tors have been associated with cardiovascular diseases (coronary artery disease, stroke, and hypertension), cancers (colon, breast, and prostate), and diabetes mellitus (U.S. DHHS, 1988). Physical inactivity has been associated with an increased risk for heart disease (Manson et al., 1992; Paffenberger et al., 1990) and colon cancer (Lee et al., 1991). The interdependence of dietary factors and physical activity patterns as risk factors for obesity has received considerable attention (Mokdad et al., 1999; Wickelgren, 1998; Hill and Peters, 1998; Tauber, 1998). Understanding these interactions as part of a more mechanistic characterization of predisease pathways (Chapter 2) to a range of cardiovascular diseases and cancers is an important research direction requiring integrative perspectives (see Chapter).

Alcohol and illicit drug use are associated with violence, injury (particularly automobile injuries and fatalities), and HIV infection (injecting drugs with contaminated needles). The annual economic costs to the United States from alcohol abuse are estimated to be $167 billion, and the costs from drug abuse are estimated to be $110 billion (U.S. DHHS, 2000). Among adolescents alcohol is the most frequently used substance among the alcohol/illicit drug items. In 1997, 21 percent of adolescents aged 12-17 years reported drinking alcohol in the last month. Such use has remained at about 20 percent since 1992. Eight percent of this age group reported binge drinking and 3 percent were heavy drinkers (five or more drinks on the same occasion on each of five or more days in the last 30 days). Data from 1998 show that 10 percent of adolescents aged 12-17 years reported using illicit drugs in the last 30 days. This rate is significantly lower than in the previous year and remains well below the all-time high of 16 percent in 1979. Current illicit drug use had nearly doubled for those aged 12 to 13 years between 1996 and 1997 but then decreased between 1997 and 1998. Among adults binge drinking has remained at the same approximate level of 16 percent since 1988, with the highest current rate of 32 percent among adults aged 18 to 25 years. Illicit drug use has been near the present rate of 6 percent since 1980. Men continue to have higher rates of illicit drug use than women, and rates are higher in urban than in rural areas (U.S. DHHS, 2000).

The above data summarize population-level profiles of adverse health behaviors (smoking, obesity and physical inactivity, alcohol and illicit drug use). Consistent with the integrative theme guiding this report (see Chapter 1), there is a great need for broadening research agendas around these topics. On the one hand, the behavioral and social sciences can help identify precursors (e.g., personality factors, coping styles, socialization processes, work and family stress, peer and community influences) to poor health practices (see Chapter 2, Chapter 5, and Chapter 6). Understanding the mechanisms through which poor health behaviors translate to chronic disease requires,



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