Health Psych Final Exam

biomedical model

• all illness can be explained by abnormal somatic processes

  • Traditional in Western medicine

  • Assumes that our health + disease is caused by physical + biological processes

    • People get sick because of physical things like viruses, mutated cells, genes, etc…

      • Ex: What contributes to heart disease? Plaque in arteries

biopsychosocial model + how it explains health

• health is influenced by biological, psychological, and social factors

  • Something to consider: placebos; they don’t have any medical ingredients, so we cannot just use the biomedical factors to explain something psychological

How significant is the role of health behaviors (e.g., tobacco use, poor diet/physical inactivity) in current major health problems in the U.S.?

these factors make up about 50% of the contribution to US mortality, with tobacco, poor diet, and alcohol, being the most significant

does correlation = causation?

no, correlation is just an association between 2 variables

• instead of A causing B, B could cause A

• or C (third variable) could cause A and B

how correlation coefficients are interpreted (r = -.04) and positive/negative correlations

• the closer you are to 1, the stronger the correlation

• r = -.04 would be a not very strong and negative correlation

• positive: variables change in same direction

• negative: variables change in opposite directions

experiment

study where the independent variable is manipulated

moderators

• variable that changes the magnitude and/or direction of the relation between the IV and DV

  • For example: If I study work experience and salary, I hypothesize that:

    • Work experience (years)  affects salary

    • Gender identity moderates the above relationship

So, the relationship between years of experience and salary differs between men, women, and nonbinary people

mediators

• variable through which the IV is related to the DV

  • For example: If I study socioeconomic status and childhood reading ability, I hypothesize that parent education level is a mediator

    • So, socioeconomic status affects reading ability mainly through its influence on parental education levels

internal validity

• likelihood that changes in DV were caused by IV

  • Confounding variable: variable potentially responsible for change in DV, but it is not the IV

    • Threat to internal validity

external validity

likelihood that same results would be obtained using same study with other people/situations (generalizability)

confounds

variable that’s potentially responsible for the change in the DV, but is not the IV

ex: students who received caffeine may have also slept more or prepared more for the exam than the control group in a caffeine study

quasi-experimental design

comparison of groups without random assignment

What conditions must be met for causality to be tentatively assumed in quasi-experimental design?

• Pre Existing groups differ

  • Study compares groups that were already formed before research started

    • Ex: you have people who don’t smoke and those who are already smokers

• Temporal priority established (time)

  • Ensuring that the IV came before the DV

    • Do people smoke first and then develop lung cancer or the other way around?

• Dose to response relationship exists

  • Relationship between amount of exposure to something and the resulting changes in body function/health

  • Do people who smoke more have higher rates of lung cancer than those who smoke less?

• Intervention has an effect

  • Smokers who quit smoking: is there a change in their outcome (does their risk of lung cancer go down?)

• Animal analogs

  • Animal behaviors used to study similar psychological phenomena in humans (usually done because it would be harmful or unethical to induce in humans)

retrospective design

• predictor variables measured after outcome variables already known (looking backwards)

  • Issue: the outcome already occurred; data collection of the predictor variable is biased

    • Ex: does stress cause ulcers?

      • Measure whether or not people have ulcers and then measure stress in the past (in the past 6 months, how many stressful life events have you experienced?)

prospective design

• predictor variables assessed in advance of outcome (looking forward in time)

  • Ex: measure stress first and see if they develop ulcers later

cross-sectional design

• collecting data from sample at one point in time

  • Issue: can’t establish temporal precedence

    • Does not have to be different age groups; it means that all variables are being measured at the same time (measuring predictor and outcome variables at same time)

    • Ex: measure people’s stress & whether or not they have ulcers

longitudinal design

• collecting data from sample at more than one point in time

  • Issue: time-consuming 

    • Ex: measure stress first and later (ex: a month) measure if they developed ulcers

meta-analysis

• Statistical combo of results of multiple studies 

• Ex: you want to know if meditation helps sleep: you could read all the studies on meditation and sleep, but if there’s a literature review, someone has compiled different studies and read about them

  • They pick out the effect size from each individual study and find the average

    • You could read one meta analysis and find out what’s going on in this field 

• Average effect size across studies

allostatic load + what contributes to it

repeated allostasis associated w/cumulative physiological cost (e.g. decreased immunity)

