Review and special article
Behavior Matters

https://doi.org/10.1016/j.amepre.2010.12.031Get rights and content

Abstract

Behavior has a broad and central role in health. Behavioral interventions can be effectively used to prevent disease, improve management of existing disease, increase quality of life, and reduce healthcare costs. A summary is presented of evidence for these conclusions in cardiovascular disease/diabetes, cancer, and HIV/AIDS as well as with key risk factors: tobacco use, poor diet, physical inactivity, and excessive alcohol consumption. For each, documentation is made of (1) moderation of genetic and other fundamental biological influences by behaviors and social–environmental factors; (2) impacts of behaviors on health; (3) success of behavioral interventions in prevention; (4) disease management; (5) quality of life, and (6) improvements in the health of populations through behavioral health promotion programs. Evidence indicates the cost effectiveness and value of behavioral interventions, especially relative to other common health services as well as the value they add in terms of quality of life. Pertinent to clinicians and their patients as well as to health policy and population health, the benefits of behavioral interventions extend beyond impacts on a particular disease or risk factor. Rather, they include broad effects and benefits on prevention, disease management, and well-being across the life span. Among priorities for dissemination research, the application of behavioral approaches is challenged by diverse barriers, including socioeconomic barriers linked to health disparities. However, behavioral approaches including those emphasizing community and social influences appear to be useful in addressing such challenges. In sum, behavioral approaches should have a central place in prevention and health care of the 21st century.

Section snippets

Behavior Matters

Behavior is central to the development, prevention, treatment, and management of the preventable manifestations of diseases and health conditions (heart disease, cancer, stroke, chronic obstructive pulmonary diseases, unintentional injuries, pneumonia and influenza, diabetes, suicide, kidney diseases, chronic liver disease and cirrhosis, HIV/AIDS) on which the U.S. spends about $1.5 trillion, 75% of our annual healthcare costs.

The breadth of connections between behavior and health is

Sampling of Research on Behavior in Health

This paper documents the role of behavior in four risk factors (tobacco use, poor diet, physical inactivity, and excessive alcohol consumption) that are, collectively, responsible for an estimated 36.8% of all deaths in the U.S.,1, 2 as well as within three major disease areas (cardiovascular disease/diabetes, cancer, and HIV/AIDS). For each of these seven risk factors and diseases, Table 1 provides examples of six types of behavioral influence. The first entails how behavioral, environmental,

Evidence Summary

As Table 1 makes clear, published research provides examples of each of the six types of behavioral influence for each of the three major diseases (cardiovascular disease/diabetes, cancer, and HIV/AIDS) as well as the four risk factors (tobacco use, poor diet, physical inactivity, and excessive alcohol consumption). The next paragraphs summarize these influences along with the role of behavioral interventions in a key example of chronic disease prevention and management (diabetes).

Discussion

The role of behavior in health is substantial and broad, extending across leading causes of death: cardiovascular disease/diabetes, cancer, HIV/AIDS, tobacco use, poor diet, physical inactivity, and excessive alcohol use. It encompasses development and prevention of disease, enhancement of health, treatment of chronic diseases, quality of life, and mortality. This central role of behavior in health, health care, and prevention has recently been recognized in the 2010 Annual Status Report of the

References (251)

  • G.C. Fonarow et al.

    Improved treatment of coronary heart disease by implementation of a Cardiac Hospitalization Atherosclerosis Management Program (CHAMP)

    Am J Cardiol

    (2001)
  • Y.I. Garces et al.

    The relationship between cigarette smoking and quality of life after lung cancer diagnosis

    Chest

    (2004)
  • J.T. Arnedt et al.

    An open trial of cognitive–behavioral treatment for insomnia comorbid with alcohol dependence

    Sleep Med

    (2007)
  • J. Castaldo et al.

    The Lowering of Vascular Atherosclerotic Risk (LOVAR) program: an approach to modifying cerebral, cardiac, and peripheral vascular disease

    J Stroke Cerebrovasc Dis

    (2008)
  • P. Ades et al.

    A controlled trial of cardiac rehabilitation in the home setting using electrocardiographic and voice transtelephonic monitoring

    Am Heart J

    (2000)
  • L. Lalonde et al.

    Comparing the benefits of diet and exercise in the treatment of dyslipidemia

    Prev Med

    (2002)
  • C. Yu et al.

