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| ID | Type | Description | Link |
|---|---|---|---|
| R01DA017476 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Institute on Drug Abuse (NIDA) | NIH |
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The purpose of this study is to compare the effects of (a) immunization setting and (b) outreach worker support on young injection drug users' (IDU) adherence to a multiple dose immunization schedule with a combined hepatitis A virus (HAV) inactivated and hepatitis B virus (HBV) recombinant vaccine.
This is a research trial consisting of a cross-sectional screening study and a prospective cohort study (randomized, 2x2 factorial design). The primary aim of the study is to evaluate the effects of immunization setting and outreach worker support on young IDU's adherence to a multiple dose immunization schedule with a combined HAV and HBV vaccine. Secondarily, the study will 1) explore the feasibility of a remote immunization network and web-based vaccine registry to improve immunization coverage of transient young IDU, 2) examine the effect of hepatitis C virus (HCV) infection in vaccine effectiveness, and 3) assess behavior change and vaccine attitudes in young IDU participating in a preventive vaccine trial.
Subjects in the screening study complete an interview, receive counseling and testing for HIV, HAV, HBV and HCV, and return in one week for test results and risk reduction counseling. Subjects eligible for the cohort study receive their first immunizations at enrollment and then are randomized to receive subsequent vaccines at either a set of syringe exchange programs (SEP) or at a public health adult immunization clinic (AIC). Subjects also are randomized to receive vaccine reminders from an outreach worker or no outreach worker support. Each subject receives a total of 4 immunizations over 6 months. Follow up visits include interviews, counseling, and viral testing. Study participation is for 12 months.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| AIC, Hepatitis A & B vaccine | Experimental | Subjects randomized to a public health department clinic, the Adult Immunization Clinic (AIC), for administration of viral hepatitis immunizations at Month 1, 2, 6. |
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| AIC, Outreach, Hepatitis A & B vaccine | Experimental | AIC + outreach: Subjects randomized to a public health department clinic, the Adult Immunization Clinic (AIC)) for administration of viral hepatitis immunizations at Month 1, 2, 6, plus outreach worker adherence support to receive all immunizations |
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| SEP, Hepatitis A & B vaccine | Experimental | SEP only: Subjects randomized to a set of syringe exchange programs for administration of viral hepatitis immunizations at Month 1, 2, 6. |
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| SEP, Outreach, Hepatitis A & B vaccine | Experimental | Subjects randomized to a set of syringe exchange programs for administration of viral hepatitis immunizations at Month 1, 2, 6, plus outreach worker adherence support to receive all immunizations |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Hepatitis A & B vaccine | Biological | Each subject will receive a total of 4 immunizations over 6 months on a 0-1-2-6 month schedule. At the initial visit, subjects>18 years of age will receive the Twinrix vaccine and subjects<18 years of age will receive the Engerix-B vaccine. Cohort subjects>18 years found to have HAV antibody at screening will receive Engerix-B for their remaining 3 immunizations. All subjects will receive: an immunization record with the first vaccine dose entered and the dates the next doses are due; helpful hints for remembering vaccine appointments; and written instructions on where and how to get immunized outside of SF. |
| Measure | Description | Time Frame |
|---|---|---|
| Vaccine Series Completion | The primary outcome was the completion of the four-dose vaccine series in a 12 month period. | 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Hepatitis B Surface Antibody Seroconversion After 3 Vaccine Doses | To examine the effect of hepatitis C virus (HCV) infection on vaccine effectiveness, we compared anti-HBs (antibody to the hepatitis B surface antigen) seroconversion after three vaccine doses between anti-HCV (antibody to the hepatitis C virus) positive and anti-HCV negative participants. | 12 months |
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Inclusion Criteria (screening study):
Exclusion Criteria (screening study):
Inclusion Criteria (vaccine cohort):
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| Name | Affiliation | Role |
|---|---|---|
| Paula J Lum, M.D., M.P.H. | University of California, San Francisco | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of California San Francisco Medical Cen | San Francisco | California | 94143 0939 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 17980513 | Result | Hahn JA, Page-Shafer K, Ford J, Paciorek A, Lum PJ. Traveling young injection drug users at high risk for acquisition and transmission of viral infections. Drug Alcohol Depend. 2008 Jan 11;93(1-2):43-50. doi: 10.1016/j.drugalcdep.2007.08.016. Epub 2007 Nov 5. | |
| 21241735 | Result | Etcheverry MF, Lum PJ, Evans JL, Sanchez E, de Lazzari E, Mendez-Arancibia E, Sierra E, Gatell JM, Page K, Joseph J. HIV vaccine trial willingness among injection and non-injection drug users in two urban centres, Barcelona and San Francisco. Vaccine. 2011 Feb 24;29(10):1991-6. doi: 10.1016/j.vaccine.2010.12.043. Epub 2011 Jan 15. |
| Label | URL |
|---|---|
| The UFO Study | View source |
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1304 persons completed initial contact form; 645 were eligible and 546 opted to participate in the cross-sectional study. The vaccine adherence cohort (n=167) included participants enrolled prior to 3/31/2007 who met additional eligibility criteria.
