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 interests are 3rd generational in determining outcomes to close the gap. There is a lovely ethics report from the American Society of Reproductive Medicine entitled Disparities in access to effective treatment for infertility in the United States: an Ethics Committee opinion. Here, they outline the common areas of disparity in reproductive medicine which have been longstanding yet exacerbated as reproductive technologies have increased in number, efficiency, and cost. When reading this document and observing challenges inherent within different populations – challenges faced in the southeast US not the same as those in Northern California – my team and are trying to be strategic in
developing solutions to close the gap. Additionally, reading much of the work from Kessler et al regarding the epidemiology behind who has access to infertility evaluations and fertility treatment – including the attrition seen at each intervention has been another strategy we’ve employed when designing solutions to narrow current disparities.
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 current area of research, I am particularly interested in increasing access to infertility education and fertility treatment within disparate populations. We recently held an intervention in which we went to a local health clinic to provide information about infertility and ways to access affordable, reliable treatments. During this event, we brainstormed other populations that would benefit from increased access among reproductive aged women and thought starting within the school system could be advantageous. We currently have a program at our safety net hospital but the population that goes unserved in San Francisco includes those with access to health insurance but without fertility coverage as well as an income that often precludes them from pursuing fertility treatment. Similar to this intervention, we hope to align with school’s in the area to provide education about infertility and ways to optimize one’s natural fertility. Once our target location can be identified, we can systematically design an intervention investigating whether the knowledge gained about infertility is affected by the intervention – with plans to extend this to outcomes postintervention (referrals to clinics/follow up with benign gyn, pursuit of treatment as necessary, etc.).