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HEALTH PSYCHOLOGY
A Biopsychosocial Approach
FIFTH EDITION

Richard O. Straub
University of Michigan, Dearborn

New York
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For Pam … still the one
About the Author

Bill McNeece
Richard O. Straub is professor of psychology and founding director of the graduate program in health psychology at the University of
Michigan, Dearborn. After receiving his Ph.D. in experimental psychology from Columbia University and serving as a National Institute of
Mental Health Fellow at the University of California, Irvine, Dr. Straub joined the University of Michigan faculty in 1979. Since then, he has
focused on research in health psychology, especially mind–body issues in stress, cardiovascular reactivity, and the effects of exercise on
physical and psychological health. His research has been published in such journals as Health Psychology, the Journal of Applied Social
Psychology, and the Journal of the Experimental Analysis of Behavior.
A recipient of the University of Michigan’s Distinguished Teaching award and the Alumni Society’s Faculty Member of the Year award, Dr.
Straub is extensively involved in undergraduate and graduate medical education. In addition to serving on the board of directors of the
Southeast Michigan Center for Medical Education and lecturing regularly at area teaching hospitals, he has created an online learning
management system for medical residency programs and authored a series of Web-based modules for teaching core competencies in
behavioral medicine.
Dr. Straub’s interest in enhancing student learning is reflected further in the study guides, instructor’s manuals, and critical thinking
materials that he has developed to accompany several leading psychology texts by other authors.
The author’s professional devotion to health psychology dovetails with his personal devotion to fitness and good health. Dr. Straub has
completed hundreds of road races and marathons (including multiple Boston Marathons, Ironman triathlons, and the 2010 Ironman-Hawaii
World Championship) and is a nationally ranked, USAT All-American triathlete. With this text, Dr. Straub combines his teaching vocation with
a true passion for health psychology.
Brief Contents
Preface

Part 1
Foundations of Health Psychology
Chapter 1 Introducing Health Psychology
Chapter 2 Research in Health Psychology
Chapter 3 Biological Foundations of Health and Illness

Part 2
Stress and Health
Chapter 4 Stress
Chapter 5 Coping with Stress

Part 3
Behavior and Health
Chapter 6 Staying Healthy: Primary Prevention and Positive Psychology
Chapter 7 Exercise, Sleep, and Injury Control
Chapter 8 Nutrition, Obesity, and Eating Disorders
Chapter 9 Substance Use, Abuse, and Addiction

Part 4
Chronic and Life-Threatening Illnesses
Chapter 10 Cardiovascular Disease and Diabetes
Chapter 11 Cancer
Chapter 12 HIV/AIDS and Other Communicable Diseases

Part 5
Seeking Treatment
Chapter 13 The Role of Health Psychology in Seeking and Obtaining Health Care
Chapter 14 Managing Pain
Chapter 15 Complementary and Alternative Medicine

Epilogue Health Psychology Today and Tomorrow

Glossary
References
Name Index
Subject Index
Contents

Cover
Title Page
Copyright
Dedication
About the Author
Brief Contents
Preface

Part 1
Foundations of Health Psychology
Chapter 1 Introducing Health Psychology
Health and Illness: Lessons from the Past
From Ancient Times Through the Renaissance
From Post-Renaissance Rationality through the Nineteenth Century
The Twentieth Century and the Dawn of a New Era
Biopsychosocial Perspective
The Biological Context
The Psychological Context
The Social Context
Diversity and Healthy Living: The Immigrant Paradox: SES and the Health of Immigrants
Biopsychosocial “Systems”
Applying the Biopsychosocial Model
Frequently Asked Questions about a Health Psychology Career
What Do Health Psychologists Do?
Your Health Assets: College Does a Mind and Body Good
Where Do Health Psychologists Work?
How Do I Become a Health Psychologist?

Chapter 2 Research in Health Psychology

Critical Thinking and Evidence-Based Medicine
The Dangers of “Unscientific” Thinking
Health Psychology Research Methods
Descriptive Studies
Interpreting Data: Association versus Causation
Experimental Studies
Quasi-Experiments
Developmental Studies
Epidemiological Research: Tracking Disease
Objectives in Epidemiological Research
Diversity and Healthy Living: Hypertension in African-Americans: An Epidemiological “Whodunit”
Research Methods in Epidemiology
Interpreting Data: Tables and Graphs
Inferring Causality
Interpreting Data: Measuring Risk

Chapter 3 Biological Foundations of Health and Illness

Cells
The Nervous System
Divisions of the Nervous System
The Brain
The Endocrine System
The Pituitary and Adrenal Glands
The Thyroid Gland and the Pancreas
The Cardiovascular System
Blood and Circulation
 The Heart
The Respiratory System
The Lungs
The Digestive System
Diversity and Healthy Living: Asthma
How Food Is Digested
The Immune System
Structure of the Immune System
The Immune Response
The Reproductive System and Behavior Genetics
Ovaries and Testes
Fertilization and the Mechanisms of Heredity
Genes and Environment

Part 2
Stress and Health
Chapter 4 Stress
Stress: Some Basic Concepts
Stressors
Significant Life Events
Daily Hassles
Diversity and Healthy Living: The Stress of Emerging Adulthood
Work
Your Health Assets: The Gallup Employee Engagement Questionnaire
Social Interactions
The Physiology of Stress
The Role of the Brain and Nervous System
Measuring Stress
How Does Stress Make You Sick?
Other Models of Stress and Illness
Selye’s General Adaptation Syndrome
Cognitive Appraisal and Stress
The Diathesis–Stress Model

Chapter 5 Coping with Stress

Responding to Stress
Problem-Focused and Emotion-Focused Coping
Coping, Gender, Genes, and Socioeconomic Status
Coping and Ethnicity
Factors Affecting the Ability to Cope
Resilience
Explanatory Style
Your Health Assets: Measuring Optimism
Personal Control and Choice
Social Support
Coping Interventions
Relaxation Therapies
Mindfulness-Based Stress Reduction
Cognitive Behavioral Therapy
Your Health Assets: Try Mindfulness-Based Stress Reduction for Yourself
Emotional Disclosure

