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

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
Preface
Introduction Tracey A. Revenson and Andrew Baum
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
2 Representations, Procedures, and Affect in Illness Self-Regulation: A Perceptual-Cognitive
Model Howard Leventhal, Elaine A. Leventhal, and Linda Cameron
3 Conceptualization and Operationalization of Perceived Control Kenneth A. Wallston
4 On Who Gets Sick and Why: The Role of Personality and Stress Richard J. Contrada and
Max Guyll
5 Visceral Learning BernardT. Engel
6 Biofeedback and Self-Regulation of Physiological Activity: A Major Adjunctive Treatment
Modality in Health Psychology Robert J. Gatchel
7 Behavioral Conditioning of the Immune System Alexander W. Kusnecov
8 Physiological and Psychological Bases of Pain Dennis C. Turk
9 Personality Traits as Risk Factors for Physical Illness Timothy W. Smith and Linda C.

Gallo
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
DiPlacido
11 Social Comparison Processes in the Physical Health Domain Jerry Suls and Rene Martin
12 Social Networks and Social Support Thomas Ashby Wills and Mamie Filer
13 Self-Efficacy and Health Brenda M. DeVellis and Robert F. DeVellis
14 The Psychobiology of Nicotine Self-Administration Neil E. Grunberg, Martha M. Faraday,
and Matthew A. Rahman
15 Obesity Rena R. Wing and Betsy A. Pulley
16 Alcohol Use and Misuse Mark D. Wood, Daniel C. Vinson, and Kenneth J. Sher
Part II. Crosscutting Issues
17 Stress, Health, and Illness Angela Liegey Dougall and Andrew Baum
18 What Are the Health Effects of Disclosure? Joshua M. Smyth and James W. Pennebaker
19 Preventive Management of Work Stress: Current Themes and Future Challenges Debra
L. Nelson, James Campbell Quick, and Bret L. Simmons
20 Environmental Stress and Health Gary W. Evans
21 Adjustment to Chronic Illness: Theory and Research AnnetteL. Stanton, Charlotte A.
Collins, and Lisa Sworowski
22 Recall Biases and Cognitive Errors in Retrospective Self-Reports: A Call for Momentary
Assessments Amy A. Gorin and Arthur A. Stone
23 Burnout and Health Michael P. Leiter and Christina Maslach
24 Sociocultural Influences on Health Caroline A. Macera, Cheryl A. Armstead', and Norman
B. Anderson
25 The Multiple Contexts of Chronic Illness: Diabetic Adolescents and Community
Characteristics Dawn A. Obeidallah, StuartT. Hauser, and Alan M. Jacobson
26 Childhood Health Issues Across the Life Span Barbara G. Melamed, Barrie Ruth, and
Joshua Fogel
27 Social Influences in Etiology and Prevention of Smoking and Other Health Threatening
Behaviors in Children and Adolescents Richard I. Evans

28 Health, Behavior, and Aging Ilene C. Siegler, Lori A. Bastian, and HaydenB. Bosworth
29 Informal Caregiving to Older Adults: Health Effects of Providing and Receiving Care Lynn
M. Martire and Richard Schulz
30 Stress Processes in Pregnancy and Birth: Psychological, Biological, and Sociocultural
Influences Christine Dunkel-Schetter, Regan A. R. Gurung, Marci Lobel, and Pathik D.
Wadhwa
31 Women's Health Promotion BarbaraK. Rimer, Colleen M. McBride, and Carolyn Crump
32 Male Partner Violence: Relevance to Health Care Providers Mary P. Koss, Maia Ingram,

