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 infertility which is a disease of the reproductive tract leading to the inability to conceive or carry a pregnancy to delivery. This is typically diagnosed after 1 year or more of unprotected intercourse with slight deviations in the definition depending on the couple and other factors (ie age). Two health factors that are particularly important to me include tubal factor infertility and age related infertility which often has different societal implications as well as ramifications for treatment. We know that race/ethnicity (as social constructs) and education as proxies for SES can affect access to reproductive health education, access to condoms for preventative care, and access to routine health screenings. Tubal factor infertility which is one of the more common etiologies of infertility in developing nations, is a cause of infertility within the United States that disproportionately affects disparate populations. Utilizing safe-sex practice is a behavior that is intrinsically linked to decreasing STI acquisition, thus decreasing risk for tubal infertility. The second health factor important to me is age related infertility. As age increases, the ability to conceive naturally or with treatment for a female largely decreases (increased genetic risk, decreased ovarian reserve). Yet, women from disparate backgrounds are less likely to access fertility counseling/care at an earlier age. Increasing access to infertility education would be an intervention that could directly affect the age at first infertility appointment, diagnoses, and treatment options available.
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 love to perform a study looking at comprehensive reproductive health education in varied population including rural, inner city, low income, racial minorities (income and race as markers of SES) and this influence on STI acquisition. Unfortunately, to longitudinally determine if this exposure decreases the outcome, you would need to follow these populations for a long period of time which may be challenging. In terms of age related infertility, I am currently trying to bridge connections with the department of public health and local community health partners. From there, it is important to identify women who have not conceived and discuss their future fertility with them. Focus groups will be important in determining the needs of this population (identifying is it lack of access to information about fertility and age related decline or is there something else that makes this population reticent to receive further care?). Because we know women from ethnic minorities and those with lower incomes are less likely to prevent for services and less likely to accept treatment, this is the population I would want to focus on.
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?
Absolutely. I am a firm believer that studying the "how" behind behavior will inform decisions for intervention. I also feel approaching populations from a sociocultural context provides a level of understanding that is deeper than the health outcome itself. In my example of infertility (and two broad behaviors which can affect it), there are well delineated roots in access to care, distrust in medical professions, and are directly influenced by markers of SES (including income and education). To not study these influences that directly lead to the behaviors that directly correlate with outcomes in infertility would lead to developing (likely) uninformed and terminable interventions.