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).
Bender WR, Koelper NC, Sammel MD, et al: Validation of a Breastfeeding History Questionnaire for the Risk of In-Hospital Formula Supplementation Among Multiparous Women. J Hum Lact 35:665–671, 2019
2. What was the definition of the construct?
The authors considered in-hospital formula supplementation any formula provided to the infant for reasons other than medical indication.
3. How did the authors provide evidence on the validity of the measure? Could you think of additional approaches to validating the measure?
The authors followed a cohort of 433 women who received their obstetric care in the clinics associated with an urban Baby-Friendly certified hospital in the NorthEast US who subsequently delivered at the hospital. The women were screened during prenatal care using the tool, and data was extracted from the EMR regarding formula use after delivery.
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 authors controlled for race, insurance status, and screening BMI and found the tool to be predictive of in-hospital formula supplementation.
5. Describe the implications of a lack of measurement validity or reliability for future research applications.
The authors mention that socioeconomic status and race are risk factors for “breastfeeding problems,” however, they miss the opportunity to explore the many complex factors at play with these problems. Breast feeding has been identified as a public health priority since there are many well documented health benefits with exclusive breast feeding. This tool is only valid and reliable assessing risk of formula supplementation during the first few days of life. Additionally, the tool is agnostic to the factors leading to a history of breastfeeding problems. I am concerned that a tool such as this one is beneficial in helping hospitals achieve and maintain Baby Friendly certification, but would make little impact on the women and infants after hospitalization. It could even lead to more breastfeeding failure and associated shame if vulnerable women are unable to continue breastfeeding after discharge.
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)
Winestone LE, Aplenc R: Disparities in Survival and Health Outcomes in Childhood Leukemia. Curr Hematol Malig Rep 14:179–186, 2019
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).
This paper evaluated disparities in survival and other outcomes including end of life care and treatment related effects of children according to race/ethnicity, insurance status, age, access to care, and socioeconomic status.
3. What is the evidence for the validity and reliability of the measures?
In this review article, the authors evaluate multiple outcomes. But, in the ALL survival section, data from the NCI Surveillance, Epidemiology, and End Results and California Cancer Registry databases are used, which are commonly used databases for pediatric cancer diagnoses and outcomes.
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 racial disparities in childhood ALL survival was White-non Hispanic children. I think this reference category makes sense because historically, White children would be more likely to be included in clinical trials compared to children of other racial and ethnic backgrounds, so much of our survival data is from a relatively homogenously white population.
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.
The paper evaluates relative disparities. I think relative disparity is the most important measure in leukemia outcomes. We have seen incredible improvements in outcomes of children with leukemia over the past 70 years, however, racial and socioeconomic disparities persist. While the field continues to try to improve overall survival, it is important that we pay special attention and try to close the gap in survival between these different groups.