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Health and Behavior: The Interplay of Biological, Behavioral, and Societal Influences
obstacle is that there are no rigorous evaluations of interventions. Evaluations may assess short-term changes, but long-term effectiveness must enter the equation because maintaining behavior change has been shown to be difficult. Only with additional research and evaluation of interventions will the best approaches be found. This report illustrates the current level of understanding and demonstrates the limits of the currently available research. The example of tobacco in Chapter 8 aims to illustrate the complications inherent in the field.
BOUNDARIES OF THE STUDY
The field of health and behavior is very large. It includes, at minimum, the intersection of biological, social, and behavioral sciences with public health and medicine. The Committee, therefore, had to make hard choices about what to include and exclude from this report. The areas represented in this report are those in which Committee members either had expertise or found to be important enough to seek expert input with the resources available. While behaviors associated with the greatest burden of illness, such as tobacco use, seemed important to consider, the Committee also found it important to focus on health, not just morbidity and mortality. Stress and adaptation, psychosocial aspects of coping with illness, and resilience were deemed important by the Committee. The Committee chose to examine developments in biological, social, and behavioral determinants of health as well as the implications of these factors for intervention and research at the levels of individuals, families, communities, and populations. Issues in translation from research to application, including cost-effectiveness, were also considered.
A number of areas were excluded for a variety of reasons. Injury and substance abuse have been the subjects of recent IOM reports (IOM 1996, 1997a, 1999), so the Committee chose not to devote resources to these. Genetics, health, and behavior were the subject of a concurrent IOM study, and developments in genetics are occurring very quickly. The Committee therefore decided not to go into depth in that area, in which recent, excellent material is available (see Collins, 1999, for an overview of medical and societal implications of the human genome project; Carson and Rothstein, 1999, for various perspectives on behavioral genetics). Child and spousal abuse are difficult and controversial topics, and the Committee was not sufficiently constituted to consider these areas from the range of perspectives necessary to be thorough. While the report does