Y Health
Y Health
Where Behavioral Change Meets Public Health with Dr. Josh West
Sometimes breaking old habits feels near impossible, especially when we’re hyperfocused on the outcome or our environment is working against us. On the other hand, community interventions, social support, and technology can be the catalyst for a desired behavioral change.
Listen to the BYU Public Health Department chair, Dr. Josh West, discuss behavioral change. Both he and Cougar emphasize that change is always possible, despite difficult circumstances.
Guest Bio
Dr. Josh West has worked at BYU for the past 15 years. He is not only a professor but also the current BYU Public Health Department chair. Dr. West earned a Master’s of Public Health with an emphasis on epidemiology from San Diego State University and later his PhD in public health from the University of California, San Diego - School of Medicine. He focuses his research on behavioral change and its intersection with technology.
For more insights on fitness apps and behavioral change, read this article.
Recorded, Edited & Produced by Christy Gonzalez, Harper Xinyu Zhang, and Tanya Gale
Cougar Hall: [00:00:09] Welcome to Y Health, a podcast brought to you by the BYU Public Health Department. I'm Dr. Cougar Hall, a professor here at Brigham Young University. Whether you are a student, parent or BYU fan, this podcast will help you navigate the world of public health. Our podcast strives to help individuals receive accurate information regarding public health. So whether it's global or local, we will discuss how it pertains to you. Just kick back and relax as we talk about why health. Dr. Josh West, welcome to the Health podcast.
Josh West: [00:00:44] Thank you. I'm happy to be here.
Cougar Hall: [00:00:45] Will you take just a moment, introduce yourself or our our audience?
Josh West: [00:00:49] Sure. My name is Josh West. I'm a professor here in the Department of Public Health, and I'm currently acting as the chair of our department. I've been here for going on 15 years. I started my undergraduate degree as a biology major. I don't know why I did that. I started because I felt like I didn't have any real direction. I remember from a young age, my brother always wanted to be an attorney. My older brother always wanted to be an attorney. My younger brother was really computer savvy, even from a young age, and I felt like I didn't have any kind of natural inclinations toward any one profession. And I remember my grandma asking me what I wanted to be when I grew up, and I had no idea. And so I think I said I wanted to be a doctor. And she said, I always knew you were smart. And that reaction probably is a 12 year old. I thought, Well, I guess that's what I'm going to do. I don't know. I don't think I'm smart. And in fact, now it's been confirmed, I'm not sure. But as a 12 year old, then I just said, Oh, I guess that's what I'll be.
Josh West: [00:01:53] And so during kind of the rest of my formative years and through high school, probably in the back of my mind, I always thought, I don't know, I'll do something like that. And. I served a mission in Guatemala and I had some really neat experiences that I do think kind of laid the groundwork of a foundation, if you will, for what would become my career. And I remember sitting two instances in particular a family that we were working with. We had visited them several times and had kind of grown to love these people and sitting in their little home and the father telling me that their daughter was really, really sick because she had asthma. And in his kind of estimation or evaluation of the situation, she was likely to die at some point soon. And I remember thinking, what are you talking about? This is a condition that's very manageable. And, you know, now looking at the father's perspective, without resources, without any knowledge really about what's happening and this is rural parts of Guatemala that, you know, kind of planted a seed in my heart that health isn't something that we can just assume exists everywhere and for everybody.
Cougar Hall: [00:03:10] Yeah, really. Well said, Josh, thank you. If you were to ask me, don't. But if you were to ask me, you know, what is Josh West do when it comes to research? I would say and I'll give you a chance to correct me if I'm wrong, I would say you have been focused in your 15 years at BYU on behavior change, which I really think is making the healthy choice the easy choice. But you've been looking at behavior change at this intersection of technology as we've innovated. Are there some technologies out there that will indeed make the healthy choice the easier choice? And I think if I reflect for a moment, you did quite a number of papers and studies looking at mobile apps when that was still a new thing on a smartphone. Right. And in that health and lifestyle category, for sure. And then we did some fun projects with e-bikes and looking at, you know, is is this a critical catalyst as we use these technologies, having a battery powered or battery assisted pedal assist bicycle, will that help those that maybe are recovering from an injury or are slightly overweight or have fallen into a more sedentary lifestyle? And this is that catalyst to get them over that hump to where physical activity, which is still going to be challenging, but it's not so challenging that it just buries you. Right. I feel like that's the space you've been working in. Is there something that you would add to that description?
