Test Bank for Health Psychology An Introduction to Behavior and Health 10th Edn by Linda Brannon by ACADEMIAMILL

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Chap 01_10e Indicate whether the statement is true or false. 1. Health psychologists rarely work in hospitals. a. True b. False 2. Death rates in the United States from both heart disease and cancer are declining. a. True b. False 3. African Americans have a higher death rate than European Americans. a. True b. False 4. Stress is the leading cause of death in the United States. a. True b. False 5. Most people in the United States die of chronic diseases. a. True b. False 6. The training of health psychologists includes earning doctoral degrees. a. True b. False 7. Currently, the leading cause of death in the United States is cancer. a. True b. False 8. Economic factors affect mortality rates in the United States. a. True b. False 9. College graduates generally have a higher death rate than those without high school diplomas. a. True b. False 10. Health is generally defined as an absence of disease. a. True b. False

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Chap 01_10e Indicate the answer choice that best completes the statement or answers the question. 11. A health psychologist who focuses on treating illness more than on preventing it or changing behaviors is more likely to work in which kind of setting? a. A school b. An HMO c. A hospital d. A worksite 12. Which of these has been a major health trend in the United States since 1900? a. Cost of medical care has risen faster than inflation. b. Health has been more frequently defined as the absence of illness. c. Acute illnesses have replaced chronic diseases as the leading causes of death. d. The biomedical model has been accepted by most psychologists. 13. In the United States, young people have a low mortality rate; those who die are most likely to die from a. cancer. b. COVID-19. c. violence. d. HIV infection. 14. Roughly what percentage of Americans who do not live past 25 years of age die from suicide, homicide, or unintentional injury? a. 10 percent b. 30 percent c. 50 percent d. 80 percent 15. Which of the following are Americans aged 15 to 24 the most likely to die from? a. Heart disease b. Unintentional injuries c. Cancer d. Suicide 16. Health psychology is best defined as the scientific study of those behaviors related to a. adoption of the sick role for persons who believe they are ill. b. health enhancement, disease prevention, and rehabilitation. c. the courses of development in psychosomatic illnesses. d. public health issues and public opinion on health only.

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Chap 01_10e 17. Based on research by Sheldon Cohen and colleagues, which of these people is more likely to catch a cold if they are all exposed to someone who has it? a. Wanda, who goes to bed and gets up at the same times each day b. Xavier, who is very friendly and regularly interacts with others c. Yolanda, who feels and expresses gratitude and joy in life daily d. Zvi, who has just went through a difficult divorce proceeding 18. Older people have higher probabilities of dying than younger people. How does this affect the statistics for causes of death? a. This has no effect, since these two are not directly related. b. This skews causes of death toward causes for older people. c. This skews causes of death toward those for young people. d. This has no effect, as causes of death differ by age groups. 19. Subject X is economically wealthy and attributes their good health largely to a nutritious diet and regular exercise, avoiding harmful substances, and minimizing and managing stress. Subject X is most likely to a. have a college degree. b. be female. c. seek medical help only in an emergency. d. be unmarried. 20. In which ethnic group is it more likely to die from homicide than by pneumonia or influenza? a. Hispanic Americans b. African Americans c. Asian Americans d. European Americans 21. What is most accurate about recent statistics on death rates relative to education? a. Adults with high school diplomas die at nearly twice the rate as people without high school diplomas. b. Adults with college diplomas die at twice the rate as those with high school diplomas. c. Adults with college diplomas die at less half the rate as those without high school diplomas. d. Adults without high school diplomas die at twice the rate than those with high school diplomas. 22. How do the numbers of Americans dying each year from chronic diseases compare to the numbers of Americans living with chronic diseases each year? a. About 65 times as many people die from them as live with them every year. b. About 65 times as many people live with them as die from them every year. c. About the same number of people live with them as die from them in a year. d. About 10 times as many people live with them as die from them every year.

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Chap 01_10e 23. Which of the following cultural views of health would be most compatible with that of ancient Roman physician Galen? a. That of late 19th-century German physician Rudolf Virchow b. That of late 19th-century Austrian physician Sigmund Freud c. That of the 17th-century philosopher/scientist René Descartes d. That of the ancient Babylonians and Assyrians and Hebrews 24. How much has health care in America gone up in cost per person, per year, between 1970 and 2019? a. A little less than 200% b. Roughly 300% c. More than 850% d. More than 1,000% 25. For which of the following ethnic groups is Alzheimer’s disease a less common cause of death than for the others? a. African Americans b. European Americans c. Hispanic Americans d. Asian Americans 26. Diseases that killed most people a century ago were more often a. from tainted food and water than from unhealthy habits. b. from misdiagnosis than from impure water or tainted food. c. from others who were ill than from food or water. d. long-term, chronic conditions rather than brief, intense infections. 27. Behavioral medicine assumes a. the combination of behavioral and medical sciences. b. the existence of a particular pathogen in any illness. c. disease can be controlled; health cannot be enhanced. d. medicine’s and psychology’s goals are incompatible. 28. How many people died of COVID-19 within the first 8 months of its emergence? a. 50,000 b. 100,000 c. 500,000 d. 750,000

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Chap 01_10e 29. Many medical advances during the 19th century were prompted by the biomedical model that a. emphasized emotional more than physical factors in disease. b. took the place of the Cartesian model for health and disease. c. led to a search for microscopic organisms that cause disease. d. promoted a holistic perspective regarding health and disease. 30. The increase in life expectancy since 1900 is due mostly to a. decreases in cancer deaths. b. the conquest of influenza. c. major lifestyle changes. d. none of these factors. 31. African Americans are more likely to die from which two diseases than European Americans, Hispanic Americans, or Asian Americans are? a. Kidney disease or septicemia b. Kidney disease or liver disease c. Suicide or homicide d. Diabetes or stroke 32. The single most important contributor to an increase in life expectancy is a. the decrease in the infant mortality rate. b. the increase in individuals’ beliefs in the importance of exercise. c. advancement in medical technology. d. advancement in medical care. 33. What is true of the field of health psychology? a. Health psychologists must procure credentials as medical physicians. b. Many health psychologists conduct research and teach. c. Health psychology primarily emphasizes pharmacological treatment. d. Health psychology is at its most basic level a research-based branch of psychology. 34. Among approaches that could rein in growing health care expenses, which is not only less expensive, but also more proactive? a. Screening people for disease and death risks b. Treating chronic disease most appropriately c. Detecting disease earlier, facilitating control d. Preventing disease through healthy lifestyles

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Chap 01_10e 35. Clara did not have any history of type 1 diabetes, but as an older adult she has developed type 2 diabetes. Related to this development, what is most likely about the contributions of lifestyle factors? a. Her condition likely developed because Clara had long been eating an unhealthy diet. b. Her condition likely developed from unhealthy diet and smoking cigarettes for years. c. Her condition likely developed because of unhealthy diet and never getting any exercise. d. Her condition likely developed through contributions from each of these factors, plus stress. 36. Which diseases are a class of diseases that include heart disease, cancer, and stroke? a. Infectious b. Chronic c. Unintentional d. Cardiovascular 37. Researchers have found that having more education provides benefits a. for people who live in the United States, primarily. b. for better health, but not for longer life expectancy. c. for longer life expectancy, but not for better health. d. for people who live in various nations of the world. 38. In contrast to the biopsychosocial model, the biomedical model views health as a. a positive condition. b. an incorporation of psychological and social factors. c. a result of a combination of factors such as genetics, beliefs, and stress. d. the absence of disease. 39. What is the connection between personal economic wealth and health? a. Health is unaffected by economic wealth. b. Wealth only correlates to health at levels above the federal poverty threshold. c. The increase of stress related to the accumulation of wealth puts wealthier people at higher levels of health risk. d. Billionaires tend to be healthier than multi-millionaires. 40. The discipline that seeks to improve health and the prevention, diagnosis, treatment, and rehabilitation of illness through integrating psychology’s behavioral knowledge with medicine’s biological knowledge is called a. behavioral health. b. health psychology. c. behavioral medicine. d. medical psychology.

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Chap 01_10e 41. Cade attributes catching a "cold" to not getting enough sleep and feelings of distress. Thus, Cade has an implicit acceptance of the ____ a. biochemical model of health. b. biomedical model of health. c. Cartesian model of health. d. biopsychosocial model of health. 42. Compared to the biomedical model of health, the biopsychosocial model promotes an approach to medical care that is more a. reductive. b. aggressive. c. conservative. d. comprehensive 43. The biomedical model of disease a. existed in the 1800s until the biopsychosocial model in the early 1900s. b. conceives of disease as caused by being exposed to specific pathogens. c. is more common among the public than with health care professionals. d. cannot explain infectious illnesses or the prevalence of viral illnesses. 44. All of the following are factors in life expectancy EXCEPT: a. age b. education c. ethnicity d. mother’s personality 45. Harry, a U.S citizen, died on his 22nd birthday. According to the National Center for Health Statistics (NCHS, 2018), what is the most likely cause of death? a. An accidental injury b. COVID-19 c. Cancer d. Cardiovascular disease 46. How has life expectancy in the United States changed from a century ago to today? a. It has risen to be more than 65% longer. b. It has increased to almost 35% longer. c. It has increased, but not significantly. d. It has slightly decreased.

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Chap 01_10e 47. During the past 30 years, death rate from heart disease in the United States has declined. At the same time, a. medical care expenses have increased. b. rates of smoking tobacco have increased. c. Americans’ life expectancy has decreased. d. biomedical model acceptance has increased. 48. Which of these most accurately describes how medical costs interact with life expectancy in the United States today? a. People with chronic conditions incur more medical costs than older people. b. Older Americans today have poorer health than older Americans in the past. c. Older Americans today represent more of Americans with chronic diseases. d. Medical costs are due to more people living longer, not to chronic diseases. 49. Krishna, a health psychologist with a PsyD, would likely do any of the following tasks EXCEPT a. offer alternatives to pharmacological treatments. b. provide behavioral interventions to treat physical disorders. c. design effective health communication to promote positive physical health. d. design drug trials to enable doctors to find a drug to treat bipolar disorder. 50. In the United States, people living below the poverty level a. are largely European Americans. b. are more likely than others to have health insurance. c. have more access to medical care. d. experience increased health risks before birth. 51. Which of the following is most correct about health care in the United States today? a. People historically had more control over their health than they have today. b. Conditions that kill people today are more related to nonbehavioral factors. c. Contributions to rising health care costs today include unhealthy behaviors. d. Increasing health care costs today are due to technology, and not behaviors. 52. Of the following people, who is exposed to the most health risk? a. Rhona, an African American millionaire b. Juana, a Hispanic American college graduate c. Leah, a European American who is housing insecure d. Jiyang, an Asian American who works in a factory

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Chap 01_10e 53. Which statement is most accurate about education and health? a. Education predicts both longevity and health, whereas intelligence does not. b. Educated people use good health habits, rather than avoid bad health habits. c. Educated people have more access to health information, and to health care. d. Education predicts not whom one associates with, but attitudes about health. 54. Which of the following ethnic groups is most at risk from dying from a chronic respiratory disease? a. European Americans b. Hispanic Americans c. African Americans d. Asian Americans 55. Which cause of death is within the top ten causes for Hispanic Americans, but not for European Americans, African Americans, or Asian Americans? a. Suicide b. Homicide c. Chronic liver disease d. Pneumonia & influenza 56. People’s beliefs about health and illness may be incorrect. Which of these common beliefs is true? a. The United States ranks in the top five nations in the world in terms of life expectancy. b. The 30-year increase in life expectancy in the United States during the 20th century was due primarily to improved medical care. c. Infectious and chronic diseases have both decreased in the United States today. d. None of these is true. 57. Which of these most correctly describes the relationship between infectious and chronic disease in the United States over the past century? a. Preventing and treating infectious diseases have decreased the occurrence of chronic diseases. b. Preventing and treating infectious diseases eliminated most chronic diseases. c. Preventing and treating infectious diseases have resulted in more diagnosis of chronic diseases. d. Preventing and treating infectious diseases have had no effect at all upon chronic diseases.

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Chap 01_10e 58. Which statement about life expectancy in the United States is correct? a. African Americans and European Americans both live longer on average than Europeans do. b. The average lifespan of a White American is virtually the same as that of an African American, when viewed in a global context. c. African Americans and European Americans live longer on average than Japanese people, but only European Americans live longer than the average Israeli does. d. Canadian citizens live longer on average than both African Americans and European Americans. 59. Pneumonia and influenza (together) account for one of the 10 leading causes of death in which ethnic groups? a. European Americans and African Americans b. European Americans and Asian Americans c. Hispanic Americans and Asian Americans d. African Americans and Hispanic Americans 60. An inverse relationship exists between educational level and death rates, which means that a. people who graduate from high school have higher death rates than those who do not. b. people who attend college have higher death rates than those who do not complete high school. c. people who attend college live longer than those who have never attended college. d. both a and b are true. 61. What is true about the duration of diseases 100 years ago in the United States, as compared to today? a. Illnesses lasted longer because fewer treatments existed then. b. Illnesses lasted longer because people did not take personal responsibility for their health. c. Illnesses were shorter because people typically went to the doctor early in the course of the disease. d. Illnesses were shorter because people either quickly died or got well. 62. Health psychology is a. a branch of medicine related to psychological health. b. a discipline within psychology related to psychological health. c. a new name for psychosomatic medicine. d. a discipline within psychology related to health. 63. Among historical and cultural perspectives about health, which one of the following is most different from the others? a. Ancient China’s b. Early Christians’ c. Native Americans’ d. Western Africans’

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Chap 01_10e 64. Among various services that clinical health psychologists can deliver, which is the best example of one that involves conducting behavioral interventions? a. Using biofeedback for pain management b. Increasing patient medication compliance c. Administering neuropsychological testing d. Therapy to help patients cope with illness 65. Cristobal comes down with a “bug,” which has hardly ever happened before, so he wonders why. Which statement is an accurate explanation? a. His being exposed to a contagious microbe is the only salient factor b. Psychological, not biological, factors got him sick. c. Biological and psychological factors far outweighed any social factors in causing his illness. d. Biological, social, and psychological factors all interacted to get him sick. 66. Psychosomatic medicine sees physical illnesses as a. including emotional and psychological factors. b. being attributable only to physiological causes. c. causing stress and subsequent organic illnesses. d. not real but imagined in some specific diseases. 67. People who graduate from college show the following positive outcomes EXCEPT a. higher average incomes. b. longer lifespans. c. better access to health care. d. less likelihood of chronic illness. 68. Which of these groups has the shortest average lifespan? a. European Americans b. Canadians c. African Americans d. Australians 69. College graduates generally have different average lifespans than people who have not completed high school. What is the most likely explanation for this? a. College graduates are more likely to smoke cigarettes. b. People who do not have high school diplomas are more likely to seek health care. c. People without high school diplomas are less likely to have health insurance. d. College graduates are more likely to have higher incomes.

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Chap 01_10e 70. What disease or disease type was more common in 1900 than it is today? a. Cancer b. Chronic disease c. Infectious disease d. Cardiovascular disease 71. How do income and education relate to health and life expectancy in America today? a. Income affects health problems; education affects life expectancy. b. Income affects life expectancy; education affects health problems. c. Income and education both affect both health and life expectancy. d. Income and education influence neither health nor life expectancy. 72. The work of health psychologists is similar to that of other psychologists because it includes a. counseling people regarding their personal problems. b. conducting research on personality and health habits. c. doing assessment, research, and providing services. d. delivering their services within health care settings. 73. What statement is true of COVID-19 in 2020? a. It was a leading cause of mortality in the United States. b. It reflected a trend in America of infectious diseases causing more deaths than chronic diseases. c. It resulted in significant mortality in the United States, but not more than other infectious diseases. d. It caused more deaths than heart disease and cancer combined. 74. From the late 1960s to the early 1990s, the role of psychologists in medicine changed most in which way? a. More psychologists began conducting health research. b. More psychologists began teaching in medical schools. c. More psychologists began working to change lifestyles. d. More psychologists began working for managing pain. 75. For health psychologists who work in the public health field, which activity they may engage in is most related to helping develop major public health decisions? a. Teaching health psychology and conducting research in the field b. Diagnosing health conditions and offering patients interventions c. Monitoring recent, current, and emergent trends related to health d. Working on placing nutrition facts on menus and food packaging

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Chap 01_10e 76. In Sheldon Cohen’s research on the common cold, all participants received a cold virus via a nasal spray, and after a week, a. all of the participants in the study had developed a cold. b. only some of the participants in the study caught a cold. c. only the healthy participants in the study caught a cold. d. only those with recent stressful experiences got a cold. 77. The field of health psychology developed a. to increase life expectancy, which was much shorter then. b. to address challenges in medical care, which was changing. c. to try to find cures for infectious diseases that caused deaths. d. to change medicine’s focus from biological to psychosomatic. 78. After the COVID-19 pandemic subsides, a. chronic disease will no longer be the leading cause of death in the United States. b. acute disease will no longer be the leading cause of death in the United States. c. there will be no change in the single leading cause of death in the United States. d. infectious disease will remain one of the leading causes of death in the United States. 79. Hypothetically, if you considered yourself plus your five nearest neighbors, all adults, how many of you would be likely to have one or more chronic diseases in a given year, based on current/recent statistics? a. Four out of the six b. Nearly three of six c. Almost two in six d. Above three in six 80. What causes the spread of SARS-CoV-2? a. Human behavior b. Viral reproduction independent of hosts c. Contact with animals d. All of the above 81. Health psychologists are MOST likely to a. be part of an interdisciplinary team. b. work as solo practitioners in private practice. c. go to medical school after getting doctoral degrees in psychology. d. do all of these.

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Chap 01_10e 82. Health psychologists are most likely to see health a. from a biomedical viewpoint. b. from a biopsychosocial viewpoint. c. as the absence of illness. d. as a single dimensional condition. 83. During the first few years of the 21st century, deaths from some chronic diseases in the United States a. began to rise more rapidly than during the previous 50 years. b. began to decrease, while deaths not due to unhealthy lifestyles and behaviors began to increase. c. began to increase, while deaths not due to unhealthy lifestyles and behaviors began to decrease. d. were replaced by acute diseases as the leading cause of death. 84. In Table 1.1 of your textbook, why are some causes of death not listed for each ethnic group? a. No data are available for those causes in those groups. b. They are not leading causes of death for those groups. c. They do not cause any deaths for those ethnic groups. d. Cause-of-death profiles are the same for some groups. 85. What best describes the biopsychosocial model of health? a. It treats health as an absence of illness. b. It makes no distinction between health and sickness. c. It is a departure from traditional Western concepts of health. d. It emphasizes pathogens over behavior. 86. In the biopsychosocial model proposed by the textbook's authors, health and disease outcomes flow DIRECTLY from a. psychological factors. b. biological factors. c. sociological factors. d. all of these factors. 87. Cardiovascular disease and cancer account for _____ of all deaths in the United States. a. the vast majority b. a small minority c. nearly half d. around one third

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Chap 01_10e 88. Research from outside your textbook finds the United States behind many other developed nations in achieving positive health care outcomes. How does this best relate to research cited in your textbook about current U.S. health care expenditures? a. U.S. health care spending is comparable to U.S. positive health care outcomes. b. U.S. health care spending far outweighs the U.S. positive health care outcomes. c. U.S. health care spending is even lower than U.S. positive health care outcomes. d. U.S. health care spending, as it rises, lowers U.S. positive health care outcomes. 89. Sheldon Cohen’s research on the common cold showcases that the ________ approach to understanding sickness and infection is inadequate. a. biopsychosocial b. biomedical c. psychological d. biochemical 90. What best describes the relationship between ethnicity and mortality in America today? a. Ethnicity is related to life expectancy, but not to cause of death. b. Ethnicity is related to cause of death, but not to life expectancy. c. Ethnicity is related to both life expectancy and to cause of death. d. Ethnicity is related to neither life expectancy nor cause of death. 91. Carla is a pregnant teenager with an income below the federal poverty threshold. What is true about associated health risks to her and/or her baby? a. She is at an increased health risk, but her baby is not. b. She is less likely to be abused, because she is pregnant. c. Her baby is more likely to have a low birth weight, raising its mortality risk. d. Her economic status has no bearing on the health risks to either her or her baby. 92. What do current death rate statistics resulting from Alzheimer’s and Parkinson’s diseases reflect most about health and health care trends in the United States? a. A fall in healthy lifestyle behaviors b. A decrease in socioeconomic levels c. An increase in the aging population d. An increase in environmental toxins

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Chap 01_10e 93. Which of the following statements is true of the level of stress reported by college-educated individuals in comparison with those who have not completed tenth grade? a. College graduates report more stress than those who have not completed tenth grade. b. College graduates report less stress than those who have not completed tenth grade. c. College graduates and people who have not completed tenth grade report roughly the same amount of stress, but people who have not completed tenth grade report more daily symptoms. d. College graduates report less stress, but report more daily symptoms than people who have not completed tenth grade. 94. What two factors can help explain some of the ethnic differences in health and life expectancy? a. Economic differences and age b. Economic differences and education level c. Education level and age d. Education level and drug use 95. What did the first few months of the COVID-19 pandemic reveal about sociocultural norms in relation to the spread of disease? a. Sweden’s cultural values are similar to that of Singapore’s b. Liberal societies in Europe and the United States were best socially equipped to limit the spread of disease. c. Because Asian countries were more comfortable with severe strictures on their behavior, the disease did not spread as rapidly there. d. Within the United States, there was unanimity of behavior despite regional differences. 96. During the last quarter of the 20th century, psychology became involved in the field of health primarily by a. treating physical diseases by changing behaviors. b. treating only traditional mental health disorders. c. studying behaviors related to disease and health. d. practicing in the field of psychosomatic medicine. 97. Which of the following has been less influential than the others in raising our life expectancy? a. Better public sanitation b. Increased immunization c. New medical innovation d. More milk pasteurization

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Chap 01_10e 98. In a 2013 interview, award-winning popular singer Linda Ronstadt told Dan Rather she could no longer sing, as she had lost that kind of control over her voice due to Parkinson’s disease. Based on recent medical data, what is true of her diagnosis? a. She is more likely to die from the disease than people of her grandparents’ generation would have been b. She is less likely to die from it than she would have if she had Alzheimer’s disease. c. She is likely to recover due to modern medical care. d. The disease she has is extremely rare in the United States. 99. Which of the following has been the LEAST significant contributor to escalating medical costs? a. Increases in population b. The aging of the population c. More sophisticated medical technology d. Increases in the number of complex surgical procedures 100. One hundred years ago, the majority of American deaths were due to a. behavioral factors. b. illness from viruses. c. disease from bacteria. d. injuries from accidents. 101. The leading cause of death in the United States a. is due to acute, infectious disease. b. is due to risky sexual behaviors. c. has shifted from cardiovascular disease to cancer. d. has shifted from acute to chronic diseases. 102. Presently, physicians and health psychologists are most likely to agree that psychosomatic illnesses are a. a primary means of coping with acute pain. b. all in the head of the person with the illness. c. linked to a complex of biological, psychological, and social factors. d. flow from unconscious factors and are a means of reducing anxiety. 103. In the United States, the two leading causes of death for adults aged 44 and older are a. cancer and cardiovascular disease. b. homicide and COVID-19 complications. c. cardiovascular disease and suicide. d. COVID-19 complications and cancer.

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Chap 01_10e 104. Compared to those who have not attended college, those who have attended college have lower death rates from ______. a. infectious diseases, but higher death rates from chronic diseases b. unintentional injuries than from any kinds of disease c. unintentional injuries, chronic diseases, and infectious diseases d. chronic and infectious diseases than they do from accidental injury 105. Chronic illnesses in the United States are responsible for the majority of health care spending. In which category do they account for the largest proportion of money spent? a. Overall health care spending b. Prescriptions that are written c. Hospitalizations for patients d. Patients’ visiting physicians 106. Mortality from which disease decreased as a result of people smoking less? a. Heart disease b. Cancer c. Stroke d. All of the above 107. Chronic diseases a. develop and persist over a period of time. b. are due to infectious agents such as bacteria or viruses. c. are not as common today as during the 19th century. d. include influenza and pneumonia. 108. Which of these is correct about relationships between statistics for mortality rates and life expectancy? a. Infant mortality rates decrease average life expectancy for the population more than mortality rates among older adults do. b. Mortality rates increase as adults become older, but causes of death remain consistent for all age groups. c. Mortality rates of those above 65 decrease average life expectancy for the population more than infant or child mortality rates do. d. Because mortality rates tend to be higher for older adults than for younger adults, they disproportionately affect the average life expectancy. 109. In the United States during the early years of the 21st century, a. deaths from Alzheimer’s and Parkinson’s diseases increased. b. deaths from accidents increased significantly. c. deaths from heart disease increased significantly. d. deaths only moderately related to lifestyle decreased significantly. Copyright Cengage Learning. Powered by Cognero.

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Chap 01_10e 110. Discuss the implications of the acceptance of the biopsychosocial model over the biomedical model. A. Implications of the acceptance of one model over another are important because models guide research and practice in any area. B. Acceptance of the biomedical model, the view that disease is a mechanistic response to pathogens, has promoted: 1. Acceptance of a mechanistic view of physiology as the source of both disease and the only route to cures. 2. Exclusion of psychological and social factors relating to illness and health because these factors do not fit into the model. C. Acceptance of the biopsychosocial model promotes: 1. A more complex, multidimensional, and contextual view of health and illness. 2. A definition of health that includes optimal functioning. 3. A focus on the behaviors that underlie the development of many chronic diseases. 4. A holistic approach to health and to treatment.

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Chap 01_10e 111. In addition to applying psychological principles to physical health care, identify some other functions of health psychology that involve interaction with biological and sociological factors. Explain briefly how biological, psychological, and sociological factors contribute to health outcomes, and how this relates to a health psychology goal. A. Functions of health psychology include: 1. Helping to identify conditions that affect health 2. Helping to diagnose some chronic diseases 3. Helping to treat certain chronic diseases 4. Helping to accomplish physiological and psychological rehabilitation by changing the behaviors these involve B. Health psychology interacts with biological and sociological aspects of health in fulfilling the above functions. C. Biological factors are the only factors directly contributing to physiological health and illness. D. Psychological and sociological factors contribute indirectly to physical health and illness. 1. For these factors to affect biological processes, they must “get under the skin,” i.e. exert some biological influence, or be manifested biologically. E. Identifying the pathways whereby psychological and sociological factors come to affect biological health and disease processes is a goal of health psychology

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Chap 01_10e 112. Discuss how medical care costs have risen in the United States from the 20th to 21st century. Give some examples of ways to control these costs. A. American medical cost rates have risen faster than our economy’s inflation rates. B The United States currently spends more than any other country on health care. C. As of 2015, the U.S. medical care costs were >16% of its gross domestic product (GDP). D. Per person, per year, total annual health care costs in America went up >850% from 1970 to 2019. E. Chronic health conditions, which increase as people age, now incur 86% of prescription costs; 76% of hospital stays; and 72% of doctors’ office visits. F. Rather than limiting medical services, a preventive approach can lower medical expenses: 1. Earlier detection of disease, and of conditions leading to disease (e.g. high cholesterol, high blood pressure, etc.) lower risks of death or serious illness. 2. Screening for disease risk is preferred over treating existing disease, which is more difficult. Quality of life is reduced by living with chronic disease. 3. Adopting healthier lifestyles can prevent many chronic diseases and is preferred over screening for disease risk or treating existing disease. 4. It is typically less expensive to maintain health than to get well after getting sick.

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Chap 01_10e 113. Describe the general nature of health psychologists’ contributions to promoting health. Give examples of services, fields, and settings included in the work of health psychologists, and explain how these are related. A. Health psychologists contribute to promoting health in a wide variety of ways. B. Services provided by health psychologists include various categories: 1. Providing biofeedback and other nonpharmacologic alternative treatments 2. Providing behavioral interventions to treat chronic pain, some gastrointestinal conditions, and other physical health problems 3. Providing behavioral interventions to increase patient adherence to medication regimens and other prescribed treatments 4. Providing assessments by administering neuropsychological and psychological tests 5. Providing psychological treatments for patients to help them cope with illnesses C. Some students of health psychology go to work in allied professions, e.g.: 1. Public health 2. Dietetics/Nutrition 3. Occupational therapy 4. Social work D. Health psychologists working in public health may: 1. Work for government agencies. 2. Work for academic institutions. 3. Monitor trends developing related to health matters. 4. Develop and/or evaluate health awareness campaigns. 5. Develop and/or evaluate educational interventions.Help to develop and evaluate large-scale decisions in public health, e.g. taxing alcohol, cigarettes, and other products that damage health; placing warning labels on cigarette packs; and placing nutrition facts on restaurant menus and food packaging.

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Chap 01_10e 114. Before the development of health psychology, how was psychology involved in health? A. Psychology's involvement in health traces back to the early years of the 20th century. 1. Psychologists were involved in medical education. 2. Despite long involvement, psychologists played a secondary role in medicine, restricted to mental health treatment and consultation. B. The development of psychosomatic medicine promoted the role of mental factors in physical health. 1. The psychodynamic view holds that personality is a factor in the development of disease. 2. The psychosomatic view began to lose popularity, replaced by behavioral medicine and health psychology.

115. Trace the development of behavioral medicine and health psychology. A. Behavioral medicine 1. Has historical roots in psychosomatic medicine. 2. Is an interdisciplinary field. 3. Aims to integrate biomedical and behavioral knowledge to enhance prevention, diagnosis, treatment, and rehabilitation. 4. Has dedicated journals, including Annals of Behavioral Medicine. B. Health psychology 1. Can be traced to the APA taskforce (1976) that found few psychologists conducted health research, and envisioned psychologists would contribute to enhancing health and preventing disease in the future. 2. Was founded by psychologists and made official when the APA established its Division 38 specifically for this field, a specialty within the psychology discipline. 3. Applies knowledge in psychology to promoting health, preventing disease, treating disease, improving the health care system, influencing public opinion about health, and establishing health policy. 4. Includes the branch of clinical health psychology. 5. Has dedicated journals, including Health Psychology.

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Chap 01_10e 116. Trace the changes in patterns of disease during the 20th century. Are there signs that those trends are changing? If so, how? A. Chronic diseases became more prevalent during the 20th century, overtaking acute diseases as leading causes of death. 1. In 1900, the leading causes of death were attributable to public or community health problems. 2. As the century progressed, diseases with behavioral components, such as heart disease, cancer, and stroke, became leading causes of death. B. In the early 21st century, the death rate from diseases with behavioral components began to decrease (such as heart disease), whereas some causes of death with minor behavioral contributions increased due to an aging population (such as Alzheimer’s and Parkinson’s diseases).

117. What roles do age and ethnicity play in mortality? A. Age is strongly related to illness and death. 1. The likelihood of chronic illness increases with age. 2. Children and young adults are much less likely to die than middle-aged and older adults, but younger people are more likely to die of unintentional injuries and violence. B. Ethnicity also plays a role in health and mortality. 1. European Americans (including Whites and Hispanics) have substantially longer life expectancies than African Americans. 2. The role of ethnicity is not entirely clear because poverty and low socioeconomic status also relate to ethnicity in the United States, and income relates to health. a. Poverty is related to ethnicity and is a negative factor in life expectancy. b. Educational level is related to ethnicity, and low educational level is an important factor in poor health.

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Chap 01_10e 118. Discuss how the preparation and work of health psychologists differ from and are similar to those of other psychologists. A. The preparation of health psychologists is similar to other psychologists, following the scientist/practitioner model. 1. Health psychologists receive doctoral degrees in psychology; many also obtain postdoctoral training. Some also pursue training in endocrinology, epidemiology, immunology, neurology, or other medical subspecialties. 2. Clinical health psychologists must also learn clinical skills and how to practice as health care team members. 3. Health psychologists often complete practicums and internships in hospitals, clinics, and other health care settings. B. Jobs of health psychologists may be similar to those of other psychologists or may vary considerably. 1. Like other research psychologists, health psychologists who conduct research usually are employed in educational settings where they combine teaching and research. 2. Unlike most research psychologists, health psychology researchers may be employed in medical centers, teaching medical students and participating in research as part of biomedical research teams. 3. Like other clinical or counseling psychologists, health psychologists who provide services may work in private practice, in hospitals or clinics, or in health maintenance organizations (HMOs), where they provide diagnosis and treatment. 4. Unlike most clinical or counseling psychologists, health psychologists who provide services may work as part of teams that provide services to people who are physically sick. 5. Unlike most psychologists, health psychologists are more likely to be involved in providing preventive services.

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Chap 01_10e 119. Explain how disease prevention contributes to longer life expectancy, including several examples that have had major effects and a category that has had comparatively minor effects. A. Vaccination widely across the population has decreased infectious diseases and increased life expectancy. B. Purifying drinking water to remove contaminants has decreased infectious diseases and increased life expectancy. C. Pasteurizing milk supplies nationwide has decreased infectious diseases and increased life expectancy. D. Healthier lifestyles (e.g. physical activity, healthy diet, avoiding smoking and drug use) prevent many chronic diseases and increase life expectancy. E. Improved nutrition nationwide promotes health and has increased life expectancy. F. Improved sanitation (e.g. sewage disposal) has increased life expectancy. G. Surprisingly, medical care advances (e.g. new technologies in surgery, antibiotic drugs, more efficient EMS teams, more skilled staff in hospital ICUs) have had only minor effects in raising life expectancy compared to the prevention measures above.

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Chap 01_10e Answer Key 1. False 2. True 3. True 4. False 5. True 6. True 7. False 8. True 9. False 10. False 11. c 12. a 13. b 14. d 15. b 16. b 17. d 18. b 19. a 20. b 21. c 22. b 23. a 24. a 25. a 26. a

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Chap 01_10e 27. a 28. d 29. c 30. d 31. a 32. a 33. b 34. d 35. d 36. b 37. d 38. d 39. d 40. c 41. d 42. d 43. b 44. d 45. a 46. a 47. a 48. c 49. d 50. d 51. c 52. c 53. c 54. a Copyright Cengage Learning. Powered by Cognero.

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Chap 01_10e 55. c 56. d 57. c 58. d 59. b 60. c 61. d 62. d 63. b 64. b 65. d 66. a 67. d 68. c 69. d 70. c 71. c 72. c 73. a 74. b 75. d 76. b 77. b 78. c 79. b 80. a 81. a 82. b Copyright Cengage Learning. Powered by Cognero.

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Chap 01_10e 83. b 84. b 85. c 86. b 87. c 88. b 89. b 90. c 91. c 92. c 93. b 94. b 95. c 96. c 97. c 98. a 99. a 100. c 101. d 102. c 103. a 104. c 105. b 106. a 107. a 108. a 109. a 110. See outline below Copyright Cengage Learning. Powered by Cognero.

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Chap 01_10e 111. See below 112. See below 113. See outline below 114. See outline below 115. See outline below 116. See outline below 117. See outline below 118. See outline below 119. See below

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Chap_02_10e Indicate whether the statement is true or false. 1. A prospective study begins with a group of participants who have a given condition or disease. a. True b. False 2. The number of new cases of a particular disease during a specific period of time is incidence. a. True b. False 3. The randomized, clinical trial is a type of retrospective study. a. True b. False 4. The number of new cases of COVID-19 per year reveals the incidence of that disease. a. True b. False 5. Placebos can lead to fewer symptoms and better quality of life when compared to no treatment, as long as the person receiving the placebo is aware that it may be a placebo. a. True b. False 6. The placebo has treatment benefits but presents problems to researchers. a. True b. False 7. Correlational studies yield information about causation. a. True b. False 8. The placebo can affect psychological disorders, but it has no effect on biological processes. a. True b. False 9. An experiment consists of at least two groups: an experimental group and a control group. a. True b. False 10. With an ex post facto study, researchers compare two or more groups. a. True b. False

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Chap_02_10e Indicate the answer choice that best completes the statement or answers the question. 11. When neither the participants nor the experimenters know which group has received the treatment and which has received a placebo, the design is called a. a control group. b. a double-blind. c. correlational. d. naturalistic. 12. Cross-sectional studies a. follow disease-free participants over a long period of time. b. follow participants with a disease over a long period of time. c. are also frequently referred to as longitudinal studies. d. may compare different age groups or developmental periods. 13. Which of the following situations would most seriously complicate the results of a study? a. A study in which participants are unaware they are part of an experiment b. A study in which participants are aware they are part of an experiment c. A study in which the participants are allowed to self-select into a group d. A study in which participants are not allowed to self-select into a group 14. The determination of causation is most easily accepted on the basis of a. clinical trials. b. studies using the risk factor approach. c. community trials. d. experimental studies. 15. One of the advantages of conducting a longitudinal study is that longitudinal studies can _____________________. a. be completed quickly. b. help identify developmental trends and patterns. c. determine causality. d. be completed with relatively few researchers. 16. What does research find about the relative effectiveness of placebos? a. Surgery has more placebo effect than injections. b. Pills have more powerful effects than injections. c. Treatments that cost less produce greater effects. d. Taking more or fewer doses makes no difference.

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Chap_02_10e 17. When scores on two administrations of the same test are in close agreement, then that test is a. reliable. b. valid. c. both reliable and valid. d. neither reliable nor valid. 18. Placebos have been known to consistently help a. broken bones knit. b. alleviate chronic pain symptoms. c. lower cholesterol. d. relieve intestinal disorders. 19. Liz is a long-time smoker, which carries a relative risk of about 23.0 for mortality from lung cancer and a 2.0 mortality risk from heart disease. From this information, you can conclude that a. Liz is more than four times as likely to die from lung cancer as from heart disease. b. Liz's absolute risk for lung cancer is greater than her absolute risk for heart disease. c. Liz is about 23 times more likely to die of lung cancer than those who do not smoke. d. Liz is about 23 times more likely to die of heart disease than her twin sister. 20. A research study found a direct, consistent association between late bedtime and childhood obesity. What type of relationship does this indicate? a. A negative relationship b. A dose–response relationship c. A positive relationship d. A causal relationship 21. Observational methods in epidemiology are most closely related to which psychology method? a. Correlational studies b. Experimental designs c. Ex post facto designs d. Case history method 22. Which type of epidemiological study is most similar to an experimental design in psychology? a. A case-control epidemiology study b. A retrospective epidemiology study c. A prospective epidemiology study d. A randomized and controlled trial

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Chap_02_10e 23. The placebo effect is a. most prominently observed in well-designed experiments. b. an imaginary effect which can be applicable to everybody. c. an imaginary effect occurring almost exclusively in hypochondriacs. d. physiologically real and can improve organic or psychological symptoms. 24. Dr. Rich is conducting research that examines whether 20-year-olds eat more low-fat foods than 70year-olds. This research is using a a. cross-sectional design. b. experimental design. c. ex post facto design. d. retrospective design. 25. The ratio of the incidence or prevalence of a disease in an exposed group to the incidence or prevalence of that disease in the unexposed group is called a. a risk factor. b. dose–response relationship. c. a relative risk. d. causation. 26. Small correlations, for example 0.08 or 0.10, a. may be statistically significant. b. cannot be statistically significant. c. show causation in correlated variables. d. both a and c 27. The results of a meta-analysis allow researchers to determine one type of information that other statistical analyses do not, which is a. the statistical significance of the effect. b. the correlation between the variables. c. the estimated overall size of the effect. d. the main effects and interactions of variables. 28. Correlational studies a. cannot indicate cause and effect. b. are a type of experimental design. c. cannot be used in psychological research. d. cannot be used in epidemiological research.

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Chap_02_10e 29. Dr. Smith, a clinical health psychologist, is conducting research on whether relaxation training before a swim meet improves swimmers’ race times. It is most likely Dr. Smith is using a __________ design. a. correlational b. single-blind c. double-blind d. retrospective 30. A scale that accurately indicates the likelihood of someone developing an eating disorders mostly demonstrates a. external validity b. indicative reliability c. predictive validity d. test–retest reliability 31. Which of these conditions is likely to produce the highest positive placebo effect? a. A physician dressed casually in blue jeans and sneakers b. A physician who is enthusiastic in describing the treatment c. A physician with a reputation for medical errors d. A physician who, when prescribing medication, says, "This may not help, but it won't hurt." 32. Mortality is to death as morbidity is to a. prevalence. b. disease. c. trauma. d. incidence. 33. Prospective and retrospective studies are both considered: a. experimental studies. b. longitudinal studies. c. clinical trials. d. correlational studies. 34. A recent research study examined whether sending text messages to overweight children would help enable them to maintain a weight-loss program. In this experiment, some children were randomly assigned to receive text messages and other children were assigned to the control condition and did not receive text messages. The dependent variable in this experiment was a. continued enrollment in a weight-loss program. b. text messages. c. weight loss. d. not receiving text messages.

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Chap_02_10e 35. Acute diseases typically tend to a. be greater in prevalence than in incidence. b. be similar in prevalence and in incidence. c. be greater in incidence than in prevalence. d. differ in ratios of incidence to prevalence. 36. What would make a placebo effect stronger? a. A pill that looked like it cost a lot of money and effort to make b. A pill that was large c. A medicated syrup that tasted sweet d. None of the above 37. A statistical technique for combining the results of several studies is a. meta-analysis. b. transactional analysis. c. hypothesis testing. d. scientific myopia. 38. Based on the follow-up findings of the Alameda County study, which of the following people would be most likely to die sooner? a. Ali, who smokes a few cigarettes every weekend b. Flora, who is obese and sleeps thirteen hours every day c. Bailey, who skips breakfast, eats snacks, and has insomnia d. Hannah, who lives alone, rarely goes out, and has one close friend who lives abroad 39. In randomized controlled trials, researchers assign participants to treatment or control groups randomly. What is the best definition of “random” as it applies to this? a. Group assignment is haphazard and not systematic. b. Participants are unaware of their group assignment. c. Researchers are unaware of the group assignments d. Everyone has an equal chance in group assignment. 40. Which of these is NOT a function of a useful theory? a. Generating research b. Being a guide to action c. Eliminating researcher bias d. Organizing research observations

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Chap_02_10e 41. Research has found that smoking is related to high blood pressure. This finding means that a. smoking is a risk factor for high blood pressure. b. smoking is an independent risk factor for high blood pressure. c. high blood pressure is not a co morbidity for people who do not smoke. d. smoking results in a high incidence of high blood pressure. 42. A risk factor is any characteristic or condition that a. occurs with a lower frequency in people with a disease than in people free from that disease. b. occurs with a higher frequency in people with a disease than in people free from that disease. c. is any factor that has been demonstrated to be responsible for causing a disease. d. is a measure of the dependent variable that is utilized in an experimental design. 43. Prospective epidemiological studies are also a. cross-sectional. b. longitudinal. c. experimental. d. clinical trials. 44. In an experimental design that investigates the effects of weight loss on heart rate in middle-aged men, the dependent variable would be a. stress. b. heart rate. c. age. d. gender. 45. Psychologists and epidemiologists would agree that which type of study is the most desirable design, the "gold standard" of scientific research? a. Case-control study b. Randomized placebo-controlled double-blind trial c. Natural experiment d. Correlational study 46. The Alameda County study is an example of a. an experimental longitudinal design. b. a prospective design. c. an experimental descriptive design. d. a correlational cross-sectional design.

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Chap_02_10e 47. A direct, consistent relationship between the independent variable and the dependent variable a. is an example of the placebo effect. b. is an example of the nocebo effect. c. defines dose-response relationship. d. indicates a transverse relationship. 48. Katie has contracted a rare virus while traveling. Her doctor prescribes a new antiviral drug whose efficacy is unproven as yet, but seems quite promising in early trials. Katie has an excellent response to the drug. What is likely in this case? a. Katie’s response is due to the placebo effect, not to the treatment. b. Katie’s response is due to the treatment, not to the placebo effect. c. Katie’s response is due to both the treatment and the placebo effect. d. Katie’s response is due to neither treatment nor placebo effect. 49. For which of the following conditions would you expect a placebo to be least effective? a. Asthma b. Nausea c. Bone fracture d. Depression 50. An inactive substance or condition that has the appearance of the independent variable and that may cause participants in an experiment to improve or change behavior due to their belief is called a. a nocebo. b. a placebo. c. a dependent variable. d. an experimental design. 51. Most health-related evidence a. is the result of a variety of research methods. b. has been discovered accidentally. c. is withheld from the general public to avoid widespread panic. d. comes from the results of experimental designs. 52. In general, what is true about the differences between prospective and retrospective research studies? a. Retrospective studies yield stronger evidence than prospective studies. b. Prospective studies yield stronger evidence than retrospective studies. c. Prospective studies are not longitudinal; retrospective studies are. d. Retrospective studies involve subjects without a disease; prospective studies’ subjects have a disease.

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Chap_02_10e 53. The extent to which a test measures what it is designed to measure is an expression of a. test-retest reliability. b. internal consistency. c. homogeneity. d. validity. 54. Dr. Sweeney is conducting research that examines aggressive behaviorin 5 year-olds. She follows up with these same participants 10 years later to measure their reactivity to stress. She is using a a. cross-sectional design. b. experimental design. c. longitudinal design. d. retrospective design. 55. What term accurately describes the following correlation between physical age and physical health: as age increases, physical health decreases? a. A positive correlation b. A negative correlation c. A weak correlation d. No correlation 56. Dr. Marcy is conducting an observational study that compares a group of people who have a specific disease to a control group of people who do not have that disease. What type of study is this? a. Prospective b. Case-control c. Retrospective d. Both B and C 57. One of the challenges of conducting health research is that it is impossible, and unethical, to manipulate certain variables, such as sexual behaviors or smoking. The research design that examines differences between groups without manipulating these groups is a. experimental b. ex post facto c. random assignment d. longitudinal 58. The branch of medicine that investigates factors contributing to the occurrence of diseases within a population is a. Psychoneuroimmunology. b. behavioral medicine. c. behavioral health. d. epidemiology.

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Chap_02_10e 59. Indira has faith in the medical profession; Solomon has a more cynical attitude about doctors. If both patients are given a placebo by a doctor in a medical study conducted in a hospital, what is most likely? a. Solomon and Indira will be equally likely to experience a placebo response. b. Indira will be more likely to experience a placebo response than Solomon will. c. Indira and Solomon will be equally likely to experience a nocebo response. d. Solomon will be more likely to experience a placebo response than Indira will. 60. If two variables increase or decrease together, they are a. positively correlated. b. negatively correlated. c. positively skewed. d. negatively skewed. 61. Which type of study begins with a group of people who already have a disease and then looks into factors that are associated with that disease? a. Experimental b. Placebo c. Prospective d. Retrospective 62. What condition has recent research shown is receptive to placebos, provided the person believes they are receiving treatment? a. Depression b. Heart arrhythmia c. Arthritis d. Diabetes 63. A doctor diagnoses Javier with an infection and prescribes a medication to treat it. Among factors contributing to a placebo response, which of the following is more indicative of expectancy than of conditioning? a. Javier has read that this medication eradicates the infection 100% of the time. b. Javier has had same medication before and recovered from a similar infection. c. Javier has had good medical experiences and associates treatment with success. d. Javier has learned from experience that taking a prescribed medication is better than not taking it. 64. A study comparing smokers’ and nonsmokers’ scores on a personality inventory is most likely to be a. an ex post facto design. b. an experimental design. c. a correlational study. d. a retrospective study. Copyright Cengage Learning. Powered by Cognero.

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Chap_02_10e 65. A study that compares cholesterol levels of 10-year-old children and 30-year-old adults would most likely be a. an experimental study. b. a cross-sectional study. c. a longitudinal study. d. an ex post facto study. 66. Correlational studies are a type of a. experimental study. b. double-blind study. c. ex post facto design. d. descriptive research. 67. In order for epidemiologists to infer that Behavior A causes Disease B, they must observe a. that Behavior A has taken place before Disease B takes place. b. a dose-response relationship between Behavior A and Disease B. c. a decline in Disease B when Behavior A is eliminated. d. all of the above. 68. Occasionally, factors that predict death or mortality are not the same factors that predict disease or _______________. a. morbidity b. incidence c. prevalence d. epidemiology 69. A research team conducts a study, and their statistical analysis yields a correlation coefficient of 0.07 between two variables. What is true about this? a. This number is so small that it is not statistically significant. b. Because this number is above zero, it is statistically significant. c. This number can be statistically significant in small observation groups. d. This number can be statistically significant in large observation groups. 70. Which of these is NOT a characteristic of longitudinal studies? a. Longitudinal studies are a comparison of two separate groups. b. Longitudinal studies tend to be time consuming. c. Longitudinal studies frequently require a team of researchers. d. Longitudinal studies are prospective designs.

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Chap_02_10e 71. A study examined two groups of people—those who regularly exercised and those who did not—and examined their past history to try to understand what accounted for the difference. This is an example of what type of correlational design? a. Retrospective study b. Prospective study c. Clinical trial study d. All of the above 72. Which of these statements is true? a. Placebo effects can influence both psychological and physical disorders. b. Valuable research is done by people outside the scientific community, but scientists universally discount its validity. c. Dramatic scientific breakthroughs happen frequently. d. Experimental—not observational—research is required to learn about patterns of disease. 73. In an experimental design that investigates the effects of a low carbohydrate diet on weight loss, diet would be a. the independent variable. b. the dependent variable. c. an extraneous variable. d. a placebo. 74. A strong placebo effect a. makes it easier to determine the effectiveness of a therapeutic intervention. b. does not produce any type of unfavorable effect. c. is easy to control in psychotherapeutic treatment. d. hampers the evaluation of the effectiveness of treatment programs. 75. A study that follows the history of overweight male participants over a 30-year period would be a. an experimental study. b. a longitudinal study. c. a cross-sectional study. d. a case-control study. 76. A study that begins with a group of participants who already have a disease is most likely to be a. a retrospective study. b. a prospective study. c. a correlational study. d. an experimental study.

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Chap_02_10e 77. Which of the following is part of an ex post facto study but not an experimental study? a. Manipulation of an independent variable b. Control of extraneous variables c. Measurement of a dependent variable d. Inclusion of a subject variable 78. To determine whether Drug Z lowers blood pressure, it is necessary to demonstrate that an experimental group, which has been given Drug Z, will have lower blood pressure than a comparison group, which has been given a. a higher dose of Drug Z. b. a lower dose of Drug Z. c. a placebo treatment. d. no treatment at all. 79. Dr. Jonas is conducting a single-blind experimental study with human participants to investigate a medical procedure’s effectiveness. What is true about this research? a. Dr. Jonas can control for participant expectancy more than in a double-blind design. b. Both Dr. Jonas and the participants will know who is receiving the active treatment. c. Dr. Jonas will need to establish the same expectancies for all the participants for control. d. Dr. Jonas is using a research design that informs participants which treatment they receive. 80. Prevalence of an illness refers to a. the proportion of the population that has a disease at a specific time. b. the number of new disease cases in a year. c. the percentage of new disease cases in a year. d. the percentage of total deaths caused by a disease in one year. 81. When a placebo effect is observed in a treatment, what does this most demonstrate? a. Objective measures supersede subjective perceptions. b. Subjective perceptions supersede objective measures. c. Objective and subjective findings can be equally valid. d. Subjective perceptions have a negligible effect on treatment. 82. The nocebo effect occurs when a. participants in a placebo study experience a negative effect. b. participants in a placebo study experience a positive effect. c. experimenters use a double-blind study. d. experimenters use the case-control method.

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Chap_02_10e 83. Theories should be viewed as a. unimportant to science. b. practical science tools. c. testable hypotheses. d. untested hypotheses. 84. We are designing a new instrument to measure happiness. If we ask participants to complete the same instrument of happiness over several days, we are testing this new instrument’s ______________. a. external validity b. interrater reliability c. predictive validity d. test-retest reliability 85. In general, chronic diseases are likely to have a. more incidence than prevalence. b. more prevalence than incidence. c. similar incidence and prevalence. d. no predictable relationship between prevalence and incidence. 86. Several college students who are friends have all decided to volunteer for a research study that will compare a medical treatment to a placebo. Ethical codes require that they all sign their informed consent to participate. What does this mean? a. The students have been informed whether they will get the treatment or a placebo. b. The students have been informed and allowed to choose the treatment or placebo. c. The students have been informed they will receive something, but not which it is. d. The students have been informed they will get a placebo and agree to participate. 87. If a test foretells some future condition, it is said to have a. a negative validity. b. criterion validity. c. predictive validity. d. a lack of validity. 88. The CONSORT (Consolidated Standards of Reporting Trials) guidelines are designed to keep researchers from: a. falsifying trial results to support a given treatment. b. suppressing trial results not supporting a treatment. c. publicizing trial results that support their treatment. d. publicizing trial results which discredit a treatment.

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Chap_02_10e 89. Two research teams are both experimenting with new treatments for a medical condition. In one study, the condition involved currently has no treatment; in the other, there is an accepted treatment, to which the researchers seek alternative and/or improved options. Both studies are comparing an experimental treatment to a placebo. Ethically, what is the most likely opinion? a. Both studies are unethical because patient welfare is not the first priority. b. The study wherein an accepted standard of care exists may be unethical. c. The study wherein no treatment exists for the condition is less ethical. d. Both studies are ethical because testing new treatments is necessary. 90. Research has found that lung cancer increases with number of cigarettes smoked. This finding a. indicates a negative relationship between smoking and lung cancer. b. indicates a positive relationship between smoking and lung cancer. c. proves that smoking cigarettes causes lung cancer. d. proves that incidence of lung cancer decreases with number of cigarettes smoked. 91. Test X is designed to predict which individuals in a smoking cessation program will successfully quit smoking. Scores from Test X administered at the beginning of a cessation program correlate .89 with length of time smokers are able to quit. This evidence suggests that Test X is a. reliable. b. valid. c. standardized. d. consistent. 92. A researcher discovers a high positive correlation between intelligence and good health. What does this mean? a. One variable is the cause; the other variable is the effect. b. Both of these variables reciprocally influence each other. c. Both of these variables occur together and at similar rates. d. One variable will increase as the other variable decreases. 93. Which of these "sugar pills" is likely to have the greatest positive effect? a. White pills rather than colored pills b. Very small pills rather than medium-size pills c. Capsules rather than tablets d. Generic pills rather than brand-name drugs 94. Although causality is difficult to determine, which scientific method most strongly yields evidence for cause and effect relationships? a. Correlational study b. Experimental design c. Ex post facto design d. Descriptive research Copyright Cengage Learning. Powered by Cognero.

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Chap_02_10e 95. A positive correlation between physical health and education would indicate that a college graduate would have a. more infectious disease. b. more chronic disease. c. worse health overall. d. better health overall. 96. An investigator measures blood pressure in a group of college students and then repeats these measurements every year for 20 years. This is an example of a. a longitudinal study. b. a cross-sectional study. c. an experimental study. d. a clinical trial. 97. What is the major difference between longitudinal studies and cross-sectional studies? a. Cross-sectional studies occur once; longitudinal studies occur over time. b. Cross-sectional studies occur over time; longitudinal studies occur once. c. Cross-sectional studies involve the same participants; longitudinal studies involve different participants d. Cross-sectional studies incorporate a few groups of people who share a particular characteristic; longitudinal studies incorporate many diverse groups. 98. Placebos can be beneficial in treating many conditions EXCEPT: a. depression. b. hypertension. c. insomnia. d. broken bones. 99. Which type of epidemiological research methodology is broken into retrospective and prospective studies? a. Natural experiments b. Randomized control trials c. Ex post facto designs d. Observational studies 100. Of the following choices, which correlation coefficient would predict the strongest positive correlation? a. -0.9 b. 0.0 c. 0.5 d. 0.8

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Chap_02_10e 101. Reliability means a. accuracy. b. structure. c. validity. d. consistency. 102. The cause of a disease or condition is most readily suggested by a. case control studies. b. experimental designs. c. correlational studies. d. a single-participant design. 103. An accurate psychometric testing instrument a. must be both valid and reliable. b. may be valid but not reliable. c. may be reliable but not valid. d. must be given with time limits. 104. After tobacco companies argued that cigarette smoking had never been proven to cause lung cancer or heart disease in humans, how did epidemiological researchers determine a causal relationship? a. They proved it through experimental studies. b. They inferred it, as all seven criteria for a cause–effect relationship were met. c. They proved it based on double-blind placebo-controlled longitudinal studies. d. They proved it through establishing a dose–response relationship. 105. Research with placebos and nocebos finds that actual physiological changes a. are unnecessary, as long as the patients feel better. b. are observed from placebos, but not from nocebos. c. are present from taking both placebos and nocebos. d. are observed from nocebos, but not from placebos. 106. Researchers want to examine whether eating fresh fruit in the morning increases feelings of hope and optimism for people with mild depression. Their subjects should be randomly assigned to one of two situations: eating fresh fruit in the morning or a. taking a placebo. b. taking medication. c. eating fresh fruit in the afternoon. d. leaving their diet unchanged.

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Chap_02_10e 107. Without regard to ethics or practicality, design a study that would settle the question of whether or not smoking causes lung cancer.

108. Discuss the role of theory in research, including defining a theory. How does psychology utilize theories? Identify three characteristics of a useful theory. How do theories further science?

109. Discuss the disadvantages and advantages of placebos.

110. Summarize seven criteria that epidemiologists use for determining a cause-and-effect relationship between a condition and a disease.

111. What are the advantages and disadvantages of experimental studies and correlational studies? What might prompt a researcher to choose a correlational design over an experimental design?

