CH-1 What Is Health Psychology? – Health Psychology : Chapter Notes

This document contains Chapters 1 to 4 Chapter 1 What Is Health Psychology? Chapter Outline I. Definitions of Health Psychology A. Why Did Health Psychology develop? II. The Mind-Body Relationship: A Brief History III. The Rise of the Biopsychosocial Model A. Psychosomatic Medicine B. Advantages of the Biopsychosocial Model C. Clinical Implications of the Biopsychosocial Model D. The Biopsychosocial Model: The Case History of Nightmare Deaths] IV. The Need for Health Psychology A. Changing Patterns of Illness B. Advances in Technology and Research C. Expanded Health Care Services D. Increased Medical Acceptance V. Health Psychology Research A. The Role of Theory in Research B. Experiments C. Correlational studies D. Prospective and Retrospective Designs E. The Role of Epidemiology in Health Psychology F. Methodological Tools VI. What Is Health Psychology Training For? Learning Objectives Define health psychology. What does a health psychologist do? Describe the changing philosophical perspectives on the mind-body relationship from the time of ancient cultures to the present day. Compare and contrast the biopsychosocial model and biomedical models of health. Summarize the advantages of the biopsychosocial model. What was Freud’s contribution? Explain the clinical implications of the biopsychosocial model. Explain the Case History of Nightmare Deaths. Describe changing patterns of illness in the United States. Differentiate between acute disorders and chronic illnesses. Describe the advances in technology and research. Describe trends in the expansion of health care services in the United States. Explain the role of theory in health psychology. Explain epidemiology, morbidity, and mortality. Describe the research methodologies employed by health psychologists. Describe the different occupations that employ health psychologists. Lecture Suggestions Careers in Practice: Health-Psych.org site provides information about the health psychology, subfields, terminology, and education. Sternberg (1997) reviews several well-known psychologists’ discussions of their work, the reasons for selecting psychology as a career, and what they like and dislike about their work. Marks and colleagues (2003) provide an overview of the role of health psychologists in clinical medical settings. Educational requirements in the United States, Europe, and the United Kingdom are reviewed and professional issues unique to this setting are examined. Dr. Jeffrey L. Helms, and Dr. Daniel T. Rogers (2010) in their book “Majoring in Psychology: Achieving Your Educational and Career Goals” provide an overview about the various career opportunities available to health psychologists. The subject is explained in terms of the kind of work, training and preparation provided, work areas available after completing graduation, and health psychology’s relation to culture. Measurement Issues: Measuring health-related outcomes is often difficult and subjective. Adoption of the biopsychosocial model of health assumes that any assessment of health must take into account the biological (all body systems), psychological (i.e., thoughts, emotions and beliefs, relationships, stress or behaviors) and social (i.e., family, friends, SES or neighborhoods) factors. Taking into account how these three forces affect individuals’ health can help health psychologists and health professionals identify the proper treatment program. The efficacy of a medical treatment or intervention by use of traditional health-related outcomes or criteria can be problematic. For example, the quality of life becomes an important issue when a biomedical criterion such as life expectancy (the number of years the patient may be expected to live based on the age-specific death rate of the birth cohort) is adopted in assessing health-related outcomes. Similar concerns are expressed by those who criticize the use of mortality rates (the proportion of deaths within a population) and morbidity rates (the number of years free from disease) as outcome measures. Thus, alternative measures such as functional status, which typically is represented as a composite measure of a person’s physical abilities, cognitive abilities, role involvement, and so on, may become increasingly useful. Kaplan (1994) presents a slightly different focus on the measurement of heath-related outcomes with his Ziggy Theorem. This theorem emphasizes patient-oriented outcomes that combine life expectancy with health-related quality of life. Bootzin & McKnight (2006) include chapters covering different domains. Chun and colleagues (2002) examine recent developments relating to theories of acculturation especially with regard to health status, addictions, and mental health. David P. French and Stephen Sutton (2010) in their book “Reactivity of measurement in health psychology: How much of a problem is it? What can be done about it?” explains the difficulties currently faced in the measurement of health related concerns and its effects on people. The book aims to outline the basic issues faced in the subject and identify areas that need future research. The Biopsychosocial Model: Berrell-Carrio and colleagues (2004) propose three ways to clarify the biopsychosocial model. First, they believe that the relationship between the mind and the body with regard to health is multifaceted; thus, one’s experience is subjected to, but cannot be reduced to, physiological laws. Second, bi-directional causality with regard to health problems must take into consideration a linear approximation when evaluating what treatment to select. Lastly, the scientists also propose to find ways to enhance the participatory role of the patient. Smith, et al. (2000) presents an overview of health psychology written for the clinical psychologist. This review provides an excellent background for an introductory lecture. Marmot and Wilkinson (2005) and Kawachi and Berkman (2003) examine the social and economic factors that affect health. The text’s presentation of the biopsychosocial model may be developed by discussing the role of environmental variables that affect health and illness. The Taylor and colleagues (1997) review describes the way in which community, work, family, and peer environments contribute to chronic and acute illness. This review also serves as an introduction to topics addressed in subsequent chapters (e.g., health behaviors, stress, and coping). Another way to develop the biopsychosocial model is to discuss the impact of sociocultural factors on minority health. Macera, et al. (2001) present health statistics for minority groups, and then examine a minority health issue, hypertension among African Americans, using a contextual model. Similarly, Brown and colleagues (2003) examine whether ethnicity is related to diabetes care among Latinos. Edward P. Sarafino and Timothy W. Smith (2010) in their book “Health Psychology: Biopsychosocial Interactions, 7th Edition” describe the biopsychosocial interactions related to health care systems. Their research gives an insight into health and lifespan development. The Changing Patterns of Illness In the Modern World: Most of us do not need to be convinced that despite technology and available treatment, people get sick or injured. When this happens, people reassess their life, their beliefs, and their behaviors. Several scientists are now examining the impact of health changes on how individuals evaluate the quality of their life. In this book, Schwartz and Sprangers (2000) examine these changes, the underlying theories and methods to explain such changes, as well as treatment options and medication decision making. Similarly, Kiple and others (1993) document the history of medicine and disease from a cross-cultural perspective. It also contains sections devoted to changing conceptions of health and disease, issues in health measurement, and major human diseases. Stephen J. Wood, Nicholas B. Allen, and Christos Pantelis (2009) in their book “The Neuropsychology of Mental Illness” talks about how psychiatric disorders impact cognitive functioning, and how neuropsychology helps to understand these diseases and hopefully provide remedies for treatment. Recommended Reading Leventhal, H., Weinman, J., Leventhal, E. A., & Phillips L. A. (2008). Health psychology: The search for pathways between behavior and health. Annual Review of Psychology, 59, 477–505. A recent review (Leventhal, et al., 2008) indicates several important issues: 1) biomedical indicators are useful in interventions; 2) interventions are too expensive and time consuming to be used in clinical and community settings; 3) current models suggest using new approaches in developing effective and cost-efficient interventions. .Resnick and Rozensky’s (1997) book provides a current survey of clinical and research issues in health psychology. Chapters address the role of health psychology in the health care delivery system, the role of psychologists in