they examined reference lists for eligible articles. Titles and abstracts were reviewed to identify relevant studies. Data on barriers to participation were synthesized both qualitatively and based on statistically significant associations with trial enrollment. Of 5257 studies that were cited, 65 studies were eligible for inclusion in the current analysis, including 46 studies on recruitment into cancer therapeutic trials, 15 studies on recruitment into prevention trials, and 4 studies on recruitment into both prevention and treatment trials. Numerous factors were reported as barriers to participation in cancer-related trials. However, only 20 of the studies reported statistically significant associations between hypothesized barriers and enrollment. The available evidence had limitations in quality regarding representativeness, justification of study methods, the reliability and validity of data-collection methods, potential for bias, and data analysis. The results indicate that underrepresented populations face numerous barriers to participation in cancer-related trials. The current systematic review highlighting the literature on recruitment of underrepresented populations to cancer trials and may be used as the evidence base toward developing an agenda for etiologic and intervention research to reduce the disparities in participation in cancer-related trials. Cancer ;112:228-42. 2008

Obesity results from a complex interaction between diet, physical activity, and the environment. The built environment encompasses a range of physical and social elements that make up the structure of a community and may influence obesity. This review summarizes existing empirical research relating the built environment to obesity. The Medline, PsychInfo, and Web of Science databases were searched using the keywords "obesity" or "overweight" and "neighborhood" or "built environment" or "environment." The search was restricted to English-language articles conducted in human populations between 1966 and 2007. To meet inclusion criteria, articles had to 1) have a direct measure of body weight and 2) have an objective measure of the built environment. A total of 1,506 abstracts were obtained, and 20 articles met the inclusion criteria. Most articles (84%) reported a statistically significant positive association between some aspect of the built environment and obesity. Several methodological issues were of concern, including the inconsistency of measurements of the built environment across studies, the cross-sectional design of most investigations, and the focus on aspects of either diet or physical activity but not both. Given the importance of the physical and social contexts of individual behavior and the limited success of individual-based interventions in long-term obesity prevention, more research on the impact of the built environment on obesity is needed.

Previous educational and behavioral interventions in type 2 diabetes have produced modest improvements in glycemic control. Future research should refine such interventions and improve methodology.

Cultural competence training shows promise as a strategy for improving the knowledge, attitudes, and skills of health professionals. However, evidence that it improves patient adherence to therapy, health outcomes, and equity of services across racial and ethnic groups is lacking. Future research should focus on these outcomes and should determine which teaching methods and content are most effective.

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