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Health Behavior
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Session 5MODELS OFINTERPERSONAL HEALTH BEHAVIOR
Sal Sanders, Ph.D.Sal Sanders, Ph.D.
HOW INDIVIDUALS, ENVIRONMENTS, AND HEALTH BEHAVIORS INTERACT: SOCIAL COGNITIVE THEORYSOCIAL NETWORKS AND SOCIAL SUPPORTSTRESS, COPING, AND HEALTH BEHAVIOR
+ObjectivesDefine and describe important concepts and
principles from the Social Cognitive Theory (SCT).
Describe the fundamental emphasis of SCT on the interaction between individuals and their environments and human capacities for learning and adaptation.
+ObjectivesDemonstrate how the social cognitive theory has
been effectively applied for personal and social change to prevent and manage chronic and infectious diseases, and provide useful insight into other problems such as violence and disaster preparedness.
Illustrate the measurement and application of key SCT concepts and principles in case studies on smoking cessation and condom use promotion.
+SOCIAL COGNITIVE THEORYFirst known as social learning theory
(SCT) (Bandura, 1977).
Renamed social cognitive theory (Bandura, 1986).
SCT included concepts from sociology and political science (Bandura, 1997).
Integrated and developed concepts from humanistic psychology.
Glanz, K, Rimmer, B.K. & Viswanath, K. (2008). Health Behavior and Health Education: Theory, Research and Practice. San Francisco: Jossey-Bass.
+SOCIAL COGNITIVE THEORYHumanistic psychology.
Glanz, K, Rimmer, B.K. & Viswanath, K. (2008). Health Behavior and Health Education: Theory, Research and Practice. San Francisco: Jossey-Bass.
+SOCIAL COGNITIVE THEORY
SCT included concepts from sociology and political science (Bandura, 1986).
Emphasizes reciprocal determination in interaction between people and their environments.
Also emphasizes the human capacity for collective action.
Glanz, K, Rimmer, B.K. & Viswanath, K. (2008). Health Behavior and Health Education: Theory, Research and Practice. San Francisco: Jossey-Bass.
+SCT: Key Concepts
Psychological Determinants of Behavior
Observational Learning
Environmental Determinants of Behavior
Self-Regulation
Moral Disengagement
+Psychological Determinants of BehaviorOutcome expectations
Human values and expectations are subjective – not based solely on objective reality – but people’s perceptions of it.
Social Outcome expectationsSimilar to Social Norms in TRA and TPB
Self evaluative outcome expectation – functions like a social outcome.
+Psychological Determinants of Behavior(SE) and Collective efficacy
Collective efficacy- SE extended to how people work in organizations.
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+Observational Learning
Capacity for Observational Learning is important to SCT.
4 Processes govern OL (Bandura)Attention – Research on Attention - VideoRetentionProductionMotivation
+Observational Learning of Health BehaviorsStory Telling may be more effective than
directly didactic or persuasive messages (Hinyard and Kreuter, 2007)
+Learning and Literacy
Literacy – Typically refers to the ability to read & write
Recognized need for:
Cultural literacy
Computer literacy
Information literacy
Pettersson, R. (1994). Learning in the information age. Educational Technology Research and Development, 42(1), 91-97.
+Learning and Literacy
Recognized need for:
Media literacy
Scientific literacy
Technical literacy
Visual literacy
Pettersson, R. (1994). Learning in the information age. Educational Technology Research and Development, 42(1), 91-97.
+Learning and Literacy
“In the information age, the competent individual needs a basic knowledge of infology, the science of verbo-visual presentations of information (Pettersson 1989, 1993 a).”
Pettersson, R. (1994). Learning in the information age. Educational Technology Research and Development, 42(1), 91-97.
+Learning and Literacy
“The various literacies and modes of thinking required in an information society will challenge the capacities of every person.”
Pettersson, R. (1994). Learning in the information age. Educational Technology Research and Development, 42(1), 91-97.
+Environmental Determinants of BehaviorSCT posits observational learning will not
lead to behavior change unless the observer’s environment supports the new behaviors (Bandura, 2002).
Consider public policies that influence behavior
Consider unintended effects of these policies.
+Self-Regulation
People have the capacity to endure short-term negative outcomes in anticipation of long-term positive outcomes.
Consider the concept of opportunity costs.
+Self-Regulation
Self-Monitoring
Goal-setting
Feedback
Self-reward
Self-instruction
Enlistment
+Moral Disengagement
People have the potential to learn moral standards for self-regulation.
These moral standards can lead them to avoid violence and cruelty to others.
Can violate these standards through moral disengagement.
