NIH Analyzes OppNet Topics of Interest

The National Institutes of Health (NIH) has posted a preliminary analysis of the overarching areas of interests derived from the January 2010 request for information (RFI) regarding the NIH Basic Behavioral and Social Science Opportunity Network (OppNet).   The RFI was designed to provide an avenue for the extramural community - including but not limited to, scientists, scientific organizations, health professionals, patient advocates, and the general public - to suggest priorities in basic behavioral and social sciences research (b-BSSR). NIH staff also was able to submit their ideas for scientific priorities.  The report is an effort by OppNet to demonstrate its "commitment to an ongoing dialogue with the relevant stakeholders as OppNet continues to develop funding opportunities for cross-cutting basic behavioral and social sciences research that is broadly relevant to human health."

According to the report, the OppNet staff received "suggestions for NIH to support specific research areas, as well as for training associated with these areas, development of shared resources to support such research, and continued efforts to improve methodology and measurement in the behavioral and social sciences."  According to the agency, the scientific themes that emerged from the data include, and are not limited to the following:  Decision making, Cognitive and emotional processes; Social, personality and cultural factors; Health behaviors and disparities; The intersection between behavior and gene/environment interactions; Lifespan/developmental perspectives; Psychosocial stress; Sleep and circadian rhythms; and Neurobiology/neuropsychology.

NIH notes that this list is not exhaustive.  According to NIH, it articulates broader themes that reflect individual responses. The analysis found that many of the "submissions reflect the complex transdisciplinary nature of contemporary health research, suggesting that across these scientific themes research is needed that spans disciplinary boundaries and levels of analysis and demonstrate strong interests to develop the field rather than to request precisely delineated funding opportunities. Multiple responses demonstrate interests in methodologies that complement each respondent's respective discipline."

White House Task Force on Childhood Obesity - Report to the President

On May 12, an Interagency Task Force on Childhood Obesity released its released its recommendations, "that taken together, will put [the] country on track to solving the problem of childhood obesity."  Twelve federal agencies participated in the deliberations of the Task force:  Department of Agriculture, Defense, Education, Health and Human Services, Housing and Urban Development, Interior, Justice, Transportation, Environmental Protection Agency, Federal Communications Commission, the Federal Trade Commission and the Corporation for National and Community Service.

According to the Task Force, the "childhood obesity epidemic in America is a national health crisis."  It notes that obesity is estimated to cause 112,000 deaths per year in the U.S." with one-third of all children born in the year 2000 expected to develop diabetes during their lifetime.  It also notes that there are "substantial economic costs" associated with childhood obesity. 

Despite the statistics, the Task Force reports that "there is much reason to be hopeful."  It recognizes the "considerable knowledge about the risk factors associated with childhood obesity."  It also acknowledges the research and scientific information on the causes and consequences of childhood obesity.  "Effective policies and tools to guide healthy eating and active living are within our grasp," the Task Force stresses.  The report focuses and expands on what can be done in concert:

1.     Create a healthy start on life for our children, from pregnancy through early childhood;

2.    Empower parents and caregivers to make healthy choices for their families;

3.    Server healthier food in schools;

4.    Ensure access to healthy, affordable food; and

5.    Increase opportunities for physical activity.

The Task Force makes a number of recommendations, that "taken together...should achieve the goal of solving the problem of childhood obesity within a generation."  It acknowledges, however, that it will not be easy.

Key Questions for Future Research

The Task Force observed that building the science for prevention will help to strengthen childhood obesity prevention efforts. It also identified research areas for consideration when developing national research agendas:

§  Research the link between traditional as well as non-television forms of advertising, such as the internet, and food preferences and consumption by children and adolescents.

§  Test studies of family-based interventions (such as studies of parenting style, home availability of healthful food, and opportunities for physical activity).

§  Identify and test approaches for community partnerships to disseminate and implement evidence-based obesity prevention programs.

§  Understand how individuals interpret and are influenced by dietary and physical activity mes­sages (such as interpersonal, cultural, and media messages, as well as food labels) through research on learning, cognition, information processing, persuasive communications, and message framing.

§  Determine whether federal farm promotion ("check-off") programs that promote certain agricultural products have an impact on Americans' compliance with the Dietary Guidelines.

§  Compare medical and surgical treatments and lifestyle changes to identify those that are most effective in improving obesity and health outcomes in children and adolescents.

§  Test models for delivering obesity prevention and treatment to change the behaviors of health practitioners and translate or disseminate evidenced-based therapies to primary care practices.

