CHIS Change Request_6-14-11

Date: June 14, 2011

To: Office of Management and Budget (OMB)

Through: Mary Forbes, Report Clearance Officer, HHS

Seleda Perryman, Program Officer, Project Clearance Branch, OPERA, NIH

Vivian Horovitch-Kelley, PRA OMB Project Clearance Liaison, OMAA, NCI

From: Nancy Breen, Ph.D.

National Cancer Institute/NIH

Subject: Non-substantive Change Request for:

California Health Interview Survey Cancer Control Module (CHIS-CCM) 2011,

OMB No. 0925-0598, Expiry Date 4/30/2014.

This is to request a non-substantive change request for the research project titled, “California Health Interview Survey Cancer Control Module (CHIS-CCM) 2011” (OMB No. 0925-0598, Expiry Date 4/30/2014).

NCI had included a series of survey items on Pap testing that were somehow removed from the final OMB package. We had fielded these questions or a subset thereof in all OMB approved surveys from 2001-2007. In 2007 we added a new question set on Human Papillomavirus (HPV) for adults and age-eligible children. Since we were still analyzing data from the CHIS 2007 questions in 2009, we removed them for one round of CHIS and we also removed the Pap test questions in 2009. Unfortunately, the NCI review of the final version of the CHIS instrument indicated that the Pap testing questions and the HPV questions for the age-eligible children that follow were missing from the 2011 OMB package. In addition, there were three questions regarding the new recommended guidelines for mammography screening that were left out of the CCM.

NCI has deleted questions on Prostate-Specific Antigen (PSA) testing, family history of cancer, two questions on hormone therapy, and questions related to cost-sharing of screening tests so as to not increase the burden by adding in the Pap Test, HPV, and mammography questions. Additional minor changes to the skip pattern and wording of some questions have been illustrated by the use of track changes in Attachment 1.

Additions:

Pap Test

Q_ID	Label	% of Base Sample	Anticipated Sample Size
QA11_B5	E VER HAD PAP TEST?	60.0%	28,776
QA11_B6	HOW MANY IN LAST 6 YEARS	57.5%	27,619
QA11_B7	HOW LONG SINCE MOST RECENT	50.7%	24,317
QA11_B8	PAY FOR COST OF PAP TEST?	34.4%	16,512
QA11_B9	MAIN REASON NOT HAD PAP IN LAST 3 YRS	13.2%	6,355
QA11_B10	DR RECOMMEND PAP IN PAST 3 YRS	55.9%	26,822
QA11_B11	WHEN EXPECT NEXT PAP	4.2%	2,030
QA11_B12	WERE RESULTS EVER NOT NORMAL	53.6%	25,728

Parental Consent for HPV Vaccine
Q_ID	Label	% of Base Sample	Anticipated Sample Size
QA11_C12	E VER HEARD OF HPV VACCINE	11.2%	5,386
QA11_C13	TEEN DAUGHTER EVER RECEIVE HPV VACCINE	7.5%	3,600
QA11_C14	TEEN DAUGHTER RECEIVE ALL THREE DOSES	1.6%	751
QA11_C15	IF DOCTOR RECOMMNEDED, WOULD GET VACCINE	8.8%	4,239
QA11_C16	MAIN REASON FOR NOT GETTING VACCINE	3.9%	1,855
QA11_C17	IS COST A REASON FOR NOT GETTING VACCINE	3.9%	1,855
QA11_C18	CHILD DAUGHTER EVER RECEIVE HPV VACCINE	0.9%	408
QA11_C19	CHILD DAUGHTER RECEIVE ALL THREE DOSES	0.2%	72
QA11_C20	IF DOCTOR RECOMMNEDED, WOULD GET VACCINE	0.9%	408
QA11_C21	MAIN REASON FOR NOT GETTING VACCINE	0.4%	180
QA11_C22	IS COST A REASON FOR NOT GETTING VACCINE	0.4%	180

Mammography

Q_ID	Label	% of Base Sample	Anticipated Sample Size
QA11_A17	DOCTOR EVER RECOMMEND MAMMOGRAM BIENNIALLY	9.9%	4,744
QA11_A18	DOCTOR EVER TALK ABOUT WHEN WOMEN GET MAMMOGRAM	14.1%	6,744
QA11_A19	DOCTOR EVER TALK ABOUT STOPPING MAMMOGRAMS	13.5%	6,456

Deletions:

Family History of Cancer
Previous Q_ID	Label	% of Base Sample	Anticipated Sample Size
QA11_E1	FAMILY HISTORY OF CANCER	100.0%	48,000
QA11_E2	BLOOD RELATIVE EVER HAVE ANY KIND CANCER	45.2%	21,701
QA11_E3	TYPE OF CANCER	5.2%	2,515
QA11_E4	MOTHER EVER DIAGNOSED WITH BREAST CANCER	7.3%	3,499
QA11_E5	SISTER EVER DIAGNOSED WITH BREAST CANCER	7.3%	3,499
QA11_E6	NUMBER OF SISTERS WITH BREAST CANCER	2.5%	1,190
QA11_E7	WHO DIAGNOSED WITH COLON/RECTAL CANCER	5.9%	2,813
QA11_E8	NUM FAM MEMBERS WITH COLON/RECTAL CANCER	1.5%	715

Prostate-Specific Antigen (PSA) Test
Previous Q_ID	Label	% of Base Sample	Anticipated Sample Size
QA11_A18	EVER HEARD OF PSA TEST	31.3%	15,029
QA11_A19	EVER HAD A PSA TEST	31.8%	15,245
QA11_A20	HOW LONG SINCE LAST PSA TEST	17.1%	8,184
QA11_A21	PAY FOR COST OF PSA TEST	17.1%	8,184
QA11_A22	PSA PROVIDED THROUGH SPECIAL LOW COST PROGRAM	8.6%	4,092
QA11_A23	REASON FOR LAST PSA TEST	17.1%	8,184
QA11_A24	DR TALK ABOUT [DIS]ADVANTAGES PSA TEST	23.8%	11,405
QA11_A25	DR TELL SOME DRS [NOT]RECOMMEND PSA TEST	23.8%	11,405
QA11_A26	DR RECOMMEND HAVE PSA TEST	23.8%	11,405

Hormone Therapy

Previous Q_ID

Label

% of Base Sample

Anticipated Sample Size

QA11_B5

TAKING TAMOXIFEN

42.2%

20,246

QA11_B6

TAKING RALOXIFENE

42.2%

20,246

Mammography

Previous Q_ID	Label	% of Base Sample	Anticipated Sample Size
QA11_A34	MAMMOGRAM PROVIDED THROUGH SPECIAL LOW COST PROGRAM	15.9%	7,642

Colo-Rectal Cancer Screening

Previous Q_ID	Label	% of Base Sample	Anticipated Sample Size
QA11_A5	FOBT PROVIDED THROUGH SPECIAL LOW COST PROGRAM	8.0%	3,828
QA11_A10	COLONOSCOPY PROVIDED THROUGH SPECIAL LOW COST PROGRAM	5.2%	2,496
QA11_A15	SIGMOIDOSCOPY PROVIDED THROUGH SPECIAL LOW COST PROGRAM	0.8%	456

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