Impact of T-ACASI on Estimates of Youth Smoking Prevalence: Results of UMASS Tobacco Study Lois Biener, 1 Charles F. Turner, 2 & Amy L. Nyman 1 1 Center for Survey Research University of Massachusetts Boston 2 Health & Behavior Measurement Program Research Triangle Institute Funded by The National Cancer Institute’s State & Community Tobacco Control Research Initiative Presented at American Public Health Association Meetings, Phila., Nov. 12, 2002

Introduction A key concern for tobacco researchers is obtaining accurate information on youth smoking behaviors. School-based self- administered surveys under-represent school drop-outs, truants and absentees, and securing cooperation from school systems is difficult. In addition, obtaining parental consent can reduce both the response rate and the representativeness of the sample. Random-digit-dial (RDD) telephone surveys can recruit representative samples, but they yield lower estimates of smoking prevalence than in-school, self- administered surveys. Although some of this discrepancy may arise from over-reporting in school settings, children’s worries about being overheard by parents and reluctance to disclose smoking to adult interviewers is likely to produce under-reporting in telephone surveys. We present results of an experiment in which these factors were reduced.

Methods A representative sample of 3800 youth, aged 12 to 17 were recruited for the UMass Tobacco Study. Two-thirds were randomly assigned to be surveyed about their smoking experiences using standard interviewer-administered questioning (T-IAQ); one-third were assigned to a private computer-administered self-interview (T-ACASI). In T- ACASI respondents listen to pre-recorded questions and enter answers on the keypad of a touchtone telephone. Before speaking with the youth, permission was obtained from a parent or guardian who had, in most cases served as the informant for a household screener which enumerated the household and collected information on the smoking status of all resident adults.

Data Collection Protocol Interviewers introduced the study to all youth respondents, and conducted the first 2 sections of the interview (18 questions) which dealt with details of school attendance, after-school activities, and television viewing patterns. Respondents assigned to T-ACASI were then connected to the computerized portion of the interview and were told that they would be connected back to the interviewer when the computerized portion was completed. After completing the 2 sections on smoking behavior (mean time 7.5 minutes), respondents were automatically returned to the interviewer and completed the remaining 6 sections of the interview.

Research Questions Is T-ACASI technology acceptable to youth 12 – 17 years of age? Are youth more likely to report smoking behavior with T-ACASI than with a live interviewer? Are youth more likely to report susceptibility to smoking with T-CASI?

Results Response rate was somewhat lower for T- ACASI (60.8%) than T-IAQ (65.8%). Some proportion of the T-ACASI decrement was due to technological problems and interviewer error.

Survey Items For Prevalence Indices ItemRespondentsNMode Difference Have you smoked at least 100 cigarettes in your life? All youth Not significant Have you ever experimented with cigarette smoking, even a few puffs? All youth except established smokers (those who’ve smoked 100 cigarettes) 3541Not significant Have you ever smoked a whole cigarette? Everyone who has puffed 890P=.001 Think about the past 30 days. Did you smoke a cigarette, even a puff, on any of those days? Everyone who has experimented 1191Not significant When did you last smoke or puff on a cigarette? Smoked or puffed but not in the past 30 days 779Not significant

Estimates of Smoking Prevalence

Ever Smoked Whole Cigarette Age N=127 N=340 N=419 *p <.05

Lifetime Smoking: Has had at least a puff Age N=1213 N=1330 N=1277 *p <.05

Past Year Smoking: Smoked at least 1 cigarette in past year Age N=1213 N=1330 N=1277 *p <.05

Past Month Smoking: Smoked at least 1 cigarette past month Age N=1213 N=1330 N=1277 *p <.05

Estimates of Susceptibility to Smoking

Do you think you will try a cigarette soon? Never smokers and “puffers ” N=1148 N=1109 N=811 *p <.05

Do you think you will smoke in the next year? N=1211 N=1328 N=1277 *p <.05

Would you smoke if best friend offered a cigarette? *p <=.05 N=1211 N=1328 N=1273

“Do your parents know that you smoke?” N=373 p <.05

Would/Do parents disapprove ‘a lot’ of your smoking? N=377 N=3463 p <.05

Results: Smoking Prevalence Estimates Estimates of lifetime smoking were 36% higher for the youngest respondents with T- ACASI compared to T-IAQ. Estimates of past year and past month smoking were 60 to 70% higher for youth years old with T-ACASI.

Results: Susceptibility to smoking Youth 12 to 15 who were least experienced with cigarettes were twice as likely to admit intentions to try a cigarette soon with T- ACASI than T-IAQ. All youth were slightly less likely to report a strong commitment not to smoke in the future with T-ACASI.

Results: Reports of parental attitudes Smokers were 50% more likely to report that their parents knew that they smoked and less likely to report parental disapproval when speaking with a live interviewer than when responding to the automated survey.

Conclusions The traditional telephone interview of Massachusetts youth results in under-reporting of current smoking among year olds by about 5 percentage points. Traditional telephone interviewing appears to under-estimate youth susceptibility to future smoking, especially among those with the lowest levels of experience with cigarettes.

Conclusions (continued) The use of T-ACASI methodology does not remove the discrepancy in smoking prevalence estimates between self- administered, school-based surveys and home-based telephone surveys of adolescents.

Past Month Smoking: Massachusetts Youth by Mode

Additional research can help to explore the proportion of the remaining discrepancy which is due to over-reporting in self- administered surveys and that due to under- reporting in telephone interviews.