Allostasis is great, but that can happen to us too much, taking a toll on us

Results from:

• Chronic stressors

• Inability to adjust to continuous or recurrent stressors (failure of coping); someone goes to work everyday, stressed because of their boss

• Inability to end stress response–traffic/aggressive behaviors of other drivers makes you stressed, then you get to work and you’re still stressed physiologically

What is the autonomic nervous system (including the sympathetic and parasympathetic nervous systems) and how is it affected by stress?

manages internal organs without conscious control

2 parts: parasympathetic and sympathetic nervous systems

sympathetic nervous system

mobilizes body to react to stressor/activity

(fight or flight; being chased by something)

• Increases heart rate

• Inhibits digestion

• Opens lungs

• Dilates pupils

• Inhibits salivation

• Increases blood glucose

• Stimulates adrenal gland to release catecholamines (epinephrine and norepinephrine)

parasympathetic nervous system

nervous system–restores body to normal state after arousal (rest and digest)

• Slows heart rate

• Stimulates digestion

• Constricts lung passages

• Constricts pupils

• Promotes salivation

• Lowers blood glucose

endocrine system + how it’s affected by stress

regulatory system that secretes hormones

hypothalamus

control pituitary gland

pituitary gland

master gland

• Secretes hormones that directly influence other endocrine glands

adrenal glands

• above kidneys

Adrenal medulla (inner part of adrenal gland; responsible for fight or flight/epinephrine/norepinephrine) and adrenal cortex (outer layer of adrenal gland; produces hormones like cortisol/blood pressure regulating hormones)

SAM system (what they release + speed/duration of response)

activated → adrenal medulla releases catecholamines–epinephrine and norepinephrine (I have a project to finish today ASAP)

• quick, short-term

HPA system (what they release + speed/duration of response)

activated → adrenal cortex secretes cortisol (Cortisol; Cortex)

• slow, more long-term

What is the Social Readjustment Rating Scale (Holmes & Rahe, 1967)? 

list of positive/negative events and how stressful they would be based on the scale (ex: marriage/divorce/death of a spouse were the highest stress/inducing ones)

What is the daily hassles approach to conceptualizing stress? 

minor annoying events which require some degree of adjustment

What does research show regarding the relation between daily hassles and health (DeLongis et al., 1982)?

Daily hassles -> negative cumulative effects on health

perceived stress approach to conceptualizing stress and what research shows regarding the relation between perceived stress and health (Young et al., 2004)?

• appraisals of life situations as unpredictable/overwhelming (how we interpret the things that happen to us)

  • Perceived stress scale (Cohen et. al)

  • Negative correlation between perceived stress and health outcomes

indirect effect model

• stress leads to unhealthy behaviors in attempt to cope w/stress

  • Stress -> unhealthy behavior -> physiological changes -> disease

    • Some people smoke/drink more when stressed, causing poor health outcomes

direct effect model

• direct link between stress & physiological changes leading to disease

  • Stress -> physiological reactions -> disease

diathesis-stress model

• Diathesis = predisposition to disease

• Stress = environment

  • Condition doesn’t develop w/o both diathesis + stress

Cannon’s fight-or-flight response, what physical changes are involved, how he made his initial discovery of ties between psychological processes and digestive processes

physiological stress response—preparation for mobilization; includes:

• sweating

• dilated pupils

• increased heart & breathing rate

• tensed + swollen muscles

used x-rays; when a cat in his experiment felt frightened/distressed, its stomach movements would stop

1. What is Selye’s general adaptation syndrome?  

   1. What are the 3 stages in the stress response?

      1. In what 2 ways was he incorrect?

• body’s generalized attempt to defend itself against stressors

3 stages:

• Alarm (fight/flight)–immediate impact; body mobilizes to respond to stress (high physiological arousal)

• Resistance (allostasis)–body keeps trying to respond to stressor–high physiological arousal (but not as high as in alarm)

• Exhaustion –physical resources (including stress hormones) are depleted

  • He wasn’t entirely correct–

    • Our stress response varies depending on the nature of the stressor–it’s not general

