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 research focuses on payment models in kidney disease, and the health outcome of interest is the progression of chronic kidney disease (CKD) leading to incident end-stage kidney disease (ESKD). One behavior that may influence incident ESKD is diet, particularly potassium restriction. CKD frequently results in hyperkalemia, so we frequently counsel patients to restrict potassium in their diet. However, patients are often unable to effectively do so because of 1) difficulty with behavior change, 2) lack of dietary education/access to a dietician, 3) food in certain cultures being high in potassium, and other factors. Hyperkalemia may lead to an inability to take ACEi/ARB medications that slow the progression of kidney disease, and may result in dialysis needing to be started. Another behavior of interest is dietary salt restriction, as salt intake may increase hypertension and fluid overload, potentially contributing to dialysis initiation.
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 study the association of race/ethnicity with potassium and sodium intake (measured by food frequency questionnaires and 24h urine potassium and sodium excretion) and dialysis initiation, controlling for confounders including demographics and clinical characteristics.
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, studying key health behaviors continues to be important because intervening on health behaviors, which may be downstream from socioeconomic factors such as neighborhood and education, may result in an improvement in health outcomes. Secondly, health behaviors may be easier and less costly to intervene upon in the short-term than factors such as neighborhoods and education. Furthermore, understanding a behavioral mechanism by which socioeconomic factors ultimately influence health outcomes may provide insight into designing interventions.