National efforts to promote behavior-change research: views from the Office of Behavioral and Social Sciences Research

The most prominent causes of death in the US have been found to be behavior related (e.g. tobacco, diet, activity levels, etc.) (McGinnis and Foege, 1993; Institute of Medicine, Committee on Health and Behavior: Research, Practice and Policy, Board on Neuroscience and Behavioral Health, 2001). Health expenditures in the US totaled over $1.2 trillion in 1999 (US Centers for Medicare and Medicaid Services, 2000). While nearly 12% of this amount is spent on pharmaceuticals, approximately 60% is accounted for by behavior or lifestyle factors, such as smoking, alcohol abuse, sedentary lifestyle and unhealthy diets (Prochaska, 1997). It has been further estimated that behavior-health programs, such as cancer prevention and control, mitigate less than 5% of the healthcare costs due to behavior (Prochaska, 1997). In October 1997, the National Institutes of Health (NIH) Office of Behavioral and Social Sciences Research (OBSSR) announced a special Request for Applications (RFA) focusing on ‘Innovative Approaches to Disease Prevention Through Behavior Change’. The goal of this initiative was to stimulate investigation of innovative strategies designed to achieve long-term healthy behavior change by focusing on tobacco use, sedentary lifestyle, poor diet and alcohol abuse. This RFA solicited intervention studies aimed at either a comparison of theoretical approaches to behavior change or assessment of