TEST BANK for Health Psychology: An Introduction to Behavior and Health 9th Edition by Linda Brannon

Chapter 1 1. As a health psychologist, Angela Bryan develops interventions to change health behaviors

that are affected by

factors.

a. psychological b. sociological c. biological *d. all these

2. Health psychologist Angela Bryan has begun to investigate genetic influences on *a. people’s responses to interventions with physical activity. b. people’s tendencies to engage in risky sexual behaviors. c. people’s likelihood to engage in safer sexual behaviors. d. people’s responses to interventions with sexual activity.

3. Based on the real-world profile of Angela Bryan, how should health psychologists

evaluate how effective their interventions are in changing health behaviors? a. By anecdotal feedback from patients they have treated b. By patients’ responses to self-reporting questionnaires *c. By applying valid and reliable research methodologies d. By interdisciplinary partners’ views of patient progress

4. 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.

5. 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.

6. Diseases that killed most people a century ago were more often from *a. tainted foods than unhealthy habits.

b. unsafe drinking water than bad foods. c. others who were ill than food or water. d. not taking available medicine prescribed.

7. What is true about the time frames of diseases 100 years ago in the United States? a. Illnesses lasted longer because fewer treatments existed then. b. Illnesses were shorter because sick people got well in weeks. c. Illnesses were shorter because sick people died within weeks. *d. Illnesses lasted for shorter times as results of all these causes.

8. 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.

9. How has life expectancy in the U.S. 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 exceeded 100 years of age.

10. Which of these most correctly describes changes in U.S. health and health care over

the past century or so? a. Preventing and treating infectious diseases have decreased chronic diseases

equally. b. Preventing and treating infectious diseases have reduced chronic disease, but not as much. *c. Preventing and treating infectious diseases have enabled predomination of chronic diseases. d. Preventing and treating infectious diseases have had no effect at all upon chronic diseases.

11. 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.

12.

diseases are a class of diseases that include heart disease, cancer, and

stroke. a. Infectious *b. Chronic c. Unintentional d. Cardiovascular

13. In 1900, most deaths in the United States were caused by

are due to

, whereas today most

.

a. pneumonia. . . cancer b. chronic diseases. . . cancer *c. infectious diseases. . . chronic diseases d. cancer. . . alcohol-related causes

14. 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 lifestyles began to increase. c. began to increase while deaths not due to lifestyles began to decrease. d. were replaced by acute diseases as the leading cause of death.

15. In America today, what is a fact about chronic diseases? *a. They cause a comparable percentage of deaths now as infectious diseases

caused in the past. b. They cause the majority of deaths now, but a lower percentage than infectious diseases once did. c. They cause a comparable percentage of deaths now to the percentage that infectious diseases cause now. d. They cause a very low percentage of actual deaths, but many people are living with them now.

16. 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.

17. 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.

18. Compared to historically, Americans today have a. more control over their health, and most people exert that control. b. less control over their health, but many people utilize more of it. *c. more control over their health, but many people do not utilize it. d. less control over their health, and cannot apply what they have.

19. 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.

20. 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 non-behavioral 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.

21. Of the following, which describes an acute disease? *a. Alberto was so sick from pneumonia that he had to be hospitalized. b. Brian had a heart attack; he now takes medication and is doing fine. c. Claudia had a minor stroke, but did not lose any mobility or speech. d. Donna was treated for a breast lump, and is pronounced cancer-free.

22. 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

23. 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.

24. In the United States, young people have a low mortality rate; those who die are most likely

to die from a. cancer. *b. unintentional injuries. c. homicide. d. HIV infection.

25. According to the National Center for Health Statistics (2016), the main causes of death for

people aged 1-44 years are ranked in which order, from high to low? a. Homicide; suicide; unintentional injuries b. Suicide; unintentional injuries; homicide c. Homicide; unintentional injuries; suicide *d. Unintentional injuries; suicide; homicide

26. Cardiovascular disease and cancer account for a. the vast majority

of all deaths in the US.

b. a small minority *c. more than a half d. around one third

27. All of the following are factors in life expectancy EXCEPT: a. age b. education c. ethnicity *d. mother’s personality

28. In the United States, people ages 15 to 24 are most likely to die from

and

. a. cancer. ...... heart disease *b. unintentional injuries ........ homicide c. homicide ........ cancer d. suicide ........ HIV infection

29. In the United States, the three leading causes of death for adults ages 35 to 44 are *a. unintentional injuries, cancer, and heart disease. b. suicide, homicide, and HIV infection. c. HIV infection, heart disease, and pneumonia. d. cancer, HIV infection, and pneumonia.

30. 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.

31. 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. Deaths caused by this diagnosis have been in recent years. a. fewer *b. more c. equal d. none

32. 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

33. According to the National Center for Health Statistics (NCHS, 2016), what is true about the

prevalence of these causes of death for Americans aged 1-44 years? *a. Deaths from suicide and homicide combined are fewer than from accidents. b. Deaths from suicide and homicide combined are more than from accidents. c. Deaths from accidental injuries occur to more than one third of this group. d. Deaths from homicide exceed deaths from suicide, but not from accidents.

34. Which of the following ethnic groups has the most statistical justification for concern about

dying from accidental injury? a. European Americans *b. Hispanic Americans c. African Americans d. Asian Americans

35. What two factors can help explain some of the ethnic differences in health and life

expectancy? a. Poverty and age *b. Poverty and low education level c. Low education level and age d. Low education level and drug use

36. People who graduate from college show the following positive outcomes EXCEPT a. higher average incomes. b. more likely to exercise. c. better access to health care. *d. more likely to eat a high-fat diet.

37. Individuals who have gone to college have lower death rates from

than those who

have not. a. infectious diseases, but higher from chronic diseases b. unintentional injuries than from any kinds of disease *c. unintentional injuries, chronic and infectious diseases d. chronic and infectious diseases than accidental injury

38. Better-educated individuals report experiencing less stress than those with less education.

How does this relate to their health status? *a. They report fewer symptoms because stress contributes to these. b. They report fewer symptoms because stress affects perceptions. c. They report no difference because stress has little health impact. d. They report more symptoms because stress raises the awareness.

39. What is most accurate about recent statistics on death rates relative to education? a. People with high school educations die half as often as people with less

education. *b. People with college educations die less than half as often as high school graduates. c. People with college educations die half as often as those with less than high school. d. People with high school or college get the same benefit compared to those without.

40. 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.

41. 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.

42. 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.

43. 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.

44. 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.

45. For which of the following ethnic groups is kidney disease a more common cause of death

than for the others? *a. African Americans b. European Americans c. Hispanic Americans d. Asian Americans

46. In which ethnic group(s) is septicemia among the 10 foremost causes of death? a. Hispanic Americans *b. African Americans c. Asian Americans d. All three of these

47. 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

48. Pneumonia and influenza (together) account for one of the 10 leading causes of death in

which ethnic group(s)? a. European Americans b. European and African Americans *c. European, Hispanic, and Asian Americans d. European, Hispanic, African, and Asian Americans

49. African Americans are more likely to die from

than European, Hispanic, or Asian

Americans. *a. homicide or septicemia b. kidney or liver disease c. suicide and homicide d. diabetes and stroke

50. How do life expectancies today compare between Americans of European descent and

Americans of African descent, and with people in other countries? a. The life expectancies for both these groups are essentially comparable. b. The life expectancies are considerably longer with African Americans. c. The life expectancies of both groups are longer than in other countries. *d. The life expectancies are significantly longer for European Americans.

51. When comparing how two American ethnic groups rank in life expectancy with each other

and with other world nations, which of these is true? a. African Americans rank half as high as European Americans, but higher than

Israelis. b. African Americans and European Americans rank about the same, but lower than Canadians. *c. African Americans rank half as high as European Americans, both lower than the Japanese. d. African Americans rank twice as high as European Americans, both higher than Italians.

52. Rhona is a 32-year-old African American college professor. Gena is a 32-year-old Hispanic

American engineer. Leah is a 32-year-old European American who has been unemployed for most of the past 10 years and living below the poverty level. Helen is a 32

a. Rhona. b. Gena. *c. Leah. d. Helen.

53. In the United States, people living below the poverty level generally a. are more likely to have lower levels of education. b. are more likely than others to have health insurance. c. are more likely members of ethnic minority groups. *d. are more likely to correspond to choices a and c both.

54. Carla is a teenager living in poverty who is pregnant. What is true about associated health

risks to her and her baby? a. Her baby is more likely to have a low birth weight, but this is not a risk. b. She is equally as likely to be abused as poor teens who are not pregnant. *c. Her baby is more likely to have low birth weight, raising mortality risk. d. She is more likely to be abused, but her baby cannot be abused in utero.

55. 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

56. 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’

57. 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.

58. 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 adult or elderly mortality rates. b. Mortality rates increase as adults become older, but causes of death for the elderly are not higher than overall causes. c. Elderly mortality rates decrease average life expectancy for the population more than infant or child mortality rates. d. Although mortality rates are higher for elderly than younger adults, causes of death are similar for both groups.

59. 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

60. 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.

61. Business owner Bill is financially very rich and enjoys better health than his rich, but not

very rich, peers. Research has discovered that this difference is most affected by a. his social status as indicated by his level of income. b. his social status as indicated by his education level. c. his social status as indicated by his occupation level. *d. his social status as indicated by his own perspective.

62. Stefan is highly wealthy and attributes his good health largely to his positive living habits of

adhering to a nutritious diet and regular exercise, avoiding harmful substances, and minimizing and managing stress. Stefan is most likely to *a. be very highly educated.

b. have a certain occupation. c. be of a specific ethnicity. d. have no spouse/children.

63. 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

64. In Sheldon Cohen’s research on the common cold, all participants received a cold virus

injection 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.

65. 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 succeeded in coping with divorce and custody

66. Dorian comes down with a “bug,” which has hardly ever happened before, so he wonders

why. Which statement is most appropriate regarding this? a. His being exposed to a contagious microbe is the single most salient factor. b. Psychological more than biological factors determine if he gets sick or not. c. Biological and psychological factors combined outweigh any social factors. *d. Biological, social, and psychological factors interacted to create this result.

67. 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 drop out of high school.

*c. people who attend college live longer than those who have never attended

college. d. both a and b are true.

68. College graduates generally live longer than people who drop out of high school. Which of

these conditions is most likely to explain these differences? a. College graduates are more likely to smoke cigars. b. High school dropouts are more likely to seek health care. c. High school dropouts are less likely to use illicit drugs. *d. College graduates are less likely to smoke cigarettes.

69. Which of these has been a major health trend in the U.S. 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.

70. 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.

71. 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

72. Research from outside your textbook finds the U.S. 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.

73. 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.

74. How much has health care in America gone up in cost per person, per year, between 1970

and 2013? *a. To more than seven times what it was b. To more than three times what it was c. To more than five times what it was d. To more than ten times what it was

75. Chronic illnesses in the U.S. 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

76. 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

77. 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.

78. 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.

79. 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.

80. What best reflects an advantage of the biopsychosocial model of health? *a. It treats health as a positive state rather than a negative of illness. b. It regards illness as a negative factor rather than a positive factor. c. It has aspects both superior and inferior to the biomedical model. d. It covers more factors, but cannot explain individual differences.

81. Cade attributes catching a "cold" to not getting enough sleep and feelings of distress. Thus,

Cade has an implicit acceptance of the

model of health.

a. biochemical b. biomedical c. Cartesian *d. biopsychosocial

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. 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.

84. 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.

85. 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.

86. 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.

87. 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.

88. 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.

89. 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.

90. 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.

91. 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.

92. 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.

93. Most experts in health psychology recommend that a. health psychologists should procure credentials as medical physicians first. *b. health psychologists should have at least two years of postdoctoral training. c. health psychology should be a separate discipline from generic psychology. d. health psychology should be a separate discipline from generic psychology.

94. 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.

95. Janelle, a health psychologist, could 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 breast cancer.

96. 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.

97. 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

98. 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

99. 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

100. Health is generally defined as an absence of disease. a. True *b. False

101. Currently, the leading cause of death in the United States is cancer. a. True *b. False

102. Most people in the United States die of chronic diseases. *a. True b. False

103. Death rates in the United States from both heart disease and cancer are declining. *a. True b. False

104. Stress is the leading cause of death in the United States. a. True *b. False

105. African Americans have a higher death rate than European Americans. *a. True b. False

106. Despite national media coverage to the contrary, poverty is not related to the mortality rate in the United States. a. True *b. False

107. College graduates generally have a higher death rate than high school dropouts.

a. True *b. False

108. The training of health psychologists includes earning doctoral degrees. *a. True b. False

109. Health psychologists rarely work in hospitals. a. True *b. False

110. 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).

Correct Answer:

See outline below

111. 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.

Correct Answer:

See outline below 112. 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.

Correct Answer:

See outline below 113. 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.

Correct Answer:

See outline below 114. 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 specialtywithin 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.

Correct Answer:

See outline below 115. 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.

Correct Answer:

See outline below 116. 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 non-pharmacologic 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.

6. 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.

Correct Answer:

See outline below

117. 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.

Correct Answer:

See below 118. 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 USA’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 >700% from 1970 to 2013.

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 ofdeath 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.

Correct Answer:

See below 119. SA: 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.

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.

Correct Answer:

See below

Chapter 2 1. 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.

2. 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.

3. 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."

4. 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.

5. 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 prove treatment effects equally.

6. For which of the following symptoms would you expect a placebo to be most ineffective? a. Pain b. Nausea *c. Fracture d. Depression

7. 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

8. 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.

9. Placebos have been known to help a. reduce insomnia. b. decrease low back pain. c. lower high blood pressure. *d. bowel movements.

10. 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.

11. 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 try to discount the importance of this research. c. Scientific breakthroughs happen every day. d. Experimental rather than observational research is required to learn about patterns of disease.

12. Using placebos 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.

13. 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.

14. 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. confounding. *b. double-blind. c. correlational. d. naturalistic.

15. 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.

16. Placebos can be beneficial in treating many conditions EXCEPT: a. depression. b. hypertension. c. insomnia. *d. broken bones.

17. Patient A was raised to view medical treatments as most effective; Patient B was raised to

believe in faith healing and avoid medical treatments. If both patients are given a placebo, what is most likely? a. The strength of their respective placebo responses should not be affected by

the differences in what they believe. *b. Each will have a stronger response to a placebo that seems most similar to their respective preferred treatments. c. Each will have a stronger response to a placebo that seems most different from the treatments that each one prefers. d. Each will have a stronger response to a placebo that seems most different from the treatments that each one prefers.

18. 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 that taking prescribed medication is better than not taking it.

19. Cynthia 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. Cynthia has an excellent response to the drug. What is likely in this case? a. Cynthia’s response is more likely due to the placebo effect than the treatment. b. Cynthia’s response is more likely due to the treatment than the placebo effect. *c. Cynthia’s response is most likely due to the treatment plus the placebo

effect. d. Cynthia’s response is most likely due to neither treatment nor placebo effect.

20. The

a placebo resembles an effective treatment, the

*a. more; stronger b. more; weaker c. less; stronger d. none of these

the placebo effect.

21. 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

22. 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. Dr. Jonas cannot control for participant expectancy as well as in double-blind designs. *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.

23. Dr. Singh, a clinical researcher, is conducting a study wherein some patients receive a drug

and others receive a placebo. If this researcher and study are typical, what does Dr. Singh want to find out from the research? *a. Whether the drug works better than the placebo b. Whether the placebo has any effectiveness at all c. Whether the placebo works better than the drug d. Whether the drug and placebo work equally well

24. 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.

25. 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.

26. Dr. Rich is conducting research that examines whether 20-year olds eat more low-fat foods

than 70-year olds. This research is using a

design.

*a. cross-sectional b. experimental c. ex post facto d. retrospective

27. 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.

28. 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. This number is so small that the correlation must be random. c. This number can predict one variable’s score from the other’s. *d. This number can be statistically significant in large populations.

29. Dr. Sweedey is conducting research that examines 5 year olds and their aggressive

behaviors. She follows up with these same participants 10 years later to measure their reactivity to stress. She is using a design. a. cross-sectional b. experimental *c. longitudinal d. ex post facto

30. There is a

correlation between physical age and physical health, such that as age increases, physical health decreases.

a. positive *b. negative c. weak d. nonexistent

31. A correlation of .80 would indicate a

and

relationship between two

variables. *a. strong; positive b. strong; negative c. weak; positive d. weak; negative

32. A positive correlation between physical health and education would indicate that as

education

, physical health

.

a. decreases, decreases b. decreases, increases c. increases, decreases *d. increases, increases

33. The major difference between longitudinal studies and cross-sectional studies is that cross-

sectional studies occur

whereas longitudinal studies occur

.

*a. once; over time b. over time; once c. with the same participants; with different participants d. with the same participants; over time

34. 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.

35. 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.

36. Researchers want to examine whether writing about the experience of breast cancer

increases feelings of hope and optimism. Breast-cancer patients were randomly assigned to one of two essay conditions: writing about their breast cancer or writing about a. hope and optimism. b. breast cancer diagnosis. c. writing about everyday tasks. *d. the essay conditions.

37. 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

38. If two variables increase or decrease together, they are *a. positively correlated. b. negatively correlated. c. positively skewed. d. negatively skewed.

39. 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.

40. Correlational studies are a type of

a. experimental study. b. double-blind study. c. ex post facto design. *d. descriptive research.

41. 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

42. 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. compare different age groups or developmental periods.

43. A study that compares cholesterol levels of 10-year-old children and 30-year-old adults

would most likely be a(n)

study.

a. experimental *b. cross-sectional c. longitudinal d. ex post facto

44. 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.

45. 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.

46. 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.

47. 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

48. 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.

49. 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.

50. 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.

51. 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

52. 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.

53. 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.

54. A risk factor is any characteristic or condition that a. occurs with a lower frequency in peole with a disease than in people freee 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.

55. Prospective and retrospective studies are both considered: a. experimental studies. b. longitudinal studies. c. clinical trials. *d. correlational studies.

56. A study examined two groups of people—those who were exercising and those who

weren’t—and examined their past history to try to understand why some people currently exercise whereas others do not. 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

57. Occasionally factors that predict death, or

predict disease, or

, are not the same factors that

.

*a. mortality, morbidity b. morbidity, incidence c. morbidity, mortality d. mortality, incidence

58. 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.

59. In general, chronic diseases are likely to have a. higher incidence than prevalence. *b. higher prevalence than incidence. c. similar incidence and prevalence. d. no usual pattern between the two.

60. 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.

61. 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

62. Prospective epidemiological studies are also a. cross-sectional. *b. longitudinal. c. experimental. d. clinical trials.

63. 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

64. In general, what is true about prospective and retrospective research studies? a. Retrospective studies obtain stronger evidence. *b. Prospective studies obtain stronger evidence. c. Both obtain a similar strength of evidence. d. Both obtain matching but weak evidence.

65. 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.

66. 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

67. 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

68. Which of the following situations would most seriously complicate the interpretation of

causation in a research design? 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 design in which the participants are allowed to self-select d. A design in which participants are not allowed to self-select

69. 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

70. Natural experiments in epidemiology are most similar to what kind of psychology study? a. Experimental *b. Ex post facto c. Correlational d. Observational

71. 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.

72. 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.

73. A statistical technique for combining the results of several studies is *a. meta-analysis. b. transactional analysis. c. hypothesis testing. d. scientific myopia.

74. 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.

75. 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.

76. Based on the follow-up findings of the Alameda County study, which of the following

people would be most likely to die sooner? a. Ed, who smokes cigarettes and drinks alcohol to excess b. Flora, who is obese and sleeps thirteen hours every day c. Gil, who skips breakfast, eats snacks, and has insomnia *d. Hana, who lives alone, rarely goes out, has three friends

77. Mortality is to death as morbidity is to a. mortality. *b. disease. c. trauma. d. gruesome.

78. Research has found that obesity is related to high blood pressure. This finding means that *a. obesity is a risk factor for high blood pressure. b. obesity is an independent risk factor for high blood pressure. c. most overweight people die of high blood pressure. d. thin people are protected against high blood pressure.

79. A research study found a direct, consistent association between late bedtime and childhood

obesity. This is known as a

relationship.

a. negative *b. dose-response c. positive d. causal

80. 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.

81. 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.

82. Wendi is a long-time smoker, which carries a relative risk of about 23.0 for lung cancer

death and 2.0 for heart disease mortality. From this information you can conclude that a. Wendi is more than four times as likely to die from lung cancer as from heart

disease. b. Wendi's absolute risk for lung cancer is greater than her absolute risk for heart disease. *c. Wendi is about 23 times more likely to die of lung cancer than those who do not smoke. d. Wendi is about 23 times more likely to die of heart disease than her twin sister.

83. 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. indicates specific proof that smoking cigarettes causes lung cancer. d. indicates smoking is more likely with personalities prone to cancer.

84. 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.

85. 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 these relationships between variables exist.

86. After tobacco companies argued that cigarette smoking had never been proven to cause lung

cancer or heart disease in humans, how did epidemiological researchers establish such a causal relationship? a. They proved it through experimental studies. b. They inferred it as all seven criteria were met. c. They inferred it via overwhelming evidence. *d. They established it by doing both (b) and (c).

87. Theories should be viewed as a. unimportant to science. *b. practical science tools. c. testable hypotheses. d. untested hypotheses.

88. 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

89. For a scale that is measuring eating disorder likelihood to have good

, it needs to be able to differentiate between those who will get eating disorders versus those who will not. a. external validity b. interrater reliability *c. predictive validity d. test-retest reliability

90. 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

91. Reliability means a. accuracy. b. structure. c. validity. *d. consistency.

92. 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.

93. 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.

94. 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.

95. 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.

96. 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.

97. The placebo has treatment benefits but presents problems to researchers. *a. True b. False

98. The placebo can affect psychological disorders, but it has no effect on biological processes. a. True *b. False

99. When the placebo treatment is described in a hidden manner, placebos can lead to fewer symptoms and better quality of life when compared to no treatment. a. True *b. False

100. Correlational studies yield information about causation. a. True *b. False

101. The number of new cases of AIDS per year reveals the incidence of that disease. *a. True b. False

102. A prospective study begins with a group of participants who have a given condition or disease. a. True *b. False

103. With an ex post facto study, researchers compare two or more groups. *a. True b. False

104. The randomized, clinical trial is a type of retrospective study. a. True *b. False

105. The number of new cases of a particular disease during a specific period of time is incidence. *a. True b. False

106. An experiment consists of at least two groups: an experimental group and a control group. *a. True b. False

107. Discuss the disadvantages and advantages of placebos.

Correct Answer:

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.

108. 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?

Correct Answer:

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.

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

Correct Answer:

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.

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

Correct Answer:

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.

111. Discuss the strengths and weaknesses of the risk factor approach.

Correct Answer:

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.

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

Correct Answer:

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.

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

Correct Answer:

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

114. 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?

Correct Answer:

Constructing theoretical models helps psychologists make sense of research results.

A. 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.

115. 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.

Correct Answer:

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.

116. Summarize some guidelines for consumers to evaluate health research information that they find on the Internet.

Correct Answer:

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 evidencebased.

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).

Chapter 3 1. 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."

2. Ollie 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. Ollie schedules an appointment with his doctor for a checkup every 6 months. b. Ollie researches any severe symptoms he may have for maximal information. c. Ollie allows himself to take it easy and accomplish less whenever he is sick. *d. Ollie follows medical advice in the hospital and avoids questioning the staff.

3. Why did Lance Armstrong put off seeking medical care for the symptoms he noticed? a. He was concerned about the expenses of medical care. *b. He was in denial that he was sick and ignored the pain. c. He did not know how to get a referral to a specialist. d. He knew an illness would have no impact on his career.

4. 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.

5. 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.

6. 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.

7. Maud has not been feeling well due to a sore throat. She has taken aspirin and spent

most of the day in bed. Her actions would be defined as *a. sick role behavior. b. illness behavior. c. both a and b. d. neither a nor b.

8. Edna waited almost 2 weeks after her sinuses started bothering her before she made

the appointment to see her doctor. Making the appointment would be considered a. sick role behavior. *b. illness behavior. c. psychotic behavior. d. health-seeking behavior.

9. 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.

10. The function of illness behavior is to *a. determine health status. b. alleviate symptoms. c. seek a cure. d. increase compliance.

11. 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

12. 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 she is experiencing the most severe instances of symptoms b. If her physical functioning is compromised by her symptoms c. If the quality of her life is sufficiently impaired by symptoms *d. If she is sufficiently anxious about coping with the symptoms

13. People experiencing high levels of stress are

likely to report symptoms and likely to have their symptoms acknowledged as indicating a disease.

a. more . . .more *b. more . . .less c. less . . .less d. less . . .more

14. 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

15. Women are more likely than men to seek health care, possibly because a. they feel less stress than men. b. they tend to be more introverted. c. they have more diseases than men. *d. they may be more sensitive to their internal body status.

16. 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

17. Jane and Betty are both experiencing fever and nausea. Jane's friend Myrna asks her

if she is sick and tells her that she looks terrible, but when she sees Betty, Myrna says nothing about Betty's appearance. Research suggests that Jane 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.

18. Which of these people is most likely to seek health care? a. A 19-year-old college man with a knot on his leg b. A 19-year old college woman who misinterprets HIV symptoms for the flu c. A 9-year-old boy knocked unconscious from a fall off his bicycle *d. A 40-year-old woman worried about a lump in her breast

19. Which of these people is most likely to seek health care? a. Mildred 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. Elmer 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."

20. With equal symptoms, who is most likely to seek health care? a. A 45-year-old man who runs his own business b. A 45-year-old unemployed man c. A 55-year-old woman with a very low level of stress *d. A 55-year-old woman with a very high level of stress

21. Research by Sheldon Cohen and colleagues correlated individuals’ responses to

symptoms with the Big Five personality traits. They found people scoring high in which trait more likely to seek medical care? a. Openness to experience b. Extraversion *c. Neuroticism d. Conscientiousness

22. 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

23. 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

24. Hiram and Lois each have the same condition affecting one leg. However, Hiram’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

25. Psychologist David Elkind defined what he called adolescent egocentrism, including

components of the personal fable, i.e. the idea that you are the center of everyone’s attention; and the myth of invincibility, i.e. the idea that nothing can harm you. A teenager refusing medical care demonstrates which of these concepts? *a. The myth of invincibility b. The personal fable c. Neither of these

d. Both of these

26. What is the relationship between adult aging and seeking medical care? a. Adults always seek medical care more frequently as they age. b. Adults attribute symptoms to aging, and seek health care less. *c. Adults avoid or delay care if they attribute symptoms to aging. d. Adults seek care sooner when they attribute symptoms to aging.

27. 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

28. Art has a high income and Kenny has a low income. As Americans, Art is likely to

experience symptoms, report medical care than Kenny is.

health, and be

likely to seek

*a. fewer; better; more b. more; worse; less c. fewer; worse; more d. more; better; less

29. Cathy has a wealthy family and Wanda has a poor family. Both are U.S. citizens.

Based on research, Wanda is likely to be hospitalized, medical care, and likely to develop serious illness.

likely to seek

a. less; more; less *b. more; less; more c. less; less; more d. more; more; less

30. Fadil, a Serb, is a member of an ethnic minority living in London. Since England has

socialized medicine, he does not need private health insurance to access health care.

What is most typical for his demographic when he experiences symptoms related to cancer? *a. He is likely to delay seeking care longer. b. He is likely to pursue health care sooner. c. He is likely to avoid seeking health care.

d. He is likely to go to an emergency room.

31. Muriel 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 non-smokers 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 non-smokers as she knows her high risk.

32. Patty and Selma both experience upper abdominal pain. Patty believes hers is from

indigestion; Selma believes hers is from a heart condition. What is the most likely outcome? a. They will both seek medical care because they both have the same symptoms. b. Neither will seek medical care, as doctors discount women’s heart symptoms. c. Patty will seek medical care first for a condition she thinks easily treatable. *d. Selma will seek medical care first for a condition perceived as more severe.

33. According to research by David Mechanic, what LEAST motivates illness behavior? *a. The objective observation that they do not have any symptoms. b. The subjective perceptions they have about their symptoms. c. The realization that their symptoms are persisting over time. d. The realization that their symptoms are worsening with time.

34. 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.

35. Sisters Patty and Selma both had chest pains. Patty thought hers were from

heartburn; Selma thought hers were from a heart attack. Their different reactions are determined most by which of the following? *a. The identity of the disease b. The time line of the disease c. The cause(s) of the disease d. The outcome of the disease

36. 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

37. 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 non-threatening 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.

38. 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

39. When people with chronic diseases view their conditions as acute, they experience a. greater management of illness. b. greater psychological distress. *c. greater psychological comfort. d. greater medication overdoses.

40. 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

41. Tammy 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 chemo/radiation. d. She believes that she will die regardless of treatment.

42. 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. John, 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. John *d. Tommy

43. 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

44. 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

45. Among Segall’s sick role rights and responsibilities, making health-related decisions

typically applies most to whom? *a. Parents b. Children c. The poor d. All of these

46. 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)

47. Which of the following is most likely unable to fulfill the sick role aspect of being

dependent on others for assistance when s/he is 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 elderly adult who suffers from dementia

48. 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 side-effects, 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

49. 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

50. 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.

51. In the rights and responsibilities defined by Segall, he has conceived of American

sick role behavior in a way that your text authors find a. erroneous. b. accurate. *c. idealistic. d. realistic.

52. Susie 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

53. A

is the event that separates illness behavior from sick role behavior. a. heart attack *b. diagnosis c. hospitalization d. death

54. Poor people, in comparison to wealthy people, utilize health care

when they do their illnesses are

, and

.

*a. less often; severe b. less often; not severe c. more often; severe d. more often; not severe

55. Of all ethnic groups,

are the most likely to report a visit to a physician.

a. Asian Americans *b. European Americans c. African Americans d. Mexican Americans

56. 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.

57. 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.

58. Women and those with higher education are more likely to seek health information

from a. their friends and family. *b. the Internet. c. newspapers and magazines. d. television.

59. Ian has recently begun to notice several different symptoms he has never had before

and is concerned they could indicate some disease. 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. Most people would do nothing.

60. 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).

61. Fred 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.

62. Fred 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.

63. Suppose you want to do online research for a paper on global health issues. The

website of which of the following would give you the information you need? a. The NIH b. The CDC *c. The WHO d. The CFAH

64. 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.

65. 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.

66. Alex found some information about a new treatment for asthma on the Internet and

shares this information with her doctor. Since Alex’s information is accurate and relevant, her relationship with her doctor will most likely a. deteriorate, as her doctor feels challenged. *b. benefit, as Alex and her doctor can discuss this new information. c. end, as Alex no longer trusts her doctor to provide her with new information. d. Both a and c.

67. Patients’

with their practitioner can lead to patients following medical advice and continuing use of medical services, like obtaining checkups. a. payment plan *b. satisfaction c. differences d. all of the above

68. To help people 65 years old and older, the United States Congress established a. the Health Maintenance Act. b. Medicaid. c. Medicare. *d. the Dole/Clinton Act of 2001.

69. Which of these industrialized nations has the greatest restrictions on access to health

care? a. France b. China c. Germany *d. the United States

70. 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.

71. As of 2016, the NCHS found

of Americans did not have health insurance.

a. under 1/10 *b. over 1/10 c. over 1/4 d. under 1/20

72. 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. may cover all medical, plus other, expenses.

73. What did a 2009 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.

74. 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

75. 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.

76. 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.

77. 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.

78. From the 20th to the 21st century, the predomination of physicians as medical

providers

, while the popularity of alternative health care providers

.

*a. decreased; increased b. increased; decreased c. stabilized; increased d. decreased; stabilized

79. The proportion of Americans using standard health care who also use alternative

health care is compared to the proportion of Americans using alternative health care who also use standard health care. a. bigger b. equal *c. smaller d. similar

80. Which of these is NOT a reason that alternative medicine has recently become more

popular with better-educated people? a. They share attitudes toward health and illness with alternative approaches.

*b. They have more education making them more knowledgeable of medicine. c. They have become dissatisfied with standard medical methods and results. d. They can better afford alternative care frequently not covered by insurance.

81. Andy 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.

82. 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

83. 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.

84. The “nonperson” treatment that hospital patients experience arises from *a. the requirement that patients follow hospital routine. 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.

85. 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.

86. Medical errors cause some deaths in the United States. Research suggests that deaths

from medical errors per year a. number between 44,000 and 98,000. b. are over 44,000 but less than 98,000. *c. may exceed 98,000 by some reports. d. are excluded from the leading causes.

87. 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

88. 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.

89. 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.

90. 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

91. What publicity have toxic drug reactions in hospitals received in recent years? a. Wide publicity but little public concern b. Strong public concern but little publicity *c. High publicity, concern; little reduction d. Low publicity and concern, no reduction

92. 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.

93. 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.

94. According to your text, which of the following is an example of a patient-focused

intervention to reduce medical errors? a. Making the typical nurse shift shorter *b. Asking doctors if they washed hands c. Making a typical doctor shift shorter d. Averting errors via computer systems

95. 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

96. 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.

97. 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.

98. 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

99. 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.

100. 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.

101. People with a disease are also ill. a. True *b. False

102. Those actions people undertake to learn whether or not they are ill are called illness behaviors. *a. True b. False

103. 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

104. Women are more likely than men to seek health care, even when pregnancy and childbirth are not considered. *a. True b. False

105. African Americans are more likely than European Americans to visit a physician. a. True *b. False

106. In the United States, medical errors are the second leading cause of death. a. True *b. False

107. 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

108. Young adults show the greatest reluctance to seek health care. *a. True b. False

109. People often seek medical information from their family and friends, also known as their lay referral network. *a. True b. False

110. Emily is trying to decide between two doctors: one is female and one is male. Research on how doctors interact with their patients suggests that Emily may want to consider choosing the female doctor, as this doctor is more likely to spend more time with her and be more positive when communicating with her. *a. True b. False

111. 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 illnessrelated 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.

