Comparing Incentives to Increase Response Rates Among African Americans in the Ohio Pregnancy Risk Assessment Monitoring System

Since 2005, the Ohio Pregnancy Risk Assessment Monitoring System (PRAMS) has used a prepaid phone card incentive in an effort to increase survey response. Although Ohio PRAMS has generally achieved an overall response rate of 70%, African American participation has been significantly lower, a persistent problem documented by other PRAMS states. We examined the effect of a gift card incentive compared to the standard phone card on African American response. Sampled women in the African American stratum of Ohio PRAMS were randomly assigned to either the experimental (n = 276) or control (n = 274) incentive ($10 CVS gift card or 30-min prepaid phone card, respectively). Response rates were calculated for the total number of sampled African American women during the study period. Partial or full completion of the survey instrument by mail or phone was considered a response. Logistic regression was used to identify independent predictors of response. Variables examined included age, education, ethnicity, marital status, smoking status, birth weight, Women Infants and Children (WIC) enrollment, prenatal care, parity, and incentive assignment. The overall unweighted response rate was significantly higher in the experimental group (60.5 vs. 48.5%, P = .002). Maternal and infant characteristics were similar between groups. Logistic regression modeling revealed that having more than 12 years of education (OR = 2.46, 1.56–3.89), gift card incentive (OR = 1.46, 1.02–2.10), and enrollment in WIC (OR = 1.57, 1.05–2.35) were independent predictors of increased survey response. Use of a $10 CVS gift card or 30-min prepaid phone card, respectively). Response rates were calculated for the total number of sampled African American women during the study period. Partial or full completion of the survey instrument by mail or phone was considered a response. Logistic regression was used to identify independent predictors of response. Variables examined included age, education, ethnicity, marital status, smoking status, birth weight, Women Infants and Children (WIC) enrollment, prenatal care, parity, and incentive assignment. The overall unweighted response rate was significantly higher in the experimental group (60.5 vs. 48.5%, P = .002). Maternal and infant characteristics were similar between groups. Logistic regression modeling revealed that having more than 12 years of education (OR = 2.46, 1.56–3.89), gift card incentive (OR = 1.46, 1.02–2.10), and enrollment in WIC (OR = 1.57, 1.05–2.35) were independent predictors of increased survey response. Use of a 10 CVS gift card incentive in place of a prepaid phone card can positively impact African American response in PRAMS.     

“Bird in the hand” cash was more effective than prize draws in increasing physician questionnaire response

ObjectiveTo investigate the effects of two monetary incentives on response rates to postal questionnaires from primary care physicians (PCPs).Study Design and SettingThe PCPs were randomized into three arms (n = 550 per arm), namely (1) €5 sent with the questionnaire (cash); (2) entry into a draw on return of completed questionnaire (prize); or (3) no incentive. Effects of incentives on response rates and item nonresponse were examined, as was cost-effectiveness.ResultsResponse rates were significantly higher in the cash (66.1%; 95% confidence interval [CI]: 61.9, 70.4%) and prize arms (44.8%; 95% CI: 40.1, 49.3%) compared with the no-incentive arm (39.9%; 95% CI: 35.4, 44.3%). Adjusted relative risk of response was 1.17 (95% CI: 1.02, 1.35) and 1.68 (95% CI: 1.48, 1.91) in the prize and cash arms, respectively, compared with the no-incentive group. Costs per completed questionnaire were €9.85, €11.15, and €6.31 for the cash, prize, and no-incentive arms, respectively. Compared with the no-incentive arm, costs per additional questionnaire returned in the cash and prize arms were €14.72 and €37.20, respectively.ConclusionBoth a modest cash incentive and entry into a prize draw were effective in increasing response rates. The cash incentive was most effective and the most cost-effective. Where it is important to maximize response, a modest cash incentive may be cost-effective.     

