Tag Archives: health

Cultural Influences on Health Disparities

Disparities in the availability, access, and delivery of health care are a great and growing concern. Some of the factors leading to disparite health include race, socioeconomic status, and gender (Chen, Martin, & Mattews, 2006). Chen et al. describes how race and socioeconomic status are major factors in the United States, based on the Healthy People 2010 data (U.S. Department of Health and Human Services, 2000). According to the results of this study, our public health efforts seem to be misguided. As the researchers of this study indicate, “race and SES effects on child health are best understood in concert, rather than separately” (p. 705). The differences in race and socioeconomic status are a factor only to White and Black children when looking at prevalence rates for activity limitations and circulatory conditions, as illustrated by Chen et al. in Figures 1 and 2. These figures show that higher education actually has a small but negative effect on the health status of Asians and Hispanics while having a dramatically positive effect on Blacks. Additionally, in Figure 3, Chen et al. show a significant negative effect of education on incidence rates for acute respiratory conditions. There is no significant relationship for the same with regards to Whites or Blacks.

This study shows that there are certainly correlations between race, economic status, and differences in the health status of children in America, but these factors might only be relative. We need to understand if other factors can be identified as causative. In order to explain how Whites and Blacks share correlations while Asians and Hispanics share correlations, we might consider the length of time each population has been exposed to American culture. Whites and Blacks have been in America for over 300 years while Asians and Hispanics have migrated more recently. In addition, there is also evidence of attitude and preference differences for minorities towards health care, though the Institute of Medicine (2002) marginalizes this phenomena in their study.

As a health care provider and regardless of the causes of disparities in health status, it is advisable that I understand these causes so that I may better direct a patient’s care with a holistic understanding of the patient.


Chen, E., Martin, A. D., & Matthews, K. A. (2006). Understanding health disparities: The role of race and socioeconomic status in children’s health. American Journal of Public Health, 96, 702-708. doi:10.2105/AJPH.2004.048124

Institute of Medicine. (2002). Unequal treatment: What healthcare providers need to know about racial and ethnic disparities in health. Retrieved from http://www.nap.edu/html/unequal_treatment/reportbrief.pdf

U.S. Department of Health and Human Services. (2000). Healthy people 2010: Understanding and improving health. Washington, DC: Author.

Immunization and Infectious Disease Mitigation

Cultural Models of Immunization and Infectious Disease Mitigation

The members of some communities, such as Puerto Rico, do not understand the scope and severity of some infectious diseases until they become infected (Pérez-Guerra, Zielinski-Gutierrez, Vargas-Torres, & Clark, 2009). The lack of a basic understanding of illness and infection poses a roadblock to mitigating disease transmission within the community. For Pérez-Guerra et al., the perception of severity and mitigation is important as they investigate the difference in attitudes towards dengue infections because dengue cannot be controlled by vaccine and must be mitigated by community participation in mosquito abatement activities. Other infectious diseases, however, can be controlled by vaccine, but efforts to limit infection are met with ignorance or misconceptions (Lau, Griffiths, Choi, & Tsui, 2010; Leask, Sheikh-Mohammed, MacIntyre, Leask, & Wood, 2006).

Public health officials, in concert with community leaders, should seek to educate affected communities about the infectious diseases they face along with effective mitigation strategies and the importance of vaccination, if available. Coreil (2010) describes the importance of cultural models in “[gaining] a deeper understanding of the cultural context of behavior” (p. 83). If behaviors are not understood, then it will be difficult to redirect them. Reaching out to community leaders has the added effect of allowing the leaders to alter the message just enough so that it might be effectively communicated to the community.

Providing a cultural health model allows for a larger scope of audience while effectively tailoring the message so that most of the target audience will appreciate the nature of the message. Approaching health behaviors from a cultural stand-point also offers the advantage of allowing peer support to propagate messages through out the community. This might be especially true when dealing with a multitude of subcultures where the message might better be disseminated via interpersonal means. Eventually, the message will be received by many individuals who will begin to have discussions with others in the community. For communities where individuals are not likely to speak to each other regarding personal health-related matters, the cultural health model allows a general message to reach each individual.


Coreil, J. (Ed.). (2010). Social and behavioral foundations of public health (2nd ed.). Thousand Oaks, CA: Sage.

