Computer-assisted Telephone Interview Survey Research Articles

Workplace-related smoking in New South Wales: extent of bans, public attitudes and relationships with relapse

Little research has examined issues surrounding employee smoking outside smoke-free workplaces. The study's aims were to: 1) document the proportion of NSW indoor employees covered by total workplace smoking bans; 2) examine community perceptions of employee smoking during working hours; 3) identify the characteristics of having a supportive attitude toward tobacco control in the workplace; and 4) describe relationships between smoking relapse and workplace-related smoking. Two cross-sectional, computer-assisted telephone interview surveys of randomly selected adults were conducted. Consent rates were 49.1% in 2004 and 45.8% in 2006, with sample sizes of 1,158 and 2,393 respectively. Total workplace bans were reported by 92.9% of indoor employees. Community attitudes to smoking in working hours were highly negative: 77.7% agreed smoking breaks waste too much time and 85.1% opposed smoking near workplace doorways. Being female, born in Australia and a non-smoker were associated with more negative attitudes. A higher proportion of smokers (78.3%) perceived smoking was more common outside their place of work or study than at five other locations: rail/bus stop (60.2%), friends' houses (59.3%), own street (35.2%), parks (34.3%), and outside school (22.6%). Of smokers making a quit attempt in the past year, 42.1% relapsed at home, 22.1% at licensed premises and 18.7% at work. Findings emphasise the low support for smoking during or near work. Smoking outside workplaces is highly visible. Data on relapse suggest a modest relationship with workplace-related smoking.

One-year prevalence of migraine in Spain: A nationwide population-based survey

The purpose of the study was to estimate the one-year prevalence of migraine among a population-based sample of Spanish adults. Men and women aged 18-65 years were selected at random according to quotas for age, sex, size of habitat (<10,000 inhabitants, 10,001-50,000 inhabitants, 50,001-200,000 inhabitants and >200,000 inhabitants) and residence proportional to the population size of the geographical location. A random-digit-dial, computer-assisted telephone interview (CATI) survey was conducted between April and July 2006. The 2004 International Headache Society operational diagnostic criteria were applied. From a total of 70,692 telephone calls and 26,255 (31.7%) valid contacts, 5,668 (21.6%) respondents completed the CATI survey. A total of 476 subjects (8.4%, 95% confidence interval [CI] 7.7-9.1%) with strict migraine and 236 with probable migraine (4.2%, 95% CI 3.7-4.7%) were recorded. The 1-year prevalence of total migraine (N = 712) was 12.6% (95% CI 11.6-13.6) (17.2% in females, 8.0% in males). The prevalence rates showed significant geographic variations, from 7.6% in Navarra to 18% in the Canary Islands. One-half of the subjects had migraine with aura. One-third of subjects were never diagnosed for migraine. The one-year prevalence of migraine in Spain is 12.6%, with a prevalence of migraine with and without aura of 8.4% and probable migraine of 4.2%. These findings add data to the current understanding of migraine.

Pharmacy access to the emergency contraceptive pill: a national survey of a random sample of Australian women

Background The emergency contraceptive pill (ECP) has the potential to assist in reducing unintended pregnancy and abortion rates. Since its rescheduling to pharmacy availability without prescription in Australia in January 2004, there is little information about Australian women's knowledge, attitudes and use of the ECP. The aim of this study was to measure the knowledge about the ECP and sociodemographic patterns of and barriers to use of the ECP. Study Design A cross-sectional study, using a computer-assisted telephone interview (CATI) survey conducted with a national random sample of 632 Australian women aged 16–35 years. Results Most women had heard of the ECP (95%) and 26% had used it. The majority of women agreed with pharmacy availability of the ECP (72%); however, only 48% were aware that it was available from pharmacies without a prescription. About a third (32%) believed the ECP to be an abortion pill. The most common reason for not using the ECP was that women did not think they were at risk of getting pregnant (57%). Logistic regression showed that women aged 20–29 years (OR 2.58; CI: 1.29–5.19) and 30–35 years (OR 3.16; CI: 1.47–6.80) were more likely to have used the ECP than those aged 16–19 years. Women with poor knowledge of the ECP were significantly less likely to have used it than those with very good knowledge (OR 0.28; CI: 0.09–0.77). Those in a de facto relationship (OR 2.21; CI: 1.27–3.85), in a relationship but not living with the partner (OR 2.46; 95% CI 1.31–4.63) or single women (OR 2.40; CI: 1.33–4.34) were more likely to have used the ECP than married women. Conclusions Women in Australia have a high level of awareness of the ECP, but more information and education about how to use it and where to obtain it are still needed.

