EPI 222: Social Determinants of Health and Health Disparities: What Every Researcher Should Know (Winter 2019)
Section outline
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Lecture: Introduction to research with diverse populations
Research in diverse populations requires an understanding of the complex multi-level influences on human health and how these are patterned by sociodemographic characteristics, including race/ethnicity and socioeconomic status. This lecture will provide an introduction to conceptual models for these multi-level influences on health, including the role of a lifecourse perspective, and their relevance to research of all types on human health. This multi-level framework will then provide the structure for the following four lectures of the course, which will review sequential layers of this model. In addition, we will review the history of research in diverse populations and on health disparities, the measurement of socioeconomic status and race, and strategies to optimize recruitment and retention of diverse populations in research studies.
Faculty: Christine Dehlendorf
Location: Mission Hall 1400-
caulfield race File
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ecology perinatalmortality File
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Quinn SC 2012 Attributes of researchers File
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Research diversepops napoles File
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Online Section
Please join my meeting from your computer, tablet or smartphone.https://ucsf.zoom.us/j/276946017
You can also dial in using your phone.
United States: +1 (669) 900-6833
Meeting ID: 276 946 017 -
Lecture: Multi-level etiologies of health in diverse population, Part 1: Social determinants of health
Social determinants of health are the conditions in which people are born, grow, work, live, and age, including education, wealth, occupation, neighborhood of residence, and the experience of racism. These factors are increasingly recognized as critical upstream influences that drive individual level health, as well as differences in health across groups. This lecture will provide an overview of what is known about the role of social determinants and their relationship to clinical research.
Faculty: Salma Shariff-Marco
Location: Mission Hall 1400-
WHO Commission SDH - Read Chapter 5.5, 5.6 and 5.7 File
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Gardners tale File
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Massoglia 2008 prison race health File
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Braveman Socioeconomic Status File
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Online Section
Please join my meeting from your computer, tablet or smartphone.https://ucsf.zoom.us/j/276946017
You can also dial in using your phone.
United States: +1 (669) 900-6833
Meeting ID: 276 946 017 -
Lecture: Multi-level etiologies of health in diverse populations, Part 2: Behavioral mechanisms
Human behavior – from what we eat, to whether we exercise, to who are friends are- has a clear, and often measurable, impact on health. Research on differences in health across groups often points to differences in behaviors as underlying causes. In this lecture, we will review what is known about the role of behavior in producing differences in health across groups and relate these differences to the social determinants of health.
Faculty: Scarlett Gomez
Location: Mission Hall 1400-
Pampel FG et al. Socioeconomic Disparities in Health Behaviors. Annu Rev Sociol. 36: 349-370. 2010 File
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Adverse Childhood Experiences and adult health behaviors File
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self control 2000 File
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Online Section
Please join my meeting from your computer, tablet or smartphone.https://ucsf.zoom.us/j/276946017
You can also dial in using your phone.
United States: +1 (669) 900-6833
Meeting ID: 276 946 017 -
Lecture: Multi-level etiologies of health in diverse populations, Part 3: Biological determinants, mediators and mechanisms
One of the most active areas of health disparities research is understanding how social experiences get “under the skin” to influence health. As discussed in previous classes, behavioral factors and clinical care are important mechanisms, but study after study has shown that behaviors and medical care cannot fully explain the magnitude of social inequalities in health. In this class we will review key hypothesized mechanisms via which adverse social experiences change human physiology and have enduring effects on long term health outcomes. Leading hypotheses include the role of epigenetic changes; dysregulation of stress responses via hypothalamic pituitary adrenal axis alterations; and physiologic triggers of behavioral patterns. We will discuss how these biological mechanisms directly relate to lifecourse models for the determinants of adult health. We will also discuss controversial perspectives on the role of genetic differences in creating social and racial inequalities in health.
Faculty: Maria Glymour
Location: Mission Hall 1400-
Gruenewald Seeman AllostaticLoad File
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HertzmannBoyceAnnualReviews File
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Weaver MaternalProgramming Epigenetic NatureNeuroscience File
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Berens Biology File
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Online Section
Please join my meeting from your computer, tablet or smartphone.https://ucsf.zoom.us/j/276946017
You can also dial in using your phone.