+Moral Disengagement: Mechanisms
Euphemistic labeling
Dehumanization and attribution of blame
Diffusion and displacement of responsibility
Perceived moral justification for harmful actions
+SCT: Health Promotion Applications
Community projects to prevent heart diseaseCaliforniaFinland
Community programs to prevent drunk driving http://www.collegedrinkingprevention.gov/supportingresearch/journal/dejong2.aspx
Programs to prevent harm from Alcohol Abuse
+SCT: Health Promotion ApplicationsAmerican Cancer Society Telephone Counseling for Smoking Cessation http://www.cancer.org/Healthy/StayAwayfromTobacco/quit-for-life
American Lung AssociationNOT (Not On Tobacco) http://www.lung.org/associations/states/colorado/tobacco/not-on-tobacco/
The AIDS Community Demonstration Projectshttp://www.cdc.gov/hiv/topics/prev_prog/acdp/index.htm
+SCT
Seeks to provide a comprehensive understanding of both why and how people change individual health behaviors.
Seeks an understanding of the social and physical environments that influence health behaviors.
+Shattered Dreams
School-based intervention aimed at reducingunderage drinkingalcohol-related crashes.
Price, M. A., Salazar, C.I., Villarreal, C. L., Guerra, C. M., Villarreal, R., Stewart, R. M. (2009). APPLYING BEHAVIORAL THEORY TO AN INNOVATIVE SCHOOL-BASED PROGRAM FOR PREVENTING UNDERAGE DRINKING AND IMPAIRED DRIVING. American Journal of Health Studies, 24(1), 223-231.
+Shattered Dreams
Applied Constructs from transtheoretical model and social cognitive theory
To operationalize change among program participants.
Price, M. A., Salazar, C.I., Villarreal, C. L., Guerra, C. M., Villarreal, R., Stewart, R. M. (2009). APPLYING BEHAVIORAL THEORY TO AN INNOVATIVE SCHOOL-BASED PROGRAM FOR PREVENTING UNDERAGE DRINKING AND IMPAIRED DRIVING. American Journal of Health Studies, 24(1), 223-231.
+Shattered Dreams
Integrated SCT constructs of:
self-efficacy
behavioral capability
expectations
observational learning
Price, M. A., Salazar, C.I., Villarreal, C. L., Guerra, C. M., Villarreal, R., Stewart, R. M. (2009). APPLYING BEHAVIORAL THEORY TO AN INNOVATIVE SCHOOL-BASED PROGRAM FOR PREVENTING UNDERAGE DRINKING AND IMPAIRED DRIVING. American Journal of Health Studies, 24(1), 223-231.
+Shattered Dreams
measured students’ expectancies regarding alcohol (positive and negative consequences)
self-efficacy
knowledge and
self-reported underage drinking and impaired driving
Price, M. A., Salazar, C.I., Villarreal, C. L., Guerra, C. M., Villarreal, R., Stewart, R. M. (2009). APPLYING BEHAVIORAL THEORY TO AN INNOVATIVE SCHOOL-BASED PROGRAM FOR PREVENTING UNDERAGE DRINKING AND IMPAIRED DRIVING. American Journal of Health Studies, 24(1), 223-231.
+Shattered Dreams
Participants reported significant decreases in
No. of drinking days in the past 30 days (pre-test mean =1.81; post-test mean = 0.91, p = 0.001)
No. of days having 5 or more drinks (binge drinking) (pretest mean = 1.09; post-test mean = 0.56, p =0.001)
Price, M. A., Salazar, C.I., Villarreal, C. L., Guerra, C. M., Villarreal, R., Stewart, R. M. (2009). APPLYING BEHAVIORAL THEORY TO AN INNOVATIVE SCHOOL-BASED PROGRAM FOR PREVENTING UNDERAGE DRINKING AND IMPAIRED DRIVING. American Journal of Health Studies, 24(1), 223-231.
+SOCIAL NETWORKS AND SOCIAL SUPPORT(SE) and Collective efficacy
Collective efficacy- SE extended to how people work in organizations.
+ObjectivesDefine functions and characteristics of social
networks.
Provide a conceptual framework for understanding the relationship between social networks and health.
Briefly review the empirical support for this relationship.
+ObjectivesList and describe types of social network
interventions.
Present two examples of social network interventions for promoting health.
+Definitions
Social Networks – The web of social relationships that surrounds individuals.
Social Integration – The existence of social ties
+Social Support
“The functional content of relationships that can be categorized into four broad types of supportive behaviors or acts:Emotional Support Instrumental Support Informational SupportAppraisal Support” (House, 1981)
+Social Support
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+Social Support
Social support approach usually focuses on one relationship at a time.
Social network approach allows the study of how change in one social relationship affects other relationships.
+Social Support
Barnes (1954) – Presented Social network concept.
John Cassel (1976) - Study of social support.
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+Social Relationships and Health
Barnes (1954) – Intimate ties and their emotional support increase survival rates for severe cardiovascular disease patients (Berkman and Glass, 2000)
1 strong intimate relationship is a predictor of good health (Michael, Colditz, Coakley and Kiwachi, 1999).
+Social Support - Who
Many types of people can provide social support. What are the differences in the likely type of support provided by a friend, a family member, a health care professional?
+Social Support - What
The perceptions of support recipients not the objective behaviors involved in interactions are most strongly related to the health & wellbeing of the recipients.
