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: Unintentional pregnancy at age <18
We know from the Adverse Childhood Events (ACE) study that teens with 4+ ACEs have an adjusted odds ratio of 4.46 for having or having caused an unintentional pregnancy at age <18 years.
One key behavior that would prevent unintentional pregnancy at age <18 is the use of a contraceptive method. However, for a teenager to use a contraceptive method consistently with each episode of intercourse, many societal factors need to be in place: she likely needs to (1) have the knowledge that a contraceptive method is necessary to prevent pregnancy, either through school, friends or family, social media, or through a health care provider; (2) have access to a method that she is able to consistently use, which may involve a visit to a clinician and a financial cost; (3) feel like she has agency over her future and not that becoming pregnant is her destiny; and, (4) have a partner who does not object to use of her chosen method. Additionally, to the point of Muraven and Baumeister, a teenager is more likely to exercise self-regulation (i.e., take a daily pill or pause prior to intercourse to apply a barrier method) if the limited resource of self-control has not been exhausted by other stressors.
Another key behavior that would prevent unintentional pregnancy at age <18 is prolonging abstinence. We know from Chin et al.’s reporting of Lantz et al. (1998) that those with less than a high school education had earlier age of first coitus compared to those with college education. Biopsychosocial factors, like schools with high-quality teachers and good career counseling, enriching after-school programming, college-educated role models who are of the same racial and socioeconomic background as the teenager, friends who are abstinent, and parents present at home who positively engage with their child may be protective in preventing unintentional pregnancy at age <18.
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.
While it is clear that contraception can prevent teenage pregnancy, I would be interested in studying the role of stress and self-regulation on contraceptive usage. This would be difficult to actually study, but it may be possible to simulate it like Muraven and Baumeister’s reports of simulations of stress. Note: this idea would need pilot testing! On entering the study site, teenagers would either be pleasantly greeted with snacks (stress reliever) or exposed to a noxious odor or distressing sound that they could not control (stressor). Next, the two groups will watch a video of a teenage pre-sexual encounter where condom use is omitted. Participants will then complete a write-in survey asking them what, if anything, was missing. I hypothesize that the stress-relieved participants would more likely be able to focus on the video and express a missing step that they personally find a priority.
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?
Yes, we need to continue studying these key health behaviors that are influenced by neighborhood, income, and/or education, because the social factors that determine these behaviors are modifiable on the societal level. Developing a deep understanding of the social etiologies of behavior can help design appropriate interventions.