Lau, J. T. F., Griffiths, S., Choi, K. C., & Tsui, H. Y. (2010). Avoidance behaviors and negative psychological responses in the general population in the initial stage of the H1N1 pandemic in Hong Kong. BMC Infectious Diseases, 10(139), 1-13. doi:10.1186/1471-2334-10-139

Leask, J., Sheikh-Mohammed, M., MacIntyre, C. R., Leask, A., & Wood, N. J. (2006). Community perceptions about infectious disease risk posed by new arrivals: A qualitative study. The Medical Journal of Australia, 185(11/12), 591-593. Retrieved from http://www.mja.com.au/public/issues/185_11_041206/lea10999_fm.pdf

Pérez-Guerra, C. L., Zielinski-Gutierrez, E., Vargas-Torres, D., & Clark, G. G. (2009). Community beliefs and practices about dengue in Puerto Rico. Pan American Journal of Public Health, 25(3), 218-226. doi:10.1590/S1020-49892009000300005

Living Longer and Happier Lives

As we age, we tend to question our mortality and how much longer we have left to live. Not that we can do much about this in order to extend our lives by this time, but if we question our health earlier, we may be able to affect positive change in order to have a longer and more productive quality of life. Dan Buettner (National Public Radio [NPR], 2008; TED, 2009) discusses how difficult it can be to control the effects of aging, but he also offers some options based on his observations of what are termed blue zones. Blue zones are geographic and cultural areas of the where people tend to live longer and healthier lives.

Buettner (NPR, 2008; TED, 2009) describes simple measures that can contribute to increasing a productive life. More importantly, he has uncovered what they do not do. The people who live in these blue zones, according to Buettner, do not tend to take daily supplements, pills, or extracts. Instead, continuous and simple movement for exercise coupled with a sensible cultural diet seems to have the biggest impact.

One of the observations that I have made over the years is that as physical movement declines, physical and emotional strength wane. For example, an otherwise healthy 70 year old woman who accidentally falls and breaks her hip decreases her life expectancy drastically unless physical rehabilitation is utilized to regain her activity level (Keene, Parker, & Pryor, 1993; Lyons, 1997). It is vitally important to maintain a healthy level of activity throughout life.

Diet is very important. Buettner (NPR, 2008; TED, 2009) credits adding nuts to the diet for an average increase of three years of life. The way in which our bodies use energy is very important, and we must supply it with a fuel that is efficient. A wholesome diet, I believe, is the best diet, especially if divided by five or more meals a day.

We cannot have a conversation about improving overall health without addressing some of the unhealthy vices that we tend to indulge in. Instead of outlining each and every thing that is detrimental to our health, I will say that moderation should be the way to combat the effects of vices. We need to enjoy life, and I feel that the mere enjoyment leads to a longer and healthier life; therefore, to strictly limit indulgences would seem to be counter-productive. Moderation should certainly be the way in which to address these issues.

We all want to live longer and healthier lives, but genetics does play a role. There are some aspects of our lifestyle that we are finding that we can change for the better, and the alternatives are not that bad. So long as we live healthy lives, we can enjoy life more completely.


Keene, G. S., Parker, M. J., & Pryor, G. A. (1993). Mortality and morbidity after hip fractures. British Medical Journal, 307, 1248-1250. doi:10.1136/bmj.307.6914.1248

Lyons, A. R. (1997). Clinical outcomes and treatment of hip fractures. American Journal of Medicine, 103(2), S51-S64. doi:10.1016/S0002-9343(97)90027-9

National Public Radio (Producer). (2008, June 8). Can ‘blue zones’ help turn back the biological clock? [Audio podcast]. Retrieved from http://www.npr.org/templates/story/story.php?storyId=91285403&from=mobile

TED (Producer). (2009, September). Dan Buettner: How to live to be 100+ [Web Video]. Retrieved from http://www.ted.com/talks/dan_buettner_how_to_live_to_be_100.html

Social Ecology of Immunization and Infectious Diseases

Vaccines are very useful as preventive medicine in public health to reduce morbidity and mortality due to communicable diseases, though they are not a substitute to safe drinking water, sanitation, nutrition and environmental health in the long run.
(Madhavi et al., 2010, p. 618)

