Face-to-face household interviews versus telephone interviews for health surveys

Prevalence of chronic pain in Brazil: A systematic review and meta-analysis

OBJECTIVE

This review synthesized existing studies on the prevalence of chronic pain in Brazil and its associated factors to produce a recent estimation to guide public health politics.

METHODS

A search was carried out in the Ovid Medline, Embase, Web of Science, and BVS Regional/Lilacs databases to identify population-based cross-sectional studies from 2005 to 2020, which reported the prevalence of benign chronic pain in Brazil (more than three months). The risk of bias was assessed using design, sample size determination, and random selection as essential issues. Pooled prevalence estimates were calculated for chronic pain in the general and elderly populations. The protocol was registered on Prospero (CRD42021249678).

RESULTS

Of the 682 identified, 15 macheted the authors' inclusion criteria. Chronic pain prevalence in the general adult population ranged from 23.02% to 41.4% (pooled estimate 35.70%, 95% Cis 30.42 to 41.17) and was described as moderate to intense. It was associated with female sex, old age, lower education, intense professional activity, excessive alcohol consumption, smoking, central obesity, mood disorder, and sedentarism. The Southeastern and Southern regions presented a higher prevalence. The prevalence in the elderly population ranged from 29.3% to 76.2% (pooled estimate 47.32%, 95% Cis 33.73 to 61.11). In addition, this population visited doctors more frequently, had more sleep disorders, and was more dependent on daily living activities. Almost fifty percent of both populations with chronic pain reported pain-induced disability.

CONCLUSION

Chronic Pain is highly prevalent in Brazil and associated with significant distress, disability, and poorly controlled.

Multimorbidity Patterns and Their Association with Social Determinants, Mental and Physical Health during the COVID-19 Pandemic

BACKGROUND

The challenge posed by multimorbidity makes it necessary to look at new forms of prevention, a fact that has become heightened in the context of the pandemic. We designed a questionnaire to detect multimorbidity patterns in people over 50 and to associate these patterns with mental and physical health, COVID-19, and possible social inequalities.

METHODS

This was an observational study conducted through a telephone interview. The sample size was 1592 individuals with multimorbidity. We use Latent Class Analysis to detect patterns and SF-12 scale to measure mental and physical quality-of-life health. We introduced the two dimensions of health and other social determinants in a multinomial regression model.

RESULTS

We obtained a model with five patterns (entropy = 0.727): 'Relative Healthy', 'Cardiometabolic', 'Musculoskeletal', 'Musculoskeletal and Mental', and 'Complex Multimorbidity'. We found some differences in mental and physical health among patterns and COVID-19 diagnoses, and some social determinants were significant in the multinomial regression.

CONCLUSIONS

We identified that prevention requires the location of certain inequalities associated with the multimorbidity patterns and how physical and mental health have been affected not only by the patterns but also by COVID-19. These findings may be critical in future interventions by health services and governments.

Health-related quality of life in adult population before and after the onset of financial crisis: the case of Athens, Greece

PURPOSE

Trends of person-oriented indices with respect to the general population have not been adequately investigated. In Athens, two Health Surveys in 2003 and 2016 provide the opportunity to analyze HRQL in the general adult population. The objectives of this study were to investigate changes in HRQL of adults in the broader area of Athens between 2003 and 2016 and their association with certain socio-demographic determinants.

METHODS

We compared participants from pre- and during-crisis cross-sectional surveys. We used data from 982 and 1060 adult residents of Athens from 2003 and 2016 surveys, respectively. Income-related missing data were treated using three alternative methods. Subscale and summary component SF-36 scores were compared with Mann-Whitney tests and linear regression analyses were used to estimate the effect of demographic and socio-economic variables on HRQL before and after the onset of crisis.

RESULTS

The analysis was based on the results of the procedure of handling missing income data as a separate income group and showed that physical component summary score (PCS) has improved and Mental Component Summary score has deteriorated. The most important predictors of HRQL were being widowed and during the crisis not being employed. Additionally, socio-demographic characteristics explained a higher proportion of variance of HRQL after the onset of crisis, especially for PCS.

CONCLUSION

Decline in mental and improvement in physical HRQL were observed between 2003 and 2016. HRQL has been certainly affected by the recession, but it is difficult to estimate the exact impact of the financial crisis on HRQL.

Socioeconomic status and cigarette expenditure among US households: results from 2010 to 2015 Consumer Expenditure Survey

OBJECTIVES

To examine (1) the association between household socioeconomic status (SES) and whether a household spends money on cigarettes and (2) socioeconomic variations in proportion of total household expenditure spent on cigarettes among smoking households.

