The Impact of Stress Eustress and Distress affect the physical functioning of the body in similar ways. What is the difference between these two ty

HEALTH PSYCHOLOGY

Shel ley E . Taylor 10E

HEALTH PSYCHOLOGY

HEALTH PSYCHOLOGY

T E N T H E D I T I O N

SHELLEY E. TAYLOR University of California, Los Angeles

HEALTH PSYCHOLOGY, TENTH EDITION

Published by McGraw-Hill Education, 2 Penn Plaza, New York, NY 10121. Copyright © 2018 by McGraw-Hill Education. All rights reserved. Printed in the United States of America. Previous editions © 2015, 2012, and 2009. No part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written consent of McGraw-Hill Education, including, but not limited to, in any network or other electronic storage or transmission, or broadcast for distance learning.

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Library of Congress Cataloging-in-Publication Data Names: Taylor, Shelley E., author. Title: Health psychology / Shelley Taylor, University of California, Los Angeles. Description: Tenth edition. | New York, NY : McGraw-Hill Education, [2018] | Includes bibliographical references and indexes. Identifiers: LCCN 2016044904| ISBN 9781259870477 | ISBN 1259870472 Subjects: LCSH: Clinical health psychology. | Medicine, Psychosomatic. | BISAC: PSYCHOLOGY / General. Classification: LCC R726.7 .T39 2017 | DDC 616.08—dc23 LC record available at https://lccn.loc.gov/2016044904

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v

For Nathaniel

vi

SHELLEY E. TAYLOR is Distinguished Professor of Psychology at the University of California, Los Angeles. She received her Ph.D. in social psychol- ogy from Yale University. After a visiting professorship at Yale and assistant and associate professorships at Harvard University, she joined the faculty of UCLA. Her research interests concern the psychological and social factors that promote or compromise mental and physical health across the life span. Professor Taylor is the recipient of a number of awards—most notably, the American Psychological Association’s Distinguished Scientific Contribution to Psychology Award, a 10-year Research Scientist Development Award from the National Institute of Mental Health, and an Outstanding Scientific Contribution Award in Health Psy- chology. She is the author of more than 350 publications in journals and books and is the author of Social Cognition, Social Psychology, Positive Illusions, and The Tending Instinct. She is a member of the National Academies of Science and the National Academy of Medicine.

A B O U T T H E A U T H O R

vii

C O N T E N T S

P A R T 1

PREFACE XV

INTRODUCTION TO HEALTH PSYCHOLOGY 1

C H A P T E R 1

What Is Health Psychology? 2

Definition of Health Psychology 3 Why Did Health Psychology Develop? 3

The Mind-Body Relationship: A Brief History 4 The Rise of the Biopsychosocial Method 5

Psychosomatic Medicine 5 Advantages of the Biopsychosocial Model 5 Clinical Implications of the Biopsychosocial

Model 6 The Biopsychosocial Model: The Case History of

Nightmare Deaths 6 The Need for Health Psychology 6

Changing Patterns of Illness 7 Advances in Technology and Research 8 Expanded Health Care Services 8 Increased Medical Acceptance 9

Health Psychology Research 9 The Role of Theory in Research 9 Experiments 10 Correlational Studies 10 Prospective and Retrospective Designs 10 The Role of Epidemiology in Health Psychology 11 Methodological Tools 11 Qualitative Research 12

What Is Health Psychology Training For? 12

C H A P T E R 2

The Systems of the Body 14

The Nervous System 15 Overview 15 The Brain 15 B O X 2.1 Costs of War to the Brain 17

The Role of Neurotransmitters 17 Disorders of the Nervous System 17

The Endocrine System 19 Overview 19 The Adrenal Glands 19 Disorders Involving the Endocrine System 19

The Cardiovascular System 20 Overview 20 The Heart 20 Disorders of the Cardiovascular System 21 Blood Pressure 22 The Blood 22

The Respiratory System 23 Overview 23 The Structure and Functions of the Respiratory

