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 primary health outcome of interest is maternal depression. There are many behaviors that are factors related to this outcome. For one example, I will discuss the behavior of family planning. About ½ of all pregnancies are unplanned. This lack of intentionality can result in poor timing of pregnancies and some studies have shown that unplanned pregnancies can result in more maternal depression. It may also be true that women who are depressed to begin with may be less proactive around their family planning. Another health behavior that is related to maternal depression (and depression of any sort) is substance use, including alcohol use. There is a lot of co-morbidity around substance use and depression and the etiology may be similar in terms of the neurochemistry. One of the ways that this interferes with successful treatment of maternal depression is that women who are also using drugs may be less likely to seek treatment due to stigma or concern about CPS involvement and the treatment options to treat the co-existing depression and substance abuse may also be limited and/or siloed.
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 could envision a study where we further examine the relationship between family planning and depression. Study would take place in an adolescent clinic, in a safety net setting that serves female adolescents of diverse racial/ethnic backgrounds and lower SES. Teens seeking family planning services could be randomized to include some sort of depression screening and then linkage to treatment if present. Teens seeking treatment for mental health issues could be randomized to TAU or an arm of the study where they are also provided with family planning services. In this study we could examine how the behavior or family planning may influence depression and vice versa.
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?
It’s definitely true that health behaviors should not be examined without attention to the fundamental causes that underlie many of these individual actions. By looking at both and developing ecological models that contextualize both health behaviors and health outcomes, we are likely to make better progress identifying and implementing effective interventions.