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

Nightmares associated with the eveningness chronotype

Relations between common nightmares and chronobiological factors remain poorly understood. The possibility that nightmare frequency and distress are associated with chronotype ("morningness-eveningness") was investigated in a sample of respondents to an Internet questionnaire. Over a 4(1/2)-year period, a total of 3978 subjects (mean age = 26.5 +/- 11.6 yrs; age range = 10-69; 2933 female, 1045 male) submitted responses to single items about chronotype and nightmares as well as to other demographic variables. Analyses of chronotype and nightmares items by age and gender replicated most previous findings for these measures-validating their further assessment-and uncovered abrupt increases in nightmare distress between ages 10-19 and 20-29 for females and ages 30-39 and 40-49 for males. Most important, there was a strong association between nightmares and eveningness for female subjects. The latter was expressed as a linear association between nightmare frequency and increasing eveningness and a cubic association between nightmare distress and increasing eveningness; the definite evening types displayed the most severe nightmares. The effect for nightmare frequency was independent of age and sleep duration but was eliminated when nightmare distress was covaried. For females, the nightmare/eveningness association appeared at ages 20 to 29 for the definite evening type and only later, at ages 30 to 39, for the moderate evening type. Findings are consistent with the possibility that nightmares are the expression of a more general pathological factor that is characteristic of eveningness and that is responsible for affective symptoms such as neuroticism and depression. This pathological factor appears to be expressed in late adolescence/ early adulthood, and relative morningness may be a protective factor delaying its onset. The well-established circadian modulations of cognitive, social, and affective tasks that are influenced by chronotype may extend to the memory and affective processes of sleep-including dreaming. This chronotypic influence, together with a likely gender difference in the neurophysiological substrate of emotional processing, may result in the differential occurrence of nightmares for female evening types.

A comparison of web-based and paper-based survey methods: testing assumptions of survey mode and response cost

Web-based surveys have become more prevalent in areas such as evaluation, research, and marketing research to name a few. The proliferation of these online surveys raises the question, how do response rates compare with traditional surveys and at what cost? This research explored response rates and costs for Web-based surveys, paper surveys, and mixed-mode surveys. The participants included evaluators from the American Evaluation Association (AEA). Results included that mixed-mode, while more expensive, had higher response rates.

Rasch model analysis of the Depression, Anxiety and Stress Scales (DASS)

BACKGROUND

There is a growing awareness of the need for easily administered, psychometrically sound screening tools to identify individuals with elevated levels of psychological distress. Although support has been found for the psychometric properties of the Depression, Anxiety and Stress Scales (DASS) using classical test theory approaches it has not been subjected to Rasch analysis. The aim of this study was to use Rasch analysis to assess the psychometric properties of the DASS-21 scales, using two different administration modes.

METHODS

The DASS-21 was administered to 420 participants with half the sample responding to a web-based version and the other half completing a traditional pencil-and-paper version. Conformity of DASS-21 scales to a Rasch partial credit model was assessed using the RUMM2020 software.

RESULTS

To achieve adequate model fit it was necessary to remove one item from each of the DASS-21 subscales. The reduced scales showed adequate internal consistency reliability, unidimensionality and freedom from differential item functioning for sex, age and mode of administration. Analysis of all DASS-21 items combined did not support its use as a measure of general psychological distress. A scale combining the anxiety and stress items showed satisfactory fit to the Rasch model after removal of three items.

CONCLUSION

The results provide support for the measurement properties, internal consistency reliability, and unidimensionality of three slightly modified DASS-21 scales, across two different administration methods. The further use of Rasch analysis on the DASS-21 in larger and broader samples is recommended to confirm the findings of the current study.

The Influence of Web- Versus Paper-based Formats on the Assessment of Tobacco Dependence: Evaluating the Measurement Invariance of the Dimensions of Tobacco Dependence Scale

The purpose of this study was to examine the influence of mode of administration (internet-based, web survey format versus pencil-and-paper format) on responses to the Dimensions of Tobacco Dependence Scale (DTDS). Responses from 1,484 adolescents that reported using tobacco (mean age 16 years) were examined; 354 (23.9%) participants completed a web-based version and 1,130 (76.1%) completed a paper-based version of the survey. Both surveys were completed in supervised classroom environments. Use of the web-based format was associated with significantly shorter completion times and a small but statistically significant increase in the number of missing responses. Tests of measurement invariance indicated that using a web-based mode of administration did not influence the psychometric functioning of the DTDS. There were no significant differences between the web- and paper-based groups' ratings of the survey's length, their question comprehension, and their response accuracy. Overall, the results of the study support the equivalence of scores obtained from web- and paper-based versions of the DTDS in secondary school settings.

