Social Epidemiology Theoretical Frameworks

• Psychosocial Theory

  Transition from agency-host → agency-host-environment

  • John Cassel (1976) – pioneer; wrote paper on contributions of social environment on health

  • Hypothesis: social environment alters the host’s susceptibility

  • Psychosocial factors→ dominance hierarchies, social disorganization, rapid social change;

  marginal status in society including social isolation

  • Social support can buffer theses factors
• The framework of the Social Production of Disease/Political Economy of Health explicitly addresses economic and political determinants of health and disease, including structural barriers to living healthy lives
• It considers the implications of capital accumulation, enforcement of the state, and distribution of resources
• Determinants of health are analyzed in relation to who benefits (e.g., policies/practices) and who suffers
• The hypothesis states that economic and political institutions create, enforce, and perpetuate economic and social privilege; inequity is the fundamental cause of social inequities in health
• Enforcing created policies has a public health impact that needs to be considered
• The focus of this framework is on social justice with little to no focus on biology
• Ecosocial/Multi-level framework

  Analyzes the current and changing population patterns of health, disease and well-

  being in relation to each level of biological, ecological, and social organization as

  manifested at every scale

  • Ecological approaches concerned w/scale; level of organization; dynamic states;

  mathematical modeling; and understanding phenomena

  • Four (4) constructs: embodiment; pathways of embodiment; cumulative interplay of

  exposure (susceptibility/resistance); accountability and agency

  • Who and what drives the current and changing patterns of social inequities in health?
• Theory of Fundamental Causes

  • Influences multiple disease outcomes

  • Affects disease outcomes through multiple risk factors

  • Involves access to resources that can avoid risks or minimize the consequences of disease

  • Association between a fundamental cause and health is reproduced over time via the

  replacement of intervening mechanisms

  • Resources include knowledge/education, money, power, prestige, and beneficial

  social connections→protective factors (potentially)
• Demand-Control 


  • Assess job strain on health

  • Interaction psychological demands and

  decision latitude (job control)

  • Association of job strain on heart disease

  • Job strain higher among blue-collar

  workers

  • Limited consideration of other work

  stressors 
• Iso-train model

  • Extension of demand-control model

  • Incorporates social support at work

  (supervisors/colleagues)

  • Posits most “toxic” jobs combine high-

  strain and social isolation

  • Interventions → Work/life balance;

  support groups; employee assistance

  programs
• Effort-Reward Imbalance 


  Worker's health determined by rewards received for efforts

  Extrinsic effort vs. intrinsic effort

  Examines individual's fit w/ in work environment

  Association w/ heart health risks
• Organizational justice

  • Distributive – fair distribution of rewards based on

  effort/performance

  • Procedural – formal workplace procedures and

  relational justice (respect, transparency, and

  fairness of supervisors)

  • Associated w/poor self-rated health; sickness

  absences; minor psychiatric disorders 
• Work/Family Conflict

   • Builds upon demand-control models

  • Links job demands, job controls, and social

  support

  • Three (3) dimensions

  • Control

  • Work-Family Demand

  • Social Support

  • May affect women more than men due to

  workplace environment/policies
• Nonstandard work schedules

  Work shifts (long), rotating schedules, early/late

  starts → new health challenges

  Increase in sleep deprivation → poor health

  outcomes

  Associated with increased risk for heart health risks

  (myocardial infarction)
• Schedule Control/Flexible Work Arrangements

  Based in enrichment role models

  Promotes health due to flexibility in work schedule

  Work schedule control associated with reduced

  work-family conflict
• Validity 


  measures the phenomenon it is intended to measure
• Specificity 


  measures only the phenomenon it is intended to measure
• Reliable 


  Produces the same results when used more than once to measure precisely the same phenomenon
• Operational 


  measurable or quantifiable
• Sensitive 


  Reflect changes in the state of the phenomenon under study
• Levels of workplace influence:

  Job level/Characteristics

  Employer/Organization

  Legislature/Policy
• The five criteria for causation are:

  Specificity

  Temporality

  Consistency

  Biological plausibility

  Strength
• Experimental Studies 


  Often conducted to identify cause of disease or determine effectiveness of vaccine, drug or interventions (Think controlling for variables or interventions)
• Types of experimental studies:

  Randomized

  non-randomized

  Blinding
• Observational Studies

  Observes natural course of events (think exposed vs not exposed and who develops the disease and health outcomes)
• Types of observational studies:

  Case/control

  Cross-sectional

  Cohort
• Indirect 


  Happens at an individual level, examines whether known risk factors are the explanation for differences that occur among dominant and subordinate groups.
• Direct 


  Happens at an individual level, here you are focusing on the subordinate group and examining whether self-reported experiences of discrimination are proportionately associated with the health outcomes.
• Social Capital


  Networks that provide a basis for trust, cooperation, and perceptions of safety.
• Confounders 


  associated with exposure and outcome
• Covariates 


  associated with outcome
• Collinearity 


  associated with the predictor variables
• What increases standard error?

  Collinearity
• Intermediaries

  Highlight "indirect" effects
• What reduces model precision?

  Collinearity
• What obscures total effect of predictors on outcome?

  Intermediaries
• a systematic process, involves data collection, process for enhancing knowledge and decision-making?

  Evaluation
• is a method of judging the worth of a program at the end of the program activities (summation). The focus is on the outcome or the final product?

  Summative evaluation
•  is a process of gathering and analyzing feedback during the development or implementation of a program, project, or product?

  Formative evaluation