112. Contrast and compare research methods in psychology with those in epidemiology.

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Chap_02_10e 113. Discuss the strengths and weaknesses of the risk factor approach.

114. Summarize some guidelines for consumers to evaluate health research information that theyfind on the Internet.

115. Contrast the concepts of reliability and validity. How is each important for psychological assessment?

116. Identify four beliefs that reflect accurate scientific information, and seven other beliefs people may have that reflect uninformed, unrealistic, and/or naïve ideas about research.

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Chap_02_10e Answer Key 1. False 2. True 3. False 4. True 5. False 6. True 7. False 8. False 9. True 10. True 11. b 12. d 13. c 14. d 15. b 16. a 17. a 18. d 19. c 20. b 21. a 22. d 23. d 24. a 25. c 26. a

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Chap_02_10e 27. c 28. a 29. b 30. c 31. b 32. b 33. d 34. a 35. c 36. a 37. a 38. d 39. d 40. c 41. a 42. b 43. b 44. b 45. b 46. b 47. c 48. c 49. c 50. b 51. a 52. b 53. d 54. c Copyright Cengage Learning. Powered by Cognero.

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Chap_02_10e 55. b 56. d 57. b 58. d 59. b 60. a 61. d 62. a 63. a 64. a 65. b 66. d 67. d 68. a 69. d 70. a 71. a 72. a 73. a 74. d 75. b 76. a 77. d 78. c 79. c 80. a 81. c 82. a Copyright Cengage Learning. Powered by Cognero.

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Chap_02_10e 83. b 84. d 85. b 86. c 87. c 88. b 89. b 90. b 91. b 92. c 93. c 94. b 95. d 96. a 97. a 98. d 99. d 100. d 101. d 102. b 103. a 104. b 105. c 106. d

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Chap_02_10e 107. A. The critical study would have to be an experiment, the only method that allows the determination of causality. 1. Such an experiment has not been done with humans for ethical reasons. 2. Such experiments have been done with nonhuman animals, but generalizing those results to humans has not been persuasive to everyone. B. The experiment 1. Begins with a representative sample of the population. 2. Randomly assigns participants to two equal groups, smoking and nonsmoking. 3. Requires the smoking group to continue and the nonsmoking group to refrain from smoking. 4. Continues for at least 20 years. 5. Controls for the events that might occur to the participants during the 20 or more years of the study so as to eliminate these factors as possible causes for lung cancer. 6. Determines cause of death for all participants who died. 7. Compares the number of deaths due to lung cancer in the smoking versus nonsmoking group. 8. Allows for conclusions concerning the causal role of smoking in the development of lung cancer. C. Because only a controlled experiment like the one described here can form the basis for conclusions about causality, obvious practical and ethical problems exist in attempting to answer this question. 108. A.Constructing theoretical models helps psychologists make sense of research results. 1. Health psychologists use theories and models to explain behaviors and conditions relating to health. 2. The uninformed may see theories as unimportant and/or impractical, but scientists see them as tools that are practical by directing their research and making it meaningful. B. A theory is defined as “a set of related assumptions that allow scientists to use logical deductive reasoning to formulate testable hypotheses” (Feist & Feist, 2006). 1. Theories interact with scientific observations. 2. Theories explain and give observations meaning; observations change and/or integrate with theories. 3. Theories are dynamic. To explain increasingly pertinent observations, they expand and increase in power. C. In all scientific disciplines including health psychology, the role of theory includes: 1. Generating hypothesis-testing research and descriptive research. 2. Organizing, explaining, and making research findings understandable—including integrating existing knowledge and generating questions promoting more research. 3. Guiding health psychology practitioners to act, i.e. to predict and change behavior. For example, each psychological theory guides corresponding therapeutic methods. D. Theories represent necessary and useful tools in developing any scientific discipline. 1. They add to knowledge, make sense of information, and help both researchers and clinicians solve everyday problems.

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Chap_02_10e 109. A. A placebo is a treatment that is capable of causing effects through expectation concerning the effectiveness of the treatment, independent of the influence of the treatment itself. B. The disadvantages of placebos occur in research settings. 1. Placebos create problems in assessing the effectiveness of treatment because people who get treatment expect the treatment to be effective, and the people show improvement even to “sugar pills.” 2. Placebos create problems in assessing the effectiveness of psychological treatment because people expect psychological interventions to work, and the people show improvement even if the treatment has no effective component. C. The advantages of placebos can be seen in treatment situations. 1. Placebos bring about improvements and cures that are indistinguishable from those brought about by medically and psychologically effective treatments. 2. The placebo effect can add to the effect of medical and psychological treatment, boosting the effectiveness. 110. Epidemiologists use a series of criteria to determine that a condition causes a disease. When their research findings meet all seven of these criteria, they can infer a causal relationship between an independent variable and a dependent variable. For example, smoking is an independent variable and lung cancer or heart disease is a dependent variable. A. The criteria are: 1. A dose-response relationship must exist between the condition and the disease. 2. Eliminating the condition must decrease the prevalence or the incidence of the disease. 3. The condition must have occurred before the disease occurred. 4. It must be physiologically plausible that a causal relationship exists between the condition and the disease. 5. Data obtained through research must consistently show a relationship between the condition and the disease. 6. The relationship between the condition and the disease must be relatively strong. 7. Well-designed research studies must be the bases for the relationship between the condition and the disease. 8. Discuss the role of theory in research 111. A. Experimental studies 1. Have the advantage of yielding information about causal relationships, a type of information that no other single method has the power to show. 2. Have the disadvantages of being difficult to conduct and somewhat artificial because experiments require the manipulation of independent variables and the control of all other variables, which includes appropriate control group (or groups). B. Correlational studies 1. Have the advantage of yielding information about the degree and direction of relationships between variables. 2. Have the disadvantage of being incapable of revealing causal relationships. C. Researchers can make the choice of correlation over experimental method because 1. Some variables cannot be manipulated as part of an experiment due to ethical or practical problems in performing the manipulation. If a researcher had an interest in such variables, that researcher would have to choose another method of investigation. 2. Some research is designed to reveal strength of relationships between variables, which makes correlational research the best choice.

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Chap_02_10e 112. A. Psychology research 1. Strives to understand behavior. 2. Includes correlational studies, cross-sectional and longitudinal studies, experimental studies, and ex post facto designs; all of these methods have different goals and are appropriate for answering different research questions. B. Epidemiology research 1. Strives to understand the origins of disease, to determine if the hypotheses about disease drawn from other studies are consistent with the epidemiological data, and to evaluate preventive procedures. 2. Includes prospective and retrospective studies; randomized, controlled trials; and natural experiments. 3. Each method has different requirements, and each answers different research questions. C. Comparing the two areas shows that 1. Both psychology and epidemiology use methods based on observation as well as manipulation. 2. Some of the methods are the same but the names may differ. a. Experiments are common to both areas. b. Ex post facto studies are similar to natural experiments. c. Prospective studies are longitudinal. 3. Some of the methods differ; for example, retrospective studies do not appear in psychology. 113. A. A risk factor is a characteristic that relates to the development of illness. 1. Risk factors are determined by correlational studies, and therefore, show no causality. 2. Many risk factors relate to the development of disease, yielding a list of risk factors each with different strengths of relationship to the disease. B. The advantages of the risk factor approach include 1. Furnishing a list of factors that relate to development of illness. 2. Allowing some predictive power based on strength of the risk factor. 3. Allowing health care professionals to focus on prevention rather than forcing them to strive toward a cure. C. The main weakness of the risk factor approach is its inability to demonstrate causation. 1. Even if a risk factor causes a disease, the risk factor approach is not capable of revealing such relationships. 2. The predictions of the development of disease based on the risk factor approach do not lead to precise predictions of who will get sick and who will remain disease free.

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Chap_02_10e 114. A. Whereas people only heard about research from their doctors in the past, today the Internet (as well as TV and newspapers) publicizes it. However, this creates the problem that consumers may be reading untrustworthy, inaccurate information. 1. News media may focus on the most sensationalistic parts to get people’s attention, misleading them. 2. Commercials may distort or disregard scientific evidence to sell health-related products or services. B. Since more than 80% of Internet users look there for health information, consumers should ask themselves some questions to evaluate this information: 1. Who is responsible for a website’s information? Sites with addresses (URLs) ending in “.org” belong to nonprofits; in “.gov” to government agencies; and in “.edu” to educational institutions, and are more likely to offer unbiased information. Sites with addresses (URLs) ending in “.com” belong to commercial/for-profit companies, and may be primarily motivated by sales. 2. What is a website’s purpose? Sites selling things are less likely to give unbiased information. As dramatic “breakthroughs” are rare in science, sites promising these are suspect. 3. What evidence supports a website’s claim? It should present findings obtained through published research studies by qualified scientists with government, research hospital, or university affiliations; and should provide references to those studies. Commercial claims and “satisfied customer” testimonials are typically not research evidence-based. 4. Is enough information available on a website for evaluating a scientific study’s research design? Studies with larger samples (participant groups) yield more reliable results. Studies must use randomized, controlled experimental designs to imply causation of specific health outcomes; control for placebo effects; and, in retrospective or prospective designs, control sufficiently for potential confounding variables; and identify participant populations. 5. Is the health information on a website reviewed by an expert with research or medical credentials before it is posted? 6. Is the information on a website current? The site should identify the date of the most recent review or posting. Updated information is important, since scientific knowledge is continually evolving. 7. Recommended websites for current scientific health information include the National Institutes of Health (www.nih.gov) and the Centers for Disease Control and Prevention (www.cdc.gov).

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Chap_02_10e 115. A. Reliability is consistency of measurement. 1. Reliability can refer to test-retest or interrater reliability. 2. Reliability is typically expressed as a correlation coefficient, and this correlation expresses the degree of relationship between the two variables (first administration of a test versus second administration; Rater 1 versus Rater 2). 3. High reliability coefficients indicate consistent measurement, but low reliability coefficients are difficult to interpret. B. Validity is accuracy of measurement. 1. Accuracy of measurement is judged against some independent criterion. 2. Validity may also be expressed as a correlation, reflecting the degree of relationship between the test score and the criterion. C. Both reliability and validity are necessary for good measurement. 1. A measurement cannot be valid without being reliable, but a measurement can be reliable and still lack validity. 2. These coefficients are important in deciding about the acceptability of scores on psychological tests, and higher reliability and validity scores indicate better tests. 116. A. For people to be informed consumers of health research, they need to check what things they believe about it. Four beliefs that reflect accurate scientific knowledge are: 1. The placebo effect can influence not only psychological, but also physical problems. 2. Patients with pain frequently experience relief after taking a placebo. 3. In general, information from longitudinal studies is more useful than information from studies of one individual. 4. The underlying cause of a disease is more likely suggested by experimental research results than by observational research results. B. Seven other beliefs that reflect uninformed, unrealistic, and/or naïve ideas about research are: 1. A good way to evaluate treatment effectiveness is from personal testimonials. 2. The importance of scientific research is accurately portrayed by TV/news reports. 3. Research methodology is unimportant for evaluating result validity because all scientific methods give equally valuable results. 4. Animal studies can be equally important as human studies for determining important health information. 5. Valuable research is conducted by people outside the scientific community, but scientists attempt to discredit this work. 6. Breakthroughs in science are an everyday occurrence. 7. Because new health research reports frequently contract earlier results, the information cannot be used for good decision-making about personal health.

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Chap_03_10e Indicate whether the statement is true or false. 1. Women are more likely than men to seek health care, even when pregnancy and childbirth are not considered. a. True b. False 2. Young adults show the greatest reluctance to seek health care. a. True b. False 3. People often seek medical information from their family and friends, also known as their lay referral network. a. True b. False 4. In the United States, medical errors are the second leading cause of death. a. True b. False 5. Those actions people undertake to learn whether or not they are ill are called illness behaviors. a. True b. False 6. African Americans are more likely than European Americans to visit a physician. a. True b. False 7. People with a disease are also ill. a. True b. False 8. Sick role behaviors occur before a person has seen a health care provider and prior to receiving a diagnosis from that health care provider. a. True b. False 9. Men tend to report only life-threatening situations, such as heart disease, whereas women tend to report more body symptoms and distress. a. True b. False

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Chap_03_10e 10. Dev has no health insurance and has had bad experiences with medical care in the past. He is trying to decide between two doctors: a woman named Angelica and a man named Don. Dev will more likely be satisfied with Angelica because she is more likely to be more empathetic when communicating with him. a. True b. False Indicate the answer choice that best completes the statement or answers the question. 11. Lian has a wealthy family, and Mei is from an economically marginalized background. Both are U.S. citizens. Based on research, a. Mei is more likely to seek medical care than Lian. b. Mei is more likely to be hospitalized than Lian. c. Mei is less likely to develop serious illness than Lian. d. Mei and Lian will both seek treatment in a hospital before they ask the advice of friends. 12. Keesha is a wealthy CEO of a restaurant chain, and Kenny’s income puts him below the federal poverty threshold. As Americans, what is true of Keesha and Kenny? a. Keesha is more likely to experience fewer symptoms than Kenny. b. Kenny is more likely to experience fewer symptoms than Keesha. c. Kenny is less likely to seek medical care than Keesha. d. Keesha is less likely to report better health than Kenny. 13. 1998 research by Lazarou and colleagues estimated how many hospitalized patients had toxic drug reactions annually, relative to how many died from such reactions? a. Between 14 times and 26 times as many b. Between twice and three times as many c. Between 10 times and 16 times as many d. Between 26 times and 50 times as many 14. Gail has not been feeling well lately. According to the model of illness conceptualization described by Howard Leventhal and his colleagues, Gail is likely to a. deny her symptoms. b. try to label her symptoms in a nonthreatening way. c. repress her symptoms and get to the point where she believes she does not experience them. d. exaggerate her symptoms and attempt to get all the sympathy she can. 15. Fatima was diagnosed with type 1 diabetes during childhood. During her youth and adulthood, which sick role behavior will she NOT be able to fulfill? a. To become completely well b. To maintain a level of health c. To use a variety of resources d. To make decisions on health Copyright Cengage Learning. Powered by Cognero.

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Chap_03_10e 16. Most adults would profit from the techniques that hospitals use to prepare children for hospitalization. The main barrier to preparing all patients who undergo stressful medical procedures is that a. adults do not have the time for these procedures. b. these procedures add to medical costs. c. patients find the preparation as stressful as the procedures, so preparation adds to the overall stress of hospitalization. d. these procedures are not effective. 17. What did the emergence of COVID-19 reveal about the relationship between symptoms and seeking treatment? a. People tended to downplay symptoms consistent with the disease. b. People tended to refuse to seek treatment because of stigmas associated with the disease. c. People tended to treat symptoms more seriously than they otherwise would have. d. People did not tend to behave any differently despite the novel risks of the disease. 18. What did a 2019 study reveal about the cost of medical care in the United States? a. More than half of people filing bankruptcy did so due to medical costs. b. Medical costs caused hardship but not bankruptcy for most Americans. c. People who had catastrophic illnesses never needed to file bankruptcy. d. Only people without health insurance were bankrupted by medical cost. 19. Sandra has Crohn’s disease, which can cause severe gastrointestinal symptoms. According to research findings, if Sandra is typical of most people, which factor will make her most likely to see a doctor? a. If her symptoms are worse than usual b. If her symptoms are unpredictable c. If she does not understand what causes her symptoms d. If she is sufficiently anxious about coping with the symptoms 20. From the 20th to the 21st century, the predomination of physicians as medical providers decreased, and the popularity of alternative health care providers_________. a. increased b. slightly decreased c. stabilized d. plummeted

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Chap_03_10e 21. Deepak and Lois each have the same condition affecting one leg. However, Deepak’s job involves sitting at a desk all day, while Lois’s job involves walking and standing all day. This differentially affects how soon each of them is likely to seek medical care. To which symptom characteristic defined by David Mechanic does this most relate? a. The frequency and persistence of symptoms b. How much the symptoms interfere with life c. How visible or apparent the symptoms seem d. The severity of symptoms that one perceives 22. Among sick role rights and responsibilities defined by Segall, a patient diagnosed with a chronic disease for which there is no cure will be LEAST able to fulfill which of these? a. Becoming dependent upon others for assistance b. Performing routine management of health care c. Making use of a range of health care resources d. Achieving and maintaining a status of wellness 23. All other factors being equal, which person would be the most likely to seek health care? a. An Asian American man b. A European American woman c. An African American man d. A Hispanic woman 24. Kwame engages in some healthy and some unhealthy attitudes or behaviors. Of the following, which represents something he does that could make his health care less effective or put him at risk? a. Kwame schedules an appointment with his doctor for a checkup every 6 months. b. Kwame researches any severe symptoms he may have for maximal information. c. Kwame allows himself to take it easy and accomplish less whenever he is sick. d. Kwame follows medical advice in the hospital and avoids questioning the staff. 25. The five beliefs defined as components of Leventhal’s model of disease conceptualization are found to predict patients’ distress levels, whether or when they will seek health care, and how well they will manage their disease. Petrie and colleagues’ research with asthma patients found that giving patients accurate information about those five components also improved which of them? a. The amounts of distress patients experience b. Whether or not patients seek out health care c. How well the patients manage their disease d. How soon the patients will seek health care

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Chap_03_10e 26. Jaime has recently begun to notice a handful of different symptoms he has never had before and is concerned they could indicate something serious. He lives in an area without access to the Internet. If he is like most people, what is the first thing he will do? a. Go see his primary care doctor. b. Consult a specialist physician. c. Consult a lay referral network. d. Do nothing unless the symptoms became unbearable. 27. What program did the U.S. Congress establish in 1965 specifically to pay hospital expenses for most Americans over the age of 65? a. Food Stamps b. Medicaid c. Medicare d. Social Security 28. Malone has been in the hospital for 2 weeks due to injuries from an automobile crash. Because he is hospitalized, he does not have to work; he receives three healthy meals a day; and most of his normal, everyday decisions are made for him. In such circumstances, Malone will probably a. enjoy his hospital stay. b. become addicted to pain medication. c. experience less stress than usual. d. experience more stress than usual. 29. Sheryl and Shakima both experience upper abdominal pain. Sheryl believes hers is from indigestion; Shakima believes hers is from a heart condition. What is most likely in regard to them seeking treatment? a. They will both seek medical care because they both have the same symptoms. b. Neither will seek medical care because they are females and have been socialized not to ask for help. c. Patty will seek medical care first because she believes her condition is easily treatable. d. Selma will seek medical care first because she perceives her condition is severe. 30. Which of the following statements best summarizes the discussion by your text authors about using the Internet to obtain health information? a. Because the Internet includes much misinformation, patients should not use it to look for health information. b. Because the Internet includes much excellent health information, the misinformation does not matter. c. Because the Internet includes misinformation and good information, patients must use judgment to evaluate. d. Because the Internet includes varied sources, it makes patients become less active in their own health care. Copyright Cengage Learning. Powered by Cognero.

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Chap_03_10e 31. Which of the following conclusions is most accurate about childhood vaccinations? a. People must not equate correlation with causation in experimental research. b. People find large-scale studies more convincing than emotional anecdotes. c. People seek answers elsewhere even when science has plenty of answers. d. People given new/different information will generally change their beliefs. 32. Sarah recently obtained health insurance and is looking for a new doctor. Which statement is most accurate about the relationships between choosing a practitioner and health insurance? a. Her insurance will have no real effect on her choice of practitioner. b. Her insurance will make Sarah more likely to pursue medical care. c. Her insurance, like all policies, only covers in-network physicians. d. Her insurance, like all policies, covers any practitioner she chooses. 33. Research has found that in the last decade and a half, medical errors in hospitals a. have decreased a lot. b. have increased a lot. c. have not increased. d. have not decreased. 34. What is the best way to summarize a point made by your text’s discussion of hospital errors? a. The goal of medical practice is ultimately to render it free of all errors. b. Systems that inhibit errors are more expensive but make patients safer. c. Systems to inhibit errors cut hospitalization cost but risk patient safety. d. Patient safety improves and costs lower via systems that inhibit errors. 35. Charisma is a person of color living in London and has often experienced and perceived discrimination. What would most likely be her approach to seeking health care for a lump on her breast? a. She is likely to delay seeking care. b. She is likely to actively pursue health care. c. She is likely to be unaware of the potential risks of her symptoms. d. She is likely to go to an emergency room instead of a preventative care doctor. 36. In the United States, a. most people with health insurance are either employed or have a family member who is employed. b. all citizens must possess health insurance. c. every person 65 or older receives free prescription drugs. d. private health insurance is not available to people with Medicare.

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Chap_03_10e 37. As of 2019, roughly how many Americans did not have health insurance, according to the NCHS? a. One in 5 b. One in 10 c. One in 50 d. One in 100 38. When diabetes patients viewed their illness as acute, rather than chronic, their illness management was a. better. b. worse. c. unchanged. d. better for a few months, then worse. 39. Joshua has been told by friends that he does not look well. He feels flushed and decides to take his temperature to determine if he has a fever. His actions would be defined as a. self-defeating behavior. b. disease behavior. c. illness behavior. d. socialized behavior. 40. Aspden and colleagues at the Institute of Medicine (2007) found that medication errors in hospitals averaged one per patient per day. How would you best evaluate this estimate? a. As an unacceptable figure for medication errors b. As a low error level in terms of hospital settings c. As an acceptable level of errors within hospitals d. As an estimate of errors that is highly inaccurate 41. What is the event that separates illness behavior from sick role behavior? a. A heart attack b. A diagnosis c. Hospitalization d. Death 42. Given equal symptoms, who among the following are most likely to seek health care? a. People with ambiguous symptoms and a lot of stress b. People with definitive symptoms and minimal stress c. People with ambiguous symptoms and minimal stress d. People with definitive symptoms and a lot of stress

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Chap_03_10e 43. Margaret finds a lump in her breast but delays seeking medical attention because she is worried it might be breast cancer. According to Leventhal, Margaret is worried about the a. consequences of her disease. b. timeline of her disease. c. determination of her disease. d. identity of her disease. 44. Who is most likely to seek health care? a. A 55-year-old woman with a rapid heartbeat b. A 26-year-old man with a sprained ankle c. A 70-year-old woman who attributes her symptoms to age d. An unemployed 30-year-old mother with four children 45. What is the most accurate way to characterize the outcomes of hospital medication errors in the United States? a. They cause more illness in patients but not more deaths. b. They cause more deaths of patients but not more illness. c. They cause longer hospitalization duration but not costs. d. They cause more illness, death, and hospitalization costs. 46. Suppose you develop a headache, sneezing, and coughing. If these symptoms are from a common cold virus, it will run its course in about a week. But if they are from a bacterial infection (e.g., sinusitis, bronchitis), a 10-day course of antibiotics your doctor can prescribe will usually resolve it. What should you probably do? a. Go to the doctor if you don’t feel better after one week. b. Go to the doctor immediately for differential diagnosis. c. Go to the doctor if your symptoms last beyond a month. d. Go to the doctor only if your symptoms become worse. 47. Chimamanda has not been feeling well due to a sore throat. She has taken aspirin and spent most of the day in bed and plans to see the doctor if she doesn’t feel better in a few days. Her actions would be defined as a. sick role behavior. b. illness behavior. c. both a and b. d. neither a nor b.

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Chap_03_10e 48. Gilbert frequently experiences symptoms consistent with irritable bowel syndrome. His wife points out that Gilbert’s cousin Miriam has similar symptoms. Gilbert has not sought medical care. Based on research by Ringström et al. (2007), there is about a 50% chance that Gilbert will a. discuss his symptoms with his cousin to get advice. b. discuss his symptoms with a physician to find help. c. discuss his symptoms with alternative practitioners. d. discuss his symptoms with (a) or (c), more than (b). 49. Which factor influencing interactions between a patient and medical practitioner do your text authors describe as possibly the most important? a. The practitioner’s personal characteristics b. The verbal communication between them c. The personal characteristics of the patient d. The technical expertise of the practitioner 50. Which of the following health services is most commonly covered by health insurance policies in America? a. Eyeglasses b. Dental care c. Doctor visits d. Mental health 51. In a group of college students participating in a research study, some are told by an experimenter that their blood pressure measurements are high, and some that theirs are normal. Later, those told of high readings report additional symptoms of hypertension. According to Leventhal’s research, why? a. Because they really did have hypertension b. Because the feedback caused them anxiety c. Because a label influenced their perception d. Because a label raised symptom awareness 52. Lazarou and colleagues (1998) conducted a meta-analysis of research into adverse drug reactions. What did they find about deaths from prescription drugs? a. These deaths were partially due to incorrect prescriptions. b. These deaths were mostly caused by patient dosing errors. c. These deaths were despite proper prescription and dosing. d. These deaths were only new admissions for drug reactions. 53. What is the relationship between adult aging and seeking medical care? a. Adults always seek medical care more frequently as they age. b. Adults are less likely to notice symptoms as they age so seek less health care. c. Adults avoid or delay care if they attribute symptoms to aging. d. Adults seek care sooner when they attribute symptoms to aging. Copyright Cengage Learning. Powered by Cognero.

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Chap_03_10e 54. Which of these is NOT a reason that alternative medicine has recently become more popular with people with more formal education? a. They share attitudes toward health and illness with alternative approaches. b. They are more knowledgeable about conventional medicine. c. They have become dissatisfied with standard medical methods and results. d. They can better afford alternative care frequently not covered by insurance. 55. Kali found some information about a new treatment for asthma on the Internet and shares this information with her doctor. Since Kali’s information is accurate and relevant, her relationship with her doctor will most likely a. deteriorate, as her doctor feels challenged. b. benefit, as Kali and her doctor can discuss this new information. c. end, as Kali no longer trusts her doctor to provide her with new information. d. Both a and c. 56. What is true of the proportion of Americans using standard health care who also use alternative health care compared to the proportion of Americans using alternative health care who also use standard health care? a. People who use standard health care do not ever use alternative health care. b. People who use alternative health care do not ever use standard health care. c. Someone who uses alternative health care is more likely to also use standard health care than someone who uses standard health care is to use alternative health care. d. Someone who uses alternative health care is less likely to also use standard health care than someone who uses standard health care is to use alternative health care. 57. What did the COVID pandemic reveal about Americans seeking medical information on the Internet? a. Americans turn to the Internet for medical information in a time of emergency or uncertainty. b. American females are less likely to rely on Internet-related medical searches than males were. c. Americans sought medical information online regardless of their economic situations or educational backgrounds. d. Americans were particularly discerning about the sites they got their medical information from. 58. What did Howard Leventhal and his colleagues’ work with young adults reveal about their attitude toward a doctor’s diagnosis? a. Young adults were strongly influenced by a doctor’s opinion. b. Young adults tended to dismiss a doctor’s concerns about their behavior. c. Young adults would seek a second opinion if they were dissatisfied with a doctor’s diagnosis. d. Young adults resisted being identified with a disease more than older people did.

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Chap_03_10e 59. Federico has symptoms of indigestion that bother him. People in his lay referral network urge him to change his current high-fat, spicy diet. What is most true about this? a. It is unusual that they would not tell him to see a doctor instead. b. It is unusual that he would consult them before seeing a doctor. c. It would be more typical if they advised an alternative therapy. d. It is typical that he would consult them before seeing a doctor. 60. The “nonperson” treatment that hospital patients experience most often arises from a. the emphasis on technical aspects of medical care. b. intentional efforts by hospitals to transfer control from patients to staff. c. physicians who do not care about their patients’ well-being. d. all of these. 61. Under which conditions are older adults most likely to seek medical care promptly? a. When mild symptoms begin abruptly b. When severe symptoms come gradually c. When mild symptoms develop gradually d. When severe symptoms come suddenly 62. Women and those with college degrees are more likely than other Americans to seek health information from a. their friends and family. b. the Internet. c. newspapers and magazines. d. television. 63. According to David Mechanic, which of these symptom characteristics is LEAST likely to determine people's response to illness? a. Cost of treatment and hospitalization b. Perceived severity of the illness c. Visibility of the symptoms d. The extent to which the symptoms interfere with normal daily functioning 64. According to your text, which of the following is an example of a patient-focused intervention to reduce medical errors? a. Making the typical nursing shift shorter b. Asking doctors if they have washed their hands c. Making the typical doctor’s shift shorter d. Averting errors via computer systems

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Chap_03_10e 65. Which of these people is most likely to seek health care? a. Nzinga is 72 years old and simply does not feel well. She refers to her symptoms as "the crud." b. Melvin is a 63-year-old owner of his own profitable business. He began to feel chest pains yesterday and is concerned. c. Rumi is 68 years old, never married, and lives alone. For the past 2 years, Elmer has experienced "shortness of breath." d. Ida is 92 years old and feels fine. However, she is lonely and would "like to talk to someone about her health." 66. What role does gender play in diagnosis? a. Female doctors are more likely to discount the complaints of their female patients. b. Male doctors are more likely to take the complaints of their female patients seriously. c. Male doctors are more likely to discount the complaints of their male patients. d. Female doctors are more likely to take the complaints of their female patients seriously. 67. When people with chronic diseases view their conditions as acute, they experience greater a. pain from symptoms. b. psychological distress. c. psychological comfort. d. medication overdoses. 68. Parents who reassure children who are about to undergo stressful medical procedures, telling them that "There's nothing to be afraid of," a. provide effective models. b. decrease the anxiety level in their children, but raise it in themselves. c. are more effective than filmed models in helping a child cope with the stressful medical procedure. d. tend to increase rather than decrease their children's fears. 69. What factor might cause a transgender person to delay seeking health care? a. They are not college-educated. b. They are anxious that their symptoms might indicate something serious. c. They live in a rural area. d. They are under an extreme amount of stress. 70. Finding a label for symptoms a. tends to catastrophize the problem. b. tends to make women believe that the problem is more serious but tends to make men believe that the problem is less serious. c. is an important component of personal understanding of illness. d. is less important than receiving support from family and professionals.

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Chap_03_10e 71. Which of these factors was NOT among the factors identified by Howard Leventhal as a component in the conceptualization of illness? a. Identification of the disease b. Monetary cost of the illness and treatment c. Cause of the disease d. Consequences of the disease 72. Alexander Segall proposed that the sick role includes three rights and privileges and three responsibilities. Which of these factors is a responsibility of people who have adopted the sick role? a. Making decisions about one's health-related issues b. Making an attempt to get better c. The duty to perform everyday chores d. The duty to depend on other people for assistance 73. Which of these factors reflects a significant trend in the health care system during the past 30 years? a. Hospital stays are much longer. b. Medical schools are graduating fewer physicians. c. The percentage of general practitioners has increased dramatically. d. Hospitalized patients are more severely ill than they were 30 years ago. 74. Several symptom characteristics predict a person's readiness to seek health care. Which of these is NOT one of these characteristics listed by David Mechanic? a. Severity of the symptom as seen by medical authorities b. Visibility of the symptom c. Frequency and persistence of the symptom d. Extent to which symptoms interfere with daily life 75. Using modeling to help children in the hospital prepare for stressful medical procedures a. is not successful in helping children prepare for surgery but can help with less serious procedures. b. is successful with children but not with adolescents or adults. c. can be more successful than drugs when modeling is combined with a cognitive behavioral intervention. d. can be effective if the parents of the young patient are not allowed to participate. 76. What can lead to patients following medical advice and continuing use of medical services, like obtaining checkups? a. A payment plan b. A patient’s satisfaction c. Cultural differences d. All of the above

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Chap_03_10e 77. A 1999 study from the Institute of Medicine found that medical errors cause approximately how many annual deaths in the United States? a. 44,000 to 98,000. b. 4,000 to 8,000. c. 260,000 to 300,000. d. over one million. 78. In the United States, people are considered to be ill a. after they have been officially diagnosed by a health care provider. b. if they have an elevated temperature for at least 24 hours. c. when a disease process first begins. d. whenever they feel sick. 79. Among Segall’s sick role rights and responsibilities, making health-related decisions typically applies most to whom? a. Parents b. Children c. Economically marginalized people d. All of these 80. Although the terms "disease" and "illness" are often used interchangeably, they have somewhat different meanings. Technically, disease refers to a. psychological disorders. b. the experience of being sick. c. the process of physical damage. d. an existing, official diagnosis. 81. According to research by David Mechanic, what LEAST motivates illness behavior? a. The objective observation that they have symptoms. b. The subjective interpretation of their symptoms. c. The realization that their symptoms are persisting over time. d. The realization that their symptoms are worsening with time. 82. What is true of publicity and public concern regarding toxic drug reactions in hospitals over the last 15 years? a. Despite wide publicity, there is little public concern about this issue. b. Despite widespread public concern, there is little publicity regarding this issue. c. Despite high publicity and widespread public concern, little has changed in hospitals. d. Because of little publicity and limited public concern, nothing has changed in hospitals.

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Chap_03_10e 83. With equal symptoms, who is most likely to seek health care? a. A 45-year-old African-American man who runs his own business b. A 45-year-old unemployed woman who lives below the poverty line c. A 55-year-old Hispanic American woman with a very high level of stress d. A 55-year-old European Amerian woman with a very high level of stress 84. A clinic specializing in cancer treatment administers not only surgery, radiation, and chemotherapy, but also nutritional programs, and naturopathic and other approaches to minimize or alleviate sideeffects, enhance response to treatment, and promote healing. Which of Segall’s rights or responsibilities of the sick role does this apply to most? a. Getting well and maintaining health b. Performing routine health management c. Utilizing a range of health care resources d. Making decisions on health-related issues 85. Among factors influencing how people respond to medical symptoms, which of these is NOT classified as a personal factor? a. The amount of stress the person is under b. The person’s personality traits c. The ethnic group the person belongs to d. The person’s perception of his/her body 86. The function of illness behavior is to a. determine health status. b. alleviate symptoms. c. seek a cure. d. increase compliance. 87. If a patient does not make the decisions regarding health-related issues, what most accurately reflects how that patient can perform routine health care management? a. The patient can only perform management which s/he decided. b. The patient can comply with treatments decided by physicians. c. The patient who cannot make decisions can do no management. d. The patient must let decision-maker(s) perform all management.

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Chap_03_10e 88. What is true of people experiencing high levels of stress? a. They are more likely to report symptoms and more likely to have their symptoms acknowledged as indicating a disease. b. They are more likely to report symptoms and less likely to have their symptoms acknowledged as indicating a disease. c. They are less likely to report symptoms and less likely to have their symptoms acknowledged as indicating a disease. d. They are less likely to report symptoms and more likely to have their symptoms acknowledged as indicating a disease. 89. What do researchers like Leape and Berwick (2005) recommend hospitals do regarding medical errors? a. Assign blame to the persons responsible for them. b. Focus on successes rather than focus on mistakes. c. Analyze the systems that enable errors to happen. d. Analyze the staff interactions that result in errors. 90. A young child is crying because the pediatrician is about to remove her bandage and she is afraid it will hurt. She begs her father, “Tell him not to do it, Daddy!” Daddy responds, “Talk to Mommy,” and as the child turns to her mother, the doctor swiftly removes the bandage before the little girl can anticipate or even feel any pain. Astonished at how quickly and easily it is over, she stops crying. Based on research findings, which factor was effective in this case? a. Distraction b. Reassurance c. Confidence d. Modeling 91. The exemption from usual duties when sick, as identified by Segall, is LEAST applicable to which group? a. People who are afraid of losing their jobs b. People who love their jobs and coworkers c. People who are hospitalized for treatment d. People who fit either description (a) or (b) 92. Carolina discovers a lump in her breast, but puts off calling a doctor. According to research by Leventhal, which is the LEAST likely reason she procrastinates? a. She does not recognize this as a cancer symptom. b. She is afraid that she will have to undergo surgery. c. She is afraid of the side-effects of chemotherapy and radiation. d. She believes that she will die regardless of treatment.

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Chap_03_10e 93. In America today, if somebody has a catastrophic illness and has health insurance coverage, the health insurance a. will cover all associated medical expenses. b. will not cover any of the medical expenses. c. may not cover many huge medical expenses. d. will prevent personal bankruptcy due to medical expenses. 94. For many years, patients with peptic ulcers were told that stress was responsible—until scientists discovered it was not, and the bacterium Helicobacter pylori was responsible for the majority of cases. This relates to which component of conceptualizing disease described by Leventhal? a. The consequences of a disease b. The determination of causality c. The controllability of a disease d. The time line for the treatment 95. Which of the following Americans is most likely to have health insurance? a. A single African American man b. A married Native American woman c. An unemployed European American woman d. A married European American man 96. Andrés has a chronic health condition but no health insurance. What is most accurate about his going to a hospital emergency room when he feels his symptoms are worse? a. It is necessary, as convenient care clinics require health insurance. b. It incurs less expense than physician practices and convenient care. c. It detracts from provision of care to patients having acute illnesses. d. It is inappropriate, as with a chronic condition, he cannot be sicker. 97. Kira can relieve her chronic asthma symptoms by using her rescue inhaler. Sandy has tried many and varied treatments for years, but with little success. José, who is allergic to bee stings, always carries an Epi-Pen. Tommy had not considered steroids because of long-term side-effects, but his current inhaler is no longer managing his severe asthma episodes, and he has heard stronger medication can be more effective. Who is most likely to seek further medical treatment? a. Kira b. Sandy c. José d. Tommy

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Chap_03_10e 98. What is possible about adverse outcomes from not having health insurance in America today? a. The only harm it causes is to the health of the uninsured. b. It may reduce care quality and raise costs for the insured. c. The only harm it causes is to overload emergency rooms. d. It may raise uninsured health crises, but not mortality risk. 99. Mercedes has chain-smoked for many years and now has initial symptoms consistent with lung cancer. Which applies most to what she may do? a. She is likely to seek medical care faster since she is aware of her higher risk. b. She is likely to seek care as much as nonsmokers because cancer is serious. c. She is likely to seek care later because of the stigma of smoking and cancer. d. She is likely to seek care more than nonsmokers as she knows her high risk. 100. When Lance Armstrong put off seeking medical care for the symptoms he noticed, he was exhibiting a. sick role behavior. b. illness behavior. c. both sick role and illness behavior. d. neither sick role nor illness behavior. 101. Which of these statements expresses a healthy attitude toward seeking medical care? a. "I believe that if I feel well, I'm healthy." b. "Only severe symptoms of a disease are worth worrying about." c. "When I don't understand my doctor’s explanations or instructions, I'll ask questions until I do understand.” d. "When facing a stressful medical procedure, I try not to think about it." 102. Which of the following is most likely unable to fulfill the sick role aspect of being dependent on others for assistance when they are ill? a. An infant who suffers with a serious illness b. A single mother caring for several children c. A child with two parents and older siblings d. An older person with a terminal disease 103. Shriti and Betty are both experiencing fever and nausea. Shriti’s friend Lan asks her if she is sick and tells her that she looks terrible, but when she sees Betty, Lan says nothing about Betty's appearance. Research suggests that Shriti a. is likely to seek health care but to advise Betty not to. b. is more likely than Betty to seek health care. c. will seek alternative health care rather than go to a physician. d. and Betty will both make appointments with a physician.

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Chap_03_10e 104. When people without health insurance are in serious need of medical attention, they are most likely to go to a. an emergency room. b. an alternative health provider. c. a pharmacist. d. another country. 105. Which of the following is an example of an institutional intervention whereby hospitals may decrease medical errors? a. Getting patients to inform physicians of their names b. Getting personnel to wash hands in between patients c. Getting computer systems to identify possible errors d. Getting patients to correct errors made by personnel 106. According to the authors of the text, Segall’s conception of American sick role behavior is a. pessimistic. b. inaccurate. c. idealistic. d. realistic. 107. Edna was diagnosed with COVID-19 and advised by her physician to quarantine for six weeks. Edna’s decision to follow her doctor’s advice and remain in her home would be an example of a. sick role behavior. b. illness behavior. c. psychotic behavior. d. health-seeking behavior. 108. James and Shufen both smoke and have heart disease. James is from London; Shufen from Taiwan. What is likely about their interpretations of their symptoms? a. James is likely to see his condition as being related to stress. b. Shufen is likely to see her condition as being related to her smoking habit. c. James and Shufen are both likely see their condition as related to stress. d. James is likely to connect his disease to his smoking habit. 109. Which statement is true of Wikipedia? a. Wikipedia is more credible than the CDC or NIH as a source for health information. b. Wikipedia is rarely used as a primary source for health information. c. Wikipedia is widely used as a primary source for health information despite potential inaccuracies. d. Wikipedia is only used as a primary source of health information by those without a strong lay referral network.

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Chap_03_10e 110. In addition to being ill, what makes hospitalization stressful? Why don't hospitals make changes to alleviate these circumstances? A. Factors that make hospitalization stressful include: 1. Necessity of conforming to hospital routine promotes impersonal treatment. 2. Increased use of technology has promoted even greater depersonalization. 3. Lack of information—patients often undergo tests and treatment but are not informed of the purpose or outcome of these procedures. 4. Lack of control—patients must relinquish control over many aspects of their lives. B. Hospitals could make changes to make hospitalization less stressful. 1. The emphasis on controlling costs makes these changes very unlikely.

111. What circumstances restrict people's access to adequate health care? A. Lack of insurance coverage 1. Health care is too expensive for most people to afford, and insurance allows access to expensive procedures. 2. People without insurance have limited access to regular health care and complex medical technology. 2. People without insurance have limited access to regular health care and complex medical technology.

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Chap_03_10e 112. Differentiate illness behavior from sick role behavior and give examples of each. A. Illness behavior 1. Consists of those activities undertaken by people who feel sick to determine if they are ill. 2. Occurs before a diagnosis. 3. Is influenced by personal reluctance to seek medical care. 4. Is exhibited more often by women than men and more readily by the economically privileged than the economically marginalized. 5. Is prompted by diseases with visible and persistent symptoms and diseases that the person believes to be serious. 6. Examples are making an appointment with a physician, taking one’s temperature, scheduling diagnostic tests, etc. B. Sick role behavior 1. Is exhibited by people who are ill in order to get well. 2. Occurs after a diagnosis and is oriented toward getting well. 3. Mandates changes in normal activities and relief from normal responsibilities—staying home from work or school, not doing regular chores, resting, and also not engaging in recreational activities. 4. Mandates behavior oriented toward getting well, such as getting prescriptions filled, taking medication, and making any required changes in behavior to comply with doctor’s orders.

113. What personal and social factors influence seeking health care? A. Personal factors such as a person's body concept and perceived levels of stress affect the decision to seek health care. B. Gender is a factor in seeking care; women are more likely to do so than men. C. Age is also a factor in seeking health care; young and middle-aged people show more reluctance than older individuals. D. Economic and cultural factors also play a role in seeking health care. 1. People with more money receive more health care. 2. European Americans are more likely to see a physician than those from other ethnic groups, possibly because they tend to have better insurance coverage than other ethnic groups.

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Chap_03_10e 114. What four characteristics of symptoms influence how people respond to disease, and how? Give brief examples. 1. The visibility of the symptom A. People whose symptoms are easier to see are more likely to look for medical help and do so sooner. Even when symptoms are visible to individuals, they are likely to wait longer to seek help if the symptoms are not visible to others, as in the case of Lance Armstrong. B. Waiting until symptoms are more visible can result in a worse condition and fewer options for treating it. 2. The perceived severity of the symptom A. People are motivated to seek help more when they perceive symptoms as severe than when they think they are less serious. For instance, Lance Armstrong initially attributed his cancer symptoms to hard training, flu, a cracked sinus, etc. and did not seek medical care as these causes were less serious than cancer. B. The patient’s perception of symptom severity differs from the physician’s. 3. The extent to which the symptom interferes with the patient’s life A. People are more likely to seek medical help when their symptoms interfere more with their normal activities and quality of life. For example, Lance Armstrong ignored his symptoms until they interfered with riding his bicycle, at which point he sought medical care. 4. The frequency and persistence of the symptoms A. People are most likely to seek medical care when their symptoms are both severe and continuous. B. Symptoms that are intermittent (i.e. they come and go) are less likely to prompt people to engage in illness behavior. Symptoms that are mild rather than severe will still motivate people to seek medical attention if they are persistent (i.e. they continue uninterrupted over time).

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Chap_03_10e 115. Differentially define the terms health, disease, and illness. Identify a drawback in the definition of health. Illustrate the distinction between disease and illness with a few brief examples. A. The World Health Organization (WHO) defines health: 1. not as negative, i.e. the lack of disease, but as: 2. positive physical, mental, and social wellbeing. 3. This definition does not inform people’s health-related or illness-related decisions regarding whether to get medical help for their symptoms. B. The distinction between disease and illness 1. People often use these as synonyms, but scientists do not. 2. Disease is defined as a process of bodily damage. 3. Disease can exist without a diagnosis or labeling. 4. Illness is defined as experiencing being sick, and 5. Illness is also defined as having a diagnosis. 6. People can have a disease even though they do not feel ill and do not have a diagnosis. Examples include undiagnosed cancer, HIV, or high blood pressure. They may feel and seem healthy and be unaware of the disease. 7. Disease and illness, while separate, can and often do overlap. For instance, somebody who has been given a doctor’s diagnosis of a specific disease and who also feels ill has both disease and illness.

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Chap_03_10e 116. How people understand disease is critical for their behavior when they believe they are ill. Discuss each of the five components that Leventhal and his associates have identified as components of illness conceptualizations in terms of the implications for illness behavior. A. Identity of the disease 1. Labeling symptoms as a disease is a critical component in illness conceptualization; labels provide a framework. 2. People tend to try to identify their symptoms as less threatening diseases. B. Timeline 1. The time course of a disease is usually part of the label, but people can misunderstand this aspect of disease. 2. People tend to interpret diseases as acute rather than chronic, implying a short timeline rather than a lifelong one. C. Determination of cause 1. People attribute their illness to some event or circumstance, but they may be inaccurate. 2. People are more likely to seek care for conditions they perceive as having a physical cause rather than mental or spiritual causes. D. Consequence of a disease 1. People try to understand the implications of having a disease, but misunderstanding is possible. 2. People may avoid health care if they believe that the consequences of a diagnosis are severe. E. Controllability 1. People want to see their condition as controllable. 2. If people believe that they can control their disease, they are less likely to seek health care than if they believe they need help to control their illness.

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Chap_03_10e 117. What are the rights and responsibilities of the sick role that Alexander Segall identified? Briefly discuss the nature of these rights and responsibilities and give some examples of situations in reality that conflict with them. A. The right to make decisions about issues related to health 1. Children and many economically marginalized people are unable to make such decisions. This makes the concept of this right more of an ideal than a realistic goal. B. The right to be excused from performing normal everyday duties when sick 1. Examples include going to work, school, and/or meetings; cooking, cleaning, child care, homework, yard work, etc. 2. This exemption is also unrealistic for many people. For instance, people may continue going to work when sick if they fear losing their jobs, or if they value and enjoy their jobs and co-workers. Parents may need to continue caring for their children. C. The right to become dependent upon other people for help when sick 1. This can be unrealistic, similarly to the right to be excused from normal duties. Parents often must not only continue to care for children rather than being exempt; their parental responsibilities also prevent them from being dependent. D. The responsibility to get well and to maintain one’s health 1. People with chronic diseases cannot fulfill this duty, as their conditions last a lifetime and they will never get well entirely. Many people with chronic illnesses experience conflict when they think their diseases are temporary, finding it difficult to accept the idea that they have ongoing disability. E. The responsibility to perform routine health care management 1. This, like the other two responsibilities, relates to the duty to try to get well. 2. Like getting completely well, this does not apply to those with chronic diseases. 3. Infants, young children, and incapacitated patients are unable to fulfill this responsibility. F. The responsibility to utilize a range of health care resources 1. This is also in the interest of the duty to pursue wellness. 2. Like performing routine health care management, this does not apply to patients (infants, young children, patients who are physically and/or mentally incapacitated) who lack the capacity to utilize health care resources.

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Chap_03_10e 118. What is a lay referral network? When and how do people use it? Give an example. Cite some related research findings. How can lay referral networks help people who are experiencing symptoms? A. A lay referral network is a social network of family and friends who give advice and information to an individual before s/he seeks medical treatment. B. Most people ultimately seek out medical care as the result of having discussed their symptoms with members of their lay referral networks first. 1. Lance Armstrong is a prominent example. 2. In a study of patients with irritable bowel syndrome, of those who did not seek out medical care, around half either asked advice from somebody with the same diagnosis or pursued alternative health care. Therefore, while they did not necessarily consult a physician, most people did seek help. C. The lay referral network can help someone understand the meaning of his/her symptoms. 1. Examples include what its diagnosis or label may be; what may have caused it; and how it may be treated. D. The lay referral network can also influence how someone perceives his/her symptoms. 1. As an example, if relatives tell someone their family has a history of heartburn, s/he will have a different reaction to chest pain than if they tell her/him their family has a history of heart attacks. E. Some members of a lay referral network may sometimes advise someone not to seek medical treatment. 1. For instance, if they believe complementary/alternative treatments or simple home remedies will be equally or more effective and have fewer unwanted side-effects, they may recommend these instead. Therefore, lay referral networks may not always encourage people to pursue standard medical care, but they are frequently the first sources that people consult about health matters to get information and advice.

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Chap_03_10e 119. What is a consideration for children who must be hospitalized and how do pediatric hospitals and health psychologists address it? Discuss some research findings about various interventions and their relative effectiveness. A. Being hospitalized can cause anxiety, stress, and distress for children. 1. They are separated from parents, in an unfamiliar environment; and undergo diagnostic testing, sedation, injections, surgery, and post-operative pain. 2. Pediatric hospitals frequently provide children with programs to prepare for hospitalization. 3. Health psychologists find special challenges in training children to cope with fear of hospitalization and treatment. They find it can be effective for reducing anxiety to supply information about hospital equipment and procedures to children and their parents. B. Research finds reassuring children does not decrease their anxiety, but increases it. 1. This includes reassurance by parents who were given training in how to reassure their children. 2. Parents who had training in reassurance reported high confidence levels that they could reduce their children’s anxiety, but this was not borne out in practice. 3. Parents not only had difficulty helping children via reassurance; they also experienced more distress themselves than other parents did, exacerbating their children’s stress. C. Research also finds that distracting children is much more effective than reassurance. D. Modeling is an additional strategy to help reduce children’s distress. 1. Modeling involves showing a child an example of another child successfully coping with a similar stressful procedure or situation. 2. Researchers found that combining modeling with cognitive-behavioral therapy, including teaching children positive self-talk, was more effective than administering Valium and other drug treatment. E. Research indicates that interventions with multiple components are more effective with children than interventions with a single component. F. Researchers find it important in preparing for children’s hospitalization both to furnish information, and to teach coping skills, to both children and parents. G. The primary difficulty with intervention strategies for minimizing children’s distress at hospitalization is not their effectiveness, but their cost. However, if interventions decrease need for further care and/or other expenses, they may be cost-effective.

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Chap_03_10e Answer Key 1. True 2. True 3. True 4. False 5. True 6. False 7. False 8. False 9. True 10. True 11. b 12. a 13. a 14. b 15. a 16. b 17. c 18. a 19. d 20. a 21. b 22. d 23. b 24. d 25. c 26. c

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Chap_03_10e 27. c 28. d 29. d 30. c 31. a 32. b 33. d 34. d 35. a 36. a 37. b 38. b 39. c 40. a 41. b 42. a 43. a 44. a 45. d 46. a 47. b 48. d 49. b 50. c 51. c 52. c 53. c 54. b Copyright Cengage Learning. Powered by Cognero.

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Chap_03_10e 55. b 56. c 57. a 58. a 59. d 60. a 61. d 62. b 63. a 64. b 65. b 66. d 67. c 68. d 69. c 70. c 71. b 72. b 73. d 74. a 75. c 76. b 77. a 78. a 79. a 80. c 81. a 82. c Copyright Cengage Learning. Powered by Cognero.

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Chap_03_10e 83. d 84. c 85. c 86. a 87. b 88. b 89. c 90. a 91. d 92. a 93. c 94. b 95. d 96. c 97. d 98. b 99. c 100. b 101. c 102. b 103. b 104. a 105. c 106. c 107. b 108. d 109. c 110. See outline below Copyright Cengage Learning. Powered by Cognero.

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Chap_03_10e 111. See outline below 112. See outline below 113. See outline below 114. See outline below 115. See outline below 116. See outline below 117. See outline below 118. See outline below 119. See outline below

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Chap_04_10e Indicate whether the statement is true or false. 1. Maria decided that she wanted to start exercising again and made a plan to “go to the gym after work on Tuesday and Thursday for 1 hour.” This is an example of implementation intentions. a. True b. False 2. Educational approaches and behavioral approaches are about equally successful in improving adherence. a. True b. False 3. Depression is more of a risk factor for nonadherence than anxiety is. a. True b. False 4. Researchers have found people’s intentions predict their future behaviors with reliability. a. True b. False 5. Patients who need to take 4–5 pills a day often have lower rates of adherence than patients who are taking 1–2 pills a day. a. True b. False 6. In assessing the rate of adherence, physicians’ estimates are typically more accurate than the patients’ judgments. a. True b. False 7. Recent meta-analyses showed that adhering to a medical regime does not make any difference in physical health outcomes. a. True b. False 8. Women have a higher rate of adherence than men do. a. True b. False 9. One criticism of both stage and continuum theories is that they fail to account for the demographic and economic factors that may affect people’s health behaviors. a. True b. False

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Chap_04_10e 10. Reciprocal determinism is the concept that human action is the result of an interaction of behavior, environment, and person factors. a. True b. False Indicate the answer choice that best completes the statement or answers the question. 11. Lakeith is 90 pounds overweight and has both high blood pressure and high serum cholesterol. However, it has never occurred to Lakeith that he might be a candidate for cardiovascular disease if he does not change his lifestyle. According to Prochaska's transtheoretical model, Lakeith is in the a. precontemplation stage. b. maintenance stage. c. contemplation stage. d. final stage. 12. In operant conditioning, “positive” means something is presented, and “negative” means something is removed. Though part of operant conditioning techniques, a. negative reinforcement is rarely used to modify nonadherent health behaviors. b. positive reinforcement is rarely used to modify nonadherent health behaviors. c. positive punishment is rarely used to modify nonadherent health behaviors. d. negative punishment is rarely used to modify nonadherent health behaviors. 13. The technique of motivational interviewing may be applied to adherence a. but no research studies have examined this approach. b. to alter client motivation and prepare to change behavior. c. and has been found effective with male but not female patients. d. to motivate patients to move from the action to maintenance stage. 14. To illustrate his point that “We are often goal-oriented but not role-oriented,” professional psychotherapist Calvin joked, “For example, I want to lose 20 pounds, but I don’t want to change my diet or exercise.” This is an example of a. implementational intentions. b. the intention–behavior gap. c. behavioral willingness. d. risk-taking behaviors. 15. According to the transtheoretical model, relapse a. is most likely during the maintenance stage. b. is most likely during the action stage. c. is equally likely during any stage. d. is more likely in earlier stages.

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Chap_04_10e 16. What term best describes people’s confidence that they can perform a behavior to produce a desired outcome in a particular situation? a. Self-esteem b. Self-efficacy c. Outcome expectations d. Perceived benefits 17. A health psychologist is planning an intervention to help a client, who keeps forgetting to take her medication as directed, improve her adherence. Based on research findings, which behavioral intervention(s) would be most effective? a. Techniques for tailoring the regimen b. Implementing a contingency contract c. A graduated regimen implementation d. Any of these would work just as well 18. What did meta-analysis of many studies find regarding the predictive value of the theory of planned behavior? a. It best predicts behaviors for abstinence. b. It best predicts use of alcohol and drugs. c. It best predicts diet and physical activity. d. It best predicts all risk-taking behaviors. 19. The theory of planned behavior predicts a. risky health behaviors. b. intentional health behaviors. c. unconscious health behaviors. d. none of the above behaviors. 20. Among challenges for health psychologists in constructing valid health behavior models, which is most related to the need to reduce complex data to meaningful generalizations? a. Balancing automaticity with active decisions in health behaviors b. Squaring individual differences with theoretical simplicity c. Asserting personal control despite large-scale societal barriers d. Addressing perceptions and beliefs vis-à-vis relationships and policies 21. What is a common criticism of the health belief model? a. It emphasizes motivational factors too little b. It emphasizes behavioral factors too heavily. c. It omits beliefs about health behavior control. d. It omits beliefs about health behavior benefits.

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Chap_04_10e 22. The concept of a nonadherent personality a. is not supported by evidence. b. has been proven to exist more among males than among females. c. has been proven to correlate with education levels. d. has been proven to correlate with age. 23. What did researchers (such as Armitage) believe about the number of stages in the health action process approach vis-à-vis the transtheoretical approach? a. A larger number of stages in the health action process is likely more useful and effective than those in transtheoretical approaches. b. A smaller number of stages in the health action process is likely more useful and effective than those in transtheoretical approaches. c. A smaller number of stages in the health action process is likely less useful and effective than those in transtheoretical approaches. d. The number of stages in the health action process has no measurable effect when compared to the number of stages in transtheoretical approaches. 24. One strategy to improve adherence is tailoring the regimen; an example is a. a written contract that both patient and practitioner sign. b. educational lectures detailing consequences of nonadherence. c. using text messages to prompt people to take their medication. d. offering financial assistance to help people pay for medications. 25. Research by Armitage and colleagues (2004) into Prochaska’s health action process approach model found it was harder for people to transition a. from the contemplation to the preparation stage than other transitions. b. from the action stage to the maintenance stage than other transitions. c. from the preparation stage to the action stage than other transitions. d. from any stage to the next than Prochaska theorized for transitions. 26. What term most accurately describes people’s motivation at a given moment to engage in a risky behavior? a. Behavioral willingness b. Perceived behavioral control c. Subjective norms d. Implementation intentions 27. Bandura's notion of reciprocal determinism assumes that human conduct results from an interaction of behavior, person factors (such as cognition), and a. the environment. b. outcome expectancies. c. subjective norms. d. intention to act. Copyright Cengage Learning. Powered by Cognero.

