Checklist (PSC) and the Child and Adolescent Needs and Strengths(CANS).

There is a lack of capacity to compare child clinical outcomes across states and California counties. Frequently used outcome measures were often not supported by scientific evidence or Delphi panel ratings. Policy action is needed to promote the selection of a common clinical outcome measure and measurement methodology for children receiving publicly funded mental health care.

Journal Article: Selection of a Child Clinical Outcome Measure for Statewide Use in Publicly Funded Outpatient Mental Health ProgramsY1521YNadereh Pourat, PhDet alN151
2/24/2019Approved1809
  
External PublicationRichard M. Scheffler

​As of 2017, California’s uninsured rate stands at just over 7 percent. Moving towards universal health coverage in California for the 3.72 million projected to be uninsured in 2020 (CalSIM data from the study California’s Health Coverage Gains to Erode without Further State Action by UC Berkeley Labor Center and UCLA Center for Health Policy Research) of which about 1.5 million are undocumented, is a significant challenge but has considerable benefits. A healthier workforce will be more productive and absenteeism will decline. Moreover, taxes collected from these healthier workers will increase. All Californians will have their risk of disease lowered. Universal coverage will allow all Californians to have improved access to care so they can prevent and treat illnesses that can be passed on to others. Children will have a better start to life and there will be less absenteeism in schools. In addition, the expensive treatment in emergency rooms would surely decline. Beyond these benefits for all Californians, it is the right thing to do. Most Californians support universal coverage, but have reservations about the cost of doing so.

External report: The Seven Percent Solution: Costing and Financing Universal Health Coverage in CaliforniaCalifornia’s Health Coverage Gains to Erode without Further State ActionCalifornia Simulation of Insurance Markets (CalSIM)N1581NStephen M. Shortell
2/19/2019Approved1804
  
Policy BriefNadereh Pourat, PhD

​While the Patient Protection and Affordable Care Act (ACA), signed into law in 2010, expanded health insurance coverage to millions of Californians, it did not extend eligibility for coverage to undocumented U.S. residents. Federal policy prohibits the use of federal funds to provide Medicaid to undocumented individuals. In 2015, the state of California extended Medi-Cal (California’s Medicaid program) to undocumented children using state funds, and policies to extend eligibility to undocumented adults have been proposed.

This policy brief includes the latest data from the California Health Interview Survey (CHIS) on the health insurance, demographics, health status, and access to care of undocumented low-income Californians ages 19-64. The data indicate that the great majority of these undocumented adults are working, live in families with children, and report being relatively healthy. However, significant disparities exist in access to health care between this group and their documented counterparts. This overview of undocumented low-income adult residents of California provides insights into the implications of extending full-scope Medi-Cal eligibility to this population, who currently have very limited options for affordable health insurance coverage and experience access disparities.

***PLEASE NOTE: WE HAVE UPDATED THE POLICY BRIEF***

On page 4, two figures shown below in boldface type were updated:

“The majority (69 percent) of low-income documented adults have coverage through public sources, including 66 percent with Medi-Cal.”

Policy Brief: Reducing Access Disparities in California by Insuring Low-Income Undocumented AdultsCalifornia Health Interview SurveyThe California Health Care FoundationY94YAna E. Martinez, MPHLow-income undocumented adults are largely locked out of health care in California315Low-income undocumented adults are largely locked out of health care in California
2/16/2019Approved1806
  
CHIS Journal ArticleJim E. Banta

In this study, 2005-2015 California Health Interview Survey (CHIS) data were used to examine the association between dietary intake frequencies and mental health – Kessler-6 scores categorized as no/low (NLPD), moderate (MPD) or serious psychological distress (SPD). The 245,891 surveys represented 27.7 million adults annually, with 13.2 percent having MPD and 3.7 percent SPD.

