Course Number: Nursing 757

Course Title: Social and Behavioral Determinants of Health (Spring, 2012)

Course Description: This course focuses on theory, research and current issues relevant to social and behavioral determinants of health. Viewed within a social-ecological framework, core concepts central to understanding determinants of population health and health disparities are addressed. Emphasis is placed on analysis, critique and synthesis of interdisciplinary literature and application to nursing and public health practice, future research and scholarly inquiry, and multi-level policies necessary to reduce disparities in the social and behavioral determinants of the public’s health.

Faculty: Professor Laura L. Hayman, PhD, RN, FAAN

Course Objectives:

Upon successful completion of the course, students will be able to:
1. Define and describe social determinants of health and explain how they differ from other (biological) determinants of health.
2. Describe the key components of “core” theories and models of behavior and behavior change for individuals, groups, and communities.
3. Describe ways in which health theories are used in nursing and public health research and practice.
4. Explain how these theories and models apply to designing health interventions based on social determinants.
5. Assess how these theories apply to specific public health problems that are influenced by social and societal determinants.

Course Readings : Recommended Texts

Evaluation Methods/Course Assignments:
Class Participation: Criteria for evaluation of participation include: evidence that the student read and applied readings to what he/she contributes to class discussions, critical thinking about the topic being discussed, and evidence of any new ideas or perspectives that the student contributes to class discussions.
Article Abstract: For this assignment, students are to select, review, critique, and submit a typed summary/abstract of an article relevant to course content and posted on Blackboard. The abstract/ summary of the main themes of the article should also address conceptual and methodological limitations, and implications for future research/scholarly inquiry, nursing ,public health practice, and/or health policy. The format of the 3-4 page (double-spaced) abstract should be consistent with a standard style manual (ie., 6th Edition of the Publication Manual of the American Psychological Association {APA}). The style manual used for this assignment should be referenced along with the complete citation of article selected.
Systematic literature review: The assignment is to review, critique and synthesize the research literature on a social determinant of a specific health condition. The literature review should be framed around a focused research question, such as “What is the effectiveness of legislation designed to influence environmental determinants of obesity in children?” Students may select any health problem or condition of interest as long as it focuses on any of the social/societal determinants of that problem or condition. Research questions must be approved by course faculty.
This paper will require a systematic, reproducible approach to reviewing the literature as described in Fink (2004). A full meta-analysis, however, is not required. The review should be no more than 12-15 pages of text (+ bibliography and appendices), typed, double-spaced, in 11-point type or larger, with one-inch margins. For most questions, it is expected that a minimum of at least 10 references will be included in the analysis (further references are likely to be necessary throughout the rest of the paper). A table summarizing the abstracted information from all studies analyzed should be presented as an appendix. The paper should be appropriately and consistently referenced, using a standard citation style (see and must not plagiarize. See: These issues will be discussed in class. See attached statement of academic integrity.
Final papers will be evaluated according to the following criteria:

Reading Schedule : (Articles posted on Black Board {BB} are required readings)

Module 1: Introduction to Social and Behavioral Determinants of Health
(Introduction to Social and Behavioral Determinants of Health and Health Disparities):
Starfield, B. Basic concepts in population health and health care. J EpidemiolCommunity Health. 2001; 55:452-454 (BB)
Krieger N. A glossary for social epidemiology. J Epidemiol Community Health. 2001; 55(10):693-700 (BB)
House, J. Understanding social factors and inequalities in health: 20th century progress and 21st century prospects. Journal of Health and Social Behavior. 2002; 43(2):125-142. (BB).
Ibrahim SA, Thomas SB, Fine MJ. Achieving health equity: An incremental journey. Am J Public Health. 2003; 93(10); 1619-1621.
Marmot, Status Syndrome, Introduction and chapter 1
Mackenbach, J. & Howden-Chapman, P. New perspectives on socioeconomic inequalities in health. Perspectives in Biology and Medicine. 2003;46(3):428-44. (BB)
Mensah GA, Mokdad AH, Ford, ES,Greenlund KJ, Croft JB. State of disparities in cardiovascular health in the United States. Circulation. 2005;111:1233-1241. (BB)
Gehlert, S., Sacks, T., Mininger, C., McClintock, M., Olopade, O. Targeting health disparities: A model linking upstream determinants to downstrean interventions. Health Afiars. 2008;27: 339-349. (BB).
Satcher, D., Higgenbotham, E.J. The public health approach to eliminating disparities in health. Am J Public Health. 2008; 98: 400-403.