Between 08/31/2004 and 11/30/2007, street-based outreach workers distributed study invitation cards to potential subjects in neighborhoods of San Francisco where young injection drug users (IDU) are known to congregate. Initial Contact form included self-reported age, IDU in last 30 days, hepatitis B immunization and HIV-positive status.
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| ID | Title | Description |
|---|---|---|
| FG000 | Cross-sectional/Screening | Cross-sectional screening to determine eligibility for vaccine adherence trial |
| FG001 | AIC Only | Subjects randomized to a public health department clinic, the Adult Immunization Clinic (AIC), for administration of viral hepatitis immunizations at Month 1, 2, 6. |
| FG002 | AIC + Outreach | Subjects randomized to a public health department clinic, the Adult Immunization Clinic (AIC)) for administration of viral hepatitis immunizations at Month 1, 2, 6, plus outreach worker adherence support to receive all immunizations |
| FG003 | SEP Only | Subjects randomized to a set of syringe exchange programs for administration of viral hepatitis immunizations at Month 1, 2, 6. |
| FG004 | SEP + Outreach | Subjects randomized to a set of syringe exchange programs for administration of viral hepatitis immunizations at Month 1, 2, 6, plus outreach worker adherence support to receive all immunizations |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pre-Randomization Cross-sectional Study |
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| ||||||||||||||||||
| Evaluation for Vaccine Adherence Cohort |
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| Vaccine Adherence Cohort |
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| ID | Title | Description |
|---|---|---|
| BG000 | All Participants | Participants in pre-randomization cross-sectional study |
| Units | Counts |
|---|---|
| Participants |
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| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Customized | Number |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Vaccine Series Completion | The primary outcome was the completion of the four-dose vaccine series in a 12 month period. | Posted | Number | participants | 12 months |
|
12 months
Participants were observed for 10-15 minutes following each vaccination and instructed to contact the clinic if any adverse event was experienced.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | AIC Only | Subjects randomized to a public health department clinic, the Adult Immunization Clinic (AIC), for administration of viral hepatitis immunizations at Month 1, 2, 6. |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Paula J. Lum | University of California, San Francisco | 415-476-4082 | 411 | plum@php.ucsf.edu |
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| ID | Term |
|---|---|
| D055118 | Medication Adherence |
| D015819 | Substance Abuse, Intravenous |
| D012309 | Risk-Taking |
| D006506 | Hepatitis A |
| D006509 | Hepatitis B |
| D006526 | Hepatitis C |
| ID | Term |
|---|---|
| D010349 | Patient Compliance |
| D010342 | Patient Acceptance of Health Care |
| D000074822 | Treatment Adherence and Compliance |
| D015438 | Health Behavior |
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| ID | Term |
|---|---|
| C433226 | twinrix |
| C075654 | Engerix-B |
| D003159 | Community-Institutional Relations |
| D018671 | Needle-Exchange Programs |
| ID | Term |
|---|---|
| D011641 | Public Relations |
| D009934 | Organization and Administration |
| D006298 | Health Services Administration |
| D011314 | Preventive Health Services |
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|
|
| Outreach | Behavioral | Outreach worker vaccine adherence support: Half of cohort subjects will be assigned to outreach worker vaccine adherence support and will meet with their outreach workers from Haight Ashbury Youth Outreach Team (HAYOT) and Glide Health Services on the day of vaccine cohort study enrollment. Intensive vaccination tracking and in-person outreach support will begin one week before the second and third vaccine doses are due, and again two weeks before the fourth dose is due. |
