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-generation research focuses on detection, identification, and documentation of disparities, including identifying vulnerable populations. Second-generation research determines causal relationships that underlie health disparities. Third-generation research seeks to provide solutions for eliminating health disparities. Fourth-generation research seeks to take action by using mixed methods approaches to evaluate comprehensive, multilevel interventions.
My area of interest is childhood obesity. Using data from NHANES, Ogden et al. (JAMA, 2014) report that, in 2011-2012, 31.8% of youth ages 2 through 19 were overweight or obese, and 16.9% of youth ages 2 through 19 were obese. Examination of the data by race/ethnicity, shows that the prevalence of overweight or obesity differed by race/ethnicity (p < 0.001, by ANOVA), and obesity was lower among non-Hispanic white youth compared to non-Hispanic black youth (p = 0.048) and Hispanic youth (p < 0.001). This is an example of first-generation research that has been performed in this field. As for second-generation research, studies have shown that socioeconomic status, environment, and lifestyle factors including diet are contributing factors. For example, Nelson et al. (Child Obes, 2018) performed a cross sectional study of 198 African American youth and found that racial discrimination and low household education predicted higher BMI in African American adolescents, particularly among girls. Currently, the field of childhood obesity is moving towards third-generation research seeking to identify solutions for eliminating health disparities. An example of this can be seen in a study performed by Callender and Thompson (Children, 2017) looking at a text messaging based obesity prevention program specifically within this population. That said, third-generation research in the field of childhood obesity certainly remains in the beginning stages.
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. Interventions like that described in the Walton article are designed to mitigate the impact of social determinants. How could you apply one of these two types of interventions to your area of research? Propose one or two interventions that engage with social determinants on some level. (Note: Next week we will discuss policy-level interventions designed to directly impact social determinants).
Peer-led interventions may be an effective way to address childhood obesity. Indeed, studies have shown that youth-mentors in nutrition interventions appear to contribute to positive health outcomes while playing a leadership role in health-related programs (Trude et al., Health Promo Pract, 2018). One potential intervention would be to train a few college-aged youth from a particular community to deliver nutrition and physical activity education, and then to have those college students go to the high school in that community and teach the high school students about nutrition and physical activity. With such an intervention, youths from that community could serve as youth advocates for others within their community.