CH-13 Heart Disease, Hypertension, Stroke, and Type II Diabetes – Health Psychology : Chapter Notes

This document contains Chapters 13 to 15 Chapter 13 Heart Disease, Hypertension, Stroke, and Type II Diabetes Chapter Outline I. Coronary Heart Disease A. What Is CHD? B. Biological Reactivity to Stress C. Stress and CHD D. Women and CHD E. Personality, Cardiovascular Reactivity, and CHD F. Depression and CHD G. Other Psychosocial Risk Factors and CHD H. Management of Heart Disease II. Hypertension A. How Is Hypertension Measured? B. What Causes Hypertension? C. Treatment of Hypertension D. The Hidden Disease III. Stroke A. Risk Factors for Stroke B. Consequences of Stroke C. Rehabilitative Interventions IV. Type II Diabetes A. Health Implications of Diabetes B. The Management of Diabetes Learning Objectives Describe the prevalence of CHD in the United States. Describe the nature of CHD, and outline the risk factors that are implicated in its development. Discuss the role of stress in CHD. Discuss the nature of gender differences in medical research and risk factors for CHD. Describe the relationship of cardiovascular reactivity, personality characteristics, and CHD. Summarize the research investigating the relationship between depression and CHD. Summarize the research investigating the relationship between other psychosocial factors and CHD. Describe the role of delay in mortality from myocardial infarction (MI). Explain the process of cardiac rehabilitation and the typical MI treatment regimens. Describe the issues surrounding the implementation of lifestyle changes following MI. Describe the problems with social support following MI. Describe the nature and prevalence of hypertension in the United States. Explain the relationship between stress and hypertension among African Americans. Define John Henryism, and explain how this phenomenon may explain hypertension risk in low-SES African Americans. Describe treatment regimens prescribed for hypertension, including drug and cognitive-behavioral treatments. Discuss the problems in treating hypertension. Describe the hidden disease. Describe the nature and prevalence of stroke in the United States. Describe the physical, psychological, social, and emotional consequences of stroke. Describe the rehabilitative interventions for stroke. Describe the nature and prevalence of Type II diabetes in the United States. Explain Type II diabetes and its causes. Describe the implications of diabetes. Describe the problems in self-management of diabetes. Discuss the problems in adherence to treatment regimens and the factors that predict adherence. Describe behaviorally oriented interventions with diabetics, and evaluate their effectiveness. Lecture Suggestions Prevention and Management of Chronic Respiratory Disorders: The prevention and management of other chronic respiratory disorders may be introduced as a supplementary lecture topic. Findings show that older individuals with chronic obstructive pulmonary disease experience cognitive impairment (Antonelli-Incalzi et al., 2008), depression and poor self-report health and functional status (Niti et al., 2007), and fatigue (Theander et al., 2007). Moreover, in developing countries, chronic respiratory diseases represent a challenge to public health because of projected trends, the economic impact and the limited resources (Ait-Khaled, et al., 2001). For instance, chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the world and increased mortality is predicted (Pauwels et al., 2001). Alex J. et al., (2012) in their article talk about the usefulness of using the Chronic Obstructive Pulmonary Disease Assessment Test to assess the severity of the aggravation of one’s COPD. Moreover, the prevalence of asthma in the United States is alarming. Asthma affects approximately 6.8 million children under the age of 18 (National Heart Lung and Blood Institute). Schmaling and her colleagues’ (2003) chapter is a useful source of lecture material for a discussion of the role of stress and other psychological factors in respiratory disorders. Kaptein, Dekker, Van der Waart, and Gill (1988) provide a review of the research on asthma. Bender and Creer (2002) provide epidemiological evidence, symptoms and characteristics, and treatment guidelines. Two sources for information about treatment options are Culpert and colleagues’ (1996) work with teaching biofeedback to pediatric patients and Maes and Schlosser’s (1988, 1989) cognitive-behavioral management program developed for people with asthma. Coronary Heart Disease “CHD”: Jordan and Barde (2007) examine the literature published since 1920 on psychological factors involved in coronary heart disease. The edited book by Vlodaver, Zeev; Wilson, Robert F.; and Garry, Daniel J (2012) provides extensive information on ischemic heart diseases. Matthews (2005) provides an overview of advances in understanding the etiology of heart disease. Smith and Ruiz (2002), O’Callahan, Andres, and Kranz (2003), and Krantz, and McCeney (2002) provide straight-forward reviews of CHD. These chapters contain information on the etiology and course of the disease, and on behavioral and psychosocial risk factors. Adjustment to both the crisis phase and the long-term phase is covered, as well as treatment components. Ford (2004) examines the relationship of depression and heart disease. The edited book by Stansfeld and Marmot (2002) has chapters on a variety of topics, e.g., social class, hostility, psychophysiological reactivity. It is an excellent resource from which to develop a lecture on a specific topic or to use for a more general lecture on CHD. Coronary Heart Disease “CHD” and Women: Women often experience different physical symptoms a month or more before they experience a heart attack (McSweeney et al., 2003). About one-third of women never experience chest pains or discomfort prior to their hear attacks and about 43 percent had no chest pain during the attack. Recent studies focusing on CHD focus on the association between social networks and inflammatory markers for CHD (Loucks et al., 2006). Hemingway’s (2007) review of the literature focuses on determinants of health and health behaviors that increase the risk for CHD for women of low socioeconomic status. A recent study examined the various factors that may affect women after a coronary event and found that women are at greater risk for disability, experience higher rate of morbidity and early death after a coronary event relative to men, and are less likely to participate in cardiac rehabilitation (Davidson et al., 2008). Although the onset of CHD typically occurs about 10 years later in women than men, more women die of heart disease than men do (American Heart Association, 2012). Further, working women with CHD are less likely to be depressed and experience great social support than those not working (Bloom et al., 2007). Cardiac Rehab: Fernandez and colleagues (2007) examine benefits associated with interventions focusing on dietary modification, smoking cessation, weight loss, and physical activity. Their findings indicate that participating in cardiac rehab after a coronary event presents several psychological and physical benefits. They also propose that more interventions should be conducted to include larger sample sizes and to include the modification of single or multiple risk factors. Lack of social support during hospitalization predicts depression during recovery (Brummett et al., 1998), and a supportive marriage predicts long-term survival following coronary artery bypass graft surgery, a common treatment for cardiac patients (King & Reis, 2012).Social support predicts exercise tolerance during cardiac rehabilitation, and so is vital to the rehabilitation process (Fraser & Rodgers, 2010). Ethnic Differences in Coronary Heart Disease: A special issue of Health Psychology (1989, Volume 8, No. 5) was dedicated to race, reactivity, and blood pressure regulation. This issue would provide a valuable source of lecture material for a discussion of ethnic and gender differences in coronary heart disease. Another more recent issue (1995, Volume 14, No. 7) also addresses sociocultural and behavioral factors relevant to ethnicity and health. Negative emotions, including anger and hostility, increase risk for metabolic syndrome (Puustinen, Koponen, Kautiainen, Mäntyselkä, & Vanhala, 2011) and for CHD (Bleil, Gianaros, Jennings, Flory, & Manuck, 2008). Low SES, including early life low SES (Janicki-Deverts, Cohen, Matthews, & Jacobs, 2012), is associated with greater risk for early-stage atherosclerosis in women, as it is in men (Gallo, Matthews, Kuller, Sutton-Tyrrell, & Edmundowicz, 2001). Hypertension and Chronic Folk Illness: Heurtin-Roberts (1993) presents an interesting study of 60 older African American women’s beliefs about hypertension. She argues that this sample’s beliefs reflected the use of a chronic folk illness, “high-pertension,” or a chronic “nervous” condition related to the blood as a method of coping with their social environment. She asserts that chronic folk illnesses may reflect a strategy of expressing one’s self within the social context. Thus, health beliefs about chronic illnesses may serve a role in adaptation and managing one’s environment. Exposure to discrimination and racism can contribute to high blood pressure among blacks (Salomon & Jagusztyn, 2008), possibly by interfering with the normal decline in blood pressure at night (Tomfohr et al., 2010). Coping with Stroke: The topic of stroke may be developed for classroom lectures. Students often think that stroke is a disease of the elderly when, in fact, young adults are increasingly likely to become victims of this disorder. Brereton and colleagues (2007) conducted a review of the effectiveness of various interventions focusing on stroke. Wilz (2007) identified factors that are associated with stroke survivors, and found that patients’ initial depression was one of the main predictors for perceived impairment. Similarly, Rochette and colleagues (2007) reported that after the stroke, coping and depression were important factors for the individuals and their caregivers. A study done by Nan Greenwood, Ann Mackenzie, Nikki Wilson, and Geoffrey Cloud (2012) explores the experience of informal caregivers of those who have survived a stroke over time. Stress and Diabetes: Hamer and Boutcher’s (2006) chapter examines psychological stress, reactivity, and health outcomes. They propose that the relationship between stress reactivity and health is moderated and mediated by several factors including lifestyle and genetics. Recent studies indicate that positive effects may protect diabetic individuals from high levels of stress. For instance, individuals who were hopeful and enjoyed life were at lower risk for mortality (Moscowitz et al., 2008). Anxiety and stress can affect glycemic control (Sultan et al., 2008). Thus, interventions targeting patients with Type II diabetes should focus on task-oriented coping strategies which tend to decrease state anxiety. Also, low levels of emotion-oriented coping predicted significant increases in blood glucose level. An article by Frans Pouwer, Nina Kupper, and Marcel C Adriaanse (2010) talks about a longitudinal study which showed that general emotional stress and anxiety is associated with the elevated risk of developing Type II diabetes. Recommended Reading Allan, R., & Scheidt, S. S. (Eds.), (1996). Heart and mind: The practice of cardiac psychology. Washington, DC: American Psychological Association. This volume provides a comprehensive review of the medical and psychological literature relevant to coronary heart disease. Topics range from Type A behavior patterns to prevention of CHD and issues relevant to treatment and rehabilitation. Arnetz, B. B., & Ekman R. (Eds.), (2006). Stress in health and disease. Weinheim, Germany: Wiley. This book includes several applied approaches to stress and health, with a specific focus on organizational impact of stress. American Diabetes Association. American Diabetes Association complete guide to diabetes, 3rd Ed. American Diabetes Association. Type 2 Diabetes: Your healthy living guide, 3rd Ed. The preceding excellent background information is written for a general audience. They are available through the American Diabetes Association, ATTN: Customer Service, 1701 North Beauregard Street, Alexandria, VA 22311, 800/DIABETES (800/342-2383) or online at http://store.diabetes.org. Friedman, M., & Rosenman, R. H. (1974). Type A behavior and your heart. New York: Knopf. The authors present an overview of the relationship of Type A behavior and coronary heart disease to a general audience. Marmot, M., & Elliott, P. (Eds), (2005). Coronary heart disease epidemiology: From etiology to public health. Oxford University Press. This book reviews major risk factors from various perspectives. Siegman, A. W., & Smith, T. W. (1994). Anger, hostility, and the heart. Hillsdale, NJ: Lawrence Erlbaum. This edited volume summarizes research on the role of anger and hostility on the causes and course of coronary heart disease. Chapters address such topics as the history of coronary-prone behavior, assessment issues, animal models of aggression, and cardiovascular disease. Activities Heart Attack Symptoms and Signs: Have students access American Heart Association and discuss the various signs of a heart attack. Get students to differentiate between men and women’s symptoms. Go Red for Women: Live Heart Healthy is a website for women. Get students to access the website to review “Go Red Heart Checkup.” Students can join the “Go Red for Women” and receive a monthly e-newsletter filled with healthy tips. Risk Profiles for Coronary Heart Disease: Have students work in small groups in order to identify their personal risk factors for coronary heart disease. This will provide an opportunity to review the risk factors described in the text within the context of their personal health habits. The National Heart, Lung, and Blood Institute has a 10-year heart attack calculator at http://hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype=pub. 4. John Henryism: Diversity issues may be introduced by using an activity on John Henryism (Whittlesey, 2001). The activity includes a reading on blood pressure in African Americans, several discussion questions, and a list of recommended readings. An instructor’s manual is available from the publisher. Whittlesey, V. (2001). Diversity activities for psychology. Boston: Allyn and Bacon. Videos American Psychological Association available at www.apa.org APA psychotherapy videotape series III: Cardiac psychology. Features a 20-minute face-to-face interview with a therapist, Dr. Robert Allan, whose practice is with individuals who have survived an initial heart attack. It is followed by a therapeutic session led by Dr. Allan and a post session debriefing with the host. APA encourages using appropriate portions of the tape to support teaching objectives. Although not a dynamic presentation, the face-to-face interview is perhaps the only segment of the video suited to this course. Fanlight Productions available at www.fanlight.com Fedigan, J., (2001). The angry heart: The impact of racism on