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 Contents

Preface xv WOULD YOU BELIEVE . . . ? Prescribing

Placebos May Be Considered Ethical 22
About the Authors xxi
IN SUMMARY 23
Research Methods in Psychology 24
PART 1 Foundations of Health Correlational Studies 24
Psychology Cross-Sectional and Longitudinal Studies 25

1 Introducing Health Psychology 1 Experimental Designs 25

Ex Post Facto Designs 26
Real-World Profile of Angela Bryan 2
CHAPTER

IN SUMMARY 27
The Changing Field of Health 3
Research Methods in Epidemiology 27
Patterns of Disease and Death 3
Observational Methods 28
WOULD YOU BELIEVE . . . ? College Is Good
for Your Health 7 Randomized Controlled Trials 29
Escalating Cost of Medical Care 8 Natural Experiments 30
What Is Health? 9 Meta-Analysis 30
WOULD YOU BELIEVE . . . ? It Takes More An Example of Epidemiological Research: The
Than a Virus to Give You a Cold 10 Alameda County Study 30

IN SUMMARY 11 IN SUMMARY 31

Psychology’s Relevance for Health 12 Becoming an Informed Reader of Health-Related

Research on the Internet 32
The Contribution of Psychosomatic Medicine 12
The Emergence of Behavioral Medicine 13
Determining Causation 33
The Emergence of Health Psychology 13 The Risk Factor Approach 33
Cigarettes and Disease: Is There a Causal
IN SUMMARY 14
Relationship? 33
The Profession of Health Psychology 14
IN SUMMARY 35
The Training of Health Psychologists 15
Research Tools 35
The Work of Health Psychologists 15
The Role of Theory in Research 35
IN SUMMARY 16
The Role of Psychometrics in Research 36
Answers 16
IN SUMMARY 37
Suggested Readings 17
Answers 37

2 Conducting Health Research 18 Suggested Readings 39

CHECK YOUR BELIEFS 19
3 Seeking and Receiving Health
CHAPTER

Real-World Profile of Sylvester Colligan 19

The Placebo in Treatment and Research 20
Care 40
CHAPTER

CHECK YOUR HEALTH RISKS 41

Treatment and the Placebo 20 Real-World Profile of Lance Armstrong 41
Research and the Placebo 22
Seeking Medical Attention 42

vii
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viii CONTENTS

Illness Behavior 43 The Intention–Behavior Gap 80

The Sick Role 48 Behavioral Willingness 80
IN SUMMARY 48 Implementational Intentions 81
Seeking Medical Information From Nonmedical IN SUMMARY 81
Sources 49 WOULD YOU BELIEVE . . . ? Text Messages
Lay Referral Network 49 Can Help Turn Intentions Into Action 82
The Internet 49 Improving Adherence 82
Receiving Medical Care 50 Becoming Healthier 84
Limited Access to Medical Care 50 IN SUMMARY 84
Choosing a Practitioner 51 Answers 85
Being in the Hospital 53 Suggested Readings 86
WOULD YOU BELIEVE . . . ? Hospitals May Be
a Leading Cause of Death 54
IN SUMMARY 56
Answers 57
PART 2 Stress, Pain, and Coping
Suggested Readings 57 5 Defining, Measuring, and Managing
Stress 87
CHAPTER

4 Adhering to Healthy Behavior 58 CHECK YOUR HEALTH RISKS 88

CHECK YOUR HEALTH RISKS 59 Real-World Profile of Lindsay Lohan 88
CHAPTER

Real-World Profile of Nathan Rey 59 The Nervous System and the Physiology of
Stress 89
Issues in Adherence 60
The Peripheral Nervous System 89
What Is Adherence? 60
The Neuroendocrine System 90
How Is Adherence Measured? 60
Physiology of the Stress Response 94
How Frequent Is Nonadherence? 61
What Are the Barriers to Adherence? 62 IN SUMMARY 95

IN SUMMARY 63
Theories of Stress 95
Selye’s View 95
What Factors Predict Adherence? 63
Lazarus’s View 97
Severity of the Disease 64
Treatment Characteristics 64 IN SUMMARY 98

Personal Factors 65 Measurement of Stress 98

Environmental Factors 66 Methods of Measurement 99
Interaction of Factors 68 Reliability and Validity of Stress Measures 100
IN SUMMARY 68 IN SUMMARY 101
Why and How Do People Adhere to Healthy Sources of Stress 101
Behaviors? 68 Cataclysmic Events 101
Continuum Theories of Health Behavior 68 Life Events 102
IN SUMMARY 74 Daily Hassles 103
Stage Theories of Health Behavior 74 WOULD YOU BELIEVE . . . ? Vacations Relieve
IN SUMMARY 80 Work Stress … But Not For Long 106

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 CONTENTS ix

IN SUMMARY 107 Answers 142

Coping With Stress 107 Suggested Readings 142
Personal Resources That Influence Coping 107
WOULD YOU BELIEVE . . . ? Pets May Be 7 Understanding and Managing
Better Support Providers Than People 110 Pain 143

CHAPTER
Personal Coping Strategies 110 CHECK YOUR EXPERIENCES 144
IN SUMMARY 112
Real-World Profile of Aron Ralston 145
Behavioral Interventions for Managing Pain and the Nervous System 145
Stress 112 The Somatosensory System 146
Relaxation Training 112 The Spinal Cord 146
Becoming Healthier 113 The Brain 147
Cognitive Behavioral Therapy 113 WOULD YOU BELIEVE . . . ? Emotional and
Physical Pain Are Mainly the Same in the
Emotional Disclosure 115 Brain 148
IN SUMMARY 117 Neurotransmitters and Pain 149
Answers 118 The Modulation of Pain 149
Suggested Readings 119 IN SUMMARY 150
The Meaning of Pain 150
6 Understanding Stress, Immunity, Definition of Pain 151
and Disease 120 The Experience of Pain 151
CHAPTER

Real-World Profile of Lindsay Lohan— Theories of Pain 154

Continued 121
IN SUMMARY 157
Physiology of the Immune System 121
The Measurement of Pain 157
Organs of the Immune System 121
Self-Reports 157
Function of the Immune System 122
Behavioral Assessments 159
Immune System Disorders 124
Physiological Measures 159
IN SUMMARY 127
IN SUMMARY 160
Psychoneuroimmunology 127
Pain Syndromes 160
History of Psychoneuroimmunology 127
Headache Pain 161
Research in Psychoneuroimmunology 128
Low Back Pain 161
WOULD YOU BELIEVE . . . ? Pictures of
Arthritis Pain 162
Disease Are Enough to Activate the Immune
System 128 Cancer Pain 162
Physical Mechanisms of Influence 130 Phantom Limb Pain 163
IN SUMMARY 131 IN SUMMARY 164
Does Stress Cause Disease? 131 Managing Pain 164
The Diathesis–Stress Model 131 Medical Approaches to Managing Pain 164
Stress and Disease 132 Behavioral Techniques for Managing Pain 166
WOULD YOU BELIEVE . . . ? Being a Sports Fan IN SUMMARY 169
May Be a Danger to Your Health 135
Answers 170
Stress and Psychological Disorders 138
Suggested Readings 171
Becoming Healthier 141
IN SUMMARY 141

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x CONTENTS

8 Considering Alternative
Approaches 172 PART 3 Behavior and Chronic
CHAPTER

CHECK YOUR BELIEFS 173 Disease

Real-World Profile of Norman Cousins 173
Alternative Medical Systems 174
9 Behavioral Factors in Cardiovascular
Disease 201

CHAPTER
Traditional Chinese Medicine 175 CHECK YOUR HEALTH RISKS 202
Ayurvedic Medicine 176 Real-World Profile of President Bill Clinton 203
IN SUMMARY 176 The Cardiovascular System 203
Alternative Practices and Products 177 The Coronary Arteries 205
Chiropractic Treatment 177 Coronary Artery Disease 205
Massage 177 Stroke 207
Diets, Supplements, and Natural Products 178 Blood Pressure 207

