On Health and Behavior

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONOn HealthNOT FOR and SALE OR Behavior— DISTRIBUTION An Introduction © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER 1 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Introduction: © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOTThe FOR SALELinks OR DISTRIBUTION Between HealthNOT FOR and SALE OR Behavior DISTRIBUTION

LEARNING OBJECTIVES YOU: Hey Sam, why are you brushing your By the end of this chapter, the reader will be able to: teeth like that? © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC • Understand that there are multiple influences on health SAM: What do you mean, why am I brush- behavior NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ing my teeth? Don’t you brush yours? I don’t • Define what is meant by the ecological model wanna get cavities or have my teeth fall out, • Explain the types of factors influencing health that are covered in an ecological model okay? What kind of a question is that? Well that’s that, then, right? End of story. Sam is brushing © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC his teeth (and doing it well) to maintain healthy teeth. Makes NOT FOR SALE OR DISTRIBUTION perfect NOTsense. FOR SALE OR DISTRIBUTION “Life is a voyage . . .” But now suppose, as you continue watching Sam per- —VICTOR HUGO, 1866, FROM THE TOILERS OF THE SEA form his tooth-brushing ritual, you see, lying conveniently on the sink, a copy of GQ magazine with a cover photo show- © Jones & Bartlett Learning, LLC © Jonesing & what Bartlett appears Learning, to be the model LLC of hip maleness—a chiseled NOT FOR SALE OR DISTRIBUTION NOT FORfigure SALE leaning OR nonchalantly DISTRIBUTION against a wall, comfortably worn THE SETTING: DAILY LIFE leather jacket open and loose, hair just right even while a Any in-depth discussion of health behavior is, of necessity, few strands display a defiant anarchy, and a carefully casual, going to involve a certain amount of wrestling with abstrac- unshaven jaw and chin. Punctuating this icon’s studied hip tions about motives, causal and contributing factors, con- gestalt is a set of perfect, strong, gleaming white teeth. © Jones & Bartlett Learning, LLC Hmm. The plot thickens.© Jones So maybe & Bartletthe is also tryingLearning, in LLC texts, cues, and otherNOT issues FOR related SALE to why OR people DISTRIBUTION do what NOT FOR SALE OR DISTRIBUTION they do. To help make sense of such discussions, it may help his own way to look like Mr. Ultimate Male. By brushing his to begin with a simple scenario about a “health behavior” teeth? that would seem to be very mundane—brushing teeth. It’s Whatever. the sort of thing that would not ordinarily be the object of Now suppose, after completing the tooth-brushing much© Jones introspection, & Bartlett to say theLearning, least. It’s the LLC kind of behavior scene, Sam,© Jones looking & intense Bartlett and preoccupied,Learning, digsLLC through thatNOT is forFOR the SALEmost part OR habit, DISTRIBUTION far below the radar of our his closetNOT for some FOR clothes SALE to wear.OR DISTRIBUTIONClearly, he is not looking thinking selves, which makes it an ideal starting point for for just any clothes. He is looking through his meager and considering the issues raised in this book. often rumpled wardrobe for something that will display just * Suppose a friend of yours—we’ll call him Sam—was brush- the right sense of je ne sais quoi. © Jones & Bartletting his teeth, Learning, and doing so LLC very vigorously. If you asked him© why Jones & Bartlett Learning, LLC he was doing this, your conversation might go as follows: * French phrase meaning, literally, “I don’t know what,” but used to refer to NOT FOR SALE OR DISTRIBUTION NOT FORsomeone SALE who is OR cool andDISTRIBUTION has a “special something” about them.

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 4 Introduction: The Links Between Health and Behavior © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION By this time, your curiosity can no longer be contained. and no health insurance. Because of the precariousness of his (and his family’s) position, he was very concerned about YOU: Okay, Sam, out with it. You going some- maintaining his health lest he have to go to a doctor with no where (heh, heh)? © Jones & Bartlett Learning,money LLC to pay. And a dentist? That ©would Jones be out & of Bartlett reach. So, Learning, LLC SAM (trying to pretend that nothing out of the as a result, he was very, even overly, concerned with prevent- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ordinary is going on): Uh, whaddya mean? ing such a situation. In yet one more wrinkle, suppose Sam’s mother instructed YOU: C’mon, Sam. What am I, an idiot? Going him, when he was very young, to brush his teeth religiously out? To dinner? A movie? A party? Whatever it after every meal. Every day, his mother drilled into Sam’s is, it looks to me like it’s no ordinary party. © Jones & Bartlett Learning, LLC head that he just© was Jones not clean & Bartlettor presentable Learning, to the world LLC SAMNOT (letting FOR down SALE his guard): OR DISTRIBUTION Okay, Okay. I without doing so.NOT The reason FOR for SALE her intense OR DISTRIBUTIONdental vigilance was invited to this party, alright? And it’s actu- was that she herself lost most of her teeth at an early age ally at her parent’s house. because, as a child, neither she nor her parents knew much about teeth or the role of brushing. Of course Sam would YOU (interrupting): Wait a minute. Whose not likely know the reasons behind her admonitions—all he © Jones & Bartlettparent’s house? Learning, LLC © Jones & Bartlett Learning, LLC would know was that it was a big thing for his mother, and NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION SAM: Well, you remember a few weeks ago I that he had grown up not feeling very presentable somehow, mentioned that I met someone I think is . . . unless his teeth were brushed. kinda special. THE QUESTIONS YOU: Okay, now I understand. The tooth © Jones & Bartlett Learning,The LLC moral of the story is this: There© Jones is an entire& Bartlett field of Learning, LLC brushing, all of it. NOT FOR SALE OR DISTRIBUTIONstudy and practice concerned withNOT the complexFOR SALE nature OR of DISTRIBUTION SAM: Here’s the thing. I’m not exactly going to health behavior, with a goal of implementing programs and be the only person there, ya know what I mean? interventions that seek to promote change in behavior in She didn’t just invite me. order to improve the health of the public or a segment of the public. You are undoubtedly familiar with these kinds of YOU:© Jones So you want & Bartlett to . . . stand Learning, out. LLC © Jones & Bartlett Learning, LLC programs—campaigns to stop smoking, warnings on adver- SAM:NOT Yeah. FOR SALE OR DISTRIBUTION tisements and onNOT cigarette FOR packaging, SALE ORand lawsuitsDISTRIBUTION against tobacco companies; television advertisements and school YOU: Got it. Lookin’ sharp. Good luck. programs warning young people about drug and alcohol use, After this, the plot is now more complete. If you were asked or about drinking and driving; public campaigns, including © Jonesto explain & Bartlett the motivations Learning, behind LLC Sam brushing his teeth ©billboard Jones ads, & Bartlettmetro and Learning, bus ads, and LLCtelevision ads, about NOT FOR(vigorously), SALE you OR now DISTRIBUTION have at least three possibilities: NOTthe risks FOR of transmitting SALE OR HIV DISTRIBUTION and the benefits of HIV testing; and public campaigns about cardiovascular health and diet, 1. For health reasons about low-carb diets or about low cholesterol food choices. 2. To look as much as possible like the male icon in the There are many more such examples. magazine (a cultural factor) Most of these programs and interventions rely on a body 3. (Related to #2) To stand out from the crowd and be as © Jones & Bartlett Learning,of knowledgeLLC about what motivates© Jonesand influences & Bartlett human Learning, LLC attractive as possible to a person of the opposite sex, NOT FOR SALE OR DISTRIBUTIONbehavior. In other words, if the publicNOT health FOR question SALE is: OR DISTRIBUTION and a special person at that Why do people behave in healthy (or unhealthy) ways? We can get more complicated with another question: This question is really just a more focused version of the Which of these three motivations do you think was dominant following: in the scenario© Jones we just & described? Bartlett Probably Learning, number LLC 2 or 3, Why do people© Jones do what &they Bartlett do? Learning, LLC right? ThisNOT time, anyway.FOR SALE But if you OR ask DISTRIBUTIONSam the same question Thus, in orderNOT to understandFOR SALE something OR DISTRIBUTION about human tomorrow, when, for example, he is barely awake and perhaps behavior as it relates to health, we have to think about this on his way to work, you might find that motivation number subset of behavior in the context of what generally motivates 1 is actually the most important, or even another one yet un- or influences human behavior. Moreover, as you saw in the named (e.g., “habit,” or “so my breath won’t smell bad”). example of Sam and brushing teeth, behavior that is often © Jones &Or, Bartlett suppose Sam Learning, was the first LLC person to go to college ©categorized Jones & as Bartlett“health behavior” Learning, is not necessarilyLLC motivated NOT FORfrom hisSALE small ORrural DISTRIBUTION town, and his family had little income NOTor influenced FOR SALE by concerns OR DISTRIBUTIONabout health. It may be in some

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 The Questions 5 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION cases. Or it may be health concerns mixed together with other the waterway may suffer health consequences from eating concerns. Or it may be based on concerns that have nothing fish or other animals contaminated by the pollutant, or from to do with “health” per se. Or it may be based on ideas about contaminated drinking water. It may be the case that they are being healthy that ©are Jones different & than Bartlett the standards Learning, of health LLC not sufficiently aware of the© Jonesrisk. Yet they& Bartlett may also Learning,be heav- LLC common to Western medicine. A case in point: For many ily dependent on fishing for their livelihood, and may have NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION cultures, being thin is not viewed as healthy. A large man— been dependent on fishing for many generations—enough to one that we might call overweight—is viewed as healthy and build up a local culture related to the fishing life. If you were “doing well.” This is particularly true for peoples who have trying to pinpoint where to start in reducing the health risk experienced food shortages throughout their history.1 Being for these people, what would you address first? thin© Jones is a reminder, & Bartlett a symbol, Learning, of starvation. LLC In ©some Jones parts of& theBartlett rapidly Learning,developing world, LLC econo- NOTAnd FOR that is SALE only part OR of the DISTRIBUTION story. Often, what people do mies andNOT societies FOR that SALE were onceOR DISTRIBUTIONrural and agrarian have or don’t do related to health has more to do with socioeco- experienced a dramatic shift to urban and more industri- nomic circumstances, or environmental conditions, or pub- alized economies. This process has many implications for lic policies and regulations. A woman may not get routinely health and social conditions in general. In their former rural © Jones & Bartlettscreened forLearning, breast cancer LLC simply because she lives in a© rural Jones life-pattern, & Bartlett people Learning, may have livedLLC in small villages that did area and health care providers who do the screenings are not not put much pressure on the local environment, and food NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION easily accessible. This doesn’t have as much to do with her may have been relatively easy to obtain. Once in the urban motivation as it does her social and geographic situation. context, the picture changes. Living conditions are more People living downstream from a factory that is polluting crowded (see Figure 1-1). Food is not as easily obtained.

© Jones & BartlettCopyright Learning, Flat Earth/FotoSearch. LLC Retrieved from “Shanty town,” ©http://en.wikipedia.org/wiki/Shanty_town. Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 6 Introduction: The Links Between Health and Behavior © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Water and sanitary systems may be overwhelmed by the • Access to health care and prevention services/infor- number of people. Housing is hard to come by. Diseases mation like tuberculosis spread more easily. Women may come to • Social stressors such as civil strife, neighborhood vio- the cities from the rural areas© andJones find themselves& Bartlett forced Learning, to LLClence, racial and other discrimination© Jones & Bartlett Learning, LLC engage in the sex trade in order to survive, placing themselves • NOT FOR SALE OR DISTRIBUTION Access to clean water NOT FOR SALE OR DISTRIBUTION and their partners at great risk for HIV/AIDS or other sexu- Political factors ally transmitted infections (STIs). Knowledge about some of these risks may be limited. In the latter case, attitudes about • Policies and funding for health promotion programs gender roles may restrict women from seeking other types of • Health insurance (policies, cost, availability) work. Where,© Jones then, would & Bartlett you begin Learning, to address theLLC health • Regulations© Jonesthat impact & Bartletthealth risk Learning,(e.g., prohibiting LLC problems NOTthat arose? FOR What SALE would OR you DISTRIBUTION point to as key influ- sale of cigarettesNOT FOR to minors) SALE OR DISTRIBUTION encing factors? Environmental factors THE COMPLEX SOCIAL-ECOLOGICAL WEB • Presence of an environmental risk, such as air and water pollution © JonesThese & examples Bartlett illustrate Learning, the complexity LLC of factors that influ- © Jones & Bartlett Learning, LLC ence human behavior with respect to health and other issues. • Disasters NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Until the late 1970s/early 1980s, health promotion profes- • Conditions for spread of an infectious disease sionals and programs focused primarily on the knowledge, This list of factors, however, doesn’t operate in the world attitudes, and motivations of individuals, without much as simply a collection of separate items. The factors tend to attention devoted to the social, cultural, and economic cir- operate together. The term ecology is thus useful to describe cumstances that are also major© Jones determinants & Bartlett of behavior. Learning,2 LLC © Jones & Bartlett Learning, LLC this system of relationships. Its origin is in biology, where it The more recent focus on the multiplicity of influences on NOT FOR SALE OR DISTRIBUTIONgenerally refers to: NOT FOR SALE OR DISTRIBUTION behavior is called the ecological model.2 Under this model or approach to understanding health behavior, it is assumed • A system of interactions between organisms and an that no one factor influences people’s behavior; instead, the environment complex interaction between individuals and an environ- • The complex relationships between organisms in the © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ment is a process that, taken together, influences behavior. In system (e.g., niches) other words,NOT behavior FOR doesn’t SALE exist OR in a DISTRIBUTION vacuum. • The dependentNOT relationshipsFOR SALE between OR DISTRIBUTIONmembers/com- So, for example, think of the following factors as a sam- ponents of the system, where if one part of the system pling of potential contributors to the behavior of individuals: is disturbed, other parts will be affected Individual factors Although the concept originates in biology, the basic © Jones & Bartlett Learning, LLC ©idea Jones is useful & inBartlett thinking Learning,about human LLCbehavior in context. • NOT FOR SALE Awareness OR and DISTRIBUTION knowledge (about health risks, ways NOTThe diagramFOR SALE in Figure OR 1-2 DISTRIBUTION may help. It shows the link- to prevent health problems, etc.) ages and connections among people, an environment,† and • Biophysical characteristics (e.g., genetics, systemic behavior. vulnerabilities) That does make the task of understanding behavior • Personal attitudes and motivations more complicated, doesn’t it? • © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Developmental stage (e.g., adolescent, adult) Clearly, answering the question “Why do people do • NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Behavior/habit socialization (e.g., from parents, family) what they do?” or its public health version “Why do people Social/cultural/group factors behave in healthy (or unhealthy) ways?” is no easy matter. Yet to know this is good. Gaining a certain respect for the • Social/peer group lifestyle patterns complexity of the task is, well, healthy. Because if you think • Cultural attitudes/beliefs (and their implications for © Jones & Bartlett Learning, LLC it’s simple, then© you Jones are more & Bartlettlikely to implement Learning, a stan- LLC health) NOT FOR SALE OR DISTRIBUTION dardized or cookie-cutterNOT FOR program SALE without OR muchDISTRIBUTION thought as • Level of social support to whether it is appropriate to the situation. And it is one goal Socioeconomic and structural factors of this book that you emerge with more wisdom than that. • Poverty © Jones &• BartlettEducation Learning, LLC ©† JonesHere we are& definingBartlett environment Learning, as that LLCwhich exists outside the NOT FOR SALE OR DISTRIBUTION NOTindividual, FOR so it SALEcould mean OR the social DISTRIBUTION as well as the physical environment.

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 The Complex Social-Ecological Web 7 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

FIGURE 1-2 Diagram of linkages and connections among people, an environment, and behavior.