heart disease among African Americans. This program focuses on a 45-year-old man who has experienced two heart attacks and quadruple bypass surgery. Several issues are examined: the relations between depression, stress, diet, smoking, and other lifestyle issues; and racism, discrimination, poverty, segregation, substandard education, and the daily tensions due to racism. Films for the Humanities & Sciences available at http://ffh.films.com Affairs of the heart. (2000). This video was not previewed. From the website: “This program examines advances in fixing broken hearts—and at ways to prevent them from breaking. The program presents the dramatic story of a Texas toddler who underwent surgery immediately after birth for his defective heart. Sixteen months later, the program observes an attempt to fix his heart permanently.” The cure: Heart disease and anti-cholesterol drugs. (2005). This video examines the history of drugs that can help individuals deal with cardiovascular disease. Women and heart disease. This video focuses on women and the increase in cardiovascular problems that may be associated with entering the workforce, stress, and smoking. References Ait-Khaled, N., Enarson, D., & Bousquet, J. (2001). Chronic respiratory diseases in developing countries: The burden and strategies for prevention and management. Bulletin of the World Health Organization, 79 retrieved on 2/10/08 from http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862001001000011 Antonelli-Incalzi, R., Corsonello, A., Trojano, L., Domenico A., Spada, A., Izzo, O., & Rengo, F. (2008). Correlation between cognitive impairment and dependence in hypoxemic COPD. Journal of Clinical & Experimental Neuropsychology, 30, 141–150. Bender, B. G., & Creer, T. L. (2002). Asthma. In Christensen, A. J., & Antoni, M. H. (Eds.), Chronic physical disorders: Behavioral medicine’s perspective (pp. 244–267). Malden, MA: Blackwell. Blom, M., Georgiades, A., Lászl, K. D., Alinaghizadeh, H., Janszky, I., & Ahnve, S. (2007). Work and martial status in relation to depressive symptoms and social support among women with coronary artery disease. Journal of Women's Health, 16, 1305–1316. Brereton, L., Carroll, C., & Barnston, S. (2007). Interventions for adult family members of people who have had a stroke: A systematic review. Clinical Rehabilitation, 21, 867–884. Culpert, T. P., Kajander, R. L., & Reaney, J. B. (1996). Biofeedback with children and adolescents: Clinical observations and patient perspectives. Journal of Developmental and Behavioral Pediatrics, 17, 342–350. Davidson, P. , Digiacomo, M.,, Zecchin, R., Clarke, M., Paul, G., Lamb, K., Hancock, K., Chang, E., & Daly, J. (2008). A cardiac rehabilitation program to improve psychosocial outcomes of women with heart disease. Journal of Women's Health, 17, 123–134. Fernandez, R., Griffiths, R., & Everett, B. (2007). Effectiveness of brief structure interventions on risk modification for patients with coronary heart disease: A systematic review. International Journal of Evidence-Based Healthcare, 5, 370–405. Ford, D. (2004). Depression, trauma, and cardiovascular health. In P. Schnurr & B. Green (Eds.), Trauma and health: Physical health consequences of exposure to extreme stress (pp. 73–97). Washington, DC: APA. Gonder-Frederick, L., Cox, D. 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Chapter 14 Psychoneuroimmunology And Immune-Related Disorders Chapter Outline I. Psychoneuroimmunology A. The Immune System B. Assessing Immune Functioning C. Stress and Immune Functioning D. Negative Affect and Immune Functioning E. Stress, Immune Functioning, and Interpersonal Relationships F. Coping and Immune Functioning G. Interventions to Improve Immune Functioning II. HIV Infection and AIDS
A. A Brief History of HIV Infection and AIDS B. HIV Infection and AIDS in the United States C. The Psychosocial Impact of HIV Infection D. Interventions to Reduce the Spread of HIV Infection E. Coping with HIV+ Status and AIDS F. Psychosocial Factors That Affect the Course of HIV Infection III. Cancer
A. Why Is Cancer Hard to Study? B. Who Gets Cancer? A Complex Profile C. Psychosocial Factors and Cancer D. Psychosocial Factors and the Course of Cancer E. Adjusting to Cancer F. Psychosocial Issues and Cancer G. Finding Meaning in Cancer H. Interventions I. Therapies with Cancer Patients IV. Arthritis A. Rheumatoid Arthritis B. Osteoarthritis V. Type I Diabetes A. Special Problems of Adolescent Diabetes Learning Objectives Describe the nature and function of the immune system. Describe two approaches to assessing immune functioning. Summarize the results of studies relating stress to immune functioning. Compare and contrast humoral and cell-mediated immunity. Summarize the results of studies relating academic stress to immune functioning. Summarize the results of studies relating negative effect to immune functioning. Summarize the results of studies relating interpersonal relationships, stress, and immune functioning. Explain how coping and coping resources moderate the stress-immune functioning relationship. Describe stress management interventions designed to enhance immunocompetence, and evaluate their effectiveness. Trace the development of the AIDS epidemic, and describe the nature and course of HIV infection. Describe the demographic risk groups for AIDS and the routes of HIV transmission. Describe the nature of interventions designed to reduce risk behaviors for AIDS and evaluate their effectiveness. Summarize the results of studies of psychological adjustment and coping with HIV infection and AIDS. Describe the factors that promote long-term survival among people who are HIV Positive. Explain how psychosocial factors may affect the course of AIDS. Describe the nature of cancer, and explain why it is hard to study. Describe the demographic risk groups for cancer. Describe the psychosocial factors that affect the initiation and course of cancer. Summarize the results of studies of the relationship between stress and cancer. Describe the physical and psychological problems associated with cancer and the role of coping strategies in dealing with these problems. Describe the nature of arthritis. Describe the nature of rheumatoid arthritis. Describe the different treatment interventions for rheumatoid arthritis, and evaluate their effectiveness. Describe the nature of osteoarthritis, and its self-care regimens. Discuss Type I Diabetes and its causes. Explain the special problems for adolescent diabetics. Lecture Suggestions Psychoneuroimmunology: This is an excellent point in the semester to review the biopsychosocial model and immune functioning. Psychoneuroimmunology, a two-volume set, is a comprehensive book that includes an interdisciplinary approach in studying the interaction of the central nervous system and the immune system and inflammatory response (Adler et al., 2006). Evidence linking deleterious effects of stress on immunity and cancer is well established; however, the mediation of this relationship is not clear. The evolution of cancer and the interactions with the immune system, along with the many conceptual and technical barriers to studying the effects of stress on immune activity is now better understood (Ben-Eliyahy et al., 2007). Animal studies indicate a role for the sympathetic nervous system in mediating the effects of stress on the immunity and the progression of a tumor. Interventions that were tested with animal studies can now be conducted with patients. In addition, Segerstrom (2007) proposes an ecological perspective to examine how the immune system may only have energy available