1. State your health outcome of interest. (It could be the one you used for week #2 or another one.) Pick two key behaviors that are important factors leading to your health outcome. Explain the importance of these behaviors either for etiology, prevention, or intervention. (If none of the behaviors in the readings are important for your health outcome, suggest another behavior that is.)
Maternal health outcomes among vulnerable ethnic groups in Central America, such as indigenous women, is my health outcome of interest. Assigning health behaviors that lead to poor maternal health outcomes is a little tenuous if disregarding larger contextual and social determinants relevant to the population. We could consider diet as a behavior outcome related to malnutrition and high intake of sugar sweetened beverages/salty processed snacks perhaps leading to high blood pressure or poor fetal development. Another behavioral factor could be antenatal care attendance or utilization. Again, there are larger access issues involved, but participation in the health care systems during pregnancy can contribute to prevention or identification of high risk pregnancies.
2. Describe how you would study the role of one of the behaviors described for question #1 and your health outcome of interest. Incorporate a social factor (e.g. race/ethnicity, social exclusion, stress) in the study approach.
Perhaps conducting a cohort study of pregnant women in 2-4 varying communities in Guatemala such as rural/urban, self-identified indigenous vs non-indigenous and follow their diet during pregnancy with diet diaries or recall surveys. We could analyze the nutrition intake and evaluate the relationship between nutrition during pregnancy and maternal health outcomes such as PIH, low-birth weight and preterm birth. Stratifying the sample will also help understand the larger contextual factors that influence diet behaviors.
3. If key health behaviors (e.g. smoking, exercise, nutritious diet) are strongly influenced by neighborhood, income, and/or education, do we need to continue to study how these behaviors influence health outcomes? Why or why not?
Yes, they provide a necessary connection between social factors and health outcomes. Understanding the entire picture of not only environment but the patient experience is important to know where to target intervention and policy.