Behavior

© Jones & BartlettHowever, Learning, lest you throwLLC up your hands and claim© that Jones situation. & Bartlett In doing Learning, this, we want LLC you to understand some of behavior is just too complicated to do anything about, con- the assumptions underlying the theory, and to take a look at NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION sider that a long tradition of researchers and practitioners where the various theories come from. Second, we are going have built up a considerable store of scientific knowledge, to present you with a general planning approach for assessing interpretive understanding, and practical application with a public health or social problem and, based on your assess- respect to changing human behavior. There are, of course, ment, tools to make a decision about what kind of program many different schools© Jones of thought, & manyBartlett different Learning, applied tra- LLCmight work best to change© it, Jones and how & to Bartlett determine Learning,whether LLC ditions, and, in keepingNOT with FOR the complexitySALE OR of theDISTRIBUTION endeavor, you have succeeded. Third,NOT you willFOR become SALE acquainted OR DISTRIBUTION with many disagreements about basic scientific truths, approaches, a range of settings in which you can apply social/behavioral strategies, and just what should be the focus of attention. theory to address a spectrum of health problems both in the United States and worldwide, including smoking, can- IN THIS BOOK © Jones & Bartlett Learning, LLC cer, cardiovascular© Jones &disease, Bartlett HIV/AIDS, Learning, maternal LLC and child In this book, we are going to review some of these different health, youth violence, and obesity. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION approaches and theoretical traditions (to understand and Treat this book not as a compendium of answers to all change human behavior), with an eye toward providing you the questions posed, but as a resource that can help guide you with enough tools so that you can make informed judgments in the ongoing search for answers—a resource that is based about what theories and approaches make sense in a given on a sampling of what is currently known in the field. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 8 Introduction: The Links Between Health and Behavior © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

YOUR THOUGHTS? © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 1. In the example of Sam and brushing teeth, NOT FOR SALE OR DISTRIBUTION what do you think NOTwere the FOR most SALE important OR DISTRIBUTION factors behind his behavior? 2. Pick five things you do that could be called “health behavior.” List three possible motiva- Chapter© Jones Questions & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC tors for each of them. What’s your pattern? NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

1. What is the goal of the field of study concerned with health behavior? © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE2. WhatOR DISTRIBUTIONis the relationship between health behav- NOT FOR SALE OR DISTRIBUTION ior and behavior in general? 3. List the ways in which a shift from an agrarian economy to an industrialized economy may impact health© conditions. Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 4. What is the mainNOT assumption FOR SALE of the ecologicalOR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION model? 5. What types of broad factors exist in the ecological model? © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 References 9 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION REFERENCES 1. Brown PJ, Konner K. An anthropological perspective on obesity. In: Brown PJ, ed. Understanding and Applying Medical Anthropology. Mountain View, CA: Mayfield Publishing; 1998. 2. Green LW, Kreuter© Jones MW, eds. & Health Bartlett Promotion Learning, Planning: An LLC © Jones & Bartlett Learning, LLC Educational and EnvironmentalNOT FORApproach SALE, 3rd ed. OR Mountain DISTRIBUTION View, CA: NOT FOR SALE OR DISTRIBUTION Mayfield Publishing; 1999.

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER 2 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Health Issues and Behavior © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

* LEARNING OBJECTIVES OBESITY By the end of this chapter, the reader will be able to: It is by now well-known that obesity and its consequences (e.g., • Describe behaviors© Jones related to & obesity Bartlett and its consequencesLearning, LLCdiabetes, heart disease) have© becomeJones a &serious Bartlett health Learning,concern LLC (e.g., diabetes,NOT cardiovascular FOR SALEhealth problems), OR DISTRIBUTION and factors in the United States and NOTother industrializedFOR SALE countries, OR DISTRIBUTION*1,2 a influencing those behaviors concern that has received considerable attention from both • Describe behaviors related to youth violence and its consequences (e.g., injury), and factors influencing those behaviors the mass media and research journals. A recent edition of • Describe behaviors related to HIV/AIDS transmission, and fac- the Journal of the American Medical Association,3 for example, tors influencing those behaviors © Jones & Bartlett Learning, LLC reported© that Jones poor diet & Bartlettand physical Learning, inactivity caused LLC 400,000 NOT FOR SALE OR DISTRIBUTION deaths inNOT the United FOR States SALE in 2000, OR accounting DISTRIBUTION for 16.6% of all deaths, second only to tobacco (18.1%). Recent estimates also suggest that 97 million adults in the United States are over- “He had had much experience of physicians, and weight or obese.4 The trend has clearly been upward; in the said ‘the only way to keep your health is to eat last two decades mean body weights have increased by nearly © Jones & Bartlettwhat you Learning, don’t want, LLC drink what you don’t like,© Jones 10%, & Bartlett and clinical Learning, obesity has nearlyLLC doubled in prevalence.5 NOT FOR SALEand ORdo what DISTRIBUTION you’d druther not.’” NOT FOROverweight SALE andOR obesityDISTRIBUTION are risk factors for coronary heart disease, non-insulin-dependent diabetes, hypertension, certain —MARK TWAIN (1835–1910) cancers, and other conditions.4 If the trend is not reversed over the next few years, some say it may overtake tobacco as the leading preventable cause of mortality.3 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC To give you a clearer sense of why an understanding of Where does behavior factor in? Because these trends in human behavior isNOT important FOR in SALE addressing OR publicDISTRIBUTION health overweight/obesity are recent,NOT most FOR agree SALE that ORinteractions DISTRIBUTION problems, let’s take a look at a few selected health issues and between people’s behavior and the environment are the pri- how they are related to behavioral factors—remembering, mary cause, rather than biological factors.5,6 In other words, as presented in the introductory chapter, that behavior (as the situation is viewed as preventable. Explanations for these understood© Jones within& Bartlett an ecological Learning, model) LLC is just one factor sudden© and Jones “epidemic” & Bartlett increases Learning, in body weight LLC among thatNOT determines FOR SALE the nature OR of DISTRIBUTION a given health problem. And, AmericansNOT and FOR populations SALE ORin other DISTRIBUTION countries generally in turn, remembering that there are many factors that influ- emphasize lifestyles associated with increased overall energy ence behavior.

* The author wishes to acknowledge the contribution of, and material © Jones & Bartlett Learning, LLC © Jonesprovided & Bartlett by, Kristen Learning, Corey, M.A., in LLCcompiling this descriptive section on NOT FOR SALE OR DISTRIBUTION NOT FORobesity. SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 12 Health Issues and Behavior © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION consumption and inactivity. A short list combining behav- • Social factors (e.g., interpersonal processes, relation- ioral and environmental causes includes the following5,6: ships, social status) • Cultural factors (shared beliefs/values related to food, • Extensive marketing of unhealthy food products the body, eating practices) (including fast food)© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC • Physical environment (availability/cost of food types • Overeating NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION or exercise options, physical layout of environment) • Lack of exercise • Increased reliance on vehicle transportation These factors interact, and to understand behavior, it • A sedentary lifestyle related in part to the ubiquity of tele- is important to understand that interaction. An ecological vision,© Jones computers, & Bartlettand other labor-saving Learning, technologies LLC intervention (with© Jonesa goal of & changing Bartlett behavior) Learning, can then LLC • Changes in the quality of available foods include components that address several factors where, NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION • Increased portion sizes for example, an environmental change supports behavior • Trends towards eating out change.11 For example, closing down vending machines, or • The growth of the convenience food industry altering the products they sell (an environmental change), • Increased advertising by the food industry will cut down on the eating of high fat snacks (a behavior). © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Think about it. How often do you eat out? When you do, Food, Eating, and Obesity NOT FORwhat doSALE you have? OR How DISTRIBUTION often do you exercise? NOT FOR SALE OR DISTRIBUTION We all know that eating involves choices about what to eat. For a while, public health efforts to address overweight So it is no surprise that taste, cost, convenience (availability), and obesity concentrated on increasing awareness through and individual food preferences are key influences on dietary education about healthy behaviors. Guidelines for exercise/ choices.12,13 This, however, does not say much in itself. A lot diet and the health consequences© Jones of overweight & Bartlett and obesity Learning, LLC © Jones & Bartlett Learning, LLC of factors go into the process of choice, including: aimed to change behavior byNOT arming FOR people SALE with OR personal DISTRIBUTION NOT FOR SALE OR DISTRIBUTION knowledge and skills. Despite moderate short-term successes, • Availability of healthy food: Many studies have docu- these approaches have not proved effective in the long term.6,7 mented the lack of supermarkets, farmers markets, This issue is a good example of the ecological model at work, and grocery stores in low-income areas.14,15 These because the problem appears to be related to environmental kinds of stores are more likely to have fresh fruits and © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC factors that shape behavior, that encourage the overconsump- vegetables. In other words, choice of food is limited tion of food,NOT and FOR that discourage SALE ORphysical DISTRIBUTION activity.6 by whereNOT one lives FOR in some SALE cases. OR DISTRIBUTION Many of these earlier efforts also relied on the use of • Attitudes, beliefs, and sociocultural norms related to individual behavior change theories—including those we will diet: The cross-cultural literature suggests that dietary be discussing in this book—that emphasize the individual as choices also are shaped by social and cultural fac- © Jonesthe target& Bartlett of change, Learning, and address LLC knowledge, attitudes, deci- © Jonestors. &16,17 Bartlett Foods are Learning,associated with LLC individual or group NOT FORsion-making SALE processes, OR DISTRIBUTION and skills. Critics of these efforts have NOT FORidentity SALE and with OR ideas DISTRIBUTION about “how daily life should cited the over-reliance on what individuals can and cannot be.” Conceptions of what constitutes food or a meal, do over sociocultural and physical environmental factors as well as how foods should be consumed and pre- that play a role in their decision making. This can’t neces- pared, vary by ethnicity, geographic region, gender, sarily be “fixed” simply by adding an intervention focusing age, and social class.18-20 An important issue is dem- on individual behavior to ©an Jonesintervention & Bartlett that targets Learning, an LLConstrated in this example: ©Peoples’ Jones ideas & aboutBartlett what Learning, LLC environmental cause, becauseNOT behavior FOR and SALE the environment OR DISTRIBUTION constitutes a good or acceptableNOT meal FOR differ. SALE Typically, OR DISTRIBUTION interact.8 across cultures, definitions of the ideal meal include a meat or other protein source and a “starchy” food Interact: “To act upon one another.”9 such as bread, rice, or one of numerous root crops. In This ©is Joneswhere ecological & Bartlett models Learning, come in.10 EcologicalLLC many cases,© Jones the starchy & Bartlettfood is the Learning,main component LLC models integrateNOT FOR the various SALE influences OR DISTRIBUTION on health behavior, of the mealNOT in FORpart because SALE it ORis more DISTRIBUTION available or including interpersonal, organizational, community, and accessible.17,18,21 public policy factors, to name a few. So, you could say that The cross-cultural literature also highlights many mean- obesity-related behavior is influenced by: ings associated with food and eating, and many of these have • © Jones & Bartlett Individual Learning,factors (e.g., genetics,LLC taste/food prefer- ©social Jones implications. & Bartlett Food Learning, sharing is commonly LLC associated NOT FOR SALEences, attitudes, OR DISTRIBUTION beliefs, knowledge, hunger) NOTwith FORstrong SALEindividual, OR family, DISTRIBUTION and group ties and often

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 Obesity 13 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

FIGURE 2-1 USDA Food Pyramid, 1999. FIGURE 2-2 USDA Food Pyramid, 2006.

Key FATS, OILS & SWEETS Fat (naturally occurring © Jones & BartlettUse sparingly Learning, LLC © Jones & Bartlett Learning, LLC and added) Sugars (added) NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION These symbols show fats, oils and added sugars in foods.

MILK, YOGURT & MEAT, POULTRY, CHEESE GROUP FISH, DRY BEANS, 2-3 servings EGGS & NUTS GROUP © Jones & Bartlett Learning, LLC2-3 servings © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION VEGETABLE GROUP FRUIT GROUP 3-5 servings 2-4 servings

BREAD, CEREAL, RICE & PASTA GROUP 6-11 servings

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Source: U.S. Department of Agriculture Center for Nutrition Policy Source: U.S. Department of Agriculture Center for Nutrition Policy and Promotion. NOT FOR SALE OR DISTRIBUTIONand Promotion. NOT FOR SALE OR DISTRIBUTION

