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 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).
My current research on hypertension in minority communities is largely 3rd generation. I am interested in identifying interventions that can be effective in eliminating disparities in hypertensive minority populations, and determining the best ways to implement these interventions. There is a large body of foundational research on racial disparities in hypertension hat has come before mine. My current work relies on a body of work that has examined how socioeconomic factors can impact hypertension. My work is also based on the understanding that certain interventions, like home blood pressure cuff monitoring, have been effective tools for clinicians and non-minority patients in the battle to control high blood pressure. Researchers in my field have spent decades unraveling these interactions through a combination of observational studies, clinical trials, and large, population-based surveys. A great example of this is NHANES, a population-based study that has identified broad racial disparities in blood pressure control in the United States that have persisted over long periods of time. Even as our understanding of the reasons behind these disparities deepens, the NHANES data set has continued to be a valuable resource to study the nuances of disparities in hypertension. Furthermore, and the longitudinal nature of the study allows researchers to not only gain a better understanding of how the disparities change with time, but how they react to broader, community and population-level interventions.
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).
I could apply an intervention that has some interaction with social determinant of health, as the investigators did in the barbershop hypertension intervention. My area of research is the same, however instead of targeting black men, I could target a geographic community – like an SF neighborhood or microhood – by centering the intervention in a community center or a location that my target population visits frequently (grocery store, corner store, library, park, etc.). I like the idea of bringing a standard medical practice (checking blood pressure) physically into the community because it reverses the dynamic of the individual going to the health care provider. Another way to do this would be bring a mobile health service into a low-income or minority community on a regular basis and provide blood pressure checks and information about high blood pressure (what it is, why it’s important to care about it, how to treat it). While all of these interventions, do require the individual to ultimately go to the doctor, by bringing hypertension to them, in their community, the threshold for initial action is lowered considerably.