Audio Computer-assisted Self-interview Research Articles

A Comparison of Self-reported Condomless Sex and Yc-DNA Biomarker Data from Young Women Engaged in High Risk Sexual Activity in Kampala, Uganda

Reporting of condom-use can limit researchers’ understanding of high-risk sexual behaviours. We compared self-reported condom-use with the Yc-DNA biomarker data and investigated potential factors influencing participation in, and reporting of, sexual behaviours. Self-reported data were collected using Audio Computer Assisted Self Interviews (ACASI) and samples for Yc-DNA biomarker were collected using self-administered and health worker-collected vaginal swabs from 644 women (aged 15–24 years) who were not living with HIV. Yc-DNA results and interview data were compared using McNemar-Bowker Analysis and Cohen’s Kappa. Test statistics for Yc-DNA biomarker were calculated. Log Binomial models for Yc-DNA and self-reported results were conducted to assess for association. We found strong evidence (p < 0.001) for a difference between Yc-DNA and self-reported results. 13.7% of participants reported consistent condom-use with all partners, regardless of HIV status. Self-reported condom-use was discordant in 50.0% (n = 206) of cases, when compared to Yc-DNA results. Positive Yc-DNA results were found to be associated with older age (RR 1.36; 95%CI 1.04, 1.76 p = 0.023). Self-reported condom-use with partners with unknown HIV status was associated with higher education (RR 0.76; 95%CI 0.58,0.99 p = 0.043). Sensitivity analysis did not determine difference between methods for controlling for missing data. We found significant under-reporting of condomless sex in the self-reported data when compared to Yc-DNA results.

The longitudinal association between sexual violence victimization and sexual risk behavior in adolescence

Being a victim of sexual violence (SV) is generally believed to be associated with subsequent sexual risk behavior (SRB) during adolescence. While this assumption makes intuitive sense, it is based on methodologically limited research, including a reliance on cross-sectional data. To address this gap in research, we test whether experiencing SV victimization in early adolescence is associated with self-reported SRB approximately two years later. The sample comprised 4,618 youth (58% female; 52% Hispanic; 39% Black) attending 44 schools in the southern United States. Self-reported data were collected using an audio computer-assisted self-interview (ACASI). Baseline data were collected when students were in 7th or 8th grade and follow-up data were collected approximately 24 months later when students were in 9th or 10th grade. Indices of SRB included behaviors related to oral, vaginal, and anal sex (e.g., number of partners, number of times without a condom). Girls, but not boys, who reported SV victimization at baseline reported engaging more frequently in all oral and vaginal SRBs at 24 month follow-up compared to their non-victimized female counterparts. Additionally, girls reporting SV victimization reported more anal sex partners than non-victimized girls. Girls who are victims of SV engage in significantly more SRB by early high school placing them at greater risk to contract STIs and become pregnant. Victims of SV should be screened for SRB and provided access to the appropriate resources. Teen pregnancy and STI prevention planning should consider SV victimization in their strategy planning.

Condom Use at Last Sex and Sexual Negotiation Among Young African American Women in North Carolina: Context or Personal Agency.

African American women are 10.8 times more likely to be diagnosed with HIV compared with White women. This descriptive study fills a gap by examining associations among social and contextual factors and sexual communication, condom use, and safer sex negotiation among African American women. Study participants between 18 and 25 years of age and who reported recent substance use were recruited from three North Carolina counties. A risk behavior survey was administered via audio computer-assisted self-interview, and logistic regression analyses were conducted to assess associations between social and contextual variables and condom use at last sex with a main partner. Education (AOR: 2.078; 95% CI: 1.214, 3.556), sexual communication with a main partner (AOR: 1.079; 95% CI: 1.050, 1.109), and condom use relationship scale (AOR: 1.059; 95% CI: 1.023, 1.098) were positively associated with condom use at last sex, whereas living with a main partner (AOR: 0.447; 95% CI: 0.210, 0.950) and the alcohol and drug problem scale (AOR: 0.971; 95% CI: 0.944, 0.998) were negatively associated with condom use (p < 0.05). The study findings show that among young African American women at risk for HIV, contextual and personal factors may influence condom use. A socio-ecological approach combining personal empowerment, interpersonal, structural, and biobehavioral strategies is necessary in implementing holistic gender-focused HIV prevention programs.