    • our physical resources aren’t depleted

What is cardiovascular reactivity? 

reaction to stress

What is the size of the relation between social support and health (relative to other known predictors of health such as smoking; Holt-Lunstad & Smith, 2012)?

social support has a greater than/equal effect on mortality rate as smoking

direct effects hypothesis

social ties provide protection during stressful & non-stressful times

buffering hypothesis

social ties provide protection against effects of stress

potential mechanisms in the relation between social support and health (e.g., cognitive appraisal)

• Cognitive appraisal– having other people around helps us cope with our stress/perceive our situations

• Health behaviors–social support improves our health by improving our healthful behaviors

  • People exercise together, “let’s try to prepare more healthful meals,” having other people support us through quitting smoking is very helpful OR people do drugs with their friends

• Adherence– people we live with remind us to do things like go to appointments, take medicine

• Psychoneuroimmunological pathways– how our psychological state impacts what’s going on in our nervous system -> immune system

  • Social support help to minimize our physiological response to stress

tend-and-befriend hypothesis

• Does social support protect us physiologically in the face of stress?

  • Females’ responses to stress may be different than males

• Successful stress responses should involve protection of offspring

• Tending–taking care of offspring

• Befriending–affiliating w/other people; during stressful times, some people, primarily females, will affiliate w/other people

Langer and Rodin’s (1976) and Rodin and Langer’s (1977) studies?

• Langer & Rodin, 1976:

  • Control in a residential setting (nursing home)

    • Greater choices to nursing-home residents -> improvement in health 3 weeks later

  • Randomly selected 2 floors in a nursing home; If they gave the residents more control over their lives, would that affect their wellbeing? 

    • Responsibility-induced (more control): you decide what to do with your furniture/make sure you water your own plants

    • Comparison condition: told the same things, but no control (giving them plants and nurses will water it)

  • Findings: 

    • If they had increased responsibility/control/choice, they were happier/more active/sociable, compared to those in the control group who did not have control

• Rodin & Langer, 1977

  • Follow up to the previous study (18 months later)

    • Those in responsibility-induced condition had significantly more happy/actively interested

      • Were half as likely to die if they had control

hardiness and its 3 components

• Commitment (extent to which people are emotionally invested in what they do; ex: a student who is really interested in the content of what they’re learning/how it applies to situations versus someone who just memorizes the content for exams)

• Control (people with high control think that what they do matters, as opposed to feeling helpless)

• Challenge (the way we think about stressful/difficult things in our lives; ex: seeing traffic as 10 minutes of your life you’ll never get back)

explanatory style

how we habitually explain the causes & future outcomes/patterns regarding bad things that happen to us

health behavior model

a. Personality -> health-related behavior -> health

b. Childhood conscientiousness -> lowest smoking & alcohol use in adulthood (Friedman et al, 1995; Hampson et al, 2006)

• someone is more conscientious, so they smoke & drink less, leading to better health outcomes

stress moderation model

1. Personality moderates the effect of stress on health

• Ex: 2 people were in a bad traffic jam in the morning: a high hostile person is getting red in the face, heart rate and temperature is rising; a low hostile person is fine, heart rate is normal, sitting

big 5 personality traits/which is related to health behaviors/longevity

• Extraversion (outgoing), agreeableness (how well you get along w/others), conscientiousness (how responsible you are, on-time), neuroticism (worry, concern, emotionally unstable), openness (creative, trying new things)

Conscientiousness

• Lower mortality risk with higher conscientiousness (Friedman et al., 1993; Turiano et al., 2013)

  • Mediators?

    • Health behaviors (conscientiousness might predict lower smoking and drinking, producing longer life)

type A personality

characterized as competitive, hurried, hostile, and tense

• Having a hostile personality drove the association between Type A and heart disease

