Hbhe600 2008 01 Intro Measurement
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HBHE 600: Psychosocial Factors in Health-Related Behavior
Victor J. Strecher, PhD Professor, HBHE School of Public Health University of Michigan
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
• Introduction • Course Syllabus • Description • Objectives • Flow • Readings • Grading • Academic conduct • Diversity issues • Why we’re here… UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
HBHE 600 DESCRIPTION HBHE 600 provides an overview of the social-psychological determinants of behavioral risk factors that affect health. We address these determinants within conceptual frameworks and models of health-related behavior. These determinants are the building blocks of intervention and program planning.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
HBHE 600 OBJECTIVES By the end of the course, participants should have a general understanding of: 1.
THE MAJOR PSYCHOSOCIAL MODELS AND THEORIES USED IN THE FIELD OF HEALTH BEHAVIOR AND HEALTH EDUCATION
2.
THE ROLE OF PSYCHOSOCIAL FACTORS IN PREDICTING A RANGE OF HEALTH-RELATED BEHAVIORS
3.
USING PSYCHOSOCIAL MODELS AND DETERMINANTS TO DEVELOP A CONCEPTUAL FRAMEWORK OF HEALTH BEHAVIOR CHANGE
4.
INTERVENTIONS TO CHANGE PSYCHOSOCIAL DETERMINANTS
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
HBHE 600 FLOW Theory Determining and measuring relevant psychosocial factors
Health Belief Model Theory of Reasoned Action Theory of Planned Behavior Social Cognitive Theory Transtheoretical Model Self-Determination Theory Chaos Theory Motivational Interviewing Behavior Modification Goal Theory Social Support Elaboration Likelihood Model Cognitive Load Theory Cognitive Schema
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Building conceptual frameworks for healthrelated behavior.
HBHE 600 READINGS
In HBHE 600 CourseTools
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
HBHE 600 GRADING • Mid-term exam (40%) • Final exam (60%) Content of the examinations will come from class lectures and the required readings.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
HBHE 600 ACADEMIC CONDUCT Students should expect faculty and graduate assistants to treat them fairly, showing respect for their ideas and opinions and striving to help them achieve maximum benefits from their experience in the School of Public Health. Similarly, courtesy, honesty, and respect should be shown by students toward faculty, graduate assistants, and fellow students.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
HBHE 600 ACADEMIC CONDUCT Student academic misconduct refers to behavior that may include plagiarism, cheating, fabrication, falsification of records or official documents, and aiding and abetting the perpetration of such acts. Preparation of the mid-term and final examinations must represent each student’s own effort.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
HBHE 600 DIVERSITY ISSUES Language Culture Background 1st /2nd /3rd generation college? Comfortable speaking up, asking questions? Is class a comfort zone or an alien environment?
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
10 leading causes of death in the United States Deaths Cause Heart disease Cancer Cerebrovasc. disease Unintentional injuries Chronic lung disease Pneumonia/ Influenza Diabetes Suicide Chronic liver disease HIV infection
Estimated # 720,058 505,322 144,088 91,983 86,679 79,513 47,664 30,906 25,188 1,757,188
McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. Vol 270, #18, 1993. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Actual causes of death in the United States Deaths Cause Tobacco Diet/ activity patterns Alcohol Microbial agents Toxic agents Firearms Sexual behavior Motor vehicles Illicit use of drugs Total
Estimated #
% Total
400,000 300,000 100,000 90,000 60,000 35,000 30,000 25,000 20,000 1,060,000
McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. Vol 270, #18, 1993. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
19 14 5 4 3 2 1 1 <1 50
10 Priorities of Nation’s 2010 Objectives
Physical activity Overweight and obesity Tobacco use Substance abuse Responsible sexual behavior
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Mental health Injury and violence Environmental quality Immunization Access to health care
Tobacco Control "Even our most conservative estimate indicates that reductions in lung cancer, resulting from reductions in tobacco smoking over the last half century, account for about 40% of the decrease in overall male cancer death rates and have prevented at least 146 000 lung cancer deaths in men during the period 1991 to 2003. A more realistic straight line projection of what lung cancer rates might have become suggests that, without reductions in smoking, there would have been virtually no reduction in overall cancer mortality in either men or women since the early 1990s. The payoff from past investments in tobacco control has only just begun. The aging of birth cohorts with lower smoking initiation rates and the anticipated future decrease in lung cancer mortality in women will help to sustain progress." Michael Thun, American Cancer Society
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 2002 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Ecological Perspectives on Health Promotion
Examine the joint or cumulative effects of personal and environmental factors in designing health promotion programs.