Reports of alcohol‐related problems and alcohol dependence for demographic subgroups using interactive voice response versus telephone surveys: The 2005 US National Alcohol Survey

Interactive voice response (IVR), a computer-based interviewing technique, can be used within a computer-assisted telephone interview (CATI) survey to increase privacy and the accuracy of reports of sensitive attitudes and behaviours. Previous research using the 2005 National Alcohol Survey indicated no overall significant differences between IVR and CATI responses to alcohol-related problems and alcohol dependence. To determine if this result holds for demographic subgroups that could respond differently to modes of data collection, this study compares the prevalence rates of lifetime and last-year alcohol-related problems by gender, ethnicity, age and income subgroups obtained by IVR versus continuous CATI interviewing. As part of the 2005 National Alcohol Survey, subsamples of English-speaking respondents were randomly assigned to an IVR group that received an embedded IVR module on alcohol-related problems (n = 450 lifetime drinkers) and a control group that were asked identical alcohol-related problem items using continuous CATI (n = 432 lifetime drinkers). Overall, there were few significant associations. Among lifetime drinkers, higher rates of legal problems were found for white and higher income respondents in the IVR group. For last-year drinkers, a higher percentage of indicators of alcohol dependence was found for Hispanic respondents and women respondents in the CATI group. Data on alcohol problems collected by CATI provide largely comparable results to those from an embedded IVR module. Thus, incorporation of IVR technology in a CATI interview does not appear strongly indicated even for several key subgroups.

Spending, Shopping and Saving: Ex-Smokers' Perceptions About Material Gains Following Quitting

AbstractObjective:To measure (a) the perceived amount of money saved by ex-smokers after quitting, (b) changes in shopping behaviours and (c) alternative uses of the money saved.Design:A 2006 computer-assisted telephone interview survey of smoking-related behaviours and attitudes in New South Wales, Australia.Main outcome measures:Participants (N= 147) who had quit smoking in the previous 12 months answered items regarding personal expenditure on tobacco smoking.Results:Most (51%) ex-smokers reported spending up to $40 per week on cigarettes when they smoked. Fifty-six per cent of lower socioeconomic status (SES) ex-smokers reported spending over $40 per week on cigarettes compared to 40% of those from higher socioeconomic areas. Almost a third (28%) of respondents reported shopping more or shopping at different locations since quitting. The three highest alternative items purchased since quitting were food (19%). other things not listed (13%) and clothing (10%); however, most respondents reported not changing their spending habits (54%).Conclusion:This study indicates that tobacco is a high-cost product with smokers spending approximately 5% of average weekly income on cigarettes. Those living in lower SES areas report spending more on cigarettes than those in higher SES areas. The majority of quitters could not identify any change in spending or saving as a result of quitting. However, changes in shopping behaviours were noted. It may be useful for quitters to quarantine their cigarette money to increase the salience and power of financial benefit as an incentive to maintain quitting.

The DECISIONS Study: A Nationwide Survey of United States Adults Regarding 9 Common Medical Decisions

Patient involvement is required before patients' preferences can be reflected in the medical care they receive. Furthermore, patients are a vital link between physicians' assessments of patients' needs and actual implementation of appropriate care. Yet no study has specifically examined how and when a representative sample of patients considered, discussed, and made medical decisions. To identify decision prevalence and decision-making processes regarding 1) initiation of prescription medications for hypertension, hypercholesterolemia, or depression; 2) screening tests for colorectal, breast, or prostate cancer; and 3) surgeries for knee or hip replacement, cataracts, or lower back pain. Computer-assisted telephone interview survey. Nationally representative sample of US adults in households with telephones. 3010 English-speaking adults age 40 and older identified using a stratified random sample of telephone numbers. Estimated prevalence of medical decisions, defined as the patient having initiated medications, been screened, or had surgery within the past 2 years or having discussed these actions with a health care provider during the same interval, as well as decision-specific data regarding patient knowledge, attitudes and patient-provider interactions. 82.2% of the target population reported making at least 1 medical decision in the preceding 2 years. The proportion of decisions resulting in patient action varied dramatically both across decision type (medications [61%] v. screening [83%] v. surgery [44%]; P < 0.001), and within each category (e.g., blood pressure medications [76%] v. cholesterol medications [55%] vs. depression medications [48%]; P < 0.001). Respondents reported making more decisions if they had a primary care provider or poorer health status and fewer decisions if they had lower education, were male, or were under age 50. Limitations. Retrospective self-reports may incorporate recall biases. Medical decisions with significant life-saving, quality of life, and cost implications are a pervasive part of life for most US adults. The DECISIONS dataset provides a rich research environment for exploring factors influencing when and how patients make common medical decisions.

