Examining Recruitment and Retention in a Counseling Trial for Underserved Postpartum Smokers

Background: Reaching underserved populations of smokers and retaining them in intensive smoking intervention studies are challenges that undermine validity and generalizability of outcomes. This study compared different recruitment strategies' ability to enroll postpartum smokers in a behavioral counseling trial (Philadelphia FRESH). We also explored factors that predict retention through intervention milestones.

Methods: Logistic regression analyses were used to examine recruitment strategy influence on enrollment. Stepwise logistic regression explored factors that predicted retention from screening to baseline assessment, from baseline to treatment start, through end of treatment (16 weeks) and through 12-month follow-up. Ineligibility included children above 4 years old, psychiatric disorder(s), and pregnancy.

Results: Preliminary analyses were conducted on 420 eligible postpartum smokers. Logistic regression suggested that passive recruitment (e.g., media advertisement) showed greater likelihood of identifying potentially eligible participants (OR=0.56, p<.00). Recruitment strategy (OR =0.68, p =.09) did not predict enrollment. This trial has shown 20% attrition during treatment and 13% at follow-up. Children rated at baseline as healthier (OR 1.03, p=.02) and with fewer healthcare visits (OR 0.50, p=.08) were more likely to be retained through treatment.

Conclusion: Targeted strategies, whether active or passive, appear to have similar success in enrolling underserved postpartum smokers in pediatric and WIC clinics. Different factors influence attrition through different durations of participation, perhaps informing future programs' retention efforts depending on duration and intensity of treatment.