Many illnesses can be prevented or limited by altering personal behavior, and public health planners have turned to psychology for guidance in fostering self-protective activity. A social theory of personal action provides an integrative framework for applying psychology to public health, disclosing gaps in our current understanding of self-regulation, and generating guidelines for improving health promotion at the population level. A social action view emphasizes social interdependence and interaction in personal control of health-endangering behavior and proposes mechanisms by which environmental structures influence cognitive action schemas, self-goals, and problem-solving activities critical to sustained behavioral change. Social action theory clarifies relationships between social and personal empowerment and helps explain stages of self-change. Every year millions of people suffer and die of illnesses that could be curbed or eliminated by altering patterns of personal behavior. Modifiable habits and customs contribute to malnutrition, communicable diseases, and chronic illnesses, and thereby augment a staggering toll of needless deaths (Elder, 1987). To lower this toll, public health planners have turned to psychology-and especially to its models of self-regulation-for guidance in fostering self-protective action among those at risk. Yet psychological theories and models often seem of limited value when applied to public health problems, and some public health theorists have questioned their usefulness in the global struggle against disease (Jeffery, 1989; Leventhal, Cleary, Safer, & Gutman, 1980). I argue that psychology does have a role to play, but that this role is constrained by inattention to pathways by which social environmental phenomena affect cognitive and biologic regulatory processes. I propose a theory of personal action designed to foster social-contextual analysis of personal change. This analysis poses important questions for selfregulation theory and discloses new opportunities for psychology to contribute to human health and well-being. Public Health and Psychology The term public health embraces a diverse array of problem-solving and health-protective activities inspired by the practice of viewing illnesses in a social context. By relating the afflictions of individuals to the groups to which they belong or to the environments in which they work and live, the public health outlook differs from that of clinical medicine, which treats diseases as attributes of isolated sufferers. This social-contextual approach has advanced disease control and enhanced quality of life in ways that would not have been possible in a clinical model. Early attempts to determine who became sick, and where and when, for example, led to significant reductions in the prevalence of infectious diseases long before the biological mechanisms of these illnesses could be explained or modified. A population perspective can reveal a previously unrecognized environmental hazard or a widespread health-endangering personal b...

Theories linking anger and blood pressure (BP) reactivity to cardiovascular disease must be able to identify naturally occurring stressors that arouse emotion with sufficient frequency to cause chronic physiologic stress. We examine the impact of normal family arguments on 43 patients (24 women, 19 men) with essential hypertension. Patients and their partners discussed a threatening disagreement for 10 min while BP and conversation were recorded. Discussing problems increased BP, but the causal pathways differed by sex. In women, hostile interaction and marital dissatisfaction were associated with increased BP; "supportive" or "neutral" exchanges were unrelated to BP. In men, BP fluctuations were related only to the patient's speech rate. These findings are consistent with other research on sex differences in communication and social problem-solving styles and implicate different mechanisms (frequent anger, active coping) through which marital discord could increase risk. Implications for intervention are considered.

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Health problems of the urban poor have been attributed to psychosocial effects of environmental stress. Testing such models requires an ability to measure neighborhood characteristics that make life stressful. The City Stress Inventory (CSI) uses self-report to assess perceived neighborhood disorder and exposure to violence. Data from an interracial sample of urban adolescents show the CSI to be internally consistent, stable, and correlated with census indices of social disadvantage. Validity for stress research is indicated by correlations with trait depression, anger, hostility, self-esteem, and mood changes during a debate with an unfamiliar peer. The CSI can be completed by persons with an 8th-grade education.