Independent and Interactive Associations of Prenatal Mood and Substance Use With Infant Birth Outcomes

The main objective of this work is to examine low prenatal mood, alcohol and tobacco use and rates of preterm (PTB) and low birth weight (LBW) births among women in Minnesota between 2002 and 2006. We examined the Minnesota version of the national, cross-sectional survey of postpartum women, the Pregnancy Risk Assessment Monitoring System (MN PRAMS). Of the 11,891 women sampled in 2002–2006, 7,457 had complete data for analysis; the weighted response rates averaged 76%. The major variables of interest were: LBW, PTB, maternal mood during pregnancy, prenatal alcohol use, prenatal tobacco use and interaction terms created from the mood and substance use variables. Women with low mood who used tobacco during pregnancy were twice as likely to have a LBW infant as women who did not smoke and reported high mood (AOR = 2.12, 95% CI: 1.35, 3.33, P = 0.001). Among women who abstained from alcohol during pregnancy, those with low mood were at an increased risk for PTB (AOR = 1.95, 95% CI: 1.54–2.45, P < 0.0001) compared to women with high mood. Low maternal mood was associated with increased risks for PTB, and LBW births among MN PRAMS respondents. Substance use and low prenatal mood co-occur and the combined effect on PTB and LBW birth outcomes warrants further investigation.     

Effectiveness of monetary incentives for recruiting adolescents to an intervention trial to reduce smoking

BACKGROUND: The study objective is to evaluate the effect of monetary incentives on response rates of adolescents to a smoking-related survey as the first step toward participation in an intervention trial. METHODS: A sample of 4,200 adolescent members of a managed care organization were randomized to one of four incentive groups: a $2 cash group, a $15 cash group, a $200 prize drawing group, or a no-incentive group. We compared group-specific response rates and willingness to be contacted about future study activities, as well as costs. RESULTS: Incentives increased survey response rates (55% response without incentive vs. a 69% response with incentive), with response of 74% in the $15 cash group, 69% in the token group, and 63% with a prize incentive. Incentives did not adversely affect willingness of adolescents to be contacted about a smoking intervention, (65% willing with incentives vs. 60% without, P = 0.03). In terms of cost per additional survey completed, token and prize groups were marginally more expensive than the no-incentive group ($0.40 and $1.42, respectively) while the large cash incentive was substantially more costly ($11.37). CONCLUSIONS: Monetary incentives improve response rates to a mailed survey, without adverse impact on willingness to further participate in intervention activities. However, a variety of issues must be considered when using incentives for recruitment to intervention studies.     

The association between social cohesion and community disaster resilience: A cross‐sectional study

A cross‐sectional study design was created, using the Index of Perceived Community Resilience (IPCR) and Buckner's Index of Cohesion (BIC) to survey 386 flood evacuees from six communities in Kelantan, Malaysia, in 2015. The respondents were mostly female (54.7%); lived in basic housing (95.6%); average income (55.9%); secondary level schooling (81.1%); not involved with community organisations (95.1%), volunteering activities (91.2%), or emergency teams (96.9%); inexperience with injury during flooding (94%); experienced the emergency disaster (61.6%); and their mean age was 49 years old. Overall, respondents scored a high level of community disaster resilience (CDR) (mean 3.9) and social cohesion (mean 3.79). Also, respondents’ housing type, event of injury during disaster, volunteering in post‐disaster activities, and emergency team participation were significantly associated with CDR (p = 0.001–0.002), organisational involvement (p = 0.016), and emergency disaster experience (p = 0.028) were significantly associated with social cohesion. The Pearson correlation coefficient results mostly showing a moderate, weak, and one with a strong relationship. There is a strong relationship between community participation (CDR) in events and BIC variables (r = 0.529, p = 0.001). Other analysis shows a moderate but significant relationship with BIC; is open to ideas (r = 0.332, p = 0.001); community has similar values/ideas (r = 0.421, p = 0.001); sense of pride (r = 0.389, p = 0.001); strong leadership (r = 0.339, p = 0.001); positive change (r = 0.484, p = 0.001); and able to handle problems (r = 0.454, p = 0.001). Overall, the results show that respondents had high levels of CDR and social cohesion, while the demographic characteristics show the impact of CDR and social cohesion. In conclusion, the data gives original insight into the level of association between social cohesion and disaster resilience, which could be used as a building block in sustainable disaster recovery. There is a need to explore this further on programmes designed to improve social cohesion across communities.     

