Comparing Methods of Recruiting Spanish-Preferring Smokers in the United States: Findings from a Randomized Controlled Trial

Recruiting Latino young adults into a vaping cessation study via social media: Feasibility and cost analysis

INTRODUCTION

This study aims to assess the feasibility and cost of recruiting young Latino adults (aged 18-25 years) to participate in a vaping cessation study via social media and to describe the baseline characteristics of participants enrolled via social media.

METHODS

Paid advertisements were launched using the Meta Ads platform, which serves ads to users on Facebook and Instagram. Key measures of audience targeting included ages 18-25 years, all genders, and the following interests: 'electronic cigarettes', 'vape', 'Latin pop', and 'Latin music'. The advertisements invited young Latino adults to join a text messaging vaping cessation study. By clicking on the advertisements, interested individuals were directed to a website to fill in a contact form. The study team contacted individuals who filled in the form, assessed them for study eligibility, and, if eligible, enrolled them in the study.

RESULTS

A total of 164 individuals completed the contact form, and 26 were successfully enrolled in the study. The enrollment efficiency ratio was 15.9% (26/164). The cost per enrollment was US$94.14. The participants' mean age was 22.7 years (SD=1.6). Half of the participants (50%) were male, 38.5% were female, and 11.5% were gender non-conforming/non-binary. Two-thirds of the participants (69.2%) were born in the US, 23.1% in Puerto Rico, and 7.7% in Mexico. Eight participants (30.7%) selected Spanish as their language of preference. In terms of the type of vaping device, 16 participants (61.5%) indicated using disposables, 6 (23.1%) cartridges/pods, and 4 (15.4%) tanks/refillable. Sixteen participants (61.5%) reported using marijuana in e-cigarettes. Six participants (23.1%) had high e-cigarette dependence. Twenty participants (76.9%) had attempted to quit e-cigarettes in the past year.

CONCLUSIONS

It is feasible to recruit young Latino adults for a vaping cessation study via social media. Social media offers a relatively low-cost approach to recruiting a diverse sample of Latino young adults who vape.

Cost-effectiveness of social media advertising as a recruitment tool: A systematic review and meta-analysis

Background

Recruitment of study participants is challenging and can incur significant costs. Social media advertising is a promising method for recruiting clinical studies and may improve cost efficiency by targeting populations likely to match a study's qualifications. Prior systematic reviews of social media as a recruitment tool have been favourable, however, there are no meta-analyses of its cost-effectiveness.

Methods

Studies evaluating recruitment costs through social media and non-social media methods were identified on MEDLINE and EMBASE. Articles were screened through a two-step process in accordance with PRISMA guidelines. Cost data were extracted from selected articles and meta-analyzed using the Mantel-Haenszel method. The primary outcome was the relative cost-effectiveness of social media compared to non-social media recruitment, defined as the odds ratio of recruiting a participant per US dollar spent. The secondary outcome was the cost-effectiveness of social media recruitment compared to other online recruitment methods only.

Results

In total, 23 studies were included in the meta-analysis. The odds ratio of recruiting a participant through social media advertising compared to non-social media methods per dollar spent was 1.97 [95% CI 1.24-3.00, P = 0.004]. The odds ratio of recruiting a participant through social media compared to other online methods only was 1.66 [95% CI 1.02-2.72, P = 0.04].

Conclusions

Social media advertising may be more cost-effective than other methods of recruitment, however, the magnitude of cost-effectiveness is highly variable between studies. There are limited data on newer social media platforms and on difficult-to-reach populations such as non-English speakers or older individuals.

Hispanic/Latinx individuals' attributions for abstinence and smoking: A content analysis of open-ended responses from a randomized cessation trial

Introduction

Little is known about facilitators and barriers to smoking cessation among Hispanics seeking treatment. This secondary analysis examined attributions for abstinence or smoking among participants in a nationwide randomized controlled trial testing a self-help smoking cessation intervention among Spanish-speaking Hispanics in the United States (US).

