Handbook of Behavioral Medicine (eBook)

Andrew Steptoe is professor of psychology in the Department of Epidemiology and Public Health at University College London. He has worked in behavioral medicine throughout his professional life and is a Past-President of both the International Society of Behavioral Medicine and the Society for Psychosomatic Research. He is a member of Academy of Behavioral Medicine Research and Fellow of the Society of Behavioral Medicine. He was founding co-editor of the British Journal of Health Psychology. He is author and editor of 16 books including Health Care and Human Behaviour (1984), Stress, Personal Control and Health (1989), Psychosocial Processes and Health (1994) and Depression and Physical Illness (2006). He has published more than 400 journal articles and book chapters.

Preface 5
Contents 7
Contributors 13
Part I Health Behaviors: Processes and Measures 25
1 Social and Environmental Determinants of HealthBehaviors 26
1 Introduction 26
2 Theoretical Frameworks 28
3 Social and Environmental Determinants of Physical Activity 28
3.1 Social Determinants of Physical Activity 29
3.1.1 Socioeconomic Position 29
3.1.2 Social Support 29
3.1.3 Personal Safety and Crime 30
3.1.4 Social Capital 30
3.2 Environmental Determinants of Physical Activity 31
3.2.1 Availability and Accessibility 31
3.2.2 Aesthetics 31
3.2.3 Neighborhood Infrastructure 32
3.2.4 Road Safety 32
4 Social and Environmental Determinants of Eating Behaviors 32
4.1 Social Determinants of Healthy Eating Behaviors 33
4.1.1 Socioeconomic Position 33
4.1.2 Social Support 33
4.1.3 Family and Household Composition 33
4.2 Environmental Determinants of Healthy Eating Behaviors 34
4.2.1 Availability and Access 34
4.2.2 Affordability 35
5 Conclusions 36
References 37
2 Cognitive Determinants of Health Behavior 41
1 Introduction 41
2 Social Cognition Models 41
2.1 The Health Belief Model 42
2.2 Protection Motivation Theory 43
2.3 Theory of Planned Behavior 44
2.4 Social Cognitive Theory 45
2.5 Stage Models of Health Behavior 46
3 Integration of Social Cognition Models 47
4 Current Directions 47
4.1 Intention Stability 48
4.2 Affective Influences 49
4.3 Implementation Intentions 49
5 Conclusions 50
References 50
3 Assessment of Physical Activity in Research and Clinical Practice 53
1 Introduction 53
2 Physical Activity and Health Outcomes 53
2.1 All-Cause and CHD-Related Mortality 53
2.2 Incidence of Chronic Diseases 55
2.2.1 Coronary Heart Disease 55
2.2.2 Diabetes Mellitus 55
2.2.3 Cancer 55
2.2.4 Osteoporosis 56
2.2.5 Clinical Depression 56
3 Defining Physical Activity 56
4 Dimensions of Assessment 57
5 Laboratory Measures 57
5.1 Exercise Treadmill Testing 57
5.2 The 6-Minute Walk Test 58
5.3 The Step Test 59
6 Field Measures 59
6.1 Pedometers 59
6.2 Accelerometers 60
6.3 Questionnaires and Activity Rating Scales 60
6.3.1 Harvard Alumni Activity Survey 61
6.3.2 Minnesota Leisure Time Physical Activity Questionnaire 63
6.3.3 Seven-Day Physical Activity Recall 63
6.3.4 Stages of Exercise Change Questionnaire 63
6.3.5 Community Healthy Activities Model Program for Seniors Activities Questionnaire 64
6.3.6 Godin Leisure Time Exercise Questionnaire 64
6.3.7 International Physical Activity Questionnaire 64
7 Physiological Measures 65
7.1 Oxygen Uptake 65
7.2 Heart Rate Monitoring 65
8 Future Directions 65
8.1 Combination Devices 65
8.2 New Technologies 66
9 Conclusions 66
References 66
4 Dietary Assessment in Behavioral Medicine 71
1 Overview of Dietary Assessment in Behavioral Medicine 71
2 Standard Dietary Assessment Tools for Use in Behavioral Medicine 72
2.1 Food Records and Diaries 72
2.2 Dietary Recalls 73
2.3 Food Frequency Questionnaires 74
2.4 Advantages and Disadvantages of Standard Dietary Assessment Instruments 75
3 Non-traditional Dietary Assessment Instruments Used in Behavioral Medicine 76
3.1 Household Food Inventories 76
3.2 Targeted Instruments 76
3.3 Eating Behavior Instruments 77
4 Summary and Conclusions 77
References 77
5 Assessment of Sexual Behavior 81
1 Assessment of Sexual Behavior 81
2 Reasons for Measuring Sexual Behavior 82
2.1 General Health Benefits 82
2.2 Sexual Health Outcomes 82
2.2.1 Positive Sexual Health Outcomes 82
2.2.2 Negative Sexual Health Outcomes 83
3 Assessment of Sexual Behavior: How to Gather the Data 83
3.1 Modes of Assessment 83
3.1.1 Interviews 83
3.1.2 Self-Administered Questionnaires 84
3.1.3 Internet Surveys 85
3.1.4 Self-Monitoring and Diary Methods 85
3.1.5 Virtual Reality 86
4 Measures of Sexual Behavior: What to Gather 86
4.1 Question Types 86
4.1.1 Frequency of Sexual Behavior 86
4.1.2 Consistency of Sexual Behavior 87
4.1.3 Dichotomies 87
4.1.4 Count Measures of Sexual Behavior 87
4.1.5 Composite Measures of Sexual Behavior 88
4.2 Standardized (Published) Measures 88
5 Challenges to Sexual Assessment 88
5.1 Cognition and Memory Challenges 89
5.1.1 Length of Recall Period 89
5.1.2 Partner and Sexual Act Specificity 90
5.2 Literacy Skills 90
5.3 Social Desirability and Presentation Concerns 91
5.4 Cultural, Developmental, Sexual Orientation and Gender Matching 91
5.5 Individual Versus Dyadic Assessments 91
6 Conclusions 91
References 92
6 By Force of Habit 95
1 By Force of Habit 95
2 The Three Pillars of Habit 95
2.1 Frequency 96
2.2 Automaticity 96
2.3 Context Cuing 96
3 Varieties of Habit 97
3.1 The Location of a Habit 97
3.2 General Versus Specific Habits 98
3.3 Mental Habits 98
4 Breaking and Creating Habit 98
4.1 Breaking Habit 99
4.2 Creating Habit 99
4.3 Habit Discontinuities 99
5 The Measurement of Habit 100
5.1 Frequency of Past Behavior 100
5.2 Past Behavioral Frequency and Habit Combined 100
5.3 Response Frequency Measure 100
5.4 Habit as a Reason for Behavior 100
5.5 A Context-Focused Habit Measure 101
5.6 Self-Report Habit Index 101
5.7 Conclusions 102
6 General Conclusions 102
References 102
7 Adherence to Medical Advice: Processesand Measurement 105
1 Introduction 105
2 Classification of Adherence 106
2.1 Acceptance of the Regimen 106
2.2 Adoption of the Regimen 106
2.3 Initiation of the Regimen 107
2.4 Treatment Continuation 107
3 Defining Adherence 109
4 Measurement of Adherence 109
4.1 Numeric Assessment of Adherence 109
4.1.1 Electronic Monitoring 110
4.1.2 Pill Counts 111
4.1.3 Pharmacy Refills 111
4.1.4 Daily Diaries 111
4.1.5 Daily Recall 112
5 Global Assessment of Adherence 112