Josh West: [00:04:35] I think that's a great description, Cougar. And I mean, obviously, we work together so much that you very aware of what it is that I do. And we spent so much time discussing these things over the years that I think that's that's great. When I see technology and behavior change, I feel like technology has impacted so many disciplines and so many spaces. And behavior change, I think is very much like those. And that is that the technology can improve and to some extent accelerate progress in some of those spaces. It can also exploit maybe some of the vulnerabilities, behavior change. As a science has developed over the years, I think we've gotten fairly good at being able to predict behaviors with, you know, a pretty high degree of reliability. And by that, I mean, we've been able to understand what are the things that precede behavior change, what are those variables? And so how can we alter those variables, the conditions that would lead to healthier, unhealthy behaviors? We've gotten really good at that over the years in I'll call them offline settings or non technology settings. We've gotten really good at that. And I mean, it's not 100% because we're dealing with people and people. There's a world out there and there are variables that we don't control. But I would say for a social science, we've done a pretty good job as a discipline.
Josh West: [00:05:56] Now when you add in the technology component, I think what we've seen is that technology can help us to measure some of those, you know, antecedents or preceding conditions or factors. It's also helped us to be able to change those in ways that maybe are quicker and maybe even a little more effective. And so, for example, if you think about mobile apps, the ability to measure your behavior, simply information like how many steps you've taken or how much you've eaten. I mean, that information, you know, fed back into a loop can at the most kind of basic level help to inform your next decision. And I mean, that's kind of a simple sequence, but it is very possible and we see that in some circumstances that influences one's decision to make a better choice. And so our ability to track behaviors and use that information more quickly has been enhanced. And I think in that regard, technology has been fantastic. There are other technologies related to social media, as an example, where we're able to communicate our messages more. Oddly and able to influence norms and kind of beliefs in communities because now we have this kind of amplified voice to reach our audience.
Cougar Hall: [00:07:12] So tapping into social support and social norms, a subjective norm, we might say, from a theoretical perspective for sure, and also cues to action. I think, you know, your phone can give you alerts and and remind you that it's time to get up and it's time to move or it's time to take a medication or it's I mean, on and on. So really cool. And the future is really bright in this area, right?
Josh West: [00:07:33] That's a real value in working with you is that you're actually the real behavior change expert. I mean, you spent years working in an environment where your goal really was to change behavior, change the behavior of young people in in the public schools. And so you probably better than I mean, almost anybody are able to see kind of the kind of in the trenches behavior change, you know, working with kids in the public schools. So you understand the theory, you understand the application. So I think you're absolutely right that behavior change is enhanced in many ways by technology. If we hold true or, you know, there's some degree of fidelity to those principles that we know work in an offline setting. If we are able to integrate those as we implement or apply the technologies, we find that we're much more effective. It's not that technology, just because it's technology changes behavior, but when we take best practice and we use technology as a tool, that our efforts are enhanced.
Cougar Hall: [00:08:34] Yeah, no, I really like that. And I would just add from my own perspective and from my professional experience, it's still hard. You can give me a smartphone or some some fancy watch that's giving me feedback in real time. And I think it's still vitally important that we have some self-compassion, that we recognize that we've spent a lifetime developing these habits and these behaviors. Right. And while we might feel incredibly motivated on a monday morning to change all of them this week, to start small and to realize it's going to take time to turn these these new behaviors into habits, to have an incredible amount of self compassion and empathy and just recognize that, hey, I'm going to start small and I'm I'm going to use that snowball effect and I'm going to build upon that. I feel like, you know, you and I, we work in this space. And yet if we brought out a plate of brownies right now, self control might might leave the door. You might leave the room, I should say. I mean, for listeners, I want to encourage the use of technology and apply that technology with those proven principles that we know in the past. But really be kind to yourself and really think about what you're able to do and to do those things that you can do now and be understanding how many times will we need to start again and get back on track. And especially if you're someone who's providing that social support and that understanding, that encouragement to make sure that you're in that space as well. Any thoughts along those lines?
