1. IMPROVING SURVEYS of SEXUAL BEHAVIOR USA National STD and Behavior Measurement Experiment (NSBME)

2. Charles Turner Alia Al-Tayyib Susan Rogers Maria Villarroel Anthony Roman James Chromy Phillip Cooley Funded by NIMH and NICHD (R01-MH56319 & R01-HD31067)

3. OBJECTIVE Importance of Self-Report Importance of Self-Report Final Installment of NSBME Final Installment of NSBME “PIs know best” “PIs know best”

4. SELF-REPORT Almost everything we know about sexual behaviors Almost everything we know about sexual behaviors Population SurveysPopulation Surveys Evaluation of InterventionsEvaluation of Interventions Clinical MedicineClinical Medicine Privacy, SAQs, and, Audio-CASIPrivacy, SAQs, and, Audio-CASI

5. Developed by Phil Cooley in 1994-95. Developed by Phil Cooley in 1994-95. Human interviewers recruit respondents and introduce survey Human interviewers recruit respondents and introduce survey Computer-recorded questions played and respondents used telephone keypad to respond Computer-recorded questions played and respondents used telephone keypad to respond First demonstration of impact of T-ACASI: First demonstration of impact of T-ACASI: 1996 ASC meetings 1996 ASC meetings

6. T-ACASI Advantages Entirely private administration Entirely private administration Completely standardized – everyone hears exactly same question wording, intonation Completely standardized – everyone hears exactly same question wording, intonation Eases multilingual interviewing Eases multilingual interviewing

7. NSBME: National STD and Behavior Measurement Experiment Two probability samples of English speaking adults ages 18-45 living in households with telephones –National stratum, N=1,543 –Baltimore stratum, N=744 Telephone numbers randomly assigned to T-IAQ or T-ACASI condition

8. NSBME FINDINGS TO DATE Increased illicit but not licit drug use Addictions, 2004 Increased same-gender sex --- particularly in gay-unfriendly regions Public Opinion Quarterly, 2006 Increased reporting of STD history STDs, 2008 Increased reporting of unpopular social attitudes Public Opinion Quarterly, 2009

9. Heterosexual Sex Forthcoming International Journal of Epidemiology Summer / Fall, 2009

10. No Sexual Experience OR= 2.1, P = 0.001

11. No Main Sex Partner in Past Year OR= 1.9, P = 0.001

12. New Sex Partners, 12 months p < 0.001

13. Extra-Relationship Sex during Committed Relationship OR= 1.6, p =.001

14. Never Oral Sex OR= 0.5, p < 0.001

15. Ever Heterosexual Anal Sex OR= 1.7, p < 0.001

16. Never Sex while Menstruating OR= 0.7, p < 0.001

17. Used Condom Every Time Past Year OR = 0.5, p < 0.001

18. Difficulty having Satisfying Sex OR = 1.4, p = 0.011OR = 1.3, p = 0.097

19. “PIs Know Best”

20. “Very Easy” to become Sexually Aroused OR = 1.8 p < 0.001 OR = 2.8 p < 0.001 OR = 1.5 p = 0.003

21. Always Asked or Told about Past Sex Partners OR = 1.4, p = 0.058OR = 1.5, p = 0.028

22. CONCLUSION T-ACASI Reduces Self-Report Bias What People Do vs. What People Say They Do Lessons in Fallibility of PI Assumptions