BEHIND THE STRUGGLE: HOW SOCIO-ECONOMIC HARDSHIPS SHAPE

RISKY BEHAVIORS AND HEALTH

Chapter 1

THE PROBLEM AND ITS BACKGROUND

This chapter focuses on the introduction, which includes the background of

the study, statement of the problem, theoretical framework, conceptual

framework, research flowchart, significance of the study, scope and delimitations,

and definition of terms.

Introduction

Socio-economic hardships, like poverty and lack of resources, have a big

impact on people’s behavior and health. These struggles often hit marginalized

groups the hardest. For example, when people don’t have enough money, it’s

hard to afford basic needs like healthy food, safe housing, or good healthcare.

This financial stress can push them toward risky behaviors like substance abuse

such as smoking and alcoholism, poor dietary or food consumption, physical

inactivity which can harm their health in the long run (Adler & Stewart, 2010;

Evans & Kim, 2013).

When people don’t have access to a good education, it makes the problem

worse. Education helps people understand health risks and make smart

decisions about their lives. Without it, they might not know how to protect
themselves from diseases, manage ongoing health problems, or seek preventive

care. This lack of knowledge keeps them trapped in cycles of poor health and

poverty (Braveman & Gottlieb, 2014; WHO, 2008).

On top of that, healthcare services are often too expensive, too far away, or hard

to access for people in low-income areas. Many avoid going to the doctor

because they can’t afford it or because they’ve faced discrimination in the

healthcare system. This leads to untreated illnesses and even preventable

diseases becoming a serious problem, especially for already struggling

communities (Wilkinson & Marmot, 2003; Krieger, 2001).

These challenges also create neighborhoods where unhealthy choices are

the easiest or the only options. For example, in poorer areas, fast food is cheap

and everywhere, but fresh, healthy food is hard to find or expensive. This

encourages poor eating habits that can lead to obesity, diabetes, and heart

problems. Similarly, unsafe or neglected neighborhoods often lack parks or

recreational spaces, making it harder for people to stay active (Drewnowski &

Specter, 2004; Sallis et al., 2006).

The constant stress of financial struggles takes a toll on mental health too.

Many people dealing with poverty feel anxious, hopeless, or overwhelmed.

Unfortunately, mental health services are often unavailable or too expensive for

them. This emotional distress sometimes leads to unhealthy habits like smoking

or drinking, making their health even worse (Adler & Stewart, 2010; Evans &

Kim, 2013).

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 Altogether, these socio-economic challenges create a cycle where poor

living conditions lead to risky behaviors, and these behaviors lead to even worse

health. To break this cycle, we need solutions that address the root problems,

like improving education, making healthcare affordable and accessible, and

creating more opportunities for financial stability. By addressing these deeper

issues, we can help reduce health inequalities and improve everyone’s quality of

life (Braveman & Gottlieb, 2014; WHO, 2008).

Statement of the Problem

This Study aims to identify how socioeconomic hardships shape risky

behaviors and health of the residents of Barangay Combado, Maasin City,

Southern Leyte.

Specifically, the Study seeks to answer the following questions:

1. What is the socio-demographic profile of the residence in terms of:

1.1 age;

1.2 sex;

1.3. marital status;

1.4. educational attainment;

1.5. monthly income;

1.6. occupation

2. What are the socioeconomic hardships experienced by the respondents in

terms of:

2.1 financial strains;

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 2.2 educational barriers;

2.3 social isolation;

2.4 living conditions; and,

2.5 access to healthcare?

3. What specific risky behaviors do individuals exhibit in response to

socioeconomic hardships in terms of;

3.1 substance abuse;

3.2 poor dietary choices; and,

3.3 physical inactivity?

4. What are the health outcomes of individuals in response to socioeconomic

hardships in terms of:

4.1 physical health;

4.2 mental health;

4.3 social health; and,

4.4 emotional health?

5. What are the reasons that individuals engage in the identified risky

behaviors?

6. What recommendation can be made based on the outcome of the study?

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Theoretical Background

The researchers have anchored the study on Biopsychosocial models

that are a class of trans-disciplinary models which look at the interconnection

between biology, psychology, and socio-environmental factors. These models

specifically examine how these aspects play a role in a range of topics but

mainly psychiatry, health and human development. The term is generally used to

describe a model advocated by George L. Engel in 1977

Figure 1: Biopsychosocial model by George L. Engel in 1977

The biopsychosocial model, proposed by George L. Engel in 1977, offers

a comprehensive framework for understanding health and illness by integrating

biological, psychological, and social dimensions, with a strong emphasis on

individual behavior. This model highlights how behavior is shaped not only by

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biological factors, such as genetic predispositions and physical health, but also

by psychological influences, including coping mechanisms, mental health, and

self-esteem. Additionally, social elements, such as family dynamics, peer

relationships, and cultural norms, play a critical role in shaping how individuals

respond to stress, seek care, or adhere to treatments. Unlike the traditional

biomedical model, which isolates physical causes of disease, Engel’s approach

underscores the dynamic interplay of these three domains, recognizing that

behavior is both a product of and a contributor to health outcomes. For example,

a person’s response to chronic illness may depend on their emotional resilience,

the support they receive from their social network, and their understanding of

their condition, illustrating the interdependence of these factors in shaping

behavior. This holistic view encourages personalized approaches to healthcare,

emphasizing the importance of addressing behavioral patterns to promote well-

being.

The biopsychosocial model's psychological component looks for a

psychological basis for a specific symptom or group of symptoms such as

impulsivity, irritability, overwhelming sadness, etc. On the one hand,

psychological variables may increase a biological predisposition by making a

genetically fragile person more inclined to engage in additional risk behaviors; on

the other hand, genetically vulnerable people may be more likely to exhibit

negative thinking that increases their risk for depression. A person with

depression, for instance, may be more prone to abuse alcohol, which can lead to

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liver damage, even though depression alone may not cause liver issues. A higher

chance of illness results from taking more risks.

Social factors encompass elements such as socioeconomic status,

culture, technology, and religion. For example, experiencing job loss or the end

of a romantic relationship can increase the likelihood of stress and illness. These

events may make an individual more susceptible to depression, which could

subsequently lead to physical health issues. The influence of social factors is

particularly evident in mental health conditions like anorexia nervosa, a disorder

marked by intentional and extreme weight loss despite being underweight.