+Social Support - When
The types of social networks and social support that enhance health & well-being differ according to age or developmental stage of the recipient of the support (Kahn and Antonucci, 1980).
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+Asthma Support
CHW’s provided support and information.
After 1 year, the participants in the high intensity intervention group (5-9 visits over 1 year) showed a larger decrease in the number of days limited by asthma and the number of times urgent health care services were utilized. (Kahn and Antonucci, 1980).
+STRESS, COPING, AND HEALTH BEHAVIOR
+ObjectivesReview major theories, research, and
applications related to stress, coping, and health.
Summarize historical concepts of health, stress, and coping.
Describe an influential theoretical framework—the Transactional Model of Stress and Coping—and key variables, definitions, and research approaches to studying this framework.
+ObjectivesDiscuss theoretical extensions of the
Transactional Model, including information seeking styles, social support, optimism, and psychoneuroimmunology.
Illustrate applications of the Transactional Model to understanding the use of coping strategies and the design and evaluation of health behavior interventions.
+Social Readjustment Rating Scale (SRRS)
http://chipts.ucla.edu/assessment/Assessment_Instruments/Assessment_files_new/assess_srrs.htm
Assessment:1. Death of a spouse 1002. Divorce 733. Marital Separation 654. Jail term 635. Death of a close family member 63Etc.
+STRESS
+STRESS
+STRESS
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+
+STRESS Chronic Stress has an adverse impact on immune
function (Moynihan, 2003)
Transactional model has been applied to public health issues Racism – may indirectly (SES) and directly (acute and chronic
stressor) influence health (Williams, 1999).
Effects of stress may be moderated by coping styles. John Henryism – strong behavioral predisposition to cope
actively with psychosocial and environmental stressors – may result in adverse health effects when coupled with limited
resources.
+Self Assessment
Stress can be positive or negative.
TRUE FALSE
+Self Assessment
The evaluation of an individual’s coping resources is which concept of the Transactional Model of Stress and Coping?
A. A. Primary appraisal
B. Secondary appraisal
C. Coping efforts
D. Outcomes of coping
+Being Poor and Coping With Stress
Individuals may cope with stress through what may be pleasurable but unhealthy behaviors.
…examined whether smoking, alcohol use, and physical inactivity moderate the relationship between perceived stress and the risk of death in the US population as a whole and across socioeconomic strata.
Krueger, P. M. & Chang, V. W. (2008). Being Poor and Coping With Stress: Health Behaviors and the Risk of Death. American Journal of Public Health, 98(5), 889-896.
+Being Poor and Coping With Stress
Data were derived from the 1990 National Health Interview Survey’s Health Promotion and Disease Prevention Supplement
n=40,335
Data linked to prospective National Death Index mortality data through 1997
Krueger, P. M. & Chang, V. W. (2008). Being Poor and Coping With Stress: Health Behaviors and the Risk of Death. American Journal of Public Health, 98(5), 889-896.
+Being Poor and Coping With Stress
Data were derived from the 1990 National Health Interview Survey’s Health Promotion and Disease Prevention Supplement
n=40,335
Data linked to prospective National Death Index mortality data through 1997
Krueger, P. M. & Chang, V. W. (2008). Being Poor and Coping With Stress: Health Behaviors and the Risk of Death. American Journal of Public Health, 98(5), 889-896.
+Being Poor and Coping With Stress
Unhealthy behaviors moderate the stress–mortality relationship in a nationally representative sample of US adults.
Physical inactivity and former smoking at baseline increased the impact of stress on mortality.
Krueger, P. M. & Chang, V. W. (2008). Being Poor and Coping With Stress: Health Behaviors and the Risk of Death. American Journal of Public Health, 98(5), 889-896.
+Being Poor and Coping With Stress
Findings are consistent with “Double Jeopardy”
“Engaging in unhealthy but pleasurable behaviors is a poor strategy for coping with high perceived stress…”
Krueger, P. M. & Chang, V. W. (2008). Being Poor and Coping With Stress: Health Behaviors and the Risk of Death. American Journal of Public Health, 98(5), 889-896.
+Being Poor and Coping With Stress
Factors that independently increase risk of death:
Stress
Unhealthy behaviors, and
Low SES
Krueger, P. M. & Chang, V. W. (2008). Being Poor and Coping With Stress: Health Behaviors and the Risk of Death. American Journal of Public Health, 98(5), 889-896.
+Being Poor and Coping With Stress
Findings are consistent with “Double Jeopardy”
“Engaging in unhealthy but pleasurable behaviors is a poor strategy for coping with high perceived stress…”
Krueger, P. M. & Chang, V. W. (2008). Being Poor and Coping With Stress: Health Behaviors and the Risk of Death. American Journal of Public Health, 98(5), 889-896.
+STRESS MANAGEMENT - VIDEO
http://hdl.handle.net/2374.OX/60014
+The Weight of the Nation - VIDEOS
http://theweightofthenation.hbo.com/films/main-films/Crisis