Encyclopedia of Family Health

Encyclopedia of Family Health


Edited by: Martha Craft-Rosenberg & Shelley-Rae Pehler


What is unique about the process in the discussion of healthcare and interventions to use when working with families? What assessment tools provide guidance for healthcare providers as they determine interventions for families in their care? What are the changing dimensions of contemporary family life, and what impact do those dimensions have on health promotion for families? How is family healthcare changing in terms of practices, delivery systems, costs and insurance coverage?Students are able to explore these questions and more in the Encyclopedia of Family Health. Approximately 350 signed articles written by experts from such varied fields as health and nursing, social and behavioral sciences, and policy provide authoritative, cross-disciplinary coverage. Entries examine theory, research and policy as they relate to family practice in a ...

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  • Reader's Guide
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  • Subject Index
  • Front Matter
  • Back Matter
    • Alcohol Addictions in the Family
    • African American Families: Perspectives of Health
    • Acute Health Problems and Interventions for the Childrearing Family
    • Adult With Disability Living at Home
    • Abortion Experienced by Childbearing Couples
    • Access to Health Care: Child Health
    • Adolescent Counseling
    • Assessing Family Health
    • Biopsychosocial Theoretical Perspectives of Family Systems
    • Autism Spectrum Disorder and the Family
    • Education of Child Life Providers in Family Health
    • Education of Health Care Providers: WHO Family Health Nurses
    • Cystic Fibrosis and the Family
    • Changing Family and Health Demographics
    • Culturagram Use With Culturally Diverse Families
    • Adults With Childhood-Acquired Conditions
    • Access to Health Care: Elderly
    • Addition of Family Members Through Marriage
    • Allergies and the Family
    • Acute Health Problems and Interventions for the Midlife Family
    • American Indian Families: Perspectives of Health
    • Bullying and the Family
    • Child Emotional Abuse and the Family
    • Asian Families: Perspectives of Health
    • Affect Management and the Family
    • Alzheimer's Disease: An Overview of Family Issues in
    • Adoption Experiences for Infertile Couples
    • Access to Health Care: Uninsured
    • Animal-Assisted Therapy and the Family
    • Developmental Assessment Scales
    • Clarifying Family as Context of Care and Family as Focus of Care in Family Health
    • Down Syndrome and the Family
    • Education of Medical Health Care Providers in Family Health
    • Education of Nursing Health Care Providers in Family Health
    • Fragile X Syndrome and the Family
    • Constructionist Family Theoretical Perspectives
    • Ecomaps for Families
    • Babysitting and the Family
    • Acute Care/Hospitalization of Family Members
    • Adult Child Returning Home
    • Alzheimer's Disease: Caregiver Burden
    • Birth Defects and the Family
    • Buddhism's Influence on Health in the Family
    • Child Neglect and the Family
    • Child Physical Abuse and the Family
    • Christianity's Influence on Health in the Family
    • Communicable Disease: Adult and Elderly
    • Alzheimer's Disease and Communication
    • Adult Child With Disability: Planning for by Parents
    • Advance Directives and the Family
    • Caregivers of Adults With Developmental Disabilities
    • Family Interviews
    • Critical Theory and Family Health
    • Genetic Conditions, Communication in Families
    • Education of Occupational Health Providers in Family Health
    • Education of Physical Therapists in Family Health
    • Genetic Conditions, Experience of Families During Prediagnosis and Diagnosis Phases of
    • Family Health Perspectives
    • Fictive Kin Relationships
    • Caregiving: Adults With Developmental Disabilities
    • Advocacy for Families
    • Adult Children Living at Home
    • Anorexia and Family Dynamics
    • Communicable Disease: Children
    • Coping Management Styles in Families
    • Child Sexual Abuse and the Family
    • Cigarettes, Smoking, and Secondhand Smoke and Family Health
    • Cultural Attitudes Toward Help Seeking and Beliefs about Illness in Families
    • Cord Blood Banking and the Childbearing Family
    • Asthma Family Issues: Prevention and Control
    • Aging and Shifting Roles in Families
    • Americans with Disabilities Act and the Family
    • Caregiving: Elderly
    • Home Environment Assessment for Families
    • Informed Consent Issues in Family Health Research
    • Genetic Discoveries, New: Health Information in Families Derived Through
    • Education of Recreational Therapy Providers in Family Health
    • Genetic Family Histories
    • Psychological Theories Related to Family Health
    • Mental Health Assessment for Families
    • Caregiving: Infants
    • Chiropractic Care for Families
    • Assisted Living Placement
    • Attention Deficit/Hyperactivity Disorder: Family Involvement and Management
    • Developmental Care of Preterm Infants and the Childbearing Family
    • Ethnic/Racial Influences in Families
    • Community Violence Exposure and Family Health
    • Conflict in Family Life, Role and Management of
    • Factors Influencing Family Health Values, Beliefs, and Priorities
    • Families Experiencing a Child's Illness
    • Attention Deficit/Hyperactivity Disorder and the Family
    • Asynchronous Development Between Partners
    • Communication in Families Related to Health and Illness
    • Caregiving: Partners/Spouses
    • Newborn Screening for Families
    • Qualitative Methods and Data Analysis in Family Health Research
    • Genetic Information and Family Interviews
    • Genetic Research Findings and Disease Management for Families
    • Quantitative Methods and Data Analysis in Family Health Research
    • Nutrition and Nutrition Promotion for Families
    • Case Management for Chronic Illness/Disability and the Family
    • Community Resources for Families Related to Health
    • Bereavement and Perinatal Loss in Childbearing Families
    • Bipolar Disorders and the Family
    • Life-Threatening Illness and the Family
    • Families: The Basic Unit of Societies
    • Death From Unnatural Causes: Drug Overdose
    • Death From Unnatural Causes: Homicides, Drive-By Shootings
    • Family Self-Management
    • Men's Health
    • Blindness and the Family
    • Birth Order of Children in Families
    • Community Services Supporting Health
    • Childproofing Medications and Dangerous Agents
    • Obesity, Weight Problems, and Healthy Weight for Families
    • Research Designs and Data Analysis Methods Used for Family Health Research
    • Genetic Research Findings and Family Health
    • Genetics: The Family Pedigree
    • Research Perspectives Used for the Study of Families
    • Prediction of Genetic Health Problems in Family Members
    • Discharge Teaching for Families Taking a Family Member Home From an Acute Care Setting
    • Complementary and Alternative Medicine
    • Changes in Family Structure
    • Bulimia and Family Dynamics
    • Prenatal Surgery and the Family
    • Hinduism's Influence on Health in the Family
    • Death From Unnatural Causes: Injuries
    • Death From Unnatural Causes: Poisoning
    • Hispanic/Latino Families: Perspectives of Health
    • Sexually Transmitted Diseases and the Family
    • Cancer in the Family
    • Changes in Family Structure, Roles
    • Computerized Records and Family Health Care Information
    • Educating the Family Regarding Chronic Physical Illness
    • Sociological Theories of Families
    • Genetics and Family Health
    • Genograms and the Family
    • Theoretical Perspectives Related to the Family
    • Educating the Family Regarding Serious Mental Illness
    • Costs of Medical Care and Existing National, State, and Private Pay Avenues for Families
    • Changing Views of Marriage, Home Responsibilities, and Caregiving
    • Cancer Survivorship and the Family
    • Sport-Related Accidents and Injuries and the Family
    • History of Families
    • Dietary and Exercise Patterns in Families
    • Drinking by Underage Family Members
