Seeing the forest and the trees: new visions in social epidemiology

Intergenerational Socioeconomic Mobility and Adult Depression: The CONSTANCES Study

ABSTARCT

Using data from the nationally representative Consultants des Centres d'Examens de Santé (CONSTANCES) study in France (2012-2014; n = 67,057), we assessed the relationship between intergenerational socioeconomic mobility and adult depression (Center for Epidemiological Studies-Depression Scale scores of ≥16 in men or ≥20 in women) and antidepressant use. Socioeconomic position was ascertained by occupational grade (childhood: maternal and paternal measures prior to age 15 years combined; adulthood: participant's own). We used logistic regression models adjusted for sociodemographic characteristics, parental history of psychiatric disorders and suicide, health behaviors, and chronic health problems. Compared with the reference group (persistently high socioeconomic circumstances), participants in other groups had elevated levels of depression (for upward mobility, multivariate odds ratios (OR) = 1.21; intermediate socioeconomic position, 1.28; downward mobility, 1.66; persistently low socioeconomic position, 1.82). Downward mobility and persistently low socioeconomic position were also associated with elevated odds of antidepressant use (for downward mobility, multivariate OR = 1.24; for persistently low socioeconomic position, 1.36). In supplementary analyses, the association of socioeconomic mobility with depression was stronger in women than in men and among younger participants (aged 18-29 years) than among older participants. Factors that contribute to depression risk and socioeconomic inequalities in this area appeared to be at play already in childhood; this should be acknowledged by clinicians and policymakers.

Are we producing the right kind of actionable evidence for the social determinants of health?

Globally, health and social inequities are growing and are created, actively maintained, and aggravated by existing policies and practices. The call for evidence-based policy making to address this injustice seems a promising strategy to facilitate a reversal of existing strategies and the design of new effective programming. Acting on evidence to address inequities requires congruence between identifying the major drivers of disparities and the study of their causes and solutions. Yet, current research on inequities tends to focus on documenting disparities among individuals or subpopulations with little focus on identifying the macro-social causes of adverse population health. Moreover, the research base falls far short of a focus on the solutions to the complex multilevel drivers of disparities. This paper focuses upon recommendations to refocus and improve the public health research evidence generated to inform and create strong evidence-based recommendations for improving population health.

Integration of social epidemiology and community-engaged interventions to improve health equity

The past quarter century has seen an explosion of concern about widening health inequities in the United States and worldwide. These inequities are central to the research mission in 2 arenas of public health: social epidemiology and community-engaged interventions. Yet only modest success has been achieved in eliminating health inequities. We advocate dialogue and reciprocal learning between researchers with these 2 perspectives to enhance emerging transdisciplinary language, support new approaches to identifying research questions, and apply integrated theories and methods. We recommend ways to promote transdisciplinary training, practice, and research through creative academic opportunities as well as new funding and structural mechanisms.

The built environment and obesity: a systematic review of the epidemiologic evidence

We completed a systematic search of the epidemiologic literature on built environment and obesity and identified 63 relevant papers, which were then evaluated for the quality of between-study evidence. We were able to classify studies into one of two primary approaches for defining place and corresponding geographic areas of influence: those based on contextual effects derived from shared pre-determined administrative units and those based on individually unique geographic buffers. The 22 contextual papers evaluated 80 relations, 38 of which did not achieve statistical significance. The 15 buffer papers evaluated 40 relations, 24 of which did not achieve statistical significance. There was very little between-study similarity in methods in both types of approaches, which prevented estimation of pooled effects. The great heterogeneity across studies limits what can be learned from this body of evidence.

Recruitment of minority and underserved populations in the United States: the Centers for Population Health and Health Disparities experience

OBJECTIVE

The recruitment of minority and underserved individuals to research studies is often problematic. The purpose of this study was to describe the recruitment experiences of projects that actively recruited minority and underserved populations as part of The Centers for Population Health and Health Disparities (CPHHD) initiative.

METHODS

Principal investigators and research staff from 17 research projects at eight institutions across the United States were surveyed about their recruitment experiences. Investigators reported the study purpose and design, recruitment methods employed, recruitment progress, problems or challenges to recruitment, strategies used to address these problems, and difficulties resulting from Institutional Review Board (IRB) or Health Insurance Portability and Accountability Act of 1996 (HIPAA) requirements. Additionally, information was collected about participant burden and compensation. Burden was classified on a three-level scale. Recruitment results were reported as of March 31, 2007.

RESULTS

Recruitment attainment ranged from 52% to 184% of the participant recruitment goals. Commonly reported recruitment problems included administrative issues, and difficulties with establishing community partnerships and contacting potential participants. Long study questionnaires, extended follow-up, and narrow eligibility criteria were also problematic. The majority of projects reported difficulties with IRB approvals, though few reported issues related to HIPAA requirements. Attempted solutions to recruitment problems varied across Centers and included using multiple recruitment sites and sources and culturally appropriate invitations to participate. Participant burden and compensation varied widely across the projects, however, accrual appeared to be inversely associated with the amount of participant burden for each project.

CONCLUSION

Recruitment of minority and underserved populations to clinical trials is necessary to increase study generalizbility and reduce health disparities. Our results demonstrate the importance of flexible study designs which allow adaptation to recruitment challenges. These experiences also highlight the importance of involving community members and reducing participant burden to achieve success in recruiting individuals from minority and underserved populations.