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).
Within the area of research surrounding bladder cancer outcomes, the literary is currently within the 1st or 2nd generation. Currently research in this field, particularly thorough and well-thought out evaluations of the factors driving disparities, is lacking. The state of the data now is really limited to adding race + insurance into regression models, with the results being the basis for the argument for racial differences in outcomes. My current work is using a national database to explore and identify potential factors on a national level. The work is limited by what is available within the database but the findings will be both hypothesis generating and lay the groundwork for further single institutional investigations with our own prospective database and more granular data.
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?
Increasing visibility within the community is key to bridging the levels of the SE model. Unfortunately, discussion of hematuria (blood in the urine) is a little bit more personal than high blood pressure, making this a less comfortable discussion to have in the open. From my own experience, many men have issues/concerns but do not feel comfortable discussing them with strangers, PCPs or other who may want to help but are not known well. Ideally, those who are being treated could potentially begin to start to discuss this with others in their family, slowly working to destigmatize the notion of discussing such health-related issues. Additionally, more discussion of the workup and steps in management by trained professionals during support groups and community info sessions would also help to bridge these gaps.