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 work is a blend of 1st and 3rd generation. My 1st generation work is in the realm of opioid prescribing where we have only just compiled the data and are now exploring whether disparities exist in terms of race/ethnicity, language, and socioeconomic status. I have also worked with 1st generation research looking at whether disparities exist in readmissions and infection rates for inpatients hospitalized at UCSF. I am also working on some 3rd generation with an intervention for residents and hospitalists by educating them on disparities and tracking to see if there are improvements. For my opioid research moving forward, I would need to think about what interventions to try and then assess if they work. I think education alone is going to be limited in its efficacy but in the right group it could move the needle. 4th generation work working with multiple stakeholders and better understanding the multifactorial mechanisms by which disparities in opioid prescribing get propagated would be the ultimate career goal.
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.
I think the framework could be applied to opioid safety and harm reduction interventions. While not my specific area of interest or focus, there is already a strong culture of persons who inject drugs helping each other and teaching each other. One could imagine an intervention in the community at a place like a barbershop or a soup kitchen that integrated some safety teaching or handed out kits of naloxone. Given the barriers to getting naloxone already, just increasing the distribution points for this life saving medication alone as an intervention would likely be an effective effort.