Version of Record: https://www.sciencedirect.

com/science/article/pii/S0277953617306561
Manuscript_d1c931c2d8c55f5dc2a78566130a0b03

HEALTH PSYCHOLOGY 1

What Are the Keys to a Longer, Happier Life?

Answers from Five Decades of Health Psychology Research

Blair T. Johnson and Rebecca L. Acabchuk

University of Connecticut

Total Words: 9,495

Date of draft: Tuesday, 31 October 2017

Author Notes

We thank Frances Aboud, Chris Dunkel Schetter, Emily Alden Hennessy, Benjamin X. White, and

Richard Wolferz, Jr. for their very helpful comments on a prior draft of this article; and, we thank Emma

Atkinson for her assistance in organizing citations relevant to this article.

The preparation of this article was supported in part by a subcontract from U.S. Public Health

Service grant 5U24AG052175.

Address correspondence to Blair T. Johnson, Institute for Collaboration on Health, Intervention,

and Policy (InCHIP), University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT 06269-1248 USA.

Email: [email protected]

© 2017 published by Elsevier. This manuscript is made available under the Elsevier user license
https://www.elsevier.com/open-access/userlicense/1.0/
HEALTH PSYCHOLOGY 1

What Are the Keys to a Longer, Happier Life?

Answers from Five Decades of Health Psychology Research

HEALTH PSYCHOLOGY 2

Abstract

Rationale. It has long been known that factors of the mind and of interpersonal relationships influence

health, but it is only in the last 50 years that an independent scientific field of health psychology

appeared, dedicated to understanding psychological and behavioral processes in health, illness, and

healthcare. Objective and method. This article (a) reviews important research that answers the question

of how human beings can have longer, happier lives; and (b) highlights trends in health psychology

featuring articles in Social Science & Medicine as well as other related literature. Results. Since the

1970s, health psychology has embraced a biopsychosocial model such that biological factors interact

and are affected by psychological and social elements. This model has illuminated all subjects of health,

ranging from interventions to lower stress and/or to improve people’s ability to cope with stressors, to

mental and physical health. Importantly, a health psychology perspective is behavioral: The majority of

chronic diseases of today can be avoided or reduced through healthy lifestyles (e.g., sufficient exercise,

proper diet, sufficient sleep). Thus, behavior change is the key target to help reduce the immense public

health burden of chronic lifestyle illnesses. Health psychology also focuses on how social patterns

influence health behavior and outcomes, in the form of patient-provider interactions or as social forces

in communities where people live, work, and play. Health psychology is congenial to other health

sciences, especially when allied with ecological perspectives that incorporate factors upstream from

individual behavior, such as networks linked to individuals (e.g., peer groups, communities). Over its

history, health psychology research has been responsive to societal and medical needs and has routinely

focused on understanding health disparities. Conclusion. By relying on a strong interdisciplinary

approach, research in health psychology provides a remarkably comprehensive perspective on how

people can live healthier lives.

HEALTH PSYCHOLOGY 3

Key words: biopsychosocial model; chronic disease; stress; coping; mental health; patient-provider

interactions; health disparities

HEALTH PSYCHOLOGY 4

1. Introduction

What are the keys to a healthy, happy, productive life? Along with other scientific fields, this question

has been richly addressed by health psychology, which is concerned with psychological and behavioral

processes in health, illness, and healthcare. Health psychology emerged in recent decades as an

important contributor to a broader effort aimed to ameliorate the most pressing health-related issues in

the world today: health, medical care, stress and coping, and how best to prevent, treat, and/or manage

chronic disease. Health psychology offers a diverse, interdisciplinary perspective featuring a

biopsychosocial model that takes into account psychological, physiological, and environmental

influences on health. Health psychology also brings other key factors to bear on health, including

culture, socioeconomic factors, stigma, patient-provider interactions, among others. Health psychology

is concerned both with morbidity and mortality.

Our main goal in this article is to review health psychology’s prominent findings and theoretical

perspectives, while giving some sense of the field’s history. Of course, it is impossible to do this subject

justice in a single article; moreover, it is important to honor all of the history of health psychology as

well as influences from related fields, even while we highlight research published in Social Science &

Medicine. Many of the trends we observe in health psychology are in fact part of trends in science and

health; at key junctures, we elucidate intersections of this field with other disciplines. It is also important

to acknowledge that whereas the field of health psychology addresses global health, this review focuses

mainly on issues related to Western society and its health. In Section 2, we describe the dominant

theoretical perspective in health psychology, the biopsychosocial model, which reveals the often

dynamic interrelationships between biological, psychological, and social factors. This model emerged

from research on health psychology’s most central subject matter, stress. This section highlights the

central role that habitual behavior plays in setting the stage for chronic illnesses such as hypertension
HEALTH PSYCHOLOGY 5

and coronary heart disease. In Section 3, we consider how social interactions and networks (e.g.,

patient-provider interactions; community stress) affect health and review interventions to lower stress,

to improve people’s ability to cope with stressors, and to address other health issues. In Section 4, we

offer reflections on trends in health psychology, and Section 5 sums up the field’s answers to the

question of how best to maximize lives lived.

2. The Necessity of an Integrative Conceptualization of Health

2.1. From Communicable to Non-Communicable Diseases and the Centrality of Health Behaviors

Medical science has witnessed many revolutions in its history, and these continue to unfold at a

quickening pace. As medical science improved, so did public health: Until this era, human lives might in

fact be well typified as nasty, brutish, and short, to paraphrase the 17th century political philosopher,

Thomas Hobbes. Between 1800 and 2000, lifespans doubled from an average of about 35 years to 70;

developed countries led the trend in expanding lifespan, but in recent decades, lagging nations have

been closing the gap. Medical science developed steadily better maternal care—saving the lives not only

of more women giving birth but also the lives of their newborn infants. Until at least the first half of the

20th century, viral influenza strains regularly killed millions of people in brief epidemics—medical

science developed antibiotics and vaccines that transformed fatal or debilitating diseases into nuisance

conditions that can be stopped before they threaten life or, at best, prevent them altogether. It is

important to recognize that it was not just improvements in medical care that drove progress but also

improved nutrition, shelter, transportation, and perhaps most of all, improved public sanitation services.

Even as medical solutions and technological advances improved public health, they also created

unanticipated problems. In developed countries, the decreasing incidence of acute infections appears to

be contributing to the increase in autoimmune and allergic diseases, according to the hygiene

hypothesis (Okada et al., 2010). Moreover, assistive technology has also led to a sedentary lifestyle
HEALTH PSYCHOLOGY 6

coupled with the easy availability of fast (and processed) food that has created a rise in avoidable

chronic diseases. While there are still over 800 million people in the world suffering from chronic

hunger, worldwide obesity rates have more than doubled since 1980, and youth obesity rates have

tripled in the past 30 years (Chan, 2016; Ogden et al., 2015). America is in the midst of a healthcare

crisis; approximately 84 million U.S. adults have prediabetes, and more than one-third of American

adults have obesity, contributing to some of the leading causes of preventable death (Ogden et al.,

2015).

The financial burden of chronic lifestyle illness is rising, placing a large toll on the healthcare system that

may not be sustainable. In 2014, 16 million people died prematurely – before the age of 70 – due to

chronic disease, according to the World Health Organization (WHO) (2015). Chronic disease conditions

are noncommunicable diseases as they are not passed from person to person, and include four main

types: 1) cardiovascular diseases (e.g., heart attacks and stroke); 2) cancers; 3) chronic respiratory

diseases (e.g., chronic obstructive pulmonary disease, asthma); and 4) diabetes. In 2015, the WHO

stated that “Premature noncommunicable disease deaths can be significantly reduced through

government policies reducing tobacco use, harmful use of alcohol, unhealthy diets and physical

inactivity, and delivering universal health care.” Notably, the success of this perspective hinges on

individuals adopting and maintaining healthy lifestyles and receiving network support such as care from

providers who understand and address the causes of these conditions. Accordingly, policy officials

increasingly view behavior change on the population level as a key target to help reduce the immense

burden of chronic disease.

