CHS 100
Introduction to Community Health Sciences
Winter 2012
Class time:
Room:
Format:
Tuesday, Thursday 3-4:50
43-105A
4 hours lecture
Instructor:
Name:
Office:
Phone:
Office Hours:
Carol S. Aneshensel, Ph.D.
21-268 CHS
310-825-7479
Tuesday 10-12 (sign-up sheet outside office) & by appointment
Special Reader:
Name:
Email:
Office:
Office Hours:
Fred Harig
fharig@ucla.edu
TBA
TBA
Course Email: chs100.w12@gmail.com USE THIS EMAIL FOR CLASS CORRESPONDENCE
Moodle site: >> https://ccle.ucla.edu/course/view/12W-COMHLT100-1
Log-in top right corner using BOL userid and password
Readings
Power point for lecture
Postings to class for questions and discussions
Course Description
This introductory course is intended to provide non-CHS MPH students and qualified undergraduates with a broad
and comprehensive overview of concepts, empirical research, and public health practice in community health
sciences with an emphasis on: (1) social context and determinants of population health and (2) principles of planning
interventions to protect and improve public health. The first half of the course describes ways to define and measure
health and illness, the social construction of illness, social and behavioral determinants of health, and health
disparities, including socioeconomic status (SES), race/ethnicity, gender, and age. In the second half of the course,
students will learn about social and behavioral theories of health-related behavior change, health promotion
strategies and methods, and public policy. The course provides case studies of evidence-based health promotion
programs. It includes lectures, assigned readings, and in-class discussions.
Course Prerequisites
The course is open to graduate students in the School of Public Health outside of CHS and other disciplines, and to
qualified undergraduates by permission of the instructor with preference given to students in the public health minor
program.
Learning Objectives
Upon completion of this course,
students should be able to:
ASPH Competencies
Social and Behavioral Sciences
1. To identify key cultural, social,
political, economic, and
psychological determinants of
health and health-related
behaviors.
E2. Identify the causes of social and behavioral factors that affect
health of individuals and populations.
E6. Describe the role of social and community factors in both the
onset and solution of public health problems.
2. To describe how health and healthrelated behavior are conceptualized
and measured at the individual,
community, and societal levels.
E2. Identify the causes of social and behavioral factors that affect
health of individuals and populations.
E6. Describe the role of social and community factors in both the
onset and solution of public health problems.
E8. Apply evidence-based approaches in the development and
evaluation of social and behavioral science interventions.
3. To explain theories of healthrelated behavior and behavior
change.
E1. Identify basic theories, concepts and models from a range of
social and behavioral disciplines that are used in public health
research and practice.
Learning Objectives
ASPH Competencies
4. To define the basic elements of
program planning and intervention.
E3. Identify individual, organizational and community concerns,
assets, resources and deficits for social and behavioral science
interventions.
E4. Identify critical stakeholders for the planning, implementation and
evaluation of public health programs, policies and interventions.
E5. Describe steps and procedures for the planning, implementation
and evaluation of public health programs, policies and
interventions.
E7. Describe the merits of social and behavioral science
interventions and policies.
E8. Apply evidence-based approaches in the development and
evaluation of social and behavioral science interventions.
E9. Apply ethical principles to public health program planning,
implementation and evaluation.
E10.Specify multiple targets and levels of intervention for social and
behavioral science programs and/or policies.
5. To give examples of types of health
promotion activities in the
community, worksites, schools, and
clinics.
E3. Identify individual, organizational and community concerns,
assets, resources and deficits for social and behavioral science
interventions.
E4. Identify critical stakeholders for the planning, implementation and
evaluation of public health programs, policies and interventions.
E5. Describe steps and procedures for the planning, implementation
and evaluation of public health programs, policies and
interventions.
E7. Describe the merits of social and behavioral science
interventions and policies.
E8. Apply evidence-based approaches in the development and
evaluation of social and behavioral science interventions.
E9. Apply ethical principles to public health program planning,
implementation and evaluation.
E10.Specify multiple targets and levels of intervention for social and
behavioral science programs and/or policies.
6. To describe community organizing
and community-based participatory
research, as well as societal level
initiatives.
