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University of North Carolina at Chapel Hill School of Medicine

Course last offered: Fall 2002
Page last updated: October 29, 2008

Contact

Sohini Sengupta, Ph.D., M.P.H.
UNC Department of Social Medicine
Room 381, Wing D Medical School, CB#7164
Email: sengups@med.unc.edu


RESEARCH-BASED HEALTH ACTIVISM

Seminars in the Humanities and Social Sciences (MEDI 231)
Fall 2002

Course Director: Sohini Sengupta, Ph.D., M.P.H.
UNC Department of Social Medicine - http://www.med.unc.edu/
Room 381, Wing D Medical School, CB#7164
Email: sengups@med.unc.edu

Office hours: By appointment; special help sessions may be scheduled, as needed.

COURSE DESCRIPTION

The purpose of this course is to facilitate medical students’ interests in shaping health care delivery and health policy through research-based health activism. Areas of interests can include access to health care for vulnerable populations, human rights violations, food and drug safety, tobacco control, illicit drug use, immigrant health, environmental exposures, mental health, violence, or medical illnesses, such as AIDS or cancer, to name a few. We encourage you to develop projects that reflect your own interests and abilities. 

The course is designed to provide practical skills in collecting and analyzing data, and being able to present them in a form understandable to policymakers in order to potentially impact health policy or health care delivery in this country and abroad.  The main focus of the Fall semester will be to develop a 5-page written proposal that may serve as the basis for a future research project. The Spring 2003 semester elective is optional, but strongly recommended for students who wish to carry out their proposed research projects.  UNC-CH faculty will be mentors to students during the course and in the subsequent Spring semester elective for those students who wish to carry out their proposed research projects.

COURSE OBJECTIVES

Participation in the Fall semester course will:

  • Introduce students to practical approaches to developing and conducting research-based projects designed to engender health activism.
  • Introduce students to a series of presentations from physicians and other health professionals who have conducted research projects to effect policy or change in the health care system.
  • Assist students to develop a 5-page written research proposal that can be used to influence health policy or health care delivery in an area of the students’ choosing. 
  • Provide students the opportunity to present their research proposals in the classroom.

If students decide to carry out their research projects, participation in the Spring  2003 semester will focus on assisting students to conduct their research projects.  This will include periodic meetings with students to discuss their works in progress.

EXPECTATIONS FROM THE STUDENTS

  • Be on time for class.
  • Read the assigned text or articles ahead of time and be prepared to discuss them during each class.
  • Complete and turn in weekly assignments; they will assist you as you develop your proposals.
  • Work in pairs to develop your research proposals.
  • Prepare and present a 7-minute presentation of the research proposal in class.
  • Turn in a 5-page written proposal at the end of the semester (last day of class).

METHODS OF INSTRUCTION

Each class session will be interactive. The first hour of class will be devoted to a presentation made by a physician or other health professional who has been involved in health activism. You will be able to ask questions and comment about their work or issues they raise. 

The second hour of class will focus on helping you to develop your research proposals. Sohini Sengupta (or other faculty member) will discuss different aspects of research methods from week to week, and you will be able to ask questions about your turned in assignments or about future assignments. Weekly assignments will be given back to you the following week with comments/suggestions for revision, but will not be graded.

GRADING

If you attend class regularly, prepare for each class, turn in weekly assignments including the final proposal, and participate in class discussions, you will automatically get a P. A grade of H will be given to students whose research proposals are clear and well-written, and demonstrate feasibility of the research activities proposed.

SCHEDULE OF SESSIONS

SESSION 1 (August 20)

Introduction: What is Research-Based Health Activism?
Presenter: Peter Lurie, M.D., M.P.H.
Public Citizen Health Research Group

Readings:

  • Lurie P, Hintzen P, Lowe RA. Socioeconomic obstacles to HIV prevention and treatment in developing countries: the roles of the International Monetary Fund and the World Bank. AIDS 1995; 9:539-46.
  • Sobel HL, Lurie P, Wolfe SM. Lead exposure from candles. JAMA. 2000 Jul 12;284(2):180.

Dr. Lurie is a visiting speaker and widely known as an activist on a number of health-related issues. Please do your best to read both articles in preparation for his presentation.

