Oregon State University
College of Public Health and Human Sciences
H571: Principles of Health Behavior
Fall 2014
Credit Hours:
Room:
Schedule:
3
Milam Hall 213
Thursdays 4-7
Course Instructor: Brian R Flay
Office Location: Waldo 411
Office Phone: 737-3837
E-Mail: brian.flay@oregonstate.edu
Office Hours: Wed 3-5, preferably
by appointment
Teaching Assistant: Jill Hoxmeier
Office Location: Milam 216
Office Phone: 406-249-9911
E-Mail: hoxmeiej@onid.orst.edu
Office Hours: Thurs 12:30-2:30, preferably
by appointment
If you have quick questions and/or can not make it to regularly scheduled office hours, please contact
me via email. You MUST use your ONID email address. I am usually able to answer emails within 24
hours except when I am traveling or have unusual scheduled commitments. Please include H571 in
the Subject line.
COURSE DESCRIPTION:
Theoretical approaches to behavior change in health promotion/education research and
practice; factors influencing health behaviors, ethical behavior change issues, behavioral
interventions for special populations.
Prerequisites:
None
Co-requisites:
None
LEARNING RESOURCES:
Required Text: DSC: DiClemente, R.J., Salazar, L.F., & Crosby, R.A. (2013). Health Behavior
Theory for Public Health: Principles, Foundations and Applications. Jones and Bartlett, Boston, MA.
ISBN: 9780763797539
NOTE: Please check with the OSU Bookstore for up-to-date textbook information for the term you
enroll (http://www.osubookstore.com/ or 800-595-0357). If you purchase course materials from other
sources, be very careful to obtain the correct ISBN.
NCI: A free, helpful monograph: National Cancer Institute (2005). Theory at a Glance: A Guide for
Health Promotion Practice (2nd edition). NIH Publication No. 05-3896, National Cancer Institute, NIH,
Washington, DC. Available in H571 folder at http://people.oregonstate.edu/~flayb/MY%20COURSES/
Reading Packet: Other required readings are also in the H571 folder at:
http://people.oregonstate.edu/~flayb/MY%20COURSES/. You will see this syllabus posted there
(updates, if any, will also be posted there) and a folder with the required readings in it.
STUDENT LEARNING OUTCOMES:
Competency #1: Communicate theoretical principles, constructs and models
used to understand and affect the behavioral aspects of health.
1. Identify the multiple determinants of health.
2. Use key terms and concepts commonly used in modifying or researching
health/illness behaviors.
3. Examine intrapersonal, interpersonal, community, and systems-based
contributors to behavior.
4. Interpret applied behavioral research and discuss the strengths and limitations of
behavioral theory in reducing risks to health.
Competency #2: Plan and Assess intervention strategies based on complexities
of human behavior and behavior change theory in the context of multi-faceted
individual and environmental challenges.
1. Analyze ethical implications of applying individual versus population-based levels
of analysis or intervention.
2. Assess the relative impact of theory-based interventions for individuals and
populations and the rationale for level of impact in specific groups.
3. Critique applied behavioral research and discuss efficacy and effectiveness of
behavioral theory in reducing risks.
4. Develop population-based interventions that integrate the ecological needs of
diverse communities and populations.
5. Demonstrate skills in applying behavioral theory in public health practice.
PROGRAM COMPETENCIES IN Health Promotion Health Behavior:
Upon satisfactory completion of the degree in MPH, the students will have met the program
competencies found at http://health.oregonstate.edu/degrees/competencies
COURSE CONTENT: This overview course is designed to provide students with basic information
concerning the interaction of biological, psychological, behavioral, socio-cultural, and environmental
processes that function in the etiology (causes) of health-related behavior and the promotion of
health and prevention of disease. Theories developed to explain health and illness behaviors at the
intrapersonal, interpersonal, and group/community levels are introduced and critiqued, and
intervention-based research examples are used to provide a basis for understanding applications in
public health practice. Ethical considerations inherent to efforts designed to produce health-related
behavior change are examined.
