Faculty publications - Dalla Lana School of Public Health

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A scoping review and thematic analysis of social and behavioural research among HIV-serodiscordant couples in high-income settings
(2015-03-13) Mendelsohn, Joshua B; Calzavara, Liviana; Daftary, Amrita; Mitra, Sanjana; Pidutti, Joel; Allman, Dan; Bourne, Adam; Loutfy, Mona; Myers, Ted
Abstract Background While HIV incidence has stabilized in many settings, increases in health and wellbeing among many people living with HIV/AIDS suggest that the number of HIV-serodiscordant relationships is growing. Given the deficit of reviews addressing social and behavioural characteristics of HIV-serodiscordant couples within high-income settings, our objective was to understand the scope of the published literature, identify evidence gaps, and suggest future research needs. Methods Ten electronic databases were searched. Studies were included if they were reported in English, used primary data, were from the combination antiretroviral (cART) era (>1996), reported on social or behavioural aspects, included any fraction of primary (i.e., stable) relationships, and were conducted in high-income settings. Studies that identified their unit of analysis as either the dyad or individual member of the couple were included. Studies were coded according to a thematic framework. Results Included studies (n = 154) clustered into eight themes: risk behaviours (29%), risk management (26%), reproductive issues (12%), relationship quality (9%), serostatus disclosure (7%), adherence to antiretroviral therapy (7%), vulnerability (5%), and social support (3%). The proportion of studies conducted among heterosexual couples, same-sex male couples, and mixed cohorts were 42%, 34%, and 24%, respectively. Most studies (70%) were conducted in the United States, 70% of all studies were quantitative (including interventions), but only one-third were focused on couples (dyads) where both partners are recruited to a study. Over 25% of studies focused on sexual risk among same-sex male couples. Conclusions Future research efforts should focus on the interrelationship of risk management strategies and relationship quality, social determinants of health and wellbeing, HIV testing, vulnerable populations, reproductive issues among same-sex couples, disclosure of serodiscordant status to social networks, dyadic studies, population-based studies, and interventions to support risk management within couples. Additional population-based studies and studies among marginalized groups would be helpful for targeting research and interventions to couples that are most in need. As HIV-positive partners are typically the link to services and research, innovative ways are needed for reaching out to HIV-negative partners. Our review suggests that significantly more research is needed to understand the social and behavioural contexts of HIV-serodiscordant relationships.
An analysis of the implementation of PEPFAR's anti-prostitution pledge and its implications for successful HIV prevention among organizations working with sex workers
(2013-03-28) Ditmore, Melissa Hope; Allman, Dan
Introduction: Since 2003, US government funding to address the HIV and AIDS pandemic has been subject to an anti-prostitution clause. Simultaneously, the efficacy of some HIV prevention efforts for sex work in areas receiving US government funding has diminished. This article seeks to explain why. Methods: This analysis utilizes a case story approach to build a narrative of defining features of organizations in receipt of funding from the President’s Emergency Plan for AIDS Relief (PEPFAR) and other US funding sources. For this analysis, multiple cases were compiled within a single narrative. This helps show restrictions imposed by the anti-prostitution clause, any lack of clarity of guidelines for implementation and ways some agencies, decision-making personnel, and staff on the ground contend with these restrictions. Results: Responses to PEPFAR’s anti-prostitution clause vary widely and have varied over time. Organizational responses have included ending services for sex workers, gradual phase-out of services, cessation of seeking US government HIV funds and increasing isolation of sex workers. Guidance issued in 2010 did not clarify what was permitted. Implementation and enforcement has been dependent in part on the interpretations of this policy by individuals, including US government representatives and organizational staff. Conclusions: Different interpretations of the anti-prostitution clause have led to variations in programming, affecting the effectiveness of work with sex workers. The case story approach proved ideal for working with information like this that is highly sensitive and vulnerable to breach of anonymity because the method limits the potential to betray confidences and sources, and limits the potential to jeopardize funding and thereby jeopardize programming. This method enabled us to use specific examples without jeopardizing the organizations and individuals involved while demonstrating unintended consequences of PEPFAR’s anti-prostitution pledge in its provision of services to sex workers and clients.
