There is growing recognition that the solutions to the most vexing public health problems are likely to be those that embrace the behavioral and social sciences as key players. To address this recognition, in 2007 OBSSR adopted a new strategic prospectus1 to guide future priorities in the behavioral and social sciences at NIH. At the core of OBSSR’s vision is a vertical integration across the levels of scientific analysis, that is, a transdis- ciplinary integration of the biomedical paradigms of molecular and physiological causal mechanisms with the ecologic paradigms of multilevel (individual, group, community, societal, and global) “causes of the causes” of health and disease. 2,3
A note on terminology: As described by Stokols et al., 4
Interdisciplinarity is a more robust approach to scientific integration in the sense that team mem- bers not only combine or juxtapose concepts and methods drawn from their own different fields, but also work more intensively to integrate their divergent perspectives, even while remaining an- chored in their own respective fields. Transdisci- plinarity is a process in which team members representing different fields work together over extended periods to develop shared conceptual and methodologic frameworks that not only inte- grate but also transcend their respective disciplin- ary perspectives.
Rosenfield5 suggests that the term interdisciplinary lies between multidisciplinary and transdisciplinary science, implying a continuum along which the terms lie. How- ever, the terms interdisciplinary and transdisciplinary sci- ence are sometimes used interchangeably, both within and outside the NIH. In the short term, because much of the work described here by OBSSR involves moving from multidisciplinary to interdisciplinary science, the term interdisciplinary is used throughout most of this document. Interdisciplinary is also the most common term used in the NIH Roadmap for Medical Research. A long-term goal of OBSSR is to facilitate a process for moving from interdisciplinary analyses to the deeper conceptual synthesis and transformative momentum promised by transdisciplinary science. 6
The Value of Behavioral and Social Sciences Research Knowledge and Practice for Improving Public Health
A great deal is known about the basic science of how to change individual and population behavior. The appli- cation of findings from behavioral and social sciences research already plays a significant role in safeguarding and improving the public’s health. The following se- lected examples provide a starting point to illustrate the tremendous power of psychosocial factors alone and the value of basic and applied behavioral and social
sciences research in informing and improving the public’s health.
Population and biological sciences identified tobacco- use behavior as the primary cause of most lung cancers and a leading cause of many other diseases, including cardiovascular disease. Behavioral and social sciences research informed the smoking interventions (individ- ual, community, and policy level) that have spurred a dramatic reduction in U.S. tobacco use since its peak in the 1960s. In fact, the past decade witnessed a decline in overall cancer death rates for the first time in a century,7 driven largely by the dramatic reduction in male smoking rates, from 54.1% at their peak in 1965 to 23.9% today.9 Within the relatively short time span of 40 years, more than 45.7 million Americans have stopped smoking.9 This is arguably one of the most successful public health interventions in recorded his- tory,10,11 and it has reduced the burden of many other diseases and excess societal expense as well. Behavioral and social sciences research can take much of the credit for this. Such research also has been at the center of understanding the multiple determinants of smoking initiation and cessation. Findings from behavioral and social sciences research have informed a broad spec- trum of approaches (e.g., policy, cessation and preven- tion programs, communication of the risks associated with tobacco use). Of these, policy interventions (e.g., smoking bans, cigarette taxes) have been found to be among the most effective strategies for reducing smok- ing prevalence. (For in-depth treatment of this topic, see Ending the Tobacco Problem: A Blueprint for the Na- tion.12) Because of behavioral and social sciences re- search, tobacco use has been changed on a massive scale despite the highly addictive nature of nicotine. 8
Another achievement of behavioral and social sci- ences research is the landmark NIH Diabetes Preven- tion Program (DPP), which showed that lifestyle changes (i.e., alterations in dietary intake and physical activity that led to a reduction in body weight) were nearly twice as effective as a common medication in reducing the risk of developing type 2 diabetes.13 An interdisciplinary effort to harness the power of the DPP intervention trial, together with lessons learned from tobacco control (especially around policy interven- tions), could help reverse the obesity and type 2 diabetes epidemics sweeping the developed world, and perhaps do so in less time than it took to cut smoking prevalence in half.
Research in the behavioral and social sciences has also spawned great progress in the development of effective treatments for the mental illnesses and disor- ders that are the leading contributors to disability. Meta-analyses show that cognitive–behavioral therapy is effective for unipolar depression, generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, posttraumatic stress disorder, childhood depressive and anxiety disorders, marital distress, an-
S212 American Journal of Preventive Medicine, Volume 35, Number 2S