Part 3
Behavior and Health
Chapter 6 Staying Healthy: Primary Prevention and Positive Psychology
Health and Behavior
Theories of Health Behavior
 Prevention
Compressing Morbidity
Promoting Healthy Families and Communities
Interpreting Data: Who Are the Uninsured and Underinsured?
Community Health Education
Message Framing
Cognitive-Behavioral Interventions
Promoting Healthy Workplaces
Positive Psychology and Thriving
Allostasis and Neuroendocrine Health
Neurobiology of Resilience
Psychosocial Factors and Physiological Thriving
Features of Psychological Thriving
Beyond Positive Psychology

Chapter 7 Exercise, Sleep, and Injury Control

Physical Activity, Exercise, and Fitness
Benefits from Physical Activity
Is It Ever Too Late to Begin Exercising?
Why Don’t More People Exercise?
Exercise Interventions
Sleep
Sleep Stages
Sleep Patterns
Sleep Loss and Sleep Disorders
Your Health Assets: How Good Is Your Sleep?
Injury Control
Childhood
Adolescence and Emerging Adulthood
Adulthood
Injury Prevention

Chapter 8 Nutrition, Obesity, and Eating Disorders

Nutrition: Eating the Right Foods
Healthy Eating and Adherence to a Healthy Diet
Diet and Disease
Weight Determination: Eating the Right Amount of Food
Basal Metabolic Rate and Caloric Intake
Your Health Assets: Super Foods for a Super You
The Set-Point Hypothesis
The Biological Basis of Weight Regulation
Obesity: Some Basic Facts
Hazards of Obesity
The Biopsychosocial Model of Obesity
Biological Factors
Psychosocial Factors
Treatment and Prevention of Obesity
Dieting
Your Health Assets: Lose Weight the Smart Way
Behavioral and Cognitive Therapy
Fit Families, Fit Communities
Eating Disorders
Demographics
Applying the Biopsychosocial Model
Diversity and Healthy Living: Acculturation and the Latest Nutrition Guidelines
Body Image and the Media
Treatment of Eating Disorders
Chapter 9 Substance Use, Abuse, and Addiction
Some Basic Facts
Mechanisms of Drug Action
Psychoactive Drugs
 Models of Addiction
Biomedical Models: Addiction as Disease
Reward Models: Addiction as Pleasure Seeking
Social Learning Models: Addiction as Behavior
Alcohol Use and Abuse
Prevalence of Alcohol Use
The Physical Effects of Alcohol Consumption
Psychosocial Consequences of Alcohol Use
Alcohol Use Disorder
Treatment and Prevention of Alcohol Use Disorders
Tobacco Use and Abuse
Prevalence of Smoking
Physical Effects of Smoking
Why Do People Smoke?
Prevention Programs
Cessation Programs
Your Health Assets: You Can Quit Smoking—Here’s How
The Rise of e-Cigarettes and the Resurgence of Marijuana
Electronic Cigarettes
The Resurgence of Marijuana

Part 4
Chronic and Life-Threatening Illnesses
Chapter 10 Cardiovascular Disease and Diabetes
The Healthy Heart
Cardiovascular Disease
The Causes: Atherosclerosis and Arteriosclerosis
The Diseases: Angina Pectoris, Myocardial Infarction, and Stroke
Risk Factors for Cardiovascular Disease
Uncontrollable Risk Factors
Controllable Risk Factors
Psychosocial Factors in Cardiovascular Disease
The Type A Personality and Its “Toxic Core”
Depression
Why Do Hostility, Anger, and Depression Promote Cardiovascular Disease?
Positive Psychological Well-Being and Cardiovascular Disease
Reducing the Risk of Cardiovascular Disease
Controlling Hypertension
Reducing Cholesterol
After CVD: Preventing Recurrence
Managing Stress, Anxiety, and Hostility
Diabetes
Types of Diabetes
Causes of Diabetes
Prevention of Diabetes
Diabetes Self-Management
Health Psychology and Diabetes
Diversity and Healthy Living: Cultural Adaptations to Evidence-Based Interventions for Type 2 Diabetes
Your Health Assets: Benefit Finding

Chapter 11 Cancer
What Is Cancer?
Types of Cancer
Cancer Susceptibility: Demographic Aspects
Risk Factors for Cancer
Tobacco Use
Alcohol Use
Nutrition
Physical Activity
Overweight and Obesity
Family History
Environmental and Occupational Hazards
 Your Health Assets: What Is Your Risk of Developing Skin Cancer?
Cancer and Infectious Disease
Stress and Immunocompetence
Childhood Adversity
Depression: Both Risk and Result
Cancer Treatment
Early Diagnosis
Treatment Options
Coping with Cancer
Emotions, Masculinity, and Ethnicity
Knowledge, Control, and Social Support
Cognitive–Behavioral Interventions

Chapter 12 HIV/AIDS and Other Communicable Diseases

Communicable and Noncommunicable Diseases
The Epidemiological Transition
Emerging and Reemerging Communicable Diseases
Antimicrobial Resistance
The AIDS Epidemic
A Brief History of AIDS
The Epidemiology of AIDS
How HIV Is Transmitted
Sexually Transmitted Infections (STIs) and HIV
Symptoms and Stages: From HIV to AIDS
How HIV Progresses
Physiological Factors in the Progression of AIDS
Psychosocial Factors in the Progression of AIDS
Medical Treatments and Psychosocial Interventions
The Success of Antiretroviral Therapy
An Overview of Psychosocial Interventions
The Basis for Psychosocial Interventions
Educational Programs
Promoting Adherence to Treatment
Cognitive Behavioral Stress Management (CBSM)
Community-Wide Interventions
Psychosocial Barriers to AIDS Intervention