IN SUMMARY 179 IN SUMMARY 210

Mind–Body Medicine 179 The Changing Rates of Cardiovascular

Disease 210
Meditation and Yoga 180
Reasons for the Decline in Death Rates 210
Becoming Healthier 181
Heart Disease Throughout the World 211
Qi Gong and Tai Chi 181
IN SUMMARY 212
Energy Healing 182
WOULD YOU BELIEVE . . . ? Religious Risk Factors in Cardiovascular Disease 212
Involvement May Improve Your Health 183 Inherent Risk Factors 213
Biofeedback 183 Physiological Conditions 215
Hypnotic Treatment 184 WOULD YOU BELIEVE . . . ? A Floss a Day May
Keep Cardiovascular Disease Away? 217
IN SUMMARY 185
Behavioral Factors 217
Who Uses Complementary and Alternative
Medicine? 185 WOULD YOU BELIEVE . . . ? Chocolate May
Help Prevent Heart Disease 219
Culture, Ethnicity, and Gender 185
Psychosocial Factors 219
Motivations for Seeking Alternative Treatment 187
IN SUMMARY 223
IN SUMMARY 187
Reducing Cardiovascular Risks 224
How Effective Are Alternative Treatments? 187
Before Diagnosis: Preventing First Heart
Alternative Treatments for Anxiety, Stress, and Attacks 224
Depression 188
Becoming Healthier 227
Alternative Treatments for Pain 189
After Diagnosis: Rehabilitating Cardiac Patients 227
Alternative Treatments for Other Conditions 192
Limitations of Alternative Therapies 195 IN SUMMARY 229

Integrative Medicine 197 Answers 229

IN SUMMARY 198 Suggested Readings 230
Answers 199
Suggested Readings 200
10 Behavioral Factors in Cancer 231
CHECK YOUR HEALTH RISKS 232
CHAPTER

Real-World Profile of Steve Jobs 232

What Is Cancer? 233
The Changing Rates of Cancer Deaths 233

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 CONTENTS xi

Cancers With Decreasing Death Rates 234 IN SUMMARY 261

Cancers With Increasing Incidence and Mortality Adjusting to Diabetes 262
Rates 236 The Physiology of Diabetes 262
IN SUMMARY 236 The Impact of Diabetes 264
Cancer Risk Factors Beyond Personal Health Psychology’s Involvement With
Control 236 Diabetes 265
Inherent Risk Factors for Cancer 237 IN SUMMARY 266
Environmental Risk Factors for Cancer 238 The Impact of Asthma 266
IN SUMMARY 239 The Disease of Asthma 267
Behavioral Risk Factors for Cancer 239 Managing Asthma 268
Smoking 239 IN SUMMARY 269
Diet 242 Dealing With HIV and AIDS 269
Alcohol 243 Incidence and Mortality Rates for HIV/AIDS 270
Sedentary Lifestyle 245 Symptoms of HIV and AIDS 272
Ultraviolet Light Exposure 245 The Transmission of HIV 272
WOULD YOU BELIEVE . . . ? Cancer Prevention Psychologists’ Role in the HIV Epidemic 274
Prevents More Than Cancer 245
Becoming Healthier 276
Sexual Behavior 246
IN SUMMARY 277
Psychosocial Risk Factors in Cancer 247
Facing Death 277
IN SUMMARY 247
Adjusting to Terminal Illness 277
Living With Cancer 247
Grieving 278
Problems With Medical Treatments for Cancer 248
IN SUMMARY 279
Adjusting to a Diagnosis of Cancer 248
Social Support for Cancer Patients 249
Answers 279
Psychological Interventions for Cancer Patients 250 Suggested Readings 280

IN SUMMARY 250
Answers 251
Suggested Readings 251 PART 4 Behavioral Health
12 Smoking Tobacco 282
11 Living With Chronic Illness 253 CHECK YOUR HEALTH RISKS 283
CHAPTER

Real-World Profile of President Ronald Real-World Profile of President Barack

CHAPTER

Reagan 254 Obama 283

The Impact of Chronic Disease 255 Smoking and the Respiratory System 284
Impact on the Patient 255 Functioning of the Respiratory System 284
Impact on the Family 256 What Components in Smoke Are Dangerous? 285

IN SUMMARY 257 IN SUMMARY 287

Living With Alzheimer’s Disease 257 A Brief History of Tobacco Use 287
WOULD YOU BELIEVE . . . ? Using Your Mind Choosing to Smoke 288
May Help Prevent Losing Your Mind 259 Who Smokes and Who Does Not? 289
Helping the Patient 260 Why Do People Smoke? 291
Helping the Family 260

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xii CONTENTS

IN SUMMARY 295 Change Without Therapy 328

Health Consequences of Tobacco Use 296 Treatments Oriented Toward Abstinence 328
Cigarette Smoking 296 Controlled Drinking 330
WOULD YOU BELIEVE . . . ? Smoking Is The Problem of Relapse 330
Related to Mental Illness 298 IN SUMMARY 331
Cigar and Pipe Smoking 298
Other Drugs 331
Passive Smoking 299
Health Effects 331
Smokeless Tobacco 300
WOULD YOU BELIEVE . . . ? Brain Damage Is
IN SUMMARY 300 Not a Common Risk of Drug Use 332
Interventions for Reducing Smoking Rates 300 Becoming Healthier 333
Deterring Smoking 300 Drug Misuse and Abuse 336
Quitting Smoking 301 Treatment for Drug Abuse 337
Who Quits and Who Does Not? 303 Preventing and Controlling Drug Use 338
Relapse Prevention 304 IN SUMMARY 339
IN SUMMARY 304 Answers 339
Effects of Quitting 305 Suggested Readings 340
Quitting and Weight Gain 305
Becoming Healthier 305 14 Eating and Weight 341
Health Benefits of Quitting 306 CHECK YOUR HEALTH RISKS 342
CHAPTER

IN SUMMARY 308
Real-World Profile of Kirstie Alley 342
Answers 308 The Digestive System 343
Suggested Readings 309 Factors in Weight Maintenance 344
Experimental Starvation 345
13 Using Alcohol and Other Drugs 310 Experimental Overeating 346
CHECK YOUR HEALTH RISKS 311 IN SUMMARY 347
CHAPTER

Real-World Profile of Charlie Sheen 311 Overeating and Obesity 347

Alcohol Consumption—Yesterday and What Is Obesity? 347
Today 312
Why Are Some People Obese? 350
A Brief History of Alcohol Consumption 312
WOULD YOU BELIEVE . . . ? You May Need a
The Prevalence of Alcohol Consumption Today 314 Nap Rather Than a Diet 352
IN SUMMARY 316 How Unhealthy Is Obesity? 353
The Effects of Alcohol 316 IN SUMMARY 354
Hazards of Alcohol 317 Dieting 355
Benefits of Alcohol 320 Approaches to Losing Weight 356
IN SUMMARY 321 Is Dieting a Good Choice? 359
Why Do People Drink? 322 IN SUMMARY 359
The Disease Model 323 Eating Disorders 360
Cognitive-Physiological Theories 325 Anorexia Nervosa 361
The Social Learning Model 326 Bulimia 365
IN SUMMARY 327 Binge Eating Disorder 367
Changing Problem Drinking 328 Becoming Healthier 367

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 CONTENTS xiii

IN SUMMARY 369 IN SUMMARY 394

Answers 369 Answers 395
Suggested Readings 370 Suggested Readings 395

15 Exercising 372
CHECK YOUR HEALTH RISKS 373
PART 5 Looking Toward the Future
CHAPTER

Real–World Profile of Tara Costa 373

Types of Physical Activity 374 16 Future Challenges 397
Reasons for Exercising 374 Real-World Profile of Dwayne and Robyn 398

CHAPTER
Physical Fitness 375 Challenges for Healthier People 399
Weight Control 375 Increasing the Span of Healthy Life 400
IN SUMMARY 376 Reducing Health Disparities 401
Physical Activity and Cardiovascular WOULD YOU BELIEVE . . . ? Health Literacy
Health 377 Can Improve by “Thinking Outside the
Box” 403
Early Studies 377
Later Studies 378 IN SUMMARY 405

Do Women and Men Benefit Equally? 379 Outlook for Health Psychology 405
Physical Activity and Cholesterol Levels 379 Progress in Health Psychology 405
IN SUMMARY 380 Future Challenges for Health Care 405

Other Health Benefits of Physical Activity 380 Will Health Psychology Continue to Grow? 411