Methods

At each follow-up assessment (6, 12, 18, and 24 months), participants (N = 1,417) responded to open-ended items regarding reasons for either abstinence or smoking. A content analysis was conducted using NVivo on the responses from 1,035 participants.

Results

Mood Management (e.g., stress and anxiety) was the most frequent reason for smoking across all timepoints. Concern for personal health and wellbeing was the most frequent reason cited for abstinence across all timepoints. Important barriers (e.g., financial stressors, environmental disasters) and facilitators (e.g., family, faith) were also identified. Quantitative subgroup analyses revealed differences in the frequency of abstinence and smoking attributions by sex, marital status, and annual household income.

Conclusion

The identified facilitators and barriers to abstinence support and expand findings from previous studies by using a geographically and ethnically diverse sample of treatment seeking, Spanish-preferring smokers. They also provide specific targets for tailoring cessation and relapse prevention interventions designed to improve cessation outcomes and reduce tobacco-related health disparities among Hispanics in the US.

Lessons Learned with a Triad of Stakeholder Advisory Boards: Working with Adolescents, Mothers, and Clinicians to Design the TRUST Study

Optimal care for pediatric and adolescent patients is carried out under a triadic engagement model, whereby the patient, caregiver, and clinician work in collaboration. Seeking input from all triad members in the development and implementation of clinical trials and interventions may improve health outcomes for children and adolescents. Sufficient evidence demonstrating how to effectively engage stakeholders from all branches of this triadic model is lacking. We address this gap by describing the successes and challenges our team has encountered while convening advisory groups with adolescent patients, parent stakeholders, and their clinicians to assist in the development and deployment of a technology-based intervention to promote the utilization of sexual and reproductive health services by increasing adolescent-clinician alone-time. Each stakeholder group contributed in unique and complementary ways. Working with advisors, our team aligned the priorities of each group with the goals of the research team. The results were improvements made in the content, design, and delivery of the TRUST intervention. While we were largely successful in the recruitment and engagement of adolescent patients and clinicians, we had less success with parents. Future research will need to explore additional strategies for recruitment and engagement of parents, particularly in rural, minority, and underserved communities.

Ask-Advise-Connect: Differential Enrollment and Smoking Cessation Outcomes Between Primary Care Patients Who Received Quitline-Delivered Treatment in Spanish vs English

PURPOSE

This study examined differences in Quitline treatment enrollment, engagement, and smoking cessation outcomes among primary care patients preferring Spanish and English using the evidence-based tobacco treatment Ask-Advise-Connect.

METHODS

Ask-Advise-Connect was implemented April 2013 through February 2016 in a large safety-net health system to connect smokers with treatment via a link in the electronic health record. Rates of treatment enrollment, engagement, acceptance of nicotine replacement therapy, and smoking abstinence (self-reported and biochemically confirmed) were compared at 6 months among patients who received treatment in Spanish and English using χ ² tests. Logistic regression examined language and nicotine replacement therapy and their interaction as predictors of abstinence.

RESULTS

The smoking status of 218,915 patients was assessed and recorded in the electronic health record. Smoking prevalence was 8.4% among patients preferring Spanish and 27.0% among those preferring English. Spanish-preferring patients were less likely to enroll in treatment (10.7% vs 12.0%, χ ² = 12.06, P = .001) yet completed more counseling calls when enrolled (median = 2 vs 1, P <.001). Patients who received treatment in Spanish (vs English) were twice as likely to be abstinent at 6 months (self-reported: 25.1% vs 14.5%, odds ratio [OR] = 1.98, 95% CI, 1.62-2.40; biochemically confirmed: 7.6% vs 3.7%, OR = 2.13, 95% CI, 1.52-2.97). Receipt of nicotine replacement therapy increased abstinence for all patients and language did not interact with nicotine replacement therapy to predict abstinence.

CONCLUSIONS

Automated point-of-care approaches such as Ask-Advise-Connect have great potential to reach Spanish-preferring smokers. Those who received tobacco treatment in Spanish (vs English) demonstrated better engagement and cessation outcomes.