NOTE: We will spend the last 15 minutes or so of class going over any questions about the syllabus and faculty mentor list (at end of syllabus).

SESSION 2 (August 27)

How Research Can Be Used to Shape Public Policy
Presenter: Pam Silberman, J.D., Dr. P.H.
UNC SPH, Department of Health Policy and Administration

Readings

  • Zervigon-Hakes AM. Translating Research Findings into Large Scale Public Programs and Policy. The Future of Children. Long-Term Outcomes of Early Childhood Programs. Winter 1995;5(3): 175-191.
  • DiFranza JR. A Researcher's Guide to Effective Dissemination of Policy-Related Research. Advocacy Institute. The Robert Wood Johnson Foundation. Technical Assistance Guide No. 11.
  • Sorian R, Baugh T. Power of Information: Closing the gap between research and policy.  Health Affairs. March/April 2002;21(2):264-273.

Writing Research Questions/Hypotheses
Presenter: Sohini Sengupta

Readings:

  • Cummings SR, Browner WS, Hulley SB. Conceiving the research question. In SB Hulley and SR Cummings, Designing Clinical Research , pp. 12-17.  Baltimore, MD: Williams & Wilkins, 1988. ISBN/ISSN:  0-683-04249-1.
  • Browner WS, Newman TB, Cummings SR, Browner WS, Hulley SB. Getting ready to estimate sample size: Hypotheses and underlying principles. In SB Hulley and SR Cummings, Designing Clinical Research, pp. 128-129.  Baltimore, MD: Williams & Wilkins, 1988. ISBN/ISSN:  0-683-04249-1.

ASSIGNMENT DUE:  Turn in a 1-page statement of your research interest and discussion with faculty mentor (from faculty mentor list).

SESSION 3 (September 3) 

The Role of a Medical Student as a Health Activist
Presenter: Bill Wood
UNC 4th year medical student

Readings:

Below are links to a number of health related research-based activism organizations, often to a particular page within the site. Please peruse at least five of these, looking at more of each site than these linked pages alone. Please answer the questions in the first paragraph below, and please pick one or two more of the below links for which you could provide an answer in class to the question noted. 

  • Health Insurance:  How much do Americans pay in taxes for our health care, compared to countries that have universal coverage?  What’s the difference between national health insurance and a national health system?  "We pay for national health insurance but don't get it" 
  • How does life expectancy compare in Canada and the U.S., according the WHO’s most recent compilation of data? http://www.who.int/en/
  • How many North Carolinians – folks you will encounter in your rotations -- do not have health insurance?  http://www.healthcareforallnc.org/index.cfm
  • Drug Safety: Why did Health Research Group petition the FDA to ban the diabetes drug troglitazone (Rezulin)?  http://www.citizen.org
  • Air pollution: Where do NC Metro areas rank, compared to New York City?  What are the health effects of ozone?  http://www.lungusa.org/
  • Drug Companies’ Marketing: What effect did one enticement have on physician prescribing patterns (look at the link to the Chest 1992 article)?  http://www.nofreelunch.org/requiredinfluence.htm
  • International Health: How many U.S. Senators voted for the Global Fund to fight AIDS, Tuberculosis and Malaria?  How did NC’s Senators vote? http://physiciansforhumanrights.org/
  • Gun violence: How many times more often is a gun in the home likely to be involved in an unintentional shooting, criminal assault or homicide, or suicide, than in self defense?  http://www.psr.org/
  • Mental Health:  How does the prevalence of depression relate to low vs. high income? http://www.who.int/
  • Abortion:  What is the primary factor influencing a country’s abortion rate?  In the attached report, which country has the lowest abortion rate?  Is abortion there legal?  http://www.guttmacher.org/
  • Resident unionizing: Which major public hospital/major medical hospital recently agreed to eliminate post-call clinic duties for residents, after four post-call car accidents by residents? http://www.cirdocs.org/
  • Child deaths:  By what percentage could child deaths beyond the first month after birth be prevented by learning lessons from child mortality data?  http://www.aap.org/  This site is one example of “organized medicine,” e.g. of a specialty organization, most of which have tons o’ data…
  • Medical Student activism:  When and where is AMSA's next national convention, which will include speakers and workshops related to many of the topics above? http://www.amsa.org/AMSA/Homepage.aspx

