Tài liệu tâm lý học sức khỏe: Cách tiếp cận tâm lý học sức khỏe

Applications to the Study of Disease 39 Hostility and Other Psychosocial Risk Factors: Effects on Health and the Potential for Successful Behavioral Approaches to Prevention and Treatmen

Andrew Baum Tracey A Revenson Jerome E Singer

Handbook

of Health Psychology

LAWRENCE ERLBAUM ASSOCIATES, PUBLISHERS

Mahwah, New Jersey London

Copyright © 2001 by Lawrence Erlbaum Associates, Inc All rights reserved No part of this book may be reproduced in any form, by photostat, microfilm, retrieval system, or any other means, without prior written permission of the publisher

CONTENTS

Part I Basic Processes

1 Factors Influencing Behavior and Behavior Change Martin Fishbein, Harry C Triandis,

Frederick H Kanfer, Marshall Becker, Susan E Middlestadt, and Anita Eichler 3

2 Representations, Procedures, and Affect in Illness Self-Regulation: A Perceptual-Cognitive Model Howard Leventhal, Elaine A Leventhal, and Linda Cameron 19

3 Conceptualization and Operationalization of Perceived Control Kenneth A Wallston 49

4 On Who Gets Sick and Why: The Role of Personality and Stress Richard J Contrada and

6 Biofeedback and Self-Regulation of Physiological Activity: A Major Adjunctive Treatment

7 Behavioral Conditioning of the Immune System Alexander W Kusnecov 105

8 Physiological and Psychological Bases of Pain Dennis C Turk 117

9 Personality Traits as Risk Factors for Physical Illness Timothy W Smith and Linda C

10 Personality's Role in the Protection and Enhancement of Health: Where the Research

Has Been, Where It Is Stuck, How It Might Move Suzanne C Ouellette and Joanne

11 Social Comparison Processes in the Physical Health Domain Jerry Suls and Rene Martin 195

12 Social Networks and Social Support Thomas Ashby Wills and Mamie Filer 209

13 Self-Efficacy and Health Brenda M DeVellis and Robert F DeVellis 235

14 The Psychobiology of Nicotine Self-Administration Neil E Grunberg, Martha M Faraday,

16 Alcohol Use and Misuse Mark D Wood, Daniel C Vinson, and Kenneth J Sher 281

Part II Crosscutting Issues

17 Stress, Health, and Illness Angela Liegey Dougall and Andrew Baum 321

18 What Are the Health Effects of Disclosure? Joshua M Smyth and James W Pennebaker 339

19 Preventive Management of Work Stress: Current Themes and Future Challenges Debra

21 Adjustment to Chronic Illness: Theory and Research AnnetteL Stanton, Charlotte A

22 Recall Biases and Cognitive Errors in Retrospective Self-Reports: A Call for Momentary

23 Burnout and Health Michael P Leiter and Christina Maslach 415

24 Sociocultural Influences on Health Caroline A Macera, Cheryl A Armstead', and Norman

25 The Multiple Contexts of Chronic Illness: Diabetic Adolescents and Community

Characteristics Dawn A Obeidallah, StuartT Hauser, and Alan M Jacobson 441

26 Childhood Health Issues Across the Life Span Barbara G Melamed, Barrie Ruth, and

27 Social Influences in Etiology and Prevention of Smoking and Other Health Threatening

28 Health, Behavior, and Aging Ilene C Siegler, Lori A Bastian, and HaydenB Bosworth 469

29 Informal Caregiving to Older Adults: Health Effects of Providing and Receiving Care Lynn

30 Stress Processes in Pregnancy and Birth: Psychological, Biological, and Sociocultural

Influences Christine Dunkel-Schetter, Regan A R Gurung, Marci Lobel, and Pathik D

31 Women's Health Promotion BarbaraK Rimer, Colleen M McBride, and Carolyn Crump 519

32 Male Partner Violence: Relevance to Health Care Providers Mary P Koss, Maia Ingram, 541

and SaraL Pepper

33 Confronting Fertility Problems: Current Research and Future Challenges Lauri A Pasch 559

34 Patient Adherence to Treatment Regimen Jacqueline Dunbar-Jacob and Elizabeth

36 Community Intervention David G Altman and Robert M Goodman 591

37 Citizen Participation and Health: Toward a Psychology of Improving Health Through

Individual, Organizational, and Community Involvement Frances Butterfoss, Abraham

