RESEARCH TRAINING AND EDUCATION CORE

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While the extent of disparities related to race, ethnicity, and socioeconomic status in Hawai'i is large, the number of investigators trained to analyze these disparities is not. The goal of the Research Training and Education Core is to develop a diverse scientific workforce to study health disparities and promote health equity, which is one of the central goals of the Center grant renewal. The outcomes described above are expected to have an important positive impact because increasing the number of investigators interested in health disparities research, improving their skill sets, and exposing them to trans-disciplinary approaches will enhance our ability to conduct innovative, comprehensive, well-designed research studies to reduce disparities and improve the health of vulnerable populations in Hawai'i and other similar at-risk populations in the Pacific and globally. Unless we invest now in building the human capital essential to understanding the nature and reasons for gaps in quality and outcomes of care, we will lessen our ability to address these disparities and improve outcomes for vulnerable populations. While overall health status in Hawai'i, whether measured by life expectancy or quality of life, is very high, Hawai'i is burdened with considerable inequities in health outcomes related to race, ethnicity, and socioeconomic status. Prominent among these disparities is the lower life expectancy and increased prevalence of disease among Native Hawaiians and other Pacific Islanders [Bitton et al.; Mau et al.; Grandinetti et al.; Maskarinec et al; Aluli et al; Harris and Jones]. Recognizing this, many investigators are interested in conducting research studies to better understand the nature and origins of these disparities, and to follow this exploratory research with targeted interventions. There are critical barriers, however, limiting investigator ability to develop the skills necessary to conduct health disparities research. Availability of instruction and statistical support are two other important issues (Specific Aims 1). There are very few courses offered at the University of Hawai'i focused on applied biostatistics. Nationally, there is an upsurge of available techniques and approaches to measuring disparities that go beyond clinical trials. These approaches focus on real world effectiveness rather than efficacy and have shorter time horizons, increasing their ability to be translated into actionable interventions. The Research Training and Education Core would fill this gap by providing a course on case-based research methodology and another course on comparative effectiveness analysis and health disparities research to doctoral students and junior faculty. Our lectures to master- and doctoral-level students regarding these methodologies will hopefully spark interest in the field at a critical point as they begin to focus on specific research topics. Assembling data can also be costly and time consuming but there are economies of scale. If we house large data sets and develop expertise, we can support many students and junior faculty. The Core would house and make available to students and faculty data for health disparities research (Specific Aim 2). The content of these datasets will depend on the interest of participants, but might include a diabetes registry created by the Center, Medicare Public Use Files (http://www.cms.gov/BSAPUFS) linked with SEER cancer data (http://seer.cancer.gov), and local and national Behavioral Risk Factor Surveillance System Data (http://www.cdc.aov/BRFSS: http://hawaii.gov/health/neighbor/statistics/brfss/brfss/index.html). An additional barrier is the "silo" approach that is often taken to reduce disparities [Marmot et al.]. For example, public health has approaches based on community-based initiatives, physicians and nurses tend to take a case by case counseling approach, pharmacists discuss medications, and alternative care providers focus on their treatment of choice. However, the problem of obesity, and other components of Cardiometabolic Syndrome, is too complex to tackle from a single perspective. By training students and investigators from various disciplines in the same course, we hope to encourage the development of a trans-disciplinary research perspective and to foster the development of interdisciplinary teams (Specific Aim 3) among young investigators. Trans-disciplinary approaches have been shown to lead to significant advances in understanding and reducing health disparities [Emmons et al]. If the proposed aims of this study are achieved and more researchers are inspired and trained in health disparities research, we believe significant advances can be made in the field that can be used to guide the development of treatments, services, and preventative interventions to achieve desired outcomes for vulnerable populations in Hawai'i.