Biomedical subjects

Kolawole S Okuyemi

Publications and source records attributed to Kolawole S Okuyemi.

At least 19 recordsLinked to original sources

PubMed2006

Interventions to facilitate smoking cessation.

Tobacco use, primarily cigarette smoking, is the leading cause of preventable morbidity and mortality in the United States, and nearly one third of those who try a cigarette become addicted to nicotine. Family physicians, who see most of these patients in their offices every year, have an important opportunity to decrease smoking rates with office-based interventions. The U.S. Public Health Service recommends that primary care physicians use the five A's (Ask, Advise, Assess, Assist, and Arrange) model when treating patients with nicotine addiction. Physicians can improve screening and increase cessation rates by asking patients about tobacco use at every office visit. Behavior modification can improve long-term smoking cessation success; even brief (five minutes or less) advice on smoking cessation during an office visit can increase cessation rates. The effectiveness of nonpharmacologic treatments generally is lower; therefore, pharmacotherapy is recommended for smokers who are willing to attempt cessation, unless medical contraindications exist. The pharmacologic agents approved by the U.S. Food and Drug Administration for treatment of tobacco dependence include bupropion (a non-nicotine therapy) and nicotine replacement therapies in the form of a gum, patch, nasal spray, inhaler, and lozenge. These agents have similar long-term success rates.

Humans↗

PubMed2006

Pathways to health: a cluster randomized trial of nicotine gum and motivational interviewing for smoking cessation in low-income housing.

Despite high smoking rates among those living in poverty, few cessation studies are conducted in these populations. This cluster-randomized trial tested nicotine gum plus motivational interviewing (MI) for smoking cessation in 20 low-income housing developments (HDs). Intervention participants (10 HDs, n = 66) received educational materials, 8 weeks of 4 mg nicotine gum, and 5 MI sessions on quitting smoking. Comparison participants (10 HDs, n = 107) received 5 MI sessions and educational materials addressing fruit and vegetable consumption. Participants had a mean age of 46.3 years and were predominantly female (70%) and African American (83%). Biochemically-verified 7-day abstinence rates at 8 weeks were 6.1% and 5.6% in the intervention and comparison arms, respectively (p = ns); and at 26 weeks were 7.6% and 9.3%, respectively (p = ns). Results suggest that nicotine gum plus MI were not effective for smoking cessation in low-income housing. Programs are needed to enhance the effectiveness of pharmacotherapy and counseling in underserved populations.

Adult↗

PubMed2006

Homelessness and smoking cessation: insights from focus groups.

Smoking prevalence among homeless persons is approximately 70%, yet little is known about tobacco use patterns or smoking cessation practices in this population. We assessed smoking attitudes and behaviors, psychosocial and environmental influences on smoking, barriers to and interest in quitting, and preferred methods for cessation among some homeless smokers. Six 90-min focus groups of current smokers (N = 62) were conducted at homeless service facilities. Participants had a mean age of 41.5 years (SD = 9.3), were predominantly male (69.4%) and African American (59%), and smoked an average of 18.3 cigarettes/day. Although most reported that they were motivated to quit, a number of barriers to quitting were identified. Participants reported that the pervasiveness and social acceptance of tobacco use in homeless settings contributed to smoking more cigarettes per day, adopting alternative smoking behaviors such as smoking cigarette butts and making their own cigarettes, and experiencing difficulty in quitting. High levels of boredom and stress also were cited as reasons for continued smoking. Smoking frequently occurred in combination with alcohol or illicit drug use or to achieve a substitute "high." Most participants (76%) reported that they planned to quit smoking in the next 6 months. Many were interested in using pharmacotherapy in combination with behavioral treatments. Results suggest that, although motivated to quit smoking, homeless smokers are faced with unique social and environmental barriers that make quitting more difficult. Interventions must be flexible and innovative to address the unique needs of homeless smokers. Smoking restrictions at homeless service facilities and funding for smoking cessation assistance in this underserved population may help to reduce prevalence.

Adult↗

PubMed2006

Smoking cessation in homeless populations: a pilot clinical trial.