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Chap_04_10e 28. Which factor in the theory of planned behavior has most in common with Bandura’s concept of selfefficacy? a. Someone’s willingness to perform an action b. Someone’s belief of how much control they have over an action c. Someone’s assessment of the outcomes of an action d. Someone’s belief about social pressures related to an action 29. The major advantage of the pill cap microprocessor as a means of assessing adherence is its a. cost effectiveness. b. ability to count the number of pills removed with each bottle opening. c. ability to count the number of bottle openings and record the time of day for each opening. d. nearly perfect validity. 30. The transtheoretical model of James Prochaska and his colleagues assumes that people go through five stages in making changes in their behavior. What is the proper order of these stages? a. Precontemplation, contemplation, preparation, action, and maintenance b. Preparation, precontemplation, self-efficacy, intention to act, and action c. Intention to act, contemplation, preparation for action, action, reaction d. Intention to act, contemplation, preparation for action, action, relapse 31. Negative reinforcement a. strengthens behavior. b. weakens behavior. c. punishes behavior. d. has no effect on behavior. 32. For the past three years, Hsu has been following his doctor's advice to cut down on his consumption of red meat and to eat more fruits and vegetables. With regard to protecting himself against heart disease, Hsu is currently in which stage of the transtheoretical model? a. Precontemplation b. Contemplation c. Maintenance d. Preparation 33. Why does the theory of planned behavior vary in its predictive ability by behavior type? a. Risk-taking behaviors are more predictable than healthy behaviors. b. Situation-specific behaviors are more predictable than planned ones. c. Situation-specific behaviors are less predictable than planned ones. d. The theory was not designed to predict ongoing individual choices.

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Chap_04_10e 34. Females are more likely than males to show lower rates of adherence to a a. medication for high blood pressure. b. smoking cessation program. c. healthy diet. d. medication to reduce cholesterol. 35. According to recent research, what factor most strongly predicts whether a person will behave in a manner consistent with their beliefs? a. Gender b. Ethnicity c. Age d. Income 36. An adherent patient who reduces her pain by taking prescribed medication as scheduled is an example of a. classical conditioning. b. negative punishment. c. positive reinforcement. d. negative reinforcement. 37. What term refers to specific plans that individuals can make that identify what, where, when, and how they will engage in a health behavior? a. Behavioral willingness b. Perceived behavioral control c. Subjective norms d. Implementation intentions 38. Research indicates that people who are compliant in one situation a. tend to be compliant in other situations. b. tend to be noncompliant in other situations. c. may or may not be compliant in other situations. d. discontinue compliance when they change physicians. 39. A health psychologist wants to research which theory or model is best at predicting the intentions of young adults for performing breast self-examinations and for avoiding unhealthy diets. What did Garcia and Mann (2003) find was the most consistent predictor? a. The health belief model b. The transtheoretical model c. The theory of planned behavior d. The health action process approach

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Chap_04_10e 40. With regard to age, studies show that nonadherence a. increases as the ages of the patients increase. b. decreases as the ages of the patients decrease. c. is related to different patient ages on a curve. d. does not have any relationship to patient age. 41. Which type of social support is beneficial for adherence? a. Living with a family b. Belonging to a large family, even one with a lot of conflict c. Being married d. Both a and c 42. A person’s willingness and ability to follow recommended health practice is known as a. behavior. b. intention. c. adherence. d. perceived behavioral control. 43. In studies with patients recovering from heart problems and patients with diabetes, a. practical support was a better determinant of adherence than emotional support. b. practical support was a better determinant of adherence than invisible support. c. emotional support was a better determinant of adherence than practical support. d. invisible support was a better determinant of adherence than emotional support. 44. Research into applications of the theory of planned behavior has found that subjective norms a. were the strongest predictors of behaviors overall. b. were equivalent in predicting all of the behaviors. c. predicted behaviors for adults more than for teens. d. were the weakest to predict most of the behaviors. 45. What is an identified strength of continuum theories? a. They inform development of individualized interventions. b. They identify a number of universally motivational beliefs. c. They incorporate self-identity as predictive for behaviors. d. They identify anticipated emotions as predicting behaviors. 46. In a meta-analysis, Rosen (2000) found that the transtheoretical model was most effective for explaining health behaviors related to a. smoking cessation b. substance abuse. c. physical activity. d. psychotherapy. Copyright Cengage Learning. Powered by Cognero.

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Chap_04_10e 47. The model or theory that suggests that behavior is shaped by one’s intention to act or not act, and that intentions are shaped by attitudes, subjective norms, and perceived behavioral control is the a. self-efficacy theory. b. health belief model. c. health action process approach. d. theory of planned behavior. 48. Using hospital personnel to monitor patient adherence a. is the only currently approved method of assessing adherence. b. creates an artificial situation that may raise adherence rates. c. violates regulations of the American Medical Association. d. both b and c are true. 49. What would be the best way to help motivate a smoker to stop smoking if s/he perceives many barriers to quitting, and you are following the health belief model? a. Convince the smoker that there are no real barriers to smoking cessation. b. Convince the smoker that risks of smoking outweigh barriers to quitting. c. Offer the smoker a variety of strategies to address the barriers perceived. d. Offer the smoker quitting techniques; they do not see barriers to quitting. 50. Research has found that planning was influential to adult physical activity a. to motivate those with no intention of exercising. b. only for those who had an intention of exercising. c. for all participants irrespective of their intentions. d. for raising awareness, but not promoting activity. 51. Research has found that which factors of the health belief model predict adherence to health behaviors most accurately? a. Perceived susceptibility to and severity of disease b. Perceived benefits of and barriers to the behaviors c. Perceived disease susceptibility and behavior benefits d. Perceived disease severity and barriers to the behaviors 52. In the health belief model, the belief that relates to an individual’s perceived risk of a disease is a. perceived susceptibility. b. perceived severity. c. perceived benefits d. perceived barriers.

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Chap_04_10e 53. What is true of adherence rates and chronic disease? a. Some chronic conditions, such as HIV and arthritis, show low adherence rates, whereas diabetes and pulmonary disease show high adherence rates. b. Some chronic conditions, such as HIV and arthritis, show high adherence rates, whereas diabetes and pulmonary disease show low adherence rates. c. All chronic diseases predict high adherence rates. d. All chronic diseases predict low adherence rates. 54. In the health belief model, the belief that relates to whether an individual faces obstacles to healthenhancing behaviors is a. perceived susceptibility. b. perceived severity. c. perceived benefits. d. perceived barriers. 55. The model or theory that defines five stages individuals move through as they adopt a health-related model is the a. behavioral theory. b. transtheoretical model. c. theory of planned behavior. d. health action process approach. 56. How much greater is the risk of nonadherence for people with depression than those who do not have depression? a. The risk is equal. b. The risk is three times as great. c. The risk is ten times as great. d. The risk of nonadherence is less for people with depression. 57. In order to successfully pursue their health goals, which of the following must a person have during the second phase of the health action process approach model? a. A perception of a personal risk b. Expectations of good outcomes c. A feeling of action self-efficacy d. Plans for anticipated setbacks 58. Patients' records of their own rate of adherence may lack validity because a. patients sometimes lie to avoid the displeasure of their physicians. b. patients may be unaware of their own rate of adherence. c. neither a nor b. d. both a and b.

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Chap_04_10e 59. People who experience high levels of stress a. become more adherent to medication routines oriented toward controlling their stress. b. become less adherent to medications for chronic conditions but not for short-term problems. c. become more likely to adhere. d. become less likely to adhere. 60. Idowu is a heavy smoker and knows that smoking increases one’s chances of lung disease. However, she believes that she is not at an increased risk for lung cancer. This is because Idowu has a(n) _____________. a. high self-efficacy b. high self-esteem c. optimistic bias d. pessimistic bias 61. Gina smokes two packs of cigarettes a day, but lately she has begun to think seriously about quitting. According to the transtheoretical model, Gina is in the a. precontemplation stage. b. contemplation stage. c. action stage. d. maintenance stage. 62. Which model has two general stages: the motivational phase and the volitional phase? a. The health belief model b. The transtheoretical model c. The health action process approach d. The theory of planned behavior 63. Which of the following have researchers found about the predictive value of the health belief model? a. Ethnicity and race do not significantly affect reasons for adherence to vaccination. b. The predictive model did not accurately promote adherence to mammography screenings. c. The health belief model is not a good predictor for ongoing behaviors. d. Common sense always predicts adherence to health-related behaviors. 64. What term correctly describes the concept that refers to tangible and intangible help a person receives from friends and family? a. Self-efficacy b. Self-esteem c. Social support d. Self-concept

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Chap_04_10e 65. Patients' self-reports of adherence a. are valid but not reliable. b. have questionable validity. c. are less valid than physicians' reports. d. are more valid than examination of biochemical evidence. 66. Because of the nature of health habits, what is true about predicting and changing health behaviors? a. Behaviors are often predicted more by people’s beliefs than by their past behaviors. b. Behavior is often best changed by changing people’s beliefs about health behaviors. c. Changing beliefs is motivating, but concrete skills and steps change behavior more. d. Beliefs are more ingrained than habits; thus intention guarantees behavior change. 67. In the health belief model, which of the following is included among factors that combine to influence health behaviors? a. Actual barriers, including financial, to health behaviors b. A patient’s objective vulnerability to disease/disability c. How severe a patient’s disease or disability is in reality d. The benefits of health behaviors perceived by a patient 68. The well-known “Scared Straight” program, wherein maximum-security prison inmates share their stories of incarceration with teenagers to deter them from criminal behaviors, is an example of a. an educational intervention. b. a behavioral intervention. c. a health action process approach. d. none of the above. 69. What is true of the effects of anxiety and depression on adherence? a. Depression predicts noncompliance more than anxiety does. b. Anxiety predicts noncompliance more than depression does. c. Anxiety and depression both predict noncompliance at high levels. d. Anxiety and depression both predict compliance at high levels. 70. Dawson's dentist calls to remind him of his scheduled appointment in three days. When Dawson arrives at the dentist's office he is permitted to select a lottery ticket as a reward for keeping his appointment. From this information, it appears that Dawson's dentist is using an approach based on the a. health belief model of adherence. b. self-efficacy model of adherence. c. theory of planned behavior model of adherence. d. behavioral theory model of adherence.

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Chap_04_10e 71. In the volitional phase of the health action process approach model, what is a crucial component of whether behavior change will be maintained over time? a. Outcome expectation b. Self-efficacy c. Risk perception d. Planning 72. Those who do not share the cultural beliefs of Western medicine a. are just as likely as those who do to comply with the advice of a physician. b. may comply with practitioners of their cultural traditions and ignore advice from physicians. c. are not likely to accept any medical tradition. d. are only likely to comply with the advice of a physician in an emergency situation. 73. Many programs used today for changing health behaviors employ behavioral techniques, which are a. compatible with stage models. b. incompatible with stage models. c. contradictory to stage models. d. unrelated to stage models. 74. Practitioners’ judgment of patient adherence is a. almost always wrong. b. almost always right. c. only slightly better than chance. d. dependent on the number of years they have been in practice. 75. For improving adherence, educational strategies are more helpful to patients who need to know why to change their behavior; which strategies are most helpful to patients who need to know how to change their behavior? a. Longitudinal b. Behavioral c. Interventionist d. Medical 76. Nonadherence rises abruptly when the prescription requires the patient to take one pill a. once a week. b. twice a week. c. once a day. d. four times a day.

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Chap_04_10e 77. Economic factors may exert a negative effect on adherence by a. limiting access to screening tests. b. preventing people from getting prescriptions filled or refilled. c. encouraging wealthier people to seek alternative methods of care. d. both a and b. 78. Which of these personal characteristics is generally the most accurate predictor of patient adherence? a. Age b. Gender c. Economic stability d. All of the above equally contribute to accurate predictions of adherence. 79. The behavioral model of adherence a. emphasizes reinforcement of compliant behaviors. b. emphasizes punishment of noncompliant behaviors. c. incorporates the concept of subjective norms. d. has very little research evidence to support it. 80. Educational methods for improving adherence increase knowledge; which approaches have been shown to increase adherence? a. Behavioral approaches b. Educational approaches c. Socioeconomic approaches d. Biochemical approaches 81. The pill cap microprocessor is an improved variation of which method of assessing adherence? a. Physician judgment b. Patient judgment c. Examining biochemical evidence d. Monitoring medication usage 82. Which continuum theory best takes into account the influences of environmental and social pressures on health behavior? a. Self-efficacy theory b. The health belief model c. Planned behavior theory d. All continuum theories do this.

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Chap_04_10e 83. Central to the transtheoretical model is the assumption that both behavior change and relapse take the shape of a a. triangle. b. rectangle. c. cone. d. spiral. 84. What most accurately describes an individual’s perceptions of how much control one has over one’s behavior, and is one factor that determines intentions in the theory of planned behavior? a. Self-efficacy b. Perceived behavioral control c. Subjective norm d. Attitude 85. Which of the following is an aspect of tailoring the regimen that research studies have found among the most effective for improving medication adherence? a. Treatment to patient stage of change b. Treatment to a patient’s personality c. Treatment including pill organizers d. Treatment on a simplified schedule 86. What does theory of planned behavior identify as an immediate determinant of behavior? a. Attitude toward the behavior b. Perceived control of behavior c. Intention regarding behavior d. Subjective norm for behavior 87. If you are a health psychologist administering smoking cessation programs, what do smokers need to believe to be motivated to quit smoking, according to the health belief model? a. That quitting smoking is worth the effort, in spite of the numerous barriers to quit b. That smoking can lead to diseases, though these are seldom ever life-threatening c. That the risks incurred by smoking outnumber the benefits attained from quitting d. That smoking risks are severe, quitting benefits clear, and barriers to quit are surmountable. 88. In the theory of planned behavior, which factor is unique? a. Subjective norms for behaviors b. Intentions regarding behaviors c. Attitudes concerning behaviors d. Ideas about control of behaviors

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Chap_04_10e 89. The relationship between adherence and age is complex. What best describes the findings of the study (Thomas et al., 1995) determining the relationship with adherence and colorectal screening? a. There was an inverse relationship between adherence and colorectal screening. b. There was a direct relationship between adherence and colorectal screening. c. There was a curvilinear relationship between adherence and colorectal screening. d. There was a dose–response relationship between adherence and colorectal screening. 90. The best predictors of health-related behavior in the health belief model are a. perceived susceptibility and perceived barriers. b. perceived severity and perceived barriers. c. perceived benefits and perceived severity. d. perceived barriers and perceived benefits. 91. Research on smoking relapse, adherence to an exercise regimen, and adherence to diabetic diet has shown that a. those who had high self-efficacy were found more likely to relapse. b. those who had high self-efficacy were found more likely to adhere. c. self-efficacy has been found to correlate negatively with adherence. d. self-efficacy prevents smoking relapse but does not affect exercise or diet. 92. What did the study by Cahill, Lancaster, and Green (2010) determine about smoking cessation interventions matched to stage theories as compared to uniform interventions consistent with continuum theories? a. They were equally effective. b. The stage theory-based interventions were more effective. c. The stage theory-based interventions were less effective. d. Neither intervention was effective. 93. Which of the following most accurately reflects an essential contrast between continuum theories and of of health behavior relative to patient adherence? a. Continuum theories explain adherence as developing gradually; stage theories explain adherence as developing discretely. b. Continuum theories explain adherence as multifactorial; stage theories explain adherence by a limited number of factors. c. Continuum theories explain adherence as being uniform; stage theories explain adherence as varying by steps in a process. d. Continuum theories explain adherence by classifying people along a continuum; stage theories will not classify individuals.

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Chap_04_10e 94. Self-efficacy refers to a. people's belief that they can perform behaviors necessary to control events that influence their lives. b. people's belief that their particular lifestyle is a healthy one even when it is not. c. people's belief that a course of action will result in an ideal state of physical and psychological health. d. people's belief that the processes of disease, and eventually death, are inevitable. 95. According to Prochaska and his colleagues, people in which stages of the health action process approach model need strategies for directly changing their behaviors? a. Precontemplation and Contemplation b. Contemplation and Preparation c. Preparation and Action d. Action and Maintenance 96. The following disease characteristic is the MOST accurate predictor of patient adherence: a. severity of the disease as seen by the attending physician. b. patient’s perception of the severity of the disease. c. severity of the medication's side effects. d. a medication with no side effects. 97. What do the results of studies about medication adherence predict about survival over a 6-month period for heart failure patients? a. Patient self-reports were far more accurate than Medication Event Monitoring Systems (MEMS) at predicting survival based on adherence. b. MEMS (Medication Event Monitoring Systems) were able to predict survival better than patient self-reports. c. Neither MEMS (Medication Event Monitoring Systems) nor self-reports were accurate predictors of survival. d. Both Medication Event Monitoring Systems (MEMS) and self-reports could accurately predict survival with the same accuracy. 98. Which theories of health behavior take a “one size fits all” approach? a. Stage theories b. Continuum theories c. Transtheoretical models d. Health action process models

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Chap_04_10e 99. The model or theory that includes four beliefs—perceived susceptibility, perceived severity, perceived benefits, and perceived barriers—to predict health-related behavior is the a. self-efficacy theory. b. health belief model. c. health action process approach d. theory of planned behavior. 100. Which of the following is an assumption of the theory of planned behavior? a. People generally are not reasonable, and must be taught to plan their behavior. b. People generally use information haphazardly, and must learn to be systematic. c. People consider the consequences before decisions, and then always take action. d. People consider the consequences before decisions, which can involve no action. 101. What most accurately describes an individual’s perception of the social pressure to perform or not to perform an action? a. Self-efficacy b. Perceived behavioral control c. Subjective norm d. Attitude 102. With regard to gender, which of these statements most clearly agrees with research? a. Females and males adhere to taking medication at different levels. b. Females keep appointments for medical tests more frequently than males. c. Males adhere to sodium-restricted diets more than females. d. Most rates of adherence do not vary greatly between females and males. 103. What is most accurate about evaluating the effectiveness of the health belief model and other continuum theories? a. Valid and reliable instruments to assess their factors are lacking. b. Instruments for assessing their factors are valid, but not reliable. c. Instruments for assessing their factors are reliable, but not valid. d. There are only a few valid or reliable tests to assess their factors. 104. Older studies found a general rate of nonadherence around 50%; more recent studies show a rate of about _______. a. 5% b. 25% c. 50% d. 75%

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Chap_04_10e 105. What have researchers found about self-efficacy theory relative to health behaviors? a. It is not predictive of adherence or medical results. b. It is not related to reducing the severity of disease. c. It is not included in most health behavior models. d. It is not inclusive of other factors for motivation. 106. One recent study used the theory of planned behavior to understand gender differences in fruit and vegetable consumption. This study found that males, in comparison to women, have a. lower perceived behavioral control and higher subjective norms. b. lower perceived behavioral control and less favorable attitudes. c. less favorable attitudes and lower subjective norms. d. higher favorable attitudes and higher subjective norms. 107. Of all methods used to assess patient adherence, a. only pill count is both reliable and valid as a method. b. examination of biochemical evidence is the most valid. c. examination of biochemical evidence is the least valid. d. no single method alone is sufficiently reliable or valid. 108. Xiang, an 18-year-old woman, sees many of her friends smoking. Research on risky behaviors in teenagers suggest that she is likely to a. report high perceived behavioral control for not smoking. b. report more behavioral willingness to engage in smoking. c. report having less favorable attitudes toward smoking. d. report having less willingness to engage in smoking. 109. Research findings indicate that people’s decisions to quit smoking were more affected by cognitive processes, and during the process of quitting, people were more affected by ________. a. brand of cigarette b. behavioral techniques c. negative reinforcement d. personality type 110. The LEAST accurate method of assessing rate of adherence is to a. ask the practitioner. b. ask the patient. c. ask the patient's family. d. monitor medication usage.

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Chap_04_10e 111. Identify and discuss some things that cause barriers for patients to adhere to health care.

112. What are stage theories of health behavior change? How do they differ from continuum theories?

113. What assessment issues have an impact on understanding adherence rates?

114. Discuss some ways to improve adherence.

115. Evaluate the contribution of personal factors to adherence to medical advice.

116. Identify the factors that predict adherence and summarize aspects of each one, other than personal factors. (*See #4 above for more on personal factors.)

117. How frequent are adherence failures?

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Chap_04_10e 118. Define the intention-behavior gap. Identify and define some related components to explain and address it.

119. Using the transtheoretical model, explain the behavior of a 22-year-old woman who quit smoking three days ago.

120. Define continuum theories. Identify several specific continuum theories and some of their salient aspects.

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Chap_04_10e Answer Key 1. True 2. False 3. True 4. False 5. True 6. False 7. False 8. False 9. True 10. True 11. a 12. c 13. b 14. b 15. c 16. b 17. a 18. c 19. b 20. b 21. c 22. a 23. b 24. c 25. c 26. a

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Chap_04_10e 27. a 28. b 29. c 30. a 31. a 32. c 33. c 34. d 35. d 36. d 37. d 38. c 39. d 40. c 41. d 42. c 43. a 44. d 45. b 46. a 47. d 48. b 49. c 50. b 51. b 52. a 53. b 54. d Copyright Cengage Learning. Powered by Cognero.

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Chap_04_10e 55. b 56. b 57. d 58. d 59. d 60. c 61. b 62. c 63. c 64. c 65. b 66. c 67. d 68. a 69. b 70. d 71. d 72. b 73. a 74. c 75. b 76. d 77. d 78. d 79. a 80. a 81. d 82. c Copyright Cengage Learning. Powered by Cognero.

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Chap_04_10e 83. d 84. b 85. d 86. c 87. d 88. a 89. c 90. d 91. b 92. a 93. c 94. a 95. d 96. b 97. b 98. b 99. b 100. d 101. c 102. d 103. a 104. b 105. d 106. b 107. d 108. b 109. b 110. a Copyright Cengage Learning. Powered by Cognero.

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Chap_04_10e 111. A. Patients may have financial difficulties in keeping doctor appointments, filling prescriptions, etc. B. Patients may encounter practical obstacles in fulfilling these tasks as well. C. Patients may find prescribed regimens not effective enough, too costly, too time-consuming, too hard to follow, too inconvenient; or they may simply forget to comply. D. Patients may treat physician instructions as advice rather than orders and follow these only selectively. E. Patients may stop taking medications or following other directions when their symptoms go away. F. Other patients stop taking medication because they feel worse, or do not feel better. G. Some patients “squirrel away” some of their pills to save for the next illness. H. Some patients have an optimistic bias, believing they will not suffer the usual consequences of not adhering to medical treatment. I. Younger and healthy people, in particular, often believe that their personal risks for health conditions are lower than that of the average person of their age. J. Adherence today requires difficult lifestyle choices. 1. Adherence was simpler when infectious diseases caused the most deaths and were treated by short-term medication, rest, etc. 2. Today, chronic diseases are the leading causes of death and are affected by diet, physical activity, and substance use. 3. Instead of just taking prescribed medications and following short-term advice, patients today must often make major changes like quitting smoking, eating differently, starting to exercise, etc., and maintaining these behaviors long-term. 112. A. Stage theories propose that people pass through discrete stages as they attempt health behavior change. B. Stage theories include: 1. The transtheoretical model. The transtheoretical model has five stages that people “spiral” through as they attempt health behavior change: precontemplation, contemplation, preparation, action, and maintenance. 2. Health action process approach. The health action process approach is actually a combination of stage and continuum theories. However, it has two stages: the motivational phase and the volitional phase. The main difference between stage theories and continuum theories is that stage theories tailor health behavior interventions to the stage that the person is in, whereas continuum theories take a more “one size fits all” approach. 113. A. Adherence rates are based on estimates, and the rates of nonadherence are not known. B. Measurements of adherence also have limitations. 1. Asking health care workers about rates of adherence does not often yield accurate results. 2. Asking patients is not valid, because they want to appear compliant and may not know what they should be doing. 3. Asking other people is not accurate, because others may not know of someone else’s nonadherence. 4. Counting pills is more accurate but does not ensure that the pills were taken correctly. 5. Measuring biological evidence is not necessarily accurate because it is not a direct measure of compliant behavior. C. Some combination of techniques is probably the best strategy to assess adherence.

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Chap_04_10e 114. A. Educational information strategies have not been found to be very effective in boosting adherence; behavioral techniques and combination educational-behavioral techniques are more effective. B. Strategies that can have some positive effect include: 1. Providing prompts such as calendars, telephone calls, text messages, or emails to remind patients of their regimen. 2. Tailoring the regimen to the patient’s lifestyle, using special pill packets. 3. Helping patients resolve the issues that block adherence; motivational interviewing may be useful in achieving this goal. 4. For regimens that require lifestyle changes, gradual implementation shapes behavior toward the goal. 5. Making responsibilities and expectations clear by providing a contract that both patient and practitioner sign and agree to follow. C. Improving adherence is difficult, and combinations of strategies seem more successful than individual strategies. 115. A. Several demographic characteristics have a small relationship to adherence. 1. Age is one such factor; older individuals may comply at higher rates, but they also face more barriers to adherence. 2. Gender is not a factor in most types of adherence. B. There is no such thing as a noncompliant personality; situational factors are more important than personality, because people who are compliant in one situation are not in other situations. C. Anxiety does not show a strong relationship to adherence, but depression is a much stronger predictor. D. Personal beliefs in the effectiveness of treatment relate to adhering to that treatment. E. When the patient’s cultural norms are compatible with the treatment, adherence increases. 116. A. The severity of the disease 1. Patient adherence is not determined by how serious a disease is objectively. 2. The patient’s subjective perception of disease severity, regardless of the facts, is more predictive of adherence rates. B. Treatment characteristics 1. Medication side-effects: Patients concerned about and/or experiencing severe side-effects are less likely to adhere to medication regimens. 2. Treatment complexity: The more doses and/or types of medication required, the less likely patients are to adhere. C. Personal factors *(See #4 above for more)—Age, gender, emotional, personality; environmental— economic, social support, cultural norms and ethnicity D. Interaction of factors 1. Many factors identified contribute singly to only small proportions of variance in adherence. Many factors are not independent of one another, but overlap and have complex ways of influencing others.

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Chap_04_10e 117. A. Estimates vary, depending on the regimen and type of patient. B. Most estimates are in the range of 20% to 70%. 1. Older studies found an average of around 50%. 2. More recent meta-analyses have found a nonadherence rate of just under 25%. C. Some adherence rates are higher than others. 1. Adherence rates for regimens designed to cure a disease are higher than those intended to prevent disease. 2. Adherence for some chronic conditions, such as HIV infection and arthritis, are higher than for other chronic conditions, such as diabetes and pulmonary disease. D. Adherence to behavioral programs (diet, exercise) averages 50% or worse. E. The rate of adherence does not improve for parents caring for children over what it would be for those adults caring for themselves. 118. A. The intention-behavior gap is the difference between people’s intention to engage in healthy behaviors, and their failure to do so. Components of this gap include: 1. Behavioral willingness = A person’s motivation to engage in a risky behavior at a given moment; i.e. a situational reaction, not a planned choice. This predicts actual behavior uniquely: although stronger intentions tend to correlate with weaker willingness; if two people have equally strong intentions to avoid risk behaviors, but one has greater willingness to engage in them, that willingness will most likely override the intentions. 2. Implementational intentions = specific plans people make identifying what they intend to do, how, where, and when. These form a connection between individuals’ goals and actual situations in which they can achieve them, giving goal pursuit more specificity and automaticity. They help prevent people from forgetting intentions, and also help transform intentions into actions. 119. A. She is in the maintenance stage, trying to maintain her changed behavior. B. This woman has passed through several other stages 1. She has passed through the precontemplation stage in which she was not interested in quitting. 2. She has passed through the contemplation stage in which she considered quitting smoking. 3. She has passed through the preparation stage in which she made preparations to quit, possibly throwing away her cigarettes and lighters. 4. She has passed through the action stage because she has quit. C. The transtheoretical model predicts that the woman may cycle back into stages she has passed, relapsing and quitting several times until she succeeds in maintaining cessation.

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Chap_04_10e 120. A. Continuum theories explain adherence using one set of factors that apply universally to all people. They were the first class of theories developed for understanding heath behavior. B. The Health Belief Model (Becker and Rosenstock)—Assumes four beliefs contribute to predict health behaviors: 1. Perceived susceptibility to disease/disability 2. Perceived severity of the disease/disability 3. Perceived benefits of health-enhancing behaviors 4. Perceived barriers to health-enhancing behaviors, including financial expenses C. Self-Efficacy Theory (Albert Bandura)—part of Bandura’s social-cognitive or social learning theory —Assumes people pursue goals they find achievable and important by using their cognitive (thinking and learning) processes. 1. Reciprocal determinism = Behavior, environment, and person factors, particularly beliefs, interact —illustrated as a triangle—to influence people’s actions. 2. Self-efficacy = “People’s beliefs in their capability to exercise some measure of control over their own functioning and over environmental events” (Bandura). Self-efficacy is not global, but situationspecific, i.e. one’s confidence that one can perform specific behaviors for specific situations. 3. Ways to acquire, increase, or decrease self-efficacy: (1) performance; (2) vicarious experience; (3) verbal persuasion; (4) physiological arousal states (e.g. stress, anxiety). 4. Outcome expectations = people’s beliefs that valuable outcomes will result from their health behaviors. D. The Theory of Planned Behavior (Ajzen)—Assumes people behave in ways to achieve goals important to them. Also assumes people are generally reasonable, use information systematically, and consider consequences before acting or not acting. Intention is the immediate factor determining behavior. Three factors influence intentions: 1. The person’s attitude toward the behavior 2. The person’s perceived control over the behavior 3. The person’s subjective norm, i.e. social pressure to act/not act 1. Behavioral Theory—Operant Conditioning (Skinner)—Assumes behaviors are strengthened—i.e. increases their probability of recurring—when reinforcement immediately follows (contingency). 1. Positive reinforcement = Presenting a pleasantly valued stimulus. 2. Negative reinforcement = Removing an unpleasantly valued stimulus. 3. Punishment = Presenting an unpleasantly valued stimulus; far less effective than reinforcement and seldom useful for improving adherence.

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Chap_06_10e Indicate whether the statement is true or false. 1. Psychoneuroimmunology is a multidisciplinary field that focuses on the interactions among behavior, the nervous system, the endocrine system, and the immune system. a. True b. False 2. The immune system protects the body against bacteria but not viruses. a. True b. False 3. T-cells are a type of nonspecific immune system response. a. True b. False 4. Most tension headaches are the result of traumatic life events. a. True b. False 5. The diathesis-stress model suggests that recent stress predisposes people to illness. a. True b. False 6. Evidence from research by Sheldon Cohen and his colleagues demonstrated that stress has no relationship to catching the common cold. a. True b. False 7. Compared with people who have little reaction to stressful events, those who react with strong emotions are more likely to have cardiovascular disease. a. True b. False 8. The functioning of the immune system occurs only in the lymph nodes. a. True b. False 9. Most heart attacks are caused by sudden traumatic experiences. a. True b. False 10. Almost all ulcers are caused by stress. a. True b. False

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Chap_06_10e Indicate the answer choice that best completes the statement or answers the question. 11. Suppression of the immune system a. is not associated with chemotherapy. b. will stop infection from developing. c. leaves the body vulnerable to infection. d. never occurs naturally, but can be induced with drugs. 12. The diathesis-stress model hypothesizes that a. stress is most likely to produce illness in a healthy person. b. stress and psychological functioning interact to produce better health. c. some people are more inherently vulnerable to the effects of stress. d. some people learn to cope with stress but not with stressful life events. 13. With regard to stress and illness, which of these statements is true? a. Stress is a better predictor of heart disease than it is of hypertension. b. Most people experiencing significant stress do not develop a disease. c. Stress is a better predictor of heart disease than cigarette smoking is. d. Stress is a low risk factor for infectious disease. 14. Investigators have found that stress may have an effect on which of these? a. The development of diabetes, but not its management b. The management of diabetes, but not its development c. Neither the development nor management of diabetes d. Both development and management of diabetes alike 15. Vaccinations may be less effective in protecting against infectious diseases among people who experience ________. a. stress b. many daily hassles c. few daily hassles d. exposure to cigarette smoke 16. Based on research findings, which is most accurate regarding the relationship between cardiovascular disease (CVD) and stress? a. Stress can precipitate heart attacks but does not contribute to developing CVD. b. Stress can contribute to developing CVD but does not precipitate heart attacks. c. Stress can precipitate heart attacks and also can contribute to developing CVD. d. Stress can correlate with but not contribute to CVD or precipitate heart attacks.

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Chap_06_10e 17. Stress may contribute to diabetes through its possible effects on _______. a. smoking b. heavy drinking c. obesity d. exercise 18. According to scientific evidence, how can stress interfere with managing diabetes? a. By changing patient blood glucose levels b. By undermining the adherence of patients c. By causing behaviors that lead to obesity d. By causing (a) and (b) but not causing (c) 19. Which of the following is an inadequate explanation for why some individuals are more vulnerable to depression than others? a. Ineffective coping strategies may increase vulnerability to depression. b. Rumination may increase vulnerability to depression. c. Major life stress may provide a “kindling” experience that increases vulnerability to depression. d. Scientific research has identified and confirmed a gene pair that causes depression. 20. By studying asthma patients, researchers have determined that acute episodes or asthma attacks can be precipitated by a. physiological, not psychological triggers. b. both physiological and psychological triggers. c. psychological, not physiological triggers. d. variables not yet identified as being triggers. 21. What has a recent study concluded about stress and ethnicity? a. African Americans and Hispanic Americans have similar biological responses to racism. b. African Americans and European Americans have similar levels of stress. c. Hispanic Americans do not experience a chemical change in their bodies due to experiences of racism. d. Cortisol production decreases if racism is experienced chronically over many years. 22. Ader and Cohen demonstrated that a. the immune system could be conditioned. b. the immune system was independent of the nervous system. c. the adrenomedullary response was independent of the adrenocortical response. d. allostasis does not apply to the General Adaptation Syndrome.

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Chap_06_10e 23. Based on research findings, what is the probable role of stress in the disease of asthma? a. Stress contributes to its development, but does not precipitate attacks. b. Stress does not contribute to its development, but it may precipitate attacks. c. Stress does not contribute to its development, nor does it precipitate attacks. d. Stress both contributes to its development and precipitates attacks. 24. The type of immunity that takes place in the bloodstream is called: a. cell-mediated immunity. b. humoral immunity. c. created immunity. d. natural immunity. 25. Interleukins are types of a. leukocytes. b. lymphocytes. c. cytokines. d. macrophages. 26. Immunity occurs when a. memory lymphocytes persist after initial exposure to a virus. b. antigens build up. c. antibody levels fall. d. interferon is transferred from one person to another. 27. The way that vaccination works is by a. introducing a stronger form of the body’s natural defenses. b. introducing a diluted version of the target microorganism. c. introducing a medication that kills a target microorganism. d. introducing a group of antibodies the body cannot produce. 28. Research in the field of psychoneuroimmunology has found evidence that immune function can be decreased by a. examination stress for medical school students. b. caring for somebody with Alzheimer's disease. c. conflict with a spouse. d. all of these. 29. Enhancing immune system function would be useful in the treatment of a. allergies. b. organ transplant patients. c. AIDS. d. cardiovascular disease. Copyright Cengage Learning. Powered by Cognero.

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Chap_06_10e 30. What statement accurately reflects a tenet of psychoneuroimmunology? a. Endocrine function affects behavior, and behavior can either raise or lower immune system function. b. Behavior affects the immune system, and immune system function affects health. c. Health and disease affect immune system function, and behavior affects the nervous system as well as the endocrine system. d. The responses of the immune, endocrine, and nervous systems are all independent of behavior. 31. Which of these is NOT an organ of the immune system? a. Liver b. Spleen c. Tonsils d. Thymus 32. Ebonie, a psychology student, is pregnant with her first child and is concerned about the possible impacts of chronic stress on the baby. She has read about studies implicating stress in premature births. She looks further, reading about research in animals as well as humans. The findings indicate which additional potential areas for concern? a. That her baby may have a low birth weight b. That her baby may be more reactive to stress c. That her baby may have developmental delays d. That her baby may have any or all these results 33. Evidence regarding the effects of stress on depression indicates that a. stress appears to be a necessary condition for developing depression. b. stress is a sufficient condition for the development of depression. c. stress is involved in more than one half of all depressive episodes. d. vulnerability and coping ability mediate how stress affects depression. 34. The discipline concerned specifically with the interactions among behavior, the endocrine system, the immune system, and the nervous system is a. transactional analysis. b. behavioral medicine. c. health psychology. d. psychoneuroimmunology. 35. The ethnic group that seems most vulnerable to developing PTSD is a. Asian Americans. b. Hispanic Americans. c. European Americans. d. African Americans. Copyright Cengage Learning. Powered by Cognero.

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Chap_06_10e 36. What is a likely biological link between stress and depression? a. Increased cytokine production b. Decreased cytokine production c. Increased T-cell production d. Increased activity of natural killer cells 37. Stress may relate to disease because people under stress may a. abuse substances. b. eat unhealthy foods. c. have sleep problems. d. do any or all of these. 38. The highest concentration of the virus for HIV is found in a. the saliva and the blood. b. the saliva and the semen. c. the blood and the semen. d. saliva, blood, and semen. 39. What is true of recent findings regarding stress reactivity among African American adolescents? a. African American adolescents have the lowest reactivity of all ethnic groups in America. b. African American adolescents have increased reactivity if they are of a lower socioeconomic status. c. African American adolescents of a higher socioeconomic status have less reactivity than European American adolescents. d. Chronic racism does not affect the reactivity of African American adolescents. 40. What did a longitudinal study by Stewart, Janicki, and Kamarck (2006) find related to increased blood pressure from noise and other situational stimuli? a. Contrary to most studies, blood pressure normalizes immediately once the stressor stops. b. Hypertension will generally persist for three years after a psychological stressor is removed. c. Contrary to most studies, blood pressure increases when the stressor is stopped. d. The duration of hypertension cannot be accurately predicted over any significant length of time. 41. In order for stress to cause illness, stress must affect physiological processes that produce illness. The most likely candidate for the mechanism which translates stress to disease is the a. immune system. b. nervous system. c. endocrine system. d. digestive system.

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Chap_06_10e 42. These chemicals secreted by immune system cells signal the nervous system: a. cytokines. b. leukocytes. c. phagocytes. d. antigens. 43. Autoimmune disease occurs when a. the immune system loses its effectiveness. b. T-cells are reduced by 90%. c. malignant cells proliferate, producing a demand for numerous immune system responses. d. the immune system attacks body cells rather than invaders. 44. South Korean researchers (Oh et al., 2004) have found that people who had asthma were at higher risk for asthma attacks if they experienced more a. sources of acute stress. b. types of chronic stress. c. acute or chronic stress. d. Irritants, but not stress. 45. Which statement about stress and disease is correct? a. Executives are more likely than middle-level managers are to develop diseases associated with stress. b. Stress can affect disease development directly through the immune system or indirectly through behaviors. c. Stress is more likely to result in psychological disorders than it is to result in physiological diseases. d. Low cortisol levels in COVID-19 patients correlated with greater mortality rates. 46. Which of the following most accurately explains the lack of a common cold vaccine? a. Every time a vaccine is developed, the common cold virus mutates. b. The common cold is a virus, and vaccines only work with bacteria. c. The common cold is caused by a great number of different viruses. d. Medical scientists do not find colds serious enough for vaccination. 47. The most solid research evidence suggests that a. stress can trigger an asthma attack. b. stress is the strongest risk factor for cardiovascular disease. c. stress is the chief cause of depression. d. stress is unrelated to both depression and anxiety.

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Chap_06_10e 48. Rhashan is an African American man with CVD. What is a likely cause of his condition? a. He has experienced many racist interactions in his life. b. He has abnormally low levels of cortisol. c. His HPA activation is infrequent. d. He experiences a lot of stress at his job as a CTO for the pharmaceutical industry. 49. Leukocytes are a. white blood cells. b. red blood cells. c. platelets. d. capillaries. 50. Direct effects of stress on the immune system occur through the adrenal medulla, and indirect effects can occur through ______. a. the autonomic nervous system b. suppression of the parasympathetic nervous system c. secretion of hormones d. the cardiovascular system 51. Allergic reactions are a. a result of digestive system dysfunction. b. an abnormal immune system reaction to a foreign substance. c. caused by viruses. d. more common in people whose immune systems are not fully functional at birth. 52. The main function of the immune system is to a. manufacture white blood cells. b. manufacture red blood cells. c. protect internal organs. d. protect against invasion by foreign microorganisms. 53. You are exposed to a common cold virus through contact with somebody who is sick. The cold virus is a(n) a. antibody. b. antigen. c. plasma cell. d. cytotoxin.

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Chap_06_10e 54. Physicians and patients commonly used to attribute stomach ulcers primarily to stress, but researchers have now identified a number of variables involved. Which of these is considered a more indirect factor than the others? a. Experiencing stress b. Releasing stress hormones due to chronic stress c. Experiencing immune function changes due to chronic stress d. Developing an infection with H. pylori 55. In a study of women with the sexually transmitted form of herpes simplex virus, women experiencing psychosocial distress were more likely to a. transmit the virus to somebody else. b. show genital lesions a few days later. c. contract other types of herpes viruses. d. have more painful symptoms. 56. The type of stress that people most closely associate with headaches is a. major life events, such as loss of a loved one. b. daily hassles. c. persistent fears and anxiety. d. depression. 57. A function of lymph nodes is to a. secrete thymosin. b. serve as a holding station for red blood cells. c. cleanse lymph of foreign debris. d. all of these. 58. Stress is a factor in a. tension but not vascular headaches. b. vascular but not tension headaches. c. both vascular and tension headaches. d. neither tension nor vascular headaches. 59. Nonspecific immune system response a. provides the first line of defense against foreign substances in the body. b. occurs in a nonspecific order. c. has the ability to create a type of memory that confers immunity. d. protects against specific immune responses that threaten the body.

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Chap_06_10e 60. One explanation as to why some individuals are more vulnerable to depression is that these individuals a. have active but small social support networks. b. have ineffective coping strategies. c. have too many stressful experiences. d. have not inherited neuroticism from their parents. 61. Among indirect contributions of stress to developing coronary artery disease, the action of the immune system promotes inflammation, and the action of stress hormones a. promotes diseased arteries. b. releases cytokine blockers. c. decreases arterial plaque. d. decreases inflammation. 62. Research shows that economically marginalized African Americans are disproportionately affected by asthma. Which of the following is an additional finding? a. Asthma’s prevalence and mortality rate are both rising among African Americans, but not among European Americans. b. Asthma’s prevalence and mortality rate are both rising among both African Americans and European Americans. c. Asthma’s prevalence is decreasing in both African and European Americans. d. Both Asthma’s prevalence and mortality rate are consistent among both African Americans and European Americans. 63. Regarding the effects of stress on pregnancy, research indicates that __________ a. acute stress is more damaging than chronic stress during pregnancy. b. stress early in the pregnancy is riskier than stress later in the pregnancy. c. stress leads to abnormally high birth weights. d. stress tends to result in preterm delivery. 64. When Sheldon Cohen and his colleagues intentionally exposed healthy volunteers to common cold viruses, they found that their previous level of stress was a. unrelated to subsequent number of colds. b. related in a dose-response manner to subsequent number of colds. c. positively related to subsequent number of colds but not in a dose-response manner. d. inversely related to subsequent number of colds. 65. Though stress may not directly cause ulcers, there may be an indirect link between stress and ulcers, as stress may increase all of the following EXCEPT: a. heavy drinking. b. smoking. c. caffeine consumption. d. exercise. Copyright Cengage Learning. Powered by Cognero.

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Chap_06_10e 66. Marital conflict is associated with a. faster response times to dangerous stimuli. b. slower response times to dangerous stimuli. c. faster wound healing. d. slower wound healing. 67. Increasing the efficiency of the immune system would be a problem for whom? a. People with cancer b. People with AIDS c. People with organ transplants d. People with bacterial diseases 68. Anneli and Viveka have each had genetic testing. Anneli has been identified as having a high genetic risk for depression; Viveka has been identified as having a low genetic risk for depression. Based on Kendler and colleagues’ 2007 findings, what is likely? a. Stress will be more predictive of depression for Anneli than for Viveka. b. Stress will be more predictive of depression for Viveka than for Anneli. c. Stress will be equally predictive of depression for both of these women. d. Stress will be no more predictive of depression for either of the women. 69. According to the APA (DSM-5, 2013), bipolar disorder involves both depressive and manic (and/or hypomanic) symptoms; as such, it is neither precisely a depressive disorder nor an anxiety disorder (the DSM classifies it under “Bipolar and Related Disorders”). However, extrapolating from the research literature on depression and anxiety, what would be the most reasonable inference to draw about a relationship between bipolar disorders and stress? a. There is likely no relationship since bipolar disorder is different from depressive or anxiety disorders. b. There is likely some relationship since at least one bipolar component, depression, is related to stress. c. There is likely no relationship since no research has connected manic/hypomanic states with stress. d. There is likely some relationship since manic and hypomanic states are equivalent with anxiety states. 70. What group of people experience poorer psychological and physical health, longer healing times for wounds, and lowered immune functioning? a. First-time mothers b. First-time fathers c. Alzheimer’s caregivers d. Married couples

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Chap_06_10e 71. In an inflammatory immune response, which cells migrate to the affected location to destroy invading microorganisms? a. Granulocytes, not macrophages b. Macrophages, not granulocytes c. Both granulocytes and macrophages d. Neither granulocytes nor macrophages 72. The development of immunity depends on the creation of a. leukocytes. b. natural killer cells. c. antigens. d. antibodies. 73. __________ enable the immune system to have a rapid response when the foreign invader reappears. a. Antigens b. Phagocytes c. Memory lymphocytes d. Leukocytes 74. Flu shots are typically offered and promoted most in the autumn, before flu season, which often coincides with when many students start college. Hypothetically, when should first-year college students prepare for flu season and also have the best immune response to the flu shot? a. Just before they arrive on campus b. After arriving, before classes start c. Two months before arrival on campus d. After arriving and starting classes 75. Research on the 2006 World Cup soccer championship indicated that a. the stress of watching matches raised the risk of cardiac events for people with cardiac problems. b. the excitement of watching matches provided relief from reactivity. c. men’s but not women’s risk of heart attack increased as a result of watching matches. d. soccer fans were more likely to experience an initial cardiac event, but individuals with a history of heart disease actually experienced a lowered risk of cardiac events during and after matches. 76. According to research findings, what is the relationship of stress to HIV infection? a. Stress affects disease progression, but does not affect response to treatment. b. Stress affects response to treatment, but does not affect disease progression. c. Stress affects both disease progression and immune response to treatments. d. Stress has no effect on either disease progression or response to treatments.

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Chap_06_10e 77. What did research by Kiecolt-Glaser and her colleagues show regarding people who cared for Alzheimer’s patients, compared with other people of the same age and gender? a. People who cared for Alzheimer’s patients had poorer psychological and physical health. b. People who cared for Alzheimer’s patients had lowered immune system function. c. People who cared for Alzheimer’s patients more quickly recovered their own health after the death of their patient. d. Both a and b are correct. 78. In comparison to using scores on life events rating scales, applying the diathesis-stress model is more predictive of illness because it takes into account _______. a. vulnerability to a much larger degree than stressors b. vulnerability as well as stressors c. vulnerability to a much lower degree than stressors d. vulnerability in lieu of stressors 79. Which of the following individuals would be most likely to have decreased immune system functioning? a. Chadwick, who will be taking his first examination in psychology this week b. Amit, who has an hour-long commute to school every week c. Shonda, who just given birth to her first child d. Jason, who is unemployed and lives in a high-crime neighborhood 80. One route through which stress may affect the immune system is through a. lowered epinephrine levels. b. elevated cortisol levels. c. reverse peristalsis. d. any of these. 81. Evidence now suggests that most colds are caused by an interaction of exposure to the virus and a. diet. b. lack of sleep. c. white blood count. d. experiencing stress. 82. Laboratory research suggests that stress may affect the immune system through activating the sympathetic nervous system. The impact of this stress is a. positive initially, but damaging if ongoing. b. damaging initially, but positive if ongoing. c. positive, both initially and over time. d. damaging, whether it is initial or ongoing.

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Chap_06_10e 83. The notion that some people respond more strongly to stress than do others is called a. Type A personality. b. Type B personality. c. reactivity. d. responsivity. 84. Which of the following perform specific immune responses? a. Phagocytoses b. T cells and B cells c. Granulocytes d. Macrophages 85. The diathesis-stress model assumes that to become ill, a. a person must have a relatively permanent predisposition to the illness. b. a person must experience some sort of stress. c. both a and b are necessary to produce illness. d. neither a nor b is necessary to produce illness. 86. Recent research that presented photographs of infectious disease to participants found that, after viewing these pictures, participants a. sneezed and felt nauseated. b. reported more trips to the health center that semester. c. had increased pro-inflammatory cytokine production. d. all of the above. 87. Which have researchers found about marital conflict relative to immune response? a. Marital conflict disrupts immune response regardless of how couples communicate. b. Marital conflict disrupts immune response less for couples who communicate productively. c. Marital conflict disrupts immune response less for couples who communicate poorly. d. Marital conflict disrupts immune response more for couples who communicate productively. 88. HIV is caused by a. a viral infection. b. a bacterial infection. c. exposure to a cancer-causing agent. d. sexual activity.

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Chap_06_10e 89. Austin suffers from recurrent intrusive memories of his experiences as a firefighter at the time of the World Trade Center attacks. He also has unpleasant dreams that replay some of these experiences. Austin is most likely suffering from a. clinical depression. b. schizophrenia. c. posttraumatic stress disorder. d. transcendent psychosis. 90. Rheumatoid arthritis is considered an autoimmune disease. How do scientists describe the mechanism of such autoimmune disorders? a. The patient’s immune system mistakenly attacks some part of the patient’s body. b. The patient’s immune system is unable to defend some part of the patient’s body. c. The patient’s immune system leaves byproducts from combating another disease. d. The patient’s immune system reacts to inflammation by increasing inflammation. 91. Concerning rheumatoid arthritis and stress, what do recent research results suggest? a. Stress may contribute to development of rheumatoid arthritis. b. Stress is found to be a typical result from rheumatoid arthritis. c. Stress is found to exacerbate symptoms of rheumatoid arthritis. d. Stress may contribute in all these ways to rheumatoid arthritis. 92. Which child would show the greatest asthma symptoms following an acute stress task? a. Bobbie, who is overweight b. Hector, who is underweight c. Ivan, who is economically marginalized d. Georgina, who is European American 93. Evidence is strongest for the hypothesis that a. there is little relationship between stress and heart disease. b. stressful experiences increase the risk of heart attack. c. stressful experiences can buffer people against cardiovascular disease. d. heart attacks were only precipitated by stress with people who already had cardiovascular disease. 94. What is true of people with a negative outlook and a tendency to ruminate over problems? a. They are less likely than other people are to complain about their being sick. b. They are at higher risk of depression than those with more positive attitudes. c. They express greater satisfaction with life in comparison to other people. d. All of these.

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Chap_06_10e 95. A recent working hypothesis by some researchers is that proinflammatory cytokines may contribute to, and even possibly cause, asthma to develop. What is a valid reason for this hypothesis? a. Asthma itself is a disease fundamentally involving higher rates of inflammation. b. Asthma disproportionately affects economically marginalized people. c. Asthma is a disease, and all diseases develop from higher rates of inflammation. d. Asthma patients tested before diagnosis all showed higher rates of inflammation. 96. Substances that evoke the production of one or more antibodies are called _____. a. antigens b. vaccinations c. phagocytes d. lymph nodes 97. The initial exposure to a foreign substance generates: a. a general immune response, but not a specific immune response. b. a specific immune response, but not a general immune response. c. neither a general immune response nor a specific immune response. d. a general immune response and a specific immune response. 98. The connection between the immune system and asthma may occur through a. the stress from its treatment. b. the process of inflammation. c. triggers, like smoke or dust. d. a person’s ethnic background. 99. There is evidence that stress contributes to the development of __________. a. depressive symptoms b. anxiety symptoms c. both anxiety and depressive symptoms d. neither anxiety nor depressive symptoms 100. Antoni and colleagues (2009) designed a cognitive behavioral stress management intervention for women with breast cancer, and over a 6-month period, improvements in what were found? a. Depression measures b. Anxiety measures c. Immune measures d. Cortisol measures

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Chap_06_10e 101. The two general, or nonspecific, mechanisms that foreign substances “face” are: a. phagocytosis and inflammation. b. phagocytosis and mucous membranes. c. inflammation and mucous membranes. d. the spleen and inflammation. 102. Which of the following people is most likely to have CVD? a. An European American teenage girl who has a family history of CVD b. A Hispanic American man who has no family history of CVD c. An African American man who perceives racism on a daily basis d. An Asian American woman who does not perceive racism directed at her 103. Sheldon Cohen and his colleagues found that development of colds a. was more strongly related to the duration of stress than its severity. b. was not reliably related to the severity of the stress but to the presence of stress. c. was related only to stress that was both long-term and also severe. d. showed no relationship between prior stress and subsequently developing colds. 104. Stress probably plays some role in the development of a. Type 1 diabetes. b. Type 2 diabetes. c. both type 1 and type 2 diabetes. d. neither type of diabetes. 105. Personality may play a role in who develops a cold. What have studies indicated might be a personality trait that reduces the chances of developing a cold? a. Conscientious b. Intolerant c. Agreeable d. Antisocial 106. A study (Sepa et al., 2005) found that stress may directly influence insulin-dependent (Type 1) diabetes development through: a. immune system disruption during infancy. b. higher rates of perceived stress over years. c. influencing patient levels of blood glucose. d. inflammation producing insulin resistance.

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Chap_06_10e 107. The secondary immune response a. is activated during initial exposure to an invasion. b. is less robust than the primary immune response. c. is far more rapid than primary immune response. d. is activated if the primary immune response fails. 108. Releasing factors are: a. hormones secreted by endocrine glands. b. hormones that are produced in the brain. c. hormones released by the adrenal glands. d. hormones that are produced as cytokines. 109. Research studies find that stress may contribute to the development of: a. Type 1 diabetes, not Type 2 diabetes. b. Type 1 diabetes and Type 2 diabetes. c. Type 2 diabetes, not Type 1 diabetes. d. Insulin resistance, but not of diabetes. 110. Explain the goals of the field of psychoneuroimmunology and evaluate its progress toward these goals. A. Psychoneuroimmunology is the multidisciplinary field that focuses on the interactions among behavior, the nervous system, the endocrine system, and the immune system. B. The goals of the field include an understanding of how each of the areas contribute to disease by establishing a connection between psychological factors and immune function and understanding how immune function relates to disease. C. Research in psychoneuroimmunology has focused on the connection between psychological factors and immune functioning. 1. The immune system can be conditioned. 2. Experiences can affect immune system function, especially negative experiences such as stress. 3. The link between immune system function and the development of disease has been demonstrated by a few studies in the field of psychoneuroimmunology. 4. Before the field can be considered successful, research must link psychological factors, immune system functioning, and disease.

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Chap_06_10e 111. Identify how the nervous system can serve as a vehicle for stress to influence immune system functioning. A. The peripheral nervous system communicates with organs of the immune system, e.g.: 1. the thymus gland; 2. the spleen; 3. the lymph nodes. B. The brain also communicates with the immune system by producing releasing factors. 1. Releasing factors are hormones that stimulate the endocrine glands to secrete other hormones.

112. What functions do nonspecific and specific immunity serve, and why are both necessary? A. Nonspecific immune responses occur as a general response to all invading bacteria, viruses, fungi, and other foreign particles. 1. The processes include a. Phagocytosis, a type of attack in which the invaders are engulfed and killed by targeting foreign particles. b. Inflammation, a complex response that acts to restore tissue that has been damaged through the increase of blood flow, release of enzymes, and migration of cells that attack invaders (granulocytes and macrophages). 2. These immune system responses occur to all invaders and do not depend on contact with each invader for mobilization of the response. B. Specific immune response occurs as a result of the immune system’s contact with invaders, tailoring cells that can kill specific invaders. 1. This process occurs when a. T-cells are sensitized by contact with invaders. b. B-cells differentiate into plasma cells that secrete antibodies that circulate in the blood, find the antigen that provoked their manufacture, bind to the antigens, and mark them for future destruction. The remnants of these antibodies can produce immunity to the antigens for years. 2. These immune system responses occur as a result of contact with specific invaders and are tailored to protect against them. C. Both types of immune responses are necessary to combat the variety of bacteria, viruses, fungi and other foreign particles that threaten the body.