6 Issues in Analysis of Adherence Data 113
7 Implications for Understanding Adherence 114
8 Summary and Recommendations 115
References 115
Part II Psychological Processes and Measures 118
8 Ecological Validity for Patient Reported Outcomes 119
1 Ecological Validity and Self-Reports 120
2 Momentary, Retrospective, and Global Self-Report 120
3 Does Ecological Validity Matter for Self-Report? 121
3.1 Variability over Time and Situation 121
3.2 Accuracy of Recall and Summary Processes 121
3.3 Implications for Global Reports 123
3.4 Implications for Retrospective Reports 123
3.5 Implications for Momentary Reports 123
4 Rationale for Taking Self-Report into Everyday Life 124
5 Conducting EMA Studies 126
5.1 Implementation of EMA and Application of Technology 127
5.2 Concerns About EMA 129
6 Conclusion 129
References 130
9 Item Response Theory and Its Application to Measurement in Behavioral Medicine 133
1 Introduction 133
2 Item Response Theory Versus Classical Test Theory 133
2.1 Limitations of Classical Test Theory 133
2.2 Item Response Theory as Ideal Model 134
3 IRT Models 135
3.1 Binary IRT Models 135
3.2 Polytomous IRT Models 136
3.3 Evaluating Item Quality 137
4 Applying IRT to Questionnaires in Behavioral Medicine 138
4.1 Questionnaire and Analysis with Polytomous IRT 138
4.2 Descriptive Statistics and Interpretation of IRT Results 138
5 Summary 143
References 143
10 Applications of Neurocognitive Assessment in Behavioral Medicine 144
1 Introduction 144
2 Neurocognition and Its Assessment 144
2.1 Orientation 145
2.2 Perception 146
2.3 Attention and Concentration 146
2.4 Executive Functions 146
2.5 Reasoning 146
2.6 Learning and Memory 147
2.7 Visuospatial and Visuoconstructional Abilities 147
2.8 Psychomotor Function 147
2.9 Verbal and Language Function 148
2.10 General Assessment Issues 148
3 Chronic Diseases, Risk Factors, and Neurocognition 148
3.1 Risk Factors and Neurocognition 149
3.2 Chronic Diseases and Neurocognition 150
3.3 Summary 150
4 Applications of Neuropsychology in Behavioral Medicine 151
4.1 Medical Decision Making 151
4.2 Quality of Life 152
5 Summary and Conclusions 152
References 152
11 Lay Representations of Illness and Treatment: A Framework for Action 156
1 What Are Lay Representations? 156
1.1 The Domains of Common-Sense Representations 156
1.1.1 Common-Sense Representations as Central Components in Feedback and Feedforward Control Systems 156
1.1.2 Representations Are Multi-level 157
1.2 Prototypes: Creating Representations of Illness and Targets for Management 158
1.2.1 The Formation of Prototypes and the Activation of Representations 158
1.2.2 Prototype Checking Is a Social Process 159
1.3 Representations Create a Context for Management 159
1.3.1 Relating Treatment and Action Plans to Illness Representations 159
1.3.2 The ''Executive Self'' and Strategies for Management 160
2 The Empirical Challenges 160
2.1 Contextual Factors Critical for the Implementation of the CSM 160
2.1.1 Are Participants Well or Ill? 161
2.1.2 Multiple Routes to Goal 161
2.1.3 Disease and Procedures for Control 162
2.1.4 Co-morbidities 162
2.1.5 Defining Goals by Action or by Target 162
2.1.6 Gender and Age 163
3 Methods for Implementation of the CSM 163
3.1 Description and Prediction in Cross-Sectional and Longitudinal Studies 163
3.1.1 Illness Representations 163
3.1.2 Prototype Checks 164
3.1.3 Prototype Checks Connect Representations to Context 164
3.1.4 Treatment Representations 165
4 The CSM: A Conceptual Tool for Generating Interventions 166
4.1 Many Paths to Outcomes: Focusing Clinical Experiments and Trials 166
4.1.1 ''Needs'' Assessment 166
4.1.2 Participant Selection 167
4.1.3 Identifying Moderators and Mediators 167
4.1.4 Identifying Gaps and/or Targets for Change 167
4.2 Implementing Interventions 167
4.2.1 Implementing Illness Representations 168
4.2.2 Implementing Treatment Representations 168
4.2.3 Implementing Action Plans 169
4.3 Practitioner Participant Relationships: Executive Function and Expert Performance 169
4.3.1 Executive Function 170
References 171
12 Conceptualization, Measurement, and Analysis of Negative Affective Risk Factors 174
1 Overview of Recent Research 175
2 Conceptual Foundations 176
2.1 Essential Distinctions 176
2.1.1 Distinctions Among Negative Affects 176
2.1.2 Distinctions Among Types of Affective Phenomena 176
2.2 Empirical Challenges to Conceptual Distinctions 177
2.2.1 Specific Symptoms Scales Are Often Indistinguishable 177
2.2.2 Symptoms of Emotional Distress Overlap with Personality Traits 178
2.2.3 Emotional Disorders and Personality Traits Overlap 178
2.2.4 Diagnosed Emotional Disorders Are Not Discrete Categories 178
2.3 Implications 179
3 Measurement 180
3.1 Models of the Domain 180
3.2 Evaluating Measures 180
3.3 Considering Temporal Factors in the Measurement Strategy 181
3.4 Methods of Measurement 181
4 Analysis 181
4.1 Approaches to Confounding and Statistical Control 182
4.2 Recommendations 183
5 Conclusions and Implications 184
References 184
13 Hostility and Health 188
1 Components and Definitions 188
2 Origins of Hostile Predispositions 189
2.1 Developmental Influences 189
2.2 Effects of Adult Adversity 190
2.3 Genetic and Physiological Influences 190
2.4 Social Environment 192
3 Hostility and Health Outcomes 192
3.1 Coronary Disease Development 192
3.2 Prognosis in Those with Established Coronary Disease 193
3.3 Total Mortality and Other Diseases 193
3.4 Demographic Factors, Hostility, and Health Risks 194
4 Mechanisms 194
4.1 Social Stressors 194
5 Physiological Links Between Social Stress and Disease Processes 195
6 Health Behaviors 196
7 Interventions 196
References 198
14 Positive Well-Being and Health 203
1 Introduction 203
1.1 The Nature of Positive Well-Being 203
1.2 The Determinants of Positive Well-Being 204
2 Positive Well-Being and Health-Protective Characteristics 204
3 Positive Well-Being and Physical Health 205
4 Pathways Linking Positive Well-Being with Health 207
5 Psychological Well-Being and Health Behaviors 208
6 Biological Processes Linking Positive Well-Being and Health 208
6.1 Experimental Studies of Biology and Well-Being 209
6.2 Naturalistic Physiological Monitoring Studies 210
7 Interventions and Implications for Health 211
8 Conclusions 211
References 211
15 Coping and Health 214
1 Stress 214
1.1 Appraisals and Psychological Stress 214
1.1.1 Physiological Responses 215
