Health and Social Behavior, Fall, 2007

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Health and Social Behavior, Fall, 2007

Transcript Of Health and Social Behavior, Fall, 2007

Health and Social Behavior (psych 415)

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Health and Social Behavior, Fall, 2007
(psych 415)
David J. McKirnan The University of Illinois at Chicago, Department of Psychology
m/c 285, 1007 W. Harrison St., Chicago, Il. 60607-7137 312-413-2634 / fax: 312-413-4122 / e-mail: [email protected]

Updated 9/13/07

Health and Social Behavior is a graduate course addressing theory and research on social and psychological factors in health and health behavior. The focus will be theories and data from clinical & social psychology and public health, addressing healthor prevention-related behavior, stress and coping, design and evaluation of behavioral interventions, and community or policy-level issues.
Readings will be primarily journal articles and reviews, with some general text chapters. Students will write a brief (1 -2 Pp., double spaced) reaction paper each week discussing the readings. The primary purpose of the reaction papers is to give you momentum for class discussion, so try to be as innovative and speculative as you can.
The major evaluation for the course will be a PHS-style grant proposal presenting an empirically testable model of a health behavior or intervention. Students are strongly advised to articulate this project with their other (MA, Prelim, Ph.D.) work.
A general topic list is given here. We will not address all of these in depth. The target behaviors & theories we address will be guided by student (and instructor!) interests (as may the class meeting time).

Course Schedule
(click on links to go to a given week)

Week 1

Introductions, student goals & projects

Week 2 Overview: How theories work

Week 3

Overview of Health behavior & behavioral medicine concepts

Week 4

Basic attitude theory, selfregulation

Week 5

Self-regulation, SelfEfficacy and the Health Belief model.

Week 6

General SocialCognitive / Affective Models: Cognitive representations of health and illness, Protection Motivation Theory

Week 7

Judgments of vulnerability: Perceived threat, motivated risk perception, realistic & unrealistic optimism.

Week 8

Self-awareness, "Automaticity", and Cognitive Escape.

Week 10 Socio-economic Status and Health.

Week 11 SES, Race and Health.

Weel 12 Overview of


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Week 13 Week 14 Week 15

Psychoimmunology 2: Effects and interventions
Policy, Economic and Political Influences on Health
Spirituality, Happiness, Mindfulness, WellBeing and Health

Misc. Class materials, updated 9/13/07 [Look for updates here!]
Paper outline here.

Weekly topics & readings.

Introductions, student goals and projects, overall framework of Health Psychology

Week 1.

This first week we will spend discussing the course and articulating student goals. So, for your "reaction" paper please describe your interests in Health Behavior, particularly vis-a-vis theories or bodies of empirical work you are particularly interested in. I will try to adjust the schedule to meet everyone's interests.

To kick off we will have readings at two extremes, just to illustrate the range of issues we will adress and to get you all thinking. The first is on social networks and obesity (the paper that has been all over the news recently), and two others taking much more of a neuro-biological look at behavior, one a review of "Social neuroscience" and another on histocompatability, mating and romantic faithfulness (and you thought love was an emotion...).

Primary Readings

Christakis, N. A., & Fowler, J. H. (2007). The Spread of Obesity in a Large Social Network over 32 Years. N Engl J Med, 357(4), 370-379. Link

Barabasi, A.-L. (2007). Network Medicine -- From Obesity to the "Diseasome". N Engl J Med, 357(4), 404-407. Link

Cacioppo, J. T., Amaral, D. G., Blanchard, J. J., Cameron, J. L., Sue Carter, C., Crews, D., et al. (2007). Social Neuroscience: Progress and Implications for Mental Health. Perspectives on Psychological Science, 2(2), 99-123. Link

Garver-Apgar, C. E., Gangestad, S. W., Thornhill, R., Miller, R. D., & Olp, J. J. (2006). Major Histocompatibility Complex Alleles, Sexual Responsivity, and Unfaithfulness in Romantic Couples. Psychological Science, 17(10), 830-835. Link