38 The Effects of Physical Activity on Physical and Psychological Health Wayne T Phillips,

III Applications to the Study of Disease

39 Hostility (and Other Psychosocial Risk Factors): Effects on Health and the Potential for Successful Behavioral Approaches to Prevention and Treatment Redford B Williams 661

40 Stress and Silent Ischemia WillemJ Kop, JohnS Gottdiener, and David S Krantz 669

41 Stress, Immunity, and Susceptibility to Infectious Disease Anna L Marsland, Elizabeth A

42 Nonpharmacological Treatment of Hypertension AlvinP Shapiro 697

43 Cancer Barbara L Andersen, Deanna M Golden-Kreutz, and Vicki DiLillo 709

44 Subjective Risk and Helath Protective Behavior: Cancer Screening and Cancer

Prevention LeonaS Aiken, Mary A Gerend, and K r i s t i n aM Jackson 727

45 Stress and Breast Cancer Douglas L Delahanty and Andrew Baum 747

Behavioral Intervention in Comprehensive Cancer Care William H Redd and Paul

47 Frontiers in the Behavioral Epidemiology of HIV/STDs Joseph A Catania, Diane Binson,

M Margaret Dolcini, Judith Tedlie Moskowitz, and Ariane van der Straten 777

48 HIV Disease in Ethnic Minorities: Implications of Racial/Ethnic Differences in Disease

Susceptibility and Drug Dosage Response for HIV Infection and Treatment Vickie M

Mays, Bennett T So, Susan D Cochran, Roger Detels, Rotem Benjamin, Erica Allen, and

49 Women and AIDS: A Contextual Analysis Jeannette R Ickovics, Beatrice Thayaparan,

50 Living with HIV Disease Sheryl L Catz and Jeffrey A Kelly 841

51 Cultural Diversity and Health Psychology Hope Landrine and Elizabeth A Klonoff 851

Subject Index

PREFACE

This volume was conceived during the waning stages of initial, rapid growth of health psychology In the preceding years the fiel d had defined itself, identified important contributions and targets of opportunity, and had achieved a remarkable degree of influence within its parent field as well as the larger behavioral medicine arena Behavioral treatments and adjunctive treatments for palliation and cure were developed, prevention that relied on behavior and behavior change was expanded, and psychological variables were more routinely included in models of the etiology of disease and promotion or maintenance of good health Public health conceptions of air- borne or water-borne diseases or disease vectors had been supplemented by “lifestyle-borne diseases” and the expansion of medical psychology practice with patients and at-risk individuals had occurred Clearly this was a time of great accomplishment that required a pause and an opportunity to reflect and integrate all that had been learned and done

As with all Handbooks, preparation and finalization of chapters and contributions took longer than was initially expected, and the pause in the rapid growth of health psychology was brief (if, indeed, there was a pause) As the volume was being put together, important new research and theory in areas like cancer, women's health, and socioeconomic or sociocultural

phenomena appeared and new emphases on community involvement, prevention, and

survivorship evolved The field was continuing to grow and mature at a rate that made it difficult to keep up Consequently, this volume had to do more than summarize previous work and chart new directions It also had to integrate new work often as related chapters were being completed The Handbook has incorporated these new and breaking developments for the most part and represents a comprehensive summary and integration of current research and theory in health psychology It should serve as a valuable resource for many years, containing the roots and seeds of future discoveries and accomplishments as well as the more established and enduring bases, applications, and implications of our work over the past 30 years

There are many people who have contributed to the development of health psychology and to this book over the years, far too many to thank in this preface One who should be singled out, for his rare vision, wit, and patience, and for his support, friendship, and enthusiasm for health psychology is Larry Erlbaum As a friend, colleague, publisher, and mentsch he has been and continues to be a pillar of the health psychology community We would also like to thank Michele Hayward for her patience, outstanding organizational and editorial skills and

stewardship of this project from its inception, and to production and editorial folks at LEA, most notably Art Lizza Most of all, we thank the contributors to this volume and to the field of health psychology for their hard work, dedication, and vision

INTRODUCTION Tracey A Revenson Andrew Baum

The woods are lovely, dark and deep, But I have promises to keep, And miles to go before I sleep, And miles to go before I sleep

(Frost, 1923)

Over the past two decades, health psychology researchers have grappled with critical

behavioral, biological, and social science questions: How do personality and behavior

contribute to the pathophysiology of cardiovascular disease? What do women gain from screening mammography if it creates anxiety and avoidance of regular screening? Why do we expect individuals to take responsibility for condom use to prevent HIV transmission when using condoms is an interpersonal negotiation? When are social relationships supportive and when are they detrimental to health? Only some of these questions have been answered adequately, many findings have been refuted, and many questions have been reframed along the way The chapters in this volume address the central questions (still) of interest for Health Psychology, and pose many more for the next decade of research and theory

