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 outcome of interest its oral squamous-cell carcinoma, the main type of oral cancer, is among the ten most common cancers in the world. Tobacco usage and alcohol intake are the two major risk factors and are synergetic. There is currently sufficient evidence on the relationship between smoking and cancer. In most cases, this relationship is also dose dependent. Epidemiological data demonstrates that almost one fourth of oral cancer cases are linked to tobacco smoking or chewing. Patients that have the habit of alcohol intake and tobacco smoking consistently are at a higher risk for oral cancer. It has been demonstrated that a large proportion of oral cancers could be preventable by the eradication of these modifiable risk behaviors. A possible intermediary factor for behaviors could be stress. The association between chronic stress and smoking/alcohol use can be explained mainly on two ways. First, individuals can self-medicate stress-induced physiological effects (such as elevated cortisol, suppressed serotonic, and catecholamine secretion) by smoking/drinking to achieve internal stability. Alcohol and tobacco could also be used as anti-anxiety or anti-depressant agents to relieve the impact of stress. Stress can reduce an individual's self-control, which makes it difficult for current smokers/drinkers to quit or reduce smoking/drinking intensity and may induce former smokers/drinkers to relapse and start to smoke/drink again. A future point to consider in this area is that cigarette consumption has decreased, but there have been no similar decreases in the use of electronic cigarettes. These new products include different types, brands, flavors and varying levels of bioavailable nicotine and nitrosamines that cause cancer. New evidence is needed on how these differentiating characteristics of electronic cigarettes and emerging tobacco products contribute to the carcinogenic process and the link with chronic stress.
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.
In this case, perhaps premalignant oral lesions (OLPs) offer an interesting model for the study of risk factors in these lesions that are associated with a well-defined risk for the subsequent development of oral cancer. Since not all lesions evolve towards cancer, it is likely that the presence of psychosocial factors (for example, stress) and behavior (for example, smoking in any form) are associated with immune alterations, which could have implications for the progression of oral disease. A cohort study could be designed to evaluate the possible interrelationships between behavioral risk factors, host immune factors and the progression of OPLs. The participants would be recruited to complete psychological, behavioral and immunological evaluations at the time of diagnosis and at 6, 12 and 24 months after diagnosis.
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, absolutely, I think it is key that we continue to study how these behaviors influence health outcomes because there is still a lot that we do not know about how much they influence health outcomes, especially when we have new actors to participate like the e-cigarettes. Furthermore, it is fundamental for implement new interventions. Over the last 20 years, we have witnessed significant advances in research and treatment for several relevant pathologies that affect human health. A notorious example is immunotherapy for the treatment of cancer. Indeed, many studies have demonstrated promising results using immunotherapy in cancer patients, however when translated into the clinical practice these effects are rather modest and usually associated to high costs for their implementation. This calls for a new, more personalized approach, based on patient characteristics (not only biologicals) in order to improve response to novel treatment strategies.