Skip Ribbon Commands
Skip to main content
Policy BriefSuzanne Ryan-Ibarra, MPH, MS

Talking, reading, and singing to children are critical to their development of literacy and language skills. Reading aloud to children when they are 5 years old or younger is associated with enhanced social and emotional development and improved behaviors and attention. This study -- which uses California Health Interview Survey data from 2005-2009 -- found:

  • trends in parents' reading and singing to their children from birth to 5trends in parents' reading and singing to their children from birth to 5 years of age
  • identified characteristics associated with reading and singing to children from birth to 5 years of age
  • assessed the reach of the Talk. Read. Sing. campaign, as well as the relationship between the campaign awareness and reading and singing to children from birth to 5 years of age.
This policy brief was made possible by funds received from First 5 California.
Parental Reading and Singing to California’s Young Children – Trends, Predictors, and Association with the Talk. Read. Sing.® CampaignAppendix: Data TablesFirst 5 CaliforniaCalifornia Health Interview Survey (CHIS)N892YTara Becker, PhD
CHIS Journal ArticleLucy B. Schulson

Authors analyzed whether perceptions of discrimination in health care changed in California over the last decade. The cross-sectional study of a racially, ethnically, and linguistically diverse adult population used data from pooled 2003 to 2005 and pooled 2015 to 2017 California Health Interview Survey (CHIS) data.


  • Perceptions of discrimination in health care decreased significantly overall from 6% to 4%.
  • In subanalyses, this finding was significant among Latino respondents, immigrants, and those with limited English proficiency.
  • However, perceptions of discrimination in health care among African American individuals have not improved and remain relatively high.
This study suggests that perceptions of discrimination in health care have improved for some populations, but interventions to reduce discrimination in health care are still necessary.
Journal Article: Changes in Perceptions of Discrimination in Health Care in California, 2003 to 2017 (JAMA Network Open)California Health Interview Survey (CHIS)N1596Net al
CHIS Journal ArticleJin Young Seo

Asians accounted for 30% of all U.S. immigrants in 2014, of which 53% were women. Foreign-born Asian immigrant (FBAI) women experience difficulties in obtaining timely and needed health care due to multifaceted barriers. Using 2014–2015 California Health Interview Survey (CHIS), this study examined factors influencing health service utilization among FBAI women compared with native-born (non-Hispanic) white American (NBWA) women.

A secondary data analysis was conducted using CHIS. Guided by a modified version of Andersen's behavioral model of health service utilization, 1,021 FBAI women aged 18 to 64 were compared with 7,086 NBWA women of the same ages. Outcome variables included having at least one doctor's visit in the past year and having an emergency room (ER) visit in the past year.


  • FBAI women were significantly less likely to have at least one doctor's visit in the past year and were less likely to have a usual source of care than NBWA women.
  • Significant predictors of having at least one doctor's visit for FBAI women were having high school education, having a usual source of care, having medical insurance, and having a chronic disease.
  • The only significant predictor of having an ER visit for FBAI women was having a chronic disease.
Health care providers must be aware of lower levels of health service utilization among FBAI women than NBWA women regardless of whether or not the FBAI women have chronic conditions. It is important to educate these women on the importance of regular health care visits.
Journal Article: Disparities in Health Care Utilization Between Asian Immigrant Women and Non-Hispanic White Women in the United StatesCalifornia Health Interview Survey (CHIS)N1598Net al
CHIS Journal ArticleMary Jung

Data on hypertension among Asian Americans is lacking and often aggregated, which can mask important ethnic differences. This study aims to provide a comprehensive view of hypertension and hypertension-related behaviors, including hypertension treatment, management, and information seeking, among Chinese, Korean, and Vietnamese Americans. Data were collected from 600 foreign-born Asian Americans (201 Chinese, 198 Korean, and 201 Vietnamese participants) in the Washington-Baltimore metropolitan area, aged 18 years and over, from 2013 to 2014. Hypertension was assessed using direct measurement and self-report of having ever been told by a physician. Hypertension prevalence was compared based on the method of assessment, ethnicity, and sex.

