Recruiting and Retaining Mobile Young Injection Drug Users in a Longitudinal Study

Abstract

Longitudinal studies that research homeless persons or transient drug users face particular challenges in retaining subjects. Between 2005 and 2006, 101 mobile young injection drug users were recruited in Los Angeles into a 2-year longitudinal study. Several features of ethnographic methodology, including fieldwork and qualitative interviews, and modifications to the original design, such as toll-free calls routed directly to ethnographer cell phones and wiring incentive payments, resulted in retention of 78% of subjects for the first follow-up interview. Longitudinal studies that are flexible and based upon qualitative methodologies are more likely to retain mobile subjects while also uncovering emergent research findings.

• Keywords Longitudinal
• qualitative methodology
• hidden population
• high-risk youth

THE AUTHORS

Stephen E. Lankenau, Ph.D., is an Associate Professor at Drexel University, School of Public Health, Department of Community Health and Prevention. Trained as a sociologist, he has studied street-involved and other high-risk populations for the past 10 years, including ethnographic projects researching homeless panhandlers, prisoners, sex workers, and injection drug users. He is Principal Investigator on a 4-year NIH study researching prescription drug misuse among high-risk youth in New York and Los Angeles.

Bill Sanders, P.hD., is an Associate Professor in the School of Criminal Justice and Criminalistics at California State University, Los Angeles. He has approximately 20 publications on a diverse range of topics, including injection drug use, club drug use, polydrug use, drug sales, homeless youth, gang youth, youth culture, and urban ethnography.

Dodi Hathazi, B.S., was as an Ethnographer at Children's Hospital Los Angeles in the Community, Health Outcomes, and Intervention Research Program where her research interests included patterns of polydrug use among homeless traveling youth and reproductive health issues experienced by high-risk youth. Currently, she is pursuing a Masters degree in Nursing at the University of Maryland.

Jennifer Jackson Bloom, M.P.H., is a biostatistician in the Community, Health Outcomes, and Intervention Research Program at Childrens Hospital Los Angeles. Her research interests include behavioral risk in substance abusing populations, modeling longitudinal change in substance use and the application of geography to drug abuse research.

Glossary

• Baseline tracking procedures: protocol implemented during the baseline interview of a longitudinal study whereby the interviewer collects various types of locator information for the purpose of study retention, e.g., address, telephone number, email address.

• Chain referral sampling: a nonrandom sampling approach that utilizes the personal network of a recruited participant to enroll more subjects.

• Community assessment process (CAP): a qualitative phase of research study involving a series of interviews with community experts and field observations to provide a current, detailed understanding of the phenomena of interest, e.g., ketamine use, from a community perspective.

• Follow-up procedures: strategies undertaken by an interviewer or team to reconnect or retain a participant after the initial baseline interview of a longitudinal study, e.g., sending interview reminders via mail, email, or telephone.

• Homeless travelers: homeless individuals, often teenagers and young adults, who travel from city to city every few weeks or months via hitchhiking or freight trains in pursuit of adventure, work, drugs, or to avoid law enforcement.

• Nontraditional populations: individuals sharing a similar stigmatized status, such as homeless persons, drug users, or persons living with HIV/AIDS, who may wish to remain hidden and thereby presenting challenges for retention in longitudinal studies.

• Targeted sampling: a nonrandom sampling technique that focuses sampling on designated neighborhoods and venues known to contain the desired population.

Notes

1 The reader is referred to Hills's criteria for causation, which were developed in order to assist researchers and clinicians determine if risk factors were causes of a particular disease or outcomes or merely associated. [Hill, A. B. (1965). The environment and disease: associations or causation? Proceedings of the Royal Society of Medicine, 58:295–300.] Editor's note.

2 The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.

3 The reader is reminded that a built in ” side effect” of language is the ease with which heterogeneous groups who are categorized are “homogenized” and if they are nontraditional populations they can easily be stigmatized, mystified and “empowered”. Editor's note.

4 The term ‘community’ has been attached to a diverse range of ideas and initiatives. One can categorize three broad types of community intervention models to consider the “demands” and “implications” of community readiness and community awareness for planned intervention. These include (1) professional agency networks, (2) community partnerships between professionals and community members and (3) grass-roots community initiative. Shiner et al (2004) Exploring community responses to drugs York, UK: Joseph Rowntree Foundation. (www.jrf.org.uk) Editor's note.

5 Alarcon is a Latino female, early 30s, college educated, with prior experience studying alcohol marketing in community settings in New Orleans. Hathazi is a white female, late 20s, college educated, with previous experience recruiting Vietnam veterans along skid row in downtown Los Angeles. Sanders is a white male, early 30s, Ph.D., with prior experience recruiting gang-involved youth in innercity London (Sanders 2005). Reported ages and education levels reflect each ethnographer's characteristic at the time of study enrollment.