BackgroundResearch is needed on what influences recruitment to smoking reduction trials, and how to increase their reach. The present study aimed to i) assess the feasibility of recruiting a disadvantaged population, ii) examine the effects of recruitment methods on participant characteristics, iii) identify resource requirements for different recruitment methods, and iv) to qualitatively assess the acceptability of recruitment. This was done as part of a pilot two-arm trial of the effectiveness of a novel behavioral support intervention focused on increasing physical activity and reducing smoking, among disadvantaged smokers not wishing to quit.MethodsSmokers were recruited through mailed invitations from three primary care practices (62 participants) and one National Health Stop Smoking Service (SSS) database (31 participants). Six other participants were recruited via a variety of other community-based approaches. Data were collected through questionnaires, field notes, work sampling, and databases. Chi-squared and t-tests were used to compare baseline characteristics of participants.ResultsWe randomized between 5.1 and 11.1% of those invited through primary care and SSS, with associated researcher time to recruit one participant varying from 18 to 157 minutes depending on time and intensity invested.Only six participants were recruited through a wide variety of other community-based approaches, with an associated researcher time of 469 minutes to recruit one participant. Targets for recruiting a disadvantaged population were met, with 91% of the sample in social classes C2 to E (NRS social grades, UK), and 41% indicating mental health problems. Those recruited from SSS were more likely to respond to an initial letter, had used cessation aids before, and had attempted to quit in the past year. Overall, initial responders were more likely to be physically active than those who were recruited via follow-up telephone calls. No other demographics or behaviour characteristics were associated with recruitment approach or intensity of effort. Qualitative feedback indicated that participants had been attracted by the prospect of support that focused on smoking reduction rather than abrupt quitting.ConclusionsMailed invitations, and follow-up, from health professionals was an effective method of recruiting disadvantaged smokers into a trial of an exercise intervention to aid smoking reduction. Recruitment via community outreach approaches was largely ineffective.Trial registrationISRCTN identifier: 13837944, registered on 6 July 2010

Declared competing interests of authors: PA has been a consultant and done research for manufacturers of smoking-cessation products. RW has undertaken research and consultancy for companies that develop and manufacture smoking-cessation medications. He is co-director of the National Centre for Smoking Cessation and Training and a trustee of the stop-smoking charity, QUIT. He has a share of a patent on a novel nicotine delivery device. All other authors have declared no competing interests.

IntroductionCurrently women of any age, including under 16-year-olds, can access confidential contraceptive services through their own or another general practitioner (GP), and through community family planning clinics (FPCs). Where available, teenagers may also use specialist services such as Brook Advisory Centres or local teenage drop-ins. About 80% of all women now receive contraceptive services from a GP. 1 In rural areas the percentage may be higher as the GP is often the only service available locally to meet the sexual health needs of teenagers, transport to other locations often being infrequent and costly.In North and East Devon, the health district studied for this paper, there is only one FPC which opens every day, Monday to Saturday. Whilst this clinic is very well used by teenagers, 2 its location renders it inaccessible to many of those in the district. The availability, cost and frequency of public transport are particularly important for teenagers. While there are also 14 satellite clinics in the district, including three at colleges for post-16s, one of the clinics is open twice a week and the rest on a weekly basis, so these are not ideal for teenagers' needs. A local survey of Year 9 and Year 11 rural school children showed that over onethird did not know the role of a FPC. They are unlikely to access a service they do not relate to their own needs. 3 School nurses may also provide some sexual health services for teenagers including the provision of condoms, pregnancy tests and referrals to local GPs or FPCs for emergency and other methods of contraception. Where rural teenagers travel into school by bus, this has the advantage of serving a larger population than is possible in more remote areas. However, school nurses are only on site for part of the week and the service varies greatly between schools. It may be particularly restricted where there is no sixth form. In addition, fear of parental disapproval may prevent school nurses from widely publicising services they do offer. 4 Given that current service provision in the district relies heavily on the ability of general practices to meet the needs of sexually active teenagers, it is important to understand the ways in which they can and cannot respond to those needs. A key issue in providing appropriate sexual health services for teenagers is confidentiality. Allen 5 described confidentiality as 'the single most important factor in designing services for young people'. Since the Fraser ruling in 1985, 6 doctors have followed guidelines enabling them to provide confidential sexual health care to under 16s, providing they are judged in need of this care and mature enough to understand their treatment. However, confidentiality for teenagers involves more than simply having faith that a health professional will not report an encounter to parents, relatives or teachers, although this may still be a concern for a minority. Other issues may be equally or even more important. These include problems of privacy, anonymity and visibility in small co...

