Letters to the Editor
To the Editor:
In sexual health services and research, it is important to maintain anonymity. Social desirability bias and concern for confidentiality may lead to participants giving inaccurate responses.1–3 Patients and research participants might prefer to provide an alias and not be linked to their real name.4,5 Difficulties arise when there is a need to reliably track individuals without collecting identifying information. The ideal identifier would be reliable over time, memorable to the individual, unique between individuals, but not identifying. We trialed the uniqueness and reliability of a novel identifying characteristic: first pet's name and first street—colloquially known as a “porn star name” (PSN).
Participants aged between 16 and 29 were recruited at a music festival and provided their PSN. A sexual health questionnaire is administered annually.6,7 Four months later, participants who consented to be contacted further were e-mailed to confirm their PSN and date of birth (DOB). The PSN was assessed on uniqueness (a lack of identical matches within the sample) and reliability (a match between names at baseline and follow-up surveys). Partial DOB (month and year) was used to differentiate nonunique cases and to confirm partial matches.
At baseline, 1281 provided a PSN; examples are shown in Table 1. PSN were unique in 99% of respondents. Utilizing the partial DOB to differentiate the 14 nonunique responses gave 100% uniqueness. In all, 707 participants provided contact details and consented to be recontacted, of whom 168 (24%) responded. Half (n = 90, 54%) of participants gave an identical name at follow-up. After correcting for spelling variations (e.g., Kitty/Kittie), this increased to 76% (n = 127). Using partial DOB, 35 of the 36 who provided a partially consistent name were matched (96% reliability overall).
A unique and reliable code name could be very useful in situations where recording real names is not appropriate, particularly internet research. Similarly, chat screen names have been used for syphilis contact tracing.8 Our study was limited by the low response rate to the follow-up question, and there may have been bias in who responded. At baseline, 104 (8%) respondents did not provide a PSN; they may have not understood the question or been offended. The advantage of calling the identifier a PSN is that it is novel and fun; however, this might also have made the question seem trivial to some participants and resulted in false responses. In more formal settings, a PSN might be inappropriate, but 2 aspects such as pets name and street name could still be used without labeling it a PSN. Further research is required to determine whether the uniqueness and reliability of the name would persist over longer recall periods and larger cohorts.
In conclusion, PSNs were a highly unique and reliable identifier of individuals. There is a strong potential for the use of such a code name in behavioral research in situations where it is desirable to identify individuals over time but it is not possible or appropriate to collect real names.
Megan S. C. Lim, PhD
Anna Bowring, BBiomedSci
Judy Gold, PhD
Margaret E. Hellard, PhD
Centre for Population Health, Burnet Institute
Melbourne, Victoria, Australia
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2. Fenton KA, Johnson AM, McManus S, et al. Measuring sexual behaviour: Methodological challenges in survey research. Sex Transm Infect 2001; 77:84–92.
3. Bjarnason T, Adalbjarnardottir S. Anonymity and confidentiality in school surveys on alcohol, tobacco, and cannabis use. J Drug Issues 2000; 30:335–344.
4. Spillane HC, McNulty AM, Wand H, et al. Who declines to give a name at a sexual health service? Sex Transm Infect 2007; 83:160–162.
5. Rendleman N. False names. West J Med 1998; 169:318–321.
6. Lim MS, Hellard ME, Aitken CK, et al. Sexual-risk behaviour, self-perceived risk and knowledge of sexually transmissible infections among young Australians attending a music festival. Sex Health 2007; 4:51–56.
7. Lim MS, Hellard ME, Hocking JS, et al. Surveillance of drug use among young people attending a music festival in Australia, 2005–08. Drug Alcohol Rev 2010; 29:150–156.
8. Klausner JD, Wolf W, Fischer-Ponce L, et al. Tracing a syphilis outbreak through cyberspace. JAMA 2000; 284:447–449.