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Chap_06_10e 113. Evaluate the evidence for stress as a factor in psychological disorders. A. The relationship between stress and depression is complex. 1. People with effective coping skills can avoid depression, even if they experience high levels of stress. 2. Genetic vulnerability may contribute to the link between stress and depression, providing the vulnerability that produces depression when vulnerable people experience stress. 3. The link between stress and depression may be through proinflammatory cytokines, which produce effects that are similar to depression. B. Anxiety disorders 1. Posttraumatic stress disorder is one of the anxiety disorders. a. This disorder is by definition related to stress. b. Some types of stress are more likely to produce PTSD than other types; for example, victims of sexual abuse, domestic violence, and natural disasters are especially vulnerable. 2. The link between stress and other anxiety disorders is less clear.

114. How strong is the relationship between stress and headache, heart disease, infectious disease, ulcers, diabetes, or any other disease? A. Stress is a factor in both vascular and tension headaches. B. The relationship between stress and cardiovascular disease is not straightforward. 1. Stress does not cause hypertension. 2. Some people show high levels of reactivity to stress, which may be a factor in the development of cardiovascular disease. C. Stress is related to vulnerability to infectious illness. D. Stress may exacerbate ulcers but is not the underlying cause of the development of ulcers. E. Stress may prompt people to engage in risky behaviors such as smoking or drinking as ways to cope with their problems. F. Other disorders such as diabetes, premature delivery in pregnancy, asthma, and rheumatoid arthritis are related to stress, but the exact role of stress in the development of these diseases is not clear. G. Evidence exists that stress is related to physical disorders, but the evidence is less clear than most people assume.

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Chap_06_10e 115. Discuss the implications of immune deficiency. A. Although immune overactivity can be a problem (such as allergies and autoimmune disorders), immune deficiency can result in several life-threatening diseases. 1. The function of the immune system must be virtually 100% effective in order to maintain health, and any substantial decrement of that efficiency would have serious consequences. 2. A weakened immune system leaves the body open to infection from viral and bacterial invaders as well as fungal and parasitic invasion. 3. Impairment of nonspecific immune function produces problems for tissue repair, inflammation, and phagocytosis. 4. Impairment of specific immune function affects antibody production, leading to a failure to attack specific invaders and form immunity. 5. Attempts at immunization could be dangerous because immunization typically occurs through the introduction of weakened forms of the disease; without the ability to form antibodies, these weakened pathogens could cause disease. B. Immune deficiency occurs both as an inherent condition and as the result of infection with the human immunodeficiency virus. 1. Children born without functional immune systems must remain isolated from pathogens or they will die from exposure to the many diseases that most people can withstand. 2. People infected with HIV lose their immune function and die from one of the many infections that their bodies can no longer fight.

116. Explain how the immune system can communicate with the nervous system, how such communication can be reciprocal, and how these relate to stress and illness. A.The immune system’s cells secrete chemical messengers called cytokines. 1. One class of cytokines is proinflammatory; i.e., they promote inflammation. B. Cytokines communicate with the brain. 1. This communication is thought to be via the peripheral nervous system. C. The interconnection between the immune and nervous systems enables reciprocal or two-way interactions between both, i.e. each can influence the other. D. This interrelationship may also enable common symptoms of illness, like fatigue and depression, to affect behavior. E. Cytokines can reach the brain through several routes (Capuron & Miller, 2011), which makes possible bidirectional interactions of the immune and nervous systems. F. Interactions between the nervous system and the immune system can result in symptoms related to stress and to illness.

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Chap_06_10e 117. How does the diathesis-stress model explain how some people get sick when exposed to stress while others remain healthy? A. The diathesis-stress model suggests that some people are predisposed to disease because of some genetic or biochemical weakness or vulnerability. 1. Acquired vulnerability may also constitute a diathesis. 2. For individuals with such predisposition, even low levels of stress may prompt the development of disease. B. For individuals without the predisposition, low levels of stress will not prompt the development of disease; even high stress may not.

118. Describe how stress influences the immune system through the secretion of hormones. A. Brain structures like the hypothalamus produce releasing factors that activate endocrine glands. 1. Hormones secreted by the endocrine glands reach the adrenal glands and other target organs by traveling to them through the bloodstream. 1. T-cells and B-cells (types of lymphocytes) are equipped with receptors for glucocorticoid stress hormones released by endocrine glands. B. Activation of the sympathetic nervous system prompts the adrenal glands to release hormones: 1. The adrenal medulla releases epinephrine and norepinephrine. a. These hormones modulate immunity, apparently via the autonomic nervous system. 2. The adrenal cortex releases cortisol. a. The hypothalamus in the brain stimulates the pituitary gland to release adrenocorticotropic hormone (ACTH). b. ACTH stimulates the adrenal cortex to release cortisol. 3. Elevated cortisol levels: a. are associated with multiple conditions of physiological and psychological distress. b. exercise an anti-inflammatory effect. 4. Both cortisol and the glucocorticoid hormones tend to inhibit: a. immune responses b. phagocytosis c. macrophage activation. C. The nervous system thus influences the immune system through: 1.the sympathetic nervous system, or 2.the neuroendocrine response to stress.

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Chap_06_10e 119. How does stress physically affect immune system function? State three ways. Describe the third way, and identify several examples and how these affect health and immunity. A. Three ways that stress physically affects immune system function are: 1. via the peripheral nervous system 2. via neuroendocrine hormone secretion 3. via behaviors that affect the immune system. B. While the first two stress responses involve chemical communication between the brain and endocrine glands, the third stress response involves people’s behaviors. C. People who are under stress may engage in behaviors including these: 1. Drink more alcohol than usual. 2. Use or abuse drugs/substances. 3. Smoke more cigarettes than otherwise. 4. Get less sleep than they need. 5. Eat unhealthy and/or unbalanced diets. 6. Not engage in enough (or any) physical activity. D. The common behaviors of people under stress listed above each raise their risk for various diseases. E. These behaviors may also exert other negative influences on the immune system.

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Chap_06_10e Answer Key 1. True 2. False 3. False 4. False 5. False 6. False 7. True 8. False 9. False 10. False 11. c 12. c 13. b 14. d 15. a 16. c 17. c 18. a 19. d 20. b 21. a 22. a 23. d 24. b 25. c 26. a

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Chap_06_10e 27. b 28. d 29. c 30. b 31. a 32. d 33. d 34. d 35. b 36. a 37. d 38. c 39. a 40. b 41. a 42. a 43. d 44. c 45. b 46. c 47. a 48. c 49. a 50. c 51. b 52. d 53. b 54. a Copyright Cengage Learning. Powered by Cognero.

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Chap_06_10e 55. b 56. b 57. c 58. c 59. a 60. b 61. a 62. b 63. d 64. b 65. d 66. d 67. c 68. b 69. b 70. c 71. c 72. d 73. c 74. a 75. a 76. c 77. d 78. b 79. d 80. b 81. d 82. a Copyright Cengage Learning. Powered by Cognero.

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Chap_06_10e 83. c 84. b 85. c 86. c 87. b 88. a 89. c 90. a 91. d 92. c 93. b 94. b 95. a 96. a 97. d 98. b 99. c 100. c 101. a 102. c 103. a 104. c 105. c 106. a 107. c 108. b 109. b 110. See below Copyright Cengage Learning. Powered by Cognero.

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Chap_06_10e 111. See below 112. See below 113. See below 114. See below 115. See below 116. See below 117. See below 118. See below 119. See below

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Chap_08_10e Indicate whether the statement is true or false. 1. Integrative medicine represents an attempt to integrate alternative with conventional medicine to improve health care. a. True b. False 2. The movement-based approaches of qi gong and tai chi are dangerous for older people with arthritis. a. True b. False 3. Chiropractors only use their hands to manipulate the spine. a. True b. False 4. Whether procedures or practices are considered alternative medicine depends solely on cultural context. a. True b. False 5. Using nutrition (such as a vegetarian or DASH diet) is among the most popular alternative approaches to not only lose weight, but also improve health. a. True b. False 6. Alternative treatments always remain on the fringe of treatment and never make the transition to conventional medicine. a. True b. False 7. More people use complementary than alternative medicine. a. True b. False 8. The notion of a vital energy that brings mind and body together is unique to traditional Chinese medicine. a. True b. False 9. Traditional Chinese medicine hypothesizes that qi is a force that is essential to health and that acupuncture and qi gong improve health by affecting qi. a. True b. False

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Chap_08_10e 10. The founder of chiropractic treatment believed that manipulation of the spine would help prevent future illness, as well as cure current illness. a. True b. False Indicate the answer choice that best completes the statement or answers the question. 11. Yoga has not been used successfully to help _______in those who did not experience a complete response to traditional medicine. a. decrease anxiety b. decrease depression c. decrease weight d. treat type 1 diabetes 12. Jane participates in a type of meditation focused on nonjudgmental awareness of one’s thoughts and feelings. What is this called? a. Mindfulness meditation b. Transcendental meditation c. Guided imagery d. Yoga 13. In which of these countries would you expect to have to pay out of pocket for CAM treatment? a. The United States b. Germany c. Australia d. The United Kingdom 14. Critics of CAM argue that few double-blind, placebo-controlled trials have demonstrated effectiveness. CAM advocates argue that a. many techniques used in conventional medicine have not been evaluated by this method either. b. double-blind, placebo-controlled trials constitute a flawed method for evaluating health research. c. researchers are already biased against CAM; therefore, the research is not fair. d. the National Center for Complementary and Alternative Medicine is underfunded. 15. Marco is looking to manage his stress and anxiety with yoga. What does recent research say about his decision? a. It will not be as effective as traditional medicine at managing his anxiety, but it will help with his stress. b. It will be effective in managing both his stress and his anxiety. c. It will help neither with his stress nor with his anxiety. d. It will not be as effective as traditional medicine at managing his stress, but it may help with his anxiety.

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Chap_08_10e 16. With the technique known as mindfulness meditation, people a. receive spiritual advice from their therapists. b. receive information about their internal biological functioning. c. focus nonjudgmentally on thoughts or sensations as they occur. d. attempt to discover and correct their irrational cognitions. 17. Which statement is true about science, religious faith, and CAM? a. Young males who believed strongly in religion were more likely to use CAM than other people. b. Young males who believed strongly in religion were less likely to use CAM than other people. c. Young males who believed strongly in science were more likely to use CAM than other people. d. Young males who believed strongly in science were less likely to use CAM than other people. 18. Evidence suggests that those patients MOST likely to receive pain relief through hypnosis are a. men. b. highly suggestible. c. different from those who respond to placebos. d. European American. 19. Matt is experiencing recurring headaches, so he uses a treatment that consists of being made aware of his physiological processes, such as muscle tension. a. Biofeedback b. Energy healing c. Hypnosis d. Mindfulness 20. What do all alternative medical systems have in common? The systems a. are holistic, considering psychological factors as well as physical factors in health. b. arose long ago and are now accepted by very few people. c. accept the importance of manipulation of the skin and organs in the healing process. d. emphasize physical factors and minimize psychological and emotional factors. 21. The notion that the mind and body form a holistic system of dynamic interaction characterizes which approach? a. Mind-body medicine b. Traditional Chinese medicine c. Ayurvedic medicine d. All these approaches to medicine

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Chap_08_10e 22. Which secular practice requires a quiet location, a specific posture, a focus of attention, and an open attitude? a. Meditation b. Qi gong c. Tai chi d. Biofeedback 23. A fundamental premise of chiropractic care is that it a. can prevent illness rather than cure it. b. can cure illness rather than prevent it. c. can both cure and also prevent illness. d. can promote health but not aid illness. 24. Thermal biofeedback training can enable a person to learn to raise skin temperature because a. skin temperature rises when relaxation prompts vasodilation. b. an increase in the resting heart rate stimulates vasodilation. c. skin temperature correlates with level of visceral activity. d. the sensorimotor rhythm stimulates adrenal system activation. 25. Chie participates in a type of meditation where she sits and repeats a sound over and over. This is most likely a. mindfulness meditation. b. transcendental meditation. c. guided imagery. d. yoga. 26. Twentieth century conventional medicine authorities strenuously opposed chiropractic. What development has followed this today? a. Chiropractic has become separated from conventional medicine. b. Chiropractic is becoming integrated into conventional medicine. c. Chiropractic has never been accepted by U.S. military divisions. d. Chiropractic is still not covered by health insurance in the USA. 27. Research on the medical benefits of qi gong indicates that a. qi gong practice creates measurable changes in electric and thermal energy. b. qi gong must be combined with tai chi to exert beneficial effects. c. the benefits are similar to relaxation training, producing mostly stress reduction. d. the benefits from qi gong are similar to the effects from placebos.

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Chap_08_10e 28. Those researchers who believe that hypnosis is an altered state of consciousness also believe that it is necessary to use what to achieve this altered state? a. Increased muscle tension b. An induction procedure c. Biofeedback d. A hypnotist with a strong personality 29. Alternative medicine is an alternative to what? a. Complementary medicine b. Conventional medicine c. Chinese medicine d. Western medicine 30. The National Center for Complementary and Alternative Medicine a. sponsors research on complementary and alternative medicine. b. promotes the use of complementary and alternative medicine through lobbying efforts. c. evaluates the safety of products and devices. d. reviews treatment programs for the National Institutes of Health on complementary and alternative practices. 31. Among the following TCM practices, which is used to stimulate OR subdue qi? a. Tui na b. Qi gong c. Acupuncture d. Acupressure 32. The exercise that originated with Ayurvedic medicine is a. qi gong. b. tai chi. c. yoga. d. rhythmic meridian movement. 33. Tai chi is practiced currently as a technique to promote health but originated as a. a method for curing neurological disorders. b. a weight loss method. c. a martial art. d. a type of meditation.

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Chap_08_10e 34. Hypnosis is particularly effective in treating what type of pain? a. Chronic pain b. Acute pain c. Headache pain d. Postsurgical pain 35. Which practice has been helpful in reducing fear of falling and improving balance in older adults? a. Tai chi b. Hypnosis c. Yoga d. Biofeedback 36. Which of the following has been shown to be most effective in treating insomnia? a. Hypnosis b. Biofeedback c. Yoga d. Acupuncture 37. Which of the following have research studies found about hypnosis? a. Brain imaging studies have concluded it is not an effective analgesic. b. Comparison studies find it is less effective than nonhypnotic suggestions. c. Brain imaging studies support that it alters consciousness. d. Comparison studies find it is more effective than nonhypnotic suggestion. 38. When people combine conventional treatments such as analgesic drugs with alternative approaches such as massage, a. they are using complementary medicine. b. the diverse treatment approaches will be ineffective. c. their conventional medicine practitioners often force them to make a choice between approaches. d. the combination of approaches will probably cancel each other out. 39. What has been suggested to help control some of the risks of Type 2 diabetes? a. Yoga b. Hypnosis c. Qi gong d. Tai Chi

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Chap_08_10e 40. What alternative treatment plan helped journalist T. R Reid most successfully relieve his shoulder pain? a. Over-the-counter medications b. An Indian practitioner’s Ayurvedic massage treatments c. A team of surgeons from the United States and France, who replaced his shoulder d. Physical therapy in a British clinic 41. What is true about similarities and differences between traditional Chinese medicine and Ayurvedic medicine? a. Only one of these incorporates some types of exercise. b. Only one of these incorporates making dietary changes. c. Only one of these incorporates the use of acupuncture. d. Only one of these incorporates preparations with herbs. 42. Who was important in formulating the view that the mind and the body work according to different principles? a. T.R .Reid b. Anton Mesmer c. Daniel David Palmer d. René Descartes 43. Which alternative treatment is most likely to be recommended by American physicians? a. Chiropractic treatment b. Dietary supplements c. Hypnotherapy d. Acupuncture 44. Which of the following is used to regulate the nervous system, flush waste materials out of the body, and promote immune system function? a. Tui na b. Tai chi c. Qui gong d. All of these 45. Which of the following has been found to be effective in controlling nausea and vomiting associated with postoperative symptoms? a. Acupuncture b. Acupressure c. Hypnosis d. Biofeedback

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Chap_08_10e 46. What condition is most likely to bring adults and children to use CAM? a. Pain b. Hypertension c. Panic attacks d. Depression 47. Integrative medicine a. attempts to integrate the use of medication and surgery to manage pain. b. attempts to integrate conventional and alternative medicine to improve treatment success. c. attempts to decrease the socioeconomic inequalities of health care treatment in the United States. d. has been discussed but not attempted. 48. Which of the following statements underlies the basis of chiropractic treatment? a. Spinal misalignments give rise to health problems. b. Health problems give rise to spinal misalignments. c. Treatments heal the body, which cannot heal itself. d. Treatment must be coordinated with a spiritual and dietary element. 49. Reviews of research into mindfulness meditation find that people who use it a. experience an increase in anxiety but a decrease in tension. b. can better manage stress and anxiety. c. have an effect on stress and anxiety, but not depression. d. can alleviate depression, but not manage anxiety. 50. Which traditional Chinese medicine technique is considered a manipulative technique? a. Acupuncture b. Acupressure c. Ayurvedic massage d. None of the above 51. The practice of yoga incorporates controlled breathing intended to _______. a. relieve pressure on the spine b. concentrate attention c. energize the body d. remove muscle tension 52. Researchers (Clarke et al., 2015) have found that many Americans use deep breathing in which way? a. As a component of a yoga practice only b. Along with other mind-body techniques c. Alone without other mind-body methods d. As parts of the meditation practices only Copyright Cengage Learning. Powered by Cognero.

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Chap_08_10e 53. Which of the following have been found to be useful in the treatment of depression? a. Acupuncture b. Yoga c. St. John’s Wort d. All of the above 54. Which practice focuses attention on moving the body in a controlled fashion, ignoring other situations or problems? a. Mindfulness meditation b. Transcendental meditation c. Guided imagery d. Yoga 55. What body parts does massage therapy manipulate? a. The spine b. The joints c. Soft tissues d. All of these 56. What do scientists who believe hypnosis is not an altered state of consciousness argue? a. It is simply a form of relaxation training. b. Induction is not necessary. c. It involves a suggestible personality trait. d. All of the above 57. Vegetarian and vegan diets are helpful in promoting good health, as they are beneficial in helping to _______________. a. reduce high cholesterol b. reduce the risk of cold and flu c. reduce the risk for osteoarthritis d. reduce all of the above problems 58. Americans are often limited in their access to CAM through a. the costs of the treatments, which are often not covered by insurance. b. physicians, who often discontinue conventional treatments for those using CAM. c. their families’ reactions to their treatment choices. d. lack of availability.

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Chap_08_10e 59. Who in the United States is most likely to use CAM? a. A middle-aged woman who recently immigrated to the United States b. A Chinese American teenage athlete c. A European American woman with a college degree d. A Hispanic American man with a college degree 60. Ayurvedic medicine originated in a. India. b. China. c. Europe. d. Japan. 61. Research has confirmed that mindfulness meditation is helpful in reducing people’s _______. a. anxiety b. stress-related problems c. depression d. All of the above 62. Which diet is not particularly restrictive and is designed to lower blood pressure? a. Vegan b. Atkins c. DASH d. Macrobiotic 63. Qi gong is a. a series of movements that offer therapeutic benefits. b. a talk-based therapy that originated in Chinese medicine. c. a herbal remedy for stress or depression. d. a type of meditation that is an effective strategy for controlling stress. 64. Which of the following vegetarian diets is the most restrictive? a. Ovo-lacto-vegetarian b. Lacto-vegetarian c. Vegetarian d. Vegan 65. The meditation technique that involves sitting relaxed with eyes closed, focusing on breathing, and repeating a single word or sound is called a. mindfulness meditation. b. transcendental meditation. c. yogic meditation. d. repetitive meditation. Copyright Cengage Learning. Powered by Cognero.

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Chap_08_10e 66. Before chemical anesthetics were discovered, hypnosis a. was tried but found ineffective during surgery. b. was used by some surgeons as an anesthetic. c. was never used to sedate surgical patients. d. was used in the 1830s during all surgery. 67. What has been found to be effective in controlling nausea and vomiting associated with chemotherapy in children? a. Acupuncture b. Acupressure c. Hypnosis d. Biofeedback 68. A treatment is classified as alternative because a. the treatment has not been approved by the FDA. b. its practitioners are not licensed. c. research evidence has not confirmed its effectiveness. d. all of these are criteria for classification as alternative. 69. In traditional Chinese medicine, channels in the body that connect body parts to one another and to the universe are called: a. Qi. b. Yin. c. Yang. d. Meridians. 70. Cancer Treatment Centers of America advertise on TV that they tailor treatment to the individual patient, and their treatments often include chemotherapy, radiation, specific food diets, nutritional supplements, exercise, naturopathic treatments, and others. Which approach does this exemplify? a. Complementary medicine b. Conventional medicine c. Alternative medicine d. Integrative medicine 71. Health psychologists have most effectively used hypnotic treatment to help people a. control pain. b. cope with stress. c. stop smoking. d. alter eating habits.

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Chap_08_10e 72. According to traditional Chinese medicine, when the qi is blocked or becomes stagnant, a. health impairment occurs. b. people lose weight. c. an increase in creativity occurs. d. lung capacity increases but digestive capacity decreases. 73. Imagine you meet someone at a party for international students. Which one would most likely have personal experience with CAM? a. An Australian woman b. A German man c. A Swiss woman d. An American man 74. The benefits of qi gong and tai chi include a. relaxation, flexibility, and better balance. b. increases in sensory acuity. c. decreased immune system responses. d. better pain relief than acupuncture. 75. As a treatment for pain, acupuncture a. is found to be no more effective than a placebo. b. produces brain changes consistent with pain relief. c. is less effective than either qi gong or tai chi. d. is more effective than medication. 76. The group of diverse medical and health care systems that are not currently considered part of conventional medicine are _____________. a. biopsychosocial medicines b. biomedicines c. alternative medicines d. complementary medicines 77. In research literature reviews, which of the following alternative treatments has been found effective for preventing formerly depressed patients from relapsing? a. Acupuncture b. St. John’s Wort c. Mindfulness-based stress reduction d. Mindfulness-based cognitive therapy

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Chap_08_10e 78. What is the technique of inserting needles into specific points of the skin that is meant to unblock the flow of qi and restore health called? a. Acupuncture b. Acupressure c. Tui na d. Tai chi 79. Acupuncture, acupressure, and tui na are techniques or practices that stem from _________. a. traditional Chinese medicine b. Ayurvedic medicine c. energy healing d. homeopathy 80. Techniques from traditional Chinese medicine have demonstrated effectiveness for managing stress and depression. Which of the following statements describes the research findings? a. Acupuncture and acupressure are effective in managing stress but less effective for depression. b. Qi gong and tai chi are effective for managing stress, anxiety, and depression, but acupuncture has not been found to be effective for these conditions. c. Qi gong and tai chi are effective for managing stress, and acupuncture is an effective treatment for depression. d. Herbal preparations are effective in managing anxiety, and qi gong is an effective treatment for depression. 81. Which type of meditation has been adapted into a stress-reduction program and has been shown to work by altering brain function? a. Mindfulness meditation b. Transcendental meditation c. Guided imagery d. Yoga 82. The goal of Ayurvedic medicine is to integrate and balance a. the body, space, and time. b. the body, mind, and spirit. c. the yin and yang. d. hot and cold forces in the body. 83. Which type of movement, also described as a “moving meditation,” Kenyatta practices? a. Qi gong b. Tai chi c. Transcendental meditation d. Mindfulness meditation

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Chap_08_10e 84. According to recent national research data, which mind-body approach is used by the most Americans? a. Yoga b. Meditation c. Guided imagery d. Deep breathing 85. Which of the following mind-body medicine techniques would only include deep, controlled breathing if attaining such breathing were the direct goal of treatment, rather than a general part of the practice? a. Meditation b. Biofeedback c. Guided imagery d. Qui gong, tai chi 86. The commonality among all the systems, practices, and products that are considered alternative is a. that they are ineffective except for the placebo response. b. their derivation from Chinese medicine. c. that they are not currently a part of conventional medicine. d. their higher degree of effectiveness compared to conventional techniques. 87. Which technique has been shown to improve the function of the immune system? a. Qi gong b. Tai chi c. Mindfulness meditation d. All of the above 88. Which physiological processes have researchers found both meditation and qi gong can affect positively? a. They can both delay some aging-related brain changes. b. They can both reverse some age-related brain changes. c. They can both achieve attention-related brain changes. d. They can both cause immune system function changes. 89. Which of the following is NOT one of the ways that massage has been viewed and used, from earlier to modern times? a. As a luxury b. As a therapy for managing pain, anxiety, and stress c. As a part of physical therapy and rehabilitation d. As a method for straightening the bones of the spine

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Chap_08_10e 90. The technique that involves inserting needles into specific points on the body and stimulating those points is a. qi gong. b. acupuncture. c. Ayurveda. d. pressure point therapy. 91. What have researchers concluded about many people who use CAM in the USA, Canada, Europe, and Israel? a. They are likely to have health conditions that result in their experiencing pain. b. They are likely to be males. c. They are likely to give up conventional treatments and substitute CAM instead. d. They are likely to seek acupuncture before chiropractic treatment. 92. Jian is in therapy with a health psychologist for relief from panic attacks. The psychologist uses a technique in which Jian is asked to imagine a peaceful pastoral scene and then concentrate on that scene during any anxiety-provoking situation. From this description, it appears that Jian’s psychologist is using a. hypnosis. b. progressive muscle relaxation. c. meditative relaxation. d. guided imagery. 93. The most critical element of the biofeedback process is a. change in the rate of breathing. b. immediate information on biological system status. c. an understanding of how and why the process occurs. d. change in the heart rate. 94. Therapeutic manipulation of the spine is the basis for a. massage therapy. b. acupuncture. c. qi gong. d. chiropractic treatment. 95. The main limitation on the use of CAM is a. the body of research that indicates no real effects for these techniques. b. the widespread lack of acceptance by the public. c. the lack of research on these techniques accepted by Western conventional practitioners. d. the campaign by conventional medicine to prevent people from using CAM.

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Chap_08_10e 96. Relaxation training, including meditation, has been found to be most successful in a. lowering blood pressure to the normal range. b. managing stress and anxiety. c. treating stress-related schizophrenia. d. treating ulcers. 97. Which of the following was shown to decrease hostility in prisoners? a. Tai Chi b. Yoga c. Hypnosis d. Mindfulness meditation 98. What has tai chi been shown to be useful in addressing? a. Fall prevention b. Pulmonary disease c. Chronic cardiac conditions d. All of the above 99. Almost _______ of adults in the US supplement their diet with vitamins, minerals, or natural products to improve their health. a. 3% b. 18% c. 64% d. 72% 100. Chiropractic treatment was the subject of a bitter fight during the middle of the 20th century. What group tried to keep chiropractors from practicing? a. The American Psychological Association b. The American Psychiatric Association c. The American Medical Association d. The National Institutes of Health 101. A recent study that examined the efficacy of hypnosis as a treatment compared hypnotic suggestion to nonhypnotic suggestion and found that pain was reduced for __________. a. patients who were under hypnosis only b. all patients, regardless of whether they were under hypnosis c. patients who expected their treatment to be effective, regardless of whether they were under hypnosis d. patients who were not hypnotized only

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Chap_08_10e 102. Two of the more common alternative treatments in the United States are a. chiropractic treatment and energy healing. b. chiropractic treatment and massage. c. massage and meditation. d. energy healing and massage. 103. One of the goals of treatment in traditional Chinese medicine is to a. reduce the amount of qi that flows through the body. b. increase the amount of qi that flows through the body. c. bring yin and yang into balance. d. increase yin forces and decrease yang forces. 104. Chronic low back pain is an extremely difficult pain syndrome to manage. What CAM treatment has demonstrated effectiveness in managing low back pain? a. Massage b. Acupuncture c. Chiropractic treatment d. All of the above 105. Which of the following manipulative techniques originated in traditional Chinese medicine? a. Acupressure and tui na b. Acupuncture and Shiatsu c. Shiatsu and acupressure d. Tai chi and yoga 106. Chiropractic practitioners a. have earned graduate degrees and obtained licenses to practice. b. attend college for about four years but do not receive any degree. c. may earn a doctoral degree or not, which affects the extent of their practice. d. train through an apprentice program rather than through colleges. 107. A person who uses some form of CAM is likely to a. be an immigrant to the United States. b. have a lower level of socioeconomic status. c. subscribe to the biomedical view of health and illness. d. accept the biopsychosocial view of health and illness.

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Chap_08_10e 108. The process of acceptance of alternative treatments can eventually change them into conventional treatments. What is a historical example of this from 150 years ago? a. Whole-grain diets b. Analgesic drugs c. Surgical treatment d. Massage therapy 109. Biofeedback a. offers clear advantages over relaxation training for migraine headaches. b. has demonstrated independent therapeutic effects for all types of headaches as well as for gastric disorders. c. is not more effective than relaxation techniques are for controlling pain. d. is more successful with psychological disorders than physiological ones.

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Chap_08_10e 110. Summarize two types of manipulative practices, including their characteristics and prevalence of use in the USA. A. Manipulative practices are oriented to treating disease conditions or relieving symptoms. B. Chiropractic treatment focuses on adjusting the spine and joints to realign them. 1. Daniel David Palmer, who founded chiropractic in 1895, believed spinal manipulation could both cure and prevent illness. 2. Chiropractic adjustments involve using the hands or machines to apply pressure. 3. Chiropractors may also use heat, ice, and electrical stimulation in treatment. 4. Chiropractors may also prescribe exercise, diet changes, or dietary supplements. 5. Chiropractic training requires four more years of study beyond college, board examinations, and licensure. 6. The AMA attacked chiropractic throughout the mid-20th century, but chiropractic prevailed. 7. Chiropractic is becoming integrated into conventional medicine. a. Sports medicine b. Available through the U.S. Departments of Defense and Veterans Affairs c. Many health insurance plans cover chiropractic services C. Massage focuses on manipulating the soft tissues for health benefits. 1. Once considered a luxury, massage has become recognized as therapeutic for physical therapy and rehabilitation, and today also for managing pain, anxiety, and stress. 2. Massage was a therapeutic approach in ancient times and many cultures. 3. Swedish massage was developed in the 19th century by Johan Mezger. 4. Traditional Chinese medicine includes manipulative techniques: a. Acupressure for unblocking qi flow b. Tui na, also for freeing qi flow 5. Shiatsu is a Japanese form of massage similar to acupressure. 6. Ayurvedic massage manipulates specific points on the body to channel the body’s healing energy, often using medicinal oils. D. Many of the different types of massage share an underlying premise that the manipulation helps the body to heal itself. E. Chiropractic treatment is among the best accepted and most widely used CAM.

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Chap_08_10e 111. Summarize some attitudes and beliefs that exemplify patient preferences for conventional medical approaches to treatment, and some contrasting beliefs that exemplify patient preferences for and/or openness to alternative medical approaches to treatment. A. Beliefs reflecting conventional medical approaches to treatment: 1. If you feel pain, you look for relief in your medicine cabinet. 2. You wish pharmaceutical manufacturers would develop a medicine that helps people to cope with stress. 1. Pain and stress are both things that are caused by factors external to the patient. 2. There are no real benefits to getting chiropractic treatments. 3. There is no way alternative treatments will ever work as well as conventional ones. B. Beliefs reflecting alternative and behavioral approaches to treatment: 1. Some herbal treatments can relieve pain as effectively as drugs can. 2. If medical treatment did not help my pain, you would try acupuncture, hypnosis, etc. 3. Taking drugs to help deal with problems is a bad habit for too many people. 4. For pain or stress, you would prefer some alternative to medical treatments. 5. The sources of pain and stress are both interactions between patient and context. 6. Alternative treatments are generally less dangerous and have fewer side-effects than conventional medical treatments. The best way to approach managing pain is to combine conventional medical and alternative treatments.

112. Analyze which people use alternative treatments. A. The people who use alternative treatments differ from those who do not in terms of beliefs, demographics, and satisfaction with their medical care. B. The beliefs of those who use CAM tend to be compatible with the biopsychosocial view of health and disease, and these individuals are more open to different worldviews. C. The demographic factors that characterize CAM users include gender, ethnicity, education, and geographic location. 1. Women are more likely than men to use CAM. 2. In the United States, well-educated European-Americans are more likely than others to use CAM. 3. People in the United States use CAM less often than those in Canada, Australia, and some European countries in which CAM is more fully integrated into the health care system. D. Individuals who have sought conventional treatment but have failed to experience satisfactory improvement are more likely to seek alternative treatment but are also likely to add this treatment, which constitutes complementary treatment.

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Chap_08_10e 113. What are the advantages of integrative medicine? What are the barriers? A. The development of integrative medicine would have many advantages. 1. The recognition of psychological factors in the development and treatment of disease would bring about a change to the more valid biopsychosocial model of health. 2. Integrative medicine would improve outcomes by adding the effective alternative treatments to conventional treatments. 3. Integrative medicine would improve patients’ experience in health care settings by acknowledging the psychological and emotional components that affect disease and treatment. 4. Alternative treatments would be more accessible if integrated with conventional medicine. B. Several barriers exist that make the development of integrative medicine difficult. 1. Practitioners of conventional and alternative medicine differ in philosophy and training, making it difficult for them to respect each other and to work together. 2. Integrative medicine is furnished by teams, which may add to the cost of medical care, and cost is already a serious problem in health care.

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Chap_08_10e 114. Discuss some popular alternative products and diets used in America today, including some examples of classification, regulation, uses, benefits, and prevalence. A. Dietary supplementation for health is an age-old practice, which millions of people currently also follow. B. Vitamin and mineral supplementation advised by physicians is classified as conventional treatment, but some natural products are classified as alternative treatments. C. The U.S. Food and Drug Administration (FDA) regulates natural products as foods, not drugs. 1. These are sold without restrictions or effectiveness evaluations, but with safety evaluations. D. Natural product supplements include: 1. Omega-3 fatty acids for reducing cardiovascular disease risks 2. Echinacea for treating cold and flu viruses 3. Glucosamine for treating osteoarthritis symptoms 4. Melatonin for promoting sleep 5. Probiotics for digestive problems or improving digestion 6. and many others. E. Functional foods are parts of a normal diet having bioactive ingredients like antioxidants. 1. Some examples include chocolate, cranberries, and soybean products. F. Dietary supplements are among the types of alternative medicine most widely used. G. Vegetarian diets tend to be lower in fat and higher in fiber, benefiting people with high cholesterol and similar health problems. 1. The American Heart Association and American Cancer Society both recommend limiting meat consumption for health reasons. H. About 3% of adults in the United States have followed a diet such as the Atkins, Zone, Ornish, DASH, or vegetarian diet plans.

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Chap_08_10e 115. What are the differences and similarities among the mind-body approaches of meditation, biofeedback, and hypnotic treatment? A. Transcendental meditation, mindfulness meditation, and guided imagery can produce relaxation, stress reduction, and decreases in anxiety. B. Hypnosis is controversial, even in terms of its existence; however, attainment of a hypnotic state is accompanied by relaxation and can alter the perception of pain. C. Biofeedback is a procedure that uses machines to give feedback about the status of a body system in order to help people learn conscious control of that system. D. Differences 1. The amount of assistance needed to use the technique differs for the three: biofeedback requires machinery and extensive training, hypnotic treatment requires a hypnotherapist and practice, and meditation requires training and practice. 2. The expense of the three procedures may not vary for the client, but cost to provide each is related to the amount of training required by the provider and the time to master the technique. Biofeedback is most expensive because of the equipment and training time. E. Similarities 1. All three procedures increase physical relaxation and decrease the physical responses associated with stress. 2. All three procedures decrease anxiety. 3. All three procedures have been used with some success in treatment for stress-related physical disorders and as treatment for pain, but hypnosis has been the most effective of the three in the management of pain.

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Chap_08_10e 116. Discuss the effectiveness of alternative treatments. A. Research evidence from high-quality studies on the effectiveness of alternative treatments is not plentiful, but studies are beginning to show that alternative treatments are effective for a variety of conditions. B. Meditation procedures include transcendental meditation, mindfulness meditation, and guided imagery. 1. Transcendental and mindfulness meditation are effective for managing anxiety, mood disorders, and depression. 2. Mindfulness meditation has been used successfully for stress-related problems. 3. Guided imagery has some effectiveness in the control of pain related to pregnancy and childbirth, headache pain, and postoperative pain. C. Research has demonstrated the effectiveness of qi gong and tai chi for several conditions. 1. Qi gong is useful in managing several types of chronic pain, including fibromyalgia. 2. Tai chi is a promising treatment for chronic headaches. D. Acupuncture is effective for several pain syndromes, including low back pain, neck pain, and osteoarthritis of the knee. E. Chiropractic treatment is effective for back, neck, and musculoskeletal pain. F. Hypnotic treatment has been shown to be effective for many types of pain. 1. These include pain associated with cancer, dental treatment, burns, headache, low back problems, and childbirth. 2. Hypnosis is more effective than a placebo for suggestible people but not for others.

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Chap_08_10e 117. Describe how acupuncture is being used as an alternative treatment in veterinary health care as well as in human health care. A. Veterinarians use acupuncture to treat pain in animals similarly to the way other physicians use it to treat pain in humans. B. Veterinary acupuncture is also similar to human acupuncture in that both are more often used as complementary—i.e. in combination with conventional medical care—rather than as alternative—i.e. instead of conventional medicine. C. One difference is the challenge that animals cannot tell doctors what hurts and when. 1. Veterinarians use behavioral changes and sensitivity to touch as cues to infer pain. D. Another difference and challenge is mapping meridians (acupuncture points) in animals, which are different from those in humans. 1. Traditional Chinese medicine has mapped meridians in horses, but other animal species are treated with veterinary acupuncture. E. People often seek acupuncture for their pets for back pain, neck pain, and arthritis pain—similar reasons that they seek acupuncture and other CAM treatments for themselves. F. People who seek acupuncture for pets tend to be demographically similar to those who seek it for themselves: 1. well-educated 2. upper-income 3. more women than men G. More than half of people who take their pets for acupuncture tend to have experience with it themselves and believe it is effective. H. Research findings about acupuncture for animals also resemble research findings about acupuncture for humans. 1. Acupuncture is found effective in animals for: a. relieving back pain b. relieving neck pain c. relieving arthritis pain d. relieving surgical pain e. relieving post-operative pain f. relieving post-operative nausea and vomiting.

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Chap_08_10e 118. Discuss the similarities and differences among the alternative medical systems. A. The alternative medical systems of traditional Chinese medicine, Ayurvedic medicine, naturopathy, and homeopathy have similarities in philosophy. 1. All hold to a view that is similar to the biopsychosocial view, that the body and mind form an interactive, functioning whole. 2. All include a view that the body is influenced by some vital energy force that can affect health. 3. All accept that bringing the mind and body into balance will improve health. B. The alternative medical systems of traditional Chinese medicine, Ayurvedic medicine, naturopathy, and homeopathy differ in geography, history, and techniques. 1. Traditional Chinese medicine has a history that goes back 2,000 years and includes the techniques of acupuncture, acupressure, herbal preparations, massage, and the movement-based practices of qi gong and tai chi. 2. Ayurvedic medicine originated in India over 2,000 years ago and includes treatment oriented toward diet, exercise (including yoga), herbal and other preparations, and better personal relationships. 3. Naturopathy and homeopathy arose in 19th-century Europe, spread to North America, became popular, and then lost popularity as conventional medicine gained prominence. a. 2015 data show 2.2% of Americans use homeopathy and 0.5% use naturopathy.

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Chap_08_10e Answer Key 1. True 2. False 3. False 4. False 5. True 6. False 7. True 8. False 9. True 10. True 11. d 12. a 13. a 14. a 15. b 16. c 17. d 18. b 19. a 20. a 21. d 22. a 23. c 24. a 25. b 26. b

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Chap_08_10e 27. a 28. b 29. b 30. a 31. a 32. c 33. c 34. a 35. a 36. d 37. c 38. a 39. a 40. b 41. c 42. d 43. a 44. a 45. a 46. a 47. b 48. a 49. b 50. b 51. b 52. c 53. d 54. d Copyright Cengage Learning. Powered by Cognero.

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Chap_08_10e 55. c 56. d 57. a 58. a 59. c 60. a 61. d 62. c 63. a 64. d 65. b 66. b 67. c 68. c 69. d 70. d 71. a 72. a 73. a 74. a 75. b 76. c 77. d 78. a 79. a 80. c 81. a 82. b Copyright Cengage Learning. Powered by Cognero.

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Chap_08_10e 83. b 84. a 85. b 86. c 87. d 88. d 89. d 90. b 91. a 92. d 93. b 94. d 95. c 96. b 97. d 98. d 99. b 100. c 101. c 102. b 103. c 104. d 105. a 106. a 107. d 108. c 109. c 110. See below Copyright Cengage Learning. Powered by Cognero.

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Chap_08_10e 111. See below 112. See below 113. See below 114. See below 115. See below 116. See below 117. See below 118. See below

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Chap_09_10e Indicate whether the statement is true or false. 1. Inherent risk factors can easily be modified through diet and exercise. a. True b. False 2. Presently, deaths from cardiovascular disease in the United States are increasing. a. True b. False 3. Heart disease and stroke are only a leading cause of death in economically marginalized communities. a. True b. False 4. Arteriosclerosis is when the arteries have “hardened” and atherosclerosis is the formation of plaques. a. True b. False 5. The term cardiovascular disease includes stroke. a. True b. False 6. Hypertension is a predictor of heart attack but not stroke. a. True b. False 7. Restriction of blood flow to the heart is called ischemia. a. True b. False 8. People who follow a cardiac rehabilitation program substantially lower their risk for a second heart attack. a. True b. False 9. A medical term for heart attack is myocardial infarction. a. True b. False 10. Modifying behavioral risk factors does not significantly reduce one’s chance of having a myocardial infarction. a. True b. False

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Chap_09_10e Indicate the answer choice that best completes the statement or answers the question. 11. For an adult, blood pressure of 120/85 would be a. normal. b. prehypertension. c. Stage 1 hypertension. d. Stage 2 hypertension. 12. Coronary arteries a. carry blood from the heart to the remainder of the body. b. carry blood from the body's extremities to the heart. c. furnish blood to the heart. d. furnish blood to the brain. 13. Approximately what percentage of Americans have hypertension? a. 5% b. 15% c. 33% d. 50% 14. Dean Ornish and his colleagues have found that coronary artery damage a. can be reversed by following the American Heart Association's guidelines that no more than 30% of calories consumed come from fat. b. can be reversed by following a vegetarian diet. c. can be reversed through cognitive-behavioral group therapy. d. cannot be reversed by any known treatment. 15. Differences in hormones may help explain some of the differing rates of cardiovascular disease in males and females. Which of the following are responsible for much of the gender gap in heart disease? a. Behavioral factors b. Physiological factors c. Psychological factors d. Both b and c 16. Coronary artery disease differs from coronary heart disease a. in terms of severity—coronary artery disease is a more severe condition than coronary heart disease. b. in terms of location—coronary artery disease is damage to the arteries; coronary heart disease is damage to the myocardium. c. in terms of the number of people affected—many more people have coronary heart disease than have coronary artery disease. d. in no significant way. Copyright Cengage Learning. Powered by Cognero.

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Chap_09_10e 17. If a diet high in salt-cured foods is an established risk factor for hypertension, then a. this type of diet is negatively correlated with hypertension. b. this type of diet is frequently associated with hypertension. c. salty foods are identified as a cause of hypertension d. salt restriction may or may not be advised for those at risk of hypertension. 18. Extra weight carried around which body part is related to an increased risk for heart attack? a. The hips b. The abdomen c. The buttocks d. The thighs 19. In general, males and females have a similar death rate from cardiovascular disease, but males have a significantly higher risk___________. a. when they are under 20 years old b. during middle age c. when they are over 75 years old d. when they are married 20. The circulation of blood permits a. the transportation of oxygen to body cells. b. the removal of carbon dioxide from cells. c. both a and b. d. neither a nor b. 21. Millions of Americans have abnormally high blood pressure, or __________. a. a stroke b. hypertension c. angina pectoris d. a myocardial infarction 22. What is the difference between anger and hostility? a. Anger is an attitude accompanied by physiological arousal, whereas hostility is a negative emotion toward others. b. Anger is an attitude accompanied by physiological arousal, whereas hostility is a negative reaction toward others. c. Anger is a reaction accompanied by physiological arousal, whereas hostility is a negative emotion toward others. d. Anger is a(n) emotion accompanied by physiological arousal, whereas hostility is a negative attitude toward others.

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Chap_09_10e 23. Stroke is the result of deprivation of oxygen to the brain; heart attacks are caused by a deprivation of oxygen to _____________. a. the myocardium b. the cerebrum c. the lungs d. the peripheral nervous system 24. Which combination yields the lowest risk of cardiovascular disease? a. Moderate total levels of cholesterol with a ratio of total cholesterol to HDL of more than 6 to 1 b. Moderate total levels of cholesterol with a 3.5 to 1 ratio of total cholesterol to LDL c. Low levels of total cholesterol with a ratio of total cholesterol to HDL of less than 4.5 to 1 d. Low total levels of cholesterol with a 3.5 to 1 ratio of LDL to total cholesterol 25. In general, which of these groups of people have the highest risk for cardiovascular disease? a. Married men b. Single, divorced, or widowed men c. Single women d. Single, divorced, or widowed women 26. Flavonoids in chocolate may protect against CVD. Which type of chocolate has the highest level of flavanols? a. Dark chocolate b. Milk chocolate c. Dutch chocolate d. White chocolate 27. What is the system that consists of the heart, arteries, and veins? a. Musculoskeletal b. Cardiovascular c. Endocrine d. Immune 28. One challenge for health psychologists is that people with an optimistic bias are not ready to change, according to the transtheoretical model. What did the study by Resnicow et al. (2001) find effective for propelling them to a point of readiness to make changes in their health behaviors? a. Music therapy b. Pessimistic training c. Hypnosis d. Motivational interviewing

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Chap_09_10e 29. Restriction of blood flow is called a. arteriosclerosis. b. ischemia c. arrhythmia. d. an embolism. 30. A disorder characterized by a restriction of oxygen to the heart, a sensation of crushing pain, and a difficulty in breathing but no loss of consciousness or damage to the myocardium is a. stroke. b. arrhythmia. c. heart attack. d. angina pectoris. 31. Rosalia is experiencing dizziness, nausea, a squeezing pain in his chest, and cold sweating. She is likely experiencing symptoms of a. a stroke. b. hypertension c. angina pectoris. d. a myocardial infarction. 32. Treating depression among cardiac patients is important, but difficult. A recent cognitive behavioral intervention showed improvements in survival among a. African American males. b. European American males. c. African American females. d. European American females. 33. The decline in deaths from cardiovascular disease during the last four decades of the 20th century was due to a. better dietary practices. b. reduction in cigarette smoking. c. improvements in medical care. d. All of these 34. Research indicates that the effects of socioeconomic background on cardiovascular disease __________. a. begin in early adulthood b. begin in early adolescence c. begin in middle adulthood d. are established from birth

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Chap_09_10e 35. People who currently smoke are how much more likely to suffer a heart attack that people who have never smoked? a. Three times as likely b. Half as likely c. Ten times as likely d. Equally as likely 36. You are MOST at risk for heart disease if you a. are a man in a happy marriage. b. are a woman in an unhappy marriage. c. are a man in an unhappy marriage. d. are a woman in a happy marriage. 37. Reducing hypertension is difficult because a. hypertension has no unpleasant symptoms and the body tends to keep blood pressure stable. b. no drugs have yet proven effective for lowering the blood pressure. c. it is difficult to diagnose. d. drugs have unpleasant side effects, and there are no behavioral changes which can reduce blood pressure. 38. All of the following are behavioral risk factors for cardiovascular disease EXCEPT: a. smoking b. diet c. physical activity levels d. educational level 39. All of the following are physiological risk factors for cardiovascular disease EXCEPT a. high-serum cholesterol. b. hypertension. c. inflammation. d. physical activity levels. 40. Sanae has Type 1 diabetes, which is a risk factor for cardiovascular disease. Therefore, Sanae a. can do nothing to protect herself against cardiovascular disease. b. has a behavioral risk factor for cardiovascular disease and can engage in certain behaviors to eliminate her risk. c. cannot eliminate her risk for cardiovascular disease, but she can learn to manage her disorder and thus lower her risks. d. has a physiological risk for cardiovascular disease and can learn to reduce her risk to that of a person with no risk factors for cardiovascular disease.

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Chap_09_10e 41. A more technical name for "hardening of the arteries” is a. angina pectoris. b. atherosclerosis. c. arteriosclerosis. d. ischemia. 42. Of the following individuals, who is the least at risk for cardiovascular disease? a. Jhumpa, a 50-year-old widow who lives by herself b. Anna, a 50-year-old woman with many friends in an unhappy marriage c. Cristobal, a 50-year-old unmarried man without many friends d. Lebron, a 50-year-old man in a happy marriage 43. Cigarette smoking is the leading behavioral risk factor for cardiovascular death in the United States. However, a. cigar and pipe smoking are unrelated to cardiovascular deaths. b. secondhand smoke is not considered a risk factor for CVD. c. declining rates of smoking have led to decreases in cardiovascular deaths due to tobacco use. d. diet remains the leading behavioral risk factor for cardiovascular death in other parts of the world. 44. Emilia Clarke is a young actress who had a stroke. What was most likely the cause of the stroke? a. Her intense workout regimen b. The stresses of playing Daenerys Targaryen c. arteriosclerosis d. a congenital condition 45. Beth had difficulty breathing and a crushing pain in her chest. However, it only lasted a few seconds. Beth likely was experiencing symptoms of a. a stroke. b. hypertension. c. angina pectoris. d. a myocardial infarction. 46. Compared with European Americans, African Americans a. have higher rates of hypertension and higher rates of cardiovascular mortality. b. have lower rates of hypertension but higher rates of cardiovascular mortality. c. have lower rates of hypertension and lower rates of cardiovascular mortality. d. have higher rates of hypertension and lower rates of cardiovascular reactivity.

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Chap_09_10e 47. The strongest physiological risk factor for cardiovascular disease is a. lack of social support. b. hypertension. c. obesity d. smoking. 48. Darlene's current blood pressure is 149 over 95. This means that Darlene has a. low blood pressure. b. prehypertension. c. Stage 1 hypertension. d. Stage 2 hypertension. 49. Atherosclerosis may affect blood supply in any part of the body, but it is most dangerous when it affects a. veins in the extremities. b. arteries in the extremities. c. any veins. d. coronary arteries. 50. Glucose metabolism problems are a risk factor for CVD a. even if not sufficiently severe to qualify as diabetes. b. only in people who are overweight in addition. c. if the problem results in the overproduction of insulin. d. only in people who also have high cholesterol. 51. Research has indicated cardiac reactivity is positively related to the a. experience of anger. b. nonexistence of anger. c. expression of anger. d. awareness of anger. 52. What accurately reflects research findings about antioxidants (vitamins, minerals, and other nutrients that prevent oxidation) relative to protection against cardiovascular disease? a. Antioxidants do not have health benefits substantiated by research. b. Antioxidants are more effective from foods than from supplements. c. Antioxidants give health benefits, but not cardiovascular protection. d. Antioxidants are more effective from supplements than from foods.

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Chap_09_10e 53. What is the term that refers to any damage to the myocardium as a result of insufficient blood supply? a. Coronary heart disease b. Coronary artery disease c. Stroke d. Hypertension 54. Which of the following food comprises a diet that offers protection against cardiovascular disease? a. Fried fish b. Broiled fish c. Chocolate d. Sugar 55. Grace owns a large manufacturing firm. She is competitive, nearly always angry, and constantly in a hurry to get things done. Grace's greatest risk for heart disease is a. her anger. b. the many decisions she has to make. c. her sense of urgency related to time. d. her competitiveness. 56. What vessels carry oxygenated blood from the heart to various parts of the body? a. Veins b. Capillaries c. Arteries d. Arterioles 57. Which ethnic group has the highest risk for cardiovascular death? a. Native Americans b. Hispanic Americans c. African Americans d. European Americans 58. Other than advancing age, what is the single most important risk factor for cardiovascular disease? a. Gender b. Hypertension c. High cholesterol d. Ethnicity

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Chap_09_10e 59. The advantages of physical activity to protect against heart disease a. appear in middle-aged individuals but not young adults. b. appear in older adults but not middle-aged or young adults. c. appear in young adults, but decrease over the lifespan. d. appear during childhood and continue over the lifespan. 60. Being economically marginalized a. does not correlate with other risk factors for stroke. b. does not correlate with other risk factors for CVD. c. does not correlate with other risk factors for hypertension. d. correlates with other risk factors for stroke, CVD, and hypertension. 61. A higher risk of having a heart attack is predicted consistently for people everywhere in the world by which of these? a. Having a car b. Having a TV c. Having a strenuous job d. A and b, not c 62. What measurement of blood pressure represents the pressure generated by the heart’s contractions? a. Hypertension index b. Diastolic c. Systolic d. Presystolic 63. What may help explain the gender gap in heart disease during middle age? a. Women have higher total cholesterol levels. b. Women have higher HDL levels. c. Women have higher LDL levels. d. The balance of total cholesterol to HDL is more even in males. 64. For people who are obese and hypertensive, a. losing weight is more important than lowering blood pressure. b. losing weight is likely to raise their blood pressure. c. losing weight is likely to lower their blood pressure. d. drastic weight loss is likely to be dangerous.

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Chap_09_10e 65. What kinds of fish in one’s diet can help to protect against cardiovascular disease? a. Fish that have high omega-3 fatty acids b. Fish that have high omega-6 fatty acids c. Fish that have high amounts of mercury d. Fish that have been fried in preparation 66. Carrie and her girlfriend argued last night, and this argument led to the end of their relationship. A week later, Carrie is thinking about the argument and is replaying everything she said over and over again. This type of self-focus is called a. expressed anger. b. reactivity. c. depression. d. rumination. 67. In the INTERHEART Study and other research, what is chronic stress a risk factor for? a. Hypertension and coronary artery disease alone b. Hypertension and stroke alone c. Coronary artery disease but not sudden cardiac death d. Hypertension, coronary artery disease, stroke, and sudden cardiac death 68. Taking anti-inflammatory drugs such as aspirin lowers the risk for CVD because a. anti-inflammatory drugs make the blood more acidic, which dissolves blood clots. b. anti-inflammatory drugs lower blood pressure, which is an important risk factor. c. anti-inflammatory drugs lower cholesterol, which is an important risk factor. d. anti-inflammatory drugs reduce inflammation, which is a risk for CVD. 69. In contrast to older people, what measurement would indicate a younger person was at significant cardiovascular risk? a. High diastolic pressure b. Low diastolic pressure c. High systolic pressure d. Low systolic pressure 70. All of the following factors predict development of cardiovascular disease and also failure to adhere to rehabilitation after a cardiac event EXCEPT a. depression. b. smoking. c. obesity. d. anxiety.

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Chap_09_10e 71. Myocardial infarctions a. are commonly known as heart attacks. b. are seldom life-threatening, but serve as a signal of possible heart disease. c. result from loss of oxygen to the brain. d. are commonly known as strokes. 72. In comparison with heart attack patients who do not participate in a cardiac rehabilitation program, those who do a. have lower death rates from cardiovascular disease. b. have an increased rate of nonfatal heart attacks. c. have an increased rate of fatal heart attacks. d. have lower death rates from heart disease but higher death rates from stroke. 73. Kelly currently eats a diet that consists mainly of red meat, junk food, and soda. To lower her risk of heart disease, she should a. maintain the same diet but also increase her intake of carbohydrates. b. maintain the same diet but also increase her intake of fruits and vegetables. c. reduce her intake of red meat, junk food, and soda and increase her intake of fruits and vegetables. d. reduce her intake of red meat, junk food, and soda and increase her intake of carbohydrates. 74. When health care researchers refer to problems in glucose metabolism, they are describing a. either Type 1 diabetes or Type 2 diabetes. b. obesity. c. elevated blood pressure. d. elevated cholesterol. 75. Dinesh’s doctor tells him that his arteries have hardened. The more technical term for this would be a. atherosclerosis. b. arteriosclerosis. c. myocardium. d. cardiac attack. 76. With regard to obesity and heart disease, it can be accurately stated that a. obesity is causally related to heart disease. b. obesity is an independent risk factor in heart disease. c. obesity is related to hypertension, which is related to heart disease. d. obesity is a variable that has not been found related to heart disease.

