Mobile phone and interactive computer interviewing to measure HIV-related risk behaviours: the impacts of data collection methods on research results

Adding Insult to Injury: Everyday Discrimination Moderates Stressor-Related Negative Affect

Studies examining the effects of discrimination on emotional well-being have often overlooked (a) differential effects of both everyday and lifetime discrimination and (b) how both types of discrimination may exacerbate stressor-related affect-even when daily stressors are unrelated to discrimination. The current study examined the effects of daily stressors not attributed to discrimination (i.e., nondiscrimination-related daily stressors) on daily negative and positive affect in the presence of either form of discrimination (everyday and lifetime). Participants who completed the second wave of the Survey of Midlife Development in the US (MIDUS-II) and the National Study of Daily Experiences (NSDE-II) answered questionnaires about everyday and lifetime discrimination. Later, they completed daily phone interviews across 8 consecutive days, asking about the nondiscrimination-related daily stressors and the positive and negative affect they had experienced that day. Multilevel model analyses revealed that everyday discrimination was associated with decreased daily positive affect and lifetime discrimination was associated with increased daily negative affect. Moreover, higher frequency of everyday discrimination exacerbated the within-person effects of nondiscriminatory daily stressors on negative affect. Results underscore the importance of considering both independent and synergistic effects of discrimination on daily emotional well-being.

Trend and Factors Associated with Condom Use Among Male Clients of Female Sex Workers in Hong Kong: Findings of 13 Serial Behavioural Surveillance Surveys

This study investigated the trend and associated factors of condom use among male clients of female sex workers (CFSW) in Hong Kong. A total of 25,443 males of the general population were screened to identify 2,330 CFSW via 13 rounds of population-based serial cross-sectional telephone surveys during 1998 through 2015. Over time, there were no significant changes in condom use with various types of female sex partners (p ranged 0. 219-0.837) and prevalence of self-reported STI (p = 0.975) in the past 6 months. Decrease in the prevalence of non-regular sex partners (p < 0.001) and increase in perceived efficacy of condom use for HIV prevention (p = 0.028) were observed. Perceived efficacy of condom use for HIV prevention and self-reported STI experience were significantly associated with condom use with various types of female sex partners in the past 6 months. No evident improvement for condom use was found. Tailored intervention programs are warranted.

Building the Evidence Base for Remote Data Collection in Low- and Middle-Income Countries: Comparing Reliability and Accuracy Across Survey Modalities

Background

Given the growing interest in mobile data collection due to the proliferation of mobile phone ownership and network coverage in low- and middle-income countries (LMICs), we synthesized the evidence comparing estimates of health outcomes from multiple modes of data collection. In particular, we reviewed studies that compared a mode of remote data collection with at least one other mode of data collection to identify mode effects and areas for further research.

Objective

The study systematically reviewed and summarized the findings from articles and reports that compare a mode of remote data collection to at least one other mode. The aim of this synthesis was to assess the reliability and accuracy of results.

Methods

Seven online databases were systematically searched for primary and grey literature pertaining to remote data collection in LMICs. Remote data collection included interactive voice response (IVR), computer-assisted telephone interviews (CATI), short message service (SMS), self-administered questionnaires (SAQ), and Web surveys. Two authors of this study reviewed the abstracts to identify articles which met the primary inclusion criteria. These criteria required that the survey collected the data from the respondent via mobile phone or landline. Articles that met the primary screening criteria were read in full and were screened using secondary inclusion criteria. The four secondary inclusion criteria were that two or more modes of data collection were compared, at least one mode of data collection in the study was a mobile phone survey, the study had to be conducted in a LMIC, and finally, the study should include a health component.

Results

Of the 11,568 articles screened, 10 articles were included in this study. Seven distinct modes of remote data collection were identified: CATI, SMS (singular sitting and modular design), IVR, SAQ, and Web surveys (mobile phone and personal computer). CATI was the most frequent remote mode (n=5 articles). Of the three in-person modes (face-to-face [FTF], in-person SAQ, and in-person IVR), FTF was the most common (n=11) mode. The 10 articles made 25 mode comparisons, of which 12 comparisons were from a single article. Six of the 10 articles included sensitive questions.

Conclusions

This literature review summarizes the existing research about remote data collection in LMICs. Due to both heterogeneity of outcomes and the limited number of comparisons, this literature review is best positioned to present the current evidence and knowledge gaps rather than attempt to draw conclusions. In order to advance the field of remote data collection, studies that employ standardized sampling methodologies and study designs are necessary to evaluate the potential for differences by survey modality.

Prevalence of and factors associated with unprotected anal intercourse with regular and nonregular male sexual partners among newly diagnosed HIV-positive men who have sex with men in China

OBJECTIVES

This study investigated the prevalence of, and multi-dimensional factors associated with, unprotected anal intercourse (UAI) with regular male sexual partners ('regular partners') and nonregular male sexual partners ('nonregular partners') among newly diagnosed HIV-positive men who have sex with men (MSM) in Chengdu, China.

