This study examined the hypothesis that the response rate in the U.S. Census 2000 could be increased by explicitly offering respondents an alternative to using the paper form. A random sample of 10,494 households received special Census 2000 mailings. Half of these households were offered the alternative of responding via the web, while the other half were offered a telephone alternative. The offer of these alternative response modes boosted response rates by more than two percentage points over households that were not offered a response mode alternative. Half the mailings included an insert that held a telephone calling card incentive, which was activated if the household chose to use the web or telephone alternative. The insert holding the calling card greatly increased responding via the alternate response modes, but this increase was more than offset by decreased responding via the paper form. The implications of the results for future decennial censuses are discussed.

The American Time Use Survey (ATUS) telephone interviews are scheduled to begin January 2003. Respondents will report all of their activities over a 24-hour period. Once these data are collected, coders will assign a three-tiered code to each activity, based upon a lexicon and coding rules developed by the Bureau of Labor Statistics (BLS). Our poster presents the results of a test of the ATUS coding procedures, including the lexicon, the documentation, and the Blaise software. For the test, nine coders received four hours of training. Then, for the next four days, they coded respondents' activities. Periodically while they worked, they filled out questionnaires and rating forms and participated in focus groups. Four of the coders were individually videotaped while coding in a usability laboratory and while participating in think-aloud interviews. Our poster presents the accuracy and productivity of the coders, the coders' improvement over time, and the sources of the coders' confusion and errors. The poster presents the coders' opinions of the lexicon, software, documentation, and coding rules, and the manner in which these opinions changed as the coders gained experience. Our poster also covers potential enhancements to the lexicon and the software that might increase coder accuracy, consistency, and efficiency.

Focus groups are widely used in qualitative research. Recently, focus groups that are held online have become increasingly popular despite the objection by some researchers that the Internet is a poor medium for focus group research. The present study was conducted to reveal differences in the characteristics of focus group discussions in the online and face-to-face formats. Participants in 4 online focus groups and 4 face-to-face focus groups discussed their opinions about several health-related Web sites. Statistical analysis of the transcripts suggested that online participants tended to contribute shorter comments and were more likely to say just a few words of agreement. In the online focus groups, participation levels tended to be more uniform; in the face-to-face groups, some participants tended to contribute a disproportionately large number of words, whereas other participants were relatively silent. The results suggest different roles for online and face-to-face focus groups in qualitative research.

ABSTRACT Expert system software was developed to assist in determining the appropriate treatment for substance abuse patients. The software applies criteria, called the Mental Health Review Criteria (MHRC(©)), which are widely used by utilization review professionals who make treatment decisions in managed health care plans. The expert system also collects a database of patient information, including the paths that led to all treatment decisions. The expert system was evaluated by comparing its decisions with those of managed care nurse reviewers and with those of a panel of physicians who helped to develop the MHRC. A set of 70 cases were assessed by the expert system, the nurse reviewers, and the physician panel. The possible decision outcomes were approval of providers' requests for inpatient detoxification or referral for further consideration. The expert system and the nurse reviewers each agreed with the physician panel in about 85 percent of the cases. Both the expert system and the nurse reviewers were more likely to agree with the physician panel in the cases that they approved for inpatient treatment than in the cases that they referred for further consideration.

From the Publisher:'Information Networks for Community Health' discusses the technological, organizational, and legal challenges of constructing a technological infrastructure, and using such a community based computer system for health care.

Several large research programs are underway that evaluate the centralized intake model for drug abuse treatment. In this model, the drug abuse treatment facilities in a city do not operate independently; their efforts are coordinated through a small number of intake centers, which handle all patient intake and data management activities. The success of such a coordinated approach to drug abuse treatment depends in large measure upon an adequate flow of patient information. For that reason, the centralized intake model brings new challenges for the field of computerized data management. The present article describes the management information system that is being used in a large research program called the District of Columbia Initiative (DCI). The methods of this system could be applied in cities where the centralized intake model for drug abuse treatment is adopted.

A computerized, telephone-based, interactive smoking cessation program was offered free to anyone who smoked cigarettes daily. The program was intended to assist a large number of smokers without requiring them to travel, schedule time, or make a public commitment to quit smoking, and without requiring much staff time. Subjects reached the system via a toll-free call from any touch-tone telephone. The system employed a “talking computer” that spoke in a natural sounding voice that had been prerecorded on computer disk. Callers interacted with the computer by pressing touch tone keys. The system automatically composed its messages to fit the needs, expectations, and progress of each individual caller. Participants could call as often as they wished, 24 h a day, for as long as they wished. A total of 571 smokers called the system over the course of a year. More than 82% called at least twice, and over 45% called five or more times. Of all subjects, 35.1% quit smoking while using the program and 14% were abstinent 6 months after their first call. Of those who called five or more times, over 68% quit smoking while using the program and over 22% were abstinent 6 months after their first call. The results suggest that the program could assist many smokers who wish that they did not smoke, are unable to quit smoking without behavioral treatment, but yet do not wish to attend face-to-face programs.