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Chap_09_10e 77. Cardiac patients experience a number of psychological problems following heart surgery. The most common of these are a. paranoia and delusions. b. anxiety and depression. c. anxiety and low self-esteem. d. anger and sleep disturbances. 78. What factor may be related to higher rates of hypertension among African Americans? a. Obesity b. Cardiac reactivity c. Hostility d. Optimistic bias 79. What personality type has a behavior pattern which has been demonstrated to predict physiological factors related to plaque development in arteries? a. Type A personality b. Type B personality c. Type C personality d. Type D personality 80. How does education most likely relate to CVD? a. Low educational levels cause CVD. b. High educational levels protect against CVD. c. Educational level is related to smoking, which is a risk factor for CVD. d. Educational level does not predict CVD. 81. In which form(s) does tobacco present a risk for CVD and heart attack? a. Smoking tobacco b. Chewing tobacco c. Breathing in secondhand smoke d. All of the above 82. Marriage seems to offer some people some protection against heart disease. The best explanation for this protection is that marriage is related to social support which in turn relates to _____. a. income level b. lower levels of tobacco use c. seeking health care d. healthier diet

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Chap_09_10e 83. The component of Type A personality that is most associated with risk for cardiovascular disease is a. competitiveness b. a sense of urgency. c. hostility. d. acquisitiveness. 84. Researchers have found that cardiac patients who completed rehabilitation programs a. lowered their physiological but not their psychological risks. b. lowered their depression levels but raised their anxiety levels. c. lowered their anxiety levels but did not lower their depression. d. lowered anxiety and depression and raised their sense of control. 85. The fifth most frequent cause of death in the United States, a result of oxygen deprivation to the brain, is ___________. a. a stroke b. hypertension c. angina pectoris d. a myocardial infarction 86. When Dean Ornish placed cardiac patients on a diet that allowed only 10% of calories from fat, he found a. a higher mortality rate among those participants than among a control group. b. lower mortality rates for the experimental group, but no regression in coronary artery plaque. c. most patients in the experimental group reduced the plaque in their coronary arteries. d. drugs were more effective than diet was for reducing coronary artery plaque. 87. Among things that can cause a stroke, which one can cause hemorrhagic stroke or death if it ruptures? a. A narrowing in an artery b. A hardening in an artery c. An embolism in an artery d. An aneurysm in an artery 88. With regard to serum cholesterol levels and risk of heart disease among middle-aged people, research suggests that a. cholesterol level may not be a risk factor for cardiovascular disease. b. total cholesterol to HDL ratio may be more important than total cholesterol. c. low-density lipoproteins may protect people against cardiovascular disease. d. maintaining a high ratio of total cholesterol to HDL is most desirable.

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Chap_09_10e 89. What factor contributes to inflammation, and may also increase the risk for cardiovascular disease? a. Anxiety b. Insomnia c. Stress d. Diabetes 90. Currently, most authorities believe that the most critical element in linking cholesterol to cardiovascular disease is a. a balance of total cholesterol to HDL. b. a balance of LDL to HDL levels. c. total HDL level. d. total LDL level. 91. Which of these strategies would NOT ordinarily be recommended to heart patients? a. Resumption of sexual activities b. High-protein diet c. Physical activity d. DASH diet 92. According to the Framingham study, what was positively related to cardiovascular disease? a. High total cholesterol level b. Low total cholesterol level c. High-density lipoprotein level d. Low-density lipoprotein level 93. What is a risk factor for cardiovascular disease, which is associated with the occurrence of a second, fatal heart attack among older people? a. Loneliness b. Anxiety c. Gum disease d. Reactivity 94. Including both heart disease and stroke, what percentage of deaths in the United States are due to cardiovascular disease? a. 10 b. 30 c. 50 d. 75

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Chap_09_10e 95. What type of diet has research estimated can reduce heart disease by 30% worldwide? a. A diet high in fish b. A diet high in fruits and vegetables c. A diet rich in antioxidants d. A diet rich in chocolate 96. What is true of adherence in cardiac rehabilitation programs? a. Lack of adherence is not a consistent problem with cardiac rehabilitation programs. b. Males tend to adhere less than females in cardiac rehabilitation programs. c. Exercise-based programs tend to be adhered to at greater rates. d. Patients who are most in need of intervention tend to be most likely to adhere. 97. The single best predictor for heart attack and stroke is a. obesity. b. hypertension. c. lack of exercise. d. high cholesterol. 98. The role of the health psychologist in cardiac rehabilitation is MOST likely to include a. assisting in surgery. b. implementing the exercise component of the program. c. helping patients make and sustain lifestyle changes to lower risk. d. designing and implementing dietary changes. 99. Between 1920 and 2002, death rates from cardiovascular disease a. increased gradually. b. increased markedly. c. decreased dramatically. d. remained about the same. 100. Individuals from economically marginalized backgrounds are at a(n) increased risk for cardiovascular disease, and this finding can be explained by ______________. a. cultural differences b. psychological factors c. modifiable lifestyle factors d. genetic differences 101. Which of these is NOT part of the Type D personality? a. An exaggerated sense of time urgency b. Social inhibition c. Negative emotionality d. Distress Copyright Cengage Learning. Powered by Cognero.

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Chap_09_10e 102. Jacquinta is a 22-year-old college student who smokes, eats high-fat foods, and doesn't exercise. She knows that heart disease is the leading cause of death in the United States, yet she views his chances of dying of heart disease as near zero. Weinstein would call Jacquinta’s attitude a. blind faith. b. unconscious denial. c. optimistic bias. d. a rationalization. 103. Research most strongly suggests that anxiety and depression are a. negatively related to the development and progression of heart disease. b. positively related to the development but not progression of heart disease. c. positively related to the development and the progression of heart disease. d. unrelated to the development of or to the progression of heart disease. 104. The disorder that includes the formation of plaque in the arteries is a. angina pectoris. b. atheromatous fatigue. c. atherosclerosis d. arteriosclerosis. 105. In low- and middle-income countries, what is the current status of mortality rates from heart disease and stroke, and why? a. They are rising because of the lack of medical treatment in these countries. b. They are rising as lifestyles become more like those of higher-income nations. c. They are stable as better lifestyles and less healthcare cancel out each other. d. They are falling as these countries are acquiring better medical technologies. 106. Why do African Americans tend to have higher blood pressure than European Americans? a. African Americans tend to have a diet higher in salt. b. African Americans tend to have a diet lower in fat and higher in fiber. c. African Americans tend to have larger and more cohesive families. d. African Americans tend to experience the effects of racial discrimination. 107. The 1964 Surgeon General’s report on the dangers of smoking was one of the studies that led to widespread lifestyle changes and lowering of cardiovascular disease rates. The other influential study was a. the Chattanooga Cardiovascular Prevention Trial. b. the 1965 Surgeon General’s report. c. the Framingham Heart Study. d. the Chattanooga Cardiovascular Prevention Trial.

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Chap_09_10e 108. Individuals with few people in their social networks a. are more than twice as likely to die of coronary artery disease than those with larger social networks. b. are approximately half as likely to die of coronary artery disease as those with larger social networks. c. are at a higher risk for cardiovascular disease if they are also married. d. are not at an elevated risk for cardiovascular disease unless they also received high scores for loneliness. 109. During recent decades, death rates from cardiovascular disease a. have been quite consistent across all nations of the world. b. dropped faster in Eastern Europe than in the United States. c. have been higher for Russian women than for Russian men. d. increased greatly in the former USSR but are now dropping. 110. If you drink and smoke and wish to lower your risk for cardiovascular disease, the BEST course of action would be to a. ignore inherent risks because you can't change them anyway. b. concentrate mostly on inherent risks, because you may be able to change them if you expend sufficient effort. c. stop drinking alcohol completely but keep smoking socially. d. monitor your blood pressure and take measures to lower it if it is at or above the prehypertension level. 111. Discuss some characteristics, measurement, and forms of cholesterol and their relationship to cardiovascular disease (CVD).

112. Define inherent risk factors. Identify four major inherent risk factors for CVD, and summarize one or more characteristics of each.

113. What behaviors can alter the risk for cardiovascular disease?

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Chap_09_10e 114. Summarize the components and functions of the cardiovascular system, and some disease processes and conditions that can predict or cause heart attacks or strokes.

115. Discuss the behavioral contributions to the physiological condition of hypertension and how this physiological condition relates to the development of cardiovascular disease.

116. Describe some interventions designed to lower serum cholesterol as a means of preventing CVD.

117. Evaluate the Type A behavior pattern, including its success and shortcomings in predicting coronary heart disease.

118. Define behavioral cardiology and explain its relation to reducing CVD risk. Identify several types of behavioral interventions to modify psychosocial risk factors for CVD.

119. What is the role of health psychology in cardiac rehabilitation?

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Chap_09_10e 120. Discuss the relationship between changes in lifestyle and decline in cardiovascular disease in the United States and other industrialized nations.

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Chap_09_10e Answer Key 1. False 2. False 3. False 4. True 5. True 6. False 7. True 8. True 9. True 10. False 11. b 12. c 13. c 14. b 15. a 16. b 17. b 18. b 19. b 20. c 21. b 22. d 23. a 24. c 25. b 26. a

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Chap_09_10e 27. b 28. d 29. b 30. d 31. d 32. b 33. d 34. b 35. a 36. c 37. a 38. d 39. d 40. c 41. c 42. d 43. c 44. d 45. c 46. a 47. b 48. d 49. d 50. a 51. c 52. b 53. a 54. b Copyright Cengage Learning. Powered by Cognero.

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Chap_09_10e 55. a 56. c 57. c 58. b 59. d 60. c 61. d 62. c 63. b 64. c 65. a 66. d 67. d 68. d 69. a 70. d 71. a 72. a 73. c 74. d 75. b 76. c 77. b 78. b 79. b 80. c 81. d 82. c Copyright Cengage Learning. Powered by Cognero.

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Chap_09_10e 83. c 84. d 85. a 86. c 87. d 88. b 89. c 90. a 91. b 92. d 93. a 94. b 95. b 96. c 97. b 98. c 99. c 100. c 101. a 102. c 103. c 104. c 105. b 106. d 107. c 108. a 109. d 110. d Copyright Cengage Learning. Powered by Cognero.

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Chap_09_10e 111. A. Cholesterol is a fat-like, waxy substance produced by the liver. As a part of the cell membranes, it is essential for human life. However, too much can contribute to CVD. B. Dietary cholesterol comes from animal food products. C. Serum cholesterol is the level of cholesterol circulating in the bloodstream. D. Dietary and serum cholesterol are related, but not perfectly. E. Serum cholesterol is measured as milligrams (mg) per deciliter (dl) of blood serum. 1. A total cholesterol measure of 200 = 200 mg cholesterol per deciliter of blood serum. F. CVD is not best predicted by total serum cholesterol. G. Several forms of lipoproteins make up serum cholesterol. 1. Low-density lipoprotein (LDL) transports cholesterol from the liver to body cells. 2. High-density lipoprotein (HDL) transports cholesterol from the tissues to the liver. 3. HDL is found somewhat protective against CVD. 4. LDL is believed to promote atherosclerosis. 5. HDL is sometimes called “good cholesterol” and LDL “bad cholesterol.” 6. Very low-density lipoprotein (VLDL) is another name for triglycerides. 7. Total cholesterol is calculated by adding HDL, LDL, plus 20% of VLDL. H. A ratio of <4.5:1, i.e. HDL that is c. 20-22% of total cholesterol, lowers CVD risk. I. A ratio of 6:1 in HDL to total cholesterol is associated with higher risk of CVD. J. The focus of much research recently has been changing the diet and/or using drugs to lower LDL. K. Conclusions suggested by cholesterol research: 1. Blood cholesterol and dietary cholesterol are related. 2. Long-term dietary habits are strongly related to the relationship of dietary and blood cholesterol. a. Dietary change can lower serum cholesterol, but this is typically a slow and difficult process. 3. It is important to lower LDL; however, most experts now agree that the ratio of HDL to total cholesterol is more critical in avoiding CVD than total cholesterol alone is.

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Chap_09_10e 112. A. Inherent risk factors come from physiological and/or genetic conditions that cannot be changed readily, like advancing age, family history, gender, and ethnicity. 1. People with inherent risk factors, if identified, can minimize their overall risk profile. 2. Though they cannot control their inherent risk factors, they can control other factors like hypertension, diet, and smoking. B. Advancing age is the primary risk factor for CVD. 1. For every 10 years older they get, older adults’ chance of dying from CVD more than doubles. a. e.g. men >85 are 2.7 times more likely to die of CVD than men aged 75-84, and b. women >85 are c. 3.7 times more likely to die of CVD than women aged 75-84. C. Family history 1. People with a history of CVD in their families are more likely to die of CVD. 2. People with a parent who had a heart attack are more likely to have a heart attack. 3. Familial risk results from the interaction of genetic and environmental factors. D. Gender 1. Gender, albeit an inherent risk factor, is complicated by many related social and behavioral conditions. a. Hence variation in risk for women and men may/may not be inherent. 2. Risk was similar for women and men in 1920, but a gender gap, with men dying younger from CVD than women, emerged in the mid-20th century and continues today. 3. Lifestyle accounts for much of the gender gap in CVD. a. Men have higher rates in their youth of unhealthy lifestyle factors. b. The great variability of gender differences in CVD deaths by country imply behavioral factors rather than inherent biological factors. E. Ethnicity and race 1. African Americans have a much higher risk for CVD death than other Americans. a. Known behavioral, economic, or social risk factors are implicated: b. The INTERHEART Study showed CVD risk factors are the same worldwide. 2. High blood pressure is the strongest risk factor for African Americans. a. Higher cardiac reactivity, secondary to ongoing racial discrimination experiences, is implicated in higher hypertension rates. 113. A. Behaviors that relate to several physiological conditions can alter the risk for cardiovascular disease, as can several behaviors themselves. B. Behaviors that relate to physiological conditions that are risk factors include 1. Eating a diet that prompts weight loss and adhering to medication are important for lowering hypertension, the largest risk factor for CVD. 2. Adhering to the medical regimen is also important for those who take cholesterol-lowering drugs. 3. Making dietary changes can lower cholesterol, and the more drastic the fat reduction in the diet, the more serum cholesterol levels fall. C. Behaviors that can reduce the risk include 1. Abstaining from cigarette smoking, which is the most important behavioral factor. 2. Eating a healthy diet, one low in fat and high in fruits and vegetables, can prevent high serum cholesterol levels. 3. Changing cynical hostility and the expression of anger can be beneficial. 4. Adopting a stress management program or participating in relaxation training can lower risks.

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Chap_09_10e 114. A. The cardiovascular system includes the heart and blood vessels. 1. The heart pumps blood, circulating it through the body. 2. The circulating blood provides organs, tissues, etc. with oxygen and removes waste products. 3. The coronary arteries supply blood to the heart. B. Atherosclerosis involves plaques forming inside the arteries, narrowing them. 1. Narrowed arteries restrict blood supply, hence oxygen, to the heart muscle (myocardium). 2. Restricted blood to the heart muscle can cause angina pectoris. a. Angina symptoms include chest pain and breathing difficulty. 3. Atherosclerosis leads to coronary artery disease. 4. Blocked coronary arteries can lead to a myocardial infarction, i.e. a heart attack. C. Arteriosclerosis involves hardening of the arteries, i.e. a loss of elasticity. D. Atherosclerosis and arteriosclerosis often occur together. 1. Either or both condition can lead to arterial blockages, i.e. coronary heart disease, and cause heart attacks. E. Obstructed arteries can also cause strokes. 1. Blocking blood flow to the brain deprives the brain of oxygen, causing tissue death. 2. In addition to atherosclerosis and arteriosclerosis, a stroke can be caused by: a. an embolism (e.g. an air bubble, a blood clot, an infection, etc.) b. an aneurysm: a weakened arterial wall can balloon out; if it ruptures, it can cause hemorrhagic stroke or death. F. Atherosclerosis and arteriosclerosis not only cause heart attacks and strokes by restricting blood flow to the heart and brain; by narrowing and stiffening the arteries, they also raise the blood pressure. Hypertension, i.e. high blood pressure, also leads to CVD, heart attacks, and strokes. 115. A. Hypertension is the strongest risk factor for CVD. 1. Its cause is not understood, so behavioral contributions cannot be confirmed. 2. It relates to obesity, and weight reduction often lowers blood pressure. 3. Management of hypertension may involve taking medication, restricting sodium intake, reducing weight, becoming physically active, and controlling stress, all of which involve behaviors. 4. Lowering blood pressure into the normal range lowers the risk for heart attack and stroke. 116. A. Dietary changes 1. Eating foods low in saturated fat 2. Eating many fruits and vegetables B. Regular physical activity C. Although diet and exercise can prevent high cholesterol and manage cholesterol levels, if someone has already developed high cholesterol, these alone are typically insufficient to lower it to an acceptable level. A. Statins and other drugs that physicians can prescribe are effective for lowering LDL and reducing CVD risk and mortality. 1. Disadvantages of drugs include their side-effects, cost, and prescription requirement. E. Complexities of recommendations for lowering cholesterol: 1. Drugs are less likely effective without also changing behaviors. 2. Lifestyle changes should be made first, especially for low-risk patients. 3. Diet and exercise can improve HDL to total cholesterol ratio and lower LDL. 4. Statin drugs tend to lower LDL, but not to raise HDL. a. For people with resistant and/or very high cholesterol, these drugs help. 5. Lowering cholesterol should be regarded more urgently by people with hypertension, smoking, diabetes, and other multiple risks for CVD. Copyright Cengage Learning. Powered by Cognero.

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Chap_09_10e 117. A. The concept of the Type A behavior pattern 1. The term was originated by cardiologists Friedman and Rosenman. 2. The concept included a pattern of behavior characteristic of coronary patients. B. During the early years of its history, the Type A concept found research support as a coronary risk factor, but research began to isolate components of the Type A pattern rather than the global Type A behavior pattern. 1. Cynical hostility was the first component singled out. 2. Later research indicated that anger rather than hostility is a better predictor of CVD. 3. More recent research has indicated that anger is a predictor of heart disease for some people but not for everyone. 118. A. Some experts advocate for developing behavioral cardiology; 1. i.e. screening people for psychological risks of CVD, and 2. recommending psychological interventions for: a. reducing depression and anxiety b. managing anger and stress. 3. Research shows CVD is less likely to recur in patients with more positive attitudes. B. For anger, clinical health psychologists recommend: 1. Learning awareness of others’ cues that trigger angry reactions 2. Departure from provoking situations before they can get angry 3. Distraction from provoking situations by doing something else 4. Using self-talk during interpersonal interactions to gain perspective 5. Using (nonhostile) humor to defuse anger 6. Practicing relaxation techniques, e.g.: a. Deep breathing exercises b. Progressive muscle relaxation c. Tension reduction training d. Guided imagery 7. Discussing feelings constructively with others C. For depression, health psychologists recommend: 1. Talking with a therapist about feelings. 2. Screening for depression among people at risk for CVD is urgently needed. a. This is because physicians may not always recognize depression. 3. People who have experienced heart attacks or other CVD events are more often depressed. a. These patients may be more willing to make changes to prevent a recurrence. 119. A. Cardiac rehabilitation programs have the goals of changing behaviors to reduce CVD risks and helping patients deal with psychological reactions to their condition. B. The lifestyle changes that health psychologists can help with include 1. Smoking cessation. 2. Eating a healthy diet. 3. Becoming physically active. 4. Adhering to medication regimen. C. Psychological reactions that often accompany heart attack include 1. Depression, and counseling can help. 2. Changed marital and family relationships, and psychological interventions can help. 3. Adherence to the rehabilitation program is important, and psychologists are involved in ways to boost compliance.

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Chap_09_10e 120. A. Cardiovascular disease (CVD) is the leading cause of death in the United States and other industrialized nations, and 30% of deaths are due to CVD. B. Deaths from CVD have declined from their high in the mid-1960s, and both lifestyle changes and medical care have contributed to the decline. C. This decline has occurred in some industrialized countries but not in others. 1. This decline has occurred in the United States, Finland, and other high-income Western countries. 2. In countries of the former Soviet Union, rates of CVD had risen dramatically, especially among middle-aged men, but began dropping in many of these countries during the first decade of the 21st century. D. About 44% of the decline in CVD is related to changes in lifestyle, and about 47% is due to improvements in medical care. 1. The rate of heart attacks has decreased, and this decrease seems to be related to changes in lifestyle. 2. Some decline in CVD mortality is due to improved medical procedures: the survival rate for those who have had heart attacks has increased.

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Chap_11_10e Indicate whether the statement is true or false. 1. AIDS is one of the top 10 leading causes of death in the United States. a. True b. False 2. Alzheimer’s caregivers experience distress and poor physical health, but this decreases as soon as care giving ends. a. True b. False 3. The progression from HIV infection to AIDS runs a similar timeline for every person—around 10 years. a. True b. False 4. Individuals who experience meaning and personal growth through loss and grief may also experience less depression and greater well-being. a. True b. False 5. In the United States, prevalence of HIV is increasing while incidence is decreasing. a. True b. False 6. Both early-onset and late-onset Alzheimer’s disease have a genetic component. a. True b. False 7. People with insulin-dependent diabetes mellitus often “outgrow” their diabetes. a. True b. False 8. There are set stages of feelings and emotions that individuals pass through as they grieve for a loved one. a. True b. False 9. Type 1 diabetes requires a special diet; Type 2 diabetes does not. a. True b. False 10. The primary goal of asthma is minimizing the individual’s asthma attacks. a. True b. False

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Chap_11_10e Indicate the answer choice that best completes the statement or answers the question. 11. Death from AIDS is due to a. a direct effect of the deadliness of the human immunodeficiency virus (HIV). b. the destruction of the immune system, leaving people vulnerable to a variety of infections, any of which can be fatal. c. poor medical care for those infected. d. the tendency of those who are infected to avoid medical care until a critical stage of infection has already been reached. 12. Donna has been experiencing night sweats, swollen lymph nodes, fever, loss of appetite, persistent diarrhea, a painful skin rash, and white spots in her mouth. She is currently in a monogamous relationship with her girlfriend, whom she has known for six months. As her friend, what should you tell her? a. That women in monogamous sexual relationships do not contract HIV b. That she should get plenty of bed rest until her symptoms disappear c. That she should go and get tested for possible infection with HIV d. That she is probably in the first stage of infection with HIV 13. What health problem is NOT associated with diabetes? a. Cardiovascular disease b. Blindness c. Kidney disease d. Gum disease 14. Barbara’s daughter was recently diagnosed with diabetes. What can be the best course of action her family could take? a. Treat her as someone who is unique because of her diabetes b. Establish a routine that minimizes Barbara’s anxiety in relation to treatment c. Tell Barbara’s siblings never to fight with their sister d. Both a and b 15. In contrast to people with acute illnesses, those with chronic disorders are more likely to a. develop a hopeless attitude toward their condition. b. accept their physician's authority. c. comply with medical advice. d. be aware of their disease.

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Chap_11_10e 16. All of the following are risk factors for asthma EXCEPT a. obesity. b. a sedentary lifestyle. c. living in a city. d. living in a rural area. 17. Early-onset Alzheimer's disease seems to be due to a. a genetic defect. b. an accumulation of stressful life events. c. an unusually high number of childhood illnesses. d. an immune deficiency. 18. Behaviors that will protect the largest number of people against HIV include a. limiting the number of sex partners and not sharing needles. b. avoiding giving blood or having blood transfusions. c. avoiding close contact with infected people. d. getting an HIV vaccine. 19. One of the difficulties that children and adolescents face in coping with diabetes is that a. most parents resist acceptance of the child’s disorder. b. they do not have the cognitive sophistication for planning their regimens. c. they may resist adhering to dietary restrictions and exercise requirements. d. children fear the long-term complications of diabetes. 20. In addition to memory loss, behavioral symptoms of Alzheimer’s disease most commonly include: a. passive, apathetic behavior. b. being too trusting of others. c. engaging in dangerous acts. d. delusions, not hallucinations. 21. What have researchers found in offering dignity therapy to terminally ill patients? a. Dignity therapy benefits Eastern patients more than Western patients. b. Dignity therapy benefits Western patients more than Eastern patients. c. Dignity therapy benefits both Eastern and Western patients the same. d. Dignity therapy benefits neither Eastern patients nor Western patients. 22. All of the following decrease an individual’s risk for Alzheimer’s disease except a. physical activity. b. cognitive activity. c. depression. d. low levels of alcohol consumption. Copyright Cengage Learning. Powered by Cognero.

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Chap_11_10e 23. What is true about the dying role that some researchers (cf. Emanuel, Bennett, & Richardson, 2007) have proposed? a. The dying role is an extension of the sick role. b. The dying role is the opposite of the sick role. c. The dying role has no rights or responsibilities. d. The dying role has many forms, all unhealthy. 24. Which ethnic group has the highest rates of asthma? a. European Americans b. African Americans c. Asian Americans d. Hispanic Americans 25. What is true of the relationship between heterosexual contact and HIV infection? a. Heterosexual contact is not a major source of HIV infections in the United States. b. Heterosexual contact is a leading source of HIV infection in both the United States and Africa. c. Heterosexual contact is responsible for more HIV infections in the United States than anywhere else in the world. d. Heterosexual contact which results in HIV infection affects European Americans at a disproportionately high rate. 26. What is a difference between asthma and other chronic lung diseases like emphysema or chronic bronchitis? a. Not all of these diseases involve inflammation. b. People with asthma have continuous symptoms. c. Other lung diseases have continuous symptoms. d. Unlike the others, asthma does not cause death. 27. Males who meet for sex via smartphone apps a. have sex without condoms far more than those who meet in other ways. b. use condoms far less than those who meet through the Internet, and not an app. c. have sex without condoms far less than those who meet in other ways. d. do not use condoms more or less than those who meet in other ways. 28. A chronic intermittent disorder that causes constriction of the bronchial tubes, thus preventing air from passing freely, is a. asthma. b. chronic obstructive pulmonary disease. c. pneumonia. d. influenza.

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Chap_11_10e 29. During the decade from 1995 to 2005, the incidence of HIV infection grew fastest for a. male-male sexual contact. b. male-female sexual contact. c. injection drug use among men. d. injection drug use among women. 30. Identical twins Howard and Harold both retired at age 66. Howard liked to spend some of his leisure time solving challenging math and word puzzles, while Harold preferred to watch TV. Based on research findings, how does this relate to their respective risk of developing Alzheimer’s disease? a. Their risk would be identical as they were identical twins. b. Harold would have a higher risk due to his leisure activity. c. Howard would have a higher risk due to his leisure activity. d. Their risk would not differ on the basis of a leisure activity. 31. The concept of the “good death” a. includes control over end-of-life issues. b. restricts access to palliative care. c. includes continued life-support measures. d. All of the above 32. What type of sensory stimulation therapy may be most beneficial for Alzheimer’s patients? a. Music b. Aromatherapy c. Exposure to sunlight d. Muscle relaxation training 33. Research studies find very little evidence to support that adjustment to chronic disease a. is a process that is dynamic in nature. b. is a process that is variable by nature. c. is a process that has many influences. d. is a process that involves passing through a stage model. 34. What percentage of people diagnosed with diabetes have Type 1 diabetes? a. Less than 10% b. 30% c. 50% d. More than 90%

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Chap_11_10e 35. Which is true regarding how the quality of death affects those left behind? a. Spouses of those who died a “good death” experience less anger. b. Spouses of those who died a “good death” experience less yearning. c. Spouses of those who did not die a “good death” experience less anger. d. Spouses and family of those who died a “good death” felt little grief. 36. Which of the following is NOT likely to result in HIV infection? a. Sharing eating utensils with someone who has the infection b. Getting a blood transfusion from someone who is infected c. Having sexual intercourse with someone who is infected d. Sharing a needle with someone who is infected. 37. Priya, a 10-year-old 5th-grade student, has been diagnosed with Type 1 diabetes. Which of these added problems would be of LEAST concern? a. Losing significant levels of cognitive functioning b. Adopting an eating schedule with regular times c. Refraining from eating some of her favorite foods d. Adopting a regular program of physical exercise 38. For a person with a terminal illness, a personal re-examination of his or her life a. usually leads to disintegration and despair. b. often causes a loss of personal relationships and social support. c. may lead the person to realize a new meaning in his or her life. d. is typically different for patients with cancer than heart disease. 39. Hypothetically, if all cases of Type 2 diabetes were eliminated, and Type 1 diabetes diagnoses were the same as in 2011 (CDC), how would this affect diabetes prevalence? a. It would decrease diabetes cases to a small minority of what they are now. b. It would reduce diagnosed diabetes cases to about half what they are now. c. It would hardly make any difference in the total number of diabetes cases. d. It would lower its incidence in new cases without affecting its prevalence. 40. The largest risk factor for Alzheimer’s disease is _______. a. genetics b. age c. body weight d. ethnicity

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Chap_11_10e 41. Which group currently accounts for more than half of HIV transmissions in the United States? a. Male–male sexual contact b. Male–female sexual contact c. Injection drug use d. Transmission from mother to baby 42. The psychosocial factor most strongly tied to poor diabetes management is: a. lack of social support. b. depression. c. anxiety. d. overly optimistic views of a cure. 43. Anna has had diabetes for over 30 years, is of a healthy weight, and manages her diabetes by regular insulin injections. Anna most likely has a. Type 1 diabetes. b. Type 2 diabetes. c. gestational diabetes. d. adult-onset diabetes. 44. Which of the following suggests that genetic vulnerability interacts with environmental factors to stimulate asthmatic reactions? a. The hardiness hypothesis b. The hierarchy of needs model c. The diathesis-stress model d. The allergy theory 45. Children who grew up exposed to more bacteria and fungi than other children are: a. less likely to have asthma. b. more likely to have asthma. c. more likely to have asthma, but then outgrow it. d. more likely to develop asthma when they are older. 46. Which of the following has been shown to increase a person’s susceptibility to Alzheimer’s disease? a. Apolipoprotein ε4 b. Glucagon c. Insulin level d. White blood cell count

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Chap_11_10e 47. Girish has just received a diagnosis of Type 2 diabetes and has agreed to participate in a cognitive behavioral program to help him cope with his diabetes. This program will a. not be effective if it is administered via the Internet. b. allow Wilford to discontinue taking his medication. c. help Wilford to adhere to a treatment regimen. d. only be effective as a treatment if Wilford is under the age of 25. 48. Studies investigating the effects of dignity therapy for the dying have found that some of the personal elements of the dying role may be _______. a. universal b. overemphasized c. underemphasized d. cultural 49. What is the disorder caused by insulin deficiency? a. Pancreatitis b. Appendicitis c. Diabetes mellitus d. Glucagon 50. Which of the following statements is best supported by the research evidence? a. The number of stressful life events has a direct and powerful effect on blood glucose regulation. b. Stress management makes a small but significant impact on blood glucose levels. c. Stress management is not useful in the management of diabetes, even though stress affects blood glucose levels in most diabetics. d. No evidence has shown a relationship between stress and blood glucose levels. 51. Which of the following can help in improving management of blood sugar levels in diabetes patients? a. Depression b. Stress c. Anxiety d. Both a and b 52. Cesar, an 86-year-old retired farmer, has a good memory and cognitive functioning. As he continues to age, a. his memory and cognitive functioning will markedly improve. b. his memory and cognitive functioning will deteriorate rapidly. c. his chance of developing Alzheimer's disease will rise rapidly. d. his chance of Alzheimer's will be less than for men in their 70s.

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Chap_11_10e 53. HIV usually progresses over a decade or more; the longest phase in its development is characterized by a. a period of latency in which the person experiences few, if any, symptoms. b. symptoms of fever, sore throat, skin rash, and headache. c. a cluster of symptoms, including swollen lymph nodes, fever, fatigue, night sweats, and loss of appetite. d. a CD4+ T-lymphocyte cell count of less than 200. 54. What percentage of Americans infected by HIV can trace their infection to heterosexual contact? a. 5% b. 10% c. 20% d. 25% 55. The largest number of HIV cases in the United States has come through a. male–male sexual contact. b. male–female sexual contact. c. injection drug use. d. blood transfusions. 56. Triggers for an asthmatic attack are LEAST likely to include a. newspaper ink. b. cigarette smoke. c. dust mites. d. chemical sprays. 57. What percentage of children has a chronic physical health problem? a. 1–5% b. 10–15% c. 25–30% d. 50–60% 58. What do most adults exhibit following the death of a loved one? a. resiliency b. acute-recovery c. improvement d. chronic low levels of well-being

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Chap_11_10e 59. Which of the following is the most influential factor in determining the quality of life of someone who is coping with a chronic illness? a. Psychological functioning b. Environmental functioning c. Physical functioning d. Emotional functioning 60. Common to both diabetes and asthma are a. triggers. b. adherence problems. c. insulin injections. d. troubles in breathing. 61. Of the various types of AIDS, the one most frequently found in Africa is a. HIV-1. b. HIV-2. c. HIV-3. d. HIV-4. 62. Which ethnic group has the lowest risk for Type 2 diabetes? a. Native Americans b. African Americans c. Hispanic Americans d. European Americans 63. Those AIDS patients who have better psychological adjustment to their situation a. do not need the help of psychopharmacology. b. are never intravenous drug users. c. have avoidance coping styles. d. have active coping styles. 64. What part of the pancreas produces glucagon and insulin? a. Islet cells b. Mellitus cells c. Diabetes cells d. Both a and b

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Chap_11_10e 65. Murray has stage 4 pancreatic cancer and sets up a trust fund to support his family after he is gone. Which element of the sick role does this demonstrate? a. All three b. Personal c. Practical d. Relational 66. Which of the following makes asthma a serious health problem in America? a. Its mortality rate is high, and also rising. b. It is the biggest cause of child disability. c. It causes the most school absence days. d. Both (b) and (c) do, but (a) is incorrect. 67. The hygiene hypothesis holds that asthma is in part a result of an increasing degree of ________________. a. dust mites b. cleanliness c. cigarette smoking d. industrial pollution 68. The lifestyle changes that are necessary to manage diabetes are essentially a problem of a. adherence. b. stress management. c. weight control. d. exercise. 69. How many American adults live with at least one chronic illness? a. 10% b. 30% c. 60% d. 80% 70. Drugs are most often given to Alzheimer's patients a. to delay the progress of impairment. b. to reverse the cognitive impairment. c. to achieve a positive placebo effect. d. to prevent patients from wandering.

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Chap_11_10e 71. Experts find that most asthma patients a. overuse preventive medications and underuse bronchodilators. b. overuse preventive medications and underuse emergency rooms. c. overuse bronchodilators and underuse preventative medications. d. overuse both preventive medications and emergency rooms. 72. Actress Halle Berry had had a diagnosis of Type 1 diabetes for 18 years when she announced she had eliminated her need for insulin shots through a healthy diet. What is the most likely explanation? a. It is possible to manage Type 1 diabetes by diet and exercise alone. b. It is possible that her diabetes mutated or transformed from Type 1 to Type 2. c. It is likely she was initially misdiagnosed and actually has Type 2 diabetes. d. It is likely she never had diabetes to begin with. 73. Insulin acts to _______. a. stimulate the stomach b. decrease hunger c. increase blood sugar level d. take glucose into cells 74. Possible risk factors for asthma include a. exercising too much. b. growing up in rural China. c. being exposed to fungi and bacteria at a young age. d. being obese. 75. Health psychology's involvement with diabetes has included a. understanding how diabetics conceptualize their illness. b. understanding the effects of stress on blood glucose metabolism. c. helping diabetics understand requirements for managing diabetes. d. All of the above 76. Feelings of loss that Alzheimer’s caregivers experience often begin a. when the patient first receives the diagnosis. b. when the memory loss first becomes apparent. c. when the patient no longer recognizes the caregiver. d. when the patient ultimately dies from the disease.

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Chap_11_10e 77. What age group most benefits from digital interventions (such as a smartphone app) in adherence with treatment protocols for asthma? a. Children and adolescents b. Young adults c. Middle-aged adults d. Older adults 78. With regard to the perception of glucose levels, most diabetics a. develop effective strategies enabling them to predict their insulin needs. b. are in possession of inaccurate beliefs concerning blood glucose levels. c. with Type 1 diabetes have more accurate beliefs than those with Type 2 diabetes. d. would rather turn their care over to professionals than learn self-monitoring. 79. Injection drug use a. is responsible for HIV infection for more females than males. b. is the leading cause of HIV infection worldwide. c. is disproportionately responsible for HIV infections among African Americans and Hispanic Americans. d. dropped from the leading cause of HIV infection to the least likely mode of infection during the late 1990s. 80. Effective measures to prevent transmission of HIV include ways to a. limit the exchange of body fluids. b. cure the infection. c. increase vaccination levels. d. stigmatize people based on their sexual behavior. 81. Which type of coping strategies tends to produce the best results when dealing with the stresses of chronic illness? a. Emotional coping b. Avoidant coping c. Active coping d. Both a and c 82. Psychologists are most likely to help diabetic patients through a. providing them with educational materials. b. regulating their programs of physical activity. c. improving their adherence to treatment regimens. d. teaching them how to self-administer their insulin.

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Chap_11_10e 83. Hodan is finding it increasingly difficult to perform activities of daily living as her terminal illness advances, so she is looking into options for home health care and medical facilities as part of what Emanuel and colleagues (2007) call the practical element of the dying role. She is also struggling with relinquishing her duties as breadwinner, spouse, and parent as part of the a. relational element of the dying role. b. personal element of the dying role. c. psychological element of the dying role. d. emotional element of the dying role. 84. What have researchers found about interventions for increasing adherence to asthma care? a. Educational interventions are more effective than behavioral ones. b. Educational and behavioral interventions are comparably effective. c. Educational components make behavioral interventions work best. d. Educational interventions can work if they are relevant for patients. 85. Acquired immune deficiency syndrome (AIDS) a. is caused by the human immunodeficiency virus. b. is a mutated form of cancer that can be traced back to the early 1900s. c. is an altered form of pneumonia that first appeared in Africa. d. is the cause of the human immunodeficiency virus. 86. What percentage of Alzheimer’s patients report depressive symptoms? a. 5% b. 20% c. 50% d. 80% 87. All of the following were characterized as common responses to bereavement EXCEPT a. being resilient. b. acute-recovery. c. improvement. d. unstably passing through several discrete emotional states. 88. Insulin is a. a neurotransmitter. b. a metabolic hormone. c. an endogenous opioid. d. an exogenous opioid.

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Chap_11_10e 89. Which of the following is NOT a risk for Alzheimer’s disease? a. Having a high educational level b. Having Type 2 diabetes c. Having a head injury d. Having prolonged inflammation 90. The leading cause of death for those with Type 2 diabetes is a. renal failure. b. pancreatic cancer. c. cardiovascular disease. d. renal cell carcinoma. 91. What is meant by “invisible” support for patients with chronic diseases? a. Support that the patient provides for themselves b. Support that neither the patient nor the provider is aware of c. External support that the patient is aware of, but does not acknowledge d. Support that the provider reports offering, but which the patient does not report receiving 92. “If only I could have more time with her, I would make it the best time of her life,” says the spouse of a terminally ill patient. Which of Kübler-Ross’s stages does this reflect? a. Anger b. Denial c. Bargaining d. Depression 93. The primary factor in asthma treatment is a. maintaining adherence to medication. b. changing the patient’s environment. c. smoking cessation. d. early hospitalization. 94. Fiona is a child recently diagnosed with asthma. Her family should a. not emphasize how this disease makes her “special.” b. not disrupt family routines to manage the illness. c. focus on the changes the disease will have to necessitate for the family. d. not try to give the illness a meaning or look for the “silver lining.”

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Chap_11_10e 95. Taking aspirin, ibuprofen, naproxen, or other NSAIDs regularly: a. cannot modify any of the risks for Alzheimer’s disease. b. can modify environmental risk for Alzheimer’s disease. c. can modify the behavioral risk for Alzheimer’s disease. d. can modify known genetic risk for Alzheimer’s disease. 96. Those who show improvement following the death of a loved one usually have gained _______. a. resiliency b. acute-recovery c. improvement d. denial 97. How does age relate to chronic disease? a. There is no connection between aging and incidence of chronic diseases. b. Multiple chronic diseases do not affect younger people in large numbers. c. More than a quarter of children have some chronic physical health problem. d. The prevalence of chronic illness is greatest among those younger than 65. 98. All of the following may be health complications that stem from Type 2 diabetes EXCEPT: a. damage to the retina. b. damage to the kidneys. c. damage to blood vessels. d. damage to short-term memory. 99. Bong has prostate cancer. What is MOST likely to be true of Bong? a. His perception of himself will change. b. He will experience few negative emotions. c. His relationship with his family will be unaffected. d. He will develop clinical depression. 100. Saehee has had diabetes for the past five years, is overweight, and manages her diabetes by attempting to eat healthier and taking daily medication. Saehee most likely has a. Type 1 diabetes. b. Type 2 diabetes. c. gestational diabetes. d. insulin-dependent diabetes.

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Chap_11_10e 101. Ziye has fulfilled roles as a spouse and parent; now she has a terminal illness. According to work by Emanuel and colleagues, what is most likely about her adopting the dying role? a. She should find the dying role to be compatible with her other roles. b. She could have difficulty integrating the dying role with her other roles. c. She will be more likely to require hospice care. d. She will be less likely to require hospice care. 102. Which statement is true of the risk factors for Alzheimer’s disease, CVD, and cancer? a. Many of the risk and protective factors for Alzheimer’s disease are the same as those for cardiovascular disease and cancer. b. Only a few of the protective factors for Alzheimer’s disease are the same as those for cardiovascular disease and cancer. c. None of the protective factors for Alzheimer’s disease are the same as those for cardiovascular disease and cancer. d. None of the risk factors for Alzheimer’s disease are the same as those for cardiovascular disease and cancer. 103. Mario, who has Alzheimer’s disease, becomes distressed when he cannot follow the plot of a movie that he and his family are watching on TV, repeatedly asking them, “What’s going on?!” He is most likely in a. the later stages of the disease. b. any of the stages of the disease. c. the earlier stages of the disease. d. the stage prior to the real disease. 104. What proportion of deaths in the United States did the Centers for Disease Control and Prevention (CDC, 2009) attribute to chronic diseases? a. Around one quarter b. Almost half of them c. Nearly three quarters d. Approximately a third 105. What is the best predictor of quality of life in individuals who are coping with a chronic illness? a. Physical strength b. Psychological function c. Access to analgesic medicine d. Family size

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Chap_11_10e 106. Chronic diseases are more common than acute diseases, and a. fewer people die of chronic diseases. b. adjustment to chronic diseases involves more than treating symptoms. c. chronic diseases are more easily cured than acute illnesses. d. people with a chronic disease are more likely to seek medical treatment. 107. Elisabeth Kübler-Ross proposed five stages of dying. Research has indicated that a. the stage of denial has the longest duration among the five stages. b. people experience described stages, but not in the proposed order. c. most people are likely to skip over the stage of bargaining. d. most people never do arrive at the stage of acceptance. 108. Heterosexual contact is the leading source of HIV infection in _______. a. the United States b. Africa c. Asia d. Russia 109. Some sexual behaviors are more likely to spread HIV infection than other behaviors. Which of the following is the highest risk? a. Kissing b. Penile–anal intercourse with a condom c. Penile–vaginal intercourse without a condom d. Penile–vaginal intercourse with a condom 110. Since 1993, death rates from AIDS in the United States have declined due to a. a drop in the incidence of AIDS. b. a shorter survival time of AIDS patients. c. a vaccine for HIV. d. a decrease in the prevalence of AIDS. 111. Summarize some findings about physiological evidence of Alzheimer’s disease, and some characteristics of age as a risk factor.

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Chap_11_10e 112. Summarize some salient factors in the physiology of diabetes, including types and some risk factors it causes for other diseases.

113. What is the role of health psychologists in the AIDS epidemic?

114. Identify three theoretical explanations for asthma, including some findings that are consistent and inconsistent with one of them; and some known risk factors for asthma.

115. What behavioral factors are important in the management of diabetes?

116. Briefly describe dignity therapy, and some cultural differences in how it was received by terminally ill patients in research studies.

117. Compare the processes involved with adjusting to chronic illness and facing death.

118. What types of behavioral interventions can help Alzheimer’s patients? Their families?

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Chap_11_10e 119. Discuss how the feelings of grief and loss apply to chronic illness. Are there any positive aspects to chronic illness?

120. What are the major challenges to people with asthma in managing their disease?

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Chap_11_10e Answer Key 1. False 2. False 3. True 4. True 5. True 6. True 7. False 8. False 9. False 10. True 11. b 12. c 13. d 14. b 15. a 16. d 17. a 18. a 19. c 20. c 21. b 22. c 23. a 24. b 25. b 26. c

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Chap_11_10e 27. d 28. a 29. b 30. b 31. a 32. a 33. d 34. a 35. a 36. a 37. a 38. c 39. a 40. b 41. a 42. a 43. a 44. c 45. a 46. a 47. c 48. d 49. c 50. b 51. d 52. d 53. a 54. d Copyright Cengage Learning. Powered by Cognero.

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Chap_11_10e 55. a 56. a 57. c 58. a 59. a 60. b 61. b 62. d 63. d 64. a 65. c 66. d 67. b 68. a 69. c 70. a 71. c 72. c 73. d 74. d 75. d 76. a 77. a 78. b 79. c 80. a 81. c 82. c Copyright Cengage Learning. Powered by Cognero.

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Chap_11_10e 83. a 84. d 85. a 86. b 87. d 88. b 89. a 90. c 91. d 92. c 93. a 94. a 95. d 96. a 97. c 98. d 99. a 100. b 101. b 102. a 103. c 104. c 105. b 106. b 107. b 108. b 109. c 110. a Copyright Cengage Learning. Powered by Cognero.

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Chap_11_10e 111. A. Alois Alzheimer (1907) first related post-mortem abnormal neurological findings to pre-mortem psychiatric symptoms. B. Alzheimer’s disease can only be conclusively diagnosed via autopsy. C. Neuroimaging technology can diagnose Alzheimer’s disease nearly 90% accurately. D. Physicians also make provisional diagnoses of Alzheimer’s disease based on behavioral symptoms of memory loss and cognitive impairment. E. Amyloid plaques and neurofibrillary tangles found in the cerebral cortex and hippocampus through microscopic examination during autopsies constitute the physiological evidence of Alzheimer’s disease. F. Age is the largest risk factor for Alzheimer’s disease. 1. Between ages 65 and 85, increasing age correlates positively with increasing incidence of the disease. 2. The disease has a lower prevalence for people under age 75. 3. Prevalence increases to 17% among people aged 75 to 84 and to 32% among people aged 85 and older.. 4. People in their 90s without signs of Alzheimer’s disease are much less likely to develop it than people aged 65-85. 112. A. The pancreas has islet cells that produce hormones including glucagon and insulin. 1. Glucagon raises blood sugar levels by stimulating the release of glucose. 2. Insulin lowers blood sugar levels by stimulating cell membranes to open and allow freer glucose entry into tissue cells. B. Insulin deficiency causes diabetes mellitus. 1. Type 1 diabetes is insulin-dependent diabetes mellitus, an autoimmune disease wherein the immune system destroys the pancreas’s islet cells, making it impossible for the body to produce insulin. It typically emerges before age 30. 2. Type 2 diabetes is non-insulin-dependent diabetes mellitus. The pancreas produces insulin, but the body loses insulin sensitivity and fails to respond. Its development is related to lifestyle factors. Type 2 accounts for 90-95% of all diabetes cases. 3. Gestational diabetes occurs during some pregnancies. It ends with the end of the pregnancy, but presents complications during pregnancy and a higher risk of developing Type 2 diabetes in the future. C. Since diabetics still have high blood sugar even with management, diabetes can lead to other illnesses: 1. Diabetics are twice as likely to develop cardiovascular disease. a. Type 2 diabetes is more likely to cause cardiovascular damage. 2. Diabetics are 17 times as likely to go blind (diabetic retinopathy). 3. Diabetics have twice the risk of pancreatic cancer. 4. Diabetics are more likely to develop kidney disease and kidney failure. a. Type 1 diabetes is more likely to cause kidney damage. 113. A. In AIDS research: 1. Psychologists study behavior, the major mode of transmission of the virus. 2. Psychologists devise interventions to change high-risk behaviors to slow the spread of HIV infection. B. In providing health care: 1. Psychologists offer counseling to those who are considering HIV testing to help them cope with the stress of deciding and learning about their HIV status. 2. Psychologists offer counseling to those who are infected with HIV, helping them manage the distress of the diagnosis. 3. Psychologists offer assistance in helping HIV-positive people to adhere to the complex medication regimen. 4. Psychologists counsel those who are HIV infected so that they will not pass on their infection and so that they will adopt healthier lives. Copyright Cengage Learning. Powered by Cognero.

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Chap_11_10e 114. A. Scientists do not yet understand the cause of asthma. B. Some speculate that asthma may really be multiple diseases with common symptoms but different pathologies. C. Experts believed until recently that asthma was an allergic reaction to substances in the environment. D. Newer research implicates more complex immune system reactions. 1. The diathesis-stress model views asthma as an immune system response caused by a combination of vulnerability and exposure to a substance not usually causing such a response. 2. The hygiene hypothesis views asthma as caused by an exaggerated inflammatory response of the immune system, which modern hygiene has left underprepared to cope with microbes by not allowing babies and children enough exposure to these. a. A refinement of this hypothesis includes both genetic vulnerability and early exposure to environmental substances. b. The hygiene hypothesis is supported by higher asthma rates in developed countries with hygienic environments, e.g. the USA, Sweden, Australia, New Zealand. c. The hygiene hypothesis is not supported by higher asthma risks and rates in the USA’s inner-city areas, where air pollution is higher. d. African Americans are more vulnerable to asthma than other Americans. E. Other known risk factors for asthma: 1. Obesity 2. Sedentary lifestyle 3. Depression 115. A. Both types of diabetes mellitus have the psychological impact of living with an incurable disease, and both require lifestyle changes and self-care in order for these patients to survive. B. Stress is a factor in blood glucose regulation, and stress management may be helpful. C. The way that patients understand the disorder of diabetes affects their behavior, including their perception of symptoms and their personal priorities for symptom management. D. Compliance with medical advice is a critical factor in diabetes. 1. Denial and anger can lead to failures to adhere to prescribed medical regimen, endangering life. 2. The problems of compliance are especially difficult in children and adolescents. 116. A. Dignity therapy is a brief psychotherapy treatment. 1. It gives terminally ill patients an opportunity to reflect on which aspects of their lives matter most, and to record for which things they want most to be remembered. 2. The opportunities offered in dignity therapy relate to the personal elements of the dying role. 3. Scientists have recently evaluated dignity therapy as a means of helping patients address psychological issues in facing death. B. Experimental research with Western participants found they reported improvements in their end-of-life experiences of dignity, quality of life, spiritual wellbeing, and perceptions of appreciation from family members. C. Experimental research with Japanese participants found difficulties providing dignity therapy, because these patients did not want to talk about issues related to dying and death. D. These research findings illustrate cultural influences on the dying role, particularly some of its personal elements. 1. Western patients tend to respond by turning their attention inward, to themselves. 2. Eastern patients tend to respond by turning their attention outward, toward others.

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Chap_11_10e 117. A. Both processes involve loss. 1. People diagnosed with chronic disease recognize the loss of their health and grieve for that loss. 2. People whose children receive a diagnosis of a chronic disease also grieve for the loss of the health of their children. 3. People who receive a diagnosis of a terminal illness usually experience grief as one of the adaptations to impending death. B. Both processes involve adaptation. 1. People with chronic illnesses must make many adaptations, including dealing with the health care system, performing self-care for their disease, renegotiating personal relationships, managing finances, and trying to be as normal as possible. 2. People who are dying must assume the dying role and made adaptations with regard to practical, relational, and personal issues. C. Barriers to both processes come from the health care system. 1. People with chronic illnesses often have trouble negotiating the health care system; that system is oriented toward cures, which do not apply to their situation. 2. People facing death may not have access to palliative care and be trapped in the health care system that is oriented toward cures. 118. A. For patients: 1. A number of drugs for treating Alzheimer's disease are being developed, but currently none offers an effective treatment for the disease. 2. Patients can receive treatment for depression, a common problem among those in the early stages of the disease, but such interventions must take into account the cognitive deficits of Alzheimer’s patients. 3. Sensory stimulation such as music, aromatherapy, and exposure to sunlight may help. 4. Modifying the patient’s environment to help control undesirable behaviors is another helpful strategy. B. For caregivers and families: 1. Programs to help caregivers develop the necessary skills can make caregivers more skilled and confident. 2. Participation in support groups can help with the stress of caregiving. 3. Online resources also offer advice and support for caregivers. 119. A. Feelings of grief and loss often accompany a diagnosis of chronic illness. 1. People experience a transformation when they are diagnosed with a chronic illness, and grief for the loss of their former selves may be part of the changes they experience. 2. Partners of Alzheimer’s patients may begin to grieve for the affected partner at the point of diagnosis. 3. Parents of children diagnosed with diabetes grieve for the loss of their healthy child. B. People with chronic diseases experience reactions similar to those with terminal illness, and those reactions are warranted because chronic diseases are leading causes of death in industrialized countries. C. After the death of a loved one, friends and family experience feelings of grief and loss. D. Some people manage to find positive aspects in chronic illness. 1. Some people with chronic diseases experience positive personal growth as a result of the adaptations that they are prompted to make, finding meaning in the experience of illness. 2. Some caregivers also manage growth-producing experiences during their experience with chronic illness.

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Chap_11_10e 120. A. Asthma is a chronic disease that requires frequent contact with the medical system and adherence to a medical regimen. 1. People with asthma must form a cooperative relationship with their health care providers to develop an individual regimen. 2. Medication may involve taking daily corticosteroids. 3. Learning how to manage attacks is also critical because attacks produce potentially fatal respiratory arrest. B. Asthma also requires lifestyle restrictions. 1. Learning the triggers for attacks and avoiding these substances or situations is important to minimize the number of attacks. 2. Triggers include mold, pollen, dust, animal dander, cockroaches, and other allergens but also emotional situations, stress, and exercise; avoiding these triggers is critical in avoiding attacks. 3. More children than adults are affected by asthma, and avoiding excitement and physical exertion is very difficult for children. C. Even with careful management, people with asthma still have attacks.

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Chap_12_10e Indicate whether the statement is true or false. 1. Genes have been identified that affect smoking behavior, mostly through the effects of genes on neurotransmitters in the brain. a. True b. False 2. Adolescents who use smokeless tobacco are not likely to begin smoking cigarettes. a. True b. False 3. Women have an easier time quitting smoking than men. a. True b. False 4. A student who is 15 pounds over their desired weight (according to a measure of body mass index) but does not smoke has a lower risk of heart disease than a student who smokes two packs of cigarettes a day but is at their ideal weight. a. True b. False 5. Currently, about 33% of the adult population of the United States smokes. a. True b. False 6. Simply informing people of the risks of smoking can normally get most people to quit smoking. a. True b. False 7. Anti-smoking media campaigns are effective, but pro-smoking media campaigns are more effective. a. True b. False 8. Most young people who begin smoking have very little knowledge of the dangers of smoking. a. True b. False 9. Most teenage smokers recognize the dangers of smoking but attribute those dangers to others and not to themselves, a belief called an optimistic bias. a. True b. False 10. Cigarettes were often given away for free to soldiers during World War II. a. True b. False Copyright Cengage Learning. Powered by Cognero.

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Chap_12_10e Indicate the answer choice that best completes the statement or answers the question. 11. What is the second leading cause of death in the United States? a. Cardiovascular disease b. Cancer c. Chronic lower respiratory disease d. Mental illness 12. The use of smokeless tobacco a. carries about the same risks for lung cancer as does cigarette smoking. b. carries about the same risks for heart disease as does cigarette smoking. c. is similar to cigarette smoking in onset, use, social influences, and quit attempts. d. is similar to cigarette smoking in terms of user gender and age and quit attempts. 13. In trying to prevent people from smoking, educational programs such as lectures and government pamphlets a. are generally not very effective. b. generate positive feelings toward smoking. c. are more effective than inoculation programs. d. are more effective with college students than middle school students. 14. A review of media influence on smoking found what type of connection between media exposure and smoking? a. A weak correlation b. A moderate correlation c. A strong correlation d. No real correlation 15. Which of the following has the highest death toll from passive smoking? a. Lung cancer b. Breast cancer c. Heart disease d. Pneumonia 16. Research on smoking, peer pressure, and adolescents suggests that a. antismoking messages serve to decrease smoking rates among groups of friends. b. overt pressure from friends is required to increase the chances a teen will smoke. c. adolescents will smoke to fit in with others, regardless whether pressure is overt. d. media exposure has not been found to influence young teens in starting to smoke.

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Chap_12_10e 17. Researchers have found that which smokers are more likely to continue smoking? a. Smokers who are older b. Smokers who are younger c. Smokers who smoke more d. Both (b) and (c) but not (a) 18. About how many smokers trying to quit on their own are successful? a. 40% of smokers b. 50% of smokers c. 60% of smokers d. 70% of smokers 19. The addictive ingredient of cigarette smoking is a. nicotine. b. acrolein. c. nitric oxide. d. formaldehyde. 20. Studies show that which of these elements make behavioral smoking cessation programs more effective? a. When programs are longer and do not specialize in smoking cessation alone b. When programs are not specialized toward smoking cessation alone c. When programs are shorter and specialize in smoking cessation d. When programs are longer and specialize in smoking cessation 21. The highest rate of per capita cigarette consumption in the United States was in ____ a. 1914 b. 1942 c. 1966 d. 2017 22. The principal function of the respiratory system is to take in oxygen and to eliminate ____. a. leukocytes b. carbon dioxide c. methane d. nitrogen

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Chap_12_10e 23. What is the single deadliest behavior in the history of the United States? a. Overeating b. Driving while intoxicated c. Smoking cigarettes d. Having multiple sex partners 24. Roughly what percentage of adults in the United States smoke cigarettes today? a. 5% b. 15% c. 30% d. 45% 25. The presence of nicotine can be detected in the brain a. as rapidly as 7 seconds after it is ingested by smoking. b. 2 minutes after smoking, 1 minute after intravenous injection. c. not until 30 to 40 minutes after ingestion by smoking. d. of a person who smokes and of one who does not smoke. 26. What bears responsibility for cigarette smoking’s addictive nature? a. Tars b. Nicotine c. Aldehydes d. Carcinogens 27. Nicotine is a. a stimulant. b. a tranquilizer. c. an opioid. d. an aldehyde. 28. When smokers are only allowed to smoke bad-tasting cigarettes, a. people who smoke for relaxation will still smoke these kinds of cigarettes. b. people who are addicted to nicotine will still smoke these kinds of cigarettes. c. people who smoke for pleasure will still smoke these kinds of cigarettes. d. All of the above 29. Which country where tobacco use was popular has successfully eliminated the habit? a. Norway b. China c. The United States d. None of the above Copyright Cengage Learning. Powered by Cognero.

