CHAPTER 2 Conducting Health Research

Lecture Outline
I. The Placebo in Research and Treatment

A placebo is an inactive substance or condition that can cause people to improve or change their behavior. Both expectancy and learning contribute to this effect.
A. Treatment and the Placebo

The placebo effect is an advantage for treatment, boosting its effectiveness. This effect may be responsible for about 35% of improvements, but some treatments (such as antidepressant drugs) have higher placebo effects than others (such as treatment for broken bones). Placebos can also produce negative effects, called the nocebo effect. Both placebo and nocebo effects are real and produce symptoms and relief that are indistinguishable from the effects obtained from drug and other physical treatments.
B. Research and the Placebo

The placebo effect presents problems for research because they prevent a clear interpretation of treatment effectiveness. Researchers try to control for placebo effects by designing single-blind and double-blind designs, arranging for participants and even researchers to be unaware of which participants receive a placebo and which get active treatment.
II. Research Methods in Psychology

For research to contribute to knowledge about health, scientists should be familiar with one another's work, use controlled methods, try to keep personal biases from contaminating results, make claims cautiously, and replicate their studies. To understand behaviors related to health and disease, researchers use a variety of methods, including correlational studies, cross-sectional and longitudinal studies, experimental designs, and ex post facto designs.
A. Correlational Studies

Correlational studies indicate the degree of relationship between two variables, such as the number of stressful life events and the risk of heart attack. This approach is one type of descriptive research. In correlational studies, the relationship between two variables is expressed in terms of correlation coefficients. Coefficients range from -1.00 to +1.00, with numbers closer to 1.00 indicating stronger relationships. Attributions of cause and effect are not possible from correlational studies
B. Cross-Sectional and Longitudinal Studies

Cross-sectional studies are conducted at one point in time and compare people of different ages, whereas longitudinal studies follow participants over an extended period of time. Cross-sectional studies can show differences between groups, but longitudinal studies can reveal developmental trends. This characteristic is an advantage of longitudinal studies, but they have the disadvantage of taking a long time and being expensive.
C. Experimental Designs

Experimental designs can determine cause and effect relationships by manipulating an independent variable and observing the effect on a dependent

variable, for example, comparing an experimental group on a low-fat diet (treatment group) to participants who maintain their regular diet (control group) and then measuring the development of cardiovascular disease (the dependent variable) in the two groups. Well-controlled experimental designs give scientists their best method to determine causation.
D. Ex Post Facto Designs

Ex post facto designs are similar to experimental designs in that both use contrasting groups, but these designs do not include manipulation of independent variables. Instead, groups of participants differing on some subject variable (or participant variable) are contrasted to determine differences in the dependent variable. For example, contrasting people with varying levels of obesity to determine in food choices is an ex post facto study. The finding that heavier individuals express food preferences that differ from those of less obese individuals does not demonstrate that obesity is causally related to food preferences because ex post facto studies do not manipulate an independent variable or control for other factors.
III. Research Methods in Epidemiology

Epidemiology is a branch of medicine that investigates factors contributing to the occurrence of a disease in a particular population. Epidemiology evolved into a scientific discipline during the 19th century and played an important role in the fight against infectious diseases. Today, epidemiologists also study factors associated with chronic illness, including its prevalence and incidence. Prevalence is the proportion of the population affected by a particular disease at a particular time, whereas incidence is the number of new cases of a disease during a particular time, usually one year. Research methods used in epidemiology are similar to those employed by psychologists. Epidemiology research falls into three broad areas: observational methods, natural experiments, and experimental investigations.
A. Observational Methods

Observational methods parallel correlation studies in psychology. The two types of observational methods are retrospective and prospective. Prospective studies are longitudinal designs that follow the forward development of a group of people starting an experience together. Retrospective studies begin with a group of people already experiencing a disease and then look for characteristics of these people that are different from those of people who do not have that disease. Retrospective studies are also called case-control studies because cases (people with a disease) are compared with controls (people not affected).
B. Randomized, Controlled Trials

Randomized, controlled trials are equivalent to experiments in psychology. Clinical trials are randomized, controlled trials designed to test the effectiveness of a drug or treatment. Researchers assign participants to groups randomly to control for self-selection. Randomized, placebo-controlled double-blind designs are often considered the zenith of research design, but comparative research indicates that observational studies can yield similarly valid results.
C. Natural Experiments