Part 5
Seeking Treatment
Chapter 13 The Role of Health Psychology in Seeking and Obtaining Health Care
Recognizing and Interpreting Symptoms
Attentional Focus, Neuroticism, and Self-Rated Health
Illness Representations
Explanatory Style and Psychological Disturbances
Seeking Treatment
Age and Gender
Socioeconomic Status and Cultural Factors
Delay Behavior
Overusing Health Services
Diversity and Healthy Living: Chronic Fatigue Syndrome
Patient Adherence
How Widespread Is Nonadherence?
What Factors Predict Adherence?
The Patient–Provider Relationship
Factors Affecting the Patient–Provider Relationship
Improving Patient–Provider Communication
Motivational Interviewing
The Internet and the Patient–Provider Relationship
The Health Care System
Hospitalization
Health Care Around the World
Patient Dissatisfaction, Patient-Centered Care, and Health Care Reform
Your Health Assets: Health Literacy
Chapter 14 Managing Pain
What Is Pain?
Epidemiology and Components of Pain
Significance and Types of Pain
Measuring Pain
Physical Measures
Behavioral Measures
Self-Report Measures
The Physiology of Pain
Pain Pathways
The Neurochemistry of Pain
Genes and Pain
Gate Control Theory
Factors That Influence the Experience of Pain
Age
Gender
Diversity and Healthy Living: Phantom Limb Pain
Sociocultural Factors
Treating Pain
Pharmacological Treatments
Surgery, Electrical Stimulation, and Physical Therapy
Cognitive Behavioral Therapy
Evaluating the Effectiveness of Pain Treatments

Chapter 15 Complementary and Alternative Medicine

What Is Complementary and Alternative Medicine?
Establishing a Category for Unconventional Medicine
Three Ideals of Complementary and Alternative Medicine
How Widespread Is Complementary and Alternative Medicine?
Medicine or Quackery?
What Constitutes Evidence?
Does Complementary and Alternative Medicine Work?
Acupuncture
Mind–Body Therapies
Biofeedback
Chiropractic
Naturopathic Medicine
Looking Ahead: Complementary and Alternative Medicine in Our Future
The Best of Both Worlds
The Politics of Medicine

Epilogue: Health Psychology Today and Tomorrow

Health Psychology’s Most Important Lessons
Lesson 1: Psychological and Social Factors Interact with Biology in Health
Lesson 2: It is Our Own Responsibility to Promote and Maintain Our Health
Lesson 3: Unhealthy Lifestyles Are Harder to Change Than to Prevent
Lesson 4: Positive Stress Appraisal and Management Are Essential to Good Health
Health Psychology’s Future Challenges
Challenge 1: To Increase the Span of Healthy Life for All People
Challenge 2: To Reduce Health Discrepancies and Increase Our Understanding of the Effects of Race, Gender, Culture, and Socioeconomic Status on Health
Challenge 3: To Achieve Equal Access to Preventive Health Care Services for All People
Challenge 4: To Adjust the Focus of Research and Intervention to Maximize Health Promotion with Evidence-Based Approaches
Challenge 5: To Assist in Health Care Reform
Conclusion

Glossary
References
Name Index
Subject Index
Preface
Not so long ago, health and psychology were separate disciplines, each aware of the other but unable to connect in any meaningful way. Then, in
1978, the field of health psychology was born, and it has grown explosively since then. Now, nearly four decades since it emerged as a specific
focus of study, an overwhelming and growing body of evidence continues to demonstrate that good health is more than just a physiological state.
From the earliest research linking Type A behavior to increased risk for cardiovascular disease, to the most current discoveries regarding
psychosocial influences on gene expression and the inflammatory processes involved in cardiovascular disease, cancer, and other chronic diseases,
health psychology already has accomplished much.
More important than individual research findings has been the ongoing refinement of the biopsychosocial model as an interdisciplinary template
for the study of health issues. Increasingly, researchers are able to pinpoint the physiological mechanisms by which anger, loneliness, and other
psychosocial factors adversely affect health, and by which optimism, social connectedness, and a strong sense of self-empowerment exert their
beneficial effects.
Experiencing these exciting and productive early years of health psychology inspired me to write this text—to share with aspiring students this
vitally important field. My goals in this text have been to present current, relevant, well-supported summaries of the main ideas of the field and to
model a scientific way of thinking about those ideas in the process. Understanding human behavior and teaching students are my two professional
passions, and nowhere have these passions come together more directly for me than in writing this text about how psychology and health are
interconnected.

What’s New in the Fifth Edition?

In this thoroughly revised fifth edition, my aim continues to be to present the science of health psychology clearly, accurately, and in an accessible
voice that helps students make meaningful connections with their own lives. Yet I’ve introduced a number of significant changes:
■ Over 300 new research citations that provide a complete and up-to-date picture of the field
■ Significant streamlining to emphasize the most important topics and make room for cutting-edge research in health psychology
■ A broader, global, evidence-based perspective that incorporates information from the World Bank, Institute for Health Metrics and Evaluation,
and World Health Organization
■ Timely new discussion of research ethics and scientific misconduct in Chapter 2 , covering informed consent, debriefing, and the need for
reproducibility of results in research
■ Expanded coverage of minority stress in Chapter 5 , including a full-page table on microaggressions experienced frequently by people of color,
and the discussion of stress issues related to the LGBT community
■ New section added on electronic cigarettes and health concerns associated with “vaping” in Chapter 9
■ New material on the resurgence of marijuana in Chapter 9 , including growing support for legalization for both medical and recreational use, and
long-term impacts on health and brain functions
■ Significantly expanded coverage of communicable and noncommunicable diseases, now in its own section in Chapter 12 . Topics in this new
section include the epidemiological transition, antimicrobial resistance, and emerging infectious diseases such as the Zika virus.
■ New Diversity and Healthy Living feature box in Chapter 4 on the Stress of Emerging Adulthood
■ Significant expansion in coverage of sleep in Chapter 7 , including a new subsection on Sleep Loss and Sleep Disorders and discussion of the
mounting evidence regarding the health effects of poor sleep
■ An updated Epilogue discussing health psychology’s current status and most significant future challenges. The Epilogue, which was placed online
in the last edition, is placed back in the actual textbook in this fifth edition.
■ New coverage of the ongoing implementation and success of the Affordable Health Care Act, including cross-cultural comparisons of how other
countries address the basic human right of health care
■ Expanded coverage of positive psychology, mindfulness, cognitive behavioral interventions, and more

