Online and Offline Recruitment of Young Women for a Longitudinal Health Survey: Findings From the Australian Longitudinal Study on Women's Health 1989-95 Cohort

Shame and depressive symptoms in men: The moderating role of environmental mastery and purpose in life

BACKGROUND

Feelings of shame are linked to increased risk for depression. Little is known about protective factors that may buffer this effect, particularly in men. Using prospective data from a community sample of Australian men, we examine the extent to which shame is associated with depressive symptoms, and the protective role of psychological wellbeing, specifically environmental mastery and purpose in life.

METHODS

Participants (n = 448) were from the longitudinal Men and Parenting Pathways (MAPP) Study. Measures were the Event Related Shame and Guilt Scale for shame, the DASS-21 for depressive symptoms and Ryff's Scales of Psychological Well-Being for environmental mastery and purpose in life. Linear regressions were used to test associations between shame and depressive symptoms concurrently and 1-year later, and the moderating effects of mastery and purpose in life.

RESULTS

Shame was strongly associated with concurrent depressive symptoms (βunadj = .76, p < .001; βadj = .63, p < .001). This effect was weaker in men with high compared to low environmental mastery (β+1SD = .46, p < .001; β-1SD = .55, p < .001) and purpose in life (β+1SD = .48, p < .001; β-1SD = .62, p < .001). Shame also predicted subsequent depressive symptoms after adjustment for prior depressive symptoms (βunadj = .59, p = .001; βadj = .34, p = .004), although environmental mastery or purpose in life did not moderate these associations.

CONCLUSIONS

Our findings suggest that promoting a sense of psychological wellbeing in men may confer protective proximal effects in the context of shame, potentially attenuating depression severity. The current study aligns with calls for strength-based approaches to reducing mental health problems in men.

The Together for Health - Virginia Research Program: A Multi-Modal Approach for Population Health Assessment

Background

The Together for Health-Virginia (T4H-VA) Research Program aimed to advance cancer prevention, education, and outreach in Virginia. Creating a representative and inclusive cohort is critical to the program's mission and quality of outcomes. The T4H-VA Research Program utilized a multi-modal sampling approach to improve population health assessment. The current study describes the technology-based, non-probability platform developed for this purpose and compares differences between the probability-based (mail-based) and non-probability-based (e-cohort) methods with respect to participant demographics, health characteristics, and health information and technology use.

Methods

T4H-VA is a research registry focusing on 54 counties within the Massey Comprehensive Cancer Center (MCCC) catchment area in Richmond, VA. Adult residents proficient in English were eligible. For the probability-based sampling, surveys were mailed to residents within the catchment area. For the non-probability sampling, an online study platform was developed and surveys were completed through the web/mobile app.

Results

Both cohorts fell short of recruitment goals. The study yielded 1158 participants (M=57, SD=16 years; 55.0% female; 72.1% White); 899 (77.6%) were sampled through the probability, mail-based approach. Participants who identified as "other" race were significantly less likely to be sampled by the non-probability method. Significant differences emerged, including health protective (greater moderate and high physical activity) and risk factors (greater alcohol consumption and personal history of cancer) in the non-probability, e-cohort relative to the probability sample. E-Cohort participants were significantly more likely to report using electronic health records.

Discussion

Overall difficulties in recruiting were caused, at least in part, by the onset of the COVID-19 pandemic and related factors. The e-cohort, which used exclusively digital recruitment strategies, fell significantly short of recruitment goals. This suggests in-person and mail-based strategies remain important for recruitment. Moreover, instead of favoring a singular approach, a combined approach to survey sampling may capitalize on the strengths of each sampling mode to increase diversity in sociodemographic and health risk characteristics.

Risk of Iron Deficiency in Women With Endometriosis: A Population-Based Prospective Cohort Study

BACKGROUND

Endometriosis may be linked to the risk of iron deficiency through chronic systemic inflammation or heavy menstrual bleeding. No longitudinal studies, however, have examined the relationship between endometriosis and the risk of iron deficiency.

METHODS

This study included 3,294 participants born from 1973 to 1978 and followed as part of the Australian Longitudinal Study on Women's Health from 2000 to 2018. Participants with endometriosis were identified using self-reported longitudinal surveys linked to administrative health records. During each survey, participants were also asked to report the diagnosis of iron deficiency, and we validated diagnoses using an administrative health database. Generalized estimating equations for binary responses with an autoregressive correlation matrix were used to examine the association between endometriosis and the risk of iron deficiency over the seven time points.

FINDINGS

We found that women with endometriosis had a significantly higher risk of iron deficiency than those without endometriosis after adjusting for sociodemographic, lifestyle, reproductive, and nutrition factors (adjusted odds ratio [aOR] = 1.46; 95% confidence interval [CI] [1.29, 1.66]; p < .0001). Women with a surgically confirmed diagnosis and those with clinically suspected endometriosis had a higher risk of iron deficiency (aOR = 1.38; 95% CI [1.17, 1.64] and aOR = 1.53; 95% CI [1.30, 1.81]), respectively. These associations, however, were slightly attenuated (by 8%) when adjusted for the presence of heavy menstrual bleeding.

CONCLUSIONS

Women with endometriosis are at a higher risk of developing iron deficiency than those without endometriosis. The findings suggest that iron deficiency should be concomitantly addressed during initial diagnosis and successive management of endometriosis.

Screening and Retaining Adolescents Recruited Through Social Media: Secondary Analysis from a Longitudinal Clinical Trial

BACKGROUND

Social media has become a popular method to recruit participants, particularly for studies with hard-to-reach populations. These studies still face challenges in data quality and, for longitudinal studies, sample retention. However, in addition to aiding in recruitment, social media platforms can help researchers with participant verification and tracking procedures during the study. There is limited previous research describing how longitudinal studies can use social media to screen and retain participants.

OBJECTIVE

This paper describes strategies implemented to screen and retain a nationwide sample of sexual minority youth who were recruited through social media platforms for a longitudinal study testing a drug abuse prevention program.

METHODS

Our screening strategies for participants included collecting necessary demographic information (name, phone, email, and social media accounts), verifying this information using publicly available web-based records, and sending confirmation emails to ensure working email addresses and correct dates of birth. Retention strategies included communications designed to develop positive participant relationships, incentives for survey completion, regular updating of participant contact information, targeting hard-to-reach participants, and using social media as an alternative means of contacting participants.

RESULTS

During enrollment, although the only demographic data required were a phone number and an email address, 87.58% (1065/1216) of participants provided their Instagram as an alternative means of contact. This form of alternative communication remains the most preferred with 87.40% (1047/1198) of participants continuing to provide an Instagram username as of January 2023, about 3 years after recruitment began. In comparison, other alternative means of contact (eg, Facebook and alternative email) were provided by only 6.43% (77/1198) to 56.18% (673/1198) of participants. Direct messaging on Instagram was used to successfully confirm participant identity, remind participants to take annual follow-up surveys, and update lost participant contact information. Screening and retention strategies used in the study have helped achieve 96.30% (1171/1216) to 96.79% (1177/1216) sample retention across 3 waves of data collection.

CONCLUSIONS

Though social media can be a helpful tool to recruit participants, attrition and participant authenticity difficulties may be associated with this method. Screening and retention strategies can be implemented to improve retention. Internet searches are effective for screening youth to ensure they meet eligibility requirements. Additionally, social media-Instagram in this study-can help to track and locate participants who do not respond to traditional contact methods.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03954535; https://clinicaltrials.gov/study/NCT03954535.

Evidence of shared genetic factors in the etiology of gastrointestinal disorders and endometriosis and clinical implications for disease management

In clinical practice, the co-existence of endometriosis and gastrointestinal symptoms is often observed. Using large-scale datasets, we report a genetic correlation between endometriosis and irritable bowel syndrome (IBS), peptic ulcer disease (PUD), gastro-esophageal reflux disease (GORD), and a combined GORD/PUD medicated (GPM) phenotype. Mendelian randomization analyses support a causal relationship between genetic predisposition to endometriosis and IBS and GPM. Identification of shared risk loci highlights biological pathways that may contribute to the pathogenesis of both diseases, including estrogen regulation and inflammation, and potential therapeutic drug targets (CCKBR; PDE4B). Higher use of IBS, GORD, and PUD medications in women with endometriosis and higher use of hormone therapies in women with IBS, GORD, and PUD, support the co-occurrence of these conditions and highlight the potential for drug repositioning and drug contraindications. Our results provide evidence of shared disease etiology and have important clinical implications for diagnostic and treatment decisions for both diseases.

Associations between endometriosis and common symptoms: findings from the Australian Longitudinal Study on Women's Health

BACKGROUND

Endometriosis has been linked to higher rates of a variety of symptoms; however, the findings from longitudinal studies are scarce and inconsistent.

OBJECTIVE

This study aimed to examine the association between endometriosis and common symptoms in a prospective cohort study.

STUDY DESIGN

This study included 7606 women born from 1973 to 1978 using data from the Australian Longitudinal Study on Women's Health that were collected every 3 years from 2009 to 2018. We identified women with endometriosis based on self-reported incidence from each survey and linked administrative health data. At each survey, women also completed a checklist on the presence of 24 symptoms. Generalized estimating equations for multinomial responses were used for analyses.

