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of the growing literature on social and behavioral interventions that may improve health, it serves to assess whether this knowledge base has been useful, or could be useful, in the development of broader public health interventions.

To aid the committee, 12 papers were commissioned from some of the nation's leading experts to review these issues in detail (see paper contributions). The first of these papers provides a descriptive overview of the challenges posed in understanding the role of behavioral and social factors in health and the distribution of disease. The second paper considers how social and behavioral factors contribute to socioeconomic and racial/ethnic health disparities. Five papers then discuss what has been learned in behavioral and social research that is of value in improving health at different stages of life. Three papers examine specific “levers” for public health intervention: media and public health marketing; legislation and public policy; and efforts to enhance the social capital of communities. In addition, one paper was commissioned to provide a review of psychosocial and biobehavioral interventions in disease processes, an area of research that offers promise to uncover specific mechanisms linking social and behavioral forces to health. Of necessity, all of these papers deal with one or another particular aspect of the problem. For this reason, one paper was commissioned to consider all of these issues simultaneously in a multilevel, multidisciplinary approach. The case of tobacco control is used to illustrate this type of multifaceted intervention program.

When these papers were completed, the committee invited the authors to attend a symposium held at the Emory Conference Center in Atlanta, Georgia. In addition, 33 discussants were invited to comment on the papers. These discussants were specifically chosen not only because of their expertise in the subject matter, but also because they brought to the discussion a diversity of opinions and experience with intervention efforts. The committee's report reflects a careful consideration of information presented in these papers, as well as in the symposium discussion.

A Social Environmental Approach to Health and Health Interventions

The committee examined a wide range of social and behavioral research that was intended to promote the health and well-being of individuals, their families, and their communities, and found an emerging consensus that research and intervention efforts should be based on an ecological model. This model assumes that differences in levels of health and well-being are affected by a dynamic interaction among biology, behavior, and the environment, an interaction that unfolds over the life course of individuals, families, and communities (Satariano, in press). This model also assumes that age, gender, race, ethnicity, and socioeconomic differences shape the context in which individuals function, and therefore directly and indirectly influence health risks and resources. These demographic factors are critical determinants of health and well-being and



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