invokes values of hospitality, mutual caring, group solidarity, © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC and common goals, as well as social and even political obliga- FIGURE 2-3 Family meal. tions.NOT17,18,22-25 FOR Failure SALE to ORshare DISTRIBUTION when it is socially expected or NOT FOR SALE OR DISTRIBUTION offering inappropriate foods is identified with negative values or used to express dissatisfaction with social relationships.26-28 In contrast to nutritional models that determine the healthi- © Jones & Bartlettness of foods Learning, based on LLCtheir composition, investigations© Jones of & Bartlett Learning, LLC NOT FOR SALElocal modelsOR DISTRIBUTION suggest that the most commonly eaten NOTfoods FOR SALE OR DISTRIBUTION that leave the consumer feeling full are often considered the most healthful.17,29 People may also be at risk for obesity-related problems because they do not know the relationship between diet and disease.18,29 Remember© Jones that calling & obesityBartlett a “disease” Learning, is a very LLC © Jones & Bartlett Learning, LLC recent phenomenon;NOT until FOR recently, SALE many OR people DISTRIBUTION would not NOT FOR SALE OR DISTRIBUTION have thought of it that way. In fact, “being large” has positive value in a number of societies. Weight gain, good appetite, and large stature have been considered signs of good physical© andJones social & health. Bartlett By contrast, Learning, weight loss,LLC poor appetite, Source:© Ryan Jones McVay/PhotoDisc/Getty & Bartlett Images.Learning, LLC andNOT thinness FOR have SALE been OR considered DISTRIBUTION signs of poor health.30-35 NOT FOR SALE OR DISTRIBUTION Decisions about whether to choose low fat/healthy foods are affected by people’s beliefs about how much benefit those foods will have and their “confidence” (usually referred to feel that obesity is not preventable given the social pressures as self-efficacy—we’ll talk about that in Chapter 5) that they surrounding eating, or they may expect a “cure” for the con- © Jones & Bartlettcan in fact Learning, manage their LLCchoices.6 Obese individuals may© also Jones dition, & Bartlett rather than Learning, dietary advice. LLC36,37 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 14 Health Issues and Behavior © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Finally, it is just hard for people to take risks seriously a serious situation. In recent years, among young people if they are not meaningfully connected to lifestyle, personal ages 10–24, homicide was the second leading cause of death experience, and ideas of lifelong health status.38-41 Although overall in the United States.51 Specifically, in that age group, many behaviors may threaten© Joneslong-term & health, Bartlett the imme-Learning,it was LLC the leading cause of death for© JonesAfrican Americans, & Bartlett the Learning, LLC diate benefits of risky behavior may be seen to enhance second leading cause of death for Hispanics/Latinos, and the NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION one’s state of well-being. This has been demonstrated with third leading cause of death for American Indians, Alaskan respect to smoking and adolescent self-image;38 with risky Natives, and Asian/Pacific Islanders.51 In 2001, 79% of needle sharing among injection drug users, in relation to its homicide victims ages 10–24 were killed by firearms.52 In the perceived practical as well as social benefits;42 with percep- same year, 5,486 people ages 10–24 were murdered, about 15 tions of alcohol© Jones use among & Bartlett American Learning, Indian adolescents; LLC 43 every day.52 Eighty-five© Jones percent & Bartlettof these people Learning, were young LLC and with NOTother risky FOR activities. SALE Thus, OR DISTRIBUTIONif there are “positive” men, while 15% NOTwere young FOR women. SALE In OR addition, DISTRIBUTION a study of social/normative benefits associated with unhealthy eating 8th and 9th graders showed that 25% had been victims of habits, these may affect subjects’ perceptions of risk in the nonsexual dating violence and 8% had been victims of sexual same manner. dating violence.53 © Jones & Bartlett Learning, LLC © JonesViolence & Bartlettis clearly a Learning, problem with LLC many variations— Physical Exercise and Obesity from intimidation and threat, to situational violence, to NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Cost, time, safety, and access are major factors affecting an intentional violence—and it is largely a problem of young individual’s decision to take on or increase regular physical people. Research on youth violence has indicated that serious activity. In the course of day-to-day life, the possibility of acts of violence generally begin between ages 12 and 20, with incorporating exercise as a common routine varies widely only a very small percentage initiating any violence before depending upon an individual’s© Jones circumstances & Bartlett related Learning, to age LLC10 or after age 20.54-57 Thus, the© peak Jones period & for Bartlett violence Learning, LLC their job, the amount of freeNOT time, FOR the availability SALE OR of space DISTRIBUTION involvement (engaging in acts of violence)NOT FOR coincides SALE with ORthe DISTRIBUTION or facilities, and the physical characteristics of the neigh- developmental stage of adolescence. borhood, worksite, or school (commonly referred to as the Why is there so much violence among young people? “built environment”). There are biological and developmental explanations con- cerning aggressive behavior54 and a range of social and psy- The built© Jones environment & Bartlett can be defined Learning, as, “the man-LLC © Jones & Bartlett Learning, LLC chological explanations that have to do, again, with behavior made surroundings that provide the setting for NOT FOR SALE OR DISTRIBUTION as it relates to interactionsNOT FOR between SALE youth OR and DISTRIBUTION their personal, human activity, ranging from the large-scale civic family, community, and school environments. Many of the surroundings to the personal places.”44 latter explanations address violence as one of a number of A number of research studies have identified links adolescent “risk behaviors,” including delinquency, sub- © Jonesbetween & Bartlett the built Learning,environment LLCand physical activity.45,46 If ©stance Jones abuse, & sexualBartlett risk, Learning,school dropout, LLC and others. NOT FORthere areSALE changes OR in DISTRIBUTIONthe built environment that remove bar- NOTLet’s FOR take SALE a look ORat a fewDISTRIBUTION of the explanations for youth riers, it may, for example, be more possible to walk or bike to violence. destinations, to exercise on lunch breaks, and simply to take the stairs.47 People will be more likely to do this on their own Risk and Protective Factor Explanations without the use of an actual intervention. Several promising This kind of explanation describes violence-related behaviors studies support the idea that© changing Jones the & built Bartlett environment Learning, by parents, LLC peers, the community, ©and Jones others that & Bartlettmay influ- Learning, LLC across different settings hasNOT an effect FOR on SALEbehavior. OR Adding DISTRIBUTION ence or shape violent behavior engagedNOT in FOR by young SALE people. OR DISTRIBUTION signs to increase stair use among shoppers,48 providing These influences are said to be “risk factors” and include showers and changing rooms for employees,49and increasing family problems, family conflict and violence, absence of access to trails in rural communities50 are examples of inter- positive role models, being a victim of violence, witnessing ventions that© Jones have increased & Bartlett physical Learning, activity. LLC violence when young,© Jones poverty, & livingBartlett in a crime-ridden Learning, com- LLC NOT FOR SALE OR DISTRIBUTION munity where weaponsNOT FOR are easily SALE available, OR social DISTRIBUTION norms that YOUTH VIOLENCE support violence, and other such factors.58-62 Typically, many When we talk about youth violence as a public health prob- of these risk factors are present as influences on violence as a lem in relation to behavior, the concern is the injury and behavior. It has been argued, however, that these risk factors personal trauma that violence causes—because, of course, can be offset by the presence of positive or protective factors © Jonesviolence & Bartlett is already aLearning, behavior and LLC for youth, it has truly been ©like Jones an adult & whoBartlett is present Learning, and cares LLCabout the youth, or NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 Youth Violence 15 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION connections to school or other youth who are not involved in important. If an adolescent can think of a satisfactory pos- violence.58,59,63-67 This complex and fluid interaction between sible self in the “conventional domains” of family, friends, an individual and risk/protective factors in one or more or school, this will help motivate him or her in making a domains has been© described Jones as& aBartlett “web of influence,”Learning, and LLC successful transition to adulthood.© Jones If & not, Bartlett adolescents Learning, may LLC draws from the ecological perspective of Brofenbrenner68 that seek alternative ways to define themselves. Delinquency and NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION we have already referred to as a key concept within public violence are alternative routes towards positive self-defini- health.69 tion and prestige,81(p114),82,83 particularly if there is a significant peer group that views these kinds of behaviors as valued.84 Problem Behavior Syndrome, Behavioral Cluster, Drawing from the theories of Ogbu85 and Bourdieu86,87 and© Jones Self-Concept & Bartlett Approaches Learning, LLC among ©others, Jones Oyserman & Bartlett and Packer Learning, note that theLLC identity- InNOT these FOR approaches, SALE violent OR DISTRIBUTION behavior and its influencing formationNOT process FOR is connectedSALE OR to specificDISTRIBUTION social contexts as factors are understood to be related to a coherent pattern well.84 So, for example, in high poverty situations where aca- of risk-taking. (This will be discussed more fully in Chapter demic success may not be perceived as related significantly 12.) Risk for substance abuse, delinquency/violence, early to available life-paths, the behavior patterns and meanings © Jones & Bartlettsexual activity, Learning, and other LLC behaviors is viewed as a “problem© Jones associated & Bartlett with academicLearning, success LLC may not be valued, whereas behavior syndrome” of one form or another, where the risk others patterns (e.g., those including violence or other risk NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION factors and trajectories are similar and/or overlapping.70–75 behaviors) will be. Hawkins and Catalano, for example, note that of the 19 risk factors they have identified for adolescent problem behavior, Socioecological Models 16 are common for both delinquency and substance abuse, In the spirit of an ecological approach, youth risk behaviors 11 are common for© violence Jones and & substanceBartlett abuse, Learning, and 9 are LLC such as violence have also© beenJones viewed & Bartlettas related toLearning, social LLC common for all three.NOT76 FOR SALE OR DISTRIBUTIONposition, that is, where NOTinvolvement FOR SALEin violence OR and DISTRIBUTION the The “coherent pattern” may reflect a kind of conflict- causes of involvement differ by socioeconomic status of ing or antagonistic relationship between youth involved in particular groups. For example, it has been argued that drug violence and the conventional world, that is, the segment of use/involvement is motivated more powerfully by economic society for which the risk behaviors are viewed as negative or factors for minority youth than for nonminority youth. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC antisocial,† a conflict with the values, goals, institutions, and Research has shown that there is more experimental drug socializingNOT FOR forces SALE of conventional OR DISTRIBUTION society. Adolescents who, use amongNOT adolescents FOR SALE from higher OR DISTRIBUTIONsocioeconomic brackets, for a wide variety of reasons including the frustration of aspi- while youth from lower socioeconomic groups tend to do less rations due to poverty, school failure, social disorganization experimenting and more selling.88-90 Clearly, drug traffick- in the community or family, or other such factors, are said to ing/selling places youth at much higher risk for violence,91-94 © Jones & Bartletthave a low Learning, commitment LLC to conventional society and do© notJones because & Bartlett violence Learning, is so often a part LLC of trafficking. W. J. Wilson, NOT FOR SALEendorse OR its DISTRIBUTIONvalues, are more likely to engage in delinquentNOT or FORin his SALE seminal OR work DISTRIBUTION on “underclass” communities, described violent behavior and substance abuse, and are more likely to the isolated and uniformly poverty-ridden nature of inner have stronger bonds to other youth who are involved in the city underclass communities, where economic opportunities same behavior patterns.74,77,78 are so limited and there is a historical pattern of disconnec- tion from mainstream economic activity, that drug selling Self-concept can be defined as “the mental image © Jones & Bartlett Learning, LLCand other aspects of the “street© Jones economy” & Bartlett become the Learning, domi- LLC one has of oneself.”9 NOT FOR SALE OR DISTRIBUTIONnant playing field for achievementNOT FOR and status, SALE95 and OR thus DISTRIBUTION have Moving beyond the idea of a “problem behavior” syn- a strong role in the development and perpetuation of norms drome is another approach that seeks to understand a little and attitudes about violence.96-102 Some of the work in this more about how that antagonistic relationship operates on area describes “codes of the street” that govern violent or an© individualJones & level. Bartlett This approach Learning, focuses LLC on self-concept, potentially© Jones violent interactions,& Bartlett with Learning, reference to LLC the imme- particularlyNOT FOR what SALE an adolescent OR DISTRIBUTION views as a “possible self” in diate socialNOT context FOR of SALE such codes. OR DISTRIBUTION the world that he or she can envision as relevant to his or Data on homicide patterns offer strong support for her life.79,80 If a “task of adolescence” is to experiment with socioecological arguments about youth violence. The steep and resolve social roles,81 the possible selves factor is very rise in juvenile homicide from the mid-1980s to the mid- 1990s was closely tied to two factors: the volatile crack © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC † See Hirschi T. Causes of Delinquency. Berkeley: University of California cocaine epidemic, which entailed the recruitment of urban NOT FOR SALEPress; 1969, OR and DISTRIBUTION other social control theory. 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© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 16 Health Issues and Behavior © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION youth into the “business,” and the consequent increase in health crises in history. It is an epidemic that affects the gun use103-106 and the subsequent incorporation of guns as well-being of societies, not just with respect to health. These part of the norm for violent interaction even well after the impacts have included a decrease in average life expectancy, 101 decline of the crack boom. © Thus Jones the codes & Bartlett or culture Learning,of the significant LLC reduction in household© incomeJones (because & Bartlett fewer Learning, LLC street now include the use of guns as routine. Some research household members work, and medical expenses may be NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION on youth gang violence follows this approach. Spergel, for high), decimation of educational system capacity and school example, outlined a comprehensive gang intervention model attendance, a general decrease in economic production and that views the presence of gangs as largely related to a lack of increase in poverty, and, as previously noted, a generation of socioeconomic opportunities, social disorganization, pov- children without parents. erty, institutional© Jones racism, & Bartlettsocial policy Learning, deficiencies, andLLC a lack HIV/AIDS has© Jonesalso been & a Bartlett crisis filled Learning, with ambiguity LLC of or misdirectedNOT FOR social controls.SALE 107OR DISTRIBUTION and controversy,NOT precisely FOR because SALE its OR epidemiology—the DISTRIBUTION way in which it spreads—is so clearly tied to behavior and Social-Cognitive Models because even though anti-retroviral drugs (administered in Lastly, while focusing on related aspects of violent behavior, multiple forms, known as highly active anti-retroviral ther- © Jonessocial-cognitive & Bartlett models Learning, of violence LLC focus on decision mak- ©apy Jones or HAART) & Bartlett can treat Learning,the condition, LLC there is still no cure. ing, reasoning, and other cognitive processes surrounding This places a huge burden on prevention, which is largely NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION acts of aggression. In this social information processing about behavior.118 There are essentially three major routes model of aggression,108-110 aggressive behavior happens when of transmission: sexual transmission (either heterosexual a youth evaluates social/behavioral “cues” (like a facial gri- or same-sex), sharing intravenous drug equipment, and mace or insult), interprets those cues based on what he or she mother-to-child (perinatal) transmission; a distant fourth understands them to mean ©in aJones particular & context,Bartlett and Learning, then is the LLC use of contaminated blood ©products Jones via & transfusion. Bartlett Learning, LLC chooses a potentially violentNOT response. FOR Aggressive SALE OR behavior DISTRIBUTION All of these routes of transmissionNOT are FORactually SALE behaviors. OR DISTRIBUTION is said to result from difficulties in coding and interpreta- Most importantly, they are behaviors that, for the most part, tion of social cues or to a limited repertoire of nonaggressive are closely intertwined with deeply rooted moral, cultural, behavioral responses. Interpretation of cues and selection of and socioeconomic issues, all interacting at the same time. responses is, not surprisingly, related to beliefs about aggres- Understandings about sexual behavior, for example, are at © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC sion. In numerous studies, aggressive behavior in youth has the center of the moral-religious systems of virtually every been relatedNOT to beliefs FOR about SALE the ORlegitimacy DISTRIBUTION of aggression,111- society and culture.NOT Yet FOR sexual SALEbehavior OR is also DISTRIBUTION closely tied to 114 and positive beliefs about aggression have been associated gender definitions and relationships across cultures, and it is with perceived neighborhood danger.115 Furthermore, such inescapably tied to issues of poverty and wealth. Therefore, to approaches also intersect with other approaches discussed understand sexual transmission of HIV in a particular place, © Jonesthus &far. Bartlett For example, Learning, several aspects LLC of the environmental ©you Jones will need & Bartlettto look at allLearning, of these factors, LLC at a minimum! NOT FORcontext, SALE such asOR prevalence DISTRIBUTION of violence in the community, NOTAnd thisFOR doesn’t SALE even OR touch DISTRIBUTION on HIV risks that people take utility of violence for achieving desired outcomes, significant because they simply don’t know that they are taking a risk. others’ (e.g., peers) perceptions of violence, and conse- The patterns by which HIV/AIDS is spread vary from quences of violence involvement, are viewed as having impli- country to country, from society to society, by gender, and cations for youth beliefs about aggressive behavior and their by subgroup. Not only that, but these patterns change over involvement in violence. © Jones & Bartlett Learning,time LLC as the epidemic evolves. A few© examples: Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION HIV/AIDS • In the United States, HIV/AIDS was first identified, and took its earliest toll, among men who had sex By the end of 2004, an estimated 34 to 46 million people with men (MSM). Not long after, it became clear that around the globe were living with HIV/AIDS,116 with a nearly injecting drug users and their partners were seriously incomprehensible additional toll in orphaned children, deci- © Jones & Bartlett Learning, LLC impacted© as Jones well, along & Bartlettwith other Learning,specific high-risk LLC mated families and workforces, and stigmatization. Well over NOT FOR SALE OR DISTRIBUTION populationsNOT (e.g., FOR sex workers,SALE ORrunaway DISTRIBUTION and home- 20 million people have died from HIV/AIDS, and there are less youth, incarcerated populations). Although the approximately 5 million or more new infections annually,117 discovery of multiple anti-retroviral therapies in the indicating that the pandemic continues to expand. Since mid-1990s reduced HIV/AIDS mortality because of the 1980s, when the disease was first identified, the global increased survival rates, new infections continue. © JonesHIV/AIDS & Bartlett pandemic Learning, has become LLC one of the worst global © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FORMore SALE recently, OR the epidemicDISTRIBUTION has centered on women

