CALIFORNIA STATE UNIVERSITY, NORTHRIDGE HEALTH SCIENCES DEPARTMENT HSCI 431 – HEALTH BEHAVIOR Spring 2009 SAMPLE MID-TERM EXAM ITEMS INSTURCTIONS: CHOOSE THE BEST ANSWER OUT OF THE POSSIBLE CHOICES. 1. The ecological approach to understanding factors influencing a particular health problem can be described asA. An emphasis on personal responsibility for health, with an understanding that individuals can be influenced by others. B. A framework in which health behavior is adaptive or maladaptive with respect to an ecological system. C. An understanding that the health behavior of a given individual is the product of a complex set of influences, such as personal attitudes, socio-cultural beliefs, the physical environment, and others. D. A focus on the interrelationship between genetic and social factors in producing health outcomes. 2. Which of the following describes the principle cause(s) of health behavior: A. Environmental factors B. Biological factors C. Socio/Cultural factors D. Genetic factors E. All of the above 3. The main assumption of the Ecological Model of health behavior is: A. No one factor independently influences human behavior B. There is a complex interaction between the individual and the environment C. Two of the above D. Man must live in harmony with the environment 4. The Health Belief Model (HBM) argues that a person will take a preventive or healthy action if: A. He/she perceives/believes that they are susceptible and perceives that the health condition/threat is severe. B. He/she perceives that there are benefits to the preventive/healthy action and perceives that the barriers to taking such action are low. C. There is some “cue to action.” D. He/she has self-efficacy with respect to the action. E. All of the above 5. The idea of “theory” as it is used today evolved from which of the following? A. The study of biology. B. An assumption that the universe is ordered and regular. C. The role of knowledge in the Middle Ages in Europe. D. The Enlightenment period in Europe. E. All of the above 6. Community mobilization is often a part of health promotion campaigns because: 1 A. It is the best way to gain financial support for your efforts. B. Public health problems are typically community problems in which a number of community characteristics/situations are related to the problem. C. In order to increase the proportion of community residents who will pay attention to health messages, it is necessary to get them involved in events “outside of the house.” D. It is a way to take into account the high level of mobility, commuting time and time spent in errands/activities requiring car travel that is so typical of today’s suburban communities. 7. Self-efficacy is: A. Confidence in one’s ability to take an action or engage in a behavior. B. The perception that a behavior is easy or simple C. The liking of one’s self D. The ability to influence other people’s behavior 8. To “encode” a health communication message means to: A. Translate health data into health information B. Formulate a health message in language that is meaningful to a specific target group or population. C. Frame the health-related information -- in terms of language, style, symbols, format, etc. – so that it is received and understood by the recipient(s) in the way that the sender intends. D. Translate health data into health knowledge 9. The culture of the “receiver” matters when you encode a message because: A. Culture guides the way people interpret information. B. If you want those who receive a message to understand it as you intend, you need to know something about the way it is being received C. Culture will guide the receiver’s interpretation, and must be taken into account by those who are developing the message. D. All of the above 10. Identify the stage of the Transtheoretical Model (TTM) – in which there is no intention of changing and for which there is a lack of awareness of or interest in a problem. A. Precontemplation B. Contemplation C. Preparation D. Action E. Maintenance 11. How is a social network approach different (as an explanation for behavior) than theories such as the Health Belief Model or Theory of Reasoned Action? A. A social networking approach focuses on decision making and its impact on behavior as opposed to the effects that social relationships coming out of Theory of Reasoned Action B. A social network approach focuses on the influence of social relationships on behavior, as opposed to internal cognitive (decision making) processes which are emphasized in the Health Belief Model and Theory of Reasoned Action. C. A social network approach focuses on the influence of perceptions shared across relationships, as opposed to the impact of behavioral reinforcement the impacts 2 behavior in the Health Belief Model D. There really are no differences between the social network approach, the Health Belief Model and the Theory of Reasoned Action when it comes to their explanations for why behavior occurs 12. Identify which of the four factors that make up a social marketing campaign (according to the theory) is associated with dissemination of information. A. Product B. Place C. Price D. Promotion 13. Which of the following is a key and unique construct of Social-Cognitive Theory (SCT)? A. Perception of susceptibility B. Risk-benefit calculation C. Perceived behavioral control D. Observational learning (modeling) E. Behaviorism 14. Which of the following best explains why it is important to collect adequate evaluation data about a health promotion project? A. Too many organizations have been making false claims about the success of their (health promotion) projects. B. Good data can help document what kinds of interventions work best. C. Increased specialization and training in the public health field have led to an increased emphasis on data in health interventions. D. Increasingly sophisticated data collection software is driving health promotion program funders to demand more. 15. Process evaluation is most closely associated with which one of the following: A. Were the components of the program implemented as planned? B. What short-term or immediate effect did the program have? C. How did the impact relate to program goals? D. How did the program affect the health problem or issue that was the longer-term target? 16. Impact evaluation is most closely associated with which one of the following: A. What short-term or immediate effect did the program have? B. How did the impact relate to program goals? C. Were the components of the program implemented as planned? D. How did the program affect the health problem or issue that was the longer-term target? 17. Outcome evaluation is most closely associated with which one of the following: A. How did the program affect the health problem or issue that was the longer-term target? B. What short-term or immediate effect did the program have? C. How did the impact relate to program goals? D. Were the components of the program implemented as planned? 18. The Risk and Protective Factors planning approach is based on the idea that youth risk behavior (e.g., risk for HIV/AIDS, substance abuse, early pregnancy, violence, and so on) is an outcome of exposure to risk factors or protective factors. 3 A. True B. False 19. What is a “risk factor”? A. Situations, information or other influences that a youth is exposed to that are correlated with negative/risky health behavior. B. Any condition that is perceived as a negative influence on behavior C. Attitudes and/or beliefs that a youth has that are correlated with positive health behavior D. A buffer or counterbalance exposure to risk factors 20. What is a “protective factor”? A. Situations, information or other influences that a youth is exposed to that are correlated with positive health behavior. B. A buffer or counterbalance exposure to risk factors. C. Attitudes and/or beliefs that a youth has that are correlated with positive health D. Two of the above 21. Which of the following factors have been identified with contributing to health disparities (inequalities) in the United States? A. Socio-Economic Status B. Lack of access to health care C. Lack of health insurance D. All of the above 22. Given the nature of the school setting, which of the following theoretical approaches are most likely to be applicable in developing a school-based intervention? A. The Health Belief Model B. Social Cognitive Theory C. Community Mobilization D. All of the above 23. If you have only two years to implement a health promotion project, which one of the following are you most advised to change? A. Health (epidemiological) outcomes B. Attitudes and awareness about the health issue C. Health behavior D. Health provider systems E. Laws or policies 24. If you are implementing a health promotion program at a workplace, which of the following advantages are you likely to have in your favor? A. Your target population is a “captive audience” B. Employee health data is not easily accessible C. Employers have a stake in the good health of their employees D. Two of the above 25. A community intervention is: A. Larger-scale B. Addresses an entire community C. Addresses at least a broad range of populations within a community D. All of the above 26. An intervention in a community is: 4 A. Smaller-scale than a community intervention B. Typically addresses one subpopulation (or a targeted subset of subpopulations) within a community C. Often can address population groups that are at high risk for a particular health problem, for example the Long Beach AIDS Community Demonstration Project D. All of the above 27. Health promotion in a global setting involves a number of potential challenges. These challenges include: A. Lack of epidemiological or surveillance data B. Inadequate health facilities C. Political instability and conflict D. All of the above HEALTH PROMOTION CASE STUDY QUESTIONS BELOW IS A SET OF FACTS ASSOCIATED WITH A CASE STUDY INVOLVING THE APPLICATION OF SOCIAL/BEHAVIORAL THEORY VIA THE PRECEDE-PROCEED PLANNING PROCESS TO DEVELOP A HEALTH PROMOTION PROGRAM. PLEASE RESPOND TO QUESTIONS 28-32 THAT FOLLOWS THE CASE STUDY. CASE STUDY: RURAL OBESITY INTERVENTION Fact a: You are leading a team that includes the Tennessee Department of Health and Vanderbilt University on a CDC-funded effort to reduce obesity among rural youth in the state of Tennessee. You have four (grant) years to achieve results. Fact b: According to State Health Department figures, obesity levels have always been somewhat high in rural counties, but in recent years they have even been higher, together with corresponding increases in diabetes and heart disease. Fact c: Most public high schools in these areas require only one year of physical education classes. Middle schools