2.2. A Biopsychosocial Approach Emerges

For the past two centuries, the biomedical model dominated medical science and practice, defining

health as freedom from disease, pain, and defects; thus, the normal human condition is “healthy.” Yet,
HEALTH PSYCHOLOGY 7

health is a continuum, and the absence of disease does not necessarily mean one is in a state of good

health. Modern medical systems are expected to excel at treating diseases of biological etiology, but in

the past, the biomedical model was built on a narrow, reductionist strategy that focused on biological

aspects of disease and illness. Is illness always caused by biological factors? Will targeting detrimental

biological factors guarantee a return to health? Health psychologists increasingly have argued that these

are false assumptions, and stress is known to interact with and exasperate diseases of biological etiology

(e.g., Wade & Halligan, 2004). Although the biomedical model certainly drove and still drives many

innovations in medicine and medical care (e.g., including increasing understanding of the biological

mechanisms of mental disorders), a biomedical perspective alone does not guarantee a positive

outcome, nor explain a number of phenomena such as placebo effects and health disparities;

psychological and social elements must also be included, as well as community-level factors and

environment.

Health care professionals bear witness to the importance of other factors besides disease in the etiology

of illness, and health psychology has provided updated models to take these factors into account. In the

1970s that the field of health psychology more formally emerged, allied with behavioral medicine, which

posited that positive behavior change creates better health (Schwartz & Weiss, 1978). Physician George

L. Engel (1977) was one of the first to propose and label a broad biopsychosocial model that emphasized

the importance of an ecological relationship between an individual and his/her environment, and how

an individual perceives his/her environment. Health psychologists quickly embraced and promoted this

perspective, and today, biopsychosocial models are nearly universally embraced—at least in theory, if

not in practice (Adler, 2009; Ogden, 1995). Moreover, as Section 3.2 expands, a biopsychosocial

perspective is congenial not only to health psychology but also to other disciplines. It provides a

foundation for “lifestyle medicine”, which is an emerging effort to broaden the scope of mainstream

medicine to include the use of evidence-based lifestyle therapeutic approaches, such as a predominantly
HEALTH PSYCHOLOGY 8

whole food, plant-based diet, exercise, sleep, stress management, alcohol moderation and tobacco

cessation, and other non-drug modalities, to prevent, treat, and, potentially even reverse lifestyle-

related, chronic diseases (Antonovsky, 1993; Egger et al., 2009). Similarly, education programs for

medical professionals are incorporating lifestyle medicine into their curriculum to help healthcare

providers better assist patients in developing self-care strategies to improve one’s own health (Vinje et

al., 2017; Egger et al., 2009). In short, a more holistic view of health is necessary.

2.3. Mechanisms Underlying Stress and Chronic Disease

Stress is a central concept in health psychology because it impacts nearly any bodily system, either

directly or indirectly. Traditionally, health psychologists measured stress based on self-reports of daily

stressors, stressful life events, adverse childhood experiences (ACEs) such as emotional, physical, and

sexual abuse, or food insecurity. More recently, biological measures of chronic stress have become more

commonplace with cortisol as a predominant biomarker. Studies linking stressful life conditions to later

morbidity and mortality show that stress can have direct and measureable effects on the body through

allostatic load, which is overall stress-induced physiological wear-and-tear. Studies often divide common

measurements of allostatic load into categories representing the underlying physiological systems, such

as (a) neuroendocrine system, (b) immune and inflammatory system, (c) metabolic system, (d)

cardiovascular and respiratory systems, and (e) nervous system (Solís et al., 2016). New biomarkers are

emerging at a rapid pace to measure the impact of stress upon each of these biological pathways. A

recent study used 23 different biomarkers to quantify allostatic load (see Fig. 1; Schwartz, 2017);

multivariate approaches that employ a broad range of biomarkers are preferred due to the high

complexity of the underlying biological systems, whereas studies that focus on only one or two

biomarkers may yield inconsistent findings (Morrisette-Thomas et al., 2014).

HEALTH PSYCHOLOGY 9

Fig. 1. Stress can have a negative long-term impact on health through multiple physiological pathways
and biological systems (Schwartz, 2017). Biological measures appear below each system; researchers
commonly combine measurements such as these to quantify overall allostatic load.

In more detail, Fig. 2 illustrates pathways through which chronic stress can contribute to chronic

disease, including physiological responses that interact with changes in mood, behavior, and

environment, and may also be influenced by genetics and epigenetic modifications. Pathways are

complex, bidirectional, and can be self-reinforcing. Studies have shown that social and environmental

stressors such as low parental education, maternal distress, and child abuse lead to increased

cardiovascular disease-related risks in children, which may be due in part to desensitization of the

children’s neuroendocrine-immune response (Riis et al., 2016). Among other results, Schwartz (2017)

found that allostatic load was higher in people who perceived more inequality, emphasizing the

importance of the perception in determining how stimuli convey their effects. Similarly, social adversity
HEALTH PSYCHOLOGY 10

(e.g., poverty, unemployment, low education, and lack of social support) increases the risk of chronic

disease through changes in immune cell distribution, contributing to the dualistic response of immune

function in the face of chronic stress (i.e., reduced immune function and increased chronic

inflammation) (Acabchuk et al,, 2017; Simons et al., 2017). Disparities in education offer a further

example of a stress-related impact, with inflammation accounting for the largest portion of the link

between low education and increased risk of mortality (Todd, Shkolnikov, & Goldman, 2016). Thus,

inflammation is emerging as an important biological pathway underlying health disparities.

Much research has shown that stress leaves a biological mark, getting “under the skin” through various

pathways to contribute to long-term health or disease (Acabchuk et al., 2017; Das, 2016). Given that

stress has such powerful effects, it is crucial not only to understand what causes stress but also to

identify plausible opportunities of intervention (Fig. 2). Programs that enhance coping skills, especially

those that build resilience, can offer a protective buffer against the negative health burden of stress.

Resilience is defined as the ability to thrive and survive despite exposure to difficulties (e.g., trauma,

adversity). Factors that improve resilience include positive appraisal coping, effective cognitive and

emotion regulation, self-efficacy, strong social support and family bonds (e.g., Bonanno, 2004; Li et al.,

2017). A large part of current research focuses on investigating mechanisms of action, or “active

ingredients” of interventions aimed to improve self-regulation and build resilience to stress in order to

maximize outcomes when such interventions are translated into community-based programs. The points

of intervention opportunities visualized in Fig. 2 emphasize the broad reach of behavior change and

resilience building strategies to reduce the burden of mental health and medical care.
HEALTH PSYCHOLOGY 11

Fig. 2. Pathways and points of intervention between stress and chronic disease. The relationship
between stress and chronic disease is highly complex, bidirectional, and often self-reinforcing (blue and
light gray arrows). Intervention opportunities to reduce the negative health burden of stress along the
pathway appear below the dashed line. See Fig. 1 for additional physiological changes.
PNS=parasympathetic nervous system; SNS=sympathetic nervous system.

3. Social Interactions, Networks, and Interventions

3.1. Social Networks for—or Against—Health

Section 2 documented the powerful role that stressors play in health and listed some social pressures

that are connected to stress (e.g., trauma, stigma). In fact, stresses humans face often result from other

people: family obligations, relationships, work stress, financial issues, legal problems, and even minor

disruptions like traffic or waiting in line. Furthermore, struggling to maintain healthy behavior (trying a

new diet, too much or too little exercise, quitting smoking) can also be a major source of stress.

