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 1st 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 1st and 2nd generation work was necessary as a foundation for your current work (or current interests).
I am interested in investigating the racial/ethnic disparities in outcomes of salivary gland cancer patients that have been previously identified. A 2014 JAMA article showed that black patients with mucoepidermoid or squamous cell carcinoma had poorer disease-specific survival than white patients. One contributing factor was found to be lower rates of surgical treatment in black vs white patients. I am specifically interested in exploring why black patients have lower rates of surgical treatment than white patients (57.3% v 77.0%, p<0.001). This question is best characterized as a second-generation question, as I am asking why this racial disparity in surgical treatment exists. Is it due to a lack of trust between the medical and black community, lack of access to highly specialized head and neck surgeons, physicians offering surgical treatments to these patients less frequently, etc.? Once several factors are identified, this knowledge can be used to design interventions specifically targeting these factors in this patient demographic to narrow this disparity. For instance, if lack of access to specialized physicians is identified, interventions changing health insurance policies to broaden access or creating incentivized programs to attract head and neck surgeons to these underserved regions can be implemented. We can then trend outcomes in black (and white) salivary gland patients to determine whether our policies were effective (third-generation research).
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.
The incidence of HPV+ oropharyngeal cancer has been on a steady incline over the last few decades. There are indications that herd immunity from the HPV vaccine, which protects against oropharyngeal, cervical, and anogenital cancers, may already be occurring. Though men in all racial/ethnic groups have higher rates of HPV+ oropharyngeal cancer than women, boys are receiving HPV vaccines at lower rates than girls (56.0% v 65.1%). Some factors causing this gender disparity could be due to persistence of outdated gender-based guidelines, as it was initially FDA-approved for only females 9-26 years of age. One intervention to bridge the gap could be to create state mandates for HPV vaccinations for school entry regardless of sex. This would be an intervention akin to the fence level in Jones’ analogy, as HPV vaccination acts as primary prevention against oropharyngeal cancer.