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.)
My health outcome of interest is the risk of sustaining pedestrian traffic-related injury, and how this risk is associated with socioecological factors. Alcohol use is an important behavioral factor to consider. Alcohol use is associated with increased risk of both intentional and unintentional injury, and the link between motor-vehicle collisions and alcohol use is well documented. Alcohol is a also risk factor in pedestrian traffic injuries (in which the victim is not driving a motor vehicle) because of the cognitive and perceptual deficits with alcohol use, the ways in which individuals under the influence of alcohol interact with their physical environments, and the impact of impaired decision-making. A second behavioral factor to consider is walking or using public to commute. People who walk or take public transit will spend more time exposed to traffic as pedestrians than those who use private transportation.
Despite the importance of these behavioral factors, it’s difficult to ignore the larger contextual framework. Lower income neighborhoods and those with largely minority populations often have less and inadequately maintained pedestrian infrastructure; these are also neighborhoods where people walk or take public transit. Furthermore, these neighborhoods disproportionately include high-speed, high-traffic roadways when compared to more affluent neighborhoods. Alcohol use is a similarly complex risk factor. It can’t be denied that alcohol use impairs judgment and motor control in ways that increase the risk of injury. However, in the larger socioecological context I think it’s important to examine alcohol use as a symptom of underlying stress and distress, and not just as a causative factor for injury.
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.
I would perform a comparative analysis of rates of pedestrian traffic injury (also, severity of injury and injury outcomes) by neighborhood. While neighborhood isn’t a perfect way to divide up groups (since we know there can be variability in many socioecological factors within a neighborhood), it does allow me to analyze built environment factors such as pedestrian infrastructure, speed limits, etc. I would overlay the means of commuting (private, public, or walking) on the analysis of traffic injury rates by neighborhood. I would also include the race/ethnicity breakdown (and SES measures such as wealth, income, education) of each neighborhood and of the patients themselves within the analysis.
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, it is still important to consider the influence of these risk factors despite their association with neighborhood, income, and education. Keeping these behavioral factors in the analysis provides a more nuanced picture of the risk profile for each patient than could be obtained from focusing just on neighborhood, income, and education. In addition, the physiologic/perceptual changes with alcohol are an important consideration outside of the larger socioecological factors.