Section outline

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  • Tuesday, January 7, 2020; 1:00 PM - 3:00 PM

    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 1406

    • Prospectus:

    • Session Slides:

    • Intro Lecture 2020 CLE File

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

    • Required Reading:

    • caulfield race File
      Not available unless: Your ID number contains 02
    • Quinn SC 2012 Attributes of researchers File
      Not available unless: Your ID number contains 02
    • Braveman Socioeconomic Status File
      Not available unless: Your ID number contains 02
    • Prather SEM File
      Not available unless: Your ID number contains 02

    • Optional Readings:

    • Bidil BibbinsDomingo File
      Not available unless: Your ID number contains 02
    • Mersha Race File
      Not available unless: Your ID number contains 02
    • Burchard asthma File
      Not available unless: Your ID number contains 02

    • Assignment:

    • Ludwig NbhdsObesityDiabetes File
      Not available unless: Your ID number contains 02

  • Tuesday, January 14, 2020; 1:00 PM - 3:00 PM

    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 1406

    • Session Slides:

    • Lecture 2 social determinants of health 14Jan2020 File

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

    • Required Reading:

    • WHO Commission SDH - Read Chapter 5.5 through 5.6.3. File
      Not available unless: Your ID number contains 02
    • Gardners tale File
      Not available unless: Your ID number contains 02
    • Neighborhood Diabetes File

      Please do not get bogged down in the methods, but rather focus on the overall concept of measuring neighborhood factors as their impact on health

      Not available unless: Your ID number contains 02

    • Optional Readings:

    • Massoglia 2008 prison race health File
      Not available unless: Your ID number contains 02

    • Assignment:

      Please post to the forum by 1pm on the day of class:

      1. Write a brief paragraph discussing what social determinants are most relevant to your area of research and why. Consider both structural stratifiers (e.g. income, education, etc) and intermediary determinants such as material and psychosocial circumstances, as described in the WHO reading. Explain why you chose the factors (might use Braveman article from last week to provide justification. The association could be reported in published research or it could be your hypothesized relationship. Consider whether how these factors might function over the lifecourse and/or intergenerationally.

      2. Write a brief paragraph describing the extent to which an socioecological framework incorporating issues related to social determinants has been applied to your area of research. Are there opportunities for improving our understanding of or approach to disparities in your area with a greater emphasis on a socioecological framework? 


  • Tuesday, January 21, 2020; 1:00 PM - 3:00 PM

    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 1406

    • Session Slides:

    • Lecture 3 behavioral Jan 2020 Gomez 01212020 File

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

    • Required Reading:

    • Pampel FG et al. Socioeconomic Disparities in Health Behaviors. Annu Rev Sociol. 36: 349-370. 2010 File
      Not available unless: Your ID number contains 02
    • Freeman CRT File
      Not available unless: Your ID number contains 02

    • Optional Reading:

    • Adverse Childhood Experiences and adult health behaviors File
      Not available unless: Your ID number contains 02
    • self control 2000 File
      Not available unless: Your ID number contains 02

    • Assignment:

      Please post to the forum by 1pm on the day of class

      1. State your health outcome of interest. (It could be the one you used for week #2 or another one.) Pick two key behaviors that are important factors leading to your health outcome. Explain the importance of these behaviors either for etiology, prevention, or intervention. (If none of the behaviors in the readings are important for your health outcome, suggest another behavior that is.)

      2. Describe how you would study the role of one of the behaviors described for question #1 and your health outcome of interest. Incorporate a social factor (e.g. race/ethnicity, social exclusion, stress) in the study approach.

      3. If key health behaviors (e.g. smoking, exercise, nutritious diet) are strongly influenced by neighborhood, income, and/or education, do we need to continue to study how these behaviors influence health outcomes? Why or why not?


  • Tuesday, January 28, 2020; 1:00 PM - 3:00 PM

    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:  Kaja LeWinn

    Location:      Mission Hall 1406

    • Session Slides:

    • Lecture4BiologicalMechanismsv8 final File

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

    • Required Reading:

    • HertzmannBoyceAnnualReviews File
      Not available unless: Your ID number contains 02
    • neighborhood allostasis File
      Not available unless: Your ID number contains 02
    • discrimination methylation File
      Not available unless: Your ID number contains 02

    • Resources:

    • Berens Biology File
      Not available unless: Your ID number contains 02
    • Weaver MaternalProgramming Epigenetic NatureNeuroscience File
      Not available unless: Your ID number contains 02
    • Gruenewald Seeman AllostaticLoad File
      Not available unless: Your ID number contains 02

    • Assignment:  

      Please post to the forum by 1pm on the day of class

      Questions Related to Week 4 Readings:

      1. Hertzmann and Boyce argue that “it is not genes or environment, nor is it genes and environment, but rather it is gene-by-environment interactions that influence developmental trajectories.”  To what extent do you think that GxE interactions can contribute to major disparities along racial/ethnic, socioeconomic, or geographic dimensions? Please consider this both in general and in respect to your particular area of interest. 

      2. Discuss implications of epigenetic mechanisms of disease for intergenerational effects on health disparities, as well as for interventions designed to address health disparities. 