Protection Against Cancer 380 IN SUMMARY 411

Prevention of Bone Density Loss 381 Making Health Psychology Personal 412
Control of Diabetes 381 Understanding Your Risks 412
Psychological Benefits of Physical Activity 381 What Can You Do to Cultivate a Healthy
WOULD YOU BELIEVE . . . ? It’s Never Too Lifestyle? 414
Late—or Too Early 382 Increase Your Health Literacy 415
IN SUMMARY 385 IN SUMMARY 416
Hazards of Physical Activity 385 Answers 416
Exercise Addiction 387 Suggested Readings 417
Injuries From Physical Activity 388
Death During Exercise 389 Glossary 418
Reducing Exercise Injuries 390
References 424
IN SUMMARY 390
Name Index 481
How Much Is Enough but Not Too Much? 390
Subject Index 509
Improving Adherence to Physical Activity 391
Becoming Healthier 392

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
 Preface
H
ealth is a far different phenomenon today
than it was just a century ago. Most serious
diseases and disorders now result from peo-
ple’s behavior. People smoke, eat unhealthily,
do not exercise, or cope ineffectively with the
stresses of modern life. As you will learn in this book,
psychology—the science of behavior—is increasingly
relevant to understanding physical health. Health psy-
chology is the scientific study of behaviors that relate to
health enhancement, disease prevention, safety, and
rehabilitation.
The first edition of this book, published in the
1980s, was one of the first undergraduate texts to
cover the then-emerging field of health psychology.
Now in this eighth edition, Health Psychology: An
Introduction to Behavior and Health remains a preem-
inent undergraduate textbook in health psychology.
The Eighth Edition
This eighth edition retains the core aspects that have
kept this book a leader throughout the decades: (1) a
balance between the science and applications of the
field of health psychology and (2) a clear and engaging
review of classic and cutting-edge research on behavior
and health.
The eighth edition of Health Psychology: An
Introduction to Behavior and Health has five parts.
Part 1, which includes the first four chapters, lays a
solid foundation in research and theory for under-
standing subsequent chapters and approaches the
field by considering the overarching issues involved
in seeking medical care and adhering to health care
regimens. Part 2 deals with stress, pain, and the man-
agement of these conditions through conventional
and alternative medicine. Part 3 discusses heart dis-
ease, cancer, and other chronic diseases. Part 4
includes chapters on tobacco use, drinking alcohol,
eating and weight, and physical activity. Part 5 looks
toward future challenges in health psychology and
addresses how to apply health knowledge to one’s
life to become healthier.
Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
What’s New?
In this edition, we bring a fresh new voice to the writing
team: John A. Updegraff. John earned his PhD from one
of the top health psychology programs in the United
States. He is an influential researcher in health psychol-
ogy, an acclaimed psychology instructor, and an expert
in the areas of health behavior and stress. John brings
his passion, knowledge, and (occasional) humor to this
revision, so the textbook remains current, accurate, and
a delightful read for instructors and students.
The present edition also reorganizes several chap-
ters to better emphasize the theoretical underpinnings
of health behavior. For example, Chapter 4 focuses on
adherence to healthy behavior and presents both classic
and contemporary theories of health behavior, includ-
ing recent research on the “intention–behavior gap.”
Readers of the eighth edition will benefit from the
most up-to-date review of health behavior theories—
and their applications—on the market.
The eighth edition also features new boxes on
important and timely topics such as
• How to evaluate the quality of research reported
on the Internet
• How the redesign of nutrition labels may improve
your health literacy
• How text messaging can help increase your physi-
cal activity
• Why your doctor might ethically prescribe ineffec-
tive medical treatments to you
• Why taking vacations can have unexpected effects
on your stress levels
• Why social rejection can feel physically painful
• Why pets may be the best social support providers
• Why you should floss your teeth more (hint: it has
nothing to do with cavities or bad breath)
• Why pictures of guns stimulate your immune system
Other new or reorganized topics within the chapters
include
• Several new Real-World Profiles, including Steve
Jobs, Barack Obama, Tara Costa, Charlie Sheen,
Kirstie Alley, and Lance Armstrong
xv
xvi PREFACE
• Expanded discussion of training and employment
opportunities for health psychologists in Chapter 1
• Discussion of publication bias and CONSORT
guidelines for reporting of clinical trials in
Chapter 2, to help students better evaluate health
psychology research
• New section on seeking medical information from
nonmedical sources such as the Internet in Chapter 3
• Technological advances in assessing adherence in
Chapter 4
• Contemporary models of health behavior, such as the
health action process approach and the “intention–
behavior gap,” are now presented in Chapter 4
• A streamlined presentation of life events scales,
focusing only on the most widely used measures
in Chapter 5
• New discussion of the role of stress in weakening
people’s responses to vaccination in Chapter 6
• New discussion of acceptance and commitment
therapy as a psychological intervention for pain
management in Chapter 7
• Reorganization of Chapter 8 to highlight the types
of complementary and alternative medicine
(CAM) that people use most often, and the latest
evidence on the effectiveness of CAM
• Up-to-date findings from the 52-nation INTER-
HEART study on heart attack risk factors in
Chapter 9
• New information on the role of human papilloma-
virus (HPV) in cancer in Chapter 10
• A streamlined presentation of the history of the
HIV epidemic in Chapter 11
• A streamlined presentation of the physiology of
the respiratory system in Chapter 12
• Greater emphasis on the similarities between alco-
hol and other drugs of abuse in Chapter 13,
including the common brain pathways that all
drugs may activate and the similarities among
treatment approaches
• Updated information in Chapter 14 on binge eat-
ing, which will appear as a disorder in DSM-V
• New section on the links between physical activity
and cognitive functioning in Chapter 15
• New organization of the section about physical activ-
ity interventions, to better distinguish the different
approaches to intervention and their effectiveness
• Chapter 16 includes a new discussion of how tech-
nological and medical advances create opportunity
for health psychologists
Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
What Has Been Retained?
In this revision, we retained the most popular features
that made this text a leader over the past two decades.
These features include (1) “Real-World Profiles” for
each chapter, (2) chapter-opening questions, (3) a
“Check Your Health Risks” box in most chapters, (4)
one or more “Would You Believe …?” boxes in each
chapter, and (5) a “Becoming Healthier” feature in
many chapters. These features stimulate critical think-
ing, engage readers in the topic, and provide valuable
tips to enhance personal well-being.
Real-World Profiles Millions of people—including
celebrities—deal with the issues we describe in this
book. To highlight the human side of health psychol-
ogy, we open each chapter with a profile of a person in
the real world. Many of these profiles are of famous
people, whose health issues may not always be well-
known. Their cases provide intriguing examples, such
as Barack Obama’s attempt to quit smoking, Lance
Armstrong’s delays in seeking treatment for cancer,
Steve Jobs’ fight with cancer, Halle Berry’s diabetes,
Charlie Sheen’s substance abuse, Kirstie Alley’s battles
with her weight, and “Biggest Loser” Tara Costa’s
efforts to increase physical activity. In the eighth edi-
tion, we also introduce a profile of a celebrity in the
world of health psychology, Dr. Angela Bryan, to give
readers a better sense of the personal motivation and
activities of health psychologists.
Questions and Answers In this text, we adopt a pre-
view, read, and review method to facilitate student’s
learning and recall. Each chapter begins with a series
of Questions that organize the chapter, preview the
material, and enhance active learning. As each chapter
unfolds, we reveal the answers through a discussion of
relevant research findings. At the end of each major
topic, an In Summary statement recaps the topic.
Then, at the end of the chapter, Answers to the chap-
ter-opening questions appear. In this manner, students
benefit from many opportunities to engage with the
material throughout each chapter.
Check Your Health Risks At the beginning of most
chapters, a “Check Your Health Risks” box personalizes
material in that chapter. Each box consists of several
health-related behaviors or attitudes that readers
should check before looking at the rest of the chapter.
After checking the items that apply to them and then
becoming familiar with the chapter’s material, readers