Young people are at risk from sexually transmitted infections (STIs)--the incidence of chlamydia in the UK is highest among young women aged 16-19. Despite this, young people lack knowledge about STIs and are more aware of the risks of unwanted pregnancy than their risk of acquiring an STI. This study used qualitative and quantitative methods to examine what teenagers know about STIs, their prevention, symptoms, treatment and services. Only one-third of respondents recognized chlamydia as an STI. The little knowledge of STIs that was revealed was superficial. Few were aware that special services existed for STIs. Condoms were seen as contraception, not as a method of preventing infection transmission. High teenage pregnancy rates have received much publicity but less attention has been paid to rising STI incidence. Programmes aimed at decreasing pregnancy rates through adoption of effective hormonal contraception not only fail to address STIs but may be detrimental to prevention efforts.

In their book Non-Voting, published in 1924, Charles E. Merriam and Harold F. Gosnell reported that many persons otherwise eligible to vote had been disfranchised by Chicago's registration requirements. Their data showed that “there were three times as many adult citizens who could not vote because they had failed to register as there were registered voters who had failed to vote in the particular election” and that “entirely different reasons [for not voting] were emphasized by those who were not registered than by those who were registered but did not vote …” Their observation can hardly be said to have been influential. Until very recently most students of voting have paid little attention to the temporally prior act of registration.Failure to do so has had important consequences. It has made it easy to discount unduly the significance of political influences on the size and composition of electorates; easy to argue unrealistically about the value of efforts to increase the turnout of voters; and easy to be puzzled about some aspects of the behavior of voters.

Objective: High levels of social and economic deprivation are apparent in many UK cities. There is evidence of certain 'marginalised' communities suffering disproportionately from poor nutrition, threatening health. Finding ways to engage with these communities is essential to identify strategies to optimise wellbeing and life skills. The Food as a Lifestyle Motivator project aimed to pilot creative methods in homeless adults for the examination of food related experiences, in order to facilitate their engagement in wellbeing discourse. Design: Creative Participatory Action Research methods including Photo-Elicitation. Setting: A homeless service provider in Plymouth, UK Method: A sample of homeless service users took photographs of their food activities over a ten-day period, then volunteered to share their photos in focus group discussions to elicit meaning related to their food experiences. Results: Five themes were generated from nine service user narratives, demonstrating that food holds meaning, elicits emotion, and exerts power. The food environment can be a critical social meeting place and food preparation can provide companionship and occupation. Conclusions: As well as being central to many health concerns, food may also be a powerful way to motivate people to change their lifestyle. The participatory methods used in this pilot hold potential to engage effectively with harder-to-reach service users. Discussions about their wellbeing indicate food as a powerful 'catalyst' for inclusion with the potential to empower individuals. This research serves to inform health education practice, design of services, and address (nutritional) health inequalities.

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BackgroundStudy attrition has the potential to compromise a trial’s internal and external validity. The aim of the present study was to identify factors associated with participant attrition in a pilot trial of the effectiveness of a novel behavioural support intervention focused on increasing physical activity to reduce smoking, to inform the methods to reduce attrition in a definitive trial.MethodsDisadvantaged smokers who wanted to reduce but not quit were randomised (N = 99), of whom 61 (62 %) completed follow-up assessments at 16 weeks. Univariable logistic regression was conducted to determine the effects of intervention arm, method of recruitment, and participant characteristics (sociodemographic factors, and lifestyle, behavioural and attitudinal characteristics) on attrition, followed by multivariable logistic regression on those factors found to be related to attrition.ResultsParticipants with low confidence to quit, and who were undertaking less than 150 mins of moderate and vigorous physical activity per week at baseline were less likely to complete the 16-week follow-up assessment. Exploratory analysis revealed that those who were lost to follow-up early in the trial (i.e., by 4 weeks), compared with those completing the study, were younger, had smoked for fewer years and had lower confidence to quit in the next 6 months. Participants who recorded a higher expired air carbon monoxide reading at baseline were more likely to drop out late in the study, as were those recruited via follow-up telephone calls. Multivariable analyses showed that only completing less than 150 mins of physical activity retained any confidence in predicting attrition in the presence of other variables.ConclusionsThe findings indicate that those who take more effort to be recruited, are younger, are heavier smokers, have less confidence to quit, and are less physically active are more likely to withdraw or be lost to follow-up.