RESULTS

Women with endometriosis had significantly more menstrual symptoms than those without endometriosis with an adjusted odds ratio (95% confidence interval) of 3.61 (3.11-4.19) for severe period pain, 2.40 (2.10-2.74) for heavy menstrual bleeding, 1.76 (1.52-2.03) for irregular bleeding, and 1.52 (1.32-1.76) for premenstrual tension. They also had higher odds of mental health problems with adjusted odds ratios of 1.67 (1.39-2.01) for depression and 1.59 (1.24-2.03) for anxiety and higher odds of allergies and nonspecific symptoms with adjusted odds of 1.62 (1.40-1.89) for allergies or hay fever or sinusitis, 1.79 (1.56-2.05) for severe tiredness, 1.56 (1.35-1.81) for sleep difficulty, and 1.77 (1.37-2.18) for palpitations. There was also a strong association with other forms of pain with an adjusted odds ratio of 1.76 (1.53-2.04) for backpain, 1.50 (1.29-1.74) for headaches or migraines, and 1.65 (1.41-1.93) for stiff or painful joints. Women with endometriosis also had increased odds of developing bowel and urinary symptoms with an adjusted odds ratio (95% confidence interval) of 1.67 (1.35-2.08) for constipation, 1.46 (1.12-1.90) for hemorrhoids or piles, 1.25 (1.03-1.52) for indigestion or heartburn, 2.80 (1.71-4.58) for urine burn or stings, and 1.37 (1.03-1.82) for vaginal discharge or irritation. The association between each symptom and endometriosis was similar whether endometriosis was surgically confirmed or clinically suspected. No association was found between endometriosis and the risk for skin problems, leaking urine, or breathing difficulty.

CONCLUSION

This study suggests that women with endometriosis are more likely to report not only menstrual symptoms but are also at an increased risk for mental health problems, other pain symptoms, bowel and urinary symptoms, and nonspecific symptoms, such as severe tiredness and difficulty sleeping.

A detour for snacks and beverages? A cross-sectional assessment of selective daily mobility bias in food outlet exposure along the commuting route and dietary intakes

The evidence of selective daily mobility bias distorting exposure-health associations is limited. Using 7-day smartphone-based global positioning system (GPS) tracking data for 67 Dutch adults aged 25-45, we conducted paired Wilcoxon tests to compare the absolute and relative exposure to food outlets along actual and modelled commuting routes. We fitted Tobit regressions to examine their associations with three daily snack and soft drink intake outcomes. We found significant differences in absolute food outlet exposure between two types of routes. Adjusted regression analyses yielded unexpected associations between dietary intakes and food outlet exposures. Our results suggested no evidence of a selective daily mobility bias in the association between the food environment along commuting routes and adults' snacks and soft drink consumption in this sample.

Impact of endometriosis on women's health-related quality of life: A national prospective cohort study

OBJECTIVE

To examine the association between endometriosis and women's health-related quality of life (HRQoL).

STUDY DESIGN

This study included 3728 women born in 1973-78 using data from the Australian Longitudinal Study on Women's Health. Women with endometriosis were identified using self-reported longitudinal surveys linked to administrative health records. A mixed effect model with only random intercept and generalised estimating equations with binary logistic regressions were used to examine the association between endometriosis and health-related quality of life over eight time points. Each HRQoL scale was analysed in terms of binary outcomes by comparing women who had a lower HRQoL (scoring below the 25th percentile) with those who had a higher HRQoL (scoring above the 25th percentile).

MAIN OUTCOME MEASURES

Women's HRQoL was assessed using the 36-item Short Form Survey every 3 years from 1996 to 2018.

RESULTS

Endometriosis was associated with significantly worse reports of HRQoL over time. In the comparison against women without endometriosis, the following adjusted odds ratios (95 % confidence intervals) were calculated for women with endometriosis having worse scores on the eight domains of the Short Form Survey: physical functioning 1.33 (1.19, 1.50), role physical 1.57 (1.41, 1.74), bodily pain 1.65 (1.48, 1.82), general health 1.61 (1.42, 1.81), vitality 1.38 (1.23, 1.55), social functioning 1.38 (1.25, 1.53), role emotion 1.19 (1.06, 1.33), mental health 1.32 (1.18, 1.48). Women with endometriosis also had significantly lower physical health 1.68 (1.51, 1.88) and mental health components scores 1.28 (1.14, 1.44).

CONCLUSIONS

Endometriosis is associated with worse physical, mental, and social functioning and well-being. Bodily pain was the most affected HRQoL domain.

Father trait anger: Associations with father–infant bonding and subsequent parenting stress

Introduction

Parent anger presents a risk to family safety and child development. Father trait anger may also compromise the early relational context of fathers and offspring, yet evidence is lacking. The aim of this study is to examine effects of father trait anger on parenting stress in the toddler years, and the mediational role of father–infant bonding.

Method

Data were from 177 Australian fathers of 205 children. Trait anger (total, angry temperament, and angry reaction), father–infant bonding subscales (patience and tolerance, affection and pride, and pleasure in interaction), and subsequent parenting stress (parental distress, difficult child, and parent–child dysfunctional interaction) were assessed. At each of the subscale levels, mediational path models examined whether father–infant bonding explained the relationship between trait anger and parenting stress. Models were presented where there was at least a small association between the mediator and both the predictor and outcome.

Results

Patience and tolerance was the only domain of father–infant bonding correlated with both trait anger and all parenting stress outcomes. Patience and tolerance partially mediated the effect of total trait anger on parental distress and fully mediated effects on difficult child and parent–child dysfunctional interaction. Patience and tolerance fully mediated relationships between angry temperament and all domains of parenting stress. Angry reactions only had a direct effect on parental distress.

Discussion

Father trait anger both directly and indirectly (through patience and tolerance in the father–infant bond) impacts their experiences of parenting stress in the toddler years. Early interventions to manage father trait anger and improve father–infant bonding may benefit fathers and children.

Social Media Recruitment Strategies to Recruit Pregnant Women Into a Longitudinal Observational Cohort Study: Usability Study

BACKGROUND

Use of social media for study recruitment is becoming increasingly common. Previous studies have typically focused on using Facebook; however, there are limited data to support the use of other social media platforms for participant recruitment, notably in the context of a pregnancy study.

OBJECTIVE

Our study aimed to evaluate the effectiveness of Facebook, Twitter, and Instagram in recruiting a representative sample of pregnant women in a longitudinal pregnancy cohort study in Calgary, Alberta, between September 27, 2021, and April 24, 2022.

METHODS

Paid advertisements were targeted at 18- to 50-year-old women in Calgary, with interests in pregnancy. Data regarding reach, link clicks, and costs were collected through Facebook Ads Manager (Meta Platforms, Inc) and Twitter Analytics (Twitter, Inc). The feasibility of each platform for recruitment was assessed based on the recruitment rate and cost-effectiveness. The demographic characteristics of the participants recruited through each source were compared using the chi-square test.

RESULTS

Paid advertisements reached 159,778 social media users, resulting in 2390 link clicks and 324 participants being recruited. Facebook reached and recruited the highest number of participants (153/324, 47.2%), whereas Instagram saw the highest number of link clicks relative to the number of users who saw the advertisement (418/19,764, 2.11%). Facebook and Instagram advertisements were cost-effective, with an average cost-per-click of CAD $0.65 (US $0.84; SD $0.27, US $0.35) and cost-per-completer of CAD $7.89 (US $10.25; SD CAD $4.08, US $5.30). Twitter advertisements were less successful in terms of recruitment and costs. Demographic characteristics of participants did not differ based on recruitment source, except for education and income, where more highly educated and higher-income participants were recruited through Instagram or Twitter. Many issues related to fraudulent responses were encountered throughout the recruitment period.

CONCLUSIONS

Paid social media advertisements (especially Facebook and Instagram) are feasible and cost-effective methods for recruiting a large sample of pregnant women for survey-based research. However, future research should be aware of the potential for fraudulent responses when using social media for recruitment and consider strategies to mitigate this problem.

How young Australian women explain their use of condoms, withdrawal and fertility awareness: a qualitative analysis of free-text comments from the CUPID study

Rates of oral contraceptive pill use have declined over the past decade in Australia. While some women use highly effective methods, others rely on less effective methods such as condoms, withdrawal and fertility awareness. We aimed to understand motivations for relying on these methods among young women in Australia. Women aged 18-23 years who reported using less effective methods and participated in the Contraceptive Use, Pregnancy Intention and Decisions (CUPID) study formed the sample for this analysis. Using thematic analysis, we analysed 140 free-text comments. Findings suggest that less effective methods were used when they were assessed as being best suited to current reproductive needs. These methods were perceived as offering benefits that hormonal and more invasive methods did not, and participants were largely satisfied with them. By contrast, some less effective method use was driven by a lack of choice or alternative options, previous bad experiences with hormonal methods, a lack of appropriate information about alternatives and difficulty accessing other methods. It is therefore essential to move beyond 'LARC-first' contraceptive counselling approaches to ensure young women are provided with accurate information regarding all contraceptive options available (including how to negotiate their use) and how to use them to their greatest efficacy.