This study, which tested two motivational interviewing treatment approaches, assessed the feasibility of conducting a community-based smoking cessation intervention among homeless smokers. Participants (N = 46) were recruited from multiple facilities in the Kansas City area and were randomized to two counseling conditions in which they received five individual motivational interviewing sessions, six group meetings, and their choice of 8 weeks of 21-mg nicotine patch or 4-mg nicotine lozenge. The two counseling conditions consisted of motivational interviewing targeted either to smoking behaviors exclusively (smoking only) or to smoking and other addictions or life events that could affect ability to quit (smoking plus). Group meetings were designed to provide educational information and social support. Measures of feasibility assessed included the proportion of participants who returned for randomization among those eligible, adherence to prescribed nicotine replacement therapies, retention rates at the week 26 final study visit, and biochemically verified 7-day abstinence at week 26. Most participants (69.6%) chose nicotine patches, and 32% of those participants reported using at least four patches per week. Carbon monoxide verified 7-day abstinence rates in the smoking-only and smoking-plus groups were 13.04% and 17.39% (ns), respectively, at week 8 and 8.70% and 17.39% (ns), respectively, at week 26. Participants who used at least four patches per week were more likely to have quit at 8 weeks than were those who used fewer patches (33.3% vs. 10.5%, p = .30). Results support the feasibility of conducting a smoking cessation intervention among homeless smokers. Findings also show promising effects for nicotine replacement therapy and counseling in this population. Developing programs to improve smoking cessation outcomes in underserved populations is an essential step toward achieving national health objectives and for ultimately reducing tobacco-related health disparities.

Adult↗

PubMed2006

Enhanced cue-elicited brain activation in African American compared with Caucasian smokers: an fMRI study.

Current evidence indicates that, although African Americans (AA) are more likely to attempt to quit smoking than Caucasians (CC) in any given year, success rates are lower for AA. However, factors contributing to these differences are not well known. In order to explore potential factors, this study assessed differences in attention to smoking cues between ethnic groups. Participants underwent morning functional magnetic resonance imaging scanning while viewing images of AA models and CC models who were either smoking (smoking cues) or engaging in everyday activities (neutral cues), interspersed with a fixation baseline period. The study was conducted at the Hoglund Brain Imaging Center of the University of Kansas Medical Center in Kansas City, KS. We studied 17 smokers (eight AA, nine CC) after 12-hour abstinence and 17 non-smokers (eight AA, nine CC) matched by age, gender, years of education, and handedness. The AA and CC smoking groups were also matched for number of cigarettes smoked per day. All results are P < 0.01, corrected for whole brain. There was a strong ethnicity by condition interaction among smokers in several a priori regions of interest. AA smokers showed a greater increase in response to smoking (versus neutral cues) than CC smokers in the medial prefrontal cortex, right lateral orbitofrontal cortex, and bilateral ventrolateral prefrontal cortex. In smoking versus baseline contrasts, additional areas of greater activation were found in AA, including the right amygdala and left caudate nucleus. No significant differences in cue-elicited brain activation were found between AA and CC non-smokers. These preliminary findings demonstrate variation in brain activation in response to smoking cues between AA and CC smokers in structures known to be associated with nicotine addiction. Differences in neural response may reflect fundamental differences in attention to smoking cues, which may in turn contribute to differences in effectiveness of nicotine dependence treatments among ethnic populations.

Adult↗

PubMed2006

Predictors of quitting among African American light smokers enrolled in a randomized, placebo-controlled trial.

OBJECTIVE: To examine the predictors of quitting among African American (AA) light smokers (<10 cigarettes per day) enrolled in a smoking cessation trial. METHODS: Baseline variables were analyzed as potential predictors from a 2 x 2 cessation trial in which participants were randomly assigned to 1 of 4 treatment groups: nicotine gum plus health education (HE) counseling, nicotine gum plus motivational interviewing (MI) counseling, placebo gum plus HE counseling, or placebo gum plus MI counseling. Chi-square tests, 2 sample t-tests, and multiple logistic regression analyses were used to identify predictors of cotinine (COT) verified abstinence at month 6. RESULTS: In the final regression model, HE rather than MI counseling (odds ratio [OR]=2.26%, 95% confidence interval [CI]=1.36 to 3.74), older age (OR=1.03%, 95% CI=1.01 to 1.06), and higher body mass index (OR=1.04%, 95% CI=1.01 to 1.07) significantly increased the likelihood of quitting, while female gender (OR=0.46%, 95% CI=0.28 to 0.76),</=$1,800/month income (OR=0.60%, 95% CI=0.37 to 0.97), higher baseline COT (OR=0.948%, 95% CI=0.946 to 0.950), and not completing all counseling sessions (OR=0.48%, 95% CI=0.27 to 0.84) reduced the odds of quitting. CONCLUSIONS: Individual characteristics may decrease the likelihood of quitting; however, the provision of directive, advice-oriented counseling focused on the addictive nature of nicotine, health consequences of smoking, benefits of quitting, and development of a concrete quit plan may be an important and effective facilitator of quitting among AA light smokers.

