Recruiting Participants for Population Health Intervention Research: Effectiveness and Costs of Recruitment Methods for a Cohort Study

Background

Public health research studies often rely on population-based participation and draw on various recruitment methods to establish samples. Increasingly, researchers are turning to web-based recruitment tools. However, few studies detail traditional and web-based recruitment efforts in terms of costs and potential biases.

Objective

This study aims to report on and evaluate the cost-effectiveness, time effectiveness, and sociodemographic representation of diverse recruitment methods used to enroll participants in 3 cities of the Interventions, Research, and Action in Cities Team (INTERACT) study, a cohort study conducted in Canadian cities.

Methods

Over 2017 and 2018 in Vancouver, Saskatoon, and Montreal, the INTERACT study used the following recruitment methods: mailed letters, social media (including sponsored Facebook advertisements), news media, partner communications, snowball recruitment, in-person recruitment, and posters. Participation in the study involved answering web-based questionnaires (at minimum), activating a smartphone app to share sensor data, and wearing a device for mobility and physical activity monitoring. We describe sociodemographic characteristics by the recruitment method and analyze performance indicators, including cost, completion rate, and time effectiveness. Effectiveness included calculating cost per completer (ie, a participant who completed at least one questionnaire), the completion rate of a health questionnaire, and the delay between completion of eligibility and health questionnaires. Cost included producing materials (ie, printing costs), transmitting recruitment messages (ie, mailing list rental, postage, and sponsored Facebook posts charges), and staff time. In Montreal, the largest INTERACT sample, we modeled the number of daily recruits through generalized linear models accounting for the distributed lagged effects of recruitment campaigns.

Results

Overall, 1791 participants were recruited from 3 cities and completed at least one questionnaire: 318 in Vancouver, 315 in Saskatoon, and 1158 in Montreal. In all cities, most participants chose to participate fully (questionnaires, apps, and devices). The costs associated with a completed participant varied across recruitment methods and by city. Facebook advertisements generated the most recruits (n=687), at a cost of CAD $15.04 (US $11.57; including staff time) per completer. Mailed letters were the costliest, at CAD $108.30 (US $83.3) per completer but served to reach older participants. All methods resulted in a gender imbalance, with women participating more, specifically with social media. Partner newsletters resulted in the participation of younger adults and were cost-efficient (CAD $5.16 [US $3.97] per completer). A generalized linear model for daily Montreal recruitment identified 2-day lag effects on most recruitment methods, except for the snowball campaign (4 days), letters (15 days), and reminder cards (5 days).

Conclusions

This study presents comprehensive data on the costs, effectiveness, and bias of population recruitment in a cohort study in 3 Canadian cities. More comprehensive documentation and reporting of recruitment efforts across studies are needed to improve our capacity to conduct inclusive intervention research.

Smoking in Young Adults: A Study of 4-Year Smoking Behavior Patterns and Residential Presence of Features Facilitating Smoking Using Data From the Interdisciplinary Study of Inequalities in Smoking Cohort

INTRODUCTION

Young adults have the highest prevalence of smoking among all age groups in most industrialized countries and exhibit great variability in smoking behavior. Differences in associations between features in residential environments and smoking initiation, prevalence, and cessation have been extensively examined in the literature. Nonetheless, in many cases, findings remain inconsistent. This paper proposes that a potential driver of these inconsistencies is an almost exclusive focus on point-specific smoking outcomes, without consideration for the different behavior patterns that this age group may experience over time.

AIMS AND METHODS

Based on data from the Interdisciplinary Study of Inequalities in Smoking cohort of 18- to 25-year-old Montreal residents (n = 1025), we examined associations between 4-year smoking patterns measured at three timepoints and proximal presence/density of tobacco retail outlets and presence of smoker accommodation facilities in Montreal, Canada. Associations were tested using two-level multinomial and logistic models.

RESULTS

In fully adjusted models, compared to never-smokers, residents of areas with a higher density of tobacco retail were more likely to (1) be characterized as established smokers, (2) have experienced repeated changes in smoking status (being "switchers") during the 4-year study period, and (3) be former smokers.

CONCLUSIONS

From a conceptual standpoint, these findings highlight the importance of acknowledging and examining smoking behavior patterns among young adults. Furthermore, specific pattern-feature associations may point to unique mechanisms by which features could influence smoking behavior patterns. These findings require replication and extension, including testing hypotheses regarding tobacco retail density's role in sustaining smoking and in influencing changes in smoking status.