Take into account linkages between various settings and levels, and how change at one level affects others.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Individual vs. Social Responsibility No one would question that, as individuals, we are responsible for our health. In the final analysis, we are the only ones who can change our behavior. We are the only ones who lift fork to mouth, who inhale smoke, who plant feet on sidewalk. And we are the only ones who can decide to do these things…[But] we don’t live in a vacuum. Whether we like it or not, our thoughts, ideas, wishes and behaviors are influenced and conditioned by the people around us, by the environments in which we find ourselves, and by the customs, traditions, fads and fashions to which we are continuously exposed…Effective behavior change therefore requires that we do our best as individuals, but also that we work together with one another to create more healthful and supportive social environments. S. Leonard Syme
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
• Theories • Determining and measuring psychosocial constructs in theories
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
What is a theory? • Definitions • Characteristics • Concepts, Constructs, and Variables
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Definitions of Theory
A set of interrelated constructs, definitions, and propositions that presents a systematic view of phenomena by specifying relations among variables, with the purpose of explaining and predicting phenomena. (Kerlinger, 1986, p. 9)
A systematic explanation for the observed facts and laws that relate to a particular aspect of life. (Babbie, 1989, p. 46)
An abstract, symbolic representation of what is conceived to be reality—a set of abstract statements designed to “fit” some portion of the real world. (Zimbardo, Ebbesen, & Maslach, 1977, p. 5)
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Characteristics of Theory
General - broad application
Abstract - not specified in detail
Testable - you can measure constructs
Replicable - can be tested again and again
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Concepts, constructs, and variables
Concepts - major components or ideas of a theory
Constructs - when concepts have been developed for use in a particular theory, they are called constructs.
Variables - are the operational form of constructs. They specify how a construct is to be measured in a specific situation.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Theories can tell you… • WHY people are or are not engaging in healthrelated behaviors. • WHAT needs to be evaluated to demonstrate program or policy effectiveness. • HOW to shape program strategies to reach people and organizations.*
*Though most psychosocial theories of health-related behavior don’t do this. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
How do we create, examine, test theories?
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Surveying Observing
From: O’Leary, Z. (2004) The Essential Guide to Doing Research. London: Sage Chapter Eleven. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Survey
Survey (noun): Information gathered by asking a range of individuals the same questions related to their characteristics, attributes, how they live, or their opinions
Survey (verb): The process of collecting such information
From: O’Leary, Z. (2004) The Essential Guide to Doing Research. London: Sage Chapter Eleven. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Basic Survey Types
Surveys can also involve populations or samples of populations:
Census: This is a survey that does not rely on a sample. A census surveys every single person in a defined or target population
Cross-sectional surveys: This type of survey uses a sample or cross-section of respondents selected to represent a target population
From: O’Leary, Z. (2004) The Essential Guide to Doing Research. London: Sage Chapter Eleven. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Basic Survey Types
Surveys can capture a moment or map trends:
Trend surveys: A trend survey asks similar groups of respondents, or the same cross-section, the same questions at two or more points in time
Panel study: A panel study involves asking the same (not similar) sample of respondents the same questions at two or more points in time
From: O’Leary, Z. (2004) The Essential Guide to Doing Research. London: Sage Chapter Eleven. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Basic Survey Types
Surveys can be administered in lots of ways:
Face to face
Telephone
Self-administered
Now the Web!
