Stephen Higgins

Changing Drug Use and Other Health-Related Behavior in Vulnerable Populations

The USA lags far behind other industrial countries on major markers of population health. When population health experts assess this situation, they identify unhealthy behavior patterns (e.g., cigarette smoking, other substance use disorders, physical inactivity and poor food choices, and nonadherence with the recommended medical regimens) as the largest contributor to the status quo. These behavior patterns increase risk for chronic diseases (e.g., cardiovascular disease, site-specific cancers, and type-2 diabetes) and associated premature death. Hence, identifying strategies to promote and sustain behavior change is critical to resolving this national problem. Because these risk behaviors are overrepresented in socioeconomically disadvantaged and other vulnerable populations, they also drive health disparities. In this report, we review research that focuses on identifying effective behavior-change strategies for reducing drug use and other risk behaviors in vulnerable populations. An extensive body of experimental preclinical and clinical research demonstrates that the reinforcement process plays a fundamental role in the acquisition and maintenance of drug use and other unhealthy behavior patterns. The research discussed here illustrates how that same reinforcement process can be leveraged in the form of incentives and other strategies to promote and sustain behavior change. The overarching focus is on drug use, but we also review research with other types of health problems, illustrating the trans-disease influence of reinforcement and the broad generality of behavior-change strategies that leverage that process.