Testing 1 2 3 Flashcards
3 Facts about the Transactional Theory of Stress & Coping
1) its dynamic/stages 2) its a paradigm shifter (thought copoing was static before), 3) its a continuous process/is cyclical
Stepps of Trans. Model of Stress & Coping
Appraisal (see as stressful)
Response (select coping technique)
Reappraisal ( see how you feel after/reassess)
Primary Appraisal is:
Process by which a person assesses whether or not an event is a stressor. Determined by 2 steps of cognitive appraisal:
1) Primary: is it a stressor?
2) Secondary: if it is, what should I do about it? (problem or focused coping?)
What are 2 factors key to coping?
1) its process-oriented
2) its context specific
What is major function of coping
Regulate distress
its the effort manage stressfull demands (regardless of success at managing it)
Coping Strategies are directed at 3 things:
1) the environment
2) inward
3) can occur due to changes in envinronment independent of person
2 types of coping strageies for research purposes?
1) emotion focused coping
2) problem focused coping
What is emotion-focused coping?
When we cope to regulate the emotions associated with stress (can have a postive or negative effect)
What is Problem-focused coping?
When we cope to alter the troubled person-environment interaction (can be toward self, others, or the situation)… tends to be pitted against emotion focused coping
Ways a person copes depends upon:
1) Their personality
2) their perceived control of the situation
3) features of the social context/situation
4) characteristics of the stressor
5) availability of support
What should we be careful to NOT do with coping?
confound coping with its outcome (i.e. coping can be good and bad, but its still coping all the same)
What is the lowest in the heirarchy of coping strategies?
Denial…but can be useful if you have a terminal illness that you cant do anything about it
Why do we cope?
1) Deal with Social and environmental demands
2) Create Motivation
3) Maintain Psychological Equilibrium
What are resources that one can depend on for coping?
There are 7
1) Health and Energy
2) Positive Beliefs
3) Psychological Factors
4) Problem Solving Skills
5) Social Skills
6) Social Support
7) Material resources (i.e. i feel ill so i can buy a massage)
What are the 4 constraints of coping?
1) Cultural Beliefs/Values
2) Psychological Deficits
3) Environmental Constraints
4) Level of Threat one feels
Critique of Coping theory
it pits emotion focused coping against probelm focused coping (and they may not be mutally exclusive)
Social Support Definition
Information from others that one is loved or valued, and the recognition of a network of people who can provide help or assistance
2 points about social support
1) can be positive or negative
2) can be seen as a type of coping, but may be its own entity
Concepts/Measures that matter in determining if a subject has Social Support:
1) Social relationships (marriage often used to determine if a subject has these but marriage can be pos or neg so be careful there!)
2) Social network (#, frequency of contact, density)
3) perceived availability (how much do you think you can rely on it?)
4) received support (how much do you get it in actuality)
Types of Social support (5 types)
1) Emotional (expressions of empathy)
2) Esteem (reassurance of value –> key to development of self-efficacy)
3) Informational (suggestions, feedback, tough love)
4) Tangible or Instrumental (performance of service, giving things that will help –> i.e. parents giving kids a ride to school)
4) Negative (criticisms, broken promises –> S.S. is not always good!)
Name 4 theories/hypotheses on how social support works:
1) Main (or Direct) Effects Model
2) Buffering (Effect Moderator) Model
3) Mediating Mechanisms
4) Negative Effects
Main (or Direct) Effects Model - what does it say?
1) Says suport is always beneficial
2) Effect of social support will always be the same…those who have high support will always be equally less depressed than those with low social support for a given level of stress. (parallel)
Buffering Hypothesis (or Effect Moderator) - what does it say?
Says support buffers stress – you wont see a difference in cases of low stress, but in high stress situations, those with high social support will always do better
How does social support act as a mediating mechanism for stress (3 ways)
1) Health behaviors (ss–>exercise–>health)
2) Psychological (ss –> good self-esteem –> health)
3) Biological (ss –> neuroendocrine responses –> health)
What about negative effects of social support?