    • Influence of Close Relationships on Health
    • Sudden Infant Death Syndrome in Childrearing Families
    • Cerebral Palsy and the Family
    • Child Beginning School
    • Decision Making in the Context of Health and Illness
    • Elder Care Options for Families: Long-Term Care
    • Huntington's Disease and the Family
    • Muscular Dystrophy and the Family
    • Exercise Promotion and Fitness
    • Early Periodic Screening, Diagnosis, and Treatment Program for Low-Income Children
    • Childbirth by Childbearing Couples: Reported Meanings
    • Chronic Health Problems and Interventions for the Childrearing Family
    • Women's Health
    • Islam's Influence on Health in the Family
    • Drug Addictions in the Family
    • Early Periodic Screening, Diagnosis, and Treatment Program for Low-Income Children
    • Judaism's Influence on Health in the Family
    • Chronic Health Problems and Interventions for the Elderly Family
    • Childlessness
    • Economics as It Relates to Family Health
    • Family Caregiving: Caring for Children, Adults, and Elders With Developmental Disabilities
    • Sickle Cell Disease and the Family
    • Family Conflict Related to Caregiving
    • Electronic Health Record and Family Health Information
    • Children's Health: Dental Development
    • Chronic Health Problems and Interventions for the Midlife Family
    • Poverty, Children in, and Health Care
    • Economic Downturn and Families
    • Elder Emotional Abuse and the Family
    • Recreation in Family Health
    • Chronic Illness and Family Management Styles
    • College Transition for Families
    • Emergency Care Use by Families
    • Family Health Maintenance
    • Family Interventions across the Life Span
    • Factors Influencing Access to Health Care for Families
    • Complicated Grief
    • Cocaine Exposure and the Neonate
    • Religious/Spiritual Influences on Health in the Family
    • Elder Neglect and the Family
    • Elder Physical Abuse and the Family
    • Resilience in Families With Health Challenges
    • Deaf and Hearing Families
    • Contraception in Childbearing Couples
    • Family Adherence to Health Care Regimen
    • Family Secrets in Family Therapy
    • Family Therapy
    • Health Care or Medical Home
    • Coparenting: Children
    • Depression in the Family
    • Rituals, Routines, and Their Influence on Health in Families
    • Elder Sexual Abuse and the Family
    • Foster Care for Minors
    • Sibling Conflict
    • Diabetes, Type 1, and the Family
    • Death: Ambiguous Feelings Related to Loss
    • Health Care Reforms, Current and Projected Future Reforms and Their Benefits for Families
    • First Aid and the Family
    • Foster Care Emancipation
    • Health System Options for Families
    • Death and the Grieving Process in Families
    • Diabetes, Type 2, and the Family
    • Socioeconomic Status of Families
    • Gambling Addictions in the Family
    • Home Environments and their Relationship to Safety
    • Stress Management Theory and Techniques in Families
    • Disabilities and Family Management
    • Death Rituals in Families
    • Health-Seeking Behavior in Families
    • Guardianship/Conservatorship
    • Health Care Transition Planning
    • HIPAA: Privacy Laws and the Family
    • Defining Family: An Overview of Family Definitions From a Historical Perspective
    • Families Experiencing Chronic Physical and Mental Health Conditions
    • Incest in Families
    • Lead Poisoning and the Family
    • Family Adherence to Health Care Regimen
    • Developmental Transitions in Families
    • Influence of Policy on Health Care for Families
    • Health-Related Accommodations
    • Home Care
    • Integrative Medicine and Health Care Settings
    • Divorce: Effect on Children or the Family
    • Family Emotional Climate and Mental Health
    • Rape and the Family
    • Refugees and Family Health
    • Family Pediatric Adherence to Health Care Regimen
    • Divorce: Loss of Family Members
    • Long-Term Care Facilities for Families
    • Home Remedies
    • Hospice Care
    • Managed Care
    • Divorce and Child Custody
    • Fetal Alcohol Exposure and Family Health
    • Risk Perception Based on Family Health History
    • Shaken Baby Syndrome in Childbearing Families
    • Food Allergies and Family Experiences
    • Employment/Unemployment and Family Health Insurance Coverage
    • Marriage and Family Therapy for Families
    • Hospitalization and Family Presence
    • Immunizations and Vaccinations
    • Medicaid and Family Health
    • Family Experiencing Transitions
    • Health Management in Families
    • Sibling Physical Abuse
    • Spouse/Domestic Partner Physical Abuse
    • Heart Disease and the Family
    • Family Transitions and Ambiguous Loss
    • Medicare and Family Health
    • Injury Prevention for Infants and Children Family Members
    • Injury Prevention for the Elderly Family Member
    • Outpatient Mental Health Care for Families
    • Grandparenting
    • HIV/AIDS and Influence on Family Structure and Roles
    • Suicide in the Family
    • Verbal Abuse in Families
    • Hypertension and the Family
    • Grandparents Parenting
    • Partnering With Families: Family-Centered Care
    • Kinship Care
    • Lifestyle Changes and Family Health
    • Pediatric Primary Care for the Family
    • Grief Work Facilitation
    • Intellectual Disability in the Family
    • War and Families
    • Learning Disabilities in the Family
    • Health Needs of Childbearing Families
    • Power of Attorney
    • Music and Family Health
    • Optimal Healing Environments for Families
    • Problem Solving in the Context of Health and Illness
    • Health Needs of Childrearing Families
    • Life Span: Care Coordination for Chronic Illness/Disabilities and the Family
    • Life-Threatening Experiences, Support for the Family
    • Homeless Families
    • Psychiatric Medication for Families
    • Pain Management in the Home
    • Palliative Care and the Family
    • Rehabilitation Act
    • Illegal Alien Status and Family Health
    • Multiple Sclerosis and the Family
    • Navigating the U.S. Educational System When a Child Has Special Needs
    • Immigrant Families
    • Resuscitation, Family Presence During
    • Pharmacotherapy in the Context of Family for Acute Mental Illness
    • Pharmacotherapy in the Context of Family for Chronic Mental Illness
    • Role of Families in Health Promotion
    • Immigration Status and Family Health
    • Oncological Radiation Process in the Family
    • Resources for Families During Life-Threatening Illnesses
    • Job Loss Transition for Families
    • Roles of Health Care Providers for Families, Current
    • Pharmacotherapy in the Context of Family for Chronic/Terminal Physical Illness
    • Psychoeducational Interventions for Families
    • Roles of Health Care Providers for Families, Emerging
    • Last Child Leaving Home
    • Schizophrenia and the Family
    • Siblings of Ill Children
    • Managing Work and Family Responsibilities in the Age of Increased Technology
    • School Nursing and the Health of Families
    • Respite Care
    • Selecting Adult Day Services
    • Selecting Health Care for Families With Children and Youth
    • Maternal Lactation
    • Spina Bifida and the Family
    • Moving, Effect on the Family
    • Social Security
    • Selecting Child Care for Children
    • Therapeutic Play and the Family
    • Social Support Systems for the Family
    • Natural Disasters, Destruction of Family Home During
    • Nonmarital Childbearing
    • Standardized Languages Use in the Health Care of Families
    • Youth Violence Prevention in the Family
    • Systems Supporting Family Health
    • Parental Abandonment
    • Parental Attachment
    • Types of Family Provider Relationships
    • Welfare Benefits and Family Health
    • Parenting
    • Postpartum Depression
    • Preconceptual Counseling for Childbearing Couples
    • Premature Infant in the Childbearing Family
    • Remarriage and Stepfamilies
    • Retirement
    • Roles and Functions of Families: Divorce
    • Same-Sex Partner Rights
    • Selecting Long-Term Care Placement for Family Members
    • Sibling Death/Loss
    • Teen Pregnancy
    • United States Military Families, Disruptions
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    • Editorial Board


