Theories of Health Behavior & Health Education BCHS 2520 (2141) 3 Credits Spring Term, January – April 2014 Thursdays 5:00 – 7:50 pm A216 Crabtree Hall OFFICE HOURS: by email appointment (for our mutual convenience) Instructor: Jeanette M. Trauth, Ph.D. Associate Professor, BCHS 217 Parran Hall Telephone: 412-624-0968 email: [email protected] Teaching Assistant: Chelsea Pallatino, MPH, CHES BCHS Doctoral Student [email protected] Administrative Assistant: Summer Haston Email: [email protected] Phone: 412-624-3106 NOTE: If you have a disability that requires a special accommodation, please contact me and the Disability Resources and Services, (412) 648-7890, 216 William Pitt Union as early as possible in the term. You may be asked to provide documentation of your disability to determine the appropriateness of accommodations.

I. Course Description: This course is a requirement for students in the MPH degree program in the Department of Behavioral and Community Health Sciences. The course is designed to introduce students to some of the major theories, models and conceptual frameworks that are frequently used to plan health promotion and disease prevention interventions that target behavior at the individual, interpersonal, community and societal levels of intervention. This course will provide you with a theoretical foundation for designing, implementing and evaluating health promotion and disease prevention intervention programs. The course material will be presented via lectures, class discussions of assigned readings, in-class exercises and guest speakers. There are no prerequisites for this course.

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The content of this course specifically addresses ASPH competencies # 1, # 2, # 6 and # 8 (highlighted below) that have been established for MPH students in the social and behavioral sciences: MPH Core Competencies in the Social and Behavioral Sciences (ASPH August 2006). Competencies: Upon graduation a student with an MPH should be able to: 1. Identify basic theories, concepts and models from a range of social and behavioral disciplines that are used in public health research and practice. 2. Identify the causes of social and behavioral factors that affect the health of individuals and populations. 3. Identify individual, organizational and community concerns, assets, resources and deficits for social and behavioral science interventions. 4. Identify critical stakeholders for the planning, implementation and evaluation of public health programs, policies and interventions. 5. Describe steps and procedures for the planning, implementation and evaluation of public health programs, policies and interventions. 6. Describe the role of social and community factors in both the onset of and solution to public health problems. 7. Describe the merits of social and behavioral science interventions and policies. 8. Apply evidence-based approaches in the development and evaluation of social and behavioral science interventions. 9. Apply ethical principles to public health program planning, implementation and evaluation. 10. Specify multiple targets and levels of intervention for social and behavioral science programs and/or policies. II. Learning Objectives Upon completion of this course students will be able to do the following. 1. Explain the purpose of selected major theories and describe how they have been used in the design of various health behavior and health education interventions. 2. Select a health or health-related problem of interest from the Healthy People 2020 (or comparable document) or the Millennium Development Goals that will provide the focus for your work throughout the semester. 3. Conduct a literature search using databases available at the University of Pittsburgh in order to identify underlying factors that may be amenable to change at various ecological levels. 4. Interview an individual(s) who have expertise related to your selected problem or population of interest. 5. Design an intervention to address your selected problem based on an appropriate conceptual framework–that is, a framework comprised of concepts, theory(s) or model(s) of health behavior change that are relevant to your chosen problem. 2

6. Develop a logic model that demonstrates how your proposed intervention will be implemented and evaluated. III. Assignments and Grading: Readings will be assigned for each session and students will be expected to be ready to discuss their reflections on the assigned material for each class. The in-class lectures, exercises and guest presentations are designed to broaden, expand and clarify the student’s understanding of health behavior theories. Students are required to complete the following assignments: 1) select a health problem and population of interest from the Healthy People 2020 or similar report or, from the United Nations Millennium Development Goals; 2) write a review of the literature relevant to your problem of interest; 3) interview an expert—i.e. an individual researcher and/or practitioner who works with your population of interest and/or the problem area; and, 4) based on the literature search and expert interview, design an intervention that is guided by a conceptual framework (i.e. a theory, model or concepts) that addresses the health problem selected from HP 2020 or the Millennium Development Goals. You will also develop a one page logic model to demonstrate how you will implement and evaluate your intervention. Grades will be determined using the following criteria: 1. 2. 3. 4. 5.