METHODS

We pooled data from six consecutive years, 2010-2015, of the Consumer Expenditure Interview Survey. The interviews involved a structured questionnaire about household income, demographics and expenditures including expenditure on cigarettes. Households that reported cigarette expenditure in the previous 3 months were distinguished as smoking households. SES indicators were household poverty status, education and occupation of the head of household. Logistic regression was used to assess the association of household smoking status with SES. Fractional logistic regression was used to assess the association of cigarette expenditure as a proportion of total household expenditure with SES. The analysis sample size was 39 218.

RESULTS

The probability of spending money on cigarettes was higher among lower SES households. Households in poverty compared with those above 300% of poverty threshold had 1.86 (95% CI 1.61 to 2.16), households headed by a person with less than high school education compared with those headed by a person with at least a bachelor's degree had 3.37 (95% CI 2.92 to 3.89) and households headed by a blue-collar work compared with those headed by a person in a managerial occupation had 1.45 (95% CI 1.26 to 1.66) higher odds of spending money on cigarettes. Similarly, the proportion of total household expenditure spent on cigarettes was higher among lower SES smoking households.

CONCLUSION

Lower SES households are more likely to spend money on cigarettes and spend a larger proportion of their total expenditure on cigarettes. We recommend strategies effective in reducing smoking among low SES smokers.

Overactive Bladder Symptoms after Transobturator Sling Surgery for Pure Stress Urinary Incontinence: A Cross-Sectional Comparative Study

INTRODUCTION

Transobturator tape (TOT) surgery has been associated with increased overactive bladder (OAB) although much controversy exists.

METHODS

In a cross-sectional study, women who underwent TOT surgery for pure stress incontinence (MonarcTM) answered the 6 questions of the symptom bother (SB) subscale of the OAB questionnaire - short form (OABq-SF) and an additional question regarding whether symptoms began after surgery. Women with SB score over the 4th quartile (≥30/100) were reassessed after a longer follow-up. Patients from primary care were recruited as controls.

RESULTS

We recruited 213 patients (135 in the TOT group and 78 age-adjusted controls). The mean age of operated patients was 58.7 ± 10.1 years with a mean follow-up of 25.9 ± 13.2 months. OABq-SF SB scores did not differ between the TOT group and controls (respectively, 18.5 ± 30 and 15.5 ± 6.7, p = 0.202). A total of 48% patients reported no relationship between symptoms and surgery. Highly symptomatic operated patients were reassessed after a longer follow-up (46.3 ± 10.6 months). The mean score in the second follow-up (n = 25) was not statistically different from the first assessment (46.4 ± 22.7 and 58.1 ± 19.8, p = 0.059).

CONCLUSIONS

Women who underwent TOT surgery did not show increased OAB SB scores when compared to controls. Our study suggests that OAB symptoms may thus be present but overlooked during initial clinical assessment.

Evaluating the Effectiveness of Home Health as a Disease Management Strategy

Home health (HH) is considered by many to be complementary to existing disease management (DM) programs, or even suitable as a stand-alone DM intervention. The advantage is thought to be with the face-to-face interaction, in contrast to the standard DM telephonic interview. However, much of the literature appears to indicate that telecommunication is as successful as face-to-face contact (typically referred to as “usual care”) for administering health surveys, providing counseling, changing health behaviors, and monitoring physiologic functioning. Given the desire to expand into the area of DM, HH agencies will need to identify and demonstrate areas in which they have a clinical and competitive edge over traditional DM models. This article describes and provides examples of three research designs that may assist the HH industry in evaluating their effectiveness in delivering DM services: the randomized controlled trial, the regression-discontinuity design, and case-control matching on the propensity score.

FRAMIG 2000: Medical and Therapeutic Management of Migraine in France

FRAMIG 2000 is a population-based survey of medical and therapeutic management of migraine in France. A total of 312 migraine sufferers were first identified from a representative sample of 4689 adult subjects using a validated questionnaire based on the IHS migraine diagnostic criteria and administered by telephone. Subjects were then interviewed using a branching questionnaire and a computer-assisted interview technique. Although 80% were self-aware of their migrainous state, 82% of migraine sufferers had no medical follow-up for migraine. The proportion of migraine sufferers who did not consult decreased slightly with increasing migraine-related disability (from 87% for subjects in MIDAS grade I to 68% for those in MIDAS grade IV). Migraine sufferers declared to effectively control only four attacks out of 10 after the first intake of the usual treatment. Only 6% of subjects in the survey received a prophylactic treatment for migraine whereas 22% were in MIDAS grade III or IV. These data show that the burden of migraine does not result from a deficit in diagnosis but instead from a deficit in patient information on the proper use of current effective treatments of migraine.

Observation of health technologies after their introduction into clinical practice: a systematic review on data collection instruments

RATIONALE, AIMS AND OBJECTIVES

Early assessment of health technologies after they are covered by the health system is deemed crucial to promptly identify and analyse unforeseen problems that may arise when these are used in real world settings. This paper aims to describe the various instruments which could be used for collecting information intended for prospective observation of health technologies, so as to choose the specific instrument best suited to each context.