Many interactive computer systems are being developed to provide health-related information to the public, but little research has explored how these systems should interact with their users to have the greatest impact. In the present study, 267 subjects were randomly dispersed among four versions of a computerized, interactive telephone-based stress management program in a two-bytwo factorial design. Two of the versions offered personalized messages; in the other two, messages were not personalized. Two of the versions contained homework assignments; two did not. The results suggested that personalization and homework motivated subjects to continue calling the program, to comply with the suggestions in the program, and to report that the program was helpful. Subjects whose messages were not personalized were more likely than other subjects to value empathic comments in the messages and to leave voice mail for the staff of the program. These results suggest that subjects prefer interactions with a computer to be conversational and directly responsive to their particular expectations.

Most cigarette smokers wish that they did not smoke, find it difficult to quit smoking on their own, but still do not seek face-to-face smoking cessation treatments. In an effort to reach these smokers, an interactive, behavioral, smoking cessation program was offered on the CompuServe computer network. The program tailored treatment to each individual participant's smoking history, progress toward quitting smoking, and responses to questions posed by the computer system. There was a stop smoking forum, which was an ongoing, computer-stored discussion. The 1, 158 participants were randomly dispersed among four groups, in a two-by-two design. Half received the full version of the program, while half received a control version that lacked most features of the full version. Half the subjects had access to the stop smoking forum, and half did not. The results suggested that subjects were more likely to stay in the program when they received the full version of the program. There was also a trend for the full version of the program to bring about higher abstinence rates. Subjects wh o received neither the forum nor the full version had particularly low abstinence rates.

The majority of smokers wish that they were nonsmokers, but very few seek help to quit smoking, despite their inability to quit alone. An on-line behavioral program was offered over EIES, a computerized communications system, to reach these smokers with personalized treatment which was tailored to each participant, and which permitted the participants and psychologist to interact. At the end of treatment, 35.7% of the 28 participants were abstinent. Three months later, 25% were abstinent. The smokers who succeeded tended to be the lightest smokers whose craving for cigarettes when not smoking was the least pronounced. It appears that the on-line system could effectively extend the reach of face-to-face treatments.

Data from a smoking cessation program were analyzed to identify the variables that best predicted posttreatment abstinence. Nonsmoking immediately following treatment was predicted by lower daily pretreatment intake of nicotine and total particulate matter (TPM), as well as higher score on the “handling” scale of the “Why Do You Smoke” scale. Abstinence at any time in the 6 months following treatment was also predicted by lower pretreatment nicotine and TPM intake; other predictors were lower scores on the “craving” scale, greater number of weeks spent participating in the program, citing reasons for wanting to quit smoking other than to overcome an addiction, and lower self-rated craving for cigarettes. Abstinence was not predicted by subjects' adherence to the treatment rules calling for changing the times, occasions and feelings that are associated with the heaviest smoking. Daily cigarette consumption dropped during treatment at similar rates for the smokers who would eventually be abstinent and those who would not. These results replicate the finding that a behavioral self-control program can bring about a reduction in smoking in many smokers, though relatively few actually quit smoking. Also, smokers who find the manipulations involved in smoking to be rewarding are more likely to be abstinent, at least temporarily, following a behaviorally oriented program than are smokers who are most rewarded by the self-administration of nicotine. Smoking cessation programs might benefit by tailoring treatment to such pretreatment subject characteristics.

SMOKE, a computer program written in BASIC, uses interactive direct mail to assist smokers who do not wish to attend formal face-to-face smoking cessation therapy. The effectiveness of the program was evaluated in a yearlong study. Of 1044 smokers who expressed interest in smoking treatment, only 11.2% wished to participate in formal therapy. The rest received mail-based treatment. A total of 21.2% of the subjects who were assigned to the computerized direct mail group participated in this treatment. The abstinence rates of the participants in the computerized direct mail and face-to-face groups were similar. The results suggest that computerized direct mail could be a useful addition to smoking cessation campaigns.

Reports of nonsmoking are usually validated by obtaining breath carbon monoxide levels or saliva thiocyanate levels. However, it is often not convenient to obtain such samples from persons who participated in a smoking cessation program long in the past. Obtaining the samples through the mail could help solve this problem, but it is possible that the time the samples spend in the uncontrolled environment of the mails might invalidate the measured levels. The present study was to see whether that possibility was indeed a real comcern. Breath and saliva samples were collected in airtight containers and allowed to remain in an uncontrolled environment (60°–80° F) for 72 hours, 24 hours, and less than one hour. The results suggest that the time spent in this environment had minimal impact on the carbon monoxide or thiocyanate levels in smokers' or nonsmokers' samples. Even after 72 hours, the samples could differentiate smokers from nonsmokers with little overlap. It appears that breath and saliva samples can be conveniently obtained through the mail without sacrificing their usefulness.