Josh West: [00:10:02] Behavior change is difficult. When we change our behavior. We don't think day to day about our behaviors. We think about the outcomes. Usually I am overweight, I have diabetes, we think about outcomes. We don't day to day think about behaviors. And so if we are to focus on those behaviors and think about, for example, being more physically active or altering our diet, sometimes those outcomes are very delayed and that can act as kind of a disincentive, if you will, right? Because I've now changed my diet. I change how I eat, I've changed my physical activity routines. I'm exercising more, for example, and I'm three days into this and I haven't lost any weight. And that, you know, can act as a disincentive in a situation where we're hoping for kind of immediate reinforcement. I mean, we're hoping that we're going to see results immediately within the hour, within the day, within the week. Right. And and so when that doesn't happen, it's difficult. And so we sometimes use social support and kind of artificial reinforcement systems to motivate people. I mean, this is kind of the essence of corporate wellness, right, is that we're going to use some incentives or some external reinforcers to be able to prop up these new and healthy behaviors until they either naturally reinforce or they just occur, you know, because they are now part of a habit or routine. And so there's this critical period and it's difficult. And that's where a lot of us off the wagon during that period, it's a time where we're pretty vulnerable. And I think you're right that some kind of compassion and understanding is for ourselves and for others is absolutely in order.
Josh West: [00:11:32] And, you know, if you think about behavior change as it relates to health and health behaviors, it's probably not all that different from other, you know, things that we're engaged in. I mean, you think about your retirement plan or your 401. K and, you know, it goes up and down. And we hope that over the course of 30 or 40 years that there's an upward trend. But that isn't to suggest that, you know, there aren't periods where, you know, there's a 10% loss or a 20% loss or whatever. And then it will it'll go up. And that takes time. And if there is a message. That I think is worth communicating as it relates to behavior change. It is that it's possible, it's difficult and at times may be more difficult than others. But it is possible, and I think we've seen some great examples. There are certainly examples, even as we study the scriptures, for example, of people who have made enormous changes. So there's hope it is possible with some persistence and with the help and support of others. This is very, very doable. I think that it's worth noting that there are different types of kind of programs or efforts or interventions to change behavior. Some of them involve individuals where we're focusing, for example, on just Josh, just Cougar. Those tend to be analyzing attitudes and behaviors and beliefs and changing those perceptions, improving self efficacy, your confidence so that you feel more confident in your ability to choose a workout routine, for example, or eat a healthy diet or resist peer pressure.
Josh West: [00:13:00] There are also programs, interventions, efforts that focus at community health or changing the environment in which we live. And those are things like, for example, building parks to improve levels of physical activity, policies to prohibit the sale of tobacco to minors or or to limit the number of retailers that can can sell tobacco close to schools or improving options for commuting on a bike, building more bike paths. Those things tend to be more community or we sometimes refer to them as ecological interventions. And then there's everything in between. And so this is kind of a broad space and I think it's important for us to remind ourselves that when we're focusing on our behavior and changing our own behavior, that we exist in an environment. And so there are things that we can do, and there are also things that our environment can do. There are things there contributions from our environment. And the reality is some environments are easier to be healthy and some are more difficult. Next week, you and our colleague Ben Crookston and myself are going to take a group of 45 students, and we're going to visit some places in Western Europe that do a really good job at community level or ecological level efforts to change behaviors in that they have a lot of bike paths and that they tend to be very focused on how can we improve our community so that we're all more healthy. And so as you make decisions there, it may be easier, right? Because you have an environment that is supportive of making these changes at the individual level.