Industries like fashion and media often promote unrealistic beauty standards that

prioritize thinness over health, creating societal pressure to conform to these

ideals, even at the expense of one’s well-being.

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Theoretical Background of the Study

This study is anchored on the following theories: Social Determinants of

Health by Michael Marmot (1999) and Biopsychosocial theory by Dr. George

Engel and Dr. John Romano (1977).

Figure 1: Social Determinants of Health Graphic by Michael Marmot (1999)

The Social Determinants of Health (SDOH) studies how various social,

economic, and environmental factors shape the health of individuals and

communities. This framework goes beyond personal choices and biological

factors, emphasizing how these interconnected components influence health

outcomes. By observing how these factors are intertwined and affect society's

health, the SDOH framework provides valuable insights that researchers can use

to uncover disparities and find ways to improve well-being.

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 One key factor is income and social status, which is foundational in

determining access to essentials like food, housing, and healthcare. Higher-

income people enjoy better health because they can afford nutritious meals, safe

living conditions, and preventive care. On the other hand, Marmot and Wilkinson

(1999) found that those in lower income brackets face more challenges, such as

chronic stress and poor health outcomes, due to financial and societal obstacles.

Addressing these income disparities is crucial to promoting fairness and

improving everyone's access to healthier lifestyles.

Education is another critical factor that shapes health by influencing

decision-making and health literacy. People with higher levels of education tend

to understand health information better, making it easier for them to navigate

healthcare systems and adopt healthier habits (Marmot and Wilkinson, 1999).

Education doesn't just impact personal health; it has a ripple effect, improving

health outcomes for individuals and communities.

Employment and living conditions are also deeply tied to health. A stable

and fair job provides financial security and supports mental health by reducing

stress and fostering social engagement. The World Health Organization (2008)

highlights that steady employment helps individuals access crucial resources like

better food and housing. Additionally, the quality of housing and neighborhoods

plays a major role. Safe, clean, supportive living environments help reduce risks

and promote healthier, happier communities.

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 Furthermore, the SDOH framework sheds light on the many factors

influencing health and the disparities that arise from them. By understanding how

social, economic, and environmental conditions intersect to shape health,

researchers can uncover key issues and develop targeted interventions and

recommendations toward better health outcomes (Marmot & Wilkinson, 1999).

This framework addresses immediate health problems and builds a groundwork

for long-term, sustainable solutions (World Health Organization, 2008).

The Social Determinants of Health (SDOH) theory is a useful framework

for understanding the complex relationship between socioeconomic hardships

and health outcomes, making it relevant to the Study. About the Study, this

theory helps explain that health is not only determined by individual choices or

genetics but by the daily social, economic, and environmental factors individuals

experience daily. The SDOH also determines how socioeconomic struggles—

such as financial strain, educational barriers, and limited access to healthcare—

contribute to risky behaviors that negatively affect health.

By applying the SDOH framework, the Study recognizes how income,

education, and employment directly shape individuals' health decisions. Though

often seen as personal choices, these behaviors are deeply influenced by the

environmental conditions created by social and economic disadvantages. SDOH

framework facilitates a comprehensive understanding of how socioeconomic

hardship contributes to risky behaviors and poor health outcomes. Ultimately,

this research aims to obtain relevant data to answer the root causes of risky

behaviors and health disparities.

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Conceptual Background

Figure: Conceptual Framework of the Study

This figure illustrates the conceptual framework where there are three

types of variables: independent, dependent, and intervening. The independent

variable refers to socioeconomic hardships experienced by individuals. These

include challenges such as poverty, high unemployment rates, limited access to

education, and poor housing conditions. Socioeconomic hardships significantly

influence an individual's lifestyle and choices, often leading to increased

exposure to stress and limited access to resources needed to maintain a healthy

life. The dependent variable refers to risky behaviors and health outcomes.

These include behaviors such as substance abuse (e.g., smoking), poor dietary

choices, and physical inactivity. The intervening variable in the framework is the

sociodemographic profile of individuals, which acts as a mediator between

socioeconomic hardships and health outcomes. This includes factors such as

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age, sex, marital status, educational attainment, annual income, and occupation.

Sociodemographic characteristics influence how individuals experience and

respond to socioeconomic challenges and, consequently, their health-related

behaviors and outcomes.

The Independent Variable, which is the Socioeconomic hardships create a

stressful environment, often leading individuals to adopt unhealthy coping

mechanisms. Financial insecurity, poor living conditions, and limited access to

education increase the likelihood of engaging in risky behaviors. According to

Guthold et al. (2018), people from low socioeconomic backgrounds are more

likely to smoke, consume alcohol, follow sedentary lifestyles, and experience

weight gain, all of which contribute to higher rates of morbidity and mortality.

The Dependent Variable is Risky Behaviors and Health Outcomes. The

health outcomes of individuals are significantly shaped by their behaviors.

Actions like substance abuse, neglecting preventive healthcare, and maintaining

unhealthy diets directly contribute to chronic illnesses. These behaviors are often

the result of cumulative stress and lack of resources, highlighting the need for

targeted interventions.

Lastly, is the Intervening Variable which is the Sociodemographic Profile.

Sociodemographic factors mediate the relationship between socioeconomic

hardships and health outcomes. For instance, people with lower SEP are more

prone to having unhealthy lifestyles than people with higher SEP (Stringhini et

al.,2010). Specifically, they are less likely to meet existing guidelines of healthy

diet and physical activity and rates of smoking and binge drinking are higher

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among them (Probst et al., 2020). Recognizing the role of these variables is

essential to understand the disparities in health outcomes across different

population groups.