METHODS

A total of 225 newly diagnosed HIV-positive MSM were interviewed using a combined interviewer-computer-assisted method in Chengdu, China.

RESULTS

The prevalence of UAI with regular and nonregular partners since diagnosis was 27.7% and 33.8% among participants reporting having sex with regular and nonregular partners (n = 159 and 133), respectively. Adjusted analysis showed that: (1) cognitive variables based on the Health Belief Model (perceived susceptibility to HIV transmission and perceived severity of the consequences of HIV transmission, perceived barriers and perceived self-efficacy related to consistent condom use), (2) emotion-related variables (worry about transmitting HIV to others), (3) psychological factors (post-traumatic growth) and (4) socio-structural factors (perceived partners' responsibility for condom use) were significantly associated with UAI with regular and/or nonregular partners.

CONCLUSIONS

Interventions are warranted, and should be designed with consideration of multi-dimensional factors and be partner type-specific.

Sexual health promotion for young people delivered via digital media: a scoping review

Background

Young people are at risk of poor sexual health and are, therefore, in need of comprehensive, effective sexual health education. Young people are confident and constant users of digital technology, such as the internet and mobile phones, and there are many innovative possibilities for sexual health education involving these technologies.

Objectives

To summarise evidence on effectiveness, cost-effectiveness and mechanism of action of interactive digital interventions (IDIs) for sexual health; optimal practice for intervention development; contexts for successful implementation; research methods for digital intervention evaluation; and the future potential of sexual health promotion via digital media.

Design

Literature review of evidence on digital interventions for sexual health for young people, integrating the findings with the views of young people, parents and experts in digital media/sexual health. IDIs are defined as digital media programmes that provide health information and tailored decision support, behaviour-change support and/or emotional support. We focus on sexual well-being for young people aged 13–24 years in the UK.

Results

There are many imaginative IDIs for sexual health promotion, but few interventions address issues that are important to young people, such as sexual pleasure and relationships. It is vital to collaborate with young people and to use Behaviour-Change Theory in designing interventions. We located 19 randomised controlled trials of IDIs for sexual health promotion for young people, finding a moderate effect on sexual health knowledge [standardised mean difference (SMD) 0.54, 95% confidence interval (CI) 0.17 to 0.92], a small effect on confidence (self-efficacy) (SMD 0.11, 95% CI 0.02 to 0.20) and a positive effect on sexual behaviour (odds ratio 1.28, 95% CI 1.01 to 1.61), but no significant effects on safer sex intention or biological outcomes. One study suggests that IDIs may be as good as face-to-face interventions for sexual health knowledge and safer sex intention. There are no existing data on the cost-effectiveness of IDIs for sexual health promotion. The impact of an IDI will be determined by the proportion of the target population reached, intervention efficacy, adoption in a setting, how well it is delivered and maintenance/sustainability. All of these elements must be addressed for IDIs to be successful. More collaboration is needed to capitalise on the knowledge of users and stakeholders, the design and software skills of the commercial sector and the theoretical expertise and evaluation skills of academia.

Conclusions

IDIs are effective for knowledge acquisition and sexual behaviour, and could usefully contribute to sexual health education in schools, in clinic settings and online; however, there are obstacles to overcome, such as access to information technology and ensuring the quality and safety of interventions.

Future work

More evidence is needed on the best designs for interventions (e.g. choice of behaviour-change mechanisms and interactive features) and the best models of delivery (e.g. setting, modes of delivery, methods of facilitation and support for engagement) to improve sexual behaviour, biological outcomes and sexual well-being in a cost-effective way.

Funding

The National Institute for Health Research Public Health Research programme.

Relationship between sexual compulsivity and sexual risk behaviors among Chinese sexually active males

Compulsivity is defined as "an insistent, repetitive, intrusive, and unwanted urge to perform specific acts often in ritualized or routinized fashions." Sexual compulsivity has been shown to be associated with some high risk sexual behaviors related to HIV and sexually transmitted infection (STI). In some Western countries, the 10-item Sexual Compulsivity Scale (SCS) has been developed to assess people's sexual compulsivity but no Chinese version has been validated. This study validated the Chinese version of the SCS and investigated its associations with specific sexual behaviors. In 2008, a random telephone survey was conducted in the sexually active male general population in Hong Kong, interviewing 1,048 participants. The Chinese version of the SCS was found to be internally consistent (Cronbach's α = 0.88 for the overall scale), with a mean total score of 20.7 (SD = 4.7). An exploratory factor analysis procedure extracted two factors that were named Controllability and Functional Consequences. Higher SCS scores were associated with multiple female sexual partnerships in the last 6 months, having had sex with either non-regular partner(s) or female sex worker(s) in the last 6 months, having contracted STI in the last 6 months, and inconsistent condom use with either non-regular partner(s) or female sex worker(s) in the last 6 months. The scale can be used to assess sexual compulsivity among sexually active Chinese men in Hong Kong. It can potentially be used in other Chinese communities. Further confirmatory studies are warranted.

