Physical Health Issues 517differences in •risk factors, clinical presentation and mortal-
ity ratesŽ of stroke patients. Therefore, they conducted a
study to examine differences in vascular risk factors, clinical
manifestation, and progression of the disease among men and
women. The “ndings demonstrated major gender dif ferences:
Women have different predictive risk factors for stroke than
men, including obesity, congestive heart failure, atrial “bril-
lation, hypertension, limb weakness, and age. The results also
indicate that women suffer more severe strokes resulting in
higher in-hospital mortality, higher neurological de“cits, and
longer hospitalization.
Similar to coronary heart disease, research on gender dif-
ferences in stroke is limited because stroke research either
excludes women or includes them in insuf“cient numbers to
evaluate gender effects (Brey & Kittner, 2000). There is a
need for research to examine gender differences in terms of
risk factors, prevention, intervention, and psychosocial ef-
fects. Last, this is an area in which health psychologists can
help women adjust to the physical and neurocognitive seque-
lae of stroke (e.g., physical limitations, memory loss, speech
de“cits).
Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease (COPD) includes
chronic bronchitis, emphysema, and asthmatic bronchitis,
which are conditions that obstruct air”ow from the lungs.
COPD is the fourth leading cause of death among women in
the United States (CDC, 1999). Although prevalence rates tra-
ditionally have been higher among men than women, COPD
rates have almost doubled over the past 20 years, with the most
rapid increases occurring in women age 75 and older (OWH,
2000). The rise in COPD rates in women is attributed to in-
creased smoking among women (Wise, 1997).
Researchers are beginning to explore possible gender
differences in the diagnosis and prognosis of the disease.
Silverman and colleagues (2000) reported that women may
have a higher risk of developing severe COPD and that this
“nding may be due to gender dif ferences in genetic predis-
position. Moreover, Chapman, Tashkin, and Pye (2001) re-
ported that COPD is underdiagnosed in women (i.e., doctors
are more likely to diagnosis men with COPD than women),
which may have implications for treatment and prognosis if
the disease is detected at a more advanced stage in women.
Additional research in this area is needed to identify effective
diagnostic testing, examine risk factors, and develop preven-
tion strategies appropriate for both men and women. Again,
as in lung cancer, health psychologists have the ability to
assist with COPD prevention by developing and facilitating
effective smoking cessation programs.
HIV/AIDSHuman immunode“ciency virus (HIV) causes acquired im-
mune de“ciency syndrome (AIDS), which is the “fth leading
cause of death among American women between the ages of
25 and 44 years, and the third leading cause of death among
African American women in this age group (CDC, 1998). There
have been dramatic increases in rates of HIV/AIDS around the
world since the “rst reported occurrence, with rates increasing
more rapidly among women than men (Richardson, 1998).
Women most commonly acquire the HIV infection
through heterosexual contact and intravenous drug use
(Richardson, 1998). Although women who practice intra-
venous drug use have a higher risk of contracting HIV be-
cause they are more likely to share a needle with a partner
(Morokoff, Harlow, & Quina, 1995), a woman changing her
own behaviors to reduce her risk does not always result in a
decrease in mortality or morbidity since women often are
affected by the risk behaviors of their partners. This is partic-
ularly true for women who are in controlling and abusive
relationships (Kamb & Wortley, 2000), which seems espe-
cially relevant given the “ndings that two-thirds of HIV-
positive women (as well as two-thirds of women at risk for
HIV infection) experience domestic violence during their
lifetimes (M. Cohen et al., 2000).
Research on gender differences in risk factors, as well as
research addressing gender differences in treatment, preven-
tion, and psychosocial effects (e.g., caregiving, social sup-
port, stigmatization, depression), is growing. Such research is
helping to inform clinicians and health care providers of the
unique effects of HIV/AIDS on women and the needs of
women living with HIV/AIDS (e.g., family planning), and
could assist in the development of improved prevention
and psychosocial treatment protocols for women and their
families. Prevention intervention efforts should include com-
ponents that educate women about possible risk behaviors of
their partners and their impact on the contraction of HIV and
sexually transmitted diseases (STDs). A recently developed
prevention intervention protocol targeting women with
chronic mental illness aims to increase the use of female-
controlled methods of STD/HIV prevention to give women
more control in limiting their risk of infection through
heterosexual contact (Collins, Geller, Miller, Toro, & Susser,
2001). See the chapter by Carey and Vanable in this volume
for additional information on HIV/AIDS.Domestic ViolenceDomestic violence, or battering, is the number one cause of
injury for women ages 15 to 44 in the United States (Novella,