will develop a more research-based understanding of
their health risks. A special “Check Your Health
Risks” appears inside the front cover of the book. Stu-
dents should complete this exercise before they read
the book and look for answers as they proceed through
the chapters (or check the website for the answers).
Would You Believe …? Boxes We keep the popular
“Would You Believe …?” boxes, adding nine new ones
and updating those we retained. Each box highlights a
particularly intriguing finding in health research. These
boxes explode preconceived notions, present unusual
findings, and challenge students to take an objective
look at issues that they may have not have evaluated
carefully.
Becoming Healthier Embedded in most chapters is
a “Becoming Healthier” box with advice on how to use
the information in the chapter to enact a healthier life-
style. Although some people may not agree with all of
these recommendations, each is based on the most cur-
rent research findings. We believe that if you follow
these guidelines, you will increase your chances of a
long and healthy life.
Other Changes and Additions
We have made a number of subtle changes in this edi-
tion that we believe make it an even stronger book than
its predecessors. More specifically, we
• Deleted several hundred old references and
exchanged them for more than 600 recent ones
• Reorganized many sections of chapters to improve
the flow of information
• Added several new tables and figures to aid stu-
dents’ understanding of difficult concepts
• Highlighted the biopsychosocial approach to health
psychology, examining issues and data from a bio-
logical, psychological, and social viewpoint
• Drew from the growing body of research from
around the world on health to give the book a
more international perspective
• Recognized and emphasized gender issues when-
ever appropriate
• Retained our emphasis on theories and models
that strive to explain and predict health-related
behaviors
Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
PREFACE xvii
Writing Style
With each edition, we work to improve our connection
with readers. Although this book explores complex
issues and difficult topics, we use clear, concise, and
comprehensible language and an informal, lively writing
style. We write this book for an upper-division under-
graduate audience, and it should be easily understood by
students with a minimal background in psychology and
biology. Health psychology courses typically draw stu-
dents from a variety of college majors, so some elemen-
tary material in our book may be repetitive for some
students. For other students, this material will fill in
the background they need to comprehend the informa-
tion within the field of health psychology.
Technical terms appear in boldface type, and a
definition usually appears at that point in the text.
These terms also appear in an end-of-book glossary.
Instructional Aids
Besides the glossary at the end of the book, we supply
several other features to help both students and
instructors. These include stories of people whose
behavior typifies the topic, frequent summaries within
each chapter, and annotated suggested readings.
Within-Chapter Summaries
Rather than wait until the end of each chapter to pres-
ent a lengthy chapter summary, we place shorter sum-
maries at key points within each chapter. In general,
these summaries correspond to each major topic in a
chapter. We believe these shorter, frequent summaries
keep readers on track and promote a better under-
standing of the chapter’s content.
Annotated Suggested Readings
At the end of each chapter are three or four annotated
suggested readings that students may wish to examine.
We chose these readings for their capacity to shed
additional light on major topics in a chapter. Most of
these suggested readings are quite recent, but we also
selected several that have lasting interest. We include
only readings that are intelligible to the average college
student and that are accessible in most college and uni-
versity libraries.
xviii PREFACE
Instructor’s Manual With
Test Bank
This edition of Health Psychology: An Introduction to
Behavior and Health is accompanied by a comprehen-
sive instructor’s manual. Each chapter begins with a
lecture outline, designed to assist instructors in prepar-
ing lecture material from the text. Many instructors are
able to lecture strictly from these notes; others can use
the lecture outline as a framework for organizing their
own lecture notes.
A test bank of nearly 1,200 multiple-choice test items
makes up a large section of each chapter of the instructor’s
manual. The authors, in conjunction with Amber Ema-
nuel of Kent State University, wrote these test items.
Some items are factual, some are conceptual, and others
ask students to apply what they have learned. These test
items will reduce instructors’ work in preparing tests. Each
item, of course, is marked with the correct answer. The test
items are also available electronically on ExamView.
We also include True–false questions and essay
questions for each chapter. The true–false questions
include answers, and each essay question has an outline
answer of the critical points.
Each chapter also includes suggested activities.
These activities vary widely—from video recommenda-
tions to student research to classroom debates. We
have tried to include more activities than any instructor
could feasibly assign during a semester to give instruc-
tors a choice of activities.
With so many electronic resources available to stu-
dents these days, we wanted to include a Exploring Health
on the Web activity. In this section, we suggest online
activities, including websites that are relevant to each
chapter. This activity expands the electronic resources stu-
dents may use to explore health-related topics.
Instructor’s Resource CD-ROM
Transparencies include art from the text, as well as sev-
eral physiology video clips and animations in Micro-
soft® PowerPoint®.
Text Companion Website
This website contains practice quizzes, web links, the
text’s glossary, flashcards, and more for each chapter
of the text.
Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
Acknowledgments
We would like to thank the people at Cengage Learning
for their assistance. Ken King served as development edi-
tor for this edition, as he did for the first edition. The
symmetry of this situation is especially pleasing. His
skill, support, sharp eye, and well-timed prods helped
us produce a better book. We also thank the rest of the
Cengage editorial team, including publisher Jon-David
Hague and editorial assistant Travis Holland for their
guidance and help throughout the process. Others who
worked on the eighth edition include: Jessica Alderman,
assistant editor; Mary Stone and Gunjan Chandola, proj-
ect managers; Kristine Janssens, permissions manager;
Susan Buschhorn, image licensing manager; Brenda Car-
michael, design director; Christine Sosa, market develop-
ment manager; Elisabeth Rhoden, senior brand manager;
Jasmin Tokatlian, associate media editor; Karen Hunt,
manufacturing planner; and Roberta Broyer, rights
acquisitions specialist.
We also are indebted to a number of reviewers
who read all or parts of the manuscript for this and
earlier editions. We are grateful for the valuable com-
ments of the following reviewers:
Silvia M. Bigatti, Indiana University
Bette Ackerman, Rhodes College
Dale V. Doty, Monroe Community College
Michael B. Madson, University of Southern
Mississippi
Mary McNaughton-Cassill, University of Texas at
San Antonio
Sangeeta Singg, Angelo State University
Elizabeth Stern, Milwaukee Area Technical
College
Joel Hughes, Kent State University
Samantha D. Outcalt, Indiana University, Purdue
University Indianapolis
Elizabeth Thyrum, Millersville University
Linda notes that authors typically thank their spouses
for being understanding, supportive, and sacrificing,
and her spouse, Barry Humphus, is no exception. He
made contributions that helped to shape the book and
provided generous, patient, live-in, expert computer
consultation and tech support that proved essential
in the preparation of the manuscript. In addition,
Drs. Futoshi Kobayashi and Grant Rich have been so
kind as to send their advice and information, which

were helpful in updating this edition. Linda also
acknowledges the huge debt to Jess Feist and his con-
tributions to this book. Although he did not work on
this or the previous edition, his work and words
remain as a guide and inspiration for her and for
John.
John also thanks his wife, Alanna, for her encour-
agement to take on this project and support through-
out the process. John also thanks his two young
children for always asking about the book, even though
Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
PREFACE xix
they didn’t comprehend most of what he told them
about it. Thanks also go to the graduate students in
his research lab (Brian Don, Amber Emanuel, Kristel
Gallagher, Cristina Godinho, Scout McCully, and Chris
Steinman) for offering a slightly younger generation’s
perspective on the material. Lastly, John thanks all of
his past undergraduate students for making health psy-
chology such a thrill to teach. This book is dedicated to
them and to the future generation of health psychology
students.
Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
 About the Authors

L
inda Brannon is a pro- carried his interest in personality theory to his author-
fessor in the Depart- ship of Theories of Personality, coauthored with his son
ment of Psychology at Greg Feist. Linda’s interest in gender and gender issues
McNeese State Univer- led her to publish Gender: Psychological Perspectives,
sity in Lake Charles, which is in its sixth edition.

J
Louisiana. Linda joined the
faculty at McNeese after re-
ohn A. Updegraff is a
ceiving her doctorate in hu-
professor of social and
man experimental psychology
health psychology in
from the University of Texas
the Department of Psy-
at Austin.
chology at Kent State

J
University in Kent, Ohio. John
ess Feist is Professor received his PhD in Social Psy-
Emeritus at McNeese chology at University of Cali-
State University. He fornia, Los Angeles, under the
joined the faculty after mentorship of pioneering
receiving his doctorate health psychologist Shelley
in counseling from the Uni- Taylor. John then completed
versity of Kansas and stayed a postdoctoral fellowship at
at McNeese until he retired University of California, Ir-
in 2005. Jess and Linda have vine, prior to joining the faculty at Kent State.
each been selected to receive John is an expert in the areas of health behavior,
the annual Distinguished health communication, stress, and coping, and is the
Faculty Award from recipient of multiple research grants from the National
McNeese State University. Institutes of Health. His research appears in the field’s
In the early 1980s, Linda and Jess became interested top journals.
in the developing field of health psychology, which led John stays healthy by running the roads and trails
to their coauthoring the first edition of this book. They near his home, and by running after his two small chil-
watched the field of health psychology emerge and grow, dren. John is also known for subjecting students and
and the subsequent editions of the book reflect that colleagues to his singing and guitar playing (go ahead,
growth and development. look him up on YouTube).
Their interests converge in the area of health psy-
chology but diverge in other areas of psychology. Jess

xxi
Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
CHAPTER
1

Introducing Health
Psychology
CHAPTER OUTLINE
■ Real-World Profile of Angela Bryan
■ The Changing Field of Health
■ Psychology’s Relevance for Health
■ The Profession of Health Psychology

QUESTIONS
This chapter focuses on three basic questions:
1. How have views of health changed?
2. How did psychology become involved in health care?
3. What type of training do health psychologists receive, and what kinds of work do they do?