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 HIV/AIDS 17 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION of color (heterosexual transmission) and has returned men (MSM), for which data, although limited, show among MSM.119,‡ that some men having sex with men concurrently • In Sub-Saharan Africa, where the pandemic is cur- have heterosexual partners, becoming a “bridge” rently most© severe,Jones heterosexual & Bartlett transmission Learning, has LLC population for HIV© transmission;Jones & Bartlett injection drugLearning, use LLC been, and remains, the primary path of transmis- (IDU)—for example, in the northeastern states of NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION sion.120 This is generally due to a number of factors, India the HIV/AIDS epidemic is expanding among including patterns of migrant work, traditional gen- injection drug users, through sharing of injection der roles in which men have multiple female partners, equipment; low status of women, contributing to the and lack of access to prevention and treatment. It is spread of the epidemic due to unequal relationships © Jonesalso exacerbated & Bartlett because Learning, prolonged LLC ethnic conflict and© Jones therefore & increasedBartlett vulnerability Learning, of LLC women to NOT andFOR civil SALE war, like OR such DISTRIBUTION conflicts everywhere, often NOTinfection; FOR and SALEstigma against OR DISTRIBUTION those who are infected, involve rape and abuse of women. • In Southeast Asia, Thailand was an early epicenter of HIV/AIDS, largely due to the sex trade but also 121 Gender Roles and HIV Risk © Jones & Bartlettbecause Learning, of high ratesLLC of injection drug use. Because© Jones & Bartlett Learning, LLC of an intense, government-led program of condom 128 NOT FOR SALE OR DISTRIBUTION NOT FOR SALEAmong OR theDISTRIBUTION Roma (Gypsies) distribution and prevention, the spread of HIV/AIDS was slowed. However, it then began to increase rap- The Roma (Gypsies), the largest ethnic minority group idly in Vietnam, due to injection drug use and the sex in Central and Eastern Europe, have cultures that are trade, and Cambodia (due to the sex trade, heterosex- traditional, often closed, and autonomous of majority ual transmission,© Jones and largely & Bartlett associated Learning, with a rapid LLC populations. Roma communities© Jones are & characterizedBartlett Learning, by LLC move towardsNOT economic FOR SALEdevelopment OR followingDISTRIBUTION the pervasive social healthNOT problems, FOR widespread SALE ORpoverty, DISTRIBUTION cessation of civil war in the 1990s, which involved limited educational opportunities, and discrimination. migrant labor in big cities such as the capital Phnom Although some evidence suggests high levels of HIV Penh), as well as in Myanmar (Burma).120,122,123 sexual risk behavior among Roma, little is known about • In Eastern Europe and Russia, the epidemic is more the cultural and social context in which risk behavior © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC recent, and is primarily associated with injection drug occurs. In this study, in-depth interviews were used to NOT useFOR and SALE its concomitant OR DISTRIBUTION spread to sexual partners elicitNOT detailed FOR information SALE aboutOR DISTRIBUTIONtypes of sexual part- of injecting drug users.123 However, according to nerships and associated sexual risk behaviors, as well as the use and perception of protection, knowledge and UNAIDS, it is rapidly expanding.120 Eastern Europe beliefs about AIDS and STDs, and sexual communication and Central Asia have the fastest growing epidemics patterns in a sample of 42 men and women aged 18–52 © Jones & Bartlettin Learning,the world, rising LLC from about 30,000 people ©living Jones & livingBartlett in Roma Learning, community settlementsLLC in Bulgaria and NOT FOR SALE ORwith DISTRIBUTION AIDS in 1994 to an estimated 1.3 million inNOT 2003. FOR SALEHungary. OR Based DISTRIBUTION on the interview data, men appeared to The economic changes after the early 1990s may have have significantly more latitude with respect to sexual a lot to do with the epidemic in the region, resulting behavior before and during marriage, engaging in unpro- in a dramatic increase in trade—both legal and ille- tected sex with primary and multiple outside partners, gal—and a scramble for ways to make money. with considerably more relationship power and control • According ©to JonesWorld Bank & Bartlett estimates, Learning, well over 5LLC than women. In contrast,© Joneswomen are & expected Bartlett to main- Learning, LLC million peopleNOT in IndiaFOR are SALE living ORwith DISTRIBUTIONAIDS.125 The tain virginity before marriageNOT and FOR then SALEsexual exclusivity OR DISTRIBUTION behavioral risk factors include unsafe sex, such that to their husbands. Condom use is not normative and is 84% of cases result from sexual transmission, with mainly perceived as a form of contraception. Although awareness of AIDS was common, it was generally not prevalence rates very high among sex workers and perceived as a personal threat. Misconceptions about related to lack of condom use. Other risk factors © Jones & Bartlett Learning, LLC how© HIV Jones is transmitted & Bartlett are widespread, Learning, and women—in LLC NOT includeFOR SALE migration OR and DISTRIBUTION mobility, where a significant particular—hadNOT FOR very SALE little knowledgeOR DISTRIBUTION about STDs, HIV number of migrant workers are away from family and transmission, and protective steps. The study suggested community for extended periods of time and likely an urgent need for the development of HIV prevention to have sex with sex workers; men who have sex with programs culturally sensitive to Roma populations in Eastern Europe, where HIV rates are rapidly rising. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ‡ Also see the entire issue of American Journal of Public Health, June 2003, NOT FOR SALEvolume OR93. DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 18 Health Issues and Behavior © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION resulting in marginalization and higher concentra- • What are the gender rules and relationships that are tions of risk. involved? Can one partner, for example, easily com- • In China, the HIV/AIDS epidemic was limited until municate to the other about HIV risk and preven- 126 the mid-1990s, when© it Jonesbegan to grow& Bartlett dramatically. Learning, LLCtion? Or will this be difficult?© Jones & Bartlett Learning, LLC This initial growth was focused among injection drug NOT FOR SALE OR DISTRIBUTIONOr, for example, to take on injectionNOT FOR drug SALEuse and ORthe DISTRIBUTION users and people using donated blood. Currently, sharing of needles: there is an estimated 650,000 people living with AIDS in China, according to a joint World Health • Who are the users (e.g., young, old, male, female, Organization and UNAIDS estimate.127 Primary risk poor, middle class)? behaviors© Jones involved & Bartlett in the spreadLearning, of the LLCepidemic • Do people© inject Jones in a public& Bartlett setting (likeLearning, a park, alley, LLC includeNOT injection FOR SALE drug use, OR contamination DISTRIBUTION of blood or house),NOT with others,FOR SALEor by themselves? OR DISTRIBUTION and blood products, commercial sex workers (lack • Is sharing of equipment common or necessary? How of knowledge about HIV risk and condom use), men is this done (for example, do people actually share who have sex with men, and migrant workers (a risk needles, or do they share water used for rinsing)? • Do injection drug users know about HIV risks? Are © Jones & Bartlettfactor for casual Learning, sexual relationships). LLC © Jones & Bartlett Learning, LLC they able to take precautions, or does addiction over- Addressing HIV/AIDS-related risk behaviors is clearly NOT FOR SALE OR DISTRIBUTION NOT FORride suchSALE attempts? OR DISTRIBUTION complex. For each of the major routes of transmission, there • What are the treatment and prevention options? Are are many behaviors involved, and a great deal of variation there, for example, needle exchange programs? Drug across cultures and circumstances. Just to take on sexual treatment programs? transmission as a topic area of research interest, here are © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC only a few of the kinds of behavioral issues you would need to think about: NOT FOR SALE OR DISTRIBUTIONBEHAVIORS, THEORIES, ANDNOT INTERVENTIONS FOR SALE OR DISTRIBUTION The three examples provided in the three previous sections • What is the range of sexual practices and in what con- show the complex link among behavior, social and environ- texts do they occur? Heterosexual? Same-sex? With mental factors, and a health problem. The kinds of theories migrant workers? and frameworks I will discuss in the book are meant to be • Which© Jones are riskiest & Bartlett for HIV transmission, Learning, multiple LLC or © Jones & Bartlett Learning, LLC tools that will help guide you through the thick web often singleNOT partners? FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION associated with health behavior. Trying to figure out what • What types of partners are there and are risk situa- to do is made at least a little easier through the process of tions different by type of partner? identifying what you think is going on (in terms of behavior and ecological influences), choosing appropriate theories or • Are there situations where sex is forced, or necessary © Jones & Bartlett Learning, LLC ©frameworks Jones & that Bartlett best address Learning, what you thinkLLC is going on, and for survival? NOT FOR SALE OR DISTRIBUTION NOTusing FORthem to SALE help you OR design DISTRIBUTION programs.

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 Chapter Questions 19 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Chapter© Jones Questions & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

1. What are some key links between the environment and behavior in terms of the problem of © Jones & Bartlettobesity? Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 2. Would it be fair to say that obesity is a problem resulting just from individual choice in terms of behavior?

3. What kinds of© factors Jones may & influence Bartlett youth Learning, to LLC © Jones & Bartlett Learning, LLC engage in violence? NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 4. What are consistent patterns of behavioral risk for HIV/AIDS around the globe? How do you think these patterns are influenced by the © Joneslarger social & Bartlett or economic Learning, context? LLC © Jones & Bartlett Learning, LLC NOT5. Where FOR would SALE you focusOR DISTRIBUTIONyour efforts to address NOT FOR SALE OR DISTRIBUTION behaviors related to obesity? Youth violence? HIV/AIDS?

