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Sexually Transmitted Diseases, March 2005, Vol. 32, No. 3, p.189-193 
DOI: 1 0.1 097/01 .olq.00001 54492.98350.90 

Copyright © 2005, American Sexually Transmitted Diseases Association 
All rights reserved. 



Randomized Trial of Supplementary Interviewing Techniques to 
Enhance Recall of Sexual Partners in Contact Interviews* 



DEVON D. BREWER, PhD,* JOHN J. POTTERAT, BA,f STEPHEN Q. MUTH, BA,t- PATRICIA Z. MALONE, BA,§ 
PAMELA MONTOYA, BA,§ DAVID L. GREEN, BA,§ HELEN L. ROGERS, BA,§ AND PATRICIA A. COX§ 



Background: People with multiple sex partners tend to forget a 
significant proportion when recalling them. 

Methods: Randomized trial of supplementary interviewing tech- 
niques during routine partner notification contact interviews for chla- 
mydia, gonorrhea, and syphilis in Colorado Springs, CO. Cases with 
multiple sex partners in the last 3 months (n = 123) participated. 
Interviewers prompted nonspeciflcally and read back the list of elicited 
partners after cases recalled partners on their own. We then randomly 
assigned cases to receive 1 of 3 sets of recall cues: (1) an experimental 
set of cues consisting of locations where people meet partners, role 
relationships, network ties, and first letters of names; (2) another 
experimental set including common first names; and (3) control cues 
referring to individual characteristics (e.g., physical appearance). 

Results: Nonspecific prompting and reading back the list each 
increased the number of additional partners elicited and located by 
3% to 5% on average. On average, the combined location/role/letter/ 
network cues elicited more additional partners (0.57) than did the 
first-name (0.29) and individual characteristics (0.28) cues. The loca- 
tion and first-name cues were the most effective in eliciting located 
partners. The supplementary techniques increased the number of new 
cases found by 12% and, importantly, identified branches of the sexual 
network that would not otherwise have been discovered. 

Conclusion: Elicitation of sex partners can be enhanced in contact 
interviews with simple interviewing techniques, resulting in improved 
network ascertainment and sexually transmitted disease case finding. 

PARTNER NOTIFICATION, 13 OR CONTACT tracing, is a fun- 
damental tool for controlling the spread of sexually transmitted 
diseases (STDs)/human immunodeficiency virus (HIV) and gain- 
ing insight into the epidemiology of these infections. 4 For partner 
notification to be effective and yield epidemiologically useful data, 
it is crucial that infected persons report their sex partners as 
completely as possible. 5 6 

Among possible reasons why people may not report all sex 
partners in such contact interviews, forgetting figures prominently. 
Many at high risk for STD forget a substantial fraction of their 
recent sex partners when asked to recall them, as indicated by 



This research was supported by grants from the National Institute on 
Drug Abuse (nos. DA12069 and DA10640). We thank Lynn Plummer, 
Tammy Maldonado, and Shana Hurlbutt for their assistance with data 
collection. 

Correspondence: Devon D. Brewer, Interdisciplinary Scientific Research, 
P.O. Box 15110, Seattle, WA 98115. E-mail: http://www.interscientific.net/ 
contact.html. 

*An earlier version of this paper was presented at the 22 nd International 
Sunbelt Social Networks Conference, February 2002, New Orleans, and 
the National STD Prevention Conference, March 2002, San Diego. 

Received June 29, 2004, and accepted September 7, 2004. 



