Computer-assisted Self-administered Interview Research Articles

Seroepidemiology of SARS-CoV-2 in healthcare personnel working at the largest tertiary COVID-19 referral hospitals in Mexico City.

We performed a longitudinal SARS-CoV-2 seroepidemiological study in healthcare personnel of the two largest tertiary COVID-19 referral hospitals in Mexico City. All healthcare personnel, including staff physicians, physicians in training, nurses, laboratory technicians, researchers, students, housekeeping, maintenance, security, and administrative staff were invited to voluntarily participate, after written informed consent. Participants answered a computer-assisted self-administered interview and donated blood samples for antibody testing every three weeks from October 2020 to June 2021. A total of 883 participants (out of 3639 registered employees) contributed with at least one blood sample. The median age was 36 years (interquartile range: 28-46) and 70% were women. The most common occupations were nurse (28%), physician (24%), and administrative staff (22%). Two hundred and ninety participants (32.8%) had a positive-test result in any of the visits, yielding an overall adjusted prevalence of 33.5% for the whole study-period. Two hundred and thirty-five positive tests were identified at the baseline visit (prevalent cases), the remaining 55 positive tests were incident cases. Prevalent cases showed associations with both occupational (institution 2 vs. 1: adjusted odds ratio [aOR] = 2.24, 95% confidence interval [CI]: 1.54-3.25; laboratory technician vs. physician: aOR = 4.38, 95% CI: 1.75-10.93) and community (municipality of residence Xochimilco vs. Tlalpan: aOR = 2.03, 95% CI: 1.09-3.79) risk-factors. The incidence rate was 3.0 cases per 100 person-months. Incident cases were associated with community-acquired risk, due to contact with suspect/confirmed COVID-19 cases (HR = 2.45, 95% CI: 1.21-5.00). We observed that between October 2020 and June 2021, healthcare workers of the two largest tertiary COVID-19 referral centers in Mexico City had similar level of exposure to SARS-CoV-2 than the general population. Most variables associated with exposure in this setting pointed toward community rather than occupational risk. Our observations are consistent with successful occupational medicine programs for SARS-CoV-2 infection control in the participating institutions but suggest the need to strengthen mitigation strategies in the community.

Seroepidemiology of SARS-CoV-2 in Healthcare Personnel Working at the Largest Tertiary COVID-19 Referral Hospitals in Mexico City

Background: We performed a longitudinal SARS-CoV-2 seroepidemiologic study in healthcare personnel of the two largest tertiary referral hospitals in Mexico City. Methods: Participants answered a computer-assisted self-administered interview and donated blood samples for antibody testing every three weeks from October 2020 to June 2021. Findings: 290/883 participants had a positive result in any of the antibody tests, yielding an overall adjusted prevalence in the study period of 33·5%. 235 positive tests were identified at baseline (prevalent cases), the remaining 55 positive tests were incident cases. Prevalent cases showed associations with both occupational (institution 2 vs. 1: adjusted odds ratio [aOR]=2·24, 95% confidence interval [CI]: 1·54, 3·25; laboratory technician vs. medical doctor: aOR=4·38, 95% CI: 1·75, 10·93) and community risk (municipality of residence Xochimilco vs. Tlalpan: aOR=2·03, 95% CI: 1·09, 3·79). The incidence rate was 3·0 cases per 100 person-months. Incident cases were mainly associated with community-acquired risk, due to contact with suspect/confirmed COVID-19 cases (HR=2·45, 95% CI: 1·21, 5·00).Interpretation: We observed similar level of exposure to SARS-CoV-2 in healthcare workers of the two largest tertiary COVID-19 referral centers in Mexico City to the general population. Most variables associated with exposure in this setting pointed toward community rather than occupational risk.Funding: Consejo Nacional de Ciencia y Tecnología (CONACyT) (Fondo FORDECYT-PRONACES) and the Mexican Government (Programa Presupuestal P016; Anexo 13 del Decreto del Presupuesto de Egresos de la Federación).Declaration of Interest: None to declare. Ethical Approval: The study was reviewed and approved by the Institutional Review Boards of both participating institutions.

Prevalence and patterns of illicit drug use in people living with HIV in Spain: A cross-sectional study.

