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.)
I’m interested in studying potentially excess death from chronic lower respiratory diseases among rural residents, as there is a growing mortality penalty for rural compared to urban populations due to chronic lower respiratory diseases (as well as due to the other four leading causes of death nationally). The most obvious related health behavior is smoking, which is known to be more prevalent among rural populations. However, I’m more interested in occupational exposures that contribute to CLRD, and the behaviors of correct use of personal protective equipment (ventilators/masks, vent hoods, etc.) and treatment seeking behaviors, including decisions to undergo screening. Correct use of equipment designed to reduce exposure to occupational hazards is important for disease prevention, while healthcare-seeking and screening are important for both prevention and effective/timely intervention.
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.
To examine the role of healthcare-seeking and screening behaviors in CLRD outcomes, one approach would be to develop a survey to assess decisions around timing of seeking healthcare and screening for use among patients with CLRD diagnoses and known potential for an occupational exposure. I would probably combine this with medical chart review for factors such as disease severity at time of diagnosis, patients’ follow up with treatment or screening advice, and disease progress. One key social factor to assess as a potential modifier would be access to adequate employer provided health insurance.
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, we need to continue to study health behaviors and their outcomes for three important reasons. The first is that we need to explicate the causal pathways and mechanisms between behaviors and their outcomes in order to develop effective interventions to disrupt these pathways and to promote health. Second, as discussed by various theories and shown by empirical analyses, health impacting behaviors and causal mechanisms have shifted, and are continuing to shift, in their prevalence and their relevance to population health, therefore requiring ongoing study. Finally, until health equity is attained, there will be a need to describe the differential distribution of health behaviors and their outcomes across groups with differential access to material, social, and cultural resources. While study at this level continues to be necessary, it should (ideally) be guided by a view to the upstream factors that may shape particular behaviors, both to enhance validity and to support the development of effective policy and interventions.