Sexual violence in early adolescence is associated with subsequent teen pregnancy and parenthood

Being a victim of sexual violence (SV) is associated with risk for teen pregnancy in cross-sectional research. However, longitudinal data are necessary to determine if SV victimization plays a causal role in early pregnancy. To address this gap in research, we test whether experiencing SV victimization in early adolescence is associated with pregnancy and having children by mid-adolescence. The current sample comprised 4594 youth (58% female; 51% Hispanic; 39% Black) attending 44 schools in the southern United States. Self-reported data were collected via audio computer-assisted self-interview (ACASI) when students were in 7th or 8th grade and again approximately 24 months later. Approximately 2.9% of boys and 8.2% of girls reported SV victimization at baseline. At follow-up, 3.4% of boys and 4.0% of girls reported being involved with one or more pregnancies; 1.1% of boys and girls reported having one or more children. Being a victim of SV at baseline was associated with pregnancy and having a child at follow-up for girls. SV was not related to outcomes among boys. The present findings indicate that girls victimized by SV are at risk of becoming pregnant and becoming teen parents. The combined sequelae of SV and teen pregnancy impair health, economic, and social functioning across the lifespan and carry forward into future generations. Future research should explore mechanisms through which victimization confers risk for pregnancy to inform prevention strategies.

A Web-Based Audio Computer-Assisted Self-interview Application With Illustrated Pictures to Administer a Hepatitis B Survey Among a Myanmar-Born Community in Perth, Australia: Development and User Acceptance Study.

Self-administered paper or electronic surveys can create accessibility issues for people with language barriers and limited literacy, whereas face-to-face interviews can create privacy issues and give rise to reporting biases, particularly in the context of sensitive subject matters. An audio computer-assisted self-interview (ACASI) offers an alternative mode of survey administration, and its use has been tested against other survey modes to determine whether the presence of a background narration helps overcome literacy and privacy issues. There are still gaps with the ACASI survey administration because audio narration alone does not assist respondents with limited literacy in choosing response options. To overcome literacy issues, a few studies have used illustrated pictures for a limited number of response options. This study aimed to illustrate all the questions and response options in an ACASI application. This research is part of a larger study comparing different modes of survey administration (ACASI, face-to-face interviews, and self-administered paper surveys) to collect data on hepatitis B knowledge, attitudes, and practices among the Myanmar-born community in Perth, Australia. This study describes the 2-phase process of developing a web-based ACASI application using illustrated pictures. The first phase was the preparation of the ACASI elements, such as questionnaire, pictures, brief descriptions of response options, and audio files. Each element was pretested on 20 participants from the target population. The second phase involved synchronizing all the elements into the web-based ACASI application and adapting the application features, in particular, autoplay audio and illustrated pictures. The preprototype survey application was tested for user acceptance on 5 participants from the target population, resulting in minor adjustments to the display and arrangement of response options. After a 12-month development process, the prototype ACASI application with illustrated pictures was fully functional for electronic survey administration and secure data storage and export. Pretesting each element separately was a useful approach because it saved time to reprogram the application at a later stage. Future studies should also consider the participatory development of pictures and visual design of user interfaces. This picture-assisted ACASI survey administration mode can be further developed and used to collect sensitive information from populations that are usually marginalized because of literacy and language barriers.

Alcohol-focused and transdiagnostic treatments for unhealthy alcohol use among adults with HIV in Zambia: A 3-arm randomized controlled trial.

Clinical and quality of life outcomes in people living with human immunodeficiency virus (PLWH) are undermined by unhealthy alcohol use (UAU), which is highly prevalent in this population and is often complicated by mental health (MH) or other substance use (SU) comorbidity. In sub-Saharan Africa, evidence-based and implementable treatment options for people with HIV and UAU are needed. We are conducting a hybrid clinical effectiveness-implementation trial at three public-sector HIV clinics in Lusaka, Zambia. Adults with HIV, who report UAU, and have suboptimal HIV clinical outcomes, will be randomized to one of three arms: an alcohol-focused brief intervention (BI), the BI with additional referral to a transdiagnostic cognitive behavioral therapy (Common Elements Treatment Approach [CETA]), or standard of care. The BI and CETA will be provided by HIV peer counselors, a common cadre of lay health worker in Zambia. Clinical outcomes will include HIV viral suppression, alcohol use, assessed by audio computer-assisted self-interview (ACASI) and direct alcohol biomarkers, Phophatidylethanol and Ethyl glucuronide, and comorbid MH and other SU. A range of implementation outcomes including cost effectiveness will also be analyzed. Hybrid and 3-arm trial design features facilitate the integrated evaluation of both brief, highly implementable, and more intensive, less implementable, treatment options for UAU among PLWH in sub-Saharan Africa. Use of ACASI and alcohol biomarkers will strengthen understanding of treatment effects.

