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Recruitment Strategy for an Adolescent WPV Study

University of Cincinnati: College of Nursing

Recruitment Strategy for an Adolescent Workplace Violence Study

Patricia I. Ramirez WISE Program Project Mentor: Professor Carolyn Smith August 2, 2013

Recruitment Strategy for an Adolescent WPV Study Abstract

The University of Cincinnatis College of Nursing is conducting a two-phased study to determine if the factors contributing to and consequences associated with workplace violence (WPV) exposure among adolescents are similar to those found among adult employees. Due to the under-representation of adolescent workers in workplace violence research, a lack of understanding of this vulnerable employee population potentially compromises the overall validity of violence prevention programs. The first phase requires 25 participants to validate 6 WPV instruments, for which we developed a recruitment strategy involving a rarely used data collection method of community assessments and Esri Community Analyst GIS software as tools. We found that our recruitment strategy effectively focused efforts on more prospective areas that consisted of our target demographic, thus increasing exposure of our study to high populations of potential participants. The use of Esri Community Analyst GIS software allowed fast access to geographic and demographic data as well as NACIS Industry databases, had easy to use layering and effective mapping functions. There are 11 confirmed participants and four that have undergone a cognitive interview needed to adapt the WPV instruments to increase clarity and reliability. Adapted instruments are used with the following participant in a consistent modification cycle until all 25 participants have been interviewed. We expect the adaptations to the WPV instruments from phase I to provide assurance that the validity of the instruments has been improved for use in phase II of this study.

Recruitment Strategy for an Adolescent WPV Study Acknowledgements

I would like to acknowledge the University of Cincinnati for their financial support; the College of Nursing for providing my project mentor, Professor Carolyn Smith, with the Deans New Investigator Award and Professor Changjoo Kim for graciously giving me the initial guidance I needed to begin learning how to use GIS software. Of course, I would also like to thank my project mentor, Professor Carolyn Smith, for allowing me, an undergraduate student with no prior research experience, to assist her with her very valuable research study. I am very honored to say that I have had the opportunity to work with such a kind, understanding and knowledgeable researcher, and would be just as honored to continue to assist her in future studies. Most importantly, I would like to acknowledge the WISE Program for creating such a valuable undergraduate research experience available to students like me. Their support of the University of Cincinnati Strategic Plan, to increase emphasis on undergraduate student research, and the College of Nursing Strategic Goal, to maximize student research in selective areas such as violence, is commendable. My participation in the WISE program provided me with an invaluable experience that impacted me professionally. I was able to develop in a professional sense thanks to the experiences I had working as a research assistant, which involved: learning skills such as reading and writing research articles, understanding the ethical guidelines of working with human subjects, collaborating with a mentor, learning to communicate with the community, presenting a research study and preparing a research report. The WISE program also impacted my professional plans because, aside from my current goals of completing my BSN degree and then pursuing a Masters and Doctorate in Nursing, I am now also considering pursuing a PhD within the field of nursing.

Recruitment Strategy for an Adolescent WPV Study Table of Contents

Abstract... 2 Acknowledgements..3 Table of Contents........ 4 Outline of Report.... 5 I. II. III. IV. V. VI. VII. VIII. IX. Problem Statement............ 6 Background/Introduction.......... 6 Research Methods......... 9 Results..13 Discussion........14 Conclusion...... 15 References... 17 Figures......................................................................................................................... 19 Tables.. 33

Recruitment Strategy for an Adolescent WPV Study Outline of Report

Abstract: gives a brief overview of this studys key goals, the significance of the study, the methodology to achieve key goals, key results, and the expected conclusions. Problem statement: gives a brief, informal explanation of the impact of the study. Background/Introduction: provides background information on the problem, includes relevant literature, explains the purpose of the study, and the motivation for conducting the study. Research methods: describes the steps taken to conduct the study, how the study was conducted and why those methods were chosen. Results: show the data gathered in both visual and textual context. Discussion: explains what the results mean. Conclusion: gives a summary of the outcome of the study, explains the impact on future studies, and points toward future steps.