Correct Answer:

See outline below 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 middle- and upper-class than the lower-class.

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. getting well.

Occurs after a diagnosis and is oriented toward

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.

Correct Answer:

See outline below 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.

Correct Answer:

See outline below 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).

Correct Answer:

See outline below 115. 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.

Correct Answer:

See outline below 116. 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 impoverished 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.

Correct Answer:

See outline below 117. 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.

Correct Answer:

See outline below 118. 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.

Correct Answer:

See outline below 119. 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. very unlikely.

Correct Answer:

The emphasis on controlling costs makes these changes

See outline below 120. 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.

Correct Answer:

See outline below

Chapter 4 1. 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.

2. 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.

3. 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.

4. 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.

5. 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

6. 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.

7. 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.

8. 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. increasing social support. *d. both a and b.

9. 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

10. 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 not with advice from physicians, but from practitioners of their

cultural traditions. c. are likely to be members of ethnic minorities and are less compliant than European Americans. d. are more likely to comply with the advice of a nurse than with that of a physician.

11. Which of these personal characteristics is generally the most accurate predictor of

patient adherence? a. Age is typically the most accurate predictor. b. Sex is generally the most accurate predictor.

c. Social class tends to predict most accurately. *d. A combination of these is the most accurate.

12. A person’s willingness and ability to follow recommended health practice is known

as a. behavior. b. intention. *c. adherence. d. perceived behavioral control.

13. Practitioners’ accuracy when judging adherence of patients is a. very valid. b. very reliable. *c. only slightly better than chance. d. the best report of patients’ adherence.

14. In a study that examined medication adherence in heart failure patients, adherence

was measured by both a Medication Event Monitoring System (MEMS) and by patient self-report. predicted survival over a 6-month period, whereas did not. a. Patient self-report; MEMS *b. MEMS; patient self-report c. Practitioner self-report; MEMS d. Exercise; MEMS

15. Some chronic conditions, such as HIV and arthritis, show

where diabetes and pulmonary disease show

adherence rates

adherence rates.

a. low; high *b. high; low c. low; low d. high; high

16. Angela 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 Angela has a(n) . a. high self-efficacy b. high self-esteem *c. optimistic bias

d. pessimistic bias

17. For individuals who are depressed, their risk of nonadherence is

greater than

individuals who are not depressed. a. four times b. five times c. two times *d. three times

18.

is 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

19. In studies with patients recovering from heart problems and patients with diabetes,

was a better determinant of adherence than

.

*a. practical support; emotional support b. emotional support; invisible support c. emotional support; practical support d. practical support; invisible support

20. Older studies found a general rate of nonadherence around

studies show a rate of about

; more recent

.

a. 25% ........ 50% *b. 50%. ...... 25% c. 75% ....... over 90% d. 10% ........ nearly 40%

21. 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.

22. Nonadherence rises abruptly when the prescription requires the patient to take one

pill a. once a day. b. twice a day. c. three times a day. *d. four times a day.

23. The relationship between adherence and age is complex. For example, one study

(Thomas et al., 1995) found that age had a(n) colorectal screening.

relationship with adherence to

a. inverse b. direct *c. curvilinear d. dose-response

24. 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.

25. Women are more likely than men to show higher rates of adherence to a a. medication for high blood pressure. b. smoking cessation program. c. physical activity program. *d. healthy diet.

26. With regard to gender, which of these statements most clearly agrees with research? *a. Women are more likely than men to comply with dietary recommendations. b. Women are generally more likely than men to comply with all medical

recommendations. c. Men are more likely to be extremely resistant to taking medication. d. Women are more likely to be extremely resistant to taking medication.

27. The noncompliant personality

*a. has not been found to exist among groups of people. b. is more common among men than among women. c. is less common among well-educated people. d. is more common among the elderly.

28. 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.

29. 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 shortterm problems. c. become more likely to adhere. *d. become less likely to adhere.

30. The effects of anxiety on failure to comply are

, and the effects of depression

are . a. small . . . also small *b. small . . . large c. large . . . also large d. large . . . small

31. Which of the following most accurately reflects an essential contrast between

continuum theories and stage theories 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.

32. 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

33. 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 few 34. 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.

35. 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

36. Which of the following have researchers found about the predictive value of the

health belief model? *a. The model’s prediction varies across factors and ethnic groups. b. The model was not found predictive for ethnic minority groups. c. The model is equally predictive among different ethnic groups.

d. The model’s prediction is equivalent across factors and groups.

37. 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.

38. 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.

39. 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.

40. Negative reinforcement

behavior.

*a. strengthens b. weakens c. punishes d. both b and c

41. 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 model of adherence. a. health belief b. self-efficacy c. theory of planned behavior *d. behavioral theory

42. 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.

43. 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.

44. 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 the others.

45. 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.

46. 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.

47. The theory of planned behavior identifies

as immediately determining

behavior. a. attitude toward the behavior b. perceived control of behavior *c. intention regarding behavior d. subjective norm for behavior

48. Which factor in the theory of planned behavior has most in common with Bandura’s

concept of self-efficacy? a. A person’s intention whether or not to perform an action *b. A person’s belief of how much s/he can control an action c. A person’s assessment concerning outcomes of an action d. A person’s belief about social pressures to take an action

49. 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

50. Researchers find American women eat more produce than American men. How does

the theory of planned behavior explain this gender difference? a. By differing attitudes rather than differing perceived control b. By differing perceived control rather than differing attitudes c. By differing subjective norms more than attitudes or control *d. By differing subjective norms, but not for all cultural groups

51. 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.

52. 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.

53. 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.

54. The influences of environmental and social pressures on health behavior are

accounted for better by a. self-efficacy theory. b. the health belief model. *c. the theory of planned behavior. d. all of these theories/models equally.

55. 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.

56. 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.

57. 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.

58. Morton is 90 pounds overweight and has both high blood pressure and high serum

cholesterol. However, it has never occurred to Morton that he might be a candidate for cardiovascular disease if he does not change his lifestyle. According to Prochaska's transtheoretical model, Morton is in the stage. *a. precontemplation b. maintenance c. contemplation d. final

59. 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 stage. a. precontemplation *b. contemplation c. action d. maintenance

60. 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 changes? *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

61. For the past three years, Loran 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, Loran is currently in which stage of the transtheoretical model?

a. Precontemplation b. Contemplation *c. Maintenance d. Preparation

62. 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.

63. 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.

of health behavior take(s) a “one size fits all” approach.

64.

a. Stage theories *b. Continuum theories c. Response efficacy d. Stages of change

65. 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.

66. 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.

67. In the health belief model, the belief that relates to whether an individual faces

obstacles to health-enhancing behaviors is a. perceived susceptibility. b. perceived severity. c. perceived benefits. *d. perceived barriers.

68. 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.

refer(s) to people’s confidence that they can perform a behavior to produce a desired outcome in a particular situation.

69.

a. Self-esteem *b. Self-efficacy c. Outcome expectations d. Perceived benefits

70. 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.

is an individual’s perception of the social pressure to perform or not to perform an action.

71.

a. Self-efficacy b. Perceived behavioral control *c. Subjective norm

d. Attitude

is 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.

72.

a. Self-efficacy *b. Perceived behavioral control c. Subjective norm d. Attitude

73. The theory of planned behavior predicts a. risky health behaviors. *b. intentional health behaviors. c. unconscious health behaviors. d. none of the above behaviors.

74. One recent study used the theory of planned behavior to understand gender

differences in fruit and vegetable consumption. This study found that men, 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.

75. In operant conditioning, “positive” means something is presented, and “negative”

means something is removed. Though part of operant conditioning techniques, is rarely used to modify non-adherent health behaviors. a. negative reinforcement b. positive reinforcement *c. positive punishment d. negative punishment

76. 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.

77. This 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

78. In the volitional phase of the health action process approach model, _

is a

crucial component of whether behavior change will be maintained over time. a. outcome expectation b. self-efficacy c. risk perception *d. planning

79. 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

80. 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.

81. 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.

82. Research findings indicate that people’s decisions to quit smoking were more

affected by .

, and during the process of quitting, people were more affected by

a. behavioral techniques; cognitive processes *b. cognitive processes; behavioral techniques c. cognitive processes; cognitive processes d. behavioral techniques; behavioral techniques

83. A study by Cahill, Lancaster, and Green (2010) found that interventions matched to

stage theories were compared to uniform interventions consistent with continuum theories when applied to smoking cessation. *a. equally effective b. more effective c. less effective d. not effective

84. Some researchers (Herzog, 2008; Armitage, 2009) believe that the

of stages in the health action process approach may be transtheoretical approach for effective interventions.

number useful than those in the

a. greater; more *b. smaller; more c. greater; less d. smaller; less

85. 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

86. 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.

87. A health psychologist wants to research which of these models and theories is better

at predicting the intentions of young adults for performing breast self-examinations and for avoiding unhealthy diets. A study by Garcia and Mann (2003) found which one better? a. The health belief model b. The transtheoretical model c. The theory of planned behavior *d. The health action process approach

88. Many programs used today for changing health behaviors employ behavioral

techniques, which are

with the stage models described in your text.

*a. compatible b. incompatible c. contradictory d. requirements

89. 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 vs. decisions in health behaviors *b. Balancing individual differences vs. theoretical simplicity c. Balancing personal control vs. large-scale societal barriers d. Balancing perceptions/beliefs vs. relationships and policies

90. To illustrate her point that “We are often goal-oriented but not role-oriented,”

professional psychotherapist Miriam 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.

91. 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. both of these combined.

d. neither one of these.

92. For improving adherence,

strategies are more helpful to patients who need to know to change their behavior; _ strategies are more helpful to patients who need to know to change their behavior. a. educational, how; behavioral, why *b. educational, why; behavioral, how c. both types, why; neither one, how d. both types, how; neither one, why

93. 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

94. 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.

95. 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

96. 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.

97.

methods for improving adherence increase knowledge; however, approaches have been shown to increase adherence. *a. Educational; behavioral b. Educational; socioeconomic c. Behavioral; educational d. Socioeconomic; educational

refers to people’s motivation at a given moment to engage in a risky

98.

behavior. *a. Behavioral willingness b. Perceived behavioral control c. Subjective norms d. Implementation intentions

99.

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

100. Julia, an 18-year old girl, sees many of her friends smoking. Research on risky

behaviors in teenagers suggest that Julia 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.

101. In assessing the rate of adherence, physicians’ estimates are typically more accurate than the patients’ judgments.

a. True *b. False

102. Women have a higher rate of adherence than men do.

a. True *b. False

103. Educational approaches and behavioral approaches are about equally successful in improving adherence. a. True *b. False

104. Recent meta-analyses showed that adhering to a medical regime does not make any difference in physical health outcomes. a. True *b. False

105. Patients who need to take 4-5 pills a day often have lower rates of adherence than those patients who are taking 1-2 pills a day. *a. True b. False

106. Depression is more of a risk factor for nonadherence than anxiety is. *a. True b. False

107. Reciprocal determinism is the concept that human action is the result of an interaction of behavior, environment, and person factors. *a. True b. False

108. 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

109. Researchers have found people’s intentions predict their future behaviors with reliability. a. True *b. False

110. 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

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

Correct Answer:

A. She is in the maintenance stage, trying to maintain her changed behavior. has passed through several other stages

B. This woman

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.

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

Correct Answer:

A. Adherence rates are based on estimates, and the rates of nonadherence are not known.

Measurements of adherence also have limitations.

B.

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.

113. How frequent are adherence failures?

Correct Answer:

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.

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

Correct Answer:

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.

115. Discuss some ways to improve adherence.

Correct Answer:

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.

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

Correct Answer:

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.

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

Correct Answer:

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 sideeffects 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.

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

Correct Answer:

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 timeconsuming, 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. Older and visually impaired patients can have difficulty reading prescription labels, and even more than half of college students cannot understand them.

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.

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

Correct Answer:

A. Continuum theories explain adherence using one set of factors that apply universally toall 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 situation-specific, 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 A. 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.

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

Correct Answer:

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.

Chapter 5 1. Individual nerve cells are called a. synapses. b. protons. *c. neurons. d. ganglions.

2. The space between neurons is called a. an interneuron. b. an intraneuron. c. a neurotransmitter. *d. the synaptic cleft.

3. The central nervous system consists of the a. heart and the blood vessels. *b. brain and the spinal cord. c. brain and the blood vessels. d. somatic and autonomic nervous systems.

4. The peripheral nervous system is divided into two parts: a. the afferent and efferent branches. b. the spinal cord and the brain. c. the spinal cord and theparasympathetic nervous system. *d. the somatic and autonomic nervous systems.

5. The autonomic nervous system has two subdivisions: a. afferents and efferents. b. central and peripheral nervous systems. c. the brain and the spinal cord. *d. sympathetic and parasympathetic nervous systems.

6. The sympathetic nervous system a. is a division of the parasympathetic nervous system. *b. mobilizes the body’s resources in stressful situations. c. is activated at an elevated rate in the exhaustion stage.

d. has the characteristics given in all these descriptions.

7. Which of the following responses is NOT part of sympathetic nervous system

activation? a. increased heart rate b. increased blood pressure *c. increased digestive activity d. decreased salivary activity

8. Activation of the sympathetic division of the autonomic nervous system produces

in heart rate, and activation of the parasympathetic division produces

.

a. increases . . . additional increases in heart rate *b. increases . . . decreases in heart rate c. decreases . . . increases in blood pressure d. decreases . . . additional decreases in heart rate

9. The term that refers to the body’s maintenance of an appropriate level of activation

under changing circumstances is a. “fight or flight” response. *b. allostatic load. c. allostasis. d. coping.

10. When the physiological stress response has been active for a prolonged amount of

time,

may occur. *a. allostatic load b. survival c. “fight or flight” response d. coping

11.

, or the wear and tear of the body, may be responsible for a number of health problems, such as high blood pressure, insulin resistance, and decline in cognitive functioning. *a. Allostatic load b. Survival c. “Fight or flight” response d. Coping

may be responsible for women’s stress response being characterized as “tend and befriend” rather than “fight or flight.”

12. The hormone

a. adrenocorticotropic hormone b. cortisol c. norepinephrine *d. oxytocin

13. If the activity level of the sympathetic nervous system increases, the level of activity

in the parasympathetic nervous system *a. decreases. b. increases. c. doubles. d. remains constant.

14. The two principal neurotransmitters of the autonomic nervous system are a. serotonin and dopamine. *b. acetylcholine and norepinephrine. c. epinephrine and dopamine. d. the same as those of the central nervous system.

15. The endocrine system consists of a. a system of ducted glands within the digestive system. b. a system of ductless glands in the brain and spinal cord. *c. a system of ductless glands distributed throughout the body. d. a system of ducted and ductless glands used for reproduction.

16. What is the difference between glands of the endocrine and neuroendocrine

systems? *a. Glands in the neuroendocrine system are controlled by the nervous system. b. Glands in the endocrine system are controlled by the autonomic nervous

system. c. Glands in the neuroendocrine system secrete hormones, but those in the endocrine system do not. d. Glands in the endocrine system secrete hormones, but those in the neuroendocrine system do not.

17. Which chemical substances of the endocrine system serve functions similar to the

neurotransmitters of the nervous system? a. Lymph nodes *b. Hormones c. Arterioles d. Efferents

18. The adrenal glands are located a. in the midbrain. b. in the forebrain. c. just above the stomach. *d. just above the kidneys.

19. The adrenal glands are an important part of the

system.

a. cardiovascular b. nervous *c. immune d. digestive

20. The class of chemicals containing epinephrine and norepinephrine is called a. acetylcholines. *b. catecholamines. c. neurotransmitters. d. glucocorticoids.

21. Epinephrine a. is produced by the pituitary gland. b. is another word meaning norepinephrine. c. is secreted only by the sympathetic nervous system. *d. is strongly related to and has been used as an index of stress.

22. During periods of extreme stress, the

for the "fight or flight" response. a. digestive system b. somatic nervous system

helps mobilize the body's resources

*c. sympathetic nervous system d. parasympathetic nervous system

23. In recent years, some observers have criticized the "fight or flight" hypothesis on the

grounds that a. it is contradictory of fundamental common sense. b. it is inconsistent with nonhuman animal behaviors. c. it is valid for adults, but it is not valid for children. *d. it is more valid for men than it is valid for women.

24. The person(s) who proposed the view of stress as a nonspecific response was *a. Selye. b. Lazarus. c. Dohrenwend. d. Meichenbaum.

25. Stress has been considered as a. a stimulus. b. a response. c. interaction of stimulus and response. *d. all of these.

26. Which of these is NOT a stage of the General Adaptation Syndrome? a. Resistance stage *b. Illness stage c. Exhaustion stage d. Alarm stage

27. One criticism of Selye’s theory of stress is that it emphasizes the

largely ignores the influence of

factors.

a. external . . . internal *b. physical . . . psychological c. psychological . . . individual d. retrograde . . . proactive

28. Lazarus and Folkman suggested that stress

factors but

a. is a non-specific response. b. is influenced by perception. c. is regarded as transactional. *d. is defined with both b and c.

29. According to Lazarus, a person's perceived ability to cope with harm or threat would

be called a. primary appraisal. *b. secondary appraisal. c. reappraisal. d. vulnerability.

30. According to Lazarus, a person who loses her job but sees the prospect of finding a

new job as a challenge would be a. more vulnerable to stress than someone who saw the event as a threat. b. more likely to reappraise the situation than someone who saw it as a threat. *c. less vulnerable to stress than someone who saw the event as a threat. d. less capable of coping than someone who saw the situation more realistically.

31. Lazarus saw stress as stemming from a. strong emotional reactions to environmental stimuli. b. negative life events. c. positive life events. *d. the person's perception of an event.

32. Both Selye's and Lazarus's theories of stress suggest that stress a. is a response that is non-specific. *b. has environmental and personal sources. c. is analogous to a pathogen. d. is characterized by all of these choices.

33. Several methods have been used to measure stress, but the approach taken by most

health psychologists is to use *a. self-report scales. b. performance tests. c. physiological measures.

d. estimates by close associates.

34. Instruments that measure stress by quantifying physiological reactions are ordinarily *a. highly reliable. b. highly unreliable. c. valid predictors of physiological illness. d. valid predictors of psychological disorders.

35. The Social Readjustment Rating Scale assumes that a. daily events are more crucial than major life events. *b. change in life events is the key for measuring stress. c. only desirable events are valid predictors for stress. d. positive life events tend to decrease levels of stress.

36. Which of the following has/have been used to measure stress? a. Blood pressure b. Daily hassles scales c. Self-reports *d. All of these

37. The Perceived Stress Scale (PSS) a. consists of 105 items that the respondents may have experienced during the

past week. b. measures changes in coping responses, as well as daily hassles and major life events. *c. measures events in people's lives that they perceive as unpredictable and uncontrollable. d. measures events in people's lives that they perceive as being predictable or controllable.

38. Lazarus's Hassles Scale assumes that a. stress is an objective environmental stimulus that must be measured

objectively. b. physiological instruments are more reliable than self-reports in measuring stress. *c. the person's perception of an event is the critical factor in measurement of stress.

d. the frequency of a person’s everyday hassles is more crucial than their

intensity.

39. The revised Hassles and Uplifts Scale *a. asks people to rate everyday events for perceived severity and importance. b. is a longer and more complex instrument than the original Hassles Scale is. c. is less able to predict headaches than the Social Readjustment Rating Scale. d. shows the number of hassles is more important than the severity of hassles.

40. Validity is whether an instrument measures what it is supposed to measure;

reliability is whether an instrument gets consistent results across administrations. If spouses fill out a self-report measure of stress from their spouse's point of view, and the spouses’ scores match closely, we can say that the self-report inventory is *a. valid. b. reliable. c. both valid and reliable. d. neither reliable nor valid.

41. Self-report inventories of stress are useful to the extent that a. they are reliable. b. they predict future illness. c. they include items people actually find stressful. *d. they satisfy all of these criteria for being useful.

42. Stressful events that are so powerful that they affect large numbers of people fit into

the category of a. life events. *b. cataclysmic events. c. daily hassles. d. unintentional events.

43. Life events produce stress by a. making the affected person’s life more unpleasant. *b. creating change and requiring adaptation. c. putting people’s lives in danger. d. accomplishing all of these.

44. Noise is considered a type of pollution because a. one person's music is another person's noise. b. one person's noise is another person's music. c. it is, by its nature, a loud stimulus. *d. it is a noxious, unwanted stimulus.

45. The experiments with rats living in highly crowded cages suggest that *a. overcrowding leads to differences in the social interactions among rats. b. overcrowding causes short life spans for most rats in crowded conditions. c. rats become more fertile, hence leading to even more crowded conditions. d. crowding eventually reduces the population to about 1/10 of its original size.

46. John, a Montana rancher, lives five miles from his nearest neighbor. John's living

conditions could be described as a. dense but not crowded. b. crowded but not dense. c. both crowded and dense. *d. neither crowded nor dense.

47. During a recent football game, 77,000 people were present in a stadium with a

capacity of 73,000. The accumulation of that number of people in a relatively small area would be consistent with Stokols's definition of *a. crowding. b. learned helplessness. c. mob behavior. d. density.

48. Which of these could be a source of stress? a. Noise b. Crowding c. Air pollution *d. Any of these

49. The experience of discrimination

*a. has been linked to health problems, including cardiovascular disease. b. creates stress, but has little ability to harm physical health. c. creates stress, which harms physical health but has little ability to produce

psychological distress. d. occurs mostly in the workplace rather than in the community.

50. Which of these jobs is ordinarily LEAST stressful? a. Farm worker b. Waiter or waitress *c. Chief executive officer d. Construction worker

51. The most stressful occupations are those that offer *a. high demands and low control. b. high demands and high control. c. low demands and low control. d. low demands and high control.

52. Which of the following is NOT a common source of stress for women? a. Occupying multiple roles as employees, wives, and mothers b. Conflicts with their husbands over household work duties *c. Having husbands who are supportive of their career goals d. Expectations for employed women to do the most child care

53. People experience less stress during and after a vacation than before a vacation.

However, this “vacation effect” tends to last only a. three to four days. b. one week. c. two weeks. *d. three to four weeks.

54. Cataclysmic events, such as 9/11 and Hurricane Katrina, can cause individuals to

experience a prolonged stress response and feelings of depression and anxiety, and after such events individuals are often diagnosed with *a. posttraumatic stress disorder. b. social anxiety.

c. stomach ulcers. d. migraines.

55. In the past year, Kelly has graduated from college, changed jobs, and bought a

house. All of these events can be classified as a. cataclysmic life events. *b. major life events. c. daily hassles. d. none of the above.

56. Amy faces a long commute to college every day, and once there, has difficulty

finding parking. These everyday events can be classified as a. cataclysmic life events. b. major life events. *c. daily hassles. d. none of the above.

57. Individuals who live closer to “green spaces” in cities report a. higher levels of stress. b. worse self-reported health. *c. lower levels of stress. d. being victims of crimes, like muggings.

58. Discrimination is a source of stress that may increase the risk for

.

a. cardiovascular disease b. mental health problems *c. either/both (a) and/or (b) d. none of these problems

59. When people use strategies to manage the distressing problems in their lives, they

are *a. coping. b. becoming more vulnerable to stress. c. dispersing sources of stress. d. in the alarm stage of the GAS.

60. To Lazarus and Folkman, several factors determine a person's ability to cope with an

event. Which of these is NOT one such factor? a. Material resources, like money b. Believing in positive outcomes c. Believing one has some control *d. The magnitude of the life event

61. A combination of emotional concern, instrumental aid, information, and appraisal

best describes a. social networks. b. social contacts. *c. social support. d. all these things.

62. Phyllis is 65 years old, lives alone, and has no close friends or relatives. Her

condition is best described as *a. social isolation. b. widowhood. c. sociopathy. d. socioeconomic deficit.

63. The benefits of marriage

in terms of health;

.

a. are not equal . . . women benefit more than men *b. are not equal . . . men benefit more than women c. are almost equal . . . college-educated women have an advantage, but other

women do not d. are equal . . . men and women benefit equally 64. Claudia believes that her own health is mostly due to genetics and germs, and she

can do very little to improve her health. This attitude is consistent with a. an internal locus of control. *b. an external locus of control. c. a high level of self-efficacy. d. a low level of self-efficacy.

65. A study by Ellen Langer and Judith Rodin of nursing home residents showed that

older people were more likely to retain good health if they

a. had live, growing plants in their rooms. b. received flowers at least once a week from family members. *c. had more minor control and responsibility in their daily lives. d. received attention from nursing staff via frequent rearrangement of room

furniture.

66. According to Ellen Langer and Judith Rodin's research about personal control and

older people, the degree of control necessary to produce health benefits *a. may be created by decisions about relatively minor matters. b. should include control over decisions about where to live. c. should include having their choice of a personal physician. d. is so extensive that it is not feasible due to safety concerns.

67. The

suggests that social support lessens or eliminates the

harmful effects of stress. *a. stress-buffering hypothesis b. personal control hypothesis c. tend and befriend hypothesis d. emotion-focused coping hypothesis

68. A 2010 large-scale epidemiological survey found that social support improved

feelings of physical and psychological health for adults *a. experiencing greater life stress. b. experiencing average life stress. c. experiencing smaller life stress. d. experiencing any level of stress.

69. Marty believes that he has control of events that shape his life. Psychologists would

say that Marty has high _

.

a. problem-solving skills b. social support c. free will *d. personal control

70. People who own a _

are over eight times more likely to be alive a year after having a heart attack than those who do not own one.

a. bicycle *b. dog c. pedometer d. heart monitor

71. Individuals who frequently face situations that offer little control have increased

production of

.

a. adrenocorticotropic hormone *b. cortisol c. norepinephrine d. oxytocin

72.

is the better coping strategy to deal with chronic stressors, such as discrimination, HIV infection, and diabetes. *a. Problem-focused coping b. Emotion-focused coping c. Avoidance-orientated coping d. Meaning-focused coping

73. Individuals are more likely to use this form of coping when they appraise the

situation as controllable. *a. Problem-focused coping b. Emotion-focused coping c. Avoidance-orientated coping d. Meaning-focused coping

74. The Alameda County Study was the first study to show a strong link between

and longevity. a. self-esteem b. narcissism *c. social support d. social isolation

75. People who are

are more likely to use problem-focused coping and adjust their coping strategies to meet the demands of specific situations. a. pessimistic

*b. optimistic c. narcissistic d. healthy

76. People who experience a trauma, such as losing a loved one, but then can find

positive aspects concerning their trauma, often experience better psychological adjustment. This type of coping is: a. problem-focused coping. b. emotion-focused coping. c. avoidance type of coping. *d. meaning-focused coping.

77. Erin is worried about her grade in a psychology class. To receive her best grade,

Erin needs to make and follow a study schedule. Folkman and Lazarus would call this preferred approach: a. reappraisal. b. danger control. *c. problem-focused coping. d. emotion-focused coping.

78. Rather than make a study schedule, Erin spends a lot of time complaining to her

roommates about how hard her psychology course is and how worried she is about her grade. Folkman and Lazarus would call this approach a. reappraisal. b. danger control. c. problem-focused coping. *d. emotion-focused coping.

79. In general, which type of coping strategy is related to good health? a. Emotion-focused coping *b. Problem-focused coping c. Avoidant coping d. Danger control

80. Research has confirmed that cultural differences in personal coping strategies exist

for

*a. people from Asian cultures, who are less likely than Westerners to seek

social support from families. b. African Americans, who are more likely than European Americans to use emotion-focused coping. c. Hispanic Americans, who are more likely than African Americans to use emotion-focused coping. d. all of these groups, who were found in multiple studies to demonstrate all of these differences.

81. Research evidence suggests that relaxation training a. reduces perceived stress after surgery but does not speed healing. *b. is useful for a variety of people and also for a variety of problems. c. works better with group training than with individualized training. d. has been found by most studies as less effective than biofeedback.

82. Cognitive behavioral therapy *a. concentrates on developing attitudes that change behaviors. b. emphasizes attitudes while minimizing the role of behavior. c. focuses on analyzing irrational beliefs rather than behavior. d. is characterized by both (b) and (c) more strongly than (a).

83. James Pennebaker has demonstrated that *a. writing or talking about traumatic events can produce positive results. b. relaxation training is more effective than biofeedback to address pain. c. social support is critical in helping patients to cope with chronic pain. d. social support is not critical in helping patients cope with chronic pain.

84. Emotional disclosure improves not only

but also

.

a. social support . . . number of close friends *b. feelings of distress . . . physical symptoms c. fever . . . hepatic indicators d. sleep problems . . . negative life events

85. Rosario participated in a program in which she wrote about a traumatic event in her

life as a way to improve her distress about this event. Maxime participated in the same program, but in addition to writing about a traumatic event in her life, she received

instructions to focus on finding something positive about this negative experience.

Research indicates that a. both women will benefit from each version of the program equally. b. Rosario will profit more than Maxime because trying to find a positive aspect

to a negative situation will detract from the value of emotional disclosure. *c. Maxime will profit more than Rosario because focusing on something positive adds additional benefits to emotional disclosure. d. neither woman will benefit from the program as much as a man would.

86. Research on the topic of emotional disclosure has demonstrated its effectiveness a. in reducing the symptoms of asthma, rheumatoid arthritis, and cancer. b. is enhanced if people find some positive aspect of their experience. c. with psychological problems, but not with physical problems. *d. with respect both to (a) and to (b), but (c) is not accurate.

87. A recent meta-analytic review showed that emotional disclosure is more effective in

helping people with

than

problems.

*a. physical; psychological b. psychological; physical c. emotional; physiological d. psychological; emotional

88.

is the most effective therapy for stress management. a. Progressive muscle relaxation b. Autogenics training *c. Cognitive behavioral therapy d. Emotional disclosure

89.

has been shown to be an effective intervention for posttraumatic stress disorder, chronic back pain, and chronic fatigue syndrome. a. Progressive muscle relaxation b. Autogenics training *c. Cognitive behavioral therapy d. Emotional disclosure

90. Which of the following do progressive muscle relaxation and autogenic training

have in common?

*a. Lessening muscular tension b. Changing how people think c. Changing what people think d. They both share all of these.

91. Which of the following is true of research findings about relaxation training? a. It is effective for college students but not with children. b. It is generally no more effective than a placebo/control. c. It aids psychological but not hormonal stress responses. *d. It may be an essential part of biofeedback and hypnosis.

92. Meichenbaum’s stress inoculation training program is a type of a. emotional disclosure therapy. *b. cognitive behavioral therapy. c. progressive relaxation training. d. mindfulness meditation training.

93. Which stage of the stress inoculation program involves educational, but not

behavioral, components? a. Skills acquisition and rehearsal b. Application and follow-through c. The stage for conceptualization *d. All stages involve both of these

94. The mechanism of Meichenbaum and Cameron’s version of a cognitive behavioral

therapy program for stress management is best understood through an analogy with *a. vaccination. b. sensitization. c. immersion. d. rejection.

95. Which type of intervention have researchers found can actually reduce production of

the stress hormone cortisol? a. The stress inoculation variation of CBT b. Cognitive behavioral therapy in general *c. Cognitive behavioral stress management

d. Emotional disclosure therapy techniques

96. Studies show that cognitive behavioral interventions: a. reduce stress in pregnant women rather than reducing stress in their fetuses. b. reduce stress for unborn babies rather than reducing stress for their mothers. c. reduce stress in HIV-positive patients less than improving immune function. *d. reduce stress in HIV-positive people more than enhancing immune function.

97. Among these effective applications of cognitive behavioral techniques, which is

identified as yielding greater outcomes than other approaches? a. Substance abuse rehabilitation programs *b. Workplace stress management programs c. Raising student standardized test scoring d. Raising student performance motivations

98. Which of the following is a difference between emotional disclosure and emotional

expression? a. Emotional expression requires some self-reflection. b. Emotional disclosure may be venting or outbursts. *c. Emotional disclosure requires the use of language. d. Emotional expression is healthy and reduces stress.

99. Carla has cancer and hypertension and is experiencing stress related to her

diagnoses. She is beginning a mindfulness stress reduction intervention. Based on research findings, what may she expect? *a. This program is likely to lower her stress and blood pressure and aid her

immunity. b. This program is likely to lower her stress but not likely to lower her blood pressure. c. This program is likely to lower her blood pressure but not aid her immune function. d. This program is likely to lower her stress but not affect blood pressure or immunity.

100.

Research finds that one reason mindfulness-based mental health interventions are effective appears to be their capacity for minimizing people’s tendencies to dwell on their stressful experiences. This evidence could indicate an avenue for further research to discover whether mindfulness interventions might be helpful for addressing:

a. high blood pressure in adults. *b. post-traumatic stress disorder. c. human immunodeficiency virus. d. hypertension in cancer patients.

101. Neurons are more like a chain than like a net. a. True *b. False

102. The two major divisions of the nervous system are the central nervous system and the peripheral nervous system. *a. True b. False

103. Catecholamines are a class of chemicals containing epinephrine and norepinephrine. *a. True b. False

104. The first stage of the general adaptation syndrome is alarm. *a. True b. False

105. According to Richard Lazarus, people's perception of their ability to cope with a stressful event can diminish their feelings of stress. *a. True b. False

106. According to the Social Readjustment Scale, a person who wins $50,000 in the lottery may experience increased stress. *a. True b. False

107. Cataclysmic events such as hurricanes and earthquakes are more stressful than those caused by intentional acts. a. True *b. False

108. Life events and everyday hassles are two terms for similar sources of stress. a. True *b. False

109. The more workplace decisions a person must make each day, the more stress that person will experience. a. True *b. False

110. Whenever Preston faces a major source of conflict, he "drowns" his problems by drinking alcohol. Such a tactic is referred to as problemfocused coping. a. True *b. False

111. Describe the physiology of stress reactions.

A. The stress reaction is controlled by the sympathetic division of the ANS, which mobilizes the body for “fight or flight.”