Acceptance of pandemic (H1N1) 2009 influenza vaccination by the Australian public

To investigate the Australian public's expectations, concerns and willingness to accept vaccination with the pandemic (H1N1) 2009 influenza vaccine. A computer-assisted telephone interview survey was conducted between 20 August and 11 September 2009 by trained professional interviewers to study issues relating to vaccine uptake and perceived safety. The sample comprised 1155 randomly selected representative adults who had participated in a 2007 national study exploring knowledge and perceptions of pandemic influenza. Likely acceptance of pandemic (H1N1) 2009 vaccination, factors associated with acceptance, and respondents' willingness to share Australian vaccine with neighbouring developing countries. Of 1155 possible participants, 830 (72%) were successfully interviewed. Twenty per cent of the study group (169/830) reported that they had developed influenza-like symptoms during the 2009 pandemic period. Most respondents (645/830, 78%) considered pandemic (H1N1) 2009 to be a mild disease, and 211/830 (25%) regarded themselves as being at increased risk of infection. Willingness to accept pandemic (H1N1) 2009 vaccination was high (556/830, 67%) but was significantly lower than when pandemic vaccination uptake was investigated in 2007 (88%; P < 0.0001). Respondents who had already been vaccinated against seasonal influenza and those who perceived pandemic (H1N1) 2009 to be severe were significantly more willing to accept vaccination. Most respondents (793/822, 96%) were willing to share surplus vaccine with developing countries in our region. Although two-thirds of Australian adults surveyed were willing to accept pandemic (H1N1) 2009 vaccination, and most supported sharing vaccine with developing countries, there is a need for accessible information on vaccine safety for those who are undecided about vaccination.

Are Australian consumers willing to pay for the installation of reversing cameras in motor vehicles?

In Australia, more than one toddler per month dies from being run over in a driveway and many more are injured. While there is currently no regulation in Australia regarding reverse warning systems, the issue has been debated over the years following several high profile cases. A computer-assisted telephone interview (CATI) survey of NSW households was undertaken in March 2008. Respondents were asked about their willingness to pay for the installation of vehicle reversing cameras at the expense of the purchaser. The survey was completed by 590 respondents. There were no significant differences between males and females for willingness to pay $500 or $300 for a reversing camera in their current vehicle; however females were more willing to pay $150. There were no significant differences between age groups in willingness to pay for the installation. More than two-thirds of respondents would support legislation if it increased the cost of new cars by $300 and more than half if it increased by $500. This study suggests that the majority of adults would be prepared to pay a small amount of money to install a reversing camera in their current vehicle, but not sufficient to cover the full cost of installation.

Factors associated with population risk perceptions of continuing drought in Australia

To determine factors associated with risk perception of continuing drought in Australia. Computer Assisted Telephone Interview survey. The sample was weighted to the New South Wales population. A total of 2004 adults aged 16 years and over. Overall 55.9% of the respondents thought drought was extremely or very likely to continue, 60.1% were extremely or very concerned that they or their family would be affected, and 86.3% reported that they had made some level of change to the way that they lived their lives because of the perceived risk of continuing drought. After controlling for confounding factors, the odds of perceived drought being extremely or very likely to continue, concern for self or family and making changes to behaviour because of the possibility of continuing drought were significantly higher in women than men by 43%, 59% and 86%, respectively. Compared with those who lived in highly accessible geographical areas, respondents who lived in remote or very remote geographical areas were 3.22 (adjusted odds ratios = 3.22; 95% CI, 1.69-6.14) times more likely to think that drought would continue and were 3.72 (adjusted odds ratios = 3.72; 95% CI, 1.10-12.56) times more likely to have changed the way they lived their lives because of the possibility of continuing drought. Over half of the New South Wales population thought drought was very or extremely likely to continue. The baseline data collected in this survey will be useful for monitoring changes over time in the population's perceptions of continuing drought.

