Table Of ContentBehavioral Epidemiology
and Disease Prevention
NA TOASI Series
Advanced Science Institutes Series
A series presenting the results of activities sponsored by the NA TO Science Committee,
which aims at the dissemination of advanced scientific and technological knowledge,
with a view to strengthening links between scientific communities.
The series is published by an internatio,)al board of publishers in conjunction with the
NATO Scientific Affairs Division
A Life Sciences Plenum Publishing Corporation
B Physics New York and London
C Mathematical D. Reidel Publishing Company
and Physical Sciences Dordrecht, Boston, and Lancaster
o
Behavioral and Social Sciences Martinus Nijhoff Publishers
E Engineering and The Hague, Boston, and Lancaster
Materials Sciences
F Computer and Systems Sciences Springer-Verlag
G Ecological Sciences Berlin, Heidelberg, New York, and Tokyo
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Volume 84-Behavioral Epidemiology and Disease Prevention
Edited by Robert M. Kaplan and Michael H. Criqui
Volume 85-Primary Photo-Processes in Biology and Medicine
Edited by R. V. Bensasson, G. Jori, E. J. Land, and T. G. Truscott
Volume 86-WheatGrowth and Modelling
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Volume 87-lndustrial Aspects of Biochemistry and Genetics
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Volume 88-Radiolabeled Cellular Blood Elements
Edited.b.y M. L. Thakur
Series A: Life Sciences
Behavioral Epidemiology
and Disease Prevention
Edited by
Robert M. Kaplan
and
Michael H. Criqui
University of California, San Diego
La Jolla, California
Plenum Press
New York and London
Published in cooperation with NATO Scientific Affairs Division
.,toc~.UN ~JUNI!\M Advanced Research Workshop on
.lQ
!i~avioral Epi~l'hrt:Qy and Disease Prevention,
April 14-20, 1I98S"1
'i~ellaaio...S'f~and Conference Center, Lake Como, Italy
Library of Congress Cataloging in Publication Data
NATO Advanced Research Workshop on Behavioral Epidemiology and
Disease Prevention (1983: Bellagio Study and Conference Center)
Behavioral epidemiology and disease prevention.
(NATO ASI series. Series A, Life sciences; v. 84)
"Proceedings of a NATO Advanved Research Workshop on Behavioral
Epidemiology and Disease Prevention, held April 14-20, 1983, at the Ballagio
Study and Conference Center, Lake Como, Italy" - T.p. verso.
"Published in cooperation with NATO Scientific Affairs Division."
Includes bibliographies and index.
1. Medicine and psychology-Congresses. 2. Epidemiology-Congresses.
3. Health behavior-Congresses. 4. Medicine, Preventive-Congresses. I.
Kaplan, Robert M. II. Criqui, Michael H. III. North Atlantic Treaty Organiza
tion. Scientific Affairs Division.IV. Title. V.Series. '[DNLM: 1. Behavioral Medi
cine-congresses. 2. Epidemiology-congresses. 3. Preventive Medicine
congresses. WA 105 N279b 1983]
R726.5.N36 1983 616.07'1 85-3611
ISBN-13: 978-1-4684-7931-7 e-ISBN-13: 978-1-4684-7929-4
DOl: 10.1007/978-1-4684-7929-4
© 1985 Plenum Press, New York
Softcover reprint of the hardcover 1st edition 1985
A Division of Plenum Publishing Corporation
233 Spring Street, New York, N.Y. 10013
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
PREFACE
In the l~nited States and in Europe~ there has been an increasing
interest in the relationship between individual behavior and disease. The
American National Academy of Sciences (Hamberg, Elliott, and Parron,
1982)' through its Institutes of Medicine, has estimated that as many as 50
percent of chronic disease cases can be traced to individual behaviors such as
smoking, diet, exercise, etc. Similar conclusions have been reached by a
variety of European investigators and institutes. The World Health
Organization has also expressed considerable interest in individual behavior
in relation to the development of chronic disease. Thus, throughout the
NATO countries there has been increased awareness of the relationship
between behavior and disease. However, communication among investigators
in different countries has been rather limited. Further, many different
scientific disciplines including psychology, sociology, medicine, microbiology,
statistics, and epidemiology have all developed new and different literatures
in this field. One purpose of this book is to bring together contributions from
scientists in each of these fields. Much of the variance in individual health
behavior occurs across countries rather than within countries. Thus, we can
learn much from comparing behavior-disease relationships across countries.
To date, there have been few studies which have had an adequate
international basis for these comparisons.
Interest in behavioral epidemiology is a relatively recent phenomena.
Thus, many scientists are entering the field without uniform background,
experience, or training. This book discusses approaches common in a variety
of NATO countries. The chapters focus on behavior patterns such as diet,
exercise, and cigarette smoking which vary across countries. For example,
cigarette smoking is on the decline in the United States while it is on the
increase in several European countries. Thus, we can learn· much about
behavior and disease relationships by examining cross-national data. On the
other hand, some observed relationships within countries may not occur in
other countries. In order to sort out these data, international studies are
needed. Contributors were selected because of known records of productive
collaborative research.
