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 type II diabetes. Two key behaviors that are important factors leading to diabetes are lack of exercise and poor diet, which are both heavily discussed in the Pampel paper. The etiology of the development of type II diabetes is multifactorial, including genetics, environmental risk factors, poor dietary habits, lack of exercise, weight gain, stress, access to care, among other things. However, those with lower SES and certain racial/ethnic minorities bear a disproportionate burden of diabetes and diabetes-related complications. Lack of exercise and poor diet can lead to weight gain, which worsens insulin resistance, and lead to the development of diabetes or poor control of diabetes. Addressing issues of lack of exercise and poor diet are important for both the prevention of diabetes (especially in patients who have pre-diabetes) as well as in helping control diabetes in those with the diagnosis.
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.
If I wanted to study the role of poor diet and diabetes, patients with diabetes could be surveyed about their overall caloric intake (both by their estimation by self report and then for more accuracy, using a calorie counting application). In this survey, I could ask about their understanding of a healthy diet and their barriers. I would also be interested in asking specifically about stress, and the role of stress in their eating patterns. In the Pampel paper, the authors discuss that overeating can be a way of coping with stress and can be a form of pleasure among those with lower SES. I would be interested in seeing racial/ethnic differences in patient’s answers of poor diets, especially among Asians, since risk of diabetes happens at a lower BMI compared to non-Asians (and therefore the recommendation to screen for diabetes among Asians is at BMI of 23 rather than 25 among non-Asians
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?
Particularly for the two health behaviors that I have discussed (exercise and diet), neighborhood, income, and education play a huge role. As a clinician, I spend a lot of the clinic visit time with my patients with diabetes focused on their individual behaviors for exercise and eating, but I think what plays an equally important, if not larger, role is neighborhood and income factors that are barriers to my patients being able to 1) exercise (if there is a lot of violence in the neighborhood or fear of safety, my patients would not want to exercise outside, particularly if they are not able to afford a gym membership) 2) make healthy eating choices (particularly if there are no fresh food options where they live or if fast food is much cheaper). Even if key health behaviors are strongly influenced by neighborhood, income, and/or education, it is still important to study these health behaviors because neighborhood, income, and/or education alone do not explain disparities in health outcomes. It is a complex interaction of both individual, neighborhood, and societal factors that contributes to health outcomes and all of these levels need to be studied in order to address well-documented disparities in health outcomes.