E6. Describe the role of social and community factors in both the
onset and solution of public health problems.
E7. Describe the merits of social and behavioral science
interventions and policies.
7. To identify the major modes of
advocacy for changing health policy
pertaining to populations.
E4. Identify critical stakeholders for the planning, implementation and
evaluation of public health programs
E5. Describe steps and procedures for the planning, implementation
and evaluation of public health programs, policies and
interventions.
E6. Describe the role of social and community factors in both the
onset and solution of public health problems.
E7. Describe the merits of social and behavioral science
interventions and policies.
E10.Specify multiple targets and levels of intervention for social and
behavioral science programs and/or policies.
Statement of Academic Integrity
Please see, UCLA Office Dean of Students: http://www.deanofstudents.ucla.edu/integrity.html
Students with Disabilities
If you wish to request an accommodation due to a suspected or documented disability, please inform your
instructor and contact the Office for Students with Disabilities as soon as possible at A255 Murphy Hall, (310) 8251501, (310) 206-6083 (telephone device for the deaf). Website: www.osd.ucla.edu. This information will be treated
as confidential.
2
Grading (Important Dates)
1. Class attendance and participation: 10% of grade
a. Maximum 2 missed classes. Minus 1 point each additional class missed without a valid excuse
b. Comment during class discussions, respond to questions, ask questions
c. Postings on Moodle board
2. Essay 1: 10% of grade
a. Handed out Tuesday 1/24/12. Due Tuesday 1/31/12
b. 2 page response to a question that applies material from lecture and readings.
3. Midterm: 30% of grade
a. Tuesday 2/7/12
b. In class, closed book.
c. Multiple choice, fill in the blank, short essay, etc.
4. Essay 2: 10% of grade
a. Handed out Tuesday 3/1/12. Due Thursday 3/8/12
b. 3 page response to a question that applies material from lecture and readings.
5. Final exam: 40% of grade
a. Last day of class. Thursday, 3/15/12
b. In class, closed book
c. Covers second half of class
d. Multiple choice, multiple choice, etc., 1 required essay, 1 essay from 3 choices applying material
from lecture and reading
e. Bring 2 blue books, one for each question.
Grading Policy: Grades on exams, essays and course are final and not open to discussion.
Classroom Atmosphere
Please do not use laptops or other electronic devices during the class: they detract from participation in the class
and are distracting to other students.
READINGS
Required Text
Glanz, K., Rimer, B.K., and Viswanath, K. 2008. Health Behavior and Health Education: Theory, Research, and
th
Practice, 4 Edition. San Francisco, CA: Jossey-Bass. Available at the bookstore.
Access to Other Readings
You may access one personal use copy of each article from the password protected Moodle site for the class. Use
your BOL username and password to log on.
Please complete all readings before the lecture.
Class
Date
Topics and Readings
I.
1
1/10
INTRODUCTION
Overview: What is Community Health?
Contrasts community health sciences approach with other areas of public health (epidemiology,
biostatistics, health services, environmental health sciences) and medicine. Specifically, CHS
focuses on: (1) populations (not only patients, clinical populations, or people who are sick), (2)
prevention (rather than solely treatment) of health problems and promotion of healthy behaviors,
and (3) the cultural, social, economic, and psychological determinants of health and healthrelated behavior.
Readings
Text: Chapter 1. Glanz, K., Rimer, B.K., and Viswanath, K. The Scope of Health Behavior and
Health Education. Pp. 3-22.
Phelan, J.C., Link, B.G., and Tehranifar, P. 2010. Social Conditions as Fundamental Causes of
Health Inequalities: Theory, Evidence, and Policy Implications. Journal of Health and Social
Behavior. 51:S28-S40.
3
Schwarte, L., et al. 2010. The Central California Regional Obesity Prevention Program:
Changing Nutrition and Physical Activity Environments in California’s Heartland. American
Journal of Public Health. 100:2124-2128.