Understanding this framework highlights the need to address

socioeconomic hardships and their associated stressors to mitigate risky

behaviors and improve overall health outcomes. By focusing on the role of

sociodemographic characteristics, interventions can be tailored to meet the

specific needs of vulnerable populations, promoting healthier behaviors and

reducing health disparities

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 Research Flowchart

Respondents in Combado, Maasin City, Southern

Leyte INPUT

PROCESS

 Once the research study is approved then a transmittal letter is

OUTPUT
provided. It will be submitted to the dean, the school president,
and the Institutional Ethics Review Board of the College of Risky
Maasin. behaviors
 Bracketing the researcher’s possible biases towards and Health
phenomenon.
 Pilot testing to people that are qualified for the research
inclusion criteria.
 Courtesy call and a transmittal letter were provided to the
barangay captain.
 Selection and recruitment of respondents by following the
inclusion criteria. PLAN OF
 Explanation of the purpose and significance of the study as ACTION
well as ethical consideration shall follow and provide informed
consent to the respondents.
 Securing informed consent that was given to the respondents.
 Collecting the socio-demographic profile of the respondents
and proceeded to the semi-structured interview.
 Transcription of data gathered through interviews.
 Formulation of meanings of significant statements.
 Construction of themes and descriptions of corresponding

Figure 4: Flow of the Study

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 Figure 4 shows the flow of the study that will be conducted in Combado,

Maasin City, Southern Leyte. The respondents for this are those who have

the characteristics included in the inclusion criteria.

The main point of this study is that the researchers wanted to seek

answers with “How do socio-economic hardships influence risky behaviors?”

and “What are the health outcomes associated with these behaviors?

This study will be presented and evaluated by the panelists.

Once the research study is approved then a transmittal letter is

provided. It will be submitted to the dean, the school president, and the

Institutional Ethics Review Board of the College of Maasin to request approval

for gathering the data through interviewing the respondents. After having the

approval, the researchers will begin to collect the data from the respondents.

To prevent bias in data gathering, the researchers will perform bracketing.

Following the approval of the research tool and bracketing, the researchers

will conduct a pilot testing to people that are qualified for the research

inclusion criteria.

A courtesy call and transmittal letter will be given to the barangay

captain to demonstrate respect for local governance. The selection and

recruitment of respondents for the actual gathering will purposive sampling

technique wherein the researchers will choose whom could correspond to the

objectives of the study. The researchers will provide informed consent forms

to the respondents, along with the necessary information the respondents

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 need to know. The researchers will explain the purpose of the study to the

respondents through a face-to-face interaction, emphasizing the objective

and relevance of the study as well as its ethical issues.

Then next, the researchers will collect the socio-demographic

profile of the respondents and will begin to conduct the semi- structured

interview. Transcription of data gathered through interviews, formulation of

meanings of significant statements, construction of themes and descriptions

of corresponding themes and formulation of conclusion and

recommendations shall follow.

Scope and Delimitation

The general intent of this study is to understand and explore how

socioeconomic hardships create conditions that influence individuals to adopt

risky behaviors in health. The researchers will conduct the study, particularly in

Combado, Maasin City, Southern Leyte. A total of 15 individuals who are ranked

as low socioeconomic class living in Combado, Maasin City, are the researchers

target respondents. This study will use qualitative research to collect and analyze

the data. Researchers will not include those who are in the middle and high

status of socioeconomic. The researchers will include solely individuals whose

risky behaviors are substance use, poor dietary choices and physical inactivity. In

addition, the main sources of data will be the results from the questionnaires

given.

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Significance of the Study

The researchers intend that the findings in this study will be beneficial to the

following:

Communities: The insights from this study can help communities better

understand the impact of socioeconomic challenges on risky behaviors that harm

health. By highlighting these links, the study emphasizes the importance of

community-driven efforts to reduce the effects of economic struggles. With these

findings, communities can push for more accessible resources, such as

educational programs, counseling, and health promotion initiatives, giving people

the tools they need to make healthier choices and improve their well-being.

Local Government Units (LGU): The study provides valuable insights

into how socioeconomic hardships directly influence health behaviors and

outcomes within their jurisdiction. LGUs can use the findings to develop targeted

programs and policies that address poverty, unemployment, and health

education, ensuring that resources are directed to vulnerable populations most at

risk. By understanding the root causes of risky behaviors, LGUs can create

sustainable initiatives to promote preventive healthcare and improve the overall

well-being of their communities.:

Community Nurses: The study can enhance community nurses'

understanding of the challenges faced by individuals experiencing

socioeconomic hardships, enabling them to provide more empathetic and

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culturally sensitive care. It equips them with evidence-based insights to design

health education programs, encourage healthy behaviors, and advocate for

resources and support systems for their patients. Community nurses can use the

findings to strengthen their role as frontline healthcare providers, bridging gaps

between vulnerable populations and healthcare services.

Future Researchers: The findings of this study will inspire future

researchers to identify new areas for investigation. The data provided can serve

as a foundation for continued academic exploration into the relationships

between socioeconomic factors, risky behaviors, and health outcomes.

Definition of Terms

To clarify some technical words, ideas and concepts used in this study, the

researchers defined the following terms:

Access to healthcare- refers to the respondent’s access to healthcare

facilities, health screenings and vaccinations adherence.

Coping Skills- refers to the respondent’s strategies on how to manage their

stress.

Education Access- refers to the ability of the respondent to obtain quality

education regardless of their socioeconomic status.

Educational barriers- refers to the lack of motivation, lack of resources and

financial problem that causes the respondent not to obtain education.

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Education -this refers to the ability of the respondent to understand health

information and make an informed decision.

Economic Stability -refers to the respondent’s household income and

employment status.

Emotional heath- refers to how respondent’s emotional well-being can

influence risky behaviors and health outcomes.

Family Relationships- refers to the emotional connection between the

respondent and the family that will influence psychological well-being.

Family Circumstances- it speaks about the family situation of the

respondent and how will it affect their well-being.

Financial strains- refers to experiencing distress financially that results in not

meeting the basic needs of the respondent.

Genetic Vulnerabilities- refers to a family history diseases of the

respondents that may affect their health.

Health- it refers to a person's physical, mental, and social well-being, which

can be negatively impacted by limited access to resources, increased stress,

and poorer living conditions associated with low socio-economic status.

Mental Health Status-this refers to how the respondent feels emotionally and

psychologically.

Poverty- this refers to having a financial problem of a person which results in

not meeting the basic necessities.

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Poor Housing- this refers to the house quality of the respondent which it

might be overcrowding or has a lack of basic utilities.

