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Abstract/Syllabus:
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410.616
Social and Behavioral Aspects of Public Health
Description
The course is designed to help students develop basic literacy regarding social concepts and processes that influence health status and public health interventions. The course also hopes to help students develop insight into populations with whom they have worked in the past or will work in the future, and to develop one kind of effective writing tool (the narrative) for communicating about psychosocial issues in public health. These overall aims are approached through lectures, discussion, readings, workshopping, individual compositions, and group discussion of student writings.
Course Objectives
- To familiarize students with views on key concepts that form a basis for literacy in the social and behavioral aspects of public health: culture, race/ethnicity, gender, poverty/disparities, factors related to behavior change, community, organizational climate, family.
- To familiarize students with the concept of a narrative as a therapeutic, policy, and investigative tool.
- To help develop empathy for and a collaborative stance toward populations with whom one will work in the field of public health.
- To promote interest in further study of the social and behavioral determinants of health.
OCW offers a snapshot of the content used in courses offered by JHSPH. OCW materials are not for credit towards any degrees or certificates offered by the Johns Hopkins Bloomberg School of Public Health.
Syllabus
Course Description
The course is designed to help students develop basic literacy regarding social concepts and processes that influence health status and public health interventions. The course also hopes to help students develop insight into populations with whom they have worked in the past or will work in the future, and to develop one kind of effective writing tool (the narrative) for communicating about psychosocial issues in public health. These overall aims are approached through lectures, discussion, readings, workshopping, individual compositions, and group discussion of student writings.
Course Objectives
- General background: The overall framework for the course is based on the biopsychosocial or ecologic perspective on health. In these models, health is seen as being determined by biologic, behavioral, social, and environmental factors that interact with each other and, to a greater or lesser extent, can be influenced by individuals and groups.
- Specific aims:
- To familiarize students with views on key concepts that form a basis for literacy in the social and behavioral aspects of public health: culture, race/ethnicity, gender, poverty disparities, factors related to behavior change, community, organizational climate, family.
- To familiarize students with the concept of a narrative as a therapeutic, policy, and investigative tool.
- To help develop empathy for and a collaborative stance toward populations with whom one will work in the field of public health.
- To promote interest in further study of the social and behavioral determinants of health.
- Teaching philosophy
- Less is more - topics are selected to introduce selected issues rather than provide comprehensive review; less reading, attempt to pick articles that are not too technical, hope in that way that busy students can actually complete the reading assignments.
- Study that is personally engaging is more likely to be meaningful. The course attempts to be engaging and not an intellectualized view of the topics.
- Emphasis on peer discussion and feedback as befitting graduate school and rich, diverse backgrounds of students. Emphasis on the community of learners versus the teacher as oracle.
- Skills/knowledge at end our course
- Have the ability to recognize importance of key biopsychosocial/ecologic concepts when they appear (or fail to appear) in studies of public health problems.
- Develop a sense of empathy and partnership with individuals and groups who become involved in public health problems; develop ability to tell/listen to stories as a mechanism for developing empathy and partnership.
- Develop ability to read and write narrative accounts of public health problems.
- Develop ability to work collaboratively to achieve clear communication (often across cultural and language barriers) about public health problems.
Course Requirements
- Units are comprised of a lecture/discussions or lectures and presentation and discussion of student narratives
- For each unit, there is one main article assigned, with other optional background readings. The lecture material serves as a framework for a large-group discussion; we will try to highlight material from the readings and encourage questions related to the readings.
- For four of the units (see schedule), students are asked to write a 2-3 page narrative describing either their personal experience with the topic or something vicariously experienced through contact with other individuals or communities. Details about writing narrative are presented in the introductory lecture.
- Narrative writing is done in stages:
- Initial composition alone
- Workshopping with a partner (time allotted in class)
- Revision alone
- Optional lab time for further revision
- Reading aloud to class followed by discussion
- Optional recording in lab time
- Lab sessions: these sessions are optional. They represent office hours to discuss course or related material in more depth and in addition:
- Opportunities for workshopping materials with the instructors
- Training in basic audio editing and recording for narratives
- Opportunities to record and edit narratives
- Reading narrative: students are asked to select a chapter from one book from the course list and use it as an example of narrative and as a source of information about the key topic or topics for which they have the most interest. Other narrative sources can include the narrative sections included in many medical journals. This will be the basis for one of the midterm assignments.