1
Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
Another random document with
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COMMENTS

If children are spoken to kindly about the condition of their hands

and several are sent at once to wash, they will take less offense. It will
seem then a matter of school-room practice rather than a personal
affront.
Drills or plays are often used to bring about habits of cleanliness.

ILLUSTRATION (FIRST GRADE)

Miss Barry organized her first grade room “Sanitary

into a “Sanitary Brigade.” Every one’s own Brigade”
ten fingers were the private soldiers over which each one’s face was
the captain. One child in each row, appointed by the teacher each
Monday morning, was the Lieutenant General of his row, and Miss
Barry was the Major General of them all.
Each captain inspected his ten soldiers and demanded that each
one—right and left Thumbkin, right and left Pointer, right and left
Longman, Ringman and Littleman—be perfectly clean. Then the
Colonel inspected the captains and finally the General had a grand
review of all the troops. The captains and colonels made daily
inspections. If they failed to do their work well they were sent to the
ranks and new officers appointed in their places. In other words, if
one did not keep his own hands clean, some one else was appointed
to be inspector and reporter of his hands. If any one was found with
unclean hands or face, a new colonel was appointed for the row in
which that child was found.
Inspection was made every morning and any reported disorder
was remedied in the lavatory. When there was no further need of
scrutiny as to clean hands and faces and when therefore the game
had lost in interest, a similar game was instituted that required clean
teeth, brushed hair, and clean shoes.

CASE 79 (THIRD GRADE)

 Miss Burr, the third grade teacher, sighed Use of
as Elma Colders passed her handkerchief to Handkerchief
her twin sister Zelma. This was a daily, almost hourly, occurrence.
The handkerchief wasn’t absolutely clean. These twins seemed to
take turns having colds, and Miss Burr believed the common
handkerchief was largely to blame for the transferred infection, but
she dared to say nothing about it.
Near to her desk sat Asa Kramer, who sniffed momentarily for
want of a handkerchief, while Fannie Black had a habit of often
wiping her nose with an upward stroke that was fast causing her nose
to have a decided skyward slant at the end.
One day she saw Morris Millspaugh repeat his habit of wiping his
nose on his coat sleeve and the following quotation popped into her
head, “Ye gods! Must I endure all this?” As if in answer to her
question, Annie Daily, in the back row, lowered her head and used
the under side of the bottom of her dress for a handkerchief.
“My query is answered,” groaned she. “Annie’s action says, ‘All
this? Ay, more!’”
Miss Burr said to a teacher friend, “If I were the family doctor of
these children, I’d be free to give their mothers a lecture on
sanitation, but since I’m not, I must keep within my prescribed
field.”

CONSTRUCTIVE TREATMENT

Correct these disgusting habits of your pupils. This can be done by

asking each child to bring a clean handkerchief every morning. A
certain teacher each morning asked all who received a grade of one
hundred in spelling or arithmetic the day before to stand and walk to
the front of the room. She then asked the other children who had
clean handkerchiefs to give them the Chautauqua salute, and the
children in front were asked to return this salute. The children
enjoyed this immensely and demanded from their mothers clean
handkerchiefs every morning in order that they might be allowed to
take part in this exercise.
COMMENTS

Miss Burr was wrong to conclude that it was not her business to
protect the health of her pupils.
There were several beneficial results accompanying the
Chautauqua salute program described above. Those who did good
work were rewarded and those who cheered them were given drill in
the hard task of praising their fellows who had succeeded where they
themselves had failed.
This salute was given in the morning, so that all handkerchiefs
would be clean for it.
Teachers can do no better than tactfully Enlist the
to enlist the aid of mothers in matters of Mothers
cleanliness.

ILLUSTRATION (FOURTH GRADE)

Miss Shaw, who taught the fourth grade in a very poor district in
New York City, organized a mothers’ meeting to convene alternate
Fridays after school hours. At one of these meetings she asked a
trained nurse to talk about cleanliness especially.
After the nurse had clearly explained the danger of infection in the
care of the nose, a mother who was a good shopper was delegated to
take orders for handkerchiefs from all present who needed them for
their children, to buy by the dozen and to deliver to the mothers at
cost.
By teaching and helping the mothers in this way, Miss Shaw
bettered conditions in her own room and established a wholesome
community spirit among her patrons.

CASE 80 (FIFTH GRADE)

Something was the matter with Dora Decaying Teeth

Payne. Miss Hubbart, her teacher, was
astonished at her stupid answers and generally inattentive attitude.
Usually Dora was alert and smiling; today she was morose, even to
tearfulness. Miss Hubbart finally said, “What is the matter, Dora?”
“My tooth aches,” said Dora.
“Did it ever ache before?”
“Yes, it ached last week and mamma took me to the dentist.”
“Charlotte, you may go with Dora to the dentist to see if he can
stop her toothache,” said Miss Hubbart.
The girls were gone only about half an hour, for it was but a few
blocks to the office of the only dentist in the village. After they came
back Dora was relieved and went on with her school work as usual.
When Miss Hubbart returned to the schoolhouse for the afternoon
session that day, she was greeted by Mr. Payne, Dora’s father, who
said:
“Dora says you sent her to Dr. Hammond’s office today.”
“Yes, she was suffering with toothache.”
“What I want to know is, who is going to pay the bill?”
“Surely you wouldn’t want Dora to suffer with toothache.”
“That tooth has troubled Dora before and my wife took her to Dr.
Hammond and he said that she’d lose this tooth in a year or so, and
we concluded not to have it worked on. When she gets her last set of
teeth it will not be money thrown away to have them filled.”
“But you wouldn’t want Dora to suffer for a year, surely.”
“Maybe we know how to take care of our own child without the
help of a stranger. I’ll thank you to keep on your own ground after
this.” And Mr. Payne stalked away with anger showing even in his
walk.

CONSTRUCTIVE TREATMENT

When you feel assured that, from a health standpoint, a child is

unfit to do school work, send him home and as soon as possible
thereafter consult with his mother as to his health, giving advice only
when you see that his parents are ignorant or neglectful.
In the matter of the care of the mouth and teeth, give instruction
as to the age a child should be when the several kinds of permanent
teeth appear. Name the causes of decay of teeth and show children
how to use their tooth brushes to the best advantage.

COMMENTS

Teachers should never send children to a Rhythmic Drills

doctor without the consent of their parents.
A teacher’s help can be rendered in instituting preventive measures
better than in administering or advising curative remedies. The harm
done to the teeth by allowing them to decay through the use of
improper food, also the proper use of the tooth brush, and the value
of a sterilizing mouth wash can easily be taught and come within the
teacher’s legitimate province. In many towns she may also secure the
coöperation of the school nurse.

ILLUSTRATION (FIFTH GRADE)

Miss Stow, who taught the fifth grade at Deadwood, made up this
motion song which the children sang occasionally, suiting the proper
motions to each verse:

This is the way we brush our teeth

At morning, noon and night,
Keeping them free from food and germs,
Making them clean and white.

This is the way we brush our hair,

Making it smooth and clean,
Keeping it free from kinks and dust
And beautiful to be seen.

This is the way we brush our shoes,

Making them fairly shine,
Then we ever shun dirt and mud
And keep them looking fine.
 When they sang the first verse she let them hold lead pencils in
front of their mouths for tooth brushes and had them make the up
and down motion that dentists recommend.
She noticed a marked improvement in the personal habits of her
children after they had learned this song, and they very much
enjoyed singing it.

