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. 2022 Nov 9;130(11):116001. doi: 10.1289/EHP11015

Figure 3.

Figure 3 is a flowchart with six steps. Step 1: Are you using social variables in your exposure research? Exposures: Yes, I am using social variables as exposures and Confounders: Yes, I am using social variables as confounding factors. Step 2: Exposures: Yes, I am using social variables as exposures leads to Does your analysis aim to be agnostic, without any a priori hypothesis, or are you testing hypotheses? and Confounders: Yes, I am using social variables as confounding factors leads to Does your analysis aim to adjust for potential spurious results caused by social variables being associated with your exposure and outcome? Step 3: Does your analysis aim to be agnostic, without any a priori hypothesis, or are you testing a hypothesis? leads to Agnostic: hypothesis generating: Advantages include to explore the data and to generate potentially new hypotheses to investigate. Disadvantages include the hierarchical relationships between structural social factors, downstream social factors and exposures are not considered, and Hypothesis testing: Advantages includes explicitly test social exposures are related to biological and or health outcomes. Disadvantages include several hypotheses that cannot be tested at the same time. Step 4: Does your analysis aim to adjust for potential spurious results caused by social variables being associated with your exposure and outcome? leads to Advantages include to account for a social variable that influences both the exposure and outcome variables in an analysis, potentially causing spurious results. Disadvantages include Researchers may be tempted to interpret the effect of the confounding variable on the outcome. Step 5: Recommended questions to ask when testing hypotheses: What mechanisms might underlie the hypothesis about how a social variable relates to biological or health outcomes (compare Bartley)? leads to Behavioral, Material, and Psychosocial. Step 6: Behavioral: Do the social variables relate to different health behaviors, such as smoking, drinking, food preferences, exercise, etc? Material: Do the social variables relate to physical and chemical exposures due to housing conditions, occupational or exposures in the place of residence? Psychosocial: Do the social variables relate to stressors such as adverse childhood experiences (A C Es), discrimination, job stress, etc?

Recommendations regarding the use of social variables in the exposome context.