HW Week 6
Please post to the forum by 1pm on the day of class
1. Give an example of a research question for investigating racial/ethnic health disparities where: [1] SES is a confounder; [2] SES is an effect modifier; [3] SES is a mediator. Briefly discuss the interpretations/implications of each approach as it relates to understanding health disparities by race/ethnicity.
[1] SES is a confounder: In this example, lower SES becomes a confounder because it leads to more unintended pregnancies and lower SES again through having more children to care for in the same family that does not have economic means.
[2] SES is an effect modifier: Are there health disparities based on race/ethnicity for unintended pregnancy? In this example, being a person of color can lead to unintended pregnancy due to living in communities that cannot access contraceptive care or abortion services due to neighborhood. But, the effect of this can be modified, for example, by having lower education and/or not having funds to travel to a place that provides contraception or abortion services. And, this can lead to higher rates of unintended pregnancy.
[3] SES is a mediator: What are the factors that mediate ethnic/racial disparities in terms of fetal death? SES is a mediator in this question (see Lorch et al). Regarding the socioeconomic factors, they found that “more Hispanic women had less than a high school education, later presentation for prenatal care, and higher use of public insurance than did non-Hispanic White women. Black women also had later presentation for prenatal care and higher use of public insurance than did non- Hispanic White women.” If SES is a mediator, then this implies that the solutions will have to be hypothesized to address factors that relate both to meeting people of color where they are at, and to providing what they need by the health care system, in addition to addressing economic issues, like transportation, healthy food, etc.
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.
One could study a contextual variable of if living in a neighborhood with less difference in race/ethnicity (like decile in % living in a neighborhood, by race) correlated with unintended pregnancy rate. You could look at census level data and then look at the unintended pregnancy rate in those census tracks. You could also look at access to clinics in those neighborhoods by distance (which has been done).