  • The age-adjusted hypertension prevalence from direct measurement was 27.5%, which is higher than the 2011-2014 National Health and Nutrition Examination Survey estimate for Asians (24.9%).
  • Hypertension prevalences from self-report among Chinese, Korean, and Vietnamese were 13.4%, 23.2%, and 22.9%, respectively, which are lower than 2014 California Health Interview Survey (CHIS) estimates (15.6%, 18.4%, and 25.8%) with the exception of Korean participants.
  • In regard to hypertension-related behaviors, 67.8% of hypertensive adults received management, 64.3% took antihypertensive medication, and 67.0% sought information to improve their hypertension.
Disaggregated data on hypertension based on measured blood pressure may prevent underestimation from self-report, particularly among those with limited healthcare access. More accurate and objective assessment of hypertension is needed for improved monitoring of hypertension among Asian-American subgroups.
Journal Article: Hypertension Prevalence, Treatment, and Related Behaviors Among Asian Americans: An Examination by Method of Measurement and Disaggregated SubgroupsCalifornia Health Interview Survey (CHIS)N1605Net al
CHIS Journal ArticleKaren Kobayashi

Authors combined 2007-2016 waves of the adult California Health Interview Survey (CHIS) to analyze a nonobese (BMI<30) sample of 2,295 Japanese Americans and 119,651 Non-Hispanic whites (NHW).


  • This representative community study of nonobese Californians indicates that the prevalence of diabetes among Japanese-American respondents was higher than their NHW counterparts, 8.0% versus 4.5%.
  • Prevalence increased markedly with age; one-quarter of nonobese Japanese Americans aged 80 and older had diabetes.

The prevalence of diabetes among nonobese Japanese Americans is significantly higher than that among NHWs. There is an urgent need to develop appropriate intervention and prevention approaches with lifestyle modification specifically targeted towards nonobese Japanese Americans.

Journal Article: Diabetes and Diabetes Care among Nonobese Japanese-Americans: Findings from a Population-Based StudyCalifornia Health Interview Survey (CHIS)N1595Net al
CHIS Journal ArticleBrent A. Langellier

The study aimed to assess the relationship between educational attainment and health care access and use among Mexican-origin populations. Data from the 2012 Mexican National Health and Nutrition Study, the 2013 Project Migrante Health Care Access and Utilization Survey, and the 2013–2014 California Health Interview Survey (CHIS) were used to examine educational gradients in health insurance, medical home, and hospitalization among Mexicans in Mexico, northbound, southbound, and deported migrants, and U.S.-and foreign-born Mexican Americans.

Authors found that college graduates had greater odds of being insured relative to those with less than a high school degree among Mexicans, northbound migrants and the foreign-born, and of having a medical home among Mexicans and the foreign-born.
Eliminating differences by educational attainment in the U.S. will require policy changes like making immigrants eligible for public insurance. In Mexico, it will require targeted outreach to enroll underserved populations in existing public insurance programs.
Journal Article: The Relationship Between Educational Attainment and Health Care Access and Use Among Mexicans, Mexican Americans, and U.S.-Mexico MigrantsCalifornia Health Interview Survey (CHIS)N759Net al
CHIS Journal ArticleMatthew Lee

Consumption of sugar-sweetened carbonated beverages (including soda) has declined nationally, but trends by state are unknown. Authors used data 2011 through 2016 California Health Interview Survey (CHIS) to assess overall changes in soda consumption among adults aged 18 or older and identified differences by education and income level.

  • Frequency of soda consumption (times per week) declined from 2011 through 2014 by 16.5% but returned to 2011 levels in 2015 and 2016.
  • Trends did not differ by education or income.
  • The proportion of the population that consumed soda did not change among adults with less than a high school diploma or equivalent, but declined significantly among those with at least a high school diploma.
Journal Article: Secular Trends in Soda Consumption, California, 2011-2016California Health Interview Survey (CHIS)N1599Net al
CHIS Journal ArticleNicole K. Eberhart

Data from the California Health Interview Survey (CHIS) can facilitate the state, regional, and county tracking of key mental health indicators, including mental health services, service use, unmet need for services, and mental health-related functioning. The purpose of this study is to examine CHIS data from 2011 to 2013 to facilitate state, regional, and county tracking of key mental health indicators. The indicators that authors examine include need for mental health services, service use, unmet need for services, and mental health-related functioning. Authors chose CHIS indicators that could be useful to routinely monitor for statewide and county-level planning and improvement of prevention and early intervention (PEI) strategies.

