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Promoting Health

Intervention Strategies from Social and Behavioral Research

Brian D.Smedley and S.Leonard Syme, Editors

Committee on Capitalizing on Social Science and Behavioral Research to Improve the Public's Health

Division of Health Promotion and Disease Prevention

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.



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Promoting Health: Intervention Strategies from Social and Behavioral Research Promoting Health Intervention Strategies from Social and Behavioral Research Brian D.Smedley and S.Leonard Syme, Editors Committee on Capitalizing on Social Science and Behavioral Research to Improve the Public's Health Division of Health Promotion and Disease Prevention INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C.

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Promoting Health: Intervention Strategies from Social and Behavioral Research NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, DC 20418 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 The Robert W.Woodruff Foundation. The views presented in this report are those of the Institute of Medicine Committee on Capitalizing on Social Science and Behavioral Research to Improve the Public's Health and are not necessarily those of the sponsor. International Standard Book Number 0-309-07175-5 Additional copies of this report are available for sale from the National Academy Press , 2101 Constitution Avenue, N.W., Box 285, Washington, D.C. 20055. 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 2000 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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Promoting Health: Intervention Strategies from Social and Behavioral Research “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE Shaping the Future for Health

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Promoting Health: Intervention Strategies from Social and Behavioral Research 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. William 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. William A.Wulf are chairman and vice chairman, respectively, of the National Research Council.

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Promoting Health: Intervention Strategies from Social and Behavioral Research COMMITTEE ON CAPITALIZING ON SOCIAL SCIENCE AND BEHAVIORAL RESEARCH TO IMPROVE THE PUBLIC'S HEALTH S.LEONARD SYME, Ph.D. (Chair), Professor of Epidemiology, Emeritus, Division of Public Health Biology and Epidemiology, University of California at Berkeley School of Public Health HORTENSIA AMARO, Ph.D., Professor, Social and Behavioral Sciences, Boston University School of Public Health EUGENE EMORY, Ph.D., Professor of Psychology, Graduate Program in Clinical Psychology, Emory University ARTHUR L.KELLERMANN, M.D., M.P.H., Professor and Chair, Department of Emergency Medicine, Emory University School of Medicine, and Director, Center for Injury Control, Emory University JANICE KIECOLT-GLASER, Ph.D., Professor of Psychiatry and Psychology, and Director, Division of Health Psychology, Ohio State University College of Medicine MARIE McCORMICK, M.D., Sc.D., Professor and Chair, Department of Maternal and Child Health, Harvard School of Public Health DAVID MECHANIC, Ph.D., Director, Institute for Health, Health Care Policy, and Aging Research, Rutgers University PAUL SHEKELLE, M.D., Ph.D., Research Associate, West Los Angeles Veterans Affairs Medical Center, Los Angeles GLORIAN SORENSEN, Ph.D., Director for Community-Based Research, Harvard School of Public Health and Dana Farber Cancer Institute, Boston CLAIRE STERK, Ph.D., Professor and Chair, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University JOHN A.SWETS, Ph.D., Chief Scientist Emeritus, BBN Technologies, Tequesta, Florida Health Promotion and Disease Prevention Board Liaison KATHLEEN E.TOOMEY, M.D., M.P.H., Director, Division of Public Health, Georgia Department of Human Resources, Atlanta Institute of Medicine Staff BRIAN SMEDLEY, Ph.D., Study Director DONNA D.DUNCAN, Division Assistant ROSE MARIE MARTINEZ, Sc.D., Director, Board on Health Promotion and Disease Prevention Commission on Behavioral and Social Sciences and Education Staff FAITH MITCHELL, Ph.D., Director, Division on Social and Economic Studies BARBARA TORREY, Executive Director, Commission on Behavioral and Social Sciences and Education

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Promoting Health: Intervention Strategies from Social and Behavioral Research Preface Participating in the development of this Institute of Medicine report has been of special importance to me. I have worked for over 40 years to identify social and behavioral factors that could be useful in improving health and wellbeing and it is especially satisfying to now work with colleagues to assess the progress that has been made in this effort. My first exposure to this field took place in 1957 when I entered the first graduate training program at Yale University in what was then called Medical Sociology. The Commonwealth Fund supported four students in that first class. Other people were already at work on these issues, notably David Mechanic who was a member of the committee for this report, but the program at Yale was the first, formal institutionalized recognition of the existence of the field. Ten years later, Professor Leo Reeder and I convened a conference in Phoenix, Arizona, to review the work that was being done in the social and behavioral sciences with special reference to the most vigorously studied disease at the time: coronary heart disease. A group of distinguished scholars spent several days assessing the evidence. In our report of the conference,* we concluded that progress was being made (but not enough to warrant interventions) and that more research was needed. Progress since then has been made but there have been at least as many false starts and dead ends as successes. But the field has grown enormously and it is entirely reasonable that we now pause again to assess the state of the field. * S.Leonard Syme and Leo G.Reeder (eds.), Social stress and cardiovascular disease. Milbank Memorial Fund Quarterly, Vol. XLV, April 1967.