METHODS

Systematic review of the medical literature aimed at retrieving general reference documents on data collection instruments for post-introduction observation of health technologies. A purpose-designed systematic bibliographic search was elaborated for the main three data collection instruments identified.

RESULTS

The three instruments are briefly described along with the main results of the studies retrieved, in terms of the advantages, drawbacks and considerations to be borne in mind when it comes to use these tools in post-introduction observation of new technologies.

CONCLUSIONS

At present, the most appropriate data collection method for conducting post-introduction observation of new technologies is the use of prospective clinical registries. Electronic clinical records may replace clinical registries in the near future, but currently there are still many doubts as to the quality of the information retrieved.

Testing Skype as an interview method in epidemiologic research: response and feasibility

INTRODUCTION

Despite its popularity, Skype has not been tested as a tool for epidemiologic research. We examined its feasibility in Germany.

METHODS

A population-based sample of young adults was randomly invited to a Skype (n = 150) or a phone interview (n = 150). Response and duration of interviews were analysed to evaluate the feasibility of Skype interviews.

RESULTS

Response was low and, with 10 % (95 % CI 5-15 %), even worse among Skype candidates, compared to 22 % (15-28 %) in the phone group. A third of the Skype group asked for being interviewed by phone. Median duration was 34.0 minutes for Skype interviews and 37.0 minutes for phone interviews.

CONCLUSIONS

Skype is not yet a feasible tool for data collection in Germany.

Estimation of nationwide vaccination coverage and comparison of interview and telephone survey methodology for estimating vaccination status

This study compared interview and telephone surveys to select the better method for regularly estimating nationwide vaccination coverage rates in Korea. Interview surveys using multi-stage cluster sampling and telephone surveys using stratified random sampling were conducted. Nationwide coverage rates were estimated in subjects with vaccination cards in the interview survey. The interview survey relative to the telephone survey showed a higher response rate, lower missing rate, higher validity and a less difference in vaccination coverage rates between card owners and non-owners. Primary vaccination coverage rate was greater than 90% except for the fourth dose of DTaP (diphtheria/tetanus/pertussis), the third dose of polio, and the third dose of Japanese B encephalitis (JBE). The DTaP4: Polio3: MMR1 fully vaccination rate was 62.0% and BCG1:HepB3:DTaP4:Polio3:MMR1 was 59.5%. For age-appropriate vaccination, the coverage rate was 50%-80%. We concluded that the interview survey was better than the telephone survey. These results can be applied to countries with incomplete registry and decreasing rates of landline telephone coverage due to increased cell phone usage and countries. Among mandatory vaccines, efforts to increase vaccination rate for the fourth dose of DTaP, the third dose of polio, JBE and regular vaccinations at recommended periods should be conducted in Korea.

Tobacco use among the elderly: a systematic review and meta-analysis

The aim of this study was to combine the results of identified surveys on the prevalence of tobacco use in old age to estimate world prevalence of tobacco use and possible factors related to such behavior among the elderly. The literature search included electronic databases such as MEDLINE, LILACS, and Biological Abstracts, hand-searching of specialist journals and cited reference searches. The combined global prevalence was estimated using the random effects model. The total number of elderly subjects included in all surveys was 140,058, with data available from all the continents. Overall prevalence of tobacco use was 13% in both genders (22% male and 8% female). The prevalence rates were heterogeneous among surveys and were associated with smoking definition, questionnaire application, and country economic status. Few epidemiological studies assessed tobacco use among the elderly. A higher prevalence rate of tobacco use in males who live in higher income countries could be found, although additional evidence regarding elderly samples is still required.

Assessing health status, behavioral risks, and health disparities in American Indians living on the northern plains of the U.S

OBJECTIVE

We assessed health status and behavioral risks in American Indians (AIs) from rural, northern plains reservation communities.

METHODS

AI interviewers from the communities administered the core and optional modules of the Behavioral Risk Factor Surveillance System (BRFSS) to 404 AI adults randomly selected from housing lists from four AI tribal communities located on the northern plains of the U.S. The BRFSS interview assessed several health functioning areas including medical conditions, preventive screenings, and behavioral risks. We measured health disparities by comparing the AI sample data with a northern plains statewide (North Dakota) sample and a U.S. national sample. We compared outcomes with BRFSS statewide (North Dakota) and U.S. national data from telephone-based interviews.

RESULTS

AI participants showed a significantly greater prevalence of diabetes, coronary heart disease, myocardial infarction, smoking, obesity, and heavy alcohol use than either the regional or national samples. They also reported being less likely to engage in leisure-time physical activity and to have had age-appropriate preventive screenings for several diseases including colorectal cancer, prostate cancer, breast cancer, and cardiovascular disease.

