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CHIS 2019 Adult CAWI Questionnaire (Self-Administered) Version 2.73 April 26, 2021 Adult Respondents Age 18 and Older

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CHIS 2019 Adult CAWI Questionnaire (Self-Administered) Version 2.73 April 26, 2021 Adult Respondents Age 18 and Older CHIS 2019 Adult CAWI Questionnaire (Self-administered) Version 2.73 April 26, 2021 Adult Respondents Age 18 and Older Collaborating Agencies: • UCLA Center for Health Policy Research • California Department of Health Care Services • California Department of Public Health Contact: California Health Interview Survey UCLA Center for Health Policy Research 10960 Wilshire Blvd, Suite 1550 Los Angeles, CA 90024 Telephone: (866) 275-2447 Fax: (310) 794-2686 Web: www.chis.ucla.edu Copyright © 2019 by the Regents of the University of California CHIS 2019 Adult Questionnaire Version 2.73 April 26, 2021 Table of Contents Section A: Demographic Information, Part I ......................................................................................... 6 Age ......................................................................................................................................................... 6 Gender Identity ...................................................................................................................................... 7 Ethnicity ................................................................................................................................................. 8 Race ....................................................................................................................................................... 9 Language Spoken at Home ................................................................................................................. 13 Additional Language Use ..................................................................................................................... 13 Marital Status ....................................................................................................................................... 14 Spouse/Partner .................................................................................................................................... 14 Adult Roster ......................................................................................................................................... 15 Section B: Health Conditions ............................................................................................................... 19 General Health ..................................................................................................................................... 19 Asthma ................................................................................................................................................. 19 Diabetes ............................................................................................................................................... 20 Hypertension ........................................................................................................................................ 21 Heart Disease ...................................................................................................................................... 21 Section C: Health Behaviors ................................................................................................................ 22 Dietary Intake ....................................................................................................................................... 22 Cigarette Use ....................................................................................................................................... 22 Influences on Health ............................................................................................................................ 29 Section D: General Health, Disability, and Sexual Health ................................................................. 30 Height and Weight ............................................................................................................................... 30 Disability ............................................................................................................................................... 30 Sexual Partners ................................................................................................................................... 31 Sexual Orientation ............................................................................................................................... 31 Registered Domestic Partner ............................................................................................................... 32 HIV Testing .......................................................................................................................................... 33 Section F: Mental Health ....................................................................................................................... 35 K6 Mental Health Assessment ............................................................................................................. 35 Repeated K6 ........................................................................................................................................ 35 Sheehan Scale ..................................................................................................................................... 37 Access & Utilization ............................................................................................................................. 38 Stigma .................................................................................................................................................. 40 Three-Item Loneliness Scale ............................................................................................................... 40 Mental Health and Technology ............................................................................................................ 41 2 CHIS 2019 Adult Questionnaire Version 2.73 April 26, 2021 Section G: Demographic Information, Part II...................................................................................... 43 Country of Birth (Self, Parents) ............................................................................................................ 43 Citizenship and Immigration ................................................................................................................ 44 Living with Parents ............................................................................................................................... 44 Teen Permission .................................................................................................................................. 45 Paid Child Care .................................................................................................................................... 48 Educational Attainment ........................................................................................................................ 48 Veteran Status ..................................................................................................................................... 49 Employment ......................................................................................................................................... 50 Employment (Spouse/Partner) ............................................................................................................ 53 Section H: Health Insurance ................................................................................................................. 54 Usual Source of Care ........................................................................................................................... 54 Emergency Room Visits....................................................................................................................... 54 Medicare Coverage .............................................................................................................................. 54 Medi-Cal Coverage .............................................................................................................................. 57 Employer-Based Coverage .................................................................................................................. 57 Private Coverage ................................................................................................................................. 57 CHAMPUS/CHAMPVA, TRICARE, VA Coverage ............................................................................... 63 AIM, MRMIP, Family PACT, HEALTHY KIDS, Other Government Coverage .................................... 63 Other Coverage ................................................................................................................................... 64 Indian Health Service Participation ...................................................................................................... 66 Spouse’s Insurance Coverage Type & Eligibility ................................................................................. 66 Managed-Care Plan Characteristics .................................................................................................... 75 High Deductible Health Plans .............................................................................................................. 76 Coverage over Past 12 Months ........................................................................................................... 77 Reasons for Lack of Coverage ...........................................................................................................
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