      Martha Craft-Rosenberg

      The University of Iowa

      Shelley-Rae Pehler

      St. Ambrose University

        Editorial Board
      • Lesley Barclay Charles Darwin University, Australia
      • Cecily Lynn Betz University of Southern California
      • Marion E. Broome Indiana University
      • Thomas L. Campbell University of Rochester
      • Suzanne Feetham University of Wisconsin-Milwaukee, Children's National Medical Center,University of Illinois at Chicago
      • Kathleen A. Knafl University of North Carolina at Chapel Hill
      • Marilyn J. Krajicek University of Colorado Denver
      • Robert E. Rakel Baylor College of Medicine
      • John Sargent Tufts University
      • Marlys Staudt The University of Tennessee


      View Copyright Page

      List of Entries

      Reader's Guide

      The Reader's Guide is provided to assist readers in locating entries on related topics. It provides a view of the scope of topics presented in entries to ensure a careful and systematic reading of related topics. It also classifies entries into 11 general topical categories to increase reader speed in locating topics of interest. Please note that entries may be listed under more than one topic.

      About the Editors

      Martha Craft-Rosenberg joined the College of Nursing faculty at the University of Iowa in 1980 after a 15-year practice career with children and families. She currently serves as Emeritus Professor in the Parent, Child, and Family Area of Study. She is an elected fellow of the American Academy of Nursing.

      An active researcher, Craft-Rosenberg has focused her studies on siblings of ill children, families of critically ill patients, and nursing standardized languages. Her language classification research includes nursing intervention classification since 1987 and diagnoses classification for a decade as principal investigator for the Nursing Diagnosis Extension and Classification team.

      The author of 70 articles and 4 book chapters, and author or editor of 10 books, Craft-Rosenberg's funded research on children and families has garnered awards from the American Association for Critical Care Nursing and the Midwest Nursing Research Society. She is the first editor of the book Nursing Interventions for Infants and Children, which was awarded the American Journal of Nursing and Pediatric Nursing Book of the Year Award in 2000. Her most recent book, based on work from the American Academy of Nursing Child Family Expert Panel, was published in 2006.

      Craft-Rosenberg recently completed a term as president of NANDA International and served as director of the Institute for Nursing Knowledge at the University of Iowa College of Nursing. She served 1 year as interim dean after having served 17 years as a department head and forming a new Parent Child Family Area of Study and initiating a doctoral program in Child-Family Nursing. In addition, she taught at both undergraduate and graduate levels. She served as the major advisor for 44 thesis/dissertation research topics.

      After she retired, Craft-Rosenberg assumed a consulting position with the University of Iowa College of Nursing.

      Shelley-Rae Pehler, PhD, RN, completed her PhD from the College of Nursing at the University of Iowa in 2006. She joined the Department of Nursing at St. Ambrose University in 2005, where she is currently serving as Associate Professor. Prior to her doctoral studies, Pehler was an active clinician and advanced practice nurse caring for children and families. She was one of the first counselors in the RTS: Resolve Through Sharing program at Lutheran Hospital in La Crosse, Wisconsin, a grief support program for families who have lost a child through miscarriage, stillbirth, or neonatal death. She continued interest in grief support of children and families as she chaired a Pediatric Bereavement Committee, also at Lutheran Hospital. Her research interests include spirituality in children and teens. Pehler has been involved in the development of the Nursing Outcome Classification (NOC), serving as a member of the NOC team, and currently is serving as chair to the Physiologic Focus Group section. Pehler has 6 publications and 12 presentations, which have included discussions of her research in the area of children and adolescent spirituality, self-esteem in children, and pediatric growth and development. While in graduate school, she received a T-32 Training in Nursing Effectiveness Grant and an F-31 National Research Science Award from the National Institute of Nursing Research.


      Marie Abraham Institute for Patient- and Family-Centered Care

      S. Heath Ackley University of Washington

      Susan A. Albrecht University of Pittsburgh

      Melissa A. Alderfer Children's Hospital of Philadelphia, University of Pennsylvania