2 Coping 216
2.1 Emotion-Focused and Problem-Focused Coping 216
2.2 Approach and Avoidance Coping 217
2.3 Positive, Meaning-Focused, and Spiritual Coping 217
2.4 Conclusions and Methodological Issues 218
3 Stress, Coping, and Health 218
3.1 What Is Health? 218
3.2 Coping and Health: Behavioral Pathways 219
3.3 Psychophysiological Pathways 219
3.4 Cautions and Qualifications 221
4 Coping Interventions for Disease Populations 221
References 222
Part III Social and Interpersonal Processes 226
16 Experimental Approaches to Social Interaction for the Behavioral Medicine Toolbox 227
1 Thioamine Acetylase Paradigm for Studying Illness Cognition 228
2 Trier Social Stress Test (TSST) Paradigm 230
3 Mental Harassment in the Context of Hostility and Cardiovascular Risk 232
4 Social Support in the Context of Behavioral Stress 233
5 Experimental Research on Advanced Directives 235
6 Conclusions 236
References 236
17 Social Support and Physical Health: Links and Mechanisms 240
1 Social Support and Health 240
2 Social Support: Definitions and Measurement 240
3 Social Support: Links to Physical Health Outcomes 241
3.1 Direct Versus Buffering Effects of Social Support on Health 243
4 Social Support and Health: Pathways 243
4.1 Psychological Pathways 243
4.2 Behavioral Pathways 244
4.3 Biological Pathways 244
5 Modifying Factors 246
6 Intervention Research 246
7 Future Directions 247
References 248
18 Social Networks and Health 252
1 Definitions and Measurement 252
2 Mechanisms Linking Social Networks to Health Outcomes 253
3 The Empirical Evidence Based Linking Social Networks to Health 254
3.1 All-Cause Mortality 255
3.2 Cardiovascular Disease 261
3.3 Cancer 261
3.4 Cognitive Decline 266
4 Future Directions 266
5 Conclusion 273
References 273
19 Social Norms and Health Behavior 277
1 Defining Norms 277
1.1 Differentiating Between Classes of Norms 277
2 Relationships of Norms to Health Behaviors 278
3 Social Norms Theory 279
3.1 The Extent of Misperceptions 279
3.2 Sources of Normative Misperceptions 280
3.3 Consequences of Misperceptions for Behaviors 280
3.4 Applications of Social Norms Theory to Behavior Change 281
3.5 Unsuccessful Social Norms Interventions: Problems and Solutions 282
4 Additional Applications of Norms to Behavior Change 283
5 Media Influence on Health Behaviors 284
6 Conclusion 285
References 285
20 Social Marketing: A Tale of Beer, Marriage, and Public Health 289
1 Introduction: It Is About People 289
2 Eight Ways of Putting People First 293
2.1 Clear Behavioral Objectives 293
2.2 Navigational Research 294
2.3 Building on Theory 294
2.4 Creating Attractive Motivational Exchanges with the Target Group 295
2.5 Recognizing that One Size Does Not Always Fit All 295
2.6 Thinking Beyond Communications 296
2.7 Thinking Beyond the Individual 298
2.8 Paying Careful Attention to the Competition 299
3 The Vital Role of Strategic Planning 299
4 Final Thoughts 300
References 301
Part IV Epidemiological and Population Perspectives 302
21 Assessment of Psychosocial Factors in Population Studies 303
1 Overview 303
2 Historical Perspective on Psychosocial Factors in Population Health 303
3 Rationale for Assessment of Psychosocial Constructs 305
4 Methods of Assessing Psychosocial Factors 309
4.1 Personality Characteristics 310
4.2 Emotional States 311
4.3 Chronic Stress and Stressors 312
4.4 Social Relationships 312
5 Advantages and Disadvantages of Self-Report Psychosocial Assessments 312
6 Future Directions 313
6.1 Multiple Psychological and Social Influences on Population Health 313
6.2 Factors Unique to Immigrant Groups and Minority Populations 314
6.3 Cultural Framework of Assessment Tools 314
6.4 Measurement and Modeling Issues 314
6.5 Pathways from Psychosocial Factors to Health and Illness 315
7 Summary 315
References 315
22 Socio-economic Position and Health 319
1 Introduction 319
2 Social Stratification and Social Class 319
2.1 Measures of Socio-economic Position 320
2.2 Education 320
2.3 Income, Wealth and Consumption 321
2.4 Occupational Class 321
2.5 Adjusting for Socio-economic Position 323
2.6 Relative or Absolute Differences 323
3 Explanations for the Association Between Socio-economic Position and Health 324
3.1 Health-Selection Explanations 325
3.2 Cultural/Behavioural Explanations 325
3.3 Materialist Explanations 326
3.4 Psychosocial Factors 326
3.5 Neo-material Explanations 327
3.6 Life Course Factors 328
3.7 Ecological Factors 328
4 Policy Implications 328
4.1 Health Gaps or Gradients 328
4.2 Social Mobility 329
4.3 The Role of Health Services and Inter-sectoral Government Action 330
5 Conclusion 330
References 331
23 Race, Ethnicity, and Health in a Global Context 333
1 Introduction 333
2 Definitions and Uses of Race and Ethnicity 334
3 The Significance of Race and Ethnicity for Health 338
4 Race/Ethnic Heterogeneity in Health Status 340
5 Mechanisms Through Which Race and Ethnicity May Affect Health 340
5.1 Socioeconomic status 340
5.2 Discrimination, Racism, and Stress 341
5.3 Medical Care 343
5.4 Immigration and Resources for Health 344
6 Future Research Directions 346
References 348
24 Neighborhood Factors in Health 352
1 Introduction 352
2 Brief Summary of Past Work on Neighborhoods and Behavioral Outcomes 353
2.1 Physical Activity 353
2.2 Diet 354
2.3 Body Mass Index and Obesity 354
2.4 Summary 355
3 Theoretical and Methodological Considerations 355
3.1 Conceptualization and Measurement of Neighborhoods 355
3.1.1 Spatial Scale 356
3.2 Measuring Neighborhood Exposures 358
3.2.1 From Psychometrics to Ecometrics 360
3.3 Improving Study Design and Causal Inference 360
3.4 Causal Diagrams 361
3.4.1 Randomization 361
3.5 Accounting for Time and Life-Course Effects 361
4 Conclusion 362
References 362
25 Health Literacy: A Brief Introduction 366
1 Introduction 366
2 Definition and Measurement 366
3 Epidemiology of Limited Health Literacy 367
3.1 Extent and Associations 368
3.1.1 Health Knowledge 368
3.1.2 Health Behavior 368
3.1.3 Health Status 369
3.2 Causal Pathways 369
4 Health Literacy Interventions 370
4.1 Enhancing Print Materials 370
4.1.1 Utilizing Visual Aids 371
4.2 Improving Oral Communication Skills 371
4.3 Simplifying Health Systems 372
4.4 Long-Term Strategies 372
4.5 To Screen or Not to Screen 373
5 Conclusion 373
References 373
26 Screening and Early Detection of Cancer: A Population Perspective 377
