Social Processes and Health (300-02) Spring 2005

Social Processes and Health (PSYC – 300-02)

DenisonUniversity, Spring 2005

Class: TR10:00 – 11:20 AM

Instructor: Sharla Wells-Di Gregorio, Ph.D.

Office: 404-D Knapp Hall

Phone: (740) 587-6368

Office Hours: 10:30 – 11:30MWF 3:30 – 4:30 MW, or by appointment

E-mail:

Blackboard:

The primary determinants of disease are mainly economic and social, and therefore its remedies must be economic and social. Geoffrey Rose (1992), The Strategy of Preventive Medicine

Course Objectives

The primary objectives of this course are to understand and discuss the social context of health and illness and to learn to facilitate stimulating group discussions. To meet these overarching objectives, we will review literature covering several areas. For each section of literature we review, we will have the following underlying objectives:

  1. Understand how society constructs concepts of health and disease.
  2. Compare and contrast biomedical and biobehavioral/biopsychosocial models of illness.
  3. Consider how we come to think of ourselves as ill and how illness is perceived in society.
  4. Learn about the lay referral process and the attachment of responsibility for illness.
  5. Investigate factors that influence help-seeking behavior in the context of health-care.
  6. Examine the power differentials that can exist within a medical encounter.
  7. Realize the uncertainties inherent in medical care and become a more informed consumer of health services.
  8. Read and discuss a contemporary critique of our current medical system.
  9. Examine social influences on health-promoting and health-corrosive behaviors.
  10. Critically examine the moral and legal regulation of health behavior.
  11. Study multiple explanations for gender disparities in health outcomes.
  12. Explore multiple factors influencing social disparities in health outcomes.
  13. Work together as a team to analyze patient narratives using qualitative methods.
  14. Distinguish between a variety of social support concepts and measures and examine factors that influence whether a person gives and/or receives support.
  15. Evaluate the methods by which social support may improve physical health.
  16. Assess the impact of unsupportive interactions and failed support attempts on health.
  17. Discover potential physiologic mechanisms of support effects.
  18. Reflect on the impact of supportive and unsupportive responses on mental health outcomes.
  19. Analyze a film looking at the impact of providing support.
  20. Gain experience analyzing the literature and presenting a summary on the impact of social support on a specific health condition or behavior.
  21. Explore social expectations and attitudes affecting the experience of death and dying.

Course Description

We will examine multiple pathways by which social interactions influence our health - from the social processes that define health and illness to social customs that shape our experience of death and dying. We will look at how our relationships affect the adoption and maintenance of healthy and unhealthy habits from childhood to older adulthood. We will study the social-cognitive processes that influence our decision to seek medical care as well as our decisions about treatment. We will also explore the means by which our social support and unsupportive interactions can impact our adaptation to and recovery from illness. This includes

the mechanisms by which our interactions with others can affect our endocrine and immune systems and our coping responses. We will consider the strengths and limitations of a variety of studies and real-world examples which demonstrate the impact of social support and social networks on human survival. This seminar will provide the opportunity to study, explore, and discuss these issues in depth.

Course Requirements

Class Reading: Reading are indicated on the course schedule. Your classmates or I will select two or three chapters or articles for each class meeting from this list and assign the readings before the next class meeting. You are expected to complete the assigned reading before coming to class. This is essential. Readings for each class period could take as long as three to four hours or more. Please plan accordingly. All reading will be available via electronic reserve on the library web-site.

Active Participation: Attendance is required. Participation is expected. Your ideas and questions are crucial to establishing this as an open, contemplative learning environment.

In order to get the most out of this course, it is essential for you to complete the readings well ahead of class time so that you are able to think about and respond to discussion questions developed by your classmates. Your participation will be counted as part of your final grade. I will randomly grade 12 class sessions for participation (10 points each) so it is important to be prepared for all class sessions. If you are unable to attend class due to illness, family emergency, or a university-sponsored event, please inform me as soon as possible before the class period. Despite your absence, you will be required to respond to your classmates’ discussion questions via Blackboard prior to or as soon as possible following this absence (in an emergency situation).

Class Presentations: As part of this course, you will be required to read and prepare discussion questions for the entire group the week prior to your scheduled presentation(s). You will post these questions to the Discussion Board on Blackboard for this course (see Student Blackboard Overview at if you have not previously used Blackboard). You will be given sample questions at the beginning of the semester to help you to structure these questions. In this course, we will attempt to ask questions that stimulate thought, help class members tocritically and constructively evaluate theory and/or research, and enhance understanding of the impact of social processes on health. You will be graded on the timeliness of your questions, the depth of your questions, the depth and breadth of understanding with which you present, and your ability to stimulate thought and facilitate discussion during the class period. You will also receive a rating from each of your classmates for your presentation. You are encouraged to seek out additional resources related to your topic for the week(s) during which you present.