|
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| AIC | Behavioral | The Adult Immunization Clinic (AIC) is a public low-cost vaccine clinic located centrally at 101 Grove Street in the lobby of the San Francisco Department of Public Health (SFDPH). The clinic is open from Monday-Friday 9 a.m. to 4 p.m. Nurses at the AIC will be available 40 hours/week to administer free immunizations to study subjects. |
|
|
| SEP | Behavioral | Subjects randomized to a set of syringe exchange programs for administration of viral hepatitis immunizations at Month 1, 2, 6. Research nurses will provide 16 hours/week of vaccine administration services at SEPs well attended by young IDU. The San Francisco Needle Exchange (SFNE) serves primarily youth and young adults on Mondays, Wednesdays, and Fridays from 5-7 p.m. in an indoor location in the Haight-Ashbury district. A study nurse will be at SFNE for a total of 6 hours per week. HIV Prevention Project (HPP) sites also operate for 2 hrs each (Tues, Thu, Fri, Sat). Medical services are provided either in a clinic setting at indoor sites (6th Street) or at outdoor sites (Hemlock Alley, Duboce). A study nurse will attend each of these 5 weekly sites for a total of 10 hours/week. |
|
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| Viral Transmission Risk Behavior Association With Travel | In a cross-sectional analysis of 355 subjects enrolled between 2004 and 2006, we estimate the associations between travel in the 3 months prior to baseline and behaviors occurring in the 30 days prior to baseline, such as drug and alcohol and sexual behaviors, that may facilitate the spread of viral infections. | Baseline |
| HIV Vaccine Trial Willingness | We assessed knowledge about vaccine trials and willingness to participate in preventive HIV vaccine trials by asking the question: "How willing would you be to join a study of a vaccine to prevent HIV infection, if the study were to start tomorrow?". Willingness was measured on a 4-point response scale, ranging from 1 (Definitely not willing) to 4 (Definitely willing). | Baseline |
| HIV Vaccine Trial Knowledge | Participants were asked if they agreed or disagreed with or were unsure of each of eight statements about HIV vaccine trial concepts from the HIV Network for Prevention Trials (HIVNET).
| Baseline |
| 18233994 | Result | Lum PJ, Hahn JA, Shafer KP, Evans JL, Davidson PJ, Stein E, Moss AR. Hepatitis B virus infection and immunization status in a new generation of injection drug users in San Francisco. J Viral Hepat. 2008 Mar;15(3):229-36. doi: 10.1111/j.1365-2893.2007.00933.x. |
| Technical difficulty loss of data |
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| Did not respond to willingness questions |
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| Interviewer lack confidence in responses |
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| Eligible for Vaccine Adherence Cohort |
|
| COMPLETED |
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| NOT COMPLETED |
|
|
| COMPLETED |
|
| NOT COMPLETED |
|
| Participants |
|
| Sex/Gender, Customized | Gender: Male, Female, Unknown or Not Reported | Number | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
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| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
| OG002 |
| SEP Only |
Subjects randomized to a set of syringe exchange programs for administration of viral hepatitis immunizations at Month 1, 2, 6. |
| OG003 | SEP + Outreach | Subjects randomized to a set of syringe exchange programs for administration of viral hepatitis immunizations at Month 1, 2, 6, plus outreach worker adherence support to receive all immunizations |
|
|
