Physical measures and biomarker collection in health surveys: Propensity to participate.

Population-based surveys have long been a key tool for health researchers, policy makers and program managers. The addition of bio-measures, including physical measures and specimen collection, to self-reported health and health behaviors can increase the value of the research for health sciences. At the same time, these bio-measures are likely to increase the perceived burden and intrusiveness to the respondent. Relatively little research has been reported on respondent willingness to participate in surveys that involve physical measures and specimen collection and whether there is any associated non-response bias. This paper explores the willingness of respondents to participate in surveys that involve physical measures and biomarkers. A Census-balanced sample of nearly 2000 adults from a national mobile panel of persons residing in the U.S. were interviewed. Willingness to participate in six specific bio-measures was assessed. The survey finds a high correlation in the willingness of respondents to participate among these specific bio-measures. This suggests there is a general propensity towards (and against) bio-measures among potential respondents, despite some differences in willingness to participate in the more sensitive, intrusive or burdensome biomarkers. This study finds the general propensity to participate in bio-measures is correlated with a number of key measures of health and illness. This suggests that the inclusion of biomarkers in health surveys may introduce some bias in key measures that need to be balanced against the value of the additional information.

Weighting Nonprobability and Probability Sample Surveys in Describing Cancer Catchment Areas.

BACKGROUND: The Population Health Assessment initiative by NCI sought to enhance cancer centers' capacity to acquire, aggregate, and integrate data from multiple sources, as well as to plan, coordinate, and enhance catchment area analysis activities. METHODS: Key objectives of this initiative are pooling data and comparing local data with national data. A novel aspect of analyzing data from this initiative is the methodology used to weight datasets from sites that collected both probability and nonprobability samples. This article describes the methods developed to weight data, which cancer centers collected with combinations of probability, and nonprobability sampling designs. RESULTS: We compare alternative weighting methods in particular for the hybrid probability and nonprobability sampling designs employed by different cancer centers. We also include comparisons of local center data with national survey data from large probability samples. CONCLUSIONS: This hybrid approach to calculating statistical weights can be implemented both within cancer centers that collect both probability and nonprobability samples with common measures. Aggregation can also apply to cancer centers that share common data elements, and target similar populations, but differ in survey sampling designs. IMPACT: Researchers interested in local versus national comparisons for cancer surveillance and control outcomes should consider various weighting approaches, including hybrid approaches, when analyzing their data.

A Feasibility Study on Using an Internet-Panel Survey to Measure Perceptions of E-cigarettes in 3 Metropolitan Areas, 2015.

OBJECTIVES: Internet-panel surveys are emerging as a means to quickly and cost-effectively collect health data, and because of their large memberships, they could be used for community-level surveys. To determine the feasibility of using an internet-panel survey to quickly provide community-level data, we conducted a pilot test of a health survey in 3 US metropolitan areas. METHODS: We conducted internet-panel surveys in Cleveland, Ohio; New York, New York; and Seattle, Washington, in 2015. Slightly more than 500 people responded to the survey in each city. We compared weighted unadjusted prevalence estimates from the internet-panel data with estimates from the 2014 Health Information National Trends Survey (HINTS) for the following question in each survey: "Compared to smoking cigarettes, would you say that electronic cigarettes are…much less harmful, less harmful, just as harmful, more harmful, much more harmful, or I've never heard of electronic cigarettes." We used multivariable logistic regression to compare associations of respondents' demographic and health characteristics with perceived harm from e-cigarettes. RESULTS: The prevalence of the perception that e-cigarettes are less harmful than smoking cigarettes ranged from 35.9% to 39.9% in the internet-panel sites and was 43.0% in HINTS. Most patterns of beliefs and respondent characteristics in the internet-panel data were consistent with patterns in HINTS. We found inconsistent patterns between internet-panel sites and HINTS by race/ethnicity and education. CONCLUSIONS: This feasibility study found that internet-panel surveys could quickly produce community-level data for targeted public health interventions and evaluation, but they may be limited in producing estimates among subgroups.

Home blood pressure monitoring and hypertension status among US adults: the National Health and Nutrition Examination Survey (NHANES), 2009-2010.

