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.)
A health outcome I am interested in exploring is childhood obesity. I am from Modesto, CA, which is the largest city in the Central Valley, a primarily agricultural area. This area is also home to the highest rates of childhood obesity and diabetes, particularly in the Hispanic population in the lower income areas within the Central Valley. These poor health outcomes are contingent upon diet and exercise, two key behaviors which are important factors leading to childhood obesity.
The lower-income areas of the Central Valley are largely food deserts, with two or three convenience stores in the area. I find it exceptionally ironic that even though the Central Valley is the largest producer of fresh fruits and vegetables, its residents have some of the lowest rates of consumption of these products. Many of the residents of poorer neighborhoods are farm workers, who simply cannot afford to live in the areas which are spatially next to grocery stores and markets.
Additionally, the lower income areas, specifically in Modesto, also have high rates of street violence and gang-related criminal activity. Many children living in these areas have reported to teachers that they are not permitted to go outside and play after school because of the exposure to violence. Their neighborhood environment deters these individuals from receiving the daily exercise and physical activity they need. They are unable to walk to and from school, and when they are home they are advised to stay indoors.
Both diet and physical activity can be preventive measures or interventions. For example, seeing these rates of childhood obesity skyrocket, I organized a Let's Move campaign with the local Boys and Girls Club of America elementary and middle schools to encourage students from vulnerable populations to eat healthier on a budget and stay active despite the barriers they face on the daily. I rallied community organizations such as local farms, recreation centers, physicians, Yogurt Mill, and Home Depot to get involved and provide materials such as gift cards, packets of fruit and vegetable seeds, jump ropes, recipes, etc to demonstrate a community-driven effort to battle this significant issue impacting the children of our area. While these interventions are effective, the socioeconomic and geographical barriers that make it difficult for these families needs to be structured from a bottom-up approach in order to truly drive behavioral change for these communities.
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.
We can conduct a retrospective case-control study to determine whether diet quality is associated with the risk of developing obesity amongst the childhood population. This can be accomplished by obtaining a large diverse cohort of children from varying levels of SES. Then, we would work to recognize the obesity cases and randomly select the controls. Using this information, we can evaluate the diets through qualitative surveys, such as Qualtrics. We would then determine whether there is any association between diet quality and obesity amongst children. Additionally, we would compare the results by income and race or ethnicity to see if the relationship differs among the various SES groups. This data analysis will allow us to examine the existence of any confounding factors in our study.
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?
I believe it is still important to explore how these behaviors influence health outcomes. Engaging with the community directly will equip researchers with the local knowledge they need to better understand the needs of the target population. With extensive information regarding the culture, behaviors, and concerns of the community, researchers can effectively design pilot interventions and policies, whose impact can be further researched. The results of these projects can then be reported back to community leaders and policymakers, who can be well-informed about the health issues facing their communities and encouraged to take tangible steps to tackle the issue at hand.