medical care settings, and the role of disease control and management. This edited volume documents the history of medicine and disease from a cross-cultural perspective. It also contains sections devoted to changing conceptions of health and disease, issues in health measurement, and major human diseases. This book provides a current survey of clinical and research issues in health psychology. Its chapters address the role of health psychology in the health care delivery system, the role of psychologists in medical care settings, and disease control and management. Activities Research Methods and Health Psychology In the Popular Press: Have students bring articles from the news media and the popular press about health issues to discuss in class. Many newspapers have a weekly health section, and magazines devoted to health, fitness, and wellness are readily available. These news items and articles may provide the basis for a discussion on the dissemination of research findings to the general population, the problems in interpreting research in health psychology, and the frustrations experienced by media consumers who may have to sift through a series of competing health-related claims. The previous exercise may be modified to provide an opportunity for students to apply the research methods adopted by health psychologists in specific instances. Organize students into groups of three to four members, and distribute a different newspaper or magazine article that makes a health-related claim to each group. Articles may be readily found in health-related magazines (e.g., Prevention, Self), general-interest magazines (e.g., Reader’s Digest, Redbook), and local newspapers. Ask students to devise a research study that would test the claims in the media report they have been assigned. Students generally can outline a research study within 30 minutes. Have them report their studies to their classmates for peer critique. Research Across Disciplines: Ask students to work in pairs or small groups to examine whether health interventions and medical treatments are relevant to “developing” countries. Once the students have responded to the activities based on their readings, ask them to share their findings with their classmates. Evaluating Information: Ask students to click on Alexander and Tate’s Web Wisdom Resources, and examines Web resource evaluation techniques. Make sure the students critically evaluate the fact that much of health information is disseminated via the Internet. It is thus important to understand how to assess the information presented out there. Beliefs About Illness and Healing—Curanderismo: Please get students to click on Traditional Latino Medicines to discuss alternative approaches to medicine. One may also include an activity from Whittlesey (2001). It includes a reading discussing Curanderismo, or folk medicine among Mexican Americans, a series of discussion questions, and a list of recommended readings. An instructor’s manual is available from the publisher. Videos 1. Barnette Jackson (2007). Measurement issues and methods in the field-based research and evaluation. Dr. Jackson reviews various topics relating to assessment; these topics include the reliability and validity of data produced using the instruments and guidelines for the design, use, and data analysis of project-specific instruments. This video can be downloaded directly from the Web site and be viewed in the classroom with the students. 2. American Psychological Association available at www.apa.org Psychology: Scientific problems solvers—Careers for the 21st century: An exciting video that focuses on interviews with psychologists working in various areas of psychology, and discusses emerging opportunities to work in psychology and ways to approach psychology as a career. Psychology: Understanding ourselves, understanding each other: This video provides the viewers with an opportunity to “walk” an exhibition that depicts 100 years of psychological research. The video illustrates peoples’ experience in research and applications of how psychology can be applied to every day life among other things. 3. Films for the Humanities & Sciences available at http://ffh.films.com Mind over matter: Advances in brain research (1997) Mind talk: The brain’s new story (1998) The mind as healer: Examines the role of the psychologist in the hospital setting. Focuses on life-threatening illnesses and the application of psychological interventions to enhance recovery from cancer treatment and weakened immune systems. References Borrell-Carrio, F., Suchman, A.L. & Epstein, R. M. (2004). The biopsychosocial model 25 years later: Principles, practice and scientific inquiry. Annals of Family Medicine, 2, 576–582. Bootzin, R. R. & McKnight, P. E. (Eds.), (2006). Strengthening research methodology: Psychological measurement and evaluation. Washington, DC: American Psychological Association. Brown, A. F., Gerzoff, R. B., Karter, A. J., Safford, M., Waitzfelder, B., et al. (2003). Health behaviors and quality of care among Latinos with diabetes in managed care. American Journal of Public Health, Vol.93,No.10: 1694–1698. Chun, K. M., Balls-Organista, P., & Marin, G. (2002). Acculturation: Advances in theory, measurement, and applied research. Washington, DC: American Psychological Association. Kaplan, R. M. (1994). The Ziggy Theorem: Toward an outcomes-focused health psychology. Health Psychology, 13, 451–460. Kawachi, I., & Berkman L.F. (2003). Neighborhoods and health. New York, NY: Oxford University Press. Kiple, K. F. (Ed.). (1993). The Cambridge world history of human disease. Cambridge, England: Cambridge University Press. Leventhal, H., Weinman, J., Leventhal, E. A., & Phillips A. (2008). Health psychology: The search for pathways between behavior and health. Annual Review of Psychology, 59, 477–505. Macera, C., Armstead, C., & Anderson, N. (2001). Sociocultural influences on health. In A. Baum, T. A. Revenson, & J. Singer (Eds.), Handbook of health psychology (pp. 427–440). Mahwah, NJ: Lawrence Erlbaum. Marks, D. F., Sykes, C. M., & McKinley, J. M. (2003). Health psychology: Overview and professional issues. In I. B. Weiner (Series Ed.) & A. M. Nezu, C. M. Nezu, & P. A. Geller (Eds.), Handbook of psychology: Vol. 9, Health psychology (pp. 5–23). Hoboken, NJ: John Wiley. Marmot, M., & Wilkinson, R. G. (2005) Social determinants of health. Oxford University Press, USA. Resnick, R. J., & Rozensky, R. H. (Eds.), (1997). Health psychology through the life span: Practice and research opportunities. Washington, DC: American Psychological Association. Schwartz, C. E., & Sprangers, M. A. G. (Eds.), (2000). Adaptation to changing health: Response shift in quality of life research. Washington, DC: American Psychological Association. Smith, T. W., Nealy, J. B., & Hamann, H. A. (2000). Health psychology. In C. R. Snyder & R. E. Ingram (Eds.), Handbook of psychological change (pp. 562–590). New York: Wiley. 15. Sternberg, R. J. (1997). Career paths in psychology: Where your degree can take you. Washington, DC: American Psychological Association. 16. Taylor, S. E., Repetti, R. L., & Seeman, T. (1997). Health psychology: What is an unhealthy environment and how does it get under the skin? In J. T. Spence, J. M. Darley, & D. J. Foss (Eds.), Annual review of psychology (Vol. 48, pp. 411–447). Palo Alto, CA: Annual Reviews. 17. Whittlesey, V. (2001). Diversity activities for psychology. Boston: Allyn and Bacon. Chapter 2 The Systems of the Body Chapter Outline I. The Nervous System A. Overview B. The Brain C. The Role of Neurotransmitters D. Disorders of the Nervous System II. The Endocrine System A. Overview B. The Adrenal Glands C. Disorders Involving the Endocrine System III. The Cardiovascular System A. Overview B. The Heart C. Disorders of the Cardiovascular System D. Blood Pressure E. The Blood IV. The Respiratory System A. Overview B. The Structure and Functions of the Respiratory System C. Disorders Associated with the Respiratory System D. Dealing with Respiratory Disorders V. The Digestive System and the Metabolism of Food A. Overview B. The Functioning of the Digestive System C. Disorders of the Digestive System VI. The Renal System A. Overview B. Disorders of the Renal System VII. The Reproductive System A. Overview B. The Ovaries and Testes C. Fertilization and Gestation D. Disorders of the Reproductive System VIII. Genetics and Health A. Overview B. Genetics and Susceptibility to Disorders IX. The Immune System A. Overview B. Infection C. The Course of Infection D. Immunity E. Disorders Related to the Immune System Learning Objectives Identify and describe the structure of the nervous system. Identify and describe the structure and function of the peripheral and autonomic nervous systems. Differentiate between the sympathetic and parasympathetic nervous systems, and describe their functions. Differentiate between the medulla, pons, and cerebellum, and describe their functions. Describe the functions of the midbrain. Describe the structure