Survey Item Response Rates by Survey Modality, Language, and Sociodemographic Factors in a Large U.S. Cohort.

BACKGROUND: Large-scale prospective cohorts traditionally use English, paper-based, mailed surveys, but Web-based surveys can lower costs and increase data quality, and multi-language surveys may aid in capturing diverse populations. Little evidence exists examining item response for multiple survey modalities or languages in epidemiologic cohorts. METHODS: A total of 254,475 men and women completed a comprehensive lifestyle and medical survey at enrollment (2006-2013) for the Cancer Prevention Study-3, a U.S.-based prospective cohort. Web-based (English only) or paper (Spanish or English) surveys were offered. Using generalized linear models, differences in item response rates overall and by topical areas (e.g., reproductive history) by modality and language were examined. We further examined whether differences in response quality by sociodemographic characteristics within each survey modality existed. RESULTS: Overall, English Web-based surveys had the highest average item response rate (97.6%), followed by English paper (95.5%) and Spanish paper (83.1%). Lower item response rates were seen among nonwhite, lower income, or less-educated participants. When examining individual survey sections by topic, results varied the most for residential history, with the lowest item response rate among Spanish language respondents (women, 62.7% and men, 64.3%) and the highest in English language Web-based, followed by paper respondents (women, 94.6% and men, 95.3%; and women, 92.8% and men, 92.1%, respectively). CONCLUSIONS: This study supports that utilizing multimodal survey approaches in epidemiologic studies does not differentially affect data quality. However, for some topic areas, further analysis should be considered for assessing data quality differences in Spanish language surveys. IMPACT: Multimodal survey administration is effective in nondifferentially capturing high-quality data.See all articles in this CEBP Focus section, "Modernizing Population Science."

Consumo alimentar e estado nutricional de carteiros pedestres de Porto Alegre / Dietary intake and nutritional status of mail carriers Porto Alegre

Introdução: O aumento da prevalência de excesso de peso e o inadequado consumo alimentar têm sido uma preocupação frequente entre os trabalhadores brasileiros. Portanto, o objetivo do presente estudo foi avaliar o estado nutricional e o consumo alimentar de carteiros pedestres de Porto Alegre, Rio Grande do Sul. Métodos: Estudo de caráter transversal com trabalhadores dos Correios de Porto Alegre. O estado nutricional foi obtido a partir de dados de altura, peso e circunferências da cintura e do pescoço. Foi utilizado um questionário de frequência alimentar adaptado e dois recordatórios de 24 horas para avaliação do consumo alimentar. Resultados: Foram entrevistados 203 carteiros, dos quais 74,5% eram homens. A média de idade foi de 41,0 ± 11,28 anos. Observou-se que a maioria dos carteiros apresentou excesso de peso (63,6%), sendo 85 (41,9%) com sobrepeso e 44 (21,7%) com obesidade. Os alimentos consumidos pelo menos três vezes por semana pela maioria dos participantes foram carne vermelha, feijão, verduras, frutas e refrigerantes ou sucos artificiais. Por outro lado, os alimentos consumidos menos de uma vez por semana foram peixes e sucos de frutas naturais. Conclusão: Constatou-se uma alta taxa de excesso de peso entre os carteiros pedestres de Porto Alegre. Além disso, observou-se um elevado consumo de carne vermelha, refrigerantes e sucos artificiais, e dos nutrientes sódio e cobre, e baixo consumo de peixes, dos ácidos graxos ômega-3 e ômega-6, e dos minerais potássio e magnésio. Portanto, enfatiza-se a necessidade de promoção de atividades que visem a educação nutricional nessa população (AU)

