Effectiveness of Recruitment Strategies of Latino Smokers: Secondary Analysis of a Mobile Health Smoking Cessation Randomized Clinical Trial

Abstract

Background Latinos remain disproportionately underrepresented in clinical trials, comprising only 2%-3% of research participants. In order to address health disparities, it is critically important to increase enrollment of Latino smokers in smoking cessation trials. There is limited research examining effective recruitment strategies for this population. Objective The purpose of this study was to compare the effectiveness of direct versus mass and high- versus low-effort recruitment strategies on recruitment and retention of Latino smokers to a randomized smoking cessation trial. We also examine how the type of recruitment might have influenced the characteristics of enrolled participants. Methods Latino smokers were enrolled into Decídetexto from 4 states—New Jersey, Kansas, Missouri, and New York. Participants were recruited from August 2018 until March 2021. Mass recruitment strategies included English and Spanish advertisements to the Latino community via flyers, Facebook ads, newspapers, television, radio, church bulletins, and our Decídetexto website. Direct, high-effort strategies included referrals from clinics or community-based organizations with whom we partnered, in-person community outreach, and patient registry calls. Direct, low-effort strategies included texting or emailing pre-existing lists of patients who smoked. A team of trained bilingual (English and Spanish) recruiters from 9 different Spanish-speaking countries of origin conducted recruitment, assessed eligibility, and enrolled participants into the trial. Results Of 1112 individuals who were screened, 895 (80.5%) met eligibility criteria, and 457 (457/895, 51.1%) enrolled in the trial. Within the pool of screened individuals, those recruited by low-effort recruitment strategies (both mass and direct) were significantly more likely to be eligible (odds ratio [OR] 1.67, 95% CI 1.01-2.76 and OR 1.70, 95% CI 0.98-2.96, respectively) and enrolled in the trial (OR 2.60, 95% CI 1.81-3.73 and OR 3.02, 95% CI 2.03-4.51, respectively) compared with those enrolled by direct, high-effort strategies. Among participants enrolled, the retention rates at 3 months and 6 months among participants recruited via low-effort strategies (both mass and direct) were similar to participants recruited via direct, high-effort methods. Compared with enrolled participants recruited via direct (high- and low-effort) strategies, participants recruited via mass strategies were less likely to have health insurance (44.0% vs 71.2% and 71.7%, respectively; P<.001), lived fewer years in the United States (22.4 years vs 32.4 years and 30.3 years, respectively; P<.001), more likely to be 1st generation (92.7% vs 76.5% and 77.5%, respectively; P=.007), more likely to primarily speak Spanish (89.3% vs 65.8% and 66.3%, respectively), and more likely to be at high risk for alcohol abuse (5.8 mean score vs 3.8 mean score and 3.9 mean score, respectively; P<.001). Conclusions Although most participants were recruited via direct, high-effort strategies, direct low-effort recruitment strategies yielded a screening pool more likely to be eligible for the trial. Mass recruitment strategies were associated with fewer acculturated enrollees with lower access to health services—groups who might benefit a great deal from the intervention. Trial Registration ClinicalTrials.gov identifier: NCT03586596; https://clinicaltrials.gov/ct2/show/NCT03586596 International Registered Report Identifier (IRRID) RR2-DOI: 10.1016/j.cct.2020.106188

Evaluating the psychometric properties of the Hispanic Stress Inventory-2 Simplified version among a diverse sample of Latinos who smoke

“…The abbreviated HSI2 consisted of 52 items that were distributed in ten factors as proposed in the original scale: Parental Stress, Occupation and Economic Stress, Marital Stress, Discrimination Stress, Immigration-Related Stress, Marital Acculturation Gap Stress, Health Stress, Language Related Stress, Pre-Migration Stress, and Family-Related Stress. The details of the clinical trial intervention and protocol have been reported in previous articles [ 27 – 29 ].…”

Decídetexto México: Recruitment and baseline characteristics of Mexican individuals who smoke in a cessation study

“…Eligibility efficiency ratio was the ratio of the number of individuals eligible to the number screened. [18][19][20] Enrollment efficiency ratio was the ratio of the number of individuals enrolled to the number screened. [18][19][20] Rates of eligibility and enrollment across the two recruitment methods were compared using chi-square tests.…”

“…[18][19][20] Enrollment efficiency ratio was the ratio of the number of individuals enrolled to the number screened. [18][19][20] Rates of eligibility and enrollment across the two recruitment methods were compared using chi-square tests. Differences in categorical variables were compared using Fisher exact test, while differences in continuous variables were compared using student's t-test.…”

Understanding the Perspectives of Latino Adults Who Smoke on Physical Activity: A Qualitative Study

“…Latinos also report a general lack of cultural sensitivity within existing Spanish language resources for smoking cessation [ 11 ]. Although barriers to accessing smoking cessation resources exist, when provided with access, Latinos are interested in participating in smoking cessation programs and in using smoking cessation treatments to support quit attempts [ 12 , 13 , 14 , 15 , 16 , 17 , 18 ].…”

“…Over the past decade, research on the development and implementation of interventions for smoking cessation among Latinos has been conducted [ 13 , 14 , 15 , 16 , 17 , 18 ]. For example, one study assessed the feasibility and acceptability of a culturally and linguistically adapted smoking cessation text messaging intervention among Latino adults who smoke [ 15 ].…”