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SYNOPSIS

Objectives

Population-based landline telephone surveys are potentially biased due to inclusion of only people with landline telephones. This article examined the degree of telephone coverage bias in a low-income population.

Methods

The Charles County Cancer Survey (CCCS) was conducted to evaluate cancer screening practices and risk behaviors among low-income, rural residents of Charles County, Maryland. We conducted face-to-face interviews with 502 residents aged 18 years and older. We compared the prevalence of health behaviors and cancer screening tests for those with and without landline telephones. We calculated the difference between whole sample estimates and estimates for only those respondents with landline telephones to quantify the magnitude of telephone coverage bias.

Results

Of 499 respondents who gave information on telephone use, 80 (16%) did not have landline telephones. We found differences between those with and without landline telephones for race/ethnicity, health-care access, insurance coverage, and several types of cancer screening. The absolute coverage bias ranged up to 6.5 percentage points. Simulation scenarios showed the magnitude of telephone coverage bias decreases as the percent of the population with landline telephone coverage increases, and as landline telephone coverage increases, the estimates from a landline telephone survey would approximate the estimates from a face-to-face survey.

Conclusions

Our findings highlighted the need for targeted face-to-face surveys to supplement telephone surveys to more fully characterize hard-to-reach subpopulations. Our findings also indicated that landline telephone-based surveys continue to offer a cost-effective method for conducting large-scale population studies in support of policy and public health decision-making.

Background

To examine the trend of "mobile only" households, and households that have a mobile phone or landline telephone listed in the telephone directory, and to describe these groups by various socio-demographic and health indicators.

Method

Representative face-to-face population health surveys of South Australians, aged 15 years and over, were conducted in 1999, 2004, 2006, 2007 and 2008 (n = 14285, response rates = 51.9% to 70.6%). Self-reported information on mobile phone ownership and usage (1999 to 2008) and listings in White Pages telephone directory (2006 to 2008), and landline telephone connection and listings in the White Pages (1999 to 2008), was provided by participants. Additional information was collected on self-reported health conditions and health-related risk behaviours.

Results

Mobile only households have been steadily increasing from 1.4% in 1999 to 8.7% in 2008. In terms of sampling frame for telephone surveys, 68.7% of South Australian households in 2008 had at least a mobile phone or landline telephone listed in the White Pages (73.8% in 2006; 71.5% in 2007). The proportion of mobile only households was highest among young people, unemployed, people who were separated, divorced or never married, low income households, low SES areas, rural areas, current smokers, current asthma or people in the normal weight range. The proportion with landlines or mobiles telephone numbers listed in the White Pages telephone directory was highest among older people, married or in a defacto relationship or widowed, low SES areas, rural areas, people classified as overweight, or those diagnosed with arthritis or osteoporosis.

Conclusion

The rate of mobile only households has been increasing in Australia and is following worldwide trends, but has not reached the high levels seen internationally (12% to 52%). In general, the impact of mobile telephones on current sampling frames (exclusion or non-listing of mobile only households or not listed in the White Pages directory) may have a low impact on health estimates obtained using telephone surveys. However, researchers need to be aware that mobile only households are distinctly different to households with a landline connection, and the increase in the number of mobile-only households is not uniform across all groups in the community. Listing in the White Pages directory continues to decrease and only a small proportion of mobile only households are listed. Researchers need to be aware of these telephone sampling issues when considering telephone surveys.

Objective

Examine the effect of including cell-phone numbers in a traditional landline random digit dial (RDD) telephone survey.

Data Sources

The 2007 California Health Interview Survey (CHIS).

Data Collection Methods

CHIS 2007 is an RDD telephone survey supplementing a landline sample in California with a sample of cell-only (CO) adults.

Study Design

We examined the degree of bias due to exclusion of CO populations and compared a series of demographic and health-related characteristics by telephone usage.

Principal Findings

When adjusted for noncoverage in the landline sample through weighting, the potential noncoverage bias due to excluding CO adults in landline telephone surveys is diminished. Both CO adults and adults who have both landline and cell phones but mostly use cell phones appear different from other telephone usage groups. Controlling for demographic differences did not attenuate the significant distinctiveness of cell-mostly adults.

