The authors examined differences between students with and without written parental consent to take part in a sensitive health survey. The data were collected using a consent procedure combining "active" and "passive" response options. Two thousand seven hundred five 9th and 12th graders whose parents provided written consent completed a full survey. An identical survey, without sex-related questions, was completed by 3,533 students whose parents gave "passive" consent to this less sensitive version. Students with written consent were more likely to be White, to live in two-parent households, to have a grade point average of B or above, and to be involved in extracurricular activities. They were also more likely to have been exposed to health promotion interventions. Irregular seat belt use was lower in the written-consent group at both grade levels. Among 9th graders, cigarette smoking was less prevalent in the written-consent group. There were no significant differences in alcohol or illicit drug use.
To pursue the goal of achieving regular use of mammography in women 40 years of age and older, a risk-based selective approach to screening was implemented at a 400,000-member managed health care system in the Northwest in 1985. This article describes the context for this approach to selective screening and reviews revisions in the algorithm used to determine when and how a woman should be screened. Changes made in 1988 with respect to age criteria, intervals for mammography, and which risk factors to include are discussed. The result of these changes is that 83% of women 40 years of age and older are now eligible for regular mammography compared with 57% under the former system. The total use of mammography in any given year remains unchanged. The results of this analysis have implications for other organizations attempting to promote the use of mammography. Cancer 66:812-818,1990.
OBJECTIVES. In a health maintenance organization that mails letters to women recommending that they schedule mammograms, we conducted a randomized trial to evaluate simple methods of increasing the use of screening mammography. METHODS. Using a 2 x 2 factorial design, we tested the effects of (1) mailing the recommendation letter from each woman's primary care physician rather than from the program director and (2) sending a subsequent reminder postcard. RESULTS. Sending a reminder postcard nearly doubled the odds that women would get mammograms within 1 year (participate). The letter from the woman's personal physician had no effect. Attending a clinic more than 45 minutes from the screening center, being a current smoker, or being in fair or poor health were negatively associated with subsequently obtaining a mammogram. The odds of participation doubled if women had had previous mammograms. CONCLUSIONS. When preceded by written recommendations to schedule mammograms, reminder postcards effectively increased participation. Future randomized trials to promote use of screening mammography should compare interventions with a reminder condition.
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