Explorando as múltiplas trajetórias de causalidade: colaboração entre antropologia e epidemiologia na coorte de nascimentos de 1982, Pelotas, RS

Abstract

OBJECTIVE:Although the relationship between epidemiology and anthropology has a long history, it has generally been comprised of the integration of quantitative and qualitative methods. Only recently have the two fi elds begun to converge along theoretical lines, leading to a growing mutual interest in explaining rather than simply describing phenomena. This paper aimed to illustrate how ethnographic analyses can be used to assist with the in-depth and theoretically-imbued interpretation of epidemiological results. METHODS:The anthropological analysis presented in this paper used ethnographic data collected as part of the ongoing 1982 birth cohort study, between 1997 and 2007 in Pelotas, Southern Brazil. Analyses were framed according to the results presented in two of the epidemiological articles published in this series on the determinants of mental morbidity and age of sexual initiation. RESULTS AND CONCLUSIONS:The ethnographic results show that statistical associations consist of multiple pathways of infl uence and causality that generally correspond to the unique experiences of specifi c subgroups. In exploring these pathways, the paper highlights the importance of an additional set of mediating factors that account for epidemiological results; these include the awareness and experience of inequities, the role of violence in everyday life, traumatic life events, increasing social isolation and emotional introversion as a response to life's diffi culties, and differing approaches towards sociopsychological maturation. Theoretical and methodological collaboration between anthropology and epidemiology is important for public health, as it has positively modifi ed both fi elds.

Contraceptive medicalisation, fear of infertility and teenage pregnancy in Brazil

“…Mothers and their children were visited several times by the first and last authors of this paper and a team of seven research assistants. Intensive periods of fieldwork, conducted in 1997, 1999, 2000 and again in 2003–2004 and 2006–2007, have been interspersed with periods of analysis and reflection (Béhague and Gonçalves 2008). The sample was selected at random from the pool of participants interviewed in the 1997 epidemiological survey (for details, see Victora et al 2003), not because we intended to conduct probabilistic analyses, but because we sought to capture the full array of experiences represented by the cohort, including those of particularly introverted and socially isolated youth.…”

The use of mediation analysis in evaluation of complex health interventions

“…This aligns with our interpretation of the intervention and context as emergent and synergistic. Although there have been successful attempts at integrating different epistemological conceptualizations of phenomena to arrive at a more comprehensive understanding Béhague and Goncalves, 2008), we did not have this success. Instead, the epistemological incongruency between conceptualizations of complexity produced results about the intervention that we could not reconcile with our experience of how it functioned in the real world.…”