Treatment of Major Depressive Disorder with Iyengar Yoga and Coherent Breathing: A Randomized Controlled Dosing Study.

Objectives: The aims of this study were to assess the effects of an intervention of Iyengar yoga and coherent breathing at five breaths per minute on depressive symptoms and to determine optimal intervention yoga dosing for future studies in individuals with major depressive disorder (MDD). Methods: Subjects were randomized to the high-dose group (HDG) or low-dose group (LDG) for a 12-week intervention of three or two intervention classes per week, respectively. Eligible subjects were 18-64 years old with MDD, had baseline Beck Depression Inventory-II (BDI-II) scores ≥14, and were either on no antidepressant medications or on a stable dose of antidepressants for ≥3 months. The intervention included 90-min classes plus homework. Outcome measures were BDI-II scores and intervention compliance. Results: Fifteen HDG (Mage=38.4±15.1 years) and 15 LDG (Mage=34.7±10.4 years) subjects completed the intervention. BDI-II scores at screening and compliance did not differ between groups (p=0.26). BDI-II scores declined significantly from screening (24.6±1.7) to week 12 (6.0±3.8) for the HDG (-18.6±6.6; p < 0.001), and from screening (27.7±2.1) to week 12 (10.1±7.9) in the LDG (-17.7±9.3; p < 0.001). There were no significant differences between groups, based on response (i.e., >50% decrease in BDI-II scores; p=0.65) for the HDG (13/15 subjects) and LDG (11/15 subjects) or remission (i.e., number of subjects with BDI-II scores <14; p=1.00) for the HDG (14/15 subjects) and LDG (13/15 subjects) after the 12-week intervention, although a greater number of subjects in the HDG had 12-week BDI-II scores ≤10 (p=0.04). Conclusion: During this 12-week intervention of yoga plus coherent breathing, depressive symptoms declined significantly in patients with MDD in both the HDG and LDG. Both groups showed comparable compliance and clinical improvements, with more subjects in the HDG exhibiting BDI-II scores ≤10 at week 12.

Independent state health surveys: responding to the need for local population health data.

CONTEXT: There is high demand for local-level population health data. A national system of state and local data collection would help improve both population health and health care delivery. The primary source of state-level population health data for adults is the Behavioral Risk Factor Surveillance System. However, many states need data on children and adolescents, racial and ethnic subpopulations, consistent estimates for localities, or more in-depth information on key topics than the Behavioral Risk Factor Surveillance System provides. Eleven state health surveys (SHSs) have emerged in an effort to address these gaps. DESIGN: Semistructured telephone interviews were conducted in 2009 with representatives of 9 SHSs. The interviews were recorded, and data were transcribed, organized, and analyzed according to the query structure. This analysis identified (1) the core elements of SHS that have been successful in meeting needs for local data and (2) the processes and strategies used by state officials in creating these surveys. RESULTS: Key findings include the following: (1) SHSs provide concrete data on local health issues that meet the needs of policy makers who wish to adopt evidence-based public health policies; (2) data from SHSs allow researchers to identify issues, apply for grants, and evaluate, assess, and track health indicators; (3) a "champion" is required to build the case for a survey and push through barriers to obtain funding and stakeholder buy-in; and (4) SHSs face challenges such as inconsistent funding and lack of uniform standards. CONCLUSION: Opportunities to support SHSs include (1) identifying sustained funding sources; (2) providing technical assistance and facilitating training to foster best practices, quality standards, and comparability across states; and (3) supporting an organization for SHS researchers to share resources, information, and experiences.

Occupation as an independent risk factor for binge drinking.