This study assessed the prevalence and patterns of drug use among people living with HIV (PLHIV) in Spain. We conducted an observational cross-sectional study including 1401 PLHIV. Data were collected through 33 sites across Spain using an online computer-assisted self-administered interview. The survey measured use of illicit drugs and other substances, treatment adherence and health-related variables. To analyse patterns of drug use we performed cluster analysis in two stages. The most frequently consumed substances were: alcohol (86.7%), tobacco (55.0%), illicit drugs (49.5%), other substances (27.1%). The most prevalent illicit drugs used were cannabis (73.8%), cocaine powder (53.9%), and poppers (45.4%). Results found four clusters of PLHIV who used drugs. Two of them were composed mainly of heterosexuals (HTX): Cluster 1 (n = 172) presented the lowest polydrug use and they were mainly users of cannabis, and Cluster 2 (n = 84) grouped mostly men who used mainly heroin and cocaine; which had the highest percentage of people who inject drugs and presented the lowest level of treatment adherence (79.8±14.2; p < .0001). The other two clusters were composed mainly of men who have sex with men (MSM), who were mostly users of recreational drugs. Cluster 3 (n = 285) reported moderate consumption, both regarding frequency and diversity of drugs used, while Cluster 4 (n = 153) was characterized by the highest drug polyconsumption (7.4±2.2; p < .0001), and 4 grouped MSM who injected recreational drugs, and who reported the highest frequency of use of drugs in a sexual context (2.6±0.8; p < .0001) and rates of sexually transmitted infections (1.8±1.1; p < .01). This is the largest multi-centre cross-sectional study assessing the current prevalence and patterns of drug use among PLHIV in Spain. The highest prevalence of drug use was found among MSM, although HTX who used heroin and cocaine (Cluster 2) had the most problems with adherence to HIV treatment and the worst health status.

Adolescent health-risk behavior and community disorder.

BackgroundVarious forms of community disorder are associated with health outcomes but little is known about how dynamic context where an adolescent spends time relates to her health-related behaviors.ObjectiveAssess whether exposure to contexts associated with crime (as a marker of community disorder) correlates with self-reported health-related behaviors among adolescent girls.MethodsGirls (N = 52), aged 14–17, were recruited from a single geographic urban area and monitored for 1 week using a GPS-enabled cell phone. Adolescents completed an audio computer-assisted self-administered interview survey on substance use (cigarette, alcohol, or marijuana use) and sexual intercourse in the last 30 days. In addition to recorded home and school address, phones transmitted location data every 5 minutes (path points). Using ArcGIS, we defined community disorder as aggregated point-level Unified Crime Report data within a 200-meter Euclidian buffer from home, school and each path point. Using Stata, we analyzed how exposures to areas of higher crime prevalence differed among girls who reported each behavior or not.ResultsParticipants lived and spent time in areas with variable crime prevalence within 200 meters of their home, school and path points. Significant differences in exposure occurred based on home location among girls who reported any substance use or not (p 0.04) and sexual intercourse or not (p 0.01). Differences in exposure by school and path points were only significant among girls reporting any substance use or not (p 0.03 and 0.02, respectively). Exposure also varied by school/non-school day as well as time of day.ConclusionsAdolescent travel patterns are not random. Furthermore, the crime context where an adolescent spends time relates to her health-related behavior. These data may guide policy relating to crime control and inform time- and space-specific interventions to improve adolescent health.

Improving Completion Rates for Client Intake Forms through Audio Computer-Assisted Self-Interview (ACASI): Results from a Pilot Study with the Avon Breast Health Outreach Program

This study compares rates of completion of client intake forms (CIFs) collected via three interview modes: audio computer-assisted self-interview (ACASI), face-to-face interview (FFI), and self-administered paper-based interview (SAPI). A total of 303 clients served through the Avon Breast Health Outreach Program (BHOP) were sampled from three U.S. sites. Clients were randomly assigned to complete a standard CIF via one of the three interview modes. Logistic regression analyses demonstrated that clients were significantly more likely to complete the entire CIF via ACASI than either FFI or SAPI. The greatest observed differences were between ACASI and SAPI; clients were almost six times more likely to complete the CIF via ACASI as opposed to SAPI (AOR = 5.8, p < .001). We recommend that where feasible, ACASI be utilized as an effective means of collecting client-level data in healthcare settings. Adoption of ACASI in health centers may translate into higher completion rates of intake forms by clients, as well as reduced burden on clinic staff to enter data and review intake forms for completion.

Rate of decay in proportion of condom-protected sex acts among adolescents after participation in an HIV risk-reduction intervention.

