BBH 316 Exam 1

(Majority of) 19th century paradigm

Miasma paradigm

End of 19th century paradigm

Germ theory/infectious disease paradigm

After WW2-Present Paradigm

Risk factor/non-communicable disease paradigm

Utilitarianism and Public Health

The most ethical choice is the one that will produce the greatest good for the greatest number

Jeremy Bentham

Public health significance

The importance of certain health behaviors at different points in time

Ex: mask wearing has much more utility now than in 2010

paradigm

worldview

addresses the major problem of the era (e.g., leading cause of death)

Utilizes new technology of era to solve problem

Proximate cause

the physiological, neurological, or environmental factors that trigger or regulate behavior

explains how and when a behavior is expressed in an individual

ex: hunger hormones released in response to low BP

Ultimate cause

the evolutionary or adaptive reason why the behavior exists

explains why a behavior is present in a species

ex: eating to obtain energy and nutrients necessary for survival

Criticisms of public health

1. Lack of focus on individual responsibility
2. Lack of privacy
3. disproportionate impact on certain groups

Health (WHO 1947)

a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmary

Why are healthy behaviors difficult?

healthy behaviors don’t feel good while doing them, unhealthy behaviors feel good while doing them

Ecological Framework

3 levels influence our health behaviors: Intrapersonal, interpersonal, and population level

Intrapersonal

individual characteristics that influence behavior such as knowledge, attitudes, beliefs, and personality traits

Interpersonal level

primary groups including family, friends, and peers that provide social identity, support, and role definition

Institutional factors

rules, regulations, policies, and informal structures that may constrain or support recommended behaviors

ex: schools, workplaces

Social capital (community) factors

social networks and norms that are formal and informal standards among individuals, groups, or organizations

ex: family, neighborhood, city

public policy factors

local, state, and federal policies and laws that regulate or support healthy actions and practices fo prevention, early detection, control, and management of disease

Health promotion

provide planned, organized, and structured activities/events over time that focus on helping individuals make informed decisions about their health

“Settings” of health promotion

any level of the ecological framework

targeting multiple levels is most effective

primary prevention

utilized in healthy individuals and is aimed at preventing disease from developing (e.g., diet, exercise, vaccine)

secondary prevention

attempting to identify disease in individuals who might be sick but aren’t displaying symptoms

identifying individuals in the early stage of disease

tertiary prevention

treatment of individuals who have already been diagnosed with disease

epidemiology

study of how diseases spread and affect people

Traditional epidemiology

focuses on risk factors (e.g., poor nutrition, lack of exercise)

positive epidemiology

focuses on health assets (e.g., parental warmth, optimism)

Prevention Paradox

A large number of people at modest risk may give rise to more cases of disease than the small number of people at high risk

High-risk strategy

addressing the small number of people who are at great risk for disease and attempting to protect them

usually superior with rare but severe conditions (e.g., cystic fibrosis, Huntington’s disease, and Marfan syndrome)

population strategy

Targeting the entire population when preventing a disease instead of just those most likely to get it

can lead to unintended consequences

social determinants of health

economic status

education access/quality

healthcare access/quality

Neighborhood and built environment

social and community context

Health disparities

differences in the incidence, prevalence, mortality, and burden of disease/adverse health conditions that exist among US populations

equality

assumption that everyone benefits from same supports

equity

everyone gets the support they specifically need

justice

the cause of inequity is addressed

Health Literacy

the ability to apply literacy skills to health situations at home, work, and the community

Effect of race/ethnicity on health

Minorities associated with low-income and low-quality education

race/ethnicity → income→ education→health literacy

Effect of low income and bad education on health

associated with inadequate health literacy

race/ethnicity→income→education→health literacy

Theory

set of concepts, definitions, and propositions that present a systematic view of events or situations by specifying relations among variables in order to explain and predict the events or situations

concept

an idea that exists outside the context of a theory

construct

a concept that has been labeled and included in the context of a theory

variable

a construct that has been operationalized for a particular situation

Health Belief model

Health behaviors are governed by our:

perceived susceptibility and severity of disease

perceived benefits

perceived barriers

perceived self-efficacy

&

external cues to action

Perceived susceptibility

expectation of one’s risk for disease

perceived severity

belief about the severity of a disease, or beliefs about how the condition or disease would affect their life

perceived self-efficacy

beliefs about one’s ability to complete health action

Perceived benefits

expectations about the positive outcomes associated with behavior

perceived barriers

expectations of barriers associated with performing behavior

cue to action

events, people, or things that trigger people to change behavior

Theory of Reasoned Action/Planned Behavior

Our behaviors are based on:

