Retention of under-represented minorities in drug abuse treatment studies.
BACKGROUND: Differential attrition by minority participants can be as limiting to interpreting final results as poor initial recruitment of minority participants. This is especially important in drug abuse treatment studies, as minorities are over-represented in substance abuse clinical treatment programs. PURPOSE: The specific aims of this secondary data analysis were to: (1) determine if there are differences in study retention rates by race/ethnicity and age, and (2) explore other client characteristics, as well as protocol and treatment program factors, that could account for differential retention rates. METHODS: We conducted a secondary analysis using data from 1737 participants in the first six clinical trials whose databases were locked in the NIDA Clinical Trials Network. Protocol level characteristics were also abstracted from these studies, and we used data from a study which assessed characteristics of community treatment programs that participated in these studies. Logistic regression was used to study the effect on retention of: client, protocol, and program characteristics. RESULTS: In the model of client characteristics, a significant age by race/ethnicity interaction term was detected based on a threshold of 0.1, with younger African Americans having the lowest odds of retention. Primary drug of abuse was also a significant factor in determining study retention, with heroin, methadone, and opiate users having the greatest odds of retention and polydrug users the lowest. Similar analyses testing treatment program characteristics found that only the presence of HIV risk screening and decreasing levels of female admissions (as a percent of total admissions) were related to study retention. In our final model, there was an effect of age, but not race/ethnicity, with younger participants having lower odds of retention. A multivariable model including protocol variables could not be developed due to the high correlation among protocol variables. LIMITATIONS: We excluded those of multi-race/ethnicity and those from minority groups other than Hispanic or African American due to small numbers. Additionally, only three therapy types were represented among the six studies. Some potential variables that would influence retention, such as client housing, and client comorbidities, the race/ethnicity and gender of the staff who conducted study follow-up assessments, and reasons for loss to follow-up, were not collected by the CTN. CONCLUSIONS: Although in our client model older African Americans and Caucasians had the greatest odds of retention and younger African Americans the lowest, in our final model, only age was significantly related to study retention. Additionally, primary drug of abuse, having HIV risk screening as a program benefit, and lower percentages of female admissions were significantly related to study retention. Efforts should be made to increase the study retention of younger participants to improve the validity and generalizability of drug abuse treatment study results.
Pubmed ID: 19528134
- Magruder KM
- Bichun Ouyang
- Miller S
- Tilley BC
Clinical trials (London, England)
June 16, 2009
- Agency: NIA NIH HHS, Id: 5 P30 AG021677
- Agency: NIDA NIH HHS, Id: 5 U010 DA013727
- Agency: NIA NIH HHS, Id: P30 AG021677
- Agency: NIA NIH HHS, Id: P30 AG021677-04
- Agency: NIDA NIH HHS, Id: U10 DA013727
- Agency: NIDA NIH HHS, Id: U10 DA013727-05
- Agency: NIDA NIH HHS, Id: U10 DA013727-08
- Agency: NIDA NIH HHS, Id: U10 DA013727-09
- Agency: NIDA NIH HHS, Id: U10 DA013727-10
- Behavior Therapy
- Clinical Trials as Topic
- Middle Aged
- Minority Groups
- Patient Acceptance of Health Care
- South Carolina
- Substance-Related Disorders
- Treatment Outcome
- Young Adult
- Clinical Trials Network, Number: NIDA-CTN-0005; Data from a study entitled " MI (Motivational Interviewing) to Improve Treatment Engagement and Outcome in Subjects Seeking Treatment for Substance Abuse" conducted by Kathleen Carroll, Ph.D. is available.
- Clinical Trials Network, Number: NIDA-CTN-0011; Data from a study entitled " A Feasibility Study of a Telephone Enhancement Procedure (TELE) to Improve Participation in Continuing Care Activities" conducted by Robert L. Hubbard, Ph.D., M.B.A. is available.
- Clinical Trials Network, Number: NIDA-CTN-0007; Data from a study entitled " Motivational Incentives for Enhanced Drug Abuse Recovery: Methadone Clinics" conducted by Maxine Stitzer, Ph.D. is available.
- Clinical Trials Network, Number: NIDA-CTN-0001; Data from a study entitled " Buprenorphine/Naloxone versus Clonidine for Inpatient Opiate Detoxification" conducted by Walter Ling, M.D. is available.
- Clinical Trials Network, Number: NIDA-CTN-0002; Data from a study entitled " Buprenorphine/Naloxone versus Clonidine for Outpatient Opiate Detoxification" conducted by Walter Ling, M.D. is available.
- Clinical Trials Network, Number: NIDA-CTN-0006; Data from a study entitled " Motivational Incentives for Enhanced Drug Abuse Recovery: Drug Free Clinics" conducted by Maxine Stitzer, Ph.D. is available.