From the 'Interdisciplinary Scientific Research, Seattle, 
Washington; flndependent consultant, Colorado Springs, 
Colorado; fQuintus-ential Solutions, Colorado Springs, Colorado; 
and §EI Paso County Department of Health and Environment, 

Colorado Springs, Colorado 



inconsistent reporting of particular partners in repeated interviews, 
self-reported forgetting, and partners not reported in interviews but 
recorded in diaries. 7 8 Individuals who report many partners are the 
most likely to forget partners. In addition, recalled and forgotten 
partners are generally similar on key epidemiologic variables, such 
as frequency and recency of exposure. 7 - 8 

In previous studies we assessed the impact of simple interview- 
ing techniques — nonspecific prompting, reading back the list of 
already elicited partners, and various types of recall cues — on the 
elicitation of sex and injection partners in research settings involv- 
ing anonymous participants and no tracing of elicited partners. 7 8 
These techniques are designed to be implemented after interview- 
ees have recalled as many partners as they can by themselves. We 
developed the recall cues from our analyses of how people orga- 
nize partners in memory as revealed by the relationships between 
successively recalled partners and the order in which partners are 
mentioned. 9 Results from these studies showed that these supple- 
mentary methods elicited meaningful proportions of additional 
partners. Despite the simplicity of these techniques, traditionally 
trained public health interviewers rarely implement them, based on 
our anecdotal observations. 

Here we describe the evaluation of these and other supplemen- 
tary interviewing techniques as applied in routine contact inter- 
views of STD cases. This evaluation permits an assessment of the 
supplementary techniques' practical impact on case finding and 
sexual network ascertainment. As part of this evaluation, we 
performed a randomized controlled trial to compare the effective- 
ness of the recall cues developed and tested in prior research with 
another experimental set of recall cues based on common first 
names and a control set of cues based on distinctive individual 
characteristics. We selected first names as another set of experi- 
mental recall cues because our earlier research 9 showed that people 
also clustered sex partners by first name when recalling them. In 
addition, McCarty et al. 10 effectively used common first names to 
elicit representative samples of respondents' acquaintances. We 
chose individuals' visual, olfactory, and auditory characteristics as 
control cues because our earlier research 9 suggested that such 
characteristics do not play a role in how partners are organized in 
memory. 



189 



190 



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Sexually Transmitted Diseases • March 2005 



Materials and Methods 

We conducted the study in Colorado Springs, CO, during a 
41 -week period from August 2000 to June 2001. All study proce- 
dures were approved by the institutional review committee at 
Memorial Hospital, Colorado Springs. Individuals diagnosed with 
gonorrhea, chlamydia, or syphilis who reported multiple sex part- 
ners in the last 90 days in interviews with El Paso County Depart- 
ment of Health and Environment (EPCDHE) disease control staff 
were eligible to participate. (During the first 4 months of the trial 
we also administered the supplementary techniques to cases who 
initially reported only 1 partner in the last 90 days; the supple- 
mentary techniques elicited additional partners from only 1 (2%) 
of 55 such cases. Therefore, we excluded cases reporting only 1 
partner in the last 90 days and did not administer the supplemen- 
tary techniques to any subsequent case reporting only 1 partner.) 
Because this study was a modification of routine public health 
operations, interviewers followed normal procedures for approach- 
ing STD cases for contact interviews; cases were not explicitly 
recruited or asked to consent for participation in the study. 

The typical interview period for all study interviews (except 
syphilis cases) consisted of the 90 days preceding diagnosis plus 
the time (if any) between diagnosis and treatment. When inter- 
viewers elicited study cases' partners, they first asked cases to 
recall their partners freely (without cues or prompts) or in reverse 
chronological order. After this, interviewers prompted nonspecifi- 
cally and then read back the list of partners elicited. Nonspecific 
prompting involves the interviewer asking the interviewee "Who 
else have you had sex with in the [interview period]?" after the 
interviewee reports no other partners and prompting repeatedly as 
appropriate. When the interviewee insists there are no other part- 
ners he or she can recall, the interviewer can slowly read aloud the 
list of partners back to the interviewee and then prompt nonspe- 
cifically again at the end. Next, the interviewer introduced the 
recall cues by briefly explaining the problem of forgetting and 
noting that the cues may bring to mind other partners in the 
interview period (see Appendix posted at http://www.interscienti- 
fic.net/csevcues.pdf for these instructions, the cues, and procedures 
used in developing the cues). The interviewer then presented 1 set 
of cues, asking the interviewee to think about people he or she 
knows who correspond to a cue and list any with whom he or she 
had sex during the interview period but had not yet mentioned. 

