1.It is often mentioned that racial/ethnic differences in health should not be investigated without consideration of socioeconomic position/status. Describe two ways to account for SES in an analytic model and the interpretations/implications of each approach.
To measure SES we can stratify groups by income. We can then analyze these groups and take into account the standard of living from their geographical areas. For example, San Francisco has higher standard of living than in other cities in the East Bay. Someone that is making 40k in San Francisco may struggle to meet their living cost and other necessities. In the other hand, another individual earning the same income in another city like Manteca would be better off. This can lead to a more accurate data. However, this approach may have implications when analyzing data. SES is very difficult to measure in ethnic background communities because often people may tend to not want to disclose their financial situation or sometimes the data is missing. Bilheimer et al. talks about how SES is challenging to measure and that even if we want to include income in our analysis, income “is often missing or not reported at all in several of the most important data systems used…” (6). One way to overcome this challenge is to use the imputation method. Bilheimer et al, mentions this statistical approach, which is a process that replaces the missing data with substituted values. However, I am not familiar with this method, but it may have implications.
In addition, another approach to account SES would be to include other variables that may have correlations with SES such as occupation and education. However, with this approach there may be some implications. Braveman et al. talks about a weak association between education and income among racial and ethnic mothers. Education may include some inaccuracy when evaluating SES because some people that have a high level of education may not be earning much and may be considered low-income earner. However, having a higher level of education may give people some privilege and open doors to opportunities which can lead these people to live better off than people that didn’t have an education.
2. Select a research question investigating associations between multi-level social factors (operating at least two levels) and a health outcome. State the exposures and outcomes, the additional study covariates that would be included in the analytic model, and a discussion of the analytic considerations in an multi-level investigations.
The study that I would investigate would be one that involves Latinos living in poor marginalized neighborhoods. The health outcome I would investigate would be diabetes. This population is exposed to neighborhoods of lower socioeconomic status. This exposes them to fewer opportunities for better jobs and quality of education, access to healthy foods, and access to material goods. SES would be accounted for by using covariates such as income and occupation. I would use Geospatial techniques to explore the correlation between neighborhoods and consumption of healthy foods (e.g. fruits, and vegetables,) amount of physical activities, access to quality education, and correlate that with BMI, A1C levels, and number of people being diagnosed with diabetes. However, multi level studies are hard to do because there are many factors that can cause disease. In the other hand, having a comprehensive conceptual model that clearly identifies and describes etiological factors, and having good and appropriate statistical models could help us understand how multi-level social factors play a role in a particular health outcome.