BACKGROUND: Understanding associations between binge drinking and occupation is important from economic and public health perspectives. OBJECTIVE: While unadjusted differences in binge drinking by occupation have been reported previously, this study tests these differences after adjusting for important common determinants. METHODS: To assess the relationship between occupation and binge drinking after adjusting for worker characteristics, a probit model was fit to data from 29,785 working-age respondents to the 2005 California Health Interview Survey. Unadjusted and adjusted marginal effects are reported. Professionals, the largest employed category, were the referent. RESULTS: Professionals had a binge drinking risk of 16.6%. Before adjustment, workers in several occupational groups had higher risk compared to professionals, including those in installation (15.2 percentage points higher; 95% CI: 9.2, 21.1), construction (14.8 percentage points higher; 95% CI: 10.4, 19.2), and sales (6.9 percentage points higher; 95% CI: 4.0, 9.9), while those without employment had a 6.6 point lower risk (95% CI: -8.4, -4.9). After adjustment, workers employed in installation were 6.7 points (95% CI: 1.8, 11.7), construction 4.8 points (95% CI: 1.0, 8.6), and salespersons 5.3 points (95% CI: 2.8, 7.7) more likely to binge drink relative to professionals. No significant adjusted differences in risk between professionals and those without a job were found. CONCLUSIONS: This study demonstrates binge drinking varies significantly across occupations. Adjusting for worker characteristics accounted for much of the unadjusted relationship between employment in physically demanding occupations (e.g., installation, construction) and binge drinking. Distinguishing between occupation- and employee-level determinants of alcohol misuse may improve employee assistance programs and preventive services.

States' use of local population health data: comparing the Behavioral Risk Factor Surveillance System and independent state health surveys.

OBJECTIVES: To identify and compare key features of independent comprehensive state health surveys (SHS) with those of the Behavioral Risk Factor Surveillance System (BRFSS) for addressing the need for statewide and local population health data. METHODS: We developed inclusion criteria, systematically collected information about federal and SHS that met these criteria, and obtained supplemental information from SHS leaders. RESULTS: We identified comprehensive independent SHS in 11 states and BRFSS surveys in all 50 states. The independent SHS meet important statewide and local data needs, filling 3 key health data gaps in the BRFSS: lack of adequate data on special populations such as children, lack of data on specific localities, and limited depth and scope of health topics surveyed on key issues such as health insurance coverage. Unlike BRFSS, independent SHS have limited comparability with each other. CONCLUSIONS: The BRFSS and independent SHS each meet some key state and local data needs but result in data gaps and inefficient use of resources. Surveys could more effectively and efficiently meet future needs for comparable data to monitor health care reform and address health disparities if they were coordinated across states and at the national, state, and local levels.

Underinsurance in the United States: an interaction of costs to consumers, benefit design, and access to care.

Underinsurance is most commonly defined as the state in which people with medical coverage are still exposed to financial risk. We argue that the adequacy of health insurance coverage should also be assessed in terms of the adequacy of specific benefits coverage and access to care. Underinsurance can be understood conceptually as comprising three separate domains: (a) the economic features of health insurance, (b) the benefits covered, and (c) access to health services. The literature provides ample evidence that people who are underinsured have high financial risk and face barriers in access to care similar to those who are completely uninsured. In response to the growing recognition of the problems associated with underinsurance, the Patient Protection and Affordable Care Act of 2010 includes numerous provisions designed to limit costs to consumers, to assure a minimum set of benefits, and to enhance access to care, especially primary care.

Uncorrected refractive error among first-grade students of different racial/ethnic groups in southern California: results a year after school-mandated vision screening.

CONTEXT: The California Department of Education requires that kindergartners receive vision screening in preparation for school. Information is not available in the literature, however, on the prevalence of and factors associated with uncorrected refractive error (ie, the lack of eyeglasses), which is the primary cause of decreased visual acuity in children, among first-grade students of different racial/ethnic groups in California. OBJECTIVE: To determine the proportion of first-grade students with decreased visual acuity who need eyeglasses but do not have any and whether the lack of eyeglasses is associated with racial/ethnic and other factors. SETTING: Three school districts in Southern California. PARTICIPANTS: The University of California, Los Angeles Mobile Eye Clinic examined the eyes of 11 332 first-grade students over a 7-year period. Statistical analyses included adjusted logistic regression and linear trend models. FINDINGS: Among 11 332 first-grade students, 6973 (61.5%) were Latino, 1511 (13.3%) were Asian/Pacific Islander, 1422 (12.5%) were African American, 310 (2.7%) were non-Hispanic white, and 1116 (9.8%) were from other or mixed races/ethnicities. The prevalence of decreased visual acuity was 8.0%; 95% of children with decreased visual acuity (858 of 906 children) lacked eyeglasses that would have helped them attain normal vision. The lack of eyeglasses was more common in boys and African American/Latino children compared with that in girls and non-Hispanic white children, respectively. The percentage of children lacking eyeglasses over the years exhibited an increasing linear trend (R = 0.86). CONCLUSIONS: Most first-grade students with decreased visual acuity, especially African American and Latino children, need eyeglasses but do not have any. Interventions to correct decreased visual acuity in first-grade students are important because the first grade is a period of critical academic development.