Types of Study Designs

Presenter: Sohini Sengupta

Readings:

  • Newman TB, Browner WS, Cummings SR, Hulley SB. Designing a new case study: cross-sectional and case-control studies. In SB Hulley and SR Cummings, Designing Clinical Research , pp. 75-86. Baltimore, MD: Williams & Wilkins, 1988.
  • Singleton RA, Straits BC. Experimental designs. In RA Singleton, BC Straits, eds., Approaches to Social Research, pp. 210-238. New York: Oxford University Press, 1999.
  • Hearst N, Hulley SB. Using secondary data. In SB Hulley and SR Cummings, Designing Clinical Research, pp. 53-62. Baltimore, MD: Williams & Wilkins, 1988.

ASSIGNMENT DUE:  Turn in research questions and/or hypotheses.

Optional assignment, if you have time (from Bill Wood): 

Bring to class a printed copy of a letter or email you have sent to either an elected official of your choice, or a letter to the editor you have sent to a major NC newspaper (not The Daily Tar Heel).   The letter/email should be on a health-related topic of your choice, and cite a fact you have researched on the web or elsewhere, which you believe needs some action in response. 

SESSION 4 (September 10)  

Long-Term Care Advocacy for Frail Elders
Presenter: Laura Hanson, M.D.
UNC Division of General Medicine

Readings:

  • Zerzan J, Stearns S, Hanson L.  Access to palliative care and hospice in nursing homes. JAMA 284(19):2489-2494, 2000.
  • Kane RL. Improving the quality of long-term care. JAMA 273(17):1376-1380, 1995.
  • Hawes C, Mor V, Phillips CD, Fries BE, Morris JN, Friedlob-Steele E, Greene AM, Nennstiel M. The OBRA-87 nursing home regulations and implementation of the resident assessment instrument: Effects on process quality. Journal of the American Geriatric Society 45:977-985, 1997.

Systematic Reviews
Presenter: Russell Harris, M.D.
UNC Co-Director, Program on Prevention in Education and Practice

Readings:

  • Cook D, Mulrow C, Haynes B. Synthesis of Best Evidence for Clinical Decisions.   In C Mulrow, D Cook, Systematic Reviews: Synthesis of Best Evidence for Health care Decisions, pp. 5-12. Philadelphia: American College of Physicians, 1998.
  • Hunt DL, McKibbon KA. Locating and Appraising Systematic Reviews. In C Mulrow, D Cook, Systematic Reviews: Synthesis of Best Evidence for Health care Decisions, pp. 13-22. Philadelphia: American College of Physicians, 1998.

(Recommended)

  • Bero LA, Jadad AR.  How Consumers and Policymakers Can Use Systematic Reviews for Decision Making. In C Mulrow, D Cook, Systematic Reviews: Synthesis of Best Evidence for Health care Decisions, pp. 45-54.  Philadelphia:  American College of Physicians, 1998.

ASSIGNMENT DUE: Turn in 1-page description of your study design.

SESSION 5 (September 17)  

Understanding the Policy Process: How to Influence Health Policy
Presenter: Jonathan Oberlander, Ph.D.
UNC Department of Social Medicine

Readings:

  • Oberlander, J. “Is Premium Support the Right Medicine for Medicare?,” Health Affairs. 19 (September/October 2000): 84-99.
  • Mebane F, Blendon RJ. Political strategy 101: how to make health policy and influence political people. J Child Neurol 2001 Jul;16(7):513-9.

Measurement and Questionnaire Design
Presenter: Sohini Sengupta

Readings:

  • Singleton RA, Straits BC. Measurement. In RA Singleton, BC Straits, eds., Approaches to Social Research , pp. 99-114. New York: Oxford University Press, 1999.
  • Singleton RA, Straits BC. Survey instrumentation. In RA Singleton, BC Straits, eds., Approaches to Social Research, pp. 278-319. New York: Oxford University Press, 1999.