(Conceptual Models of Health Determinants: Life Course and other Social-ecologic Perspectives)
Halfon N, Hochstein M. Life course health development: an integrated framework for developing health, policy, and research. Milbank Q. 2002; 80(3):433-79 (BB).
Hayman, L L., Helden, L., Chyun, D. A., Braun, L.T. A life course approach to cardiovascular disease prevention. Journal of Cardiovascular Nursing. 2011; 26 (4); S22-S34. (BB)
Ben-Shlomo Y, Kuh D. A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives. Int JEpidemiol. 2002; 31(2):285-93. (BB)
Hayman LL. Behavioral medicine across the life course: Challenges and opportunities for interdisciplinary science. Annals of Behavioral Medicine. 2007, 33(3):236-241.
Krieger N, Davey Smith G. "Bodies count," and body counts: social epidemiology and embodying inequality. Epidemiol Rev. 2004;26:92-103
Krieger N. Embodiment: a conceptual glossary for epidemiology. J Epidemiol Community Health. 2005; 59(5):350-5. (BB)
Kuh D, Ben-Shlomo Y, Lynch J, Hallqvist J, Power C. Glossary: Life course epidemiology. J Epidemiol Community Health. 2003; 57(10):778-83 (BB)
Lynch L, Davey Smith G. A life course approach to chronic disease epidemiology. Annual Review of Public Health. 2005; 26:1-35.
Institute of Medicine (IOM). 2001 Health and Behavior, Chapter 2: Biobehavioral factors in health and disease (BB)

Theories of Health Behavior and Behavior Change: Individual, Group, Community
Fisher EB, Fitzgibbon M, Glasgow RE, Haire-Joshu D, Hayman LL, Kaplan R M, Nanney S. Ockene JK. Behavior matters. (2011). American Journal of Preventive Medicine, 40 (5): e15-e30. (BB).
Livingood, WC, Allegrante, JP, Airhihhenbuwa, CO, Clark, NM, Windsor, RC, Zimmerman, MA, Green, LW. Applied social and behavioral science to address complex health problems. American Journal of Preventive Medicine. 2011;41 (5): 525-531. (BB).
National Cancer Institute: Health behavior theory at a glance. (BB)
Noar SM, Zimmerman RS. Health Behavior Theory and cumulative knowledge regarding health behaviors: are we moving in the right direction? Health Educ Res. 2005;20(3):275-90 (BB)
Minkler M. Personal responsibility for health? A review of the arguments and the evidence at century's end. Health Educ Behav. 1999;26(1):121-40 (BB)
Ockene IS, Hayman LL, Pasternak RC, Schron ES, Dunbar-Jacob J. Adherence issues and behavior change: Achieving a long-term solution. Journal of the AmericanCollege of Cardiology. 2002; 40(4): 579-651.
Shumaker SA, Ockene JK, & Riekert K (Eds.), Thehandbook of health behavior change (3rd ed.), New York: Springer Publishing, 2009.
Marmot, Status Syndrome, chapter 2

