Section outline

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    • Advanced Concepts and Methods in Research on Health Disparities and the Social Determinants of Health

              Spring 2019 (2 units)
      .
      Course Director: Christine Dehlendorf, MD, MAS
      Associate Professor, Department of Family and Community Medicine
    • EPI 223 Forum

  • Monday, April 1, 2019; 1:00 PM - 3:00 PM

    Lecture:  Classic conceptual papers

    Seminal theories and frameworks that have shaped discourse about the nature and etiology of health disparities and the role of social determinants of health.

    Faculty:  Christine Dehlendorf

    Location:       Mission Hall 1407

    • Session Slides:

    • Advanced Methods and Concepts in Research on Health April1 File

    • Session Audio/Video Recording (Access restricted to registered students):

    • Watch URL
      Not available unless: You belong to a group in Registered Students Only

    • Required Reading:

    • Link and Phelan, Social conditions as fundamental causes of disease File
      Not available unless: Your ID number contains 02
    • Phelan JC, Link BG. Is racism a fundamental cause of inequalities in health. Annual Review of Sociology. 2015 Aug 14;41311-30 File
      Not available unless: Your ID number contains 02
    • Krieger N. Theories for social epidemiology in the 21st century an ecosocial perspective. International journal of epidemiology. 2001 Aug 1;30(4)668-77. File
      Not available unless: Your ID number contains 02
    • Krieger N. Epidemiology and the web of causation has anyone seen the spider. Social science medicine. 1994 Oct 1;39(7)887-903. Required reading starting on page 896 until the end. The rest of the article is optional. File
      Not available unless: Your ID number contains 02

    • Optional Reading:

    • The Krieger article, as above

    • Lynch J and Kaplan G. Chapter 2, Socioeconomic Position. In: Berkman LF and Kawachi I (eds). Social Epidemiology. New York: Oxford University Press (2000), pp. 13-35 URL
      Not available unless: Your ID number contains 02
    • Susser M, Susser E. Choosing a future for epidemiology I. Eras and paradigms. American Journal of Public Health. 1996 May;86(5)668-73. File
      Not available unless: Your ID number contains 02
    • McMichael M. Prisoners of the Proximate Loosening the Constraints on Epidemiology in an Age of Change. Am J Epidemiology 1999 149;10887-97. File
      Not available unless: Your ID number contains 02

    • Assignment:

      Below are discussion questions we will consider in class for each reading. Please think about these as you do the readings and be prepared to discuss them. If you will not attend class, please submit written responses to each question of approximately one half to one page per question (email to christine.dehlendorf@ucsf.edu).

      Link and Phelan:
      1. How would you describe the essential shift in thinking within epidemiology that the authors of this paper urge?
      2. What are the key insights of fundamental cause theory about the role of social conditions on health?
      3. What are the implications of the fundamental cause theory for research on health disparities?
      Phelan and Link:
      1. What is the shift in thinking about the role of race in health that is evidenced between this paper and the original fundamental cause paper published in 1995 (the first reading)?
      2. Do you agree that “a large proportion of the racial differences in health outcomes are attributable to racial differences in SES”? Why or why not?
      3. What implication does considering racism as a fundamental cause have for research on health disparities?
      Krieger papers:
      1. What is meant by the “spiderless web”?
      2. What are the strengths and limitations of psychosocial theory? Of social production of disease?
      3. How does ecosocial theory relate to fundamental cause theory?
      4. Is theory necessary to advance health equity? Why or why not?
      5. Describe the central concept of embodiment.

  • Monday, April 8, 2019; 1:00 PM - 3:00 PM

    Lecture:  Racism

    Methods for investigating the impact of racism on health outcomes

    Faculty:  Meghan Morris & Kelsey Holt

    Location:     Mission Hall 1407


    Guidelines for leading journal article presentations during class:

    Here is a rough guide to help you prepare. You're welcome to adapt to meet the journal article or your needs.

    o   5 minute high-level summary – one slide to introduce the key points of the article (objective/methods/key results)

    o   Some reflections/questions about the paper and the content for discussion.

    o   Then start the larger conversation for the article – this could be you answering or starting a conversation about each of the article discussion question or pose new questions related to theory, methods, or application/implications of the article.  

    • Session Slides:

    • Week2 Race 8April2019 File

    • Session Audio/Video Recording (Access restricted to registered students):

    • Watch URL
      Not available unless: You belong to a group in Registered Students Only

    • Required Reading:

    • Braveman PTB File
      Not available unless: Your ID number contains 02
    • Williams racism review 2009 File
      Not available unless: Your ID number contains 02
    • Beck-Causal Inference File
      Not available unless: Your ID number contains 02

    • Optional Reading:

    • Kawachi CausalInf MoneySchoolingHealth File
      Not available unless: Your ID number contains 02

    • Assignment: Below are discussion questions we will consider in class, that you should be thinking about as you do the reading. If you will not attend class, please submit written responses to each question (email to meghan.morris@ucsf.edu).