Introduction: Increased prevalence of overweight and inadequate dietary intake have become a serious concern among Brazilian workers. Thus, the objective of the present study was to evaluate the nutritional status and the dietary intake of mail carriers in Porto Alegre, state of Rio Grande do Sul, Brazil. Methods: This was a cross-sectional study with Porto Alegre's mail carriers. Nutritional status was obtained using data on height, weight, and waist and neck circumferences. Dietary intake was evaluated by an adapted food frequency questionnaire and two 24-hour dietary recalls. Results: A total of 203 mail carriers were interviewed, of which 74.5% were men. Mean age was 41.0 ± 11.28 years. Most mail carriers showed excessive weight (63.6%) ­ 85 (41.9%) were overweight and 44 (21.7%) were obese. Foods consumed at least three times a week by most participants were red meat, beans, vegetables, fruits and soft drinks or artificial juices. Conversely, foods consumed less than once a week were fish and natural juices. Conclusions: There was a high rate of overweight among mail carriers in Porto Alegre. In addition, high consumption of red meat, soft drinks, artificial juices, and sodium and copper, and low consumption of fish, omega-3 and omega-6 fatty acids, and potassium and magnesium were observed. Therefore, there is a strong need to promote activities aimed at the nutritional education of this population (AU)

Health care system-level factors associated with performance on Medicare STAR adherence metrics in a large, integrated delivery system.

BACKGROUND: The Centers for Medicare and Medicaid Services provide significant incentives to health plans that score well on Medicare STAR metrics for cardiovascular disease risk factor medication adherence. Information on modifiable health system-level predictors of adherence can help clinicians and health plans develop strategies for improving Medicare STAR scores, and potentially improve cardiovascular disease outcomes. OBJECTIVE: To examine the association of Medicare STAR adherence metrics with system-level factors. RESEARCH DESIGN: A cross-sectional study. SUBJECTS: A total of 129,040 diabetes patients aged 65 years and above in 2010 from 3 Kaiser Permanente regions. MEASURES: Adherence to antihypertensive, antihyperlipidemic, and oral antihyperglycemic medications in 2010, defined by Medicare STAR as the proportion of days covered ≥ 80%. RESULTS: After controlling for individual-level factors, the strongest predictor of achieving STAR-defined medication adherence was a mean prescribed medication days' supply of > 90 days (RR=1.61 for antihypertensives, oral antihyperglycemics, and statins; all P < 0.001). Using mail order pharmacy to fill medications > 50% of the time was independently associated with better adherence with these medications (RR = 1.07, 1.06, 1.07; P < 0.001); mail order use had an increased positive association among black and Hispanic patients. Medication copayments ≤ $10 for 30 days' supply (RR = 1.02, 1.02, 1.02; P < 0.01) and annual individual out-of-pocket maximums ≤ $2000 (RR = 1.02, 1.01, 1.02; P < 0.01) were also significantly associated with higher adherence for all 3 therapeutic groupings. CONCLUSIONS: Greater medication days' supply and mail order pharmacy use, and lower copayments and out-of-pocket maximums, are associated with better Medicare STAR adherence. Initiatives to improve adherence should focus on modifiable health system-level barriers to obtaining evidence-based medications.

Informed consent and research with stored biological samples.

OBJECTIVE: To report practical experience in obtaining consent for a retrospective study conducted at the Brazilian National Cancer Institute (INCA). The study involved review of medical records and analysis of paraffin blocks of patients surgically treated for colon cancer between 2000 and 2004. Attempts to obtain informed consent were made in compliance with the resolution 196/96 of the Brazilian National Health Council and determination of INCA Research Ethics Committee. METHODS: At scheduled appointments, we could approach only four patients for consent during three months. After attempting contact by phone, an information sheet summarizing the content of informed consent, two copies of the consent form and a prepaid return envelope were then mailed to the patients. RESULTS: Of the 155 consent forms mailed, 115 were returned (74%). Of these, 111 patients gave consent to participate in the study, one refused consent, and we were informed that three patients had died. The time course of return of these forms ranged from 2 to 89 days (median: 10 days). Attempts to contact patients by phone were successful in 60 out of 160 cases (37.5%). The Research Ethics Committee waived the requirement of consent for those who had died or not responded. Overall mailing cost was R$ 1,004.40. CONCLUSION: Obtaining consent from patients by phone and mail for a retrospective clinical study is feasible. Most patients responded to contact and gave consent to participate. However, the process entails costs and risks that cannot be overlooked.