EVALUATION OF STUDENT PERFORMANCE:
1. Class Participation (Includes attendance, in-class discussion)
2. Weekly readings (One small-group presentation by every student)
3. Periodic in-class tests and activities
4. Three writing assignments
5. Final paper
5 points
15 points
10 points
30 points
40 points
FINAL GRADES:
A total of 100 points is possible for the course and the percentage of the total points obtained will be
used to determine your grade according to the following:
91-100% = A
61-65% = C
86-90% = A56-60% = C81-85% = B+
51-55% = D+
76-80% = B
46-50% = D
71-75% = B61-45% = D-
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66-70% = C+
< 60% = F
COURSE PHILOSOPHY:
Graduate education is largely a self-directed approach to learning. Although there are
demonstrations of competencies expected, you will learn more and experience greater professional
growth if you come to class prepared, seek out additional resources covering specific topics, and
become actively engaged in working with your peers to discuss, learn and grow. I will facilitate
thinking, discussion and application of principles through specific assignments; however, because
the scope and sequence of this course is huge (and the class is large), you will learn best if you put
in the extra effort to really understand the material and how it might be applied in everyday public
health practice. In many respects, you will get the most out of the course if you really stretch your
imagination and investigate areas of interest that you have not yet had a chance to explore (in other
words, don’t pick the same worn out topic from your last year of classes in your major, or in former
job area, etc.). Pick something fun, something that will hold your interest, and perhaps something
that you will be able to utilize in H549 Winter term or H576 Spring term.
COURSE OUTLINE:
PART I: Introduction/Overview, Intrapersonal Theories, Interpersonal Theories
Week 1: Intro to health behavior theory in public health and health promotion
DSC Chapter 1: Health behavior in the context of the “new” PH
DSC Chapter 2: How theory informs HP and PH practice
NCI: Pages 4 -7 Foundations of Theory in HP
Snyder & Flay, 2012: Brief introduction to the Theory of Triadic Influence (TTI)
(We’ll use the TTI many times during the course)
Week 2: Value-Expectancy Theories
DSC Chapter 4: Value-Expectancy Theories
NCI: Bottom pg 16-18 Theory of Planned Behavior and Theory of Reasoned Action
NCI Gibbons: Intentions Expectations, Willingness
NCI Trafimow: Normative Beliefs
French et al., 2005: The importance of affective beliefs and attitudes
Plotnikoff et al., 2011: Test of TPB to predict physical activity in adolescents
Richardson et al., 2012: Test of TRA to predict whistle-blowing against hazing
Week 3: Perceived Threat and Fear Appeals
DSC Chapter 5: Models based in perceived threat and fear appeals
NCI: Second half of pg 12-14 The Health Belief Model
Carpenter, 2010: Meta-analysis of HBM predictors
Brewer et al 2004: Risk perceptions and their relation to risk behavior
Green & Witte 2006: Fear Arousal in PH campaigns
Writing assignment #1 due (via email) by start of class Week 4
Week 4: Stage Models
DSC Chapter 6: Stage models
NCI: Pages 15-16 Stages of Change (Transtheoretical) Model
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Bridle et al., 2005: Systematic review of transtheoretical interventions
West 2005: Putting the TTM to rest
Week 5: Social Cognitive Theory
DSC Chapter 8: Social cognitive theory applied to health behavior
NCI: Second half pg 19-21 Social Cognitive Theory
NCI Thompson & Schlehofer: Perceived control
NCI Schwarzer & Luszczynska: Self-efficacy
White et al., 2012: SCT influences on physical activity in adults
Writing assignment #2 due (via email) by start of class Week 6
PART II: Sociocultural Theories
Week 6: Behavioral Economics
DSC Chapter 7: Behavioral economics
Buttenheim & Asch, 2012: Behavioral economics and maternal and child health
AND either
Lee et al., 2011: Behavioral economics to design persuasive communications
OR (esp. for policy students)
Robinson & Hannitt, 2011: Behavioral economics and regulatory analysis
Week 7: Communications theories
DSC Chapter 9: Health communication: Theory, social marketing, and tailoring
