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When Do Causes Work Together? 

When Do Causes Work Together?
When Do Causes Work Together?

Katherine M. Keyes

and Sandro Galea

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date: 05 August 2020

This chapter introduces step 6: assess the evidence for causes working together. For nearly all health indicators of interest to public health, exposures of interest are embedded in a host of other component causes that work together to activate the exposure’s effect. In developing and testing hypotheses regarding the potential effects of an exposure on a health indicator, it is critical to conceptualize, measure, and assess the other component causes that may work in concert with the exposure of interest. When multiple component causes work together to produce a particular health indicator, this process is termed interaction. This chapter provides a conceptual overview of interaction rooted in a graphical and intuitive metaphor of disease causation through marble jars. The chapter then presents quantitative approaches to assessing interaction in epidemiologic data and interaction across multiplicative and additive scales as well as modern techniques for quantifying interaction.

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