Psychology 415; Social Bases of Health Behavior
Fall, 2011
Dr. David J. McKirnan
The University of Illinois at Chicago
Department of Psychology

Why are healthy decisions so difficult?

Social Basis of Health Behavior will address theory and data from clinical & social psychology, public health, and economics addressing health- or prevention-related behavior, stress and coping, design and evaluation of behavioral interventions, and community or policy-level issues. We will only briefly address behavioral medicine , although we will review the immune system and psycho-immunology.

Readings will be primarily journal articles and reviews, with some general text chapters.  For the course to be truly worthwhile students must read the core papers prior to class each week, and come to class with something to say about them.

Lecture Notes. Many weeks have PowerPoint notes associated with them. If you decide to print them your might wait until the week before each class to print these, since I will likely be changing them as we proceed.

Class Wiki. To facilitate discussion we will have a class Wiki, here. (A PowerPoint presentation demonstrating how to register for the course Wiki is here.) You all are required to write something smart and incisive by at least a day or two before class each week. Wiki comments can be on papers, other's comments on papers, issues raised in class, or other great thoughts related to the course. These will not be individually graded, but your consistently providing thoughtful Wiki posts will be part of your class grade.

Grant Proposal. The other evaluation is your writing a brief PHS-style grant proposal, presenting an empirically testable model of a health behavior or intervention. Students are strongly advised to articulate this project with their other (MA, Prelim, Ph.D.) work. We will discuss these in class. I will also expect students to present their ideas to the class in 15 minute APA-style talks (we will see if we have time for everyone to get a turn). An over-inclusive paper outline is here.

The Health Blog I have been periodically writing to is here. I plan to use in for class, so check it out.

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This first week we will articulate goals. So, for your Wiki entry, besides commenting on the papers please note your interests in Health Behavior and/or theories or empirical questions you are particularly interested in. I will try to adjust the schedule to meet everyone's interests.

To kick off we will have readings at two extremes, to illustrate the range of issues we will address and to get you all thinking. The first is on social networks and obesity, and two others taking a neurobiological look at behavior, one a review of "Social neuroscience" and another on histocompatability, mating and romantic faithfulness (and you thought love was an emotion...).

Warm-up Reading

Do your friends make you fat (happy, fit, a smoker...)? Read a nice overview of social network approaches to health, particularly the Christakis & Fowler analyses of the Framingham study, from the NYT Sunday Magazine (click image; a word version is here).
Thompson, C. Are Your Friends Making You Fat? New York Times, September 13, 2009.

Click this image for a critique of the Christakis & Fowler analysis, also from the NYT:

Primary Readings

Christakis, N. A., & Fowler, J. H. (2007). The Spread of Obesity in a Large Social Network over 32 Years. N Engl J Med, 357(4), 370-379. Link
Electronic version (access on campus or sign in to UIC) here. Multimedia demonstration of results here.

Barabasi, A.-L. (2007). Network Medicine -- From Obesity to the "Diseasome". N Engl J Med, 357(4), 404-407. Link
Key figure from the Barabasi paper here.

Cacioppo, J. T., Amaral, D. G., Blanchard, J. J., Cameron, J. L., Sue Carter, C., Crews, D., et al. (2007). Social Neuroscience: Progress and Implications for Mental Health. Perspectives on Psychological Science, 2(2), 99-123. Link

Garver-Apgar, C. E., Gangestad, S. W., Thornhill, R., Miller, R. D., & Olp, J. J. (2006). Major Histocompatability Complex Alleles, Sexual Responsivity, and Unfaithfulness in Romantic Couples. Psychological Science, 17(10), 830-835. Link

Bonus Papers Other papers from this study:

Christakis, N. A., & Fowler, J. H. (2008). The Collective Dynamics of Smoking in a Large Social Network. N Engl J Med, 358(21), 2249-2258. Link

Fowler, J. H., & Christakis, N. A. (2008). Dynamic spread of happiness in a large social network: longitudinal analysis over 20 years in the Framingham Heart Study. British Medical Journal, 337(dec04_2), a2338-a2347. Link

Click here for comments and rebuttals on this line of research

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Health behavior & behavioral medicine concepts
Stress, affect and "allostatic load".

These readings are a little dated but give good overviews of core concepts and models.  We will do more "big picture" stuff as we go along, particularly on the Psychosocial side.  The Krantz article is limited to CHD, but gives a more recent look at core constructs.

Lecture Notes Here

Primary readings

Breslow, L.  (2004). Perspectives: The Third Revolution in Health.  Annual Review of Public Health, Preface,Vol. 25, xii - xviii.  Link

House, J.S., Landis, K.R., & Umberson, D (1988).  Social relationships and health.  Science, 241, 540-545.  Link

Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social Relationships and Mortality Risk: A Meta-analytic Review. PLoS Med, 7(7), e1000316. Link

Baum, A. & Posluszny, D.M. (1999).  Health Psychology: Mapping Biobehavioral Contributions to Health and Illness.  Annual Review of Psychology, 50, 137-163.  Link

Krantz, D. S., & McCeney, M. K. (2002). Effects Of Psychological And Social Factors On Organic Disease: A Critical Assessment of Research on Coronary Heart Disease. Annual Review of Psychology, 53(1), 341-369.  Link

Bonus Reading

Does crime spread like an infectious disease?  Could other "problem" behaviors such as smoking or unsafe sex?  Equally important, is the spread of one of these problems non-linear (unlike virtually all of our statistical models) such that a "flat" distribution suddenly takes off after some crucial threshold has been reached?  We will  address "diffusion" and norm models as we go, but here is a cute piece from the New Yorker on the Tipping Point.  (Gladwell went on to write the book about this topic...).

Gladwell, M.  The Tipping Point.  New Yorker.  Link

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Basics of personality theory and applications to coping, health behavior, and physical health.

The "Big 5" personality perspective has been increasingly applied to coping, health and health behavior. "Neuroticism" is one of these factors, and as we will see this variable shows up in many papers ranging from the immune system to sexual safety. "Conscientiousness" also emerges in some data on health precaution.

As many of you know, "sensation seeking" is a long-standing personality construct related to health, as are variants such as impulsivity and behavioral inhibition / activation. So, I have sampled each of these areas for your readings this week. This makes for a lot of reading. So, even though several faculty and students have been interested in the behavioral inhibition / activation systems ("BIS" and "BAS"), I also have put a paper on that in the "Bonus" section.