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Chap_12_10e 30. More intensive cessation programs are more expensive; research indicates that a. the expense is worth it—such programs are more effective. b. the expense is not worth it—such programs are no more effective than less expensive ones. c. nicotine replacement is more effective than programs with many components. d. relapse was not a problem for those who participated in an intensive program. 31. Weiyi is a nonsmoking 16-year-old high school sophomore who has a large cigarette-sponsored poster in her bedroom. Compared with nonsmoking Bao, who has no such poster in her room, Weiyi is more likely to a. begin smoking. b. never smoke a cigarette. c. have a pessimistic bias. d. be an only child. 32. Some people smoke because smoking is negatively reinforcing for them. An example of a negative reinforcer would be a. a reduction in tension. b. a feeling of anxiety. c. satisfying manual needs. d. the smell of tobacco smoke. 33. One way that smokers show an optimistic bias is a. believing that their friends are less likely than others to contract cardiovascular disease. b. believing that their brand of cigarettes is less likely to cause disease. c. believing that smoking does not cause cardiovascular disease. d. believing they will not live to age 75 regardless of whether they smoke or not. 34. The decline in the rate of cigarette smoking in the United States can be traced to a. an advertising ban. b. warning labels on cigarette packages. c. increased prices for cigarettes. d. All of the above 35. Nicotine a. decreases the metabolic level. b. increases appetite. c. is solely responsible for the most dangerous health effects of smoking. d. creates the need for a “fix” in addicted smokers.

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Chap_12_10e 36. Long-time smokers who quit a. reduce their chances of dying of heart disease much more quickly than they lower their risk of death from lung cancer. b. reduce their chances of dying of lung cancer much more quickly than they lower their risk of death from heart disease. c. reduce their risk of both lung cancer and heart disease at about the same rate. d. increase their risk of heart disease but decrease their risk of dying of lung cancer. 37. Of the following, which group is more likely to be current smokers? a. Females more than males b. Asian Americans more than Native Alaskans c. Older adults more than younger adults d. Economically marginalized people more than economically privileged people 38. The reinforcement explanation of smoking assumes that, for someone who becomes a smoker, a. the positive consequences outweigh the negative consequences. b. the negative stimulus of one's first attempt at smoking arouses a corresponding positive process. c. the positive stimulus of one's first attempt at smoking arouses a corresponding negative process. d. the individual has not experienced any negative consequences. 39. A behavioral reason that many smokers continue smoking is that they a. receive positive and negative reinforcement. b. are genetically disposed to addiction. c. have pessimistic bias. d. receive intermittent reinforcement. 40. Which of the following diseases is rarely diagnosed among nonsmokers? a. Cardiovascular disease b. Cancer of the prostate c. Cancer of the breast d. Chronic lower respiratory disease 41. The site of oxygen and carbon dioxide exchange is the a. alveoli. b. diaphragm. c. bronchi. d. trachea.

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Chap_12_10e 42. Cigarette smoking in the United States reached its peak per capita consumption a. during the Revolutionary War. b. during the Civil War. c. during the early 20th century. d. during the middle of the 1960s. 43. What is true of smoking and weight gain? a. Smokers do not gain weight while smoking. b. Quitting smoking does not result in weight gain. c. Five years after quitting, former smokers’ weight is similar to those who never smoked. d. Smokers who quit often gain a substantial amount of weight. 44. Andrew, a 22-year-old college senior, wants to quit smoking, but he is worried that he will gain weight. What would you advise him to do? a. Keep smoking; the weight gains associated with quitting are dangerous. b. Adopt a low-carbohydrate diet, and then quit smoking. c. Quit smoking and also start a regular exercise program. d. Smoke on social occasions only 45. As many as 75% of individuals who try to quit smoking are smoking again within ________. a. two days b. one week c. three months d. six months 46. When the nicotine content of cigarettes is lowered, smokers tend to a. smoke the same number of cigarettes. b. smoke fewer of the low-nicotine cigarettes. c. take more puffs of low-nicotine cigarettes. d. take fewer puffs of low-nicotine cigarettes. 47. The half-life of nicotine is ________. a. 7 seconds b. 5 minutes c. 30 minutes d. 10 minutes

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Chap_12_10e 48. How many cigarettes smoked in one’s lifetime does it typically take to make it exponentially harder to quit?. a. 1 cigarette b. 15 cigarettes c. 50 cigarettes d. 100 cigarettes 49. Heavy cigarette smoking decreases life expectancy by almost a. 2 years. b. 5 years. c. 9 years. d. 15 years. 50. Which of the following have researchers found about behavioral smoking cessation programs? a. Client-practitioner contact correlates positively with effectiveness. b. Individual counseling is found more helpful than group counseling. c. Group counseling is found more helpful than individual counseling. d. Psychologists are more effective providers than physicians or nurses. 51. In general, research on the health effects of environmental tobacco smoke (passive smoking) has found that passive smoking a. may slightly increase people's risks for lung cancer. b. neither increases nor decreases risk of lung cancer. c. decreases people's risk for getting lung cancer. d. doubles people's risk for getting lung cancer. 52. What percentage of relative risk of dying from cancer do males who smoke cigars or pipes have, as compared to nonsmokers? a. 5 b. 16 c. 26 d. 50 53. Chris is a smoker. What is likely true of Chris? a. Chris is a man who has a college degree. b. Chris is a woman who has a college degree. c. Chris has parents who do not smoke. d. Chris began smoking as a teenager.

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Chap_12_10e 54. When did cigarette smoking begin to become popular among American women? a. During World War I b. During the 1920s c. During mid-1800s d. During World War II 55. Joe wants to lose weight and has started smoking. What is likely true of Joe? a. Joe will gain weight. b. Joe will lose weight. c. Joe is a middle-aged man. d. Joe is a college-educated woman. 56. A disorder characterized by the obstruction of respiratory passages and loss of bronchial elasticity is a. bronchitis. b. allergy. c. emphysema. d. bulimia. 57. In comparing who quits smoking to who does not quit smoking, all of the following are correct EXCEPT a. males quit smoking more than females. b. younger people quit smoking more than older people do. c. college-educated people quit smoking more than people who do not have a high school diploma. d. most people who try to quit receive social support. 58. Which of the following is the most likely reason Fatwa, a typical 14-year-old American girl, would start smoking? a. Curiosity b. Self-esteem c. Depression d. Anxiety 59. A systematic view of studies on smoke-free workplaces indicates smoke-free workplaces a. increase the number of cigarettes workers smoke at home. b. decrease the prevalence of smoking. c. decrease worker satisfaction. d. increase the number of workers who smoke on breaks.

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Chap_12_10e 60. Ivan has been smoking for 20 years and enjoys the smell of cigarette smoke. For Ivan, the smell of a burning cigarette would be a. a negative reinforcer. b. a positive reinforcer. c. a noxious stimulus. d. an unconditioned stimulus. 61. Compared to nonsmokers, what percentage of relative risk of dying from cancer do males who smoke cigarettes have? a. 5.0 b. 15.8 c. 23.3 d. 50.0 62. Of the following people, who is more likely to gain more weight upon quitting smoking? a. Abel, who is already overweight b. Bella, who is not overweight c. Cris, who smokes two packs of cigarettes a day d. D’Wayne, who has tried to quit many times 63. In general, which lifestyle change would result in a longer extension of life? a. Eating no more than 10% of calories from saturated fat b. Quitting smoking at the age of 35 years c. Beginning an exercise program d. Quitting drinking alcohol 64. Cigarettes contain at least 60 types of _______. a. tars b. nicotine c. aldehydes d. carcinogens 65. Which of these factors is LEAST common to addicted smokers? a. They find quitting to be only moderately difficult. b. They are usually aware of the fact that they are smoking. c. They are seldom aware of the fact that they are not smoking. d. They give inaccurate estimates of the time since their last cigarette.

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Chap_12_10e 66. In the United States, about what percentage of smokers try to quit each year? a. 20% b. 50% c. 75% d. 95% 67. Which of the following is most accurate about the effects of national health campaigns to reduce rates of smoking? a. If the number of people who are exposed to the message is large, many people will quit. b. Television campaigns are no longer effective. c. The price of cigarettes does not affect who smokes. d. Campaigns focused on making smoking unacceptable are not effective. 68. What is true of cigarette consumption in the United States? a. Native Americans have a lower rate of cigarette consumption than Asian Americans do. b. Income barriers make smoking less attractive for people in economically marginalized situations. c. Graduating high school makes it less likely that someone will smoke cigarettes. d. Smoking levels increase with age. 69. What did a 2015 study by Stice and colleagues find about young women whose motivations to smoke included weight concerns? a. Smokers lost more weight by dieting and smoking than by dieting alone. b. Smokers actually gained more weight over time than nonsmokers gained. c. Smokers lost equal weight from smoking as nonsmokers did from dieting. d. Smokers actually lost less weight by smoking and dieting than by dieting. 70. A systematic review of nicotine replacement therapy indicated that this approach is a. less effective than a placebo. b. more effective than a placebo. c. about as effective as a placebo. d. more effective after 4 years than 3 months. 71. How many Americans die every year from tobacco use? a. 25,000 b. 57,000 c. 175,000 d. 480,000

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Chap_12_10e 72. Many of the adolescents who begin smoking a. do not believe that smoking-related hazards apply to them. b. are unaware of the dangers from smoking. c. do so because adults tell them not to smoke. d. do so out of an unconscious death wish. 73. Ingrid wants to quit smoking and asks you for advice. You should tell her a. that programs with the best results include practitioner support, counseling, and nicotine replacement therapy. b. most people who quit cannot do so on their own. c. to seek a trained hypnotist who can help her by using hypnosis. d. if she becomes more fully aware of the dangers of smoking, it will be easier to quit. 74. What group comprises the largest proportion of people who believe that smoking will help them lose weight? a. Pregnant women b. Obese men c. Young women d. Older men 75. Evidence that smoking causes lung cancer comes from data showing that from 1959 to 1988 a. lung cancer death rates for nonsmokers rose steadily. b. lung cancer death rates for nonsmokers fell. c. lung cancer death rates among smokers rose steadily. d. cigarette consumption rose sharply. 76. As many as two thirds of individuals who try to quit smoking on their own relapse after _______. a. two days b. one week c. three months d. six months 77. Pharmacological approaches have largely been shown to be effective in helping smokers quit except in the case of a. female smokers. b. male smokers. c. teenage smokers. d. chronic smokers.

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Chap_12_10e 78. Which of these factors helped to popularize smoking in the United States? a. The availability of ready-made cigarettes b. The development of a “blended” cigarette c. The recommendation of doctors d. All of the above 79. A smoker exhibiting an optimistic bias would a. cut down on the number of cigarettes they smoke per day. b. believe that they are as likely to get lung cancer as other people. c. believe that other smokers may get lung cancer, but they will not. d. believe that smoking causes effects that are positive for their health. 80. What is true about the most effective programs for helping people to quit smoking? a. Pharmacological interventions are more effective than behavioral interventions. b. Behavioral interventions are more effective than pharmacological interventions. c. Pharmacological and behavioral interventions together are more effective than either used singly. d. Both interventions are equally effective, but should not be used in combination with each other. 81. Some ex-smokers "slip" and have one cigarette. Then, they equate this slip with a full relapse and resume smoking at their former rate. This phenomenon is called the a. false relapse effect. b. curious overload effect. c. abstinence violation effect. d. smoking Hawthorne effect. 82. Programs that provide adolescents with information about the risks of smoking a. deter smoking for older teenagers but not for younger ones. b. are more successful than programs for smoking cessation. c. are effective if the messages include graphic images of diseased lungs. d. have little effect because adolescents do not attend to health warnings. 83. The most common chronic lower respiratory disease, which occurs when bronchi lose their elasticity is _______. a. lung cancer b. emphysema c. acute bronchitis d. chronic bronchitis

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Chap_12_10e 84. Than h says that he wants to quit smoking and is considering using nicotine replacement to help him quit. What is your advice to him? a. He should not need any help in quitting; just quit. b. Nicotine replacement therapy is not very effective; save his money. c. Nicotine replacement therapy can help people stop smoking; give it a try. d. Try chewing regular gum rather than chewing the nicotine replacement gum. 85. Which of these is NOT a frequent result of cigarette smoking? a. Poorer balance b. Periodontal disease c. Sharpened cognition d. Neuromuscular impairment 86. Which of the following statements can most be challenged for validity in relation to e-cigarettes? a. Young people think e-cigarettes are safer than traditional cigarettes. b. Young people are using these today more than traditional cigarettes. c. Young people are less likely to quit them than traditional cigarettes. d. Young people who use e-cigarettes are less likely to smoke traditional cigarettes. 87. What is the water-soluble residue of tobacco smoke condensate called? a. Carcinogen b. Aldehyde c. Nicotine d. Tars 88. Long-time employees of one or more of the "5 B's" (bars, bowling alleys, bingo parlors, betting establishments, and billiard halls) a. have as much as an 18 times greater nicotine concentration than other workers. b. have an 11 times greater incidence of lung cancer than do other workers. c. have both the greater concentration and incidence identified in a and b. d. have neither the greater concentration nor incidence given in a or b. 89. People cough in response to smoke because a. coughing expels irritants from the respiratory tract. b. coughing is a substitute for sneezing. c. coughing draws oxygen more deeply into the lungs. d. of the action of the alveoli.

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Chap_12_10e 90. Terrell has been a light smoker for 20 years. If he quits smoking, his mortality risk will a. return to that of a nonsmoker in about two years. b. return to that of a nonsmoker in about 16 years. c. continue to match that of a moderate to heavy smoker. d. become greater than that of a moderate to heavy smoker. 91. Which of the following people is more likely to quit smoking? a. The person who smokes for the pleasure of it b. The person who smokes as a coping strategy c. The person who is also living with a smoker d. The person who lacks social support to quit 92. Which of these smokers exhibits an optimistic bias? a. Amit overestimates the danger of smoking and believes he has a very high chance of developing a smoking-related disease before age 60. b. Shanoz believes that smoking is not really dangerous and she has about the same risk for smoking-related diseases as other people have. c. Former smoker Muhammad overestimates the danger of smoking and believes that she has about the same risk for smoking-related diseases as his chain-smoking sister does. d. Pedro understands the danger of smoking but believes that his risk of getting a smoking-related disease is less than that of other smokers. 93. Who suffer the most health problems from passive smoking? a. Children b. Adolescents c. Young adults d. Middle-aged adults 94. Smokers are more likely to attempt to quit if physicians ____________. a. provide information on the dangers of smoking b. provide information on the success rates in quitting c. advise smokers to quit d. do not try to pressure smokers to quit 95. Nicotine affects the __________. a. central nervous system b. peripheral nervous system c. anterior nervous system d. both a and b

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Chap_12_10e 96. In general, which group of people suffers more respiratory diseases from exposure to secondhand smoke? a. Adult men b. Adult women c. Older parents of smoking children d. Younger children of smoking parents 97. People who smoke a. believe that smoking generally has few negative health consequences. b. believe that smoking has fewer negative health outcomes than drinking. c. believe that smoking is dangerous as much as nonsmokers do. d. have less consistent attitudes about smoking as adults than they do as adolescents. 98. Pamir is upset because she keeps trying to quit, but the stress which accompanies quitting smoking consistently leads to relapse. What is Pamir experiencing? a. Cessation fatigue b. Abstinence violation effect c. Optimistic bias d. Cognitive dysfunction 99. Smokers who are most likely to quit are a. those who are aware of the dangers of smoking but have not been diagnosed with a disease. b. those who have support from their therapists and families. c. those who have been diagnosed with heart disease or cancer. d. people with a small social circle. 100. What is true of smoking and fears of weight gain? a. Gender is not a strong predictor for correlating smoking with fears of weight gain. b. College students do not typically smoke as a means of weight control. c. Weight concern was more of a factor in continuing to smoke for White males than for Black females. d. Men do not smoke as a means of attempting to control their weight. 101. Most people who successfully quit smoking cigarettes do so a. on their own. b. through the use of hypnosis. c. by switching to cigars or pipes. d. by joining Smokers Anonymous.

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Chap_12_10e 102. In general, people smoke a. in order to relax. b. for a variety of reasons. c. to satisfy their oral needs. d. to satisfy a need to use their hands. 103. What is most typical of behavioral approaches toward smoking cessation? a. Behavior modification is more effective than cognitive-behavioral training. b. Most behavioral approaches typically include a combination of strategies. c. Relaxation training and social support work better than contracts or groups. d. Group therapy and stress management are better than behavioral contracts. 104. Gerard died of cancer this year. What are the odds he was a smoker? a. 5% b. 10% c. 30% d. 50% 105. By the time students reach the 12th grade, what percentage of people in their class are frequent smokers? a. 1% b. 5% c. 15% d. 25% 106. According to study findings, what kind(s) of contact will make behavioral programs successful to help people stop smoking? a. Face-to-face contact is the only effective method. b. Computer/web-based contact is best for teens. c. Text messaging is not effective. d. Smokers can quit and avoid relapse through in-person contact, through text messages, and through Internet support approaches. 107. How much money is spent in the United States on smoking-related illnesses and work productivity losses per year? a. Tens of millions of dollars b. Hundreds of millions of dollars c. Billions of dollars d. Trillions of dollars

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Chap_12_10e 108. What would Tom, a heavy smoker, likely do if he had no choice but to smoke lower-nicotine cigarettes? a. He’d likely smoke more cigarettes. b. He’d likely smoke fewer cigarettes. c. He’d likely smoke the same number of cigarettes. d. He’d quit smoking. 109. Esme is 14 years old and has smoked about 200 cigarettes in her lifetime. Esme should know that a. quitting will be quite easy because she is not yet a regular smoker. b. she can smoke for another four or five years and then quit. c. quitting later will be impossible without formal therapy. d. quitting right now will be quite difficult for her. 110. What type of cancer is connected with cigarette smoking? a. Cervical cancer b. Kidney cancer c. Esophageal cancer d. All of the above 111. Do the reasons that people start smoking differ from the reasons that people continue to smoke? A. Different reasons probably underlie starting to smoke and continuing to smoke. B. People may start to smoke as a result of 1. Wanting to achieve a particular image. 2. Wanting to fit in with a group of peers. 3. Seeing family members smoking. 4. Being with friends who smoke. 5. Smoking as a weight control strategy. C. No single reason is sufficient to explain why people continue to smoke. 1. People become addicted to nicotine. 2. Some smoke to increase positive feelings, and others smoke to decrease negative feelings. 3. Some people smoke out of habit, when they find themselves in specific situations. 4. Some people continue to smoke because they fear the weight gain that often accompanies quitting.

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Chap_12_10e 112. Do people who quit smoking gain sufficient weight to pose health hazards? Would they be healthier if they continued to smoke and stayed thinner? A. Smokers believe that they will gain weight if they quit, and they are generally correct. 1. The estimates of weight gain from various studies vary, but the average gain is around 6-11 pounds. 2. Weight gain associated with smoking cessation may be temporary, and many people lose at least part of the weight they gain over the years after they quit smoking. B. Gaining weight is healthier than continuing to smoke. 1. Weight gain that places a person in the obese range is uncommon among former smokers. 2. Quitting smoking is better than adopting a very low fat diet in changing health risk profiles to lower risks of premature death.

113. Evaluate the dangers of passive smoking. A. Passive smoking or environmental tobacco smoke (ETS) is irritating, but for most people in most circumstances, it is not a major health risk. 1. The risk of lung cancer is slightly elevated by passive smoking. 2. The risk of heart disease is elevated by ETS, which presents a more pervasive risk than that from lung cancer. B. Children are at greater danger than adults for illnesses from passive smoking. 1. Infants of smokers are at increased risk of sudden infant death. 2. Infants of smokers are at increased risk of respiratory diseases. 3. Smoking is a danger for the unborn, being associated with low birth weight. 4. The dangers of ETS decrease after children turn 2 years old.

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Chap_12_10e 114. Compare the success of people using behavioral versus pharmacological methods of quitting smoking and point out successful techniques. A. Most people who quit do so on their own and without the help of a formal therapy program, and people who seek therapy are less successful than those who quit on their own. B. Pharmacological approaches can be effective. 1. Nicotine patches, inhalers, lozenges, spray, or gum replace the nicotine formerly available from smoking, helping addicted smokers to quit. 2. Nicotine replacement alone helps smokers to quit. C. Behavioral treatments can be effective. 1. Psychological interventions typically combine several elements, such as behavior modification, contracts between smoker and therapist, cognitive components, booster sessions to prevent relapse, and possibly other components as well. 2. Practitioner support is an effective component of behavioral programs. 3. Both individual and group therapy can be successful. D. Combining nicotine replacement with some behavioral treatment can be more effective than either alone.

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Chap_12_10e 115. Identify and describe several components in cigarette tobacco that are dangerous. A. At least 60 of the at least 4,000 compounds in processed cigarette tobacco are known carcinogens. B. The process of lung damage caused by cigarette smoke is complex and not fully understood yet. C. Nicotine is the pharmacological agent underlying cigarette smoking addiction. 1. Nicotine is a stimulant affecting the central and peripheral nervous systems. 2. Certain receptors in the central nervous system are nicotine-specific. 3. Smoking delivers nicotine to the brain with great effectiveness: it can arrive within 7 seconds of inhaling, faster than by intravenous injection. 4. Nicotine has a 30-40-minute half-life; addicted smokers seldom wait longer than that between smokes. D. Receptors in the brain are stimulated by nicotine to release and metabolize a number of neurotransmitters. 1. These include acetylcholine, dopamine, glutamate, epinephrine, and norepinephrine. Overall, these arouse the cerebral cortex. 2. Beta-endorphins, the brain’s natural opiates, are also released through smoking. 3. Neurotransmitter release may explain the pleasurable effects of smoking. 4. Also, nicotine lowers appetite and raises metabolic level. E. Additional harmful compounds in tobacco include tars and aldehydes. 1. Tars are water-soluble substances left over from condensed tobacco smoke. They contain known and suspected carcinogenic compounds. No amount of tar is safe, so “reduced-tar” cigarettes are not either. a. Though smoking-related disease deaths decline along with tar levels, experienced smokers inhale more deeply and smoke more when using low-nicotine cigarettes, causing increased dangerous tar exposure. 2. Aldehydes are irritating compounds that include acrolein and formaldehyde. a. Formaldehyde is a known carcinogen, damages cells, and disrupts tissue proteins. b. Nitric oxide and hydrocyanic acid are gases released through tobacco smoking. These could be dangerous because they affect oxygen metabolism. F. Consumers encounter an obstacle to knowing the level of health risks from cigarettes: 1. Tobacco companies do not make specific information about cigarette contents available to the public. a. This lack of information also makes it difficult for scientists to determine which specific components of tobacco smoke are connected with which sources of disease and death.

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Chap_12_10e 116. Discuss methods of deterring teenagers from starting to smoke, highlighting the less and more successful strategies. A. Programs that only provide information on the harmful consequences of smoking are not effective in deterring smoking. B. Programs that integrate smoking education into a comprehensive health education program show some success. 1. These programs are usually school-based programs. 2. The programs are more successful if booster sessions occur throughout several years. 3. Programs are more successful when they include some community-wide interventions involving parents, media campaigns, or both.

117. Evaluate the statement, "Social pressure is the main reason people start smoking." A. Social pressure is an important reason why many people start smoking. B. Social pressure comes in many forms. 1. Peers who smoke exert both direct and indirect pressure to smoke. 2. Movies and other media can present an image of smokers that people want to emulate. 3. Family members who smoke increase the likelihood that a child will become a smoker. 4. Indirect social pressure to smoke may come from using smoking as a weight control strategy. C. Factors other than social pressure also influence smoking. 1. Smoking may have some genetic component through involvement with the neurotransmitter dopamine or serotonin. 2. Advertising and marketing make smoking attractive.

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Chap_12_10e 118. Identify two protective factors against health risks from smoking, and nine risk factors for it. Also cite a statistic on tobacco-related deaths in the USA. A. Having smoked fewer than 100 cigarettes in one’s lifetime is protective factor. B. Having smoked between 100-200 cigarettes in one’s lifetime, but not having smoked any in over five years, and not wanting to smoke, also protect against health risks. C. Smoking more than 10 cigarettes daily is a health risk. D. Smoking more than two packs of cigarettes a day (>40 cigarettes) is even worse. E. Believing that smoking’s health risks have been exaggerated is itself a health risk. F. Believing that smoking is likely harmful, but one will stop before realizing those harmful effects, is a health risk. 1. Damage can occur before it is identified. 2. Also, it is notoriously difficult for many people to quit smoking. G. Some people think it is safer to smoke cigars or pipes than cigarettes, but tobacco smoking is still a health risk regardless. 1. People who think health problems are a low risk with smoking cigars or pipes are mistaken. H. Some people think e-cigarettes are safer than paper cigarettes—especially young adults, who are using them more than regular cigarettes now. 1. Although e-cigarettes are not proven harmful, evidence is accumulating that they are. I. Nonsmokers who live with smokers are at risk for health problems from passive inhalation (secondhand smoke). J. People who use chewing tobacco, snuff, or other smokeless tobacco daily are also at risk for health problems. K. Tobacco products are accountable for approximately 480,000 deaths annually in the USA. The majority of these fatalities are from cancer, cardiovascular disease, and chronic lower respiratory disease (i.e. chronic obstructive pulmonary disease/COPD)

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Chap_12_10e 119. Identify and describe three common respiratory diseases that are related to smoking. Briefly explain why health psychologists are especially interested in studying and intervening with cigarette smoking. A. Air pollution, including smoke, causes the respiratory system to secrete extra mucus while inhibiting the system’s protective mechanisms. 1. This makes the respiratory system vulnerable to problems. 2. People cough to expel mucus, but coughing can also irritate the bronchial walls. a. Irritated and/or infected bronchial walls can destroy bronchial tissue and damage the respiratory system. 3. Coughing, irritation, infection, and scar tissue formation in the bronchi are symptoms of bronchitis. a. Bronchitis is included among chronic obstructive pulmonary disease (COPD), aka chronic lower respiratory diseases. b. This group of diseases is the third leading cause of death in America. c. Infection causes acute bronchitis, typically resolved readily by antibiotics. d. Persistent irritation and its underlying cause result in chronic bronchitis. e. While occupational and environmental exposure to pollutants can underlie chronic bronchitis, cigarette smoke is the most major cause. 4. Emphysema is the most common type of COPD. a. When airways are blocked by mucus and scar tissue, the bronchi lose elasticity and collapse, trapping air in the alveoli (air sacs in the lungs where gas exchanges occur). b. Trapped air breaks down alveolar walls, damaging and destroying alveoli, and causing enlargement of those left. c. Damage to and enlargement of alveoli impairs oxygen and carbon dioxide exchange, and restricts blood flow to intact alveoli. d. As the respiratory system loses efficiency, less oxygen is delivered through breathing. e. People with emphysema have trouble breathing. They typically are unable to engage in strenuous physical activity. 5. Lung cancer is another serious disease of the respiratory system. a. The irritation and damage caused by inhaling smoke is the most major factor in the development of lung cancer. B. Health psychologists are especially interested in studying and intervening with cigarette smoking. 1. This is because air pollution and occupational exposure are social problems that people cannot personally control directly, but smoking cigarettes is a voluntary behavior that people can choose to engage in or not. The voluntary nature of smoking makes it the recipient of negative publicity and interventions to help people quit.

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Chap_12_10e 120. How have U.S. smoking rates changed since 1964? Has this change been the same for all age and ethnic groups? A. Cigarette smoking grew throughout the first half of the 20th century. 1. Smoking rates steadily climbed from 1900 until 1966. 2. In 1966, smoking hit its highest rate in the United States; 44% of adults smoked. B. Since the 1964 Surgeon General’s report and the subsequent publicity, smoking rates have declined. 1. Currently, about 16.5% of all adults smoke tobacco; there were slightly more former smokers than current smokers, and more than half had never smoked. 2. More men have been smokers, but more men have quit, and the percentages are closer than in the past; gender is no longer the best predictor of smoking 3. Educational level is currently the best predictor of smoking, but ethnicity and socioeconomic level are related to smoking. a. Native Americans and African Americans smoke at higher rates than Asian Americans and European Americans. b. People with less education smoke at higher rates. c. People below the poverty level smoke at higher rates. 4. Smoking among teenagers increased during the early 1990s, but that increased reversed; however, young adults’ smoking rate is higher than other age groups.

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Chap_12_10e Answer Key 1. True 2. False 3. False 4. True 5. False 6. False 7. True 8. False 9. True 10. True 11. b 12. c 13. a 14. c 15. c 16. c 17. d 18. c 19. a 20. d 21. c 22. b 23. c 24. b 25. a 26. b

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Chap_12_10e 27. a 28. b 29. d 30. a 31. a 32. a 33. b 34. d 35. d 36. a 37. d 38. a 39. a 40. d 41. a 42. d 43. c 44. c 45. d 46. c 47. c 48. c 49. c 50. a 51. a 52. a 53. d 54. b Copyright Cengage Learning. Powered by Cognero.

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Chap_12_10e 55. a 56. c 57. b 58. a 59. b 60. b 61. c 62. a 63. b 64. d 65. b 66. b 67. a 68. c 69. b 70. b 71. d 72. a 73. a 74. c 75. c 76. a 77. c 78. d 79. c 80. c 81. c 82. d Copyright Cengage Learning. Powered by Cognero.

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Chap_12_10e 83. b 84. c 85. c 86. d 87. d 88. a 89. a 90. b 91. a 92. d 93. a 94. c 95. d 96. d 97. c 98. a 99. b 100. c 101. a 102. b 103. b 104. c 105. b 106. d 107. c 108. a 109. d 110. d Copyright Cengage Learning. Powered by Cognero.

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Chap_12_10e 111. 112. 113. 114. 115. 116. A. Programs that only provide information on the harmful consequences of smoking are not effective in deterring smoking. B. Programs that integrate smoking education into a comprehensive health education program show some success. 1. These programs are usually school-based programs. 2. The programs are more successful if booster sessions occur throughout several years. 3. Programs are more successful when they include some community-wide interventions involving parents, media campaigns, or both. 117. 118. 119. 120.

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Chap_13_10e Indicate whether the statement is true or false. 1. Women are more likely than men to seek treatment for problem drinking. a. True b. False 2. The Food and Drug Administration classifies marijuana as a Schedule I drug. a. True b. False 3. A meta-analysis of studies on alcohol confirmed that expectancy plays an important role in alcohol’s effects. a. True b. False 4. Epigenetic studies indicate that stress can trigger a predisposition to alcohol abuse. a. True b. False 5. The most commonly used drug in the United States is marijuana. a. True b. False 6. Regardless of how much you drink, alcohol has negative effects on the cardiovascular system. a. True b. False 7. Research has definitively proven that light to moderate drinking provides more health benefits than abstaining from drinking. a. True b. False 8. Most psychologists regard alcoholism as a disease. a. True b. False 9. Alcohol is a drug that does not produce withdrawal symptoms. a. True b. False 10. Most psychoactive drugs cause damage to the nervous system. a. True b. False

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Chap_13_10e Indicate the answer choice that best completes the statement or answers the question. 11. People who have been drinking a. tend to lose interest in sex. b. are less likely to be perpetrators of sexual violence. c. are less likely to be victims of sexual violence. d. are more willing to have unprotected sex. 12. The most effective prevention programs for children and teens are programs that a. highlight the dangerous effects of alcohol and illegal drugs. b. use moral training. c. boost self-esteem. d. teach social skills. 13. What type of drinking is having 14 or more drinks per week for men or having 7 or more drinks per week for women? a. Binge drinking. b. Heavy drinking. c. Regular drinking. d. Moderate drinking. 14. A research study that asked participants to rate themselves on a variety of traits suggests that a. alcohol makes people feel better about themselves. b. alcohol makes people feel worse about themselves. c. alcohol makes people worry more. d. alcohol has no consistent relationship with self-worth. 15. According to social learning theory, people begin to drink because a. alcohol has pleasurable, and immediate, effects. b. alcohol offers an escape from an unpleasant situation. c. they see other people drinking and learn from them. d. All of the above 16. After the legal age for buying alcohol was raised to 21, consumption among adolescents ages 12 to 17 a. dropped dramatically. b. dropped slightly. c. remained about the same. d. rose dramatically.

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Chap_13_10e 17. A major problem with chemical treatments (such as disulfiram) for people with alcohol use disorders is a. their ineffectiveness. b. their high relapse rates. c. their low compliance rates. d. they rarely are used with other treatments. 18. Roughly what percentage of 18- to 25-year-olds are binge drinkers? a. 10% b. 25% c. 33% d. 40% 19. The disease model explains why people ___________________. a. drink too much better than why people start drinking b. experience cognitive deficits while drinking better than why some people can abstain from drinking c. model the drinking behavior of others better than why people drink too much d. start drinking better than the genetic contributions to alcoholism 20. The concepts of modeling, positive reinforcement, and negative reinforcement are important ingredients in _________. a. the tension reduction model of drinking b. the alcohol myopia model of drinking c. the brain disease model of drinking d. the social learning model of drinking 21. For problem drinkers, most relapses occur how long after the end of the treatment program? a. 1 week b. 90 days c. 6 months d. 1 year 22. Research indicates that alcohol consumption a. promotes aggression. b. decreases high-density lipoprotein. c. at any level reduces life expectancy. d. causes lung cancer.

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Chap_13_10e 23. Low to moderate levels of drinking may decrease the risk for ______________. a. automobile crashes b. Alzheimer’s disease c. Korsakoff syndrome d. lung cancer 24. In general, which of the following groups are most likely to be heavy and problem drinkers? a. People with college diplomas b. People with high school diplomas c. People without high school diplomas d. People without college diplomas 25. Which Amendment ended Prohibition in the United States? a. The Eighteenth Amendment b. The Twentieth Amendment c. The Twenty-First Amendment d. The Twenty-Fourth Amendment 26. Which statement about drugs is true? a. Legal drugs pose no health threat; illegal drugs do. b. Neither legal drugs nor illegal drugs pose a health threat. c. More people are killed by using illegal drugs than by using legal drugs. d. Both legal drugs and illegal drugs may pose a health threat. 27. The combination of physiological dependence and withdrawal symptoms is usually referred to as a. tolerance. b. addiction. c. psychological addiction. d. psychological dependence. 28. Physical symptoms, such as restlessness, irritability, and tremors, may occur when a person is experiencing a. tolerance to alcohol. b. dependence on alcohol. c. withdrawal from alcohol. d. overconsumption of alcohol.

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Chap_13_10e 29. In the United States, people of this ethnic background tend to have the highest rate of drinking. a. European Americans b. Hispanic Americans c. African Americans d. Asian Americans 30. How many fatal unintentional injuries throughout the world each year involve alcohol? a. 100,000 b. 500,000 c. 800,000 d. 1,000,000 31. In the United States, what percentage of people are considered binge drinkers? a. 6% b. 26% c. 46% d. 66% 32. Which theory developed parallel with advances in neuro technology? a. The brain disease model b. The disease model c. The tension reduction hypothesis d. The social learning model 33. Alcohol dehydrogenase and aldehyde dehydrogenase are a. enzymes involved in the metabolism of alcohol. b. toxic byproducts of excessive alcohol consumption. c. found in fermented but not distilled alcoholic beverages. d. used to convert hops into beer and grain into whiskey 34. All of the following support the alcohol myopia model EXCEPT: a. intoxicated people analyze information at a superficial level. b. intoxicated people are more susceptible to distraction. c. intoxicated people recall fewer details of situations they have experienced. d. intoxicated people focus on abstract, not specific, cues in the environment. 35. Per capita alcohol consumption decreased dramatically after 1830 in the United States because of a. strict enforcement of import quotas on foreign wines and spirits. b. the high cost of distilled beverages, which related to periodic grain shortages. c. the passage of the 18th Amendment. d. the spread of the temperance movement. Copyright Cengage Learning. Powered by Cognero.

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Chap_13_10e 36. Sam has just taken a drug that leaves him feeling relaxed, but it has the side effect of giving him a cough. Sam has most likely a. consumed alcohol. b. smoked marijuana. c. consumed MDMA. d. smoked crack cocaine. 37. What drug has some hallucinogenic properties but lacks most other characteristics of hallucinogens? a. Heroin b. Cocaine c. Marijuana d. MDMA 38. When a drug becomes incorporated into the functioning of the body's cells and thus becomes necessary for "normal" functioning, what has occurred? a. Dependence b. Withdrawal c. Tolerance d. Death 39. Natalie has just taken a drug that leaves her feeling happy and pleasant, but the side effect is that it may affect the regulation of her body’s temperature. Natalie has most likely taken a. marijuana. b. caffeine. c. nicotine. d. ecstasy. 40. Research on the relationship between alcohol and homicide indicates that a. the perpetrator is likely to have been drinking. b. the victim is likely to have been drinking. c. both victim and perpetrator are likely to have been drinking. d. there is a direct correlation between alcohol consumption and crime. 41. Which ethnic group has the lowest rates of heavy and binge drinking? a. Asian Americans b. Native Americans c. Hispanic Americans d. European Americans

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Chap_13_10e 42. What is the connection between education and regular alcohol consumption? a. People without a high school diploma have the highest rate of regular alcohol consumption. b. People with high school diplomas but no college experience have the highest rate of regular alcohol consumption. c. People with college diplomas have the highest rate of regular alcohol consumption. d. No relationship exists between educational level and consumption of alcohol. 43. What is the most widely consumed drug in the United States? a. Marijuana b. Alcohol c. Cocaine d. Ecstasy 44. The Alcoholics Anonymous doctrine a. calls for complete abstinence. b. adopts a psychological approach to quitting drinking. c. holds that most alcoholics will eventually be cured of problem drinking. d. includes the notion that members must give up tobacco as well as alcohol. 45. Heavy consumption of alcohol may affect pregnancy by a. decreasing fertility. b. increasing fertility. c. increasing the risk of fetal alcohol syndrome. d. both a and c. 46. Which of the following is considered a direct hazard of alcohol consumption? a. Aggressive behavior b. Automobile accidents c. Liver cancer d. Alzheimer’s disease 47. Which of the following is an indirect effect of alcohol consumption? a. The relationship between drinking and cirrhosis of the liver b. The relationship between drinking and motor vehicle crashes c. An increased risk of fetal alcohol syndrome in pregnant women d. A decrease in thiamin absorption through consuming alcohol

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Chap_13_10e 48. All of the following are benefits of being a light to moderate alcohol drinker EXCEPT a. lower chance of developing Type 2 diabetes. b. lower risk of experiencing gallstones. c. decreased risk for Alzheimer’s disease. d. lower chance of hemorrhagic stroke. 49. If not consumed, alcohol turns into vinegar. If it is consumed, it a. also turns into vinegar. b. turns into ethanol. c. is digested and excreted. d. turns mostly into sugar 50. Amphetamines a. can cause hallucinations and delusions. b. usually decrease the blood pressure. c. cannot produce any dependence. d. cannot produce any tolerance. 51. The balanced placebo design by Marlatt and his colleagues has been used to measure a. the heritability of alcohol dependence. b. the role of expectancy in alcohol’s effects. c. people's personal awareness of need to drink. d. withdrawal symptoms in the alcohol-dependent. 52. In contrast to psychologically-based treatment programs or treatment programs in Canada, Europe, and Australia, the US medical community tends to privilege _______________. a. the tension reduction hypothesis b. the stress response dampening model c. the disease model d. the social learning model 53. Disulfiram is used in the treatment of alcohol abuse a. by affecting GABA transmission. b. because it produces unpleasant effects if combined with alcohol. c. because it is associated with a therapy called counter conditioning. d. due to its ability to treat liver damage.

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Chap_13_10e 54. Erik drinks about seven or eight drinks a day. Besides the risk of accidents, Erik's greatest INCREASED risk is that of a. heart disease. b. oral cancer. c. lung cancer. d. liver cirrhosis. 55. Subject Q was involved in a fatal crash related to drinking. What is most likely true of subject Q? a. He is a 74-year-old man. b. She is a 24-year-old woman. c. He is a 30-year-old man. d. She is a 60-year-old woman. 56. Which of these statements regarding Alcoholics Anonymous is true? a. It follows a social learning model of drinking. b. It insists on the goal of controlled drinking. c. It insists on the goal of total abstinence. d. It assumes people have complete control over drinking. 57. What type of relationship has been found between drinking alcohol and anxiety or tension? a. Most studies have found that alcohol reduces tension and anxiety. b. Alcohol has been found to reduce anxiety, but to increase tension. c. Alcohol increases anxiety for some people, but decreases it for others. d. Drinking alcohol increases physical anxiety, but decreases social anxiety. 58. On a global level, the benefits of drinking alcohol a. are immediate and certain, and appear as soon as one begins to drink. b. are immediate and certain, and appear among young adults. c. are immediate and certain, and appear during middle age. d. are unclear; indeed, the benefits do not necessarily outweigh the risks. 59. All of the following drugs are classified as sedatives EXCEPT: a. barbiturates. b. alcohol. c. opiates. d. LSD.

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Chap_13_10e 60. Reviews of psychological interventions for problem drinking show a. cognitive behavioral therapies are the most consistently effective. b. psychotherapeutic programs overall are more effective if they are of long duration. c. chemical treatments are necessary in conjunction with talk therapy. d. group therapy has been found to be more effective than individual therapy has been. 61. Which of these conditions is positively related to light and moderate alcohol consumption? a. Increased depression b. Decreased bone density c. Decreased heart disease d. Decreased general health 62. Morphine and heroin are a. stimulant drugs. b. opiate drugs. c. used medically to relieve pain. d. more likely to damage the brain than alcohol. 63. What have epigenetic researchers concluded about the progression from alcohol use to alcohol abuse? a. Alcohol abuse is exclusively due to genetic predisposition and does not relate to environmental factors. b. There is no genetic basis for predicting who is likely to abuse alcohol. c. Genetic predisposition to alcohol abuse can be triggered by life experiences but is not transmitted before birth d. Genetic predisposition to alcohol abuse can be triggered by life experiences and also be transmitted before birth. 64. Alcohol consumption in the United States reached its peak during a. the early 1800s. b. the Civil War. c. Prohibition. d. World War II. 65. Along with cirrhosis of the liver, alcohol's principal threat to health is its likelihood of causing a. lung cancer. b. heart disease. c. unintentional injuries. d. chronic obstructive pulmonary disease.

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Chap_13_10e 66. What was the effect of the passage of the 18th Amendment to the United States Constitution on alcohol consumption? a. Illegal alcohol consumption increased among the rich who could afford the cost. b. Consumption increased initially but decreased steadily afterwards. c. Consumption decreased dramatically from previous levels. d. There was no effect. 67. What percentage of adults in the United States are classified as current drinkers? a. 33% b. 50% c. 68% d. 80% 68. According to the FDA, Schedule I drugs have a. high abuse potential and no accepted medical use. b. high abuse potential but accepted medical use. c. low abuse potential but no accepted medical use. d. low abuse potential and accepted medical use. 69. Near the end of a party at which Traci had been drinking heavily, someone offered her cocaine. By using cocaine and alcohol together, a. Traci would find that the effects of each one of these canceled out the other. b. Traci's body would produce cocaethylene, a potentially deadly chemical. c. Traci was combining two depressants. d. Traci was combining two stimulants. 70. With regard to the consumption of alcohol in the United States, it is most accurate to say that about a. 90% of adults drink and about one fourth abuse alcohol. b. 75% of adults drink and about one tenth abuse alcohol. c. 68% of adults drink and about 26% binge drink. d. 90% of adults drink and about 5% abuse alcohol. 71. Anabolic steroids a. produce tolerance and dependence in only a few days. b. decrease body fat and increase muscle mass. c. are used more by women than by men. d. decreases submission and aggression in monkeys.

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Chap_13_10e 72. What, combined with alcohol, predicts intimate partner violence? a. Sexual dysphoria b. Jealousy c. Depression d. Economic insecurity 73. The drugs naltrexone and acamprosate are chemical treatments for alcohol use disorders a. that produce nausea when a person takes either drug and drinks alcohol. b. that are used in aversion therapy. c. that have shown modest but positive results. d. that are well understood and widely effective. 74. Korsak off syndrome is sometimes found among long-term, heavy users of alcohol and is characterized by a. nonfunctional scar tissue on the liver. b. confusion, disorientation, and memory impairment. c. high blood pressure and rapid, irregular heartbeat. d. excessive trembling, sweating, anxiety, and hallucinations. 75. Binge drinking can lead to all of the following EXCEPT a. intoxication. b. poor judgment. c. impaired coordination. d. long-term cognitive deficits. 76. One year after the end of treatment, what percentage of people with an alcohol use disorder who have completed treatment are still abstinent? a. 5% b. 15% c. 35% d. 55% 77. Which neurotransmitter is involved in the effects of several drugs that affect brain function? a. Dopamine b. Epinephrine c. THC d. Methylapoprobate

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Chap_13_10e 78. Mariah is a licensed professional counselor who has just begun working with people with alcohol abuse disorder. She read some studies on controlled drinking, and she plans to help people learn to control their rate of alcohol consumption. Mariah should know that a. harm reduction has not been scientifically established as a valid treatment program. b. most treatment facilities in the United States do not support this goal. c. controlled drinking is less successful with older people seeking treatment. d. treatment using harm reduction has been rejected in the United Kingdom. 79. All of the following drugs could be classified as stimulants EXCEPT: a. marijuana. b. caffeine. c. nicotine. d. cocaine. 80. The drug MDMA (“Ecstasy”) produces its effects by a. prompting neurons to release stored dopamine in greater than normal amounts. b. slowing the release of GABA. c. prompting a massive release of serotonin. d. inhibiting the release of dopamine. 81. Amphetamines a. are stimulants. b. are depressants. c. include opium and marijuana. d. include barbiturates and tranquilizers. 82. Ashley, who is a light to moderate drinker during pregnancy, a. has a higher risk of having a child who has deficits in cognitive functioning. b. has a higher risk of having a child who has conduct disorders in childhood. c. has a higher risk of having a miscarriage or of having a stillbirth. d. All of the above 83. Which of the following is a "direct hazard" of alcohol consumption? a. An association between consumption and aggression b. Increased consumption leading to increased accidents c. Alcohol's effect on coordination and cognitive functions d. Progressive liver damage from long-term heavy drinking

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Chap_13_10e 84. Both in the philosophy and the administration of treatment, treatment for the use and abuse of illegal drugs is similar to the treatment of ____. a. alcohol abuse b. smoking c. overeating d. exercise addiction 85. A history of social attitudes toward drunkenness reveals that a. drunkenness has always been acceptable in wine-drinking countries. b. drunkenness and drinking have generally been equally condemned. c. drunkenness has generally been acceptable in beer-drinking countries. d. drunkenness is often acceptable onlyat special occasions. 86. As an explanation for why people drink, the tension reduction hypothesis has generally a. not been supported. b. been supported for both men and women. c. been supported for men but not for women. d. been supported for women but not for men. 87. Before the legal age of buying alcohol was raised to 21, more than 40% of adolescents aged 12–17 were current drinkers. What percentage of this age group were current drinkers in 1992? a. 10% b. 20% c. 33% d. 40% 88. What condition refers to the accumulation of nonfunctional scar tissue in the liver? a. Cirrhosis b. Liver cancer c. Pancreatitis d. Jaundice 89. In most studies of the relationship between drinking and mortality rate, a J-shaped or U-shaped relationship has been found. This pattern suggests that a. light drinkers and moderate drinkers have a higher death rate than heavy drinkers. b. moderate drinkers and heavy drinkers have a lower death rate than light drinkers. c. light drinkers and nondrinkers have a higher death rate than moderate and heavy drinkers. d. light and moderate drinkers have a lower death rate than nondrinkers and heavy drinkers.

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Chap_13_10e 90. The alcohol dependency syndrome a. considers alcoholism a medical disease. b. assumes that people struggling with alcohol addiction lose complete control of their drinking. c. views alcoholism as an inherited disease. d. assumes different people have different patterns of drinking. 91. Tolerance refers to a. the ability to tolerate large doses of drugs without impairment of psychological or physical abilities. b. a strong psychological desire and craving for a drug. c. the property of a drug that requires increasingly higher levels to get the same effect. d. the property of a drug that requires changes in the body's physical functions, making the drug necessary for normal functioning. 92. Where would a treatment program for alcohol use disorder MOST likely involve the harm reduction strategy? a. Bozeman, Montana b. London, England c. New York City d. San Francisco, California 93. Which of these terms does NOT apply to alcohol dependency syndrome? a. Withdrawal symptoms b. Inability to abstain c. Personal awareness of the need to drink d. Loss of control or impaired control 94. The most common form of treatment for problem drinking is a. inpatient treatment. b. outpatient treatment. c. through self-help groups. d. prescription medication. 95. Carla, a 120-pound woman, and her twin brother Carlos, a 200-pound man, decided to celebrate their 21st birthday by equally dividing a pack of six beers, although neither had consumed much alcohol before this time. Everything else being equal, what is the most likely result? a. Carla will be more affected by the beer than Carlos. b. Carlos will be more affected by the beer than Carla. c. the twins will be equally affected by the beer. d. neither will be affected, as beer does not have enough alcohol to cause intoxication.

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Chap_13_10e 96. Opiate drugs a. have no potential for medical use. b. do not produce tolerance or dependence. c. quickly cause tolerance and dependence. d. can be refined into barbiturates. 97. Sunil, a college senior, has been a moderate drinker for the past two years. Now, he needs more drinks than he did two years ago to feel “buzzed,” which suggests that he has developed ________. a. tolerance b. addiction c. dependence d. withdrawal 98. Consuming 5 or more drinks on the same occasion at least once per month is considered a. binge drinking. b. heavy drinking. c. regular drinking. d. moderate drinking. 99. Motivational interviewing is a psychotherapy technique used for treating problem drinking, and this technique has the advantage of a. having a 90% improvement rate for problem drinking. b. being more effective in group settings than individual administration. c. being a brief intervention that requires few sessions. d. reducing GABA transmission as much as Naltrexone does. 100. In the United States, people of this ethnic background tend to have the highest rates of binge drinking and heavy drinking. a. European Americans b. Hispanic Americans c. African Americans d. Native Americans 101. All drugs that cross the blood-brain barrier a. change brain chemistry. b. have side effects. c. alter perception. d. All of the above

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Chap_13_10e 102. Hakim is torn between going out and getting a drink and stopping drinking altogether. What stage of the brain disease model is Hakim in? a. Binge and intoxication b. Withdrawal and negative affect c. Preoccupation and anticipation d. Self-regulation and susceptibility 103. The alcohol myopia view of drinking assumes that alcohol consumption leads to a. a minimizing of one's accomplishments. b. an increase of worry. c. increased friendliness and aggression. d. increased inhibitions and sexiness. 104. Over 20 years since the 1980s, per capita consumption of alcohol in the United States has a. increased dramatically. b. increased slightly. c. been stable. d. declined. 105. Barbiturates are synthetic drugs that a. are classified as steroids. b. have little or no tolerance, dependence, or withdrawal properties. c. are taken recreationally as "stay awake” pills. d. produce both tolerance and dependence. 106. Alcohol treatment programs with abstinence as the goal a. have never resulted in a statistically significant number of people who resume controlled drinking. b. are not generally compatible with the harm reduction model. c. are effective in over two-thirds of people. d. comprise the vast majority of treatment centers in the UK. 107. What was the effect of the introduction of distilled alcoholic beverages into 18th century England? a. All social classes dramatically increased consumption of the new alcoholic beverages. b. Consumption of distilled spirits rapidly decreased among the lower classes because of cost. c. Widespread consumption and drunkenness increased among the richest social class. d. Consumption and intoxication increased dramatically among the lower and working classes.

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Chap_13_10e 108. During the mid-1800s in the United States, the most significant political movement regarding alcohol consumption advocated ____________. a. temperance, or the moderate use of alcohol b. prohibition, or the abstinence from alcohol c. tolerance, as long as people were not drunk d. celebration; people drank in large amounts 109. Which of the following is a type of therapy where therapists convey their empathy with the client’s situation? a. Motivational interviewing b. Alcoholics Anonymous interventions c. Spontaneous remission therapy d. Aversion therapy 110. Rather than controlling the availability of drugs, some authorities have contended that a more effective approach would be to control the potential for harm from using drugs. This approach a. has been influential among legislators but not among drug abuse authorities. b. has been influential both with legislators and among drug abuse authorities. c. has been accepted in all countries of the world except the United States. d. is still controversial in the United States, but has become more common there.

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Chap_13_10e 111. Differentially define the terms tolerance, dependence, withdrawal, addiction, and abuse and their relationships relative to alcohol use. A. Tolerance means that with continued use, more and more of a substance (like alcohol) is needed to achieve the same effect. 1. Drugs with high potential for tolerance can be dangerous as people keep taking more. 2. Alcohol generally has a moderate potential for tolerance; however, its effects vary among individuals. a. Some people develop tolerance within a week of daily moderate drinking; others only develop it after extended periods of heavy drinking. B. Dependence means that a body’s cells have a drug (like alcohol) so incorporated into their functioning that “normal” functioning requires the drug. 1. In dependence, stopping (i.e. withdrawing) the drug causes withdrawal symptoms. a. Withdrawal symptoms signify that the body is adjusting to functioning without the substance. b. Symptoms are generally the obverse of the drug effects. c. Since alcohol is mainly a depressant, alcohol withdrawal symptoms include irritability, restlessness, and agitation. d. Withdrawal symptoms are very unpleasant from many drugs; those from alcohol are among the worst. Cardiovascular effects can be life-threatening. Other symptoms include tremors, usually the first to emerge; and in the severely addicted, delirium tremens, including disorientation, hallucinations, and sometimes convulsions. e. Withdrawal typically lasts from two days to a week. f. Physical risks are serious enough to warrant special alcohol treatment facilities. C. Tolerance and dependence are independent of one another. 1. They may occur together, or either one may occur without the other. 2. Using alcohol or other drugs will not inevitably cause tolerance or dependence. D. Addiction is sometimes defined as the combination of dependence and withdrawal. 1. While definitions vary, compulsive use and craving for the substance are included in all definitions. 2. Experts differentiate dependence vs. addiction by compulsive behavior and the damage it does to users’ lives. a. Loss of control of use b. Compulsive seeking and use regardless of consequences 3. Some experts also distinguish addiction vs. alcohol/drug abuse. a. In this definition, somebody who is not dependent or addicted engages in alcohol/drug abuse if the use is harmful and excessive. E. Tolerance, dependence, addiction, and abuse are all separate and all included among the properties of alcohol. F. The “psychological” dependence or addiction some people refer to is not the same as dependence on alcohol or similar drugs, which has major physiological aspects. 1. Psychological dependence involves habituation to the behaviors of use. 2. A controversy about the validity of this concept is that if a substance/drug does not underlie the behaviors, psychological dependence is not clearly analogous to physiological dependence.

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Chap_13_10e 112. Identify some psychosocial interventions that have been used following detoxification from drug/substance abuse and their relative effectiveness. Also do the same with prevention programs. A. Support groups like Narcotics Anonymous (modeled after Alcoholics Anonymous) have low success rates. B. More effective interventions include contingency management (a behavioral technique) and cognitive behavioral therapy. 1. These types of interventions work best with marijuana users. 2. These types of interventions work least with abusers of multiple substances. C. Interventions to prevent relapse have not been found very effective. D. Prevention programs intended to inhibit or delay child and teen drug use have not had much success. 1. Of these, the programs generally found ineffective include those that raise self-esteem, provide factual drug risk information, give moral training, or use scare tactics. a. One example is the Drug Abuse Resistance Education (DARE) program, which has been popular yet minimally effective. E. The Life Skills Training Program (Botvin & Griffin, 2015) is found more effective, in both the short term and the long term. 1. This program teaches social skills: a. Personal and social competence b. Enhanced decision-making skills c. Resistance skills against social pressure to use drugs. F. Prevention programs customized for cultural compatibility with target groups appear more effective than generalized programs. G. According to systematic reviews, school-based prevention programs are more effective when they have the following components: 1. They are intensive. 2. They are interactive. 3. They focus on life skills. 4. Prevention efforts are most effective with children between the ages of 11-13 years. H. Limiting availability: 1. This is common through laws limiting drug access in all Western countries. 2. This strategy can cause other serious social problems. a. Prohibition in the United States is an example: outlawing alcohol resulted in bootlegging, organized crime, tax revenue losses, and corruption of law officials. b. Today, controversy over legally controlling access applies to marijuana use. I. Harm reduction strategy: 1. This approach is practical, aimed at minimizing drug use dangers, rather than moralistic: it assumes people will use drugs, and prioritizes reducing the health consequences. 2. One example is providing needle exchanges for injection drug users to reduce HIV transmission. 3. Another example is the designated driver approach to prevent impaired driving. 4. The harm reduction strategy is also controversial. 5. From a systematic review of these programs, researchers concluded that for illegal drugs, the evidence supports adopting a harm reduction policy. 6. Others also argue that harm reduction and abstinence approaches are not as incompatible as has been suggested by the disagreements over them. a. Controlling drug abuse may benefit from both of these approaches.

