Overview

Behavior change is critical to addressing many health risks; at least 40% of all preventable premature deaths are due to specific patterns of behavior. Notable among health-injuring behaviors are smoking, drinking, drug abuse, and risky sex. The dangerous effects of inactivity, poor diet, and chronically stressful environments are now also widely appreciated. In addition, people are often unable or unwilling to adhere to medically prescribed treatments and preventative behavioral regimens for a wide variety of conditions including diabetes, hypertension, drug addiction, and HIV/AIDS. Behavioral interventions to address many health issues have favorable side effect profiles and can complement other treatments, but the mechanisms of change are not understood, and the resulting behavior change is often not maintained. More generally, it is difficult for people to initiate behavior change, even when they intend to do so, and it is even more difficult to maintain behavior change over time. Furthermore, most health behavior change occurs outside the context of professional interventions. Concepts we often describe using the terms “willpower” and “self-control” are important, but the mechanisms underlying these concepts are not clear. It is clear, however, that breakthroughs in the science of behavior change could lead to substantial improvements in public health.

The NIH has long supported research addressing specific problem behaviors that are relevant to the missions of various institutes. It has also supported research in emerging basic biobehavioral science. These studies, including work in cognitive and affective neuroscience, neuroeconomics, behavioral genetics, and behavioral economics including the use of default approaches, are increasingly relevant to our understanding of how to effect positive behavior change. Researchers in the field of behavior change, however, often work on disease- or condition-specific problems in relative isolation. In addition, the application of emerging and basic science to problems in behavior change has sometimes been slow. Further, some fundamental work on behavior change may have broad relevance to NIH but there is no close match with the interests of any one institute or center. NIH is uniquely poised to facilitate a unified science of behavior change, with the goals of decreasing isolation, increasing the adoption of exciting new science, and linking basic and applied behavioral science, in order to produce potent behavior change interventions to improve the public health.

The purpose of this Roadmap Pilot is to establish the groundwork for a unified science of behavior change that capitalizes on both the emerging basic science and the progress already made in the design of behavioral interventions in specific disease areas. By focusing basic research on the initiation, personalization, and maintenance of behavior change, and by integrating work across disciplines, this Roadmap effort and subsequent trans-NIH activity could lead to an improved understanding of the underlying principles of behavior change. This should drive a transformative increase in the efficacy, effectiveness, and (cost) efficiency of many behavioral interventions.

The scientific challenges in developing an integrated science of behavior change are daunting. Foundational work is needed before more definitive work is likely to be productive. The Pilot will include a series of trans-NIH conferences on behavior change that will bring together a broad range of basic and behavioral scientists, economists, quantitative and informatics experts, and others. The purpose of the conferences will be to share findings, identify common concepts and approaches across conditions, and identify the most feasible, promising, and innovative lines of interdisciplinary research for further developing the science of behavior change. Individual conferences will focus on topics including issues related to the initiation and personalization of behavior change, maintaining behavior change and fostering adherence, and translating behavior change efforts from the laboratory and the clinic to the world at large. Discussions will be held with the National Academy of Sciences and the Institute of Medicine about a parallel NAS-IOM study of trends in the efficacy and cost-effectiveness of past and ongoing behavior change interventions. Building on the conclusions and results of these efforts, the NIH will then support exploratory and interdisciplinary research applying new emerging science to the general problems of the initiation, personalization, and maintenance of behavior change.

The results of this pilot will be used both to assess what larger scale Roadmap activities in the science of behavior change will be most productive and to ensure that an interdisciplinary scientific community is prepared to undertake the transformative research on behavior change that will be required.

The URL for the NIH Roadmap Web site is nihroadmap.nih.gov. Support for the NIH Roadmap is provided by the NIH Common Fund, and teams of staff across the NIH direct and oversee each initiative. Scientists who wish to discuss opportunities related to this initiative should contact the initiative co-chairs, who are Dr. Richard Suzman and Dr. Patricia Grady. Dr. Jonathan King is the coordinator for the pilot roadmap project, and the email address for the initiative is behavior_change@nih.gov. For information about the role of the Office of Portfolio Analysis and Strategic Initiatives (OPASI) in this program, contact Dr. Mary Perry, OPASI Program Director (perryma@mail.nih.gov). Further information about the NIH can be found at its Web site: www.nih.gov.

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