Showing papers by "RAND Corporation published in 2002"

Preliminary guidelines for empirical research in software engineering

Abstract: Empirical software engineering research needs research guidelines to improve the research and reporting processes. We propose a preliminary set of research guidelines aimed at stimulating discussion among software researchers. They are based on a review of research guidelines developed for medical researchers and on our own experience in doing and reviewing software engineering research. The guidelines are intended to assist researchers, reviewers, and meta-analysts in designing, conducting, and evaluating empirical studies. Editorial boards of software engineering journals may wish to use our recommendations as a basis for developing guidelines for reviewers and for framing policies for dealing with the design, data collection, and analysis and reporting of empirical studies.

Overdiagnosis Due to Prostate-Specific Antigen Screening: Lessons From U.S. Prostate Cancer Incidence Trends

Abstract: Background Overdiagnosis of clinically insignificant prostate cancer is considered a major potential drawback of prostate-specific antigen (PSA) screening. Quantitative estimates of the magnitude of this problem are, however, lacking. We estimated rates of prostate cancer overdiagnosis due to PSA testing that are consistent with the observed incidence of prostate cancer in the United States from 1988 through 1998. Overdiagnosis was defined as the detection of prostate cancer through PSA testing that otherwise would not have been diagnosed within the patient's lifetime. Methods We developed a computer simulation model of PSA testing and subsequent prostate cancer diagnosis and death from prostate cancer among a hypothetical cohort of two million men who were 60-84 years old in 1988. Given values for the expected lead time--that is, the time by which the test advanced diagnosis--and the expected incidence of prostate cancer in the absence of PSA testing, the model projected the increase in population incidence of prostate cancer associated with PSA testing. By comparing the model-projected incidence with the observed incidence derived from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry data, we determined the lead times and corresponding overdiagnosis rates that were consistent with the observed data. Results SEER data on prostate cancer incidence from 1988 through 1998 were consistent with overdiagnosis rates of approximately 29% for whites and 44% for blacks among men with prostate cancers detected by PSA screening. Conclusions Among men with prostate cancer that would be detected only at autopsy, these rates correspond to overdiagnosis rates of, at most, 15% in whites and 37% in blacks. The observed trends in prostate cancer incidence are consistent with considerable overdiagnosis among PSA-detected cases. However, the results suggest that the majority of screen-detected cancers diagnosed between 1988 and 1998 would have presented clinically and that only a minority of cases found at autopsy would have been detected by PSA testing.

Entry by Spinoffs

Abstract: Entry by spinoffs from incumbent firms is investigated for the laser industry A model in which spinoffs exploit knowledge from their parents is constructed to explain the types of firms that spawn spinoffs, the market conditions conducive to spinoffs, and the relationship of spinoffs to their parents The model is tested using detailed data on all laser entrants from the start of the industry through 1994 Our findings support the basic premise of the model that spinoffs inherit knowledge from their parents that shapes their nature at birth Implications of our findings for organizational behavior, business strategy, entry and industry evolution, and technological change are discussed

The interaction between predation and competition: a review and synthesis

Abstract: This review discusses the interface between two of the most important types of interactions between species, interspecific competition and predation. Predation has been claimed to increase, decrease, or have little effect on, the strength, impact or importance of interspecific competition. There is confusion about both the meaning of these terms and the likelihood of, and conditions required for, each of these outcomes. In this article we distinguish among three measures of the influence of predation on competitive outcomes: short-term per capita consumption or growth rates, long-term changes in density, and the probability of competitive coexistence. We then outline various theoretical mechanisms that can lead to qualitatively distinct effects of predators. The qualitative effect of predators can depend both on the mechanism of competition and on the definition of competitive strength/impact. In assessing the empirical literature, we ask: (1) What definitions of competitive strength/impact have been assumed? (2) Does strong evidence exist to support one or more of the possible mechanisms that can produce a given outcome? (3) Do biases in the choice of organism or manipulation exist, and are they likely to have influenced the conclusions reached? We conclude by discussing several unanswered questions, and espouse a stronger interchange between empirical and theoretical approaches to this important question.