Trademark Features of This Text

In an effort to communicate the excitement and value of the field, I have maintained my focus on ensuring that students understand—rather than just
memorize—the concepts that make up health psychology. I have retained the following key features:
■ Biopsychosocial approach. The book follows the biopsychosocial model as the basic organizing template. Throughout, I have strived to
convey how the components of this model interact dynamically in influencing the well-being of the whole person. Each chapter dealing with a
specific health problem—on cardiovascular disease and diabetes, cancer, and substance use/abuse, for example—presents a critical analysis
of what we know to be the underlying biological, psychological, and social factors in the onset of the health problem, as well as how these
factors affect the course of the disease and the outcome. My commitment to this interdisciplinary systems perspective on behavior stems from
my eclectic graduate training (some would say, inability to make up my mind as to which career path I would follow!) as a student of learning
theorist Herbert Terrace, physiological psychologist Richard Thompson, and social psychologist (and health psychology pioneer) Stanley
Schachter.
■ Up-to-date coverage. Few psychological disciplines generate more research each year—and from such a wide variety of related fields—than
does health psychology. I have retained the field’s classic studies and concepts, but I have also presented the most important recent
developments. More than 25 percent of the references in this fifth edition are from research published since 2012. Across the chapters, health
statistics have been updated with the most recent demographic and prevalence information available.
■ Fully integrated gender and cultural diversity coverage. One of my major goals has been to promote understanding of and respect for
differences among groups of people and how these differences affect health and illness. This effort extends beyond merely cataloging ethnic,
cultural, and gender differences in disease, health beliefs, and behaviors. I have made an in-depth effort to stimulate students’ critical thinking
regarding the origins of these differences. For example, many differences in health-related behaviors are the product of restrictive social
stereotypes and norms, economic forces, and other overarching ecological processes. Whenever possible, the text digs deeply into diversity
issues by considering the origins of these behaviors and their implications for health-promoting treatments and interventions. Examples of this
integrated coverage are provided in Tables 1 , 3 , and 4 on pages xvi –xviii . The Diversity and Healthy Living boxes found throughout the
text expand the integrated coverage of gender and multicultural issues by highlighting specific health issues. For example, students will explore
why hypertension is so prevalent among African-Americans, and cultural differences in adapting to type 2 diabetes interventions.
■ The life-course perspective. In integrated coverage throughout the text, students will learn about the special needs and health challenges of
people in every season of life. As with gender and diversity, my approach is to teach students to think critically about aging and health.
Increasingly, researchers are realizing that much of what was once considered normal aging is actually disease. Many older people who have
made healthy lifestyle choices are “rewriting the book” on successful aging. The choices people make as children and adolescents may
determine their fates in later years. Table 2 on page xvii outlines examples of coverage of life-span issues.
■ Coverage of complementary and alternative medicine. According to a recent Journal of the American Medical Association report, 4
out of 10 Americans use acupuncture, massage therapy, naturopathy, or some other form of nontraditional medicine. Chapter 15 carefully
explores the validity of these high-interest, alternative interventions.
In addition, the fifth edition retains these effective pedagogy and features:
■ Your Health Assets boxes that give students self-testing opportunities to connect the material to their own experiences. The fifth edition
includes two new Your Health Assets boxes: One is a self-test on What Is Your Risk of Developing Skin Cancer? and the other is on Health
Literacy (the ability to read a nutritional label on a pint of ice cream).
■ Interpreting Data boxes that help students become more comfortable with the crucial quantitative component of research in a health
psychology context.
■ End-of-chapter Weigh In on Health features that emphasize critical thinking to help students assess their understanding of material and to
make meaningful connections between the course and their own life experiences.
■ Helpful study aids. This text is designed to bring health psychology alive and reinforce learning at every step. Its clean, student-friendly visual
appeal is enhanced by numerous clear graphs of research findings, useful and interesting photos, and compelling artwork that illustrates
anatomical structures as well as important concepts and processes. In addition, each chapter includes the following learning aids:
a. An engaging case study or vignette at the beginning of each chapter connects the world of health psychology to some concrete
experience and weaves a thread of human interest throughout the chapter. All of these describe real situations. For example, Chapter 11
describes my own family’s life-changing battle against the cancer that threatened my young son’s life.
b. All important terms, which are boldfaced in the body of the text, are defined concisely and clearly in the margins to enhance students’
study efforts. All key terms and concepts to remember are listed, with their page numbers, at the end of each chapter.
c. End-of-chapter summaries distill the important points, concepts, theories, and terms discussed in the chapters.

The Multimedia Supplements Package

As an instructor and supplements author, I know firsthand the importance to a textbook of a good, comprehensive teaching package. Fortunately,
Worth Publishers has a well-deserved reputation for producing the best psychology supplements around, for both faculty and students. The
supplements package includes several valuable components, described next.
Instructor’s Resource Manual
The digital Instructor’s Resource Manual accompanying Health Psychology, Fifth Edition, features chapter-by-chapter previews and lectures,
learning objectives, suggestions for planning and teaching health psychology, ideas for projects, and more. They are available for download at:
www.macmillanlearning.com/psychology
Downloadable Computerized Test Bank in Diploma
The comprehensive Test Bank, based on my classroom experience and testing, contains well over 1000 multiple-choice and short-answer essay
questions, each keyed to the American Psychological Association’s goals for the undergraduate psychology major and Bloom’s Taxonomy. The
questions include a wide variety of applied, conceptual, and factual questions, and each item is keyed to the topic and page in the text on which the
answer can be found. They are available for download at: www.macmillanlearning.com/psychology
Illustration and Lecture Slides
The Lecture Slides to accompany Health Psychology, Fifth Edition, focus on key terms and themes from the text and feature tables, graphs, and
figures.
The Illustration Slides include all the illustrations, photos, and tables featured in the text. All slides can be used as they are or customized to fit
course needs. They are available for download at: www.macmillanlearning.com/psychology
LaunchPad Solo for Health Psychology
The LaunchPad Solo for Health Psychology offers a variety of simulations, tutorials, and study aids organized by chapter, including the following:
■ Online quizzing This helpful feature offers multiple-choice quizzes tied to each of the book’s chapters.
■ Check Your Health These inherently interesting, automatically tallying self-assessments allow students to examine their own health beliefs and
 behaviors. For example, students will learn about their stress-management styles, their ability to control anger, potential high-risk health
behaviors, and cognitive restructuring of headache pain. Each exercise also gives specific tips that encourage students to manage their own
health more actively.
■ Critical thinking exercises The text has two major goals: (1) to help students acquire a thorough understanding of health psychology’s
knowledge base and (2) to help students learn to think like health psychologists. The second goal—learning to think like psychologists—
involves critical thinking. To support this goal directly, the LaunchPad Solo for Health Psychology includes a complete exercise for each
chapter designed to stimulate students’ critical-thinking skills. These skills include asking questions, observing carefully, seeing connections
among ideas, and analyzing arguments and the evidence on which they are based.
■ Interactive flashcards Students can use these flashcards for tutoring on all chapter and text terminology, and then to quiz themselves on those
terms.
■ PsychSim: Interactive Exercises for Psychology Key modules from these series (by Thomas Ludwig, a psychology professor at Hope
College) allow students to explore research topics, participate in experiments and simulations, and apply health psychology to real-world
issues.
■ Health Psychology video activities consist of a collection of video clips spanning the topics in the book.
LaunchPad Solo for Health Psychology is available without charge when packaged with this fifth edition of Health Psychology, using ISBN 1-
319-11584-5. Alternatively, LaunchPad Solo for Health Psychology can be previewed and purchased at: launchpadworks.com.

