Collecting behavioural data using the world wide web: considerations for researchers

Self-Determination and Meaningful Work: Exploring Socioeconomic Constraints

This study examined a model of meaningful work among a diverse sample of working adults. From the perspectives of Self-Determination Theory and the Psychology of Working Framework, we tested a structural model with social class and work volition predicting SDT motivation variables, which in turn predicted meaningful work. Partially supporting hypotheses, work volition was positively related to internal regulation and negatively related to amotivation, whereas social class was positively related to external regulation and amotivation. In turn, internal regulation was positively related to meaningful work, whereas external regulation and amotivation were negatively related to meaningful work. Indirect effects from work volition to meaningful work via internal regulation and amotivation were significant, and indirect effects from social class to meaningful work via external regulation and amotivation were significant. This study highlights the important relations between SDT motivation variables and meaningful work, especially the large positive relation between internal regulation and meaningful work. However, results also reveal that work volition and social class may play critical roles in predicting internal regulation, external regulation, and amotivation.

Human Papillomavirus Infection in Women Who Submit Self-collected Vaginal Swabs After Internet Recruitment

Submission of vaginal samples collected at home could remove barriers that women face in getting screened for cervical cancer. From December 2013 to January 2014, women aged 21-30 years were recruited online to participate in either (1) self-collected testing for human papillomavirus (HPV) infection and an online survey, or (2) an online survey regarding their perceptions of self-collected testing for HPV infection. Demographics, risk factors, testing perceptions, and satisfaction with self-collected testing were assessed with online questionnaires. Women who performed self-collection were sent a home sampling kit by US mail, which was returned via US mail for HPV testing. A total of 197 women were enrolled, with 130 completing the online survey and 67 participating in both the survey and self-collection. Of the 67 women who were sent kits, 62 (92.5%) were returned for testing. Sixty kits contained a sample sufficient for testing. The overall prevalence of HPV infection was 17.8%, however 6 women (9.7%) were infected with >1 type of HPV. Women who self-collected a sample reported more favorable attributes of self-collection compared to women who only participated in the online survey, including ease of sampling (87.1 vs. 18.9%), no pain during sampling (72.6 vs. 5.6%), and lack of embarrassment (67.7 vs. 12.9%). A high prevalence of HPV infection was demonstrated among women recruited via the internet. Online recruitment and at home screening methods have the potential to engage women in screening by offering an approach that might be more acceptable to women of different backgrounds.

Association of household income and education with eating behaviors in Japanese adults: a cross-sectional study

BACKGROUND

Socioeconomic inequalities as social determinants of health are important issues in public health and health promotion. However, the association between socioeconomic status and eating behaviors has been investigated poorly in Japanese adults. To fill this gap, the present study examines the association of eating behaviors with household income and education.

METHODS

The sample comprised 3,137 Japanese adults (1,580 men and 1,557 women) aged 30 to 59 years who responded to an Internet-based cross-sectional survey in 2014. Data on the following eating behaviors were collected via self-report: "taking care of one's diet for health," "eating vegetables," "frequency of eating breakfast," "frequency of family breakfasts," "frequency of family dinners," "using the information on nutrition labels," and "conversations with family or friends during meals." Self-reported data on socioeconomic status (household income and education) and demographic variables (gender, age, district of residence, marital status, residence status, and employment status) were also collected. The associations between eating behaviors and household income or education were tested using binomial logistic regression analysis with eating behaviors as dependent variables and household income and education as independent variables. A trend P -value was calculated for three categories of household income (less than 3,000,000 JPY, 3,000,000-7,000,000 JPY, and over 7,000,000 JPY) and education (junior high/high school, 2-year college, and 4-year college/graduate school).

RESULTS

Higher household income and education were significantly associated with higher rates of eating vegetables, using the information on nutrition labels, and conversation with family or friends during meals in Japanese men and women. Higher household incomes were significantly associated with lower rates of frequency of family breakfasts in Japanese men and lower rates of frequency of family dinners in Japanese men and women.

CONCLUSIONS

Higher socioeconomic status as indicated by household income or education was associated with eating more vegetables and conversation with family or friends during meals in Japanese men and women. Socioeconomic status should be considered in health promotion and diet improvement.

Risky decision making in a laboratory driving task is associated with health risk behaviors during late adolescence but not adulthood

Adolescence is characterized by increasing incidence of health risk behaviors, including experimentation with drugs and alcohol. To fill the gap in our understanding of the associations between risky decision-making and health risk behaviors, we investigated associations between laboratory-based risky decision-making using the Stoplight task and self-reported health risk behaviors. Given that there has been no examination of potential age differences in the associations between risky decision-making and health risk behaviors, we also examined whether the association of risky decision-making with health risk behaviors is consistent across adolescence and adulthood using two-group structural equation modeling (SEM). The results indicated significant differences across the two age groups: adolescents (17-20 year olds) who took more risks on the Stoplight task reported greater frequency and earlier onset of substance use, whereas stoplight performance was not associated with substance use frequency or onset among adults (31-61 year olds). Our findings suggest that a laboratory-based measure of risky decision-making is significantly related to health risk behaviors among adolescents but not among adults.

The Good, the Bad, and the Incomprehensible: Typifications of Victims and Offenders as Antecedents of Beliefs About Sex Crime

Public opinion has played a critical role in the development of sex crime laws. However, little scholarly work has focused directly on the origins of negative attitudes toward sex offenders. We address this research gap by developing and testing a theoretical account of such views. Drawing on recent national survey data, we examine the extent to which typifications about sexual victims and offenders--believing sex crime typically affects children and female victims and is committed by strangers--explain beliefs about the reformability of sex offenders, harm inflicted on victims, and the causes of offending. Results indicate that judging children to be typical targets of sex crimes is a key determinant of public views. We discuss the implications of our findings.

A safety app to respond to dating violence for college women and their friends: the MyPlan study randomized controlled trial protocol

BACKGROUND

Research demonstrates high rates of physical and sexual victimization of women by intimate partners on college campuses (Black et al. 2001). College women in abusive relationships must weigh complex factors (health, academics, economics, and social stigma) during critical decision-making regarding the relationship. Rather than access formal support systems (e.g., campus security, administrators, counselors), research indicates abused college women most often turn to informal networks; specifically friends (Perspect Psychiatr Care 41:162-171, 2005), who often lack the knowledge or resources to provide effective support (Nurs Res 54(4):235-242, 2005). Decision aids have been shown to assist with health-related decisions by improving knowledge, creating realistic expectations, and resolving decisional conflict (Cochrane Database Syst Rev 1:1-332, 2014).

