Online questions from 12/3 DataSpeak Web Conference
Questions for Dr. Iannotti:
Q: What is the process for adding or subtracting questions on the survey?
A: Any question included in the international HBSC survey must have published evidence of reliability and validity in more than one country. The usual process for adding questions is for them to be initially proposed as optional items which may be adopted by countries that are interested. Modifications to the mandatory international questions are decided by the Scientific Development Group of the HBSC, which is composed of representative from different content areas. I am a member of that group.
The US HBSC survey includes all of the mandatory international questions and those optional questions that are of particular interest to the US investigators. In addition, there are some US-specific items which are appropriate to US youth, culture, and/or organizations but are not included among the mandatory or optional international items. As health priorities change or as more appropriate assessments are developed, items may be replaced on the survey.
Q: Is there any possibility to include any Asian countries in the future?
A: Investigators in China have indicated an interest in joining the HBSC. There is hope that they will conduct a pilot of the survey during the 2009-2010 school year.
Q: What instrument/measure was used to collect fruit intake?
A: Fruit intake was assessed with a single item that asks: “How many times a week do you usually eat or drink …” with choices being never, less than once a week, once a week, 2-4 days a week, 5-6 days a week, once a day, and every day, more than once.
Q: Since state and local data is not always available are you willing to share your survey and data analysis program so that local health departments are able to collect and use the data at a local level and also provide you with data for your survey?
A: There are several reasons we do not currently provide the survey or survey results to states. A major concern is student anonymity and because of the sampling design it might be possible to link student data to a particular classroom or student when there are a limited number of classrooms sampled within a state. We conduct the survey every four years so it is important that we are not competing with our own survey when we approach school districts for permission to conduct the survey. Finally, we are under obligation to the international HBSC to limit exposure to the HBSC items and to supervise all use of the HBSC survey items and data.
Q: Is the survey conducted in the school district? If so, how do you obtain permission?
A: We start by contacting the state-level department of education and then contact the randomly selected school district within the primary sampling unit. Schools and classrooms are also randomly selected within the school district. We obtain permission from the school principal (and classroom teacher) and from parents and children. Only selected classrooms are selected within any single school district.
Q: Does "TV time" included all screen time such as computers and video games?
A: Screen-based sedentary behavior was a composite of three items asking: how many hours a day do you usually watch television (including videos and DVDs) in your free time; how many hours a day do you usually use a computer for chatting on-line, internet, emailing, homework etc. in your free time; and how many hours a day do you usually play games on a computer or games console (Playstation, Xbox, GameCube etc.) in your free time. The first item is used for data on TV time.
Q: How was bullying defined in the survey?
A: We say a student is BEING BULLIED when another student, or a group of students, say or do nasty and unpleasant things to him or her. It is also bullying when a student is teased repeatedly in a way he or she does not like or when he or she is deliberately left out of things. But it is NOT BULLYING when two students of about the same strength or power argue or fight. It is also not bullying when a student is teased in a friendly and playful way.
Q: Any thought about looking at the impact of Cyber-bullying?
A: Yes! We specifically ask about Cyber-bullying and a manuscript examining characteristics of Cyber-bullying and how it may differ from other forms of bullying is currently under preparation.
Q: Any idea why sedentary behavior was related to aggressiveness?
A: Sedentary behavior, as defined in HBSC, is screen-based activities. There have been numerous studies showing an association between television viewing and aggressive behavior. Computer games that include violence may also be linked to this association.
Q: How does sampling frame and results compare with YRBS on similar items?
A: Our sampling frame is similar, but not identical, to YRBS. For selecting the primary sampling units (PSUs), the population of PSUs was stratified by Census divisions. Within each Census division, the PSUs were sorted by the rural and urban and a sample was selected with probability proportional to total enrollment in grades 6 to 10. Unlike YRBS, there was no explicit stratification of PSUs by rural and urban for sampling. Within each selected school district, schools were stratified by three grade ranges: Grade 6, grades 7 and 8, grades 9 and 10. Because of differences in the wording of some questions we have not compared our data to YRBS (although this could be done). HBSC differs from YRBS in other ways such as the focus on the social and environmental context for the health behaviors and the inclusion of youth younger than those sampled in YRBS.
Questions for Dr. Simons-Morton:
Q: What is the correlation between tobacco, cannabis, and alcohol use?
A: The correlation between tobacco and alcohol is about .2, and both tobacco and alcohol with cannabis are about .35, with some variations by age and sex.
Q: Why would we see an increase alcohol use among girls? Could gender inequity issues, in part, explain the difference between girls and boys?
A: Basically, in the US boys start using alcohol at younger ages than girls, but the girls largely catch up by high school. However, in virtually every country a higher percentage of boys than girls uses alcohol, but the difference has been declining over time in some countries. I believe the main reason for the decline in the gender gap is increased freedom for girls, leading to greater opportunities for girls to obtain and use alcohol.
Q: Why do strict alcohol policies in the US coincide with reduced youth use while strict cannabis policy is related to greater use in the US? What are the theories around why cannabis use does not appear from this data to be reduced by policy interventions?
A: This is a key question. One of the reasons is that alcohol restrictions are associated with a host of alcohol policies that have made underage drinking somewhat less desirable than it was formerly. Social norms among adolescents in this regard have changed over time and are increasing consistent with the policies. Marijuana policy, however, is way out of step with how adolescents view marijuana, so they tend to ignore the law.
Q: Have there been studies of differential underreporting of alcohol use by strictness of policies?
A: Good question. I am not aware of any such studies.
Q: Are there any statistics that indicate percent of grade 10 drunkenness progress to alcohol problems?
A: Most such studies have looked at early use leading to later alcohol problems. I am not aware of any studies that have looked at this specific question.
Q: Have you seen an increase in teen pregnancy related to the increased drinking among teen girls?
A: Adolescent drinking and sexual behavior are highly associated. Drinking prevalence has declined in the past decade, but I am not so sure about sexual behavior. In any case, I strongly doubt that the association between drinking and sexual behavior among adolescents has declined.