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.)
Health outcome of interest: Cancer clinical trial enrollment
Key behaviors: Seeking medical care; Obtaining stable housing
In order to be considered for a clinical trial you need to seek medical attention at a minimum. However key behaviors are more complex than that for treatment protocols that may require several visits. You also have to demonstrate an ability to adhere to a schedule and follow a protocol. An implicit key behavior is a stable social circumstance. Investigators want to recruit and retain participants in clinical trials and if housing is tenuous or patients have other large priorities that my override the ability to adhere to a protocol, individuals are less likely to be enrolled.
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 investigate stable housing. My literature review suggested that "stable housing" has multiple definitions and there is not consensus on what it means. I would choose one definition (e.g. maximum of two reported home addresses for patient during four year period). I would then look at how many patients met criteria for stable housing who were enrolled in cancer clinical trials compared to patients not enrolled in trials. I would have to perform a regression and adjust for nSES, race/ethnicity, healthcare payer).
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?
Of course we need to investigate and deeply understand the effect of each behavior on health outcomes. If we understand the effect then we can drill down on ways to design interventions to mitigate these effects or even drive behavior change.