METHODS/DESIGN

This study is a randomized controlled trial testing the effectiveness of an interactive safety decision aid web-based and smartphone application (App) for abused college women and their friends. Three hundred female college students experiencing abuse and three hundred friends of female college students experiencing abuse will be recruited in Maryland and Oregon and randomized to either the intervention safety decision aid, accessible by website or smartphone App, or a usual safety planning control website/App. The intervention App allows users to enter information on: a) relationship health; b) safety priorities; and c) severity of violence/danger in relationship. The App uses this information to provide personalized safety planning information and resources. Self-reported outcome measures for abused college women on safety seeking behaviors, decisional conflict, IPV exposure and mental health will be collected at baseline, six, and 12-months post-baseline via the study App/website. Outcomes measured for friends are IPV awareness, confidence to intervene, supportive behaviors and decisional conflict. Protocols for safely recruiting, retaining and collecting data from abused women via web/App are discussed.

DISCUSSION

This trial may provide important information on the impact of an App and web-based safety planning tool on college women's decisional conflict and safety behavior use when making difficult safety decisions. This study is the first, to our knowledge, to test an intervention that engages friends of abused college women. The trial may also inform researchers on the feasibility of safely conducting research with abused women using online recruitment and enrollment methods and collecting data via an App or website.

TRIAL REGISTRATION

Clinicaltrials.gov ID: NCT02236663.

Geospatial patterns of human papillomavirus vaccine uptake in Minnesota

OBJECTIVES

To identify factors associated with human papillomavirus (HPV) vaccination and to determine the geographic distribution of vaccine uptake while accounting for spatial autocorrelation.

DESIGN

This study is cross-sectional in design using data collected via the Internet from the Survey of Minnesotans About Screening and HPV study.

SETTING AND PARTICIPANTS

The sample consists of 760 individuals aged 18-30 years nested within 99 ZIP codes surrounding the downtown area of Minneapolis, Minnesota.

RESULTS

In all, 46.2% of participants had received ≥ 1 dose of HPV vaccine (67.7% of women and 13.0% of men). Prevalence of HPV vaccination was found to exhibit strong spatial dependence ([Formula: see text] = 0.9951) across ZIP codes. Accounting for spatial dependence, age (OR=0.76, 95% CI 0.70 to 0.83) and male gender (OR=0.04, 95% CI 0.03 to 0.07) were negatively associated with vaccination, while liberal political preferences (OR=4.31, 95% CI 2.32 to 8.01), and college education (OR=2.58, 95% CI 1.14 to 5.83) were found to be positively associated with HPV vaccination.

CONCLUSIONS

Strong spatial dependence and heterogeneity of HPV vaccination prevalence were found across ZIP codes, indicating that spatial statistical models are needed to accurately identify and estimate factors associated with vaccine uptake across geographic units. This study also underscores the need for more detailed data collected at local levels (eg, ZIP code), as patterns of HPV vaccine receipt were found to differ significantly from aggregated state and national patterns. Future work is needed to further pinpoint areas with the greatest disparities in HPV vaccination and how to then access these populations to improve vaccine uptake.

Impact of Baseline Assessment Modality on Enrollment and Retention in a Facebook Smoking Cessation Study

Background

Few studies have addressed enrollment and retention methods in online smoking cessation interventions. Fully automated Web-based trials can yield large numbers of participants rapidly but suffer from high rates of attrition. Personal contact with participants can increase recruitment of smokers into cessation trials and improve participant retention.

Objective

To compare the impact of Web-based (WEB) and phone (PH) baseline assessments on enrollment and retention metrics in the context of a Facebook smoking cessation study.

Methods

Participants were recruited via Facebook and Google ads which were randomly displayed to adult smokers in the United States over 27 days from August to September 2013. On each platform, two identical ads were randomly displayed to users who fit the advertising parameters. Clicking on one of the ads resulted in randomization to WEB, and clicking on the other ad resulted in randomization to PH. Following online eligibility screening and informed consent, participants in the WEB arm completed the baseline survey online whereas PH participants completed the baseline survey by phone with a research assistant. All participants were contacted at 30 days to complete a follow-up survey that assessed use of the cessation intervention and smoking outcomes. Participants were paid $15 for follow-up survey completion.

Results

A total of 4445 people clicked on the WEB ad and 4001 clicked on the PH ad: 12.04% (n=535) of WEB participants and 8.30% (n=332) of PH participants accepted the online study invitation (P<.001). Among the 726 participants who completed online eligibility screening, an equivalent proportion in both arms was eligible and an equivalent proportion of the eligible participants in both arms provided informed consent. There was significant drop-off between consent and completion of the baseline survey in the PH arm, resulting in enrollment rates of 32.7% (35/107) for the PH arm and 67.9% (114/168) for the WEB arm (P<.001). The overall enrollment rate among everyone who clicked on a study ad was 2%. There were no between group differences in the proportion that installed the Facebook app (66/114, 57.9% WEB vs 17/35, 49% PH) or that completed the 30-day follow-up survey (49/114, 43.0% WEB vs 16/35, 46% PH). A total of $6074 was spent on ads, generating 3,834,289 impressions and resulting in 8446 clicks (average cost $0.72 per click). Per participant enrollment costs for advertising alone were $27 WEB and $87 PH.

Conclusions

A more intensive phone baseline assessment protocol yielded a lower rate of enrollment, equivalent follow-up rates, and higher enrollment costs compared to a Web-based assessment protocol. Future research should focus on honing mixed-mode assessment protocols to further optimize enrollment and retention.

Web-Based Study of Risk Factors for Pain Exacerbation in Osteoarthritis of the Knee (SPARK-Web): Design and Rationale

Background

Knee osteoarthritis (OA) is the most frequent cause of limited mobility and diminished quality of life. Pain is the main symptom that drives individuals with knee OA to seek medical care and a recognized antecedent to disability and eventually joint replacement. Many persons with symptomatic knee OA experience recurrent pain exacerbations. Knowledge and clarification of risk factors for pain exacerbation may allow those affected to minimize reoccurrence of these episodes.

Objective

The aim of this study is to use a Web-based case-crossover design to identify risk factors for knee pain exacerbations in persons with symptomatic knee OA.

Methods

Web-based case-crossover design is used to study persons with symptomatic knee OA. Participants with knee pain and radiographic knee OA will be recruited and followed for 90 days. Participants will complete an online questionnaire at the baseline and every 10 days thereafter (totaling up to 10 control-period questionnaires); participants will also be asked to report online when they experience an episode of increased knee pain. Pain exacerbation will be defined as an increase in knee pain severity of two points from baseline on a numeric rating scale (NRS 0-10). Physical activity, footwear, knee injury, medication use, climate, psychological factors, and their possible interactions will be assessed as potential triggers for pain exacerbation using conditional logistic regression models.