Pregnancy-Specific Stress during the First Lockdown of the COVID-19 Pandemic: Assessing Face-to-Face versus Online Recruitment

The study aims to assess pregnancy-specific stress among pregnant women in Spain during the first lockdown of the COVID-19 pandemic. Two samples of pregnant women from the south of Spain (Andalusia) were assessed using the Prenatal Distress Questionnaire (PDQ) and a sociodemographic and obstetric questionnaire. Group 1 (N = 155) was recruited face-to-face, whereas Group 2 (N = 78) was recruited online. Pregnancy-specific stress levels were significantly different in both groups. The face-to-face group (Group 1) had higher pregnancy-specific stress levels than the online group (Group 2). The online sample over-represents young adult pregnant women with high education levels and a high number of previous miscarriages. The face-to-face study seems more accessible to racially and ethnically diverse groups. The main concern among both groups was the risk of having a sick neonate. Research during the COVID-19 pandemic can benefit from using online resources to collect data to screen and identify perinatal mental health problems in a crisis environment. Nevertheless, researchers should be aware of the potential limitations this strategy can have, for example, certain groups of people may have limited access to the internet.

Patterns of contraceptive use among young Australian women with chronic disease: findings from a prospective cohort study

BACKGROUND

Given chronic disease is increasing among young women and unintended pregnancies among these women are associated with poor maternal and fetal outcomes, these women would benefit from effective preconception care. However, there is a lack of understanding of how these women use or don't use contraception to inform such interventions. This study examined patterns of contraceptive use among an Australian cohort of young women and investigated the influence of chronic disease on contraceptive use over time.

METHODS

Using data from 15,244 young women from the Australian Longitudinal Study on Women's Health (born 1989-1995), latent transition analysis was performed to identify distinct contraceptive patterns among women who were at risk of an unintended pregnancy. Multinomial mixed-effect models were used to evaluate the relationship between contraceptive combinations and chronic disease.

RESULTS

Contraceptive use for women with cardiac and autoinflammatory diseases differed to women without chronic disease over the observation period. Compared to women without chronic disease using the pill, women with cardiac disease had double the odds of using 'other' contraception and condoms (OR = 2.20, 95% CI 1.34, 3.59) and a modest increase in the odds of using the combined oral contraceptive pill and condoms (OR = 1.39, 95% CI 1.03, 1.89). Compared to women without chronic disease who used the pill, women with autoinflammatory disease had increased odds of using LARC and condoms (OR = 1.58, 95% CI 1.04, 2.41), using 'other' contraception and condoms (OR = 1.69, 95% CI 1.11, 2.57), and using the combined oral contraceptive pill and condoms (OR = 1.38, 95% CI 1.09, 1.75). No differences in contraceptive patterns over the observation period were found for women with asthma or diabetes when compared to women without chronic disease.

CONCLUSION

The findings identified a need for effective contraceptive counselling as part of routine chronic disease care and improved communication between health care providers and women with chronic disease to improve young women's contraceptive knowledge and agency in contraceptive choice, particularly for those with cardiac or autoinflammatory conditions. This may be the key to reducing high-risk unintended pregnancies among this vulnerable population.

Predicting Real-world Hypoglycemia Risk in American Adults With Type 1 or 2 Diabetes Mellitus Prescribed Insulin and/or Secretagogues: Protocol for a Prospective, 12-Wave Internet-Based Panel Survey With Email Support (the iNPHORM [Investigating Novel Predictions of Hypoglycemia Occurrence Using Real-world Models] Study)

BACKGROUND

Hypoglycemia prognostic models contingent on prospective, self-reported survey data offer a powerful avenue for determining real-world event susceptibility and interventional targets.

OBJECTIVE

This protocol describes the design and implementation of the 1-year iNPHORM (Investigating Novel Predictions of Hypoglycemia Occurrence Using Real-world Models) study, which aims to measure real-world self-reported severe and nonsevere hypoglycemia incidence (daytime and nocturnal) in American adults with type 1 or 2 diabetes mellitus prescribed insulin and/or secretagogues, and develop and internally validate prognostic models for severe, nonsevere daytime, and nonsevere nocturnal hypoglycemia. As a secondary objective, iNPHORM aims to quantify the effects of different antihyperglycemics on hypoglycemia rates.

METHODS

iNPHORM is a prospective, 12-wave internet-based panel survey that was conducted across the United States. Americans (aged 18-90 years) with self-reported type 1 or 2 diabetes mellitus prescribed insulin and/or secretagogues were conveniently sampled via the web from a pre-existing, closed, probability-based internet panel (sample frame). A sample size of 521 baseline responders was calculated for this study. Prospective data on hypoglycemia and potential prognostic factors were self-assessed across 14 closed, fully automated questionnaires (screening, baseline, and 12 monthly follow-ups) that were piloted using semistructured interviews (n=3) before fielding; no face-to-face contact was required as part of the data collection. Participant responses will be analyzed using multivariable count regression and machine learning techniques to develop and internally validate prognostic models for 1-year severe and 30-day nonsevere daytime and nocturnal hypoglycemia. The causal effects of different antihyperglycemics on hypoglycemia rates will also be investigated.

RESULTS

Recruitment and data collection occurred between February 2020 and March 2021 (ethics approval was obtained on December 17, 2019). A total of 1694 participants completed the baseline questionnaire, of whom 1206 (71.19%) were followed up for 12 months. Most follow-up waves (10,470/14,472, 72.35%) were completed, translating to a participation rate of 179% relative to our target sample size. Over 70.98% (856/1206) completed wave 12. Analyses of sample characteristics, quality metrics, and hypoglycemia incidence and prognostication are currently underway with published results anticipated by fall 2022.

CONCLUSIONS

iNPHORM is the first hypoglycemia prognostic study in the United States to leverage prospective, longitudinal self-reports. The results will contribute to improved real-world hypoglycemia risk estimation and potentially safer, more effective clinical diabetes management.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04219514; https://clinicaltrials.gov/ct2/show/NCT04219514.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/33726.

Urinary incontinence, body mass index, and physical activity in young women

BACKGROUND

Current evidence suggests that excess weight and obesity are important risk factors for urinary incontinence in women. However, limited data exist regarding the relationships among body mass index, physical activity, and urinary incontinence in women in their 20s.

OBJECTIVE

This study aimed to (1) compare prevalence rates of urinary incontinence and high body mass index in 2 cohorts of young women, (2) explore associations between changes in body mass index and urinary incontinence using analysis of combined data from the 2 cohorts, and (3) explore the associations between physical activity and urinary incontinence, with adjustment for body mass index.

STUDY DESIGN

Data were collected from 2 cohorts of young women in the Australian Longitudinal Study of Women's Health (n=16,065), born 17 years apart: 1973-1978 (cohort 1) and 1989-1995 (cohort 2). The women in both cohorts completed the surveys at age 18 to 23 years (T1), with follow-up 4 years later (age, 22-27 years; T2). Self-reported urinary incontinence and body mass index were assessed in both surveys. As physical activity was measured using different questions in cohort 1 at T1, self-reported physical activity data were from T2 only. A total of 9 body mass index transition categories (based on body mass index status at baseline and follow-up) and 4 physical activity categories were created to assess multivariate-adjusted prevalence ratios for urinary incontinence at T2, using Poisson regression.

RESULTS

Rates of obesity increased in both cohorts over 4 years, from 6.6%% (95% confidence interval, 6.1-7.2) to 10.4% (95% confidence interval, 9.7-11.0) in cohort 1 and from 11.7% (95% confidence interval, 11.0-12.4) to 19.6% (95% confidence interval, 18.7-20.5) in cohort 2. Compared with women who maintained normal body mass index at T1 and T2, the prevalence ratio for urinary incontinence among those with body mass index >30 at age 22 to 27 years was higher, regardless of body mass index category at age 18 to 23 years (prevalence ratio at T1: 1.39 for normal body mass index [95% confidence interval, 1.1-1.76]; 1.44 for overweight [95% confidence interval, 1.27-1.63]; and 1.51 for obese [95% confidence interval, 1.36-1.67]). In cohort 1, there was no relationship between physical activity and urinary incontinence. However, in cohort 2 there was an inverse dose-response relationship between physical activity and urinary incontinence.

CONCLUSION

The strong association between obesity and urinary incontinence in young women is a public health concern, given that obesity rates are likely to increase further with age and parity. The potential mitigating effects of physical activity on the obesity-incontinence relationship merit further investigation.

Cohort profile: the Men and Parenting Pathways (MAPP) Study: a longitudinal Australian cohort study of men's mental health and well-being at the normative age for first-time fatherhood

PURPOSE

The Men and Parenting Pathways (MAPP) Study is a prospective investigation of men's mental health and well-being across the normative age for transitioning to fatherhood. This includes trajectories and outcomes for men who do and do not become fathers across five annual waves of the study.

PARTICIPANTS

Australian resident, English-speaking men aged 28-32 years at baseline were eligible. Recruitment was over a 2-year period (2015-2017) via social and traditional media and through engagement with study partners. Eight hundred and eighteen eligible men consented to participate. Of these, 664 men completed the first online survey of whom 608 consented to ongoing participation. Of the ongoing sample, 83% have participated in at least two of the first three annual online surveys.

