HLTH 335 final

Process (5 Steps) of Selecting a Theory/Model

1) develop a problem statement 2) Identify target behavior 3) conduct functional asessment (surveys/observations of behavior) 4) select theory or model 5) develop theory-based intervention

Summarize Bobo Doll experiment (SCT)

3 different groups. One group was shown a toy being violent to another. Another group was shown toys being passive. And another group was a control group. The children were taken to a room with toys and observed how they played with the toys. When behavior is reinforced.

What is an outcome expectation?

A connection between a behavior and an outcome

Main points of article about phone quitline for smokers (TTM)

A telephone counseling protocol for smoking cessation, previously proven efficacious, was effective when translated to a real-world setting. Public Health Service recommend use of the telephone to deliver cessation-counseling services, in part because such "quitlines" have the potential to reach large numbers of smokers the intervention achieved its effect through two mechanisms: by increasing the percentage of smokers making attempts to quit and by reducing the probability of relapse

example of a modifying influence?

An immune-compromised AIDS pt's perception about her own risk for contracting TB

Based upon the best ways to change self-efficacy, which of the following would most influence self-efficacy for parenting?

Babysitting

Self-Efficacy Theory main person(s) + constructs

Bandura Mastery Exp: when we try something and succeed (babysitting --> parenting) Vicarious Exp: learning via observation, best w/someone close to us that we respect Verbal Persuasion: encourage/convince someone to do something, works best if you know the person (pep talk) Somatic/Emotional States: physical/emotional states can help or hinder the uptake o f new behavior (don't start a diet during finals week)

Social Cognitive Theory main person(s) + constructs

Bandura behavior can be described using the Triadic Reciprocal Model of Determinism, which takes into account the behavior, environmental factors and personal factors such cognitions, self-perceptions and biological events. The theory asserts that all three of these factors influence both behavior and each other CONSTRUCTS: knowledge situational perception: How many teenagers do you think are pregnant? outcome expectations: belief about likelihood of behavior leading to specific outcome - If you get the flu shot, you wouldn't expect to get the flu outcome expectancy: value/importance we place on an outcome environment: can be physical or social self-efficacy reinforcement: Positive: Encouragement Negative reinforcement: getting yelled at Must be immediate, positive is always better.

What is the name most associated with the Ecological Model?

Bronfenbrenner

Ecological Model main person(s) + 5 Levels

Bronfenbrenner Intrapersonal: personal attitudes, perceptions and beliefs Interpersonal: family, friends Organizational: church, school, work Community Policy

What do we learn from the Bobo Doll studies?

Consequences administered to other people influence our behavior.

Samuel has smoked for 15 years, since he was 13 years old. He said he would like to quit smoking someday, but isn't ready to do so right now. I tried to set a goal with him, but he said maybe in a few months. Which stage of change is Samuel in?

Contemplation bc Samuel is thinking about changing (rules out precontemplation), but not ready to make a change (rules out action or maintenance).

What is likely to happen to your self-efficacy after a failed attempt to quit smoking?

Decrease

From the Gibson article, which of the following was true?

Density of grocery stores was related to body mass index (BMI).

most similar to an outcome evaluation?

Detecting early signs of heart disease is VERY IMPORTANT TO ME as a general practitioner

What did you learn from the article about retailer proximity?

Drug use is influenced by the environment.

Helping a parent to recognize that their smoking addiction has caused his children to develop serious asthmatic symptoms is characteristic of which process/strategy?

Environmental re-evaluation

T/F A conditioned reinforcer is one that is inherently valuable to the individual (e.g., food) and does not require pairings.

F

T/F A tenet is just another term for a construct in social cognitive theory.

F

T/F Ecological models focus exclusively on the environment, to the exclusion of the individual perspective.

F

With respect to food, T/F Rich countries' citizens all have easy access to fruits and vegetables?

F

In the "Matching Law," which two things need to be in balance for behavior to occur reliably?