Black People↗

PubMed2005

Predictors of fecal occult blood test (FOBT) completion among low-income adults.

BACKGROUND: Fecal occult blood testing (FOBT) can reduce colorectal cancer (CRC) mortality. Unfortunately, CRC screening is underutilized. Sociocultural mediators of FOBT adherence have not been extensively studied in lower income, minority populations. This study prospectively studied FOBT return in a low-income, multiethnic population. METHODS: Participants (N = 298), aged > or =40 years, were surveyed and given FOBT kits with instructions. Those not returning kits within 30 days received a reminder telephone call. Bivariate and multivariate analyses assessed predictors of FOBT card return at 90 days. RESULTS: Participants (median age = 48) were predominately African American (69%), without private insurance (88%), and of low income. The largest group of participants preferred FOBT alone (46%), followed by whatever my doctor recommends (19%), endoscopy + annual FOBT (16%), endoscopy alone (14%), and no screening (5%). In multivariate analyses, FOBT return was predicted by age (OR = 1.05) and lack of reported FOBT barriers (OR = 3.81). Among those > or =50 and not up-to-date with screening, FOBT return was predicted by cancer fatalism (OR = 0.83). FOBT barriers were associated with age (OR = 0.96), less than high school education (OR = 2.05), and less physician trust (OR = 2.12). Endoscopy barriers were associated with age (OR = 0.93), less physician trust (OR = 1.95), and female gender (OR = 3.45). CONCLUSIONS: Younger individuals and those with less education, less trust in health care providers, and more fatalistic beliefs are at risk for CRC screening non-adherence. Strategies addressing common misconceptions should improve CRC screening rates in low-income, multiethnic populations.

Adult↗

PubMed2005

The influence of depressive symptoms on smoking cessation among African Americans in a randomized trial of bupropion.

The influence of depressive symptoms on smoking cessation was examined among 600 African American smokers who participated in a randomized, placebo-controlled trial of sustained-release bupropion hydrochloride. Depressive symptoms were assessed at baseline, at week 6 (end of treatment), and at 6-month follow-up. The study examined three separate questions: (a) Whether depressive symptom levels were related to smoking cessation, (b) whether bupropion was more effective for smokers who had higher depressive symptoms at baseline (i.e., a moderator model), and (c) whether changes in depressive symptoms would account for the efficacy of bupropion for smoking cessation (i.e., a mediator model). Depressive symptoms at baseline were not predictive of cessation; however, increases in depressive symptoms from baseline predicted reduced cessation at the end of treatment, and higher depressive symptoms at week 6 and month 6 were associated with a reduced likelihood of smoking cessation at those time points. The moderator model was not supported, but the mediation analyses indicated that alleviation of depressive symptoms partly accounted for bupropion-assisted smoking cessation at end of treatment. Results extend prior findings to African American smokers and suggest that clinicians consider increases in depressive symptoms after quitting rather than baseline depressive symptoms in predicting risk of treatment failure. Results also suggest that even though bupropion may facilitate cessation in part by reducing depressive symptoms, it appears to be no more effective for more depressed smokers, and that mechanisms other than depressive symptom alleviation account for most of its efficacy.

Adult↗

PubMed2004

Comparison of smoking relapse curves among African-American smokers.

We examined the smoking relapse curves for African-American smokers by level of smoking to characterize nicotine dependence in this population of smokers. This analysis was conducted from data originally collected to study differences in level of smoking among African-Americans at an inner-city health center in Midwest. Relatively little research has been conducted to clarify smoking and quitting patterns among African-American smokers. The median number of cigarettes smoked currently was 7 cigarettes per day (cpd) for light smokers and 20 cpd for the moderate to heavy smokers. The heavier smokers reported smoking at this rate longer than light smokers, 11 and 5 years, respectively. The major finding in this study is that African-American light smokers have abstinence rates very similar to heavier smokers and the median length of their most recent quit attempts were also similar. Therefore, stable light smokers may also need smoking cessation interventions similar to those used for heavier smokers in order to successfully stop smoking.