Findings: Survey-adjusted regression adjusting for gender, age, race, education, poverty, marital status, BMI, geography and year found MPD and SPD associated with lower consumption of fruits, vegetables, and increased consumption of French fries, fast food, soda and variance-adjusted daily teaspoons of sugar. In this large population-based sample, moderate and SPD were independently associated with unhealthy diet. Targeted public health interventions could focus on young adults and those with less than 12 years of education.

Journal Article: Mental Health Status and Dietary Intake Among California Adults: A Population-based SurveyCalifornia Health Interview Survey (CHIS)N328Net al
2/10/2019Approved1813
  
CHIS Journal ArticleCinthya K. Alberto

​The study examines disparities in provider-related barriers to health care by race and ethnicity of children in California after the implementation of the Affordable Care Act (ACA). Authors used California Health Interview Survey data for children (0-11 years) 2014-2016 to conduct multivariable logistic regressions to estimate the odds of reporting any provider-related barrier, trouble finding a doctor, child's health insurance not accepted by provider, and child not being accepted as a new patient. 

Compared with parents of non-Latino white children, parents of non-Latino black, Latino, Asian, and other/multiracial children were not more likely to report experiencing any of the four provider-related barrier measures. The associations between children's race and ethnicity and parents' reports of provider-related barriers were nonsignificant. Findings demonstrate that there are no significant racial/ethnic differences in provider-related barriers to health care for children in California in the post-ACA era.

Journal Article: Racial and Ethnic Disparities in Provider-Related Barriers to Health Care for Children in California After the ACA (Global Pediatric Health)California Health Interview Survey (CHIS)N1561NJessie Kemmick PintorRyan M. McKennaN1414Dylan H. Roby, PhD
2/8/2019Approved1811
  
Journal ArticleNadereh Pourat, PhD

​Millions of Americans have uncontrolled hypertension and are low-income or uninsured populations. Health Resources and Services Administration-funded health centers (HCs) are primary providers of care to these patients and a majority have adopted the patient-centered medical home (PCMH). PCMH includes principles of care coordination or integration and care management — support important to the treatment of hypertension. Authors examined whether the receipt of PCMH concordant care by HC patients improved hypertension outcomes. 

Authors used a nationally representative survey of adult HC patients with hypertension conducted between October 2014 and April 2015. Data from the 2013 and 2014 Uniform Data System were used to include characteristics of the HCs where these patients received their care. Outcome measures included flu shots, number of primary care visits, normal blood pressure at last visit, emergency department (ED) visits, confidence in self-care, and compliance with provider recommendations. The primary independent variables were (i) whether the HC coordinated and referred patients to specialists; (ii) provided counseling, health education, coaching, treatment plans, and advice on hypertension control; and (iii) helped patients to obtain government benefits, medical transportation, and basic needs such as housing and food. Logistic and negative binomial multivariate regression models were performed. 

Results showed hypertension-focused coaching was associated with normal blood pressure at last visit and fewer ED visits. Behavioral health counseling was associated with increased self-efficacy in self-care management.

Journal Article: Assessing the Impact of Patient-Centered Medical Home Principles on Hypertension Outcomes Among Patients of HRSA-Funded Health CentersUCLA Center for Health Policy Research - Health Economics and Evaluation Research ProgramHealth Resources & Services AdministrationY94YXiao Chen, PhD Christopher Lee, MPHN1258Weihao Zhou, MS
2/5/2019Approved1803
  
External PublicationLaurel Lucia

Undocumented Californians are, for the most part, left out of the health insurance system. Undocumented residents make up the largest group of Californians who lack insurance — approximately 1.5 million are projected to lack insurance in 2020. The uninsured rate for low-income undocumented adults is particularly high: 90 percent of undocumented California adults with household income at or below 138 percent of the Federal Poverty Level (FPL) lack insurance compared to 10 percent of all other California adults in the same income range in 2015-2016, according to findings from Six Facts About Undocumented Californians.

