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.)
ANSWER: My health outcome of interest in response to an anti-diabetes medication called metformin. Two behaviors that are important factors that modulate response to metformin are chronic exposure to an unhealthy diet (either high fat or high in high glycemic index carbohydrates, low in non-starchy fruits/vegetables) and medication adherence (taking the drug as prescribed). Chronic exposure to an unhealthy diet is indirectly associated with response to metformin because an unhealthy diet is directly affects etiology and severity of the disease metformin treats (type 2 diabetes). The baseline severity of type 2 diabetes directly affects how well patients respond to metformin. So a patient’s response to metformin is indirectly impacted by previous long-term exposure to an unhealthy diet. Furthermore, response to metformin is most likely indirectly impacted by current diet.
Adherence to medications directly impacts the ability to intervene, inhibit or stop progression of the disease by taking metformin as prescribed. Other SES impact adherence (income, work schedule, stress) and those SES an indirectly affect response to metformin. If you cannot take a drug appropriately, you won’t respond to the drug appropriately.
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.
ANSWER: I would study the role of unhealthy diet on response to metformin by asking the question “Do patients who currently have an unhealthy diet have a blunted response to metformin”?. To answer this I would measure baseline diets of each subject then randomized subjects to intense nutrition/dietary education plus metformin treatment or standard nutrition education plus metformin treatment. I would measure baseline HbA1c then measure HbA1c at 3, 6, 9 and 12 months to evaluate the initial response (3months) and the chronic response (12months). I would measure demographics like self-identified race, educational level, stress and occupation to make sure these confounders are equally distributed in the 2 groups and to stratify analysis based on these factors. Statistically, I would use student’s t-test to compare the group’s HbA1c level at the different time points and do multivariate linear regression to determine if there are associations below change in HbA1c and those factors.
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?
ANSWER: The underlying assumption behind this question is that “we have figured out the vast majority of all significant associations between key health behaviors and health outcomes.” The issue with this assumption is that we assume that “health behaviors” and “health outcomes” are static. But in reality, there are always “emerging” health behaviors (for example vaping or e-cigarettes) that have unknown effects on general health outcomes. Vice-versa also occurs: smoking may cause an unknown or “under the radar” health outcome that impacts overall health.