Adult↗

PubMed2004

Predictors of smoking cessation among African-Americans enrolled in a randomized controlled trial of bupropion.

OBJECTIVES: Identification of individual characteristics that predict successful smoking cessation treatment has been limited to studies with mostly white participants. This study identifies factors that predict successful quitting among African-Americans participating in a smoking cessation trial. METHODS: Twenty-one baseline variables were analyzed as potential predictors from a double-blind placebo-controlled, randomized trial that used bupropion SR for smoking cessation among 600 African-American smokers. Chi-square tests, two sample t tests, and multiple logistic regression procedures were employed to identify predictors of 7-day abstinence among the 535 participants who completed the 7-week medication phase. RESULTS: Univariate predictors of cessation were receiving bupropion (P < 0.0001), not smoking menthol cigarettes (P = 0.0062), smoking after 30 min of waking (P < 0.0001), older age (P = 0.0085), smoking fewer cigarettes per day (P = 0.0038), and lower cotinine levels (P = 0.0002). Logistic regression identified three significant independent predictors. Participants who received bupropion treatment were more than twice as likely to quit smoking at the end of treatment compared to participants who received placebo (OR = 2.62; 95% CI = 1.77-3.88, P < 0.0001), while smoking within 30 min of waking (OR = 0.40; 95% CI = 0.25-0.62, P < 0.0001) and higher salivary cotinine levels at baseline (OR = 0.799; 95% CI = 0.629-0.922, P < 0.0001) reduced the likelihood of quitting. CONCLUSIONS: This is the first report identifying predictors of smoking cessation among African-Americans participating in a clinical trial. Results indicate that, aside from bupropion treatment, various indicators of addiction were the strongest predictors. While this is similar to findings among white smokers, thresholds of addiction may need to be adjusted for African-American smoking patterns. Additional studies focused on diverse populations are needed to improve treatment approaches and to identify population-specific factors that are important for treatment-matching approaches.

Adult↗

PubMed2004

Use of a brief Smoking Consequences Questionnaire for Adults (SCQ-A) in African American smokers.

Purposes of the present study were to (a) examine psychometric properties of a brief Smoking Consequences Questionnaire-Adult (SCQ-A) among an African American sample and (b) explore differences in smoking expectancies across levels of smoking-nicotine dependence. Four hundred eighty-four smokers attending an urban health clinic completed the brief SCQ-A. Maximum likelihood factor extraction with a varimax rotation specifying 9 factors replicated 9 factors of the original SCQ-A. Evidence for the brief SCQ-A's reliability and validity was found. Heavier and/or more dependent smokers had significantly higher scores than lighter and/or less dependent smokers on positive expectancies SCQ-A subscales. Results suggest the brief SCQ-A may be a useful alternative to the full scale SCQ-A. Results also provide evidence for the SCQ-A's validity with African American smokers.

Adult↗

PubMed2004

Differences in smoking and quitting experiences by levels of smoking among African Americans.

BACKGROUND: Despite smoking fewer cigarettes per day than their White counterparts, African Americans have higher tobacco-related morbidity and mortality. Since most tobacco control efforts have focused on heavy smokers, little is known about smoking and quitting experiences of African-American occasional and light smokers. METHODS: We conducted a survey of 484 African-American smokers, which included: 104 occasional (smoked in < or = 25 of last 30 days), 176 light [smoked 1-10 cigarettes per day (cpd)], 69 moderate (11-19 cpd), and 135 heavy (> or = 20 cpd) attending an inner-city clinic. The survey assessed their sociodemographic characteristics, smoking characteristics, and cessation experiences. RESULTS: Compared with moderate and heavy smokers, occasional and light smokers were, on average, younger, more likely to be female, and more likely to initiate regular smoking at an older age. Forty percent of occasional smokers used other tobacco products compared to 23.3%, 24.6%, and 27.4% for light, moderate, and heavy smokers, respectively. Motivation and confidence to quit were higher among occasional and light smokers. Interest in participating in a formal cessation program was equally high in all 4 groups (mean ranged from 7.6-8.0 on a scale of 1-10). The use of pharmacotherapy for smoking cessation was similar, and generally low, among all 4 groups. CONCLUSIONS: High levels of motivation for smoking cessation exist among African-American occasional and light smokers. The interest of these lighter smokers in smoking cessation represents a window of opportunity to design programs for a group that has been excluded from most cessation interventions.