Conclusions

While careful weighting can mitigate noncoverage bias in landline telephone surveys, the rapid growth of cell-phone population and their distinctive characteristics suggest it is important to include a cell-phone sample. Moreover, the threat of noncoverage bias in telephone health survey estimates could mislead policy makers with possibly serious consequences for their ability to address important health policy issues.

Background

In Australia telephone surveys have been the method of choice for ongoing jurisdictional population health surveys. Although it was estimated in 2011 that nearly 20% of the Australian population were mobile-only phone users, the inclusion of mobile phone numbers into these existing landline population health surveys has not occurred. This paper describes the methods used for the inclusion of mobile phone numbers into an existing ongoing landline random digit dialling (RDD) health survey in an Australian state, the New South Wales Population Health Survey (NSWPHS). This paper also compares the call outcomes, costs and the representativeness of the resultant sample to that of the previous landline sample.

Methods

After examining several mobile phone pilot studies conducted in Australia and possible sample designs (screening dual-frame and overlapping dual-frame), mobile phone numbers were included into the NSWPHS using an overlapping dual-frame design. Data collection was consistent, where possible, with the previous years’ landline RDD phone surveys and between frames. Survey operational data for the frames were compared and combined. Demographic information from the interview data for mobile-only phone users, both, and total were compared to the landline frame using χ2 tests. Demographic information for each frame, landline and the mobile-only (equivalent to a screening dual frame design), and the frames combined (with appropriate overlap adjustment) were compared to the NSW demographic profile from the 2011 census using χ2 tests.

Results

In the first quarter of 2012, 3395 interviews were completed with 2171 respondents (63.9%) from the landline frame (17.6% landline only) and 1224 (36.1%) from the mobile frame (25.8% mobile only). Overall combined response, contact and cooperation rates were 33.1%, 65.1% and 72.2% respectively. As expected from previous research, the demographic profile of the mobile-only phone respondents differed most (more that were young, males, Aboriginal and Torres Strait Islanders, overseas born and single) compared to the landline frame responders. The profile of respondents from the two frames combined, with overlap adjustment, was most similar to the latest New South Wales (NSW) population profile.

Conclusions

The inclusion of the mobile phone numbers, through an overlapping dual-frame design, did not impact negatively on response rates or data collection, and although costing more the design was still cost-effective because of the additional interviews that were conducted with young people, Aboriginal and Torres Strait Islanders and people who were born overseas resulting in a more representative overall sample.

Objective

To assess the effect of wireless telephone substitution in a survey of health care reform opinions.

Data Source

Survey of New Jersey adults conducted by landline and wireless telephones from June 1 to July 9, 2007.

Study Design

Eighty-one survey measures are compared by wireless status. Logistic regression is used to confirm landline–wireless gaps in support for coverage reforms, controlling for population differences. Weights adjust for selection probability, complex sample design, and demographic distributions.

Principal Findings

Significant differences by wireless status were found in many survey measures. Wireless users were significantly more likely to favor coverage reforms. Higher support for government-sponsored universal coverage, income-related state coverage subsidies, and an individual mandate remain after adjustment for demographic variables.

Conclusions

Opinion polls excluding wireless users are likely to understate support for coverage reforms.

Background

The purpose of this study was to estimate the prevalence and patterns of CAM use in Korean children via a telephone based survey. We also investigated parent satisfaction, a proxy for their child, with CAM therapy and determined the factors affecting satisfaction with CAM use.

Methods

This study used a landline telephone-based survey to examine a random sample representative of Korean children, aged 0 to 18 years. We assigned and surveyed 2,000 subjects according to age group, gender, and geographical distributions by proportionate quota and systematic sampling of children throughout Korea in 2010. A household of 1,184 with a 18.6% response rate was projected to yield 2,077 completed data. We performed statistical analyses using sampling weight.

Results

The prevalence of CAM use was 65.3% for the Korean children in our sample population. The most commonly used CAM category was natural products (89.3%). More than half of CAM user’s parents reported satisfaction with their therapies (52.7%), but only 29.1% among them had consulted a Western trained doctor regarding the CAM therapies used. Doctor visits were associated with lower satisfaction with CAM use but not with consultation rate with a doctor.