Table 1 Coverage of Culture and Multicultural Experience

Coverage of culture and multicultural experiences can be found on the following pages:
Acculturation p. 236
African-American adolescents and personal control, p. 126
African-Americans and hypertension, pp. 40 –41 , 290 –291
Alcohol use, p. 225
Antismoking campaigns, p. 268
Body mass and hypertension among African-Americans, p. 333
Cancer
and age, p. 320
and diet, pp. 323 –324
screening interventions, p. 333
survival rates, p. 332
Cardiovascular disease
racial and ethnic differences in, pp. 289 –290
Childbirth pain, pp. 420 –421
Death rates among racial/ethnic groups, pp. 4 , 17
Diabetes, pp. 304 , 306 –307
Eating disorders, pp. 235 –236
Food deserts, pp. 225 –226
Health care use, pp. 381 –382 , 388 –390
Health insurance, pp. 153 –155
Health system barriers, pp. 153 –155 , 388 –390
HIV
counseling and education, p. 366
intervention, pp. 364 , 369 –370
transmission and AIDS, p. 357 –358
Immigrants, p. 18
LGBT issues, pp. 89 –90 , 120 –122 , 354 –355
Microaggressions, p. 120 –121
Obesity, pp. 223 –226
Optimism and Hispanic-Americans, p. 125
Pain, pp. 420 –421
Personal control, p. 129
Smoking cessation programs, p. 269
Sociocultural perspective in health psychology, pp. 17 –18
Socioeconomic status
and cancer, p. 320
and cardiovascular disease, pp. 298 –290
and health care providers, pp. 390 –391
and health care use, pp. 381 –382
and obesity, pp. 381 –382
and patient communication problems, pp. 390 –391
and provider communication problems, pp. 388 –390
Substance abuse, pp. 254 –255
Tobacco use, pp. 263 –264
Table 2 Coverage of Life-Span Issues
Life-span issues are discussed on the following pages:
Adolescence and
exercise, p. 184
hypertension, p. 291
perceived vulnerability to risky behaviors, p. 148
tobacco use, pp. 264 –265
Age differences in sick role-behavior, pp. 379 –380
Ageism and compliance, p. 380
Age-pain relationship, p. 417
Age-related conditions and cortisol, p. 99
Alcohol, pp. 150 , 254
Asthma and childhood, p. 68
Cancer
and age, p. 320
and children, pp. 320 , 341
Children coping with pain and medical procedures, p. 423
Cigarette advertising and children, pp. 264 –265
Cigarette antismoking campaign and children, p. 267
Community and wellness, pp. 154 , 156
Diabetes and age, pp. 304 –305
Eating disorders, demographics and genders, p. 223
treatment of, pp. 237 –340
HIV/AIDS and age-appropriate counseling, pp. 365 –367
Life-course perspective, pp. 13 –14
Longevity and lifestyle, p. 152
Obesity–health relationship
and age, p. 220
and gender, pp. 219 –221
Optimism and children, p. 125
Reactivity and hypertension in children, p. 110
Research methods, pp. 36 –37
Resilience in children, p. 123
Seeking health services, pp. 379 –380
Shaping pain behavior in children, p. 423
Sleep and health, pp. 186 –187
Smoking and aging, p. 264
Stress and social support, pp. 130 –131
Workplace, pp. 160 –162

Table 3 Coverage of the Psychology of Women and Men

Coverage of the psychology of women and men can be found on the following pages:
AIDS and HIV
and psychosocial barriers to intervention, pp. 370 –371
and transmission, pp. 356 –357
Alcohol
and behavior and personality traits, pp. 21 –22
dating behavior, p. 257
gender and drinking contexts, pp. 254 –255
Cancer, p. 319
Cardiovascular disease, p. 289
Coping styles, pp. 117 , 119
Gender, stress, and taste, p. 223
Gender and obesity, pp. 219 –220 , 224 –225
Gender and use of health services, pp. 380 –381
Gender bias in medicine, pp. 18 –22
Gender perspective, pp. 18 –22
Hostility and anger, p. 294
Male-pattern and female-pattern obesity, p. 219
Pain, pp. 417 –419
Reactivity and hypertension in men, p. 110
Reproductive system, pp. 76 –79
Role overload and conflict, pp. 92 –93
Sexism in health care, pp. 19 –20 , 390
Sexually transmitted infections, pp. 358 –359
Sexual practices, p. 367
Sick role behavior, pp. 379 –381
Smoking cessation programs, pp. 270 , 273
Social support and effects on PSA, pp. 131 –132
Stress response, pp. 96 , 98 –99 , 117
Substance abuse, pp. 254 –255
Use of health care services, pp. 380 –381

Table 4 Coverage of Women’s Health

Coverage of women’s health can be found on the following pages:
AIDS, pp. 356 –357
Alcohol and pregnancy, p. 256
Body image and the media, pp. 236 –237
Body image dissatisfaction, pp. 234 –237
Breast cancer
and relationship to alcohol, p. 323
coping with, p. 336
and diet, pp. 323 –324
and emotional disclosure, pp. 342 –343
and ethnic differences, p. 320
and exercise, p. 325
and heredity, pp. 325 –326
and Nurses’ Health Study, p. 324
and obesity, p. 325
and social support, pp. 340 –341
Caregiving role and stress, pp. 95 –96
Eating disorders, pp. 232 –240
treatment of, pp. 237 –240
Employment and health, pp. 90 –95
Fertilization, pp. 77 –78
HIV transmission
with breast feeding, p. 357
during pregnancy, p. 358
Lung cancer, pp. 319 , 322
Medical treatment, in comparison to males, pp. 18 –22
Reactivity with bullying, p. 110
Self-efficacy and high-risk sexual behaviors, pp. 366 –368 , 369 –370
Smoking and miscarriage, p. 263

