Diabetes, breast cancer, and tuberculosis are three important health concerns issues in the United States and in other parts of the world, but let’s be clear about this, there are several other important health issues affecting our people that have very significant importance. My criterion for selection is the United State, English language, and no specific age group.
Diabetes as we know is when the body fails to produce enough insulin, which then causes sugar to build up in your blood. Diabetes affects over 25.8 million people, which is 8.3% of the U.S population, of that 18.8million people are diagnosed and 7.0 million undiagnosed. Among U.S. residents aged 65 years and older 10.9 million, or 26.9%, had diabetes in 2010. About 215,000 people younger than 20 years had diabetes (type 1 or type 2) in the United States in 2010. About 1.9 million people aged 20 years or older were newly diagnosed with diabetes in 2010 in the United States. Type I diabetes was previously called insulin dependent mellitus or juvenile-onset diabetes. Type I diabetes develops when the body’s immune system destroys pancreatic beta cells, the cells that produce insulin that regulates blood glucose. To survive, people with this type must have insulin delivered by injection or pump. This type normally strikes children and young adults, but may occur at any age according and type I diabetes accounts for 5% of all diagnosed cases of diabetes. Risk factors can be may be autoimmune, genetic, or environmental according to (“national diabetes fact, 2011). Type II diabetes called non-insulin dependent diabetes mellitus or adult-onset. In adults, type 2 diabetes accounts for about 90% to 95% of all diagnosed cases of diabetes. Usually it begins as insulin resistance, which is a disorder where the cells cannot use insulin properly and as the need for insulin begin to rise; the pancreas will gradually began to lose its ability to produce it. Type II diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity (“national diabetes general”, 2011). Gestational diabetes is a form of glucose intolerance diagnosed during pregnancy it occurs more frequently in African Americans, Hispanic/Latino Americans, and American Indians. It is also common among obese women and women with a family history of diabetes (“national diabetes general”, 2011). The US Department of Health and Human Service state that African Americans are almost twice more likely to be diagnosed with diabetes than non-Hispanic whites. They are also more likely to suffer complications from diabetes, such as end-stage renal disease and lower extremity amputations (“The diabetes epidemic”, 2008, 1-5). These populations are also closely associated with low socio-economic status (de-navas-walt et al., 4, 2008). Race is a risk factor for diabetes, but because risk groups normally live in poverty, with proper intervention the likelihood that lifestyle changes will decrease. Many researchers believe certain genes play a role in the development of type I diabetes, while genes can affect insulin function it can contribute to the development of type II diabetes. Many researchers think that some African Americans, Hispanic/Latino Americans, American Indians, Asian Americans, and Pacific Islander American inherited a “thrifty gene” which helped their ancestors store food energy better during times when food was plentiful. Also, poverty, lack of access to health care, cultural attitudes and behaviors are all barriers to preventive management. I feel the researchers chose cohort study design because of the fact they were able to make a clear assumption of the data and what I mean by that is the greater assumption of specific whole fruits per say. If a person decreases their calorie intake and increases their physical activity there is a good chance to reduce the risk of type II diabetes. Whole fruits are better than fruit juice especially blueberries, grapes, apples, and bananas it tends to lower the risk if type II diabetes. Also in previous readings cohort studies are used because you can study several potential exposures at the same time and it lends itself to hospital based studies for rare diseases and outbreaks (Schneider, 2013)
Some of the proximate or underlying determinants of risks factors that are associated with this study are poverty; personal behaviors based on lifestyles decisions. When these vulnerable patients be black, Hispanic, Native American, poor, or immigrant fail to change their diet or lose weight or exercise. Genetic, psychological, familial, economic, health impact, increased weight, changes in food cost, obesity, and people from low-income and minority communities all of these are factors (candib, 2008).
Tuberculosis is caused by a bacterium called Mycobacterium tuberculosis which usually attacks the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain. If not treated properly, it can be fatal (Centers for Disease and Control). I chose for one reason only which was because it does not care who it chooses. It is airborne. It is spread through the air from person to person, if a person coughs, sneezes, or sings you are likely to become infected with this bacterium.
According to Centers for Disease and Control and Prevention, Tuberculosis is one of the world’s deadliest diseases. One third of the world’s population is infected with TB. In 2011, nearly 9 million people around the world became infected with the disease. There were around 1.4 million related deaths worldwide and is the leading killer of people who are HIV infected. Some socio economic factors would be poverty, malnutrition, lack of housing, financial concerns, and access to health care and access to water sanitation.