The Sexunzipped trial: optimizing the design of online randomized controlled trials

Background

Sexual health problems such as unwanted pregnancy and sexually transmitted infection are important public health concerns and there is huge potential for health promotion using digital interventions. Evaluations of digital interventions are increasingly conducted online. Trial administration and data collection online offers many advantages, but concerns remain over fraudulent registration to obtain compensation, the quality of self-reported data, and high attrition.

Objective

This study addresses the feasibility of several dimensions of online trial design—recruitment, online consent, participant identity verification, randomization and concealment of allocation, online data collection, data quality, and retention at 3-month follow-up.

Methods

Young people aged 16 to 20 years and resident in the United Kingdom were recruited to the “Sexunzipped” online trial between November 2010 and March 2011 (n=2036). Participants filled in baseline demographic and sexual health questionnaires online and were randomized to the Sexunzipped interactive intervention website or to an information-only control website. Participants were also randomly allocated to a postal request (or no request) for a urine sample for genital chlamydia testing and receipt of a lower (£10/US$16) or higher (£20/US$32) value shopping voucher compensation for 3-month outcome data.

Results

The majority of the 2006 valid participants (90.98%, 1825/2006) were aged between 18 and 20 years at enrolment, from all four countries in the United Kingdom. Most were white (89.98%, 1805/2006), most were in school or training (77.48%, 1545/1994), and 62.81% (1260/2006) of the sample were female. In total, 3.88% (79/2036) of registrations appeared to be invalid and another 4.00% (81/2006) of participants gave inconsistent responses within the questionnaire. The higher value compensation (£20/US$32) increased response rates by 6-10%, boosting retention at 3 months to 77.2% (166/215) for submission of online self-reported sexual health outcomes and 47.4% (118/249) for return of chlamydia urine samples by post.

Conclusions

It was quick and efficient to recruit young people to this online trial. Our procedures for obtaining online consent, verifying participant identity, automated randomization, and concealment of allocation worked well. The optimal response rate for the online sexual health outcome measurement was comparable to face-to-face trials. Multiple methods of participant contact, requesting online data only, and higher value compensation increased trial retention at 3-month follow-up.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 55651027; http://www.controlled-trials.com/ISRCTN55651027 (Archived by WebCite at http://www.webcitation.org/6LbkxdPKf).

Acceptability of circumcision among clients of female sex worker in Hong Kong

Clients of female sex workers (CFSW) are at high risk of HIV transmission. Circumcision reduces the risk of heterosexual transmission of HIV. A total of 353 CFSW were interviewed using a combined interviewer-computer-assisted method. Amongst the participants, 28.0% were circumcised, whilst 63.8% of the uncircumcised participants were willing to take up circumcision (conditioned on being briefed about a 50% potential risk reduction effect). In a stepwise logistic regression model, frequency of patronizing female sex workers and factors related to the Health Belief Model were significantly associated with conditional willingness. Amongst uncircumcised participants, 20.9% anticipated risk compensation (i.e. would use condoms less frequently after being circumcised). Adjusting for background variables, inconsistent condom use during commercial sex and self-reported STD history in the last 6 months were significantly associated with anticipated risk compensation. It is feasible to promote circumcision among CFSW but such programs also need to promote condom use.

A simple new method to triangulate self-reported risk behavior data--the bean method

BACKGROUND

Human immunodeficiency virus (HIV)/sexually transmitted disease (STD)-related interventions rely on self-reported risk behavioral data, which are biased toward social desirability. It is warranted to develop methods for data triangulation.

METHODS

Some questions on HIV/STD-related behaviors that were asked in 5 face-to-face (FTF) surveys were repeated at the end of the surveys, using the newly developed bean method (BM), which requested participants to transfer a bean of a particular color from a large jar to a smaller one, depending on whether the answer was affirmative (yellow, white, green, or red) or not (black); both jars contained 500 mixed-up colored beans. At the end of each day, the number of beans for each color was counted and was compared with the results of the FTF interviews. Participants were ensured that the researchers would not trace their responses.

RESULTS

Among female sex workers who were noninjecting drug users, the BM as compared with the FTF interviews, reported higher prevalence of inconsistent condom use in the last 6 months, unprotected sex with the last client, and STD in the last 6 months. Among men who have sex with men in Hong Kong, the BM as compared to the FTF interviews, reported higher prevalence of unprotected sex with another man and having >3 sex partners in the last 12 months. No statistically significant between-method differences were reported among injecting drug users.

CONCLUSIONS

Results of HIV/STD-related behaviors are dependent on mode of data collection. The simple BM can be used regularly to triangulate self-reported HIV-related behavioral data obtained from FTF interviews.

