The purpose of this review is to describe the state of the art in recruiting participants for clinical trials designed to test new methods of treatment or disease prevention. The ultimate objective of this review is to provide a summary of key issues in recruiting diverse populations into clinical trials, particularly ethnic and racial minorities. An overview of general issues related to clinical trial participation is followed by a detailed discussion of specific issues that must be addressed by investigators as they recruit minority populations for clinical trial. To date, the majority of clinical trials have included a limited segment of the U.S. population: middle-class, married white males. These trials have faced many problems in their efforts to recruit participants, including barriers to physician participation, barriers to subject participation, barriers to planning and implementing effective recruitment strategies, and costs of the recruitment phase of clinical trials. Following this general introduction is a discussion of the definition of diverse populations. The first step investigators must take as they prepare to recruit study participants is to develop a relevant definition of the subject populations. A detailed review of investigators' experiences in recruiting minorities into clinical trials is presented, including barriers to minority recruitment, barriers inherent in study design, researcher bias, barriers to minority physician participation, as well as strategies for minority recruitment, modifications of study design, and cost issues. Formal evaluation of recruitment strategies has been limited. Most investigators present descriptive reports of their experience in recruiting diverse populations into clinical trials. Research into the issues presented and rigorous testing of specific strategies is needed. A series of steps that are essential to effective clinical trials recruitment of diverse populations is presented.

Cancer incidence in Appalachia was not found to be elevated. However, incidence of cancer of the lung/bronchus, colon, rectum, and cervix was elevated in Appalachia. The rates of unstaged cancer of every examined site were elevated in rural Appalachia, suggesting a lack of access to cancer health care.

Residents of Appalachia, especially those in rural Appalachia, are generally considered to be medically underserved. In fact, cancer mortality in Appalachia, especially in rural Appalachia, is higher than it is in the remainder of the United States. Developing from the Appalachia Leadership Initiative on Cancer, the Appalachia Cancer Network (ACN) is a network of academic and community organizations that seek to conduct surveillance, intervention, and dissemination research to reduce this excess cancer burden in Appalachia. The purpose of this report is to (1) describe the approach to cancer control research in ACN, a Special Population Network, among the medically underserved of Appalachia, and (2) to put forward observations from this experience to enhance the research of other academic and community networks among underserved populations. ACN has instituted a conceptual model, organizational structure, and other methods to foster this research and to develop junior and community-based investigators. Important issues and questions related to the effectiveness of such research networks have also been articulated.

The purpose of this study was to identify potential opportunities for improving member participation in community-based coalitions. We hypothesized that opportunities for influence and process competence would each foster higher levels of individual member participation. We tested these hypotheses in a sample of 818 members within 79 youth-oriented coalitions. Opportunities for influence were measured as members’ perceptions of an inclusive board leadership style and members’ reported committee roles. Coalition process competence was measured through member perceptions of strategic board directedness and meeting effectiveness. Members reported three types of participation within meetings as well as how much time they devoted to coalition business beyond meetings. Generalized linear models accommodated clustering of individuals within coalitions. Opportunities for influence were associated with individuals’ participation both within and beyond meetings. Coalition process competence was not associated with participation. These results suggest that leadership inclusivity rather than process competence may best facilitate member participation.

The purpose of this study was to identify attributes of community-based coalitions associated with member perceptions of greater impact. Based on Hackman’s model of work group effectiveness, we hypothesized that member effort, knowledge and skill, and performance strategies would affect their perceptions of coalition impact. Findings from a lagged regression on a sample of forty-five youth-oriented coalitions indicated that two aspects of member effort were associated with subsequent perceived impact, as were performance strategies for both coalition governance and community interventions. There were no associations, however, between member knowledge and skill and perceived impact. These results suggest that leaders may improve perceived coalition impact by encouraging member participation in discussions and interventions and by developing effective strategies for both governance and implementation.