Another set of factors was slow to develop but
ultimately had a strong impact. By the 1960s, many
major infectious diseases had been conquered. The
helping professions began to turn their attention to
two of the biggest killers: cardiovascular diseases
and cancer. Behaviors such as overeating, smoking,
and drinking were increasingly identified as major
correlates of these diseases. The spotlight began to
shine not just on the disease process itself but also
on the associated behaviors whose reduction or
elimination might reduce individuals’vulnerability
to disease.
During the 1960s, stressful life events began to
be implicated as specific risk factors for illness (e.g.,
Holmes & Rahe, 1967). The examination of how
stressful major life events affect health led to an
examination of the health consequences of daily
hassles, which can also prove stressful (e.g., Lazarus,
1984). A related line of research demonstrated how
personality and behavioral style can influence
health. The impetus came from two cardiologists
who were impressed with a common constellation
of traits and behaviors shared by many who suffered
from coronary heart disease. The so-called Type A
personality (Friedman & Rosenman, 1974) is char-
acterized by hostility, competitiveness, and being
time-driven. Although subsequent research has
failed to support a direct link between Type A per-
sonality and heart disease (Brannon & Feist, 2010;
Suls & Bunde, 2005), the hypothesis stimulated
research in health psychology and served to focus
attention on other behavioral risk factors for coro-
nary heart disease (e.g., smoking and lack of exer-
cise) as well as on prevention efforts.
The recognition that both psychological and
social factors influence illness and health is the
basis of an influential perspective known as thebio-
psychosocial model(Engel, 1977). In many ways, this
model can be viewed as an integration of the bio-
medical and psychosocial perspectives. As the name
implies, the biopsychosocial model holds that illness
and health are a function of biological, psychologi-
cal, and social influences. Biological influences can
include genetic predispositions, nutritional deficien-
cies, and biochemical imbalances. Psychological
influences can include the individual’s behaviors,
emotions, and cognitions. Finally, social influences
can include friends, family members, home envi-
ronment, and life events. This biopsychosocial
model represents how health psychologists concep-
tualize problems and plan interventions.
Many other factors wereimportant in the devel-
opment of the field of health psychology. The tre-
mendous cost of health care has already been noted,
along with the fact that infectious diseases were no
longer the principal culprits. A large portion of health
care costs are directly traceable to human behaviors
and lifestyles that result in injuries, accidents, poison-
ings, or violence. Lifestyle choices such as alcohol and
drug abuse, smoking, and dietary patterns contribute
to a variety of illnesses and diseases.
The foregoing are just a few of the more
prominent factors in the development of the health
psychology field. We turn now to a discussion of
how stress, lifestyle and behavior, personality, social
support, and health are linked. These links form the
basis of the field of health psychology and pediatric
psychology.Linking Stress, Lifestyle and Behavior,
Personality, Social Support, and Health
What are the processes by which psychological and
social factors influence health and disease?Stress and Health. Although the term stressis
frequently used, it is not often precisely defined
(Brannon & Feist, 2010). Some use the term to
refer to a quality of an external stimulus (e.g., a stressful
interview), others to refer to a response to a stimulus
(the interview caused stress), and still others believe
stress results from an interaction between stimulus
and response (stress resulted because the interview
was challenging and I was not prepared). Most con-
temporary health psychologists adopt this third, inter-
actionist viewpoint, seeing stress as a process that
involves an environmental event (a stressor), its apprai-
sal by the individual (is it challenging or threatening?),
the various responses of the organism (physiological,
emotional, cognitive, behavioral), and the reevalua-
tions that occur as a result of these responses and
changes in the stressor (Rice, 1998). This transactional488 CHAPTER 17