Comparison of web and mail surveys in collecting illicit drug use data: a randomized experiment

Knowledge, attitudes and practices of undergraduate health sciences students on hepatitis B vaccination at a South African university highlight the need for improvement of policies, implementation and co-ordination

BACKGROUND

Hepatitis B virus (HBV) infection causes nearly 300 million chronic infections globally. Healthcare workers face up to four times the risk of HBV infection through occupational exposure to contaminated blood and bodily fluids. Health sciences students (HSSs) are regarded as at an even greater risk as they embark on their clinical training journey. While chronic hepatitis B is incurable, it can be prevented by the safe and effective hepatitis B vaccine (HepB). The South African National Department of Health recommends at least three doses of vaccine (HepB3) for HSSs before patient contact. However, data on policy implementation at training institutions, vaccine coverage and HBV immunity in HSSs are lacking or limited.

OBJECTIVES

To investigate knowledge, attitudes and practices of HSSs at the University of the Witwatersrand (Wits) in relation to international guidelines and institutional HepB programmes included in the Wits vaccination policy. Sociodemographic factors predicting HepB uptake were also investigated.

METHODS

A cross-sectional study was conducted between February and June 2021. An electronic, self-administered survey was emailed to all current HSSs (N=3 785). The survey included questions on sociodemographic characteristics, knowledge of and attitudes towards HepB- related international guidelines and Wits policies, and HepB uptake and vaccine practices at Wits. Descriptive statistical analyses, followed by multivariable regression modelling, were used to identify factors associated with HepB uptake.

RESULTS

A response rate of only 7.1% yielded 269 returned surveys, of which 221 were adequate for analysis. Most respondents were female (69.2%), with a mean (standard deviation) age of 22.5 (3.5) years, and were studying a Bachelor of Medicine and Surgery (MB BCh) degree (76.9%). Only 78% of those students who reported a history of vaccination (89.1% of study sample) reported a completed vaccine series. The only significant predictor, when adjusted for interactions, was being enrolled in MB BCh compared with other courses (odds ratio 4.69; p=0.026). Students displayed higher levels of knowledge around institutional (Wits) vaccine recommendations (94.1%) compared with international recommendations (75.6%). Most students were in favour of mandatory vaccination (91.4%), but not of serological testing following vaccination (42.5%). Half of our students received vaccinations in private facilities, but no follow-up or record was made of this by the designated Wits Campus Health and Wellness Centre.

CONCLUSION

Institutional HepB policies are suboptimal, with no centralised co-ordination or implementation strategy. Urgent efforts are required to create awareness around policy and management, ensure vaccination coverage in this high-risk group, and foster positive practices with adequate monitoring.

Mental health stigma among college students: misperceptions of perceived and personal stigmas

ObjectiveThe purpose of this study was to assess the relationship between college student perceived and personal mental health stigmas. Participants: A sample of 352 undergraduate college students from two large Universities in the Eastern United States was utilized. Methodology: A self-report anonymous online survey was utilized. The survey contained demographics as well as questions to assess participant levels of perceived stigma, personal stigma, and social desirability.ResultsResults revealed that college student perceived stigma was significantly greater than personal stigma, and that perceived stigma and personal stigma were significantly and positively correlated. Conclusions: Overall findings suggest a misperception of campus mental health stigma levels. Based upon these student misperceptions of stigma, best practices for addressing stigma within the clinical setting are discussed. Overall implications for college counseling centers are presented, including campus outreach strategies.

Just you wait… and fill out this survey. Discussion of the methodological aspects of waiting room surveys

A method commonly used in health care research is the waiting room (WR) survey. While patients are waiting for their appointment, they are asked to complete a questionnaire measuring their attitudes, behaviors and other characteristics. In this paper we synthesize practical guidelines for WR surveys by comparing the method with two similar approaches: public intercept (PI) surveys and drop-off-pick-up (DOPU) surveys. In this comparison we use the Total Survey Error approach Groves (Survey Methodology, Wiley, New York, 2004); (Groves in Public Opinion Quarterly 74(5): 849-879, 2010) and apply it to three case examples in which one of the three surveys is used. We take into account measurement (validity, measurement- and processing error) and representation (coverage-, sampling- and nonresponse error). From our review, we conclude that waiting room surveys, though limited to patients and their caregivers, can provide useful information on patients’ perspective on health care. Response rates in waiting rooms are usually high, but often not even reported. We recommend adjustment for sampling bias by taking into account the number of visits to the hospital per respondent and sample times proportionate to the number of sample members expected on a particular time. These surveys also allow for collection of para-data; i.e., relevant information in the circumstances of a request to participate in survey research, and behavior of surveyors can easily be controlled, or investigated in an experimental design.

Exploring the use of cognitive enhancement substances among Portuguese university students

Background

Prescription drug use and the consumption of substances to enhance college students' cognitive performance, described as pharmacological cognitive enhancement (PCE), is a known phenomenon potentially impacting individuals' health. University and college students are two specific subpopulations noted to use PCE (up to 17%, on average). To our knowledge, no data have been published on the use of PCE drugs among university students at a national level in Portugal and the factors that might be associated with this usage.

Objective

The main objective was to estimate the prevalence of PCE use by Portuguese university students and to identify the PCE substances commonly used by university students, i.e., those classified as prescription drugs and other legal and nonprescribed substances, including food supplements.

Methods

The study followed a cross-sectional exploratory, descriptive design and pursued a convenience sample of students from Portuguese public and private universities (22 higher education institutions).

Results

From a sample of 745 university students, 32% indicated the use of prescribed and nonprescribed substances. The most consumed substances were food supplements with CNS stimulants being the most frequent prescription-only drugs but not necessarily accessed through a medical prescription. A significant statistical association was found between substance consumption and the field of study. Health science students reported more food supplements and drug intake, allegedly under prescribed regimens, compared to humanities and exact sciences students. The study discusses the need to better understand the competitive societies that produce and support young students' outputs and the perceived ‘need’ for performance-enhancing substances.

Conclusions

One-third of the university students aimed to improve their performance by pharmacological cognitive enhancement, with a preference for food supplements dispensed in pharmacies. PCE substance consumption in higher education is thus non-negligible. The study suggests the need to improve regulations on potential inequalities in academic rankings and success and an observant attitude concerning implications that negatively affect health in the long run.

Self-reported Subjective Effects of Analytically Confirmed New Psychoactive Substances Consumed by e-Psychonauts: Protocol for a Longitudinal Study Using a New Internet-Based Methodology

Background

During the last few years, the continuous emergence of new psychoactive substances (NPS) has become an important public health challenge. The use of NPS has been rising in two different ways: buying and consuming NPS knowingly and the presence of NPS in traditional drugs as adulterants. The rise of NPS use is increasing the number of different substances in the market to an extent impossible to study with current scientific methodologies. This has caused a remarkable absence of necessary information about newer drug effects on people who use drugs, mental health professionals, and policy makers. Current scientific methodologies have failed to provide enough data in the timeframe when critical decisions must be made, being not only too slow but also too square. Last but not least, they dramatically lack the high resolution of phenomenological details.

Objective

This study aims to characterize a population of e-psychonauts and the subjective effects of the NPS they used during the study period using a new, internet-based, fast, and inexpensive methodology. This will allow bridging an evidence gap between online surveys, which do not provide substance confirmation, and clinical trials, which are too slow and expensive to keep up with the new substances appearing every week.

Methods

To cover this purpose, we designed a highly personalized, observational longitudinal study methodology. Participants will be recruited from online communities of people who use NPS, and they will be followed online by means of a continuous objective and qualitative evaluation lasting for at least 1 year. In addition, participants will send samples of the substances they intend to use during that period, so they can be analyzed and matched with the effects they report on the questionnaires.