In dealing with infectious diseases, two primary methods of prevention are worthwhile: immunization and avoidance. Avoidance is nearly impossible as valence for various pathogens vary so greatly and community network structure influences (Ciccaroneet al., 2010; Salathé & Jones, 2010). Immunization, on the other hand, allows for proximal contact with a specific pathogen without the likelihood to effective transmission, or active infection. Immunization, or innoculation, is the process of introducing the immune system to potential future pathogens so that it may form lifelong antibodies that can readily attack the pathogen if infected in the future (Centers for Disease Control, 2009). Immunization is gaining stronger support in the face of a growing number of antibiotic-resistant pathogens and pathogens with a propensity for recombination under heavy environmentally selective pressures, and though antibiotic therapy is a reliable and effective secondary prevention method, it seems to be true that antibiotic therapy is becoming less effective the more we rely on it as a prophylaxis (Laxminarayan & Brown, 2001). Additionally, antibiotics are only effective in the treatment of bacterial infections and have no effect on viral infections. Antiviral medications are typically more expensive and less available.

Luckily, when speaking about infectious processes, there is little need for continuous care after the acute presentation (Ciccarone et al., 2010). The pathogen is typically eradicated from the host by means of the natural combative effects of the immune system in combination, when required, with pharmacological assistance, and there is only a small chance of the host suffering any lasting effects. Unfortunately, there are some pathogens that continue to cause harm well after the acute phase of infection. Pathogens, such as the human immunodeficiency virus, ravage the immune system making the host susceptible to a number of other opportunistic infections that can become life-threatening. Other pathogens, such as hepatitis, can damage the natural filtration system of the host’s body that other deleterious effects surface creating a chronic disease process of the organs. In these, and other, cases, tertiary prevention strategies can help to offer the host a meaningful quality of life with the presence of the disease process. Some effective tertiary methods include medications aimed at improving the function of certain organs or systems. Diet and exercise also plays a major role in tertiary prevention strategies (Stokols, 1992).

Depending on the particular pathogen, infection might not affect me as much as others. As a paramedic, I have a comfortable knowledge of infectious disease processes, and I understand that a simple regimen of antibiotic medication, along with rest and fluid intake, will cure most of the infectious bacterial diseases that I might face, albeit some drug-resistant pathogens are not so easy to manage. Additionally, I have isolation equipment at my disposal that allows me to create a barrier from these and other infectious diseases. Ciccarone et al. (2010) further describe many of the psychosocial barriers Asian and Pacific Islanders face when confronted with the early stages of some infections. “Psychosocial issues such as depression, embarrassment, and shyness were reported to have influenced time to seeking medical attention” (Ciccarone et al., 2010, p. 143). Although I accept that I may suffer one or more of these barriers, my education, along with mandatory workplace reporting requirements, empower me to seek medical care when needed.

Addressing prevention strategies, Stokols (1992) introduces a model using the social ecology of health. Though he does not categorize primary, secondary, and tertiary means, he does hint at prevention strategies being proximal or distal. Further, Stokols outlines a variety of means related directly to an understanding of environmental roles and pressures. Understanding how an individual relates to, from, and within his or her ecology allows the health practitioner to provide more focused means of prevention and education.


Centers for Disease Control. (2009). Parent’s Guide to Immunizations [Excerpt]. Retrieved from http://www.cdc.gov/vaccines/vac-gen/downloads/pg_how_vacc_work.pdf

Ciccarone, R. M., Kim, M., Tice, A. D., Nakata, M., Effler, P., Jernigan, D. B., … & Sinkowitz-Cochran, R. L. (2010). Prevention of community-associated methicillin-resistant staphylococcus aureus infection among Asian/Pacific Islanders: A qualitative assessment. Hawai‘i Medical Journal, 69(6), 142-144. Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/

Laxminarayan, R. & Brown, G. M. (2001). Economics of antibiotic resistance: A theory of optimal use. Journal of Environmental Economics and Management, 42(2), 183-206. doi:10.1006/jeem.2000.1156

Madhavi, Y., Puliyel, J. M., Mathew, J. L., Raghuram, N., Phadke, A., Shiva, M., … & Banerji, D. (2010). Evidence-based national vaccine policy. Indian Journal of Medical Research, 131, 617-628. Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/

Salathé, M. & Jones, J. H. (2010). Dynamics and control of diseases in networks with community structure. PLoS Computational Biology, 6(4), e1000736. doi:10.1371/journal.pcbi.1000736

Stokols, D. (1992). Establishing and maintaining healthy environments: Toward a social ecology of health promotion. American Psychologist, 47(1), 6-22. doi:10.1037/0003-066X.47.1.6

Botulism: A Measurement of Occurrence

 Botulism, caused by the Clostridium botulinum bacterium, is typically caused by poorly prepared, home-canned foods and can cause symptoms as simple as blurred or double vision to full body paralysis, sometimes causing death (Centers for Disease Control and Prevention [CDC], 1996). The incidence of botulism is said to be extremely low with only 126 reported cases in the United States in 2003; with only eight attributable to foodborne vectors, the predominant cause is accidental contamination (CDC, 2004).