| Secondary | Hepatitis B Surface Antibody Seroconversion After 3 Vaccine Doses | To examine the effect of hepatitis C virus (HCV) infection on vaccine effectiveness, we compared anti-HBs (antibody to the hepatitis B surface antigen) seroconversion after three vaccine doses between anti-HCV (antibody to the hepatitis C virus) positive and anti-HCV negative participants. | 139 participants who completed 3 vaccine doses were included in the analysis. Enrollment for this aim continued after enrollment into the 12-month vaccine adherence trial closed; an additional 51 persons were found eligible and enrolled. | Posted | Number | Participants | 12 months |
|
|
|
| Secondary | Viral Transmission Risk Behavior Association With Travel | In a cross-sectional analysis of 355 subjects enrolled between 2004 and 2006, we estimate the associations between travel in the 3 months prior to baseline and behaviors occurring in the 30 days prior to baseline, such as drug and alcohol and sexual behaviors, that may facilitate the spread of viral infections. | Cross-sectional analysis of 355 subjects enrolled between 2004 and 2006 | Posted | Number | percentage of participants | Baseline |
|
|
|
|
| Secondary | HIV Vaccine Trial Willingness | We assessed knowledge about vaccine trials and willingness to participate in preventive HIV vaccine trials by asking the question: "How willing would you be to join a study of a vaccine to prevent HIV infection, if the study were to start tomorrow?". Willingness was measured on a 4-point response scale, ranging from 1 (Definitely not willing) to 4 (Definitely willing). | Per the Participant Flow, 409 participants in the cross-sectional study had complete and valid baseline data | Posted | Number | Participants | Baseline |
|
|
|
| Secondary | HIV Vaccine Trial Knowledge | Participants were asked if they agreed or disagreed with or were unsure of each of eight statements about HIV vaccine trial concepts from the HIV Network for Prevention Trials (HIVNET).
| Per the Participant Flow, 409 participants in the cross-sectional study had complete and valid baseline data | Posted | Number | Participants | Baseline |
|
|
|
| 0 |
| 47 |
| 0 |
| 47 |
| EG001 | AIC + Outreach | Subjects randomized to a public health department clinic, the Adult Immunization Clinic (AIC)) for administration of viral hepatitis immunizations at Month 1, 2, 6, plus outreach worker adherence support to receive all immunizations | 0 | 43 | 0 | 43 |
| EG002 | SEP Only | Subjects randomized to a set of syringe exchange programs for administration of viral hepatitis immunizations at Month 1, 2, 6. | 0 | 36 | 0 | 36 |
| EG003 | SEP + Outreach | Subjects randomized to a set of syringe exchange programs for administration of viral hepatitis immunizations at Month 1, 2, 6, plus outreach worker adherence support to receive all immunizations | 0 | 41 | 0 | 41 |
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| D001519 | Behavior |
| D019966 | Substance-Related Disorders |
| D064419 | Chemically-Induced Disorders |
| D001523 | Mental Disorders |
| D006525 | Hepatitis, Viral, Human |
| D014777 | Virus Diseases |
| D007239 | Infections |
| D004769 | Enterovirus Infections |
| D010850 | Picornaviridae Infections |
| D012327 | RNA Virus Infections |
| D006505 | Hepatitis |
| D008107 | Liver Diseases |
| D004066 | Digestive System Diseases |
| D000086982 | Blood-Borne Infections |
| D003141 | Communicable Diseases |
| D018347 | Hepadnaviridae Infections |
| D004266 | DNA Virus Infections |
| D018178 | Flaviviridae Infections |
| D006296 | Health Services |
| D005159 | Health Care Facilities Workforce and Services |
| Used (injected/snorted/smoked) crack cocaine |
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| Used (injected/snorted/smoked) methamphetamine |
|
| More than one of the above (poly-substance use) |
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| Heavy drinking (>14, >21 per week; women, men) |
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| Drank until blacked out |
