middle-class American men. This bias pervades our thinking despite the demographic heterogeneity of American society (U. S. Bureau of the Census, 1992) and the substantial body of epidemiologic evidence that indicates significant group differences in health status, burden of morbidity and mortality, life expectancy, quality of life, and the risk and protective factors that con­ tribute to these differences in health outcomes (National Center for Health Statistics, 1994; Myers, Kagawa-Singer, Kumanyika, Lex, & M- kides, 1995). There is also substantial evidence that many of the health promotion and disease prevention efforts that have proven effective with more affluent, educated whites, on whom they were developed, may not yield comparable results when used with populations that differ by eth­ nicity, social class, gender, or sexual orientation (Cochran & Mays, 1991; Castro, Coe, Gutierres, & Saenz, this volume; Chesney & Nealey, this volume).