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 recovery from anorexia nervosa, which is often defined as eating disorder psychopathology within 1SD of community norms and weight (at least 95% of target goal weight). Two key behaviors that are important to this health outcome include increasing caloric intake/decreasing physical activity to assist with weight gain and engaging in behaviors that challenge eating disorder cognitions (e.g., eating “fear foods”). Eating behavior (overall energy intake), physical activity (excessive/compulsive exercise), and adhering to food/exercise rules are all risk factors for developing an eating disorder, and the intervention is therefore focused on reversing these behaviors (i.e., food is the medicine) through parental supervision (i.e., parents serve and supervise all meals and snacks, absence of exercise) guided by psychological 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 could examine the extent to which meals/snacks are supervised by a parent, teacher, school counselor, older sibling. Given the importance of weight gain in the treatment of anorexia nervosa, I could monitor the extent to which caloric intake was adequate. Household income and working status of parents as markers of socioeconomic status may in part determine the availability of parents to directly monitor, or the need for other adults (or non-adults) to supervise, or the inability to identify anyone appropriate who could monitor meals/snacks. Parents and the youth could separately monitor food/supervision across 5 days for a measure caloric intake and meal supervision.
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, because the “how” will help to inform the intervention strategies that may help to increase health equity, such as increasing the patient’s sense of autonomy as an aspect of care that would help to more effectively engage AABM-PLWH patients in their health management. While it may not be feasible to directly impact neighborhood, income, or education in the short-term, other factors that may be more proximally related to the outcome (such as a mediator of the effect of neighborhood, for example, on smoking) could nevertheless be a target for intervention.