The views presented are those of the author(s) and do not represent the views of any Government Agency/Department or Westat.

Westat @ JSM 2022 — Take Statistical Research to New Heights

Need telephone show cards for your inperson survey due to a pandemic-induced

multimode data collection shift?

PATH Study Lessons Learned 2020 to Present

Tori Castleman and Sarah Dipko, Westat

2022 FCSM Conference

October 25-27, 2022
Overview of Presentation

❯ Overview of the PATH Study

❯ Impact of COVID-19 on data collection

❯ Shift to telephone mode

❯ Show card development

❯ Refinements and lessons learned

2
Population Assessment of Tobacco and Health 

(PATH) Study - Overview

❯ Nationally representative longitudinal cohort study of U.S. civilian, noninstitutionalized population

❯ Over 46,000 people ages 12 and older recruited in 2013 initial sample

• Funded by the FDA Center for Tobacco Products (CTP)

• Administered by the National Institute on Drug Abuse (NIDA)

• Developed by FDA and NIH with assistance from Westat and Westat 

Scientific Partners

❯ Captures data on behaviors, attitudes, biomarkers, and health outcomes 

associated with tobacco use

• Inform FDA’s regulatory activities under the 2009 FSPTC Act.

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PATH Study – Tobacco Products

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PATH Study – Health Measures

❯ Overall health

❯ Mental health

❯ Physical health

❯ Cardiovascular health

❯ Respiratory health

❯ Dental and oral health

❯ Diabetes

❯ Digestive health

❯ Eye health

❯ Cancer

❯ Bone health

❯ Sexual health

❯ Pregnancy and reproductive health

❯ Medication use

❯ Substance use

❯ COVID-19

5
PATH Study – Data Collection

❯ Adults and youth are selected during household screening

• Parent/guardian interviewed each time youth is interviewed

❯ Annual or biennial in-person interviews

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Interview Type Target 

Length

Mode of 

Administration

Parent Interview 15 minutes CAPI

Youth Interview 45 minutes ACASI

Adult Interview 60 minutes ACASI
ACASI Interview – tobacco products image

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ACASI Interview – long response list

8
THE COVID-19 

PANDEMIC BEGINS

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Wave 5.5 and COVID-19

❯ PATH Study Wave 5.5 started December 2019

❯ March 2020 – COVID-19-induced halt to field operations

❯ Immediate push to transition to telephone administration:

• Updates to project systems/management software and programming

• Updates to operational processes and mailings

• Updates to instrument programming to adjust for telephone 

administration

• Development of show cards for select questionnaire content

• Re-training of field interviewers for telephone administration

• Pilot test of urine by mail biospecimen collection

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Show card development 

and design considerations

11
Show Card Development Steps

❯ Identified which items needed telephone show cards

❯ Developed the structure

❯ Assigned unique identifiers

❯ Designed paper booklet

❯ Developed a web site

12
Identified items

❯ Started with the essential existing images used in CAPI and ACASI:

• Images of tobacco and nicotine products

• Images of health campaigns

❯ Added other items with:

• High levels of sensitivity

• Long or detailed lists of response options

13
Identified items (continued)

PATH Study 

W5.5 Interview

Number of 

Questions

Questions with 

show cards

Number of 

show cards

Parent Interview 173 15 13

Youth Interview 880 162 103

Adult Interview 1,335 166 89

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Developed structure – Adult Interview sections

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1. Introductory 

Demographics

2. Tobacco Use

3. Cigarette

4. Electronic Nicotine 

Products

5. Cigar

6. Pipe

7. Hookah

8. Snus

9. Smokeless Tobacco

10. Polyuse

11. Nicotine Dependence 

12. Packaging and Health 

Warnings

13. Risk Perceptions and 

Attitudes

14. Secondhand Smoke 

Exposure

15. Social Norms, Peer and 

Family Influences

16. Health

17. Substance Use

18. Media and Marketing

19. Additional 

Demographics

20. COVID-19

21. Product Barcode 

Scanning

22. Contact Information
Assigned unique identifiers

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1. Introductory 

Demographics

2. Tobacco Use

3. Cigarette

4. Electronic Nicotine 

Products

5. Cigar

6. Pipe

7. Hookah

8. Snus

9. Smokeless Tobacco

10. Polyuse

11. Nicotine Dependence 

12. Packaging and Health 

Warnings

13. Risk Perceptions and 

Attitudes

14. Secondhand Smoke 

Exposure

15. Social Norms, Peer and 

Family Influences

16. Health

17. Substance Use

18. Media and Marketing

19. Additional 

Demographics

20. COVID-19

21. Product Barcode 

Scanning

22. Contact Information

A

B

C

D

E

F

G

H

I

J

K

L

M
ACASI questionnaire changes to alert field 

interviewers to show cards

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ACASI Interview – awareness of health campaign