Adult↗

PubMed2004

Workplace tobacco policies and smoking cessation practices of physicians.

OBJECTIVE: To further our understanding of the workplace smoking policies and smoking cessation practices of physicians in Nigeria. DESIGN: Cross-sectional survey distributed to 619 physicians practicing in two teaching hospitals in southwestern Nigeria. PARTICIPANTS: Three-hundred-seventy-three physicians who returned completed surveys. MAIN OUTCOME MEASURES: Physician's self-reported workplace smoking policies, attitudes toward smoking cessation, and use of recommended smoking cessation guidelines/policies. RESULTS: Physicians rated quitting as "extremely important." The majority assessed their patients smoking status over the past three months (81%) and thought counseling smokers would help them quit (95%). However, < 1% prescribed pharmacotherapy for smoking cessation in the last three months. Significant differences were found in the workplace smoking policies of the two teaching hospitals (p < 0.001). Differences were also found in the attitudes and smoking cessation practices of physicians in Hospital A and Hospital B. CONCLUSIONS: Physicians are aware of smoking and the importance of quitting but few have guidelines/policies to assist their patients with quitting. Workplace smoking policies appear to impact the smoking cessation attitudes and practices of physicians in Nigeria. Encouraging the adoption of workplace smoking restrictions, as well as training physicians to use recommended smoking cessation interventions, is critical to addressing the tobacco epidemic in Nigeria.

Adult↗

PubMed2004

African-American menthol and nonmenthol smokers: differences in smoking and cessation experiences.

BACKGROUND: Despite smoking fewer cigarettes per day, African Americans have lower cessation rates and experience disproportionately higher rates of smoking-related health consequences. Because of their high preference for menthol cigarettes, it has been suggested that smoking menthol cigarettes may contribute to the excess smoking-related morbidity experienced by African Americans. Smoking menthol cigarettes could increase health risks from smoking if smokers of menthol cigarettes have lower cessation rates and thereby have longer duration of smoking compared to smokers of nonmentholated cigarettes. Few studies have examined associations between smoking of mentholated cigarettes and smoking cessation among African Americans. This study examined the smoking patterns of menthol cigarette smokers and their smoking cessation experiences. METHODS: A cross-sectional survey of 480 African-American smokers at an inner-city health center. Survey examined sociodemographics, smoking characteristics, and smoking cessation experiences of participants. Menthol smokers (n = 407) were compared to nonmenthol smokers (n = 73) in these characteristics. RESULTS: Menthol smokers were younger and more likely to smoke cigarettes with longer rod length, with filters, and those high in nicotine and tar. Although both groups did not differ by number of past quit attempts, time since most recent quit attempt was shorter for menthol smokers. The durations of most recent and longest-ever quit attempts were nonsignificantly shorter for menthol, compared to nonmenthol smokers. CONCLUSIONS: These data suggest that African-American menthol smokers are less successful with smoking cessation. Prospective studies are needed to confirm these findings and examine mechanisms underlying such differences.

Adolescent↗

PubMed2003

Predicting adoption of home smoking restriction by inner-city black smokers.

OBJECTIVE: To identify predictors of future adoption of home smoking restriction (HSR), given that 40% of inner-city smokers report current HSR. DESIGN: Secondary analysis of data on smokers enrolled in a double-blind, placebo-controlled, randomized trial of bupropion hydrochloride for smoking cessation. SETTING: Community health center in Kansas City, Kan, from August 1, 2000, to December 31, 2001. PARTICIPANTS: Six hundred eligible black smokers, at least 18 years old, who smoked at least 10 cigarettes per day and were interested in quitting within the next 30 days. Enrollment was limited to 1 smoker per household. MAIN OUTCOME MEASURES: Adoption of HSR by 6 months by those who did not have it at baseline. Result Baseline HSR was reported by 36% of all smokers. Of 383 smokers without baseline HSR, 311 smokers had complete baseline and 6-month data. Thirty-seven percent of households without HSR at baseline had adopted HSR by 6 months. Adoption was associated with a nonsmoking adult or children in the home, progress in stage of change, and smoking cessation. Odds of adopting HSR increased with progress in stage of change (odds ratio [OR], 4.20), baseline preparatory stage of change (OR, 3.28), and having a nonsmoking partner (OR, 2.35) or children (OR, 1.75) in the home. CONCLUSIONS: A smoker's motivation to quit and the presence in the home of a nonsmoking adult or of children predict adoption of HSR by inner-city black smokers. Therefore, health professionals should motivate the smoker toward HSR and the nonsmoking partner toward advocating home smoking bans, thereby eliminating environmental tobacco smoke in the home.

