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.