Regardless of whether stresses are caused by other people or not (e.g., food insecurity, lack of

electricity, extreme weather), social support is a key element of the solution; allied networks can be a

force for health.

HEALTH PSYCHOLOGY 12

3.1.1. Networks can be positive or negative for health

There are two sides to social networks, negative and positive. On the negative side, it is no surprise that

other people cause stress, ranging from the death of a close friend or family member to the stress

caused by a demanding boss, abusive spouse, or sick child. The influence of the social environment is

especially critical during development: Youth from a family environment marked by socioeconomic

disadvantage, a lack of support and structure, hostility, and conflict (and other ACEs) are at higher risk

for developing poor mental and physical health outcomes such as depression, substance use,

cardiovascular disease, hypertension, and obesity (Repetti et al., 2002). Parental smoking is one of the

best predictors for smoking in their children (Palmer, 1970). More family illnesses occur when a parent is

deeply depressed (Lewis et al., 1989). Stressed or burnt-out teachers also stress their pupils (Oberle &

Schonert-Reichl, 2016). Of course, having a particular disease or illness potentially links into negative

social pressures, as has been amply demonstrated in the stigma associated with HIV/AIDS (e.g., Parker &

Aggleton, 2003), mental illness (Livingston & Boyd, 2010), and addiction (McGinty et al., 2015). The

same is true for people with stigmatized identities in terms of gender (Hankivsky, 2012), sexual

orientation (Hatzenbuehler et al., 2014), or race (Reid, Dovidio, Ballester, & Johnson, 2014). Workplace

inequality creates stress-related illness (e.g., de Jonge, Bosma, Peter, & Siegrist, 2000; Marmot et al.,

1991; Schnorpfeil et al., 2003; Siegrist et al., 2004). People commonly fret economic debts or time

commitments to others. Such robust effects offer stark testimony to the stress that negative social

networks often create. It may even often be, as the French existential philosopher Jean-Paul Sartre put

it, that “hell is other people.”

On the positive side, other people are essential to human development itself and good social

relationships help individuals thrive (Folkman, 1997). Of course, secure child development is associated

with longer, happier, more productive lives (Berkman, Glass, Brissette, & Seeman, 2000). But the health

benefits of strong relationships are not limited to development; they are essential throughout the
HEALTH PSYCHOLOGY 13

lifespan. Marital satisfaction was found to be a better buffer of day-to-day fluctuations in perceived

health and happiness in older adults compared to time spent with others, emphasizing the importance

of strong relationship bonds in maintaining happiness in the lives of older adults (Waldinger et al., 2010).

Quality of close relationships appear crucial; for example, in a Harvard study, relationship satisfaction at

age 50 predicted health at age 80 better than any biomarker (Waldinger & Schulz, 2016). People with

larger social networks suffer fewer colds despite direct exposure to a rhinovirus (Cohen et al., 1997).

Positive networks can promote having a greater sense of purpose, which is a critical determinant of

longevity (Boyle et al., 2010). People who volunteer for community causes improve their mental health

(Borgonovi, 2008). Social support, whether in the form of friends or family, was found to assist minority

women in initiating an exercise regimen (Eyler et al., 1999). Marriage is consistently linked to health

(Lewis et al., 2006); Umberson (1992) found that married men engage in healthier behavior because

their spouses monitor and attempt to control their health behavior. As Mineo (2017) aptly summarized,

“Good genes are nice, but joy is better.” Open communication between father and child positively

affects the family’s psychosocial functioning (Christensen, 2004). Social networks also have a role in

illness recovery: Breast cancer patients who felt satisfied with the level of support they received from

family members were significantly less anxious and depressed (Neuling & Winefield, 1988). Many people

with serious disabilities nonetheless report having a high quality of life, in part due to good relationships

(Albrecht & Devlieger, 1999). Some people and communities are more resilient than others due to the

positive social interactions at critical junctures (Bonanno, 2004; Berkman & Syme, 1979). In summary,

positive social networks improve productivity, healthy behavior, immune function, disease recovery,

purpose, resilience and overall quality of life. Clearly, social networks, at their best, improve physical

health and are probably the biggest contributor to positive mental health.
HEALTH PSYCHOLOGY 14

3.1.2. Interventions to improve behavior are positive networks in action

Interventions to improve health behavior by altering appraisal strategies are common targets for

intervention. Stressful life events may be inevitable, but how one perceives and interprets these events

can greatly influence the magnitude of harm imparted upon one’s health (Hagger et al., 2017; Leventhal,

Leventhal, & Contrada, 1998). Cognitive distortions, such as rumination, magnification and

catastrophizing can cause additional stress beyond the initial stressor, contributing to prolonged,

chronic stress (Zola, 1973), which can contribute to chronic disease (Fig. 2). Thus, coping interventions

(e.g., cognitive behavioral therapy, mindfulness-based interventions, goal setting, etc.) emphasize

strategies such as emotion regulation, impulse control and cognitive restructuring to improve mental

health and health behavior (e.g., Giles-Corti & Donovan, 2002; Barker, 2014; Britton et al., 2012; Loucks

et al., 2015; Ferguson, Bender, & Thompson, 2015; Folkman & Lazarus, 1988). New research is beginning

to determine the components of behavior change interventions in order to identify critical regulatory

mechanisms that underlie improved coping skills for stress reduction. For example, a recent dismantling

trial identified acceptance as a critical component of mindfulness training, where acceptance is an

attitude of receptivity and equanimity toward all momentary experiences that allows even stressful

stimuli to pass without reactivity (Lindsay et al., 2017).

Most health psychology interventions focus closely on self-regulation of emotions, cognitions, and

behaviors (e.g., Barker, 2014; Felton, Revenson, & Hinrichsen, 1984; Folkman & Lazarus, 1988). In so

doing, interventionists network with target individuals to promote health in person, or more recently,

through technology and social media (Head, Noar, Iannarino, & Harrington, 2013; Johnson et al., 2010).

This strategy attempts to educate, provide needed skills, or to enhance motivation to act in a healthy

fashion. Behavior change theories provide frameworks for evaluating interventions and identifying

target mechanisms that produce desired outcomes (e.g., Fisher & Fisher, 1992; Gardner et al., 2010). A
HEALTH PSYCHOLOGY 15

behavior change technique taxonomy provides researchers with a reliable method for identifying the

key “active ingredients” of a behavior change intervention (e.g., prompts/cues, social support, and

feedback) (Michie et al., 2013). Certain behavior change techniques, such as goal setting and self-

monitoring, appear particularly useful in promoting the development of healthy behaviors, while factors

related to internal motivation and autonomy appear more critical for maintaining those efforts

(Kwasnicka et al., 2016; Samdal et al., 2017). Nonetheless, health behavior change and maintenance do

not happen in a vacuum; social networks are critical. Interventions that accommodate social contagion

will spread behavior change more effectively (Aral & Nicolaides, 2017). Loneliness and high conflict

relationships undermine health, and strong positive close relationships offer protective factors to both

the mind and body. Close relationships help keep us happy and healthy, but they are not a quick fix:

relationships take time and effort to establish and maintain. Although much research has highlighted the

importance of close personal relationships to improve physical and mental health, the challenge remains

to translate such knowledge into interventions to improve social relationships (Dunkel Schetter, 2017).

