National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×

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.

Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×

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.

Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×

“Knowing is not enough; we must apply.
Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE

Shaping the Future for Health

Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×

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.

Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×

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

Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×
This page in the original is blank.
Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×

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.

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×

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

Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×

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

Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×

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.

Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×

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.

Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×
This page in the original is blank.
Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×
Page R1
Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×
Page R2
Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×
Page R3
Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×
Page R4
Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×
Page R5
Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×
Page R6
Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×
Page R7
Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×
Page R8
Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×
Page R9
Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×
Page R10
Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×
Page R11
Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×
Page R12
Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×
Page R13
Suggested Citation:"Front Matter." Institute of Medicine. 2000. Promoting Health: Intervention Strategies from Social and Behavioral Research. Washington, DC: The National Academies Press. doi: 10.17226/9939.
×
Page R14
Next: Introduction »
Promoting Health: Intervention Strategies from Social and Behavioral Research Get This Book
×
Buy Paperback | $55.00 Buy Ebook | $43.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

At the dawn of the twenty-first century, Americans enjoyed better overall health than at any other time in the nation’s history. Rapid advancements in medical technologies, breakthroughs in understanding the genetic underpinnings of health and ill health, improvements in the effectiveness and variety of pharmaceuticals, and other developments in biomedical research have helped develop cures for many illnesses and improve the lives of those with chronic diseases.

By itself, however, biomedical research cannot address the most significant challenges to improving public health. Approximately half of all causes of mortality in the United States are linked to social and behavioral factors such as smoking, diet, alcohol use, sedentary lifestyle, and accidents. Yet less than five percent of the money spent annually on U.S. health care is devoted to reducing the risks of these preventable conditions. Behavioral and social interventions offer great promise, but as yet their potential has been relatively poorly tapped. Promoting Health identifies those promising areas of social science and behavioral research that may address public health needs.

It includes 12 papers—commissioned from some of the nation’s leading experts—that review these issues in detail, and serves to assess whether the knowledge base of social and behavioral interventions has been useful, or could be useful, in the development of broader public health interventions.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!