Although there are a variety of recent books on epidemiology and on
behavioral interventions, we are not aware of a publication that attempts to
systematically integrate these areas from an international perspective.
v
Preface
With the assistance of a NATO Advanced Research Workshop grant,
the contributors were brought together at the Bellagio Study and Conference
Center near Lake Como in Italy in April of 1983. PrE;liminary versions of the
chapters were presented and critiqued at the meeting. Then, using feedback
from the other participants, each author continued to develop their
manuscript until they eventually resulted in the chapters for this book.
The contributors to this volume represent only a small sample of the
distinguished investigators interested in behavioral epidemiology. Our
funding only allowed us to bring together a small group and we had to select
participants to represent specific points of view. Clearly there are many
others who could have offered different and important insights.
This book would not have been possible without the help of several
individuals and institutions. First, we are grateful to the North Atlantic
Treaty Organization, Division of Scientific Affairs who provided the financial
support for the meeting. Second, The Rockefeller foundation generously
provided the Bellagio Conference and Study Center for the meeting. This
excellent facility provided an ideal environment for the nurturing of many of
the ideas represented in this volume. Susan Garfield of the Rockefeller
Foundation helped with many of the arrangements while Angela Barmettler
served as an exceptional hostess at the Bellagio Center.
Besides the authors, many others contributed to this volume. Na;n
Criqui helped with many of the arrangements at the Bellagio Center. Debbe
O'Brien and Becky Caruso helped with the countless clerical chores. Connie
Toevs and Therese Chaucon worked on many aspects of the conference
organization and the subsequent manuscript preparation. Valerie Ruud did a
superb job of editing the papers. Finally, we are most appreciative of
Barbara Dupuie Boyer who typed the entire manuscript and supervised the
typesetting.
RMK
MHC
La Jolla, California, USA
Reference
Hamberg, D. A., Elliott, G. R., and Parron, D. L. Health and Behavior
Frontiers of Research in the Biobehavioral Sciences. Washington, D.C.:
National Academy Press, 1982.
vi
CONTENTS
PART I
Methods in Epidemiology
Chapter 1
Reflections on Epidemiologic Methodology in the Study
of Disease Etiology and Health Services..................................................... 3
Dimitrios Trichopoulos and Loucas Sparos
Chapter 2
The Problem of Response Bias ......................................................................... 15
Michael H. Criqui
Chapter 3
Quantification of Health Outcomes for Policy Studies
in Behavioral Epidemiology ....................................................................... 31
Robert M. Kaplan
PART II
Epidemiology
Chapter -4
Apolipoproteins, the Lipid Hypothesis, and Ischemic
Heart Disease ............................................................................................. 57
Pietro Avogaro
Chapter 5
Alcohol and Cardiovascular Mortality .............................................................. 67
Michael H. Criqui
Chapter 6
The Pros and Cons of Economic Development ................................................. 91
Denis Burkitt
Chapter 7
Regional Differences in Mortality in Belgium ................................................... 103
J. V. Joossens and J. Geboers
vii
Contents
Chapter 8
Dietary Components and the Risk of Coronary Heart
Disease Mortality ....................................................................................... 121
Daan Kromhout
Chapter 9
The Rationale for Treatment of "Mild" Hypertension .....................................1 35
Darwin R. Labarthe
Chapter 10
Dietary Factors and Cancer ............................................................................ .161
Andrew P. Haines
Chapter 11
The Control of Diabetes .................................................................................. .183
Georges Tchobroutsky and Fabienne Elgrably
Chapter 12
Medical Care Utilization and Self-Reported Health of
Hypertensives - Results of the Munich Blood Pressure Study .................... 201
Ursula Hartel, U. Keil and V. Cairns
PART III
Stress
Chapter 13
Life Change, Social Support, Coping, and Health .............................................2 19
Irwin G. Sarason and Barbara R. Sarason
Chapter 14
Psychosocial Aspects of Chronic Illness: Direct and Indirect
Associations with Ischemic Heart Disease Mortality .................................. 237
George A. Kaplan
Chapter 15
Stress, Personality, Immunity, and Cancer: A Challenge
for Psychosomatic Medicine ....................................................................... 271
Massimo Biondi and Paolo Pan cheri
viii
Contents
PART IV
Behavioral Interventions
Chapter 16
Primary Prevention of Hypertension: A Program with
Adolescents ................................................................................................3 01
Thomas J. Coates and Craig K. Ewart
Chapter 17
A Family-Based Approach to Cardiovascular Risk Reduction
Education ..................................................................................................3 29
Philip R. Nader and Tom Baranowski
Chapter 18
The Behavioral Management of Type II Diabetes Mellitus ..............................3 53
Robert M. Kaplan and Catherine J. Atkins
Chapter 19
The Community Studies of the Stanford Heart Disease
Prevention Program ...................................................................................3 85
Nathan Maccoby, John W. Farquhar, and Stephen P. Fortmann
Chapter 20
Exercise and Disease Prevention ................................................................4 01
Roy J. Shephard
Contributors .....................................................................................................4 23
Author Index ...................................................................................................4 27
Subject Index ...................................................................................................4 49
ix
PART I
METHODS IN EPIDEMIOLOGY
This first section reviews selected methodologic issues in the interface
between epidemiology and behavioral science. The first paper, by Trichopoulos
and Sparos provides a general overview of epidemiologic research methodology.
The second paper, by Criqui, reviews response bias which is a behaviorally based
and major problem in epidemiologic surveys. Finally, R. Kaplan describes general
health outcome measures and the interface between epidemiology and policy
sCIence.