1 The Public Health Context of Screening 377
2 Screening and Cancer Control 377
3 Characteristics of Good Screening Tools 378
4 Provision of Cancer Screening Services 379
5 Optimizing Screening Uptake 380
6 Predictors of Uptake 381
6.1 Demographic Factors 381
6.1.1 Sex 381
6.1.2 Age 381
6.1.3 Marital Status 382
6.1.4 Socio-economic Status 382
6.1.5 Ethnicity 382
6.2 Psychosocial Predictors 383
6.2.1 Cognitive Factors 383
6.2.2 Emotional Factors 383
6.3 Practical and Service-Level Factors 383
7 Intention Versus Action 384
8 Interventions to Promote Uptake 384
9 Psychological Impact 385
9.1 Overall Impact of Screening Programs 385
9.2 Impact of a Normal Screening Result 385
9.3 Impact of Abnormal Results 385
9.4 Interventions to Reduce Negative Psychological Consequences of Screening 386
10 Issues for Future Research 386
10.1 Tackling Inequalities 386
10.2 Shift of Boundary Between Risk and Disease 387
10.3 Informed Decision-Making 387
11 Conclusion 388
References 388
27 The Impact of Behavioral Interventions in Public Health 392
1 Introduction 392
2 The Public Health Case for Behavioral Interventions 392
3 Creating the Evidence Base 393
4 What Has Deterred Wider Impact? 395
4.1 Translation of Evidence to Practice 395
4.2 Failure to be Holistic 396
4.3 Limited Use of Behavioral Models 396
5 Public Health as Social Movement 398
6 The Need for Robust Tools and Methods 400
6.1 Social Network Analysis 400
6.2 Hierarchical Linear Modeling 400
6.3 Geographical Information Systems 401
6.4 Health Impact Assessment (HIA) 401
6.5 Social Movement Assessment 401
7 Conclusion 401
References 402
Part V Genetic Process in Behavioral Medicine 405
28 Quantitative Genetics in Behavioral Medicine 406
1 Introduction 406
2 Genetic Variance 408
2.1 Monogenetic Trait Variation 408
2.2 Polygenetic Trait Variation 410
3 Heritability Estimation 411
3.1 Twin Design 413
3.2 Structural Equation Models 415
4 Twin Studies on Cardiovascular Traits Often Used in Behavioral Medicine 418
5 Multivariate Structural Equation Models 418
5.1 Genetic and Environmental Correlation 420
6 GeneEnvironment Interaction 422
7 GeneEnvironment Correlation 424
8 Ongoing Evolution of Structural Equation Models for Twin Family Data 425
9 Conclusion 426
References 427
29 Candidate Gene and Genome-Wide Association Studies in Behavioral Medicine 430
1 Introduction 430
2 A (Very) Short Introduction to Molecular Genetics 431
3 Candidate Gene Association Studies 432
3.1 Cohort Studies: Continuous/Quantitative Traits 434
3.2 Case--Control Studies: Disease Traits 435
3.3 Gene Gene and Gene Environment Interaction 435
3.4 Power and Sample Size Considerations 435
3.5 Non-significance, Non-replication, and Inconsistency 437
4 Genome-Wide Association (GWA) Studies 437
4.1 Quality Control 438
4.2 Imputation of SNPs 439
4.3 Association Analysis 439
4.4 Multiple Testing 440
4.5 Population Stratification 441
4.6 Interaction and Haplotype Analysis 441
4.7 Meta-analysis 442
4.8 Copy Number Variants (CNVs) 443
4.9 Genetical Genomics 443
5 Beyond Genome-Wide Association Studies 443
5.1 Rare Variants 443
5.2 Identification of Causal Variants 443
5.3 Clinical Relevance and Disease Prediction 444
6 Conclusions 444
References 444
30 Functional Genomic Approaches in Behavioral Medicine Research 449
1 Genomics Primer 449
1.1 Basics of Protein Synthesis 449
1.2 Determinants of Gene Expression 450
1.3 Measuring Gene Expression 452
2 Functional Genomics in Action 452
2.1 Background 453
2.2 Differential Gene Expression 454
2.3 Inflammatory Consequences 455
2.4 Underlying Mechanisms 456
2.5 Implications 456
2.6 Applicability 457
3 Conclusions 457
References 457
31 Genetics of Stress: Gene--Stress Correlationand Interaction 460
1 Introduction 460
1.1 Conceptualization and Measurement of Stress 460
2 GeneEnvironment Correlation 462
3 GeneStress Correlation 462
3.1 Stressful Life Events 462
3.2 Traumatic Experiences 464
3.3 Parenting and Family Environments 464
3.4 Perceived Stress and Social Support 465
3.5 Summary of Gene--Stress Correlation 466
4 GeneEnvironment Interaction 467
4.1 Examples of Gene--Environment Interaction 467
5 GeneStress Interaction 468
5.1 Gene--Stress Interaction: Life Events and Other Natural Stressors 469
5.1.1 Gene--Stress Interaction and the Challenge of Replication 470
5.2 Gene--Stress Interaction: Acute Stressors 473
6 Conclusions 475
References 477
32 Nicotine Dependence and Pharmacogenetics 484
1 Introduction 484
1.1 The Magnitude of the Problem 484
1.2 The Neurobiology of Nicotine Dependence 484
2 Heritability of Nicotine Dependence 485
2.1 Smoking Initiation and Dependence 485
2.2 Smoking Cessation and Persistence 485
3 Genetic Studies of Smoking Among Adolescents 485
3.1 Pharmacokinetic Candidate Genes 485
3.2 Pharmacodynamic Candidate Genes 486
3.2.1 Nicotinic Pathway Genes 486
3.2.2 Dopaminergic Pathway Genes 487
3.2.3 Serotonergic Pathway Genes 487
4 Genetic Studies of Smoking Among Adults 487
4.1 Linkage Studies 487
4.2 Pharmacokinetic Candidate Genes 488
4.3 Pharmacodynamic Candidate Genes 488
4.3.1 Nicotinic Pathway Genes 488
4.3.2 Dopaminergic Pathway Genes 489
4.3.3 Serotonergic Pathway Genes 489
4.3.4 Endogenous Opioid Pathway Genes 490
4.3.5 GABA-ergic Pathway 490
4.3.6 Miscellaneous Genes 490
5 Pharmacogenetic Studies of Nicotine Replacement Therapy 490
5.1 Pharmacokinetic Candidate Genes 490
5.2 Pharmacodynamic Candidate Genes 491
5.2.1 Nicotinic Pathway Genes 491
5.2.2 Dopaminergic Pathway Genes 491
5.2.3 Serotonergic Pathway Genes 491
5.2.4 Endogenous Opioid Pathway Genes 492
6 Pharmacogenetic Studies of Bupropion 492
6.1 Pharmacokinetic Candidate Genes 492
6.2 Pharmacodynamic Candidate Genes 493
6.2.1 Nicotinic Pathway Genes 493
6.2.2 Dopaminergic Pathway Candidate Genes 493
6.3 Summary of Pharmacogenetic Findings 493
7 Genetic Studies of Nicotine Dependence Endophenotypes 493
7.1 Genetic Associations with Nicotine Reward 493
7.2 Genetic Associations with Nicotine Sensitivity 494
7.3 Genetic Associations with Mood-Related Measures 494
7.4 Genetic Associations with Smoking Phenotypes in Neuroimaging Studies 494
8 Conclusions and Future Directions 495
8.1 Nicotine Dependence 495
8.2 Smoking Cessation 496
8.3 Future Directions 496
References 496
33 Genetics of Obesity and Diabetes 504
1 Introduction 505
2 Obesity 506
2.1 Candidate Gene Studies 506
2.2 Genome-Wide Studies 508
2.2.1 Genome-Wide Linkage Studies 508
