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Social & Behavioral Final


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Name four (of seven) biologic systems that are affected by stress.
circulatory, respiratory, nervous, digestive, excretory
Briefly describe the autonomic nervous system, i.e. what it does.
It's responsible for the self-controlling aspects of the body's nervouse network. It helps people adjust to changes in the environment, adjusting or modifying functions in response to stress.
Briefly describe the functions of the sympathetic nervous system.
It causes flight or fight responses in moments of stress or stimulus, such as increased heart rate, vasoconstriction, increased blood pressure, and increased blood flow into lungs by increasing the bronchium's diameter. It's under control of the cerebral cortex, the hypothalmus, and the brain stem.
Briefly describe the functions of the parasympathetic nervous system.
Counterbalances the effect of the sympathetic nervous system by slowing the heart rate, dilating blood vessels, and relaxing involuntary smooth muscle fibers. It's under control of the cerebral cortex, the hypothalmus, and the brain stem. Rest & Digest
Define stress.
A state in which the brain interprets the quantity of stimulation as excessive or its quality as threatening, thus responding in a generalized way.
Give a definition for the stress response.
1. Physiologic reactions normally associated with responding to threats to self or others.
2. A rapid "flight or fight" reaction that clasically quickly returns to homeostasis, ie maintenance of constant and appropriate internal conditions.
Identify the hormone that the hypothalmus releases in response to amygdala stimulation (perceived threat or stress).
corticotrophin-releasing hormone (CRH)
Identify the primary (first) target organ affected by CRH and the chemical (hormone) this target organ releases in response.
pituitary gland - adrenocorticotrophin hormone (ACTH) & beta endorphin
Identify the target organ of ACTH and its major physiologic response/secretion product (effect).
adrenal cortex - stimulates secrection of glucocorticoids (mainly cortisol)
Identify the primary secretion product of the adrenal medulla.
Describe the common effect of cortisol on carbohydrates, fats, and protein.
carbohydrate metabolism - raise blood sugar so the brain and muscles will have more energy to deal with stress, increases formation of glycogen in the liver; fat - breaks down fat to make fatty acids available as a glucose fuel substitute; protein - catbolises protein (through ACTH) to make glucose
Name two of the four epinephrine effects given.
converstion of glycogen to glucose mainly in the liver (but also skeletal muscle); increased heart rate and force of heart contractions; increased blood flow to the muscles and brain; relaxation of some smooth muscles e.g. bronchodilation
Name one effect of two norepinephrine effects.
strong vasoconstrictive effects, increasing blood pressure; effect on smooth muscle, metabolic processes, and cardiac output is small
Define allostasis
achieving homeostasis through constant adjustment of components of stress response
Define allostatic load
wear and tear of a body as a result of repeated allostatic response
Define circadian rhythms
rise and fall of biological substances due to changes in light/dark, sleep/waking...
Identify three common maladaptive reponses to stress.
aggression, cigarette smoking, alcohol consumption, increased calorie and fat comsumption, exposure to physical hazards, & decreased activity
Identify two characteristics of unsuccessful coping.
avoidance, social withdrawal, greater anxiety & depression
Site three pieces of evidence that stress is related to negative health consequences for animals or humans.
handling of new born rats leads to decreased stress hormone for life; early trauma in humans leads to poorer health as adults; transition from traditional to urban society lead to high blood pressure
What does NHQR stand for?
National Healthcare Quality Report
Who produced NHQR?
The Agency for Healthcare Research and Quality (AHRQ) - an agency of DHHS is mandated by law to create this annual report
What is the NHQR?
The first comprehensive national effort to measure the quality of healthcare in America.
When was the NHQR first published?
Where did the questions in the National Healthcare Disparities Report come from?
Identify three indicators that could help us identify if there is a social (race or income) dimension to receiving quality healthcare, explain why these are good indicators, and then describe the data results.