Health Professional’s Perceptions and Practices in Relation to Functional Capacity Evaluations: Results of a Quantitative Survey

Introduction This study investigated the perceptions and practices of Australian health professionals in relation to the use of functional capacity evaluations (FCE’s). Methods A quantitative cross-sectional study design was used to survey health professionals who conduct FCE’s and who were working for one of 219 rehabilitation providers in NSW, Australia. Seventy seven returned surveys were eligible for inclusion. Results Eleven different FCE’s were being utilised with many health professionals using more than one FCE. The most commonly used FCE was non-standardised (56%, n = 43) followed by 52% (n = 40) using the Workhab, and 18% (n = 14) using Valpar. Both non-standardised and standardised assessments were being used by 90% (n = 69) of respondents. Health professionals reported using all or parts of the FCE, and indicated identical FCE’s are not always conducted, with adaptation of the FCE, due to client injury (82%, n = 62) and job (80%, n = 43) occurring. About 60% of respondents had no choice in the type of FCE they conducted, and of the 40% with a choice, this was not influenced by other stakeholders in the process. Accreditation and training, characteristics of assessment tasks, standardisation, reliability, cost, length and flexibility were all identified as factors affecting the selection of an FCE. Conclusions This study demonstrated that health professionals in NSW Australia, are not routinely using standardised tools for FCE’s. Health professional perceptions suggest accreditation, training and the characteristics of the FCE were important factors in FCE selection. In practice, participants tended to use parts of an FCE rather than the whole FCE. Adaptation of FCE’s was common, due to client injury and specific job requirements.     

“Pay them if it works”: Discrete choice experiments on the acceptability of financial incentives to change health related behaviour

The use of financial incentives to change health-related behaviour is often opposed by members of the public. We investigated whether the acceptability of incentives is influenced by their effectiveness, the form the incentive takes, and the particular behaviour targeted. We conducted discrete choice experiments, in 2010 with two samples (n = 81 and n = 101) from a self-selected online panel, and in 2011 with an offline general population sample (n = 450) of UK participants to assess the acceptability of incentive-based treatments for smoking cessation and weight loss. We focused on the extent to which this varied with the type of incentive (cash, vouchers for luxury items, or vouchers for healthy groceries) and its effectiveness (ranging from 5% to 40% compared to a standard treatment with effectiveness fixed at 10%). The acceptability of financial incentives increased with effectiveness. Even a small increase in effectiveness from 10% to 11% increased the proportion favouring incentives from 46% to 55%. Grocery vouchers were more acceptable than cash or vouchers for luxury items (about a 20% difference), and incentives were more acceptable for weight loss than for smoking cessation (60% vs. 40%). The acceptability of financial incentives to change behaviour is not necessarily negative but rather is contingent on their effectiveness, the type of incentive and the target behaviour.     

Incentives increased return rates but did not influence partial nonresponse or treatment outcome in a randomized trial

OBJECTIVE: Our aim was to analyze monetary incentives and shortening the questionnaire as means of increasing response rates in a mailed follow-up survey 1 year after inpatient psychotherapeutic treatment. Additionally, effects on partial nonresponse and the assessment of treatment outcome were examined. STUDY DESIGN AND SETTING: In a 2x2 factorial design, a sample of 3,825 patients was randomized to the two following interventions: (1) receiving a prepaid monetary incentive or none; and (2) getting a short or a long questionnaire. Treatment outcome was measured prospectively by a self-assessment instrument for psychopathology. RESULTS: When using incentives, the response rate significantly increased by 7.3% (95% confidence interval [CI] 2.6-11.9%). Receiving a short questionnaire led to an augmentation of the response rate of 3.7% (95% CI 0.9-8.3%), which was not significant. The corresponding odds ratios were significantly increased for monetary incentives (1.36; 95% CI 1.30-1.88), and when abridging the questionnaire (1.15; 95% CI 1.01-1.31). However, partial nonresponse and treatment outcome were independent of the two factors. CONCLUSION: Incentives and a shorter questionnaire led to higher return rates but did not affect partial nonresponse and self-report of treatment outcome in a randomized postal survey.     