Creating and Implementing a Principal Investigator Tool Kit for Enhancing Accrual to Late Phase Clinical Trials: Development and Usability Study

Background

Accrual to oncology clinical trials remains a challenge, particularly during the COVID-19 pandemic. For late phase clinical trials funded by the National Cancer Institute, the development of these research protocols is a resource-intensive process; however, mechanisms to optimize patient accrual after trial activation are underdeveloped across the National Clinical Trial Network (NCTN). Low patient accrual can lead to the premature closure of clinical trials and can ultimately delay the availability of new, potentially life-saving therapies in oncology.

Objective

The purpose of this study is to formally create an easily implemented tool kit of resources for investigators of oncology clinical trials within the NCTN, specifically the NRG Oncology cooperative group, in order to optimize patient accrual.

Methods

NRG Oncology sought to formally develop a tool kit of resources to use at specific time points during the lifetime of NRG Oncology clinical trials. The tools are clearly described and involve the facilitation of engagement of the study principal investigator with the scientific and patient advocate community during the planning, activation, and accrual periods. Social media tools are also leveraged to enhance such engagement. The principal investigator (PI) tool kit was created in 2019 and thereafter piloted with the NRG Oncology/Alliance NRG-LU005 phase II or III trial in small-cell lung cancer. The PI tool kit was developed by the NRG Oncology Protocol Operations Management committee and was tested with the NRG/Alliance LU005 randomized trial within the NCTN.

Results

NRG Oncology/Alliance NRG-LU005 has seen robust enrollment, currently 127% of the projected accrual. Importantly, many of the tool kit elements are already being used in ongoing NRG Oncology trials, with 56% of active NRG trials using at least one element of the PI tool kit and all in-development trials offered the resource. This underscores the feasibility and potential benefits of deploying the PI tool kit across all NRG Oncology trials moving forward.

Conclusions

While clinical trial accrual can be challenging, the PI tool kit has been shown to augment accrual in a low-cost and easily implementable fashion. It could be widely and consistently deployed across the NCTN to improve accrual in oncology clinical trials.

Trial Registration

ClinicalTrials.gov NCT03811002; https://clinicaltrials.gov/ct2/show/NCT03811002

Hispanic/Latinx ethnic subgroup differences in sociodemographic, sociocultural, and smoking characteristics in a cessation trial: An exploratory study

INTRODUCTION

Hispanic/Latinx smokers in the United States are often treated as a homogeneous group. However, population-based studies suggest cigarette use differs among Hispanic/Latinx subgroups by sociodemographic or sociocultural characteristics. This secondary analysis aimed to advance the limited literature by examining differences in smoking-related variables.

METHODS

We used baseline data from a randomized controlled trial testing a self-help Spanish-language smoking cessation intervention. Puerto Rican (PR), Mexican, and Cuban, the three largest Hispanic/Latinx subgroups in the sample (N=1028), were first compared on sociodemographic and sociocultural variables (acculturation and familism). Primary analyses assessed subgroup differences in cigarette use variables [e.g., cigarettes per day (CPD), nicotine dependence (Fagerström Test for Nicotine Dependence), daily smoking] and smoking-related cognitive constructs (motivation to quit, smoking outcome expectancies and abstinence self-efficacy) controlling for sociodemographic and sociocultural variables. Additional analyses explored differences between men and women within subgroups.

RESULTS

Mexicans exhibited the lowest levels of daily smoking (90% vs. 95% Cubans and 96% PR; p=.001), CPD (M=13.5, SD=9.5 vs. M=20.1, SD=9.9 Cubans and M=16.7, SD=10.1 PR; p=.016), and nicotine dependence (M=4.2, SD=2.3 vs. M=6.0, SD=2.1 Cubans and M=5.7, SD=2.2 PR; p< .001), with no differences between PRs and Cubans. Within-subgroup comparisons between men and women showed the most differences among PRs [e.g., men were more nicotine dependent (M=6.0, SD=1.9) than women (M=5.4, SD=2.3; p=.041)] and Cubans [e.g., men smoked more CPD (M=22.2, SD=12.2) than women (M=19.3, SD=12.0; p=.042)], and the fewest among Mexicans.