Association of Electronic Cigarette Use by US Adolescents With Subsequent Persistent Cigarette Smoking

Many studies have reported a positive association of youth electronic cigarette (e-cigarette) use with subsequent cigarette smoking initiation, but it remains unclear whether e-cigarette use is associated with continued cigarette smoking after initiation. To assess the association of youth baseline e-cigarette use with their continued cigarette smoking 2 years after initiation. The Population Assessment of Tobacco and Health (PATH) Study is a national longitudinal cohort study. This sample consisted of youth who participated in waves 3, 4, and 5 of the study (wave 3 was from October 2015 to October 2016, wave 4 was from December 2016 to January 2018, and wave 5 was from December 2018 to November 2019) and had never used cigarettes (cigarette-naive) by wave 3. The current analysis used multivariable logistic regressions in August 2022 to assess the association between e-cigarette use among cigarette-naive adolescents aged 12 to 17 years in 2015 and 2016 and subsequent continued cigarette smoking. PATH uses audio computer-assisted self-interviewing and computer-assisted personal interviewing to collect data. Ever and current (past 30-day) use of e-cigarettes in wave 3. Continued cigarette smoking in wave 5 after initiating smoking in wave 4. The current sample included 8671 adolescents who were cigarette naive in wave 3 and also participated in waves 4 and 5; 4823 of the participants (55.4%) were aged 12 to 14 years, 4454 (51.1%) were male, and 3763 (51.0%) were non-Hispanic White. Overall, regardless of e-cigarette use, few adolescents (362 adolescents [4.1%]) initiated cigarette smoking at wave 4, and even fewer (218 participants [2.5%]) continued smoking at wave 5. Controlling for multiple covariates, the adjusted odds ratio of baseline ever e-cigarette use, compared with never e-cigarette use, was 1.81 (95% CI, 1.03 to 3.18) for continued smoking measured as past 30-day smoking at wave 5. However, the adjusted risk difference (aRD) was small and not significant. The aRD was 0.88 percentage point (95% CI, -0.13 to 1.89 percentage points) for continued smoking, with the absolute risk being 1.19% (95% CI, 0.79% to 1.59%) for never e-cigarette users and 2.07% (95% CI, 1.01% to 3.13%) for ever e-cigarette users. Similar results were found using an alternative measure of continued smoking (lifetime ≥100 cigarettes and current smoking at wave 5) and using baseline current e-cigarette use as the exposure measure. In this cohort study, absolute and relative measures of risks yielded findings suggesting very different interpretations of the association. Although there were statistically significant odds ratios of continued smoking comparing baseline e-cigarette users with nonusers, the minor risk differences between them, along with the small absolute risks, suggest that few adolescents are likely to continue smoking after initiation regardless of baseline e-cigarette use.

Leprosy among female prisoners in Brazil.

To estimate the prevalence of leprosy among Brazilian female prisoners and identify factors associated with the disease. Cross-sectional study conducted between 2014 and 2015 in 15 Brazilian female prisons. The data of 1,327 women were collected using Audio Computer-Assisted Self-Interviewing and dermatological and neurological examination to identify suspicious lesions of leprosy. The average age was 33.4 years. Suspicion of leprosy was identified in 5.1% of women in prison, and lifetime self-reported prevalence was 7.5%. The variables that were associated with lifetime self-reported leprosy were: women in prison once being twice as likely to have leprosy; white women were 1.4 time more likely to have leprosy than non-white women; women who knew someone with leprosy was 1.9 time more likely to have leprosy; and women who shared a cell with 11 or more women were 2.5 times more likely to have leprosy than women who shared a cell with two or fewer people. The leprosy prevalence among female prisoners in Brazil were greater than that found in a Brazilian woman of the general population and show the extremely high vulnerability of this population generated through pre-incarceration poverty, as well as potential transmission in prison.