The rate of uninsurance for undocumented California adults is high for several reasons, including exclusion from full-scope Medi-Cal benefits under federal policy; ineligibility to buy insurance on Covered California because of immigration status; employment in industries/occupations that do not offer employer-sponsored insurance. Using CalSIM and other data, the study estimates 1.15 million undocumented in the state could gain health insurance in 2020 if the state expands Medi-Cal to all low-income adults regardless of immigration status, reducing uninsured population by as much as 25 percent.

Report: Towards Universal Health Coverage: Expanding Medi-Cal to Low-Income UndocumentedUC Berkeley Center for Labor Research and EducationCalSIMSix Facts About Undocumented CaliforniansCalifornia’s Health Coverage Gains to Erode without Further State ActionY944http://laborcenter.berkeley.edu/author/laurel-lucia/
1/16/2019Approved1798
  
Policy BriefJanet C. Frank, DrPH

The Workforce, Education and Training component of California’s Mental Health Services Act, which passed in 2004, has infused resources into the public mental health system. However, these resources have not kept pace with an existing behavioral health workforce shortage crisis, the rapid growth of an aging population, and the historical lack of geriatric training in higher education for the helping professions. This policy brief draws on recent study findings, state planning documents, and a review of the literature to describe gaps and deficiencies in the behavioral health workforce that serves older adults in California. 

A series of recommendations to improve workforce preparation and distribution are presented to specific audiences: state policy makers and administrators; educational institutions, accrediting bodies, and licensing boards; and county mental health/behavioral health departments and their contracted providers.

Policy Brief: California’s Behavioral Health Services Workforce Is Inadequate for Older AdultsCalifornia Mental Health Older Adult System of Care ProjectArchstone FoundationY40YKathryn G. Kietzman, PhD, MSWAlina PalimaruN1512California must build workforce to serve older adults’ behavioral health needs312California must build workforce to serve older adults’ behavioral health needs
12/24/2018Approved1802
  
Journal ArticleNadereh Pourat, PhD

​Millions of Americans have uncontrolled hypertension and are low-income or uninsured. Health Resources and Services Administration-funded health centers (HCs) are primary providers of care to these patients and a majority have adopted the Patient-Centered Medical Home (PCMH). Study authors examined whether HC patients who received PCMH concordant care showed improved hypertension outcomes.

Using data from the 2013 and 2014 Uniform Data System, authors used a nationally representative survey of 2,280 adult HC patients with hypertension. Study outcome measures included flu shots, number of primary care visits, normal blood pressure at last visit, emergency department (ED) visits, confidence in self-care, and compliance with provider recommendations. The primary independent variables were (1) whether the HC coordinated and referred patients to specialists; (2) provided counseling, health education, coaching, treatment plans, and advice on hypertension control; and (3) helped patients obtain government benefits, medical transportation, and basic needs such as housing and food. Logistic and negative binomial multivariate regression models were performed. Authors found hypertension-focused coaching was associated with normal blood pressure at last visit and fewer ED visits. Behavioral health counseling was associated with increased self-efficacy in self-care management.

Journal Article: Assessing the Impact of Patient-Centered Medical Home Principles on Hypertension Outcomes among Patients of HRSA Funded Health CentersY94YXiao Chen, PhD Weihao Zhou, MSY1419Christopher Lee, MPH
12/18/2018Approved1795
  
Policy BriefSusan H. Babey, PhD

​This policy brief describes civic engagement among California adolescents in high school. Using data from the 2013-14 California Health Interview Survey (CHIS), the study found that the most common civic engagement activity among high school teens in California is volunteering. Latino teens and those from low-income families have lower rates of civic engagement. Higher rates of civic engagement are associated with better health status, fewer days of missed school due to health, better grades and greater perceived likelihood of attending college.

Strategies to increase adolescent civic engagement could help promote healthy developments. Policymakers, schools, and community organizations can promote civic engagement among all youth by expanding programs, encouraging youth participation in school and community organizations and engage youth who have not traditionally been included in civic activities.

