HEALTH PROMOTION AND DISEASE AND
INJURY PREVENTION R&D

1. ENHANCE, MAINTAIN, AND BETTER UTILIZE THE
DATA SYSTEMS THAT SUPPORT R&D IN HEALTH
PROMOTION AND DISEASE AND INJURY PREVENTION

Efforts in this area will increase the understanding of patterns and trends in injury, disease and disability by expanding the availability, quality, analytical power, and use of new, existing and linked data bases. To achieve this goal, we need to:

(a) Improve the quality and linkage capabilities of national, regional, state and local surveillance systems to monitor health indices.

(b) Improve surveillance data bases that monitor exposures and risk factors experienced by the population such as genetic susceptibilities, behaviors leading to illness and injury, and contaminants in food, air, water and workplace.

(c) Develop data linkages within medical care information (including exposures, illnesses, and outcomes) while continuing to maintain patient confidentiality.

(d) Establish databases for health outcomes and monitor data for patterns and trends, to support evaluating the effectiveness of public health initiatives and programs in promoting health and preventing/reducing illness, mental illness, substance abuse, disability, and injury.

(e) Develop computer-based, dynamic-system, simulation models that depict health trends derived from epidemiologic and surveillance data bases, and test the potential value of changes in prevention interventions.

(f) Ensure linked data bases are user-friendly and widely available to researchers, health practitioners, policymakers, and the public.

Agency Roles-All member agencies are involved in health promotion and disease and injury prevention data systems and surveillance. Some representative new efforts include:

• NIH-Expanding surveillance programs to determine causative factors for the development and treatment of cancer, heart disease and diabetes within diverse populations.
• NIH and DOD-New databases will help assess disease risks for women.
• DoEd-A new database will identify how stages of HIV-related illness and diagnoses relate to functional status and employment outcomes.
• NIH-Develop international epidemiological surveillance systems to monitor emerging problems from drug abuse in vulnerable populations in Asia and Latin America.
• CDC, DOE, EPA, ATSDR, and CEH-Develop model programs in hazard and medical surveillance to prevent occupational and environmental disease.
• DOT and CDC-Traffic crash data will link medical and financial outcomes data.
• DOL-Worksite-specific injury and illness data will be used to generate patterns that guide inspection targeting.
• CDC-Integration of public health surveillance systems.

2. DEVELOP AND IMPROVE THE SCIENCE BASE, METHODS
AND MEASUREMENTS USED IN HEALTH PROMOTION AND
DISEASE AND INJURY PREVENTION R&D

Efforts in this area will enhance our understanding of controllable factors in disease, injury, and disability. This includes environmental and occupational exposures, and socioeconomic, behavioral and biomechanical factors, through an enriched science base and improved methods and measurements. To achieve this goal, research needs to:

(a) Improve, develop, and standardize methods of measuring exposures to risk factors.

(b) Develop standard or uniform coding and nomenclature for collection and classification of data.

(c) Further define risk factors for health impairment, injury and disease through research on personal health-related behaviors.

(d) Advance and modify existing analytical methods so that relevant variables are included in models used to evaluate disease impact or health status.

(e) Develop methods for examining and measuring interactions among risk factors arising from the environment, personal behavior, and genetic susceptibilities.

(f) Improve identification of acute and chronic public health risks and exposure hazards.

(g) Identify environmental, occupational, biological, and behavioral factors that cause illnesses, injuries, disabilities, birth defects, mental disorders, substance abuse, and violence through analysis of data integrated via linked surveillance systems.

(h) Develop research designs that enable isolating the effect of comorbidities and other confounding variables in interpreting risk relationships from observational data.

(i) Enhance the integration of effective existing and emerging technologies to facilitate development of multidisciplinary approaches to risk assessment.

(j) Utilize geographic information to correlate health status to nutrition, substance abuse, crime, occupational hazards, and environmental quality data.

Agency Roles-All member agencies are involved in research in this strategy. Some representative new efforts include:

• CDC-Expand population-based emerging infectious disease programs to provide financial and technical support to state health departments for surveillance, laboratory research, investigation, and education.
• NIH-Expand epidemiologic studies of chronic diseases to include minority and underserved groups, including biomarkers to define genetic and exposure risk and the interactions between them.
• DoEd and NIH-Develop and study measurements of quality of life and functional capacity.
• EPA, NIH, and DOI-Study action mechanisms of various chemicals and pollutants in producing endocrine disruption, and related dose/response models for this.
• DOE, DOD, NRC and HHS-Evaluate radiation effects in Russian nuclear weapons production workers to improve the knowledge base on cancer induction, dose rate, biological response, and bio-dosimetry.
• NIH-Act on a national plan for research aimed at the prevention of mental disorders.