BACKGROUND: Currently, no national prevalence is available on home blood pressure monitoring (HBPM). METHODS: This report is based on national-level, cross-sectional data for noninstitutionalized US adults aged ≥18 years (n = 6,001 participants) from the National Health and Nutrition Examination Survey (NHANES), 2009-2010. RESULTS: Overall, 21.7% of the population reported HBPM in the past year. Using 2010 Census data as a reference, approximately 33 million (14.5%) individuals engaged in monthly or more frequent HBPM. The frequency of HBPM increased with higher age, higher body mass index, higher family income-to-poverty ratio, and a higher number of health-care visits (all, P < 0.05). Adults with health-care coverage engaged in monthly or more frequent HBPM than adults without coverage (16.1% vs. 8.4%; P < 0.05). Among people with hypertension (blood pressure ≥140/90mm Hg or currently taking medication), 36.6% engaged in monthly or more frequent HBPM. Of those with hypertension whom were aware, treated, and controlled, 41.9%, 43.5%, and 42.1%, respectively, engaged in monthly or more frequent HBPM. Adjusting for covariables, those who were aware of, treated for, and controlled their hypertension were more likely to have a higher frequency of HBPM than the reference: unaware, untreated, and uncontrolled (odds ratio (OR) = 3.59; OR = 3.96; and OR = 1.50, respectively). CONCLUSIONS: Approximately 14.5% of adults engaged in monthly or more frequent HBPM. Being aware of hypertension, being pharmacologically treated, and being controlled were associated with an increased frequency of HBPM. Even among these categories of people with hypertension, <50% were using HBPM.

Comparison of dried blood spot to venous methods for hemoglobin A1c, glucose, total cholesterol, high-density lipoprotein cholesterol, and C-reactive protein.

BACKGROUND: Compared to venipuncture, dried blood spots (DBS) can be collected by non-phlebotomists in non-clinical settings, is relatively inexpensive, more easily transported and stored conveniently. Disadvantages of DBS include difficult assay development and validation. This study compared DBS to venous methods for hemoglobin A1c, glucose, total cholesterol, high-density lipoprotein cholesterol, and C-reactive protein (CRP). METHODS: DBS collection and venipuncture were performed on 401 participants. The DBS were collected on Whatman 903 protein saver card. For analysis, 3.2mm blood punches were placed into a 96-well microtiter plate for elution and then analyzed. RESULTS: The Pearson squared correlation coefficients were high for hemoglobin A1c (0.92), CRP (0.84) and glucose (0.81) and low for total cholesterol (0.34) and high-density lipoprotein (HDL) cholesterol (0.30). Sensitivity (>82%) and specificity (>90%) were high for CRP, glucose and hemoglobin A1c at selected clinical cut-points. Low sensitivity (<41%) and high specificity (>87%) were seen for total and HDL cholesterol. CONCLUSIONS: The hemoglobin A1c, glucose and CRP correlated well between DBS and venous methods (r(2)>0.80), but there was a poor correlation for total and HDL cholesterol (r(2)<0.34). This resulted in low sensitivity of DBS methods for total and HDL cholesterol.

Implementation of therapeutic hypothermia after cardiac arrest--a telephone survey of Connecticut hospitals.

RATIONALE: We hypothesize that despite excellent evidence supporting use of therapeutic hypothermia (TH) after cardiac arrest, only some of Connecticut hospitals utilize this technique for cardiac arrest patients. METHODS: Telephone survey of all adult acute care Connecticut hospitals between January and April 2010. RESULTS: Among 31 adult acute care hospitals, 27 care for cardiac arrest patients. Seventeen out of 27 hospitals use TH (63%) for cardiac arrest patients. No significant association was found between use of TH and hospital size (P=0.14), ICU type (P=0.07) or BC/BE critical-care physician staffing (P= 0.22). Lack of resources and cost of TH were commonly mentioned as barriers. CONCLUSIONS: Therapeutic hypothermia is underutilized in Connecticut with almost half of all hospitals currently not employing TH. Given the slow adoption rate of TH, state-level leadership may be indicated to accelerate implementation of this life-saving technique.

Effectiveness and acceptability of a computerized decision support system using modified Wells criteria for evaluation of suspected pulmonary embolism.

STUDY OBJECTIVE: Ready availability of computed tomography (CT) angiography for evaluation of pulmonary embolism in emergency departments (EDs) is associated with a dramatic increase in the number of CT angiography tests. The aims of this study are to determine whether a validated prediction algorithm embedded in a computerized decision support system improves the positive yield rate of CT angiography for pulmonary embolism and is acceptable to emergency physicians. METHODS: This study was conducted as a prospective interventional study with a retrospective preinterventional comparison group. RESULTS: The implementation of the computerized physician order entry-based computerized decision support system was associated with an overall increase in the positivity rate of from 8.3% (95% confidence interval [CI] 4.9% to 12.9%) preintervention to 12.7% (95% CI 8.6% to 17.7%) postintervention, with a difference of 4.4% (95% CI -1.4% to 10.1%). A total of 404 patients were eligible for inclusion. Physician nonadherence to the computerized decision support system occurred in 105 (26.7%) cases. Fifteen patients underwent CT angiography despite low Wells score and negative D-dimer result, all of whose results were negative for pulmonary embolism. Emergency physicians did not order CT angiography for 44 patients despite high pretest probability, with one receiving a diagnosis of pulmonary embolism on a subsequent visit and another, of DVT. When emergency physicians adhered to the computerized decision support system for the evaluation of suspected pulmonary embolism, a higher yield of CT angiography for pulmonary embolism occurred, with 28 positive results of 168 CT angiography tests (16.7%; 95% CI 11.4% to 23.2%) and a difference compared with preintervention of 8.4% (95% CI 1.7% to 15.4%). Physicians cited the time required to apply the computerized decision support system and a preference for intuitive judgment as reasons for not adhering to the computerized decision support system. CONCLUSION: Use of an evidence-based computerized physician order entry-based computerized decision support system for the evaluation of suspected pulmonary embolism was associated with a higher yield of CT angiography for pulmonary embolism. The computerized decision support system, however, was poorly accepted by emergency physicians (partly because of increased computer time), leading to possibly selective use, reducing the effect on overall yield, and leading to removal of the computerized decision support system from the computer order entry. These findings emphasize the importance of facilitation of rule-based decisionmaking in the ED and attentiveness to the complex demands placed on emergency physicians.

