The future of random-digit-dial surveys for injury prevention and violence research.

A central issue facing injury prevention research today is how to collect self-reported data on injury and violence from a geographically dispersed public, quickly, cost effectively, and with a reasonable degree of confidence in the quality of the results. Questions about eroding frame coverage, declining participation rates, and increasing potential for bias have raised doubts about the long-term viability of random-digit-dial (RDD) telephone surveys for injury prevention research. So where does the future lie? The four articles in this volume, as well as other research, point down two paths: (1) continued reliance on RDD, or (2) adoption of alternative survey designs. Continued use of RDD methodology will require additional research in the areas of response rate improvement, techniques for enhancing post-survey adjustments, and cost-effective approaches to nonresponse bias analysis. Moving away from a strict reliance on RDD methodology, injury prevention research could adopt mixed-mode approaches (such as combining telephone, mail, and web-based surveys) or make use of address-based sampling frames as a method for reaching sample members currently missed by most RDD approaches. Either way, the future of collecting self-reports of injury and injury prevention data will be more complex and require considerable resources.

Address-based versus random-digit-dial surveys: comparison of key health and risk indicators.

Use of random-digit dialing (RDD) for conducting health surveys is increasingly problematic because of declining participation rates and eroding frame coverage. Alternative survey modes and sampling frames may improve response rates and increase the validity of survey estimates. In a 2005 pilot study conducted in six states as part of the Behavioral Risk Factor Surveillance System, the authors administered a mail survey to selected household members sampled from addresses in a US Postal Service database. The authors compared estimates based on data from the completed mail surveys (n = 3,010) with those from the Behavioral Risk Factor Surveillance System telephone surveys (n = 18,780). The mail survey data appeared reasonably complete, and estimates based on data from the two survey modes were largely equivalent. Differences found, such as differences in the estimated prevalences of binge drinking (mail = 20.3%, telephone = 13.1%) or behaviors linked to human immunodeficiency virus transmission (mail = 7.1%, telephone = 4.2%), were consistent with previous research showing that, for questions about sensitive behaviors, self-administered surveys generally produce higher estimates than interviewer-administered surveys. The mail survey also provided access to cell-phone-only households and households without telephones, which cannot be reached by means of standard RDD surveys.

Chronic disease in health emergencies: in the eye of the hurricane.

INTRODUCTION: Inadequately controlled chronic diseases may present a threat to life and well-being during the emergency response to natural disasters. An estimate of the possible numbers of people who may require treatment for chronic diseases should help in planning a response, but such information for local areas is not easily accessible. We explored how a current surveillance system could be used to provide estimates of the potential needs for emergency treatment of chronic diseases in the wake of a natural disaster. METHODS: We used data from adults aged 18 years or older who participated in the Behavioral Risk Factor Surveillance System (BRFSS) in 2004 to estimate the prevalence and numbers of people with diabetes, heart disease, stroke, hypertension, and current asthma who lived in the New Orleans-Metairie-Kenner, La, metropolitan statistical area. RESULTS: About 9.0% of participants had diabetes, 4.6% had angina or coronary heart disease, 3.0% had had a myocardial infarction, 2.0% had had a stroke, and 6.3% had current asthma. About 25.4% adults had at least one of the above conditions. CONCLUSION: A surveillance system such as the BRFSS can provide potentially useful baseline information about the numbers of people with chronic diseases and the treatment that they receive; this information can assist the medical and public health community in assessing the needs of people with chronic diseases after disasters and in planning relief efforts.

Racial and ethnic disparities in influenza vaccination coverage among adults during the 2004-2005 season.

During the 2004-2005 influenza season, the supply of vaccine to the United States was significantly reduced. In response, the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices issued interim recommendations for prioritizing vaccination. Given trends in racial/ethnic disparities in vaccination for influenza, the authors assessed the impact of the shortage on those historically less likely to be vaccinated. Using data from the Behavioral Risk Factor Surveillance System, they considered vaccination coverage among those non-Hispanic Whites, non-Hispanic Blacks, and Hispanics who had priority for being vaccinated during the 2004-2005 influenza season. The vaccine shortage had a significant negative effect on coverage among adults aged 65 years or older across the three racial/ethnic groups. Yet, the magnitude of the disparities in coverage did not change significantly from previous seasons. This finding may imply similar patterns of vaccine-seeking behavior during shortage and nonshortage years. No racial/ethnic differences were seen among adults aged 18-64 years, which likely reflects the higher percentage of health-care workers in this age group. Yearly monitoring of influenza vaccine coverage is important to assess the long-term impact of shortages on overall coverage and gaps in coverage between racial/ethnic groups.