Cross-boundary substance uses among Hong Kong Chinese young adults

The study documents the characteristics of Hong Kong residents who used substances in mainland China. Characteristics of such users were compared with those using substances elsewhere. A cross-sectional survey was used. Data analyses were stratified by gender, and multivariate analyses were performed. Respondents, Hong Kong adults aged 18-30 (n = 6,528), were interviewed using a mixed interviewer and computerized mobile phone method, at the Hong Kong-mainland China boundary. Cross-border substance users and other types of substance users had characteristics that were quite different (e.g., education level, perceived harmfulness of substance use in general, having friends who frequently used substances in mainland China). Cross-boundary substance users also found it easier to obtain substances in mainland China than in Hong Kong (males: 60.5%, females: 39.6%) and perceived no chance of being arrested in mainland China because of substance use (men: 28.8%, women: 24.5%). They tended to use substances in discos/rave parties together with friends (men: 77%, women: 81%), and substances were often obtained for free (men: 63.2%, women: 78%). Ecstasy and ketamine were often used (men: 86.5% & 79.4%, women: 81% & 70.2%), and multiple uses of different substances were common (men: 81.3%, women: 68.6%). Lower price, peer influence, and better availability were reasons behind cross-boundary substance use behaviors. Cross-boundary substance users have specific characteristics. Prevention policies should take these characteristics into account. Regional collaborations are highly warranted.

Prevalence and psychological correlates of complicated grief among bereaved adults 2.5-3.5 years after September 11th attacks

A Web-based survey of adults who experienced loss during the September 11, 2001, terrorist attacks was conducted to examine the prevalence and correlates of complicated grief (CG) 2.5-3.5 years after the attacks. Forty-three percent of a study group of 704 bereaved adults across the United States screened positive for CG. In multivariate analyses, CG was associated with female gender, loss of a child, death of deceased at the World Trade Center, and live exposure to coverage of the attacks on television. Posttraumatic stress disorder, major depression, anxiety, suicidal ideation, and increase in post-9/11 smoking were common among participants with CG. A majority of the participants with CG reported receiving grief counseling and psychiatric medication after 9/11. Clinical and policy implications are discussed.

Prevalence and psychosocial factors associated with being bothered by nonavailability of sexual partners among Hong Kong Chinese: a population-based study

This study investigated the prevalence of being bothered by sexual-partner non availability (SPNA), associated risk factors, and associations with mental health and sexual satisfaction using a computer-assisted telephone survey. A random sample of 3257 and 1568 Chinese male and female respondents (aged 18-59) were interviewed. Sexual partner non-availability was highest in the male nonmarried/noncohabitating group, (18.6%) and the prevalence ranged from 1.4% to 7.9% for other age-sex subgroups. Younger age and male gender were associated with SPNA. Being bothered by SPNA was significantly associated with mental health and vitality quality of life, general life satisfaction, and sexual satisfaction (OR = 1.41 to 5.21).

Alcohol consumption, sex, and use of psychotropic substances among male Hong Kong-mainland China cross-border substance users

The study investigated the prevalence and associated factors for co-occurrence of psychotropic substance use, alcohol consumption and sexual activities among substance users. Totally, 1167 Hong Kong Chinese males aged 18-30 having used substances in mainland China in the last year were identified. Of them, 72.5% and 42.7% respectively reported having consumed alcohol and engaged in sexual activities in conjunction with the last episode of substance use. Among those using substances exclusively in mainland China, multivariate analyses showed that having friends who frequently used substances in China (OR=3.18) and being accompanied by friends in the last episode of substance use (OR=2.31) were associated with alcohol consumption; older age (OR=2.01), higher education level (OR=2.31), alcohol consumption (OR=2.72), belief that substance use increased sexual potency (OR=2.81) and use of multiple types of psychotropic substances in China (OR=2.94) were significantly associated with having sex in conjunction with the last episode of using psychotropic substances. Cross-border psychoactive substance use often co-occurs with alcohol and sex. High levels of risk are involved. Different types of preventive programs need to be integrated.

A large specific deterrent effect of arrest for patronizing a prostitute

Background

Prior research suggests that arrest, compared with no police detection, of some types of offenders does not decrease the chances they will reoffend.

Methodology/Principal Findings

We assessed the specific deterrent effect of arrest for patronizing a street prostitute in Colorado Springs by comparing the incidence of arrest for clients of prostitutes first detected through public health surveillance with the incidence of rearrest for clients first detected by police arrest. Although these sets of clients were demographically and behaviorally similar, arrest reduced the likelihood of a subsequent arrest by approximately 70%. In other areas of the United States, arrest did not appear to displace a client's patronizing.

Conclusions/Significance

Our results suggest that apprehending clients decreases their patronizing behavior substantially.

Alcohol consumption before and during pregnancy comparing concurrent and retrospective reports

BACKGROUND

Reported alcohol consumption during pregnancy has proven to be higher when reported retrospectively during or after the pregnancy, compared with concurrent reports. In a longitudinal, population-based questionnaire study, we investigated whether these findings could be replicated.