Description of the health problem of interest: 10% Literature search: 30% Expert interview (your observations and critique of the discussion): 20% The theory-driven intervention and logic model: 30% Participation (in-class as well as written reflections): 10%

Grades can range from A+ to C: 97-100 = A+ 93- 96 = A 89- 92 = A85- 88 = B+ 81- 84 = B 77- 80 = B73- 76 = C+ 70- 72 = C < 70 = F Academic Integrity: All students are expected to adhere to the school’s standards of academic honesty. Any work submitted by a student for evaluation must represent his/her own intellectual contribution and efforts. The GSPH policy on academic integrity, which is based on the University policy, is available online at http://www.publichealth.pitt.edu/interior.php?pageID=126. The policy includes obligations for faculty and students, procedures for adjudicating violations, and other critical information. Please take the time to read this policy. Students committing acts of academic dishonesty, including plagiarism, unauthorized collaboration on assignments, cheating on exams, misrepresentation of data, and facilitating dishonesty by others, will receive sanctions appropriate to the violation(s) committed. Sanctions include, but are not limited to, reduction of a grade for an assignment or a course, failure of a course, and dismissal from GSPH. 3

All student violations of academic integrity must be documented by the appropriate faculty member; this documentation will be kept in a confidential student file maintained by the GSPH Office of Student Affairs. If a sanction for a violation is agreed upon by the student and instructor, the record of this agreement will be expunged from the student file upon the student’s graduation. If the case is referred to the GSPH Academic Integrity Hearing Board, a record will remain in the student’s permanent file.

IV. Course Readings 

The primary required text to be used in this course is: Karen Glanz, Barbara K. Rimer and K. Viswanath, Editors. Health Behavior and Health Education: Theory, Research, and Practice, 4th edition, Jossey-Bass, 2008. The book is available at: www.amazon.com. (The cost for purchasing a new text is approximately $54 (new) and $45 (used) and kindle edition for $44. You can also rent the book for $19-$33.

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Each week's assigned readings will be available in CourseWeb under the appropriate week. To access the materials, log onto: www.my.pitt.edu and click on CourseWeb.

V. Course Assignments: Detailed instructions for each assignment can be found in Course Web under the Assignments tab. Assignment #1: Problem Statement (10%) Select a problem of interest from either Healthy People 2020 (or a comparable document) or the Millennium Development Goals. The problem selected will be the focus for all 4 course assignments. Students have the option of selecting either a domestic public health problem or a global health issue. Write a 1-2 page paper discussing the health problem you selected. Your paper must include: 1) a statement of your specific objective related to the HP 2020 or MDG Goals; 2) a discussion of the importance of the health problem you selected; Provide some data to support your choice of problem. 3) state the particular population of interest (e.g. age range, race/ethnicity, gender) or if you are focusing on communities, identify the characteristics of community—e g. size, income, urban/rural etc.); 4) state why you have selected the particular population (e.g. individuals at risk, schools, communities, state legislators, healthcare providers) as the focus for your paper. The Guidelines for Assignment 1 are posted under the Assignments tab in CourseWeb. Assignment #2: A Review of the Literature Regarding your Problem of Interest (30%) Write a 10-12 page critique based on your literature search regarding your problem of interest. You must use the following headings to organize and summarize your discussion. The Guidelines for Assignment 2 are posted under the Assignments tab in CourseWeb. 1. Underlying factors: identify and discuss the underlying social and behavioral factors that affect your chosen health problem;

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2. Modifiable factors: discuss what factors are modifiable and could potentially be the focus of an intervention; 3. Interventions: discuss interventions that have been done relative to your problem that have been reported in the peer-reviewed literature; and, 4. Conceptual Frameworks: identify and discuss the theories, models, constructs, or frameworks that guided the design of the interventions you identified. Assignment #3: Expert Interview (20%) Conduct an interview with someone who has expertise in either your health problem area or the population of interest. Write a 4-5 page summary describing your interview. An Interview Guide form is posted under the Assignments tab in CourseWeb. Assignment #4: Intervention Design (30%) Design an intervention to address your chosen health problem that is guided by an appropriate conceptual framework (i.e. a theory(s), model(s) or concepts) that addresses the health problem selected from HP 2020 or the Millennium Development Goals. Write a 5 page paper and develop a one-page logic model that describes a theorydriven intervention to address your health problem. Based on your literature search, you should have identified some modifiable factors that explain why the health problem exists. The answers to the why questions should suggest targets for intervention at some ecological level—individual, interpersonal, organizational, community or policy. The Guidelines for Assignment 4 are posted under the Assignments tab in CourseWeb.