  • Mental health issues seemed to more adversely affect California women, as compared with men. Women in the state had slightly higher rates of serious psychological distress than men did, and women in turn had much higher rates of mental health or substance use service utilization than men did. California women were more likely than men to get help for a mental health or substance use issue. Despite this higher rate of service utilization, California women were still somewhat more likely to have unmet need
  • Latino and black Californians exhibited the highest mental health disparities in the state. Both groups had somewhat higher rates of serious psychological distress, compared with white Californians, as well as higher rates of unmet need for mental health or substance use services (10–11% among these diverse groups, versus 8% among whites). Latino and black Californians also have higher rates of serious psychological distress.
  • Compared with adults ages 25–64, young adults ages 18 to 24 had somewhat higher rates of unmet need for mental health or substance use service sand were somewhat more likely to report severe impairment in work or daily.

Findings suggest that in an environment of limited resources, mental health program planning and policymaking in California may benefit from a focus on improving outcomes for women, Latino and black Californians, and young adults.

Journal Article: Monitoring Californians' Mental Health: Population Surveillance Reveals Gender, Racial/Ethnic, Age, and Regional DisparitiesCalifornia Mental Health Services AuthorityCalifornia Health Interview Survey (CHIS)N1527Net al
CHIS Journal ArticleHena Naz Din

Using the 2015-2016 California Health Interview Survey (CHIS) dataset, this study aims to assess population-level characteristics associated with different types of internet use, particularly for seeking online health information. Internet use was classified as never used the internet (Never use), ever used the internet but not to search for health information in the last 12 months (Use not for health), and ever used the internet and have used it to search for health information in the last 12 months (Use for health).

  • Among 42,087 participants (weighted sample of 29,236,426), 19% reported Never Use of the internet, 27.9% reported Use not for health, and 53.1% reported Use for health. Compared to Never Use individuals, Use for health individuals were more likely to be younger, female, and non-Hispanic white and have a higher socioeconomic status.
  • Overall, characteristics for the Use not for health and Use for health groups were similar, except for those with lower levels of education and respondents not having visited a physician in the last year. For these two characteristics, the Use not for health group was more similar to the Never Use group.
These findings support the need for interventions to target internet access and health literacy among Never Use and Use not for health groups.
Journal Article: Profiles of a Health Information-Seeking Population and the Current Digital Divide: Cross-Sectional Analysis of the 2015-2016 California Health Interview SurveyCalifornia Health Interview Survey (CHIS)N1611Net al
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
Journal ArticleNadereh Pourat, PhD

In this retrospective, observational study, authors aimed to examine the rate of follow-up visits among patients with behavioral health conditions and to assess the impact of this visit on the subsequent rate of readmission. They analyzed data from 1,905 low-income uninsured adults with behavioral health conditions enrolled in a health care coverage program implemented by a California County from 2012 to 2013.  Administrative encounter and eligibility data and two logistic regression models were used to predict the (1) likelihood of a timely follow-up outpatient visit and (2) likelihood of a readmission given a timely outpatient visit. The outcomes were to calculate the marginal effects of an outpatient visit within 15 days and a readmission within 30 days of the index admission. 


  • The 15-day follow-up visit rate was 42% and readmission rate was 13%. 
  • Higher severity of illness and prior visits to providers increased the probability of a follow-up visit within 15 days. 
  • Follow-up visits and a shorter index admission also reduced the risk of 30-day readmissions.

Authors conclude the findings provide evidence that timely linking of behavioral health patients to outpatient care after hospitalization is an effective care transition strategy, as it is likely to reduce readmission rates.

