1. Opening • Issue: if health behavior is related to some stable attribute of the person, what is that? How is it changed? • “Personality”: stable (unlearned?) trait • “Attitude”: Learned evaluative response • Attitudes: • Core evaluation of an object • [Context dependent] Behavioral disposition • Attitude theory core issue: • Attitude  behavior consistency • Beliefs v. affect? • Conflicting beliefs? • Habit? • Self-efficacy?

2. Core constituents: Attitude Models • Knowledge • Information re: health practices • Awareness of health related stimuli ► “Cues to action” • Attitudes and Beliefs • Preferences or evaluations: e.g., consumer preferences. • Beliefs, ► Perceived vulnerability, ► Outcome expectancies • Affect , e.g., depression / anxiety & information seeking ► “Affect as information” models • Behavior • Behavioral history; ►habit formation • Behavioral intentions; context & behavior -specific cognitive “set”

3. Some basic attitude elements • Context dependence • Potentially multiple attitudes • Context dependency  attitude – behavior inconsistency • Accessibility & strength • priming effects • speed of recall • Ambivalence • cognition v. affect • Approach  avoidance • Anchoring effects • Value congruence • “Instrumental” attitudes; functional in predicting outcomes of behavior, modifiable via information or direct experience... • “Value expressive”; expression of basic ideology or principles...less responsive to experience or information.

4. Basic attitude elements, 2 • Primacy of affect & evaluation • Affect >> cognition when they are in conflict • Congruent affect & cognition  strong / change resistant attitude • Affective / evaluative Rx precedes cognitive processing • Affective priming independent of cognitive processes • sleeper effect? • Expectancy x value: core underpinning of attitude models • Attitude = [belief1x value1] + [belief2 x value2] + … • Key variables: • # & nature of key beliefs, • direction & strength of valuation (affective response).

5. Basic attitude elements, 3 • Cognitive accessibility of beliefs • Cs goals and motivations  accessibility • Arousal & accessibility (Oxytocin & sexual stimuli) • Positive goal features  accessible for long-term decisions • Negative goal features  accessible for short term decisions • Key approach  avoidance conflict: • Long-term self-regulation (approach health goal) more effortful & cognitive demanding • Short-term affective coping (avoidance) less effortful. • Attentional “narrowing” and lessening accessibility • Alcohol / drug effects • Cognitive avoidance

6. Attitude change/formation/Persuasion • Consistency theories • dissonance theory • value -- attitude congruence • consistency & attraction • averaging models (v. “tipping point” perspective) • Exposure / conditioning • Simple repetition, pairing of attitude with existing positive response. • Heritability • Happiness set point? • Affectivity? • Other set points; substance use, temperament, food. • Tolerance for ambiguity? • Heuristic - systematic models of persuasion • Motivated; argument strength predicts (strong & enduring) attitude change • Non-motivated: peripheral / heuristic elements predict less strong / enduring change

7. Attitude change • Receiver characteristics • “Involvement” --> greater motivation... • Personal relevance • Defending pre-existing attitude • Express values • Intermediate levels of self-esteem --> change • Mood • Source characteristics • Message clarity x source credibility (interaction with ‘motivation’) • In group v. out group

8. Attitude change, 2 • Message characteristics • Fear arousal: Rogers’ protection motivation theory • Basic message x receiver effects: • Seriousness of message; • personal susceptibility; • outcome expectancies; • efficacy expectancies • Framing; • Context effects • Gain v. loss & reflection effect

9. Basic models • Triandis [belief x affect] + belief 2 x affect 2].... = behavioral disposition • Fishbein [belief x value] + [belief2 x value2].... [norm x value] + [norm2 x value2].... • Ajzen; theory of Planned Behavior Self efficacy Behavioral intention Behavioral disposition Habit

10. Psychosocial challenges for health behavior:Informational / Cognitive • Complexity and non-stability of health related information • “Press conference” science • Food industry influence on HHS information • “Food pyramid” complexity • Credibility of multiple information sources • The WEB and informational tunneling • Powerful cognitive message effects • Framing: (in)congruence with approach / avoidant attitudes • Gain / loss: gain framing >> loss framing. • Cognitive salience of competing messages • Powerful anchoring effects of even trivial information • Social norms • “Fat” norms • Culturally – specific norms; e.g., Gay community & drug use.