VI. Course Schedule: Session 1 Date: January 9, 2014 Topics: Introductions and review of the syllabus. In this first class we will focus on getting acquainted with one another and discussing the course goals, structure, assignments and the expectations for student performance. In addition, we will discuss the 4 major assignments and the resources available to complete the assignments. To that end, we will briefly discuss two major planning documents: Healthy People 2020 and the Millennium Development Goals, which summarize the health goals of United States and the global community respectively. You will select a health problem from one of these or a comparable document (assignment 1) which will provide the basis for all of the subsequent course assignments. Guest Presenter: Chelsea Pallatino, MPH, CPH, CHES. She will discuss how the Millennium Development Goals were the focus of her Maternal and Child Health work for SHARE INDIA during the last 2 summers. This is relevant to those of you who are interested in selecting a problem of international concern for the semester’s assignments. 5

Required Reading: The readings listed below are found in Courseweb Week 1. Center for Disease Control and Prevention. (2013). The Guide to Community Preventive Services: The Community Guide. Retrieved from www.thecommunityguide.org United Nations Department of Public Information. (2013). Millennium Development Goals. Retrieved from www.un.org/millenniumgoals U.S. Department of Health and Human Services. (2013). Healthy People 2020. Retrieved from www.healthypeople.gov Supplemental Reading: NONE Session 2 Date: January 16, 2014 Topic: Social determinants of health. This week the readings focus on the social conditions that affect health outcomes and disparities in health between various segments of the population. The World Health Organization has defined social determinants of health as “the circumstances, within which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.” We will explore the literature on the impact of socioeconomic factors on health and possible mechanisms by which this occurs. In particular, the readings will explore the role that fundamental factors, such as education, income/wealth and race/ethnicity play in health outcomes and health disparities—especially in the United States. Guest Presenter: Kristi Burry, MPH, CHES, CPH. Director of Child and Community Health, Homewood Children’s Village (HCV). Ms. Burry will discuss the mission of HCV and the programs that she directs to address the social determinants of health. The HCV is modeled on the Harlem Children’s Zone in New York City. Required Reading: See Courseweb Week 2 assigned reading. Braveman, P. A., Cubbin, C., Egerter, S., Williams, D. R., & Pamuk, E. (2010). Socioeconomic disparities in health in the United States: what the patterns tell us. American Journal of Public Health. 100(Suppl 1), S186–S196. Link, B. G. & Phelan, J. C. (2002). McKeown and the idea that social conditions are fundamental causes of disease. American Journal of Public Health, 92(5), 730-732. Phelan, J. C., Link, B. G., Diez-Roux, A., Kawachi, I., & Levin, B. (2004). "Fundamental causes" of social inequalities in mortality: a test of the theory. Journal of Health and Social Behavior, 45(3), 265-285.

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Woodward, A. & Kawachi, I. (2000). Why reduce health inequalities? Journal of Epidemiology and Community Health. 54(12), 923-929. Supplemental Reading: Anderson, K.M. (2012). How far have we come in reducing health disparities?: Progress since 2000: workshop summary. National Academies of Sciences. Retrieved from http://www. .nap.edu/catalog.php?record_id=13383. Leonhardt, D. (2013, July 22). In climbing income ladder, location matters. The New York Times. Retrieved from http://www.nytimes.com/2013/07/22/business/in-climbing-income -ladder-location-matters.html. National Public Radio. (Producer). (2013). New research on inner city fathers [Radio webcast]. In The Diane Rehm Show. Retrieved from http://thedianerehmshow.org/shows/2013-0528/new-research-inner-city-fathers. Reardon, S. F. (2013, April 27). No rich child left behind [Blog post]. Retrieved from http://opini onator.blogs.nytimes.com/2013/04/27/no-rich-child-left-behind/?_r=0. Robert, S. A. & Booske, B. C. (2011). U.S. Opinions on health determinants and social policy as health policy. American Journal of Public Health, 101(9), 1655-1663. Tavernise, S. (2013, January 10). For Americans under 50, stark findings on health. The New York Times. Retrieved from http://www.nytimes.com/2013/01/10/health/americansunder-50-fare-poorly-on-health-measures-new-report-says.html? r=0. Session 3 Date: January 23, 2014 Topic: This week we will discuss how health problems can be viewed from a Social Ecological perspective. We will read two articles by Susser and Susser that discuss several eras in public health and the associated theoretical paradigms that have led to the current era focusing on a social-ecological approach to public health problems. We will read two works by Krieger, a noted Harvard social epidemiologist who has done some of the seminal work influencing the thinking in this area. The Social-Ecological framework will provide a foundation for all of the subsequent weeks’ readings. Required Reading: See Courseweb Week 3 assigned reading. Krieger, N. & Davey Smith, G. (2004). “Bodies count” and body counts: social epidemiology and embodying inequality. Epidemiologic Reviews, 26, 92-103. Krieger, N. (2001). Theories for social epidemiology in the 21st century: an ecosocial perspective. International Journal of Epidemiology, 30(4), 668-677. 7