Conclusions

Our study suggests that CAM is widely used among children in Korea. Medical doctors should actively discuss the use of CAM therapies with their patients and provide information on the safety and efficacy of diverse CAM modalities to guide the choices of CAM users.

Background

Households with fixed-line telephones have decreased while mobile (cell) phone ownership has increased. We therefore sought to examine the feasibility of recruiting young women for a national health survey through random digit dialling mobile phones.

Methods

Two samples of women aged 18 to 39 years were surveyed by random digit dialling fixed and mobile numbers. We compared participation rates and responses to a questionnaire between women surveyed by each contact method.

Results

After dialling 5,390 fixed-lines and 3,697 mobile numbers, 140 and 128 women were recruited respectively. Among women contacted and found to be eligible, participation rates were 74% for fixed-lines and 88% for mobiles. Taking into account calls to numbers where eligibility was unknown (e.g. unanswered calls) the estimated response rates were 54% and 45% respectively. Of women contacted by fixed-line, 97% reported having a mobile while 61% of those contacted by mobile reported having a fixed-line at home. After adjusting for age, there were no significant differences between mobile-only and fixed-line responders with respect to education, residence, and various health behaviours; however compared to those with fixed-lines, mobile-only women were more likely to identify as Indigenous (OR 4.99, 95%CI 1.52-16.34) and less likely to live at home with their parents (OR 0.09, 95%CI 0.03-0.29).

Conclusions

Random digit dialling mobile phones to conduct a health survey in young Australian women is feasible, gives a comparable response rate and a more representative sample than dialling fixed-lines only. Telephone surveys of young women should include mobile dialling.

The Behavioral Risk Factor Surveillance System (BRFSS) was originally conducted by using a landline telephone survey mode of data collection. To meet challenges of random-digit–dial (RDD) surveys and to ensure data quality and validity, BRFSS is integrating multiple modes of data collection to enhance validity. The survey of adults who use only cellular telephones is now conducted in parallel with ongoing, monthly landline telephone BRFSS data collection, and a mail follow-up survey is being implemented to increase response rates and to assess nonresponse bias. A pilot study in which respondents' physical measurements are taken is being conducted to assess the feasibility of collecting these data for a subsample of adults in 2 states. Physical measures would allow for the adjustment of key self-reported risk factor and health condition estimates and improve the accuracy and usefulness of BRFSS data. This article provides an overview of these new modes of data collection.

Incorrect beliefs about memory have wide-ranging implications. We recently reported the results of a survey showing that a substantial proportion of the United States public held beliefs about memory that conflicted with those of memory experts. For that survey, respondents answered recorded questions using their telephone keypad. Although such robotic polling produces reliable results that accurately predicts the results of elections, it suffers from four major drawbacks: (1) telephone polling is costly, (2) typically, less than 10 percent of calls result in a completed survey, (3) calls do not reach households without a landline, and (4) calls oversample the elderly and undersample the young. Here we replicated our telephone survey using Amazon Mechanical Turk (MTurk) to explore the similarities and differences in the sampled demographics as well as the pattern of results. Overall, neither survey closely approximated the demographics of the United States population, but they differed in how they deviated from the 2010 census figures. After weighting the results of each survey to conform to census demographics, though, the two approaches produced remarkably similar results: In both surveys, people averaged over 50% agreement with statements that scientific consensus shows to be false. The results of this study replicate our finding of substantial discrepancies between popular beliefs and those of experts and shows that surveys conducted on MTurk can produce a representative sample of the United States population that generates results in line with more expensive survey techniques.