Association between prior experiences of discrimination and patients' attitudes towards health care providers collecting information about race and ethnicity.

BACKGROUND: Previously, we reported a high level of comfort among Californians for collecting race/ethnicity information by health care providers (HCPs). However, minorities were less comfortable providing race/ethnicity information and were more worried than non-Hispanic whites about the potential misuse of this information. OBJECTIVE: To determine if perceived experiences of discrimination (both in general and in medical care) were associated with comfort providing race/ethnicity information, and conversely, to worry about providing the information. DESIGN AND PARTICIPANTS: Telephone survey of 480 Californians, including 101 whites, 98 Asians, 173 Hispanics, 82 blacks, and 26 multiracial individuals. MEASUREMENTS: Comfort level giving HCPs information about race/ethnicity (measured on a 1-10 scale, with text anchors of "very uncomfortable" at 1 and "very comfortable" at 10), worry that the information could be used to discriminate against patients, and worry that the information could be used to find undocumented immigrants. Worry was measured using a four-point Likert scale- not worried at all, a little worried, somewhat worried, and very worried. Respondents were also asked about perceived discrimination in general and perceived discrimination in medical care. RESULTS: Compared to whites, Hispanics (Beta-coefficient (BC) = -1.16, SE = 0.51) and Mandarin/Cantonese-speaking Asians (BC = -1.40, SE = 0.65) reported significantly less comfort giving HCPs information about their race/ethnicity, while blacks (BC = 0.70, SE = 0.16), Hispanics (BC = 0.91, SE = 0.18), and multiracial individuals (BC = 0.63, SE = 0.24) were significantly more worried that race/ethnicity information could be used to discriminate against them. Adjusting for perceived experiences of discrimination in general and in medical care partially explained the higher discomfort and worry among minorities. CONCLUSIONS: Perceived experiences of discrimination are associated with greater discomfort and worry about providing race/ethnicity data. Health care institutions should consider how they can address the public's concerns about possible misuses of data.

Exploring nonresponse bias in a health survey using neighborhood characteristics.

OBJECTIVES: We examined potential nonresponse bias in a large-scale, population-based, random-digit-dialed telephone survey in California and its association with the response rate. METHODS: We used California Health Interview Survey (CHIS) data and US Census data and linked the two data sets at the census tract level. We compared a broad range of neighborhood characteristics of respondents and nonrespondents to CHIS. We projected individual-level nonresponse bias using the neighborhood characteristics. RESULTS: We found little to no substantial difference in neighborhood characteristics between respondents and nonrespondents. The response propensity of the CHIS sample was similarly distributed across these characteristics. The projected nonresponse bias appeared very small. CONCLUSIONS: The response rate in CHIS did not result in significant nonresponse bias and did not substantially affect the level of data representativeness, and it is not valid to focus on response rates alone in determining the quality of survey data.

Sociodemographic, family, and environmental factors associated with active commuting to school among US adolescents.

Active commuting (non-motorized transport) to school can be an important source of physical activity for children and adolescents. This research examined sociodemographic, family, and environmental characteristics associated with active commuting to or from school among 3,451 US adolescents aged 12-17 years, who responded to the 2005 California Health Interview Survey. Logistic regression results indicated that those more likely to actively commute were males, Latinos, from lower-income families, attending public school, living in urban areas, and living closer to school. Adolescents without an adult present after school and those whose parents know little about their whereabouts after school were also more likely to actively commute. Parental walking for transportation and perceptions of neighborhood safety were not associated with adolescent active commuting. Important family and individual correlates of walking or biking to school among adolescents were identified, even after adjusting for distance to school and urbanicity.

A mixed-methods approach to developing a self-reported racial/ethnic discrimination measure for use in multiethnic health surveys.