During the trial, 1 of 3 sets of recall cues (location/alphabetic/ 
role/network cues, first name cues, or individual characteristics 
cues) was randomly assigned to be administered to study cases 
interviewed in a given week. We performed the randomization of 
weeks within 15-week blocks to ensure that the 3 arms of the trial 
were evenly represented in each season. This constraint prevented 
longer-term changes in sexual activity or partnership patterns from 
influencing the results of the trial. Due to unintentional interviewer 
errors, 10 cases received recall cues that were different from those 
assigned for that week. Because these errors were haphazard, we 
analyzed the data based on which recall cues study cases actually 
received. 

The location, alphabetic, role, and network cues used in our 
prior work 8 were combined (the timeline cues were excluded 
because the relatively long time required to create the timeline 
made them inefficient). The 78 combined cues included 32 loca- 
tions where persons at risk for STD/HIV meet their partners (e.g., 
restaurant), 26 letters, 18 role relationships between persons at risk 
for STD/HIV and their partners (e.g., ex-boyfriend/girlfriend), and 
2 network cues (on average). Administration of the network cues 
involved reading back to the case the names or descriptions of 
partners already elicited in the interview but asking the case to 
think of other persons who know or interact with a particular cue 



partner and to report those who are partners within the interview 
period but had not yet been mentioned. Common first names (e.g., 
Brenda, Keith) served as cues (n = 79) in the second experimental 
arm of the trial. The locations, roles, and first names used as cues 
were the most common listed in several EPCHDE STD Program 
databases. The 79 most common female names cover 53% of the 
female EPCDHE patient population in those databases, and the 79 
most common male names cover 68% of listed males. We ob- 
served few race differences in which names were the most com- 
mon. The control arm consisted of cues (n = 79) pertaining to 
individual characteristics: general appearance, aspects of particular 
parts of body/face, clothing/adornments, ways people sound, ways 
people smell, skin types, hair types, and racial/ethnic groups. In 
administering the first name and individual characteristics cues, 
interviewers asked study cases whether they had had sex with 
someone with a particular name or characteristic within the inter- 
view period whom they had not yet mentioned. We produced 3 
randomizations of the cues for each set, and study cases received 
1 of these randomized cue orders (see online Appendix for details 
on cue randomization). 

Before the trial began, Brewer provided all EPCDHE interview- 
ing staff 4 hours of training in the supplementary techniques. 
Halfway through the trial, Brewer provided a booster training and 
review session. Throughout the trial, Brewer gave feedback to 
individual interviewers based on audiotapes of study interviews 
(n = 12, or 10% of study interviews) conducted on randomly 
selected days during the trial. 

Statistical Analysis 

We used univariate summary statistics to describe study cases' 
characteristics. To test whether study cases were statistically rep- 
resentative of eligible cases interviewed by EPCDHE in the study 
period, we conducted )f and t tests for categorical and interval 
scale variables, respectively. 

For each of the different supplementary techniques, we com- 
puted the proportion of cases reporting additional partners in the 
interview period in response to the technique, the mean number of 
additional partners in the interview period elicited and located, and 
the mean proportional increase in additional partners elicited and 
located. We considered a partner to be located if the disposition for 
that partner was preventively treated; refused preventive treatment, 
not infected; infected, brought to treatment; previously treated for 
this infection; not infected; or located, refused examination. We 
computed % 2 and t tests (as appropriate) for each of these mea- 
sures, contrasting cases in each experimental arm with those in the 
control arm of the trial. 

To assess the effect of the supplementary techniques on case 
finding, we noted the number of new cases (infected persons 
brought to treatment) who were elicited before the supplementary 
techniques and by the supplementary techniques. We then com- 
puted the number of subsequent new cases found as a result of 
interviewing these 2 sets of infected persons brought to treatment. 
We displayed selected network components (sets of persons con- 
nected by direct or indirect sexual links) that included chains of 
such newly detected infections. For these analyses, we used all 
contact tracing data from calendar years 2000 and 2001, including 
data based on interviews of cases not in the study. 

