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Correspondence: Address correspondence to Leslie Curry, Braceland Center for Mental Health and Aging, The Institute of Living, Hartford Hospital Mental Health Network, 200 Retreat Avenue, Hartford, CT 06106. E-mail: lcurry@harthosp.org
Advances in scientific knowledge must begin to address the significant health disparities that persist among ethnic and racial minority groups in the United States (Pinn, 2000; Ruffin, 2000). Exceedingly low participation rates of older ethnic minorities and women in health research have been well documented (Gavaghan, 1995). Policies encouraging involvement of underrepresented groups in health research have been in place at the National Institutes of Health (NIH) since the mid 1980s (Roth, Pinn, Hartmuller, Bates, & Fanning, 2000), and, in 1994, NIH issued Guidelines on Inclusion of Women and Minorities as Subjects in Clinical Research mandating such inclusion.
The NIH, and the Office of Research on Women's Health (ORWH) in particular, have stressed the importance of recruiting women as research volunteers, especially those from diverse cultures and minority populations (Becker et al., 1992; NIH, ORWH, 1997). Policy and research efforts such as the Women's Health Initiative are anticipated to address past discrepancies in many scientific areas (Hall, 1999). A recent Government Accounting Office (GAO) evaluation reported that NIH has made significant progress in increasing representation of women in clinical research (GAO, 2000).
Nevertheless, the science of recruitment and retention of ethnic minorities is in its early stages, with models only recently being developed and evaluated (Ory, Lipman, Barr, Harden, & Stahl, 2000; Swanson & Ward, 1995). Although there are a few practical guides to assist investigators (for example, LaRosa, Seto, Caban, & Hayunga, 1995; NIH, ORWH, 1994), current information about effective approaches is quite limited. Barriers and facilitators to research participation among ethnic minorities of all ages are just beginning to be examined, with much of the literature focusing on cancer prevention (Giuliano et al., 2000; Underwood, 2000). Research on older adults has primarily addressed recruitment and retention in clinical trials for cancer (Moinpour et al., 2000; Zhu et al., 2000), osteoporosis (Unson, Dunbar, Curry, Kenyon, & Prestwood, 2001), Alzheimer's disease (Gauthier & Clarke, 1999), mental health services (Areán & Gallagher-Thompson, 1996) and primary prevention studies such as dietary interventions and exercise trials (Coleman et al., 1997; Dennis & Neese, 2000; Lewis et al., 1998; Prohaska, Walcott-McQuigg, & Peters, 2000). Several themes emerge from this growing body of literature: (a) trust and connection with the community is central, (b) involvement of ethnic and racial minority researchers at all levels (lead investigator to data collector) is essential, and (c) barriers to recruitment can stem from research institutions as well as the minority community of interest (Levkoff, Levy, & Weitzmann, 2000). Despite recent progress, the need persists for development of theory-based, population-specific models of recruitment and retention, coupled with systematic evaluation of impact and cost-effectiveness (Ory et al., 2000).
Against this backdrop, the National Institute on Aging (NIA) sponsored a preconference to The Gerontological Society of America's 1999 Annual meeting, "Involving Older Ethnic Minorities in Health-Related Research." The workshop faculty examined recruitment and retention of research volunteers in older ethnic minority populations with regard to four core scientific domains: (a) cultural competence, (b) barriers to participation, (c) ethical considerations, and (d) implementing recruitment and retention activities. Collaborating NIA-supported centers included the Resource Centers on Minority Aging Research, the Claude Pepper Older Americans Independence Centers, the Edward R. Roybal Centers for Research on Applied Gerontology, and the Alzheimer's Disease Centers. The conference faculty featured 25 ethnically diverse investigators from various universities, research institutions, and government agencies.
Conference evaluation data (n = 64; 50% of participants) indicated a significant need for information regarding practical strategies for recruitment and retention of ethnic minority populations, both in clinical and health services aging research. When asked about supports available to assist investigators to involve older ethnic and racial minorities in research, attendees reported informal networks and/or colleagues as the most common resource (77%) and the presence of minority investigators as the least common (21%). More than half of the respondents rated their efforts at recruitment and retention of older minorities as only moderately successful. This likely underestimates success in aging research generally, as this self-selected group of conference attendees may devote greater attention to the issue of involving minority populations. The majority (58%) of respondents reported their university does not provide sufficient supports to accomplish their recruitment goals. Cross-center collaboration among investigators studying ethnic minority populations is quite limited (34%). Only one third (34%) of respondents indicated they presently collaborated with other NIA-supported centers in the area of recruitment and retention of minority populations.
A representative selection of six articles from this 1999 scientific meeting is shared in this issue of The Gerontologist. The articles address diverse populations historically underrepresented in health-related research, including older African American and Latino men and women. Barriers to recruitment and retention of ethnic minorities in research are examined in the context of clinical trials, health services research, and survey research. The series opens with an overview of lessons learned by the NIA-sponsored Exploratory Centers on Minority Aging and Health Promotion by Sue Levkoff and colleagues. The "matching model of recruitment" addresses barriers and enablers to recruitment from the perspective of both the researcher and participant community. Next, Marvella Ford examines issues related to recruitment of low-income African American men to a randomized cancer screening trial. Consumer-centered approaches to recruitment and retention are described by Patricia Areán in the context of mental health services research, an area of particular relevance for minority older adults. Recommendations for recruitment in clinical intervention research with Latina caregivers are based on the experiences of Dolores Gallagher-Thompson and colleagues. An innovative model of community and church-based recruitment of African Americans is evaluated by Peter Reed and colleagues at Duke. Finally, Diane Brown and colleagues explore the role of attitudes and knowledge in decisions to participate in clinical treatment trials among African Americans and Whites.
These articles, along with the valuable but limited prior literature, begin to forge an empirical science of recruitment and retention of older ethnic and racial minority participants in health research. The work represented by these six articles highlights challenges and presents important opportunities for advancing research intended to reduce the large and unacceptable racial and ethnic disparities in health status and service delivery among older adults.
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1Braceland Center for Mental Health and Aging and University of Connecticut School of Medicine, Hartford. 
1Institute for Social Research, University of Michigan, Ann Arbor.
Received for publication July 11, 2002. Accepted for publication July 12, 2002.
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