Hybrid choice models : Progress and challenges

Abstract: We discuss the development of predictive choice models that go beyond the random utility model in its narrowest formulation. Such approaches incorporate several elements of cognitive process that have been identified as important to the choice process, including strong dependence on history and context, perception formation, and latent constraints. A flexible and practical hybrid choice model is presented that integrates many types of discrete choice modeling methods, draws on different types of data, and allows for flexible disturbances and explicit modeling of latent psychological explanatory variables, heterogeneity, and latent segmentation. Both progress and challenges related to the development of the hybrid choice model are presented.

Advantages and Disadvantages of Internet Research Surveys: Evidence from the Literature:

Abstract: E-mail and World Wide Web surveys have been the subject of much hyperbole about their capabilities as well as some criticism of their limitations. In this report, the authors examine what is known ...

Quality collaboratives: lessons from research

Abstract: Quality improvement collaboratives are increasingly being used in many countries to achieve rapid improvements in health care. However, there is little independent evidence that they are more cost effective than other methods, and little knowledge about how they could be made more effective. A number of systematic evaluations are being performed by researchers in North America, the UK, and Sweden. This paper presents the shared ideas from two meetings of these researchers. The evidence to date is that some collaboratives have stimulated improvements in patient care and organisational performance, but there are significant differences between collaboratives and teams. The researchers agreed on the possible reasons why some were less successful than others, and identified 10 challenges which organisers and teams need to address to achieve improvement. In the absence of more conclusive evidence, these guidelines are likely to be useful for collaborative organisers, teams and their managers and may also contribute to further research into collaboratives and the spread of innovations in health care.

Can patient self-management help explain the SES health gradient?

Abstract: There are large differences in health outcomes by socioeconomic status (SES) that cannot be explained fully by traditional arguments, such as access to care or poor health behaviors. We consider a different explanation—better self-management of disease by the more educated. We examine differences by education in treatment adherence among patients with two illnesses, diabetes and HIV, and then assess the subsequent impact of differential adherence on health status. One unique component of this research is that for diabetes we combine two different surveys—one cohort study and one randomized clinical trial—that are usually used exclusively by either biomedical or/and social scientists separately. For both illnesses, we find significant effects of adherence that are much stronger among patients with high SES. After controlling for other factors, more educated HIV+ patients are more likely to adhere to therapy, and this adherence made them experience improvements in their self-reported general health. Similarly, among diabetics, the less educated were much more likely to switch treatment, which led to worsening general health. In the randomized trial setting, intensive treatment regimens that compensated for poor adherence led to better improvements in glycemic control for the less educated. Among two distinct chronic illnesses, the ability to maintain a better health regimen is an important independent determinant of subsequent health outcomes. This finding is robust across clinical trial and population-based settings. Because this ability varies by schooling, self-maintenance is an important reason for the steep SES gradient in health outcomes.

The Growth of Obesity and Technological Change: A Theoretical and Empirical Examination *

Abstract: This paper provides a theoretical and empirical examination of the long-run growth in weight over time. We argue that technological change has induced weight growth by making home- and market-production more sedentary and by lowering food prices through agricultural innovation. We analyze how such technological change leads to unexpected relationships among income, food prices, and weight. Using individual-level data from 1976 to 1994, we then find that such technology-based reductions in food prices and job-related exercise have had significant impacts on weight across time and populations. In particular, we find that about forty percent of the recent growth in weight seems to be due to agricultural innovation that has lowered food prices, while sixty percent may be due to demand factors such as declining physical activity from technological changes in home and market production.

Profiles of Older Medicare Decedents

Abstract: OBJECTIVES: To evaluate the usefulness of a clinical scheme to classify older decedents to better understand the issues associated with healthcare use and costs in the last year of life. DESIGN: We analyzed Medicare claims data for a random sample of 0.1% of all Medicare beneficiaries with expenditures between 1993 and 1998. This sample yielded 7,966 deaths. SETTING: Medicare claims data. PARTICIPANTS: Medicare beneficiaries. MEASUREMENTS: We classified decedents into groups representing four trajectories at the end of life: sudden death, terminal illness, organ failure, and frailty. RESULTS: Ninety-two percent of decedents were captured by the profiling strategy. The four trajectory groups had distinct patterns of demographics, care delivery, and Medicare expenditures. Frailty was a dominant pattern, with 47% of all decedents, whereas sudden death claimed only 7%; cancer claimed 22%, and organ system failure, 16%. CONCLUSIONS: The clinical scheme to classify decedents appears to fit most decedents and to form groups with substantial clinical differences. Acknowledging the differences among these groups may be a fruitful way to evaluate expenditures and develop strategies to improve care at the end of life.