Module 2: Empirical Evidence of Health Disparities

Socioeconomic Status and Health Across the Life Course
Adler NE, Ostrove JM. Socioeconomic status and health: What we know and what we don't. Ann N Y Acad Sci. 1999; 896:3-15. (BB)
Gorey, K.M., Luginaah, I.N., Bartfay, E., Fung, K.Y., Holowaty, E.J., Wright, F.C., Hamm, C., Kanjeekal, S.M. Effects of socioeconomic status on colon cancer treatment and accessibility and survival in Toronto, Ontario, and San Francisco, California, 1996-2006. Am J Public Health. 2011; 101 (1): 112-119.
Krieger N, Williams DR, Moss NE. Measuring social class in US public health research: concepts, methodologies, and guidelines. Annual Rev Public Health. 1997; 18:341-78. (BB).
Marmot, M. The influence of income on health: views of an epidemiologist. Health Affairs. 2002; 21(2):31-46. (BB).
Singh-Manoux A, Ferrie JE, Chandola T, Marmot M. Socioeconomic trajectories across the life course and health outcomes in midlife: Evidence for the accumulation hypotheses? International Journal of Epidemiology. 2004;33:1072-1079. (BB).
Pollitt RA, Rose KM, Kaufman JS. Evaluating the evidence for models of life course socioeconomic factors and cardiovascular outcomes: A systematic review. BMC PublicHealth.2005;7doi:10.1186/1471-2458-5-7
(available from
Miech RA, Kumanyika SK, Stettler N, Link BG, Phelan JC, Chang VW. Trends in the association of poverty with overweight among US adolescents, 1971-2004. Journal ofthe American Medical Association. 2006; 295(20): 2385-2393. (BB).
Brown AF, Ettner SL, Piette J. Weinberger M, Gregg E, Shapiro MF, et al. Socioeconomic position and health among persons with diabetes mellitus: A
conceptual framework and review of the literature. Epidemiologic Reviews. 2004; 26: 63-77.
Aber, L. et al. The effects of poverty on child health and development. Annual Review of Public Health. 1997; 18:463-83. (BB).
Bauman LJ, Silver EJ, Stein RK. Cumulative social disadvantage and child health. Pediatrics. 2006; 117:1321-1328. (BB)
Marmot , Status Syndrome, Chapters 3, 4 and 9

Race/Ethnicity and Health
LaVeist TA. Disentangling race and socioeconomic status: a key to understanding health inequalities. J Urban Health. 2005; 82(2 Suppl 3) (BB). Stuckler, D., Basau, S., McKee, M. Health care capacity and allocations among South Africa’s Provinces: Infrastructure-inequality traps after the end of apartheid. Am J PublicHealth. 2011;101 (1): 165-172. (BB).
Tuchman, A.N. Diabetes and race: A historical perspective. Am J PublicHealth. 2011; 101(1): 24-33.
Travassos C, Williams DR. The concept and measurement of race and their relationship
to public health: a review focused on Brazil and the United States.
Cad Saúde Pública.2004; 20(3):660-78.
Tuchman AM. Diabetes and race: A historical perspective. Am J Public Health. 2011;101(1):24-33. (BB).
Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health. 2003; 93(2):200-8 (BB).
Duster T. Race and reification in science. Science. 2005; 307 (5712): 1050-1051.
Ossorio P, Duster T. Race and genetics: Controversies in biomedical, behavioral and forensic sciences. American Psychologist. 2005;60 (1): 115-128. (BB).

Module 3: Contextual Factors/Processes and Social and Behavioral Determinants of Health and Health Disparities

Social Connectedness and Health : Social integration, social networks, social support, social capital; Processes and pathways linking social connectedness and health: (March 20)
Berkman LF, Glass T, Brissette I, Seeman TE. From social integration to health: Durkheim in the new millennium. Soc Sci Med. 2000; 51(6):843-57. (BB).
Macinko J, Starfield B. The utility of social capital in research on health determinants. Milbank Q. 2001; 79(3):387-427 (BB).
Lynch, J, Due P, Muntaner C, Davey Smith G. Social capital---Is it a good investment strategy for public health? J Epidemiol Community Health. 2000; 54: 404-408 (BB).
Antoni MH, Lutgendorf SK, Cole SW, Dhabhar FS, Sephton SE, McDonald PG, et al. The influence of biobehavioral factors on tumour biology; Pathways and mechanisms. Nature. 2006; 6:24-248.
Marmot, Status Syndrome, chapters 6, 7