Internet-based Illness Study: For this class, we will complete an internet-based research study. This will be a small-group project in which you will work as a team to solicit responses from list-serv’s catering to individuals with a specific illness. You will seek their responses to several predetermined questions and will use this data to develop a team presentation about the social factors influencing the illness experience for your sample. Details of this assignment will be provided in a separate handout.

Social Support Literature Summary: Early in the semester, you will determine which illness or health behavior you would like to study in more detail. You will begin collecting empirical articles describing the effects of social support on this illness or health behavior. In class, we will discuss different methods used to assess social support and you will incorporate this understanding into your summary. You will be asked to discuss your findings during class with seminar participants and make recommendations for future research and intervention for the illness you have studied. You are strongly encouraged to begin this project early as many of the references you will need (from medical and public health journals) may not be available at Denison or online. You will need to order these articles, so please anticipate the extra time this might require to complete your review.

Final (Open-Materials) Exam: In order to consolidate your learning, you will be asked to complete 10 short-essay questions (2-3 paragraphs) covering only the material we have covered in class (not articles or chapters on our reading list that we have not discussed). This final exam will be due on the last day of class, April 28, before the start of class. You will receive the questions for this exam at the beginning of April so you will have 3 weeks to complete the exam.

Final Grade

Participation (20%)120

Class Presentation(s) (22%)130

Internet-Based Illness Presentation(22%)130

Literature Summary/Presentation(20%)120

Final Exam (17%)100

600

Your grade for the course will be based on the percentage of total possible points you earned during the semester.

Grading Scale

A+97%-100%B+87%-89%C+77%-79%D+67%-69%

A93%-96%B83%-86%C73%-76%D63%-66%

A-90%-92%B-80%-82%C-70%-72%D-60%-62%

Course Policies

Assignments: Assignments are due at the beginning of class on the due date, unless otherwise indicated. Late assignments will result in a 10% point deduction for each day the assignment is late (including Saturday and Sunday). The assignment is considered one day late if it is not turned in at the start of class on the date it is due (even if it is turned in on the same day after the class period). I will only allow an extension on the due date of an assignment in the case of a documented illness or family emergency. Assignments will not be accepted after we have discussed them in class or I have returned the graded assignments.

Academic Dishonesty: Any instance of academic dishonesty will result in zero credit on the exam or assignment, in addition to being referred to the chair of the department and the Board for Academic Integrity. Examples of this are cheating, assisting another student in dishonest practices, and plagiarism. Please consult, Writing with Sources: Paraphrasing, Quoting, and Plagiarism writtenby Jim Davis of Denison’s English Department for further information regarding how to successfully cite sources and avoid plagiarism. If you do not have a copy of this document after the first week of classes, please see me to obtain a copy.

Accommodation of Disability: Any student who feels he or she may need an accommodation based on the impact of a disability should contact me privately as soon as possible to discuss your specific needs. I rely on the Academic Support and EnrichmentCenter in 104 Doane to verify the need for reasonable accommodations based on documentation on file in their office.

Course Schedule

DateTopic, Reading, and Project Assignment(s)

1/18/05Introductions & Course Review – What is Health?

1/20/05I. Defining Health and Illness

Dubos, R. (1979). Mirage of health. In B. Davey, A. Gray, & C. Seale (1995), Health and Disease: A Reader (pp. 4-10), Buckingham: Open University Press.

Blaxter, M. (1990). What is health? In B. Davey, A. Gray, & C. Seale (1995), Health and Disease: A Reader (pp. 26-32), Buckingham: Open University Press.

Hardey, M. (1998). Understanding health and constructing illness. In M. Hardey, The Social Context of Health (pp. 21-46). Buckingham: Open Universities Press.

Freund, P.E.S. & McGuire, M.B. (1999). The social construction of medical knowledge. In P.E.S. Freund & M.B. McGuire, Health, Illness, and the Social Body: A Critical Sociology, Third Edition (pp. 188-216). Upper Saddle River, NJ: Prentice Hall.

1/25/05II. Biopsychosocial versus Biomedical Models of Health

Freund, P.E.S. & McGuire, M.B. (1999). Modern biomedicine: Knowledge and practice. In P.E.S. Freund & M.B. McGuire, Health, Illness, and the Social Body: A Critical Sociology, Third Edition (pp. 188-216). Upper Saddle River, NJ: Prentice Hall.

Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129-136.