Recruitment Strategy for an Adolescent WPV Study Problem Statement

Workplace violence studies lack data from adolescent workers, potentially hindering efforts for development of violence prevention programs. A recruitment strategy, involving the use of community assessments and GIS software as data collection tools, would be efficient in qualitative research, such as that of workplace violence studies, for targeting a specific population, such as adolescent workers. Background/Introduction Approximately 2 million American workers report having been victims of workplace violence each year, ranging from threats and verbal abuse to physical assaults and even homicide (DOL). In 2011, workplace violence was responsible for 458 total homicides and 24 homicides of underage workers (DOL 2012 p.7-10), and is seen to negatively affect the psychological health of bullied respondents (Hansen, Hogh, Persson, Karlson, Garde, & Orbaek, 2006) therefore, it is clearly a work hazard that needs to be taken seriously. The OSHA workplace violence prevention programs are dedicated to management commitment and worker involvement, worksite analysis, hazard prevention and control and safety and health training (DOL 2012 OSHA p. 6), however the effectiveness of these programs is lessened by the fact that too little is known regarding specific characteristics of perpetrators, victims, companies, and circumstances surrounding violent events (CDCP 2006 p.8). To gauge the violence exposure and prevention training experienced by workers and the effects of such exposure, workplace violence assessments have been created; these instruments contribute to workplace violence research and collection of data. As a result, many workplace violence research studies have been conducted regarding adult employees in numerous areas

Recruitment Strategy for an Adolescent WPV Study

including: individual factors, environmental factors, and organizational characteristics, which are factors associated with increased risk for or exposure to workplace violence, and fear of future violence (BLS, 2006; Lanza, 2006; LeBlanc & Kelloway, 2002; Mueller & Tschan, 2011); negative effects on individual employees physical (Hogh & Viitasara, 2005; Lanza, 2006) and also psychological health (Hogh & Viitasara, 2005; Lanza, 2006; Wieclaw, Agerbo, Mortensen, Burr, Tuchsen, & Bonde, 2006), decreased job satisfaction (Driscoll, Worthington, & Hurrell, 1995) and decreased organizational commitment (BLS, 2006), which are consequences associated with workplace violence. Commonly excluded from this essential research regarding identification of workplace violence effects, are adolescent workers, even though according to the latest U.S Labor Force Statistics, about 16% of the nations 8.9 million adolescents, ages 16-17, were employed in 2012 (DOL 2013). The few WPV studies conducted with adolescents include studies focused on: whether adolescent employees ever experience workplace violence (Rauscher, 2008; Smith, 2012), occupational safety concerns among adolescent employees such as lack of safety training, and job characteristics associated with increased risk for workplace violence exposure (Runyan, Bowling, Schulman, & Gallagher, 2005; Runyan et al., 2007). The importance of including adolescents in these WPV studies, is based on the fact that because adolescents are not as fully developed as adults in their cognitive, emotional, and social abilities (National Research Council, 1998), they may have a limited ability to understand and respond appropriately to any potential or actual workplace violence events. Because no studies have been conducted for adolescents on the many factors associated with and consequences of workplace violence exposure, it is unknown how vulnerable to workplace violence the adolescent employee population actually is.

Recruitment Strategy for an Adolescent WPV Study

This two-phased study is significant to workplace violence prevention efforts because it is focused on an under-represented population that has been omitted from important workplace violence research. The purpose of the first phase, is to validate workplace violence instruments, in the form of surveys, among adolescent employees; this is accomplished with the use of a recruitment strategy, followed by cognitive interviews with the recruited participants to progressively adapt the instruments, and final analysis of the instruments for security in their clarity and relevance when tested with an adolescent population. The recruitment strategy from phase I is the focus of this report because of the introduction of a rarely used dual method for data collection that includes community assessments and ESRI Community Analyst GIS software. Community assessments are a data collection tool used in numerous recruitment strategies, which includes qualitative research (Thomas 1999), as well as studies involving minority populations (Horowitz 2009), and sexual violence victims (Martsolf 2006). Geographic Information System (GIS) software, although widely used by governments for area specific service planning (Karen 2007), communities for public health community assessments (Graham 2011), and businesses to improve marketing strategies (Pick 2005), has rarely been used in recruitment strategies. However, a graduate student study from Loma Linda University tested The Benefits of Using Geographic Information Systems as a Community Assessment Tool and found GIS to be valuable tool in the data collection process (Graham 2011). Because the objective of the recruitment strategy is to maximize exposure of our study in areas with high populations of individuals that meet our demographic criteria in order to qualify as potential participants, it would be beneficial to have a data collection method that is thorough, accurate, purposeful, fast, and easy to use.