3.1.3. Patient-provider interactions as social networks

Medical and other health providers must interact with patients for routine care and in the case of illness

and other maladies. Since the 1970s, medical practice has moved toward a patient-centered approach

such that patients are no longer passive recipients of health instructions but in fact “have expectations

of the doctor, evaluate the doctor’s actions, and are able to make their own treatment decisions”

(Stimson 1974, p. 97; see also Mead & Bower, 2000). Indeed, part of the placebo response to medical

treatments may stem from the patient’s beliefs and expectations about the provider (Bishop et al.,

2012; Noble, Douglas, & Newman, 2001). Interestingly, Hall and Dornam’s (1988) meta-analysis on

patient satisfaction surveys found that patients considered the overall quality, humaneness, and

competence of the provider to be of higher importance than actual health outcomes. How and when

doctors choose to impart critical medical information can influence a patient’s ability to comprehend
HEALTH PSYCHOLOGY 16

and recall such information (e.g., providing instructions while under the duress of impending test results

may not be ideal; Portnoy, 2010). Effective communication strategies may be even more important

when the patients are members of vulnerable populations (e.g., low SES patients, children). In their

systematic review, Kodjebacheva, Sabo, and Xiong (2016) found that medical communications with

children improved when providers undertook role-playing and seminars, when parents read booklets or

attended discussions, and when children watched videos showing how to communicate with physicians.

Together, these studies illustrate just some of the reasons why patient-provider interactions are an

important component of the healthcare network.

Another issue related to patient-provider interactions is the need to adhere to medical regimens that

the provider prescribes, because adherence is a primary determinant of treatment success. The WHO

found that only 50% of patients who suffer from chronic diseases adhere to treatment

recommendations (Sabate, 2003). Consequences of poor adherence include both health and economic

implications; thus, the issue of compliance is a major focus of health change research. Since the 1980s,

medical regimen adherence has been viewed more as an issue of self-regulation, albeit triggered by a

visit with a provider, rather than of compliance based on the doctor-patient relationship (Conrad, 1985);

that is, even if patients have a strong positive relationship with their doctor (and finances are not the

issue), they may still have trouble adhering. Not surprisingly, interventions to improve medical regimen

adherence succeed better when they incorporate more social support (de Bruin et al., 2010). Thus, some

part of medical compliance stems from others’ influence, the network regulation of health behavior.

3.2. Connections of Health Psychological Processes Mediate Upstream and Downstream Forces

Our discourse highlights the fact that networks are crucial for individual health. Berkman and colleagues

(2000) posited that factors at a broader, upstream level cascade into lower levels downstream using

processes and structures such as Fig. 3 lists. Thus, cultural, socioeconomic, political, and social change
HEALTH PSYCHOLOGY 17

factors influence social networks, which in turn affect individual outcomes. This and other ecological

models emphasize that, without congenial upstream factors, it is difficult to reduce health burdens at

the individual level. Accordingly, for example, neighborhood factors such as perceived safety, sidewalks,

and proximity to recreational facilities have some influence on physical activity levels (Carver et al.,

2010); similarly, a supportive physical environment is necessary to enhance recreational physical

activity, but not sufficient to induce behavior (Giles-Corti & Donovan, 2002). In the U.S. and many

developed nations, income inequality has increased in recent decades, which marks an environment

that selectively disadvantages some over others and worsens health (Pickett & Wilkinson, 2015). Thus,

reducing income inequality is increasingly a good way to improve public health, because it improves the

ecology for all concerned. Note that the material we have covered in this article is congenial to both

upstream and downstream factors that Bergman and colleagues identified: Health psychology

mechanisms would seem to be central to public health.

HEALTH PSYCHOLOGY 18

Fig. 3. A conceptual model of how social networks impact health (from Berkman et al., 2000).

4. Trends in Health Psychology Research

Although health psychologists have published their work in a wide variety of outlets, many have

appeared in the journal in which this article appears, Social Science & Medicine (SSM), which Pergamon

Press established in 1967 (in 1991, Elsevier Limited acquired Pergamon Press). Thus, this article and

others celebrate SSM’s golden jubilee; in this article, we cited classic sources, many of which appeared

in SSM (for methods, see Appendix A in the online supplement). From its onset, SSM featured articles

from the then-fashionable term medical psychology and it has maintained a health psychology office for

decades. In the past 50 years, SSM has published over 18,000 articles, with a substantial subset focusing

on health psychology.
HEALTH PSYCHOLOGY 19

4.1. Trends in topics.

As Figure 4 shows, prominent articles published in the 1970s tended to focus more on doctor-patient

relationships/satisfaction, stress, coping, and cardiovascular health, whereas articles since 2010 have

focused more on health or mortality, obesity, mental illness/health, and socioeconomic factors

impacting health, illustrating a shift towards a more proactive approach by looking at behavior change

and programs that attempt to improve practices for better health. Yet, such illustrations cannot capture

all recent advances, such as the crucial importance of sufficient sleep for health (e.g., Exelmans & Van

den Bulck, 2016). Trends in health psychology often reflect current disease epidemics, especially when

funding is allocated to address the issue. For example, the HIV/AIDS epidemic that began in the 1980s

led to a flow of funding that allowed researchers to work across national boundaries, focusing efforts on

behavior change research evaluating prevention programs and strategies to improve care for those

living with or affected by HIV/AIDS (e.g., Parker & Aggleton, 2003). Knowledge gained from HIV/AIDS

interventions is now being translated to additional health domains. Similarly, research follows the

impact of world events, such as the mental health of refugees arriving from war-torn countries (e.g.,

Miller & Rasmussen, 2010). Topics in health psychology also address policy ramifications, which can be

powerful motivators of behavior change. For example, Noar et al.’s (2016) meta-analysis documented

that strengthened cigarette pack warnings increased knowledge, quit line calls, and quit attempts, and

ultimately were associated with decreased smoking consumption and prevalence.

HEALTH PSYCHOLOGY 20

1970s 2010s

Fig. 4. Primary subjects of prominent articles published in Social Science & Medicine during the 1970s
(left) and between 2010 and 2016 (right), sized according to frequency of appearance. Appendix C in
the online supplement offers additional such word cloud figures.

Health disparities have always been an important research agenda for social science, and health

psychology in particular; health disparities are known to persist even after controlling for access-related

factors (Bastos et al., 2010). Racial disparities exist in terms of how physicians perceive and act with

patients, and vice versa (Sussman et al., 1987; Van Ryn & Burke, 2000). Such discrimination can directly

impact treatments or treatment-seeking behavior. For example, Burgess et al. (2008) showed

experimentally that doctors use racial stereotyping when prescribing opioids to manage pain, employing

different decision-making strategies for Whites and Blacks. Rising awareness of extremes of wealth and

prevalence of poverty ought to pressure society’s leaders to address health inequalities. As noted, in the

United States and many developed nations, income inequality has increased in recent decades, which

marks an environment that selectively disadvantages some over others and worsens health (Pickett &

Wilkinson, 2015). Thus, reducing income inequality is logically a way to improve public health.
HEALTH PSYCHOLOGY 21

4.2. Societal and Technological Trends.

Culture and social networks shape habits and behavior in almost an unconscious level, having a strong

impact on how we cope with stress and handle anxiety (Bourdieau, 1984; Zola, 1973). Fewer people are

involved in organized religion, which traditionally helped facilitate a sense of community and connection

with a meaningful set of values. A contemporary rise in spirituality may be an attempt to fill this void, as

people seek to find meaning in their lives (e.g., WHOQoL SRPB Group, 2006). Importantly, educational

systems are working to bring healthy meals and mind-body programs into the classroom to improve

student attention and behavior; corporations are investing in lifestyle programs for employees to

increase productivity and reduce healthcare costs; law enforcement personnel are receiving training to

reduce implicit bias and discrimination to improve relationships between police officers and community

members.