Kaplan, R.M. (1990). Behavior as the central outcome in health care. American Psychologist, 46, 1211-1220.

Cunningham-Burley, S. & Boulton, M. (2003). The social context of the new genetics. In G.L. Albrecht, R. Fitzpatrick, and S.C. Scrimshaw, Handbook of Social Studies in Health and Medicine (pp. 173-187). London: Sage Publications.

1/27/05III. Living with Chronic Illness & Stigma (Written Responses)

Charmaz, K. (2003). Experiencing chronic illness. In G.L. Albrecht, R. Fitzpatrick, & S.C. Scrimshaw (Eds.), The Handbook of Social Studies in Health and Medicine (pp. 277-292). London: Sage Publications.

Freund, P.E.S. & McGuire, M.B. (1999). The illness experience. In P.E.S. Freund & M.B. McGuire, Health, Illness, and the Social Body: A Critical Sociology, Third Edition (pp. 138-164). Upper Saddle River, NJ: Prentice Hall

Lupton, D. (2003). The lay perspective on illness and disease. Medicine as Culture (pp. 84-112). London: Sage Publications.

Quinn, G.P. & Coreil, J. (2001). Health and illness behavior. In J. Coreil, C.A. Bryant, J.N. Henderson (Eds.), Social and Behavioral Foundations of Public Health (pp. 75-101). Thousand Oaks, CA: Sage Publications.

2/1/05IV. Lay Referral and Illness Responsibility

Sanders, G.S. (1982). Social comparison and perceptions of health and illness. In G.S. Sanders & J. Suls, Social Psychology of Health and Illness (pp. 129-157). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.

Freund, P.E.S. & McGuire, M.B. (1999). Seeking health and help. In P.E.S. Freund & M.B. McGuire, Health, Illness, and the Social Body: A Critical Sociology, Third Edition (pp. 165-187). Upper Saddle River, NJ: Prentice Hall

Freund, P.E.S. & McGuire, M.B. (1999). The social meanings of sickness. In P.E.S. Freund & M.B. McGuire, Health, Illness, and the Social Body: A Critical Sociology, Third Edition (pp. 117-137). Upper Saddle River, NJ: Prentice Hall.

Sontag, S. (1978). Illness as Metaphor (pp. 43-87). New York, NY: Anchor Books, Doubleday.

2/3/05V. Health-Care Seeking

Meador, C.K. (1994). The last well person. The New England Journal of Medicine, 330(6), 440-441.

Berkanovic, E., Telesky, C., & Reeder, S. (1981). Structural and social psychological factors in the decision to seek medical care for symptoms. Medical Care, 19(7), 693-709.

McMullen, P. A., & Gross, A. E. (1983). Sex differences, sex roles, and health-related help-seeking, New Directions in Helping (Vol. 2, pp. 223-263): Academic Press, Inc.

Wallston, K.A. & Wallston, B.S. (1982). Who is responsible for your health? The construct of health locus of control. In G.S. Sanders & J. Suls, Social Psychology of Health and Illness (pp. 65-95). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.

2/8/05 VI. Power and Influence in the Medical Encounter

Kirmayer, L.J. (2000). Broken narratives: Clinical encounters and the poetics of illness experience. In C. Mattingly & L.C. Garro, Narrative and the Cultural Construction of Illness and Healing. Berkeley, CA: University of California Press.

Lupton, D. (2003). Power relations and the medical encounter. Medicine as culture (pp. 113-141). London: Sage Publications.

Coreil, J., Bryant, C.A., & Henderson, J.N. (2001). Deviance and social control. Social and Behavioral Foundations of Public Health (pp. 149-159). Thousand Oaks, CA: Sage Publications.

Coulter, A. & Fitzpatrick, R. (2003). The patient’s perspective regarding appropriate health care. In G.L. Albrecht, R. Fitzpatrick, & S.C. Scrimshaw (Eds.), The Handbook of Social Studies in Health and Medicine (pp. 454-464). London: Sage Publications.

Lorber, J. (1997). Treating social bodies in social worlds: Feminist health care. In J. Lorber, Gender and the Social Construction of Illness (pp. 94-102). Thousand Oaks, CA: Sage Publications.

2/10/05VII. Introduction to Medical Uncertainty

Sackett, D.L. (2002). The arrogance of preventive medicine. Canadian Medical Association, 167(4), 363-364.

Fox, R.C. (2003). Medical uncertainty revisited. In G.L. Albrecht, R. Fitzpatrick, & S.C. Scrimshaw (Eds.), The Handbook of Social Studies in Health and Medicine (pp. 409-425). London: Sage Publications.