OBJECTIVE: The development of measures of self-reported racial/ethnic discrimination is an active area of research, but few measures have been validated across multiple racial/ethnic and language groups. Our goal is to develop and evaluate a discrimination measure that is appropriate for use in surveys of racially and ethnically diverse populations. METHODS: To develop our measure, we employ a mixed-methods approach for survey research, drawing from both qualitative and quantitative traditions, including literature review, cognitive testing, psychometric analyses, behavior coding as well as two rounds of field testing using a split-sample design. We tested our new measure using two different approaches to elicit self-reported experiences of racial/ethnic discrimination. RESULTS: Our new measure captures four dimensions of racial/ethnic discrimination: 1) frequency of encounters with discrimination across several domains (eg, medical care, school, work, street and other public places); 2) timing of exposure (eg recent, lifetime); 3) appraisal of discrimination as stressful; and 4) responses to discrimination. CONCLUSIONS: Because of the growing interest in measurement of racial/ethnic discrimination in health surveys, we think this report on the methods informing the development and testing of the discrimination module that will be used on the California Health Interview Survey would be useful to other researchers. The application of mixed methods to rigorously test the validity and reliability of our instrument proves to be a good roadmap for measuring racial/ethnic discrimination in multicultural and multilingual populations.

Switching health insurance and its effects on access to physician services.

BACKGROUND: This study examines the factors associated with discontinuous health insurance coverage without periods of uninsurance during the past year (ie, switching coverage), and whether it has a detrimental effect on basic access to care. RESEARCH DESIGN: We analyze the 2003 California Health Interview Survey samples of adults, ages 19-64 (n = 32,850) and children, ages 0-18 (n = 13,062), using weighted bivariate and multivariate analyses. We stratified the population first by age (modeling adults separately from children) and then by health status (modeling the full population and the population reporting fair or poor health separately). RESULTS: Income, race/ethnicity, age, gender, and rural status were significant factors associated with switching coverage. Adults who switched insurance had significantly reduced odds of having a usual source of care [odds ratio (OR) = 0.63, P < 0.001)] compared with those with continuous coverage. In addition, adults and children who switched coverage were significantly more likely to report delaying care because of cost or insurance issues (adults: OR = 1.65, P < 0.001; children: OR = 2.00, P < 0.001). Children in fair or poor health who switched insurance coverage had much higher odds of reporting a delay in care (OR = 5.48, P < 0.001). CONCLUSIONS: Children and adults had disruptions in their basic access to health care when they experienced discontinuous insurance. These findings highlight the advantages of retention of enrollees as one means of promoting access to health care, in the short term, and the benefit of a continuous national health insurance program in the long term.

Physical activity among adolescents. When do parks matter?

BACKGROUND: The availability of places to engage in physical activity may influence physical activity levels. This study examined whether the relationship between physical activity and access to parks differs depending on adolescents' sociodemographic, housing, and neighborhood characteristics. METHODS: Data were analyzed from 4010 adolescents who responded to the 2003 California Health Interview Survey (CHIS). Analyses were conducted in 2005-2006. Five sets of logistic regressions were conducted to examine the relationship between physical activity and access to a safe park among adolescents living in (1) urban versus rural areas; (2) apartment buildings versus houses, (3) neighborhoods perceived as unsafe versus safe; (4) lower- versus higher-income families; and (5) adolescents who were Latino, African American, Asian, or white. Analyses also examined interactions between park access and these factors. RESULTS: Access to a safe park was positively associated with regular physical activity and negatively associated with inactivity for adolescents in urban areas, but not rural areas. Additionally, adolescents with access to a safe park were less likely to be inactive than those without access among those living in (1) apartment buildings, (2) unsafe neighborhoods, and (3) lower-income families. Park access was not associated with regular physical activity for these groups. The association between park access and physical activity varied by race/ethnicity. CONCLUSIONS: These findings suggest that the relationship between physical activity and access to parks differs depending on adolescents' sociodemographic, housing, and neighborhood characteristics, and that parks may be particularly important for promoting physical activity among urban adolescents.

Who is using emergency contraception? Awareness and use of emergency contraception among California women and teens.

INTRODUCTION: Emergency contraception (EC) reduces women's risk for pregnancy after unprotected intercourse, and women's awareness of the method is increasingly important for expanding access. However, knowledge of EC alone does not predict use, and few population data exist to describe EC use among those aware of the method. METHODS: Using data from the 2003 California Health Interview Survey, we measured EC awareness among 11,392 women ages 15-44, and EC use among 7,178 respondents who were aware of EC and at risk for pregnancy. Using chi(2) analyses and multivariable logistic regression, we examined population characteristics that epidemiologically predict EC awareness and use, including age, race/ethnicity, income, health insurance status, usual source of health care, immigration status, languages spoken at home, and urban versus rural residence. RESULTS: Nearly 76% of respondents had heard of EC, but awareness was lower among teens, women of color, poor women, women with publicly funded health insurance, those without a usual source of care, immigrants, non-English-language speakers, and rural residents. Among women aware of EC, about 4% reported having used the method in the previous year; young age, low income, attending a community/government clinic for care or not having a source of care, and living in an urban area significantly increased the odds for using EC. CONCLUSIONS: Among California women in 2003, awareness and use of EC remained low. However, similar rates of use were reported among racial, ethnic, and linguistic subgroups. Those most likely to report use of the method included population groups at high risk for unintended pregnancy.

