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Chronic diseases account for 7 out of 10 deaths in the United States and 60% of the Nation’s health care expenses. Tobacco use, lack of physical activity and poor nutrition account for one third of US mortality. Behavioral surveillance systems such as the Behavioral Risk Factor Surveillance System (BRFSS) provide information on rates of behavior in the population and among different demographic categories. While these systems are essential for health promotion they do not assist the health educator in understanding psychosocial factors which may be related to the rates. A psychosocial surveillance system can aid in understanding the behavior change process and in the readiness of the population for behavior change. Results can assist states and localities in targeting health promotion messages and programs and can help in the allocation of often scarce health promotion funds. In 2000, the Hawaii Department of Health launched the Healthy Hawaii Initiative, a statewide program to reduce tobacco use, increase physical activity, and improve nutrition. As part of the evaluation, researchers at the University of Hawaii implemented a psychosocial surveillance system for the three target behaviors to assess changes in hypothesized mediators including stage of change, self efficacy, attitude and social norms. A random digit dial survey was conducted in the Spring and Fall of 2002 with 4,706 and 4,555 participants, respectively. Results show stability in the demographic characteristics and health behaviors of the sample but changes in the psychosocial variables. Several possible areas for interventions and messaging are demonstrated. A psychosocial surveillance system can be an important tool for health promotion and can lead to better understanding of health behaviors and attitudes.
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