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 kidney health, in which some significant outcomes of interest include incident end-stage kidney disease (ESKD), rates of transplantation, and chronic kidney disease progression (measured in various ways, e.g. doubling of creatinine, eGFR slope, etc). Key behaviors that importantly influence these outcomes from an etiologic perspective include control of chronic conditions, diabetes and hypertension, via adherence to medication therapy and dietary modification. Medications, such as antihypertensive/antihyperglycemic regimens, specifically with ACE/ARB or SGLT2i, slow CKD progression in many cases. Dietary modification is important for self-management of blood pressure and diabetes, but also for preventing metabolic abnormalities with progressive kidney dysfunction.
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.
The role of medication adherence for CKD treatment is potentially complicated by the overlap of medications with hypertension, heart failure, and diabetes treatment. In particular, these medications have multiple clinical effects, such as SGLT2i potentially affecting glycemic control, volume status, blood pressure, in addition to their side effect profile. Frequent medication adjustment, changes in dosing, having to split tabs or take multiple tabs, incorporation of special instruction such as 'sick day' rules or 'don't take on the morning of dialysis', etc can make adherence challenging even for highly health literate individuals. The study approach would need to account for different distribution of age and comorbidities across race/ethnicity.
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?
It is still important to study these behaviors because they are on the pathway and still influence health. Even if they are not root causes, they are still targets for intervention, which can still be effective (even if it is limited by lack of a full accounting for social factors). Understanding upstream factors such as neighborhood, income, education that impact behaviors is helpful for leveraging them for improving health. Additionally, these may not be the only social factors influencing health behaviors.