- Midterm assignments
- Students will be asked to turn in their second narrative. The submitted material should include the original narrative and the final workshopped version. Criteria for evaluation include:
- Is there a focus? This need not come out immediately with a topic sentence; however, by the end, the reader should feel that there has been a specific point or points made?
- Does your voice or the voice of the protagonist really come through? What techniques are used to do this?
- Is it detail-rich and multi-layered? Are specific events, people, and situations described?
- Does the writing convey feelings?
- Is the flow of ideas coherent? Are there discontinuities in voice or topic, are these explained?
- Are there insights revealed beyond telling the story? This goes back to (a): is the story a stepping-off point to something deeper or more generalizable?
- A brief review of the outside narrative material (described above). The review should be 3-4 pages long and include a summary of the following points. When addressing these points, use specific examples. Give full bibliographic information about the narrative so that others can locate it.
- Implications for public health interventions or policies that stem from the experiences of the lead character(s) and his/her/their community
- Techniques the author(s) use to help readers understand the social reality of the characters
- Techniques the authors(s) use to convey the voice of the subjects and to create a personal connection with the reader
- Final assignments
- A portfolio of the narratives written during the course. Each narrative should be preceded by a 1-2 paragraph definition of the key topic to which it is linked. The definition should include references. The original version of each narrative plus the revised workshopped version should be included. Evaluation of the portfolio will be based on 1) the definition paragraphs, 2) overall completeness of the portfolio, and 3) detailed reading by the instructors of one of the narratives (students should indicate which they would like the instructor to read in detail).
- Short answer exam about a short narrative. It involves reading a short narrative and answering some questions about its content, form, and related information from the course.
- Evaluation: 15% on the mid-term narrative, 15% on the midterm narrative review/analysis, 20% on the final short answer exam, and 50% on the portfolio.
- Readings
- The required and recommnded readings for each unit are available on the Readings page.
- The books illustrating narrative are readily available for purchase from on-line sources or at area bookstores. They are also available in libraries, and you may own one or more already. Feel free to suggest others: please, however, run it by the instructor prior to deciding to use it. It is permissible to use a book you have already read, if you are willing to revisit it. We will also entertain the possibility of using narrative material in other media - films, audio, collections of photographs.
Schedule
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1 |
This talk introduces several important concepts, including the idea that individuals inhabit and are inhabited by a multilevel environment of influences with which they interact. However, individuals are not passive entities floating in this environment - they have abilities both to shape it and to selectively perceive it. Finally, the individual, features of the environment, and the transaction with the environment evolve over time, so that we become interested not only in static states but in the way in which an individual and his or her environment are changing.
This talk also introduces narratives, the concept of meaning, and the role meaning is thought to have in shaping health, behavior, and development.
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Lecture
Composition of trial narratives
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2 |
Critical response/An introduction to workshopping
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Lecture
Readings from student s' trial narratives with opportunity for response.
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3 |
What is the difference between sex and gender?
What are the mechanisms that relate gender to wellness and illness?
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Lecture |
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4 |
Why think about health in a cultural perspective?
This talk introduces a description of culture, uses some examples contrasting American Indian and 'White' US health-related attitudes, and talks about Arthur Kleinman's concept of 'explanatory models' as a way of exploring the implications of culture for a particular health-related issue.
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Lecture |
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5 |
The goal of this session is to introduce the concept of race as a social construct ('how you see yourself, how others see you') that is both meaningless and meaningful, and to discuss some of the public health implications of the concept. |
Lecture
Workshopping Narrative 1
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6 |
Race and ethnicity continued.
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Lecture
Sharing Narrative 1
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7 |
The goal of this session is to discuss ways in which poverty is measured, and to explore mechanisms by which poverty is thought to contribute to poor health. Concepts of social support and social capital are introduced as factors that may ameliorate the impact of poverty.
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Lecture |
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8 |
Nearly everyone lives with or is connected to family members. Families have particular ethics - family members are special to each other in ways that have important consequences, yet these relationships are frequently ignored in health programs. |
Lecture
Workshopping Narrative 2
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9 |
Role of Families continued
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Lecture
Sharing Narrative 2
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10 |
Is there such a thing as "rational" decision-making. |
Lecture |
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11 |
Spirituality and religion are not only important aspects of identity for many populations, but can have direct and indirect implications for physical and psychological health outcomes. Evidence for this connection will be discusses, as well as the debated role of spirituality in public health and/or medical care.
