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 the reduction of injection-drug related infections patients who use injection drugs, including transmissable infections like HIV, HCV, or bacterial infections like cellulitis/abscesses and endocarditis. Two key behaviors (aside from the obvious cessation of injection drug use) are 1) the use of clean needles during drug use to avoid transmission of disease and 2) using sterile water when "cooking" drugs to avoid injection of bacterial pathogens into the skin and/or bloodstream. Harm reduction behaviors like these are proven to reduce the incidence of infections among patients who use injection drugs more so than abstinence only interventions and represent important interventions with major public health impact to prevent spread of disease.
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.
One way to study the role of use of clean needles and prevention of transmissable infections is to study access to needle exchange programs, and one of the social factors studied would be access to transportation. It is already well known that the role of clean needles does work to reduce transmission of HIV and HCV, though it could be hypothesized that reducing barriers to transportation would increase uptake and use of needle exchanges. Not only would easier access and use of transportation likely encourage participants to attend needle exchange programs, reduction in barriers to transportation may also encourage the distribution of clean needles to less trafficked areas of the region that have poorer access to needle exchanges.
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, especially for my specific question, neighborhood, income, self-perceived perceived social status are especially important factors that can influence whether a participant may choose to participate in a needle exchange program or how they would otherwise access clean needles. Neighborhood is a factor in how far away are the closest needle exchanges from participants who need them? Do participants have regular means of income to allow them to participate in needle exchanges in the day during regular business hours or do they have a job that precludes from doing so? Due the stigmatized nature of drug use, are participants less likely to participate in needle exchanges due to fear of being recognized? These are all important questions to examine when recognizing how participants access needle exchange programs to increase the uptake of clean needle use.