Part 1:
1. Choose a paper describing the development or validation of a measure of relevance in health disparities research (please give the full citation and/or upload the paper if that's possible).
- Felliti et al attempted to quantify the impact of early childhood experiences on health-related outcomes in adult life.
2. What was the definition of the construct?
- The researchers measured adverse childhood experiences across seven dimensions, from three categories of childhood abuse having occurred before the age of 18: psychological abuse (2 questions), physical abuse (2 questions), or contact sexual abuse (4 questions). The final measurement was the cumulative score of response (yes = 1; no =0) having occurred prior to age 18 (see attached for table defining measurements).
3. How did the authors provide evidence on the validity of the measure? Could you think of additional approaches to validating the measure?
- To provide evidence for impact on health outcomes, the researchers performed a logistic regression to adjust for effects of demographic factors on the association between the cumulative number of categories of childhood exposures (range: 0–7) and risk factors for the leading causes of death in adult life (diabetes, hepatitis or jaundice, and any skeletal fractures (as a proxy for risk of unintentional injuries), smoking, severe obesity, physical inactivity, depressed mood, suicide attempts, alcoholism, any drug abuse, parenteral drug abuse, a high lifetime number of sexual partners ($50), and a history of having a sexually transmitted disease, and reported health based on the question: “Do you consider your physical health to be excellent, very good, good, fair, or poor?”)
4. How did the authors provide evidence on the reliability of the measure? Could you think of additional approaches to evaluating the reliability of the measure?
- A follow-up study by the same research group, Dube et al used “test-retest reliability [which] provides an estimate for the consistency of a measurement [measure as]… the degree to which an instrument measures the same responses each time it is used under the same condition with the same respondents. This differs from validity which is a measure of the extent to which an observed situation reflects the “true” situation. A measure is considered reliable if a respondent’s score is similar when the same test is given twice. Assessing reliability is essential because it provides an idea of the consistency of responses to retrospective and sensitive questions, such as childhood trauma, over time.” This is an effective way to measure reliability of retrospective/recalled exposures.
5. Describe the implications of a lack of measurement validity or reliability for future research applications.
- They found a kappa score of 0.48 (incarceration of a household member) – 0.86 (parental divorce) for all survey responses. A kappa score of >0.75 represents excellent agreement, which means that some, but not all, of these survey questions had excellent reliability in predicting childhood adverse events. This validates the use of adverse childhood events in predicting negative health outcomes.
Part 2:
1. Find a paper describing a health disparity (please give the full citation or, even better, upload the paper so everyone else can look at it too)
- Doshi et al used a multi-level measurement of housing status to evaluate for disparities in clinical outcomes in HIV care, specifically virologic suppression.
2. Summarize the construct and measurement of the dimension of disparity (e.g., racial inequalities?, SES inequalities?) and the outcome measured (e.g., self-rated health).
- Housing status was defined as: unstable housing (emergency shelter, a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings (including a vehicle; an abandoned building; a bus, train, or subway station or airport; and anywhere outdoors), jail, prison, a juvenile detention facility, or a hotel or motel paid for with an emergency shelter voucher); temporary (transitional housing for homeless people; temporary accommodations with family members or friends; and other temporary accommodations such as those provided by a Ryan White HIV/AIDS Program housing subsidy, temporary placement in an institution, or a hotel or motel paid for without an emergency shelter voucher); stable (rented or owned unsubsidized room, house, or apartment; unsubsidized permanent accommodations with family members or other self-sufficient arrangements; accommodations funded with assistance from the Housing Opportunities for Persons with AIDS Program of the Department of Housing and Urban Development; a house or apartment subsidized by some other program (including the federally funded Section 8 housing voucher program, the HOME Investment Partnerships Program, and public housing programs, permanent housing for formerly homeless people, and institutional settings with support and continued residence expected).
3. What is the evidence for the validity and reliability of the measures?
- These measurements have not been validated for reliability in reporting actual housing status. Tsemberis et al 2007 used test-retest reliability scores to measure reliability of 6-month recall and for availability over time. They found that kappa coefficients for evaluating housing location (stable 0.82 – 0.92 for literally homeless).
4. What is the reference category used for the disparity measure (ie, who is the comparison group)? Why does this reference category make sense (or not) for this research question?
- Stable: as defined above. The reference category is reasonable
5. How is the disparity quantified or measured? Is this an absolute or relative measure or are both provided? Describe which type of measure you would prefer for this research area, or, if both, why.
- This a three-level predictor variable using a relative measurement to predict differences in the percent of patients with virologic suppression between the different groups of housing status.
Unattached references
Felliti et al Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults The Adverse Childhood Experiences (ACE) Study. Am Journal of Prev Med 1998
Dube et al Assessing the reliability of retrospective reports of adverse childhood experiences among adult HMO members attending a primary care clinic. Child Abuse & Neglect 2004.