IMPLICATIONS

Results from this study highlight the importance of describing and examining different young adult smoking behavior patterns and how they may be influenced by residential environment features such as the density of tobacco retail. Findings suggest that young adults residing in areas with a higher density of tobacco retailers are more likely to have experienced repeated changes in smoking status and to be established smokers. Further research in this area is needed to advance knowledge of the putative mechanisms by which residential features may influence smoking behavior patterns and to ultimately orient policy and interventions seeking to curb smoking at the local level.

Do Social Inequalities in Smoking Differ by Immigration Status in Young Adults Living in an Urban Setting? Findings From the Interdisciplinary Study of Inequalities in Smoking

Objectives:

We assessed whether social inequalities in smoking observed among young adults born in Canada were also apparent in same-age immigrants.

Methods:

Data were drawn from an investigation of social inequalities in smoking conducted in an urban setting (Montreal, Canada). The sample included 2077 young adults age 18 to 25 (56.6% female; 18.9% immigrants who had lived in Canada 11.6 (SD 6.4) years on average). The association between education and current smoking was examined in multivariable logistic regression analyses conducted separately in young adults born in Canada and in immigrants.

Results:

About 19.5% of immigrants were current smokers compared to 23.8% of young adults born in Canada. In immigrants, relative to those with university education, the adjusted odds ratios (OR) (95% confidence interval) for current smoking were 1.2 (0.6, 2.3) among those with pre-university/vocational training and 1.5 (0.7, 2.9) among those with high school education. In non-immigrants, the adjusted ORs were 1.9 (1.4, 2.5) among those with pre-university/vocational training and 4.0 (2.9, 5.5) among those with high school.

Conclusion:

Young adults who had immigrated to Canada did not manifest the strong social gradient in smoking apparent in young adults born in Canada. Increased understanding of the underpinnings of this difference could inform development of interventions that aim to reduce social inequalities in smoking.

Is Smoking Cessation in Young Adults Associated With Tobacco Retailer Availability in Their Activity Space?

INTRODUCTION

The presence of tobacco retailers in residential neighborhoods has been inversely associated with residents' likelihood of quitting smoking. Few studies have yet explored whether this association holds when accounting for tobacco retailers found in the multiple environments where people conduct their daily activities, that is, their activity space.

METHODS

We analyzed cross-sectional data from 921 young adults (18- to 25-years old) participating in the Interdisciplinary Study of Inequalities in Smoking (Montreal, Canada). Respondents self-reported sociodemographic, smoking, and activity location data. Log-binomial regression was used to estimate prevalence ratios (PRs) for the association between smoking cessation and (1) the number of tobacco retailers (counts), and (2) the distance to the closest retailer (proximity) in participants' residential neighborhood and activity space.

RESULTS

Smoking cessation was positively associated with low and intermediate tertile levels of tobacco retailer counts in both the residential neighborhood and activity space, and with the furthest distance level in the activity space [PR (95% CI) = 1.21 (1.02 to 1.43)].

CONCLUSIONS

Individuals encounter resources in the course of their regular daily activities that may hamper smoking cessation. This study highlights the relevance of considering the tobacco retail environment of both individuals' residential neighborhood and activity space to understand its association with smoking cessation.

IMPLICATIONS

This article contributes to the literature on the association between the tobacco retail environment and smoking cessation in young adults by moving beyond the residential neighborhood to also assess individuals' access to tobacco retailers in the multiple areas where they regularly spend time, that is, their activity space. Findings suggest that lower numbers of tobacco retailers in both the residential neighborhood and activity space, and further distance to tobacco retailers in the activity space are associated with increased smoking cessation.

"Don't smoke in public, you look like trash": An exploratory study about women's experiences of smoking-related stigmatisation and the connection to neighbourhood-level deprivation

In this exploratory qualitative study we used Goffman's theory of stigmatisation to examine how women experience smoking-related stigma in relation to neighbourhood-level deprivation. From an existing cohort, we recruited fifteen women who smoked. We found differences in the women's experiences and abilities to negotiate and avoid a stigmatised smoking identity based on neighbourhood-level deprivation. Women in high-deprivation neighbourhoods described limited access to such places and this restricted their abilities to 'pass' as non- or not-quite-smokers and avoid smoking-related stigmatisation. We discuss the implications of the findings in relation to social-spatial inequalities in health and public health policy.