System 23 Disorders Associated with the Respiratory System 24 Dealing with Respiratory Disorders 25

viii Contents

Genetics and Health 29 Overview 29 Genetics and Susceptibility to Disorders 29

The Immune System 31 Overview 31 Infection 31 The Course of Infection 31 B O X 2.2 Portraits of Two Carriers 32

Immunity 32 Disorders Related to the Immune System 34

The Digestive System and the Metabolism of Food 25 Overview 25 The Functioning of the Digestive System 25 Disorders of the Digestive System 25

The Renal System 27 Overview 27 Disorders of the Renal System 27

The Reproductive System 28 Overview 28 The Ovaries and Testes 28 Fertilization and Gestation 28 Disorders of the Reproductive System 28

P A R T 2

HEALTH BEHAVIOR AND PRIMARY PREVENTION 37

C H A P T E R 3

Health Behaviors 38

An Introduction to Health Behaviors 39 Role of Behavioral Factors in Disease and

Disorder 39 Health Promotion: An Overview 39

Health Behaviors and Health Habits 39 Practicing and Changing Health Behaviors:

An Overview 40 Barriers to Modifying Poor Health Behaviors 41 Intervening with Children and Adolescents 42 Intervening with At-Risk People 43 Health Promotion and Older Adults 44 Ethnic and Gender Differences in Health Risks

and Habits 45 Changing Health Habits 45

Attitude Change and Health Behavior 45 The Health Belief Model 47 The Theory of Planned Behavior 47 Criticisms of Attitude Theories 49 Self Regulation and Health Behavior 49 Self Determination Theory 49 Implementation Intentions 49 Health Behavior Change and the Brain 50

Cognitive-Behavioral Approaches to Health Behavior Change 50

Cognitive-Behavior Therapy (CBT) 50 Self-Monitoring 50 Stimulus Control 51 The Self-Control of Behavior 51

B O X 3.1 Classical Conditioning 52 B O X 3.2 Operant Conditioning 53 B O X 3.3 Modeling 54

Social Skills and Relaxation Training 54 Motivational Interviewing 54 Relapse Prevention 55 Evaluation of CBT 56

The Transtheoretical Model of Behavior Change 56 Stages of Change 56 Using the Stage Model of Change 57

Changing Health Behaviors Through Social Engineering 58 Venues for Health-Habit Modification 59

The Practitioner’s Office 59 The Family 59 Self-Help Groups 60 Schools 60 Workplace Interventions 60 Community-Based Interventions 60 The Mass Media 61 Cellular Phones and Landlines 61 The Internet 61

C H A P T E R 4

Health-Promoting Behaviors 64

Exercise 65 Benefits of Exercise 65 Determinants of Regular Exercise 66 Exercise Interventions 67

Contents ix

Evaluation of Cognitive-Behavioral Weight-Loss Techniques 90

Taking a Public Health Approach 90 Eating Disorders 91

Anorexia Nervosa 91 B O X 5.3 The Barbie Beauty Battle 92

Bulimia 93 Binge Eating Disorder 94

Alcoholism and Problem Drinking 94 The Scope of the Problem 94 What Is Substance Dependence? 95 Alcoholism and Problem Drinking 95 Origins of Alcoholism and Problem Drinking 95 Treatment of Alcohol Abuse 96 Treatment Programs 97 B O X 5.4 After the Fall of the Berlin Wall 97 B O X 5.5 A Profile of Alcoholics Anonymous 98 B O X 5.6 The Drinking College Student 99

Evaluation of Alcohol Treatment Programs 100 Preventive Approaches to Alcohol Abuse 100 Drinking and Driving 101 Is Modest Alcohol Consumption a Health

Behavior? 101 Smoking 101

Synergistic Effects of Smoking 102 A Brief History of the Smoking Problem 102 Why Do People Smoke? 103 Nicotine Addiction and Smoking 105 Interventions to Reduce Smoking 106 Smoking Prevention Programs 109 B O X 5.7 The Perils of Secondhand Smoke 110

Accident Prevention 68 Home and Workplace Accidents 68 Motorcycle and Automobile Accidents 69