To describe individual differences in study cases' responsive- 
ness to the supplementary techniques, we calculated various mea- 
sures and tests of association between case (e.g., demographics) 
and interview context variables (e.g., interview date, interview 
mode) and whether a case listed additional partners within the 
interview period in response to the supplementary techniques. We 
performed these analyses separately for cases assigned to different 



vol 32. No 3 INTERVIEWING TECHNIQUES TO ENHANCE RECALL OF SEX PARTNERS 
TABLE 1. Summary of Recall Cue Effectiveness Measures by Study Arm: Partners Within Interview Period* 


191 




Location/alphabetic/ 




Individual 




network/role cues 


First-name cues 


characteristics cues 


Measure 


(n = 35) 


(n = 41) 


(n = 47) 


Mean no. elicited before cuest 

Proportion of cases listing additional partners 

from cues 
Mean no. elicited by cues 

Mean proportional increase in no. elicited by cues 
Mean no. elicited before cues who were located 
Mean no. elicited by cues who were located 


2.23 (1.19) 
0.17 

0.57 (1 .48) 
0.21 (0.59) 
1 .40 (0.98) 
0.11 (0.32)t 


1.85 (0.91) 
0.12 

0.29 (1 .27) 
0.09 (0.34) 
1.02 (0.76) 
0.10 (0.37) 


2.45 (2.51) 
0.11 

0.28 (1.21) 
0.07 (0.25) 
1 .02 (0.99) 
0.00 (0)tt 



'Standard deviations appear in parentheses. 
fMedian = 2 for each arm. 
^Difference between arms P < 0.05. 



arms of the trial, as well as for cases pooled across arms. Finally, 
we compared partners elicited before the supplementary tech- 
niques with those elicited by the techniques in terms of several 
partnership variables (e.g., recency and frequency of sexual con- 
tact). For each case who listed additional partners in response to 
the cues, we computed a 4> or point biserial correlation (i.e., 
Pearson correlation between 2 dichotomous variables or between 
interval scale and dichotomous variables, respectively) between 
each partnership variable and whether a partner was recalled 
before the techniques or elicited by the techniques. To summarize 
these across cases, we calculated the unweighted mean correla- 
tion 11 for each partnership variable. 

Results 

Case Characteristics 

One hundred twenty-three cases participated in the randomized 
trial, including 70 female (57%) and 53 male cases. These 123 
include 113 persons with 1 case each and 5 persons with 2 cases 
each (4 of these 5 persons were assigned to a study arm in their 
second case that was different from the arm in their first case). 
Cases' mean age was 21.2 years (median = 20, s.d. = 4.5, range = 
14-42). Forty-two percent were white, 36% black, 18% Hispanic, 
4% Asian/Pacific Islander, and 1% American Indian. Based on sex 
of reported partners, 84% of study cases were heterosexual (45% 
female, 39% male), 13% were bisexual (10% female, 3% male) 
and 3% were homosexual (2% female, 1% male). Eight-three 
percent of cases had chlamydia only, 9% gonorrhea only, 1% 
syphilis, and 7% both chlamydia and gonorrhea. Forty-five percent 
of cases were symptomatic and sought care, 28% were asymptom- 
atic and were diagnosed through screening, and another 28% were 
discovered as contacts to disease. Most (87%) study cases were 
diagnosed at the STD clinic, 5% at the community hospital, and 
the remainder by other providers. Most (82%) study cases were 
interviewed face to face, although 21 (18%) were interviewed by 
telephone (data on interview mode are missing for 9 cases). A total 
of 5 interviewers interviewed study cases, but 3 accounted for 98% 
of the cases interviewed in the trial. 