CASE 81 (FOURTH GRADE)

Merrill MacFarland was elected to a Scattering Paper

position as teacher of the fourth grade after
three years of experience in the country schools. He had found the
circumstances in his former situation very unsatisfactory, and
resolved that since he was entering upon work in a graded school, he
would have some things different. Looking over the room after he
had wrestled his way through the first week, and recalling the events
of the past five days, he was strongly reminded of his former school
experience, since there was really a disgraceful amount of waste
paper all over the floor. The janitor had been complaining about the
matter, but MacFarland had been too busy with other matters to give
attention to it.
Monday morning, after the opening exercises, he made this
announcement:
“Now, I want every one of you boys and girls just the moment you
have a piece of waste paper in your hand to go to the wastebasket
and throw it in. Last Friday our room was a perfect disgrace. On
every desk there were slips of torn-up paper and some whole sheets.
We can’t get along this way. George, you just this moment dropped a
piece of paper in the aisle there at your left. Pick it up at once and put
it in the wastebasket as I just told you.” George noisily moved his
slow frame according to the order, hardly imagining what would be
the case if the teacher’s idea were literally carried out and no more
waste papers were thrown upon the floor.
As soon as he had reached the basket, Mr. MacFarland discovered
that there were several pieces of paper on the floor in different parts
of the room, and said, “Each one look about his desk now and see if
there is any rubbish on the floor that should be taken away. If so,
pick it up at once and throw it into the basket as I told you. This is
the thing to do at any time when you want to throw something
away.”
It need hardly be said that, with a great bustle, each one made the
desired search, and about nine pupils soon were on their way to the
basket with something or almost nothing that needed to be thrown
away.
However unsatisfactory the noisy method had proved, it did bring
about the condition desired, for at the end of the day there was really
nothing that needed to be complained of regarding the cleanliness of
the room, so far as waste paper was concerned.

CONSTRUCTIVE TREATMENT

A wise teacher does not make so much ado about one aspect of
school-room management. Mr. MacFarland could easily have
foreseen that he was introducing another evil along with his reform.
Reverse the process. Arrange that the wastebasket be passed around
mid-way between intermissions according to a definite schedule. Let
the passing of the basket be a privilege that is handed down from one
pupil to another according as they are seated, beginning with the
pupil who sits to the extreme right of the teacher’s desk. One pupil
each day is appointed as guardian of waste. The privilege and honor
will be appreciated, and with a word of caution, the service can be
performed with the very slightest interruption.
The following instructions might be properly given to the children
when the new system is established:
“We are going to save time as much as possible. Four times every
day we shall pass the wastebasket and you may put into it whatever
you have on hand to be thrown away. Nothing is to be said to the
person who carries the basket. He will go quietly, promptly, passing
down the aisles, doing a favor to everyone in the room by his careful
attention to this matter.”

COMMENTS
 It is of the utmost importance that the necessary organization of
school-room conduct be established according to principles and
policies that are useful to the child at home and in other situations
outside of school life. He must be taught how to economize his own
time, and the attention of his fellows, how to do necessary things in a
way that shall be both effective and unobtrusive.
While the handling of waste is a small affair for one room in a
school, taken on a larger scale for home, state and nation, the
problem of waste is big enough to command the attention of every
citizen; therefore, to dispose of the matter properly in school is a
valuable lesson in civics and economics.

ILLUSTRATION (FIFTH AND SIXTH GRADES)

Supt. Kennelworth suffered the inconvenience of moving from an

old building into the new one near the middle of a school year.
In the final plans for the proper use of the Bags for Paper
new plant, it had been agreed that each
pupil must bring with him a small waste-paper bag to be attached to
each desk. There were no very definite rules as to its size, but the
warning was given that it must not be too large for the convenience
of all concerned.
The matter was brought up only once, each teacher making the
announcement in his own room according to the superintendent’s
instructions.
Wallace Jackson made his announcement for the fifth and sixth
grades as follows: “Each one of you is to bring a small, neatly made
waste-paper bag, barely large enough to hold what you think is the
waste paper that gathers at your desk every day. Are there any
questions about this?” A hand went up and the question was asked,
“Who is going to empty these bags?”
“Well,” said Mr. Jackson, “you will empty them yourselves. Just
before the close of school each day the wastebasket will be passed;
your bags will be laid down upon your desk, and in just a very few
minutes every bag will be emptied and placed in your desk. Any more
questions?”
 Another hand and another question, “How are we going to decide
who will carry the basket?”
This was answered by the statement: “I shall appoint some pupil to
this task every day. The method of selection will be announced to you
later. The only matter I want now to tell you about is the making of
the bags. Further details will be given to you when we actually begin
our work next Thursday in the new building.” Owing to the fact that
some success in keeping a neat room had been attained already in
the old building, Mr. Jackson’s announcement was received without
surprise or anxiety.
(10) Imitation of wrong social standard. There is an imitation of
mere precedent which is a sort of social instinct, that can best be
handled socially. This is because the responsibility can be fixed on no
one individual, and as all the members of the group are equally
guilty, all should share in the needed lesson.

CASE 82 (RURAL SCHOOL)

George Marston went into the country as Dropping Shot

teacher in a school in which there had been
much bad order. The directors were in earnest; they wanted a good
school, but for the salary they offered they had not been able to
secure a man who could handle the big boys who made the trouble.
They were not especially bad boys; but the tradition of mischief in
the school was so persistent that no teacher had been able to
overcome it.
During the fall term there was no trouble, for then only meek little
girls and small boys attended. But on the first Monday after
Thanksgiving, corn-shucking being over, the older pupils came in an
avalanche of good-natured noise. The room, before so sparsely
populated by a few pupils, seemed to overflow with their energy.
Trouble was not long in coming, and it took the shape of a shower of
fine shot, which pattered down from the ceiling during the spelling
lesson. George knew that the hour of trial had come, and he called
out bravely:
“Who did that?”
 There was no response. The little girls were peeping timidly from
their books, but the big boys and girls frankly relished the coming
fun.
“We may as well settle it now,” said George Marston. “We can’t
have a school without good order. Of course I want to be just, and
first of all I want to know who threw that shot. Will you tell me?”
No one spoke. Then the teacher went around the room, asking
each one in turn if he had done it. Every one denied it. There was
clearly an understanding among the pupils that gave the teacher no
chance.
So Marston gave it up for the time being, and lessons were taken
up again. But at four o’clock he asked four of the leading boys, those
he suspected most, to stay after school. When the rest had gone, he
conducted an exhaustive examination, trying to find who was
responsible for the disturbance. The evidence was flippant,
contradictory, mockingly frank; but he found out nothing. Still with
his idea of locating the offense in one person, George held another
trial the next night, with the same result. Then he took the matter to
the board.
“One or two persons must have thrown that shot,” he said to the
board members, “and if I can find the person who did it, and make
an example of him, then I know I can manage the school without
trouble. But so far I can’t find the offender. There doesn’t seem to be
a ringleader; they all hang together so.”
“Why can’t you find the offender?” asked one member.
“Because they all lie about it—at least there’s one person who is
lying. If only I could find that one person!”
“Why not lick them all, since they’re all mixed up in it?” This
director was a coarsely practical man.
“Because one person did the deed, and he ought to bear the
punishment,” George replied. “If I keep my eyes open and wait, in
time I’ll be sure to catch the boy that threw that shot.”
So he waited and kept his eyes open, but he never discovered the
shot-thrower. There was much more misbehavior during the days
that followed, and the struggle to keep even a semblance of order
made the term a nightmare to the harassed teacher. Little real work
was accomplished. The board, anxious to have a good school, but
ignorant of principles and methods, saw its desire come to nothing.
Marston’s ideas of discipline seemed to be centered on “making an
example” of some one offender, and the school took a mischievous
satisfaction in shielding each offender from discovery.
The crisis came late in January. Marston Explosion
had just put a full scuttle of coal on the
blazing fire in the big stove, when a sharp noise and a great puff of
smoke and flame burst from it. The explosion broke apart the
sections of the stove, and a serious fire was averted with some
difficulty. When they had made things safe and could look at each
other with smoke-grimed faces, teacher and pupils knew that a
reckoning was at hand.
“John Coffey, you brought in that coal. Did you put the gunpowder
in it?” John was fairly cool, and the reckless boys had been cowed
and sobered by the extent of the mischief that had been done.
“No, sir, I didn’t,” replied John; and his denial rang true.
“Did you, Carl?”
“No, sir.”
Marston went around the circle, as he had many times before; and
all denied their guilt. Finally Marston turned to the school.
“You may all go home now. We can’t have school until this mess is
cleaned up, of course. I shall see the board at once.”
The board decided, at a called meeting, that it would best get a new
teacher, and Marston resigned with infinite relief. The board sent to
a state normal school, explained the situation, and asked for a strong
man.