1) not all ss is positive
2) example - intimate partner violence
What is main additive aspect of social cognitive theory?
shows direct reinforcement is not necessary for behavior (coming out of era of behaviorism/operant conditioning); vicarous reinforcement and modeling counts too
Overarching emphasis of SCT?
1) Interaction between person and environment
2) Its a dynamic model (reinforcement and interplay between person and environment)
3 Key constructs in Social Cognitive Theory:
1) Personal factors (knowledge/expectations/attitudes)
2) Environmental Factors (social norms, access in community, ability to influence others/environment/personal agency)
3) Behavioral Factors (Obeservational Learning/Reinforcements/Practice/self-efficacy)
Four Major Concepts in SCT are:
1) Observational Learning (peer modeling)
2) Reciprocal Determinism (Bandura’s triangle)
3) Self-Regulation
4) Self-Efficacy
What is observational learning?
Vicarious reinforcement and modeling can impact behavior
What is the classic observational learning experiment?
the Bobo doll experiment
What are the 4 processes of observational learning?
Attention, Retention, Production, Motivation
What is attention in Observational Learning?
Access to role models & outcomes expectations (i see what they’re doing … if i were to engage in same behavior, what would I expect to have happen)?
What is Retention in Observational Learning?
Intellectual capacity (some people learn in different ways…can you reproduce what you see the model do?)
What is Production in Observational Learning?
Self efficacy (belief you can reproduce the activity) and physical and communication skills (physical ability to reporduce the activity)
What is motivation in Observational Learning?
Outcomes expectations about costs and benefits (i.e. if u think the benefit of doing the behavior is high, you’re more likely to do it!).
What is Reciprocal Determinism (Bandura’s Triangle)
Interaction between behavior, environment, and personal factors …they influence each other simultaneously… person can be both the agent and responder to change
What is a difficult aspect of Reciprocal Determinism?
Its hard to test it - difficult to test bi-directionality
Self-regulation in SCT: what is it?
Systematic Control of one’s behavior
Name 6 types of self-regulation
1) Self-Monitoring (i.e. food journals, smoking logs to see triggers)
2) Goal Setting (long and short term goals…builds self-efficacy)
3) Feedback (quantity/quality, room for improvement)
4) Self-reward (short-term reinforcement/frequent)
5) Self-instruction (self-talk to avoid bad behavior)
6) Enlistment of social support
Self-Efficacy in SCT - definition (3 parts)
a) beliefs in ability to engage in behaviors that lead to desired outcomes
b) confidence in ability to take action and persist in said action despite obstacles or challenges
c) Beliefs about capacity to influence events that affect person’s life
What are outcome expectations related to, and what role do outcome expectations play in SCT?
- they’re related to our attitudes and beliefs
* combine with self-efficacy to determne health behavior
3 types of outcome expectations
1) Situation-outcome expectancies (what consequences will occur if i dont act?)
2) outcome expectancies (what consequences will occur if I do act?)
3) Self-efficacy expectancies (do i think i can do that action to get the outcome i want?)
How are outcome expectations measured? 3 ways
1) Magnitude
2) Strength or Certainty
3) Generality
What do TRA & TPB say w/ regards to outcome expectations?
Say outcome expectations and self-efficacy work together to shape individual health behavior
What does SCT say about outcome expectations & self-efficacy?
SCT thinks self-efficacy is more powerful than outcome expectations, bc SE involves action/maintenance, but OE only involve intentions. (intent vs actually doing).
Ecological Model - what does it take into account?
Multiple levels of influence
Where is the ecological model derived from?
biological science – interrelations between organisms and their environment
What does the ecological model emphasize?
That environmental and policy influence behavior
What two types of influences does the ecological model incorporate?
Psychological and Social Influences
What can the ecological model be used to develop?
Comprehensive interventions that address the whole system
What are the 4 levels of the ecological model?