Study cases represent 38% of eligible cases interviewed by 
EPCDHE staff during the study interval. Factors involved in not 
interviewing eligible cases with the supplementary techniques 
included staffing shortage, cases cutting interviews short, inter- 
viewers forgetting to administer the supplementary techniques, and 
interviewers choosing not to administer the techniques (e.g., in 
response to cases who were hostile to being interviewed). Some of 
these factors may have been increased by the departure of the 



STD/HIV Programs director (JJP) early in the study period and the 
subsequent discontinuation of the position. Study cases did not 
differ meaningfully or significantly from eligible cases who did not 
participate in the study in terms of race, sex, disease, reason for 
presentation, or source of diagnosis. Study cases were slightly 
younger (mean age = 21.2 years) than eligible cases who did not 
participate in the study (mean age = 22.5 years; P < 0.05). Also, 
the 3 primary interviewers for the study varied moderately and 
significantly (P < 0.001) in the proportion of eligible cases to 
whom they administered the supplementary techniques. 

Nonspecific Prompting and Reading Back the List 

On average, study cases listed 2.1 partners in the interview 
period before nonspecific prompting (median = 2, s.d. = 1.7, 
range = 0-16). Seven percent of study cases listed additional 
partners in the interview period in response to nonspecific prompt- 
ing and/or reading back the list. Nonspecific prompting elicited 
0.07 additional partners (5% increase) on average and reading back 
the list elicited a further 0.06 partners (3% increase) on average. 

Effectiveness of Recall Cues 

The percentage of cases receiving the combined location/alpha- 
betic/role/network cues who listed additional partners was mod- 
estly higher than the percentages for cases receiving the other 
types of cues (Table 1). Most cases in each arm listed no additional 
partners in response to the cues. On average, the combined loca- 
tion/alphabetic/role/network cues elicited an additional 0.56 part- 
ners, or a 21% increase, beyond those elicited before the recall 
cues (Table 1). This increase is 2 to 3 times as many additional 
partners in absolute and proportional terms as elicited by the first 
name and individual characteristics cues. Eighty-five percent of the 
partners elicited by the combined cues were elicited by the location 
cues. The supplementary techniques (nonspecific prompting, read- 
ing back the list, and recall cues) increased the number of partners 
elicited by 32% and 25%, on average, for cases who received the 
combined cues and first name cues, respectively. Overall, 17% of 
study cases listed additional partners within the interview period in 
response to 1 or more of the supplementary techniques. 

The combined cues and first-name cues yielded about 0.10 to 
0.11 additional located partners on average, but the individual 
characteristics cues did not elicit any located partners (Table 1). 
Partners elicited by the recall cues were somewhat less likely to be 
located than partners elicited before the recall cues. When aggre- 
gated across study cases, 52% (133/254) of partners elicited before 
nonspecific prompting were located, as were 38% (3/8) of those 



Coi 



192 



BREWER ET AL. 



Sexually Transmitted Diseases • March 2005 



elicited by nonspecific prompting and 57% (4/7) of those elicited 
by reading back the list. Twenty-four percent (4/17) of partners in 
the interview period elicited by location cues were located, and 
33% (4/12) of those elicited by first-name cues were located. None 
of the partners elicited by alphabetic, role, network, or individual 
characteristics cues was located. 

Supplementary Techniques' Impact on Case Finding and 
Network Ascertainment 

Although technique-elicited partners were somewhat less likely 
to be located than partners elicited before the supplementary 
techniques, both types of partners were likely to be infected. Of the 
14 technique-elicited partners who were located and tested, 7 
(50%) were infected. In comparison, of the 131 partners elicited 
before the supplementary techniques who were located and tested, 
75 (54%) were infected. 

The supplementary techniques improved case finding and net- 
work ascertainment meaningfully, increasing the number of in- 
fected persons brought to treatment (i.e., not previously treated for 
this infection) by 9%: 44 infected partners brought to treatment 
were elicited before the techniques (39 within the interview pe- 
riod), and 4 such partners were elicited by the techniques (3 within 
the interview period). Three of these latter partners were elicited 
by first-name cues and 1 was elicited by nonspecific prompting. 
This increase in case finding is likely to be an underestimate of 
what is possible with the supplementary techniques, as 38% of the 
study cases received the comparatively ineffective individual char- 
acteristics cues. 