B.

The mobilization occurs through two routes:

1.

A direct route occurs through activation of the adrenomedullary systems, which a.

Activates the adrenal medulla to release epinephrine and norepinephrine. b.

Produces effects throughout the body such as increased heart, respiration, decreased digestion, etc.

2.

An indirect route through the hypothalamic-pituitaryadrenal axis, which a.

Stimulates the hypothalamus to produce corticotropin releasing hormones b.

Activates the anterior pituitary to secrete ACTH, which causes the adrenal cortex to secrete glucocorticoids. c.

Mobilizes the body's energy resources, raising blood sugar and suppressing the inflammation response.

Correct Answer:

See below 112. Compare and contrast the views of stress of Selye and Lazarus.

A.

Selye’s view 1.

Was strongly influenced by his background in

physiology.

2.

Initially described stress as a stimulus but later as a response to a wide range of stimuli.

3.

Emphasizes the physical response to stressors, including the general adaptation syndrome with its three stages.

4.

Holds that the stress response could weaken resistance and injure organ systems, making people sick.

B.

Lazarus’s view 1.

Emphasizes the cognitive variables that mediate

stress.

2.

Includes individual appraisal and reappraisal, which affect the response to stressful events.

3.

Includes coping resources and how these influence the appraisal of threat.

Correct Answer:

See below 113. What types of hassles arise from the psychosocial environment to produce stress?

A. Discrimination is a stressor that is a fairly common experience for women and members of ethnic minorities.

1.

Discrimination occurs in the workplace.

2.

This experience applies to many daily activities and has been linked to a variety of health problems.

B.

Workplace stress also arises from the psychosocial environment.

1.

Jobs with high demands and low control are particularly stressful.

2.

Stress in the workplace may spill over into relationships, creating conflict.

C. Relationships may produce stress, but they also offer the possibility of social support, which can buffer stress.

1.

Work and family demands often conflict.

2.

Women’s multiple roles of employee, wife, and mother create a workload that is difficult to fulfill; trying to do so often creates stress.

Correct Answer:

See below 114. In what ways does social support influence health?

A. The Alameda County study is a longitudinal study that established a link between social support and health.

1. mortality rate.

2.

People with the fewest social ties had the highest The relationship is apparent for both women and men.

B. Gender is a factor in social support; men receive greater benefits from social support than women do.

1.

Women may experience costs associated with giving social support as well as benefits from receiving support.

2.

C.

Men receive benefits from marriage that women do not.

Several types of social support are helpful.

1. than for women.

2.

Marriage decreases health risks, but more so for men Relationships that offer emotional support are

beneficial.

D. The beneficial effects of social support may occur through several routes.

1.

Social support buffers the harmful effects of stress and helps people cope with negative life events.

2.

Social support urges people to care for themselves, including caring for their physical health.

3.

Someone who prompts a person to take care of their health can be useful.

Correct Answer:

See below 115. What are the advantages of problem-focused coping? Does emotionfocused coping have any advantages?

A. Problem-focused coping is aimed at changing the source of the stress, which is generally more effective than emotion-focused coping, a strategy aimed at managing the emotions that accompany stress.

1.

Problem-focused strategies are effective when the situation is controllable.

2.

Problem-focused strategies are effective when effort can change the source of the stress.

3.

Meta-analyses show that using problem-focused strategies is related to good health.

B. Emotion-focused strategies are effective when the situation is uncontrollable and the person must endure the stressful situation.

C. What strategy is more effective depends on the situation, and either problem-focused or emotion-focused coping can be effective.

Correct Answer:

See below 116. Evaluate the behavioral interventions for managing stress, addressing the types of stress-related problems for which each is successful.

A. Relaxation training is suitable for a wide range of problems in a variety of people, including children, adolescents, and adults.

1. easy to learn.

Techniques such as progressive muscle relaxation are

2.

Relaxation is an excellent choice for helping people manage daily stress, sleep problems, and stress related to treatment for cancer and other stressful chronic conditions.

B. Cognitive behavioral therapy (CBT) is effective in treating many stress-related conditions.

1.

CBT addresses the cognitions that may create stress and teaches ways to cope more effectively.

2.

Stress inoculation is one type of CBT that is effective in helping with problems such as managing school or workplace stress, but it can also be useful in treating posttraumatic stress disorder (PTSD).

3.

Cognitive behavioral stress management is directed toward stress management and is one of the most effective approaches for PTSD. C.

Emotional disclosure is also helpful in managing stress.

1.

Talking or writing about traumatic events can relieve distress, possibly through the process of self-reflection that occurs when people use language to frame their experience.

2.

People who use this process experience decreased distress and increased health.

3.

Finding meaning in the traumatic experience and finding some positive aspect of the trauma adds to the effectiveness of emotional disclosure.

D. Mindfulness has been studied by Dr. Jon Kabat-Zinn for 30 years as a method for managing stress to improve mental and physical health.

1. Mindfulness is awareness or consciousness achieved by deliberately focusing attention on the present moment in an accepting, non-judgmental way. It is derived from Zen Buddhist meditation practices.

2. Kabat-Zinn developed an eight-week stress reduction program based on exercises teaching mindfulness skills, e.g. focusing on one’s breathing, body sensations, sounds, everyday activities, and thoughts.

3. Most people naturally focus on the past and/or the future in responding to stress; mindfulness meditation redirects attention to the immediate situation in the present.

4. Literature reviews suggest mindfulness-based stress reduction interventions can lower stress, depression, and anxiety for breast cancer patients; increase pain acceptance in lower-back pain patients; and reduce stress and potentially improve the progression of disease for HIV-positive patients.

5. Mindfulness may also improve physical health: better immunity, lower stress hormones, and lower blood pressure in cancer patients were associated with a mindfulness-based stress reduction intervention. Adults at risk for hypertension also had lower blood pressure via this intervention.

6. Mindfulness-based stress reduction interventions appear to improve mental health by decreasing worry, focusing attention, and decreasing people’s natural tendencies to dwell on stressful experiences.

7. Some studies find that even mindfulness-based stress reduction interventions shorter than eight weeks can still achieve benefits similar to eight-week programs.

Correct Answer:

See below 117. Identify two main categories of methods researchers use for measuring stress. Identify and summarize specific examples of both types.

A. Physiological measures are one of two main categories of approaches for measuring stress.

1. Physiological measures evaluate components of the body’s physical stress response directly. These include heart rate, blood pressure, respiration rate, galvanic skin response, and elevated secretion of cortisol, epinephrine, and other stress hormones.

These data give researchers a glimpse into HPA axis and sympathetic nervous system activation.

2. Measuring epinephrine and norepinephrine hormone secretions in urine or blood samples can indicate stress immediately following stressful experiences.

3. Cortisol in saliva can be measured for up to 20 minutes after stressful events.

4. Measuring cortisol in human hair indicates the body’s past six months of cortisol production to indicate stress over a longer recent time period.

5. Advantages: Physiological measures of stress are easy to quantify, highly reliable, and direct. Disadvantages: Electrical and mechanical hardware and clinical settings used for physiological measurement can cause stress themselves.

6. Due to the disadvantages of physiological measurement, selfreports are more commonly used.

B. Self-report measures are the other main category of approaches for measuring stress.

1. Life Events Scales have been developed since the late 1950s-early 1960s as self-report instruments. The best known and earliest of these is Holmes and Rahe’s Social Readjustment Rating Scale (SRRS, 1967). a. The SRRS lists 43 life events ranked from most to least stressful, each assigned a value from 100 to 11 points. b. Respondents check items they experienced recently, e.g. the last 6-24 months. c. Totaling point values yields a stress score for each respondent. d. Stress scores can be correlated with future illness incidence to determine the relationship between these.

2. Additional stress inventories include the Life Events Scale for Students. College students who mark more stressful situations on the scale are likely to use more health services.

3. Cohen, Kamarck, and Mermelstein’s Perceived Stress Scale (PSS, 1983) does not emphasize actual stressful events, but rather people’s perceptions of them. a. The PSS has 14 items, which respondents rate as “unpredictable, uncontrollable, and overloading” in the last month. b. The PSS evaluates three stress components: (1) daily hassles; (2) major events; (3) changes in coping resources. c. Researchers use the PSS for measuring prenatal stress in pregnant women, evaluating how effective a relaxation program is for elementary school teachers, and predicting burnout in college athletic coaches. d. Researchers have used the PSS in a variety of projects, owing to its good validity, reliability, and shortness.

4. Everyday Hassles Scales were pioneered by Richard Lazarus and colleagues. a. These are based on Lazarus’s theory of stress as a dynamic, transactional complex, influenced by people’s appraisal of environmental situations and their perceived capabilities to cope with those situations. b. Lazarus and colleagues require these self-report scales be able to evaluate personal beliefs, goals, commitments, appraisal, and other subjective elements. c. The original Hassles Scale correlates only somewhat with life events, suggesting these are different types of stress. d. The Hassles Scale can predict psychological health more accurately than life events scales. e. A shorter version of the Hassles Scale predicts headache frequency and intensity and IBD episodes better than the SRRS, showing that everyday annoyances can influence health more than more serious life events. f. The Urban Hassles Index (Miller & Townsend, 2005) measures stressors for urban adolescents.

g. The Family Daily Hassles Inventory (Rollins & Garrison, 2002) measures daily stressors for parents.

Correct Answer:

See below 118. Discuss how personal control interacts with people’s ability to cope with stress, including a related theory, research study findings, and some cultural differences and commonalities.

A. People’s ability to cope with life stressors is improved by a sense of personal control, i.e. of confidence in their control over lifeshaping events.

1. Julian Rotter (1966) formulated the concept of locus of control. a. People who have internal locus of control believe they can control their own lives. They attribute events to factors like their own abilities, attitudes, and efforts. b. People who have external locus of control believe factors outside themselves control their lives. They attribute events to factors like luck, fate, or other people’s actions. c. A study of people with chronic illness (Livneh, Lott, & Antonak, 2004) found that patients who had adapted better had a higher internal locus of control.

2. Ellen Langer and Judith Rodin (1976) studied the effects of personal control for nursing home residents.a.

One group of residents were encouraged to take more control and responsibility for minor aspects of their lives, like choice of leisure activities, choice of whom to visit in the home and when, and furniture rearrangement. They were also offered a small live plant that they could reject, or accept and care for as they chose. b.

A comparison group of residents were given information emphasizing the nursing staff’s responsibility, and also were given a living plant. c.

The first, “responsibility-induced” group showed higher wellbeing, alertness, activity, and happiness within three weeks, with 93% showing overall physical and mental improvement; whereas 71% of the comparison group had progressed in debilitation within the same time. Follow-ups found the first group had maintained the improvement after 18 months, with a lower mortality rate than the comparison group.

3. A meta-analysis (Dickerson & Kemeny, 2004) of >200 studies found people’sproduction of cortisol highest, and recovery time longest, from stress tasks allowing little control, e.g. exposure to uncontrollable loud noises, performing under extreme time pressure, or performing impossible tasks.

4. The research suggests that even a little control can benefit health, and lack of control can damage health.

1. Western cultures that value individualism may influence the benefits of personal control. a. A study comparing stress and coping in Japanese and British people (O’Connor and Shimizu, 2002), Japanese participants reported lower sense of personal control; however, only British participants reported stress due to loss of control. b. However, the fact that stress occurs universally indicates that all cultures devise strategies for coping with stress.

Correct Answer:

See below 119. Discuss the influences of personal optimism on coping with stress, including differential definitions of optimism and pessimism; research findings; and three reasons that optimism may benefit health.

A. Psychologists define optimism as an individual’s general belief or expectation that good things will occur; and pessimism as an individual’s general belief or expectation that bad things will occur. These beliefs significantly affect mental health, physical health, and how people cope with stress.

B. Studies of new college students, cancer patients, coronary bypass surgery patients, and caregivers to Alzheimer patients all find optimists experience less emotional distress than pessimists.

C. Optimistic beliefs are found in research to predict mortality and physical health.

1.

A study (Tindle et al., 2009) found optimistic women 30% less likely to die than pessimistic women from cardiovascular events after eight years.

2.

A meta-analysis (Rasmussen, Scheier, & Greenhouse, 2009) found better physical health for optimists than pessimists with a variety of health conditions.

D. Reasons that optimism as a personal resource may benefit health: 1.

Optimists tend to have stronger social support networks than pessimists. Positive

expectations may enable them to use more energy and time to build social relationships, and their greater likability may facilitate developing social networks.

2.

Optimists may recover faster from cardiovascular stress responses through their more positive moods, which may improve immune function and reduce cumulative wear and tear on the body.

3. People are more likely to persevere in pursuing important goals despite setbacks and stressors when they have confidence good outcomes will occur. Pessimists tend to avoid problems. One major difference between optimists and pessimists is their use of different coping strategies.

Correct Answer:

See below 120. Describe some of the influences of culture and gender on coping with stress.

A. Although one might expect collectivist cultures, which emphasize social harmony and value cooperation above competition, would use social coping strategies more, researchers have found otherwise.

1.

To maintain social harmony, Asian Americans are less likely to pursue social support to cope with stress than European Americans.

2.

African Americans are found more likely to seek social support from their families than European Americans.

3.

Studies examining people in similar situations tend to find cross-cultural similarities in coping strategies: A study comparing adolescents across seven European countries found similar coping strategies, particularly related to jobs, in all teenagers.

B. Researchers find women more likely to use social coping strategies than men.

C. Otherwise, gender differences in coping with similar situations tend to be small.

D. Stressors faced may vary according to gender roles, causing gender differences in coping strategies.

In one study, women experienced more stressors related to family, whereas men experienced more stressors related to work and money.

E. Since different cultures have different gender roles, culture and gender may interact, producing variations in situational coping demands for men and women in different cultures.

Correct Answer:

See below

Chapter 6 1. The main function of the immune system is to a. manufacture white blood cells. b. manufacture red blood cells. c. protect internal organs. *d. defend against foreign invaders.

2. Leukocytes are *a. white blood cells. b. red blood cells. c. platelets. d. capillaries.

3. 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.

4. Which of these is NOT an organ of the immune system? *a. Liver b. Spleen c. Tonsils d. Thymus

5. Which of the following performs specific immune responses? a. Phagocytosis *b. T-cells and B-cells c. Granulocytes d. Macrophages

6. 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.

7. In an inflammatory immune response, invading microorganisms.

migrate to the affected location to destroy

a. granulocytes b. macrophages *c. both of these d. neither of these

8. The initial exposure to a foreign substance generates: a. a general immune response. b. a specific immune response. c. neither kind of immune response. *d. both types of immune responses.

9. 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.

10. 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.

11. 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.

12. 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.

13. The development of immunity depends on the creation of a. leukocytes. b. natural killer cells. c. antigens. *d. antibodies.

14. 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.

15. 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.

16. HIV is caused by *a. a viral infection. b. a bacterial infection. c. exposure to a cancer-causing agent. d. homosexuality.

17. 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.

18. 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.

19. 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.

20. 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

21. Enhancing immune system function would be useful in the treatment of a. allergies. b. organ transplant patients. *c. AIDS. d. cardiovascular disease.

22. 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.

23. Substances that evoke the production of one or more antibodies are called

.

*a. antigens b. vaccinations c. phagocytes d. lymph nodes

24.

enable the immune system to have a rapid response when the foreign invader reappears. a. Antigens

b. Phagocytes *c. Memory lymphocytes d. Leukocytes

25. 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.

26. 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.

27. 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.

28. Interleukins are types of a. leukocytes. b. lymphocytes. *c. cytokines. d. macrophages.

29. What relationship is the basis 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 action of the immune system is independent of behavior, and the endocrine and nervous systems are less dependent than previously assumed.

30. 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 also if ongoing. d. damaging, whether it is initial or ongoing.

31. 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. relationship conflict affecting married couples. *d. all of these.

32. Research by Kiecolt-Glaser and her colleagues has shown that Alzheimer’s

caregivers, compared with other people of the same age and gender, a. had poorer psychological and physical health. b. had lowered immune system function. c. more quickly recovered their own health after the death of the Alzheimer's

patient. *d. both a and b are correct.

33. Recent research that presented photographs of infectious disease to participants

found that, after viewing this pictures, participants a. sneezed and felt nauseated. b. reported more trips to the health center that semester. *c. had increased proinflammatory cytokine production. d. all of the above.

34. 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.

35.

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. People who are elderly

36. Which have researchers found about marital conflict relative to immune response? a. Marital conflict disrupts immune response regardless of whether or 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 in any way. d. Marital conflict disrupts immune response more for couples who communicate in any way.

37. Which of the following individuals would be most likely to have decreased immune

system functioning? a. Anna, who will be taking her first examination in psychology this week b. Nathan, who has an hour-long commute to school every week c. Marissa, who just given birth to her first child *d. Claude, who is unemployed and lives in a high-crime neighborhood

38. Antoni and colleagues (2009) designed a cognitive behavioral stress management

intervention for women with breast cancer, and over a 6-month period, improvements in were found. a. depression measures b. anxiety measures *c. immune measures d. cortisol measures

39. These chemicals secreted by immune system cells signal the nervous system: *a. cytokines. b. leukocytes. c. phagocytes. d. antigens.

40. In order for stress to cause illness, stress must affect physiological processes that

produce illness. The most likely candidate for a mechanism is the

system.

*a. immune b. nervous c. endocrine d. digestive

41. 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.

42. Direct effects of stress on the immune system occur through

effects can occur through

, and indirect

.

a. the cardiovascular system . . . autonomic nervous system activation effects b. the sympathetic nervous system . . . parasympathetic nervous system

suppression *c. connections between the immune and nervous systems . . . secretion of hormones d. the adrenal medulla . . . activation of the pituitary gland and releasing factors 43. 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.

44. 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. Both a and c are correct.

45. 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.

46. 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.

47. With regard to stress and disease, 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. both a and c are correct.

48. 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.

49. In comparison to using scores on life events rating scales, applying the diathesis-stress model is predictive of illness because it takes into account . a. less; vulnerability more than stressors *b. more; vulnerability as well as stressors c. less; vulnerability less than stressors d. more; vulnerability in lieu of stressors

50. 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.

51. 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.

52. 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.

53. 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.

54. 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.

55. 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 college freshmen 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. Spring, immediately before finals d. After arriving and starting classes

56. 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. most heart attacks among middle-age men are related to marital stress.

57. 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.

58. Among indirect contributions of stress to developing coronary artery disease, the action of promotes , whereas the action of promotes . *a. the immune system, inflammation; stress hormones, diseased arteries b. stress hormones, inflammation; the immune system, diseased arteries c. stress hormones, cytokine release; the immune system, arterial plaque d. the immune system, cytokine release; stress hormones, inflammation

59. What did a longitudinal study by Stewart, Janicki, and Kamarck (2006) find related to increased blood pressure from noise and other situational stimuli? a. Their findings confirmed those in the literature that blood pressure normalizes once the stressor stops. *b. They found that the duration to normalize blood pressure predicts hypertension over a three-year time. c. Their findings refuted those in the literature that blood pressure normalizes once the stressor is stopped. d. They found that the duration to normalize blood pressure is longer in people with existing hypertension.

60. 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.

61. In what way does reactivity relate to ethnic background? *a. African American men show more reactivity to stress than European

American men.

b. European American children show more reactivity than African American

children. c. European American children with a family history of heart disease have the highest reactivity rates. d. Both b and c are correct.

62. Robert, a middle-aged African American man, believes another person has just

called him a derogatory name. According to research, Robert is most likely to a. react by insulting the other person. b. react by moving away from the other person. *c. react with an increase in his blood pressure. d. react by realizing he may have misunderstood.

63. 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.

64. Stress probably plays some role in the development of a. Type 1 diabetes. b. Type 2 diabetes. *c. both types of diabetes. d. neither type of diabetes.

65. 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.

66. 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.

67. 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.

68. People with a negative outlook and a tendency to ruminate over problems a. are less likely than other people are to complain about their being sick. *b. are at higher risk of depression than those with more positive attitudes. c. express greater satisfaction with life in comparison to other people. d. all of these.

69. Austin suffers from recurrent intrusive memories of his experiences as a fire fighter

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.

70. Personality may play a role in who develops a cold. In one study, people who were fewer colds than others.

developed

*a. conscientious b. extraverted c. agreeable d. conscientious

71. 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

72. 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.

73. 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. all of the above.

74. Which of the following ethnic groups has been shown to have lowest reactivity in response to a laboratory stressor? *a. Asian American b. African American c. European American d. Caribbean Americans

75. In laboratory experiments, the comparative rates of blood pressure reactivity for Asian Americans vs. European Americans has what relationship to rates of cardiovascular disease (CVD) for these ethnic groups? a. A relationship between these two variables is not reliably identified. b. An inverse relationship exists; i.e., as one rises, the other goes down. *c. A positive correlation exists, i.e. reactivity corresponds to CVD rate. d. A relationship only exists for people who already have hypertension.

76. 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.

77. 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. The influence of undergoing chronic stress

b. The influence of releasing stress hormones c. The influence of immune function changes d. The influence of an infection with H. pylori

78. Stress may contribute to diabetes through its possible effects on

.

a. smoking b. heavy drinking *c. obesity d. exercise

79. 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.

80. 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

81. 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.

82. 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)

83. Regarding the effects of stress on pregnancy, research indicates that a. acute stress is the riskiest for complications to occur during pregnancy. b. stress early in the pregnancy is riskier than stress later in the pregnancy. *c. stress later in the pregnancy is riskier than stress early in the pregnancy.

d. both a and c.

84. 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

85.

children show the greatest asthma symptoms following an acute stress task. a. Overweight b. Underweight *c. Low socioeconomic status d. High socioeconomic status

86. Research shows that poor, urban 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 rising in both African and European Americans, but only mortality rate in African Americans. d. Asthma’s prevalence and mortality rate today are both stable among both African Americans and European Americans.

87. 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 affects more poor African Americans with higher rates of inflammation. 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.

88. Based on research findings, what is the probable role of stress in the disease of asthma? a. Contributing to its development, but not subsequently precipitating attacks b. Not contributing to its development, but subsequently precipitating attacks c. Not contributing to its development, nor subsequently precipitating attacks *d. Both contributing to its development and subsequently precipitating attacks

89. 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.

90. By studying asthma patients, researchers have determined that acute episodes or asthma attacks can be precipitated by: a. physiological but not psychological triggers. *b. physiological but also psychological triggers. c. psychological but not physiological triggers. d. variables not yet identified as being triggers.

91. 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

92. 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.

93. 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.

94. 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. all of the above

95. 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. Certain genes have been implicated in vulnerability to depression, regardless of environmental factors.

96.

may help explain why stress can lead to depression. *a. Increased cytokine production b. Decreased cytokine production c. Increased T-cell production d. Increased activity of natural killer cells

97. 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.

98. 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.

99. The ethnic group that seems most vulnerable to developing PTSD is a. Asian Americans. *b. Hispanic Americans. c. European Americans.

d. African Americans.

100. The immune system protects the body against bacteria but not viruses. a. True *b. False

101. T-cells are a type of nonspecific immune system response. a. True *b. False

102. 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

103. The functioning of the immune system occurs only in the lymph nodes. a. True *b. False

104. The diathesis-stress model suggests that recent stress predisposes people to illness. a. True *b. False

105.

Most tension headaches are the result of traumatic life events. a. True *b. False

106. Evidence from research by Sheldon Cohen and his colleagues demonstrated that stress has no relationship to catching the common cold.

a. True *b. False

107.

Most heart attacks are caused by sudden traumatic experiences. a. True *b. False

108. 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

109. Almost all ulcers are caused by stress. a. True *b. False

110. 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.

Correct Answer:

See below 111. 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.

Correct Answer:

See below 112. 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 endocrinesystem, 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.

Correct Answer:

See below 113. 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.

Correct Answer:

See below 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.

Correct Answer:

See below 115. 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. stress.

This disorder is by definition related to

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. anxiety disorders is less clear.

The link between stress and other

Correct Answer:

See below 116. 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.

Releasing factors are hormones that stimulate the endocrine glands to secrete other hormones.

Correct Answer:

See below 117. 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: the sympathetic nervous system, or 2.the neuroendocrine response to stress.

Correct Answer: See below

118. 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. Behavioral responses can activate processes affecting the immune system, as pointed out by Michael Irwin (2008).

F. Interactions between the nervous system and the immune system can result in symptoms related to stress and to illness.

Correct Answer: See below

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.

Correct Answer:

See below

Chapter 7 1. The

system allows us to interpret certain sensory information as pain. *a. somatosensory b. endocrine c. skeletal d. muscular

2. Primary afferents convey sensory impulses to the *a. spinal cord. b. peripheral nervous system. c. brain. d. motor neurons.

3. Myelinated afferent neurons are called *a. A fibers. b. beta afferents. c. C fibers. d. delta afferents.

4. More than half of all sensory afferents are a. A-beta fibers. b. A-delta fibers. *c. C fibers. d. myelinated.

5. Sherman stubbed his toe on the sidewalk. His sensation of pain traveled first to the a. muscles in the foot. b. brain. *c. spinal cord. d. cranial nerves.

6. This system conveys sensory information from the body to the brain. a. Endocrine system

b. Digestive system *c. Somatosensory system d. Immune system

7.

neurons carry nerve impulses away from the brain and toward the muscles. *a. Efferent b. Afferent c. Beta afferents d. Delta afferents

8. Nociception refers to the process of perceiving

.

a. stress *b. pain c. anger d. oxygen

9. Stimulation of the A-delta fibers, since they are myelinated, leads to a

unmyelinated C fibers often result in

, whereas the

.

a. “slow pain” response; “fast pain” response b. “no pain” response; “slow pain” response *c. “fast pain” response; “slow pain” response d. “no pain” response; “fast pain” response

10. Afferent fibers group together after leaving the skin, forming a

.

*a. nerve b. cell c. cell body d. ganglion cell

11. Nerves are: a. entirely afferent. b. entirely efferent. *c. a mixture of both. d. not any of these.

12. The branches of nerve bundles are

brain; and

tracts, which route information tracts, which route information the brain.

the

a. motor, toward; sensory, from *b. sensory, toward; motor, from c. dorsal, toward; sensory, from d. sensory, inside; motor, inside

13. When pain is experienced in some other location than the site where the pain was inflicted,

this is called a. phantom limb pain. *b. referred pain. c. prechronic pain. d. chronic recurrent pain.

14. If you receive exactly the same painful stimulus to your hand or your back, which will feel

more pain, and why? a. Your back, because it has larger surface area b. Your hand, because it has much thinner skin c. Your back, because it has more pain receptors *d. Your hand, because it has more pain receptors

15. PET scan and fMRI imaging show that pain stimuli activate which parts of the brain? a. The primary and secondary somatosensory cortices b. The primary somatosensory cortex and thalamus c. The anterior cingulate cortex and the cerebellum *d. Many areas of the brain, including all of these

16. Recent research gave participants

to reduce people’s feelings of social pain.

a. a shock b. a hug *c. Tylenol d. Morphine

17. Participants who are socially excluded show more activity in the anterior cingulate cortex,

similar to people who are experiencing *a. physical pain b. depression c. anxiety d. all of the above

.

18.

are chemicals that carry information between nerves. a. Afferent neurons b. Efferent neurons *c. Neurotransmitters d. Interneurons

19.

are neurochemicals that help modulate, or lessen, the experience of pain. *a. Endorphins b. Interneurons c. Glutamates d. Proinflammatory cytokines

20. Mark got paint stripper in his eye and the hospital gave him morphine, so he was feeling no

pain when he got home. Why was this drug most likely effective? *a. Because the brain is most accepting of novel types of chemicals b. Because its properties resemble those of natural brain chemicals c. Because it stimulates the brain to release its own neurochemicals d. Because the mechanisms of opiates may involve both (b) and (c)

21. These proteins produced by the immune system increase pain sensitivity, along with

increasing fatigue and sickness: *a. proinflammatory cytokines. b. endorphins. c. opiates. d. both a and b.

22. The dorsal horns are located in the a. brain stem. b. kidneys. c. midbrain. *d. spinal cord.

23. The substantia gelatinosa is *a. in the dorsal horns of the spinal cord. b. in the midbrain region, adjacent to the thalamus.

c. composed of a gelatin-like material that surrounds the lower portion of the

brain. d. a hypothetical structure that has not yet been confirmed.

24. Which structure is most capable of modulating sensory input? a. Primary afferents b. Secondary afferents *c. Substantia gelatinosa d. Spinothalamic tract

25. Sensory input information passes through what brain structure? a. The parietal lobe of the cerebral cortex b. The pons c. The cerebellum *d. The thalamus

26. What brain structure contains a representation of the skin’s surface? *a. Somatosensory cortex b. Parietosensory area c. Sensorimotor cortex d. Occipital cortex

27. Neurotransmitters like

decrease pain, but those like

increase the

experience of pain. a. serotonin . . . dynorphin *b. endorphins . . . glutamate c. substance P . . . serotonin d. endorphins . . . enkephalins

28. Which of the body's own neurochemicals does NOT have opiate-like effects? *a. Bradykinin b. Enkephalins c. Endorphins d. Dynorphin

29. Which of the following structures located in the midbrain relieves pain when activated?

a. The medulla b. Dorsal horn neurons *c. Periaqueductal gray d. Substantia gelatinosa

30. Pain is usually defined as a. a sensory experience only. b. an emotional experience only. c. neither a sensory nor an emotional experience. *d. both a sensory and an emotional experience.

31. Victoria has just cut her hand with a sharp knife. The pain she feels can best be described as *a. acute. b. pre-chronic. c. chronic intractable. d. chronic.

32. Which of these is NOT a distinction between chronic and acute pain? a. Acute pain is usually adaptive; chronic pain is not. *b. Acute pain is physical; chronic pain is psychological. c. Chronic pain is frequently reinforced environmentally; acute pain needs no

such reinforcement. d. Chronic pain has no biological benefit; acute pain warns the person to avoid further injury.

33. Henry Beecher reported that many soldiers wounded at the Anzio beachhead during World

War II experienced

pain.

a. chronic, intractable b. stress-related c. severe, excruciating *d. very little

34. What proportion of people report feeling no immediate pain from scrapes, cuts, or burns

compared to people feeling no immediate pain from stab wounds, sprains, or broken bones? a. Approximately 25% fewer b. Fewer than half as many

*c. Almost twice as many d. About three times more

35. Not all people in ERs for accidental injuries report pain, but all people who are tortured

experience pain. What can explain this difference? a. Beliefs b. Expectations c. Lack of control *d. Any or all of these

36. Kyle is experiencing headaches and his partner has taken over the household chores.

Research by Pence et al. (2008) would suggest that Kyle’s headaches are likely to *a. increase in intensity. b. decrease in intensity. c. completely disappear. d. disappear until his partner makes him do the chores again.

37. This personality trait has been associated with a “pain-resistant” personality. a. Conscientiousness b. Extraversion c. Neuroticism *d. There is no “pain-resistant” personality.

38. Physicians are likely to underestimate the pain of a. Asian Americans. *b. African Americans. c. European Americans. d. no ethnic group; doctors treat all patients equally.

39. According to the gate control theory, emotions such as

opening the gate, whereas emotions such as a. happiness; depression b. joy; anxiety *c. anxiety; happiness d. depression; anxiety

could increase pain by could decrease pain by closing the gate.

40. Matthew is running a marathon and trips over a pile of acorns, but finishes the race.

Afterward, he finds out his ankle is sprained. What theory best accounts for the fact that Matthew did not immediately stop running after tripping? a. Specificity theory of pain *b. Gate control theory of pain c. Delayed gratification theory of pain d. None of the above theories of pain

41. People in pain frequently receive attention and sympathy, which may provide

for these pain behaviors. *a. reinforcement b. negative scheduling c. punishment d. generalization

42. In some cultures, people undergo initiation rituals that call for them to have their body

pierced, cut, tattooed, burned, or beaten. These individuals. a. feel no pain during these initiation rituals. b. show little or no pain from accidental injuries. *c. feel pain, but are culturally trained not to show it. d. offer proof that pain is completely psychological.

43. What is the relationship between the experience of pain and some types of

psychopathology? a. People with personality disorders have heightened pain perception. b. People with pain-prone personalities tend to have borderline personality

disorder. c. People with pain-resistant personalities tend to have bipolar disorder. *d. It is unclear whether psychopathology leads to chronic pain, or vice versa.

44. During childbirth, women in some cultures exhibit many more signs of pain than women in

other cultures. This observation shows that a. the experience of pain varies from culture to culture. *b. cultural practices can influence the expression of pain. c. natural childbirth produces less pain than opiate drugs. d. women showing little pain during labor are using self-hypnosis.

45. With regard to gender, a. women sense pain more quickly than men. b. women are more likely to hide their pain. c. men are more likely aware of their pain. *d. men are less likely to report their pain.

46. Specificity theory hypothesizes that a. a person's interpretation of pain is more important than tissue damage in

determining the intensity of pain. b. acute pains tend to intensify over time. *c. the experience of pain matches the amount of tissue damage or injury. d. chronic pain can become acute over time.

47. Which of these findings casts doubt on the specificity theory of pain? a. Researchers have failed to find specific skin receptors devoted to relaying

pain. b. Phantom limb pain occurs in 70% of amputees. c. Injury can occur without pain, such as that experienced by the soldiers at Anzio beach. *d. All of these are challenges to the validity of the specificity theory of pain.

48. The theory of pain proposed by Melzack and Wall has been called the

theory.

*a. gate control b. sensory decision c. cognitive-emotional d. tension-reduction

49. According to the gate control theory of pain, the structure that is the likely location of the

gate is *a. the substantia gelatinosa. b. the ventral horns of the spinal cord. c. the transverse section of the medulla. d. supraspinal nerve endings.