have not emphasized this either, with students being able to opt out for various reasons. In addition, most middle and high schools only had part-time school nurses, and very little budget for health education activities. Fact d: Income levels are generally low in the target rural areas, with jobs primarily in mining (mountain counties), agriculture, and low-paid assembly work. Unemployment is higher among men than women. There are few jobs for youth. The primary centers for youth social and physical activities are through churches. Fact e: Surveys and focus groups previously done by Vanderbilt University show the following: A large percentage of people eat fast food at least three times per week. 65% of people who had a body mass index of over 30 did not consider themselves “obese” or at any particular health risk. A “stout body” was viewed as normal, even an indication of “not being hungry.” Eating was also viewed as a major element of social gatherings, and these gatherings featured “meat and 5 potatoes” fare (e.g., ham, potato casserole, sweet potato pie, etc.). These attitudes crossed racial/ethnic lines and were common among both Caucasian and African-American respondents. And, one of the most popular country singers in the area is himself very large. Fact f: Previous public information campaigns to the general public (“It’s right to eat light...”), using bus posters, public service ads on billboards, and information given out at doctor’s offices, have had little or no impact. 28. What information would you consider appropriate for Social Assessment? A. The target population lives in a low-income, rural area, with more unemployment among men and youth than women. B. The target population has few school health and physical activity resources available. C. Low levels of obesity exist in the target population D. Two of the above 29. What information would you consider appropriate for Educational/Ecological Assessment? A. Awareness regarding obesity – 65 percent of people with a BMI over 30 did not consider themselves obese. B. Social norms favor large body size, C. An influential community figure (popular country singer) is himself obese. D. All of the above 30. Considering that you have four years to achieve results, and that multi-level interventions are often the most effective, which of the following program components would you utilize to achieve your goal of reducing obesity and its health consequences? [NOTE: This question calls for three specific components of an overall health promotion intervention. A. A community-wide communications campaign to increase awareness about obesity as a problem and to present behavior-change alternatives such as realistic diet options and physical exercise. B. Increasing health education components in the schools (with information about obesity and its consequences), together with an increase in physical activity programs (required physical activity, sports/recreation opportunities) for students and families. C. The introduction of church-based education sessions, and diet and exercise support groups that would be engaged in a range of activities, including cookouts, sports activities, hiking/walking, etc. D. All of the above 31. What social/behavioral theories might be applicable to the facts at hand and the intervention you propose? A. Social cognitive theory: The use of “social models” (such as the country singer) in communications campaigns to promote change in diet and physical exercise; and an increase in self-efficacy regarding changes in diet and physical exercise promoted through church-based programs. B. Health Belief Model: In school-based education, curriculum components that increase the perception of susceptibility and severity with respect to obesity, and also seek to lower perceived barriers to behavior change. C. Social network theory: Implementing diet/exercise programs in key social 6 networks such as those at church, in order to build on the network influence to support behavior change. D. All of the above 32. Considering that you have four years, what could you do to evaluate the intervention you proposed? A. PROCESS: For Component One – track the number of communications materials/programs produced and distributed. Component Two – Document change in number of health education activities (about obesity), documenting new physical activity programs implemented and attendance at those programs. Component Three – Document the number of educational sessions implemented and support groups created, with attendance numbers; track the number of support group activities and attendance at those activities. B. IMPACT: Using periodic surveys (as well as in-class questionnaires for schoolbased activities), assess change in knowledge about the risks of obesity and what can be done to prevent it, as well as self-reports about the number of people who engage in regular physical activity and who eat lower-fat foods as part of their diet. C. OUTCOME: Using State Health Department data assess change in obesity prevalence and morbidity/mortality rates from obesity-related diseases such as diabetes or cardiovascular disease. D. All the above 33. According to B.F. Skinner’s Behaviorism theory which of the following is correct: A. Reinforcement can increase behavior B. Reinforcement can decrease behavior C. Reinforcers are inherently positive or negative D. All of the above E. Two of the above 34. According to the following graphic the mind plays what kind of a role in the behaviorist’s view of behavior. A. Is of great importance B. Is of some importance C. Is of little importance D. Is of no importance 35. The following picture depicts an experimental subject (a rat) learning a new behavior. Which of the following is the stimulus that serves as the signal to engage in the new behavior? A. The light B. The food pellets C. The lever D. The food tray 36. 