Q&A with Dr. Bess Marcus

Getting people to change their behavior is much easier than getting them to maintain it. That is one of the key challenges Dr. Bess Marcus has faced over the course of her career as a clinical health psychologist. She has spent the last 25 years conducting research on physical activity behavior, and her primary research interests are in the prevention of cardiovascular disease and cancer, and the promotion of women's health. Now she serves as Chair of UC San Diego's Department of Family and Preventive Medicine.

What sparked your interest in medicine and health psychology?

Marcus: As an undergraduate at Washington University in St. Louis, I majored in Psychology, minored in Women's Studies, and took numerous courses in the Dance Department. I also had leadership roles as a Resident Advisor in the dorms, a peer counselor at the student-run counseling center, and a volunteer at the Campus YMCA, where I provided community service to diverse populations-in-need in the St. Louis community. I combined all of these interests as a graduate student in Clinical Psychology at Auburn University, as I was struck by the fact that much of what ails people (cancer, heart disease, diabetes, etc.) could be prevented if we could help people substitute healthy behaviors for their unhealthy habits. Thus began my interests in health behavior change and the development of programs to help people change poor health habits (sedentary living, poor diet, cigarette smoking, etc.).

What have you learned through your research?

Marcus: What I learned pretty quickly is that we could help people change their habits, but it was very challenging to help them maintain these new habits. Motivated people can often make positive health-behavior changes for brief periods of time, but they are rarely able to maintain these changes. A variety of factors likely contribute to this problem, ranging from individual struggles to environmental variables.

I also learned that people who live in rural communities and/or come from low-income and minority backgrounds are much less likely to have access to many program offerings; this led to my interests in using non-face-to-face approaches and technology (print, telephone, email) to deliver programs to people in diverse locations, and adapting programs for populations with different needs (non-English-speaking individuals, pregnant women, individuals struggling with addiction, etc.).

What helps people to succeed in maintaining healthy habits?

Marcus: There are several key strategies to help people maintain a healthy habit, like participating in a regular program of exercise. Some of these strategies are setting realistic goals, planning ahead to fit activity into your day, reminding yourself to be active, enlisting the help of others to support you and rewarding yourself for meeting goals. Another key strategy is to stay positive with yourself and not let a missed day or two of exercise (a "slip") turn into a relapse or, even worse, a full-on collapse where you pretty much give up on ever being regularly active again.

Do you think enough emphasis is placed on preventive medicine? How can we improve the field?

Marcus: I do not think enough emphasis is placed on preventive medicine, and I do not think we have enough preventive medicine physicians in the field. There is not enough time in the standard patient encounter to provide all the necessary preventive services that could and should be offered according to United States Preventive Services Task Force (USPSTF) guidelines. As a result, it is difficult to adequately manage chronic diseases such as diabetes, hypertension, HIV, depression and other complex problems.

We need more population-based approaches to address the many environmental, behavioral and systemic factors that influence preventive care, but our public health departments are underfunded. Although public health approaches for smoking cessation have been quite successful, other problems that negatively influence health, such as poor diet, physical inactivity, drug abuse, risky sexual behavior and others, would likely benefit from a comprehensive public health approach.

What are your main priorities as the Chair of Family and Preventive Medicine?

Marcus: My main priorities are to build on the numerous strengths of faculty in the department by enhancing our ability to provide top-quality primary care to diverse patient groups and focusing research resources in Centers of Excellence. Our new Centers of Excellence include Cardiovascular Epidemiology and Prevention, Cancer Prevention Energetics (interaction of healthy diet and healthy physical activity for Cancer Prevention), Health Behavior Change in Underserved and Vulnerable Populations, Women's Health, and Tobacco Cessation and Control. Another priority is to build more connectivity between the School of Medicine and the campus, possibly by collaborating with others to launch an undergraduate program in public health. It is also very important to me to strengthen the department, as well as the university, by building a more diverse faculty through active recruitment of individuals from traditionally under-represented groups, who provide the benefit of different backgrounds and experiences, enhancing the quality of existing research and programs.

How has the Department of Family and Preventive medicine evolved, and what is its future?

Marcus: Our department houses an extraordinary group of researchers, as well as a strong cadre of family physicians primarily committed to clinical care and teaching. But the outside world tends to know our exceptional individual faculty rather than department programs of national stature. By increasing connectivity among the faculty, I hope to spark collaborations that will lead to expansion of department programs and, as a result, the building of our national and international reputation as leaders in our fields. I am also committed to building post-doctoral training programs and increasing the number of junior faculty in the department to provide for the growing public health needs of the community in San Diego, nationally and internationally.

What attracted you to your current position at UC San Diego?

Marcus: I was attracted to UC San Diego because of the quality of the faculty, the strong commitment to research, education and service, the explosive growth of the School of Medicine and the Medical Center, and the numerous exciting collaborative opportunities.

Many of your research projects are interdisciplinary in nature. Why is it important to collaborate across disciplines in research and education?

Marcus: Science advances fastest when we get out of our comfort zone and talk to and work with people who have different backgrounds, training and interests. The whole is greater than the sum of its parts, and that is the beauty of interdisciplinary collaborations.