From: O’Leary, Z. (2004) The Essential Guide to Doing Research. London: Sage Chapter Eleven. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Interview Types
Interviews can range from fixed to free:
Structured: Uses pre-established questions, asked in a predetermined order, using a standard mode of delivery
Semi-structured: As the name suggests, these interviews are neither fully fixed nor fully free, and are perhaps best seen as flexible
Unstructured: Attempts to draw out information, attitudes, opinions, and beliefs around particular themes, ideas, and issues without the aid of predetermined questions
From: O’Leary, Z. (2004) The Essential Guide to Doing Research. London: Sage Chapter Eleven. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Response Categories for Closed Questions
Yes / No - Agree / Disagree: Do you drink alcohol?
Yes/ No
Fill in the blank: How much do you weigh?
______________
Choosing from a list: What would you drink most often? Beer
Wine
Spirits
Mixed drinks
Cocktails
Ordering options: Please place the following drinks in order of preference Beer
Wine
Spirits
Mixed drinks
Cocktails
Likert type scaling: It is normal for teenagers to binge drink
1 2 strongly disagree disagree
3 unsure
From: O’Leary, Z. (2004) The Essential Guide to Doing Research. London: Sage Chapter Eleven. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
4 agree
5 strongly agree
Self-efficacy Example: Please rate how confident you are that you can keep from smoking cigarettes in the following situations: Not at all confident
Extremely confident
1
2
3
4
5
When I feel stressed
O
O
O
O
O
After I have just finished a meal
O
O
O
O
O
While drinking coffee with friends
O
O
O
O
O
When I feel sad or lonely
O
O
O
O
O
While talking on the telephone
O
O
O
O
O
When I am around people who are smoking
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
When I feel angry or frustrated When I am happy and feel like celebrating While driving When I feel nervous or anxious When I am bored When at a bar or a party
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Motives
The medication is good for my diabetes.
I feel guilty if I don’t take my med’s.
It’s an important choice that I make for myself.
I’ve seen what diabetes has done for others.
I like the challenge of taking responsibility for my health.
My family and/or friends get upset with me if I don’t take my med’s.
I want to be in charge of my diabetes.
My physician gets upset with me if I don’t take my med’s.
It is consistent with my goals of taking control of my diabetes.
I can avoid or delay getting other health problems if I take my med’s.
I want to set a good example for others.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Motives
Intrinsic
Extrinsic
The medication is good for my diabetes.
I feel guilty if I don’t take my med’s.
It’s an important choice that I make for myself.
I’ve seen what diabetes has done for others.
I like the challenge of taking responsibility for my health.
My family and/or friends get upset with me if I don’t take my med’s.
I want to be in charge of my diabetes.
My physician gets upset with me if I don’t take my med’s.
It is consistent with my goals of taking control of my diabetes.
I can avoid or delay getting other health problems if I take my med’s.
I want to set a good example for others.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Validity of self-reported data:
In some cases validity varies by demographic characteristics
More important are:
•
Surroundings
•
Person or thing asking the question
•
How the question is asked
•
The questions preceding the question
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Surveying Observing
From: O’Leary, Z. (2004) The Essential Guide to Doing Research. London: Sage Chapter Eleven. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Types of Observation
Observational techniques can range from highly structured to unstructured.
Structured: Highly systematic and often rely on predetermined criteria related to the people, events, practices, issues, behaviors, actions, situations, and phenomena being observed.
Semi-structured: Observers generally use some manner of observation schedule or checklist to organize observations, but also attempt to observe and record the unplanned and/or the unexpected.
Unstructured: Observers attempt to observe and record data without predetermined criteria.