Results

This project has been funded by the National Health and Medical Research Council (NHMRC). The enrollment for the study has started. So far, 343 participants have been enrolled. The study is expected to be finished in October 2015.

Conclusions

This study will identify risk factors for pain exacerbations in knee OA. The identification and possible modification/elimination of such risk factors will help to prevent the reoccurrence of pain exacerbation episodes and therefore improve knee OA management.

Recent anxiety symptoms and drug use associated with sexually transmitted infection diagnosis among an online US sample of men who have sex with men

The extent to which mental health problems, including current anxiety and depressive symptoms, may co-occur, or are associated, with the acquisition of sexually transmitted infections other than HIV remains largely unexplored among men who have sex with men. In a cross-sectional survey of 8,381 US men who have sex with men recruited from a sexual networking website, 15 percent reported a past 60-day sexually transmitted infection diagnosis. Among HIV-negative men, increased odds of reporting a sexually transmitted infection were associated with current anxiety symptoms and past 60-day drug use. Findings underscore the need to better understand causal pathways among anxiety, drug use, and sexually transmitted infection acquisition and transmission among men who have sex with men.

Towards a model of contemporary parenting: the parenting behaviours and dimensions questionnaire

The assessment of parenting has been problematic due to theoretical disagreement, concerns over generalisability, and problems with the psychometric properties of current parenting measures. The aim of this study was to develop a comprehensive, psychometrically sound self-report parenting measure for use with parents of preadolescent children, and to use this empirical scale development process to identify the core dimensions of contemporary parenting behaviour. Following item generation and parent review, 846 parents completed an online survey comprising 116 parenting items. Exploratory and confirmatory factor analyses supported a six factor parenting model, comprising Emotional Warmth, Punitive Discipline, Anxious Intrusiveness, Autonomy Support, Permissive Discipline and Democratic Discipline. This measure will allow for the comprehensive and consistent assessment of parenting in future research and practice.

Recruiting online: lessons from a longitudinal survey of contraception and pregnancy intentions of young Australian women

Recruitment of young people for epidemiologic research remains challenging, with marked decreases in the effectiveness of face-to-face, mail, and telephone recruitment methods. We report on the implementation and feasibility of an innovative and flexible approach used to recruit participants for a longitudinal cohort study about contraceptive use and pregnancy (the Contraceptive Use, Pregnancy Intention, and Decisions (CUPID) Study). Australian women aged 18-23 years were recruited using a range of online, networking, and offline methods, including social media (primarily Facebook (Facebook Inc., Menlo Park, California; http://www.facebook.com)), face-to-face events, distribution of promotional material, and media releases. Over the course of the 1-year recruitment period (beginning in September 2012), a total of 3,795 eligible women were recruited to complete the online survey, at a cost of approximately A$11 per participant. This sample was found to be broadly representative of the Australian population of women aged 18-23 years in terms of demographic characteristics, with the exception of an overrepresentation of tertiary-educated women (88.7% compared with 72.6%). This study demonstrated that although current recruitment strategies are required to be innovative and flexible in order to engage young people in epidemiologic research, representative samples can be achieved online at reasonable cost.

Use of online safety decision aid by abused women: effect on decisional conflict in a randomized controlled trial

BACKGROUND

An Internet safety decision aid was developed to help abused women understand their risk for repeat and near-lethal intimate partner violence, clarify priorities related to safety, and develop an action plan customized to these priorities.

PURPOSE

To test the effectiveness of a safety decision aid compared with usual safety planning (control) delivered through a secure website, using a multistate RCT design. The paper evaluates the effectiveness of the safety decision aid in reducing decisional conflict after a single use by abused women.

DESIGN

RCT referred to as Internet Resource for Intervention and Safety (IRIS).

SETTING/PARTICIPANTS

Abused women who spoke English (n=708) were enrolled in a four-state RCT.

INTERVENTION

The intervention was an interactive safety decision aid with personalized safety plan; the control condition was usual safety planning resources. Both were delivered to participants through the secure study website.

MAIN OUTCOME MEASURES

This paper compares women's decisional conflict about safety: total decisional conflict and the four subscales of this measure (feeling: uninformed, uncertain, unsupported, and unclear about safety priorities) between intervention/control conditions. Data were collected from March 2011 to May 2013 and analyzed from January to March 2014.

RESULTS

Immediately following the first use of the interactive safety decision aid, intervention women had significantly lower total decisional conflict than control women, controlling for baseline value of decisional conflict (p=0.002, effect size=0.12). After controlling for baseline values, the safety decision aid group had significantly greater reduction in feeling uncertain (p=0.006, effect size=0.07) and in feeling unsupported (p=0.008, effect size=0.07) about safety than the usual safety planning group.

CONCLUSIONS

Abused women randomized to the safety decision aid reported less decisional conflict about their safety in the abusive intimate relationship after one use compared to women randomized to the usual safety planning condition.

Cluster-randomized trial of a German leisure-based alcohol peer education measure

Because of scarce research, the effectiveness of substance abuse prevention in leisure settings remains unclear. In this study, we evaluated the effectiveness of a peer-led educational prevention measure with adolescent groups in unstructured leisure settings, which is a component of the complex German nationwide 'Na Toll!' campaign. Using a cluster-randomized two-group post-test-only design, we tested whether the measure influenced component-specific goals, namely risk and protective factors of alcohol use such as risk perception, group communication and resistance self-efficacy. The sample consisted of 738 adolescents aged 12-20 years who were recruited at recreational locations and completed an online questionnaire 1 week after the peer education or recruitment event. Sixty-three percent of the sample participated in the 3-month follow-up assessment. Data analysis revealed post-test effects on risk perception, perceived norm of alcohol communication in the peer group and resistance self-efficacy. Follow-up effects were not observed, with the exception of a significant effect on risk perception. In conclusion, the peer-led education measure in leisure settings might have supported the adolescents in this study to perceive alcohol-related risks, to feel accepted to talk about alcohol problems with their friends and to be more assertive in resisting alcohol use in the short term.

ADHD symptomatology and risky health, driving, and financial behaviors in college: the mediating role of sensation seeking and effortful control

OBJECTIVE

To examine the extent to which effortful control (EC) and sensation seeking (SS) tendencies explain the association between the severity of ADHD symptoms and risky behaviors.

METHOD

Participants included 555 college students (66% females) who completed self-report measures assessing their ADHD symptoms, EC abilities, SS tendencies, and risky health (e.g., substance use) and driving/financial behaviors (e.g., misuse of credit cards).