United States: +1 (669) 900-6833
Meeting ID: 276 946 017 -
Lecture: Multi-level etiologies of health in diverse populations, Part 4: Health systems and health care determinants
While the social determinants of health are key in determining who gets sick, health care access and quality is key to determining the outcome of illness. This class will review how ethnic/racial (and other) health care disparities play out in the highly complex US health care system. We will discuss the contributions of provider bias, health system structural inequities, and segregated care to health care disparities while also examining how fundamental assumptions about the role of the individual, family, and society play out in the care of acute and chronic illness. Finally, we will review the experience of quality improvement programs in mitigating health care disparities.
Faculty: Christine Dehlendorf
Location: Mission Hall 1400-
Hidden Curriculum Brooks File
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vanryn disparities File
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DISTANCE Interpreter JGIM File
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iom on health disparities.020601 File
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pnas.201516047 pain article File
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Online Section
Please join my meeting from your computer, tablet or smartphone.https://ucsf.zoom.us/j/276946017
You can also dial in using your phone.
United States: +1 (669) 900-6833
Meeting ID: 276 946 017 -
Lecture: Basic measurement issues in health disparities research
How do we describe the magnitude of health disparities, or decide whether health disparities are getting smaller or larger? Although it may sound simple, there are many different approaches to quantifying disparities, and sometimes they give very different insights. In this class we will compare some approaches, such as focusing on absolute versus relative inequalities and how to choose a reference category. We will also address some basic concepts in measurement of variables in health disparities research. Rigorous, reproducible measurement protocols are essential to scientific progress, but many key variables in health disparities research are controversial to define or difficult to measure, such as segregation, racism, or social capital. We will discuss some strategies to overcoming these measurement challenges and to give health disparities research a strong scientific grounding.
Faculty: Maria Glymour
Location: Mission Hall 1400-
Watch URL
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Watch 2018 URL
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Watch 2017 URL
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Krieger EverydayDiscrimination File
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Stewart- Can we afford to ignore measurement File
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Capistrant et al-2014-Journal of the American Geriatrics Society File
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Online Section
Please join my meeting from your computer, tablet or smartphone.https://ucsf.zoom.us/j/276946017
You can also dial in using your phone.
United States: +1 (669) 900-6833
Meeting ID: 276 946 017 -
Lecture: Strategic science in health disparities research
Doing research that has an impact on our understanding of and ability to address health disparities requires being strategic about what research questions to ask and how to disseminate the results. This lecture will provide guidance on how to ensure your research has the greatest possible impact, including discussions of how to do research that is policy relevant, how to communicate one’s results to the media and public, and how to translate research results into policy.
Faculty: Kirsten Bibbins-Domingo
Location: Mission Hall 1400-
Gollust AJPH Dec 2009 polarizing effects of news msgs re SDOH File
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socially responsible science.NATURE File
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BIDIL.ANNALs.BibbinsDomingo File
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Online Section
Please join my meeting from your computer, tablet or smartphone.https://ucsf.zoom.us/j/276946017
You can also dial in using your phone.
United States: +1 (669) 900-6833
Meeting ID: 276 946 017 -
Lecture: Multi-level etiologies of health in diverse populations, Part 5: Social policy
Many policies regulating areas such as housing, income security, education, criminal justice, environmental safety, or discrimination strongly influence health and health disparities, even though health was not the primary or original focus of these policies. In other words, the most important policies affecting health may not be health policies at all, but rather policies that shape the multilevel determinants of health. Health researchers with multilevel frameworks are rapidly focusing research attention to formally evaluate how these policies influence health and health inequalities and provide evidence to policymakers about unanticipated health consequences of diverse policies. In this class we will discuss examples of such policies and approaches to rigorously evaluating the health impacts of policies.
