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National Institutes of Health (US); Biological Sciences Curriculum Study. NIH Curriculum Supplement Series [Internet]. Bethesda (MD): National Institutes of Health (US); 2007.

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NIH Curriculum Supplement Series [Internet].

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Information about the Science of Healthy Behaviors

What Is Behavior?

Webster's New World Dictionary defines behavior as "the way a person behaves or acts."28 Behavior effectively includes anything and everything an individual or group does. Behaviors play key roles in survival, long- and short-term health, and emotional and physical well-being. Some behaviors are instinctual, and others are conscious choices. Behaviors result from a complex interaction between genetics and the environment, and they include emotional and physical actions and reactions. Some behaviors are learned and vary from culture to culture. Some behaviors are social, involving interactions with others. Behaviors change based on an individual's age, education, social status, and situation.

Given the inclusiveness of the term, it should not be surprising if students have difficulty defining behavior. One of the goals of this curriculum supplement is for students to gain a more complete understanding of what constitutes behavior. Students will also begin to analyze the causes and effects of behaviors and think about the process and results of modifying behaviors. Ideally, this information will provide students with tools to evaluate their own behavioral choices, with the goal of improved health.

Studying Behavior

Behavioral and Social Sciences

The goal of the behavioral and social sciences is to better understand human behaviors and apply this understanding to improving the quality of life for people. Because so many behaviors have an impact on health, social and behavioral sciences are an important component of studying individual and group health.

Social and behavioral sciences are an important component of studying individual and group health.

Developing a valid scientific method for studying behavior is a challenge because behavior is so broadly defined. Virtually any activity, from language to walking, constitutes behavior, and behavior may be studied in an individual or in groups. In addition, the requirement of detaching emotionally from the subject and not projecting personal beliefs or feelings onto the study is difficult to meet. It becomes more difficult when one is studying, ultimately, oneself. Tools and measurable variables for the accurate and reproducible study of behaviors have been designed and identified, however.

Figure 1. Some behaviors are instinctual and others are conscious choices.

Figure 1

Some behaviors are instinctual and others are conscious choices.

The limits of behavioral and social science are difficult to draw since any behavior is a legitimate topic of study. In addition, the subjects of the field of study range from the individual to the global and include internal behaviors, interactions between people, and interactions between people and their environments.22

In this curriculum supplement, behavioral and social science refers to a large number of fields involved in studying behavior, including traditional fields such as psychology and sociology. The term also includes fields that are based on behavioral and social science methods such as epidemiology, anthropology, and the relatively new field of biopsychosocial research. Biopsychosocial research (also known as biobehavioral or biosocial research) involves the study of the interactions of biological factors with behavioral and social variables and of how they affect each other.

Behaviors include not only cognition, attitudes, emotions, sensation, motivation, perception, and communication but also eating, drinking, sexual, aggressive, and parental behaviors. Biopsychosocial research includes research on basic mechanisms as well as clinical research, and it is not restricted to humans. It includes normal as well as pathological function. It reflects an understanding of the relationship between behavior and health and combines traditional behavioral sciences with clinical and applied biology fields, as in psychoneuroimmunology (the scientific study of the interactions among behavior, the brain, and the immune system).8 Virtually any field that involves humans makes use of behavioral and social science to some degree.

These combined sciences have brought many changes to the way we live, from fundamental shifts in how society views and copes with mental illness to the design of ergonomically improved environments. Since behavior affects so many aspects of society, behavioral or social science research may contribute to conclusions in other fields such as politics and medicine. For example, polls are a form of survey, and epidemiology relies heavily on behavioral and social science methods for collecting reliable information.

Behavioral and social science research plays an increasing role in health care. By examining the human factors involved in successful treatments, researchers can identify ways to improve the effectiveness of those treatments. In our society, where lifestyle-induced chronic illnesses are affecting an increasing percentage of the population, developing effective behavioral modification therapy and behavior-based disease prevention is essential. Effective behavioral treatments, just like traditional medical treatments, are based on rigorous scientific research.