2
1/12
Reference Glossary (Optional)
WHO Health Promotion Glossary
http://whqlibdoc.who.int/hq/1998/WHO_HPR_HEP_98.1.pdf
Defining Health and Illness
The WHO definition of health, which is not limited to lack of disease. Contrasts “differential
diagnosis” used in clinical medical practice to diagnose and define illness with the social
construction of health and illness: how health/illness is defined in each paradigm, how to
determine whether someone is healthy or ill, and the obligations of people perceived as ill.
Readings
Kleinman, A., Eisenberg, L., and Good, B. 2006. Culture, Illness, and Care: Clinical Lessons
from Anthropologic and Cross-Cultural Research. Focus. 4:140-149.
Mechanic, D. 1995. Sociological Dimensions of Illness Behavior. Social Science & Medicine.
41:1207-1216.
Declaration of Alma-Ata http://www.who.int/hpr/NPH/docs/declaration_almaata.pdf
Ottawa Charter https://www.who.int/healthpromotion/conferences/previous/ottawa/en/
II. METHODS OF STUDYING HEALTH AND ILLNESS
3
1/17
Indicators of Health Status
Measures of the health status and health-related behaviors of a population (as distinct from an
individual): mortality rates, morbidity rates (disease registries or survey data), and DALYs and
disability-free life expectancy types of measures. Sources of data such as: vital registration
system, population registers in other countries, censuses, disease registries, and surveys.
Readings
Etches, V., Frank, J., Di Ruggiero, E., and Manuel, D. 2006. Measuring Population Health: A
Review of Indicators. Annual Review of Public Health. 27:29-55.
McFall, J.A. 2003. Population: A Lively Introduction. Washington, DC: Population Reference
Bureau. 58:10-14 on Mortality.
4
1/19
Jylhä, M. 2009. What is Self-Rated Health and Why Does it Predict Mortality? Towards a
Unified Conceptual Model. Social Science & Medicine. 69:307-316.
Measuring Health Status: Surveys and Qualitative Methods
Key aspects of quantitative and qualitative methods used in community health research,
including: quantitative surveys and qualitative methods based on focus group and interview data
collection.
Readings
Mokdad, A.H. 2009. The Behavioral Risk Factors Surveillance System: Past, Present, and
Future. Annual Review of Public Health. 30:43-54.
Campbell, O., Cleland, J., Collumbien, M., and Southwick, K. 1999. Social Science Methods for
Research on Reproductive Health. World Health Organization. Chapters 2, 4, and 6.
Blum, L.S., et al. 2009. Childhood Drowning in Matlab, Bangladesh: An in-depth Exploration of
Community Perceptions and Practices. Social Science & Medicine. 68:1720-1727.
Also explore “Survey and Data Collection”
http://www.cdc.gov/nchs/surveys.htm
4
Suggested
Scheuren, F. What Is a Survey. 2004. American Statistical Association. Chapters 1-4.
Aday, L.A. and Cornelius, L.J. 2006. Designing and Conducting Health Surveys: A
Comprehensive Guide. San Francisco, CA: Jossey-Bass.
Partially available at
http://books.google.com/books?id=gfHpTiGcdO4C&lpg=PR12&dq=Aday%20and%20Cornelius
&pg=PR4#v=onepage&q&f=false
III. SOCIAL DETERMINANTS OF HEALTH AND HEALTH-RELATED BEHAVIOR
5
1/24
Heath Disparities: Basic Concepts
Social stratification of society by gender, age, race/ethnicity, immigrant status, socioeconomic
status (SES), and other categories; defining health disparity; examples by national income
(GDP), race/ethnicity, gender, age, and SES; measurement of health disparities; reducing
health disparities—does it mean that everyone should or will have the same health?
Readings
Satcher, D. 2000. Eliminating Global Health Disparities. The Journal of the American Medical
Association. 284:2864.
Braveman, P. 2006. Health Disparities and Health Equity: Concepts and Measurement. Annual
Review of Public Health. 27:167-194.
6
1/26
Williams, D.R., et al. 2008. Moving Upstream: How Interventions that Address the Social
Determinants of Health Can Improve Health and Reduce Disparities. Journal of Public Health
Management & Practice. 14:S8-S17.
Socioeconomic Status (SES)
The social gradient between SES and health; main hypotheses about the reasons for this
relationship: SES differences in health care; health-related behavior; stressful occupations,
home lives, environments; and discrimination.