Peers- refers to people close to the respondent that may influence them on

good or risky behavior.

Physical Health- refers on health status, presence of chronic conditions and

physical fitness of the respondent that may affect mental health.

Risky behaviors- it refers to the behaviors that are molded in relation to

socio-economic hardships that influences individuals to engage such as

alcoholism, smoking, substance abuse, and gambling.

Socio-economic status- measure of a person or group's economic and

social position in society, typically based on factors such as income,

education, and occupation.

Socio-economic hardships- refer to the challenges of the respondent face

due to poverty, unemployment, poor housing and lack of education.

Social Skills- refers to the ability of the respondent to express feelings and

interact with other people.

Stress and Coping Mechanism- this refers to how the respondent manages

his/her stress.

Social Support Network- this refers to a relationship between the

respondent and the significant others that will support in challenging times.

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Substance Abuse- in this study, this can be measured through alcohol and

tobacco consumption of the respondent.

Social & Community Context- refers to the community engagement and

social relationship of the respondent.

Social Health- refers to how social support from important people in the life

of the respondent can help in difficult times.

Socio-demographic profile- contains the age, sex, marital status,

educational attainment, monthly income, and occupation of the respondent

that will be used in the study.

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 Chapter 2

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter presents a comprehensive overview of the conceptual

literature and empirical research that explains the intricate relationship between

socioeconomic hardships and their influence on risky behaviors and health

outcomes. As socioeconomic status (SES) serves as a critical determinant of

health, understanding how economic challenges shape individual choices and

behaviors is essential for addressing public health disparities.

Conceptual Literature

The interplay between socioeconomic hardships and health behaviors is a

critical area of public research. Understanding how socioeconomic status (SES)

influences individual choices and behaviors is essential for addressing health

disparities. According to Gutman, N., et. al. (2023), those low socioeconomic

individuals, especially the children and adolescents have higher risk of indulging

into unhealthy behaviors (e.g. smoking, unhealthy diet, sedentary lifestyle, drug

abuse). Conversely, those from higher socioeconomic statuses have the

prevalence of healthy- promoting behaviors (e.g. healthy diet, engagement in

active lifestyle).

Chronic stressors associated with low SES play a significant role in

shaping health behaviors. Individuals who are facing financial problems are more

prone to stress due to problems like financial insecurity, job instability, and social

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isolation. Chronic stress can lead to unhealthy coping strategies such as

substance abuse, as those individuals seek relief through their psychological

stress. A research article by Park, S. (2024) examined the impact of

socioeconomic factors on students’ health behaviors during the COVID-19

pandemic found that those from lower economic status shows an increased

sedentary lifestyle and decreased physical activity indicating that economic

instability worsen and may lead to unhealthy lifestyle choices. The cumulative

impact of these stressors can further hinder efforts to adopt healthier lifestyles.

Access to healthcare services in underserved communities is significantly

impacted by socioeconomic status, with profound implications for health

outcomes. Article by Nfah-Abbenyi, (2024) indicates that individuals from lower

socioeconomic backgrounds face barriers such as financial constraints, limited

education, and inadequate health insurance coverage, which restrict their ability

to seek and afford necessary medical care. Consequently, these populations

often experience disparities in healthcare access, leading to delayed diagnosis,

untreated chronic conditions, and higher rates of preventable diseases. In

addition, Arpey NC, et. Al. (2017), states that socioeconomic status (SES) affects

an individual’s health outcomes and the health care they receive. People of lower

SES are more likely to have worse self-reported health, lower life expectancy,

and suffer from more chronic conditions when compared with those of higher

SES. They also receive fewer diagnostic tests and medications for many chronic

diseases and have limited access to health care due to cost and coverage.

Psychosocial factors, such as occupational stress, social support or

isolation, sleep quality, and mental health, are shaped by racial, economic, and

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other societal structures. For example, unemployment and loss of income may

lead to increased stress and feelings of worthlessness, which then affect health

through lifestyle or behavioral changes (e.g., less healthy eating, increased

drinking or smoking) (Matthews, K. A., & Gallo, L. C., 2011). Being healthy is

crucial to function optimally, since it is important for long-term well-being and

prevention of disease burden and mortality. This, however, is not a given for

everyone. Individuals from low SES backgrounds may develop feelings of

hopelessness or fatalism regarding their health outcomes, believing that healthy

behaviors will have little impact on their longevity. This mindset diminishes

motivation to engage in positive health behaviors, leading to a higher prevalence

of risky practices. Review article from Van den Bekerom, L., et. al. (2024)

indicates that individuals with lower SES are more likely to engage in unhealthy

lifestyle choices due to limited access to information about health-promoting

behaviors and resources. This lack of awareness can perpetuate cycles of poor

health and risky behaviors.

Educational attainment significantly influences health literacy, which in

turn affects health behaviors. Individuals with a lower education level frequently

have unhealthier behaviors than individuals with a higher education level (Friis,

K., 2016). Individuals with lower eduactional attainment may have limited

knowledge about healthy practices or the long-term consequences of risky/

unhealthy behaviors. Low levels of health literacy may lead to a delay in timely

diagnosis of diseases and might increase the incidence of various diseases, and

ultimately an increase in the rate of mortality in people (Bayati, 2018). Enhancing

educational opportunities and implementing effective health literacy programs

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can empower individuals to make informed decisions regarding their health,

ultimately reducing disease incidence and improving overall community well-

being.

Individuals who have access to social support and community resources

lessens some negative effects of socioeconomic hardships on health behaviors.

Communities with strong social network often provide individuals with emotional

support that they need and the practical resources that encourage healthier

choices. However, those isolated or disadvantaged individuals may lack in

access to such supports and resources leading to increased vulnerability to

indulge in risky/ unhealthy behaviors. Thus, fostering social connections plays a

pivotal role in enhancing a healthier lifestyle.

Understanding the interplay between socioeconomic hardships and health

behaviors has important policy implications. Public health initiatives aimed at

reducing health disparities must consider the broader social determinants

affecting individual choices. Interventions should focus not only on promoting

healthy behaviors but also on addressing the underlying socioeconomic factors

that contribute to risk-taking behavior. Policies that enhance access to education,

healthcare, and economic opportunities are essential for fostering healthier

communities.