by reducing other activities. As such, the immune system may be suppressed when other activities are more important than immunity for total well-being. Lyons and Chamberlain’s (2006) book integrates the immune system and examines the potential mediating effects of psychosocial factors on illness and disease. The text includes many debates and controversies. Jorge H. Daruna (2012) in his book “Introduction to Psychoneuroimmunology” provides a brief overview about the topic, and explains the relationship between bodily systems and the environment. AIDS, Therapy, and Depression: Carey and Vanable (2003) give background information on AIDS/HIV including epidemiology, transmission, impact, and primary and secondary prevention. Antoni (2002) provides a clear presentation of the biobehavioral aspects of HIV and AIDS. He examines these factors as they relate to disease course and reviews individual and group therapies for managing the psychosocial factors. The introduction of Highly Active Anti-Retroviral Therapy “HAART” has changed the way we approach the treatment of HIV/AIDS (Anthony & Bell, 2008). HAART has significantly decreased morbidity and mortality for individuals infected with HIV, including the decreases for dementia. Ferrando and Freyberg (2008) provide a comprehensive and critical review of the literature relating to depression and HIV/AIDS. Dan Kabonge Kaye, Othman Kakaire, Michael Odongo Osinde, John Chrysestom Lule, Nelson Kakande (2013) in their article “The impact of highly active antiretroviral therapy on high-risk behavior of HIV-infected patients in Sub-Saharan Africa” explain the HIV infection, care, high-risk behavior among patients in Sub-Saharan Africa. Women, Ethnic Minorities and AIDS: A discussion of the effects of AIDS on women is useful in emphasizing the fact that AIDS is related to high-risk behaviors rather than to identification with a certain group. The most rapid growth of HIV/AIDS is in the heterosexual ethnic minority population. The topic of genetic differences in susceptibility to disease can be addressed using AIDS. Mays et al. (2000) present evidence that this may be related to the low levels or absence of the CCR5 allele. They report research indicating differential infection and progression rates with HIV and other diseases. HIV/AIDS among Hispanics is disproportionately high (CDC, 2007). In 2005, the annual rate of HIV diagnosis was three times greater for Hispanics than non-Hispanic whites. Findings indicate the mode of HIV infections vary based on place of birth suggesting that interventions should consider cultural and behavioral differences. A June 2007 report from the CDC indicated that blacks accounted for 51 percent of newly diagnosed HIV/AIDS infections in the United States between 2001 and 2004 (CDC, 2007). African American women are more likely to be affected by HIV. Of all the women living with AIDS in the United States, 60 percent are African American and two out of three African American women acquired HIV from having unprotected sex with a man (CDC, 2007). Johnson and colleagues (2007) examined the health-related needs of Native Americans who may be living with HIV/AIDS, hepatitis, or abusing substances, and found that social support is essential in developing interventions. Ickovics and Rodin (1992) and Ickovics and others (2000) present recent epidemiological data. Campbell (1990) discusses heterosexual transmission of AIDS and special problems faced by women who are diagnosed with AIDS, as well as women who are caregivers for AIDS patients (see also Hackl et al., 1997). Catania et al. (2000) discuss the factors associated with the heterosexual transmission of HIV/AIDS and STDs and examines the impact of gender roles on safer sex practices. Ronald Valdiserri (2013) in his article “Improving Health Outcomes for Racial/Ethnic Minorities Is Key Focus of FY13 Awards by Secretary’s Minority AIDS Initiative Fund” talks about the AIDS initiative fund, goals for the national AIDS strategy, and improving the HIV care continuum. Cancer: Nezu and his colleagues (2003) present an overview of psychosocial factors in cancer including risks, emotional effects, and interventions. Anderson and colleagues (2000) and Andersen and Wells (2002) provide a review of the biobehavioral aspects of cancer as well as research relevant to each period in the progression. Delahanty and Baum (2000) examine the relationship of stress and breast cancer, including onset and progression. The effects of stress reduction are discussed. The edited volume by Baum and Anderson (2001) provides a variety of models of intervention. Many of the chapters in the edited book by given and his colleagues (2003) are useful for lectures on interventions. Stacy Simon (2013) in her article “Breast Cancer Journey Empowers Women at All Stages of Disease” provides a step by step guide on how to cope with the disease, and live better through different stages of the disease. Managing Stigma: Two disorders discussed in this chapter, cancer and AIDS, are associated with significant social stigma. Thus, secondary victimization is often a problem faced by patients diagnosed with these disorders. Chapple and colleagues (2004) found that many individuals with cancer felt particularly stigmatized, especially those with lung cancer. Such stigma resulted in hiding their condition which had harmful consequences, both financial and social support. Women who underwent a mastectomy are faced with complex issues with regard to their bodies (Manderson & Stirling, 2007). For example, the sexual self or maternal self have to be reexamined. Another form of stigma relates to multiple sclerosis (MS) and social relationships. Grytten and Maseide (2006) examined the stigma people with MS experience in social settings, and found that such individuals perceive that their physical performance and impression management were being continually judged in social setting. Goffman’s (1963) discussion of the problems of identity management may be discussed within the context of health-related issues. Susman (1994) presents a review of the research investigating illness-related stigma, and Muzzin et al. (1994) discuss the stigma experienced by cancer patients and their families. An extremely sensitive case, facial cancer, may provide a useful focus of the discussion (see Koster & Bergsma, 1990). Finally, Lawless and colleagues (1996) present interviews with 27 women who discuss their experience with the stigma of HIV infection. Anish P. Mahajan, Jennifer N. Sayles, and Thomas J. Coates (2008) in their research paper “Stigma in the HIV/AIDS epidemic: A review of the literature and recommendations for the way forward” elaborate on the stigma or secondary victimization faced by individuals infected with AIDS. The paper discusses the impact of social stigma and discrimination patients face due to HIV/AIDS, and the prevention and treatment programs for the same. Stress-diathesis Approach to understanding Arthritis: Although rheumatoid arthritis and osteoarthritis have a biological component, they, like fibromyalgia, are best understood within the framework of the interacting biological, psychological, and social sources of stress and vulnerability. Burke and her colleagues (2002, 200) examine each of these disorders focusing on each of the factors. A recent article published by the University of Maryland, Medical Center (2012) provides and in-depth report on rheumatoid arthritis, how it affects the human body, and treatments and remedies to deal with it. Lesbians and Chronic Diseases: Do chronically ill and disabled lesbians differ from heterosexual