§  Examine effects of targeted strategies focused on subpopulations at elevated obesity risk, such as those in racial and ethnic minority populations, tribal populations, lower socioeconomic status, rural communities, people with disabilities, and individuals taking medications that can increase body weight (such as psychotropics or insulin).

§  Examine the efficacy of increased habitual sleep time on metabolic regulation such as reduc­ing body weight, regulating appetite, and improving glucose tolerance and insulin sensitivity.

§  What are the teaching methods that best engage students in PE, including the relative benefits of technology in the PE classroom, for achieving long-term behavioral changes in physical activity habits?

§  What kinds of outdoor activities for children are most likely to produce lasting increases in physical activity levels? Are the benefits different from indoor physical activity?

§  How can we better target physical activity interventions to multiple communities, including diverse ethnic populations and children with disabilities? What are the most effective methods for reaching these populations?

§  What are appropriate measurement tools for tracking trends in physical activity?

§  Do health impact assessments change health outcomes in communities where they are used?

§  What percentage of children lives within walking or biking distance from school or a park entrance?

§  Does the built environment increase physical activity rates for children and reduce obesity? If so, what are the mechanisms for this reduction?

§  How can the insights of behavioral economics, such as changing the default choice in a given situation, be used to promote physical activity among young people?

§  How can we make healthy foods more affordable for use in schools? And more attractive to children?

§  What can we learn from behavioral economics to support healthful eating in schools, and how can schools promote healthful eating over the longer term?

§  What are the correlative and/or causal linkages between exposure to food marketing in schools and food consumption patterns or obesity?

§  How can effective school-based nutrition education models be identified and scaled up to national implementation?

§  How does participation in the afterschool snack and meal programs supported by USDA affect children's diets, opportunities for nutrition education and physical activity?

§  To what extent are health promotion and disease prevention services such as nutrition counsel­ing, improved diet, and recreational programs, provided to youth in the juvenile justice system? What evidence-based food services, nutritional education, and exercise programming can best address the needs of youth involved in juvenile justice systems?

§  The definition, measurement, and consequences of food deserts on food access, diet, and weight outcomes;

§  The impact of improved access on dietary quality and obesity rates;

§  How agricultural policy may affect food prices and obesity rates;

§  The comparative efficacy of sales taxes and price subsidies on weight outcomes; and

White House Task Force on Childhood Obesity - Report to the President

On May 12, an Interagency Task Force on Childhood Obesity released its released its recommendations, "that taken together, will put [the] country on track to solving the problem of childhood obesity."  Twelve federal agencies participated in the deliberations of the Task force:  Department of Agriculture, Defense, Education, Health and Human Services, Housing and Urban Development, Interior, Justice, Transportation, Environmental Protection Agency, Federal Communications Commission, the Federal Trade Commission and the Corporation for National and Community Service.

According to the Task Force, the "childhood obesity epidemic in America is a national health crisis."  It notes that obesity is estimated to cause 112,000 deaths per year in the U.S." with one-third of all children born in the year 2000 expected to develop diabetes during their lifetime.  It also notes that there are "substantial economic costs" associated with childhood obesity. 

Despite the statistics, the Task Force reports that "there is much reason to be hopeful."  It recognizes the "considerable knowledge about the risk factors associated with childhood obesity."  It also acknowledges the research and scientific information on the causes and consequences of childhood obesity.  "Effective policies and tools to guide healthy eating and active living are within our grasp," the Task Force stresses.  The report focuses and expands on what can be done in concert:

1.    Create a healthy start on life for our children, from pregnancy through early childhood;

2.    Empower parents and caregivers to make healthy choices for their families;

3.    Server healthier food in schools;

4.    Ensure access to healthy, affordable food; and

5.    Increase opportunities for physical activity.

The Task Force makes a number of recommendations, that "taken together...should achieve the goal of solving the problem of childhood obesity within a generation."  It acknowledges, however, that it will not be easy.

Key Questions for Future Research

The Task Force observed that building the science for prevention will help to strengthen childhood obesity prevention efforts. It also identified research areas for consideration when developing national research agendas:

§ Research the link between traditional as well as non-television forms of advertising, such as the internet, and food preferences and consumption by children and adolescents.

§  Test studies of family-based interventions (such as studies of parenting style, home availability of healthful food, and opportunities for physical activity).

§  Identify and test approaches for community partnerships to disseminate and implement evidence-based obesity prevention programs.

§  Understand how individuals interpret and are influenced by dietary and physical activity mes­sages (such as interpersonal, cultural, and media messages, as well as food labels) through research on learning, cognition, information processing, persuasive communications, and message framing.