      Harlene Anderson Our Lady of the Lake University

      Keith A. Anderson The Ohio State University

      Denise B. Angst Advocate Health Care

      Christine M. Aramburu Alegría University of Nevada, Reno

      Carolyn Arcand University of Massachusetts Boston

      Sally Baddock Otago Polytechnic, New Zealand

      Don Bailey Research Triangle Institute International

      Susan Balandin Molde University College, Norway

      Dennis A. Balcom Private Practice

      Margaret Barnes University of the Sunshine Coast, Australia

      Barbara Beacham University of Pennsylvania

      Rosina M. Becerra University of California, Los Angeles

      Dorothy S. Becvar Saint Louis University

      Cynthia J. Bell Indiana University

      Linda G. Bell Indiana University-Purdue University Indianapolis

      Didem Bernard U.S. Agency for Healthcare Research and Quality

      Diane Berry University of North Carolina at Chapel Hill

      Stephanie Cosner Berzin Boston College

      Cecily Lynn Betz University of Southern California

      Donald W. Black The University of Iowa

      Deborah Blizzard Rochester Institute of Technology

      John Blosnich West Virginia University

      Mitzi Boilanger Riley Hospital for Children, Clarian Health

      Rebecca M. Bolen The University of Tennessee

      Georg Bollig Universitetet i Bergen, Norway

      Barbara L. Bonner University of Oklahoma

      Robert M. Bossarte University of Rochester

      Michel Boudreaux University of Minnesota

      Sharon Bowland University of Louisville

      Dalia Brahmi Albert Einstein College of Medicine

      Linda Brannon McNeese State University

      Bonnie Braun University of Maryland

      Moriah Brier Memorial Sloan Kettering Cancer Center, New York

      Angela D. Broadus University of Nevada, Reno

      Tricia A. Brodbeck University of California, Riverside

      Alvin C. Bronstein Rocky Mountain Poison Center

      Marion E. Broome Indiana University

      Sean E. Brotherson North Dakota State University

      Suzanne Brown Case Western Reserve University

      Kathleen C. Buckwalter The University of Iowa

      Lisa Burkhart Loyola University Chicago

      Joe Burrage, Jr. Indiana University

      Cori Bussolari University of San Francisco

      Jorie M. Butler University of Utah

      Jane Caflisch City University of New York

      Samantha Callan Conservative Party, UK

      Lynn Clark Callister Brigham Young University

      Christine Calmes VA Capitol Healthcare Network MIRECC

      Laura K. Campbell Medical University of South Carolina

      Alice Campbell Reay Dudley and Walsall Mental Health Partnership Trust

      Nicole Campione-Barr University of Missouri

      Jane M. Carrington University of Colorado Denver

      John P. Caughlin University of Illinois at Urbana-Champaign

      Julie Cerel University of Kentucky

      I. Joyce Chang University of Central Missouri

      Subrata Chattopadhyay West Bengal University of Health Sciences, India

      Claudia Chaufan University of California, San Francisco

      Barry Chiswick University of Illinois at Chicago

      Jin Young Choi Sam Houston State University

      Becky J. Christian University of Alabama at Birmingham

      Marilyn Coleman University of Missouri

      Terri Combs-Orme The University of Tennessee

      Elaine P. Congress Fordham University

      Ann E. Cornell University of Rochester

      Amy C. Cory Valparaiso University, Indiana

      Steven S. Coughlin Environmental Epidemiology Service, Washington, D.C.

      Julia Muennich Cowell Rush University

      Martha Craft-Rosenberg The University of Iowa

      W. E. Craighead Emory University

      Cheryl Lee Crisp Riley Hospital, Indianapolis

      Donna Miles Curry Wright State University

      Holly Dabelko-Schoeny The Ohio State University

      Constance Dallas University of Illinois at Chicago

      Judith C. Daniluk University of British Columbia, Canada

      Maryanne Davidson Yale University

      Jonathan C. Davis Samford University

      Janet A. Deatrick University of Pennsylvania

      Sharon A. Denham Ohio University

      Janet DesGeorges University of Colorado

      Mary Amanda Dew University of Pittsburgh

      Ada Diaconu-Muresan University of Nevada, Reno

      Heather E. Dillaway Wayne State University

      M. Robin DiMatteo University of California, Riverside

      Chamlong Disayavanish Chiang Mai University, Thailand

      Lisa Dixon University of Maryland

      Jan Dougherty Banner Alzheimer's Institute, Phoenix

      Amy Drapalski VA Maryland Healthcare System

      Howard Dubowitz University of Maryland

      Naomi Nichele Duke University of Minnesota

      Marie-Anne Durand University of London, UK

      Carmel B. Dyer University of Texas

      Julia Eggert Clemson University

      W. Suzanne Eidson-Ton University of California, Davis

      Shelly Eisbach Johns Hopkins University

      Deborah Ellis Wayne State University

      Glyn Elwyn Cardiff University, UK

      Janet Enslein St. Ambrose University

      Sharon Lindhorst Everhardt Delta College

      Robin S. Everhart Bradley/Hasbro Research Center, Brown Medical Center

      Heidi Harriman Ewen Miami University, Ohio

      William S. Fals-Stewart University of Rochester

      Melissa Spezia Faulkner University of Arizona

      Michele A. Faulkner Creighton University

      Suzanne Feetham University of Wisconsin-Milwaukee, Children's National Medical Center, University of Illinois at Chicago

      Noelle Fields The Ohio State University

      Barbara H. Fiese University of Illinois at Urbana-Champaign

      Gordon E. Finley Florida International University

      Kathleen Fitzpatrick Stanford University

      P. Maria Flavin University of Pittsburgh

      Kathleen Flecky Creighton University

      Paula Fomby University of Colorado Denver

      Karen Forrest Keenan University of Aberdeen, UK

      Roxie L. Foster University of Colorado Denver

      Nathan S. Fox Mount Sinai School of Medicine

      Peter Fraenkel City College of the City University of New York

      Cynthia Franklin University of Texas at Austin

      Debbie Fraser Athabasca University, Canada

      Cynthia Ann Frosch University of Texas at Dallas

      Eric Frost Université de Sherbrooke, Canada

      Tamas Fulop Université de Sherbrooke, Canada

      Michael E. Galbraith University of Colorado Denver

      Maribeth Gallagher Hospice of the Valley

      Lawrence Ganong University of Missouri

      Linda Garand University of Pittsburgh

      Joseph E. Gaugler University of Minnesota

      Kerstin Gerst University of Texas

      Ellen Giarelli University of Pennsylvania

      Roseann Giarrusso California State University, Los Angeles

      Stephen R. Gillaspy University of Oklahoma

      Laura N. Gitlin Thomas Jefferson University

      Mitch Golant Cancer Support Online Community

      Jacqueline Lytle Gonzalez Miami Children's Hospital

      Judith Goodell University of San Francisco

      Joan S. Grant University of Alabama at Birmingham

      Lacey Teneal Greathead University of Miami

      Kimberly Greder Iowa State University

      Robert-Jay Green Alliant International University

      Mary Ruth Griffin University of Charleston

      Terry Griffin Rush University Medical Center

      Victor Groza Case Western Reserve University

      Mary P. Guerrera University of Connecticut

      Elaine M. Gustafson Yale University

      Barbara Habermann Indiana University

      Nora Hager University of Missouri

      Geri R. Hall Banner Alzheimer's Institute, Phoenix

      Barbara U. Hamilton University of Colorado Denver

      Shirley May Harmon Hanson Oregon Health & Science University

      Carl Haub Population Reference Bureau, Washington, D.C.