      Beck article:

      1. DAGs, like the one presented in this article, are critical tools for researchers interested in drawing causal inferences from study findings. Draw a simple DAG relevant to an area of health disparities that you are interested in.

      2. How is the concept of race conceptualized differently in this study compared to other epidemiologic studies you have read where race is included as a predictor variable?

      3. The IPTW method described in this article is complex and it is beyond the scope of this course to expect a complete grasp on this analytical approach. However, in simple terms, what is this approach trying to accomplish?

      Williams article:
       
      1.    How does racism and other forms of discrimination lead to health disparities? 
      2.    What are some identified challenges in measuring discrimination?
      3.    What are the most important areas to focus on in research on racism? How can this lead to interventions to impact health disparities?
       
      Braveman article: 
       
      1.    What type of interventions could be informed by the findings of this study?
      2.    What are the implications for the findings of this study on the intergenerational impact of racism?

  • Monday, April 15, 2019; 1:00 PM - 3:00 PM

    Lecture:   Intersectionality

    Methods for investigation of  intersection between different dimensions of vulnerability

    Faculty:  Meghan Morris

    Location:      Mission Hall 1407

    • Session Audio/Video Recording (Access restricted to registered students):

    • Watch URL
      Not available unless: You belong to a group in Registered Students Only

    • Required Reading:

    • Bowleg Intersectionality 2012 File
      Not available unless: Your ID number contains 02
    • Bauer SSM 2014 File
      Not available unless: Your ID number contains 02
    • Logie PV 2018 File
      Not available unless: Your ID number contains 02

    • Optional Reading:

    • Coley birth File
      Not available unless: Your ID number contains 02
    • White SSM-2018 File
      Not available unless: Your ID number contains 02
    • Viruell-Fuentes IntersectionalityImmigration 2012 File
      Not available unless: Your ID number contains 02
    • English PV 2018 File
      Not available unless: Your ID number contains 02
    • VanderWeele SEM AJE 2012 File
      Not available unless: Your ID number contains 02

    • Intersectionality: Kimberle Crenshaw, The urgency of intersectionality:


    • Assignment: Below are discussion questions we will consider in class, that you should be thinking about as you do the reading. If you will not attend class, please submit written responses to each question (email to meghan.morris@ucsf.edu).

      Bowleg:
       
      1. How does intersectionality relate to the socioecological model? To Krieger’s metaphor of the fractal?
      2. What are the biggest challenges you see to incorporating intersectionality into your work? What are the benefits?
       
      Bauer:
       
      1. The question of whether all intersectional positions are of equal value is important for both analysis and results interpretation. Provide one or two suggestions for assessing whether individual intersectional positions deserve different value weighs, how you would go about assessing this conceptually and analytically.  
      2. In your own words describe what chunkwise model building is and how it may enhance analytic approaches for health disparities research. And how this enhances results interpretation related to intersectionality?

      Logie:

      1. Review figure 1 and provide a written description of the relationship between gender discrimination and mental health quality of life. In what ways could social support and economic insecurity mediate the relationship between gender discrimination and mental health quality of life? How may this be different based on a women’s race/ethnicity? 
      2. What are strengths and limitations to using measures of stigma to examine the relationship between discrimination and QoL? Propose one or two alternative measures that could complement this analysis, and why.

       

  • Monday, April 22, 2019; 1:00 PM - 3:00 PM

    Lecture:  Health care disparities

    Influential papers establishing health care disparities as a factor contributing to health disparities, as well as studies using novel methodologies to investigate and address health care disparities, including standardized patients and between and within hospital comparisons.

    Faculty:  Brittany Chambers

    Location:      MIssion Hall 1407

    • Session Audio/Video Recording (Access restricted to registered students):

    • Watch URL
      Not available unless: You belong to a group in Registered Students Only

    • Required Reading:

    • Shavers et al. 2012 File
      Not available unless: Your ID number contains 02
    • Van ryn Coronaryartery File
      Not available unless: Your ID number contains 02
    • Li Y.JAMA.2011.Lect.2pdf File
      Not available unless: Your ID number contains 02

    • Optional Reading:

    • Bias Review 2017 File
      Not available unless: Your ID number contains 02
    • neff File
      Not available unless: Your ID number contains 02
    • Dehlendorf File
      Not available unless: Your ID number contains 02
    • dovidio File
      Not available unless: Your ID number contains 02
    • Anand healthcaredisparities File
      Not available unless: Your ID number contains 02
    • health equity curriculum File
      Not available unless: Your ID number contains 02

    • Assignment:

      Please consider these questions below when reading each article. If you are unable to attend the class session, please post answers to these questions to the forum by midnight on May 8th.

