Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 1

The 3rd revolution in health

1. Communicable disease Direct product of “civilizing” / urbanization of

populations Moderate population density greater disease resistance

Exposure & recovery from pathogens

Genetic drift (?)

High population density, poor sanitation, exposure to toxins high disease burden

Epidemiology “Broad Street Pump”

Urban renewal, waste & water treatment…

“Contact” disease spread & colonization…

Chicago River direction: Mississippi v. Great Lakes watersheds

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 2

3rd revolution in health

2. Chronic “lifestyle” disease Increasingly product of individual behaviors

The big 7:

Key risk disposition: social & marketing environment Tobacco marketing

“Industrialized” food production

Built environment Suburban sprawl and exercise opportunities

“Food deserts”

Quickening economic pace chronic arousal

Increasing socio-economic stratification morbidity & mortality

Lessing quality & quantity of social interactions / support

Primary prevention via health behavior change

• Not smoking• Moderate alcohol• Exercise• Sleep• Moderate weight• Regular meals• Breakfast

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 3

The 3rd revolution in health

3. Health as positive resource Health defined positively rather than as absence of

disease

Capabilities > limitations

Expansion of domains of study & intervention

Physical

Ψ

Social

Health as a human right (?)

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 4

A general frameworkExogenous variables

Stressor, pathogen,

culture

Internal Process

Health Outcome

Chronic•Stress•Chronic disease•Environmental exposure•Social inequity•Cultural norms• “Person” variables

TemperamentPersonality

Acute• Stress• Affect• Environmental

exposure

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 5

A general frameworkEndogenous variables

ψ•Affective state•Self-perception•Perceived vulnerability•Self-efficacy, etc.

Physical•Arousal• “Allostatic load”•HPT activation• Inflammation• “Metabolic syndrome”• Immunocompetence

Stressor, pathogen,

culture

Internal Process

Health Outcome

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 6

A general frameworkOutcome variables

Behavioral•Health behaviors•Alcohol drug abuse•Risk, etc.

Biomedical•CHD•BMI• Infection, etc.

Stressor, pathogen,

culture

Internal Process

Health Outcome

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 7

Course topics

Overview of Health behavior concepts

Applications of personality theory to health

Basic attitude theory, self-regulation, self-efficacy

General Social-Cognitive / Affective Models

Judgments of vulnerability, risk estimation:

Self-awareness, "automaticity" and Cognitive Escape.

Socio-economic Status, race / ethnicity, and health.

Psychoimmunology: affect, coping, interventions

Policy, Economic and Political Influences on Health

Spirituality, happiness, mindfulness & well-being

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 8

Health behavior & behavioral medicine concepts

CHD as core example of health behavior process

1. Direct effects of stress or affect Anger

Chronic arousal,

Depression

2. Behavioral variables Smoking

Dietary

3. Illness-related behaviors Illness conceptions

Recognition, “definition”, treatment seeking

Adherence

Exercise

Sleep...

Stress or Arousal (“allostatic load”)

Hypothalamic-Pituitary-Adrenal axis (HPA axis)

Immunomodulation, inflammation, “illness behavior”

CHD

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 9

Personality theory & health / health behavior

Stable, individual differences: Direct effects

“Type A” personality & chronic arousal

“Negative affectivity” and immune (or behavioral) effects

“Neuroticism” (versus optimism?) and common factor in disease vulnerability

Variations on the “Big 5” health behavior & outcomes

Indirect effects

Sensation seeking and risk taking

Conscientiousness and precautionary behavior

Impulsivity risk taking, perceived vulnerability

Temperament and relative balance of inhibition v. activation (“Bis – Bas”)

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 10

Basic attitude theory, self-regulation

“Rational operator” perspective Simple beliefs behavior views.

Outcome expectancies

Beliefs x values intentions

More complex attitude theories

Perceived vulnerability to health threats

Risk estimation

Health Belief models

“Action Identification”, Autonomous Regulation and similar social-cognitive models

Regulatory models

Self-efficacy expectancies

Cybernetic / feedback models

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 11

Social-Cognitive / Affective Models

“Affect as information”, self-regulation Dual Process models

Affect v. cognitions Impulse and Self-Control

Cognitive capacity and self-regulation of impulse

Classic self-regulation & social cognitive models

Goals, values, behavioral dispositions and behavioral self-regulation

Self-efficacy (again)

Health protection motivation

Perceived vulnerability

Outcome expectancies

Efficacy expectancies

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 12

Judgments of vulnerability

Personal involvement in health behavior Perceived threat

Cognitive heuristics and risk estimation

Perceived control and vulnerability judgments

Motivated risk perception

Affect (“need states”) and judgments of health risks

Realistic & unrealistic optimism

Unrealistic optimism and mental health

Dispositional optimism and immune function / health status

Optimism (realistic or unrealistic) and risk behavior

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 13

Self-awareness, "automaticity" and health

Cognition as cause and effect… Controlled versus automatic processing

The limitations of conscious controls over behavior

“Mindlessness” and automaticity

Anchoring effects

Automatically activation:

Cognitive processes

Behavioral “scripts”

“Mindfulness” interventions (“making the unconscious conscious…”)

Cognitive Escape and strategic mindlessness

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 14

Social group processes

Core dimensions of society & health: Socio-economic Status

The robust effect of the SES gradient

Increasing SES stratification and health

Minority group stress

Stress, helplessness, anger and immune functioning

Sexual orientation, stress, disfranchisement & health

Race / ethnicity

Mechanisms Physical barriers

Health care access

“Food deserts”

Subordination and immune function

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 15

Psychoimmunology

Basic immune system features

Stress, affect, coping and immune status Reviews of effects

Marital stress

Bereavement

Experimental stress induction

Immune functioning and, e.g., CHD

Illness, immunology and affect “illness behavior”

Psychological variables and immune status Self-perception

“Self-discrepancy”

Self-efficacy

Thought suppression

Ψ Interventions

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 16

Policy, Economic and Political Influences

Industry & politics and health

The Oreo® and obesity

Tobacco / drug / alcohol policy

Can health policy shape behavior?