Exploring Nonresponse Bias in a Health Survey Using Neighborhood Characteristics

Objectives. We examined potential nonresponse bias in a large-scale, population-based, random-digit-dialed telephone survey in California and its association with the response rate.Methods. We used California Health Interview Survey (CHIS) data and US Census data and linked the two data sets at the census tract level. We compared a broad range of neighborhood characteristics of respondents and nonrespondents to CHIS. We projected individual-level nonresponse bias using the neighborhood characteristics.Results. We found little to no substantial difference in neighborhood characteristics between respondents and nonrespondents. The response propensity of the CHIS sample was similarly distributed across these characteristics. The projected nonresponse bias appeared very small.Conclusions. The response rate in CHIS did not result in significant nonresponse bias and did not substantially affect the level of data representativeness, and it is not valid to focus on response rates alone in determining the quality of survey data.Declining survey response rates over the last decade have raised concerns regarding public health research that uses population-based survey data. Response rates are commonly considered the most important indicator of the representativeness of a survey sample and overall data quality, and low response rates are viewed as evidence that a sample suffers from nonresponse bias.^1,2 Recent survey research literature, however, suggests that response rates are a poor measure of not only nonresponse bias but also data quality.^3–7The decline in survey response rates over the past several decades has led to a number of rigorous studies and innovative methods to explore the relationship between survey response rates and bias. A meta-analysis that examined response rates and nonresponse bias in 59 surveys found no clear association between nonresponse rates and nonresponse bias.⁸ Some surveys with response rates under 20% had a level of nonresponse bias similar to that of surveys with response rates over 70%. This is because nonresponse bias is either a function of both the response rate and the difference between respondents and nonrespondents in a variable of interest,⁹ or it is a function of covariance between response propensity and a variable of interest.¹⁰ Therefore, response rates alone are not the determinant of nonresponse bias of the survey estimates. Although it may be convenient to use the response rate as a single indicator of a survey''s representativeness and data quality, nonresponse bias is a property of a particular variable, not of a survey.Nonetheless, declining survey response rates increase the potential for nonresponse bias and have raised questions about the representativeness of inferences made from probability sample surveys. Inferences from surveys are based on randomization theory and assume a 100% response from the sample. Although the gap between theory-based assumptions and the reality of survey administration has always been a concern, the increasing deviation from the full response assumption increases this concern.Nonresponse is multidimensional, not a unitary outcome, and is roughly divided into 3 components: noncontact, refusal, and other nonresponse.⁹ Most examples of nonresponse compose the first 2 components. A study by Curtin et al. found that refusal rates in a telephone survey remained constant between 1979 and 2003, although the contact rates decreased dramatically.¹¹ Another study by Tuckel and O''Neill found the same pattern.¹²Arguably, different dynamics lead to noncontact and refusal.^13,14 Noncontact (e.g., unanswered phone calls in random-digit-dialed surveys) is related to accessibility. Call screening devices, phone usage, and at-home patterns affect accessibility, and calling strategy (e.g., number of call attempts and timing of calls) directly influences contact rates.^7,12 Refusal occurs only after contact is made. The decision to participate or not is an indicator of the respondent''s amenability to the survey and is also influenced by other factors.Noncontact and refusal may affect different types of potential biases, and these biases may offset one another.^7,15 For example, measures on volunteerism may be biased through noncontact because those who spend much time volunteering may be hard to reach in random-digit-dialed surveys. On the other hand, those who refuse to participate in the same survey may have opinions and behaviors related to volunteerism that differ dramatically from those of persons who are never contacted. Because aggregating noncontact and refusal may obscure our understanding of nonresponse bias, understanding detailed response behaviors along with overall nonresponse bias is important.The decline in response rates is more rapid for random-digit-dialed telephone surveys than for other survey types. The difficulties inherent in examining nonresponse bias arise from the absence of data on nonrespondents. Unlike face-to-face surveys, in which interviewers make direct observation of the sampled individual and have an opportunity to gather contextual information regardless of response status, such information is scarce in telephone surveys because interviewers do not visit the individual and the interviewer–respondent interaction, if any, remains oral and over the telephone. Follow-up with nonrespondents in a telephone survey can be conducted to study its nonresponse bias, but such efforts are resource intensive. Additionally, unless 100% participation is achieved, there still remains some level of nonresponse.Alternatively, nonresponse can be studied through the use of the geographic identifiers associated with sampled telephone numbers. Phone numbers from random-digit-dialed sampling frames can be readily associated with a limited number of geographic identifiers, such as zip codes. In addition, most phone numbers can be matched to a postal address and consequently to a census tract and county, which provides a unique opportunity to evaluate patterns of nonresponse as a function of neighborhood characteristics. A few recent nonresponse bias studies have used such contextual data.^16–19We examined potential nonresponse bias in the 2005 CHIS, a large random-digit-dialed telephone survey, by comparing a wide range of census tract–level neighborhood characteristics by response behavior as well as examining response rates across neighborhood characteristics. Although these characteristics are not specific to individual cases (households), neighborhood characteristics at the census tract level serve as useful proxy indicators of differences in the population. This is because census tracts are relatively permanent small geographic divisions with 1500 to 8000 people that are designed to be homogeneous with respect to sociodemographic characteristics.²⁰ Unlike previous studies that focused on statistical significance, we discuss substantive significance. We explored nonresponse bias in a large, population-based telephone health survey in California. We linked data from the California Health Interview Survey (CHIS) to US Census data at the tract level to compare respondents and nonrespondents across a broad range of neighborhood characteristics.     