  • Hostility associated w/increased risk of heart disease & death

internality vs externality

internality–making an internal attribution for bad outcomes; that bad thing happened because of me; self blame when we do not deserve that blame

externality–this job wasn’t made for me, this situation doesn’t match me well

stability vs instability

stability–does this type of thing always happen to me?; stability over time; “Oh this always happens to me time and time again/it will never get better,” “I’ll never get a job”

instability–it was just this one time; “This one time I didn’t get the job”

globality vs specificity

globality–our thoughts about this leaking into other areas of our life; we think, “my life is bad”) specificity–”this area of my life is not going well”)

problem-focused coping

• addressing the source of our stress

  • Ex: Prof’s friend is not satisfied with her job, but she got a professional resume consultant, looking for new jobs

emotion-focused coping

• not addressing the source of our stress, but our emotions about it

  • Ex: prof’s friend is doing emotion-focused coping; talking about it, seeking social support, having a good cry

approach coping

• changing conditions/expressing emotions (taking emotions head on)

  • Expressive writing, positive

avoidance coping

• ignoring/denying the problem

  • Abusing alcohol, sleeping, excessive video games

  • It can be okay for a short term stressor (ex: if you have a root canal appointment, it might be better to not think about it)

relation between religiosity and health (McCullough et al., 2000)

• religiosity associated with better health, lower mortality risk (McCullough et al., 2000)

  • Moderator: public v. private religious involvement (public = going to services/activities; private = praying on your own); the public involvement had a greater effect

relation between expressive writing and subsequent health outcomes (Pennebaker & Frattaroli)

• Write about trauma (experimental) or superficial topic (placebo control; Pennebaker & Beall, 1986)

• Outcomes:

  • Reduced # of doctors visits

  • Enhanced immune functioning

  • Lower BP and heart rate

  • Better self-rated health

• Mean effect size

  • d = .47 (r = .23) (Smyth, 1998) medium effect size (.2 = small, .5 = medium, >.8 = large)

  • d = .15 (r = .075) (Frattaroli, 2006) small/extra small effect size

    • Moderators where people benefited more from expressive writing: physical health problems, history of trauma, disclose at home, previously undisclosed

What is the relation between gratitude and health?  What were the results of Emmons and McCullough’s (2003) study?

gratitude leads to better health

• 3 conditions: gratitude, hassles, events

• Gratitude -> psychological and physical well-being

• Thinking about what we’re grateful for helps us continue to savor the good things in our lives

  • For 10 weeks, once a week, the gratitude condition wrote about one thing they were grateful for 

  • Hassles–told to think about things that were hassles

  • Events–neutrals; events that they experienced

mindfulness and health outcomes of mindfulness

focus on and awareness of current thoughts; accept & acknowledge the present

• Health outcomes:

• Stronger immune functioning

• Lower blood pressure

• Less pain

how humor is related to health

• Humor -> health

• Potential mechanisms:

  • Physiological changes in the systems of the body–laughter lowers cortisol levels, improves respiration

  • Inducing positive emotional states

  • Moderating adverse effects of stress on health–humor is a good way of coping w/stress

  • Increasing social support

self-affirmation

• Positive affirmation of values–we are a person who enjoys ___ and has good friends, and is a kind friend, etc…

  • Lowers physiological response to stress (lower epinephrine)

    • Participants wrote about important personal values before exam -> lower physiological response to stress (Sherman et., 2009)

    • self-affirmation was most helpful to those w/high psychological vulnerability

temptation bundling

• pairing immediately satisfying activities with those that require more effort but provide long term benefits (Milkman et al., 2014)

Ex: exercise; “I think I should exercise because it will lower my chances of developing heart disease; I should watch a show (and only when I’m exercising) while I do it”

friction

• Make unwanted behavior less rewarding by adding friction–external barriers (e.g effort) that make performing the behavior more difficult (e.g Wood 2019)

  • Ex: I’m trying to reduce blood sugar: I can make it inconvenient to eat them; Instead of having the pack of cookies out, I could put them on a high shelf where it is harder to get them

• Make desired behavior easier by removing friction

  • Ex: Why don't more of us eat fruits/veggies? 

    • If I were to want a watermelon, I would have to wash, cut it, etc…

      • Solution: get a watermelon, cut it up, put it in a container, put it in your fridge for next time 

health belief model and its 6 components

• 4 factors influence participation in preventive health behaviors:

1. Perceived susceptibility–beliefs about the degree of health threat

   1. Should I get a COVID booster? Am I susceptible to getting it?

2. Perceived severity–beliefs about consequences of the illness

   1. How bad would it be if I got COVID?

3. Perceived benefit of behavior change–beliefs that engaging in the behavior will reduce the threat of the illness

   1. “The COVID booster is highly effective, it will protect me from contracting it”

4. Perceived barriers–beliefs about obstacles to engaging in a behavior

   1. “What’s stopping me from getting a COVID booster? The pain? Side effects?”