Susser, M. & Susser, E. (1996). Choosing a future for epidemiology: I. eras and paradigms. American Journal of Public Health, 86(5), 668-673. Susser, M. & Susser, E. (1996). Choosing a future for epidemiology: II. from black box to Chinese boxes and eco-epidemiology. American Journal of Public Health, 86(5), 674677. Supplemental Reading: Harlem Children’s Zone Development Office. (2010). Harlem Children’s Zone: Path to Sustainability. Retrieved from http://www.hcz.org/hcz/downloads/path_to_sustainability pdf. (2012, August 18). The human microbiome: me, myself, and us. The Economist: Science and Technology. Retrieved from http://www.economist.com/node/21560523.

Session 4 Date: January 30, 2014 Topic: This week we will continue our discussion of the Social Ecological model. The required readings provide examples of the application of the social ecological model to different types of health problems. The Ali article is a case study of the largest outbreak of waterborne E coli in Canadian history. The author examines the socio-political context of this environmental health disaster and describes the intertwined social and ecological sequence of events that led up to the disaster. The Woolf et al. article discusses the differences in the prevalence of unhealthy behavior in communities with differing levels of social and economic resources—suggesting that contextual factors play an important causal role. The authors offer recommendations for changing the environmental conditions of daily living to make them more conducive to healthy living. The Goodman article provides a concrete example of a social ecological approach to the design of a community-based youth substance abuse program. Guest Presenter: Judy Cameron, PhD. Professor of Psychiatry. Our guest presenter will discuss her work examining how early childhood experiences affect the architecture of the human brain and thus health and human development. This is an example of the concept of embodiment from last week’s readings by Krieger. Required Reading: See Courseweb Week 4 assigned reading. Ali, S. H. (2004). A socio-ecological autopsy of the E. coli 0157:H7 outbreak in Walkerton, Ontario, Canada. Social Science & Medicine, 58(12), 2601-2612. Goodman, R. M. (2000). Bridging the gap in effective program implementation: from concept to application. Journal of Community Psychology, 28(3), 309-321. 8

Kristof, N. D. (2012, January 8). A poverty solution that starts with a hug. The New York Times. Retrieved from http://www.nytimes.com/2012/01/08/opinion/sunday/kristof-a-poverty-so ution-that-starts-with-a-hug.html. Shonkoff, J. P. & Garner, A. S. (2011). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), 232-246. Woolf, S. H., Dekker, M. M., Byrne, F. R., & Miller, W. D. (2011). Citizen-centered health promotion building collaborations to facilitate healthy living. American Journal of Preventive Medicine, 40(1S1), S38-S47. Supplemental Reading: Harvard University: Center on the Developing Child. (2013). Briefs. Retrieved from http://develo pingchild.harvard.edu/resources/briefs/. Session 5 Date: February 6, 2014

FIRST ASSIGNMENT DUE TODAY

Topic: Workshop: Conducting a Literature Search & Designing a Logic Model. This week’s class will be held in Falk Library. During the first part of the class, you will have the opportunity to begin conducting your literature search. Ms. Barb Folb, who is the GSPH public health informationist and reference librarian will guide you through a hands-on exercise on how to undertake a literature search that will assist you with your 2nd assignment. Following Barb Folb's presentation, Dr. Mary Hawk will teach the basics of how to develop a logic model for the purposes of the 4th assignment. PLEASE GO TO THE FALK LIBRARY IN SCAIFE HALL. ONCE INSIDE THE LIBRARY, GO TO CLASSROOM 2 ON THE 2ND FLOOR OF THE LIBRARY. Class will not meet today in A-216. Guest Presenters: Ms. Barb Folb, MM, MLS, MPH. is the reference librarian for the Graduate School of Public Health. Mary Hawk, DrPH. Visiting Assistant Professor, BCHS. Required Reading: See Courseweb Week 4 assigned reading. W.K. Kellogg Foundation. (2004). Chapter 1: Introduction to Logic Models. Kellogg Logic Model Development Guide, pp.1-14. Retrieved from http://www.uwsa.edu/edi/grants/ Kellogg_Logic_Model.pdf. Supplemental Reading: NONE