Question Order and Interviewer Effects in CATI Scale-up Surveys

The scale-up estimator is a network-based estimator for the size of hidden or hard to count subpopulations. Several issues arise in the public health context when the aim is the estimation of injuries occurring in a certain population, where two common problems are present: (a) Small injuries are usually difficult to observe and rarely reported in the official data and (b) people are not always compliant in giving information about some specific injuries, in particular when children are involved. This study checked the methodological issues arising from using a computer-assisted telephone interview (CATI) survey using the scale-up methodology for detecting the number of injuries due to choking in children ages 0 to 14 in Italy. For this purpose, 1,000 CATI interviews were conducted during a week using a questionnaire based on 33 questions about populations of known size according to census data. Then, each respondent was asked about other questions related to the main target population (e.g., number of children known to suffer from a choking accident). A sensitivity analysis was conducted for estimating the effect of varying subpopulations, order of the questions, and interviewer effects on the resulting estimates. For the interviewer effect, no particular differences were observed in the overall estimates of injuries. The conclusion is the scale-up estimator in association with CATI methodology shows a high potential in the field of injury prevention, being accurate and robust, but particular attention should be given to the training of the interviewers to improve stability of the estimates.

Knowledge about pandemic influenza and compliance with containment measures among Australians

To examine the level of stated compliance with public health pandemic influenza control measures and explore factors influencing cooperation for pandemic influenza control in Australia. A computer-assisted telephone interview survey was conducted by professional interviewers to collect information on the Australian public's knowledge of pandemic influenza and willingness to comply with public health control measures. The sample was randomly selected using an electronic database and printed telephone directories to ensure sample representativeness from all Australian states and territories. After we described pandemic influenza to the respondents to ensure they understood the significance of the issue, the questions on compliance were repeated and changes in responses were analysed with McNemar's test for paired data Only 23% of the 1166 respondents demonstrated a clear understanding of the term 'pandemic influenza'. Of those interviewed, 94.1% reported being willing to comply with home quarantine; 94.2%, to avoid public events; and 90.7%, to postpone social gatherings. After we explained the meaning of 'pandemic' to interviewees, stated compliance increased significantly (to 97.5%, 98.3% and 97.2% respectively). Those who reported being unfamiliar with the term 'pandemic influenza,' male respondents and employed people not able to work from home were less willing to comply. In Australia, should the threat arise, compliance with containment measures against pandemic influenza is likely to be high, yet it could be further enhanced through a public education programme conveying just a few key messages. A basic understanding of pandemic influenza is associated with stated willingness to comply with containment measures. Investing now in promoting measures to prepare for a pandemic or other health emergency will have considerable value.

Patterns of medication use by chronic and episodic headache sufferers in the general population: Results from the frequent headache epidemiology study

Though symptomatic medication overuse is believed to play a role in progression from episodic headaches (EH) to chronic daily headaches (CDH), population-based data on this topic are limited. Our objective was to describe patterns of medication use among CDH and EH sufferers in a general population sample. We compared medications used to treat headache in CDH cases and EH controls identified from a large population-based computer-assisted telephone interview survey. CDH began within 5 years of the computer-assisted telephone interview. Questions on medication use focused on treatment prior to the onset of CDH for cases and on an equivalent period in the past for controls. We asked about the likelihood of treating, time waiting to treat, number of different medications used, first, second and third most frequently used headache pain medication, and total treatment days. Questions were also asked about the use of medication for non-headache pain. Current treatment patterns and past treatment patterns were assessed. Likelihood of use of specific medications was compared between CDH cases and EH controls after adjusting for age, sex, primary headache type and number of medications taken to treat pain. Our sample consists of 206 CDH cases and 507 EH controls. CDH subjects were more likely than EH controls to use over-the-counter/caffeine combination products, triptans, opioid compounds and 'other' prescription pain medications. Use of aspirin was protective. After adjustment, aspirin and ibuprofen were (negatively) associated with CDH [OR = 0.5 (0.3-0.9), OR = 0.7 (0.5-1.0)] and opioids remained positively associated with CDH [OR = 2.3 (1.3-3.9)]. For past use, CDH was positively associated with over-the-counter/caffeine combination products and opioid compounds and was negatively associated with use of aspirin. Only ibuprofen remained (negatively) associated with CDH after adjustment [OR = 0.6 (0.4-0.9)]. After adjusting for demographic factors, primary headache type and number of medications taken, CDH sufferers are more likely to use opioid-combination analgesics, and less likely to use aspirin or ibuprofen, than EH sufferers.

