Research Methods and Procedures:Participants, 2862 eligible overweight and obese (BMI ϭ 27 to 40 kg/m 2 ) members from four regions of Kaiser Permanente's integrated health care delivery system, were randomized to receive either a tailored expert system or information-only Web-based weight management materials. Weight change and program satisfaction were assessed by self-report through an Internet-based survey at 3-and 6-month follow-up periods. Results: Significantly greater weight loss at follow-up was found among participants assigned to the tailored expert system than among those assigned to the information-only condition. Subjects in the tailored expert system lost a mean of 3 Ϯ 0.3% of their baseline weight, whereas subjects in the information-only condition lost a mean of 1.2 Ϯ 0.4% (p Ͻ 0.0004). Participants were also more likely to report that the tailored expert system was personally relevant, helpful, and easy to understand. Notably, 36% of enrollees were African-American, with enrollment rates higher than the general proportion of African Americans in any of the study regions. Discussion: The results of this large, randomized control trial show the potential benefit of the Web-based tailored expert system for weight management compared with a Web-based information-only weight management program.
The relationship between women's employmentand the risk of divorce is bothcomplex and controversial. The role specialization (orinterdependence) viewof marriage argues that thegainsto marriage for bothpartners decrease when both arein the labor force, and hence women's employment destabilizes marriage. In contrast, the economic opportunity hypothesis asserts thatfemale labor force participation does not intrinsically weaken marriage, but gives women resources that they can useto leave unsatisfactory marriages. Here we use data from the two waves of the National Surveyof Families and Households to conduct thefirstlarge-scale empirical testof those conflicting claims. Our results provideclear evidence that, at the individual level, women's employment does not destabilize happy marriages but increases the riskof disruption in unhappy marriages.One major line of theoretical research on the causes of divorce in the West has drawn on a combination of ideas based on the principles of utility maximization and social exchange (
Background Attrition, or dropout, is a problem faced by many online health interventions, potentially threatening the inferential value of online randomized controlled trials.Objective In the context of a randomized controlled trial of an online weight management intervention, where 85% of the baseline participants were lost to follow-up at the 12-month measurement, the objective was to examine the effect of nonresponse on key outcomes and explore ways to reduce attrition in follow-up surveys.Methods A sample of 700 nonrespondents to the 12-month online follow-up survey was randomly assigned to a mail or telephone nonresponse follow-up survey. We examined response rates in the two groups, costs of follow-up, reasons for nonresponse, and mode effects. We ran several logistic regression models, predicting response or nonresponse to the 12-month online survey as well as predicting response or nonresponse to the follow-up survey.ResultsWe analyzed 210 follow-up respondents in the mail and 170 in the telephone group. Response rates of 59% and 55% were obtained for the telephone and mail nonresponse follow-up surveys, respectively. A total of 197 respondents (51.8%) gave reasons related to technical issues or email as a means of communication, with older people more likely to give technical reasons for noncompletion; 144 (37.9%) gave reasons related to the intervention or the survey itself. Mail follow-up was substantially cheaper: We estimate that the telephone survey cost about US $34 per sampled case, compared to US $15 for the mail survey. The telephone responses were subject to possible social desirability effects, with the telephone respondents reporting significantly greater weight loss than the mail respondents. The respondents to the nonresponse follow-up did not differ significantly from the 12-month online respondents on key outcome variables.ConclusionsMail is an effective way to reduce attrition to online surveys, while telephone follow-up might lead to overestimating the weight loss for both the treatment and control groups. Nonresponse bias does not appear to be a significant factor in the conclusions drawn from the randomized controlled trial.
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