Reduce Response Burden Research Articles

Optimizing the environmental attitudes inventory

Purpose – The purpose of this study was twofold: first, to optimize the Environmental Attitudes Inventory (EAI) and second, to establish a baseline of the difference in environmental attitudes between first and final year students, taken at the start of a university’s declaration of commitment to EfS. Design/methodology/approach – The psychometrically designed EAI was used to overcome the problems and limitations of the much-used, but controversial, revised New Environmental Paradigm (NEP) Scale. The performance of the original 72-item EAI was compared with our 37-item reduced form using a population of first- and final-year university students. Findings – The reduced 37-item EAI provides a reliable and valid tool for investigating structured, multi-dimensional environmental attitudes of university students while reducing response burden and increasing response and completion rates compared with the longer versions of the EAI. Research limitations/implications – No attempt is made to link elements of the university experience with changes in attitude between first- and third-year students. The authors expect the 12-faceted EAI to provide more detailed feedback on the affective outcomes of EfS initiatives than currently used instruments. Originality/value – This research contributes to establishing the EAI as a gold standard with which to monitor students’ environmental attitudes. Although most studies aimed at understanding the impact of EfS measure attitude change over relatively short periods of time – typically using the brief NEP scale administered immediately before and after a specific semester course – the approach developed here is designed to detect attitudinal change that may be ascribed to the entire university experience between students’ first and final year.

Tracking daily travel; Assessing discrepancies between GPS-derived and self-reported travel patterns

Global Positioning Systems (GPS) technologies have been used in conjunction with traditional one- or two-day travel diaries to audit respondent reporting patterns, but we used GPS-based monitoring to conduct the first assessment to our knowledge of travel reporting patterns using a seven-day travel log instrument, which could reduce response burden and provide multiple-day, policy-relevant information for evaluation studies. We found substantial agreement between participant-reported daily travel patterns and GPS-derived patterns among 116 adult residents of a largely low-income and non-white transportation corridor in urbanized Los Angeles in 2011–2013. For all modes, the average difference between daily GPS- and log-derived trip counts was only about 0.39 trips and the average difference between daily GPS- and log-derived walking duration was about −11.8min. We found that the probability that a day would be associated with agreement or discrepancies between these measurement tools varied by travel mode and participant socio-demographic characteristics. Future research is needed to investigate the potential and limitations of this and other self-report instruments for a larger sample and a wider range of population groups and travel patterns.

Applying computer adaptive testing to optimize online assessment of suicidal behavior: a simulation study.

BackgroundThe Internet is used increasingly for both suicide research and prevention. To optimize online assessment of suicidal patients, there is a need for short, good-quality tools to assess elevated risk of future suicidal behavior. Computer adaptive testing (CAT) can be used to reduce response burden and improve accuracy, and make the available pencil-and-paper tools more appropriate for online administration.ObjectiveThe aim was to test whether an item response–based computer adaptive simulation can be used to reduce the length of the Beck Scale for Suicide Ideation (BSS).MethodsThe data used for our simulation was obtained from a large multicenter trial from The Netherlands: the Professionals in Training to STOP suicide (PITSTOP suicide) study. We applied a principal components analysis (PCA), confirmatory factor analysis (CFA), a graded response model (GRM), and simulated a CAT.ResultsThe scores of 505 patients were analyzed. Psychometric analyses showed the questionnaire to be unidimensional with good internal consistency. The computer adaptive simulation showed that for the estimation of elevation of risk of future suicidal behavior 4 items (instead of the full 19) were sufficient, on average.ConclusionsThis study demonstrated that CAT can be applied successfully to reduce the length of the Dutch version of the BSS. We argue that the use of CAT can improve the accuracy and the response burden when assessing the risk of future suicidal behavior online. Because CAT can be daunting for clinicians and applied scientists, we offer a concrete example of our computer adaptive simulation of the Dutch version of the BSS at the end of the paper.

The Hunter Syndrome-Functional Outcomes for Clinical Understanding Scale (HS-FOCUS) Questionnaire: item reduction and further validation.