1. receiving antibiotics promptly after you are hospitalized with pneumonia - Hispanics and blacks receive timely antibiotics about 20% less than Asian and Pacific Islanders; 2. influenza vaccination - Hispanics and black had a little more than half the rate of vaccinations of Asians; 3. Effective management of diabetes including lipid management, eye examination, foot examination, influenza immunization - Diabetics who are black, hispanic, or poor receive less of these services.
In general, what race groups have the hardest time getting into the healtcare system? Cite atleast one set of contrasting statistics to make your case.
Hispanics and Asian and Pacific Islanders - Only about 50% of poor or near poor Hispanics and API are insured. By contrast, almost 75% of poor or near poor blacks are insured. - Similarly, about 25% of Hispanics and API report not being able to get help when needed. By contrast only about 15% whites (and a few % more blacks, 18%) note this problem.
Does income affect your being referred to a medical specialist in the US? Cite data to defend your answer.
Yes. About 30% of poor or near poor people report having problems getting referred. Less than 20% of wealthier people report this.
Socio-economic status is an amorphous concept usually operationally defined by several proxy variables. Identify the three most common and two that probably should be added.
income, occupation, education - gender, life course
Are the three common SES indicators strongly, moderately, or mildly associated with mortality rates?
Identify a difficulty with using income as an SES measure.
It's a point estimate, failing to capture the effects of sustained exposure to low income.
Two adult white people of the same age are sitting at a bus stop. One has a household income of around $5,000, the other around $50,000. If the crude death rate for the one making 50K is 400/100,000 (a reasonable estimate) what is the rate for the one ma
720/100,000 It's 80% greater or 400 * 1.8 = 720
True/False If you adjust (subtract the effects of) age, smoking, BP, cholesterol, diabetes, and previous myocardial infarction, the effects of income on mortality disappear.
False: according to MRFIT data
True/False The higher incidence of mortality at high incomes, when compared to higher incomes, largely disappears when comparing middle incomes to higher incomes.
False: The relationship is "graded and continuous." The higher mortality is not just found among the poor - as the Whitehall longitudinal studies in England found - it's also occupation description/status related.
True/False Most of the differences in mortality attributable to SES are due to differences in access to medical services.
False, as long as we say "most." The IOM believes access is related to mortality, but believes this accounts for only a small percent of the variation. Both treatable and non-treatable COD show similar mortality gradients across SES. So access is clearly not the only (or even the major) determinant of increasing mortality gradient across decreasing SES. Other factors are involved.
List three (of six) aspects of the physical environment that may play a role in the excess mortality seen in low SES groups.
crowding, unsanitary housing, air and water pollution, inadequate food supply, and poor working conditions
Identify two (of four) ways the social environment may affect behaviors that affect health.
shaping norms, enforcing patterns of social control, providing socal opportunities for engaging in particular behaviors, producing or reducing stress which may make some activities look favorable
Briefly explain what is meant by "reverse causation" or "social selection" and when(if at all) it seems to valid.
Poor health lead to low SES.
It's valid for specific conditions like schizophrenia and severe mental illness, but has a small influence in relation to the overall SES effect of health.
Describe two ways social networks are often measured.
the number of voluntary organizations you participate in; the number of friends you have
List two (of four) ways social networks can influence health.
provide social support that buffers stress, provide social influence - shaping health activities, provide social engagement that may also buffer stress, person-to-person contacts by which infectious diseases can be spread
True/False Objective indicators of stress and health are more powerful than subjective indicators or social isolation.
False: People's own perceptions of their degree of social isolation are better predictors of their stress levels and health
True/False Social support is phsycologically pleasing, but has no significant physiologic effects. If false, cite two pieces of evidence.
False: having a friend with you while you do a task decreases BP and heart rate; people with fewer ties have a higher death rate over 9 years, the number of social ties is positively associated with resistance to rhinovirus
True/False The evidence linking social isolation to a greater death rate is largely confined to cardiovascular disease.
False: It occurs over a wide range of diseases.
True/Fasle Weak social ties are often more effective than strong ones.
