UICPsychology 415; Social Bases of Health Behavior
Fall, 2012
Dr. David J. McKirnan

The University of Illinois at Chicago
Department of Psychology

Course Schedule
(Click on a week for course content)
Week 1
8 / 30

Introduction: Course goals, student goals, evaluations.
Examples of health behavior models: Social networks, "social neuroscience", non-conscious determinants of behavior.
Week 2
9 / 6

Overview of Health behavior & behavioral medicine concepts

Week 3
9 / 13

Applications of personality theory to health & health behavior.

Week 4
9 / 20

Basic attitude theory, self-regulation

Week 5
9 / 27

Self-regulation, Self-Efficacy and Health Belief models.

Week 6
10 / 4

Cognitive respresentations of health and illness.

Week 7
10 / 11

Dual systems theories: affect, cognition and self-regulation.

Week 8
10 / 18

Judgments of vulnerability & risk estimation.

Any time.

Some out-of-the-blue bonus readings on evolutionary perspectives.

Week 9
10 / 25

Self-awareness, "Automaticity", and Cognitive Escape.

Week 10
11 / 1

Overview of  Psychoimmunology: affect, coping and health.

Week 11
11 / 8

Psychoimmunology 2: Effects and interventions

Week 12
11 / 15

Socio-economic Status, Race & and Health. Minority Stress.

Week 13
11 / 22
No class: Have a happy Thanksgiving.
Week 14
11 / 29

Policy, Economic and Political Influences on Health

Week 15
12 / 6

Spirituality, Happiness, Mindfulness, Well-Being and Health.





Social Basis of Health Behavior
will address theory and data from clinical & social psychology, public health, and economics addressing health- or prevention-related behavior, stress and coping, design and evaluation of behavioral interventions, and community or policy-level issues. We will only briefly address behavioral medicine , although we will review the immune system and psycho-immunology.

Readings will be primarily journal articles and reviews, with some general text chapters.  For the course to be truly worthwhile students must read the core papers prior to class each week, and come to class with something to say about them.

Lecture Notes. Many weeks have PowerPoint notes associated with them. If you decide to print them your might wait until the week before each class to print these, since I will likely be changing them as we proceed.

Class Wiki. To facilitate discussion we will have a class Wiki, here. (A PowerPoint presentation demonstrating how to register for the course Wiki is here.) You all are required to write something smart and incisive by at least a day or two before class each week. Wiki comments can be on papers, other's comments on papers, issues raised in class, or other great thoughts related to the course. These will not be individually graded, but your consistently providing thoughtful Wiki posts will be part of your class grade.

Grant Proposal. The other evaluation is your writing a brief PHS-style grant proposal, presenting an empirically testable model of a health behavior or intervention. Students are strongly advised to articulate this project with their other (MA, Prelim, Ph.D.) work. We will discuss these in class. I will also expect students to present their ideas to the class in 15 minute APA-style talks (we will see if we have time for everyone to get a turn). An over-inclusive paper outline is here.

The Health Blog I have been periodically writing to is here. I plan to use in for class, so check it out.

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Week 1

8 / 30

Introductions, student goals and projects, overall framework of Health Psychology

This first week we will articulate goals. So, for your Wiki entry, besides commenting on the papers please note your interests in Health Behavior and/or theories or empirical questions you are particularly interested in. I will try to adjust the schedule to meet everyone's interests.

To kick off we will have readings at two extremes, to illustrate the range of issues we will address and to get you all thinking. The first is on social networks and obesity, and two others taking a neurobiological look at behavior, one a review of "Social neuroscience" and another on histocompatability, mating and romantic faithfulness (and you thought love was an emotion...).Fat & networks

Warm-up Reading

Do your friends make you fat (happy, fit, a smoker...)? Read a nice overview of social network approaches to health, particularly the Christakis & Fowler analyses of the Framingham study, from the NYT Sunday Magazine (click image; a word version is here).
Thompson, C. Are Your Friends Making You Fat? New York Times, September 13, 2009.Networks critique


Click this image for a critique of the Christakis & Fowler analysis, also from the NYT:

Lecture Notes Here

Primary Readings

Christakis, N. A., & Fowler, J. H. (2007). The Spread of Obesity in a Large Social Network over 32 Years. N Engl J Med, 357(4), 370-379. Link
Electronic version (access on campus or sign in to UIC) here. Multimedia demonstration of results here.

Fat friends

Barabasi, A.-L. (2007). Network Medicine -- From Obesity to the "Diseasome". N Engl J Med, 357(4), 404-407. Link
Key figure from the Barabasi paper here.

Cacioppo, J. T., Amaral, D. G., Blanchard, J. J., Cameron, J. L., Sue Carter, C., Crews, D., et al. (2007). Social Neuroscience: Progress and Implications for Mental Health. Perspectives on Psychological Science, 2(2), 99-123. Link

Garver-Apgar, C. E., Gangestad, S. W., Thornhill, R., Miller, R. D., & Olp, J. J. (2006). Major Histocompatability Complex Alleles, Sexual Responsivity, and Unfaithfulness in Romantic Couples. Psychological Science, 17(10), 830-835. Link

Friends - fatBonus Papers Other papers from this study:

Christakis, N. A., & Fowler, J. H. (2008). The Collective Dynamics of Smoking in a Large Social Network. N Engl J Med, 358(21), 2249-2258. Link

Fowler, J. H., & Christakis, N. A. (2008). Dynamic spread of happiness in a large social network: longitudinal analysis over 20 years in the Framingham Heart Study. British Medical Journal, 337(dec04_2), a2338-a2347. Link

Click here for comments and rebuttals on this line of research

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Week 2
9 / 6

Stress Health behavior & behavioral medicine concepts
Stress, affect and "allostatic load".

These readings are a little dated but give good overviews of core concepts and models.  We will do more "big picture" stuff as we go along, particularly on the Psychosocial side.  The Krantz article is limited to CHD, but gives a more recent look at core constructs.

Lecture Notes Here

Primary readings

Breslow, L.  (2004). Perspectives: The Third Revolution in Health.  Annual Review of Public Health, Preface,Vol. 25, xii - xviii.  Link

House, J.S., Landis, K.R., & Umberson, D (1988).  Social relationships and health.  Science, 241, 540-545.  Link

Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social Relationships and Mortality Risk: A Meta-analytic Review. PLoS Med, 7(7), e1000316. Link

Baum, A. & Posluszny, D.M. (1999).  Health Psychology: Mapping Biobehavioral Contributions to Health and Illness.  Annual Review of Psychology, 50, 137-163.  Link

Krantz, D. S., & McCeney, M. K. (2002). Effects Of Psychological And Social Factors On Organic Disease: A Critical Assessment of Research on Coronary Heart Disease. Annual Review of Psychology, 53(1), 341-369.  Link

Bonus Reading

Does crime spread like an infectious disease?  Could other "problem" behaviors such as smoking or unsafe sex?  Equally important, is the spread of one of these problems non-linear (unlike virtually all of our statistical models) such that a "flat" distribution suddenly takes off after some crucial threshold has been reached?  We will  address "diffusion" and norm models as we go, but here is a cute piece from the New Yorker on the Tipping Point.  (Gladwell went on to write the book about this topic...).

Gladwell, M.  The Tipping Point.  New Yorker.  Link

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Week 3
9 / 11

Basics of personality theory and applications to coping, health behavior, and physical health.

"Personality" encompasses many theories and variables: "temperament", The "Big 5", Type A / C / D, "Bis-Bas", impulsivity, and so on. We will not remotely cover all this territory.

For this week I want you to understand how personality constructs are validated, and to get a sense of the "Big 5" personality model, currently the big dog of personality theory, as well as other constructs that have been associated with health.