An evaluation was made of the use of telephone survey methods to collect illicit drug use data. Using data from a national survey that collects data by personal interviews, marijuana and cocaine use prevalence rates among households with telephones and those without were compared in order to assess coverage errors in telephone surveys. Drug use rates were substantially higher among households without telephones, with 24.9 percent of those living in households without telephones reporting use of marijuana in the past year, compared with only 9.4 percent of persons living in households with telephones. Trends in drug use were divergent, with substantial decreases in use occurring between 1985 and 1988 in households with telephones, but not in those without. National prevalence patterns and trends among households with telephone appear to be consistent with national patterns and trends in the total household population, because about 93 percent of the population lives in households with telephones. However, surveys conducted by telephone were found to produce underestimates of illicit drug use prevalence. In a 1988 national telephone survey, estimated rates of past year use were 5.2 percent for marijuana and 1.4 percent for cocaine. Comparable data from a personal visit survey (including only households with telephones and reedited and reweighted to control for differences in data collection protocols) were 8.0 percent for marijuana and 3.1 percent for cocaine use. Comparisons with several other telephone surveys collecting illicit drug use data showed similar results. Based on these results, researchers are advised to use caution in using telephone surveys to produce drug use prevalence estimates.

Context

Ethnoracial differences may exist in exposure to trauma and post-traumatic outcomes. However, Asian-Americans and Native Hawaiians/Other Pacific Islanders (NHOPI) are vastly underrepresented in research pertaining to trauma and health status sequelae.

Objective

To determine whether there are ethnoracial disparities in sexual trauma exposure and its sequelae for health and functioning among Asian-Americans and NHOPI.

Design, Setting, Participants

We examined data on sexual assault exposure from the 2006–2007 Hawai`i Behavioral Risk Factor Surveillance System (H-BRFSS), cross-sectional adult community-based probability sample (n = 12,573). Data were collected via computer-assisted random-digit landline telephone survey. Survey response rate was found to be about 48% in 2006 and 52% in 2007.

Main Outcome Measures

Demographic information, the Sexual Violence Module regarding unwanted sexual experiences, and questions about health lifestyles, chronic diseases and disability, and health status and quality of life.

Results

Participants were 42.3% White, 14.4% NHOPI, and 39.3% Asian-American. NHOPI had a higher 12-month period prevalence (2.24 per 100, CI=1.32–3.78) of any unwanted sexual experience, but a lower prevalence estimate and odds ratio for any lifetime unwanted sexual experience (prevalence: 9.38 per 100, CI=7.59–11.55; odds ratio: 0.61, CI=0.47–0.81) relative to Whites, after adjusting for age, gender, income and education level. Asian-Americans had lower prevalence estimates for 12-month period prevalence (0.78 per 100, CI=0.44–1.39), and lower lifetime prevalence estimates and odds ratios (prevalence: 3.91 per 100, CI=3.23–4.72; odds ratio: 0.27, CI=0.21–0.34). 12-month and lifetime prevalence estimate any unwanted sexual experiences for Whites were 0.71 per 100 (CI=0.45–1.12) and 12.01 per 100 (CI=10.96–13.14), respectively. Sexual assault experiences were highly associated with adverse health status sequelae (e.g., disability, poor general health), but there were no significant ethnoracial disparities on self-reported health outcomes among those with a lifetime history of unwanted sexual experiences.

Conclusions

Data revealed significant ethnoracial differences among Whites, Asian-Americans, and NHOPIs on unwanted sexual experiences, with relative risk differing by time period. This pattern of disparity could represent early stages of a new trend in local assaultive behaviors toward NHOPIs and merits attention. Across all ethnoracial groups, a lifetime history of any unwanted sexual experience is associated with a wide range of adverse health status sequelae.

The National Immunization Survey (NIS) was designed to measure vaccination coverage estimates for the US, the 50 states, and selected urban areas for children ages 19-35 months. The NIS includes a random-digit-dialed telephone survey and a provider record check study. Data are weighted to account for the sample design and to reduce nonresponse and non-coverage biases in order to improve vaccination coverage estimates. Adjustments are made for biases resulting from nonresponse and nontelephone households, and estimation procedures are used to reduce measurement bias. The NIS coverage estimates represent all US children, not just children living in households with telephones. NIS estimates are highly comparable to vaccination estimates derived from the National Health Interview Survey. The NIS allows comparisons between states and urban areas over time and is used to evaluate current and new vaccination strategies.

