risk (National Research Council, 1989; Woloshin and Schwartz, 1999). Thus, increased dissemination to the larger public of effective prevention strategies must be a key NIH priority.
While primary prevention is the cornerstone of good public health, the most proactive version of positive health is the promotion of optimal health behaviors and sustaining supportive environments. The distinction between primary prevention and positive health promotion is usefully illustrated with an intervention program designed to teach “life skills” to high-risk adolescents (Danish, 1997). This project rests on the observation that “to be successful in life, it is not enough to know what to avoid; one must also know how to succeed. For this reason, our focus is on teaching youth ‘what to say yes to' as opposed to ‘just say no'” (p. 292). The Going for the Goal (GOAL) program views early adolescence as an appropriate time to teach life skills, promotes interventions that simultaneously increase health-enhancing behaviors and decrease health-compromising behaviors, recognizes that those who do not have positive future expectations are at risk for engaging in health-compromising behaviors, and realizes that teaching skills is a critical route to changing behavior and cognition. Using a peer-teaching model, high school-aged adolescents teach life skills to both older and younger peers, emphasizing how to formulate and pursue positive life goals, including learning how to surmount obstacles to goal attainment. Since 1992, GOAL has been implemented in many cities. Students participating in the program achieve more of the goals they set, have better school attendance, and report fewer health-compromising behaviors (e.g., getting drunk, smoking cigarettes, violence) compared with those in control groups.
In addition to positive health promotion via life skills training, we reiterate the health significance of optimism and hope as well as of social and emotional support. While these are relatively new areas of inquiry, emerging evidence shows that such factors promote longer-term survival for those suffering from specific health challenges (see above), and these effects may be of even wider significance for the general population. Optimists and adults with low anxiety have lower ambulatory blood pressure and more positive moods than pessimistic and anxious adults (Räukkönen et al., 1999). Individuals growing up with feelings of warmth and closeness with parents had, 35 years later, decreased incidence of diagnosed diseases in midlife (coronary artery disease, hypertension, duodenal ulcers, alcoholism; Russek and Schwartz, 1997). Other recent advances in the social and behavioral sciences, such as studies of emotion coaching in parents (Gottman et al., 1996), positive emotions (Fredrickson, 1998), purpose and meaning (Wong and Fry, 1998), coping and problem solving (Thoits, 1994),