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 20 Health Issues and Behavior © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION REFERENCES 28. Young M. Fighting with Food: Leadership, Values, and Social Control in a Massim Society. Cambridge, England: Cambridge University Press; 1. Flegal K, Carroll M, Ogden C, Johnson C. Prevalence and trends in 1971. obesity among U.S. adults 1999–2000. JAMA. 2002;288(14):1723–1727. 29. Messer E. Methods for determinants of food intake. In: Pelto G, 2. World Health Organization (WHO). Diet, nutrition and the preven- Pelto P, Messer E, eds. Research Methods in Nutritional Anthropology. Tokyo: tion of chronic diseases. Report of© a jointJones WHO/FAO & Bartlett expert consultation. Learning, United LLC Nations University; 1989. © Jones & Bartlett Learning, LLC WHO Technical Report Series No. 916.NOT Geneva, FOR Switzerland. SALE OR DISTRIBUTION30. Brown P, Konner M. An anthropologicalNOT perspective FOR onSALE obesity. AnnOR DISTRIBUTION 3. Mokdad A, Marks J, Stroup D, Gerberding J. Actual causes of death N Y Acad Sci. 1987;499:29–46. in the United States, 2000. JAMA. 2004;291(10):1238–1245. 31. Cassidy C. The good body: when big is better. Med Anthropol. 4. National Heart, Lung and Blood Institute (NHLBI). Clinical 1991;13:181–213. Guidelines on the Identification, Evaluation, and Treatment of Overweight 32. deGarine I, Pollock N, eds. Social Aspects of Obesity. Luxembourg: and Obesity in Adults: The Evidence Report. NIH Publication No. 98–4083. Gordon and Breach; 1995. Rockville, MD:© NationalJones Institutes & Bartlett of Health. Learning, LLC 33. Nichter M, Nichter© Jones M. Hype and& weight.Bartlett Med Anthropol. Learning, 1991;13:249– LLC 5. JefferyNOT RW, Utter FOR J. The SALE changing ORenvironment DISTRIBUTION and population obe- 284. NOT FOR SALE OR DISTRIBUTION sity in the United States. Obesity Res. 2003;11(Suppl):12S–22S. 34. Ritenbaugh C. Obesity as a culture-bound syndrome. Culture Med 6. French SA, Story M, Hannan P, et al. Cognitive and demographic Psychiatry. 1982;6:347–361. correlates of lowfat vending snack choices among adolescents and adults. J 35. Sobo E. The sweetness of fat: health, procreation, and sociability Am Diet Assoc. 1999;99(4):471–476. in rural Jamaica. In: Counihan C, Van Esterik P, eds. Food and Culture: A 7. Jeffery RW. Community approaches to obesity treatment and pre- Reader. New York: Routledge; 1997:256–271. © Jonesvention: & theBartlett Minnesota Learning,experience. Prog ObesLLC Res. 1999;8:837–843. © Jones36. Cohn &S. BeingBartlett told what Learning, to eat: conversations LLC in a diabetes day NOT FOR 8. BanduraSALE A. ORSocial FoundationsDISTRIBUTION of Thought and Action: Social Cognitive NOTcentre. FORIn Caplan SALE P, ed. Food,OR Health,DISTRIBUTION and Identity. London: Routledge; Theory. NJ: Prentice-Hall; 1986. 1999:193–212. 10. Green LW, Kreuter MW. Health Promotion Planning: An Educational 37. Massara E. Que gordita. In Counihan C, Van Esterik P, eds. Food and and Ecological Approach. New York: McGraw Hill; 1999. Culture: A Reader. New York: Routledge; 1997:251–255. 11. Stokols D. Establishing and maintaining healthy environments: 38. Amos A, Gray D, Currie C, Elton R. Healthy or druggy? Self image, toward a social ecology of health promotion. Am Psychol. 1992;47(1):6–22. ideal image, and smoking behavior among young people. Soc Sci Med. 12. Glanz K, Basil M, Maibach E,© Goldberg Jones J, Snyder & Bartlett D. Why Americans Learning, 1997;45(6):847–858. LLC © Jones & Bartlett Learning, LLC eat what they do: taste, nutrition, cost, convenience, and weight control con- 39. Douglas M, Wildavsky A. Risk and Culture: An Essay on the Selection cerns as influences on food consumption.NOT FORJ Am Diet SALE Assoc. 1998;98:1464– OR DISTRIBUTIONof Technological and Environmental Dangers.NOT Berkeley, FOR CA: SALE University OR of DISTRIBUTION 1467. California Press; 1982. 13. Story M, Neumark-Sztainer D, French SA. Individual and envi- 40. Nations M. Epidemiological research on infectious disease: quantita- ronmental influences on adolescent eating behaviors. J Am Diet Assoc. tive rigor or rigormortis? Insights from ethnomedicine. In: Janes C, Stall R, 2002;102(3):S40–S51. Gifford S, eds. Anthropology and Epidemiology: Interdisciplinary Approaches 14. Weinberg© Jones Z. No place & to Bartlett shop: food access Learning, lacking in the LLC inner city. to the Study of Health© and Jones Disease. &Dordrecht: Bartlett Routledge Learning, and Kegan Paul;LLC Race, Poverty Environ. 2000;7(2):22–24. 1986:97–123. 15. MorlandNOT K, Wing FOR S, Diez SALE Roux A, ORPoole C.DISTRIBUTION Neighborhood character- 41. Rose G. The StrategyNOT of FOR Preventive SALE Medicine OR. Oxford, DISTRIBUTION England: Oxford istics associated with the location of food stores and food service places. Am University Press; 1992. J Prev Health. ;22(1):23–29. 42. Bourgois P, Lettiere M, Quesada J. Social misery and the sanctions 16. Counihan C, Van Esterik P, eds. Food and Culture: A Reader. London: of substance abuse: confronting HIV risk among homeless heroin addicts in Routledge; 1997. San Francisco. Soc Prob. 1997;44(2):155–174. 17. Messer E. Anthropological perspectives on diet. Ann Rev Anthropol. 43. O’Nell TD, Mitchell CM. Alcohol use among American Indian © Jones1984;13:205–249. & Bartlett Learning, LLC ©adolescents: Jones the& Bartlettrole of culture Learning, in pathological LLC drinking. Soc Sci Med. NOT FOR18. PollockSALE N. TheseOR RootsDISTRIBUTION Remain: Food Habits in Islands of the Central NOT1996;42:565–678. FOR SALE OR DISTRIBUTION and Eastern Pacific Since Western Contact. Honolulu, HI: University of 44. Wikipedia, http://en.wikipedia.org/wiki/Built_environment. Hawaii Press; 1992. 45. Saelens BE, Sallis JF, Black J, Chen D. (2003). Neighborhood-based 19. Weismantel M. Food, Gender, and Poverty in the Ecuadorian Andes. differences in physical activity: An environment scale evaluation. American Prospect Heights, IL: Waveland Press; 1988. Journal of Public Health, 93, 1552–1558. 21. Douglas M. Deciphering a meal. In: Counihan C, Van Esterik P, eds. 46. Centers for Disease Control. 2005. The Guide to Community Preventive Food and Culture: A Reader. London:© Routledge;Jones 1997:36–54. & Bartlett Learning,Services: LLC What Works to Promote Health. Oxford:© Jones Oxford University & Bartlett Press. Learning, LLC 22. Bindon J. Taro or rice, plantationNOT FOR or market: SALE dietary OR choice DISTRIBUTION in 47. Colditz GA, Samplin-Salgado M, RyanNOT CT, Dart FOR H, Fisher SALE L, Tokuda OR DISTRIBUTION American Samoa. Food Foodways. 1988;3:59–78. A, Rockhill B. “Harvard Report on Cancer Prevention, Volume 5: Fulfilling 23. Flinn J. Tradition in the face of change: food choices among Pulapese the potential for cancer prevention: policy approaches.” Cancer Causes in Truk State. Food Foodways. 1988;3:19–39. Control, 13:199–212 (2002). 24. Kahn M. Men are taro (they cannot be rice): political aspects of food 48. Andersen RE, Wadden TA, Bartlett SJ, Zemel BS, Verde TJ, choices in Wamira, Papua New Guinea. Food Foodways. 1988;3:41–57. Franckowiak SC. Effects of lifestyle activity vs structured aerobic exercise in 25. Manderson© Jones L, ed. Shared& Bartlett Wealth and Learning, Symbol: Food, Culture,LLC and obese women: a randomized© Jones trial. JAMA & Bartlett 281:335–340, Learning, 1999. LLC Society in Oceania and Southeast Asia. Cambridge, England: Cambridge NOT FOR SALE OR DISTRIBUTION 49. Vuori IM, OjaNOT P, Paronen FOR O. (1994). SALE Physically OR activeDISTRIBUTION commuting to University Press; 1986. work—testing its potential for exercise promotion. Medicine and Science in 26. Kahn M. Always Hungry, Never Greedy: Food and the Expression of Sports and Exercise, 26, 844–850. Gender in a Melanesian Society. Cambridge, England: Cambridge University 50. Brownson RC, Housmann RA, Brown DR, et al. (2000). Promoting Press; 1986. physical activity in rural communities. Walking trail access, use and effects. 27. Nichter M. Modes of food classification and the diet-health contin- American Journal of Preventive Medicine 18:235–41. © Jonesgency: & a SouthBartlett Indian caseLearning, study. In: Khare LLC R, Rao MSA, eds. Food, Society © Jones51. Anderson & BartlettRN, Smith BL. Learning, Deaths: leading LLCcauses for 2001. Nat Vital and Culture: Aspects in South Asian Food Systems. Durham, NC: Carolina Stat Rep. 2003;52(9):1–86. NOT FORAcademic SALE Press; 1986:185–221. OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 References 21 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 52. Centers for Disease Control and Prevention (CDC). May 24, 2004. 73. Elliott DS, Huizinga D, Menard S. Multiple Problem Youth: Web-based injury statistics query and reporting system (WISQARS). Delinquency, Substance Use, and Mental Health Problems. New York: Available at: www.cdc.gov/ncipc/wisqars. Accessed Springer-Verlag; 1989. 53. Foshee VA, Linder GF, Bauman KE, et al. The safe dates project: 74. Oetting ER, Beauvais F. Peer cluster theory, socialization char- theoretical basis, evaluation design, and selected baseline findings. Am J Prev acteristics and adolescent drug use: a path analysis. J Counsel Psychol. Med 1996;12(5 Suppl):39–47.© Jones & Bartlett Learning, LLC1987;34(2):205–220. © Jones & Bartlett Learning, LLC 54. U.S. DepartmentNOT of Health FOR and HumanSALE Services. OR YouthDISTRIBUTION Violence: A 76. Elliott DS, Huizinga D, NOTAgeton S.FOR Explaining SALE Delinquency OR andDISTRIBUTION Drug Report of the Surgeon General. Rockville, Md.: U.S. Department of Health Abuse. Beverly Hills, CA: Sage; 1985. and Human Services, Centers for Disease Control and Prevention, National 77. Hawkins JD, Weis JG. The social development model: an integrated Center for Injury Prevention and Control, Substance Abuse and Mental approach to delinquency prevention. J Primary Prev. 1985;6:73–97. Health Services Administration, Center for Mental Health Services, and 78. Markus H, Wurf E. The dynamic self-concept: a social-psychological National Institutes of Health, National Institute of Mental Health; 2001. perspective. Ann Rev Psychol. 1987;38:299–337. ©55. Jones Huizinga & D, Bartlett Loeber R, Learning,Thornberry TP. LLCRecent Findings from 79. Oyserman© Jones D, Markus & BartlettH. Possible selves Learning, and delinquency. LLC J Personality theNOT Program FOR of Research SALE on ORCauses DISTRIBUTION and Correlates of Delinquency. (U.S. Soc Psychol.NOT 1990;59(1):112–125. FOR SALE OR DISTRIBUTION Department of Justice, Office of Justice Programs, Office of Juvenile 81. Hirschi T. Causes of Delinquency. Berkeley, CA: University of Justice and Delinquency Prevention, NCJ 159042). Washington, DC: U.S. California Press; 1969. Government Printing Office; 1995. 82. Sutherland EH, Cressey DR. Criminology, 10th ed. Philadelphia: 56. Thornberry TP, Huizinga D, Loeber R. The prevention of serious Lippincott; 1978. delinquency and violence: implications from the program of research on 83. Oyserman D, Packer MJ. Social cognition and self-concept: a socially © Jones & Bartlettcauses and correlatesLearning, of delinquency. LLC In Howell JC, Krisberg B, Hawkins© JonesJD, contextualized & Bartlett model Learning, of identity. In: Nye LLC JL, Brower AM, eds. What’s Social NOT FOR SALEWilson ORJ, eds. DISTRIBUTIONSourcebook on Serious, Violent and Chronic Juvenile OffendersNOT FORAbout SALE Social Cognition? OR DISTRIBUTION Research on Socially Shared Cognition in Small Thousand Oaks, CA: Sage; 1995:213–237. Groups. Thousand Oaks, CA: Sage; 1996. 57. Elliott DS. Serious violent offenders: onset, developmental course, 84. Ogbu JU. Minority coping responses and school experience. J and termination. The American Society of Criminology 1993 Presidential Psychohistory. 1991;18:433–456. Address. Criminol. 1994;32:1–21. 86. Bourdieu P. 1990. The Logic of Practice. (Trans. R. Nice.) Cambridge, 58. Catalano RF, Hawkins JD. Risk Focused Prevention: Using the Social England: Polity (originally published 1980). Development Strategy. Seattle,© Jones WA: Developmental & Bartlett Research Learning, and Programs; LLC 87. Bourdieu P. 1977. Outline© Jones of a Theory & Bartlettof Practice. Cambridge: Learning, LLC 1995. Cambridge University Press. 59. Hawkins JD, CatalanoNOT RF,FOR Miller SALE JY. Risk ORand protective DISTRIBUTION factors 88. Baumrind D. Familial antecedentsNOT FOR of adolescent SALE drug OR use: DISTRIBUTIONa devel- for alcohol and other drug problems in adolescence and early adulthood: opmental perspective. In: Jones CL, Battjes RJ, eds. Etiology of Drug Abuse: implications for substance abuse prevention. Psychol Bull. 1992;112:64–105. Implications for Prevention. Rockville, MD: National Institute on Drug 60. Bell CC, Jenkins EJ. Community violence and children on Chicago’s Abuse; 1985:13–44. Southside. Psychiatry. 1993;56:46–54. 89. Kaplan HB, Martin SS, Johnson RJ, Robbins C. Escalation of mari- © 61.Jones Dryfoos JG.& AdolescentsBartlett at Risk:Learning, Prevalence and LLC Prevention. New York: juana use:© application Jones of & a generalBartlett theory Learning,of deviant behavior. LLC J Health Soc Oxford University Press; 1990. Behav. 1986;27:44–61. NOT62. Tolan FOR P, Guerra SALE N. WhatOR worksDISTRIBUTION in reducing adolescent violence: 90. Simcha-FaganNOT FOR O, Gersten SALE JC, LangerOR DISTRIBUTION TS. Early precursors and con- an empirical review of the field. In: Report to The Center for the Study and current correlates of patterns of illicit drug use in adolescents. J Drug Issues. Prevention of Violence. Chicago: University of Illinois at Chicago; 1994. 1986;16:7–28. 63. Garmezy N. Resiliency and vulnerability to adverse developmental 91. Herrenkhol TL, Maguin E, Hill KG, Hawkins JD, Abbott RD, outcomes associated with poverty. Am Behav Sci. 1991;34(4):416–430. Catalano RF. 2000. “Developmental Risk Factors for Youth Violence.” 64. Pransky J. Prevention: The Critical Need. Springfield, MO: Burrell Journal of Adolescent Health 26:176–186. © Jones & BartlettFoundation Learning,and Paradigm Press; LLC 1991. © Jones &92. Bartlett Blumstein A.Learning, 1995. “Youth Violence,LLC Guns and the Illicit-Drug NOT FOR SALE65. BensonOR DISTRIBUTION P, Galbraith J, Espeland P. What Kids Need to Succeed.NOT Search FORIndustry.” SALE Journal OR of Criminal DISTRIBUTION Law and Criminology 86:10–36. Institute and Free Spirit Publishing; 1994. 93. Spunt BJ, Goldstein PJ, Bellucci PA, Miller T. Race/ethnicity and 66. Search Institute. 1998. Developmental assets: an investment in youth. gender differences in the drugs-violence relationship. J Psychoactive Drugs. Available at: http://www.search-institute.org/assets/index.htm. Accessed 1990;22(3):291–303. January 4, 1999. 94. Goldstein P. The drugs/violence nexus: a tripartite conceptual frame- 67. Benard B. Fostering Resiliency in Kids: Protective Factors in the Family, work. J Drug Issues. 1985;493–506. School, and Community.© Unpublished Jones paper;& Bartlett 1991. Learning, LLC 95. Wilson WJ. The Truly Disadvantaged:© Jones The & Inner Bartlett City, the Underclass,Learning, LLC 68. Brofenbrenner NOTU. 1979. FOR The EcologySALE of ORHuman DISTRIBUTION Development. and Public Policy. Chicago: UniversityNOT of FORChicago SALEPress; 1987. OR DISTRIBUTION Cambridge, MA: Harvard University Press. 96. Bourgois P. In Search of Respect: Selling Crack in El Barrio. Cambridge, 69. Green LW, Kreuter MW (Eds). 1999. Health Promotion Planning: An England: Cambridge University Press; 1996. Educational and Environmental Approach. Third Edition. Mountain View, 97. Bourgois P. In search of Horatio Alger: culture and ideology in the CA: Mayfield Publishing Co. crack economy. Contemp Drug Prob. 1989;16(4):619–650. 70. Jessor R, Jessor SL. Problem Behavior and Psychosocial Development: A 98. Anderson E. The story of John Turner. In: Harrell AV, Peterson GE, Longitudinal© Jones Study & ofBartlett Youth. New York:Learning, Academic Press; LLC 1977. eds. Drugs,© CrimeJones and Social& Bartlett Isolation. Washington, Learning, DC: UrbanLLC Institute NOT71. Jessor FOR R, SALEDonovan ORJ, Costa DISTRIBUTION FM. Beyond Adolescence: Problem Press; 1992.NOT FOR SALE OR DISTRIBUTION Behavior and Young Adult Development. New York: Cambridge University 99. Anderson E. Streetwise: Race, Class and Change in an Urban Press; 1991. Community. Chicago: University of Chicago Press; 1990. 70. Donovan JE, Jessor R. The structure of problem behavior in adoles- 100. Fagan J. Drug selling and licit income in distressed neighborhoods: cence and young adulthood. J Consult Clin Psychol. 1985;53:890–904. the economic lives of street-level drug users and dealers. In: Harrell AV, 72. Donovan JE, Jessor R, Costa FM. Syndrome of problem behavior in Peterson GE, eds. Drugs, Crime and Social Isolation. Washington, DC: Urban © Jones & Bartlettadolescence: Learning, a replication. J Consult LLC Clin Psychol. 1988;56(5):762–765.© JonesInstitute & Bartlett Press; 1992. Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 22 Health Issues and Behavior © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 101. Fagan J, Wilkinson DL. 1998. “Guns, Youth Violence and Social 115. Colder CR, Mott J, Levy S. 2000. “The Relation of Perceived Identity in Inner Cities.” In M. Tonry and M. H. Moore (eds), Youth Neighborhood Danger to Childhood Aggression.” American Journal of Violence. Chicago: University of Chicago Press. Community Psychology 28(1):83–103. 102. Edberg M. AIDS risk behavior among runaway youth in the 116. UNAIDS. 2004 Report on the Global AIDS Epidemic. Geneva, Washington, DC-Baltimore area. In: Report of Multi-Site Runaway Risk Switzerland: UNAIDS; 2004. Behavior Study. Rockville, MD: National© Jones Institute on& DrugBartlett Abuse; 1992. Learning, 117.LLC Piot P, Bartos M, Ghys PD, Walker© N, Jones Schwartlander & BartlettB. The global Learning, LLC 103. Cook PJ, Laub JH. AugustNOT 2001. After FOR the Epidemic:SALE Recent OR Trends DISTRIBUTION impact of HIV/AIDS. Nature. 2001;410:968–973.NOT FOR SALE OR DISTRIBUTION in Youth Violence in the United States. Working Paper SAN01–22, Terry 118. Auerbach JD, Wypijewska C, Brodie HKH. AIDS and Behavior: An Sanford Institute of Public Policy. Durham, NC: Duke University. Integrated Approach. Washington, DC: National Academy Press; 1994. 104. Blumstein A. 1995. “Youth Violence, Guns and the Illicit-Drug 119. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Industry.” Journal of Criminal Law and Criminology 86:10–36. Report, 2003, Vol. 15. Atlanta, GA: U.S. Department of Health and Human 105. Blumstein A. 2001. “Why is Crime Falling?—Or Is It?” Perspectives Services, Centers for Disease Control and Prevention; 2004. on Crime and© Justice Jones Lecture & Series. Bartlett Washington, Learning, DC: National LLCInstitute of 120. UNAIDS. 2006© Jones Report on & the Bartlett Global AIDS Learning, Epidemic. Geneva, LLC Justice. NOT FOR SALE OR DISTRIBUTION Switzerland: UNAIDS;NOT 2006. FOR SALE OR DISTRIBUTION 106. Blumstein A, Wallman J (Eds.). 2000. The Crime Drop in America. 121. Beyrer C, Jittiwootikarn J, Teokul W, et al. Drug use, increasing New York: Cambridge University Press. incarceration rates, and prison-associated HIV risks in Thailand. AIDS 107. Spiegel I. 1995. The Youth Gang Problem: A Community Approach. Behav. 2003;7(2):153; citing Ministry of Public Health, Thailand, HIV/AIDS New York: Oxford University Press. Sentinel Surveillance Report. Bangkok; 2000. 108. Crick NR, Dodge KA. A review and reformulation of social infor- 122. UNAIDS Joint United Nations Programme on HIV/AIDS. AIDS © Jonesmation-processing & Bartlett mechanisms Learning, in children’s LLC social adjustment. Psychol Bull. ©Epidemic Jones Update: & BartlettDecember 2003. Learning, Geneva, Switzerland: LLC UNAIDS; 2003. NOT FOR1994;115:74–101. SALE OR DISTRIBUTION NOT123. FOR Dehne SALEKL, Pokrovskiy OR V,DISTRIBUTION Kobyshcha Y, Scwartlander B. Update 109. Crick NR, Dodge KA. Social information processing mechanisms in on the epidemics of AIDS and other sexually transmitted infections in the reactive and proactive aggression. Child Dev. 1996;67:993–1002. newly independent states of the former Soviet Union. AIDS. 2000;14(Suppl): 110. Cole J, Dodge KA. (1998). Aggression and antisocial behavior. In S75–S84. W. Damon (Editor in Chief) and N. Eisenberg (Vol. Ed.), Handbook of 124. UNAIDS/WHO. Epidemiological Fact Sheets on HIV/AIDS and child psychology, 5th edition. Volume 3. Social, emotional, and personality Sexually Transmitted Infections, 2004 Update. Geneva, Switzerland: UNAIDS; development. NY: John Wiley & Sons.© Jones & Bartlett Learning,2004. LLC © Jones & Bartlett Learning, LLC 111. Huesmann LR, Guerra NG. Children’s normative beliefs about aggres- 125. World Bank, www.worldbank.org. sion and aggressive behavior. J PersonalityNOT Soc FOR Psychol. SALE 1997;72:408–419. OR DISTRIBUTION 126. Chinese Bureau of Hygiene and TropicalNOT Diseases. FOR AIDS SALE Newsletter. OR DISTRIBUTION 112. Farrington DP. The psychosocial milieu of the offender. In: Gunn J, Beijing: Chinese Bureau of Hygiene and Tropical Diseases; 1996. Taylor PJ, eds. Forensic Psychiatry: Clinical, Legal and Ethical Issues. Oxford: 127. Chinese Ministry of Health, UNAIDS, and WHO. 2005 Update Butterworth-Heinemann; 1995:252–285. on the HIV Epidemic and Response in China. Beijing: Chinese Ministry of 113. Lochman JE, Dodge KA. Social-cognitive processes of severely vio- Health; 2006. lent, moderately© Jones aggressive and& Bartlettnon-aggressive Learning, boys. J Consult ClinLLC Psychol. 128. Kelly JA, Amirkhanian© Jones YA, & Kabakchieva Bartlett E, et Learning, al. Gender roles LLCand 1994;62:366–374. HIV sexual risk vulnerability of Roma (gypsies) men and women in Bulgaria 114. SlabyNOT RG, Guerra FOR NG. SALE Cognitive OR mediators DISTRIBUTION of aggression in adoles- and Hungary: an ethnographicNOT FOR study. AIDSSALE Care .OR 2004;16(2):231–245. DISTRIBUTION cent offenders: 1. Assessment. Dev Psychol. 1988;24:580–588.

