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.)
I am interested in gender-based disparities that contribute to differential access to the waitlist for kidney transplantation among patients with end-stage renal disease. One possible health-related behavior that may influence transplantation candidacy includes physical inactivity (typically studied in its extreme as frailty). Time set aside for exercise and access to gym memberships may be different by gender. If this risk factor is differentially present, programs that target pre-transplantation “conditioning” may help to overcome this. Another factor that I’m interested in deals with a potential disparity by gender with respect to role as primary caregiver to young children in the household. In theory, inaccess to backup childcare may be a reason why some women who are often the primary caregiver are unable to successfully complete the rigorous transplantation evaluation. If this is a risk factor, then interventions designed to help provide backup childcare may be useful.
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.
If my outcome of interest is time between diagnosis of end-stage renal disease and time to activitation on the transplantation waitlist, I would assess measures of physical functioning and performance by survey. I would also ask questions about how many children under 18 are present in the household, whether participants consider themselves to be primary caregiver, and whether there is easy access to backup childcare. I would like to further assess the intersection of race with gender, to see if any differential effects vary across races.
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. Even if these behaviors are influenced by structural factors like income and neighborhood, interventions could be better designed, targeted, and followed with the knowledge of how these differ by population.