A general framework Exogenous variables

1
A general frameworkExogenous variables
Stressor, pathogen, culture
Internal Process
Health Outcome

• Chronic
• Stress
• Chronic disease
• Environmental exposure
• Social inequity
• Cultural norms
• Person variables
• Temperament
• Personality

• Acute
• Stress
• Affect
• Environmental exposure

2
A general frameworkEndogenous variables
Stressor, pathogen, culture
Internal Process
Health Outcome

• ?
• Affective state
• Self-perception
• Perceived vulnerability
• Self-efficacy, etc.

• Physical
• Arousal
• Allostatic load
• HPT activation
• Inflammation
• Metabolic syndrome
• Immunocompetence

3
A general frameworkOutcome variables
Stressor, pathogen, culture
Internal Process
Health Outcome

• Behavioral
• Health behaviors
• Alcohol drug abuse
• Risk, etc.

• Biomedical
• CHD
• BMI
• Infection, etc.

4
Course topics

• Overview of Health behavior concepts
• 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

5
Health behavior behavioral medicine concepts

• CHD as core example of health behavior process
• Behavioral variables
• Smoking
• Dietary
• Affect / stress
• Anger
• Chronic arousal,
• Depression
• Physical process
• Stress or Arousal (allostatic load)

• Exercise
• Sleep, etc.

?
Hypothalamic-Pituitary-Adrenal axis (HPA axis)
?
Immunomodulation, inflammation.
6
Personality theory health / health behavior

• Stable, individual differences
• Direct effects
• Type A personality chronic arousal
• Negative affectivity and immune (or
  behavioral) effects
• Neuroticism (versus optimism?) and common
  factor in disease vulnerability
• 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)

7
Basic attitude theory, self-regulation

• Simple utility models of behavior
• 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

8
Social-Cognitive / Affective Models

• 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 self-regulation
• Self-efficacy (again)
• Health protection motivation
• Perceived vulnerability
• Outcome expectancies
• Efficacy expectancies

9
Judgments of vulnerability

• 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

10
Self-awareness, "automaticity" and health

• 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

11
Social group processes

• Core dimensions of society health
• 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

12
Psychoimmunology

• Some 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
• Psychological variables and immune status
• Self-perception
• Self-discrepancy
• Self-efficacy
• Thought suppression
• ? Interventions

13
Policy, Economic and Political Influences

• 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

14
The big picture Spirituality, happiness,
mindfulness well-being

• 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

15
General Approaches to Health Research Evolving
conceptions of mind ?? body

• Core construct

• General process mediating models
• What explains or accounts for a stress ? outcome
  effect
• Basic theory development testing
• 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.

16
Mediating (and additive) models
Environ-mental change, Adaptation syndrome
Arousal / allostatic load, inflammation
CHD

• ? distress, helplessness
• Physiological
• Corticosteroids, pro-inflammatory cytokines, HPA
  activation
• Lipids, insulin section metabolic syndrome

Health behavior Diet, smoking

• Developmental changes
• SES, culture, etc.
• Individual stress
• ? change

17
Mediating (and additive) models
Environ-mental change, Adaptation syndrome
Psych. Process
Arousal, inflammation
CHD
Self-efficacy Helplessness / depression Social
isolation
Health behavior diet, exercise, smoking
18

• Basic mediating models in health behavior

Immune function
Negative health behavior
Stress
Illness
Exposure to pathogens
Arousal (coritco-steroids)
19

• Health models with structural exogenous variables

Allostatic load / Immune function
Stress
Negative health behavior
Illness
Socio-economic status
Exposure to pathogens
Structural cultural barriers to health care
20
Basic moderating model
21
Direct effects of ? on health

• Psychoimmunology Adars work on affect, learning
  and immune function
• Classical conditioning models
• immune status, tolerance, withdrawal, placebo
  effects
• Etiology arousal or affective effects on health
• stress responses, arousal, and cardio-vascular
  health
• bereavement and health see House on social ties
  and mortality
• affect (depression), self-concept, optimism,
  sense of coherence and immune function
• Specific stressors and obesity

Key issue articulation of complex relations
among CNS, ANS, Immune, and other systems.
22
Indirect effects of ? on health

• Health behaviors risks, protective behaviors
  primary prevention

• Individual social / cognitive models of ...
• 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

23
Indirect effects of ? on health Health behaviors

• Group-level variables controlling exposure,
  definition, and availability of (un)healthy
  behavior
• social norms and/or socially structured rewards
  and punishments
• gender, age, cultural group effects X,
  smoking, etc.
• models of (un)healthy behavior processes of
  modeling influences
• relations of individuals/groups with health
  system providers, govt., schools, etc.
• Cultural level variables
• Economic / corporate incentives for (un)healthy
  behaviors
• Main effects of socio-economic disparity
• Main effects of ethnicity (objective status?)

24
Illness related behaviors 2nd / 3rd prevention

• Key steps
• Recognition of health problems
• Definition of disturbance or problem
• Treatment or help seeking
• Recognition of a health threat
• surveillance early detection
• basic health information approaches
• Perceived vulnerability susceptibility Core
  precursor of virtually all health models
• Weinstein core ? variables (controllability)
• Khaneman Relative irrationality of risk
  perception
• interpretation of symptoms or signs implicit
  health models
• Health belief model
• Info about health threat
• Cues to action
• Health cognitions

25
Illness related behaviors 2nd / 3rd prevention

• Definition of disturbance or problem
• 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

26
Illness related behaviors 2nd / 3rd prevention

• 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