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 the development of cognitive impairment in individuals with type 2 diabetes. This becomes quite complicated to model when one considers all of the social factors contributing to both the development and management of diabetes. In terms of the etiology of the primary metabolic disturbance, diet and exercise both contribute significantly to BMI and the development of insulin resistance. However, more subtle behaviors such as planning and disease management (through medication adherence, etc.) can greatly influence an individual's disease trajectory and his/her ultimate risk of developing cognitive impairment. For example, greater variability in fasting blood glucose attributed to medication adherence problems can increase the rate of serum protein glycation, contributing to vascular endothelial damage and the upregulation of inflammatory mediators, which are the likely mediators of accelerated cognitive decline in T2DM.
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.
Given the large number of social confounders and the relatively subtle contributions of individual health-related behaviors, large prospective cohort studies are the ideal research design for studying the impact of individual behaviors on cognitive impairment in diabetes. In such a study, one can measure and attempt to adjust for many important social factors such as race/ethnicity, neighborhood socioeconomic status, level of education, number of primary care doctors within a given radius, etc..
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, of course we should still continue to study how these behaviors influence health outcomes. For one, it is important in designing public health interventions and policy changes in order to target behaviors/products that are most likely to affect the health of the population at risk. Additionally, new understanding of disease processes and the impact of individual behaviors is a continuing valuable source of scientific/medical knowledge and can be translated to changes in medical interventions and clinical practice strategies.