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| Injected daily, past 30 days |
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| Number of injecting partners >=5 |
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| Lent a needle/syringe |
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| Injected with someone else's used needle/syringe |
|
| Pooled money to buy drugs |
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| Shared cooker/spoon to prepare drugs |
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| Syringe was backloaded |
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| Did someone's "rinse" |
|
| Median number of sexual partners >=2 |
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| Traded sex for money or drugs |
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| >90% condom use if sexually active |
|
|
Adjusted odds with 95% confidence intervals for travel as a risk factor for each behavior. |
| Regression, Logistic |
Odds ratios adjusted for age, race, sex, years injecting. |
| 0.01 |
| Odds Ratio (OR) |
| 1.76 |
| 2-Sided |
| 95 |
| 1.12 |
| 2.76 |
Odds for travel in the past 3 months as a risk factor for having Used (injected/snorted/smoked) powder cocaine in the past 30 days |
| No |
| Superiority or Other |
| Adjusted odds with 95% confidence intervals for travel as a risk factor for each behavior. | Regression, Logistic | Odds ratios adjusted for age, race, sex, years injecting. | 0.05 | Odds Ratio (OR) | 1.56 | 2-Sided | 95 | 1.00 | 2.44 | Odds for travel in the prior 3 months as a risk factor for having Used (injected and/or snorted) crack cocaine in the past 30 days | No | Superiority or Other |
| Adjusted odds with 95% confidence intervals for travel as a risk factor for each behavior. | Regression, Logistic | Odds ratios adjusted for age, race, sex, years injecting. | 0.03 | Odds Ratio (OR) | 0.59 | 2-Sided | 95 | 0.35 | 0.98 | Odds for travel in the prior 3 months as a risk factor for having Used (injected/snorted/smoked) methamphetamine in the past 30 days | No | Superiority or Other |
| Adjusted odds with 95% confidence intervals for travel as a risk factor for each behavior. | Regression, Logistic | Odds ratios adjusted for age, race, sex, years injecting. | <0.01 | Odds Ratio (OR) | 1.99 | 2-Sided | 95 | 1.11 | 3.59 | Odds for travel in the prior 3 months as a risk factor for poly-substance use in the past 30 days | No | Superiority or Other |
| Adjusted odds with 95% confidence intervals for travel as a risk factor for each behavior. | Regression, Logistic | Odds ratios adjusted for age, race, sex, years injecting. | <0.01 | Odds Ratio (OR) | 6.87 | 2-Sided | 95 | 3.84 | 12.28 | Odds for travel in the prior 3 months as a risk factor for Heavy drinking (>14 and >21 drinks/week for women and men respectively) in the past 30 days | No | Superiority or Other |
| Adjusted odds with 95% confidence intervals for travel as a risk factor for each behavior. | Regression, Logistic | Odds ratios adjusted for age, race, sex, years injecting. | <0.01 | Odds Ratio (OR) | 3.63 | 2-Sided | 95 | 2.02 | 6.50 | Adjusted odds for travel in the prior 3 months as a risk factor for Drank until blacked out in the past 30 days | No | Superiority or Other |
| Adjusted odds with 95% confidence intervals for travel as a risk factor for each behavior. | Regression, Logistic | Odds ratios adjusted for age, race, sex, years injecting. | 0.04 | Odds Ratio (OR) | 0.56 | 2-Sided | 95 | 0.33 | 0.93 | Adjusted odds for travel in the prior 3 months as a risk factor for Injected daily, past 30 days | No | Superiority or Other |
| Adjusted odds with 95% confidence intervals for travel as a risk factor for each behavior. | Regression, Logistic | Odds ratios adjusted for age, race, sex, years injecting. | <0.01 | Odds Ratio (OR) | 2.16 | 2-Sided | 95 | 1.37 | 3.40 | Adjusted odds for travel in the prior 3 months as a risk factor for Median number of injected partners >= 5 in the past 30 days | No | Superiority or Other |