Consumer health organisations for people with diabetes and arthritis: who contacts them and why?

As health systems worldwide confront a growing prevalence of chronic disease, attention has focused on self-management as a strategy for delivering better outcomes for individuals and the health system. Consumer health organisations (CHOs) offer an existing, but under-utilised, resource for supporting self-management. This paper reports on a study designed to investigate the use of CHOs among people with diabetes and arthritis. A cross-sectional computer-assisted telephone interview survey was completed by 279 people who had made contact with one of four CHOs in Queensland, Australia, between July and August 2006. Self-reported data were collected on the participants' socio-demographic and health-related characteristics, pathways to, use and benefits of CHO contact and subsequent health actions. People contacted CHOs primarily to obtain further information about their condition or to access services or products. Most believed CHOs offered useful information relevant to their health and better ways to manage health problems. Almost half reported that they had started exercising or changed diet following contact. More than two-thirds of diabetes contacts had been directed to the organisation by a health professional, compared with less than one-third of those with arthritis. Correspondingly, people with diabetes reported shorter periods between diagnosis and contact and more prior contact with the organisation and were less likely to wish they had made contact earlier. The study concludes that people who contact CHOs report benefits and health actions conducive to better self-management. The integration of CHOs within the wider health system, as in the case of the diabetes CHO in this study, is likely to facilitate contact. Further attention to the role of these organisations as part of a comprehensive approach to chronic illness care is warranted.

Are messages about lifestyle walking being heard? Trends in walking for all purposes in New South Wales (NSW), Australia

Objective To examine population trends in lifestyle walking in New South Wales (NSW), Australia between 1998 and 2006. Methods Computer Assisted Telephone Interviewing surveys were conducted in 1998 and annually from 2002 to 2006. The weighted and standardized prevalence estimates of any walking (AW) for exercise, recreation or travel (i.e. ≥ 10 min/week) and of regular walking (RW) (i.e. ≥ 150 mins/week over ≥ 5 occasions) in population sub-groups were determined for each year. Adjusted annual change was calculated using multiple regression analyses. Results The prevalence of AW was high in 1998 (80.0%, 95% CI: 79.4%–80.6%) and increased to 83.5% (95% CI: 82.7%–84.3%) in 2006. The prevalence of RW was stable between 1998 and 2003 (∼ 29%), and gradually increased between 2004 (32.9%, 95% CI: 32.0%–33.8%) and 2006 (36.5%, 95% CI: 35.4%–37.6%). The yearly increases differed in magnitude but were significant for all population sub-groups including 75 years and older, the obese, people living in remote locations and those in the most disadvantaged socio-economic status quintile. Socio-economic differential in RW was no longer significant in 2006. Conclusion Over time, everyday walking has the potential to reduce health inequalities that is due to inactivity. Public health efforts to promote active living and address obesity, as well as a rise in gasoline prices, might have contributed to this trend.

Methodological issues in the design and conduct of public health computer assisted telephone interview surveys: the case of informal carers in Australia

The academic literature contains surprisingly little information regarding the design and conduct of surveys dealing with sensitive social issues. The present paper is an attempt to help fill that gap so that other researchers conducting similar projects can learn from our experience. In particular, I focus on the various challenges we encountered in carrying out a computer assisted telephone interview (CATI) survey of informal carers in Australia, our responses to these challenges and our learnings from this endeavour. In the present article, I discuss the following issues: cost-efficient sampling for small numbers; opt-out versus opt-in approaches to respondent participation; status errors in administrative data; reducing respondent refusals; interviewing non-English speakers; questionnaire topic order; carers who care for more than one person; and interviewer training, including interviewer and/or respondent distress. The conclusions were: (1) carers are generally willing and able to answer quite sensitive questions around caring, despite the fact that they may become distressed in doing so; (2) carers are willing to answer a rather long (25 min) telephone survey; (3) thorough interviewer training is critically important, with an emphasis on achieving a balance between sensitivity and efficiency; and (4) respondents should be given the opportunity at the end of the interview to make additional comments and to provide their contact details should they desire follow up from an appropriate authority.

