Design and operation of the National Asthma Survey.

OBJECTIVES: This report presents detailed information on the National Asthma Survey (NAS), a module of the State and Local Area Integrated Survey program conducted by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics. NAS, sponsored by the CDC's National Center for Environmental Health, was designed to produce national prevalence estimates of adults and children with asthma; to describe the health, socioeconomic, behavioral, and environmental predictors that relate to controlling asthma better; and to characterize the content of care and limitations of persons with asthma. National prevalence estimates were constructed to be consistent with those produced from the CDC's National Health Interview Survey (NHIS), although prevalence estimates for subpopulations may or may not be consistent with NHIS. METHODS: Two separate random-digit-dial telephone studies were fielded: a national study and a four-state study in Alabama, California, Illinois, and Texas. Children aged 0-17 years and adults aged 18 years and over were included in both studies. The screening procedure differed between the studies. Percentages can be generated for the four states combined or for each state separately. A substudy was conducted in the national study to examine the accuracy of proxy reports of asthma. RESULTS: Data were collected from February 2003 to March 2004. A total of 955 detailed asthma interviews were completed in the national study and 5,741 in the four-state study. A data file has been released for each study that contains asthma, health, and demographic data, as well as sampling weights. The weighted overall response rates were 47.2% for the national sample and 48.5% for the four-state sample.

Physician exposure to and attitudes toward advertisements for genetic tests for inherited cancer susceptibility.

Commercial marketing materials may serve as a source of information for physicians about genetic testing for inherited cancer susceptibility (GTICS) in addition to medical guidelines, continuing education, and journal articles. The primary purposes of this study were to: (1) determine the percentage of physicians who received advertisements for GTICS early in the diffusion of commercial GTICS (1999-2000); (2) assess associated characteristics; and (3) measure the perceived importance of commercial advertisements and promotions in physicians' decisions to recommend testing to patients. A nationally representative, stratified random sample of 1,251 physicians from the American Medical Association (AMA) Physician Masterfile completed a 15-20 min mixed mode questionnaire that assessed specialty, previous use of genetic tests, practice characteristics, age, and receipt of advertising materials (response rate = 71%). Overall, 27.4% (n = 426) had received advertisements. In multivariate analysis, factors associated with receipt of advertisements included: specialties in obstetrics/gynecology, oncology, or gastroenterology; past GTICS use, and age 50+. One of four felt that advertisements would be important in their decision to recommend GTICS. Study results indicate that physicians, particularly in oncology, obstetrics/gynecology, and gastroenterology, began receiving GTICS advertisements commensurate with the early diffusion of commercially available tests into clinical practice. At that time, one-quarter of the physicians considered advertisements to play an important role in their clinical decision making, suggesting attention to other sources of information and additional factors.

Design and Operation of the National Survey of Children's Health, 2003.

Objectives-This report presents the development, plan, and operation of the National Survey of Children's Health(NSCH), a module of the State and Local Area Integrated Telephone Survey, conducted by the Centers for Disease Control and Prevention's(CDC) National Center for Health Statistics. This survey was designed to produce national and State-specific prevalence estimates for a variety of physical, emotional, and behavioral health indicators and measures of children's experiences with the health care system. The survey also includes questions about the family (e.g., parents' health status, stress and coping behaviors, family activities) and about respondents' perceptions of the neighborhoods where their children live. Primary funding for this survey was provided by the Maternal and Child Health Bureau, Health Resources and Services Administration. Additional support was received from the CDC's National Center for Infectious Diseases, using funds provided by the National Vaccine Program Office. Methods-A random-digit-dial sample of households with children under 18 years of age was selected from each of the 50 States and the District of Columbia. One child was randomly selected from all children in each identified household to be the subject of the survey. The respondent was the parent or guardian who knew the most about the child's health and health care. Results-A total of 102,353 interviews were completed from January 2003 to July 2004. The weighted overall response rate was 55.3%. A data file has been released that contains demographic information on the selected child, substantive health and well-being data for the child and his/her family, and sampling weights. Estimates based on the sampling weights generalize to the noninstitutionalized population of children in each State and nationwide.

Estimating the prevalence of uninsured children: an evaluation of data from the National Survey of Children with Special Health Care Needs, 2001. Data evaluation and methods research.

UNLABELLED: The National Survey of Children with Special Health Care Needs revealed that 8.3% of children under 18 years of age were uninsured, a rate lower than the rate estimated by other national surveys. This report presents the results of an evaluation of the quality of this estimate, based on analyses of non-response, question design, interviewer and respondent effects, and the weighing and estimation process. National and State-level statistics on health insurance coverage for children with special health care needs (CSHCN) and for children without special needs are included in an appendix. SOURCE OF DATA: The National Survey of CSHCN is a survey module of the State and Local Area Integrated Telephone Survey. This survey of parents and guardians collected health insurance coverage information for a national sample of 215, 162 children. Data were collected from October 2000 through April 2002. RESULTS: Compared with other surveys, weighted data from the National Survey of CSHCN describe a population with a slightly larger proportion of Hispanic children and children from households with higher incomes. The National Survey of CSHCN was also the only survey to use a child-level design: A randomized experiment that varied the health insurance questions found that repeating the coverage questions for each child produced lower unisurance rates than household-level questions that first asked if anyone in the househol was insured. CONCLUSION: Question design differences explain much of the discrepancy between survey estimates of the uninsurance rate, but a definitive conclusion regarding the relative accuracy of the uninsurance rates is not possible.