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Discussion of grant proposal assignment. Overview of basic theories
Defining the research phenomena
Contrast spaces, defining research questions, counterfactuals.
What is explained in social science: structural presuppositions in explanations, “counterfactuals” and explanations.
Decisions about research strategies: testing theories, using theory to test applications.
Week 2. Criteria for causation: covariation, changeability, etc. The importance of construct validity.
Boundary conditions in research; the nature & importance of moderator effects in data & theory.
Non-linear models of social & behavioral change
The first two readings are pdf copies of Xerox copies – they may be a little difficult to read. Let me know if they are too rough. The first reading can be dense -- if you can put in some time on it, it is very rewarding. The White paper is a nice historical overview of concepts of "cause", whereas the Cook & Campbell paper is a nice fast read applying these concepts to psychology. Not here are structural modelling perspectives, which we can discuss in class. Primary Readings
Garfinkel, A. (1981). Forms of Explanation: Rethinking the Questions in Social Theory. Yale University Press, New Haven. Pp. 1-74. Link
McGuire, W.J. (1983). A Contextualist theory of knowledge: Its implications for innovation and reform in psychological research. In L. Berkowitz (Ed.), Advances in Experimental Social Psychology, 16, 1-47, New York: Academic Press. Link
White, P.A. (1990). Ideas About Causation in Philosophy and Psychology. Psychological Bulletin, 1990, Vol. 108, No. 1, 3-18. Link
Cook, T.D. & Campbell, D.T. (1979). Quasi-experimentation: Design & Analysis Issues for Field Settings. Houghton Mifflin Co., Boston. Chapter 1, Causal inference and the language of experimentation, Pp. 1-36. Link
For a nice web- based overview go to:
Bonus Reading:
A lot of university-based research pertenent to health is funded privately. The most conspicuous of this is drug research, although many other clinical trials are private funded. Pre-clinical and efficacy trials for a new medication can easily cost half a million dollars or more, so private industry is an important source of funding. However, this raises some serious reporting and validity issues. This piece from Atlantic is a nice


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overview. Press, E. & Washburn, J. (2000). The Kept University. The Atlantic Monthly. Volume 285, No. 3; page 39-54. (On-line version; Link

2-pager assignment For each week I want a 1 to 2 page (double spaced, regular margins) thought paper. Use this as a spring board to make insightful points in class and impress your fellows. For this week see if you can apply some of the causality / contrast space / explanatory relatively concepts to your ongoing research. How have you struggled with defining your "contrast space" or articulating the "boundary conditions" of your research? Can you actually say what causes what in your specific research or in your field generally? Why is (or is not) this larger topic important in your area?.

Overview of Health behavior & behavioral medicine concepts

Week 3.

These readings are a little dated but give good overviews of core concepts and models. We will do more "big picture" stuff as we go along, particularly on the Psychosocial side. The Krantz article is limited to CHD, but gives a more recent look at core constructs.

Theory-testing PowerPoint show here. Basic health models PowerPoint show here.
Primary readings

Breslow, L. (2004). Perspectives: The Third Revolution in Health. Annual Review of Public Health, Preface,Vol. 25, xii - xviii. Link

House, J.S., Landis, K.R., & Umberson, D (1988). Social relationships and health. Science, 241, 540-545. Link

Baum, A. & Posluszny, D.M. (1999). Health Psychology: Mapping Biobehavioral Contributions to Health and Illness. Annual Review of Psychology, 50, 137-163. Link

Krantz, D. S., & McCeney, M. K. (2002). Effects Of Psychological And Social Factors On Organic Disease: A Critical Assessment of Research on Coronary Heart Disease. Annual Review of Psychology, 53(1), 341-369. Link

Bonus Reading Does crime spread like an infectious disease? Could other "problem" behaviors such as smoking or unsafe sex? Equally important, is the spread of one of these problems nonlinear (unlike virtually all of our statistical models) such that a "flat" distribution suddenly takes off after some crucial threshold has been reached? We will address "diffusion" and norm models as we go, but here is a cute piece from the New Yorker on the Tipping Point. Gladwell, M. The Tipping Point. New Yorker. Link

2-pager assignment You class assignment will be a short version of a PHS research grant proposal. Begin thinking about your grant proposal topic and design; optimally you should take an active research interest and apply it directly to a core health behavior or health status (biomedical) outcome. Apply one of the models we discuss this week -- be prepared to chat about it during class so each of us can be discussing the actual applicability of


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these general models and findings

Basic attitude theory, self-regulation

Week 4.