18
Web design and paper 

alternative

19
Web design for telephone show cards

❯ Access to show cards provided on 

public project website

❯ Separate links/sets of cards for 

Parent, Youth, Adult interviews

❯ Language toggle to switch from 

English to Spanish

❯ Nimble navigational tools provided for 

users

❯ Responsive to device being used, 

supporting access on desktop PCs, 

laptops, and smart phones

❯ Ability to use screen readers or zoom 

for those with vision limitations

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pathstudyinfo.nih.gov
pathstudyinfo.nih.gov

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pathstudyinfo.nih.gov

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pathstudyinfo.nih.gov

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pathstudyinfo.nih.gov

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pathstudyinfo.nih.gov

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The paper alternative...

❯ Need for paper show cards identified during initial contact with 

household

❯ Paper show cards share same visual design as web show cards

❯ Field interviewer able to request shipment of the show card booklet to 

participant

• Shipment also included interview consent form

• Shipment typically included booklets for all sampled participants

❯ Telephone interview attempted five days after shipment of booklet(s)

❯ Streamlines both the consent and interview processes

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Paper Telephone Show Card Booklet

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Is the paper show card alternative necessary?

Wave 6 Interviews n Web Paper Chi-Square, p

All telephone interviews 20,982 89% 11%

Youth (ages 14 to 17)

Adults:

18 to 29 years old

30 to 49 years old

50 to 64 years old

65 and older

2,978

8,747

4,583

2,736

1,938

94%

96%

92%

75%

58%

6%

4%

8%

25%

42%

2681.27, 

<.0001 

Adult English

Adult Spanish

17,479

525

88%

67%

12%

33%

210.38, 

<.0001 

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Discoveries and refinements 

since initial launch of 

telephone show cards

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Discoveries and refinements since initial launch of 

telephone show cards

❯ As expected, telephone interviews are longer than in-person interviews

• Increase of 30-40 minutes for Adult and Youth interviews

❯ Use of show cards helps keep respondents (especially youth) engaged!

❯ Additional show cards added based on field interviewer feedback

• simple and repetitive response options to eliminate reading aloud

❯ Additional show cards added for ‘composite’ items – image + text

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New Composite Wave 6 Show Cards 

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Identification of questions in need of telephone 

interview show cards – Wave 6

PATH Study 

W5.5 Interview Questions Questions with 

show cards

Show cards 

used W6 Interview

Parent Interview 173

196

15

20

13

18

Youth Interview 880

941

162

406

103

247

Adult Interview 1,335

1,476

166

510

89

287

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Conclusions

❯ Alternative modes of collection may be with us for awhile

❯ Consider instrument flow when designing your show card structure 

❯ Repeat specific show cards, or repeat them more often, to aid 

respondents and streamline telephone administration

❯ Provide an easy way for interviewers to communicate cards with 

respondents

❯ Ensure web versions are accessible and nimble

❯ Prepare a paper alternative

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Thank You

Funding Statement 

and Disclaimer

Questions or comments?

• VictoriaCastleman@Westat.com

• SarahDipko@Westat.com

 This presentation is supported with Federal funds from the National 

Institute on Drug Abuse, National Institutes of Health, and the Center 

for Tobacco Products, Food and Drug Administration, Department of 

Health and Human Services, under contract to Westat (Contract No. 

HHSN271201600001C). 

 The preliminary findings and conclusions presented herein are in 

preparation and published results may differ from those reported 

here. This is not a formal dissemination of information and the views 

and opinions expressed in this presentation are those of the author(s) 

and do not necessarily represent the official position of the U.S. 

Department of Health and Human Services or any of its affiliated 

institutions or agencies. 

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