PurposeThe Hunter Syndrome-Functional Outcomes for Clinical Understanding Scale (HS-FOCUS) Questionnaire is a patient and parent-completed disease-specific instrument used in Hunter syndrome (mucopolysaccharidosis II), a rare paediatric progressive multi-systemic lysosomal storage disease. The objective of this study was to shorten the number of items of the Questionnaire to reduce response burden while maintaining its content validity.MethodsData collected in a clinical trial were used. An iterative process helped identifying redundant or low performing items based on content validity and psychometric properties. Validation on the retained items was assessed using patients and parent’s responses in terms of reliability, validity and responsiveness.ResultsThe HS-FOCUS was completed by 49 patients and 84 parents. Items were mainly removed owing to high floor effects, high inter-item correlations (>0.80) or inadequate content. The shortened patient and parent versions (18 and 21 items) each contained five function domains. Internal consistency and test–retest reliability were >0.70 for most domains, except Breathing and School/work. Concurrent validity was demonstrated by significant correlations (>0.30) with similar concepts of previously validated measures. Significant differences were found in all domain scores across levels of disability.ConclusionsThe shortened HS-FOCUS is a reliable, valid and responsive measure, where burden in answering the Questionnaire was reduced without compromising its validity.

Psychometrically improved, abbreviated versions of three classic measures of impulsivity and self-control.

Self-reported impulsivity confers risk factor for substance abuse. However, the psychometric properties of many self-report impulsivity measures have been questioned, thereby undermining the interpretability of study findings using these measures. To better understand these measurement limitations and to suggest a path to assessing self-reported impulsivity with greater psychometric stability, we conducted a comprehensive psychometric evaluation of the Barratt Impulsiveness Scale-11 (BIS-11), the Behavioral Inhibition and Activation Scales (BIS/BAS), and the Brief Self-Control Scale (BSCS) using data from 1,449 individuals who participated in substance use research. For each measure, we evaluated (a) latent factor structure, (b) measurement invariance, (c) test-criterion relationships between the measures, and (d) test-criterion relations with drinking and smoking outcomes. Notably, we could not replicate the originally published latent structure for the BIS, BIS/BAS, or BSCS or any previously published alternative factor structure (English language). Using exploratory and confirmatory factor analysis, we identified psychometrically improved, abbreviated versions of each measure: 8-item, 2-factor BIS-11 (root-mean-square error of approximation [RMSEA] = .06, comparative fit index [CFI] = .95); 13-item, 4-factor BIS/BAS (RMSEA = .04, CFI = .96); and 7-item, 2-factor BSCS (RMSEA = .05, CFI = .96). These versions evidenced (a) stable, replicable factor structures, (b) scalar measurement invariance, ensuring our ability to make statistically interpretable comparisons across subgroups of interest (e.g., sex, race, drinking/smoking status), and (c) test-criterion relationships with each other and with drinking/smoking. This study provides strong support for using these psychometrically improved impulsivity measures, which improve data quality directly through better scale properties and indirectly through reducing response burden.

Trip Purpose Identification from GPS Tracks

Travel surveys are increasingly taking advantage of GPS data, which offer precise route and time observations and a potentially reduced response burden. In these surveys, travel diaries are usually constructed automatically where research on the employed procedures has been focused on mode identification. The goal of the research reported here was to improve trip purpose identification. The analysis used random forests, a machine-learning approach that had been successfully applied to mode identification. The analysis was based on GPS tracks and accelerometer data collected by 156 participants who took part in a 1-week travel survey in Switzerland that was completed in 2012. The results show that random forests provide robust trip purpose classification. For ensemble runs, the share of correct predictions was between 80% and 85%. Different setups of the classifier were possible and sometimes required by the application context. The training set and its input variables (feature set) of the classifier were defined in various ways. Four relevant setups were tested for this study.

Music Can Reduce Anxiety in ICU Patients

Music Can Reduce Anxiety in ICU Patients

Abstract 248: The KCCQ-12: A Short Version of the Kansas City Cardiomyopathy Questionnaire

