- 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 completed a study on mortality of patients with gun-related injuries seen at Highland Hospital in Oakland who survived to discharge. Our cohort of patients were predominantly young men, all of which who had been exposed to either accidental or intentional gun violence, and the behaviors that lead to mortality in this demographic group are different than other groups. Two behaviors that I think are important factors leading to mortality for this demographic group include violence/criminal justice/risk taking associated behaviors such as being in a gang and carrying a weapon.
- 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.
I would be interested in how carrying a weapon relates to mortality. I would attempt to study this behavior by starting a prospective cohort trial that enrolls patients seen at Highland Hospital ED for gun-related injuries. I would survey enrolled patients at time of initial ED visit and ask what percentage of time outside the house they carried a weapon with them during the last month. I would then create four cohorts based on quartiles of time spent with a weapon and see how this ordinal variable related to mortality in next 2 years. I could then do subgroup analysis based on type of weapon. Since weapon carrying is likely influenced by a large group of social factors, I think it would be interesting to try to also collect and control for variables such as stress, feelings of social exclusion, attitudes and past experiences with police, race, perceived safety of neighborhood, and neighborhood characteristics (income, education and crime rate).
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?
I think it is useful to continue to study how these behaviors influence health as well as how neighborhood, income, and education effect these behaviors as studying both helps us as researchers understand full causal pathways. Without studying both, our DAGs would be incomplete