The research design I feel that was conducted was the case control design. I say this because in most case study designs they are easier to conduct because they do not require cooperation of the entire body, and a greater number of cases can be recruited (stein, 2011). A major advantage is that of family-based designs for the study of infectious diseases is the characterization of the exposure, individuals living in the same household 9 times out of ten will be infected or exposed so this would be a valid case control study.
The proximate or underlying determinants or risk factors associated with tuberculosis are those that directly increase exposure to infectious droplets. A necessary risk factor for TB infection is contact with a person with active disease. The likelihood of having such a contact is determined by the underlying disease burden in the community. People living or working in high environments where TB prevalence is particular high are obviously at high risk of infection, for example prison staff and inmates (bobrik et al., 2005) and certain health care worker (menzies, joshi, & pai, 2007). Depression and stress can have a negative effect on the cell-mediated system and could therefore in theory increase the risk of TB (prince et al., 2007).
Cancer is very important to me also. Most people think when we say someone have cancer it always has to be breast cancer. Well no. My grandmother had cancer in her leg and she did pass away from that. My husband had it in his shoulder back in 1996, he did not have to go through any chemotherapy but it was definitely a scary situation for all involved. According to Centers for Disease Control and Prevention Center, cancer is a disease in which cells in the body grow out of control. When cancer starts in the breast it is called breast cancer/ Except for skin cancer, breast cancer is the most common cancer in American women. Some reproductive risk factors are being young when you had your first menstrual period; never giving birth, or being older at birth of your first child, starting menopause at a later age, or using hormone replacement therapy for a long time. Some signs of breast cancer are a lump or pain in the breast, thickening or swelling of part of the breast, irritation or dimpling of breast skin, redness or flaky skin on the breast just to name a few.
The socioeconomic factors that would effect this study the most obvious are African Americans, Asian Americans, Hispanic/Latinos, or underserved Whites are more likely to have a higher death rate of cancer and this will be due to lack of health coverage and low socioeconomic status. All of this is based on a person’s occupation, income, education level, and other factors. Then you have the prevalence of behavioral risk factors such as tobacco smoking, physical inactivity, obesity, and excessive alcohol intake.
The research design I feel being used in this observational study design or case control study because upon doing my homework assignment, the researcher will observe and collect information, but will not try to change the people that are being observed. In an observational study there is no intervention. For example taking urine samples during Monday morning lectures (yes, you are intervening to take the samples, but are not trying to change the urine content level); a survey of drinking habits among college students.
The proximate or underlying determinants of risk factors associated with any health problem in this study are attitude, social influence, and efficacy. Ajzen (14) suggested past behavior would not have a great unique contribution in predicting behavior after controlling for attitude, social influence, self-efficacy, and intention. Gender, age, hereditary variables, social and cultural factors also play a big part (“genetic epidemiology of,” 2011). Attending breast cancer screening programs is lower for older women, for women without a spouse, and for women with a lower educational background.

Works Cited:
Brobrick, A., Danishes, K., Eroshina, K., & McKee, M. (2005). Prison Health in Russia: the larger picture, Journal of Public Health Policy 26, 30-59
Candib, L. (2008). Obesity and diabetes in vulnerable populations, reflections on proximal and distal causes. Retrieved from website: http:www.annfammed.org
Centers for disease and control and prevention, (2011). National diabetes fact sheet. Retrieved from website: http:www.cdc.gov
DeNavas-Walt, C, BD Proctor, and JC. Smith “Income, Poverty and Insurance Coverage in the United States: 2007”US Census Bureau. (2008) 60-235.
Menzies, D., Joshi, R., & Pai, M., (2007). Risk of tuberculosis infection and disease associated with work in health care settings. The International Journal of Tuberculosis and Lung Disease, 11, 593-605.
National diabetes information clearing house, (2008). Diabetes epidemic in African Americans. Retrieved from website: http://www.diabetes.niddk.nih.gov
Prince, M., Patel. V., Saxena, S., Maj. M., Maselko, J., Phillips, M. R., et al, (2007). No health without mental health. Lancet, 370, 859-877.
Schneider, M. (2013). Introduction to Public Health (4th ed). Jones & Bartlett Learning. Retrieved from http://digitalbookshelf.southuniversity.edu.
Stein, C. (2011). Genetic epidemiology of tuberculosis susceptibility. Retrieved from website: http://www.plospathogens.org

U.S. Department of Health and Human Services, Centers for Disease and Prevention, (2011). National diabetes general information on diabetes prediabetes in the United States.
Retrieved from website: http://www.cdc.gov