CONCLUSIONS

Face-to-face interviews conducted by AI community members are an effective means of gathering health information about AIs living in rural, reservation communities. AIs living in these communities on the northern plains have a much higher prevalence of many health-risk behaviors and some medical conditions than are found in the general population. Improved health-care access, better preventive screenings, and culturally appropriate community-based health promotion programs and policies should be examined as possible ways to reduce health disparities.

Sampling procedures and sample representativeness in a national telephone survey: a Portuguese example

OBJECTIVES

This paper aims to assess the yielding of the sampling procedures and the representativeness of a sample evaluated in a national telephone survey in Portugal.

METHODS

The Portuguese telephone book (2007/2008) was the sampling frame for subjects >39 years (n = 1,934). The time spent with interviews and unsuccessful contacts was quantified and the yielding of the contact attempts compared according different schedules. Demographic and health characteristics of the participants were compared with those of the Portuguese population.

RESULTS

Among eligible individuals, the percentage of refusals was 40.4%, higher on Saturdays (45.2% vs. 30.7%) and evenings (45.2% vs. 36.7%). Evening interviews yielded a higher percentage of men (26.2% vs. 21.0%) and active workers (31.8% vs. 21.8%). Compared to the Portuguese population, our sample included a higher proportion of women (76.7% vs. 54.1%), elderly (>59 years: 61.4% vs. 46.2%) and more educated participants (>4 years: 38.3% vs. 26.3%). Sex- and age-specific estimates of smoking and obesity were similar to those in the Portuguese population.

CONCLUSION

Despite the difficulties in reaching participants, this strategy may produce unbiased estimates for important health indicators.

Non-response to a life course socioeconomic position indicator in surveillance: comparison of telephone and face-to-face modes

Background

Measurement of socioeconomic position (SEP) over the life course in population health surveillance systems is important for examining differences in health and illness between different population groups and for monitoring the impact of policies and interventions aimed at reducing health inequities and intergenerational disadvantage over time. While face-to-face surveys are considered the gold standard of interviewing techniques, computer-assisted telephone interviewing is often preferred for cost and convenience. This study compared recall of parents' highest level of education in telephone and face-to-face surveys.

Methods

Questions about father's and mother's highest education level were included in two representative population health surveys of South Australians aged 18 years and over in Spring 2004. A random sample selected from the electronic white pages (EWP) responded to a computer-assisted telephone interview (n = 2999), and a multistage clustered area sample responded to a face-to-face interview (n = 2893). A subsample of respondents in the face-to-face sample who owned a telephone that was listed in the EWP (n = 2206) was also compared to the telephone interview sample.

Results

The proportion of respondents who provided information about their father's and mother's highest education level was significantly higher in the face-to-face interview (86.3% and 87.8%, respectively) than in the telephone interview (80.4% and 79.9%, respectively). Recall was also significantly higher in the subsample of respondents in the face-to-face interview who had a telephone that was listed in the EWP. Those with missing data for parents' education were more likely to be socioeconomically disadvantaged regardless of the survey mode.

Conclusion

While face-to-face interviewing obtained higher item response rates for questions about parents' education, survey mode did not appear to influence the factors associated with having missing data on father's or mother's highest education level.

Research interviewers' experience in the Early Births study of very preterm birth: qualitative assessment of data collection processes in a case-control study

This paper describes an evaluation study that aimed to assess data collection processes in a population-based case-control study of very preterm birth. Semi-structured interviews were conducted with the 10 research interviewers to determine their perceptions of the hypotheses, the differences between interviewing cases and controls and between modes of interview, their reactions to questions which they had to ask in interviews and their training. Time and cost of the collection of data were also considered. None of the research interviewers identified which of the questions in the interview constituted the primary hypothesis. All interviewers interviewed cases and controls (including mothers of twins and singletons), and collected data face-to-face and by telephone. Whilst half of the interviewers had no issue with asking sensitive questions, hearing of intimate partner violence, risk-taking behaviour and inappropriate medical care were confronting for others. Training was judged as adequate, as was the continuing support of the project co-ordinator. On average, interviewing took 40% of research interviewers' time, and 25 interviews were completed per effective full-time month of interviewer time. Each interview cost approximately $170AU to complete. In relation to this case-control study, interviewer bias may be lessened since research interviewers had been unable to infer the hypothesis of the study. All interviewers had interviewed both cases and controls and any systematic differences can be adjusted for in the analysis.

Is there a difference in health estimates between people with listed and unlisted telephone numbers?

OBJECTIVE

To examine the characteristics of people with a silent telephone by demographic and health-related issues and to assess the potential bias in telephone surveys that use the White Pages as the sampling frame.

METHOD

A representative annual population health survey of South Australians aged 15 years and over conducted in 1994, 1998, 1999 and 2002. Self-reported information on telephone connection and listings in the White Pages was provided by participants. Questions were included in the 1998 survey on reasons why telephone number was not listed.