2.2.2 Genome-Wide Association Studies 510
2.3 Obesity Susceptibility Genes, Food Intake and Energy Expenditure 513
3 Type 2 Diabetes 513
3.1 Candidate Gene Studies 513
3.2 Genome-Wide Studies 515
3.2.1 Genome-Wide Linkage Scans 515
3.2.2 Genome-Wide Association Studies 515
4 Genetic Prediction of Obesity and Diabetes 519
5 GeneEnvironment Interactions in Obesity and Diabetes 519
6 Future Directions 521
References 522
Part VI Development and the Life Course 527
34 A Life Course Approach to Health Behaviors: Theory and Methods 528
1 Introduction 528
2 Life Course Epidemiology 529
2.1 Life Course Epidemiology: Theoretical Models 529
2.2 Critical Period Versus Sensitive Periods 531
2.3 How Do We Disentangle the Different Life Course Models? 531
2.4 Methodological Challenges Encountered in Studying the Life Course 532
3 Life Course Perspective on Health Behavior Models 532
3.1 Individual-Level Models 532
3.2 Interpersonal Models 533
3.3 Community-Level Models 533
3.4 Ecological Perspective 533
4 Life Course Framework for Health Behavior 534
4.1 Socioeconomic Environment in Childhood and the Initiation and Maintenance of Health Behaviors 535
4.2 Initiation 536
4.3 Maintenance 536
4.4 Education 536
4.5 Tracking from Childhood and Adolescence into Adult Life 537
4.6 Behavioral Capital 537
4.7 Adult Transitions 537
5 Implications for Policy 538
6 Future Research 538
7 Conclusion 539
References 539
35 Prenatal Origins of Development Health 543
1 Introduction 543
2 Maternal Investment and Fetal Priming Within an Evolutionary Framework 545
3 The Link Between Birth Weight and Later Health 547
4 Prenatal Antecedents of Allergies and Asthma 549
5 Challenges to Fetal Well-being: Maternal Stress 550
6 The Mixed Blessing of Antenatal Corticosteroids 552
7 The Risks Posed by Prenatal and Perinatal Infection 553
8 Other Mediating Pathways of Importance: The Significance of Maternal Iron 554
9 Conclusion 555
References 556
36 The Impact of Early Adversity on Health 561
1 Early Family Environment 561
2 Childhood Socioeconomic Status 561
3 Early Family Environment 562
4 Genes and GeneEnvironment Interactions 563
5 Emotion Regulation 563
6 Social Skills 564
7 Chronic Negative Affect 564
8 Health Habits 565
9 Neural Regulation of Stress Responses 565
10 Impact of Early Environment on Biological Stress Responses 567
11 Early Adversity and Health Outcomes: Tests of the Model 568
12 Conclusions 569
References 569
37 Health Disparities in Adolescence 573
1 Introduction 573
2 Socioeconomic Disparities in Health Outcomes in Adolescence 573
3 Reasons for Why These Disparities Might Exist in Adolescence 576
3.1 Individual Level: Child Health Behaviors 576
3.2 Individual Level: Child Psychological Characteristics 577
3.3 Family Factors 577
3.4 Neighborhood Factors 578
3.5 Access to Care 579
3.6 Biological Pathways 580
4 Conclusion 581
References 582
38 Reproductive Hormones and Stages of Life in Women: Moderators of Mood and CardiovascularHealth 586
1 Menstrually Related Mood Disorders 586
1.1 Diagnosis and Prevalence 586
1.2 Pathogenesis of PMDD 586
1.2.1 Review of the Menstrual Cycle and Role of Gonadal Steroid Hormones in PMDD 586
1.2.2 Assessing Menstrual Cycle Phase and Cardiovascular Stress Reactivity in PMDD 587
1.2.3 The Role of Historical Factors in the Pathogenesis of PMDD 588
1.2.4 Progesterone-Derived GABAergic Neurosteroids in PMDD 588
1.3 Conclusions and Future Research Directions 589
2 Oxytocin and Vasopressin: Information from Animal Models 590
2.1 Oxytocin and Vasopressin: Information from Human Studies 592
2.2 Conclusions and Future Directions 594
3 The Menopause: Determining Female Reproductive Stage 594
3.1 Estrogen Deprivation Increases Risk for Depression and Medical Illness 595
3.2 Estrogen Replacement for Depression, Cardiovascular Disease, and Osteoporosis in Peri- and Postmenopausal Women 596
3.3 Conclusions and Future Research Directions 597
4 General Conclusions 598
References 598
39 Aging and Behavioral Medicine 603
1 The Importance of Aging 603
2 Aging and Behavioral Aspects 604
2.1 Social Function in Old Age 604
2.2 Psychological Function in Old Age 604
2.3 Lifestyle Behaviors in Old Age 606
3 Impact of Behavioral Factors on Health Outcomes in the Older Population 606
3.1 Mortality and Morbidity 606
3.2 Aging-Related Outcome: Physical Decline and Disability 607
3.3 Aging-Related Outcome: Frailty 609
3.4 Aging-Related Outcome: Cognitive Impairment 609
4 Specific Considerations for Behavioral Medicine in the Aging Population 610
4.1 Selective Survival 610
4.2 Somatic Confounding 611
4.3 Differential Role of Physiological Stress Mechanisms in the Oldest Old 611
5 Concluding Remarks 612
References 613
Part VII Biological Measures and Biomarkers 616
40 Use of Biological Measures in Behavioral Medicine 617
1 Introduction 617
2 Biological Measures in Animal Experiments 617
3 Population-Level Epidemiological Studies 618
3.1 Biomarkers of Disease State 618
3.2 Biological Indicators of Health or Resistance to Disease 619
3.3 Interpretation of Biomarker Results in Population Studies 620
4 Psychophysiological Stress Testing 622
5 Naturalistic and Ambulatory Monitoring of Biological Variables 623
5.1 Cortisol 623
5.2 Cardiovascular Measures 624
5.3 Musculoskeletal Measures 625
5.4 New Developments in Ambulatory Monitoring Devices 626
5.5 Summary and Limitations 626
6 Conclusions 628
References 628
41 Laboratory Stress Testing Methodology 631
1 Introduction 631
2 The Laboratory Setting May Have Powerful, Unintended Effects 632
2.1 Experimenter Characteristics 632
2.2 Experimenter Behavior 633
2.3 Delivery of Instructions 633
2.4 The Social Context 634
2.5 Evaluation Apprehension 634
2.6 Demand Characteristics 635
2.7 Experimenter Expectancies 635
3 Methodological and Procedural Considerations 635
3.1 Between-Subjects and Within-Subjects Designs 635
3.2 Use of Multiple Stressors Within a Single Session 636
3.3 Inter-task Baseline 637
3.4 Sampling Framework Is Specific to the Biological Outcomes 637
3.5 Pre-session Instructions and Controls 638
4 The Experimental Session 639
4.1 Adaptation 639
4.2 Instructions 639
4.3 Instrumentation 639
4.4 Baseline 639
4.5 Exposure to Stress 640
5 Selection of the Stressor 640
5.1 Conceptuality 640
5.2 Feasibility 640
5.3 Psychometric Properties 640
5.4 Usage 641
6 Stressor/Task Domains and Specific Tasks 641