FINDINGS TO DATE

Three waves of data collection are complete. The first longitudinal analysis of MAPP data, published in 2020, identified five profiles that characterise men's patterns of depressive symptom severity and presentations of anger. Profiles indicating pronounced anger and depressive symptoms were associated with fathers' lack of perceived social support, and problems with coparenting and bonding with infants. In a second study, MAPP data were combined with three other Australian cohorts in a meta-analysis of associations between fathers' self-reported sleep problems up to 3 years postpartum and symptoms of depression, anxiety and stress. Adjusted meta-analytic associations between paternal sleep and mental health risk ranged from 0.25 to 0.37.

FUTURE PLANS

MAPP is an ongoing cohort study. Waves 4 and 5 data will be ready for analyses at the end of 2021. Future investigations will include crossed-lagged and trajectory analyses that assess inter-relatedness and changing social networks, mental health, work and family life. A nested study of COVID-19 pandemic-related mental health and coping will add two further waves of data collection in a subsample of MAPP participants.

E-cigarette use and cigarette smoking initiation among Australian women who have never smoked

INTRODUCTION AND AIM

Evidence regarding the association between e-cigarette use and subsequent initiation of smoking mostly relates to the US population. In Australia, no studies are available investigating the association between the uses of e-cigarettes and smoking initiation among young adults who have never smoked. This study aimed to determine the association between lifetime e-cigarette use and subsequent initiation of cigarette smoking among tobacco-naïve Australian women aged 20-27.

DESIGN AND METHODS

The current study used data (n = 5398) from the third (2015) and fourth (2016) surveys collected from a cohort of Australian women born in 1989-1995 who participated in the Australian Longitudinal Study on Women's Health. Multivariable logistic regression was used to identify the association between lifetime e-cigarette use at the baseline survey and initiation of cigarette smoking (smoked 100 cigarettes or more in the last year) at the follow up adjusting for possible confounders. Effects were expressed as odds ratios with 95% confidence interval.

RESULTS

The mean (± SD) age of the study participants at baseline (third survey) was 22.5 (±1.7). Ever e-cigarette use at baseline was positively associated with smoking initiation at follow up (adjusted odds ratio 3.71; 95% confidence interval 2.33, 5.93). History of depression, binge drinking and higher childhood adversity score were also risk factors for subsequent smoking initiation in the follow up.

DISCUSSION AND CONCLUSIONS

This study identified a strong association between e-cigarette use and subsequent initiation of smoking. Enforcing the existing restriction of sale and supply of e-liquid containing nicotine is essential to prevent never smokers from nicotine addiction via e-cigarettes.

The impact of adverse childhood experiences on the health and health behaviors of young Australian women

BACKGROUND

Adverse childhood experiences have been linked to poor health and adverse health behavior in adulthood.

OBJECTIVE

This study aimed to estimate the prevalence of adverse childhood experiences among young Australian women (aged 20-25) and examine associations between adverse childhood experiences and adult health behaviors and physical and mental health.

PARTICIPANTS AND SETTINGS

Data were from the 1989-95 cohort of the Australian Longitudinal Study on Women's Health, who completed the Adverse Childhood Experiences Scale at Survey 3 in 2015 (N = 8609).

METHODS

Outcomes included: self-rated health, sexual health, psychological distress, depression, anxiety, suicide ideation, self-harm, substance abuse (drinking, smoking, illicit drugs), severe obesity, and exercise. Prevalence of childhood adversities were presented, with the association between childhood adversity and outcomes evaluated using log-binomial multivariable regressions (99% CI).

RESULTS

While 59% of women reported experiencing at least one childhood adversity, 10% of participants reported adverse childhood experiences across four or more categories, indicating a significant burden of risk for young Australian women. Women reporting four or more categories had higher rates of poor physical health (adjPR = 1.79, 99% CI = 1.51-2.12), sexually transmitted infections (adjPR = 1.36, 99% CI = 1.11-1.67), and poor mental health (adjPR = 2.78, 99% CI = 2.34-3.32), and increased rates of severe obesity (adjPR = 2.14, 99% CI = 1.61-2.86) and smoking (adjPR = 2.23, 99% CI = 1.89-2.64).

CONCLUSION

Using nationally representative data, this study shows adverse childhood experiences directly impact physical and mental health, and health behaviors in adulthood among young Australian women. The management of health and wellbeing in adulthood should look beyond the contemporaneous factors, incorporating a focus on how childhood adversity may negatively influence health behavior, health and wellbeing in later life.

Social media recruitment for mental health research: A systematic review

BACKGROUND

Social media holds exciting promise for advancing mental health research recruitment, however, the extent and efficacy to which these platforms are currently in use are underexplored.

OBJECTIVE

A systematic review was conducted to characterize the current use and efficacy of social media in recruiting participants for mental health research.

METHOD

A literature review was performed using MEDLINE, EMBASE, and PsychINFO. Only non-duplicative manuscripts written in the English language and published between 1/1/2004-3/31/2019 were selected for further screening. Data extracted included study type and design, participant inclusion criteria, social media platform, advertising strategy, final recruited sample size, recruitment location, year, monetary incentives, comparison to other recruitment methods if performed, and final cost per participant.

RESULTS

A total of 176 unique studies that used social media for mental health research recruitment were reviewed. The majority of studies were cross-sectional (62.5%) in design and recruited adults. Facebook was overwhelmingly the recruitment platform of choice (92.6%), with the use of paid advertisements being the predominant strategy (60.8%). Of the reviewed studies, substance abuse (43.8%) and mood disorders (15.3%) were the primary subjects of investigation. In 68.3% of studies, social media recruitment performed as well as or better than traditional recruitment methods in the number and cost of final enrolled participants. The majority of studies used Facebook for recruitment at a median cost per final recruited study participant of $19.47. In 55.6% of the studies, social media recruitment was the more cost-effective recruitment method when compared to traditional methods (e.g., referrals, mailing).

CONCLUSION

Social media appears to be an effective and economical recruitment tool for mental health research. The platform raises methodological and privacy concerns not covered in current research regulations that warrant additional consideration.

Obesity, menstrual irregularity and polycystic ovary syndrome in young women with type 1 diabetes: A population-based study

BACKGROUND

Type 1 diabetes (T1D) is associated with reproductive dysfunction, particularly in the setting of poor metabolic control. Improvements in contemporary management ameliorate these problems, albeit at the cost of increased exogenous insulin and rising obesity, with emerging reproductive implications.

OBJECTIVE

To evaluate changes in body mass index (BMI) and the relationship between obesity, menstrual irregularity and polycystic ovary syndrome (PCOS) in young women with T1D, compared with controls.

METHODS

Longitudinal observational study using data from the Australian Longitudinal Study in Women's Health of the cohort born in 1989-95, from 2013 to 2015. Three questionnaires administered at baseline and yearly intervals were used to evaluate self-reported menstrual irregularity, PCOS and BMI.

RESULTS

Overall, 15 926 women were included at baseline (T1D, n = 115; controls, n = 15 811). 61 women with T1D and 8332 controls remained at Year 2. Median BMI was higher in women with type 1 diabetes (25.5 vs 22.9 kg/m² , P < .001), where over half were overweight or obese (54.4% vs 32.9%, P < .001). Median BMI increased by 1.11 and 0.45 kg/m² , in the T1D and control groups, respectively. T1D was independently associated with an increased risk of menstrual irregularity (RR 1.22, 95% CI 1.02-1.46) and PCOS (RR 2.41, 95% CI 1.70-3.42). Obesity conferred a 4-fold increased risk of PCOS, compared to those with normal BMI (RR 3.93, 95% CI 3.51-4.42).

CONCLUSIONS

Obesity is prevalent amongst women with T1D and may be a key contributor to the higher risk of menstrual irregularity and PCOS in this cohort, representing an important opportunity for prevention and intervention.

Performance, Cost-Effectiveness, and Representativeness of Facebook Recruitment to Suicide Prevention Research: Online Survey Study

BACKGROUND

Researchers are increasingly using social media advertisements to recruit participants because of their many advantages over traditional methods. Although there is growing evidence for the effectiveness and cost-effectiveness of social media recruitment in the health sciences, no studies have yet examined this in the context of suicide prevention, which remains to be a highly stigmatized and sensitive topic.

OBJECTIVE

This study aims to recruit a general community sample to complete a survey on suicide literacy, stigma, and risk via Facebook advertisements. Specifically, we aim to establish the performance of the advertisements, cost-effectiveness, sample representativeness, and the impact of gender-specific advertising on recruiting men into the study.

METHODS

From June 2017 to March 2019, we released Facebook advertisements targeted at adults 18 years or older, residing in the New South Wales (NSW) trial or control regions, and involved in the LifeSpan suicide prevention trial. Cost-effectiveness was examined descriptively using metrics provided by Facebook. Chi-square analyses were conducted to determine demographic differences between our sample and the general NSW population as well as the impact of gender-specific advertisements on gender engagement.

