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CHIS 2009 Adult Questionnaire Version 3.4 March 1, 2011

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CHIS 2009 Adult Questionnaire Version 3.4 March 1, 2011 CHIS 2009 Adult Questionnaire Version 3.4 March 1, 2011 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 OMB Approval Number: 0925-0598 Copyright © 2009-2010 by the Regents of the University of California CHIS 2009 Adult Questionnaire Version 3.4 March 1, 2011 Table of Contents SECTION A – DEMOGRAPHIC INFORMATION, PART I ........................................................... 6 Age ............................................................................................................................................... 6 Gender ......................................................................................................................................... 7 Race ............................................................................................................................................. 8 Marital Status ............................................................................................................................. 13 SECTION B –HEALTH CONDITIONS ....................................................................................... 14 General Health ........................................................................................................................... 14 Asthma ....................................................................................................................................... 14 Diabetes ..................................................................................................................................... 17 Pre-Diabetes/Borderline Diabetes ............................................................................................. 17 Gestational Diabetes ................................................................................................................. 21 Hypertension .............................................................................................................................. 22 Heart Disease ............................................................................................................................ 22 Flu Shot ...................................................................................................................................... 24 Family History of Cancer ........................................................................................................... 24 Colon Cancer Screening ............................................................................................................ 27 Prostate Specific Antigen (PSA) Test ........................................................................................ 30 SECTION C – HEALTH BEHAVIORS ....................................................................................... 32 Walking for Transportation and Leisure ..................................................................................... 32 Moderate and Vigorous Physical Activity .................................................................................. 33 Dietary Intake ............................................................................................................................. 35 Fast Food ................................................................................................................................... 37 Sun Exposure ............................................................................................................................ 38 Cigarette Use ............................................................................................................................. 38 Second Hand Smoke ................................................................................................................. 39 Alcohol Use/Abuse .................................................................................................................... 40 SECTION D – GENERAL HEALTH, DISABILITY, AND SEXUAL HEALTH ............................ 41 Height and Weight ..................................................................................................................... 41 Disability ..................................................................................................................................... 41 Sexual Partners ......................................................................................................................... 43 Sexual Orientation ..................................................................................................................... 44 LGBT Domestic Partner ............................................................................................................. 45 SECTION E – WOMEN’S HEALTH ........................................................................................... 46 Age at Menarche ....................................................................................................................... 46 Pregnancy Status ...................................................................................................................... 46 Menopause ................................................................................................................................ 47 Births .......................................................................................................................................... 47 Mammography ........................................................................................................................... 48 Hormone Replacement Therapy ................................................................................................ 51 Birth Control Medications ........................................................................................................... 53 SECTION F – MENTAL HEALTH .............................................................................................. 54 K6 Mental Health Assessment ................................................................................................... 54 Repeated K6 .............................................................................................................................. 55 Sheehan Scale........................................................................................................................... 57 Access & Utilization ................................................................................................................... 58 Stigma ........................................................................................................................................ 61 2 CHIS 2009 Adult Questionnaire Version 3.4 March 1, 2011 SECTION G – DEMOGRAPHIC INFORMATION, PART II ....................................................... 63 Country of Birth (Self, Parents) .................................................................................................. 63 Language Spoken at Home ....................................................................................................... 66 Additional Language Use ........................................................................................................... 66 Citizenship and Immigration ...................................................................................................... 67 Spouse ....................................................................................................................................... 68 Living with Parents ..................................................................................................................... 68 Child and Teen Selection ........................................................................................................... 69 Paid Child Care .......................................................................................................................... 70 Educational Attainment .............................................................................................................. 71 Veteran Status ........................................................................................................................... 71 Employment ............................................................................................................................... 72 Employment (Spouse) ............................................................................................................... 74 SECTION H – HEALTH INSURANCE ....................................................................................... 75 Usual Source of Care ................................................................................................................ 75 Emergency Room Visits ............................................................................................................ 75 Medicare Coverage ................................................................................................................... 76 Medi-Cal Coverage .................................................................................................................... 80 Healthy Families Coverage ........................................................................................................ 81 Employer-Based Coverage .......................................................................................................
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