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Global Health MSc Thesis / The construct of loneliness is well explored within the arts and humanities, but has only recently been considered to be a condition that should be addressed by public health policy. Definitions explored include common sense, existential loneliness, and the cognitive approach. The governments of Japan and the UK have implemented policy that specifically addresses loneliness as a result of its recent identification as a health concern linked to dementia, heart disease, hypertension, and greater risk of morbidity. This thesis undertook an integrative literature review across the arts, humanities, sciences, and grey literature to provide a comprehensive picture of a modern conceptualization of loneliness. The results of this thesis find that loneliness is both a health risk and social problem that is being addressed at the municipal and federal levels in Japan and the UK. However, the question remains as to whether loneliness should be considered a public health concern or a social concern. More international collaboration on the impact of loneliness on populations is recommended. / Thesis / Master of Health Sciences (MSc) / The construct of loneliness is well explored within the arts and humanities, but has only recently been considered to be a condition that should be addressed by public health policy. The governments of Japan and the UK have implemented policy that specifically addresses loneliness as a result of its recent identification as a health concern linked with dementia, heart disease, hypertension, and greater risk of morbidity. This thesis undertook an integrative literature review across the arts, humanities, sciences, and grey literature to provide an expansive picture of a modern conceptualization of loneliness. The results of this thesis find that loneliness is both a health risk and social problem which can be appropriately addressed by government action. However, the question remains as to whether loneliness should be considered a public health concern or a social concern. More international collaboration on the impact of loneliness on populations is recommended.

Information on the overall health risk behaviors of college students is limited and it is unknown if being enrolled in an elective or a required health course affects behavior change among the students. There are mixed reports on whether or not health education courses affect behavior change. Factors that may affect change are self-efficacy and the constructs that build the Health Belief Model (i.e. perceived susceptibility and perceived barriers). A sample of convenience was gathered for the current study using two universities in the state of Virginia. Virginia Tech students within the sample were enrolled in an elective health course (n = 375) and James Madison University students within the sample were enrolled in a required health course (n = 202). The National College Health Risk Behavior Survey (NCHRBS) and the Self-Efficacy Scale survey were used to gather information on overall health risk behaviors, health behavior changes, and self-efficacy levels of the students. To acquire health behavior change data, the NCHRBS was administered at the beginning of the Fall 2003 semester and again at the end of the semester. The results of the study indicated that, overall, the type of course a student was enrolled in and self-efficacy did not have a significant effect on health behavior change. However, possible trends were identified with alcohol use, tobacco use, and dietary behaviors, indicating that further research should be performed to analyze underlying factors, not analyzed in this study, which may be affecting health risk behaviors. / Ph. D.

Despite decades of effort in developing evidence-based treatments, drug addiction remains one of the most problematic and enduring public health crises. Developing a new generation of theoretically-derived interventions constitutes an important clinical and scientific gap that, if addressed, may open innovative treatment opportunities. Based on the Reinforcer Pathology theory, altering the temporal window over which reinforcers are integrated (i.e., measured by delay discounting) would alter drug valuation and consumption. The first investigation—in 2 separate studies— test the Reinforcer Pathology theory by examining the effect of expanding and constricting the temporal window of integration using two mating narratives (long-term and short-term relationships, respectively) on cigarette valuation among cigarette smokers. The second investigation, test the Reinforcer Pathology theory by assessing the effect of remotely delivered Episodic Future Thinking (EFT) narratives (expands the temporal window) on real-world alcohol consumption among individuals with alcohol use disorder (AUD). Together, these investigations supported the Reinforcer Pathology theory and demonstrated its relevance for understanding and intervening in addiction. The current findings provide scientific justification to further investigate Reinforcer Pathology based interventions that expand the temporal window to change drug valuation and consumption. The construction of multi-component treatments that incorporate Reinforcer Pathology based interventions to systematically alter the temporal window may provide a novel intervention to reduce alcohol consumption. / Doctor of Philosophy / The following studies provide evidence that altering the temporal widow (how far in the future one can imagine and integrate into the present) would alter drug valuation. In the following studies, we used narratives describing long-term or short-term mating relationships (Study 1) and Episodic Future Thinking (EFT; represents one's capability to pre-experience the future; Study 2) to alter the valuation of cigarettes and alcohol, respectively. In the first study, cigarette smokers who read and vividly imagined long-term romance relationship narrative (expands the temporal window) valued cigarettes less than control (imagined looking for a lost key). In contrast, those who read and vividly imagined a short-term sexual encounter (shortens the temporal window) valued cigarettes more than controls. The second study employed EFT (expands the temporal window) as a strategy to reduce alcohol consumption, in real-world settings, over two weeks in individuals with alcohol use disorder. The study found that expanding the temporal window using EFT reduced alcohol consumption. Together, these two studies provide support to employing interventions that extend the temporal window to change drug valuation and consumption. The construction of multi-component treatments that incorporate interventions expanding the temporal window may reduce drug consumption.