of the forebrain. Differentiate between the thalamus and the hypothalamus, and describe their functions. Describe the structure and functions of the four lobes that make up the cerebral cortex. Describe the structure and functions of the limbic system. Describe the nature and functions of neurotransmitters. Identify and describe the common disorders of the nervous system. Describe the structure and functions of the endocrine system. Describe the functions of the adrenal glands and their role in the endocrine system. Describe the nature of diabetes, differentiating between Type I and Type II diabetes. Describe the structure and function of the cardiovascular system. Describe the structure and function of the heart, and identify common disorders of the cardiovascular system. Describe the factors that influence blood pressure. Describe the composition of blood, and identify common blood-related disorders. Describe the structure and function of the respiratory system, and identify common respiratory system disorders. Describe the structure and function of the digestive system, and identify common digestive system disorders. Describe the structure and function of the renal system, and identify common disorders of the renal system. Describe the structure and function of the male and female reproductive systems. Explain the processes of fertilization and gestation. Identify common disorders of the reproductive system. Explain the inheritance of susceptibility to disease. Explain the role of the health psychologist in genetics, and discuss genetic counseling. Describe the structure and function of the immune system. Describe the routes of disease transmission and the course of infection. Describe the nature of immunity, and differentiate between nonspecific and specific immune mechanisms. Differentiate between humoral and cell-mediated immunity. Describe the role of the lymphatic system in immunity. 32. Identify common disorders of the immune system. Lecture Suggestions Definition of Systems: One important concept for students to get out of this chapter is that each of our body systems is interconnected and dependent on each other. For example, the heart will not beat unless the nervous system sends the proper signals. The skeletal system depends on the digestive system for increase in size and strength, so if a child does not get the proper nutrients, the bones and muscles may not develop properly. The muscular system needs the respiratory and circulatory systems to supply energy in the form of blood flow distribution of oxygen and nutrients. Julian F. Thayer, Shelby S. Yamamoto, and Jos F. Brosschot (2010) in their article “The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors” talks about how the sympathetic and parasympathetic system is associated with various pathological conditions, including cardiovascular diseases. The body is thus viewed as a system or a collection of interrelated entities that work together. Genetic Counseling: Another area of interest for students studying health psychology is genetic testing. The decision to undergo genetic testing is viewed as a way to manage diseases such as Huntington’s disease, Alzheimer’s disease, hereditary breast/ovarian cancer, or hereditary colorectal cancer. Yet, getting tested and the prospects of being identified as having a harmful mutation can be stressful despite some benefits. Gooding and colleagues (2006) propose a reduction in uncertainty, and an increase in control over the risk of getting a specific disease as benefits. For instance, coping with the stress can be better managed with positive coping role models, accurate empathy from family or friends, use of humor, and benefit finding. Baum and colleagues (1997) describe the benefits and the potential for psychological distress that may accompany risk analysis. Serretti and others (2007) examine biological processes and discuss the effects of drugs and environmental factors in moderating the effects of genes on psychiatric disorders. MacBrayer (2007) reviews relevant literature and discusses her personal experience with the process. Rolland (2006) provides an overview of the family systems genetic illness (FSGI) model and highlights the importance of multicultural issues in genetic screening and testing and the need for further research in this area. Schwartz and colleagues (2005) believe that genetic testing will transform how health professionals approach disease prevention strategies. Cunningham-Burley and Boulton’s (2000) handbook provides a sociohistorical overview of the growth of genetics with particular emphasis on genetics’ early association with the eugenics movements. The second part examines the gap between genetic information and treatment interventions, with an emphasis on lay knowledge and responses to genetic screening. Finally, Napolitano and Ogunseitan (1999) provide an overview of the possibilities and problems associated with the ethics of the application of genetic engineering techniques. Their study examines the gender differences in attitudes toward genetic engineering as applied to human reproduction and thus provides an interesting set of questions for discussion. Dar-Nimrod & Heine (2011) in their article “Genetic Essentialism: On the Deceptive Determinism of DNA” talks about how many people think that genetic risks are immutable and that any efforts they might undertake to affect their health would be fruitless if genes are implicated. Recommended Reading Noble, Mark I. M. (2002) Cardiovascular System in Health and Disease. London: World Scientific Publishing Company. This book explains the basic aspects of the cardiovascular system. This book also explains the disorders of the cardiovascular system using a series of case descriptions. Peter S. Harper. (2010). Practical Genetic Counselling. Taylor and Francis. This book contains up-to-date information on the impact of genetic components in common disorders. It also contains information on the associated psychosocial and ethical considerations and concerns. Activities Carriers: Carriers are people who transmit a disease to others without actually contracting that disease themselves. They are especially dangerous because they are not ill and so they can infect dozens, hundreds, or even thousands of people while going about the business of everyday life. Ask your students to read the two cases given in Box 2.2 in this chapter, and ask them to share their knowledge on such carriers with the class. Clotting Disorders: One way to get your students to better understand Hemophilia is by watching this video: Understanding hemophilia. After they watch the video, ask your students to write a report on the types of clotting disorders. Videos 1. American Psychological Association available at http://www.apa.org/ Breathing easy: What home buyers and sellers should know about radon. (2003): Radon is the second leading cause of lung cancer in the United States. An environmental problem that is responsive to a simple behavioral change. The students can gain more knowledge on testing for and repairing problems by watching this video: Government Document Depositories. 2. Bullfrog Films available at http://www.bullfrogfilms.com/ Gene blues: Dilemmas of DNA testing. (1997): It addresses problem areas associated with genetic testing. The video discusses issues such as loss of privacy, insurance, and employment discrimination based on DNA information, and loss of respect for persons with disabilities. 3. Fanlight Productions available at http://www.fanlight.com/ Deadly inheritance. (1998). This documentary follows a 38-year-old woman during the 38 days from her genetic test until she learns the results. The burden of knowledge. (1994): This powerful video explores difficult ethical issues arising from advances in biotechnology that make it possible to identify genetic defects during pregnancy. Seven couples who were offered prenatal testing, along with caregivers and people with disabilities, are interviewed. 4. Films for the Humanities & Sciences available at http://ffh.films.com/ Anatomy of the human brain. (1997). Dissection of the human brain. The brain. (1995). Brain structure and function. Blood. (1995): Using sickle-cell anemia, blood and circulation are explained. New technology used to improve diagnosis and treatment is presented. The interactive body: Systems at work (2004): The interactive body: Systems at work Circulatory system: The plasma pipeline. (2000): Using the analogy of a big-city transportation system, this program covers the structure and function of the heart, the lymphatic system, and blood pressure. It uses a news report format. Digestive system: The power plant. (2000): Using the analogy of a power plant, this program examines the structure and processes of the digestive system. It uses a news report format. Respiratory system: Intake and exhaust. (2000): Using a news report format, this program examines the structure and functions of the respiratory system. It compares the respiratory system to an automobile’s fuel intake and exhaust system. National Action Plan on Breast Cancer. (1997). Genetic testing for breast cancer risk: It’s your choice. (VHS, National Action Plan on Breast Cancer, U.S. Public Health Service’s Office on Women’s Health, U.S. Department of Health and Human Services, c/o R.O.W. Sciences, Inc., 1700 Research Blvd., Suite 400, Rockville, MD 20850, 14 min., color). 