Effectiveness of Cash Transfer Delivered Along With Combination HIV Prevention Interventions in Reducing the Risky Sexual Behavior of Adolescent Girls and Young Women in Tanzania: Cluster Randomized Controlled Trial.

BackgroundPoverty and social inequality exacerbate HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Cash transfers can influence the structural determinants of health, thereby reducing HIV risk.ObjectiveThis study assessed the effectiveness of cash transfer delivered along with combination HIV prevention (CHP) interventions in reducing the risky sexual behavior of AGYW in Tanzania. The incidence of herpes simplex virus type 2 (HSV-2) infection was used as a proxy for sexual risk behavior.MethodsA cluster randomized controlled trial was conducted in 15 matched pairs of communities (1:1 intervention to control) across 3 strata (urban, rural high-risk, and rural low-risk populations) of the Shinyanga Region, Tanzania. The target population was out-of-school AGYW aged 15-23 years who had completed 10-hour sessions of social and behavior change communication. Eligible communities were randomly assigned to receive CHP along with cash transfer quarterly (intervention group) or solely CHP interventions (control group) with no masking. Study recruitment and baseline survey were conducted between October 30, 2017 and December 1, 2017. Participants completed an audio computer-assisted self-interview, HIV counselling and testing, and HSV-2 testing at baseline and during follow-up visits at 6, 12, and 18 months after the baseline survey. A Cox proportional hazards model with random effects specified at the level of clusters (shared frailty) adjusted for matching pairs and other baseline imbalances was fitted to assess the effects of cash transfer on the incidence of HSV-2 infection (primary outcome). Secondary outcomes included HIV prevalence at follow-up, self-reported intergenerational sex, and self-reported compensated sex. All secondary outcomes were measured at each study visit.ResultsOf the 3026 AGYW enrolled in the trial (1482 in the intervention and 1544 in the control), 2720 AGYW (1373 in the intervention and 1347 in the control) were included in the final analysis. Overall, HSV-2 incidence was not significantly different at all follow-up points between the study arms in the adjusted analysis (hazard ratio 0.96, 95% CI 0.67-1.38; P=.83). However, HSV-2 incidence was significantly lower in the rural low-risk populations who received the cash transfer intervention (hazard ratio 0.45, 95% CI 0.29-0.71; P=.001), adjusted for potential confounders.ConclusionsAlthough this trial showed no significant impact of the cash transfer intervention on HSV-2 incidence among AGYW overall, the intervention significantly reduced HSV-2 incidence among AGYW in rural low-risk communities. Factors such as lesser poverty and more asset ownership in urban and rural high-risk communities may have undermined the impact of cash transfer.Trial RegistrationClinicalTrials.gov NCT03597243; https://clinicaltrials.gov/show/NCT03597243

Detecting underreporters of abortions and miscarriages in the national study of family growth, 2011-2015.

This paper draws on individual-level data from the National Study of Family Growth (NSFG) to identify likely underreporters of abortion and miscarriage and examine their characteristics. The NSFG asks about abortion and miscarriage twice, once in the computer-assisted personal interviewing (CAPI) part of the questionnaire and the other in the audio computer-assisted self-interviewing (ACASI) part. We used two different methods to identify likely underreporters of abortion and miscarriage: direct comparison of answers obtained from CAPI and ACASI and latent class models. The two methods produce very similar results. Although miscarriages are just as prone to underreporting as abortions, characteristics of women underreporting abortion differ somewhat from those misreporting miscarriages. Underreporters of abortions tended to be older, poorer, less likely to be Hispanic or Black, and more likely to have no religion. They also reported more traditional attitudes toward sexual behavior. By contrast, underreporters of miscarriage also tended to be older, poorer, and more likely to be Hispanic or Black, but were also more likely to have children in the household, had fewer pregnancies, and held less traditional attitudes toward marriage.