Kick off with a modest length 2010 paper by Carver & Connor -Smith on personality and coping. This provides a nice, concise overview of the "Big 5" model, the coping literature, and the concept of stress. They then present a fairly descriptive discussion of linkages between personality "types" and coping styles.

We then get more direct links between personality and physical illness and, in a broad epidemiological study, all-cause mortality.

Lecture Notes Here

Take the Big 5 personality inventory here.
...and contribute to the data set on the Big 5 being compiled by a research group at Berkeley.

Warm-up reading

Primary readings

Carver, C. S., & Connor-Smith, J. (2010). Personality and Coping. Annual Review of Psychology, 61(1), 679-704. Link

Smith, T. W., & MacKenzie, J. (2006). Personality and Risk of Physical Illness. Annual Review of Clinical Psychology, 2(1), 435-467. Link

Taylor, M. D., Whiteman, M. C., Fowkes, G. R., Lee, A. J., Allerhand, M., & Deary, I. J. (2009). Five Factor Model Personality Traits and All-Cause Mortality in the Edinburgh Artery Study Cohort. [Article]. Psychosomatic Medicine, 71(6), 631-641. Link

de Wit, H. (2009). Impulsivity as a determinant and consequence of drug use: a review of underlying processes. [Article]. Addiction Biology, 14(1), 22-31. Link

Yanovitzky, I. (2005). Sensation Seeking and Adolescent Drug Use: The Mediating Role of Association With Deviant Peers and Pro-Drug Discussions. Health Communication, 17(1), 67-89. Link

Bonus Readings
I have one bonus paper from the home team, plus a student-based paper that presents a nice model for dissertation research.

Crawford, I., Hammack, P. L., McKirnan, D. J., Ostrow, D., Zamboni, B. D., Robinson, B., et al. (2003). Sexual sensation seeking, reduced concern about HIV and sexual risk behaviour among gay men in primary relationships. AIDS Care, 15(4), 513-524. Link

Amodio, D. M., Master, S. L., Yee, C. M., & Taylor, S. E. (2008). Neurocognitive components of the behavioral inhibition and activation systems: Implications for theories of self-regulation. [Article]. Psychophysiology, 45(1), 11-19. Link

Raynor, D. A., & Levine, H. (2009). Associations Between the Five-Factor Model of Personality and Health Behaviors Among College Students. [Article]. Journal of American College Health, 58(1), 73-81. Link.

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Basic attitude theory, self-regulation

There are some more recent attitude reviews than those I have included, but Ajzen's seems most straightforward, and I am not sure the field has changed that much in the past few years. Ajzen wrote the granddaddy of attitude theories - the theory of reasoned action - with Marty Fishbein at UIUC.  We will spend a lot of time later on more sophisticated cognitive theories from Social Psychology, but this is a good review.

The Karoly paper is a little old but is still a nice overview of self-regulation, more from an information processing frame.  There are also two more applied / descriptive papers.

I am also including a bonus paper on attitude change and persuasion by Wendy Wood. To some extent that is the real bottom line for us, but I don't want to load you up with too many readings. Get to it if you can, however.

Lecture Notes Here

Primary readings

Bonus Reading

This paper is not really about attitudes or norms per se. (a key component of the Fishbein model is social norms), although I guess I could make a linkage between cultural norms, sexual attitudes, and lax self-regulation in key environments.  Anyway, this is an excellent piece on the "down low" phenomenon among African-American men who have sex with men.  Just to spice up your week...   Link

Wood, W. (2000). Attitude Change: Persuasion and Social Influence. Annual Review of Psychology, 51(1), 539-570. Link

Politics, fear mongering, and attitudes toward vaccines

Jon Stewart takes on the Swine Flu "doubt break" and vaccine fears (click image).

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More on self-regulation & Self-Efficacy.

This week we have a good self-regulation overview by Carver & Scheier.  This is a little redundant with the Karoly paper, but is more comprehensible.  They also provide a brief overview of Robin Vallacher's Action Identification theory, Gray's approach-avoidance framework, and some non-linear models.  Also in the general self-regulation frame is Bandura's paper on self-efficacy and health behavior. This is dated but represents a nice overview of his perspective, plus some nice health data.  The bonus paper is a monster chapter by Bandura giving his Sermon from the Mount on how all of behavior works. 

Lecture Notes Here

Warm-up media
Go to the Miscellany section to hear a report / read about the effect of touch on health.

Warm-up reading
Click the image for a nice "self-regulatory energy" (AKA "will power") overview from the NYT.
AAMODT, S & WANG, S. Tighten Your Belt, Strengthen Your Mind. New York Times, April 2, 2008.

Primary readings

Myrseth, K., & Fishbach, A. (2009). Self-Control: A Function of Knowing When and How to Exercise Restraint. Current Directions in Psychological Science, 18(4), 247-252. Link

Bandura, A. (1991). Self-efficacy Mechanism in Physiological Activation and Health-Promoting Behavior. In J. Madden (Ed.), Neurobiology of Learning, Emotion, and Affect. New York : Raven, Pp. 229-269.  Link

Bonus Reading

Bandura, A. (1991). Self-regulation of motivation through anticipatory and self-reactive mechanisms. In R.A. Dienstbier (Ed.), Perspectives on Motivation: Nebraska Symposium on Motivation. Vol. 38, Pp. 69-164. Lincoln: University of Nebraska Press.    Link

Bandura has a concise overview of his model-of-all-of-behavior on his web site.

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Cognitive representations of health and illness:
Attitudes & expectancies, stress, coping, and affective responses.

This week we review the general literature on "Cognitive Representations of Health". This is less a bounded "theory" than an approach to understanding health vis-à-vis "thinking about how people think".

The first paper is a nice (brief!) overview of the history of cognitive - health models, with a reveiw of applications of one model to adherence and health in diabetes.

The Wu paper applies a Protection Motivation model to drug use in adolescents. This model is basically a marriage of self-efficacy to risk appraisals. Read it in terms of individual differences in the salience of health and risk avoidance.

The Benyamini paper provides a good review of Leventhal's "illness cognition" model, and moves us squarely toward cognitive appraisals of illness and coping resources. They examine affective responses as an outcome variable among women who are coping with a naturally occuring stressor, that of infertility treatment.