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Session 6 Date: February 13, 2014 Topic: An overview of theory. This week will provide you with an overview of health behavior theory. We will discuss the origins, meaning and purpose of health behavior theories as well as the different types and levels of theories. We will discuss key terms and their definitions including what are constructs and how are they measured. We will also examine the relationship between theory, research and practice in public health. Finally, we will begin to examine the practical considerations in applying theory to the design of an intervention including how to select an appropriate theory. Guest Presenter: Dan Swayze, DrPH Required Reading: See Courseweb Week 6 assigned reading. Epstein, H. (2003, October 12). “GHETTO MIASMA: Enough to make you sick?” The New York Times. Retrieved from http://www.nytimes.com/2003/10/12/magazine/ghetto-mias ma-enough-to-make-you-sick.html?pagewanted=all&src=pm. Gee, G. C., Walsemann, K. M., & Brondolo, E. (2012). A life course perspective on how racism may be related to health inequities. American Journal of Public Health, 102(5), 967-974. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institute. (1997). Theory at a Glance: A Guide for Health Promotion Practice (NIH Publication No. 97-3896). Retrieved from http://www.cancer.g ov/cancertopics/cancerlibrary/theory.pdf. U. S. Department of Housing and Urban Development: Office of Policy Development and Research. (2011). Moving to Opportunity for Fair Housing Demonstration Program: Final Impacts Evaulation. Retrieved from http://www.huduser.org/publications/pdf/ MTOFHD_fullreport_v2.pdf. Students, PLEASE READ THE REQUIRED READING IN THE FOLLOWING ORDER: 1) NYT article: Enough to Make you Sick, 2) NBER monograph: Moving to Opportunity Final Evaluation (the Executive Summary); 3) Gee article: A Lifecourse Perspective, 4) NIH: Theory at a Glance. Supplemental Reading: Van Ryn, M. & Heeney, C. A. (1992). What’s the use of theory? Health Education Quarterly, 19 (3), 315-330.

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Session 7 Date: February 20, 2014 Topic: This week we begin our discussion of theories/models used to change individual behavior. We will first focus on two theories that explain behavior change from a cognitive perspective. The first of these is the Health Belief Model. This Model proposes that health behavior change occurs as a result of an individual's perception of a particular health threat coupled with their beliefs about the benefits of and barriers to taking a prescribed course of action, their self-efficacy and cues or reminders to take action. Today’s readings describe the use of the HBM as part of a multi level intervention to address childhood asthma in inner-city Detroit. Required Reading: See Courseweb Week 7 assigned reading. Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Chapter 3: The Health Belief Model. (4th Edition), Health Behavior and Health Education: Theory, Research, and Practice (pp.4565). San Francisco: Jossey-Bass. Parker, E. A., Baldwin, G. T., Israel, B., & Salinas, M. A. (2004). Application of health promotion theories and models for environmental health. Health Education & Behavior, 31(4), 491-509. Parker, E. A., Israel, B. A., Robins, T. G., Mentz, G., Xihong, L., Brakefield-Caldwell, W., Ramirez, E,. Edgren, K. K., Salinas, M., & Lewis, T. C. (2008). Evaluation of Community Action Against Asthma: a community health worker intervention to improve children’s asthma-related health by reducing household environmental triggers for asthma. Health Education & Behavior, 35(3), 376-395. Supplemental Reading: Hansley, S. (2013, May 9). Price Break for Cervical Shots in Developing World. NPR. Retrieved from http://www.npr.org/blogs/health/2013/05/09/182567228/price-break-for-cervical-ca ncer-shots-in-developing-world. Hansley, S. (2013, March 8). Worried Parents Balk at HPV Vaccine for Daughters. NPR. Retrieved from http://www.npr.org/blogs/health/2013/03/18/174617709/worried-parentsbalk-at-hpv-vaccine-for-daughters.