Technology continues to change society rapidly, altering many facets of daily life and as an extension,

people’s health. With these changes come both new opportunities and new problems, and new

problems require novel solutions. Health-related benefits of an ever-more-wired era include online

support groups, easily accessible apps to help people deal with problems like addiction, and an array of

fitness trackers, app monitors, and feedback tools that empower people to take control over their own

personal health. Technology is also transforming the doctor-patient relationship in positive ways,

through improved communication, increased monitoring capabilities, and more personalized care. Of

course there are also many concerns associated with the rise in use of technology, such as reduced face-

to-face interactions with physicians due to the push towards telemedicine, which could potentially

impair quality of interaction and subsequent compliance. Examples of other concerns include increased

screen time in youth contributing to childhood obesity, diminished social skills, depression, or issues

with attention and impulse control in a society surrounded by instant gratification (e.g., Liu et al., 2015;
HEALTH PSYCHOLOGY 22

Exelmans & Van den Bulck, 2016; Head et al., 2013). It is not yet known whether social media

addiction (e.g., obsessive monitoring of ‘likes’ on Instagram) will translate into increased health issues

and risk behaviors, but research does suggest that repetitive stimulation of dopaminergic reward

systems can prime addiction pathways, especially during development (Kim et al., 2017). Recent studies

investigate new internet-related issues that arise such as the prevalence of biased online reviews of

medical treatment outcomes (de Barra, 2017), which can lead to consumers/patients basing treatment

decisions on evidence-based hearsay rather than principles of evidence-based medicine (Ioannidis

2017).

4.3. Research Trends and Scientific Advancements.

Similar to trends found in related fields, health psychology increasingly investigates causal pathways.

While earlier work focused on identifying and exploring what mental, behavioral, environmental and

cultural factors influence health and illness, as we documented in section 2.3, more recent

investigations work to identify how these factors influence health. Exemplifying this trend in depression,

early studies focused on identifying groups vulnerable to depression, and investigated ethnic differences

in care seeking behavior (Sussman et al., 1987). More recent studies address how environmental factors

contribute to depression. For example, studies ask: Does neighborhood crime influence depressive

symptoms via epigenetic alterations (Lei et al., 2015)? And, what is the directional link between

inflammation and depression (Das, 2016)? These studies illustrate a larger biodemographic trend that

relies on interdisciplinary strategies, often combining “big data” (e.g., spatially linking large public

datasets) with advanced biomarker technology to address challenging health-related issues.

As collaborations across fields seek to provide novel insight into complex health issues that are often

beyond any single scientist’s area of expertise, it becomes essential to proceed with care; social

scientists must appreciate the rigor required and honor the limitations of biological measurements, and
HEALTH PSYCHOLOGY 23

basic scientists must appreciate the challenges involved in working with uncontrolled samples outside of

the laboratory setting (Johnson & Michie, 2015; Kaufman et al., 2014). Choosing appropriate study

designs is critical, especially when using biomarkers such as cortisol or alpha-amylase that have naturally

occurring diurnal variations (Skoluda et al., 2017). As we noted, new biomarkers for stress and

inflammation are emerging and more commonly used, especially as less invasive methods of collection

become available. Rather than having to obtain blood or urine samples, several markers can now be

analyzed via saliva, and hair samples may even be used to examine temporal change in chronic stress

gauged through cortisol levels (Pacella et al., 2017).

In the future, emerging scientific advances including those derived from animal studies will likely spur

the field of health psychology to address novel questions related to health, stress, and disease. As an

illustration, animal studies on the microbiota-gut-brain axis have shown that stress changes the internal

environment of the intestinal tract to make it less habitable for the ‘good’ bacteria, increasing levels of

the ‘bad’ bacteria. Changes in the microbiome can affect signaling in the brain, alter mood regulation,

increase pain sensitivity and may even be related to increased risk of disease (e.g., vascular issues that

can lead to stroke or cognitive decline) (Tang et al., 2017). Scientific advances in understanding the

influence of gut microbiota on emotion, cognition and behavior may propel social scientists to ask new

questions about the associations between nutrition and stress, mental health and disease. This

interdisciplinary research is essential to tackling maternal depression and developmental consequences

of child malnutrition worldwide.

Advances in neuroscience demonstrate that while environmental stressors can create lasting

impairments in behavior and brain functioning through neuroplasticity, these effects can also be

reversible through persistent re-patterning (Liston et al, 2009). Such findings lend important implications

for stress reduction strategies and learned coping skills to mitigate the sequelae of chronic stress (e.g.,
HEALTH PSYCHOLOGY 24

improve cognitive function and behavior). New forms of cognitive behavioral therapy based on

mindfulness, compassion, gratitude, and acceptance (Kahl et al., 2012; Otto et al., 2016) are examples of

mind-body interventions geared towards empowering individuals to take greater control over their own

thoughts, emotions, behaviors and habits. Fortunately, neuroplasticity exists even late in life (Ellwardt,

Van Tilburg, & Aartsen, 2015; Boyke et al., 2008), potentiating positive health behavior change and

maintenance. Similarly, rejecting negative stereotypes about aging is associated with more successful

aging (Levy, Pilver, & Pietrzak, 2014).

5. Conclusion: The Secret to Successful Living

To reduce the immense burden of chronic disease, health behavior change is necessary at the

population level. Positive social networks along with efforts to improve self-regulation are critical to

establishing and maintaining healthy attitudes and behavior. Public policy to address income inequality

will help alleviate health disparities, but similar to the underlying biological mechanisms of stress, issues

surrounding inequality are highly complex and often bidirectional. A wide opportunity for intervention

lies in improving coping strategies and stress reactions, such as resilience training to reduce additional

suffering that often goes beyond the initial stressor.

Although not commonly stated as such, the lessons of health psychology research offer an answer to the

secret to successful living: Maintain a sense of purpose, positive social relationships and healthy habits,

including a healthy diet, sufficient exercise and sleep; moderation and optimism are best. Not only is this

a recipe for successful living, but successful aging, as well. The caveat is that many factors can interfere

with these lessons, and unless social networks are supportive, health will be compromised. Although

many factors may remain out of an individual’s control (Figs. 2 and 3), behavior change strategies can

empower individuals and populations to improve health, longevity and quality of life. In the end, the

ultimate lesson of health psychology is that good health hinges on taking a comprehensive approach
HEALTH PSYCHOLOGY 25

that optimizes biological, psychological, social, and environmental (natural and built) forces. Future

research that uses increasingly rigorous and interdisciplinary perspectives will elaborate the

mechanisms involved and ensure that, in years to come, health psychology will continue to play an

essential role in understanding the keys to a long, happy, productive life.

HEALTH PSYCHOLOGY 26

References

Acabchuk, R.L., Kamath, J., Salamone, J.D., & Johnson, B.T. (2017). Stress and chronic illness: The

inflammatory pathway. Social Science & Medicine, 185, 158-165.

Adler, R.H. (2009). Engel’s biopsychosocial model is still relevant today. Journal of Psychosomatic

Research, 67(6), 607-611.

Albrecht, G.L., & Devlieger, P. J. (1999). The disability paradox: High quality of life against all odds. Social

Science & Medicine, 48(8), 977-988.

Antonovsky, A. (1993). The structure and properties of the sense of coherence scale. Social Science &

Medicine, 36(6), 725-733.

Aral, S., & Nicolaides, C. (2017). Exercise contagion in a global social network. Nature

Communications, 8.

Barker, K.K. (2014). Mindfulness meditation: Do-it-yourself medicalization of every moment. Social

Science & Medicine, 106, 168-176.