      Nancy Havil University of North Carolina

      Bert Hayslip, Jr. University of North Texas

      Bronwyn Hemsley University of Queensland, Australia

      Laura Mendoza Hernandez Miami Children's Hospital

      Dalice L. Hertzberg University of Colorado Denver

      Brian J. Higginbotham Utah State University

      Jennifer M. Hill Oregon State Hospital

      Andreas Hoff University of Oxford, UK

      Bonnie Holaday Clemson University

      M. Cay Holbrook University of British Columbia, Canada

      Mary L. Houston Baylor University

      Amy Houtrow University of California, San Francisco

      Jidong Huang University of Illinois at Chicago

      Angela J. Huebner Virginia Polytechnic Institute and State University

      Daniel Hughes Quittie Glen Center for Mental Health, Pennsylvania

      Robert E. Hurd Cincinnati Veterans Affairs Medical Center

      Alfreda P. Iglehart University of California, Los Angeles

      Evan Imber-Black Ackerman Institute for the Family, New York

      Melissa Dodd Inglese Children's Memorial Hermann Hospital, Houston

      Jessica Jablonski Richard Stockton College of New Jersey

      Robert M. Jacobson Mayo Clinic

      Tyler Jamison University of Missouri

      Parastoo Jangouk Kennedy Krieger Institute, Baltimore

      Yun-Hee Jeon University of Sydney

      Jason Aaron Jones Alliant International University, California and Mexico City

      Vanya Jones Johns Hopkins Bloomberg School of Public Health

      Allan M. Josephson University of Louisville

      Tess Judge-Ellis The University of Iowa

      Evangelos C. Karademas University of Crete, Greece

      Jennifer K. Kauder Poweshiek County Mental Health Center, Iowa

      David J. Kavanagh Queensland University of Technology, Australia

      Melissa Keene Northwestern University

      Victoria Floriani Keeton University of California, San Francisco

      Rick D. Kellerman University of Kansas

      Michael S. Kelly Loyola University Chicago

      Norman Lee Keltner University of Alabama at Birmingham

      Judith Kendall Oregon Health & Science University

      Christine Kennedy University of California, San Francisco

      Lisa Zaynab Killinger Palmer College of Chiropractic

      Il-Ho Kim University of Toronto, Canada

      Yeoun Soo Kim-Godwin University of North Carolina Wilmington

      Patricia A. Kinne University of Louisville

      Mumbe Kithakye Oklahoma State University

      Dorte Kjaer Randers Hospital, Denmark

      George J. Knafl University of North Carolina at Chapel Hill

      Kathleen A. Knafl University of North Carolina at Chapel Hill

      Stan Knapp Brigham Young University

      Kathie Kobler Advocate Lutheran General Hospital, Illinois

      Emily Koert University of British Columbia, Canada

      Marilyn J. Krajicek University of Colorado Denver

      Miriam Aroni Krinsky ABA Youth At RiskCommission, University of California, Los Angeles

      Jeffrey Todd Kullgren University of Pennsylvania

      Anahid Kulwicki Florida International University

      Jane M. Kurz Temple University

      Wendy K. K. Lam University of Rochester

      Wendy G. Lane University of Maryland

      Suzanne Lareau University of Colorado Denver

      Dana Lassri Ben-Gurion University of the Negev, Israel

      gretchen Lawhon Children's Regional Hospital at Cooper University

      David Lester Richard Stockton College of New Jersey

      Linda Ann Lewandowski Wayne State University

      M. Kay Libbus University of Missouri

      Howard A. Liddle University of Miami

      Russell F. Lim University of California, Davis

      Rana Limbo Gundersen Lutheran Medical Foundation, Inc., Wisconsin

      Darlene M. Lindahl University of Minnesota

      Megan F. Liu The University of Iowa

      James Lock Stanford University

      Bruce Lott Brigham Young University, Retired

      Sana Loue Case Western Reserve University

      Carol Loveland-Cherry University of Michigan

      Courtney Lupia Blasi University of Colorado Denver

      Barbara Mandleco Brigham Young University

      Elizabeth Frost Maring University of Maryland

      Gillian Marit University of Guelph, Canada

      Beth Marks University of Illinois at Chicago

      Sara Martino Richard Stockton College of New Jersey

      Donna D. McAlpine University of Minnesota

      Graham McCaulley University of Missouri

      Betsy M. McDowell Newberry College

      James P. McHale University of South Florida St. Petersburg

      Linda McKie Glasgow Caledonian University, UK

      Susan M. McLennon Indiana University

      Diane McNaughton Rush University

      Cynthia Mears Northwestern University

      William P. Meehan III Children's Hospital Boston

      Natthani Meemon University of Central Florida

      Suzanne Mellon Saint Anselm College

      Lyle J. Micheli Children's Hospital Boston

      Elizabeth Miller University of California, Davis

      Laura E. Miller The University of Tennessee

      Lou Ann Montgomery The University of Iowa

      Amanda Sheffield Morris Oklahoma State University

      Margaret P. Moss University of Minnesota

      Kim T. Mueser Dartmouth College

      Carles Muntaner University of Toronto, Canada

      Anjana Muralidharan Emory University

      Harvey J. Murff Vanderbilt University

      Colleen I. Murray University of Nevada, Reno

      Ian Murray University of Stirling, UK

      Wendy M. Nehring East Tennessee State University

      Alice W. Newton Children's Hospital Boston

      Katherina Nikzad-Terhune University of Kentucky

      Ashley N. Nolan University of Massachusetts Lowell

      M. Lelinneth Beloy Novilla Brigham Young University

      Ruth A. O'Brien University of Colorado Denver

      Thomas Olkowski Private Practice

      Alessandra Padula Università degli Studi dell' Aquila, Italy

      Kyle S. Page University of North Texas

      Jane Peace University of Wisconsin-Madison

      Geraldine S. Pearson University of Connecticut

      Julie K. Philbrook Hennepin County Medical Center

      Sabrina Pickens University of Texas at Houston

      Carl Pickhardt Private Practice, Author

      Laura Pickler University of Colorado Denver

      Makeba Pinder University of Texas at Austin

      Martin Pinquart Philipps University, Marburg, Germany

      Carol Ann Podgorski University of Rochester

      Vincent H. K. Poon Tyndale Seminary, Canada

      Eileen Jones Porter University of Missouri

      Samuel F. Posner Centers for Disease Control and Prevention

      Michèle Preyde University of Guelph, Canada

      Christine Proulx University of Missouri

      Linda Quan University of Washington

      Oliver Quarrell Sheffield Children's Hospital, UK

      Carol Quayle Mercy Health and Aged Care, Australia

      Jill Radtke University of Pittsburgh

      Minna Raivio Memory Research and Treatment Centers, Lahti, Finland, Department of Health, Helsinki, Finland

      Ann M. Rhodes The University of Iowa

      Nancy Ellen Richeson University of Southern Maine

      Roberta Riportella University of Wisconsin-Madison

      Karen A. Roberto Virginia Polytechnic Institute and State University

      Carole A. Robinson University of British Columbia, Canada

      John C. Robinson University of Charleston

      Rosemarie Rodriguez University of Miami

      Brian Rothberg University of Colorado Denver

      Jennifer Rowe University of the Sunshine Coast, Australia

      Polly Ryan University of Wisconsin-Milwaukee

      Rajiv Samant Ottawa Hospital Cancer Centre, Canada

      Katherine Sanchez University of Texas at Austin

      Yoshie Sano Washington State University Vancouver

      Marilyn Sass-Lehrer Gallaudet University

      Edward J. Saunders The University of Iowa

      Teresa A. Savage Northwestern University

      Kathleen J. Sawin Children's Hospital of Wisconsin, University of Wisconsin-Milwaukee

