1. Write a paragraph describing the extent to which a socioecological framework incorporating issues related to social determinants has been applied to your area of research. Are there opportunities for improving our understanding of or approach to disparities in your area with a greater emphasis on a socioecological framework?
My research interest is lung cancer. Smoking is implicated in 85% of all lung cancers. The prevalence of smoking is higher in racial categories other than caucasians. Consequently, the incidence of lung cancer is higher in racial/ethnic categories other than Caucasians. For example, the incidence of lung cancer is 20% higher in black men. Race-related variances in lung cancer are complicated by differences in socioeconomic status, which are not only related to disparities in smoking rates, but also the type of cigarettes smokes, and exposure to inhaled agents in the workplace. Historically most research in lung cancer has been conducted in Caucasians. The international trials also are predominantly in North American, European and some of the Asian countries. The emphasis in Asians is due to high mutation rates of certain driver mutations in this population. In terms of treatment, higher mortality is seen in blacks and hispanics which is in large part due to socioeconomic factors. So, there are opportunities in reducing the rates of smoking, early detection and treatment especially in black and hispanic populations.
2. In the WHO reading, A conceptual framework for action on the structural determinants of health, the authors describe structural stratifiers (e.g. income, education, etc) and intermediary determinants such as material and psychosocial circumstances. Pick 3 of these factors (at least one structural and one intermediary). Explain why you chose the factors (might use Braveman article to provide justification) and describe how each could be an important determinant of a health outcome of your choosing. The association could be reported in published research or it could be your hypothesized relationship. Consider whether how these factors might function over the lifecourse and/or intergenerationally.
Occupation. Occupation can influence incidence and treatment of lung cancer directly and indirectly. Certain occupational and environmental exposures are related to lung cancer – arsenic, radon, chromium, nickel, radiation, asbestos and secondhand smoke. Reducing these exposures will reduce the incidence of lung cancer. Indirectly, occupation is strongly related to income and financial stability. It influences access to health care, social network and health-related information.
Race/ethnicity. Race/ethnicity can lead to discriminatory practices due to lack of understanding of the cultural heritage leading to mistrust in healthcare. This is evident from very little enrollment of Hispanic, native American and African American population in clinical trials, although the incidence and mortality is higher in these populations.
Behavioral Factors. As mentioned above, one of the behavioral factors – smoking is causative of 85% of lung cancers. Cigarette smoking is strongly linked to employment status, education, occupation and income. Passive smoking can increase the risk of lung cancer in other members of the family.