Bastos, J.L., Celeste, R.K., Faerstein, E., & Barros, A. J. (2010). Racial discrimination and health: A

systematic review of scales with a focus on their psychometric properties. Social Science &

Medicine, 70(7), 1091-1099.

Berkman, L.F., Glass, T., Brissette, I., & Seeman, T.E. (2000). From social integration to health: Durkheim

in the new millennium. Social Science & Medicine, 51(6), 843-857.

Berkman, L.F., & Syme, S.L. (1979). Social networks, host resistance, and mortality: A nine-year follow-up

study of Alameda County residents. American Journal of Epidemiology, 109(2), 186-204.

Bishop, F.L., Jacobson, E.E., Shaw, J.R., & Kaptchuk, T. J. (2012). Scientific tools, fake treatments, or

triggers for psychological healing: How clinical trial participants conceptualise placebos. Social

Science & Medicine, 74(5), 767-774.

HEALTH PSYCHOLOGY 27

Blair, I.V., & Brondolo, E. (2017). Moving beyond the individual: Community-level prejudice and health.

Social Science & Medicine, 183, 169-172.

Bonanno, G.A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity

to thrive after extremely aversive events? American Psychologist, 59(1), 20-28.

Borgonovi, F. (2008). Doing well by doing good: The relationship between formal volunteering and self-

reported health and happiness. Social Science & Medicine, 66(11), 2321-2334.

Boyle, P.A., Buchman, A.S., & Bennett, D.A. (2010). Purpose in life is associated with a reduced risk of

incident disability among community-dwelling older persons. The American Journal of Geriatric

Psychiatry, 18(12), 1093-1102.

Bourdieu, P. (1984). Distinction: A social critique of the judgement of taste. Harvard University Press.

Boyke, J., Driemeyer, J., Gaser, C., Büchel, C., & May, A. (2008). Training-induced brain structure changes

in the elderly. Journal of Neuroscience, 28, 7031-7035.

Burgess, D. J., Crowley-Matoka, M., Phelan, S., Dovidio, J. F., Kerns, R., Roth, C., ... & van Ryn, M. (2008).

Patient race and physicians’ decisions to prescribe opioids for chronic low back pain. Social

Science & Medicine, 67(11), 1852-1860.

Carver, A., Timperio, A., Hesketh, K., & Crawford, D. (2010). Are children and adolescents less active if

parents restrict their physical activity and active transport due to perceived risk? Social Science

& Medicine, 70(11), 1799-1805.

Chan, M. (2016) Obesity and diabetes: The slow-motion disaster Keynote address at the 47th meeting of

the National Academy of Medicine, World Health Organization. Accessed on 3 Oct 2017.

http://www.who.int/dg/speeches/2016/obesity-diabetes-disaster/en/

Christensen, P. (2004). The health-promoting family: a conceptual framework for future research. Social

Science & Medicine, 59(2), 377-387.

HEALTH PSYCHOLOGY 28

Cohen, S., Doyle, W. J., Skoner, D.P., Rabin, B.S., & Gwaltney, J.M. (1997). Social ties and susceptibility to

the common cold. JAMA, 277(24), 1940-1944.

Conrad, P. (1985). The meaning of medications: Another look at compliance. Social Science &

Medicine, 20(1), 29-37.

Cohen, S., Doyle, W. J., Skoner, D.P., Rabin, B.S., & Gwaltney, J.M. (1997). Social ties and susceptibility to

the common cold. JAMA, 277(24), 1940-1944.

Das, A. (2016). Psychosocial distress and inflammation: Which way does causality flow? Social Science &

Medicine, 170, 1-8.

de Barra, M. (2017). Reporting bias inflates the reputation of medical treatments: A comparison of

outcomes in clinical trials and online product reviews. Social Science & Medicine, 177, 248-255.

de Bruin, M., Viechtbauer, W., Schaalma, H.P., Kok, G., Abraham, C., & Hospers, H. J. (2010). Standard

care impact on effects of highly active antiretroviral therapy adherence interventions: A meta-

analysis of randomized controlled trials. Archives of Internal Medicine, 170(3), 240-250.

de Jonge, J., Bosma, H., Peter, R., & Siegrist, J. (2000). Job strain, effort-reward imbalance and employee

well-being: A large-scale cross-sectional study. Social Science & Medicine, 50(9), 1317-1327.

Dunkel Schetter, C. (2017). Moving research on health and close relationships forward—a challenge and

an obligation: Introduction to the special issue. American Psychologist, 72(6), 511-516. doi:

10.1037/amp0000158

Egger, G. J., Binns, A.F., & Rossner, S.R. (2009). The emergence of “lifestyle medicine” as a structured

approach for management of chronic disease. Medical Journal of Australia, 190(3), 143-145.

Ellwardt, L., Van Tilburg, T.G., & Aartsen, M.J. (2015). The mix matters: Complex personal networks

relate to higher cognitive functioning in old age. Social Science & Medicine, 125, 107-115.

Engel, G.L. (1977). The need of a new medical model: A challenge for biomedicine. Science, 196, 129-

136.
HEALTH PSYCHOLOGY 29

Eyler, A.A., Brownson, R.C., Donatelle, R. J., King, A.C., Brown, D., & Sallis, J.F. (1999). Physical activity

social support and middle-and older-aged minority women: results from a US survey. Social

Science & Medicine, 49(6), 781-789.

Exelmans, L., & Van den Bulck, J. (2016). Bedtime mobile phone use and sleep in adults. Social Science &

Medicine, 148, 93-101.

Felton, B. J., Revenson, T.A., & Hinrichsen, G.A. (1984). Stress and coping in the explanation of

psychological adjustment among chronically ill adults. Social Science & Medicine, 18(10), 889-

898.

Ferguson, K.M., Bender, K., & Thompson, S.J. (2015). Gender, coping strategies, homelessness stressors,

and income generation among homeless young adults in three cities. Social Science & Medicine,

135, 47-55.

Fisher, J.D., & Fisher, W.A. (1992). Changing AIDS risk behavior. Psychological Bulletin, 111, 455-474.

Folkman, S. (1997). Positive psychological states and coping with severe stress. Social Science &

Medicine, 45(8), 1207-1221.

Folkman, S., & Lazarus, R.S. (1988). The relationship between coping and emotion: Implications for

theory and research. Social Science & Medicine, 26(3), 309-317.

Gardner, B., Whittington, C., McAteer, J., Eccles, M.P., & Michie, S. (2010). Using theory to synthesise

evidence from behaviour change interventions: The example of audit and feedback. Social

Science & Medicine, 70(10), 1618-1625.

Giles-Corti, B., & Donovan, R. J. (2002). The relative influence of individual, social and physical

environment determinants of physical activity. Social Science & Medicine, 54(12), 1793-1812.

Glass, T.A., & McAtee, M. J. (2006). Behavioral science at the crossroads in public health: Extending

horizons, envisioning the future. Social Science & Medicine, 62(7), 1650-1671.
HEALTH PSYCHOLOGY 30

Hagger, M. S., Koch, S., Chatzisarantis, N. L., & Orbell, S. (2017). The Common Sense Model of Self-

Regulation: Meta-analysis and test of a process model. Psychological Bulletin, 143(11), 1117-

1154.

Hall, J.A., & Dornan, M.C. (1988). What patients like about their medical care and how often they are

asked: A meta-analysis of the satisfaction literature. Social Science & Medicine, 27(9), 935–939.

Hankivsky, O. (2012). Women’s health, men’s health, and gender and health: Implications of

intersectionality. Social Science & Medicine, 74(11), 1712-1720.