Health behaviors are a leading cause of illness and death in the United States. Efforts to improve public health require information on the prevalence of health behaviors in populations — not only to target programs to areas of most need but also to evaluate the effectiveness of intervention efforts. Telephone surveys, such as the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, are a good way to assess health behaviors in populations. These data provide estimates at the national and state level but often require multiple years of data to provide reliable estimates at the local level. With changes in telephone use (eg, rapid decline in the ownership of landlines), innovative methods to collect data on health behaviors, such as in health care settings or through Internet-based surveys, need to be developed.

The usefulness of landline random digit dialing (RDD) in epidemiologic studies is threatened by the rapid increase in households with only cellular telephone service. This study assessed the feasibility of including cellular telephone numbers in RDD and differences between young adults with landline telephones and those with only cellular telephones. Between 2008 and 2009, a total of 9,023 cellular telephone numbers were called and 43.8% were successfully screened; 248 men and 249 women who resided in 3 Washington State counties, were 20–44 years of age, and used only cellular telephones were interviewed. They were compared with 332 men and 526 women with landline telephones interviewed as controls for 2 case-control studies conducted in parallel with cellular telephone interviewing. Cellular-only users were more likely to be college educated and less likely to have fathered/birthed a child than were their landline counterparts. Male cellular-only users were less likely to be obese and more likely to exercise, to be Hispanic, and to have lower incomes, while female cellular-only users were more likely to be single than landline respondents. Including cellular telephone numbers in RDD is feasible and should be incorporated into epidemiologic studies that rely on this method to ascertain subjects, although low screening rates could hamper the representativeness of such a sample.

Background

Computer assisted telephone interviewing (CATI) is widely used for health surveys. The advantages of CATI over face-to-face interviewing are timeliness and cost reduction to achieve the same sample size and geographical coverage. Two major CATI sampling procedures are used: sampling directly from the electronic white pages (EWP) telephone directory and list assisted random digit dialling (LA-RDD) sampling. EWP sampling covers telephone numbers of households listed in the printed white pages. LA-RDD sampling has a better coverage of households than EWP sampling but is considered to be more expensive due to interviewers dialling more out-of-scope numbers.

Methods

This study compared an EWP sample and a LA-RDD sample from the New South Wales Population Health Survey in 2003 on demographic profiles, health estimates, coefficients of variation in weights, design effects on estimates, and cost effectiveness, on the basis of achieving the same level of precision of estimates.

Results

The LA-RDD sample better represented the population than the EWP sample, with a coefficient of variation of weights of 1.03 for LA-RDD compared with 1.21 for EWP, and average design effects of 2.00 for LA-RDD compared with 2.38 for EWP. Also, a LA-RDD sample can save up to 14.2% in cost compared to an EWP sample to achieve the same precision for health estimates.

Conclusion

A LA-RDD sample better represents the population, which potentially leads to reduced bias in health estimates, and rather than costing more than EWP actually costs less.

Background

Low cost, effective interventions are needed to deal with the major global burden of HIV/AIDS. Telephone consultation offers the potential to improve health of people living with HIV/AIDS cost-effectively and to reduce the burden on affected people and health systems. The aim of this systematic review was to assess the effectiveness of telephone consultation for HIV/AIDS care.

Methods

We undertook a comprehensive search of peer-reviewed and grey literature. Two authors independently screened citations, extracted data and assessed the quality of randomized controlled trials which compared telephone interventions with control groups for HIV/AIDS care. Telephone interventions were voice calls with landlines or mobile phones. We present a narrative overview of the results as the obtained trials were highly heterogeneous in design and therefore the data could not be pooled for statistical analysis.

Results

The search yielded 3321 citations. Of these, nine studies involving 1162 participants met the inclusion criteria. The telephone was used for giving HIV test results (one trial) and for delivering behavioural interventions aimed at improving mental health (four trials), reducing sexual transmission risk (one trial), improving medication adherence (two trials) and smoking cessation (one trial). Limited effectiveness of the intervention was found in the trial giving HIV test results, in one trial supporting medication adherence and in one trial for smoking cessation by telephone.