From: O’Leary, Z. (2004) The Essential Guide to Doing Research. London: Sage Chapter Eleven. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Victor J. Strecher, PhD Professor, HBHE School of Public Health University of Michigan
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
• Introduction • Course Syllabus • Description • Objectives • Flow • Readings • Grading • Academic conduct • Diversity issues • Why we’re here… UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
HBHE 600 DESCRIPTION HBHE 600 provides an overview of the social-psychological determinants of behavioral risk factors that affect health. We address these determinants within conceptual frameworks and models of health-related behavior. These determinants are the building blocks of intervention and program planning.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
HBHE 600 OBJECTIVES By the end of the course, participants should have a general understanding of: 1.
THE MAJOR PSYCHOSOCIAL MODELS AND THEORIES USED IN THE FIELD OF HEALTH BEHAVIOR AND HEALTH EDUCATION
2.
THE ROLE OF PSYCHOSOCIAL FACTORS IN PREDICTING A RANGE OF HEALTH-RELATED BEHAVIORS
3.
USING PSYCHOSOCIAL MODELS AND DETERMINANTS TO DEVELOP A CONCEPTUAL FRAMEWORK OF HEALTH BEHAVIOR CHANGE
4.
INTERVENTIONS TO CHANGE PSYCHOSOCIAL DETERMINANTS
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
HBHE 600 FLOW Theory Determining and measuring relevant psychosocial factors
Health Belief Model Theory of Reasoned Action Theory of Planned Behavior Social Cognitive Theory Transtheoretical Model Self-Determination Theory Chaos Theory Motivational Interviewing Behavior Modification Goal Theory Social Support Elaboration Likelihood Model Cognitive Load Theory Cognitive Schema
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Building conceptual frameworks for healthrelated behavior.
HBHE 600 READINGS
In HBHE 600 CourseTools
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
HBHE 600 GRADING • Mid-term exam (40%) • Final exam (60%) Content of the examinations will come from class lectures and the required readings.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
HBHE 600 ACADEMIC CONDUCT Students should expect faculty and graduate assistants to treat them fairly, showing respect for their ideas and opinions and striving to help them achieve maximum benefits from their experience in the School of Public Health. Similarly, courtesy, honesty, and respect should be shown by students toward faculty, graduate assistants, and fellow students.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
HBHE 600 ACADEMIC CONDUCT Student academic misconduct refers to behavior that may include plagiarism, cheating, fabrication, falsification of records or official documents, and aiding and abetting the perpetration of such acts. Preparation of the mid-term and final examinations must represent each student’s own effort.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
HBHE 600 DIVERSITY ISSUES Language Culture Background 1st /2nd /3rd generation college? Comfortable speaking up, asking questions? Is class a comfort zone or an alien environment?
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
10 leading causes of death in the United States Deaths Cause Heart disease Cancer Cerebrovasc. disease Unintentional injuries Chronic lung disease Pneumonia/ Influenza Diabetes Suicide Chronic liver disease HIV infection
Estimated # 720,058 505,322 144,088 91,983 86,679 79,513 47,664 30,906 25,188 1,757,188
McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. Vol 270, #18, 1993. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Actual causes of death in the United States Deaths Cause Tobacco Diet/ activity patterns Alcohol Microbial agents Toxic agents Firearms Sexual behavior Motor vehicles Illicit use of drugs Total
Estimated #
% Total
400,000 300,000 100,000 90,000 60,000 35,000 30,000 25,000 20,000 1,060,000
McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. Vol 270, #18, 1993. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
19 14 5 4 3 2 1 1 <1 50
10 Priorities of Nation’s 2010 Objectives
Physical activity Overweight and obesity Tobacco use Substance abuse Responsible sexual behavior
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Mental health Injury and violence Environmental quality Immunization Access to health care
Tobacco Control "Even our most conservative estimate indicates that reductions in lung cancer, resulting from reductions in tobacco smoking over the last half century, account for about 40% of the decrease in overall male cancer death rates and have prevented at least 146 000 lung cancer deaths in men during the period 1991 to 2003. A more realistic straight line projection of what lung cancer rates might have become suggests that, without reductions in smoking, there would have been virtually no reduction in overall cancer mortality in either men or women since the early 1990s. The payoff from past investments in tobacco control has only just begun. The aging of birth cohorts with lower smoking initiation rates and the anticipated future decrease in lung cancer mortality in women will help to sustain progress." Michael Thun, American Cancer Society
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 2002 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
<10%
10%–14%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
15%–19%
20%–24%
25%–29%
≥30%
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Ecological Perspectives on Health Promotion
Examine the joint or cumulative effects of personal and environmental factors in designing health promotion programs.