Prenotification but not envelope teaser increased response rates in a bulimia nervosa mental health literacy survey: A randomized controlled trial

ObjectivesUnderstanding attitudes to mental health issues can inform public health interventions. However, low response rates may contribute to nonresponse bias. In a randomized controlled trial we examined the effect of sending a prenotification postcard before the questionnaire and the placement of a short message on the survey envelope (teaser) on response rates to a mailed questionnaire about bulimia nervosa “mental health literacy”.Study Design and SettingQuestionnaires were mailed to 3,010 adults (50.6% female and 49.4% male) aged 18–65 years. In a 2 (pre-notification–present; absent) by 2 (teaser–present; absent) design, questionnaire recipients were randomly allocated to the experimental strategies. Outcomes considered were response rate, response time, and cost.ResultsThe overall response rate was 22.0%. Significant main effects showed higher response rates for the use of prenotification (present = 23.6%; absent = 20.3%), among female participants, and older participants. A significant interaction of teaser by gender indicated lower response rates for men who received the teaser but not for women. Older participants returned the questionnaire more promptly than younger participants. Females—but not males—who received the teaser were slower to return the questionnaire. Higher response rates for participants receiving the postcard compensated for increased costs, particularly for males and older participants.ConclusionResponse rates to a mental health postal survey can be increased through the use of prenotification.     

Can incentives undermine intrinsic motivation to participate in epidemiologic surveys?

