Centers for Disease Control and Prevention National Center for Health Statistics

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1 Wireless-Only and Wireless-Mostly Households: A growing challenge for telephone surveys Stephen Blumberg sblumberg@cdc.gov Julian Luke jluke@cdc.gov Centers for Disease Control and Prevention National Center for Health Statistics Percentage of U.S. Households Without Landline Telephones Based on National Health Interview Survey data 17.5% of households h have only wireless telephones Early 3 Late 5 Early 1

2 Goals of this Presentation Describe the telephone coverage of the U.S. household population, with a particular focus on persons who have substituted wireless telephones for landline telephones Examine the potential bias that may result when health surveys exclude households without landline telephones National Health Interview Survey In-person survey of the civilian noninstitutionalized U.S. population Annual household-level level response rates are very high (6-92%) Includes questions on residential telephone numbers to permit recontact of participants 3: Added d questions on working cellular l telephones 7: Added questions on relative frequency of calls received on landlines and cell phones 2

3 1 Percentage of adults and percentage of children living in households with only wireless telephone service or no telephone service: United States, Percent January 5 June Adults with no telephone service July 5 December 5 Adults with wireless service only January 6 June July 6 December Children with no telephone service January 7 June Children with wireless service only July 7 December January June Prevalence of Wireless-Only Adults by Home Ownership Status % of adults renting their home % of adults owning or buying their home Jul ' Dec ' Jan '5 Jun '5 Jul '5 Dec '5 Jan '6 Jun '6 Jul '6 Dec '6 Jan '7 Jun '7 Jul '7 Dec '7 Jan ' Jun ' 3

4 Prevalence of Wireless-Only Adults by Household Structure % of adults living with roommates Jul ' Dec ' Jan '5 Jun '5 Jul '5 Dec '5 Jan '6 Jun '6 Jul '6 Dec '6 Jan '7 Jun '7 Jul '7 Dec '7 Jan ' Jun ' 2.6% of adults living alone 15.1% of adults living i with children.5% of adults living with related adults Prevalence of Wireless-Only Adults by Age % of % of % of 3-9.2% of 5-6 Jul ' Dec ' Jan '5 Jun '5 Jul '5 Dec '5 Jan '6 Jun '6 Jul '6 Dec '6 Jan '7 Jun '7 Jul '7 Dec '7 Jan ' Jun ' 2.% of 65+

5 Prevalence of Wireless-Only Adults by Sex 2 1.% of men 1.% of women Jul ' Dec ' Jan '5 Jun '5 Jul '5 Dec '5 Jan '6 Jun '6 Jul '6 Dec '6 Jan '7 Jun '7 Jul '7 Dec '7 Jan ' Jun ' Prevalence of Wireless-Only Adults by Race/Ethnicity % of Hispanic adults 1.5% of Black nonhispanic adults 1.6% of White nonhispanic adults Jul ' Dec ' Jan '5 Jun '5 Jul '5 Dec '5 Jan '6 Jun '6 Jul '6 Dec '6 Jan '7 Jun '7 Jul '7 Dec '7 Jan ' Jun ' 5

6 Prevalence of Wireless-Only Adults by Household Poverty Status % of adults in poverty 22.6% of adults near poverty 1.2% of higher income adults Jul ' Dec ' Jan '5 Jun '5 Jul '5 Dec '5 Jan '6 Jun '6 Jul '6 Dec '6 Jan '7 Jun '7 Jul '7 Dec '7 Jan ' Jun ' Prevalence of Wireless-Only Adults by Metropolitan Statistical Area Status % of adults in MSAs 1.9% of adults not in MSAs Jul ' Dec ' Jan '5 Jun '5 Jul '5 Dec '5 Jan '6 Jun '6 Jul '6 Dec '6 Jan '7 Jun '7 Jul '7 Dec '7 Jan ' Jun ' 6