Vaccinations and Screening 69 Vaccinations 70 Screenings 70 Colorectal Cancer Screening 71

Sun Safety Practices 71 Developing a Healthy Diet 72

Changing Diet 73 Resistance to Modifying Diet 73

Sleep 75 What Is Sleep? 75 Sleep and Health 75

Rest, Renewal, Savoring 76

C H A P T E R 5

Health-Compromising Behaviors 79

Characteristics of Health-Compromising Behaviors 80 Obesity 81

What Is Obesity? 81 Obesity in Childhood 83 B O X 5.1 The Biological Regulation of Eating 85

SES, Culture, and Obesity 85 Obesity and Dieting as Risk Factors for Obesity 86 Stress and Eating 87 Interventions 87 B O X 5.2 Don’t Diet 88

Cognitive Behavioral Therapy (CBT) 88

P A R T 3

STRESS AND COPING 113

C H A P T E R 6

Stress 114

What Is Stress? 115 What Is a Stressor? 115 Appraisal of Stressors 115

Origins of the Study of Stress 115 Fight or Flight 115 Selye’s General Adaptation Syndrome 115 Tend-and-Befriend 117 How Does Stress Contribute to Illness? 117

The Physiology of Stress 118 Effects of Long-Term Stress 119 Individual Differences in Stress Reactivity 120 Physiological Recovery 121 Allostatic Load 121 B O X 6.1 Can Stress Affect Pregnancy? 122

What Makes Events Stressful? 122 Dimensions of Stressful Events 122 Must Stress Be Perceived as Such to Be Stressful? 123 Can People Adapt to Stress? 124

x Contents

Psychosocial Resources 140 B O X 7.2 Religion, Coping, and Well-Being 142

Resilience 142 Coping Style 143 Problem-Focused and Emotion-Focused Coping 144 B O X 7.3 The Brief COPE 145

Coping and External Resources 146 B O X 7.4 Coping with HIV 146

Coping Outcomes 147 Coping Interventions 147

Mindfulness Meditation and Acceptance/Commitment Therapy 147

Expressive Writing 148 Self-Affirmation 149 Relaxation Training 149 Coping Skills Training 149

Social Support 151 What Is Social Support? 151 Effects of Social Support on Illness 152 B O X 7.5 Is Social Companionship an Important

Part of Your Life? 153 Biopsychosocial Pathways 153 Moderation of Stress by Social Support 154 What Kinds of Support Are Most Effective? 155 B O X 7.6 Can Bad Relationships Affect Your

Health? 156 Enhancing Social Support 157

P A R T 4

How Has Stress Been Studied? 124 Studying Stress in the Laboratory 124 Must a Stressor Be Ongoing to Be Stressful? 124 Inducing Disease 125 Stressful Life Events 125 B O X 6.2 Post-Traumatic Stress Disorder 126

Daily Stress 127 Sources of Chronic Stress 128

Effects of Early Stressful Life Experiences 128 B O X 6.3 Can an Exciting Sports Event Kill You?

Cardiovascular Events During World Cup Soccer 128

B O X 6.4 A Measure of Perceived Stress 129 B O X 6.5 The Measurement of Daily Strain 130

Chronic Stressful Conditions 130 Stress in the Workplace 131 B O X 6.6 Can Prejudice Harm Your Health? 132

Some Solutions to Workplace Stressors 134 Combining Work and Family Roles 134

C H A P T E R 7

Coping, Resilience, and Social Support 137

Coping with Stress and Resilience 138 Personality and Coping 138 B O X 7.1 The Measurement of Optimism:

The LOT-R 140

SEEKING AND USING HEALTH CARE SERVICES 159

C H A P T E R 8

Using Health Services 160

Recognition and Interpretation of Symptoms 161 Recognition of Symptoms 161 Interpretation of Symptoms 162 Cognitive Representations of Illness 162 B O X 8.1 Can Expectations Influence Sensations?