Results

The research protocol was approved by the Institutional Review Board of the Hospital del Mar Research Institute on December 11, 2018. Data collection started in August 2019 and was still ongoing when the protocol was submitted (September 2020). The first data collection period of the study ended in October 2020. Data analysis began in November 2020, and it is still ongoing. The authors expect to submit the first results for publication by the end of 2021. A preliminary analysis was conducted when the manuscript was submitted and was reviewed after it was accepted in February 2021.

Conclusions

It is possible to conduct an institutional review board–approved study using this new methodology and collect the expected data. However, the meaning and usefulness of these data are still unknown.

International Registered Report Identifier (IRRID)

DERR1-10.2196/24433

Effect of a Home Pregnancy Test Intervention on Cohort Retention and Pregnancy Detection: A Randomized Trial

We conducted a parallel, nonblinded randomized trial to assess whether offering home pregnancy tests (HPTs) to preconception cohort study participants influenced cohort retention or pregnancy detection. Pregnancy Study Online participants were female, aged 21-45 years, attempting pregnancy, and not using fertility treatment. At enrollment (2017-2018), 1,493 participants with 6 or fewer cycles of attempt time were randomly assigned with 50% probability to receive 12 Clearblue visual HPTs plus the standard protocol (n = 720) or the standard protocol alone (n = 773). Women completed bimonthly questionnaires for 12 months or until conception, whichever came first. In intent-to-treat analyses, retention (≥1 follow-up) was higher in the HPT arm (n = 598; 83%) than the standard protocol arm (n = 535 (69%); mean difference = 15%, 95% CI: 10, 19). Mean time at first pregnancy testing was identical in both arms (2 days before expected menses), as was mean gestational weeks at first positive pregnancy test (4 weeks). Conception was reported by 78% of women in the HPT arm and 75% in the standard protocol arm. Spontaneous abortion was reported by 21% in the HPT arm (mean gestational weeks = 7) and 21% in the standard protocol arm (mean gestational weeks = 6). Randomization of HPTs was associated with greater cohort retention but had little impact on incidence or timing of pregnancy detection.

Prevalence of Performance-Enhancing Substance Use and Associated Factors among Portuguese Gym/Fitness Users

Background: Nowadays, doping is not confined to elite sport, it is also spread throughout gymnasia and fitness centers, and it is seen as a public health concern. Studies focusing on performance-enhancing substances (PES) use among gym users are few and mostly concern the practice of bodybuilding and the use of anabolic-androgenic steroids (AAS), without providing information about social indicators to further explore why this specific population use these substances. Objectives: To investigate the extent of PES use and examine the way social indicators, exercise profile and gym modalities influence the use of these substances among a sample of gym users. Methods: Cross-sectional descriptive study, among a convenience sample of 453 Portuguese gym users, recruited directly by five institutional gyms´ email and Facebook. Data were collected via a structured web-based survey, between October and November 2017. Multiple binary logistic regression, the Chi-Square test or Monte Carlo Simulation or Fisher's Exact test were used. The odds ratios and their respective 95% confidence intervals were calculated. Results: 11,1% of gym users reported the use of prohibited PES, which varies significantly according to gender, education, exercise profile and type of practice. Gender was associated with the class of PES used. Polypharmacy was a common practice among users, increasing the risk of side-effects. Peer effect and media appear to be strikingly important in the misuse of PES. Conclusion: Results provide precise insight into the specific factors associated with PES use, which could support prevention strategies in gym/fitness context.

Dissatisfaction with opioid maintenance treatment partly explains reported side effects of medications

BACKGROUND

Drop-out is a core problem in opioid maintenance treatment (OMT), but patients' reactions to and acceptance of the various OMT medications are insufficiently investigated. In Norway, there has been vocal patient resistance to the newest medication, buprenorphine-naloxone (BNX), and complaints have focused on the side effect profile. There has been no comparison of patient satisfaction and side effects of the three most common OMT medications.

AIM

To compare patient satisfaction with OMT and side effects of BNX, buprenorphine monopreparate (BUP), and methadone (MET) as reported by patients.

METHODS

Data were drawn from a national peer-to-peer survey developed by a patient advocacy group. The survey engaged more than 1000 OMT patients, corresponding to one seventh of OMT patients in Norway. The associations between side effects, treatment satisfaction, and patient characteristics were tested in multinomial logistic regressions.

RESULTS

High patient satisfaction with OMT overall was reported despite lower satisfaction with medication itself and widely prevalent side effects. Among each medication group, dissatisfaction with medications or OMT in general along with poor health status increased the relative risk ratio of reporting the heaviest side effect burden. MET users reported the highest side effect burden and BNX users the lightest, but BNX users were more dissatisfied with their medication.

CONCLUSIONS

Side effects are a concern for nearly all OMT patients, and they do not appear to accumulate with age or length of treatment. BNX users' dissatisfaction with their medication is of particular concern, and expectations and preferences of medication may be influencing their dissatisfaction.

A Sequential Mixed-Mode Experiment in the U.S. National Monitoring the Future Study

The national Monitoring the Future (MTF) study examines substance use among adolescents and adults in the United States and has used paper questionnaires since it began in 1975. The current experiment tested three conditions as compared to the standard MTF follow-up protocol (i.e., MTF Control) for the first MTF follow-up survey at ages 19/20 years (i.e., one or two years after high school graduation). The MTF Control group included participants who completed in-school baseline surveys in the 12th grade in 2012-2013 and who were selected to participate in the first follow-up survey in 2014 (n = 2,451). A supplementary sample of participants who completed the 12th grade baseline survey in 2012 or 2013 but were not selected to participate in the main MTF follow-up (n = 4,950) were recruited and randomly assigned to one of three experimental conditions: (1) Mail Push, (2) Web Push, (3) Web Push + E-mail. Results indicated that the overall response rate was lower in Condition 2 compared to MTF Control and to Condition 1; there were no differences between Condition 3 and other conditions. Web response was highest in Condition 3; among web responders, smartphone response was also highest in Condition 3. Subgroup differences also emerged such that, for example, compared to white participants, Hispanics had greater odds of web (versus paper) response and blacks had greater odds of smartphone (versus computer or tablet) response. Item nonresponse was lowest in the Web Push conditions (compared to MTF Control) and on the web survey (compared to paper). Compared to MTF Control, Condition 3 respondents reported higher rates of alcohol use in the past 30 days. The total cost was lowest for Condition 3. Overall, the Condition 3 Web Push + E-mail design is promising. Future research is needed to continue to examine the implications of web and mobile response in large, national surveys.

Perceived Satisfaction With Long-Term Oxygen Delivery Devices Affects Perceived Mobility and Quality of Life of Oxygen-Dependent Individuals With COPD

BACKGROUND

Although routine physical activity for individuals with COPD is recommended, there are inherent limitations of available oxygen delivery devices that may result in hypoxemia during activity. Changes in Medicare laws have resulted in an increased use of oxygen cylinders and a reduction in the use of liquid oxygen devices. The aim of this survey was to assess the impact of perceived satisfaction with various oxygen delivery devices on perceived mobility and quality of life (QOL) of oxygen-dependent subjects with COPD.

METHODS

A survey was developed to measure perceived satisfaction with current portable oxygen delivery devices, perceived mobility, and perceived QOL. The survey was deployed via a link posted on the COPD Foundation's COPD360SOCIAL social media site for 5 weeks, which resulted in the recruitment of 529 participants, of which 417 were included in the data analysis.