Conclusions

We found some evidence of the benefits of interventions delivered by telephone for the health of people living with HIV or at risk of HIV. However, only limited conclusions can be drawn as we only found nine studies for five different interventions and they mainly took place in the United States. Nevertheless, given the high penetration of low-cost mobile phones in countries with high HIV endemicity, more evidence is needed on how telephone consultation can aid in the delivery of HIV prevention, treatment and care.

Objective

To discern how the public in four countries, each with unique health systems and cultures, feels about efforts to restrain healthcare costs by limiting the use of high-cost prescription drugs and medical/surgical treatments.

Design

Cross-sectional survey.

Setting

Adult populations in Germany, Italy, the UK and the USA.

Participants

2517 adults in the four countries. A questionnaire survey conducted by telephone (landline and cell) with randomly selected adults in each of the four countries.

Main outcome measures

Support for different rationales for not providing/paying for high-cost prescription drugs/medical or surgical treatments, measured in the aggregate and using four case examples derived from actual decisions. Measures of public attitudes about specific policies involving comparative effectiveness and cost-benefit decision making.

Results

The survey finds support among publics in four countries for decisions that limit the use of high-cost prescription drugs/treatments when some other drug/treatment is available that works equally well but costs less. The survey finds little public support, either in individual case examples or when asked in the aggregate, for decisions in which prescription drugs/treatments are denied on the basis of cost or various definitions of benefits. The main results are based on majorities of the public in each country supporting or opposing each measure.

Conclusions

The survey findings indicate that the public distinguishes in practice between the concepts of comparative effectiveness and cost-effectiveness analysis. This suggests that public authorities engaged in decision-making activities will find much more public support if they are dealing with the first type of decision than with the second.

Article summary

Article focus

Despite increasing concerns among government officials about high healthcare spending, a survey of the public in four countries finds little support for decisions that limit use of high-cost prescription drugs and treatments.

The results provide insights for policy-makers, indicating that the public distinguishes in practice between the concepts of comparative effectiveness and cost-benefit analysis. They will generally support decisions related to the first but not the second.

Key messages

Government agencies dealing with cost-control issues should highlight those decisions not to pay for or provide the more expensive drug or treatment when two prescription drugs or treatments have the same outcome but one is more expensive than the other.

Policy-makers need to be aware that when they discuss limiting the availability of high-cost prescription drugs or treatments based on the assessment of broader benefits, they may face considerable public controversy.

Strengths and limitations of this study

This is the only multi-country study of attitudes on this subject. It is unique in that it includes responses for four actual cases where governments made decisions about what should be paid for or provided.

For general public respondents, these are complex issues that may be difficult to understand, and some responses might differ if respondents were aware of other factors.

Background: On 29 March 2004, the Republic of Ireland (ROI) became the first EU country to introduce a nationwide ban on workplace smoking. While the focus of this measure was to protect worker health by reducing exposure to second-hand smoke, other effects such as a greater reduction in smoking prevalence and consumption were likely among bar workers. Methods: A random sample of bar workers from Cork city were surveyed before (n = 129) and after (n = 107; 82.9% follow-up rate) implementation of the smoke-free legislation. Self report and combined self report and cotinine concentration were used to determine smoking status. For comparison a cross-sectional random telephone survey of the general population (ROI) was conducted before and 1 year after the smoke-free legislation. There were 1240 pre- and 1221 participants post-ban in the equivalent age and occupational subset of the general population. Results: There was a non-significant decline in smoking prevalence among bar workers 1 year post-ban (self report: −2.8% from 51.4% to 48.6%, P = 0.51; combined self report and cotinine: −4.7% from 56.1% to 51.4%, P = 0.13), but a significant decline in consumption of four cigarettes (95% CI 2.21–6.36) per day. Within the occupationally equivalent general population sub-sample there was a significant drop (3.5%, P = 0.06) in smoking prevalence but no significant change in consumption. Conclusions: Ireland's smoke-free workplace legislation was accompanied by a drop in smoking prevalence in both bar workers and the general population sub-sample.

Objective

To evaluate the psychosocial and behavioural impact of the first ever national level comprehensive workplace smoke‐free law, implemented in Ireland in March 2004.