Race, ethnicity, and linguistic isolation as determinants of participation in public health surveillance surveys.

INTRODUCTION: To plan, implement, and evaluate programs designed to improve health conditions among racial and ethnic minority populations in the United States, public health officials and researchers require valid and reliable health surveillance data. Monitoring chronic disease and behavioral risk factors among such populations, however, is challenging. This study assesses the effects of race, ethnicity, and linguistic isolation on rates of participation in the Behavioral Risk Factor Surveillance System (BRFSS). METHODS: County-level data from the 2003 BRFSS survey and 2000 U.S. census were used to examine the effects of race, ethnicity, and linguistic isolation on six measures of survey participation (i.e., rates of resolution, screening, cooperation, response, language barriers, and refusal). RESULTS: Participation rates were significantly lower in counties with higher percentages of black people and people who did not speak English. Response rates decreased by 4.6% in counties with the highest concentration of black residents compared with counties with few black residents. Likewise, response rates decreased by approximately 7% in counties in which a larger percentage of the population spoke only Spanish or another Indo-European language compared with counties in which all residents spoke English. CONCLUSION: The negative relationship between the percentage of Spanish-only-speaking households and participation rates is troubling given that the BRFSS is conducted in both Spanish and English. The findings also indicate that more needs to be done to improve participation among other minorities. Researchers are investigating several ways of addressing disparities in participation rates, such as using postsurvey adjustments, developing more culturally appropriate data-collection procedures, and offering surveys in multiple languages.

Alternative modes for health surveillance surveys: an experiment with web, mail, and telephone.

BACKGROUND: Web and mail surveys as complements to telephone surveys may help resolve concerns about declining participation in telephone surveys for public health surveillance. Little is known, however, about how responses obtained in Web surveys compare with those from mail or telephone surveys. METHODS: The Behavioral Risk Factor Surveillance System 2003 core interview was conducted in 3 survey modes: Web (n = 1143), mail (n = 836), and telephone (n = 2072). All 3 samples were drawn randomly. We compared respondent demographics and responses to 8 key questions on health conditions and risk behaviors (including asthma, diabetes, obesity, and HIV testing) across the 3 survey modes. RESULTS: Demographic characteristics of mail and Web respondents varied considerably from those interviewed by telephone. The unadjusted prevalence of outcomes varied by survey mode. After adjustment for respondent demographic characteristics, there were still differences among survey modes in several of the health conditions and risk behaviors, although for some of these, the pattern was different for the unadjusted and adjusted results. CONCLUSIONS: As health surveys take advantage of new technologies and moved towards mixed-mode designs, researchers need to test for and, if necessary, account for the effect of mode in the estimates they produce.

Effects of survey mode on self-reports of adult alcohol consumption: a comparison of mail, web and telephone approaches.

OBJECTIVE: Mail and Web surveys are two possible alternatives for reducing potential nonresponse bias in telephone-based studies of alcohol consumption. Mail surveys have been a staple of epidemiological research, but there is a dearth of similar research on Web surveys. Most studies using Web surveys have been conducted among college students or other specialized populations where Internet penetration is relatively high. The present study examines differences in self-reports of alcohol consumption among adult members of the general public surveyed by mail, Web and telephone. METHOD: Web and mail versions of the 2003 Behavioral Risk Factor Surveillance System (BRFSS) instrument, traditionally a telephone-only survey, were developed and administered to address-matched households drawn from the random-digit dialed sampling frame used for the BRFSS. Comparisons were made with results from the ongoing telephone-based surveillance. RESULTS: A total of 4,051 interviews (836 mail, 1,143 Web, and 2,072 telephone) were completed with adults ages 18 or older in four U.S. states. The findings indicate considerable variation in the estimates for heavy drinking (five or more drinks on an occasion during the past 30 days) obtained across these modes and population subgroups, particularly among the Web respondents. CONCLUSIONS: Mail surveys appear to be a viable alternative to more traditional telephone surveys, whereas use of Web surveys with the general public appears more problematic. Both approaches, however, may complement telephone studies when used in mixed-mode designs. Because alcohol consumption is associated with a number of diseases, caution is required when using different modes of data collection in epidemiological studies.