50. According to the gate control theory of pain, the spinal cord a. mechanically relays sensory input information.

*b. modulates the input of sensory information. c. does not have the physiological capacity to affect pain perception. d. is less important in pain perception than the cerebellum.

51. The gate control theory of pain assumes a. the physiological reality of pain. b. the nature of motor output factors in pain perception. c. that chronic pain is heavily influenced by both spinal cord and brain activity. *d. that sensory input is not the only factor in pain perception.

52. Melzack proposed the

theory, which is an extension of the gate control theory.

a. sensory decision b. specificity *c. neuromatrix d. cerebellar

53. According to the neuromatrix theory, the neuromatrix is a network of brain neurons

composed of loops between a. the thalamus and the cortex. b. the cortex and limbic system. c. the thalamus and limbic system. *d. both (a) and (b) rather than (c).

54. Valid and reliable measures of pain are important to health psychologists primarily because *a. such measurements permit accurate evaluation of various pain therapy

programs. b. self-reports are more useful than physiological measures. c. pain is a product of both physiological and emotional factors. d. behavioral assessments are more reliable and valid.

55. Which of these methods have been used to measure pain? a. Self-reports b. Behavioral assessment c. Physiological measures *d. All of these

56. The Visual Analog Scale is considered to be *a. a self-report measure. b. an evoked potential measure of pain. c. a behavioral assessment of pain. d. a pain questionnaire.

57. The most widely used pain questionnaire was developed by Ronald Melzack and is known

as the a. Melzack and Wall Pain Questionnaire. b. Visual Analog Scale. c. Minnesota Multiphasic Personality Inventory. *d. McGill Pain Questionnaire.

58. A personality inventory sometimes used to assess pain is the a. California Personality Inventory. *b. Minnesota Multiphasic Personality Inventory. c. Edwards Personality Schedule. d. Guilford-Zimmerman Temperament Survey

59. Heart rate predicts perceptions of pain, but only for

.

a. children b. the elderly *c. men d. women

60. Which of these techniques measures muscle tension as an index of pain? *a. Electromyography b. Thermography c. Blood flow in the temporal artery d. Heart rate

61.

pain is the most common of all syndromes of pain with a lifetime incidence rate of more than 99%. *a. Headache b. Low back c. Burn

d. Knee

62. Rosa suffers from recurrent attacks of pain that are accompanied by exaggerated sensitivity

to light, loss of appetite, and nausea. From these characteristics you would diagnose Rosa as having *a. migraine headaches. b. tension headaches. c. cancer pain. d. phantom limb pain.

63. With regard to migraine headaches, a. men are somewhat more likely than women to have migraines. *b. women are much more likely than men to have migraines. c. women are slightly more likely than men to have migraines. d. women and men are about equally susceptible to migraines.

64. Carlos is a 45-year-old civil engineer who has never had a migraine headache. His chances

of a first migraine are a. very high. b. about 50/50. *c. very low. d. nonexistent.

65. What type of pain has a gradual onset, sensations of tightness around the neck and

shoulders, and a steady ache on both sides of the head? a. Lower back pain b. Migraine headache c. Cluster headache *d. Tension headache

66. Wendy suffers from headaches that occur nearly every day for about a month, but then go

away for about a year or more. From this description, it appears that Wendy suffers from *a. cluster headaches. b. migraine headaches. c. tension headaches. d. none of the above.

67. The two most common types of pain are a. cancer and headache. b. arthritis and low back. *c. headache and low back d. cancer and low back.

68. Which of these conditions may contribute to low back pain? a. Pregnancy b. Improper lifting of heavy objects c. Aging *d. All of these

69. Low back pain has many causes. About what percent of back pain patients have an

identified, physical cause for their pain? *a. 20% b. 50% c. 75% d. About 40% of men and about 60% of women

70. Unlike rheumatoid arthritis, osteoarthritis a. affects young and old equally. b. affects primarily men. c. is an autoimmune disorder. *d. affects primarily older people.

71. Chronic pain affects approximately a. 50% b. 10% c. 75% *d. 30%

72. The three primary kinds of headaches are a. migraine, cluster, chronic. b. chronic, tension, cluster. *c. migraine, cluster, tension.

of the population in the United States.

d. tension, migraine, chronic.

73. What types of headaches are more common in men than in women? a. Chronic *b. Cluster c. Migraine d. Tension

74. International studies show almost

of all cancer patients’ pain was untreated.

a. 10% b. 20% *c. 50% d. 90%

75. Jesse’s leg was amputated when he was 20. Almost 10 years later, he still occasionally feels

pain in that missing limb. This pain is called a. missing limb pain. *b. phantom limb pain. c. amputation pain. d. neuroses.

76. For phantom limb pain, the pain is more likely in the missing limb when: *a. there was much pain before the amputation. b. there was no pain before the amputation. c. all phantom pain has the same intensity. d. the limb that was amputated was a leg.

77.

effect, and

occurs when the body needs more and more of the drug to reach the same occurs when removal of the drug causes withdrawal symptoms.

a. Withdrawal; dependence b. Dependence; withdrawal *c. Tolerance; dependence d. Dependence; tolerance

78. The tendency to catastrophize is associated with *a. magnification of pain. b. lessening of pain.

c. no differences in perception of pain. d. magnification of pain, but only with other people present.

79. Cognitive behavioral therapy has been shown to be effective in relieving pain for a. headache patients. b. fibromyalgia patients. c. patients with AIDS pain. *d. all of the above patients.

80. One variation of cognitive behavioral therapy encourages participants to

and focus their attention on valued activities. a. deny *b. accept c. enjoy d. commit to

81. Medical procedures used in pain management have traditionally included a. cognitive therapy. b. drugs. c. surgery. *d. both drugs and surgery.

82. What is true about opiate drugs? a. They are effective analgesics. b. They produce dependence. c. They produce tolerance. *d. They do all of these.

83. About what percentage of people who receive opiate is at risk of addiction? *a. less than 1% b. more than 5% but less than 25% c. about 50% d. almost 100%

84. Systems for self-paced administration of analgesic drugs *a. overcome the problem of undermedication

their pain

b. increase the probability of patient addiction. c. lead to overmedication in c. 45% of patients. d. are responsible for causing all these results.

85. Aspirin-type analgesic drugs are most effective in a. treating gastric disorders. b. relieving cancer pain. *c. treating injuries accompanied by inflammation. d. treating patients who are candidates for surgery.

86. Analgesic drugs are effective for pain control, but a. most people misuse these drugs by taking dangerous amounts. b. NSAIDS are more effective than opiates. c. anesthetic drugs are preferable for controlling chronic pain. *d. antidepressant drugs may also help treat some types of pain.

87. Bailey has tried many treatments for chronic back pain. His treatment of last resort would

probably be *a. surgery. b. TENS. c. opiates. d. opiates.

88. Researchers have found that transcutaneous electrical nerve stimulation (TENS) a. is effective for acute but not chronic pain. b. increases pain during stimulation, but patients report less pain after

stimulation. *c. is not found to be very effective for relieving pain. d. has no advantage over other medical methods.

89. The type of spinal stimulation that is most effective in controlling pain is a. transcutaneous electrical nerve stimulation (TENS). *b. implanted devices that stimulate the spinal cord. c. subcutaneous chemical stimulation (SCS). d. alternating stimulation of the peripheral nerves near the site of injury and

stimulation close to the spinal cord.

90. Relaxation training has been used successfully to a. treat rheumatoid arthritis. b. treat low back pain. c. treat headache pain. *d. treat all of these.

91. Behavior modification techniques rely most heavily on a. classical conditioning concepts. *b. operant conditioning principles. c. observational learning theory. d. cognitive learning strategies.

92. Wilbert Fordyce, along with others advocating a behavior modification view of pain,

claimed that a. pain itself is rewarding to the individual pain patient. b. pain sensations can be eliminated by the use of behavior modification. *c. pain behaviors may have reinforcing consequences for the pain patient. d. cognitive therapy is the most effective means of pain control.

93. Pain authority Frank Andrasik proposed that pain traps occur when *a. situations push people experiencing pain toward chronic pain. b. a person with a pain-prone personality experiences pain. c. A-delta fibers are stimulated at the same time as C fibers. d. a person experiences pain at the same time as some positive situation.

94. In behavior modification programs for pain management, pain behaviors are *a. ignored. b. punished. c. rewarded. d. Any of these.

95. What might be a reinforcer for pain behavior? a. The sensory input b. The motor output c. The disapproval of family members

*d. Monetary compensation for injury

96. In comparison to behavior modification techniques, cognitive therapy a. is less effective. b. is more solidly based in learning theory. *c. places more emphasis on the interpretation of events. d. has a longer tradition of use for pain management.

97. Acceptance and commitment therapy (ACT) is a type of

effective for

which has been found

.

a. relaxation training; managing chronic pain b. behavioral therapy; alleviating acute pain c. cognitive therapy; ameliorating acute pain *d. cognitive-behavioral therapy; chronic pain

98. Of these medical and psychological interventions for managing chronic pain,

is/are probably the most effective. a. surgery b. opiate drugs c. biofeedback *d. cognitive behavioral therapy

99. Isaiah suffers from chronic pain and is considering a mindfulness-based intervention to help

manage it. Based on research findings, what should he consider? a. Mindfulness is less expensive but also less effective than drugs. *b. Mindfulness helps pain by avoiding catastrophizing judgments. c. Mindfulness is less effective than cognitive-behavioral therapy. d. Mindfulness can reduce perceived pain, but not improve mood.

100. The largest organ of the body is the skin. *a. True b. False

101. A recent study examined social rejection and found that the resulting emotional pain affected brain activity similarly to physical pain. *a. True

b. False

102. Based on recent research by Yoshino et al. (2010) on mood and pain, if Courtney is feeling happy, she should experience less pain than when she is feeling sad. *a. True b. False

103. Efferent neurons carry nerve impulses away from the brain, whereas afferent neurons carry nerve impulses toward the brain. *a. True b. False

104. Acute pain has no benefit to the person experiencing it. a. True *b. False

105. Delmar constantly complained to his wife Merna about pain in his knee. Merna decided to stop sympathizing with Delmar and to withhold any sort of positive reinforcement to his pain behaviors, so we would expect Delmar to stop feeling pain in his knee. a. True *b. False

106. In general, women are much more sensitive to pain than men. a. True *b. False

107. The gate control theory assumes that pain experiences can be increased or decreased by mechanisms in the brain and spinal cord. *a. True b. False

108. Medication is an important treatment for people with low back pain, and undermedication is a serious problem for these patients. a. True *b. False

109. Surgery is not a successful treatment for many people with low back pain. *a. True b. False

110. Jonathan has just cut his left hand while chopping onions. Trace the sensory input from finger to brain, mentioning the important structures in the nervous system.

Correct Answer:

A. In the skin, the cut activates primary afferents.

1. The neurons that relay pain are called nociceptors.

2. Large A-beta fibers and smaller A-delta fibers are stimulated and rapidly transmit neural impulses toward the spinal cord.

3. Although more difficult to stimulate, the cut would activate small C-fibers, and these neural impulses would also travel to the spinal cord.

B. Sensory afferents form nerves that travel toward the spinal cord, either in sensory nerves or mixed nerves.

C. Sensory input enters the dorsal horns of the spinal cord.

1. Many primary afferents synapse with secondary afferents in the dorsal horns, but other primary afferents continue to the brain.

2. The arrangement and interconnections of laminae of the dorsal horns receive sensory input, modulate it, and relay these messages toward the brain, D. Sensory input travels to the brain by way of the spinal cord and crosses from the left side of the body to the right side of the brain.

E. Sensory neurons synapse in the thalamus, and then go to the right somatosensory cortex in the parietal lobe of the forebrain.

1. The primary somatosensory cortex maps those receptors in the hand, providing a representation of the hand in the brain.

2. The somatosensory cortex is involved with interpretation of the sensory input, most likely as pain.

111. Did Jonathan’s cut finger hurt? What experiences and psychological factors might increase or decrease his experience of pain?

Correct Answer:

A. Jonathan’s cut finger most likely hurt.

1. If Jonathan has a congenital insensitivity to pain, then the cut did not hurt, but this disorder is very unusual.

2. The type of pain that he experienced was acute pain.

B. Jonathan’s pain would probably be increased if 1. He was alone and had no distracting stimuli.

2. He was depressed or anxious.

3. He was looking at the cut when he cut himself.

4. He focused on his cut finger.

5. He thought about how much the cut hurt.

6. He had been rewarded previously for experiencing and complaining about pain.

C. Jonathan’s pain would probably be decreased if 1. He was involved with some other activity in addition to chopping onions when he cut himself; for example, if he was talking to someone, listening to music, or watching television.

2. He was not looking at his hand when the injury occurred.

3. He did not look at his finger after the cut so that he did not see the extent of his injury.

4. He pressed tightly on the cut finger, stimulating other neurons in addition to the ones carrying pain messages and partially blocking the pain.

5. He experienced some other type and location of pain immediately after cutting his finger; for example, if he dropped the cutting board on his toe.

6. He believed that men should not be bothered by minor injuries or that he was the type of man who should not feel pain by such an injury.

112. Differentiate among the three stages of pain.

Correct Answer:

A. Acute pain 1. This type of pain is the most common, produced by injury from lacerations, dental work, surgery, burns, abrasions, cuts, and other injuries.

2. This type of pain is adaptive, signaling injury to body tissue and alerting the person to avoid further injury.

B. Pre-chronic pain

1. This type of pain is experienced between acute and chronic pain.

2. The experiences that occur during this period may make the critical difference in the alleviation of pain or the onset of chronic pain.

C. Chronic pain 1. This type of pain persists after the period of healing has been completed and isoften experienced without detectable tissue damage.

2. This type of pain is often involved with situations that elicit reinforcement for the person who is in pain such that continued pain ensures reinforcement although it also ensures pain.

3.

This type of pain never has a biological benefit but takes a substantial psychological toll on both the sufferer and the family

113. Discuss the statement "Injury does not necessarily equal pain."

Correct Answer:

A. This statement reflects the variability of the experience of pain.

B. Some types of injuries are more likely to result in pain than other types.

1. Broken bones, sprains, and stab wounds are more likely to produce immediate pain than cuts, scrapes, and burns.

2. Unintentional injuries are less likely to produce pain than intentional injuries; for example, people who have been tortured all report pain, regardless of the severity of their injuries.

C. Some people are more likely to experience pain than others.

1. Soldiers wounded during battle in World War II were less likely to experience pain than civilians with comparable injuries.

2. Operant conditioning produces pain, and people who have prior experience with a type of pain are more likely to experience pain in similar circumstances.

3. Individual variations in pain perception are attributable to situation and experience. a. Evidence does not support a pain-resistant (or pain-prone) personality type. b. Ethnic and gender differences in pain perception may be attributable to cultural and gender roles than allow the display of pain behaviors and also to sensory and perceptual differences in pain.

114. Compare the specificity and the gate control theory on their emphasis of psychological factors in pain.

Correct Answer:

A. Specificity theory explains pain by hypothesizing that specific pain fibers and pain pathways exist.

1. This theory views pain as mechanistic signaling of tissue damage.

2. This theory does not take individual variability or psychological factors into account in the experience of pain.

B. The gate control theory of pain emphasizes physiology but includes behavioral and situational influences.

1. Pain has motivational and emotional components, which are affected by experience and expectation.

2. Incoming stimuli are modulated in the spinal cord by the “gating” mechanism in the substantia gelatinosa.

3. The central control trigger is a brain mechanism that activates a descending control system that may modulate or suppress pain.

115. What are the advantages and disadvantages of physiological measures, behavioral assessments, and self-report measures of pain?

Correct Answer:

A. Self-reports include rating scales, pain inventories, and standardized objective tests.

1. Advantages include the ability to capture the patients’ feelings and subjective aspects of pain, the simplicity of administration for ratings scales, and the psychometric sophistication of standardized tests like the McGill Pain Questionnaire and the MMPI. 2. Disadvantages include the problems in definition of some of these tests, the high reading level of some tests, and the questionable validity of applying a personality test such as the MMPI to diagnose pain.

B. Behavioral assessments include observation by significant others or by trained professionals.

1. Advantages include direct observability, the opportunity to observe the person in many settings by significant others, and the reliability of ratings that can be achieved by trained professionals.

2. Disadvantages include the lack of observability of some aspects of pain and the lack of strong relationship between some behaviors and pain.

C. Physiological measures include muscle tension, autonomic indices, and temperature.

1. Advantages include objectivity of measurement and freedom from subject and observer bias.

2.

Disadvantages include the lack of a strong relationship between autonomic indices and pain severity.

116. Evaluate the success and hazards of medical interventions for pain.

Correct Answer:

A. Medical treatments for pain have been more successful and carry less risk in treating acute rather than chronic pain.

B. Analgesic drug treatments are common for acute pain and are sometimes used for chronic pain.

1. NSAIDs such as aspirin are very common and successful in managing mild to moderate pain, but their side effects make them unsuitable for some patients.

2. Opiate drugs are very successful in relieving severe pain, but they produce tolerance and dependence, creating the potential for abuse and making these drugs risky for treating chronic pain; these properties have created public fear of their hazards, resulting in their underuse in situations of severe pain.

C. Surgery 1. Cutting the nerves that carry sensory input or lesioning the central nervous system can bring relief from pain.

2. The hazards often outweigh the potential benefits, because any effect, including unpleasant ones, may be permanent; surgery usually does not produce relief from chronic pain; and the surgery itself is hazardous.

117. What are the similarities and differences of behavior modification and cognitive therapy as used for pain management? How does cognitive behavior therapy combine these approaches?

Correct Answer:

A. Behavior modification 1. Has the goal of shaping behavior; cognition or feelings are not a concern.

2. Has been used as a treatment for the control of pain, with the assumption that pain can be reinforcing for some people because they receive positive reinforcement for expressing pain.

B. Cognitive therapy

1. Employs the persons’ thoughts and feelings and assumes that behavior is shaped by these cognitive processes.

2. Can be used for pain management to help people change their attitudes and cognitions about the experience of pain.

C. Similarities 1. Both use a psychological approach.

2. Both share the goal of changing behavior.

3. Many cognitive therapy approaches, such as pain inoculation, combine cognitive and behavioral techniques, making a cognitive behavioral technique.

D. Differences 1. The two approaches emphasize different routes to their similar goals of behavior change; behavior modification through the shaping of overt behavior and cognitive therapy through changes in cognitions.

2. Cognitive therapies work toward improving patients’ feelings of efficacy, the feeling that they can be effective in dealing with their problems, whereas behavior modification deals only with overt behaviors.

3. Cognitive therapies tend to emphasize self-management, whereas behavior modification programs tend to rely on reinforcement from others to change behavior.

E. Cognitive behavior therapy combines the techniques and goals of the cognitive and behavioral approaches.

1. It works toward changing attitudes and thoughts.

2. It includes behavioral goals.

3.

Cognitive behavioral therapy is more effective for stress and pain management than either cognitive therapy or behavior modification.

118. Eric hurt his back two years ago when he was at work, and since that time he has experienced periods during which he could not work because of his low back pain. Workers’ compensation has helped financially during those times, but his wife has been burdened by doing Eric’s chores and caring for him when he is incapacitated. His physician is reluctant to continue his prescription of opiate analgesics but understands that Eric’s back pain is a problem and would like to get him into a program that would help his pain. After reviewing the options, recommend a program for Eric.

Correct Answer:

A. Eric receives reinforcement for his pain behaviors, including 1. Monetary compensation.

2. Supportive care from others.

3. Relief from work and family responsibilities.

B. A behavior modification program might help Eric exhibit fewer pain behaviors.

1. This type of program would probably teach Eric’s family to ignore his chronic complaints about his pain and encourage him to resume his normal life’s activities.

2. This program would probably systematically reinforce Eric’s desirable, normal behaviors such as getting up without complaints of pain, getting dressed, interacting with his family, and so forth.

3. Such programs tend to be successful in helping patients to be more active and to request less medication.

C. A cognitive or cognitive behavioral therapy program might be a good alternative if Eric has the motivation to self-regulate his behavior.

1. Such programs place more responsibility on the patient and on the desire to change one’s own behavior than behavior modification programs do.

2. A cognitive pain management program would include stages in which Eric would reconceptualize his pain and the role of psychology in the perception of pain, acquire new skills to cope with pain, and follow-through the reconceptualization and learning by practicing these skills.

3.

Some research has indicated that Eric might make slower progress in a cognitive pain management program but that his gains would increase, making this type of program potentially more successful than a behavior modification program.

119. Summarize some salient characteristics, including one similarity between, and the relative effectiveness of, ACT and mindfulness as pain management techniques.

Correct Answer:

A. Acceptance and commitment therapy (ACT): 1. Is a form of cognitive-behavioral therapy (CBT).

2. Encourages patients to accept their pain more, 3. While focusing attention on other activities and goals they value.

4. May particularly help chronic pain patients. a. Disability and distress can result from trying to control pain directly.

5. A meta-analysis has found ACT significantly reduced pain intensity and improved physical functioning.

6. ACT may be another good alternative to traditional CBT for chronic pain management.

7. ACT shares a common focus on acceptance of pain with mindfulness-based interventions.

B. Mindfulness: 1. Involves deliberately focusing one’s attention on the present moment 2. Without judging, but with acceptance 3. To achieve a quality of awareness or consciousness.

4. For chronic pain, mindfulness-based interventions work to increase awareness and acceptance of all sensations, including physical discomfort and pain, 5. And the emotions accompanying those sensations.

6. Recent research finds mindfulness and CBT interventions both significantly reduced pain in >40% of patients, contrasting with only 25% of patients who received usual care.

7. Mindfulness can decrease anxiety and depression, which can thereby reduce perceptions of pain.

8. Mindfulness reduces people’s tendency to catastrophize about their pain.

9. Mindfulness interventions teach patients to attend closely to bodily sensations without judging how severe, debilitating, or permanent they may be. a. Patients may realize their pain is less frequent than they believed, and

Observe factors that decrease or increase their pain.

10. Several studies have found that by decreasing catastrophizing, mindfulness decreases pain.

11. Some experts have suggested that since they are non-pharmacological and relatively inexpensive, mindfulness-based interventions could be effective as the first step in treating chronic pain.

Chapter 8 1. Norman Cousins used his personal experience with illness and healing to accomplish

which of the following? a. He worked outside of conventional medicine to advocate for alternatives. *b. He helped shift healthcare from the biomedical to biopsychosocial model. c. He demonstrated that alternative medicine cured all autoimmune diseases. d. He proved positive emotions were always superior to traditional medicine.

2. 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.

3. 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

4. Alternative medicine is an alternative to what? a. Complementary medicine *b. Conventional medicine c. Chinese medicine d. Western medicine

5. 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 accepted within conventional medicine. d. their higher degree of effectiveness compared to conventional techniques.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. Ayurvedic medicine originated in

*a. India. b. China. c. Europe in the 19th century. d. Japan.

12. 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.

13. The exercise that originated with Ayurvedic medicine is a. qi gong. b. tai chi. *c. yoga. d. rhythmic meridian movement.

14. 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.

15. 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. d. the campaign by conventional medicine to prevent people from using CAM.

16. Therapeutic manipulation of the spine is the basis for a. massage therapy. b. acupuncture. c. qi gong. *d. chiropractic treatment.

17. Which traditional Chinese medicine technique is considered a manipulative

technique? a. Acupuncture *b. Acupressure c. Both of these d. Neither of these

18. Among the following TCM practices, which is used to stimulate OR subdue qi? *a. Tui na b. Qi gong c. Acupuncture d. Acupressure

19. 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.

20. 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

21. Which alternative treatment is most likely to be covered by insurance plans in the

United States? *a. Chiropractic b. Dietary supplements c. Hypnotherapy d. Tai chi classes

22. 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 exercise

23. The group of diverse medical and health care systems that are not considered part of

conventional medicine are

.

a. biopsychosocial medicines b. bio-medicines *c. alternative medicines d. complementary medicines

24. Acupuncture, acupressure, and tui na are techniques or practices that stem from

. *a. traditional Chinese medicine b. Ayurvedic medicine c. energy healing d. homeopathy

25.

is a technique of inserting needles into specific points of the skin that is meant to unblock the flow of qi and restore health. *a. Acupuncture b. Acupressure c. Tui na d. Tai chi

26. 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

27. 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.

28. 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.

29. 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

30. Which of the following vegetarian diets is the most restrictive? a. Ovo-lacto-vegetarian b. Lacto-vegetarian c. Vegetarian *d. Vegan

31. Which of the following has/have recommended people limit their meat consumption

for health reasons? a. The American Heart Association b. The American Cancer Society *c. Both have recommended this d. Neither has recommended it

32. Almost

of adults in the US supplement their diet with vitamins, minerals, or natural products to improve their health. a. 7% *b. 18% c. 24% d. 62%

33. 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.

34. Chiropractic treatment is based on an assumption that: *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. Chiropractic has a basis in all of these assumptions.

35. 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.

36. What body parts does massage therapy manipulate? a. The spine b. The joints *c. Soft tissues d. All of these

37. In which sequence has massage been viewed and used in modern times, from earlier

to now? *a. As a luxury; as a part of physical therapy and rehabilitation; as a therapy for

managing pain, anxiety, and stress b. As a therapy for managing pain, anxiety, and stress; as a part of physical therapy and rehabilitation; as a luxury c. As a part of physical therapy and rehabilitation; as a therapy for managing pain, anxiety, and stress; as a luxury d. As a part of physical therapy and rehabilitation; as a luxury; as a therapy for managing pain, anxiety, and stress

38. 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

39. Who was important in formulating the view that the mind and the body work

according to different principles? a. Norman Cousins b. Anton Mesmer c. Daniel David Palmer *d. René Descartes

40. 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.

41. 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.

42. Snyder is in therapy with a health psychologist for relief from panic attacks. The

psychologist uses a technique in which Snyder 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 Snyder's psychologist is using a. hypnosis. b. progressive muscle relaxation. c. meditative relaxation. *d. guided imagery.

43. 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

44. 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

45. 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

46. The practice of yoga includes many postures that are intended to

controlled breathing that is intended to

and

.

a. relieve pressure on the spine . . . reframe their problems *b. concentrate energy in the body . . . concentrate attention c. induce a trance . . . energize the body d. concentrate muscle tension . . . remove muscle tension

47. 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.

48. 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.

49. Tai chi is practiced currently as

but originated as

.

a. a relaxation technique . . . a method for curing neurological disorders b. an exercise to increase strength . . . a weight loss method *c. a technique to promote health . . . a martial art d. a type of meditation . . . an aerobic workout

50. When practiced as a connected set of movements, tai chi a. is not as beneficial as when practiced as disconnected, discrete movements. b. has few physical benefits, but produces many psychological benefits. c. is no longer suitable for older people because of safety issues. *d. provides moderate intensity, low-impact aerobic exercise.

51. 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.

52. 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.

53. An increasingly common secular practice, _

and an open attitude. *a. meditation b. qi gong c. tai chi d. biofeedback

involves a focus of attention

54. Martha participates in

, a type of meditation where she sits and repeats a

sound over and over. a. mindfulness meditation *b. transcendental meditation c. guided imagery d. yoga

55. Jane participates in

, a type of meditation focused on non-judgmental awareness of one’s thoughts and feelings. *a. mindfulness meditation b. transcendental meditation c. guided imagery d. yoga

56. 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

57. A key component of

is the focus of 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

58. There has been evidence to suggest that

produce(s) changes in the function

of the immune system. *a. qi gong b. tai chi c. mindfulness meditation d. all of these techniques

59. Sean practices this type of movement that could be described as a “moving

meditation:”

a. qi gong. *b. tai chi. c. transcendental meditation. d. mindfulness meditation.

60. 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

61. 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.

62. 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 d. patients who were not hypnotized only

63. Those researchers who believe that hypnosis is an altered state of consciousness also

believe that it is necessary to use

to achieve this altered state.

a. increased muscle tension *b. an induction procedure c. biofeedback d. a hypnotist with a strong personality

64. Scientists who believe hypnosis is not an altered state of consciousness believe: a. It is simply a form of relaxation training. b. It necessitates an induction nevertheless. c. It involves a suggestible personality trait.

*d. It is described by (a) and (c), but not (b).

65. Which of the following have research studies found about hypnosis? a. Brain imaging studies do not support it is a state of altered consciousness. b. Comparison studies find it is less effective than non-hypnotic suggestions. *c. Brain imaging studies support that it is altering consciousness apart from

effect. d. Comparison studies find it is more effective than nonhypnotic suggestion.

66. 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.

67. 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.

68. Most people in the United States who use some form of CAM use it as

rather than as

_.

a. something their physician recommended . . . something they believe in *b. complementary medicine . . . alternative medicine c. alternative medicine . . . complementary medicine d. a last resort . . . a first choice

69. Who in the United States is most likely to use CAM? a. A middle-aged Asian American woman b. A teenage athlete *c. A well-educated European American woman d. A well-educated Asian American man

70. Young men who believed strongly in

were

to use CAM than other

people. a. religion; more b. religion; less c. science; more *d. science; less

71. In the United States, who is most likely to use CAM? *a. A well-educated European American woman b. A poorly educated Hispanic woman c. An Asian American whose parents immigrated to the United States d. People with low back injuries

72. 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.

73. Between 2007 and 2012, Marco experimented with some CAM techniques, settled

on yoga, and adopted it as a regular practice. According to statistics, what is true about this? a. This was one of several CAM practices that rose significantly during that

time. *b. This was the only CAM practice that increased significantly during that period. c. This was the only CAM practice that did not rise significantly during that time. d. This was one of several CAM practices that did not increase during that period.

74. 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 have pain relief but side-effects from conventional medicine.

c. They are likely to give up conventional treatments and substitute CAM

instead. d. They are likely to possess any one, any two, or all three of these characteristics.

75. In which of these countries could you most expect people to use CAM less often

than people in the United States? a. United Kingdom b. Germany c. Australia *d. Sweden

76. 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.

77. 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.

78. 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 manage stress better as well as stress-related disorders. c. benefit the same regardless of how much they practice it. d. can alleviate depression, but not prevent relapse into it.

79. 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.

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. 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 well established than either qi gong or tai chi. d. is found in research to have all of these characteristics.

82. Which of the following have been found to be useful in the treatment of depression? a. Acupuncture b. Yoga practice c. Saint John’s Wort *d. All of these have been

83. 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 these are effective

84. 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.

85. Hypnosis is more effective in controlling

pain than

pain.

*a. acute . . . chronic b. chronic . . . acute c. low back . . . headache d. fibromyalgia . . . postsurgical

86. 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. patients who share all of these characteristics.

87. The benefits of qi gong and tai chi include *a. relaxation, flexibility, and better balance. b. pain relief and increases in sensory acuity. c. decreased immune system responses. d. nothing more than placebo responses.

88. People may be 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. none of these.

89. 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 inequalities of health care treatment to ethnic

minorities in the United States by establishing a series of facilities that treat people from all ethnic groups. d. has been discussed but not attempted.

90. 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

91. Yoga has 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. decrease all of these

92. 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

93.

has been found to be effective in controlling nausea and vomiting associated with chemotherapy in children. a. Acupuncture b. Accupressure *c. Hypnosis d. Biofeedback

94.

has been suggested to help control some of the risks of Type 2 diabetes. *a. Yoga b. Hypnosis c. Qi gong d. Tai Chi

95.

was shown to decrease hostility in prisoners. a. Tai Chi b. Yoga c. Hypnosis *d. Mindfulness meditation

96.

has been found to be effective in controlling nausea and vomiting associated with postoperative symptoms. *a. Acupuncture b. Accupressure c. Hypnosis d. Biofeedback

97.

has been shown to be effective in treating insomnia. a. Hypnosis b. Biofeedback c. Yoga *d. Acupuncture

98. The practice of

has been helpful in reducing fear of falling and improving

balance in older adults. *a. tai chi b. hypnosis c. yoga d. biofeedback

99. 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

100. Alternative treatments always remain on the fringe of treatment and never make the transition to conventional medicine.

a. True *b. False

101. More people use complementary than alternative medicine. *a. True b. False

102. 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

103. Whether procedures or practices are considered alternative medicine depends solely on cultural context. a. True *b. False

104. The notion of a vital energy that brings mind and body together is unique to traditional Chinese medicine. a. True *b. False

105. 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

106. Chiropractors only use their hands to manipulate the spine. a. True *b. False

107. Following a diet to lose weight (such as the Atkins, Zone, or Ornish plans) or to improve health (such as vegetarian or macrobiotic diet) are among the most popular alternative approaches. *a. True b. False

108. The movement-based approaches of qi gong and tai chi are dangerous for older people with arthritis. a. True *b. False

109. Integrative medicine represents an attempt to integrate alternative with conventional medicine to improve health care.

*a. True b. False

110. 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.

Correct Answer:

See below 111. 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. disease risks

Omega-3 fatty acids for reducing cardiovascular

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

6.

and many others.

digestion

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.

The American Heart Association and American Cancer Society both recommend limiting meat consumption for health reasons.

H. About 3% of adults in the U.S. have followed a diet such as the Atkins, Zone, Ornish, Pritikin, or vegetarian diet plans.

Correct Answer:

See below 112. 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. F. Massage has been used by fewer than 8% of people in the U.S., and

other CAM approaches are even less common.

Correct Answer:

See below 113. 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 relaxationand 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.

Correct Answer:

See below 114. 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.

Correct Answer:

See below 115. 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.

Correct Answer:

See below 116. 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.

Correct Answer:

See below 117. 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. as drugs can.

Some herbal treatments can relieve pain as effectively

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.

Correct Answer:

See below

118. Explain how Norman Cousins devised his own alternative treatment, the outcome, and how he subsequently influenced health care.

A. In 1964, Saturday Review of Literature editor Norman Cousins was diagnosed with ankylosing spondylitis, an inflammatory degenerative disease of the spinal connective tissue, and given a 1 in 500 probability of recovery.

