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).
Our current analysis characterizing NAFLD prevalence by food insecurity would best fit within the 1st/2nd generation, since we are better documenting potential disparities among vulnerable populations. Limited by a large, cross-sectional study, we raise potential causal relations that may underlie these disparities (food quality, stress around scarcity, binge-patterns inducing central obesity – increased by food access and competing demands by marginalized groups, etc), and hope to further describe potential upstream causal with longitudinal data in another cohort. A way to bridge to 3rd generation would be to use a mixed methods approach with community engagement to assess if urban farming may both address upstream determinants above and impact 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. 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).
Similar to disproportionate burden seen with T2Dm/obesity, there may be an increased risk among middle-aged Hispanics (Rich et al 2018). Extending clinical services ‘at the safety-net’, one could design a similarly incentivized prediabetes screening campaign (NDPP diabetes screening questionnaire) with lifestyle education and targeted goals (ie~ pedometers with reimbursement with threshold goal) in churches and/or local markets. Using Walton strategy, could enroll/identify high-risk metabolic disease adults in similar settings/screening- but rather than passive education programs +/- incentives – could evaluate peer-education groups, with pre-identified subjects managing or partner of someone managing diabetes from similar ethnicity and within the community.