      3. Discuss how the findings in the Robinette paper relate to socioecological model we are using in this course – e.g. briefly describe how the different levels displayed in this model are related to each other in this paper. 



  • Tuesday, February 4, 2020; 1:00 PM - 3:00 PM

    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 1406

    • Session Slides:

    • HCD Lecture 2020 CLE File

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

    • Required Reading:

    • Hidden Curriculum Brooks File
      Not available unless: Your ID number contains 02
    • chapman Bias File
      Not available unless: Your ID number contains 02
    • LEP DM File
      Not available unless: Your ID number contains 02

    • Optional Reading:

    • implicitbias review File
      Not available unless: Your ID number contains 02
    • iom on health disparities.020601 File
      Not available unless: Your ID number contains 02
    • pnas.201516047 pain article File
      Not available unless: Your ID number contains 02

    • Assignment:

      Please post to the forum by 1pm on the day of class:

      1) How do individual physicians contribute to health care disparities?  Thinking about an area of health care of particular interest to you, what research do you think could be done to either understand the effect of individual physicians on health disparities, or to decrease this effect?

      2) Structural issues within health care delivery are implicated in health care disparities.  Please brainstorm 4 structural issues that might contribute to these disparities. Which of these are relevant to your particular area of research, and how?


  • Tuesday, February 11, 2020; 1:00 PM - 3:00 PM

    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 1406

    • Session Slides:

    • Basic Analysis Issues for Health Disparities Research 02 10 20 File

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

    • Required Reading:

    • 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
      Not available unless: Your ID number contains 02
    • 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
      Not available unless: Your ID number contains 02
    • 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
      Not available unless: Your ID number contains 02
    • 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
      Not available unless: Your ID number contains 02

    • Optional Reading:

    • 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
      Not available unless: Your ID number contains 02
    • 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
      Not available unless: Your ID number contains 02
    • 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
      Not available unless: Your ID number contains 02

    • Resources:

    • Basic Analysis Issues for health disparities worksheet File
    • empirical example of confounding and mediation File

    • Assignment:

      Please post to the forum by 1pm on the day of class

      1. Give an example of a research question for investigating racial/ethnic health disparities where: [1] SES is a confounder; [2] SES is an effect modifier; [3] SES is a mediator. Briefly discuss the interpretations/implications of each approach as it relates to understanding health disparities by race/ethnicity.

      2. Describe a potential effect modifier, mediator, or contextual variable (for definition of contextual variable, see Diez-Roux reading) for an association of interest to you and relevant to health disparities. For example, for investigating the association between education and hypertension, I might be interested in evaluating whether the association between years of education and hypertension is different for Black men than for White men. Describe how you would study whether this relationship exists.

      3. Respond to one other person's post on the forum with a comment or suggestion.


  • Tuesday, February 18, 2020; 1:00 PM - 3:00 PM

    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 1406

    • Session Slides:

    • rhamad - Epi 222 social policies lecture, 20 Feb 2018 File

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

    • Required Reading:

    • Ludwig NbhdsObesityDiabetes File
      Not available unless: Your ID number contains 02
    • Adler et al JAMA brief of NAM report File
      Not available unless: Your ID number contains 02
    • Hamad 2018 - Short-term effects of EITC on child health File
      Not available unless: Your ID number contains 02
    • Liu 2012 - Segregation and teen fertility File
      Not available unless: Your ID number contains 02

    • Optional Readings:

    • Osypuk Policies File
      Not available unless: Your ID number contains 02

    • Assignment:

      Please post to the forum by 1pm on the day of class

      · Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.

      · Describe why an evaluation of that policy is informative (e.g., determining effects of the policy, or primarily a test of hypothesized mediators).

      · Specify the outcomes and populations you think most affected or least affected by the policy.

      · Propose a study design to evaluate the policy.

      · Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health.


  • Tuesday, February 25, 2020; 1:00 PM - 3:00 PM

    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:  Patience Afulani

    Location:     Mission Hall 1406

    • Session Slides:

    • Afulani-Health disparities measurement-2-11-25 File

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

    • Watch URL
      Not available unless: You belong to a group in Registered Students Only
    • Watch 2018 URL
      Not available unless: You belong to a group in Registered Students Only
    • Watch 2017 URL
      Not available unless: You belong to a group in Registered Students Only

    • Required Reading:

    • Krieger EverydayDiscrimination File
      Not available unless: Your ID number contains 02
    • Stewart- Can we afford to ignore measurement File
      Not available unless: Your ID number contains 02

    • Optional Reading:

      Chapter 12 in Social Epidemiology, 2nd edn.  Berkman, Kawachi, and Glymour eds. Oxford Press 2014.

    • Capistrant et al-2014-Journal of the American Geriatrics Society File
      Not available unless: Your ID number contains 02
    • Afulani et al-2017-Kenya validation File
      Not available unless: Your ID number contains 02
    • Measures Epi File
      Not available unless: Your ID number contains 02

    • Assignment:

       Hi everyone, homework this week has three parts (the first two parts are pretty straightforward though). 

      Part 1:

      1. Choose a paper describing the development or validation of a measure of relevance in health disparities research (please give the full citation and/or upload the paper if that's possible). 