Our attitudes on the behavior

subjective norms around the behavior

our perceived control

Attitude

Behavioral beliefs & evaluations of behavioral outcomes

Subjective norms

Normative beliefs & motivation to comply

Perceived control

Control beliefs & perceived power

Behavioral belief

the expected outcome of engaging in a particular behavior

expectancy

evaluations of behavioral outcomes

perceived worth/value of the potential outcome of engaging in the behavior

value

Normative belief

the probability that influential people will support or oppose a behavior

expectancy

Motivation to comply

how much one wants to do what their influential people desire

value

Control beliefs

beliefs about resources, opportunity, and skills needed for an activity (e.g., money, time, support, equipment)

expectancy

Perceived power

belief in one’s ability to overcome any perceived barriers or obstacles to performing the behavior

expectancy

Social cognitive theory

Holds that our behaviors are based on:

personal factors

environmental factors

Outcome expectations

Large emphasis on observational learning and the effect of the self on others (not addressed in other explanatory theories)

observational learning

behavioral acquisition that occurs through watching the actions of others and the outcomes of their behaviors

Social network

the existence of social ties that could be supportive

network environment

social conventions, values, and beliefs of network members

position in network

Individual’s position in their social network can affect and be impacted by others

social network qualities

size, density, and centrality

social support

physical and emotional comfort given to us by our family, friends, coworkers, and others

Structural support

how well people are connected in their community or how much they are a part of their social networks

Functional support

the mechanisms of support, or the different kinds of help that a person perceives they have

emotional

instrumental

belonging

informational

emotional support

conveying that a person is being thought about, appreciated, or valued enough to be cared for in ways that are health-promoting

Instrumental support

provision of tangible aid and services such as gifts of money, moving furniture, food, assistance with cooking, or childcare

Belonging

sense of feeling connected to a social group

informational support

provision of advice, suggestions, or info that a person can use to address a particular situation

Explanatory theories

Explain why behavior occurs/ is changed

Health belief model

Theory of Planned Behavior/Reasoned Action

Social Cognitive Theory

Change theories

Operant conditioning

Diffusion of innovation

default bias

loss aversion

gain and loss framing

Operant conditioning

Behaviors can be changed through reinforcement or punishment in response to behavior

Positive reinforcement

Adding something the subject likes to increase the likelihood of the behavior occurring again

Positive Punishment

Adding something the subject doesn’t like to decrease likelihood that behavior continues

Negative Punishment

Taking away something the subject likes to decrease likelihood of behavior occurring again

Negative reinforcement

Taking away something the subject does not like to increase likelihood of behavior occurring again

Diffusion of Innovation

There are different groups in each population that adopt innovation at different times and affect how latter groups will adopt innovation

Limitations of diffusion of innovation

focuses on promoting new behaviors, not cessation or prevention

doesn’t consider individual’s resources

Factors affecting speed and extent of innovation diffusion

relative advantage

compatibility

complexity

trialability

observability

relative advantage

is the innovation better than what it replaces?

compatibility

does the innovation fit with the intended audience?

complexity

is the innovation easy to use?

trialability

can the innovation be tried before making a decision to adopt?

observability

are the results of the innovation observable and easily measurable?

Default Bias

Whether an established system is opt in or opt out and how that affects behavior

Opt In

Individual must actively make a choice or take some kind of action to enroll in a certain program, policy, or behavior

Opt out

individual is automatically enrolled in a program, policy, or behavior and must take some action to cancel or decline it

Gain frame

if you act, good things happen; bad things will NOT happen

more effective for health promotion/prevention behaviors

Loss frame

If you don’t act, bad things happen; good things will NOT happen

more effective for disease detection behaviors

Avuncular approach

using insights from behavioral economics to design policies and interventions that will nudge individuals towards making choices that are in their best interest

Paternalistic approach

using psychological theories or behavioral economics to influence people’s behavior erodes their autonomy and personal freedom