The final paper provides a very good overview of coping models, stress, and key dimentions of affect. It presents a meta-analysis of experimental stress manipulations, a nice contrast to the measurement models that dominate this field. Their outcome variable is cortisol and immune function, so read this as a warm-up to the psychoimmunology section.

Your (short!!) bonus paper questions whether any of these social-cognitive models are really testable per se., with a reply by Ajzen. I also put in a substantive paper taking a developmental perspective on Protection-Motivation theory.

Lecture notes here

How do placebos work?
Speaking of health cognition ... listen to an cute overview of placebo effects by WNYC Radiolab. Click the embed, or link to the site here. Click the "Sucrosa" image for an important review of a new medication from The Onion.

Introductory Social Cognition Classic

We will kick off with a seminal paper by Hazel Markus on social schema. This paper, more than any other, began the shift in Social Psychology toward the study of "self-schema" as a core unit of analysis for social cognition and behavior. She also articulated a distinction between explicit and implicit schema, a distinction that is currently a key component of the field, and is increasingly entering the health domain.

Markus, H. (1977). Self-schemata and processing information about the self. Journal of Personality and Social Psychology, 35(2), 63-78. Link

Primary readings

Harvey, J. N., & Lawson, V. L. (2009). The importance of health belief models in determining self-care behaviour in diabetes. Diabetic Medicine, 26(1), 5-13. Link

Wu, Y., Stanton , B. F., Li, X., Galbraith, J., & Cole, M. L. (2005). Protection Motivation Theory and Adolescent Drug Trafficking: Relationship Between Health Motivation and Longitudinal Risk Involvement. Journal of Pediatric Psychology, 30(2), 127-137. Link  

Benyamini, Y., Gozlan, M., & Kokia, E. (2004). On the self-regulation of a health threat: Cognition, coping, and emotions among women undergoing treatment for infertility. Cognitive Therapy & Research, 28(5), 577-592.  Link

Denson, T. F., Spanovic, M., & Miller, N. (2009). Cognitive Appraisals and Emotions Predict Cortisol and Immune Responses: A Meta-Analysis of Acute Laboratory Social Stressors and Emotion Inductions. Psychological Bulletin, 135(6), 823-853.Link

Bonus Readings

Ajzen, I., & Fishbein, M. (2004). Questions Raised by a Reasoned Action Approach: Comment on Ogden (2003). Health Psychology, 23(4), 431-434.  Link

Sturges, J.W. & Rogers, R.W. (1996). Preventive health psychology from a developmental perspective: An extension of protection motivation theory. Health Psychology, 15(3), 158-166.  Link

Ismail, K., Winkley, K., & Rabe-Hesketh, S. (2004). Systematic review and meta-analysis of randomised controlled trials of psychological interventions to improve glycaemic control in patients with type 2 diabetes. The Lancet, 363(9421), 1589-1597.

Important reference readings

Higgins, E. T. (1987). Self-discrepancy - a theory relating self and affect. Psychological Review, 94(3), 319-340. Link

Carver, C. S., Lawrence, J. W., & Scheier, M. F. (1999). Self-discrepancies and affect: Incorporating the role of feared selves. Personality and Social Psychology Bulletin, 25(7), 783-792. Link

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Judgments of vulnerability:
Perceived threat, motivated risk perception, realistic & unrealistic optimism.

Perceived vulnerability to a health threat is central to protective or risk behavior.  How and when we make such judgments is a core question.  

We will read Neil Weinstein's basic perspective on optimistic bias in risk perceptions, plus two empirical articles that illustrate these effects. Then read Janet Talor’s classic discussion of how optimism – realistic or otherwise – may in fact underlie positive mental health and coping. Following are two papers demonstrating how individual differences in optimism may in fact not only affect coping, but more direct measures of health.

The bonus paper, which I recommend you wade through, is from an excellent book by Kahneman, Slovic and Tversky on cognitive heuristics. Tversky went on to win a Nobel prize for this work as it applied to Economics. This chapter summarizes many of their concepts as they apply to risk perceptions. For those interested in optimism I have included a bonus paper addressing whether “optimism - pessimism” actually has construct validity, or is simply a variant on neuroticism or negative – positive affectivity.

Most of these articles are short, so do not be put off  by the raw number.

Warm up NPR report

Primary Readings

Segerstrom, S. C., Taylor, S. E., Kemeny, M. E., & Fahey, J. L. (1998). Optimism is associated with mood, coping and immune change in response to stress. Journal of Personality & Social Psychology, 74(6), 1646-1655.  Link

Bonus Readings

Smith, T. W., Pope, M. K., Rhodewalt, F., & Poulton, J. L. (1989). Optimism, neuroticism, coping, and symptom reports: An alternative interpretation of the Life Orientation Test. Journal of Personality & Social Psychology, 56(4), 640-648.  Link

Click the image for a New York Times / Science Times
special issue on decoding health information:

Self-awareness, "Automaticity", and Cognitive Escape.

This week we review the larger phenomenon of self-awareness. Most models we have discussed assume that people "know what they are doing" and make conscious decisions about behavior. That assumption may not always hold.  Karoly several weeks ago and Bargh here notes that much of behavior is relatively “mindless” (that is, “automatic” rather than “controlled”).  Automatic cognitive behavior (such as lexical processing, generative grammar, etc.) is dramatically more efficient: imagine if you had to consciously parse each sentence you recognize or speak.  The same may be the case for much of our self-regulatory behavior. 

Of course there may be times when being “mindful” of our behavior and its consequences is actually aversive, and we are motivated to escape self-awareness.  Heatherton’s semi-classic article reviews this, as does my humble entry in the HIV area.  Christensen has two papers describing both self-awareness as it varies by symptom levels, and a self-awareness intervention.

Bonus: A cute paper by our former faculty member Len Newman, plus a larger review by Bargh for those interested in further readings.

Lecture notes here

Video warm up

Rosemary's Baby (the classic horror flick by Roman Polanski, starring Mia Farrow and John Cassavetes) has a great scene illustrating the interplay of mindlessness and self-awareness here.

