Course: Integrating Social and Behavioral Theory into Public Health: Foundations/Macro-Mezzo Levels

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Topic Activities

Session 1: Introduction

We will start with an overview of the course and then go on to look at some of the epidemiologic evidence that behavioral and emotional problems are responsible for an ever-increasing burden of morbidity and mortality -- the so-called epidemiologic transition. We will then introduce the model developed by Berkman and colleagues that links social ecology to health behavior and health status. We will situate this model within the larger family of ecologic models. We will try to use this model to stay "oriented" as we move throughout the course, building a mental image of complementary and competing pathways that we will try to draw on paper in the last small group exercise in December.

In brief, we will talk about how macro-level social factors influence an individual's social ties (e.g., network membership), and then how those ties, in turn, influence the body's psychic and physiologic milieu, which can impact health both directly and indirectly.  These are the two anchors of the Berkman-Glass model -- the social networks in which we live, and the mental processes (they focus on attachment, but we might expand this to a wider array of "social emotions" and to the mechanisms that seem to influence our conscious and unconscious decision-making) that regulate our 1:1 interactions with people in those networks (and that also influence the form and extent of those networks, along with larger social factors).

We will finish up with the example of "Safe Walk to School" as a multilevel intervention illustrative of the model.

Lecture: Introduction to the model and course


Session 2: Personal Health Behavior Change

We will start off with a review of what we mean by theories and models - since the terms are bandied about a lot in class and it will be nice to have a common understanding.  We will then get working on lab session 1 - the personal health behavior change. 

The form of the lab journal entries will  evolve over the course into personal narratives.  Narratives have many functions in public health: they are a research tool, they are often used as a tool for personal exploration and support, and they have a long-standing role in advocacy.  During the course, we will have an opportunity to write narratives, workshop them, and record them.

Lecture: Review of Theories and Models


Lab Session 1: Introduction to the personal health behavior change

Sessions 3 and 4: Culture

Culture as a macro-level determinant of health. Main points include:

  • Definitions of culture, focusing on the "shared set of arbitrary practices" that help a group of people to manage their interactions and expectations, but
  • Sources of cultural influence and variation
  • Kleinman�s concept of explanatory models as a framework for exploring culture in a clinical or public health interaction about a specific problem
  • How culture defines illness, and the difference between disease and illness
  • Acculturation

Lecture: Culture


Lab Session 2: Culture and explanatory models

Sessions 5 and 6: Socioeconomic Status and Health

SES as a macro-level determinant of health.  The next three classes overlap to some extent. We will first talk about definitions of socioeconomic status and poverty, including absolute and relative poverty.  We will review briefly some of the data that link relative poverty to poor health, and some of proposed mechanisms. This discussion continues with the first small group discussion which offers a chance to look in detail at a paper that examines the links between relative income and cardiovascular disease.

Lecture: Socioeconomic Status, Poverty, and Income Inequality


Small Group Discussion

Sessions 7 and 8: Social Capital and Social Support

This class continues the discussion of SES.  It talks about social support and social capital - both of which in theory act to promote health at any level of SES.  However, we then circle back to income inequality with evidence that differences in social capital and social support may be among the factors that mediate the relationship between relative SES and health.

Lecture: Social Capital and Social Support


Lab Session 3: Social capital and collective efficacy compared to social support

Midterm Quiz during Session 8

Session 9: Intervention Illustration - Social Networks

The lecture will present a social network approach to understanding and intervening on microstructural influences on health-related risk behaviors.  Applications from HIV prevention will be used to illustrate key constructs and their operationalization in intervention development.

Lecture: Intervention Illustration - Social Networks


Session 10: Race

This talk will examine the history of racial classification and its relationship to pseudoscience as well as broader political/economic forces. Important subtopics include: genetics and race; racial disparities in health in the US; racial identity; and race as a "natural" variable in studies and interventions.  We will touch on how the legacy of the "natural" differences between races was written into US housing policy with long-standing impact on cities such as Baltimore, and conclude with some small group discussion time about the legitimate uses of "race" as a study variable.

Lecture: Race


Session 11: Structural Interventions, Advocacy and Strategic Communication

This lecture will define and explore macro-level structural influences on health.  Structural interventions can occur anywhere that it is possible to put into place policies or collective agreements that provide "passive" incentives to better health behaviors, improve access to care, or eliminate health risks from the environment.  Examples from tobacco, alcohol and injury control, HIV, health care access, and obesity prevention will demonstrate the potential of structural interventions, and introduces the challenging and often slow process of achieving and implementing them. 

Lecture: Structural Interventions


Session 12: Community, Political Action, and Health

Professor DeMarco will talk about the political process behind several important Maryland campaigns including legislation affecting gun control and health care.  The emphasis of the session is on the process of organizing at the community level and how that translates into political action.

Lecture: Community, Political Action, and Health (Not Currently Available)


Session 13: Introduction to Media Theory and Effects - Situating Communication Within Culture and Health

In this session we will consider the evolution of communication theories, their origins in the sciences, behavioral sciences, and humanities, and how they relate to contemporary communication about culture, health, and health behavior. Although there is considerable overlap among theories available to health communication scholars and practitioners, these theories tend to vary in terms of the level of social organization they emphasize and the conception of society and human agency they reflect. We will examine several core perspectives on the process of communication and consider their implications for health communication research and practice.

Media Effects: What roles do media play in a democratic society and what is their influence on health?  In this session, we will explore the information and "symbolic" environment cultivated by news and entertainment media and socially constructed by audiences.  We will begin to explore ways in which the media have both positive and negative effects on health; how they function (or not) as sources of health information; the role they play in health policy debates; and how communication campaigns employ media to influence health behavior and health status.

Lecture: Introduction to Media Theory and Effects - Situating Communication Within Culture and Health


Session 14: Communities and Community Collaboration

This session discusses communities as part of the mezzo level of the overall model. Major points include:

  • Defining "community" and community health promotion
  • Community-based participatory research
  • Community Organizing: Community development, Social planning, Social action
  • To what extent do community-based interventions "work"?
  • Strengths and challenges of using community models

We will keep the "lecture" short and spend the majority of the time on the small group exercise below.

Lecture: Communities and Community Collaboration


Session 15: Lab Group Presentations

Presentations/discussions from each lab group on progress to date on behavior changes. This will be an opportunity to share strategies, barriers, exchange ideas about evaluation.