Recruiting Community-Based Dementia Patients and Caregivers in a Nonpharmacologic Randomized Trial: What Works and How Much Does It Cost?

OBJECTIVES: The aim of this study was to evaluate the yield and cost of three recruitment strategies-direct mail, newspaper advertisements, and community outreach-for identifying and enrolling dementia caregivers into a randomized trial testing a nonpharmacologic approach to enhancing quality of life of patients and caregivers (dyads). METHOD: Enrollment occurred between 2006 and 2008. The number of recruitment inquiries, number and race of enrollees, and costs for each recruitment strategy were recorded. RESULTS: Of 284 inquiries, 237 (83%) dyads enrolled. Total cost for recruitment across methodologies was US$154 per dyad. Direct mailings resulted in the most enrollees (n = 135, 57%) and was the least costly method (US$63 per dyad) compared with newspaper ads (US$224 per dyad) and community outreach (US$350 per dyad). Although enrollees were predominately White, mailings yielded the highest number of non-Whites (n = 37). DISCUSSION: Direct mailings was the most effective and least costly method for enrolling dyads in a nonpharmacologic dementia trial.

THE PROFITS AND PERILS OF PUBLICITY: ALLGEMEINE LITERATUR- ZEITUNG, THE THURN UND TAXIS POST, AND THE PERIODICAL TRADE AT THE END OF THE EIGHTEENTH CENTURY.

Recent historiography on the growth of periodical publishing has emphasized newspapers and journals as constituents of an emergent communications system in early modern Europe. This system comprised the newspapers, journals and other publications that contributed its content, and also the postal systems that were the principal method of distributing that content. This article describes how the growth of this system in central Europe was supported in large measure by financial incentives that it offered to both constituents. First, in contrast with postal systems in France and the UK, the Thurn und Taxis Reichspost inserted itself as a middleman in the sale of periodicals, which gave the Reichspost an incentive to promote the trade. Second, the financial conditions for periodical publication made their costs depend more heavily on costs that were scalable to circulation than is true today, which resulted in the viability of publications with a lower circulation. The same cost structure also made it possible for certain prominent periodicals of the era to earn considerable profits for their publishers, as illustrated in this article by Allgemeine Literatur-Zeitung, which was published in Jena from 1785.

Local news media framing of obesity in the context of a sugar-sweetened beverage reduction media campaign.

OBJECTIVE: This study examined local news media's framing of obesity preceding and surrounding the Philadelphia sugar-sweetened beverage reduction media campaign. METHODS: Using key search terms pertaining to obesity and sugary beverages, the authors searched the LexisNexis database and gathered local news stories (n = 167) that were aired or published between October, 2010 and March, 2011. They conducted a content analysis, coding for framing-related outcome measures (underlying factors, action steps, and contextual agents). RESULTS: Overall, the news media employed individual-level framing in the majority of stories when discussing obesity, both before and after the campaign launch. After the campaign launched, however, stories were significantly more likely to mention systemic-level contextual agents such as food companies (P = .008), beverage companies (P = .03), and champions or advocates (P = .001). CONCLUSIONS AND IMPLICATIONS: The researchers observed a shift in the local news media discourse toward more thematic framing of obesity, and suggest that public health officials consider the potential impact of news media frames on garnering public support for future policy implementations.

Paying for what was free: lessons from the New York Times paywall.

In a national online longitudinal survey, participants reported their attitudes and behaviors in response to the recently implemented metered paywall by the New York Times. Previously free online content now requires a digital subscription to access beyond a small free monthly allotment. Participants were surveyed shortly after the paywall was announced and again 11 weeks after it was implemented to understand how they would react and adapt to this change. Most readers planned not to pay and ultimately did not. Instead, they devalued the newspaper, visited its Web site less frequently, and used loopholes, particularly those who thought the paywall would lead to inequality. Results of an experimental justification manipulation revealed that framing the paywall in terms of financial necessity moderately increased support and willingness to pay. Framing the paywall in terms of a profit motive proved to be a noncompelling justification, sharply decreasing both support and willingness to pay. Results suggest that people react negatively to paying for previously free content, but change can be facilitated with compelling justifications that emphasize fairness.

Quid pro quo: tobacco companies and the black press.