| Adjusted odds with 95% confidence interval for travel in the prior 3 months as a risk factor for having Lent a needle/syringe in the past 30 days | Regression, Logistic | Odds ratios adjusted for age, race, sex, years injecting. | 0.19 | Odds Ratio (OR) | 1.26 | 2-Sided | 95 | 0.81 | 1.97 | Adjusted odds for travel in prior 3 months as a risk factor for having Lent a needle/syringe in the past 30 days | No | Superiority or Other |
| Adjusted odds ratio with 95 % confidence interval for travel in prior 3 months as a risk factor for having injected with someone else's used needle/syringe in the past 30 days | Regression, Logistic | Odds ratios adjusted for age, race, sex, years injecting. | <0.01 | Odds Ratio (OR) | 1.61 | 2-Sided | 95 | 1.01 | 2.55 | Adjusted odds for travel in prior 3 months as a risk factor for having Injected with someone else's used needle/syringe in the past 30 days | No | Superiority or Other |
| Adjusted odds with 95% confidence interval for travel in the prior 3 months as a risk factor for having Pooled money to buy drugs in the past 30 days | Regression, Logistic | Odds ratios adjusted for age, race, sex, years injecting. | <0.01 | Odds Ratio (OR) | 3.07 | 2-Sided | 95 | 1.79 | 5.27 | Adjusted odds for travel in prior 3 months as a risk factor for having Pooled money to buy drugs in the past 30 days | No | Superiority or Other |
| Adjusted odds ratios with 95% confidence interval for travel in prior 3 months as risk factor for risk behaviors | Regression, Logistic | Odds ratios adjusted for age, race, sex, years injecting. | <0.01 | Odds Ratio (OR) | 2.10 | 2-Sided | 95 | 1.34 | 3.32 | Adjusted odds for travel in prior 3 months as a risk factor for having Shared cooker/spook to prepare drugs in the past 30 days | No | Superiority or Other |
| Adjusted odds with 95 % confidence interval for travel as a risk factor for risk behaviors | Regression, Logistic | Odds ratios adjusted for age, race, sex, years injecting. | <0.01 | Odds Ratio (OR) | 1.87 | 2-Sided | 95 | 1.19 | 2.95 | Adjusted odds for travel in prior 3 months as a risk factor for having used Backloaded Syringe in the past 30 days | No | Superiority or Other |
| Adjusted odds with 95% confidence interval for travel in prior 3 months as a risk factor for risk behavior in past 30 days | Regression, Logistic | Odds ratios adjusted for age, race, sex, years injecting. | 0.13 | Odds Ratio (OR) | 1.32 | 2-Sided | 95 | 0.83 | 2.10 | Adjusted odds for travel in prior 3 months as a risk factor for having done Someone's "rinse" in the past 30 days | No | Superiority or Other |
| Adjusted odds ratios and 95% confidence intervals for travel in prior 3 months as a risk factor for risk behaviors in past 30 days | Regression, Logistic | Odds ratios adjusted for age, race, sex, years injecting. | <0.01 | Odds Ratio (OR) | 2.21 | 2-Sided | 95 | 1.40 | 3.49 | Adjusted odds for travel in prior 3 months as a risk factor for Median number of sexual partners >=2 in the past 30 days | No | Superiority or Other |
| Adjusted odds and 95% confidence interval for travel in prior 3 months as a risk factor for risk behaviors in past 30 days | Regression, Logistic | Odds ratios adjusted for age, race, sex, years injecting. | 0.86 | Odds Ratio (OR) | 0.91 | 2-Sided | 95 | 0.45 | 1.85 | Adjusted odds for travel in prior 3 months as a risk factor for having Traded sex for money or drugs in the past 30 days | No | Superiority or Other |
| Adjusted odds and 95% confidence interval for travel in prior 3 months as a risk factor for engaging in risk behavior during the past 30 days | Regression, Logistic | Odds ratios adjusted for age, race, sex, years injecting. | 0.73 | Odds Ratio (OR) | 1.09 | 2-Sided | 95 | 0.59 | 2.02 | Adjusted odds for travel in prior 3 months as a risk factor for condom use >90% (if sexually active) | No | Superiority or Other |
| Title | Measurements |
|---|---|
|
| 4=Definitely willing |
|