Recruitment outcomes, challenges and lessons learned: the Healthy Communities Study.

BACKGROUND: The Healthy Communities Study (HCS) was a national study of community programs and policies that aimed to address childhood obesity; it necessitated recruitment of a large sample of children from communities throughout the United States. OBJECTIVE: The HCS aimed to complete visits with an average of 45 children and 12 key informants from at least 120 communities, diverse with respect to region of the country, urbanicity, socioeconomic status, race, ethnicity and intensity of community programs and policies that aim to address childhood obesity. METHODS: Purchased address lists were utilized to select households for recruitment during Wave 1 of the study, and recruitment of families through schools was employed for Wave 2. RESULTS: The HCS successfully obtained approval from 149 school districts and 478 schools in 130 communities, recruited 5138 families, and interviewed 1421 key informants to allow for characterization of overall intensity of obesity prevention/treatment efforts in each community. CONCLUSIONS: Lessons learned are presented. Future studies should plan for inclusion of the following in development of recruitment strategies: literature review, formative research, pilot testing, and ongoing monitoring and adjustment.

Why are US women not using long-acting contraceptives?

CONTEXT: Given the level of unintended pregnancy in the United States, it is somewhat surprising that hormonal implants and injectables-methods that are long-acting, reversible, highly effective and convenient--have not attained the popularity enjoyed by other medical methods. Knowing the reasons why women have so far spurned these methods might lead to the design and implementation of interventions and targeted social marketing to promote their use. METHODS: Data from the 1993 and 1995 rounds of the National Survey of Women are used to examine the reasons women gave for not having used the implant or injectables, whether they intended to use these methods and how their attitudes toward them may influence their decision to use such methods in the future. Logistic regression models were used to identify the social and demographic characteristics that influence women's decisions not to use these methods. RESULTS: Fewer than 2% of women who were at risk of an unintended pregnancy in 1995 were using the implant, and under 3% were using the injectable. Women gave three major reasons for not using either of these methods: lack of knowledge; fear of side effects or health hazards; and satisfaction with the method they were currently using. Age, education, marital status, parity and current contraceptive method strongly predicted fear of side effects, lack of knowledge and satisfaction with the current method as reasons for not using the implant or the injectable. For example, women aged 30 or older and those with a college education were half as likely as younger women and those with no college education to mention fear of side effects as their main reason for not using the implant. Likewise, single women, women with one or more children and those using a barrier method were 2-3 times as likely as married women, childless women and those using a medical method to attribute nonuse to the implant's side effects. Few women said they intended to use these methods in the next 12 months: 5% for the implant and 10% for the injectable. Single women, women with no college education, women with children, women wanting to have a child (or another child) and women with positive attitudes toward the effect of using an injectable were significantly more likely to say they intended to use the injectable. Nevertheless, substantial proportions of women reported quite negative attitudes about these methods. CONCLUSIONS: The low prevalence of use and the low level of use intention for the implant and for injectables raise questions about the promise for the future of these methods. Each method seems to appeal to certain subgroups of women, however. Thus, if proper interventions and social marketing are targeted to such groups, they may be disabused of misperceptions regarding these methods and possibly become more willing to try them.

Men's behavior change following infection with a sexually transmitted disease.

An analysis of data on 20-39-year-old men participating in the 1991 National Survey of Men finds that of 466 respondents who had ever had a sexually transmitted disease (STD), 25% had sex while infected. However, 85% of these men informed their partner of their infection before having intercourse. Black men were significantly less likely than whites to have had sex while infected. Overall, 29% of men with an STD did not modify their sexual behavior or condom use. Blacks, married men and men who were affiliated with a religious group were less likely than whites, single men and those with no religious affiliation to maintain the same behavior subsequent to the diagnosis of an STD infection as before. Black men were more likely than whites to start using condoms; blacks, religious men, less-educated men and those who were older when they had their first sexual experience were the most likely to stop having sex with casual partners once they learned that they were infected with an STD.

PIP: The effects of individual characteristics on the likelihood that a man will modify risk-related sexual behaviors once he learns he is infected with a sexually transmitted disease (STD) were investigated through use of data from the 1991 US National Survey of Men. Of the 3321 men 20-39 years of age (1238 Blacks and 2083 Whites) interviewed for the survey, 494 (15%) reported ever having had an STD; 298 men had gonorrhea. 25% of men with an STD (13% of those with gonorrhea) had had sex while they were infected, but 85% (86% of men with gonorrhea) informed their partners in advance of intercourse that they had an STD. 70% of those with infection (76% of those with gonorrhea) returned to the clinic to be retested for the disease. Overall, 29% of men (22% of those with gonorrhea) had not modified their sexual behavior or condom use in response to an STD diagnosis. Black men were significantly less likely than Whites to have had sex while infected--and also less likely to inform their partner they were infected--and more likely to have stopped having sex with casual partners and to have begun condom use. Blacks, religious men, less educated men, and those who were older when they had their first sexual experience were the most likely to stop having sex with casual partners once they learned they were infected with an STD. Overall, Blacks, married men, and those who were affiliated with a religious group were less likely than Whites, single men, and those with no religious affiliation to maintain the same behavior subsequent to diagnosis of an STD. These findings provide a useful starting point for the understanding of the dynamics of STD transmission and the design of prevention programs.