Curt Johanson
Epidemiology 222
23 March 2019
HW 2 Makeup From 22JAN2019
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 health outcome of interest is PrEP access and to prevent HIV infection. The high risk group young men who have sex with men (yMSM) 16-25 years old have difficulty staying HIV negative and experience challenges with PrEP access and adherence. Please note that I am including all yMSM in this current discussion. Two of the key behaviors that can lead to less optimal outcomes are drug/alcohol use and heightened early promiscuity. Intervening early with safer sex education, harm reduction for substance use and early PrEP prescription with yMSM who are strongly predicted to exhibit these behaviors in their later teen years could be hugely beneficial to driving down infection rates in the overall population. Unfortunately, many experts and scholars would find this approach controversial as encouraging promiscuity and pill pushing. Even if better alternatives may be just around the corner, this is the best prevention tool we have currently and the downside of inaction would be another 10-20 year population bracket wracked with a preventable illness. Abstinence programs and “just say no” would be the social conservative alternative but most know that approach has the opposite effect.
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 know from the reading that young adults who have multiple adverse childhood experiences (ACES) are more likely to engage in early promiscuity and higher amounts of substance use. In order to test this and a subsequent intervention, we could propose that troubled teens going into counseling for family trauma and stress could be offered further education and an intervention since high risk behavior is predicted. That could also possibly lead to an advanced intervention being offered including PrEP and follow up care, testing and counseling. This could be as a study randomization in a trial but it should be carefully constructed and IRB reviewed carefully by ethics groups for the intersection of several sensitive population characteristics. ( juveniles, trauma victims, substance use) . Participation in a PrEP program should also be offered in a non-randomized cohort as well since it would be unethical to randomize a high risk candidate to no PrEP.
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?
We need to keep studying these behaviors so we know how to quantify the size of their effects across different populations and areas of the country. The effects of SES elements are constantly moving and any one predictor or outcome behavior cannot usually be generalized to other ethnicities, religions, or even different times in history. Perhaps the first health behavior mentioned “smoking” might eventually go away but humans will most likely always need exercise and nutrition. It is not something you solve once and you are finished with that area of study forever. All of the components of SES and linked behaviors are constantly shifting in each population, each subgroup and even on each individual. You can use similar advanced epidemiology methods that are rigorous and well tested to recalculate effect sizes, but even Epidemiology methods themselves must still be constantly tested and refined.