Cleveland is characterized by an extremely high poverty rate, substantial numbers of racial/ethnic minorities, and marked health disparities. We propose to engage Cleveland's health care providers, educational institutions, community organizations, and government agencies to understand and reduce health disparities. To take advantage of pre-existing community and institutional strengths, we will focus initially on 3 interrelated prototypical conditions: hypertension, kidney disease, and transplantation. These conditions affect many individuals and have some of the most striking health disparities observed in the United States. The Research Core includes projects that involve (a) utilizing lay health advisors to help patients address the social contextual factors that act as barriers to hypertension management, (b) utilizing interpreters as advocates for Spanish speaking patients with hypertension or kidney disease, and (c) utilizing transplant recipients as navigators to improve access to kidney transplantation. The Research Training/Education Core involves (a) recruiting students, particularly from minority backgrounds, into undergraduate, graduate, and postdoctoral programs related to health disparities, (b) providing diverse educational opportunities relevant to health disparities research, and (c) supporting postdoctoral students and junior faculty, particularly from underrepresented groups, to ensure successful entry into academic positions. The Community Engagement/Outreach Core involves a community-based video intervention to enhance signing of organ donor cards. The Administrative Core will coordinate and foster interactions across projects/cores, provide shared resources and personnel, assist in other community efforts to address disparities, lead interactions with other NCMHD Research Centers of Excellence, disseminate findings, and develop future initiatives. Each of the three research projects as well as the Community Engagement/Outreach Core focus on testing interventions to reduce health disparities. Moreover, the design of these interventions is informed by an understanding of the mechanisms that created health disparities in each of the areas studied. Other strengths and innovative features of our application include selection of projects through a community-wide approach, a strong institutional commitment, and the experience and commitment of the study team. In addition, the proposed projects have been designed not only to address an important aspect of health disparities but also to set the stage for future larger scale efforts. The community and institutional infrastructure established as a result of conducting these projects will be used in future efforts that target a broader range of conditions.
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