METHODS

A longitudinal, population-based questionnaire study. Among a representative half of pregnant women in Oslo, 92% accepted to join the study. Non-Norwegian speaking and/or immigrants from nonwestern countries were not invited. Questionnaires were answered at 17 (T1) and 30 weeks of pregnancy (T2) and 6 months after term (T3). The response rate was at T1 93% (N = 1,749), at T2 82%, and at T3 94% [representing 86% (T1), 70% (T2), and 64% of those invited to join the study].

RESULTS

Significantly more alcohol consumption after pregnancy recognition was reported retrospectively at both T2 and T3 [T2 0.15 and T3 0.18 standard units per week (SU/wk)] than concurrently at T1 or T2 (T1 0.10 and T2 0.14 SU/wk). When comparing the 2 retrospective reports at T2 and T3, there was a significant increase over time. Predictive factors for higher retrospective reports were higher age, more SU per week before pregnancy, reported alcohol use after pregnancy recognition (at T1), and depression after the pregnancy. A predictive factor for lower retrospective reporting was anxiety during, but not after, the pregnancy. Contrary to previous suggestions, anxiety concerning abnormality in the 6-month-old child was not a predictive factor.

CONCLUSION

Concurrently reported alcohol consumption during pregnancy is probably under-reported. Thus, concurrent reports appear to underestimate fetal exposure.

Web-based methods in terrorism and disaster research

This article provides an overview of the use of the Internet for conducting studies after terrorist attacks and other large-scale disasters. We begin with a brief summary of the scientific and logistical challenges of conducting such research, followed by a description of some of the most important design features that are required to produce valid findings. We then describe one approach to Internet surveys that, although not perfect, addresses many of the challenges well. We close with some thoughts about how the Internet-based methods available today are likely to develop further in coming years.

Mental health and lifestyle correlates of sexual problems and sexual satisfaction in heterosexual Hong Kong Chinese population

OBJECTIVES

To examine the lifestyle, mental health, and stress-related factors associated with various types of sexual problems among sexually active, heterosexual Hong Kong residents aged 18 to 59 years.

METHODS

An anonymous, cross-sectional, random telephone survey was conducted using a special, validated, computerized telephone interview method. A total of 1281 men and 2130 women completed the interview (response rate 50.6%). Sexual problems were determined according to the Diagnostic and Statistical Manual (of Mental Disorders) IV definitions.

RESULTS

Among the men, multivariate analyses indicated that older age, poor spousal relationship, less exercise, high level of family stress, high level of financial-related stress, and past year substance use were significantly associated with sexual problems (odds ratio [OR] 1.41 to 3.83). Among the women, being married or cohabiting with a partner was positively associated with lubrication problems, lack of orgasm, lack of pleasure, lack of interest (OR 1.43 to 1.73) and negatively associated with pain during intercourse (OR 0.66) and anxiety (OR 0.62). A high level of financial stress and neuroses diagnoses were also associated with various female sexual problems (OR 1.40 to 2.66). Sexual satisfaction was associated with being married/cohabitating (OR 1.94) and negatively associated with a poor spousal relationship, low level of exercise, and a high level of work-related stress among men (OR 0.37 to 0.71). Among women, a poor spousal relationship and high levels of family stress and financial stress were associated with not being satisfied sexually (OR 0.24 to 0.71).

CONCLUSIONS

Mental health, stress-related factors, and lifestyle factors contribute to sexual problems among Hong Kong Chinese adults. The factors differed between the two sexes.

Prevalence and factors of sexual problems in Chinese males and females having sex with the same-sex partner in Hong Kong: a population-based study

A cross-sectional, anonymous telephone survey was conducted to examine sexual problem (SP) among sexually active, Chinese homosexual adults in Hong Kong. Of the homosexual respondents, 49.1% of males and 75.6% of females reported at least one SP, of whom 36.0 and 65.7% of the males and females, respectively, felt very bothered by the SP. The prevalence of SP ranged from 3.6% (pain) to 21.8% (premature orgasm) for men and from 16.9% (anxiety) to 39.3% (lubrication problems) for females. Female homosexuals were less likely to be satisfied with their sex life and more bothered by an SP than heterosexual females and homosexual males. There were few significant differences between homosexual and heterosexual males. Female homosexuals were also more likely than male homosexuals to experience lack of orgasm and pain during intercourse. Being bothered by SP was associated with erectile dysfunction among homosexual men and lubrication problems and lack of pleasure among the homosexual women.

Consistency of Reported Alcohol Use by Pregnant Women: Anonymous Versus Confidential Questionnaires With Item Nonresponse Differences

BACKGROUND

Self-report is the best method to attain information about moderate alcohol consumption. However, reported alcohol consumption before and during pregnancy is sensitive to response bias.