Table 5 Coverage of Positive Health Psychology

Coverage of positive health psychology can be found on the following pages:
Alcohol abuse prevention programs, pp. 261 –262
Behavioral control, pp. 396 –398
Cancer-fighting foods, p. 324
Daily uplifts and stress, p. 87
Education programs, pp. 261 –262 , 267 –268 , 366 –367
Explanatory style, pp. 123 –126
Family therapy, p. 238
Health behaviors, pp. 145 –150
Health psychology interventions, defined, pp. 23 –24
Heart and healthy diets, pp. 293 , 302
Hospitalization, increasing perceived control prior to, pp. 393 –394
Hostility and anger, control of, pp. 303 –304
Hypertension, control of, pp. 301 –302
Nutrition, pp. 208 –213
Optimism
and coping with cancer, p. 336
and immune system health, pp. 124 –126
Personal control and self-efficacy, pp. 126 –127
Reducing cholesterol, p. 302
Relaxation, pp. 135 –136
Resilience, pp. 122 –123
Self-efficacy beliefs in safer sex behaviors, pp. 366 –368 , 369 –370
Self-regulation, pp. 127 –130
 Smoking
and effects of, pp. 263 –264
inoculation programs, pp. 268 –269
Social support
and cancer, pp. 340 –341
and cardiovascular disease, p. 298
and health and mortality, pp. 130 –133
and physiology, pp. 130 –133
Work site wellness programs, pp. 161 –162

Acknowledgments
Although as the author, my name is on the cover of this book, I certainly did not write the book alone. Writing a textbook is a complex task
involving the collaborative efforts of a large number of very talented people.
Many of my colleagues played a role in helping me develop this text over the years. I am indebted to the dozens of academic reviewers who
read part or all of this book, providing constructive criticism, suggestions, or just an encouraging word. Their input made this a much better book,
and I hope they forgive me for the few suggestions not followed.
I begin by thanking the following reviewers for their excellent advice and encouraging words in the creation of this thoroughly revised fifth
edition and its multimedia supplements:
Anthony Austin
University of Arkansas at Pine Bluff
Donald DeLorey
University of West Florida
Marc Dingman
Pennsylvania State University
Deborah Flynn
Canadore College
Tawanda Greer
University of South Carolina—Columbia
Erin Merz
California State University—Dominiguez Hills
Jeremy Moss
Swedish Institute
Erin O’Hea
Stonehill College
Kari-Lyn Sakuma
Oregon State University
Brian M. Saltsman
Allegheny College
Barbara Stetson
University of Louisville
Kevin Thompson
University of South Florida
Michelle Williams
Holyoke Community College
I thank the following reviewers for their excellent advice and consultation during the first, second, third, and fourth edition process:
Christine Abbott
Johnson County Community College
David Abwender
State University of New York at Brockport
Christopher Agnew
Purdue University
Jean Ayers
Towson University
Justin Bailey
Limestone College
Mary Jill Blackwell
DePaul University
Joy Berrenberg
University of Colorado
Amy Badura Brack
Creighton University
Pamela Brouillard
Texas A&M—Corpus Christi
Marion Cohn
Ohio Dominican University
Karen J. Coleman
University of Texas at El Paso
Mark E. Christians
Dordt College
Dale V. Doty
Monroe Community College
Dennis G. Fisher
California State University Long Beach
Deborah Flynn
Nipissing University
Phyllis R. Freeman
State University of New York at New Paltz
Tim Freson
Washington State University
Eliot Friedman
Williams College
Sharon Gillespie
Andrews University
Arthur J. Gonchar
University of La Verne
Bonnie A. Gray
Scottsdale Community College
Linda R. Guthrie
Tennessee State University
Carol A. Hayes
Delta State University
Donna Henderson-King
Grand Valley State University
Rob Hoff
Mercyhurst University
April Kindrick
South Puget Sound Community College
Marc Kiviniemi
University of Nebraska—Lincoln
Robin Kowalski
Western Carolina University
Kristi Lane
Winona State University
Sherri B. Lantinga
Dordt College
Sheryl Leytham
Grand View University
Mee-Gaik Lim
Southeastern Oklahoma State University
Robyn Long
Baker University
Linda Luecken
Arizona State University
Angelina Mackewn
University of Tennessee at Martin
Jon Macy
Indiana University
Dr. J. Davis Mannino
Santa Rosa Junior College
Charlotte Markey
Rutgers University
Leslie Martin
La Sierra University
Cathleen McGreal
Michigan State University
Julie Ann McIntyre
Russell Sage College
Matthias R. Mehl
University of Arizona
Katie Mosack
University of Wisconsin—Milwaukee
James P. Motiff
Hope College
David Nelson
Sam Houston State University
Virginia Norris
South Dakota State University
John Pilosi
Pennsylvania State University
Amy Posey
Benedictine College
Mary Pritchard
Boise State University
Kathleen M. Schiaffino
Fordham University
Elisabeth Sherwin
University of Arkansas at Little Rock
Eve Sledjeski
Kent State University
Margaret K. Snooks
University of Houston—Clear Lake
Rebecca Spencer
University of Massachusetts Amherst
Peter Spiegel
California State University, San Bernardino
Amy Starosta
University at Albany, State University of New York
Alexandra Stillman
Saint Paul College
Gabriele B. Sweidel
Kutztown University of Pennsylvania
Richard J. Tafalla
University of Wisconsin—Stout
Christy Teranishi
Texas A&M International University
Benjamin Toll
Yale School of Medicine
Diane C. Tucker
University of Alabama at Birmingham
Rebecca Warner
University of New Hampshire
Eric P. Wiertelak
Macalester College
Nancy L. Worsham
Gonzaga University
David M. Young
Indiana University—Purdue University at Fort Wayne
Diane Zelman
California School of Professional Psychology
At Worth Publishers—a company that lets nothing stand in the way of producing the finest textbooks possible—a number of people played key
roles. Chief among these are Vice President of Content Management Catherine Woods, whose initial interest, vision, and unflagging support gave
me the push needed to start the project and sustained me throughout; Senior Associate Editor Sarah Berger, whose wonderful hands-on approach
and attention to detail were key factors in building our new team and the conceptualization and execution of this edition; Director of Content
Management Enhancement Tracey Kuehn, Managing Editor Lisa Kinne, Senior Project Editor Jane O’Neill, Production Supervisor Bob Cherry,
Copyeditor Sharon Kraus, and Proofreader Andrew Roney, who worked wonders throughout production to keep us on course; Art Manager
Matthew McAdams, Senior Design Manager Blake Logan, and Interior Designer Patrice Sheridan, whose creative vision resulted in the distinctive
design and beautiful art program that exceeded my expectations; Editorial Assistant Melissa Rostek, who meticulously prepared manuscript for
production and commissioned reviews and surveys to inform the revision; Executive Marketing Manager Katherine Nurre, who has enthusiastically
championed Health Psychology since its second edition and Senior Photo Editor Christine Buese and Photo Researcher Teri Stratford, who
researched the photos that helped give the book its tremendous visual appeal. Finally, no one deserves more credit than Development Editor Jim
Strandberg. Jim’s skillful editing, encouragement, and as-needed prodding brought out the best in me. His influence can be found on virtually every
page.
As ever, my heartfelt thanks go to Pam, for her unwavering confidence and support; to Jeremy, Rebecca, and Melissa, for helping me keep
things in perspective; and to the many students who studied health psychology with me and assisted in the class testing of this book. They are a
constant reminder of the enormous privilege and responsibilities I have as a teacher; it is for them that I have done my best to bring the field of
health psychology alive in this text.
To those of you who are about to teach using this book, I sincerely hope that you will share your experiences with me. Drop me a line and let
me know what works, what doesn’t, and how you would do it differently. This input will be vital in determining the book’s success and in shaping
its future.
Richard O. Straub
University of Michigan, Dearborn
Dearborn, MI 48128
rostraub@umich.edu
 PART
1 Foundations of Health Psychology