Anthropometric measurements in Canadian children: A scoping review.
(Canadian Public Health Association, 2013) Patton, I ; McPherson, AC
Objective The objective of the current study was identifying what forms of anthropometric measurement are currently being utilized with Canadian children and youth and what are the gaps in the literature on this topic. Method The current study utilized a scoping review methodology in order to achieve the study objectives. Online databases Medline and PubMed and CINAHLwere used to search articles from the last decade (2002-2012) that addressed Canadian children aged 2 years-18 years. Synthesis 50 studies were included in this review. A variety of anthropometric measurements were identified including body mass index, waist circumference, hip-to-waist ratio among others. Six of the included studies (12%) utilized nationally representative data from large scale studies. BMI was the most reported form of measurement with 88% of studies colleting it. Waist circumference was a distant second with 20% of studies reporting it. Several gaps in the literature exist, with regards to First Nations (FN) research, many of the measurement methods were not used. Additionally FN accounted for only 2.5% of the study’s sample. The majority of studies took place in Quebec (29%) and Ontario (27%). Conclusion Body mass index is the most reported method of anthropometric measurement used for children. Efforts should be taken by health care practitioners and researchers to collect other forms of measurement in order to assist in understanding the validity of other measures and their value when used with children. Furthermore, attention needs to be put into utilizing and studying various forms of anthropometric measurement across all Canadian regions and populations.
The art and science of knowledge synthesis
(Elsevier, 2010-03-01) Tricco, Andrea C; Tetzlaff, Jennifer; Moher, David
Objectives: To review methods for completing knowledge synthesis. Study Design and Setting: We discuss how to complete a broad range of knowledge syntheses. Our article is intended as an introductory guide. Results: Many groups worldwide conduct knowledge syntheses, and some methods are applicable to most reviews. However, variations of these methods are apparent for different types of reviews, such as realist reviews and mixed-model reviews. Review validity is dependent on the validity of the included primary studies and the review process itself. Steps should be taken to avoid bias in the conduct of knowledge synthesis. Transparency in reporting will help readers assess review validity and applicability, increasing its utility. Conclusion: Given the magnitude of the literature, the increasing demands on knowledge syntheses teams, and the diversity of approaches, continuing efforts will be important to increase the efficiency, validity, and applicability of systematic reviews. Future research should focus on increasing the uptake of knowledge synthesis, how best to update reviews, the comparability between different types of reviews (eg, rapid vs. comprehensive reviews), and how to prioritize knowledge synthesis topics.
Articulating connections between the harm-reduction paradigm and the marginalisation of people who use illicit drugs
(2016-07) Souleymanov, Rusty; Allman, Dan
In this paper, we argue for the importance of unsettling dominant narratives in the current terrain of harm-reduction policy, practice and research. To accomplish this, we trace the historical developments regarding the Human Immunodeficiency Virus (HIV), the Hepatitis C Virus (HCV) and harm-reduction policies and practice. We argue that multiple historical junctures rather than single causes of social exclusion engender the processes of marginalisation, propelled by social movements, institutional interests, state legislation, community practices, neo-liberalism and governmentality techniques. We analyse interests (activist, lay expert, institutional and state) in the harm-reduction field, and consider conceptualisations of risk, pleasure, stigma, social control and exclusionary moral identities. Based on our review of the literature, this paper provides recommendations for social workers and others delivering health and social care interested in the fields of substance use, HIV prevention and harm reduction.
