Public health initiatives across the prevention spectrum

The committee recommends that the U.S. Congress provide funds for CDC to enhance its investigator-initiated program for prevention research while maintaining a strong CIO-generated research program. CDC should take steps that include

• Expanding the external peer review mechanism for review of investigator-initiated research;

• Allowing research to be conducted over the more generous time lines often required by prevention research; and

• Establishing a central mechanism for coordination of investigator-initiated proposal submissions.

Furthermore, CDC should authorize an analysis of the funding levels necessary for effective Prevention Research Center functioning, taking into account the levels authorized by P.L. 98-551 as well as the amount of prevention research occurring in other institutions and organizations.

National Institutes of Health

The National Institutes of Health (NIH) is the single largest source of health research funding, with a fiscal year 2000 research budget of nearly $20 billion (compared to CDC's total research budget of $570 million) (IOM, 2002). Although NIH emphasizes biomedical research, it is increasingly funding what it terms prevention research. It has invested in large-scale community trials (Green et al., 2001), conducts research on risk factors for disease, and evaluates drugs for secondary prevention of disease.

The National Institute of Environmental Health Sciences (NIEHS) developed a program in collaboration with the Environmental Protection Agency and CDC to "promote translation of basic research findings into applied intervention and prevention methods." NIEHS conducts multidisciplinary basic, applied research, and "community-based prevention research," including studies on the causes and mechanisms of children's disorders having an environmental etiology; studies to identify relevant environmental exposures; intervention studies to reduce hazardous exposures and their adverse effects; and studies to decrease the prevalence, morbidity, and mortality of environmentally related childhood diseases (NIH, 2002a).

Eight Centers for Children's Environmental Health and Disease Prevention Research were funded to conduct the first set of studies that will focus on respiratory disease and growth and development. The National Institute of Child Health and Human Development web page (NIH, 2002b) describes several prevention research projects, which include studies designed to conduct the following activities:

• Test the efficacy of a multicomponent program of school-based interventions for the primary prevention of problem behavior in a sample of middle school students;

• Identify determinants of the lack of age-appropriate immunizations;

• Examine the efficacy of an integrated system of office-based primary pediatric care interventions for the prevention of medically attended injuries;

• Assess determinants of parent-to-child transfer of responsibility for asthma self-management;

• Determine whether parent and teen expectations predict teens' driving behaviors during their first year of driving; and

• Determine relevant factors and effective interventions for family management of type 1 diabetes.

Despite the many NIH-funded research activities labeled as prevention research, these efforts tend to focus on individual health and on secondary prevention and risk factor analysis rather than on the health of populations

(Scrimshaw et al., 2001). This committee has defined community-based prevention research as a collaborative approach that involves all stakeholders in each aspect of a study designed to evaluate the application and impact of new discoveries aimed at improving the health of a defined population. The findings detailed in this section demonstrate that assuring adequate funding for prevention research is a population health priority and is particularly relevant to the work of the nation's federal agencies engaged in public health research. Therefore, the committee recommends that NIH increase the portion of its budget allocated to population- and community-based prevention research that

• Addresses population-level health problems;

• Involves a definable population and operates at the level of the whole person;

• Evaluates the application and impacts of new discoveries on the actual health of the population; and

• Focuses on the behavioral and environmental (social, economic, cultural, physical) factors associated with primary and secondary prevention of disease and disability in populations.

Furthermore, the committee recommends that the Director of NIH report annually to the Secretary of DHHS on the scope of the population-and community-based prevention research activities undertaken by the NIH centers and institutes.

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