Primary readings

Bargh, J. A. and T. L. Chartrand (1999). "The unbearable automaticity of being." American Psychologist 54(7): 462-479. Link

Heatherton, T.F. & Baumeister, R.F. (1991).  Binge eating as escape from self-awareness.  Psychological Bulletin, 110(1), 86-108. Link

McKirnan, D.J., Ostrow, D., & Hope, B. (1996).  Sex, drugs and escape: A psychological model of HIV-risk sexual behaviors.  AIDS Care, 8(6), 655-669. Link

Christensen, A. J., P. J. Moran, et al. (2002). "Effect of a behavioral self-regulation intervention on patient adherence in hemodialysis." Health Psychology 21(4): 393-397. Link

Christensen, A. J., J. S. Wiebe, et al. (1996). "Body consciousness, illness-related impairment, and patient adherence in hemodialysis." Journal of Consulting and Clinical Psychology 64(1): 147-152. Link

Bonus Reading

Newman, L. & Bausmeister, R. (1996).  Toward and explanation of the UFO abduction phenomenon: Hypnotic elaboration, extraterrestrial sadomasochism, and spurious memories.  Psychological Inquiry, 7(2), 99-126. Link

Bargh, J. A. and M. J. Ferguson (2000). "Beyond behaviorism: On the automaticity of higher mental processes." Psychological Bulletin 126(6): 925-945. Link

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Some out-of-the-blue bonus readings on evolutionary perspectives.

The cognitive-social perspective is a little dyspeptic toward the role of cognition in health behavior. Cognition is biased, illusory, or simply irrelevant, since so much of behavior is automatic anyway.  When a topic is difficult we may want to escape from what self-awareness we do have.

This gets even worse in an evolutionary frame, where the core assumption is that many key behaviors -- mate selection, social organization, eating behaviors – are governed by naturally selected brain mechanisms that operate wholly outside of conscious awareness.  This assumption has been important to those who stress the continuity of humans and other primates, and therefore assign no special status to the distinctive human characteristics of reflexive consciousness and verbal behavior. 

Bering & Shackelford counter this trend with interesting discussion of the possible role of human consciousness as a causal factor in evolution.  Take a look at this if you need some reassurance that “mind” may still be important.  I am including an Annual Review paper by Caporael that provides a general overview of evolutionary theories applied to Psychology, FYI.

In applying evolutionary theories more directly to health I am including a Darwinian view of stress reactions I found very interesting by Korte.  He argues that most species divide into “Hawks” and Doves”, each of which represents a coherent approach to coping with adversity (environmental pressure, feeding…), and each of which has distinctive consequences for stress responses and physical health.  This gets a little far afield from our discussion of social cognition (it reviews animal research and falls into the “unconscious evolutionary mechanism” camp), but is a very interesting read on possibly naturally selected stress responses.

Bering, J. M., & Shackelford, T. K. (2004). The Causal Role of Consciousness: A Conceptual Addendum to Human Evolutionary Psychology. Review of General Psychology, 8(4), 227-248.
Caporael, L. R. (2001). Evolutionary psychology: Toward a unifying theory and a hybrid science. Annual Review of Psychology Vol 52 2001, 607-628. http://psych annualreviews org/.
Korte, S., Koolhaas, J. M., Wingfield, J. C., & McEwen, B. S. (2005). The Darwinian concept of stress: Benefits of allostasis and costs of allostatic load and the trade-offs in health and disease. Neuroscience & Biobehavioral Reviews, 29(1), 3-38.

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Dual systems theories: Affect and cognition

As I read the "dual systems" literature it becomes clear that a lot of this theorizing is old wine in new bottles. Carver, in the second paper, makes this clear in harkening back to the psychoanalysts (the "ego psychology" school) for the origins of this view. From a more modern perspective, a lot of this thought overlaps with the "controlled" versus "automatic" distinction in perception and cognition. The difference is that here affect weighs heavily in the "automatic" side, rather than, e.g., highly accessible or automatic thoughts.

The Hoffman et al. paper is a very good overview, so spend time on that. Carver attempts a historical and highly integrative review, with more emphasis on stable individual differences in impulsivity or constraint.

The Gailliot papers address the very interesting finding that cognitive control or restraint may be a limited resource: after exercising self-regulation on one task people are generally less able to self-regulate on a subsequent task. This is consistent with the larger view that cognitive control is tenuous at best ("...a reed blown in the wind of the emotions." to quote Freud). The first paper reports some relatively minor effects, but does show the effect on actual sexual behavior in the lab (!). The second paper attributes these effects to blood glucose levels, suggesting a relatively straightforward mechanism.

The bonus podcast is excellent - make time for it if you can. They review these issues in a very entertaining and informative fashion. Visit for RadioLab site for a variety of really good shows. Finally, you clinical students will be interested in the Carver bonus paper: he ties this process into serotonin levels, and further into depression and aggression.

Warm-up PodCast

Listen to a great show from NYC RadioLab on choice. From the producers:

Lecture notes here

Primary readings

Hofmann, W., Friese, M., & Strack, F. (2009). Impulse and Self-Control From a Dual-Systems Perspective. Perspectives on Psychological Science, 4(2), 162-176. Link

Carver, C. S. (2005). Impulse and Constraint: Perspectives From Personality Psychology, Convergence With Theory in Other Areas, and Potential for Integration. Personality & Social Psychology Review (Lawrence Erlbaum Associates), 9(4), 312-333. Link

Gailliot, M. T., & Baumeister, R. F. (2007). Self-regulation and sexual restraint: Dispositionally and temporarily poor self-regulatory abilities contribute to failures at restraining sexual behavior. [Article]. Personality and Social Psychology Bulletin, 33(2), 173-186. Link

Gailliot, M. T., Baumeister, R. F., DeWall, C. N., Maner, J. K., Plant, E. A., Tice, D. M., et al. (2007). Self-control relies on glucose as a limited energy source: Willpower is more than a metaphor. [Article]. Journal of Personality and Social Psychology, 92(2), 325-336. Link

Bonus Reading

Carver, C. S., Johnson, S. L., & Joormann, J. (2008). Serotonergic Function, Two-Mode Models of Self-Regulation, and Vulnerability to Depression: What Depression Has in Common With Impulsive Aggression. [Review]. Psychological Bulletin, 134(6), 912-943. Link

For the truncated version of this paper, see:
Carver, C. S., Johnson, S. L., & Joormann, J. (2009). Two-Mode Models of Self-Regulation as a Tool for Conceptualizing Effects of the Serotonin System in Normal Behavior and Diverse Disorders. Current Directions in Psychological Science, 18(4), 195-199. Link

Strack F, Deutsch R. Reflective and impulsive determinants of social behavior. Personality and Social Psychology Review. 2004;8(3):220-247.

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Psychoimmunology and "Illness Behavior" .