females? There is very little empirical evidence of lesbian health. For the past 20 years, various studies have been conducted to examine the various challenges faced by lesbians with regard to their physical and mental health. Dr. Walden’s (in press) comprehensive review of lesbian health examines the various issues and barriers that lesbians experience (i.e., health professionals’ negative views; increased incidence of breast cancer, obesity, alcohol abuse, and depression among many other issues). Walden EL (2009) in his exploratory research “An exploration of the experience of lesbians with chronic illness” talks about the problems faced by lesbians in dealing with chronic illnesses. This article provides an overview of the patients’ experiences, and it also studies the impact of wellness programs that have been designed to help them. Type I Diabetes: Why is Type I Diabetes in this chapter, and not explored in the previous chapter with Type II? A good place to start with this lecture is to discuss the differences in the causes and the special problems that arise with both types. How does diagnosis and adherence differ between the two? Romesh Khardori (2013) in his article “Type 1 Diabetes Mellitus” has provided a detailed review on the disease, its pathophysiology, etiology, prognosis, and patient care. The article also provides information on treatment and medication for the same. Recommended Reading Berger, M. T. (2005). Workable sisterhood: The political journal of stigmatized women with HIV/AIDS. Princeton University Press. This book examined 16 HIV-positive women with a history of drug use, conflict with the law or working in the sex trade. This book explores the barriers of stigma in relation to women of color, already experiencing race, class, and gender oppression and to women’s status as drug users, sex workers, and HIV-positive women. Patrick, W.C. (2004). On the stigma of mental illness: Practical strategies of research and social change. APA. This book examines mental disabilities and the stigma associated with them. The author examines the causes of such stigmatizing attitudes, including media images and a culture that does not positively view people with mental illnesses. This easy-to-read book describes people’s attempts to manage their spoiled identities that result from being stigmatized by others due to diagnoses of certain illnesses, facial disfigurement, and so on. Levy, J. A., Jasmin, C., Bez, G. (Eds.), (1997). Cancer, AIDS, and quality of life. New York: Plenum. This volume focuses on issues of long-term survivorship and quality of life among people with cancer and AIDS. Chapters address psychosocial issues as well as treatment interventions. Saphier, D. (1993). Psychoimmunology: The missing links. In J. Schulkin (Ed.), Hormonally induced changes in mind and brain (pp. 191–224). San Diego: Academic Press. This chapter reviews the basic principles of psychoimmunology. It discusses psychosomatic interactions, the effects of stress on immune functioning, the relationship between the nervous, endocrine, and immune systems, and more. Shilts, R. (1988). And the band played on: Politics, people and the AIDS epidemic. New York: Penguin. This controversial book presents the argument that homophobia, lack of political direction, and a delayed response by public health administrators have exacerbated the transmission of AIDS among the American population. Winiarski, M. G. (Ed.). (1997). HIV mental health for the 21st century. New York: New York University Press. The intended audience for this book is mental health practitioners. Many chapters, however, address topics relevant to health psychology, including secondary prevention interventions, models of medical care, program evaluation, and so on. The appendix is an up-to-date list of sources for additional information. Activities HIV Education: Perhaps one of the most relevant classroom activities would be to invite a guest speaker for a frank discussion of HIV transmission and high-risk sexual behaviors. Knowledgeable speakers may usually be recruited from public health organizations. Student counseling centers also may have speakers available who are trained in conducting workshops in communication-skills training that specifically target sexual behavior and STDs. An excellent introduction to the topic is a test of the students’ knowledge of AIDS myths. One such activity is found in Whittlesey (2001) Diversity activities for psychology. There is a worksheet and a list of recommended readings. An instructor’s manual is available from the publisher. One may also get students to go TeachEngineering.com to complete the AIDS knowledge survey. HIV and Sexual Behavior: Have students write essays that describe the manner in which they would approach the topic of HIV and STDs within the context of their role as parents providing sex education and counseling to their children. A sample assignment follows. You are a college-educated parent. You realize that you and your two children, Joe (age 11) and Clara (age 13), should discuss matters related to birth control and sexuality; however, you also would like to discuss HIV transmission and infection. Write an essay that describes this discussion. Make sure you include examples of high-risk behaviors, as well as behaviors associated with safer sex. Life-Threatening Illness and Identity Management: The text argues that one of the most distressing aspects of chronic, advancing, and terminal disease is the threat to one’s self and identity. The cancer research discussed in this chapter most clearly raises these issues. Have students write an essay discussing the relationship between identity management, illness, and coping. This assignment might also be used as an integrative final exam question. Videos A website dedicated to HIV/AIDS can be found at http://www.aidsvideos.org/. This website provides informative, introductory videos. Fanlight Productions available at www.fanlight.com\ Does anyone die of AIDS anymore? (2002). This video discusses the role of the media in promoting unprotected sex, and exaggerating reports on the effectiveness of new treatments. Secret people: The naked place of leprosy in America. (1999). This video depicts stories of outrageous discrimination and stigma. Alone together: Young adults living with HIV. (1995) tells the story of several young people, straight and gay, male and female, from a variety of ethnic and economic backgrounds who were infected by the HIV virus in their teens. Undetectable: The new face of AIDS. (2001). This moving documentary follows five multiethnic individuals as they struggle with AIDS over a three-year period. All are attempting treatment with protease inhibitors. Their stories highlight the difficulties of adhering to this regimen. Not all treatments are successful. Soft smoke: AIDS in the rural west. (2000). This video considers the increasing problem of AIDS in small rural towns on the Colorado western slope. Includes interviews with young people living and working with the disease and with the health official responsible for initiating partner notification of those who have tested HIV positive. Includes a facilitator’s guide. Stories of lupus. (1999). This is an excellent video. It provides students with knowledge about a disease of which many know nothing. It also highlights many of the issues that the text points out about living with a chronic illness, e.g., stigma, uncertainty, physical problems, family support and lack thereof. Healthy Learning (1999). The impact of stress, exercise and lifestyle on the immune system available at