The relationship between socioeconomic hardships and risky behaviors is

complex and multifaceted. Theoretical framework like social determinants of

health help explain these dynamics by illustrating how economic challenges

influence individual choices. These frameworks emphasize that health behaviors

are not just personal choices but are deeply rooted in the broader social context.

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Therefore, public health initiatives must address these underlying socioeconomic

factors rather than solely focusing on promoting healthy behaviors.

In conclusion, addressing the interplay between socioeconomic hardships

and health behaviors requires a comprehensive approach that considers the

broader social determinants affecting individual choices. By implementing

targeted interventions and policies that tackle these interconnected factors,

public health efforts can promote healthier lifestyles among vulnerable

populations and ultimately improve public health outcomes.

Research Literature

Socioeconomic status (SES) is a critical determinant of health and

behaviors. Individuals experiencing economic hardship often face challenges that

profoundly influence their physical, mental, and social well-being. This literature

review explores the impact of socioeconomic struggles on health outcomes and

risky behaviors, drawing insights from various studies to highlight the connection

of financial stress, behavioral adaptations, and overall health.

The study "Socioeconomic Status and Health Behavior In Children and

Adolescents” by Dessie et al. (2023) examined the impact of socioeconomic

status (SES) on health behavior among youth. The researchers highlighted that

individuals from lower SES backgrounds are more likely to engage in unhealthy

behaviors. These behaviors include early smoking initiation, poor dietary habits

(e.g., consumption of high-energy-dense foods), limited physical activity, and

substance abuse. The study pointed out that these behaviors are often seen as

coping mechanisms to deal with the psychological and social stressors

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associated with economic disadvantage. Adolescents facing poverty and low

social standing may turn to substances or unhealthy diets as a form of escape,

contributing to long-term health disparities. The authors emphasized the need for

public health interventions aimed at addressing the root causes of such

behaviors in youth from disadvantaged communities to reduce the risk of chronic

diseases in adulthood.

A research study entitled "Socioeconomic Status, Diet, and Behavioral

Factors and Cardiovascular Disease,” by Androulakis et al. (2017) explored how

socioeconomic status impacts dietary patterns, health behaviors, and their

subsequent effects on cardiovascular health. This cohort study demonstrated

that low-SES groups tend to have poorer dietary habits, including higher intake of

processed foods, lower fruit and vegetable consumption, and higher

consumption of unhealthy fats and sugars. These dietary patterns are linked to

an increased risk of cardiovascular diseases (CVD). The study also highlighted

that SES influences other health behaviors such as physical activity levels,

smoking, and alcohol consumption. Importantly, the study underlined that

improving diet quality and promoting healthier lifestyle choices could significantly

reduce cardiovascular risk, especially in economically disadvantaged

populations. Therefore, addressing diet and behavior in these groups is crucial

for preventing health disparities and improving overall public health.

A study with the title, "Risky Health Behaviors and Chronic Conditions

Among Aged Persons,”by Navaneetham et al. (2023) explored the relationship

between risky health behaviors and chronic health problems among the aging

population. The study revealed that an increasing trend of risky behaviors—such

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as smoking, excessive alcohol consumption, poor diet, and lack of exercise—

was contributing to the rise in chronic health conditions like hypertension,

diabetes, and cardiovascular diseases among the aging population. Moreover,

the research highlighted that individuals from lower socioeconomic backgrounds

are particularly vulnerable to these risky behaviors. This cohort study suggests

that socioeconomic disadvantages in older age are increased by poor health

behaviors in youth and middle age, leading to earlier onset and more severe

forms of chronic disease. The authors recommended implementing targeted

public health interventions aimed at reducing risky health behaviors and

improving access to healthcare for the elderly in low-SES communities to reduce

the burden of chronic conditions.

A research paper entitled “Health and Health Behaviors in Adolescence as

Predictors of Educational Level and Socioeconomic Status in Adulthood,”

conducted by Braaten et al. (2024), explored how health behaviors during

adolescence influence educational attainment and future socioeconomic status in

adulthood. The study found that adolescents who engage in risky health

behaviors such as poor nutrition, lack of physical activity, and substance abuse

are more likely to have lower educational achievement, which often leads to

lower SES in adulthood. This is partly because poor health in adolescence can

lead to absenteeism from school, decreased cognitive development, and long-

term health problems that can limit opportunities for employment and economic

mobility. The study shows that encouraging healthy behaviors in young people

can improve their education and future income, helping to reduce the cycle of

poverty that affects families over time.

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 Another research study entitled “The Influence of Socioeconomic Status

on the Association Between Lifestyle Factors and Adverse Health Outcomes,” by

Foster et al. (2023) conducted a comprehensive review examining how

socioeconomic status modifies the relationship between lifestyle factors (such as

diet, physical activity, smoking, and alcohol use) and adverse health outcomes.

The study concluded that SES plays a significant role in shaping the impact of

lifestyle behaviors on health. Specifically, people with lower socioeconomic

status are more likely to experience the harmful effects of unhealthy habits,

which makes them more vulnerable to conditions like heart disease, diabetes,

and mental health issues. The review found that individuals with lower SES often

face barriers such as limited access to healthy food, safe spaces for physical

activity, and healthcare resources, which heighten the impact of unhealthy

behaviors. The authors argued for the importance of social policies and public

health strategies aimed at addressing these disparities, such as improving

access to healthy food options and healthcare services for low-SES populations,

to reduce the health burden associated with poor lifestyle choices.

Synthesis

This chapter examines the relationship between socioeconomic

challenges and health by reviewing a variety of sources, such as books, articles,

and online references. Financial difficulties frequently result in stress, scarce

finances, and limited access to medical treatment, all of which can contribute to

unhealthy habits. In addition to having an impact on the person, these behaviors

have the potential to start generations-long cycles of health problems. It is

29
essential to comprehend these connections in order to create solutions that

improve health and wellbeing.

Health outcomes have significant effects by socioeconomic status (SES).