ILLUSTRATION (RURAL SCHOOL)

The president of the normal school sent them Isidor Thomberg, a

man of experience and high scholarship. He came with the
understanding that the board was to support whatever he did, and he
agreed to reduce the school to order. He was confident, fearless, and
told no one of his plans. But he did meet the board on the night of his
arrival, and heard their full account of the troubles.
 The next morning school opened as usual, with the new teacher
and the new stove dividing the honors of attention. Mr. Thomberg
made just one reference to the situation:
“Of course you know why I’m here,” he said. “I want to say one
thing. I shall never waste a moment’s time trying to find out who
does anything bad. We have to make up for a great deal of lost time
this winter; you’ll have to work hard from now until spring. We shall
have no school but a good one. Now we’ll go to work.”
Under the stimulus of his quiet confidence, the order was excellent
that first day. The school needed organization, and much time was
spent in showing the pupils economical ways of doing things. While
the novelty lasted there was no tendency to disorder, and when
things settled down into a regular routine the lessons proved so
interesting under Mr. Thomberg’s teaching that the boys forgot for a
time to have fun in the old way. A fancy skating club had been
organized; a new era seemed to have dawned, when one day, quite
unexpectedly, the old problem popped up again.
A row of pupils, coming quietly forward to the recitation bench,
found themselves stepping on a number of match-heads which had
been scattered in the aisle. At the same moment Mr. Thomberg
himself, who had stepped to a window to adjust a shade, exploded
two of these little trouble-makers. Every one looked up in surprise,
for bad order had been almost forgotten.
The teacher went to his desk. Very quietly he sent the class back to
their seats. Then he told the pupils to put away all books, and they
obeyed in a dazed way, afraid of they knew not what.
“I told you when I came,” said Mr. Thomberg, “that we couldn’t
have anything but a good school. The reason that we can’t afford to
have bad order is that we have too much serious work to do. I had
begun to like you all so much that I’m sorry some one has had to
spoil our pleasant beginning. But I meant what I said. So this school
is closed, now, indefinitely. You are all, without exception, suspended
from school until further notice. You will pass out as you always do.”
There was a breathless silence. Such a thing as suspending a whole
school had never been heard of before. Mr. Thomberg gave the usual
signals, and the boys and girls passed into the hall as though they
had been at a funeral. Mr. Thomberg went to the nearest house and
called the directors by telephone for a conference, which was scarcely
begun when parents began to inquire indignantly why their children,
guiltless of dropping match-heads, had been suspended from school.
Mr. Thomberg dictated the answer:
“Tell them,” he said, “that I have no time to ferret out the doers of
silly little tricks in my school. When the school gives me the
assurance that there’ll be no more trouble, then we’ll go back to
work. Whoever dropped those match-heads thought the school liked
that sort of thing, and you must show him that he is mistaken. I am a
teacher, not a policeman.”
The parents really wanted their children in school, and guided by
the suggestion, skillfully made by the teacher, they took steps to
secure the concerted action which Mr. Thomberg knew was the
remedy for the evil. He was reading the daily paper in the living
room of his boarding house that evening, when the response for
which he had planned came. There were seventeen of his twenty-six
pupils in the party which called on him. One of the older boys, Felix
Curry, was spokesman.
“We came to ask you if you’d have us in school again,” he said. “All
our fathers and mothers want us to go back, and we’ll be good if
you’ll let us. The boy that threw the match-heads will tell you about it
himself. He told us he would.”
“There is no need of that, although he may do so privately
tomorrow if he wants to. But I should rather not know who did it, if
you’ll all be responsible for its not happening again. You see, I like
you all so much that I’d hate to know who did so foolish and wrong a
thing. And if you will agree that it is to be a good school, in which
everyone works together in the right spirit, I’ll agree to stay until the
end of the year. Otherwise I pack my trunk tonight.”
The pupils gave ample promises, which were not broken. Mr.
Thomberg stayed through that year and the next one also, and had
the best school in the county.

COMMENTS

This is an extraordinarily difficult situation. Mr. Thomberg’s

success in dealing with this unusual case depended first of all on the
fact that his knowledge of pedagogy enabled him to analyze the
situation truly. He saw that the bad order was not caused by any one
pupil, but was the result of a social tradition for which many persons,
in and out of the school, were responsible. All the pupils upheld the
disorder; therefore all the pupils were dealt with in a group.
In the second place he was independent, as a really first-class
teacher can be. He set the standard of behavior, and required his
students to come up to it or give up school altogether. Had the school
declined to take the social responsibility he asked of them, he would
really have packed his trunk and left. He was well prepared for his
work, and was greatly in earnest about it, nor did he propose to do
what he considered an undignified thing in probing for evil.
His personality was strong enough to set up a new standard for
imitation, and to supplant the old one of inefficiency and mischief.
The problem of order was for a time swallowed up in the greater one
of securing real mental development in his pupils, and when it did
show itself he treated it as a matter to be dealt with socially by the
pupils. This seemed to put upon them a responsibility they had been
used to having the teacher assume unaided, and they rose to the new
honors imposed upon them. Mr. Thomberg utilized imitation in
setting up a new regime, by requiring united action of his pupils. In
this way he met a psychological situation with psychological
weapons.
(11) Snobbishness. Snobbishness is a very hard thing to meet
wisely, and a sin which is too easily learned by imitation.

CASE 83 (HIGH SCHOOL)

Joseph Lescinszky was a tailor in a small Middle West city, who

lived in five small rooms over his shop, with his wife and seven
children. He had plenty of patronage, for he was a good tailor, but he
was unhappy, for one of the dreams long associated with his
American citizenship had failed to materialize. His eldest son,
Joseph Junior, was in the high school—a homely, awkward boy with
great wistful eyes and an incurable shyness. He was a good student,
but suffered constantly under the heartless, matter-of-fact ridicule of
his American schoolmates.
 This ridicule was but the echo of the Race Prejudice
attitude of the whole community toward the
Polish family. They were the only foreigners in the place, and their
appearance, habits and speech afforded unlimited amusement to
everyone. Men who had had their suits made by the skillful, little,
Polish tailor told funny stories in which his broken English figured as
the chief point, and their sons and daughters in turn laughed at the
shy and awkward children whom they met at school.
No one realized how this ridicule embittered the life of the tailor
until Miss Swainson came to Hovey to teach in the high school. She
took her old cape to the tailor one day, thriftily planning to have it
made into a coat for school wear; and over the making of the coat,
tailor and teacher began to discuss Joseph and his school life. No
teacher had ever talked to him about Joseph before, and the little
Pole voiced his feelings tremblingly.
“My Joseph does not like the school,” he confided. “He goes
because I command him that he shall, but he has not his heart in it.”
“He does very good work,” comforted Miss Swainson. “His lessons
are always excellent.”
“Ah, the lessons he gets with no trouble. But the boys, they like
him not. They all time make fun on him, and my poor Joseph is not
happy. He is Polack, they say. It is not true—we are Americans now;
there is the paper,” and he pointed proudly to the naturalization
paper, framed upon the wall.
“We’ll see if we can’t make Joseph happy at school,” Miss
Swainson promised. “I’ll see what I can do.”
Now, Miss Swainson was one of the upright, downright people
who go at things directly and openly. She began a campaign for the
kinder treatment of Joseph Lescinszky, Junior. She had no doubt of
her success.
An opportunity for beginning her kindly efforts in Joseph’s behalf
came soon. Joseph was always the butt for practical jokes, and
Charlie Owen was his particular tormentor. Therefore, when Joseph
was tripped, going to the dictionary, by Charlie’s projecting toes, she
kept Charlie after school and had a serious talk with him.
“Don’t you see what a contemptible thing it is for you to tease this
bright boy just because he is of Polish blood?” she inquired warmly
of smiling Charlie Owen.
“Why, Miss Swainson, he don’t mind. Everybody always laughs at
those Lescinszkies, and they don’t care. If they ever showed fight like
Americans I guess we’d let them alone, but they don’t. They’re not
like us.”
“That’s just why you should treat them better. They haven’t
learned that a boy has to fight in order to be decently treated,” Miss
Swainson returned with fine scorn.
“No, ma’am. If they could only learn that, they’d be all right.” Fine
scorn was wasted on Charlie.
All Miss Swainson’s efforts ended in this way. Secure in their
feeling that traditional American means for securing respect were the
only ones, smug with the provincialism of the small town, the school
children continued to express to the alien boy the contempt they had
imbibed from their elders. They merely smiled at Miss Swainson’s
indignant efforts to win justice and kindness for their Polish
schoolmate.
Toward the end of the year the young teacher thought she detected
a shade of difference in the treatment given Joseph. This was due
partly to her constant shaming of the thoughtless cruelty of their
conduct, and partly to the respect he himself won by his good work in
the classroom. But although this small degree of success comforted
her somewhat, she felt still the defeat of her efforts keenly, not
realizing that a change of conduct based on imitation must come
through a change of example followed.

