The research enterprise fueled by the necessary infrastructure and capacity is a powerful tool for advancing knowledge about health disparities. However, we have discovered during the past 4 years of leading the Center for the Advancement of Health Disparities Research (CAHDR) that equally powerful experiences and lessons about our approach to health disparities research have come through the development of relationships with those communities who experience health disparities. It seems that the key to a successful research partnership is the careful integration of the academic pursuit of research with the experience, participation, and guidance of community members whose future can be improved through the research enterprise. This supplement is intended to share the results of research supported through the CAHDR and to tell the story of the center's advocacy for a community-initiated approach to reducing health disparities. You will hear the voices of our investigators throughout the journal and, if we have told the story well, the voices of our collective communities as well.

In response to a Request for Applications in 2002 from the National Institute of Nursing Research to establish Nursing Partnership Centers on Health Disparities using the P20 mechanism, the University of Hawaii at Manoa School of Nursing and Dental Hygiene and the University of Washington School of Nursing developed the vision for a research center whose purpose was to collaborate to strengthen the research capacity and infrastructure of each university in pursuing excellence in health disparities research. In addition, we wanted to create a center that would mentor nurse researchers through learning institutes, guided research studies, and dissemination of new knowledge and to create a knowledge base for innovation in health disparities research.

The conceptual framework for the center expressed our interest in a range of issues that were related to health disparities (research trends and appropriate methodology, determinants of health, effects on population health, healthcare needs and costs, and policy and system supports).1 These issues were correlated with variables of interest to researchers wanting to study health disparities, such as evidence-based nursing interventions, racial and ethnic discrimination, mental health, access to care, and quality indicators. Our partnership, the CAHDR, was designed to build capacity in health disparities, facilitate research opportunities, engage with communities, recruit new researchers, mentor nurse investigators, and disseminate research findings. We imagined that overtime our center could ultimately contribute to the reduction of health disparities in those communities who engaged with us in research.

The collaborative relationship between the University of Washington and the University of Hawaii at Manoa has fostered sustainable mechanisms for research and research capacity development in health disparities. Because of the Hawaiian diverse ethnic population, geographic isolation, relatively stable population, and evidence of health disparities across the life span, many research needs were identified by the University of Hawaii at Manoa faculty and their community Advisory Board. The University of Washington School of Nursing has strength as a research one university and has been able to assist investigators in advanced research training. The CAHDR has mentored researchers in both institutions and community partners. These mentored researchers have begun the development of a knowledge base in health disparities research, which is continuing through the development and funding of larger extramural grants by CAHDR grantees.

Since we began in 2003, the CAHDR has funded 23 health disparities--related studies. Presented in this supplement are the results of 8 of our investigators who received grants through the CAHDR to conduct pilot studies focused on health disparities. These studies have focused on 3 of the 5 issues related to the health disparities identified in the conceptual framework developed to guide CAHDR's mission: the determinants of health, the healthcare needs, and the effects on population health.1 The determinants of health for individuals with physical limitations are explored by Warms and colleagues. Cooke describes social and environmental issues that influenced her research with spouses of incarcerated men. The effects of health disparities on population health were explored in the programmatic influences on foster children (Ellermann), in the influence of acculturation on Korean mothering (Kim et al), in the breastfeeding patterns of Native Hawaiian mothers (Hodgson et al), and in the lived-experience of obsessive-compulsive disorder within a multiethnic community (Olson et al). An ethnographic study of Chinese immigrant restaurant workers' occupational health issues (Tsai and Salazar) and an immunization clinic intervention study with underserved children (Niederhauser et al) addresses disparities found within the delivery of healthcare. Clearly, these are pilot studies, beginning explorations within populations having identified health disparities. The CAHDR has been able to facilitate this initial work along with developing the skills of these researchers, who are currently continuing to study these issues building on what has been learned. This model of capacity building through collaboration between schools of nursing has been successful; however, to enable the growth and development of health disparities research beyond this initial level into research in methodology and policy, a continued collaborative effort is required. This is our goal.

Bobbie Berkowitz, PhD, RN, FAAN

Joan Dodgson, PhD, MPH, RN, Issue Editors

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