1) Individual
2) Microsystem/Interpersonal (family, peers, siblings)
3) Exosystem/Community (school, neighborhood, mass media, work environment, extended family)
4) Macrosystem/Institutional (history, policy, laws, culture, economics, social conditions)
Core concepts of ecological model (3):
1) behavior has multiple levels of influences
2) health behaviors are maximized when environment and policies support healthy choices
3) interventions are successful more beacause of # of forms, rather than specific form, of treatment
Four principles of ecological system
1) Multiple levels influence health behaviors
2) There is interaction across the levels between behavioral influences
3) We should target specific behaviors while understanding the influences at each level
4) Multi-level interventions are most efficient in changing behavior
3 Strengths of the Ecological Model
1) premise is simple
2) causation of behavior is distributed between levels of influence
3) based on the importance of interaction
5 Weaknesses of Ecological Model
1) little variation in social/enviornmental/policy variables (they’re so big picture hard to establish if they were effective or not)
2) Model lacks specificity (know variables work in combo, but dont know what is most successful part)
3) Inconsistant support for interractions across levels
4) Experimental design is at odds w/ model (cant do rct)
5) requires multidisciplinary research
Rose’s population perspective – what are the two ways of approaching poor health?
1) Individual approach - focus on high-risk prevention strategy
2) Population approach - address the whole population and work to shift risk curve to the left, resulting in macro reduction in disease
When do you risk a type 3 error in approaching poor health?
When you use the individual approach to address population level problems
What is the issue with using individual approaches for population health issues?
Ubiquitous Exposure
What is the issue with Ubiquitous Exposure?
Factors that explain differences between individuals within a population (cases) may not explain differences between popultions (incidence rate)
What do we mean by ubiqutous exposure?
1) is a factor that affects the entire population
2) is hard to identify because its universally present
example: london diet affected everyone, so wasnt observable cause of hypertension
How do we counter act the bias given by ubiquitous exposure?
1) need cross-context comparisons to discover pop. characteristics that determine incidence
2) if you dont investigate these, you cant intervene
Fundamental Causes Theory - why was it developed?
In response to trends that focused on individual risk factors and ignored social conditions as causes of disease. Noted there was a persistant relationship between social position and health status.
What is a fundamental cause?
Upstream social factors put people at “risk of risks” (vs. downstream proximal causes
What does the Fundamental Causes Theory seek to do?
1) Understand the and address the root causes to reduce social inequalities in health
2) contextualize risk factors by showing why people are exposed to individual risk factors
3 Key concepts in Fundamental Causes Theory
1) F.C’s are persistently associated with disease despite changes in multiple intervening mechanisms
2) When the effect of one intervening mechanism declines, the effect of another becomes more prevalent (ie. importance of sanitation issues dies down, but smoking by poor rises up)
3) Unless the link between social position and health is broken, old patterns will reproduce over time
Why do fundamental causes maintain an enduring relationship with disease?
They affect the access to and ability to deploy flexible resources
Policy Implication of Fundamental Causes Theory
“Prevention Paradox” - prevention efforts can have perverse effect of widening social disparities in health outcomes
3 Levels of racism issues
1) Structural/Institutional/Systematic (differential access to resources and power bc fo policies and practices)
2) Interpersonal (prejudice and discrimination)
3) Individual (acceptance, internalization and/or awareness of neg. sterotypes about ones group –> doll test)
Definition of Stereotype Threat
Threat that other’s judgements or actions will negatively sterotype a person in a particular domain –> the threat leads to confirmation of the stereotype (self-fullfiling prophecy)
What do people affronted with sterotype threat inadvertenly end up doing?
ironically create the undesired outcome –> threat impairs performance when thats the last thing you want to do
Stereotype Threat Spillover into Health
Confirmation of stereotype can spill over into domains unrelated to stereotype (i.e. ice cream test –> those primed with stereotype threat experienced weaker self-regulation –> ate more icecream)
Weathering - what is it?