Although this is a first edition, one could argue that there are two precursors of this volume In

1979, Health Psychology-A Handbook, edited by George Stone, Frances Cohen, and Nancy Adler, was published by Jossey-Bass, Inc At that time the term health psychology was a fairly new one; only a handful of doctoral programs in psychology specifically trained health

psychologists, and the Division of Health Psychology (Division 38) had just been established within the American Psychological Association (Wallston, 1997) In the mid-1980s, a series of five edited volumes were published by Lawrence Erlbaum Associates under the title, Handbook

of Psychology and Health (Baum & Singer, 1982, 1987; Baum, Taylor, & Singer, 1984; Gatchel, Baum, & Singer, 1982; Krantz, Baum, & Singer, 1983) In contrast to the Stone et al volume, the books in this series focused on specific topic areas, such as child and adolescent health, cardiovascular disorders, coping and stress, or on subdisciplines within psychology (clinical, social) This series was published over several years just as Health Psychology became firmly established in its own right Although there has been a number of textbooks and edited

volumes in the area of health psychology published since then, there has been no other comprehensive “handbook” 1 As there have been great advances in knowledge about health-behavior relationships in the past decade, the time seemed right for a handbook Although many publications bear the designation of “handbook”, the New Shorter Oxford English

Dictionary offers the following definition, “A book containing concise information on a particular subject; a guidebook” (1997, E 19) At nearly 900 pages, one could argue that this Handbook is not concise, but the chapters do synthesize current theory and knowledge on many

substantive areas in the field, taking us through the development of a concept to its future directions The preface to Stone, Cohen, and Adler's handbook is just as fitting today as it was

21 years ago: “In recent years there has been a growing concern about problems of health and illness and about the state and cost of the current health care delivery system

1 There have been other handbooks in specialty areas, for example, Handbook of Stress: Theoretical and Clinical Aspects (Goldberger & Breznitz, 1983, second edition, 1993); Behavioral Health: A Handbook of Health Enhancement and Disease Prevention (Matarazzo

et al., 1984); Handbook of Behavioral Medicine (Gentry, 1984)); Health Psychology: A Psychobiological Perspective (Feurestein, Labbe, & Kuczmierczyk, 1986); Behavioral

Medicine & Women: A Comprehensive Handbook (Blechman & Brownell, 1988, revised 1998); and Handbook of Diversity issues in Health Psychology (Kato & Mann, 1996)

There has also been increasing awareness of the significance of psychological factors in the etiology, course, and treatment of disease and in the maintenance of health” (1979, p ix)

Let us use these two sentences as a springboard to report on the progress of health

psychology, place current challenges in sociopolitical context, and guide our work for the future

THE CURRENT SOCIOPOLITICAL

CONTEXT OF HEALTH PSYCHOLOGY

An article published a decade ago in the New England Journal of Medicine illustrated one important aspect of the current health care crisis when it concluded that a black man in Harlem was less likely to reach 65 years of age than was a man in Bangladesh (McCord & Freeman, 1990) Americans spend more of their gross domestic product on health services than any other major industrialized country; in 1998, national health care expenditures totaled

$1.15 trillion, or 13.5% of the gross domestic product (U.S Health Care Financing

Administration, 1999) Yet, the quality of healthcare and its availability to our citizens is more limited than in many nations that spend less These enormous health expenditures do not assure better quality care or better health for all Americans Despite overall declines in

mortality, disparities among racial/ethnic groups in mortality and morbidity remain substantial:

