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 care utilization
- acute care visits: hospitalizations, emergency room visits and urgent care visits by housing status.
- behaviors: drug abuse and adherence to anti-retroviral therapy. Drug abuse
- Drug abuse and adherence to anti-retroviral therapy are important mediators (separate and possibly related) to acute care utilization in hosing unstable patients with HIV (PLHIV). Drug abuse leads to infections, exacerbation of psychiatric disease, risky sex behavior and trauma/violence, which are important causes of care utilization. Another mediator in the pathway from drug abuse and the outcome of choice is adherence to anti-retroviral therapy. Poor adherence leads to viral non-suppression and itself may lead to acute care visits. Moreover, however, poor adherence and drug abuse may not only accumulate in the context of unstable housing, but may also exacerbate each other (see below).
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.
- The Environomental affordances model has appeal because it uses the ecology of persons’/group’s are important upstream causes of health behaviors. In my research, homeless is considered a structural/ecological arrangement in which behaviors and stressors accumulate and synergize that lead to certain health outcomes. For instance, in the context of housing instability drug abuse and adherence may worsen and exacerbate each other (drug abuse -> poor adherence, and poor adherence makes patients feel unhealthier worse -> more drug abuse) and be associated to poorer engagement in care.
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 to study behavioral factors (smoking, exercise, nutritious diet) understand how these behaviors interact with other characteristics that lead to disparities at each level of neighborhood SES, and how they interact with different factors (race/ethnicity, education level, income) within each level of neighborhood SES. For instance, smoking, environmental toxins may play an important role within a neighborhood with low SES, but there may be important differences in a between different racial groups, income or other educational levels. For instance, in my research, if you take literal homelessness as an equivalent of neighborhood SES, then drug abuse may be differentially associated with outcomes between different genders, racial groups, or those with mental health.