Begin with two nice overviews by Smith. The first covers construct validity and other issues surrounding personality theory, while the second is a concise discussion of how personality may actually relate to health.

Then read about the Big 5 and all cause mortality. This provides a quick overview of the theory, and data addressing how it may predict health (hint: neuroticism and (low) conscientious will kill you!).

Then read Harriet de Wit's excellent paper on impulsivity and drug use. Impulsivity is associated with lots of poor health behavivors, as she quickly reviews, and may be itself increased by drugs.

Then get to a concise overview of Type D personality (negative affect / neuroticism plus social inhibition) and cardiac disease. If you are interested in this construct I have two very good bonus papers by Denollet on the development of the DS14 scale of Type D

Risky brains? Lecture Notes Here

Take the Big 5 personality inventory here.
...and contribute to the data set on the Big 5 being compiled by a research group at Berkeley.

Take the DS14 (type D personality) here. Score yourself using the attached sheet.

Warm-up reading

Are kids inherently riskier than adults? Is it their brain? Or is that a myth? Click image for an interesting NYT op-ed piece.
Males, M. This Is Your (Fatherís) Brain on Drugs. New York Times, September 17, 2007.

Primary readings

Smith, T. W., & MacKenzie, J. (2006). Personality and Risk of Physical Illness. Annual Review of Clinical Psychology, 2(1), 435-467. Link

Smith, T.W. (2006). Personality as risk and resilience in physical health. Current Directions in Psychological Science, 15(5), 227-231. Link

Taylor, M. D., Whiteman, M. C., Fowkes, G. R., Lee, A. J., Allerhand, M., & Deary, I. J. (2009). Five Factor Model Personality Traits and All-Cause Mortality in the Edinburgh Artery Study Cohort. Psychosomatic Medicine, 71(6), 631-641. Link

de Wit, H. (2009). Impulsivity as a determinant and consequence of drug use: a review of underlying processes. Addiction Biology, 14(1), 22-31. Link

Sher, L. (2005). Type D personality: The heart, stress, and cortisol. Quarterly Journal of Medicine, 98, 323-329. Link

Bonus Readings
The two Denollet papers chart the history of the DS14 development. If you are thinking of measurement development for your thesis read these!
I have one bonus paper from the home team, plus a student-based paper that also presents a nice model for dissertation research.

Denollet, J., Sus, S.U., Stroobant, N., Rombouts, H., Gillebert, T.C., Brutsaert, D.L. (1996). Personality as independent predictor of long-term mortality in patients with coronary heart disease. The Lancet, 347, 417-421. Link

Denollet, J. (2005). DS14: Standard assessment of negative affectivity, social inhibition and Type D personality. Psychosomatic medicine, 67, 89-97. Link

Yanovitzky, I. (2005). Sensation Seeking and Adolescent Drug Use: The Mediating Role of Association With Deviant Peers and Pro-Drug Discussions. Health Communication, 17(1), 67-89. Link

Carver, C. S., & Connor-Smith, J. (2010). Personality and Coping. Annual Review of Psychology, 61(1), 679-704. Link

Crawford, I., Hammack, P. L., McKirnan, D. J., Ostrow, D., Zamboni, B. D., Robinson, B., et al. (2003). Sexual sensation seeking, reduced concern about HIV and sexual risk behaviour among gay men in primary relationships. AIDS Care, 15(4), 513-524. Link

Amodio, D. M., Master, S. L., Yee, C. M., & Taylor, S. E. (2008). Neurocognitive components of the behavioral inhibition and activation systems: Implications for theories of self-regulation. [Article]. Psychophysiology, 45(1), 11-19. Link

Raynor, D. A., & Levine, H. (2009). Associations Between the Five-Factor Model of Personality and Health Behaviors Among College Students. [Article]. Journal of American College Health, 58(1), 73-81. Link.

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Week 4
9 / 20

Basic attitude theory, self-regulation Bad attitude

I am changing to a new lead attitude article this year, Bohner & Dickel's Annual Review paper. This may be a little tough for those of you who have had no introduction to attitude theory/research, but it does cover some recent, very exciting developments in that field with direct relevance to health.

I have put my old lead article as a bonus; it reviews basic attitude theories well.. Quickly look it over first if you can.

The Karoly paper is a little old but is still a nice overview of self-regulation, more from an information processing frame.  There are also two more applied / descriptive papers.

I am also including a bonus paper on attitude change and persuasion by Wendy Wood. To some extent that is the real bottom line for us, but I don't want to load you up with too many readings. Get to it if you can, however.

Attitudes Lecture Notes Here

Warm-up media
Over the years students have requested more video (or was it more cowbell*...?). I'm not sure what that really should consist of, but I did find a very informative video clip on attitudes: click the image to the right to be enlightened.

FrontLine logoRequired media

On a more serious note, click the image to the left for an excellent piece from Frontline on the "vaccine wars". Beginning in the late 90s - and extending in a big way until Lancet retracted a phoney research paper that had poured fuel on that fire -- this huge attitude shift left many kids here and particularly in Briton unvaccinated. Of course these cultural fears continue now, and affect medical decision making (fear being far stronger than bland science in steering attitudes and decisions.)

Primary readings

Bohner, G. & Dickel, N. (2011). Attitudes and Attitude Change. Annual Review of Psychology, 62, 391–417. Link

Karoly, P. (1993). Mechanisms of self-regulation: A systems view. Annual Review of Psychology, 44, 23-52. Link

Williams, G.C., Rodin, G.C., Ryan, R.M., Grolnick, W./S., & Deci, E.L. (1998). Autonomous regulation and long - term medication adherence in adult outpatients. Health Psychology, 17(3), 269-276. Link

Albarracin, D., Johnson, B. T., Fishbein, M., & Muellerleile, P. A. (2001). Theories of reasoned action and planned behavior as models of condom use: A meta-analysis. Psychological Bulletin, 127(1), 142-161.Link

Bonus Reading

The Ajzen paper was my leed reading for this section. It is a very good overview of basic attitude models, but does not include some of the recent affect-based models. If you are not familiar with attitudes at all try to take a quick look at it.

Ajzen, I. (2001). Nature And Operation Of Attitudes. Annual Review of Psychology, 52(1), 27-58.  Link

Wood, W. (2000). Attitude Change: Persuasion and Social Influence. Annual Review of Psychology, 51(1), 539-570. Link

This paper is not really about attitudes or norms per se. (a key component of the Fishbein model is social norms), although I guess I could make a linkage between cultural norms, sexual attitudes, and lax self-regulation in key environments.  Anyway, this is an excellent piece on the "down low" phenomenon among African-American men who have sex with men.  Just to spice up your week...   Link

Stewart, H1N1 panic

Politics, fear mongering, and attitudes toward vaccines

Jon Stewart takes on the Swine Flu "doubt break" and vaccine fears (click image).

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*Bonus points if you get that key cultural reference

Week 5
9 / 27

More on self-regulation & Self-Efficacy.

This week we have a good self-regulation overview by Carver & Scheier.  This is a little redundant with the Karoly paper, but is more comprehensible.  They also provide a brief overview of Robin Vallacher's Action Identification theory, Gray's approach-avoidance framework, and some non-linear models.  Also in the general self-regulation frame is Bandura's paper on self-efficacy and health behavior. This is dated but represents a nice overview of his perspective, plus some nice health data.  The bonus paper is a monster chapter by Bandura giving his Sermon from the Mount on how all of behavior works. 

Lecture Notes Here

Warm-up media
Go to the Miscellany section to hear a report / read about the effect of touch on health.

Warm-up reading
Click the image for a nice "self-regulatory energy" (AKA "will power") overview from the NYT.
AAMODT, S & WANG, S. Tighten Your Belt, Strengthen Your Mind. New York Times, April 2, 2008.