Journal Article: Timely Outpatient Follow-up Is Associated with Fewer Hospital Readmissions among Patients with Behavioral HealthY94YXiao Chen, PhD Shang-Hua Wu, MSN888Anna C. Davis
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 Lucia, MPPSrikanth Kadiyala, PhDN1570Petra Rasmussen, MPH
CHIS Journal ArticleJack Thompson


Categorization of terms/concepts/constructs that allows for better understanding and comparison of public health interventions is often lacking in program implementation and evaluation. A classification system such as a lexicon, when used appropriately, can help address this need. This narrative describes a lexicon of policy, systems, and environmental change strategies (PSEs) that was developed and prototyped to aid local implementation of Supplemental Nutrition Assistance Program Education (SNAP-Ed) interventions in obesity prevention. The lexicon was reviewed and refined by a panel of experts who provided iterative feedback on the system's scope and utility.


To develop the lexicon, a team from the local health department: (i) conducted an inventory (community context scan) of SNAP-Ed PSEs implemented in Los Angeles County during 2010–2015; (ii) assessed commonalities among PSEs, using the California Health Interview Survey (CHIS) and other sources, that were translated into “index factors” to contextualize terms/concepts/constructs relevant to SNAP-Ed services planning; and (iii) convened a panel of experts to review and test the classification system for quality and usability. In the latter activity, the panel reviewed the terms/concepts/constructs within the context of two geographical areas and by the selected PSEs. The final version of the lexicon organized the terms/concepts/constructs of the local SNAP-Ed PSEs into overarching categories, so they can be compared/assessed by type, content, and/or impact.


The goal of the project was to create a classification system that can help facilitate meaningful communications among program implementers, evaluators, and community stakeholders. The lexicon has practical implications and potential applications for other jurisdictions interested in reducing obesity rates through SNAP-Ed PSEs.


Journal Article: The Added Value of Establishing a Lexicon to Help Inform, Compare, and Better Understand the Implementation of Policy, Systems, and Environmental Change Strategies in Supplemental Nutrition Assistance Program EducationSupplemental Nutrition Assistance Program EducationCalifornia Department of Public HealthCalifornia Health Interview Survey (CHIS)N1610Net al
External PublicationCalifornia Food Policy Advocates

Across California, 4.7 million adults and 2.0 million children live in low-income households affected by food insecurity. Food insecurity means having limited, uncertain, or inconsistent access to the quality and quantity of food that is necessary to live a healthy life. Having sustained access to enough food is tied to positive social, physical, and mental health outcomes. 

While the data shared in this fact sheet focus on Californians with incomes below 200% of the official federal poverty measure ($50,930 for a family with two adults & two children), food insecurity also affects households with higher incomes. In many California communities, the official federal poverty measure does not reflect the true level of need ― and neither do program eligibility criteria based on that measure. The fact sheet includes a comparison of the maximum allowable income (before deductions) for CalFresh, income limits for school meal programs, and the living wage deemed necessary to meet the basic needs of a family of four in California.

This publication uses 2015-2016 California Health Interview Survey (CHIS) data. 

Fact Sheet: Struggling to Make Ends Meet: Food Insecurity in CaliforniaCalifornia Health Interview Survey (CHIS)N1063
CHIS Journal ArticleTaeho Greg Rhee

This study investigates whether perceived racism is associated with delayed/forgone care among minority older adults, and whether poor doctor communication mediates this relationship. Study cohort consisted of 1,756 minority participants, aged 65 years and older, in the 2015 California Health Interview Survey (CHIS). Multivariable logistic regression analyses were conducted with relevant covariates, including insurance coverage, years living in the U.S., and language. A mediation analysis was also performed.

