Brief report
Sampling bias due to consent procedures with adolescents

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Abstract

Positive consent was solicited from parents of 604 seventh grade students in four middle schools. Three hundred and fifty eight (59%) returned consents and completed a questionnaire under “bogus pipeline” conditions with saliva and air samples. Two weeks later both students with consent and those without were administered a second questionnaire without physiological measures. Comparison between consent and nonconsent students show significant differences in the smoking of cigarettes and marijuana, but no difference in the use of alcohol. Additional significant differences were found in exposure to smoking models, and level of education of both parents. The bias shown on significant dependentvariables may adversely effect the generalizability of results of studies of adolescent drug use that depend upon positive parental consent.

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    Significant differences between respondents and nonrespondents may also emerge in the prevalence of risk behaviors when active consent procedures are used [12,17]. For example, Severson and Ary [18] reported a significantly higher number of risk behaviors (e.g., smoke tobacco, marijuana, and drink alcohol) reported by students whose parents did not provide consent compared to students with consenting parents. Estimates of prevalence rates may also be affected by an interaction between consent procedures and subject characteristics.

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    Families were recruited using a two-gate procedure consisting of an in-school screening and an in-home diagnostic interview. In order to facilitate recruitment of a representative sample of students, we used a combined passive parental consent and active student assent protocol for the school screening (Biglan and Ary, 1990; Severson and Ary, 1983). Active parent consent and adolescent assent for the full assessment were obtained prior to the diagnostic interview.

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    Requiring parental consent, for example, significantly affects the level of nominator participation (Courser, Shamblen, Lavrakas, Collins, & Ditterline, 2009; Pokorny, Jason, Schoeny, Townsend, & Curie, 2001). Studies of participation rates with active and passive consent demonstrate that requiring active consent results in lower participation rates (Courser, Shamblen, Lavrakas, Collins, & Ditterline, 2009; Ellickson & Hawes, 1989; Esbensen, Miller, Taylor, He, & Freng, 1999; Fendrich & Johnson, 2001; Kearney, Hopkins, Mauss, & Weisheit, 1983; Lueptow, Mueller, Hammes, & Master, 1977; Severson & Ary, 1983; White, Hill, & Effendi, 2004). Furthermore, non-participation can introduce selection bias by race (Dent, Galaif, Sussman, & Stacy, 1993; Esbensen, Miller, Taylor, He, & Freng, 1999; Kearney, Hopkins, Mauss, & Weisheit, 1983; Unger et al., 2004), sex (Courser, Shamblen, Lavrakas, Collins, & Ditterline, 2009; Dent, Galaif, Sussman, & Stacy, 1993; Pokorny, Jason, Schoeny, Townsend, & Curie, 2001; Schuster, Bell, Berry, & Kanouse, 1998), age (Courser, Shamblen, Lavrakas, Collins, & Ditterline, 2009; Esbensen, Miller, Taylor, He, & Freng, 1999; Kearney, Hopkins, Mauss, & Weisheit, 1983), and psychosocial risk status (Severson & Ary, 1983).

  • Parental consent in adolescent substance abuse treatment outcome studies

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    Frissell et al. (2004) saw consistently lower reporting of high-risk drinking behaviors from students in schools that required active parental consent compared with those that only required passive consent. Three additional studies found lower reported drug use in active consenting conditions for some but not all types of drugs (Anderman et al., 1995; Esbensen et al., 1999; Severson & Ary, 1983), and a separate study found that active consenting resulted in lower drug use reporting only for younger adolescents (White et al., 2004). However, one study found lower reports for only 2 of 26 risk behaviors (i.e., inadequate fruit/vegetable consumption, sports participation) in schools collecting active parental consent (Eaton et al., 2004), with no differences on substance use prevalence.

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This investigation was supported by Grant 1-RO1-HD13409 awarded by the National Institute of Child and Human Development, Department of Health, Education and Welfare. The authors wish to acknowledge editorial assistance and thoughtful review by Anthony Biglan, Edward Lichtenstein and Hyman Hops. Assessment was done by Cheri Nautel and Carol Faller.

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