      Anju Purohit Sawni Wayne State University, Children's Hospital of Michigan

      John Scanzoni University of Florida

      Maximilian D. Schmeiser University of Wisconsin-Madison

      Janet U. Schneiderman University of Southern California

      Lisa S. Segre The University of Iowa

      Barbara H. Settles University of Delaware

      Nina G. Shah Epidemiologist

      Golan Shahar Ben-Gurion University of the Negev, Israel

      Jenelle R. Shanley University of Oklahoma

      Constance Hoenk Shapiro University of Illinois

      Martha C. Shaw The University of Iowa

      Linda Shields Curtin University, Australia

      William J. Sieber University of California, San Diego

      Leigh Ann Simmons Duke University

      Paul D. Simmons University of Louisville

      Nancy L. Sin University of California, Riverside

      Douglas A. Singh Indiana University South Bend

      Anita Sinicrope Maier Philadelphia Educational Network for Eating Disorders

      Jasmina Sisirak University of Illinois at Chicago

      Kathryn Smith Childrens Hospital Los Angeles

      Kelly Smith The University of Iowa

      Julia A. Snethen University of Wisconsin-Milwaukee

      Linley Snyder University of Missouri

      Elena McKeogh Spearing Private Practice

      Janet K. Pringle Specht The University of Iowa

      Mary Virginia Sprang University of Kentucky

      Amy R. Stanley University of Massachusetts Lowell

      Marlys Staudt The University of Tennessee

      Richard Albert Stein Princeton University

      Deborah Stiffler Indiana University

      Elizabeth A. Stormshak University of Oregon

      Wilma Powell Stuart Shannon Medical Center

      Monica H. Swahn Georgia State University

      Martha K. Swartz Yale University

      Jane H.-C. Tang Immaculata University

      Jennifer L. Tanner Rutgers University

      Bonita E. Taylor HealthCare Chaplaincy

      Donald H. Taylor Duke University

      Sandra Taylor, Jr. University of Tasmania, Australia

      Heide S. Temples Clemson University

      Sanna J. Thompson University of Texas at Austin

      Sally E. Thorne University of British Columbia, Canada

      Leanne Togher University of Sydney, Australia

      Ellen Tsai Queen's University, Canada

      Tara Tucker University of Ottawa, Canada

      Judith M. Tuerck Oregon State Public Health Laboratory

      Prudence Twigg Indiana University

      Paul N. Van de Water Center on Budget and Policy Priorities, Washington, D.C.

      Marcia Van Riper University of North Carolina at Chapel Hill

      Beth Vaughan-Cole Brigham Young University

      Judith A. Vessey Boston College

      Ruvanee P. Vilhauer Felician College

      Augusta M. Villanueva Drexel University

      Kathryn R. Wagner Kennedy Krieger Institute, Baltimore

      Froma Walsh University of Chicago

      Thomas T. H. Wan University of Central Florida

      Sharon M. Wasco University of Massachusetts Lowell

      Janice G. Weber The University of Louisiana at Lafayette

      Karin Weber-Gasparoni The University of Iowa

      Stevan Weine University of Illinois at Chicago

      Christian E. Weller University of Massachusetts Boston

      James M. White University of British Columbia, Canada

      Sarah W. Whitton University of Cincinnati

      Sharon Wallace Williams University of North Carolina at Chapel Hill

      Lucia D. Wocial Clarian Health, Indiana University

      Danuta Wojnar Seattle University

      Alan D. Woolf Harvard University

      Kynna Wright University of California, Los Angeles

      Jin-Shang Wu National Cheng Kung University, Taiwan

      Guohua Xia University of California, Davis

      Glen L. Xiong University of California, Davis

      Daniel J. Yoo Emory University

      Arlene R. Young Simon Fraser University, Canada

      Talia Zaider Memorial Sloan Kettering Cancer Center, New York

      Michelle Zeager Harvard University

      Denis Zilaff Sacramento County

      David J. Zucker Shalom Park, Denver


      Even though discussions of health conditions (e.g., diabetes) occurring in families are common, the relationship of these conditions to family context and to the family unit is too often left unstated. A major reference is needed to provide that relationship. The concept of the Encyclopedia of Family Health originated from this need to provide a compilation of knowledge on health and families for all learners, practitioners, researchers, theorists, and educators across the disciplines of health-related sciences as well as to the general public. The purpose of the encyclopedia is to provide knowledge for readers with diverse interests. Some readers are just beginning an interest in families. In contrast, some readers will be seeking an update on their existing knowledge. The direct aim of this encyclopedia is to increase family health knowledge. The indirect aim is to improve the health of families.

      The specification of content to be included in this Encyclopedia of Family Health was a combined effort among Sage Publications, the Editorial Board, the two editors, and the contributors. First, staff members from Sage identified health issues occurring in the literature related to family health that might be included as headwords in the encyclopedia. Next, these potential headwords were reviewed by members of the Editorial Board, and modifications were made. Members of the Editorial Board represent the disciplines of family medicine, nursing, child psychiatry, and social work. They live in the United States and Australia. Final decisions on content were made by the editors. Importantly, each topic, or headword, specifies a relationship to family. Encyclopedia contributors were asked to provide their working definition or perspective of family for their entries.

      The editors searched electronic databases to identify the experts who are actively contributing to family health knowledge through the conduct of research, education, practice, and policy development. The contributors to the Encyclopedia of Family Health are nationally and internationally recognized authorities. Even though the encyclopedia content reflects a U.S. perspective, the editors recruited writers from around the world, with the exception of contributors for topics that are central to the United States (e.g., health care reform, Medicare, Medicaid). These contributors provide a global perspective of family health issues. The editors searched for expertise, wherever it might dwell.

      It is with great appreciation we acknowledge these entry contributors. The individuals who have written for this encyclopedia are experts in theory, research, practice, and education. We find it exciting to see the breadth and depth of theory and research that contributors are utilizing to improve to knowledge in family health.

      The future of family health, like all disciplines, rests with the leaders. Those with a commitment to families will find continued excitement and challenges throughout their careers. Those in practice encounter the complexity of family communication, reciprocity, and relationships on a daily basis. Wise practitioners will observe and listen carefully to enlarge perspectives and to increase skills. Educators will use creativity to explicate family dynamics with an awareness of the paucity of family knowledge we have compared to that needed. Theorists and researchers will continue to struggle to keep up with the changing nature of families in their attempts to assist all of us committed to family health.

