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The 3rd revolution in health

1. Communicable disease Psychology 415; Social Basis of Health Behavior

 Direct product of “civilizing” / urbanization of populations

 Moderate population density  greater disease resistance  Exposure & recovery from pathogens  Genetic drift (?)

“Contact” disease spread & colonization…

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

 Epidemiology  “Broad Street Pump”

 Urban renewal, waste & water treatment… Chicago River direction: Mississippi v. Great Lakes watersheds Overview, 9/1/10

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3rd revolution in health

2. Chronic “lifestyle” disease Psychology 415; Social Basis of Health Behavior

 Increasingly product of individual behaviors  The big 7:

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• Not smoking • Moderate alcohol Key risk disposition: social & • Exercise • Sleep  Tobacco marketing • Moderate weight  “Industrialized” food production • Regular meals • Breakfast Built environment

marketing 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 Overview, 9/1/10

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The 3rd revolution in health

3. Health as positive resource Psychology 415; Social Basis of Health Behavior

 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 (?)

Overview, 9/1/10

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Psychology 415; Social Basis of Health Behavior

A general framework Exogenous variables Stressor, pathogen, culture

Internal Process

Health Outcome

Chronic Acute • Stress • Stress • Chronic disease • Affect • Environmental exposure • Environmental • Social inequity exposure • Cultural norms • “Person” variables Temperament Personality Overview, 9/1/10

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Psychology 415; Social Basis of Health Behavior

A general framework Endogenous variables Stressor, pathogen, culture

Internal Process

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

Overview, 9/1/10

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Health Outcome

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

Psychology 415; Social Basis of Health Behavior

A general framework Outcome variables Stressor, pathogen, culture Behavioral • Health behaviors • Alcohol drug abuse • Risk, etc.

Overview, 9/1/10

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Internal Process

Biomedical • CHD • BMI • Infection, etc.

Health Outcome

Course topics  Overview of Health behavior concepts Psychology 415; Social Basis of Health Behavior

 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 Overview, 9/1/10

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Health behavior & behavioral medicine concepts

Psychology 415; Social Basis of Health Behavior

 CHD as core example of health behavior process 1. Direct effects of stress or affect Stress or Arousal  Anger (“allostatic load”)  Chronic arousal,  Depression  Hypothalamic-Pituitary-Adrenal axis (HPA axis)

2. Behavioral variables  Smoking  Dietary

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 Exercise 

Immunomodulation, inflammation, Sleep...

3. Illness-related behaviors

“illness behavior” CHD

 Illness conceptions  Recognition, “definition”, treatment seeking  Adherence Overview, 9/1/10

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Personality theory & health / health behavior

 Stable, individual differences: Psychology 415; Social Basis of Health Behavior

 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”) Overview, 9/1/10

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Basic attitude theory, self-regulation

 “Rational operator” perspective Psychology 415; Social Basis of Health Behavior

 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 Overview, 9/1/10

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Social-Cognitive / Affective Models

 “Affect as information”, self-regulation Psychology 415; Social Basis of Health Behavior

 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 selfregulation

 Self-efficacy (again)  Health protection motivation  Perceived vulnerability  Outcome expectancies  Efficacy expectancies Overview, 9/1/10

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Judgments of vulnerability

 Personal involvement in health behavior Psychology 415; Social Basis of 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

Overview, 9/1/10

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Self-awareness, "automaticity" and health

 Cognition as cause and effect… Psychology 415; Social Basis of Health Behavior

 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

Overview, 9/1/10

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Social group processes

 Core dimensions of society & health: Psychology 415; Social Basis of Health Behavior

 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 Overview, 9/1/10

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Psychoimmunology

Psychology 415; Social Basis of Health Behavior

 Basic immune system features  Stress, affect, coping and immune status  Reviews of effects  Marital stress  Bereavement  Experimental stress induction

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 Immune functioning and, e.g., CHD  Illness, immunology and affect  “illness behavior” Psychological variables and immune status  Self-perception  “Self-discrepancy”  Self-efficacy

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 Thought suppression Ψ Interventions

Overview, 9/1/10

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Policy, Economic and Political Influences

Psychology 415; Social Basis of Health Behavior

 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

Overview, 9/1/10

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

Psychology 415; Social Basis of Health Behavior

 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 Overview, 9/1/10

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General Approaches to Health Research:

Psychology 415; Social Basis of Health Behavior

Evolving conceptions of mind  body

Stressor, pathogen, culture

Internal Process

Health Outcome

1. General process: mediating models •

What explains or accounts for a stress  outcome effect

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Basic theory development & testing

2. Individual differences: moderating models •

Establish “boundary conditions” of effect or theory

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Specify sub-population characteristics of an effect

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

Overview, 9/1/10

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Psychology 415; Social Basis of Health Behavior

Mediating (and additive) models Environmental change, Adaptation syndrome

Arousal / “allostatic load”, inflammation

CHD

Ψ: • Distress, helplessness • Anger

• • • •

Physiological:

Developmental changes • Corticosteroids, pro-inflammatory Health cytokines, HPA activation SES, culture, etc. behavior: • Lipids, Diet, insulin section & “metabolic Individual stress syndrome” smoking… Ψ change

Overview, 9/1/10

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Psychology 415; Social Basis of Health Behavior

Mediating (and additive) models

Environmental change, Adaptation syndrome

Psych. Process

Arousal, inflammation

Self-efficacy Helplessness / depression Social isolation

Health behavior: diet, exercise, smoking… Overview, 9/1/10

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CHD

Psychology 415; Social Basis of Health Behavior

Basic mediating models in health behavior

Immune function

Stress

Negative health behavior Illness Exposure to pathogens

Arousal (coritcosteroids) Overview, 9/1/10

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Psychology 415; Social Basis of Health Behavior

Health models with structural exogenous variables “Allostatic load” / Immune function

Stress Negative health behavior

Socioeconomic status

Illness Exposure to pathogens

Structural & cultural barriers to health care Overview, 9/1/10

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Psychology 415; Social Basis of Health Behavior

Basic moderating model

Immune function

Stress

“Optimism”,

“hardiness”, social support

Overview, 9/1/10

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Interaction of stimulus by Ψ resources

Health status Health behavior

Ψ & health: Direct effects

Psychology 415; Social Basis of Health Behavior

 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 onKey health issue:  stress responses, arousal, and cardio-vascular health complex relations  bereavement and health: seeamong House on social ties and CNS, ANS, mortality Immune, and other  affect (depression), self-concept, optimism, systems.“sense of coherence” and immune function

 Specific stressors and obesity Overview, 9/1/10

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Ψ & health: Indirect effects

Psychology 415; Social Basis of Health Behavior

 “Health behaviors”:

 Individual  Group / Cultural  Structural

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 Overview, 9/1/10

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Indirect effects of Ψ on health; Health behaviors Group-level variables: exposure, definition, and availability of Psychology 415; Social Basis of Health Behavior

(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 Overview, 9/1/10

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Illness related behaviors 2nd / 3rd prevention

Psychology 415; Social Basis of Health Behavior

 Key steps:

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

 Recognition of a health threat  Basic health information approaches 

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 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”

Overview, 9/1/10

cognitions

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Illness related behaviors 2nd / 3rd prevention  Definition of “disturbance” or problem Psychology 415; Social Basis of Health Behavior

 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

Overview, 9/1/10

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Illness related behaviors 2nd / 3rd prevention Psychology 415; Social Basis of Health Behavior

 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

Overview, 9/1/10

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