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).
Most of my research projects are all over the spectrum of being 1-4th generation. For example, one of my projects is 3rd generation and uses implementation science principles to evaluate the effectiveness and outcomes related to Managed Alcohol Programs all across the world. Managed Alcohol Programs (MAP) are programs targeting patients with severe alcohol use disorder who have not done well in usual abstinence-based treatment settings and have a history of frequent contacts with ED, police, and other social services. MAP programs offer stable housing, food, health care access, and provide hourly doses of alcohol using a harm reduction model. In Canada, where most of the world's MAPs are located, Indigenous communities are disproportionately affected by AUD compared to Whites, and some MAPs are comprised of entirely Indigenous participants. One of the goals of these MAPs were to meet the needs of Indigenous communities affected by AUD, including consulting with Indigenous communities in the creation and ongoing maintenance of MAPs, having weekly visits from Indigenous Elders at the MAP who conduct drum circles and other Indigenous ceremonies, and training/educating non-Indigenous staff on cultural Indigenous practices. This work was informed by 1st generation data collection elucidating the disparities of AUD among Indigenous communities and 2nd generation CBPR with Indigenous communities to determine causal relationships that could be targeted to reduce this disparity.
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.
In my area of interest regarding substance use disorders, safe injection sites also known as safe consumption sites (SCS) are an intervention to mitigate the social determinants of health and act as a form of harm reduction for patients with IV drugs use (PWID). SCS provide a safe, clean, monitored space for patients to use all types of drugs without fear of prosecution from police and allow quick medical response for any person experiencing a drug overdose. SCS often provide PWID with an array of options, including injection
supplies and education around safe injecting practices to prevent skin/soft tissue infections and communicable blood borne diseases like HIV/HCV, connection
to health care services like HIV/HCV testing/treatment, and help develop
relationships in an otherwise marginalized community that often do not
feel welcome in medical settings like clinics and hospitals. SCS have existed for the past several years in countries all of the world, and not a single overdose death has ever been reported at any site. There is also significant evidence that there is increased utilization of treatment options, improved relationships with the medical community, less spread of communicable diseases like HIV/HCV, among several other reasons proving its effectiveness as a public health intervention. The United States is now considering opening its first SCS, most likely in Philadelphia in the coming weeks. Therefore, significant opportunities for research exist to assess the implementation of US' first SCS including determining how SDoH should be addressed in SCS implementation and what are the ways we can maximize the benefits for this marginalized population.