Background: The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a well-validated and widely used 23-item instrument that measures patient-reported symptoms, function and quality of life for patients with heart failure. We sought to develop a shortened version to reduce response burden and facilitate greater use within busy clinical environments. Methods: We used data from 2 multicenter randomized trials (EVEREST: n=2,005; EPHESUS: n=1,616) and one multicenter outpatient cohort study (n=547) to develop and validate a short version of the KCCQ. We included items from the Physical Limitation, Symptoms, Quality of Life and Social Limitation scales, which directly measure patients’ current health status. In development cohorts, we used equidistant item-total correlation methods to identify items that best correlated with their respective full-version score across the entire range of scores. We considered item response variability and missingness in choosing between similarly performing items. Using the selected items, we calculated summary scores for each of the 4 scales, and an overall summary score as the average of the 4 scale scores. (As in the full KCCQ, scores were rescaled so that 0 denotes the worst and 100 the best possible health status.) Finally, in independent validation cohorts, we conducted a range of analyses to investigate the validity, reproducibility, and responsiveness of the short-version scores. Results: We identified 12 items that tracked strongly with their corresponding full-version scores (3 of 6 Physical Limitation items; 4 of 8 Symptom items; 2 of 3 Quality of Life items; 2 of 3 Social Limitation items). Correlations between the resulting short-version and full-version scores was excellent (r=0.92 to 0.99), and missing rates were the same or lower for all scores. In validation studies, the KCCQ-12 demonstrated strong performance comparable to the full KCCQ (Table). Conclusions: The KCCQ-12 is a valid, reproducible, responsive instrument for assessing disease-specific health status among patients with heart failure, with properties and performance similar to the full KCCQ but with a substantially reduced response burden.

Abstract 54: The SAQ-7: A Short Version of the Seattle Angina Questionnaire

Background: The Seattle Angina Questionnaire (SAQ) is a well-validated and widely used 19-item instrument that measures patient-reported symptoms, function and quality of life for patients with coronary artery disease. We sought to develop a shortened version to reduce response burden and facilitate greater use within busy clinical environments. Methods: We used data from 4 U.S. multicenter longitudinal cohorts studies (2 PCI: n=1,507 and 2,206; 2 AMI: n=2,487 and 4,340) to develop and validate a short version of the SAQ. We included items from the Physical Limitation, Angina Frequency and Quality of Life scales, which directly measure patients’ current health status. We conducted parallel analyses for 3 distinct clinical scenarios (stable CAD, peri-PCI, acute MI). In development cohorts, we used equidistant item-total correlation methods to identify items that best correlated with their respective full-version score across the entire range of scores. We also considered item response variability and missingness in choosing between similarly performing items. Using the selected items, we calculated summary scores for each of the 3 scales, and an overall summary score as the average of the 3 scale scores. (As in the full SAQ, scores were rescaled so that 0 denotes the worst and 100 the best possible health status.) Finally, in independent validation cohorts, we conducted a range of analyses to investigate the validity, reproducibility, and responsiveness of the short-version scores. Results: We identified 7 items that tracked strongly with their corresponding full-version scores (3 of 9 Physical Limitation items; 2 of 2 Angina Frequency items; 2 of 3 Quality of Life items). These items were consistently identified across all 3 clinical scenarios. Correlations between the resulting short-version and full-version scores were excellent (r=0.95 to 1.00), and missing rates were the same or lower for all scores. In validation studies, the SAQ-7 demonstrated strong performance comparable to the full SAQ (Table). Conclusions: The SAQ-7 is a valid, reproducible, responsive instrument for assessing disease-specific health status among patients with coronary artery disease, with properties and performance similar to the full SAQ but with a substantially reduced response burden.

Do incentives, reminders or reduced burden improve healthcare professional response rates in postal questionnaires? two randomised controlled trials