Natural experiments are similar to ex post facto studies in psychology; both involve the selection rather than the manipulation of a variable. Natural experiments can be conducted when two similar groups of people naturally divide themselves into those exposed and those not exposed to a pathogen. D. Meta-analysis

The statistical technique of meta-analysis allows researchers to evaluate many research studies on the same topic, even if the research methods differed. In addition, meta-analysis provides an index of the size of the effect, which allows researchers to gauge the importance of the effect.
E. An Example of Epidemiological Research: The Alameda County Study

Epidemiology provides techniques for taking a first look at a health-related problem. An important example is the Alameda County Study, which began in 1965 in an effort to identify certain health practices that relate to subsequent mortality and morbidity. Alameda County researchers found that people who practiced six or seven basic health-related behaviors were less likely to die than those who practiced zero to three of these behaviors. These health practices included (1) getting seven or eight hours of sleep daily, (2) eating breakfast almost every day, (3) rarely eating between meals, (4) drinking alcohol in moderation or not at all, (5) not smoking, (6) exercising regularly, and (7) maintaining weight near the prescribed ideal.
IV. Determining Causation

Most epidemiological studies do not prove causation, rather, they point to specific risk factors that are associated with a particular disease or disorder.
A. The Risk Factor Approach

A risk factor is any characteristic or condition that occurs with greater frequency in people with a disease than it does in people free from that disease. Although they do not determine causation, risk factors can be used to estimate the probability of developing a disease. Scientists using the risk factor approach must distinguish relative risk from absolute risk. Relative risk is the ratio between the number of people in an exposed group with a disease and the number in an unexposed group with the disease. Absolute risk refers to a person's chance of developing a disease independent of the risk for other people.
B. Cigarettes and Disease: Is There a Causal Relationship?

Epidemiologists have gradually uncovered evidence linking cigarette smoking to lung cancer and heart disease. Although scientists have no evidence from experimental designs proving that cigarette smoking causes heart disease and lung cancer in humans, the accumulation and consistency of other evidence has led researchers to conclude that cigarette smoking causes both heart disease and lung cancer. This evidence is based on seven conditions for determining causation from nonexperimental research and shows that (1) a dose-response relationship exists between smoking and the disease; that is, the more cigarettes a person smokes, the greater the risk for heart disease and lung cancer; (2) the prevalence and incidence of heart disease declines when people stop smoking; (3) cigarette smoking precedes heart disease and lung cancer; (4) the relationship between cigarette smoking and disease is consistent with other data and makes sense from a biological viewpoint; (5) research in this area yields a consistent pattern of resultsa pattern that has been established through meta-analysis, a statistical technique that allows the combination of information from several studies into one analysis; (6) the size of the relative risk is largeabout 23.0 for lung cancer; and (7) the evidence is based on a number of well-designed studies. A combination of these criteria can allow epidemiologists to determine causality from nonexperimental designs.

V. Research Tools

Theories and psychometric methods are tools that researchers use to determine areas of inquiry and to measure variables essential to their research.
A. The Role of Theory in Research

A theory can be defined as a set of related assumptions that allow scientists to use logical deductive reasoning to formulate testable hypotheses. Theories are not idle speculations but are useful tools in any scientific discipline. Theory-based models allow researchers to (1) organize data, (2) render them meaningful, (3) generate descriptive research, (4) test a variety of hypotheses, and (5) follow a guideline for working through daily problems.
B. The Role of Psychometrics in Research

Health psychologists, like other scientists, use measuring instruments to test their hypotheses and to build their theories. To be useful, measuring devices must be both reliable (consistent) and valid (accurate).
1. Establishing Reliability

The reliability of any measuring tool is the extent to which that tool measures in a consistent fashion. Reliability can be established through testretest and interrater methods. Reliability is usually expressed in terms of correlation coefficients.
2. Establishing Validity

Measuring instruments can be reliable (consistent) and yet lack validity (accuracy or truthfulness). Validity is the extent to which a measuring instrument measures what it is designed to measure. Predictive validity is an estimate of an instrument's ability to predict which participants will develop a particular condition and which ones will remain disease-free.