6.1 Active Coping 641
6.2 Emotional Arousal 641
6.3 Social Interaction Tasks, Speech Tasks 642
6.3.1 The Trier Social Stress Test (TSST) 642
6.4 The Cold Pressor 642
6.5 Duration of Stressor Exposure 642
7 Manipulation Checks/Probe Measures 643
8 Statistical/Measurement Issues 643
8.1 Measurement Reliability 643
8.2 Type I Error 644
8.3 Assessment of Post-Stress Recovery 645
9 Summary and Conclusion 645
References 645
42 Stress and Allostasis 647
1 Introduction 647
2 Stress and Allostatic Overload-Related Illnesses 650
3 Circadian Timing: Brain and Body Clocks 651
3.1 Disruption of Circadian Rhythms as an Allostatic State 653
3.2 Circadian Dysfunction Is a Hallmark of Many Physical and Neural Disorders 653
4 Concluding Remarks 654
References 655
43 Neuroendocrine Measures in Behavioral Medicine 657
1 Scope of Neuroendocrine Research 657
1.1 Neuroendocrine Systems 657
1.1.1 The Hypothalamic--Pituitary Unit 657
1.1.2 Inhibitory Feedback Regulation of Neuroendocrine Activity 658
1.2 Methodological Aspects: What Sort of Biological Samples Are Useful? 658
1.3 Methodological Aspects: When to Measure Neuroendocrine Markers? 659
1.3.1 Basal Hormone Assessment and Endocrine Circadian/Ultradian Rhythms 659
1.3.2 Challenge Tests 659
1.4 Confounding Factors in Neuroendocrine Research 659
2 The HypothalamicPituitary Adrenal Axis 660
2.1 Cortisol Awakening Rise and Day Profiles 660
2.2 The HPA Axis Under Challenge 661
3 The HypothalamicPituitary Gonadal Axis 662
4 HypothalamicPituitaryThyroid Axis 663
5 The HypothalamicPituitary Growth Hormone Axis 663
6 The Prolactinergic System 664
7 The Oxytocinergic System 664
8 The Vasopressinergic System 664
9 The Sympatho-Adrenal-Medullary System 664
10 Insulin and the Pancreas 665
11 Summary and Outlook 665
References 666
44 Immune Measures in Behavioral Medicine Research: Procedures and Implications 669
1 Introduction 669
2 Circulatory Measures 669
2.1 Natural Killer Cells 669
2.1.1 Clinical Studies Involving Natural Killer Cells 670
2.2 T Cells 670
2.2.1 Clinical Studies Involving T Lymphocytes 672
2.3 Reactivation of Latent Herpes Viruses 673
2.3.1 Clinical Studies Involving the Reactivation of Latent Viruses 673
3 Elicited Functional Measures 674
3.1 Wound Healing 674
3.1.1 Clinical Studies of Wound Healing 675
3.2 Experimental Infection and Vaccination 675
3.2.1 Clinical Studies Involving Experimental Infection and Vaccination 676
4 Importance of Animal Models 677
5 Conclusion 678
References 679
45 Circulating Biomarkers of Inflammation, Adhesion, and Hemostasis in Behavioral Medicine 682
1 Cytokines: Description and Classification 682
1.1 Cytokines: Central Nervous System (CNS) Interactions 683
1.2 Cytokines: Hypothalamic--Pituitary--Adrenal Axis (HPA) Interactions 683
1.3 Cytokines, Stress, Negative Affect, and Sleep 684
1.3.1 Cytokines and Acute Stress 684
1.3.2 Cytokines and Chronic Stress 685
1.3.3 Cytokines and Fatigue 686
1.3.4 Cytokines and Depression 686
1.3.5 Cytokines and Sleep 687
1.4 Cytokine Measurement 687
2 Leukocyte Trafficking and Cellular Adhesion Molecules 689
2.1 CAMs and Behavioral Stressors 689
2.1.1 CAMs and Acute Behavioral Stressors 689
2.1.2 CAMs and Chronic Behavioral Stressors 690
2.2 Underlying Mechanisms and Mediators: Sympathetic Nervous System (SNS) and Hypothalamic--Pituitary--Adrenal (HPA) Cortical Axis Activation 690
2.3 CAM Measurement 691
3 Hemostasis 691
3.1 Hemostasis Factors and Cardiovascular Disease 692
3.2 Effects of Behavioral Stressors and Negative Affect on Hemostasis 693
3.2.1 Acute Stressors 693
3.2.2 Modulators of the Acute Procoagulant Stress Response 693
3.2.3 Hemostasis and Chronic Stressors 695
3.2.4 Hemostasis and Negative Affect 695
3.3 Physiological Mechanisms of Acute and Chronic Stress Effects on Hemostasis 695
3.4 Coagulation Measurement 696
4 Inflammation, Adhesion, and Hemostasis: Clinical Relevance and Future Directions in Behavioral Medicine 696
References 697
46 The Metabolic Syndrome, Obesity, and Insulin Resistance 701
1 Defining the Metabolic Syndrome 701
2 Epidemiology of Obesity and the Metabolic Syndrome 705
3 Lifestyle Modification of the Metabolic Syndrome, Type 2 Diabetes, and CVD 705
4 Pathophysiology of the Metabolic Syndrome 707
5 Assessment of the Metabolic Syndrome and Insulin Resistance 709
5.1 Insulin Resistance and Hyperglycemia 709
5.2 Dyslipidemia 711
5.3 Blood Pressure 711
5.4 Obesity and Waist Circumference 711
6 Conclusion 712
References 712
47 The Non-invasive Assessment of Autonomic Influences on the Heart Using Impedance Cardiography and Heart Rate Variability 718
1 Autonomic Balance and Health 718
2 Aspects of Cardiac Function: Chronotropy, Inotropy, and Dromotropy 719
3 The Baroreflex 720
4 Impedance Cardiography 721
4.1 The Genetics of Impedance Derived Measures 723
4.2 Summary 723
5 Heart Rate Variability 724
5.1 Physiological Regulation 725
5.2 Emotional Regulation 725
5.3 Cognitive Regulation 726
5.4 Models of Neural Control of HRV 726
5.4.1 The Polyvagal Theory 726
5.4.2 The Model of Neurovisceral Integration 726
5.5 Measures of HRV 727
5.6 Time Domain Indices of HRV 727
5.7 Frequency Domain Indices of HRV 728
5.7.1 The Ultra low-Frequency Band: 0.003 Hz 728
5.7.2 The Very Low-Frequency Band: 0.003 0.04 Hz 729
5.7.3 The Low-Frequency Band: 0.04 0.15 Hz 729
5.7.4 The High-Frequency Band: 0.15 0.4 Hz 729
5.8 The Genetics of HRV 731
5.9 Summary 731
6 Conclusion 731
References 732
48 Cardiac Measures 736
1 Myocardial Imaging 736
1.1 SPECT Imaging 736
1.2 MUGA Imaging 737
1.3 PET Imaging 738
1.4 CT Angiography 738
1.5 Cardiac MRI 738
2 Peripheral Arterial Tonometry (PAT) 739
3 Electrocardiogram (ECG) Measures 739
3.1 Standard 12 Lead and Ambulatory Monitoring 739
3.2 ECG Responses to Stress 740
4 ECHO Measurements 741
5 Differences Between Exercise and Psychological Stress-Induced Cardiac Responses 741
6 Summary 741
References 741
49 Behavioral Medicine and Sleep: Concepts, Measures, and Methods 743
1 Introduction 743
2 Dimensions of Sleep Important to Health and Functioning 744
2.1 Sleep Duration 744
2.1.1 Sleep Duration: Definitions and Measurement 744
2.1.2 Sleep Duration and Health: Evidence 746
2.2 Sleep Continuity 748
2.2.1 Sleep Continuity: Definitions and Measurement 748
2.2.2 Sleep Continuity and Health: Evidence 749
2.3 Sleep Architecture 750
2.3.1 Sleep Architecture: Definitions and Measurement 750