First, the amount of effort required to perform the behavior. This is related to how challenging the behavior is, or how difficult it is to perform; second, the size of the reinforcement or consequence. Behaviors that are easy to do require small reinforcers; behaviors that are hard to do require large reinforcers.

Health Belief Model main person(s) + constructs

Godfrey Hochbaum was offering free TB tests through the USPHS, but very few people were taking advantage and he wanted to understand why all of the PERCEIVED stuff CONSTRUCTS: Perceived Susceptibility: how susceptible do you think you are to a disease/outcome if you do/don't adopt behavior Perceived Severity: yep Perceived Benefits: any benefits to new behavior adoption? Perceived Barriers: yep Modifying Variables (Influences): individual's personal factors that affect whether the new behavior is adopted. ie. experience, education, culture, etc. (A student studying public health that has a knowledge and education based in healthy behaviors, is more likely to engage in healthy behaviors such as exercising, eating a healthy diet, and not smoking.) Cues to Action: things in the environment that help to trigger the action Self Efficacy

An immigrant woman is attempting to get a mammography. The clinic hours conflict with her work schedule as a hotel maid. What statement most closely represents perceived power?

I am able to negotiate with my manager to get time off to go to the clinic during the regular hours

example of a behavioral belief?

I'll be more productive and better prepared if I use social media in my job

Order the EM levels from smallest to biggest

Intrapersonal Interpersonal Organizational Community Policy

What's the problem w/coercion and punishment?

It doesn't teach new/proper behavior

Which of the following is most true about contingent reinforcement?

It is administered if and only if the behavior occurs.

Transtheoretical Model (Stages of Change) main person(s) + constructs

James Prochaska addiction In the early stage of change we are more worried about cons. In the later stage of change we are more worried about pros. pre-contemplation: not thinking about changing contemplation: problem identified, but not committed to changing yet preparation: getting ready to change action: maintenance CONSTRUCTS (strategies/processes of change): Consciousness Raising: doctor sits you down and explains that you are at a high risk of getting lung cancer and/or heart disease because of your smoking habit Dramatic Relief: try to get people emotionally energized Self-Re-evaluation: person's assessment of their self-image associated with the new behavior Environmental Re-evaluation: help people realize or become aware of how their behavior is affecting their environment around them Counterconditioning: sever associations - Getting rid of cigarettes once you want to quit smoking, so that you know they're gone, so the stimulus is gone Contingency Management: Consequences are extended based on taking steps in one direction or another. Contingency based on reinforcement - Withholding a reward because the changed behavior wasn't done Stimulus Control: antecedent stimulus that elicits a behavior that is then reinforced Differentiate or see if something is going to lead to reinforcement or punishment/good or bad outcome - you have a group of friends that smoke and you're trying to quit, you try to find new friends

In the Bobo Doll studies, which of the following was true?

Kids were more aggressive after an adult reinforced the model for being aggressive

What is true, based on the Freedman article you read?

Living in economically disadvantaged areas predicts onset of heart disease.

What is the social gradient?

Marmot's claim that individuals lower on the gradient tend to suffer most

Theory of Reasoned Action/Planned Behavior (TRA/TPB) main person(s) + constructs

Martin Fishbein and Icek Azjen TRA came before TPB behavior is driven by intentions to behavior, which are influenced by attitudes and subjective norms + perceived behavioral control → TPB aims to explain the relationship between attitudes and behaviors 3 MAIN CONSTRUCTS: ATTITUDES toward the behavior (e.g., like/dislike toward behavior, whether they believe that texting while driving is dangerous or will result in a negative outcome) 2 sub-constructs: behavioral beliefs & outcome evaluation Outcome eval = expectancies from SCT (value) behavioral belief = behavior + subsequent/corresponding connection SUBJECTIVE NORMS (e.g., whether the individual believes that important others approve or disapprove of texting while driving) 2 sub-constructs: normative beliefs ("What do they think you should be doing?") & motivation to comply (if low, can cancel out normative beliefs) PERCEIVED BEHAVIOR CONTROL (e.g., whether the individual believes they have the ability to avoid texting while driving) *similar to self-efficacy* 2 sub-constructs: control beliefs (perceived likelihood of environmental influences impeding you engaging in health-related behavior) & perceived power (ability to overcome environmental barriers to behavior) INTENTIONS = construct that's the main determinant of behavior

