1. A general framework Exogenous 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 framework Endogenous variables Stressor, pathogen, culture Internal Process Health Outcome ψ Affective state Self-perception Perceived vulnerability Self-efficacy, etc. Physical Arousal “Allostatic load” HPT activation Inflammation “Metabolic syndrome” Immunocompetence

3. A general framework Outcome 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”) Hypothalamic-Pituitary-Adrenal axis (HPA axis) Immunomodulation, inflammation.   Exercise Sleep, etc.

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  Ψ 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: Stressor, pathogen Internal Process Health Outcome 1.General process: mediating models What explains or accounts for a stress  outcome effect Basic theory development & testing 2.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 Developmental changesDevelopmental changes SES, culture, etc.SES, culture, etc. Individual stressIndividual stress Ψ changeΨ change Health behavior: Diet, smoking… Ψ ; distress, helplessness Physiological: Corticosteroids, pro-inflammatory cytokines, HPA activation Lipids, insulin section & “metabolic syndrome” Ψ ; distress, helplessness Physiological: Corticosteroids, pro-inflammatory cytokines, HPA activation Lipids, insulin section & “metabolic syndrome”

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

18. Basic mediating models in health behavior Stress Illness Immune function Exposure to pathogens Arousal (coritco- steroids) Negative health behavior

19. Health models with structural exogenous variables Stress Illness “Allostatic load” / Immune function Negative health behavior Exposure to pathogens Socio- economic status Structural & cultural barriers to health care

20. Basic moderating model Stress Health status Immune function Health behavior Interaction of stimulus by Ψ resources “ Optimism”, “hardiness”, social support

21. Direct effects of Ψ on health  Psychoimmunology; Adar’s 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 Ψ 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 Ψ 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 2 nd / 3 rd 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 Ψ 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 2 nd / 3 rd 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 2 nd / 3 rd 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