Take into account linkages between various settings and levels, and how change at one level affects others.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Individual vs. Social Responsibility No one would question that, as individuals, we are responsible for our health. In the final analysis, we are the only ones who can change our behavior. We are the only ones who lift fork to mouth, who inhale smoke, who plant feet on sidewalk. And we are the only ones who can decide to do these things…[But] we don’t live in a vacuum. Whether we like it or not, our thoughts, ideas, wishes and behaviors are influenced and conditioned by the people around us, by the environments in which we find ourselves, and by the customs, traditions, fads and fashions to which we are continuously exposed…Effective behavior change therefore requires that we do our best as individuals, but also that we work together with one another to create more healthful and supportive social environments. S. Leonard Syme
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
• Theories • Determining and measuring psychosocial constructs in theories
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
What is a theory? • Definitions • Characteristics • Concepts, Constructs, and Variables
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Definitions of Theory
A set of interrelated constructs, definitions, and propositions that presents a systematic view of phenomena by specifying relations among variables, with the purpose of explaining and predicting phenomena. (Kerlinger, 1986, p. 9)
A systematic explanation for the observed facts and laws that relate to a particular aspect of life. (Babbie, 1989, p. 46)
An abstract, symbolic representation of what is conceived to be reality—a set of abstract statements designed to “fit” some portion of the real world. (Zimbardo, Ebbesen, & Maslach, 1977, p. 5)
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Characteristics of Theory
General - broad application
Abstract - not specified in detail
Testable - you can measure constructs
Replicable - can be tested again and again
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Concepts, constructs, and variables
Concepts - major components or ideas of a theory
Constructs - when concepts have been developed for use in a particular theory, they are called constructs.
Variables - are the operational form of constructs. They specify how a construct is to be measured in a specific situation.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Theories can tell you… • WHY people are or are not engaging in healthrelated behaviors. • WHAT needs to be evaluated to demonstrate program or policy effectiveness. • HOW to shape program strategies to reach people and organizations.*
*Though most psychosocial theories of health-related behavior don’t do this. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
How do we create, examine, test theories?
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Surveying Observing
From: O’Leary, Z. (2004) The Essential Guide to Doing Research. London: Sage Chapter Eleven. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Survey
Survey (noun): Information gathered by asking a range of individuals the same questions related to their characteristics, attributes, how they live, or their opinions
Survey (verb): The process of collecting such information
From: O’Leary, Z. (2004) The Essential Guide to Doing Research. London: Sage Chapter Eleven. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Basic Survey Types
Surveys can also involve populations or samples of populations:
Census: This is a survey that does not rely on a sample. A census surveys every single person in a defined or target population
Cross-sectional surveys: This type of survey uses a sample or cross-section of respondents selected to represent a target population
From: O’Leary, Z. (2004) The Essential Guide to Doing Research. London: Sage Chapter Eleven. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Basic Survey Types
Surveys can capture a moment or map trends:
Trend surveys: A trend survey asks similar groups of respondents, or the same cross-section, the same questions at two or more points in time
Panel study: A panel study involves asking the same (not similar) sample of respondents the same questions at two or more points in time
From: O’Leary, Z. (2004) The Essential Guide to Doing Research. London: Sage Chapter Eleven. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Basic Survey Types
Surveys can be administered in lots of ways:
Face to face
Telephone
Self-administered
Now the Web!