Work and Neighborhood/Community Environments and Health Across the Life course :
Freedman VA, Grafova IB, Rogowski J. Neighborhoods and chronic disease onset in later life. Am J Public Health. 2011; 101(1); 79-86.
He, Q-Q, Wong, T-W, Du, L, Jiang, Z-Q, Qiu, H, Gao, Y,Wong, AHS, Liu, W-J, Wu, J-G. Environmental tobacco smoke exposure and Chinese school children’s respiratory health: A prospective cohort study. American Journal of Preventive Medicine. 2011:41 (5): 487-493.
Tropped, PJ, Tamura, K, Whitcomb, HA, Laden, F. Perceived built environment and physical activity in U.S. women by sprawl and region. American Journal ofPreventive Medicine. 2011;41 (5): 473-479.
Tsutsumi A, Kawakami N. A review of empirical studies on the model of effort-reward imbalance at work: reducing occupational stress by implementing a new theory. Soc Sci Med. 2004; 59(11):2335-59. (BB).
LaVeist TA, Wallace JM Jr. Health risk and inequitable distribution of liquor stores in African American neighborhood. Soc Sci Med. 2000; 51(4):613-7.
Virtanen, M. et al. Temporary employment and health: a review. International Journal of Epidemiology. 2005; 34:610-622. (BB)
Morland K, Wing S, Diez -Roux A, Poole C. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med. 2002; 22(1):23-9. (BB)
Horowitz CR, Colson KA, Hebert PL, Lancaster K. Barriers to buying healthy foods for people with diabetes: Evidence of environmental disparities. Am Journal of Public Health. 2004; 94(9): 1549-1554. (BB).
Guimont C, Brisson C, Dagenais G, Milot A, Vezina M, Masse B, et al. Effects of job strain on blood pressure: A prospective study of male and female white-collar workers. American Journal of Public Health. 2006; 96:1436-1443. (BB).
Marmot, Status Syndrome, chapter 5

Health Care “Systems” and Health (Part 1) & Discussion of systematic literature review paper:
Fisher EB, Fitzgibbon M, Glasgow RE, Haire-Joshu D, Hayman LL, Kaplan R M, Nanney S. Ockene JK. Behavior matters. (2011). American Journal of Preventive Medicine, 40 (5): e15-e30. (BB).
Colgrove, J. The McKeown Thesis: A historical controversy and its ongoing influence. Am Journal of Public Health. 2002; 92: 725-729. (BB)
Link, B. & Phelan, J. McKeown and the idea that social conditions are fundamental causes of disease. Am Journal of Public Health. 2002; 92: 730-2. (BB).
Nolte, E. & M. McKee. Does healthcare save lives? London: the Nuffield Trust. Chapter 1 only, pages 1-63 (BB).
Koh HK Sebelius KG. Promoting prevention through the Affordable Care Act. N EnglMed. 2010; 363 (14):1296-1299.
Koh HK. A 2020 vision for healthy people. N Engl J Med. 2010; 362 (18):1653-1656.
Fink, A. 2004. Conducting research literature reviews: From paper to the Internet (2nd edition).Thousand Oaks: Sage Publications. (entire). Note: students do not need to present/discuss this book –but will need to apply Fink’s methods to systematic literature review paper.

Health Care “Systems” and Health (Part 2)

