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.)
One health outcome of interest to my work is understanding reasons that lead to disparities in colon cancer among racial and ethnic minority groups. It is current knowledge that African-American men have the highest incidence of colorectal cancer and highest mortality related to this disease beyond any other racial/ethnic group. While there has been much published speculating why this disparity may exist, often in the way of survey and patient perception data, I believe it’s helpful to consider this in the broader scope of approaching cancer diagnosis and borrowing work from other cancer related fields. In using this approach 2 key behaviors that might be important would be:
Social connectivity: Scarlett Lin Gomez and colleagues have demonstrated that social connectivity using ethnic enclaves as a surrogate, can be useful in determining the incidence of cancers and in their research, they’ve discovered this to be an important factor in cancer related mortality. Ethnic enclave is defined as a geographic area (often a residential area) with high ethnic concentration, characteristic cultural identity, and economic activity. In their studies, one which focused on cervical cancers, they found that there was lower incidence of cervical cancer among Asian and Hispanic women who lived within an ethnic enclave compared to Asian and Hispanic women who lived in more heterogeneous neighborhoods regardless of SES. They also demonstrated that there was increased survival among those diagnosed with cervical cancer in these areas. I think this work is very interesting and is likely due to social connectivity and support that comes from living within these social enclaves. While similar work hasn’t been conducted in colorectal cancer in African-Americans per se, this is an area of interest as in general we believe social connectivity (historically measured in other ways) to be an important factor in patient’s decision to screen for colorectal cancer and ultimately complete treatment if diagnosed.
Diet: Diets high is meats and in particular, processed meats have been linked with higher rates of colorectal cancer. A report from the WHO supporting these findings was released 2 years ago and raised a lot of public concern. Eating behaviors and diets differ by gender and racial and ethnic minority groups and could lead to differences observed in colorectal cancer by racial/ethnic groups. Diets high in sugar and fats have been linked to higher rates of hypertension, hyperlipidemia and diabetes in African-American and Hispanic populations and it is likely that diets higher in processed meats (in addition to many other factors) may play a role in the higher incidence of colorectal cancer observed in African-American men.
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.
One study that I would like to conduct, would be evaluating the incidence and survival of colorectal cancer among African-American men who live in ethnic enclaves compared to those who don’t. While such a trial would not be conducted with the goal of designing future interventions, it would provide further support to the importance of connectivity in colon cancer research and outcomes.
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! I believe these are important factors that in many ways have not been completely evaluated. Having a better understanding of how neighborhood factors influence health behaviors of interest will allow for design and implementation of specific interventions to address these issues, some at the patient level but more importantly at the system-level (ex. Access to healthier foods, transit, etc.)