Design Pics Inc/Alamy

Health and Illness: Lessons from the Past
A lthough all human civilizations have been affected by disease, each one has understood and treated it differently (Figure 1.1 ).

From Ancient Times Through the Renaissance

Our efforts at healing can be traced back 20,000 years. A cave painting in southern France, for example, which is believed to be 17,000 years
old, depicts an Ice Age shaman wearing the animal mask of an ancient witch doctor. In religions based on a belief in good and evil spirits, only a
shaman (priest or medicine man) can influence these spirits.
For preindustrial men and women, confronted with the often-hostile forces of their environment, survival was based on constant vigilance against
these mysterious forces of evil. When a person became sick, there was no obvious physical reason for it. Rather, the stricken individual’s condition
was misattributed to weakness in the face of a stronger force, bewitchment, or possession by an evil spirit.
During this period of time, sick people were often treated with rituals of sorcery, exorcism, or even a primitive form of surgery called
trephination . Archaeologists have unearthed prehistoric human skulls containing irregularly shaped holes that were apparently drilled by early
healers to allow disease-causing demons to leave patients’ bodies. Historical records indicate that trephination was practiced in Europe, Egypt,
India, and Central and South America.
Ancient healers did search for a more rational understanding of how the human body functioned. Given the importance of the Nile River, it is not
surprising that Egyptian healers drew parallels with how its channels were used to irrigate farmers’ fields. The Nile Theory reflects their belief that
the body had similar channels carrying air, water, and blood, and that people became sick when blockages occurred.
In Greece, the philosopher and physician Hippocrates (460–377 B.C.E.) also rebelled against the ancient focus on mysticism and superstition.
Hippocrates, who is often called the “father of Western medicine,” was the first to argue that disease is a natural phenomenon and that the causes
of disease (and therefore their treatment and prevention) are knowable and worthy of serious study. In this way, he built the earliest foundation for
a scientific approach to healing. Historically, physicians took the Hippocratic Oath, with which they swore to practice medicine ethically. Over the
centuries, the oath has been rewritten to suit the values of various cultures that were influenced by Greek medicine.
… I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound
of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter.
May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those
who seek my help.
—Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, this is the
modern version of the Hippocratic Oath used in many medical schools today.
Hippocrates proposed the first rational explanation of why people get sick. According to his humoral theory, a healthy body and mind resulted
from equilibrium among four bodily fluids called humors: blood, yellow bile, black bile, and phlegm. To maintain a proper balance, a person had
to follow a healthy lifestyle that included exercise, sufficient rest, a good diet, and the avoidance of excesses. When the humors were out of
balance, however, both body and mind were affected in predictable ways, depending on which of the four humors was in excess. Those suffering
from headaches and anxiety, for example, might have been considered choleric, with an excess of yellow bile and a fiery temperament. They might
have been treated with bloodletting (opening a vein to remove blood), liquid diets, enemas, and cooling baths.
humoral theory
A concept of health proposed by Hippocrates that considered wellness a state of perfect equilibrium among four basic body fluids, called
humors . Sickness was believed to be the result of disturbances in the balance of humors.
FIGURE 1.1
A Timeline of Historical and Cultural Variations in Illness and Healing From the ancient use of trephination to remove evil spirits to
the current use of noninvasive brain scans to diagnose disease, the treatment of health problems has seen major advances over the
centuries. A collection of treatments across the ages is shown (from left to right): trephination (on an ancient Peruvian skull); acupuncture
from China; early surgery in seventeenth-century Europe; and vaccination by the district vaccinator in nineteenth-century London.
 Credits (left to right): Trepanned skull from Incidents of Travel and Exploration in the Land of the Incas by George E. Squier, published in 1878 (engraving)/English School (nineteenth century)
Private Collection/Bridgeman Images; illustration showing acupuncture: Everett Collection Historical/Alamy; The Surgeon, (engraving) (b/w photo)/German School (seventeenth century):
Private Collection/Bridgeman Images; Vaccination engraving, 1871: Hulton Archive/Getty Images.