Models of environmental influence

The “built environment” and health

“Thin French women”: culture and health

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 17

The big picture: Spirituality, happiness, mindfulness & well-being

Spirituality Are religious influences on health “real”?

Subjective spirituality and health

Happiness Positive coping

“Happiness training” and health

Mindfulness Stress reduction

Coping & health

Well-being Personal autonomy and “eudaimonic well-being”

Quality of life

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 18

General Approaches to Health Research: Evolving conceptions of mind body

1. General process: mediating models• What explains or accounts for a stress outcome effect

• Basic theory development & testing

2. Individual differences: moderating models• Establish “boundary conditions” of effect or theory

• Specify sub-population characteristics of an effect

• Descriptive or theory-based: important to specify in advance for efficacy trials.

Stressor, pathogen,

culture

Internal Process

Health Outcome

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 19

Mediating (and additive) models

Environ-mental

change, Adaptation syndrome

Arousal / “allostatic

load”, inflammation

CHD

• Developmental changes• SES, culture, etc.• Individual stress• Ψ change

Health behavior:

Diet, smoking…

Ψ:• Distress, helplessness• Anger

Physiological: • Corticosteroids, pro-inflammatory

cytokines, HPA activation• Lipids, insulin section & “metabolic

syndrome”

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 20

Mediating (and additive) models

Environ-mental

change, Adaptation syndrome

Arousal,inflammation CHD

Psych. Process

Health behavior: diet, exercise,

smoking…

Self-efficacy

Helplessness / depression

Social isolation

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 21

Basic mediating models in health behavior

Stress Illness

Immune function

Exposure to pathogens

Arousal (coritco-steroids)

Negative health

behavior

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 22

Health models with structural exogenous variables

Stress

Illness

“Allostatic load” /

Immune function

Negative health

behavior

Exposure to pathogens

Socio-economic

status

Structural & cultural

barriers to health care

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 23

Basic moderating model

Stress

Health status

Immune function

Health behavior

Interaction of stimulus by Ψ resources“Optimism”,

“hardiness”,

social support

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 24

Ψ & health: Direct effects

Psychoimmunology; Adar’s work on affect, learning and immune function Chronic disease Immune suppression “illness behavior”

Classical conditioning models: immune status, tolerance, withdrawal, placebo effects

Arousal or affective effects on health stress responses, arousal, and cardio-vascular health bereavement and health: see House on social ties and

mortality affect (depression), self-concept, optimism, “sense of

coherence” and immune function Specific stressors and obesity

Key issue: complex relations among CNS, ANS, Immune, and other

systems.

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 25

Ψ & health: Indirect effects

“Health behaviors”:

Individual social / cognitive models:• Self-regulation (self-awareness, self-monitoring, self-efficacy)

• Health information processing

• Self-perception and decision making:

• optimism (realistic or unrealistic)

• readiness to (“stage of”) change

• risk estimation (normative and non-normative)

• change motivation, intrinsic – extrinsic motive

• Affective state,

• Alcohol & drug use

• Social support

Individual Group / Cultural Structural

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 26

Indirect effects of Ψ on health; Health behaviors

Group-level variables: exposure, definition, and availability of (un)healthy behavior

• social norms and/or socially structured rewards and punishments

• gender, age, cultural group effects; smoking, etc.

• models of (un)healthy behavior; processes of modeling influences

• relations of individuals/groups with health “system”; providers, govt., schools, etc.

Structural variables

• Economic / corporate incentives for (un)healthy behaviors

• Main effects of socio-economic disparity

• The built environment and constraints on behavior

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 27

Illness related behaviors 2nd / 3rd prevention Key steps:

Recognition of health problems Definition of “disturbance” or problem Treatment or help seeking

Recognition of a health threat

Basic health information approachesAvailability & usefulness of health information

Surveillance & early detection

Social norms for “deviance”Elasticity of norms

Causal attribution biases

Perceived vulnerability & susceptibilityWeinstein: core Ψ variables (controllability)

Khaneman: Relative irrationality of risk perception

Stress, arousal & avoidance of illness recognition: rejection of “hot” cognitions

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 28

Illness related behaviors 2nd / 3rd prevention

Definition of “disturbance” or problem interpretation of symptoms or signs; implicit health models

Health belief model

Info about health threat

“Cues to action”

Health cognitions

Outcome expectancies for health / illness behavior

“Adaptation level” and drifting criteria for diagnosis

Causal attribution models

Ps

yc

ho

log

y 4

15

; S

oc

ial

Ba

sis

of

He

alt

h B

eh

av

ior

Overview, 9/1/10 29

Illness related behaviors 2nd / 3rd prevention

Treatment or help seeking Health belief / health barrier models: approach of treatment

source

Individual and group differences in efficacy for behavior change

Coping models: instrumental v. affective coping

Socio-cultural variables in treatment response

adherence to treatments