This week we begin Psychoimmunology. The real details of the immune system go well beyond the scope of this course. However, several of these papers provide brief overviews. A good NIH overview of the immune system Here. Click the image for another good immune system primer by Paul Bugl of the University of Hartford.

The Kiecolt-Glaser Annual Review chapter is a good review from a more psychological perspective. They have a lot of interesting work in this area – do an APA search for them for other interesting articles on immune functioning in response to social stresses, marital conflict, etc.

Segerstrom – whose paper on optimism and blood pressure we read earlier – here has a review and meta-analysis of stress and immune function. Kop’s shorter piece follows this with a more specific focus on depression, immune function and CHD. Finally, Suinn discusses the “terrible twos” – anxiety and anger – in terms of immune function, disease outcomes, and mental health and behavior.

You have two excellent bonus articles. The paper by Ader reviews his and others’ work on classical conditioning processes in immune function. This is really interesting work that he compliments with a more detailed discussion of immunology and stress responses. Ader is one of the key figures in this area (as is this paper), so it is work working through. The McDade paper is from Anthropology, where there has been considerable interest and good work on larger ecological processes in health and the distribution of disease.

Lecture notes here

Primary readings

Kiecolt-Glaser, J. K., McGuire, L., Robles, T. F., & Glaser, R. EMOTIONS, MORBIDITY, AND MORTALITY: New Perspectives from Psychoneuroimmunology. (2002). Annual Review of Psychology, 53(1), 83-107. Link.

Segerstrom, S. C., & Miller, G. E. (2004). Psychological Stress and the Human Immune System: A Meta-Analytic Study of 30 Years of Inquiry. Psychological Bulletin, 130(4), 601-630. Link.

Kop, W. J., & Gottdiener, J. S. (2005). The Role of Immune System Parameters in the Relationship Between Depression and Coronary Artery Disease. Psychosomatic Medicine, 67(Suppl1), S37-S41. Link.

Suinn, R. M. (2001). The terrible twos--anger and anxiety: Hazardous to your health. American Psychologist, 56(1), 27-36. Link

Everything you needed to know about stress, cytokines, illness behavior and depression:
Dantzer, R., O'Connor, J. C., Freund, G. G., Johnson, R. W., & Kelley, K. W. (2008). From inflammation to sickness and depression: when the immune system subjugates the brain. [Review]. Nature Reviews Neuroscience, 9(1), 46-57. Link

Very interesting evolutionary / ecological perspective on immune function:
McDade, T. W. (2005). The Ecologies Of Human Immune Function. Annual Review of Anthropology, 34(1), 495-521. Link

Of course all these variables interact with genetics. For an overview of "Epigenetics" - the influence of early and ongoing environmental stimulation on the activation of genetic traits - see:
Zhang, T.-Y., & Meaney, M. J. (2010). Epigenetics and the Environmental Regulation of the Genome and Its Function. Annual Review of Psychology, 61(1), 439-466. Link

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Psychoimmunology 2; Psychsocial perspectives.

This week we consider some variables we addressed in the early part of the course. I am biasing these toward actual experimental demonstrations of psychological effects on immunity, particularly interventions. Most of these papers are short, so please stay with them!To no surprise the self-efficacy people weigh in here: Wiedenfeld shows that enhancing self-efficacy among phobics has immuno-enhancing properties. Strauman takes Tory Higgin’s model of ideal-real self discrepancy and shows it to have effects on NK counts. Thus, feeling enhanced control over one’s behavior or affective responses increases immunocompetence, whereas feeling further from your ideal self has the opposite effect.

Petrie uses Pennebaker’s model of written emotional expression to show that thought suppression (or, conversely, the expression of trauma-related thoughts) has significant health and immune effects. I have included a short bonus paper addressing this paradigm among HIV patients, and a meta-analyses describing the Pennebaker paradigm vis-à-vis health outcomes.

Miller provides a larger meta-analysis of psychological interventions for immune functioning. Here intervention effect sizes are less large than individual reports may lead one to expect, but generally interventions work. I am including a short mechanism paper by Robles; it can get technical but stay with it. The effect of chronic stress on immune functioning and disease is mediated by an increase in proinflammatory cytokines, particularly Interlukin-6, which itself is immuno-suppressant. Conversely, an experimental increase in IL-6 induces depression in lab animals: depression and immune functioning have bi-directional effects. Finally, stress-induced increases in cytokines may “sensitize” the animal, such that the cytokine -> HPA / immune cascade occurs at lower and lower thresholds. I have two bonus papers addressing this that are well worth wading through.

Lecture notes here

Primary readings

Wiedenfeld, S. A., O'Leary, A., Bandura, A., Brown, S., & et al. (1990). Impact of perceived self-efficacy in coping with stressors on components of the immune system. Journal of Personality and Social Psychology, 59(5), 1082-1094. Link

Strauman, T. J., Lemieux, A. M., & Coe, C. L. (1993). Self-discrepancy and natural killer cell activity: Immunological consequences of negative self-evaluation. Journal of Personality and Social Psychology, 64(6), 1042-1052. Link

Petrie, K. J., Booth, R. J., & Pennebaker, J. W. (1998). The immunological effects of thought suppression. Journal of Personality and Social Psychology, 75(5), 1264-1272. Link

Miller, G. E., & Cohen, S. (2001). Psychological interventions and the immune system: A meta-analytic review and critique. Health Psychology, 20(1), 47-63. Link

Robles, T. F., Glaser, R., Kiecolt-Glaser, J. K. (2005). Out of Balance: A New Look at Chronic Stress, Depression, and Immunity. Current Directions in Psychological Science, 14(2), 111-115. Link

Smyth, J. M. (1998). Written emotional expression: Effect sizes, outcome types, and moderating variables. Journal of Consulting and Clinical Psychology, 66(1), 174-184. Link

Petrie, K. J., Fontanilla, I., Thomas, M. G., Booth, R. J., & Pennebaker, J. W. (2004). Effect of Written Emotional Expression on Immune Function in Patients With Human Immunodeficiency Virus Infection: A Randomized Trial. Psychosomatic Medicine, 66(2), 272-275. Link

Anisman, H., & Merali, Z. (2002). Cytokines, stress, and depressive illness. Brain, Behavior, & Immunity, 16(5), 513-524. Link

Simmons, D. A., & Broderick, P. A. (2005). Cytokines, stressors, and clinical depression: augmented adaptation responses underlie depression pathogenesis. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 29(5), 793-807. Link