Low SES individuals frequently experience stress from unstable jobs, money

troubles, and loneliness, which can result in unhealthy coping strategies like drug

abuse, smoking, or overeating. Children from low-income households became

less active during the COVID-19 pandemic, demonstrating how behavioral issues

may be influenced by socioeconomic difficulties. In addition, untreated illnesses

and chronic diseases are exacerbated by restricted access to treatment because

of financial limitations and ignorance, which deters people from adopting healthy

habits.

In low-income households, children, teenagers, and elderly people are

especially susceptible to poor health. Young people are more likely to develop

harmful behaviors as adults due to stress and a lack of alternatives, which raises

their chance of developing chronic diseases. Conditions like diabetes and heart

disease are frequently brought on by financial hardships for older folks. Despite

these obstacles, healthy choices may be promoted via supportive social

networks and educational initiatives. Breaking the cycle of poverty and poor

health and eventually building healthier and more equal communities requires

addressing financial problems, expanding access to healthcare, and empowering

community support.

30
 Chapter 3

RESEARCH METHODOLOGY

The methods on how the research study was conducted are presented in

this chapter. It presents the description of the research design, subjects of the

study, the instrumentation, data gathering procedure that was applied to the

analysis of the data.

Research Design

The researchers will employ a qualitative research design utilizing the

phenomenological analysis method. Phenomenological research will examine

lived experiences through the detailed descriptions provided by respondents.

The objective will be to elucidate the significance of each experience for the

individuals involved. The research phenomenological method stresses how the

researchers will acquire insights from participants and will attribute these

experiences, making it valuable data for qualitative research (Smith, J. A., et al.,

2009).

A key characteristic of the phenomenological method is its distinction from

purely interpretive approaches. Providing in-depth information that will account

for participants' experiences enables researchers to gain a deeper understanding

of how these experiences are lived. Given the research study focuses on how

socioeconomic challenges in Barangay Combado, Maasin City, influence

residents' risky behaviors and their effects on health, this research method is

appropriate for obtaining the necessary information.

31
Research Environment

Maasin City, the provincial capital of Southern Leyte in the Philippines, is

classified as a fourth-class city, with a population of 87,446 based on the 2020

census. It functions as both the commercial and spiritual hub of the province and

is recognized as a key pilgrimage site in the region. Spanning 21,171 hectares,

Maasin City consists of 70 barangays and is located in the western part of

Southern Leyte, an area celebrated for its cultural richness and beautiful coastal

landscapes.

This study will be conducted in Barangay Combado, Maasin City, Southern

Leyte. According to the latest census from the Philippine Statistics Authority

(2020), the barangay has a population of 5,874 residents. Barangay Combado is

an urban area in Maasin City and it has the highest population in the city,

accounting for 6.69% of the total population percentage (PhilAtlas, 2020). High

population has the potential to lead to significant social challenges in the

community. These challenges often emerge in different aspects of societal life,

affecting multiple social domains (Sadigov, R., 2022). Overpopulation adversely

impacts the economy. Rising prices cause less savings and make the people

more vulnerable to economic distress. The researcher selects Barangay

Combado as the research environment because it aligns with the purpose and

objectives of the study, ensuring a suitable setting for data-gathering procedures.

Overpopulation adversely impacts the economy. Rising prices cause less

savings and make the people more vulnerable to economic distress.

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Research Sampling

In this study, the researchers will utilize non-probability sampling. In which

non-probability sampling disregards random selection of subjects. A selection of

the respondents will be done through purposive sampling, also called as

judgmental sampling, it is the one whose characteristics are defined for a

purpose that is relevant to the study (Andrade,C,2020). This means that

researchers intentionally select participants who possess specific traits pertinent

to the research. The respondents that were chosen through judgmental sampling,

they will be the one who has a possession of qualification or background that

needs to be seek for the study. First, the researchers will ask the barangay who

were the individuals that has a ranked of as low socio-economic status. In doing

so, the researchers will be able to collect information and data that will be utilized

to identify the qualified respondents for the study.

Research Respondents

The respondents of the study will be the indiviuals who ranked in socio-economic

status as low, specifically in Combado, Maasin City. The researchers will choose

and select a total of 15 respondents, and pose questions through prepared

interview guide.

The chosen respondents should have the criteria of:

1. Living in Combado, Maasin City for at least 5 years

2. 15-24 yrs. old

33
 3. An income of lower than 12,000 per month

Research Instrument

The research instrument is composed of two parts. The first part is the

socio-demographic profile of the respondents. The second part is a semi-

structured interview, the respondents can choose from choices and they have to

explain the reasons behind their choice. The approach that the researchers

utilize is the individual interview. In an Individual Interview, participants can freely

answer and may feel more comfortable discussing sensitive topics, such as risky

behaviors and health issues in a private setting and this can also allow

participant to share their personal experience that will lead to a deeper

understanding of their experience and how it will influence their behaviors and

health.

Data Gathering Procedure

The conduction of the preliminary survey included gathering the number of

household and population in the said barangay. Upon the approval to conduct the

study, a transmittal letter will be sent to the dean of the College of Nursing,

president of the College of Maasin, and the research ethics review board of the

College of Maasin requesting an approval to proceed with the data collection

through a face-to-face interview. The researchers will have a proper discussion

on how to conduct the interview and practice how to ask the respondents with the

34
use of the guide questions prepared to maintain the uniformity of questions to be

asked. The researchers will conduct a pilot testing to determine whether the

research tool was effective in obtaining meaningful and useful data.

A courtesy call will be conducted, following by the sending of another transmittal

letter to the Barangay Captain of Combado requesting permission to conduct the

study. The schedule for the research activity will be created, and the interview will

take place immediately. Informed consent will be presented to the respondents,

and the researchers will explain the study's purpose and objectives, ethical

considerations, and instructions on completing the survey tool. Researchers will

also emphasize the importance of maintaining confidentiality, anonymity, and the

uniformity of questions. The respondents will be informed that the interview

process will be audio-recorded using the researchers’ phone for documentation

and analysis purposes. The written data that will be gathered from the interviews

and informed consent will be stored in a plastic folder. After all interviews,

transcription and encoding of the recordings will be carried out, along with the

extraction of significant statements. The researchers will analyze the data to

identify emerging themes. Finally, conclusions and recommendations will be

formulated based on the findings.