RESULTS

The 14 Facebook advertisement campaigns reached a total of 675,199 people, yielding 25,993 link clicks and resulting in 9603 individuals initiating the survey (7487 completions) at an overall cost of Aus $2.81 (US $2.01) per participant. There was an overrepresentation of younger (P=.003), female (P=.003), highly educated (P<.001) participants and mental health conditions (P<.001) compared with the total NSW population. The use of male-specific advertisements resulted in a significantly higher proportion of men completing the survey relative to gender-neutral advertisements (38.2% vs 24.6%; P<.001).

CONCLUSIONS

This study demonstrates the potential of Facebook to be an effective, low-cost strategy for recruiting a large sample of general community participants for suicide prevention research. Strategies to improve sample representativeness warrant further investigation in future research.

Using Facebook to Improve Participation Among 25-Year-Olds Enrolled in a Longitudinal Preterm Birth Cohort Study

OBJECTIVE

Facebook is a popular social media platform used globally to keep connected and informed. The aims of this study were to determine the contribution of Facebook to the participation rate of young adults enrolled in a longitudinal cohort study, and to examine systematic differences in participants recruited through Facebook compared with those recruited through traditional methods.

METHODS

Potential participants comprised 297 consecutive survivors born extremely preterm (<28 weeks' gestation) or extremely low birth weight (<1000 g birth weight) in 1991-92 in the state of Victoria, Australia, and 260 contemporaneously recruited normal birth weight (>2499 g birth weight) controls who had participated previously in a prospective cohort study. At 25 years of age participants were approached initially via traditional methods (mail, telephone, texts), and subsequently by Facebook for those difficult to contact or locate.

RESULTS

Contact was attempted with 523 young adults via traditional methods and 49% (n = 255) agreed to participate. Of the 208 participants unable to be located or contacted via traditional methods, 153 were subsequently located via Facebook. Of these 82% (n = 125) responded promptly within a day of receiving the Facebook invite, and 41% (n = 63) ultimately participated. The participation rate increased from 49% (255 of 523) to 61% (318 of 523) with the addition of Facebook, an absolute increase of 12%. Participants recruited by Facebook were slightly older, had lower rates of school completion and lower cognitive score at 18 years of age compared with those recruited via traditional methods.

CONCLUSIONS

Using Facebook improved participation of young adults enrolled in this longitudinal preterm follow up study, 25 years after original recruitment.

Urinary incontinence in young women: Risk factors, management strategies, help-seeking behavior, and perceptions about bladder control

AIM

The aim was to describe the characteristics of young adult women who report urinary incontinence (UI), the types of UI they experience, the strategies they use or consider important for managing UI, and help-seeking behavior.

METHODS

Data were from the 1989-1995 Australian Longitudinal Study on Women's Health cohort (n = 8457) at age 22 to 27 (in 2017). Descriptive statistics were used to summarize: characteristics of young women who experience UI; the types of UI they experience; which strategies women use to manage UI; perceptions of bladder control; and the proportion of women who seek help (and reasons why not). Prevalence ratios for UI according to sample characteristics were calculated using Poisson regression models.

RESULTS

At age 22 to 27, 11% (n = 986) of young women reported UI in the past month. Compared with women who did not have UI, those reporting UI were 7 kg heavier on average and were more likely to be in the obese body mass index category, report high psychological distress, and have at least one child. Most women with UI reported mixed symptoms of UI (stress and urge), and used a combination of strategies to self-manage UI symptoms. Only one in five women had sought help or advice from a healthcare professional.

CONCLUSIONS

Obesity, parity, and high psychological distress are strong correlates of UI in young women. As the majority of women with UI do not seek help, the antenatal period may be a critical time for healthcare providers to identify those at risk, and encourage early prevention or effective management strategies. As physical activity is positively associated with better outcomes for obesity and psychological distress, there may also be concurrent improvements in UI if these issues are addressed.

Alcohol-related risk from pre-loading and heavy episodic drinking (HED) among a cohort of young Australian women: a cross-sectional analysis

OBJECTIVE

To cross-sectionally examine heavy episodic drinking (HED) and pre-loading with alcohol among young Australian women in relation to the alcohol-induced adverse outcomes of memory loss, vomiting and injury.

METHODS

A total of 7,800 participants, aged 20-25 years, from the 1989-95 cohort of the Australian Longitudinal Study on Women's Health answered all questions on alcohol use, reported drinking alcohol in the previous year and were not pregnant at the third survey in 2015. Log-binomial models were used to estimate prevalence ratios for adverse outcomes associated with increased frequency of HED and pre-loading.

RESULTS

The majority of participants reported HED (83.4%) and/or pre-loading (65.6%), which had a moderate correlation (r=0.646). Just over half (55.2%) of participants experienced at least one adverse event, with vomiting being most common. As the frequency of HED or pre-loading increased, so did the risk of an adverse outcome.

CONCLUSIONS

Both HED and pre-loading pose a risk to young Australian women, and that risk rises with increased frequency. Implications for public health: Although HED has been a target of public health policy and interventions, pre-loading has received limited attention. In addition to addressing HED, there is a need to consider the risk posed by pre-loading, a related, yet unique risky drinking behaviour.

Physical activity and sedentary behaviour in women with and without polycystic ovary syndrome: An Australian population-based cross-sectional study

OBJECTIVE

Lifestyle is the first-line treatment for women with polycystic ovary syndrome (PCOS). This study examines the physical activity (PA) levels and sedentary behaviours of women with and without PCOS, and their alignment with the PCOS PA guideline.

METHODS

This cross-sectional study on women (aged 22-27 years) in the Australian Longitudinal Study on Women's Health was conducted in 2019 using data collected in 2017. Self-reported PA levels and total daily sitting time (ST) of women with (n = 7051) and without (n = 796) self-reported PCOS were presented, stratified by body mass index (BMI) and a combined overweight/obese group.

RESULTS

71.0% and 56.7% of the entire study cohort achieved PA levels recommended for weight maintenance and weight loss, respectively. Overall, PA levels were lower and ST was higher in women with than without PCOS. In each BMI category, similar proportions of women with and without PCOS met the PA guidelines but became lower as BMI category increased. Fewer overweight/obese group women with than without PCOS aligned with recommendations for weight maintenance (58.7% vs 65.7%, P = .003) or weight loss (45.1% vs 50.3%, P = .032). ST ≥8 h/d was observed in two-thirds of women with and without self-reported PCOS similarly before and after stratifying by BMI.

CONCLUSION

High sedentary behaviour was extremely prevalent. Although the majority of women met PA recommendations for weight maintenance, only one in two overweight/obese women met PA recommendation for weight loss. Overweight/obese women with PCOS were more likely to participate in insufficient PA and require increased support to achieve sustainable healthy lifestyle.

Using online technologies to improve diversity and inclusion in cognitive interviews with young people

BACKGROUND

We aimed to assess the feasibility of using multiple technologies to recruit and conduct cognitive interviews among young people across the United States to test items measuring sexual and reproductive empowerment. We sought to understand whether these methods could achieve a diverse sample of participants. With more researchers turning to approaches that maintain social distancing in the context of COVID-19, it has become more pressing to refine these remote research methods.

METHODS

We used several online sites to recruit for and conduct cognitive testing of survey items. To recruit potential participants we advertised the study on the free online bulletin board, Craigslist, and the free online social network, Reddit. Interested participants completed an online Qualtrics screening form. To maximize diversity, we purposefully selected individuals to invite for participation. We used the video meeting platform, Zoom, to conduct the cognitive interviews. The interviewer opened a document with the items to be tested, shared the screen with the participant, and gave them control of the mouse and keyboard. After the participant self-administered the survey, the interviewer asked about interpretation and comprehension. After completion of the interviews we sent participants a follow-up survey about their impressions of the research methods and technologies used. We describe the processes, the advantages and disadvantages, and offer recommendations for researchers.

RESULTS

We recruited and interviewed 30 young people from a range of regions, gender identities, sexual orientations, ages, education, and experiences with sexual activity. These methods allowed us to recruit a purposefully selected diverse sample in terms of race/ethnicity and region. It also may have offered potential participants a feeling of safety and anonymity leading to greater participation from gay, lesbian, and transgender people who would not have agreed to participate in-person. Conducting the interviews using video chat may also have facilitated the inclusion of individuals who would not volunteer for in-person meetings. Disadvantages of video interviewing included participant challenges to finding a private space for the interview and problems with electronic devices.

CONCLUSIONS

Online technologies can be used to achieve a diverse sample of research participants, contributing to research findings that better respond to young people's unique identities and situations.

Psychiatric comorbidities and adverse childhood experiences in women with self-reported polycystic ovary syndrome: An Australian population-based study

PURPOSE

PCOS is associated with increased risk for depression and anxiety but its association with other psychiatric disorders is less clear, especially in community drawn populations. We aimed to investigate the prevalence of psychiatric disorders in women with PCOS and examine the factors associated with psychiatric disorders in this population.