Assessment of thiopurine S-methyltransferase activity in patients prescribed thiopurines: a systematic review
(American College of Physicians, 2011-06-21) Booth, Ronald A; Ansari, Mohammed T; Loit, Evelin; Tricco, Andrea C; Weeks, Laura; Doucette, Steve; Skidmore, Becky; Sears, Margaret; Sy, Richmond; Karsh, Jacob
Background: The evidence base for testing thiopurine methyltransferase (TPMT) enzymatic activity or genotype before thiopurine therapy is unclear. Purpose: To examine the sensitivity and specificity of TPMT genotyping with reference to TPMT enzymatic activity, thiopurine harms reduction with pretesting, and association of thiopurine toxicity with TPMT status in adults and children with chronic inflammatory diseases. Data Sources: MEDLINE, EMBASE, the Cochrane Library, and Healthstar from inception to December 2010; and BIOSIS and Genetics Abstracts to May 2009 were searched. Study Selection: Two reviewers screened records and identified relevant studies in English. Data Extraction: One author extracted, and another independently verified, data on patient characteristics, outcomes, and risks of bias. Data Synthesis: 54 observational studies and one RCT were included.Insufficient evidence addressed pre-testing effectiveness. Genotyping sensitivity to identify patients with low and intermediate TPMT enzymatic activity ranged from 70.33% to 86.15% (95% CI, lower bound 54.52% to 70.88%; upper bound 78.50% to 96.33%). There is sparse data of genotype sensitivity to identify patients with low to absent enzymatic activity. Genotyping specificity approached 100%. Compared with noncarriers, heterozygous and homozygous genotypes were associated with leukopenia (OR 4.29, 95% CI 2.67, 6.89; OR 20.84, 95% CI 3.42, 126.89, respectively). Compared with intermediate or normal activities, low TPMT enzymatic activity was significantly associated with myelotoxicity and leukopenia. Limitations: Available evidence is not rigorous and underpowered to detect a difference in outcomes. Conclusions: Insufficient evidence addresses TPMT pre-testing effectiveness in patients with chronic inflammatory diseases. Estimates of sensitivity of genotyping are imprecise. Evidence confirms known associations of leukopenia and/or myelotoxicity with reduced TPMT activity or variant genotype.
The assessment of weight status in children and young people attending a spina bifida outpatient clinic: a retrospective medical record review
(Psychology Press, Taylor & Francis Group, 2013) McPherson, AC; Swift, JA; Yung, E; Lyons, J; Church, P
Purpose Children with disabilities are 2-3 times more likely to become overweight or obese than typically developing children. Children with spina bifida (SB) are at particular risk, yet obesity prevalence and weight-management with this population are under-researched. This retrospective chart review explored how weight is assessed and discussed in a children’s SB outpatient clinic. Method Height/weight data were extracted from records of children aged 2-18 with a diagnosis of SB attending an outpatient clinic at least once between June 2009 – 2011. Body Mass Index (BMI) was calculated and classified using CDC cut-offs. Notes around weight, diet and physical/sedentary activities were transcribed verbatim and analysed using descriptive thematic analysis. Results Of 180 eligible patients identified, only 63 records had sufficient data to calculate BMI; 15 patients were overweight (23.81%) and 11 obese (17.46%). Weight and physical activity discussions typically related to function (e.g. mobility, pain). Diet discussions focused on bowel and bladder function and dietary challenges. Conclusions Anthropometrics were infrequently recorded, leaving an incomplete picture of weight status in children with SB and suggesting that weight is not prioritized. Bowel/bladder function was highlighted over other benefits of a healthy bodyweight, indicating that health promotion opportunities are being missed.