Recruitment Strategy for an Adolescent WPV Study

Including a rarely used data collection method, in a recruitment strategy, for a qualitative study such as this one, is an approach through innovative thinking because it provides future studies to consider the benefits of combining reliable traditional methods with state-of-the-art technologies made available to the public.

Research Methods For phase I of this study, we need to recruit 25 adolescent participants that meet specific requirements: be 14-17 years of age, live in Hamilton County, have at least two months of current or recent taxable work experience within the last six months, participants must have parental consent, and be capable of understanding and responding to survey questions in English. To recruit participants we devised a recruitment strategy with the intention to maximize exposure of our adolescent WPV study within the areas in Hamilton County that contained the largest populations of our target demographic. In order to understand the communities we needed data collection tools that would allow us to find specific community types, search for recruitment locations, and track areas. Because of the popularity of community assessments in qualitative studies, which involve driving through target areas, taking note of locations and speaking with community members, we knew to include this tool in our recruitment strategy, but we also needed to find equally reliable GIS software. After investigating the many types of software, we discovered from a vendor study that Esri GIS software, had the lowest precision error total for both population and households (Cropper 2012 p. 6), and is therefore known for having the most precise demographic data available. Upon further inspection, we zoned in on Esri Community Analyst, which had many functional features for conducting our community assessments.

Recruitment Strategy for an Adolescent WPV Study Esri Community Analyst allows users to create a smart map search by selecting demographic criteria from an extensive list that includes many census data, selecting a

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geography that ranges from states to census block groups, and finally refine criteria to include or exclude areas with certain ranges. We used the smart map search under the explore community tab to search for total population by ages, we selected ages 14, 15, 16, and 17; then we picked census block groups for the geography size because we wanted to see exactly where the most concentrated areas of 14-17 year olds were located; we refined criteria to include populations for each age starting at the highest range 50+, then gradually decreasing to 40+, 35+ and 30+; and created a map for the resulting locations (see fig. 1). Our next search was to find the target areas using larger scale geography so that we could easily distinguish boundaries when conducting community assessments by driving through the target areas. We kept the individual age ranges for the demographic criteria, but instead of looking at census block groups, we chose zip codes; and because the general population was much larger, we looked at areas that had at least 400 individuals for each age and mapped the resulting locations (see fig. 2). I then combined the two map layers and this time I searched for select businesses within those areas by using the NACIS Industry database available on the system. We had pre-meditated going to areas like barbershops, grocery stores, beauty salons, nail salons, some restaurants, libraries, community centers, recreation centers and churches because we believe posting a recruitment flyer there would result in the most exposure to interested potential participants. With the NACIS database I could search for each business category and select the establishments I wanted to map. I created drive circles around each target area so the business that fit our criteria would only show up if they were within ten minutes of each target area. The potential flyer locations were plotted over the target areas for future reference (see fig. 3).

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My project mentor and primary investigator, Professor Carolyn Smith, had developed recruitment flyers explaining the purpose of the study, the requirements, and a statement of UC IRB approval. But by this point, we still did not have IRB approval for our study so, when we did community assessments guided by the maps of target areas, we were unable to begin distributing flyers. We drove around the county subdivisions and I took notes about the areas we went to, the locations we saw, and the business we stopped at. For every business we stopped at I collect the address, owner or managers contact information, a general idea of if they would or would not allow for us to potentially post a flyer to inform community members of the study, and what kind of available space they had for the flyer. We discovered that many locations had strict policies regarding solicitation and distribution of materials so we had to take a number of potential locations off of our lists. Once we had IRB approval, which took longer than expected, we were able to take out our lists of checked potential locations and go back into the communities to post the recruitment flyers. During this recruitment stage, we have made contact with multiple individuals about the study, attempted to speak with more locations about posting flyers, and gone to farmers markets to distribute flyers and speak with vendors about any suggestions for local areas we could go to post flyers. After every day of flyer distribution, the locations where recruitment flyers have been posted were mapped on Esri Community Analyst (see fig. 4). Since distribution of recruitment flyers began, we have received referrals from people who know adolescents that meet our criteria, spoken with numerous adolescents and community members, received calls from individuals that have seen the recruitment flyers or heard about the study, and collected contact information from potential participants.