Effective behavioral treatments, just like traditional medical treatments, are based on rigorous scientific research.

Types of Research

Behavioral and social science researchers can conduct basic or applied research. Basic research examines general questions, which may or may not have an immediate and obvious application. For example, studying how a rat learns to perform a task does not necessarily have an immediate application in humans, but research of this type often leads researchers to new ideas about human behaviors. People doing applied research often use ideas derived from basic research to develop useful tools for society. For example, applied research in ergonomics led to the design of the more-visible fluorescent-green fire engines.

Laboratory or clinical research is often tightly controlled to allow researchers to answer specific questions. For example, if researchers want to study the effect of a certain vitamin in a group of patients, they can control the dosage of the vitamin and observe effects in a small group. For a variety of reasons, animals are sometimes studied instead of humans:

  • Studying basic behaviors in relatively simple organisms can yield insights about complex behaviors in humans. For example, in studying how a rat or pigeon learns to respond to certain stimuli, such as a flash of light, scientists can better understand how human behaviors are shaped.
  • Humans are difficult to work with. They usually don't eat a controlled diet, they grow and reproduce very slowly, and they are not available to the researcher for extended periods of time.
  • In some cases, using humans as study subjects would be unethical. For example, in research on addiction, animals are addicted to alcohol or drugs and then exposed to various treatments. This would not be allowed in humans.

Behavioral and social science research is also carried out in a variety of other settings. The concept of "laboratory" research has expanded to include field research, in which humans or animals are studied in their natural settings. This provides a rich source of information about complex behaviors and group interactions that may not be available in the traditional laboratory. For example, nonhuman primate studies in the animals' natural habitat provide a great deal of information about societies and how social structures affect individual and group well-being.

Behavioral and Social Science Tools

All science is based on the collection of measurable data. Behavioral scientists might measure the number of times a behavior is repeated, the degree to which a subject agrees or disagrees with a question, or the rapidity with which a new behavior is learned. Two tools commonly used in behavioral and social sciences are observation and surveys. The students using this curriculum will be introduced to these tools, including their applications and limits.

Figure 2. Many behavioral scientists work with rats or nonhuman primates.

Figure 2

Many behavioral scientists work with rats or nonhuman primates.

Two tools commonly used in behavioral and social sciences are observation and surveys.

Observation

Effective observation requires attention to detail, careful note taking, and detachment. These skills make comparison of observations across time possible. It is important to observe what is actually happening, or to watch for specific behaviors, while remaining detached from the situation. For example, primatologists studying nonhuman primate behavior must be careful not to allow their own values and judgments to color their observations. Observations are often converted into numbers—for example, the number of times a behavior was observed or the degree to which a behavior was exhibited. These numbers can be analyzed. Alternatively, observation may lead the scientist to ask new questions, such as why a behavior was exhibited or how the behavior developed.

Survey

Another common tool of social and behavioral science is the survey. It allows collection of data from a larger number of individuals than would be possible with observation. A well-designed survey also reduces the impact of the researcher's bias. However, designing an effective survey is very difficult. Questions must elicit useful answers that aren't misleading. For example, if one were to ask, "What did you eat today?" the answer might be a very detailed list of food, but without any quantities. So although two people answered, "Cereal," one might have eaten one bowl of cereal and the other, three bowls.

Two other aspects of surveys are representative sample and sample size. They both affect the validity of survey results. Representative sample refers to the idea that different groups of people will respond differently to a survey, so each group should be represented in the study population. For example, the National Longitudinal Study of Adolescent Health, also known as the Add Health study, is a national survey of middle school students.18 Because the survey could not be administered to every middle school student in the United States, a smaller population of students representing the different socioeconomic groups in the general population was surveyed. The results can then be extrapolated to the general middle school population. Another approach to surveys is to target a particular group and administer the survey to that group. This limits the results of the survey to only that group.

