Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 49
Behavioral and Social Science
We know that the greatest improvements in the nation 's health wiR
result from a better understanding of social and behavioralfactors
that affect health.
S. Leonard Syme, Chair, IOM Committee on Promoting Health:
Intervention Strategies from Social and Behavioral Research
Approximately half of all deaths in the United States, as well as
the majority of diseases and disabilities, are linked to behav-
ioral and social factors. Some of these factors such as
smoking, poor diet, excess alcohol use, and sedentary lifestyles re-
late directly to the choices and actions of
individuals. Other factors, such as pov- Approximately half of all cleaths in
erty and exposure to environments that the United States, as well as the
discourage healthy behavior, involve majority of diseases and disabili-
society at large. All of these factors are ties, are linked to behavioral anc!
amenable to change, but research tells us social factors.
that achieving change at the individual
or environmental level is difficult. Yet, less than 5 percent of the ap-
proximately $] tnIlion spent annually on health care nationwide is de-
voted to reducing risks posed by behavioral and social factors. Greater
investments are needed to address the fundamental behavioral and so-
cial causes of disease, disability, and mortality.
Health and Behavior: Frontiers of Research in the Biobehavioral
Sciences (1982) brought national attention to the important role of
49
OCR for page 50
Informing the Future: Critical Issues in Health
behavior in health. The report reviewed research on the role of be-
havior in the prevention and treatment of a variety of diseases, de-
scnbed psychosocial arid behavioral risk factors and prevention ef-
forts, discussed the relationship of mental health care with primary
care, arid recommended directions for research on health and behav-
ior. The report was one of the first to recognize the contributions of
the behavioral sciences to medical practice and to promote multidis-
ciplinary research on known behavioral risk factors for disease.
The charge to society is to blend Prowess since 1982 has been dis-
the skepticism of a scientist, the appointingly slow. Today, such re-
passion of an advocate, the search comprises a small but growing
pragmatism of a policymaker, the segment of the National Institutes of
creativity of a practitioner, and the Health's portfolio, while also receiving
devotion of a parent and to use support from the Centers for Disease
existing knowledge to ensure both Control and Prevention and several
a decent quality of life for all our foundations. However, major baITiers
children end a productive future remain In the design, funding, and
for the nation. conduct of research to develop reliable
interventions to change individual and
From Neurons lo Neighborhoods:
The Science of Early Chilc/hoo~ population-level patterns in such areas
Deve/opment(2000) as ~et, smoking, and exercise. Even
when effective interventions are
known, communicating them to diverse populations presents a major
challenge. Healthy People 2010, the national health agenda developed
by the Of lice of the Surgeon General, with input from the TOM, offers
a roadmap for achieving major improvements in the nation's health
and for reducing health disparities among diverse populations. Suc-
cessful navigation of this roadmap depends on continued progress in
Me behavioral and social sciences, as well as on incorporation of the
resulting knowledge into education, clinical practice, arid population-
leve! health interventions.
The TOM continues to play an important role in assessing needs in
the behavioral and social sciences and in the translation of research
findings into practice.
50
OCR for page 51
Behavioral and Social Science
ADVANCING THE FIELD
A key to helping people enjoy longer, healthier lives is to
understand how to promote behavioral change arid to create
healthier environments. Promoting Health: Intervention
Strategies Mom Social and Behavioral Research (2000)
summarizes what has been learned in behavioral and so-
cial research that is of value in improving health at differ-
ent stages of life. The report acknowledges that health,
disease, arid well-being are complex states that develop
and change over the entire life course. In addition, behav-
ioral and social influences on health are complex, and no
single intervention, or set of interventions, is likely to ad-
dress all of these factors. Thus, health experts must use
multiple approaches (e.g., education, laws, social support
systems, and programs designed to help people change their dest~c-
tive behaviors), and they must address multiple levels of influence
simultaneously (e.g., individuals, families, communities, states, and
the nation as a whole).
For example, efforts to reduce the number of people who smoke
should take into account not only the physiological and psychological
effects of nicotine addiction, but also such larger issues as the ~nflu-
ence of friends amp colleagues who smoke, the availability of tobacco
products, amp the number of public
places where smoking is allowed.. The . . . children shouIcl be a major
report also notes Mat children should focus of [behavioral] intervention
be a major focus of intervention ef- efforts, since many of the risk
forts, since many of the risk factors factors observed in adults, such as
observed in adults, such as being beina overweight and shunning
overweight and shunning physical ac-
tivitv can he detecte(l—and chanced—
as' ^.ce ce..
' - 'nut'Or con
PROMOS
HEALTH
INT_mNnON STRATEGIES
FROM SOCUU AND
11F14AVU,Q&[ I
- - _ _ _
physical activity, can be detected—
and changed in childhood.