HIV risk-reduction interventions have demonstrated efficacy in enhancing the proportion of condom-protected sex (CPS) acts among diverse populations. Although postintervention exposure increase in CPS are often observed, there is scant empirical data quantifying decay of intervention efficacy (declines in CPS after cessation of the intervention among participants reporting an initial postintervention increase in CPS). Thus, the objective of this study was to quantify the rate of decay in intervention efficacy over a 24-month follow-up. African American adolescent females (ages: 14-20; n = 349) completed a baseline audio computer-assisted self-administered interview, participated in an HIV risk-reduction intervention, and were assessed at 6-month intervals for 24 months postintervention. Intervention efficacy was conceptualized as an increase in participants' CPS relative to baseline. Analyses focused on the subset of participants who reported an initial increase in CPS from baseline to the 6-month postintervention assessment (n = 121) to quantify the rate of decay in intervention efficacy over a 24-month follow-up period. CPS increased markedly from baseline to 6-month follow-up assessment. However, from 6 to 12 months, a marked decline in CPS was observed. Further CPS declines, though not statistically significant, were observed from 12 to 18 months and 18 to 24 months. Cumulative reductions in CPS over the entire 24-month follow-up resulted in no statistical difference between baseline and 24-month follow-up; indicative of a nonsignificant intervention effect at 24-month assessment. Innovative postintervention optimization strategies are needed to minimize CPS decay over protracted time periods by reinforcing, sustaining, and potentially amplifying initial gains in condom use.

Human Papillomavirus Vaccine Intention Among College Men: What's Oral Sex Got to Do With It?

Objective: To identify associations between engaging in oral sex and perceived risk of oral cancer among college men. Also, to identify associations, and their moderating factors, between oral sex and human papillomavirus (HPV) vaccine acceptance. Methods: Young men were recruited from 2 university campuses in the South (N = 150). Men completed an audio computer-assisted self-administered interview. Results: With the exception of receiving fellatio, each measure of oral sex behavior was significantly associated with greater perceived risk of oral cancer. Four oral sex behaviors evidenced significant associations with vaccine acceptance. Men engaging in recent oral sex or reporting oral sex behaviors with more than 2 partners were more likely to indicate vaccine intent. African American/black race, communication with parents about sex-related topics, and HPV-related stigma/shame were identified as moderating factors. Conclusion: Young college men giving or receiving oral sex with multiple partners may be predisposed to HPV vaccination.

Swiss and migrant adolescents – similarities and differences

A total of 1352 adolescents were interviewed by computer-assisted self-administered interview to examine differences and similarities between Swiss and non-Swiss migrant boys and girls, concerning well-being (depression, anxiety), self-esteem and self-efficacy, relationship with parents, delinquency and health-related behaviour such as substance use, physical complaints and medical and psychosocial assistance. We distinguish two different migrant groups (migrants born in Switzerland, second generation; migrants not born in Switzerland, first generation) and two age groups (11–15, 16–20). Using multi-variable analysis of covariance, no differences of practical importance concerning depression and anxiety could be seen but there are significant differences concerning suicidal tendencies, for which Swiss adolescents score higher. The most important finding is that socio-demographic background plays an important role at least for the older boys. Independent of their residence status (Swiss nationals or migrants), youths with a lower socio-demographic background score higher in suicidal tendencies. Their relationship with parents is also worse. Moreover, on delinquency and substance use they also score higher. Therefore, we conclude that it is not nationality that makes the difference but the differences in socio-demographic background.

Identification of HIV-Infected 12- to 24-Year-Old Men and Women in 15 US Cities Through Venue-Based Testing

To test whether "venue-based testing" could identify human immunodeficiency virus (HIV) infection in US youth, 12 to 24 years of age, who were otherwise not aware of their infection. Racial and ethnic minority women and men who have sex with men (WSM and MSM) compose the majority of new HIV cases among adolescents and young adults. Cross-sectional study. Selected venues in communities surrounding the 15 Adolescent Trials Network for HIV/AIDS Interventions (ATN) clinical sites over a 3-month period. At each venue, ATN sites recruited 20 to 30 English- or Spanish-speaking at-risk youth (12 to 24 years of age), resulting in a total of 1217 study participants, including 611 MSM and 606 WSM. Intervention Venue-based HIV testing with 2 components: an anonymous audio computer-assisted self-administered interview and an anonymous HIV antibody assay. The prevalence of HIV infection in MSM and WSM. The prevalence of HIV infection in MSM and WSM was 15.3% and 0.3%, respectively. Sixty percent of the MSM and 100% of the WSM claimed to not know of their infection. Venue-based testing may be an important strategy to identify HIV-infected younger MSM; however, other strategies are needed for WSM.