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT OnFOR SALE the OR DISTRIBUTION Roots of Behavior— © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONA MultidisciplinaryNOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION CHAPTER 3 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Social/Behavioral Theory © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FORand SALE OR Its DISTRIBUTION Roots

about theory we need to make sure we are proceeding with LEARNING OBJECTIVES the same understandings about what it is we are talking By the end of this chapter, the reader will be able to: about. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC • Understand what is meant by the term “theory” in relation to First of all, the idea of theory is most associated with its explanations of behavior NOT FOR SALE OR DISTRIBUTIONuse in the context of the scientificNOT FOR method SALE. Let’s examine OR DISTRIBUTION that, • Understand some of the assumptions underlying theory as it is used in a scientific context, and the history behind those because its association with science gives the term a specific assumptions kind of meaning. Here, for example, is one definition of • Describe key influences on behavioral theory from psychology, theory, specifically oriented to the way in which theory is put social psychology, sociology, cultural anthropology, and the © Jonesstudy &of ecology/biologicalBartlett Learning, systems LLC into practice© Jones in social & science:Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT[Theory FOR is . . .] SALE A set of OR interrelated DISTRIBUTION constructs (concepts), definitions, and propositions that present a systematic view of phenomena by speci- “We vivisect the nightingale fying relations among variables, with the purpose To probe the secret of his note” © Jones & Bartlett Learning, LLC © Jones & Bartlettof explaining Learning, and predicting LLC phenomena.”1 NOT FOR SALE OR DISTRIBUTION—T.B. ALDRICH (1836–1907), AMERICAN WRITERNOT FOR SALEThe philosopher OR DISTRIBUTION of science Karl Popper framed theory in the manner most commonly used today in scientific inquiry.2 “No theory is good except on condition that one For Popper, a theory is a proposed explanatory solution to uses it to go beyond.” a problem. Most important, though, a theory’s validity is © Jones & —BartlettANDRE GIDE Learning, (1869–1951) LLCnot determined by proving© Jonesthe theory & true, Bartlett because Learning, that is LLC NOT FOR SALE OR DISTRIBUTIONeasy to do (i.e., it is easy toNOT come FOR up with SALE cases thatOR confirm DISTRIBUTION “It is difficult, if not impossible, for most a theory). The true test is in falsifying a theory. Therefore, people to think otherwise than in the fashion of theory is an explanatory proposition that can be tested, and their own period.” tested by falsification. If over time it is not falsified—assum- ing that it is tested in situations relevant to what the theory © Jones & Bartlett—GEORGE Learning, BERNARD LLCSHAW (1856–1950) claims—then© Jones it remains & Bartlett part of the Learning, ongoing body LLC of scien- NOT FOR SALE OR DISTRIBUTION tific knowledge.NOT FOR If it is SALE falsified, OR then DISTRIBUTION it can be either reworked or discarded. Either way, science is advanced. Before going any further, however, let’s take a look at THINKING ABOUT THEORY what theory is in a more basic sense. Definitions of theory, © Jones & BartlettYou’ve heard Learning, this discussion LLC before, perhaps in a science© Jones boiled & Bartlett down to Learning,their essence, referLLC to a kind of story (I will NOT FOR SALEclass orOR a philosophy DISTRIBUTION class. Still, before we proceed toNOT talk FORuse SALEthe broader OR term DISTRIBUTION account). So, we can think of theory as

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 26 Social/Behavioral Theory and Its Roots © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION an account that is said to explain something, and to posit Now we might hear this theory of the origin of men connections between phenomena. For example: and women, and the various derivative hypotheses, and pass “It is theorized that apples, and other physical objects, them off as mere “folk tales.” But why? By what standards fall from trees because of a ©force Jones called &gravity Bartlett which Learning,exerts would LLC we make such a judgment? We© Jones would say, & mostBartlett likely, Learning, LLC that effect.” that there is no proof for such things, and that they contra- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION “It is theorized that certain substances, called car- dict known facts about the origins of gender. cinogens, cause cells in the human body to mutate and Who is right? grow abnormally, out of control (in other words they are The problem here is that evaluating the validity of a the- cancerous).” ory or specific proposition is, of necessity, based on some set From© theories, Jones you & can Bartlett derive more Learning, specific applications LLC of standards or rules© Jones by which & toBartlett make such Learning, a judgment. LLC In such as hypotheses,NOT FOR principles, SALE and OR constructs. DISTRIBUTION We are going this sense, theoriesNOT can beFOR seen asSALE “language OR games” DISTRIBUTION like those to spend a little more time on these applications later in this described by philosopher Ludwig Wittgenstein,3 or a type of chapter. But first let’s focus on the general idea of theory as statement that is part of the tautological discourse of science a story or account. It could be said that a key characteristic described by recent French philosopher Michel Foucault.4-7 © Jonesof modern & Bartlett humans Learning, from prehistoric LLC times has been the cre- © JonesThey are& Bartlettpropositions Learning, that have meaning, LLC validity, and ation of tales, myths, and stories that, for example, describe truth (or falsity) within a specific context, such as a historical NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION an entire cosmological system, explain the creation of society, context, a social context, or a cultural context. Within their explain how men and women came to be what they are, and contexts, they are commonly held to be meaningful. Thus, so on. These are all theories in the broad sense, for they pres- to understand why a particular theory is meaningful, or to ent a coherent account from which more specific judgments evaluate its validity, you need to understand the contextual and conclusions can be drawn.© Jones So, if a theory& Bartlett says that Learning, men ground LLC rules, so to speak. Understanding© Jones those & ground Bartlett rules Learning, LLC were created from fire andNOT women FOR from SALE water, oneOR could DISTRIBUTION is one of the most important toolsNOT you can FOR have SALE in making OR DISTRIBUTION hypothesize, for example, that: a good assessment of theories about human behavior and in deciding when and where those theories will be useful to you • Men are highly emotional and prone to conflict (fire), in a practical sense. while women are better at solving or stopping con- What, then, is the context in which we use theory? What flicts© Jones(water on & fire). Bartlett Learning, LLC © Jones & Bartlett Learning, LLC are the ground rules? • MenNOT are destructive,FOR SALE while OR women DISTRIBUTION nourish. NOT FOR SALE OR DISTRIBUTION • Men provide what is necessary to survive in adverse THE CONTEXT OF THEORY IN THE WESTERN conditions (fire, warmth), while women provide the TRADITION sustenance (water) necessary all the time. Let’s start right out by stating that the term theory as it © Jones & Bartlett Learning, LLC ©is Jones commonly & Bartlettused derives Learning, its meaning LLC from a context of NOT FOR SALE OR DISTRIBUTION NOTWestern FOR philosophy SALE and OR science—that DISTRIBUTION is, the tradition origi- nating with the Greek philosophers and carried through in Michel Foucault (1926-1984): various forms, largely in Europe and North America. To say so is not to privilege this understanding of theory, but simply Basically, Foucault argued, in his many writings, that: to understand where it comes from so that its use can be situ- 1) discourse—which refers© to Jones a broader & category Bartlett of the Learning, ated LLC—that is, placed in a social and© historicalJones context.& Bartlett Now Learning, LLC various modes of expression,NOT including FOR SALElanguage, OR and DISTRIBUTIONof course, over the years this traditionNOT has FOR been SALEinfluenced, OR DISTRIBUTION how they are actually used—is the product of a his- amplified, and paralleled by currents of thought from out- torical period and its dominant social-economic institu- side its Euro-American mainstream, for example, by Islamic tions; and that 2) the discourse of a particular historical scholars Avicenna (ibn-Sina) and Averroes (ibn-Roshd), and period© incorporates Jones & a kindBartlett of system Learning, of rules for howLLC to Chinese philosophers© Jones Confucius & Bartlett (Figure 3-1), Learning, Chuang Tzu, LLC think about the world (what is true and false, normal and others. But for the most part, we are going to be talk- or notNOT normal, FOR and soSALE on). In ORthe Modernist DISTRIBUTION era of the NOT FOR SALE OR DISTRIBUTION ing about the concept of theory as a Western philosophical Industrial Revolution and science, for example, the type product. of discourse associated with science predisposes us to think in terms of truth or falsity based on rational or Confucius’s teachings are thought to have laid the © Jones &empirical Bartlett criteria. Learning, LLC © Jonesgroundwork & Bartlett for the Learning, “ideal man” LLC including how NOT FOR SALE OR DISTRIBUTION NOTman FOR (and SALE woman) OR should DISTRIBUTION live and interact with

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 The Context of Theory in the Western Tradition 27 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION others, and how man (and woman) should par- ticipate in society. Source: http://plato.stanford. FIGURE 3-1 Confucius (551–479 BCE) edu/entries/confucius/ What does “the© WesternJones tradition”& Bartlett mean? Learning, Again, let’s LLC © Jones & Bartlett Learning, LLC boil it down. HereNOT are several FOR key SALE elements OR of DISTRIBUTIONthe tradition NOT FOR SALE OR DISTRIBUTION that are relevant to understanding our use of theory. Order and Regularity It© would Jones be silly & Bartlettto suggest thatLearning, the idea of LLC order is unique to © Jones & Bartlett Learning, LLC Western thought. All cultures have at their root ideas about NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION the “natural order of things.” This is truly a fundamental human characteristic. And some of the most important non-Western philosophies and systems of society, including Confucianism, Taoism, and Navajo cosmology, include © Jones & Bartletthighly elaborated Learning, concepts LLC of natural order. © Jones & Bartlett Learning, LLC NOT FOR SALEHowever, OR DISTRIBUTION in Western society the idea of order tookNOT a FOR SALE OR DISTRIBUTION specific turn that fed directly into the development of science. The progressive discovery of an assumed order underlying nature, combined with the practical application of that knowledge to human© Jonesends, has & been Bartlett the focus Learning, of Western LLC © Jones & Bartlett Learning, LLC philosophy and science at least since the early Greeks. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Somewhere around the 4th century BCE, Democritus began to conceptualize the world as being composed of what he called “atoms,” discrete bits of matter that have size, shape, and solidity. Aristotle, in a series of astounding works, ana- Source: Picture downloaded from: http://en.wikipedia.org/wiki/ lyzed© Jones the logic & ofBartlett language, Learning, and, among LLC other intellectual Confucius© Jones & Bartlett Learning, LLC feats,NOT explicated FOR SALE a scheme OR for categorizingDISTRIBUTION and understanding NOT FOR SALE OR DISTRIBUTION natural phenomena based on concepts of matter and form, motion, space, and time.8 In contrast to other seminal Greek philosophers such as Plato, however, Aristotle emphasized turies) represented a fundamental break from church control ordering (classification) systems that would have practical over knowledge and theory. This came about for a number of © Jones & Bartlettapplication. Learning, Other early LLC Greeks were involved in the search© Jones reasons: & Bartlett the invention Learning, of the printing LLC press in the 15th cen- NOT FOR SALEfor order OR as DISTRIBUTION well, including a number of mathematiciansNOT such FORtury SALE and the ORresulting DISTRIBUTION spread of literacy; exploration of new as Pythagoras and Euclid. lands bringing evidence of human and geographic diversity; In the Middle Ages, roughly the period from the fall discoveries in astronomy that revealed other planets and sug- of the Roman Empire in the 5th century ACE to the 15th gested that the earth was not the center of the universe (e.g., century ACE, inquiry© Jones into the &order Bartlett of nature Learning, was treated LLC Galileo); the rise of natural© philosophers Jones & likeBartlett Locke, Voltaire,Learning, LLC as synonymous withNOT understanding FOR SALE divine OR order. DISTRIBUTION This is not Rousseau, and others; andNOT new directionsFOR SALE in art OR during DISTRIBUTION the surprising, because a key characteristic of the Middle Ages Renaissance. During the Enlightenment, the locus of expla- was a monopoly of knowledge and scholarship by the church. nation for natural phenomena shifted from the divine to Thus, Thomas Aquinas (in Summa Theologica, transcribed in the secular—to what was viewed as the primacy of reason the 13th century) argues for the coexistence of philosophy, and worldly evidence. Importantly, the rise in secular and created© Jones by human & Bartlett reason, andLearning, theology, revealedLLC knowledge rationalistic© Jones explanations & Bartlett also coincided Learning, with the LLC beginnings thatNOT exceeds FOR human SALE reason OR andDISTRIBUTION must be accepted on faith. of the IndustrialNOT FOR Revolution, SALE and OR the DISTRIBUTION shift in power from the His proof of the existence of God, for example, includes the church and monarchy to those who exploited science and argument that the order inherent in the natural world pre- technology for the production of goods. supposes a being that created the order. Yet the focus on order and regularity remained; the uni- © Jones & BartlettThe Learning,explosion of LLCscientific discovery in the period© Jones verse & Bartlett could be viewed Learning, through LLCthe metaphor of a mechanical NOT FOR SALEknown OR as the DISTRIBUTION Enlightenment (in general, the 17th–18thNOT cen- FORclock SALE whose ORgears DISTRIBUTIONclicked and turned inexorably, in autono-