This is a fairly recent attitude overveiw by Ajzen, who wrote the granddaddy of attitude thoeries with Marty Fishbein at UIUC. We will spend a lot of time late on more sophisticated cognitive theories from Social Psychology, but this is a good review.

The Karoly paper is a little old but is still a nice overview of self-regulation, more from an information processing frame. There are also two more applied / descriptive papers.

Primary readings

Ajzen, I. (2001). Nature And Operation Of Attitudes. Annual Review of Psychology, 52(1), 27-58. Link

Karoly, P. (1993). Mechanisms of self-regulation: A systems view. Annual Review of Psychology, 44, 23-52. Link

Williams, G.C., Rodin, G.C., Ryan, R.M., Grolnick, W./S., & Deci, E.L. (1998). Autonomous regulation and long - term medication adherence in adult outpatients. Health Psychology, 17(3), 269-276. Link

Albarracin, D., Johnson, B. T., Fishbein, M., & Muellerleile, P. A. (2001). Theories of reasoned action and planned behavior as models of condom use: A meta-analysis. Psychological Bulletin, 127(1), 142-161.Link

Bonus Reading This paper is not really about attitiudes or norms per se. (a key component of the Fishbein model is social norms), although I guess I could make a linkage between cultural norms, sexual attitudes, and lax self-reglation in key environments. Anyway, this is an excellent piece on the "down low" phenomenon among African-American men who have sex with men. Just to spice up your week... Link

2-pager assignment Attitude theory is in fact one important perspective on self-regulation; it assumes that these consciously available, fairly rational constructs directly guide our behavior within the specific situations they pertain to. Azjen adds some perspective from Efficacy and related theories, suggesting that simple "here is what I should do" judgements may not be the whole story. Karoly and others of course go well beyond this. What is your take on the utility of these different theories in the health area you are most interested, and why? (Of course, any intelligent alternative 2-pager topic is just fine...).

More on self-regulation, plus Self-Efficacy and the Health Belief model.
This week we have a good self-regulation overview by Carver & Scheier. This is a little redundant with the Karoly paper, but is more comprehensible. They also provide a brief overview of Robin Vallacher's Action Identification theory, Gray's approach-avoidance framework, and some non-linear models. Also in the general self-regulation frame is Bandura's paper on self-efficacy and health


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behavior. This is dated but represents a nice overview of his perspective, plus some nice health data. The bonus paper is a monster chapter by Bandura giving his Sermon from the Mount on how all of behavior works. The Health Belief paper is a big bird's-eye-view discussion that could be more critical but provides a nice overview.

Week 5.

We will return briefly to the Karoly paper at the beginning of class to finish that off, then get to Carver. After the break we can do Bandura and Health Belief. If we do not get through the Health Belief model we will pick it up next week, when we cover a other social-psychology infused health behavior models. These files are large -- particularly the bonus paper.

