pronouncements of some of its practitioners. In some
cases, biofeedback seems to operate largely as a pla-
cebo. Biofeedback may not, by itself, lead to optimal
therapeuticgains.Whenitiseffective,itisusuallypart
of a larger package that also includes relaxation or cog-
nitive strategies; if removed from such a package, bio-
feedback may lose its effectiveness. However, it may
serve as an example to the patient that self-regulation in
life is possible. It may be that biofeedback works better
in the clinic than in the research laboratory because the
clinic places the biofeedback machine in a larger
context of an understanding clinical relationship and
additional therapeutic techniques. At the very least,
biofeedback appears to be a useful technique to teach
patients to become more aware of their bodily signals
and what they may mean.
PREVENTION OF HEALTH
PROBLEMSNearly everyone agrees that a few simple behaviors,
if widely practiced, would dramatically reduce the
toll of human misery and the torrent of dollars pour-
ing into the health care system. These include reduc-
ing our consumption of salt and fatty foods, driving
carefully and using seat belts, exercising regularly,
avoiding cigarettes, and decreasing stress. But giving
advice and having people take it are two very differ-
ent things. Therefore, psychologists, other behavioral
specialists, and medical professionals have mounted
research programs to learn how to treat and prevent
a variety of potentially harmful human behaviors. In
this section, we discuss prevention efforts in several
important areas related to health: cigarette smoking,
alcohol abuse, and weight control.
Cigarette SmokingIncreased awareness of the dangers of cigarette smok-
ing has led to a steady decline since the mid-1960s in
thepercentageofAmericanswhoarehabitualsmo-
kers. However, rates of smoking differ according to
gender, level of education, and income. According
to the Centers for Disease Control (CDC), it is esti-
mated that 20% of high-school-aged adolescents
smoke at least one cigarette a day within a 30-day
period; data on adults suggest that 23% of males and
18% of females over 18 years of age smoke (Pleis et al.,
2010). Current adult smokers were over-represented
among younger adults (age 18–44; 23%), among those
with a high school degree or less (29%), among those
with a family income of $35,000.00 or less (28%), and
among White males (25%).
Cigarette smoking has been linked to an
increased risk of cardiovascular disease and cancer,
the two leading causes of death in the United States.
Even though smoking increases one’s chances of pre-
mature death from diseases such as coronary heart
disease, cancers of the respiratory tract, emphysema,
and bronchitis, people still smoke. Why? Possible
reasons include tension control, social pressure,
weight control, rebelliousness, the addictive nature
of nicotine, and genetically influenced personality
traits such as extraversion (Brannon & Feist, 2010).
Tension control, weight control, genetics, and social
pressure are thought to be reasons for initiation of
smoking, whereas rebelliousness, addiction, and per-
sonality are seen primarily as maintaining factors.
A variety of techniques have been used to induce
people to stop smoking, including educational
programs, aversion therapy (e.g., rapid smoking),
behavioral contracts, acupuncture, pharmacologic
interventions, cognitive therapy, and group support
(Brannon & Feist, 2010). Relapse rates are high
(70–80%), however, and research findings about
which cessation approach is best are conflicting.
Most smokers who quit do so on their own.
The best approach seems to be to prevent the
habit from starting in the first place. Unfortunately,
education alone (e.g., warning messages on
packages) does not appear to deter young people
from smoking (Brannon & Feist, 2010). What
appears more effective is focusing on immediate
rather than delayed negative consequences, provid-
ing information on social/peer influences, teaching
refusal skills, and increasing feelings of self-efficacy
(La Torre, Chiaradia, & Ricciardi, 2005).
One of the early encouraging multiple-
component prevention programs aimed at children
and teenagers was based on social learning princi-
ples and used peer role models (Evans, 1976).HEALTH PSYCHOLOGY ANDBEHAVIORAL MEDICINE 499