From: O’Leary, Z. (2004) The Essential Guide to Doing Research. London: Sage Chapter Eleven. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Interview Types
Interviews can range from fixed to free:
Structured: Uses pre-established questions, asked in a predetermined order, using a standard mode of delivery
Semi-structured: As the name suggests, these interviews are neither fully fixed nor fully free, and are perhaps best seen as flexible
Unstructured: Attempts to draw out information, attitudes, opinions, and beliefs around particular themes, ideas, and issues without the aid of predetermined questions
From: O’Leary, Z. (2004) The Essential Guide to Doing Research. London: Sage Chapter Eleven. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Response Categories for Closed Questions
Yes / No - Agree / Disagree: Do you drink alcohol?
Yes/ No
Fill in the blank: How much do you weigh?
______________
Choosing from a list: What would you drink most often? Beer
Wine
Spirits
Mixed drinks
Cocktails
Ordering options: Please place the following drinks in order of preference Beer
Wine
Spirits
Mixed drinks
Cocktails
Likert type scaling: It is normal for teenagers to binge drink
1 2 strongly disagree disagree
3 unsure
From: O’Leary, Z. (2004) The Essential Guide to Doing Research. London: Sage Chapter Eleven. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
4 agree
5 strongly agree
Self-efficacy Example: Please rate how confident you are that you can keep from smoking cigarettes in the following situations: Not at all confident
Extremely confident
1
2
3
4
5
When I feel stressed
O
O
O
O
O
After I have just finished a meal
O
O
O
O
O
While drinking coffee with friends
O
O
O
O
O
When I feel sad or lonely
O
O
O
O
O
While talking on the telephone
O
O
O
O
O
When I am around people who are smoking
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
When I feel angry or frustrated When I am happy and feel like celebrating While driving When I feel nervous or anxious When I am bored When at a bar or a party
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Motives
The medication is good for my diabetes.
I feel guilty if I don’t take my med’s.
It’s an important choice that I make for myself.
I’ve seen what diabetes has done for others.
I like the challenge of taking responsibility for my health.
My family and/or friends get upset with me if I don’t take my med’s.
I want to be in charge of my diabetes.
My physician gets upset with me if I don’t take my med’s.
It is consistent with my goals of taking control of my diabetes.
I can avoid or delay getting other health problems if I take my med’s.
I want to set a good example for others.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Motives
Intrinsic
Extrinsic
The medication is good for my diabetes.
I feel guilty if I don’t take my med’s.
It’s an important choice that I make for myself.
I’ve seen what diabetes has done for others.
I like the challenge of taking responsibility for my health.
My family and/or friends get upset with me if I don’t take my med’s.
I want to be in charge of my diabetes.
My physician gets upset with me if I don’t take my med’s.
It is consistent with my goals of taking control of my diabetes.
I can avoid or delay getting other health problems if I take my med’s.
I want to set a good example for others.
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Validity of self-reported data:
In some cases validity varies by demographic characteristics
More important are:
•
Surroundings
•
Person or thing asking the question
•
How the question is asked
•
The questions preceding the question
UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Surveying Observing
From: O’Leary, Z. (2004) The Essential Guide to Doing Research. London: Sage Chapter Eleven. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
Types of Observation
Observational techniques can range from highly structured to unstructured.
Structured: Highly systematic and often rely on predetermined criteria related to the people, events, practices, issues, behaviors, actions, situations, and phenomena being observed.
Semi-structured: Observers generally use some manner of observation schedule or checklist to organize observations, but also attempt to observe and record the unplanned and/or the unexpected.
Unstructured: Observers attempt to observe and record data without predetermined criteria.
From: O’Leary, Z. (2004) The Essential Guide to Doing Research. London: Sage Chapter Eleven. UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH
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