OBJECTIVES: We explored the relationship between tobacco companies and the Black press, which plays an important role in conveying information and opinions to Black communities. METHODS: In this archival case study, we analyzed data from internal tobacco industry documents and archives of the National Newspaper Publishers Association (NNPA), the trade association of the Black press. RESULTS: In exchange for advertising dollars and other support, the tobacco industry expected and received support from Black newspapers for tobacco industry policy positions. Beginning in the 1990s, resistance from within the Black community and reduced advertising budgets created counterpressures. The tobacco industry, however, continued to sustain NNPA support. CONCLUSIONS: The quid pro quo between tobacco companies and the Black press violated journalistic standards and represented an unequal trade. Although numerous factors explain today's tobacco-related health disparities, the Black press's service to tobacco companies is problematic because of the trust that the community placed in such media. Understanding the relationship between the tobacco industry and the NNPA provides insight into strategies that the tobacco industry may use in other communities and countries.

Changelings: transformative perceptions of San José's street children, 1965-1981.

Between 1965 and 1981, Costa Ricans changed their perceptions of which characteristics they thought defined appropriate urban childhoods. By 1981, the model of a modern, urban Costa Rican child was that of a child who attended school, did not work on the streets, and played in specifically designated places. Children who did not fit this mold began, in the late 1970s and early 1980s, to be viewed as dangerous to society and as evidencing social pathology. Whereas children who worked on the streets during the 1960s were considered part of the urban landscape, and their childhoods, though difficult, were not perceived as deviant, these same children, two decades later, were viewed as marginal and problematic. To trace this change, this article focuses on the changing perceptions about children on the streets that writers for and public contributors to La Nación, one of the preeminent Costa Rican newspapers, show during the sixteen-year period under analysis.

Strange old worlds: socio-critical reports about old-age experiences in West German print media (1970s-1990s).

This article examines West German images of old age and the elderly in a period when this increasingly became a topical issue. Between the 1970s and the 1990s, the elderly were the subject of socio-critical reports in leading political magazines like Der Spiegel, Die Zeit and Stern. In these specific journalistic formats, the media entered unfamiliar places like old people's homes, the elderly's private apartments or tea dances for senior citizens. By analysing the language used in such media reports, this article shows continuity and change in attitudes towards the elderly, explores the impact of the new old-age model 'the young at heart', and the relevance of gender and generational ascriptions. In doing so, this article uncovers the recent historical context of current social debates about old age.

Evaluation of active and passive recruitment methods used in randomized controlled trials targeting pediatric obesity.

OBJECTIVE: Evaluate enrollment numbers, randomization rates, costs, and cost-effectiveness of active versus passive recruitment methods for parent-child dyads into two pediatric obesity intervention trials. METHODS: Recruitment methods were categorized into active (pediatrician referral and targeted mailings, with participants identified by researcher/health care provider) versus passive methods (newspaper, bus, internet, television, and earning statements; fairs/community centers/schools; and word of mouth; with participants self-identified). Numbers of enrolled and randomized families and costs/recruitment method were monitored throughout the 22-month recruitment period. Costs (in USD) per recruitment method included staff time, mileage, and targeted costs of each method. RESULTS: A total of 940 families were referred or made contact, with 164 families randomized (child: 7.2+/-1.6 years, 2.27+/-0.61 standardized body mass index [zBMI], 86.6% obese, 61.7% female, 83.5% Caucasian; parent: 38.0+/-5.8 years, 32.9+/-8.4 BMI, 55.2% obese, 92.7% female, 89.6% caucasian). Pediatrician referral, followed by targeted mailings, produced the largest number of enrolled and randomized families (both methods combined producing 87.2% of randomized families). Passive recruitment methods yielded better retention from enrollment to randomization (p<0.05), but produced few families (21 in total). Approximately $91,000 was spent on recruitment, with cost per randomized family at $554.77. Pediatrician referral was the most cost-effective method, $145.95/randomized family, but yielded only 91 randomized families over 22-months of continuous recruitment. CONCLUSION: Pediatrician referral and targeted mailings, which are active recruitment methods, were the most successful strategies. However, recruitment demanded significant resources. Successful recruitment for pediatric trials should use several strategies. CLINICAL TRIALS REGISTRATION: NCT00259324, NCT00200265.

Cost effectiveness of recruitment methods in an obesity prevention trial for young children.

