cessation and offer pharmacotherapy and follow-up to all users of tobacco products (Fiore et al., 2000).

Physical inactivity, poor diet, and obesity. The combination of physical inactivity and detrimental dietary patterns, including excess caloric intake, is the second most important factor contributing to mortality and morbidity in the United States (McGinnis and Foege, 1993; Mokdad et al., 2004). Sedentary lifestyles have been linked to 23 percent of deaths from major chronic diseases, while dietary factors are associated with 4 of the 10 leading causes of death—coronary heart disease, stroke, type II diabetes, and some forms of cancer (Hahn et al., 1990). Obesity, which is often linked to physical inactivity and poor diet, is a major factor in type II diabetes (Morsiani et al., 1985). Physical inactivity and obesity are widespread in the United States, where more than 60 percent of adults do not meet current physical activity guidelines, and 61 percent of adults are overweight or obese (U.S. DHHS, 2001).

Excessive alcohol consumption. Long-term excessive use of alcohol increases the risk of hypertension, arrhythmias, cardiomyopathy, and stroke, as well as some cancers (NIAAA, 2002) and poor pregnancy outcomes (Hoyert, 1996). Heavy use of alcohol is a major risk factor for chronic liver disease and cirrhosis (NIAAA, 1998) and is a major contributor to fatalities resulting from motor vehicle accidents. There were 19,358 alcohol-induced deaths in the United States in 2000, not including fatalities from motor vehicle accidents, and 26,552 deaths from chronic liver disease and cirrhosis to which alcohol consumption was a major contributor (Minino et al., 2002; NIAAA, 2002). Yet alcohol use is a complex issue because low levels of alcohol consumption (one drink per day for women, two drinks per day for men) have been shown to have protective health effects for certain diseases (Sacco et al., 1999; Valmadrid et al., 1999). Fully 62 percent of U.S. adults are considered current drinkers at any level of consumption, and 32 percent of current drinkers had five or more drinks on a single occasion at least once in the past year (NCHS, 2002; U.S. DHHS, 2000a).

Risky sexual behavior. Sexually transmitted diseases are especially problematic among adolescents, a group with a high frequency of short-term relationships, and only about 60 percent of adolescents who are currently sexually active regularly use condoms (CDC, 2002b). HIV, the virus that causes AIDS, is transmitted primarily through sexual contact or the sharing of needles among drug users (IOM, 2003b). Efforts to decrease HIV transmission therefore focus on behavioral interventions that minimize high-risk behaviors and decrease exposure to HIV. Other, more common sexually transmitted infections (e.g., human papilloma virus infection, gonorrhea, and chlamydia infection) have also been associated with poor health outcomes, including cancer, infertility, and long-term disability (IOM, 2003b). The Centers for Disease Control and Prevention esti-



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