The Case of Premenstrual Symptoms 163 Lay Referral Network 164 The Internet 164

Who Uses Health Services? 164 Age 164 Gender 164

Social Class and Culture 165 Social Psychological Factors 165

Misusing Health Services 165 Using Health Services for Emotional

Disturbances 165 Delay Behavior 166 B O X 8.2 The June Bug Disease: A Case of

Hysterical Contagion 167

C H A P T E R 9

Patients, Providers, and Treatments 170

Health Care Services 171 Patient Consumerism 171

Contents xi

Who Uses CAM? 192 Complementary and Alternative Medicine: An

Overall Evaluation 192 The Placebo Effect 193

History of the Placebo 193 What Is a Placebo? 193 Provider Behavior and Placebo Effects 194 B O X 9.6 Cancer and the Placebo Effect 194

Patient Characteristics and Placebo Effects 194 Patient-Provider Communication and Placebo

Effects 195 Situational Determinants of Placebo Effects 195 Social Norms and Placebo Effects 195 The Placebo as a Methodological Tool 196

C H A P T E R 1 0

The Management of Pain and Discomfort 199

The Elusive Nature of Pain 201 B O X 10.1 A Cross-Cultural Perspective on Pain:

The Childbirth Experience 202 Measuring Pain 202 The Physiology of Pain 204 B O X 10.2 Headache Drawings Reflect Distress and

Disability 204 B O X 10.3 Phantom Limb Pain: A Case History 206 Neurochemical Bases of Pain and Its Inhibition 206

Clinical Issues in Pain Management 207 Acute and Chronic Pain 207 Pain and Personality 209

Pain Control Techniques 209 Pharmacological Control of Pain 210 Surgical Control of Pain 210 Sensory Control of Pain 211 Biofeedback 211 Relaxation Techniques 211 Distraction 212 Coping Skills Training 213 Cognitive Behavioral Therapy 214

Pain Management Programs 214 Initial Evaluation 215 Individualized Treatment 215 Components of Programs 215 Involvement of Family 215 Relapse Prevention 215 Evaluation of Programs 215

Structure of the Health Care Delivery System 171 Patient Experiences with Managed Care 172

The Nature of Patient-Provider Communication 173 Setting 173 Provider Behaviors That Contribute to Faulty

Communication 174 B O X 9.1 What Did You Say?: Language Barriers

to Effective Communication 175 Patients’ Contributions to Faulty Communication 175 Interactive Aspects of the Communication

Problem 176 Results of Poor Patient-Provider Communication 177

Nonadherence to Treatment Regimens 177 Good Communication 177 B O X 9.2 What Are Some Ways to Improve

Adherence to Treatment? 178 Improving Patient-Provider Communication and Increasing Adherence to Treatment 178

Teaching Providers How to Communicate 178 B O X 9.3 What Can Providers Do to Improve

Adherence? 179 The Patient in the Hospital Setting 180

Structure of the Hospital 181 The Impact of Hospitalization on the Patient 182 B O X 9.4 Burnout Among Health Care

Professionals 183 Interventions to Increase Information in Hospital Settings 184 The Hospitalized Child 184

B O X 9.5 Social Support and Distress from Surgery 185

Preparing Children for Medical Interventions 185 Complementary and Alternative Medicine 186

Philosophical Origins of CAM 186 CAM Treatments 188

Dietary Supplements and Diets 188 Prayer 188 Acupuncture 189 Yoga 189 Hypnosis 190 Meditation 190 Guided Imagery 190 Chiropractic Medicine 191 Osteopathy 191 Massage 191

xii Contents

C H A P T E R 1 2

Psychological Issues in Advancing and Terminal Illness 239

Death Across the Life Span 240 Death in Infancy and Childhood 240 Death in Adolescence and Young Adulthood 243 Death in Middle Age 244 Death in Old Age 244 B O X 12.1 Why Do Women Live Longer Than

Men? 245 Psychological Issues in Advancing Illness 246

Continued Treatment and Advancing Illness 246 B O X 12.2 A Letter to My Physician 247 Psychological and Social Issues Related to

Dying 247 B O X 12.3 Ready to Die: The Question of Assisted

Suicide 248 The Issue of Nontraditional Treatment 249

Are There Stages in Adjustment to Dying? 249 Kübler-Ross’s Five-Stage Theory 249 Evaluation of Kübler-Ross’s Theory 250

