Jerry M. Suls - US grants

physiologic stressor; aggression; disease /disorder proneness /risk; coronary disorder; stress; data collection; behavioral medicine; human subject;

stress; type A /type B personality; coronary disorder; behavioral medicine; disease /disorder proneness /risk; psychological stressor;

DESCRIPTION (provided by applicant): Older adults who survive a myocardial infarction (MI) tend to have more severe illness than their younger counterparts, are frequently depressed, have more comorbid conditions and are less medically adherent. Interventions are needed to improve the elderly patient's sense of self-efficacy and increase medical adherence and motivation for cardiac rehabilitation. This revised R21 seeks support to assess the feasibility of a brief social psychological intervention to achieve these goals among older post-Mi patients who have just recently returned home from the hospital. Application of a new social psychological theory, the Interpretation-Comparison model, suggests a means by which a patient's learning about how other fellow patients are coping may increase self-efficacy and motivation. Specifically, it is predicted that instructing participants to explicitly compare with another patient who is coping very well or exposing participants (without explicit instructions to compare) to another patient who is coping poorly will result in positive outcomes. This prediction will be tested in a sample of approximately 127 post-Mi patients (65+ years). Self-efficacy, quality of life, and perceived symptoms will be assessed prior to and immediately following the comparison exposure and at 4-, 12- and 20 weeks. Actual attendance at cardiac rehabilitation will also be assessed. Depression, which is common in older post-Mi patients, will be measured in the baseline interview and at follow-up and also will be evaluated as a potential moderator of comparison intervention effects. This intervention is not intended to replace more intensive psychosocial interventions and home-based case-management approaches, but it may effect change during the critical post-discharge period when cardiac patients are still in the process of making decisions about significant lifestyle changes and may increase their enrollment in cardiac rehabilitation. The results also should shed light on the kinds of patient models and instructions that may be most beneficial in educational videos used in rehabilitation, and suggest when social comparisons in social support groups can be productive or counterproductive to patient coping. Although the present research focuses on adaptation to cardiac disease, results should also be relevant and exportable to older adults that are coping with other chronic illnesses.

Abstract

On April 13, 2006, at least five F-2 tornadoes with wind speeds of 150 mph left a path of destruction 4 miles long and 1/3rd of a mile wide in downtown Iowa City the home of the University of Iowa. The storms inflicted serious injuries and extensive damage to several businesses, over 1,000 homes and apartments, and hundreds of automobiles. Many college students and permanent residents were forced to leave their homes because of storm damage. It is estimated that the storms resulted in at least $10 million in damages to public buildings and tens of millions more to private property. This natural disaster provides a unique, time-limited opportunity to examine important questions about perceptions of vulnerability. When people encounter a natural disaster that inflicts extensive injury and damage on their community, what effect does the experience have on their beliefs about vulnerability and preparedness for future disasters? Prior research with populations that have not experienced natural disaster or other kinds of major negative life events indicates that most people tend to believe they are less vulnerable (i.e., unrealistically optimistic) than their peers to future disasters. Less is known, however, about whether this belief changes when a significant negative event actually occurs. The proposed research will determine whether people return to unrealistic optimism and how this relates to future efforts aimed at emergency preparedness. Building on preliminary research with 220 participants contacted within 3-weeks after the tornadoes struck, this project will survey both community residents and college students who reside in Iowa City and were present at the time of the tornados to identify the trajectory of beliefs following a disaster and to advance knowledge about motivational and cognitive processes contributing to unrealistic optimism. Questionnaires/Interviews will be administered at 6- and 10-months post-disaster that contain the same items about beliefs, absolute risk, and objective likelihood. There also will be items about any experience with weather-related disasters or other major negative events since the April tornadoes. ANOVA, t-tests, correlations, and chi-square will be used to examine differences as a
function of subject groupings. The tests of changes over time will be assessed with growth curve analysis. ANOVA (or ANCOVA with demographics) will be used to assess differences across cross-sectional samples. Multiple regression will be used to examine the role of potential moderators and mediators of beliefs and preventive behaviors. Because social psychologists conceptualize the illusion of non-vulnerability as one of the fundamental ways that people cope with uncertainty and anxiety about the future, the answers to these questions, in the context of natural disaster, are important and potentially can extend understanding about coping with disasters that affect entire communities. Findings from this research will address theoretical and practical questions about whether the degree of personal exposure and consequences of a disaster influence beliefs of non-vulnerability and emergency preparedness behaviors.

People routinely encounter situations in which they must decide how to respond to a potential danger or health threat (e.g., tornado siren, flu virus, undercooked food, asbestos, sports injury, a dark alley, cigarette smoke, sun exposure, an icy road, a pit bull). A person?s response to a danger or threat should depend on, among other things, the likelihood of harm. For example, a person would be foolish to stop or avoid a desired activity because of a negligible likelihood of harm, yet would be ill-advised to continue with an activity associated with a high likelihood of serious harm. Consequently, it is crucial to understand what shapes people?s perceptions of vulnerability (i.e., subjective likelihood of harm from a threat) and how these perceptions influence behavior.

This is a complex challenge because for any given threat, there is a variety of information that could influence perceived vulnerability. To illustrate, consider a person who is about to walk on a forest trail and is thinking about the threat of mosquitoes carrying West Nile Virus. Perceived vulnerability to West Nile might be affected by knowledge of the frequencies of getting bites on past walks, the extent to which the trail seems representative of the type that attracts mosquitoes, a newspaper story about the rates of West Nile Virus, and whether other hikers seem to be concerned about the virus.

A key goal for this project is to refine and test a new theory of how various factors jointly shape perceptions of vulnerability and behavior. Unlike existing theories, this one is explicit in representing six factors that drive vulnerability and also makes an important distinction between people?s explicit reports of judged likelihood and the perceptions of vulnerability that drive behavior. An interrelated second goal of the project is to develop a flexible computer-based paradigm that can be used by a broad array of researchers for experimentally testing how various jointly operating factors influence decisions and behavior in the presence of a potential threat.

The theory and empirical findings from this project should have important implications across fields concerned with subjective threat assessment and/or decision making under uncertainty. This includes fields like health psychology, occupational safety/injury prevention, and decision making. The studies should also provide insight about how to best measure people?s perceived vulnerability to health risks, as well as how to design public?health interventions aimed at making people aware of their vulnerability.