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 study the causes and consequences of kidney disease, which is markedly shaped by social determinants of health. Two major drivers of chronic kidney disease (CKD) include diabetes and obesity. Diabetic kidney disease (DKD) is one of the most common causes of chronic kidney disease end stage kidney disease (ESKD). Glucose control among people with diabetes is the foundation for preventing the development and progression of kidney disease. For those who have access to healthcare and can afford antihyperglycemic medications (e.g. insulin), health behaviors determine how well diabetes is controlled. Missing antihyperglycemic medication doses, sedentary lifestyle, and failure to monitor blood sugars result inadequate diabetes control and set the stage for progressive kidney disease. Another key driver of kidney disease is obesity, of which there is a large behavioral component. Obesity contributes to hypertension, another common cause of CKD, and can cause severe kidney disease on its own (through secondary focal segmental glomerulosclerosis). Exercise has been suggested as a behavioral intervention to prevent CKD because it helps to control blood pressure, prevents obesity, and improves glucose control in diabetic patients.
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.
To study the role of diabetes medication adherence and glucose management as well as obesity and exercise, I would focus on how these behaviors might be mediated by efficacy and agency as discussed in the Pampel et al. (2010) paper. Patients with an external locus of control and those with low levels of self-efficacy may be less inclined toward the behaviors necessary for optimal glucose control or weight control. Along these lines, education may be a key determinant of agency when it comes to health-oriented behaviors. In addition to those factors that bias long-term decision-making (e.g. neighborhood stress and safety concerns), I would want to specifically study the association of educational attainment on diabetes management and weight control.
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?
We certainly must continue to study these behaviors even if they influenced by environmental factors. First, it will always be important to understand the behavioral interventions that could improve health; to given up on this because of the difficulties in achieving behavioral change is fatalistic. But it is certainly true that for behavioral interventions to be effective, we need to understand the social factors that will stand in the way of these behaviors. Ultimately, a thorough understanding of behavioral factors and the social factors that influence them will be necessary to improve public health. For example, if we know that regular exercise reduces the rate of some cancers but exercise is inhibited by neighborhood factors, we can design public health interventions that seek to increase exercise by making neighborhoods more conducive to walking, jogging, and other activities.