Behavioral Ecological Model main person(s) + 4 levels

Mel Hovell expansion and clarification of the Ecological Model in that it gives more of an explanation of 'how' ecological models can change individuals' behavior focuses on hierarchical (interacting) contingencies BIDIRECTIONAL diff level names from EM Individual: beliefs and attitudes Local Network: community, co-workers, Clinical service, Education service Community (laws & policy): environment/larger groups of organizations Society: cultures, values, social norms

Applied Behavior Analysis (behavior modification) + 4 ideas

More about environmental determinants neglected from behavior change interventions on account of interventionists' hope that individuals will engage in healthy behaviors to be healthy, not because of a reward (three-term) Contingencies - involve an Antecedent stimulus an (invitation to behave), a Behavior, and a Consequence think ABC 4 ideas of ABA: 1. Behaviors exist because they serve a purpose 2. New Behaviors that serve a purpose can be learned easily 3. Practice is important in establishing new behaviors 4. Coercion interferes with learning and uptake of new behaviors

Is violence one of the major Social Determinants of Health?

No

David is at risk for heart disease. His dad just died from a heart attack. David wants desperately to be normal weight and live a healthy lifestyle. He just started exercising. Which construct does this most closely represent?

Outcome expectancy

Which construct is the following strategy based upon? "A health educator teaches a smoking cessation class and says that smoking causes lung cancer and, based upon the relative risk calculated from epidemiological studies, mentions that this risk is 22 times higher for a smoker than a nonsmoker."

Perceived susceptibility

The emergence of anti-retrovirals has done a lot to influence which construct with respect to HIV/AIDS?

Perceptions of severity

Which construct does the following definition most closely align with? "Subjective belief in the extent of harm that can result from the acquired disease or harmful state (as a result of behavior/non-behavior)"

Perceptions of severity

What does Marmot say about addictions?

Poor people have higher rates of addiction.

What is one of the main reasons that Behavior Modification strategies have failed to mainstream in public health?

Practitioners want clients to "internalize" health behaviors.

The Shasta County Health Department is considering a punishment-based approach at parent training. What should their concern be?

Punishment doesn't teach new behaviors.

Social Capital main person(s) + 2 types/constructs

Robert Putnam less well-defined theory that does not include specific constructs mediator between the Social Determinants of Health and Health Outcomes SDH <--> SC <--> HO 2 types of SC bridging: social connections within a heterogenous community or between people with differences. bonding: social connections within a homogenous community or between people with similarities

Which region of the United States demonstrates the lowest levels of Social Capital?

SE

What does James Sallis say about Ecological Model interventions?

Sallis says that ecological model interventions are among the best with great long-term results, but they are difficult to manage and require stakeholder buy-in, which is why they tend to be less common.

major limitation of self-efficacy theory?

Self-efficacy is not observable, and therefore difficult to measure and know when it's changed.

The ability of an individual to determine that he/she has had enough to drink, and therefore should stop, is reflective of which social cognitive theory tenet?

Self-regulatory capability

Social Determinants of Health/Behavior main person(s) + 10 constructs/determinants

Sir Michael Marmot body of literature supporting the idea that the poor suffer more negative health-related outcomes than wealthier individuals. social determinants of health behavior or the CAUSES OF THE CAUSES of illness aka they contribute to the conditions which cause illness 10 determinants: Social Gradient (mo' money, less problems) Stress: (chronic is worse than acute) Early life Social Exclusion (homeless) Work: Job Control = good for you Unemployment- bad for you Social Support Addiction Food Transport (healthy transport means less driving & more walking and cycling)

What is "bridging" Social Capital?