Psychological Issues and the Terminally Ill 251 Medical Staff and the Terminally Ill Patient 251 Counseling with the Terminally Ill 253 The Management of Terminal Illness in Children 253

Alternatives to Hospital Care for the Terminally Ill 253 Hospice Care 253 Home Care 254

Problems of Survivors 254 B O X 12.4 Cultural Attitudes Toward Death 255 The Survivor 255 Death Education 257

C H A P T E R 1 3

Heart Disease, Hypertension, Stroke, and Type II Diabetes 259

Coronary Heart Disease 260 What Is CHD? 260 Risk Factors for CHD 260 Stress and CHD 261 Women and CHD 263 Personality, Cardiovascular Reactivity, and CHD 264

C H A P T E R 1 1

Management of Chronic Health Disorders 218

Quality of Life 220 What Is Quality of Life? 220 Why Study Quality of Life? 220

Emotional Responses to Chronic Health Disorders 221 Denial 221 Anxiety 222 Depression 222

Personal Issues in Chronic Health Disorders 223 B O X 11.1 A Future of Fear 223 The Physical Self 223 The Achieving Self 224 The Social Self 224 The Private Self 224

Coping with Chronic Health Disorders 224 Coping Strategies and Chronic Health Disorders 224 Patients’ Beliefs About Chronic Health Disorders 225 B O X 11.2 Chronic Fatigue Syndrome and Other

Functional Disorders 226 Comanagement of Chronic Health Disorders 227

Physical Rehabilitation 227 B O X 11.3 Epilepsy and the Need for a Job

Redesign 228 Vocational Issues in Chronic Health Disorders 228 Social Interaction Problems in Chronic Health

Disorders 228 B O X 11.4 Who Works with People with Chronic

Health Disorders? 229 Gender and the Impact of Chronic Health

Disorders 232 Positive Changes in Response to Chronic Health

Disorders 232 When a Child Has A Chronic Health Disorder 232

Psychological Interventions and Chronic Health Disorders 234

Pharmacological Interventions 234 Individual Therapy 234 Relaxation, Stress Management, and Exercise 235 Social Support Interventions 236 B O X 11.5 Help on the Internet 236 Support Groups 237

P A R T 5

MANAGEMENT OF CHRONIC AND TERMINAL HEALTH DISORDERS 217

Contents xiii

Negative Affect and Immune Functioning 287 Stress, Immune Functioning, and Interpersonal

Relationships 288 Coping and Immune Functioning 288 Interventions to Improve Immune Functioning 289

HIV Infection and AIDS 290 A Brief History of HIV Infection and AIDS 290 HIV Infection and AIDS in the United States 291 The Psychosocial Impact of HIV Infection 292 Interventions to Reduce the Spread of HIV

Infection 293 Coping with HIV+ Status and AIDS 296 Psychosocial Factors That Affect the Course of HIV

Infection 297 Cancer 298

Why Is Cancer Hard to Study? 299 Who Gets Cancer? A Complex Profile 299 Psychosocial Factors and Cancer 299 Psychosocial Factors and the Course of Cancer 301 Adjusting to Cancer 301 Psychosocial Issues and Cancer 302 Post-traumatic Growth 302 Interventions 303 Therapies with Cancer Patients 304

Arthritis 304 Rheumatoid Arthritis 305 Osteoarthritis 306

Type I Diabetes 306 Special Problems of Adolescent Diabetics 307

B O X 13.1 Hostility and Cardiovascular Disease 265 Depression and CHD 266 Other Psychosocial Risk Factors and CHD 267 Management of Heart Disease 267 B O X 13.2 Picturing the Heart 269 Prevention of Heart Disease 271

Hypertension 272 How Is Hypertension Measured? 272 What Causes Hypertension? 272 Treatment of Hypertension 274 The Hidden Disease 275

Stroke 275 Risk Factors for Stroke 276 Consequences of Stroke 277 Rehabilitative Interventions 277

