​Todd Hughes is the director of the California Health Interview Survey (CHIS), the nation's largest state health survey, which released new 2015 data today. In this brief interview, Hughes discusses new topics, such as gender identity and telemedicine, and the role of cell phones and computers in CHIS data gathering.

Q: What new questions and innovations are in the 2015 CHIS?

​CHIS always tries to be responsive to the latest research questions and health challenges. Important new topics in the survey include whether Californians have experienced discrimination based on race or ethnicity ― allowing researchers and others to see for the first time whether bias is a factor in how people access and receive health care. We're also releasing new indicators on topics of emerging importance, such as telemedicine, which is receiving care from a doctor or health professional through a video or telephone conversation.

According to CHIS, 1 in 10 people used some form of telemedicine in 2015, a sizable percentage for such a new field and one that is likely to grow. In an era when it's hard for people to travel to a doctor, such as in rural areas with few providers or get an in-person appointment to see a doctor in a timely manner, telemedicine may be the only way some people get access to health care.

We're also releasing preliminary results of highly-anticipated data on adult gender identity and teen gender expression ― the first time we've ever collected these data. Even more data on these topics will be released in early 2017 when we publish an article on CHIS transgender data in the American Journal of Public Health in partnership with The Williams Institute at the UCLA School of Law.

As exciting as all our new topics are, CHIS is tremendously valuable for the many questions it asks again and again, allowing researchers to trend health and health care over time.

Q: How many indicators are being released by CHIS and why are some being held back?

​We are releasing more than 200 indicators with CHIS 2015 ― the most ever released at one time by CHIS. It's a big year! However, there are always questions that are held for later release. These are usually few and include open-ended question, like health insurance plan name, industry and occupation. We want to take special care and ensure we accurately capture the intent of the participant. Data for these additional questions will be released in early 2017.

Q: What proportion of respondents do you reach by cell phone? Will CHIS eventually move to an online survey?

​The design of CHIS has evolved to better reflect changes in the population and the increasing number of households that only have telephone service through mobile devices. In 2013-2014, we reached about 80 percent of respondents through land lines and 20 percent by cell phone. In 2015, we changed our sample design to contact roughly half of our survey respondents by cell phone.

Telephone surveys still allow us to reach a broad set of Californians, despite a changing culture with fewer people answering incoming phone calls. However, many surveys are moving to designs that involve asking people to respond by mail or Internet. These surveys may experience higher cooperation rates and can be conducted less expensively than telephone surveys, but there are some disadvantages as well. CHIS makes special efforts to conduct interviews in a large set of languages other than English to reflect California's diverse population, and this would be more challenging in a mail or Internet survey.

Someday, an approach that involves a blend of different approaches may make sense, and we will begin next year to examine these approaches in more detail.

​Todd Hughes is the director of the California Health Interview Survey (CHIS), the nation’s largest state health survey. In this brief interview, Hughes discusses the survey’s new topics and his vision for new data collection methods.

Q: What new topics and questions are covered in the 2018 CHIS?

​The questions included in CHIS vary somewhat each year to reflect emerging health issues and the evolving needs of our funding organizations. The 2018 questionnaire included new questions about tobacco and e-cigarette usage, including questions about flavored tobacco and e-cigarette products; usage of non-cigarette tobacco products; secondhand smoke exposure; and rules on smoking and vaping. Additional questions on quality of life were added to allow for the creation of a well-being measure.

Also, to better understand the health impacts of the implementation of California’s Adult Use of Marijuana Act, additional detailed questions on marijuana use, methods of use, and whether use was for medical purposes, were added in 2018.

Finally, questions on condition of teeth and missing school due to dental problems returned to the CHIS teen survey in 2018.

Q: What data may be of interest to policymakers and news media?

​Last year CHIS identified evidence of declines in mental health in 2017, and in 2018, CHIS provided further evidence of declines in mental health and increases in the use of mental health visits. In fact, 2018 CHIS respondents reported the highest levels of both moderate and severe impairment due to mental and emotional health challenges ever seen in CHIS.

Current e-cigarette usage was found to be quite high in 2018 among young adults age 18-25 years old, and the data indicate that among this age group, many young adults are trying e-cigarettes and continuing with current use. Marijuana usage in the past 30 days has significantly increased in 2018; and although smoking marijuana in a joint is the most popular method of use, vaping cannabis is also frequently reported. With the recent focus on pulmonary disease related to vaping reported by the U.S. Centers for Disease Control and Prevention, it will be important to continue to monitor rates of vaping cannabis or nicotine in California using CHIS.