The impact of touch-tone data entry on reports of HIV and STD risk behaviors in telephone interviews.

Respondents concerns about privacy can decrease reporting of HIV and STD risk behaviors in general population telephone surveys. The purpose of this paper is to describe the results of an experimental study evaluating whether one method for increasing privacy, touch-tone data entry (TTDE), is effective in increasing estimates of sexual behaviors from a population-based survey. We conducted a random-digit-dial telephone survey of adults in New Jersey (n = 405), with half the respondents using TTDE for answering sexual behavior questions. TTDE led to increased reports of same-sex sexual behavior, certain HIV and STD risk factors, and concern about one s risk for HIV and STD transmission. TTDE also narrowed the difference between men s and women s reports of the number of different sexual partners over the past 10 years. The feasibility and limitations of TTDE are discussed, as well as possible alternative interpretations that consider the impact of TTDE on the dynamics of the interaction between the respondent and the interviewer.

Design and operation of the National Survey of Children with Special Health Care Needs, 2001.

OBJECTIVES: This report presents the development, plan, and operation of the National Survey of Children with Special Health Care Needs (CSHCN), a module of the State and Local Area Integrated Telephone Survey, conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention. This survey was designed to produce national and State-specific prevalence estimates of CSHCN, describe the types of services that they need and use, and assess aspects of the system of care for CSHCN. This study included two additional modules to provide health care coverage estimates for all children and to collect data on the reasons that low-income uninsured children lack health care coverage. Primary funding for this survey was provided by the Maternal and Child Health Bureau, Health Resources and Services Administration. METHODS: A random-digit-dial sample of households with children under 18 years of age was selected from each of the 50 States and the District of Columbia. Depending on the health care needs of the children in each household, a detailed interview was conducted for one randomly selected child with special needs and a brief health insurance interview was conducted for one randomly selected child without special needs. The respondent was the parent or guardian who knew the most about the child's health and health care. RESULTS: A total of 196,888 household screening interviews were completed from October 2000 to April 2002. This resulted in 38,866 completed special-needs interviews and 176,296 completed health insurance interviews for children without special needs. The weighted overall response rate for special-needs interviews was 61.0%.

Physician use of genetic testing for cancer susceptibility: results of a national survey.

Genetic testing for inherited germ-line mutations associated with cancer susceptibility is an emerging technology in medical practice. Limited information is currently available about physician use of cancer susceptibility tests (CSTs). In 1999-2000, a nationally representative survey was conducted to estimate prevalence of CST use by United States physicians and assess demographic, training, practice setting, and practice patterns associated with use. A stratified random sample of clinicians in eight specialties was selected from a file of all licensed physicians. In total, 1251 physicians, including 820 in primary care and 431 in tertiary care, responded to a 15-min questionnaire by mail, telephone, fax, or Internet (response rate = 71.0%). In the previous 12 months, 31.2% [95% confidence interval (CI), 28.5-33.9] overall, including 30.6% (95% CI, 27.5-33.7) in primary care and 33.4% (95% CI, 27.9-38.9) in tertiary care, had ordered CSTs or referred patients elsewhere for risk assessment or testing. More physicians referred patients elsewhere [26.7% (95% CI, 24.2-29.2)] than directly ordered tests [7.9% (95% CI, 6.3-9.5)]. Factors associated with ordering or referring included practice location in the Northeast [odds ratio (OR), 2.30; 95% CI, 1.46-3.63%], feeling qualified to recommend CSTs (OR, 1.96; 95% CI = 1.41-2.72), receiving CST advertising materials (OR, 1.97; 95% CI, 1.40-2.78%), and most notably, having patients who asked whether they can or should get tested (OR, 5.52; 95% CI, 3.97-7.67%). Lower CST use was associated with not knowing if there were local testing and counseling facilities (OR, 0.39; 95% CI, 0.23-0.66%). These findings underscore the importance of establishing effective clinical approaches to test use and promoting physician education to facilitate communication with patients about cancer genetics.

Design and operation of the National Survey of Early Childhood Health, 2000.

OBJECTIVES: This report presents the development, plan, and operation of the National Survey of Early Childhood Health, a module of the State and Local Area Integrated Telephone Survey, conducted by the National Center for Health Statistics, Centers for Disease Control and Prevention. This survey was designed to assess parents' perceptions of their children's pediatric care. In addition, data were collected that can be used to examine relationships between the promotion of health in the pediatric office and promotion of health in the home. Funding for the survey was provided by The Gerber Foundation, the American Academy of Pediatrics, and the Maternal and Child Health Bureau, Health Resources and Services Administration. The UCLA Center for Healthier Children, Families, and Communities contributed to the design of the study and the questionnaire. METHODS: A national random-digit-dialed (RDD) sample of households with children 4-35 months of age was selected. The study included an oversample of households having an eligible black non-Hispanic or Hispanic child. In households with more than one eligible child, one was randomly selected to be the subject of the interview. The respondent was the parent or guardian who was most responsible for the child's health care. A computer-assisted telephone interviewing (CATI) system was used to collect the data. RESULTS: A total of 2,068 interviews were completed during the first half of 2000. The response rate was 65.6%. A data file has been released that contains demographic information on the focal child and respondent, substantive health and health-related data, and sampling weights. Estimates based on the sampling weights generalize to the entire U.S. population of children 4-35 months of age.