Policy Brief: Civic Engagement Among California High School TeensCalifornia Health Interview Survey (CHIS)The California EndowmentY211YJoelle Wolstein, PhD, MPP, MA
12/11/2018Approved1797
  
Fact SheetUCLA Center for Health Policy Research

California Health Interview Survey (CHIS), the nation’s largest state health survey, continued to play a significant role in informing health policies and highlighting health issues of state and national importance in 2018. Examples:

  • CHIS diabetes data on American Indian/Alaska Natives to illustrate health disparities in testimony about funding of the Indian Health Service before the U.S. House of Representatives Committee on Appropriations, Subcommittee on Interior, Environment, and Related Agencies.
  • Analysis on prediabetes based on CHIS was used to inform a California law that requires healthier default beverage choices for kids’ meals served at restaurants.
  • CalSIM, the microsimulation model that uses CHIS data, provided supporting evidence in analysis of two California bills (SB974 and AB2965) that aimed to expand Medi-Cal to adults in the state, including the undocumented population.
  • CHIS survey questions were expanded to gauge what long-term supports are being used by the state’s elders to help guide future state policy.
  • Our analysis of ‘public charge’ rule changes, which includes CHIS data, were cited in official comments by U.S. Senator Kamala Harris and Nanette Diaz Barragán, California Attorney General Xavier Becerra, and advocacy groups such as the California Latino Legislative Caucus, The California Endowment, Blue Shield of California Foundation, Health Access and Western Center on Law & Poverty. State Assemblyman Rob Bonta cited data from our analysis in a Capitol Weekly op-ed article. 
This fact sheet gives an overview of legislation, training, government studies, health advocacy group publications, and policy reports and journal articles by Center researchers and other academic researchers that used CHIS data in 2018.
AskCHIS and AskCHIS NE users made more than 143,500 queries in 2018, proving the value of CHIS data to those passionate about understanding and improving public health and reducing health disparities.
Since 2003, more than 69,200 registered AskCHIS and AskCHIS NE users have made 1.44 million queries, and more than 44,701 public use data files have been downloaded by researchers and others seeking reliable, credible data on the health of Californians.
Fact Sheet: CHIS in Action 2018California Health Interview Survey (CHIS)California Simulation of Insurance Markets (CalSIM)Fact Sheet: What has CHIS done in 2017?Fact Sheet: CHIS Making an Impact - 2016N28
12/7/2018Approved1796
  
Journal ArticleErin Shigekawa

Policymakers and practitioners show a continued interest in telehealth’s potential to increase efficiency and reach patients facing access barriers. However, telehealth encompasses many applications for varied conditions and populations, making it difficult to draw broad conclusions about telehealth’s efficacy. This rapid review examines recent evidence both about telehealth’s efficacy by clinical area and about telehealth’s impact on utilization. 

Authors searched for systematic reviews and meta-analyses of the use of telehealth services by patients of any age for any condition published in English January 2004 to May 2018. Twenty systematic reviews and associated meta-analyses are included in this review, covering clinical areas such as mental health and rehabilitation. 

Broadly, telehealth interventions appear generally equivalent to in-person care. However, telehealth’s impact on the use of other services is unclear. Many factors should be carefully considered when weighing the evidence of telehealth’s efficacy, including modality, evidence quality, population demographics, and point-in-time measurement of outcomes.

 

The Current State of Telehealth Evidence: A Rapid Review (Health Affairs)N1575YDylan H. Roby, PhDet alN151
12/4/2018Approved1789
  
Fact SheetNinez A. Ponce, PhD, MPP
Authors of the fact sheet report changes to “public charge” rules proposed by the U.S. Department of Homeland Security could lead to losses of up to $1.67 billion in federal benefits for California and even greater economic losses across the state.
 
When a person applies for lawful permanent residency (a “green card”) or for a visa to enter the country, U.S. immigration officials conduct a public charge test to determine if that person may become primarily dependent on the government to meet their basic needs. Currently, only two public benefits – cash assistance and long-term institutional care – are considered for the public charge test. Under the proposed changes to federal immigration rules, people could be denied status as lawful permanent residents if they’ve received certain health care, housing or nutrition assistance benefits. In addition, the proposed rule adds harsher standards for personal circumstances that make someone less likely to receive a green card or be granted entry to the U.S., such as having limited English proficiency, limited educational attainment, low income, being a child or being a senior.
 
