Web-based eligibility quizzes to verify opioid use and county residence among rural young adults: Eligibility screening results from a feasibility study

April M. Ballard, Hannah L.F. Cooper, April M. Young

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background: Web-based methods can be used to collect data from hidden populations, including people who use drugs (PWUD). These methods might be especially advantageous among PWUD in rural areas, where transportation barriers are prevalent, stigma may heighten concerns about confidentiality, and internet access is improving. However, Web-based research with PWUD can be challenging, especially in verifying eligibility. Administering quizzes to verify residential and substance use eligibility could prove valuable in online research among PWUD, yet the utility of this approach is currently unknown. Objective: This study describes the implementation of online eligibility quizzes about the local community to verify residence in the target study area along with drug dose, appearance, and price to verify opioid misuse. Methods: To be eligible, individuals had to live in 1 of 5 eastern Kentucky counties, report using opioids to get high in the past 30 days, and be 18 to 35 years old. Participants recruited from August 2017 to July 2018 were asked questions about their opioid use followed by a quiz about drug dose, appearance, and price to verify substance use eligibility. Residential eligibility was verified with 5-question quizzes assessing knowledge of the county where they reported living. Questions tested knowledge about towns, festivals, and landmarks; local school mascots and colors; and presence of certain retail stores, restaurants, and facilities (eg, jails). A subsample that reported using opioids in the past 24 hours was randomly selected to complete urine drug testing (UDT). Nonparametric tests were performed to explore differences across demographic subgroups. Results: Of the 410 entries assessed for eligibility, 39.3% (161/410) were ineligible as they reported no substance use, being outside the age range, or living outside the study area. Of the remaining 249 who met the eligibility criteria based on age, residency, and opioid misuse, 94.0% (234/249) passed the eligibility quizzes. Among those who passed the heroin quiz, 99.4% (167/168) recognized the image of powdered heroin, 94.6% (159/168) answered the cap size (ie, the purchase unit) question correctly, and 97.0% (163/168) answered the street price question correctly. Among those who passed the drug quiz for prescription opioids, 95% (36/38) answered the dose question correctly, and 82% (31/38) selected the correct image. In a random sample of participants who completed UDT within 3 days of their online screening, 74% (25/34) tested positive for an opioid. Conclusions: This study demonstrated the utility of using online eligibility screening quizzes to verify opioid misuse and residence. Participants accurately recognized heroin and prescription opioid doses, prices, and images and correctly answered questions about features of their county. Online quizzes to screen and enroll PWUD hold promise for future research as an alternative to more time- and resource-intensive approaches that could offset the advantages of Web-based methods.

Original languageEnglish
Article numbere12984
JournalJMIR Research Protocols
Issue number6
StatePublished - Jun 1 2019

Bibliographical note

Funding Information:
This study was funded by the National Institute on Drug Abuse (R21 DA042727; principal investigators (PIs): HLFC and AMY). Community partners who provided feedback during the development of the quiz were identified through an ongoing study supported by the National Institute on Drug Abuse, Centers for Disease Control and Prevention (CDC), Substance Abuse and Mental Health Services Administration (SAMHSA), and the Appalachian Regional Commission (ARC; UG3 DA044798; PIs: AMY and HLFC); the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, CDC, SAMHSA, or ARC. The authors thank community researchers, Mary Beth Lawson, Travis Green, and Cindy Jolly for assistance with survey administration and logistics, as well as the Emory Center for AIDS Research (P30 AI050409; PIs: del Rio, Curran, Hunter), Nicole Luisi, and Danielle Lambert for technical support with survey programming, and Nadya Prood for study support.

Publisher Copyright:
© April M Ballard, Hannah LF Cooper, April M Young. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 09.06.2019.


  • Confidentiality
  • Eligibility determination
  • Internet
  • Opioid use
  • Recruitment
  • Rural health
  • Sampling methods
  • Substance-related disorders
  • Surveys and questionnaires
  • Web-based methods

ASJC Scopus subject areas

  • Medicine (all)


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