Health Disparties Forum

My research focuses mainly on postpartum contraception and cervical dysplasia. An important theme in both fields is access to preventative health care which is influenced by a complex interplay of behavior, policy, cultural believes, insurance status, language and healthcare system proficiency. Although the effect of disparities on health outcomes is not the primary focus of my research, in order to do high quality research it is imperative that I understand the effect that disparities have on the outcomes that I am studying.  In my own research I have to attempt to adequately measure, adjust for, race and SES in order to produce unbiased estimates.  I have to acknowledge in my discussion when my study is limited by the fact that I not adequately powered to detect differences between difference racial groups. If I have the resources, I will always consider a sample size that allows me to better understand whether there is interaction between SES and race and my outcomes of interest and what other underlying unmeasured disparities may explain such an observed difference (such as education or wealth).

In addition, this class has been instrumental in helping me read literature critically. For instance, I am able to think more systematically about which racial group was used as a comparator in analyses and what the effect that choice had on the presented results. I am acutely aware of which social determinants were collected in studies, and how these variables were analyzed when “controlling for SES”.

As someone who works with vulnerable cancer population, my research questions are related to challenges to cancer care in this population and disparities in treatment. Racial disparities in cancer are well recognized and SES, insurance status has all been shown to correlate with cancer outcomes. My interest is to understand the mechanisms for worse outcomes in vulnerable populations. The course emphasis on looking at health from multiple levels and thinking of any disease in an ecological framework has allowed me think of not just  what I see in the in clinic but  from perspective of other determinants beyond health care. At SFGH majority of lung cancer patients present at stage III and IV much higher than a national database, about 10%  higher absolute percentage point for stage IV.  This is a huge difference. My hypothesis is that access to primary care and having interacted with health care system in last 6 months may be an important determinant of stage at diagnosis.  I am interested to see if ACA may impact this pattern in some of our patients. I now have an understanding that several factors will influence this such as race, SES, education, insurance status, and immigration status and neighborhood factors.

The course has allowed me to move away from biological fallacies which are used to explain away most of the cancer disparities. Even apparent biological differences are results of exposures and factors that likely precede the development of cancer. 

Social position, economic status, culture  and environment is a critical determinant of who develops and survives cancer and quality of life of cancer survivors.

My research interests are in the role of systems of care to improve transitions of care quality in medically and socially complex patient populations. In particular, I have interests in the role social support and perceived social support have on health outcomes for vulnerable populations, and design of interventions that target the needs of these populations.

The content in the class has been useful in my research approach through improved characterization of disparities (whether through systems, community, self-imposed), providing a framework for disparities research via socio-ecological framework, the discussion on measurement of SES, social support, and other community measures, and strategies for reaching minority/vulnerable patient populations.

In my current project examining social support role in readmission, I think the class has challenged my current work in that it has forced me to think critically about what measures of social support I have access too, how to adjust for race/ethnicity and SES factors. Moving forward, I think it is challenging to fit the concepts of health disparities into an analysis/project that uses statistical methods that may not be the best fit to answer these questions (i.e logistic regression), how to do this might be a natural next step in a second course.  

I do research on general health and health care for people with disabilities.  I found this course helpful for conceptualizing disparities and thinking about how to apply these concepts to my population and research.  Since disability is cross-cutting when it comes to race, SES, age, sexual orientation, gender, etc. it is also helpful for me to have some approaches for addressing health disparities experienced by these groups in the context of trying to understand the issues faced by people with disabilities.

One of the most helpful aspects of the class for me were the conversations about contextual variables such as neighborhood, culture, interpersonal relationships, etc. since disability is an interactional concept that depends on both an individual's health condition(s) and also his or her environment.  The course expanded my thinking on the breadth and types of elements that need to be considered as part of the total environment, and was helpful for thinking about how to break environment down into measurable elements.  I found several of the models presented in class to be very useful examples in this regard.

Thanks to all of you who taught this course and to my classmates.

I do research on mental health integration into primary care, primarily in safety net settings. Much of my work focuses on Latino populations, as most of my patients are Latino and Spanish-speaking and they face many difficulties in accessing quality mental health care.  This class helped to reinforce many of the frameworks and concepts for approaching health disparities research.  I found the last week's discussion on the generations of research particularly useful as a way of conceptualizing my research and whereit might fit in to add to current knowledge and where further gap sin knowledge lie.  I think it is important to understand the goal of your research and the audience, and framing it within the generations of research can help clarify that and vice versa. 

I also felt that the emphasis and classes on measurements were particulalry useful. As we learn to be good researchers, I think it is always important to evaluate the measures your are using and to always question and evaluate whether your variables or measures are adequately capturing what you are trying to measure. I think this is particularly important with race and ethnicity, as it interacts with class and SES in myriad ways, and differently in different contexts (such as Brazil vs US).  The classes on these issues, and the conceptual frameworks for organizing research on health disparities were particularly useful.

This class was a good overview of the field, and as others have mentioned, served as a good way to learn how to critically appraise the current literature. Thank you for interesting discussions! One of the most useful things was learning about other people's research interests and how we approach disparities in very different ways!