B. After hospitalization and large doses of anti-inflammatory drugs, Cousins questioned the effectiveness of the drugs, unending tests, hospital routine, and hospital food. He also objected to passively observing his health care and wanted to take an active part in healing.

C. Cousins chose to stay in a nice hotel instead of a hospital.

Instead of taking drugs, he gave himself prescriptions of healthy foods, large vitamin C doses, an optimistic outlook, and a regular schedule of watching movies and TV shows that made him laugh.

D. Cousins eventually recovered completely from a condition thought to have no cure.

E. He published a 1976 article in the New England Journal of Medicine, and a 1979 book about his experience with the article as its first chapter.

F. Norman Cousins accepted an Adjunct Professor of Medical Humanities position offered him by the University of California at Los Angeles (UCLA).

1. This enabled him to advocate for alternative treatments within the context of conventional medicine.

A. He wrote and spoke about the power we have within to heal ourselves.

B. He advocated for the need to widen medicine to include psychological factors in healing,and to be patient-centered.

He promoted the healing powers of positive emotions for the rest of his life, until 1990.

Through sharing his own story and through his advocacy, Cousins helped influence medical care to shift from the domination of the biomedical model, which identified the causes of diseases as pathogens, to acceptance of a biopsychosocial model, which identifies psychological, cultural, and social factors as underlying disease and health as well.

Correct Answer:

See below 119. 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.

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.

Correct Answer:

See below

Chapter 9 1. 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.

2. 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.

3. The disorder that includes the formation of plaque in the arteries is a. angina pectoris. b. atheromatous fatigue. *c. atherosclerosis d. arteriosclerosis.

4. A more technical name for "hardening of the arteries” is a. angina pectoris. b. atherosclerosis. *c. arteriosclerosis. d. ischemia.

5. Restriction of blood flow is called a. arteriosclerosis. *b. ischemia c. arrhythmia. d. an embolism.

6. 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.

7. 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 way that has been able to be clearly identified.

8. 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. fit none of these descriptions.

9. What is the system that consists of the heart, arteries, and veins? a. Musculoskeletal *b. Cardiovascular c. Endocrine d. Immune

10.

carry oxygenated blood from the heart to various parts of the body, whereas moves deoxygenated blood toward the heart. a. Veins; arteries b. Arteries; capillaries *c. Arteries; veins d. Veins; arterioles

11. Mike’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.

12. 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

13. Bob is experiencing dizziness, nausea, a squeezing pain in his chest, and cold

sweating. He is likely experiencing symptoms of a. a stroke. b. hypertension c. angina pectoris. *d. a myocardial infarction.

14. 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.

15. The fifth most frequent cause of death is

, which is the result of oxygen

deprivation to the brain. a. a stroke b. hypertension *c. angina pectoris d. a myocardial infarction

16. For blood pressure,

contractions and contractions.

pressure represents pressure generated by the heart’s _, pressure represents pressure experienced between

a. diastolic; systolic b. diastolic; presystolic *c. systolic; diastolic d. presystolic; diastolic

17. Millions of Americans have abnormally high blood pressure, or

.

a. a stroke *b. hypertension c. angina pectoris d. a myocardial infarction

18. Approximately

of Americans have hypertension.

*a. one-third b. one-fourth c. one-half d. two-thirds

19. In younger individuals, high

pressure is most strongly related to cardiovascular risk; but in older individuals, high pressure is more indicative of cardiovascular risk. *a. diastolic; systolic b. diastolic; presystolic c. systolic; diastolic d. presystolic; diastolic

20. 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.

21. Stroke is the result of deprivation of oxygen to the

to the

, and a similar restriction

causes heart attack. *a. brain . . . myocardium b. cerebrum . . . cerebral arteries c. heart . . . lungs d. central nervous system . . . peripheral nervous system

22. 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

23. 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.

24. For an adult, blood pressure of 190/130 would be a. normal. b. prehypertension. c. Stage 1 hypertension. *d. Stage 2 hypertension.

25. The single best predictor for heart attack and stroke is a. obesity. *b. hypertension. c. lack of exercise. d. high cholesterol.

26. Including both heart disease and stroke, almost

% of deaths in the U.S. are

due to cardiovascular disease. a. 20 *b. 30 c. 70 d. 85

27. Since 1960, death rates from cardiovascular disease have a. increased gradually. b. increased markedly. *c. decreased dramatically.

d. remained about the same.

28. 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. a combination of all of these.

29. 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.

30. In underdeveloped and developing 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 developed countries. 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.

31. 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.

32. 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.

33. Bill Clinton, whose story was introduced this chapter, had some family history of

heart disease and had eaten a high-fat diet for many years of his life. Which of his risks would be an inherent cardiovascular risk factor for former President Clinton? a. His high-stress job as president *b. His male gender c. His history of being overweight d. His diet

34. Judith has Type 1 diabetes, which is a risk factor for cardiovascular disease.

Therefore, Judith 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.

35. In general, men and women have a similar death rate from cardiovascular disease,

but there is a discrepancy, with men

having a significantly higher risk.

a. under 20 years old *b. during middle age c. over 75 years old d. who are married

36. 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.

37. African Americans experience

, which tends to increase blood pressure.

a. a diet higher in salt than European Americans b. a diet lower in fat and higher in fiber c. larger and more cohesive families *d. discrimination based on skin color

38. The strongest physiological risk factor for cardiovascular disease is a. lack of social support. *b. hypertension. c. obesity d. smoking.

39. Differences in hormones may help explain some of the differing rates of

cardiovascular disease in men and women; gender gap in heart disease.

_ are responsible for much of the

*a. behavioral factors b. physiological factors c. psychological factors d. both b and c

40. Which ethnic group has the highest risk for cardiovascular death? a. Native Americans b. Hispanic Americans *c. African Americans d. Asian Americans

41. All of the following are physiological risk factors for cardiovascular disease

EXCEPT: a. cholesterol. b. hypertension. c. inflammation. *d. physical activity levels.

42. Currently, most authorities believe that

is the most critical element in

linking cholesterol to cardiovascular disease. *a. a balance of total cholesterol to HDL b. a balance of LDL to HDL levels c. total HDL level d. total LDL level

43. Overall, women have a higher level of

gap in heart disease.

, which may help explain the gender

a. total cholesterol levels *b. HDL levels c. LDL levels d. the balance of total cholesterol to HDL

44. Factors that contribute to inflammation, such as

and depression, may also

increase the risk for cardiovascular disease. a. anxiety b. insomnia *c. stress d. diabetes

45. All of the following are behavioral risk factors for cardiovascular disease EXCEPT: a. smoking b. diet c. physical activity levels *d. educational level

46. People who currently smoke are

to suffer a heart attack that people who

have never smoked. *a. three times as likely b. just as likely c. ten times as likely d. twice as likely

47. In which form(s) does tobacco present a risk for CVD and heart attack? a. Smoking it, and only if the smoker inhales b. Smoking it without inhaling, or chewing it c. Environmental secondhand smoke exposure *d. All of these add some CVD/heart attack risk

48. Extra weight carried around which body part is related to an increase risk for heart

attack? a. The hips *b. The abdomen c. The chest

d. The thighs

49. 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 intake of carbohydrates. b. maintain the same diet but also increase intake of fruits and veggies. *c. reduce her intake of red meat, junk food, and soda and increase her intake of

fruits and veggies. d. reduce her intake of red meat, junk food, and soda and increase her intake of carbohydrates.

50. 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

51. 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.

52. 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 job *d. A and b, not c

53. Individuals from low socioeconomic backgrounds are at a(n)

cardiovascular disease, and this finding can be explained by a. decreased; modifiable lifestyle factors b. decreased; psychological factors *c. increased; modifiable lifestyle factors

risk for .

d. increased; psychological factors

54. 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

55. In the INTERHEART Study and other research, what is the most likely connection

between high CVD risks/rates and low education? a. People with less education typically experience greater amounts of life stress. *b. People with less education tend to practice fewer protective health behaviors. c. People with less education tend to earn less, but income does not affect CVD. d. People with less education typically are ethnic minorities in the United States.

56.

is a risk factor for cardiovascular disease, and, in the elderly, is associated with the occurrence of a second, fatal heart attack. *a. Loneliness b. Anxiety c. Gum disease d. Reactivity

57. Of the following individuals, who is the least at risk for cardiovascular disease? a. Betty, a 50-year old widow who lives by herself b. Anna, a 50-year old married woman with many friends c. Pete, a 50-year old married man who has many friends *d. Frank, a 50-year old unmarried man who lives by himself

58. 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 and anger d. competitiveness, a sense of urgency, hostility and anger.

59. Anger is a(n)

negative

accompanied by physiological arousal, whereas hostility is a toward others.

a. attitude; emotion b. attitude; reaction c. reaction; emotion *d. emotion; attitude

60.

may be related to higher rates of hypertension among African Americans. a. Obesity *b. Cardiac reactivity c. Hostility d. Suppressed anger

61. Carrie and her boyfriend 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.

62. Other than advancing age,

is the single most important risk factor for

cardiovascular disease. a. gender *b. hypertension c. high cholesterol d. ethnic background

63. According to the Framingham study, not all cholesterol is equally implicated as a

cardiovascular risk. was found to offer some protection against heart attack, but was positively related to cardiovascular disease. a. Total cholesterol level . . . omega-3 fatty acid b. Lipoproteins . . . cholesterol c. Low-density lipoproteins . . . high-density lipoproteins *d. High-density lipoproteins . . . low-density lipoproteins

64. 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.

65. 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 66. When health care researchers refer to problems in glucose metabolism, they are

describing a. either Type 1 diabetes or Type 2 diabetes. b. one component of the metabolic syndrome. c. elevated blood pressure and elevated cholesterol combined. *d. answer choice (a), answer choice (b), or both (a) and (b).

67. 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.

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. 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. the increase in men's smoking habits would predict an even greater risk of

cardiovascular deaths in the future. *c. declining rates of smoking have led to decreases in cardiovascular deaths due to cigarette smoking. d. diet remains the leading behavioral risk factor for cardiovascular death in other parts of the world.

70. With regard to obesity and heart disease, it can be 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.

71. An analysis of fruit and vegetable consumption in countries around the world

indicated that *a. higher consumption of these foods could decrease heart disease by over 30%. b. people in developing countries eat more fruits and vegetables than is optimal

for good health. c. wealthy people in industrialized countries eat an adequate amount of these foods, but poor people in industrialized countries do not. d. both b and c.

72. A diet high in

offers protection against cardiovascular disease.

a. monounsaturated fats *b. fruits, vegetables, and fish c. high-fiber cereals and grains d. foods that are high in oxidants

73. Flavonoids may protect against CVD, and one food very rich in flavonoids is *a. dark chocolate. b. milk chocolate. c. chocolate milk. d. any of these, which have about the same flavonoid content.

74. 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.

75. People with low levels of education have high rates of death from cardiovascular

disease. What is the most valid explanation for this observation? a. Low educational levels cause CVD. b. High educational levels protect against CVD. *c. Educational level is related to smoking, physical activity, diet, and obesity. d. Educational level is related to gender, which is related to amount of smoking,

which is related to CVD. 76. High social rank and status a. are risks for heart disease. b. are risks for all-cause mortality. *c. offer protection against cardiovascular disease. d. are related to educational level but not to health.

77. 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

78. Marriage seems to offer some people some protection against heart disease. The best

explanation for this protection is that marriage is related to to . a. income level . . . gender b. gender . . . hypertension *c. social support . . . seeking health care d. healthier diet . . . less cigarette smoking

79. Individuals with few people in their social networks

, which in turn relates

*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.

80. You are MOST at risk for heart disease if you a. are a woman. *b. are an unmarried man. c. eat lots of fruits and vegetables. d. never or seldom become angry.

81. 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.

82. Which of these is NOT part of the original Type A behavior pattern? a. An exaggerated sense of time urgency *b. A job requiring constant decisions c. A component involving hostility d. A high level of competitiveness

83. Recent research concerning the Type A behavior pattern has indicated that one

of the behaviors of the pattern may be more critical than the others as a predictor of heartdisease. This behavior pattern is marked by a. impatience. *b. hostility. c. time urgency. d. greediness.

84. 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.

85. Research has indicated that the

of anger is positively related to cardiac

reactivity. a. experience b. nonexistence *c. expression d. awareness

86. Brady is a 22-year old college student who smokes, eats high-fat foods, and doesn't

exercise. Brady knows that heart disease is the leading cause of death in the United States, yet he views his chances of dying of heart disease as near zero. Weinstein would call Brady's attitude a. blind faith. b. unconscious denial. *c. optimistic bias. d. a rationalization.

87. One challenge for health psychologists is that people with

are not ready to change, according to . A study (Resnicow et al., 2001) found effective for propelling them to a point of readiness to make changes in their health behaviors. a. a pessimistic bias; motivational interviewing; the transtheoretical model b. a lower risk profile; the transtheoretical model; motivational interviewing c. a lower motivation; motivational interviewing; the transtheoretical model *d. an optimistic bias; the transtheoretical model; motivational interviewing

88. Reducing hypertension is difficult because *a. hypertension has no visible symptoms and set points are common. b. no drugs have yet proven effective for lowering the blood pressure. c. most cardiologists do not consider hypertension a risk factor for heart disease. d. high cholesterol is a powerful side-effect of reductions in blood pressure.

89. 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.

90. 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.

91. Treating depression among cardiac patients is important, but difficult. A recent

cognitive behavioral intervention showed improvements in survival among a. African American men and women only. *b. European American men only. c. European American men and women only. d. all ethnic groups.

92. All of the following factors predict development of cardiovascular disease and also

failure to adhere to rehabilitation after a cardiac event EXCEPT: a. being depressed. b. being a smoker. c. being overweight. *d. being anxious.

93. Researchers have found that cardiac patients who completed rehabilitation

programs: a. lowered their physiological but not psychological risks. b. lowered their depression levels but raised anxiety levels. c. lowered their anxiety levels but did not lower depression. *d. lowered anxiety and depression and raised sense of control.

94. 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.

95. 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.

96. 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. Reduction of calories from fat

97. 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 diet with considerably less fat than that recommended by the American Heart Association. c. can be reversed through cognitive-behavioral group therapy. d. cannot be reversed by any known treatment.

98. 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.

99. Dean Ornish believes that the dietary recommendations of the American Heart

Association a. may be sufficient to prevent coronary artery disease. b. are not sufficient to reverse coronary artery disease. *c. are both a and b.

d. are neither a nor b.

100. If you 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 only. *d. monitor your blood pressure and take measures to lower it if it is at or above the prehypertension level.

101. The term cardiovascular disease includes stroke. *a. True b. False

102. Restriction of blood flow to the heart is called ischemia. *a. True b. False

103. A medical term for heart attack is myocardial infarction. *a. True b. False

104. Hypertension is a predictor of heart attack but not stroke. a. True *b. False

105. Arteriosclerosis is when the arteries have “hardened” and atherosclerosis is the formation of plaques. *a. True b. False

106. Presently, deaths from cardiovascular disease in the United States are increasing. a. True *b. False

107. People who follow a cardiac rehabilitation program substantially lower their risk for a second heart attack. *a. True b. False

108. Heart disease and stroke are only a leading cause of death in industrialized countries, but not a concern in developing and underdeveloped countries. a. True *b. False

109. Inherent risk factors can easily be modified through diet and exercise. a. True *b. False

110. Modifying behavioral risk factors does not significantly reduce one’s chance of having a myocardial infarction. a. True *b. False

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

Correct Answer:

A. Cardiovascular disease (CVD) is the leading cause of death in the United States and other industrialized nations, and 34% 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.

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

Correct Answer:

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.

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

Correct Answer:

A. The concept of the Type A behavior pattern cardiologists Friedman and Rosenman.

1. The term was originated by

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.

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

Correct Answer:

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 cholesterollowering 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.

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

Correct Answer:

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.

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

Correct Answer:

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.

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

Correct Answer:

A. Inherent risk factors come from physiological and/or genetic conditions that cannot be changed readily, like advancing age, family history, gender, and ethnic background.

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. 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. Ethnic background 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.

118. Discuss some characteristics, measurement, and forms of cholesterol and their relationship to cardiovascular disease (CVD).

Correct Answer:

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. Dietary cholesterol comes from animal food products.

B.

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.

119. Describe some interventions designed to lower serum cholesterol as a means of preventing CVD. Correct Answer:

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.

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.

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

A. Some experts advocate for developing behavioral cardiology; for psychological risks of CVD, and

1. i.e. screening people

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 (non-hostile) 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.

Chapter10 1. Cancer a. is a relatively new disease, first diagnosed during the latter half of the 19th

century. *b. is a group of diseases marked by the growth and spread of new cells. c. is due to a parasite that attacks new cells. d. is due almost completely to contact with dangerous chemicals.

2. All cancer tumors are a. invasive. b. neoplastic. c. malignant. *d. all of these.

3. Benign tumors: a. are always harmless. *b. are usually localized. c. can also metastasize. d. contain normal cells.

4. The main difference between benign and malignant tumors is *a. that malignant cells can invade surrounding tissues. b. the ability of benign tumors to metastasize. c. the size of the tumor each produces. d. that benign tumors attack nearly any tissue, whereas malignancies are specific

to animal (including human) tissue cells.

5. Metastasis refers to a. the measured growth rate of benign tumors. *b. the spread of malignancy across body parts. c. one specific variety of breast cancer. d. a particularly deadly form of lung cancer.

6. All of the following are types of malignant growths EXCEPT: a. leukemia.

b. carcinoma. c. lymphoma. *d. benign cells.

7. Janet was told that her cancer originated in her blood; therefore, she is likely to have a

form of

.

*a. leukemia b. sarcoma c. carcinoma d. lymphoma

8.

is a form of cancer that arises from cells in connective tissues, such as bones or muscles. a. Leukemia *b. Sarcoma c. Carcinoma d. Lymphoma

9. An oncologist informs a patient that he has lymphoma. This type of cancer is

identified as causing

of all malignancies.

a. the majority b. around half *c. the minority d. one quarter

10. Three patients meet in the waiting room of an oncology practice. Ronald has a type of skin cancer; Farrah has cancer in a mucous membrane; and Isabella has cancer in her stomach lining. These patients all have what kind of cancer? a. Sarcoma b. Leukemia c. Lymphoma *d. Carcinoma

11. Which of the following is most accurate about how people get cancer? a. People very often inherit cancer from their parents. b. People are never genetically predisposed to cancer. *c. People’s behaviors contribute primarily to cancers. d. People’s cancer rates vary over longer time periods.

12. From about 1900 until the mid-1990s, cancer death rates in the United States *a. rose steadily. b. exceeded death rates from cardiovascular disease. c. dropped steadily. d. remained quite constant.

13. Since the mid-1990s, cancer deaths in the United States a. remained quite constant. b. rose steadily. *c. began to drop. d. leveled off.

14. Which of these best explains the recent drop in cancer death rates in the U.S.? a. Better procedures for treatment of cancer b. Better techniques for diagnosis of cancer c. Changes in the lifestyles of many citizens *d. Both a and c have contributed to this drop

15. Most cancer deaths in the United States are caused by a. pollution. b. genetic factors. *c. diet and smoking. d. damage by the sun.

16. Since about 1993, cancer death rates in the United States have a. increased for men, but decreased for women. *b. decreased significantly for both men and women. c. increased sharply for women, but remained about the same for men. d. increased a great deal for both men and women.

17. During and since the 1990s, how did cancer mortality rates change for women and men? a. They decreased significantly for men but not significantly for women. b. They decreased for both women and men, but neither was significant. c. They decreased significantly for both, but more for women than men. *d. They decreased significantly for both, but more for men than women.

18. In the United States,

cancer accounts for about 28% of all cancer deaths but only about 14% of all cancer cases. *a. lung b. breast c. prostate d. colon/rectal

19. Which cancer has the highest incidence but not the highest death rate for women in

the United States? a. Lung *b. Breast c. Cervical d. Colon

20. In the United States, both prostate cancer and breast cancer a. have the highest incidence and the highest mortality rates. b. have low incidence and low mortality rates. *c. have high incidence but relatively lower mortality rates. d. have none of these characteristics in common.

21. There is a

incidence of

in America, and a

mortality from

. *a. much higher, breast and prostate cancer; much higher, lung cancer b. much lower, breast and prostate cancer; much higher, lung cancer c. much higher, lung cancer; much higher, breast and prostate cancer d. much lower, breast and prostate cancer; much lower, lung cancer

22. In the United States,

cancer has the second highest death rate of any cancer.

a. lung *b. colorectal c. breast d. prostate

23. The second leading cause of cancer deaths in the United States is a. lung cancer.

b. breast cancer. c. stomach cancer. *d. colorectal cancer.

24. During the 1990s, death rates from lung cancer for men *a. began to decline. b. increased slightly. c. increased sharply. d. were exceeded by death rates from prostate cancer for the first time since the

19th century.

25. According to the American Cancer Society (2012), roughly how many deaths from cancer in the US are attributable to smoking, diet, sedentariness, and other lifestyle factors? a. One half *b. Two thirds c. Three quarters d. One third

26. Breast, colorectal, lung, and prostate cancer together are the causes of around all cancer deaths in America. a. one third b. one quarter c. two thirds *d. one half

27. Which of these ethnic groups has the strongest risk for colorectal cancer deaths? a. Hispanic Americans b. European Americans *c. African Americans d. Asian Americans

28. Which of the following is correct regarding both lung cancer and liver cancer? *a. They both are among the deadlier forms of cancer. b. They both are decreasing in both women and men. c. They both are commoner in European Americans. d. They both share every one of these characteristics.

of

29. All of the following cancers have increased in recent years EXCEPT: a. liver cancer. b. melanoma. *c. colorectal cancer. d. these all increased.

30. All of the following cancers have decreased in recent years EXCEPT: *a. liver cancer. b. prostate cancer. c. breast cancer. d. lung cancer.

31. The decline in the breast cancer death rate is due mainly to a. decline in alcohol consumption. b. decline in cigarette smoking. *c. improvements in early detection and treatment. d. increases in women using hormone replacement therapy.

32. Which of these is the strongest inherent risk factor for cancer? a. Ethnic background *b. Advancing age c. Family history d. Gender

33. Testicular cancer a. has age-related risks similar to other cancers. b. varies from the age-related risk of other cancers, striking middle-aged men

more often than older men. *c. varies from the age-related risk of other cancers, striking young men more often than older ones. d. has a higher mortality rate than lung or prostate cancer.

34. Recent evidence suggests that genetic factors play the biggest part in the

development of *a. breast b. prostate c. lung

cancer.

d. colorectal

35. Women whose mothers developed breast cancer before age 40, compared with those

whose mothers did not have cancer, are *a. about two times more likely to develop breast cancer. b. about five to ten times as likely to develop breast cancer. c. no more likely to have breast cancer. d. much less likely to have breast cancer.

36. The BRCA genes are related to breast cancer; a. women with these genes are about 20 times as likely to develop breast cancer

as women without them. *b. women with mutated forms of these genes are vulnerable to breast cancer. c. these genes are responsible for about 50% of breast cancer cases. d. women with these genes will develop breast cancer, and 40% of them will do so before age 35.

37. With regard to radiation and cancer, evidence suggests that a. any exposure to radiation greatly increases one's risk for cancer. b. any exposure to radiation slightly increases one's risk for cancer. c. medical/dental staff working with X-rays have significantly higher risks of

cancer. *d. long-time employment in a nuclear power plant increases death rates from cancer.

38. Across all cancers,

are due to inherited genetic mutations.

a. 1-2% *b. 5-10% c. 15-20% d. 25-30%

39. When examining the cancer risk of exposure to radiation, living in a community

near a nuclear power plant a. increases the risks for all cancers. b. increases risks for mouth, throat, and lung cancer. c. increases the risk for all cancers in men. *d. does not increase the risks for cancers.

40.

risk factors for cancer include genetics and family history, whereas risk factors include smoking and diet. *a. Inherent; behavioral b. Inherent; environmental c. Behavioral; inherent d. Behavioral; environmental

41. African Americans have lower survival rates for most cancers compared to other

ethnic groups. These ethnic discrepancies are most likely due to *a. social factors. b. genetic factors. c. biological factors. d. racial discrimination.

42. Ethnic minorities in America develop many cancers at

European Americans, and they typically have cancer diagnosed

rates compared to .

a. higher; later b. higher; earlier c. lower; earlier *d. lower; later

43. When researchers (Du, Meyer, & Franzini, 2007) controlled for socioeconomic

factors, what did they find about cancer in ethnic minorities compared to in European Americans? a. Their rates of cancers became lower. *b. Their rates of survival became equal. c. Their rates of cancers became equal. d. Their rates of survival became lower.

44. Asian Americans have

mortality rates from cancer in general than European Americans, but mortality rates for stomach and liver cancers specifically than European Americans. *a. lower; much higher b. higher; much lower c. lower; a bit higher d. higher; a bit lower

45.

is the leading cause of death among children aged 1-14 years and the second leading cause of death for that age group.

is

a. Cancer; unintentional injury b. Cancer; cardiovascular disease *c. Unintentional injury; cancer d. Cardiovascular disease; cancer

46. Women with a mutated form of the BRCA 1 gene are as many as

develop

as likely to cancer as someone who has the non-mutated form of the gene.

a. seven times; lung *b. seven times; breast c. twice; breast d. twice; lung

47. Being members of ethnic minorities has

cancer compared to their

effect on Americans’

of

of cancer.

*a. more; survival; incidence b. more; incidence; survival c. equal; survival; incidence d. less; prevalence; incidence

48. Alberta is African American, and her friend Eleanor is European American.

Statistically, Eleanor is to die of it.

likely to develop breast cancer than Alberta and

likely

a. less; more b. more; more *c. more; less d. less; less

49. According to survey research, most people

the genetic risk factors for

cancer. *a. overestimate b. underestimate c. are unaware of d. accurately guess

50. Inherited genetic mutations are most likely to lead to which kinds of cancers?

a. Cancers of the reproductive systems b. Cancers of the endocrine system c. Cancers of the digestive system *d. Cancers of both (a) and (c)

51.

factors have a greater influence on cancer development than

factors. *a. Environmental and behavioral; genetic b. Genetic and environmental; behavioral c. Behavioral and genetic; environmental d. Behavioral; genetic and environmental

52. Some types of infections and chronic inflammation raise cancer risks. What is

believed about these? a. Infections may be more attributable to environmental exposure. b. Inflammation may be more attributable to behavioral variables. *c. Both infections and inflammation may be more from behavior. d. Both infections and inflammation may be more environmental.

53. The number one preventable cause of death in the United States is/are a. high serum cholesterol. *b. cigarette smoking. c. accidents. d. AIDS.

54. How many American cancer deaths does the U.S. Department of Health and Human

Services attribute to smoking? *a. One third b. One half c. A quarter d. One fifth

55. Bettye is a 40-year old X-ray technician who smokes about two packs of cigarettes a

day, drinks about two alcoholic beverages a day, and eats a diet low in saturated fats. Her number one risk for cancer death is her a. occupation.

*b. smoking. c. gender. d. diet.

56. Taylor is a 28-year-old stockbroker with a 6-year-old son. She smokes about 30

cigarettes a day and consumes about 5 to 10 alcoholic drinks during a week. Because her mother died of cancer of the esophagus at age 64, Taylor is trying to reduce her risk of cancer. Her best course of action would be to a. change jobs. b. have another child. *c. quit smoking. d. stop drinking.

57. Although the leading cause of lung cancer deaths continues to be smoking,

is another important behavioral risk for all other cancers in the United States. *a. diet b. alcohol c. unsafe sex d. stressful life events

58. Cigarette smokers are

times more likely to die of lung cancer than those

who have never smoked. a. 10.9 *b. 24.9 c. 50 d. 67.2

59. Studies on the attitudes toward smoking in Denmark compared to in the United

States indicate that may play an important role in how individuals understand their perceived risk from smoking. a. the acceptability of smoking b. the cultural prevalence of smoking c. the overall mortality rates from smoking *d. the influences of both a and b on smoking

60. A high-fat diet that contributes to high cholesterol levels appears to be a high risk

factor for

.

a. lung cancer

b. breast cancer *c. testicular cancer d. colorectal cancer

61. Nick eats a high-fat diet, and this may multiply his risk for

cancer.

a. colorectal *b. testicular c. kidney d. lung

62. John eats a lot of meat in his diet, mainly preserved meats, such as ham and bacon.

His diet increases his risk of

cancer.

*a. colorectal b. testicular c. kidney d. lung

63. Mary is obese, and her weight increases her risk for all of the following cancers

EXCEPT: a. esophageal. b. kidney. c. endometrial. *d. colorectal.

64. Bruce eats a diet high in fiber. High-fiber diets have been shown to be protective

against

cancer. a. esophageal b. kidney c. endometrial *d. colorectal

65. In moderate amounts, selenium offers protection against

cancer(s).

a. prostate b. kidney c. colon *d. a and c

66. Women who consume

breast cancer.

drinks per

_ have a moderate to strong risk for

a. 1-2; week b. 1-2; day c. 3+; week *d. 3+; day

67. Individuals who keep a healthy weight, maintain a healthy diet, stay physically

active, and drink in moderation have a lower risk for cancer-related death than individuals who do not adhere to those healthy behaviors. a. 21% *b. 30% c. 48% d. 66%

68. Individuals who keep a healthy weight, maintain a healthy diet, stay physically

active, and drink in moderation have a lower risk for cardiovascular diseaserelated death than individuals who do not adhere to those healthy behaviors. a. 21% b. 30% *c. 48% d. 66%

69. Susan regularly tans using an indoor tanning bad. Compared to other young adults

who do not use tanning beds, Susan is at a

increased risk for melanoma.

a. 25% b. 45% c. 50% *d. 75%

70. Exposure to the human papillomavirus (HPV) increases risk for

and

cancer. a. cervical; breast *b. cervical; oral c. breast; oral d. oral; throat

71. During the past 75 years, the introduction of refrigeration and food additives has

been linked most strongly to a. decreases in lung cancer.

b. increases in colon cancer. c. increases in stomach cancer. *d. decreases in stomach cancer.

72. Some evidence indicates that being

is positively related to colon and

rectal cancer. *a. obese b. female c. male d. European American

73. Currently, the evidence that some dietary nutrients can prevent cancer is *a. difficult to establish through randomized, controlled trials. b. stronger for taking supplements than for eating specific foods. c. about as strong as the evidence that smoking is related to cancer. d. nonexistent.

74. Among the following, which of these factors carries the lowest risk for cancer? a. Having several family members get cancer before age 50 *b. Eating a diet high in vegetables and fruits c. Being African American d. Having had multiple sex partners

75. Lee Ann believes that diet is an important factor in cancer. She wants to eat a diet

that will protect her. Current research indicates that a. Lee Ann should concentrate on eating a high-protein diet. b. Lee Ann should take vitamin supplements. c. Lee Ann should eat "natural" foods with no preservatives. *d. Lee Ann should eat a diet high in fruits and vegetables.

76. One reason that consuming red meat may raise the risk for cancer is *a. the methods of preparation, such as grilling and smoking, create risks. b. the high protein content of red meat is a risk. c. the high carbohydrate content of red meat is a risk. d. meat is more likely to be contaminated than grains, nuts, or vegetables.

77. Josh is a 22-year-old, nonsmoking college senior who wants to reduce his risk for

lung cancer. His best course of action would be to a. take large doses of vitamin E, vitamin C, and vitamin A supplements. b. take moderate doses of a variety of supplements. *c. adopt a lifelong diet that contains high levels of fruits and vegetables. d. avoid high levels of dietary vitamin C.

78. As a risk factor for cancer, alcohol has a. about the same risk as cigarette smoking. b. about the same risk as an improper diet. *c. a synergistic effect with smoking. d. a synergistic effect with UV light.

79. Current evidence for a link between alcohol consumption and breast cancer is *a. convincing, as studies show higher consumption causes higher risk. b. strong, because all studies are showing a causal relationship. c. weak, because most studies are showing no connection. d. nonexistent, because no studies have yet investigated any relationship.

80. Physical activity seems to offer some protection against a. non-Hodgkin’s lymphoma. *b. colon cancer. c. bone cancer. d. lung cancer.

81. Physical activity is most likely to protect women against breast cancer if *a. they begin a physical activity program when young and maintain physical

activity. b. they postpone physical activity until after menopause. c. they begin a physical activity program when young and then stop or greatly reduce exercise after menopause. d. they are married and have at least one child.

82. Kristy is a 21-year-old college student who is concerned about breast cancer because

both her mother and grandmother developed the disease before the age of 55. Current evidence shows that Kristy can reduce her chances of breast cancer through

a. continuing not to drink. b. continuing not to smoke. c. regular physical activity. *d. engaging in all of these.

83. Skin cancer is more common among a. dark-skinned people. *b. light-skinned people. c. light-skinned people who avoid the sun. d. people in Europe rather than people in the United States.

84. HIV infection is associated with increases in a. lung cancer. b. Kaposi's sarcoma. c. non-Hodgkin's lymphoma. *d. both Kaposi's sarcoma and non-Hodgkin's lymphoma.

85. In the United States, *a. most people with non-Hodgkin's lymphoma do not have AIDS. b. most people with Kaposi's sarcoma do not have AIDS. c. most people with rectal cancer have AIDS. d. most people with colon cancer have AIDS.

86. Kaposi's sarcoma is a cancer that occurs most frequently in the United States as a

result of a. UV light. *b. HIV infection. c. suppression of emotion. d. Type A behavior pattern.