  • Among minority older individuals, perceived racism was significantly associated with delayed/forgone care.
  • Poor doctor communication significantly and partially mediated the relationship, accounting for 9.9% of the total effect.
Perceived racism may contribute to health disparities for older minority individuals in part through doctors communicating messages that discourage adequate utilization of health care. Future research should explore culturally sensitive communication skills that reduce this barrier to receiving adequate health care.
Journal Article: Impact of Perceived Racism on Healthcare Access Among Older Minority AdultsCalifornia Health Interview Survey (CHIS)N1602Net al
CHIS Journal ArticleDavid A. Stupplebeen


This study examined whether the association between weight status and four chronic diseases (heart disease, hypertension, lifetime asthma, and type 2 diabetes) varied according to sexual orientation identity among adult men, controlling for demographic, socioeconomic, and other factors. Pooled 2003–2012 California Health Interview Survey (CHIS) data from 72,214 male adult participants were used along with logistic regression models to estimate whether the associations between weight status and chronic diseases varied by sexual orientation identity.



  • Weight status was positively associated with each of the chronic diseases (hypertension, heart disease, asthma, and diabetes) among both gay and bisexual men and heterosexual men; however, the associations varied significantly by sexual orientation identity.
  • Among gay and bisexual men, the associations were stronger and statistically significant — with the exception of lifetime asthma — particularly for men in the obese classifications, before and after controlling for age, marital status, race/ethnicity, education, income, health insurance status, food security level, smoking, and nativity.


Weight status had stronger detrimental associations with chronic disease among gay and bisexual men despite these men having greater socioeconomic advantage and lower body mass index than heterosexual men. Future research should examine mechanisms, including stress related to minority status, which may lead to greater risks for chronic diseases among sexual minority men.

Journal Article: Differential Influence of Weight Status on Chronic Diseases by Reported Sexual Orientation Identity in MenCalifornia Health Interview Survey (CHIS)N1601NMichele J. EliasonAllen J. LeBlancN947Emma V. Sanchez-Vaznaugh
Journal ArticleAudrey Jones

Black and Latino minorities have traditionally had poorer access to primary care than non-Latino Whites, but these patterns could change with the Affordable Care Act (ACA). To guide post-ACA efforts to address mental health service disparities, authors used a nationally representative sample to characterize baseline race-, ethnicity-, and nativity-associated differences in mental health services in the context of primary care.

Data were obtained from the Medical Expenditures Panel Survey (MEPS), a two-year panel study of health care use, satisfaction with care, and costs of services in the United States (US). Authors pooled data from six waves (14–19) of participants with serious psychological distress to examine racial, ethnic, and nativity disparities in medical and mental health visits to primary care (PC) and specialty mental health (SMH) providers around the time of ACA reforms, 2010–2015.


  • Of the 2,747 respondents with serious psychological distress, 1,316 were non-Latino White, 632 non-Latino Black, 532 identified as Latino with Mexican, Central American, or South American (MCS) origins, and 267 as Latino with Caribbean island origins; 525 were foreign/island born.
  • All racial/ethnic groups were less likely than non-Latino Whites to have any PC visit.
  • Of those who used PC, non-Latino Blacks were less likely than Whites to have a PC mental health visit, while foreign-born MCS Latinos were less likely to visit an SMH provider.
  • Conditional on any mental health visit, Latinos from the Caribbean were more likely than non-Latino Whites to visit SMH providers versus PC providers only, while non-Latino Blacks and U.S.-born MCS Latinos received fewer PC mental health visits than non-Latino Whites in PC-provided mental health services.

Journal Article: Racial, Ethnic, and Nativity Differences in Mental Health Visits to Primary Care and Specialty Mental Health Providers: Analysis of the Medical Expenditures Panel Survey, 2010–2015 (Healthcare)N1613NSusan D. CochranGerald F. Kominski, PhDY144Vickie M. Mays
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
External PublicationLaurel Lucia, MPP

​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)Y944
CHIS Journal ArticleKeith Tsz-Kit Chan

Family doctors are increasingly managing the diabetes care of Korean Americans. Little is known about the prevalence of diabetes among non-obese Korean Americans, or the extent to which they receive timely and appropriate diabetes care. The purpose of this investigation is to: (1) identify the prevalence of diabetes and to determine the adjusted odds of diabetes among non-obese Korean-Americans compared to non-Hispanic white (NHW) Americans, (2) examine the factors associated with having diabetes in a large sample of non-obese Korean Americans, and (3) determine the prevalence and adjusted odds of optimal frequency of eye care, foot care and A1C blood glucose level monitoring among non-obese Korean-Americans with diabetes in comparison to NHWs with diabetes. Secondary analysis of population-based data from the combined 2007, 2009, and 2011 adult California Health Interview Survey (CHIS), which included 74,361 respondents with body mass index (BMI) <30 kg/m2 (referred to as 'non-obese BMI'), of whom 2,289 were Korean-Americans and 72,072 were NHWs, and 4,576 had diabetes.