RESULTS

The rate of unlisted telephone numbers significantly increased (17.3% to 20.2%) in South Australia between 1994 and 2002. People with an unlisted number are more likely to be living in the metropolitan area, single adult households, current smokers, and in the younger age groups. In the multivariate analyses the only health and risk factor variable that was consistently significant over the years was smoking status. The main reason for having an unlisted number was to avoid market research or telemarketing calls (33%).

CONCLUSION

Telephone surveys using White Pages samples are suitable to collect information for prevalence on most commonly collected self-reported health conditions and health-related issues. The exception is smoking status.

IMPLICATIONS

The use of Whites Pages telephone samples is a suitable method for obtaining population health information because it is efficient when there is limited time and funds.

Vigilancia de los factores de riesgo de las enfermedades no transmisibles mediante encuesta telefónica: resultados de la Comunidad de Madrid en el período 1995-2003

OBJECTIVE

To illustrate -for the first time with Spanish data- the usefulness of telephone-interview-based surveillance of non-communicable diseases risk factors for the purpose of drawing up public health policies.

METHODS

We analysed information from the Non-Communicable Disease Risk Factor Surveillance System (Sistema de Vigilancia de Factores de Riesgo asociados a Enfermedades No Transmisibles- SIVFRENT) for the period 1995-2003. This system is based on monthly telephone interviews covering a representative population sample, aged 18-64 years. 18,049 interviews were conducted for the whole period. Indicators of overweight and obesity, sedentary lifestyle, diet, tobacco and alcohol consumption, preventive practices, accidents and injuries, and road safety were calculated. The time trend was estimated using average annual prevalence ratios, obtained from generalised linear models with binomial family and logarithmic link.

RESULTS

Among men, the changes of greatest magnitude corresponded to an increase in overweight and obesity, which registered a relative annual rise of 3.7%, and a decrease in dieting (-3%), high alcohol consumption (-6.1%) and non-use of safety belts (-4%). Among women, there was a marked increase in overweight and obesity (3.3%), cessation of smoking (3.1%) and recourse to mammograms (6.4%), and a decrease in dieting (-4.1%) and non-use of safety belts (-4.5%).

CONCLUSIONS

Although important progress was observed in a number of indicators, such as tobacco and alcohol consumption, road safety and the undertaking of preventive practices, the situation worsened in others, i.e., fundamentally the increase in overweight and obesity.

Changes in beliefs about cancer in Western Australia, 1964–2001

OBJECTIVE

To assess changes in people's knowledge and beliefs about cancer between 1964 and 2001.

DESIGN

Questions in a 1964 survey of beliefs about cancer (randomly selected households) were replicated in a 2001 telephone survey (random-digit dialing).

SETTING

Perth, Western Australia.

PARTICIPANTS

984 and 491 participants aged 20 years or older in the 1964 and 2001 surveys, respectively (response rates, 86.8% and 47.0%).

MAIN OUTCOME MEASURES

Changes in knowledge and beliefs about cancer.

RESULTS

Between 1964 and 2001, there were major improvements in knowledge about the causes of cancer, with several myths dispelled. In 1964, the proportion of Perth residents surveyed who believed that cancer is contagious was 20% (95% CI, 18%-22%), compared with 3% (95% CI, 2%-4%) in 2001. Similarly, the proportion who believed cancer is caused by "a knock" was 25% (95% CI, 22%-28%) in 1964, compared with 1% (95% CI, 0-2%) in 2001. Cancer screening participation rates also greatly improved, from 18% (95% CI, 16%-20%) in 1964 to 77% (95% CI, 73%-81%) in 2001. Changes in participants' sources of knowledge about cancer were also evident, with family members and television increasing markedly as sources of information.

CONCLUSIONS

Improved education of the public in health matters over the past four decades appears to have had a major and positive impact on knowledge about cancer.

Comparación entre encuestas telefónicas y encuestas «cara a cara» domiciliarias en la estimación de hábitos de salud y prácticas preventivas

OBJECTIVE

This study examines the influence of the interview method (telephone or face-to-face in households) on the assessment of health behaviors and preventive practices.

MATERIAL AND METHOD

The same questionnaire was completed by two independent samples of the population aged 18-64 years living in the municipality of Madrid. One sample (n = 1,391 subjects) completed the questionnaire by telephone interview and the other (n = 739) by face-to-face interview in households. The results of the two samples for 28 variables related to anthropometry, physical activity, food consumption, tobacco and alcohol use, preventive practices and injuries were compared.

