Behavioral Medicine Approaches to Cardiovascular Disease Prevention

By Kristina Orth-Gomér; Neil Schneiderman | Go to book overview

In addition to job stress, the concept of control of destiny is consistent with several other concepts in psychosocial epidemiology. In our work with people undergoing coronary angiography, for example, Seeman and I ( 29) showed that the important components of social support involve the instrumental dimension. For example, less coronary atherosclerosis was seen among people who had friends to help them with advice, economic assistance, and transportation help. This instrumental support was more important than that of emotional support or network size. One way to interpret this finding is to say that instrumental social support helps people solve problems, influence the events that impinge on them, and control their destiny.

Following this type of reasoning, it is possible to suggest that mobility is a risk factor for CHD because it disrupts social relationships and the help they provide. Life events such as birth, death, marriage, and job loss also disrupt these relationships. Similarly, Type A behavior can be seen as a continuous, but unsuccessful, effort to control events.

There is a growing literature on physiological mechanisms that is consistent with this approach. This literature suggests that animals lower in the social order experience greater threats to well-being. They also exhibit more physiological arousals and poorer health ( 30- 32).

Regardless of whether control of destiny is an appropriate concept for our work, we need some idea of this kind to help us integrate findings from research between groups, between people, and within people. We need some theoretical and conceptual integration in our field so that we can better talk with one another and begin to choose important and strategic topics for research, instead of selecting projects simply because they are interesting. Our findings also must be capable of explaining (or at least be consistent with) research observations at the social, individual, and physiological levels.


REFERENCES
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Antonovsky A. "Social class, life expectancy and overall mortality". Milbank Mem Fund Q 1967; 45: 31-73.
2.
Syme SL, Berkman LF. "Social class, susceptibility and sickness". Am J Epidemiol 1976; 104: 1-8.
3.
Kitagawa EM, Hauser PM. Differential mortality in the United States. Cambridge, MA: Harvard University Press, 1973.
4.
Haan MN, Kaplan GA, Syme SL. "Socioeconomic status and health: old observations and new thoughts". In: Bunker JP, Gomby DF, Kehrer BH, editors. Pathways to health: The role of social factors. Palo Alto, CA: H.J. Kaiser Family Foundation, 1989:76-117.
5.
Marmot MG, Rose G, Shipley M, et al. "Employment grade and coronary heart disease in British civil servants". J Epidemiol Comm Health 1978; 3: 244-49.
6.
Susser MW, Watson W, Hopper K. Sociology in medicine. New York: Oxford University Press, 1985.
7.
Syme SL. "Strategies for health promotion". Prev Med 1986; 15: 492-507.
8.
"Multiple Risk Factor Intervention Trial Research Group". The Multiple Risk Factor Intervention Trial -- risk factor changes and mortality results. JAMA 1982; 248: 1465-76.

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