87. Which is a risk factor for cancer of the cervix? a. Having a first child later in life *b. Large number of sexual partners c. Use of diaphragms and condoms d. Having a high level of education

88. When cancerous growth has not yet metastasized,

is/are most likely to be

recommended. *a. surgery b. immunotherapy c. hormonal therapy d. chemotherapy and/or radiation

89. Which of these cancer treatments has serious and painful side effects? a. Surgery b. Radiation c. Chemotherapy *d. All of these do

90. Research indicates that a diagnosis of cancer often *a. leads to feelings of fear, anxiety, and anger in most patients. b. leads to committing suicide in about 25% of patients. c. leads to significant psychosocial problems in most patients. d. leads to clinical depression in more than half of patients.

91. When cancer patients have surgery, what do researchers find they frequently get in terms of emotional support compared to other surgery patients? a. More emotional support, and distributed equally across all types of cancers b. Less emotional support, and distributed equally across all types of cancers c. More emotional support, and particularly with breast and prostate cancers *d. Less emotional support, and particularly with breast and prostate cancers

92. Elsa has recently experienced fatigue, weight change, hair loss, nausea, loss of

sexual interest, sleep problems, and loss of appetite after her treatment for cancer. These symptoms are most likely to follow *a. chemotherapy. b. surgery. c. hormonal treatment. d. immunotherapy.

93. Leo has been diagnosed with prostate cancer. Leo is LEAST likely to experience

high levels of stress if

a. he is unmarried. b. his wife tries to protect him from the reality of his illness. c. his wife provides social support, but Leo does not notice her efforts. *d. he perceives more social support available from his wife and others.

94. Psychologists' involvement in cancer has centered mostly on a. diagnosis and cure. b. diagnosis and prevention. c. neoplastic research and prevention. *d. prevention and helping patients to cope.

95. When researchers wanted to investigate whether psychosocial and complementary

and alternative medicine interventions might benefit cancer patients, what were plausible mechanisms they thought might prolong life? a. Improvements in immune response b. Improvements in patient functioning c. Improvements in treatment adherence *d. Improvements in all these are included

96. Research indicates that psychotherapy can help cancer patients a. make a good adjustment to their disease and extend their lives. *b. reduce the distress of cancer and treatment but not extend their lives. c. accept the reality of illness and develop a more optimistic perspective. d. achieve a better level of integration of family and health care personnel.

97.

is related to adjusting well to a diagnosis of cancer, but not necessarily survival of cancer. *a. Optimism b. Hardiness c. Social support d. Physical Energy

98. Women with greater

with less. a. emotional support *b. structural social support c. problem-focused support

show slower cancer progression than women

d. invisible means of support

99. Thus far, research evidence suggests that psychological interventions

.

a. prolong the lives of those with cancer *b. improve short-term emotional support c. can accomplish both (a) and also (b) d. can accomplish neither (a) nor (b)

100. Research has found a plausible mechanism for life extension through

psychological interventions. Research evidence also shows that psychological interventions: *a. can increase quality of life but not longevity. b. can increase longevity but not quality of life. c. can increase longevity and the quality of life. d. can increase neither longevity nor life quality.

101. Currently, cancer death rates in the United States are rising. a. True *b. False

102. In the United States, lung cancer accounts for the highest percent of all cancer deaths for bothwomen and men.

*a. True b. False

103. Among women in the United States, breast cancer has the highest death rate but not the highest incidence. a. True *b. False

104. Among men in the United States, prostate cancer has the highest death rate but not the highest incidence. a. True *b. False

105. Individuals are developing cancer at the same rates as they did decades ago, but improved healthcare prolongs the life of cancer patients, which accounts for the decrease in cancer-related deaths in the past decade. a. True *b. False

106. During the past 65 years, death rates from stomach cancer have dropped dramatically. *a. True b. False

107. In the United States, most cancers are due to industrial pollution and second-hand smoke. a. True *b. False

108. More than half of cancer deaths in the United States are attributable to diet and smoking. *a. True b. False

109. Cigarette smoking is the only form of tobacco use that increases risk for cancer. a. True *b. False

110. Alcohol may protect against cardiovascular disease, but it contributes to the development of cancer. *a. True b. False

111. Differentiate malignant from nonmalignant growths.

A. Both types consist of neoplastic cells, which show the properties of nearly unlimited growth.

1.

Their growth pattern can rob other body cells of nutrients, interfere with the functioning of the host’s body, and cause damage to the host’s body.

2.

These cells reproduce without any restraint, a characteristic of both benign and malignant tumors.

B.

Benign tumors 1.

Tend to remain localized.

2.

Are usually less dangerous than malignant tumors.

3.

Can be dangerous, even fatal, depending on the location of the tumor (e.g., a benign brain tumor can be fatal).

C.

Malignant tumors

1.

Tend to metastasize—spread to other sites in the body, where they form other tumors.

2.

Are usually more dangerous than benign tumors.

3.

Include many types, divided into carcinoma (cancer of the epithelial tissue), sarcoma (cancer of the connective tissue), leukemias (cancer of the blood), and lymphomas (cancer of the lymphatic system).

Correct Answer:

See below 112. Evaluate the trends in cancer deaths over the past 100 years in the United States.

A. During almost all of the 20th century, cancer deaths increased, but that trend stopped in 1993, and overall cancer deaths began to decline.

1.

The decline is partly attributable to changes in lifestyle, which lower the incidence of cancer.

2.

Early diagnosis and more effective treatments have also played a role.

B. Death rates for some types of cancer decreased in the past 50 years.

1.

For example, for both men and women, stomach and colorectal cancers have decreased.

2.

C.

For women, death from uterine cancer has decreased.

However, incidence of some cancers has increased.

1.

Liver cancer deaths are increasing.

3.

Melanoma, a highly fatal form of skin cancer, is

increasing.

4.

Cancer of the esophagus is on the rise for men but on the decline for women.

D. Some of the cancers responsible for many deaths have begun to decline.

1.

Prostate cancer diagnoses increased sharply during the 1980s but decreased during the 1990s.

2.

For men, lung cancer deaths have dropped sharply during the past dozen years, but deaths for women have remained about the same. However, at the present time, lung cancer deaths are the greatest sources of cancer deaths for both men and women in the U.S.

Correct Answer:

See below 113. Compare the cancer risks for smoking, diet, alcohol consumption, exercise, sun tanning, and sexual behavior.

A. Most cancers are produced by behaviors, and each of these behaviors constitutes risk factors for developing cancer.

B. Smoking is a major risk for many types of cancer, especially lung cancer.

1. Smoking is a risk not only for lung cancer but also for cancers of the oral cavity, the pancreas, the esophagus, the bladder, the pancreas, and the breast.

2. Compared to nonsmokers, people who smoke cigarettes are 23 times as likely to die from lung cancer. Pipe and cigar smokers are two to three times more likely to die of lung cancer than are nonsmokers.

C. Diet is another major risk; between 33% and 50% of cancers are attributable to diet.

1. Diets high in fat or salt, foods that have spoiled or are contaminated with toxins, preserved foods, and grilled and smoked meats raise the risk of cancer.

2. A diet high in fruits and vegetables may protect against cancer, but dietary supplements of Vitamin C, beta-carotene, and selenium offer less protection.

D. Alcohol is not a strong risk factor in cancer, with only a small percentage of cancers being due to drinking.

1.Alcohol increases the risk for breast cancer.

2. However, alcohol and tobacco act synergistically, thus, elevating the risk above what it would be for either alone.

E.

Exercise has shown some power to decrease the risk for cancer.

1. Exercise decreases the risk for breast cancer in women, especially activity that began early in life and continues throughout.

2. Physical activity decreases the risk of colon cancer for both men and women.

F. Sun tanning is a major risk factor for skin cancers.

1. The most common type of skin cancer is rarely fatal, but this type has dramatically risen in the United States since the mid1970s.

2. Exposure to ultraviolet light is also a major factor in malignant melanoma, a type of cancer that is often fatal; this type ofcancer has also risen in recent years.

G. Sexual behavior 1. Early sexual activity is a risk for women’s chances of developing cancers of the reproductive tract, but early pregnancy decreases the risk of breast cancer.

2. Anal intercourse is a risk factor in the spread of AIDS, and both men and women who engage in this practice are at elevated risk of being infected and developing one of the other cancers associated with AIDS.

Correct Answer:

See below 114. What is the contrast between the risk and the perceived risk of smoking for the development of lung cancer?

A. The risk from smoking is substantial.

1. Lung cancer has a relative risk of about 24.9 for cigarette smokers.

2. This link is the strongest for any behavior-illness pairing.

B. Smokers' perceived risk is not as strong as their actual risk; people who engage in risky behaviors have trouble acknowledging that their behavior places them at risk.

1.Smokers have an optimistic bias, believing that the negative consequences of smoking will happen to other people but not to them.

2. Both high school and adult smokers believe that they will escape the risks associated with smoking.

Correct Answer:

See below 115. Evaluate the role of eating and drinking in the development of cancer.

A. Some diets increase the risk for cancer.

1. A diet that includes a great deal of salt-cured and smoked foods and food stored at room temperature constitute a risk.

2. A high-fat diet (and obesity) raises the risk for colon cancer.

B. One estimate proposes that worldwide cancer deaths could be decreased by over 2 million if people increased consumption of fruits and vegetables, but evidence for specific nutrients is lacking.

1. Some research indicates that foods rich in betacarotene, Vitamin C, and selenium offer protection, but other studies have failed to find benefits.

2. Flavonols are anti-oxidants that may protect against cancer, but the research is not clear at this point.

3. Research has failed to confirm the value of vitamin and mineral supplements; eating foods containing the nutrients is a better choice.

C.Drinking alcohol poses some risk for cancer.

1. Heavy drinking raises the risk for liver cancer.

2. Even light drinking raises the risk for breast cancer.

3. The combination of smoking and drinking has a synergistic effect, which multiply the risk.

Correct Answer:

116. What can a person do to avoid cancer?

A. Avoiding cancer completely is probably impossible because so many factors relate to its development, including some inherent factors such as advancing age and genetic factors.

B. People can lower their risk in several ways.

1. Do not smoke or use any other form of tobacco.

2. Avoid a high-fat diet and concentrate on increasing intake of fruits, vegetables, and grains.

3. Avoid excessive drinking, especially in combination with smoking.

4. Participate regularly in physical exercise.

5. Avoid sun exposure and do not try to develop a tan.

6. Avoid risky sexual behaviors and a large number of sexual partners.

7. Develop a support network and a sense of health efficacy to combat feelings of helplessness.

Correct Answer:

See below 117. Summarize the story of Steve Jobs’ experience with cancer. Also comment on what things he might have done that might and might not have changed the outcome.

A. Steve Jobs was the head of the major technology corporation Apple, Inc. in 2003 when a CT scan revealed neuroendocrine pancreatic cancer.

1. Pancreatic cancer is among the most lethal kinds; neuroendocrine is a rare form of it.

2. Because of its poor prognosis with standard treatments, people often seek alternative treatments for pancreatic cancer.

3. Steve Jobs initially refused the recommended surgery out of aversion to the operation.

B. Jobs initially sought help through alternative therapies like acupuncture, herbal remedies, a vegan diet, and a psychic.

C. He agreed to surgery after nine months.

1. By that time, the cancer had metastasized to other sites in his body.

D. Jobs then got radiation therapy and a liver transplant as the most advanced, aggressive treatments available.

1. The side-effects of these treatments combined with the cancer itself caused Steve to become increasingly debilitated.

E. Owing to progressively deteriorating health, he resigned as head of Apple in August 2011.

F. Steve Jobs died in October of 2011 from respiratory failure caused by complications secondary to advanced pancreatic cancer.

G. Although the treatments he ultimately had might or might not have eliminated his cancer or put it into remission, and he might still have died despite those treatments, Jobs’ delaying treatment allowed the cancer to metastasize, making treatment more difficult and prognosis poorer. Getting those treatments sooner, before the cancer had spread, might possibly have enabled some better outcomes—but not necessarily.

Correct Answer: See below

118. Identify some common types of cancer that are related to AIDS and HPV, and some male sexual behaviors related to prostate cancer risk.

Correct Answer:

A. Some cancer deaths are from cancers that result from AIDS (Acquired Immune Deficiency Syndrome). Two common forms are: 1. Kaposi’s sarcoma causes lesions on the skin and in the mouth, lungs, bladder, spleen,adrenal glands, and lymph nodes. a. This was a rare cancer until the 1980s, mainly in older men of Mediterranean ancestry. b. Men and women in every age group now contract Kaposi’s sarcoma related to AIDS. c. Gay male AIDS patients are more susceptible to it than people who contracted AIDS through heterosexual contact or using injected drugs.

2. Non-Hodgkin’s lymphoma causes tumors that grow rapidly and spread through the lymphatic or circulatory system. a. AIDS patients of both genders and all ages can get this cancer. b. Most non-Hodgkin’s lymphoma patients do NOT have AIDS. B. Unprotected sex with an HIV-positive partner is still the greatest risk for AIDS-related cancers.

C. Exposure to the human papilloma virus (HPV) increases risks for cervical and oral cancers.

1. HPV is the leading cause of cervical cancer.

2. HPV infection rates are high, particularly for young, sexually active persons.

3. Women with earlier first sexual intercourse and many sexual partners are more exposed to HPV, and hence more vulnerable to cervical cancer.

4. Men who have sex with many women who have also had many sexual partners increase their female sex partners’ risk for cervical cancer.

5. HPV also causes some oral cancers.

a. Rates of HPV-related oral cancers increased from 16% in the late 1980s to 73% by the early 2000s. b. Some researchers estimate that by 2020, new diagnoses of HPV-related oral cancers will surpass those of cervical cancers. c. HPV-related oral cancer is twice as frequent in men as in women. d. Oral HPV is likely transmitted through oral sex. e. Oral HPV infections are more likely to persist in people who smoke tobacco.

D. Prostate cancer risk can also be raised by men’s sexual behaviors.

1. Researchers found a significant positive correlation between prostate cancer and: a. Lifetime number of female (but not male) sexual partners b. Early age of first sexual intercourse c. Previous gonorrhea infection.

1. The same research did NOT find lifetime frequency of sexual intercourse associated with any risk for prostate cancer.

119. Identify some research findings about psychosocial risk factors for cancer.

Correct Answer:

A. Using the Eysenck Personality Inventory, researchers did not find the Big Five personality traits of extraversion and neuroticism to predict increased cancer probability.

B. Researchers have tried to relate personality and other psychosocial factors to cancer incidence and mortality for the past several decades.

1. Some studies identify personality factors apparently related to cancer development.

2. However, large-scale studies and literature reviews find only weak associations between cancer and any psychosocial factors.

3. Negative emotionality and the tendency to repress rather than express emotion are factors showing the strongest relationship. a. These personality traits are related more strongly to patient response following cancer diagnosis than to cancer development.

120. Discuss some aspects of psychological interventions for cancer patients, including types, goals, and outcomes.

Correct Answer:

A. Psychologists use both individual and group therapy techniques.

B. An intervention should accomplish at least one of two goals to be effective:1. Increase survival time; 2. Improve emotional wellbeing;

1. Or both of these.

C. Reviews find that psychological interventions in general realize short-term benefits for helping cancer patients manage their distress related to the illness.

D. Some physiological outcomes, like immune function measures and cortisol responses, are improved for women with breast cancer by some psychological interventions.

E. Some psychological interventions focus on cognitive behavioral stress management skills.

F. Some psychological interventions focus on providing social support and opportunities for expressing emotions.

G. Research finds evidence that both types of interventions improves some patient outcomes.

H. To be effective for every individual, any psychotherapeutic, educational, supportive, or multi-component program should be matched to individual cancer patient needs and characteristics.

I. There is less evidence that psychological interventions prolong cancer patients’ life spans.

J. 1. Some researchers observed that breast cancer patients for whom a multi-component psychological intervention managed pain, anxiety, and depression also lived longer. This observation motivated other researchers to investigate this possibility further.

2. Though one subsequent study found some evidence, large-scale reviews find little evidence that psychological interventions reliably extend the length of survival for cancer patients.

3. Therefore, improving the cancer patient’s quality of life is the main value of psychological interventions.

Chapter 11 1. According to the CDC (2009), what proportion of American adults live with chronic

illness? a. Three quarters b. Almost a third *c. Nearly one half d. Over two thirds

2. What proportion of deaths in the U.S. 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

3. Chronic diseases are more common than acute diseases, but a. fewer people die of chronic diseases. *b. people who have a chronic disease try to live as normal a life as possible. c. chronic diseases are more easily cured than acute illnesses. d. people with a chronic disease are more likely to seek medical treatment.

4. The diagnosis of a chronic disease may be seen as a crisis or a psychosocial

transition, but both views acknowledge that such a diagnosis *a. requires adaptation by those affected. b. affects families more than individuals. c. is more difficult for women than for men. d. is more difficult with diabetes than Alzheimer’s.

5. 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 includes some stages.

6. 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.

7. Russell has prostate cancer. What is MOST likely to be true of Russell? *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.

8. Wilford 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. a. This program will help Wilford develop emotion-focused coping strategies. b. This program will allow Wilford to discontinue taking his medication. *c. This program will help Wilford and his family adapt to changes he needs to

make in his life. d. This type of program will not be as effective in helping Wilford as relaxation or hypnosis.

9. The type of social support that tends to be most helpful to people with chronic illness

may be described as a. selective. b. coming from partners rather than family. c. “circumplex.” *d. “invisible.”

10. Families with a chronically ill child should *a. find some positive aspect in their situation. b. devote themselves full-time to their child. c. reinforce all their child's illness behaviors. d. realize the child's illness will soon be cured.

11. Chronic diseases affect children, with

physical health problem.

of children having some chronic

a. 1-5% *b. 10-15% c. 25-30% d. 50-60%

12.

appears to matter more than of someone who is coping with a chronic illness.

in determining the quality of life

*a. Psychological functioning; physical functioning b. Psychological functioning; environmental functioning c. Physical functioning; psychological functioning d. Physical functioning; emotional functioning

13.

functioning is the best predictor of quality of life in individuals who are coping with a chronic illness. a. Physical *b. Psychological c. Physiological d. Environmental

14. Which type of coping strategies tend 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

15. Barbara’s daughter was recently diagnosed with diabetes. The best course of action

her family could take is to a. treat her as someone who is unique because of her diabetes. *b. establish a routine that is close to normal. c. tell the other daughters never to fight with their sister. d. both a and b.

16. The largest risk factor for Alzheimer’s disease is a. genetics *b. age

.

c. body weight d. all of the above

17. 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

18. 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.

19. 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.

of the factors for Alzheimer’s disease are the same as those for cardiovascular disease and cancer.

20.

*a. Many; risk and protective b. A few; risk and protective c. Many; risk, not protective d. A few; protective, not risk

21. 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.

22. A common psychological problem among Alzheimer’s patients is depression, with

as many as

of patients reporting depressive symptoms.

a. 10% *b. 20% c. 30% d. 50%

23. Hal, 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.

24. 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

25. 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.

26. Henry, 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.

27. 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

28. 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.

29. 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.

30. 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.

31. 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 most accurate about this situation? a. It is possible to manage Type 1 diabetes symptoms 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 with her age, weight, and

symptoms. d. It is likely she had incorrectly self-diagnosed, as she had no medical treatment.

32. 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.

33. Insulin is a. a neurotransmitter. *b. a metabolic hormone. c. an endogenous opioid. d. an exogenous opioid.

34. Glucagon acts to

, and insulin acts to

.

a. stimulate the stomach . . . stimulate the pancreas b. increase hunger . . . decrease hunger c. decrease blood sugar levels . . . increase blood sugar level *d. stimulate the release of glucose . . . take glucose into cells

35. The

of the pancreas produce glucagon and insulin.

*a. islet cells b. mellitus cells c. diabetes cells d. both a and b

36.

is the disorder caused by insulin deficiency. a. Pancreatitis b. Appendicitis *c. Diabetes mellitus d. Glucagon

37. 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.

38. Kyle has had diabetes for the past five years, is overweight, and manages his

diabetes by attempting to eat healthier and taking daily medication. Kyle most likely has a. Type 1 diabetes. *b. Type 2 diabetes. c. gestational diabetes. d. insulin-dependent diabetes.

39.

diabetes is the most common type of diabetes, representing

_ of all cases

of diabetes. a. Type 1; 70-80% b. Type 1; 90-95% c. Type 2; 70-80% *d. Type 2; 90-95%

40. 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.

41. 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.

42. Interventions aimed at teaching diabetes patients to manage their

help improve their management of blood sugar levels. a. depression b. stress c. anxiety *d. both a and b

can also

43. The psychosocial factor most strongly tied to poor diabetes management is: *a. social support. b. depression. c. anxiety. d. weight.

44. Which ethnic group has the lowest risk for Type 2 diabetes? a. Asian Americans b. African Americans c. Hispanic Americans *d. European Americans

45. What health problem is NOT associated with diabetes? a. Cardiovascular disease b. Blindness c. Kidney disease *d. Gum disease

46. 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.

47. Amy, 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

48. 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 these have been included in health psychology’s involvement.

49. 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.

50. The lifestyle changes that are necessary to manage diabetes are essentially a problem

of *a. adherence. b. stress management. c. weight control. d. exercise.

51. 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.

52. 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.

53. 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.

54. 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.

55. 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.

56. The

model hypothesizes that genetic vulnerability interacts with environmental factors to stimulate asthmatic reactions. a. hardiness b. hierarchy of needs *c. diathesis-stress d. allergy

57. The hygiene hypothesis holds that asthma is a result of

become common in modern society. a. dust mites *b. cleanliness c. cigarette smoking d. industrial pollution

58. Which ethnic group has the highest rates of asthma? a. European Americans *b. African Americans c. Asian Americans d. Hispanic Americans

that has/have

59. Which age group has the highest rates of asthma? *a. Children and teens b. Young adults c. Middle-aged adults d. Older adults

60. 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.

61. All of the following are risk factors for asthma EXCEPT: a. obesity. b. sedentary lifestyle. c. living in a developed country. *d. living in a rural area.

62. Possible risk factors for asthma include a. high levels of physical fitness. b. being European American. c. living in a rural area. *d. being obese.

63. Triggers for an asthmatic attack are LEAST likely to include *a. newspaper ink. b. cigarette smoke. c. dust mites. d. chemical sprays.

64. Common to both diabetes and asthma are a. triggers. *b. adherence problems. c. insulin injections. d. troubles in breathing.

65. The primary factor in asthma treatment is *a. maintaining adherence to medication. b. changing the patient’s environment. c. smoking cessation. d. early hospitalization.

66. Experts find that most asthma patients overuse

and underuse

.

a. preventive medications; inhalers b. preventive medication; hospitals *c. inhalers; preventive medications d. their physicians; bronchodilators

67. 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.

68. 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.

69. 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.

70. Of the various types of AIDS, the one most frequently found in the Africa is a. HIV-1. *b. HIV-2. c. HIV-3.

d. HIV-4.

71. 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 decrease in the prevalence of HIV infection among heterosexual men. d. a decrease in the prevalence of HIV infection among heterosexual women.

72. 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.

73. The proportion of new HIV cases in the United States has decreased most for a. Hispanic American women. b. injection drug users. c. African American women. *d. gay men.

74. Women now account for about

of all HIV cases in the United States.

a. 5% b. 10% *c. 20% d. 33%

75. 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.

76. 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 boyfriend, 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

77. 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. All of these are high-risk behaviors for an HIV infection

78. Some sexual behaviors are more likely to spread HIV infection than other behaviors.

Which of the following is the highest risk? a. Kissing *b. Anal intercourse c. Vaginal intercourse d. All of these are high-risk behaviors

79. 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.

80. Injection drug use a. is responsible for HIV infection for more women than men. b. is the leading cause of HIV infection worldwide. *c. affects African Americans and Hispanic Americans more than European

Americans. d. dropped from the leading cause of HIV infection to the least likely mode of infection during the late 1990s.

81. Heterosexual sex is more likely to a. spread HIV infection than sharing needles. *b. lead to HIV infection in women than in men. c. lead to HIV infection in men than in women. d. spread HIV infection than homosexual sex.

82. Which group currently accounts for more than half of HIV transmissions? *a. Male-male sexual contact b. Male-female sexual contact c. Injection drug use d. Transmission from mother to baby

83. Heterosexual contact is the leading source of HIV infection in

.

a. the United States *b. Africa c. Eastern Europe d. Russia

84. Most protective measures to prevent transmission of HIV include ways to *a. prevent exchange of body fluids. b. isolate the infected people. c. reduce sexual activity, especially among gay men and lesbians. d. avoid gay men and lesbians.

85. Behaviors that will protect the largest number of people against HIV include *a. limiting the number of sex partners and using condoms. b. avoiding giving blood and having blood transfusions. c. avoiding drug use and avoiding homosexuals. d. avoiding people who have AIDS entirely.

86. Those AIDS patients who have better psychological adjustment to their situation a. contracted HIV through injection drug use rather than male-male sexual

contact. b. contracted HIV through heterosexual contact, not male-male sexual contact. c. have avoidance coping styles. *d. have active coping styles.

87. The concept of the “good death” a. includes control over end-of-life issues. b. includes having access to palliative care. c. includes continued life-support measures. *d. includes having (a) and (b) rather than (c).

88. 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.

89. “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

90. 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.

91. Margaret 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 other roles. c. She will not transition more easily if she previously took a sick role. d. She will keep responsibilities but not gain privileges in a dying role.

92. 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

93. Jamil is finding it increasingly difficult to perform activities of daily living as his terminal illness advances, so he is looking into options for home health care and medical facilities as part of what Emanuel and colleagues (2007) call the element of the dying role. He is also struggling with relinquishing his duties as breadwinner, spouse, and parent as part of the element of the dying role. *a. practical; relational b. personal; practical c. relational; personal d. personal; relational

94. 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.

95. 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.

96. Studies investigating the effects of dignity therapy for the dying have found that some of the elements of the dying role may be . a. practical; universal b. relational; cultural c. personal; universal *d. personal; cultural

97. 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.

98. All of the following were characterized as responses to bereavement EXCEPT a. being resilient. b. acute-recovery. c. improvement. *d. being in denial.

99. Most adults exhibit

following a death of a loved one.

*a. resiliency b. acute-recovery c. improvement d. chronic low levels of well-being

100. Those who show improvement following the death of a loved one usually have

gained

. *a. resiliency b. acute-recovery c. improvement d. denial

101. Both early-onset and late-onset Alzheimer’s disease have a genetic component. *a. True b. False

102. Individuals who experience meaning and personal growth through loss and grief may also experience less depression and greater wellbeing. *a. True b. False

103. Alzheimer’s caregivers experience distress and poor physical health, but this decreases as soon as caregiving ends. a. True *b. False

104. Type 1 diabetes requires a special diet; Type 2 diabetes does not. a. True *b. False

105. People with insulin-dependent diabetes mellitus often “outgrow” their diabetes. a. True *b. False

106. The primary goal of asthma is minimizing the individual’s asthma attacks. *a. True b. False

107. The progression from HIV infection to AIDS runs a similar timeline for every person—around 10 years. *a. True b. False

108. AIDS is one of the top 10 leading causes of death in the United States. a. True *b. False

109. In the United States, prevalence of HIV is increasing while incidence is decreasing. *a. True b. False

110. There are set stages of feelings and emotions that individuals pass through as they grieve for a loved one. a. True *b. False

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

Correct Answer:

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.

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

Correct Answer:

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.

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

Correct Answer:

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.

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

Correct Answer:

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.

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

Correct Answer:

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.

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

Correct Answer:

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.

117. Summarize some findings about physiological evidence of Alzheimer’s disease, and some characteristics of age as a risk factor.

Correct Answer:

A. Alois Alzheimer (1907) first related post-mortem abnormal neurological findings to premortem 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 doubles around every 5 years.

4. By age 85, nearly half of people show signs of Alzheimer’s disease.

5. People in their 90s without signs of Alzheimer’s disease are much less likely to develop it than people aged 65-85.

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

Correct Answer:

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.

119. 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.

Correct Answer:

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

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

Correct Answer:

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 anddeath.

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.

Chapter 12 1. The annual number of excess deaths in the United States attributable to smoking has been

estimated to be about a. 25,000. b. 57,000. c. 175,000. *d. 480,000.

2. The principle function of the respiratory system is to take in

and to eliminate

. a. leukocytes . . . oxygen *b. oxygen . . . carbon dioxide c. oxygen . . . methane d. nitrogen . . . carbon dioxide and methane

3. The site of oxygen and carbon dioxide exchange is the *a. alveoli. b. diaphragm. c. bronchi. d. trachea.

4. 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.

5. A disorder characterized by the obstruction of respiratory passages and loss of

bronchial elasticity is a. bronchitis. b. allergy. *c. emphysema. d. bulimia.

6. The addictive ingredient of cigarette smoking is

*a. nicotine. b. its good taste. c. the approval of peers. d. the aroma of the smoke.

7. Nicotine is *a. a stimulant. b. a tranquilizer. c. both of these. d. neither of these.

8. 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

9. There are at least 60 types of

in cigarettes.

a. tars b. nicotine c. aldehydes *d. carcinogens

10.

is/are responsible for cigarette smoking’s addictive nature. a. Tars *b. Nicotine c. Aldehydes d. Carcinogens

11. Nicotine affects the a. central b. peripheral c. anterior *d. both a and b

nervous system.

12. The half-life of nicotine is

.

a. 7 seconds b. 5 minutes *c. 30 minutes d. 10 minutes

13.

is/are water-soluble resides of tobacco smoke. a. Carcinogens b. Aldehydes c. Tars *d. Tars

14. Nicotine a. is a depressant for smokers, but a stimulant for nonsmokers. b. is the primary reason that people begin smoking. c. is more important than social pressure for starting to smoke. *d. is known to have properties making it addictive.

15. 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.

16. 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.

17. 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 historically low prices for cigarettes *d. Both a and b helped popularize smoking

18. 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

19. People who opposed tobacco use in America from the days of Columbus until the

middle of the 19th century did so: a. on social and/or moral grounds. b. on economic/xenophobic grounds. *c. on both/either a and/or b, but not d. d. on medical and/or scientific grounds.

20. The decline in the rate of cigarette smoking in the United States can be traced to *a. a report from the U.S. Surgeon General that linked smoking with adverse

health effects. b. weather conditions in southeastern states that significantly reduced the tobacco crops. c. the successful use of hypnosis by health psychologists to get people to stop smoking. d. an agreement by movie producers and directors to stop portraying cigarette smoking.

21. Currently, almost

% of adults in the United States smoke cigarettes.

a. 21 *b. 17 c. 42 d. 68

22. The highest rate of per capita cigarette consumption in the US was in a. 1934 b. 1962 *c. 1966 d. 2012

.

23. Of the following, which group is more likely to be current smokers? a. Females compared to males *b. American Indians compared to Asian Americans c. Older adults compared to younger adults d. Highly educated compared to high-school educated

24. Of the following, which group is more likely to be current smokers? a. Females compared to males b. Older adults compared to younger adults *c. Poorer adults compared to wealthier adults d. Highly educated compared to high-school educated

25. By the time students reach the 12th grade,

of boys and girls are frequent

smokers. a. 1-3% *b. 6-8% c. 10-12% d. 17-20%

26. Research on smoking, peer pressure, and adolescents suggests that a. anti-smoking 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.

27. A review of media influence on smoking found

media exposure and smoking. a. a weak b. a moderate *c. a strong d. no real

association between

may be the influence in adolescents’ decisions to begin smoking.

28.

*a. Curiosity b. Self-esteem c. Depression d. Anxiety

29. A behavioral reason that many smokers continue smoking is that they receive a. positive reinforcement. b. negative reinforcement. *c. either or both (a) and (b). d. intermittent reinforcement.

30. In understanding who is addicted to cigarette smoking, smoking more than

in one’s lifetime increases the difficulty of quitting. a. 1 cigarette b. 50 cigarettes *c. 100 cigarettes d. 1000 cigarettes

31. Addicted smokers

when they are limited to smoking lower-nicotine

cigarettes *a. are found to smoke more cigarettes b. are found to smoke fewer cigarettes c. smoke the same number of cigarettes d. refuse to smoke this type of cigarettes

32. One way that smokers show an optimistic bias is a. believing that their friends are less likely than others to die by smoking. *b. believing that their brand of cigarettes is less likely to cause disease. c. believing that smoking does not cause cardiovascular disease. d. believing that both a and b are true rather than believing c.

33. Chris is a smoker. What would be your predictions about Chris? a. Chris is a male who has a college degree. b. Chris is a female with a college degree. *c. Chris has parents who do not smoke.

d. Chris began smoking as a teenager.

34. Many of the adolescents who begin smoking *a. do not believe that the hazards apply to them. b. are unaware of the dangers from smoking. c. do because adults tell them not to smoke. d. do out of an unconscious death wish.

35. Madison is a nonsmoking 16-year-old high school sophomore who has a large

cigarette-sponsored poster in her bedroom. Compared with nonsmoking Wendy, who has no such poster in her room, Madison is more likely to *a. begin smoking. b. begin smoking but quit in two months. c. have a pessimistic bias. d. be an only child.

36. Who is most likely to begin smoking as a means of weight control? a. Middle-aged women who may gain weight b. Teenage boys who are involved with athletics *c. Teenage girls who have a fear of gaining weight d. Middle-aged men who have been gaining weight

37. Ashley is a 16-year-old girl of normal weight who wants to lose weight and has started

smoking to help her do so. Ashley is at risk for *a. other risky weight loss strategies. b. switching to illicit drugs. c. skipping school. d. Type 2 diabetes.

38. What has research found about young adult motivations to smoke for weight

control? a. Young women and young men do this in comparable proportions. b. Young women reported that they would smoke instead of dieting. *c. Young women reported that they would smoke along with dieting. d. Young women and young men do since it does cause weight loss.

39. 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.

40. Barrett is 14 years old and has smoked about 200 cigarettes in her lifetime. Barrett

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.