Method of Interpretation

To gather and evaluate the data for this study, the procedures from

Heidegger’s Hermeneutic Phenomenology will be used. Hermeneutics is about

interpretation and focuses on the historical and social contexts that surround text

35
interpretation (Gadamer, 2008). This interpretation is molded by a hermeneutic

circle that oscillates between an individual's experience and the totality of

experience in all living occurrences (Laverty, 2003).

Hermeneutic phenomenology is a branch of science that studies people.

Part and whole, contingent and essential, value and desire are all reintegrated. It

fosters a keen awareness of the nuances and seemingly insignificant features of

our daily educational lives. Hermeneutic phenomenology tries to pay attention to

both terms of its methodology: it is a descriptive methodology because it wants to

pay attention to how things appear and let things speak for themselves; it is an

interpretive methodology because it claims that there are no uninterpreted

phenomena. The implied conflict can be reconciled by accepting that "facts" of

lived experience are always meaningfully experienced. Furthermore, the "facts"

of lived experience must be documented in language and this is necessarily an

interpretive process (van Manen, 1990).

Max van Manen (1990) names the methodological structure which

includes six research activities:

1.Turning to the nature of lived experience – Every attempt at

phenomenological inquiry stems from a deep desire to understand and

address a pressing issue. It’s about cultivating thoughtful reflection and

staying fully engaged with a single idea, exploring it deeply and meaningfully.

At its heart, this work is always carried out by a real person, someone striving

to make sense of a specific aspect of human life within the unique context of

36
their individual, social, and historical experiences. It sheds light on the true

purpose and essence of the phenomenological journey.

2. Investigating experience as we live it – Phenomenological research seeks

to reestablish contact with original experience. On the one hand, it implies

that phenomenological inquiry needs the researcher to be present in the

whole of life, in the midst of the world of live relations and shared situations.

On the other hand, it indicates that the researcher actively investigates the

category of lived experience in all of its modalities and features;

3. Reflecting on essential themes – A true reflection on lived experience is a

conscious, reflective awareness of what it is that gives this or that unique

event its special value. As a result, phenomenological inquiry distinguishes

between appearance and essence, between the things we experience and

that which bases our experiences;

4.The art of writing and re-writing – Doing phenomenological research is

already, immediately, and constantly a coming to speech of something.

Phenomenology is the application of logos (language and thoughtfulness) to a

phenomenon (a facet of daily experience), to what appears exactly as it

seems;

5. Maintaining a strong and oriented relation – A strong researcher's

orientation towards a fundamental question or notion prevents side-tracking

and aimlessness. This requires a human-centered approach, avoiding

superficialities and falsities, and avoids adopting a scientific disinterestedness

attitude; a

37
 6. Balancing the research context by considering parts and whole – One must

continually weigh the overall design of the study/text against the importance

that the components must play in the overall textual structure. At numerous

moments, it is vital to take a step back and examine the whole, the contextual

givens, and how each of the components must contribute to the total.

Role of the Researchers

The primary role of the researchers in this study is to identify how

socioeconomic hardships shape risky behaviors and health of the residents of

Barangay Combado, Maasin City, Southern Leyte.

In addition, the researchers took part in all procedures to determine what

factors in the respondents' lives influenced health in relation to socio-economic

hardships that resulted in the development or engagement to risky behaviors.

The researchers will be involving in all phases of the study, from obtaining

informed consent from respondents after providing full disclosure of the study to

handling the prepared survey tool to be answered via face-to-face approach. The

researchers will provide proper discussion on how to conduct the interview and

practiced how to interview the respondents with the use of the guide questions

prepared to maintain the uniformity of questions to be asked.

The responses of the participants in the study will be keep confidential by

the researchers. The identities of the respondents will be keep private by the

researchers. Furthermore, the researchers will maintain a trustworthy relationship

38
with the respondents and assure the respondents that the responses will not be

disclosed to anyone else.

Mode of Verification

Examining, confirming, assuring, and being certain are all part of the

verification process. In qualitative research, verification refers to the techniques

used throughout the research process to gradually increase the formality of the

study by ensuring its authenticity and reliability. The researchers created a data

collection tool to aid in the implementation and operation of the research study. A

research tool is an instrument used to collect, measure, and analyze correct

insights for research purposes using standard approved methodologies.

Before pilot testing, the research tool was checked by the research adviser

to ensure that it is capable of gathering enough data for the study. A pilot test

was conducted to assess the research tool's validity and credibility. The data

collected during pilot testing was analyzed and verified through van Manen’s

method of analysis.

Ethical Consideration

The study's ethical consideration is one of its most important aspects. With

that in mind, the researchers made sure that it is properly observed. To ensure

39
these were upheld, the researchers prioritized voluntary participation, allowing

respondents the freedom to withdraw at any point. Before participation,

respondents were fully informed about the study's purpose, background, data

collection process, and assurances regarding their involvement. Consent was

given freely, without any coercion. The researchers also prioritized the privacy

and anonymity of respondents. After completing the data collection and analysis,

all survey materials will be securely handled such as paper documents which will

be burned, and audio recordings which will be deleted from the researchers'

devices.

40
SOURCES:

Adler, N. E., & Stewart, J. (2010). Preface to The Biology of Disadvantage:

Socioeconomic Status and Health. Annals of the New York Academy of

Sciences, 1186(1), 1-4.

Arpey NC, Gaglioti AH, Rosenbaum ME. How Socioeconomic Status Affects

Patient Perceptions of Health Care: A Qualitative Study. Journal of Primary Care

& Community Health. 2017;8(3):169-175. Doi:10.1177/2150131917697439

Bayati, T., Dehghan, A., Bonyadi, F., & Bazrafkan, L. (2018). Investigating the

effect of education on health literacy and its relation to health-promoting

behaviors in health center. Journal of education and health promotion, 7, 127.

https://doi.org/10.4103/jehp.jehp_65_18

Beenackers, M. A., Kamphuis, C. B. M., Giskes, K., et al. (2012). Socioeconomic

inequalities in physical activity: The role of social-psychological and

environmental factors. American Journal of Preventive Medicine,

43(6), 616-626. Retrieved from:

https://link.springer.com/article/10.1186/1479-5868-9-116#Sec21

41
Baptiste-Roberts K, Hossain M. Socioeconomic Disparities and Self-reported

Substance Abuse-related Problems. Addict Health. 2018

Apr;10(2):112-122. doi: 10.22122/ahj.v10i2.561. PMID: 31069035;

PMCID: PMC6494986. Retrieved from:

https://pmc.ncbi.nlm.nih.gov/articles/PMC6494986/#abstract1

Barakat, C., & Konstantinidis, T. (2023). A Review of the Relationship between

Socioeconomic Status Change and Health. International Journal of

Environmental Research and Public Health, 20(13), 6249.

https://doi.org/10.3390/ijerph20136249

Braveman, P., & Gottlieb, L. (2014). The Social Determinants of Health: It's Time

to Consider the Causes of the Causes. Public Health Reports, 129(Suppl 2), 19–

31.

