Social Epidemiology: Social and Behavioral

ConceptsNicole Kunkel

Purpose

➔ Effectively communicate terminology used in social epidemiology in a manner by which the general population can understand.

➔ Improve knowledge and awareness of the general population regarding social epidemiology concepts.

Social Epidemiology ➔ “Comprehensive study of health, well-being, social conditions or problems,

and diseases and their determinants” ➔ Use of epidemiology and behavioral/social science to improve and promote

health ◆ Epidemiology: branch of medicine dealing with incidence, distribution,

and possible control of disease and related health factors ➔ Used to develop interventions, programs, policies, and institutions that

promote public health ➔ Studies: social distribution and social determinants of different states of

health➔ Understanding: social variables and conditions can determine which

factors affect illness and health ◆ Emphasis: social factors

Chronic Illness ➔ A persistent or long-lasting disease that progresses slowly and is usually

controlled, but cannot be cured ➔ Alternation between symptomatic periods and periods of remission or

stability ◆ Remission: periods of relative health with little to no symptoms in

between symptomatic periods or episodes ◆ Some chronic illnesses have acute episodes with abrupt symptom

changes in between remission periods ● Acute episode/occurrence: abrupt onset of intense symptoms,

usually within a short duration ➔ Usually applied when the course of the disease lasts longer than 3 months➔ Ex: Cancer, Ulcerative Colitis, HIV/AIDS, Epilepsy, Sickle Cell Anemia

Infectious Disease ➔ Caused by pathogenic microorganisms (bacteria, viruses, parasites, fungi)➔ Can be spread and transmitted directly or indirectly

◆ Person to person ◆ Animal/Insect to person◆ Ingestion of contaminated food or water

➔ Vaccines effectively prevent the spread of some infectious diseases ◆ Ex: Measles, chickenpox, smallpox, whooping cough

➔ Frequent and thorough handwashing prevents spread and transmission➔ Recent rise of infectious diseases, especially in poverty-stricken countries

with environments conducive to spread and transmission

Risk & Protective FactorsRisk Factor

➔ Variable associated with an increased probability of disease, infection, or health behavior problem◆ Increased likelihood of

negative/undesirable outcome➔ Host or environmental relation ➔ Immutable factors: age, race,

gender, ethnic background➔ Adjustable factors: Change with

intervention ◆ Ex: attitudes, behaviors

Protective Factor➔ Variable associated with a reduced

probability of disease, infection, or health behavior problem◆ Increased likelihood of

positive/desirable outcome ➔ Ex: family history, healthy

home/family environment, social support, routine doctor visits, access to resources

★ Both have cumulative effect on development/reduced development of health problems

Morbidity Rate ➔ Indicates rates of a disease,

behavior, or health problem

Morbidity Rate: Total # of cases of disease/behavior

Estimated total population at the midpoint of time period

Mortality Rate: Total # of deaths from disease/behavior

Estimated total population at the midpoint of time period X 100,000

Morbidity & Mortality RatesMortality Rate

➔ Indicates rates of death from a specific disease, behavior, or health problem

➔ Statistics collected by each country routinely: basic information on health status◆ Collected via death certificates and

coded by underlying cause of death ➔ Higher in young children, then decrease ➔ Increase again with age

◆ After age 40, increases by twofold for every decade

➔ Young children (<4) and older adults (>65) at highest risk during epidemics and outbreaks

Prevalence & Incidence RatesIncidence Rate

➔ New cases: the current rate at which a disease/health problem is being reported ◆ Used to calculate morbidity

Prevalence Rate ➔ Existing case rates of a disease or

health problem in a population; the spread or distribution of the problem in a population

Incidence Rate:# of people who contract the disease/condition in specified time period

# of people exposed to risk during this period

Prevalence Rate: # of people with the disease or condition at that time

# of people in the population at risk at that time

Prevalence Rate➔ Increased rate:

◆ long duration or short remission periods ◆ when incidence increases◆ increased likelihood of contraction from

high-risk individuals via poor general health

➔ Decreased rate: ◆ improved rate of cure ◆ short duration of illnesses◆ fatality rates increase◆ decline of infection rate◆ immigration of healthy

population/emigration of ill population

Incidence Rate ➔ Estimate of the probability of an

individual, belonging to an exposed population, developing a disease during a specific time period