Sample size affects how accurately a population is represented by a survey. The larger the sample, the more accurate the survey will be. Everyone has heard a story about a friend or family member who smoked or did other unhealthy things and lived to be very old. But even though one hears about these exceptional people more often than others, the reality is that they are exceptions and do not represent the most common experience. Looking at many people, or a "large sample size," ensures that those unusual people do not skew, or influence, the results too much.

Sample size affects how accurately a population is represented by a survey. The larger the sample, the more accurate the survey will be.

Figure 3. The Add Health study is a national survey of middle school students that relates behaviors to health.

Figure 3

The Add Health study is a national survey of middle school students that relates behaviors to health.

Careers in Behavioral and Social Sciences

While people who have a background in behavioral and social science contribute to society through a variety of careers, some individuals train specifically as social scientists or behavioral scientists. Some of these professionals conduct basic research—for example, studying animal models to gain insight into human behaviors or studying mechanisms underlying normal behaviors in humans to understand disordered behaviors caused by disease. These studies can occur in laboratories or in the field. Others may develop practical applications based on research.

Behavioral and social science is used in many other fields as well. For example, in the healthcare profession, studies of risks and behaviors can help healthcare providers better understand and more effectively serve their patient populations. Community leaders, politicians, and government workers in a variety of fields can use social science to help them design better policies for their constituents. Ergonomics is a field dedicated to studying how people behave in their environments and then using that information to improve the environments by adapting them to human needs and limitations. Educators may also find behavioral and social science helpful in developing educational models to address academic and nonacademic issues.

Influences on Behavior

Behavior does not occur in a vacuum. A variety of influences—from genetic to social—weighs in on behaviors. These influences create the reasons for behaviors. The chart on page 28 lists many influences, but it's far from comprehensive. The grouping of various influences into categories is subject to rearrangement based on the situation, behavior, or person. Interactions between influences mediate or exacerbate the effect of other influences. For example, the media may enhance a family influence in attitude about sports. The media can introduce a person to particular lifestyles, and then that person's peer group might encourage an illegal behavior associated with a lifestyle. Different influences have different degrees of influence as well. For example, a strong genetic predisposition to alcoholism may overwhelm a family influence of abstinence from alcohol and a societal message of moderation.

A final mediator of influences on behavior is the level of personal control an individual exercises over that influence. For example, people cannot modify their genetics. However, a person who is genetically predisposed to develop heart disease might actively engage in behaviors that will decrease their risk of heart disease. Another level of control depends on social situation. An adult may decide to improve his or her diet as a result of influences, such as advice from healthcare professionals, educational opportunities, and the availability of a new local market. This person is in a position to modify his or her eating behavior. However, a child in this person's home has very little control over what the family eats.

Adolescents do have control over many influences in their lives. In some cases, they don't realize the extent to which they can modify their own behaviors. It's important for adolescents to be able to

  • recognize influences on their behaviors and
  • analyze which behaviors they have the ability to modify.

Influences on Behavior: Examples, by Category

Biology/GeneticsBasic NeedsPersonal GoalsFamily
  • Hormones
  • Diseases
  • Puberty
  • Health
  • Disabilities/ handicaps
  • Food
  • Shelter
  • Clothing
  • Social interactions
  • Affection
  • Being healthy
  • Making friends
  • Grades
  • Popularity
  • Image
  • Success
  • Morals
  • Adult support
  • Family values
  • Culture
  • Sibling rivalry
  • Religion
ResourcesMediaSocialEnvironment/ Community
  • Money
  • Time
  • Educational
  • opportunities
  • Transportation
  • TV
  • Video games
  • Magazines
  • Movies
  • Music/music videos
  • Sports
  • Advertisements
  • Peers
  • Teachers
  • Sports teams/clubs
  • Cliques
  • Mentors/role models
  • Friends
  • Neighborhood
  • Weather
  • Playgrounds/parks
  • Transportation
  • Policies/laws
  • Culture