a White female child born in 1997 can expect to live 79.9 years, a black female child 74.7 years; the comparable figures for males are 74.3 and 67.2 (Hoyert, Kochanek, & Murphy, 1999) In 1997, overall mortality was 55 percent higher for Black Americans than for White Americans (National Center for Health Statistics, 1999) Many causes of mortality that may explain this differential include behaviorally-linked conditions, such as HIV infection, homicide, firearm-related deaths, unintentional injuries, and stroke Stage-specific survival rates among women with breast cancer have increased overall in the past quarter-century, but the overall 5-year survival rates for women from 1989–1994 were 87% for White women and 71% for Black women (National Center for Health Statistics, 1999) Explanations for these disparities include the fact that, on average, white women receive prenatal care more often and earlier in their pregnancies, and seek medical care for breast cancer at an earlier stage of the disease Chronic diseases often affect those people who have the least access to health care and the fewest financial resources to pay for it In 1998 an estimated 44.3 million Americans (16.3% of the population) were not covered by health insurance at any time during the year, and the percentage was double (32.3%) for poor people (National Center for Health Statistics, 1999) The uninsured rate among Hispanics was three times higher than that of non-Hispanic Whites (National Center for Health Statistics, 1999) Ethnic minority and elderly individuals, families living in poverty, and people living in rural areas or inner cities are often in the poorest health, have multiple risk factors for serious illness, receive the poorest health care, have little or no insurance coverage, and are less likely to receive preventive care Despite medical progress in the past quarter-century that has led to reductions in the major causes of death (cancer, heart disease, and stroke), many underserved and ethnic minority groups are lagging behind

(Macera, Armstead, & Anderson, chap 24; Landrine & Klonoff, chap 51) For example, the age-adjusted mortality rate (for all causes) for Blacks is approximately one and a half-times that of Whites (Macera et al., chap 24) Approximately 31% of this excess mortality can be accounted for by six well-established risk factors related to behavior: smoking, alcohol intake, total serum cholesterol, blood pressure, obesity, and diabetes An additional 38% can be accounted for by family income, despite the fact that income and the prevalence of risk factors co-vary On a disease-specific level, coronary heart disease as a cause of death among Blacks far exceeds that of Whites, with both physiological factors (e.g, hypertension, cardiovascular reactivity) and social environmental factors (e.g., racial stress, socioeconomic status) playing a role HIV/AIDS has disproportionately affected certain ethnic minority groups in this country as well

as people in poverty, with behavioral mediating processes including intravenous drug injection and unprotected sex (Catania, Binson, Dolcini, Moskowitz, & van der Straten, chap 47; Mays,

So, Cochran, Detels, Benjamin, Allen, & Kwon, chap 48) The research these examples reflect suggests we look more closely at the interaction of person, situation, and social- structural factors in understanding these health differentials Important social structural factors include education and the economics of health care, which are mutually influential and which both influence health practices

There are other factors that argue for the approach generally taken by health psychology and related disciplines like behavioral medicine, medical sociology, and medical anthropology Perhaps the most important is that the medical model of disease and health that has

dominated the prevention, treatment, and scientific study of these phenomena simply cannot account for nor explain the onset and progression of illness- who becomes ill, why people get particular diseases at a certain time in their life, and how these diseases respond to treatment Where major diseases were once caused by microorganisms that could be controlled or' eradicated with wonder drugs, improved sanitation, and other biological interventions, the diseases that dominate health care today are not Rather, they are diseases of lifestyle, aging,

or behavior interacting with genetic predisposition and biological changes Most cardiovascular diseases have substantial genetic origins, reflect biological processes in their pathophysiology, and respond to medications and medical treatments However, considerable variance in their development and course is explained by behavior: diet, exercise, tobacco use, and stress appear to contribute directly and indirectly to these diseases Other major health threats in this modem era also appear to arise at least in part because of these factors, and cancer, diabetes, HIV disease, and other major diseases may be more readily controlled through thoughtful and systematic application of biobehavioral principles and the sociocultural context (e.g., Amaro, 1995) The confluence of the changing face of healthcare, the unequal burden of disease across our society, and the dominance of chronic diseases with substantial behavioral

components has been key in the development of health psychology

CURRENT APPROACHES IN HEALTH

PSYCHOLOGY

At the time it was established, the discipline of health psychology brought together

psychologists trained in traditional areas of psychology who shared a common interest in problems of health and illness and a common conceptual approach- but who brought their own disciplinary paradigms and methodologies to the table Not surprisingly, this cacophony of scientific jargons, models, and approaches was confusing at times It also brought a breadth and eclecticism to the study of health and behavior that has been partly responsible for its success

The common approach was labeled the biopsychosocial model (engel, 1977; Schwartz, 1982)

In contrast to the biobehavioral model it replaced, this eponynymously named approach suggests a transaction of psyche and soma-that physiological, psychological and social factors are braided together in health and illness The biopsychosocial model does not give primacy to biological indices; they are not the ultimate criteria for defining health and illness Instead, the model argues, it is impossible to understand disease processes by knowing about only one component of the model The biopsychosocial model was inclusive enough to be applied to risk estimates for particular diseases as well as health- promoting behaviors and environments, to disease progression as well as psychosocial adaptation to illness, and to individually- oriented therapeutic and behavior change interventions as well as broader community-based and media approaches The biopsychosocial model stimulated more effective theories and research designs; facilitated multi-disciplinary thinking and, most importantly, suggested a multi-cause multi-effect approach to health and illness, rather than the limiting single-cause, single-effect approach