Adult↗

PubMed2003

Does menthol attenuate the effect of bupropion among African American smokers?

BACKGROUND: African Americans have higher tobacco-related morbidity and mortality and are more likely to smoke menthol cigarettes than their white counterparts. This study examined differences between African American menthol and non-menthol smokers in smoking characteristics and cessation. METHODS: The study sample consisted of 600 African American smokers enrolled in a clinical trial that assessed the efficacy of sustained-release bupropion for smoking cessation. Menthol (n = 471) and non-menthol (n = 129) smokers were compared on smoking-related characteristics and abstinence rates at 6 weeks and 6 months. RESULTS: Menthol smokers were younger (41.2 versus 52.9 years), more likely to be female (73.7% versus 56.6%) and more likely to smoke their first cigarette within 30 minutes of waking up (81.7% versus 69.8%) compared to non-menthol smokers (all P < 0.01). Cigarette taste (50% versus 40%, P = 0.054) was rated non-significantly higher by menthol smokers. Seven-day point-prevalence abstinence from smoking at 6 weeks were 28% and 42% (P = 0.006) and at 6 months were 21% and 27% (P = 0.21) for menthol and non-menthol smokers, respectively. At 6 weeks follow-up, stepwise logistic regression revealed that among those younger than 50 years, non-menthol smokers were more likely to quit smoking (odds ratio = 2.0; 95% CI = 1.03-3.95) as were those who received bupropion (odds ratio = 2.12; 95% CI = 1.32-3.39). CONCLUSION: African American menthol smokers had lower smoking cessation rates after 6 weeks of treatment with bupropion-SR, thereby putting menthol smokers at greater risk from the health effects of smoking. Lower overall cessation rates among African Americans menthol smokers may partially explain ethnic differences in smoking-related disease risks.

Adult↗

PubMed2003

Perceptions of smoking among African American light smokers.

Despite smoking fewer cigarettes per day, African Americans extract more nicotine per cigaretts smoked, and have higher than expected tobacco-related morbidity and mortality. The present study explores perceptions about smoking and motivations for smoking cessation among African American light smokers. Four focus groups consisting of 22 adults were conducted at an inner-city community health center. Participants were recruited through flyers and referral by clinic staff. Two major themes were identified: (1) similar smoking patterns, and (2) perceived differences from heavy smokers. Many participants perceived themselves as addicted to nicotine, experienced withdrawal symptoms with past quit attempts, and are interested in smoking cessation. Perceptions about nicotine addiction, difficulty with quitting, and interest in smoking cessation suggest a need to design and test cessation interventions among this understudied population.

Black or African American↗

PubMed2003

Successful recruitment of minorities into clinical trials: The Kick It at Swope project.

Ethnic minorities are often underrepresented in clinical trials, and their recruitment can challenge researchers. Developing and communicating effective and efficient recruitment strategies may help researchers enroll more minorities into research studies. Kick It at Swope was a double-blind, randomized trial that evaluated bupropion for smoking cessation among 600 adult African Americans who smoked 10 or more cigarettes a day. Proactive recruitment strategies (in-person appeals by study staff and health care providers) and reactive recruitment strategies (disseminating information that asked people to call a study hotline) were implemented sequentially in an additive fashion over 16 months. Resulting patterns of recruitment are described and the two phases are compared based on their relative effectiveness, efficiency, and cost. More enrollees were recruited in the reactive phase (n=534) than in the proactive phase (n=66). Those recruited in the reactive phase were more likely to be eligible (OR=4.8) and more likely to be enrolled (OR=4.2) than those recruited in the proactive phase. Participants recruited in the reactive phase reported significantly higher levels of education and income, better health, and significantly lower indicators of depression and life hassles, compared with those recruited in the proactive phase. The reactive recruitment phase was less expensive than the proactive recruitment phase (22 US Dollars/enrollee vs. 159 US Dollars/enrollee). Reactive recruitment strategies added to multiple proactive clinic-based recruitment strategies were more effective, more efficient, and less costly than proactive recruitment alone. Close monitoring combined with the use of multiple recruitment methods and flexible recruitment plans can lead to successful, efficient, and low-cost recruitment of minorities into clinical trials.

Adult↗