5. Oregon Public Broadcasting available at http://www.opb.org/ A question of genes: Inherited risks. (1998): This video uses seven cases to explore issues of genetic testing. A discussion guide is available from the OPB. References Baum, A., Friedman, A. L., & Zakowski, S. G. (1997). Stress and genetic testing for disease risk. Health Psychology, 16, 8–19. Cunningham-Burley, A., & Boulton, M. (2000). The social context of the new genetics. In G. L. Albrecht & R. Fitzpatrick (Eds.), The handbook of social studies in health and medicine (pp. 173–187). Gooding, H. C., Organista, K., Burack, J., & Bowles Biesecker, B. (2006) Genetic susceptibility testing from a stress and coping perspective. Social Science & Medicine, Vol.62, 1880–1890. MacBrayer, E. K. (2007). My life as a mutant: The BRCA1 experience. Professional Psychology: Research and Practice, 38, 571–575. Napolitano, C. L., & Ogunseitan, O. A. (1999). Gender differences in the perception of genetic engineering applied to human reproduction. Social Indicators Research, 46, 191–204. Rolland, J. S. (2006). Genetics, family systems, and multicultural influences. Families, Systems, & Health, 24, 425–441. Schwartz, M. D.; Peshkin, B. N.; & Tercyak, K. P. (2005). Decision making and decision support for hereditary breast-ovarian cancer susceptibility. Health Psychology, 24, S78-S84. Serretti, A., Olgiati, P., & De Ronchi, D. (2007). Genetics of Alzheimer’s disease. A rapidly evolving field. Journal of Alzheimer’s Disease, 1, 73–92. Weil, J. (2000). Psychological genetic counseling. New York: Oxford University Press. Chapter 3 Health Behaviors Chapter Outline I. An Introduction to Health Behaviors A. Role of Behavioral Factors in Disease and Disorder II. Health Promotion: An Overview A. Health Behaviors and Health habits B. Practicing and Changing Health Behaviors: An Overview C. Barriers to Modifying Poor Health Behaviors D. Intervening with Children and Adolescents E. Intervening with At-Risk People F. Health Promotion and Older Adults G. Ethnic and Gender Differences in Health Risks and Habits III. Changing Health Habits
A. Attitude Change and Health Behavior B. The Health Belief Model C. The Theory of Planned Behavior D. Self-Determination Theory E. Criticisms of Attitude Theories F. Implementation Intentions G. Health Behavior Change and the Brain IV. Cognitive-Behavioral Approaches to Health Behavior Change A. Cognitive-Behavior Therapy (CBT) B. Self-monitoring C. Stimulus Control D. The Self-Control of Behavior E. Social Skills and Relaxation Training F. Motivational Interviewing G. Relapse Prevention H. Evaluation of CBT V. The Transtheoretical Model of Behavior Change A. Stages of Change B. Using the Stage Model of Change VI. Changing Health Behaviors Through Social Engineering VII. Venues for Health-Habit Modification A. The Private Practitioner’s Office B. The Health Practitioner’s Office C. The Family D. Self-Help Groups E. Schools F. Workplace Interventions G. Community-Based Interventions H. The Mass Media I. Cellular Phones and Landlines J. The Internet Learning Objectives 1. Define health promotion and describe the factors that have fueled the movement toward health promotion in the United States. 2. Describe the role of behavioral factors in disease and disorder. 3. Define health behaviors, health habits, and primary prevention. 4. Summarize the relationship of individual difference variables, social factors, emotional factors, cognitive factors, perceived symptoms, and factors related to access to medical care to health behaviors. 5. Describe the health-habit factors that undermine health practices. 6. Summarize the findings of research investigating the success of health promotion and primary prevention efforts across the lifespan and with at-risk people. 7. Describe ethnic and gender differences in health behaviors. 8. Summarize the effectiveness of educational appeals and the use of fear appeals in changing attitudes and health behaviors. 9. Describe the components of the health belief model, and explain how useful it is in predicting and changing health behaviors. 10. Define self-efficacy, and explain the relationship between self-efficacy and health behaviors. 11. Describe the components of the Theory of Planned Behavior, and evaluate its usefulness in predicting health behaviors. 12. Describe why attitude change may not result in behavior change. 13. Describe the basic principles of cognitive-behavioral therapy. 14. Define self-monitoring, and describe its use in cognitive-behavioral therapy. 15. Define discriminative stimulus, and describe its use in cognitive-behavioral therapy. 16. Define classical conditioning, unconditioned response, conditioned response, unconditioned stimulus, and conditioned stimulus. Describe the use of classical conditioning in cognitive-behavioral therapy. 17. Define operant conditioning, and differentiate between different schedules of reinforcement. Describe the use of operant conditioning in cognitive-behavioral therapy. 18. Define modeling, and describe its use in cognitive-behavioral therapy. 19. Define self-control, self-reinforcement, self-reward, and self-punishment, and describe their use in cognitive-behavioral therapy. 20. Define contingency contracting, and describe its use in cognitive-behavioral therapy. 21. Define behavioral assignments, and describe their use in cognitive-behavior therapy. 22. Define social skills training or assertiveness training, and describe their use in cognitive-behavior therapy. 23. Define relaxation training, and describe its use in cognitive-behavioral therapy. 24. Define motivational interviewing and describe its use in cognitive-behavior therapy 25. Explain the nature and rate of relapse in addictive disorders and health behavior change. 26. Explain the abstinence violation effect and its relationship to relapse. 27. Explain the factors that are predictive of relapse. 28. Describe behavioral interventions to control relapse and their effectiveness in relapse prevention. 29. Define covert self-control, cognitive restructuring, and self-talk, and describe their in cognitive-behavior therapy. 30. Describe the principles of broad-spectrum cognitive-behavior therapy. Summarize the advantages of a multimodal approach to health behavior change. 31. Describe the stages of health behavior change and the effectiveness of this model in explaining health behavior change. 32. Describe the use of social engineering in changing health behaviors. 33. Describe the use of various venues for changing health behaviors, and summarize the advantages and disadvantages of each. 34. Explain the effect of the mass-media on changing health behaviors and getting the message out. Lecture Suggestions Models of Health/Risk Behavior and Behavior Change: Theoretical models provide a framework for understanding the questions posed and the answers proposed within an area. Social Psychological Foundations of Health and Illness: Edited by Jerry Suls and Kenneth A. Wallston focuses on the most prominent theories of health behavior and of behavior change, presents models focusing on prevention, and models of health behavior and change. Baranowski and colleagues (2003) examine several theories and models used to understand behavior and call for more research to understand how those models can contribute in preventing obesity. Polly A Ryan, (2009) in her article “Integrated Theory of Health Behavior Change: Background and intervention development” suggests that health behavior change can be fostered by inculcating knowledge, beliefs, and self-management techniques. Although, the article primarily focuses on clinical nurse specialists, it is useful in understanding how holistic care is provided. Conceptions of Health and Illness Across the Lifespan: Children’s understanding of health and illness is limited by their cognitive development. That is not to say, however, that children are unable to take responsibility for certain health-related behaviors. In fact, childhood may be a very important period during which health habits are established. How Children Learn to be Healthy by Barbara J. Tinsley (2003) explores how children learn about health and their understanding of health from early childhood through adolescence. In their research, Rew (2005), Seiffge-Krenke (1998), and Santrock (1996) examine the health factors that affect the adolescents.
