History of Hints

Appendix A: History of HINTS I through IV (2001-2015)
The development and communication of public messages about cancer prevention, detection,
diagnosis, treatment, and survivorship require comprehensive understanding of individuals’
access to cancer related information; perceived trust in information sources; cancer- and healthrelated knowledge; and factors that facilitate or hinder communication. In response to the critical
mission of informing dissemination and communication of cancer information to the public and
to support related programmatic efforts, NCI funded the first HINTS in June 2001 (OMB #09250507, Exp. Date: 8/31/03). The purpose of funding a national probability survey to assess health
communication processes is to provide communication researchers with population estimates of
the prevalence of cancer-relevant knowledge, attitudes, and information-seeking behaviors in the
U.S. adult population (18+). Through each administration of HINTS, survey content is aligned
with emerging theories of media usage (Viswanath and Finnegan, 1996), risk information
processing (Fischhoff, Bostrom, and Quadrel, 1993; Croyle and Lerman, 1999), behavior change
(Weinstein, 1993), health communication (Glanz, Lewis, and Rimer, 1997), and the diffusion of
innovations (Rogers, 1995), to expand the scientific knowledge base in health communication
and support evidence-based planning of population-level interventions.
HINTS I
The first round of HINTS (HINTS I), administered in 2002 and 2003, used a probability-based
sample, drawing on random digit dialing (RDD) telephone numbers as the sample frame of
highest penetration at that time. Data were collected from 6,369 respondents. HINTS I yielded a
response rate of 33 percent, which was lower than anticipated but consistent with declining
response rates for RDD studies in the field of survey research overall (Singer, Van Hoewyck, &
Maher, 2000).
HINTS II
In an effort to address diminishing response rates, the second cycle of HINTS (OMB #09250538, Exp. 11/30/2007), conducted in 2005, included embedded methodological experiments to
compare data collected by telephone with data collected through the Internet. In addition, this
field study explored the impact of varying levels of incentives on response rates. Even though
data were collected from 5,586 respondents, the overall response rate for HINTS 2 was low at 24
percent. Although decreasing telephone response rates had been experienced across the survey
industry (Dillman, 2000; Curtin, et al., 2005), it had been expected that providing respondents
with an Internet alternative, a monetary incentive for nonresponders, and making nonresponse
conversion a priority would reduce the impact of declining response rates. However, this did not
prove to be the case.
HINTS III
HINTS III (OMB #0925-0538, Exp. 11/30/2008), conducted in 2008, included the additional
priority of exploring strategies to increase response. The mixed-mode data collection design
employed dual sampling frames, both RDD and Addressed Based Sampling (ABS) frames, and
provided a nationally representative sample in each. An RDD telephone survey and a mail
questionnaire were implemented as the two modes including telephone follow up of a subsample
of the nonrespondents. RDD respondents received the full questionnaire administered via
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computer-assisted telephone interview (CATI). Data were collected from 4,092 respondents via
CATI and 3,582 respondents via mail for a total of 7,674 respondents. HINTS 3 results showed
that the CATI interview had an overall response rate of 24 percent while the mailed survey had
an overall response rate of 31 percent.
HINTS IV
Based on the higher response rates for the mail survey (over the RDD survey) described above,
HINTS IV (OMB #0925-0538, Exp. 10/31/2014) employed a single-mode mail survey with the
inclusion of the $2 incentive. To more quickly address emerging issues in the field of health
communication while still maintaining the ongoing measurement of trends, HINTS IV included
4 data collection cycles. The instrument for each data collection cycle included a core module of
trended items in addition to special topic modules implemented in only some of the cycles,
increasing capacity of the HINTS instruments to include additional topics and measures. As
with previous rounds, HINTS IV included embedded methodological experiments designed to
maximize response rates, reduce bias, and obtain the highest quality data. Experiments included
variations in the respondent selection process, the formatting and structure of questionnaire items
administered by mail, and specific activities targeting Spanish-speaking populations.
Table A1 HINTS Data Collection Cycles History
Number of Response
Rate
Respondents

Data Collection Dates
HINTS I

2002 -2003

6,369

33%

HINTS II

2005

5,586

24%

HINTS III

2008

7,674

28%

HINTS IV - Cycle 1

October 25, 2011 –
February 21, 2012

3,565

37%

HINTS IV - Cycle 2

October 9, 2012 –
January 22, 2013

3,630

40%

HINTS IV - Cycle 3

September 5 –
December 3, 2013

3,185

35%

HINTS IV - Cycle 4

August 19 –
October 31, 2014

3,677

35%

OMB Clearance
Numbers
#0925-0507,
Exp. Date: 8/31/03
#0925-0538,
Exp. 11/30/2007
#0925-0538,
Exp. 11/30/2008

#0925-0538,
Exp. 10/31/2014

References

Croyle, R.T., and Lerman, C. (1999). Risk communication in genetic testing for Journal of the National
Cancer Institute. Monographs, 25, 59-66.
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Curtin, R., Presser, S., and Singer, E. (2005). Changes in the telephone survey nonresponse over the
past quarter century. Public Opinion Quarterly, 69, 87-98.
Dillman, D. A. (2000). Mail and Internet surveys: The tailored design method, (2nd ed.). New York: John
Wiley & Sons
Fischhoff, B., Bostrom, A., and Quadrel, M.J. (1993). Risk perception and communication. Annual
Review of Public Health, 14, 183-203.
Glanz, K., Lewis, F.M., and Rimer, B.K. (1997). Health behavior and health education. San Francisco:
John Wiley & Sons, Inc.
Rogers, E.M. (1995). Lessons for guidelines from the diffusion of innovations. The Joint Commission
Journal on Quality Improvement, 21(7), 324-328.
Singer, E., Van Hoewyck, J., & Maher, M. P. (2000). Experiments with incentives in telephone surveys.
Public Opinion Quarterly, 64, 171–188.
Viswanath K., and Finnegan J.R. (1996). The knowledge gap hypothesis: 25 years later. In B. Burleson
(Ed.) Communication Yearbook 19, 187-227. Thousand Oaks, Calif.: Sage Publications.
Weinstein, N.D. (1993). Testing four competing theories of health-protective behavior. Health
Psychology, 12(4), 324-333.

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