Illich, I. (1976). The epidemics of modern medicine. In B. Davey, A. Gray, & C. Seale (1995), Health and Disease: A Reader (pp. 237-242), Buckingham: Open University Press.

Oakley, A. (1980). Doctor knows best. In B. Davey, A. Gray, & C. Seale (1995), Health and Disease: A Reader (pp. 332-337), Buckingham: Open University Press.

Winkler, F. (1993). Tranferring power in health care. In B. Davey, A. Gray, & C. Seale (1995), Health and Disease: A Reader (pp. 278-284), Buckingham: Open University Press.

Pietroni, P.C. (1995). The greening of medicine. In B. Davey, A. Gray, & C. Seale, Health and Disease: A Reader (pp. 388-392), Buckingham: Open University Press.

2/15/05VIII. Medical Uncertainty and Our Health

Avorn, J. (2004) Powerful Medicine (pp. 3-125). New York, NY: Alfred A. Knopf/Random House.

2/17/05IX. Peer & Professional Influence on Health-Related Behavior

Perry, C.L. (2000). Preadolescent and adolescent influences on health. In B.D. Smedley & Syme, L., Promoting Health: Intervention Strategies from Social and Behavioral Research (pp. 217-253), Washington, D.C.: NationalAcademy Press.

Perri, M.G., Lauer, J.B., Yancey, D.Z., McAdoo, W.G., McAllister, D.A., Jordan, R.C., & Nezu, A.M. (1987). Effects of peer support and therapist contact on long-term weight loss. Journal of Consulting and Clinical Psychology, 55(4), 615-617.

Nagasawa, M., Smith, M.C., Barnes, J.H., & Fincham, J.E. (1989). Meta-analysis of correlates of diabetes patients’ compliance with prescribed medications. The Diabetes Educator, 16(3), 192-200.

Stanton, A.L. (1987). Determinants of adherence to medical regimens by hypertensive patients. Journal of Behavioral Medicine, 10(4), 377-394.

Ewart, C. K. (1991). Social action theory for a public health psychology. American Psychologist, 46(9), 931-946.

Sallis, J. F., & Owen, N. (1997). Ecological models. In K. Glanz & F. M. Lewis & B. K. Rimer (Eds.), Health behavior and health education (pp. 403-424). San Francisco: Jossey-Bass.

2/22/05X. Morality, Social Control, and Health Behavior

Umberson, D. (1992). Gender, marital status and the social control of health behavior. Social Science and Medicine, 34(8), 907-917.

Lewis, M.A. & Rook, K.S. (1999). Social control in personal relationships: Impact on health behaviors and psychological distress. Health Psychology, 18(1), 63-71.

Leichter, H.M. (1997). Lifestyle correctness and the new secular morality. In A.M. Brandt & P. Rozin, Morality and Health (pp. 359-378). New York, NY: Routledge.

Gostin, L. (1997). The legal regulation of smoking (and smokers): Public health or secular morality? In A.M. Brandt & P. Rozin, Morality and Health (pp. 331-357). New York, NY: Routledge.

Marelich, W.D. & Rotheram-Borus, M.J. (1999). From individual to social change: Current and future directions of health interventions. In W.D. Marelich & J.S. Erger (2004). The Social Psychology of Health: Essays and Readings (pp. 95-110). Thousand Oaks, CA: Sage Publications.

2/24/05XI. Gender and Health

Annandale, E. (1998). Health, illness, and the politics of gender. In D. Field & S. Taylor (Eds.), Sociological Perspectives on Health, Illness, and Health Care (pp. 115-133). Osney Mead, Oxford: Blackwell Science Ltd.

Lorber, J. (1997). Women get sicker, but men die quicker: Social epidemiology. In J. Lorber, Gender and the Social Construction of Illness (pp. 14-34). Thousand Oaks, CA: Sage Publications.

Lupton, D. (2003). Feminisms and medicine. Medicine as Culture (pp. 142-174). London: Sage Publications.

Williams, D.R. (2003). The health of men: Structured inequalities and opportunities. American Journal of Public Health, 93(5), 724-731.

Shumaker, S. A., & Hill, D. R. (1991). Gender differences in social support and physical health. Health Psychology, 10(2), 102-111.

3/1/05XII. Social Disparities and Health

Jeffery, R. (1979). Normal rubbish: Deviant patients in casualty departments. In B. Davey, A. Gray, & C. Seale (1995), Health and Disease: A Reader (pp. 345-351), Buckingham: Open University Press.

Adler, N.E., Boyce, W.T., Chesney, M.A., Folkman, S., & Syme, L.S. (1993). Socioeconomic inequalities in health: No easy solutions. Journal of the American Medical Association, 269(24), 3140-3145.