Subsequent interviewing of the 4 new cases elicited by the 
supplementary techniques identified 2 additional infected persons 
brought to treatment who would not have been discovered as early 
or at all had the supplementary techniques not been administered. 
(Neither of these cases received the supplementary techniques 
when interviewed.) No other cases interviewed by the program, 
including those not in the study and those interviewed in the 
several months after the study period, reported these persons as 
partners. 

Figures la and b depict the new branches of the sexual networks 
discovered as a result of administering the supplementary tech- 
niques. The figures focus on 2 components, each involving a study 
case who listed 1 additional partner in response to the supplemen- 
tary techniques. Nodes labeled as "C" refer to cases (infected 
persons), and the subscripts indicate the temporal order of their 
diagnoses and interviews. Nodes labeled as "P" refer to partners 
who were not infected or not located. Arrows reflect which case 
named which partner, and double-headed arrows indicate 2 in- 
fected persons who named each other. The infected partners with 
an asterisk were elicited by one of the supplementary techniques. 
In Figure la, C 3 , C 4 , P 4 , and P 5 would not have been identified 
without the supplementary techniques. C x was a study case, who 
listed C 3 in response to a first-name cue. C 3 then named C 4 , P 4 , and 
P 5 . In Figure lb, C 6 , C 7 , and P 9 would not have been detected 
without the supplementary techniques. C 5 was a study case who 
listed C 6 in response to a first-name cue. C 6 then named P 9 and C 7 
(who, when interviewed, named C 6 back). 

Subsequent interviewing of the 44 infected partners brought to 
treatment who were elicited from study cases before the supple- 
mentary techniques uncovered a total of 7 additional infected 
persons brought to treatment (only 1 of these persons was even- 
tually reported as a partner of another case interviewed by the 
program). One further new case was identified from interviewing 
these 7 additional cases. The yield (in terms of new cases found) 
from interviewing new cases identified by the supplementary tech- 
niques (0.50 or 2/4) is higher than that for interviewing new cases 



A P, P 3 




Fig. 1. a and b, Two selected components that illustrate the 
impact of the supplementary interviewing techniques on case find- 
ing. (C = case; P = partner not infected/located; asterisk = tech- 
nique-elicited partner; arrows indicate who names whom; see text 
for full explanation). 

elicited before the supplementary techniques (0.18 or 8/44). Thus, 
6 new cases were discovered directly or indirectly from adminis- 
tering the supplementary techniques, which represents a 12% 
increase over the number of new cases (52) that were detected 
directly or indirectly from partners elicited before the supplemen- 
tary techniques. These results suggest that infected partners elic- 
ited by the supplementary techniques are at least as likely to be 
mediating nodes in chains of transmission as infected partners 
elicited otherwise. 

Comparison Between Partners Elicited Before and by the 
Supplementary Techniques 

Twenty-one study cases listed additional partners within the 
interview period in response to the supplementary techniques. For 
each of these cases, we compared partners recalled before the 
supplementary techniques with those elicited by the supplementary 
techniques in terms partner age, whether partner and case were of 
the same race, frequency of sexual contact, and recency of sexual 
contact. We computed a point biserial or <j) correlation coefficient 
for each of the 21 cases on a given variable and then summarized 
coefficients across these cases. The results indicate that technique- 
elicited partners do not differ substantially from freely recalled 
partners in terms of age (mean unweighted correlation = —.22, 
median = — .45 [technique-elicited partners modestly younger]) or 
similarity to the study case's race (mean = 0.08, median = 0.19 
[technique-elicited partners slightly more likely to be of a race 
different from the study case]). However, technique-elicited part- 
ners tended to have had moderately less frequent (mean r = —.31, 
median = —.50) and less recent (mean r = 0.71, median = 0.72) 
sexual interactions with study cases than partners elicited before 
the supplementary techniques. Nonetheless, all partners in these 
analyses fell within the interview period. 