Accuracy in self-reported health insurance coverage among Medicaid enrollees.

The largest portion of the Medicaid undercount is caused by survey reporting error--that is, Medicaid recipients misreport their enrollment in health insurance coverage surveys. In this study, we sampled known Medicaid enrollees to learn how they respond to health insurance questions and to document correlates of accurate and inaccurate reports. We found that Medicaid enrollees are fairly accurate reporters of insurance status and type of coverage, but some do report being uninsured. Multivariate analyses point to the prominent role of program-related factors in the accuracy of reports. Our findings suggest that the Medicaid undercount should not undermine confidence in survey-based estimates of uninsurance.

Determinants of children's participation in California's Medicaid and SCHIP programs.

OBJECTIVE: To develop a comprehensive predictive model of eligible children's enrollment in California's Medicaid (Medi-Cal [MC]) and State Children's Health Insurance Program (SCHIP; Healthy Families [HF]) programs. DATA SOURCES/STUDY SETTING: 2001 California Health Interview Survey data, data on outstationed eligibility workers (OEWs), and administrative data from state agencies and local health insurance expansion programs for fiscal year 2000-2001. STUDY DESIGN: The study examined the effects of multiple family-level factors and contextual county-level factors on children's enrollment in Medicaid and SCHIP. DATA COLLECTION/EXTRACTION METHODS: Simple logistical regression analyses were conducted with sampling weights. Hierarchical logistic regressions were run to control for clustering. PRINCIPAL FINDINGS: Participation in MC and HF programs is determined by a combination of family-level predisposing, perceived need, and enabling/disabling factors, and county-level enabling/disabling factors. The strongest predictors of MC enrollment were family-level immigration status, ethnicity, and income, and the presence of a county-level "expansion program"; and the county-level ratio of OEWs to eligible children. Important HF enrollment predictors included family-level ethnicity, age, number of hours a parent worked, and urban residence; and county-level population size and outreach and media expenditure. CONCLUSIONS: MC and HF outreach/enrollment efforts should target poorer and immigrant families (especially Latinos), older children, and children living in larger and urban counties. To reach uninsured eligible children, it is important to further simplify the application process and fund selected outreach efforts. Local health insurance expansion programs increase children's enrollment in MC.

Treatment of Major Depressive Disorder with Iyengar Yoga and Coherent Breathing: A Randomized Controlled Dosing Study.

OBJECTIVES: The aims of this study were to assess the effects of an intervention of Iyengar yoga and coherent breathing at five breaths per minute on depressive symptoms and to determine optimal intervention yoga dosing for future studies in individuals with major depressive disorder (MDD). METHODS: Subjects were randomized to the high-dose group (HDG) or low-dose group (LDG) for a 12-week intervention of three or two intervention classes per week, respectively. Eligible subjects were 18-64 years old with MDD, had baseline Beck Depression Inventory-II (BDI-II) scores ≥14, and were either on no antidepressant medications or on a stable dose of antidepressants for ≥3 months. The intervention included 90-min classes plus homework. Outcome measures were BDI-II scores and intervention compliance. RESULTS: Fifteen HDG (Mage = 38.4 ± 15.1 years) and 15 LDG (Mage = 34.7 ± 10.4 years) subjects completed the intervention. BDI-II scores at screening and compliance did not differ between groups (p = 0.26). BDI-II scores declined significantly from screening (24.6 ± 1.7) to week 12 (6.0 ± 3.8) for the HDG (-18.6 ± 6.6; p < 0.001), and from screening (27.7 ± 2.1) to week 12 (10.1 ± 7.9) in the LDG (-17.7 ± 9.3; p < 0.001). There were no significant differences between groups, based on response (i.e., >50% decrease in BDI-II scores; p = 0.65) for the HDG (13/15 subjects) and LDG (11/15 subjects) or remission (i.e., number of subjects with BDI-II scores <14; p = 1.00) for the HDG (14/15 subjects) and LDG (13/15 subjects) after the 12-week intervention, although a greater number of subjects in the HDG had 12-week BDI-II scores ≤10 (p = 0.04). CONCLUSION: During this 12-week intervention of yoga plus coherent breathing, depressive symptoms declined significantly in patients with MDD in both the HDG and LDG. Both groups showed comparable compliance and clinical improvements, with more subjects in the HDG exhibiting BDI-II scores ≤10 at week 12.