3. IMPROVE THE ABILITY TO TRANSLATE AND TRANSFER
THE RESULTS OF HEALTH PROMOTION AND DISEASE AND
INJURY PREVENTION R&D INTO INTERVENTIONS AND
EVALUATE THEIR EFFICACY

Efforts in this area will accelerate our understanding of how to effectively translate interventions to prevent injury, disease, and disability by developing, establishing, and evaluating technologies and programs drawn from the full range of basic and applied science. Research includes:

(a) Expand the support and resources for evaluating the effectiveness of promising preventive interventions and strategies using population-based studies to determine which should be translated into public health action and how they should be implemented.

(b) Develop new methods for evaluating the application and measuring the effectiveness of population-based health promotion/disease preventive interventions.

(c) Identify and evaluate health promotion and disease and injury prevention measures and interventions currently in practice to eliminate those which are ineffective or more harmful than good.

(d) Integrate advances in technology, basic research, and applied science to design and implement new approaches and strategies to reduce risks and promote health.

(e) Capitalize on research advances in epidemiology, behavioral, social and basic sciences to enhance the adoption of new science- based interventions by user communities.

(f) Investigate radiation technologies to reduce ecologic and human health impacts of foodborne pathogens, spoilage organisms, and insects. Research radioprotective agents to provide intervention and prevention of radiation injury.

(g) Better utilize fundamental science information to develop, test, and evaluate preventive interventions for efficacy, effectiveness and cost-effectiveness.

(h) Increase support for evaluating basic research findings that have potential for greatly reducing morbidity and mortality from preventable health problems.

(i) Identify the barriers to technology transfer and public translation through population-based research techniques such as community trials and defined population studies.

(j) Develop evidential criteria for selecting research results ready for translation.

Agency Roles-All member agencies are involved in research for this strategy. New efforts include:

• NIH, CDC and AID-Administer current routine childhood immunizations, and consolidate them into a single vaccine using new molecular biological tools.
• NIH-Develop topical microbicide to prevent sexual transmission of HIV and other STDs.
• NIH-Identify protective factors to drug abuse and test theory- based prevention interventions that foster resilience to social and psychological influences.
• CDC-Develop cost-effective technologies to control hazardous exposures in industrial and small-business workplace situations where technological design is needed.

4. ESTABLISH AND MAINTAIN THE INFRASTRUCTURE
NECESSARY TO EFFECTIVELY INVESTIGATE, INTEGRATE,
COMMUNICATE, AND APPLY PREVENTIVE MEASURES

Efforts in this area will facilitate the transfer of preventive activities to the general public by bolstering the personnel and systems needed to interpret, integrate, disseminate and apply research on effective preventive measures to build a healthy citizenry. This strategy includes research to:

(a) Reinvent existing public health practice to direct more attention to implementing and delivering prevention programs.

(b) Craft and support prevention research to identify and evaluate effective implementation approaches, predictors of intervention success, and cost-effectiveness.

(c) Expand the study and practice of prevention, and train leaders in the field by attracting multidisciplinary researchers not traditionally in this area.

(d) Expand traditional public health knowledge by integrating areas of expertise such as risk assessment and perception, behavior, economics, community impact, and marketing in public health and medical curricula.

(e) Expand the knowledge core and utilization of public health principles and clinical prevention services by health professionals and systems administrators in health care delivery.

(f) Design a prevention practice model that incorporates basic research, application strategies, and effectiveness evaluation to promote wide dissemination and adoption of preventive interventions.

(g) Encourage partnerships with communities in designing and implementing prevention programs to promote diverse population participation and to better assure the relevance and effectiveness of such programs across geographic and socioeconomic groups.

Agency Roles-All member agencies are involved in research in this strategy. Some representative new efforts include:

• NIH-Expanding minority-based Community Clinical Oncology Programs to link community cancer specialists, primary care physicians, and others into clinical trials network.
• CDC and NIH-Expanding Breast and Cervical Cancer Early Detection Program to assist underserved in 50 states.
• CDC-Collaborating with community, state, national and international partners to provide health professionals with intervention research findings on HIV/AIDS.
• CDC, NIH, HRSA, IOM-Examining and evaluating successful and unsuccessful school health and health education activities.
• DOD-Reviewing self-care programs, including disease and injury prevention information and education, to determine cost- effectiveness of such demand reduction techniques.
• DOT and CDC-Integrating injury control at the community level through grants to academic centers, trauma centers, hospitals, and other institutions.
• DOL, CDC and others-Evaluating control technology interventions for hazardous workplace exposures.
• DOE-Research and training of experts in radiation-related public health and prevention.
• CDC-Collaborating with the American Psychological Association to develop post-doctoral training in occupational health psychology.

FOOD SAFETY, SECURITY AND PRODUCTION R&D