Linda J Luecken, Danielle S Roubinov, Rika Tanaka (2013) in their recent article “Childhood family environment, social competence, and health across the lifespan” provide an overview about how one’s family, society, and environment in childhood can influence the development of physical and psychological diseases later in life. Health-Promotion Interventions: Children and the Elderly: The text’s descriptions of lifestyle health-promotion programs can be developed by discussing interventions that target different age groups. Edited volumes by Wilson et al. (1997) and Weissberg et al. (1997) describe several health promotion programs designed to improve children’s health. The chapters describe programs that have been developed for several venues (i.e., family, school, and community). Many chapters from these volumes also can be used to illustrate concepts from Chapters 4 and 5. Recent interventions have focused on encouraging physical activity (King et al., 2007; King et al., 2006; Marcus et al., 2007; Zabinski et al., 2007), osteoporosis prevention among young women (Schmiege et al., 2007), changes in HIV treatment beliefs and sexual risk behaviors among gay and bisexual men (Kalichman et al., 2007), smoking cessation (Simmons & Brandon, 2007); sun protection behaviors (Mahler et al., 2007); and condom use (Morisky et al., 2006). Norman Daniels (2013) in his recent article “Global aging and the allocation of health care across the life span” talks about societal ageing in most developed nations, and how the health care systems are poorly equipped to handle this situation. The article also discusses measures that need to be taken in order to tackle this problem. Community Programs: Healthy People 2010, U.S. Department of Health and Human Services, provide a discussion of 10 health indicators that reflect the major public health concerns. These indicators were selected because they reflect individual behaviors, physical and social environmental factors, and health system issues affecting the health of individuals and communities. The paper provides data supporting their importance and objective measures to measure progress. Nathan J Grills, Priscilla Robinson and Maneesh Phillip (2012) in their research article “Networking between community health programs: a case study outlining the effectiveness, barriers and enablers” explain another kind of community health program done in the Indian subcontinent. It explores primary health care in India, NGOs, and the barriers and facilitators in providing health care. Self-Efficacy: An important concept used repeatedly throughout the text is that of self-efficacy. DeVellis, B. M., and DeVellis, R. F. (2001). Self-efficacy and health. In A. Baum & T. Revenson (Eds.) Handbook of health psychology. Mahwah, NJ: Lawrence Erlbaum provides resources for an in-depth lecture on this topic. They review the basic processes of self-efficacy, compare it to other constructs (e.g., health locus of control, coping), and identify sources of self-efficacy. Ralf Schwarzer and Aleksandra Luszczynska (2011) in their research paper “Perceived Self-Efficacy” have explained the use of self-efficacy in several constructs, and they have also explained the benefits of self-efficaciousness. Stages of Change: As noted in the text, the Stages of Change “model deserves to be true, but so far its applications have shown mixed success.” Whitelaw et al. (2000) examine the existing database and conclude that there are problems with both design and execution.Norman et al., (2000) also address this issue with one study supporting the model and another finding only partial supports. More recently, DiClemente (2003) presents research evidence supporting the transtheoretical model. This discussion provides an opportunity to model scientific criticism. Caroline C. Horwath; Susan M. Schembre, Robert W. Motl, Rod K. Dishman, and Claudio R. Nigg (2013) in their article “Does the Transtheoretical Model of Behavior Change Provide a Useful Basis for Interventions to Promote Fruit and Vegetable Consumption?” have cleverly used the transtheoretical model to study the consumption of fruits and vegetables. This study helps to understand how the stages of change affect basic consumption patterns, and it also helps to design future interventions on similar patterns. Self-Determination Theory: Another theory seldom included in health psychology books but which has shown promising results is the Self-Determination Theory (SDT). SDT examines the role of autonomy, competence, and relatedness in health care and physical activity. Sheldon et al. (2003) use SDT in the clinic to motivate physical and mental health. A plethora of empirical articles use the SDT to review the theory from a health perspective and offer theoretical discussions. Most articles are published on the SDT Website. Pedro J Teixeira, Eliana V Carraça1, David Markland, Marlene N Silva, and Richard M Ryan (2012) in their article “Exercise, physical activity, and self-determination theory: A systematic review” provide an overview about self-determination and its impact on exercise and other physical activities. Worksite Interventions: Although evaluations of worksite interventions are fraught with design and execution problems, evidence of their effectiveness is mounting. Pelletier’s (2001) review of 27 new studies discusses the difficulties inherent in these evaluations and the extent to which worksite interventions demonstrate both clinical- and cost-effective outcomes. Cliona Ni Mhurchu, Louise M Aston, and Susan A Jebb (2010) in their article “Effects of worksite health promotion interventions on employee diets: a systematic review” describe the effects of the worksite intervention on employee diets, and also assess whether such an intervention is useful to workers. Cultural Influences: Hogue, et al., (2000) present the findings and policy implications from the Commonwealth Fund Minority Health Survey. Recently, several studies have examined cultural factors with regard to health issues such as population demographics (Landine & Klonoff, 2001; Macera, et al., 2001; Yali & Revenson, 2004), children’s injuries (Schwebel, et al., 2005; Vaughan, et al., 2004), eating behaviors (Elder, et al., 2005), sexual behaviors (Mustanski, et al., 2007), smoking (Johnsen, et al., 2002), and socioeconomic status (Ostrove, et al., 2000). Kazarian and Evans (2003) present an argument for incorporating culture into the science and practice of health psychology. They present a case study with discussion questions at the close of the chapter. Marjorie Kagawa Singer (2012) in her recent article “Applying the concept of culture to reduce health disparities through health behavior research” studies the relationship between cultural diversity and health behaviors. Research has led people to believe that there is a strong relationship between the two. Recommended Reading Lewis, M. K. (2002). Multicultural health psychology: Special topics acknowledging diversity. Boston, MA: Allyn & Bacon. This book can be used in the classroom to examine health and culture. The author includes key concepts, study questions, and student activity for each chapter. Kazdin, A. E. (2000). Behavior modification in applied settings. (6th Ed.). Belmont, CA: Wadsworth Publishing. This book provides a comprehensive approach to behavior modification, and it is useful in understanding therapy in the clinic and the school. Keller, C., & Fleury, J. (2000). Health promotion for the elderly. Thousand Oaks, CA: Sage. This brief book addresses the issues of changes related to aging. It provides a rationale and suggestions for intervention in several areas (e.g., physical activity, nutrition planning). Mulatu, M. S., & Berry, J. W., (2001). Health care practice in a multicultural context: Western and non-western assumptions. In S. Kazarian & D. Evans (Eds.), Handbook of cultural health psychology (pp. 45–61). San Diego: Academic Press. Norman, P., Abraham, C., & Conner, M. (Eds.), (2000). Understanding and changing health behavior: From health beliefs to self-regulation. Amsterdam: Harwood. The edited book examines a variety of social cognition models of health behavior. Applications and extensions to several models (e.g., Theory of Planned Behavior, Stages of Change) are presented. Rotan, L. W., & Ospina-Kammerer, V. (2006). MindBody medicine. Routledge Psychosocial Stress Series. Rotan and Ospina-Kammerer have collected existing studies relating to interventions designed to modify, increase and boost individuals’ thoughts, emotions, and behaviors, and promote improved health and wellness. Shumaker, S. A., Schron, E., Ockene, J., & McBee, W. L. (Eds.), (1998). The handbook of health behavior change. New York: Springer. Theoretical and empirical approaches to health behavior change are reviewed in this text for advanced students or practitioners. General models of behavior change and relapse preventions are discussed in addition to problems in promoting lifestyle interventions in high-risk groups. Smedley, B. D., & Syme, S. L. (Eds.), (2000). Promoting health: Intervention strategies from social and behavior research. The National Academies Press. This book includes 12 chapters written by the national leading health experts. These chapters