Glass and mcatee

Glass and McAtee
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Unformatted text preview: Social Science & Medicine 62 (2006) 16501671 Behavioral science at the crossroads in public health: Extending horizons, envisioning the future Thomas A. Glass , Matthew J. McAtee Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, MD 21205, USA Available online 29 September 2005 Abstract The social and behavioral sciences are at a crossroads in public health. In this paper, we attempt to describe a path toward the further integration of the natural and behavioral sciences with respect to the study of behavior and health. Three innovations are proposed. First, we extend and modify the stream of causation metaphor along two axes: time, and levels of nested systems of social and biological organization. Second, we address the question of whether upstream features of social context are causes of disease, fundamental or otherwise. Finally, we propose the concept of a risk regulator to advance the study of behavior and health in populations. To illustrate the potential of these innovations, we develop a multilevel framework for the study of health behaviors and obesity in social and biological context. r 2005 Elsevier Ltd. All rights reserved. Keywords: Behavior; Causality; Epidemiology-history; Epidemiology-theory; Social class; Social factors Introduction ENOUGH! A century of misunderstanding, the drawn-out Verdun and Somme of Western intellectual history, has run its exhausting course, and the culture wars are an old game turned stale. It is time to call a truce and forge an alliance. Within the broad middle ground be- tween the strong versions of the Standard Social Science Model { caps in the original } and genetic determinism, the social sciences are intrinsically compatible with the natural sciences. The two great branches of learning will benefit to the extent that their modes of causal explanation are made consistent. E. O. Wilson (1998, p. 188) The social and behavioral sciences are at a crossroads in public health. Decades of behavioral research has culminated in a series of large-scale intervention trials yielding unsatisfactory results ( Susser, 1995 ). Flagship studies like the ( Multiple Risk Factor Intervention Trial (MRFIT), 1982 ; Stallones, 1983 ), Community Intervention Trial for Smoking Cessation (COMMIT) ( Anonymous, 1995 ) and, more recently, the Enhancing Recovery in Coronary Heart Disease trial (ENRICHD) ( Berkman et al., 2003 ), have yet to demonstrate the expected efficacy of behavioral interventions to modify health outcomes ( Glass, 2000 ; Relman & Angell, 2002 ). While it is generally accepted that modest changes in health behavior can be achieved with carefully designed, and theoretically informed interventions, the extent to which behavior change is lasting, or translates into health improvements at a population-level is considerably less clear ARTICLE IN PRESS 0277-9536/$- see front matter r 2005 Elsevier Ltd. All rights reserved.2005 Elsevier Ltd....
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