Centers for Disease Control and Prevention. (n.d.). Socioeconomic factors. In

Division for Heart Disease and Stroke Prevention. Retrieved January 7, 2025,

from https://www.cdc.gov/dhdsp/health_equity/socioeconomic.htm

Centers for Disease Control and Prevention. (2023). Psychosocial pathways.

https://www.cdc.gov/dhdsp/health_equity/psychosocial.htm

42
Charitonidi, E., Studer, J., Gaume, J. et al. Socioeconomic status and substance

use among Swiss young men: a population-based cross-sectional

study. BMC Public Health 16, 333 (2016). Retrieved from:

https://doi.org/10.1186/s12889-016-2949-5

Darmon, N., & Drewnowski, A. (2008). Socioeconomic status and diet quality: the

challenge of dietary inequity. American Journal of Clinical Nutrition,

87(5), 1107-1117. Retrieved from:

https://doi.org/10.1093/ajcn/87.5.1107

Drewnowski, A., & Specter, S. E. (2004). Poverty and obesity: the role of energy

density and energy costs. American Journal of Clinical Nutrition, 79(1), 6–16.

Engel, G. L. (1977). The need for a new medical model: A challenge for

biomedicine. Science, 196(4286), 129–136.

https://doi.org/10.1126/science.847460

Evans, G. W., & Kim, P. (2013). Childhood Poverty, Chronic Stress, Self-

Regulation, and Coping. Child Development Perspectives, 7(1), 43-48.

Friis, K., Lasgaard, M., Rowlands, G., Osborne, R. H., & Maindal, H. T. (2016).

Health Literacy Mediates the Relationship Between Educational Attainment and

Health Behavior: A Danish Population-Based Study. Journal of health

communication, 21(sup2), 54–60.

https://doi.org/10.1080/10810730.2016.1201175

43
Gautam, N., Dessie, G., Rahman, M. M., & Khanam, R. (2023). Socioeconomic

status and health behavior in children and adolescents: a systematic literature

review. Frontiers in public health, 11, 1228632.

https://doi.org/10.3389/fpubh.2023.1228632

Guthold, R., Stevens, G. A., Riley, L. M., & Bull, F. C. (2018). Worldwide trends

in insufficient physical activity from 2001 to 2016: A pooled analysis of 358

population-based surveys with 1.9 million participants. The Lancet Global Health,

6(e1077–e1086). https://doi.org/10.1016/S2214-109X(18)30357-7

Krieger, N. (2001). Epidemiology and the People's Health: Theory and Context.

Oxford University Press.

Matthews, K. A., & Gallo, L. C. (2011). Psychological perspectives on pathways

linking socioeconomic status and physical health. Annual review of psychology,

62, 501–530. https://doi.org/10.1146/annurev.psych.031809.130711

Nfah-Abbenyi. (2024). Impact of Socioeconomic Status on Access to Healthcare

Services in Underserved Communities in Cameroon. American Journal of Public

Policy and Administration, 9(2), 25–36. https://doi.org/10.47672/ajppa.1852

Park S (2024) Exploring the mechanisms between socio-economic status and

health: Mediating roles of health-related behaviors before and during COVID-19.

PLoS ONE 19(1): e0288297. https://doi.org/10.1371/journal.pone.0288297

44
Philippines Statistics Authority (2020.) Province of Southern Leyte. Retrieved

from: https://psa.gov.ph/classification/psgc/citimuni/0806400000.

PhilAtlas (2020). Maasin, Province of Southern Leyte. Retrieved from:

https://www.philatlas.com/visayas/r08/southern-leyte/maasin.html

Probst, C., Kilian, C., Sanchez, S., Lange, S., & Rehm, J. (2020). The role of

alcohol use and drinking patterns in socioeconomic inequalities in mortality: A

systematic review. The Lancet Public Health, 5(6), e324-e332.

https://doi.org/10.1016/S2468-2667(20)30052-9

Sallis, J. F., Prochaska, J. J., & Taylor, W. C. (2000). A review of correlates of

physical activity of children and adolescents. Medicine & Science in Sports &

Exercise, 32(5), 963–975.

Smith, J. A., Flowers, P., & Larkin, M. (2021). Interpretative Phenomenological

Analysis: Theory, Method and Research. SAGE Publications. Retrieved

from: https://www.torrossa.com/it/resources/an/5282221

Stringhini S, Sabia S, Shipley M, et al. Association of Socioeconomic Position

With Health Behaviors and Mortality. JAMA. 2010;303(12):1159–1166.

doi:10.1001/jama.2010.297

45
Van den Bekerom, L., van Gestel, L. C., Schoones, J. W., Bussemaker, J., &

Adriaanse, M. A. (2024). Health behavior interventions among people with lower

socio-economic position: a scoping review of behavior change techniques and

effectiveness. Health psychology and behavioral medicine, 12(1), 2365931.

https://doi.org/10.1080/21642850.2024.2365931

Venice Family Clinic. (n.d.). *Social determinants of health*. Retrieved January 8,

2025, from https://venicefamilyclinic.org/street-medicine/taking-social-medicine-

to-the-unsheltered/venice-family-clinic-approach-to-street-medicine/social-

determinants-of-health/

Wilkinson, R. G., & Marmot, M. (Eds.). (2003). Social Determinants of Health:

The Solid Facts (2nd ed.). World Health Organization.

World Health Organization. (2008). World Health Statistics 2008. World Health

Organization.

46