examine the knowledge base of social and behavioral factors and propose useful strategies to consider in designing successful interventions. Snyder, C. R., & Lopez S. J. (Eds.), (2005). Handbook of positive psychology. New York, NY: Oxford University Press. This handbook includes the history of positive psychology and 10 chapters focusing on topics such as resilience, flow, positive affectivity, and positive emotions. Activities Health Locus of Control Scale: Have students complete the Health Locus of Control Scale (Wallston, et al., 1978) in class. A discussion of students’ scores on each of the subscales should make the multidimensional nature of the scale clear. Ask students if they think that their scores would be predictive of their typical health habits. Students living on campus in residential colleges often underestimate the effect that dormitory and cafeteria schedules have on their health habits. Versions of the complete scale, scoring instructions, and normative information are available on Wallston’s Website. Health Consciousness Scale: Stephen J. Gould describes a scale designed to assess self-focused attention to one’s personal health. This scale may be distributed, completed, and scored in class. Gould presents evidence that scores on the scale’s four factors (i.e., health self-consciousness, health alertness, health self-monitoring, and health involvement) are related to self-reported health-related variables. Ask students if they think their scores reflect their self-perceived concern for their health and whether their scores would be predictive of their usual health behaviors. The complete scales, scoring instructions, and normative information are available in Gould (1990). Analysis of Media Appeals: Have students bring to class two to three media appeals designed to modify health behaviors (e.g., a magazine advertisement from the American Cancer Society), and discuss the effectiveness of each appeal. The effectiveness of each appeal could be analyzed in terms of the text’s discussion of factors influencing the effectiveness of health messages. The text notes that several factors often limit the effectiveness of such messages, and a discussion of specific media appeals may reinforce the importance of these factors. Health Belief Model: An independent project would provide an opportunity for students to critically evaluate the relationship between beliefs and attitudes toward health promotion and wellness. Have students interview a friend about his or her health-related beliefs, attitudes, and behaviors, and analyze them within the context of the issues discussed in this chapter and in the lecture. Assignments might be structured in a manner similar to the sample assignment that follows: Develop a brief interview format that one can use to discuss the relevant beliefs, attitudes, and behaviors. Make it specific in order to address the goals of this assignment. One must include his or her interview format as an appendix to the assignment. Explicitly discuss the relationship between actual behaviors and attitudes and beliefs. Is there a strong positive relationship between beliefs and attitudes or are some beliefs at odds with others? How are beliefs and attitudes translated into behaviors? Cognitive-Behavioral Modification: Have students work in groups of three to four in order to develop a comprehensive multimodal cognitive behavioral therapy. Case histories that describe hypothetical patients, their psychosocial characteristics, and a target behavior to be changed can be prepared before class or developed by each group. Having each group report the nature of the intervention that has been designed gives an opportunity to assess students’ comprehension of the principles of cognitive-behavioral modification. The text asserts that the complementary nature of methods chosen for such programs is a critical variable associated with successful health behavior modification. Discussing the reasons each group presents for, including each component in the therapeutic program, should reinforce this point. Social Engineering: The concept of social engineering is often new to students, and they may have difficulty recognizing it in their own environment. Have several students take pictures of examples of social engineering on campus and prepare a PowerPoint presentation. These examples do not necessarily need to be health-related. They can include “No Smoking” signs, extra lighting in hazardous areas, landscaping to control foot traffic, and so on. If students can borrow a digital camera from the school’s audiovisual resources, it will make the project simpler and less expensive, and also increase their technology skills. Mass Media: As a semester-long project, have the students put together a blog about health behaviors. Discuss how to focus the message, how to get it in front of the right people, and how to effectively use the Internet to this end. Videos Persons, J. B. Cognitive-behavior therapy. APA Videos ITEM #: 4310774, available at http://www.apa.org/pubs/videos/4310774.aspx References Baranowski, T. (2005). Integration of two models, or dominance of one? Journal of Health Psychology, 10, 19–21. DeVellis, B., & DeVellis, R. (2001). Self-efficacy and health. In A. Baum, T. Revenson, & J. Singer. (Eds.), Handbook of health psychology (pp. 235–247). Mahwah, NJ: Lawrence Erlbaum. DiClemente, C. (2003). Addiction and change: How addictions develop and addicted people recover. New York: Guilford. Elder, J. P., Ayala, G. X., & Campbell, N. R. (2005). Interpersonal and print nutrition communication for a Spanish-dominant Latino population: Secretos de La Buena Vista. Health Psychology, 24, 49–57. Freeman, A., Felgoise, S. H., Nezu, A. M., Nezu, C. M., & Reineck, M. A. (Eds.), (2005). Encyclopedia of cognitive behavior therapy. Gould, S. J. (1990). Health consciousness and health behavior: The application of a new health consciousness scale. American Journal of Preventive Medicine, 6, 228–237. Hogue, C., Hargraves, M., & Collins, K. (Eds.), (2000). Minority health in America. Baltimore: Johns Hopkins. Johnsen, L., Spring, B., & Pingitore, R. (2002). Smoking as subculture? Influence on Hispanic and non-Hispanic white women’s attitudes toward smoking and obesity. Health Psychology, 21, 279–287. Kalichman, S. C., Eaton, L., & Cain, D. (2007). Changes in HIV treatment beliefs and sexual risk behaviors among gay and bisexual men, 1997–2005. Health Psychology, 26, 650–656. Kazarian, S. & Evans, D. (Eds.), (2001). Handbook of cultural health psychology (pp. 3–43). San Diego: Academic Press. King, A. C., Friedman, R., & Marcus, B. (2007). Ongoing physical activity advice by humans versus computers: The Community Health Advice by Telephone (CHAT) trial. Health Psychology, 26, 718–727. King, A. C., Marcus, B., & Ahn, D. (2006). Identifying subgroups that succeed or fail with three levels of physical activity intervention: The activity counseling trial. Health Psychology, 25, 336–347. Landine, H., & Klonoff, E. (2001). Cultural diversity and health psychology. In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of health psychology (pp. 851–891). Mahwah, NJ: Lawrence Erlbaum. Macera, C., Armstead, C., & Anderson, N. (2001). Sociocultural influence on health. In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of health psychology (pp. 427–440). Mahwah, NJ: Lawrence Erlbaum. Mahler, H. I. M., Kulik, J. A., & Gerrard, M. (2007). Long-term effects of appearance-based interventions on sun protection behaviors. Health Psychology, 26, 350–360. Marcus, B. H., Napolitano, M. A., & King, A. C. (2007). Telephone versus print delivery of an individualized motivationally tailored physical activity intervention: Project STRIDE. Health Psychology, 26, 401–409. Morisky, D. E., Stein, J. A., & Chiao, C. (2006). Impact of a social influence intervention on condom use and sexually transmitted infections among establishment-based female sex workers in the Philippines: A multilevel analysis. Health Psychology, 25, 595¬603. Mustanski, B., Viken, R. J., & Kaprio, J. (2007). Sexual behavior in young adulthood: A population- based twin study. Health Psychology, 26, 610–617. Norman, P., Abraham, C., & Conner. C. (Eds.), (2000). Understanding and changing health behaviour: From health beliefs to self-regulation. Amsterdam: Harwood. Ostrove, J. M., Adler, N. E. & Kuppermann, M. (2000). Objective and subjective assessments of socioeconomic status and their relationship to self-rated health in an ethnically diverse sample of pregnant women. Health Psychology, 19, 613–618. Pelletier, K. (2001). A review and analysis of the clinical- and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: 1998–2000 update. American Journal of Health Promotion, 16, 107–116. Rew, L. (2005). Adolescent health: A multidisciplinary approach to theory, research, and intervention. Thousand Oaks: Sage Publications. Santrock, J. W. Adolescence. (1996). Brown & Benchmark Publishers, (6th ed.). Dubuque, IA. Schmiege, S. J., Aiken, L. S., & Sander, J. L. (2007). Osteoporosis prevention among young women: Psychosocial models of calcium consumption and weight-bearing exercise. Health Psychology, 26, 577–587. Schwebel, D. C., Brezausek, C. M., & Ramey, C. T. (2005). Injury risk among children of low-income U.S.