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 research investigating health disparities in neurooncology, specifically progression-free survival and outcomes (including Karnofsky Performance Scale Score) following primary brain tumor diagnosis falls within the category of first generation research. Hopefully, this work will be able to detect, identify and document disparities in survival, outcome in patients of different socioeconomic and ethnic groups if they exist. Hopefully, with knowledge gained from this work, second, third, and fourth generation research can be implemented. For example, once we have defined that disparities exist, then research can dig into the cause of such disparities. I envision work crossing multiple disciplines including genetic profiling, observational studies that explore the health care system evaluation including radiographic and pathologic characteristics of tumors, provider influence, distance to health facility (geo-mapping), and patient health literacy to identify causal determinants of disparities in accordance with second generation research. To move into third and fourth generation research where solutions can be identified and offered to eliminate disparities, I envision a randomized controlled trial to intervene after a diagnosis of primary brain tumor has been established. The intervention group may be one where the patients are guided through their post-diagnosis care with the help of a study liaison and the control group receives only the usual care. This would address issues related to the health system, geographic location of patients, and health literacy from potential contributors to disparities in outcomes and allow researchers to hone in on contributors to disparities in care.
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 types of clinical interventions can you think of in your area of research that could similarly bridge levels of the socioecological model?
In my area of research interest, disparities of care in neurosurgery, a clinical intervention that may be able to bridge levels of the socioecological model might best address neurotrauma. It is known that African-American men are the most vulnerable population as victims of trauma in the United States. Perhaps a community-based intervention based in African-American churches that addresses gun violence may be able to make an impact in this sphere. Outreach events held in such churches where former victims of neurotrauma speak to the community about gun violence, its disproportionate effect on African-American men, and the importance of educating the youth to break the cycle of violence may be useful in this sphere.