CONCLUSIONS

Findings support heterogeneity within Hispanic/Latinx smokers and highlight the potential utility of examining sociodemographic, sociocultural, and smoking characteristics important for developing salient cessation interventions.

IMPLICATIONS

Findings demonstrate that treatment-seeking Hispanic/Latinx smokers in the US differ in sociodemographic, sociocultural, and smoking-related variables (cigarette use and smoking-related cognitive constructs) by subgroup (i.e., Puerto Rican, Mexican, Cuban) and within subgroups by sex. These differences suggest that heterogeneity among subgroups should be considered when developing cessation interventions for Hispanics/Latinxs. Future research should examine how differences in sociodemographic and smoking-related variables impact intervention outcomes and explore the role of sociocultural factors (e.g., acculturation and familism) as determinants of cessation.

Recruiting racially and ethnically diverse smokers seeking treatment: Lessons learned from a smoking cessation randomized clinical trial

INTRODUCTION

Recruiting racial/ethnic minorities in smoking cessation trials is a priority. This study described lessons learned from recruiting a diverse sample of African American, White, and Hispanic/Latinx smokers in a smoking cessation trial.

METHODS

We implemented a 42-month recruitment campaign utilizing reactive (e.g., word-of-mouth, newspaper, radio, online ads, flyers, community partnerships) and proactive (e.g., direct invitations) strategies. We included 821 participants in the analysis. We described our recruitment strategies' implementation, their enrollment yield and rate (number enrolled/number screened) by race/ethnicity, and direct cost-per-participant (CPP: total cost/number of enrolled) for paid strategies.

RESULTS

Enrollment yields were higher using reactive strategies than proactive strategies (94.3% vs. 5.7%). The top source of enrollment was word-of-mouth among African Americans (36%) and Whites (44%), and flyers among Hispanics/Latinxs (34%). Proactive recruitment, word-of-mouth, and flyers were more successful among African Americans than other groups. Newspaper and online ads were more successful among Hispanics/Latinxs than other groups (P < .05). Word-of-mouth was cost-free and yielded 23.1% of enrollment. The most economic method among paid strategies was flyer distribution (CPP = $47.6; yield 17.5%), followed by newspaper ($194.7; 23.7%) and online advertisements ($264.6; 24.0%). Radio and television ads were the most expensive and produced the least participant yield ($4,755.6; 0.8%).

CONCLUSION

Recruiting racially/ethnically diverse samples into smoking cessation clinical trials requires implementing multiple strategies and adjusting these strategies based on their enrollment yield and cost. Word-of-mouth, flyers, and newspaper and online ads were more successful among racial/ethnic minorities. Flyers and newspaper ads were the most economic methods for recruitment.

Social Media and Clinical Research in Dermatology

Purpose of Review

The immense growth of social media has afforded new opportunities in dermatology clinical research. This review serves to outline how social media has impacted clinical research and to explore future avenues for which social media can make a significant impact in dermatology clinical research.

Recent Findings

Recent clinical trials augmented by social media have demonstrated increased participant enrollment, shortened recruitment timelines, and decreased recruitment cost. The incorporation of social media into clinical research has also afforded greater access to teledermatology and the initiation of virtual clinical trials.

Summary

Clinical research serves as a primary source of evidence for refining healthcare practices by expanding the understanding of patient demographics, methods for improving patient care, and new therapeutic discoveries. Since its initiation, social media has played an integral and ever-expanding role in clinical research.

Self-help smoking cessation intervention for Spanish-speaking Hispanics/Latinxs in the United States: A randomized controlled trial

BACKGROUND

Hispanic/Latinx smokers living in the United States face unique challenges in quitting smoking. This study evaluated the efficacy of a culturally relevant, Spanish-language, extended self-help smoking cessation intervention among Hispanic smokers.