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Promoting Health: Intervention Strategies from Social and Behavioral Research The charge to our committee was both clear and challenging: to identify promising areas of social science and behavioral research that could improve the public's health. The committee met for the first time in the spring of 1999 to consider this charge and to think about ways to best address it. That first meeting was a difficult one and it was not until after our second meeting that we finally were able to reach our first two decisions: one of these decisions—by far the easiest one—was to focus attention not only on the behavior of individuals but also on the social forces in the environment that shape and support such behavior. The second decision was more difficult and controversial: we decided not to focus our work on such clinical disease categories as coronary heart disease, arthritis, and cancer, because most behavioral and social factors affect many diseases. For the same reason, we decided not to organize our work around such disease risk factors as smoking, overeating, and physical inactivity. We decided instead to emphasize the role of social and behavioral factors as they influence health and disease at various stages of the life cycle. This was a difficult decision because almost everything we do in the health field is organized around clinical diseases. While this way of thinking about health may be appropriate for the diagnosis and treatment of disease in individuals, it may not be as useful in thinking about the prevention of disease. Our success in preventing most infectious diseases involved classifying them not on the basis of their clinical characteristics but on their modes of transmission. Thus, by considering diseases as being water, food, air, or vector borne, one could more effectively target prevention efforts. We thought we could adopt this conceptual model in thinking about the diseases of concern today. Our next decision was to invite some of the most thoughtful scholars in the nation to prepare papers that addressed this model in their particular area of expertise. The papers they wrote provide a valuable and unique resource that we hope will stimulate new thinking regarding social and behavioral interventions. These papers were of great help to the committee but to further enhance their value, the committee invited an additional group of 33 distinguished researchers and practitioners to provide their assessments of these papers. All of these experts were carefully chosen because they brought a diversity of opinion about and experience with intervention programs. The committee's final recommendations are based therefore not only on its own deliberations but also on the considered judgement of a larger group of outstanding thinkers with diverse backgrounds and experience. I hope this report will stimulate a dialogue about its importance for health in our society. S.Leonard Syme, Ph.D. Chair

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Promoting Health: Intervention Strategies from Social and Behavioral Research Acknowledgments Many individuals contributed directly and indirectly to the information contained in this report. In addition, several others assisted greatly in the February 2–3, 2000, symposium that the committee staged at the Emory Conference Center in Atlanta, Georgia. The committee expresses its appreciation to Emory University, the U.S. Centers for Disease Control and Prevention (CDC), and the Morehouse School of Medicine for their cosponsorship of the symposium. In particular, the committee wishes to thank individuals representing these institutions, including Drs. Michael M.E.Johns and David Blake of the Robert W. Woodruff Health Sciences Center at Emory University; Drs. Louis Sullivan and Peter MacLeish of the Morehouse School of Medicine; and Drs. Lynda Doll, Lynda Anderson, Ruth Berkelman, and Dixie Snyder of CDC. Renee Brown-Bryant of CDC was particularly helpful in securing Internet access for the symposium, so that the event could be viewed worldwide by individuals unable to attend in person. In addition, the committee wishes to thank Barbara and Jerome Grossman, M.D., whose generous gift supported the symposium. The committee also extends its thanks to several of the above individuals for their thoughtful comments provided during the symposium. Dr. Johns, Dr. Snyder, and Dr. James Curran of the Rollins School of Public Health provided introductions for keynote speakers. These speakers included Dr. Sullivan, Dr. Berkelman, and Dr. William Foege of Emory University. The symposium featured paper presentations by several authorities; versions of these papers are included in this volume. The committee wishes to express its gratitude to these authors (in order of appearance at the symposium and in this volume): Drs. George Kaplan, Susan Everson, and John Lynch of the