Seizure reduction and quality of life improvements in people with epilepsy

Abstract: Summary: Purpose: Previous research suggests that seizure freedom may be necessary to improve health-related quality of life (HRQOL) for epilepsy surgery patients, but little is known regarding the seizure-frequency reduction needed to improve HRQOL among medically treated individuals. Methods: With data from 134 adults with refractory complex partial seizures participating in a randomized controlled antiepileptic drug (AED) trial, we compared the change in HRQOL across groups having different levels of change in seizure frequency: 100%, 75–99%, 50–74% reduction, and 0–50% increase or decrease. Changes over time within each seizure-reduction group also were assessed. HRQOL was measured by the QOLIE-31, QOLIE-89, and SF-36. Results: Subjects who became seizure free reported significantly more positive change than those who did not on the QOLIE-31 and QOLIE-89 overall scores, the QOLIE-89 mental health, physical health, and epilepsy-targeted composites, as well as the SF-36 mental health summary score. Changes over time in overall QOLIE-31 and QOLIE-89 scores were significantly more positive for subjects who achieved seizure freedom (i.e., 100% reduction in seizure frequency) than for those who did not. No significant change in QOLIE-31 and QOLIE-89 overall scores was observed for subjects who did not achieve seizure freedom. Conclusions: In this study, HRQOL improvement occurred primarily among patients who achieved complete seizure freedom. Many AED trials use a 50% seizure-frequency reduction criterion as a trial end point, but measurable impacts of this degree of reduction in seizure frequency on HRQOL in this sample were not observed. These results further support striving for seizure freedom as an epilepsy care goal.

Principles of survey research: part 5: populations and samples

Abstract: This article is the fifth installment of our series of articles on survey research. In it, we discuss what we mean by a population and a sample and the implications of each for survey research. We provide examples of correct and incorrect sampling techniques used in software engineering surveys.

A new decision sciences for complex systems

Abstract: Models of complex systems can capture much useful information but can be difficult to apply to real-world decision-making because the type of information they contain is often inconsistent with that required for traditional decision analysis. New approaches, which use inductive reasoning over large ensembles of computational experiments, now make possible systematic comparison of alternative policy options using models of complex systems. This article describes Computer-Assisted Reasoning, an approach to decision-making under conditions of deep uncertainty that is ideally suited to applying complex systems to policy analysis. The article demonstrates the approach on the policy problem of global climate change, with a particular focus on the role of technology policies in a robust, adaptive strategy for greenhouse gas abatement.

Diabetes and Incidence of Functional Disability in Older Women

Abstract: OBJECTIVE—To examine the relationship between diabetes and the incidence of functional disability and to determine the predictors of functional disability among older women with diabetes. RESEARCH DESIGN AND METHODS—We analyzed data from 8,344 women enrolled in the Study of Osteoporotic Fractures, a prospective cohort of women aged ≥65 years. Diabetes (n = 527, 6.3% prevalence) and comorbidities (coronary heart disease, stroke, arthritis, depression, and visual impairment) were assessed by questionnaire and physical examination. Incident disability, defined as onset of inability to do one or more major functional tasks (walking 0.25 mile, climbing 10 steps, performing household chores, shopping, and cooking meals), was assessed by questionnaire over 12 years. RESULTS—The yearly incidence of any functional disability was 9.8% among women with diabetes and 4.8% among women without diabetes. The age-adjusted hazard rate ratio (HRR) of disability for specific tasks associated with diabetes ranged from 2.12 (1.82–2.48) for doing housework to 2.50 (2.05–3.04) for walking two to three blocks. After adjustment for potential confounders at baseline (BMI, physical activity, estrogen use, baseline functional status, visual impairment, and marital status) and comorbidities (heart disease, stroke, depression, and arthritis), diabetes remained associated with a 42% increased risk of any incident disability and a 53–98% increased risk of disability for specific tasks. Among women with diabetes, older age, higher BMI, coronary heart disease, arthritis, physical inactivity, and severe visual impairment at baseline were each independently associated with disability. CONCLUSIONS—Diabetes is associated with an increased incidence of functional disability, which is likely to further erode health status and quality of life.