Bibliographic study showed improving statistical methodology of network meta-analyses published between 1999 and 2015
(Elsevier, 2016-11-15) Petropoulou, Maria; Nikolakopoulou, Adriani; Veroniki, Areti-Angeliki; Rios, Patricia; Vafaei, Afshin; Zarin, Wasifa; Giannatsi, Myrsini; Sullivan, Shannon; Tricco, Andrea C; Chaimani, Anna; Egger, Matthias; Salanti, Georgia
Objectives: To assess the characteristics and core statistical methodology specific to network meta-analyses (NMAs) in clinical research articles. Study Design and Setting: We searched MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from inception until April 14, 2015, for NMAs of randomized controlled trials including at least four different interventions. Two reviewers independently screened potential studies, whereas data abstraction was performed by a single reviewer and verified by a second. Results: A total of 456 NMAs, which included a median (interquartile range) of 21 (13–40) studies and 7 (5–9) treatment nodes, were assessed. A total of 125 NMAs (27%) were star networks; this proportion declined from 100% in 2005 to 19% in 2015 (P = 0.01 by test of trend). An increasing number of NMAs discussed transitivity or inconsistency (0% in 2005, 86% in 2015, P < 0.01) and 150 (45%) used appropriate methods to test for inconsistency (14% in 2006, 74% in 2015, P < 0.01). Heterogeneity was explored in 256 NMAs (56%), with no change over time (P = 0.10). All pairwise effects were reported in 234 NMAs (51%), with some increase over time (P = 0.02). The hierarchy of treatments was presented in 195 NMAs (43%), the probability of being best was most commonly reported (137 NMAs, 70%), but use of surface under the cumulative ranking curves increased steeply (0% in 2005, 33% in 2015, P < 0.01). Conclusion: Many NMAs published in the medical literature have significant limitations in both the conduct and reporting of the statistical analysis and numerical results. The situation has, however, improved in recent years, in particular with respect to the evaluation of the underlying assumptions, but considerable room for further improvements remains.
Bisexuality and HIV Risk: Experiences in Canada and the United States
(Taylor and Francis Group, 1997) Doll, Lynda; Myers, Ted; Kennedy, Meaghan; Allman, Dan
The human immunodeficiency virus (HIV) epidemic has presented unparalleled challenges to sex researchers. Investigators have sought to understand a range of sexual behaviors and have scrutinized their roles in disease transmission. Opportunities have also emerged for developing and evaluating large-scale behavioral interventions to facilitate sexual risk reduction. In this article, we examine a topic of interest to sex researchers and HIV prevention programs, namely the relationship between bisexual behavior and HIV risk. We have gathered the theoretical and empirical literatures from two countries, Canada and the United States, permitting us to describe diverse experiences in countries in which variations in demographics and social norms as well as prevention programs may have consequences for the prevalence and contexts of bisexual behavior and for HIV risk. We begin our article with a review of the theories of bisexual behavior and a critique of methods used to study these populations. These sections provide a foundation for interpreting the empirical literature and for understanding the limitations of research related to HIV risk. We then provide for each country and for each gender a brief overview of data on the prevalence of bisexual behavior, HIV prevalence and AIDS cases, and the prevalence and determinants of HIV risk behaviors. We also review the emerging findings on prevention approaches for each population. Our review ends with a synthesis of the data across countries and genders and a proposed research agenda to increase our understanding of bisexual behavior and HIV risk among men and women who engage in sexual behavior with both genders.
Bisexuality and HIV/AIDS in Canada
(Taylor & Francis, 1996) Myers, Ted; Allman, Dan
This chapter explores what is known about bisexuality and HIV/AIDS in Canada. It focuses primarily on research definitions, behavioural manifestations, and the political movement and organization of bisexuals in relation to HIV/AIDS. Published research, largely epidemiological, relating to the sexual behaviour of various populations since the beginning of the AIDS epidemic are the predominant source of information. This documentation is critical because it is the only Canadian information currently available on bisexuality. While these data shed some light on the national picture as well as on regional variation, they ultimately raise more questions than answers. Scholarly reflection on sexuality in Canada and the placement of bisexuality along the continuum of human sexual relations is a discourse in its infancy. Our consideration of bisexuality in the arena of HIV/AIDS has had to take this into account.