Faculty: Rita Hamad
Location: Mission Hall 1400-
Ludwig NbhdsObesityDiabetes File
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Adler et al JAMA brief of NAM report File
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Hamad 2018 - Short-term effects of EITC on child health File
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Liu 2012 - Segregation and teen fertility File
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Osypuk Policies File
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Online Section
Please join my meeting from your computer, tablet or smartphone.https://ucsf.zoom.us/j/276946017
You can also dial in using your phone.
United States: +1 (669) 900-6833
Meeting ID: 276 946 017 -
Lecture: Basic analytic issues in HDR
Given the complex social and biologic context in which health disparities are manifested, research in this areas requires nuanced application of statistical concepts related to confounding, mediation, moderation, and clustering. In this lecture, we will highlight aspects of statistical analysis of particular relevance to health disparities, including how to quantify disparities and evaluate determinants of inequalities, how to best build multivariate models, how to investigate race/SES interactions, principles of sub-group reporting and statistical power in health disparities research, as well as an overview of multilevel analyses.
Faculty: Anusha M Vable
Location: Mission Hall 1400-
Victora CG et al. The Role of Conceptual Frameworks in Epidemiological Analysis: A Hierarchical Approach. International Journal of Epidemiology. Voll. 26. No.1 1997 File
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Vable AM et al. Do the health benefits of education vary by sociodemographic subgroup? Differential returns to education and implications for health inequities. Annals of Epidemiology Vol 28 pg. 759-766. 2018 File
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Diez-Roux, AV. Bringing Context Back into Epidemiology: Variables and Fallacies in Multilevel Analysis. American Journal of Public Health. Vol. 88, No. 2. 1998 File
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Lorch SA et al. Factors That Mediate Racial/Ethnic Disparities in US Fetal Death Rates. American Journal of Phublic Health. Vol 102, No.10. October 2012 File
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Coley SL. Does Neighborhood Risk Explain Racial Disparities in Low Birth Weight among Infants Born to Adolescent Mothers? J Pediatr Adolesc Gynecol. 2016 April ; 29(2): 122–129. File
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Merlo J et al. A brief conceptual tutorial of multilevel analysis in social epidemiology: linking the statistical concept of clustering to the idea of contextual phenomenon. J Epidemiol Community Health 2005;59:443–449 File
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Kawachi, I and Subramanian SV. Measuring and Modeling the Social and Geographic Context of Trauma: A Multilevel Modeling Approach. Journal of Traumatic Stress. Vol. 19, No. 2. 2006 File
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Online Section
Please join my meeting from your computer, tablet or smartphone.https://ucsf.zoom.us/j/276946017
You can also dial in using your phone.
United States: +1 (669) 900-6833
Meeting ID: 276 946 017 -
Lecture: Doing research to reduce health disparities
While all health disparities research has a common goal of addressing pervasive and unjust differences in health outcomes, the research methods that can be employed to accomplish this goal are diverse. In this lecture, we will review the “three generations” of health disparities research – from description to intervention – and discuss toolbox of research approaches that can be used to answer questions relevant to health disparities across these generations, including qualitative methods, implementation research, patient-centered outcomes research, and community based participatory research.
Faculty: Christine Dehlendorf
Location: Mission Hall 1400-
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Walton intervention File
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Online Section
Please join my meeting from your computer, tablet or smartphone.https://ucsf.zoom.us/j/276946017
You can also dial in using your phone.
United States: +1 (669) 900-6833
Meeting ID: 276 946 017 -
Lecture: Student presentation
Each of you will give a short presentation to share with us something about how the material in this class has or will inform your work. This can really be anything, but examples would include application of the socioecological model to your area of research, measurement or analytic issues, and how to think strategically about your area of research.
Each presenter will have 5-10 minutes, with a few minutes for questions, so you should only prepare 3-8 slides. In addition to this presentation, the final project will be a 1-2 page paper where you can expand a bit more on this topic.
Please send me your slides by midnight on Sunday, March 17th so I can compile them all and we can be as efficient as possible (my email is christine.dehlendorf@ucsf.edu).
Faculty: Christine Dehlendorf and Kelsey Holt
Location: Mission Hall 1400-
Watch URL
