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 interest is in detecting health disparities in children with complex congenital heart disease as it relates to mortality and morbidities. Although several risk factors have been identified for poor outcomes in these children (mostly patient specific risk factors), the role of race/ethnicity and SEP has not been fully evaluated. I consider this 1st generation work. This work will detect, identify and document possible health care disparities in this specific population of patients. If this work reveals disparities in outcomes by race/ethnicity and/or SEP, it would be the groundwork to identify vulnerable populations that may benefit from resources and special programs to improve outcomes. This would be the groundwork leading to 3rd/4th generation work. In particular, specific programs can be studied (i.e. programs that seek to improve access to prenatal care to increase prenatal detection of CHD) systematically to assess their effectiveness in improving outcomes.
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?
My research interest is in detecting whether race/ethnicity and/or SEP are associated with the number of hospital readmissions in the first year of life and 1 year mortality in infants with complex congenital heart disease. If this is found to be true, a possible clinical intervention to improve outcomes in vulnerable populations would be home nursing visits during the highest risk periods (i.e. first 2-3 months after neonatal surgery). This would allow the home nurse to assess for adequate weight gain, nutrition, medication administration and overall education of the family.