John P. Kirscht’s research while affiliated with University of Michigan and other places

Over a period of 6 months, factors related to change in cigarette smoking were investigated in a group of 250 adult outpatients, all of whom smoked at the time of enrollment in the study. Among the variables tested were demographic, social, and situational factors, beliefs about the health effects of smoking and difficulty of quitting, and intentions regarding future smoking. Information was gathered at baseline and the first and sixth months by means of telephone interviews. Relative to smoking at 6 months, intention, education, and professional advice made independent contributions to cessation. The processes of quitting were examined in more detail. Attempting to quit was related to intention, professional advice, level of smoking, and social cues to smoke. Among those who tried to stop, difficulty with urges to smoke, and education affected success versus failure. Earlier success related to less anxiety and tension, and to less difficulty in not smoking when in negative situations. The findings suggest that a complex set of social and cognitive factors affect change in smoking behavior, and that somewhat different factors are operative at different stages.

Longitudinal analyses reported here explored the relationship between a perceived sense of being at risk for AIDS and a variety of behavioral, social, and psychological consequences. Data were obtained from a cohort of 637 homosexual men living in Chicago, who are participating in a psychosocial study and have completed two waves of data collection. Their perceptions of risk were quantified using both an absolute and a comparative measure; these were combined into a risk index, scored from one to nine (x̄= 3.91; SD= 1.64). Univariate analyses demonstrated that level of risk was related to several measures of subsequent behavioral risk reduction. However, after adjustment for sociodemographic variables, initial behavior, and other components of a model predicting behavior change, this was no longer true. Of the 12 behavioral outcomes assessed, only one was related to risk after appropriate adjustment, and this relationship was negative. Other longitudinal analyses examined the impact of a sense of risk on measures of psychosocial functioning which have been theoretically linked to health behaviors and to measures of psychological/ social distress. These demonstrated a range of potentially adverse consequences for those who perceived themselves to be at greater risk for AIDS, including increased barriers to behavioral change, obsessive/compulsive behavior, social role impairment, and more intrusive worries and concerns about AIDS. Taken together, these results suggest that there is little or no observable benefit to an increased sense of risk, but that such a sense subsequently leads to distress and dysfunction in a variety of realms. The implications of these findings for development of policy concerning antibody testing of at-risk populations is discussed.

This study describes the mental health of a large cohort of gay men participating in the Chicago Multicenter AIDS Cohort Study/Coping and Change Study. Six biannual questionnaires were self-administered between 1984 and 1988. General mental health was determined by the Hopkins Symptom Checklist (HSCL). An abbreviated version of the Center for Epidemiologic Study Depression Scale (CESD-5) and an adapted Diagnostic Interview Schedule (DIS) question also measured depression. Suicidal ideation was assessed by one question in the HSCL. AIDS-specific distress was determined by three subscales specifically developed for this study. While mean HSCL and CESD-5 scores were stable during the observational period, AIDS-specific distress increased over time. The HSCL scores for the cohort were somewhat elevated above general population norms but considerably below psychiatric outpatient norms. Fewer than 12% of the men reported elevated HSCL or CESD-5 scores three or more times. A self-reported episode of depression of two weeks or more, measured by the DIS screening question, was experienced by 40.1% of the sample. Suicidal ideation was reported on three or more visits by 18.8% of the men. The younger members of this cohort exhibit greater general and AIDS-specific distress. Income was inversely associated with general distress. HIV-seropositive participants had generally higher AIDS-specific distress scores than those who were seronegative, but their scores were equivalent on the HSCL and CESD-5.

In a general population sample, we examined relationships between sociodemographic characteristics and health beliefs. Individual questionnaire measures for components of the health belief model were combined to form six scales. In analyses which adjusted for perceived levels of health, sociodemographic markers of social disadvantage (e.g., black race, or low socioeconomic status) appeared to associate with favorable health beliefs, that is, with health beliefs often associated with health promoting behaviors. Specifically, we found that blacks expressed greater concern about health. Women believed they tended to get sick more often and to suffer more severely from illness. Female and older respondents placed greater value on the kinds of services provided by members of the health professions. Female, black, older, and lower socioeconomic status respondents placed greater value on such healthful personal habits as exercise, alcohol avoidance, and proper diet. These results suggested that the poor health suffered by relatively disadvantaged members of society are not, in some manner, a consequence of fundamental beliefs about health.