METHOD

A cross-sectional analysis of survey data was performed in community-recruited women born 1989-95 from the Australian Longitudinal Study of Women's Health (ALSWH). 760 and 7910 women with and without self-reported PCOS were included. The outcomes examined were self-reported depression, anxiety, post-traumatic stress disorder, bipolar affective disorder, obsessive compulsive disorder, borderline personality disorder and other disorders. The main explanatory variable was self-reported PCOS status. Other factors examined included adverse childhood experience scale (ACES), social support, perceived stress, sociodemographic and lifestyle factors. Chi-square tests were used to examine the differences in prevalence between groups. Logistic regression analyses were performed to assess factors associated with psychiatric disorders.

RESULTS

Women with PCOS reported a significantly higher prevalence of the psychiatric disorders examined, compared with women without PCOS. PCOS was significantly associated with depression (adjusted odds ratio (OR) 1.4, 95 % confidence interval (CI) 1.2-1.7), anxiety (adjusted OR 1.2, 95 % CI 1.0-1.5), post-traumatic stress disorder (adjusted OR 1.5, 95 % CI 1.1-1.9) and obsessive compulsive disorder (adjusted OR 1.8, 95 % CI 1.2-2.5). More women with PCOS reported adverse childhood experiences (ACES ≥4: 19.3 % vs 9.2 %) and this was the strongest factor associated with psychiatric disorders (ACES ≥4: adjusted OR 2.9, 95 % CI 2.4-3.5).

CONCLUSIONS

Women with PCOS had higher prevalence of various psychiatric conditions and adverse childhood experiences compared with women without PCOS. ACES was the strongest correlate of psychiatric disorders. These findings support PCOS is a reproductive, metabolic and psychological disorder and reinforces guideline recommendations to assess psychological wellbeing for in women with PCOS.

Impact of a Social Media Campaign on Reach, Uptake, and Engagement with a Free Web- and App-Based Physical Activity Intervention: The 10,000 Steps Australia Program

Social media campaigns provide broad-reach and convenience for promoting freely-available health programs. However, their effectiveness and subsequent engagement of new users is unknown. This study aimed to assess the reach and new member registration rates resulting from a dedicated 10,000 Steps social media campaign (SMC) and to compare program engagement and time to non-usage attrition of new users from the SMC with other users. SMC reach (using Facebook, Instagram, and display advertisements engagement metrics), new-user numbers, engagement (usage of the website and its features), and time to non-usage attrition were assessed using generalized linear regression, binary logistic regression, and Cox proportion hazards regression models. During the SMC, Instagram and display advertisement impressions, Facebook reach and new daily registrations were significantly higher compared with six weeks and one year prior. There were no between-group differences in the average usage of most website/program features. Risk of non-usage attrition was higher among new users from the SMC than new users from one year prior. The SMC was effective in promoting awareness of the 10,000 Steps program. Further research to identify long-term engagement strategies and the most effective combination of social media platforms for promotion of, and recruitment to, health programs is warranted.

Consent to data linkage in a large online epidemiological survey of 18-23 year old Australian women in 2012-13

Background

Consent to link survey data with health-related administrative datasets is increasingly being sought but little is known about the influence of recruiting via online technologies on participants’ consents. The goal of this paper is to examine what factors (sociodemographic, recruitment, incentives, data linkage information, health) are associated with opt-in consent to link online survey data to administrative datasets (referred to as consent to data linkage).

Methods

The Australian Longitudinal Study on Women’s Health is a prospective study of factors affecting the health and well-being of women. We report on factors associated with opt-in consent to data linkage at the end of an online survey of a new cohort of 18–23 year old Australian women recruited in 2012–13. Classification and Regression Tree analysis with decision trees was used to predict consent.

Results

In this study 69% consented to data linkage. The provision of residential address by the individual, or not (as a measure of attitudes towards privacy), was the most important factor in classifying the data into similar groups of consenters (76% consenters versus 47% respectively). Thereafter, for those who did not provide their residential address, the incentives and data linkage information that was offered was the next most important factor, with incentive 2: limited-edition designer leggings and additional information about confidentiality showing increases in consent rates over Incentive 1: AUD50 gift voucher: 60% versus 37%.

Conclusions

In young Australian women, attitudes towards privacy was strongly associated with consenting to data linkage. Providing additional details about data confidentiality was successful in increasing consent and so was cohort appropriate incentives. Ensuring that prospective participants understand the consent and privacy protocols in place to protect their confidential information builds confidence in consenting to data linkage.

Successful ageing from old to very old: a longitudinal study of 12,432 women from Australia

OBJECTIVES

We examined the development of disease and disability in a large cohort of older women, the extent to which these conditions exempt them from being classified as successful agers and different trajectories of disease, disability and longevity across women's later life.

METHODS

We used survey data from 12,432 participants of the 1921-26 birth cohort of the Australian Longitudinal Study of Women's Health from 1996 (age 70-75) to 2016 (age 90-95). Repeated measures latent class analysis (RMLCA) identified trajectories of the development of disease with or without disability and according to longevity. Bivariate analyses and multivariable multinomial logistic regression models were used to examine the association between participants' baseline characteristics and membership of the latent classes.

RESULTS

Over one-third of women could be considered to be successful agers when in their early 70s, few women could still be classified in this category throughout their later life or by the end of the study when they were in their 90s (~1%). RMLCA identified six trajectory groups including managed agers long survivors (9.0%) with disease but little disability, usual agers long survivors (14.9%) with disease and disability, usual agers (26.6%) and early mortality (25.7%). A small group of women having no major disease or disability well into their 80s were identified as successful agers (5.5%). A final group, missing surveys (18.3%), had a high rate of non-death attrition. Groups were differentiated by a number of social and health factors including marital status, education, smoking, body mass index, exercise and social support.

CONCLUSIONS

The study shows different trajectories of disease and disability in a cohort of ageing women, over time and through to very old ages. While some women continue into very old age with no disease or disability, many more women live long with disease but little disability, remaining independent beyond their capacity to be classified as successful agers.

Patterns of home and community care use among older participants in the Australian Longitudinal Study of Women's Health

The aims of this study were to investigate patterns of home and community care (HACC) use and to identify factors influencing first HACC use among older Australian women. Our analysis included 11,133 participants from the Australian Longitudinal Study of Women's Health (1921-1926 birth cohort) linked with HACC use and mortality data from 2001 to 2011. Patterns of HACC use were analysed using a k-median cluster approach. A multivariable competing risk analysis was used to estimate the risk of first HACC use. Approximately 54% of clients used a minimum volume and number of HACC services; 25% belonged to three complex care use clusters (referring to higher volume and number of services), while the remainder were intermediate users. The initiation of HACC use was significantly associated with (1) living in remote/inner/regional areas, (2) being widowed or divorced, (3) having difficulty in managing income, (4) not receiving Veterans' Affairs benefits, (5) having chronic conditions, (6) reporting lower scores on the SF-36 health-related quality of life, and (7) poor/fair self-rated health. Our findings highlight the importance of providing a range of services to meet the diverse care needs of older women, especially in the community setting.

Adverse childhood experiences and electronic cigarette use among young Australian women

Researchers have identified positive relationships between childhood adversities and smoking, problem drinking and illicit drug abuse. Nonetheless, to our knowledge, in no studies has there been an examination of the association between adverse childhood experiences (ACEs) and e-cigarette use. This study aimed to investigate the association between ACEs and e-cigarette use. Data from the Australian Longitudinal Study on Women's Health were used. Study respondents (N = 8915) from the 1989-95 cohort (third wave) aged 19-26 years completed an online survey in 2015. Multivariate logistic regression analysis was used to examine the association between ACEs and e-cigarette use, adjusted for socio-demographic variables and smoking status. Participants who reported past year e-cigarette use were more likely to report childhood psychological abuse (Adjusted odds ratio (AOR) = 1.45, 99%CI: 1.11, 1.90), physical abuse (AOR = 1.30, 99%CI, 1.03, 1.82), or sexual abuse (AOR = 1.41, 99%CI, 1.02, 1.95), All abuse types associated with past year e-cigarette use were also associated with ever e-cigarette use. Ever e-cigarette use was also associated with household substance abuse (AOR = 1.35, 99%CI, 1.08, 1.68), witnessing domestic violence (AOR = 1.28, 99%CI, 1.01, 1.69), or having a mentally ill household member (AOR = 1.28, 99%CI, 1.05, 1.58) compared with those who were not. A positive dose-response relationship was observed between the number of ACEs and the odds of e-cigarette use. This study identified an association between ACEs and e-cigarette use. Improvements in supportive parenting skills and the provision of counselling services for those exposed to ACEs may help avert health-harming behaviours, including e-cigarette use.

How different online recruitment methods impact on recruitment rates for the web-based coortesnaweb project: a randomised trial

Background

The number of web-based E-epidemiologic studies using online recruitment methods is increasing. However, the optimal online recruitment method in terms of maximizing recruitment rates is still unknown. Our aim was to compare the recruitment rates of three online recruitment methods and to describe how these rates differ according to individual’s socioeconomic and demographic factors.

Methods

A total of 2394 members of the 1993 Pelotas birth cohort that provided an e-mail address, a Facebook name, and a WhatsApp number during a face-to-face follow-up were randomly allocated to be recruited by e-mail, Facebook or WhatsApp (798 individuals per method). This was a parallel randomised trial applying a block randomisation (block size = 3). Between January and February 2018, we sent messages inviting them to register into the web-based coortesnaweb platform. Recruitment rates were calculated for each method, and stratified according to the individual’s socioeconomic and demographic characteristics. We also analysed absolute and relative inequalities on recruitment according to schooling and socioeconomic position.

