Table 1.

Examples of how epidemiology can advance understanding and promote effective primary prevention of food allergy via a social determinants of health approach

Social Determinant	Economic Stability	Neighborhood and Physical Environment	Education	Food	Community and Social Context	Health Care System
Specific domains	Employment Income Wealth Debt Medical Bills	Housing Transportation Safety Geography	Literacy Language Educational attainment	Access to healthy, diverse, safe dietary options Hunger	Social support Social integration Community engagement Discrimination Stress	Health Coverage Provider availability Provider linguistic and cultural competency Quality of care
Epidemiological research questions	Do access to high-quality preventive care and/or food allergy outcomes differ across employment, income, and/or wealth strata, independent of race/ethnicity? Do food allergy outcomes differ by insurance type or between insured vs. uninsured patients independent of race/ethnicity and SES?	Does variability in neighborhood- and/or household-level environmental exposures associated with race/SES (e.g. dust mites, cockroach, environmental toxicants) influence the effectiveness of early introduction or otherwise influence atopy risk? Do patients have adequate transportation to access health care? Does variability in dust mite and cockroach exposure fully account for increased sensitization to shellfish, where targeted early introduction might be more critical?	Do parents/caregivers with differing health literacy and/or educational attainment interpret the NIAID-sponsored peanut allergy prevention guidelines similarly? Does the timing/frequency/diversity of allergenic solids introduction differ across linguistic groups (e.g. English vs Spanish speakers), independent of race/ethnicity and SES? Do food allergy outcomes vary by patient/caregiver health literacy and/or educational attainment, independent of race/ethnicity and SES? Can patient education materials be modified (e.g. through inclusion of more visual/pictographic elements) to encourage understanding and guideline implementation among low literacy populations?	Are diverse, allergenic solid foods accessible and affordable across racial/SES populations? Do different preparations of peanut (e.g. boiled vs. roasted peanuts) influence the feasibility and/or effectiveness of early introduction across racial/ethnic groups? What is the optimal dose, frequency and timing of peanut to introduce during infancy for maximal protection against allergy and does this differ by atopy status and//or across sociodemographic strata? Do baby formulas and foods provided by government-sponsored supplemental nutrition programs (e.g. WIC) support the implementation of food allergy prevention?	Are parents/caregivers socially supported in their efforts to introduce allergenic solids per the PPA guidelines? How do differing community norms regarding infant feeding by race/SES impact adherence to PPA guidelines? Does stress stemming from community factors (e.g. exposure to community violence, structural racism) influence food allergy outcomes? How do racial/SES differences influence the home structure in ways that influence food allergy prevention (e.g. multi-generational, # of individuals in one home, breast-feeding practices, access to diverse foods, concepts and understanding of FA, cultural norms of feeding)	Does pediatrician and allergist PPA guideline adherence vary depending on the sociodemographic characteristics of the patient populations they serve? Can high-risk infants with severe eczema/egg allergy access timely confirmatory testing to inform peanut introduction within the recommended window for “early” introduction? Is patient race/SES associated with: being at “high-risk ” of peanut allergy differential access to prompt assessment via SPT, sIgE, and/or OFC to confirm safety of peanut introduction Can the emergency department setting be better leveraged for epidemiological FA surveillance (via greater uniformity in coding practices) and/or promoting PPA guideline adherence (via improved patient education and linkage to follow-up care) Does access to specialty allergy care and preventive care differ regionally and/or between rural/urban areas?