Problems with self-report measures for smoking motivate the use of biochemical tests in treatment trials for smoking. These biochemical tests, unfortunately, are not perfect. In this paper, we present an algebraic model of bias in treatment trials for smoking. Bias is expressed in terms of the deception rate among continued smokers in a control group, the relative deception rate among continued smokers in an experimental group, and the sensitivity and specificity of a biochemical test which may be used either to confirm self-reports of quitting or to replace self-report entirely. For given test specificity and sensitivity, the model defines deception rates for which different biochemical testing strategies are preferred. The model is presented in the context of current knowledge on the phenomenon of deception among adult smokers. The paper concludes that better judgements regarding the role of biochemical tests in treatment trials for smoking require more precise information regarding the magnitude and determinants of deception.

The Health Belief Model (HBM) has been applied to a variety of health conditions: most are less threatening and require less complex responses than those arising in the case of AIDS. The utility of the HBM in understanding preventive behaviors in AIDS is examined in a cohort of homosexual men at two different time points. Longitudinal analyses estimated the relationship of indices assessing susceptibility, severity, benefits, and barriers, as well as sociodemographic factors, to sexual behavior across the next 18 months. Analyses further defined these associations in specific subgroups of participants, such as those initially at lower or higher risk. In general, measures of severity and socioeconomic advantage had the most consistently beneficial effect on various measures of behavior. Little or no beneficial effect was observed for other components of the HBM, notably a measure of perceived susceptibility. These analyses suggest that the special features of AIDS may require development of more adequate theoretical frameworks.

To analyze the mechanisms by which psychosocial factors affect health, this research investigated social integration and indicators of coping style and their relation to health behaviors and health status. The analysis was conducted using the results of a 1977 survey of 854 household interviews from a multi-stage probability sample of adult residents of Washtenaw County, Michigan. Physical-health status was evaluated by two indices: Self-rated global health and self reports of chronic disability. Mental health was assessed with the Center for Epidemiologic Studies Depression Scale. Overall, the effects of the psychosocial factors were stronger for mental health than physical health. Social integration was shown to have direct effects on both physical and mental-health status. Internal locus of control was associated with lower levels of depressive symptoms. Chronic conditions were primarily affected by age, sex, and health behavior. Evidence from the path analyses suggested that part of the health benefit that women accrue from social integration and an active coping style is related to better health behavior. This mediation effect was not found for men.

An important role of applied social science in health has been the promulgation of theory designed to account for health behaviors of individuals and groups. Efforts to model various health-related actions have multiplied and become increasingly sophisticated. Stone (1979), in his comprehensive review of psychology and the health system, noted that “the questions of why people behave as they do and how they may be induced to behave differently have represented the core of American psychology throughout this century” (p. 70). Recent growth in the study of health behavior has significant roots in the pioneering efforts of applied psychologists and sociologists, represented in the frameworks outlined in the seminal article by Kasl and Cobb (1966). As noted by Leventhal, Zimmerman, and Gutmann (1984) in their critical review, “the health belief model is the cognitive model most frequently used in studies of health behavior and compliance” (p. 384).

Peer Reviewed http://deepblue.lib.umich.edu/bitstream/2027.42/66724/2/10.1177_109019818701400408.pdf

We examined the ability of a provider-initiated, minimal-contact intervention to modify the smoking behavior of ambulatory clinic patients. Smokers at two outpatient sites were assigned to one of three groups: provider intervention only (PI); provider intervention plus self-help manual (PI/M); and usual care (control) group (C). The physician message emphasized the patient's personal susceptibility, the physician's concern, and the patient's ability to quit (self-efficacy). The nurse consultation concentrated on benefits and barriers associated with stopping, and on strategies for cessation. Telephone interviews were conducted with the 250 participants within a few days of their clinic visit and again at one and six months. Both PI and PI/M proved to be superior to usual care in motivating attempts to quit at both one-month and six-month follow-ups, and logistic regression analyses indicated that participants receiving the self-help manual in addition to the health provider message were between two and three times more likely to quit smoking during the study period than were participants in either of the other study groups.