BACKGROUND: Recruitment of participants for clinical trials requires considerable effort and cost. There is no research on the cost effectiveness of recruitment methods for an obesity prevention trial of young children. METHODS: This study determined the cost effectiveness of recruiting 70 families with a child aged 4 to 7 (5.9+/-1.3) years in Western New York from February 2003 to November 2004, for a 2-year randomized obesity prevention trial to reduce television watching in the home. RESULTS: Of the 70 randomized families, 65.7% (n=46) were obtained through direct mailings, 24.3% (n=17) were acquired through newspaper advertisements, 7.1% (n=5) from other sources (e.g., word of mouth), and 2.9% (n=2) through posters and brochures. Costs of each recruitment method were computed by adding the cost of materials, staff time, and media expenses. Cost effectiveness (money spent per randomized participant) was US $0 for other sources, US $227.76 for direct mailing, US $546.95 for newspaper ads, and US $3,020.84 for posters and brochures. CONCLUSION: Of the methods with associated costs, direct mailing was the most cost effective in recruiting families with young children, which supports the growing literature of the effectiveness of direct mailing.

The Cost-Time Index: a new method for measuring the efficiencies of recruitment-resources in clinical trials.

Paid media are important resources used to recruit subjects in clinical trials. An index for evaluating which advertising resource has minimal cost and time requirement for patient accrual, for a given study design, has not been previously introduced. In this communication the authors present a new index, the Cost-Time Index, which represents a measure of the average amount of money and time spent, simultaneously, on a given advertising resource to recruit one analyzable subject. This index can be calculated using retrospective data and may be a useful tool for comparing recruitment efficiencies among various resources. The authors demonstrate the utility of the Cost-Time Index and recommend its use as an additional variable in future studies regarding recruitment strategies in clinical trials.

Print news and health psychology: some observations.

This commentary overviews the look of health news in American print journalism and the research that suggests how health news creates influence at both the individual and policy levels. Crime and violence are argued to be public health issues, but unfortunately they are often not treated as such. There is clearly room for improvement in all areas of health news, but unfortunately the extreme stress that newspapers are under to maintain their high profit margins suggests that the resources for such improvement are unlikely to be available. Examination of the Minneapolis Star Tribune's coverage of health, crime and violence exemplifies problematic aspects.

Chemical, physical, and environmental properties of pelleted newspaper compared to wheat straw and wood shavings as bedding for horses.

Two experiments were conducted comparing pelleted recycled newspaper (PN) to wheat straw (S) and kiln-dried pine wood shavings (WS) as an animal bedding material. Adult horses housed 20 to 21 h/d in boxstalls served as the animal model for comparisons. In Exp. 1 eight boxstalls, each housing one horse, were each bedded with two types of PN (0.32 and 0.64 x 2.54 cm), S, and WS over four 5-d periods (replicated 4 x 4 Latin square). Initial amounts of bedding materials surpassed most commercial conditions, but stalls were cleaned daily of feces only and additional clean bedding was added as needed to maintain animal cleanliness, thus challenging the bedding properties of each material. In Exp. 2 nine boxstalls were bedded with PN (0.32 x 2.54 cm), S, and WS over three 14-d periods (three 3 x 3 Latin squares) during summer and autumn. Feces and wet spots were removed daily and clean bedding was added to reestablish working volume and simulate commercial conditions. In Exp. 1 and 2 daily additions of clean bedding varied (P < 0.05) with material (S > WS > PN). The higher water-holding capacity of PN and WS contributed to fewer bedding replacements. Usage of each material was greater (P < 0.05) during the autumn; PN had the greatest increase. Type of material and season also influenced bedding environment. Bedding pH increased (P < 0.05) with use and was highest in PN and lowest in S. Higher concentrations of breathable NH3 N were present in stalls bedded with PN and during autumn. Higher pH of used PN and decreased ventilation due to closed doors and windows during autumn were contributing factors. Season, type of bedding, and duration of its use affected (P < 0.05) numbers as well as species of microorganisms present in the breathing zone, nasal cavity, and on the leg of the horse. Clean and used WS contained greater (P < 0.05) quantities of particle fines, but with 5 d of use, particle fines in PN also increased. Quantities of breathable dust during cleaning of stalls varied (P < 0.05) with material and duration of its use; dust peaked at d 7 with PN but continued to decrease with S and to increase with WS through d 14. These data indicate that management of bedding materials varies with type of material and season of year. Use of PN as a bedding material has high potential.