(e.g. Muller et al. 1994, 1985; Moller et al. 1999). They are acute events and involve a
sudden rupture and thrombogenesis. Johnston (2002) argues that this reflects an
acute model of the link between stress and illness with acute stress triggering a
sudden cardiac problem. This explains how exercise can be protective in the longer
term but a danger for an at-risk individual. It also explains why and when a heart
attack occurs.
However, the acute and chronic processes are intrinsically interlinked. Chronic
stress may simply be the frequent occurrence of acute stress, acute stress may be more
likely to trigger a cardiac event in someone who has experienced chronic stress and
acute stress may also contribute to the wear and tear on the cardiovascular system.
Furthermore, both the chronic and acute processes highlight the central role for stress
induced changes in behaviour and changes in physiology. These will now be
considered.STRESS AND CHANGES IN BEHAVIOUR
Stress has been mostly studied in the context of coronary heart disease (CHD). However,
there are also studies exploring links between illnesses such as cancer, diabetes and
recovery from surgery. Research exploring the links between stress and CHD highlight
the impact of stress on the classic risk factors for CHD, namely raised blood cholesterol,
raised blood pressure and smoking. These risk factors are strongly influenced by
behaviour and reflect the behavioural pathway between stress and illness (Krantz et al.
1981). In line with this, some research has examined the effect of stress on specific
health-related behaviours.Smoking
Smoking has been consistently linked to a range of illnesses including lung cancer and
coronary heart disease (see Chapter 5). Research suggests a link between stress and
smoking behaviour in terms of smoking initiation, relapse and the amount smoked.
Wills (1985) argued that smoking initiation in adolescents was related to the amount
of stress in their lives. In addition, there has been some support for the prediction that
children who experience the stressor of changing schools may be more likely to start
smoking than those who stay at the same school throughout their secondary educa-
tion (Santi et al. 1991). In terms of relapse, Lichtenstein et al. (1986) and Carey et al.
(1993) reported that people who experience high levels of stress are more likely to
start smoking again after a period of abstinence than those who experience less stress.
Research also indicates that increased smoking may be effective at reducing stress. In
an experimental study, Perkins et al. (1992) exposed smokers to either a stressful or a
non-stressful computer task and asked the subjects to smoke a cigarette or sham
smoke an unlit cigarette. The results showed that regardless of whether the smokers
smoked or not, all subjects reported an increased desire to smoke in the stressful
condition. However, this desire was less in those smokers who were actually allowed to
smoke. This suggests that stress causes an increased urge for a cigarette, which can be254 HEALTH PSYCHOLOGY