True: Especially when those with more weak ties are compared to those with fewer strong ties
True/False Negative social interactions are generally more strongly linked to negative psychlogical consequences than positive interactions to positive psychological consequences.
Define job-strain.
The combination of psychologically demanding and low job-control.
Identify and define the most robust job-related predictor.
Job control- the opportunity to use and develop skills and to exert authority over workplace decisions.
20. True/False A psychologically demanding workplace is consistently associated with a higher incidence of cancer in many studies. If false, generate a related true statement.
False. The IOM never talked about psychologically demanding workplace and cancer. They emphasized the consistent connection (17 of 25 studies) between job control and heart disease.
True/False American data generally does not support the relationship between unemployment and increased mortality in the 45-64 age group.
True, so far. But in Europe the estimates are that unemployment causes a rise in mortality of between 10-50% (between a standardized mortality ratio of about 110, i.e. an observed/expected ratio of 1.1, and relative risks of about 1.5). These studies are difficult to interpret because of the possibility that poor health leads to unemployment. Also note that chronic adverse changes in neuron-endocrine and CV measures in relation to enduring unemployment are infrequently documented (Kasl and Jones, 2000).
True/False Retirement is usually associated with negative health effects.
False, the reverse.
23. Describe the difference in income between the richest and poorest Americans. Also identify the proportion of wealth the richest 1 % owns.
The average income of the richest 20% is $106,000.
The average income of the poorest 20% is only 8% of this.

The richest 1% owns 40-50% of the nation’s wealth.
Explain the relationship between income inequality and life expectancy.
The greater the inequality in income between rich and poor in a country, the lower is the life expectancy.

Also, the more national income goes to the poorest 70%, the greater the life expectancy.
Briefly explain two (of the three) ways in which income inequality may affect health.
1. Human capital explanation: States with high income inequality invest the least in education. The effect on poor health and life-expectancy may be thru this failure to invest in educating human capital.
2. Social Cohesion Erosion: States with high income inequality have populations that are more distrustful of each other and belong to fewer civic organizations. Negative health effects may be the result of this erosion in social cohesion.
3. Relative deprivation: Frustration and envy associated with not meeting culturally defined lifestyle expectations may result in poor health. The relative deprivation that occurs in conditions of income inequality may accentuate psychologically induced health effects – like high BP. In addition, those living in societies with income inequalities may experience physical deprivation as they have less access to conveniences which the more wealthy have introduced into the health system, e.g. cars, computers, email, telephones,…
True/False The disparity in life expectancy between blacks and whites disappears after controlling for income.
False. It does reduce the disparity, but it persists even after controlling for income. The IOM thinks this may be the result of discrimination itself.
List three (of six listed) ways in which discrimination may influence health.
Greater exposure and susceptibility to
Economic and social deprivation
Toxic substances and hazardous conditions
Socially inflicted trauma (mental, physical, sexual⬦)
Targeted marketing of legal/illegal psychoactive substances
Inadequate health care facilities and providers.
Reactions to these exposures may also be harmful, e.g. violence
Define a socially integrated society.
It’s one with moral resources, such as trust, and norms of social reciprocity.
List one way in which social capital can be measured –according to the IOM.
There’s other ways too, but the IOM report mentions:
Density of the number of memberships in voluntary organizations (church/mosque/synagogue, sport groups, hobby associations, fraternal organizations…) in a community
Density of the number of memberships in civic organizations in a community
Percent of members of a community agreeing with notions of social reciprocity, i.e. that they trust neighbors to repay altruistic behaviors with same.)
List two (of five) ways increased social cohesion might influence health.
•More rapid diffusion of health information
•More likely to adopt healthy norms
•Exerting control over deviant health behaviors
•Increasing access –i.e. cohesive communities get access for their members.
•Social support
Identify the variable that must be controlled when studying the association between attendance at religious functions and mortality.
Baseline health status. Otherwise you don’t know if people are dying early because they don’t go to religious services or because they are too sick and thus can’t go (i.e. selection bias).
