1. Health Cognitions Bill Klein Department of Psychology University of Pittsburgh Pittsburgh Mind-Body Center Summer Institute June 5, 2008

2. OutlineOutline Health Cognitions and Physical Health Health Cognitions and Physical Health Health Cognitions Health Cognitions Attitudes and knowledge Attitudes and knowledge Social cognitions Social cognitions Perceived vulnerability Perceived vulnerability Perceived control/efficacy Perceived control/efficacy Behavioral intentions Behavioral intentions Mental representations of illness Mental representations of illness Attribution and blame Attribution and blame

3. Cognitions and Behavior Leading causes of death are behavioral (e.g., smoking, alcohol use, nutrition, high risk sex) Leading causes of death are behavioral (e.g., smoking, alcohol use, nutrition, high risk sex) Need to understand cognitions that underlie these behaviors in order to change them Need to understand cognitions that underlie these behaviors in order to change them Health Behavior Models Health Behavior Models Theory of Planned Behavior (Ajzen & Madden, 1986) Theory of Planned Behavior (Ajzen & Madden, 1986) Health Belief Model (Janz & Becker, 1984) Health Belief Model (Janz & Becker, 1984) Protection Motivation Theory (Rogers, 1983) Protection Motivation Theory (Rogers, 1983) Stage Models: Transtheoretical Model (Prochaska, DiClemente, & Norcross, 1992); Precaution Adoption Process Model (Weinstein et al., 1998) Stage Models: Transtheoretical Model (Prochaska, DiClemente, & Norcross, 1992); Precaution Adoption Process Model (Weinstein et al., 1998)

4. PBC Subjective Norms Attitudes IntentionsBehavior Theory of Planned Behavior

5. Problems with Models Cross-sectional Cross-sectional Role of environmental constraints and temptations Role of environmental constraints and temptations Past behavior Past behavior Interactions and paths often not specified Interactions and paths often not specified

6. Attitudes and Knowledge Knowledge Knowledge Perceived costs and benefits Perceived costs and benefits Framing health messages (Rothman & Salovey, 1997) Framing health messages (Rothman & Salovey, 1997) Affective orientation toward behavior Affective orientation toward behavior Cognitive dissonance Cognitive dissonance Induced hypocrisy (Stone et al., 1994) Induced hypocrisy (Stone et al., 1994) Defensive processing of health messages Defensive processing of health messages Fear appeals (Hovland et al., 1953) Fear appeals (Hovland et al., 1953) Perceived threat (Croyle et al., 1993) Perceived threat (Croyle et al., 1993) Perceived credibility (Liberman & Chaiken, 1992) Perceived credibility (Liberman & Chaiken, 1992) Self-affirmation (Sherman et al., 2000) Self-affirmation (Sherman et al., 2000)

7. Social Cognitions Subjective norms Subjective norms Injunctive vs. descriptive norms Injunctive vs. descriptive norms Perceived prevalence/social comparison Perceived prevalence/social comparison False consensus and false uniqueness (Suls et al., 1988) False consensus and false uniqueness (Suls et al., 1988) Norm misperception (Prentice & Miller, 1993) Norm misperception (Prentice & Miller, 1993) Threatening social comparisons (Klein & Kunda, 1993) Threatening social comparisons (Klein & Kunda, 1993) Prototype perception Prototype perception Adolescent prototypes (Gibbons et al., 1998) Adolescent prototypes (Gibbons et al., 1998) Stereotypes (Weinstein, 1980) Stereotypes (Weinstein, 1980) Self-presentation Self-presentation Appearance vs. health (Mahler et al., 2003) Appearance vs. health (Mahler et al., 2003)

8. Perceived Vulnerability I Conceptualization Conceptualization Perceived risk (absolute and comparative), perceived probability, perceived likelihood, unrealistic optimism Perceived risk (absolute and comparative), perceived probability, perceived likelihood, unrealistic optimism Role of affect (e.g., “feeling at risk” and regret) Role of affect (e.g., “feeling at risk” and regret) Lay problems with risk estimation Lay problems with risk estimation Use of probability (e.g., small vs. large, 50/50 ≠ 50%) Use of probability (e.g., small vs. large, 50/50 ≠ 50%)

9. Perceived Risk of Breast Cancer (Lipkus, Klein, Skinner, & Rimer, 2005)

10. Perceived Vulnerability I Conceptualization Conceptualization Perceived risk (absolute and comparative), perceived probability, perceived likelihood, unrealistic optimism Perceived risk (absolute and comparative), perceived probability, perceived likelihood, unrealistic optimism Role of affect (e.g., “feeling at risk” and regret) Role of affect (e.g., “feeling at risk” and regret) Lay problems with risk estimation Lay problems with risk estimation Use of probability (e.g., small vs. large, 50/50 ≠ 50%) Use of probability (e.g., small vs. large, 50/50 ≠ 50%) Use of heuristics (availability heuristic, base rate fallacy) Use of heuristics (availability heuristic, base rate fallacy)