Fact Sheet: Proposed Changes to Immigration Rules Would Cost California Jobs, Harm Public HealthRegional Data TablesMethodology ReportRelated Seminar: “How Proposed Changes to the ‘Public Charge’ Rule Will Affect Health, Hunger, and the Economy in California”California Health Interview Survey (CHIS)UC Berkeley Center for Labor Research and EducationCalifornia Food Policy AdvocatesY243YLaurel LuciaTia ShimadaY1571http://laborcenter.berkeley.edu/author/laurel-lucia/https://cfpa.net/our-team/#tia_shimada
12/4/2018Approved1794
  
Policy BriefBrad Sears, JD

Many Americans worry about the high costs of prescription medications. A recent poll by the Kaiser Foundation found that about 60 percent of Americans report taking at least one prescription medication and the 80 percent of all Americans feel that the current cost of prescriptions drugs is unreasonable. There is currently broad public support for addressing this issue, which is likely to be a focus in the next session of Congress. Using California Health Interview Survey from 2015-2017, this brief provides a snapshot of Californians’ access to prescription medications among LGBTQ and cisgender and straight/heterosexual adults.

Policy Brief: LGBT People & Access To Prescription MedicationsCalifornia Health Interview Survey (CHIS)Y1511YKerith J. Conronhttps://williamsinstitute.law.ucla.edu/staff/kerith-conron/
11/27/2018Approved1788
  
Research ReportMiranda Dietz

​In 2016, 10.4 percent of non-elderly Californians lacked insurance, compared to 16.6 percent in 2012, according to the California Health Interview Survey (CHIS). Without state action to protect and build upon these coverage gains, authors project that the uninsurance rate could grow to 11.7 percent in 2020, or approximately 4.0 million people, and to 12.9 percent in 2023, or 4.4 million people. These uninsured rates are based on a definition of insurance that excludes restricted-scope Medi-Cal for undocumented Californians.

The federal law zeroing out the ACA individual mandate penalty beginning in 2019 will result in lower individual market and Medi-Cal enrollment, but there is significant uncertainty about how much enrollment will decline in California. Using the California Simulation of Insurance Markets (CalSIM) microsimulation model and a range of assumptions about the extent to which the penalty influences enrollment decisions, the authors project that between 150,000 and 400,000 more Californians will be uninsured in 2020, growing to between 490,000 and 790,000 more uninsured in 2023, compared to if the ACA penalty had been maintained. The most substantial enrollment changes will occur in the individual market, where the authors project enrollment will decline by 10.1 percent in 2020 and 14.4 percent in 2023.
 
Report: California's Health Coverage Gains to Erode Without Further State ActionCalifornia Simulation of Insurance Markets (CalSIM)California Health Interview Survey (CHIS)UC Berkeley Center for Labor Research and EducationN945YLaurel LuciaDylan H. Roby, PhDY202Ken Jacobshttp://laborcenter.berkeley.edu/author/laurel-lucia/http://laborcenter.berkeley.edu/staff/jacobs.shtml
11/16/2018Approved1790
  
CHIS Journal ArticleElisa K. Tong

​Little is known about how incentives may encourage low-income smokers to call for quitline services. Using weighted population estimates from the 2011–2015 California Health Interview Survey data, this study evaluates the impact of outreach through health channels on California Medicaid (Medi-Cal) quitline caller characteristics, trends, and reach.

Statewide outreach was conducted with health providers, Medi-Cal plans (all-household mailings with tracking codes), and public health organizations (March 2012–July 2015). For incentives, Medi-Cal callers could ask for a $20 gift card; in September 2013, callers were offered free nicotine patches. In total, 92,000 Medi-Cal smokers called, a 70 percent increase from prior annual averages. Annual reach increased from 2.3 percent  in 2011 to peak at 4.5 percent in 2014.