Results

Out of the 2394 individuals analysed, 642 registered into the platform. The overall recruitment rate was 26.8%. Recruitment rates for women were almost 10 percentage points higher compared to men. Facebook was the most effective recruitment method, as 30.6% of those invited through the social network were recruited. Recruitment rates of e-mail and WhatsApp were similar (recruitment rate = 24.9%). E-mail and Facebook were the most effective recruitment methods to invite highly educated and wealthier individuals. However, sending e-mails to recruit individuals also reflected in the highest inequalities according to schooling and socioeconomic position. In contrast, the lowest inequalities according to socioeconomic position were observed using Facebook.

Conclusions

Facebook was the most effective online recruitment method, also achieving the most equitable sample in terms of schooling and socioeconomic position. The effectiveness of online recruitment methods depends on the characteristics of the sample. It is important to know the profile of the target sample in order to decide which online recruitment method to use.

Trial registration

Brazilian Registry of Clinical Trials, identifier: RBR-3dv7gc, retrospectively registered in 10 April 2018.

Electronic supplementary material

The online version of this article (10.1186/s12874-019-0767-z) contains supplementary material, which is available to authorized users.

Increased prevalence of eating disorders, low self-esteem, and psychological distress in women with polycystic ovary syndrome: a community-based cohort study

OBJECTIVE

To evaluate the prevalence of eating disorders in women with polycystic ovary syndrome (PCOS) compared with women without PCOS and examine the relationship between PCOS, body mass index, self-esteem, and psychological distress scores.

DESIGN

Cross-sectional, community-based study.

SETTING

Not applicable.

PATIENT(S)

A total of 8,467 participants born between 1989 and 1995 in the Australian Longitudinal Study on Women's Health with self-reported PCOS status (PCOS n = 875 vs. non-PCOS n = 7,592).

INTERVENTION(S)

None.

MAIN OUTCOME MEASURES(S)

Self-reported eating disorders, Rosenberg Self-Esteem Scale, and Kessler psychological distress scale.

RESULT(S)

Compared with women not reporting PCOS, women reporting PCOS had higher prevalence of eating disorders (11.0% vs. 7.6%), low self-esteem (31.7% vs. 24.2%), and psychological distress (severe psychological distress: 21.0% vs. 13.5%). After adjusting for confounders, women reporting PCOS were more likely to report eating disorders (adjusted odds ratio [OR] 1.6, 95% confidence interval [CI] 1.2-2.0). Low self-esteem and psychological distress were highly correlated and further increased the odds of eating disorders in women reporting PCOS. Polycystic ovary syndrome was significantly associated with low self-esteem and psychological distress but not after adjusting for confounders. Obesity was associated with low self-esteem (adjusted OR 1.5, 95% CI 1.2-1.8) and psychological distress (adjusted OR 1.2, 95% CI 1.0-1.4) but not eating disorders. Underweight women had increased odds for eating disorders (adjusted OR 2.5, 95% CI 1.8-3.4).

CONCLUSION(S)

Women with PCOS are more likely to report low self-esteem, psychological distress, and eating disorders. Low self-esteem and psychological distress are highly correlated and further increased the risk for eating disorders.

Compliance with Multiple Health Behaviour Recommendations: A Cross-Sectional Comparison between Female Cancer Survivors and Those with no Cancer History

Lifestyle behaviours have an important role in preventing cancer, reducing treatment side effects, and improving survival and quality of life for cancer survivors. This study investigated adherence to multiple lifestyle behaviours among women with and without a cancer history. From the Australian Longitudinal Study on Women’s Health (ALSWH) surveys, 2407 cancer survivors and 3896 controls (cancer free population) were identified. Based on the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations, adherence to six health behaviours (smoking, physical activity, fruit and vegetable intake, alcohol consumption, sugary drink intake, and Body Mass Index [BMI]) were assessed. Overall adherence was low, and there were no differences between survivors and controls on adherence to any of the six individual health behaviours. However, both recent and long-term cancer survivors were more likely than controls to adhere to multiple health behaviours (p < 0.05). When participants with melanoma or non-melanoma skin cancer were excluded, adherence was less likely (but not significant) in the cancer group than controls. Higher education (p < 0.01), being married (p < 0.01), and lower comorbidity of chronic illnesses (p < 0.01) were significantly associated with adherence to multiple lifestyle behaviours. Overall, the findings suggest that a cancer diagnosis may result in increased compliance with multiple health behaviour guidelines.

Facebook ads to the rescue? Recruiting a hard to reach population into an Internet-based behavioral health intervention trial

OBJECTIVE

Facebook (FB) ads are touted as a way to facilitate recruitment of hard to reach participants into digital health research but the evidence has been mixed. This study aimed to empirically evaluate the impact and cost-effectiveness of paid ads for recruitment into a national trial testing an Internet-based, coached intervention for parents of children with Fetal Alcohol Spectrum Disorders.

METHODS

Post hoc analysis of FB ad data and Google analytics on the online trial consent site (myStudies) were conducted on 11 campaigns employing static image/text ads. Standard metrics (e.g., click through rate, cost per 1000 impressions, cost per consent) were calculated and descriptive statistics comparing FB ad engagement and enrolled participants over time were conducted.

RESULTS

Ad campaigns were active for a combined 115 days over 58 weeks resulting in 1533 links to the online recruitment site. During the ad campaigns, the mean rate of enrolment was 1 participant every 2 days. The first 3 ad campaigns were the most cost-effective. Mean cost per enrolment was $19.27 (Canadian dollars).

CONCLUSIONS

FB ads were efficient and cost-effective in broad dissemination of trial information, but more research is needed to explore the impact of saturation (how often ads are posted), design (what is in the ad), and individual determinants (who is likely to respond to an ad) on converting FB ad engagement into enrolment. Avoiding a reductionist approach to analytics will help ensure appropriate and targeted strategies remain the priority for digital health research recruitment through social media.

Factors Influencing Web-Based Survey Response for a Longitudinal Cohort of Young Women Born Between 1989 and 1995

Background

With health research practices shifting toward rapid recruitment of samples through the use of online approaches, little is known about the impact of these recruitment methods on continued participation in cohort studies.

Objective

This study aimed to report on the retention of a cohort of young women who were recruited using an open recruitment strategy.

Methods

Women from the 1989-95 cohort of the Australian Longitudinal Study on Women’s Health, recruited in 2012 and 2013 were followed up annually via Web-based surveys in 2014, 2015, and 2016. Prevalence ratios for survey response were calculated using log-binomial models with generalized estimating equations including demographic, health-related, and recruitment method characteristics examined as explanatory factors.

Results

Of the 17,012 women who completed the baseline survey (Survey 1) in 2012 to 2013, approximately two-thirds completed Survey 2 (2014), and just over half completed Surveys 3 (2015) and 4 (2016). Women demonstrated transient patterns of responding with 38.21% (6501/17,012) of women completing all 4 surveys. Although retention of young women was associated with older age, higher education, higher self-rated health status, and low engagement with adverse health behaviors, the method of recruitment was a key determinant of study participation in the multivariate model. Although women were more likely to be recruited into the cohort via social media (eg, Facebook), retention over time was higher for women recruited through traditional media and referral approaches.

Conclusions

A balance must be obtained between achieving representativeness, achieving rapid cohort recruitment, and mitigating the pitfalls of attrition based on recruitment method in the new era of cohort studies, where traditional recruitment methods are no longer exclusively viable options.

Using Paid and Free Facebook Methods to Recruit Australian Parents to an Online Survey: An Evaluation

Background

The prevalence of social media makes it a potential alternative to traditional offline methods of recruiting and engaging participants in health research. Despite burgeoning use and interest, few studies have rigorously evaluated its effectiveness and feasibility in terms of recruitment rates and costs, sample representativeness, and retention.

Objective

This study aimed to determine the feasibility of using Facebook to recruit employed Australian parents to an online survey about managing work and family demands, specifically to examine (1) recruitment rates and costs; (2) sample representativeness, compared with a population-based cohort of parents; and (3) retention, including demographic and health characteristics of parents who returned to complete a follow-up survey 6 weeks later.

Methods

Recruitment was conducted using 20 paid Facebook advertising campaigns, supplemented with free advertising approaches such as posts on relevant Facebook pages and requests for professional networks to circulate the survey link via Facebook. Recruitment rates and costs were evaluated using the Checklist for Reporting Results of Internet E-Surveys, including view rate, participation rate, completion rate, cost per consent, and cost per completer. Sample representativeness was evaluated by comparing demographic and outcome variables with a comparable sample from the Longitudinal Study of Australian Children including educational attainment, marital status, country of birth, neighborhood disadvantage, work-family conflict, and psychological distress. Retention was evaluated by comparing the number and demographic characteristics of participants at recruitment and at 6-week follow-up.