BackgroundHealthcare professional response rates to postal questionnaires are declining and this may threaten the validity and generalisability of their findings. Methods to improve response rates do incur costs (resources) and increase the cost of research projects. The aim of these randomised controlled trials (RCTs) was to assess whether 1) incentives, 2) type of reminder and/or 3) reduced response burden improve response rates; and to assess the cost implications of such additional effective interventions.MethodsTwo RCTs were conducted. In RCT A general dental practitioners (dentists) in Scotland were randomised to receive either an incentive; an abridged questionnaire or a full length questionnaire. In RCT B non-responders to a postal questionnaire sent to general medical practitioners (GPs) in the UK were firstly randomised to receive a second full length questionnaire as a reminder or a postcard reminder. Continued non-responders from RCT B were then randomised within their first randomisation to receive a third full length or an abridged questionnaire reminder. The cost-effectiveness of interventions that effectively increased response rates was assessed as a secondary outcome.ResultsThere was no evidence that an incentive (52% versus 43%, Risk Difference (RD) -8.8 (95%CI −22.5, 4.8); or abridged questionnaire (46% versus 43%, RD −2.9 (95%CI −16.5, 10.7); statistically significantly improved dentist response rates compared to a full length questionnaire in RCT A. In RCT B there was no evidence that a full questionnaire reminder statistically significantly improved response rates compared to a postcard reminder (10.4% versus 7.3%, RD 3 (95%CI −0.1, 6.8). At a second reminder stage, GPs sent the abridged questionnaire responded more often (14.8% versus 7.2%, RD −7.7 (95%CI −12.8, -2.6). GPs who received a postcard reminder followed by an abridged questionnaire were most likely to respond (19.8% versus 6.3%, RD 8.1%, and 9.1% for full/postcard/full, three full or full/full/abridged questionnaire respectively). An abridged questionnaire containing fewer questions following a postcard reminder was the only cost-effective strategy for increasing the response rate (£15.99 per response).ConclusionsWhen expecting or facing a low response rate to postal questionnaires, researchers should carefully identify the most efficient way to boost their response rate. In these studies, an abridged questionnaire containing fewer questions following a postcard reminder was the only cost-effective strategy. An increase in response rates may be explained by a combination of the number and type of contacts. Increasing the sampling frame may be more cost-effective than interventions to prompt non-responders. However, this may not strengthen the validity and generalisability of the survey findings and affect the representativeness of the sample.

Use of Computer Adaptive Testing in the Development of Machine Learning Algorithms: Table 1

In this issue, Tighe and colleagues present a novel approach for “classifying large amounts of data into useful information.” Their study demonstrates the use of machine learning (ML) algorithms for clinical predictions and highlights the promise of such advances in mining secondary databases. Recently, a new approach to ML, Computer Adaptive Testing (CAT), has been applied to the collection of patient-reported outcomes (PROs). CAT relies on computer algorithms that select the most informative subset of items for each individual from a larger “bank” of self-report items. The algorithm improves efficiency by administering fewer items and reducing response burden. As the choice of items to be administered is tailored to the individual, measurement precision is not sacrificed. The ML algorithms applied by Tighe and colleagues were used to identify accurate and efficient formulas for predicting subsequent femoral nerve blocks as are the CAT algorithms. In CAT, levels of self-reported health outcomes are estimated (predicted) by administering the most efficient subset of items for any given individual. The methodological advances of ML and CAT have the potential to meaningfully impact both research and clinical practice. This editorial describes ML as it relates to the collection of PROs and explores recent applications of this computer-based measurement strategy. In addition, we discuss how the existence of CAT-assessed PROs might improve the prediction of ML algorithms such as those applied by Tighe and colleagues. The need to reduce the number of items administered in measuring PROs has long been an issue in health outcomes research. This concern has led researchers away from reliance on classical testing models and toward emerging theories and applications such as item response theory (IRT) and CAT. These methods have been used successfully for several decades in settings as varied as education, licensure, achievement testing, personality assessment, and selection of military …

Further validation of the short form versions of the pelvic floor Distress Inventory (PFDI) and pelvic floor impact questionnaire (PFIQ)

To evaluate validity and responsiveness of PFDI and PFIQ short forms across four multi-center studies and develop conversion formulas between short and long versions. 1,006 participants in four prospective studies of pelvic floor disorders completed long versions of the PFDI, PFIQ, and SF-36 (or SF-12) at baseline and 3 and 12 months after treatment. Responses were used to calculate scores for the short versions. We calculated correlations between scale versions using Pearson's correlation coefficient and compared their relative responsiveness using the standardized response mean. PFDI and PFIQ short form scale scores demonstrated excellent correlations with long versions and similar responsiveness. Responsiveness was good to excellent for PFDI-20 urinary and prolapse scales, moderate for PFDI-20 colorectal scale and each of the PFIQ-7 scales, and poor for SF-36 (or SF-12) summary scores. Conversion formulas demonstrated excellent goodness of fit. The long and short forms of the PFDI and PFIQ correlate well and have similar overall responsiveness in participants from four different prospective multicenter studies consisting of diverse patient populations with a broad range of pelvic floor disorders. The short forms provide a reliable and valid alternative in situations where reduced response burden is desired.

