Section outline

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  • Monday, March 30, 2020; 1:00 PM - 3:00 PM

    Lecture:  Conceptual models (fundamental cause/ecosocial theory)

    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:  Maria Glymour

    Location:       Zoom only

    • Session Slides:

    • Advanced Methods and Concepts in Research on Health April1 File

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

    • Watch 2020 Media Resource
      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
    • Ford PHCRP 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
    • 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

    • 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.
      Ford:
      1. How do the principles of PHCRP relate to the theories laid out in the Link and Phelan and Kieger papers? Have you seen examples of PHCRPbe operationalized in research? How could you do so in your own work? What are the challenges to doing so? What are the benefits

  • Monday, April 6, 2020; 1:00 PM - 3:00 PM

    Lecture:  Racism (measurement, impact, etc)

    Methods for investigating the impact of racism on health outcomes

    Faculty:  Thu Nguyen

    Location:     Zoom only

    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 2020 Media Resource
      Not available unless: You belong to a group in Registered Students Only

    • Required Reading:

    • Beck-Causal Inference File
      Not available unless: Your ID number contains 02
    • Williams Racism File
      Not available unless: Your ID number contains 02
    • Braveman PTB File
      Not available unless: Your ID number contains 02
    • CHB 2018 Nguyen TT Twitter derived measure of sentiment towards minorities File
      Not available unless: Your ID number contains 02

    • Optional Reading:

    • Williams racism review 2009 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 the forum.

      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?


      CHB article: 
       
      1.    Why might racial attitudes towards racial and ethnic minorities impact birth outcomes of total population, including Non-Hispanic Whites?
      2.    What are some implications of this research?

  • Monday, April 13, 2020; 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

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

    • Watch 2020 Media Resource
      Not available unless: You belong to a group in Registered Students Only

    • Required Reading:

    • Franks Community 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.

      1. How does the concept of Research Justice relate to Community-Based Participatory Research?

      2. What are the strengths and limitations of the process described in this article? What recommendations do you have for ways to overcome some of the identified challenges/limitations?

      3. How could the approach described in this article be more systematically included in the process of funding and doing research?

  • Monday, April 20, 2020; 1:00 PM - 3:00 PM

    Lecture:  Intersectionality

    Methods for investigation of  intersection between different dimensions of vulnerability

    Faculty:  Paul Wesson

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

    • Watch 2020 Media Resource
      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
    • Veenstra - Race, gender, class, sexuality (RGCS) and hypertension 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
    • Logie PV 2018 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?

      Veenstra:

      1. How does this paper use statistical methods to model intersectionality? 
      2. Why do you think Veenstra states that “statistical significance is typically granted more ‘significance’ in quantitative intersectional analyses than it deserves”? (page 3)
      3. How did the intersectional analysis in this paper deepen the understanding of the patterning of hypertension, as compared to an additive model?

       

  • Monday, April 27, 2020; 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

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

    • Watch 2020 Media Resource
      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, May 4, 2020; 1:00 PM - 3:00 PM

    Lecture:  Multilevel modeling

    Approaches to analyzing complex data to investigate influence across multiple levels

    Faculty:  Ellicot Matthay

    • Session Slides:

    • Multi level slides Matthay 2020 04 30 to share File

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

    • 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 11, 2020; 1:00 PM - 3:00 PM

    Lecture: Maternal morbidity and mortality case studies, bringing together the whole class

    TBA

    Faculty:  Christine Dehlendorf

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

    • Required Reading:

      We are assigning 4 readings for this week. However, there are a large number of other papers we could have assigned, so there are five 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
    • Owens Maternal Morbidity File
      Not available unless: Your ID number contains 02
    • 2019 Altman SSM 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
    • Pestronk 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?

      Owens:

      1. Why is it important to understand history when addressing health inequities?

      2. What is the difference between “non-racist” health interventions and “anti-racist” health interventions? How are the interventions described anti-racist?

      Altman:

      1. What s the role of qualitative research in understanding health inequities?

      2. How is intersectionality evident in the results of this study?

      3. What interventions would you recommend based on the results of this study?


    • Watch 2020 Media Resource
      Not available unless: You belong to a group in Registered Students Only

  • Monday, May 18, 2020; 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

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

    • 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 25, 2020; 1:00 PM - 3:00 PM - No Class

    Lecture:  No Class - Memorial Day

  • Monday, June 1, 2020; 1:00 PM - 3:00 PM

    Lecture:  Student Presentations

    Faculty:  Christine Dehlendorf

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

    • 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).