Finally, 2018 CHIS data for insurance coverage show that California uninsured rates in 2018 remain lower than prior to the implementation of the Affordable Care Act. California’s interventions to reduce the effect of federal policy changes are allowing the uninsured rate here to remain stable, despite increases in the national uninsured rate.

Q: It was recently announced that CHIS will transition to a mixed-mode survey allowing respondents to answer via web or telephone. What is your vision on how this will transform data collection and response methods for such a well-cited survey?

​CHIS is innovating in order to respond to increasing challenges with obtaining high levels of participation in today’s environment. With cultural changes in telephone usage and technological developments such as caller ID, robocalls, and call blockers, it was becoming more and more expensive to rely on the telephone as the only method of data collection for CHIS, as has been done since the inception of CHIS in 2001.

In 2018, we designed and conducted two independent field tests exploring a new design for CHIS: Mailing invitations to a representative sample of addresses across the state to encourage these selected households to go online to complete CHIS, and then following up by telephone (when a phone number can be identified for the address) with those households that don’t respond by web. Due to the success of these tests, the 2018 CHIS will be the last round of CHIS conducted by telephone only. The 2019 CHIS will move to the new design using web plus phone.

Using a mail invitation for households to respond by web will allow us to more successfully reach busy households that aren’t likely to respond by telephone. Retaining the option for telephone interviewing will allow us to include households that don’t have internet access, or may be more comfortable participating by phone, such as the elderly population. Both the web and telephone versions of the survey will include multiple languages other than English to ensure that CHIS continues to represent the linguistic diversity of California.

More than half — or 55% — of California adults said they have received a positive COVID-19 test result: 46% used only a self-test kit, 27% received their positive result from both a self-test kit and testing site, and 26% from a clinic, hospital, lab or other test, according to May 2023 data released today by the California Health Interview Survey (CHIS).

While self-test kits have made it faster and more convenient to test for COVID-19, the results are not reported to health care providers or local public health departments, making case rates impossible to track.

The data, made available to the public on the 2023 California Health Interview Survey Preliminary COVID-19 Estimates Dashboard, was published today by the UCLA Center for Health Policy Research using surveys collected in May 2023 from 3,660 California adults and 717 teenagers and children. The dashboard features information about access to masks, vaccination status and reasons for not getting vaccinated, COVID-19 testing and more.

Data shows that Californians continue to experience personal and financial impacts. About 11% of California adults experienced financial difficulties with paying rent or mortgage, 2% reported being treated unfairly because of their race or ethnicity, 3% quit their job to care for themselves or a family member due to COVID-19 illness, 2% experienced financial difficulties with paying COVID-19 medical bills, and 2% had difficulty obtaining child care, or experienced an increase in child care experiences.

“Although you may think some of the percentages are small at 2% — when considering the overall California population, we’re talking about more than half a million Californians,” said Todd Hughes, director of the CHIS. “There is nothing insignificant about that. Thousands of Californians are still impacted, years after the initial COVID-19 outbreak.”

The data also highlights some disparities among racial and ethnic groups: 17% of Latinx adults said they had financial difficulties with paying rent or mortgage, three times the 5% of white adults who experienced difficulties.

Other highlights include:

Vaccination Status

• More than 1 in 3 (37%) California teens and children have not completed the primary vaccine series for COVID-19.
• More than half (56%) of teens said the reason they have not completed the primary vaccine series is because their parents don’t want them to get the vaccine.
• Among California adults who have not completed the primary vaccine series for COVID-19, 48% think a vaccine for COVID-19 is unnecessary.
• More than a third (36%) of California adults said they will not get additional COVID-19 vaccine doses if recommended by health guidelines.

Mask Use

• 1 in 8 (12%) California adults said they would not wear a N95, KN95, or KF94 mask even if public health recommended it as a COVID-19 protection.
• 1 in 9 (11%) California adults said they could not get an N95, KN95, or KF94 mask even if public health recommended it as a COVID-19 protection.
• Among California adults who do not have a N95, KN95, or KF94, 43% of California adults said the reason for not being able to get an N95, KN95, or KF94 mask is because they are too expensive.

Earlier this month, CHIS released March and April 2023 COVID-19 data and will be releasing additional data in the coming weeks.