Primary readings
Carver, C.S. & Scheier, M.F. (2000). On the structure of behavioral self-regulation. In: M. Boekaerts, P. Pintrich & M. Zeidner (Eds)., Handbook on Self-Regulation. New York: Academic Press. Pp. 41-84. Link
Bandura, A. (1991). Self-efficacy Mechanism in Physiological Activation and HealthPromoting Behavior. In J. Madden (Ed.), Neurobiology of Learning, Emotion, and Affect. New York: Raven, Pp. 229-269. Link
Strecher, V.J., Cahampion, V.L. & Rosenstock, I.M. (1997). The health belief model and health behavior. In D.S. Gochman (Ed.), Handbook of Health Behavior Research I: Personal and Social Determinants. New York, Plenum, Pp. 71-91.Link
Bonus Reading Bandura, A. (1991). Self-regulation of motivation through anticipatory and self-reactive mechanisms. In R.A. Dienstbier (Ed.), Perspectives on Motivation: Nebraska Symposium on Motivation. Vol. 38, Pp. 69-164. Lincoln: University of Nebraska Press. Link
2-pager assignment With Karoly and Carver & Scheier and, to some extent, Bandura we are getting into the real cognitive-social guts of self-regulation. We will get more applied as me move along. For now, think of your health research interests from the perspective of more basic mechanisms; what core cognitive processes may underlie whatever phenomenon you are addressing. Extra points if you can apply Chaos theory or another sexy non-linear model!
As usual, any intelligent alternative topic is just fine....

General Social-Cognitive / Affective Models: Cognitive representations of health and illness, Protection Motivation Theory, Miller’s “C-SHIP” model.

Week 6.

This week we review three perspectives on how people respond to potential health threats. Like the Health Belief Model, Cognitive Representations of Health is less a bounded "theory" than a more general orientation toward understanding health vis-à-vis "thinking about how people think". Rogers and others purport to “test” Protection Motivation as a bounded theory, although it really just marries self-efficacy or perceived control to perceived vulnerability. Miller ties many of these perspectives together in her general C-SHIP model. Miller’s model is not testable per se, nor has it remained in the literature as a specific theory of health behavior. However, this (somewhat poorly written … sorry!) review does summarize many perspectives, and provides a strong and interesting role for


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negative affect in the health behavior process.
Your (short!!) bonus paper questions whether any of these social-cognitive models are really testable per se., with a reply by Ajzen..
Primary readings
Wu, Y., Stanton, B. F., Li, X., Galbraith, J., & Cole, M. L. (2005). Protection Motivation Theory and Adolescent Drug Trafficking: Relationship Between Health Motivation and Longitudinal Risk Involvement. Journal of Pediatric Psychology, 30(2), 127-137. Link
Sturges, J.W. & Rogers, R.W. (1996). Preventive health psychology from a developmental perspective: An extension of protection motivation theory. Health Psychology, 15(3), 158-166. Link
Lau, R. (1997). Cognitive representations of health and illness. In: D.S. Gochman (ed.), Handbook of Health Behavior Research I. Plenum, New York, Pp. 41 - 67. Link
Benyamini, Y., Gozlan, M., & Kokia, E. (2004). On the self-regulation of a health threat: Cognitions, coping, and emotions among women undergoing treatment for infertility. Cognitive Therapy & Research, 28(5), 577-592. Link
Miller, S.M., Shoda, Y., & Hurley, K. (1996). Applying cognitive-social theory to healthprotective behavior: Breast self-examination in cancer screening. Psychological Bulletin, 119(1), 70-94. Link Bonus Reading Ogden, J. (2003). Some problems with social cognition models: A pragmatic and conceptual analysis. Health Psychology, 22(4), 424-428. Link
Ajzen, I., & Fishbein, M. (2004). Questions Raised by a Reasoned Action Approach: Comment on Ogden (2003). Health Psychology, 23(4), 431-434. Link
2-pager assignment
The usual -- see what you can apply here, or just give me some intelligent comments that you can use to sound smart in class. Of some interest -- to me at any rate -- is the integration of affect with these other models. Use your 2-pager to speculate or to move toward real hypotheses...
Judgments of vulnerability: Perceived threat, motivated risk perception, realistic & unrealistic optimism.
Perceived vulnerability to a health threat is central to protective or risk behavior. How and when we make such judgments is a core question. We will read Neil Weinstein's basic perspective on optimistic bias in risk perceptions, plus two empirical articles that illustrate these effects. Then read Janet Talor’s classic discussion of how optimism – realistic or otherwise – may in fact underlie positive mental health and coping. Following are two papers demonstrating how individual differences in optimism may in fact not only affect coping, but more direct measures of health.


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Week 7.

