Political scientists largely agree that causal mechanisms are crucial to understanding causation. Recent advances in qualitative and quantitative methodology suggest that causal explanations must be contextually bounded. Yet the relationship between context and mechanisms and this relationship's importance for causation are not well understood. This study defines causal mechanisms as portable concepts that explain how and why a hypothesized cause, in a given context, contributes to a particular outcome. In turn, it defines context as the relevant aspects of a setting in which an array of initial conditions leads to an outcome of a defined scope and meaning via causal mechanisms. Drawing from these definitions is the argument that credible causal explanation can occur if and only if researchers are attentive to the interaction between causal mechanisms and context, regardless of whether the methods employed are small-sample, formal, statistical, or interpretive.

Objectives. We assessed the health status of people undergoing mortgage foreclosure in the Philadelphia region to determine if there was a relationship between foreclosure and health. Methods. Participants were recruited in partnership with a mortgage counseling agency. Participants' health status and health care use were compared with a community sample from the 2008 Southeastern Pennsylvania Household Health Survey. We used publicly filed foreclosure records to assess response bias. Results. Of the 250 people recruited, 36.7% met screening criteria for major depression. The foreclosure sample was significantly more likely than the community sample to not have insurance coverage (adjusted odds ratio [AOR] = 2.28; 95% confidence interval [CI] = 1.49, 3.48) and to not have filled a prescription because of cost in the preceding year (AOR = 3.44; 95% CI = 2.45, 4.83). Approximately 9% of the participants reported that their own or a family member's medical condition was the primary reason they were undergoing foreclosure. More than a quarter of those in foreclosure (27.7%) stated that they owed money to medical creditors. Conclusions. Foreclosure affects already-vulnerable populations. Public health practitioners may be able to leverage current efforts to connect homeowners with mortgage counseling agencies to improve health care access.

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