- 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.)
We conducted a study on length of hospital stay after renal trauma at San Francisco General Hospital in order to evaluate whether management of their kidney (operatively vs non-operatively) made a difference in the length of their hospital stay. However, there are also other factors that play into the hospitalization itself for renal trauma, among them behavioral.
One is violence and criminal justice – many of these patients sustain renal trauma because of gang-related violence. The etiology of the kidney injury, penetrating vs. blunt, can be related to violence because someone is much more likely to sustain a penetrating injury (gun or knife wound) from violent behavior rather than a blunt kidney injury, which is more likely to occur during a motor vehicle accident. Violence also has to do with preventing these injuries in the first place – targeting gang-related violence might help to decrease the number of people that are hospitalized with a violent injury in the first place.
Another related behavioral factor that is important is self-control. Patients who sustain gang-related violence have made choices about participating in gangs and violent behavior. They are choosing to put themselves in situations where they might sustain injuries in the first place. They are making choices about who to surround themselves with and who their support system is. These patients may stay longer in the hospital if they do not have adequate support at home. Unfortunately we’ve also seen that they may be back in the hospital with another injury if they don’t change their behavior after their first hospitalization. Targeting self-control for these individuals while in the hospital might help them to find a new path once they are discharged to prevent future injuries.
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.
In order to see how violence relates to length of hospital stay after renal trauma, we could retrospectively look back at our renal trauma database and identify all renal injuries resulting in hospitalization. We could then compare those injuries sustained by violent mechanisms (guns/knives) to the length of hospitalization of those traumas to those that were sustained by non-violent mechanisms (such as motor vehicle accident or falls). Given that gang violence is often tied to race/ethnicity, we would also want to be sure to capture the race/ethnicity of the patient and we could control for this factor in a multivariate analysis. It would also be interesting to collect information about the neighborhood where the patients live, which might also tie to their likelihood of being involved in a gang or subjected to gang violence.
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! In order to enact change, we need to understand how these health behaviors are linked to health outcomes. We may not be able to change a patient’s neighborhood, income, or education, but we potentially target health behaviors that, if changed, could result in a change/improvement in a downstream health outcome. In this way, studying health behaviors gives us as clinicians and public health workers something to target – it gives us a behavior that we can try to change, rather than just identifying a causal link to a characteristic that we might not have the power to change.