-born and immigrant mothers. Health Psychology, 24, 501–507. Seiffge-Krenke, I. (1998). Adolescents’ health: a developmental perspective. Mahwah, NJ: Lawrence Erlbaum Associates. Sheldon, K.M., Williams, G.C., & Joiner, T. (2003). Self-Determination Theory in the clinic: Motivating physical and mental health. New Haven, CT: Yale University Press. Simmons, V. N., & Brandon, T. H. (2007). Secondary smoking prevention in a university setting: A randomized comparison of an experiential theory-based intervention and a standard didactic intervention for increasing cessation motivation. Health Psychology, 26, 268–277. Suls, J., & Wallston, K. A. (Eds.), (2003). Social psychological foundations of health and illness. Malden, MA: Blackwell. Tinsley, B. J. (1997). Health behaviors of young mothers. In D. S. Gochman (Ed.), Handbook of health behavior research (Vol. I). NY: Plenum Press, 223–240. Tinsley, B.J. (2003). How children learn to be healthy. New York, NY: Cambridge University Press. Tinsley, B. J., & Lees, N. B. (1995). Health promotion by parents. In M. Bornstein (Ed.), Handbook of parenting, Volume 4. Hillsdale, NJ: Lawrence Erlbaum Associates, 187–204. U.S. Department of Health and Human Services. Healthy people 2010: understanding and improving health. (2nd ed.). (November 2000). Washington, DC: U.S. Government Printing Office. For sale by the U.S. Government Printing Office, Superintendent of Documents, Washington, DC 20402–9382, Stock Number 017-001-001-00-550-9. Vaughan, E., Anderson, C., & Agran, P. & Winn, D. (2004). Cultural differences in young children’s vulnerability to injuries: A risk and protection perspective. Health Psychology, 23, 289–298. Wallston, K. A., Wallston, B. S., & DeVellis, R. (1978). Development of the multidimensional health locus of control (MHLC) scales. Health Education Monographs, 6, 160–170. Weissberg, R. P., Gullotta, T. P., Hampton, R. L., Ryan, B. A., & Adams, G. R. (Eds.), (1997). Healthy children 2010: Enhancing children’s wellness. Thousand Oaks, CA: Sage. Whitelaw, S., Baldwin, S., Bunton, R., & Flynn, D. (2000). The status of evidence and outcomes in Stages of Change research. Health Education Research, 15, 707–718. Whitman, T.L., Merluzzi, T. V., & White, R. D. (Eds.), (1999). Lifespan perspective on health and illness. Lawrence Erlbaum Associates. Wilson, D. K., Rodriguez, J. R., & Taylor, W. C. (Eds.), (1997). Health-promoting and health-compromising behaviors among minority adolescents. Washington, DC: American Psychological Association. Yali, A. M., & Revenson, T. A. (2004). How changes in population demographics will impact health psychology: Incorporating a broader notion of cultural competence into the field. Health Psychology, 23, 147–155. Zabinski, M. F., Norman, G. J., & Sallis, J. F. (2007). Patterns of sedentary behavior among adolescents. Health Psychology, 26, 113–120. Chapter 4 Health-Promoting Behaviors Chapter Outline I. Exercise A. Benefits of Exercise B. Determinants of Regular Exercise C. Exercise Interventions II. Accident Prevention A. Home and Workplace Accidents B. Motorcycle and Automobile Accidents III. Cancer-Related Health Behaviors A. Mammograms B. Colorectal Cancer Screening C. Sun Safety Practices IV. Developing a Healthy Diet A. Changing Diet B. Resistance to Modifying Diet C. Interventions to Modify Diet V. Sleep A. What is Sleep B. Sleep and Health VI. Rest, Renewal, Savoring Learning Objectives Summarize the benefits of exercise. Describe the typical exercise prescription. Describe the effects of exercise on psychological health, mood, and self-esteem. Summarize the individual characteristics associated with adherence to exercise regimens. Describe the group of individuals that engages in exercise. Summarize the characteristics of the setting associated with adherence to exercise regimens. Summarize the characteristics of interventions associated with adherence to exercise regimens. Describe individualized exercise programs. Describe the role of accidents as a major cause of death and injury at home and the workplace. Describe the role of accidents as a cause of death in older adults. Describe the role of motorcycle and automobile accidents as a major cause of death. Describe the problem of adherence to mammography recommendations and strategies for increasing women’s use of mammography. Describe the nature of colorectal cancer, prevention, and interventions to decrease the incidence of colorectal cancer. Describe the nature of skin cancer and strategies designed to increase the use of sunscreen. Explain the health risks associated with a poor diet. Discuss the problems associated with modifying diet for health purposes. Describe the factors associated with obesity and the relationship between stress and eating. Describe the nature and effectiveness of dietary intervention programs. Describe the nature of the treatment of obesity in the United States. Describe the nature of a public health approach to dietary change, and evaluate its effectiveness. Define sleep and the four stages of sleep; explain the health risks of inadequate sleep. Describe sleep apnea and associated health risks. Lecture Suggestions Exercise: The health benefits of exercise are substantial. A mere 30 minutes of exercise a day can decrease the risk of several chronic diseases, including heart disease, diabetes, and some cancers (Facts of Life, March 2004). Exercise accelerates wound healing in those with injuries (Emery, Kiecolt-Glaser, Glaser, Malarkey, & Frid, 2005), and can be critical to recovery from disabilities, such as hip fracture (Resnick et al., 2007). The typical exercise prescription for a normal adult is 30 minutes or more of moderate-intensity activity on most or all days of the week or 20 minutes or more of vigorous or aerobic activity at least 3 days a week (U.S. Department of Health and Human Services, 2009). Obesity: Overweight and obesity worldwide are rising very fast. An article (Deitel, 2003) indicates that 1.7 billion people worldwide are now either overweight or obese. Obesity is common in developed and developing countries and more importantly is now affecting children (Epstein et al., 2007). Smith et al. (2004) examine prevention and health promotion with regard to obesity. Corsica and Perri (2003) provide a comprehensive review of the current literature on the definitions of obesity and its consequences, as well as contributors and treatments. Wing & Polley (2001) focus on the behavioral factors associated with the development of obesity. They present lifestyle interventions for both prevention and treatment. Experts estimate that unhealthful eating contributes to more than 400,000 deaths per year (Centers for Disease Control and Prevention, 2009b; Mokdad, Marks, Stroup, & Gerberding, 2004). Physical Activity: Habitual physical activity promotes health and emotional well being, and abundant empirical evidence links an inactive lifestyle with poor physical health and increased risk for heart disease and morbidity. Tenenbaum and Eklund’s (2007) recent handbook of sport psychology includes a comprehensive review of theoretical approaches, interventions, gender and cultural diversity, and more importantly, adopts a lifespan approach. The article by Booth and Neufer (2005) is an excellent resource for background information on why exercise is associated with health. According to the National Center for Health Statistics (2001), physical activity is more common among men than women, among Whites than African-Americans and Hispanics, among younger than older adults, and among those with higher versus lower incomes. Insomnia: Teofilo (2005) brings together sleep experts to discuss sleep in a comprehensive handbook that includes over 100 topics relating to sleep and sleep disorders. Hamilton and colleagues examine sleep disturbance as a result of stress and chronic pain. According to Espie (2002), sleep disturbance is a common complaint that often persists over many years. Insomnia constitutes an important public health problem. Although usually treated as a symptom that does not merit treatment in its own right, he argues that it can be either a symptom or a disorder in that it may cause considerable distress and functional impairment. The various proposed causes are reviewed, e.g., faulty conditioning, poor chronobiological timing, and physiological and cognitive hyperarousal. Problems with the literature in each area are examined. A psychobiological model of normal sleep is proposed as well as a psychobiological inhibition model of insomnia. Additionally, poor sleep can be a particular problem in certain high-risk occupations, such as police work, in which officers are exposed to traumatic events (Irish, Dougall, Delahanty, & Hall, 2013). Recommended