Recruitment for large cohort studies is typically challenging, particularly when the pool of potential participants is limited to the descendants of individuals enrolled in a larger, longitudinal “parent” study. The increasing complexity of family structures and dynamics can present challenges for recruitment in offspring. Few best practices exist to guide effective and efficient empirical approaches to participant recruitment. Social and behavioral theories can provide insight into social and cultural contexts influencing individual decision-making and facilitate the development strategies for effective diffusion and marketing of an offspring cohort study. The purpose of this study was to describe the theory-informed recruitment approaches employed by the Jackson Heart KIDS Pilot Study (JHKS), a prospective offspring feasibility study of 200 African American children and grandchildren of the Jackson Heart Study (JHS)—the largest prospective cohort study examining cardiovascular disease among African American adults. Participant recruitment in the JHKS was founded on concepts from three theoretical perspectives—the Diffusion of Innovation Theory, Strength of Weak Ties, and Marketing Theory. Tailored recruitment strategies grounded in participatory strategies allowed us to exceed enrollment goals for JHKS Pilot Study and develop a framework for a statewide study of African American adolescents.

Objectives The objectives of the study were to examine knowledge and perceptions of undergraduate and graduate students regarding participation in clinical trials and explore the degree to which knowledge and perceptions about research participation can vary by race. Methods A cross-sectional survey was administered to undergraduate and graduate students between 18 and 35 years of age at a public minority-serving institution and a private, predominately-white university in the Southern United States. A total of 171 African American students and 119 Caucasian students completed the survey. Results Descriptive analyses were conducted and T-and chisquare tests were used to assess racial differences across key indicators. Fifty-nine percent of respondents were African American and 41 % were male. African American and Caucasian participants had similar experiences with research participation and had comparable knowledge about research participation. Racial differences were found in two areas. African American students with no prior research experience were more willing to participate in a future clinical trial (33 vs 22 %, p<0.0001) and had a higher average perception of clinical research score (29.7 vs 27.4 %, p<0.001). Conclusions The results from this study suggest that the gap between African American and Caucasian knowledge and perceptions about research may be closing and additional studies are needed to explore how generational differences can impact these factors among underrepresented groups. A deeper understanding of key influences associated with knowledge and perceptions among hard-to-reach populations would go a long way toward the development of culturally relevant and respectful clinical trial education programs that would inform potential participants before recruitment.

Background: It remains unclear if individuals with low Framingham risk score (FRS) could benefit from coronary artery calcium (CAC) screening for coronary heart disease (CHD) risk, especially in African Americans (AA) who have a lower prevalence of CAC and in whom the FRS is less robust. The CAC score has previously been shown to independently predict hard events in AA men and women. We assessed the association of CAC with cardiovascular risk factors and its distribution by the FRS categories in AA who were part of the Jackson Heart Study (JHS). Methods: CAC was measured with non-contrast cardiac CT in 2944 participants between April 2007 and February 2010 in the JHS, a NHLBI-funded cohort study of AA based in Jackson, MS. Participants were dichotomized based on the presence or absence of CAC. FRS was calculated based on 10 year risk for each participant and categorized as low (<10%), intermediate (10–20%) and high (>20%). Multi-variable linear and logistic regression analyses were used to estimate the associations of CAC with cardiovascular risk factors by FRS categories in AA. Results: The mean age of the cohort is 60 years, 65% were females, 26% had diabetes mellitus, 50% were obese (BMI≥30) and 30% were current or former smokers. Participants with CAC were significantly older (mean age 65 vs. 55 years, p<0.0001), had high mean SBP (131 vs.124mmHg, p<0.0001) and had lower HDL. Males were more likely to have CAC compared with females [odds ratio (95% CI): 1.50(1.29 – 1.75), p<0.0001], current and former smokers were also more like to have CAC compared with never smokers [OR (95%CI): 2.24(1.75 – 2.89), p<0.006 and 2.10(1.73 – 2.55), p<0.002 respectively]. Diabetics were more likely to have CAC compared with non diabetics [OR (95%CI): 3.27(2.70 – 3.96), p<0.0001]. Total cholesterol and BMI were not different among subjects with CAC or without CAC. The distribution of CAC stratified by FRS groups of low, intermediate and high 10 year risk of CHD results in mean [median, range] CAC scores of 132.3 [0, (0–3884)], 101.8 [0, (0–5498)] and 315.1 [33.8, (0–10801)] and CAC prevalence of 39.7%, 42.1%, and 65.8%, respectively. After adjusting for age, gender, smoking status, systolic blood pressure and diabetes status, subjects with high FRS were about 3 times as likely to have CAC compared with subjects in the intermediate or low risk category [OR(95%CI): 2.92(2.41 – 3.51), p<0.0001]. Individuals with intermediate FRS had similar rate of CAC compared with low FRS individuals. Conclusion: CAC in AA is strongly associated with traditional CV risk factors. Interestingly, AA with low and intermediate FRS have similar amounts and prevalence of CAC. This finding suggests that further refinement of traditional CHD risk models, such at FRS, may allow improved prediction of CHD and better targeting of prevention in the AA community.