RESULTS

Quantile regression analysis revealed that the median perceived device satisfaction score was significantly higher in the liquid oxygen device group (P < .001) compared with the portable oxygen cylinder and portable oxygen concentrator (POC) groups. The median perceived mobility score was significantly higher in the liquid oxygen device group (P < .001) compared with the portable oxygen cylinder group, but not the POC group. The median QOL score was significantly higher in the liquid oxygen device group (P < .001) compared with the POC and portable oxygen cylinder groups. Moreover, partial least-squares structural equation modeling regression analysis showed that perceived mobility is significantly affected by perceived satisfaction with the long-term oxygen therapy (LTOT) device (adjusted R² = 0.15, P < .001), and perceived QOL is significantly affected by both perceived satisfaction with the LTOT device and perceived mobility (adjusted R² = 0.45, P < .001).

CONCLUSIONS

For individuals with COPD requiring LTOT, perceived satisfaction with a portable LTOT device significantly and positively affects perceived mobility and QOL.

The effects of using answer sheets on reported drug use and data quality in a classroom survey: A cluster-randomized study

BACKGROUND

We compare self-reported prevalence of drug use and indicators of data quality from two different response modes (with and without an independent answer sheet for recording responses) in a survey conducted in 2015 among secondary school students.

METHODS

Stratified cluster-randomized study conducted among students in grades 8-12 from public, private and subsidized schools in Chile (N=2317 students in 122 classes). Measurements included were: percentage reporting substance use (tobacco, alcohol, marijuana, cocaine, ecstasy); number of inconsistent responses; number of item nonresponses; percentage of extreme reports of drug use; percentage reporting using the nonexistent drug, relevón; and completion times.

RESULTS

Compared with those who responded directly in the questionnaire booklet, students who used a separate answer sheet took 17.6 more minutes (95% confidence interval [CI]: 14.4-20.8) to complete the survey and had on average 1.5 more inconsistent responses (95%CI: 0.91-2.14). The prevalence and variance of drug use was higher among those who used an answer sheet for all substances except tobacco; the prevalence ratio (PR) of reported substance use for low-prevalence substances during the past year were: cocaine PR=2.5 (95%CI: 1.6-4.1); ecstasy PR=5.0 (95%CI: 2.4-10.5); relevón PR=4.8 (95%CI: 2.5-9.3).

CONCLUSIONS

Using an answer sheet for a self-administered paper-and-pencil survey of drug use among students result in lower quality data and higher reports of drug use. International comparison of adolescent drug use from school-based surveys should be done with caution. The relative ranking of a country could be misleading if different mode of recording answers are used.

Minority stress, psychological distress, and alcohol misuse among sexual minority young adults: A resiliency-based conditional process analysis

BACKGROUND

Sexual minority young adults experience elevated rates of distal stress (discrimination, victimization), and related psychological distress and alcohol misuse. However, few studies have examined the degree to which personality trait differences confer risk/resilience among sexual minority young adults. We hypothesized that psychological distress would mediate the relationship between distal stress and alcohol misuse, but that these relationships would be moderated by personality trait differences.

METHOD

Sexual minority young adults (N=412) were recruited nationally. Survey measures included demographic questions, minority stressors, Five Factor personality traits, and current psychological distress and alcohol misuse symptoms. We used a data-driven two-stage cluster analytic technique to empirically derive personality trait profiles, and conducted mediation and moderated mediation analyses using a regression-based approach.

RESULTS

Our results supported a two-group personality profile solution. Relative to at-risk individuals, those classified as adaptive scored lower on neuroticism, and higher on agreeableness, extraversion, conscientiousness, and openness to experience. As predicted, psychological distress mediated the relationship between distal stress and alcohol misuse. However, personality moderated these relationships to the degree that they did not exist among individuals classified as adaptive.

DISCUSSION

In the current study, we found that personality moderated the established relationships between distal stress, psychological distress, and alcohol misuse among sexual minority young adults. Future research is needed to further explicate these relationships, and in order to develop tailored interventions for sexual minority young adults at risk.

Beyond testosterone cypionate: evidence behind the use of nandrolone in male health and wellness

Characterized by low serum testosterone levels and diverse symptoms, male hypogonadism is a common condition. Current medical treatment focuses on testosterone supplementation using multiple modalities such as injections, gels and pellets. Interestingly, while testosterone is considered an anabolic androgenic steroid, it has not been saddled with the social stigma that other, similar medications have. The goal of this review is to highlight an anabolic steroid, 19-nortestosterone (i.e., nandrolone, deca-durabolin) and illustrate prospective therapeutic applications for male health. Containing a chemical structure similar to testosterone, nandrolone has a higher myotrophic: androgenic ratio resulting in improved effects on muscle mass. Animal models have suggested application in the improvement of joint healing following rotator cuff repair. Minimal literature exists regarding the use of nandrolone and, as such, further human studies are required.

LMX as a negative predictor of presenteeism climate

Purpose

– Some underlying mechanisms regarding presenteeism still remain unclear, namely, the construct of “presenteeism climate” and the importance of “leadership” Leader-Member Exchange (LMX) for presenteeism. In order to shed some light into this phenomenon, the purpose of this paper is to develop and apply a new scale of presenteeism climate.

Design/methodology/approach

– In Study 1, the authors identified a pool of items from the literature and, in Study 2 (n=147) the authors tested 26 items that were pilot studied with exploratory factor analysis. In Study 3 (n=293) the authors tested a three-factor model – extra-time valuation, supervision distrust and co-workers competitiveness – with confirmatory factor analysis.

Findings

– Results showed that LMX has a negative correlation with presenteeism climate. Study 3 also showed that this structure remained invariant with additional samples from employees working in hospitals from Ecuador (n=90) and China (n=237). Finally, the authors included suggestions for future studies to overcome the limitations of this research.

Practical implications

– This study has implications for managers and academics, as it emphasizes the importance of favorable behaviors between leaders and employees in order to decrease presenteeism and its adverse consequences.

Originality/value

– The main contribution consists of identifying dimensions of presenteeism climate and developing measures. Additionally, the authors contribute to the literature on leadership by studying the influence of LMX on presenteeism climate.

Opioid use among interscholastic sports participants: an exploratory study from a sample of college students

PURPOSE

Involvement in sports increases the risk for injury and the risk for prescription opioid use and misuse. This was an exploratory retrospective study to examine if previous involvement in interscholastic sports was associated with a greater lifetime prevalence of medical prescription opioid use, lifetime risk for diverting prescribed opioids, and lifetime risk for nonmedical prescription opioid use.

METHOD

A Web-based survey was self-administered to a sample of 4,187 full-time undergraduate students at a large public university located in the Midwest. Student demographics, involvement in interscholastic sports during high school, lifetime medical prescription opioid use, lifetime risk for diverting prescribed opioids, and lifetime risk for nonmedical prescription opioid use were measured and analyzed for this study.

RESULTS

Multiple logistic regression analyses indicated that those who participated in at least 1 interscholastic sport during high school had greater odds for lifetime medical prescription opioid use on multiple occasions and greater odds for being approached to divert their prescribed opioid medications on multiple occasions when compared with their peers who did not participate in interscholastic sports during high school.

CONCLUSIONS

The findings indicate some association between previous involvement in interscholastic sports and prescription opioid use and misuse. These findings further suggest that greater awareness should be instilled in parents and coaches regarding this form of substance misuse.

Disparities in Weight and Weight Behaviors by Sexual Orientation in College Students

Objectives. We assessed disparities in weight and weight-related behaviors among college students by sexual orientation and gender. Methods. We performed cross-sectional analyses of pooled annual data (2007-2011; n = 33 907) from students participating in a Minnesota state-based survey of 40 two- and four-year colleges and universities. Sexual orientation included heterosexual, gay or lesbian, bisexual, unsure, and discordant heterosexual (heterosexuals engaging in same-sex sexual experiences). Dependent variables included weight status (derived from self-reported weight and height), diet (fruits, vegetables, soda, fast food, restaurant meals, breakfast), physical activity, screen time, unhealthy weight control, and body satisfaction. Results. Bisexual and lesbian women were more likely to be obese than heterosexual and discordant heterosexual women. Bisexual women were at high risk for unhealthy weight, diet, physical activity, and weight control behaviors. Gay and bisexual men exhibited poor activity patterns, though gay men consumed significantly less regular soda (and significantly more diet soda) than heterosexual men. Conclusions. We observed disparities in weight-, diet-, and physical activity-related factors across sexual orientation among college youths. Additional research is needed to better understand these disparities and the most appropriate intervention strategies to address them.