Session 8

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Date: February 27, 2014 Topic: Transtheoretical Model & Motivational Interviewing. This week we continue our examination of cognitive models of individual health behavior change focusing on the Transtheoretical Model—also known as the Stages of Change. This model says that individuals are at different levels of readiness to undertake a behavior change. They move forward using different strategies based on their given stage and based on their assessment of the pros and cons of behavior change where the benefits outweigh the barriers to change. We will also discuss Motivational Interviewing which is a patient-centered technique to help individuals change behavior by resolving their ambivalence regarding change. Guest Presenter: Kamden Hoffmann, PhD. Faculty, University Center for International Studies. Dr. Hoffmann will discuss her work using Motivational Interviewing to promote health and wellness. Required Reading: See Courseweb Week 8 assigned reading. Emmons, K. M. & Rollnick, S. (2001). Motivational interviewing in health care settings: opportunities and limitations. American Journal of Preventive Medicine, 20(1), 68-74. Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Chapter 5: The Transtheoretical Model and Stages of Change. (4th Edition), Health Behavior and Health Education: Theory, Research, and Practice (pp.97-121). San Francisco: Jossey-Bass. Gold, M. A. & Kokotailo, P. K. (2007). Motivational interviewing strategies to facilitate adolescent behavior change. A Clinical Guide for Pediatricians, 20(1), 1-10. Havas, S., Anliker, J., Greenberg, D., Block, G., Block, T., Blik, C., Lengenberg, P., & DiClemente, C. (2003). Final results of the Maryland WIC food for life program. Preventive Medicine 37(5), 406-416. Supplemental Reading: Glasgow, R. E., Emont, S., & Miller, D. C. (2006). Assessing delivery of the five ‘As’ for patient-centered counseling. Health Promotion International, 21(3), 245-255. Littell, J. H. & Girvin, H. (2002). Stages of change: a critique. Behavior Modification, 26(2), 223-273. Riemsma, R. P., Pattenden, J., Bridle, C., Sowden, A. J., Mather, L., Watt, I. S., & Walker, A. (2002). A systematic review of the effectiveness of interventions based on a stages-ofchange approach to promote individual behavior change. Health Technology Assessment 6(24), 1-256. Session 9

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Date: March 6, 2014 Topic: This week we transition from examining theories at the individual level to those at the interpersonal level of intervention by focusing on Social Cognitive Theory. This theory emphasizes that behavior change occurs via the reciprocal interaction that occurs between an individual, her behavior and the larger environment. Key to the behavior change process are processes of self-regulation, which occurs via skill development and self-efficacy. We will examine various strategies for self-regulation of individual behavior that have been used in diabetes prevention and management programs such as the Diabetes Prevention Program (DPP) and the Look AHEAD program to prevent cardiovascular disease in persons with type 2 diabetes. Guest Presenter: Beth Venditti, PhD. Assistant Professor of Psychiatry and Epidemiology. She is also a member of the Group Lifestyle Balance Program team that has translated the DPP to community settings. Required Reading: See Courseweb Week 9 assigned reading. Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior, 31(2), 143-164. Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Chapter 8: How Individuals, environments, and Health Behaviors Interact: Social Cognitive Theory. (4th Edition), Health Behavior and Health Education: Theory, Research, and Practice (pp. 167-188). San Francisco: Jossey- Bass. Sharma, M., Petosa, R., & Heaney, C. A. (1999). Evaluation of a brief intervention based on social cognitive theory to develop problem-solving skills among sixth-grade children. Health Education & Behavior, 26(4), 465-477. Venditti, E. M. & Kramer, K. (2012). Necessary components for lifestyle modification interventions to reduce diabetes risk. Current Diabetes Reports, 12(2), 138-146. Supplemental Reading: Knowler, W. C., Barrett-Connor, E., Fowler, S. E., Hamman, R. F., Lachin, J. M., Walker, E. A., & Nathan, D. M. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346(6), 393-403. Knowler, W. C., Fowler, S. E., Hamman, R. F., Costas, C. A., Hoffman, H. J., Brenneman, A. T., Brown-Friday, J. C., Goldberg, R., Venditti, E., & Nathan, D. M. (2009). 10-year followup of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet, 374(9702), 1677-1686. U.S. Sustainable Agriculture Research and Education Program, Public Health Solutions, School Food FOCUS, Agricultural Sustainability Institute, UC Davis, & C. S. Mott Group for 13