RESULTS

Severity of college students' ADHD symptoms, EC abilities, and SS tendencies were related to all risky behaviors. Multiple mediational analyses further indicated that students' SS tendencies significantly mediated the association between ADHD symptoms and the risky health factor but not the risky driving/financial factor. EC, however, significantly mediated the association between ADHD symptoms and both the risky health and driving/financial factors.

CONCLUSION

The current study provides initial data showing potentially different mechanisms that explain the link between college students' severity of ADHD symptoms and risky behaviors.

Acceptability and feasibility of using established geosocial and sexual networking mobile applications to promote HIV and STD testing among men who have sex with men

This study is the first published multi-app study, of which we are aware, to evaluate both the acceptability and feasibility of providing sexual health information and HIV/STD testing referrals via established geosocial and sexual networking apps for MSM. Data were collected using an online survey and through four apps (A4A Radar, Grindr, Jack'd, and Scruff). Two-thirds (64 %) found apps to be an acceptable source for sexual health information. MSM who found apps as acceptable were more likely non-white, not sure of their current HIV status, and have low HIV testing self-efficacy. One-quarter (26 %) of informational chats with the health educator resulted in users requesting and being referred to local HIV/STD testing sites. There were significant differences in the number and types of interactions across apps. Established apps designed for MSM may be both an acceptable and feasible platform to promote HIV/STD testing. Future research should evaluate interventions that leverage this technology.

Obtaining information about cancer: prevalence and preferences among Japanese adults

Background

Providing information about cancer prevention might increase awareness of prevention and promote preventive behaviours. A better understanding about the prevalence and preferences of obtaining information about cancer might help to identify targeted individuals and design effective strategies for promoting cancer-preventive behaviours. Thus, the present study examined the prevalence and correlates of obtaining information about cancer among Japanese adults, and described preferences including source and content.

Methods

Data were analysed for 3,058 Japanese adults (mean age 45.0 ± 13.4 years) who responded to an Internet-based cross-sectional survey. The data included whether information about cancer had been obtained, sources, preference for content, sociodemographic variables, health status, and cancer histories. Force-entry logistic regression analysis was used.

Results

Overall, 46.7% of respondents had obtained information about cancer. Gender, age, and education level were statistically significant correlates of doing so. Women were more likely to obtain information (OR = 1.97) as were older age groups (40–49: OR = 1.54, 50–59: OR = 2.27, 60–69: OR = 3.83), those with higher education (2 years college or equivalent degree: OR = 1.31, college graduate or higher: OR = 1.48) and those with having cancer histories (personal: OR = 3.52, family: OR = 1.57, friends/co-worker: OR = 2.09). The most prevalent source of information about cancer was mass media. Content of prevention is most needed among inconsistent contents with the frequently obtained contents.

Conclusions

Less than half of the respondents information about cancer. The finding suggests that better health communication strategies would be necessary to inform Japanese people about cancer. Understanding which subgroups were less likely to obtain information and preferences of information might be effective in promoting cancer prevention.

Latent structure of irritable bowel syndrome symptom severity

AIM: To investigate the latent structure of an irritable bowel syndrome (IBS) symptom severity scale in a population of healthy adults.

METHODS: The Birmingham IBS symptom questionnaire which consists of three symptom specific scales (diarrhea, constipation, pain) was evaluated by means of structural equation modeling. We compared the original 3-factor solution to a general factor model and a bifactor solution in a large internet sample of college students (n = 875). Statistical comparisons of competing models were conducted by means of χ² difference tests. Regarding the evaluation of model fit, we examined the comparative fit index (CFI) and the Root Mean Square Error of Approximation (RMSEA).

RESULTS: Results clearly favored a bifactor model of IBS symptom severity (CFI = 0.99, RMSEA = 0.05) which consisted of a strong general IBS somatization factor and three symptom specific factors (diarrhea, constipation, pain) based on the subscales of the Birmingham IBS symptom questionnaire. The fit indices of the competing one factor model (CFI = 0.85, RMSEA = 0.17) and three factor model (CFI = 0.97, RMSEA = 0.08) were clearly inferior. χ² difference tests showed that the differences between the models were indeed significant in favor of the bifactor model (P < 0.001). Correlations of the four latent factors with measures of pain sensitivity, somatoform dissociation, fatigue severity, and demographic variables support the validity of our bifactor model of IBS specific symptom severity.

CONCLUSION: The findings suggest that IBS symptom severity might best be understood as a continuous and multidimensional construct which can be reliably and validly assessed with the B-IBS.

Prescription Drug Diversion: Predictors of Illicit Acquisition and Redistribution in Three U.S. Metropolitan Areas

OBJECTIVE

Prescription drug diversion, the transfer of prescription drugs from lawful to unlawful channels for distribution or use, is a problem in the United States. Despite the pervasiveness of diversion, there are gaps in the literature regarding characteristics of individuals who participate in the illicit trade of prescription drugs. This study examines a range of predictors (e.g., demographics, prescription insurance coverage, perceived risk associated with prescription drug diversion) of membership in three distinct diverter groups: individuals who illicitly acquire prescription drugs, those who redistribute them, and those who engage in both behaviors.

METHODS

Data were drawn from a cross-sectional Internet study (N = 846) of prescription drug use and diversion patterns in New York City, South Florida, and Washington, D.C.. Participants were classified into diversion categories based on their self-reported involvement in the trade of prescription drugs. Group differences in background characteristics of diverter groups were assessed by Chi-Square tests and followed up with multivariate logistic regressions.

RESULTS

While individuals in all diversion groups were more likely to be younger and have a licit prescription for any of the assessed drugs in the past year than those who did not divert, individuals who both acquire and redistribute are more likely to live in New York City, not have prescription insurance coverage, and perceive fewer legal risks of prescription drug diversion.

CONCLUSION

Findings suggest that predictive characteristics vary according to diverter group.

Frequent nonprescription stimulant use and risky behaviors in college students: the role of effortful control

OBJECTIVE

The goal of this study was to (a) investigate the association between nonprescription stimulant use (NPSU) and risky behaviors, including risky sex, driving, financial behaviors, and drug use and (b) collect preliminary evidence on mechanisms that may link NPSU to risky behaviors.

PARTICIPANTS

A sample of 555 college students was collected between August 2010 and February 2012.

METHODS

Students completed several self-report measures assessing their drug use history, attention-deficit and hyperactivity symptoms, temperament, and risky behaviors beyond drug use.

RESULTS

Those who reported more frequent NPSU were more likely to engage in high-risk behavior across all 4 domains studied. Further, effortful control abilities partially mediated the link between NPSU and risky behaviors.

CONCLUSIONS

These results highlight the associated risks of frequent NPSU for college students as well as provide future directions for examining effortful control as a potentially important mechanism linking NPSU to other risky behaviors.