RESULTS

The telephone sample had a higher rate of failed contact (31.8% vs. 22.2%) but a greater degree of cooperation than the sample for the face-to-face interview (83.0% vs. 74.0%). In total, 19 of the 28 variables showed a relative variation of less than 10% between the two surveys; the differences found were between 10 and 20% for eight variables and were higher than 20% for one variable. Differences were statistically significant for only four variables (sedentary leisure time, consumption of vegetables, giving up smoking and cholesterol measurement), with a relative variation of 6.1% (p < 0.01), 10% (p < 0.001), 36.7% (p < 0.01) and 8.6% (p < 0.01), respectively. The total cost of the telephone interview was half that of the face-to-face household interview.

CONCLUSIONS

The results of both surveys were very similar. Because of its lower cost, the telephone interview is a good option in public health research when data collection by interview is required.

The effectiveness of the interview for predicting the presence of polycystic ovary syndrome

Polycystic ovary syndrome (PCOS), a leading cause of female infertility, occurs in approximately 4% of women of reproductive age. Multifamily studies have established that PCOS has strong inherited traits. Although diagnosis of PCOS in the relatives of affected women can readily be made by clinical and biochemical evaluations, these methods are costly and laborious. The aim of this investigation was to determine whether clinically evident PCOS could be detected by a written questionnaire, which is a significantly less expensive means of detection than direct determination. A questionnaire about the history of possible androgenic symptoms of PCOS was presented to patients and their first-degree female relatives, who were also evaluated by physical and laboratory examinations. The sensitivity, specificity, and positive predictive value (PPV) and negative predictive value (NPV) for the detection of PCOS by interview were calculated. The NPV of the proband interview was significantly lower for sisters than for mothers (82% vs. 100%, respectively; p < 0.05). When the family member completed the written questionnaire directly, the specificity and NPV of self-reporting were equally high (> 90%) for both mothers and sisters. Thus direct interviewing of PCOS patients or their mothers and sisters reliably predicts affected status, but patient interview alone will not predict PCOS in almost 50% of the affected sisters.

Elevated asthma and indoor environmental exposures among Puerto Rican children of East Harlem

OBJECTIVE

East Harlem in New York City, a community with a large Puerto Rican population, has among the highest rates of asthma hospitalizations and mortality in the United States, but it is not known if the high rates are related to the ethnic composition, environmental or community factors, or if the higher rates reflect differentials in access to appropriate asthma care. A survey was conducted to: (a) estimate the prevalence of current asthma by ethnicity among school-age children, (b) assess indoor environmental risk factors for childhood asthma, and (c) assess health care utilization and school absences associated with childhood asthma.

DESIGN

A cross-sectional survey of parents of elementary school children, using a self-administered questionnaire with a 12-month recall on asthma symptoms based on the International Study of Asthma and Allergies in Childhood.

SETTING

Two public elementary schools in East Harlem (n = 1615 students 5-12 years of age).

RESULTS

Among the 1319 respondents (response rate 82%), the prevalence for current asthma (doctor or nurse diagnosis at any time plus wheezing in the past 12 months) was 23%. Puerto Rican children had a prevalence of 35%. Puerto Rican children reported both higher symptomatic frequencies and higher rates of physician diagnosis. Living in a home where cockroaches, rats, or mice had been seen in the past month and with a dust-enhancing heating system also was associated with having asthma, regardless of ethnicity. Compared with other children with asthma, Puerto Rican children with asthma were more likely to live in homes where rats or mice had been seen in the past month. Regardless of ethnicity, children with more frequent, more severe asthma symptoms and incomplete asthma action plans were more likely to have visited the emergency department in the past year. Puerto Rican children were more likely to have missed school because of their asthma in the past year.

CONCLUSION

The prevalence of current asthma was significantly higher among Puerto Ricans, who had higher symptomatic frequency and greater diagnosis rates. Although all children with asthma in the East Harlem study appear to be sensitive to selected indoor environmental risk factors, only Puerto Rican children with asthma appear to be sensitive to the presence of rodents in their buildings. However, their higher school absence rate suggests problems with routine asthma management that could be addressed by improved medical management, programs to help parents manage their children's asthma, or school staff assistance with medications.

Injury prevention attitudes and awareness in New Zealand

OBJECTIVES

This study was designed to obtain New Zealand data on beliefs related to a broad spectrum of injuries and their prevention.

METHODS

A cross sectional phone survey was conducted of approximately 400 randomly selected households from each of 13 territorial local authorities across New Zealand, giving a total of 5282. Respondents were asked questions on awareness and attitudes to injury prevention, ownership and use of safety equipment, safety behaviours, and incidence of self reported injury.

RESULTS

84% agreed with the statement that "Most injuries are preventable" and 91% rated their homes as "very safe" or "reasonably safe". A high proportion of homes had smoke alarms (81%) and first aid kits (81%), and more than half (56%) had turned down the temperature of their hot water to 55 degrees C or lower. However, less than half of the respondents said that they practised the other safety behaviours. Significant associations were found between the practise of safety behaviours and respondents' home safety ratings. There was a significant association between home safety ratings and the incidence of injury occurring in all settings (p<0.0001), however there was no discernable association between home safety ratings and injury occurring in the home.