Blinded versus unblinded assessments of risk of bias in studies included in a systematic review
(Wiley, 2011-09-07) Morissette, Kate; Tricco, Andrea C; Horsley, Tanya; Chen, Maggie H; Moher, David
The importance of appraising the risk of bias of studies included in systematic reviews is well-established. However, uncertainty remains surrounding the method by which risk of bias assessments should be conducted. Specifically, no summary of evidence exists as to whether blinded (i.e. the assessor is unaware of the study author's name, institution, sponsorship, journal, etc.) versus unblinded assessments of risk of bias yield systematically different assessments in a systematic review.
The Building Science of Office Surfaces: Implications for Microbial Community Succession
(2015-06) Zare, Mahnaz; Siegel, Jeffrey Alexander; Civil Engineering
The Surface Project studied the microbial succession on office surfaces in nine offices in three North American cities. Building science parameters including relative humidity (RH), temperature, equilibrium relative humidity (ERH), illumination, and occupancy were measured to investigate their impact on microbial communities. Parameters were measured every five minutes over the course of a year. ERH, RH, temperature, occupancy, and illumination varied between offices, and cities which suggests that building characteristics and climate are important factors. RH, ERH, and temperature showed clear seasonal variation. The drywall ERH varied from ERH of ceiling tile and carpet and from the RH of air. Illumination was different in occupied and unoccupied offices. Occupancy did not cause that much difference in RH. Methodology analysis revealed no difference between different frequency measurements, although it is suggested that short-term intervals to be considered since long-term intervals may not show the large variation of building science parameters.
A call for caution in use of pertussis vaccine effectiveness studies to estimate waning immunity: A Canadian Immunization Research Network Study
(Oxford Academic, 2020-05-08) Crowcroft, Natasha S; Schwartz, Kevin L; Savage, Rachel D; Chen, Cynthia; Johnson, Caitlin; Li, Ye; Marchand-Austin, Alex; Bolotin, Shelly; Deeks, Shelley L; Jamieson, Frances B; Drews, Steven J; Russell, Margaret L; Svenson, Lawrence W; Simmonds, Kimberley; Righolt, Christiaan H; Bell, Christopher; Mahmud, Salaheddin M; Kwong, Jeffrey C
Background: Vaccine effectiveness (VE) studies provide essential evidence on waning vaccine-derived immunity, a major threat to pertussis control. We evaluated how study design affects estimates by comparing two case-control studies conducted in Ontario, Canada. Methods: We compared results from a test-negative design (TND) with a frequency-matched design (FMD) case-control study using pertussis cases from 2005-15. In the first study, we identified test-negative controls from the public health laboratory that diagnosed cases and in the second, randomly selected controls from patients attending the same physicians that reported cases, frequency-matched on age and year. We compared characteristics of cases and controls using standardized differences. Results: In both designs, VE estimates for the early years post-immunization were consistent with clinical trials (TND 84%, FMD 89% at 1-3 years post-vaccination), but diverged as time since last vaccination increased (TND 41% and FMD 74% by 8 years post-vaccination). Overall, we observed lower VE and faster waning in the TND than the FMD. In the TND but not the FMD, controls differed from cases in important confounders, being younger, having more comorbidities and higher healthcare use. Differences between the controls of each design were greater than differences between cases. TND controls were more likely to be unvaccinated or incomplete vaccinated than FMD controls (p<0.001). Conclusions: The FMD adjusted better for healthcare-seeking behaviour than the TND. Duration of protection from pertussis vaccines is unclear because estimates vary by study design. Caution should be exercised by experts, researchers and decision-makers when evaluating evidence on optimal timing of boosters.