Early health deterioration as a consequence of cumulative impact of a repeated experience with social or economic adversity and political marginalization (gap in health between dominant group and marginalized group gets bigger over time)
Minority Stress - what is it?
chronic experience of social or economic adversity and political marginalization
Measure of weathering
Allostatic load - cumulative wear and tear on systems due to stressors; measured via biomarkers across multiple body systems
5 factors about the Relationship between SES and health
1) Incremental
2) Evident above a level of acute deprivation
3) Not explained by traditonal risk factors (i.e. health behavior)
4) Modifiable
5) Bi-directional (ses can hurt health, bad health can hurt ses)
Social Gradient in Health – definition and challenge
Higher SES is associated with better health at every SES level – tough to explain bc even the middle class is worse off than the upper class, but all their material needs are met!
What was the early evidence of social gradients in health?
Black Report in Britain – even when you control for disease prevalence, etc., there are still several residual unexplained reasons for health differences between social classes (recall 1% vs .001%)
What is a key driver of Social Gradients?
Structural equality (fall of USSR and pursuing divergence in qual of life between educated/uneducated)…involves who gets access to resources
Social Drift/Reverse Causation
Theory that health can actually be a driver of SES (if you get sick, you might not be able to work, reducing your power and leading to a lower SES)
What are 4 theories of health causation? & what is the correct theory?
1) genetics only
2) social causation
3) social drift/reverse causation
4) Bidirectional (correct analysis)
What are tradeoffs/implications in ways to measure the causal relationship between SES and Health? 3 different ones…
1) Individual vs. Area Level
2) Absolute vs. Relative
3) Objective vs. Subjective
What is acculturation
When members of one cultural group adopt the beliefs and behaviors of another, more dominant group –> adopt the host country’s lifestyle
Limitations of acculturation theory
rarely defined, assumes static cultural identities, neglests ses, overly dependent on individual choice (too focused on toxic us environment)
Latino/Immigrant Paradox
Immigrants have lower SES (associated normally w/ poor health) but have better health than dominant group in US..but protective effect is not sustained over time
What group do we not see the latio paradox in?
Puerto Rican’s –> US territory
Selection bias reasons behind paradox
1) healthier immigrants more likely to immigrate
2) higher SES people in native countries more likely to immigrate
3) cant assess appropriately
Health Deterioration Hypothesis for why paradox goes away after 1st generation (5 possibilities)
1) acculturation/neg. assimilation
2) cumulative exposure to toxis us environment
3) selective return migrations (go home to die)
4) Changing expectations/standards (usually self-reported, so as you compare yourself to more people, your happy view diminishes)
5) Increasing access to HC (getting a diagnosis uncovers illness that might be ignored)
Other hypothesis for why the latino paradox goes away?
Segmented assimilation
What is segmented assimilation?
Assimilation is complicated w/out a clear trajectory… how you assimilate depends upon SES and subroup heterogeneity
What are key determinants of assimilation trajectories?
1) Individual human capital/resources
2) Receiveing Environment (govt policy, native pop response, size of co-ethnic population)
Why does age of arrival matter?
more susceptible to microaggressions when you’re younger so they may have bigger health impact - time (weathering) vs timing (acculturation/recognition of othering)
Othering
The imposition, construction, and perception of racial categories and corresponding social meanings (are negotiated and have to do with discrimination vs. ethnic identity)
Two example studies on othering
PR birthweight in PR or NYC vs in other states; arabic name babies birthweight pre/post 9/11
What is sexual orientation a function of? (3 things)
Sexual behavior, Sexual attraction, Self-identification
Period of concealment
time between when you think you might be homosexual/and or know you might be homosexual until you tell others you are
Ecological Approach to Sexual Orientation Stigma - what 3 levels?
