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 am interested in describing differences in outcomes in patients with idiopathic pulmonary fibrosis (IPF) and associations with a variety of social determinants of health. To start, I am interested in several outcomes, including differences in pulmonary function (which are linked to prognosis and mortality), mortality, and lung transplantation, as well as other outcomes surrounding quality of life. There are several behaviors that are important to consider when evaluating these outcomes, however smoking and exercise (specifically pulmonary rehab) are associated with some or all of these outcomes. For example, smoking leads to worsening pulmonary function, increased mortality, and a lack of consideration for lung transplantation in patients with idiopathic pulmonary fibrosis. Pulmonary rehabilitation improves quality of life surrounding dyspnea scores in particular in patients with IPF, and also provides strength and conditioning leading into lung transplantation. There is also preliminary evidence that pulmonary rehab may delay the decline in lung function that is seen in patients with IPF, as this disease will progress even with the pharmacotherapies that are offered.
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.
It would be interesting to study whether pulmonary rehabilitation led to improved outcomes by urban/rural geography in patients with idiopathic pulmonary fibrosis, especially regarding quality of life based on what is known. I hypothesize that more rural areas may have more difficult access to pulmonary rehab centers, and that this may lead to differences in quality of life scores.
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 should continue to study how all of these behaviors influences health outcomes, because though they may be mediated by neighborhood, this may not be the only explanation for any association that is found between these behaviors and various outcomes. Further, it’s important to study them with a variety of other social determinants of health as the outcomes may vary even further.