Primary readings

Carver, C.S. & Scheier, M.F. (2000). On the structure of behavioral self-regulation. In: M. Boekaerts, P. Pintrich & M. Zeidner (Eds)., Handbook on Self-Regulation. New York : Academic Press. Pp. 41-84.  Link

Myrseth, K., & Fishbach, A. (2009). Self-Control: A Function of Knowing When and How to Exercise Restraint. Current Directions in Psychological Science, 18(4), 247-252. Link

Bandura, A. (1991). Self-efficacy Mechanism in Physiological Activation and Health-Promoting Behavior. In J. Madden (Ed.), Neurobiology of Learning, Emotion, and Affect. New York : Raven, Pp. 229-269.  Link

Bonus Reading

Bandura, A. (1991). Self-regulation of motivation through anticipatory and self-reactive mechanisms. In R.A. Dienstbier (Ed.), Perspectives on Motivation: Nebraska Symposium on Motivation. Vol. 38, Pp. 69-164. Lincoln: University of Nebraska Press.    Link

Bandura has a concise overview of his model-of-all-of-behavior on his web site.

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Week 6
10 / 4

Cognitive representations of health and illness:
Attitudes & expectancies, stress, coping, and affective responses.

Placebo prescriptionThis week we review the general literature on "Cognitive Representations of Health". This is less a bounded "theory" than an approach to understanding health vis-à-vis "thinking about how people think".

The first paper is a nice (brief!) overview of the history of cognitive - health models, with a review of applications of one model to adherence and health in diabetes.

The Wu paper applies a Protection Motivation model to drug use in adolescents. This model is basically a marriage of self-efficacy to risk appraisals. Read it in terms of individual differences in the salience of health and risk avoidance.

The Benyamini paper provides a good review of Leventhal's "illness cognition" model, and moves us squarely toward cognitive appraisals of illness and coping resources. They examine affective responses as an outcome variable among women who are coping with a naturally occurring stressor, that of infertility treatment.

The final paper provides a very good overview of coping models, stress, and key dimentions of affect. It presents a meta-analysis of experimental stress manipulations, a nice contrast to the measurement models that dominate this field. Their outcome variable is cortisol and immune function, so read this as a warm-up to the psychoimmunology section.

Your (short!!) bonus paper questions whether any of these social-cognitive models are really testable per se., with a reply by Ajzen. I also put in a substantive paper taking a developmental perspective on Protection-Motivation theory.

Lecture notes here

How do placebos work?
Speaking of health cognition ... listen to an cute overview of placebo effects by WNYC Radiolab. Click the embed, or link to the site here. Click the "Sucrosa" image for an important review of a new medication from The Onion.

Introductory Social Cognition Classic

We will kick off with a seminal paper by Hazel Markus on social schema. This paper, more than any other, began the shift in Social Psychology toward the study of "self-schema" as a core unit of analysis for social cognition and behavior. She also articulated a distinction between explicit and implicit schema, a distinction that is currently a key component of the field, and is increasingly entering the health domain.

Markus, H. (1977). Self-schemata and processing information about the self. Journal of Personality and Social Psychology, 35(2), 63-78. Link

Primary readings

Harvey, J. N., & Lawson, V. L. (2009). The importance of health belief models in determining self-care behaviour in diabetes. Diabetic Medicine, 26(1), 5-13. Link

Wu, Y., Stanton , B. F., Li, X., Galbraith, J., & Cole, M. L. (2005). Protection Motivation Theory and Adolescent Drug Trafficking: Relationship Between Health Motivation and Longitudinal Risk Involvement. Journal of Pediatric Psychology, 30(2), 127-137. Link   Benyamini results

Benyamini, Y., Gozlan, M., & Kokia, E. (2004). On the self-regulation of a health threat: Cognition, coping, and emotions among women undergoing treatment for infertility. Cognitive Therapy & Research, 28(5), 577-592.  Link

Denson, T. F., Spanovic, M., & Miller, N. (2009). Cognitive Appraisals and Emotions Predict Cortisol and Immune Responses: A Meta-Analysis of Acute Laboratory Social Stressors and Emotion Inductions. Psychological Bulletin, 135(6), 823-853.Link

Bonus Readings

Ogden, J. (2003). Some problems with social cognition models: A pragmatic and conceptual analysis. Health Psychology, 22(4), 424-428.  Link

Ajzen, I., & Fishbein, M. (2004). Questions Raised by a Reasoned Action Approach: Comment on Ogden (2003). Health Psychology, 23(4), 431-434.  Link

Sturges, J.W. & Rogers, R.W. (1996). Preventive health psychology from a developmental perspective: An extension of protection motivation theory. Health Psychology, 15(3), 158-166.  Link

Ismail, K., Winkley, K., & Rabe-Hesketh, S. (2004). Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycemic control in patients with type 2 diabetes. The Lancet, 363(9421), 1589-1597.

Important reference readings

Higgins, E. T. (1987). Self-discrepancy - a theory relating self and affect. Psychological Review, 94(3), 319-340. Link

Carver, C. S., Lawrence, J. W., & Scheier, M. F. (1999). Self-discrepancies and affect: Incorporating the role of feared selves. Personality and Social Psychology Bulletin, 25(7), 783-792. Link

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Week 7
10 / 11
Dual systems theories: Affect, Cognition and Self-Regulation

How do we "choose" the correct path to be healthy? We think we rationally choose our dietary, exercise, romantic, or other health-related behaviors, but do we?

The "rational operator" models of Social Psychology assume that conscious choices, based on attitudes, values, stoical norms and the like, guide us toward or away from health. However, cognitive control over health choice may be tenuous at best; Freud described consciousness as "...a reed blown in the wind of the emotions." The "dual systems" literature most clearly articulates the affect versus cognition conflict we have been dancing around in trying to understand the psychological basis of health behavior.

The Hoffman et al. paper is a good & not too long overview, so spend time on that. You will see that a lot of this thought overlaps with the "controlled" versus "automatic" distinction in perception and cognition. The difference is that here affect weighs heavily in the "automatic" side, rather than, e.g., highly accessible or automatic thoughts.

Click for a mind-body-music article and album from Frontiers in Human Neuroscience

Carver, in the second paper, harkens back to psychodynamic views (the "ego psychology" school) in showing how long this distinction has held in Psychology. He provides an historical and highly integrative review, with more emphasis on stable individual differences ("personality") in impulsivity or constraint.

The Gailliot papers address the very interesting finding that cognitive control or restraint may be a limited resource: after exercising self-regulation on one task people are generally less able to self-regulate on subsequent tasks. The first paper reports (relatively minor) effects of self-regulatory depletion on actual sexual behavior in the lab (!). The second paper attributes these effects to blood glucose levels, suggesting a relatively straightforward physiological mechanism.

The warm-up podcast is excellent - make time for it. The RadioLab guys review the issue of choice, emotions and mindfulness in a very entertaining and informative fashion. I have already spoken about some of the research they review.

The clinical students will be interested in the Carver bonus paper: he ties self-regulatory ability into serotonin levels, and further into depression and aggression.

Finally - do bacteria in your gut actually communicate to your central nervous system to cause emotional states? Read a quick review of a fascinating new perspective on "gut feelings" from last month's APA Monitor.

Warm-up PodCast

Listen to a great show from NYC RadioLab on emotions, logic, self-awareness and choice. From the producers:

radiolab - choiceChoice

We turn up the volume on the voices in our heads and try to make sense of the babble. On a journey around the country to understand how emotion and logic interact to guide us through our options, we ponder how we get through the million choices and decisions we make every day. Forget free will, some important decisions could come down to a steaming cup of coffee.

Click the RadioLab icon to go to the show.