NCI: Pages 29-33 Communication Theory
NCI: Second half pg 36-39 Social Marketing
Abroms & Maibach, 2008: Effectiveness of mass communication to change health behavior
AND either
Evans et al., 2008: Systematic review of PH branding (the up-and-coming approach to social
marketing)
OR (esp. for policy students)
Freudenberg et al., 2009: PH campaigns to change industry practices that damage health
Writing assignment #3 due (via email) by start of class Week 8
Week 8: Diffusion of Innovations and community theories
DSC Chapter 10: Diffusion of innovations theory
NCI: Pages 22-29 Community Level & Diffusion of Innovations
AND either
Israel et al., 1998: Review of community-based research
OR (especially for environmental health students)
Parker et al, 2004: Application of HP theory (including community) to environmental health
Weeks 9 & 10: Ecological approaches and integrative theories
(Note: About 50% more pages than usual)
DSC Chapter 11: Ecological approaches
NCI: Pages 10-12 The Ecological Perspective
Flay, Snyder & Petraitis, 2009: Theory of Triadic Influence (skip/skim pgs 468-479 if you like)
Resnicow & Vaughn, 2006: Chaotic view of behavior change
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Final Paper due by 7am Saturday (December 6th)
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ASSIGNMENTS:
Required assignments are:
A) In-class small-group presentation, B) 3 small writing assignments, and C) final paper.
A) SMALL-GROUP PRESENTATION
Each student will participate in one small-group (3 or 4 members) presentation about a portion of
the assigned readings from one week. Each presentation should be 15-20 minutes, to be shared by
the group members. Members should work as a group to create the presentation, but then divide it up
for the actual presentation to your classmates and us. A draft of the powerpoint, with speaker notes,
should be emailed to me and the GTA by 4:00pm the day before class. [Remember to include
H571 in the subject line.] We will provide feedback to you by 10pm that will sometimes require you to
make some modifications. The presentation should include a summary of the main new ideas you
learned from the assigned chapter and one of the other readings, and a critical thought you have
about the usefulness/applicability of one or several of the ideas/theories to health promotion in your
area of interest.
B) WRITING ASSIGNMENTS:
Each student will write 3 brief (1 page, single-spaced) paper summarizing and critiquing current
reviews of studies that have used theory to understand your chosen topics.
Assignment #1: Limiting yourselves to theories that we read about during weeks 2 & 3.
Find several papers that use one of the theories we've discussed/covered in the first 2 weeks to
explain your chosen behavior. Evaluate the use of the theory to explain that behavior, how the
theory was used, whether gaps in the explanation exist, etc.
Assignment #2: Find two papers that use theories from weeks 4 & 5, one paper for each theory, to
explain your chosen behavior, this time focusing on a specific population, like the disabled or the
elderly. Compare and contrast the theoretical applications to explaining your chosen health behavior
for your selected population.
Assignments 1 & 2 should address the following components:
How theories have been applied to understand:
1. The risk factors contributing to (predicting, causing, correlating with) the problem, and how
they have improved understanding (or not) of these risk factors.
2. The protective factors that are correlated with less of the problem, and how they have
improved understanding (or not) of these protective factors.
Assignment #3: Find a paper that describes and/or reports a test of a theoretically-based intervention
(that used any of the theories from weeks 2 – 7), preferably related to your chosen behavior. Write a
critique of the application of the theory to the development and/or test of the intervention.
Assignment #3 should address the theory or theories that have been used to:
3. Develop health promotion or prevention efforts to date, how well they have been applied, and
the success of these efforts to prevent or reduce your selected problem for your population.