Reassessing the marijuana gateway effect

Abstract: Aims. Strong associations between marijuana use and initiation of hard drugs are cited in support of the claim that marijuana use per se increases youths' risk of initiating hard drugs (the "marijuana gateway" effect). This report examines whether these associations could instead be explained as the result of a common factor, drug use propensity, influencing the probability of both marijuana and other drug use. Design. A model of adolescent drug use initiation in the United States is constructed using parameter estimates derived from U.S. household surveys of drug use conducted between 1982 and 1994. Model assumptions include: 1) individuals have a nonspecific random propensity to use drugs that is normally distributed in the population; 2) this propensity is correlated with the risk of having an opportunity to use drugs and with the probability of using them given an opportunity; and 3) neither use nor opportunity to use marijuana is associated with hard drug initiation after conditioning on drug use propensity. Findings. Each of the phenomena used to support claims of a

Ethnicity, peer harassment, and adjustment in middle school: An exploratory study.

Abstract: In an urban middle school, African American (n = 116), Latino (n = 118), and students from four other ethnic groups (labeled multiethnic, n = 172) completed nomination procedures that identified classmates who were perceived as aggressive or as victims of peer harassment. Peer acceptance and rejection also were measured by nomination procedures, and participants reported their self-perceived loneliness, social anxiety, and global self-esteem. Compared to Latino and multiethnic respondents, more African American students were nominated as aggressive, and fewer were nominated as victims of harassment. However, African American harassment victims reported more loneliness and lower self-esteem than did harassment victims in the other ethnic groups, and they were more rejected by peers. The data were interpreted as evidence that deviations from normative perceptions of a person’s group (i.e., being a victim of harassment when the perceived group norm is aggressiveness) are particularly detrimental to psycholog...

Agent-based modeling: a revolution?

Abstract: A clear consensus among the papers in this Colloquium is that agent-based modeling is a revolutionary development for social science. However, the reasons to expect this revolution lie more in the potential seen in this tool than through realized results. In order for the anticipated revolution to occur, a series of challenges must be met. This paper surveys the challenges suggested by the papers of this session.

Employer Drug Benefit Plans and Spending on Prescription Drugs

Abstract: ContextWith drug spending rising rapidly for working-aged adults, many employers and health insurance providers have changed benefits packages to encourage use of fewer or less expensive drugs. It is unknown how these initiatives affect drug costs.ObjectiveTo examine how innovations in benefits packages, such as those that include multitier formularies and mandatory generic substitution, affect total cost to insurance providers for generic and brand drugs and out-of-pocket payments to beneficiaries.Design and ParticipantsRetrospective study from 1997 to 1999 linking claims data of 420 786 primary beneficiaries aged 18 through 64 years who worked at large firms (n = 25) with health insurance benefits that included outpatient drugs.Main Outcome MeasuresOverall drug costs; generic, single-source brand, and multisource brand costs; and drug expenditures by health insurance providers and out-of-pocket costs for beneficiaries.ResultsFor a 1-tier plan with a $5 co-payment for all drugs, the average annual spending was $725 per member. Doubling co-payments to $10 for all drugs reduced the annual average drug cost from $725 to $563 per member (22.3%, P<.001). Doubling co-payments in a 2-tier plan from $5 for generics and $10 for brand drugs to $10 for generics and $20 for brand drugs reduced costs from $678 to $455 (32.9%, P<.001). Adding an additional co-payment of $30 for nonpreferred brand drugs to a 2-tier plan ($10 generics; $20 brand) lowered overall drug spending by 4% (P<.001). Requiring mandatory generic substitution in a 2-tier plan reduced drug spending by 8% (P<.001). Doubling co-payments in a 2-tier plan increased the fraction beneficiaries' paid out-of-pocket from 17.6% to 25.6%.ConclusionsAdding an additional level of co-payment, increasing existing co-payments or coinsurance rates, and requiring mandatory generic substitution all reduced plan payments and overall drug spending among working-age enrollees with employer-provided drug coverage. The reduction in drug spending largely benefited health insurance plans because the percentage of drug expenses beneficiaries paid out-of-pocket rose significantly.