CONCLUSIONS

Although this survey found that most respondents believed that injuries are preventable and considered their homes to be safe, the public need to be further encouraged to adopt common safety practices and behaviours in the home.

Sunburn reduction through parental role modeling and sunscreen vigilance

OBJECTIVES

To identify characteristics associated with child sunburn experience and sun protection practices, including parent and child demographics, phenotype, and sun-related knowledge, attitudes, and behaviors.

STUDY DESIGN

A nationally representative telephone survey conducted in 1999 with 651 parents of children 5 to 12 years of age to collect data relating to the sun-related knowledge, attitudes, and behaviors of the parent and child.

RESULTS

Nearly half of parents (49%) and children (44%) were sunburnt during the previous summer. Parents who reported that they had been sunburnt were more likely to have children who had been sunburnt (OR = 2.9, 95% CI = 2.0, 4.2). Conversely, parents with a high level of sun protection behavior were less likely to report being sunburnt (OR = 0.6, 95% CI = 0.4, 0.9), and their children were more likely to have a high level of sun protection behavior (OR = 3.0, 95% CI = 2.0, 4.6) and sunscreen vigilance (OR = 2.7, 95% CI = 1.7, 4.5). High sunscreen vigilance was associated with a 60% reduction in child sunburning.

CONCLUSIONS

The sunburn experience and sun protection practices of children (5-12 years of age) are closely linked to a number of modifiable attitudes and behaviors of their parents. Therefore the inclusion of parents and care givers in interventions targeting children may increase program efficacy.

The experience of using random digit dialling methods in a population-based chronic pain study

OBJECTIVES

To describe response rates and call characteristics using random digit dialling (RDD) methods in a population-based prevalence study of chronic pain; to compare respondent characteristics according to telephone number listing status.

METHODS

A RDD telephone study of chronic pain was conducted using computer-assisted telephone interview (CATI) methods in the Northern Sydney Area in 1998.

RESULTS

Unlisted number respondents (18.5%) were younger, had a higher proportion of males, and were less likely to live in households with three or more eligible adults. There was no difference in chronic pain status between the two groups. The overall response rate was 73.4% (unlisted number group 66.3%; listed number group 75.0%). Answering machine messages boosted response rates (79.7%). 10.9% of unlisted numbers used in the study resulted in completed interviews, compared with 31.3% of the listed numbers used.

CONCLUSIONS

The relatively high response rate obtained, differences in characteristics associated with listing status and reduction in sampling bias provided by using RDD methods have to be balanced against the differential response rates between listed and unlisted number groups and higher costs (including opportunity costs). IMPLICTIONS: Published data on the experience of using RDD methods can assist public health researchers in deciding whether to use these methods in telephone surveys.

Chronic pain in Australia: a prevalence study

This study reports chronic pain prevalence in a randomly selected sample of the adult Australian population. Data were collected by Computer-Assisted Telephone Interview (CATI) using randomly generated telephone numbers and a two-stage stratified sample design. Chronic pain was defined as pain experienced every day for three months in the six months prior to interview. There were 17,543 completed interviews (response rate=70.8%). Chronic pain was reported by 17.1% of males and 20.0% of females. For males, prevalence peaked at 27.0% in the 65--69 year age group and for females, prevalence peaked at 31.0% in the oldest age group (80--84 years). Having chronic pain was significantly associated with older age, female gender, lower levels of completed education, and not having private health insurance; it was also strongly associated with receiving a disability benefit (adjusted OR=3.89, P<0.001) or unemployment benefit (adjusted OR=1.99, P<0.001); being unemployed for health reasons (adjusted OR=6.41, P<0.001); having poor self-rated health (adjusted OR=7.24, P<0.001); and high levels of psychological distress (adjusted OR=3.16, P<0.001). Eleven per cent of males and 13.5% of females in the survey reported some degree of interference with daily activities caused by their pain. Prevalence of interference was highest in the 55--59 year age group in both males (17.2%) and females (19.7%). Younger respondents with chronic pain were proportionately most likely to report interference due to pain, affecting 84.3% of females and 75.9% of males aged 20--24 years with chronic pain. Within the subgroup of respondents reporting chronic pain, the presence of interference with daily activities caused by pain was significantly associated with younger age; female gender; and not having private health insurance. There were strong associations between having interfering chronic pain and receiving disability benefits (adjusted OR=3.31, P<0.001) or being unemployed due to health reasons (adjusted OR=7.94, P<0.001, respectively). The results show that chronic pain impacts upon a large proportion of the adult Australian population, including the working age population, and is strongly associated with markers of social disadvantage.

What are the long-term results of endoscopic pancreatic sphincterotomy?