4. Evaluate health promotion or prevention efforts to date, how well they have been applied, and
the understanding of these evaluations to assess prevention or reduction efforts for your
selected problem and population.
Each paper should include:
1. A short Introduction summarizing the significance of your chosen public health problem for
your chosen target population
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2. A Conclusions section where you provide a concluding comment about the value (or not) of
theories for understanding the predictors and prevention of your selected problem with your
selected population
3. In-text citations
4. A Reference section (not included in the page length requirement).
Note: all articles should be appropriately cited using the APA 6th edition format – see 2 “APA
citation” files on the course website.
C) FINAL PAPER (due by 7am Saturday of Week 10 – Dec 6th in 2014)
The final project is designed to help you develop the skills necessary to effectively justify a particular
health promotion intervention utilizing an appropriate theoretical approach. You will take the first
steps in utilizing the existing literature about a specific health problem in a specific population to
select the “best” theory or combination of theories with which to develop a plan for developing an
effective intervention for preventing the problem among your selected population. You will make
suggestions for designing an intervention – which some of you might follow through on in H576.
For your chosen/assigned topic, for each of TWO of the theories discussed in weeks 1-10, find
one article or an appropriate set of articles (different from prior assignments) that apply(ies) one of
the theories to promote the positive behavior and/or prevent/reduce the problem. Write a succinct
(One page per theory) statement of the primary theories your selected paper authors say are
important in working with your chosen/assigned problem and population. For each theory, first give a
brief description of the theory; then be sure that your description provides brief, but in-depth,
coverage of the following issues:
1. What evidence do they cite, if any, that their choice of theory is appropriate?
2. Do they provide an adequate explanation of how they use this theory?
3. How do they know that this theory works for this issue/population?
4. What environmental/social supports were or were not included in the study? How important do
you think they would be?
5. What is the essential “nugget of wisdom” that you would take away from this paper that should
be helpful to you in future?
6. Other points you would like to make.
In a 4-6 paragraph summary (no more than 1 page), provide your judgment about which of the 2
theories you have discussed, or another one, is the most applicable to your health behavior and likely
to lead to the most effective approach to its promotion or prevention/control. This section is where
your own judgment is critical.
Please use APA format to the letter (except I want single-spaced, Calibri 11-point font, like this paragraph).
You may include short introduction and conclusions sections. Thus, your final paper should be no more than 4
pages (½ page introduction, 1 page per theory, 1 pages summary, and perhaps ½ page conclusion) before
references or figures.
Summary Comment
Each of these assignments should be thoughtful, provide a graduate level, critical analysis of the
readings and be written utilizing solid grammar and sentence structure. In short, I’m not looking for,
”We thought this was interesting,” but rather, thoughtful and critical work based on what you know
from professional experience, your readings, public health practice recommendations, etc. Is it
realistic? Does it apply to something you’ve seen/observed in your work or practice? Is it really a
public health approach rather than an individual-level approach? Is it consistent with theory? I am
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interested in your opinions only if they are supported by facts/research/literature. However, writing in
the first person is ok – it is becoming more common in scientific journals.
H 571 Writing - Notes from prior classes that you might find helpful
First, see APA 6th Edition Writing Style Workshop pdf (available on course website)
Paper content and structure
1. I want to see that each of you clearly understands more than one theory of health behavior and
their application.
2. I also want to see a critical appraisal of their use in the literature.
3. Also take care to be critical of causal statements. Ask yourself if it is possible/likely that the causal
direction could be the opposite of how it is stated.