Behavioral and Social Science Research and Cardiovascular Disease

In this curriculum supplement, students role-play behavioral clinicians in a scenario involving a patient with heart disease. Heart disease is a collection of conditions that limit the flow of blood to the heart muscle itself, including atherosclerosis, angina, and heart attack. Together, heart disease and stroke, which is a loss of blood flow to the brain, comprise the main components of cardiovascular disease (CVD). Over 930,000 people in the United States die annually as a result of cardiovascular disease, and 64 million Americans suffer from cardiovascular disease.7 CVD has traditionally been a disease of older people; however, recently, the incidence of heart disease in younger people has risen.

Health Outcomes of Behavior

Heart disease and stroke share several of the same risk factors, many of which are preventable. These are the same factors that contribute to other chronic diseases, such as diabetes, which can complicate treatment and research. The CDC has identified a limited number of behaviors that are often established during adolescence and contribute to chronic diseases Americans face today:

  • tobacco use (smoking, chewing);
  • dietary behaviors (food selection, portion-size selection, attitudes toward foods and eating);
  • physical activity (type, intensity, duration, frequency);
  • alcohol and other drug use;
  • sexual behaviors (leading to acquiring sexually transmitted diseases, unwanted pregnancies); and
  • behaviors that may result in violence and unintentional injuries (use of weapons, motor vehicles).

Due to large-scale public education efforts, most people, even adolescents, are aware of the risks unhealthy behaviors pose to their health, yet they continue to engage in these behaviors.

Most people, even adolescents, are aware of the risks unhealthy behaviors pose to their health, yet they continue to engage in these behaviors.

A variety of influences contributes to an individual's decision to engage in unhealthy behaviors or avoid them. Among these is an individual's perception of long- and short-term health risks. Behaviors with short-term, or more immediate, health risks may be less appealing than behaviors with long-term risks. For example, while an individual might not refrain from overindulging in alcohol due to long-term consequences, such as addiction or liver disease, he or she might refrain to avoid being ill immediately.

Many people, especially adolescents, believe long-term health consequences can be avoided by a vague plan to change the behavior "later." These expectations of changing behaviors can be unrealistic since changing behaviors is difficult. For example, 79 percent of smokers relapse after quitting.3

Figure 4. Engaging in unhealthy behaviors is influenced by the perception of long- and short-term risks.

Figure 4

Engaging in unhealthy behaviors is influenced by the perception of long- and short-term risks.

Identifying Behavioral Trends, Risky Behaviors, and At-Risk Groups

Behavioral and social science research contributes to health care by identifying potential health problems, studying risky behaviors, and evaluating the efficacy of treatments. The influences on the patient's health-related behaviors are similar to the influences on any behavior. For example, genetics, family and cultural norms, and the media play roles in an individual's behaviors.

Research in behavioral and social sciences examines healthcare data to determine the trends in health-related behaviors, including the prevalence of unhealthy behaviors and who is at risk. The research examines the influences that play major roles in these behaviors and that can enhance the effectiveness of prevention programs or medical treatments by determining how to reduce negative influences and enhance beneficial ones. This research can help the healthcare industry identify where to concentrate preventive efforts or how to prepare for upcoming health needs.

Epidemiological reports, such as the American Heart Association's (AHA's) annual report on CVD, reveal disease trends in the population.1 The AHA report, a statistical analysis of CVD in the United States, provides information on the incidence of CVD, treatments, and at-risk populations. Studies of risk behaviors can identify groups that are more likely to develop CVD. Another report examined the connection between smoking prevalence and levels of education and income.17

Healthcare workers with epidemiological information can target at-risk groups for maximal impact of preventive and early care. For example, a 1999 study showed that men whose parents suffered from CVD developed atherosclerosis at a high rate.27 This was not a surprise, based on genetics; however, the behavioral aspect of the research indicated that stress was a major factor in triggering atherosclerosis in these patients. The behavioral factor was unexpected and can be used to select appropriate preventive treatments for this group of patients.