Journal Article: The Medi-Cal Incentives to Quit Smoking Project: Impact of Statewide Outreach Through Health ChannelsCalifornia Health Interview Survey (CHIS)N819Net al
11/1/2018Approved1799
  
Journal ArticleNina T. Harawa, PhD, MPH

Because Black men who have sex with men (BMSM) experience high rates of both HIV and incarceration relative to other groups, the various stages of criminal justice involvement may serve as important intervention points for addressing HIV and related conditions in this group. Study authors describe the range and impact of published HIV, sexually-transmitted infection (STI), and related substance use interventions for US-based criminal justice-involved (CJI) populations and to understand their relevance for Black men who have sex with men (BMSM) by using systematic searches in the following databases: PubMed, MEDLINE, Cochrane, CINAHL, and PsycINFO, covering the period preceding December 1, 2016.

Fifty-eight articles met inclusion criteria, including 8 (13.8 percent) modeling or cost-effectiveness studies and 13 (22.4 percent) randomized controlled trials. Just 3 studies (5.2 percent) focused on sexual or gender minorities, with only 1 focused on BMSM. In most studies (n= 36; 62.1 percent), however, more than 50 percent of participants were Black. The most common intervention addressed screening, including 20 empirical studies and 7 modeling studies. Screening programs consistently indicated cost-effectiveness, including with BMSM. Care continuum interventions for people living with HIV showed mixed results; just 3 involved randomized controlled trials, and these interventions did not show significant differences compared with control conditions. A minority of programs targeted non–custody-based CJI populations, despite their constituting a majority of the CJI population at any given time. Screening CJI populations for HIV and other STIs is effective and cost-efficient and holds promise for reducing HIV in BMSM. Education-based and care provision interventions also hold promise for addressing HIV, STIs, mental health, and substance use in CJI populations.

Journal Article: HIV, Sexually Transmitted Infection, and Substance Use Continuum of Care Interventions Among Criminal Justice–Involved Black Men Who Have Sex With Men: A Systematic ReviewY1292Net al
10/31/2018Approved1787
  
Policy BriefTara Becker, PhD

​This brief examines health care coverage rates and sources of coverage among nonelderly (under age 65) Californians based on the 2017 California Health Interview Survey (CHIS), with 2013 and 2016 CHIS data used for comparisons before and after expansion of the Patient Protection and Affordable Care Act. The authors focus on nonelderly Californians because those over 65 are nearly universally covered by Medicare. The major coverage expansions of the ACA were implemented starting in 2014, and by 2016 the uninsured rate among nonelderly Californians fell from 15.5 percent in 2013 to a historic low of 8.5 percent in 2016 and stayed at that level in 2017. For ease of presentation, this is referred to in the text as the “uninsured rate.” 

The tremendous gains under the ACA largely persist, including historic progress in closing racial/ethnic disparities in coverage. However, lagging progress among Latinos, persistent variation across regions, and the fact that many Californians are still uninsured point to the need for further work to ensure all Californians can get access to health insurance.

ACA Reduces Racial/Ethnic Disparities in Health CoverageCalifornia Health Interview Survey (CHIS)California Health Care FoundationY1099
10/17/2018Approved1786
  
Policy BriefJoelle Wolstein, PhD, MPP, MA

​This policy brief examines differences in health care access, health behaviors, and health outcomes by sexual orientation among California adults. Using data combined data from the 2011 to 2014 California Health Interview Survey, the study finds that although lesbian, gay, and bisexual women and men have similar or better rates of insurance coverage compared to straight women and men, they are more likely to experience delays in getting needed health care. Lesbians, bisexual women, and bisexual men have higher rates of smoking and binge drinking than straight women and men; however, gay men are less likely to consume sugary beverages and to be physically inactive. Lesbians and bisexuals had poorer health status and higher rates of disability than straight adults.

Future research is needed to explain these disparities, as well as to identify health care and structural interventions that will improve access to care and health outcomes for this population.

