Health Related Research and Education
H E A L T H B E H A V I O R
I N F O R M A T I O N T R A N S F E R ( H A B I T )
June 24, 2003 <> Vol. 6, No. 6
C O N T E N T S
1. NIH Employees, Grantees Worried About Outsourcing Plan
2. Markle Foundation Releases E-Health Report
3. IOM: Obesity Prevention In Schools
4. Obesity Drags Down Child Well-Being Index
5. Journal Roundup: Race, Reform and Global Diabetes
6. Hopkins Announces New Health Behavior Department
7. Washington Update
*SPOTLIGHT ON RESOURCES
*HEALTH AND BEHAVIOR IN THE NEWS
*ANNOUNCEMENTS, FUNDING, CALLS FOR SUBMISSIONS/NOMINATIONS AND CONFERENCES/EVENTS
Editor: Becky Ham, Ph.D.
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G R E E T I N G S
This month’s HABIT illustrates some of the many forces at play in translating research into practice. From political tinkering in research policy, the creation of health-undermining environments in school, and the commercial considerations behind using advanced technology in the clinical setting — it’s a complex and winding path from the best available scientific evidence to better health.
As always, HABIT welcomes your comments on these and other issues, so drop us a line and let us know what you’re thinking about this summer.
Jessie Gruman, Ph.D.
President and Executive Director
Center for the Advancement of Health
F E A T U R E S
1.NIH EMPLOYEES, GRANTEES WORRIED ABOUT OUTSOURCING PLAN
A government-wide plan to put certain federal jobs up for competitive bidding with the private sector has many NIH employees concerned for their future careers and NIH grantees worried that qualified scientists will no longer oversee their grant applications.
The plan, known sometimes as competitive sourcing or "A-76" from the Office of Management and Budget bulletin that describes the policy, asks all federal agencies to decide which of their positions are "inherently governmental" and which could be performed by a commercial contractor. NIH is required to review 25 percent of these commercial positions by the end of FY 2004 to determine whether current employees in these positions will be required to submit bids for their work that will compete with those from the private sector.
Most of the affected NIH positions are clerical or technical, but many are worried about the plan's possible effect on grant managers, including scientific review administrators (SRAs) and health science administrators (HSAs). Scientists are concerned that private contractors might not have the expertise to handle the technical grants or that they will be more susceptible to outside commercial or political pressure.
Charles Leasure Jr., NIH deputy director for management, says that he believes most SRA and other grant management positions will be found "inherently governmental." He has also said that no NIH employees will ultimately lose their jobs, although they may need to join a contract staff or take another job at NIH or somewhere else in the federal government.
In the meantime, several NIH staff members have said that morale among employees is low due to the plan, and that many are still confused about what their future might hold. E-mail is also circulating among researchers concerned that the A-76 review will siphon money away from NIH's FY 2004 research budget.
The Washington Post reports that NIH employees recently received an additional form for their job performance plans — to be signed by employee and supervisor — that says they "commit to achieve" the HHS management objectives, including A-76.
To read more information about A-76 from HHS and NIH:
2. MARKLE FOUNDATION RELEASES E-HEALTH REPORT
Robert G. Brown keeps medical records for his daughter, who has a rare form of cancer, in inches-thick binders that he totes along to each of her doctor visits. One of her physicians was impressed by the thorough documentation. "He told me that he wished all of his patients would do this," he recalled.
But Brown’s binders are rare among patients, many of whom believe their life’s medical records already follow them around from doctor to hospital to pharmacy, according to a report by the Markle Foundation’s Connecting for Health initiative.
The report was unveiled at a June 5 event at the National Press Club in Washington, D.C., and applauded by HHS Secretary Tommy Thompson, AHRQ Director Carolyn Clancy and presidential hopeful Gov. Howard Dean, D-Vt.
Connecting for Health includes more than 100 public and private organizations dedicated to bringing the health care system into the electronic age. Health care has lagged far behind other fields in fully integrating information technology, according to the event’s speakers.
“Today’s medicine is still practiced as a cottage industry, a paper-based art,” said Russell J. Ricci, M.D., of IBM Global Healthcare Industry.
Their report recommends a set of data standards for medical imaging, prescription drug information, lab tests and several other types of medical communication. It also concludes that nearly two-thirds of Americans surveyed by the initiative would support at least some features of a Personal Health Record, an Internet-based set of tools including lifelong health records, the ability to transfer files and e-mail doctors and to track medication and test results.
To read more about the initiative and to download the key findings of their report, go to www.connectingforhealth.org/index.html.
3. IOM: OBESITY PREVENTION IN SCHOOLS
Local and state legislation that would ban soda machines and other high-calorie foods from schools is on the rise, but few of these proposed laws have been passed so far, researchers said at a June 16 IOM workshop on school nutrition and physical activity.
“There is enormous potential for environmental change through policy reform,” Harold Goldstein, Dr.P.H., told members of the IOM’s Committee on Prevention of Obesity in Children and Youth.