More Psychosocial-oriented Readings in Psychoimmunology

Cohen, S., Frank, E., Doyle, W. J., Skoner, D. P., Rabin, B. S., & Gwaltney, J. M., Jr. (1998). Types of stressors that increase susceptibility to the common cold in healthy adults. Health Psychology, 17(3), 214-223. Link

Leventhal, H., Patrick-Miller, L., & Leventhal, E. A. (1998). It's long-term stressors that take a toll: comment on Cohen et al. (1998)[comment]. Health Psychology, 17(3), 211-213. Link

Cole, S. W., Kemeny, M. E., Taylor, S. E., & Visscher, B. R. (1996). Elevated physical health risk among gay men who conceal their homosexual identity. Health Psychology, 15(4), 243-251. Link

Kiecolt-Glaser, J. K., Page, G. G., Marucha, P. T., MacCallum, R. C., & Glaser, R. (1998). Psychological influences on surgical recovery: Perspectives from psychoneuroimmunology. American Psychologist, 53(11), 1209-1218. Link

Pennebaker, J. W., Kiecolt-Glaser, J. K., & Glaser, R. (1988). Disclosure of traumas and immune function: Health implications for psychotherapy. Journal of Consulting and Clinical Psychology, 56(2), 239-245. Link

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Socio-economic Status and Health.

This week we begin discussing SES and health. Two readings by Nancy Adler describe and explore the famous gradient between SES and health: health increases with every increment in wealth, not just at levels above poverty. Adler describes several potential explanations for this.

Gallo and Matthews discuss the role of negative emotions as a possible mechanism for SES - Health effects.  As we have seen, negative affect has direct immune consequences, making this link all the more plausible.  Finally, Shelly Taylor describes mechanisms whereby environmental events (work, family, stress, etc.) may influence health.  Take a look at her discussion of “allostatic load”: it represents a core construct in this area.

I have two excellent short bonus articles for you - try to get to them if you can. The first is an overview of social stress, immune and neuroendocrine changes, and infant birth weight: a very concrete example of the stress and health processes we have been discussing. Dunkel-Schetter makes clear references to SES and race in her discussion of these effects.

The second is a little far afield - is it an overview of animal studies of separation, proinflammatory cytocine stimulation, and "depression". The interesting element here is that introducing an exogenous anti-inflamatory agent (IL-10) breaks up these strong effects.

I also have a link to a very good NYT series on social class in the U.S.

Lecture notes here

Adler, N. E., Boyce, T., Chesney, M. A., Cohen, S., & et al. (1994). Socioeconomic status and health: The challenge of the gradient. American Psychologist, 49(1), 15-24. Link

Adler, N. E., & Snibbe, A. C. (2003). The role of psychosocial processes in explaining the gradient between socioeconomic status and health. Current Directions in Psychological Science, 12(4), 119-123. Link

Gallo, L. C., & Matthews, K. A. (2003). Understanding the association between socioeconomic status and physical health: Do negative emotions play a role? Psychological Bulletin, 129(1), 10-51. Link

Taylor, S. E., Repetti, R. L., & Seeman, T. (1997). HEALTH PSYCHOLOGY: What is an Unhealthy Environment and How Does It Get Under the Skin? Annual Review of Psychology, 48(1), 411-447. Link

The New York Times has an excellent series on social class in America. We will read the overview piece and an article on health for next week. Click the image for the complete series exploring many aspects of the nature and consequences of social class in the U.S.

Brief article outlining an informative model of how stress, behavior and immune function contribute to preterm birth (with a focus on SES and race):
Dunnkel-Schetter, C. (2009). Stress Processes in Pregnancy and Preterm Birth. [Article]. Current Directions in Psychological Science, 18(4), 205-209. Link

Hennessy, M. B., Schiml-Webb, P. A., & Deak, T. (2009). Separation, Sickness, and Depression: A New Perspective on an Old Animal Model. [Article]. Current Directions in Psychological Science, 18(4), 227-231. Link

Oakes, J. M., & Rossi, P. H. (2003). The measurement of SES in health research: current practice and steps toward a new approach. Social Science & Medicine, 56(4), 769-784. Link

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Culture, stress, resources & Health.

There a lots of readings this week, but most are short & easy so do not panic (and do actually work your way through them...).

Begin with an article addressing minority stress, social norms and health behavior among men who have sex with men. This outlines what a minority stress perspective looks like, and addresses some mechanisms. A link to the special issue on GLBT health that this is from is given below. Following this is a very interesting (and short) commentary on how the U.S. meritocracy ideology - we can all be president if we just work hard - may actually harm African-American health. Read this as another variation on the minority stress view.

We then have a piece by Rosmond on the Metabolic Syndrome, a key construct in the pathways linking stress and health. This paper does a nice (brief!) job summarizing the general construct of stress, the cluster of poor health outcomes that characterized the metabolic syndrome (high blood pressure, antipose fat, high glucose levels...), and its effects on cardiac health.

Nancy Krieger provides a concise discussion of conceptual and methodological questions in addressing the concept of "Race" and health. The LaVeist paper is also nice and short, here describing methodological / conceptual issues in assessing social class.

I am including a number New York Times articles addressing the larger issues of social class, race, and health, drawn from general NYT issues and from the NYT special issue on Social Class in America. A piece in the APS Observer discusses health consequences of increasing SES stratification in the U.S. The Observer article references a piece by Paul Krugman from NYT that I am also including. 

Finally, some bonus papers. I am including two related pieces from NEJM on the attempt by the Bush administration to ignore SES and racial Disparities in health, by altering a DHHS report in 2004. I am also including a good paper discussing environmental toxins and health in poverty-prone areas.

Lecture notes here

Primary readings

Hamilton, C. J., & Mahalik, J. R. (2009). Minority stress, masculinity, and social norms predicting gay men's health risk behaviors. Journal of Counseling Psychology, 56(1), 132-141. Link.

Kwate, N. O. A., & Meyer, I. H. (2010). The Myth of Meritocracy and African American Health. American Journal of Public Health, 100(10), 1831-1834. Link

Rosmond, R. (2005). Role of stress in the pathogenesis of the metabolic syndrome. Psychoneuroendocrinology 30(1): 1-10. Link

Krieger, N. (2003). "Does racism harm health? Did child abuse exist before 1962? On explicit questions, critical science, and current controversies: An ecosocial perspective." American Journal of Public Health 93(2): 194-199. Link

LaVeist, T. A. (2005). Disentangling Race and Socioeconomic Status: A Key to Understanding Health Inequalities. Journal of Urban Health, 82, iii26-iii34. Link.