Examining Potential Substance Use Disorders Among Former Interscholastic Athletes

BACKGROUND

Despite numerous studies examining the association between competitive sports participation and substance use behaviors among adolescents and young adults, the use of standardized measures to assess potential substance use disorders has been largely neglected. The objective of this study was to examine if past involvement in interscholastic sports (competitive school-sponsored sports) was associated with potential substance use disorders in young adulthood.

METHODS

Data for this study were taken from the Student Life Survey (SLS). A total of 3442 young adults participated in the SLS during the spring semester in 2013, with 74% of males and 71% of females indicating participation in interscholastic sport during high school.

RESULTS

Respondents who participated in interscholastic sports during high school had higher odds of positive screens for potential alcohol use disorders when compared with their peers who did not participate in interscholastic sports. No association was detected between interscholastic sports participation and potential drug abuse disorders. Moreover, previous involvement in certain types of sports was found to be associated with positive screens for potential alcohol use disorders (i.e., crew and football) and positive screens for potential drug abuse disorders (i.e., lacrosse) among the sample of young adults.

CONCLUSIONS

School and community sport organizations should be aware of the potential link between sports participation and potential substance use disorders, and may consider brief substance use screeners during yearly physicals to monitor potential substance use problems among athletes.

Stress, Drugs, and Alcohol Use Among Health Care Professional Students

Objective:

To contrast the characteristics of pharmacy, medicine, and physician assistant (PA) students regarding the prevalence of drug, alcohol, and tobacco use and to identify risk factors associated with prescription stimulant use.

Participants:

Five hundred eighty nine students were recruited to complete a 50-item Web-based survey.

Main Outcome Measures:

Demographics, nonmedical prescription medication use, illicit drug and alcohol use, Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision; DSM-IV-TR) psychiatric diagnoses, and perceived stress scale (PSS) scores.

Results:

Medicine and PA students reported greater nonmedical prescription stimulant use than pharmacy students (10.4% vs 14.0% vs 6.1%; P < .05). Medicine and PA students were more likely to report a history of an anxiety disorder (12.1% vs 18.6% vs 5.9%; P < .05), major depressive disorder (9.4% vs 8.1% vs 3.3%; P < .05), and attention-deficit hyperactivity disorder (ADHD; 4.0% vs 9.3% vs 0.7%; P < .001) than pharmacy students. PSS scores for all 3 groups (21.9-22.3) were roughly twice as high as the general adult population.

Conclusion:

Illicit drug and prescription stimulant use, psychiatric disorders, and elevated stress levels are prevalent among health care professional students. Health care professional programs may wish to use this information to better understand their student population which may lead to a reassessment of student resources and awareness/prevention programs.

A comparison of tablet computer and paper-based questionnaires in healthy aging research

Background

Digital questionnaire delivery offers many advantages to investigators and participants alike; however, evidence supporting digital questionnaire delivery via touchscreen device in the older adult population is lacking.

Objective

The objective of this study was to compare the use of tablet computer-delivered and printed questionnaires as vehicles for the collection of psychosocial data from older adults to determine whether this digital platform would be readily adopted by the sample, and to identify whether tablet delivery influences the content of data received.

Methods

The participants completed three questionnaires using both delivery methods, followed by a brief evaluation.

Results

A nonparametric one-sample binomial test indicated a significantly greater proportion of individuals preferred the tablet-delivered questionnaires (z=4.96, SE 3.428, P<.001). Paired sample t tests and Wilcoxon sign-rank tests indicated that measures collected by each method were not significantly different (all P≥.273). Ease of use of the tablet interface and anxiety while completing the digital questionnaires were significantly correlated with preferences, (r_s=.665, P<.001 and r_s=.552, P<.001, respectively). Participants most frequently reported that the tablet delivery increased speed of use and improved data entry, although navigation was perceived as being more difficult. By comparison, participants felt that the paper packet was easier to read and navigate, but was slow and cumbersome, and they disliked the lack of dynamic features.

Conclusions

This study provides preliminary evidence suggesting that questionnaires delivered to older adults using contemporary tablet computers may be acceptable and do not substantively influence the content of the collected data.

Does self-selection affect samples' representativeness in online surveys? An investigation in online video game research

Background

The number of medical studies performed through online surveys has increased dramatically in recent years. Despite their numerous advantages (eg, sample size, facilitated access to individuals presenting stigmatizing issues), selection bias may exist in online surveys. However, evidence on the representativeness of self-selected samples in online studies is patchy.

Objective

Our objective was to explore the representativeness of a self-selected sample of online gamers using online players’ virtual characters (avatars).

Methods

All avatars belonged to individuals playing World of Warcraft (WoW), currently the most widely used online game. Avatars’ characteristics were defined using various games’ scores, reported on the WoW’s official website, and two self-selected samples from previous studies were compared with a randomly selected sample of avatars.

Results

We used scores linked to 1240 avatars (762 from the self-selected samples and 478 from the random sample). The two self-selected samples of avatars had higher scores on most of the assessed variables (except for guild membership and exploration). Furthermore, some guilds were overrepresented in the self-selected samples.

Conclusions

Our results suggest that more proficient players or players more involved in the game may be more likely to participate in online surveys. Caution is needed in the interpretation of studies based on online surveys that used a self-selection recruitment procedure. Epidemiological evidence on the reduced representativeness of sample of online surveys is warranted.

Trends in medical use, diversion, and nonmedical use of prescription medications among college students from 2003 to 2013: Connecting the dots

OBJECTIVES

To examine trends in the lifetime and past-year prevalence of medical use, diversion, and nonmedical use of four prescription medication classes (i.e., sedative/anxiety, opioid, sleeping, and stimulant) among college students between 2003 and 2013; and to identify demographic and background characteristics associated with trends in past-year nonmedical use of prescription medications.

METHODS

A self-administered, cross-sectional Web survey was conducted in 2003, 2005, 2007, 2009, 2011, and 2013 at a large public four-year university in the Midwest United States.

RESULTS

Approximately one in every five individuals reported nonmedical use of at least one prescription medication class in their lifetime. The past-year prevalence of medical use, diversion and nonmedical use of prescription stimulants increased significantly between 2003 and 2013 while the past-year prevalence of medical use, diversion and nonmedical use of prescription opioids decreased significantly over this same time period. The odds of past-year nonmedical use of each prescription medication class were generally greater among males, Whites, members of social fraternities and sororities, and those with a lifetime history of medical use of prescription medications or a past-year history of being approached to divert their prescription medications.

CONCLUSIONS

The present study represents the first investigation to demonstrate that trends in medical use of controlled medications parallel changes in diversion and nonmedical use of the same medication class among college students. The findings reinforce the importance of continued monitoring of prescription medication use at colleges to help guide prevention and intervention efforts.

Characteristics and Behaviors of Older Male Anabolic Steroid Users

OBJECTIVE

To compare and contrast the characteristics of 2 groups of men ≥40 years old: reported anabolic-androgenic steroid (AAS) users and nonusers.

DESIGN

Cross-sectional survey.

SETTING

Thirty-eight online fitness, weight lifting, bodybuilding, and steroid Web sites.

PARTICIPANTS

A total of 67 male AAS users and 76 male nonusers ≥40 years old.

MAIN OUTCOMES MEASURED

Demographics, utilization of AAS and other performance-enhancing agents (PEAs), exercise patterns, history of illicit drugs and alcohol use, and psychiatric traits/diagnoses.

