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
1
3rd revolution in health
2. Chronic “lifestyle” disease
Psychology 415; Social Basis of Health Behavior
 Increasingly product of individual behaviors
 The big 7:


• 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
2
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
3
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
4
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
5
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
6
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
7
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

 Exercise

Immunomodulation, inflammation,
Sleep...
3. Illness-related behaviors
“illness behavior”
CHD
 Illness conceptions
 Recognition, “definition”, treatment seeking
 Adherence
Overview, 9/1/10
8
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
9
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
10
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
11
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
12
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
13
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
14
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

 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
Overview, 9/1/10
15
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
16
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
17
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
•
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.
Overview, 9/1/10
18
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
19
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
20
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
21
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
22
Psychology 415; Social Basis of Health Behavior
Basic moderating model
Immune
function
Stress
“Optimism”,
“hardiness”,
social
support
Overview, 9/1/10
23
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
24
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
25
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
26
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


 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
27
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
28
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
29