xiii
xv

3
19
49
59
85
95
105
117
139

175
195
209
235
249
263
281
321

339
349
365
387
405
415
427
441
449
459
469
477

495
519
541


and SaraL. Pepper
33 Confronting Fertility Problems: Current Research and Future Challenges Lauri A. Pasch
34 Patient Adherence to Treatment Regimen Jacqueline Dunbar-Jacob and Elizabeth
Schlenk
35 Rehabilitation Robert G. Frank
36 Community Intervention David G. Altman and Robert M. Goodman
37 Citizen Participation and Health: Toward a Psychology of Improving Health Through
Individual, Organizational, and Community Involvement Frances Butterfoss, Abraham
Wandersman, and Robert M. Goodman
38 The Effects of Physical Activity on Physical and Psychological Health Wayne T. Phillips,
Michaela Kiernan, and Abby C. King
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
40 Stress and Silent Ischemia WillemJ. Kop, JohnS. Gottdiener, and David S. Krantz
41 Stress, Immunity, and Susceptibility to Infectious Disease Anna L. Marsland, Elizabeth A.
Bachen, Sheldon Cohen, and Stephen B. Manuck
42 Nonpharmacological Treatment of Hypertension AlvinP. Shapiro
43 Cancer Barbara L. Andersen, Deanna M. Golden-Kreutz, and Vicki DiLillo
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
45 Stress and Breast Cancer Douglas L. Delahanty and Andrew Baum
Behavioral Intervention in Comprehensive Cancer Care William H. Redd and Paul
Jacobsen
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
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
Susan Kwon
49 Women and AIDS: A Contextual Analysis Jeannette R. Ickovics, Beatrice Thayaparan,
and Kathleen A. Ethier
50 Living with HIV Disease Sheryl L. Catz and Jeffrey A. Kelly
51 Cultural Diversity and Health Psychology Hope Landrine and Elizabeth A. Klonoff
Author Index
Subject Index

559
571
581
591

613
627

661
669
683
697
709
727
747
757
777

801
817
841
851
893


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 healthbehavior 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 ageadjusted 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 lowbirthweight 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

indicators, risk factors, and habits Rodin & Salovey, 1989). While recognizing the importance of
primary prevention, health psychologists have concentrated their efforts on secondary
prevention at the individual or small group level, to increase early detection of disease (for
example, by encouraging routine screening for cancer). The successes of secondary prevention
can be seen clearly in the area of cancer prevention and control-for example, the ability of
mammography to identify breast cancer at an early stage improves the opportunity for
effective treatment and survival (Aiken et al., chap. 44; MMWR 2000). Psychological
interventions such as support groups and information hotlines have minimized the incidence of
mental health problems as a consequence of illness (Stanton et al., chap. 21; Wills & Filer,
chap. 12).
Most behavioral interventions focus on the individual as the target of change (or on aggregates
of individuals). In contrast, Stokols (1992), among others, urges us “to provide environmental
resources and interventions that promote enhanced well-being among occupants of an area”
(1992, pp. 6–7). We are only beginning to understand the effects of living in neighborhoods
that lack basic environmental resources- neighborhoods with extreme poverty, high crime
rates, inadequate housing, public transportation or schools-on health and well-being (Fullilove,
1999). The case study detailed by Butterfoss et al. (chap. 37) in this handbook provides a
blueprint for how researchers and health educators allied with community coalitions can
improve community health outcomes. Altman and Goodman (chap. 36) describe a broader
range of community-wide or policy strategies that can lead to community-wide change in
health behaviors, such as changing the community's social norms regarding health behaviors
such as smoking, nutrition or exercise (see also Revenson & Schiaffmo, 2000). They stress the
importance of including community members in health-promoting programs from their
inception, and devising culturally-sensitive health promotion strategies in order for health
interventions to be incorporated by the community once researchers have moved on. Clearly,
“translating” our knowledge of biobehavioral mechanisms in health and illness to more
widespread efforts will be a challenge for the next decade of community psychology.

CONCLUSION

The exponential growth in brain and behavioral sciences over the past decade is mirrored in
the field of health psychology. But rapid growth also begets growing pains. Health
psychologists have taken stock, many times, to assess our progress and our pitfalls (Coyne,
1997; Landrine & Klonoff, 1992; Taylor, 1984; 1987; 1990). As recently as March, 2000, when
APA's division of Health Psychology sponsored a conference on the future of health psychology,
a unified definition or vision for the field still did not exist. Despite this-or perhaps as a result of
it-health psychologists have managed to make great progress in our understanding of the
cognitive, behavioral, cognitive-behavioral, physiological, social, environmental, social
environmental, personality, and developmental factors underlying health and illness processes
over the past quarter- century. But there are many miles to go before we sleep.