11. Psychosocial challenges for health behavior:Affective • “Hot” information and cognitive or behavioral avoidance • Cf: Miller C-SHIP model • HIV testing data, cancer screening, etc. • Cognitive avoidance in chronic disease • Self-efficacy: Fear of difficulty of behavioral change • “Demotivating” effects of negative mood • “Strategic” use of negative health behavior to enhance mood enhancing • “Denial” of health threat via group membership • Outgroup stereotypes and perceived non-vulnerability • Peer & cultural conformity pressure toward (or ‘not against’) health threats

12. Psychosocial challenges for health behavior:Behavioral • Difficulty of delaying gratification, decreasing “stimulus boundedness” • “Automaticity”, cognitive capacity, and real limitations on cognitive control over behavior • Self-monitoring and self-regulation needed to process and follow health information • “Self-regulation capacity” models • 7 +2 informational capacity • Real difficulty of health alternatives • “Food deserts” • Violent neighborhoods / build environment & exercise availability • American industrial food system • Outcome & efficacy expectancies

13. Self-Regulation • Core elements: • Goal setting • Self-evaluative reactions • Self-efficacy for goal-related behavioral performance

14. Self-regulation elements: 1. Goal setting • Stable “action schema” or “script” • Abelson: “automatic” behavioral scripts • Higgins: discrepancies between “actual”, “ideal” & “ought” selves • Modest ideal  actual: intrinsic motivation for goals • Modest ought actual: extrinsic motivation for goals • Strong ideal  actual: guilt, anxiety • Strong ought actual: depression, helplessness • Goals as preferences: Ajzen attitude models • Goals and Action Identification • Higher-order identification: generalized values • Lower-order ID: concrete behaviors • Houston: shifts in ID to serve self-regulation

15. Goals, 2: Action Identifications High Low • Abstract & longer-term, end states • Difficult to monitor: slow-moving & non-specific • Typically “approach” oriented / positive affect. • Concrete & immediate, behavioral intentions • Specific, easier to monitor • Mix of approach & avoidant (+ & - affect).

16. Self-regulation: Basic cybernetic frame Behavioral intentions Actual behavior Available feedback Behavioral standards Self-monitoring of ongoing behavior Behavioral “Comparator”

17. Potential self-regulation failures Behavioral intentions Actual behavior Available feedback Behavioral standards Self-monitoring of ongoing behavior Behavioral “Comparator” • Loose linkage between attitude / intention  behavior • Role of habit / “automaticity,” contextual constraints • Social network press for behavioral consistency • Ambivalence: affective attraction of bad behavior v. pallid, high-level action identification of being good • Mixed, complex attitudes

18. Potential self-regulation failure, 2 Behavioral intentions Actual behavior Available feedback Behavioral standards Self-monitoring of ongoing behavior Behavioral “Comparator” • Clarity & specificity of behavioral standards • Concreteness & specificity of behavioral plans • Extrinsic v. intrinsic motivation & standards

19. Potential self-regulation failure, 3 Behavioral intentions Actual behavior Available feedback Behavioral standards Self-monitoring of ongoing behavior Behavioral “Comparator” • Quality & amount of feedback • Frequency & visibility of target behaviors • Availability of feedback from others • Simple attention, memory capacity

20. Potential self-regulation failure, 4 Behavioral intentions Actual behavior Available feedback Behavioral standards Self-monitoring of ongoing behavior Behavioral “Comparator” • Effortful self-awareness of behavior • Automaticity of target behavior – Monitoring is… • Productive for initiating behaviors • Disruptive for automatic behaviors • Effortful monitoring  “Coping fatigue”, generally aversive • Tediousness of formal monitoring

21. Potential self-regulation failure, 5 Behavioral intentions Actual behavior Available feedback Behavioral standards Self-monitoring of ongoing behavior Behavioral “Comparator” • Quality & nature of comparison • Self-focused attention as prerequisite for comparator • Clarity & specificity of behavioral standards • Cognitive avoidance of “hot” information (i.e., failure)

22. Potential self-regulation failure, 6 Behavioral intentions Actual behavior Available feedback Behavioral standards Self-monitoring of ongoing behavior Behavioral “Comparator” • Negative “actual” v. “ought” or “ideal” comparisons • “Actual” versus: “ought”  anxiety, shame  avoidance • “ideal”  depression  amotivation • Self-efficacy: behavioral change versus avoidance • Self-regulatory resource models

23. Potential self-regulation failure, 7 Behavioral intentions Actual behavior Available feedback Behavioral standards Self-monitoring of ongoing behavior Behavioral “Comparator” • Lowering standards in the face of failure • Motivated downward comparison processes • “What the hell” phenomenon • Cognitive escape / “defensive” self-evaluation