Readings
Elo, I.T. 2009. Social Class Differentials in Health and Mortality: Patterns and Explanations in
Comparative Perspective. Annual Review of Sociology. 35:553-572.
Pampel, F.C. Kruger, P.M. 2010. Socioeconomic Disparities in Health Behavior. Annual Review
of Sociology. 36:349-370.
Woolf, S.H., Johnson, R.E., Phillips, R.L., and Philipsen, M. 2007. Giving Everyone the Health
of the Educated: An Examination of Whether Social Change Would Save More Lives Than
Medical Advances. American Journal of Public Health. 97:679-683.
Suggested
Marmot, M.G. 1994. Social Differentials in Health within and between Populations. Daedulus.
123:197-216.
1/31/12
7
ESSAY 1 DUE BEGINNIG OF CLASS
1/31
Race, Ethnicity and Immigration Status
Definitions of race, ethnicity and culture; race, ethnic, and immigrant status differentials in health
outcomes; the role of group differences in SES; group differences in health-related behaviors
and access to care; cultural influences; measurement issues related to acculturation and
promotion of cultural competency.
Readings
Singh, G.K. and Hiatt, R.A. 2006. Trends and Disparities in Socioeconomic and Behavioural
Characteristics, Life Expectancy, and Cause-specific Mortality of Native-born and Foreign-born
Populations in the United States, 1979-2003. International Journal of Epidemiology. 35:903-919.
5
Williams, D.R., Mohammed, S.A., Leavell, J., and Collins, C. 2010. Race, Socioeconomic
Status, and Health: Complexities, Ongoing Challenges, and Research Opportunities. Annals of
the New York Academy of Sciences. 1186:69-101.
Suggested
Alegría, M., et al. 2007. Prevalence of Psychiatric Disorders Across Latino Subgroups in the
United States. American Journal of Public Health. 97:68-75.
Lee, S.S-J., Mountain, J., and Koenig, B. 2001. The Meanings of “Race” in the New Genomics:
Implications for Health Disparities Research. Yale Journal of Health Policy, Law, and Ethics.
1:33-75.
Richmond, C.A.M., Ross, N.A., and Egeland, G.M. 2007. Social Support and Thriving Health: A
New Approach to Understanding the Health of Indigenous Canadians. American Journal of
Public Health. 97:1827-1833.
8
2/2
Data Compendium of Immigration Statistics
http://www.migrationinformation.org/USFocus/display.cfm?ID=747
Gender Across the Life Course
Gender differences in health and mortality across the life course including, fetal survival to birth
and sex ratios at birth, childhood, adolescents and young adults, middle adulthood, and old age;
and, reasons for differentials, including biological differences in survival (e.g., survival in
prenatal period), risk taking, reproductive, sexual, and maternal health, health-related
behaviors.
Readings
Lynch, J. and Smith, G.D. 2005. A Life Course Approach to Chronic Disease Epidemiology.
Annual Review of Public Health. 26:1-35.
Williams, D.R. 2002. Racial/Ethic Variations in Women’s Health: The Social Embeddedness of
Health. American Journal of Public Health. 92:588-597.
Williams, D.R. 2003. The Health of Men: Structured Inequalities and Opportunities. American
Journal of Public Health. 93:724-731.
Explore the CDC Website on Men’s Health
http://www.cdc.gov/men/
Explore the CDC Website on Women’s Health
http://www.cdc.gov/women/
Suggested
Moss, N.E. 2002. Gender Equity and Socioeconomic Inequality: A Framework for the Patterning
of Women's Health. Social Science & Medicine. 54:649-661.
Rieker, P.P. and Bird, C.E. 2005. Rethinking Gender Differences in Health: Why We Need to
Integrate Social and Biological Perspectives. Journals of Gerontology. 60B:40-47.
9
MIDTERM
2/7
IV. CHANGING HEALTH-RELATED BEHAVIOR AT THE INDIVIDUAL & COMMUNITY LEVEL
10-11
2/92/14
Theories of Health-related behavior and Change: Individual-Level
Intrapersonal and interpersonal theories that explain behavior change, including: (1) Health
Belief Model, (2) Social Cognitive Theory, (3) the Trans-theoretical Model, and (4) the Theory of
Reasoned Action/Theory of Planned Behavior.