What is media advocacy?
The use of mass media to advance a social or public policy initiative
Explain how media advocacy differs fromt he traditional use of mass media for health education.
Traditional use assumes that the problem is the individual's lack of information about risk.
Media advocacy assumes that the problem is the socal context and that political power is needed to change things.
Name one thing that Wallack feels is wrong with Partnership for Drug Free America ads: e.g. the "Just say no" or ecstacy ads.
They assume falsely that the problem is individual. They do not address social conditions that give rise to drug use: poverty, family turmoil, alienation, poor housing, poor education, lack of economic opportunity, lack of security , self medication, boredom
They do not address political problems. For example government spending money on law enforcement instead of treatment.
They often blame the victim.
What are two functions of media advocacy?
1. Use the media to place an issue on the public agenda.
2. Focus on social and political causes of the issue.
3. Advance a specific social policy initiative.
Identify the two things that are, according to the Wallack et al, "the fundamental mechanism for developing the political will necessary for policy change.
Community organization and coalition building.
According to Wallack: What are the first three steps in the practice of media advocacy?
1. Establish your policy goal - what you want to change.
2. Identify your target - who you must change in order to reach your goal.
3. Frame your issue to focus on policy and construct your message.
Identify two short term goals of medica advocacy.
Get on the media agenda, build public awareness, alert opinion leaders to the importance of an issue, discredit the opposition, stimulate community concern or mobilize community resources
How do you frame a story for media access? Give one example.
Make the story newsworthy:
timely, relevant, and in the public interest; sensational: add conflict, mystery, celebrity, deviance, trajedy, or proximity; offer breaking news; or human interest: difficult odds, helping others
Explain what is meant by the "authentic voice" and what is the dilemma with using it.
It is the voice of those most affected by the problem, speaking on their own behalf. The dilemma is that they are often not trained in how to speak to the media.
Identify one question that is likely on a journalist's mind and that you should use when making your pitch.
Why would I want to write about this?
How will it satisfy my editor/producer, sell papers/win ratings, get my story promienty placed in the newspaper or on the newscast?
How does following up on this story fulfill our outlet's mission of letting the community in on significant events happening in and around it?
Identify one thing you can do to get ready for a media interview for advocacy.
Develop a file of arguments and counter arguments on your issue and rehearse them with your colleagues.
Get to the place where the interview will be early - so you know the environment (Where will you stand/sit? Where will the camera be? Should you look at it?
Ask what the first question will be and think about how to use this to get to YOUR key point.
Make your point early, media time runs fast.
How do you fram for content? Give one example.
Emphasize the environmental (not personal)causes of the health problem.
Show that bad health behaviors may be more a function of a corporate-made environment/bad policies than of just individual choice.
Show the benefits of environmental solutions: they are often more effective (and cheaper) than treating individuals.
Emphasize our society's foundation on social justice and equality.
Briefly explain the framing dilemma and what advocates are often forced to do.
An essential task of the advocate is to frame social and health issues in a social and political context to highlight public policy approaches rather than personal-behavioral solutions. However, the journalist looks to the individual or episodic frame as a way of organizing the facts of the story to draw the attention of the viewer. This contributes to the very thing that the advocate wants to move away from - reinforcing an individual level definition of cause and solution. To accommodate journalists' needs, the advocate will often have to use an individualistic frame to gain initial access and later try to reframe the issue using a broader social perspective.
How do you advance the policy? Give one example.
be clear about the policy objective; develop broad-based support; anticipate message sabotage and how you'll reframe the issue; know what symbols to use, issues to link, voices to provide, messages to communicate
What are two problems with coalitions?
coalitions and their structures have been poorly defined; communities and coalitions in the US are rife with ethnic, racial, and class divisions that complicate intervention efforts and lead to cooaptation; communities have histories and narratives of past interventions - how these are remembered and interpreted affects current intervention efforts
What is a coalition?
an organization of individuals representing diverse organizations, factions, or constituencies who agree to work together in order to achieve a common goal
What is community capacity?
a measure of the ability of members of a community to come together and effectively solve problems
What are three dimensions of community capacity?
