Health Disparities Forum

Hi everyone, homework this week has three parts (the first two parts are pretty straightforward though).  You will find part 2 substantially easier after you read the Harper reading for this week:

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). 

Michaels, Stuart et al. “Improving Measures of Sexual and Gender Identity in English and Spanish to Identify LGBT Older Adults in Surveys” LGBT health vol. 4,6 (2017): 412-418.

2. What was the definition of the construct? The paper was looking at assessing the comprehension of older LGBT adults with a 2 question gender and sexuality assessment and trying to improve on that measure so that results were consist across both Spanish and English speakers.

3. How did the authors provide evidence on the validity of the measure? Could you think of additional approaches to validating the measure? They found that the heterosexual Spanish speaking respondents had difficulty understanding the term heterosexual and that the most of them selected sexuality as ”something else” as they seemed to fear the homosexual category None of the Spanish speakers selected gay or lesbian, 1 picked bisexual an the rest selected sexuality as something else.

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? The follow up test was revised to have different survey questions that used less jargon like “heterosexual/homosexual” to say gay or lesbian and men or trans male or female

5. Describe the implications of a lack of measurement validity or reliability for future research applications. You cannot normalize the data and use it across language barriers and with very large LGBT populations if the survey is not getting at the key answer sought after if 30% of respondents do not understand the question.

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). Family rejection was the construct as assessed in the survey as the predictor variable. The measures used to see if there was a dependence relationship involved survey questions about mental health, substance use, and sexual behavior.

3. What is the evidence for the validity and reliability of the measures? The FAP family rejection scale has been tested and re-tested for accuracy and reliability and the other measures were self-reported and with 245 LGB young adults tested it is well powered and a strong effect.

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? The reference category for the disparity measure is LGB young adults who did not experience family rejection. Yes this makes sense since it is the rejection of trauma that is being compared against a group without rejection.

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.  Rejection was scored from the FAP family rejection scale and then transformed into a dichotomous variable with choices “ever” or “never”. They reported the scaled scores and it showed Latino men with the highest level of rejection and white women with lowest level. This was better than yes/ no scoring as it was able to see the differences in sub groups.

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. 

I looked at the article another student posted about the rates of adverse outcomes in pregnancy between black and white women. I think this most clearly illustrates how for years black babies have been delivered by white male ivy league graduates who have very little knowledge African American physiology and preferences in delivery. another article I read in this area talked about the few states allow licensed midwives to deliver the baby and the complications have gone way down and the incidence of unnecessary procedures being added is reduced. The next comparison that should be done could be based on midwife vs. obgyn and gender and race of provider as other variables to see if the outcomes are vastly different based on provider race and gender.