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Once there are participants that have been confirmed, completing the cognitive interviews becomes the second objective for completing phase I of the study. Participants are only required to contribute about an hour of their time to complete an audio-recorded cognitive interview that is then used to adapt and validate WPV instruments for use with adolescents in phase II. The cognitive interview process involves confirming a participant by screening them though a phone call, getting verbal and written parental consent, scheduling a date, time, and place for the cognitive interview, meeting with the participant the day of the interview, checking for the parental consent form, explaining again the interview process, starting the recording equipment and beginning the interview. To track the participants information they are asked at the beginning to give their zip code and corresponding community name, are assigned an ID code, and asked to complete a demographics questionnaire. At the end of the interview the participant is thanked for their time, given a $10 Target gift card for their participation, and encouraged to spread the word about their participation in the study to any friends that might be interested in participating. The third and final objective for completing phase I of this study is to analyze the cognitive interviews. We first look at what can be changed sometimes during the interview process, but always at the end of the interview. The participant is asked what parts of the instruments components they did not fully understand and what they think could be changed to increase clarity. The participants suggestions are noted and the recording is sent off for professional transcription. The transcription process takes two days and is received by the private investigator in a Word document. The transcription is reviewed for any further analysis; the intended and interpreted meanings of each instruments component are compared, and the participants responses are analyzed to improve clarity and readability of the instruments. Any

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necessary modifications to an instruments components are done so before the following recruited participant is interviewed; in this way, the adapted instruments are consistently being modified. This analysis process is continued with each participant until 25 cognitive interviews have been successfully completed, to ensure that the final product will have been thoroughly inspected and deemed valid for use in phase II.

Results Although we have not completed community assessments in all the target areas (see fig. 2), or returned to distribute flyers at all the potential locations (see fig. 3), and were limited by policies regarding soliciting; we have been able to post flyers in more than 107 locations (see fig. 4) and distribute numerous flyers at several farmers markets. In less than a month of distribution efforts, we already collected contact information from 15 potential participants through referrals, direct interactions and interested callers; confirmed 11 participants for participation in the study, and conducted 4 cognitive interviews. Demographic data from the areas in which we have posted flyers can be seen in table 1 (see table 1). The areas are identified by the zip code and community name. Each area has a column depicting its total population and total population of adolescents for the ages of 14, 15, 16 and 17. These demographics allows us to identify the type of community it is by the population numbers and then from the last column we can easily identify how many flyers are posted so far in each of the target areas. Of the data collected from the community assessments and GIS software, we located census block groups and zip codes that showed target locations (see figure 1) and target locations with areas where community assessments were conducted (see figure 2). Of the census block groups seen in figure 1 and figure 2, there were 2 that had populations selected each age group at

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50+ shown in red (390610080.001 and 390610251.012), 3 that had populations selected for each age group at 40+ shown in yellow (390610226.012, 390610243.211, and 390610249.025), 7 that had populations selected each age group at 35+ shown in green (390610215.082, 390610207.051, 390610211.012, 390610213.033, and 390610244.007) and 10 that had populations selected each age group at 30+ shown in blue (390610207.073, 390610207.072, 390610206.024, 390610208.113, 390610085.012, 390610211.022, 390610243.032, 390610243.224, 390610250.011, and 390610251.034). Of the zip codes seen in figure 1 and figure 2, there were 6 that were found to have populations in each age group at 400+ shown in pink (45140, 45215, 45231, 45238, 45340, and 45244). Of the areas where community assessments were conducted, seen in figure 2, there were 18 identified zip codes shown in light blue (45208, 45211, 45215, 45218, 45219, 45224, 45230, 45231, 45236, 45239, 45240, 45241, 45242, 45243, 45246, 45248, 45251, and 45255), of these 18 zip codes, 3 were from the 6 identified zip code target areas in pink (45240,45231 and 45215).