The bonus paper, which I recommend you wade through, is from an excellent book by Kahneman, Slovic and Tversky on cognitive heuristics. Tversky went on to win a Nobel prize for this work as it applied to Economics. This chapter summarizes many of their concepts as they apply to risk perceptions. For those interested in optimism I have included a bonus paper addressing whether “optimism - pessimism” actually has construct validity, or is simply a variant on neuroticism or negative – positive affectivity.

Most of these articles are short, so do not be put off by the raw number.
Primary Readings Weinstein, N. (1989) Optimistic Biases about Personal Risks. Science, New Series, 246 (4935),1232-1233. Link
Weinstein, N.D. (1980) Unrealistic optimism about future life events. Journal of Personality and Social Psychology, 39, 806-820. Link
Arnett, J. J. (2000). Optimistic bias in adolescent and adult smokers and nonsmokers. Addictive Behaviors, 25(4), 625-632. Link
Blanton, H., & Gerrard, M. (1997). Effect of sexual motivation on men's risk perception for sexually transmitted disease: There must be 50 ways to justify a lover. Health Psychology, 16(4), 374-379. Link
Taylor, S. & Brown, J.D. (1988). Illusion and well-being: A social psychological perspective on mental health. Psychological Bulletin, 103(2), 193-210. Link

Raikkonen, K., Matthews, K. A., Flory, J. D., Owens, J. F., & Gump, B. B. (1999). Effects of optimism, pessimism, and trait anxiety on ambulatory blood pressure and mood during everyday life. Journal of Personality & Social Psychology, 76(1), 104-113. Link
Segerstrom, S. C., Taylor, S. E., Kemeny, M. E., & Fahey, J. L. (1998). Optimism is associated with mood, coping and immune change in response to stress. Journal of Personality & Social Psychology, 74(6), 1646-1655. Link
Bonus Readings

Slovic, P., Fishhoff, B. & Lichtenstein, S. (1982). Facts versus fears: Understanding perceived risk. In: D. Kahneman, P. Slovic & A. Tversky (Eds.), Judgment Under Uncertainty: Heuristics and Biases. Cambridge, Cambridge University Press, 1982.Link

Smith, T. W., Pope, M. K., Rhodewalt, F., & Poulton, J. L. (1989). Optimism, neuroticism, coping, and symptom reports: An alternative interpretation of the Life Orientation Test. Journal of Personality & Social Psychology, 56(4), 640-648. Link

2-pager assignment
The usual -- see what you can apply here, or just give me some intelligent comments that you can use to sound smart in class.

Some out of the blue bonus readings on science and empiricism in modern life
After Harry Frankfort wrote the essay On Bullshit it made its way onto the web, and subsequent semi-fame. He has recently expanded it into a book-length treatment. He makes a vital distinction between lying and "bullshit". In his view lying reflects a respect


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for and knowledge of the truth (or at least a possible truth), despite a conscious decision to make a contrary statement. He describes bullshit as a simple disregard for the actual or even potential truth value of a statement, or perhaps even a belief that there is no such thing as "truth". For Frankfort bullshit is a situation where sincerity or personal conviction outweighs or even replaces any concern about the factual basis of statements. The application to current social and political discourse is obvious.
I am also enclosing a nice piece from the New Yorker by Allen Orr on Why Intelligent Design Isn't. FYI and edification.

Self-awareness, "Automaticity", and Cognitive Escape.

Week 8.

This week we review still more basic cognitive-social processes, here the larger phenomenon of self-awareness. As you have noted, most models we have discussed assume that people "know what they are doing" and make conscious decisions about behavior. That assumption may not always hold. Karoly several weeks ago and Bargh here notes that much of behavior is relatively “mindless” (that is, “automatic” rather than “controlled”). Automatic cognitive behavior (such as lexical processing, generative grammar, etc.) is dramatically more efficient: imagine if you had to consciously parse each sentence you recognize or speak. The same may be the case for much of our self-regulatory behavior.