COMMENTS

Miss Swainson’s method did not go deep enough. Mere protest will
occasionally effect a change, but not often. If she could have gotten
behind Charlie Owen’s attitude, and found its roots, which were
probably in the attitude of some member of his family or a powerful
older friend, she might have truly converted Charlie to her way of
thinking. His statement that “everybody always laughs at those
Lescinszkies,” might have given her a clue, but she did not realize
that she was only working on the surface.
ILLUSTRATION (RURAL SCHOOL)

Sallie Lou Pinkston came from Mobile, Alabama, to the small,

northern town of Cade Mills, when she was ten years old. She was
the only girl in an adoring family of brothers—a lovely, sunny-haired
child, with the confidence in her right to rule her world which her
happy family life had given her. She entered the fifth grade that fall,
and scored an immediate success with the whole room, teacher
included. Her southern accent was a continual source of delight; her
matter-of-course assumption that everyone wanted to do the
entertaining things she planned kept the whole room, with two
exceptions, tied to her dainty apron-strings.
The two exceptions were Laurastine and Enameline Flack.
Laurastine and Enameline belonged to the one colored family in
town, and they had always attended the public school and had always
been well treated by the other children. But when Sallie Lou cast her
golden charm over the room, things changed. Sallie Lou didn’t
understand why they should be there at all, and she surely didn’t
intend to tolerate them as her social equals. Led by the irresistible
charm of Sallie Lou, vying with each other to stand in her graces, the
other children began to ignore the two little colored girls, or openly
to laugh at them and pointedly to leave them out of their games.
Miss Stone, the teacher, being a northern woman and a believer in
literal democracy, thought this a very bad state of things indeed. The
two little girls were well behaved, wistful, little creatures, whose tears
at the new turn of things went straight to Miss Stone’s big heart. She
knew that the remedy must come in some way through Sallie Lou,
who had caused the havoc; for there was no possible way to supplant
her dominant influence, nor was such a thing desirable except for
this one cause. Sallie Lou had wakened the room to a new interest in
many things, and in everything except the treatment of the little
“niggers” she was sweetness and docility itself.
Could Sallie Lou be converted? Miss Stone tried it, with doubt in
her heart; she knew what prejudice is. She invited Sallie Lou to her
house for supper one Friday night, and after supper they sat by the
fire and had a long talk about it. Miss Stone presented the pathetic
cases of Laurastine and Enameline as touchingly as she could, but
Sallie Lou merely smiled divinely and told her, most sweetly, that of
course she wanted to do what was right, but that it wasn’t right for
“niggers” to mix socially with white people, and that the town should
provide a separate school for them. She was firmly entrenched
behind the prejudice of her rearing in a community which solved the
problem this way.
Miss Stone reluctantly retreated from the attack, but she did not
give up. She went behind the prejudice to its support, behind the
example to its example. She cultivated Sallie Lou’s mother, her
father, her four charming brothers. The parents, finding few cultured
people in the little town, welcomed the well-read teacher and were
very cordial to her. When she had won their respect and liking, Miss
Stone asked for a frank talk with them about the conditions in her
room, and told them just how the irresistible Sallie Lou was leading
all the other children in the fifth grade to snub the two little Flacks.
At first the Pinkstons were amused, then they were indignant.
They too felt that the two colored children had no business in a
school for white children. But when Miss Stone had shown them that
a separate school was impracticable in a town that had but one
colored family, that conditions were very different from those of a
southern city, and that a change in Sallie Lou’s attitude would avert a
personal tragedy for two innocent little girls, the parents came finally
to see the matter from her point of view. They promised to talk to
Sallie Lou and to persuade her to change her tactics. Miss Stone
thanked them, and changed the subject quickly and brightly to
something else.
Sallie Lou, at first with formal and awkward condescension, but
later with the same frank charm that won everyone to her, asked the
two little outcasts back into the fold of fifth grade fun. The rest fell
easily into their old democratic way of sharing things. Miss Stone
had solved the problem of race prejudice by changing the example.
2. Play—A Second Form of the Adaptive Instincts
The child never reveals his whole nature as he does when playing. His physical,
mental and moral powers are all called then into vigorous exercise. On the
playground the boy begins to learn how to struggle with his fellow men in the great
battle of life. His strength and his weakness both manifest themselves there, so
that it pays to study him.

—Hughes.
 Much school trouble is caused by the purely sportive impulses of
childhood, impulses which are in themselves entirely innocent and
wholesome. One of the most valuable parts of a child’s training is the
acquiring of a set of notions as to appropriateness—the knowledge of
when he may, and when he may not, rightly give rein to his wish to
play. Some children acquire these ideas of propriety readily, and
adapt themselves seemingly without effort to the customs of their
environment; but most children stumble through the period of
adaptation with many backslidings, for the instinct of play is stronger
than the instinct of adaptation to requirement.
But let it be remembered meanwhile that this same play instinct is
one of the strongest allies of the teacher in securing such adaptation,
if the instinct is properly directed. What lesson of politeness,
neatness, unselfishness, protection of the weak, promptness,
responsibility, care of pets, coöperation, chivalry—yes, even of duty
and religion—may not be taught through play! Draining off the play
impulses into these legitimate channels will relieve many a
wearisome, perplexing day for both teacher and pupils, and at the
same time speed on the child toward conscious self-control.
Perhaps the greatest single help in teaching children the voluntary
limitation of their play impulses, is the knowledge that play is only
postponed, not forbidden. Most children have so strong a love of
approbation that they like to do things in the proper way if the
sacrifice be not too great. They are willing to put off their fun, but not
to put it off forever. The teacher who says, “If you’ll wait until recess,
I’ll show you how to play a new game with marbles,” will secure
willing obedience, when she who takes the marbles away has only
sullen submission for her reward. Here the teacher utilizes the
instinctive love of novelty in teaching control of play impulses.
During the period, when conduct is so largely a matter of instinct,
wise teachers play off one instinct against another to the child’s gain,
knowing that some impulses need encouragement and others need to
be inhibited.
(1) “Just mischief.” One of the most First Grade
frequent ways in which the play instinct
expresses itself in the first and even in higher grades is in the little
annoyances which teachers group together under the general term,
mischief. An energetic child, if he is not constantly employed,
naturally vents his energy either in play or in trying to satisfy his
curiosity.
The principle of suggestion alone will often be sufficient to control
the child. The principle of substitution will work equally well.
Coöperation can be correlated with either of these, and expectation
that the child will do what the teacher desires should be used in
whatever method the teacher may adopt.
The mischievous boy will be quiet so long as he is reciting, but
while others are reciting he will immediately hunt for something else
to do. He will drag his shoe on the floor, reach over and touch his
neighbor, pull out a pocketful of string or help himself to his
neighbor’s pencil.
It is not a case for punishment, but a time to apply one or more of
the fundamental principles. The teacher, without even a word or
look, may reach over and draw him to her side, asking him to look on
her book, or better still she may look on his book (suggesting that he
attend to his lesson). She may send him on some little errand—to
bring a book or a piece of crayon—and by the time she whispers,
“Thank you, you did that like a little gentleman,” he will have
forgotten all about his mischief (substitution and approval).
When the class is dismissed, however, the teacher must see that
the mischievous boy is kept busy and his work changed once or twice
within the half hour. She must not fail to show an interest in his
work. The comment, “That is so good, my boy, that I want you to put
it on my desk where we can look at it,” will so elate the child that he
will work industriously to do his best, and doing his best will keep
him busy a long time. When on the playground or in the gymnasium
the teacher must see that he gets plenty of “full-of-fun” play. It will
use up some of his restless energy.
The teacher must have an abundance of busy work ready for the
next restless period that comes, sorting blocks or marbles, straws or
papers, cutting or coloring pictures, putting books on the shelf, and
anything that will keep him innocently busy. Stencil cards, cutting
out words or letters, the distributing of materials for the class to use,
games for the recess and noon periods, frequent story periods during
school hours, interesting lessons, vigorous exercise, generous
approval of every effort to please the teacher—all these will gradually
win the mischievous boy to habits of self-control and industry. All