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Chap_13_10e

113. Contrast the success of treatment programs oriented toward abstinence with those oriented toward controlled drinking. A. Neither type of treatment is very successful on a long-term basis unless relapse prevention is a component of the program. B. Treatments oriented toward abstinence include Alcoholics Anonymous, psychotherapy (individual and group), and chemical treatments (like Antabuse, naltrexone, or acamprosate). 1. The dropout rate is high for these treatments, and many problem drinkers receive repeated treatments. 2. Adherence is a problem for the chemical treatments. 3. These treatments tend to be more effective in the short term than after several years. C. Controlled drinking attempts to teach problem drinkers how to drink in a nonproblem way. 1. This outcome was discovered in treatments oriented toward abstinence and developed as a viable goal for treatment. 2. The treatment is very controversial, and almost nonexistent in the United States (although more common in Great Britain, Canada, and Australia). 3. The success rate is no better or worse than for programs oriented toward abstinence, but heavy long-term problem drinkers are not suitable candidates for this treatment.

114. Discuss the balanced placebo design and the research that it has generated about drinking. A. The balanced placebo design is a design used in research on drinking. 1. The design contains four groups—two that get alcohol and two that do not; of the people in each of the two groups, the members of one group believe that they are getting alcohol and those in the other believe that they are not getting alcohol. 2. The design allows for the evaluation of alcohol's effects and for the evaluation of the placebo effect of alcohol, the belief about alcohol's effects. B. Research with the balanced placebo design has revealed that expectancy effects occur in the use of alcohol and that these effects are separate from the physical effects of alcohol. 1. People who think that they have received alcohol exhibit effects of alcohol. 2. People who think that they have not received alcohol fail to show the effects of alcohol at low levels but show effects at high levels of alcohol consumption. 3. The loss of control and craving that accompany problem drinking have an expectancy component.

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Chap_13_10e 115. Trace the development of explanations for problem drinking from the moral model to the alcohol dependency syndrome. A. The moral model explained problem drinking as a moral weakness. 1. People have free will and choose to moderate their drinking or not, making those who could not morally weak. 2. This view was the leading explanation until the late 19th century. B. The medical model replaced the moral model. 1. This model conceptualizes problem drinking as symptomatic of underlying physical problems. 2. The notion of a hereditary component of problem drinking grew from this view, and research has supported that some hereditary component exists for problem drinking. C. The disease model is a variant of the medical model. 1. The disease model holds that people with problem drinking have the disease of alcoholism. 2. This model arose during the 1930s and remains influential today, forming the basis for Alcoholics Anonymous and many treatment programs. D. The alcohol dependency syndrome grew out of dissatisfaction with the disease model. 1. The term syndrome suggests a group of related behaviors that accompany alcohol dependence. 2. The concept adds flexibility and the possibility of individual variability in expression of the syndrome.

116. What are the hazards of alcohol? What are the benefits? A. Several hazards are associated with drinking. 1. Heavy drinking is harmful to the liver. 2. Prolonged heavy drinking can result in neurological damage called Korsakoff syndrome. 3. A slight increase in risk for cancer is associated with drinking, but the risk is greater when drinking is combined with smoking. 4. Fetal alcohol syndrome occurs when pregnant women drink heavily, and even light drinking may affect a developing fetus. 5. Alcohol affects decision making and coordination, making risky behavior and unintentional injuries of all types more likely. 6. Alcohol increases aggression in some people, and drinking is associated with homicide and suicide. B. Drinking may also be associated with several health benefits. 1. Light to moderate drinking may be beneficial; heavy drinking and binge drinking are not. 2. Light to moderate drinkers may have lower levels of mortality, and cardiovascular benefits are the main reason. 3. Light to moderate drinking may lower the risk for Type 2 diabetes, gallstones, ulcers, and Alzheimer’s disease. 4. Systematic reviews have cast doubt on whether the benefits outweigh the risks.

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Chap_13_10e 117. Compare the health effects of illegal drug use with those of alcohol. A. The use of illegal drugs is not without dangers, but the low number of people who use these drugs (as opposed to drinkers) makes the health consequences of illegal drug use small in comparison. 1. Alcohol is far more widely used than marijuana. 2. Drugs such as sedatives and cocaine can have negative health effects. 3. Illegal drug use has large social implications, but the health threats are minor, and not, generally speaking, neurological in nature. B. The direct and indirect effects of alcohol are large and numerous. 1. The direct effects produce liver damage, Korsakoff syndrome, and cases of fetal alcohol syndrome. 2. The indirect effects are reflected in unintentional injury and death, homicide, and suicide, which are leading causes of death in the United States.

118. Jason and Parvesh live in the same neighborhood and are both 19 years old. Jason does not drink and has had a total of less than 10 drinks during his lifetime, whereas Parvesh drinks almost every day and gets drunk most weekends. How does the social learning model explain the differing behavior of the two? A. The social learning model conceptualizes drinking as learned behavior, similar to other learned behaviors. 1. People who drink must find reinforcement in drinking or some stimuli associated with it, or they would not drink. 2. People who do not drink find more aversive than positive consequences in drinking, leading them to avoid drinking. B. The social learning model explains Jason’s failure to drink in terms of a greater balance of aversive than positive consequences. Many possibilities exist or combine to make Jason a nondrinker. 1. Jason may have negative physical reactions to alcohol. 2. Jason may not like the taste of alcohol. 3. Jason may not like the feeling of intoxication. 4. Jason may believe that drinking is wrong for moral or religious reasons. 5. Jason may have friends or family who disapprove of drinking. C. The social learning model explains Parvesh’s drinking in terms of a greater balance of positive than aversive consequences. Many possibilities exist or combine to make Parvesh a heavy drinker. 1. Parvesh may have friends who encourage his drinking. 2. Parvesh may enjoy the taste or effects of alcohol, or both. 3. Parvesh may enjoy going to places where drinking is the expected norm. 4. Parvesh may be trying to cultivate an image that is consistent with drinking.

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Chap_13_10e 119. Contrast the attitudes and rates of drinking today with the attitudes and rates of drinking throughout history. A. Ancient cultures (such as Egyptians, Romans, and Greeks) found drinking and even drunkenness acceptable, but the acceptability of drunkenness was limited to specified occasions. B. In 18th century England, drunkenness became more common with the rise of distilleries, and drinking distilled spirits became associated with the lower classes and thus less acceptable. C. In colonial and early America, drinking was widespread for all age groups. 1. Alcoholic beverages were seen as a blessing. 2. Societal disapproval of drunkenness was harsh, and so were punishment for it. D. The temperance movement began in the mid-1800s and changed attitudes toward drinking. 1. Alcohol was seen as an evil force. 2. Drunkenness was seen as the source of many social problems. 3. The temperance movement succeeded in getting the manufacture and sale of alcohol banned by amendment to the United States Constitution, but a later amendment revoked the ban. E. Currently, about two-thirds of adults in the United States drink alcoholic beverages. 1. About 6% of drinkers are heavy drinkers, and about 23% are binge drinkers. 2. Drinking decreased over the past 20 years, and attitudes about drunkenness have become more negative, even among adolescents, who drink more than older adults. 3. Ethnicity is also a factor in drinking, and European Americans drink at higher rates than Hispanic Americans or African Americans.

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Chap_13_10e Answer Key 1. False 2. True 3. True 4. True 5. False 6. False 7. False 8. False 9. False 10. False 11. d 12. d 13. b 14. a 15. d 16. a 17. c 18. c 19. a 20. d 21. b 22. a 23. b 24. c 25. c 26. d

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Chap_13_10e 27. b 28. c 29. a 30. b 31. b 32. a 33. a 34. d 35. d 36. b 37. c 38. a 39. d 40. c 41. a 42. c 43. b 44. a 45. d 46. c 47. b 48. d 49. a 50. a 51. b 52. c 53. b 54. d Copyright Cengage Learning. Powered by Cognero.

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Chap_13_10e 55. c 56. c 57. c 58. d 59. d 60. a 61. c 62. b 63. d 64. a 65. c 66. c 67. c 68. a 69. b 70. c 71. b 72. b 73. c 74. b 75. d 76. c 77. a 78. b 79. a 80. c 81. a 82. d Copyright Cengage Learning. Powered by Cognero.

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Chap_13_10e 83. d 84. a 85. d 86. a 87. b 88. a 89. d 90. d 91. c 92. b 93. b 94. c 95. a 96. c 97. a 98. a 99. c 100. d 101. d 102. c 103. c 104. d 105. d 106. b 107. d 108. b 109. a 110. d Copyright Cengage Learning. Powered by Cognero.

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Chap_13_10e 111. 112. 113. 114. 115. 116. 117. 118. 119.

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Chap_14_10e Indicate whether the statement is true or false. 1. A person with a body mass index (BMI) of 45 would be considered obese. a. True b. False 2. . Assessing where excess weight is distributed on the body can help predict health risks. a. True b. False 3. The body mass index (BMI) considers neither gender nor body frame. a. True b. False 4. Metabolic rates are similar across people. a. True b. False 5. Among college students, bulimia would be more prevalent than anorexia. a. True b. False 6. The set-point model suggests that it should be quite easy to gain or lose weight. a. True b. False 7. Bulimia is more likely to be fatal than anorexia. a. True b. False 8. Overeating is the sole cause of obesity. a. True b. False 9. Young women who compete in beauty pageants are more likely to have an eating disorder than young women who pursue theater in college, but both are at a higher risk than young women who do neither. a. True b. False 10. Without moisture provided by the salivary glands, taste buds on the tongue do not function. a. True b. False

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Chap_14_10e Indicate the answer choice that best completes the statement or answers the question. 11. Obesity can result from a. overeating. b. slow metabolism. c. too little physical activity. d. All of the above 12. Initially those treated for anorexia had less than 40% remission. After 20 years, the percentage of those who had recovered was roughly a. 20%. b. 40%. c. 60%. d. 90%. 13. Researchers have suggested several reasons that obesity has increased in the United States over the past two decades. One possibility is that people are a. increasing their consumption of meals at home. b. increasing their intake of fast foods and sodas. c. increasing their percentages of dietary fat. d. decreasing their consumption of sugar. 14. What is true of eating disorders and gender? a. Binge eating disorder is more common in males than in females. b. Anorexia is more common in males than bulimia is. c. Bulimia is more common in males than in females. d. Binge eating is the most common eating disorder among males. 15. What largely involuntary process propels food through the digestive system? a. Peristalsis b. Gastric juices c. Salivary glands d. Parotids 16. What levels would signal low fat stores, prompting a person to eat? a. Low leptin b. High leptin c. Low insulin d. High insulin

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Chap_14_10e 17. Which type of diet is the least nutritionally balanced? a. A single food diet b. A vegan diet c. A ketogenic diet d. A liquid diet 18. Gastric bypass surgery a. usually produces massive weight loss. b. carries health risks from the surgical procedure. c. has replaced liposuction as the most common surgical approach to weight control. d. both a and b. 19. Although individual differences exist among people with anorexia, people at the highest risk are a. young females. b. older females. c. gay males. d. gender fluid. 20. What furnish(es) moisture that allows food to be tasted? a. The esophagus b. The tongue c. Salivary glands d. Teeth 21. Rhythmic contraction and relaxation of the circular muscles that propel food through the digestive system is known as a. the esophagus. b. peristalsis. c. voluntary digestion. d. acidic flow. 22. . In general, the relationship between weight and poor health is a. S-shaped. b. U-shaped. c. direct—the heavier the person, the greater the risk for poor health. d. inverse—the heavier the person, the lower the risk for poor health. 23. The immediate aim of treatment programs for people with anorexia is usually a. increased self-esteem. b. better relationships with parents. c. weight restoration. d. healthy weight loss. Copyright Cengage Learning. Powered by Cognero.

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Chap_14_10e 24. During the 1990s, extreme obesity in American adults ______. a. stayed the same b. more than doubled c. tripled d. decreased 25. In general, which of these people would have the GREATEST risk for health problems in relation to weight? a. A 50-year-old woman who is underweight b. A 50-year-old man who has a beer belly c. A 50-year-old woman who carries excess fat on her thighs d. A 26-year-old man who carries excess fat on his thighs 26. Levels of which of the following fall, when fat stores fall, and may provide a long-term signal to eat more? a. Leptin b. Ghrelin c. Cholecystokinin (CCK) d. Agouti-related peptide 27. All of the following are methods to assess body fat EXCEPT: a. imaging the body. b. skin-fold technique. c. body-mass index. d. self-reports. 28. Who is most likely to benefit the most from treatment for an eating disorder? a. An adult man b. An adult woman c. An adolescent woman d. Treatment for eating disorders are rarely effective. 29. Studies of adopted children and identical twins have found that a. genetic factors are important in weight and fat distribution. b. environmental factors are more important than genetic factors in determining weight. c. genetic factors are more important for men, and environmental factors are more important for women in determining weight. d. genetic factors are more important for women, and environmental factors are more important for men in determining weight.

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Chap_14_10e 30. Carl is overweight. What is also likely true of Carl? a. He reports to his doctor that he eats more than others. b. He is also obese. c. He eats more food than is necessary. d. He eats food with a high caloric density. 31. All of the following are explanations that researchers have suggested for why obesity has increased in the past two decades EXCEPT a. increased consumption of fast foods. b. increased consumption of sweetened soda. c. increased consumption of genetically modified foods. d. decreased engagement in physical activity. 32. Regarding eating and metabolism, research has shown that a. overeating changes metabolism. b. undereating changes metabolism. c. both overeating and undereating can change metabolism. d. metabolism is set by genetics and thus cannot be changed. 33. Production of the peptide hormone cholecystokinin results in a. feelings of satiation. b. feelings of hunger. c. a need to engage in physical activity. d. depression, anxiety, and loss of energy. 34. Throughout most of history, being overweight a. was a sign of laziness. b. was a mark of prosperity. c. was a signal of poor health. d. characterized economically marginalized people. 35. . How does set-point influence metabolism during a period of severe food restriction? a. It increases metabolism. b. It decreases metabolism. c. It does not influence metabolism. d. It increases metabolism initially but decreases it if the food restriction continues.

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Chap_14_10e 36. Behavior modification programs for weight control usually a. punish unhealthy eating habits. b. punish weight gain. c. reinforce healthy eating habits. d. reinforce weight loss. 37. In the study of experimental starvation, what were the effects of semi-starvation on the behavior of the participants? a. They showed high group morale and cooperation. b. They exercised vigorously to distract themselves from feelings of hunger. c. They became aggressive and lost interest in their normal activities. d. They became overly attached to other group members. 38. A review of commercial weight loss programs found that in a year or two, individuals are highly likely to ________. a. regain 50% of lost weight b. keep off their lost weight c. regain 10% of lost weight d. keep losing more weight 39. Tran has bulimia and is 13. What treatment will likely be best for her? a. Cognitive behavioral therapy independent of her family b. Family-based cognitive behavioral therapy c. Interpersonal psychotherapy d. Prescription drugs 40. Changes in diagnostic criteria for the DSM-5 resulted in the rise of diagnoses of a. anorexia among females b. anorexia among males c. obesity among females d. obesity among males 41. Although there is support for a genetic explanation of obesity, this does not fully explain why obesity rates have _________________ . a. decreased for children but not for their parents in the past two decades b. sharply risen in the past two decades c. precipitously dropped in the past two decades d. stabilized in the past two decades

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Chap_14_10e 42. What percentage of people in the United States likely have symptoms of bulimia? a. 0–2% b. 4–7% c. 7–9% d. 9–12% 43. Bart’s 75-year-old grandfather is slightly overweight, and Bart wants to share his health concerns with him. Bart should first understand that a. losing weight after age 60 doubles the risk for cardiovascular disease. b. being slightly overweight may be less risky than being underweight at his age. c. his grandfather is at a risk for all-cause mortality. d. his grandfather likely has the risk factors consistent with metabolic syndrome. 44. Which of these techniques represents a person's distribution of body fat? a. Waist-to-hip ratio b. Skinfold technique c. Weight charts d. Water immersion technique 45. The body mass index (BMI) a. is a measure of total weight. b. considers both age and gender in calculating obesity. c. is defined as a person's height (in meters) divided by body weight (in kilograms) squared. d. is defined as body weight (in kilograms) divided by height (in meters) squared. 46. What did dieters do who lost twice as much weight as those on the same program that did not as per the result of a recent study? a. Attended therapy sessions b. Kept a diary c. Exercised twice a week d. Both a and c were found. 47. If the definition of obesity is having a BMI of 30 or higher, then nearly what percent of US adults are obese? a. 10% b. 20% c. 40% d. 60%

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Chap_14_10e 48. When humans or rats have a variety of tasty foods available, a. humans increase their food intake, but rats do not. b. rats increase their food intake, but humans do not. c. both rats and humans increase their food intake. d. food intake remains constant for both. 49. The principal function of the stomach is to a. begin the process of digestion. b. pass digested food into the large intestine. c. pass digested food into the blood stream. d. mix food particles with gastric juices. 50. What is true of treatment for eating disorders? a. Anorexia treatments are more effective overall than treatments for bulimia. b. Bulimia treatments are more effective overall than treatments for anorexia. c. People with anorexia respond better to antidepressants than people with bulimia do. d. Both anorexia and bulimia are virtually impossible to effectively treat. 51. Both low-carbohydrate diets and low-fat diets share which of the following drawbacks? a. Neither produces weight loss. b. Both are unhealthy. c. Any weight loss is hard to maintain. d. The risk for eating disorders. 52. Research has shown a positive relationship between obesity and a. high blood pressure. b. cardiovascular disease. c. Type 2 diabetes. d. All of the above 53. The set-point concept assumes that a. people have a kind of internal thermostat that regulates weight. b. gaining weight is a significantly easier process than losing weight. c. losing weight is a somewhat easier process than gaining weight. d. a person's weight has no relationship to any hereditary component. 54. Research has found which of these weight-related factors to be MOST dangerous? a. Distribution of weight around the waist and abdomen b. Distribution of weight around the thighs and hips c. Having a low body mass index d. Having a high metabolism Copyright Cengage Learning. Powered by Cognero.

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Chap_14_10e 55. In the study of experimental starvation, the effects of starvation on participants were all of the following EXCEPT a. aggressive behavior. b. losing interest in normal activities. c. cooperation with others. d. obsession with food. 56. From an anthropological perspective, what would be the advantage of a “thrifty metabolism” for fat? a. Fat helped protect people during food shortages. b. Fat enhanced physical attractiveness and reproduction. c. Fat helped protect individuals from injuries. d. Fat made individuals less attractive to predators 57. Males with anorexia tend to differ from females with anorexia in terms of a. what each believes an ideal body shape looks like. b. what is an effective treatment. c. social class. d. prognosis. 58. Research suggests that a. losing weight as rapidly as possible is the best strategy for dieting. b. those who lost weight on their own more likely maintain the loss. c. dieting speeds up the metabolic rate, thus facilitating weight loss. d. people should not remain on the same diet for more than 6 weeks. 59. What is true of commercial-diet programs? a. Most participants lose more than 5% of their body weight. b. Most participants lost less than 5% of their body weight. c. Program completion is nearly universal for participants. d. They are not particularly effective for very overweight people. 60. Diets that contain what are good choices to help weight loss? a. Many fruits and vegetables b. Many foods low in all fats c. Many foods low in carbohydrates d. Many or all foods in liquid forms

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Chap_14_10e 61. One simple technique to keep yourself on track after a weight loss program is to ___________. a. weigh yourself daily b. join a different weight loss program c. exercise daily d. never weigh yourself 62. Min is five feet four and has a body mass index of 17.5. Min could most accurately be described as a. extremely thin. b. somewhat thin. c. average in weight. d. overweight. 63. According to the positive incentive model of weight control, a. people will have difficulty weighing much more or less than their biologically determined weight range. b. people’s motivations for eating include pleasure. c. people are motivated to eat less in cultures where being underweight is valued. d. people are motivated to eat more in cultures where being overweight is valued. 64. What approach to dieting seeks to remove a stigma from overweight? a. Health at every size b. Atkins diet c. Paleo diet d. Veganism 65. From the stomach, digested food passes into the a. small intestine. b. large intestine. c. anus. d. blood stream. 66. The safest and surest way to lose weight and be healthy is to a. exercise. b. eat healthily. c. rely on diet pills. d. both a and b, not c.

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Chap_14_10e 67. Which of these is the most effective combination for substantial weight loss during dieting and maintaining weight loss after 1 year? a. Getting liposuction with a liquid protein diet b. Using prescription and nonprescription drugs c. A low-calorie diet and more physical activity d. A high-carbohydrate diet and psychoanalysis 68. An analysis of the women who have won the Miss America contest in the past century showed what percent of them in the underweight range? a. 25% b. 50% c. 75% d. 100% 69. People with anorexia and people with bulimia are similar in many ways, including a. increased sexual promiscuity. b. having a lack of impulse control. c. feeling dissatisfied with their bodies. d. All of the above 70. Digestion of most types of nutrients occurs in the __________. a. large intestine b. stomach c. small intestine d. gall bladder 71. Eating foods high in which of the following may increase appetite rather than lead to feelings of satiation? a. Calories b. Carbohydrates c. Fat and sugar d. Flavor 72. The goal of Keys's project, begun during World War II, was to study a. the effects of hunger and food deprivation. b. the rate of weight gain due to systematic overfeeding. c. the effects of set-point readjustment with drugs. d. the optimum ratio of fat to lean body tissue in volunteers.

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Chap_14_10e 73. Using BMI to define obesity and overweight, roughly what percentage of adults are overweight and obese in the United States? a. 20% b. 34% c. 55% d. 70% 74. Stable weight is maintained when a. a person eats a high-protein diet. b. calories expended equal calories eaten. c. calories absorbed by the intestines are half the calories eaten. d. activity is at a minimum and basal metabolism is at a maximum. 75. The history of the human species has been marked mostly by shortages of food, a. which would make a “thrifty” metabolism a survival advantage. b. which lends support to the concept of the set-point. c. which casts doubt on the positive incentive model. d. which casts doubt on the role of hormones in weight regulation. 76. The relationship between eating and weight maintenance is best described by which of the following statements? a. Weight gain is proportional to overeating. b. A person who eats more than 3,000 calories a day will gain weight. c. Metabolic rate is a factor in weight maintenance. d. Obese people eat fewer calories per day than people who are not obese. 77. Which of these characteristics is LEAST likely among people with anorexia? a. Involvement in college theater or dance b. Preoccupation with food c. Viewing oneself as too thin d. Ambition and perfectionism 78. The cognitive behavioral treatment for bulimia aims to a. change the eating patterns of the individual. b. change distorted cognitions concerning body image. c. change behaviors such as vomiting and laxative use. d. All of the above

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Chap_14_10e 79. Most people who see themselves as being overweight are a. males. b. not at risk for increased mortality. c. adolescents. d. overweight. 80. Zendaya enjoys tasty food, and she will eat food she likes even when she isn't hungry. This eating pattern is most consistent with the _____. a. positive incentive model b. psychodynamic model c. set-point model d. behavior modification model 81. What is true of self-reports? a. They indicate that overweight people eat less, while objective measurements indicate that overweight people eat more. b. They indicate that overweight people eat less, and objective measurements also indicate that overweight people eat less. c. They indicate that overweight people eat more, and objective measurements also indicate that overweight people eat more. d. They indicate that overweight people eat more, while objective measurements indicate that overweight people eat less. 82. People who have anorexia are most likely to have experienced a. physical and sexual abuse. b. emotional support from their parents. c. poverty. d. failures related to their performance in school. 83. The pattern of risk factors called the metabolic syndrome include all of the following EXCEPT: a. excessive abdominal fat. b. cardiovascular disease. c. insulin resistance. d. cholesterol problems. 84. After several weeks on a 500-calorie a day diet, Loraine is constantly hungry, tired, and not interested in much of anything. According to the set-point concept, a. these are the effects of damage to her hypothalamus. b. she is losing too much muscle tissue. c. she has gone below her set-point. d. she is still above her set-point.

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Chap_14_10e 85. What range of BMI is defined as overweight? a. 30 to 45 b. 25 to 29.9 c. 17.9 to 25 d. 25to 30 86. Franny consumes as little as 300 calories a day, and though she is underweight, she believes herself to be overweight and is afraid of gaining more weight. It is likely Franny has ________. a. anorexia b. bulimia c. binge eating disorder d. obsessive-compulsive disorder 87. One possible explanation as to why individuals have differing set-points is a. genetics. b. past success or failure at diets. c. ethnicity. d. age. 88. When overweight children attempt to lose weight, a. they are typically less successful in their attempts than adults. b. they succeed in behavioral programs involving family. c. boys succeed in their attempts, but girls do not. d. they tend to become diabetic after losing about 10% of their body weight. 89. DeShawn has bulimia. What is a potential health risk he faces? a. Electrolyte imbalance b. Alkalosis c. Anemia d. All of the above 90. The results of the studies on experimental starvation and experimental overeating a. indicate that eating is a learned behavior. b. suggest that eating is always pleasurable. c. are consistent with the concept of set-point. d. find eating relatively unimportant in most people’s lives.

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Chap_14_10e 91. Exercise a. stimulates the appetite, which results in overeating and weight gain. b. is more effective combined with calorie restriction for weight loss. c. tends to increase the set-point, adjusting it upward. d. is typically sufficient by itself to cause weight loss. 92. Research on sleep and weight has shown that __________. a. short sleep duration precedes weight gain b. taking many naps precedes weight gain c. a long sleep cycle precedes weight gain d. insomnia precedes weight gain 93. After treatment that includes hospitalization and weight gain, people with anorexia a. show lack of impulse control. b. are usually cured. c. rarely show other psychological problems. d. are more likely to experience success if they are adolescents. 94. What would you tell your friend who is overweight and wants your expert advice on the most effective and healthy way to lose weight? a. "Give up sweets for 6 weeks." b. "Cryolipolysis is safer than liposuction and a quick way to start fresh." c. "Exercise three times a week and eat more fruits and vegetables." d. "Try an all-liquid diet." 95. Most people who lose weight a. maintain weight loss. b. lose it independently. c. lose it by taking diet pills. d. continue a downward spiral of weight loss. 96. The skinfold technique and bioelectrical impedance are inexpensive, if somewhat unreliable ways to measure a. the utilization of glucose by adipose tissue. b. the percentage of body fat. c. the metabolic activity of fat. d. the ratio of height to body weight

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Chap_14_10e 97. Which weight loss program is likely to have the greatest problem with relapse? a. A very low-calorie diet that produces quick weight loss b. A program that adds posttreatment sessions c. A behavior modification program d. A program that includes social support and aerobic exercise 98. Which hormone produced by the stomach has levels which rise before and fall after meals, providing a short-term signal to eat? a. Leptin b. Ghrelin c. Cholecystokinin (CCK) d. Glucagon-like peptide 1 99. Which of the following people’s mortality can LEAST be predicted by being overweight? a. Aliyah, who is a 70-year-old retired accountant b. Shilu, who is a 25-year-old music teacher c. Lionel, who is a 40-year-old professional athlete d. Jackson, who is a 16-year-old student 100. Which system of the body is plagued with more diseases and disorders than any other system? a. Immune b. Digestive c. Cardiovascular d. Reproductive 101. Studies from the United States and Europe show that people begin to have a slightly higher risk for allcause mortality when they are a. overweight. b. underweight. c. either extremely thin or extremely heavy. d. thin because they are also sick. 102. Victoria has an eating disorder. Which of these is LEAST likely to be characteristic of her? a. She has experienced violence in her family. b. She is an adolescent. c. She has gained interest in sexual activity. d. She has lost hair on her head.

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Chap_14_10e 103. Fernando has shown some marked improvement in his condition after being treated for an eating disorder with antidepressants. What condition does Fernando most likely have? a. Bulimia b. Binge eating c. Anorexia d. Obesity 104. What provides a long-term signal for regulating weight? a. CCK b. Insulin c. Serotonin d. Leptin 105. When the participants in the study on experimental starvation were re-fed at the end of the starvation phase of the experiment, a. many of them gained more weight than they had lost. b. most of them were not able to regain lost weight. c. they became more cheerful and optimistic than they had been prior to the starvation phase. d. they no longer had much interest in food. 106. In Sims's studies on experimental overeating, some volunteers had trouble returning to their original weight after the experiment. This problem was associated with a. family histories of obesity. b. family histories of diabetes. c. a permanent change in set-point brought about by the overeating. d. a permanent change in blood glucose level. 107. Chris has recently developed an eating disorder. Which of these is LEAST likely to be a characteristic of Chris? a. Chris is a gay man. b. Chris is a woman in her 60s. c. Chris is ambitious. d. Chris hates to exercise. 108. What is NOT part of the digestive system? a. The teeth b. The esophagus c. The stomach d. The bronchioles

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Chap_14_10e 109. Marco and his female friend Rachel both have anorexia. What is likely similar about them? a. They come from the same economic situation. b. They both identify as heterosexual. c. They both exhibit high levels of physical activity as a symptom. d. They both were pushed toward anorexia by similar factors. 110. Evaluate the role of hormones in weight regulation.

111. Evaluate the adequacy of the set-point model and the positive incentive model to explain obesity.

112. Describe the general process of human digestion from beginning to end.

113. Summarize the conditions and outcomes of the overeating study conducted by Sims and colleagues.

114. Summarize Keys et al.’s experimental study with controlled starvation and its outcomes.

115. What are the behavioral differences between anorexia, bulimia, and binge eating? Are there similarities?

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Chap_14_10e 116. What are the differences in health consequences among anorexia, bulimia, and binge eating?

117. What is the relationship between overeating and obesity?

118. Rolando is overweight. Should he diet to improve his health?

119. Don is overweight, and he believes he should go on a diet. Advise him as to what type of diet to choose and what type to avoid.

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Chap_14_10e Answer Key 1. True 2. True 3. True 4. False 5. True 6. False 7. False 8. False 9. True 10. True 11. d 12. c 13. b 14. b 15. a 16. a 17. a 18. d 19. a 20. c 21. b 22. b 23. c 24. b 25. b 26. a

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Chap_14_10e 27. d 28. c 29. a 30. d 31. c 32. c 33. a 34. b 35. b 36. c 37. c 38. a 39. b 40. d 41. b 42. b 43. b 44. a 45. d 46. b 47. c 48. c 49. d 50. b 51. c 52. d 53. a 54. a Copyright Cengage Learning. Powered by Cognero.

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Chap_14_10e 55. c 56. a 57. a 58. b 59. b 60. a 61. a 62. a 63. b 64. a 65. a 66. d 67. c 68. d 69. c 70. c 71. c 72. a 73. d 74. b 75. a 76. c 77. c 78. d 79. b 80. a 81. a 82. a Copyright Cengage Learning. Powered by Cognero.

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Chap_14_10e 83. b 84. c 85. b 86. b 87. a 88. b 89. d 90. c 91. b 92. a 93. d 94. c 95. b 96. b 97. a 98. b 99. a 100. b 101. c 102. c 103. a 104. d 105. a 106. a 107. b 108. d 109. a

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Chap_14_10e 110. A. Weight regulation involves a number of hormones. 1. The action of hormones provides both short-term and long-term regulation mechanisms. 2. The hypothalamus is a brain structure that is involved in the reception of these hormones. B. Ghrelin is a hormone secreted by the stomach. 1. Its level rises before and falls after meals. 2. This action indicates that ghrelin is a short-term hunger signal. C. Cholecystokinin (CCK), glucagon-like peptide 1, and peptide Y are secreted by the intestines. 1. All act on the hypothalamus and are related to feelings of satiation. 2. CCK seems to be a short-term satiation signal. D. Leptin is a hormone produced by fat cells. 1. Low fat stores result in lower leptin levels. 2. Low leptin levels are interpreted by the brain as a signal to eat. E. Insulin is a hormone produced by the pancreas. 1 Insulin allows body cells to take in glucose. 2. High insulin levels are positively related to body fat. 111. A. The set-point model hypothesizes that weight is homeostatically controlled. 1. Deviations in either direction activate feelings of hunger that prompt eating or lack of hunger that motivate weight loss. 2. The model explains why people can maintain a constant weight, why people who lose weight often gain it back, and why some people find it difficult to gain weight. 3. The model fails to explain individual variations in set-point or why some people’s set-point should be at the obese level, but it is the most comprehensive of the models. B. Genetic explanations of obesity come in two varieties. 1. One version explains the tendency to gain weight because of a “thrifty” metabolism that protected against starvation in human prehistory. 2. One version examines twins and adopted children and has determined that there is a genetic component for weight and fat distribution. C. The positive incentive model holds that a variety of positive reinforcers can accompany eating, and these reinforcers may lead to overeating and consequently to obesity. 1. People have several types of motivation to eat, including personal pleasure, pleasant social surroundings, and biological factors. 2. Personal pleasure can come from the act of eating, including the taste of food and how pleasurable eating is at any particular time. 3. The social context of eating includes the cultural background as well as the other people present and whether they are eating or not. 4. The biological factors include the length of time since the person's last ingestion of food as well as blood glucose levels. 5. The positive incentive model predicts a variety of body weights, depending on food availability, personal experiences with food, cultural encouragement to eat various kinds of food, and the cultural view of ideal weight. 6. The positive incentive model does a better job than the set-point model in explaining individual variations in body weight.

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Chap_14_10e 112. Digestion starts in the mouth. 1. The teeth tear, grind, and mix food with saliva. 2. Salivary glands provide moisture enabling taste buds to work. 3. Saliva also includes an enzyme that digests starch. B. After voluntary swallowing, food moves through the pharynx and esophagus automatically via peristalsis (rhythmic contraction and relaxation of muscles). 1. The stomach and the glands emptying into it secrete gastric juices. 2. Rhythmic muscular contractions in the stomach mix swallowed food with gastric juices. C. Food mixed with digestive juices moves gradually from the stomach into the small intestine. 1. The pancreas secretes several acid-reducing enzymes, as the small intestine cannot tolerate high acidity. 2. Pancreatic juices are also necessary to digest carbohydrates and fats. 3. Starch digestion begun in the mouth is finished in the upper small intestine. 4. Protein digestion begun in the stomach is finished in the upper small intestine. 5. Undigested fats are absorbed in the middle third of the small intestine, broken down by bile salts made in the liver and stored in the gall bladder, and then acted on by a pancreatic enzyme. 6. Bile salts are later reabsorbed in the lower third of the small intestine. 7. 90% of water and digestive juices reaching the small intestine is absorbed, including vitamins and electrolytes, into the body. D. Digestions proceeds from the small intestine to the large intestine. 1. Peristalsis in the large intestine is more irregular and sluggish than in the small intestine. 2. Bacteria living in the large intestine produce several vitamins. 3. The large intestine typically only absorbs water, the vitamins it makes, and a few minerals. E. After digestion, what is left includes undigested fiber and nutrients, inorganic material, water, and bacteria, which make up the feces or solid waste matter. 1. Peristalsis moves feces through the large intestine to the rectum, and then into the anus for excretion.

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Chap_14_10e 113. In the late 1960s and early 1970s, Sims and colleagues conducted an experimental study with male inmates of Vermont State Prison who volunteered to gain 20-30 pounds. 1. Volunteers had plenty of delicious food, restricted physical activity to facilitate weight gain, and other special living arrangements. 2. Initially, participants gained weight with relative ease, but this did not continue. 3. The volunteers had to eat increasing amounts to keep gaining weight. a. To maintain their normal weights, they needed about 3,500 calories. b. To keep gaining weight, many men had to eat twice as many calories (=7,000). 4. Not all the participants were able to reach their weight gain goals. a. One inmate ate more than 10,000 calories a day and still did not gain the goal amount of weight. 5. Compared to volunteers in a semi-starvation experiment (Keys et al., 1950), these inmates were not as miserable; however, they did find overeating aversive. a. Despite excellent food quality and preparation, they came to find food repulsive and had to force themselves to eat. Many participants considered dropping out of the study due to this unpleasantness. B. Once the part of the study involving weight gain had ended, the inmates drastically reduced the amounts they ate and lost weight. 1. Some did not lose weight as quickly as others did. 2. Two participants had some difficulty getting back to their original weights. a. Though these two men had never been overweight themselves, the researchers examined their medical backgrounds and discovered some family history of obesity. C. The results of this study show that: 1. People of normal weights have difficulty gaining substantial amounts of weight. 2. Even if they do gain substantial amounts, they have difficulty maintaining those weight gains.

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Chap_14_10e 114. Conducted during World War II and reported/published in 1950, this study involved 36 young male conscientious objectors who volunteered. 1. Participants had normal weights, normal/above normal IQs, and emotional stability. 2. They ate normally for the first three months of the study to establish baseline calorie needs. B. After the first three months, the researchers cut participant rations in half, while supplying adequate nutrients to prevent starvation; the men were almost constantly hungry. The goal was to lower their body weights by 25%. 1. Participants lost weight rapidly at first, but this did not continue. 2. They had to eat even less to keep losing weight. 3. Most of them completed the six-month project, and most met the 25% weight loss goal. C. The researchers were surprised at the behaviors accompanying the semi-starvation diet. 1. Although initially cheerful and optimistic, the participants soon developed uncharacteristic irritable, aggressive, and combative behaviors. 2. While the hostile behavior lasted throughout the six months, the participants also developed apathy and lethargy, and avoided physical activity as much as possible. a. They neglected their appearances, their dormitory, and their girlfriends. 3. The volunteers developed increasingly obsessive thoughts about food. a. Meals became central to their lives. b. They tended to be very sensitive to food’s taste and to eat very slowly. c. Around three months into the restricted diet, they were too afraid of cheating on it to leave the dormitory alone and had to go out only in groups or pairs. d. Normal, stable, polite, dedicated young men became abnormal and unpleasant under the semi-starvation conditions of the study. 4. Participants continued their abnormal negative attitudes and food obsession during the refeeding phase of the study. a. Refeeding had been planned as gradually increasing over three months. b. However, the volunteers raised such strong objections that the experimenters accelerated the schedule. c. The men then ate as often and as much as they could; some ate up to five large meals daily. d. Most participants regained the weight they lost during the experiment by the end of the refeeding period, and some gained slightly more than they had lost. e. Around half of the volunteers were still preoccupied with food. f. Many of the participants had not entirely regained their pre-diet cheer and optimism.

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Chap_14_10e 115. A. Differences 1. Anorexia nervosa involves self-starvation; bulimia involves eating large quantities of food and then purging by either vomiting or taking laxatives; binge eating involves bingeing but not purging. 2. People with anorexia are dangerously thin; people with bulimia are usually of normal weight; people with binge eating disorder are usually overweight. 3. People with anorexia practice a great deal of self-denial, starving and exercising a great deal; people with bulimia and people with binge eating disorder are self-indulgent, impulsive, eat a lot, take drugs or drink alcohol, and steal. 4. People with bulimia and people with binge eating disorder are often depressed, but people with anorexia are often euphoric and hyperactive. 5. Bulimia and binge eating are much more common than anorexia-—about 4 to 10 times more frequent. 6. Anorexia is life threatening; bulimia and binge eating are rarely life threatening. 7. People with anorexia resist treatment, denying that they have a problem; people with bulimia and people with binge eating disorder sometimes seek and rarely resist treatment, admitting that they have a problem. B. Similarities 1. All three are more common among young women than older women or men of any age. 2. Individuals with any of these eating disorders are likely to have a distorted body image. 3. All are secretive about their eating habits. 4. Behavioral therapies are typically more successful with both than are traditional medical therapies. 116. A. All three disorders have health consequences that can be serious. 1. Anorexia is life threatening. 2. Bulimia is rarely life threatening but includes a variety of health problems. 3. Binge eating is associated with obesity, which carries health risks. B. Anorexia can produce death through cardiac, respiratory, or kidney failure, but it typically produces: 1. Amenorrhea (cessation of the menses). 2. Loss of hair on the scalp and growth of downy overall body hair. 3. Feeling of constant chill. 4. Fatigue and exhaustion. C. Bulimia can lead to serious kidney damage, dehydration, and spastic colon, but its more typical health consequences include: 1. Hypoglycemia (low blood sugar), accompanied by fatigue, dizziness, and depression. 2. Dental problems caused by stomach acid from repeated vomiting. 3. Anemia (low red blood cell count). 4. Electrolyte imbalance (incorrect balance of essential minerals in the body). 5. Alkalosis (abnormally high level of alkaline in the body). D. Binge eating is associated with overweight and obesity as well as psychological problems. 1. Obesity raises the risk for a variety of health problems, including cardiovascular disease, gallstones, and Type 2 diabetes. 2. Personality disorders are associated with binge eating.

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Chap_14_10e 117. A. Both concepts are difficult to define, complicating the answer to this question. 1. Overeating may be defined as eating that produces overweight, regardless of the amount eaten. 2. Obesity has various definitions, but assessing percent of body fat is common to all. a. Techniques to measure body fat are difficult and expensive, such as potassium-40 analysis or ultrasound, MRI, or other high-tech imaging procedures. b. The skinfold technique is easy but not very accurate. c. Defining obesity as a body mass index of 30 or over is easiest but not as accurate as the other approaches. B. In general, obese people eat more than people who are not obese, but they may not believe that they do. 1. Low metabolic levels can produce obesity, but it is not the reason underlying most obesity. 2. People who are obese are more likely to binge eat than people who are not obese. 3. People who are obese tend to eat more high-fat food than people who are not obese. 4. Obese people are less physically active than people who are not obese. 118. A. If Rolando is younger, losing weight might have health benefits. 1. If Rolando’s blood pressure is normal and does not have diabetes, his overweight is probably not a substantial health threat, though. 2. If Rolando has the pattern of fat distribution that most men do—fat accumulated on the waist rather than around the hips and thighs —his excess weight is may be a threat to his health. 3. Being overweight is usually not a threat to health until it reaches 30% above the charted weight, far more than Rolando’s 15 pounds. B. Dieting may be an unwise choice for Rolando if: 1. Rolando is not sufficiently overweight to gain health benefits from dieting. 2. Losing weight may involve extreme diets that can threaten health. 3. If Rolando is older, losing weight might not have health benefits. 119. A. Don should choose a program that: 1. Contains a variety of foods, so that he will not get bored with the diet. 2. Provides sufficient calories to produce a slow weight loss rather than a rapid one. 3. Is low in fat, contains sufficient protein for maintenance of muscle, and is sufficiently high in carbohydrates to provide energy. 4. Decreases portion size rather than eliminating a specific food or foods. 5. Includes exercise as well as changes in eating. 6. He can adapt to a permanent change in her eating patterns rather than a temporary change to produce weight loss. B. Don should avoid diets that: 1. Are very low in carbohydrates and high in fat because these diets make poor lifelong diets. 2. Are high in sugar. 3. Consist of a single food because these diets are boring, difficult to continue, and nutritional disasters. 4. Rely on drugs to suppress her appetite.

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Chap_15_10e Indicate whether the statement is true or false. 1. Moderate exercise improves cholesterol ratios more by raising HDL than by lowering LDL. a. True b. False 2. People who wish to lose weight in one specific part of their body (for example, the hips) should understand that spot reduction does not work. a. True b. False 3. Genetic factors play a larger role in organic fitness than in dynamic fitness. a. True b. False 4. Physical activity may reduce some of the cognitive declines that come from aging. a. True b. False 5. The most effective type of exercise for reducing the risk for cardiovascular disease is anaerobic exercise. a. True b. False 6. Physically active children benefit from exercise more than physically active adults benefit. a. True b. False 7. Mass media campaigns are useful in promoting awareness of physical activity as well as getting individuals to adopt and maintain their physical activity programs. a. True b. False 8. Some people begin an exercise program and lose inches in the waist and hips, but do not lose weight. The best explanation for this is that they are building muscle and that muscle weighs more than fat. a. True b. False 9. School-based physical education programs increase physical activity both inside and outside of the school. a. True b. False 10. Physically active people can expect to live, on average, 5 years longer than physically inactive people a. True b. False Copyright Cengage Learning. Powered by Cognero.

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Chap_15_10e Indicate the answer choice that best completes the statement or answers the question. 11. Brooke is bedridden after an auto accident. What exercise would help her maintain muscular strength in her arms with a minimum of movement? a. Isometric b. Isotonic c. Aerobic d. Isokinetic 12. What type of exercise is recommended for people over the age of 65? a. Vigorous exercise at least 1 hour a week b. Exercise which helps maintain or improve balance c. Strength training exercise at least 5 days a week d. Exercise throughout the day 13. The optimal time for beginning a structured exercise program is during a. early childhood. b. adolescence. c. young adulthood. d. middle adulthood. 14. Most sudden deaths during exercise are the result of a. inadequate clothing for weather conditions. b. some type of pre-existing heart disease. c. getting hit by cars while running/walking. d. lifting weights without a spotter. 15. Research has found that people who experienced the greatest benefits from physical activity were: a. those who changed from a sedentary to an active lifestyle. b. those who changed from an active to a more active lifestyle. c. women. d. children. 16. Authors of recent (2011; 2018) studies have concluded which of these about the effects of physical activity on risk of all-cause mortality? a. Some activity is far better than none, but more is no better than some. b. Some activity is much better than none, and more is better than some. c. More activity is better than none, but some is not any better than none. d. No activity is better than a little, and some is greatly better than more.

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Chap_15_10e 17. Pilar injured her knee while downhill skiing and is currently in a rehab program to help regain strength and flexibility in her knee. She is most likely doing ________. a. anaerobic exercise b. aerobic exercise c. isometric exercise d. isokinetic exercise 18. Yu-jung was considered a natural athlete in college, but she has not been active since she left college 10 years ago. Presently, the type of fitness that Yu-jung probably has is a. dynamic fitness. b. organic fitness. c. both dynamic and organic fitness. d. neither dynamic nor organic fitness. 19. Pushing muscles hard against an immovable object is an example of _____. a. aerobic exercise b. anaerobic exercise c. isokinetic exercise d. isometric exercise 20. Aerobic fitness gained through vigorous physical activity a. decreases the risk of heart attack. b. decreases cardiorespiratory fitness. c. increases resting heart rate. d. decreases exercise-related injuries. 21. In addition to muscle-strengthening activities, current physical activity recommendations are that adults should engage in a. 1 hour of moderate to vigorous physical activity each day b. 2.5 hours of moderate to vigorous physical activity each day c. 30 minutes of moderate physical activity each week d. 20 minutes of moderate physical activity each day 22. Physically active people can expect to live, on average, how much longer than physically inactive people? a. 2 years b. 5 years c. 10 years d. 15 years

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Chap_15_10e 23. The type of exercise that requires the LEAST amount of physical activity is a. isometric. b. isotonic. c. isokinetic. d. anaerobic. 24. Isotonic exercise is designed to a. increase cardiovascular fitness. b. increase muscle endurance. c. increase muscle strength. d. increase both (b) and (c). 25. A systematic review of the literature on the relationship between physical activity and cardiovascular disease found that physical activity confers a a. 10% reduction in risk of death due to cardiovascular causes. b. 10% increase in risk of death due to cardiovascular causes. c. 35% reduction in risk of death due to cardiovascular causes. d. no reduction in risk of death due to cardiovascular causes. 26. Regarding diet, exercise, and weight loss, which statement is true? a. Exercise alone can produce weight loss. b. Dieters lose weight, but they also retain lean muscle tissue. c. Exercisers lose weight, but they lose mostly lean muscle tissue. d. Both a and b are true. 27. What is the relationship between exercise and depression in clinical patients? a. Isometric exercise decreases depression; aerobic exercise increases depression. b. Endorphins released by exercise cause depression to increase. c. Moderate exercise is associated with a decrease in depression. d. Group psychotherapy is superior to exercise for treating mild depression. 28. Megan is a professional soccer player and wants to increase her physical flexibility. What is most accurate about exercise toward this goal? a. Any exercise that he does to increase muscle strength will decrease his flexibility. b. Any exercise that he does to increase muscle endurance also increases flexibility. c. Any exercise that he does to increase his flexibility will be the same for all joints. d. Any exercise that he does to increase his flexibility will lower his risk of injuries.

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Chap_15_10e 29. Which type of intervention is beneficial for increasing knowledge of the benefits of physical exercises but has not shown the same efficacy for getting individuals to adopt physical activity? a. Informational interventions b. Behavioral interventions c. Social interventions d. Environmental interventions 30. Angelo has moderate weight and good organic fitness. If he begins an aerobic exercise program, he will probably a. lose muscle. b. gain muscle. c. increase lean body weight and decrease body fat. d. decrease lean body weight and increase body fat. 31. What are the important characteristics of aerobic exercise? a. Intensity and duration b. Duration and frequency c. Intensity and frequency d. Frequency and oxygen consumption 32. The emphasis on exercise as a factor in weight control programs has come about because of research that found that a. exercise elevates the rate of the body’s metabolism. b. exercise burns more calories than previously believed. c. exercise acts differently on muscle tissue in the obese. d. isometric exercise is the most advantageous type. 33. Adults who participate in regular physical exercise show a. greater attentional focus. b. greater executive functioning. c. greater memory. d. All of the above 34. Organic fitness is determined by a. inherent body characteristics. b. taking the exercise stress test. c. regular and strenuous exercise. d. the degree of muscular strength.

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Chap_15_10e 35. Regarding physical activity and breast cancer, evidence suggests that a sedentary lifestyle a. protects against breast cancer. b. is unrelated to breast cancer. c. may be more of a risk for some women than for others. d. protects against breast cancer in men but not in women. 36. Research has generally found that a program of regular physical activity a. can add as much as two years to people's lives. b. has no real effect on lifespan. c. adds quantity, but not quality to life. d. adds quality, but not quantity to life. 37. Activities such as jogging, cross-country skiing, or swimming are classified as _________. a. anaerobic exercise b. aerobic exercise c. isometric exercise d. isokinetic exercise 38. In addition to muscle- and bone-strengthening activities, current physical activity recommendations are that adolescents should engage in a. 1 hour of moderate to vigorous physical activity each day. b. 1.25 hours of moderate to vigorous physical activity per week. c. 30 minutes of moderate physical activity each week. d. 20 minutes of moderate physical activity each day. 39. A series of landmark longitudinal studies begun in the 1950s with San Francisco longshoremen by Paffenbarger and associates found which of the following relative to coronary heart disease (CHD) and physical activity? a. Men who began in worse shape had higher CHD death rates despite PA. b. Men who began in better shape had lower CHD death rates despite PA. c. Men who had less PA over time had significantly greater CHD deaths. d. Men who had more PA over time had significantly higher CHD deaths. 40. Benito wants to exercise with a minimum of injury. What precautions should he take? a. He should limit exercise to temperatures between 30° and 80° F. b. He should use proper shoes and equipment. c. He should use a personal trainer. d. He should not bother about any of the above because injury is not likely.

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Chap_15_10e 41. Regarding stress and exercise, research suggests that a. exercise is ineffective in protecting stressed people from getting sick. b. exercise provides a buffer against most diseases. c. exercise can reduce stress and help people cope. d. exercise probably increases stress, but nevertheless is a buffer against cancer and heart disease. 42. Kwame, a 15-year-old high school sophomore, sits in front of his computer eating "junk food" almost constantly when he is not sleeping or in school. How can Kwame’s behavior affect his weight? a. His inactivity is positively related to weight gain. b. His high caloric intake is positively related to weight gain. c. His eating increases his metabolic rate, which is related to weight loss. d. Both a and b, but not c, are behavioral factors that can affect his weight. 43. What have researchers found about the relationship between physical fitness and stress? a. Exercising decreases stress on a physiological level. b. Exercising decreases stress on a psychological level. c. Exercising has no influence on stress on either level. d. Exercising decreases stress on both these two levels. 44. Young children who exercise regularly a. do not gain health benefits from their exercise programs. b. gain more protection against heart disease than adolescents who exercise regularly. c. have lower cholesterol than children with no consistent exercise program. d. receive life-long protection against heart disease. 45. Children who live where are more likely to be physically active and less likely to be obese? a. In the urban neighborhoods within larger cities b. In more rural settings c. In neighborhoods with parks and playgrounds d. In warmer climates 46. What percentage of reduction in risk of death due to all causes is conferred by physical activity? a. 5% b. 12% c. 24% d. 33%

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Chap_15_10e 47. What type of exercise is not necessarily good for someone with coronary heart disease? a. Aerobic exercise b. Isometric exercise c. Anaerobic exercise d. Isokinetic exercise 48. If you are young now and want to avoid developing osteoporosis when you are older, which kind of exercise would be most effective? a. Swimming laps b. Jumping rope c. Walking d. Tai chi 49. What percentage of women in the United States engages in regular physical activity? a. 10% b. 19% c. 33% d. 52% 50. Vetri wants to increase his muscular strength; Sinclair wants to increase his muscular endurance. What should each of them do to achieve these goals? a. Vetri should do more repetitions with less exertion; Sinclair should do fewer repetitions with more exertion. b. Vetri should do more repetitions with more exertion; Sinclair should do fewer repetitions with less exertion. c. Vetri should do fewer repetitions with less exertion; Sinclair should do more repetitions with more exertion. d. Vetri should do fewer repetitions with more exertion; Sinclair should do more repetitions with less exertion. 51. Which type of interventions seeks to raise public awareness of the importance and benefits of physical activity? a. Informational interventions b. Behavioral interventions c. Social interventions d. Environmental interventions 52. The optimal type of physical activity for someone wanting protection from osteoporosis is a. high-impact exercise, like running and jumping. b. lower-impact exercise, like walking. c. low-impact exercise, like tai chi. d. no type of exercise. Copyright Cengage Learning. Powered by Cognero.

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Chap_15_10e 53. Research into the effects of exercise on anxiety has generally found that a. aerobic exercise does not reduce state anxiety. b. weight lifting does not reduce anxiety. c. exercise does reduce state anxiety. d. exercise can increase state anxiety. 54. Some researchers have found that people can lift their moods and manage stress through as little as a. thirty minutes of vigorous exercise. b. ten minutes of moderate exercise. c. twenty minutes of light exercise. d. five minutes of any exercise. 55. Physical activity can be a useful treatment for_______. a. Type I diabetes b. Type II diabetes c. gestational diabetes d. All of the above 56. Scott's coach suggests that he exercise through the pain he feels during basketball workouts. The coach's advice a. is correct for isotonic exercise but not for isokinetic exercise. b. will produce maximum pain tolerance with minimum muscle damage. c. should increase muscular endurance but not muscle strength. d. is based on an exercise myth and is associated with further injury. 57. Which of the following causes a disproportionate number of injuries? a. Regular exercise b. Inconsistent exercise c. Aerobic exercise d. Anaerobic exercise 58. Which of these is characteristic of movement training designed to develop flexibility? a. It involves sudden, fast movements and bouncing. b. It involves slow, sustained, stretching movements. c. It involves more intensity than endurance training. d. It involves greater intensity than strength training. 59. High-impact exercise is MOST likely to protect against osteoporosis at older ages among _______. a. young women b. middle-aged and older women c. young men d. middle-aged men Copyright Cengage Learning. Powered by Cognero.

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Chap_15_10e 60. Evidence suggests that a regular exercise regimen can a. decrease depression. b. reduce anxiety. c. buffer stress. d. All of the above 61. What proportion of runners had experienced an injury in the past year as per a 1996 Surgeon General’s Report? a. One quarter b. One third c. One half d. Two thirds 62. Musculoskeletal injuries correlate _______. a. inversely with exercise frequency and intensity b. exponentially with exercise frequency and intensity c. positively with exercise frequency and intensity with exercise frequency and intensity d. negatively with exercise frequency and intensity 63. School-based physical education programs a. actually decrease physical activity inside school. b. have no effect on physical activity inside school. c. do not increase physical activity outside of the school. d. also increase physical activity outside of the school. 64. Which type of interventions aim to create a social environment that makes for adoption and maintenance of physical activity more successful? a. Informational interventions b. Behavioral interventions c. Social interventions d. Environmental interventions 65. Physical activity causes a. less than 25% of all musculoskeletal injuries. b. a little more than 50% of all musculoskeletal injuries. c. around 75% of all musculoskeletal injuries. d. well over 90% of all musculoskeletal injuries.

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Chap_15_10e 66. Ava would like to quit smoking, but she is concerned that she will gain weight. What advice would you give her? a. Keep smoking, because some people who quit gain as many as 40 or 50 pounds. b. Quit smoking, but begin a 1,000 calorie a day diet. c. Quit smoking, eat regularly, and begin a regular physical activity program. d. Quit smoking but begin a very low calorie diet and a physical activity program. 67. Evidence is clearest that physical activity protects against what type of cancer in both men and women? a. Colon cancer b. Lung cancer c. Stomach cancer d. Skin cancer 68. Ahmed is relatively satisfied with the looks of his chest, but he wants to lose weight on his belly while retaining the rest of his body composition. Ahmed should a. understand spot reduction is unlikely. b. begin a program of aerobic exercises. c. begin to perform isometric exercises. d. begin to perform isokinetic exercises. 69. Children and adolescents who die during exercise are most likely to die from a. strokes. b. congenital heart defects. c. the effects of stress. d. blood clots. 70. How should Bao, a preschool child, exercise? a. She should stay active throughout the day. b. She should do at least one hour of muscle or bone-strengthening activity a week. c. She should do exercise which helps her maintain balance. d. She should do 2.5 hours of moderate-intensity aerobic activity per week 71. Colin was a long-distance runner in high school and college. Now, at age 30, he lives an inactive life. Colin believes that his earlier experiences as a track star will offer permanent protection against cardiovascular disease (CVD). Colin's a. belief is correct. b. belief is incorrect. c. future risk of CVD will be about 50% lower compared to men his age who have never exercised. d. future risk of CVD will be higher than men of his age who have never exercised.