Of course there may be times when being “mindful” of our behavior and its consequences is actually aversive, and we are motivated to escape selfawareness. Heatherton’s semi-classic article reviews this, as does my humble entry in the HIV area. Christensen has two papers describing both selfawareness as it varies by symptom levels, and a self-awareness intervention.

Bonus: A cute paper by our own Len Newman, plus a larger review by Bargh for those interested in further readings.

Primary readings
Bargh, J. A. and T. L. Chartrand (1999). "The unbearable automaticity of being." American Psychologist 54(7): 462-479. Link
Heatherton, T.F. & Baumeister, R.F. (1991). Binge eating as escape from selfawareness. Psychological Bulletin, 110(1), 86-108. Link
McKirnan, D.J., Ostrow, D., & Hope, B. (1996). Sex, drugs and escape: A psychological model of HIV-risk sexual behaviors. AIDS Care, 8(6), 655-669. Link
Christensen, A. J., P. J. Moran, et al. (2002). "Effect of a behavioral self-regulation intervention on patient adherence in hemodialysis." Health Psychology 21(4): 393-397. Link
Christensen, A. J., J. S. Wiebe, et al. (1996). "Body consciousness, illness-related impairment, and patient adherence in hemodialysis." Journal of Consulting and Clinical Psychology 64(1): 147-152. Link
Bonus Reading


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Newman, L. & Bausmeister, R. (1996). Toward and explanation of the UFO abduction phenomenon: Hypnotic elaboration, extraterrestrial sadomasochism, and spurious memories. Psychological Inquiry, 7(2), 99-126. Link
Bargh, J. A. and M. J. Ferguson (2000). "Beyond behaviorism: On the automaticity of higher mental processes." Psychological Bulletin 126(6): 925-945. Link
2-pager assignment
The usual -- see what you can apply here, or just give me some intelligent comments that you can use to sound smart in class. Let's begin moving these Rx papers toward real, testable hypotheses!! Apply these concepts to something other than what you already know a lot about, or spin off some new aspect of your area to address.
Two out of the blue bonus readings on evolutionary perspectives.
The cognitive-social perspective is a little dyspeptic toward the role of cognition in health behavior. Cognitions are biased, illusory, or simply irrelevant since so much of behavior is automatic anyway. When a topic is difficult we may want to escape from what selfawareness we do have. This gets even worse in an evolutionary frame, where the core assumption is that many key behaviors -- mate selection, social organization, eating behaviors – are governed by naturally selected brain mechanisms that operate wholly outside of conscious awareness. This assumption has been important to those who stress the continuity of humans and other primates, and therefore assign no special status to the distinctive human characteristics of reflexive consciousness and verbal behavior. Bering & Shackelford counter this trend with interesting discussion of the possible role of human consciousness as a causal factor in evolution. Take a look at this if you need some reassurance that “mind” may still be important. I am including an Annual Review paper by Caporael that provides a general overview of evolutionary theories applied to Psychology, FYI.
In applying evolutionary theories more directly to health I am including a Darwinian view of stress reactions I found very interesting by Korte. He argues that most species divide into “Hawks” and Doves”, each of which represents a coherent approach to coping with adversity (environmental pressure, feeding…), and each of which has distinctive consequences for stress responses and physical health. This gets a little far afield from our discussion of social cognition (it reviews animal research and falls into the “unconscious evolutionary mechanism” camp), but is a very interesting read on possibly naturally selected stress responses.
Bering, J. M., & Shackelford, T. K. (2004). The Causal Role of Consciousness: A Conceptual Addendum to Human Evolutionary Psychology. Review of General Psychology, 8(4), 227-248.
Caporael, L. R. (2001). Evolutionary psychology: Toward a unifying theory and a hybrid science. Annual Review of Psychology Vol 52 2001, 607-628. http://psych annualreviews org/.
Korte, S., Koolhaas, J. M., Wingfield, J. C., & McEwen, B. S. (2005). The Darwinian concept of stress: Benefits of allostasis and costs of allostatic load and the trade-offs in health and disease. Neuroscience & Biobehavioral Reviews, 29(1), 3-38.
Week 9. Class cancelled this week.