Results

Recruitment strategies together resulted in 6653 clicks on the survey link, from which 5378 parents consented to participate and 4665 (86.74%) completed the survey. Of those who completed the survey, 85.94% (4009/4665) agreed to be recontacted, with 57.79% (2317/4009) completing the follow-up survey (ie, 43.08% [2317/5378] of parents who consented to the initial survey). Paid Facebook advertising recruited nearly 75% of the sample at Aus $2.32 per completed survey (Aus $7969 spent, 3440 surveys completed). Compared with a population-based sample, participants at baseline were more likely to be university educated (P<.001), experience greater work-family conflict (P<.001) and psychological distress (P<.001), and were less likely to be born outside Australia (P<.001) or live in a disadvantaged neighborhood (P<.001).

Conclusions

Facebook provided a feasible, rapid method to recruit a large national sample of parents for health research. However, some sample biases were observed and should be considered when recruiting participants via Facebook. Retention of participants at 6- to 8-week follow-up was less than half the initial sample; this may reflect limited ongoing participant engagement for those recruited through social media, compared with face-to-face.

Changes in smoking, drinking, overweight and physical inactivity in young Australian women 1996-2013

Issue addressed Smoking, risky drinking, overweight and obesity, and physical inactivity are health-risk factors (HRFs) that contribute significantly to morbidity worldwide. Several initiatives have been introduced over the past two decades to reduce these HRFs. This paper examines changes in the prevalence of HRFs in young women (aged 18-23 years) between 1996 and 2013, overall and within demographic groups. Methods Data from two cohorts of the Australian Longitudinal Study on Women's Health, born in 1973-78 (n=14247) and 1989-95 (n=17012) were weighted to provide national estimates. Prevalence ratios were used to compare HRFs in 2013 relative to 1996. Results In 1996, 32% were current smokers, 38% were risky drinkers, 22% were overweight or obese and 7% were physically inactive. In 2013, corresponding estimates were 19%, 35%, 33% and 6%. Between 1996 and 2013, overall smoking prevalence decreased, but remained over 43% among least educated women. Overweight and obesity increased in all demographic groups. Conclusions The findings suggest that only smoking, which has been the subject of changes in taxation, legislation and regulation, declined significantly, in all except the least educated women. In contrast, the prevalence of overweight and obesity, which has largely been addressed through awareness campaigns and voluntary actions by the food industry, increased markedly in all demographic sub-groups. So what? The findings show that comprehensive health promotion interventions, such as those for tobacco control, are successful (but may still be ineffective among less educated women). In contrast the measures to control population weight gain among young women have been futile so far.

Predictors of E-cigarette Use Among Young Australian Women

INTRODUCTION

E-cigarette use is controversial worldwide. The majority of previous studies on e-cigarette use were not gender specific. This study aimed to identify the predictors of e-cigarette use among young Australian women.

METHODS

This study used cross-sectional data from the 1989-1995 cohort of the Australian Longitudinal Study on Women's Health. In 2015, study participants (N=8,915) aged 19-26 years completed an online survey. Multivariable logistic regression was used to identify predictors of e-cigarette use. Data were analyzed in 2018.

RESULTS

The prevalence of ever and past-year e-cigarette use among young Australian women was 11.1% and 6.4%, respectively. More than a quarter of past-year and ever e-cigarette users were never cigarette smokers. Use of e-cigarettes in the past year was associated with younger age (AOR per year increase=0.87, 95% CI=0.82, 0.93); financial difficulty (AOR=0.68, 95% CI=0.54, 0.87); being an ex-smoker (AOR=5.05, 95% CI=3.64, 7.01) or current cigarette smoker (AOR=10.01, 95% CI=7.77, 12.89); drinking at a level of lifetime risk of harm from alcohol-related disease or injury (AOR=1.23, 95% CI=1.01, 1.53). Ever e-cigarette use showed similar associations and was also associated with rural residence (AOR=0.74, 95% CI=0.60, 0.91) and intimate partner violence (AOR=1.44, 95% CI=1.17, 1.76).

CONCLUSIONS

The high prevalence of e-cigarette use among never cigarette smokers has significant public health implications. Interventions to curb the use of e-cigarettes among young Australian women should focus on risk factors, such as early age, cigarette smoking, alcohol use, and intimate partner violence.

Facebook recruitment of smokers: comparing gain- and loss-framed ads for the purposes of an Internet-based smoking cessation intervention

Abstract: Gain- and loss-framed messages about smoking behavior have commonly been used to promote cessation. However, there are still no clear conclusions as to what kind of message is more effective for motivating smokers to quit. This study compared the effectiveness of loss- and gain-framed messages in the online recruitment of smokers via Facebook Advertising. Loss- and gain-framed messages about smoking were created and released as Facebook ads. Users who clicked on the ads were automatically redirected to the “Live Without Tobacco” intervention (http://www.vivasemtabaco.com.br). The amount spent on the ads was BRL 647.64. Data were collected from the Facebook Ads platform and from a relational database. Analyses were performed on the 6,350 users who clicked on one of the ads and 1,731 who were successfully redirected to the intervention. Gain-framed ads reached 174,029 people and loss-framed ads reached 180,527. The former received 2,688 clicks, while the latter received 3,662. The cost of the click was BRL 0.12 per gain-framed ad and BRL 0.09 per loss-framed ad. Loss-framed ads reached more users, got more clicks (and website accesses), and led to more accounts and quit plans being created. Loss-framed messages about smoking appear to be more cost-effective for both initial recruitment and intervention engagement. Facebook has proven to be a good outreach and recruitment tool and can be a solution for the difficulty in reaching smokers for cessation interventions.

Retention strategies in longitudinal cohort studies: a systematic review and meta-analysis

BACKGROUND

Participant retention strategies that minimise attrition in longitudinal cohort studies have evolved considerably in recent years. This study aimed to assess, via systematic review and meta-analysis, the effectiveness of both traditional strategies and contemporary innovations for retention adopted by longitudinal cohort studies in the past decade.

METHODS

Health research databases were searched for retention strategies used within longitudinal cohort studies published in the 10-years prior, with 143 eligible longitudinal cohort studies identified (141 articles; sample size range: 30 to 61,895). Details on retention strategies and rates, research designs, and participant demographics were extracted. Meta-analyses of retained proportions were performed to examine the association between cohort retention rate and individual and thematically grouped retention strategies.

RESULTS

Results identified 95 retention strategies, broadly classed as either: barrier-reduction, community-building, follow-up/reminder, or tracing strategies. Forty-four of these strategies had not been identified in previous reviews. Meta-regressions indicated that studies using barrier-reduction strategies retained 10% more of their sample (95%CI [0.13 to 1.08]; p = .01); however, studies using follow-up/reminder strategies lost an additional 10% of their sample (95%CI [- 1.19 to - 0.21]; p = .02). The overall number of strategies employed was not associated with retention.

CONCLUSIONS

Employing a larger number of retention strategies may not be associated with improved retention in longitudinal cohort studies, contrary to earlier narrative reviews. Results suggest that strategies that aim to reduce participant burden (e.g., flexibility in data collection methods) might be most effective in maximising cohort retention.

Patterns of aged care use among older Australian women: A prospective cohort study using linked data

BACKGROUND

Women live longer than men and have an increased need for long-term care. The objective of this study was to identify patterns of aged care use among older Australian women and to examine how these patterns were associated with their demographic and health-related characteristics.

METHODS

The sample consisted of 8768 women from the 1921-1926 birth cohort of the Australian Longitudinal Study on Women's Health (ALSWH), who had survived to age 75-80 years. ALSWH survey and linked administrative aged care and death datasets from 2001 to 2011 were utilized. Patterns of aged care use were identified using a repeated measure latent class analysis.

RESULTS

We identified four patterns of aged care use over time, differentiated by timing of service onset, types of service use and time of death. Approximately 41% of the sample were non-users or using basic home and community care (HACC), while 24% were at high risk of using moderate to high-level HACC/community aged care package (CACP). Only 11% had a greater risk of using residential aged care (RAC) over time. Being widowed, residing in remote/regional areas, having difficulty in managing income, having a chronic condition, reporting poor/fair self-rated health, and lower SF-36 quality of life scores were associated with an increased odds of being a member of the following classes: 1) moderate to high-level HACC/CACP, 2) increasing RAC, and 3) early mortality, compared with the non-user class.

CONCLUSIONS

Distinct patterns of aged care use were identified. These results will facilitate future capacity planning for aged care systems in Australia.

Research strategy for health sciences: Facebook friend request is non-differentially accepted in a diverse, young adult population

Social media is being used for recruitment and the study of health-care choices and behavior, and could be particularly helpful to reach young adult populations outside of a 4 year college setting. The aim of this study was to report on overall success of recruiting young adults in diverse settings with respect to education and employment into a study using Facebook (FB). Young adults (n = 380, 50% male, 44% white) who had been involved in a longitudinal research project received a friend request from the research study group's profile. Acceptance rates of friend requests and sociodemographic and mental health factors associated with acceptance were evaluated. Approximately 67% of 318 participants who received a friend request accepted the request. Sociodemographic and mental health characteristics were similar between those who did and did not accept friend requests, suggesting non-differential recruitment through FB. Friending through FB is a feasible way to reach young adults involved in health and behavioral research, and could be a way to expand the populations that are studied in health science research to maximize generalizability of the conclusions drawn.