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.)
My outcome of interest is diabetes.
Unhealthy diet. The high consumption of sugar, particularly for sugared sweetened beverages, as well as high consumption of junk food, with a high content of sugar and saturated fat, are one of the leading risk factors for diabetes incidence. The high consumption of sugar increases the risk of diabetes by two mechanisms: first through a high-calorie intake that increases BMI, being BMI a mediator to diabetes incidence. The other pathway is the sugar intake independently of BMI, increases the risk diabetes. The high availability of this products is high, in specific in low-middle class neighborhoods and in schools. For example, in Mexico in 2010 started a regulation of food and beverages in schools, however, there are a high number of mobile food vendors around the school selling particularly sugar sweetened beverages and junk food. (Barrera LH, Am J Prev Med 2016).
Physical inactivity. Physical inactivity is another risk factor for diabetes. physical activity can help to lower blood glucose levels and increase insulin sensitivity, as well as maintain a healthy BMI. Interventions such as increase physical activity in schools or workplaces have shown to be effective. However, a community level, some of the barriers to increase physical activity are the lack of parks and places to do physical activity, insecurity in public places, or lack of sidewalks on the streets.
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 would do a behavioral intervention giving recommendations for changes in dietary behaviors and increase physical activity to improve glucose levels. I would obtain the dietary information through a food frequency questionnaire as well as a physical activity through a validated questionnaire or accelerometer. I would include characteristics of the neighborhood, considering the number of parks or places for physical activity as well as the number of grocery stores and super or minimarkets in a one mile-buffer around the house.
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 include these factors because we need to continue studying the main risk factors for diabetes prevention and how these factors are related by other social determinants, in order to propose policy strategies that could target the most vulnerable population. The evidence obtained doing studies with health behaviors could help to have a better understanding of the disease as well as the strategies and policies required to have better health outcomes.