7 Prevalence of Wireless-Only Adults by Geographic Region % in South 17.% in Midwest 13.7% in West 9.% in Northeast Jul ' Dec ' Jan '5 Jun '5 Jul '5 Dec '5 Jan '6 Jun '6 Jul '6 Dec '6 Jan '7 Jun '7 Jul '7 Dec '7 Jan ' Jun ' Coverage Bias Two factors determine the degree of coverage bias due to telephone ownership in a telephone survey: The percentage of persons without landline telephones in the population of interest The magnitude of the difference between persons with and without landline telephones for the variable of interest 7

8 Health Characteristics Examined Health-related behaviors 5+ alcoholic drinks in one day (past year) Smoking (current) Leisure-time physical activity (regularly) Health status Excellent or very good health status Serious psychological distress (past 3 days) Obesity Asthma episode (past year) Diabetes (ever diagnosed) Health care service use Has a usual place to go for medical care Received influenza vaccine (past year) Tested for HIV (ever) Financial barrier to needed care (past year) Uninsured (current) For these 13 estimates, preliminary weighted data from July December 7 were produced by the NHIS Early Release Program. Percent of U.S. Adults with Various Health Characteristics, by Phone Status Has a landline telephone Wireless- only No telephone July December 7 5+ alcoholic drinks in 1 day Current smoker Psychological distress Health excellent / very good Ever diagnosed with diabetes Regular physical activity

9 Percent of U.S. Adults with Various Health Characteristics, by Phone Status Has a landline telephone No telephone July December 7 Uninsured (when interviewed) Financial barriers to care Has a usual place for care Flu vaccination Ever tested for HIV Percent of Young Adults with Various Health Characteristics, by Phone Status Has a landline telephone Wireless- only Wireless- only January December 7 5+ alcoholic drinks in 1 day Current smoker Regular physical activity 33.. Has a usual place for care Uninsured (when interviewed)

10 Potential Bias (in Percentage Points) if an RDD Survey Only Includes Landlines January December 7 Young Adults 1-29 Statistically significant bias after controlling for demographic characteristics 5+ alcoholic drinks in 1 day 6..9 Current smoker 2.5 Regular physical activity Has a usual place for care. 3.1 Uninsured (when interviewed) Potential Bias (in Percentage Points) if an RDD Survey Only Includes Landlines January December 7 Low- Income Adults Statistically significant bias after controlling for demographic characteristics 5+ alcoholic drinks in 1 day.9 3. Current smoker Regular physical activity 2..9 Has a usual place for care Uninsured (when interviewed)

11 Potential Bias in Uninsurance Estimates January December 7 Without Adjustment With Adjustment for 1 Demographic Characteristics With Partial Adjustment (Age, Sex, Race/Ethnicity, Education) All Adults Young Adults (1-29) Low-Income Adults All of these estimates of potential bias are statistically significant, p <.5. Percent Distribution of Household Telephone Status for Adults, January-June June Phoneless: 2.1% Unknown:.% Wireless Only:.1% Landline Only: 17.9% Wireless Mostly: 1.% Landline with Some Wireless:.6% 11

12 Percent of Adults who are Wireless-Only or Wireless-Mostly by Employment Status Last Week Wireless Mostly Wireless Only Working at a Job Keeping House Going to School Something Else or Not Employed Proportion of Adults Who Cannot Be Contacted by Landline Cannot Be Contacted: 1.2% %

13 Percent of Adults who are Wireless-Only or Wireless-Mostly by Household Structure Wireless Mostly Wireless Only Living Alone Living with Roommates Living with Related Adults..5 Adults with Children Percent of Adults who are Wireless-Only or Wireless-Mostly by Age Wireless Mostly Wireless Only 1-2 Yrs Yrs Yrs Yrs

14 What To Do About Undercoverage? Ignore this issue Make statistical ti ti adjustments t to the sampling weights Add cell-phone frames to RDD surveys and conduct interviews on cell phones Move away from RDD sampling frames 1

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