Lecture notes here

Primary readings

Make up reading from last week:
Weinstein, N. (1989) Optimistic Biases about Personal Risks. Science, New Series, 246 (4935),1232-1233. Link

Hofmann, W., Friese, M., & Strack, F. (2009). Impulse and Self-Control From a Dual-Systems Perspective. Perspectives on Psychological Science, 4(2), 162-176. Link

Carver, C. S. (2005). Impulse and Constraint: Perspectives From Personality Psychology, Convergence With Theory in Other Areas, and Potential for Integration. Personality & Social Psychology Review (Lawrence Erlbaum Associates), 9(4), 312-333. Link

Gailliot, M. T., & Baumeister, R. F. (2007). Self-regulation and sexual restraint: Dispositionally and temporarily poor self-regulatory abilities contribute to failures at restraining sexual behavior. [Article]. Personality and Social Psychology Bulletin, 33(2), 173-186. Link

Gailliot, M. T., Baumeister, R. F., DeWall, C. N., Maner, J. K., Plant, E. A., Tice, D. M., et al. (2007). Self-control relies on glucose as a limited energy source: Willpower is more than a metaphor. [Article]. Journal of Personality and Social Psychology, 92(2), 325-336. Link

Crum, A. J., Corbin, W. R., Brownell, K. D., & Salovey, P. (2011). Mind Over Milkshakes: Mindsets, Not Just Nutrients, Determine Ghrelin Response. Health Psychology, 30(4), 424-429. doi: 10.1037/a0023467. Link.

Bonus Readings

Carpenter, S. (2012). That Gut Feeling. APA Monitor, 9/2012. Link

Carver, C. S., Johnson, S. L., & Joormann, J. (2009). Two-Mode Models of Self-Regulation as a Tool for Conceptualizing Effects of the Serotonin System in Normal Behavior and Diverse Disorders. Current Directions in Psychological Science, 18(4), 195-199. Link

For the full version of this paper:
Carver, C. S., Johnson, S. L., & Joormann, J. (2008). Serotonergic Function, Two-Mode Models of Self-Regulation, and Vulnerability to Depression: What Depression Has in Common With Impulsive Aggression. [Review]. Psychological Bulletin, 134(6), 912-943. Link

Tierney, decision fatigue Why are healthy decisions so difficult? Click the image for a NYT Sunday MagazIne overview of "decisional fatigue":

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Week 8
10 / 18

Judgments of vulnerability:

Perceived threat, motivated risk perception, realistic & unrealistic optimism.

VulnerabililtyPerceived vulnerability to a health threat is central to protective or risk behavior.  How and when we make such judgments is a core question.  

We will read Neil Weinstein's basic perspective on optimistic bias in risk perceptions, plus two empirical articles that illustrate these effects. Then read Janet Talor’s classic discussion of how optimism – realistic or otherwise – may in fact underlie positive mental health and coping. Following are two papers demonstrating how individual differences in optimism may in fact not only affect coping, but more direct measures of health.

The bonus paper, which I recommend you wade through, is from an excellent book by Kahneman, Slovic and Tversky on cognitive heuristics. Tversky went on to win a Nobel prize for this work as it applied to Economics. This chapter summarizes many of their concepts as they apply to risk perceptions. For those interested in optimism I have included a bonus paper addressing whether “optimism - pessimism” actually has construct validity, or is simply a variant on neuroticism or negative – positive affectivity.

Most of these articles are short, so do not be put off  by the raw number.

Warm up NPR report

Click here for an NPR report on how patient attitudes - including perceptions of over vulnerability - drive up health costs.

Primary Readings

OptimismWeinstein, N. (1989) Optimistic Biases about Personal Risks. Science, New Series, 246 (4935),1232-1233. Link

Weinstein , N.D. (1980) Unrealistic optimism about future life events. Journal of Personality and Social Psychology, 39, 806-820.  Link

Arnett, J. J. (2000). Optimistic bias in adolescent and adult smokers and nonsmokers. Addictive Behaviors, 25(4), 625-632.  Link

Blanton, H., & Gerrard, M. (1997). Effect of sexual motivation on men's risk perception for sexually transmitted disease: There must be 50 ways to justify a lover. Health Psychology, 16(4), 374-379. Link

Taylor, S. & Brown, J.D. (1988). Illusion and well-being: A social psychological perspective on mental health. Psychological Bulletin, 103(2), 193-210.  Link

Raikkonen, K., Matthews, K. A., Flory, J. D., Owens, J. F., & Gump, B. B. (1999). Effects of optimism, pessimism, and trait anxiety on ambulatory blood pressure and mood during everyday life. Journal of Personality & Social Psychology, 76(1), 104-113.  Link

Segerstrom, S. C., Taylor, S. E., Kemeny, M. E., & Fahey, J. L. (1998). Optimism is associated with mood, coping and immune change in response to stress. Journal of Personality & Social Psychology, 74(6), 1646-1655.  Link

Calvin - My brain is trying to kill me

Bonus Readings

Slovic, P., Fishhoff, B. & Lichtenstein, S. (1982). Facts versus fears: Understanding perceived risk. In: D. Kahneman, P. Slovic & A. Tversky (Eds.), Judgment Under Uncertainty: Heuristics and Biases. Cambridge, Cambridge University Press, 1982.Link

Smith, T. W., Pope, M. K., Rhodewalt, F., & Poulton, J. L. (1989). Optimism, neuroticism, coping, and symptom reports: An alternative interpretation of the Life Orientation Test. Journal of Personality & Social Psychology, 56(4), 640-648.  Link
Health info

Click the image for a New York Times / Science Times
special issue on decoding health information:

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Week 9
10 / 25
Self-awareness, "Automaticity", and Cognitive Escape.

This week we review the larger phenomenon of self-awareness. Most models we have discussed assume that people "know what they are doing" and make conscious decisions about behavior. That assumption may not always hold.  Karoly several weeks ago and Bargh here notes that much of behavior is relatively “mindless” (that is, “automatic” rather than “controlled”).  Automatic cognitive behavior (such as lexical processing, generative grammar, etc.) is dramatically more efficient: imagine if you had to consciously parse each sentence you recognize or speak.  The same may be the case for much of our self-regulatory behavior. 

Of course there may be times when being “mindful” of our behavior and its consequences is actually aversive, and we are motivated to escape self-awareness.  Heatherton’s semi-classic article reviews this, as does my humble entry in the HIV area.  Christensen has two papers describing both self-awareness as it varies by symptom levels, and a self-awareness intervention.

Bonus: A cute paper by our former faculty member Len Newman, plus a larger review by Bargh for those interested in further readings.

Lecture notes here

Video warm up

Rosemary's Baby (the classic horror flick by Roman Polanski, starring Mia Farrow and John Cassavetes) has a great scene illustrating the interplay of mindlessness and self-awareness here.

Warm-up reading

Does stress make us stupid? Brain changes in response to stress make make us less able to change our ineffective coping behaviors. Click the image for a recent overview from the NYT.
Angier, N.  Brain Is a Co-Conspirator in a Vicious Stress Loop.  New York Times, August 18, 2009.