Behavioral risk disparities in a random sample of self-identifying gay and non-gay male university students

This Internet-based study was designed to compare health risk behaviors of gay and non-gay university students from stratified random cross-sectional samples of undergraduate students. Mean age of the 4,167 male participants was 20.5 (+/-2.7) years. Of these, 206 (4.9%) self-identified as gay and 3,961 (95.1%) self-identified as heterosexual. After adjusting for selected characteristics and clustering within university, gay men had higher odds of reporting: multiple sexual partners; cigarette smoking; methamphetamine use; gamma-hydroxybutyrate (GHB) use; other illicit drug use within the past 30 days and during lifetime; and intimate partner violence (IPV). Understanding the health risk behaviors of gay and heterosexual men is crucial to identifying associated factors and intervening upon them using appropriate and tailored strategies to reduce behavioral risk disparities and improve health outcomes.

The Impact of Personalized Prenotification on Response Rates to an Electronic Survey

The purpose of this post-hoc investigation was to determine the difference in response rates between respondents who received personalized prenotification prior to receiving an electronic survey and those who did not. An electronic survey was e-mailed to 236 program directors or other designated individuals from nurse practitioner (NP) programs around the United States. Seventy six percent of the NP program directors were personally contacted about the survey in advance, and 97.5% agreed to participate. The remaining 24% were sent e-mails with a link to the survey without prenotification. Response rates for those in the prenotification group who had agreed to participate versus those who did not receive prenotification were 49% and 45%, respectively. Personalized prenotification did not affect the electronic survey response rates. Electronic research methodology offers a unique opportunity to potentially survey an entire population (e.g., nursing faculty), thus further investigation regarding factors associated with electronic survey response rates and ways to improve these rates is warranted.

Prevalence and correlates of self-injury among university students

OBJECTIVE

The authors' purpose in this research was to establish estimates of the prevalence and correlates of nonsuicidal self-injury among university students.

PARTICIPANTS

The authors recruited participants (N = 2,843) from a random sample of 5,021 undergraduate and graduate students attending a large midwestern public university.

METHODS

Using an Internet-based survey, the authors measured the prevalence of self-injury and potential risk factors, including depression, anxiety, eating disorders, suicidal thoughts, and negative health behaviors.

RESULTS

Seven percent of students reported any self-injury over the previous 4 weeks. Factors associated with a significantly higher likelihood (p <.05) of self-injury included cigarette smoking, concurrent depressive and anxiety disorders, and for men, growing up in a family of low socioeconomic status and having symptoms of eating disorders. Only 26% of those who reported self-injury received mental health therapy or medication in the previous year.

CONCLUSIONS

Students who harm themselves experience high anxiety and distress, yet are unlikely to seek help.

The Freshman 15: is it real?

OBJECTIVE

The belief that college students gain 15 lbs during freshman year is widespread, yet the evidence for this is limited. The authors aimed to determine whether college students gain weight during freshman year.

PARTICIPANTS

The authors studied unmarried freshmen living on-campus at a private university in the northeastern United States.

METHODS

The authors used an online survey to collect information about social behaviors and weight.

RESULTS

The authors observed an average weight gain of 2.7 lbs. About half of the students gained weight, and 15% lost weight. Men gained more weight than did women.

CONCLUSIONS

Freshman weight gain was 5.5 times greater than that experienced by the general population.

Race/ethnicity and gender differences in drug use and abuse among college students

This study examines race/ethnicity and gender differences in drug use and abuse for substances other than alcohol among undergraduate college students. A probability-based sample of 4,580 undergraduate students at a Midwestern research university completed a cross-sectional Web-based questionnaire that included demographic information and several substance use measures. Male students were generally more likely to report drug use and abuse than female students. Hispanic and White students were more likely to report drug use and abuse than Asian and African American students prior to coming to college and during college. The findings of the present study reveal several important racial/ethnic differences in drug use and abuse that need to be considered when developing collegiate drug prevention and intervention efforts.