Response rates to surveys are decreasing. The purpose of this study was to evaluate the use of lottery tickets as incentives in an epidemiologic control group. A self-administered questionnaire was sent to parents in the municipality of Stockholm, Sweden, who were to be used as a control group in a study addressing stress in parents of children with cancer. A stratified random sample of 450 parents were randomized into three incentive groups: (a) no incentive; (b) a promised incentive of one lottery ticket to be received upon reply; (c) a promised incentive of one lottery ticket to be received upon reply and an additional lottery ticket upon reply within 1 week. The overall response rate across the three groups was 65.3%. The response rate was highest in the no incentive group (69.3%) and lowest in the one plus one lottery ticket group (62.0%). In a survival analysis, the difference between the two response curves was significant by the log-rank test (P = 0.04), with the no incentive group having a shorter time to response than the incentive group. Our findings suggest that the use of lottery tickets as incentives to increase participation in a mail questionnaire among parents may be less valuable or even harmful. Incentives may undermine motivation in studies in which the intrinsic motivation of the respondents is already high.     

Self-Reported Interest to Participate in a Health Survey if Different Amounts of Cash or Non-Monetary Incentive Types Were Offered

The objective of this study was to assess monetary and non-monetary factors that can influence the decision to participate in a future health survey. A questionnaire was administered to eligible, low-income participants (n?=?1502) of the 2012 Los Angeles County Health and Nutrition Examination Survey (LAHANES-II). Multivariable regression analyses were performed to describe factors potentially associated with future intent to participate in similar survey designs. The results of the survey suggest that, overall, female participants had a greater interest in participating under a variety of incentive scenarios. Compared to the 25–34 age group, older participants (35–44, 45–84) reported more interest to participate if $10 cash [prepaid gift/debit card], a coupon for product/travel, or a small item [e.g., granola bar, t-shirt, pen] was offered, whereas younger participants (18–24) reported greater interest for $25 cash or a coupon for product/travel. Non-Whites, when compared to Whites/Non-Hispanics, reported greater interest to participate if any of the incentives was offered. High school graduates, when compared to those with some college education, reported greater interest to participate if $10 cash, a small item, or a lottery ticket was offered. Presence of two or more chronic conditions increased interest while concerns about participation in LAHANES-II was associated with reduced interest to participate in future health-related surveys. The results suggest that both incentives and non-monetary considerations (e.g., personal concerns about participating and individual level characteristics) can influence the decision to participate in health-related surveys and offer insights into strategies that can improve response rates for these assessments that are often used to inform community planning.     

NHS commissioning in probation in England – Still on a wing and a prayer

Policy reforms in England and Wales mean that all individuals released from prison will have some contact with probation services, either serving a community sentence, or being on licence post‐release. Despite often having complex health needs, including a higher prevalence of mental health problems, substance misuse problems and physical health problems than the general population, this socially excluded group of people often do not access healthcare until crisis point. This is partly due to service‐level barriers such as a lack of appropriate and accessible healthcare provision. We conducted a national survey of all Clinical Commissioning Groups (CCGs, n = 210) and Mental Health Trusts (MHTs, n = 56) in England to systematically map healthcare provision for this group. We compared findings with similar surveys conducted in 2013 and 2014. We had excellent response rates, with the data analysed here representing responses from 75% of CCGs and 52% of MHTs in England. We found that just 4.5% (n = 7) of CCG responses described commissioning a service specifically for probation service clients, and 7.6% (n = 12) described probation‐specific elements within their mainstream service provision. Responses from 19.7% of CCGs providing data (n = 31) incorrectly suggested that NHS England are responsible for commissioning healthcare for probation clients rather than CCGs. Responses from 69% (n = 20) of MHTs described providing services specifically for probation service clients, and 17.2% (n = 5) described probation‐specific elements within their mainstream service provision. This points to a need for an overarching health and justice strategy that emphasises organisational responsibilities in relation to commissioning healthcare for people in contact with probation services to ensure that there is appropriate healthcare provision for this group.     