Primary readings

Bargh, J. A. and T. L. Chartrand (1999). "The unbearable automaticity of being." American Psychologist 54(7): 462-479. Link

Heatherton, T.F. & Baumeister, R.F. (1991).  Binge eating as escape from self-awareness.  Psychological Bulletin, 110(1), 86-108. Link

McKirnan, D.J., Ostrow, D., & Hope, B. (1996).  Sex, drugs and escape: A psychological model of HIV-risk sexual behaviors.  AIDS Care, 8(6), 655-669. Link

Christensen, A. J., P. J. Moran, et al. (2002). "Effect of a behavioral self-regulation intervention on patient adherence in hemodialysis." Health Psychology 21(4): 393-397. Link

Christensen, A. J., J. S. Wiebe, et al. (1996). "Body consciousness, illness-related impairment, and patient adherence in hemodialysis." Journal of Consulting and Clinical Psychology 64(1): 147-152. Link

Bonus Reading

Newman, L. & Baumeister, R. (1996).  Toward and explanation of the UFO abduction phenomenon: Hypnotic elaboration, extraterrestrial sadomasochism, and spurious memories.  Psychological Inquiry, 7(2), 99-126. Link

Bargh, J. A. and M. J. Ferguson (2000). "Beyond behaviorism: On the automaticity of higher mental processes." Psychological Bulletin 126(6): 925-945. Link

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Some out-of-the-blue bonus readings on evolutionary perspectives.

The cognitive-social perspective is a little dyspeptic toward the role of cognition in health behavior. Cognition is biased, illusory, or simply irrelevant, since so much of behavior is automatic anyway.  When a topic is difficult we may want to escape from what self-awareness we do have.

This gets even worse in an evolutionary frame, where the core assumption is that many key behaviors -- mate selection, social organization, eating behaviors – are governed by naturally selected brain mechanisms that operate wholly outside of conscious awareness.  This assumption has been important to those who stress the continuity of humans and other primates, and therefore assign no special status to the distinctive human characteristics of reflexive consciousness and verbal behavior. 

Bering & Shackelford counter this trend with interesting discussion of the possible role of human consciousness as a causal factor in evolution.  Take a look at this if you need some reassurance that “mind” may still be important.  I am including an Annual Review paper by Caporael that provides a general overview of evolutionary theories applied to Psychology, FYI.

In applying evolutionary theories more directly to health I am including a Darwinian view of stress reactions I found very interesting by Korte.  He argues that most species divide into “Hawks” and Doves”, each of which represents a coherent approach to coping with adversity (environmental pressure, feeding…), and each of which has distinctive consequences for stress responses and physical health.  This gets a little far afield from our discussion of social cognition (it reviews animal research and falls into the “unconscious evolutionary mechanism” camp), but is a very interesting read on possibly naturally selected stress responses.

Bering, J. M., & Shackelford, T. K. (2004). The Causal Role of Consciousness: A Conceptual Addendum to Human Evolutionary Psychology. Review of General Psychology, 8(4), 227-248.
Caporael, L. R. (2001). Evolutionary psychology: Toward a unifying theory and a hybrid science. Annual Review of Psychology Vol 52 2001, 607-628. http://psych annual reviews org/.
Korte, S., Koolhaas, J. M., Wingfield, J. C., & McEwen, B. S. (2005). The Darwinian concept of stress: Benefits of allostasis and costs of allostatic load and the trade-offs in health and disease. Neuroscience & Biobehavioral Reviews, 29(1), 3-38.

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Week 10
11 / 1

  Psychoimmunology and "Illness Behavior" .

Immune cellsThis week we begin Psychoimmunology. The real details of the immune system go well beyond the scope of this course. However, several of these papers provide brief overviews. An NIH overview of the immune system Here. Click the image for an excellent immune system primer by Paul Bugl of the University of Hartford.

The Kiecolt-Glaser Annual Review chapter is a good review from a more psychological perspective. They have a lot of interesting work in this area – do an APA search for them for other interesting articles on immune functioning in response to social stresses, marital conflict, etc.

Segerstrom – whose paper on optimism and blood pressure we read earlier – here has a review and meta-analysis of stress and immune function. Kop’s shorter piece follows this with a more specific focus on depression, immune function and CHD. Finally, Suinn discusses the “terrible twos” – anxiety and anger – in terms of immune function, disease outcomes, and mental health and behavior.

I have added a paper by Sheldon Cohen, who has done a lot of work on stress and the immune system. This older paper remains one of the excellent studies experimentally demonstrating the differential effect of short- v. long- term stressors on upper respiratory infections.

You have two excellent bonus articles. The paper by Ader reviews his and others’ work on classical conditioning processes in immune function. This is really interesting work that he compliments with a more detailed discussion of immunology and stress responses. Ader is one of the key figures in this area (as is this paper), so it is work working through. The McDade paper is from Anthropology, where there has been considerable interest and good work on larger ecological processes in health and the distribution of disease.

Lecture notes here

Primary readings

Kiecolt-Glaser, J. K., McGuire, L., Robles, T. F., & Glaser, R. EMOTIONS, MORBIDITY, AND MORTALITY: New Perspectives from Psychoneuroimmunology. (2002). Annual Review of Psychology, 53(1), 83-107. Link.

Segerstrom, S. C., & Miller, G. E. (2004). Psychological Stress and the Human Immune System: A Meta-Analytic Study of 30 Years of Inquiry. Psychological Bulletin, 130(4), 601-630. Link.

Kop, W. J., & Gottdiener, J. S. (2005). The Role of Immune System Parameters in the Relationship Between Depression and Coronary Artery Disease. Psychosomatic Medicine, 67(Suppl1), S37-S41. Link.

Suinn, R. M. (2001). The terrible twos--anger and anxiety: Hazardous to your health. American Psychologist, 56(1), 27-36. Link

Cohen, S. et al., (1998). Types of Stressors That Increase Susceptibility to the Common Cold in Healthy Adults. Health Psychology, 17(3), 214-223. Link

Bonus readings Dantzer, cytokine - depression model

Classic paper describing conditioning processes in immune function:
Ader, R., & Cohen, N. Psychoneuroimmunology: Conditioning and Stress. (1993). Annual Review of Psychology, 44(1), 53-85. Link

Everything you needed to know about stress, cytokines, illness behavior and depression:
Dantzer, R., O'Connor, J. C., Freund, G. G., Johnson, R. W., & Kelley, K. W. (2008). From inflammation to sickness and depression: when the immune system subjugates the brain. [Review]. Nature Reviews Neuroscience, 9(1), 46-57. Link

Very interesting evolutionary / ecological perspective on immune function:
McDade, T. W. (2005). The Ecologies Of Human Immune Function. Annual Review of Anthropology, 34(1), 495-521. Link

Of course all these variables interact with genetics. For an overview of "Epigenetics" - the influence of early and ongoing environmental stimulation on the activation of genetic traits - see:
Zhang, T.-Y., & Meaney, M. J. (2010). Epigenetics and the Environmental Regulation of the Genome and Its Function. Annual Review of Psychology, 61(1), 439-466. Link

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Week 11
11 / 8

Psychoimmunology 2; Psychosocial perspectives.

This week we consider some variables we addressed in the early part of the course. I am biasing these toward actual experimental demonstrations of psychological effects on immunity, particularly interventions. Most of these papers are short, so please stay with them!To no surprise the self-efficacy people weigh in here: Wiedenfeld shows that enhancing self-efficacy among phobics has immune properties. Strauman takes Tory Higgin’s model of ideal-real self discrepancy and shows it to have effects on NK counts. Thus, feeling enhanced control over one’s behavior or affective responses increases immunocompetence, whereas feeling further from your ideal self has the opposite effect.

Petrie uses Pennebaker’s model of written emotional expression to show that thought suppression (or, conversely, the expression of trauma-related thoughts) has significant health and immune effects. I have included a short bonus paper addressing this paradigm among HIV patients, and a meta-analyses describing the Pennebaker paradigm vis-à-vis health outcomes.