Development of a Web-based questionnaire to collect exposure and symptom data in children and adolescents with asthma

BACKGROUND

Questionnaires are an important component of epidemiologic studies. Maintaining compliance in longitudinal studies is a challenge, particularly from children and adolescents.

OBJECTIVE

To implement a Web-based questionnaire for children and adolescents with asthma for daily self-completion, minimizing recall bias and maximizing compliance.

METHODS

We determined symptoms, exposure to asthma triggers, peak expiratory flow rate, and medications taken, including dose and dose time. The Web-based system can be less time-consuming and a source of fewer errors than paper questionnaires and permits review of the data and compliance during the study. The Web programming of the questionnaire included branching, so that questions deemed irrelevant based on a previous response were not presented to participants, minimizing the completion time.

RESULTS

Sixty-four students with asthma participated nearly daily for between 2 and 4 months. Financial incentives for the participants were calculated in real time based on completion rates. Monitoring of the subject's completion included an extensive administrative hierarchical alert system, enabling the staff to target individuals who fell behind in entries and needed the most encouragement.

CONCLUSIONS

Similar compliance and completion rates were obtained using the Web-based questionnaire as reported for smaller paper questionnaires by parents of children. The Web-based system provides a mechanism to obtain daily responses directly from an age group not often accessible by traditional questionnaire approaches.

A league of their own: demographics, motivations and patterns of use of 1,955 male adult non-medical anabolic steroid users in the United States

Background

Rule violations among elite-level sports competitors and tragedies among adolescents have largely defined the issue of non-medical anabolic-androgenic steroid (NMAAS) use for the public and policy makers. However, the predominant and oft-ignored segment of the NMAAS community exists in the general population that is neither participating in competitive sports nor adolescent. A clearer profile of NMAAS users within the general population is an initial step in developing a full understanding of NMAAS use and devising appropriate policy and interventions. This survey sought to provide a more comprehensive profile of NMAAS users by accessing a large sample of user respondents from around the United States.

Methods

U.S.-based male NMAAS users (n = 1955) were recruited from various Internet websites dedicated to resistance training activities and use of ergogenic substances, mass emails, and print media to participate in a 291-item web-based survey. The Internet was utilized to provide a large and geographically diverse sample with the greatest degree of anonymity to facilitate participation.

Results

The majority of respondents did not initiate AAS use during adolescence and their NMAAS use was not motivated by athletics. The typical user was a Caucasian, highly-educated, gainfully employed professional approximately 30 years of age, who was earning an above-average income, was not active in organized sports, and whose use was motivated by increases in skeletal muscle mass, strength, and physical attractiveness. These findings question commonly held views of the typical NMAAS user and the associated underlying motivations.

Conclusion

The focus on "cheating" athletes and at risk youth has led to ineffective policy as it relates to the predominant group of NMAAS users. Effective policy, prevention or intervention should address the target population(s) and their reasons for use while utilizing their desire for responsible use and education.

Participation Rates in Epidemiologic Studies

Participation rates for epidemiologic studies have been declining during the past 30 years with even steeper declines in recent years. This wholesale decrease in participation rate, or at the very least the increase in refusal, has, quite understandably, occasioned some concern among epidemiologists who have long considered a high study participation rate as one of the hallmarks of a "good" epidemiologic study. In this review we synthesize the issues that are central to epidemiologic thinking around declining study participation rates. We consider the reasons why study participation has been declining, summarize what we know about who does participate in epidemiologic studies, and discuss the implications of declining participation rates. We conclude with a discussion of methods that may help improve study participation rates.

Web-based question-answering service of a family physician -- the characteristics of queries in a non-commercial open forum

The use of the Internet is growing rapidly. Up to 70% of American Internet surfers use the Web for some kind of medical purpose. Only a few studies characterized the consulting population and their inquiries. The objective of this study was to define the content of queries and the characteristics of the consulting population in an open access 'Ask the family physician' non-commercial open forum. Data had been collected from the family medicine forum in www.doctors.co.il. This site has 10 - 15 new queries daily, and a physician reply is given on most occasions within 24 h. We analysed demographic characteristics and the content of the queries. In addition, we sent detailed questionnaires to 200 randomly selected consulters. We analysed 1,002 consecutive queries. The average age of the consulters was 31.8 years, 63.4% women. Women applied more often for someone else, compared to men (13.7 versus 8%p = 0.01). 82.2% applied to the forum for a first opinion on the subject matter. The most frequent subjects were: infectious diseases (7.3%), deciphering blood chemical analysis results (3.2%), vitamin B(12) (3.2%), deciphering blood count analysis results (2.9%), Epstein - Barr virus and Cytomegalovirus (2.8%), and hypertension (2.4%). Only 10% (20/200) replied to our e-mail questionnaire. We described the characteristics of inquiries to a Web-based question answering service. Its consumers are mainly younger females who consult the virtual physician prior to consulting their own family physician. They mainly seek medical knowledge especially in interpreting laboratory tests and information about various medical conditions.