      If you are interested in more detail about the scope and causes of implicit bias among providers, you can review some of the optional reading. The Bias_Review provides an overall overview of the literature on implicit bias, including the fact that health care providers have consistently been found to have the same level of bias as members of the general population. The Dovidio article goes into more depth on the underlying nature of bias.

       

      Shavers:

      1.       What is the current prevalence of racial/ ethnic discrimination in health care settings?

      2.       Has the perception of or receipt of discriminatory health care changed over time?

      3.       How does racial/ethnic discrimination influence health in health care settings?

      4.       How do system level factors, such as institutional practices, policies and regulations contribute to discriminatory health care services?


      Van ryn:

      1.       What insight do the findings of this study provide about the origin of health care disparities?

      2.       How can the findings of this study be used to inform interventions designed to minimize health care disparities?

      3.       What hypothesis do you have for why there may have been differences by race in recommendations for men, but not women?

       

      Li:

      1.       Put into your own words what this study found, and what these results suggest as potential causes for health disparities.

      2.       What interventions would be warranted given these findings?


  • Monday, April 29, 2019; 1:00 PM - 3:00 PM

    Lecture:  Community Engagement methods

    Theory and practice of community-based participatory research, including its challenges and benefits.

    Faculty:  Brittany Chambers

    Location:       Mission Hall 1407

    • Session Audio/Video Recording (Access restricted to registered students):

    • Watch URL
      Not available unless: You belong to a group in Registered Students Only

    • Required Reading:

    • Vasquez CBPR File
      Not available unless: Your ID number contains 02
    • Andrews CBPR File
      Not available unless: Your ID number contains 02
    • Minkler CBPR File
      Not available unless: Your ID number contains 02

    • Optional Reading:

    • Yeary CBPR File
      Not available unless: Your ID number contains 02
    • Comm Engaged Research Guide USC File
      Not available unless: Your ID number contains 02
    • Wallerstein and Duran 2010 File
      Not available unless: Your ID number contains 02
    • AJPH.2014 Cacari Wallerstein Garcia Minkler File
      Not available unless: Your ID number contains 02

    • Assignment:

      Please consider these questions below when reading each article. If you are unable to attend the class session, please post answers to these questions to the forum by midnight on the 25th.

      Minkler:

      • What do you think of the claimed benefits of CBPR?
      • Which challenges in doing CBPR  do you think are most significant?
      • What do you think Minkler means by “systems development and local community capacity development”? How can this be accomplished?

      Andrews:

      • What do you think of the “origin story” of this collaboration?
      • What do you think of how CBPR principles were applied in this project?
      • How did the use of CBPR influence the intervention development? The study design?
      • How did they address sustainability?

      Vasquez:

      • What do you think of how CBPR principles were applied in this project?
      • What challenges did they face? How did they address them?
      • How was this project effective in changing policy? What aspects of this could be generalized to other projects?
      • What do you think of the academic partner’s statement that “the motivation for involvement did not lie in identifying policy goals but rather in trying to fill scientific gaps”?



  • Monday, May 6, 2019; 1:00 PM - 3:00 PM

    Lecture:  Multilevel modeling

    Approaches to analyzing complex data to investigate influence across multiple levels

    Faculty:  Kelsey Holt

    Location:       Mission Hall 1407

    • Session Slides:

    • Multi level slides File

    • Session Audio/Video Recording (Access restricted to registered students):

    • Watch URL
      Not available unless: You belong to a group in Registered Students Only

    • Required Reading:

    • Diez-Roux multilevel File
      Not available unless: Your ID number contains 02
    • Subramanian et al. File
      Not available unless: Your ID number contains 02
    • Gausman et al. File
      Not available unless: Your ID number contains 02

    • Assignment: Please consider these questions below when reading each article. If you are unable to attend the class session, please post answers to these questions to the forum by midnight.

      Diez-Roux article:

      1. Multi-level modeling approaches aim to analyze contextual effects beyond individual characteristics. Briefly describe the benefits of conducting a multilevel analysis for health disparities research areas. 

      2. Draw from your own research or interest area to give an example of macro-level factors or group-level properties that influence individual health.

      3. Define the ecological and atomistic fallacies and explain how these fallacies differ from psychologistic and sociologistic fallacies. 