Policy Brief: Disparities in Health Care Access and Health Among Lesbians, Gay Men, and Bisexuals in CaliforniaCalifornia Health Interview Survey (CHIS)The California EndowmentY550YShana Alex Charles, PhD, MPPSusan H. Babey, PhDY211Allison L. Diamant, MD, MSHSEven with health insurance, lesbian, gay and bisexual adults are more likely to delay medical care 303Even with health insurance, lesbian, gay and bisexual adults are more likely to delay medical care
10/1/2018Approved1800
  
Research ReportSteven P. Wallace, PhD

The book, Contextualizing Health and Aging in the Americas: Effects of Space, Time and Place, offers new insights into the consequences of growth in and impact of the older segment of aging communities on local economies, employs National Institute of Aging (NIA) data sets for analyses of Hispanic aging populations in Mexico, the Americas, and the Caribbean, and provides a broad array of data and methodologies used in comparative research on Hispanic aging.

Steven P. Wallace is author of the final chapter of the book, Epilogue: Looking to the Future — Priorities for Creating New Knowledge. In his article, he discusses the lack of research on older Latinos, particularly as they comprise a growing proportion of the country’s population. His conclusion says that paying attention to institutional factors that effect lives of Latino elders and improving the health of their overall families and the communities in which they age will not only improve the health of Latinos of all ages, but potentially that of all races and ethnicities.
Epilogue: Looking to the Future — Priorities for Creating New KnowledgeRelated: Contextualizing Health and Aging in the Americas: Effects of Space, Time and PlaceY163
9/28/2018Approved1785
  
CHIS Journal ArticleHyunjeong Park

The purpose of this study was to explore and compare differences in factors associated with psychological distress among Asian subgroups including Chinese, Filipino, Vietnamese, Korean, Japanese, and non-Hispanic Whites. Using a cross-sectional study design, California Health Interview Survey (CHIS) 2011/2012 data were analyzed. The sample consisted of 29,142 participants: 25,645 non-Hispanic Whites; 3,497 non-Hispanic Asian-Americans; 1,156 Chinese; 471 Filipinos; 864 Vietnamese, 704 Koreans; and 302 Japanese. Sociodemographic characteristics included gender; age group, marital status, education, poverty level, working status, health insurance, level of acculturation, social cohesion, neighborhood safety, and civic engagement. Physical health status included disability and chronic illness. Psychological distress was evaluated using the Kessler 6 (K6) scale.

Results showed that psychological distress levels ranged between 1.96 (Japanese) and 4.52 (Korean) out of 24 and associated factors were significantly different among the five Asian subgroups and non-Hispanic Whites.

Journal Article: Racial/Ethnic Differences in Correlates of Psychological Distress Among Five Asian-American Subgroups and Non-Hispanic WhitesCalifornia Health Interview Survey (CHIS)N1528Net al
9/27/2018Approved1775
  
Policy BriefSusan H. Babey, PhD

This policy brief describes two types of walking among California adults: walking for transportation and walking for leisure. Using data from the 2003 and 2013-14 California Health Interview Surveys, the study found that the prevalence of both types of walking has increased since 2003. The prevalence of walking for both transportation and leisure varies with age, income, race/ethnicity, and neighborhood safety and cohesion. Additional efforts by state and local policymakers, as well as by communities, are needed to reduce disparities and promote walking among adults.

This policy brief was funded by The California Endowment.

Policy Brief: Walking Among California AdultsRelated Policy Brief: Few California Children and Adolescents Meet Physical Activity GuidelinesCalifornia Health Interview Survey (CHIS)The California EndowmentY211YJoelle Wolstein, PhD, MPP, MAAllison L. Diamant, MD, MSHSY107In California, 2 in 3 kids fail to meet exercise standards, according to UCLA study302In California, 2 in 3 kids fail to meet exercise standards, according to UCLA study
9/27/2018Approved1776
  
Policy BriefSusan H. Babey, PhD

​This policy brief describes physical activity among California children and adolescents. Using data from the California Health Interview Survey (CHIS) from 2013-14, the study found that only 31 percent of children ages 5-11 and 18 percent of adolescents ages 12-17 meet the physical activity guidelines of engaging in at least one hour of physical activity every day. Neighborhood characteristics, including safety and proximity to parks, are related to physical activity levels among youth. Also, among older children, boys are more active than girls. Additional efforts by state and local policymakers, as well as communities, are needed to promote physical activity to increase the proportion of children and adolescents achieving recommended amounts of physical activity.

