474 Health Psychology

IN PERSON CLASS ONLY - Class Course Outline (Fall 2019) so far...
('on-line' class follows a different format)

I. Introduction to Health Psychology (Chapter 1 of Taylor + Lecture)
   A) Overview of the Field
   B) Biopsychosocial Model of Health
   C) Methods in Health Psychology

II. Fields Related to Health Psychology (Lecture only)
   A) Medical Sociology
      1) Macro/Meso/Micro level of analysis
      2) Disease = biomedical problem seen thru a Social Lens
      3) Social Construction of Disease
         [Medicalization of Deviant Behavior/Expert Control, etc.]
         a) Hyperkinesis (now ADHD)
         b) Menopause and hormone replacement therapy
         c) Black lung (mentioned)
      4) Parsons and the Sick Role
    B) Public Health
       1) The Idealist, Being Robin Hood, being cunning
       2) Brief History of Public Health (1869 1st State Health Dept. in Mass.; garbage disposal in NYC 200 years ago)
       3) Public Health Investigation -- John Snow and Cholera (London, 1849 ~ 1954)
    C) Epidemiology
       1) Salmonella outbreak and Investigation (in Minnesota, 1973)
       2) Epidemiology Triangle -- host, agent, environment

III. Kaplan and Health Care Outcomes (Lecture only]
     A) Aspirin Study and Coronary Heart Disease
     B) Cholesterol and Elevated Blood Pressure meds/side effects
     C) Coffee as cause of Death
     C) FOCUS of health care should be on Quality of Life and Life Expectancy (i.e., mortality or death outcomes)

IV. Attitude and Behavior Change/Health Promotion (Chapter 3,4 Taylor, Lecture)
     A) Behavioral Understanding, Prediction, Control
     B) Person/Environment interaction (Behavior is a function of the person x environment)
     C) Issue of Health Habits (hard to change) vs. Attitudes which are changeable
     C) Attitude, Intent, Behavior link
     D) 8 key attitude/behavior change components
     E) What is a Theory?  
          -Lipsey and the Black Box
          -Desirable Qualities of a Theory
     F) Theories/Models/Frameworks
        1) Individual change
             -Health Believe Model
             -Theory or Reasoned Action
             -Theory of Planned Behavior
             -Stages and Process of Change  
        2) Group change
             -Tipping Point (based on Broken Glass Theory)
             -Diffusion of Innovations
                 -Kelly's intervention research on HIV/AIDS and using Opinion Leaders
             -Message Framing (based on Prospect Theory)
                 -Barrett and Marelich research to increase Condom Use
        3) Society Change
             - Barker's Ecological Psychology
             - Social Ecology and Health Promotion (Stokols)

V. Patients in Treatment Settings
    A) How Patients 'enter' or engage the Treatment Setting
         -Recognition of health problems
         -Interpretation of symptoms
    B) Once recognized, now "IN" the Setting
         -Who uses services more?
         -Healthcare service misuse
         -Delay behaviors
    C) Patients in Hospital Settings
         -Changes over time
         -Goals of Hospital
         -Medical/Admin Hierarchy
         -Communication within Hospitals among staff
         -Organizational Constraints
         -Myths, Archetypes, and Organizational Structures (Marelich study)
     D) Treatment/Patient Labels
         -Rosenhan study on being Sane in Insane Places
         -Stickiness of labels
____________________________________________________________
MIDTERM
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VI. Stress
   A) Theories of Stress
      -Fight or Flight (Cannon)
      -General Adaptation Syndrome (Selye)
      -Tend and Befriend (Taylor)
      -Psychological Appraisal -- Primary/Secondary (Folkman and Lazarus)
   B) Effects of Exposure to Long Term Stressors
   C) Ways to Assess Stress
   D) Dimensions of Stress
      -Overload
      -Negative Events
      -Uncontrollable Events
      -Ambiguous Events
   E) Stress adaptation -- Individual types (groups) that don't handle stress well
   F) Anticipated stress also an issue
   G) After Effects of Stress (costs)
   H) Life Events and Daily Hassles