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 28 Social/Behavioral Theory and Its Roots © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION mous, infinite repetition. Scientific inquiry abounded with energies or ideas; and the positive, where phenomena are the discovery of new laws; Newton and the law of gravity explained by observation, hypothesis, and experimentation.9 is a classic example. As scientific discovery grew, domains In Comte’s view, the orderly application of a positivistic of inquiry that were once unified© Jones as natural & Bartlett philosophy Learning, or approach LLC would eventually lead to© an Jones ability to& predictBartlett and Learning, LLC natural science began to diverge into discrete “fields”—biol- thus shape society. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ogy, physics, astronomy, and later sociology, anthropology, and psychology. The latter three fields, focusing more on the Empirical Data study of human beings and society, sought to (and still do) Here is where we have to bring in an important word—epis- develop as sciences in the same way as the physical sciences. temology. Basically, epistemology refers to ideas about how Foreshadowed© Jones by Francis & Bartlett Bacon and Learning, later Voltaire, LLC Auguste we know what we© know.Jones For & example: Bartlett Do Learning, we know some- LLC Comte andNOT others FOR in the SALE 19th century OR pushedDISTRIBUTION for a science of thing to be true NOTbecause FOR we see SALE it and ORcan touchDISTRIBUTION it? Do we humanity that would discover and use laws of human behav- know something is true because the thought exists in our ior—order and regularity—for the development of society. mind? Do we know it is true because somewhere in a sacred This general view was called positivism. text it is said to be true? These three questions actually represent three major trends in thought about how we know what © Jones &Positivism: Bartlett The Learning, philosophical LLC tradition asserting © Jones & Bartlett Learning, LLC we know—the first corresponds to empiricism, the second NOT FORthat SALE knowledge OR DISTRIBUTION is based on natural phenomena NOT FOR SALE OR DISTRIBUTION corresponds to rationalism, and the third corresponds to a and their properties and relations as verified by the theologic or deist orientation. empirical sciences. The scientific tradition in which the concept of theory Not all scientists or thinkers agreed with this trend, and developed is rooted in the empiricist tradition of John Locke in a debate that continues to© resonate Jones today, & Bartlett the human Learning, sci- and LLCDavid Hume, both British empiricists.© Jones The &epistemology Bartlett Learning, LLC ences were and remain splitNOT by controversies FOR SALE about OR whether DISTRIBUTION underlying empiricism is encapsulatedNOT by FOR the idea SALE that what OR DISTRIBUTION they should conceptualize themselves in the same way as the we know comes to us from our senses. We perceive an objective physical sciences, or as something different in important reality that is “out there” to be perceived, and our ideas about ways (see the work of Schiller, Dilthey, Husserl, as well more existence stem from those perceptions. This is in contrast to recent postmodern thinkers such as Foucault and others). In the rationalist tradition (from Descartes) in which reality is © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC any case, the idea of theory today is inseparable from the idea based in our mind (not an objective world “out there”), or the of order. NOT FOR SALE OR DISTRIBUTION phenomenologicalNOT tradition FOR (e.g., SALE William OR Dilthey, DISTRIBUTION Edmund Husserl), which argues that because it is individuals who Predictability do the perceiving, and individual perception is necessarily In a sense, predictability is the child of order and regular- influenced by both biology and one’s own life experiences, © Jonesity, for& Bartlettif nature is Learning,ordered, and LLCwe discover the details and ©culture, Jones and & history,Bartlett that Learning, perception is LLC never objective, but NOT FORrules ofSALE this order, OR thenDISTRIBUTION we can, theoretically, predict what NOTsubjective; FOR therefore, SALE ORwhat DISTRIBUTION we know of reality can never will happen. By now, this idea is so ingrained in our com- extend beyond our experience of it. Reality is then not objec- mon sense knowledge that few people actually stop to think tive, but an experienced reality. that it is itself an idea. But every night, when we listen to the Science in the empiricist tradition has thus relied on the weather report, we have an expectation that someone is using collection of observable, tangible data as evidence for state- science to make accurate (more© Jones or less) predictions& Bartlett about Learning, the ments LLC about reality. In keeping with© Jonesthe ideas &of Bartlettorder and Learning, LLC weather tomorrow or over theNOT next FORweek. WhenSALE we OR go to DISTRIBUTION the predictability, then, a theory in thisNOT tradition FOR is supposedSALE OR to DISTRIBUTION doctor and get a prescription, we assume that the doctor has say something about the observable, tangible relationships diagnosed the trouble and, based on science, is predicting between phenomena—relationships that are evidence-based. that a 10-day course of the prescribed medication will allevi- In later chapters, we will see how this “standard of evidence” ate or cure© the Jones problem. & Bartlett Learning, LLC is embedded in ©almost Jones all the & theoretical Bartlett approaches Learning, we willLLC It wasNOT Auguste FOR Comte SALE (1798–1857) OR DISTRIBUTION who really institu- study, and we willNOT also askFOR if that SALE is always OR enough. DISTRIBUTION tionalized this as a goal for the social or human sciences. He argued that human beings had gone through three stages Progress and Perfectability of thought on the road to modern science: the theologi- Progress in some form or another is part of many cultural cal, attributing events and phenomena to the supernatural; traditions of thought. In Buddhist or Hindu cultures, for © Jonesthe metaphysical,& Bartlett Learning,attributing phenomena LLC to fundamental ©example, Jones progress & Bartlett entails Learning, the recycling LLC of one’s soul, one’s NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 Antecedents 29 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION karma, through reincarnation, until the soul reaches a state of enlightenment or nirvana. In Western culture, the idea of A Sample of Thinkers in the progress has some roots that sound very similar. In Plato’s Western Tradition seminal philosophical© Jones work, the & Republic Bartlett, there Learning, is the famous LLC © Jones & Bartlett Learning, LLC allegory of the cave, in which the path to true knowledge is NOT FOR SALE OR DISTRIBUTION • Plato and Aristotle:NOT Classical FOR Greek SALE philosophers, OR DISTRIBUTION represented by a journey from the depths of a cave where all focusing on wide-ranging themes from ethics to the is shadow and image (not the “real thing”), to the final stage nature of social organization, the composition of of emergence out into the light, where it is possible to see the matter, the classification of knowledge, and much true essence (the “Form”) of things. more. © JonesFrancis Bacon,& Bartlett philosopher, Learning, one-time LLC Lord Chancellor • Rene© Jones Descartes: & French Bartlett philosopher Learning, and progenitor LLC of inNOT England, FOR and SALE grand intellectualOR DISTRIBUTION reformer of the late 16th theNOT rationalist FOR tradition.SALE OR DISTRIBUTION and early 17th centuries, proposed (in several treatises on • John Locke and David Hume: English philosophers and the advancement of learning) to replace the entire existing representatives of the empiricist tradition. intellectual framework, which consisted of unchallenged • Auguste Comte: Originator of the idea of a “science of society.” © Jones & Bartlettsuperstition, Learning, philosophy, LLC and style over substance, with© Jones a & Bartlett Learning, LLC new paradigm emphasizing empiricism, progress, and the • Edmund Husserl and William Dilthey: Proponents of NOT FOR SALE OR DISTRIBUTION NOT FOR SALEthe tradition OR DISTRIBUTION of phenomenology. practical use of knowledge.10-12 • Charles Darwin: Key founder (with others) of evolu- Almost every major scientific and social thinker from tionary theory and natural selection. the Enlightenment onward has incorporated the assumption • Emile Durkheim (sociology), Franz Boas (anthropol- of progress as an essential part of their theories. You can cer- ogy), Sigmund Freud (psychology): Influential social tainly say this about,© for Jones example, & CharlesBartlett Darwin Learning, and evolu- LLC theorists of the early© 20thJones century. & Bartlett Learning, LLC tionary theory; HerbertNOT Spencer FOR andSALE Social OR Darwinism; DISTRIBUTION G.W. • Karl Popper: PhilosopherNOT of FORscience SALE and champion OR DISTRIBUTIONof Friedrich Hegel and the historical progression of spirit; social the scientific method. theorists Karl Marx, Max Weber, and Emile Durkheim and • Michel Foucault: French philosopher of the mid-20th their respective ideas about the stages through which societ- century who elucidated the connections among lan- ies evolve; and psychologists such as Sigmund Freud and Erik guage, power, and thought. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Erikson and the stages of psychological development. For all theseNOT thinkers, FOR SALEtime does OR not DISTRIBUTIONstand still. NOT FOR SALE OR DISTRIBUTION In short, the assumption of progress is an integral part of our way of thinking. For the endeavor we call science, and Psychology/Social Psychology the meaning of theory, it is impossible to separate progress As in any discipline today, there are numerous subfields and © Jones & Bartlettout. “Doing Learning, science” by LLC definition involves a continuous© Jones subdisciplines. & Bartlett ThisLearning, is also true LLC for psychology, but certain NOT FOR SALEaccumulation OR DISTRIBUTION of knowledge, leading towards a moreNOT and FORsubfields SALE have OR had DISTRIBUTION the most impact on behavioral theory more expansive understanding of our world. Proposing and in public health. Freudian psychology, for example, has not testing theory is an essential part of this process, where theory left much of a mark in this respect. But behavioral, cognitive, is the “tactic” used to generate scientific investigation, and to ecological, and humanistic psychological theory have all made build knowledge. significant contributions, as has social psychology. From this description,© Jones can & Bartlettyou see how Learning, theory, in LLC © Jones & Bartlett Learning, LLC this context, incorporatesNOT FOR concepts SALE of order, OR predictability,DISTRIBUTION Behaviorist Psychology NOT FOR SALE OR DISTRIBUTION empirical data, and progress? This is an early school of psychology dating from the late 19th century in which behavior is said to be learned or condi- ANTECEDENTS tioned through the action of stimulus-response mechanisms. Let’s© Jones now review & Bartlett a range of moreLearning, specific theoreticalLLC anteced- Little importance© Jones is & placed Bartlett on the Learning, thinking process LLC itself, or entsNOT to currentFOR SALE behavioral OR theory DISTRIBUTION as it is employed in public such thingsNOT as FORemotion, SALE because OR human DISTRIBUTION beings are treated as health. The primary fields from which public health behav- organisms and the most important process is considered to ioral theory have been derived are psychology and social be the impact of an environment on what were viewed as the psychology, so we will begin with these, then proceed briefly brain’s reflexive responses. Internal mental processes are thus to several other fields, including ecology, sociology, anthro- treated as a kind of “black box,” where a stimulus is applied © Jones & Bartlettpology, and Learning, others that haveLLC made important contributions.© Jonesand & aBartlett behavior results.Learning, The first LLC behaviorists were Russian, NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 30 Social/Behavioral Theory and Its Roots © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION including the seminal researcher Ivan Pavlov (1849–1936). Planned Behavior, and Social-Cognitive Theory (among Pavlov designed an experiment using an approach that has others), all of which assume that internal processes, to one come to be called classical conditioning. He rang a bell at the degree or another, determine behavior. This includes calcu- same time that he placed meat© Jones powder & on Bartlett a dog’s tongue Learning, lations LLC of risk and benefit, expectations© Jones related & to Bartlett outcome, Learning, LLC (which caused the dog to salivate). After repeating this a and so on. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION number of times, he tried ringing the bell alone, with no meat powder. The dog salivated anyway, demonstrating the effect Humanistic Psychology of the conditioned stimulus of the bell, which had become In part a reaction to what some perceived as the mecha- associated with the meat powder. In the United States, nistic and determinist character of behaviorism, cognitive Edward Thorndike© Jones and & John Bartlett Watson Learning, were well-known LLC early psychology, and© Freudian Jones psychology, & Bartlett the Learning, development LLCof behaviorists.NOT FOR SALE OR DISTRIBUTION humanistic psychologyNOT FORdrew SALEon a philosophical OR DISTRIBUTION tradition B.F. Skinner (1904–1990) transformed classical condi- that emphasizes individual agency, the capacity of people to tioning into its modern version, called operant conditioning.13 make choices and determine their future. The basic belief or Still based on the same basic assumptions about the reflexive assumption underlying humanistic psychology is that human © Jonesresponses & Bartlett between Learning, the human mindLLC and its environment, ©beings Jones ultimately & Bartlett desire toLearning, grow and attainLLC their potential. this form of conditioning involves a number of steps and However, as Abraham Maslow articulated in his famous hier- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION processes: A specific behavior is conditioned through the archy of needs,18 before people can pursue this kind of higher- application of positive and negative reinforcements associ- level growth, they must first be able to satisfy a set of needs, ated with the behavior. Reinforcements, however, can be from basic physiological to emotional and social. provided at various intervals or schedules that have different Although the ties between this approach and a specific effects in terms of maintaining© Jones the behavior, & Bartlett and a behavior Learning, public LLC health theory are not always© Jones direct, it& isBartlett clearly a Learning, LLC can be learned through shapingNOT—by FOR reinforcing SALE approxima- OR DISTRIBUTIONgeneral influence on the “philosophy”NOT of publicFOR health,SALE com- OR DISTRIBUTION tions of the behavior that keep getting closer and closer to monly expressed in definitions of public health or health the actual behavior. Behaviors can also be deconditioned. The promotion as the goal of improving quality of life for the approach as a whole is referred to as behavior modification. general public, or goals related to the promotion of healthy Behaviorist approaches are currently used as ther- lifestyles and healthy choices. Thus health promotion, in part, © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC apy in smoking cessation and other addiction treatments. involves the promotion of conditions, including the satisfac- Importantly,NOT for FORour purposes, SALE the OR basic DISTRIBUTION assumptions about tion of basic needsNOT such FOR as housing, SALE employment, OR DISTRIBUTION and access learning behavior through positive and negative reinforce- to health care, which allow people to live healthier (higher ment appear in a number of health behavior theories. quality) lives. Cognitive Psychology Social Psychology © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORAs its SALEname suggests, OR DISTRIBUTION cognitive psychology focuses on the NOTAlthough FOR the SALE discipline OR of psychologyDISTRIBUTION as a whole is concerned thinking process itself as the source of behavior. So, in con- with the mental processes and behaviors of individuals, the trast to behaviorism which views internal mental processes branch known as social psychology is concerned about how as insignificant, the inside of the black box is of interest this individuals (and their mental processes) interact with their time. The thinking process as addressed in cognitive psychol- social surroundings—groups, relationships, and other social ogy includes perception, memory,© Jones decision & making,Bartlett interpre- Learning,units. LLC This may include inquiries ©regarding Jones issues & Bartlett of group Learning, LLC tation, reasoning, and judgment,NOT among FOR other SALE faculties. OR DISTRIBUTIONdynamics, authority and legitimacy,NOT emotion FOR and SALE its expres- OR DISTRIBUTION According to Jean Piaget, one of the most influential sion, aggression, self and identity, motivation, gender, group thinkers in this school, there are two key ways in which we prejudices (the process of “othering”), norms, attitudes, and process information: assimilation, fitting new information other related topics. Health behavior, as we saw in the first into existing© Jones categories & ofBartlett knowledge, Learning, and accommodation LLC , chapter, is often complex© Jones and &motivated Bartlett by social Learning, factors, so LLCthe changing/adaptingNOT FOR existing SALE beliefs OR to incorporateDISTRIBUTION new infor- subject matter ofNOT social psychologyFOR SALE is clearly OR related DISTRIBUTION to a num- mation.14-17 Piaget is also famous for his theory on the stages ber of behavioral theories and approaches in public health. of cognitive development: sensorimotor, preoperational, Like everything else we have been discussing, we can’t concrete operational, and formal operational. possibly cover the whole of social psychology, so we will have Cognitive psychology is an important part of such to pick out a few individuals or approaches for illustrative © Jonesbehavioral & Bartlett theories Learning, as the Health LLC Belief Model, Theory of ©purposes. Jones One& Bartlett important Learning, issue is the nature LLC of social influ- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 Antecedents 31 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ence on individual behavior; for example, the famous experi- Influences from sociology on public health include: ments on authority and obedience conducted by psychologist • The influence and role of social structure and class on Stanley Milgram19,20 in which he tested the willingness of the paths available to individuals: Karl Marx, Friedrich individuals to administer a harmful electric shock to other © Jones & Bartlett Learning, LLC Engels, Max Weber,© Jonesand many & othersBartlett have Learning, written LLC individuals if instructed to do so by persons who were pre- NOT FOR SALE OR DISTRIBUTION about the ways inNOT which FOR societies SALE are ORdivided DISTRIBUTION by sented as “authorities.” The results of this study were widely class; more recently, theorists like Pierre Bourdieu28 publicized and raised considerable questions about people’s have looked at the way in which class/social position willingness to set aside their own moral judgments in order becomes part of one’s practical understanding about to obey or conform to authority. Other studies have looked at what to expect in terms of day-to-day life (including the© effectJones of belonging& Bartlett to groups Learning, on conformity LLC of behavior © Jones & Bartlett Learning, LLC health). This has also played a role in concepts about and thought. Irving Janis,21,22 for example, investigated the NOT FOR SALE OR DISTRIBUTION socialNOT ecologies FOR SALE and their OR role DISTRIBUTION in health. phenomenon of “groupthink” in government decision mak- • The influence of the group on behavior: Group norms ing; Crandall23 investigated the same phenomenon in terms and conformity. There is overlap here with social psy- of its effect on eating disorders within a sorority. chology; however, these issues are very important to Another area of focus has to do with attitudes and behav- © Jones & Bartlett Learning, LLC © Jones & Bartlettlater developments Learning, in healthLLC behavior theory. Emile ior. Attitudes are complex connections of belief, identity, and NOT FOR SALE OR DISTRIBUTION NOT FOR SALEDurkheim, OR DISTRIBUTION29 among others, had a tremendous early social relations. Social psychologists have been interested for influence on the discussion of social conformity. a considerable period of time in the relationships between • Social capital: The social networks and resources one attitudes and behavior and the consistency of attitudes. has, and how these influence access to education, Two early positions included the idea that when behaviors jobs, health care, and other social benefits.30-32 contradict attitudes© ( dissonanceJones &), peopleBartlett tend Learning, to rationalize LLC © Jones & Bartlett Learning, LLC • Social organization: Durkheim,29 Weber,33,34 and oth- or adjust their attitudes in order to address the dissonance NOT FOR SALE OR DISTRIBUTION ers contributed significantlyNOT FOR to theory SALE and OR analysis DISTRIBUTION of between attitudes and behavior.24 Another view held that the ways in which society is structured, the ways in people infer their attitudes over time from experiences about which labor is divided, and the nature of and motiva- how they behave in similar situations.25 Very much related tion for social action. to specific health behavior theories we will be discussing in © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC later chapters, psychologists Martin Fishbein and Icek Ajzen Anthropology has, since early in the history of the disci- proposedNOT FOR intentions SALE as anOR intermediate DISTRIBUTION factor between atti- pline, addressedNOT FOR issues SALE related ORto public DISTRIBUTION health.* In the early tudes and behavior, where attitudes are one of several factors 20th century, Franz Boas laid the groundwork in his fight to (including perceived norms/opinions of significant others) counter racist stereotypes and to help the public understand that act on intentions.26,27 varieties of cultural patterns on their own terms. Margaret © Jones & Bartlett Learning, LLC © JonesMead, & Bartlett perhaps theLearning, most public LLC of anthropologists, utilized Social Sciences: Sociology, Cultural Anthropology NOT FOR SALE OR DISTRIBUTION NOT FORher SALEresearch ORon childrearing, DISTRIBUTION adolescence, and gender issues Sociology and anthropology have some similarities in that to influence the debate here in the United States about how both fields focus on the social, societal, or cultural aspects of to understand and work with adolescents (among other behavior in contrast to the more individual focus of psychol- issues). ogy. Neither are clinical disciplines; thus, research and theory A number of anthropologists in the mid-20th century, rely on different methods© Jones and approaches& Bartlett than Learning, are found in LLC including Ruth Benedict, ©Margaret Jones Mead, & Bartlett Abram Kardiner, Learning, LLC psychology, but fromNOT there FOR they differ.SALE Sociology OR DISTRIBUTION has gener- Cora DuBois, John and BeatriceNOT FOR Whiting, SALE Irving OR Hallowell, DISTRIBUTION ally focused more on domestic social phenomena, whereas and Anthony F.C. Wallace, focused their work on the con- cultural anthropology has addressed both global and domes- nections between culture and personality, and its expression tic themes, often in a comparative manner. Sociologists are as behavior. This line of inquiry continued with cognitive and more© Jones interested & Bartlett in social groups,Learning, social LLChierarchies, social psychological© Jones anthropologists & Bartlett such Learning, as Ward Goodenough, LLC structures,NOT FOR and SALE the nature OR DISTRIBUTIONof social interaction. Cultural Roy D’Andrade,NOT FOR Melford SALE Spiro, OR Claudia DISTRIBUTION Strauss, Dorothy anthropologists are interested more in the role of culture in human behavior, in the ways in which life patterns are organized, in systems of knowledge and belief, and in the * Anthropology as a whole encompasses four subfields: sociocultural anthropology, archaeology, physical (biological) anthropology, and language, symbols, and other ways we “represent” life and © Jones & Bartlett Learning, LLC © Jonesanthropological & Bartlett linguistics. Learning, Cultural anthropology LLC and physical anthropology its meaning. have had the most interaction with issues of public health. 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© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 32 Social/Behavioral Theory and Its Roots © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Holland, and Naomi Quinn, who have looked, for example, other issues. Arthur Kleinman has been a pioneer in at cultural models people refer to in patterning their behavior. exploring and presenting the sociocultural nature of Other directions in anthropology, for example the material- disease and illness, and how these are experienced 40 ist tradition exemplified by ©the Jones work of &Marvin Bartlett Harris, Learning, have LLCand treated across cultures.© Jones & Bartlett Learning, LLC focused more on the relationship between human behavior NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION and systems of production. Ecology and Biological Systems Influences of cultural anthropology on public health In a different vein, the fields of ecology and human ecology theory and practice include: have influenced the way in which health behavior is cur- • The© holisticJones approach & Bartlett to health Learning, (and other) LLC behavior rently conceptualized© Jones as an outcome & Bartlett of a complex Learning, system LLC of reflected in what is known as the ecological model:35 influences from several domains (e.g., policy and regulation, ThisNOT refers FOR to the SALE idea that OR human DISTRIBUTION behavior can never sociocultural factors,NOT the FOR physical SALE environment, OR DISTRIBUTION and indi- properly be understood outside of the social, cultural, vidual factors). This is known as the ecological model,35,41,42 and situational context in which it occurs, as we saw and it is the prevalent general framework in public health for in our introductory chapter. understanding health behavior. (Remember? We referred to © Jones &• BartlettThe idea of Learning, cultural competency LLC or culturally appro- ©it Jonesin Chapter & 1.)Bartlett Learning, LLC NOT FOR SALEpriate (health) OR DISTRIBUTION programs and care: Health, concepts NOTEcology FOR SALEis the study, OR within DISTRIBUTION the general field of biology, of what is healthy or not healthy, classifications of of the ways in which living organisms function within sys- disease and/or illness and the causes of diseases and tems. The food chain is an obvious example: Many different illnesses, what kinds of treatments are appropriate organisms depend on other organisms and a specific physical and who are the health providers, and how to inter- environment for their existence. When there is a disruption © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC act with someone who is ill are heavily influenced in the system, say, if one organism becomes extinct or a cru- by culture. Given theNOT diversity FOR of SALE patient OR popula- DISTRIBUTIONcial body of water dries up, the entireNOT system FOR and SALE its organ- OR DISTRIBUTION tions, understanding what kinds of health beliefs isms are affected. Human ecology applies the same focus to and practices a patient brings and how to interact the ways in which humans function as a part of a biophysical with diverse populations is a very important part of and social environment. In other words, human existence the© development Jones & ofBartlett health promotion Learning, and treatmentLLC cannot be conceptualized© Jones as &separate Bartlett from Learning,the environment LLC programs.NOT FOR SALE OR DISTRIBUTION in which we live.NOT From bothFOR fields, SALE the general OR DISTRIBUTION principle is the • The relationship of specific cultural settings and prac- same: Life, and the behavior of living organisms, exists within tices to health problems: Anthropologists like Merrill interdependent systems. Singer36 and Paul Farmer37,38 have been deeply The idea of ecology should help you tie together all the involved in research underscoring the link between kinds of theories and approaches we will cover in this book, © Jones & Bartlettconditions Learning,of poverty and LLC oppression and the spread ©in Jones the sense & that Bartlett each theory Learning, is useful in LLCdescribing or under- NOT FOR SALEof HIV/AIDS. OR DISTRIBUTION Mark Nichter is well known for his NOTstanding FOR a piece SALE of the OR puzzle. DISTRIBUTION Yet it is the way that the pieces work on culture and adolescent smoking,39 among work together that is the key.

