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Executive Summary
Pages 1-18

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From page 1...
... Does such unhealthy behavior indicate a simple lack of willpower? How floes the social environment influence these behaviors?
From page 2...
... It also looked at research aciciressing interventions intenclec3 to change health~relatec3 be' havior, cognition, anc3 emotions, or interactions with the social environ' ment (i.e., psychosocial factors) with the aim of improving health.
From page 3...
... DEFINITION OF HEALTH Health is sometimes negatively defined as the absence of disease and injury, sometimes as a normative judgment referring to the average state of most people, and sometimes as a positive concept of wellbeing. This report uses "health" with the meaning of "positive health." Although dis' ease is commonly regarded as either present or absent, most health prob' lems fall on a continuum.
From page 4...
... Research with laboratory animals indicates that early~life experiences strongly in' fluence lifetime allostatic load. For example, in laboratory animals poor maternal care is associated with increased behavioral and stress hormone reactivity in adult life.
From page 5...
... Behavioral Factors Several behaviors that exert a strong influence on health are reviewed in this report: tobacco use, alcohol abuse, physical activity anc3 diet, sexual practices, anc3 disease screening. Although epidemiologic data on the relationships between these behaviors anc3 various health outcomes were available in the early 1980s, many refinements in knowledge have oc' currec3 since then.
From page 6...
... Changes in the physical anc3 social environment can help people maintain the neces' sary long-term lifestyle changes both for diet and for physical activity. Physical activity floes not need to be vigorous to be beneficial to health.
From page 7...
... Researchers examining social relationships in early and later life describe the importance of deep, meaningful, loving human connections and of affect in intimate relationships. Individuals on positive relationship pathways (positive ties with parents during childhood, intimate ties with spouse during adulthood)
From page 8...
... The fact that socioeconomic differences in health are not confined to segments of the population that are materially cleprivec3 in the conventional sense suggests strongly that socioeconomic differences are not simply a function of absolute poverty. Moreover, because causes of death that are purportedly not amenable to medical care show socioeconomic gradients similar to those of potentially treatable causes, differential access to health care programs anc3 services cannot be solely responsible for these cliFerentials in health.
From page 9...
... Multiple modalities of support are used in the practices that are most heavily committed to encouraging beneficial behavior change and that target individual patients. However, engaging busy practices to reach into new health promotion endeavors rather than to focus on delivery of acute care is challenging.
From page 10...
... A large number of people exposed to a small risk might generate more cases than will a small number exposed to a high risk, so that when risk is widely clistributec3 in the population, small changes in behavior across an entire population can yield larger improvements in population-attributable risk than would larger changes among a smaller number of high-risk inclivicluals. Population-basec3 intervention trials in a community, worksite, or school often focus on changing individual behavior for primary prevention of disease.
From page 11...
... Reviews of youth smokingcontrol interventions generally conclude that social influence interventions can curb smoking onset, although with a somewhat guarclec3 picture of their efficacy. School-basec3 interventions for physical activity in the 1980s anc3 l990s were found to improve student knowledge anc3 psychosocial factors but were less likely to change behavior significantly.
From page 12...
... However, a few studies demonstrate improved family relationships associated with better health outcomes. Family-focusec3 intervention studies of dementia in the elderly (especially Alzbeimer's disease)
From page 13...
... Community~level interventions can reduce the social, structural, anc3 environmental stressors that clegracle health status anc3 that are be' yoncl the ability of any single person to control or change. Communitylevel interventions also can strengthen the situational factors, such as so' cial support, community empowerment, community capacity, and social cohesion, that have been shown to protect against cleleterious effects of stress.
From page 14...
... Many social, economic, political, anc3 cultural factors are associated with health anc3 disease for which changes in incliviclual health behaviors alone are not likely to result in improved health anc3 quality of life. Public health laws provide a number of approaches to prevent injury anc3 disease anc3 to promote the population's health.
From page 15...
... Some very well clesignec3 intervention trials, however, conclucle that the approaches used were ineffective. A review of governmentlevel approaches to tobacco use prevention anc3 cessation revealed that single approaches via clean air laws, price increases, counter-aclvertising, enforcement of existing laws restricting youth access, anc3 others may be effective with some people.
From page 16...
... Social anc3 psychological factors include socioeconomic status, social inequalities, social networks anc3 support, work conditions, depression, anger, anc3 hostility. Recommendation 2: Research efforts to elucidate the mechanisms by which social and psychological factors influence health should be en couraged.
From page 17...
... Such efforts should address the psychosocial factors associated with health status (e.g., access to healthy foods or safe places to exercise) as well as individual behavior.
From page 18...
... Recommendation 7: Program planners and policy makers need to con sider modifying social and societal conditions to enable healthy behav for and social relationships. Interventions must be evaluated to enable continuous improvement of programs anc3 policies.


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