Discussion: What is one major implication of the strict behaviorist perspective for the TTI?

2 DECISIONS/INTENTIONS SOCIAL S ITUATION BIOLOGY/ P ERSONALITY THE THEORY OF TRIADIC INFLUENCE ATTITUDES TOWARD THE BEHAVIOR SOCIAL NORMATIVE BELIEFS Trial Behavior EXPERIENCES: Expectancies -- Social Reinforcements -- Psychological/Physiological SELF-EFFICACY BEHAVIORAL CONTROL Nurture/CulturalBiological/Nature Intrapersonal StreamSocial/Normative StreamCultural/Attitudinal Stream Distal Influences Proximal Predictors Levels of Causation Ultimate Causes Social/ Personal Nexus Expectancies & Evaluations Affect and Cognitions Decisions Experiences a b c d e f g h i j k m n o p q r s t u v w x Related Behaviors J K C F I B E H A D G CULTURAL E NVIRONMENT Strict behaviorists do not believe in thoughts and feelings

Thanks to Jill Hoxmeier for some of these slides

“Reduction and prevention of morbidity and mortality in populations in a public health goal that can be achieved only by behavior change.” (Hovell, Wahlgren & Adams, 2009) » A Need for New Model of Health Behavior ˃Current approaches have limited success ˃In part due to theory, and in part due to focus on individual ˃Approaches need to be population-focused Which HRB are you going to change?

» The Behavioral Ecological Model (BEM) ˃Links behavioral to biological sciences: Foundation for behavior and learning ˃Emphasis on ecological principles of selection of behaviors by consequences ˃At individual level and group/culture level » Mentalism vs. Contextualism ˃Friend who orders the salad / low-fat dressing… ˃What do we assume to the cause? ˃What could be the contextual cause? “Behavioral principles describe the relations between behavior and environment that account for the acquisition and maintenance of learned behavior.” – Glenn, 2004 (Hovell, Wahlgren & Adams, 2009)

Community Social/Cultural Individual Level Local Learning History Physiology Anatomy Genome Behavior Consequences Context Within the Skin Outside the Skin Determine Likeliness of Specific Behavior (Hovell, Wahlgren & Adams, 2009)

» Operant Selection & Conditioning ˃Reinforcements / Consequences select for operant behavior ˃Rush-hour traffic and selecting for commute time » Cultural Selection (Meta-Contingencies) ˃Practices select for behavior from contingencies of culture ˃What defines a “culture”? » Natural Selection ˃Genetic variants such as reflexes and ability to learn » Unlearned and Learned Reinforcers ˃Innate vs. Acquired ˃Conditional reinforcers can become extremely powerful if paired with multiple established reinforcers +Can we use money to reinforce or punish for certain HRB? (Hovell, Wahlgren & Adams, 2009)

» Group Contingencies ˃Monitor and modify through group “culture” rules: bike vs. climb community » Cultural Practices ˃Repetition of learned behavior; Interlocking patterns of behavior » Metacontingencies vs. Macrocontingencies? ˃Aggregate product of group behavior… not interlocked at Macro-level Weight-Loss Support Groups vs. Nation-wide Weight-loss Media Campaign

» Does… ˃Higher gas prices + higher food prices (because of gas prices) = less driving, more walking, and growing your own food? » Social Learning vs. Individual Learning ˃All learning is individual learning ˃Learning comprises the events... an individual organism relating to environmental events ˃The social content in the contingencies that support most of the learning accomplished by humans is a defining feature of cultures (Glenn, 2004)

“Unintended and culturally damaging results of ongoing human behavior are first identified, then bemoaned, and sometimes, finally dealt with… But can they be dealt with fast enough to ensure survival?” (Glenn, 2004) » Examples of culturally damaging results of human behavior? » Warning signs of predictive delayed impact? » Responsible “subcultures”?

» Question for the class: ˃What is the meta-contingency context in which the HRB exists? The more widespread a practice, the greater its cumulative effects; the greater the cumulative effects, the more important they are to the well-being of large numbers of people.” (Glenn, 2004)

» Purpose: assess determinants of early WIC participation in NC county. » Measurement: Likert-type questionnaire to assess intrapersonal, interpersonal, organization/system, and community/cultural contingencies » Result: barriers at all levels influence WIC participation » Recommendations: BEC framework to account the personal, cultural, and environmental influences that promote the adoption of positive HRB

» Individual Level Contingencies: ˃Perceived threat ˃Perceived benefits ˃Perceived barriers ˃Self-efficacy ˃Cues to action Measurement: 42 item survey using _____ to assess the following. With a partner, develop one survey item for each individual level contingency. » Does this sound familiar?

» Individual Level Contingencies: Perceived Threat ˃I believe a pregnant woman can feel sick if she does not eat right ˃I believe a baby may be born with health problems if its mother does not eat well during pregnancy ˃I believe a newborn baby could get sick if it is not properly fed » Individual Level Contingencies: Perceived Benefits ˃WIC helps me to eat better ˃My baby benefits from WIC ˃I believe I am healthier because I eat WIC foods » Individual Level Contingencies: Perceived Barriers ˃I don’t like to use the food vouchers WIC provides

» Individual Level Contingencies: Self-Efficacy ˃Changing the foods I eat was hard to do ˃Changing the foods my children eat was hard to do » Individual Level Contingencies: Cues to Action ˃Have you used WIC during previous pregnancies? ˃I heard about WIC through (friend, family, neighbor, church, health dept., hospital)

» Local Network: Family, Friends, and Co-Workers ˃My friends and family have used WIC services ˃I heard about WIC through (friend, family, neighbor, church, health dept., hospital) » Community Contingencies: Policies/Cultural Competency ˃The people on the WIC staff are helpful ˃I believe the people at WIC respect me ˃It was hard to get on WIC » Social Contingencies: Normative Beliefs, Laws, Policies ˃It is hard to get on WIC because I have transportation problems

» Local Network: Family, Friends, and Co-Workers » Community Contingencies: Policies/Cultural Competency » Social Contingencies: Normative Beliefs, Laws, Policies As a class, what are some strategies we can develop to address the barriers found by the BEC survey?

» Local Network: Family, Friends, and Co-Workers ˃Increase awareness of WIC program ˃Increase awareness of WIC among social networks ˃Provide incentives for referral » Community Contingencies: Policies/Cultural Competency ˃Increase helpfulness of staff ˃Increase ease of entering program ˃Increase hours of operation ˃Decrease length of time in between client contact and first appointment » Social Contingencies: Normative Beliefs, Laws, Policies ˃Increase awareness of WIC program to all associations, coalitions, formal and information leaders ˃Increase awareness of WIV benefits ˃Provide incentives to refer target population to WIC ˃Develop culturally appropriate social marketing plans which markets WIC benefits of WIC to ethnically divers sub populations ˃Implement a culturally appropriate social marketing plans which market WIC benefits of WIC to ethnically diverse populations