Effectiveness of Particular Cues 

The particular location and first-name cues which elicited addi- 
tional partners tended to be those referring to the relatively more 



Vol. 32 -No. 3 



INTERVIEWING TECHNIQUES TO ENHANCE RECALL OF SEX PARTNERS 



193 



common locations and first names in the databases from which 
these cues were derived. In addition, the partners elicited by the 
first-name cues often did not have same first name as the first-name 
cue. Partners elicited by these cues sometimes had names or parts 
of names that sounded similar or had very different names (per- 
haps triggered by other associations with the first-name cue). 

Case and Contextual Correlates of the Supplementary 
Techniques ' Effectiveness 

Numerous factors (case age, sex, race, sexual orientation, dis- 
ease, number of partners elicited before supplementary techniques, 
date of interview, interviewer, source of case report, reason for 
presentation, and interview mode [face to face vs. telephone]) bore 
negligible relationships with whether a study case reported addi- 
tional partners within the interview period in response to any 
supplementary technique (detailed results available on request). 

Discussion 

Simple interviewing techniques can enhance the elicitation of 
sex partners in contact interviews. Nonspecific prompting and 
reading back the list of elicited partners generated mild increases 
in the number of partners elicited and located. In the randomized 
trial, the combined cues, particularly the location cues, elicited 
more partners than the other types of cues, but both the location 
and first-name cues produced meaningful increases in the number 
of partners located. Located partners elicited before the techniques 
and those elicited by the techniques were about equally likely to be 
infected. The supplementary techniques also identified new 
branches of the sexual network of infected persons, improving case 
finding appreciably and presumably preventing further disease 
spread. 

Partners in the interview period elicited before and by the 
techniques were similar in demographic terms, although tech- 
nique-elicited partnerships tended to involve fewer and temporally 
more distant sexual encounters than partnerships elicited before 
the techniques. None of the demographic, behavioral, and contex- 
tual variables we examined meaningfully predicted cases' respon- 
siveness to the supplementary techniques. The strongest predictor 
in our earlier research 8 — number of partners recalled before the 
supplementary techniques are administered — may not have been 
as salient in our study because we included only those cases who 
reported multiple partners. 

The proportional increases of partners elicited by nonspecific 
prompting, reading back the list, and the location cues in this study 
are comparable with those we observed in earlier research 7 ' 8 with 
anonymous participants, longer interview periods, and no tracing 
of partners. This similarity of results reinforces the idea that 
forgetting may be the predominant cause of underreporting of 
partners in contact interviews, regardless of context. Moreover, the 
proportional increases in partners elicited by the supplementary 
techniques are as large or larger than those observed for reinter- 
viewing in research and partner-notification settings. 712 - 13 This is 
especially important because reinterviewing is often impractical, 
time consuming, or impossible. Administration of the supplemen- 
tary techniques typically required 5 to 10 minutes of interviewing 
time, which is consistent with our prior work, 8 although precise 
data on the time involved in the current study are not available. 

The superiority of the location and first-name cues over the 
individual-characteristics cues also affirms the value of using 
memory organizational structures identified by patterns in recall to 
develop effective recall cues. 9,14 - 15 As in our initial evaluation of 



supplementary interviewing techniques, 8 one key for enhancing 
recall of partners is providing interviewees appropriate mental 
contexts in which to search. 16 Location cues seem to address this 
need. The network cues performed poorly in this study, which may 
be explained by their similarity to reading back the list, as well as 
the low density of social ties in individuals' personal sexual 
networks. 9 Further anecdotal evidence for the effectiveness of the 
recall cues comes from study cases' reactions to the cues. Cases 
were frequently surprised at recalling additional partners in re- 
sponse to the cues and often approached the cues as a game, 
spontaneously noting how successful and fun the cues were. 

More research is required to determine the generalizability of 
these results to other locales, populations, interviewers, and inter- 
viewing modes. Further work is also needed to ascertain the most 
effective and time-efficient combination of location and first-name 
cues. The only requirements for implementing the supplementary 
techniques in routine contact interviewing are motivated staff, 
modest training of interviewers, and development of locally tai- 
lored cues based on analysis of STD program databases. 9 

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