Violence exposure, posttraumatic stress disorder, and depressive symptoms among recent immigrant schoolchildren

Abstract: Objective Many recent immigrant children are at risk for violence exposure and related psychological distress resulting from experiences before, during, and after immigration. This study examines the rates of violence exposure and associated symptoms among recent immigrant children in Los Angeles. Method 1,004 recent immigrant schoolchildren (aged 8–15 years) were surveyed about their prior exposure to violence and symptoms of posttraumatic stress disorder (PTSD) and depression. Participants included children whose native language was Spanish, Korean, Russian, or Western Armenian. Results Participants reported high levels of violence exposure, both personal victimization and witnessing violence, in the previous year and in their lifetimes. Thirty-two percent of children reported PTSD symptoms in the clinical range, and 16% reported depressive symptoms in the clinical range. Although boys and older children were more likely to have experienced violence, girls reported more PTSD and depressive symptoms. Linear multiple regressions revealed that PTSD symptoms were predicted by both recent and lifetime violence exposure ( p values p p Conclusion These findings document the need for interventions addressing the psychological sequelae of violence exposure in immigrant children.

Forest fires, air pollution, and mortality in Southeast Asia

Abstract: I assess the population health effects in Malaysia of air pollution from a widespread series of fires that occurred in Indonesia between April and November of 1997. I describe how the fires occurred and why the associated air pollution was so widespread and long lasting. The main objective is to uncover any mortality effects and to assess how large and important they were. I also investigate whether the mortality effects were persistent or whether they represented a short-term, mortality-harvesting effect. The results show that the smoke haze from the fires had a deleterious effect on the health of the population in Malaysia.

On the Evaluation of Systemic Science Education Reform: Searching for Instructional Sensitivity.

Abstract: We propose a multilevel-multifaceted approach to evaluating the impact of education reform on student achievement that would be sensitive to context and small treatment effects. The approach uses different assessments based on their proximity to the enacted curriculum. Immediate assessments are artifacts (students' products) from the enactment of the curriculum; close assessments parallel the content and activities of the unit/curriculum; proximal assessments tap knowledge and skills relevant to the curriculum, but topics can be different; and distal assessments reflect state/national standards in a particular knowledge domain. To provide evidence about the sensitivity of the multilevel approach in ascertaining outcomes of hands-on science programs we administered close, proximal, and distal performance assessments to evaluate the impact of instruction based on two Full Option Science System units—Variables, and Mixtures and Solutions—in a Bay Area school district. Results indicated that close assessments were more sensitive to the changes in students' pre- to post-test performance than proximal assessments. © 2002 Wiley Periodicals, Inc. J Res Sci Teach 39: 369–393, 2002

Tools and techniques for developing policies for complex and uncertain systems.

Abstract: Agent-based models (ABM) are examples of complex adaptive systems, which can be characterized as those systems for which no model less complex than the system itself can accurately predict in detail how the system will behave at future times. Consequently, the standard tools of policy analysis, based as they are on devising policies that perform well on some best estimate model of the system, cannot be reliably used for ABM. This paper argues that policy analysis by using ABM requires an alternative approach to decision theory. The general characteristics of such an approach are described, and examples are provided of its application to policy analysis.

Relations of income inequality and family income to chronic medical conditions and mental health disorders: national survey

Abstract: Objectives: To analyse the relation between geographical inequalities in income and the prevalence of common chronic medical conditions and mental health disorders, and to compare it with the relation between family income and these health problems. Design: Nationally representative household telephone survey conducted in 1997-8. Setting: 60 metropolitan areas or economic areas of the United States. Participants: 9585 adults who participated in the community tracking study. Main outcome measures: Self report of 17 common chronic medical conditions; current depressive disorder or anxiety disorder assessed by clinical screeners. Results: A strong continuous association was seen between health and education or family income. No relation was found between income inequality and the prevalence of chronic medical problems or depressive disorders and anxiety disorders, either across the whole population or among poorer people. Only self reported overall health, the measure used in previous studies, was significantly correlated with inequality at the population level, but this correlation disappeared after adjustment for individual characteristics. Conclusions: This study provides no evidence for the hypothesis that income inequality is a major risk factor for common disorders of physical or mental health. What is already known on this topic Several studies have found a relation between income inequality and self reported health or mortality What this study adds There is a strong social gradient in health, as measured by the prevalence of chronic medical conditions and specific mental health disorders, by income or education No such association is seen between income inequality and health

Principles of survey research part 4: questionnaire evaluation

Abstract: This article discusses how to avoid biased questions in survey instruments, how to motivate people to complete instruments and how to evaluate instruments. In the context of survey evaluation, we discuss how to assess survey reliability i.e. how reproducible a survey's data is and survey validity i.e. how well a survey instrument measures what it sets out to measure.