Sensed presence as a correlate of sleep paralysis distress, social anxiety and waking state social imagery

Isolated sleep paralysis (ISP) is a common parasomnia characterized by an inability to move or speak and often accompanied by hallucinations of a sensed presence nearby. Recent research has linked ISP, and sensed presence more particularly, with social anxiety and other psychopathologies. The present study used a large sample of respondents to an internet questionnaire (N=193) to test whether these associations are due to a general personality factor, affect distress, which is implicated in nightmare suffering and hypothesized to involve dysfunctional social imagery processes. A new measure, ISP distress, was examined in relation to features of ISP experiences, to self-reported psychopathological diagnosis, to scores on the Leibowitz Social Anxiety Scale and to scores on a new questionnaire subscale assessing social imagery in a variety of waking states. Three main results were found: (1) ISP experiences are only weakly associated with a prior diagnosis of mental disorder, (2) sensed presence during ISP is associated preferentially with ISP distress, and (3) ISP distress is associated with dysfunctional social imagery. A general predisposition to affective distress may influence the distress associated with ISP experiences; overly passive social imagery may, in turn, be implicated in this affect distress influence.

Personalized mailed feedback for college drinking prevention: a randomized clinical trial

The current study was designed to evaluate the efficacy of a mailed feedback and tips intervention as a universal prevention strategy for college drinking. Participants (N = 1,488) were randomly assigned to feedback or assessment-only control conditions. Results indicated that the mailed feedback intervention had a preventive effect on drinking rates overall, with participants in the feedback condition consuming less alcohol at follow-up in comparison with controls. In addition, abstainers in the feedback condition were twice as likely to remain abstinent from alcohol at follow-up in comparison with control participants (odds ratio = 2.02), and feedback participants were significantly more likely to refrain from heavy episodic drinking (odds ratio = 1.43). Neither gender nor severity of baseline drinking moderated the efficacy of the intervention in these analyses, but more conservative analyses utilizing last-observation carryforward suggested women and abstainers benefited more from this prevention approach. Protective behaviors mediated intervention efficacy, with participants who received the intervention being more likely to use strategies such as setting limits and alternating alcohol with nonalcoholic beverages. Implications of these findings for universal prevention of college drinking are discussed.

Paranoid delusions and threatening hallucinations: a prospective study of sleep paralysis experiences

Previously we reported a three-factor structure for hallucinations accompanying sleep paralysis (SP). These earlier analyses were, however, based on retrospective accounts. In a prospective study, 383 individuals reported individual episodes online providing further evidence for the three-factor structure as well as clearer conceptually meaningful relations among factors than retrospective studies. In addition, reports of individual episodes permitted a more fine-grained analysis of the internal structure of factors to assess predictions based on the hypothesis that a sensed or felt presence (FP) is a core experience affecting other SP hallucinations. Results were generally consistent with this hypothesis. In particular, associations among, and temporal stability of, sensory hallucinations were largely explained by their common association with FP. The findings are consistent with REM initiation of a threat activated vigilance system with pervasive effects on the SP experience and suggest a potential model for the thematic organization of nightmares and dreams more generally.

Web-based survey of depression, anxiety and stress in first-year tertiary education students in Hong Kong

OBJECTIVE

The mental health of tertiary education students is an area of increasing concern worldwide. The objective of this study is to examine the prevalence of depression, anxiety and stress in first-year tertiary education students in Hong Kong.

METHOD

Depression, anxiety and stress were measured by the 42-item Depression Anxiety Stress Scales, completed on the web by participating students anonymously.

RESULTS

A total of 7915 students completed the survey, yielding a response rate of 27.5%. Depression, anxiety and stress levels of moderate severity or above were found in 21%, 41% and 27% of our respondents, respectively.