Cougar Hall: [00:14:34] That built environment really is it's it's not that we can't engage in healthy behaviors when the environment is not supportive, it's just that it makes it exponentially easier. You've taught me over the years that that really is public health, making the healthy choice, the easy choice. So I typically end with this question. Josh, I hope it's okay. Is there something that you're reading right now? Some someone or something you're listening to that's helping you sharpen the sauce, so to speak, and and expanding your own thoughts, your own perspectives? Because I think in academia, it's really important to realize we don't we don't know everything. In fact, the more you know, the more you realize I am clueless. Is there is there something that you're listening to or reading right now that you feel like is is helping you recharge and and stay at the top of your game?
Josh West: [00:15:23] So I'm going to flip this on its head. It isn't what I'm reading necessarily or what I'm listening to, but there is something that I benefit in the same way from and that is I benefit from. Learning with my colleagues. I've learned from you, from Dr. Crookston, from other colleagues here in the department to have what we would call a growth mindset, continue to be flexible and moldable. And I can't be so set in my ways politically or in any way, but I need to be able to to grow and to develop. And as I've had conversations with with you, with Dr. Crookston, with, you know, Lori, I mean, just go down the list of colleagues in the department. But I'd say, you know, once a week or twice a week, we sit and talk about current events for someone on the outside. They might look at that and say, what a waste of time, what a waste if you're going to sit and talk about what's in the news. But actually what I'm doing is I'm learning I'm learning that there are two, three, four or five, maybe six ways to look at this problem. And that my views I concocted those or developed those while sitting at home looking at the newspaper. And that it's important for me to bounce those ideas off my colleagues and friends, but also to see how they see the world. And that will help to inform my own views. And it's going to cause me to it's going to cause me to bend a little bit.
Josh West: [00:16:51] And it's going to cause me to say, you know what? You're absolutely right. I actually hadn't thought that way, but I can see why you would say that. I've really enjoyed that over the years. And like I said, we probably do that a couple of times a week. And and I think it's an incredibly useful way to spend my time because it is forced me into this growth mindset where I need to say, wow, there are so many ways to look at this and I grow, I learn and I develop as I engage with my colleagues, as I've talked with you about current events and there are plenty of them related to public health from, you know, COVID to gun violence and how we message to be able to dissect and break these things down and be able to talk with my friends and colleagues openly in a safe environment, but also to be challenged. And it causes me to, like I said, expand my views, change how I see things. And that has been the single most influential kind of learning impetus, if you will, that really that I could think of. And so, I mean, there are other things that I that I do. I mean, I listen to podcasts and stuff, but that experience has changed me and I look forward to it. Like someone would look forward to listening to a book or reading a book.
Cougar Hall: [00:18:02] I love it. I love the growth mindset. And I wonder if that's not what all of society needs, is to have a series of meaningful discussions where we really we really hear and really listen to each other and recognize that we don't know everything and that there's a lot that we can gain from hearing from others, especially some of those voices that haven't had the microphone in the past. Right. And and to really just approach learning with humility, recognizing that I can learn something from every person, every student, every colleague. Well said.
Josh West: [00:18:36] Your wife Hillary is a librarian. Yeah, at the middle school. So that's about my reading level. So I get good book recommendations from your wife.
Cougar Hall: [00:18:45] Is that right?
Josh West: [00:18:46] But I really benefit professionally from visiting with my colleagues, so.
Cougar Hall: [00:18:49] I'm really happy to hear that you can still read. I've lost that ability with this little app on my phone called Audible. So with Audible, I no longer need to read, thank heavens. Right. So you keep reading. That'll keep Hillary very happy. She wants to check some books out, keep circulation humming. So, Dr. West, thank you. I look forward to having you back here and maybe, maybe six weeks, maybe eight weeks following the study abroad program. I want to hear about all the great experiences you have with the students there in Western Europe. So all the best. Great.
Josh West: [00:19:18] Thanks so much. Looking forward to it.
Cougar Hall: [00:19:22] Thank you for joining us today. Catch us on our next episode. And don't forget to subscribe to Future Y Health episodes.