BACKGROUND

Endoscopic pancreatic sphincterotomy has been touted as effective therapy for chronic pancreatitis and unexplained abdominal pain resulting from pancreatic sphincter dysfunction. Although short-term data are encouraging, there are no reports on how these patients fare beyond the first few months.

METHODS

We performed a retrospective review of records on all patients who had pancreatic sphincterotomy during a 4-year period between August 1992 and November 1996. Chronic pancreatitis was diagnosed by pancreatography. Patients were evaluated for symptomatic response to pancreatic sphincterotomy and clinical improvement was defined as greater than 50% reduction in the magnitude of pain.

RESULTS

Fifty-five patients had pancreatic sphincterotomy including patients with (n = 40) and without (n = 15) chronic pancreatitis. After a median follow-up of 16 months, 60% of all patients reported improvement of pain scores (3.6 +/- 3.4 vs. 8.8 +/- 1.8; p < 0.01) with the best response in patients without evidence of chronic pancreatitis. Complications of pancreatic sphincterotomy included pancreatitis in 5 patients (9%), bleeding in 2 (3.6%) and early stent occlusion in 5 patients (9%). There were no deaths.

CONCLUSIONS

In a subgroup of patients with pancreatic sphincter dysfunction, endoscopic pancreatic sphincterotomy results in significant sustained clinical improvement.

An evaluation of patients' quality of life before, 6 weeks and 6 months after total hip replacement surgery

Annually, throughout the world, more than 800,000 primary total hip replacement surgery procedures are performed on patients suffering from hip joint arthrosis. Since 1991, approximately 11,000 of these procedures are performed annually in Sweden. This study aimed to investigate any changes in the patients' life quality 6 weeks and 6 months after their total hip replacement surgery had been performed, compared to that immediately prior to the operation. It also aimed to examine the reason for surgery, the types of prostheses used, postoperative pain, complications and the actual usage of ambulation support. The Sickness Impact Profile self-appraisal instrument, together with personal patient interviews have been used as the basis of the research. A total of 51 patients responded to the quality of life instrument prior to their operation, 47 of these participated 6 weeks after the operation, and 40 patients 6 months after the operation. Significant differences in patients' total, physical and psychosocial quality of life 6 months postoperatively compared to the situation prior to the operation were found, but not between the situation before and 6 weeks after the total hip replacement surgery. The majority of patients were of the opinion that it was more important that the pain had disappeared or decreased, than any overall increase in the quality of life. Postoperative complications occurred within 6 weeks, and even after 6 months some patients still suffered from these.

Random digit dialling and Electronic White Pages samples compared: demographic profiles and health estimates

OBJECTIVE

To compare the methodologies of and health estimates derived from two telephone household survey methods. In particular, to establish if White Pages telephone listings provide a relatively unbiased sampling frame for population health surveys.

METHOD

In South Australia in 1998, a health survey questionnaire was administered by telephone to two randomly selected population samples. The first method used EWP (Electronic White Pages, n = 6,012), which contains all listed residential telephone numbers as the sampling frame. The results were compared to a RDD (random digit dialling, n = 3,080) sample where all listed and unlisted telephone numbers were included in the sampling frame. Demographic variables and health estimates were compared between the surveys, and then compared to a 'gold standard' door-to-door household survey conducted concurrently.

RESULTS

The response rate for EWP (83.8%) exceeded that of RDD (65.4%). More than four times as many calls were required per completed interview in RDD. Demographic profiles and health estimates were substantially similar.

CONCLUSIONS

EWP requires fewer telephone calls and enables approach letters establishing the bona fides of the survey to be sent to each selected address before calling, increasing the response rate. RDD is a more inclusive sampling frame but also includes non-connected and business numbers, and offers no significant advantages in providing health estimates.

IMPLICATIONS

There are substantial methodological and cost advantages in using EWP over RDD as the sampling, frame for population health surveys, without introducing significant bias into health estimates.

Estimates of smoking and related behaviour in an immigrant Lebanese community: does survey method matter?

OBJECTIVE

To estimate the prevalence of smoking, stage-of-change and GP advice to quit in the Sydney Lebanese community and whether these findings varied by survey method.

METHOD

Three methods--telephone interviews using sampling from the electronic White Pages, personal interviews of a household member selected using cluster sampling and a mailed survey using an electoral roll sample--were used in separate surveys of persons born in Lebanon living in three postcode areas of Sydney in 1997.

RESULTS

Smoking prevalence was consistent across the three methods, with male smoking averaging 49% and female smoking averaging 29%. About two-thirds of smoking respondents across each of the survey methods had no plans for quitting.

CONCLUSIONS

As smoking prevalence did not vary across the three sampling and survey methods used here, the simplest and most inexpensive method (the electronic White Pages and telephone surveying of identifiable ethnic surnames) should be preferred.

IMPLICATIONS

Smoking prevalence in the Sydney Lebanese community is determined consistently using a variety of survey methods.