4. Always include introduction and conclusion paragraphs or sections.
5. Try to include “connection” sentences to improve the flow between sections.
6. Almost all of you will need to use more references – see further notes about references below.
Some advice to improve your writing in graduate school and work:
Value succinctness in writing – it makes for better communication in all realms. [See “The
Presentation Secrets of Steve Jobs: How to Be Insanely Great in Front of Any Audience” by Carmine
Gallo. This little book provides great guidelines for “insanely great” communications of all kinds, not
just presentations. I recommend it to you all, but especially those of you who plan on doing
communication-type work in the future (which will be most of you at some level).] Succinct writing also
allows you to say more in less space – so you should get into the practice of outlining your papers
before you write anything. Often, you will find that the outline, if you have all of the points you should
have in it, will already be a quarter to a third as long as your final paper should be. That is, your
outline will need only little elaboration as you turn it into complete sentences and paragraphs – and
you will be done.
You should do several rounds of editing to get to a polished product. This means that you cannot
leave everything until the last minute – you should allow at least a few days for several rounds of
editing! Book writers, and journal article writers go through numerous rounds of editing before they
submit a product for review, and then another round or two in response to reviewer comments. Try to
get into the habit of doing that with your writing and you will all get better grades.
For scholarly or professional writing, you should not make statements like, “In 1997, Charlie
Brown of the University of Podunk published a study published in the Journal of Unhealthy Behavior
about unsafe sex among Aborigines.” That is ok for newspaper or magazine reports, but not for
graduate school (or most of you in your professional life). You should just say, “Brown (1997) found
that …”
Editing comments:
1. Always show pagination.
2. Don’t use full justification.
3. Facts need citations!
4. Provide a reference the first time you mention a theory.
5. Put in a reference the first time you mention a study.
6. If multiple statements (sentences) come from the one study, then you need to introduce the study
(with the reference) first, followed by your summary of its findings.
7. You almost always should include the date with the authors – don't list the authors earlier in a
sentence and put the date at the end. That style is used only with direct quotations.
8. References at the end of a sentence go before the period – they are part of the sentence.
9. You should provide a link (either in the text or a footnote or in the references) whenever you cite a
website/page.
10. You should cite original sources (that you have checked), not the text book.
11. You must provide the page numbers when you include a quote.
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12. Don’t over use “which” – do a “which hunt” and replace many of them with “that” or change the
structure of the sentence.
13. Data are always plural, despite increasingly common usage to the contrary!
14. People always deserve “who” – never “that.”
15. Always use the past tense when describing/reporting the findings from a (past) study.
16. Don’t use “while” when there is no time involved – use “although” or some other construction.
17. Hyphenate two words that modify a noun. E.g, Long-term effects, harm-reduction approaches.
But not in “strategies over the long term that promote harm reduction.”
SPECIAL EXPECTATIONS:
1.
2.
3.
4.
5.
6.
7.
8.
9.
All readings are to be read ahead of each session, and full participation in in-class discussion is expected
from every student.
Attendance IS important to your instructor (and to your professional knowledge in the future ☺). If you
miss one class, you have missed an entire week, not to mention wasting your hard earned money. Since
we do not have class on the Thursday of Thanksgiving, we have only 9 classes in which to pack lots of
information. Plan your schedules accordingly. If you leave before the class is over, you may miss an inclass activity and this will NOT be something you can “make up.”
All assignments have a due date and time. For each day late, you will lose 10 points from the original
starting point. Any requests to deviate from this policy must be approved well in advance of the due
date. I will not give incompletes in this course except under University approved exemptions (death,
injury, health, etc.).
The two papers must be typed single-spaced (1.0, not 1.15) with Calibri 11-point font (as this section is),
no additional space between paragraphs, and NO MORE than 1-inch margins. They are all to be emailed
to us by the due date/time.
All work must be completed at a GRADUATE LEVEL. That implies thoughtful discussion, thorough
analysis, and appropriate citation of all material taken in any form from another article or journal. Use
Refereed Journals for all course work, not wiki pages or other websites. Read the complete articles, not
just the abstract. Abstracts rarely give full overviews of the research topic, methods or results,
particularly in the behavioral literature. Think critically about everything you read and be prepared to
question and discuss it.