Although the strength of experimental evidence is not consistent across all diseases or all psychological variables implicated in disease, research of the past 20 years strongly supports the biopsychosocial model In a recent Annual Review chapter, Baum and Posluszny (1999) specify three pathways in which psychosocial or behavioral factors affect, and are affected by, health and illness: (1) direct biological changes that cause or are caused by emotional or behavioral processes; (2) behaviors that convey health risks; and (3) behaviors associated with illness or the possibility of becoming ill Behavioral conditioning of the immune system

(Kusnecov, chap 7), pain processes (Turk, chap 8), and the effects of stress on physiology (Dougall & Baum, chap 17; G Evans, chap 20; Dunkel-Schetter, Gurung, Lobel, & Wadhwa, chap 30; Kop, Gottdiener, & Krantz, chap 40; Marsland, Bachen, Cohen, & Manuck, chap 41;

Delahanty & Baum, chap 45) all exemplify direct influences-sometimes reciprocal, sometimes parallel-of psychological and physiological processes

Many other phenomena of interest to health psychologists illustrate the second and third pathways: cognitive appraisals of control, abilities or others' situations (Fishbein, Triandis, Kanfer, Becker, Middlestadt, & Eichler, chap 1; Leventhal, Leventhal, & Cameron, chap 2; Wallston, chap 3; Suls & Martin, chap 11; DeVellis & DeVellis, chap 13); personality (Contrada

& Guyll, chap 4; Smith & Gallo, chap 9; Ouellette & DiPlacido, chap 10; Williams, chap 39); coping (Stanton, Collins, & Sworowski, chap 21); interpersonal relationships (Wills & Filer, chap 12; Smyth & Pennebaker, chap 18; Evans, chap 27) screening (Rimer, McBride, & Crump, chap 31; Aiken, Gerend, & Jackson, chap 44;) and adherence (Dunbar-Jacob &

Schlenk, chap 34) Well-established behavioral risk factors (pathway 2) include: smoking (Grunberg, Faraday, & Rahman, chap 14,) alcohol intake (Wood, Vinson, & Sher, chap 16), and weight control (Wing & Polley, chap 15)

The role of biological, psychological and social factors in health and illness is not hard to accept What has been more difficult to understand, and to translate into testable theories, is how health is affected by the interplay of those physiological, psychological, sociological and cultural factors Previously, card-carrying health psychologists were trained in one of the more

“traditional” areas of psychology (developmental, social, clinical, experimental) and, they tended to define problems through the paradigmatic lenses of that area More recently, the field has seen a concerted attempt to blend approaches, conduct “translational” research, and develop more synergistic models For example, the area of psychoneuroimmunology not only connects areas within psychology, but links them to a subdiscipline of biology/ medicine (Andersen, Golden-Kreutz, & Dilillo, chap 43; Andersen, Kiecolt-Glaser, & Glaser, 1994) A recent focus in cancer control and prevention examines how the presence of disease

biomarkers affects treatment choices, screening behavior, and mental health (Lerman, 1997)

In 1995, this emphasis on multidisciplinary knowledge found “legs” in the creation of the Office

of Behavioral and Social Science Research at NIH in 1995 The mission of this office is, “to enhance and accelerate scientific advances in the understanding, treatment, and prevention of disease by greater attention to behavioral and social factors and their interaction with

biomedical variables” (Anderson, 1999)

Other notable changes have occurred in the way health- behavior processes are studied First,

we have seen more and more research set in the world of everyday experience, linked to the social problems we face For example, the pressing problems of violence against women (Koss, Ingram, & Pepper, chap 32), alcohol and drug use (Grunberg et al., chap 14; Wing & Polley, chap 15); and workplace stress (Nelson, Quick, & Simmons, chap 19; Leiter & Maslach, chap 23) fall under the rubric of health psychology because of their health-damaging consequences

Second, health psychology (like its mother-field) has gone beyond individual-level processes to examine phenomena within social systems: the family (Martire & Schulz, chap 29; Pasch, chap 33); workplace (Nelson et al., chap 19); school (G Evans, chap 20) and community (Obeidallah, Hauser, & Jacobson, chap 25; Altman & Goodman, - chap 36; Butterfoss,