Predictors of Pre-exposure Prophylaxis Awareness among African American Young Adults in Louisville, Kentucky

Low pre-exposure prophylaxis (PrEP; medication to reduce HIV risk among HIV-negative people) awareness may be partially responsible for racial/ethnic differences in treatment uptake. Little research has examined PrEP awareness among African Americans with diverse HIV risk profiles. Audio computer-assisted self-interviews were distributed to 204 African American young adults (age 18-29) demonstrating heightened HIV vulnerability. Chi square analysis and logistic regressions were conducted to determine factors associated with PrEP awareness. While unadjusted logistic regression indicates that age 18-21 years (p&lt;.01), heterosexuality (p&lt;.05), lower education (p&lt;.05), less frequent HIV testing (p&lt;.01), STI diagnosis history (p&lt;.05), not having casual sex (p&lt;.05), and not having a one night stand (p&lt;.01) were associated with decreased PrEP awareness, only heterosexuality (p&lt;.05), lower education (p&lt;.05), and less HIV testing (p&lt;.01) remained significant in adjusted analysis. PrEP-focused education efforts should include outreach across education gradients and sexual orientations. Counselling efforts included with HIV testing may be responsible for accelerating PrEP knowledge among testers.

Prevalence and predictors of depression among women attending antenatal care in Moshi, Tanzania: a cross-sectional study

IntroductionAntenatal depression in low-and middle-income countries is under-diagnosed and leads to poorer outcomes in the pregnancy and postpartum periods. The aim of this study was to quantify depressive symptoms among pregnant women in Moshi, Tanzania, and identify factors associated with probable depression.MethodsBetween March and December 2019, we enrolled 1039 pregnant women attending their first antenatal care appointment at two government health facilities to complete an audio computer-assisted self-interview. Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale (EPDS), with a score > 13 indicating probable depression. A log-binomial regression model was used to identify factors associated with probable antenatal depression.ResultsA total of 11.5% (119/1033) met criteria for probable depression. Depression was more common among women who were not married (16.5% vs. 7.9%, PrR = 1.5, 95% CI 1.0, 2.1) and women who reported a lifetime history of violence (22.6% vs. 5.3%, PrR = 3.3, 95% CI 2.2, 5.0). Depression was less common among women who reported more partner-specific support (PrR = 0.92, 95% CI 0.87, 0.96).ConclusionsScreening pregnant women for depressive symptoms is an essential component of evidence-based maternity care and should be accompanied by appropriate support and resources. Women who are not married, have limited support from a partner, or have experienced violence are especially vulnerable to depressive symptomatology during pregnancy.

Estimating the effects of legalizing recreational cannabis on newly incident cannabis use.

Liberalized state-level recreational cannabis policies in the United States (US) fostered important policy evaluations with a focus on epidemiological parameters such as proportions [e.g., active cannabis use prevalence; cannabis use disorder (CUD) prevalence]. This cannabis policy evaluation project adds novel evidence on a neglected parameter-namely, estimated occurrence of newly incident cannabis use for underage (<21 years) versus older adults. The project's study populations were specified to yield nationally representative estimates for all 51 major US jurisdictions, with probability sample totals of 819,543 non-institutionalized US civilian residents between 2008 and 2019. Standardized items to measure cannabis onsets are from audio computer-assisted self-interviews. Policy effect estimates are from event study difference-in-difference (DiD) models that allow for causal inference when policy implementation is staggered. The evidence indicates no policy-associated changes in the occurrence of newly incident cannabis onsets for underage persons, but an increased occurrence of newly onset cannabis use among older adults (i.e., >21 years). We offer a tentative conclusion of public health importance: Legalized cannabis retail sales might be followed by the increased occurrence of cannabis onsets for older adults, but not for underage persons who cannot buy cannabis products in a retail outlet. Cannabis policy research does not yet qualify as a mature science. We argue that modeling newly incident cannabis use might be more informative than the modeling of prevalences when evaluating policy effects and provide evidence of the advantages of the event study model over regression methods that seek to adjust for confounding factors.