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Chap_15_10e 72. Graciela had a sedentary parent who had a heart attack and has been sedentary herself. She starts exercising to reduce her cardiovascular risk. Murph starts exercising because he lost weight by changing his diet and wants to maintain the weight loss. How can each of them achieve their goals? a. Murph will need to exercise at higher intensities for longer durations than Graciela will. b. Graciela will need to exercise at a higher intensity for a shorter duration than Murph will. c. Graciela will need to exercise at higher intensity for longer duration than Murph will. d. Murph and Graciela will both need to exercise equally to meet their goals. 73. Jolie is undergoing chemotherapy treatment for cancer and undertakes a program of exercise training. Based on research results, what can she expect? a. She will get stronger. b. She will be less fatigued c. She will lose weight d. She will be more fatigued 74. Two early studies that examined the association between physical activity and cardiovascular disease found that a. physically active men had lower rates of heart disease than sedentary men. b. physically active women had lower rates of heart disease than sedentary women. c. physically active men had lower rates of stroke than sedentary men. d. physically active men had lower rates of heart disease than physically active women. 75. What most closely predicts obesity? a. Sitting b. Lack of anaerobic exercise c. Lack of organic fitness d. Binge eating 76. Children who are physically fit show a. increases in brain volume. b. greater planning abilities. c. greater performance on standardized tests. d. All of the above 77. Willa is a track star in college. Her specialties are the 100-meter dash and the 200-meter dash. The type of exercise she is receiving during these races is mostly a. isometric. b. isotonic. c. isokinetic. d. anaerobic.

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Chap_15_10e 78. Researchers have recently suggested which of the following as likely mechanisms whereby physical activity lowers cancer risks? a. Physical activity inhibits the initial formation of cancer tumors. b. Physical activity inhibits the growth of existing cancer tumors. c. Physical activity inhibits release of proinflammatory cytokines. d. All of the above 79. The type of fitness known as flexibility is best increased by a. weight lifting. b. stretching. c. jogging. d. short, fast runs. 80. Which type of interventions aim to teach people the skills necessary for adoption and maintenance of physical activity? a. Informational interventions b. Behavioral interventions c. Social interventions d. Environmental interventions 81. What has been shown to increase a person’s likelihood of staying physically active? a. Social support b. Self-esteem c. Depression d. Personal trainers 82. Exercise like yoga and tai chi can help provide muscle _______. a. strength b. endurance c. flexibility d. fitness 83. Aerobic fitness training contributes to _______. a. increases in brain volume in older adults b. lower risk of Alzheimer’s disease in older adults c. greater performance on standardized tests in older adults d. All of the above

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Chap_15_10e 84. Aerobic fitness tends to a. increase muscle strength. b. increase resting heart rate. c. decrease resting blood pressure. d. decrease muscle strength. 85. What distinguishes anaerobic exercise from aerobic exercise? a. The amount of muscle contraction b. The amount of oxygen consumption c. The degree of joint rotation d. The amount of body movement 86. Studies of the effects of exercise on clinically depressed patients have generally found that exercise a. does not affect depression in clinically depressed patients. b. can reduce depression, but is less effective than psychotherapy. c. can reduce depression, but is less effective than drug therapy. d. can reduce depression and may be as effective as other therapy. 87. Research indicates that exercise protects against heart disease by a. raising high-density lipoprotein cholesterol. b. raising total cholesterol. c. lowering total cholesterol. d. lowering high-density lipoprotein cholesterol. 88. Women who exercise a. have about the same rate of all-cause mortality as men who exercise. b. likely have a lower risk of all-cause mortality than men who exercise do. c. likely have a higher risk of all-cause mortality than men who exercise do. d. benefit more from their exercise than men do. 89. Obligatory exercisers are at increased risk of a. eating disorders. b. CVD. c. asthma. d. stroke. 90. Exercise may protect against what type of cancer? a. Breast cancer b. Colorectal cancer c. Lung cancer d. All of the above Copyright Cengage Learning. Powered by Cognero.

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Chap_15_10e 91. What is true about the relationship between muscle strength and muscle endurance? a. A muscle may have endurance without strength. b. A muscle may be strong but not have endurance. c. Muscle strength and muscle endurance are different terms for the same phenomenon. d. A muscle needs a different exercise type for each. 92. Marta would likely be an obligatory exerciser if she a. exhibited obsession with her body. b. denied when she was experiencing pain. c. had a single-minded commitment to endurance. d. All of the above 93. What did a study of almost 1,000 older adults after a five-year period find? a. Those who exercised a lot seemed cognitively 10 years younger than those who did not. b. Those who exercised a lot seemed cognitively five years younger than those who did not. c. Those who did not exercise seemed cognitively 10 years younger than those who did. d. Those who did not exercise seemed to lose five years cognitively; those who exercised a lot did not lose years. 94. A 1978 study of Harvard alumni found those who expended the equivalent of 20 miles of jogging weekly had lower heart attack risk than those less physically active. What else did this study find? a. More exercise benefited the alumni who were smokers, but not those with hypertension. b. More exercise benefited the alumni with hypertension, but not smokers. c. More exercise benefited alumni who were smokers and those who had hypertension. d. More exercise did not benefit alumni who smoked or had hypertension. 95. Moderate to high levels of physical activity may be able to reduce the incidence of lung cancer a. but not to reduce the incidence of breast cancer. b. and heart disease, but not the incidence of stroke. c. for women and men, but more strongly for men. d. for women and men, but more strongly for women. 96. What is the name for the disorder characterized by a reduction in bone density due to calcium loss? a. Endometrial cancer b. Type II diabetes c. Atherosclerosis d. Osteoporosis

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Chap_15_10e 97. Researchers have found that physical activity is associated with lower levels of depression a. in moderately depressed individuals. b. in people being treated for depression. c. similar to the effects of cognitive therapy. d. All of the above. 98. Your aunt Inez has trouble falling asleep, and her adolescent son Horace has sleep apnea. What can you tell her about the benefits of exercise? a. Exercise will help Horace more than it helps Inez. b. Exercise will cure Horace of his sleep apnea, and will also help aunt Inez sleep more deeply. c. Exercise will help Inez if it is not at all strenuous and takes place immediately before bed, but it will not help Horace. d. Exercise, if it is moderately strenuous, will likely help both Horace and Inez. 99. What measures how powerfully a muscle can contract? a. Strength b. Endurance c. Flexibility d. Fitness 100. Kermit wants to exercise with a minimum of injury. What precautions should he take? a. He should limit exercise to temperatures between 30° and 80° F. b. He should use proper shoes and equipment. c. He should use a personal trainer. d. He should not stretch too often. 101. While jogging, sudden death due to cardiac arrest is a. about as likely as during periods of rest. b. more likely than during periods of rest. c. less likely than during periods of rest. d. not as likely as during tennis games. 102. What type of exercise requires specialized equipment to promote muscle strength and muscle endurance? a. Isokinetic b. Isotonic c. Isometric d. Anaerobic

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Chap_15_10e 103. Regarding exercise and depression in a clinical population, research suggests that a. exercise increases depression. b. moderate exercise can decrease depression. c. isotonic exercise (weight lifting) can decrease depression. d. exercise can decrease depression, but not to a clinically significant degree. 104. One problem of maintaining a physical activity regime is that once people stop for a few days, they never start again. This is an example of a. a lack of self-control. b. the abstinence violation effect. c. influences from the environment. d. a lack of sufficient social support. 105. If the goal of your exercise program is to improve your cardiovascular health, you should most likely engage in ________. a. anaerobic exercise b. aerobic exercise c. isometric exercise d. isokinetic exercise 106. Which type of interventions are cost-effective and can actually change people’s behavior? a. Mass media campaigns b. “Point of decision” prompts c. Environmental interventions d. Individually tailored programs 107. People may lose weight through exercise alone if they a. do vigorous physical activity for about an hour daily. b. combine isometric exercise with isokinetic exercise. c. run for short distances at an extremely rapid speed. d. combine isokinetic exercise with isotonic exercise. 108. Isometric exercise is designed to a. increase cardiovascular fitness. b. increase lung capacity. c. increase muscle endurance. d. increase muscle strength.

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Chap_15_10e 109. What is the role of exercise in weight control?

110. Explain how exercising can protect people against osteoporosis.

111. Discuss the cardiovascular benefits and risks of exercise. Are the cardiovascular benefits of exercise sufficient to outweigh the risks?

112. Evaluate the various types of exercise according to their contribution to different types of fitness.

113. Discuss how physical activity can protect people against the risks of various cancers.

114. What are some methods to improve adherence to physical activity?

115. Summarize some of the cognitive benefits of physical activity.

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Chap_15_10e 116. Identify some of the American College of Sports Medicine’s (ACSM) recommendations for amounts and types of physical activity relative to different health goals for adults.

117. What are some of the psychological benefits of exercise?

118. Describe how physical activity can help people to manage both types of diabetes.

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Chap_15_10e Answer Key 1. True 2. True 3. True 4. True 5. False 6. False 7. False 8. True 9. False 10. False 11. a 12. b 13. a 14. b 15. a 16. b 17. d 18. b 19. d 20. a 21. b 22. a 23. a 24. d 25. c 26. a

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Chap_15_10e 27. c 28. d 29. a 30. c 31. a 32. a 33. d 34. a 35. c 36. c 37. b 38. a 39. c 40. b 41. c 42. d 43. d 44. c 45. c 46. d 47. c 48. b 49. b 50. d 51. a 52. a 53. c 54. b Copyright Cengage Learning. Powered by Cognero.

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Chap_15_10e 55. a 56. d 57. b 58. b 59. a 60. d 61. c 62. c 63. c 64. c 65. d 66. c 67. a 68. a 69. b 70. a 71. b 72. a 73. b 74. a 75. a 76. d 77. d 78. d 79. b 80. b 81. a 82. c Copyright Cengage Learning. Powered by Cognero.

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Chap_15_10e 83. a 84. c 85. b 86. d 87. a 88. b 89. a 90. d 91. b 92. d 93. a 94. c 95. d 96. d 97. d 98. d 99. a 100. b 101. b 102. a 103. b 104. b 105. b 106. b 107. a 108. d

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Chap_15_10e 109. A. Exercise has traditionally been a component in weight control programs. 1. Physical activity is a factor in the weight-maintenance equation, increasing the number of calories expended. 2. Exercise builds muscle tissue, whereas dieting produces a loss of both fat and muscle; exercise combined with dieting can lead to a more favorable fat-to-muscle ratio. 3. Exercise is not effective for spot reduction. B. Research on the role of exercise in weight loss has revealed that 1. Exercise alone can produce weight loss, but the exercise must be vigorous and frequent. 2. Exercise may raise the metabolic level, producing greater calorie expenditures than the exercise itself uses. C. Exercise can also be beneficial for those who are not overweight, helping them to maintain a lean body mass. 110. A. Osteoporosis is a disorder caused by calcium loss which decreases bone mineral density (BMD), making bones brittle and more vulnerable to fractures. B. Exercise can protect both women and men against BMD loss. 1. Childhood and early adolescence is when bone minerals accumulate. 2. For bone health, physical activity during childhood and early adolescence may be particularly significant. a. One study found retired athletes aged 60 had kept more BMD and sustained fewer fractures than comparable 60-year-olds who were not former athletes. A. Women and men can both protect bone density through high-impact (weight-bearing) exercise, e.g. jumping and running. 1. One caveat is to consider injury vulnerability, particularly for older people. B. In general, younger and older people both benefit from exercise. C. One experimental study found significantly higher BMD in young, premenopausal women who did high-impact exercise than in young, premenopausal women who did not. D. Two other studies that experimented, one with walking and one with tai chi, did not show these were as clearly effective as the study using higher-impact exercise did. 111. A. Early studies indicated that people who get more exercise were at reduced risk for cardiovascular disease, but these studies were plagued by problems of self-selection. B. Later studies have confirmed the benefits of physical activity for decreasing the risk of cardiovascular disease. 1. An international panel reviewed the evidence and concluded that there is a dose-response relationship between physical activity and lowered risk for CVD. 2. The cardiovascular benefits of exercise extend to both women and men. 3. People from a variety of ethnic backgrounds and nationalities derive cardiovascular benefits from exercise. C. Exercise has cardiovascular risks as well as benefits. 1. Sedentary people may have undiagnosed cardiovascular disease and may have a heart attack if they begin a vigorous exercise program. 2. Death during exercise is more common than death during sedentary activities. D. The benefits of exercise typically outweigh the risks. 1. Regular exercise is required for cardiovascular benefits to occur. 2. For at-risk individuals, a stress test is a wise precaution. 3. For those with cardiovascular disease, supervised exercise is a wise precaution.

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Chap_15_10e 112. A. Isometric exercise is performed by contracting muscles against an immovable object. 1. It contributes to muscle strength. 2. It does not contribute to other types of fitness—muscle endurance, flexibility, or aerobic (cardiorespiratory) fitness. B. Isotonic exercise requires contraction of muscles and movement of joints and includes weightlifting and traditional calisthenics. 1. It can improve muscle strength and muscle endurance. 2. It does not contribute to flexibility or aerobic fitness. C. Isokinetic exercise is a departure from traditional weightlifting or calisthenics and requires specialized equipment. 1. It requires exertion both in lifting and in returning to the original position. 2. It is more useful in rehabilitation than in achieving fitness. D. Anaerobic exercise requires large energy expenditure in a short amount of time, such as running sprints. 1. It can improve muscle strength 2. It does not require endurance or lead to aerobic fitness. E. Aerobic exercise requires increased oxygen consumption over a period of 12 to 20 minutes, combining duration and intensity. 1. It produces cardiovascular benefits. 2. It can also produce muscle strength and muscle endurance as well as being the best type of exercise for weight control. 3. It generally does not produce increased flexibility. 113. A. Among hundreds of research studies on the relationship between physical activity and cancers, several reviews focused on evaluating mostly studies on colorectal, breast, endometrial, prostate, and lung cancer. Physical activity protects against all these cancers. 1. The strongest evidence of this is for colorectal and breast cancer. 2. Physical activity’s protection against colorectal cancer appears equally strong for both women and men. 3. Physical activity seems to protect postmenopausal women against breast cancer more than premenopausal women, and non-Caucasian women more than Caucasian women. 4. Moderate to high physical activity levels appear to reduce lung cancer incidence in both sexes, but more for women than men. B. While it is not clearly known how physical activity lowers cancer risk, research suggests two possible reasons: 1. Physical activity may influence the initiation and growth of tumors. 2. Physical activity influences pro-inflammatory cytokines, which are involved in cancer (as well as cardiovascular disease) development. C. People who already have cancer may also benefit from exercising. 1. Physical activity benefits chemotherapy patients by increasing their aerobic fitness, weight, and strength. 2. Physical activity also helps patients manage the fatigue that cancer treatment often causes. D. Hence physical activity is effective for both preventing several kinds of cancers and managing treatment sideeffects.

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Chap_15_10e 114. A. Only about 26% of men, 19% of women, and 20% of adolescents in the United States get regular physical activity at either a moderate or vigorous intensity. There are a few different tactics to use to increase physical activity: 1. Informational interventions are one method used to try to increase physical activity. a. They do so by increasing public awareness of the importance of physical activity and the benefits of engaging in physical activity. b. One example of informational interventions is mass media campaigns. Mass media campaigns increase awareness of the importance of physical activity but are not successful at actually getting people to engage in physical activity. c. “Point of decision” prompts are another example of informational interventions and are more successful at behavior change than mass media campaigns. 2. Behavioral and Social Interventions a. Behavioral interventions attempt to teach people the skills they would need to engage in physical activity, whereas social interventions aim to create social environments that would enable successful behavior change and maintenance. b. One example of behavioral interventions is school-based PE programs. These programs increase physical activity during school hours but do not increase physical activity after school hours. Thus, kids are not taking what they learn during school and using it later c. Social Interventions are interventions such as developing a “buddy system” or workout partner. Having a workout partner does help an individual adopt and maintain a physical activity program. 3. Environmental Interventions a. Environmental interventions are when the environment is changed to make exercise more likely. For example, having sidewalks and parks—places to exercise—increases physical activity.

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Chap_15_10e 115. A. A 2016 study of almost 1,000 older adults found that those engaging in high physical activity levels had cognitive skills five years later equivalent to people 10 years younger, whereas a comparison group engaging in little or no physical activity did not. 1. This suggests physical activity could not only extend life expectancy, but improve cognition. B. Cognitive functioning includes, among other things, being able to focus attention; to store and retrieve memories; process new information at optimal speeds; and executive functioning, e.g. being able to plan and pursue goals successfully. C. Cognitive functioning often declines with advancing age. 1. Therefore, most research into the relationship between cognitive functioning and physical activity focuses on older adults. 2. A 2010 review of studies using exercise interventions found that adults participating in physical activity programs demonstrate higher attention, processing speed, memory, and executive functioning than adults not participating in physical activity programs. 3. Physical activity seems to decrease some age-related cognitive declines. a. Physical activity interventions demonstrate greater memory protection in older than younger adults, and in adults at most risk for Alzheimer’s disease. b. Aerobic fitness training is found to contribute to increased brain volume in older but not younger adults. c. One study found that among older adults with memory problems indicating risk of Alzheimer’s disease, those who participated in a home-based physical activity intervention for six months had improved cognitive functioning 18 months later, while those who did not participate had no change. D. Recent research also shows that physical activity can improve children’s cognitive functioning. 1. Physically fit children demonstrate better memory performance and greater hippocampus volume than less physically fit children. 2. In research providing a three-month physical activity intervention, sedentary and overweight children demonstrated better standardized math test performance and better planning abilities after the intervention. E. Although the precise reason that physical activity improves cognitive function is unknown, researchers suggest two possibilities: 1. Increased cerebral blood flow 2. Increased expression of brain-derived neurotrophic factor (BDNF). 116. A. More recent research has identified lower amounts and types of physical activity for achieving desired health benefits. 1. The ACSM revised its recommendations in 2018 to reflect these findings. B. Healthy adults should engage in moderately vigorous activity for 2.5 hours per week, C. or vigorous activity for 1.25 hours per week. D. Muscle-strengthening activities are recommended on at least 2 days per week. E. Experts identify this level of exercise as sufficient for protection against cardiovascular and other chronic disease. F. Moderate exercise (e.g. walking) provides health benefits; vigorous exercise is unnecessary. 1. Moderate exercise may be better for some cardiovascular risk factors than more intense exercise. G. Weight loss or its maintenance cannot be attained through the recommendations above. 1. To lose weight or maintain weight loss, the intensity and duration of exercise must be greater than those recommended for health benefits alone. H. Hence the specific health goals involved dictate how much exercise is enough

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Chap_15_10e 117. A. People who exercise regularly claim various psychological benefits, and research has confirmed advantages for several psychological factors. B. Decreased depression is a consistent difference between active and more sedentary people. 1. People who are more active are less depressed than more sedentary people. 2. Physical activity has been shown to be effective in lowering levels of clinical depression and may provide a useful addition to other therapies for mild and moderate depression. 3. Exercise is as effective as cognitive therapy and antidepressant drugs in reducing depression. C. Even moderate exercise can have beneficial effects on state anxiety. D. Physical activity may act as a buffer against stress, and it also provides a strategy to allow people to cope with stress. 118. A. Since exercise is established as a means of weight control, and obesity and overweight are established factors in Type 2 diabetes, it is logical that physical activity should help control it. 1. Systematic reviews of research studies confirm that exercise: a. Helps improve insulin resistance, b. Helps prevent development of Type 2 diabetes, c. Helps patients manage their Type 2 diabetes, d. And lowers the risk of mortality among diabetics. B. Physical activity is also found important in managing Type 1 diabetes. 1. A meta-analysis of behavioral interventions shows this. 2. Adolescents with Type 1 diabetes who are physically active show lower risks for cardiovascular problems than those less physically active. 3. Studies show physical activity affords modest protection for diabetics, not that it is a cure-all for controlling diabetes. Nonetheless, it does help. C. Physical activity is a useful component for both treating Type 1 diabetes and protecting against developing Type 2 diabetes.

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Chap_16_10e Indicate whether the statement is true or false. 1. Secondary prevention consists of screening people at risk for a disease to discover. a. True b. False 2. On average, Native Americans live longer than European Americans. a. True b. False 3. The United States has the highest per capita health care expenditure in the world. a. True b. False 4. Immunizations are an example of primary prevention, but lifestyle changes are not. a. True b. False 5. Whether people are healthy or ill when they are older is strongly influenced by the health habits they develop as young adults. a. True b. False 6. College students are less likely to smoke cigarettes but more likely to binge drink. a. True b. False 7. Hispanic Americans have a lower death rate than European Americans. a. True b. False 8. In the United States, wealthy people have more well-years than economically marginalized people, but they do not live longer than economically marginalized people. a. True b. False 9. African Americans have a longer life expectancy than European Americans. a. True b. False 10. The United States leads the world in number of years of healthy life expectancy. a. True b. False

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Chap_16_10e Indicate the answer choice that best completes the statement or answers the question. 11. In the 21st century, the costs of medical and health care in the USA have risen: a. at a lower rate than inflation, but a higher rate than other costs of living. b. at a higher rate than inflation and higher rates than other costs of living. c. at a lower rate than inflation and a lower rate than other costs of living. d. at a higher rate than inflation, but a lower rate than other costs of living. 12. The escalating costs that plague the United States’ health care system a. have stabilized in the past five years, but still represent a problem. b. are unique to the United States and Canada and do not affect other countries around the world. c. are more severe in European countries than in the United States. d. are more serious in the United States, but affect all industrialized countries. 13. Health psychology, i.e. the application of psychology to health-related behaviors and outcomes, has influenced health care since its foundation. The future of health psychology itself will be influenced by: a. social factors. b. economic factors. c. psychological factors. d. (a) and (b) but not (d). 14. What is the most common type of sexual violence which occurs on college campuses? a. Attempted rape b. Rape c. Unwanted sexual touching and threats d. Revenge porn 15. Which Hispanic American group tends to have the highest personal wealth, most education, and greatest access to medical care? a. Cuban Americans b. Mexican Americans c. Puerto Ricans d. Venezuelan Americans 16. What percentage of college students seriously considered suicide within the past school year as per the findings of a recent research (ACHA, 2020)? a. 4% b. 8% c. 10% d. 15%

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Chap_16_10e 17. It was historically uncommon for psychologists to conduct research into the subject of physical health until a. the 1960s. b. the 1970s. c. the 1980s. d. the 1990s. 18. Which of the following are the most documented health disparities in the United States? a. Racial and ethnic disparities b. Gender and sexual orientation disparities c. Education and income disparities d. Geographic location 19. Among significant roles for health psychology, which one will still apply to our oldest citizens in the future but receive relatively less emphasis than the others? a. Promoting and maintaining health b. Helping them to prevent illnesses c. Helping them in coping with pain d. Promoting ways of healthy aging 20. In the early 1900s, when Kendra’s great-great-grandmother was born, 4% of America’s population was over 65 years old. By 2020, when Kendra was 10, her family celebrated her grandmother’s 67th birthday. How many more Americans are, like Kendra’s grandmother, over the age of 65 than there were in 1900? a. 50% more b. Twice as many c. Three times as many d. 100 times as many 21. In the year 2016, Martha, George, Honey, and Nick are all 76 years old. If they all live to their 80th birthdays in 2020, a. they will have exceeded projections of life expectancy by 10 years. b. they will have satisfied projections for life expectancy. c. they still will not have met projections for life expectancy. d. they will have exceeded projections of life expectancy by 7 years. 22. From the 20th to 21st century, the life expectancy of Americans rose by: a. very nearly 40 years. b. more than 30 years. c. not quite 20 years. d. close to 50 years.

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Chap_16_10e 23. One protective health habit that is more common among college students than other young adults is a. not smoking. b. not drinking alcohol. c. eating a high-carbohydrate diet. d. maintaining a high level of physical activity. 24. Which of the following is a difference today in other industrialized nations as compared to in the United States? a. Fewer of their citizens are aging than in the United States. b. Fewer of their citizens have chronic diseases today. c. Fewer of their citizens cost as much for health care. d. Fewer of their citizens are getting good health care. 25. All of the following reasons contributed to the disproportionate incidence of COVID-19 among African Americans. What is the MOST likely reason that more African Americans died of COVID-19 than any other group of Americans? a. African Americans lived in crowded housing conditions. b. African Americans had jobs which put them at risk of infection. c. African Americans had high risk factors such as obesity. d. African Americans had more severe symptoms at the time of hospital admission. 26. Which of the following have researchers implicated in health disparities for African Americans? a. Inadequate medical treatment b. Disparities in health literacy c. Racial discrimination d. All of the above 27. While significant proportions of college students fail to meet health goals for physical activity and weight, as a group they are also a. less likely than the general population to exercise and more likely to be overweight. b. more likely than the general population to exercise and less likely to be overweight. c. more likely than the general population to exercise and more likely to be overweight. d. less likely than the general population to exercise and less likely to be overweight. 28. Research into gender-based health disparity has thus far met with a lack of evidence for which of these factors? a. Genetics b. Lifestyles c. Social support d. Coping strategies

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Chap_16_10e 29. Emma is a young woman about to attend college. By the time she graduates, what are the chances she will have experienced rape or attempted rape? a. 3% b. 15% c. 20% d. 50% 30. Which of these countries has the highest per capita health care expenditures? a. The United States b. Great Britain c. Canada d. Germany 31. Compared to populations in other countries, Americans are attaining a. greater increases in life expectancy than in health expectancy. b. greater increases in health expectancy than in life expectancy. c. approximately equal increases in life and health expectancies. d. approximately equal decreases in life and health expectancies 32. Burke and colleagues (2007) observed that what proportion of college students accrued fewer than 30 minutes a day of physical activity? a. 1/3 of women and nearly 1/4 of men b. Only a very insignificant proportion c. 1/4 of women and nearly 1/3 of men d. Over one half of the men and women 33. Zacharias is an exchange student studying the health habits of people living in the United States. His host family asks him what he thinks is one of the greatest dangers to the health of Americans. What would Zacharias tell them is an increasing risk for mortality despite other gains in healthy behavior? a. Obesity b. Homicide c. Stroke d. Cancer 34. The greatest challenge facing the health care system in the United States is a. too many physicians. b. pressure from drug companies to lower costs. c. escalation in the costs of health care. d. the growing attitude of consumerism among patients.

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Chap_16_10e 35. Which of the following statements most accurately reflects a current condition that has contributed to rising medical costs in the USA? a. A shortage of specialist physicians has increased the medical care costs. b. A shortage of primary care physicians has increased medical care costs. c. A shortage of all physicians has lowered competition and medical costs. d. An increase in physicians has raised competition, decreasing care costs. 36. Which of these groups of people is served LEAST by health care in the United States? a. Native Americans b. Hispanic Americans c. Asian Americans d. European Americans 37. Compared with European Americans, Asian Americans have a. lower infant mortality. b. longer life expectancy. c. lower cardiovascular mortality. d. All of the above 38. The U.S. Department of Health and Human Services (HHS) series of Healthy People initiatives includes goals; current goals are challenging. What does HHS report about the United States’ history relative to similar past goals? a. The United States has never made any progress toward past Healthy People goals. b. The United States has made progress toward many earlier goals, but never met any. c. The United States has both made progress toward, and met many of the prior goals. d. The United States has met a few of these past goals, but never progressed in others. 39. What is true of health literacy and disparities in health care based on ethnicity? a. Health literacy disparities largely explain differences in vaccination based on ethnicity. b. Health literacy disparities largely explain differences in medication use based on ethnicity. c. Health literacy disparities largely explain differences in diabetes and AIDS management based on ethnicity. d. Health literacy disparities partly explain differences in vaccination, diabetes and AIDS management, and medication use. 40. What growing health risk to Americans will likely replace the decline in tobacco use that has occurred in the past few decades? a. AIDS b. Obesity c. COVID-19 d. Violence

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Chap_16_10e 41. Health research that provides guidelines for a healthy lifestyle comes from a. the Alameda County Study. b. news reports on television. c. the HART trials. d. the Cunningham study. 42. What is most accurate about binge drinking among college students? a. It is a health risk only for those who do it very frequently. b. It is a health risk if done regularly, even if only monthly. c. It is a health risk even when it is only done occasionally. d. It is a health risk only when it causes violence or injury. 43. Miguel will soon have his 50th birthday. Had he been living in 1900 instead of today, based on US Census Bureau statistics, he would have been much more likely to a. have died before that age. b. have been chronically ill. c. have had an acute illness. d. have been healthier then. 44. What percentage of young adults engage in binge drinking? a. 20% b. 30% c. 40% d. 60% 45. When young people are injured or die unintentionally, what is the most frequent cause? a. Suicide b. Homicide c. A car crash d. Drowning 46. Which of the following accurately represents statistics about dating violence among college students? a. Emotionally abusive relationships are much more common than physically abusive relationships. b. Physically abusive relationships are much more common than emotionally abusive relationships. c. Women who are involved in physically abusive relationships are at decreased risk for other types of victimization. d. College men are far more likely than women to initiate dating violence.

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Chap_16_10e 47. Research findings of college students who engage in little or no physical activity have indicated that they: a. are always overweight. b. have high cholesterol. c. have hypertension. d. (b) and (c), not (a). 48. If the people of the United States can increase their span of healthy life, then they will have a. increased their longevity. b. reached all major Healthy People 2020 goals. c. increased their number of well-years. d. All of the above 49. College students are more likely than their peers to _______. a. smoke cigarettes b. drive after drinking c. use cell phones while driving d. engage in both behaviors b and c 50. A 2007 study of Greek college students found that: a. students living on campus ate less healthy diets. b. students living at home ate more unhealthy diets. c. students living on campus or home ate similar diets. d. student diets were unrelated to their place of residence. 51. The crisis in the U.S. health care system may be summarized as: a. Too many people require treatment, and there are too few health care professionals. b. The health care system has not responded to meet the needs created by changing patterns of illness during the 20th century. c. Patients have become reliant on drugs and surgery and are reluctant to change their behaviors to achieve better health. d. Lawmakers do not understand the problems faced by the health care system, and the resulting laws that control health care expenditures restrain competition and actually increase costs. 52. Health care interventions and policies will be limited in resolving health disparities by: a. the biological bases of disparities. b. the lack of ethnic upward mobility. c. the rising cost of US medical care. d. the biology of health expectancies.

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Chap_16_10e 53. One dangerous health habit that is more common among college students than other young adults is a. smoking cigarettes. b. binge drinking. c. eating a low-carbohydrate diet. d. leading a sedentary lifestyle. 54. Which group of U.S. citizens has the longest life expectancy? a. European Americans b. Asian Americans c. African Americans d. Hispanic Americans 55. What proportion of people who were overweight roughly equaled the proportion of college students who were obese as per the research findings (Burke, Lofgren, Morrell, & Reilly, 2007)? a. One quarter b. One fifth c. One half d. One third 56. What best describes women’s survival advantage over men between 1900 and 2010? a. Women have never had a survival advantage over men. b. Women’s survival advantage has decreased in the last century or so. c. Women’s survival advantage over men steadily increased until the 1970s, when it began to decline. d. Women’s survival advantage over men steadily decreased until the 1970s, when it began to increase. 57. How has the life expectancy for American women changed over the past century or so? a. It remained stable for the first half of this period, and then rose significantly in the second half. b. It decreased over the first 30 years of the 20th century, and increased over the next 80+ years. c. It increased significantly through the 20th century and has remained stable during the 21st. d. It rose significantly over the first 70+ years, and then fell somewhat over the next 40+ years. 58. As our population ages, how does this affect work to meet the first Healthy People 2020 goal to increase health expectancy? a. It will make little difference. b. It will make this work easier. c. It will make this work harder. d. It will make it less important.

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Chap_16_10e 59. Among college students, the risk of violent behavior is increased in which of these? a. Couples wherein both partners are about equal in their dominance b. Couples wherein one partner is more dominant than the other one c. Couples wherein both partners are passive rather than dominating d. Couples wherein both partners have co-dependence on each other 60. Relative to the Healthy People 2020 goal of eliminating health disparities, what is expected for the near future? a. Diversity will increase, continuing the challenge. b. Diversity will decrease, alleviating the challenge. c. Diversity will be stable, maintaining a challenge. d. Diversity will continue not to present a challenge. 61. Which of the following accurately reflects discrimination in the medical treatment of African Americans compared to European Americans? a. African Americans are less likely to have aggressive coronary heart disease treatment. b. African Americans are more likely to be referred to cardiologists. c. African Americans are more likely to receive kidney dialysis. d. African Americans are less likely to receive treatment for COVID-19 infection. 62. Driving after drinking alcohol a. is not as common among college students as other young adults. b. is more common among college students than other young adults. c. is a common practice of college students in the United States alone. d. has decreased in the United States, only to be replaced with driving while using cell phones. 63. As health psychology increasingly collaborates with gerontology, which of the following most accurately predicts what its priorities will be? a. Promoting health will be more important than maintaining health will. b. Managing chronic pain will be more important than promoting health. c. Health care policy will be more important than preventing illness will. d. Healthy aging will be more important than forming health care policy. 64. Which nation has the highest health expectancy in the world? a. The United States b. Sweden c. Singapore d. Italy

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Chap_16_10e 65. Relative to campus violence, students are a. less safe on college campuses compared to their safety in most communities. b. as safe on college campuses compared to their safety in most communities. c. at risk on college campuses only if they are women. d. safer on college campuses compared to their safety in most communities. 66. The term well-year refers to a. the life expectancy of a person at birth. b. the number of positive health practices a person performed in a calendar year. c. the wellness behaviors associated with preventive health care. d. the equivalent of a year of life free of health-related problems. 67. Which of the following is NOT a contributing factor to the high cost of health care? a. The increase of technological advances in medicine b. The high numbers of physicians who are specialists c. The decrease in the average length of hospital stays d. The profit-orientation of our system of medical care 68. Which ethnic group in the United States paradoxically has a lower mortality rate despite also having higher rates of smoking, obesity, and hypertension? a. Hispanic Americans b. African Americans c. European Americans d. Asian Americans 69. One barrier to the expansion of health psychology is a. the lack of a body of knowledge related to the field. b. the costs for services provided by health psychologists. c. the inexperience of health psychologists, especially in collaboration. d. the amount of research that substantiates the biomedical model. 70. Sarah is a physician. Compared to a hospital, how much of health care spending does she receive? a. Significantly less b. Significantly more c. Roughly the same d. There is no pattern

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Chap_16_10e 71. Toby has made some changes in his lifestyle this year; one can raise his health expectancy while another can lower it. If Toby is typical of most Americans, which of the following changes would reflect current health trends? a. He quit smoking and gained weight. b. He lost weight and he quit smoking. c. He started smoking and lost weight. d. He gained both weight and started smoking. 72. To help them manage stress, it is important for college students to develop which of these? a. Disengagement coping strategies b. Emotion-focused coping strategies c. Problem-focused coping strategies d. All of the above 73. Before the advent of COVID-19, projections by experts were that by the year 2020, what percentage of the total U.S. population would be over the age of 75 years? a. Over 10% b. Below 5% c. Above 6% d. About 20% 74. Which of the following is the ability to read and understand health information to make health-related decisions? a. Health expectancy b. Health literacy c. Health disparity d. Health communication 75. To which of the following factors is the overall lower life expectancy of Hispanic Americans MOST attributed? a. The much higher likelihood of Hispanic Americans for development of obesity b. The much higher likelihood of Hispanic Americans to develop Type 2 diabetes c. The much higher likelihood of Hispanic Americans in developing hypertension d. The much higher likelihood of Hispanic American young men for violent death 76. Which of the following activities may allow individuals to cope better with stressful situations as per the recommendation from the Alameda County study? a. Social support b. Drinking c. Exercise d. Studying

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Chap_16_10e 77. Laverne is a 65-year-old resident of a state in the United States who will likely be able to expect 15 more years of healthy life, among the highest in the nation. Where does she live? a. Mississippi b. West Virginia c. Indiana d. Connecticut 78. Like Dwayne and Robyn in the Real-World Profile, college student Amari perceives that his good health will persist independently of his behaviors. This belief is a. not a problem, because it both is accurate and is beneficial. b. potentially hazardous for inaccuracy and risks of accidents. c. dangerous mainly by raising his short-term risks for illness. d. not accurate but harmless since the perception is beneficial. 79. What statement best explains the challenges in studying racial and ethnic health disparities in the United States? a. Disparities are difficult to measure because they are subtle. b. Disparities vary widely and are inconsistent based on geographic region. c. Disparities have changed rapidly over time, and longitudinal studies cannot keep up. d. Disparities based on race and ethnicity are inextricably linked to socioeconomic and educational disparities. 80. Research (AHRQ, 2011) has found that African Americans receive poorer health care than Europeans on how many of the quality measures for medical care? a. About one quarter b. Almost one third c. Almost one half d. About two thirds 81. If life expectancy continues to increase, a. more people will die from chronic illness. b. the number of well-years will decrease. c. the role of health psychologists will diminish. d. more people will die from acute illnesses. 82. The nation that leads the world in number of years of healthy life expectancy is a. Japan. b. Singapore. c. Germany. d. Canada.

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Chap_16_10e 83. Researcher Joetta Carr (2007) has observed that some parts of campus violence reflect all BUT which of the following? a. Discrimination based on race b. Discrimination based on gender c. Discrimination based on sexual orientation d. Discrimination based on socioeconomic status 84. Health psychologists can help the health care system by a. improving people’s understanding of genetic risk information. b. understanding people’s emotional responses to genetic testing. c. encouraging people to employ healthy behaviors and lifestyles. d. contributing to improving health care through all these actions. 85. In the United States, women experience a. shorter life expectancy and better health care than men do. b. longer life expectancy and poorer health care than men do. c. longer life expectancy and better health care than men do. d. shorter life expectancy and poorer health care than men do. 86. Despite increases in life expectancy, why is the United States 36th in the world in health expectancy? a. Many Americans have smoking-related diseases. b. Many Americans have AIDS-related problems. c. Many Americans have encountered violence. d. All of the above 87. Which of the following do college students identify most often as causing academic problems? a. Being away from home or family b. Being subjected to more stressors c. Being distracted by those partying d. Being unprepared by high schools 88. Compared to European Americans, African Americans have a. shorter life expectancy. b. lower health expectancy. c. both a and b. d. None of the above

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Chap_16_10e 89. Which of these is the current trend in the United States? a. People are living for more years and more well-years. b. People are living for fewer years and more well-years. c. People are living for more years and fewer well-years. d. People are living for fewer years and fewer well-years. 90. Many ethnic health disparities can be attributed to one or more of the following factors. Which of these has proven more difficult to analyze than the others? a. Health literacy differences b. Educational differences c. Economic differences d. Gender differences 91. College students can increase their health literacy by a. gathering health information from the Internet. b. listening to advice from their family and friends. c. evaluating all the findings from health research. d. visiting their primary care physicians more often. 92. Psychologists are expected to be needed in the next few decades by aging Americans to assist them with a. adjusting to challenges from chronic illnesses. b. maintaining healthy and productive lifestyles. c. aligning lifestyles with those of young adults. d. the life tasks in (a) and (b) but not (c). 93. What is most accurate about the relative health literacy of college students and how they can increase it? a. College students typically do not actively seek out health information. b. College students typically have better health literacy due to education. c. College students should make their own choices, not listen to experts. d. College students should use critical thinking to evaluate health claims. 94. Most college students rate their health as good to excellent; that perception a. is accurate—individuals in this age group have lower morbidity and mortality. b. is accurate for college women but not for college men, who experience poorer health. c. is not accurate—individuals in this age group experience more health problems than older adults. d. is true only for those college students who do not consume any alcohol.

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Chap_16_10e 95. The most important health behavior you could adopt is a. maintaining a healthy weight. b. drinking alcohol in moderation. c. refraining from smoking tobacco. d. sleeping seven to eight hours a night. 96. Deaths among college students are traceable to a. high cholesterol levels contributing to heart disease. b. high smoking rates that cause lung and other cancer. c. increased risky behaviors which contribute to unintentional injuries. d. high rates of committing suicide compared to others. 97. What two groups in the United States have similar levels of health disparity, when measured by lack of access to medical care, insufficient health literacy, and economic marginalization? a. African Americans and Hispanic Americans b. Hispanic Americans and Native Americans c. African Americans and Native Americans d. Hispanic Americans and European Americans 98. Which of the following features do the health care systems in Canada, Great Britain, Germany, and Japan all have in common that the United States does not? a. A single-payer system b. Universal health care c. Limits on technology d. Healthier populations 99. Even with universal access to health care, disparities exist between wealthy and economically marginalized people. One factor that may explain this discrepancy is a. education and health literacy are higher among those with more personal wealth. b. health varies within countries, and women are healthier overall than men. c. those with lower social support levels are healthier than those with many social contacts. d. wealthier nations tend to have longer life expectancies. 100. The trend toward chronic diseases as the most common health problem a. will probably continue well into the 21st century. b. will probably reverse itself within the next decade. c. will probably be replaced by a growing problem with infectious diseases. d. will probably result in the consequences of both b and c.

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Chap_16_10e 101. Research with college students in multiple countries (Straus, 2008) found what about dating violence relative to gender? a. Men are much more likely than women to initiate dating violence. b. Women are much more likely than men to initiate dating violence. c. Women are almost as likely as men are to initiate dating violence. d. Men and women are both equally likely to initiate dating violence. 102. Over the past four years at your college, you have personally known or been aware of at least four students who are now deceased. Which of these individuals died from a cause that is less common among college students than the others? a. Student A, who died after drinking and driving b. Student B, who died while texting and driving c. Student C, who died by suicide d. Student D, who died of cancer 103. The number of years a person lives free from disability is called _________. a. well-years b. life expectancy c. health expectancy d. life-years 104. Marisol tells her grandfather, a health psychologist, that she is interested in following in his footsteps and majoring in the same field in college. Her grandfather tells her he feels he was lucky to enter this profession when he did, because it was founded a little more than_______. a. ten years ago b. twenty years ago c. thirty years ago d. forty years ago 105. During the past 35 years, people in the United States have a. decreased their rates of obesity and overweight. b. decreased their rates of cardiovascular disease. c. decreased their rates of utilizing car seat belts. d. increased their rates of unintentional injuries. 106. A 2007 study by Burke and associates found that, among college students, a. more women than men were overweight. b. more men than women were overweight. c. as many men as woman were overweight. d. more people were obese than were overweight.

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Chap_16_10e 107. Balachandra’s father was one of the first health psychologists, and Balachandra has chosen the same profession. Which of the following most accurately represents a difference he and his father have likely experienced? a. He is no more likely to be accepted by other practitioners of health care than his father was. b. He is more likely to publish research in health care and medical journals than his father was. c. He is equally as likely as his father was to avoid the rising costs of other medical care. d. He is no more likely to be able to contribute to medical and health care than his father was. 108. What explains the difference between life expectancy and health expectancy? a. Economic factors b. The changing nature of disease c. Health care costs d. Both a and b 109. Beatrice is an African American woman. Her best friend Greta is European American. What statement is likely true about them? a. Greta will not live as long as Beatrice. b. If Beatrice and Greta both live to age 65, it is likely that Beatrice will have a disability before Greta does. c. Beatrice will receive better medical care than Greta. d. There is no way to predict their health or mortality in relation to each other. 110. Researchers have found that college students are more at risk for suicidal ideations and attempts when they experience which of the following factors? a. Involvement in an abusive relationship b. Feelings of depression or hopelessness c. Identifying as gay, lesbian, or bisexual d. All of the above 111. Summarize how life expectancy and health expectancy are changing in America, how healthy life expectancy in the US compares to that in other industrialized nations, and what is possible in the future.

112. What factors have affected (and will continue to affect) the growth of health psychology?

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Chap_16_10e 113. Compare health insurance practices in the US vs. those in four other industrialized nations in terms of how these affect health care costs and health expectancies.

114. Analyze the health benefits and risks that apply to college students compared with those that apply to other young adults.

115. Identify two broad factors that account for differences between life expectancy and health expectancy in the USA, including examples explaining the second factor. Identify an expert recommendation based on these differences.

116. Discuss the obstacles to and advantages of achieving the two broad goals from the Healthy People 2020 report.

117. Identify and briefly explain five behaviors identified by the Alameda County study that improve health and lower mortality.

118. How can health disparities in the US be reduced?

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Chap_16_10e 119. Contrast life expectancy with health expectancy. What are the implications of the difference?

120. Discuss why it is more important to prevent than treat disease, including the role of health psychologists.

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Chap_16_10e Answer Key 1. True 2. False 3. True 4. False 5. True 6. True 7. True 8. False 9. False 10. False 11. b 12. d 13. d 14. c 15. a 16. b 17. b 18. a 19. b 20. c 21. b 22. b 23. a 24. c 25. d 26. d

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Chap_16_10e 27. b 28. a 29. c 30. a 31. a 32. a 33. a 34. c 35. b 36. a 37. d 38. c 39. d 40. b 41. a 42. c 43. a 44. c 45. c 46. a 47. d 48. d 49. d 50. a 51. b 52. a 53. b 54. b Copyright Cengage Learning. Powered by Cognero.

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Chap_16_10e 55. d 56. a 57. d 58. c 59. b 60. a 61. a 62. d 63. c 64. c 65. d 66. d 67. c 68. a 69. b 70. a 71. a 72. c 73. c 74. b 75. d 76. a 77. d 78. b 79. d 80. c 81. a 82. b Copyright Cengage Learning. Powered by Cognero.

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Chap_16_10e 83. d 84. d 85. b 86. d 87. b 88. c 89. c 90. d 91. c 92. d 93. d 94. a 95. c 96. c 97. c 98. b 99. a 100. a 101. c 102. d 103. c 104. c 105. b 106. b 107. b 108. d 109. b 110. d Copyright Cengage Learning. Powered by Cognero.

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Chap_16_10e 111. A. Life expectancy is rising in the USA, but healthy life expectancy is falling. 1. America’s health expectancy ranks 36th in the world. 2. The USA is behind most other industrialized nations due to high rates of smoking-related diseases, violence, and health problems related to AIDS. 3. Americans’ healthy life expectancy is improved by fewer people smoking in recent decades. 4. However, increasing American obesity rates are expected to offset the gains from more people’s quitting smoking. B. Because health expectancies are much higher in other industrialized nations, it should be possible for the United States to improve its health expectancy in the future as well. 112. A. The founding of health psychology was influenced by: 1. Emphasis on behaviors related to health and interest in behavioral components of prevention. 2. Realization by psychologists that they had contributions to make to health. B. The growth of health psychology has been influenced by: 1. The growing body of research implicating behavioral factors in physical health. 2. The growth of employment opportunities for psychologists in health-related settings. 3. The acceptance of psychologists as part of research and treatment teams in health care settings. C. Health care costs will limit all health services, including those offered by health psychologists.

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Chap_16_10e 113. A. Canada, Great Britain, Germany, and Japan share the problem of rising health care costs with the United States, but they have controlled some of the influencing factors that the US has not. 1. Canada minimizes administrative costs by using a single-payer system. 2. Great Britain limits access to high-technology medicine. 3. Germany limits hospital expenditures on high-tech equipment, and limits some payments to physicians. 4. Japan uses an insurance system like the US, but with some important differences: a. The government regulates service costs and fee amounts. b. Insurers do not compete with one another as they do in the US. c. Japan also has lower obesity rates than many other nations, contributing to better population health. A. Disadvantages of the cost containment strategies above: 1. Canadians wait longer for knee replacement, MRIs, mammograms, and similar procedures than Americans. a. However, these procedures cost significantly less in Canada than in the US. b. Delays may present health and life risks in some cases. c. In some cases, Americans are overtreated; limiting access could have minimal effects on health outcomes, or even improve life and health expectancies. 2. Based on the longer life expectancy of Canadians, it is inferred that the health care delays they encounter do not present major dangers. B. Canada, Great Britain, Germany, and Japan have all reduced competition for profits by health insurers, but the USA has not. C. The four countries above all provide universal health care coverage, but the USA does not. D. President Barack Obama’s 2010 Patient Protection and Affordable Care Act has increased access for many Americans. 1. While many have tried to obstruct this law’s implementation, the US Supreme Court upheld its constitutionality in 2012. 2. Despite implementation of the law, health care reform in the USA is still an urgent matter. 114. A. College students have several health benefits that other young adults possess to a significantly lesser extent. 1. College students are likely to have higher health literacy, allowing them to evaluate health claims and make good decisions about health behaviors and health care. 2. Smoking rates are lower, which is a situation that offers many health benefits. 3. College students are less likely to be overweight or obese, which decreases the risk for several diseases. 4. College students are more likely to be physically active (but 23% to 33% are not). B. College students experience health risks like other young adults; some behaviors put college students at higher risk. 1. Like other young adults, college students are more likely to die of unintentional injuries and violence than from any other cause. 2. College students are more likely to binge drink, drive after drinking, and use cell phones while driving than others, elevating their risks for unintentional injuries. 3. Like other young adults, college students often make unwise food choices; those who do tend to adhere to many other elements of a healthy lifestyle, such as using seatbelts, engaging in physical activity, and sleeping well. 4. Intentional violence also affects college students, but rates of intentional violence have decreased in the United States, and college campuses tend to have lower rates of such violence than other communities. Copyright Cengage Learning. Powered by Cognero.

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Chap_16_10e 115. A. One reason that life expectancy and health expectancy differ is the effects of economic factors. 1. Comparing the wealthiest and most economically marginalized countries, or even the wealthiest and most economically marginalized sectors of the population within one country, yield even bigger differences. 2. Level of economic wealth predicts health expectancy and life expectancy. B. A second factor accounting for the difference is the changing nature of disease. 1. Life expectancy is affected by diseases that cause death. 2. Health expectancy is affected by diseases that compromise health. 3. Circulatory disorders are the leading diseases affecting both life expectancy and health expectancy. 4. Cancer and accidents are major factors affecting life expectancy. 5. Disorders restricting movement and respiratory disorders are major factors affecting health expectancy. 6. Depression affects health expectancy more than it affects life expectancy. C. Interventions designed to improve life expectancy will not necessarily improve health expectancy or quality of life. 1. Therefore, experts recommend that as an index of a population’s overall health, its health expectancy (not life expectancy) be used. 116. A. Increasing the span of healthy life is one goal. 1. Achieving this goal would require: a. Reducing the health problems that affect the elderly. b. Concentrating on some disorders that are not leading causes of mortality, but are leading causes of disability. 2. Obstacles to achieving this goal include: a. Financing additional health care for a group that already is responsible for a large proportion of health care costs. b. Finding ways to prevent diseases, beginning as early as adolescence, so that people experience a healthier old age. B. Reducing health disparities among Americans is the second goal because the United States does a poorer job of dispensing health care to its citizens than any other industrialized country. 1. Achieving this goal would: a. Provide high-quality health care for more U.S. residents. b. Boost life expectancy in the United States, making it consistent with that in other industrialized nations. 2. Obstacles to achieving this goal involve removing the health disparities among ethnic groups: Economically marginalized African Americans and Hispanic Americans have shorter life expectancies and poorer health than European Americans and Asian Americans. a. Economic factors as well as discrimination may contribute to these ethnic differences. b. Educational disparities may also contribute to health disparities among Americans.

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Chap_16_10e 117. A. Not smoking cigarettes/tobacco: 1. This is the health behavior most strongly connected with longevity. 2. This includes secondhand smoke exposure, which is also hazardous. B. Adopting a lifestyle incorporating regular physical activity: 1. This improves health and prevents disease and disability for all ages. 2. It also can improve mood, cognitive function, and learning. a. These may be more immediate outcomes than long-term health benefits. C. People who both abstain from smoking and exercise regularly receive both longer life expectancies and shortterm health benefits. D. Moderating alcohol intake: 1. Moderate drinking is more important for older adults. 2. Because light drinking can become binge drinking for college students, they are advised to avoid heavy drinking, binge drinking, and drinking and driving. E. Healthy diet and food choices: 1. Avoid high-fat diets, which increase cardiovascular disease risks. 2. Diets with plenty of fruits and vegetables afford many health benefits. F. Not smoking, being physically active, moderating alcohol intake, and eating a healthy diet can extend a person’s life for an estimated 14 years longer. A. Getting 7-8 hours of sleep every night: 1. People who sleep fewer than 6 hours or more than 8 hours nightly have higher mortality rates than people who sleep 7-8 hours nightly. 2. Additional, immediate benefits include more energy, better concentration, and possibly even better immune system functioning. B. Social support: 1. People with social networks are healthier than those with few social contacts. Social support offers one kind of coping strategy; it is advised to develop a variety of others, including problemfocused and emotion-focused strategies, and appropriately apply them. 118. A. Health disparities are health differences that are linked to social, economic, and/or environmental disadvantages. 1. Racial and ethnic disparities are important as they underlie health disparities in the US. B. Ways to reduce health disparities would be to tackle what causes health disparities, such as: 1. Health literacy. Health literacy is the ability to read and understand health information. Health literacy helps individuals make informed health care decisions. Ethnic minorities are more likely to have low health literacy, and thus make uninformed health care decisions. 2. Lack of access to medical care. Ethnic minorities often receive poorer medical care than European Americans. 3. Economic factors. Poverty relates to receiving poor medical care, possibly because those below the federal poverty threshold are less likely to have health insurance. a. Economic exploitation also relates to risky health habits, such as eating a high-fat diet and leading a sedentary lifestyle.

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Chap_16_10e 119. A. Life expectancy is how long people can be expected to live, often described by age, nationality, or some other variable. 1. Life expectancy in the United States increased from 47 years to 78 years during the 20th century. 2. In the United States, women live longer than men, and European Americans live longer than African Americans. B. Health expectancy is the period during life that a person spends free of disability. 1. In the United States, health expectancy is 11 to 13 years shorter than life expectancy. 2. The discrepancy represents the years of life lived with some disability. C. Decreasing the discrepancy is a major goal of health initiatives. 1. Increasing the span of healthy life improves the quality of life. 2. Increasing the span of healthy life would decrease medical costs for the elderly, a group that receives a disproportionate amount of health care. 120. A. Around 10% of our population incurs c. 70% of medical care expenses; the healthy people making up around 50% of our population incur c. 3%. This difference shows the importance of prevention for controlling medical care expenses. 1. Health psychologists can contribute to lowering these costs, because: a. Most of the medical expenses are for chronic diseases, e.g. cardiovascular disease, cancer, diabetes, and chronic lower respiratory diseases; and b. Unhealthy behaviors make major contributions to the development of these diseases. 2. People with good health habits incur half the lifetime medical costs as people with poor health habits. 3. But long-term good health can be expensive too, because people who live longer have more years of life for accumulating medical expenses. 4. Short-term, an important means of lowering medical service needs is prevention through promoting good health behaviors. B. Increases in available medical technologies have fed common beliefs that modern medicine can cure anything, leading to people’s relying too much on medicine, instead of on good health behaviors for prevention and selfmanagement for chronic conditions. C. The USA will need to make significant changes in its health care system to contain medical care expenses. 1. As health care reform affects them all, insurers, hospitals, and doctors have all resisted change. 2. Many other industrialized nations do better at providing the best quality of medical care more cost-effectively than the USA currently does. D. Our medical care system has not changed its orientation toward providing acute care. 1. But our country’s needs (and those of other industrialized nations) have shifted. 2. Chronic illnesses are now the leading causes of death and disability rather than acute illnesses, yet the system has not adapted to meet these changing needs. 1. Management of chronic illnesses is an important need, as almost 70% of US deaths are caused by these. 2. Undertreatment, overtreatment, and mistreatment abound in chronic disease care. a. As an example, stroke patients were undertreated, in that 20-30% had diagnosed hypertension but received no treatment for it. b. 30% of primary care clinic patients were overtreated for asthma diagnoses despite lacking evidence of symptoms. c. Medical provider errors, which occur alarmingly often, cause mistreatment. 3. Shifting from hospital-based and physician-based care to a team approach, including patient education to improve monitoring and self-care, and access to necessary medical care, is needed for our health care system to provide more effective management of chronic illnesses. E. Primary prevention is typically most cost-effective. This includes: 1. Immunizations against diseases. Copyright Cengage Learning. Powered by Cognero.

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Chap_16_10e 2. Programs encouraging lifestyle changes. 3. A 2001 research study concluded healthy lifestyle can extend life by 10 years. 4. Life expectancy and health expectancy can be improved through primary prevention initiatives tailored for different age groups across the life span. F. Secondary prevention involves screening people at risk for developing diseases. 1. Since the number of people at risk can far exceed the number who will develop the diseases, screening can be very expensive and not cost-effective. 2. Physicians’ time costs too much for them to focus on health education. 3. Hospitals focus on acute care rather than on prevention services. 4. More cost-effective provision of health education can be made by: a. Public health agencies, b. Health educators, c. And health psychologists. 5. Expanding these providers’ roles in the health care system may not only help contain medical care expenses, but also help provide better health care.

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