Associations between obsessive-compulsive symptoms, revenge, and the perception of interpersonal transgressions

Anger and aggression have only recently gained center stage in research on obsessive-compulsive disorder (OCD). An investigation of obsessive-compulsive (OC) symptoms focusing on the outcome of unresolved anger (i.e., revenge), however, is absent from the literature. The objective of the present research was therefore to provide a first step towards filling this gap and, hence, to systematically examine the associations between OC symptoms and different aspects of revenge (i.e., attitudes, dispositions, motivations). In three independent studies with nonclinical participants (N=504), we tested the hypothesis that OC symptoms relate to greater revenge. Individuals high in OC symptoms reported more positive attitudes toward revenge (Study 1), scored higher on a measure of trait revenge (Study 2), and reported increased revenge motivation regarding a real-life transgressor (Study 3). Furthermore, Study 4 (N=175) demonstrated that individuals high in OC symptoms perceived interpersonal transgressions more frequently in their daily lives. OC symptoms were positively related to the number of transgressions that respondents disclosed. Our results suggest that revenge and interpersonal hurt play a significant role in OCD.

Advantages of asynchronous online focus groups and face-to-face focus groups as perceived by child, adolescent and adult participants: a survey study

Background

Online focus groups (OFGs) are increasingly used as a method of data collection. Although their advantages for research have repeatedly been described, participants’ opinions about OFGs have seldom been studied. We investigated OFG participants’ preference for participation in an OFG or a face-to-face focus group (FTF), as well as their perceptions of the advantages of both methods. We also investigated whether any differences exist between the perceptions of child, adolescent, and adult participants.

Methods

Participants’ opinions were studied by means of a questionnaire completed by 284 persons (aged 8–72 years) after their participation in one of 50 OFGs. The OFGs were conducted between December 2005 and December 2013 as part of 19 separate studies. Chi square tests with p <0.05 were used to test differences in perceived advantages of OFGs and FTFs between children, adolescents and adults.

Results

The most important advantage of OFGs as perceived by OFG participants was the possibility to participate at a moment most convenient to them. Adolescents and adults (90.5% and 95.9%) more often reported this as an advantage than children did (30.8%, p < 0.02). Another important perceived advantage of OFGs was the possibility to participate from home (69.1%). The most important advantage of FTFs was respondents’ perception that it is easier to have a discussion with the whole group when there is personal contact with others (48.5%). This advantage was mentioned significantly more often by adults (78.4%) than by children and adolescents (4.8% and 17.7%, p < 0.02).

Conclusions

Participants’ perceptions of OFGs partly concur with the advantages of OFGs as a research method. Whereas respondents generally value the convenience of participating at their own time and place, the anonymity of OFGs and the increased ease to discuss personal issues were mentioned less often as advantages by the participants. An aspect that may need more attention when conducting an OFG, is the absence of a fluid discussion, which is, according to our respondents, easier to achieve in an FTF. This underlines the importance of the moderator in enabling a constructive discussion.

Comparing health survey data from Internet- and paper-based convenience samples of lesbian women in Germany

Background Members of populations that are measured online should be compared with paper-based samples in order to determine whether data from these different sources can be merged or must be analysed separately due to substantial differences. Methods: A sample of lesbian women recruited via the Internet were compared with a paper-based sample. Both groups used a questionnaire consisting of demographic variables, questions regarding dealing with homosexuality, psychological burden, access to care, and discrimination experience within the German healthcare system. Results: Only small differences emerged in dealing with homosexuality between both groups. Moderately more women in the Internet-based sample suffered from nervous tension and the impression of being out of balance. Moderately more women in the paper-based sample stated that their main contact person regarding health matters was informed about their sexual orientation. Most differences had small effect sizes. No substantial differences occurred between the two groups in the area of discrimination experience. No large differences in socioeconomic data, psychological burden, healthcare utilisation, or dealing with or experiences with homosexuality were found. Conclusions: Health survey data derived from Internet- and paper-based samples of lesbian women in Germany are not too dissimilar. Further research in additional contexts is needed to decide whether they can be merged for further analyses.

Estimation of geographic variation in human papillomavirus vaccine uptake in men and women: an online survey using facebook recruitment

Background

Federally funded surveys of human papillomavirus (HPV) vaccine uptake are important for pinpointing geographically based health disparities. Although national and state level data are available, local (ie, county and postal code level) data are not due to small sample sizes, confidentiality concerns, and cost. Local level HPV vaccine uptake data may be feasible to obtain by targeting specific geographic areas through social media advertising and recruitment strategies, in combination with online surveys.

Objective

Our goal was to use Facebook-based recruitment and online surveys to estimate local variation in HPV vaccine uptake among young men and women in Minnesota.

Methods

From November 2012 to January 2013, men and women were recruited via a targeted Facebook advertisement campaign to complete an online survey about HPV vaccination practices. The Facebook advertisements were targeted to recruit men and women by location (25 mile radius of Minneapolis, Minnesota, United States), age (18-30 years), and language (English).

Results

Of the 2079 men and women who responded to the Facebook advertisements and visited the study website, 1003 (48.2%) enrolled in the study and completed the survey. The average advertising cost per completed survey was US $1.36. Among those who reported their postal code, 90.6% (881/972) of the participants lived within the previously defined geographic study area. Receipt of 1 dose or more of HPV vaccine was reported by 65.6% women (351/535), and 13.0% (45/347) of men. These results differ from previously reported Minnesota state level estimates (53.8% for young women and 20.8% for young men) and from national estimates (34.5% for women and 2.3% for men).

Conclusions

This study shows that recruiting a representative sample of young men and women based on county and postal code location to complete a survey on HPV vaccination uptake via the Internet is a cost-effective and feasible strategy. This study also highlights the need for local estimates to assess the variation in HPV vaccine uptake, as these estimates differ considerably from those obtained using survey data that are aggregated to the state or federal level.

Does self-selection affect samples' representativeness in online surveys? An investigation in online video game research

Background

The number of medical studies performed through online surveys has increased dramatically in recent years. Despite their numerous advantages (eg, sample size, facilitated access to individuals presenting stigmatizing issues), selection bias may exist in online surveys. However, evidence on the representativeness of self-selected samples in online studies is patchy.

Objective

Our objective was to explore the representativeness of a self-selected sample of online gamers using online players’ virtual characters (avatars).

Methods

All avatars belonged to individuals playing World of Warcraft (WoW), currently the most widely used online game. Avatars’ characteristics were defined using various games’ scores, reported on the WoW’s official website, and two self-selected samples from previous studies were compared with a randomly selected sample of avatars.