Design

Quasi‐experimental prospective cohort survey: parallel cohort telephone surveys of national representative samples of adult smokers in Ireland (n  =  769) and the UK (n  =  416), surveyed before the law (December 2003 to January 2004) and 8–9 months after the law (December 2004 to January 2005).

Main outcome measures

Respondents' reports of smoking in key public venues, support for total bans in those key venues, and behavioural changes due to the law.

Results

The Irish law led to dramatic declines in reported smoking in all venues, including workplaces (62% to 14%), restaurants (85% to 3%), and bars/pubs (98% to 5%). Support for total bans among Irish smokers increased in all venues, including workplaces (43% to 67%), restaurants (45% to 77%), and bars/pubs (13% to 46%). Overall, 83% of Irish smokers reported that the smoke‐free law was a “good” or “very good” thing. The proportion of Irish homes with smoking bans also increased. Approximately 46% of Irish smokers reported that the law had made them more likely to quit. Among Irish smokers who had quit at post‐legislation, 80% reported that the law had helped them quit and 88% reported that the law helped them stay quit.

Conclusion

The Ireland smoke‐free law stands as a positive example of how a population‐level policy intervention can achieve its public health goals while achieving a high level of acceptance among smokers. These findings support initiatives in many countries toward implementing smoke‐free legislation, particularly those who have ratified the Framework Convention on Tobacco Control, which calls for legislation to reduce tobacco smoke pollution.

Increasingly, telephone interviewing has become the data collection procedure of choice in large-scale health services research surveys. Previous analyses indicate that excluding nontelephone households does not seriously affect most national parameter estimates, such as yearly estimates of number of ambulatory visits, mainly because the proportion of households without telephones is small. Moreover, if the exclusion of nontelephone households simply underestimates the proportions in the population with certain characteristics, such as age and ethnicity, and the "true" proportions are known, it is possible to appropriately weight the study group in order to mitigate the telephone-exclusion bias. However, regression analyses undertaken on three years of national Health Interview Surveys indicate, at least on some key measures such as having health insurance, that persons living in households with and without telephones represent different populations, and parameter estimates are distorted by excluding nontelephone households. Under these circumstances, it is not possible to adjust parameter estimates to take into account nontelephone households.

Background

Refugees and asylum seekers experience language barriers in general practice. Qualitative studies have found that responses to language barriers in general practice are ad hoc with use of both professional interpreters and informal interpreters (patients' relatives or friends). However, the scale of the issues involved is unknown. This study quantifies the need for language assistance in general practice consultations and examines the experience of, and satisfaction with, methods of language assistance utilized.

Methods

Data were collected by telephone survey with general practitioners in a regional health authority in Ireland between July-August 2004. Each respondent was asked a series of questions about consulting with refugees and asylum seekers, the need for language assistance and the kind of language assistance used.

Results

There was a 70% (n = 56/80) response rate to the telephone survey. The majority of respondents (77%) said that they had experienced consultations with refugees and asylum seekers in which language assistance was required. Despite this, general practitioners in the majority of cases managed without an interpreter or used informal methods of interpretation. In fact, when given a choice general practitioners would more often choose informal over professional methods of interpretation despite the fact that confidentiality was a significant concern.

Conclusion

The need for language assistance in consultations with refugees and asylum seekers in Irish general practice is high. General practitioners rely on informal responses. It is necessary to improve knowledge about the organisational contexts that shape general practitioners responses. We also recommend dialogue between general practitioners, patients and interpreters about the relative merits of informal and professional methods of interpretation so that general practitioners' choices are responsive to the needs of patients with limited English.

This study constitutes the first national longitudinal survey to address the relationship between workplace harassment and service utilization. We examine how patterns of sexual harassment and generalized workplace harassment are linked to utilization of mental health, health, legal, spiritual, and work-related services, and whether and how gender influences these relationships. Data derive from a random digit dial telephone survey with a continental U.S. sample of employed adults. Eligibility criteria were being 18 years of age or over, and being employed at least 20 hours per week at some time in the 12 months prior to the wave 1 survey. Out of 4,116 households with eligible individuals, 2,151 agreed to participate at wave 1. 1,418 participated at wave 2, thus, the overall response rate was 34.5%. We show that the patterning of workplace harassment over two time points (chronic, remission, onset, never harassed) is associated with the use of different types of services. Gender partially moderated the relationship between workplace harassment and services.

