New Behavioral Risk Factors for Coronary Heart Disease: Implications for Intervention
Margaret A. Chesney University of California-San Francisco
Behavioral interventions to reduce coronary heart disease (CHD) morbidity and mortality target the standard risk factors, such as cigarette smoking, and the more recently recognized coronary-prone behaviors, such as hostility. There is increasing evidence that low socioeconomic status (SES), depressive symptoms, and social isolation should be added to the list of targets for interventions because these factors are associated with increased risk for adverse health outcomes, including CHD. The purpose of this chapter is to drawattention to these new behavioral or psychosocial risk factors, and to explore implications for behavioral interventions. The first three sections of this chapter briefly highlight the evidence that each of these psychosocial factors is associated with CHD risk, and sketch out the potential role that intervention could play in diminishing that risk. In the final section, a new intervention -- Coping Effectiveness Training -- is described. This intervention, based on stress and coping theory, is designed to train individuals to cope with environmental and social stressors, increase social support, and manage negative mood states. As such, Coping Effectiveness Training (CET) is an approach that may be applicable to addressing the new behavioral risk factors for heart disease.
A positive association between SES and health has existed for centuries ( 1, 2). Individuals of lower SES status experience greater morbidity and mortality from almost every disease than those of higher status. Persuasive arguments have been