Hatzenbuehler, M.L., Bellatorre, A., Lee, Y., Finch, B.K., Muennig, P., & Fiscella, K. (2014). Structural

stigma and all-cause mortality in sexual minority populations. Social Science & Medicine, 103,

33-41.

Head, K. J., Noar, S.M., Iannarino, N.T., & Harrington, N.G. (2013). Efficacy of text messaging-based

interventions for health promotion: A meta-analysis. Social Science & Medicine, 97, 41-48.

Ioannidis, J.P.A. (2017). Does evidence-based hearsay determine the use of medical treatments? Social

Science & Medicine, 177, 256-258.

Johnson, B.T., & Michie, S. (2015). Towards healthy theorising about health behaviouACrs in the maze of

messy reality: A reaction to Peters, de Bruin, and Crutzen. Health Psychology Review, 9(1), 21-

24.

Johnson, B.T., Redding, C.A., DiClemente, R. J., Mustanski, B.S., Dodge, B., Sheeran, P., ...& Carey, M.P.

(2010). A network-individual-resource model for HIV prevention. AIDS and Behavior, 14(2), 204-

221.

Kahl, K.G., Winter, L., & Schweiger, U. (2012). The third wave of cognitive behavioural therapies: What is

new and what is effective? Current Opinion in Psychiatry, 25(6), 522-528.

HEALTH PSYCHOLOGY 31

Kaufman, M. R., Cornish, F., Zimmerman, R. S., & Johnson, B. T. (2014). Health behavior change models

for HIV prevention and AIDS care: Practical recommendations for a multi-level approach. JAIDS

Journal of Acquired Immune Deficiency Syndromes, 66, S250-S258.

Kawachi, I., & Subramanian S.V. (2017). Social epidemiology for the 21st century. Social Science &

Medicine.

Kendall, E., Catalano, T., Kuipers, P., Posner, N., Buys, N., & Charker, J. (2007). Recovery following stroke:

The role of self-management education. Social Science & Medicine, 64(3), 735-746.

Kim, H. J., Lee, J. H., Yun, K., & Kim, J. H. (2017). Alterations in Striatal Circuits Underlying Addiction-Like

Behaviors. Molecules and cells, 40(6), 379.

Kodjebacheva, G.D., Sabo, T., & Xiong, J. (2016). Interventions to improve child-parent-medical provider

communication: A systematic review. Social Science & Medicine, 166, 120-127.

Kwasnicka, D., Dombrowski, S.U., White, M., & Sniehotta, F. (2016). Theoretical explanations for

maintenance of behaviour change: A systematic review of behaviour theories. Health

Psychology Review, 10(3), 277–296.

Lei, M.K., Beach, S.R., Simons, R.L., & Philibert, R.A. (2015). Neighborhood crime and depressive

symptoms among African American women: Genetic moderation and epigenetic mediation of

effects. Social Science & Medicine, 146, 120-128.

Levy, B.R., Pilver, C.E., & Pietrzak, R.H. (2014). Lower prevalence of psychiatric conditions when negative

age stereotypes are resisted. Social Science & Medicine, 119, 170-174.

Leitner, J.B., Hehman, E., Ayduk, O., & Mendoza-Denton, R. (2016). Racial bias is associated with ingroup

death rate for Blacks and Whites: Insights from Project Implicit. Social Science & Medicine, 170,

220-227.

Leventhal, H., Leventhal, E. A., & Contrada, R. J. (1998). Self-regulation, health, and behavior: A

perceptual-cognitive approach. Psychology and Health, 13(4), 717-733.

HEALTH PSYCHOLOGY 32

Lewis, F. M., Woods, N. F., Hough, E. E., & Bensley, L. S. (1989). The family’s functioning with chronic

illness in the mother: The spouse’s perspective. Social Science & Medicine, 29, 1261-1269.

Lewis, M.A., McBride, C.M., Pollak, K.I., Puleo, E., Butterfield, R.M., & Emmons, K.M. (2006).

Understanding health behavior change among couples: An interdependence and communal

coping approach. Social Science & Medicine, 62(6), 1369-1380.

Li, X., Harrison, S.E., Fairchild, A.J., Chi, P., Zhao, J., & Zhao, G. (2017). A randomized controlled trial of a

resilience-based intervention on psychosocial well-being of children affected by HIV/AIDS:

Effects at 6-and 12-month follow-up. Social Science & Medicine, 190, 256-264.

Lindsay, E.K., Young, S., Smyth, J.M., Brown, K.W., & Creswell, J.D. (2017). Acceptance lowers stress

reactivity: Dismantling mindfulness training in a randomized controlled

trial. Psychoneuroendocrinology.

Livingston, J.D., & Boyd, J.E. (2010). Correlates and consequences of internalized stigma for people living

with mental illness: A systematic review and meta-analysis. Social Science & Medicine, 71(12),

2150-2161.

Loucks, E.B., Schuman-Olivier, Z., Britton, W.B., Fresco, D.M., Desbordes, G., Brewer, J.A., & Fulwiler, C.

(2015). Mindfulness and cardiovascular disease risk: State of the evidence, plausible

mechanisms, and theoretical framework. Current Cardiology Reports, 17(12), 112.

Marmot, M.G., Stansfeld, S., Patel, C., North, F., Head, J., White, I., ...& Smith, G.D. (1991). Health

inequalities among British civil servants: The Whitehall II study. The Lancet, 337(8754), 1387-

1393.

Marrouch, N., & Johnson, B.T. (in press). Geocoding: Using space to enhance social psychological

research. In H. Blanton & G.D. Webster (Eds.), Social psychological assessment. New York:

Psychology Press.
HEALTH PSYCHOLOGY 33

McGinty, E.E., Goldman, H.H., Pescosolido, B., & Barry, C.L. (2015). Portraying mental illness and drug

addiction as treatable health conditions: effects of a randomized experiment on stigma and

discrimination. Social Science & Medicine, 126, 73-85.

Mead, N., & Bower, P. (2000). Patient-centredness: A conceptual framework and review of the empirical

literature. Social Science & Medicine, 51(7), 1087-1110.

Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., ...& Wood, C.E. (2013).

The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building

an international consensus for the reporting of behavior change interventions. Annals of

Behavioral Medicine, 46(1), 81-95.

Miller, K.E., & Rasmussen, A. (2010). War exposure, daily stressors, and mental health in conflict and

post-conflict settings: Bridging the divide between trauma-focused and psychosocial

frameworks. Social Science & Medicine, 70(1), 7-16.

Mineo, L. (2017). Good genes are nice, but joy is better. Harvard Gazette

https://news.harvard.edu/gazette/story/2017/04/over-nearly-80-years-harvard-study-has-

been-showing-how-to-live-a-healthy-and-happy-life accessed 27 October 2017.

Morrisette-Thomas, V., Cohen, A.A., Fülöp, T., Riesco, É., Legault, V., Li, Q., ... & Ferrucci, L. (2014).

Inflamm-aging does not simply reflect increases in pro-inflammatory markers. Mechanisms of

Ageing and Development, 139, 49-57.

Noar, S.M., Francis, D.B., Bridges, C., Sontag, J.M., Ribisl, K.M., & Brewer, N.T. (2016). The impact of

strengthening cigarette pack warnings: Systematic review of longitudinal observational studies.

Social Science & Medicine, 164, 118-129.

Noble, L.M., Douglas, B.C., & Newman, S.P. (2001). What do patients expect of psychiatric services? A

systematic and critical review of empirical studies. Social Science & Medicine, 52(7), 985-998.
HEALTH PSYCHOLOGY 34

Neuling, S.J., & Winefield, H.R. (1988). Social support and recovery after surgery for breast cancer:

frequency and correlates of supportive behaviours by family, friends and surgeon. Social Science

& Medicine, 27(4), 385-392.

