Improving Diversity in Smoking Cessation Trials

A study evaluated the efficacy of strategies meant to improve the recruitment of racially and ethnically diverse participants in smoking cessation trials. These findings were published in Addictive Behaviors.

The Importance of Smoking Cessation

Smoking cigarettes and other tobacco products is the number one modifiable risk factor of lung cancer.

“Tobacco smoking causes about 9 out of 10 cases of lung cancer in men and about 8 out of 10 cases of lung cancer in women,” writes MedlinePlus.gov. Exposure to cigarette smoke, or secondhand smoke, can also expose non-smoking individuals to the same chemicals present in cigarettes.

The Centers for Disease Control and Prevention write that, “Although African Americans usually smoke fewer cigarettes and start smoking cigarettes at an older age, they are more likely to die from smoking-related diseases than Whites.” Thus, interventions to promote quitting smoking are critically important for African Americans and other people of color.

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

Reactive and Proactive Recruiting

For this study, the researchers conducted a 42-month recruitment campaign for their smoking cessation trial. They used two types of recruitment: reactive and proactive.

Reactive campaigns implemented the following recruiting strategies: word-of-mouth; newspaper, radio, and online ads; flyers; and community partnerships. Proactive campaigns included direct invitations to the trial.

The primary study endpoints were enrollment yield and rate (number enrolled/number screened) according to participant race/ethnicity and direct cost-per-participant (total cost/number enrolled) for paid strategies. Overall, 821 patients were recruited into the smoking cessation trial.

The researchers found that reactive strategies yielded dramatically higher enrollment rates compared to proactive strategies (94.3% vs. 5.7%). The most successful campaigns according to patient race were word-of-mouth strategies for African American (36%) and white participants (44%) and flyers among Hispanic or Latinx participants (34%).

Word-of-mouth, proactive recruitment, and flyers were more successful among African American individuals compared to other racial/ethnic groups. Newspaper and online ads were more successful among Hispanic/Latinx participants than for other races.

Costs Associated with Recruitment

Word-of-mouth, which was cost-free, yielded 23.1% of enrollment. Among paid strategies, the most economical methods were flyer distribution (CPP = $47.6; yield 17.5%), newspaper ads ($194.7; 23.7%), and online ads ($264.6; 24.0%). Radio and television ads were the most expensive methods and led to the lowest participant yield ($4,755.6; 0.8%).

Takeaways for Smoking Cessation Trials

In conclusion, the authors wrote, “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.”