ASSIGNMENT DUE:  No assignment

SESSION 6 (September 24)  

Community Consultation in Research Settings
Presenter: Ronald P. Strauss, D.M.D., Ph.D.
UNC, Departments of Dental Ecology (Chair) and Social Medicine

Readings: 

  • Kathleen M. MacQueen, Eleanor McLellan, David S. Metzger, Susan Kegeles, Ronald P. Strauss, Roseanne Scotti, Lynn Blanchard, and Robert T. Trotter, II.   What Is Community? An Evidence-Based Definition for Participatory Public Health Am J Public Health 2001 91: 1929-1938.
  • Ronald P. Strauss, Sohini Sengupta, Sandra Crouse Quinn, Jean Goeppinger, Cora Spaulding, Susan M. Kegeles, and Greg Millett. The Role of Community Advisory Boards: Involving Communities in the Informed Consent Process. Am J Public Health 2001 91: 1938-1943.

(Recommended)

  • Lawrence W. Green and Shawna L. Mercer. Can Public Health Researchers and Agencies Reconcile the Push From Funding Bodies and the Pull From Communities? Am J Public Health 2001 91: 1926-1929.

Basic Statistics
Presenter: Sohini Sengupta

Readings: No readings

ASSIGNMENT DUE: Turn in variable definitions and how they will be operationalized. If proposing to do a survey, additionally turn in 1-page questionnaire. If proposing to do a systematic review, additionally turn in abstract sheet.

SESSION 7 (October 15)

Mental Health Consequences of Human Rights Violations
Presenter: Jeffrey Sonis, M.D., M.P.H.
UNC Department of Social Medicine

Readings:

  • Sonis J, Crane T. Family physicians and human rights: a case example from former Yugoslavia. Fam Med 1995; 27:242-248.
  • de Jong JT. Komproe IH. Van Ommeren M. El Masri M. Araya M. Khaled N. Van De Put W. Somasundaram D.  Lifetime events and posttraumatic stress disorder in 4 postconflict settings. JAMA 2001;  286:555-562.

(Recommended)

  • Sonis J, Gorenflo DW, Poonam J, Williams C. Teaching of human rights in US medical schools. JAMA 1996; 276(20):1676-8.

Content Analysis (Type of Qualitative Research)
Presenter: Sohini Sengupta

Readings:

  • Nuendorf KA. Defining content analysis. In KA Nuendorf, The Content Analysis Guidebook , pp.1-25. Thousand Oaks, CA: Sage Publications, 2002. ISBN 0-7619-1978-3.

ASSIGNMENT DUE:  Turn in plan of data analysis.

SESSION 8 (October 22)

Tobacco Control and Media Advocacy
Presenter: Adam Goldstein, M.D.
UNC Department of Family Medicine
Readings: NEED READINGS

How to Write a Research Proposal
Presenter: Sohini Sengupta
Readings:

  • Cummings SR, Washington E, Ireland C, Hulley SB. Writing and funding a research proposal. In SB Hulley and SR Cummings, Designing Clinical Research , pp. 184-196. Baltimore, MD: Williams & Wilkins, 1988.

ASSIGNMENT DUE:  Turn in plan of data analysis if proposing to do qualitative research.

SESSION 9 (October 29)

Advocacy in the Face of Travesty: Mental Health Services in North Carolina
Presenter: Sue Estroff, Ph.D.
UNC Department of Social Medicine

Readings:

Several short articles from the Journal of Common Sense, 6(3), Winter 2000/2001:

  • Stein J. Unhealthy state of our mental health: Introduction, 3-4.
  • Fitzsimon C. Plea for political courage, 5-6.
  • Estroff S. Now what? An analysis of recent reports on NC mental health services, 16-19.
  • No author. Some findings and recommendations: From reports on mental health, 20.
  • Stroup S. Adult care homes, 32-34.
  • Swartz M. Treating persons with dual disorders, 35-36.
  • Estroff S. Harmony in three parts: Why is this a Utopian scenario?, 41-45. h

Proposal Peer Review I: 2nd hour of class

ASSIGNMENT DUE:  Turn in draft of research proposal and applicable appendixes (2 copies).