Readings
Text: Chapter 2. Glanz, K., Rimer, B.K., and Viswanath, K. Theory, Research, and Practice in
Health Behavior and Health Education. Pp. 23-40
6
Text: Chapter 3. Champion, V.L. and Skinner, C.S. The Health Belief Model. Pp. 45-66.
.
Text: Chapter 4. Montaño, D.E. and Kasprzyk, D. Theory of Reasoned Action, Theory of
Planned Behavior, and the Integrated Behavioral Model. Pp. 67-96.
Text: Chapter 8. McAlister, A.L., Perry, C.L., and Parcel, G.S. How Individuals, Environments,
and Health Behaviors Interact: Social Cognitive Theory. Pp.169-188.
12
2/16
Text: Chapter 5: Prochaska, J.O., Redding, C.A., and Evers, K.E. The Transtheoretical Model
and Stages of Change. Pp. 97-122.
Suggested
National Cancer Institute, Theory at a Glance: A Guide for Health Promotion Programs, Part 1
Pp. 3-8, Part 2 Pp. 9-19. All NCI readings are in one PDF file.
Theories of Health-related behavior and Change: Social-Level
Theories of behavior change that take a larger frame, including social ecological theory,
organizational theories, social networks effects and the diffusion of innovations.
Readings
Text: Chapter 9. Heaney, C.A. and Israel, B.A. Social Networks and Social Support. Pp. 189210.
Text: Chapter 20: Sallis, J.F., Owen, N., and Fisher, E.B. Ecological Models of Health Behavior.
Pp. 465-486.
Suggested
National Cancer Institute, Theory at a Glance: A Guide for Health Promotion Programs, Part 2
Pp. 22-31. All NCI readings are in one PDF file, see session 10.
13
2/21
Frieden, T. R. 2010. A Framework for Public Health Action: The Health Impact Pyramid.
American Journal of Public Health. 100: 590-595.
Intervention Planning and Evaluation: General Principles
Basic steps in planning for community or organization-based interventions, including: (1) needs
assessments, (2) formative research, (3) creating objectives, (4) picking a strategy and
implementation plan, (5) monitoring implementation, and (6) understanding outcomes.
Readings
Text: Chapter 18. Gielen, A.C., McDonald, E.M., Gary, T.L., and Bone, L.R. Using the PrecedeProceed Model to Apply Health Behavior Theories. Pp. 407-434.
Text: Chapter 21. Glasgow, R.E. and Linnan, L.A. Evaluation of Theory-Based Interventions.
Pp. 487-508.
14
2/23
Suggested
National Cancer Institute, Theory at a Glance: A Guide for Health Promotion Programs, Part 3
Pp. 35-47. All NCI readings are in one PDF file, see session 10.
Health Communication Interventions
Guest Lecture: Professor Deborah Glick
Basic strategies used to communicate with publics and professionals, including social marketing
and health campaigns, media interventions, and risk communications.
Readings
Text: Chapter 16. Finnegan, J.R. and Viswanath, K. Communication Theory and Health
Behavior Change: The Media Studies Framework. Pp. 363-388.
Text: Chapter 19. Storey, J.D., Saffitz, G.B., and Rimón, J.G. Social Marketing. Pp. 435-464.
Randolph, W. and Viswanath, K. 2004. Lessons Learned from Public Health Mass Media
7
Campaigns: Marketing Health in a Crowded Media World. Annual Review of Public Health.
25:419-437.
15
2/28
Suggested
Maibach, E.W., Abroms, L.C., and Marosits, M. 2007. Communication and Marketing as Tools
to Cultivate the Public’s Health: A Proposed “People and Places” Framework. BMC Public
Health. 7:1-15.
Community Organizing & Community-Based Participatory Research
Guest Lecture: Professor Michael Prelip
Different models for organization of communities from social planning or community mobilization
through Freire’s conscientization to today’s community-based participatory research and
coalition building.
