Snowball sampling by mail: application to a survey of smokers in the general population

In a series of surveys intended for current and former smokers but sent to a random sample of the general population, we asked never smokers and smokers who did not wish to participate to transmit the questionnaire to any ever smoker they knew. We compared participants who received the questionnaire directly from us (original participants) to participants who received it from an addressee (secondary participants).

Questionnaires on smoking were mailed to 3300 residents of Geneva (Switzerland) in 1997, and returned by 1167 people (35%).

The final sample consisted of similar numbers of original participants (n = 578, primary response rate = 18% of total sample, or about 46% of ever smokers) and secondary participants (n = 566). Original participants were 1.7 years older than secondary participants (P = 0.03) and were more likely to be men (50% versus 43%, P = 0.009). Proportions of current smokers, stages of change, confidence in ability to quit smoking, cigarettes per day and attempts to quit smoking were similar in the two groups. Secondary participants had lower self-efficacy scores (-0.30 standard deviation (SD) units, P < 0.03), and they derived more pleasure from smoking (+0.25 SD units, P = 0.04). Among ex-smokers, direct participants were less active than secondary participants in coping with the temptation to smoke (-0.58 SD units, P = 0.002). Associations between smoking-related variables were similar in original and secondary participants.

Allowing non-eligible addressees to transmit the questionnaire to someone else doubled the response rate, produced moderate bias on some variables only and had no detectable impact on associations between smoking-related variables.