Comparison between Self-administered Questionnaire and Computer-assisted Self-interview for Supplemental Survey Nonresponse

This article examines the correlates of nonresponse for self-administered questionnaire (SAQ) sections by comparing two General Social Survey (GSS) years, 2000 and 2002, during which the GSS switched the paper-and-pencil personal interview (PAPI) and SAQ to the computer-assisted personal interview (CAPI) and computer-assisted self-administered interview (CASI) format. The authors find that CASI not only lowers the supplemental response rate but also changes the dynamics of who responds. Unlike PAPI and SAQ data collection in 2000, even those aged 45—64 were less likely to respond to the CASI supplemental survey compared to CAPI in 2002. Compared to Whites, Blacks and other ethnic groups were more likely to be nonrespondents with CASI. Researchers should be more attentive to the potential bias of supplemental nonresponse in CASI.

Identifying Hidden Sexual Bridging Communities in Chicago

Bridge populations can play a central role in the spread of human immunodeficiency virus (HIV) by providing transmission links between higher and lower prevalence populations. While social network methods are well suited to the study of bridge populations, analyses tend to focus on dyads (i.e., risk between drug and/or sex partners) and ignore bridges between distinct subpopulations. This study takes initial steps toward moving the analysis of sexual network linkages beyond individual and risk group levels to a community level in which Chicago's 77 community areas are examined as subpopulations for the purpose of identifying potential bridging communities. Of particular interest are "hidden" bridging communities; that is, areas with above-average levels of sexual ties with other areas but whose below-average AIDS prevalence may hide their potential importance for HIV prevention. Data for this analysis came from the first wave of recruiting at the Chicago Sexual Acquisition and Transmission of HIV Cooperative Agreement Program site. Between August 2005 through October 2006, respondent-driven sampling was used to recruit users of heroin, cocaine, or methamphetamine, men who have sex with men regardless of drug use, the sex partners of these two groups, and sex partners of the sex partners. In this cross-sectional study of the sexual transmission of HIV, participants completed a network-focused computer-assisted self-administered interview, which included questions about the geographic locations of sexual contacts with up to six recent partners. Bridging scores for each area were determined using a matrix representing Chicago's 77 community areas and were assessed using two measures: non-redundant ties and flow betweenness. Bridging measures and acquired immunodeficiency syndrome (AIDS) case prevalence rates were plotted for each community area on charts representing four conditions: below-average bridging and AIDS prevalence, below-average bridging and above-average AIDS prevalence, above-average bridging and AIDS prevalence, and above-average bridging and below-average AIDS prevalence (hidden bridgers). The majority of the 1,068 study participants were male (63%), African American (74%), and very poor, and the median age was 44 years. Most (85%) were sexually active, and 725 provided useable geographic information regarding 1,420 sexual partnerships that involved 57 Chicago community areas. Eight community areas met or came close to meeting the definition of hidden bridgers. Six areas were near the city's periphery, and all eight areas likely had high inflows or outflows of low-income persons displaced by gentrification. The results suggest that further research on this method is warranted, and we propose a means for public health officials in other cities to duplicate the analysis.

Correlates of Lending Needles/Syringes Among HIV-Seropositive Injection Drug Users

Among HIV-positive injection drug users (IDUs), we examined the correlates of lending needles/syringes with HIV-negative and unknown status injection partners. HIV-positive IDUs (N=738) from 4 cities in the United States who reported injection drug use with other IDUs in the past 3 months participated in an audio computer-assisted self-administered interview. Eighteen percent of study participants self-reported having lent their needles to HIV-negative or unknown status injection partners. Multivariate analyses showed that 6 variables were significantly associated with this high-risk injecting practice. Older IDUs, high school graduates, and those reporting more supportive peer norms for safer drug use were less likely to lend needles/syringes. Admission to a hospital for drug treatment in the past 6 months, having injected with >1 person in the past 3 months, and having more psychiatric symptoms were all associated with more risk. These findings underscore the need for a continued prevention focus on HIV-positive IDUs that recognizes the combination of drug use, mental health factors, and social factors that might affect this high-risk injecting practice, which could be associated with HIV and hepatitis C transmission.

Resilience of youth in transition from out-of-home care to adulthood

Youth in transition from out-of-home care to adulthood are a vulnerable sub-population of the foster care system. In addition to the trauma of maltreatment, and challenges associated with out-of-home care, these youth face the premature and abrupt responsibility of self-sufficiency as they leave care for independent living. The purpose of this study was to identify personal and interpersonal factors that contribute to resilience of young adults who left out-of-home care of a large urban child welfare system during a one year period. Sixty percent of the eligible young adults participated in a computer-assisted self-administered interview about their self-sufficiency including: educational attainment, employment, housing, parenthood, health risk behavior, criminal activity, and perceived levels of social support, spiritual support, community support, and global life stress. This study explored the relationship between support systems, life stress, and the young adults' resilience reflecting key outcomes. The study's findings indicated that females, older youth, and youth with lower perceived life stress had higher resilience scores. Implications for child welfare practice, policy, theory, and research advance knowledge about young adults in transition from out-of-home care.