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 Chapter Questions 33 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Chapter© Jones Questions & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

1. Define theory. Why is a theory like a story?

© Jones & Bartlett2. The Learning,term theory as LLC we know it takes its mean- © Jones & Bartlett Learning, LLC NOT FOR SALE ingOR from DISTRIBUTION a Western tradition of philosophy NOT FOR SALE OR DISTRIBUTION and science that has four main tenets. What are they? 3. What are the “schools of thought” in psychology that contributed© Jones to &modern Bartlett behavioral Learning, LLC © Jones & Bartlett Learning, LLC theory? NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 4. What are some contributions from the social sciences—sociology and anthropology—on modern behavioral theory? ©5. JonesWhy, as &public Bartlett health practitioners,Learning, is LLC it impor- © Jones & Bartlett Learning, LLC NOTtant FOR for us SALE to understand OR DISTRIBUTION the concepts of social NOT FOR SALE OR DISTRIBUTION psychology? Anthropology? 6. How has the study of natural systems contributed an important concept to modern behav- © Jones & Bartlettioral Learning, theory in public LLC health? © Jones & Bartlett Learning, LLC NOT FOR SALE7. WhyOR isDISTRIBUTION it important to develop health promo- NOT FOR SALE OR DISTRIBUTION tion programs within the context of an ecological model?

© Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 2006 34 Social/Behavioral Theory and Its Roots © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION REFERENCES 22. Janis IL. Groupthink: Psychological Studies of Policy Decisions and Fiascoes, 2nd ed. Boston, MA: Houghton Mifflin; 1982. 1. Kerlinger, FN. (1986). Foundations of behavioral research (3rd ed.). 23. Crandall CS. Social contagion and binge eating. J Pers Soc Psychol. New York: Holt, Rinehart and Winston. 1988;55:588–598. 2. Popper K. Conjectures and Refutations. London: Routledge and 24. Festinger L, Carlsmith JM. Cognitive consequences of food compli- Kegan Paul; 1963. © Jones & Bartlett Learning,ance. LLC J Abnorm Soc Psychol. 1959;58:203–210.© Jones & Bartlett Learning, LLC 3. Wittgenstein L. PhilosophicalNOT Investigations. FOR SALENew York: OR Macmillan; DISTRIBUTION 25. Bem D. An experimental analysisNOT of self-persuasion. FOR SALE J Exp ORSoc DISTRIBUTION 1965. Psychol. 1965;1:199–218. 4. Foucault M. The Archaeology of Knowledge. Sheridan Smith AM, 26. Fishbein M, Azjen I. Attitudes towards objects as a predictor of trans. New York: Harper Colophon; 1972. single and multiple behavioral criteria. Psychol Rev. 1974;81:59–74. 5. Foucault M. The Birth of the Clinic: An Archaeology of Medical 27. Fishbein M, Azjen I. Belief, Attitude, Intention, Behavior: An Perception. Sheridan Smith AM, trans. New York: Vintage/Random House; Introduction to Theory and Research. Reading, MA: Addison Wesley; 1975. 1976. © Jones & Bartlett Learning, LLC 28. Bourdieu P. ©Outline Jones of a Theory & Bartlett of Practice. Cambridge: Learning, Cambridge LLC 6. FoucaultNOT M. DisciplineFOR SALE and Punish: OR The BirthDISTRIBUTION of the Prison. Sheridan University Press; 1977.NOT FOR SALE OR DISTRIBUTION A, trans. New York: Vintage/Random House; 1979. 29. Durkheim E. The Division of Labor in Society. New York: Free Press; 7. Foucault M. Power/Knowledge: Selected Interviews & Other Writings, 1893/1997. 1972–1977. Gordon C, ed. Gordon C, Marshall L, Mepham L, Soper K, trans. 30. Bourdieu P. The forms of capital. In: Richardson J, ed., Handbook New York: Pantheon Books; 1980. of Theory and Research for the Sociology of Education. New York: Macmillan; 8. Aristotle. The Complete Works of Aristotle: The Revised Oxford 1986: © JonesTranslation & Bartlett. Barnes J, ed. Learning, Princeton University LLC Press; 1984. © Jones31. Coleman & BartlettJS. Social capital Learning, in the creation LLC of human capital. Am J NOT FOR 9. SALEThe Columbia OR Encyclopedia, DISTRIBUTION 6th ed. Comte, Auguste. New York: NOTSociol. 1988;94(Suppl):S95–S120.FOR SALE OR DISTRIBUTION Columbia University Press; 2001. 32. Putnam R. Bowling Alone: The Collapse and Revival of American 10. Gaukroger S. Francis Bacon and the Transformation of Early-Modern Community. New York: Simon and Schuster; 2000. Philosophy. New York: Cambridge University Press; 2001. 33. Weber M. Economy and Society. Roth G, Wittich C, trans/eds. New 11. Vickers B. ed. Francis Bacon. New York: Oxford University Press; York: Bedminster Press; 1968. 1996. 34. Weber M. Essays in Sociology. Gerth HH, Mills CW, eds. New York: 12. Whitney C. Francis Bacon© and Jones Modernity. & New Bartlett Haven, CT: Learning, Yale Oxford LLC University Press; 1958. © Jones & Bartlett Learning, LLC University Press; 1986. 35. Green LW, Kreuter MW, eds. Health Promotion Planning: An 13. Skinner BF. Walden II. NewNOT York: Macmillan;FOR SALE 1948. OR DISTRIBUTIONEducational and Environmental Approach,NOT 3rd ed. FOR Mountain SALE View, ORCA: DISTRIBUTION 14. Piaget J. The Child’s Conception of the World. New York: Harcourt, Mayfield; 1999. Brace Jovanovich; 1929. 36. Singer M. AIDS and the health crisis of the urban poor: The perspec- 15. Piaget J. The Moral Judgment of the Child. New York: Harcourt, tive of critical medical anthropology. Soc Sci Med. 1994;39(7):931–948. Brace Jovanovich; 1932. 37. Farmer P. Infections and Inequalities. Berkeley: University of 16. Piaget© J. Jones The Mechanisms & Bartlett of Perception Learning,. London: Rutledge LLC & Kegan California Press; 1998.© Jones & Bartlett Learning, LLC Paul; 1969. 38. Farmer P. Pathologies of Power. Berkeley: University of California 17. PiagetNOT J. The FOR Science ofSALE Education OR and DISTRIBUTIONthe Psychology of the Child. Press; 2003. NOT FOR SALE OR DISTRIBUTION New York: Grossman; 1970. 39. Nichter M. Smoking: what’s culture got to do with it? Addiction. 18. Maslow A. Motivation and Personality, 3rd ed. New York: Harper; 2003;98(Suppl 1):139–145. 1987. 40. Kleinman A. Patients and Healers in the Context of Culture: An 19. Milgram S. Behavioral study of obedience. J Abnorm Soc Psychol. Exploration of the Borderland Between Anthropology, Medicine and Psychiatry. 1963;67:371–378. Berkeley: University of California Press; 1981. © Jones20. & Milgram Bartlett S. Obedience Learning, to Authority. LLC New York: Harper & Row; © Jones41. Bronfenbrenner & Bartlett U. The Learning,Ecology of Human LLC Development. Cambridge, NOT FOR1974. SALE OR DISTRIBUTION NOTMass.: HarvardFOR UniversitySALE Press;OR 1979.DISTRIBUTION 21. Janis IL. Victims of Groupthink. Boston, MA: Houghton Mifflin; 42. Lewin K. In: Cartwright D, ed. Field Theory in Social Science: Selected 1972. Theoretical Papers. New York: Harper & Row; 1951.