Type II Diabetes 278 Health Implications of Diabetes 280 Psychosocial Factors in the Development of

Diabetes 280 The Management of Diabetes 281 B O X 13.3 Stress Management and the Control of

Diabetes 281

C H A P T E R 1 4

Psychoneuroimmunology and Immune-Related Disorders 284

Psychoneuroimmunology 285 The Immune System 285 Assessing Immune Functioning 285 Stress and Immune Functioning 285 B O X 14.1 Autoimmune Disorders 287

P A R T 6

TOWARD THE FUTURE 311

C H A P T E R 1 5

Health Psychology: Challenges for the Future 312

Health Promotion 314 A Focus on Those at Risk 314 Prevention 314 A Focus on Older Adults 314 Refocusing Health Promotion Efforts 315 Promoting Resilience 315 Health Promotion and Medical Practice 316 Health Disparities 316

Stress and Its Management 318 Where Is Stress Research Headed? 318

Health Services 319 Building Better Consumers 319

Management of Serious Illness 320 Quality-of-Life Assessment 320 The Aging of the Population 320

Trends in Health and Health Psychology 321 The Research of the Future 321 The Changing Nature of Medical Practice 321

xiv Contents

GLOSSARY 328

REFERENCES 338

NAME INDEX 412

SUBJECT INDEX 438

Systematic Documentation of Cost Effectiveness and Treatment Effectiveness 322

International Health 324 Becoming a Health Psychologist 325

Undergraduate Experience 325 Graduate Experience 325 Postgraduate Work 326 Employment 326

xv

P R E F A C E

When I wrote the first edition of Health Psychology over 30 years ago, the task was much simpler than it is now. Health psychology was a new field and was relatively small. In recent decades, the field has grown steadily, and great research advances have been made. Chief among these developments has been the use and refinement of the biopsychosocial model: the study of health issues from the stand- point of biological, psychological, and social factors acting together. Increasingly, research has attempted to identify the biological pathways by which psychosocial factors such as stress may adversely affect health and potentially protective factors such as social support may buffer the impact of stress. My goal in the tenth edition of this text is to convey this increasing sophistication of the field in a manner that makes it accessible, comprehensible, and exciting to undergraduates. Like any science, health psychology is cumulative, building on past research advances to develop new ones. Accordingly, I have tried to present not only the fundamental contributions to the field but also the current research on these issues. Because health psychology is developing and changing so rapidly, it is essential that a text be up to date. Therefore, I have not only reviewed the recent research in health psychology but also obtained information about research proj- ects that will not be available in the research literature for several years. In so doing, I am presenting a text that is both current and pointed toward the future. A second goal is to portray health psychology appropriately as being inti- mately involved with the problems of our times. The aging of the population and the shift in numbers toward the later years has created unprecedented health needs to which health psychology must respond. Such efforts include the need for health promotion with this aging cohort and an understanding of the psychosocial issues that arise in response to aging and its associated chronic disorders. Because AIDS is a leading cause of death worldwide, the need for health measures such as con- dom use is readily apparent if we are to halt the spread of this disease. Obesity is now one of the world’s leading health problems, nowhere more so than in the United States. Reversing this dire trend that threatens to shorten life expectancy worldwide is an important current goal of health psychology. Increasingly, health psychology is an international undertaking, with researchers from around the world providing insights into the problems that affect both developing and devel- oped countries. The tenth edition includes current research that reflects the inter- national focus of both health problems and the health research community. Health habits lie at the origin of our most prevalent disorders, and this fact underscores more than ever the importance of modifying problematic health behav- iors such as smoking and alcohol consumption. Increasingly, research documents the importance of a healthy diet, regular exercise, and weight control among other positive health habits for maintaining good health. The at-risk role has taken on more importance in prevention, as breakthroughs in genetic research have made it possible to identify genetic risks for diseases long before disease is evident. How people cope with being at risk and what interventions are appropriate for them represent important tasks for health psychology research to address. Health psychology is both an applied field and a basic research field. Accord- ingly, in highlighting the accomplishments of the field, I present both the scientific