One of the concerns regarding botulism is its toxicity. Botulinum toxin is the most potent toxin known to man (CDC, 2006). This potency lends to botulinum’s ability to be used as an agent of bioterrorism, though most of the known cases have been shown to be accidental in nature (CDC, 1996; CDC, 2006). Another concern is the accidental or negligent contamination of any food prepared for wide distribution, such as canned vegetables from a large manufacturer.

Surveillance is important to identify each and every case in order to have the most accuracy possible when considering increasing or decreasing trends of incidence and prevalence of the disease. The cause of any increase or decrease in incidence of botulism should always be investigated.

Any increase of incidence could identify a possible problem while a decreased incidence could foretell efficacy in the efforts of mitigation. More appropriately, though, as Friis and Sellers (2009) show, further identification should be made in order to focus on specific descriptive factors, such as affected populations, the geography of these populations, known vectors, and factors of time. This process will ensure that more accurate trends are observed.

For instance, the CDC (2004) has stated that in a typical year, such as 2004, the incidence of botulism is less than 200. With incidence reporting covering the entire United States, increases or decreases in this crude number serve only to identify general changes in frequency; whereas, further identification of certain characteristics of the disease pattern will help to further isolate affected individuals and etiologies (Friis et al., 2009). Within the CDC’s (2004) data, infant occurrence of botulism is identified as the major contributor to incidence, thereby isolating the remaining occurrences to adults. The CDC has gone further to separate the incidences of botulism into three groups, infant occurrence, foodborne infection, and wound infection. A separate group is reserved for other occurrences relating to the use of pharmacological botulin.

Using descriptive factoring of the 2003 CDC data (2004), further geographic isolation of occurrences show that infant occurring botulism is fairly wide-spread with a small number of incidences in each of twenty-two States, though California and Pennsylvania account for about half of the reported infant occurrences. Foodborne and wound occurrences of botulism were isolated to Alaska, California, Colorado, Oregon, Utah, and Washington. Texas had the only two reportable cases classified as “Other”. Theoretical assumptions can now be used to show that the problem in Texas is resolved but should continue to be monitored, and food safety education projects should focus on home-canning in the western regions of the United States.

In conclusion, epidemiology is an important means of understanding and identifying causation and etiology, as well as preparing for mitigation and outbreak response. In this example of botulism, I have identified localization of the disease, common pathways of infection, or vectors, and means of helping to mitigate future occurrences of the disease. Botulism numbers are quite low, but dealing with other diseases of larger scale, grouping the data into useful subsets will assist in following the progression of the disease from outbreak to outbreak and in consideration of mitigation techniques employed.


Centers for Disease Control and Prevention, U. S. Department of Health and Human Services. (1996). Botulism (Clostridium botulinum): 1996 case definition [CSTE Position Statement No. 09-ID-29]. Retrieved from http://www.cdc.gov/ncphi/disss/nndss/casedef/botulism_current.htm

Centers for Disease Control and Prevention, U. S. Department of Health and Human Services. (2004). Surveillance for Outbreaks of Botulism [Summary of 2003 Data]. Retrieved from the Centers for Disease Control and Prevention website: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/files/Botulism_CSTE_2003.pdf

Centers for Disease Control and Prevention, U. S. Department of Health and Human Services. (2006). History of Bioterrorism: Botulism. CDC Emergency Preparedness and You [Podcast]. Washington, DC: CDC Bioterrorism Preparedness and Response Program.

Friis, R. H., & Sellers, T. A. (2009). Epidemiology for public health practice (4th ed.). Sudbury, MA: Jones & Bartlett.