Miller provides a larger meta-analysis of psychological interventions for immune functioning. Here intervention effect sizes are less large than individual reports may lead one to expect, but generally interventions work. I am including a short mechanism paper by Robles; it can get technical but stay with it. The effect of chronic stress on immune functioning and disease is mediated by an increase in pro inflammatory cytokines, particularly Interlukin-6, which itself is immuno-suppressant. Conversely, an experimental increase in IL-6 induces depression in lab animals: depression and immune functioning have bi-directional effects. Finally, stress-induced increases in cytokines may “sensitize” the animal, such that the cytokine -> HPA / immune cascade occurs at lower and lower thresholds. I have two bonus papers addressing this that are well worth wading through.

Lecture notes here

Primary readings

Wiedenfeld, S. A., O'Leary, A., Bandura, A., Brown, S., & et al. (1990). Impact of perceived self-efficacy in coping with stressors on components of the immune system. Journal of Personality and Social Psychology, 59(5), 1082-1094. Link

Strauman, T. J., Lemieux, A. M., & Coe, C. L. (1993). Self-discrepancy and natural killer cell activity: Immunological consequences of negative self-evaluation. Journal of Personality and Social Psychology, 64(6), 1042-1052. Link

Petrie, K. J., Booth, R. J., & Pennebaker, J. W. (1998). The immunological effects of thought suppression. Journal of Personality and Social Psychology, 75(5), 1264-1272. Link

Click Me

Miller, G. E., & Cohen, S. (2001). Psychological interventions and the immune system: A meta-analytic review and critique. Health Psychology, 20(1), 47-63. Link

Robles, T. F., Glaser, R., Kiecolt-Glaser, J. K. (2005). Out of Balance: A New Look at Chronic Stress, Depression, and Immunity. Current Directions in Psychological Science, 14(2), 111-115. Link

Bonus readings

Good example of a psychotherapy intervention study: Therapy to lessen depression among breast cancer patients also lowers inflammation:
Thornton, L. M., Andersen, B. L., Schuler, T. A., & Carson, W. E. (2009). A Psychological Intervention Reduces Inflammatory Markers by Alleviating Depressive Symptoms: Secondary Analysis of a Randomized Controlled Trial. Psychosomatic Medicine, 71(7), 715-724. Link

Smyth, J. M. (1998). Written emotional expression: Effect sizes, outcome types, and moderating variables. Journal of Consulting and Clinical Psychology, 66(1), 174-184. Link

Petrie, K. J., Fontanilla, I., Thomas, M. G., Booth, R. J., & Pennebaker, J. W. (2004). Effect of Written Emotional Expression on Immune Function in Patients With Human Immunodeficiency Virus Infection: A Randomized Trial. Psychosomatic Medicine, 66(2), 272-275. Link

Anisman, H., & Merali, Z. (2002). Cytokines, stress, and depressive illness. Brain, Behavior, & Immunity, 16(5), 513-524. Link

Simmons, D. A., & Broderick, P. A. (2005). Cytokines, stressors, and clinical depression: augmented adaptation responses underlie depression pathogenesis. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 29(5), 793-807. Link

More Psychosocial oriented Readings in Psychoimmunology

Cohen, S., Frank, E., Doyle, W. J., Skoner, D. P., Rabin, B. S., & Gwaltney, J. M., Jr. (1998). Types of stressors that increase susceptibility to the common cold in healthy adults. Health Psychology, 17(3), 214-223. Link

Leventhal, H., Patrick-Miller, L., & Leventhal, E. A. (1998). It's long-term stressors that take a toll: comment on Cohen et al. (1998)[comment]. Health Psychology, 17(3), 211-213. Link

Cole, S. W., Kemeny, M. E., Taylor, S. E., & Visscher, B. R. (1996). Elevated physical health risk among gay men who conceal their homosexual identity. Health Psychology, 15(4), 243-251. Link

Kiecolt-Glaser, J. K., Page, G. G., Marucha, P. T., MacCallum, R. C., & Glaser, R. (1998). Psychological influences on surgical recovery: Perspectives from psychoneuroimmunology. American Psychologist, 53(11), 1209-1218. Link

Pennebaker, J. W., Kiecolt-Glaser, J. K., & Glaser, R. (1988). Disclosure of traumas and immune function: Health implications for psychotherapy. Journal of Consulting and Clinical Psychology, 56(2), 239-245. Link

Weisse, C. S. (1992). Depression and immunocompetence: A review of the literature. Psychological Bulletin, 111(3), 475-489. Link

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Week 12
11 / 15

Socio-economic Status and Health.

Environment - health flowThis week we begin discussing SES and health. Two readings by Nancy Adler describe and explore the famous gradient between SES and health: health increases with every increment in wealth, not just at levels above poverty. Adler describes several potential explanations for this.

Gallo and Matthews discuss the role of negative emotions as a possible mechanism for SES - Health effects.  As we have seen, negative affect has direct immune consequences, making this link all the more plausible.  Finally, Shelly Taylor describes mechanisms whereby environmental events (work, family, stress, etc.) may influence health.  Take a look at her discussion of “allostatic load”: it represents a core construct in this area.

I have two excellent short bonus articles for you - try to get to them if you can. The first is an overview of social stress, immune and neuroendocrine changes, and infant birth weight: a very concrete example of the stress and health processes we have been discussing. Dunkel-Schetter makes clear references to SES and race in her discussion of these effects.

The second is a little far afield - is it an overview of animal studies of separation, proinflammatory cytokine stimulation, and "depression". The interesting element here is that introducing an exogenous anti-inflamatory agent (IL-10) breaks up these strong effects.

I also have a link to a very good NYT series on social class in the U.S.

Lecture notes here

Primary readings

Gineau pigAdler, N. E., Boyce, T., Chesney, M. A., Cohen, S., & et al. (1994). Socioeconomic status and health: The challenge of the gradient. American Psychologist, 49(1), 15-24. Link

Adler, N. E., & Snibbe, A. C. (2003). The role of psychosocial processes in explaining the gradient between socioeconomic status and health. Current Directions in Psychological Science, 12(4), 119-123. Link

Gallo, L. C., & Matthews, K. A. (2003). Understanding the association between socioeconomic status and physical health: Do negative emotions play a role? Psychological Bulletin, 129(1), 10-51. Link

Taylor, S. E., Repetti, R. L., & Seeman, T. (1997). HEALTH PSYCHOLOGY: What is an Unhealthy Environment and How Does It Get Under the Skin? Annual Review of Psychology, 48(1), 411-447. Link

Bonus readings

NYT, Class MattersThe New York Times has an excellent series on social class in America. We will read the overview piece and an article on health for next week. Click the image for the complete series exploring many aspects of the nature and consequences of social class in the U.S.

Brief article outlining an informative model of how stress, behavior and immune function contribute to pre term birth (with a focus on SES and race):
Dunnkel-Schetter, C. (2009). Stress Processes in Pregnancy and Pre term Birth. [Article]. Current Directions in Psychological Science, 18(4), 205-209. Link

Hennessy, M. B., Schiml-Webb, P. A., & Deak, T. (2009). Separation, Sickness, and Depression: A New Perspective on an Old Animal Model. [Article]. Current Directions in Psychological Science, 18(4), 227-231. Link

Oakes, J. M., & Rossi, P. H. (2003). The measurement of SES in health research: current practice and steps toward a new approach. Social Science & Medicine, 56(4), 769-784. Link

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Week 13
11 / 22
Happy Thanksgiving!
All students will be required to report on the health status of their Thanksgiving dinner next class.

Week 14
11 / 29

Culture, Policy, stress & Health.

Paying a price for doughnutsThis week we discuss larger political, economic and social variables.

There are a number of readings, but most are short & easy, so do actually work your way through them....

Begin with minority stress, social norms and health behavior among men who have sex with men. This outlines a minority stress perspective emphasizing the intersection of cultural vulnerability and individual stress. A link to this Jr. Counseling Psychology special issue on GLBT health is given below.

