multiple levels that influence behavior individual (physiological, psychological), family, social networks, organizations, community, and society (state or national population). For example, a person might lose weight as the result of an intervention, but in the months and years after that intervention, the effects of family and friends, eating and offering favorite fatty foods, advertisements for high-calorie treats, exposure to situations in which more nutritious food is not readily available, stress at work combined with little time to seek out nutritious foods, and confusing labeling or messages emphasizing low-fat but not sugar and caloric content are likely to result in weight gain. Interventions that involve family and community members and others with whom an individual has social relationships; community, organizational, and workplace changes; and public policy interventions have all been demonstrated to affect behavior. However, additional research is needed on the functioning and effectiveness of interventions at the levels of family, community, organizations, and public policy, as well as on combinations of them to determine which might be most effective and under what circumstances. Interventions that focus solely on individual attributes, such as self-control or willpower, to change behavior leave many relevant factors to chance and thus are unlikely to be successful over the long term unless other factors (e.g., family and social relationships, work policies, social norms, and individual stress reactivity) happen to be aligned in a way that is conducive to the desired change.

AN INTERVENTION CASE STUDY: TOBACCO

Tobacco use is the leading cause of preventable death in the United States (McGinnis and Foege, 1993), and tobacco control provides a good illustration of the translation of research to application. This example was selected because there is substantial evidence that tobacco use causes ill health (Chapter 3), public health interventions and clinical effectiveness have been evaluated, and cost-effectiveness studies are available.

Clinical Interventions

In 1994, the Agency for Health Care Policy and Research (AHCPR) launched a comprehensive effort to translate research findings on the most effective smoking-cessation strategies into clinical guidelines for health care providers, administrators, and smoking-cessation specialists. AHCPR



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