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Promoting Health: Intervention Strategies from Social and Behavioral Research University of Michigan; Drs. James House and David Williams of the University of Michigan; Dr. Carol Korenbrot of the University of California, San Francisco and Dr. Nancy Moss of the Pacific Institute for Women's Health; Drs. Allison Fuligni and Jeanne Brooks-Gunn of Columbia University; Dr. Cheryl Perry of the University of Minnesota; Dr. Karen Emmons of the Harvard School of Public Health; Dr. George Maddox of Duke University; Dr. Lawrence Wallack of Portland State University; Dr. Robert Sampson of the University of Chicago and Dr. Jeffrey Morenoff of the University of Michigan; Lawrence Gostin of the Georgetown University Law Center; Dr. Kenneth Warner of the University of Michigan; and Dr. Andrew Baum of the University of Pittsburgh. Several equally distinguished authorities reviewed these papers and provided thoughtful commentary during the symposium. Much of this commentary is reflected in the committee's findings and recommendations. Discussants included (in order of appearance at the symposium): Dr. Bruce Link of Columbia University; Dr. David Takeuchi of Indiana University; Dr. Thomas LaVeist of the Johns Hopkins University; Dr. Ruth Zambrana of the University of Maryland; Dr. Carol Hogue of the Rollins School of Public Health at Emory University; Dr. Margaret Heagarty of the Harlem Hospital Center and College of Physicians and Surgeons, Columbia University; Dr. Amado Padilla of Stanford University; Dr. Penny Hauser-Cram of Boston College; Dr. Deborah Coates of the City University of New York; Dr. William Vega of the Robert Wood Johnson Medical School; Dr. Dennis German of Texas A &M University; Dr. Ralph DiClemente of the Rollins School of Public Health, Emory University; Dr. Louise Russell of Rutgers University; Dr. Fernando Trevino of the University of North Texas Health Sciences Center; Dr. Sherry Mills of the National Cancer Institute; Dr. Robert Kahn of the University of Michigan; Dr. Manuel Miranda of California State University, Los Angeles; Dr. Elaine Leventhal of the Robert Wood Johnson Medical School; Dr. Howard Leventhal of Rutgers University; Dr. Rima Rudd of the Harvard School of Public Health; Dr. William Smith of the Academy for Educational Development; Dr. Nina Wallerstein of the University of New Mexico; Dr. Ichiro Kawachi of Harvard Medical School; Dr. Marshall Kreuter of CDC; Patricia King of the Georgetown University Law Center; Dr. Ralph Hingson of the Boston University School of Public Health; Jon Vernick of the Johns Hopkins University; Dr. Judith Auerbach of the Office of AIDS Research, National Institutes of Health; Dr. J.Michael McGinnis of the Robert Wood Johnson Foundation; Dr. Carol Runyan of the University of North Carolina; Dr. Neil Schneiderman of the University of Miami; Dr. Vicki Hegelson of Carnegie-Mellon University; and Dr. Ann O'Leary of CDC. The committee also expresses gratitude to Dr. Kathleen Toomey of the Georgia Department of Human Resources for her help in planning and moderating a panel during the symposium on public health needs of Georgia, featuring committee members Drs. Eugene Emory, Arthur Kellermann, and Claire Sterk.

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Promoting Health: Intervention Strategies from Social and Behavioral Research REVIEWERS The report was reviewed by individuals chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council's Report Review Committee. The purpose of this independent review is to provide candid and critical comments to assist the authors and the Institute of Medicine in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The contents of the review comments and the draft manuscript remain confidential to protect the integrity of the deliberative process. The committee wishes to thank the following individuals for their participation in the report review process: Nancy E.Adler, Ph.D., Professor of Medical Psychology and Director, Health Psychology Program, Center for Social, Behavioral, and Policy Studies, University of California at San Francisco School of Medicine Lisa Berkman, Ph.D., Professor of Health and Social Behavior and Epidemiology, Harvard School of Public Health Richard J.Bonnie, L.L.B., Battle Professor of Law and Director, Institute of Law, Psychiatry, and Public Policy, University of Virginia Susan Scrimshaw, Ph.D., Dean, University of Illinois at Chicago School of Public Health Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Elaine Larson, R.N., Ph.D., Professor of Pharmaceutical and Therapeutic Research, Columbia University School of Nursing, appointed by the Institute of Medicine and Lee N.Robins, Ph.D., Professor of Social Science, Department of Psychiatry, Washington University School of Medicine, appointed by the NRC's Report Review Committee, who were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Promoting Health: Intervention Strategies from Social and Behavioral Research Contents      INTRODUCTION   1      A Social Environmental Approach to Health and Health Interventions,   2      Summary of Findings and Recommendations,   5      FINDINGS AND RECOMMENDATIONS   6      Overarching Recommendations,   6      Promising Intervention Strategies,   9      Research Needs,   20      Community as Partners,   29      Funding,   29      CONCLUSION   33      REFERENCES   35     PAPER CONTRIBUTIONS    A   The Contribution of Social and Behavioral Research to an Understanding of the Distribution of Disease: A Multilevel Approach, George A.Kaplan, Susan A.Everson, and John W.Lynch   37  B   Understanding and Reducing Socioeconomic and Racial/Ethnic Disparities in Health, James S.House and David R.Williams   81  C   Preconception, Prenatal, Perinatal, and Postnatal Influences on Health, Carol C.Korenbrot and Nancy E.Moss   125

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Promoting Health: Intervention Strategies from Social and Behavioral Research  D   The Healthy Development of Young Children: SES Disparities, Prevention Strategies, and Policy Opportunities, Allison Sidle Fuligni and Jeanne Brooks-Gunn   170  E   Preadolescent and Adolescent Influences on Health, Cheryl L.Perry   217  F   Behavioral and Social Science Contributions to the Health of Adults in the United States, Karen M.Emmons   254  G   The Behavioral and Social Dynamics of Aging Well, George L.Maddox   322  H   The Role of Mass Media in Creating Social Capital: A New Direction for Public Health, Lawrence Wallack   337  I   Public Health and Safety in Context: Lessons from Community-Level Theory on Social Capital, Robert J.Sampson and Jeffrey D.Morenoff   366  J   Legal and Public Policy Interventions to Advance the Population's Health, Lawrence O.Gostin   390  K   The Need for, and Value of, a Multi-Level Approach to Disease Prevention: The Case of Tobacco Control, Kenneth E.Warner   417  L   Behavioral and Psychosocial Intervention to Modify Pathophysiology and Disease Course, Andrew Baum   450     COMMITTEE BIOGRAPHIES   489