http://www.amazon.com/Impact-Stress-Exercise-Lifestyle-Immune/dp/B00BJB2G2Y/ref=sr_1_2?ie=UTF8&qid=1384862919&sr=8-2&keywords=The+impact+of+stress%2C+exercise+and+lifestyle+on+the+immune+system. An excellent adjunct to a lecture on psychoneuroimmunology, this video is an illustrated lecture by Dr. Connie Rogers. She introduces the cells of the immune system and discusses the effects of stress, exercise, and lifestyle. References Ader, R., Dantzer, R., Glaser, R., Heijnen, C., Irwin, M., Padgett, D., & Sheridan J. (Eds.), (2006). Psychoneuroimmunology. Academic Press Andersen, B. L., & Wells, S. (2003). Cancer. In Christensen, A. J., & Antoni, M. H. (Eds.), Chronic physical disorders: Behavioral medicine’s perspective (pp. 112–136). Malden, MA: Blackwell. Anderson, B. L., Golden-Kreutz, D. M., & DiLillo, V. (2000). Cancer. In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of health psychology (pp. 709–725). Mahwah, NJ: Lawrence Erlbaum. Anthony, I. C., & Bell, J. E. (2008). The neuropathology of HIV/AIDS. International Review of Psychiatry, 20, 15–24. Antoni, M. H. (2002) HIV and AIDS. In Christensen, A. J., & Antoni, M. H. (Eds.), Chronic physical disorders: Behavioral medicine’s perspective (pp. 191–219). Malden, MA: Blackwell. Baum, A., & Anderson, B. L. (Eds.). (2001). Psychosocial interventions for cancer. Washington, DC: American Psychological Association. Ben-Eliyahu, S., Page, G. G., & Schleifer, S. J. (2007). Stress, NK cells, and cancer: Still a promissory note. Brain, Behavior and Immunity, 21, 881–887. Burke, H. M., Zautra, A. J., Davis, M. D, Schultz, A. S., &. Reich, J. W. (2002). Arthritis and musculoskeletal conditions. 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. 169–190). Hoboken, NJ: John Wiley. Burke, H. M., Zautra, A. J., Schultz, A. S., Reich, J. W., & Davis, M. D. Arthritis (2002). In Christensen, A. J., & Antoni, M. H. (Eds.), Chronic physical disorders: Behavioral medicine’s perspective (pp. 268–287). Malden, MA: Blackwell. Campbell, C. (1990). Women and AIDS. Social Science and Medicine, 30, 407–415. Catania, J. A., Binson, D., Dolcini, M. M., Muskowitz, J. T., & van der Straten, A. (2000). Frontiers in the behavioral epidemiology of HIV/STDs. In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of health psychology (pp. 775–793). Mahwah, NJ: Lawrence Erlbaum. Centers of Disease Control and Prevention HIV/AIDS among Hispanics—United States; (2001–2005). 2007; 56:1052–1057 http://www.cdc.gov/hiv/resources/reports/mmwr/2007.htm. Centers of Disease Control and Prevention. (2007). HIV and African American women. http://www.cdc.gov/healthmarketing/entertainment_education/tips/hiv_women.htm. Centers of Disease Control and Prevention. Update to Racial/Ethnic Disparities in diagnoses of HIV-AIDS—33 states, (2001–2005) 56(09);189–193. http://www.cdc.gov/hiv/resources/reports/mmwr/mm5609a1.htm Chapple, A., Ziebland, S., & McPherson, A. (2004). Stigma, shame and blame experienced by patients with lung cancer: Qualitative study. British Medical Journal, 329, 1470. Coughlan, R. (2004). Stigma, shame, and blame experienced by patients with lung cancer: Health promotion and support groups have a role. BMJ 329: 402–403. Goffman, E. (1963). Stigma. Englewood Cliffs, NJ: Prentice-Hall. Current awareness in human psychopharmacology. Human psychopharmacology: Clinical & Experimental, 23, 71–78. Delahanty, D. L., & Baum, A. (2000). Stress and breast cancer. In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of health psychology (pp. 747–756). Mahwah, NJ: Lawrence Erlbaum. Ferrando, S. J., & Freyberg, Z. (2008). Treatment of depression in HIV positive individuals: A critical review. International Review of Psychiatry, 20, 61–71. Given, C., Given, B., Champion, V., Kozachik, S., & DeVoss, D. (Eds.), (2003). Evidence-based cancer care and prevention: Behavioral interventions. New York, NY: Springer. Grytten, N., Maseide, P. (2006). “When I am together with them I feel more ill.” The stigma of multiple sclerosis experienced in social relationships. Chronic Illness 2: 195–208. Hackl, K. L., Somlai, A. M., Kelly, J. A., & Kalichman, S. C. (1997). Women living with HIV/AIDS: The dual challenge of being a patient and caregiver. Health and Social Work, 22, 53–62. Ickovics, J. R., & Rodin, J. (1992). Women and AIDS in the United States: Epidemiology, natural history, and mediating mechanisms. Health Psychology, 11, 1–16. Ickovics, J. R., Thayaparan, B., & Ethier, K. A. (2000). Women and AIDS: A contextual analysis. In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of health psychology (pp. 817–839). Mahwah, NJ: Lawrence Erlbaum. Johnson, J. L., Gryczynski, J., & Wiechelt, S. A. (2007). HIV/AIDS, substance abuse, and hepatitis prevention needs of Native Americans living in Baltimore: In their own words. Aids Education & Prevention, 19, 531–544. Koster, M. E. T. A., & Bergsma, J. (1990). Problems and coping behavior of facial cancer patients. Social Science and Medicine, 30, 569–578. Lawless, S., Kippax, S., & Crawford, J. (1996). Dirty, diseased, and undeserving: The positioning of HIV positive women. Social Science and Medicine, 43, 1371–1377. Lyons, A. C., & Chamberlain, K. (2006). Health psychology: A critical introduction. Cambridge University Press. Manderson, L., Stirling, L. (2007). The Absent Breast: Speaking of the Mastectomied Body. Feminism Psychology, 17, 75–92. Mays, V. M., So, B. T., Cochran, S. D., Detels, R., Benjamin, R., Allen, E., & Kwon, S. (2000). HIV disease in ethnic minorities: Implications of racial/ethnic differences in disease susceptibility and drug dosage response for HIV infection and treatment. In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of Health Psychology (pp. 801–817). Mahwah, NJ: Lawrence Erlbaum. Muzzin, L. J., Anderson, N. J., Figueredo, A. T., & Gudelis, S. O. (1994). The experience of cancer. Social Science and Medicine, 38, 1201–1208. Nezu, A., Nezu, C., Felgoise, S., & Zwick, M. (2003). 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. 267–292). Hoboken, NJ: John Wiley. Segerstrom, S. C. (2007). Stress, energy, and immunity: An ecological view. Current Directions in Psychological Science, 16, 327–330. Susman, J. (1994). Disability, stigma, and deviance. Social Science and Medicine, 38, 15–22. Walden, E. (in press). An exploration of the experience of lesbians with chronic illness. Journal of Homosexuality. Whittlesey, V. (2001). Diversity activities for psychology. Boston: Allyn and Bacon. Chapter 15 Health Psychology: Challenges for the Future Chapter Outline I. Health Promotion A. A Focus on Those at Risk B. Prevention C. A Focus on Older Adults D. Refocusing Health Promotion Efforts E. Promoting Resilience F. Health Promotion and Medical Practice G. Health Disparities II. Stress and Its Management A. Where is Stress Research Headed? III. Health Services A. Building Better Consumers IV. Management of Serious Illness