Behavioral Interventions

When patients develop diseases with strong behavioral components, such as cardiovascular disease, behavioral interventions are often recommended in addition to medical treatments. In chronic diseases strongly affected by behavior, changing behavior can help control the disease. Behavioral and social science research has provided many new nondrug interventions for managing chronic diseases, thus preventing the development of new diseases and promoting healthy behaviors.22

Behavioral and social science research has provided many new nondrug interventions for managing chronic diseases.

Interventions address self-efficacy or self-confidence issues, provide problem-solving skills, and promote the development of social support systems. Successful interventions take into account various influences in the patient's life and involve individual, family, and community organizations in behavioral modification.10

Behavioral intervention is an approach to addressing a behavior that has poor health outcomes and replacing it with a more productive behavior. The primary care provider, such as a physician, nurse midwife, or nurse practitioner, works with the patient to design an initial behavioral intervention plan. First, the patient's readiness for change may be assessed, as well as the patient's views on how important the change is and how likely he or she is to succeed. The patient's medical and behavioral history is reviewed to identify problem behaviors, such as smoking or not exercising. This process involves input by both patient and care provider, and leads to the development of a behavioral modification plan.9 The patient may be referred to behavioral therapists and other healthcare professionals as needed. Follow-up care with the primary care provider is an important part of treating any chronic disease.4

Figure 5. Behavioral interventions help patients with heart disease improve their health.

Figure 5

Behavioral interventions help patients with heart disease improve their health.

Maximizing Effective Medical and Behavioral Treatments

Studying how patients deal with chronic disease is an important component of developing effective medical and behavioral treatments. Hostility, depression, and stress play major roles in the progression of many chronic diseases.12 One important reason for a behavioral intervention approach is that the patient is largely responsible for the day-to-day treatment of chronic illness. This can be an overwhelming task without the proper preparation and support.

Although a patient may be highly motivated to change, many factors are involved in successful behavior change. In addition to learning about healthy and unhealthy behaviors, patients need to learn new skills and new behaviors, such as self-monitoring.26 Other important factors include social support and self-confidence.

Patients who have been diagnosed with chronic diseases react differently to sudden requirements to change lifelong behaviors. Some may succeed in changing their behaviors on their own; many others will be only partially successful or even fail completely. Behavioral and social science research can analyze these outcomes to determine what generates successes and failures, giving healthcare providers more information for successful treatment of their patients.

Approaches to changing behaviors include participating in formal programs or support groups and individualized therapy. Many health maintenance organizations (HMOs) and other healthcare groups provide classes, seminars, and printed materials to encourage healthy behaviors. Private groups offer programs designed to change specific habits, such as how to lose weight or stop smoking. One important aspect of behavioral intervention is having a long-term approach. Realistic goal setting, support from friends and family, and adding healthy behaviors before removing unhealthy behaviors all increase success rates.9, 10 The experience of "going cold turkey" may work for some individuals, but most need to pursue a more gradual approach.

Alternative treatments such as yoga, meditation, acupuncture, and biofeedback may be successful for some patients.14 Behavioral and social sciences research can be translated into effective behavioral interventions and thus complement or enhance the effectiveness of medical treatment of chronic diseases.

Behavioral and Social Science Research and Public Health

Behavioral interventions can be provided as informational programs, behavioral and social interventions, or environmental and policy approaches.11 Because the response to behavioral treatments can vary among demographic groups, meta-analysis of programs is a useful tool. In meta-analyses, researchers compare the results of several similar studies or programs. This allows the researchers to draw conclusions about the general applicability of various approaches to determine whether one approach is more effective than another or whether effectiveness depends on the target audience.