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Lecture
Workshopping Narrative 3
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12 |
Yoga intervention demonstration: Demonstration of a yoga intervention tailored to patients with rheumatoid arthritis. Special consideration is given in this intervention to the role of spirituality in the management of chronic disease, as well as the importance of sensitivity to physical limitations of diversely-abled participants.
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Lecture
Sharing Narrative 3.
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13 |
Making change within systems: the case of changing medical provider behavior. This session will start by discussing observed variation in practice patterns, followed by issues encountered in trying to influence those patterns through educational means. We will end by talking about factors within medical practices that influence the process of change.
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Lecture |
14 |
Marketing change at a mass and individual level. This talk plucks from the huge health behavior change literature three 'trendy' concepts that have much appeal and are potentially more accessible than some other approaches. We will talk first about behavior change theories in general, and then address the theory of 'stages of change,' followed by a discussion of motivational interviewing and social marketing.
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Workshopping Narrative 4.
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15 |
Continuing talk on behavior change
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Lecture
Sharing Narrative 4
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16 |
Summing up: comparing quantitative with anecdotal, narrative ways of knowing and persuasion; thinking about how the narrative process has or has not made the experience of this class different from other classes; brief reports from class members about books; presentation of audio versions of narratives from those who have chosen to make them. |
Exam |
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Further Reading:
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Readings
Suggested books involving narrative and public health topics
Coles R. Children of Crisis series. Coles is a child psychiatrist who has written many books using and about narrative and fiction. The Children of Crisis series was about the experiences of children during desegregation in the American south.
Cousins N. Anatomy of an illness: as perceived by the patient. New York , Bantam Books, 1981. An erudite and personal account of the multiple paths to dealing with an illness.
Duff A. Once were warriors. New York , Vintage Books, 1995. A novel, but written by someone who has written non-fiction about the same subject - modern life among the Maori, New Zealand 's first people.
Fadiman A. The spirit catches you and you fall down. New York . Farrar, Straus & Giroux, 1998. Fascinating non-fiction about the case of a Hmong family and their unfortunate encounters with the medical system in California.
Kotlowitz A. There are no children here. New York , Doubleday, 1991. The story of two boys growing up in a housing project in Chicago .
Kozol J. Rachel and her children: homeless families in America . New York , Ballantine Books, 1989.
Rothman, BK. Weaving a family: untangling race and adoption. Beacon Press, 2005.
Simon D, Burns E. The corner: a year in the life of an inner-city neighborhood. New York , Broadway Books, 1997. Detailed documentary about the people on and around a corner in West Baltimore were hard drugs are sold and used.
Agee J, Evans W. Let us now praise famous men; three tenant families (1941). Boston : Houghton Mifflin, 1960.
Williams WC. The doctor stories. (Various editions)
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Unit 1: Ecology, Narrative, and Meaning |
Required
Sharf BF. Out of the closet and into the legislature: breast cancer stories. How narratives about one disease have shaped policy. Health Affairs 2001;January-February;1:213-218.
Newman TB. The power of stories over statistics. BMJ 2003;327:1424-1427.
Lerman, Liz. Toward a process for critical response. High Performance. #64, Winter 1993.
Recommended
Pennebaker JW, Seagal JD. Forming a story: the health benefits of narrative. J Clin Psychol. 1999 Oct;55(10):1243-54.
Sameroff AJ. Environmental risk factors in infancy. Pediatrics. 1998 Nov;102(5 Suppl E):1287-92.
Shelov SP. The use of media to impact legislation. Pediatric Annals 1995;24:419-425.
Steiner JF. The use of stories in clinical research and health policy. JAMA 2005;294:2901-2904.
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Unit 2: Gender |
TBA |
Unit 3: Cultural Perspective |
Required
Kleinman A, Eisenberg L, Good B. Culture, illness, and care. Annals of Internal Medicine 1978;88:251-258 .
Recommended
O'Nell TD. Cultural formulation of psychiatric diagnosis. Psychotic depression and alcoholism in an American Indian man. Cult Med Psychiatry. 1998 Mar;22(1):123-36.
Hunt LM, Schneider S, Comer B. Should "acculturation" be a variable in health research? A critical review of research on US Hispanics. Soc Sci Med. 2004 Sep;59(5):973-86.
Cauce AM, Domench-Rodriguez M, Paradis M. Cochran BN, Shea JM, Srebnik D, Baydar N. Cultural and contextual influences in mental health seeking: a focus on ethnic minority youth. J Cons Clin Psych 2002:70:44-55.