This policy brief was funded by The California Endowment.

Policy Brief: Few California Children and Adolescents Meet Physical Activity GuidelinesRelated Policy Brief: Walking Among California AdultsCalifornia Health Interview Survey (CHIS)The California EndowmentY211YJoelle Wolstein, PhD, MPP, MAAllison L. Diamant, MD, MSHSY107In California, 2 in 3 kids fail to meet exercise standards, according to UCLA study302In California, 2 in 3 kids fail to meet exercise standards, according to UCLA study
9/18/2018Approved1771
  
Policy BriefShana Alex Charles, PhD, MPP

​As Medi-Cal enrollment expanded during the early years of expansion of the Patient Protection and Affordable Care Act (2014 and 2015), county health department spending in California also swelled. For most counties and regions in the state, the two measures tracked closely. However, exceptions in Northern California (with high enrollment and low spending growth) and Central California (low enrollment but high spending growth) show that other factors may also have had an effect. Importantly, if Medi-Cal is turned into a capped block-grant program at the federal level, counties would be heavily impacted and could be left with budget shortages. This policy brief uses data from the 2012, 2014 and 2015 California Health Interview Survey and the 2015 California State Controller.

This policy brief was funded by The California Endowment.

Policy Brief: Rise in Medi-Cal Enrollment Corresponded to Increases in California County Health Spending During ACA ImplementationGrowth in Medi-Cal in 2015 Fueled Unprecedented Drop in California’s UninsuredCalifornia Health Interview Survey (CHIS)The California EndowmentY81NFrancis NepomucenoGerald F. Kominski, PhDY144Plans to change federal Medi-Cal funding could force some California counties to slash health coverage301Plans to change federal Medi-Cal funding could force some California counties to slash health coverage
9/12/2018Approved1774
  
CHIS Journal ArticleAlexander N. Ortega

​This article provides statewide estimates on health care access and utilization patterns and physical and behavioral health by citizenship and documentation status among Latinos in California.

Using data from the 2011-2015 California Health Interview Survey (CHIS), authors examine health care access and utilization and physical and behavioral health among a representative sample of all nonelderly Latino and U.S.-born non-Latino white adults. Multivariable regressions estimated the associations between the dependent measures and citizenship/documentation status among Latinos (U.S.-born, naturalized citizen, green card holder, and undocumented).

Adjusted results from multivariable analyses observed worse access and utilization patterns among immigrant Latinos comapred with U.S.-born Latinos, with undocumented immigrants using significantly less health care. Undocumented Latinos had lower odds of self-reporting excellent/very good health status compared with U.S.-born Latinos, despite them having lower odds of having several physical and behavioral health outcomes (overweight/obesity, physician-diagnosed hypertension, asthma, self-reported psychological distress, and need for behaviorial health services). Among those reporting a need for behaviorial health services, access was also worse for undocumented Latinos when compared with U.S.-born Latinos.

Patterns of poor health care access and utilization and better physical and behavioral health are observed across the continuum of documentation status, with undocumented immigrants having the worse acces and utilization patterns and less disease. Despite fewer reported diagnoses and better mental health, undocumented Latinos reported poor health status than their U.S.-born counterparts.

 

Journal Article: Health Care Access and Physical and Behavioral Health Among Undocumented Latinos in CaliforniaCalifornia Health Interview Survey (CHIS)N69NRyan M. McKennaJessie Kemmick PintorN1557Brent A. Langellier
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