Psychology 415; Social Basis of Health Behavior Overview, 9/1/10 1 The 3 rd 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

Psychology 415; Social Basis of Health Behavior Overview, 9/1/ rd 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 Not smoking Moderate alcohol Exercise Sleep Moderate weight Regular meals Breakfast

Psychology 415; Social Basis of Health Behavior Overview, 9/1/10 3 The 3 rd 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Ψ  Social  Health as a human right (?)

Psychology 415; Social Basis of Health Behavior Overview, 9/1/10 4 A general framework Exogenous variables Stressor, pathogen, culture Internal Process Health Outcome Chronic Stress Chronic disease Environmental exposure Social inequity Cultural norms “Person” variables Temperament Personality Acute Stress Affect Environmental exposure

Psychology 415; Social Basis of Health Behavior Overview, 9/1/10 5 A general framework Endogenous 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

Psychology 415; Social Basis of Health Behavior Overview, 9/1/10 6 A general framework Outcome variables Behavioral Health behaviors Alcohol drug abuse Risk, etc. Biomedical CHD BMI Infection, etc. Stressor, pathogen, culture Internal Process Health Outcome

Psychology 415; Social Basis of Health Behavior 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

Psychology 415; Social Basis of Health Behavior 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 Stress or Arousal (“allostatic load”) Hypothalamic-Pituitary-Adrenal axis (HPA axis) Immunomodulation, inflammation,  “illness behavior”  CHD  

Psychology 415; Social Basis of Health Behavior 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”)

Psychology 415; Social Basis of Health Behavior 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

Psychology 415; Social Basis of Health Behavior 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

Psychology 415; Social Basis of Health Behavior 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

Psychology 415; Social Basis of Health Behavior 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

Psychology 415; Social Basis of Health Behavior 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

Psychology 415; Social Basis of Health Behavior 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

Psychology 415; Social Basis of Health Behavior 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

Psychology 415; Social Basis of Health Behavior 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

Psychology 415; Social Basis of Health Behavior 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

Psychology 415; Social Basis of Health Behavior Overview, 9/1/10 19 Mediating (and additive) models Environ- mental change, Adaptation syndrome Arousal / “allostatic load”, inflammation CHD Developmental changesDevelopmental changes SES, culture, etc.SES, culture, etc. Individual stressIndividual stress Ψ changeΨ change Health behavior: Diet, smoking… Ψ : Distress, helplessness Anger Physiological: Corticosteroids, pro-inflammatory cytokines, HPA activation Lipids, insulin section & “metabolic syndrome” Ψ:Ψ: Distress, helplessness Anger Physiological: Corticosteroids, pro-inflammatory cytokines, HPA activation Lipids, insulin section & “metabolic syndrome”

Psychology 415; Social Basis of Health Behavior Overview, 9/1/10 20 Mediating (and additive) models Environ- mental change, Adaptation syndrome Arousal, inflammation Arousal, inflammation CHD Psych. Process Health behavior: diet, exercise, smoking… Self-efficacy Helplessness / depression Social isolation Self-efficacy Helplessness / depression Social isolation

Psychology 415; Social Basis of Health Behavior Overview, 9/1/10 21 Basic mediating models in health behavior Stress Illness Immune function Exposure to pathogens Arousal (coritco- steroids) Negative health behavior

Psychology 415; Social Basis of Health Behavior 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

Psychology 415; Social Basis of Health Behavior 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

Psychology 415; Social Basis of Health Behavior 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.

Psychology 415; Social Basis of Health Behavior 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

Psychology 415; Social Basis of Health Behavior 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

Psychology 415; Social Basis of Health Behavior Overview, 9/1/10 27 Illness related behaviors 2 nd / 3 rd prevention  Key steps:  Recognition of health problems  Definition of “disturbance” or problem  Treatment or help seeking  Recognition of a health threat  Basic health information approaches Availability & usefulness of health information Surveillance & early detection  Social norms for “deviance” Elasticity of norms Causal attribution biases  Perceived vulnerability & susceptibility Weinstein: core Ψ variables (controllability) Khaneman: Relative irrationality of risk perception Stress, arousal & avoidance of illness recognition: rejection of “hot” cognitions

Psychology 415; Social Basis of Health Behavior Overview, 9/1/10 28 Illness related behaviors 2 nd / 3 rd 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

Psychology 415; Social Basis of Health Behavior Overview, 9/1/10 29 Illness related behaviors 2 nd / 3 rd 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