    Long-term changes in exercise capacity, quality of life, body anthropometry, and lipid profiles after a cardiac rehabilitation program in obese patients with coronary heart disease

    Am J Cardiol

    (2003)
  • R.C. Brownson et al.

    Promoting physical activity in rural communities: walking trail access, use, and effects

    Am J Prev Med

    (2000)
  • A.H. Mokdad et al.

    Actual causes of death in the U.S., 2000

    JAMA

    (2004)
  • A.H. Mokdad et al.

    Correction: actual causes of death in the U.S., 2000

    JAMA

    (2005)
  • K.I. Morley et al.

    Exploring the inter-relationship of smoking age-at-onset, cigarette consumption and smoking persistence: genes or environment?

    Psychol Med

    (2007)
  • H.H. Maes et al.

    Genetic and cultural transmission of smoking initiation: an extended twin kinship model

    Behav Genet

    (2006)
  • A. Agrawal et al.

    Correlates of regular cigarette smoking in a population-based sample of Australian twins

    Addiction

    (2005)
  • P.A. Madden et al.

    The genetics of smoking persistence in men and women: a multicultural study

    Behav Genet

    (1999)
  • M.S. Faith

    Behavioral science and the study of gene-nutrition and gene-physical activity interactions in obesity research

    Obesity (Silver Spring)

    (2008)
  • A. Navarro-Allende et al.

    Impact of genetic and environmental determinants of taste with food preferences in older adults

    J Nutr Elder

    (2008)
  • S. Li et al.

    Physical activity attenuates the genetic predisposition to obesity in 20,000 men and women from EPIC-Norfolk prospective population study

    PLoS Med

    (2010)
  • F. Ducci et al.

    Interaction between a functional MAOA locus and childhood sexual abuse predicts alcoholism and antisocial personality disorder in adult women

    Mol Psychiatry

    (2008)
  • R.B. Williams

    Lower central nervous system serotonergic function and risk of cardiovascular disease: where are we, what's next?

    Stroke

    (2007)
  • D. Ornish et al.

    Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention

    Proc Natl Acad Sci U S A

    (2008)
  • The health consequences of smoking: a report of the Surgeon General

    (2004)
  • M. Sharma

    Behavioural interventions for preventing and treating obesity in adults

    Obes Rev

    (2007)
  • The Surgeon General's call to action to prevent and decrease overweight and obesity 2001

    (2001)
  • C.E. Lewis et al.

    Mortality, health outcomes, and body mass index in the overweight range: a science advisory from the American Heart Association

    Circulation

    (2009)
  • Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults

    (1998)
  • E.E. Calle et al.

    Obesity and cancer

    Oncogene

    (2004)
  • J.H. Goldberg et al.

    Physical activity and weight management across the lifespan

    Annu Rev Public Health

    (2007)
  • M.B. Schulze et al.

    Primary prevention of diabetes: what can be done and how much can be prevented?

    Annu Rev Public Health

    (2005)
  • S.N. Blair et al.

    Physical fitness and all-cause mortalityA prospective study of healthy men and women

    JAMA

    (1989)
  • W.L. Haskell et al.

    Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association

    Med Sci Sports Exerc

    (2007)
  • J.A. Berlin et al.

    A meta-analysis of physical activity in the prevention of coronary heart disease

    Am J Epidemiol

    (1990)
  • C.S. Autenrieth et al.

    Association between domains of physical activity and all-cause, cardiovascular and cancer mortality

    Eur J Epidemiol

    (2010 Dec 14)
  • Healthy People 2010. Leading Health Indicators...
  • H. Eyre et al.

    Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association

    Circulation

    (2004)
  • The contributions of behavioral and social sciences research to improving the health of the nation: a prospectus for the future

    (2007)
  • B. Rockhill et al.

    A prospective study of recreational physical activity and breast cancer risk

    Arch Intern Med

    (1999)
  • C.E. Matthews et al.

    Lifetime physical activity and breast cancer risk in the Shanghai Breast Cancer Study

    Br J Cancer

    (2001)
  • I. Thune et al.

    Physical activity and the risk of breast cancer

    N Engl J Med

    (1997)
  • J. Leserman

    Role of depression, stress, and trauma in HIV disease progression

    Psychosom Med

    (2008)
  • N.R. Anthonisen et al.

    The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial

    Ann Intern Med

    (2005)
  • Cited by (151)

    • Introduction to Volume 8: Health Psychology

      2022, Comprehensive Clinical Psychology, Second Edition
    View all citing articles on Scopus
    View full text