Results

We used scores linked to 1240 avatars (762 from the self-selected samples and 478 from the random sample). The two self-selected samples of avatars had higher scores on most of the assessed variables (except for guild membership and exploration). Furthermore, some guilds were overrepresented in the self-selected samples.

Conclusions

Our results suggest that more proficient players or players more involved in the game may be more likely to participate in online surveys. Caution is needed in the interpretation of studies based on online surveys that used a self-selection recruitment procedure. Epidemiological evidence on the reduced representativeness of sample of online surveys is warranted.

Prevalence of sexual victimization and correlates of forced sex in Japanese men who have sex with men

Studies of men who have sex with men (MSM) in diverse geographic and cultural contexts have identified health challenges affecting this population. MSM might be particularly vulnerable to sexual victimization and forced sex. The aim of this research study was to examine prevalence of sexual victimization and correlates of forced sex among Japanese MSM. We recruited a sample of 5,731 Japanese MSM who completed an internet-administered survey. Participants reported on history of different types of sexual victimization, unprotected anal sex, other health risk behaviors, exposure to gay-related teasing and bullying, depression, and suicidality. Over one-fifth of the sample (21.4%) reported experiencing at least one form of sexual victimization, and 8.7% reported a history of forced sex. MSM who had ever experienced forced sex were significantly more likely to report experiencing psychological risks (depression OR = 1.55, 95% CI = 1.28–1.89; attempted suicide OR = 2.25, 95% CI = 1.81–2.81; other forms of bullying OR = 1.38, 95% CI = 1.13–1.68) and other behavioral risks (unprotected anal sex OR = 1.56, 95% CI = 1.29–1.90; sex venue attendance OR = 1.27, 95% CI = 1.04–1.54; methamphetamine use OR = 1.57, 95% CI  = 1.05–1.36), compared to MSM who had not experienced forced sex. Efforts to develop holistic and integrated health services for Japanese MSM are warranted, particularly related to psychosocial determinants of HIV prevention. However, due to cultural factors that emphasize familial and social relations and that stigmatize same-sex behavior, Japanese MSM might experience challenges to seeking social support and health services. Interventions must be provided in safe and non-judgmental settings where Japanese MSM feel comfortable disclosing their health and social support needs.

Use of the Internet and mobile-based "apps" for sex-seeking among men who have sex with men in New York City

The Internet continues to be a popular venue for men who have sex with men (MSM) to seek sexual partners. Increased sexual risk behavior has been linked to MSM who use the Internet to seek partners. However, there has been little research on how new mobile-based social networking applications ("apps") may affect sex-seeking and sexual risk behaviors of MSM. One hundred twenty-six MSM in New York City were recruited to complete an online survey on the use of the Internet and other technology for sex-seeking. The authors collected data on variables of interest including sexual sensation seeking, gay identity affirmation, internalized homophobia, Internet/app use, and sexual behavior with men met via the Internet and mobile apps. Results indicated that men who use both the Internet and mobile apps to seek partners were younger and reported higher incomes (p<.05) than men who used the Internet only. There were no significant differences between the groups with regard to race, sexual sensation seeking, gay identity affirmation, or internalized homophobia, indicating that the use of mobile-based apps for sex-seeking may be simply an example of evolving technologies. These findings may provide insight for the feasibility and planning of effective mobile app-based HIV/STI programs for MSM.

Considerations for conducting Web-based survey research with people living with human immunodeficiency virus using a community-based participatory approach

Background

Web or Internet-based surveys are increasingly popular in health survey research. However, the strengths and challenges of Web-based surveys with people living with human immunodeficiency virus (HIV) are unclear.

Objective

The aim of this article is to describe our experience piloting a cross-sectional, Web-based, self-administered survey with adults living with HIV using a community-based participatory research approach.

Methods

We piloted a Web-based survey that investigated disability and rehabilitation services use with a sample of adults living with HIV in Canada. Community organizations in five provinces emailed invitations to clients, followed by a thank you/reminder one week later. We obtained survey feedback in a structured phone interview with respondents. Participant responses were transcribed verbatim and analyzed using directed content analysis.

Results

Of 30 people living with HIV who accessed the survey link, 24/30 (80%) initiated and 16/30 (53%) completed the survey instrument. A total of 17 respondents participated in post-survey interviews. Participants described the survey instrument as comprehensive, suggesting content validity. The majority (13/17, 76%) felt instruction and item wording were clear and easy to understand, and found the software easy to navigate. Participants felt having a pop-up reminder directing them to missed items would be useful.

Conclusions

Strengths of implementing the Web-based survey included: our community-based participatory approach, ease of software use, ability for respondents to complete the questionnaire on one’s own time at one’s own pace, opportunity to obtain geographic variation, and potential for respondent anonymity. Considerations for future survey implementation included: respondent burden and fatigue, the potentially sensitive nature of HIV Web-based research, data management and storage, challenges verifying informed consent, varying computer skills among respondents, and the burden on community organizations. Overall, results provide considerations for researchers conducting community-based participatory Web-based survey research with people living with HIV.

Innovative uses of electronic health records and social media for public health surveillance

Electronic health records (EHRs) and social media have the potential to enrich public health surveillance of diabetes. Clinical and patient-facing data sources for diabetes surveillance are needed given its profound public health impact, opportunity for primary and secondary prevention, persistent disparities, and requirement for self-management. Initiatives to employ data from EHRs and social media for diabetes surveillance are in their infancy. With their transformative potential come practical limitations and ethical considerations. We explore applications of EHR and social media for diabetes surveillance, limitations to approaches, and steps for moving forward in this partnership between patients, health systems, and public health.

Prevalence and types of rectal douches used for anal intercourse: results from an international survey

BACKGROUND

Rectal products used with anal intercourse (AI) may facilitate transmission of STIs/HIV. However, there is limited data on rectal douching behavior in populations practicing AI. We examined the content, types of products, rectal douching practices and risk behaviors among those reporting AI.

METHODS

From August 2011 to May 2012, 1,725 women and men reporting receptive AI in the past 3 months completed an internet-based survey on rectal douching practices. The survey was available in English, French, German, Mandarin, Portuguese, Russian, Spanish, and Thai and included questions on sexual behaviors associated with AI including rectal douching. Differences by rectal douching practices were evaluated using chi-square methods and associations between reported douching practices and other factors including age and reported STI history were evaluated using logistic regression analysis.