Later, additional concepts were added to this model:

• Cues to action–any type of reminder about a potential health problem/behavior

  • Ex: your doctor sends you a reminder to get your booster, your friend gets COVID, you have a dream about the last time you had COVID

Self-efficacy–a person’s belief that they will be able to execute a behavior

theory of planned behavior and its 4 components

• Behavioral intentions: a person’s commitment to performing the behavior

  • Intentions are determined by:

    • Attitudes–person’s feelings about engaging in a particular behavior

      • I’m considering being physically active; what are my attitudes?

        • I think about how it may prevent heart disease, etc…

    • Subjective norms–people’s beliefs about whether important others would support them in changing their behavior and beliefs about what other people are doing

      • Will people in my life be supportive of me doing this? Will my family criticize me?

      • Are my peers physically active while I’m not?

    • Perceived behavioral control–the extent to which a person believes they will be able to engage in a behavior

      • Same as self-efficacy

implementation intentions

• Implementation intentions–specific plans for when, where, and how one will engage w/ a behavior 

  • Implementation intention example: I am going to replace eating frosted flakes for breakfast with oatmeal 

    • You’re much more likely to follow through with implementation intentions than goal intentions

transtheoretical model and its stages

• Behavior change is a complex process

• Changes aren’t always linear → spiral change

• Includes relapse 

• 6 stages:

1. Precontemplation– no intentions to change problem behavior

   1. Before they’re thinking about making a change (ex: someone who is smoking and not thinking about quitting; rationalizing why they’re not quitting)

2. Contemplation– beginning to consider changing behavior

   1. Ex: smoker starts to realize they’re worried about health outcomes from smoking; information-seeking

3. Preparation– commitment to change behavior

   1. Ex: smoker is still smoking, but makes a public commitment to quitting (public commitment makes you more likely to follow through); gathering plans for how to quit (setting a date, looking at different techniques)

4. Action– start engaging in a new behavior

   1. First 6 months of the behavior change; when the behavior change is new

5. Maintenance– change is sustained over time

6. Termination– no longer much risk of relapse 

   1. Ex: someone who quit smoking is not tempted at all to go back

most important component across various models of health behavior

behavior intent

primary prevention

• taking measures to prevent illness

  • Meant to prevent disease from occurring at all (sunscreen, vaccines, healthful diet, physical activity)

secondary prevention

• detecting/treating illness at an early stage as a way of reducing the illness’ potential effects 

  • Catch the disease at an early stage (screenings; mammograms, blood scans, giving yourself insulin to manage diabetes)

tertiary prevention

• actions taken to minimize/slow the damage caused by an illness that has developed past an early stage 

  • Disease has already developed; advanced illnesses

for what types of health behaviors (detection vs. prevention) are loss- and gain-framed messages most effective?

• Screening/detection: risky–we’re scared something’s wrong with us (better paired w/loss-framed)

  • Any test; mammogram, blood test

• Prevention: not risky–doesn’t make people scared

  • Health promotion; getting vaccinated, eating fruits/veggies (better paired w/gain-framed)

How effective are fear-based interventions (e.g., Leventhal et al., 1965) and what factors contribute to their effectiveness?

When they work:

• when there is a moderate level of fear

• a specific strategy is provided for change

  • ex: Leventhal 1965—tetanus shots

    • fear & strategy was most likely to lead to behavior change (told the tetanus shot was very effective & gave them a map of campus and appt times)

    • fear only (graphic images of people w/tetanus): hardly anyone got the shot

• focus on short-term consequences (ex: not being able to get a date)

• image of having a particular condition (“that could be me”)

What are behavioral nudges?  What were the results of Dai et al.’s (2021) study on behavioral nudges and Covid-19 vaccinations?

