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Summary. Interventions to change health behaviors have had limited success to date at establishing enduring healthy lifestyle habits. Despite successfully increasing people's knowledge and favorable intentions to adopt healthy behaviors, interventions typically induce only short-term behavior changes. Thus, most weight loss is temporary, and stepped-up exercise regimens soon fade. Few health behavior change interventions have been successful in the longer term. In this article, we unpack the behavioral science of health-habit interventions. We outline habit-forming approaches to promote the repetition of healthy behaviors, along with habit-breaking approaches to disrupt unhealthy patterns. We show that this two-pronged approach-breaking existing unhealthy habits while simultaneously promoting and establishing healthful ones-is best for long-term beneficial results. Through specific examples, we identify multiple intervention components for health policymakers to use as a framework to bring about lasting behavioral public health benefits.
In 1991, the National Cancer Institute and industry partners rolled out a nationwide educational public health campaign-the 5 A Day for Better Health Program-to boost consumption of fruits and vegetables. The campaign was remarkably successful in changing people's knowledge about what they should eat: Initially, only 7% of the U.S. population understood that they should eat at least five servings of fruit and vegetables per day, whereas by 1997, fully 20% were aware of this recommendation.1 Unfortunately, actual fruit and vegetable consumption remained flat. During the years 1988 to 1994, 11% of U.S. adults met this target amount of fruit and vegetable consumption, and the percentage did not shift during 1995-2002.2 Another national campaign launched in 2007, called Fruit & Veggies-More Matters, also failed to move the fruit and vegetable consumption needle.3
These failures are not surprising. A body of research shows that many public health campaigns do successfully educate and motivate people, especially in the short run. However, when push comes to shove, they often fail at changing actual behaviors and long-term health habits, such as the consumption of optimal amounts of fruit and vegetables.4,5
Not all behavior change interventions fail to change behavior. Often, some behavior change happens, but it does not maintain over time.6 To show how this works, we depicted the results of some of the highest quality health interventions to date in Figure 1. These studies all appeared in top scientific journals,...