HHS plans to use PCs for tobacco survey

Looking for a way to improve privacy in a survey that has become part of the raging debate over tobacco, the Department of Health and Human Services is considering using computer technology to conduct a study of tobacco use among young people.

For months, HHS has been preparing a survey of 20,000 individuals between the ages of 12 and 17 to measure their use of cigarettes, snuff, chewing tobacco, cigars, pipes and roll-your-own tobacco. President Clinton this month announced that as part of an effort to monitor youths' smoking habits he has instructed HHS to expand the survey to identify the cigarette brands teens smoke.

HHS is considering using computers to gather information on youths' tobacco use. Last month, HHS issued a request for information (RFI) asking industry for recommendations on how to use computer technology to conduct the survey.

"Given the sensitive nature of the data to be collected and the need for privacy, accuracy and efficiency, the department is interested in pursuing state-of-the-art technologies for data collection: [for example], computer-assisted personal interview (CAPI), computer-assisted self-interview (CASI) or audio computer-assisted self-interview

(A-CASI)," according to the RFI. The computer-assisted data collection methods would allow the youths to take the survey in private. For example, CASI would display the questionnaire on a computer screen, and respondents would answer by pressing numbered keys on the keyboard. With A-CASI, interviewees would listen over headphones to questions that have been digitally recorded on a laptop computer, and then they would key in their responses.

HHS officials declined to comment on the RFI.

Other organizations have turned to computers to conduct large surveys that deal with sensitive subjects, such as sexual habits, and illegal behavior, such as drug use. The National Opinion Research Center (NORC), a social science research institute at the University of Chicago, used computers to conduct the Adolescent Health Study, a longitudinal study of school-age children, and the HIV Cost and Services Utilization Study, which collected data on the types and the costs of medical care that patients with the human immuno-

deficiency virus receive in the United States. "Almost all of our studies use [computers]," said Julie Antelman, public information coordinator at NORC.

A study published in the May issue of Science magazine indicated that computer surveys offer teen-agers more privacy than paper-and-pencil survey forms do, making the respondents feel freer to admit unsafe behavior and resulting in a more accurate survey.

"We thought the pencil-and-paper form would be perceived as private, but respondents appear to be willing to divulge more sensitive information to a computer," said Charles Turner, director of the health and behavior measurement program at the Research Triangle Institute, a nonprofit contract research organization in Research Triangle Park, N.C.

Computers allow respondents to shut the screen off if someone walks in the room, and they protect information through encryption, Turner said.

Computer-assisted methods also allow agencies to survey a more nationally representative group by including individuals who cannot read or write. "This technology is the only way I know to make these sensitive measurements for people who can't read and write," Turner said. "The computer ensures that you can do that for everyone."

Computer-survey technology also provides a completely standardized measurement system and eliminates some of the human error associated with written questionnaires, said Nancy Brener, a research psychologist at the Centers for Disease Control and Prevention.

CDC plans to use computers in 2000 for the second wave of its School Health Policies and Programs Study, a national survey of school health programs that was first run in 1994. "We're using CAPI to do on-site personal interviews in schools," Brener said.

Although the survey will be conducted through a contract with the Research Triangle Institute, it does not involve sensitive information. "CAPI is more of a technological convenience," Brener said. "It's a lot quicker than the typical paper-and-pencil form. It's just far superior."

Unlike the Youth Tobacco Survey, the CDC's questionnaire will target adults. While it has been reported that the positive results of using computers for gathering survey data for teens can be applied to older age groups, Turner said, "The generalization to adults is problematic."

The technology, however, offers benefits that the paper form does not, regardless of the respondent's age. Using less-advanced types of surveys, "you either lose the data or gather it with bias," he said.