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).
My current research focuses on the association between Atopic Dermatitis and Depression in pediatric populations. It is a well-established phenomenon that adults with atopic dermatitis are at higher risk for depression, however the bi-directionality of this association and its presence in pediatric populations has not been well studied. Moreover atopic dermatitis is often considered to be more prevalent in higher-SES populations. Therefore taking into account the very significant contributions of social determinants of health in the development of depression and the fact that individuals of lower SES are thought to be at higher risk for mental health diseases, further characterizing this AD-Depression association is worthwhile. Therefore I would categorize my research as 1st generation, possibly 2nd generation. This is because we are detecting and documenting the disparities, but also hoping to shed light on the causal determinants of this association. 3rd or 4th generation work could examine whether improving access to pediatric dermatologic care affects pediatric mental health outcomes, or conversely whether improving living and working conditions in a lower-income communities (this could be done through a variety of interventions) would affect the community’s pediatric mental health outcomes and development or management of pediatric AD.
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.
One example of an intervention could be to target pediatric dermatology patients in safety-net hospitals where patients are largely enrolled in Medicaid or lack health insurance coverage altogether. Dermatologists caring for these patients could provide extended social support, including social services targeting housing but also support groups for caregivers with skin diseases, vouchers to facilitate transportation to the hospital and/or more dermatologic clinics. Measures would include validated pediatric depression screening questionnaires such as the Short Moods and Feelings and Questionnaire and a chosen validated atopic dermatitis scoring system to standardize outcome measures, and both would be taken at successive visits.