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.)
One health outcome of interest is early development of advanced knee osteoarthritis. A variety of factors contribute to development of this condition. In particular, as obesity contributes significantly to worsening of degenerative changes within the knee, any health behaviors which increase the likelihood of obesity may lead to this health outcome. Diet and exercise directly affect BMI and interventions focused on affecting these behaviors clearly will make a considerable impact. However, traumatic injuries to the knee are another well-established contributor to early development of advanced knee osteoarthritis. Therefore, patient behaviors following significant knee injury including adherence to recommended diagnostic imaging as well as treatment regimens (follow-up appointments with orthopedics/sports medicine/physical therapy) are underexplored dimensions which may contribute significantly to this health outcome.
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.
One approach to studying patient adherence to recommended diagnostic and treatment regimens, would be to perform a retrospective cohort study of patients who have had high grade ligamentous or osseous injuries of the knee (no significant degenerative changes of the knee at baseline). This group could be divided into one of two cohorts: those that progressed to advanced knee osteoarthritis (based on radiographic grading) within five years and those that did not. Adherence behaviors could then be studied in this context, exploring, for example, using the electronic health record or a survey of these persons regarding the frequency of missed care opportunities. A wide range of social factors could be directly compared between the two groups, including race/ethnicity and neighborhood socioeconomic status.
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, we should still continue to study how these behaviors influence health outcomes even if they are strongly influenced by neighborhood, income, and/or education. For any given health outcome, it will be difficult to know a priori the precise interaction of behavioral effects with social determinants. Specific behaviors may represent the best target for an ideal cost-effective approach to a health outcome intervention and without a more complete understanding of these interactions we will be unable to construct the best possible policy recommendations.