      After 2 years of locating and interacting with the contributors to this encyclopedia, we feel a sense of awe and wonder at the global talent in place to improve the health of families. For this reason, we are confident that remaining challenges will be addressed and that our knowledge will continue to grow.

      All of us are from families, and most adults are responsible for families. The intent of this encyclopedia is to help anyone with questions related to health and questions related to families who may be at any point in family life and the family health continuum. Students and practitioners in the health sciences will find specific help from this readily accessible information that they will use throughout their careers. This encyclopedia is a unique source for the public and for health care professionals.

      As you begin to explore the encyclopedia content, we recommend that you begin with the entries on “Defining Family” by Barbara H. Settles, “Family Health Perspectives” by M. Lelinneth Beloy Novilla, and “Families: The Basic Unit of Societies” by Linda McKie and Samantha Callan to provide a background for further reading. Next, we recommend that you review the Reader's Guide to examine the scope and organization of content available to you in the encyclopedia. Use this guide often to increase the breadth of your knowledge and to increase your efficiency in accessing the knowledge.

      We hope that you learn and that you enjoy.


      The conceptualization of the Encyclopedia of Family Health began with the vision of Martha Craft-Rosenberg and Jim Brace-Thompson, the Sage Acquisition Editor. Guidance for the process of developing the encyclopedia was provided by the Developmental Editor, Carole Maurer, and Systems Coordinator, Laura Notton. Kate Schroeder was our Production Editor, who helped us see new options for presenting content. All of these individuals represent the epitome of professionalism in both their competence and their ability to provide encouragement and helpful suggestions even during the most difficult periods in this 2-year process. We feel privileged to have worked with them, and we will miss them.

      Members of the Editorial Board provided a balance of constructive criticism and assistance throughout the process. Board members were always accessible to the editors at any time of the day or night to provide opinions, answer questions, and give us contributor suggestions. Some Editorial Board members even took advantage of professional meetings to recruit. Their support was invaluable to this project.

      The individuals we invited to contribute are passionate, committed, and hard working. It was common for us to receive e-mail messages sent in the middle of the night from the United States and several countries. All contributors were patient with the editing process and responded rapidly to e-mail messages from both encyclopedia and Sage editors. Their talent and their willingness to work through the process with the editors were incredible. They are the reason you have this strong resource for your use.

      On a more personal note, we wish to thank our husbands, Guy Rosenberg and Adrian Pehler, who became accustomed to seeing their wives from a side or back view during the hours of computer work. Their understanding and support made the long hours comfortable and possible.

      MarthaCraft-Rosenberg, and Shelley-RaePehler

      The Relationship of Family to Health: Historical Overview

      The purpose of this historical overview is to describe the evolving definitions and constructs of family and our understanding of the relationship of family to health. Historical exemplars of the evolving science of family and health are described.

      Scholars and researchers have reported on the relationship of family and health from the time of Florence Nightingale. Although the findings have varied based on the discipline lens of the scholars, there are consistent findings reported and also persistent deficits in our knowledge due to conceptual and measurement issues.

      Health as a Function of the Family

      Findings across the decades of research and scholarship support the significant relationship and importance of the family to the health of the family, individual family members, and communities. The family is described as the primary unit for health and as the most important social context in which health and illness occur and illness is resolved. Some report that one of the primary purposes, if not the primary purpose of family, is to ensure the health and well-being of its members (Friedman, Bowden, & Jones, 2003) and that health is a criterion for family life (Grzywacz & Ganong, 2009). The family is seen as a dynamic system that helps to maintain health, offers support to family members, affects health decisions, and attaches meaning to illness (Pardeck & Yuen, 2001; Rolland, 1987; Wright & Bell, 2009). The health of the family and family members is considered a function of the family the same as other functions such as biological reproduction, emotional development, and socialization (Friedman et al., 2003; Litman, 1974). The ability of families to meet their primary functions rests, at least in part, on the health of individual family members (Doherty & Campbell, 1988). For example, the state of family members' physical and mental health determines if and how family functions are met. These functions include the ability for employment, consistent monitoring of the behavior of children, and providing a safe environment for family members. Health is also reported as essential to effective family interactions and relationships. In 1976, the World Health Organization (WHO) reported that family is not only the basic unit of human social organization, but it is one of the most accessible for preventive and therapeutic intervention. WHO also noted that the health of the family is more than the sum of the health of individual family members.

      A distinction has been made between the health of individual family members and the health of the family. In 1976, WHO reported that the health of a family goes beyond the physical and mental conditions of its members to the extent that it provides a social environment for the natural development and fulfillment of all who live within it. Importantly, WHO recognized that health is the interaction between social variables and family health; these social variables include ethnicity, socioeconomic status, employment, migration, and social and cultural norms and mores. This distinction between health and family health is considered a landmark in the recognition that multiple factors interact to affect health and that the health of family members is different from the health of the family.

      Definitions of Health, Family Health, and Familial Health

      How health, family health, and familial health are defined directs the actions and relationship of health professionals and families. The 1948 World Health Organization definition of health as “a state of complete physical, mental and social well being and not merely the absence of disease or infirmity” remains a global standard. It was a major conceptual advance in that it expanded the definition of health to psychological and social dimensions. A dilemma in these ensuing years has been a need for an operational definition of health and that the lack of such a definition continues to limit our understanding of the relationship of family to the health of its members and to the family system (Grzywacz & Ganong, 2009; Saracci, 1997). One effort to attempt to address this gap in the understanding of the relationship of the family to health was led by WHO in 1976. WHO established a workgroup, the WHO Consultation Family Unit and Health, to better describe the role of the family and health (WHO, 1976). The goal of the workgroup was to identify statistical indices of family and health by examining the family research and policy across four approaches: demographic, epidemiological (medical), social, and economic. The 1976 report resulted in recommendations and priorities for research, but the workgroup members were not able to identify specific indices of family health because of the complexity of measurement and because “family health is more than the sum of the health of individual family members” (p. 13). Through their work, they differentiated family health from familial health. The report recommended that family health, as an established concept, should apply to the sum of the states of health of the individual family members. Family health is measured by the ability of the family to meet its functions and not by the health of individual family members. Mauksch (1974) and Pardeck and Yuen (2001) further reported that family health is demonstrated by the development of, and continuous interaction among, the physical, mental, emotional, social, economic, cultural, and spiritual dimensions of the family, which results in the holistic well-being of the family and its members.

      In contrast, familial health was proposed to indicate the functioning of the family for the promotion of the health and well-being of individual family members and the family system. To measure familial health requires the recognition that the level of health may be different across family members, ranging from demonstrated illnesses and conditions to the absence of observable illness to the actual positive health measured by development, function, and physiological measures (WHO, 1976). These are distinctions that can guide the research and scholarship on families.