A. Quality-of-Life Assessment V. The Aging of the Population VI. Trends in Health and Health Psychology A. The Changing Nature of Medical Practice B. Systematic Documentation of Cost Effectiveness and Treatment Effectiveness C. International Health VII. Becoming a Health Psychologist A. Undergraduate Experience B. Graduate Experience C. Postgraduate Work D. Employment Learning Objectives Describe the goals of health psychology research in health promotion, including the shift of focus from mortality to morbidity, the role of environmental hazards that may pose health risks, and changes in medical practice and research. Describe the goals of health psychology research in stress and its management, including populations at risk, the psychophysiology of stress, and social support. Describe the goals of health psychology research in the use of health services, including building better consumers. Describe the goals of health psychology research in patient-provider communication, including trends in medical education and care. Describe the goals of health psychology research in quality of life. Describe the goals of health psychology research in chronic illness. Summarize the changing nature of medical practice and technology. Describe the comprehensive intervention model. Explain the role of health psychology in the systematic documentation of treatment effectiveness and cost effectiveness. Describe the role of health psychologists in international health. Describe the training requirements for health psychologists and the areas in which they are employed. Lecture Suggestions Health Psychology in the 21st Century: The topics in Chapter 15 may be expanded by discussing various themes and trends. Keefe and Blumenthal (2004) examine the future of health psychology, and highlight several important themes and trends. The authors focus on behavior genetics in dealing with tailoring treatments, the need to make sure that health psychological interventions are efficient in improving symptoms and quality of life and cost effective. Lastly, they highlight the importance of integrating technology and improving the biopsychosocial models. Porter and Olmsted Teisberg (2007) propose a health care reform that is market based but physician led. They believe that physician leadership is essential and offer several strategies for change. Frist (2005) discusses his vision of the 21-century health care system and examines current issues with respect to health care such as patient-centered, consumer-driven, and provider-friendly care. Chesney (1993) discusses five trends in health psychology: (1) early identification of at-risk individuals, (2) increasing expectations of successful behavior change programs, (3) growing populations of persons coping with chronic illness, (4) shifts to community and public health perspectives, and (5) the need to treat problems on a global scale. These issues are discussed within the context of HIV infection. Many health care providers are still unfamiliar with the skills and interventions that psychologists have to offer, and so a continued collaboration with the medical community to marry psychological and medical treatments in a patient-centered approach to care is vital (Johnson, 2012). Obesity: A Vision for the Future: Approximately 34 percent of adults aged 20 and older are obese (CDC, 2007). The World Health Organization estimates that 500 million people worldwide are obese and 1.5 billion are overweight, including 43 million children under age 5 (World Health Organization, March 2011). Overweight and obese individuals are at increased risk for several health problems such as hypertension, osteoarthritis, dyslipidemia, Type 2 diabetes, coronary hearth disease, stroke, and some cancers. More importantly, the prevalence of overweight children has tripled. Overweight children will experience various health problems during their youth and as adults, and are more likely to become obese as adults. The Surgeon General identifies 15 activities as national priorities, one of which is education for parents, teachers, and children; and the other focuses on increasing physical activity and decreasing sedentary behaviors (USDHHS, 2007). Obesity is tied to poor cognitive functioning as well (Verstynen et al., 2012). Baby Boomers and Age-Related Issues: Chen and colleagues (2007) examine cohort differences in self-rated health for preboomer women (1935–1944) and baby boomer women (1945–1954). Self-rated health was examined longitudinally, and findings reveal that baby boomers report lower self-rated health and more rapid decline per year relative to the preboomers even after adjusting for demographics, socioeconomic variables, individual differences, health behaviors, chronic illness and depression. An important area of future efforts for health psychologists are variations in health and illness related to one’s place in the life span. Of particular interest are those areas of high morbidity and mortality—childhood and older adulthood. Melamed and others (2000) examine issues relevant to children. Evans (2000) focuses on health-threatening behaviors of children and adolescents. Siegler and others (2000) discuss differences in normal aging and diseases of old age. They identify the interaction of gender and age-of-onset as an important factor in health behaviors and outcomes. The aging of the population poses multiple challenges for health psychologists (Yali & Revenson). As our population ages, we can expect to see a higher incidence of chronic but not life-threatening conditions, such as arthritis, osteoporosis, hearing losses, incontinence, and blindness. International Health Issues: Recently, recommendations were formulated to focus on sustainable and effective health promotion worldwide (IUHPE, 2008). The Centers for Disease Control (CDC) is focusing their attention on international health issues because illness no longer can be contained in specific geographic locations. With the globalization of industry has come the globalization of disease. Piko (2004) discusses the role of health psychology in Eastern Europe’s public health. The edited book by Panday (2001) contains several chapters on health psychology in India. Both will serve as excellent resources for a lecture on this topic. Many developing nations, such as China and India, are beginning to experience the burden of increases in chronic disease (Reddy, Shah, Varghese, & Ramadoss, 2005; Yamada, 2008; Zhu, 2010), and international attention may be required to offset this dangerous course (McKay, 2011). Cultural Diversity: Taylor identifies the study of health and illness in diverse populations as an important task for health psychologists. Lewis’ (2002) book, Multicultural health psychology: Special topics acknowledging diversity addresses a wide range of factors that impact individuals’ health behaviors and their experience of illness. Whitfield and his colleagues (2003) and Landine and Klonoff (2000) review the literature on social (e.g., job status, SES, access to medical care) and cultural (i.e., factors purposefully transmitted through socialization) variants among a variety of ethnic minority groups. Macera, Armstead, and Anderson (2000) focus on specific biopsychosocial factors implicated in hypertension in blacks. Mays et al. (2000) present evidence that this may be related to the low levels or absence of the CCR5 allele. They report research indicating differential infection and progression rates with HIV and other diseases. Millions of people in the United States have difficulty paying their health care bills (Cohen & Bloom, 2010; U.S. Department of Commerce, 2009). Latinos and African Americans are especially affected (Bloom & Cohen, 2011). Climate Change and Health Issues: Climate change is likely to have potential impacts on human health. According to the U.S. Environmental Protection Agency, human health is affected directly and indirectly. For instance, changes in temperature may affect people differently based on their socioeconomic status and their vulnerability to health problems. Extreme weather events, as witnessed with Katrina, can be very destructive and according to the EPA, the frequency and severity of hurricanes will increase. Moreover, climate-sensitive diseases may appear more frequently in warm areas. These diseases include malaria, dengue