1. Write a paragraph describing the extent to which an socioecological framework incorporating issues related to social determinants has been applied to your area of research. Are there opportunities for improving our understanding of or approach to disparities in your area with a greater emphasis on a socioecological framework? Consider drawing a DAG or a socioecological model (like the one shown in class for obesity) to illustrate your point (you can take a picture to post on the forum).
My research interests are in pedestrian traffic injury and how socioecological factors influence both the risk of sustaining an injury and the outcomes following injury. The association of SES or income (as a proxy) on the risk of pedestrian trauma is recognized in the literature, as is the fact that sustaining a trauma has a greater negative impact on patients with lower SES. On a community level, we recognize that built environment factors have historically been deployed asymmetrically in ways that result in dangerous conditions for pedestrians in neighborhoods with lower SES measures. On a societal level, there is still a need for regulations and monetary investments that ameliorate the historical disadvantages to certain social groups as a result of city planning which did not recognize these impacts. While the body of literature in this area is growing, there is still a need for investigation within a socioecological framework into how groups with particular challenges (e.g. the homeless, the physically disabled) are impacted by disparities in city planning and urban environment initiatives that don’t always consider their needs.
2. In the WHO reading, the authors describe structural stratifiers (e.g. income, education, etc) and intermediary determinants such as material and psychosocial circumstances. Pick 3 of these factors (at least one structural and one intermediary). Explain why you chose the factors (might use Braveman article to provide justification) and describe how each could be an important determinant of a health outcome of your choosing. The association could be reported in published research or it could be your hypothesized relationship. Consider whether how these factors might function over the lifecourse and/or intergenerationally..
Income (structural): Investigation into the factors associated with pedestrian traffic injury suggests that lower income both increases the risk of injury and is associated with worse outcomes following trauma. Potential explanations for this association include individual-level factors such as less vehicle ownership and increased pedestrian activity by individuals with lower incomes. In addition, differences in the built environment such as lack of pedestrian infrastructure and the presence of high-speed arterial roadways in lower income neighborhoods exacerbate the risk to those who live and work in these neighborhoods. Furthermore, individuals with lower incomes who are already at higher risk of sustaining a pedestrian traffic injury also are less able to deploy resources in order to adequately recover.
Race/ethnicity (structural): Racism at a structural level has played a part in political and urban-planning decisions that increase the risk of pedestrian traffic injury to minorities. Neighborhoods with higher minority populations sustain a disproportionate number of pedestrian crashes with correspondingly higher mortality rates. The differences in built environment factors depending on the racial/ethnic makeup of a neighborhood echo those of lower income neighborhoods; areas with a higher proportion of minorities have less pedestrian infrastructure, poorer maintenance of existing infrastructure, and more high-speed roadways than predominantly white neighborhoods.
Substance abuse (intermediary): Substance abuse by pedestrians is associated with increased risk of traffic injury. This association is present with both alcohol and drug use, and is hypothesized to be partly due to the perceptual deficits associated with substance use as well as the cognitive deficits and increased likelihood of risky decision-making.