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: Survival time after diagnosis of cutaneous T cell lymphoma
Key Health Behaviors: Attending doctor’s appointments, Medication adherence
Ability to attend doctor’s appointments and medication adherence are key factors for intervention and therapy after a cancer diagnosis. In the biopsychosocial model of health, health behaviors are considered a result of biologic, psychologic, and social factors. An objective biologic outcome like survival time is influenced by numerous factors outside of the biologic sphere, including the patient’s mental health and social setting. For example, a patient without reliable access to transportation may face numerous logistic barriers to attending a healthcare appointments or filling prescriptions.
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.
It would be interesting to see how medication adherence affects survival time, and whether the relationship is mediated by social factors such as race/ethnicity, SES, and urban/rural location. Cancer patients often have more access to social services after their diagnosis as social workers can help them access health insurance, transportation vouchers, and ancillary support services. However, in the rural setting these services may be much harder to access and less effective due lack of public transportation or if a patient lives very far from specialized care centers. I would be interested to collect data on self-reported medication adherence and survival time in several medical centers in rural and urban settings to see whether that variable mediates survival time.
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 is important to study how health behaviors influence health outcomes and investigate how these behaviors are influenced by social determinants of health. That way you can implement public health policy that can change these health behaviors on a broad social scale, which has been shown in several contexts to be more effective than counseling for individual behavior change (Chin et. al 2000).