Video Computer-Assisted Self-Administered Interviews for Deaf Respondents

As sign language is the primary communication channel for the vast majority of deaf persons, options for survey research with this population are limited. A video computerassisted self-administered interview (CASI) instrument developed for deaf respondents is introduced. With the help of a case study involving 234 deaf persons in Austria, the impact of multimedia-supported CASI methods for special populations is discussed.

Collection of Ego-Centered Network Data with Computer-Assisted Interviews

Although ego-centered network data provide information that is limited in various ways as compared with full network data, an ego-centered design can be used without the need for a priori and researcher-defined network borders. Moreover, ego-centered network data can be obtained with traditional survey methods. However, due to the dynamic structure of the questionnaires involved, a great effort is required on the part of either respondents (with self-administration) or interviewers (with face-to-face interviews). As an alternative, we will show the advantages of using CASI (computer-assisted self-administered interview) methods for the collection of ego-centered network data as applied in a study on the role of social networks in substance use among college students.

Blood-donor perceptions of health history screening with a computer-assisted self-administered interview.

Computer-assisted self-interviewing (CASI) has been shown to promote disclosures of sensitive information. Using CASI to screen blood-donor candidates might encourage reports of deferrable risks without discouraging eligible donors. In 1998, an anonymous mail survey was sent to donors from eight blood centers. The relationship of donor demographics, donation history, and infectious risks (HIV test-seeking behavior, unreported deferrable risk, or reactive donor-screening test result) on attitudes toward CASI were assessed. Of 92,581 blood donors surveyed, 52,650 (57%) responded; of these, 4713 (7%) had an infectious risk. Among donors with risks, 29 percent felt they would be encouraged to reveal personal data, and 7 percent reported they would be discouraged from donating by CASI. Young, minority, female, and first-time donors were the most likely to report that CASI would encourage personal disclosures. Among donors without risks, 5 percent felt CASI would discourage them from donating. Although most donors felt their donation practices would not be influenced, CASI might reduce the proportion of donors with infectious risks by fostering personal disclosures and self-deferrals. The potential for CASI to improve donor screening and increase appropriate self-deferrals should be balanced against the possible loss of reluctant safe donors.

A computer-based assessment detects regimen misunderstandings and nonadherence for patients on HIV antiretroviral therapy

Accurately assessing nonadherence is a necessary first step toward improving adherence to highly active antiretroviral therapy (HAART). Patient self report is the most practical method for assessing adherence in clinical settings, but may produce unreliable and invalid results unless optimally performed. A computer-assisted, self-administered interview (CASI) may improve the disclosure of medication nonadherence by providing a neutral and seemingly private interview. One hundred and ten patients completed a computer program which assessed their understanding of and adherence to HIV medications and produced a report for their providers. Eleven providers of these patients completed a questionnaire describing their patients' medication regimens and estimating adherence. Patients completed a written exit survey and providers completed an exit interview to assess the acceptability of our CASI-based assessment. More than half of patients (54%) made at least one error in reporting their medication regimen. Providers tended to overestimate their patients' adherence and correctly classified only 24% of nonadherent patients at the 80% adherence level. Computerized HIV medication adherence assessment is feasible and acceptable to patients and providers. Clinical tools that can accurately and efficiently detect important medication errors and nonadherence, and alert providers to these problems, will help ensure the health of HIV-seropositive patients.

Eliciting Student Expectations of the Returns to Schooling

We report here on the design and first application of an interactive computer-assisted self-administered interview (CASI) survey eliciting from high school students and college undergraduates their expectations of the income they would earn if they were to complete different levels of schooling. We also elicit respondents' beliefs about current earnings distributions. Whereas a scattering of earlier studies have elicited point expectations of earnings unconditional on future schooling, we elicit subjective earnings distributions under alternative scenarios for future schooling. In this exploratory study, we find that respondents are willing and able to respond meaningfully to questions eliciting their earnings expectations in probabilistic form. The 110 respondents vary considerably in their earnings expectations but there is a common belief that the returns to a college education are positive and that earnings rise between ages 30 and 40. There is a common belief that one's own future earnings are rather uncertain. Moreover, respondents tend to overestimate the current degree of earnings inequality in American society.