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Unit 4: Race and Ethnicity |
Required
Van Ryn M, Fu SS. Paved with good intentions: do public health and human service providers contribute to racial/ethnic disparities in health? Am J Public Health. 2003 Feb;93(2):248-55.
Recommended
Nobles M. History counts: a comparative analysis of racial/color categorization in US and Brazilian censuses. Am J Public Health. 2000 Nov;90(11):1738-45.
Harrell JP, Hall S, Taliaferro J. Physiological responses to racism and discrimination: an assessment of the evidence. Am J Public Health. 2003 Feb;93(2):243-8.
Bamshad M. Genetic influences on health. Does race matter? JAMA 2005;294:937-946.
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Unit 5: Poverty, Social Support, and Social Capital |
Required
Putnam R. Social capital measurement and consequences. ISUMA 2001 (spring):41-51.
Recommended
Ceballo R, McLoyd VC. Social support and parenting in poor, dangerous neighborhoods. Child Development 2002;73:1310-1321.
Costello EJ, Compton SN, Keeler G, Angold A. Relationships between poverty and psychopathology: A natural experiment. JAMA 2003;290:2023-2029.
Cohen DA, Farley TA, Mason K. Why is poverty unhealthy? Social and physical mediators. Soc Sci Med 2003;57: 1631-1641.
Ronzio CR, Pamuk E, Squires GD. The politics of preventable death: local spending, income inequality, and prematurity in US cities. J Epidemiol Comm Health 2004;58:175-179.
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Unit 6: Role of Families |
Required
Perrino T, Gonzalez-Soldevilla A, Pantin H, Szapocznik J. The role of families in HIV prevention: a review. Clinical Child and Family Psychology Review 2000;3:81-96.
Recommended
Repetti RL, Taylor SE, Seeman TE. Risky families: family social environments and the mental and physical health of offspring. Psychological Bulletin 2002;128:330-366.
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Unit 7: Rational Decision Making |
Required
Hibbard JH, Slovic P, Jewett JJ. Informing consumer decisions in health care: implications from decision-making research. MMFQ 1997;75:395-414.
Recommended
Gerrard M, Gibbons FX, Reis-Bergan M. The effect of risk communication on risk perceptions: the significance of individual differences. JNCI Monographs 1999;25:94-100.
Taylor SE, Kemeny ME, Reed GM, Bower JE, Gruenewald TL. Psychological resources, positive illusions, and health. American Psychologist 2000;55:99-109.
Lakoff G. Don't think of an elephant! White River Junction: Chelsea Green Publishing, 2004.
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Unit 8: Spirituality |
Required
Powell, Lynda H.; Shahabi, Leila; Thoresen, Carl E. Religion and spirituality: Linkages to physical health. American Psychologist. 2003 Jan Vol 58(1) 36-52
Recommended
Shahabi L, Powell LH, Musick MA, Pargament KI, Thoresen CE, Williams D, Underwood L, Ory MA. Correlates of self-perceptions of spirituality in American adults. Annals of Behavioral Medicine 2002 Winter; 24(1) 59-68
Larimore WL, Parker M, Crowther M. Should clinicians incorporate positive spirituality into their practices? What does the evidence say? Annals of Behavioral Medicine 2002 Winter; 24(1):69-73
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Unit 9: Change Within Systems |
Required
Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999 Oct 20;282(15):1458-65
Miller WR. Motivational interviewing: research, practice, and puzzles. Addictive Behaviors 1996;21:835-842.
Recommended
Miller WL, McDaniel RR Jr, Crabtree BF, Stange KC. Practice jazz: understanding variation in family practices using complexity science. J Fam Pract. 2001 Oct;50(10):872-8.
Cifuentes M, et al. Prescription for health: changing primary care practice to foster healthy behaviors. Ann Fam Med 2005;3(supp 2):S4-S12.
Cohen DJ, Tallia AF, Crabtree BF, Young DM. Implementing health behavior change in primary care: lessons from prescription for health. Ann Fam Med 2005:3(Suppl 2):S12-S19.
Goldman LK, Glantz SA. Evaluation of antismoking advertising campaigns. JAMA 1998;279:772-777.
Prochaska JO. A stage paradigm for integrating clinical and public health approaches to smoking cessation. Addictive Behaviors. 1996;21:721-732.
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