Risky decision-making and social influence are associated with many health-risk behaviors. However, more work is necessary to understand risky decision-making and social influence. Additionally, to begin identifying ways to change individuals' engagement in health-risk behaviors, more work is necessary to understand whether and how risky decision-making and social influence can be modulated. Using computational modeling in conjunction with other techniques, this dissertation 1) explores mechanisms underlying risky decision-making under social influence (Study 1) and 2) examines how individuals could modulate risky decision-making and social influence (Studies 2 and 3). Study 1 identifies a novel social heuristic decision-making process whereby individuals who are more uncertain about risky decisions follow others and proposes dorsolateral prefrontal cortex (dlPFC) as a 'controller' of this heuristic. Study 2 finds that giving individuals agency in viewing social information increases the utility of that information. Study 3 finds that some individuals can modulate brain patterns associated with risky decision-making using a real-time fMRI (rt-fMRI) neurofeedback paradigm, and preliminarily shows that this leads to behavior change in risky decision-making. In sum, these studies expand on previous work elucidating mechanisms of risky decision-making under social influence and suggest two possible avenues (agency and real-time fMRI neurofeedback) by which individuals can be taught to change their behavior when making risky decisions under social influence. / Doctor of Philosophy / Risky decision-making and social influence are associated with many health-risk behaviors such as smoking and alcohol use. However, more work is necessary to understand risky decision-making and social influence. Additionally, to identify ways to change individuals' engagement in health-risk behaviors, more work is necessary to understand how risky decision-making and social influence can be changed. Here, computational modeling, a way to quantify individual's behavior, is used in a series of studies to 1) understand how individuals make risky decisions under social influence (Study 1) and 2) test ways in which individuals can be guided to change the way they respond to social influence (Study 2) and make risky decisions (Study 3). Study 1 shows that individuals who do not have strong preferences respond to social information in a different way than those who do and utilizes neuroimaging to identify a particular brain region which may be responsible for this process. Study 2 shows that individuals are more influenced by others when they ask to see their choices, as compared to passively viewing others' choices. Study 3 shows that a brain–computer interface can be used to guide individuals to change their brain activity related to risky decision-making and preliminarily demonstrates that following this training individuals change their risky decisions. Together, these studies further the field's understanding of how individuals make risky decisions under social influence and suggest avenues for behavior change in risky decision-making under social influence.

Behavioral and physiological reactivity, and its relationship to cardiovascular disease has been studied in men for a number of years, and the expression of anger has been identified as a possible contributing factor. Few studies, however, have focused specifically on the reactivity of women, and those which have suggest that women are less reactive to laboratory tasks than men. For the present study, 45 undergraduate women, ages 19-21 were selected from a larger sample of 135 women to represent three discrete groups: (1) low anger/low denial, (2) high anger/low denial, and (3) low anger/high denial, based on their scores on the State-Trait Anger Expression Inventory, P and the Marlowe-Crowne Social Desirability Scale. It was hypothesized that the three groups would show reliable differences in heart rate and blood pressure during presentation of a stressful laboratory stimulus, the Stroop Color and Word Test. Each subject received three counterbalanced conditions: (1) no feedback, (2) error feedback without observer present, (3) error feedback with observer present. As hypothesized, women who reported a high level of denial and a low level of anger exhibited reliably greater systolic blood pressure to the no-feedback condition than subjects who reported low levels of denial and anger. The hypothesis that all groups would display greater A reactivity in a condition which provided error feedback with observation was not supported. / Master of Science

