CHIS 2021 Adult CAWI Questionnaire (Self- administered) Version 1.28 May 17, 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 © 2021 by the Regents of the University of California CHIS 2021 Adult Questionnaire Version 1.28 May 17, 2021 Table of Contents Section A: Demographic Information, Part I ......................................................................................... 7 Age ......................................................................................................................................................... 7 Gender Identity ...................................................................................................................................... 8 Ethnicity ................................................................................................................................................. 9 Race ..................................................................................................................................................... 10 Language Spoken at Home ................................................................................................................. 15 Additional Language Use ..................................................................................................................... 15 Marital Status ....................................................................................................................................... 16 Spouse/Partner .................................................................................................................................... 16 Adult Roster ......................................................................................................................................... 17 Section B: Health Conditions ............................................................................................................... 21 General Health ..................................................................................................................................... 21 Asthma ................................................................................................................................................. 21 Diabetes ............................................................................................................................................... 22 Hypertension ........................................................................................................................................ 23 Heart Disease ...................................................................................................................................... 23 Section CV: COVID-19 ........................................................................................................................... 24 Section C: Health Behaviors ................................................................................................................ 29 Dietary Intake ....................................................................................................................................... 29 Cigarette Use ....................................................................................................................................... 29 CBD Use .............................................................................................................................................. 40 Alcohol Use .......................................................................................................................................... 44 Influences on Health ............................................................................................................................ 45 Section GV: Gun Violence .................................................................................................................... 46 Section D: General Health, Disability, and Sexual Health ................................................................. 48 Height and Weight ............................................................................................................................... 48 Disability ............................................................................................................................................... 48 Sexual Partners ................................................................................................................................... 48 Sexual Orientation ............................................................................................................................... 49 Registered Domestic Partner ............................................................................................................... 49 HIV Testing .......................................................................................................................................... 51 2 CHIS 2021 Adult Questionnaire Version 1.28 May 17, 2021 Section F: Mental Health ....................................................................................................................... 52 K6 Mental Health Assessment ............................................................................................................. 52 Repeated K6 ........................................................................................................................................ 52 Sheehan Scale ..................................................................................................................................... 54 Access & Utilization ............................................................................................................................. 55 Stigma .................................................................................................................................................. 57 Mental Health and Technology ............................................................................................................ 57 Climate Change ................................................................................................................................... 59 Section G: Demographic Information, Part II...................................................................................... 60 Country of Birth (Self, Parents) ............................................................................................................ 60 Citizenship and Immigration ................................................................................................................ 61 Living with Parents ............................................................................................................................... 62 Teen Permission .................................................................................................................................. 63 Paid Child Care .................................................................................................................................... 67 Educational Attainment ........................................................................................................................ 68 Veteran Status ..................................................................................................................................... 69 Employment ......................................................................................................................................... 70 Employment (Spouse/Partner) ............................................................................................................ 72 Section H: Health Insurance ................................................................................................................. 74 Usual Source of Care ........................................................................................................................... 74 Emergency Room Visits....................................................................................................................... 74 Medicare Coverage .............................................................................................................................. 74 Medi-Cal Coverage .............................................................................................................................. 77 Employer-Based Coverage .................................................................................................................. 77 Private Coverage ................................................................................................................................. 77 CHAMPUS/CHAMPVA, TRICARE, VA Coverage ............................................................................... 82 AIM, MRMIP, Family PACT, HEALTHY KIDS, Other Government Coverage .................................... 83 Other Coverage ................................................................................................................................... 83 Indian Health Service Participation ...................................................................................................... 85 Spouse’s Insurance Coverage Type & Eligibility ................................................................................