, ~ ~ -
in childhood. And, in designing ~nter-
vention programs for people of all ages, public health practitioners arid
researchers should seek community involvement and work closely
with the individuals who are targeted for participation.
51
OCR for page 52
Informing the Future: Critical Issues in Health
Health and Behavior: The Interplay of Cells, Self; and Society
(2001) reviews the evidence linking biological, psychological, and
social risk factors to medical disease. For example, the relationships
between cardiovascular disease and the neuroendocnne system,
stress, individual behavior, social networks, and socioeconomic status
are explored. The report also describes the variety of interventions
that have been used at the levels of the individual, the family or social
network, the organization, the commurlity, and society, and it evalu-
ates the limitations and potential of these approaches. The recom-
mendations for future directions in research could help federal agen-
cies arid foundations make decision about priorities for funding.
52
Behavioral and social science research provides a
frame of reference to better understand drug and sub-
stance abuse. Dispelling the Myths about Ad~dtictiorl
(1997) describes the psychosocial factors, as well as the
biological factors, that influence an individual's potential
for drug use and addiction. Beliefs and attitudes, many of
which are learned from role models at home, in the com-
munity, or in the media, have a strong influence on drug
use. The report notes that cognitive and behavioral re-
search on the psychosocial factors related to drug initia-
tion and use Carl lead to the development of new and ef-
fective prevention interventions.
WORKING ACROSS DISCIPLINES
Providing answers to the comniex health questions facing today's so-
. . .
, . ~
ciety requires an integrated approach that melds multiple disciplines.
A recently released report, Bridging Disciplines in the Brain, Behav-
ioral, and Clinical Sciences (2000), examines the needs, obstacles,
and strategies for interdisciplinary research and training in these
fields. Its findings may be broadly applicable in other fields of scien-
tific research and training as well. The report concludes that while
interdisciplinary training programs are growing in number, barriers
persist. For example, disciplinary jargon and cultural differences
among scientists inhibit easy interactions. Some believe that interdis-
OCR for page 53
Behavioral and Social Science
20%
1992 1993 1994 1995 1996 1997 1998 1999
Year
153 Interdisciplinary
O Single Discipline
O Unclassified
Annual distribution of Requests for Applications (RFAs) at the National
Institutes of Health. RFAs are posted to encourage research in fields of
special interest. The importance of interdisciplinary research at NIH is
clear, as an average Of 23% Of all RFAs issued in 1992-1999 by NIH
institutes addressed interdisciplinary research. SOURCE: Bridging Dis-
ciplines in the Brain, Behavioral, and Clinical Sciences, 2000; page 48.
ciplinary research reduces the likelihood of receiving funding or
achieving "first authorship" of publications, recognition that tradi-
tionally has been essential in gaining tenure. The duration and cost of
interdisciplinary education also can be discouraging.
Among the proposed remedies, government funding agencies caI1
implement peer-review procedures that reward scientists working
across disciplines, fiend shared core facilities, and require universities
to endorse interdisciplinary efforts. For their put, universities can
take preemptive steps to ensure that ap-
pointment, promotion, and tenure poli- Interdisciplinary research shouIcl
cies do not impede interdisciplinary re- supplement, not clisplace, single-
search and teaching; develop ways discipline efforts. . .
allocate appropriate credit for interdis-
ciplinary efforts; and to support the types of shared facilities that are
needed when bndg~ng disciplines. Interdisciplinary research should
supplement, not displace, single discipline efforts, but interdiscipli-
nary training opportunities should be available at all stages of a sci-
entist's career.
53
OCR for page 54
Informing the Future: Critical Issues in Health
80 -
70
60
40
30
10
o
Under 1-~ar old Under 6-years old 6- to 17-years old
1 975
1 999
Trends in the proportion of mothers in the labor force, by age of
child, 197~1999. NOTE: since 1975 data for mothers with children
under 1 year of age are not available, the data for this column are
from the June 1977 Current Population Survey. SOURCE: From
Neurons to Neighborhoods: The Science of Early Childhood Devel
Opment, 2000; page 270.
TRANSLATING KNOWLEDGE INTO PRACTICE
As a nation, we are not taking full advantage of what is known about
early childhood development, between bird and age 5. Such inatten-
tion could not come at a worse time. Despite the unprecedented na-
tional prospenty, financial hardship is
not uncommon. ~ fact, preschoolers
today are more likely to be Tom poor
f~nilies than they were 25 years ago.
Marty parents work long hours out of
economic necessity, aIld open outside
the typical 9-to-5 time Dame, an in-
creased workload that has left many
parents straining to balance making a living with family time. Record
numbers of women win young children work outside the home, re-
suldng In Increased reliance on childcare for infarcts and toddlers.
Despite the unprecedented
national prosperity, financial harcI-
ship is not uncommon. In fact,
preschoolers today are more likely
to be from poor families than they
were 25 years ago.
