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.)
Cervical Cancer screening uptake is my health outcome of interest. I think two important key behaviors that important factors leading to this health outcome are smoking and poor clinic follow up. Smoking as established in the Pampel article is much more prevalent in low SES groups, those with less education, low income, are unemployed, and who rent. Smoking has been found to increase the risk of cervical cancer and is one of the main modifiable risk factors for developing cervical cancer. Another health behavior would be health care follow up. Often in low SES Groups patients will only come to the healthcare center once every few years, and when they do, they often have something specific they want to talk about. When discussing with patients the importance of cervical cancer, they may opt to have the pap smear in office, or schedule at a future date and never follow up. I think this lack of follow up could be a cause of larger cases of cervical cancer in low SES groups.
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.
Smoking would be an easy factor to study, just asking smoking status, which is often done in normal intake of new patients, or for follow up patients would allow for easy ascertainment of smoking status in patients. Understanding follow up might be a bit more difficult, as these patients hardly have the time to make it to the health care center, they may have even less time to participate in a study. But a possible option would be to have a qualitative study seeking to contact patients that are informed they are due for cervical cancer screening and opt to schedule it for another time and do not schedule it within 6 months and try to understand through focus groups or interviews why these patients did not schedule a follow up. I think this interview/focus group could focus on stressors, such as employment, income, and could even probe regarding questions about expected self-life expectancy.
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, I think we do need to continue to study these behaviors. It is important to show that these health behaviors are linked to health outcomes. I think in addition to this we also need to continue to do research that shows how these health outcomes are influenced by the neighborhood, income, and education of low SES groups and how these influencers also impact health behaviors. These two combined factors could hopefully influence our society to understand that more resources need to be used to help those with certain health behaviors and those in certain SES groups with adverse health influences to better improve environments where those influences are present. By studying both the health behaviors and the influencers of health behaviors we can hopefully begin to develop future interventions that specifically target unique populations that might be more useful that taking an intervention that has been shown to work in one group with low SES and applying it to another group with low SES, because it is important to understand, while low SES groups may share a lot of the same health behaviors and influencers of behaviors, they are unique groups and should be approached as such to have successful interventions targeted to improve health outcomes.