7 36. According to Social Learning Theory: A. No direct reward is necessary to explain the learning of a new behavior B. Thinking plays an important role in the development of new behaviors C. Changing cognition of the learner will impact the development of new behaviors D. All of the above 37. Who is this leader of learning theory? A. Albert Bandura B. B.F. Skinner C. Ayn Ran D. Tony Soprano 38. When a person learns by observing the behavior of others and the consequences of that behavior, this process is called: A. Social Learning B. Vicarious Learning C. Reciprocal Determinism D. Behavioral Capability 39. Which of the following is or are a critique of learning theory? A. No big picture of the person B. Too much focus on situations C. Ignores biological factors D. Mechanical -- No free will E. All of the above 40. Determinism is associated with which of the following: A. Free will B. All behavior follows scientific laws C. Humanistic D. All of the above 41. According to Ayn Ran human behavior is a direct consequence of: A. Individual motivation B. Mysticism C. Circumstantial forces D. The times in which we live 42. Robert K. was accused of molesting several children for ten years. They included his daughter. According to the sworn testimony presented at Mr. K’s trial he had been sexually abused by both of his own parents, all of his siblings had psychological problems (e.g., depression; sexual disturbances), he was an alcoholic, he was poor and uneducated, had a diagnosed brain tumor that when removed corresponded with the cessation of Mr. K’s molesting behavior. From a Determinism point of view how would you vote and why if you had a seat on the jury? A. Not guilty due to mitigating circumstances B. Guilty due to mitigating circumstances C. Not guilty by reason of insanity related to the effects of the tumor D. Guilty because he had a choice to act as he did and there was no proof of the causal relationship between the tumor and the molesting behavior 8 43. What is a Social/Environmental Context? A. The frame that you place your life picture B. The forces that influence the way in which you develop C. The backdrop for the development of your unique set of beliefs, attitudes and behaviors D. All of the above 44. Which of the following are components of Social Cognitive Theory? A. Individual characteristics B. Environmental factors C. Reciprocal determinism D. All of the above 45. Reciprocal determinism is: A. The process of acting to a given number of social and environmental cues B. Adjusting behavior to the consequences of the actions of others C. Adjusting to the feedback of an action-reaction sequence of behaviors D. All the above 46. According to Social Cognitive Theory which of the following represents a person’s expectation that a behavior is going to have a good or rewarded outcome A. Behavioral Capabilities B. Expectations C. Expectancies D. Self-Control 47. According to Social Cognitive Theory a person’s ability to deal with emotions involved in a behavior change is called: A. Self-Efficacy B. Expectancies C. Self-Control D. Emotional Coping 48. The single factor that sets Social Network Theory (SNT) apart from all other behavior theories is: A. Individual personal characteristics are not so important in understanding behavior B. What occurs between people C. Stimulus/Reward patterns D. Two of the above 49. According to the World Bank millions people in India are living with AIDS. Which one of the following behavioral risk factors is the primary factor identified as correlating with AIDS in India? A. Unsafe sex B. Population migration C. Homosexuality among men D. Unclean syringes 50. Falsifying a theory is a method by which: A. Data is tested to be true B. A method of determining if something will continue to be part of the ongoing body of scientific knowledge C. Data is tested to be false 9 D. All of the above 51. According to Michel Foucault discourse is: A. A mode of expression B. A product of a historical period and its dominant social-economic institutions C. A kind of system of rules for how to think D. All of the above 52. Fundamental to the way in which we view human behavior is the idea that: A. The world is orderly and regular B. The world is disorderly and irregular C. The world is a direct consequence of the Big Bang Theory D. The world is largely unpredictable in its function 53. An influential social theorist of the early 20th century was: A. Karl Popper B. Edmund Husserl C. Emile Durkheim D. Michel Foucault 54. The key difference between sociology and anthropology is: A. The way they focus on social issues B. The way they focus on cultural aspects of behavior C. The fact that one is a clinical discipline and the other is not D. None of the above 55. Those who adhere to the ecological model of health behavior are most at odds with which of the following ideas: A. Context of a behavior