Challenges for the sexual health and social acceptance of men who have sex with men in Nigeria
(2007) Allman, Dan; Adebajo, Sylvia; Myers, Ted; Odumuye, Oludare; Ogunsola, Sade
Little research exists regarding men who have sex with men and sexual risk in Nigeria. Prior to the implementation of a targeted HIV/STI prevalence study, structured focus groups incorporating anonymous questionnaires were conducted with members of this population in secure locations in Nigeria. A purposive sample of men was recruited by word-of-mouth. Five focus groups were conducted with a total of 58 men. Mean age was 27 years (range 16-58); 60% had post-secondary education; 56% were employed full or part-time; 83% were Christian; 16% were Muslim; 66% self-identified as bisexual; 31% as homosexual. Participants' experiences were diverse, with ethnic, religious and class distinctions strongly structuring sexual expression. Same-sex community networks were hidden, with social activities taking place in non-commercial, private venues. Socially ostracized by culture, religion, and political will, the risks embodied within same-sex activity are high. For Nigeria--a nation culturally rich and religiously devout--the implications for public health policy are complex. However, these research findings suggest that immediate action is vital to mitigate the impacts of HIV and other STIs.
Charitable Giving for HIV and AIDS: Results from a Canadian National Survey
(2014-08-25) Allman, Dan; Calzavara, Liviana; Worthington, Catherine; Tyndall, Mark; Adrien, Alix; Walters, Melissa; White, Samantha; Jones, Marcella K.
Background: For the first time, a national survey of adults in Canada posed questions on charitable giving for HIV and AIDS. The objective of this analysis was to explore the behaviour and attitudes of this population in terms of charitable giving. Methods: In 2011, individuals in Canada 16 years of age or older were recruited for a survey from an online panel supplemented by random digit dial telephone interviewing. The margin of error was +/22.1 percentage points (95%). Chi-square tests were used to detect bivariate associations. A multivariate logistic regression model was fit to compare those who had donated to HIV and AIDS in the past 12 months with those who had donated to other disease or illness charities. Results: 2,139 participated. 82.5% had donated to a charitable cause in the past 12 months. 22.2% had ever donated to HIV and AIDS, with 7.8% doing so in the past 12 months. Individuals who had donated to HIV and AIDS versus other disease or illness charities tended to be younger (p,0.05), single (p,0.005), more highly educated (p,0.001) and to self-identify as a member of a sexual minority group (p,0.001). Multivariate analysis revealed individuals who self-identified as a member of a sexual minority group were significantly much more likely to have donated to HIV and AIDS than to other disease or illness charities in the past 12 months (OR, 7.73; p,0.001; CI 4.32–13.88). Discussion: Despite a generally philanthropic orientation, relatively few respondents had ever been involved in charitable giving for HIV and AIDS. Those who had could be understood relationally as individuals at closer social proximity to HIV and AIDS such as members of sexual minority groups.
Clinical trials as an industry and an employer of labour
(2011) Folayan, Morenike O; Allman, Dan
To produce drugs, clinical trials depend upon the labour of volunteer participants. For ethical reasons, participants are described as volunteers because to position them otherwise could be considered undue inducement. By using a labour market perspective, we argue that clinical trial participants may be understood as workers. Ethical guidelines argue that remuneration for ‘work done’ by participants in research may result in coercion: research participants will feel obliged to remain in a research trial despite any discomfort and distress simply because of remunerations received. However, we suggest that monetary benefits – in the form of wages – for research participants are no more coercive than the existing and accepted level of inducement. In our commentary, we review clinical trial conduct as it has evolved over the past two decades, the changing investments in this multi-million dollar industry, the ways in which beneficiaries and benefits are conceptualized and how these framings fall short. While it is acknowledged that framing research participants as labourers through the payment of wages has the potential to entrench inequities, we argue that it opens space to consider ways to link global health to the economic empowerment of individuals. Recognizing volunteers not as participants but as ‘workers’ has the capacity to widen the discourses on bioethics as a relevant and powerful counterweight to the injustices of the world today.
A Collection of Exercises in Advanced Mathematical Statistics: The Solution Manual of All Odd-Numbered Exercises from "Mathematical Statistics" (2000)
(Chapman & Hall/CRC Press LLC, 2018-07-01) Soltanifar, Mohsen; Knight, Keith
A Collection of Exercises in Advanced Probability Theory: The Solutions Manual of All Even-Numbered Exercises from "A First Look at Rigorous Probability Theory" (2006)
(World Scientific Publishing Co. Ltd., 2020-01-01) Soltanifar, Mohsen; Li, Longhai; Rosenthal, Jeffrey S.