• Behavioral nudge–interventions that aim to promote positive behaviors w/o limiting choice (ex: putting fruit at the entrance of the dining halls)

• Intervention to increase Covid vaccine behavior (Dai et al., 2021)

  • Sent invitations to schedule vaccine appts to patients 

    • IV1; randomized to receive text message reminder to schedule appt and link to scheduling website (vs. no text message) associated with higher rates of getting the vaccine than no message

      • IV2: addressed motivation w/message creating feelings of psychological ownership (“the vaccine has just been made available for you”; “claim your dose”) vs. no message increasing ownership; ownership was more effective than non-ownership

      • IV3: video (challenging misconceptions about vaccine, increasing vaccine interventions) vs. no video

What is the nicotine regulation model? (and Strasser et al.’s study)

an extension of the fixed-effect model: nicotine level must be above body’s set-point for nicotine to provide pleasurable effects

• Smokers smoked lower-nicotine cigarettes (Strasser et al., 2007)

  • # and size of puffs measured

  • Compensation for lower nicotine 

  • People took more and bigger puffs of lower nicotine cigarettes to reach the set-point of nicotine

affect-regulation model and supporting studies (McEwen et al., 2008; Schachter et al., 1977)

• People smoke to increase positive affect or decrease negative affect

  • Positive affect–smoke to enhance pleasure (smoking after a delicious meal, which enhances the pleasure)

  • Negative affect–smoke to cope w/anxiety, stress, tension 

    • Schacter et al., 1977: Smokers exposed to high/low stress (strong/mild shock)

    • Smoking measured

    • High stress → more puffs

      • High stress–given electric shocks that would increase in intensity until participant couldn’t take it anymore

      • Low stress–mild shocks

McEwen et al., 2008—among a list of reasons, relief from stress was the #1 reason why smokers smoked

What are important aspects of social influence programs to prevent smoking (e.g., highlight peer attitudes)?

• Targeted at high-risk group (adolescents)

• Provide education about short-term negative effects of smoking

• Highlight peer attitudes against smoking

• Use role models

What are self-management strategies (e.g., stimulus control)?

• Stimulus control–identify stimuli that make you want to smoke and eliminate/avoid them

• Response substitution–when you have to urge to smoke, do something else instead

• Stress management–people use smoking as a coping mechanism, so they need to come up with others

• Contingency contracting–contract we make w/someone that is contingent upon us continuing not to smoke

  • Identify trusted member of social network and give them $$$

  • Goal: not smoke for the next 6 months; if I smoke even 1 cigarette in the next 6 months, the friend keeps the money

alcohol myopia & results of MacDonald’s et al. study

behavior influenced by most salient (but not most important/relevant) cues

• When we’re intoxicated, we can only focus on cues that are immediately in front of us; being cognitively limited because of alcohol (social cues, informational cues)

• Macdonald et al., 1995:

  • Does alcohol affect attitudes, intentions, and moral obligations toward risky behaviors?

    • Sober and intoxicated participants were assessed for attitudes, intentions, & moral obligations related to drinking & driving

    • Questions presented in contingent/noncontingent manner

    • Non contingent: “I would drive while intoxicated”

    • Contingent: “If I only had a short distance to drive, I would drive while intoxicated”

  • Intoxicated participants–higher intentions to drink & drive when asked contingent question than when asked non-contingent question

tension-reduction theory

theory that people drink to cope w/negative emotions

What is pluralistic ignorance? What was Prentice and Miller’s (1993) study?

assumption that our own attitudes & beliefs differ from others’ (despite our behavior being the same)

• “You and I are behaving the same way, acting like everything is fine, but in private, we both think people are drinking too much”

  • I think that you think it’s more fine than you actually think, and that idea is reciprocal 

• Students believe that there is too much alcohol use on campus, but believe other students approve of the amount of alcohol use (Prentice & Miller, 1993)

  • We misperceive norms

aspects of intervention programs to prevent alcohol abuse

focuses on people at risk

• Provide info about consequences (usually not as effective; college students know how harmful alcohol is)

• Skills training–provide strategies for decreasing alcohol (ex: how to drink in moderation; they’re given alcohol, BAC measured, taught how many drinks it takes to get to a certain BAC)

• Challenge expectations about alcohol use (giving real/placebo alcohol) –people think they need alcohol to be sociable/have fun, but that is only what they think (ex: participants are taught that they are the funny ones and alcohol is not the thing causing that)

• Social influence–challenge perceptions about others alcohol use (give info about peers’ alcohol use) –we inflate what others are doing

antabuse

specifically helps people avoid alcohol; causes violent illness if you drank alcohol while on it

what is problematic about using BMI to predict obesity?

