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 health outcome of interest is days to diagnostic follow-up after an abnormal mammogram, which was studied and published by Press et al. 2008. Two key behaviors that are important to this health outcome include: traveling to clinic for follow-up, and engaging in non-in-person follow-up communication with one's provider such as by phone. At the time that the study was published, there was no consensus yet on what constituted a reasonable follow-up time interval after abnormal mammogram. Some studies suggested that follow-up times of up to 3 months may not influence overall survival, whereas other studies showed that women who presented for follow-up more than 30 days after breast cancer detection were more likely to face breast cancer recurrence or death. In either case, it is known that breast cancer survival is lower for African American and Hispanic women, so it is important to examine the many different factors that may contribute to this, including behaviors pertaining to follow-up care and obtaining treatment.
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.
I would want to build on the study by Press et al. 2008 and study in further detail the different types of follow-up that patients engage in, not just days to in-person follow up. These other types of follow-up can include: telephone call, text messaging, mail, and secure email (e.g. MyChart)--both individually and different combinations of these. For example, sometimes providers' offices will send automatic appointment reminders to patients by both text message and email in case patients check one more frequently than the other. If possible, these communications should be in the patient's preferred language. Social factors that I would incorporate to see if they make a difference in terms of how patients engage in follow-up include: race/ethnicity, income, insurance status, location of care, location of residence, and number of dependents.
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?
Although health behaviors may be strongly influenced by social factors such as neighborhood, income, and/or education, I think that we still need to continue studying how these behaviors influence health outcomes. As the Freeman et al. reading showed, this type of research can give us much clearer and nuanced insight into how exactly social factors are related to health behaviors. We can then use that knowledge to develop interventions to that will hopefully effectively target the disparities in question. For example, as the Freeman reading showed, it is not enough to know that race affects patient's engagement with HIV care--the next questions are exactly why and how. The findings can be used to develop interventions that, for instance, incorporate "self-determination," a factor found through the study to be important for building trust among AABH-PLWH patients.
Reference:
Press, Rebecca, et al. "Racial/Ethnic Disparities in Time to Follow-Up after an Abnormal Mammogram." J Womens Health (Larchmt). 2008 Jul; 17(6): 923–930. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2942754/.