METHODS

We compared identical questionnaires completed either confidentially or anonymously by pregnant women. A representative half of the pregnant women in Oslo attending ultrasound screening between June 2000 and May 2001 were invited to join a confidential questionnaire study. Another group of pregnant women, selected in the identical manner, were asked to answer the same questionnaire anonymously during the summer of 2001. The questionnaire was completed by 1749 confidentially and 191 anonymously (response rate 93.4% vs 84.4%). For the current study, only women with Scandinavian ethnicity were included: 1707 and 178, respectively. Measures were T-ACE (screening measure for pregnancy risk drinking), reported frequency of alcohol use, Standard Units (SU) per occasion (po), SU per week, and binge drinking (>or=5 SU po), before and during pregnancy.

RESULTS

There were no significant differences in reported alcohol consumption between the confidential and the anonymous group for the sample as a whole. Any alcohol consumption was reported by 22.6% and 23.3% during pregnancy week 7-12 and 13+ (confidential group) versus 22.5% and 25.8% (anonymous group). Differences between the groups tended to be larger for SU per week (p=0.07 both before pregnancy and after week 12 of pregnancy) than for the indirect alcohol (T-ACE) and the binge drinking questions. In the confidential group, the women with lower education had close to twice as high item nonresponse on the direct alcohol questions during pregnancy compared with those with higher education. This difference was smaller in the anonymous group. The rate of smoking was not reported differently in the anonymous group.

CONCLUSIONS

Among pregnant women, there was no significant difference in self-reported alcohol consumption obtained by confidential or anonymous questionnaires.

Prevalence of male and female sexual problems, perceptions related to sex and association with quality of life in a Chinese population: a population-based study

The prevalence of sexual problems (SP) and sexual satisfaction and their associations with sex-related perceptions and quality of life (QOL) were investigated by interviewing 3257 and 1568 Chinese adults in Hong Kong by a specially designed computerized telephone-interviewing method. SP was prevalent among male (50.9%) and female (54%) respondents; approximately 50% were dissatisfied with their sexual life. Of respondents, 23.9% of men and 5.9% of women perceived sex as important and 52.5% for men and 33.8% of women reported adequate sexual knowledge. The prevalence of SP ranged from 3.4% (pain) to 29.7% (premature orgasm) for men and 6.9% (anxiety) to 24.7% (lack of interest) for women. Prevalence of erectile and lubrication problems were 9.6 and 23.6%, respectively. Sex-related knowledge, perceived importance of sex, perceived physical health status, sexual satisfaction were predictors of SP. Gender differences and strong cultural influences appear to exist. Moreover, SP and sexual satisfaction were associated with mental health and vitality QOL and overall life satisfaction.

Prevalence, health outcomes, and patterns of psychotropic substance use in a Chinese population in Hong Kong: a population-based study

Two anonymous population-based surveys were conducted between August 2001 and April 2002 using computer-assisted telephone interviews of 3793 male and 3244 female randomly selected residents of Hong Kong in order to estimate the prevalence of psychotropic substance use and identify risk factors and associations with health outcomes among users in Hong Kong. The study cohort was comprised of ethnically Chinese adults between the ages of 18 and 60 years of age. In the last 12 months, 5% of males and 1.8% of females had used psychotropic substances such as cannaboids, methylamphetamines, ketamines, cocaine, opiates, barbiturates, and benzodiazepines. Of the male drug users, almost one-third had done so outside of Hong Kong. "Risk factors" for substance use included: younger age, unemployment, being an early school leaver, being unmarried, "heavy alcohol consumption," and smoking. Psychotropic substance use in the past year was strongly associated with increased prevalence of long-lasting (> or =3 months) sexual health problems during the past year and with a higher prevalence of HIV/STD risk behaviors. The prevalence of substance use in Hong Kong has been under-reported. Although significant correlations were noted between substance use and various respondent attributes, the directionality of the associations needs to be determined with longitudinal studies. It may be prudent to integrate substance use and HIV/STD prevention efforts.

HIV related behaviours and attitudes among Chinese men who have sex with men in Hong Kong: a population based study

OBJECTIVE

This study was conducted in order to determine the prevalence of men having sex with men (MSM) and their HIV related behaviours and attitudes among Chinese men in Hong Kong.

METHODS

A large scale, random, population based, anonymous telephone survey of 14 963 men between the ages of 18-60 was conducted. The overall response rate was approximately 57%.

RESULTS

Of the respondents, 4.6% had ever engaged in MSM activity. In the 6 months preceding the survey, 2.0% had engaged in MSM behaviours (active MSM) and 0.5% reported having engaged in anal sex MSM behaviours. Among anal sex MSM, consistent condom use was 42.9% with male non-commercial sex partners and even lower with male commercial sex partners (35.7%). Approximately 11% of anal sex MSM and 4.1% of the non-anal sex MSM had contracted an STD in the last 6 months. The prevalence of HIV testing was only 20.6% among anal sex MSM and 11.9% among non-anal sex MSM.

CONCLUSIONS

Active MSM in Hong Kong are at high risk of HIV infection. The belief of low vulnerability to HIV is prevalent among active MSM in Hong Kong with only 2.0% believing that their chances of HIV infection as being "very likely."