Discussion The figures show that although GIS software is very useful for finding and mapping select points and areas, actually recruiting locations for flyer distribution is not as simple; maps can be generated in a few minutes while it can take days to cover even a few target areas. The maps from figures 1 and 2 show the target areas that remain to be assessed and imply how the recruitment process can take a considerable amount of time when trying to get to all the target areas; but, without the right tools, we would likely be looking for participants in all the wrong places.

Recruitment Strategy for an Adolescent WPV Study When creating a recruitment strategy, community assessments should still be an

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important part of the process. In order to get an actual understanding of a community physical interaction is needed, without in-person community assessments, there would have been no opportunity for person-to-person contact and sharing of information from individuals who know the community best. However, without GIS software, we would have missed out on the ability to easily find and map areas using precise demographic data that was very helpful for guiding our community assessments. Our results support the continued use of community assessments in recruitment strategies because of the clear impact that a personal view of an area can have in the networking and direct recruitment process, as well as the use of GIS software more specifically Esri Community Analyst, in recruitment strategies because it was a valuable data collection tool that was easy to use, fast, functional and reliable.

Conclusion Utilizing a dual method recruitment strategy for collecting data resulted in very quick responses from the communities, which we targeted. The method allowed us to uncover areas with high populations of the target demographic of 14-17 year olds, provided easy access to databases used to find potential locations for posting recruitment flyers, and overall helped focus recruitment efforts to maximize exposure of the study in areas containing high population numbers that met demographic criteria. Aside from current use of GIS for phase I of this study, in the future, we plan to use GIS software again to recruit an even larger adolescent population of 180 individuals for phase II of this study.

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Although multiple studies conducted with adult workers have been successful in discovering new workplace violence factors and consequences, workplace violence has been recognized as a leading cause of occupational mortality and morbidity [since the 1980s] (CDCP 2006 p. 5), and it is still a work hazard that affects many employees in various ways. Research on this subject is not yet complete; therefore, steps need to be taken to encourage more studies regarding workplace violence in the areas that require it, including the differences and similarities found between adolescent and adult workers regarding their experiences with workplace violence and the effects it may have had on them. By validating the selected workplace violence instruments in a small adolescent population of 25 participants in the first phase, and then collecting finalized data by testing the adapted instruments with an adolescent population of 180 participants in the second phase, this study is opening the doors to future research in unexplored workplace violence areas on large adolescent employee populations.

Recruitment Strategy for an Adolescent WPV Study References

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Centers for Disease Control and Prevention (2006). Workplace Violence Prevention Strategies and Research Needs. NIOSH Publications and Products. <http://www.cdc.gov/niosh/docs/2006-144/pdfs/2006-144.pdf>. Web. 2 Aug. 2013. Cropper, Matthew, Jerome N. McKibben, David A. Swanson, Jeff Tayman, and Lynn Wombold. (2012). Vendor Accuracy Study. ArcWatch: GIS News, Views, and Insights. Esri, <http://www.esri.com/library/brochures/pdfs/vendor-accuracy-study.pdf>. Web. 2 Aug. 2013. Driscoll, R. J., Worthington, K. A., & Hurrell, J. J. (1995). Workplace assault: An emerging job stressor. Consulting Psychology Journal: Practice and Research, 47(4), 205-212. Graham, S. R., Carlton, C., Gaede, D., & Jamison, B. (2011). The benefits of using geographic information systems as a community assessment tool. Public Health Reports (Washington, D.C. : 1974), 126(2), 298-303. Hansen, A. M., Hogh, A., Persson, R., Karlson, B., Garde, A. H., & Orbaek, P. (2006). Bullying at work, health outcomes, and physiologic stress response. Journal of Psychosomatic Research, 60, 63-72. Hogh, A., & Viitasara, E. (2005). A systematic review of longitudinal studies of nonfatal workplace violence. European Journal of Work and Organizational Psychology, 14(3), 291-313. doi:10.1080/13594320500162059 Horowitz, C. R., Brenner, B. L., Lachapelle, S., Amara, D. A., & Arniella, G. (2009). Effective recruitment of minority populations through community-led strategies. American Journal of Preventive Medicine, 37(6 Suppl 1), S195-S200. doi:10.1016/j.amepre.2009.08.006 Karen Hertel, Nancy Sprague, (2007) GIS and census data: tools for library planning, Library Hi Tech, Vol. 25 Iss: 2, pp.246 259 Lanza, M. (2006). Violence in nursing. In E. K. Kelloway, J. Barling, & J. J. Hurrell, Jr. (Eds.), Handbook of workplace violence, (pp. 147-167). Thousand Oaks, CA: SAGE Publications. LeBlanc, M. M., & Kelloway, E. K. (2002). Predictors and outcomes of workplace violence and aggression. Journal of Applied Psychology, 87(3), 444-453. doi:10.1037//00219010.87.3.444 Martsolf, D. S., Courey, T. J., Chapman, T. R., Draucker, C. B., & Mims, B. L. (2006). Adaptive sampling: Recruiting a diverse community sample of survivors of sexual violence. Journal of Community Health Nursing, 23(3), 169-182. doi:10.1207/s15327655jchn2303_4 Mueller, S., & Tschan, F. (2011). Consequences of client-initiated workplace violence: The role of fear and perceived prevention. Journal of Occupational Health Psychology, 16(2), 217229. doi:10.1037/a0021723