The Socio-economics and Certain Illnesses or Injuries

Kovner and Knickman (2008) describe health disparities as health problems common to specific populations, and they differentiate health care disparities as a “[reflection of] the interaction of health care access and utilization with broader societal issues related to racial and ethnic, socioeconomic, and gender differences” (p. 421). Many social groups take part in risky behaviors. If these social groups are drawn along certain socio-economic lines, then it would appear that there is a causal relationship between socio-economics and certain illnesses or injuries when the correlation is truly the risk-taking behavior. Blacks having a ten-fold incidence of AIDS over whites may be related to preliminary health education with no causal relationship to the access of health care (Kovner et al., 2008). Additionally, Kovner et al. point out a higher incidence of Blacks leaving emergency departments before being cared for. Could this be a result of Blacks seeking emergent care for non-emergent problems? Certainly, there are health problems and health care problems common to specific populations.

Initially, when considering racial and ethnic differences, my views revolve around socioeconomic determinants where causal relationships are not what many would consider. Most, I imagine, would consider the cause of poor care to be uncaring health care professionals, but I would venture that the attitudes of some health professionals are the end-result that correlates to poor care. If a health care provider treats patients who continually dismiss their poor health or take part in risky health behavior without considering the long-term effects, the health care professional becomes dispassionate and disconnected, mistrusting patients, and delivering care that is substandard, but presumed to be aligned with the responsibilities taken by the patients, generally speaking. Ergo, if they don’t care, why should I? This generalization creates a common distrust between patient and provider. Aside from the patient-provider relationship, there seems to be a more daunting issue of access to health insurance, which obviates the correlation to a lack of health care access. What are the causes of these disparities?

How do we address the disparities in health care? First, we need to identify if there are truly disparities, what they are exactly, and what is causing them. Recent research suggests a need to find the methods most appropriate to tackle these questions (Kirby, Taliaferro, & Zuvekas, 2006; Lê Cook, McGuire, Meara, & Zaslavsky, 2009; Lê Cook, McGuire, & Zuvekas, 2009). Do we need to understand the problem? Educating both the providers and patients effectively in how to approach each other as well as instituting quality improvement strategies within each health care practice should assure, at least retrospectively, that all patients within a practice would get the same care as any other patient treated by that practice. Additionally, providing patient education about how to access health care appropriately and effectively would help to avoid some of the pitfalls common in our health care system. Some of which may be attributable causes to many of the health care disparities of today.

In conclusion, I feel that many of the health care disparities are not caused by the health care system, though the relationship is noticeable. There are many other factors that need to be considered, and as Kirby et al. point out, “Researchers and policymakers may need to broaden the scope of factors they consider as barriers to access if the goal of eliminating disparities in health care is to be achieved” (p. I64).


Kirby, J. B., Taliaferro, G., & Zuvekas, S. H. (2006) Explaining racial and ethnic disparities in health care. Official Journal of Medical Care, 44(5), I64-I72. doi:10.1097/01.mlr.0000208195.83749.c3

Kovner, A. R., Knickman, J. R., & Jonas, S. (Eds.). (2008). Jonas & Kovner’s health care delivery in the United States (9th ed.). New York, NY: Springer.

Lê Cook, B., McGuire, T. G., Meara, E., & Zaslavsky, A. M. (2009). Adjusting for Health Status in Non-Linear Models of Health Care Disparities [Manuscript]. Health Service Outcomes Research Methodologies, 9(1), 1–21. doi:10.1007/s10742-008-0039-6

Lê Cook, B., McGuire, T. G., & Zuvekas, S. H. (2009). Measuring Trends in Racial/Ethnic Health Care Disparities [Manuscript]. Medical Care Research Review, 66(1), 23-48. doi:10.1177/1077558708323607

Reducing our Health Care Expenditures

With the recent signing into law of the Patient Protection and Affordable Care Act (2010), more affectionately known as ‘Obama Care’, much of the health care discussion has turned from deciding what we should do to how we should do it. Many us acknowledge that the current state of our health care needs reformation; the only problem seems to be choosing the best approach. As a licensed out-of-hospital provider, I am in a unique position to observe patients entering our health care system, being treated by our health care system, and exiting (for good or bad) our health care system. I can see that our health care needs are not being met, and I can see both how patients approach their care and how practitioners approach their patients — inefficiently and ineffectively. We need to resolve these issues.