Sustainable Food Systems at Michigan State University (2011). School food learning lab in Saint Paul, Minnesota: a case study of procurement change in action. Retrieved from http://www.schoolfoodfocus.org/wp-content/uploads/2011/10/SPPS-Case-StudyFinal-for-SAREPweb.pdf. Session 10 Date: March 20, 2014 Topic: This week we begin to explore theoretical approaches that focus on social and community influences on health. The first of these approaches examines how health behaviors are influenced by an individual's social network and, in turn, how Social Support and one's Social Networks can be used to bring about behavior change. Guest Presenter: Jason Flatt, PhD. MPH Postdoctoral Fellow, Clinical and Translational Science Institute, University of Pittsburgh. He will discuss his research utilizing social network theory in his work with the elderly.

Required Reading: See Courseweb Week 10 required readings. Berkman, L. F., Glass, T., Brissette, I., & Seeman, T. E. (2000). From social integration to health: Durkheim in the new millennium. Social Science & Medicine, 51(6), 843-857. Christakis, N. & Fowler, J. (2009, September 13). Is happiness catching? The New York Times. Retrieved from http://www.nytimes.com/2009/09/27/magazine/27letters-t-ISHAPPINES SC_LETTERS.html. Cohen, S. & Janicki-Deverts, D. (2009). Can we improve our physical health by altering our social networks? Perspectives on Psychological Science. 4(4), 375-378. Supplemental Reading: Pachucki, M. A., Jacques, P. F., & Christakis, N. A. (2011). Social network concordance in food choice among spouses, friends, and siblings. American Journal of Public Health, 101 (11), 2215-2222. Stossel, S. (2009, October 1). You and your friend’s friend’s friends. The New York Times. Retrieved from http://www.nytimes.com/2009/10/04/books/review/Stossel-t.html?page wanted=all& r=0.

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Session 11 Date: March 27, 2014 (SECOND AND THIRD ASSIGNMENTS DUE TODAY) Topic: Modeling Social Networks. Human beings are social creatures. We are linked to one another by means of relationships, experiences, norms as well as by shared geographical spaces such as neighborhoods. People also take actions that affect others. For instance, people may imitate—for better or worse, the behavior of others they encounter. People may also choose not to take action—such as, getting vaccinations or using condoms thus affecting the likelihood of the spread of disease. These examples of how the action of one individual affects the health conditions of others are a central concern of public health research and practice. Today’s reading highlights the value of network modeling—that is, why it is important to understand how individual actions can lead to complex and often unintended collective results. Ultimately, network modeling is a versatile tool for researchers who are interested in taking a more structural versus an individualistic approach to their research. Network modeling focuses on relationships as the primary unit of analysis. By understanding the key properties of networks such as clustering, for example, we can develop interventions to support the spread of social norms that are conducive to healthy communities. Guest Presenter: Christina Mair, PhD. Assistant Professor, BCHS. Our guest speaker today will discusses the concept of a social networks and introduce us to network models. He will show us how we can graphically represent the interactions between three or more individuals (aka actors) based on some rules that specify how actors connect with one another. Required Reading: Keane, C. (2014). A Network Approach to Public Health Research in Emerging Methods in Community Public Health Research. New York: Springer. Rauch, J. (2002, April 1). Seeing around corners. The Atlantic. Retrieved from http://www.the atlantic.com/magazine/archive/2002/04/seeing-around-corners/302471/. Supplemental Reading: NONE Session 12 Date: April 3, 2014 Topic: Theory of Gender and Power. This week we will discuss the Theory of Gender and Power (TGP). This theory states that power relationships between genders and within genders arise from the global dominance of men over women. This is a social structural model that 15