Trends in use and yield of chest computed tomography with angiography for diagnosis of pulmonary embolism in a Connecticut hospital emergency department.

RATIONALE: We hypothesize that the ready availability of chest computed tomography (CT) scan, with angiography (CTA), for pulmonary embolism (PE) has resulted in its increased use in the emergency department (ED) with an associated decrease in positive studies. RESULTS: CTA for diagnosis of PE increased over 13-fold from 2000 to 2005. The diagnostic yield of CTA for PE decreased from 14% in 2000 to a mean (SD) of 7.2 (.91)% during subsequent years (P =.007). No significant change in yield occurred after 2001 (P = 0.51). Significantly more segmental and subsegmental embolisms were observed with the 16-slice CT in years 2004-2005 when compared to the single-slice CT used in years 2000-2003. CONCLUSIONS: CTA for PE in our hospital ED has a low-positive yield rate, suggesting overutilization. However, the positive-yield rate remained steady despite increasing numbers of CTA, suggesting increased detection of PE and/or false-positive CTA.

Comparison of FEV6 and FVC for detection of airway obstruction in a community hospital pulmonary function laboratory.

The National Lung Health Education Program recommends that primary care providers perform spirometry tests on cigarette smoking patients 45 years or older in order to detect airways obstruction and aid smoking cessation efforts [Ferguson GT, Enright Pl, Buist AS, et al. Office spirometry for lung health assessment in adults: a consensus statement from the national lung education program. Chest 2000; 117: 1146-61]. An abbreviated forced expiratory maneuver that requires exhalation for 6s (FEV6) has recently been proposed as a substitute for forced vital capacity (FVC) to facilitate performance of such spirometry. We set out to assess the accuracy of diagnosis of obstruction and abnormal pulmonary function using FEV6 in comparison to FVC in a community hospital population. One hundred pulmonary function tests performed at a community hospital were randomly selected and retrospectively analyzed. Sixty-three of the 100 tests had satisfactory 6-s expiration and were subject to further analysis. We compared the spirometric interpretation using Morris predictive equations for FEV1/FVC and Hankison predictive equations for FEV1/FVC and FEV1/FEV6. The Hankison set of equations is the only published reference formulas for prediction of FEV6. We found that versus our Morris gold standard, Hankison based FEV1/FVC interpretation was 100% sensitive and 67% specific for the diagnosis of obstruction and 100% sensitive and 65% specific for the diagnosis of any abnormality. The Hankison based FEV1/FEV6 interpretation was 97% sensitive and 47% specific for diagnosing obstruction and 100% sensitive and 50% specific for identifying any abnormality versus the Morris FVC based gold standard. In conclusion, in our hospital based pulmonary function laboratory, FEV6 based interpretation has excellent sensitivity for detection of spirometric abnormalities. However, its moderate specificity may hinder its utility as a screening test. Further testing is necessary to determine its reliability in different patient populations with less highly trained operators.

Developing a metadata data model for the National Health and Nutrition Examination Survey (NHANES).

The National Health and Nutrition Examination Survey (NHANES), developed by the Centers for Disease Control and Prevention (CDC), is a large and comprehensive health survey utilizing leading edge technologies to produce national estimates of health measures and the nutritional status of the U.S. population. Early NHANES metadata models grouped data by categories with little specificity and often not capturing the complexity of the survey. Subsequently, existing models at the Census Bureau, CDC, and the EPA were evaluated in addition to industry standards, such as DDI, Dublin Core, and ISO 1179. For the NHANES metadata model, the DDI standard and CDC Public Health Conceptual Model were chosen as the backbone for constructing the data model. The new model has led to increased data accuracy and several value-added products for producing codebooks, automatically checking questionnaire skip patterns, and producing questionnaire instrumentation.