§  Determine whether federal farm promotion ("check-off") programs that promote certain agricultural products have an impact on Americans' compliance with the Dietary Guidelines.

§  Compare medical and surgical treatments and lifestyle changes to identify those that are most effective in improving obesity and health outcomes in children and adolescents.

§  Test models for delivering obesity prevention and treatment to change the behaviors of health practitioners and translate or disseminate evidenced-based therapies to primary care practices.

§  Examine effects of targeted strategies focused on subpopulations at elevated obesity risk, such as those in racial and ethnic minority populations, tribal populations, lower socioeconomic status, rural communities, people with disabilities, and individuals taking medications that can increase body weight (such as psychotropics or insulin).

§  Examine the efficacy of increased habitual sleep time on metabolic regulation such as reduc­ing body weight, regulating appetite, and improving glucose tolerance and insulin sensitivity.

§  What are the teaching methods that best engage students in PE, including the relative benefits of technology in the PE classroom, for achieving long-term behavioral changes in physical activity habits?

§  What kinds of outdoor activities for children are most likely to produce lasting increases in physical activity levels? Are the benefits different from indoor physical activity?

§  How can we better target physical activity interventions to multiple communities, including diverse ethnic populations and children with disabilities? What are the most effective methods for reaching these populations?

§  What are appropriate measurement tools for tracking trends in physical activity?

§  Do health impact assessments change health outcomes in communities where they are used?

§  What percentage of children lives within walking or biking distance from school or a park entrance?

§  Does the built environment increase physical activity rates for children and reduce obesity? If so, what are the mechanisms for this reduction?

§  How can the insights of behavioral economics, such as changing the default choice in a given situation, be used to promote physical activity among young people?

§  How can we make healthy foods more affordable for use in schools? And more attractive to children?

§  What can we learn from behavioral economics to support healthful eating in schools, and how can schools promote healthful eating over the longer term?

§  What are the correlative and/or causal linkages between exposure to food marketing in schools and food consumption patterns or obesity?

§  How can effective school-based nutrition education models be identified and scaled up to national implementation?

§  How does participation in the afterschool snack and meal programs supported by USDA affect children's diets, opportunities for nutrition education and physical activity?

§  To what extent are health promotion and disease prevention services such as nutrition counsel­ing, improved diet, and recreational programs, provided to youth in the juvenile justice system? What evidence-based food services, nutritional education, and exercise programming can best address the needs of youth involved in juvenile justice systems?

§  The definition, measurement, and consequences of food deserts on food access, diet, and weight outcomes;

§  The impact of improved access on dietary quality and obesity rates;

§  How agricultural policy may affect food prices and obesity rates;

§  The comparative efficacy of sales taxes and price subsidies on weight outcomes; and

Congressional Briefing on Healthy Development - A Summit on Young Children's Mental Health

On May 3, the Society for Research in Child Development (SRCD) and the American Psychological Association (APA) sponsored a standing-room only Congressional briefing on the report, Healthy Development: A Summit on Young Children's Mental Health.  The report is the result of a summit convened by SRCD and APA along with the support of more than 20 other organizations concerned that despite the "burgeoning scientific research," the majority of the American public "remains unable to define mental health or identify its critical role in the healthy development of children."  There is a gap between the evidence and public understanding, explained Marty Zaslow, director of SRCD Office for Policy and Communications and Senior Scholar, Child Trends.

It is a matter of importance explained, Jean Smith, Wake County, NC Department of Human Services, because mental health disorders affect a large number of young people.  According to Smith, almost one in five young people have a diagnosable mental disorder at any given time.  And one in ten young people have significant emotional or behavioral disorders causing impairment to functioning at home, school or in their community. Smith noted only 20 percent of children in need of diagnosable disorder receive services.  In addition, while "efficacious prevention services exist," she lamented that translation and application in practice is even more limited than for treatment services.  Smith stressed that there are life long effects for these children, their families, schools and communities once a mental health disorder has emerged.  The costs are both psychosocial and economic with treatment and lost productivity being estimated at $247 billion annually.

Smith provided a snapshot of what mental health problems look like in young children:  Preschoolers expelled from multiple day care centers, causing parents to lose jobs; Children arriving at kindergarten unable to get along with other children despite normal intelligence; Children who bully classmates and disrupt the learning environment in elementary school; Toddlers moved from foster home to foster home due to uncontrollable tantrums; and Children in foster homes unable to feel safe even though the system thinks they are safe.  She explained that mental health is "not merely the absence of disorders.  For young children it is positive social-emotional development - forming secure relationships, handling emotions, managing one's own behavior, feeling safe, secure and loved, and exploring and learning.

