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 research focuses on gender disparities in presentation, treatment, and outcomes of vascular disease, particularly peripheral artery disease (PAD). Behaviors are extremely important especially in the etiology and prevention of vascular disease, particularly tobacco use and physical activity, as discussed in the article by Pampel et al. Cardiovascular disease is one that is greatly influenced by behavior, with many studies showing associations between tobacco use/sedentary lifestyle and disease severity. In fact, these behavioral factors affect intervention as well, given the first line management for peripheral arterial disease includes smoking cessation and a supervised walking program.
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.
An important and interesting question is the effect of physical activity on intervention. Specifically, I would be interested to know if a monitored exercise program can prevent invasive treatment for PAD in low socioeconomic populations. Many studies have examined the role of walking programs in preventing invasive treatment, however these studies control for factors describing SES rather than examining them as predictors of interest and understanding the interactions between physical activity and SES and their effect on PAD interventions. I would develop a cohort study, using the STARS core questionnaire in the study population to better capture SES. Measuring physical activity can be challenging using questionnaires due to recall and social acceptability biases, therefore I would use an activity tracker than directly streams data back to the electronic health record. I would then follow these patients for disease progression and additional interventions.
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, social determinants of health are extremely complicated (I’m learning even more so that I previously thought), and we need to use every tool we have to better understand them and how to provide equity in healthcare and health outcomes. Health behaviors provide an important piece of the “social determinants” puzzle, and provide potential areas for interventions to promote health equity. Additionally, I believe there are some important biologic components of these behaviors, not just social, that are important to understand.