xvi Preface

progress and its important applications. Chief among these are efforts by clinical psychologists to intervene with people to treat biopsychosocial disorders, such as post-traumatic stress disorder; to help people manage health habits that have become life threatening, such as eating disorders; and to develop clinical interven- tions that help people better manage their chronic illnesses. Finding the right methods and venues for modifying health continues to be a critical issue. The chapters on health promotion put particular emphasis on the most promising methods for changing health behaviors. The chapters on chronic diseases highlight how knowledge of the psychosocial causes and consequences of these disorders may be used to intervene with people at risk—first, to reduce the likelihood that such disorders will develop, and second, to deal effectively with the psychosocial issues that arise following diagnosis. The success of any text depends ultimately on its ability to communicate the content clearly to student readers and spark interest in the field. In this tenth edition, I strive to make the material interesting and relevant to the lives of student readers. Many chapters highlight news stories related to health. In addition, the presentation of material has been tied to the needs and interests of young adults. For example, the topic of stress management is tied directly to how students might manage the stresses associated with college life. The topic of problem drinking includes sections on college students’ alcohol consumption and its modification. Health habits relevant to this age group—tanning, exercise, and condom use, among others—are highlighted for their relevance to the student population. By providing students with anecdotes, case histories, and specific research examples that are relevant to their own lives, they learn how important this body of knowl- edge is to their lives as young adults. Health psychology is a science, and consequently, it is important to commu- nicate not only the research itself but also some understanding of how studies were designed and why they were designed that way. The explanations of par- ticular research methods and the theories that have guided research appear throughout the book. Important studies are described in depth so that students have a sense of the methods researchers use to make decisions about how to gather the best data on a problem or how to intervene most effectively. Throughout the book, I have made an effort to balance general coverage of psychological concepts with coverage of specific health issues. One method of doing so is by presenting groups of chapters, with the initial chapter offering general concepts and subsequent chapters applying those concepts to specific health issues. Thus, Chapter 3 discusses general strategies of health promotion, and Chapters 4 and 5 discuss those issues with specific reference to particular health habits such as exercise, smoking, accident prevention, and weight control. Chapters 11 and 12 discuss broad issues that arise in the context of managing chronic health disorders and terminal illness. In Chapters 13 and 14, these issues are addressed concretely, with reference to specific disorders such as heart disease, cancer, and AIDS. Rather than adopt a particular theoretical emphasis throughout the book, I  have attempted to maintain a flexible orientation. Because health psychology is taught within all areas of psychology (for example, clinical, social, cognitive, physiological, learning, and developmental), material from each of these areas is included in the text so that it can be accommodated to the orientation of each instructor. Consequently, not all material in the book is relevant for all courses. Successive chapters of the book build on each other but do not depend on each

Preface xvii

other. Chapter 2, for example, can be used as assigned reading, or it can act as a resource for students wishing to clarify their understanding of biological concepts or learn more about a particular biological system or illness. Thus, each instruc- tor can accommodate the use of the text to his or her needs, giving some chapters more attention than others and omitting some chapters altogether, without under- mining the integrity of the presentation.

■ NEW TO THIS EDITION

∙ Coverage of qualitative methods, such as how interviews and personal narra- tives can enrich our understanding of health experiences (Chapter 1)

∙ Discussion of Alzheimer’s disease, its toll, and its increasing importance as a disease of an aging population (Chapter 2)

∙ New section on the self-regulation of health behaviors, including the impact of self affirmation on health behavior change (Chapter 3)

∙ Coverage of perceived barriers to health behavior change, one of the most important reasons why people do not practice better health habits (Chapter 3)

∙ Coverage of the post childbirth period as a teachable moment (Chapter 3) ∙ Discussion of the health risks of being sedentary and sitting for long periods

of time (Chapters 4, 13) ∙ Expanded coverage of vaccinations and ways to overcome resistance to getting

children vaccinated for major diseases (Chapter 4) ∙ Coverage of new research on sleep and health (Chapter 4) ∙ Enhanced coverage of eating disorders, including binge eating diso

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