Prevalence and Risk Behaviors of Hong Kong Males Who Seek Cross-Border Same-Sex Partners in Mainland China

BACKGROUND

Little is known about cross-border sex-networking behaviors among men who have sex with men (MSM) GOAL: The goal of this study was to determine the prevalence of cross-border sex-networking in mainland China among MSM in Hong Kong and the associated risk behaviors

STUDY

A telephone survey was conducted. A total of 15,230 Hong Kong Chinese men aged 18 to 60 participated in the study.

RESULTS

Of the 283 MSM engaged in some MSM behaviors in the last 6 months, 15.2% had engaged in sexual activity with a man in mainland China in the 6 months before the survey. These "cross-border MSM" were more likely than others to have practiced risk behaviors such as having patronized male commercial sex workers, having contracted a sexually transmitted disease (STD), having had > or = 3 MSM partners, and having higher prevalence of HIV testing in the last 6 months (adjusted odds ratio, 3.32-43.83).

CONCLUSIONS

There is an urgent need for a regional approach to HIV/STD prevention for MSM in southern China.

Prevalence and risk behaviors of Chinese men who seek same-sex partners via the internet in Hong Kong

To examine the prevalence of Internet sex networking among men who have sex with men (MSM) in Hong Kong and risk behaviors associated with the behavior, a telephone survey of 15,230 Hong Kong Chinese men aged 18-60 was conducted. Of the 283 active MSM (having engaged in some MSM behaviors in the last 6 months) identified, 17.7% had networked for MSM partners via the Internet in the last 6 months. Younger age (odds ratio [OR] for age < or = 25 vs. age >25 = 4.67, 95% confidence interval [CI] = 2.35-9.28) and being an anal-sex MSM (OR = 4.72, 95% CI=2.36-9.44) were independent predictors of Internet sex networking. Being an Internet sex networker was associated with some risk behaviors such as having contracted a sexually transmitted disease (adjusted OR = 4.79, 95% CI = 1.34-17.11), having had > or = 3 MSM partners (adjusted OR = 4.74, 95% CI = 2.20-10.23), and having engaged in anal sex (adjusted OR = 3.95, 95% CI = 1.89-8.23). HIV prevention programs for MSM should thereby include Internet-based interventions.

HIV/AIDS Behavioral Surveillance Surveys of the Cross-Border Sex-Networker Population in Hong Kong From 1997 to 2001

BACKGROUND

Mobility is an important risk factor in the spread of HIV.

GOAL

The goal was to conduct behavioral surveillance surveys on Hong Kong males crossing the border to mainland China to have sex with female sex workers (FSW) or nonregular female sex partners who were not FSW (NRP).

STUDY DESIGN

Four surveys (1997-2001), using a special data collection method, were conducted at the Hong Kong-mainland China border checkpoint (n=5294).

RESULTS

Consistently, a notable proportion of the travelers had patronized FSW or had had sex with NRP in the preceding trip to mainland China. Inconsistent condom use was high (> or =40%) and HIV antibody testing was low (<12%). Self-perceived susceptibility of contracting HIV also was low.

CONCLUSION

No remarkable improvement on the level of risk behaviors was observed over the study period. Sustained efforts to promote safer sex and awareness of the risk associated with sex-networking are required.

Effects of two telephone survey methods on the level of reported risk behaviours

OBJECTIVE

Reporting bias due to social desirability is an important consideration in carrying out surveys on sensitive issues. The study compared the frequency of self reported sensitive behaviours and response rates between the conventional "telephone interviewer method" (TIM) and a combined interviewer and computerised data capturing method (telephone interviewer and computerised questionnaire method, or TICQM).

METHODS

A total of 580 males and 582 females were recruited and randomly assigned to either of the two methods in a cross sectional study. The overall response rate was about 51.6%.

RESULTS

While the two methods both had high completion and low item non-response rates, the TICQM respondents reported higher frequencies of sensitive risk behaviours. Sexually active female respondents interviewed by the TICQM were more likely to report that their sex partners were their steady boyfriend, instead of their husband; and were also more likely to admit that they had had "one night stand" experiences or had undergone an HIV antibody test, when compared with their counterparts in the TIM group. Similar contrasts were observed for sexually active male respondents, that the TICQM group were more likely to report that they had had sexual intercourse with female sex workers or non-regular sex partners. Sex differences in the strength of association were observed between some studied behaviours (for example, HIV testing and substance abuse) and modes of data collection.

CONCLUSION

The choice of data collection method has a significant impact on the results of sensitive studies; special attention should be given to designing the study and interpreting the results.

Behavioral surveillance surveys of the male clients of female sex workers in Hong Kong: results of three population-based surveys

BACKGROUND

Male clients of female sex workers (FSWs) are an important group vulnerable to HIV infection.

GOALS

The goal was to administer and assess behavioral surveillance surveys of male clients of FSWs in Hong Kong.