Prevalence of Self-Reported Postpartum Depression Specific to Season and Latitude of Birth: Evaluating the PRAMS Data

To determine whether season of infant birth or amount of daylight at time and location of birth is a risk factor for self-reported postpartum depression (PPD). The primary hypothesis was that the prevalence of PPD will peak during the darkest winter months. A cross-sectional analysis was conducted using the Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 5 (2004–2006) data set (N = 67,079). Self-reported PPD was established using a modified version of the Patient Health Questionnaire-2 (PHQ-2) included in the PRAMS questionnaire. Logistic regression for complex survey design was used to determine odds ratios and 95% confidence intervals. No significant relationship was found between mild or moderate PPD and either season of birth or length of daylight at birth. By analyzing a large, multi-state sample, this study adds to the equivocal preexisting literature suggesting that there is no significant relationship between the season of birth or length of daylight at birth and PPD.     

The Pregnancy Risk Assessment Monitoring System (PRAMS): Methods and 1996 Response Rates from 11 States

Objectives: To determine if the Pregnancy Risk Assessment Monitoring System (PRAMS) is a unique and valuable MCH data source and an effective mechanism for states to collect MCH data, and to assess if recent changes in it have improved efficiency and flexibility. Methods: Each component of the PRAMS methodology is described: sampling and stratification, data collection, questionnaire, and data management and weighting. To assess effectiveness, we calculated response rates, contact rates, cooperation rates, refusal rates, and questionnaire completion rates. Logistic regression was used to examine the relationship between maternal and infant characteristics and the likelihood of response. Four criteria were defined to measure improvement in PRAMS functioning. Results: Overall response rates for the 11 states in 1996 ranged from 66% to 80%. Cooperation rates were high (85–99%), with contact rates somewhat lower (73–87%). Response rates were higher for women who were older, White, married, had more education, were first-time mothers, and had a normal-birthweight infant. In all states, parity and education were the most consistent predictors of response, followed by marital status and race. Between 1988–1990 and 1996–1999, the number of states and areas participating in PRAMS increased from 6 to 23, response rates improved, and the time for a state to start data collection and to obtain a weighted dataset both decreased. Conclusions: PRAMS is a unique and valuable MCH data source. The mail/telephone methodology used in PRAMS is an effective means of reaching most women who have recently given birth in the 11 states examined; however, some population subgroups are not reached as well as others. The system has become more efficient and flexible over time and more states now participate.     

Postpartum Contraception Use by Urban/Rural Status: An Analysis of the Michigan Pregnancy Risk Assessment Monitoring System Data

ObjectiveWe sought to examine rural/urban differences in postpartum contraceptive use, which are underexplored in the literature.MethodsWe analyzed phase 5 (2004–2008) of the Michigan Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Using Rural–Urban Commuting Area codes and weighted multinomial logistic regression, we examined the association between self-reported postpartum contraceptive method and rural/urban residence among postpartum women not desiring pregnancy (n = 6,468).ResultsPostpartum (mean, 16.5 weeks after delivery), 14.4% of respondents were using sterilization, 6.7% long-acting reversible contraception (LARC), 37.3% moderately effective hormonal methods, 38.4% less effective methods or no method, and 3.2% abstinence. Multivariable analysis yielded sporadic geographic patterns. Odds of method use varied significantly by age, parity, body mass index, and breastfeeding status. Not discussing contraception with a prenatal healthcare provider decreased odds of postpartum LARC use (odds ratio, 0.52; 95% CI, 0.36–0.75). Number of prenatal visits and weeks since delivery were not associated with postpartum contraception method.ConclusionsWe did not observe strong variation in postpartum contraceptive use based on geography. Low uptake of highly effective contraception across rural and urban areas suggests a need for education and outreach regarding these methods.     

2014—2018年海南地区各级医院住院患者医院感染现患率

目的 了解2014—2018年海南地区各级医院住院患者医院感染现患率情况,为降低海南地区医院感染发病率提供科学指导依据.方法 采用横断面调查法对2014、2016和2018年参与海南省医院感染现患率调查日的住院患者进行床旁调查和病历调查,调查数据采用SPSS 20.0软件进行统计分析.结果 2014、2016、2018...