Are people with dental fear under-represented in oral epidemiological surveys?

Dental phobia is associated with poorer dental attendance so epidemiological surveys requiring participants to undertake a dental examination may result in an under-representation of participants with high dental fear. We compared the dental fear distribution of participants and non-participants in an oral examination component of a national epidemiological survey of oral health. Of 12,606 in-scope dentate people aged 15+ who completed a structured computer-assisted telephone interview (CATI) survey, 5,505 (43.7%) participated in the oral examination. Dental fear was assessed with a single-item measure in the CATI. There was a significant difference between the percentages of participants and non-participants who rated themselves as "extremely" afraid, although the absolute difference (1.9%) was small. The association between extreme dental fear and participation was significant (OR = 0.66, 95% CI = 0.56-0.77) in multivariate analyses after controlling for possible confounders. Females with extreme dental fear were also significantly less likely to undertake an oral examination. Even though people with dental fear and phobia may delay or avoid dental visits, they do not appear to be appreciably under-represented in oral epidemiological surveys.

Impact of Health Communication Campaigns on Health Behaviors in Singapore

The government of Singapore established the Health Promotion Board (HPB) in 2001 with an annual budget close to S$100 million to drive its health promotion and disease prevention programs. This article reviews the social marketing efforts of the HPB, in particular those campaigns related to healthy lifestyle during 2003–2006. A computer-assisted telephone interview survey conducted on over 300 Singaporeans reveals the impact of these campaigns on patterns of health awareness, health consciousness, risk perception, knowledge, and motivation that lead to adoption or nonadoption of prescribed disease prevention and health improvement practices. The survey found that while awareness of HPB campaigns is at a medium range among the respondents, a majority of those exposed to the campaigns have been influenced to adapt behaviors that lead to a healthy lifestyle.

Prevalence and correlates of resistance training in a regional Australian population

BackgroundThe core components of physical activity, cardiovascular endurance, muscular strength, balance and flexibility can provide many health benefits and potentially slow declines associated with aging. Aerobic exercise message to the...

Socio‐economic differences in public opinion regarding water fluoridation in Queensland

To describe public opinion relating to the fluoridation of drinking water in a sample of the Queensland population. Data were collected by means of a computer-assisted telephone interview survey from a sample of the Queensland population. Descriptive statistics and logistical regression were used to examine associations between variables. Seventy per cent of the total sample supported water fluoridation of their local supply. More than 71% of the total sample agreed that water fluoridation was safe. People living in areas of higher socio-economic/relative socio-economic advantage were more likely to support the addition of fluoride to local drinking water and agree that it was safe. Opinions about fluoridation varied by respondent age and gender. General support was found in this sample of the Queensland population for fluoridation of drinking water. In Queensland, fluoridation of the water supply is now a political decision. Information about public opinion on fluoridation may assist decision makers in the final determination.

Australian survey on community knowledge and attitudes regarding the fortification of food with folic acid

In response to the proposal that mandatory fortification be introduced in Australia to reduce the incidence of NTDs, the purpose of this study was to establish, for the adult community, baseline data on knowledge, attitudes, and behaviors towards the fortification of foods with folic acid. A cross-sectional, Computer Assisted Telephone Interviewing survey with respondents recruited randomly from the electronic version of the Western Australian telephone directory was used. One thousand members of the community aged 18 years or older were interviewed for the study. Interviews were conducted in September 2006, with a response rate of 76%. Half the respondents were aware folate is currently added to some breakfast cereals (59%) and some breads (53%), but awareness of other food types that may be voluntarily fortified with folate was much lower. Only 13% of respondents were concerned about folate being added to bread, 10% believed folate should not be added to foods, and 9% said they would avoid foods with added folate. Generally, around half the respondents were uncertain about the benefits of fortifying foods with folate and around a quarter were uncertain about any risks or concerns with this practice. The community appears no more concerned about the fortification of bread with folate than they are about other existing fortification programs in Australia, and appear more likely to support rather than oppose the fortification of foods with folate, particularly if they are informed of the benefits of such a program.