2.3.2 Sleep Architecture and Health: Evidence 751
2.4 Sleep Quality 752
2.4.1 Sleep Quality: Definitions and Measurement 752
2.4.2 Sleep Quality and Health: Evidence 752
3 Behavioral Medicine and Sleep: Future Directions 753
References 754
Part VIII Brain Function and Neuroimaging 760
50 Neuroimaging Methods in Behavioral Medicine 761
1 Overview of Neuroimaging Methods 761
2 Functional Neuroimaging Methods 761
2.1 Positron Emission Tomography 762
2.2 Functional Magnetic Resonance Imaging 763
2.3 Arterial Spin Labeling 765
3 Structural MRI Methods 766
3.1 Volumetric MRI 766
3.2 Diffusion MRI 766
4 Neurochemical Imaging 766
4.1 Magnetization Transfer MRI 766
4.2 Magnetic Resonance Spectroscopy 766
5 Electrophysiological and Optical Imaging 767
5.1 Electroencephalograph (EEG) 767
5.2 Magnetoencephalography (MEG) 767
5.3 Optical Imaging 768
5.3.1 Near InfraRed Spectroscopy (NIRS) 768
5.3.2 Event-Related Optical Signal (EROS) 768
6 Some Basic Design Principles in Functional Neuroimaging 769
7 Summary 770
References 771
51 Applications of Neuroimaging in Behavioral Medicine 774
1 Value of Neuroimaging Applications in Medicine 774
2 Behavioral Medicine Applications 774
2.1 Psychological Processes 774
2.2 Social and Interpersonal Processes 776
2.3 Genetic Processes 777
2.4 Development and the Life Course 780
2.5 Biomarkers 780
2.6 Behavioral and Psychosocial Intervention 781
2.7 Neuroimaging and Treatment 783
2.8 Epidemiology and Population 783
3 Stress Reactivity 783
4 Conclusions 787
References 788
52 Neuroimaging of Depression and Other Emotional States 794
1 Introduction 794
2 Normative Emotional States 796
3 Overview of Brain Changes in MDD 798
4 Structural Brain Changes in MDD 799
5 Functional Brain Changes in MDD 800
6 Changes in Brain Function due to Antidepressant Treatment 802
7 Brain-Based Treatments of Depression 803
8 Conclusions 804
References 804
53 The Electric Brain and Behavioral Medicine 811
1 Introduction 811
2 Cardiovascular Disease 813
3 Diabetes and Neuroendocrine Disorder 815
3.1 Hypoglycemia 815
3.2 Hypoglycemic Awareness 816
3.3 Long-Term Effects of Diabetes 817
4 EEG and the Effects of Hormone Treatment 817
5 Stress 818
6 Cancer 819
7 Immunological Disorders 820
7.1 Hepatitis B and C 820
7.2 Human Immunodeficiency Virus and Lupus 820
8 Chronic Pain 821
8.1 Fibromyalgia 821
8.2 Chronic Fatigue Syndrome 822
8.3 Rheumatoid Arthritis and Low Back Pain 823
9 Respiratory Diseases 823
10 Kidney/Blood Diseases 824
11 Health Behaviors 825
12 Biofeedback 826
13 Conclusion 827
14 Appendix 827
References 829
Part IX Statistical Methods 833
54 Reporting Results in Behavioral Medicine 834
1 Introduction 834
2 Some General Principles 835
3 The Introduction and Background Section 835
4 The Methods Section 836
4.1 Design Considerations 836
4.2 Describing Measures 837
4.3 The Analytic Plan 838
4.4 The Confirmatory Versus Exploratory Continuum 840
4.5 Statistical Power 841
5 The Results Section 841
5.1 Describing the Sample 841
5.2 Primary Results 842
5.3 Secondary Outcomes and Analyses 842
5.4 Some Specific Cases 843
5.4.1 Group Means or Frequencies 844
5.4.2 Multivariable Models: Some General Considerations 844
5.4.3 Results from Regression Models 847
5.4.4 Confounding and Mediation 849
6 Tables 850
7 Graphics 851
8 Interpretation 854
References 855
55 Moderators and Mediators: The MacArthur Updated View 858
1 Introduction 858
2 M Moderates the Effect of T on O 860
3 M Mediates the Effect of T on O 860
4 Issues Raised in the Consideration of the MacArthur Approach 861
4.1 Cross-Sectional and Longitudinal Studies 861
4.2 Variable Definition 861
4.3 First Moderation, then Mediation 861
4.4 The Problem of Causal Inferences 862
4.5 When Treatment Choice Moderates Event/Change on Outcome 863
4.6 How Distinct Must M,T,O Be? 863
5 Extensions to Other Relationships 863
5.1M Is Proxy to T with Respect to O 863
5.2 M and T Are Overlapping Risk Factors with Respect to O 864
5.3 M and T Are Independent Risk Factors for O 864
6 Implementation Questions 864
6.1 Population Specificity 864
6.2 Studies to Detect and to Confirm Moderation or Mediation 865
6.3 ''Proving'' Lack of Correlation 865
6.4 The Clinical Significance of Moderation/Mediation? 865
6.5 Will Methods Developed for the B''K Model Still ''Work'' with the MacArthur Model? Will Conclusions Change? 866
7 Conclusions 868
References 868
56 Multilevel Modeling 870
1 Introduction 870
2 Multilevel Framework: A Necessity for Understanding Ecologic Effects 871
3 A Typology of Multilevel Data Structures 872
4 The Distinction Between Levels and Variables 873
5 Multilevel Analysis 873
5.1 Evaluating Sources of Variation: Compositional and/or Contextual 873
5.2 Describing Contextual Heterogeneity 874
5.3 Characterizing and Explaining the Contextual Variations 874
6 Specifying Multilevel Models 875
7 Variance Component or Random Intercepts Model 875
8 Modeling Places: Fixed or Random? 876
9 Random Coefficient or Random Slopes Model 878
10 Modeling the Fixed Effect of a Neighborhood Predictor 879
11 Exploiting the Flexibility of Multilevel Models to Incorporating Realistic Complexity 880
12 Summary 881
References 881
57 Structural Equation Modeling in Behavioral Medicine Research 883
1 Introduction 883
2 Model Specification 883
2.1 Notation 884
2.2 Path Diagram 884
3 Parameter Estimation and Model Fit 886
3.1 Path Analysis 887
3.2 Model Parameters 888
4 Measurement Model 888
4.1 Measurement Model Parameters 890
4.2 Formative Indicators 890
5 Mean Structures 890
6 Multiple Groups 891
7 Latent Growth Model 891
7.1 Latent Difference Scores 892
8 Missing Data 892
9 Sample Size and Power 893
10 Categorical Outcomes 893
11 Latent Class and Mixture and Multilevel Models 894
12 Concluding Comments 894
References 894
58 Meta-analysis 897
1 Introduction 897
2 Effect Sizes 897
2.1 Studies Measuring Outcomes on a Binary Scale 898
2.2 Studies Measuring Outcomes on a Continuous Scale 899
3 Combining Estimates of Effect Size Across Studies 900
3.1 Fixed Effects Methods Combining Estimates 900
3.1.1 Example 901
3.2 Mantel-Haenszel Methods 903
3.2.1 Example 904
3.3 Random Effects Methods 904
3.3.1 Example 907
4 Methods for Testing for Differences Between Groups of Studies 907
5 Forest Plots 908
6 Publication Bias 908
7 Conclusion 908
References 908
Part X Behavioral and Psychosocial Interventions 910
59 Trial Design in Behavioral Medicine 911