      2. What was the definition of the construct?

      3. How did the authors provide evidence on the validity of the measure? Could you think of additional approaches to validating the measure?

      4. How did the authors provide evidence on the reliability of the measure? Could you think of additional approaches to evaluating the reliability of the measure?

      5. Describe the implications of a lack of measurement validity or reliability for future research applications. 

      Part 2:

      1. Find a paper describing a health disparity (please give the full citation or, even better, upload the paper so everyone else can look at it too) 

      2. Summarize the construct and measurement of the dimension of disparity (e.g., racial inequalities?, SES inequalities?) and the outcome measured (e.g., self-rated health).

      3. What is the evidence for the validity and reliability of the measures?

      4. What is the reference category used for the disparity measure (ie, who is the comparison group)? Why does this reference category make sense (or not) for this research question?

      5. How is the disparity quantified or measured?  Is this an absolute or relative measure or are both provided?  Describe which type of measure you would prefer for this research area, or, if both, why. 

      Part 3:

      1. Read someone else's response to part 1 above (identifying a construct) and comment, specifically noting whether you can see any additional implications of measurement quality for future research or whether you agree with those noted by your classmate.

  • Tuesday, March 3, 2020; 1:00 PM - 3:00 PM

    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 1406

    • Session Slides:

    • HD research 2019 CLE File

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

    • Required Reading:

    • barbershop File
      Not available unless: Your ID number contains 02
    • annurev-publhealth-031210-101136 File
      Not available unless: Your ID number contains 02
    • cliff-analogy File
      Not available unless: Your ID number contains 02
    • poi160066 (1) File
      Not available unless: Your ID number contains 02

    • Optional Reading:

    • Walton intervention File
      Not available unless: Your ID number contains 02

    • Assignment:

      Please post to the forum by 1pm on the day of class

      1. After reading the article by Thomas et al., comment on where your research, or your research interests, fit into the generational framework for health disparities research. If your work is 1rst or 2nd generation, comment on how your work could lead in the future to 3rd or 4th generation work. If your work is 3rd or 4th generation, comment on what 1rst and 2nd generation work was necessary as a foundation for your current work (or current interests).

      2. The barbershop hypertension intervention, while essentially a clinical services intervention operating at either the fence or safety-net level as described by Jones, has some engagement with the social determinants of health. Interventions like that described in the Gottleib article are designed to mitigate the impact of social determinants. How could you apply one of these two types of interventions to your area of research? Propose one or two interventions that engage with social determinants on some level.

      3. Please respond to one other classmate's responses to this assignment – post this response as a separate post in the forum.


  • Tuesday, March 10, 2020; 1:00 PM - 3:00 PM

    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:      Zoom only

    Zoom Link: https://ucsf.zoom.us/j/431428230 or +1 669 900 6833 (Meeting ID: 431 428 230)

    • Session Slides:

    • strategic science.social determinants of health.03102020.FINAL File

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

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

    • Required Reading:

    • Gollust AJPH Dec 2009 polarizing effects of news msgs re SDOH File
      Not available unless: Your ID number contains 02
    • socially responsible science.NATURE File
      Not available unless: Your ID number contains 02
    • BIDIL.ANNALs.BibbinsDomingo File
      Not available unless: Your ID number starts with 02

    • Optional Reading:

    • Assignment:

      Please post to the forum by 1pm on the day of class

      John Ruffin, former head of the National Institute of Minority Health and Health Disparities wrote:

      "The 19th-century scientist and pathologist Rudolph Virchow gave voice to many of our present-day concerns about disparities and went a long way toward defining the task before us. A socially minded man, he believed that science should speak the language of the common people and that medicine should serve the public's health. He wrote, 'If medicine is to fulfill her greatest task, then she must enter the political and social life…'"

      Do you agree and why?  Is it permissible for scientists to become advocates in the areas of their research?  What steps can one take to balance advocacy with the objectivity that is considered the ideal in scientific inquiry?

      Please describe an of controversy for health disparities research that you learned about in this course, or alternatively an area of research that should be prioritized in health disparities. Include why you find this area interesting or controversial.



  • Tuesday, March 17, 2020; 1:00 PM - 3:00 PM

    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 5-8 minutes, with a few minutes for questions, so you should only prepare 3-5 slides. In addition to this presentation, the final project will be a brief 1 page summary of what you will discuss in your presentation..

    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 Ellie Matthay

    Location:      Zoom only

    Ellie Matthay section zoom Link: https://ucsf.zoom.us/j/606832721 or +1 669 900 6833 (Meeting ID: 606 832 721)

    Christine Dehlendorf section zoom Link: https://ucsf.zoom.us/j/511925184 or +1 669 900 6833 (Meeting ID: 511 925 184)

    • Session Slides:

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

    • Watch C.Dehlendorf Section 03.17.2020 Media Resource
      Not available unless: You belong to a group in Registered Students Only
    • Watch E.Matthay Section 03.17.2020 Media Resource
      Not available unless: You belong to a group in Registered Students Only

    • Required Reading:

    • Optional Reading:

    • Assignment: