1. What are 3 different ways to account for SES in analytic models when investigating racial/ethnic health disparities? Briefly discuss the interpretations/implications of each approach as it relates to understanding health disparities by race/ethnicity.
SES as a mediator: Considering SES as a mediator for race/ethnicity and health disparities means that SES is an intermediate in the pathways race/ethnicity àhealth disparity and that the effect of SES explains part of the impact of race/ethnicity on health disparity outcomes. The challenge, then, is to determine how much of the disparity is related to race/ethnicity and how much is related to SES. Performing a mediation analysis would help better tease out the relationship between the variables.
SES as an effect modifier: Considering SES as an effect modifier means that SES affects the degree to which race/ethnicity impacts a health disparity outcome, depending on the SES level. An example would be if while studying the association between Native American ethnicity and hypertension, you find that the magnitude of the effect depends partly on the SES of the patients
SES as a contextual variable: considering SES as a contextual variable means that it operates on a group or collective level that is distinct from individual level variables such as race and ethnicity. Contextual elements like the availability of healthy food within a neighborhood may impact health outcomes on the whole neighborhood population.
2. Describe a potential effect modifier, mediator, or contextual variable (for definition of contextual variable, see Diez-Roux reading) for an association of interest to you and relevant to health disparities. For example, for investigating the association between education and hypertension, I might be interested in evaluating whether the association between years of education and hypertension is different for Black men than for White men. Describe how you would study whether this relationship exists.
I’m interested in the association between SES and risk of traffic-related injury. There are a number of interesting contextual variables that could be included in this analysis; two that I find interesting are the percent of the neighborhood living below the poverty line and the median owner-occupied home value. These variables may have implications for the political capital of the neighborhood, which can in turn affect investment in the built neighborhood environment.
3. Please respond to one other classmate's responses to this assignment.
In response to the proposal looking at income and low birth weight different for indigenous Guatemalan women vs non-indigenous Guatemalan women, it would be interesting to also look at contextual variables that might impact birth weight. For example, in addition to individual-level nutrition, the availability of food on a neighborhood or regional level or the presence of a healthcare provider in the neighborhood could be included in the model.