Variation in complementary and alternative medicine (CAM) use across racial/ethnic groups and the development of ethnic-specific measures of CAM use.

OBJECTIVES: The use of complementary and alternative medicine (CAM) is likely to vary among racial/ethnic groups because its use is related to cultural and health beliefs. Understanding patterns of CAM use among ethnic groups could inform clinical practice and the study of CAM use in a diverse population. The authors compared CAM use among Asian-Americans, American Indians, African Americans, Latinos, whites, and other racial/ethnic groups in order to develop ethnic-specific measures of CAM use and explore factors associated with such CAM use across ethnic groups. DESIGN: A cross-sectional survey of a sample of 9187 adults representative of the California population was performed. OUTCOME MEASURES: Ethnic-specific constructs for Asian-Americans, American Indians, African Americans, Latinos, and whites were devised. RESULTS: The authors identified ethnic-specific CAM modalities for each ethnic group. Demographic and clinical factors associated with use of ethnic-specific CAM differed from the predictors of overall CAM use in the general population and varied by ethnicity. CONCLUSIONS: Patterns of CAM use and ethnic-specific CAM use vary across racial/ethnic groups. Evaluation of CAM use in ethnically diverse populations should recognize ethnic-specific modalities and variation across ethnicity.

Language barriers to health care access among Medicare beneficiaries.

This study examined language barriers to health care access among a population-based sample of Medicare seniors in California in 2001 and 2003. Results indicate that Medicare beneficiaries with limited English proficiency (LEP) had less access to a usual source of care and were less likely to receive preventive cancer screening tests. LEP Medicare beneficiaries who also were covered by Medicaid tended to fare better than those without Medicaid. This could be due to federal civil rights rules that require Medicaid health care providers to offer free language assistance, but exclude from these requirements physicians who provide only Medicare services. Findings suggest the federal government should take steps to reduce language barriers in Medicare.

The impact of private and public health insurance on medication use for adults with chronic diseases.

This article examines the impact of public and private health insurance on the use of medications for California adults with any of four chronic diseases: heart disease, high blood pressure, diabetes, and asthma. The data set used is the 2001 California Health Interview Survey. Multivariate analyses were conducted on individuals who had been diagnosed with each of these diseases. Controlling for various demographic, health status, and employment characteristics, the authors find that the uninsured are far less likely to be taking medications for each of the conditions than those with private insurance. Interestingly, those with Medicaid coverage are even more likely than those with private insurance to be taking such medications. The results of this study underscore the importance of health insurance for all persons with chronic conditions and the benefits of Medicaid in particular for low-income adults with chronic conditions.

Community-based participatory research in the California Health Interview Survey.

INTRODUCTION: The California Health Interview Survey, the largest state health survey in the United States, uses community-based participatory research principles to develop each cycle. Other large-scale health surveys rarely include participatory research approaches. Every 2 years, the California Health Interview Survey generates state and local population-based data on health insurance coverage, access to health care, chronic disease prevalence and management, health behaviors and disease prevention, and other health issues in California. The survey is used for policy and program development, advocacy, and research. METHODS: The development of the California Health Interview Survey involves more than 145 people from more than 60 state and local policymaking bodies, public health agencies, advocacy groups, research organizations, and health care organizations. They participate as volunteers in an advisory board, on technical advisory committees, and in work groups that interact with California Health Interview Survey research staff in an accountable advisory process that shapes survey topics, measures, and sample design and determines languages selected for translation. Survey results and data are provided to the communities involved in the survey. RESULTS: California Health Interview Survey data have been widely used by local, state, and national public health leaders, policymakers, advocates, and researchers to improve access to health insurance and health care services and to develop and target prevention programs for obesity and chronic illnesses. CONCLUSION: The California Health Interview Survey participatory research model has been an effective approach to planning and implementing a health survey and should be considered by developers of other large health surveys.