1. What are 3 different ways to account for SES in a 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.
Effect modifier: enhances or diminishes effect of outcome of interest as SES changes. Explains why some studies opt to differentiate subgroups by SES + race/ethnicity and SES or race/ethnicity alone
Effect mediator: Implies indirect pathway to outcome of interest in addition to direct pathway effect. Should be included in model/DAG as the indirect pathway helps explain entire effect of SES. May explain some of the complexity of using SES in our models of health outcomes
Effect confounder- in some models attempting to evaluate a causal relationship between race/ethnicity and a particular health outcome SES may act as a confounder impacting both the effect and outcome independently.
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.
As discussed in previous posts, severe and recurrent malaria infection typically impacts young children of lower SES (primarily in rural areas in sub Saharan Africa). I have been working with a cohort of children who have survived cerebral malaria in an attempt to describe developmental outcomes post CM. HIV infection is also common in this cohort and may act as a mediator in the model of CM -> developmental outcomes. For example, CM may independently cause developmental delay or a plateau in childhood developmental as a causal relationship though not all children have developmental delay post CM. Children with comorbid HIV may appear to have more significant delay post CM suggesting that HIV infection may mediate an indirect causal pathway between CM -> HIV (poorly controlled ) -> developmental delay
3. Respond to one other person's post on the forum with a comment or suggestion.
Re low birth weight in indigenous vs non indigenous Guatemalan women- empowerment appear to be a challenging, more vague term to define in this model (compared to nutrition and maternal age). I’d be curious to learn more if there are validated ways to assess for women’s empowerment in this specific population. It may also be a term that requires careful definition to avoid vague responses from study participants.