Psychology 407 - Health Psychology
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Lecture 3: Epidemiology of Disease and Health

 A. CV Epidemiological Studies

I. Multiple Risk Factor Intervention Collaborative Trials

 

Epidemiology Terms:

 Epidemiology: The study of risk factors for disease, health breakdown and disease prevention in a population

 

Behavioral Epidemiology: The study of behavioral (lifestyle)(or psychological) factors for disease or health in an identified population.

 

III. Behavioral Epidemiology

A. Definitions and Concepts

1. Morbidity vs. Mortality

2. Incidence vs. Prevalence

3. Relative Risk Ratio

4. Study Types:

Longitudinal, Cross-Sectional,

Retrospective (Historical/Case History)

Cohort

Panel

Case-Control

Experimental

5. Efficacy vs. Effectiveness of Intervention

Incidence: (New Cases) Rate at which new cases (of a disease or risk factor) ARE occurring.

Prevalence: (All Cases) Overall number of known (diagnosed) cases (of a particular disease, risk factor, or characteristic thought related to disease or non-disease) at a particular point in time.

(= incidence rate X duration of disease)

 

Relative Risk Ratio: Represents a measure of the relative significance of a specific risk factor or characteristic as a cause of a particular disease or disorder. It is determined by comparing the ratio, or percentage of individuals who share a particular factor (such as high blood pressure) who develop a disease or suffer a specific disease endpoint (such as heart disease or heart attack) -- as compared to those who do not share this factor (they have normal blood pressure) and who also develop this disease or health breakdown. It is then stated as a ratio of the percentage of those with the risk factor or characteristic who have the disease to (divided by) the percentage of those who do not have the factor and suffer the disease.

Correlational vs. Causal Relationships.

Affirming the consequent (diagnosis by Tx)

Depression

HA

Cohort Study: Groups (population samples) of people who share the same characteristic (e.g. alcoholic fathers) are followed over time, to determine if there are common health outcomes (e.g. becoming alcoholic themselves; develop liver cancer). The same population is again sampled over time, though the same individuals may not (and likely will not be) sampled at that time.

Panel Study: Similar to the Cohort Study, it requires that the SAME original subjects be followed over time at each future assessment point. An example: smoking parents and SIDS...

Cross Sectional Studies: Examine different groups of subjects in a population sample at one point in time (whereas Longitudinal Studies follow the same group of subjects over time) to determine risk factors for disease and health breakdown or disease prevention.

Experimental Studies: Often manipulate variables in order to change health outcomes. It may be Controlled, Randomized and/or double-blinded.

Examples: HELPS; drug studies

 

 The Epidemiology of Disease in the US

A. From Infection to Lifestyle:

A Century of "Progress"

 

 

B. Diseases in the U.S. Now: Black vs. White

(The ‘Racial Gap’)

C. Diseases and Their Costs

D. The Behavior Problem

 

 

Sex/Mortality Ratios: Men and Women in the Disease and Death Race.

 

 

IV. Basic Models in Behavioral Medicine

(the example of HBP)

 

A. The Medical/Disease Model

All or nothing -

absence of disease="health"

 

B. The Health Model

Gradations of disease risk/health compromising lifestyles and risk factors (Heart Disease; HBP)

 

C. The Health Belief Model

Is Knowledge of disease, risk factors and extent of personal risk sufficient for health behavior change? Research=no.

Good face validity and sense but tenuous empirical support.

(Swain - Mich. HBP study) vs. (Stanford 3/5-City proj.-CVD; NHBPEP)

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