All citations utilized in papers/assignments must be clearly noted using either the American Psychological
Association (APA) format. [Special note here: If you make a series of points from the same paper, cite it in
the first sentence of a section or paragraph and construct that sentence to make clear that the following
section/paragraph will draw from it.] Use citations to emphasize your points, provide statistics, etc., not
to write your paper. Using quotes is fine, in moderation. If it’s more than a sentence or two, indent,
single space and provide the page number.
You MAY NOT use the same (or a very similar) paper for multiple classes – that would be self-plagiarism.
All papers must be original documents (not submitted elsewhere) and must conform to the guidelines
established for this class. Please proof your papers for writing style, spelling, grammar, sentence
structure and general mechanics. Please do not email/fax papers to the department, as these will not be
accepted. Papers should be emailed to me and the GTA by the due date/time.
Plagiarism and all forms of academic dishonesty will result in a FAILING grade for the course. If you have
questions about the details of OSU's academic dishonesty policies, please review the OSU website listed
on page 3.
For major assignments, I encourage you to work in groups to brainstorm, discuss issues, and think
through complex questions, projects and research article critiques. You will learn and grow through
thoughtful interactions and attention to detail. Although this is a basic (but graduate level) course, it is
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essential for adequate performance in other courses on mass media and health, program evaluation,
program planning and proposal writing and other MPH track requirements.
10. Enjoy the class!
FINAL NOTES:
As one of the core courses in the Oregon MPH, materials learned in this course form the basis for
the mass media course (H549) and the planning course (H576). They also will be part of the final
MPH EXAMINATION to be scheduled at the completion of all course work in your MPH program.
Incompletes — Take this course only if you plan to finish it in a timely manner (during this term). I
assign an "I" or incomplete only when there is a strong and compelling case for doing so (e.g., health
reasons, military commitment). I will not consider assigning an incomplete unless you have
completed over 50% of the course tasks. Please note that students receiving incompletes are subject
to assignment weight reduction (and consequently may not be eligible for A or A- grades) because
some of their work will be submitted late.
DIVERSITY STATEMENT
The College of Public Health and Human Sciences strives to create an affirming climate for all
students including underrepresented and marginalized individuals and groups. Diversity
encompasses differences in age, color, ethnicity, national origin, gender, physical or mental ability,
religion, socioeconomic background, veteran status, sexual orientation, and marginalized groups. We
believe diversity is the synergy, connection, acceptance, and mutual learning fostered by the
interaction of different human characteristics.
EXPECTATIONS FOR STUDENT CONDUCT
The Student Conduct Code establishes community standards and procedures necessary to maintain
and protect an environment conducive to learning, in keeping with the educational objectives of
Oregon State University. This code is based on the assumption that all persons must treat one
another with dignity and respect in order for scholarship to thrive. For the full Student Conduct Code
see http://oregonstate.edu/studentconduct/
Academic or Scholarly Dishonesty is prohibited and considered a serious violation of the Student
Conduct Code. It is defined as an act of deception in which a Student seeks to claim credit for the
work or effort of another person, or uses unauthorized materials or fabricated information in any
academic work or research, either through the Student's own efforts or the efforts of another. For
specifics related to offenses proscribed by the University see:
http://oregonstate.edu/studentconduct/offenses-0
RELIGIOUS HOLIDAY STATEMENT
Oregon State University strives to respect all religious practices. If you have religious holidays that
are in conflict with any of the requirements of this class, please see me immediately so that we can
make alternative arrangements.
STUDENTS WITH DOCUMENTED DISABILITIES
“Accommodations are collaborative efforts between students, faculty, and Disability Access Services
(DAS). Student with accommodations approved through DAS are responsible for contacting the
faculty member in charge of the course prior to or during the first week of the term to discuss
accommodations. Students who believe they are eligible for accommodations but who have not yet
obtained approval through DAS should contact DAS immediately at 737-4098.”
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