Patient Protection and Affordable Care Act: Public Law No: 111-148:;h3590enr.txt.pdf
Institute of Medicine (IOM).2003. : The Future of the Public’s Health in the 21st Century.
Washington, DC: National Academies Press. (Chapter 5: The Health Care Delivery System).
Mensah G. Eliminating disparities in cardiovascular health: Six strategic imperatives and a framework for action. Circulation. 2005;111:1332-1336. (BB).
Hayman LL, Hughes S. Cardiovascular health for all. Journal of Cardiovascular Nursing. 2006; 21(2):154-155. (BB)
Hoffman, B. Health care reform and social movements in the United States. Am J PublicHealth. 2008; S69-S80.
Hayman LL, Reineke P. Promoting cardiovascular health in children and adolescents. Journal of Cardiovascular Nursing. 2006; 21 (4):268-275.
Hayman LL, Meininger JC, Daniels SR, McCrindle BW, Helden L, Ross J, Dennison BA, Steinberger J, Williams CL. Primary prevention of cardiovascular disease in nursing practice: Focus on children and youth. Circulation. 2007; 116(3), 344-357.
Glasgow RE, Orleans CT, Wagner EH, Curry SJ, Solberg LI. Does the chronic care model also serve as a template for improving prevention? The Millbank Quarterly. 2001; 79(4): 579-612. (BB).

The Socio-Political Context of Health:
Navarro V, Shi L. The political context of social inequalities and health. Soc Sci Med. 2001 ;52(3):481-91. (BB).
Mechanic D. Disadvantage, inequality, and social policy. Health Affairs (Millwood). 2002 ;21(2):48-59.
Macinko JA, Shi L, Starfield B, Wulu JT. Income inequality and health: a critical review of the literature. Med Care Res Rev. 2003;60(4):407-52. (BB).
Brownson RC, Haire-Joshu D, Luke DA. Shaping the context of health: A review of environmental and policy approaches in the prevention of chronic disease. AnnualReview of Public Health. 2006;27:341-370. (BB).
Mello MM, Studdert DM, Brennan TA. Obesity- The new frontier of public health law. New England Journal of Medicine. 2006; 354 (24):2601-2610. (BB).
Nestle M. Food marketing and childhood obesity-A matter of policy. New EnglandJournal of Medicine. 2006; 354 (24):2601-2610.
Kumanyika S. Obesity, health disparities, and prevention paradigms: Hard questions and hard choices. CDC: Preventing Chronic Disease [serial online] 2005 October {accessed Feb 2, 2008}.
Available from: URL:
Woolf SH, Johnson RE, Geiger J, Hyg MS. The rising prevalence of severe poverty in America: A growing threat to public health. American Journal of PreventiveMedicine. 2006; 31 (4). (BB)
Institute of Medicine (IOM). 2001. Health and Behavior. Chapter 6: Organizations, communities, and society (BB)
Marmot Status Syndrome, chapter 8, 9

Module 4: Reducing and Eliminating Social and Behavioral Disparities in Indicators of Health and Health Outcomes: Progress and Prospects

Current National and International/Global Initiatives
Mackenbach JP, Bakker MJ; European Network on Interventions and Policies to Reduce Inequalities in Health. Tackling socioeconomic inequalities in health: analysis of European experiences. Lancet. 2003.;362(9393):1409-14.(BB).
Koh HK, Oppenheimer SC, Massin-Short SB, Emmons KM, Geller AC, Viswanath K. Translating research evidence into practice to reduce health disparities: A social determinants approach. Am J Public Health. 2010: Suppl 1:S72-S80.
World Health Organization (WHO) 2005. Commission on Social Determinants of Health. Action on the social determinants of health: Learning from previousexperiences. (Update expected early 2011).
Marmot M. Social determinants of health inequalities. Lancet. 2005; 365: 1099-1104. (BB).
IOM. 2001. Health and Behavior. Chapter 8: Findings and recommendations (BB).

21st Century Visions: Eliminating Health Disparities
Abrams DB. Applying transdisciplinary research strategies to understanding and eliminating health disparities. Health Education & Behavior. 2006; 33(4): 515-531. (BB).
Marmot M. Dreaming a different epidemiological future. European Journal ofEpidemiology. 2005; 20:3-4. (BB)
Glass TA, McAtee MJ. Behavioral science at the crossroads in public health: Extending horizons, envisioning the future. Social Science & Medicine. 2006; 62:165-1671. (BB).
Institute of Medicine (IOM) 2005. Informing the Future: Critical issues in health. Washington, DC: National Academy Press.