Several substantive observations formed the basis for this research. First, the observation of stagnating life expectancy in the United States over the first two decades of the 21st century, representing a dubious form of American exceptionalism. Second, evidence suggesting that novel measures of biological aging might provide allow for early evaluation of population-level health trajectories, based on direct observation of health status in still-living people. Third, the opportunity to apply these measures for study of population-level phenomena, using methods routinely used in the fields of sociology, demography, and economics. This dissertation represents a proof-of-concept work to support the application of biological aging measures to population health surveillance. In Chapter 2, I conduct a systematic literature review of novel measures and approaches to the quantification of population aging published since 2000, and identify 3 major classes of novel population aging measures. Biological-aging measures can be understood as a specific application of Sanderson and Scherbov’s α-ages approach, which indexes “true age” to the distribution of some aging-related characteristic in a reference sample. Relative to other novel measures and approaches, however, biological-aging algorithms hold particular promise in their ability to provide direct measures of pre-clinical, aging-related health risk across the entire adult age range of a population. In chapters 3 and 4, I apply published biological aging algorithms to blood-chemistry and organ-test data collected by the National Health and Nutrition Examination Surveys (NHANES) to test whether the U.S. population has grown biologically older over the past two decades, as some interpretations of life expectancy data would suggest, and to evaluate the extent to which selected social and environmental exposures might explain these trends. Formal age-period-cohort analysis revealed consistent period increases in biological aging from 1999-2018; while population aging slowed after the training cohort was measured in NHANES III (1988-1994), aging trajectories have reverted towards early-1990s levels since the turn of the century. Limited evidence of cohort effects was observed, with findings consistent regardless of age, race, and sex – although racial disparities in biological aging persisted over the entire study period. Kitagawa-Blinder-Oaxaca decomposition analysis of four candidate exposures (i.e., BMI, smoking status, blood lead, and urinary polycyclic aromatic hydrocarbon levels) suggested that changes in the distribution of behavioral and environmental risk factors accounted for a substantial proportion of observed period trends and/or racial disparities in biological aging over the first two decades of the 21st century. Broadly, these results suggest that measures of biological aging can provide earlier and more precise readouts of population health trajectories and their drivers, ultimately informing next-generation public health efforts to promote healthy aging and aging health equity.

This research sought to better understand the antecedents of consumers' perceptions of risk (health and safety risks specifically), and the relationship between the perceived risk of an option, and judgments about the acceptability of that option. The specific objective of the proposed research was to build a model of risk perception and risky option acceptability for hazardous products and activities (i.e., that present downside risks to a consumer's health and safety), using several variables that have been postulated to be important, using a multiple linear regression model building approach. One goal was to integrate the study of perceived risk in consumer behavior with various concepts and models of risk perception and risk acceptability from the behavioral decision sciences, an integration suggested previously by Jacoby (1981). Emphasis was placed on conceptual and methodological issues that confront researchers from either domain that need to be resolved if risk is to occupy a central place in marketing theory. Two of the variables included in the study of the determinants of perceived risk comprise the conceptual definition of perceived risk used in this research: probability of a negative outcome, and severity of a negative outcome. Specifically, both were hypothesized to be positively correlated with perceptions of risk. Six additional variables were also examined as determinants of perceived risk. Given the definition of risk used in this research, these variables relate to either or both of the constructs probability and severity, and implicitly were also hypothesized to be significant determinants of risk perception. The variable examined that relates to probability exclusively was controllability. Specifically, a negative relationship was hypothesized between the perceived risk of a product and the controllability of the negative outcome associated with that product. Variables which relate to severity exclusively include reversibility, dreadedness, and immediacy. Specifically, judgments of negative consequences as immediate, dreaded, and irreversible were hypothesized to be positively correlated with perceptions of risk. Finally, two variables that relate to both probability and severity included availability and catastrophic potential. Specifically, there should be a positive relationship between the perceived risk of a product and the availability and catastrophic potential of the negative outcome associated with that product. All hypotheses with the exception of those relating to immediacy were supported; the hypotheses relating confidence to acceptability was only partially supported. All variables with the exception of immediacy were concluded to belong in a comprehensive model of perceived risk and option acceptability. / Ph. D.