B. Determinism C. Sociology D. Cultural Anthropology 56. According to the Health Belief Model which of the following is critical in understanding if we are to successfully analyze human behavior? A. Perception B. Motivation C. Circumstances D. Relationships 57. According to the Health Belief Model which of the following refers to the degree to which a person feels at risk for a health problem. A. Perceived Susceptibility B. Perceived Severity C. Perceived Benefits D. Perceived Barriers 58. According to the Health Belief Model which of the following refers to the degree to which a person believes the consequences of the health problem will be damaging. A. Perceived Susceptibility B. Perceived Severity C. Perceived Benefits D. Perceived Barriers 59. A critiques of the Health Belief Model is: 10 A. It focuses on social and environmental factors and not the individual B. It assumes that everyone has equal access to information about their health C. There are disparities in knowledge D. Two of the above 60. The Theory of Planned Behavior focuses on: A. Attitudes B. Intentions C. Behavior D. All of the above 61. A social norm is: A. A standard adhered to by a group B. A guide as to how to behave C. An affirmation behind the meaning of the behavior D. All of the above 62. Which of the following is something you would do if you were using the Theory of Planned Behavior to reduce tobacco smoking: A. Determine the social norms associated with smoking among the target population B. Determine the barriers (or constraining factors) to quitting the smoking behavior C. Two of the above D. None of the above 63. The Transtheoretical Model relies upon: A. Stages of change B. Reinforcement C. Cognition D. Attitudes 64. According to the Transtheoretical Model which one of the following indicates that a person does not intend to take action toward changing behavior: A. Precontemplation B. Preparation C. Inaction D. Preparation 65. Diffusion of Innovation refers to the process by which a behavior or technology makes its way into a population and is or is not adopted. A. True B. False 66. Which of the following makes human communication for the most part unique? A. It is so complicated B. It is symbolic C. It is oral D. None of the above 67. In communication theory the process of encoding is most closely associated with: A. The sender B. Receiver C. The mode of sending D. None of the above 68. Community mobilization is a process that increases community awareness about a health 11 problem. A. True B. False 69. Using an anthropological approach means: A. Behavior is treated as an adaptation that enables a person to survive or thrive in a particular environment B. Behavior is viewed as a product of people to people interactions C. Following the scientific method of behavioral inquiry D. None of the above 70. The terms that refer to the major elements of a public health planning model are: A. Appraisal, Programming, and Evaluation B. Assessment, Intervention and Evaluation C. Measurement, Intervention and Evaluation D. Measurement, Inclusion and Estimation 71. Which one of the following is the most well-known approach to public health planning? A. PRODUCE-PLAN B. PRECEDE-PROCEED C. PREELED-PROCEED D. PLANND-PRECEDE 72. Attempting to answer the question how does the health problem relate to what else is happening in the community is an example of : A. Epidemiological Assessment B. Behavioral and Environmental Assessment C. Educational and Ecological Assessment D. Social Assessment 73. Predisposing, enabling and reinforcing factors are part of: A. Epidemiological Assessment B. Behavioral and Environmental Assessment C. Educational and Ecological Assessment D. Social Assessment 74. Which of the following are part of the Epidemiological Assessment: A. Morbidity data B. Mortality data C. Incidence data D. All of the above 75. Gathering data about quality-of-life issues that may be related to a health problem is connected to which of the following: A. Epidemiological Assessment B. Behavioral and Environmental Assessment C. Educational and Ecological Assessment D. Social Assessment 76. The process of implementing regulations and working with organizations/ community structures is associated with: A. Behavioral and Environmental Assessment B. Educational and Ecological Assessment C. Social Assessment 12 D. Administrative and Policy Assessment 77. Assessing a program’s implementation, that is did the program leaders do what they said they would do is called: A. Process Evaluation B. Impact Evaluation C. Outcome Evaluation D. None of the above 78. The key characteristic that distinguishes the Risk and Protective Factors Planning Model from all other models is: A. This planning model focuses on health risk behaviors B. This planning model focuses on predisposing factors C. This planning model focuses on enabling factors D. This planning model focuses on reinforcing factors 79. According to the Institute of Medicine a prevention intervention that targets individuals or groups that are a high risk for a particular health problem is: A. A Universal Prevention intervention B. A Selected Prevention intervention C. An Indicated Prevention intervention D. None of the above 80. Community interventions tend to result in small changes, but over a large number of people. A. True B. False 81. Studies have shown that it is just as easy for heavy smokers to