behavior are influenced by factors at multiple levels, including biological, psychological, and social. Interventions that involve only the person—for example, using self-control or willpower—are unlikely to change long-term behavior unless other factors, such as family relationships, work situation, or social norms, happen to be aligned to support a change” (IOM, 2001a).

A striking finding is the recurrent demonstration of the importance of interventions that combine several different channels of information or types of influence, are sustained, and address self-management or behavioral skills for the identification and attainment of personal goals and for the avoidance of temptations that would undermine those efforts.

A number of effective behavioral interventions exist, but no “magic bullet” or particular intervention is remarkably more effective than others. Additionally, different interventions may be effective in achieving similar goals. Thus, counseling as part of the delivery of primary heath care, mass media campaigns, and messages tailored to those not yet ready to change their behaviors may each be effective in reaching individuals and helping motivate change. Individual counseling, group programs, or self-help materials may each be effective in helping people plan their lifestyle changes and master behavioral self-management skills to avoid relapse. Follow-up from professionals, from trained volunteers, or through print or other media may help those who have changed their behavior maintain the healthy behavior.

To be successful, behavioral health interventions delivered in health care settings must overcome the principle barriers that confront providers and health care systems. The greatest barriers to providers’ delivery of smoking cessation counseling are lack of education and training, limitations of time and practice setting systems, poor reimbursement levels, and a perceived lack of success with patients who smoke. For diet and physical activity, an additional critical barrier is the lack of clear guidelines regarding recommendations for cancer control.

The potential for combinations of effects and the importance of the use of multiple approaches underscore the need for the use of comprehensive approaches. There are many different effective interventions, and their aggregate effects may not be captured by the evaluation of each one in isolation. Comprehensive programs that combine different intervention methods and channels have appreciable effects on all key behaviors for the prevention of cancer (CDC, 1999a; Rimer, 1997). Within such comprehensive programs, no single intervention method or channel is necessary or sufficient, but several different sets of strategies and methods may achieve comparable results. What is important is the overall strategy of combining multiple methods and channels.



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