Second is a commentary on how our meritocratic ideology harms the health of groups that are discriminated against. Meritocracy presupposes that personal characteristics - rather than any political or structural variables - underlies our successes and problems. So, those who "don't make it" must have character flaws, potentially a stressful and self-defeating view. This perspective is topical given some recent conservative depictions of the "bottom 47%" as lazy and entitled.

Rosmond describes the Metabolic Syndrome, a key construct in the pathways linking stress and health. This paper does a nice (brief!) job summarizing the general construct of stress, genetic contributions, and the cluster of poor health outcomes that characterized the metabolic syndrome (high blood pressure, antipose fat, high glucose levels...).

Piano Stairs

Then is a Chicago Tribune series on the Oreo® cookie. The history of the Oreo illustrates a variety of issues, including financial pressure for “junk” food production, the role of regulation, and the potential influence of scientific findings, including whether researchers can or should ever be neutral about these topics.

Brownson et al. review a wide range of policy and structural interventions for disease prevention. This is mostly tables; do not spend too much time on it, but go through it to get a sense of the diversity of structural interventions out there.

The first cluster of bonus papers are very informative and eye-opening. I did not list them as required but it would be a big benefit for you to read them. They are all NYT-style commentaries, so they are easy reads.

Unhealthy guyWarm-up reading
Click the image to the left for a timely report on the food industry and their contribution to personal health and development.

Lecture notes here

Primary readings

Metabolic syndrome Hamilton, C. J., & Mahalik, J. R. (2009). Minority stress, masculinity, and social norms predicting gay men's health risk behaviors. Journal of Counseling Psychology, 56(1), 132-141. Link.

Kwate, N. O. A., & Meyer, I. H. (2010). The Myth of Meritocracy and African American Health. American Journal of Public Health, 100(10), 1831-1834. Link

Rosmond, R. (2005). Role of stress in the pathogenesis of the metabolic syndrome. Psychoneuroendocrinology 30(1): 1-10. Link

Manier, J., Callahan, P., & Alexander, D. (2005) The Oreo, Obesity and Us. Chicago Tribune, 8/21/05, Link.

Brownson, R. C., Haire-Joshu, D., & Luke, D. A. (2006). Shaping the Context of Health: A Review of Environmental and Policy Approaches in the Prevention of Chronic Diseases. Annual Review of Public Health, 27, 341-370. Link

Bonus readings

Political & Economic Changes and Health:
The excellent Herbert & Krugman articles well articulate structural chages in the U.S. economy that have downstream costs of health challenges for the "99%". Michael Pollen - the food guru - has a fascinating paper describing the politics of corn production and health.
Krugman, P. (2002). For Richer. The New York Times, 10/20/2002 Link
Hébert, R. (2003). In Sickness or in Wealth: Cognitive responses to stress link socio-economic status and incidence of disease. APS Observer, 16(11). Link
Pollan, M. (2003). THE WAY WE LIVE NOW: The (Agri)Cultural Contradictions Of Obesity. New York Times, 10/12/2003. Link.

Economic changes and obesity:
Basic economic trends and obesity; Gross, D. (2005). ECONOMIC VIEW; Cigarettes, Taxes and Thin French Women. New York Times, 7/24/05. Link.
Chou, S. Y., Grossman, M., & Saffer, H. (2004). An economic analysis of adult obesity: results from the Behavioral Risk Factor Surveillance System. Journal of Health Economics, 23(3), 565-587. Link.Gruber, J. (2002). The economics of tobacco regulation. Health Affairs, 21(2), 146-162. Link.

"Environmental Racism" refers to the location of powerless groups - not only racial minorities but poor people generally - in hazardous environments.
Evans, G.W. & Kantrowitz, E. (2002). Socioeconomic Status and Health: The Potential Role of Environmental Risk Exposure. Annual Review of Public Health, 23, 303-331. Link

Companion to the Brownson paper on the "built environment" and health, here focused on obesity.
French, S. A., Story, M., & Jeffery, R. W. (2001). Environmental influences on eating and physical activity. Annual Review of Public Health, 22, 309-335. Link.

Certain political constituencies in the U.S. simply do not want to hear about health disparities. The Bloche & Steinbrook pieces from NEJM describe an attempt by the Bush administration to ignore SES and racial Disparities in health by altering a DHHS report in 2004
Bloche, M. G. (2004). Health Care Disparities — Science, Politics, and Race.  New England Journal of Medicine, 350, 1568-1570. Link
Steinbrook, R. (2004). Disparities in Health Care — From Politics to Policy.  New England Journal of Medicine, 350, 1486-1488. Link

What is "racism"? "Classism"? How & when do they overlap / differ?
Krieger, N. (2003). "Does racism harm health? Did child abuse exist before 1962? On explicit questions, critical science, and current controversies: An ecosocial perspective." American Journal of Public Health 93(2): 194-199. Link
LaVeist, T. A. (2005). Disentangling Race and Socioeconomic Status: A Key to Understanding Health Inequalities. Journal of Urban Health, 82, iii26-iii34. Link.

These New York Times articles address the larger issues of social class, race, food deserts and health, drawn from general NYT issues and from the NYT special issue on Social Class in America.
Scott, J. (2005). Life at the Top in America Isn't Just Better, It's Longer. The New York Times, 5/16/2005. Link
Epstein, H. (2003). GHETTO MIASMA; Enough To Make You Sick? The New York Times, 10/12/2003. Link
Gonzalez, D. (2005). Paying a Price for Doughnuts, Burgers and Pizza. The New York Times, 1/25/2005. Link.

A nice overview of social class differences in food resources and diet:
Miller, L, (2010). Divided We Eat: What food says about social class in America. Newsweek / Daily Beast, 11/22/2010. Link.

Fat Stigma: The perception that you are (too) fat may cause health problems beyond the actual physical effects of weight...
Muennig, P., Jia, H. M., Lee, R. F., & Lubetkin, E. (2008). I think therefore I am: Perceived ideal weight as a determinant of health. American Journal of Public Health, 98(3), 501-506. Link

The Hamilton paper is from a special issue of Jr. Counseling Psychology on GLBT issues in mental health:
Journal of Counseling Psychology, (2009), Vol. 56 (1). here.

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Week 15
12 / 6

Spirituality, Happiness, Mindfulness, Well-Being and Health

As a final, really high-level conceptualization of mind and body, this final week we consider spirituality and health. I have a lot of readings for this week - there is a lot of literature addressing this general topic. Begin with a nice overview from Time Magazine about brain effects of prayer, meditation and other "altered" states, then read a recent paper more systematically addressing executive functioning among "true believers" while being prayed for.

We have the (currently) definitive study on whether being prayed for "works" on clear biomedical outcomes, plus two brief comments. This is followed by two papers (one co-authored by Leila Shahabi, one of our grads!) addressing whether simply being religious is health inducing. The Miller paper presents a nice overview of the question (for a special issue of American Psychologist), whereas the Powell paper actually provides a literature review.

Then we get the "warm and fuzzy" side of our field. First, Ryan and Deci review the larger area of well-being, and introduce the relevant jargon (“eudemonic well-being”?). Brown and Ryan review some data on “mindfulness” as a psychological intervention: there is lately a lot of research on this construct in clinical and, to a lesser extent, health research. I included a short paper by Folkman on positive coping, also an area of increasing attention. This is from a special issue of American Psychologist on coping, a worthwhile collection for you coping types.

No testimony is sufficient to establish a miracle, unless the testimony be of such a kind, that its falsehood would be more miraculous than the fact which it endeavors to establish. David Hume


Warm-up reading

Click the image for a good TIME article about brain effects of spiritual beliefs. (Word version here)

See also a Chicago Tribune discussion of whether Christian Science prayer should be covered as "treatments" in an earlier version of a comprehensive health care bill here.

