Effective Strategies for Recruiting Families Ascertained Through Alcoholic Probands Kimberly L. Seaton, Jodi L. Cornell, Kirk C. Wilhelmsen and Cassandra Vieten Background: Recruiting a large number of participants meeting strict inclusion criteria can be challeng- ing, particularly when selecting for a condition associated with a social stigma such as alcoholism, when participation involves collection of medical specimens and sensitive information, and when the participa- tion of family members or other collaterals is required. Developing and implementing a successful recruit- ment plan depends upon identifying the most effective recruitment strategies given the available resources. Methods: Several strategies for recruiting subjects for a large family study on the genetics of alcoholism were evaluated over a two-year period with regard to participant yield, time and cost expenditure. Results: Overall effectiveness of a recruitment strategy was determined based on a composite of yield, cost and time expenditure. The most effective recruitment strategies were direct mail, press release, the Internet and treatment center collaborations. Conclusion: Results provide insight into successful strategies for recruiting large numbers of participants and their family members selected for a condition associated with a social stigma. Key Words: recruitment, alcoholism, family, genetics, linkage. R ECRUITING A LARGE number of participants meeting specific enrollment criteria is challenging, particularly when selecting for a condition associated with a social stigma. In family studies where more than one person from each family is required to participate, recruiting pro- bands who extend to informative relatives provides addi- tional challenges. A comprehensive recruitment plan that includes specific recruitment strategies, a budget desig- nated for recruitment, enrollment goals and a time frame for the recruitment effort is essential to overcoming these challenges and ensuring a steady flow of participants. The most successful recruitment plans rely on ongoing monitor- ing and a flexible approach (Adams et al., 1997, Connett et al., 1993) allowing for a prompt response to recruitment needs (Zweben et al., 1994). A common misconception in recruitment is that the total population of eligible participants will be predictive of the number of individuals who volunteer for a study (Hunning- hake et al., 1987). Enrollment of numbers lower than orig- inally expected may result from this inaccurate assumption. A survey of recruitment in clinical studies has shown that recruiting an appropriate number of participants within the expected duration rarely occurred (Hunninghake et al., 1987). In many cases, the time period allocated for recruit- ment was extended, resulting in elevated recruitment costs as well as increased costs for the entire study (Hunninghake et al., 1987 and Valanis et al., 1998). Some studies have found it necessary to modify their eligibility criteria midway through the data collection phase to meet their enrollment goals, potentially impacting the generalizability or specific- ity of findings, while other studies have been terminated due to recruitment problems (Hunninghake et al., 1987). Lack of a sufficient number of participants can negatively affect not only the length and cost of a study but can also impact statistical power if the sample size is reduced (Vala- nis et al., 1998). Difficulty with recruitment can create an uneven or excessive workload (Lovato et al., 1997) and may negatively impact staff morale (Valanis et al., 1998). These problems increase the probability that resources will have to be diverted to recruitment, thereby reducing availability for other study functions (Hunninghake et al., 1987). Prob- lems with recruitment are ameliorated somewhat by offer- ing easily accessible participation at flexible times and in locations convenient for the participant (Black and Smith, 1994 and Vollmer et al., 1991), and providing a tangible incentive (Black and Smith, 1994). A number of strategies for recruiting individual partici- pants have been evaluated in the literature. Some studies have found that direct mail campaigns were successful enough to become the sole method of recruitment (Con- nett et al., 1993), as they provided a consistently predictable Ernest Gallo Clinic and Research Center, University of California, San Francisco (KLS, JLC, KCW, CV). October 2, 2002; October 28, 2003. This research was supported by funds provided by the State of California for medical research on alcohol and substance abuse through the University of California, San Francisco. Reprint requests: Kirk C. Wilhelmsen, MD, PhD, Department of Genetics and Bowles Center for Alcohol Research, University of North Carolina Chapel Hill, 4109 Neuroscience Research Building, Chapel Hill, NC 27599-7264. Copyright © 2004 by the Research Society on Alcoholism. DOI: 10.1097/01.ALC.0000107200.88229.57 0145-6008/04/2801-0078$03.00/0 ALCOHOLISM:CLINICAL AND EXPERIMENTAL RESEARCH Vol. 28, No. 1 January 2004 78 Alcohol Clin Exp Res, Vol 28, No 1, 2004: pp 78–84