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Research Topicsin Social Epidemiology
Laura Rudkin, Ph.D.Division of Sociomedical SciencesDepartment of Preventive Medicine
& Community Health
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General Purposes of Epidemiology To describe To explain To predict To control
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General Purposes of Social Epidemiology To describe social differentials in health
outcomes. To explain the observed social differentials by
identifying causal mechanisms. To predict how policy changes and
psychosocial interventions might reduce the differentials.
To control and improve population health.
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Identifying, Investigating Social Differentials in Health Outcomes
Social Factors•SES•Race/Ethnicity•Gender•Age, Life Course•Place, Environment
Health Outcomes•Mortality•Morbidity•Disability•Well-being
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Identifying, Investigating Social Differentials in Health Outcomes
Social Factors•SES•Race/Ethnicity•Gender•Age, Life Course•Place, Environment
Health Outcomes•Mortality•Morbidity•Disability•Well-being
Health Behaviors
Psychosocial Stressors and
Resources
Physical Environmental
Stressors
Health Care Access,
Utilization,and Quality
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Social Factors
Socioeconomic statusEducation, income, occupation
Wealth
Childhood SES
Community SES
Social relationshipsSocial support
Social networks
Social isolation
Social engagement
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Social Factors
Occupational factorsDemand-control
Effort-reward imbalance
Social inequalitiesRace, ethnicity
Nativity status
Gender
Sexual orientation
Religious belief, affiliation
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Sources of Heterogeneity
Reverse causalitySelective drift
Differential susceptibilitySpurious relationship, third variable is causal
Individual lifestyleHealth-related behaviors
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Sources of Heterogeneity
Physical environmentHarmful exposures to physical, chemical, biological agents
Social environment & psychological responseStressors, social & coping resources
Health care servicesDifferential access, quality, utilization
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Williams, 1997
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Basic v. surface causes
Basic causesDistal causes, also called fundamental causes
Work through multiple pathways, affect multiple outcomes
What puts people at risk for risk?
Surface causesProximal causes, traditional risk factors
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FIGURE 1. Conceptual framework for the relation between socioeconomic position and health among persons with diabetes mellitus. Numbers and letters refer to pathways mentioned in the text. From: Brown: Epidemiol Rev, Volume 26(1).July 2004.63-77
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FIGURE 2. Distal mediators and moderators of the relation between socioeconomic position and health behaviors, access to care, processes of care, and health among persons with diabetes mellitus. From: Brown: Epidemiol Rev, Volume 26(1).July 2004.63-77
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Direct & Buffering EffectsDirect & Buffering Effectsof Social Supportof Social Support
STRESSOR APPRAISAL COPINGHEALTH
OUTCOMES
•SOCIAL SUPPORT•Instrumental•Emotional•Informational•Appraisal
•Stressors may activate social support•Social support may reduce stressors
Buffering effects
Direct effect
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Social Position
SocialEnvironment
SocialInteraction
Perceptionsof Injustice
NegativeEmotionalResponse
High Allostatic Load
Poor Health Outcomes
Genetic Endowment
Development
Daily Life
•Personal•Productive•Societal
Social Structure
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FIGURE 2. Upstream and downstream determinants of population health. Reprinted with permission from Promoting Health: Intervention Strategies from Social and Behavioral Research, by the National Academy of Sciences. Courtesy of the National Academies Press, Washington, DC. From: Kaplan: Epidemiol Rev, Volume 26(1).July 2004.124-135
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Underlying Assumptions
Biological, behavioral, social factors interact through multiple feedback mechanisms to influence individual health over time.
Interactions often bidirectional, so cause-and-effect models, used alone, likely to misrepresent actual relationships.
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Underlying Assumptions
Because health is a function of biological, psychological, social variables, many events, interventions traditionally considered irrelevant actually are quite important for health status of individuals, populations.