RESULTS

The majority of AAS users ≥40 years old were caucasian (92.5%), heterosexual (97.0%), and classified themselves as recreational exercisers (79.1%). AAS users took more PEAs (11.5 ± 5.6 vs 4.6 ± 2.7; P < .001), were more likely to binge drink (47.8% vs 29.0%; P = .025), report heavy alcohol use (21.0% vs 7.9%; P = .031), meet criteria for substance dependence disorder (27.4% vs 4.0%; P < .001), and report an anxiety disorder diagnosis (12.0% vs 2.6%; P = .046) than nonusers.

CONCLUSIONS

AAS misuse is prevalent among older men and is associated with polypharmacy, more aggressive alcohol use, and a higher incidence of substance dependence and anxiety disorders compared to nonusers. This information may help clinicians and researchers identify and develop appropriate intervention strategies for AAS abuse among older men.

Anabolic steroid-induced hypogonadism: diagnosis and treatment

OBJECTIVE

To develop an understanding of hypogonadal men with a history of anabolic-androgenic steroid (AAS) use and to outline recommendations for management.

DESIGN

Review of published literature and expert opinions. Intended as a meta-analysis, but no quality studies met the inclusion criteria.

SETTING

Not applicable.

PATIENT(S)

Men seeking treatment for symptomatic hypogonadism who have used nonprescribed AAS.

INTERVENTION(S)

History and physical examination followed by medical intervention if necessary.

MAIN OUTCOME MEASURES(S)

Serum testosterone and gonadotropin levels, symptoms, and fertility restoration.

RESULT(S)

Symptomatic hypogonadism is a potential consequence of AAS use and may depend on dose, duration, and type of AAS used. Complete endocrine and metabolic assessment should be conducted. Management strategies for anabolic steroid-associated hypogonadism (ASIH) include judicious use of testosterone replacement therapy, hCG, and selective estrogen receptor modulators.

CONCLUSION(S)

Although complications of AAS use are variable and patient specific, they can be successfully managed. Treatment of ASIH depends on the type and duration of AAS use. Specific details regarding a patient's AAS cycle are important in medical management.

Is it time to abandon paper? The use of emails and the Internet for health services research--a cost-effectiveness and qualitative study

RATIONALE

A multidisciplinary primary care clinic in Sydney, Australia, was planning to use electronic questionnaires to measure patient-reported outcomes.

METHODS

Semi-structured interviews with 20 patients were undertaken to explore, among other things, practical issues regarding different questionnaire formats. The response rates and costs of email versus postal invitations were also evaluated.

RESULTS

Compared with postal invitations, email invitations offered a cost-effective and practical alternative, with a greater proportion of patients volunteering for an interview. Assuming the interface is well-designed and user-friendly, many patients were happy to use the Internet to answer questionnaires. Most patients thought alternate formats should also be offered. Patients discussed advantages and disadvantages of the Internet format. Although more younger patients and females had given the clinic an email address; both sexes, and young and old patients, expressed strong preferences for either wanting or not wanting to use the Internet.

CONCLUSION

Researchers should consider using email invitations as a cost-effective first-line strategy to recruit patients to participate in health services research. Internet questionnaires are potentially cheaper than paper questionnaires, and the format is acceptable to many patients. However, for the time being, concurrent alternate formats need to be offered to ensure wider acceptability and to maximize response rates.

Psychological and physical impact of anabolic-androgenic steroid dependence

STUDY OBJECTIVE

To contrast the characteristics of two groups of anabolic-androgenic steroid (AAS) users-those with versus those without AAS dependence.

DESIGN

Subanalysis of data from the Anabolic 500, a cross-sectional survey.

PARTICIPANTS

One hundred twelve male AAS-dependent users and 367 AAS-nondependent users who completed an online survey between February 19 and June 30, 2009.

MEASUREMENTS AND MAIN RESULTS

Respondents were recruited from the Internet discussion boards of 38 fitness, bodybuilding, weightlifting, and steroid Web sites. The respondents provided online informed consent and completed the Anabolic 500, a 99-item Web-based survey. Self-reported data included demographics, exercise patterns, use of AAS and other performance-enhancing agents, adverse effects of AAS use, behavior consistent with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria for AAS dependence, history of illicit drug and alcohol use, history of sexual or physical abuse, and psychiatric conditions diagnosed according to the DSM-IV-TR. Behavior consistent with AAS dependence was identified in 23.4% of the survey participants. These AAS-dependent users were more excessive in their AAS use (e.g., higher doses, higher quantity of agents, longer duration of use), more likely to report a history of illicit heroin use in the last 12 months (5.4% vs 1.9%, p=0.049), and more likely to report a diagnosis of an anxiety disorder (16.1 vs 8.4%, p=0.020) or major depressive disorder (15.2% vs 7.4%, p=0.012) than AAS-nondependent users.

CONCLUSION

Data from the Anabolic 500 survey showed that almost one quarter of AAS users were dependent on these drugs. These AAS-dependent users had a higher rate of heroin use as well as anxiety and major depressive disorders compared with AAS-nondependent users. These findings can help clinicians and researchers better understand and address the potential illicit drug use and psychiatric comorbidities that may be present among AAS-dependent users.

Weightlifting's risky new trend: a case series of 41 insulin users

Use of performance-enhancing drugs (PEDs) is common among strength-trained individuals, and a growing concern is the misuse of insulin. A 99-item Internet-based survey was posted on discussion boards of various fitness, bodybuilding, weightlifting, and anabolic steroid Web sites between February and June 2009. A case series of 41 nondiabetic insulin users is described. The typical insulin user was 30.7 ± 9.2 years old, male (97.6%), and Caucasian/white (86.8%) who classified himself as a "recreational exerciser" (47.5%). The average insulin user also used anabolic steroids (95.1%) and practiced polypharmacy by incorporating 16.2 ± 5.6 PEDs in his or her yearly routine. Hypoglycemia was reported by most of the subjects (56.8%), and one individual reported unconsciousness. Insulin was obtained most commonly from local sources (e.g., friends, training partners, gym member/dealer; 40.5%) and community pharmacies (37.8%), with most (80.6%) finding it "easy" to acquire their insulin. Strategies aimed to prevent insulin misuse are needed.

Variations in dream recall frequency and dream theme diversity by age and sex

We assessed dream recall frequency (DRF) and dream theme diversity (DTD) with an internet questionnaire among a cohort of 28,888 male and female participants aged 10–79 years in a cross-sectional design. DRF increased from adolescence (ages 10–19) to early adulthood (20–29) and then decreased again for the next 20 years. The nature of this decrease differed for males and females. For males, it began earlier (30–39), proceeded more gradually, and reached a nadir earlier (40–49) than it did for females. For females, it began later (40–49), dropped more abruptly, and reached nadir later (50–59). Marked sex differences were observed for age strata 10–19 through 40–49 and year-by-year analyses estimated the window for these differences to be more precisely from 14 to 44 years. DTD decreased linearly with age for both sexes up to 50–59 and then dropped even more sharply for 60–79. There was a sex difference favoring males on this measure but only for ages 10–19. Findings replicate, in a single sample, those from several previous studies showing an increase in DRF from adolescence to early adulthood, a subsequent decrease primarily in early and middle adulthood, and different patterns of age-related decrease in the two sexes. Age-related changes in sleep structure, such as decreasing %REM sleep which parallel the observed dream recall changes, might help explain these findings, but these sleep changes are much smaller and more gradual in nature. Changes in the phase and amplitude of circadian rhythms of REM propensity and generational differences in life experiences may also account for some part of the findings. That decreases in DTD parallel known age-related decreases in episodic and autobiographical memory may signify that this new diversity measure indexes an aspect of autobiographical memory that also influences dream recall.