RESULTS

Respondents represented 112 countries, were mostly male (88%), and from North America (55%) or Europe (22%). Among the 1,339 respondents (66%) who reported rectal douching, most (83%) reported always/almost always douching before receptive AI. The majority of rectal douchers reported using non-commercial/homemade products (93%), with water being the most commonly used product (82%). Commercial products were used by 31%, with the most common product being saline-based (56%). Rectal douching varied by demographic and risk behaviors. The prevalence of rectal douching was higher among men (70% vs. 32%; p-value < .01), those reporting substance-use with sex (74% vs. 46%; p-value < .01), and those reporting an STI in the past year (69% vs. 57% p-value < .01) or ever testing HIV-positive (72% vs. 53%; p-value < .01). In multivariable analysis, adjusting for age, gender, region, condom and lubricant use, substance use, and HIV-status, douchers had a 74% increased odds of reporting STI in the past year as compared to non-douchers [adjusted odds ratio (AOR) = 1.74; 95% CI 1.01-3.00].

CONCLUSION

Given that rectal douching before receptive AI is common and because rectal douching was associated with other sexual risk behaviors the contribution of this practice to the transmission and acquisition of STIs including HIV may be important.

Motivational interviewing in a Web-based physical activity intervention with an avatar: randomized controlled trial

BACKGROUND

Developing Web-based physical activity (PA) interventions based on motivational interviewing (MI) could increase the availability and reach of MI techniques for PA promotion. Integrating an avatar in such an intervention could lead to more positive appreciation and higher efficacy of the intervention, compared to an intervention that is purely text-based.

OBJECTIVE

The present study aims to determine whether a Web-based PA intervention based on MI with an avatar results in more positive appreciation and higher effectiveness of the intervention, when compared to an intervention that is purely text-based.

METHODS

A three-arm randomized controlled trial was conducted, containing the following research conditions: (1) a Web-based PA intervention based on MI with an avatar, (2) a content-identical intervention without an avatar, and (3) a control condition that received no intervention. Measurements included PA behavior and process variables, measured at baseline, directly following the intervention and 1 month post intervention.

RESULTS

Both interventions significantly increased self-reported PA at 1 month, compared to the control condition (beta(AVATARvsCONTROL)=.39, P=.011; beta(TEXTvsCONTROL)=.44, P=.006). No distinctions were found regarding intervention effect on PA between both interventions. Similarly, the results of the process evaluation did not indicate any significant differences between both interventions. Due to the limited relational skills of the avatar in this study, it probably did not succeed in forming a stronger relationship with the user, over and above text alone.

CONCLUSIONS

The findings suggest that avatars that do not strengthen the social relationship with the user do not enhance the intervention impact. Future research should determine whether Web-based PA interventions based on MI could benefit from inclusion of a virtual coach capable of more complex relational skills than used in the current study, such as responding in gesture to the user's state and input.

TRIAL REGISTRATION

Dutch Trial Register trial number: NTR3147; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3147 (Archived by WebCite at http://www.webcitation.org/6NCbwdUJX).

Migrants Examined for Determinants of psychopathology through INternet Assessment (MEDINA) study: a cross-sectional study among visitors of an Internet community

INTRODUCTION

Migration is a risk factor for the onset of psychopathology. A range of social factors may play a role in the aetiology of psychiatric disorders in migrants. A better understanding of these associations is needed to develop preventive interventions to reduce the disease burden in the migrant population. Research among minority groups is generally time consuming and it is difficult to recruit participants. Internet can offer interesting new possibilities to conduct research among ethnic minorities. This article describes the design of an epidemiological study in the Moroccan-Dutch population, which will be entirely performed online. We investigate the association between social factors and psychopathology.

METHODS AND ANALYSIS

The website Marokko.nl is visited by 70% of the young Moroccan-Dutch population in the Netherlands. This website therefore provides a unique possibility for research within this population. We will conduct a survey with online questionnaires via this website. The online survey consists of several validated short self-report questionnaires, measuring depressive and anxiety symptoms (The Kessler Psychological Distress Scale (K10)), psychotic symptoms (The Prodromal Questionnaire-16 (PQ-16)) and instruments measuring discrimination, social support and social defeat. Furthermore, demographic characteristics are collected. We will use univariate and multivariate methods for analysing the data.

ETHICS AND DISSEMINATION

The local medical ethical committee has assessed the study protocol and judged that the study could be conducted without their approval. Knowledge dissemination will take place through peer-reviewed publication in scientific journals as well as publication for participants on the project website.

DISCUSSION

In this study we further explore the association between psychopathology and social factors within an online Moroccan-Dutch sample. The recruitment of participants via the website Marokko.nl creates a big advantage in collecting a large sample of a specific migrant population. Strengths and limitations of the methodology are discussed. Furthermore, we review the advantages and challenges of online epidemiological research methods.

Computer-based programmes for the prevention and management of illicit recreational drug use: a systematic review

The last few decades have seen increasing use of computer-based programmes to address illicit recreational drug use but knowledge about their effectiveness is limited. We conducted a systematic review to examine evidence on these programmes. Eight electronic databases were searched to identify primary research studies evaluating computer-based programmes to prevent or reduce use of illicit recreational drugs. From an initial 3413 extracted studies, 10 were identified for inclusion, covering a range of intervention types, target groups and settings. Universal drug prevention programmes were effective in reducing the frequency of recreational drug use in the mid-term (<12 months), but not immediately post intervention. Programmes targeting recreational drug users showed more inconsistent results but were generally effective in reducing use of drugs both immediately and in the mid-term. Computer-based programmes have the potential for use in addressing recreational drug use when targeted both universally and at illicit drug users, at least in the mid-term. However, longer term evaluations are needed to better understand the duration of effects. Given the benefits that computer-based programmes can have over traditional delivery methods, research is needed to better understand the value of human contact in health interventions and help inform whether, and how much, professional contact should be involved in computer-based programmes.

Examining Social Class and Work Meaning Within the Psychology of Working Framework

In this article, we used the psychology of working framework to examine how social class relates to the experience of meaningful work with two samples of working adults. In Study 1, participants in higher social classes were more likely to experience work meaning than people in lower social classes. Regardless of class, participants reported serving others or contributing to the greater good as the primary source of their work’s meaning. In Study 2, we used a latent, multiple mediator model to test whether the three components of work volition mediated the relation between social class and work meaning. The model was a good fit to the data and partially supported our hypotheses. Specifically, volition and financial constraints fully mediated the relation between social class and work meaning, suggesting that social class may be linked to work meaning due to increased volition and decreased financial constraints.

Secondhand smoke exposure and smoking behavior among young adult bar patrons

OBJECTIVES

We described frequency of secondhand smoke (SHS) exposure among young adults patronizing bars and associations between SHS exposure, attitudes, and smoking behavior.

METHODS

We collected cross-sectional surveys from randomized time-location samples of bar patrons aged 18 to 26 years in San Diego, California, and Oklahoma City and Tulsa, Oklahoma, in 2010 to 2011. Multivariate logistic regression evaluated associations between SHS exposure, attitudes about dangers of SHS, susceptibility to smoking initiation among nonsmokers, and quit attempts among current smokers.