quit smoking as it is for light to moderate smokers. A. True B. False 82. When you implement a project in the community you are typically doing so through or in collaboration with community structures. What is a community structure? A. Government agencies B. Task forces C. Responses A and B D. A local commercial radio station 83. The term aggregates of people refers to: A. All people in the United States B. All people in the state of California C. All people who share a common characteristic D. Two of the above 84. You have been asked to develop a health education program to address sickle-cell anemia. Identify from the following choice which one would be the best approach to focus your efforts to segment your target population. A. Geography B. Genetics C. Socio-economics D. Occupation 85. Which of the following is an example of tailoring your health promotion efforts? A. Look at health problems of a particular population 13 B. Include the target community in designing a program C. Refer, as much as possible, to situations, people, and issues relevant to the target community/population D. All of the above 86. You can find existing, relevant health promotion programs through: A. Federal agency clearinghouses B. Nonprofit associations focused on a particular health problem C. Professional associations D. All of the above 87. Making sure to train and hire members of the community to operate community health programs is an example of: A. Tailoring B. Population-based health promotion C. Sustainability D. Communities as experts 88. When students are empowered to see themselves as being in control of improving their quality of life, they are said to have a(n): A. Internal locus of control B. External locus of control C. Peripheral locus of control D. Self-efficacy 89. Health education is: A. A continuum of learning throughout life B. Isolated learning activities focusing on knowledge C. Learning anatomy and physiology D. Ongoing health inspections by teachers to assure reduction in transmission of contagious diseases 90. An assumption of the wellness approach to living is that: A. People try a variety of health fads and trends B. People rely heavily on medical care professionals for decision-making and advice C. People follow information provided in health advertisements D. People take responsibility for their own well-being 91. Health education and health promotion are: A. The same B. Different in scope C. Both concerned only with physical education D. Are concerned only with school-based health centers 92. The most important determinant of health status is: A. Health behaviors B. Genetics C. Education D. Gender 93. Health education can be defined as: A. Curriculum development for grades K through 12 B. Sequential learning of health facts C. The process of providing learning experiences which favorably influence 14 well-being D. The acquisition of facts and statistics that inevitably leads to developing a wellness lifestyle 94. The Youth Risk Behavior Surveillance System (YRBSS) provides information on: A. The quality of education in the classroom B. The influence of the environment of health behavior C. The health behaviors practiced by young people D. Hone of the above 95. A health teacher should be able to: A. Force appropriate opinions on others B. Plan and implement effective health education programs C. Teach controversial subjects regardless of the neighborhood or culture D. All of the above 96. "Increasingly, behavior termed 'road rage' is being viewed as a public health issue, because of the number of deaths and injuries related to it. Such behavior is often a reaction to feeling one has been treated unfairly by another driver, and is much less likely to occur if a driver is treated fairly. 'Fair play' on the road includes the observance, not only of traffic regulations, but also of the rules of courtesy. Courteous driving is based on common sense consideration for other drivers and a strong desire to make the roads safe for everyone. Good highway manners should become just as much a matter of habit as other kinds of manners." Which one of the following statements is best supported by the above selection? A. Courteous driving contributes to road safety. B. Those who are generally polite are also courteous drivers. C. Unlike driving courtesy, the observance of traffic regulations is a matter of habit. D. Being courteous when driving is more important than observing traffic regulations. 97. In Social Marketing the Four “Ps” refers to: A. Product, Price, Place and Promotion B. People, Performance, Projection, and Progress C. Panic, Protection, Prognostication, and Panacea D. None of the above 98. The following diagram is called a: Person 2 Person in Network (called “Alter” Focus individual (Called “Ego”) Person 5 Person 6 Person 3 Person 4 15 A. Paragram B. Diagram C. Sociogram D. Communogram 99. Which of the following focuses on the thinking process itself as the source of behavior? A. Social Psychology B. Humanistic Psychology C. Cognitive Psychology D. Cultural Anthropology 100. Epistemology refers to: A. The study of the sources of knowledge; that is, the principles by which one may distinguish what is true from what is not true. B. The study of what is meant by "knowledge". What does it mean to "know" something as opposed to merely having an opinion. C. Both choice A and B D. Neither choice A or B 16