Measurement of sexual identity in surveys: implications for substance abuse research

Researchers are increasingly recognizing the need to include measures of sexual orientation in health studies. However, relatively little attention has been paid to how sexual identity, the cognitive aspect of sexual orientation, is defined and measured. Our study examined the impact of using two separate sexual identity question formats: a three-category question (response options included heterosexual, bisexual, or lesbian/gay), and a similar question with five response options (only lesbian/gay, mostly lesbian/gay, bisexual, mostly heterosexual, only heterosexual). A large probability-based sample of undergraduate university students was surveyed and a randomly selected subsample of participants was asked both sexual identity questions. Approximately one-third of students who identified as bisexual based on the three-category sexual identity measure chose "mostly heterosexual" or "mostly lesbian/gay" on the five-category measure. In addition to comparing sample proportions of lesbian/gay, bisexual, or heterosexual participants based on the two question formats, rates of alcohol and other drug use were also examined among the participants. Substance use outcomes among the sexual minority subgroups differed based on the sexual identity question format used: bisexual participants showed greater risk of substance use in analyses using the three-category measure whereas "mostly heterosexual" participants were at greater risk when data were analyzed using the five-category measure. Study results have important implications for the study of sexual identity, as well as whether and how to recode responses to questions related to sexual identity.

The Anabolic 500 survey: characteristics of male users versus nonusers of anabolic-androgenic steroids for strength training

STUDY OBJECTIVE

To contrast the characteristics of two groups of men who participated in strength-training exercise-those who reported anabolicandrogenic steroid (AAS) use versus those who reported no AAS use.

DESIGN

Analysis of data from the Anabolic 500, a cross-sectional survey.

PARTICIPANTS

Five hundred six male self-reported AAS users (mean age 29.3 yrs) and 771 male self-reported nonusers of AAS (mean age 25.2 yrs) who completed an online survey between February 19 and June 30, 2009.

MEASUREMENTS AND MAIN RESULTS

Respondents were recruited from Internet discussion boards of 38 fitness, bodybuilding, weightlifting, and steroid Web sites. The respondents provided online informed consent and completed the Anabolic 500, a 99-item Web-based survey. Data were collected on demographics, use of AAS and other performance-enhancing agents, alcohol and illicit drug use, substance dependence disorder, other Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnoses, and history of sexual and/or physical abuse. Most (70.4%) of the AAS users were recreational exercisers who reported using an average of 11.1 performance-enhancing agents in their routine. Compared with nonusers, the AAS users were more likely to meet criteria for substance dependence disorder (23.4% vs 11.2%, p<0.001), report a diagnosis of an anxiety disorder (10.1% vs 6.1%, p=0.010), use cocaine within the past 12 months (11.3% vs 4.7%, p<0.001), and report a history of sexual abuse (6.1% vs 2.7%, p=0.005).

CONCLUSION

Most of the AAS users in this study were recreational exercisers who practiced polypharmacy. The AAS users were more likely than nonusers to meet criteria for substance dependence disorder, report a diagnosis of an anxiety disorder, report recent cocaine use, and have a history of sexual abuse. The information uncovered in this study may help clinicians and researchers develop appropriate intervention strategies for AAS abuse.

Misuse of prescribed stimulant medication for ADHD and associated patterns of substance use: preliminary analysis among college students

OBJECTIVES

To explore the prevalence and characteristics associated with college students who misuse their prescribed stimulants for attention-deficit hyperactivity disorder (ADHD) and examine diversion and substance use behaviors as a function of misuse.

METHODS

Cohort of 55 past-year prescribed stimulant users was identified from a random sample (n = 1738) at a large Midwestern research university following the self-administration of a web-based survey. An index was created to assess misuse of prescribed stimulants (i.e., Misuse Index).

RESULTS

Of 55 college students who reported past-year use of prescribed stimulants for ADHD, 22 (40%) endorsed at least one item on the misuse index. The most frequently endorsed misuse items were used too much (36%), self-reported misuse (19%), and intentionally used with alcohol or other drugs (19%). Misusers of prescribed stimulant medication were more likely to report cigarette smoking (p = 0.022), binge drinking (p = 0.022), illicit use of cocaine (p = 0.032), and screen positive on the Drug Abuse Screening test (DAST-10) criteria (p = 0.002). The bivariate odds ratio for the DAST-10 findings was 8.4 (95% CI: 2.0-34.6). Diversion of prescribed stimulants was common (36%) and occurred more frequently among stimulant misusers (57%; p = 0.008).

CONCLUSION

There is a strong relationship between misuse of prescribed stimulants for ADHD and substance use behaviors, as well as other deleterious behaviors such as diversion. These findings suggest the need for close screening, assessment, and therapeutic monitoring of medication use in the college population.

Using web-based and paper-based questionnaires for collecting data on fertility issues among female childhood cancer survivors: differences in response characteristics

BACKGROUND

Web-based questionnaires have become increasingly popular in health research. However, reported response rates vary and response bias may be introduced.

OBJECTIVE

The aim of this study was to evaluate whether sending a mixed invitation (paper-based together with Web-based questionnaire) rather than a Web-only invitation (Web-based questionnaire only) results in higher response and participation rates for female childhood cancer survivors filling out a questionnaire on fertility issues. In addition, differences in type of response and characteristics of the responders and nonresponders were investigated. Moreover, factors influencing preferences for either the Web- or paper-based version of the questionnaire were examined.

METHODS

This study is part of a nationwide study on reproductive function, ovarian reserve, and risk of premature menopause in female childhood cancer survivors. The Web-based version of the questionnaire was available for participants through the Internet by means of a personalized user name and password. Participants were randomly selected to receive either a mixed invitation (paper-based questionnaire together with log-in details for Web-based questionnaire, n = 137) or a Web-only invitation (log-in details only, n = 140). Furthermore, the latter group could request a paper-based version of the questionnaire by filling out a form.

RESULTS

Overall response rates were comparable in both randomization groups (83% mixed invitation group vs 89% in Web-only invitation group, P = .20). In addition, participation rates appeared not to differ (66% or 90/137, mixed invitation group vs 59% or 83/140, Web-only invitation group, P =.27). However, in the mixed invitation group, significantly more respondents filled out the paper-based questionnaire compared with the Web-only invitation group (83% or 75/90 and 65% or 54/83, respectively, P = .01). The 44 women who filled out the Web-based version of the questionnaire had a higher educational level than the 129 women who filled out the paper-based version (P = .01). Furthermore, the probability of filling out the Web-based questionnaire appeared to be greater for women who were allocated to the Web-only invitation group (OR = 2.85, 95% CI 1.31-6.21), were older (OR = 1.08, 95% CI 1.02-1.15), had a higher educational level (OR high vs low = 0.06, 95% CI 0.01-0.52), or were students (OR employed vs student = 3.25, 95% CI 1.00-10.56).

CONCLUSIONS

Although overall response as well as participation rates to both types of invitations were similar, adding a paper version of a questionnaire to a Web-only invitation resulted in more respondents filling out the paper-based version. In addition, women who were older, had a higher level of education, or were students, were more likely to have filled out the Web-based version of the questionnaire. Given the many advantages of Web-based over paper-based questionnaires, researchers should strongly consider using Web-based questionnaires, although possible response bias when using these types of questionnaires should be taken into account.

TRIAL REGISTRATION

Nederlands Trial Register NTR2922; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2922 (Archived by WebCite at http://www.webcitation.org/5zRRdMrDv).

A comparison of data quality and practicality of online versus postal questionnaires in a sample of testicular cancer survivors

OBJECTIVE

We aimed to compare data quality from online and postal questionnaires and to evaluate the practicality of these different questionnaire modes in a cancer sample.

METHODS

Participants in a study investigating the psychosocial sequelae of testicular cancer could choose to complete a postal or online version of the study questionnaire. Data quality was evaluated by assessing sources of nonobservational errors such as participant nonresponse, item nonresponse and sampling bias. Time taken and number of reminders required for questionnaire return were used as indicators of practicality.

