1. I’ll use the outcome of pre-term birth, with two behaviors that lead to this outcome being smoking and poor nutrition. Identifying smoking and encouraging cessation can be important interventions to reduce pre term birth and improve maternal health. Similarly identifying those at risk for poor nutrition can be important in order to refer patients to appropriate food support systems.
2. You could do a prospective cohort study looking at the association between smoking and pre term birth, with all participants having routine prenatal care. Some of the participants will continue to smoke despite recommendation from their physicians, and this can be the exposed group. It would be extremely important to capture a variety of social determinants, given that many of them contribute to both smoking and maternal health outcomes. One example of this could be race/ethnicity. Because we know that race has a huge impact on maternal health outcomes, it would be important to include this in models and look at interaction between race and smoking as they are associated with pre term birth.
3. Yes, we absolutely need to continue to study how behaviors influence health outcomes, but we must always contextualize them in the social and political realities our patients live in. Identifying a specific behavior as leading to a poor health outcome can be important for developing targeted interventions to mitigate the behavior’s effect on the health outcome, but that doesn’t mean we simultaneously have to discard how SDH influence that behavior either.