CONCLUSIONS

The web-based survey methodology was well accepted by our sample group of tertiary education students. We found high rates of psychological morbidity in first-year tertiary education students in Hong Kong. The high prevalence of depression, anxiety and stress symptoms in the first year of college life is alarming. It illustrates the need for primary and secondary prevention measures, with development of adequate and appropriate support services for this group.

A modified version of the Drug Abuse Screening Test among undergraduate students

The present study assesses the prevalence of items from a modified version of the Drug Abuse Screening Test, Short Form (DAST-10) for substances other than alcohol among undergraduate students. More than 4,500 undergraduate students at a large Midwestern research university completed a web-based survey in 2005. Nearly 1 every 10 undergraduate students experienced three or more DAST-10 items in the past 12 months. Although the prevalence of illicit drug use did not differ by gender, undergraduate men were significantly more likely than women to report DAST-10 items. Less than 6% of individuals who reported three or more drug DAST-10 items had ever used treatment services for substance use. As a brief screening instrument, the DAST-10 offers promise for detecting possible drug abuse among college students. Based on the prevalence of drug use, colleges and universities are encouraged to provide screening opportunities to identify and to provide services for students at high risk for drug abuse.

Medical use, illicit use and diversion of prescription stimulant medication

The objective of this study was to examine the prevalence and factors associated with the illicit use of prescription stimulants and to assess the relationship between the medical and illicit use of prescription stimulants among undergraduate college students. A Web survey was self-administered by a random sample of 9,161 undergraduate students attending a large public midwestern university in the spring of 2003. A total of 8.1% reported lifetime illicit use of prescription stimulants and 5.4% reported past year illicit use. The number of undergraduate students who reported illicit use of prescription stimulants exceeded the number of students who reported medical use of prescription stimulants for ADHD. The leading sources of prescription stimulants for illicit use were friends and peers. Multivariate logistic regression analyses revealed several risk factors for illicit use of prescription stimulants such as being male, White, member of a social fraternity or sorority, Jewish religious affiliation, and lower grade point average. All of these characteristics were also related to medically prescribed use of prescription stimulants. Those who initiated medically prescribed use of prescription stimulants for ADHD in elementary school were generally not at increased risk for illicit use of prescription stimulants or other drugs during college as compared to those who were never prescribed stimulant medication. The present study provides evidence that the illicit use of prescription stimulants is a problem among undergraduate college students, and certain subgroups appear to be at heightened risk.

Heat loss prevention in the delivery room for preterm infants: a national survey of newborn intensive care units

BACKGROUND

Hypothermia incurred during delivery room resuscitation continues to cause morbidity in infants <29 weeks gestation. Three recent trials have shown that wrapping such infants instead of drying prevents heat loss, resulting in higher infant temperatures at Newborn Intensive Care Unit (NICU) admission.

OBJECTIVE

To describe current NICU practices with respect to wrapping preterm infants to prevent heat loss in the delivery room.

STUDY DESIGN

E-mail survey of neonatologists from national registry using a web-based survey tool.

RESULTS

Of 411 e-mails successfully delivered, 125 (30%) responded. Most (87%) represented level III NICUs. Almost one-fifth of respondents (20%) use occlusive material instead of drying preterms in the delivery room. Considerable variation exists regarding choice of wrap and duration of use. Few adverse events were reported.

CONCLUSION

"In all" was added -This implies 20% of all NICU's changed practice, 20% of level III NICUs responding have changed delivery room resuscitation practices rapidly in response to new evidence. No "gold" standard exists nationally and there is considerable variation in practice. Neonatal resuscitation guidelines for premature infants should include recommendations regarding choice occlusive wrap and application techniques.

Feasibility study for collecting alcohol and other drug use data among secondary school students: a web-based survey approach

This study examined the feasibility of using a Web-based survey to collect alcohol and other drug use data from secondary school students in an urban school district in the Midwest. A Web-based survey was self-administered by a random sample of 6th through 11th grade students in the spring of 2002. The final sample consisted of 1,536 secondary school students (781 women and 755 men). The sample was 57% White, 40% African American, and 3% from other racial and ethnic groups. Several indicators of data quality were examined including response rate, absenteeism, refusals, substantive data, and data processing time. The study achieved a response rate of 89.1%. The results of the present study provide evidence that a Web-based survey can be successfully implemented in an economically and racially diverse urban sample of secondary students. While researchers conducting survey research within secondary schools should consider using Web-based survey approaches, additional research is needed to compare Web-based surveys to more traditional approaches to collecting data.