Developing a Short Form of the Simple Rathus Assertiveness Schedule Using a Sample of Adults With Sickle Cell Disease

Ethnic and cultural norms influence an individual's assertiveness. In health care, assertiveness may play an important role in health outcomes, especially for predominantly minority populations, such as adults with sickle cell disease. Therefore, it is important to develop measures to accurately assess assertiveness. It is also important to reduce response burden of lengthy instruments while retaining instrument reliability and validity. The purpose of this article is to describe development of a shorter version of the Simple Rathus Assertiveness Schedule (SRAS). Data from a cross-sectional descriptive study of adults with sickle cell disease were used to construct a short form of the SRAS, guided by stepwise regression analysis. The 19-item Simple Rathus Assertiveness Scale-Short Form (SRAS-SF) had acceptable reliability (α = .81) and construct validity and was highly correlated with the SRAS (r = .98, p = .01). The SRAS-SF reduces response burden, while maintaining reliability and validity.

The relationship between a short measure of health status and physical activity in a workplace population

Many interventions promoting physical activity (PA) are effective in preventing disease onset, and although studies have found a positive relationship between health-related quality of life (HRQL) and PA, most of these studies have focused on older adults and those with chronic conditions. Less is known regarding the association between PA level and HRQL among healthy adults. Our objective was to analyse the relationship between PA level and HRQL among a sample of 573 employees aged 20–68 taking part in a workplace intervention to promote PA. Measures included HRQL (using a single item) and PA (i.e. Godin Leisure-Time Questionnaire). The Modified Canadian Aerobic Fitness Test (MCAFT) was also completed by 10% of the employees. MET-minute scores (assessing energy expenditure over one week) were compared across HRQL categories using ANOVA. A multiple linear regression analysis was conducted to further examine the relationship between HRQL and PA, controlling for potential covariates. Participants in the higher health status categories were found to report higher levels of energy expenditure (one-way ANOVA, p < 0.001). In the multiple linear regression model, each unit increase in health status level translated in a mean increase of 356 MET-minutes in energy expenditure (p < 0.001). This single-item assessment of health status explained six percent of the variance in energy expenditure. The study concludes that higher energy expenditure through PA among an adult workplace population is positively associated with increased health status, and it also suggests that a single-item HRQL measure is suitable for community- and population-based studies, reducing response burden and research costs.

Computer adaptive testing improved accuracy and precision of scores over random item selection in a physical functioning item bank

Backgrond and Objective Measuring physical functioning (PF) within and across postacute settings is critical for monitoring outcomes of rehabilitation; however, most current instruments lack sufficient breadth and feasibility for widespread use. Computer adaptive testing (CAT), in which item selection is tailored to the individual patient, holds promise for reducing response burden, yet maintaining measurement precision. We calibrated a PF item bank via item response theory (IRT), administered items with a post hoc CAT design, and determined whether CAT would improve accuracy and precision of score estimates over random item selection. Methods 1,041 adults were interviewed during postacute care rehabilitation episodes in either hospital or community settings. Responses for 124 PF items were calibrated using IRT methods to create a PF item bank. We examined the accuracy and precision of CAT-based scores compared to a random selection of items. Results CAT-based scores had higher correlations with the IRT-criterion scores, especially with short tests, and resulted in narrower confidence intervals than scores based on a random selection of items; gains, as expected, were especially large for low and high performing adults. Conclusion The CAT design may have important precision and efficiency advantages for point-of-care functional assessment in rehabilitation practice settings.

Caring Behaviors Inventory

Caring traditionally has been at the center of nursing. Effectively measuring the process of nurse caring is vital in nursing research. A short, less burdensome dimensional instrument for patients' use is needed for this purpose. To derive and validate a shorter Caring Behaviors Inventory (CBI) within the context of the 42-item CBI. The responses to the 42-item CBI from 362 hospitalized patients were used to develop a short form using factor analysis. A test-retest reliability study was conducted by administering the shortened CBI to new samples of patients (n = 64) and nurses (n = 42). Factor analysis yielded a 24-item short form (CBI-24) that (a) covers the four major dimensions assessed by the 42-item CBI, (b) has internal consistency (alpha =.96) and convergent validity (r =.62) similar to the 42-item CBI, (c) reproduces at least 97% of the variance of the 42 items in patients and nurses, (d) provides statistical conclusions similar to the 42-item CBI on scoring for caring behaviors by patients and nurses, (e) has similar sensitivity in detecting between-patient difference in perceptions, (f) obtains good test-retest reliability (r = .88 for patients and r=.82 for nurses), and (g) confirms high internal consistency (alpha >.95) as a stand-alone instrument administered to the new samples. CBI-24 appears to be equivalent to the 42-item CBI in psychometric properties, validity, reliability, and scoring for caring behaviors among patients and nurses. These results recommend the use of CBI-24 to reduce response burden and research costs.

