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American Journal of Epidemiology Advance Access originally published online on June 4, 2008
American Journal of Epidemiology 2008 168(2):202-211; doi:10.1093/aje/kwn113
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American Journal of Epidemiology © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

PRACTICE OF EPIDEMIOLOGY

Using Sexually Transmitted Infection Biomarkers to Validate Reporting of Sexual Behavior within a Randomized, Experimental Evaluation of Interviewing Methods

Paul C. Hewett1, Barbara S. Mensch1, Manoel Carlos S. de A. Ribeiro2, Heidi E. Jones1,3, Sheri A. Lippman4,5, Mark R. Montgomery1 and Janneke H. H. M. van de Wijgert1,6

1 Population Council, New York, NY
2 Department of Social Medicine, Santa Casa School of Medical Sciences, São Paulo, Brazil
3 Division of Family Planning and Preventive Services, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY
4 Division of Epidemiology, University of California Berkeley, Berkeley, CA
5 Population Council, Campinas, Brazil
6 Center for Poverty-Related Communicable Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Correspondence to Dr. Paul C. Hewett, Population Council, One Dag Hammarskjold Plaza, New York, NY 10017 (e-mail: phewett{at}popcouncil.org).

Received for publication October 16, 2007. Accepted for publication April 3, 2008.

This paper examines the reporting of sexual and other risk behaviors within a randomized experiment using a computerized versus face-to-face interview mode. Biomarkers for sexually transmitted infection (STI) were used to validate self-reported behavior by interview mode. As part of a parent study evaluating home versus clinic screening and diagnosis for STIs, 818 women aged 18–40 years were recruited in 2004 at or near a primary care clinic in São Paulo, Brazil, and were randomized to a face-to-face interview or audio computer-assisted self-interviewing. Ninety-six percent of participants were tested for chlamydia, gonorrhea, and trichomoniasis. Reporting of STI risk behavior was consistently higher with the computerized mode of interview. Stronger associations between risk behaviors and STI were found with the computerized interview after controlling for sociodemographic factors. These results were obtained by using logistic regression approaches, as well as statistical methods that address potential residual confounding and covariate endogeneity. Furthermore, STI-positive participants were more likely than STI-negative participants to underreport risk behavior in the face-to-face interview. Results strongly suggest that computerized interviewing provides more accurate and reliable behavioral data. The analyses also confirm the benefits of using data on prevalent STIs for externally validating behavioral reporting.

biological markers; computing methodologies; condoms; data collection; regression analysis; sexual behavior; sexually transmitted diseases; social desirability

Abbreviations: ACASI, audio computer-assisted self-interviewing; HIV, human immunodeficiency virus; RSB, risky sexual behavior; STI, sexually transmitted infection


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