Primary readings

This is your brain on prayerThis is your brain on prayer:
When a charismatic person such as a shaman or televangelist prays over a true believer, how does that have an effect? By dampening the pre-frontal cortex, apparently...

Schjoedt, U., Stodkilde-Jorgensen, H., Geertz, A. W., Lund, T. E., & Roepstorff, A. (2010). The power of charisma: Perceived charisma inhibits the frontal executive network of believers in intercessory prayer. Social Cognitive and Affective Neuroscience, 5(2-3). (click image for paper, here for supplemental material showing scan images).

[By-the-by, an orgasm does the same thing. Click
here for a thorough review of brain mechanisms underlying sexual response].

Does prayer work?
Research on the direct (or "divine") effect of prayer on health ranges from questionable to simple fraud. "New age" believers to conservative Christians have seized on a few dubious studies to support the belief that intercessionary prayer - typically defined as people praying for you without your knowing it - "works" beyond the simple effect of social support. The most definitive study of intercessionary prayer, that carefully separated the effects of actual prayer from patients' perception of being prayed for, was by Benson et al.

Benson, H., Dusek, J. A., Sherwood, J. B., Lam, P., Bethea, C. F. et al. (2006). Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: A multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer. American Heart Journal, 151(4), 934-942. Link


Why did one arm of the STEP study show apparent harm from prayer? Were the investigators culturally insensitive in assuming that prayer could only do good or be harmless? After all, any biomedically active treatment has the prospect of adverse side effects.
Krucoff, M. W., Crater, S. W., & Lee, K. L. (2006). From efficacy to safety concerns: A STEP forward or a step back for clinical research and intercessory prayer?: The Study of Therapeutic Effects of Intercessory Prayer (STEP). American Heart Journal, 151(4), 762-764. Link

Can science test the miraculous? Should a believer even care what a clinical trial shows?
matt Dorn, J. (2006). Intercessory prayer. American Heart Journal, 152(3), e25-e25. Link


What qualities of religious faith may enhance health?
Begin with a good overveiw of research on different religious orientations and effects on cardiovascular reactivity. (The bonus section contains an excellent paper by Tartaro that explores gender differences in these effects). Following is a nice overview paper that has not beed subtantially updated in the last number of years.

Masters, K.S. (2008). Mechanisms in the relation between Religion and Health with an Empasis on Cardiovascular Reactivity to Stress. Research in the Scientific Study of Religion, 19, 91-115. Link.

Powell, L. H., Shahabi, L., & Thoresen, C. E. (2003). Religion and spirituality: Linkages to physical health. American Psychologist, 58(1), 36-52. Link.

Happiness, positive coping and mindfulness: A secular spirituality?
Both these papers have some heft to them, but please read on!! Ryan & Deci are the autonomous regulation guys, and their review of happiness, well-being and the like is very good and readable. Brown & Ryan give an very good overveiw of assessment and operation of mindulness. See bonus papers for empirical studies of mindulness & immune function..

Ryan, R. M., & Deci, E. L. (2001). ON HAPPINESS AND HUMAN POTENTIALS: A Review of Research on Hedonic and Eudemonic Well-Being. Annual Review of Psychology, 52(1), 141-166. Link.

Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822-848. Link.

Bonus Readings
I have lots of bonus readings for this week: the task for primary readings was to eliminate, not add interesting papers. This section begins with an overview on positive coping by Sue Folkman, whose work on coping we continue to cite. Following is a randomized controlled trial comparing Transcendental Medication to muscle relazation and education control on BP; very high quality study.

Jane Simoni explores subjective spirituality among HIV+ women, a major issue in working with African-American and other ethnic minority women in HIV/AIDS. This is followed by some papers on mindfulness, and the remaining papers from that American Psychologist set. Then I have included most of the papers from a special issue of Behavioral Medicine on spirituality and health, FYI.

Folkman, S., & Moskowitz, J. T. (2000). Positive affect and the other side of coping. American Psychologist, 55(6), 647-654. Link.

Schneider, R., et al. (1995). A Randomized Controlled Trial of Stress Reduction for Hypertension in Older African Americans. Hypertension; 26: 820-827. Link

Tartoro, J., Luecken, L.J., & Gunn, H.E. (2005). Exploring Heart and Soul: Effects of Religiosity/Spirituality and Gender on Blood Pressure and Cortisol Stress. Journal of Health Psychology, 10(6) 753–766. Link.

Wink, P., Dillon, M., & Larsen, B. (2005). Religion as Moderator of the Depression-Health Connection. RESEARCH ON AGING, Vol. 27 No. 2, March 2005 197-220. Link

Miller, W. R., & Thoresen, C. E. (2003). Spirituality, religion, and health: An emerging research field. American Psychologist, 58(1), 24-35. Link.

Simoni, J. M., Martone, M. G., & Kerwin, J. F. (2002). Spirituality and psychological adaptation among women with HIV/AIDS: Implications for counseling. Journal of Counseling Psychology, 49(2), 139-147. Link.

Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65(4), 564-570. Link.

Carlson, L. E., Speca, M., Patel, K. D., & Goodey, E. (2003). Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosomatic Medicine, 65(4), 571-581. Link.

Seeman, T. E., Dubin, L. F., & Seeman, M. (2003). Religiosity/spirituality and health: A critical review of the evidence for biological pathways. American Psychologist, 58(1), 53-63. Link.

Hill, P. C., & Pargament, K. I. (2003). Advances in the conceptualization and measurement of religion and spirituality: Implications for physical and mental health research. American Psychologist, 58(1), 64-74. Link.

Special Issue of The Annals of Behavioral Medicine:

Mills, P. J. (2002). Spirituality, Religiousness, and Health: From Research to Clinical Practice. Annals of Behavioral Medicine, 24(1), 1-2. Link.

Thoresen, C. E., & Harris, A. H. S. (2002). Spirituality and Health: What's the Evidence and What's Needed? Annals of Behavioral Medicine, 24(1), 3-13. Link.

Sloan, R. P., & Bagiella, E. (2002). Claims About Religious Involvement and Health Outcomes. Annals of Behavioral Medicine, 24(1), 14-21. Link.

Underwood, L. G., & Teresi, J. A. (2002). The Daily Spiritual Experience Scale: Development, Theoretical Description, Reliability, Exploratory Factor Analysis, and Preliminary Construct Validity Using Health-Related Data. Annals of Behavioral Medicine, 24(1), 22-33. Link
Ironson, G., Solomon, G. F., Balbin, E. G., O'Cleirigh, C., George, A., Kumar, M., et al. (2002). The Ironson-Woods Spirituality/Religiousness Index Is Associated With Long Survival, Health Behaviors, Less Distress, and Low Cortisol in People With HIV/AIDS. Annals of Behavioral Medicine, 24(1), 34-48. Link
Peterman, A. H., Fitchett, G., Brady, M. J., Hernandez, L., & Cella, D. (2002). Measuring Spiritual Well-Being in People With Cancer: The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). Annals of Behavioral Medicine, 24(1), 49-58.

Shahabi, L., Powell, L. H., Musick, M. A., Pargament, K. I., Thoresen, C. E., Williams, D., et al. (2002). Correlates of Self-Perceptions of Spirituality in American Adults. Annals of Behavioral Medicine, 24(1), 59-68. Link.

Larimore, W. L., Parker, M., & Crowther, M. (2002). Should Clinicians Incorporate Positive Spirituality Into Their Practices? What Does the Evidence Say? Annals of Behavioral Medicine, 24(1), 69-73. Link.

Lawrence, R. J. (2002). The Witches' Brew of Spirituality and Medicine. Annals of Behavioral Medicine, 24(1), 74-76. Link.

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