fever, yellow fever, and encephalitis. Together with warmer temperature and more rainfall, transmission of such diseases in some areas may increase. Air quality problems and respiratory disorders may be more frequent with more smog and air pollution. Indirect changes will occur through changes in agricultural yields and production, especially in developing countries, resulting in an increase in the number of undernourished individuals. Climate change will also add to social disruption, economic decline, and displacement of populations. The IPCC (2007) posits that “Human beings are exposed to climate change through changing weather patterns (for example, more intense and frequent extreme events) and indirectly through changes in water, air, food quality and quantity, ecosystems, agriculture, and economy.” Climate change affects patterns of illness. For example, tropical diseases such as malaria and diarrheal disorders are increasing in frequency and spreading north (Jack, 2007, April 25). Many of the major fatal illnesses such as diarrhoeal diseases, malnutrition, malaria and dengue are extremely climate sensitive and are expected to exacerbate as the climate changes (World Health Organization, 2013). Health Psychology Education: A good website to recommend to students is APA Graduate Education. This site provides various links to help students explore their options and provide various resources. Recommended Reading 2020 Vision: Health in the 21st century. Proceedings of the Institute of Medicine 25th Anniversary Symposium. Washington, DC: National Academy Press. The 25th Anniversary Symposium raised many issues and challenges. The presentations in this volume focus much on health and poverty, global health and the need for bringing together different disciplines to solve the challenges we will encounter. Kato, P. M., & Mann, T. (Eds.). (1996). Handbook of diversity issues in health psychology. New York: Plenum. The changing demographics of the United States and related health concerns are the focus of this volume. Chapters focus on health psychology across the life span and the influence of gender, sexual orientation, and ethnicity on physical and mental health. Activities An interesting topic to discuss in the classroom is health care reform. Do Americans want national health care? Ask students to access health care reform and follow some of the links posted on the site. Then ask students to access Physicians for a National Health Program and discuss the different issues relating to health care reform. President Obama’s views on health care reform, including myths and facts about the so-called “Obama-care” can be found at the White House page. Another pertinent topic to consider for the subject of 21st-century health is to examine climate change and its effects on health and the environment. The EPA website includes several governmental reports with which students should become familiar. Videos American Psychological Association available at www.apa.org Psychology: Scientific problem-solvers careers for the 21st century. A video designed to capture the interests of today’s youth. The video provides information about the various areas of psychology, new opportunities in the field, and ways to pursue a career in psychology. Films for the Humanities & Sciences available at http://ffh.films.com\ Hypochondriacs: Inside health anxiety. (2007). A video that explores how individuals can use the Internet for information regarding their health. Meridian allied health series. (2008). A video that examines opportunities in the health care industry. NewsHour medical ethics and issues anthology. Discussions with health care professionals regarding rising health care costs, uninsured Americans, longevity and income, a plan to insure everyone, and other interesting episodes relating to health care. Health news and interviews: Nutrition and obesity video clips. (2007). A collection of 16 video clips relating to nutrition and obesity. Diet confidential: Heavy marketing with a dash of nutrition. (2006). A documentary that explores the media and diets, Americans’ obsession with slimness and dieting, and the tools used by the media to market new products and diets. References Baum, T. Revenson, & J. Singer (Eds.), Handbook of health psychology. Mahwah, NJ: Lawrence Erlbaum. Belar, C. D. (1997). Clinical health psychology: A specialty for the 21st century. Health Psychology, 16, 411–416. Center for Disease Control. New CDC study finds no increase in obesity among adults: but levels still high. Release 11/28/2007. Retrieved on 2/29/08 on http://www.cdc.gov/nchs/pressroom/07newsreleases/obesity.htm Chen, H., Cohen, P., & Kasen, S. (2007). Cohort differences in self-rated health: Evidence from a three-decade, community-based, longitudinal study of women. American Journal of Epidemiology, 166, 439–446. Chesney, M. A. (1993). Health psychology in the 21st century: Acquired immunodeficiency syndrome as a harbinger of things to come. Health Psychology, 12, 259–268. Frist., W. H. (2005). Health care in the 21st century. The New England Journal of Medicine, 352: 267–272. IPCC (2007). Climate change 2007: Impacts, adaptation and vulnerability. Contribution of Working Group II to the Third Assessment Report of the Intergovernmental Panel on Climate Change [Parry, Martin L., Canziani, Osvaldo F., Palutikof, Jean P., van der Linden, Paul J., and Hanson, Clair E. (Eds.)]. Cambridge University Press, Cambridge, United Kingdom, 1000 pp. Keefe, F. J., & Blumenthal, J. A. (2004). Health Psychology: What will the future bring? Health Psychology, 23, 157–157. Koss, M. P., Ingram, M., & Pepper, S. L. (2000). Male partner violence: Relevance to health care providers. In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of health psychology (pp. 541–557). Mahwah, NJ: Lawrence Erlbaum. Landrine, H., & Klonoff, E. A. (2000). Cultural diversity and health psychology. In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of health psychology (pp. 851–891). Mahwah, NJ: Lawrence Erlbaum. Lewis, M. K. (2002). Multicultural health psychology. Boston, Allyn & Bacon. Macera, C. A., Armstead, C. A., & Anderson, N. B. (2000). Sociocultural influences on health. In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of health psychology (pp. 427–440). Mahwah, NJ: Lawrence Erlbaum. Pandey, J. (Ed.), (2001). Psychology in India revisited: Developments in the discipline, Vol. 2: Personality and health psychology. New Delhi, India: Sage. Piko, B. (2004). Interplay between self and community: A role for health psychology in Eastern Europe’s public health. Journal of Health Psychology, 9, 111–120. Rimer, B. K., McBride, C. M., Crump, C. (2000). Women’s health promotion. In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of health psychology (pp. 519–539). Mahwah, NJ: Lawrence Erlbaum. Shaping the future of health promotion: Priorities for action. (2008). Health Promotion International, 23, 98–102. U.S. Department of Health & Human Services. (2007). Overweight and obesity: A vision for the future retrieved on 2/29/08 on http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_vision.htm U.S. Environmental Protection Agency. (2007). Health. Retrieved on 2/29/08 from http://www.epa.gov/climatechange/effects/health.html#ref7 Whitfield, K., Weidner, G., Clark, R., & Anderson, N. (2003). Cultural aspects of health psychology. In I. B. Weiner (Series Ed.) & A. M. Nezu, C. M. Nezu, & P. A. Geller (Vol. Eds.), Handbook of psychology: Vol. 9, Health psychology (pp. 545¬567). Hoboken, NJ: John Wiley. Instructor Manual for Health Psychology Shelley E. Taylor 9780077861810