Survey Respondent - NCBI

LETTERS

schools of public health are adapting to the changing job environment. However, we hope that more is required of health administrators. Health care cannot simply be "picked up on the job." It is vital that health administrators be knowledgeable about health policy, questions of access and equity, health behavior and other subjects. People who manage and direct health services must also have insight into the health problems and needs of their constituencies. We feel that our public health school graduates are very competitive with business school graduates. So far, reports from our graduates confirm this. Michael K. Gemmell Executive Director, ASPH, 1015 15th Street, NW, Suite 404, Washington, DC 20005

Kish Method for Mail Survey Respondent Selection Sampling is one of the key difficulties to be overcome in community survey studies. Even after appropriate methods have been devised to select representative households there is the problem of appropriate selection of the member of the household to interview. There are many potential biases (i.e., the oversampling of homemakers). Kish has developed a selection method to overcome this difficulty.' This method has gained acceptance in interview studies and was selected for use in the Epidemiologic Catchment Area (ECA) community study.2 To our knowledge, no one has attempted previously to adapt the Kish method to a mail survey. This report is a pilot attempt to do so. One hundred packets were mailed to households from selected census tracts in a city of 50,000 population. Each packet contained a cover letter explaining the purpose of the study, a form of demographic information to fill out, and a 163-item coping style interview (the PDQ).3 These items took 20-30 minutes to complete. Fifty of the packets gave no instructions as to who in the household was to fill it out; 50 had instructions (available on request to authors) for listing household occupants by age and sex and also for selecting the respondent. These instructions duplicated the Kish method.' Approximately one month after the first mailing a follow-up mailing was performed. Of the 50 questionnaires with no specific respondent requested, 56 per 206

cent were returned appropriately filled out. Of the 50 questionnaires with Kish respondent instructions returned, 60 per cent were returned appropriately filled out. There is no significant difference in the rate of return for the two groups. Kish respondents were 20.6 per cent female, average age 53.5 years, and 75.9 per cent married. Corresponding figures were 32 per cent, 58.0 years, and 80 per cent married for the nonKish population. Initially we were skeptical whether mail respondents would be willing or able to take the time to follow the Kish instructions for respondent selection. The results clearly show that it resulted in no decrement in response rate for the two groups. This result, although promising, deserves replication due to the small sample size involved. REFERENCES 1. Kish L: A procedure for objective respondent selection within the household. Am Stat Assoc J 1949; 44:380-381. 2. Eaton WW, Holzer CE, Von Korff M, et al: The design of the Epidemiologic Catchment Area Survey. Arch Gen Psychiatry 1984; 41:942-948. 3. Hyler S, Reider R, Spitzer R, et al: Personality Diagnostic Questionnaire (PDQ). New York: New York State Psychiatric Institute, 1983. James Reich, MD, MPH Assistant Professor of

Psychiatry William Yates, MD Resident in Psychiatry Robert Woolson, PhD, Professor Department of Preventive Medicine University of Iowa College of Medicine, and University of Iowa Hospitals & Clinics, Iowa City, IA 52242

Snuff and Neuromuscular Performance Massachusetts has become the first state to require a health warning on

labels of snuff beginning December 1, 1985.1 Furthermore, Surgeon General Everett Koop recently acknowledged the link between oral cancer and use of smokeless tobacco. The Federal Trade Commission, National Cancer Institute, Centers for Disease Control, and the Surgeon General's Office are undertaking comprehensive investigations regarding the health dangers of smokeless tobacco. Last Spring a teenager from Ada, Oklahoma died from oral cancer associated with the use of smokeless tobacco and his parents are pursuing litigation against the US Tobacco Company for failure to notify their son ofthe health dangers of the tobacco via a warning printed on the container. This young man was an athlete and, like many other young people, he may have been influenced by the advertisements for smokeless tobacco which employ

former athletes as spokesmen for the product. Moreover, our research shows a common perception among male athletes that smokeless tobacco enhances reaction time and heightens one's ability to concentrate during an athlete contest.2 Although baseball and softball are the sports most often associated with smokeless tobacco use, male athletes in many of the individual and team sports regularly use smokeless tobacco (Glover ED, Edwards SW: The Oklahoma smokeless tobacco study, in preparation at East Carolina University). We compared the effects between athletes and non-athletes using 60 college males to determine if snuff use improved reaction time. Our findings indicate no neuromuscular performance enhancement due to the use of snuff. Neither the athletes or non-athletes improved in reaction time, movement time, or total response time on a common laboratory test of neuromuscular reactivity. The athletes and nonathletes did show 8 per cent and 9 per cent increases, respectively, in heart rate during the 25-minute testing period. These heart rate changes may create generalized feelings of preparedness in the body but actual reactivity remained unaffected. Given that lower heart rates during rest and exercise are associated with athletic fitness, the heart rate increases induced by use of snuff are counterproductive and serve to reduce the cardiovascular response flexibility of the athlete. We support the implementation of warning label on snuff. containers and hope that other states will follow Massachusetts' lead. Although it may be difficult to communicate the dangers of snuff use to young adults, a warning label on the product is an excellent first step toward that goal. REFERENCES 1. Massachusetts is first state to put warning on snuff. The Nation's Health August 1985; 15:1. 2. Glover ED, Edwards SW, Christen AG, Finnicum PA: Smokeless tobacco research. Health Values 1984; 8:21-25.

Steven W. Edwards, PhD School of HPELS, Oklahoma State University, Stillwater, OK 74078

Elbert D. Glover, PhD School of Allied Health, East Carolina University, Greenville, NC 27834 Editor's Note: See also related articles pp 190,193 and 1%, and editorial p 133 this issue. O 1986 American Journal of Public Health 0090-0036/86 $1.50

A2JPH February 1986, Vol. 76, No. 2