Goldstein, executive director of the California Center for Public Health Advocacy, suggested that publicly available statistics on obesity at the city ward level or nationally may prod local politicians into working for school nutrition reforms like the recent decision by the Los Angeles Unified School District to ban all soda sales by 2004.
“Most of them have never seen data related to a health issue specific to their district,” he said.
Alex Molnar, Ph.D., of Arizona State University, presented data showing that commercialism in schools, including education materials sponsored by food companies, advertisements and exclusive vending contracts, has increased since 1990.
Both Molnar and Goldstein noted that schools often do not make as much money from these commercial contracts as some have suggested. They likened the arrangement to a “lottery with negative consequences,” where students end up paying for the same products that are supposed to bring money into the school and risking their health as well.
To read more about the IOM committee’s work, go to www.iom.edu/iom/iomhome.nsf/Pages/FNB+Obesity.
4. OBESITY DRAGS DOWN CHILD WELL-BEING INDEX
Children's overall health has experienced a "pretty steady decline" since 1975, but most of this decline can be attributed to the problems of obesity, a Duke researcher told congressional staffers at a Capitol Hill briefing.
The finding comes from the latest release of the Child Well-Being Index, a project supported by the Foundation for Child Development and coordinated by Kenneth C. Land, Ph.D., of Duke University. Land delivered a mix of good and bad news at the briefing on June 6.
The rate of children with "very good or excellent health" increased and the mortality rate for children ages 1 to 19 decreased between 2000 and 2001, says Land. Smoking and drinking by 12th graders and the teenage birth rate also declined during this time.
But rates of low birth weights, drug use and children who had limitations on their physical activity increased from 2000 to 2001, leading to an overall drop in health indicators within the Child Well-Being Index's 2001 report card.
The downturn in 2001 runs contrary to most of the yearly health trends in the index since 1975 — but only if obesity is left out of the picture. With obesity included, overall children's health improves slightly between 1975 and 1991, and then begins a steady decline, says Land.
The briefing was sponsored by the Federation of Behavioral, Psychological and Cognitive Sciences. To read more about the Child Well-Being Index, go to www.soc.duke.edu/resources/child_wellbeing/
5. JOURNAL ROUNDUP: RACE, REFORM AND GLOBAL DIABETES
Should biomedical researchers write about race? The consensus seems to be yes, especially since race and ethnic identification can be important in documenting health disparities. But researchers should include racial or ethnic categories only when they are clearly defined and are relevant to their study, say Judith B. Kaplan, M.S., and Trude Bennett, Dr.P.H., in the May 28, 2003, issue of the Journal of the American Medical Association. (http://jama.ama-assn.org/cgi/reprint/289/20/2709; subscription or 24-hour access purchase required)
Among the writing guidelines outlined in the JAMA paper are warnings not to use racial or ethnic data as a proxy for genetic variation and to consider the effect of socioeconomic status and similar factors before comparing racial groups.
In the June 13 issue of Science (http://www.sciencemag.org/cgi/reprint/300/5626/1680), Floyd Bloom, M.D., Ph.D., predicts the “imminent collapse of the American health system” unless radical change begins soon. Building off his presidential address at the AAAS annual meeting earlier this year (see HABIT, Feb. 25, 2003, at http://www.cfah.org/habit/vol6no2/), Bloom calls for a new federal commission to look at how the health care system could be overhauled to ensure that biomedical discoveries are turned into meaningful health advances.
Finally, a story in the June 5 issue of Nature (http://www.nature.com/cgi-taf/DynaPage.taf?file=/nature/journal/v423/n6940/full/423599a_fs.html; free access) by evolutionary biologist Jared Diamond, Ph.D., looks at why Europeans have largely escaped the global epidemic of type 2 diabetes. Diamond suggests that many populations around the world have a genetic predisposition to diabetes that has been awakened by the Western “coca-colonization” lifestyle. These populations were predisposed to diabetes by waves of food shortages that helped select for calorie-collecting genes, says Diamond, who suggests that Europeans have not experienced similar shortages in recent history.
6. HOPKINS ANNOUNCES NEW HEALTH BEHAVIOR DEPARTMENT
The Johns Hopkins Bloomberg School of Public Health is establishing a new department dedicated to studying human behavior and its effects on health. The Department of Behavior and Health was created by a $20 million gift from an unnamed donor.
“When we target ways to prevent infectious disease, we study the vectors that spread the illness and develop vaccines and medications for treatment. When the target is disease and death-causing behaviors, the tools and methods are less developed, which is what we will research and create in this new department,” said Scott Zeger, Ph.D., chair of the school committee that recommended the department’s creation.
Although the new department will continue the study of individual behaviors, its researchers will focus especially on system and social interventions that promote healthier lifestyles, including government regulation, legislation and social policies.
“We now understand that interventions that target the individual alone are inadequate,” said Alfred Sommer, M.S., M.H.S., dean of the School of Public Health.