RESULTS

Participant nonresponse was significantly higher among participants who chose the postal questionnaire. The proportion of questionnaires with missing items and the mean number of missing items did not differ significantly by mode. A significantly larger proportion of tertiary-educated participants and managers/professionals completed the online questionnaire. There were no significant differences in age, relationship status, employment status, country of birth or language spoken by completion mode. Compared with postal questionnaires, online questionnaires were returned significantly more quickly and required significantly fewer reminders.

CONCLUSIONS

These results demonstrate that online questionnaire completion can be offered in a cancer sample without compromising data quality. In fact, data quality from online questionnaires may be superior due to lower rates of participant nonresponse. Investigators should be aware of potential sampling bias created by more highly educated participants and managers/professionals choosing to complete online questionnaires. Besides this issue, online questionnaires offer an efficient method for collecting high-quality data, with faster return and fewer reminders.

Comparing sexual assault prevalence estimates obtained with direct and indirect questioning techniques

Concerns have been expressed about the validity of self-reported data on sexual assault, as victims might be reluctant to disclose what happened to them. In this study, using an anonymous, web-based survey, a sample of 5,446 undergraduate women were asked about their experiences with physically forced sexual assault using both direct and indirect questioning methods. The prevalence of physically forced sexual assault obtained via indirect questioning was slightly higher than, though not substantially or statistically different from, the estimate obtained via direct questioning. The results suggest that either direct questioning yields reasonably valid estimates of the prevalence of sexual assault or that the item count technique does not produce estimates that are any more valid.

Medication costs to private insurers of diversion of medications for attention-deficit hyperactivity disorder

BACKGROUND

The diversion of prescription stimulants for misuse, particularly those used in the treatment of attention-deficit hyperactivity disorder (ADHD), is potentially a significant problem for public health and for healthcare funding and delivery. Most prior research on the diversion of prescription stimulants for misuse, particularly those used in the treatment of ADHD, has focused on the 'end users' of diverted medications rather than the suppliers. Furthermore, little is known about the direct costs of diversion for third-party insurance payers in the US.

OBJECTIVES

The objectives of this study were to estimate the prevalence in the US of people whose private insurance paid costs for ADHD prescriptions that they gave or sold to another person (diversion), and to estimate medication costs of diversion to private insurers.

METHODS

Estimates are from a cross-sectional survey of respondents from two Internet survey panels targeting individuals aged 18-49 years in the civilian, noninstitutionalized US population, principally for those who filled prescriptions for ADHD medications in the past 30 days that were covered by private health insurance. Analysis weights were post-stratified to control totals from the Current Population Survey and National Health Interview Survey. Weighted prevalence rates and standard errors for diversion are reported, as are the costs of diverted pills using drug prices reported in the 2008 Thomson Reuters RED BOOK™. Sensitivity analyses were conducted that varied the cost assumptions for medications.

RESULTS

Among individuals aged 18-49 years whose private insurance paid some costs for ADHD medications in the past 30 days, 16.6% diverted medications from these prescriptions. Men aged 18-49 years for whom private insurance paid some costs of ADHD drugs in the past 30 days were more than twice as likely as their female counterparts to divert medications from these prescriptions (22.5% vs 9.1%; p = 0.03). After a pro-rated co-payment share was subtracted, the estimated value of diverted medications in a 30-day period was $US8.0 million. Lower- and upper-bound estimates were $US6.9 million to $US17 million, for a range of $US83 million to $US204 million annually. Overall, diversion accounted for about 3.6% of the total costs that private insurers paid for ADHD medications (range: 3.5-4.5%). The percentages varied by medication category, although relative differences were sensitive to inclusion of a pro-rated co-payment. A higher percentage of the costs of extended-release (XR) medications was lost to diversion compared with that for immediate-release (IR) medications.

CONCLUSIONS

Costs of ADHD medications paid for by private insurers that were lost to diversion were small relative to the total estimated medication costs and relative to total estimated healthcare costs for treating ADHD. Nevertheless, there may be significant cost savings for insurers if diversion can be reduced, particularly for XR medications. These findings represent a first step to informing policies to reduce diversion both in the interest of public health and for direct and indirect cost savings to insurers.

Contemporary options for longitudinal follow-up: lessons learned from a cohort of urban adolescents

This study reports efforts to locate and survey participants in Project Northland Chicago (PNC), a longitudinal, group-randomized trial of an alcohol preventive intervention for racial/ethnic minority, urban, early-adolescents, 3-4 years following the end of the intervention. Data were collected annually among students from 6th-8th grade and then at age 17-18. Tracking procedures were used to maintain contact with participants and data collection consisted of three phases: (1) Internet- and mail-based surveys; (2) in-school survey administration; and (3) courier service delivery. Contact was lost with 11% of this urban cohort from the end of the PNC intervention activities through these longterm follow-up efforts, as indicated by returned locating postcards. Fifty-three percent of the cohort responded to the survey, the majority completing in Phase 1 of our data collection. Additional school-based and courier-delivery efforts increased our response rate by 11.5%. Costs per completed survey were $118 in Phase 1, $166 in Phase 2, and $440 in Phase 3. This study illustrates that it is possible to track and follow-up a high-risk cohort as they progress through adolescence, even with minimal efforts in intervening years. Lessons learned from this study may inform future efforts to track and collect longitudinal data among high-risk populations.

An experiment to test the feasibility and quality of a web-based questionnaire of teachers

The use of web-based surveys to gather information from teachers has become increasingly common primarily based on the premise that they can reduce costs. Yet, relatively, little is known about the quality or cost effectiveness of web-based versus mail surveys for teachers. To study the efficacy of web-based teacher surveys, the author randomly assigned a nationally representative sample of 877 elementary school teachers to a paper or web survey mode. The cost savings from the web administration were not enough to offset the loss of sample due to missing/inaccurate email addresses and the lower response rates that resulted from the web survey.

Web-based questionnaires: the future in epidemiology?

The traditional epidemiologic modes of data collection, including paper-and-pencil questionnaires and interviews, have several limitations, such as decreasing response rates over the last decades and high costs in large study populations. The use of Web-based questionnaires may be an attractive alternative but is still scarce in epidemiologic research because of major concerns about selective nonresponse and reliability of the data obtained. The authors discuss advantages and disadvantages of Web-based questionnaires and current developments in this area. In addition, they focus on some practical issues and safety concerns involved in the application of Web-based questionnaires in epidemiologic research. They conclude that many problems related to the use of Web-based questionnaires have been solved or will most likely be solved in the near future and that this mode of data collection offers serious benefits. However, questionnaire design issues may have a major impact on response and completion rates and on reliability of the data. Theoretically, Web-based questionnaires could be considered an alternative or complementary mode in the range of epidemiologic methods of data collection. Practice and comparisons with the traditional survey techniques should reveal whether they can fulfill their expectations.

Women and anabolic steroids: an analysis of a dozen users

OBJECTIVE

To provide an in-depth analysis of 12 female self-reported anabolic-androgenic steroid (AAS) users.

DESIGN

Web-based survey.

SETTING

A Web-based survey was posted on 38 discussion boards of various fitness, bodybuilding, weightlifting, and steroid Web sites between February and June 2009.

INTERVENTIONS

Participants completed a survey regarding demographics and use of AAS and other performance-enhancing agents (PEAs).

PARTICIPANTS

A cohort of 1519 strength-trained subjects fully completed and submitted a valid survey. Five hundred eighteen subjects were self-reported AAS users consisting of 12 women and 506 men. One thousand one subjects were non-AAS users consisting of 230 women and 771 men.

MAIN OUTCOME MEASURES

Demographic data and use of AAS and other PEAs.