Association Between Subjective Age and Depressive Symptoms Among Middle-Aged and Aging HIV-Positive and HIV-Negative Men in the Multicenter AIDS Cohort Study

Introduction Older subjective age, or felt age, has been positively associated with being HIV-positive and having less than a high school education, depressive symptoms, diabetes, and medium and low aging satisfaction. To our knowledge, there is no literature exploring the association between subjective aging and depression among people living with HIV. Data from the Multicenter AIDS Cohort Study (MACS) was used to understand the role that subjective aging plays on depression among people who are living with and without HIV. We hypothesized that feeling older will be negatively associated with presenting symptoms of depression among men living with HIV compared to men living without HIV following an adjustment to the model to control for covariates. Methods The MACS is an observational cohort study that follows sexual minority men living with and without HIV in four sites within the United States: Baltimore, Maryland/Washington, DC; Chicago, Illinois; Los Angeles, California; and Pittsburgh, Pennsylvania/Columbus, Ohio. MACS participants attend semiannual visits that collect social, behavioral, medical history, and specimens using an Audio Computer-Assisted Self-Interview and standardized clinical examinations. The study design of the MACS has been described elsewhere. From 1984 to 2018, 7,352 men have been enrolled the MACS. 1,118 of these men were included in this study from the MACS substudy, ‘Understanding Patterns of Healthy Aging Among Men Who Have Sex With Men’, which was administered in six waves between March 2016 and September 2019. We used cross-sectional data from October 2016 to April 2017. Odds ratios (including 95% CIs) were generated using logistic regression models to test the association of subjective age with the presence of depressive symptoms (defined as a score &gt;=16 using the Center for Epidemiological Study Depression scale). Odds ratios were adjusted for age, race/ethnicity, educational attainment, smoking status, history of hypertension, renal disease, dyslipidemia, liver disease, diabetes and HIV status. Results After adjusting for covariates, older age discrepancy was associated with higher odds of depressive symptoms (vs younger discrepancy; OR: 4.00; 95% CI: 2.39-6.69). Increasing age (5-year increase; OR: 0.81; 95% CI: 0.72-0.91) was associated with lower odds of depressive symptoms. Lower educational attainment was associated with higher odds of depressive symptoms (less than high school degree vs graduate school; OR: 5.33; 95% CI: 1.96-14.53) (high school vs graduate school: OR: 1.93; 95% CI: 1.10-3.37). There was no statistically significant association of HIV status or other covariates with risk of depressive symptoms. Conclusion Our findings demonstrated a statistically significant positive association between older subjective age (independent of increasing chronological age) and greater risk of depressive symptoms. We also found that having a high school or less than a high school education also increased this risk. Statistical significance was not present based on HIV status or other covariates in the adjusted model. Health care professionals should be aware of their patient’s perception of aging in order to address depressive symptoms related to feeling older. Counteracting a person feeling older can be achieved through exercising regularly, prioritizing preventive care, maintaining a vibrant social life, and having an optimistic attitude on the years ahead of them.

Alcohol, drug use, and sexual risk among young African American women in North Carolina: is educational attainment protective?

ABSTRACT Previous research has shown that educational attainment is a protective factor for substance use and sexual risk among adolescents and young adults. Evidence also shows that this relationship may differ by race/ethnicity and gender. This study aimed to elucidate the relationship between educational attainment, substance use, and sexual risk among African American women in emerging adulthood. This study uses cross-sectional data from 646 African American women (aged 18 to 25) enrolled in a randomized trial of a behavioral HIV risk-reduction intervention. At enrollment, participants completed a risk behavior assessment via audio-computer assisted self-interview and provided a urine sample for drug screening. Bivariate logistic regression analyses were conducted to examine substance use and sexual risk factors associated with educational attainment: completing some college or more as compared with completing high school or less. Participants who completed some college or more (52%) were more likely to report heavy alcohol use (four or more drinks in one day) in the past 30 days (OR = 1.48; p = 0.014) and more likely to report alcohol or other drug use just before or during last sex (OR = 1.43; p = 0.026) compared with participants who completed high school or less. Completing some college or more was protective for having a positive urine screen for cocaine (OR = 0.43; p = 0.018) and reporting condomless sex at last sex (OR = 0.71; p = 0.041). Differences in positive marijuana screens, reporting a previous STI, or reporting their partner used alcohol or other drugs at last sex were not statistically significant. The findings reveal notable differences in the magnitude and direction of associations between educational attainment and substance use and sexual risk. Although educational attainment is subject to change because of the frequent pursuit of education during emerging adulthood, the findings may have important implications for tailoring HIV risk-reduction interventions to key populations, such as African American women.