STUDY DESIGN

Three population-based telephone surveys of males aged 18 to 60 were conducted from 1998 to 2001 (n=5159).

RESULTS

Of all respondents, about 10.8% to 14% had patronized FSWs in the previous 6 months. Among male clients of FSWs, about 25% did not always use condoms, 4% to 6% had contracted a sexually transmitted disease, 16% had undergone HIV antibody testing, and 20% or more reported having four or more sex partners in the previous 6 months. There was no improvement in condom use over time. Cross-border (from Hong Kong to mainland China) commercial sex was common.

CONCLUSION

The level of risk behaviors associated with male clients of FSWs remained substantial. The overall effectiveness and coverage of relevant prevention programs were questioned.

The relationship between condom use, sexually transmitted diseases, and location of commercial sex transaction among male Hong Kong clients

OBJECTIVE

This study investigated the consistency of condom use and the prevalence of self-reported sexually transmitted diseases (STD) among male Hong Kong commercial sex clients with respect to the geographical location of these transactions.

DESIGN AND METHODS

Male clients were identified via three independent, population-based surveys conducted in 1998, 1999, and 2001. A unique confidential telephone system was used to collect sensitive information.

RESULTS

Respondents patronizing female sex workers (FSW) in 'mainland China only' or in 'mainland China and other places' were more likely to be inconsistent condom users (28 and 34%) than those patronizing FSW in 'Hong Kong only' (9.1%). A similar pattern was found for self-reported STD in the past 6 months (10.1, 8.1 and 1.0%, respectively). Patronizing FSW in mainland China was associated with a higher prevalence of self-reported STD (adjusted OR 4.16), independent of consistent condom use and other potential confounding factors, including calendar year of survey, age, educational attainment, HIV-related knowledge, perceived efficacy of condom use for HIV/AIDS prevention, number of female sex partners, and the presence of a regular female sex partner in the past 6 months. Clients who had commercial sex both in mainland China and Hong Kong were more likely to use condoms in Hong Kong than in mainland China (paired OR 4.67, < 0.05).

CONCLUSION

The geographical location of commercial sexual activity is related to the consistency of condom use, irrespective of the clients engaged in such activity. Prevention programmes need to be aware of how risk behaviour is dependent on local contexts.

HIV-related behaviours among voluntary blood donors in Hong Kong

The present study examined the prevalence of and factors associated with deferrable risk behaviours practised by male voluntary blood donors in Hong Kong. Attitudes and knowledge related to HIV/AIDS and blood donation among both male and female blood donors were also studied. In total, 2,162 (1,190 male and 972 female) blood donors in four Hong Kong Red Cross Blood Transfusion Services (HKRCBTS) centres completed an anonymous structured questionnaire. About 11% of the male respondents have practised deferrable risk behaviours (e.g. sharing syringes, commercial sex-networking, or having sex with another man). Furthermore, among male respondents, 5.9% indicated that they are using blood donations as a means of testing for their HIV status. These male 'potential test seekers' tended to be younger, single, unemployed and first-time donors; relevant knowledge and perceptions towards the screening guideline were also associated with potential test seeking and deferrable risk. About 5% of all respondents would go to the HKRCBTS to perform an HIV test, if required. Many blood donors in Hong Kong were not knowledgeable about HIV-related issues. There is a need to review the effectiveness of the present deferral system, which is based on the goodwill of the donor to disclose personal health risk factors.

Behavioral surveillance and factors associated with condom use and std incidences among the male commercial sex client population in Hong Kong--results of two surveys

The present study compared the results of behavioral surveillance data obtained on the male clients of female sex workers (FSWs) population in Hong Kong. Two surveys, using an identical method, were completed in 1998 and 2000. Respectively, 1,020 and 2,074 respondents aged 18-60 who were randomly selected from the general population participated in the study. About 12% of the respondents had patronized FSWs in the past 6 months in 2000 as compared with 14% in 1998 (p = .143). Crossing the border for sex and purchasing sex in multiple geographic areas was very common and a higher percentage of respondents reported having patronized FSWs in mainland China in 2000 than in 1998 (p = .003). About 25% of the respondents in both surveys had not always been using condoms (i.e., not used condoms every time) when having sexual intercourse with FSWs. Those who practiced commercial sex in mainland China were less likely to have always been using condoms with FSWs (p < .01) and were more likely to have ever contracted STD in the past 6 months (p < .05), when compared with those who had purchased sex only in Hong Kong or in other places.

Prostitution and the sex discrepancy in reported number of sexual partners

One of the most reliable and perplexing findings from surveys of sexual behavior is that men report substantially more sexual partners than women do. We use data from national sex surveys and studies of prostitutes and their clients in the United States to examine sampling bias as an explanation for this disparity. We find that prostitute women are underrepresented in the national surveys. Once their undersampling and very high numbers of sexual partners are factored in, the discrepancy disappears. Prostitution's role in the discrepancy is not readily apparent because men are reluctant to acknowledge that their reported partners include prostitutes.