41. When the nicotine content of cigarettes is lowered, smokers tend to a. smoke the same number of cigarettes. b. smoke less of the low-nicotine cigarettes. *c. smoke more of the low-nicotine cigarettes. d. quit smoking altogether as they dislike them.

42. 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.

43. When smokers are allowed to smoke only bad-tasting cigarettes, a. people who smoke for relaxation will show little interest in smoking these

kinds of cigarettes. b. people who are addicted to nicotine will not cut back on the number of cigarettes they smoke. c. people who smoke for pleasure will smoke very few or none of these kinds of cigarettes. *d. people who smoke for each of these reasons will demonstrate each one of these behaviors.

44. 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.

45. Randy has been smoking for 20 years and enjoys the smell of cigarette smoke. For

Randy, the smell of a burning cigarette would be a. a negative reinforcer. *b. a positive reinforcer. c. a noxious stimulus. d. an unconditioned stimulus.

46. 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 relaxation. c. satisfying manual needs. d. the smell of tobacco smoke.

47. 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.

48. A smoker exhibiting an optimistic bias would

a. cut down on the number of cigarettes s/he smokes per day. b. believe that s/he is as likely to get lung cancer as other people. *c. believe that other smokers may get lung cancer, but s/he will not. d. believe that smoking causes effects that are positive for the health.

49. 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, much as do people who do not smoke. d. have less consistent attitudes about smoking as adults than as adolescents.

50. Which of these smokers exhibits an optimistic bias? a. Jim overestimates the danger of smoking and believes he has a very high

chance of developing a smoking-related disease before age 60. b. Loraine believes that smoking is not really dangerous and she has about the same risk for smoking-related diseases as other people have. c. Robbie overestimates the danger of smoking and believes that she has about the same risk for smoking-related diseases as do other people. *d. Joe understands the danger of smoking but believes that his risk of getting a smoking-related disease is less than that of other smokers.

51. With regard to smokers and fear of weight gain, research suggests that a. older female smokers express the greatest fears of weight gain. b. European American women accept weight gain more than African American

women. *c. young female smokers express the greatest fears of weight gain. d. young male smokers express the greatest fears of weight gain.

52. Pat, a smoker who fears that stopping smoking would lead to weight gain, is most

likely *a. a woman under 30 years of age. b. a woman 45 years old or older. c. a man under 30 years of age. d. a man 45 years old or older.

53. The trends in smoking rates and the number of lung cancer deaths have followed

approximately the same pattern, except that *a. increased smoking rates preceded the increase in lung cancer deaths by about

20 to 25 years. b. increased smoking rates preceded the increase in lung cancer deaths by about 2 to 3 years. c. increased lung cancer rates preceded the increase in smoking death rates by about 20 to 25 years.

d. increased lung cancer rates preceded the increase in smoking death rates by

about 2 to 3 years.

54. 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 were stable. c. lung cancer death rates among smokers rose steadily. *d. lung cancer death rates fitted (b) and (c) but not (a).

55. 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

56. Which of these is NOT a frequent result of cigarette smoking? a. Poorer balance b. Periodontal disease *c. Sharpened cognition d. Neuromuscular impairment

57. 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.

58.

is the deadliest behavior in the history of the United States. a. Drunk driving *b. Cigarette smoking c. Illegal drug use d. Homicide

59.

is the second leading cause of death in the US, but the leading cause of smoking-related deaths. a. Cardiovascular disease *b. Cancer c. Chronic lower respiratory disease d. Mental illness

60. Men who smoke cigarettes have a

relative risk of dying from cancer

compared to nonsmokers. a. 5.0 b. 15.8 *c. 23.3 d. 50.0

61. Men who smoke cigars or pipes have a

relative risk of dying from cancer

compared to nonsmokers. *a. 5.0 b. 15.8 c. 23.3 d. 50.0

62. Heavy cigarette smoking decreases life expectancy by

years.

a. 2.1 b. 4.7 *c. 8.8 d. 15.2

63. Which of the following has the highest death toll from passive smoking? a. Lung cancer b. Breast cancer *c. Heart disease d. Pneumonia

64. 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.

65.

suffer the most health problems from passive smoking. *a. Children b. Adolescents c. Young adults d. Middle-aged adults

66. 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

67. 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.

68. 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 are safer without the tobacco of traditional cigarettes.

69. 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.

70. 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.

71. 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.

72. 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.

73. David 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.

74. Helen 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. to continue to smoke, but to cut down to decrease her disease risk, and also to avoid weight gain. c. to seek a trained hypnotist who can help her by using hypnosis. d. to find a therapist who will use shock therapy.

75. 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.

76. Smokers who are most likely to quit are a. women rather than men and/or younger female smokers. *b. those who have support from their therapists and families. c. those who have been diagnosed with heart disease or cancer. d. unmarried people having fewer social connections than others.

77. In the US, about

of smokers try to quit each year.

a. 20% *b. 44% c. 64% d. 90%

78. Quitting smoking on one’s own is possible, and one study found that more than

of smokers trying to quit were successful. a. 40% b. 50% *c. 60% d. 70%

79. Pharmacological approaches have largely been shown to be effective in helping

smokers quit except for a. female smokers. b. male smokers. *c. teenage smokers. d. elderly smokers.

80. 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.

81. 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.

82. 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 required for counseling to be effective. b. Computer/web-based contact is more effective than in-person. c. Text messaging is found less effective than web-based contact. *d. Smokers can quit and avoid relapse through all these methods.

83. If physicians give

, then smokers are more likely to attempt to quit.

a. information on the dangers of smoking b. information on the success rates in quitting *c. information that they advise smokers to quit d. information involving both a and b but not c

84. 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 even more effective. d. Both interventions are equally effective, but these are not better in combination.

85. Studies show that which of these elements make behavioral smoking cessation

programs more effective? a. When programs are briefer by having fewer sessions

b. When programs are specialized toward only smoking c. When programs are longer and provide other services *d. When programs are longer and specialize in smoking

86. A systematic view of studies on smoke-free workplaces indicate that this strategy a. reduces the number of cigarettes workers smoke. b. decreases the prevalence of smoking. c. decreases worker satisfaction. *d. accomplishes both a and b.

87. Which of the following is most accurate about the effects of community and media

health campaigns to reduce rates of smoking? *a. The percentage of people who quit is very low, so these programs do not

work. b. If the message reaches thousands of people, ultimately large numbers will quit. c. Campaigns alter acceptance of smoking, but this does not affect smoking rates. d. Systematic review finds these campaigns neither raise quitting nor lower rates.

88. In comparing who quits smoking to who does not quit smoking, all of the following

are correct EXCEPT: a. men quit smoking more than women. *b. young people quit smoking more than old people. c. highly educated people quit smoking more than less educated people. d. all of the above statements are correct regarding who quits/who does not.

89. 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)

90. 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

91. 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

92. 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

93. 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.

94. Many smokers worry about weight gain if they quit smoking. Research suggests that a. men are more concerned about weight gain than women. b. weight gain from quitting smoking is a myth. *c. the average weight gain is often fairly modest. d. the average weight gain is substantial, above 40 pounds.

95. 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 of a normal weight c. Cris, who is already underweight d. Starting weight has no influence

96. Jill, a 22-year-old college senior, wants to quit smoking, but she is worried that she

will gain weight. What would you advise her to do? a. Keep smoking, but reduce her level to about one-half. b. Adopt a low-carbohydrate diet, and then quit smoking. *c. Quit smoking and also start a regular exercise program. d. Keep smoking: losing weight helps more than quitting.

97. Pamir is upset because after quitting smoking, she has gained six pounds. According

to research results, what might she expect in the next five years? *a. The odds are that she will gain another six pounds. b. The odds are that she will maintain this new weight. c. The odds are that she will lose more than she gained. d. The odds are that she will lose the pounds she gained.

98. 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.

99. 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.

100. 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

101. Currently, about 33% of the adult population of the United States smokes. a. True *b. False

102. Cigarettes were often given away for free to soldiers during World War II. *a. True b. False

103. Most young people who begin smoking have very little knowledge of the dangers of smoking. a. True *b. False

104. Genes have been identified that affect smoking behavior, mostly through the effects of genes on neurotransmitters in the brain. *a. True b. False

105. Anti-smoking media campaigns are effective, but pro-smoking media campaigns are more effective. *a. True b. False

106. A middle-age woman who is 15 pounds over her desired weight (according to a measure of body mass index) but does not smoke has a lower risk of heart disease than a middle-aged woman who smokes two packs of cigarettes a day but is at her ideal weight.

*a. True b. False

107. 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

108. Adolescents who use smokeless tobacco are not likely to begin smoking cigarettes. a. True *b. False

109. Simply informing people of the risks of smoking can normally get most people to quit smoking. a. True *b. False

110. Women have an easier time quitting smoking than men. a. True *b. False

111. 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 21% of all adults smoked; 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

c.

People below the poverty level smoke at higher

rates. 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.

Correct Answer:

See below 112. 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.

Correct Answer:

113. 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.

Correct Answer:

114. 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. infant death.

Infants of smokers are at increased risk of sudden

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.

Correct Answer:

115. 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.

Correct Answer:

116. 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.

C.

Nicotine replacement alone helps smokers to quit.

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.

Correct Answer:

117. 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.

Correct Answer:

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. Non-smokers 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).

Correct Answer:

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.

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.

Correct Answer:

120. 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 nicotinespecific.

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 lownicotine 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.

3. 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.

Correct Answer:

Chapter 13 1. 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.

2. 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 has always been acceptable only for special occasions.

3. Alcohol consumption in the United States reached its peak during *a. the early 1800s. b. the Civil War. c. Prohibition. d. World War II.

4. 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.

5. 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.

6. 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.

7. With regard to the consumption of alcohol in the United States, it is most accurate to

say that about a. 90% of adults drink; about one fourth abuse alcohol. b. 75% of adults drink; about one tenth abuse alcohol. *c. 66% of adults drink; about 23% binge drink. d. 90% of adults drink; about 5% abuse alcohol.

8. In the United States, people of this ethnic background have the highest rate of

drinking. *a. European Americans b. Hispanic Americans c. African Americans d. Asian Americans

9. In the United States, people of this ethnic background have the highest rate of binge

drinking and heavy drinking. a. European Americans b. Hispanic Americans c. African Americans *d. Native Americans

10.

is the most widely consumed drug in the United States. a. Marijuana *b. Alcohol c. Cocaine d. Ecstasy

11. During the mid-1800s in the United States, the attitude toward alcohol was one of

. 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

12. The

outlawed the manufacture or sale of alcohol and the

ended

Prohibition. a. 18th Amendment; 19th Amendment *b. 18th Amendment; 21st Amendment c. 21st Amendment; 22nd Amendment d. 21st Amendment; 24 Amendment

13.

of adults in the US are classified as current drinkers. a. 33% b. 50% *c. 66% d. 10%

14. In the United States,

binge drinkers, and

of people are classified as regular drinkers, as heavy drinkers.

as

a. 50%, 25%, 13% *b. 50%, 23%, 6% c. 66%, 15%, 10% d. 66%, 10%, 6%

15.

drinking is having 5 or more drinks on the same occasion at least once per

month. *a. Binge b. Heavy c. Regular d. Moderate

16.

drinking is having 14 or more drinks per week for men or having 7 or more drinks per week for women.

a. Binge *b. Heavy c. Regular d. Moderate

17. Which ethnic group has the lowest rates of heavy and binge drinking? *a. Asian Americans b. Native Americans c. Hispanic Americans d. European Americans

18. In the age group of 18- to 24-year-olds, more than

are binge drinkers.

a. 10% b. 25% *c. 33% d. 40%

19. Binge drinking can lead to all of the following EXCEPT a. intoxication. b. poor judgment. c. impaired coordination. *d. long-term cognitive deficits.

20. In the 12- to 17-year-old age group of,

_ were current drinkers in 1992.

a. 10% *b. 20% c. 33% d. 40%

21. 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.

22. In general, a. high school dropouts have the highest rate of alcohol consumption. b. people with high school educations have the highest rate of alcohol

consumption. *c. college graduates have the highest rate of alcohol consumption. d. no relationship exists between educational level and consumption of alcohol.

23. In general,

are less likely to binge or drink heavily, whereas likely to be heavy and problem drinkers

are more

*a. college graduates . . . high school dropouts b. high school dropouts . . . college graduates. c. college graduates . . . high school graduates d. men . . . women

24. 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

25. 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. biological markers differentiating alcoholics from nonalcoholics.

26. Carla, a 120-pound woman, and her twin brother Carlos, a 200-pound man, decided

to celebrate their 21st birthday by equally dividing a six-pack of beer, although neither had consumed much alcohol before this time. You would guess that *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.

27. 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.

28. When a drug becomes incorporated into the functioning of the body's cells and thus

becomes necessary for "normal" functioning,

has occurred.

*a. dependence b. withdrawal c. tolerance d. death

29. The combination of physiological dependence and withdrawal symptoms is usually

referred to as a. tolerance. *b. addiction. c. psychological addiction. d. psychological dependence.

30. 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

31. Erick drinks about seven or eight drinks a day. Besides the risk of accidents, Erick's

greatest INCREASED risk is that of a. heart disease. b. oral cancer. c. lung cancer. *d. liver cirrhosis.

32. Korsakoff 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.

33. 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.

34. A woman who is a light to moderate drinker during pregnancy a. has a higher risk of having a child with fetal alcohol syndrome. b. has a higher risk of having a child with facial abnormalities only. *c. has a higher risk of having a miscarriage or of having a stillbirth. d. has a higher risk of having a child with heavier than average birth weight.

35. 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

36. 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.

37. Research indicates that alcohol *a. increases aggression in some people. b. decreases high-density lipoprotein. c. increases concentration. d. causes lung cancer.

38. Research on the relationship between alcohol and homicide indicates that a. the killer is likely to have been drinking. b. the victim is likely to have been drinking. *c. both victim and killer are likely to have been drinking. d. alcohol consumption causes people to commit homicides.

39. College-aged men who have been drinking a. tend to lose interest in women. b. tend to drive motor vehicles more cautiously. c. report that they can concentrate better on schoolwork. *d. are more likely than sober men to be willing to have unprotected sex.

40. 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.

41. 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

42. Low to moderate levels of drinking decrease the risk for

drinking increase the risk for

.

a. automobile crashes . . . automobile crashes. *b. Alzheimer’s disease . . . Korsakoff syndrome c. bicycle injuries . . . ulcers d. gallstones . . . lung cancer

; high levels of

43. Kane, 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

44. Physical symptoms, such as restlessness, irritability, and tremors, may occur when a

person is experiencing _

from alcohol.

a. tolerance b. dependence *c. withdrawal d. addiction

45. Liver damage and mouth cancer both are considered

motor vehicle accidents and aggressive behavior both are considered

of alcohol, and .

a. indirect hazards; direct hazards *b. direct hazards; indirect hazards c. indirect hazards; direct benefits d. direct hazards; direct benefits

46.

is the accumulation of nonfunctional scar tissue in the liver. *a. Cirrhosis b. Liver cancer c. Pancreatitis d. Jaundice

47. Around

of fatal unintentional injuries throughout the world involve alcohol.

a. 11% *b. 17% c. 47% d. 69%

48. Which of the following ethnic groups are more likely to drive after drinking?

*a. European Americans b. Hispanic Americans c. African Americans d. Asian Americans

49.

combined with alcohol predicts intimate partner violence. a. Trait anger *b. Jealousy c. Emotional lability d. Both a and b

50. 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.

51. The benefits of drinking alcohol appear a. as soon as one begins to drink. b. among young adults. *c. during middle age. d. never; benefits do not outweigh risks.

52. Research on the genetic component of alcoholism tends to indicate a. no hereditary influence either or women or for men. b. a strong hereditary influence for both women and men. c. a strong hereditary influence for women but not for men. *d. some support for hereditary influence, especially in men.

53. During the past 60 years, the medical community has been most strongly influenced

by this explanation for why people drink: a. the tension reduction hypothesis. b. the stress response dampening model. *c. the disease model. d. the social learning model.

54. The alcohol dependency syndrome a. considers alcoholism as a medical disease. b. assumes that alcoholics lose complete control of their drinking. c. views alcoholism as an inherited disease. *d. assumes different people have different patterns of drinking.

55. The disease model explains why people

better than

.

*a. drink too much . . . why people start drinking b. experience cognitive deficits while drinking . . . why some people can abstain

from drinking c. model the drinking behavior of others . . . why people drink too much d. start drinking . . . the genetic contributions to alcoholism 56. Which of these terms does NOT apply to the 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

57. 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.

58.

suggests that people drink because they do not exercise control over

their drinking. *a. The alcohol dependency syndrome b. The moral model c. The alcohol myopia model d. The social learning model

59. One major criticism of this model is that it fails to address why people begin to

drink. *a. The disease model

b. The tension-reduction model c. The alcohol myopia model d. The social learning model

60. A research study that asked participants to rate themselves on a variety of traits

suggests that *a. alcohol inflates a person’s self-evaluation. b. alcohol deflates a person’s self-evaluation. c. alcohol inflates a person’s self-evaluation of other people only. d. alcohol deflates a person’s self-evaluation of other people only.

61. 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.

62. 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 are reasons they begin to drink.

63. 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.

64. 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.

65. The alcohol myopia view of drinking assumes that alcohol consumption leads to a. deflation of one's accomplishments. b. loss of control over one's drinking. *c. increased friendliness and sexiness. d. increased inhibitions, plus insights.

66. The concepts of modeling, positive reinforcement, and negative reinforcement are

important ingredients in this model of drinking. a. The tension reduction model b. The alcohol myopia model c. The alcohol dependency syndrome *d. The social learning model

67. 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.

68. 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.

69. Reviews of psychological interventions for problem drinking show *a. brief interventions and techniques oriented toward changing motivation are

most effective. b. psychotherapeutic programs overall are less effective than Alcoholics Anonymous. c. once a person is an alcoholic, that person can never return to controlled drinking. d. group therapy has been found to be more effective than individual therapy has been.

70. 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. all of these as characteristics of this technique.

71. Disulfiram is used in the treatment of alcohol abuse a. but is limited to controlled drinkers. *b. because it produces unpleasant effects if combined with alcohol. c. because it is associated with a therapy called counterconditioning. d. due to its ability to treat liver damage.

72. The most common form of treatment for problem drinking is a. inpatient treatment. b. outpatient treatment. *c. the self-help groups. d. no formal treatment.

, a type of therapy where therapists convey their empathy with the client’s situation, has been shown to be effective in decreasing problem drinking.

73.

*a. Motivational interviewing b. Alcoholics Anonymous c. Spontaneous remission d. Aversion therapy

74. For problem drinkers, most relapses occur within

after the end of the

treatment program. a. 1 week *b. 90 days c. 6 months d. 1 year

75. One year after the end of treatment, about

completed the treatment are still abstinent. a. 10%

of problem drinkers who have

b. 25% *c. 35% d. 55%

76. A major problem with chemical treatments for alcohol abusers (such as disulfiram)

is a. their ineffectiveness. b. their high relapse rates. *c. their low compliance rates. d. they rarely are used with other treatments.

77. The drugs naltrexone and acamprosate are chemical treatments for alcohol abuse a. that produce nausea when a person takes either drug and drinks alcohol. b. that are used in aversion therapy. *c. that help control cravings for alcohol and maintain abstinence. d. both a and b

78. Alcohol treatment programs with abstinence as the goal *a. sometimes produce patients who are able to resume normal drinking

patterns. b. generally have higher success rates than programs that teach controlled drinking. c. have yet to produce patients who are able to resume normal drinking patterns. d. are most frequently found to subscribe to the social learning model of drinking.

79. Studies on controlled drinking have found that a. no true alcoholics can be trained to resume normal drinking. b. all subjects were functioning well after three years. *c. abstinence-oriented programs sometimes produce controlled drinkers. d. participants trained to abstain were more likely to be successful than those

trained to control their drinking.

80. Molly is a licensed professional counselor who has just begun working with problem

drinkers. She read some studies on controlled drinking, and she plans to help people learn to control their rate of alcohol consumption. Molly should know that

a. controlled drinking is less effective than 12-step programs such as Alcoholics

Anonymous. *b. most treatment facilities in the United States do not support this goal. c. controlled drinking is less successful with patients after the age of 50. d. controlled drinking is the goal of most programs in the United States.

81. The neurotransmitter

is involved in the effects of several drugs that

affect brain function. *a. dopamine b. epinephrine c. THC d. methylapoprobate

82. 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 legal drugs. *d. Both legal drugs and illegal drugs may pose a heath threat.

83. All drugs that cross the blood-brain barrier a. change brain chemistry. b. have side effects. c. alter perception. *d. do all of these.

84. 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.

85. 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.

86. Morphine and heroin are a. stimulant drugs. *b. opiate drugs. c. used medically to relieve pain. d. both b and c are correct.

87. 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.

88. Amphetamines *a. are stimulants. b. are depressants. c. include opium and marijuana. d. include barbiturates and tranquilizers.

89. Amphetamines *a. can cause hallucinations and delusions. b. usually decrease the blood pressure. c. cannot produce any dependence. d. cannot produce any tolerance.

90. 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 a depressant and a tranquilizer. d. all of these are things that apply to Traci’s situation.

91. 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.

92. The most commonly used illegal drug in the United States is a. heroin. b. cocaine. *c. marijuana. d. anabolic steroids.

93. All of the following drugs are classified as sedatives EXCEPT: a. barbiturates. b. alcohol. c. opiates. *d. LSD.

94. All of the following drugs could be classified as stimulants EXCEPT: *a. marijuana. b. caffeine. c. nicotine. d. cocaine.

95. BethAnne 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. BethAnne hasmost likely taken a. marijuana. b. caffeine. c. nicotine. *d. ecstasy.

96. Samuel has just taken an illegal drug that leaves him feeling relaxed, but it has

the side effect of impairing his judgment and coordination. Samuel has most likely taken a. alcohol. *b. marijuana. c. caffeine. d. cocaine.

97. 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.

98. 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.

99. Treatment for the use and abuse of illegal drugs is similar to the treatment of

,

both in the philosophy and the administration of treatment. *a. alcohol abuse b. smoking c. overeating d. exercise addiction

100. 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 controversial and not yet widely accepted, but supported by evidence.

101. Alcohol is a drug that does not produce withdrawal symptoms. a. True *b. False

102. Most psychologists regard alcoholism as a disease. a. True *b. False

103. The Food and Drug Administration considers marijuana as a Schedule I drug. *a. True b. False

104. The most commonly used illegal drug in the United States is marijuana. *a. True b. False

105. Regardless of how much you drink, alcohol has negative effects on the cardiovascular system. a. True *b. False

106. Light to moderate drinking provides health benefits compared to abstaining from drinking. *a. True b. False

107. Twin studies and adoption studies indicate that genetics plays a stronger role in problem drinking for men than women. *a. True b. False

108. A meta-analysis of studies on alcohol confirmed that expectancy plays an important role in alcohol’s effects. *a. True b. False

109. Women are more likely than men to seek treatment for problem drinking. a. True *b. False

110. Most psychoactive drugs cause damage to the nervous system. a. True

*b. False

111. Contrast the attitudes and rates of drinking today with theattitudes 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.

Correct Answer:

See below 112. 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 is also associated with several health benefits.

1.

Light to moderate drinking is beneficial; heavy drinking and binge drinking are not.

2.

Light to moderate drinkers have lower levels of mortality, and cardiovascular benefits are the main reason.

3.

Light to moderate drinking lowers the risk for Type 2 diabetes, gallstones, ulcers, and Alzheimer’s disease.

4.

Light to moderate drinkers also have decreased rates of hospitalization and illness as well as higher levels of health when compared to nondrinkers or heavy drinkers.

Correct Answer:

See below 113. 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.

19th century.

B.

This view was the leading explanation until the late

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.

Correct Answer:

See below 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.

Correct Answer:

See below 115. Jason and Justin 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 Justin 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, similar to the reaction that some Asians experience.

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 Justin’s drinking in terms of a greater balance of positive than aversive consequences. Many possibilities exist or combine to make Justin a heavy drinker.

1.

Justin may have friends who encourage his drinking.

2.

Justin may enjoy the taste or effects of alcohol, or

both.

3. expected norm.

Justin may enjoy going to places where drinking is the

4.

Justin may be trying to cultivate an image that is consistent with drinking.

Correct Answer:

See below 116. 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 drinkin a non-problem way.

to

teach

problem

drinkers

how

to

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.

Correct Answer:

See below 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, the most commonly used illegal drug.

2. health effects.

Drugs such as sedatives and cocaine can have negative

3.

Illegal drug use has large social implications, but the health threats are minor.

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.

Correct Answer:

See below 118. 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.

Correct Answer:

See below 119. 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.

Correct Answer:

See below

Chapter 14 1.

NOT part of the digestive system. a. The teeth are b. The esophagus is c. The stomach is *d. The bronchioles are

2. 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.

3.

furnish(es) moisture that allows food to be tasted. a. The esophagus b. The tongue *c. Salivary glands d. Teeth

4.

propels food through the digestive system, a largely involuntary process. *a. Peristalsis b. Gastric juices c. Salivary Glands d. Parotids

5. Digestion of most types of nutrients occurs in the

.

a. large intestine b. stomach *c. small intestine d. gall bladder

6. Which system of the body is plagued with more diseases and disorders than any other

system? a. Immune *b. Digestive

c. Cardiovascular d. None of the above

7. 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.

8. From the stomach, digested food passes into the *a. small intestine. b. large intestine. c. anus. d. blood stream.

9. 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.

10.

levels fall when fat stores fall, which may provide a long-term signal to eat

more. *a. Leptin b. Ghrelin c. Cholecystokinin (CCK) d. Agouti-related peptide

11.

is a hormone produced by the stomach. Its levels rise before and fall after meals, which may provide a short-term signal to eat. a. Leptin *b. Ghrelin c. Cholecystokinin (CCK) d. Glucagon-like peptide 1

12. 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.

13. The hormone

provides a short-term signal for eating, and a long-term signal for regulating weight.

provides

a. insulin . . . CCK b. leptin . . . insulin c. serotonin . . . epinephrine *d. ghrelin . . . leptin

14. 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. Fat people eat fewer calories per day than do thin people.

15. 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.

16. 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.

17. 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.

18. 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.

19. 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.

20.

levels signal low fat stores, prompting individuals to eat. *a. Low leptin b. High leptin c. Low insulin d. High insulin

21. 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.

22. Obesity can result from a. overeating. b. slow metabolism. c. too little physical activity. *d. any or all of these.

23. Carl is five feet, ten inches tall, has a medium frame, and weighs 154 pounds. In other

words, Carl is about in the middle of the ideal weight range according to the Metropolitan Life Insurance Company's desirable weight charts. This means that Carl a. has a healthy waist-to-hip ratio. b. needs to gain a few pounds. c. should try to lose a few pounds. *d. none of these.

24. The skinfold technique and bioelectrical impedance are 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

25. 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.

26. 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

27. Christi is five feet four and has a body mass index of 17.5. Christi could most accurately be

described as *a. extremely thin. b. somewhat thin. c. average in weight. d. somewhat heavy.

28. Throughout most of history, being plump or fat

a. was a sign of laziness. *b. was a mark of prosperity. c. was a signal of poor health. d. characterized working-class people.

29. An analysis of the women who have won the Miss America contest since 1978 showed what

percent of them in the underweight range? a. 25% b. 50% c. 75% *d. 100%

30. Most people who see themselves as being overweight are a. African American women. *b. not at risk for increased mortality. c. greatly at risk for increased mortality. d. both a and c are true.

31. During the past 20 years, Americans have reduced the percent of calories obtained from

dietary fat, and a. they have become thinner. *b. they have increased their sugar consumption. c. they have decreased their fast food consumption. d. their average weight has remained the same.

32. 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.

33. 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.

34. From an anthropological perspective, what would be the advantage of a set-point 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

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.

36. 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.

37. 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.

38. 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.

39. 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.

40. 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 get reinforcements for having fat children. d. people get punishments for having fat children.

41. Nelson enjoys tasty food, and he will eat food he likes even when he isn't hungry. This

eating pattern is most consistent with the

model.

*a. positive incentive b. psychodynamic c. set-point d. behavior modification

42. 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.

43. 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.

44. Self-reports indicate that overweight people

that overweight people *a. eat less; eat more b. eat less; eat less

.

and objective measurements indicate

c. eat more; eat more d. eat more; eat less

45. Using body mass index (BMI), a BMI of

to

is defined as overweight.

a. 30; 45 *b. 25; 29.9 c. 17.9; 25 d. 25; 30

46. Extreme obesity in American adults

during the 1990s.

a. stayed the same *b. doubled c. tripled d. decreased

47. 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.

48. If using BMI to define obesity and overweight, then at least

of adults are overweight

and obese in the US. a. 20% b. 34% c. 55% *d. 70%

49. 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.

50. Although there is support for a

explanation of obesity, this does not fully explain why obesity rates have skyrocketed in the past two decades.

a. set-point *b. genetic c. positive incentive d. biological

51. Research on sleep and weight has shown that

precedes weight gain.

*a. short sleep duration b. taking many naps c. a long sleep cycle d. both a and b

52. Eating foods high in

may increase appetite rather than lead to feelings of satiation.

a. calories b. carbohydrates *c. fat and sugar d. flavor

53. 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.

54. 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.

55. Studies from the United States and Europe show that people begin to have a slightly higher

risk for all-cause mortality after their body mass index reaches a. 20 b. 24 c. 28 *d. 32

or higher.

56. Bart is concerned because his 75-year-old grandfather has always been about 20 pounds

overweight and refuses to diet. Bart should know that a. losing weight after age 60 doubles the risk for cardiovascular disease. *b. overweight may protect his grandfather’s mortality a bit at his age. c. his grandfather should go on a diet whether he wants to do so or not. d. both a and c are correct.

57. In general, which of these people would have the GREATEST risk for health problems due

to being overweight? a. A 50-year-old man who is 20% over his ideal weight with most of the extra

weight on his thighs and hips *b. A 50-year-old man who is 20% over his ideal weight with most extra weight around his abdomen c. A 50-year-old woman who is 20% over her ideal weight d. A 26-year-old woman who is 25% over her ideal weight 58. Research has shown a positive relationship between obesity and a. high blood pressure. b. cardiovascular disease. c. Type 2 diabetes. *d. all of these health risks.

59. 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. Being 10 pounds overweight

60. Which of these people has the GREATEST danger of developing a health problem? a. A woman who is 15 pounds overweight b. A woman whose weight is 10% above the weight recommended by the weight

charts c. A man whose weight is a stable 12% above the weight recommended by the

weight charts *d. A man who gains 20% above the ideal recommended weight

61. A low-carbohydrate, high-fat diet a. may initially produce weight loss. b. is an attractive dieting choice for many people. c. produces a lower dropout rate than some other programs. *d. may include any or all of these characteristics.

62. A single-food diet (for example, all the hard-boiled eggs you want) a. will not produce weight loss unless the single food is low in calories. b. is nutritionally more balanced than most liquid diets are. *c. may produce weight loss via boredom from no variety. d. is usually a high fiber, low-carbohydrate diet.

63. Both low-carbohydrate diets and low-fat diets share one drawback: a. neither produces weight loss. b. both are unhealthy. *c. modest long-term weight loss. d. all of these are drawbacks.

64. 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

65. 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.

66. 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.

67. 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.

68. What would you tell your female friend who is 15 pounds above her ideal weight and who

has asked you for advice? a. "Give up sweets for 6 weeks." b. "You look great. Forget about losing weight." *c. "Forget about dieting; adopt a regular exercise program and stop overeating." d. "Eat the same kinds of food you're eating now, but only about half as much."

69. 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

70. 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.

71. 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.

72. 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.

73. In surveys (2013, 2004) of adults,

of women were trying to lose weight in 2012, and

were in 2002. a. 20%, 15% *b. 38%, 23% c. 22%, 33% d. 76%, 67%

74. Diets that contain

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

75. One recent study found that dieters who

lost twice as much weight as those on the

same program that did not a. attended therapy sessions *b. maintained a food diary c. exercised twice a week d. both a and c were found

76. A review of commercial weight loss programs found that individuals are highly likely to

in 1-2 years. *a. regain 50% of lost weight b. keep off their lost weight c. regain 10% of lost weight d. keep losing more weight

77. 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

78. 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.

79. Who is most likely to gain health benefits from dieting? a. A person with a BMI of 26 who is able to lose weight but gains it back b. A 55-year-old who has gained 15 pounds over the past 5 years c. A person who was 25 pounds over ideal weight but has already lost 15 pounds *d. A person who is 40 pounds overweight and is able to lose 10% of body

weight 80. People who

lose weight may experience health benefits; those who lose weight are at increased risk for health problems.

a. unintentionally . . . intentionally *b. intentionally . . . unintentionally c. rapidly . . . slowly d. always . . . never

81. Victoria is anorexic. Which of these is LEAST likely to be characteristic of her? a. To have experienced little emotional support from her family b. To be of upper-middle or upper social class *c. To have increased interest in sexual activity d. To experience a loss of scalp hair

82. Which of these characteristics is LEAST likely among anorexics? a. Young, white, and female b. Preoccupation with food *c. Viewing oneself as too thin d. Ambition and perfectionism

83. Although individual differences exist among anorexics, one characteristic typically found is a. a denial of femininity. b. a fear of motherhood.

*c. achievement orientation. d. a dislike of cooking or food.

84. Chris is anorexic. Which of these is LEAST likely to be a characteristic of Chris? a. A view of oneself as being too fat *b. Being of the male gender c. Preoccupation with food d. Ambitious, with high needs for achievement

85. Anorexics are most likely to have experienced *a. physical and sexual abuse. b. emotional support from their parents. c. close, warm relationships with their mothers. d. failures related to their performance in school.

86. Male anorexics are quite similar to female anorexics in terms of social class and family

configuration, symptoms, treatment, and prognosis. However, they differ from female anorexics in that their ideal body build is *a. muscular. b. tall. c. short. d. corpulent.