      Historical Evolution of Science of Family and Health

      From the time of Nightingale, nurses have been encouraged to consider family members as important for nursing care (Whall & Fawcett, 1991). In a detailed case study in 1945, physician Henry Richardson acknowledged the importance of the family and emphasized the need to connect activities within the home and across family members to the care of individual patients. From the 1950s to the present, sociologists have been major contributors to our understanding of families and health, with their systematic focus on the role of the family with ill individual family members and their beginning study of the impact of illness on family (Litman, 1974; Vincent, 1963). Researchers examined intergenerational health care and the family, including patterns of decision making and the role of the family in health and illness behavior (Hill, 1958). Similar to current research, sociologists reported that families were unable and unwilling to care for sick family members in the home (Parsons & Fox, 1952). During this time, Sussman (1953) reported that existing techniques for measuring the interrelationship of family behavior to the etiology of disability and chronic illness were too limited to clearly advance our understanding of the important relationship between family and health. Litman and Venters (1979) noted that although much was known about health and health care of the populations, far less was known about the family as the unit of health. Importantly, this research began to examine the reciprocal nature of illness on the family and the effect of the family on health and illness of family members. It was also noted that mothers were the primary source of family data, resulting in the research being the mothers' perceptions of the family and its members. Wakefield and colleagues, in a state of the science review, further delineated the conceptual and methodological issues in research of families (Wakefield, Allen, & Washchuck, 1979). They noted that the research focused on the internal family processes and gave limited attention to the interdependence of individual family members and the family to the larger social and physical environment. They reported that such a focus inferred the cause-and-effect relationship of family and health was internal to the family.

      Beginning in the 1980s, more clinician family scholars such as Campbell (1986), Doherty (1993), Doherty and Campbell (1988), Feetham (1984, 1999), Feetham and Thomson (2006), Friedman (1981, 1998), Friedman et al. (2003), Gilliss and Knafl (1999), Grzywacz and Ganong (2009), McCubbin (1999), McDaniel, Campbell, Hepworth, and Lorenz (2003), Ransom (1986), Ross and Mirowsky (2002), and Wright and Bell (2009) advanced our understanding of the relationship of family to health through review articles synthesizing the state of the science. The reviews focused on two primary areas: family roles in health and illness and the effects of health and illness on individual family members and the family as an interdependent, interactive system. The outcomes of this research further demonstrate the importance of the family to the health of the individual family members and to the family system.

      Roles of Family in Health of Family Members

      One family role is in the health promotion and risk reduction for the family and its members (Roth & Simanello, 2004). The WHO (1976) cites the family as the primary social agent in the promotion of health and well-being. Families are known to have a significant effect on behaviors that influence individual health; these include exercise, diet, and substance use (alcohol, cigarette smoking, and drugs; McDaniel et al., 2003). The family creates the environment in which the family members develop their behavioral patterns that promote health or result in risk for illness and injury. During the past decades, genomics has contributed to our knowledge of the mechanisms of and prevention of disease (Feetham & Thomson, 2006). This research has also strengthened our understanding of the relationship of the biological family to the health of individual family members and the intergenerational family (Rolland & Williams, 2005). Family is the convergence of sociocultural and genetic influences. The intergenerational family influences how individual family members and the family respond to genetic information and the risk of disease, including behaviors to reduce their risk (Feetham & Thomson, 2006; Rolland & Williams, 2005).

      The family is known to have a role in psychosocial factors and disease risk. Building from the knowledge that psychosocial factors can affect an individual's susceptibility to disease, research has shown that the family is an important source of support of family members and also a source of stress (Fisher, 2006). For decades, researchers have demonstrated that the family can be related to the onset of illness and affect the trajectory of illness (Coyne et al., 2001). The family is also reported as an important influence or buffer between the family member with an illness and the larger system, including the health care system (Weihs, Enright, & Simmens, 2008). Some researchers have reported a relationship to depression or stress and a decrease in cellular immunity. For example, Meyer and Haggerty (1962) demonstrated that chronic stress in families was related to the incidence of strep infections and days of school missed in children. Similarly, in a study of 500 families, a relationship between family stress and the increased utilization of health care was shown (Roghmann & Haggerty, 1973).

      Families are also known to play a critical role in appraising both physical and mental health. While mothers are recognized as the gatekeeper of family members' access to the health care system, the mother's health care use is more of a predictor of the child's access to care than the child's health status. In addition to the role of the family as health appraiser, patterns of health service utilization are related to family structure and health beliefs.

      Family Responses to Health and Illness in Family Members

      Family responses to illness in family members and the role of the family in adaptation to illness and recovery provide further evidence of the importance of family and the health of family members (Deatrick, Alderfer, Knafl, & Knafl, 2006). Research focused on family responses to specific illnesses has resulted in a body of literature reporting that the interactions within the family system affect the health outcomes of family members (Fisher, 2006; Svavarsdottir, McCubbin, & Kane, 2000). The progression of disease and disability can be linked to relationship of family members (Coyne et al., 2001; Holder, 1997; Reiss, 1990). Grzywacz and Ganong (2009) note that we determine the health of the family by how they respond to changes in the physical and mental health status of family members and how they function to prevent health problems. Because of the research design and measures, we know more about the negative outcomes of acute and chronic illness on the family than the strengths and resources demonstrated by families. The family as caregiver has been examined from childhood to family members with acute and chronic illness across the age continuum (Gilliss & Knafl, 1999).

      Summary: What Do We Know about Family and Health?

      The interdependence and importance of health and the family are accepted in theory and supported by research. Although our knowledge of this relationship has increased, it has also been limited in that research continues to focus more on measures of the negative outcomes (e.g., depression) of illness and injury on the family and family members. The research also continues to focus more on the responses of individual family members than on the responses of the family as a unit. Because the focus has been on the individual as the unit of measure and on conducting research of families with physical and/or mental pathology, less knowledge has been generated about health and how the family functions. A classic exception is the synthesis by McCubbin (1999) of research of normative family transitions and health outcomes. If research of families would build on the premise that health is a criterion of family, Grzywacz and Ganong (2009) suggest that such research should result in knowledge and strategies for protecting and promoting health across the life span while distinguishing the interdependence of activities of family to health of the family and individual family members. A limitation of this science is the lack of translation into the education of health professionals and practice in health care systems. As important is that the knowledge of the significance of family to the health of the family and family members has not translated into policy. This limitation is due in part to the conceptual and methodological limitations of the research but more importantly because there is not sufficient recognition of the need to build the process of informing policy into programs of research and scholarship (Feetham, 1999; Feetham & Meister, 1999; Healthy People 2010, n.d.). As a result, the family is not seen as the context of care, and the health care system continues to focus on the health and illness of individuals and not the health of families as a system (Feetham, 1999; Feetham & Meister, 1999; Par deck & Yuen, 2001).

      SuzanneFeethamPhD, RN, FAAN
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