1) Individual
2) Structural
3) Interpersonal
Individual Factors re sexual orientation stigma:
1) hidden stigma (vs visible)
2) concealment (daily decision on if to disclose or not disclose)
3) stigma-based rejection sensitivity
What is stigma-based rejection sensitivity
chronic anxious expectations of rejection based on stigmatized characteristic…intense reaction to threat…can have biological and health consequences
example: hiv+ men – if rejection senstive progressed about 2 yrs faster to variety of hiv health outcomes even when controlled for other differences bc of impact of anxiety on immune system. Therefore stigma is a potential cause for increased biological he arm.
4 types of structural stigma
1) social policies (i.e. employment/mariage laws…interventions: act up, state policies to protect employment)
2) economic impact of discrimination (i.e. homosexual couples can file taxes jointly federally but not at all state levels)
3) state laws (hate crime statute)
4) cultural norms (pew study - 31% said homosexuality should be discouraged, 40% said sad if kids are LGB)
2 study examples of structural stigma
1) states w/ no protective policies - lgb individuals have higher psychiatric disorders than in states with them)
2) as structural stigma increasese, so do MH probs in LGB population (constitutional bans - if your state banned, 36% increase in MH probs, vs if your state didnt, 23.6% decrease in MH probs). even whithin the state that did it, hetero’s only experienced 2.6% increase in mh probs, vs 36% in lgb.
Interpersonal Stigma
1) family rejection –> homelessness
eg. LGB youth make up 40% of homeless youth, even though only 3% of population
Difference betwen sex and gender
Sex is biological
Gender is a social construct, a continuum, intersects and has weight in power
3 important concepts in sex and gender
1) Essentialism/determinism vs. social constructionism
2) patriarchy
3) Hegemony
Social construction
gender is culturally bound and societally produced
Patriarchy
control by men of a disproportionately large share of power in society; is a broad social institution, implemented by law
Hegemony
The propagation of an ideology throughout society that normalizes the status quo by those IN POWER. It explains why and how PEOPLE IN POWER use ideology to maintain
power to justify inequality. Show their power as natural. In masculinity, it represents power and authority and subordinates feminists.
Gender Health Paradox
women are socially disadvantaged, but are advantaged in health. gender social inequalities are not same as gender health inequalities.
Gender health paradox exists everywhere except
1) in countries with traditional patriarchal regimes
2) with respect to outcomes like gender based violence and eating disorders
Us women are still
22nd in the gender gap, globally
Why is there a gender paradox?
1) material, behavioral, psychosocial stress all tie into health
2) Biology: more infant mortality for boys/estrogen protective for heart disease (not whole story)
3) cohabitation and common interests
4) gender norms and behaviors (widowhood effect/risk taking)
5) Hegemonic sexism (natural attitudes about gender)
What is sexism?
a system of rewards and punishments that provide incentive for women to remain in conventional gender roles
Sexism and health
1) biomedical research just on men
2) rectify sexism with paternalism
Ambivalent Sexism
2 sides: hostile sexism and benevolent sexism; challenges simplistic equation of sexism with antipathy, of overt antagonism toward women
What is benevolent sexism?
valorization of women, not meant to be hostile, so taken as less offensive
Scale for ambivalent sexism
ranks between hostile acts to benevolent acts (ambivalent sexism inventory)
factors of benevolent sexism (4)
1) its insidious
2) its harder to see and therefore easier to accomodate
3) there can be greater risks to ehalth if you dont accomodate
4) reflected in system justifying beliefs
What are system justifying beliefs?
It explains why the PEOPLE NOT IN POWER, those who do
not benefit from the status quo or inequality to accept the ideology and propagate it.
The idea that people rationalize the social order, which is linked to subjective well-being, because it is uncomfortable to perceive injustice and we are inclined to justify it.
Male privilege
Doesnt translate into unambigous health benefits for men… there is a problematic equation of gender & health with women’s health
What is the effect of plurality on men
there are differences among and within men so there are multiple masculinities
Courtenay article
different types of masculinities: hegemony vs hyper compulsive, oppositional, compensatory, protest.
Society has a vested interest to be able to leverage forms of masculinities.