The quality of available:
skills, required structures, leadership, the degree of connectedness, a culture of learning, a high level of civic participation, articulated moral values
Name one cognate of community capacity.
community competence, social capital, civic capital, public capital
What is community organization?
Organizing is people working together to get things done.
What was the settlement house movement?
A charity movement of upper-class educated women (and some men) who moved into the crowded settlements of immigrants to teach them domestic and occupational skills and who also organized them to clean their environment, push for child labor laws, and child welfare services.
What are the three types of community organization?
locality development, social planning, and social action
What is locality development?
critical points: broad participation and non-confrontation
What is social planning?
planning by planning professionals, e.g. content experts
What is social action?
a model of community organization based on conflict
Who is the author of the quote about social action?
Frederick Douglas
What are two of Alinsky's 13 Rules for Radicals?
1. Power is not only what you have but what the enemy thinks you have.
2. Never go outside the experience of your people.
3. Whenever possible go outside the experience of the enemy.
4. Keep the pressure on.
5. The threat is usually more terrifying than the thing itself.
What are three examples of famous advocates of social action?
Frederick Douglas, WEB Dubois, Mother Jones, Saul Alinsky
What is empowerment?
a social action process by which individuals, communities, and organizations gain mastery over their lives in the context of changing their social and political environment to improve equity and quality of life
What are the different types (or levels) of empowerment?
individual, organizational, and community
What is conscientization?
the conciousness that comes through social analysis of conditions and people's role in changing them
What is the essential method of Freirian education?
problem-posing through a series of presented codes (somewhat abstract materials) that reflect peoples existential situation
What are two trends in community organization according to Minkler and Wallerstein?
tend to:
be more community or empowerment driven;
emphasize strengths as opposed to needs;
develop strengths through the recognition of shared values and diversity (including feminist perspectives and communities of color);
emphasize coalition and partnerships building and development
What is Nyswander's Principle of Relevance?
In organization, start where the people are.
What is the downside of the Nyswander approach according to Tai-Seale?
the people may not have the right epidemiological issues - they might now have any health agenda;
What is the Principle of Participation?
Def 1: the process by which individuals and families assume responsibility for their own health and welfare and for those of the community and develop the capacity to contribute to their and the community's development
def 2: the social process of taking part (voluntarily) in either formal or informal activities, programs, and/or discussions to bring about planned change or improvement in community life, services and/or resources
What is a problem with the principle of participation?
few may want to participate; health organizers often have different goals than participants, e.g. to gather scientifically useful information, to only address specific topics
What are two things (of four listed) that experts advise about selecting issues in community organization?
Select issues that"
are winnable; able to unite the members of the group; affects lots of people so you can build the organization and support to push the issue; are part of a larger plan or strategy
What are two weaknesses of community development?
1. if the problems are not local, local solutions don't work
2. community workers are hard to find, train, and successfully work with
3. health professionals will find it difficult to be non-directive
4. the CD process often accepts the local power structure and is thus dominated by them
What is a social network?
the linkages among people that are useful for understanding behavior; or the linkages through which social identity is maintained and support received
What is the maximum number of social links? Avg?
150; 120
What are two dimensions of social networks?
Structure: size, density
Interactional characteristics: reciprocity, durability, frequency of interaction, geographic dispersion
Functional characteristics: affective support, instrumental support, cognitive support, maintenance of social identity, social outreach
What is boundedness?
the proportion of all ties of network members that stay within network boundaries, e.g. within an organization
What is reachability?
the average number of ties required to link any two network members
How does a social network analysis of health behavior tend to differ from a traditional behavior change analysis?
network analysis tends to interpret behavior in terms of structural constraints on activities instead of inner forces like attitudes
What is social support?
the degree to which a person's basic needs are gratified through interaction with others
What are two types of social support?
emotional, appraisal, informational, instrumental, social-emotional, problem-oriented, daily
How does social support work?
either by indirect (that is, by buffering the effects of stress) and/or direct effects (supplying information, resources)
What is one theoretical basis for the effects of social networks and social support?
exchange theory: people act to obtain maximum rewards at minimum costs; social comparison theory: people use both others and standards to evaluate their opinions/actions
Can you describe one study that links social support with decreased mortality?