VII. Coping
   A) Personality and Coping
      -Negative affect
      -Positivity (pessimistic explanatory style)
      -Optimism
      -Psychological control
      -Resilience
  B) Coping Style
      -Avoidance vs. Approach
      -Problem Solving
      -Emotion focused
   C) Coping Strategies
      -Marelich research on coping with HIV/AIDS (7 strategies)
   D) Social Support
      -Informational
      -Emotional
      -Informational
      -Tangible
   E) Does social support work (yes, generally)
       -moderates stress>>outcome relationship
       -sometimes doesn't work however
   F) Patients and Empowerment
      -Marelich/Murphy research with HIV patients
         -Joint Decision-making
         -Patients taking control
         -Initial passivity then involvement
         -Patients as knowledge gatherers
       -Research by Langer/Rodin on those living in old-age homes

VIII. Alternative Topics in Health Psychology (Marelich text)
    A) Why Mixed Findings in Health Research?
       -Selected Study Participants
       -Study Designs
           -example: saturated fat studies, French Paradox, etc.
       -Statistics Used
       -Testimonials

    B) Why do we use Alternative Medications?
       -Current treatments in US
       -Allopathic vs. Alternative Treatment outcomes
       -Barriers to Alternative Medication Use
           -$$ barriers
           -Best practices model for Western Medicine
           -Lack of Funding for research
           -Researcher biases and research paradigms
       -Why is Alternative Medicine attractive?
           -Ease of access
           -Ease of use
           -Ease of getting information
       -Problems with Alternative medicine use
           -unknown risks (Steve Jobs example)
           -questionable viability of information sources
       -What do we do?

    C) Culture and Medicine
       -How does culture effect treatments and outcomes?
            - Cargo Cult Societies and culture development
            - Ambiguity and the Unknown
                 -When faced with the explainable, we come up with explanations.
                 -We want our bodies and minds to be in balance
                -We don't like ambiguity. We don't like uncertainty.
             -Thus -- when we get symptoms, illness, and even death that cannot be explained by our treatment and belief systems, we go searching for               
                        anything that may help us understand, predict, control.

        -Why not just rely on Western Medicine? Why turn to cultural cures?
                 -Access issues
             -geography
             -race/ethnicity issues
             -gender issues
             -SES
             -sexual identity issues
            -LGBTQ+
                        -HIV and Gay men
                 -Lack of Official Government recognition that the disease is a disease (e.g., HIV/AIDS)
                -Bias toward those being treated (e.g., those with HIV - plagued by God, historically slaves, immigrants)
                 -Lack of information
                 -Lack of trust in outsiders
                 -Lack of trust in remedies that don't make sense (boiling water)

        -OKAY, then WHAT are the options available via culture for treatment/cures?  What do we do?
                 -We seek patterns in behaviors, seeing cause and effect, superstition, etc.
             -We turn to SOCIAL cause and effect models, social patterns, faulty cause-effect, faulty patterns
            -we seek patterns out of chaos, and we'll often find them
         -Social remedies are then offered
            -voodoo, witchcraft, sorcerers
            -WHAT if these actually work?? Scared not to trust them?  
                 -Turn to natural remedies -- Why?  Because they are available.  
                -Black south -- white doctors won't treat, must find alternatives
         -Turn to unproven remedies -- Why? Desperate times - desperate measures
            -some cancers and Laetrile (travel to Mexico)
                -HIV/AIDS examples

          -Other issues with Culture and cures?    
                 -Trying to conduct 'research' within third-world countries (from reading)
                        -culture based systems hard to break into
                 -Challenge of changing cultural norms (from reading)
               -Renal disease reading (kidney -- heavy salt)

    D) Treatment and Wellness Explanations
       -Prospect Theory, Tversy & Khaneman
           -Framing benefits and risks
           -What is Risky?  What is Risk?
               -An issue can be 2-sided (example: vaccines)
                   -Why?  Because we bolster/deny information (Cognitive dissonance)