Although humoral theory was discarded as advances were made in anatomy, physiology, and microbiology, the notion of personality traits being
linked with body fluids still persists in the folk and alternative medicines of many cultures, including those of traditional Eastern and Native
American cultures. Moreover, as we’ll see in the next chapter, we now know that many diseases involve an imbalance (of sorts) among the brain’s
neurotransmitters, so Hippocrates was not too far off. Hippocrates was also interested in patients’ emotions and thoughts regarding their health and
treatment, and thus he called attention to the psychological aspects of health and illness. “It is better to know the patient who has the disease,”
Hippocrates said, “than it is to know the disease which the patient has” (quoted in Wesley, 2003).
At the same time that Western medicine was emerging, different traditions of healing were developing in other cultures. For example, more than
2,000 years ago, the Chinese developed an integrated system of healing, which we know today as traditional Oriental medicine (TOM) . TOM
is founded on the principle that internal harmony is essential for good health. Fundamental to this harmony is the concept of qi (sometimes spelled
chi ), a vital energy or life force that ebbs and flows with changes in each person’s mental, physical, and emotional well-being. Acupuncture, herbal
therapy, tai chi, meditation, and other interventions are said to restore health by correcting blockages and imbalances in qi.
Ayurveda is the oldest-known medical system in the world, having originated in India around the sixth century B.C.E., coinciding roughly with
the lifetime of the Buddha. The word ayurveda comes from the Sanskrit roots ayuh, which means “longevity,” and veda, meaning “knowledge.”
Widely practiced in India, ayurveda is based on the belief that the human body represents the entire universe in a microcosm and that the key to
health is maintaining a balance between the microcosmic body and the macrocosmic world. The key to this relationship is held in the balance of
three bodily humors, or doshas: vata, pitta, and kapha, or, collectively, the tridosha. We’ll explore the history, traditions, and effectiveness of
these and other non-Western forms of medicine in Chapter 15 .
The fall of the Roman Empire in the fifth century C.E. ushered in the Middle Ages (476–1450), an era between ancient and modern times
characterized by a return to supernatural explanations of health and disease in Europe. Religious interpretations colored medieval scientists’ ideas
about health and disease. Illness was viewed as God’s punishment for evildoing, and epidemic or pandemic diseases, such as the two great
outbursts of plague (a bacterial disease carried by rats and other rodents) that occurred during the Middle Ages, were believed to be a sign of
God’s wrath. Medical “treatment” in this era often involved attempts to force evil spirits out of the body. There were few scientific advances in
European medicine during these thousand years.
epidemic
Literally, among the people ; an epidemic disease is one that spreads rapidly among many individuals in a community at the same time.

pandemic
A pandemic disease is one that affects people over a large geographical area, such as multiple continents or worldwide.

The Middle Ages began with an outbreak of plague that originated in Egypt in 540 C.E. and quickly spread throughout
the Roman Empire, killing as many as 10,000 people a day. So great in number were the corpses that gravediggers
could not keep up. The solution was to load ships with the dead, row them out to sea, and abandon them.
In the late fourteenth century, a new age—the Renaissance—was born. Beginning with the reemergence of scientific inquiry, this period saw the
revitalization of anatomical study and medical practice. The taboo on human dissection was lifted sufficiently that the Flemish anatomist and artist
Andreas Vesalius (1514–1564) was able to publish an authoritative, seven-volume study of the internal organs, musculature, and skeletal system of
the human body. The son of a druggist, Vesalius was fascinated by nature, especially the anatomy of humans and animals. In the pursuit of
knowledge, no stray dog, cat, or mouse was safe from his scalpel.
One of the most influential Renaissance thinkers was the French philosopher and mathematician René Descartes (1596–1650), whose first
innovation was the concept of the human body as a machine. He described all the basic reflexes of the body, constructing elaborate mechanical
models to demonstrate his principles. He believed that disease occurred when the machine broke down, and the physician’s task was to repair the
machine.
Descartes is best known for his beliefs that the mind and body are autonomous processes that interact minimally, and that each is subject to
different laws of causality. This viewpoint, which is called mind–body dualism (or Cartesian dualism ), is based on the doctrine that humans have
two natures, mental and physical. Descartes and other great thinkers of the Renaissance, in an effort to break with the mysticism and superstitions
of the past, vigorously rejected the notion that the mind influences the body. Although this viewpoint ushered in a new age of medical research
based on confidence in science and rational thinking, it created a lasting bias in Western medicine against the importance of psychological
processes in health. As we’ll see, this bias has been rapidly unraveling since the 1970s.

From Post-Renaissance Rationality through the Nineteenth Century

Following the Renaissance, physicians were expected to focus exclusively on the biological causes of disease. English physician William Harvey
(1578–1657) offered the first detailed description of the circulation of blood, and he also noted that emotions were often associated with how the
heart functioned. Physician and Quaker preacher John Fothergill (1656–1745) was noteworthy for being the first to identify diseases that affect the
nerves and also for emphasizing the importance of practicing temperance and self-control in maintaining health. Surgeon John Hunter (1728–
1793), one of the most distinguished scientists of his day, was an early advocate of careful observation and the importance of applying the scientific
method in medicine. Although a ground lens had been used for magnification in ancient times, the first practical microscopes were developed in this
era. This made it possible to view blood cells and the structure of skeletal muscles.
Once individual cells became visible, the stage was set for the germ theory of disease—the idea that bacteria, viruses, and other
microorganisms that invade body cells cause them to malfunction. The germ theory forms the theoretical foundation of modern medicine and was
followed by rapid advances in medical knowledge and procedures.
In 1846, William Morton (1819–1868), an American dentist, introduced the gas ether as an anesthetic. This great advance made it possible to
operate on patients, who experienced no pain during procedures and thus remained completely relaxed. The German physicist Wilhelm Roentgen
(1845–1943) discovered x-rays 50 years later, and, for the first time, physicians were able to directly observe internal organs in a living person.
Before the end of the nineteenth century, researchers had identified the microorganisms that caused malaria, pneumonia, diphtheria, syphilis,
typhoid, and other diseases that my great-grandmother’s generation feared. Armed with this information, medicine began to bring under control
diseases that had plagued the world since antiquity.
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