Losing weight, quitting smoking, and getting fit are among the most popular New Year’s resolutions that get both made and broken every year, and with good reason: unhealthy behaviors are hard to change. The situation is overrepresented in socioeconomically disadvantaged populations, for whom these behaviors are contributing significantly to widespread chronic conditions and health care costs (i.e., health disparities). Experts in the Vermont Center on Behavior and Health (VCBH) at the University of Vermont (UVM) are on a mission to reverse that problem.

Stephen Higgins, Ph.D., VCBH director, UVM professor of psychiatry and psychology, and guest editor of a special issue of Preventive Medicine on “Behavior Change, Health, and Health Disparities,” says “The evidence is clear that personal behavior patterns like cigarette smoking and physical inactivity/obesity are critically important proximal causes of chronic disease (cardiovascular disease, site-specific cancers, type-2 diabetes) and as such, behavior change will need to be a key component of their management.”

The research highlighted in the issue – all presented at the VCBH’s 2013 annual national conference – provides evidence that change is possible, with cigarette smoking serving as a particularly good example, thanks to 50 years of programmatic effort, including intervention strategies that are showing success in VCBH research.

Two such studies, both featured in the special Preventive Medicine issue, address smoking among pregnant women – an unhealthy behavior fraught with consequences, including miscarriage, pre-term birth and SIDS. Higgins and colleague Sarah Heil, Ph.D., UVM associate professor of psychiatry and psychology, examined two aspects of quitting smoking during pregnancy.

Heil’s research is the first study ever to establish the time course of changes in smoking when women learn of their pregnancy. Of the 107 pregnant women participating in the study, the majority (84 percent) reported making fundamental changes in their smoking behavior within the first two days after learning of pregnancy. The participants were categorized into one of three groups – abstainers, reducers, or maintainers – depending on whether or not they had stopped smoking upon learning of their pregnancy, reduced smoking upon learning of their pregnancy, or continued smoking upon learning of their pregnancy respectively. Heil and her coauthors found a link between educational attainment and smoking behavior.

“Abstainers started smoking later and smoked fewer cigarettes pre-pregnancy relative to reducers and maintainers and abstainers and reducers were better educated, more likely to be pregnant for the first time, and more likely not to have smoking friends/family compared to maintainers,” say the authors.

A strategy used by Higgins, a pioneer and internationally respected expert in the field of contingency management – the use of financial and material incentives to reduce unhealthy behaviors like substance abuse – and colleagues more than doubled smoking abstinence rates and increased healthy fetal growth in socioeconomically disadvantaged pregnant women smokers. In his study of 118 study participants received one of two different sets of vouchers – exchangeable for healthy retail items – based on objective proof of abstinence via breath and urine tests. In addition the participants underwent ultrasound testing to examine fetal growth.

“We still need to find a way to get a larger percentage of women/infants to benefit from the intervention, but these study results show we’re on the right track,” says Higgins.

But why are these behaviors so difficult to alter? UVM’s Mark Bouton, Ph.D., professor of psychology, addresses the issue in his article in the special issue of Preventive Medicine, which provides a selective review of research on behavior change, including several UVM-led studies. The lessons learned from these studies, maintains Bouton, include acknowledging that learning a new behavior does not erase the old behavior. Lapses and relapses will occur, so understanding the contexts within which they occur and developing strategies to reintroduce the healthy behavior are critical. Among his discussion of new methods for promoting behavior change, Bouton comments on the concept of “reconsolidation” – the process of retrieving a memory and making it permanent – and opportunities for disrupting the process via drugs or other means.

“At this point in time, we do not know enough about the conditions that permit reconsolidation to take place,” he says in the article. “Until we do, the safest approach to promoting behavior change may be to assume that lapse and relapse can potentially occur, especially with a change of context.”

Learn more about the Vermont Center on Behavior and Health.

PUBLISHED

12-23-2014
Jennifer Nachbur