Health Disparities Forum

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).

I am currently working on a few projects, but the one I am most excited about is the implementation of a free Fatty Liver education class at SFGH. This project is a combination of a 2^nd/3rd generation project. Black and Latino patients have previously been identified as being at risk for worse outcomes with regards to metabolic syndrome – obesity, diabetes, hypertension. Latino and Asian patients have worse outcomes when diagnosed with particular chronic liver diseases. We have created the class with the goal of educating our diverse population of patients about their disease(s), helping them to understand the risk factors and potential consequences of metabolic syndrome and fatty liver disease, as well as changes they can make in their lives to help address risk factors and potentially prevent progression of their liver disease in particular. This class is given to patients’ in their preferred language, is interactive, family members are allowed to attend, and our goal was to attempt to address challenges that our patients seen at a safety-net hospital specifically face. This is the 3^rd generation portion of the study.

I think this is also a 2^nd generation project as we are also asking our patients several questions about their knowledge of the disease, their SES including education, employment, income, neighborhood, access to safe areas to exercise, access to healthy food, etc., as well as their feelings toward dietary changes and exercise. We are also interested in learning more about how their family feels about these lifestyle changes, and how these changes are easier or more difficult based on their education level, financial and housing situation, culture and social support system. Our goal with these questions is to determine causal relationships within each racial/ethnic group that may be contributing to the health disparities previously observed.

I would say overall, my research interests fall within the 2^nd to 3^rd generations, but I hope that I can eventually participate in a 4^th generation work as described in Thomas et al. For now, this class alone has helped me to become more of a self-reflective researcher, which I very much appreciate.

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 am interested in both non-alcoholic fatty liver disease (NAFLD) and alcohol-associated liver disease (AALD). For each of these diseases, lifestyle changes are absolutely crucial, and while they are extremely challenging changes to make for everyone, they may be more difficult for patients seen at SFGH for a variety of factors. In the future, I would like to study the impact of having a multi-disciplinary team available in hepatology clinic for these patients to see if it improves outcomes in these diseases. For NAFLD, having a nutritionist available to visit with patients in real-time compared to referring the patient to a nutritionist. Although this still requires that the patient come into liver clinic, it eliminates an additional visit, which can be very difficult when income is limited, work hours are less flexible, transportation is difficult, childcare is limited, etc. Similarly, I would like to see if having an addiction specialist available in liver clinic makes a difference in alcohol cessation for AALD patients. Alcohol abstinence is crucial to prevent progression/decompensation of AALD and is a requirement for patients to be referred to UCSF’s liver transplant clinic, which is a common barrier for these patients. I would be interested to see if this intervention changes clinical outcomes but also impacts the referral/transplant rate.