Considering the age-graded nature of associations between socioeconomic characteristics and smoking during the transition towards adulthood

Young adulthood is a sensitive period characterized by the accumulation of resources and transitions in and out of education, employment, family, and housing arrangements. The association between these characteristics and smoking outcomes likely varies with age yet few studies address its dynamic age-graded nature. To explore this, we examined 2083 young adults ages 18-25 from the 2011-2012 cross-sectional sample of the Montreal-based Interdisciplinary Study of Inequalities in Smoking. We operationalized participants' socioeconomic characteristics using their resources (e.g., education, income, financial difficulties) and transition stages (i.e., studying, working full-time, living arrangements with parents and children, and being in a relationship). We examined differences in these characteristics' associations with occasional and daily smoking across two-year categories (18-19, 20-21, 22-23, and 24-25) using multinomial logistic regression models with age-based interaction terms. Findings highlighted four characteristics, i.e., educational attainment, personal income, student status, and relationship status, with significant differences in associations with smoking outcomes across age categories. Between the age groups of 18-19 and 24-25: 1) the negative association between low educational attainment and daily smoking increased; 2) the positive association between personal income and daily smoking decreased; 3) the negative association between student status and both outcomes decreased; 4) the negative association between relationship status and occasional smoking increased. Findings support that the associations between young adults' socioeconomic characteristics and smoking outcomes vary substantially during the second and third decades of life. Addressing this has critical implications for identifying vulnerable populations and developing appropriate age-based policies in this age group.

Social inequalities in health information seeking among young adults in Montreal

Over their lifecourse, young adults develop different skills and preferences in relationship to the information sources they seek when having questions about health. Health information seeking behaviour (HISB) includes multiple, unequally accessed sources; yet most studies have focused on single sources and did not examine HISB's association with social inequalities. This study explores 'multiple-source' profiles and their association with socioeconomic characteristics. We analyzed cross-sectional data from the Interdisciplinary Study of Inequalities in Smoking involving 2093 young adults recruited in Montreal, Canada, in 2011-2012. We used latent class analysis to create profiles based on responses to questions regarding whether participants sought health professionals, family, friends or the Internet when having questions about health. Using multinomial logistic regression, we examined the associations between profiles and economic, social and cultural capital indicators: financial difficulties and transportation means, friend satisfaction and network size, and individual, mother's, and father's education. Five profiles were found: 'all sources' (42%), 'health professional centred' (29%), 'family only' (14%), 'Internet centred' (14%) and 'no sources' (2%). Participants with a larger social network and higher friend satisfaction were more likely to be in the 'all sources' group. Participants who experienced financial difficulties and completed college/university were less likely to be in the 'family only' group; those whose mother had completed college/university were more likely to be in this group. Our findings point to the importance of considering multiple sources to study HISB, especially when the capacity to seek multiple sources is unequally distributed. Scholars should acknowledge HISB's implications for health inequalities.

Do social characteristics influence smoking uptake and cessation during young adulthood?

OBJECTIVES

This study uses a Bourdieusian approach to assess young adults' resources and examines their association with smoking initiation and cessation.

METHODS

Data were drawn from 1450 young adults participating in the Interdisciplinary Study of Inequalities in Smoking, a cohort study in Montreal, Canada. We used logistic regression models to examine the association between young adults' income, education, and peer smoking at baseline and smoking onset and cessation.

RESULTS

Young adults where most or all of their friends smoked had greater odds of smoking onset. Young adults that had completed pre-university postsecondary education also had higher odds of smoking onset after controlling for social support, employment status, and lacking money to pay for expenses. Income and the sociodemographic variables age and sex were not associated with smoking onset. Young adults where half of their friends smoked or where most to all of their friends smoked had lowers odds of smoking cessation. Men were more likely to cease smoking than women. Education, income and age were not associated with cessation.

CONCLUSIONS

Interventions focusing on peer smoking may present promising avenues for tobacco prevention in young adults.

Beyond Smoking Prevalence: Exploring the Variability of Associations between Neighborhood Exposures across Two Nested Spatial Units and Two-Year Smoking Trajectory among Young Adults

Young adults have the highest prevalence of smoking amongst all age groups. Significant uptake occurs after high school age. Although neighborhood exposures have been found to be associated with smoking behavior, research on neighborhood exposures and the smoking trajectories among young adults, and on the role of geographic scale in shaping findings, is scarce. We examined associations between neighborhood exposures across two nested, increasingly large spatial units and smoking trajectory over two years among young adults living in Montreal, Canada. A sample of 2093 participants aged 18-25 years from the Interdisciplinary Study of Inequalities in Smoking (ISIS) was surveyed. The dependent variable was self-reported smoking trajectory over the course of two years. Residential addresses, data on presence of tobacco retail outlets, and the presence of smoking accommodation facilities were coded and linked to spatial units. Three-level multinomial models were used to examine associations. The likelihood of being a smoker for 2+ years was significantly greater among those living in larger spatial unit neighborhoods that had a greater presence of smoking accommodation. This association was not statistically significant at the smaller spatial units. Our findings highlight the importance of studying young adults' smoking trajectories in addition to static smoking outcomes, and point to the relevance of considering spatial scale in studies of neighborhoods and smoking.