RESULTS

More than 80% of respondents reported past 7-day exposure to any SHS, and more than 70% reported exposure at a bar. Current smokers reported more SHS exposure in cars and their own homes than did nonsmokers. Among nonsmokers, SHS exposure was associated with susceptibility to initiation, but those who believed that SHS exposure is harmful were less susceptible. Belief that SHS is dangerous was associated with quit attempts among smokers.

CONCLUSIONS

Smoke-free environments and education about the harms of SHS may decrease tobacco use among young adults who frequent bars, where they are heavily exposed to SHS.

Evaluation of the UNREST questionnaire for testing the social resistance framework

BACKGROUND

The recently developed social resistance framework addresses a widespread pattern whereby non-dominant minority groups, such as ethnic/racial minorities and people of low socioeconomic status, often engage in unhealthy and risky behaviours at higher rates compared with society at large. The framework suggests that power relations within society may encourage members of non-dominant minority groups to actively engage in acts of everyday resistance, which may include risky and unhealthy behaviours.

METHODS

The current paper develops and psychometrically evaluates a research tool to test this innovative framework. The UNREST questionnaire measures the key concepts of the framework, along with four high-risk and unhealthy behaviours, as well as demographic and socioeconomic characteristics. A pilot survey was conducted among representative subsamples of a non-dominant group (African-Americans) and a dominant group (Caucasians).

RESULTS

Consistent with the general premises of the framework, the evaluation of the questionnaire produced six valid and reliable scales, which were significantly correlated with some criterion-related items as well as unhealthy and risky behaviours.

CONCLUSIONS

The preliminary results of our pilot study suggest that the new tool may be useful for testing the framework. The results also provide support for the framework in general.

Suicide protective factors among trans adults

A recent study indicated a suicide attempt rate of 41 % among trans (e.g., trans, transgender, transexual/transsexual, genderqueer, two-spirit) individuals. Although this rate is alarming, there is a dearth of literature regarding suicide prevention for trans individuals. A vital step in developing suicide prevention models is the identification of protective factors. It was hypothesized that social support from friends, social support from family, optimism, reasons for living, and suicide resilience, which are known to protect cis (non-trans) individuals, also protect trans individuals. A sample of self-identified trans Canadian adults (N = 133) was recruited from LGBT and trans LISTSERVs. Data were collected online using a secure survey platform. A three block hierarchical multiple regression model was used to predict suicidal behavior from protective factors. Social support from friends, social support from family, and optimism significantly and negatively predicted 33 % of variance in participants' suicidal behavior after controlling for age. Reasons for living and suicide resilience accounted for an additional 19 % of the variance in participants' suicidal behavior after controlling for age, social support from friends, social support from family, and optimism. Of the factors mentioned above, perceived social support from family, one of three suicide resilience factors (emotional stability), and one of six reasons for living (child-related concerns) significantly and negatively predicted participants' suicidal behavior. Overall, these findings can be used to inform the practices of mental health workers, medical doctors, and suicide prevention workers working with trans clients.

Internet addiction symptoms, disordered eating, and body image avoidance

Internet addiction is an increasing concern among young adults. Self-presentational theory posits that the Internet offers a context in which individuals are able to control their image. Little is known about body image and eating concerns among pathological Internet users. The aim of this study was to explore the association between Internet addiction symptoms, body image esteem, body image avoidance, and disordered eating. A sample of 392 French young adults (68 percent women) completed an online questionnaire assessing time spent online, Internet addiction symptoms, disordered eating, and body image avoidance. Fourteen men (11 percent) and 26 women (9.7 percent) reported Internet addiction. Body image avoidance was associated with Internet addiction symptoms among both genders. Controlling for body-mass index, Internet addiction symptoms, and body image avoidance were both significant predictors of disordered eating among women. These findings support the self-presentational theory of Internet addiction and suggest that body image avoidance is an important factor.

Opinions of youngsters with congenital below-elbow deficiency, and those of their parents and professionals concerning prosthetic use and rehabilitation treatment

Background

Youngsters with unilateral congenital below-elbow deficiency (UCBED) seem to function well with or without a prosthesis. Reasons for rejecting prostheses have been reported earlier, but unfortunately not those of the children themselves. Furthermore, reasons for acceptance are underexplored in the literature.

Objectives

To investigate opinions of children and early and late adolescents with UCBED, and those of their parents and healthcare professionals, concerning (1) reasons to wear or not to wear prostheses and (2) about rehabilitation care.

Methods

During one week of online focus group interviews, 42 children of 8–12 y/o, early and late adolescents of 13–16 and 17–20 y/o, 17 parents, and 19 healthcare professionals provided their opinions on various topics. This study addresses prosthetic use or non-use of prosthetics and rehabilitation care. Data were analyzed using the framework approach.

Results

Cosmesis was considered to be the prime factor for choosing and wearing a prosthesis, since this was deemed especially useful in avoiding stares from others. Although participants functioned well without prostheses, they agreed that it was an adjuvant in daily-life activities and sports. Weight and limited functionality constituted rejection reasons for a prosthesis. Children and adolescents who had accepted that they were different no longer needed the prosthesis to avoid being stared at. The majority of participants highly valued the peer-to-peer contact provided by the healthcare professionals.

Conclusions

For children and adolescents with UCBED, prostheses appeared particularly important for social integration, but much less so for functionality. Peer-to-peer contact seemed to provide support during the process of achieving social integration and should be embedded in the healthcare process.

Attachment Styles Within the Coach-Athlete Dyad: Preliminary Investigation and Assessment Development

The present preliminary study aimed to develop and examine the psychometric properties of a new sport-specific self-report instrument designed to assess athletes’ and coaches’ attachment styles. The development and initial validation comprised three main phases. In Phase 1, a pool of items was generated based on pre-existing self-report attachment instruments, modified to reflect a coach and an athlete’s style of attachment. In Phase 2, the content validity of the items was assessed by a panel of experts. A final scale was developed and administered to 405 coaches and 298 athletes (N = 703 participants). In Phase 3, confirmatory factor analysis of the obtained data was conducted to determine the final items of the Coach-Athlete Attachment Scale (CAAS). Confirmatory factor analysis revealed acceptable goodness of ft indexes for a 3-first order factor model as well as a 2-first order factor model for both the athlete and the coach data, respectively. A secure attachment style positively predicted relationship satisfaction, while an insecure attachment style was a negative predictor of relationship satisfaction. The CAAS revealed initial psychometric properties of content, factorial, and predictive validity, as well as reliability.