The theme for this Program Project is Promoting Effective Communication and Decision-Making in Diverse Populations. Research proposed builds on our experience over the last decade conducting studies aimed at facilitating the reduction of racial and ethnic health disparities. This experience, along with findings from other research, has led us to believe that ineffective communication, resulting in suboptimal decision-making, is a core problem contributing substantially to the health gap observed today. Specifically, we hypothesize that racial/ethnic disparities in health may be attributable to less effective communication and decision-making in minority populations compared to their counterparts, leading to differences in technical processes of care that affect outcomes. In this Program Project we will I) identify elements of effective communication in diverse populations; 2) determine factors that enhance effective, patient-preference based, clinical decision-making (screening, diagnostic and treatment choices); 3) Evaluate methods for communicating risks (probability and outcomes) in diverse populations; 4) Lay foundation for developing decision-assisting tool(s) for coronary disease evaluation and treatment, and for cancer screening; and 5) Develop greater capacity for health services research, including a) expanding the pool of minority investigators focused on racial and ethnic minority populations, and b) improving methodologies for conducting research in diverse populations (scientific advancement). Findings from this Program Project will illuminate the elements of communication, expectations, values and interpersonal relationships that characterize the delivery and use of health care services for patients of different race/ethnicity, so that effective interventions may be devised. We will make these critical advances in the field by a) developing a more comprehensive specification of influences and variables hypothesized to explain disparities in health care and health; b) using a variety of complementary methodologies (primary data collection, secondary data analysis and direct observation) ; and c) employing multi-level approaches designed to capture the complexities of multiple pathways to health in diverse populations.