Nurse researchers and educators often engage in outreach to narrowly defined populations. This article offers examples of how variations on the snowball sampling recruitment strategy can be applied in the creation of culturally appropriate, community-based information dissemination efforts related to recruitment to health education programs and research studies. Examples from the primary author’s program of research are provided to demonstrate how adaptations of snowball sampling can be effectively used in the recruitment of members of traditionally underserved or vulnerable populations. The adaptation of snowball sampling techniques, as described in this article, helped the authors to gain access to each of the more vulnerable population groups of interest. The use of culturally sensitive recruitment strategies is both appropriate and effective in enlisting the involvement of members of vulnerable populations. Adaptations of snowball sampling strategies should be considered when recruiting participants for education programs or subjects for research studies when recruitment of a population based sample is not essential.

The neuropsychological performance of 85 women with early stage breast cancer scheduled for chemotherapy, 43 women scheduled for endocrine therapy and/or radiotherapy and 49 healthy control subjects was assessed at baseline (T1), postchemotherapy (or 6 months) (T2) and at 18 months (T3). Repeated measures analysis found no significant interactions or main effect of group after controlling for age and intelligence. Using a calculation to examine performance at an individual level, reliable decline on multiple tasks was seen in 20% of chemotherapy patients, 26% of nonchemotherapy patients and 18% of controls at T2 (18%, 14 and 11%, respectively, at T3). Patients who had experienced a treatment-induced menopause were more likely to show reliable decline on multiple measures at T2 (OR ¼ 2.6, 95% confidence interval (CI) 0.823 -8.266 P ¼ 0.086). Psychological distress, quality of life measures and self-reported cognitive failures did not impact on objective tests of cognitive function, but were significantly associated with each other. The results show that a few women experienced objective measurable change in their concentration and memory following standard adjuvant therapy, but the majority were either unaffected or even improve over time.

Smokers (N = 3,030) were randomized to receive 1 of 3 interventions: (a) a self-help quit kit, (b) a quit kit plus 1 telephone counseling session, or (c) a quit kit plus up to 6 telephone counseling sessions, scheduled according to relapse probability. Both counseling groups achieved significantly higher abstinence rates than the self-help group. The rates for having quit for at least 12 months by intention to treat were 5.4% for self-help, 7.5% for single counseling, and 9.9% for multiple counseling. The 12-month continuous abstinence rates for those who made a quit attempt were 14.7% for self-help, 19.8% for single counseling, and 26.7% for multiple counseling. A dose-response relation was observed, as multiple sessions produced significantly higher abstinence rates than a single session. The first week after quitting seems to be the critical period for intervention.Telephone counseling has attracted increasing interest as an alternative system for delivery of services in the field of smoking cessation (e.g., Anderson, Duffy, Hallet, & Marcus, 1992;Curry, McBride, Louie, Grothaus, & Wagner, 1992;DeBusk et al., 1994; Lando, Hellerstedt, Pirie, & McGovern, 1992;Orleans et al., 1991;Ossip-Klein et al., 1991;Prochaska, DiClemente, Velicer, & Rossi, 1993;Shiffman, Read, Maltese, Rapkin, & Jarvik, 1985). From the smoker's standpoint, its main attractions are accessibility and convenience. There are no transportation difficulties and fewer scheduling conflicts than in most other cessation programs. Also, receiving counseling in the privacy of one's home provides treatment access to individuals who might not normally seek "counseling" to quit smoking. These factors encourage smokers to use the service (Zhu etal., 1995 cantly increases the success rate (e.g., Orleans et al., 1991;Ossip-Klein et al., 1991), others report only a short-term effect, with the long-term outlook no better than that of selfhelp(e.g., Curry etal., 1992; Lando etal., 1992). Those studies that have shown a significant intervention effect for telephone counseling, however, did not include a randomized design to test for a dose-response relation between the number of sessions and the treatment effect.The present study examined the effects of two levels of telephone counseling and compared them with the effects of a selfhelp approach. The lower intensity counseling consisted of one session before quitting. The higher intensity counseling included the same pre-quit session plus up to five sessions after the smoker had quit. We tested two hypotheses: (a) that counseling would produce a higher abstinence rate than a self-help quit kit, and (b) that multiple sessions of counseling would produce a higher abstinence rate than a single session.

Goals-Previous investigations have shown that women undergoing chemotherapy for breast cancer experience both disturbed sleep and fatigue. However, most of the previous research examined women either during or after chemotherapy. This study examined sleep, fatigue, and circadian rhythms in women with breast cancer before the start of chemotherapy.Patients and methods-Eighty five women with Stages I-IIIA breast cancer who were scheduled to begin adjuvant or neo-adjuvant anthracycline-based chemotherapy participated. Each had sleep/ wake activity recorded with actigraphy for 72 consecutive hours and filled out questionnaires on sleep, fatigue, depression, and functional outcome.Main results-On average, the women slept for about 6 h a night and napped for over an hour during the day. Sleep was reported to be disturbed and fatigue levels were high. Circadian rhythms were robust, but women who were more phase-delayed reported more daily dysfunction (p<0.01). Conclusions-The data from the current study suggest that the women with breast cancer likely experience both disturbed sleep and fatigue before the beginning of chemotherapy. Although their circadian rhythms are robust, breast cancer patients with more delayed rhythms experience more daily dysfunction secondary to fatigue. These data suggest that strategies to improve disturbed sleep and to phase-advance circadian rhythms prior to initiation of chemotherapy may be beneficial in improving daily function in breast cancer patients.