Lifestyle behaviors compromise public health

December 19, 1999

While this century's medical advances and public health efforts have dramatically reduced the threat of infectious disease in the US, another threat to public health remains - poor health due to lifestyle behaviors, say researchers.

"The heaviest burden of illness today is due to chronic diseases that are, to a large degree, preventable," said lead study author C. Tracy Orleans, PhD, of the Robert Wood Johnson Foundation in Princeton, New Jersey.

Such illnesses - which are estimated to be responsible for 70 percent of all medical care spending - are linked to lifestyle behaviors involving tobacco use, alcohol and drug abuse, lack of healthy diet and exercise, and risky sexual practices.

Evidence exists that modification efforts directed toward these lifestyle behaviors can lead to improved health and reduced health care costs, according to Orleans and colleagues, who examined the efficacy of such efforts at individual, community, and public policy levels.

Their research results appear in the current issue of the American Journal of Health Promotion.

At the individual level, the researchers found clinic or self-help-based methods effective in improving health behavior, but mostly for highly-motivated individuals. "The best of these interventions typically reach a minority of Americans," said Orleans.

Room for improvement also exists with regard to health programs initiated in work environments, health clinics, hospitals, and schools. Such programs don't tend to be tailored to individuals, but rather have a "one-size-fits-all" approach that is not effective in the long run, according to the researchers.

Behavior modification efforts launched in primary care settings have been successful, but such efforts have been under-implemented, according to Orleans.

"For example, while 67 percent of physicians advise improved nutrition, particularly lowering fat and dietary cholesterol, few use dietary assessments or individualized diet counseling, citing lack of staff training and time as well as lack of insurance coverage," said Orleans.

As for public policy efforts, their success is difficult to measure, but growing evidence suggests that a "full court press" combination of public policy with other types of interventions works best, according to the researchers. The result of this type of effort has been especially well demonstrated for tobacco and alcohol behavior modification. For example, the combination of school-based prevention with policies such as youth drinking age and advertising restrictions has been effective.

Promising trends include advances in the understanding of addiction that will lead to better treatment methods; a shift to lower cost self-help treatments; and the development of individualized, rather than one-size-fits-all approaches to health behavior modification. "But we still have much work to do to improve the efficacy and reach of health behavior change programs and strategies," concluded Orleans.
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The American Journal of Health Promotion is a bimonthly peer-reviewed journal dedicated to the field of health promotion. For information about the journal call (248) 682-0707 or visit the journal's website at www.healthpromotionjournal.com .

Posted by the Center for the Advancement of Health < http://www.cfah.org >. For information about the Center, call Petrina Chong, < pchong@cfah.org> (202) 387-2829.

Center for Advancing Health

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