• Substantial % of overweight & obese people healthy, substantial % of normal weight people unhealthy (Tomiyama et al., 2016)

  • Over 40k participants, were either normal/overweight/obese

  • Blood pressure, glucose level, insulin resistance measured

  • There was so much overlap, therefore you can’t reasonably use BMI as a proxy for health; there is a big range of health indicators 

• More accurate–% of body fat 

• Distribution of fat (“apples” vs “pears”)

  • Waist-to-hip ratio 

  • Apple shaped (more abdominal fat is much bigger risk for things like heart disease 

  • Pear shaped–more gluteal fat

set-point theory

• Body seeks to maintain certain weight

  • Consume fewer calories → metabolism slows

  • Consume more calories → metabolism increases (“that’s too much, let’s burn that off”)

  • “Normal weight” participants consumed 1000 extra calories per day for 9 weeks (Levine et al., 1999)

    • Large range in weight gain 

    • Some gained more than 9 pounds, some gained less than 1 pound

internal-external hypothesis

• use of external cues rather than internal cues (hunger)  for eating

  • Ex: food taste, smell

  • Variety

mood regulation theory and Rutters et al. (2009)

Mood regulation/emotional eating/stress eating–food is used to manage moods (stress, anxiety, depression)

• Stress → eating in the absence of hunger (Rutters et al., 2009)

  • All full (they gave them all lunch)

  • Induced stress (induced by solving math problems that had no solution vs ones that had an easy solution)

  • Offered snacks to relax 

  • Stress → higher consumption of food

restraint theory

people restrict the amount & type of food they eat in an attempt to lose weight

Do diets work? How do they affect stress levels?

Diets May Fail

• Dieting increases stress (Tomiyama et al. 2010)

  • Participants assigned to restricting

• Results:

  • Restricting → increased cortisol

  • Monitoring → increased stress

What are some ways of non-adhering?

• Failure to keep scheduled appointments

• Failure to take full dose

• Taking other meds

• Failure to take mds at correct intervals

• Taking expired meds

• Creative/intelligent/rational nonadherence

average rate of nonadherence

25%-50%

causes of nonadherence

• Cost

• Patient factors

  • Forgetting

  • Failure to understand

  • Not believing in efficacy of treatment

  • Anxiety, depression, self-efficacy

• Environmental factors

  • Social support

  • Culture

• Treatment factors

  • Long-term treatment

  • Complex treatment

  • Interference w/activities

  • Aversive side effects

  • Expected benefits and efficacy of treatment 

• Physician-patient communication

  • Clarity of instructions (“take with meals”)

how physician-patient communication is related to adherence (Haskard-Zolnierek and DiMatteo (2009))

• Physician communication → better patient adherence

• Physician training → better patient adherence

how can adherence be increased?

• Association between physician communication & patient adherence–meta-analysis

• Clear written materials, tape of visit

• Reminders

• Simplifying regimens 

• Physicians’ nonverbal behavior

• Increasing positive affect

What did Guéguen et al. (2010) find with regard to physicians’ nonverbal behavior and patient adherence?

• Intervention–physician gave instructions and touched or didn’t touch forearm

• DVs–touching the patient on the forearm increased adherence significantly and increased more for males than females 

  • # pills left in bottle

  • Higher perceived competence of doctor

  • Higher perceived concern (care) of doctor 

supplier-induced demand

when health care providers encourage patients to seek more services or treatments than medically necessary

What are Szasz and Hollender’s (1956) 3 models of physician-patient interaction (e.g., activity-passivity)?

1. Activity-passivity– physician in control, patient passive (very doctor-centered)

2. Guidance--cooperation–patient has voice, physician makes decisions (patient can give preferences, but physician has final say

3. Mutual participation–equal partnership

How important is patient history (what the patient says) in making a diagnosis?

56-85% diagnoses can be made on the basis of what the patient says (can be more important than doing tests)