1 Introduction 911
2 Control Conditions 911
2.1 Control vs. Comparison 911
2.2 The Standard Hierarchy of Control Conditions 912
2.3 Usual Care, Treatment as Usual, and Standard of Care Controls 913
2.4 Usual Care and Its Variants in the Hierarchy of Control Conditions 916
3 Design Issues in Behavioral Medicine Research 916
3.1 Efficacy and Effectiveness Trials 916
3.2 Factorial Designs in Efficacy Research 918
3.3 Safety Trials 919
3.4 Mediation Trials 920
3.5 Statistical Power and Trial Design 922
3.6 Falsification Research 923
3.7 Mechanistic Research 923
4 Summary 924
References 924
60 Methodological Issues in Randomized Controlled Trials for the Treatment of Psychiatric Comorbidity in Medical Illness 926
1 Why Do We Need RCTs for Treatments for Psychiatric Disorders in Medical Patients? 926
2 The Influences of Medical Illness on Psychological Functioning 926
2.1 Occurrence of Psychiatric Disorders in Medical Populations 926
2.2 Identifying Psychiatric Disorders in Medical Populations 928
2.3 Measurement Issues Specific to Medical Populations 928
3 Effects of Medical Illness and Environmental Factors on Psychiatric Symptoms Longitudinally: Implications for RCTs 929
3.1 Interactions Between Medical Illness and Psychiatric Symptoms Longitudinally 930
3.2 The Influence of Environmental Factors on Psychiatric Symptoms 932
4 The Effects of Medical Illness on Access and Adherence to Psychological and Behavioral Treatments 933
5 Reconceptualizing RCTs of Psychological and Behavioral Treatments in Medical Populations to Include Prognosis 934
6 Summary 936
References 936
61 Quality of Life in Light of Appraisal and Response Shift 939
1 Patient-Reported Outcomes of Quality of Life 940
1.1 Generic and Disease-Specific Measures 940
1.2 The Value of Evaluating QOL 941
2 Methodological Advances in QOL Research 941
3 The Influence of Adaptation and Appraisal Processes on QOL Evaluations 942
3.1 History of Response Shift 942
3.2 Theoretical Foundation of Response Shift 943
3.3 The Relationship Between QOL and Response Shift to Other Frameworks from Psychology and the Social Sciences 944
4 Limitations of Current Measures of QOL in Light of Response Shift 945
4.1 Psychometric Properties of QOL Measures in Light of Response Shift 945
4.2 Implications of Response Shift for Evaluation of Psychosocial and Healthcare Interventions 945
5 Methodological Advances in Evaluating Changes in QOL and Response Shift Detection 946
6 Future Directions in QOL and Response Shift Research 948
References 948
62 Behavioral Interventions for Prevention and Management of Chronic Disease 953
1 Background 953
2 Overview of Systematic Reviews of Behavioral Change Interventions 954
2.1 Search Strategy and Selection Criteria 954
2.2 Characteristics of the Intervention Trials in the Systematic Reviews 955
2.2.1 Target Population 955
2.2.2 Intervention Setting 955
2.2.3 Mode of Delivery 955
2.2.4 Purpose of Systematic Reviews 955
2.3 Intervention Outcomes 961
2.3.1 Dietary Interventions 961
2.3.2 Exercise Only Interventions 961
2.3.3 Combined Diet and Exercise/Weight Reduction Interventions 962
2.3.4 Tobacco Control Interventions 962
2.3.5 Multiple Risk Factor Interventions 963
2.3.6 Disease Management Interventions 963
3 Relevant Findings from Narrative Reviews 964
3.1 Intervention Settings 964
3.2 Information and Communications Technology in Intervention Delivery 964
3.2.1 Web-Based Interventions 964
3.2.2 Interventions Delivered via Telephone 965
3.3 Effectiveness of Theory-Based Interventions 965
4 Lifestyle Change Current Issues and Future Challenges 966
4.1 Features of the Intervention and Its Delivery 966
4.2 Intervention Sustainability in the ''Real World'' and Future Uptake of Interventions 969
5 Summary 970
References 970
63 Psychosocial--Behavioral Interventions and ChronicDisease 973
1 Introduction 973
2 Coronary Heart Disease 974
2.1 Risk Factors 974
2.2 Psychosocial--Behavioral Interventions with Acute Coronary Syndrome Patients 975
3 HIV/AIDS 977
3.1 Disease Processes in HIV/AIDS 977
3.2 Factors Influencing HIV Disease Progression 978
3.2.1 Mood and Affect 978
3.2.2 Medication Adherence 978
3.2.3 Stressors and Stress-Related Processes 979
3.3 Psychosocial--Behavioral Intervention in HIV/AIDS 979
3.3.1 Primary Prevention Interventions 979
3.3.2 Secondary Prevention to Improve Antiretroviral Medication Adherence 980
3.3.3 Secondary Prevention to Reduce Depression and Stress-Related Processes 980
4 Cancer 982
4.1 Risk Factors for Initiation, Promotion, and Recurrence 982
4.2 Psychosocial Factors and Disease Progression 982
4.3 Psychosocial Interventions, Optimizing Health/Survival and Improving Quality of Life 984
4.3.1 Improving Psychosocial Adjustment and QOL 984
4.3.2 Psychosocial--Behavioral Intervention and Survival 985
5 Conclusions 986
References 987
64 The Role of Interactive Communication Technologies in Behavioral Medicine 992
1 Introduction 992
2 The Reach of eHealth Applications 992
2.1 Technology Channels 993
2.2 Organizational Channels 994
3 The Efficacy of eHealth Applications 995
3.1 Self-Navigated Help Seeking 995
3.2 Tailored Expert Systems 996
3.3 Online Support Groups and Virtual Communities 997
4 The Future of eHealth 998
4.1 Integration of Consumer and Medical Informatics Systems 998
4.2 Integration of Consumer and Public Health Informatics Systems 999
4.3 Integration of Consumer and Bioinformatics Systems 999
5 Conclusion 1000
References 1000
65 Behavioral Medicine, Prevention, and Health Reform: Linking Evidence-Based Clinical and Public Health Strategies for Population Health Behavior Change 1003
1 Introduction 1003
2 Behavioral Medicine and Health Behavior Change: History and Paradigms 1004
3 Evidence-Based Clinical and Public Health Behavior Change Interventions and Guidelines 1006
3.1 The United States Preventive Services Task Force (USPSTF) 1007
3.2 The Community Preventive Services Task Force (CTF) 1008
3.3 Use of Evidence-Based Clinical and Public Health Behavior Change Strategies 1010
4 Linking Evidence-Based Clinical and Community Strategies 1011
4.1 Multiple Risk Health Behavior Change 1011
4.2 Tobacco Cessation and Control 1012
4.2.1 Practice-Level 1013
4.2.2 Health Plan Level 1013
4.2.3 Community Level 1014
4.2.4 State Level 1014
5 Recommendations for the Future for Behavioral Medicine Research and Practice 1015
References 1015
Subject Index 1018