and societal level (e.g., tobacco control legislation, changes in standards for school nutrition programs) (Winett et al., 1989; McLeroy et al., 1988). These levels are not mutually exclusive, and reflect an evolution in prevention research from a primary focus on determinants of behavior within the individual to broader perspectives that encompass interpersonal, organizational, and community influences.
This chapter begins with a description of the many opportunities to deliver behavioral interventions, from clinical settings to public health programs. An overview is then provided of conceptual frameworks and intervention paradigms that underlie much of the reviewed behavioral research. Next, treatment-outcome research is summarized for tobacco cessation and prevention, physical activity, and diet (weight loss interventions and modification of eating patterns). Lastly, the challenges faced by health care providers in delivering effective interventions are reviewed.
The delivery of health behaviorial interventions can take place in the context of a clinical setting or be more broadly applied to public health practice (Lichtenstein and Glasgow, 1992). Clinical programs include group and individual counseling offered through a variety of channels, including private, non-profit agencies, commercial programs, community organizations such as schools, health care centers, churches or other religious institutions, and worksites. The target population for clinical interventions is usually individuals who are motivated (or who can be motivated) to actively seek treatment. Interventions may be delivered by medical or allied health professionals or by non-medical professionals with specialty training. Behavioral interventions are often intensive, involving multiple sessions.
The target population for public health interventions is usually an unselected group of individuals or members of specific high-risk groups, regardless of their motivation to change their behavior. Interventions are delivered in natural settings, and the providers of interventions are not necessarily specialists. Public health interventions can include translating intensive behavioral programs into formats that can be delivered on a wide scale, such as self-help guides, computer-generated messages or reminders, and outreach telephone counseling. Advances in information technology have made it possible to create customized or tailored materials and to deliver them via the Internet. Also in the realm of public health interventions are large-scale efforts such as mass media programs (which can be paired with written self-help materials that are disseminated, for example, through community retail outlets) and legislative or regulatory approaches (e.g., excise taxes, school lunch policies).
Related to the clinical-public health continuum of intervention is the construct of “program impact.” The impact of an intervention is a product