- 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 1st 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 1st and 2nd generation work was necessary as a foundation for your current work (or current interests).
ANSWER: My research is currently focused on looking at the genetic contributions and the underlying biological mechanisms that are involved in a Type 2 Diabetic’s response to metformin, a drug used to treat T2D. I think this research is 2nd and 3rd generational (that will be explained later) and can lead to more comprehensive 3rd generational and 4th generational research.
As is well known, the prevalence of T2D varies based on race and ethnicity in both adult and pediatric population in the United States (NHANES 2013). However, it is not as well known that previous published literature (some RCT, observational studies) has shown that there is a differential response to metformin by race/ethnicity. Specifically, African-Americans when compared to Caucasian-Americans on average respond better to metformin. So this initial first generation research has noted a difference in disease prevalence (higher in Blacks and Latinos) but also a racial difference in response to a specific pharmacologic intervention (metformin).
A metformin response GWAS (genome wide association study) was conducted by my lab that found a genetic variant that was associated with having a better response to metformin. Interestingly, this genetic variant has a higher frequency in Blacks (70%) versus Whites (30%); this parallels the previous findings that Blacks respond better to metformin than Whites. Thus, this study could be considered a 2nd generation research. This study used self-reported race that was verified using ancestry-related markers. However, like most GWAS studies, race was used only as a demographic variable and other SES and structural determinants of health were not included in the regression model.
I am interested in determining the biological mechanisms that cause better response to metformin and doing more 2nd and 3rd generation research by doing the following: 1. “Updating” the GWAS research, by adding in SES and other KNOWN environmental conditions that affect T2D prevalence and severity (i.e. diet, physical activity, stress) to the model to confirm/verify that genetic finding (to make sure the genetic finding is real and not a confounder related to race/class/environment) 2. Performing NOVEL pharmacological (drugs that affect the biological mechanisms that I am studying) and non-pharmacological (non-drug treatments that affect the biological mechanisms that I am studying) interventions amongst different racial/ethnic populations to show which interventions work better in different populations.
I think that health disparities with respect to T2D and T2D interventions (drug and non-drug interventions) will only be improved until 2nd, 3rd and 4th generation research seriously and comprehensively includes race, SES and other structural determinants of health.
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 socio-ecological model?
ANSWER: Free health fairs in communities of color are a great way to engage the community regarding issues that affect their health (e.g. Black Panthers and sickle cell anemia testing). For my area of interest, conducting small T2D health fairs (using trained pharmacy/medical/dental/dietary professional students) in front of well known community restaurants (with the approval of the owner) could provide not only interventions for Pre-diabetes and T2D diagnosis via glucometer BG readings but also educating the participants about treatment interventions by referring participants to free nutrition counseling/services and free physical activity/gym memberships in their community. This bridges the community level to the individual level. Also, local, state & federal government can also fund initiatives to reduce food deserts in racial/ethnic/poverty-stricken communities that show local convenience store owners how to stock fresh or prepackaged produce (apples, bananas, tangarines, lettuce, etc) to increase the availability of healthy fruits and vegetables in those communities.
3. Please respond to one other classmate's responses to this assignment.
ANSWER: (Rachel Issaka post) I think its interesting (and effective) that you chose librarians as a means of reaching out to an older demographic. If interested in focusing on a particular racial or ethnic demographic, choice of venue is very important. Maybe local churches/temples or restaurants in the community can be another way to determine screening status & distribute education.