Depression screening instruments made good severity measures in a cross-sectional analysis

Objective Test equivalence of different survey instruments to diagnose depression and to assess its severity. Where equivalence exists, describe how to convert scores between instruments. Study Design Cross-sectional analysis of six convenience samples consisting of 71 members of a health plan and 107 patients of mental health specialty practices with psychiatric diagnoses were compared using the Beck Depression Inventory (BDI) and one or more of the Primary Care Screener for Affective Disorder, Prime-MD-PHQ, Inventory to Diagnose Depression, the depression subscale of the Psychiatric Diagnostic Screening Questionnaire, and the Mental Health Inventory from the SF-36. Results Correlations between the screening instruments and the BDI ranged from 0.79 to 0.95 and the sensitivity to depression and the specificity against nondepressive mental health diagnoses was equally good or better. We also describe a method for equating severity scores across instruments and labeling the screener-based severity measures with clinically meaningful descriptions comparable to those used for the BDI. Conclusions Screener-based severity measures extensively overlap each other. Good screeners for depression can also be good severity instruments. Exploiting screeners as severity instruments can significantly reduce response burden without sacrificing performance.

Relationship between two anxiety instruments in patients receiving mechanical ventilatory support

The primary aim of this paper is to discuss the relationship between the Visual Analog Scale-Anxiety (VAS-A) and the Spielberger State Anxiety Inventory (SAI) in patients receiving mechanical ventilatory support. A secondary aim is to provide suggestions for the nurse-researcher to consider when selecting an instrument to measure anxiety. Anxiety is a common experience for critically ill patients receiving mechanical ventilatory support. It is a challenge, however, for nurse-researcher to select an instrument to measure anxiety that is valid and reliable yet does not cause great response burden for participants. Visual analog scales may reduce response burden, but lack sound validation in research participants receiving mechanical ventilatory support. This study used a correlational design. A convenience sample of critically ill patients receiving mechanical ventilatory support (n = 200) were asked to rate their current level of anxiety on the 20-item Spielberger SAI and a 100-mm VAS-A. Eight participants were unable to complete the Spielberger SAI; 100% completed the VAS-A. The two instruments were found to be significantly correlated at r = 0.50; P = 0.01. The VAS-A was found to be less burdensome for research participants than the Spielberger SAI, resulting in no missing data on the VAS-A. Findings from this study provide initial validation of the VAS-A as a justifiable instrument to measure anxiety in patients receiving mechanical ventilatory support. Researchers are advised to balance reliability and validity properties with response burden when selecting an instrument to measure anxiety in patients with communication challenges and energy limitations.

Do Respondents Really "Mark All That Apply" On Self-Administered Questions?

An experiment was conducted to assess the effect of using mark all that apply question instructions on survey re- porting as part of the field test for the Second Follow-up of the National Education Longitudinal Study of 1988 Eighth Graders (NELS:88). Mark-all-that-apply instructions were compared with instructions asking respondents to indicate yes or no to each response option on responses to three items dispersed throughout the questionnaire and consisting of different topics and numbers of response options. For the three items, signifi- cantly fewer response options were selected with the mark-all- that-apply instructions than with the yes/no instructions, but be- cause external validity criteria were not available, overreporting to the yes/no instructions cannot be ruled out. Instruction- dependent primacy effects, predicted under the hypothesis that respondents would engage in more superficial processing when given the mark-all-that-apply instructions, were not found. In an attempt to reduce response burden, designers of self-admin- istered survey questionnaires often use the technique of asking respon- dents to examine a list and mark, circle, or check all the items on the list that apply. The mark-all-that-apply instructions have been used in many circumstances. One application is in questions asking about a set of respondent behaviors. For example, respondents might be asked, Which of the following have you done in order to finance your child's education after high school? (Mark all that apply.) or To KENNETH A. RASINSKI is a National Opinion Research Center (NORC) senior survey methodologist, DAVID MINGAY is a survey methodologist at NORC, and NORMAN M. BRADBURN is NORC senior vice president for research and Tiffany and Margaret Blake