54
OCR for page 55
Behavioral and Social Science
From Neurons to Neighborhoods: The Science of Early Child-
hood Development (2000) takes a comprehensive look at the interac-
tions among a child's genetic inheritance, early environment, and per-
sonal experiences, and provides science-based advice about the
interventions that can make a difference in a child's cognitive, physi-
cal, and emotional development. The report notes, for example, that a
child's early relationships are cntical, and that a child who lacks at
least one loving and consistent care-
giver, whether a parent or attentive . . . the nation's policies and
child-care provider, may suffer from practices regarding childcare and
severe and long-lasting developmental early childhood education are
problems. Yet, the nation's policies often based on little or no evidence
and practices regarding childcare and that they actually promote chil-
early childhood education are often dren's well-being. .
based on little or no evidence that they
actually promote children's well-being. The report calls for a Presi-
dential task force to review all public investments in child care and
early childhood education, with the goal of making the most of scien-
tific knowledge. The task force would be charged with developing a
lO-year plan focused on ways to foster sustained relationships be-
tween preschoolers and qualified careg~vers; that addresses the spe-
cial needs of children with developmental disabilities or chronic
health conditions; and that ensures all child-care settings are safe,
stimulating, and responsive to families' concerns. The report also
recommends that the major funding sources for child care and early
education should support improvements in qualifications, pay, and
benefits of child-care professionals.
Encouraging the adoption of healthy behaviors and avoidance of
n sky ones, requires usefill intonation on specific health issues and
clear incentives to change. ~ culturally and demographically diverse
populations, many factors magnify this challenge. For example, cul-
tural differences in the perception of health and disease, differences in
health literacy, and differences in social norms, as well as social arid
system barriers interfere with adoption of recommended behavior
charges. ~ this regard, diversity is not limited to race, ethnicity, gen-
der, or age. Socioeconomic status, education, religious affiliation, sex-
ual preference' health status, and geographic location often exert
en
OCR for page 56
Informing the Future: Critical Issues in Health
greater influence over the processes of health communication and be-
havior change than do the more easily identified charactenstics. The
upcoming report Speaking of Health: Assessing Health Communica-
tior' Strategies for Diverse Populations (2001) will review recent ad-
vances in research on health communication and health behavior
change, offer specific examples of public health interventions, and
evaluate the characteristics of individuals, social networks, and com-
munities that influence the effectiveness of public health campaigns.
Promising strategies will be identified for public health interventions
to achieve a sustained change in the behaviors in diverse populations.
56
OCR for page 57
OCR for page 58
Selected Recommendations for
Public Health Policy. ~ .
HIV Prevention: The nation urgently needs a comprehensive, effective,
and efficient strategy for prevention of HIV. The organizing principle should
be to avert as many new HIV infections as possible within the resources
available for Hi\/ prevention. It will be necessary to improve the way the
epidemic is monitored, change how prevention resources are allocated and
how activities are prioritized and conducted, foster interactions between the
public and private sectors to promote new prevention tools and technolo-
gies, and reduce or eliminate social barriers to HIV prevention. (No Time to
Lose: Getting More from HIV Prevention)
Food Safety: Develop a comprehensive food safety plan that includes a
unified, science-based food safety mission; integrates federal, state, and lo-
cal food safety activities; allocates funding in accordance with science-based
assessments of risk and benefit; and provides adequate support for research
and surveillance. Congress should establish a unified and central framework
for managing federal food safety programs, one that is headed by a single
official with the responsibility and control of resources for all federal food
safety activities. (Ensuring Safe Food: From Production to Consumption)
Tobacco Policy: Congress should enact a comprehensive regulatory
statute delegating to an appropriate agency the necessary authority to
regulate tobacco products, for the dual purpose of discouraging consump-
tion and reducing the morbidity and mortality associated with use of to-
bacco products. The agency should be authorized to regulate the design
and constituents of tobacco products, with the purpose of setting and
gradually reducing ceilings on their nicotine content. (Growing Up Tobacco
Free: Preventing Nicotine Addiction in Children and Youths)
Sexually Transmitted Diseases: Sexually transmitted diseases (STDs)
are at epidemic levels in the United States, with tremendous health and
economic consequences. Congress and the administration should collabo-
rate to develop and support a national system for STD prevention. Major
components of this system will closely parallel an effective strategy for HIV
prevention and thus have multiple payoffs. (The Hidden Epidemic: Con-
fronting Sexually Transmuted DiseasesJ
.
Tuberculosis: The opportunity exists to virtually eliminate tuberculosis in
the United States over the next decade through relatively modest invest-
ments in prevention efforts. The opportunity should not be lost. IOM rec-
ommends a series of actions from fully funding the TO Strategic Plan to in-
creased professional training, and from mandated completion of therapy to
vaccine development. (Ending Neglect: The Elimination of Tuberculosis in
the United States ~
Representative terms from entire chapter:
food safety