7. WASHINGTON UPDATE
*The STOP AIDS Project, a San Francisco HIV prevention group, has received a letter from the CDC warning them to shut down workshops that “appear to encourage or promote sexual activity,” according to reports from the Associated Press and the Washington Post. The CDC sent a similar letter to the San Francisco Department of Public Health. STOP AIDS officials think the CDC’s letter comes in response to political pressure from Congressman Mark Souder, R.-Ind. (see HABIT, April 29, 2003, at http://www.cfah.org/habit/vol6no4/). To read more, go to http://www.washingtonpost.com/ac2/wp-dyn/A56979-2003Jun13?language=printer or http://news.yahoo.com/news?tmpl=story2&cid=534&u=/ap/20030615/ap_on_he_me/hiv_workshops&printer=1.
*On June 3, Surgeon General Richard Carmona told a House of Representatives subcommittee that he was in favor of a ban on tobacco products in the United States. But the White House says that Carmona’s comment “is not the policy of the administration” and that Carmona was commenting as a physician and not as a spokesman for official policy. Carmona told Rep. Ed Whitfield, R.-Ky., that he saw “no need for any tobacco products in society.”
*Should the Food and Drug Administration regulate tobacco products? The idea has surprising support from tobacco company Philip Morris, which fought legislation in 1996 that would have given the FDA authority to regulate tobacco as a “medical device.” Philip Morris now says the FDA could provide guidelines for manufacturing so-called “reduced risk” products like cigarettes that heat rather than burn tobacco. Anti-smoking advocates warn that weak FDA oversight might allow the companies to market a harmful product with the government’s implicit stamp of approval. Several versions of a bill extending the FDA’s oversight were introduced in Congress last year. Anti-smoking advocates favored the version co-sponsored by Sen. Edward Kennedy, D.-Mass., and Sen. Mike DeWine, D.-Ohio, while Philip Morris backed a version sponsored by Rep. Tom Davis, R.-Va. The bill numbers were S. 2626 (Kennedy), H.R. 2180 (Davis) and S. 190, a third bill sponsored by Sen. Bill Frist, R.-Tenn. To read them, go to http://thomas.loc.gov/ and search by bill number under the 107th Congress.
*Presidential candidate Sen. John Edwards, D-N.C., called for a national medical translation system in a speech to the Mexican American Legal Defense and Education Fund on June 11. The system proposed by Edwards would include on-call translators in at least five languages at hospitals in the nation’s 100 most populous counties, a 24-hour translation hotline for small and rural hospitals and funding to encourage providers to become medical translators.
*The federal government needs to invest more in “learning effective ways to improve the performance of the U.S. health system” if it hopes to control health care costs, according to Senate testimony given by Commonwealth Fund President Karen Davis on June 11. Davis spoke in support of a greater budget for the Agency for Healthcare Research and Quality and singled out investment in information technology and quality standards as ways to create a cost-effective and efficient health care system. Read Davis’ full testimony at www.cmwf.org/programs/quality/davis_senatecommitteetestimony_654.pdf.
*Mark Goldman, Ph.D., is the new associate director at the National Institute on Alcohol Abuse and Alcoholism. He comes to NIAAA from the University of South Florida, where his research focused on alcohol risk and development of drinking among children and young adults. Goldman will work on initiatives targeting underage drinkers ages 9 to 15 and efforts to integrate behavioral and biomedical research at the institute, according to NIAAA Director Ting-Kai Li, M.D.
SPOTLIGHT ON RESOURCES
Research about the importance of health communication is piling up, while resources to help practitioners wade through what works and what doesn’t are much scarcer. This month’s spotlight falls on a Web site with a peer-reviewed list of health communication materials ranging from academic texts to CD-ROM sets.
The Anthology of Health Communication Materials was collected by the Communication Initiative, a partnership of organizations including UNICEF, PANOS and the Rockefeller Foundation that works on communication projects related to international development. The anthology was commissioned by the Pan American Health Organization in 2002.
A team of health communications experts reviewed the final list of 61 materials with an eye toward those products with proven success in the field. Topics include health issues among children and adolescents, gender, HIV/AIDS, reproductive health and family planning, health worker training materials and even tips for promoting health initiatives to the media.
Each listing briefly describes the materials and their original audience, and provides information on how to purchase or links to download the materials for free.
The anthology is located at http://www.comminit.com/mahealthanthol/sld-7327.html.
Many of the materials are available in Spanish as well as English. The anthology itself is available in Spanish through La Iniciativa de Comunicación at http://www.comminit.com/la/laantologia/sld-2644.html
The NIH Bulletin, the Institutes' public-friendly face on the Web, is published every month with information on public events and activities, new resources and announcements. This month's issue features a middle school lesson plan on fetal alcohol syndrome (using brine shrimp) and a quiz on "portion distortion." Visit the site at http://forthepublic.nih.gov/newsbulletins/june2003.
HEALTH AND BEHAVIOR: IN THE NEWS
* Don't forget to check the Center's most recent news stories drawn from articles of interest that appear in a variety of journals. This is the best way to keep up with new developments in disciplines other than your own. www.cfah.org
*For psychology stories in the news, see Psychwatch: www.psychwatch.com.
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