      Subramanian:

      1. Drawing on your area of work, what is an example of a potential individualistic fallacy and how could a multi-level modeling approach help lead to more meaningful analysis of individual level relationships?

      2. Briefly describe the difference between fixed effects and random effects in the models in this paper. In broad stokes, in what circumstances would you use one or the other to examine a higher level variable?

      3. What is a main takeaway you got from reading the authors’ analysis of Robinson’s original paper in historical context?

      Gausman:
      (note: for this article, please try to glean the big picture approach without getting bogged down in the technical modeling details; we can discuss the models more in class if there is interest)

      1. On page 3, discussing Table 2, the authors point out that “the fact that the variance parameters remain significantly different from zero indicates that the geographic variation at these levels is not entirely determined by differences in population composition.” Describe what the authors would have missed if they had not conducted a multi level model with random effects for community and country.

      2. Briefly describe the main findings and their implications for interventions to address childbearing before age 16 in low and middle income countries. How does the examination by country in Figure 1 change your answer, if at all?


  • Monday, May 13, 2019; 1:00 PM - 3:00 PM

    Lecture:  Case Study: Maternal and Infant Mortality

    TBA

    Faculty:  Christine Dehlendorf, Bristtany Chambers, Meghan Morries


    Location:      MIssion Hall 1407

    • Session Audio/Video Recording (Access restricted to registered students):

    • Watch URL
      Not available unless: You belong to a group in Registered Students Only

    • Required Reading:

      We are assigning 3 readings for this week. However, there are a large number of other papers we could have assigned, so there are four that we have assigned as optional and encourage you to at least read the abstracts to give you a broader view on the topic of disparities in perinatal outcomes!


    • Kramer Hogue File
      Not available unless: Your ID number contains 02
    • Wallace structuralracism File
      Not available unless: Your ID number contains 02
    • Pestronk File
      Not available unless: Your ID number contains 02

    • Optional Reading:

    • Chambers2019 Article UsingIndexOfConcentrationAtThe File
      Not available unless: Your ID number contains 02
    • Chae SSM File
      Not available unless: Your ID number contains 02
    • Burris File
      Not available unless: Your ID number contains 02
    • Howell HCD File
      Not available unless: Your ID number contains 02

    • Assignment:

      Please consider these questions below when reading each article. If you are unable to attend the class session, please post answers to these questions to the forum by midnight on May 15th.


      Kramer:

      1. Does Figure 2 adequately capture the pathways between race and very preterm birth? Are there additional pathways/mechanisms you would consider? Why or why not?

      2. Do you agree with how this paper describes the potential role of genetic and epigenetic factors in very preterm birth? Why or why not?

      3. What potential interventions are suggested by the conceptual model proposed by this paper?

      Wallace:

      1. What are the strengths and weaknesses of the described approach to measuring institutional racism?

      2. How does this paper deal with the need to include multiple levels in the analysis?

      3. What are the implications of the findings of this analysis for interventions to decrease disparities in infant mortality?

      Pestronk:

      1. What are the strengths of the described approach to addressing infant mortality?

      2.How would you suggest studying the effects of the described approach? What would be the challenges to this evaluation?


  • Monday, May 20, 2019; 1:00 PM - 3:00 PM

    Lecture:  Student Presentation/Other Sessions

    Research on relationship of incarceration and the penal system on health outcomes and health disparities, as an example of research on a policy-level social determinant and its downstream impacts.

    Faculty:  Meghan Morris and Brittany Chambers

    Location:      MIssion Hall 1407

    • Session Audio/Video Recording (Access restricted to registered students):

    • Watch URL
      Not available unless: You belong to a group in Registered Students Only

    • Required Reading:

    • Optional Reading:

    • Assignment: Below are discussion questions we will consider in class, that you should be thinking about as you do the reading. If you will not attend class, please submit written responses to each question of approximately one half to one page per question (email to christine.dehlendorf@ucsf.edu).

  • Monday, May 27, 2019; 1:00 PM - 3:00 PM - No Class

    Lecture:  No Class - Memorial Day

  • Monday, June 3, 2019; 1:00 PM - 3:00 PM

    Lecture:  Student Presentations

    Faculty:  Christine Dehlendorf

    Location:      MIssion Hall 1407

    • Session Audio/Video Recording (Access restricted to registered students):

    • Watch URL
      Not available unless: You belong to a group in Registered Students Only

    • Required Reading:

    • Optional Reading:

    • Resources:


    • Assignment: Below are discussion questions we will consider in class, that you should be thinking about as you do the reading. If you will not attend class, please submit written responses to each question of approximately one half to one page per question (email to christine.dehlendorf@ucsf.edu).