Is the collaborative activity of organizations in a network associated with the capacity of individual organizations? How might the structure of collaborative activity and the location of high capacity organizations in a network be related to the network's overall ability to influence community conditions? This article explores these questions among 23 local organizations providing women and new mothers with health care, advocacy, and other services in a single US city. Changes in the interorganizational network of collaborations are depicted in four time periods spanning 12 years and analyzed over time using both whole network and local network measures. Organizational attributes associated with dimensions of organizational learning and organizational effectiveness are examined in relation to interorganizational network changes over time. Results indicate that more adaptable organizations and those with higher capacity were not necessarily central in the network. Overall, findings suggest that increases in cohesion across a structurally diffuse network, relatively well dispersed high capacity organizations, and strategic relational investments may have influenced the reduction in health disparities for infants and expecting mothers. Although community-level interventions often focus on building a strong, central group of high capacity organizations, these findings suggest a need to also take into account the strategic action of a range of individual organizations, their local networks, and how they may advance change in the broader network over time.

Health is locally produced by individuals, families, and households through the interplay and strategic utilization of a variety of internal and external resources, yet distally influenced by the larger ecological environment within which these are situated. The specific environmental factors that influence health vary across time and space, but are important to understanding and addressing health disparities. Data for this project come from 33 Hmong women who participated in focus groups conducted as part of an exploratory community-based research study investigating cervical cancer screening disparities in the Milwaukee, Wisconsin Hmong community. Participants identified a number of factors broadly falling into two ecological contexts-culture (beliefs about disease causation, treatment seeking, and modesty) and community (collective decision making, health literacy, and language)-influencing screening decisions. Understanding of these factors is important for developing culturally embedded and locally relevant solutions aimed at effectively increasing cervical cancer screening rates and improving health outcomes for Hmong women.

We present four lessons learned that can be useful to partnerships seeking to address health disparities at multiple ecological levels beyond individual-level change. We recommend that CBPR practitioners consider the role of SDH in CBPR studies involving health disparities.

For a seven-year period, the disparity in birth outcomes between Blacks and non-Hispanic Whites in one

We posit that the integral involvement of the Hmong community from the outset promoted buy-in of ensuing Consortium education and outreach efforts, and helped to ensure fit with community perspectives, needs, and priorities.