Social Capital that goes on between heterogeneous groups

What was the original name for the social cognitive theory?

Social learning theory

T/F Environment could include both the physical and social environments.

T

T/F Putting more parks in is an example of an ecological intervention.

T

T/F Social Capital may be able to buffer the side effects of low Social Determinants of Health.

T - This will be very valuable to the average public health worker that struggles to address the Social Determinants of Health.

What is the difference between the theory of reasoned action and the theory of planned behavior?

TRA doesn't include perceived behavioral control

What distinguishes the BEM from a typical ecological model?

The BEM emphasizes bidirectional influences, within the ecological framework.

Based on Hovell's chapter about the BEM, which is the best example of a BEM intervention?

The California Tobacco Control Program

Which of the following comments by Marmot is most true?

The importance of wealth relates to a relative value.

What does satiation mean?

The reinforcer is no longer valuable, probably because it is freely available, and in abundance.

What did James Sallis say about individual level interventions?

They often don't work, because they "can't" work (because of the environment).

Playing "COD: Modern Warfare" represents which SCT tenet?

Vicarious learning capability

Are church attendance and blood donations related?

Yes

Based on what you've learned about verbal persuasion, is a lay health worker likely to be effective?

Yes

Is it plausible that successfully quitting smoking could impact self-efficacy for quitting illegal drug use?

Yes

What is normally done in cases where there are multiple measures for each theory of reasoned action/theory of planned behavior construct?

You normally combine the responses.

ex of a behavioral cue?

a family member calls you in the morning to remind you to eat 5 fruits today

acculturation definition & example

a person's progression toward adopting attitudes, beliefs and behaviors of a new culture - ANY age Ex. A foreign student dressing like his/her peers.

What is a contingency?

a term used to describe the relationship between behavioral antecedents, behavior, and the consequences that follow

View all problems in terms of ___________, not _____________.

behavior, outcome

"If I text while driving I'm likely to get into an accident" is an example of what?

behavioral belief

Robert Putnam states that the analogy to the current reductions in Social Capital is mirrored by trends in the US about what?

bowling leagues

What are the two types of Social Capital?

bridging and bonding

What is not a core component for changing self-efficacy?

changing attitudes

What type of stress does Marmot identify as being most problematic for long-term health?

chronic

With respect to work, what is the functional aspect for SDH that influences health?

controllability/autonomy

John is quitting smoking. Brewing coffee triggers a desire to smoke. When John comes to my office I brew coffee continually so that he is exposed to it without a chance to smoke. Which process/strategy does this reflect?

counterconditioning

What has happened to levels of trust among individuals in the United States over the past few decades?

decreased

Showing a billboard display of a death certificate of an adolescent that died from using drugs is an example of which construct/process?

dramatic relief

Pablo is an 8-year-old boy in El Centro, CA. His family is poor. He reads below grade level. Which SDH does Marmot say is likely the cause (among other things, too) of his delayed reading?

early life

At which stage would the following strategy be most effective? "Telling smokers that by smoking they are more likely to get sick and die."

early stages of change

When is consciousness raising more important?

early stages of change

Where does UT rank nationally in Social Capital?

high

In the theory of planned behavior (TPB), what is the main construct, or predictor of behavior?

intentions

3 types of theories discussed in class

intrapersonal, interpersonal, community/ecological

Kids were more aggressive after an adult reinforced the model for being aggressive

knowledge

At what stage is contingency management most effective?

later stages of change

What is vicarious experience?

learning from observing somebody else's behavior

George stopped smoking for approximately 2 weeks before he relapsed. Upon relapsing, what is the likely state of his self-efficacy?

low

Unskilled/manual laborers have _______ life expectancy than professionals/executives.

lower

Difference between model and theory

model = subset of constructs that make up a theory (gives simplified way to overcome problems w/a behavior) theory = BIGGER, observations about a behavior change, provides guidance through interventions