11. Illusory Correlation Breast Cancer No Breast Cancer High Antibiotic Use 84 Low Antibiotic Use 42

12. Perceived Vulnerability I Conceptualization Conceptualization Perceived risk (absolute and comparative), perceived probability, perceived likelihood, unrealistic optimism Perceived risk (absolute and comparative), perceived probability, perceived likelihood, unrealistic optimism Role of affect (e.g., “feeling at risk” and regret) Role of affect (e.g., “feeling at risk” and regret) Lay problems with risk estimation Lay problems with risk estimation Use of probability (e.g., small vs. large, 50/50 ≠ 50%) Use of probability (e.g., small vs. large, 50/50 ≠ 50%) Use of heuristics (availability heuristic, base rate fallacy) Use of heuristics (availability heuristic, base rate fallacy) Matching percentages to labels Matching percentages to labels

13. EC Verbal Labels VERBAL DESCRIPTOR EC ASSIGNMENT AVERAGE LAY ESTIMATE Very Common > 10% Common1-10% Uncommon0.1-1% Rare0.01-0.1% Very rare <.01% (Berry, Raynor, & Knapp, 2006)

14. EC Verbal Labels VERBAL DESCRIPTOR EC ASSIGNMENT AVERAGE LAY ESTIMATE Very Common > 10% 65% Common1-10%45% Uncommon0.1-1%17% Rare0.01-0.1%8% Very rare <.01% 4% (Berry, Raynor, & Knapp, 2006)

15. Perceived Vulnerability II Relation to health outcomes Relation to health outcomes Mammography (McCaul et al., 1996): r =.16 across samples; r =.33 among women with a family history Mammography (McCaul et al., 1996): r =.16 across samples; r =.33 among women with a family history Condom use (Gerrard et al., 1996) Condom use (Gerrard et al., 1996) Processing health information (Radcliffe & Klein, 2002) Processing health information (Radcliffe & Klein, 2002) Methodological concerns (Weinstein et al., 1998) Methodological concerns (Weinstein et al., 1998)

16. Perceived Control/Efficacy Control perceptions (Langer & Rodin, 1977) Control perceptions (Langer & Rodin, 1977) Self-efficacy (Bandura, 1977) Self-efficacy (Bandura, 1977) Response efficacy (Rogers, 1983) Response efficacy (Rogers, 1983) Perceived behavioral control (Ajzen, 1991) Perceived behavioral control (Ajzen, 1991) Health locus of control (Wallston, 1992) Health locus of control (Wallston, 1992) Biases in control perceptions Biases in control perceptions Illusion of control (Langer, 1975) Illusion of control (Langer, 1975) Comparative perceptions (Klein & Kunda, 1994) Comparative perceptions (Klein & Kunda, 1994)

17. Drug Problem Imagine you are making a choice between the following two drug treatments for reducing heart attack risk: Drug A has lung-related side effects 1 out of every 100,000 times. However, when these side effects occur, they are instantly fatal. Overall, then, there is a 1 in 100,000 chance of a fatality if you take this drug. Drug B has lung-related side effects 4 out of every 100,000 times. However, when they occur, there are measures you can take to avoid becoming a fatality. The side effects lead to death about 50% of the time. Overall, then, there is a 2 in 100,000 chance of a fatality. Which drug do you prefer? ________ Klein & Kunda, 1994

18. Behavioral Intentions Intentions (Ajzen & Madden, 1986) Intentions (Ajzen & Madden, 1986) Protection motivation (Rogers, 1983) Protection motivation (Rogers, 1983) Willingness (Gibbons et al., 1998) Willingness (Gibbons et al., 1998) Contemplation (Prochaska et al., 1992) Contemplation (Prochaska et al., 1992)

19. Illness Cognition I Illness Representations (Meyer, Leventhal, & Guttman, 1985) Illness Representations (Meyer, Leventhal, & Guttman, 1985) Cause, consequence, timeline, identity, control Cause, consequence, timeline, identity, control Acute vs. chronic illness Acute vs. chronic illness Age differences (Gump et al., 2001) Age differences (Gump et al., 2001) Unrealistic pessimism regarding coping (Blanton et al., 2001); affective forecasting Unrealistic pessimism regarding coping (Blanton et al., 2001); affective forecasting

20. Illness Cognition II Attribution (Seligman, 1975) Attribution (Seligman, 1975) Global, stable, internal attributions for negative events associated with earlier illness onset and mortality (e.g., U. S. Presidents, Hall of Fame baseball players) Global, stable, internal attributions for negative events associated with earlier illness onset and mortality (e.g., U. S. Presidents, Hall of Fame baseball players) Characterological blame worse than behavioral blame over time (e.g., Glinder & Compas, 1999) Characterological blame worse than behavioral blame over time (e.g., Glinder & Compas, 1999) Counterfactual thinking might promote less adaptive coping (Roese & Olson, 1995) Counterfactual thinking might promote less adaptive coping (Roese & Olson, 1995)