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).
First: Document existence of health disparities
Second: Explain reasons for health disparities
Third: Provide solutions for eliminating health disparities
Fourth: Using comprehensive, multi-level interventions and evaluations that focus on multiple outcomes and multiple levels of the socioecologic model.
A current research project that I worked on involves first generation research in that I am attempting to document a potential health disparity between South Asians compared to other race/ethnic groups in the US. The primary association of interest is between radiographically measured adiposity and coronary artery calcium with the proposed mediator of race/ethnic group. The baseline cohort data I am using only allows for cross-sectional analysis. If it can be demonstrated that race/ethnic group mediates this interaction, the second generation research could then attempt to explain why South Asians have different distributions of ectopic fat adiposity and how these may causally lead to differential rates and progression of atherosclerotic disease and ultimately coronary and cardiovascular death/morbidity. Third and fourth generation research would then attempt to eliminate these disparities on several levels, including genetic (precision-medicine based initiatives to create targeted genetic and molecular therapies for South Asians specifically), risk factor reduction strategies (increase activity levels and improve diets of South Asians), community-based strategies (raising awareness through temples, etc.), among others.
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. What aspects of this program might be generalizable to other areas of health? How might this apply to your area of research?
The manuscript Introduction provides important background on the differences between Black men and women, and the community activities they reliably partake in. Not only do Black men consistently frequent the barbershop and remain loyal to the barbershop they go to, but they also have a good relationship with the barber and a palpable sense of community with their fellow patrons at these barbershops. When you think about many of the social determinants of health in this race and gender subgroup, it is important to note that there an element of trust in this setting that may be negatively impact interventions say in a clinic or office setting. Members of the same community are discussing topics important to them without other socioeconomic differences that may hamper communication and influence. This intervention also brings health into an every day context that is harder to compartmentalize. This program may indeed be generalizable to other areas of health in that the model can be used for other health disparities such as diet or diabetic screening/treatment. This definitely applies to my research in South Asians in that it gets me thinking about third and fourth generation approaches to designing interventions that use the unique community-centered characteristics of the South Asian community to design interventions. In South Asians, for example, temples may be once such location for targeted interventions. The take home message for me in reading this paper is that it is important to move beyond the prototypical Stage 3 intervention of a clinic/office-based intervention that may be limited in effect by the hidden socioecologic barriers. It emphasizes the need to be creative and use my understanding of the South Asian community to design potentially more effective and influential strategies to tackle important disparities.