SESSION 10 (November 5)

Gaps in the Health Care Safety Net for the Medically Needy and Uninsured
Presenter: Wes Wallace, M.D.
UNC Department of Emergency Medicine

Readings:

  • Grumbach K, Bodenheimer T. Reins or fences:  A physician's view of cost containment. Health Affairs, Winter: 121-6, 1990.
  • Himmelstein DU, Woolhandler S. A national health program for the United States: A physician's proposal. New England Journal of Medicine, 320:102-108, 1989.

Last Proposal Peer Review and How to Prepare for Final Presentations: 2nd hour of class

ASSIGNMENT DUE:  Turn in draft of research proposal and applicable appendixes (2 copies).

SESSION 11 (November 12)

Proposal Presentations:  1st hour of class

What’s Next? Conducting Your Research
Presenter: Sidney Wolfe, M.D.
Public Citizen Health Research Group

ASSIGNMENT DUE:  Turn in final proposals.

FACULTY MENTOR LIST

As part of your first assignment, you are asked to contact and choose one faculty member from the list below who you will work with while you are developing your research proposal. Your choice should depend on whether your research interests are compatible with theirs, and what you agree on in terms of how they will mentor you. For example, a faculty member can mentor you with a database he/she has for you to analyze.  Another faculty member may mentor you with helping to shape your research idea. THE FACULTY MENTORS ARE NOT AVAILABLE TO HELP YOU WRITE YOUR RESEARCH PROPOSAL. 

For August 27th, working in pairs (ideally), write a one-page statement that 1) identifies your faculty mentor and why you chose that person, 2) describes your research interest, and 3) discusses how your faculty mentor will help you with your research idea.

Adam Goldstein, M.D., Assistant Professor, Department of Family Medicine
Tel: 966-4090
Email: aog@med.unc.edu

Primary interests are in media advocacy and tobacco control.   He also teaches a course to 4th year medical students entitled, Medical Activism and Advocacy.

Laura Hanson, M.D., M.P.H., Associate Professor, Department of Medicine
Tel: 966-5945
Email: lhanson@med.unc.edu

Primary interests are in geriatrics, medical ethics, end-of-life care, and palliative care. Research on end-of-life care and palliative care includes establishing a palliative care program to determine whether better symptom care management can reduce pain for individuals at the end-of-life.

Jonathan Oberlander, Ph.D., Assistant Professor, Department of Social Medicine
Tel: 843-8269
Email: jonathan_oberlander@med.unc.edu

Primary interests are in health care politics and policy. This includes Medicare, issues in American health care reform, international health care delivery, and the role of medical insurance programs in the modern welfare state.   Research on Medicare resulted in a book chronicling the political development of Medicare from 1965 to the present, exploring how Medicare operated within a political consensus about program philosophy during its first three decades and how that consensus is now unraveling.

Pam Silberman, J.D., Dr. P.H., Associate Director of Policy Analysis, Sheps Center For Health Services Research
Tel: 966-2670
Email: pam_silberman@unc.edu

Primary interests are in managed care, vulnerable populations, and the uninsured. A focal point in her research looks at access to care for vulnerable populations, including low-income families and individuals living in rural areas in the U.S.

Jeffrey Sonis, M.D., M.P.H., Assistant Professor, Department of Social Medicine
Tel: 843-8264
Email: jsonis@med.unc.edu

Primary research interests are on the psychosocial consequences of extreme trauma, particularly for individuals affected by human rights violations. One research project examines the psychological effects of torture and related trauma among Bosnian refugees seen in primary care settings in Detroit.

Ronald P. Strauss, D.M.D., Ph.D., Professor and Chair, Department of Dental Ecology, School of Dentistry
Tel: 966-2788
Email: ron_strauss@unc.edu

Primary research interests have been on the social impacts of chronic health problems, especially dental conditions, craniofacial anomalies and HIV/AIDS. One project examined how communities perceive biomedical research and how HIV vaccine testing might be ethically undertaken with the involvement of African American communities.

Wes Wallace, M.D., FACEP, Associate Professor, Department of Emergency Medicine
Tel: 919-966-6440
Email: wmw@med.unc.edu

Primary interests are in medicine and social justice, providing medical information to political decision makers, and wilderness medicine. He is a former national President of Physicians for Social Responsibility and advocates to improve access to health care for underserved populations and for the understanding of linkages between environmental and health issues.

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