Canada is a fairly close approximation to the United States in locale, geography, economy, and political ideology (Doran, ca. 2000; “GNI per capita”, 2010). It might make sense for us to look towards Canada to see if they have adopted a plan that we could either emulate, or, in the very least, research for a sense of best practices. Kovner, Knickman, and Jonas (2008) describe Canada as having a national health insurance (NHI) system of health care, in that the system is provisioned by a mix of both public and private contributions. Two benefits of Canada’s health care system include a high life expectancy (77.4 for males at birth) and a low cost ($3,165 per capita, or 9.9% of GDP; Kovner et al., 2008, Table 6.2, p. 165). In comparison, Kovner et al. shows that the life expectancy for males in the United States is 74.8 under a system that costs $6,102 per capita (or, 15.3% of GDP). These numbers are significant because we need to understand what we can expect from our investments, and I feel that the average life expectancy is a great benchmark of a health care system as a whole. One worry that I would have, though, is if we were to adopt the same pharmaceutical cost controls, research and development in the industry may suffer, as well as any other technology burdened by cost-cutting measures. I have to assume that the free market would effectively drive these areas, however.

In order to adopt such sweeping changes of our health care system, both liberals and conservatives would have to negotiate their ideals. I am a fairly conservative citizen who believes in smaller government and spending constraints. If reducing our health care expenditures by realigning the modes and methods of health care delivery was realistic, I could be in favor of such a reform. Political agendas aside, Canada’s health care system is certainly one that we should further consider.


Doran, H. (ca. 2000). Politics and political parties in Canada. Internet sources for journalists and broadcasters. Retrieved on April 22, 2010, from http://www.synapse.net/radio/can-pol.htm

“GNI per capita, Atlas method (current US$)”. (2010). Data catalog. The World Bank Group. Retrieved on April 22, 2010, from http://data.worldbank.org/indicator/NY.GNP.PCAP.CD

Kovner, A. R., Knickman, J. R., & Jonas, S. (Eds.). (2008). Jonas & Kovner’s health care delivery in the United States (9th ed.). New York, NY: Springer.

Patient Protection and Affordable Care Act of 2010, H.R. 3590, 111th Cong. (2010).

Health Promotion: Workplace Health Screening

Cardiovascular disease (CVD), diabetes mellitus (DM), and colorectal cancer (CRC) are all significant health concerns facing us today (Anonymous, 2005; Bagai, Parsons, Malone, Fantino, Paszat, & Rabeneck, 2007; de Koning, 2009; Korhonen, Jaatinen, Aarnio, Kantola, & Saaresranta, 2008; Matthews, Nattinger, Venkatesan, & Shaker, 2007). In the U.S., CRC is estimated to kill 56,000 people per year, while, in the U.K., the numbers are around 16,000. (Anonymous, 2005). CVD is on the decline but is expected to continue to have a global impact, taking off the most years of life, and DM creates a 4-fold increase of dying from CVD (de Koenig, 2009).

Through efforts at targeting healthy lifestyle changes, the mortality of these diseases has decreased over the past few years, but the numbers remain high, and studies suggest that identifying those people with risk factors or early signs of disease helps to both treat for the disease effectively and decrease the overall incidence (Anonymous, 2005; Bagai et al., 2007; de Koning, 2009; Matthews et al., 2007).

As Bagai et al. (2007) point out, health promotion activities focused on screening are notably scarce within the workplace. Researchers, Hamashima and Yoshida, have shown that early detection of CRC is effective at decreasing overall morbidity (as cited in Bagai et al., 2009). Bagai et al. attempted to apply this reasoning within the confines of a typical Canadian work environment by introducing CRC screening to the men and women of the Toronto police force. With workplace screening programs being limited in Canada, Bagai et al. hoped to show the effectiveness of these screening programs, and they were successful, but unfortunately, the participation in the study was limited.

Another study (Matthews et al., 2007) aims at increasing CRC screening among the residents of the Midwestern States in the U.S. The literature seems to suggest that participation in screening procedures is contingent on education and insistence by the physician, specifically.

Not only does this correlate to the thought that the primary care physician has an important role in screening and detecting disease, but in order for workplace screening programs to be successful, the physicians need to make the recommendation that the patient uses the screening programs available to him or her.

Korhonen et al. (2008) used the waist circumference criteria (women: 88 cm; men: 102 cm) set forth by the American Heart Association and the National Heart, Lung, and Blood Institute to assess the effectiveness of at-home screening for CVD and DM risk by using a simple questionnaire and a tape measure. Taking very little time and requiring little expertise, this process could be incorporated with any workplace screening program to increase its efficacy.