Developing ACASI questionnaires in Borno State, Nigeria during COVID-19: Using data-informed processes to address complexity, sensitivity, and functionality of family functioning and wellbeing measures

ABSTRACT Audio Computer-Assisted Self-Interview (ACASI) has become increasingly popular for collecting data on sensitive topics among populations with lower levels of literacy. However, the development of an ACASI tool is an involved process that can be further complicated when working in humanitarian contexts during the COVID-19 pandemic. This study describes the development of an ACASI tool to be used in a family-focused intervention evaluation. Participants included adolescent girls aged 10-14, adolescent boys aged 15-19, and caregivers in Borno State, Nigeria.  Data to inform the tool’s development were collected using cognitive interviews, ACASI demonstrations, and post-demonstration assessments with adolescent girls, adolescent boys, and caregivers, as well as a focus group discussion with enumerators. Data found high levels of acceptance for the tool and helped identify appropriate visual representations for various answer options to maximize usability. The survey was found to be too long to administer solely through ACASI; the final tool employs a combination of ACASI and computer-assisted personal interview formats. Findings highlight the importance of repeatedly piloting and testing these types of tools to ensure content and language resonate with intended users. However, the steps employed demonstrate that researchers can maintain a commitment to developing high-quality, community-grounded research tools despite challenges germane to humanitarian settings.

Use of Menthol Cigarettes, Smoking Frequency, and Nicotine Dependence Among US Youth

Menthol may make cigarette smoke less aversive and could lead youth to smoke more frequently and become more dependent on nicotine. To assess the association of menthol use with cigarette smoking frequency and nicotine dependence (ND) among youth cigarettes users. This cohort study used a pooled sample of cohorts of US youth (aged 12-17 years at their baseline and follow-up interviews) in the Population Assessment of Tobacco and Health Study (September 2013 to November 2019). Household interviews were conducted using audio computer-assisted self-interviews. US youth who were past-30-day cigarette smokers at any of wave 2 through wave 5, completed the preceding survey (eg, wave 2 past-30-day cigarette smokers completed wave 1), and indicated whether they used menthol cigarettes were eligible. The association of menthol use with smoking frequency and ND was estimated using inverse probability of treatment weighting adjusted mean differences (aMDs), adjusted risk ratios (aRRs), and corresponding 95% CIs. Data were analyzed from December 2021 to March 2022. Menthol use and transitions in use (switching to or from menthol cigarettes). Main outcomes were the number of days smoked in the past 30 days, the risk of frequent smoking (smoking ≥20 days in the past 30 days), and symptoms of ND. There were a total of 1492 observations among 1096 US youth cigarette smokers, of whom 49.4% were female, 67.2% were non-Hispanic White, and 28.7% were aged 12 to 14 years at their baseline survey (all percentages are weighted). Among those who switched from not smoking to smoking (61% of the sample), menthol use was associated with smoking on 3.1 additional days (aMD; 95% CI, 1.9 to 4.2 days), 59% higher risk of being a frequent smoker (aRR, 1.59; 95% CI, 1.23 to 2.06), and 10% higher ND scores (aMD, 1.09; 95% CI, 1.02 to 1.17). Switching from smoking menthol to smoking nonmenthol (vs maintaining menthol use) was associated with smoking on 3.6 fewer days (aMD; 95% CI, -6.3 to -0.9 days) and 47% lower risk of being a frequent smoker (aRR, 0.68; 95% CI, 0.50 to 0.92). These findings suggest that the addition of menthol to cigarettes is associated with increased smoking frequency and ND among US youth.

Comparison of the ACASI Mode to Other Survey Modes in Sexual Behavior Surveys in Asia and Sub-Saharan Africa: Systematic Literature Review.