RESULTS

The female AAS users reported using an average of 8.8 PEAs in their routine. Compared with male AAS users and female non-AAS users, respectively, female AAS users were more likely to have met criteria for substance-dependence disorder (58.3% vs 23.4%; P = 0.01; 58.3% vs 9.1%; P < 0.001), have been diagnosed with a psychiatric illness (50.0% vs 17.4%; P = 0.01; 50.0% vs 22.2%; P = 0.04), and have reported a history of sexual abuse (41.7% vs 6.1%; P < 0.001; 41.7% vs 15.3%; P = 0.03).

CONCLUSIONS

Female AAS users practice polypharmacy. Female AAS users are more likely to have qualified for substance-dependence disorder, have been diagnosed with a psychiatric illness, and have a history of sexual abuse than both male AAS users and female non-AAS users.

The influence of response mode on study results: offering cigarette smokers a choice of postal or online completion of a survey

Background

It is unclear whether offering online data collection to study participants affects compliance or produces bias.

Objective

To compare response rates, baseline characteristics, test-retest reliability, and outcomes between cigarette smokers who chose to complete a survey by mail versus those who chose to complete it online.

Methods

We surveyed cigarette smokers who intended to stop smoking within the next 30 days to determine barriers to calling a smoking quit line. Participants were offered the choice of completing a paper version of the survey sent through the mail or an online version at a password-protected website. Participants were called 2 months later to determine if they had made a quit attempt and/or called a smoking quit line since the baseline survey. We compared characteristics and outcomes among those who chose postal versus online completion. We measured test-retest reliability of the baseline survey by resurveying a semirandom sample of participants within 10 days of the original survey.

Results

Of 697 eligible respondents to newspaper ads in 12 US cities, 438 (63%) chose to receive a mailed paper survey and 259 (37%) chose an Internet survey. Survey return rates were the same for the 2 modes (92% versus 92%, P = .82). Online respondents were younger (mean of 46 versus 51 years old for postal, P < .001), more likely to be white (76% versus 62%, P < .001), less likely to be African American (18% versus 30%, P < .001), more highly educated (34% college graduate versus 23%, P < .001), more likely to intend to stop smoking in the next 30 days (47% definitely versus 30%, P < .001), and more likely to have heard of a smoking quit line (51% versus 40%, P = .008). Participants did not differ on gender (54% female for online versus 55% for postal, P = .72) or cigarettes smoked per day (mean of 19 versus 21, P = .30). Online respondents had slightly fewer missing items on the 79-item survey (mean of 1.7% missing versus 2.3%, P = .02). Loss to follow-up at 2 months was similar (16% for online and 15% for postal, P = .74). There was no significant difference between online and postal respondents in having called a smoking quit line during the 2-month follow-up period (20% versus 24%, P = .22) or in having made a quit attempt (76% versus 79%, P = .41).

Conclusions

Cigarette smokers who chose to complete a survey using the Internet differed in several ways from those who chose mailed surveys. However, more importantly, online and postal responses produced similar outcomes.

Body image disturbance in 1000 male appearance and performance enhancing drug users

Body image disturbance (BID) among men has only recently become a phenomenon of clinical significance with noted heterogeneity in the behavioral consequences of these disturbances. The degree of heterogeneity among appearance and performance enhancing drug (APED) users is unknown and an empirically derived framework for studying BID is necessary. APED users (N=1000) were recruited via the Internet and they completed a comprehensive online assessment APED use patterns, motivations, consequences, and BID. Data were evaluated using latent trait, latent class, and factor mixture models. Model results were validated using a range of covariates including cycle characteristics, age, APED history, and APED risk. A 1-Factor, 4-Class model provided the best fit to the data with Class 1 scoring the highest on all measures of BID and Class 4 the lowest on all measures. Class 2 differed in their preference for being lean over muscular and Class 3 preferred adding mass and size. Each class was associated with unique risks, APED history, and training identity. Not all APED users suffer from significant BID and there are unique profiles for those with elevated BID. Future research on male BID should account for this structure in order to better define relevant diagnostic categories and evaluate the clinical significance of BID.

Using the internet to research hidden populations of illicit drug users: a review

AIMS

To review the current research of hidden populations of illicit drugs users using web-based methods and discuss major advantages and disadvantages.

METHODS

Systematic review of 16 databases, including PubMed, PsycINFO (EBSCOhost), CSA Sociological Abstracts, Expanded Academic ASAP and Google Scholar.

FINDINGS

Substances researched were most commonly 'party/club drugs' (such as ecstasy) and cannabis. All of the studies reviewed concluded that the internet is a useful tool for reaching hidden populations, but is likely to impose some bias in samples. Advantages include: access to previously under-researched target groups; speed; international applications; increased ease of data entry; and improved confidentiality for respondents. The major disadvantage is a lack of representativeness of samples.

CONCLUSIONS

Internet research is successful at accessing hidden populations of illicit drugs users, when appropriately targeted and provides unprecedented opportunities for research across a wide range of topics within the addictions field. Findings are unlikely to be generalisable to the general public, but appropriate for describing target populations.

Validity of self-reported misuse of prescription opioid analgesics

AIM

To determine concurrent validity of self-reported misuse of prescription opioids.

DESIGN AND SETTING

Cross-sectional study in five U.S. methadone maintenance programs.

PARTICIPANTS

92 addicts.

MEASUREMENTS

Self-reported questionnaire assessing past-month misuse of 14 opioid analgesics, and color photographs of five opioid analgesics with instructions to mark those used in the past month "to get high." Concordance between self-report and photograph endorsement was assessed via Kappa statistic.

FINDINGS

29 respondents completed both questionnaire and photograph endorsements. Kappas were 0.62 (OxyContin), 0.59 (methadone), 0.49 (Dilaudid), and 0.46 (generic extended-release oxycodone).

CONCLUSIONS

Good-to-fair concurrent validity of self-reported abuse was seen for OxyContin, methadone, Dilaudid, and generic extended-release oxycodone.

A comparison of mail and telephone administration of district-level questionnaires for the School Health Policies and Programs Study (SHPPS) 2006: effects on estimates and data quality

BACKGROUND

The School Health Policies and Programs Study (SHPPS) is a national study periodically conducted to assess school health policies and programs at the state, district, school, and classroom levels. For SHPPS 2006, district-level questionnaires were designed for telephone administration, but mixed-mode data collection that also used paper-and-pencil mail questionnaires was required to obtain an acceptable response rate. Because most mode effect research has involved person-level rather than institution-level data, little is known about the effects of mixed-mode data collection on data quality and prevalence estimates obtained through surveys of school personnel.

METHODS

SHPPS 2006 used 1-stage stratified cluster sampling to select a nationally representative sample of public school districts. Personnel in about half of the 538 responding districts completed paper questionnaires and returned them via mail. Analyses were performed comparing data quality and prevalence estimates for mail and telephone administration.

RESULTS

Prevalence estimates for only 7.0% (39) of 554 questions tested across the 7 questionnaires differed significantly by response mode at the p < .01 level. Regarding data quality, use of the "don't know" response was higher for telephone administration.

CONCLUSIONS

The results of this study demonstrate that SHPPS 2006 successfully used a mixed-mode approach, allowing the data to be used without concern about the mixed-mode administration. The results may also be useful to other researchers interested in using surveys to collect data on schools or school districts or other data that is not person level.

The touro 12-step: a systematic guide to optimizing survey research with online discussion boards

The Internet, in particular discussion boards, can provide a unique opportunity for recruiting participants in online research surveys. Despite its outreach potential, there are significant barriers which can limit its success. Trust, participation, and visibility issues can all hinder the recruitment process; the Touro 12-Step was developed to address these potential hurdles. By following this step-by-step approach, researchers will be able to minimize these pitfalls and maximize their recruitment potential via online discussion boards.