An Analytical Framework for the Embodiment of Structural Inequities

Abstract

Objective: The goal of this article is to describe a conceptual multilevel model that provides evidence of embodiment of a societal stressor on the health of the individuals and illustrate with simulated data how omitting components in the analysis model fails to properly capture how context influences health. Method: We describe a two-level model with variables at each level: stress at the group level and appraisal at the individual level. These factors are assumed to influence the blood pressure of individuals. Importantly, the person-level predictor is responsible for bringing the group-level predictor to the individual level by a cross-level interaction between stress and appraisal and/or a mediated effect of stress. When combined, the model components may be partitioned into a pure direct effect, a pure indirect effect, pure interaction effect, and an interaction-in-mediation effect. Data were generated in accordance with the model with each component accounting for some proportion of variance in blood pressure. Results: To the extent these components operate in the process of embodiment, a proposition we argue is reasonable, failure to specify the analytic model with all components leads to failure to characterize embodiment and misattribution of the effect and mechanism. Conclusions: To fully quantify embodiment of a societal stressor on a health outcome, studies should use multilevel designs and estimate cross-level interactions and mediated effects.