METHODS

A 2-arm parallel randomized controlled trial was conducted with Hispanic/Latinx smokers living in the United States who preferred health information in Spanish and smoked 5 or more cigarettes per week. Participants were randomly allocated to receive Libre del Cigarrillo (LDC), which consisted of 11 booklets and 9 pamphlets mailed monthly over 18 months, or the usual care (UC), which was a single Spanish-language self-help booklet from the National Cancer Institute. The primary outcome was self-reported 7-day point prevalence smoking abstinence assessed 6, 12, 18, and 24 months after the baseline. Eight prespecified moderators of the intervention were evaluated. Cost-effectiveness was also evaluated. All statistical tests were 2-sided.

RESULTS

Data from all participants randomized to LDC (n = 714) or UC (n = 703) were used for analyses after multiple imputation to manage missing data. Generalized estimating equation analyses indicated that LDC abstinence rates were higher (P < .001) across all assessments. Logistic regression analyses revealed that at 24 months, the abstinence rate was greater for LDC (33.1%) than UC (24.3%; odds ratio, 1.54; 95% confidence interval, 1.18-2.02; P = .002). Men exhibited a strong intervention effect at all assessments (P values < .001), whereas the intervention effect for women was observed only at 6 and 12 months (P values < .018). In comparison with UC, the incremental cost per quitter in the LDC arm was $648.43 at 18 months and $683.93 at 24 months.

CONCLUSIONS

A culturally relevant, Spanish-language intervention was efficacious and cost-effective for smoking cessation.

LAY SUMMARY

Research is needed to develop interventions for ethnic minority smokers. The aim of the current study was to test a Spanish-language adaptation of a validated and easily implemented self-help smoking cessation intervention in a nationwide randomized controlled trial. The findings demonstrated that the intervention produced greater smoking abstinence in comparison with a standard self-help booklet. Participants also were more satisfied with the intervention, and it was cost-effective. Efforts aimed at promoting tobacco abstinence in this underserved population could have significant public health implications, including potential reductions in cancer health disparities associated with tobacco smoking.

A Text Messaging Intervention for Coping With Social Distancing During COVID-19 (StayWell at Home): Protocol for a Randomized Controlled Trial

BACKGROUND

Social distancing is a crucial intervention to slow down person-to-person transmission of COVID-19. However, social distancing has negative consequences, including increases in depression and anxiety. Digital interventions, such as text messaging, can provide accessible support on a population-wide scale. We developed text messages in English and Spanish to help individuals manage their depressive mood and anxiety during the COVID-19 pandemic.

OBJECTIVE

In a two-arm randomized controlled trial, we aim to examine the effect of our 60-day text messaging intervention. Additionally, we aim to assess whether the use of machine learning to adapt the messaging frequency and content improves the effectiveness of the intervention. Finally, we will examine the differences in daily mood ratings between the message categories and time windows.

METHODS

The messages were designed within two different categories: behavioral activation and coping skills. Participants will be randomized into (1) a random messaging arm, where message category and timing will be chosen with equal probabilities, and (2) a reinforcement learning arm, with a learned decision mechanism for choosing the messages. Participants in both arms will receive one message per day within three different time windows and will be asked to provide their mood rating 3 hours later. We will compare self-reported daily mood ratings; self-reported depression, using the 8-item Patient Health Questionnaire; and self-reported anxiety, using the 7-item Generalized Anxiety Disorder scale at baseline and at intervention completion.

RESULTS

The Committee for the Protection of Human Subjects at the University of California Berkeley approved this study in April 2020 (No. 2020-04-13162). Data collection began in April 2020 and will run to April 2021. As of August 24, 2020, we have enrolled 229 participants. We plan to submit manuscripts describing the main results of the trial and results from the microrandomized trial for publication in peer-reviewed journals and for presentations at national and international scientific meetings.

CONCLUSIONS

Results will contribute to our knowledge of effective psychological tools to alleviate the negative effects of social distancing and the benefit of using machine learning to personalize digital mental health interventions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04473599; https://clinicaltrials.gov/ct2/show/NCT04473599.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/23592.