87. The immediate aim of treatment programs for anorexics is usually a. increased self-esteem. b. better relationships with parents. *c. weight restoration. d. weight loss.

88. Which of these groups of people are LEAST motivated to seek help for their eating

disorder? a. Men with bulimia *b. Women with anorexia c. Moderately overweight women d. Men who are severely obese

89. An anorexic is MOST likely to make which statement? a. "I wish I had as much control over my weight as other people." *b. "If I gain one pound, I'll never stop gaining." c. "I can't stand the sight or smell of food." d. "I would give anything to be like other people."

90. Demographic descriptions of anorexics and bulimics are similar in many ways. Which is

NOT a similarity? a. Being female b. Having a desire to be thin *c. Having impulse control deficits d. Childhood physical or sexual abuse

91. After treatment that includes hospitalization and weight gain, anorexics a. usually retain the urge to be thin. b. usually return to normal eating. c. often show other psychological problems. *d. both a and c.

92. After treatment, anorexics a. usually become bulimic. b. usually change their body images. *c. may still have trouble reaching healthy body weights. d. typically become more compliant with their parents' wishes.

93. Unlike anorexics, bulimics a. are usually male. b. are less often female. c. never abuse fasting or exercise. *d. are more likely motivated to change.

94. Terry is bulimic. Which of these is LEAST likely to be characteristic of Terry? a. Female *b. Severe obesity c. Kleptomania d. Alcohol problems

95. Charlotte is bulimic. Which of these is LEAST likely to be characteristic of Charlotte? a. Bingeing b. Purging *c. Amenorrhea d. Use of laxatives

96.

are MOST likely to be described as lacking impulse control. a. Anorexics b. Bulimics c. Binge eaters *d. Bulimics and binge eaters

97. Tiffany has been diagnosed with bulimia. A strong possibility exists that Tiffany a. is a high achiever in school. *b. was sexually abused as a child. c. is 30 to 40 pounds underweight. d. has a high level of self-esteem.

98. The cognitive behavioral treatment for bulimia aims to a. change the eating patterns of the individual. b. change distorted cognitions concerning body image. c. prompt weight gain. *d. both a and b.

99. 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 is a. bulimic *b. anorexic c. bingeing d. both a and c

100. All of the following are risks for eating disorders EXCEPT *a. having relatively little ambition. b. having negative family interactions.

.

c. a history of childhood sexual abuse. d. having a lower self-esteem level.

101. Without moisture provided by the salivary glands, taste buds on the tongue do not function. *a. True b. False

102. Overeating is the sole cause of obesity. a. True *b. False

103. Metabolic rates are similar across people. a. True *b. False

104. A person with a body mass index (BMI) of 45 would be considered obese. *a. True b. False

105. The body mass index (BMI) considers neither gender nor body frame. *a. True b. False

106. The set-point model suggests that it should be quite easy to gain or lose weight. a. True *b. False

107. A big butt is healthier than a fat gut. *a. True b. False

108. In a population of college women, bulimia would be more prevalent than anorexia. *a. True b. False

109. Bulimia is more likely to be fatal than anorexia. a. True *b. False

110. European American females are more likely to have an eating disorder than any other ethnic group. a. True *b. False

111. What is the relationship between overeating and obesity?

Correct Answer:

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 normal weight people, 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 normal weight people.

3. People who are obese tend to eat more high-fat food than normal weight people.

4. Obese people are less physically active than leaner individuals.

112. Evaluate the role of hormones in weight regulation.

Correct Answer:

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.

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

Correct Answer:

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.

114. Darlene is 15 pounds heavier than the ideal (according to the Metropolitan Insurance Company charts), and she believes she should go on a diet to lose 15 pounds. Advise her as to what type of diet to choose and what type to avoid.

Correct Answer:

A. Darlene should choose a program that: 1. Contains a variety of foods, so that she 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. She can adapt to a permanent change in her eating patterns rather than a temporary change to produce weight loss.

B. Darlene 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.

115. Darlene is 15 pounds heavier than the ideal. Should she diet to improve her health?

Correct Answer:

A. Darlene may want to lose weight to be closer to the current thin body ideal, but she probably does not need to diet to improve her health.

1. If Darlene’s blood pressure is normal and she does not have diabetes, her deviation from the ideal is probably not a substantial health threat.

2. If Darlene has the pattern of fat distribution that most women do—fat accumulated on the thighs and hips rather than around the waist—her excess weight is not likely to be a threat to her health; if her excess weight is around her waist, however, a diet might not be completely unreasonable.

3. Being overweight is usually not a threat to health until it reaches 30% above the charted weight, far more than Darlene’s 15 pounds.

B. Dieting may be an unwise choice for Darlene because: 1. Darlene is not sufficiently overweight to gain health benefits from dieting.

2. Losing weight may involve extreme diets that can threaten health.

3. She is likely to gain back the weight she has lost, and gaining weight is more of a health risk than losing is a benefit.

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

Correct Answer:

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. Anorexics are dangerously thin; bulimics are usually of normal weight; binge eaters are usually overweight.

3. Anorexics practice a great deal of self-denial, starving and exercising a great deal; bulimics and binge eaters are self-indulgent, impulsive, eat a lot, take drugs or drink alcohol, and steal.

4. Bulimics and binge eaters are often depressed, but anorexics 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. Anorexics resist treatment, denying that they have a problem; bulimics and binge eaters 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.

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

Correct Answer:

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.

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

Correct Answer:

Digestion starts in the mouth.

A. 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.

Peristalsis moves feces through the large intestine to the rectum, and then into the anus for excretion.

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

Correct Answer:

Conducted during World War II and reported/published in 1950, this study involved 36 young male conscientious objectors who volunteered.

A. 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.

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

Correct Answer:

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.

A. 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.

Chapter 15 1. Isometric exercise is designed to a. increase cardiovascular fitness. b. increase lung capacity. c. increase muscle endurance. *d. increase muscle strength.

2. The type of exercise that requires the LEAST amount of physical activity is *a. isometric. b. isotonic. c. isokinetic. d. anaerobic.

3. 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

4. Pushing muscles hard against an immovable object is an example of

exercise.

a. aerobic b. anaerobic c. isokinetic *d. isometric

5. Isotonic exercise is designed to a. increase cardiovascular fitness. b. increase muscle endurance. c. increase muscle strength. *d. increase both (b) and (c).

6. What type of exercise requires specialized equipment to promote muscle strength and

muscle endurance? *a. Isokinetic

b. Isotonic c. Isometric d. Anaerobic

7. 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

8. 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.

9. 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.

10. Tatum 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 Tatum probably has is a. dynamic fitness. *b. organic fitness. c. both dynamic and organic fitness. d. neither dynamic nor organic fitness.

11. The type of fitness known as flexibility is best increased by a. weight lifting. *b. stretching. c. jogging. d. short, fast runs.

12. Cynthia 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 exercise. a. anaerobic b. aerobic c. isometric *d. isokinetic

13. Activities such as jogging, cross-country skiing, or swimming are classified as

exercise and activities such as short-distance running or softball are classified as exercise. a. anaerobic; aerobic b. isometric; aerobic *c. aerobic; anaerobic d. aerobic; isometric

14. If the goal of your exercise program is to improve your cardiovascular health, you should

most likely engage in

exercise.

a. anaerobic *b. aerobic c. isometric d. isokinetic

15. 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.

16. Aerobic fitness tends to a. increase muscle strength. b. decrease resting heart rate. c. decrease resting blood pressure. *d. decrease b and c, not increase a.

17. What is/are the important features of aerobic exercise? a. Intensity

b. Duration c. Frequency *d. (a) and (b)

18. People who have high aerobic fitness, compared with those who have low aerobic fitness, a. have about the same rate of all-cause mortality. b. have a higher rate of all-cause mortality. *c. have a lower death rate from heart disease. d. have a higher death rate from heart disease.

19. Bess has moderate weight and good organic fitness. If she begins an aerobic exercise

program, she will probably a. lose 10 to 15 pounds. b. gain 10 to 15 pounds. *c. increase lean body weight and decrease body fat. d. decrease lean body weight and increase body fat.

20. 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.

21. Lynn 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.

22. Muscle *a. strength b. endurance c. flexibility d. fitness

is a measure of how strongly a muscle can contract.

23. 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. A muscle needs each one of these to get the other. d. A muscle needs a different exercise type for each.

24. Arnold wants to increase his muscular strength; Sinclair wants to increase his muscular

endurance. What should each of them do to achieve these goals? a. Arnold should do more repetitions with less exertion; Sinclair should do fewer

repetitions with more exertion. b. Arnold should do more repetitions with more exertion; Sinclair should do fewer repetitions with less exertion. c. Arnold should do fewer repetitions with less exertion; Sinclair should do more repetitions with more exertion. *d. Arnold should do fewer repetitions with more exertion; Sinclair should do more repetitions with less exertion.

25. Exercise like yoga and tai chi can help provide muscle

.

a. strength b. endurance *c. flexibility d. fitness

26. Jerry is a professional football player and wants to increase his 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.

27. 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.

28. Tara is relatively satisfied with the looks of her upper body, but she wants to lose weight on

her hips while retaining the rest of her body composition. Tara 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.

29. 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.

30. Joel, 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 Joel'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.

31. 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.

32. 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 (PA)? 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.

33. A 1978 study of Harvard alumni found those who expended 2,000 kcal weekly (like 20

miles of jogging or equivalent weekly) had lower heart attack risk than those less physically active. What else did this study find? a. More exercise also benefited the men who were smokers. b. More exercise also benefited the men with hypertension. *c. More exercise also benefited the men in both (a) and (b). d. More exercise than 2,000 kcal lowered heart risk further.

34. Authors of recent (2011) 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.

35. 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.

36. Clinton was a long-distance runner in high school and college. Now, at age 30, he lives an

inactive life. Clinton believes that his earlier experiences as a track star will offer permanent protection against cardiovascular disease (CVD). Clinton'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.

37. Women who exercise *a. have about the same rate of all-cause mortality as men who exercise. b. have a lower risk of all-cause mortality than do men who exercise. c. have a higher risk of all-cause mortality than do men who exercise. d. have about the same risk of all-cause mortality as men, but their rate of lung

cancer is much higher than that of men who exercise.

38. Research has generally found that a program of regular physical activity a. can add as much as two years to people's lives. b. can lower levels of disability during old age. *c. can accomplish the outcomes in both a and b. d. results in more deaths than an inactive lifestyle.

39. The benefits of physical activity are most strongly evident with *a. heart disease. b. injuries. c. cancer. d. young children.

40. 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.

41. 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.

42. 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.

43. A systematic review of the literature on the relationship between physical activity and

cardiovascular disease found that physical activity confers a to cardiovascular causes.

reduction in risk of death due

a. 10% b. 25% *c. 35% d. 0%

44. Physical activity confers a

reduction in risk of death due to all causes.

a. 5% b. 12% c. 24% *d. 33%

45. Physically active people can expect to live, on average,

longer than physically

inactive people. *a. 2 years b. 5 years c. 10 years d. 15 years

46. 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. in men, but not to reduce this incidence in women. *d. for women and men, but more strongly for women.

47. Evidence is clearest that physical activity protects against

cancer in both men and

women. *a. colon b. lung c. stomach d. skin

48. 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.

49. Researchers have recently suggested which of the following as likely mechanisms whereby

physical activity (PA) lowers cancer risks? a. PA inhibits the initial formation of cancer tumors. b. PA inhibits the growth of existing cancer tumors. c. PA inhibits release of proinflammatory cytokines. *d. PA inhibits each of these cancer-related processes.

50. Jolie is undergoing chemotherapy treatment for cancer and undertakes a program of exercise

training. Based on research results, what can she expect? a. Exercise will improve her aerobic fitness but not her strength. *b. Exercise will not help her nausea but help manage her fatigue. c. Exercise will improve her strength but not her aerobic fitness. d. Exercise will improve her appetite, but not change her weight.

51. High-impact exercise is MOST likely to protect against osteoporosis at older ages when

do it. *a. young women b. middle-aged and older women c. young men d. middle-aged men

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.

53. Your great aunt Inez is a healthy 85-year-old who has led an essentially sedentary lifestyle.

Now she is thinking about walking in the shopping mall and asks you for advice. What would you tell her? *a. "See a trainer, who will likely tell you to start easy and gradually increase

speed and distance." b. "Walking is not a sufficiently vigorous form of exercise. You should take up jogging instead." c. "It's too late for you to gain any benefits from physical activity at your age." d. "Find a partner who will push you to raise your heart rate to 150 or higher."

54. Exercise may protect non-Caucasian women against

better than Caucasian women.

*a. breast cancer b. colorectal cancer c. lung cancer d. endometrial cancer

55.

is a disorder characterized by a reduction in bone density due to calcium loss. a. Endometrial cancer b. Type II diabetes c. Atherosclerosis *d. Osteoporosis

56. 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

57. Physical activity can be a useful treatment for

against the development of

and may offer some protection

.

a. Type II diabetes; Type I diabetes *b. Type I diabetes; Type II diabetes c. Type I diabetes; gestational diabetes d. Type I diabetes; Type I diabetes

58. Evidence suggests that a regular exercise regimen can a. decrease depression. b. reduce anxiety. c. buffer stress. *d. all of the above.

59. Adults who participate in regular physical exercise show a. greater attentional focus. b. greater executive functioning. c. greater memory. *d. all of the above.

60. Aerobic fitness training contributes to

in older adults.

*a. increases in brain volume b. lower risk of Alzheimer’s disease c. greater performance on standardized tests d. all of the above

61. 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.

62. 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 bother about any of the above because injury is not likely.

63. The optimal time for beginning a structured exercise program is during *a. early childhood. b. adolescence. c. young adulthood. d. middle adulthood.

64. 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 these.

65. 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.

66. 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.

67. 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.

68. Research into the effects of exercise on anxiety have 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. both a and b are accurate results.

69. 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.

70. 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.

71. 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.

72. A study (Wiley et al., 2016) of almost 1,000 older adults found which of the following? *a. Those who exercised a lot seemed cognitively 10 years younger than those who did

not after five years. b. Those who exercised a lot seemed cognitively five years younger than those who did not after 10 years. c. Those who did not exercise lost about 10 years cognitively; those who exercised a lot did not lose years. d. Those who did not exercise lost about five years cognitively; those who exercised a lot did not lose years.

73. Mariah would likely be an obligatory exerciser if she a. felt a need for mastery over her body. b. denied when she was experiencing pain. c. had a single-minded commitment to endurance. *d. demonstrated each one of the above characteristics.

74. A 1996 Surgeon General’s Report found that

the past year. a. one quarter b. one third *c. one half d. two thirds

75. Most sudden deaths during exercise are the result of a. inadequate clothing for weather conditions. *b. some type of pre-existing heart problems. c. getting hit by cars while running/walking. d. not having sufficient physical fitness levels.

76. Obligatory exercisers have more than their share of *a. eating problems. b. divorces.

of runners had experienced an injury in

c. cardiovascular problems. d. colon cancers.

77. Which of the following causes more sore muscles and minor injuries? a. Consistent exercise *b. Inconsistent exercise c. Any kind of exercise d. Absence of exercise

78. Musculoskeletal injuries correlate

with exercise frequency and intensity.

a. inversely b. neutrally *c. positively d. not at all

79. Physical activity causes

of all musculoskeletal injuries.

a. the minority b. about a half c. one quarter *d. the majority

80. Leonard'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.

81. 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 bother about any of the above because injury is not likely.

82. 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.

83. 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.

84. In general, the minimum amount of exercise necessary for cardiovascular health is about *a. 20 to 30 minutes of brisk walking or jogging, 5 times a week. b. 30 to 45 minutes of moderate jogging, 5 or 6 times a week. c. 30 to 45 minutes of vigorous running, 7 times a week. d. 45 to 60 minutes of jogging, 5 to 7 times a week.

85. A panel of experts reviewed the evidence on how much exercise is enough and

recommended that every adult should a. exercise vigorously at least 40 minutes a day, 6 days a week, plus complete

strength training. b. engage in 45 minutes of aerobic exercise daily. *c. participate in 20 minutes of moderately vigorous activity 5 days a week, plus strength training. d. accumulate 60 minutes of moderate physical activity a day or at least on most days.

86. Current physical activity recommendations are that children and 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.

87. Current physical activity recommendations are that adults should engage in a. 1 hour of moderate to vigorous physical activity each day *b. 1 hour 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

88. Murph had a sedentary parent who had a heart attack and has been sedentary himself. He

starts exercising to reduce his cardiovascular risk. Graciela starts exercising because she lost weight by changing her diet and wants to maintain the weight loss. H a. Murph will need to exercise at lower intensities for longer durations. b. Graciela will need to exercise at a higher intensity for a shorter time. *c. Graciela will need to exercise at higher intensity for longer duration. d. Murph and Graciela will both need to exercise equally to meet goals

89. Only

of adults in the US get regular physical activity.

a. 10% b. 27% *c. 33% d. 52%

90. Which type of interventions seek to raise public awareness of the importance and benefits of

physical activity? *a. Informational interventions b. Behavioral interventions c. Social interventions d. Environmental interventions

91. 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

92. 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

93. 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

94. 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

95. School-based physical education programs

physical activity inside and

physical activity outside of the school. a. increase; decrease b. decrease; increase *c. increase; do not increase d. decrease; do not increase

96. Exercising with a friend or family member can help increase the amount of time you spend

on physical activity, and thus staying physically active.

has been shown to increase a person’s likelihood of

*a. social support b. self-esteem c. depression d. personal trainers

97. 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.

98. Children who live

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

99. The most effective type of exercise for reducing the risk for cardiovascular disease is anaerobic exercise. a. True *b. False

100. Genetic factors play a larger role in organic fitness than in dynamic fitness. *a. True b. False

101. 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

102. 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

103. Physical activity may reduce some of the cognitive declines that come from aging. *a. True b. False

104. Moderate exercise improves cholesterol ratios more by raising HDL than by lowering LDL. *a. True b. False

105. Physically active people can expect to live, on average, 5 years longer than physically inactive people a. True *b. False

106. 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

107. School-based physical education programs increase physical activity both inside and outside of the school. a. True *b. False

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

Correct Answer:

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.

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

Correct Answer:

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

Correct Answer:

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.

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

Correct Answer:

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.

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

Correct Answer:

Currently only 33% of adults get regular physical activity per recommended guidelines.

A. 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 are 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 are 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.

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

Correct Answer:

A. Among hundreds of research studies on the relationship between PA and cancers, several reviews focused on evaluating mostly studies on colorectal, breast, endometrial, prostate, and lung cancer. PA protects against all these cancers.

1. The strongest evidence of this is for colorectal and breast cancer.

2. PA’s protection against colorectal cancer appears equally strong for both women and men.

3. PA seems to protect postmenopausal women against breast cancer more than premenopausal women, and non-Caucasian women more than Caucasian women.

4. Moderate to high PA levels appear to reduce lung cancer incidence in both sexes, but more for women than men.

B. While it is not clearly known how PA lowers cancer risk, research suggests two possible reasons: 1. PA may influence the initiation and growth of tumors.

2. PA influences proinflammatory cytokines, which are involved in cancer (as well as cardiovascular disease) development.

C. People who already have cancer may also benefit from exercising.

1. PA benefits chemotherapy patients by increasing their aerobic fitness, weight, and strength.

2. PA also helps patients manage the fatigue that cancer treatment often causes.

D. Hence PA is effective for both preventing several kinds of cancers and managing treatment side-effects.

114. Explain how exercising can protect people against osteoporosis.

Correct Answer:

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.

115. Describe how physical activity (PA) can help people to manage both types of diabetes.

Correct Answer:

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 PA should help control it.

A. 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 PA affords modest protection for diabetics, not that it is a cure-all for controlling diabetes. Nonetheless, it does help.

C. PA is a useful component for both treating Type 1 diabetes and protecting against developing Type 2 diabetes.

116. Summarize some of the cognitive benefits of physical activity (PA).

Correct Answer:

A. A 2016 study of almost 1,000 older adults found that those engaging in high PA levels had cognitive skills five years later equivalent to people 10 years younger, whereas a comparison group engaging in little or no PA did not.

1. This suggests PA 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 PA focuses on older adults.

2. A 2010 review of studies using exercise interventions found that adults participating in PA programs demonstrate higher attention, processing speed, memory, and executive functioning than adults not participating in PA programs.

3. PA seems to decrease some age-related cognitive declines. a. PA 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 PA 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 PA 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 PA intervention, sedentary and overweight children demonstrated better standardized math test performance and better planning abilities after the intervention.

E. Although the precise reason that PA improves cognitive function is unknown, researchers suggest two possibilities: 1. Increased cerebral blood flow 2. Increased expression of brain-derived neurotrophic factor (BDNF).

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

Correct Answer:

A. More recent research has identified lower amounts and types of PA for achieving desired health benefits.

1. The ACSM revised its recommendations in 2011 to reflect these findings.

B. Healthy adults under age 65 should engage in moderately vigorous activity for 30 minutes five times a week, C. or vigorous activity for 20 minutes three times a week, D. and 8-10 sets of 12 repetitions each of strength training exercises at least twice a 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.

118. Physically active children benefit from exercise more than physically active adults benefit. a. True *b. False

Chapter 16 1. 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.

2. Peaches and Rufus have decided to adopt healthier lifestyles. If they are like most Americans

who have done this, they are more likely to lower their risks of dying from the other causes here than from which two? *a. Of obesity and Type 2 diabetes b. Cardiovascular disease, stroke c. Murder and accidental injuries d. Cancer and respiratory disease

3. The U.S. Department of Health and Human Services (HHS) series of Healthy People

initiatives include goals; current goals are challenging. What does HHS report about the United States’ history relative to similar past goals? a. The U.S. has never made any progress towards past Healthy People goals. b. The U.S. has made progress toward many earlier goals, but never met any. *c. The U.S. has both made progress toward, and met many of the prior goals. d. The U.S. has met a few of these past goals, but never progressed in others

4. 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. accomplished all of these objectives.

5. 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.

6. At age 65, women in the United States can expect to live another 16 years. Of those 16 years,

they can expect that about

will be free of disability.

a. 9 *b. 7 c. 5 d. 3

7. Nobu lives in Japan and her cousin Keiko lives in America. Which of the following is most

accurate about their respective differences between life expectancy and health expectancy?

N o a. Both cousins can expect to live 9 times their expected years with b disability. u b. Nobu can expect to live 9 times, Keiko 9.3 times, expected disability c years. a *c. Nobu can expect to live 9.3 times, Keiko 9 times expected n disability years. e d. Nobu can expect to live 8 times, Keiko 10 times, expected disability x years. p e c 8. The people in the United States who use health care services more than any other group are a. children b. adolescents. c. young adults. *d. older people.

9. 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

10. 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.

11. Japan has the highest life expectancy and health expectancy of any world nation. What can

people in Japan expect in terms of years of living with disease or disability? a. They can expect fewer years of disability than in other countries. *b. They can expect equal years of disability as in the United States. c. They can expect more years of disability than in other countries. d. They can expect more years of disability than people in the U.S.

12. The following factors influence health expectancy in the U.S. by causing health problems.

Which of them is currently increasing? a. AIDS *b. Obesity c. Smoking d. Violence

13. 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 smoking.

14. The nation that leads the world in number of years of healthy life expectancy is a. America. *b. Japan. c. Germany. d. Canada.

15. Which of these groups of people is served LEAST by health care in the United States? *a. Native Americans b. Well-educated African Americans c. Cuban Americans d. European Americans

16. People with high educational levels live longer than people with low educational levels

because they

a. have lower smoking rates. b. have higher health literacy. c. have greater access to health care. *d. have a combination of these factors.

17. The number of years a person lives is

from disability is

, and the number of years a person lives free

.

a. health expectancy; well-years b. health expectancy; life expectancy *c. life expectancy; health expectancy d. life expectancy; life-years

18. 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

19. 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

20. In America, which of these factors contributing to disease and medical care can be most

easily isolated? a. Ethnicity from social factors b. Ethnicity from economic factors c. Ethnicity from educational factors *d. Ethnicity from none of these factors

21.

is the ability to read and understand health information to make healthrelated decisions. a. Health expectancy *b. Health literacy c. Health disparity d. Health communication

22. Even with universal access to health care, disparities exist between wealthy and poor

individuals. One factor that may explain this discrepancy is *a. education and health literacy are higher among those with higher incomes. 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. these are all factors contributing to socioeconomically based health disparities.

23. Which group of U.S. citizens has the longest life expectancy? a. European Americans *b. Asian Americans c. African Americans d. Hispanic Americans

24. Compared with European Americans, Asian Americans have a. lower infant mortality. b. longer life expectancy. c. lower cardiovascular mortality. *d. each one of these characteristics.

25. Compared to European Americans, African Americans have: a. shorter life expectancy. b. lower health expectancy. *c. both of these differences. d. neither of these differences.

26. Which of the following have researchers implicated in health disparities for African

Americans? a. Inadequate medical treatment b. Limitations in health literacy c. Discrimination in treatment *d. These have all been named

27. Research (AHRQ, 2011) has found that African Americans receive poorer health

care than Europeans on _

of the quality measures for medical care.

a. about one quarter b. almost one third *c. almost one half d. about two thirds

28. What is true of ethnic health disparities attributable to disparities in health literacy? a. Ethnic vaccination differences are not related to disparities in health literacy. b. Ethnic diabetes management differences are not attributed to health literacy. c. Ethnic HIV management differences are found unrelated to health literacy. *d. Ethnic medication use differences have been attributable to health literacy.

29. Which of the following accurately reflects discrimination in the medical treatment

of African Americans? *a. They are more likely to have less aggressive coronary heart disease

treatment. b. They are more likely to be referred to cardiologists than European Americans. c. They are more likely to receive kidney dialysis than European Americans are. d. They are more likely to receive no treatment for HIV infection than others are.

30. Lack of access to medical care, poor health literacy, and low income affect Native

Americans

compared to African Americans.

a. much less strongly b. way more strongly *c. at least as strongly d. in unknown ways

31. Among Hispanic Americans, which groups tend to have better or poorer medical

care and health corresponding to better or poorer income and education? *a. Cuban Americans have better health, and Puerto Ricans have poorer health. b. Mexican Americans have better, and Cuban Americans have poorer, health. c. Puerto Ricans have better, but Cuban and Mexican Americans worse, health. d. Cubans and Puerto Ricans have better, but Mexican Americans worse, health.

32. 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 33. Hispanic Americans have high rates of smoking, obesity, and hypertension, yet

lower mortality rates than European Americans and many other Americans. What is the most plausible explanation for this apparent contradiction? a. Hispanic Americans must have superior genetic protections against related

chronic diseases. b. The statistics on Hispanic Americans’ rates of these poor health behaviors must be incorrect. *c. Hispanic immigrants must not have had time to develop chronic diseases from American lifestyles. d. Hispanic Americans’ better social support systems must override their unhealthy behaviors.

34. Marisol tells her father, a health psychologist, that she is interested in following in

his footsteps and majoring in the same field in college. Her father tells her he feels he was lucky to enter this profession when he did, because it had not existed ago. *a. four decades b. two decades c. five decades d. three decades

35. 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.

36. 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).

37. 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.

38. 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.

39. 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.

40. 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.

41. In the early 1900s when Greta’s great-great-grandmother was born,

of America’s population was over 65 years old. By 2007 when Greta was 10, her family celebrated her grandmother’s 67th birthday, making her grandmother one of more than as many Americans aged over 65 than there were in 1900. a. 10%; two times b. 2%; three times *c. 4%; three times d. 6%; four times

42. 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.

43. Joe 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. Projections by experts are that by the year 2020,

of the total U.S.

population will be over the age of 75 years. a. over 10% b. below 5% *c. above 6% d. about 20%

45. 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. *b. they will have satisfied projections for life expectancy. c. they will live to 85, by projections for life expectancy. d. they will live 10 years as by projected life expectancy.

46. 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.

47. 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) instead of with (a).

48. 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

49. 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.

50. 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.

51. 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

52. In the United States, women experience

life expectancy and

health care than men do. a. shorter; better *b. longer; poorer c. longer; better d. shorter; poorer

53. Women had

_ survival advantage over men in 1900, advantage during the 1970s, and survival advantage by 2011.

survival

a. no; around 5 years; 8 years b. some; c. 3 years; c. 9 years *c. a small; over 7 years; 5 years d. a big; nearly 4 years; 6 years

54. 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.

55. 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

56. 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.

57. 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.

58. 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

59. 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.

60. 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.

61. Which of these countries has the highest per capita health care expenditures? *a. The United States

b. Great Britain c. Canada d. Germany

62. 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.

63. 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

64. 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.

65. 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 larger problems in European countries than in the United States. *d. are more serious in the United States, but affect all industrialized countries.

66. 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 U.S.A.

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.

67. 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

68. 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.

69. Like Dwayne and Robin 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.

70. 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. high behaviors contributing to unintentional injuries. d. high rates of committing suicide compared to others.

71. 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 in an auto accident

b. Student B, who died as a murder victim c. Student C, who died committing suicide *d. Student D, who died from having cancer

72. When young people are injured or die unintentionally,

are the most

frequent causes. a. suicides b. homicides *c. car crashes d. drownings

73. 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 many world countries. *d. is identified by research as characterized by both answers b and c.

74. Which of the following accurately represents statistics about dating violence among

college students? *a. Emotional abuse is far more common than physical abuse. b. Physical abuse is far more common than emotional abuse. c. College students are less frequently victimized by stalkers. d. College men are far more likely than women to be violent.

75. 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.

76. 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

77. 2016 research (ACHA) found that

of college students had attempted suicide as had contemplated it in the previous school year. a. around the same proportion b. around twice the proportion *c. about 1/5 to 1/4 the percent d. about 1/3 to 1/2 the percent

78. 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. Gay, lesbian, or bisexual identification *d. These factors all increase suicidal risks

79. 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

80. Which of these is found to increase risk for suicide but not for all forms of violence

on college campuses? a. Using drugs *b. Being LGBT c. Drinking alcohol d. Mental health issues

81. Relative to campus violence, students are

to their safety in most communities. a. less safe b. as safe c. at risk *d. safer

on college campuses compared

82. College student Judith was accosted and touched sexually by a stranger near

campus. Statistically, how does this affect her health risks? a. She is more likely to smoke, but she is not any more likely to use drugs. b. She is more likely to develop an eating disorder than to think of suicide. *c. She is more likely to develop any of these behaviors causing health risk. d. She is more likely to do none of these as there was no rape/rape attempt.

83. 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.

84. 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.

85. 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.

86. 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.

87. While significant proportions of college students fail to meet health goals for

physical activity and weight, as a group they are also likely than the general population to exercise and likely to be overweight.

a. less; more *b. more; less c. more; more d. less; less

88. A 2007 study by Burke and associates found that

among college students

were overweight. a. more females than males *b. more males than females c. equal males and females d. only the tiniest numbers

89. Research findings (Burke, Lofgren, Morrell, & Reilly, 2007) showed that the

proportion of college students who were obese equaled roughly who were overweight.

of the proportion

a. one quarter b. one fifth c. one half *d. one third

90. 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

91. 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).

92. 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

93. 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 these types of coping strategies

94. 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.

95. 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.

96. 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

97. Over

of young adults engage in binge drinking.

a. 20% b. 30% *c. 40% d. 60%

98. 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.

99. 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.

100. An important recommendation from the Alameda County study emphasizes

, which may allow individuals to cope better with stressful situations. *a. social support b. drinking c. exercise d. both a and c

101. In the United States, wealthy people have more well-years than poor people, but they do not live longer than poor people. a. True *b. False

102. The United States leads the world in number of years of healthy life expectancy. a. True *b. False

103. African Americans have a longer life expectancy than European Americans. a. True *b. False

104. Hispanic Americans have a lower death rate than European Americans. *a. True

b. False

105. On average, Native Americans live longer than European Americans. a. True *b. False

106. Immunizations are an example of primary prevention, but lifestyle changes are not. a. True *b. False

107. College students are less likely to smoke cigarettes but more likely to binge drink *a. True b. False

108. The United States has the highest per capita health care expenditure in the world. *a. True b. False

109. Secondary prevention consists of screening people at risk for a disease to discover *a. True b. False

110. 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

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

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 U.S., 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 U.S., health expectancy is 8 to 9 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.

Correct Answer:

See below 112. Discuss the obstacles to and advantages of achieving the two broad goals from the Healthy People 2020 report.

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: poor 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.

Correct Answer:

See below 113. 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.

A. Life expectancy is rising in the USA, but healthy life expectancy is falling.

1. America’s 70 years of healthy life 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.

Correct Answer:

See below 114. 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.

A. One reason that life expectancy and health expectancy differ is the effects of economic factors.

1. Comparing the wealthiest and poorest countries, or even the wealthiest and poorest sectors of the population within one country, yield even bigger differences.

2. Rich people live not only more years, but also more healthy years.

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.

Correct Answer:

See below 115. 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.

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.

Correct Answer: See below

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

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 self-management 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. includes: 1.

Primary prevention is typically most cost-effective. This

Immunizations against diseases.

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.

Correct Answer:

See below

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

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.

Correct Answer:

See below 118. Analyze the health benefits and risks that apply to college students compared with those that apply to other young adults.

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 talk on 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.

Correct Answer:

See below 119. How can health disparities in the US be reduced?

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. Low socioeconomic status. Poverty relates to receiving poor medical care, possibly because those in poverty are less likely to have health insurance. a. Poverty also relates to risky health habits, such as eating a highfat diet and leading a sedentary lifestyle.

Correct Answer:

See below 120. Identify and briefly explain five behaviors identified by the Alameda County study that improve health and lower mortality.

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 short-term 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, andpossibly 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 problem-focused and emotionfocused strategies, and appropriately apply them.

Correct Answer:

See below