Increasing these screening programs, particularly within the workplace, should target the population most at risk to CRC, CVD, and DM. Targeting specific risk groups to educate about these diseases should ultimately lead to a higher survivability, decreased incidence, and lower morbidity rates. More research should be aimed at studying the effects of more targeted workplace health screenings to understand how this tool could be best implemented to provide better screening for CVD, DM, CRC, and, perhaps, other pathological processes.


Anonymous. (2005). Colorectal cancer: Not an embarrassing problem. Lancet, 366, 521. doi:10.1016/S0140-6736(05)67030-4

Bagai, A., Parsons, K., Malone, B., Fantino, J., Paszat, L., & Rabeneck, L. (2007). Workplace colorectal cancer–screening awareness programs: An adjunct to primary care practice? Journal of Community Health, 32(3), 157-167. doi:10.1007/s10900-006-9042-4

Cyranoski, D. & Williams, R. (2005). Health study sets sights on a million people. Nature, 434, 812. doi:10.1038/434812a

de Koning, H. J. (2009). Testing at home—the screening of the future? European Journal of Public Health, 19(1), 5–6. doi:10.1093/eurpub/ckn120

Geltman, P. L., & Cochran, J. (2005). A private-sector preferred provider network model for public health screening of newly resettled refugees. American Journal of Public Health, 95, 196-199. doi:10.2105/AJPH.2004.040311

Korhonen, P. E., Jaatinen, P. T., Aarnio, P. T., Kantola, I. M., & Saaresranta, T. (2008). Waist circumference home measurement – a device to find out patients in cardiovascular risk. European Journal of Public Health, 19(1), 95–99. doi:10.1093/eurpub/ckn090

Matthews, B. A., Nattinger, A. B., Venkatesan, T., & Shaker, R. (2007). Colorectal cancer screening among Midwestern community-based residents: Indicators of success. Journal of Community Health, 32(2), 103-120. doi:10.1007/s10900-006-9038-0

Smith, G. D., Ebrahim, S., Lewis, S., Hansell, A. L., Palmer, L. J., & Burton, P. R. (2005). Genetic epidemiology 7: Genetic epidemiology and public health: Hope, hype, and future prospects. Lancet, 366, 1484-1498. doi:10.1016/S0140-6736(05)67601-5

Summary – Public Health Theory: Social Cognitive Theory

Building on Social Learning Theory, Social Cognitive Theory (SCT) (as cited in Bandura, 1989; U.S. Health and Human Services, National Institutes of Health, National Cancer Institute, 2005) has been a mainstay in psychology since 1986 when Albert Bandura explored the relationship between the individual, his or her personal traits, the physical environment, and society, and how each of theses factors impact and influence the others. Since this time, SCT has shown to have increasing applicability across the spectrum of health education. Using SCT to focus on these relationships, the health practitioner can understand that individuals are able to overcome obstacles to their health with an increased sense of responsibility, motivation, and control (U.S. Health and Human Services, National Institutes of Health, National Cancer Institute, 2005). By allowing an individual to understand that they can shape their environment just as their environment shapes them, the individual regains their locus of control, motivation, and sense of self.

A dynamic process, SCT has been used successfully to assess treatment techniques, improving on areas lacking in benefit. Brand and Nyland (2009) identify that 30-35% of patients with anterior cruciate ligament repair do not recover to their preinjury level of activity participation; however, they have identified that, using SCT, bolstering pre- and postoperative self-efficacy levels could ultimately improve a patient’s return to the preinjury activity level. Analyzing and identifying psychological factors which inhibit a sense of self-efficacy, allow the health practitioner more opportunity to improve overall success in surgery and rehabilitation.

In recent years, innovative researchers have been exploring other positive roles where SCT may be employed, including the creation of internet-based grief counseling programs. Dominick et al., (2009) show that identification of an individual’s grieving style can assist with forming adaptive cognitive therapies which, even provided in an online format, can assist the uncomplicated griever by positively affecting attitude, self-efficacy, and increasing knowledge about their personal grieving style.

SCT’s adaptive and dynamic nature allows for the health practitioner to analyze a problem and apply the theory’s constructs to change as much or as little as necessary for the development of a working solution with specific focus and control. In this way, SCT allows program development to follow a structured and informed methodology allowing a higher percentage of success.


Bandura, A. (1989). Social cognitive theory. In R. Vasta (Ed.), six theories of child development. Annals of child development, 6, 1-60. Greenwich, CT: JAI Press.

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