Meta-analyses of risk factors and behavioral interventions provide a summary of findings for practitioners. For example, the Guide to Community Preventive Services offers continually updated summaries of a variety of public health interventions.11 Practitioners can look up the behavior of interest, see what programs have been scientifically tested for effectiveness, and determine which might be most appropriate for their community. A recent review examined the effectiveness of media campaigns and summarized the important points for an effective campaign based on a scientific analysis of this type of campaign.23 Meta-analysis ensures that evidence-based methods are available to practitioners, which reduces wasted time, effort, and money.

In addition to studying the effectiveness of programs, specifically whether or not the program resulted in the proposed outcomes, social science also examines feasibility of programs.2 This is particularly important for public health programs, in which a wide audience is targeted with limited funds. Social science research can provide information about which program is most likely to be effective in a particular community. For example, the Guide to Community Preventive Services offers information on effective interventions on a variety of levels, and also provides information about the cost-effectiveness of these programs.11 An affordable program may not be effective, or a very effective program may require high funding levels and, therefore, be impractical. In addition, information about the community to be served, such as local risk factors, community priorities, and local resources, is critical to ensure an appropriate choice for a given community.2

Another important consideration in developing behavioral health programs is cultural sensitivity.13 Effective programs must be culturally accessible, using people, language, and clothing with which the target audience can identify. In addition, a deeper sense of culture that takes into account traditions and history will increase the effectiveness of programs.24 For example, in one study on improving nutrition in a black population, the intervention was based in black churches. The churches proved to be an effective location for intervention efforts for this community.25

Effective programs must be culturally accessible, using people, language, and clothing with which the target audience can identify.

The Science of Healthy Behaviors

In this curriculum supplement, students are introduced to the complexities of studying behaviors. Learning how to understand behaviors on a scientific level and deriving practical healthcare applications is a complex but effective process. Through playing the roles of professionals, students should become aware that behaviors can be studied and that there is a scientific basis to behavioral intervention. They should also learn about the many influences on behavior and how an individual can modify behavior. Through their increased understanding of behavior, they should come to understand that changing behaviors "later" is not a good plan, or an easy task. In addition, they should become aware of the many factors that increase the likelihood of successful behavior changes. Students should be able to apply these behavioral and social science concepts to their own lives, thus improving their own chances of successfully practicing healthy behaviors.

Web Resources

The following Web sites contain information that may be useful to you:

References

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American Heart Association. Heart Disease and Stroke Statistics—Updates, 2004. Retrieved November. 2004;5:2004. , from the World Wide Web: http://www​.americanheart​.org/downloadable​/heart/1075102824882HDSStats2004UpdateREV1-23-04.pdf.
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Briss P.A., Brownson R.C., Fielding J.E., Zaza S. Developing and using the Guide to Community Preventive Services: Lessons learned about evidence-based public health. Annual Review of Public Health. 2004;25:281–302. [PubMed: 15015921]
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Burke L.E., Dunbar-Jacob J.M., Hill M.N. Compliance with cardiovascular disease prevention strategies: A review of the research. Annals of Behavioral Medicine. 1997;19:239–63. [PubMed: 9603699]
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Centers for Disease Control Prevention. Preventing heart disease and stroke: Addressing the nation's leading killers. Retrieved November. 2004;4:2004. , from the World Wide Web: http://www​.cdc.gov/nccdphp/aag/aag_cvd​.htm. Update available at http://www​.cdc.gov/nccdphp​/publications/aag/cvh.htmI (April 2006).
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Gotay C.C. Behavior and cancer prevention. Journal of Clinical Oncology. 2005;23:301–10. [PubMed: 15637393]
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Office of Behavioral Social Sciences Research. Behavioral and Social Sciences Research in the 21st Century: Summary of Recommendations from Six National Academy of Sciences Reports. Retrieved from the World Wide Web on June. 2003;17:2003. : obssr.od.nih.gov/Content/ Publications/Books_And_Reports/NRC-Reports.htm.
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Copyright © 2007-, BSCS.
Bookshelf ID: NBK20365

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