Validation of Socially Desirable Health Behaviors and Implications for Case-Control and Other Health Surveys : Does Salience Matter ?

Many major health surveys ask respondents about their health behaviors, including the use of cancer prevention tests for women, such as mammograms and Pap smear tests. In addition, case-control studies related to cancer query women with the diseases as well as control cases to compare them to. An important question is: Does the salience of the topic, including past negative experiences, affect the quality of the recall? If it does, and if "cases" recall more accurately than "controls," the variability in the quality of the data may significantly affect the value of the conclusions. We present findings from a factorial experiment designed to evaluate four approaches to collecting autobiographical health information that was then compared to medical records. Data were collected from a random sample of women aged 50 and older who were either interviewed by telephone or by using audio computer-assisted selfinterviewing equipment in their homes. They were asked for the dates they received mammograms and Pap smear tests over the past 36 months. Upon obtaining written permission, medical records staff at their provider facilities recorded the actual dates of such tests and the responses were compared. Of the 1,005 women who participated in the study, medical record information was obtained for 588. The accuracy of the information was analyzed controlling for measures of salience, including having had a "problem" mammogram (requiring a followup mammogram or biopsy), having breast cancer, having a relative with cancer, particularly breast cancer, or having had a "problem" Pap smear test (requiring re-testing or followup). Results indicate that there was no significant difference in the accuracy of the recall by the salience measures. ______________________________ Paper presented at the 57 Annual Conference of the American Association for Public Opinion Research, May 13–16, 2004, Phoenix, Arizona. *This study was supported by National Cancer Institute grant RO1-CA77315 awarded to our friend and colleague, the late Seymour Sudman, Principal Investigator, and authors Johnson, O’Rourke, and Warnecke, coInvestigators Therefore, at least for common cancer prevention tests such as mammograms and Pap smears that are taken frequently and easily recalled, past experience and possible salience is not an issue. INTRODUCTION Health promotion and disease prevention are goals of most nations (1). Many major health surveys ask respondents about their past and current health behaviors. In addition to the response errors that may occur in all survey research (2-5), recall of autobiographical information is even more problematic. Over the past two decades, researchers studying the cognitive processes of survey response have gained a better understanding of the process and how to control error (6-13), but information about health behaviors, particularly socially desirable or undesirable ones, and particularly dating those behaviors are still very problematic. For recall of autobiographical events, memory is basically a function of time (between the recollection and the event) and the salience of the event. In this paper, we focus on salience, which has been defined as being “a function of the unusualness of an event, its economic and social costs and benefits, and its continuing consequences” (14, p.88). Salient events may be more likely to be retained in long-term memory and may be more likely to be accessible to survey respondents (14, 15). Thus, in addition to memory problems that relate to overall autobiographical recall, another potential error factor may be the differential salience of the topic among respondents. This is particularly important for case-control studies that query women with a disease/condition as well as control cases (who do not have that disease/condition) to compare them to. An important question is: Does the salience of the topic, including past negative experiences, affect the quality of the recall? If it does, and if "cases" recall more accurately than "controls," the variability in the quality of the data may significantly affect the value of the conclusions in many epidemiological surveys American Association for Public Opinion Research