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 |
File Type | application/msword |
Author | goodmann |
Last Modified By | NCI User |
File Modified | 2011-06-24 |
File Created | 2011-06-24 |