Fundamental Cause Theory

Social Science Discipline Identification:
Sociology (Medical Sociology, Social Epidemiology) & Economics
Main Tenet Summaries:
Fundamental cause theory (FCT) seeks to answer why there is an association between
socioeconomic status and health disparities, even once diseases thought to disproportionately
affect low socioeconomic populations have been resolved. Polinijo and Carpiano’s study (2013)
looks at how the mechanisms of fundamental cause are created, specifically as they relate to the
Human Papilloma Virus (HPV) vaccination, and attempt to empirically test FCT. The HPV
vaccine is targeted at adolescent girls in the hopes that it will prevent cervical cancer. As noted
by Polinijo and Carpiano, there have been multiple studies that indicate

there is a socioeconomic
and racial disparity in cervical cancer incidence; their study “test[s] hypotheses regarding
socioeconomic status (SES) and racial/ethnic disparities in three distinct stages of the adoption of
this new [HPV] treatment: (1) parent/guardian knowledge about the HPV vaccine, (2) health
professional recommendation to receive the HPV vaccine, and (3) uptake of the HPV vaccine
(both initiation and completion of the three shot series) by adolescent girls” (Polinijo &
Carpiano, 2013, 116). Their study hypothesized that racial/ethnic minority status and low SES
will negatively impact parental knowledge of the vaccine, negatively impact the rate at which a
medical professional will recommend it, negatively impact the likelihood a girl will start the
series (at least one shot), and ultimately negatively affect whether she finishes the sequence (all
three shots).
Because the HPV vaccine is new (it originated in 2006), it presents a unique opportunity to
empirically test the fundamental cause theory.

Also, because the target population is
adolescents, usage is dependent on parental consent. This means parental knowledge and
approval are ultimately impacting the cervical cancer rates of future women.
Implications:
The implications of empirically studying fundamental cause theory are the ability to better
determine intervention points [such as the school-based, publicly-funded HPV vaccination
programs in place in Canada (Wilson et al., 2013)] and help account for differences in access to
information for racial/ethnic minorities and low SES populations.
Polinijo and Carpiano determined that lower socioeconomic status and race/ethnicity pose
barriers to all three tested adoption stages. However, once initial knowledge is obtained, medical
recommendation becomes more significant. In low SES populations with both knowledge and
recommendation, the disparities between race and ethnicity are almost eliminated (2013, p121).
As Polinijo and Carpiano noted, “it will be decades before the impact of the HPV vaccine on
cervical cancer morbidity and mortality can be directly tested (the median age of cervical

cancer
diagnosis is 47 [CDC, 2011]), [but] the disparities in vaccine uptake … that we observe in this
study indicate that this innovation may be creating a latent mechanism whereby health impacts
are not immediately evident, but rather revealed at a later stage of the life course when these
adolescents reach adulthood” (2013, p122).