Reading Brownell, K.D., & Horgen, K.B. (2003). Food fight: The inside story of the food industry, America’s obesity crisis, and what we can do about it. New York: McGraw-Hill. This popular book explores the United States’ love-affair with fast and easy food. It presents compelling evidence that food companies are providing food in such ways that people will buy in large quantities rather than what is healthy and satisfying. Although controversial, their arguments are compelling and disturbing. Capaldi, E. D. (Ed.) (1996). Why we eat what we eat: The psychology of eating. Washington, DC: American Psychological Association. Although the primary focus of this book is on how people learn (and change) food preferences, its chapters also discuss developmental, social, cognitive, and physiological perspectives on normal hunger and eating. This volume presents a thorough review of the psychological research in this area. Logue, A. W. (1991). The psychology of eating and drinking (2nd ed.). New York: W. H. Freeman. This text presents a review of the biological, psychological, and social factors affecting hunger and thirst. Chapters address the physiological, genetic, and environmental determinants of hunger and thirst, eating and drinking disorders, and weight control. Activities 1. Obesity: Have students keep a journal of their eating, exercising, and sleeping behaviors for one week, and ask them to bring their journal to school. Ask students to work in pairs and identify: Factors that may affect their eating, exercising, and sleeping behaviors Ways they could increase healthy food and decrease unhealthy food intake Increase their daily physical activity Ways to enhance their sleeping habits 2. Personal Health Behavior Change: Assign independent projects and have students identify a health behavior of their own that they would like to modify. Complete projects might include a self-observation log that chronicles the behavioral antecedents, the target behavior, and its consequence; a planned cognitive-behavioral modification program designed to modify the behavior; and, an evaluation of the effectiveness of the intervention. 3. Health Education and Promotion: Greenberg’s (2004) book examines the theory and practice relating to health education, instructional strategies relating to group process, exploration of values and health, and strategies for substance abuse, sexuality and family living, environmental health, nutrition, personal health, and mental health. One way to begin a discussion of health-enhancing behaviors would be to have students reflect on their personal practice of wellness. The Friedman School of Nutrition at Tufts University provides a modified food pyramid for adults. 4. Breast Self-Exam and Testicular Self-Exam: A risk-assessment program for breast cancer is available from the National Action Plan on Breast Cancer, U.S. Public Health Service’s Office on Women’s Health, U.S. Department of Health and Human Services, c/o R.O.W. Sciences, Inc., 1700 Research Blvd., Suite 400, Rockville, MD 20850. The packet includes a computer program to use with clients to assess risk and handouts to assist them in deciding whether to have genetic testing. Rabak and colleagues (1998) describe a four-day class exercise designed to engender changes in attitudes and behaviors regarding one’s body image. It involves viewing a video, critiquing advertisements, constructing a collage, and preparing and delivering a class presentation. See Video Clips at the end of this chapter. 5. Exercise and Older Adults: The NIA offers a video entitled Exercise: A Video from the National Institute on Aging along with a free booklet, Exercise: A Guide from the National Institute on Aging. These can be ordered at http://www.niapublications.org/exercisebook/bookandvideo.asp. The video is $7.00 and the booklet is free. This is an excellent resource for students who are developing exercise programs for older adults. Videos National Action Plan on Breast Cancer. (1997). Genetic testing for breast cancer risk: It’s your choice. (VHS, National Action Plan on Breast Cancer, U.S. Public Health Service’s Office on Women’s Health, U.S. Department of Health and Human Services, c/o R.O.W. Sciences, Inc., 1700 Research Blvd., Suite 400, Rockville, MD 20850, 14 min., color). ABC News correspondent Cokie Roberts narrates this video. It presents the pros and cons of genetic testing for breast cancer. The video includes a companion brochure and fact sheet. Available at low cost from the National Action Plan on Breast Cancer center. American Psychological Association available at www.apa.org. Weight loss and control: Dr. Kearney-Cooke discusses her cognitive-behavioral approach with issues relating to weight. 3. Fanlight Productions available at http://www.fanlight.com/. The Website is well organized, and videos are easy to locate. A short synopsis describes each video. The weight of obesity: Obesity is one of the leading causes of preventable deaths in the United States. This documentary examines the consequences of obesity and offers some approaches to change. Let’s them eat cake: This humorous documentary examines junk food and beverages marketed to children. The family meal: Another documentary that examines the decline in family meals as one reason for the obesity crisis. 4. Films for the Humanities & Sciences available at http://ffh.films.com/ Shop safety: A video that examines the dangers that are present in the industrial and manufacturing world and how to prevent accidents. Accidents do happen: Accidental death leads to many “what ifs.” The video discusses the families and the bewilderment, anger, and grief when people lose a child. References Bachman, C.M., Baranowski, T., & Nicklas, T. (2006). Is there an association between sweetened beverages and adiposity? Nutrition Reviews, 64(4), 1–22. Corsica, J., & Perri, M. (2003). Obesity. In I. V. Weiner (Series Ed.) & A. M. Nezu, C. M. Nezu, & P. A. Geller (Vol. Eds.), Handbook of psychology: Vol. 9, Health psychology (pp. 121–145). Hoboken, NJ: John Wiley. Deitel, M. (2003). Overweight and obesity worldwide now estimated to involve 2.7 billion people. Obesity Surgery, 13, 329–330. Epstein, L. H.; Paluch, R. A.; Roemmich, J. N. (2007). Family-based obesity treatment, then and now: Twenty-five years of pediatric obesity treatment. Health Psychology, 26, 381–391. Espie, C. A. (2002). Insomnia: Conceptual issues in the development, persistence, and treatment of sleep disorder in adults. Annual Review of Psychology, 53, 215–243. Fairburn, C. G., & Wilson G. T. (1996). Binge eating: Nature, assessment, and treatment. The Guilford Press. Greenberg, J. S. (2003). Health education and health promotion: Learner centered instructional strategies with PowerWeb Bind in Passcard. 5ed. New York: McGraw-Hill. Gura, T. (2007). Lying in weight: The hidden epidemic of eating disorders in adult women. New York: HarperCollins Book. Hamilton, N. A.; Catley, D., & Karlson, C. (2007). Sleep and the affective response to stress and pain. Health Psychology, 26, pp. 288–295. Keel, P. (2005). Eating disorders. Upper Saddle River: NJ: Pearson Education, Inc. Kinoy, B. P. (Ed.). (2001). Eating disorders: New directions in treatment and recovery (2nd ed.). New York: Columbia University. Menassa, B. (2004). Preventing eating disorders among preteen girls: A step-by-step guide. Westport, CT: Praeger. Polivy, J., & Herman, C. P. (2002). Causes of eating disorders. Annual review of psychology, 53, 187–213. Rabak-Wagener, J., Eickhoff-Shemek, J., & Kelly-Vance, L. (1998). The effect of media analysis on attitudes and behaviors regarding body image among college students. College Health, 47, 29–35. Ricciardell, L., & McCabe, M. (2004). A biopsychosocial model of disordered eating and the pursuit of muscularity in adolescent boys. Psychological Bulletin, 130, 179–205. Smith, T, W.; Orleans, C. T.; Jenkins, C. D. (2004). Prevention and health promotion: Decades of progress, new challenges, and an emerging agenda. Health Psychology, 23, 126–131. Stewart, D. E., & Erlick Robinson, G. (2001). Eating disorders and reproduction. In N. L. Stotland & D. W. Stewart (Eds.), Psychological aspects of women’s health care: The interface between psychiatry and obstetrics and gynecology (2nd ed.). (pp. 441–456). Washington, DC: American Psychiatric Press. Stice, E., & Shaw, H. (2004). Eating disorder prevention programs: A meta-analytic review. Psychological Bulletin, 130, 206–227. Tenenbaum, G., & Eklund, R. C. (2007). Handbook of Sport Psychology, (3rd ed.). New York: Wiley. Teofilo, L. L. C. (Ed.), (2005). Sleep: A comprehensive handbook. New York: Wiley. Waltson, S. (2007). Binge eating. Rosen Pub Group. Whittlesey, V. (2001). Diversity activities for psychology. Boston: Allyn and Bacon. Wing, R., & Polley, B. (2001). Obesity. In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of health psychology (pp. 263–279). Mahwah, NJ: Lawrence Erlbaum. Instructor Manual for Health Psychology Shelley E. Taylor 9780077861810