Wandersman, & Goodman, chap 37) Ecological approaches that examine the transactional relationships among individuals and the environments they live in, as well as inter-relationships among these settings, have received much theoretical attention and offer promise for

understanding disease processes within cultural groups and for designing effective

interventions (Anderson & McNeilly 1991; Revenson, 1990; Smith & Anderson, 1986; Taylor, Repetti, & Seeman, 1997; Winnett, King, & Altman, 1989) These models have been applied to understanding health phenomena such as the effects of environmental stress (G Evans, chap 20), HIV infection among women (Amaro, 1995; Ickovics, Thayaparan, & Ethier, chap 49); and social inequalities in health outcomes (Anderson, 1995; Macera et al., chap 24) An ecological approach also recognizes the fact that health-behavior processes are developmental, and that

we must understand the specific linkages at different stages of the life cycle (Melamed, Roth, & Fogel, chap 26; Siegler, Bastian, & Bosworth, chap 28; Martire & Schulz, chap 29; Pasch, chap 33; Ickovics et al., chap 49)

Third, health psychologists look to health-promoting behaviors as well as health-damaging ones (Rimer et al., chap 31) Health is clearly more than the absence of the signs and

symptoms of physical disease The inclusive definition offered by the World Health

Organization defines health as a state of complete physical, mental and social well-being, and not as the mere absence of disease and infirmity (symptoms) For example, regular exercise may be one of the most powerful determinants of overall health, as well as a deterrent for many diseases (Phillips, Kiernan, & King, chap 38) Early detection of breast and cervical cancers (as well as many other cancers) has resulted in lowered mortality rates among women

of all ages (Rimer et al., chap 31; Aiken et al., chap 44)

All three of these changes have been shadowed by a call to bring cultural differences in health front and center when understanding the behavioral and social factors in health and illness (Amaro, 1995; Landrine & Klonoff, chap 51) This may be the area where health psychology has had the least success but has the potential for the greatest contribution Although it has been a central tenet of medical sociology and epidemiology for years, only recently have psychologists acknowledged the strong direct and indirect influences of socioeconomic status

on health (e.g., Adler et al., 1994), whether conceptualized in terms of income, education or social class For example, people with less than a high school education have death rates that are twice those for people with education beyond high school (National Center for Health Statistics, 1999) In a similar fashion, health psychology has increased attention to within group health-behavior processes for women (Stanton & Gallant, 1995), people of color

(Anderson, 1995; Anderson & Eisner, 1997); and older persons (Manuck, Jennings, & Baum, 2000; Resnick & Rozensky, 1996)

Finally, there has been a willingness to blur the boundaries between what is termed “basic” and “applied” science, and to work to integrate knowledge and practice Exemplars of this work are described in the chapters in the third section of this volume, as scholars translate research findings into effective and cost-effective techniques for individual treatment (Shapiro, chap 42; Redd, & Jacobsen, chap 46) and community- based interventions (Altman &

Goodman, chap 36; Butterfoos et al., chap 37)

TRANSLATING HEATH PSYCHOLOGY RESEARCH INTO PRACTICE AND POLICY

With the exception of AIDS, the nature and patterns of disease over this century have changed from acute, infectious, and often fatal diseases to chronic disabling illnesses

Heart disease, cancer, and stroke account for the greatest number of deaths in the United States, for both men and women, and, with other chronic conditions, account for increased disability, hospitalization days, and lowered quality of life Much of this illness and disability-the preventable portion-has been linked to behavioral or lifestyle factors (Healthy People 2000, 1990; Matarazzo et al., 1994) A prime example is cigarette smoking, which has been

implicated in the development of lung cancer, stroke, coronary artery disease, and

low-birthweight babies

The dramatic drop in mortality from infectious diseases such as tuberculosis, diphtheria, and polio over the past century was largely a result of advances in public health, accomplished by changes in the physical environment or through the use of preventive or therapeutic measures such as vaccines and antibiotics No single exposure preventive interventions comparable to vaccines can “remove” the behavioral and lifestyle factors that are involved in the onset and progression of chronic disease And, although recent emphases on disease prevention and health promotion among the medical and public health sectors provide a welcome contrast to the traditional biomedical model, most disease prevention efforts have been defined and practiced by the medical community in ways that seriously limit their utility

Health psychology's contribution to decreasing the prevalence of illness has revolved primarily around individual behavior change, consistent with the foundations and history of the

discipline Similarly, most research in health psychology (translated into practice by its cousin, behavioral medicine) has been directed toward individual or group differences in health status