Hébert, R. (2003). In Sickness or in Wealth: Cognitive responses to stress link socio-economic status and incidence of disease. APS Observer, 16(11). Link

Krugman, P. (2002, 10/20/2002). For Richer. The New York Times. Link

Scott, J. (2005, 5/16/2005). Life at the Top in America Isn't Just Better, It's Longer. The New York Times. Link

Epstein, H. (2003, 10/12/2003). GHETTO MIASMA; Enough To Make You Sick? The New York Times. Link

Gonzalez, D. (2005, 1/25/2005). Paying a Price for Doughnuts, Burgers and Pizza. The New York Times. Link.

The Hamilton et al. paper is from a special issue of Jr. Counseling Psychology on gay/lesbian issues in mental health. Take a look at that for some other very good papers on this general topic: Journal of Counseling Psychology, Volume 56, Issue 1, 2009, here.

Evans, G.W. & Kantrowitz, E. (2002). Socioeconomic Status and Health: The Potential Role of Environmental Risk Exposure. Annual Review of Public Health, 23, 303-331. Link

Bloche, M. G. (2004). Health Care Disparities — Science, Politics, and Race.  New England Journal of Medicine, 350, 1568-1570. Link

Steinbrook, R. (2004). Disparities in Health Care — From Politics to Policy.  New England Journal of Medicine, 350, 1486-1488. Link

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Policy, Economic and Political Influences on Health

This week we take the larger view and discuss political / policy issues in health behavior, including the regulatory and physical environment. The focus of most research and thinking in this area has been on smoking and weight control – there is less work on, e.g., chronic disease management or sexual risk. Following this trend, our articles will focus on tobacco and obesity.

Begin with the Chicago Tribune’s series on the Oreo® cookie. The history of the Oreo illustrates a variety of issues, including financial pressure for “junk” food production, the role of regulation, and the potential influence of scientific findings (including whether researchers can or should ever be neutral about these topics). We then have two review papers on environmental and policy effects on obesity, exercise and tobacco. These are a little redundant, so you can read the second a little faster. French et al. give a nice overview of social and structural issues – obesity is a “perfect storm” of individual and structural inducements toward poor health – whereas Brownson et al. review the outcomes of structural-level interventions. Wang and Brownell take these themes and describe the dangers of individual-level (or “medical”) explanations, and promulgate more science-based advocacy for policy and regulatory change. This takes on meaning now since obesity has recently been recognized as a medical disorder, justifying 3rd party payments for (individual-based) treatment.

Craig Ewart’s influential paper on Social Action Theory is a nice integration of the individual-level variables we went over in the early section of the class, plus interpersonal and social variables.

The bonus papers are interesting if you can get to them. First, a nice – and alarming – NYT Sunday Magazine piece by Pollan discussing how corporate agriculture (“Agribiz”) has lobbied for highly favorable supports and regulations to dramatically increase corn production, leading to the glut of high fructose corn syrup that is driving the U.S. obesity epidemic. (Michael Pollen has several excellent books on the nutrition and the food production process). Szreter reviews the history of population-level health approaches and the relation of population health to economic development and political change.

Then a set of three: a short NYT article discusses a paper by Chou and Gross addressing the economics of smoking and weight. They argue that obesity rates have gone up as smoking has become more expensive and difficult (due to restrictive regulation): basically, as public health regulation lessened one key health threat it exacerbated another in the process. Gruber disagrees: I could not find his paper directly addressing Grossman’s analysis of the population trend data, so I enclosed another piece of his that provides a larger view of tobacco regulation.

Warm-up readings
Click the image for a timely report on the food industry and their contribution to personal health and development.

Primary readings

Manier, J., Callahan, P., & Alexander, D. (2005) The Oreo, Obesity and Us. Chicago Tribune, 8/21/05, Link.

French, S. A., Story, M., & Jeffery, R. W. (2001). Environmental influences on eating and physical activity. Annual Review of Public Health, 22, 309-335. Link.

Brownson, R. C., Haire-Joshu, D., & Luke, D. A. (2006). Shaping the Context of Health: A Review of Environmental and Policy Approaches in the Prevention of Chronic Diseases. Annual Review of Public Health, In Press. Link
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Wang, S. S., & Brownell, K. D. (2005). Public Policy and Obesity: The Need to Marry Science with Advocacy. Psychiatric Clinics of North America, 28(1), 235-252. Link.

Ewart, C. K. (1991). Social action theory for a public health psychology. American Psychologist, 46(9), 931-946. Link.

Click the image for a clip from Guys and Dolls that puts the entire course in perspective.

Bonus Readings

Pollan, M. (2003). THE WAY WE LIVE NOW: The (Agri)Cultural Contradictions Of Obesity. New York Times, 10/12/2003. Link.
Szreter, S. (2003). The Population Health Approach in Historical Perspective. American Journal of Public Health, 93(3), 421-431. Link.

Gross, D. (2005). ECONOMIC VIEW; Cigarettes, Taxes and Thin French Women. New York Times, 7/24/05. Link.

Chou, S. Y., Grossman, M., & Saffer, H. (2004). An economic analysis of adult obesity: results from the Behavioral Risk Factor Surveillance System. Journal of Health Economics, 23(3), 565-587. Link.

Gruber, J. (2002). The economics of tobacco regulation. Health Affairs, 21(2), 146-162. Link.

Fat Stigma: The perception that you are (too) fat may cause health problems beyond the actual physical effects of weight...
Muennig, P., Jia, H. M., Lee, R. F., & Lubetkin, E. (2008). I think therefore I am: Perceived ideal weight as a determinant of health. [Article]. American Journal of Public Health, 98(3), 501-506. Link

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Spirituality, Happiness, Mindfulness, Well-Being and Health

As a final, really high-level conceptualization of mind and body, this final week we consider spirituality and health. I have a lot of readings for this week - there is a lot of literature addressing this general topic. Begin with a nice overview from Time Magazine about brain effects of prayer, meditation and other "altered" states, then read a recent paper more systematically addressing executive functioning among "true believers" while being prayed for.