       -Placebos
           -Sugar pill, but can be other things
           -Gold standard for research is the double-blind study (which will use placebos)
           -Why do placebos work?  body/mind interactions
           -Early placebo work: Mesmerism
           -Placebos shown effective:
                 -post-perative pain, headaches, anxiety, seasickness, coughs, colds
                 -placebo surgery
                 -antidepressants
           -Overall, placebos work sometimes, but not all the time
              -no real correct % of success (general rule is 33% of the time effective)
              -won't work in some situations (e.g., infertility, mental retardation, herpes)
              -However, some things enhance placebo effectiveness:
                  -dosages, brand effect, injections are better, more expensive the better effects, told more powerful
                      
     E) Summary (based on Marelich textbook - overarching themes presented in lecture)
        -Import of Social Factors on Health
            -B=f(PxE) -- from Lewin
        -We constantly strive for Health Predictability and Stability
            -Thus, we seeking information streams that provide us information in this effort, accurate or not
    
IX. Chronic Illness (taken from Taylor)
    A) Focus on Quality of Life issues
    B) Emotional responses to chronic illness
    C) Body Image Issues
    D) Coping
    E) Physical Rehab problems with treatment
    F) Social interaction issues (stereotypes of those with cancer, breast cancer, etc.)

X. Terminal Illness (taken from Taylor)
   A) Mortality and causes of death (U.S.)
   B) Issues people face with Advancing illness and death
   C) Changes in Self-concept
   D) Adjusting to death
        -Kubler-Ross research

XI. Lecture on HIV/AIDS Epidemic
    A. Where are we now with the epidemic (latest statistics)
    B. Early evidence HIV (thru genetic testing -- 1884)
    C. Where did HIV come from?
       -Africa, probably mutated form of SIV in mangabey monkey (pets, food, etc.)
       -Probably HIV popped up, then burnt out over the past 80 years in parts of Africa
       -After WWII, travel routes, etc., opened Africa up -- technology in terms of travel made HIV (and any other virus) more likely to travel (roads, boats, cars     

        airplanes, etc.)
    D. Epidemic noted June 5, 1981 - 5 cases Pneumocystis pneumonia in Los Angeles (MMWR)
    E. HIV in early 1980's was situated in gay men, and IV drug users
    F. Sexual Ecology explanation for epidemic in gay men (Rotello book)
       -brief history gay male liberation
       -Stonewall riot
       -1970's embracing "open" sexual lifestyle
    G. Once HIV outbreak, what let to it being worse?
       -Gay culture push-back on prevention (closing bath houses)
       -Lack of US Government recognition of the disease
       -Fighting between the US gov and French gov in terms of who has the rights to the
        HIV test (by March, 1985, test was available)
       -AIDS-related illness specific to women not recognized until the early 1990's
    H. The CDC/Darrow sexual cluster study and Patient Zero (really "O")
    I. And the Future?
       -Use of PREP- pre exposure prophylaxis -- for uninfected individuals
       -Keeping viral load down with HAART (highly active antiretroviral treatments)
       -Vaccine studies in Africa and Thailand
    J. AIDS Activism (from Wachter paper)
       -Roots of AIDS activism
       -Impact of AIDS activism
           -increased federal spending, cheaper drugs, expanded drug access
       -Criticism of activism
          -level of funding went out of proportion (too much to AIDS), harmful fast-track drug approvals, focus on treatment not prevention, shut-down of freedom of    
            speech
       -Challenges to activism
          -make-up of the 'activated' group, agenda, strategies
       -AIDS activism generalizations
          -Women's breast cancer, Alzheimer's

XIII. Where is Health Psychology Going?  What does the Future look like?

      A) Talk on Kaplan article -- primary and secondary prevention
      B) Talk on Kipnis article -- ethics of behavioral technologies
      C) From Taylor...the future is...
           - Health Promotion, addressing health disparities, stress management, social support
           - Quality of life
           - Becoming a Health Psychologist

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