Open Access Open Badges Research article

Response rates and selection problems, with emphasis on mental health variables and DNA sampling, in large population-based, cross-sectional and longitudinal studies of adolescents in Norway

Espen Bjertness12*, Åse Sagatun3, Kristian Green1, Lars Lien45, Anne Johanne Søgaard16 and Randi Selmer6

Author Affiliations

1 Section for Preventive Medicine and Epidemiology, Institute of General Practice and Community Medicine, Faculty of Medicine, University of Oslo, Box 1130 Blindern, 0318 Oslo, Norway

2 Tibet University Medical College, No. 1 South Luobulinka Road, Lhasa, 850002 Tibet, China

3 Research Department, Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Box 4623 Nydalen, 0405 Oslo, Norway

4 Institute of Psychiatry, University of Oslo, Box 1130 Blindern, 0318 Oslo, Norway

5 Innlandet Hospital Trust HF, DPS Gjøvik, Kyrre Grepps 22, 2819 Gjøvik, Norway

6 Division of Epidemiology, Norwegian Institute of Public Health, Box 4404 Nydalen, 0403 Oslo, Norway

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BMC Public Health 2010, 10:602  doi:10.1186/1471-2458-10-602

Published: 12 October 2010



Selection bias is a threat to the internal validity of epidemiological studies. In light of a growing number of studies which aim to provide DNA, as well as a considerable number of invitees who declined to participate, we discuss response rates, predictors of lost to follow-up and failure to provide DNA, and the presence of possible selection bias, based on five samples of adolescents.


We included nearly 7,000 adolescents from two longitudinal studies of 18/19 year olds with two corresponding cross-sectional baseline studies at age 15/16 (10th graders), and one cross-sectional study of 13th graders (18/19 years old). DNA was sampled from the cheek mucosa of 18/19 year olds. Predictors of lost to follow-up and failure to provide DNA were studied by Poisson regression. Selection bias in the follow-up at age 18/19 was estimated through investigation of prevalence ratios (PRs) between selected exposures (physical activity, smoking) and outcome variables (general health, mental distress, externalizing problems) measured at baseline.


Out of 5,750 who participated at age 15/16, we lost 42% at follow-up at age 18/19. The percentage of participants who gave their consent to DNA provision was as high as the percentage that consented to a linkage of data with other health registers and surveys, approximately 90%. Significant predictors of lost to follow-up and failure to provide DNA samples in the present genetic epidemiological study were: male gender; non-western ethnicity; postal survey compared with school-based; low educational plans; low education and income of father; low perceived family economy; unmarried parents; poor self-reported health; externalized symptoms and smoking, with some differences in subgroups of ethnicity and gender. The association measures (PRs) were quite similar among participants and all invitees, with some minor discrepancies in subgroups of non-western boys and girls.


Lost to follow-up had marginal impact on the estimated prevalence ratios. It is not likely that the invitation to provide DNA influenced the response rates of 18/19 year olds. Non-western ethnicity, male gender and characteristics related to a low social class and general and mental health problems measured at baseline are associated with lost to follow-up and failure to provide DNA.