THROUGH THE KALEIDOSCOPE

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THROUGH THE KALEIDOSCOPE VIEWING THE CONTRIBUTIONS OF THE BEHAVIORAL AND SOCIAL SCIENCES TO HEALTH The Barbara and Jerome Grossman Symposium Summary of the Institute of Medicine Symposium on Contributions of the Behavioral and Social Sciences to Health Lisa F. Berkman, Ph.D., editor Institute of Medicine and Division of Behavioral and Social Sciences and Education National Research Council NATIONAL ACADEMY PRESS Washington, D.C.

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NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, DC20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. Support for this project was provided by a generous gift from Barbara and Jerome Grossman. The views presented in this report are those of the authors and are not necessarily those of the funding organizations. International Standard Book Number 0-309-08442-3 Additional copies of this report are available for sale from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, DC20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP’s home page at www.nap.edu. The full text of this report is available at www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu. Copyright 2002 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

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THE NATIONAL ACADEMIES National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

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Acknowledgments The Institute of Medicine (IOM) would like to thank Barbara and Jerome Grossman for providing the funds to support this symposium. The symposium and publication of this report would not have been possible without their generous gift. I would also like to thank each of the symposium speakers for their thoughtful, informative, and lively presentations. Their work has been and will continue to be instrumental in recognizing the importance of behavioral, social, economic, and environmental influences on health. I extend special appreciation to the symposium chair and report editor, Lisa F. Berkman, for keeping the lively discussions focused and moving forward throughout the day. I would like to thank the following IOM and National Research Council (NRC) staff for their help in planning the symposium, drawing from their experience as staff officers on projects from which the symposium largely drew its content: Christine R. Hartel, Director of the Board on Behavioral, Cognitive, and Sensory Sciences, National Research Council; Terry C. Pellmar, Director, Board on Neuroscience and Behavioral Health; Brian D. Smedley, Study Director, Board on Health Sciences Policy, Institute of Medicine; and Alexandra K. Wigdor, Study Director, National Research Council. I would also like to thank the following IOM staff for assisting in the logistics, planning, and execution of the symposium: Barbara D. Boyd,

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Administrative Assistant, Institute of Medicine; Donna D. Duncan, Deputy Director, Office of Council and Membership Services, Institute of Medicine; Don Tiller, Senior Membership Assistant, Office of Council and Membership Services, Institute of Medicine; Hallie Wilfert, Manager of New Media, Institute of Medicine; and especially Leslie Baer, who stepped in at the last minute to do a terrific job of handling the meeting logistics. And a special thanks goes to Jennifer Otten, who took the lead in organizing this effort early on and who has played a continuing key role in this effort. We also extend a special thanks to those who attended the symposium and continue to keep the dialogue alive. Susanne A. Stoiber Executive Officer Institute of Medicine

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Contents     Introduction   1     Introduction to the Subject Lisa F. Berkman, Ph.D., Chair, Department of Health and Social Behavior, Florence Sprague Norman and Laura Smart Norman Professor of Health and Social Behavior, Harvard School of Public Health, Harvard University   3     What We Know: The Tantalizing Potential         Etiology, Part I John Cacioppo, Ph.D., Tiffany and Margaret Blake Distinguished Service Professor; Director, Social Psychology Program; and Co-Director, Institute for Mind and Biology, The University of Chicago   8     Etiology, Part II Robert J. Sampson, Ph.D., Lucy Flower Professor in Sociology, Department of Social Sciences, The University of Chicago   12

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    Early Childhood Interventions: Theories of Change, Empirical Findings, and Research Priorities         Interventions, Part I Jack P. Shonkoff, M.D., Dean, Heller Graduate School; Samuel F. and Rose B. Gingold Professor of Human Development and Social Policy, Brandeis University   16     Interventions, Part II Margaret Chesney, Ph.D., Professor of Medicine, Professor of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco   20     Why Exploiting This Knowledge Will Be Essential to Achieving Health Improvements in the 21st Century Raynard S. Kington, M.D., Ph.D., Associate Director of Behavioral and Social Sciences Research, National Institutes of Health   24     Refocus Lisa F. Berkman, Ph.D., Harvard School of Public Health   29     Research to Understand the Mechanisms Through Which Social and Behavioral Factors Influence Health Bruce S. McEwen, Ph.D., Alfred E. Mirsky Professor, Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, The Rockefeller University   31     Investments in Longitudinal Surveys, Databases, Advanced Statistical Research, and Computation Technology Robert M. Hauser, M.D., Vilas Research Professor of Sociology, Center for Demography of Health and Aging, University of Wisconsin   36     Investments in Research and Interventions at the Community Level S. Leonard Syme, Ph.D., Professor Emeritus, Division of Public Health Biology and Epidemiology, University of California, Berkeley   42

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    Reactor Panel for Research Funders Lynda A. Anderson, Ph.D., Senior Health Scientist, Prevention Research Centers Program, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention J. Michael McGinnis, M.D., Senior Vice President and Director, Health Group, Robert Wood Johnson Foundation Judy Vaitukaitis, M.D., Director, National Center for Research Resources, National Institutes of Health   46     Wrap-up Kenneth I. Shine, M.D., President, Institute of Medicine   53 Appendix A:   Symposium Agenda   57

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