Question ID: WS-60
Submitted by: Sudha Sivaram
February 11, 2011
In resource poor countries, can we develop interventions that address both individual level as well as structural level factors influencing behaviors that facilitate risk of cancer? Background. Worldwide modifiable risk factors are a key target for cancer prevention programs. For instance, between 1998 and 2003, individuals reporting heavy smoking in China doubled (25 to 51%) (Qian et al., 2010, Bull WHO); childhood obesity in a study of 14-17 year olds in New Delhi, India showed an increase in obese/overweight children from 16% to 24% in the period from 2002 to 2006(Bharadwaj et al., 2008, Asia Pac J Clin Nutr). While economic changes including globalization have been posited as factors associated with these behavioral trends, there is also discussion about the role of social norms and expectations as well as increasing access to tobacco products and alcohol. Structural factors such as poverty limit contact with the health care system while gender norms and expectations disallow women to become informed and seek care for cancer and other diseases. Feasibility. Behavior change interventions developed and delivered based on an understanding of social norms, perceptions and attitudes of individuals towards disease as well as their interaction with the health care system have been shown to be efficacious in the US and elsewhere. Other behavioral interventions that have been efficacious consider structural influences such as poverty and gender disparities and their interaction with health outcomes (Pronyk et al., 2006, Lancet; Jewkes et al, BMJ 2008 – both HIV/AIDS research examples). Implications for Public Health. Behavior change intervention research offers unique opportunities to gather evidence to explain trends and gaps in advancement of cancer control and prevention. Inequities in health care have been identified by WHO as a key social determinant of health. Designing studies to understand these factors that operate out of the control of the individuals might offer lessons in sustaining the impact of cancer prevention programs.
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