  • The prevalence and adjusted odds of diabetes among non-obese Korean-Americans are significantly higher than among their NHW peers.
  • More than 90% of Korean-Americans with diabetes were non-obese. NHWs had substantially higher odds of having optimal frequency of eye care, foot care and A1C glucose level monitoring, even after adjusting for insulin dependence, sex, age, education, income, and BMI.
Non-obese Korean-Americans are at higher risk for diabetes and are much less likely to receive optimal diabetes care in comparison to NHWs. Targeted outreach is necessary.
Journal Article: Diabetes Care of Non-obese Korean Americans: Considerable Room for ImprovementCalifornia Health Interview Survey (CHIS)N929NKaren Kobayashiet alN151
Journal ArticleMekdes K. Gebremariam

This study assessed the change in body mass index (BMI) distribution among 18‐ or 19‐year‐olds in Norway over 24 years. It also investigated parallel changes in the distribution of birth weight and in the association between birth weight and later risk of overweight and/or obesity. Parental educational variations in the trends and associations were explored.

The study used data on 606,832 male military conscripts enlisted between 1985 and 2008. Quantile regression was used to assess the temporal change in BMI and birth weight distribution. The association between birth weight and overweight and/or obesity at age 18 or 19 years was quantified by using logistic regression.

Authors found:

  • Increases in BMI over time were found namely in the 90th, 95th, 97th, and 99th percentiles.
  • Socioeconomic differences in this increase were documented in the 75th to 97th percentiles. The distribution of birth weight and the association between birth weight and the risk of overweight and/or obesity at age 18 or 19 years remained stable over time.

Authors conclude the difference in the increase in BMI between low and high percentiles indicates the limited role of mean BMI in reflecting population changes. The results suggest a need to focus on those with low socioeconomic position in the upper ends of the BMI distribution to combat increasing disparities in obesity-related outcomes.


Journal Article: Change in BMI Distribution over a 24-Year Period and Associated Socioeconomic Gradients: A Quantile Regression AnalysisN1479YOnyebuchi A. Arah, MD, PhD, MPHet alN151
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
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
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
CHIS Journal ArticleShaoqing Gong

Authors aimed to examine the association between immigrant generation and obesity among Californian adults and Asian Americans using pooled weighted data on 2,967 Asian Americans from the 2013–2014 California Health Interview Survey (CHIS). Multiple logistic regression analyses were used with adjustment for age, sex, family income, smoking status, marital status, education, physical activity, and fast food consumption.



  • The percentage of first, second, and third generation were 72.7%, 22.6%, and 4.6%, respectively.
  • Overall, 23.3% of the Asian population was obese, and 40.0% was overweight.
  • Overall, first generation of Asians had lower odds of being obese compared to whites.
  • Multiple logistic regression analyses showed that overall, second generation and third generation Asians had higher odds of being obese compared to first generation Asians.
  • Among Chinese, compared to the first generation, the third generation had increased likelihood of being obese.


Compared to white people, Hispanics, and black people, Asian immigrants are less likely to be obese. Among Asians, second and third generations were more likely to be obese compared to first generation. The obesity rate seems to increase the longer Asian immigrants remain in the U.S.


Journal Article: The Influence of Immigrant Generation on Obesity Among Asian Americans in California from 2013 to 2014California Health Interview Survey (CHIS)N1562NKesheng Wanget alN151
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.


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
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
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
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
External PublicationLaurel Lucia, MPP

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 ActionY944
1 - 30Next