explains women’s health risks as a function of three interlinked structures that characterize the gendered relationships between men and women. These three structures are: 1) the sexual division of labor, 2) the sexual division of power and, 3) the structure of affective attachments and social norms. Today’s readings highlight contemporary examples of these dimensions of power between genders and the resultant problems. Guest Presenter: TBD. Required Reading: See Courseweb Week 11 required readings. Doucleff, M. & Chatterjee, R. (2013, June 20). WHO finds violence against women is “shockingly” common. NPR. Retrieved from http://www.npr.org/blogs/health/2013/06/20 /193475321/who-finds-violence-against-women-is-shockingly-common. Kristof, N. D. (2013, January 12). Is Delhi so different from Steubenville? The New York Times. Retrieved from http://www.nytimes.com/2013/01/13/opinion/sunday/is-delhi-so-different -from-steubenville.html. Kristof, N. D. & WuDunn, S. (2009, August 23). The women’s crusade. The New York Times. Retrieved from http://www.nytimes.com/2009/08/23/magazine/23Women-t.html?pagew anted=all. Landler, M. (2009, August 23). A new gender agenda. The New York Times. Retrieved from http://www.nytimes.com/2009/08/23/magazine/23clinton-t.html?pagewanted=all&_r=0. Rosenberg, T. (2013, July 17). Talking female circumcision out of existence [Blog post]. Retrieved from http://opinionator.blogs.nytimes.com/2013/07/17/talking-female-circumci sion-out-of-existence/. (2013, January 5). Rape and murder in Delhi. The Economist, 29(1), 8-9. Wingood, G. M. & DiClemente, R. J. (2000). Application of the theory of gender and power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Education & Behavior, 27(5), 539-565. Supplemental Reading: Kirkpatrick, D. D. & Sheikh, M. E. (2013, March 14). Muslim brotherhood’s statement on women stirs liberals’ fears. The New York Times. Retrieved from http://www.nytimes.co m/2013/03/15/world/middleeast/muslim-brotherhoods-words-on-women-stir-liberal-fears .html.

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Session 13 Date: April 10, 2014 Topic: This week we will discuss structural intervention approaches. Guest Presenter: Suzanne Kinsky, BCHS Doctoral student. Suzanne Kinsky has over 12 years’ experience in the HIV and nonprofit field. Most recently, Suzanne was the Director of Access to Care at AIDS United, a national HIV grantmaking and policy organization based in Washington, DC. There, she was responsible for managing and evaluating a grantee portfolio of community-based programs to find and link HIV-positive individuals to care. Prior to coming to AIDS United, she conducted HIV prevention program evaluation and managed statewide HIV testing data for the Maryland AIDS Administration. Suzanne has also been the Women’s Services Director at Our Place in Washington, DC, a non-profit serving incarcerated and recently-released women. In addition, Suzanne was a Bill Emerson National Hunger Fellow with the Congressional Hunger Center, where she worked on issues of welfare reform and antipoverty initiatives. Suzanne holds a Master of Public Health degree from the Johns Hopkins Bloomberg School of Public Health and a Bachelor’s degree in Rural Sociology from Cornell University. She is currently pursuing a PhD in Public Health at the University of Pittsburgh, where her research interests focus on health disparities in the LGBT population. Required Readings: See Courseweb Week 13 assigned reading. Blankenship, K.M., Friedman, S.R., Dworkin, S., & Mantell, J.E. (2006). Structural interventions: Concepts, challenges, and opportunities for research. Journal of Urban Health, 83(1), 59-72. Frieden, T.R., Mostashari, F., Kerker, B.D., Miller, N. Hajat, A., & Frankel, M. (2005). Adult tobacco use levels after intensive tobacco control measures: New York City, 20022003. American Journal of Public Health, 95(6), 1016-1024. Grynbaum, M.M. (2012, January 23). In N.A.A.C.P. industry gets ally against soda ban. The New York Times. Retrieved from http://www.nytimes.com/2013/01/24/nyregion/fightover-bloombergs-soda-ban-reaches-courtroom.html. Grynbaum, M.M. (2012, May 30). New York plans to ban sale of big sizes of sugary drinks. The New York Times. Retrieved from http://www.nytimes.com/2012/05/31/nyregion/bloombe rg-plans-a-ban-on-large-sugared-drinks.html. Vijayaraghavan, M., Messer, K., White, M.M., & Pierce, J.P. (2013). The Effectiveness of cigarette price and smoke-free homes on low-income smokers in the United States. Research and Practice, 103(12), 2276-2283. Supplemental Reading: 17

Goldstein, J. (2013, August 13). Is it nuts to give to the poor without strings attached? The New York Times. Retrieved from http://www.nytimes.com/2013/08/18/magazine/is-it-nuts-togive-to-the-poor-without-strings-attached.html? Session 14 Date: April 17, 2014 Topic: Student Presentations. Session 15 Date: April 24, 2013 Topic: Student Presentations FINAL ASSIGNMENT DUE TODAY

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