What does the following concept most closely represent? "The degree to which a person wants to act in accordance with the perceived wishes of those significant in one's life."

motivation to comply

Tweets about problem drinking are likely to influence future behavioral intentions through which construct?

normative belief

What might be a measure of Social Capital?

participation in the PTA

Ingrid is a recent immigrant from war-torn Kosovo. Community health workers told her she should get a mammography. She works as a hotel maid from 7:30 am to 5:30 pm. Which construct is at play in preventing her from engaging in the health behavior?

perceived barriers

Which TPB construct is most similar to self-efficacy?

perceived behavioral control

Working at a place where your employer blocks your access to social media sites is significantly related to lower behavioral intentions to use social media. Which theory of reasoned action/theory of planned behavior construct is most similar to an employer blocking social media access?

perceived behavioral control

Manuel lives in East LA. He just joined an adult soccer league because he believes that physical activity will help him avoid getting diabetes. Which construct is most important here?

perceptions of benefits

Which of the following could plausibly be the last (largest) influence in the Ecological Model?

policy

An anti-tobacco advertisement that lists a number to call a quit line is most likely targeting individuals in which stage of change?

prep

Bandura introduces the triadic model of reciprocal determinism. Which one is not a major domain? environment, behavior, individual, primary care

primary care

community/ecological theory pros & cons

pros: addresses large pop, long-lasting cons: not individualized, requires stakeholder buy-in

intrapersonal theory pros & cons

pros: better for individuals, psychological (consistent w/medical model), allows for behavior change from within w/o anyone else cons: have to do it alone, expensive

interpersonal theory pros & cons

pros: addresses important psychological constructs, focuses on immediate social environment, peer reviewed cons: dual emphasis --> high cost and not enough attention in both areas

Ingrid is a recent immigrant from war-torn Kosovo. She speaks little English. Community health workers taught her how to request a mammography, in English. She now feels competent and able to call and schedule an appointment. Which construct is emphasized here?

self-efficacy

State initiatives to require individuals to present evidence of their citizenship to vote could plausibly represent which SDH?

social exclusion

What is a modifying variable or modifying influence?

something that has the power to increase or decrease perceptions about severity or susceptibility

What is not emphasized in self-efficacy theory?

stages of change (ARE emphasized: behavioral beliefs, outcome expectancies, mastery experience)

Your dad is at risk for heart disease. He has some terrible eating habits, mostly because his colleagues at work invite him to eat lunch at fast food restaurants, every day. In an effort to help him, you have told your dad to avoid his colleagues during the hour before and during lunch, so that they don't invite him. Which process/strategy is this?

stimulus control

David is a life coach and uses "reinforcement" to change his clients' behavior. Which aspect of reinforcement makes it most effective?

the immediacy of the reinforce

What does function mean?

the reason/motivation for the behavior

What does topography mean?

the way behavior looks (to an observer)

Main points of James Sallis Article about ecological models

thesis = multilevel interventions based on ecological models and targeting individuals, social environments, physical environments, and policies must be implemented to achieve population change in physical activity

Why was the Health Belief Model originally developed?

to help the US Public Health Service understand why people weren't being screened for tuberculosis

Which of the following is an example of a cascading contingency?

tobacco policy → restaurant smoking ban → social criticism for smoking outside a restaurant

topography vs function

topography = behavior manifested in a specific way function = reason behind/cause of the behavior ex: 2 people running in forest, one from bear another for fun

What is a hierarchical contingency?

when one level of the BEM influences another

Stimulus control

when you are able to differentiate if something is going to lead to reinforcement or punishment. Differentiating if something will have a good/bad outcome

What is a group contingency?

where the reinforcement is contingent on the whole/most group behaving as expected

Can Social Capital be developed in settings other than face-to-face?

yes

Is "role play" an effective strategy for helping develop mastery experience?

yes

Matching Law

you should get out what you put in - more effort = more return

What is self-efficacy?

your confidence in your ability to engage in a specific behavior