The Effects of Subjective Survival on Retirement and Social Security Claiming

Abstract: According to the life-cycle model, mortality risk will influence both retirement and the desire to annuitize wealth. We estimate the effect of subjective survival probabilities on retirement and on the claiming of Social Security benefits because delayed claiming is equivalent to the purchase of additional Social Security annuities. We find that those with very low subjective probabilities of survival retire earlier and claim earlier than those with higher subjective probabilities, but the effects are not large. The great majority of workers claim as soon as they are eligible.

Programmable system for processing a partitioned network infrastructure

Abstract: The present invention relates to a general-purpose programmable packet-processing platform for accelerating network infrastructure applications which have been structured so as to separate the stages of classification and action. Network packet classification, execution of actions upon those packets, management of buffer flow, encryption services, and management of Network Interface Controllers are accelerated through the use of a multiplicity of specialized modules. A language interface is defined for specifying both stateless and stateful classification of packets and to associate actions with classification results in order to efficiently utilize these specialized modules.

Patients Using Chiropractors in North America : Who Are They, and Why Are They in Chiropractic Care?

Abstract: Summary of background data and objectives Alternative health care was used by an estimated 42% of the U.S. population in 1997, and chiropractors accounted for 31% of the total estimated number of visits. Despite this high level of use, there is little empirical information about who uses chiropractic care or why. Methods The authors surveyed randomly sampled chiropractors (n = 131) at six study sites and systematically sampled chiropractic patients seeking care from participating chiropractors on 1 day (n = 1275). Surveys collected data about the patient's reason for seeking chiropractic care, health status, health attitude and beliefs, and satisfaction. In addition to descriptive statistics, the authors compared data between patients and chiropractors, and between patients and previously published data on health status from other populations, corrected for the clustering of patients within chiropractors. Results More than 70% of patients specified back and neck problems as their health problem for which they sought chiropractic care. Chiropractic patients had significantly worse health status on all SF-36 scales than an age- and gender-matched general population sample. Compared with medical back pain patients, chiropractic back pain patients had significantly worse mental health (6-8 point decrement). Roland-Morris scores for chiropractic back pain patients were similar to values reported for medical back pain patients. The health attitudes and beliefs of chiropractors and their patients were similar. Patients were very satisfied with their care. Conclusion These data support the theory that patients seek chiropractic care almost exclusively for musculoskeletal symptoms and that chiropractors and their patients share a similar belief system.

Nonmarital childbearing: influences of education, marriage, and fertility.

Abstract: We examined the determinants of nonmarital fertility, focusing on the effects of other life-course events: education, marriage, marital dissolution, and marital fertility. Since these determinants are potentially endogenous, we modeled the processes that generate them jointly with nonmarital fertility and accounted for the sequencing of events and the unobserved correlations across processes. The results showed that the risk of nonmarital conception increases immediately after leaving school and that the educational effects are less pronounced for black women than for other women. The risk is lower for previously married women than for never-married women, even controlling for age, but this reduction is significant only for black women. The more children a woman already has, the lower her risk of nonmarital childbearing, particularly if the earlier children were born during a previous marriage. Ignoring endogeneity issues seriously biases the estimates of several substantively important effects.

Use of complementary/alternative therapies by women with advanced-stage breast cancer

Abstract: This study sought to describe the pattern of complementary/alternative medicine (CAM) use among a group of patients with advanced breast cancer, to examine the main reasons for their CAM use, to identify patient's information sources and their communication pattern with their physicians. Face-to-face structured interviews of patients with advanced-stage breast cancer at a comprehensive oncology center. Seventy three percent of patients used CAM; relaxation/meditative techniques and herbal medicine were the most common. The most commonly cited primary reason for CAM use was to boost the immune system, the second, to treat cancer; however these reasons varied depending on specific CAM therapy. Friends or family members and mass media were common primary information source's about CAM. A high proportion of advanced-stage breast cancer patients used CAM. Discussion with doctors was high for ingested products. Mass media was a prominent source of patient information. Credible sources of CAM information for patients and physicians are needed.