Oberle, E., & Schonert-Reichl, K.A. (2016). Stress contagion in the classroom? The link between

classroom teacher burnout and morning cortisol in elementary school students. Social Science &

Medicine, 159, 30-37.

Ogden, C. L., Carroll, M.D., Fryar, C.D, & Flegal, K.M. (2015). Prevalence of obesity among adults and

youth: United States, 2011–2014. NCHS data brief, no 219. Hyattsville, MD: National Center for

Health Statistics.2015.

Ogden, J. (1995). Psychosocial theory and the creation of the risky self. Social Science & Medicine, 40(3),

409-415.

Okada, H., Kuhn, C., Feillet, H., & Bach, J.F. (2010). The ‘hygiene hypothesis’ for autoimmune and allergic

diseases: An update. Clinical & Experimental Immunology, 160(1), 1-9.

Orchard, J., & Price, J. (2017). County-level racial prejudice and the black-white gap in infant health

outcomes. Social Science & Medicine, 181, 191-198.

Otto, A.K., Szczesny, E.C., Soriano, E.C., Laurenceau, J.P., & Siegel, S.D. (2016). Effects of a randomized

gratitude intervention on death-related fear of recurrence in breast cancer survivors. Health

Psychology, 35(12), 1320.

Pacella, M.L., Hruska, B., Steudte-Schmiedgen, S., George, R.L., & Delahanty, D.L. (2017). The utility of

hair cortisol concentrations in the prediction of PTSD symptoms following traumatic physical

injury. Social Science & Medicine, 175, 228-234.

Palmer, A.B. (1970). Some variables contributing to the onset of cigarette smoking among junior high

school students. Social Science & Medicine, 4, 359-366.

HEALTH PSYCHOLOGY 35

Parker, R., & Aggleton, P. (2003). HIV and AIDS-related stigma and discrimination: A conceptual

framework and implications for action. Social Science & Medicine, 57(1), 13-24.

Pickett, K.E., & Wilkinson, R.G. (2015). Income inequality and health: a causal review. Social Science &

Medicine, 128, 316-326.

Portnoy, D.B. (2010). Waiting is the hardest part: Anticipating medical test results affects processing and

recall of important information. Social Science & Medicine, 71(2), 421-428.

Reid, A.E., Dovidio, J.F., Ballester, E., & Johnson, B.T. (2014). HIV prevention interventions to reduce

sexual risk for African Americans: The influence of community-level stigma and psychological

processes. Social Science & Medicine, 103, 118-125.

Repetti, R. L., Taylor, S. E., & Seeman, T. E. (2002). Risky families: family social environments and the

mental and physical health of offspring. Psychological bulletin, 128(2), 330.

Riis, J.L., Granger, D.A., Minkovitz, C.S., Bandeen-Roche, K., DiPietro, J.A., & Johnson, S.B. (2016).

Maternal distress and child neuroendocrine and immune regulation. Social Science &

Medicine, 151, 206-214.

Sabate, E. (2003). Adherence to long-term therapies: Evidence for action. Geneva: World Health

Organization.

Samdal, G.B., Eide, G.E., Barth, T., Williams, G., & Meland, E. (2017). Effective behaviour change

techniques for physical activity and healthy eating in overweight and obese adults: Systematic

review and meta-regression analyses. International Journal of Behavioral Nutrition and Physical

Activity, 14(1), 42.

Schnorpfeil, P., Noll, A., Schulze, R., Ehlert, U., Frey, K., & Fischer, J.E. (2003). Allostatic load and work

conditions. Social Science & Medicine, 57(4), 647-656.

Schwartz, G.E.& Weiss, S.M. (1978). Behavioral medicine revisited: An amended definition. Journal of

Behavioral Medicine, 1, 249-251.

HEALTH PSYCHOLOGY 36

Schwartz, J.A. (2017). Long-term physical health consequences of perceived inequality: Results from a

twin comparison design. Social Science & Medicine, 187, 184-192.

Siegrist, J., Starke, D., Chandola, T., Godin, I., Marmot, M., Niedhammer, I., & Peter, R. (2004). The

measurement of effort–reward imbalance at work: European comparisons. Social Science &

Medicine, 58(8), 1483-1499.

Simons, R.L., Lei, M.K., Beach, S.R., Barr, A.B., Cutrona, C.E., Gibbons, F.X., & Philibert, R.A. (2017). An

index of the ratio of inflammatory to antiviral cell types mediates the effects of social adversity

and age on chronic illness. Social Science & Medicine, 185, 166-170.

Skoluda, N., La Marca, R., Gollwitzer, M., Müller, A., Limm, H., Marten-Mittag, B., ...& Nater, U.M.

(2017). Long-term stability of diurnal salivary cortisol and alpha-amylase secretion patterns.

Physiology & Behavior, 175, 1-8.

Solís, C.B., Fantin, R., Castagné, R., Lang, T., Delpierre, C., & Kelly-Irving, M. (2016). Mediating pathways

between parental socio-economic position and allostatic load in mid-life: Findings from the 1958

British birth cohort. Social Science & Medicine, 165, 19-27.

Stimson, G.V. (1974). Obeying doctor's orders: A view from the other side. Social Science & Medicine, 8,

97-104.

Sussman, L.K., Robins, L.N., & Earls, F. (1987). Treatment-seeking for depression by black and white

Americans. Social Science & Medicine, 24(3), 187-196.

Tang, A.T., Choi, J.P., Kotzin, J. J., Yang, Y., Hong, C.C., Hobson, N., ...& Cao, Y. (2017). Endothelial TLR4

and the microbiome drive cerebral cavernous malformations. Nature, 545(7654), 305-310.

Todd, M.A., Shkolnikov, V.M., & Goldman, N. (2016). Why are well-educated Muscovites more likely to

survive? Understanding the biological pathways. Social Science & Medicine, 157, 138-147.

Umberson, D. (1992). Gender, marital status and the social control of health behavior. Social Science &

Medicine, 34(8), 907-917.

HEALTH PSYCHOLOGY 37

Van Ryn, M., & Burke, J. (2000). The effect of patient race and socio-economic status on physicians'

perceptions of patients. Social Science & Medicine, 50(6), 813-828.

Vinje, H.F., Ausland, L.H., & Langeland, E. (2017). The application of salutogenesis in the training of

health professionals. In The Handbook of Salutogenesis (pp.307-318). Springer International

Publishing.

Wade, D.T., & Halligan, P.W. (2004). Do biomedical models of illness make for good healthcare systems?

BMJ: British Medical Journal, 329(7479), 1398.

Waldinger, R.J., & Schulz, M.S. (2016). The long reach of nurturing family environments: links with

midlife emotion-regulatory styles and late-life security in intimate relationships. Psychological

Science, 27(11), 1443-1450.

WHO (2015, 19 January). WHO news release: Noncommunicable diseases prematurely take 16

million lives annually, WHO urges more action.http://www.who.

Int/mediacentre/news/releases/2015/noncommunicable-diseases/en/

WHO (1946). Preamble to the Constitution of WHO as adopted by the International Health Conference,

New York, 19 June - 22 July 1946.

WHOQoL SRPB Group. (2006). A cross-cultural study of spirituality, religion, and personal beliefs as

components of quality of life. Social Science & Medicine, 62(6), 1486-1497

Williams, B. (1994). Patient satisfaction: A valid concept? Social Science & Medicine, 38(4), 509-516.

Zola, I.K. (1973). Pathways to the doctor—from person to patient. Social Science & Medicine, 7(9), 677-

689.