We have the (currently) definitive study on whether being prayed for "works" on clear biomedical outcomes, plus two brief comments. This is followed by two papers (one co-authored by Leila Shahabi, one of our grads!) addressing whether simply being religious is health inducing. The Miller paper presents a nice overview of the question (for a special issue of American Psychologist), whereas the Powell paper actually provides a literature review.

Then we get the "warm and fuzzy" side of our field. First, Ryan and Deci review the larger area of well-being, and introduce the relevant jargon (“eudaimonic well-being”?). Brown and Ryan review some data on “mindfulness” as a psychological intervention: there is lately a lot of research on this construct in clinical and, to a lesser extent, health research. I included a short paper by Folkman on positive coping, also an area of increasing attention. This is from a special issue of American Psychologist on coping, a worthwhile collection for you coping types.

Warm-up reading

Click the image for a good TIME article about brain effects of spiritual beliefs. (Word version here)

See also a Chicago Tribune discussion of whether Christian Science prayer should be covered as "treatments" in any new health care bill here.

Primary readings

This is your brain on prayer: .
When a charismatic person such as a shaman or televangelist prays over you, how does that have an effect (insofar as it does...)? By dampening your pre-frontal cortex, apparently...

Schjoedt, U., Stodkilde-Jorgensen, H., Geertz, A. W., Lund, T. E., & Roepstorff, A. (2010). The power of charisma: Perceived charisma inhibits the frontal executive network of believers in intercessory prayer. Social Cognitive and Affective Neuroscience, 5(2-3). (click image for paper, here for supplemental material showing scan images)

Does prayer work?
There is a lot of junk science - and simple fraud - in the study of prayer and health. Studies of "intercessionary" prayer, typically defined as people praying for you without your knowing it, have a particularly sorry history. "New age" believers to conservative Christians have seized on a few dubious studies to support their belief that prayer "works" beyond the simple effect of social support. The most definitive study of intercessionary prayer, that carefully separated the effects of actual prayer from the patients' perception of being prayed for, was conducted by Benson et al.

Benson, H., Dusek, J. A., Sherwood, J. B., Lam, P., Bethea, C. F., Carpenter, W., et al. (2006). Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: A multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer. American Heart Journal, 151(4), 934-942. Link

Does simply being religous help?

Miller, W. R., & Thoresen, C. E. (2003). Spirituality, religion, and health: An emerging research field. American Psychologist, 58(1), 24-35. Link.

Powell, L. H., Shahabi, L., & Thoresen, C. E. (2003). Religion and spirituality: Linkages to physical health. American Psychologist, 58(1), 36-52. Link.

Happiness, positive coping and mindfulness: A secular spirituality?

Ryan, R. M., & Deci, E. L. (2001). ON HAPPINESS AND HUMAN POTENTIALS: A Review of Research on Hedonic and Eudaimonic Well-Being. Annual Review of Psychology, 52(1), 141-166. Link.

Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822-848. Link.

Folkman, S., & Moskowitz, J. T. (2000). Positive affect and the other side of coping. American Psychologist, 55(6), 647-654. Link.

Bonus Readings

I have lots of bonus readings for this week: the task for primary readings was to eliminate, not add interesting papers. This section begins with some empirical papers. The first is by Jane Simoni that explores subjective spirituality among HIV+ women, a major issue in working with African-American and other ethnic minority women in HIV/AIDS. This is followed by some papers on mindfulness, and the remaining papers from that American Psychologist set. Then I have included most of the papers from a special issue of Behavioral Medicine on spirituality and health, FYI.

Simoni, J. M., Martone, M. G., & Kerwin, J. F. (2002). Spirituality and psychological adaptation among women with HIV/AIDS: Implications for counseling. Journal of Counseling Psychology, 49(2), 139-147. Link.

Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F., et al. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine, 65(4), 564-570. Link.

Carlson, L. E., Speca, M., Patel, K. D., & Goodey, E. (2003). Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosomatic Medicine, 65(4), 571-581. Link.

Seeman, T. E., Dubin, L. F., & Seeman, M. (2003). Religiosity/spirituality and health: A critical review of the evidence for biological pathways. American Psychologist, 58(1), 53-63. Link.

Hill, P. C., & Pargament, K. I. (2003). Advances in the conceptualization and measurement of religion and spirituality: Implications for physical and mental health research. American Psychologist, 58(1), 64-74. Link.

Special Issue of The Annals of Behavioral Medicine:

Mills, P. J. (2002). Spirituality, Religiousness, and Health: From Research to Clinical Practice. Annals of Behavioral Medicine, 24(1), 1-2. Link.

Thoresen, C. E., & Harris, A. H. S. (2002). Spirituality and Health: What's the Evidence and What's Needed? Annals of Behavioral Medicine, 24(1), 3-13. Link.

Sloan, R. P., & Bagiella, E. (2002). Claims About Religious Involvement and Health Outcomes. Annals of Behavioral Medicine, 24(1), 14-21. Link.

Underwood, L. G., & Teresi, J. A. (2002). The Daily Spiritual Experience Scale: Development, Theoretical Description, Reliability, Exploratory Factor Analysis, and Preliminary Construct Validity Using Health-Related Data. Annals of Behavioral Medicine, 24(1), 22-33. Link
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Ironson, G., Solomon, G. F., Balbin, E. G., O'Cleirigh, C., George, A., Kumar, M., et al. (2002). The Ironson-Woods Spirituality/Religiousness Index Is Associated With Long Survival, Health Behaviors, Less Distress, and Low Cortisol in People With HIV/AIDS. Annals of Behavioral Medicine, 24(1), 34-48. Link
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Peterman, A. H., Fitchett, G., Brady, M. J., Hernandez, L., & Cella, D. (2002). Measuring Spiritual Well-Being in People With Cancer: The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp). Annals of Behavioral Medicine, 24(1), 49-58.

Shahabi, L., Powell, L. H., Musick, M. A., Pargament, K. I., Thoresen, C. E., Williams, D., et al. (2002). Correlates of Self-Perceptions of Spirituality in American Adults. Annals of Behavioral Medicine, 24(1), 59-68. Link.

Larimore, W. L., Parker, M., & Crowther, M. (2002). Should Clinicians Incorporate Positive Spirituality Into Their Practices? What Does the Evidence Say? Annals of Behavioral Medicine, 24(1), 69-73. Link.

Lawrence, R. J. (2002). The Witches' Brew of Spirituality and Medicine. Annals of Behavioral Medicine, 24(1), 74-76. Link.

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