BackgroundReliable data about sexual behaviors is fundamental in the prevention and control of HIV, hepatitis, and other sexually transmitted infections. Generally, sexual behaviors are regarded as a sociocultural taboo in Africa and Asia, and this results in biased sexual behavior survey data due to social desirability. Various modes of survey delivery, including audio computer-assisted self-interviews (ACASIs), have been investigated to improve data quality.ObjectiveThis study aimed to review studies that compared the ACASI mode to other survey modes in sexual behavior surveys in Asia and sub-Saharan Africa to ascertain the impact of survey mode on responses to sexual behavior questions.MethodsA systematic literature review was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis. The review protocol was registered at PROSPERO (International Prospective Register of Systematic Reviews). Six databases were searched.ResultsA total of 21 papers were included. The face-to-face interview (FTFI) mode was the survey mode most frequently compared to the ACASI mode. Among the most commonly reported outcome variable groups, ACASI participants were more likely to report sexual behaviors, such as “forced sex,” “multiple partners,” “transactional sex,” and “ever had sex,” as compared to FTFI participants. In addition to the survey mode effect, other factors were found to have had an impact on data quality, for example, participant characteristics, social norms, study design, and data collection setting.ConclusionsUse of ACASIs for administering sexual behavior surveys among populations in Asia and sub-Saharan Africa demonstrated higher reports for some sexual behaviors than the use of FTFIs. More studies that compare the ACASI mode to other survey modes would improve our understanding of the usefulness of ACASIs in sexual behavior surveys in these regions.

Number of sexual partners and serum testosterone levels in a population-based sample of unpartnered heterosexual men.

The relationship between men's testosterone levels and their sexual behaviors is unclear as existing studies find mixed results. The key objective of this study is to assess whether men's testosterone levels are affected by sexual behaviors and to explore whether this relationship varies by age. Specifically, this study addresses the question: Are men's testosterone levels affected by the number of sexual partners they accrue? This analysis was based on a nationally representative sample of 977 unpartnered heterosexual men between the ages of 20 and 65 in the United States. Serum testosterone levels were measured from blood samples using isotope dilution liquid chromatography tandem mass spectrometry and the number of sexual partners in the past 12months was ascertained from an audio computer-assisted personal self-interview. Using ordinary least squares regression, serum testosterone levels were predicted as a function of the number of sexual partners that men reported, sociodemographic characteristics, and factors known to affect endocrine regulation. An interaction term between the number of sexual partners in the past 12months and age was included. The correlation between the number of sexual partners in the past 12months and testosterone levels is contingent upon age: The relationship is positive for younger men but negative for older men. Among 20-year-old unpartnered heterosexual men, an additional sexual partner in the past 12months is associated with an increase of 5.55ng/dl of testosterone (95% confidence interval (CI): 2.92, 8.19). This initial positive effect at age 20 is reduced by 0.25ng/dl of testosterone (95% CI: -0.44, -0.06) with each year that men age. Testosterone levels in men are related to reproductive behaviors, but the direction of this relationship changes as men age.

Discrepant abortion reporting by interview methodology among men from the United States National Survey of Family Growth (2015-2017)

Objective: To examine discrepancies in men's abortion reporting when queried via face-to-face interview versus audio computer-assisted self-interviewing (ACASI) in the National Survey of Family Growth (NSFG). Study Design: The NSFG collects nationally representative data on family life, sexual behavior, and reproductive health in the United States. The questionnaire is administered to participants via face-to-face interview (FTF), with selected items also asked of the same participant via ACASI for direct comparison. As the 2015-2017 NSFG queried individuals’ abortion history via both methods, we examined discrepant reporting among respondents. We additionally explored sociodemographic and reproductive characteristics associated with discrepant abortion reporting in a multivariable logistic regression model. Results: Of 4540 male respondents ages 15-49, 45.3% reported a pregnancy. Via FTF, 12.3% reported an abortion, compared to 19.9% via ACASI (p < 0.01). With respect to discrepancies in the number of reported abortions, 8.5% of respondents reported more abortions via ACASI versus FTF. Multivariable logistic regression modeling noted independently greater odds of abortion reporting in ACASI among non-Hispanic Black men (aOR 2.31, 95% CI 1.19-4.45), men living below the Federal Poverty Level (less than 100% FPL: aOR 3.65, 95% CI 1.93-6.89; 100-400% FPL: aOR 2.04, 95% CI 1.20-3.45), and those desiring more children in the future (aOR 1.91, 95% CI 1.20-3.04). Conclusion: Men were more likely to disclose their abortions in ACASI compared to FTF interview. Disproportionate, discrepant abortion reporting among low-income, minority men who report desiring more children in the future warrants further research. Implications: Surveys utilizing ACASI as an adjunct to FTF interviews may more accurately capture men's abortion experience.