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.)
Outcome of interest: HIV infection
1. Anal/vaginal sex without a condom with an HIV-infected partner
2. Sharing intravenous needles with an HIV-infected partner
I think it is well known that HIV can be transmitted by blood in addition to semen, vaginal fluids and breast milk. The two behaviors I picked above are known risk factors for becoming infected with HIV via exposure to these fluids. I would say these behaviors play a key role in the etiology of becoming infected, and are the place to intervene for prevention of HIV. This is not to say that these behaviors are unaffected by socioecological factors – on the contrary, these factors underlie the behaviors as has been demonstrated in the literature.
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.
Behavior: Anal/vaginal sex without a condom with an HIV-infected partner
I would be interested in looking at LGBT youth exposed to various forms of sex education (existent, nonexistent, abstinence only etc.) and the impact on the behaviors of LGBT youth. I would also be interested in evaluating the role of race/ethnicity as a social factor that could be related to these behaviors (or not), as minority populations are disproportionately affected by the HIV epidemic, with infections increasing among Black and Latino MSM in recent years. The entire study would thus be focused on understanding risk of HIV infection, and the behaviors (condomless sex) would be the conduit for the outcome, but many of the exposures of interest would be sex education, race/ethnicity, SES etc. The study design would be observational, with two cohorts: one with complete sex education and one with abstinence only education, and I would follow these individuals over time and track HIV acquisition cumulative incidence. I think it would be important to know if there are differences in HIV acquisition according to the resources available regarding sex education, and would be helpful in informing necessary policy changes.
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?
I think so, yes. This question raises an important point, though, which is highlighting the role of social determinants such as neighborhood, income, education and other circumstances that shape behavior. This in essence implies that to get at the root of the problem, we must go upstream to the underlying influences to prevent the outcome. Although this is true, I think it is important to also focus on behaviors because many successful interventions focus on the individual level and helping patients change their behavior (motivational interviewing, ACT therapy, CBT etc.). In many senses, a lot of the referrals and resources available to patients at this very moment focus on behavior, and have the potential to truly make a difference for a patient regardless of the social factors that have shaped this patient’s behavior. Thus it is important to tackle these issues from multiple standpoints, including from a behavior perspective and the role of behavior in influencing health outcomes. This is a complement to other more systemic approaches.