Emotional support is strongly linked to survival of MI and stroke recovery
Can you describe if there are any links between social support and improved physical health?
the evidence for the effects of social support are strongest in recovery, rehabilitation, adaptation/adjustment to illness/injury
Can you cite findings that link social support with improved mental health?
lack of network or support is associated with depression in women
Are there any potential negative effects of increasing social networks?
people may increase patient stress while trying to offer support
What are two types of network or support interventions?
strenthening existing networks, developing and enhancing new networks, bring overlapping networks together for problem-solving
Name the researcher who showed that most of the decline in death since the 1700s has been due to changes in diet and sanitation, not medicine.
Thomas McKeown
What is a community-based health program and when did they begin?
Grassroots decision-making to improve health. It began in the 1960s and grew in the 1970s. Even now it continues, though its more often called community-based participatory research (or action research).
Identify the major strategy to improve health in Primary Health Care (PHC).
Address the underlying social, economic, and political causes of poor health as well as providing basic medical services. In short, it was to be comprehensive.
Name three authors (or documents that bear their names) whose works are considered the academic roots of the social determinants literature.
McKeown, Lalonde, Black, McKinlay, Rose, Tarlov
Give two main characteristics of neoliberalism.
no government intervention in the economy, i.e. a free-market; few restrictions on business and property; reject or lessen minimum wage and collective bargaining rights; opening foreign markets to free trade; opposes socialism, protectionism, and environmentalism
Explain what happened to primary health care and why this is a cause for concern.
Much of it was transformed into selective primary health care, abandoning the focus on underlying social determinants. It's a concern because the determinants remain.
Describe the finding of the Whitehall report.
the rate of CHD declined with increasing professional grade in the British Civil Service
Describe one of the economic trends in this country that affect health.
There's a growing number of poor and a growing number of rich (who are getting richer quicker)
Describe the IOM's dual approach to population health.
Improve the health of all through broad social interventions.
Give special attention to the disadvantaged.
Will most health problems resolve if there is universal health insurance? If no, why?
No. Universal health care would only give access to the medical system and would not address the underlying social determinants of health: good education, good income, good employment, good housing, good food, protection from unemployment, access to political power, and participation in decisions affecting these things.
Identify the factor that is seen by many researchers as the link between health status and health inequalities.
social position
Identify two mechanisms for improving social position.
early childhood diet and cognition development programs; income protection for those out of work; involve workers in decision-making; involve neighbors in neighborhood planning
Describe the Ypsilanti Preschool program
Preschoolers were enrolled in a skill-based program to help them find and develop their own interests. Those in the program had markedly better high school graduation rates, much lower participation in crims, and much fewer teen pregnancies
Describe the San Francisco bus driver study
Researchers found that the cause of high BP in bus drivers was job stress and poor working/living conditions. This led to bus-driver organization to change these determinants.
What does MAPP stand for?
mobilizing for action through planning and partnerships
What organization devised MAPP?
What are the four assessments used in MAPP?
Community Themes and strengths, local public health system, community health system, forces of change
What is the community themes and strenths assessment?
"what is important to our community?" "how is quality of life perceived in our community?" and "what assets do we have that can be used to improve community health?"
What is the local public health system assessment?
"what are the components, activities, competencies, and capacities of our local public health system?" "how are the essential services being provided to our community?"
What is the community health status assessment?
identifies priority community health and quality of life issues. "how healthy are our residents?" "what does the health status of our community look like?"
What is the forces of change assessment?
identifying legistlation, technology, and other implending changes that affect the context in which the community and its public health system operate. "what is occurring or might occur that affects the health of our community or the local public health system?

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