Smith pointed out that there is a gap between what is known and what is done.  Research tells us that many problems are preventable and good evidence-based treatments exist, she stated.  The key is identifying the problem and intervening early before problems become more severe.  But in practice, she explained, very few services are offered that help families function more effectively and there is too often a failure to screen for social emotional problems.  This is the result of too few skilled mental health providers, especially for young children, said Smith.

                            "No Unified, Viable Agenda Consistent With the Science"

Why the focus on young children's mental health, asked Karen Saywitz, University of California, Los Angeles.  Saywitz explained that we "are in the midst of a remarkable expansion of new knowledge in neuroscience, genetics, child development and economics."  In addition, building on the momentum of the two previous administrations there is the opportunity to "catalyze creation of effective, science-based policies to prevent and treat mental health problems in children."   New discoveries show effective ways to promote positive mental health in all children, identify early warning signs to prevent many problems, and treat mental disorders.   Delaying services to middle childhood, she explained, is less effective and more expensive as problems become entrenched.  Also, early intervention has better outcomes and is less expensive than remediating problems later in life.

The summit was needed because of the diverse stakeholders in child mental health.  The different disciplines often have differing definitions, issues and approaches.  As a result there is "no unified, viable agenda consistent with the science," said Saywitz.  This has led to public exposure to unclear and competing messages - Is mental illness genetic, inborn, intractable, a chemical inbalance, a function of child rearing or exposure to trauma?

Carol Brunson Day, National Black Child Development Institute, discussed the cultural differences in children's mental health services.  These differences matter, said Day, because   "culture is the lens through which children learn the rules of relationships that enable them to develop."  She noted that there are disparities in child mental health:  boys were expelled at a rate of more than 4.5 times that of girls; African-Americans attending state-funded Pre-K were twice as likely to be expelled as Latino and Caucasian children, and more than five times as likely to be expelled as Asian-American children; 80 percent of African American children, 82 percent of Latino children, and 72 percent of Caucasian children with mental  health problems have not received mental health services within the last 12 months.  Day also pointed out that there is diversity within diversity with barriers to access differing across racial and ethnic groups. 

Day emphasized the "importance of having leaders who represent the culture of the parent and the children they are working with."  In addition, she noted that teacher education programs are not doing enough to prepare teachers for culturally relevant practice. Day recommended:    Support for early learning and development programs in the full range of diverse communities; Emphasis on social and emotional development in a way that takes into account cultural strengths; Support for workforce diversity; Preparation of culturally competent education and mental health professionals; Culturally sensitive mental health assessments; and an Evaluation pipeline for community-based programs.

Mary Ann McCabe, George Washington University School of Medicine and George Mason University, explained the policy implications from the Summit.  She pointed out that it is a critical time for policymakers to focus on young children's mental health as they consider diverse areas of:  child care, early education, welfare reform, child welfare, disasters, health disparities, health care reform, health care delivery systems, mental health parity, school bullying, and teacher preparation.  Because children's mental health is not confined to a single area of policy, McCabe insisted that it is important for policy makers to ask consistently how these various priorities and funding streams can advance children's mental health.  Investing in young children's mental health can result in savings for both individuals and society, including in the areas of education, special education, juvenile justice, child welfare, and health care.

McCabe emphasized the need for the full integration of mental health policy with health policy.  The policies need to support the delivery of evidence-based practice across a range of treatment settings.  They need to promote interdisciplinary training and collaboration (e.g., integrated health care, developmental consultation in schools).  The policies also need to ensure reimbursement for these services and this collaboration.  She pointed out, however, that there are significant challenges to ensuring the delivery of effective mental health services for children and families.  Accordingly, policy makers will need to attend to:  access to care (particularly for families living in underserved areas and/or who are at heightened risk), reimbursement for prevention and treatment, appropriate training of mental health workforce that delivers child and family services, and maintenance of reasonable caseloads in public settings.

McCabe also stressed the need for enhanced research funding, particularly in order to investigate:  benefit-cost analysis for mental health promotion and prevention programs to determine whether universal or targeted prevention approaches are most effective; the ideal timing and dosing of prevention approaches; treatment effectiveness in communities; common factors across effective treatments; the translation and implementation of evidence-based or promising treatments in new settings; and the efficacy of new treatment.

Healthy Development - A Summit on Young Children's Mental Health is available online at www.apa.org/pi/families/summit-report.pdf.  Printed copies may be obtain from:  Amani Chatman at achatman@apa.org.