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.
Research question for investigating racial/ethnic health disparities where SES is a confounder
[1] Pregnancy at younger age may have worse health outcomes. Here SES, may act as a confounder - poor uneducated women are more likely to be pregnant and less likely to have better health facility.
Pregnancy <- SES -> Birth Outcomes
Poor women with racial difference are more likely to have worse effects
[2] SES as an effect modifier –
Education <- SES -> Future Earnings
With lower SES, individuals are less likely to have higher education and thus lower income. In addition, with higher SES individuals are more likely to have higher education and thus greater future income.
Again, poor individuals with lower income along with racial discrimination may have lesser future earnings.
[3] SES is a mediator
Tax credits -> change SES -> Health Outcomes
Policies with income supplements based on tax credits improves short term SES level and motivate people to participate in the labor force it would also affect the health outcomes. These benefits also result in improved health outcomes especially among poor racial groups.
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.
Interested in looking at the young adult’s population post insurance expansion and would like to look at the racial differences in them. Association between mental health utilization and insurance expansion.
Investigating the association between mental health utilization and insurance expansion, would be interested in evaluating whether the association between mental health utilization after insurance expansion would be different for black and white young population.