Objective

To examine the impact of response rate variation on survey estimates and costs in three health telephone surveys.

Data Source

Three telephone surveys of noninstitutionalized adults in Minnesota and Oklahoma conducted from 2003 to 2005.

Study Design

We examine differences in demographics and health measures by number of call attempts made before completion of the survey or whether the household initially refused to participate. We compare the point estimates we actually obtained with those we would have obtained with a less aggressive protocol and subsequent lower response rate. We also simulate what the effective sample sizes would have been if less aggressive protocols were followed.

Principal Findings

Unweighted bivariate analyses reveal many differences between early completers and those requiring more contacts and between those who initially refused to participate and those who did not. However, after making standard poststratification adjustments, no statistically significant differences were observed in the key health variables we examined between the early responders and the estimates derived from the full reporting sample.

Conclusions

Our findings demonstrate that for the surveys we examined, larger effective sample sizes (i.e., more statistical power) could have been achieved with the same amount of funding using less aggressive calling protocols. For some studies, money spent on aggressively pursuing high response rates could be better used to increase statistical power and/or to directly examine nonresponse bias.

Background

Epidemiological research often requires collection of data from a representative sample of the community or recruitment of specific groups through broad community approaches. The population coverage of traditional survey methods such as mail-outs to residential addresses, and telephone contact via public directories or random-digit-dialing is declining and survey response rates are falling. There is a need to explore new sampling frames and consider multiple response modes including those offered by changes in telecommunications and internet technology.

Methods

We evaluated response rates and cost-effectiveness for three modes of survey administration (postal invitation/postal survey, postal invitation/internet survey and postal invitation/telephone survey) and two styles of contact approach (personalised and generic) in a community survey of greywater use. Potential respondents were contacted only once, with no follow up of non-responders.

Results

The telephone survey produced the highest adjusted response rate (30.2%), followed by the personalised postal survey (10.5%), generic postal survey (7.5%) and then the internet survey (4.7% for the personalised approach and 2.2% for the generic approach). There were some differences in household characteristics and greywater use rates between respondents to different survey modes, and between respondents to personalised and generic approaches. These may be attributable to the differing levels of motivations needed for a response, and varying levels of interest in the survey topic among greywater users and non-users. The generic postal survey had the lowest costs per valid survey received (Australian $22.93), followed by the personalised postal survey ($24.75).

Conclusions

Our findings suggest that postal surveys currently remain the most economic option for population-based studies, with similar costs for personalised and generic approaches. Internet surveys may be effective for specialised groups where email lists are available for initial contact, but barriers other than household internet access still exist for community-based surveys. Given the increasing recruitment challenges facing community-based studies, there is an imperative to gather contemporary comparative data on different survey modes and recruitment approaches in order to determine their strengths, limitations and costs. Researchers also need to document and report on the potential biases in the target and respondent populations and how this may affect the data collected.

Background

Epidemiological and other studies that require participants to respond by completing a questionnaire face the growing threat of non-response. Response rates to household telephone surveys are diminishing because of changes in telecommunications, marketing and culture. Accordingly, updated information is required about the rate of telephone listing in directories and optimal strategies to maximise survey participation.

Methods

A total of 3426 households in Sydney, Australia were approached to participate in a computer assisted telephone interview (CATI) regarding their domestic (recycled and/or drinking) water usage. Only randomly selected households in the suburb and postcode of interest with a telephone number listed in the Electronic White Pages (EWP) that matched Australian electoral records were approached.

Results

The CATI response rate for eligible households contacted by telephone was 39%. The rate of matching of electoral and EWP records, a measure of telephone directory coverage, was 55%.

Conclusion

The use of a combination of approaches, such as an advance letter, interviewer training, establishment of researcher credentials, increasing call attempts and targeted call times, remains a good strategy to maximise telephone response rates. However, by way of preparation for future technological changes, reduced telephone number listings and people's increasing resistance to unwanted phone calls, alternatives to telephone surveys, such as internet-based approaches, should be investigated.