➔ Calculation of new cases that occur within a specific time frame

➔ Incidence rate is used to calculate prevalence rate◆ P= I x D

● P: Prevalence rate ● I: Incidence rate ● D: Average duration of

disease

Prevalence & Incidence Rates

Case Fatality Rate➔ Expresses severity of symptoms and the likelihood that the

disease/behavior/health problem will result in death ➔ Percentage of people diagnosed with the disease, who die within a

specified time period after onset, in which the disease is diagnosed as underlying cause of death

➔ Case fatality rate vs. mortality rate: ◆ Mortality rate: denominator is total population ◆ Case fatality rate: denominator is number of people who have the

disease of interest

Case Fatality Rate: # of deaths from the disease/behavior within a specific time period after onset

Total # of cases identified during the same time period

Survival Rate➔ Number of patients over a specific time period who are still alive at the end

of said time period ➔ Usually reported after longer periods of time

◆ More appropriate for chronic illnesses with long incubation periods ➔ Usually calculated as one or five year cumulative survival rate:

Cumulative survival rate: # of patients surviving

total # of cases at the beginning of the period

Self-Efficacy ➔ Key element in how people change

behavior that goes beyond the mechanistic conditioning process of change ◆ Gives individuals a role in their own

change➔ A person’s belief in his or her ability to

take action and confidence to overcome obstacles

Reciprocal Determinism ➔ Behavior is part of a continuous interactive cycle that includes individuals

and their social environment ➔ Interactive process: a person acts based on individual factors or

social/environmental cues, receives a response from the environment, adjusts behavior accordingly, and acts again.

Health Disparities ➔ The differences in health status between the majority population and population subgroups

◆ Ex: race, ethnicity, socioeconomic status ➔ Exist in terms of:

◆ Quality health care◆ Access to health care ◆ Levels and types of care ◆ Clinical conditions (cancer, mental health, etc.)

➔ Identified in several health outcomes: ◆ Life expectancy ◆ Overall life status ◆ Infant mortality ◆ Cancer ◆ HIV/AIDS◆ Violence◆ Diabetes

Health Disparities: Causes ➔ Causes of health disparities:

◆ Socioeconomic status ◆ Lack of access to resources◆ High poverty levels ◆ Immigration ◆ Cultural beliefs/attitudes ◆ Lack of health care coverage ◆ Mistrust towards

government/physicians ◆ Discrimination ◆ Environmental risks ◆ Social exclusion

◆ Lack of cultural competence◆ Housing segregation ◆ Neighborhood

characteristics and physical environment

➔ Individual approach ◆ address individual knowledge and awareness among a specific population ◆ Use theories to structure education and intervention

➔ Social, community, and group approaches ◆ Community mobilization or advocacy

● Ex: improve access to healthcare, remove environmental risk affecting a minority community

◆ Health communications strategies, social network, and cultural approaches● Used to address shared norms, beliefs, and attitudes of a population

◆ Community mobilization with ecological approaches ● Used as part of a coordinated community strategy in order to reduce

socioeconomic disparities

Addressing Health Disparities

Addressing Health Disparities ➔ Organizational theory

◆ Improve organizations or systems, resulting in improved access and care for disparities populations

◆ Local, state, or national level➔ Multilevel approaches➔ Lack of coordination hinders improvement in health disparities:

communication is key

Epidemiological Triangle➔ Basic model developed in order to study

health problems ➔ 3 factors: Host, Agent, and Environment➔ Disease is produced by exposure of a

susceptible host to a noxious agent in the presence of environmental factors that aid or hinder agents of disease

Epidemiological Triangle ➔ Host: the person/animal harboring the infectious agent, acted upon by

noxious noninfectious agent, or has experienced event/behavior of interest ◆ the “who” of the triangle

➔ Agent: infectious microorganism, chemical, or vulnerable substance◆ the “what” of the triangle ◆ Ex: lead, radiation, excess/deficiency of nutritional elements such as

calories, carbs, or iron ➔ Environmental Factors: external conditions that promote or hinder the

action of an agent on a susceptible host ◆ the “where” of the disease ◆ Ex: drought, high temperatures, rain

Impact Application ➔ Slideshare: upload of presentation to public presentation database

➔ Studyblue: upload of presentation to public study material site