Readings
Text: Chapter 13. Minkler, M., Wallerstein, N., and Wilson, N. Improving Health Through
Community Organization and Community Building. Pp. 287-312.
16
3/1
Text: Chapter 15. Butterfoss, F.D., Kegler, M.C., and Francisco, V.T. Mobilizing Organizations
for Health Promotion: Theories of Organizational Change. Pp. 335-362.
Health Promotion in Schools, Work Sites and Clinics
Health promotion initiatives in school, work sites and clinical settings, such as tobacco use,
contraceptives, exercise, diet.
Readings
Text: Chapter 11. Street, R.L. and Epstein, R.M. Key Interpersonal Functions and Health
Outcomes: Lessons from Theory and Research on Clinician–Patient Communication. Pp. 237270.
Calear, A.L. and Christensen, H. 2010. Systematic Review of School-Based Prevention and
Early Intervention Programs for Depression. Journal of Adolescence. 33:429-438.
17
3/6
Health Policy and Advocacy
Health promotion through changing the policy environment in which people live; major modes of
advocacy/affecting policy: (1) changing the law through legislation (Congress or legislatures),
(2) changing regulations or enforcement (Administrative branch), (3) changing the law through
law suits (Judicial system), and (4) changing public opinion (mass media campaigns); major
elements of advocacy.
Readings
Text: Chapter 14: Oldenburg, B. and Glanz, K. Diffusion of Innovations. Pp. 313-334.
Minkler, M. 2010. Linking Science and Policy Through Community-Based Participatory
Research to Study and Address Health Disparities. American Journal of Public Health. 100:S81S87.
Shiffman, J. and Smith, S. 2007. Generation of Political Priority for Global Health Initiatives: A
Framework and Case Study of Maternal Mortality. The Lancet. 370:1370-1379.
Eriksen, M.P. and Cerak, R.L. 2008. The Diffusion and Impact of Clean Indoor Air Laws. Annual
Review of Public Health. 29:171-185.
IV. HEALTH PROMOTION INTERVENTIONS: APPLIED EXAMPLES
3/8/12
ESSAY 2 DUE BEGINNIG OF CLASS
8
18
3/8
Health Promotion Interventions: Stress and Mental Health
Promoting mental health versus preventing mental illness; identifying groups at high risk;
preventing first onset and relapse; families and prevention for children; school-based prevention
and early intervention.
Readings
Text: Chapter 10. Glanz, K. and Schwartz, M.D. Stress, Coping, and Health Behavior. Pp. 211236.
Barrera, A.Z., Torres, L.D., and Muñoz, R.F. 2007. Prevention of Depression: The State of the
Science at the Beginning of the 21st Century. International Review of Psychiatry. 19:655-670.
Cuijpers, P., et al. 2008. Preventing the Onset of Depressive Disorders: A Meta-Analytic Review
of Psychological Interventions. American Journal of Psychiatry. 165:1272-1280.
19
3/13
Saxena, S., Jané-Llopis, E., and Hosman, C. 2006. Prevention of Mental and Behavioural
Disorders: Implications for Policy and Practice. World Psychiatry. 5:5-14.
Health Promotion Interventions Across the Life Course
The concept of the life course; key health problems at major points in the life course;
considerations for interventions with populations of that specific age group.
Readings
Berkman, L.F. 2009. Social Epidemiology: Social Determinants of Health in the United States:
Are We Losing Ground? Annual Review of Public Health. 30:27-41.
Tan, E.J., et al. 2010. Marketing Public Health Through Older Adult Volunteering: Experience
Corps as a Social Marketing Intervention. American Journal of Public Health. 100:727-734.
Guilamo-Ramos, V., et al. 2010. The Linking Lives Health Education Program: A Randomized
Clinical Trial of a Parent-Based Tobacco Use Prevention Program for African American and
Latino Youths. American Journal of Public Health. 100:1641-1647.
Stewart, A.L., et al. 2006. Diffusing a Research-based Physical Activity Promotion Program for
Seniors into Diverse Communities: CHAMPS III. Preventing Chronic Disease: Public Health
Research, Practice, and Policy. 3:1-16.
20
3/15
FINAL EXAM
Covers material since the midterm
9