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National Research Council. (1998). Protecting youth at work: Health, safety, and development of working children and adolescents in the United States. Washington, DC: The National Academies Press. Pick, J. B., & Books24x7, I. (2005). Geographic information systems in business. Hershey, PA: Idea Group Pub. Rauscher, K. J. (2008). Workplace violence against adolescent workers in the U.S. American Journal of Industrial Medicine, 51(7), 539-544. doi:10.1002/ajim.20590 Runyan, C. W., Schulman, M., Dal Santo, J., Bowling, J. M., Agans, R., & Ta, M. (2007). Workrelated hazards and workplace safety of U.S. adolescents employed in the retail and service sectors. Pediatrics, 119(3), 526-534. doi:10.1542/peds.2006-2009 Smith, C. R. (2012). Exploring adolescent employees perceptions of safety from workplace violence (Unpublished doctoral dissertation). University of Cincinnati, Cincinnati, OH. Thomas A Arcury, & Sara A Quandt. (1999). Participant recruitment for qualitative research: A site-based approach to community research in complex societies. Human Organization, 58(2), 128. U.S. Bureau of Labor Statistics. (2006). Survey of workplace violence prevention, 2005 (USDL Publication No. 06-1860). Washington, DC: Author. U.S. Department Of Labor (2012). Census of Fatal Occupational Injuries Summary, 2011. Bureau of Labor Statistics. <http://www.bls.gov/news.release/pdf/cfoi.pdf>. Web. 2 Aug. 2013. U.S Department of Labor (2013). Labor Force Statistics from the Current Population Survey. Bureau of Labor Statistics. <http://www.bls.gov/cps/cpsaat03.htm>. Web. 2 Aug. 2013. U.S Department of Labor (n.d). OSHA <https://www.osha.gov/SLTC/workplaceviolence/index.html>. Web. 2 Aug. 2013. U.S Department of Labor (2012). Recommendations for Workplace Violence Prevention Programs in late-night retail establishments. OSHA. <https://www.osha.gov/Publications/osha3153.pdf>. Web. 2009. Wieclaw, J., Agerbo, E., Mortensen, P. B., Burr, H., Tuchsen, F., & Bonde, J. P. (2006). Work related violence and threats and the risk of depression and stress disorders. Journal of Epidemiology and Community Health, 60(9), 771-775. doi:10.1136/jech.2005.042986

Recruitment Strategy for an Adolescent WPV Study Figures

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Figure 1.) Map of target areas: Census Block Groups and Zip Codes

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Figure 2.) Map of target areas overlaid by community assessment locations

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Figure 3.) Map of target areas overlaid by community assessment locations and pins of potential recruitment flyer locations

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Figure 4.) Map of community assessment areas overlaid with pins of current locations of posted recruitment flyers

Recruitment Strategy for an Adolescent WPV Study Tables

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Table 1.) Demographic data for current locations of posted recruitment flyers