Community centrality and social science research
(2015-12) Allman, Dan
Community centrality is a growing requirement of social science. The field's research practices are increasingly expected to conform to prescribed relationships with the people studied. Expectations about community centrality influence scholarly activities. These expectations can pressure social scientists to adhere to models of community involvement that are immediate and that include community-based co-investigators, advisory boards, and liaisons. In this context, disregarding community centrality can be interpreted as failure. This paper considers evolving norms about the centrality of community in social science. It problematises community inclusion and discusses concerns about the impact of community centrality on incremental theory development, academic integrity, freedom of speech, and the value of liberal versus communitarian knowledge. Through the application of a constructivist approach, this paper argues that social science in which community is omitted or on the periphery is not failed science, because not all social science requires a community base to make a genuine and valuable contribution. The utility of community centrality is not necessarily universal across all social science pursuits. The practices of knowing within social science disciplines may be difficult to transfer to a community. These practices of knowing require degrees of specialisation and interest that not all communities may want or have.
A Comparison of Web and Telephone Responses From a National HIV and AIDS Survey
(2016-07-29) Jones, Marcella K; Calzavara, Liviana; Allman, Dan; Worthington, Catherine A; Tyndall, Mark; Iveniuk, James
Background: Response differences to survey questions are known to exist for different modes of questionnaire completion. Previous research has shown that response differences by mode are larger for sensitive and complicated questions. However, it is unknown what effect completion mode may have on HIV and AIDS survey research, which addresses particularly sensitive and stigmatized health issues. Objectives: We seek to compare responses between self-selected Web and telephone respondents in terms of social desirability and item nonresponse in a national HIV and AIDS survey. Methods: A survey of 2085 people in Canada aged 18 years and older was conducted to explore public knowledge, attitudes, and behaviors around HIV and AIDS in May 2011. Participants were recruited using random-digit dialing and could select to be interviewed on the telephone or self-complete through the Internet. For this paper, 15 questions considered to be either sensitive, stigma-related, or less-sensitive in nature were assessed to estimate associations between responses and mode of completion. Multivariate regression analyses were conducted for questions with significant (P≤.05) bivariate differences in responses to adjust for sociodemographic factors. As survey mode was not randomly assigned, we created a propensity score variable and included it in our multivariate models to control for mode selection bias. Results: A total of 81% of participants completed the questionnaire through the Internet, and 19% completed by telephone. Telephone respondents were older, reported less education, had lower incomes, and were more likely from the province of Quebec. Overall, 2 of 13 questions assessed for social desirability and 3 of 15 questions assessed for item nonresponse were significantly associated with choice of mode in the multivariate analysis. For social desirability, Web respondents were more likely than telephone respondents to report more than 1 sexual partner in the past year (fully adjusted odds ratio (OR)=3.65, 95% CI 1.80-7.42) and more likely to have donated to charity in the past year (OR=1.63, 95% CI 1.15-2.29). For item nonresponse, Web respondents were more likely than telephone respondents to have a missing or “don’t know” response when asked about: the disease they were most concerned about (OR=3.02, 95% CI 1.67-5.47); if they had ever been tested for HIV (OR=8.04, 95% CI 2.46-26.31); and when rating their level of comfort with shopping at grocery store if the owner was known to have HIV or AIDS (OR=3.11, 95% CI 1.47-6.63). Conclusion: Sociodemographic differences existed between Web and telephone respondents, but for 23 of 28 questions considered in our analysis, there were no significant differences in responses by mode. For surveys with very sensitive health content, such as HIV and AIDS, Web administration may be subject to less social desirability bias but may also have greater item nonresponse for certain questions.

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